INTRAVERTEBRAL EXPANDABLE IMPLANTS IN THORACOLUMBAR VERTEBRAL COMPRESSION FRACTURES

ABSTRACT Current scientific evidence enhances the importance of the anatomic restauration of vertebral bodies with compression fractures aiming, as with other human body joints, to obtain a biomechanic and functional spine as close as the one prior to the fracture as possible. We consider that anatomic reduction of these fractures is only completely possible using intravertebral expandable implants, restoring vertebral endplate morphology, and enabling a more adequate intervertebral disc healing. This enables avoiding disc and osteodegenerative changes to that vertebral segment and its adjacent levels, as well as the anterior overload of adjacent vertebral bodies in older adults - a consequence of post-traumatic vertebral flattening - thus minimizing the risk of adjacent vertebral fractures. The ability of vertebral body fracture reduction and height maintenance over time and its percutaneous transpedicular application make the intra-vertebral expandable implants a very attractive option for treating these fractures. The authors show the direct and indirect reduction concepts of vertebral fractures, review the biomechanics, characteristics and indications of intravertebral expandable implants and present a suggestion for updating the algorithm for the surgical treatment of vertebral compression fractures which includes the use of intravertebral expandable implants. Level of Evidence V, Expert Opinion.

摘要 现有科学证据进一步凸显了椎体压缩骨折解剖复位的重要性——与其他人体关节的治疗目标一致，旨在获得与骨折前脊柱尽可能一致的生物力学性能与功能状态。本文作者认为，此类骨折的解剖复位仅能通过椎体内可膨胀植入物（intravertebral expandable implants）完全实现，该植入物可恢复椎体终板形态，并促进更充分的椎间盘愈合。此举可避免该椎体节段及其邻近节段出现椎间盘退变与骨退行性改变，同时可规避老年患者因创伤后椎体变平引发的邻近椎体前方负荷过载，进而降低邻近椎体骨折的风险。椎体内可膨胀植入物具备椎体骨折复位与长期维持椎体高度的能力，且可经皮椎弓根入路应用，使其成为治疗此类骨折的极具吸引力的选择。本文作者阐述了椎体骨折的直接与间接复位理念，综述了椎体内可膨胀植入物的生物力学特性、特点及临床适应证，并提出了更新椎体压缩骨折外科治疗算法的建议，该算法纳入了椎体内可膨胀植入物的应用。证据等级：V级，专家意见。