Downward penetrating endplate screw technique under O-arm navigation posterior fusion in patients with osteoporotic vertebral body fractures associated with diffuse idiopathic skeletal hyperostosis
- Department of Neurosurgery, Inazawa Municipal Hospital, Inazawa City, Nagoya, Japan.
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
- Department of Neurosurgery, Aichi Medical University, Nagakute, Japan.
Daimon Shiraishi, Department of Neurosurgery, Inazawa Municipal Hospital, Inazawa City, Japan.
DOI:10.25259/SNI_762_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Daimon Shiraishi1, Yu Yamamoto1, Ishii Motonori1, Yusuke Nishimura2, Masahito Hara3, Ryuta Saito2, Masakazu Takayasu1. Downward penetrating endplate screw technique under O-arm navigation posterior fusion in patients with osteoporotic vertebral body fractures associated with diffuse idiopathic skeletal hyperostosis. 23-Sep-2022;13:436
How to cite this URL: Daimon Shiraishi1, Yu Yamamoto1, Ishii Motonori1, Yusuke Nishimura2, Masahito Hara3, Ryuta Saito2, Masakazu Takayasu1. Downward penetrating endplate screw technique under O-arm navigation posterior fusion in patients with osteoporotic vertebral body fractures associated with diffuse idiopathic skeletal hyperostosis. 23-Sep-2022;13:436. Available from: https://surgicalneurologyint.com/surgicalint-articles/11882/
Background: A downward penetrating endplate screw (PES) technique combined with caudal anchor screws inserted in the upward direction under O-arm navigation (i.e., crossing screw technique) avoided screw backout and proximal junctional kyphosis (PJK) in three patients with osteoporotic vertebral body fractures and diffuse idiopathic skeletal hyperostosis (DISH).
Methods: The PES techniques were utilized for patients with T12 (one patient) and L1 (two patients) spontaneous fusion across the targeted vertebrae, with minimal damage to the involved endplates/intervertebral discs. The average number of instrumented vertebrae was 5.3.
Results: There were no perioperative complications over the mean follow-up period of 28.7 months; no screw loosening, and no PJK.
Conclusion: The PES technique prevented screw backout, and PJK in three patients with lumbar osteoporotic vertebral fractures and DISH.
Keywords: Diffuse idiopathic skeletal hyperostosis, Endplates penetrating screw, Osteoporotic vertebral body fracture, Posterior spinal fixation
The penetrating endplate screw (PES) technique (i.e., single or double endplate penetrating screw SEPS or DEPS) was utilized for posterior fusions in three patients with lumbar osteoporotic vertebral body fractures and diffuse idiopathic skeletal hyperostosis (DISH).[
Our institutional review board approved this study. The PES technique was utilized to treat three patients with lumbar vertebral body osteoporotic fractures (i.e., T12 [1 patient] and L1 [2 patients]) and DISH. Notably, the posterior rod/ screw fusion was performed two levels above and two levels below the spontaneously fused index level fractured vertebral body.
For the two levels above the index fractured vertebral body, the cephalad PES screws were inserted in a downward direction from the outer cranial side to the inner caudal side; this included attempted penetration by the screw of two endplates, one at the index level and the other at the adjacent caudal level [
The average number of instrumented vertebrae was 5.3 (4–6) [
It is difficult to obtain rigid fixation in osteoporotic bone for patients with osteoporotic compression fractures and DISH patients. The endplate penetrating screw technique (i.e., lumbar pedicular transvertebral screw fixation) was first reported by Abdu et al. in 1994.[
Downward and upward PES technique
In the downward PES technique, the screw is inserted downward from the outer cranial side to the inner caudal side, penetrates the inferior facet, the superior facet, the pedicle, the caudal endplate of the vertebral body at the index level, and reaches the cranial endplate of the adjacent caudal vertebral body. The caudal screws are similarly inserted but in an upward direction. The PES technique offers more cortical bone-screw interface, better resists screw back-out, and largely prevents PJK, and proximal junctional failure (PJF).[
The combined use of the PES cephalad (i.e., downward) and caudal (i.e., upward) PES technique utilized in three patients with DISH 2–3 levels above/below osteoporotic T12 and L1 lumbar vertebral fractures, resisted screw back-out, prevented PJK, and avoided PJF.
Institutional Review Board (IRB) permission obtained for the study.
There are no conflicts of interest.
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