Feasibility of percutaneous interbody fusion as a treatment for adjacent vertebral stress fracture of ankylosing spondylitis with intervertebral pseudarthrosis formation

OBJECTIVE: The objective of this study was to evaluate the feasibility of percutaneous interbody fusion (PIF) using bone cement for adjacent vertebral stress fracture of ankylosing spondylitis (AS) with intervertebral pseudarthrosis formation. PATIENTS AND METHODS: From January 2010 to February 2018, eleven consecutive patients (seven men and four women; median age, 56.09±13.64 years; age range, 33–80 years) who underwent PIF as a treatment for adjacent stress fracture of AS with intervertebral pseudarthrosis formation were retrospectively analyzed. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) score were assessed before and after the procedure; meanwhile, the procedure duration, length of hospital stay and complications were assessed. Moreover, anterior/lateral and computed tomography (CT) scans were utilized for the assessment of bone cement distribution and interbody fusion. RESULTS: Technical success was achieved in all patients, and they experienced good interbody fusion with bone cement after PIF. Mean VAS scores declined significantly from 8.82±0.87 before the procedure to 3.36±0.67 1 day after the procedure and 2.73±0.65 1 month after the procedure, while the mean ODI scores decreased from 82.91±3.02 before treatment to 31.64 ±2.66 1 day after treatment and 30.00±3.10 1 month after treatment. The mean procedure duration was 49.73±6.12 minutes (range, 42–65 minutes). The average length of hospital stay was 7.09±1.45 days (range, 5–10 days). Extraosseous cement leakage occurred in one case without causing any clinical complications. CONCLUSION: PIF is a feasible therapeutic technique for adjacent vertebral stress fracture of AS with intervertebral pseudarthrosis formation, which can significantly relieve pain and stabilize the fractured spine.