Abstract
OBJECTIVES:To evaluate the safety and efficacy of a novel bone cement-injectable cannulated pedicle screw augmented with polymethylmethacrylate in osteoporotic spinal surgery.METHODS:This study included 128 patients with osteoporosis (BMD T-score –3.2±1.9; range, –5.4 to –2.5) who underwent spinal decompression and instrumentation with a polymethylmethacrylate-augmented bone cement-injectable cannulated pedicle screw. Postoperative Visual Analogue Scale scores and the Oswestry Disability Index were compared with preoperative values. Postoperative plain radiographs and computed tomography (CT) scans were performed immediately after surgery; at 1, 3, 6, and 12 months; and annually thereafter.RESULTS:The mean follow-up time was 42.4±13.4 months (range, 23 to 71 months). A total of 418 polymethylmethacrylate-augmented bone cement-injectable cannulated pedicle screws were used. Cement extravasations were detected in 27 bone cement-injectable cannulated pedicle screws (6.46%), mainly in cases of vertebral fracture, without any clinical sequela. The postoperative low back and lower limb Visual Analogue Scale scores were significantly reduced compared with the preoperative scores (<0.01), and similar results were noted for the Oswestry Disability Index score (p<0.01). No significant screw migration was noted at the final follow-up relative to immediately after surgery (p<0.01). All cases achieved successful bone fusion, and no case required revision. No infection or blood clots occurred after surgery.CONCLUSIONS:The polymethylmethacrylate-augmented bone cement-injectable cannulated pedicle screw is safe and effective for use in osteoporotic patients who require spinal instrumentation.
Highlights
In recent decades, internal fixation with a pedicle screw system has been the gold standard for the treatment of an unstable spine [1] caused by degenerative diseases of the thoracolumbar spine, trauma, or tumors
Pedicle screws are the workhorse of spinal instrumentation in the adult spine [20], pedicle screw loosening or pullout is the most severe and common problem in osteoporotic patients who undergo spinal surgery that requires spine internal fixation
Several experimental and clinical studies have demonstrated that PMMA augmentation can improve resistance to pullout in osteoporotic and normal vertebrae [1,26,27,28]
Summary
Internal fixation with a pedicle screw system has been the gold standard for the treatment of an unstable spine [1] caused by degenerative diseases of the thoracolumbar spine, trauma, or tumors. Relevant techniques include increasing the diameter or length of the screw [2]; improving the design of the screw-rod [3] or the screw threads [4]; choosing a proper insertion angle and trajectory [5]; stabilizing the spine with bicortical fixation [4,6]; and using expandable pedicle screws [4,7,8] and bone cement-augmented pedicle screws [8,9,10,11] These strategies have potential shortcomings, such as screw loosening or pullout, screw fracture, vascular or visceral injury, and complications associated with cement leakage [9]. New techniques that improve the safety and effectiveness of instrumentation are required for the surgical treatment of osteoporosis
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