Abstract
BackgroundCannulated pedicle screw (CPS) augmented by polymethylmethacrylate (PMMA) can achieve satisfactory clinical efficacy in the treatment of lumbar spondylolisthesis with osteoporosis. However, accurate application of CPSs will help to avoid the difficulty of screw revision and reduce the incidence of PMMA-related complications. This study aimed to investigate the mid-term efficacy of CPS compared to unilateral and bilateral applications in this common lumbar degenerative disease.MethodsMay 2011 and May 2018, 50 patients with lumbar spondylolisthesis with osteoporosis who underwent posterior fixation and fusion using traditional pedicle screws or CPSs were included in the study. Patients were divided into two groups based on the application: the unilateral PMMA-augmented CPS group (UC, n = 29) and the bilateral PMMA-augmented CPS group (BC, n = 21). Operation time, blood loss, average hospitalization time, PMMA leakage, and other complications were recorded. The visual analog scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate symptom recovery. Radiographic results were compared for intervertebral fusion and screw loosening.ResultsThere were no significant differences in the baseline data of the two groups.The VAS and ODI scores improved significantly after surgery (P < 0.05), with no significant differences between the groups (P > 0.05). The operation time and blood loss in the UC group were significantly lower than those in the BC group (P < 0.05). However, the loss of intervertebral disk height and Taillard index did not differ significantly between the groups. The rates of PMMA leakage in the UC and BC groups were 7.0% and 11.9%, respectively (P < 0.05). Bony fusion was achieved in all groups without screw loosening at the last follow-up. Only one patient experienced superficial infection in both groups, while cerebrospinal fluid leakage was observed in two patients in the BC group.ConclusionsUnilateral application of PMMA-augmented CPS may provide adequate clinical safety and effectiveness in the surgical treatment of lumbar spondylolisthesis with osteoporosis.
Highlights
Cannulated pedicle screw (CPS) augmented by polymethylmethacrylate (PMMA) can achieve satisfactory clinical efficacy in the treatment of lumbar spondylolisthesis with osteoporosis
The stability of the pedicle screw is greatly decreased in the lumbar spondylolisthesis cases that are combined with osteoporosis, which might lead to adverse events, such as screw loosening, extraction, or even breakage [2, 3], leading to failure of bony fusion
In the UC group, 58 CPSs were implanted in 29 patients, and PMMA leakage during surgery occurred in four screws, with an incidence of 7.0%
Summary
Cannulated pedicle screw (CPS) augmented by polymethylmethacrylate (PMMA) can achieve satisfactory clinical efficacy in the treatment of lumbar spondylolisthesis with osteoporosis. Accurate application of CPSs will help to avoid the difficulty of screw revision and reduce the incidence of PMMA-related complications. Pedicle screw fixation is the main technique applied to maintain the stability and biomechanical characteristics of the spine [1]. Many researchers have attempted to solve this issue, and cannulated pedicle screw (CPS) augmented by polymethylmethacrylate (PMMA) is recognized as the most effective method developed to date [4, 5]. Accurate and reasonable application of CPS fixation during surgery improves the effectiveness of surgery and minimizes the risk of PMMA-related complications
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