Abstract
BackgroundThe increase of augmented level and bone cement dose are accompanied by the rising incidence of cement leakage (CL) of cement-augmented pedicle screw instrumentation (CAPSI). But the effect and potential risks of the application of CAPSI to osteoporotic lumbar degenerative disease (LDD) have not been studied in the case of multilevel fixation. This study aimed to investigate the effectiveness and potential complications of using multilevel CAPSI for patients with osteoporotic LDD.MethodsA total of 93 patients with multilevel LDD were divided into the CAPSI group (46 subjects) and the conventional pedicle screw (CPS) group (47 subjects), including 75 cases for three levels and 18 cases for four levels. Relevant data were compared between two groups, including baseline data, clinical results, and complications.ResultsIn the CAPSI group, a total of 336 augmented screws was placed bilaterally. The CL was observed in 116 screws (34.52%). Three cemented screws (0.89%) were found loosened during the follow-up and the overall fusion rate was 93.47%. For perioperative complications, two patients (4.35%) experienced pulmonary cement embolism (PCE), one patient augmented vertebral fracture, and three patients (6.52%) wound infection. And in the CPS group, thirty-three screws (8.46%) suffered loosening in cranial and caudal vertebra with a fusion rate of 91.49%. The operation time and hospital stay of CAPSI group were longer than the CPS group, but CAPSI group has a lower screw loosening percentage (P<0. 05). And in terms of blood loss, perioperative complications, fusion rate, and VAS and ODI scores at the follow-up times, there were no significant differences between the two groups.ConclusionsPatients with osteoporotic LDD underwent multilevel CPS fixation have a higher rate of screw loosening in the cranial and caudal vertebra. The application of cemented pedicle screws for multilevel LDD can achieve better stability and less screw loosening, but it also accompanied by longer operating time, higher incidence of CL, PCE and wound infections. Selective cement augmentation of cranial and caudal pedicle screws may be a worthy strategy to decrease the complications.
Highlights
The increase of augmented level and bone cement dose are accompanied by the rising incidence of cement leakage (CL) of cement-augmented pedicle screw instrumentation (CAPSI)
Patients with osteoporotic lumbar degenerative disease (LDD) underwent multilevel conventional pedicle screw (CPS) fixation have a higher rate of screw loosening in the cranial and caudal vertebra
The application of cemented pedicle screws for multilevel LDD can achieve better stability and less screw loosening, but it accompanied by longer operating time, higher incidence of CL, pulmonary cement embolism (PCE) and wound infections
Summary
The increase of augmented level and bone cement dose are accompanied by the rising incidence of cement leakage (CL) of cement-augmented pedicle screw instrumentation (CAPSI). Pedicle screw fixation is widely used in degenerative lumbosacral disease, secondary kyphosis or deformity, and thoracolumbar fractures due to a variety of indications, such as bony fusion promotion, deformity correction, and fixation for vertebral fractures [1,2,3] It is the gold standard for the treatment of degenerative and traumatic spinal diseases [2], the purchase strength of it in low-quality bone still reduced significantly [4, 5]. Instrument failure, such as screw loosening and backout, associated with nonunion, pseudoarthrosis, and progressive kyphosis, is the most common complication of posterior internal fixation in osteoporosis patients [6, 7]. Since both osteoporosis and multilevel lumbar degenerative disease (LDD) are common disorders in elderly patients [2], improving the attachment of internal instruments for patients with multilevel osteoporotic LDD has become an essential mission for spine surgeons
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
