Polymethylmethacrylate-augmented thoracolumbar pedicle screw fixation guided by the three-dimensional navigation in osteoporotic patients

Abstract

Objective To evaluate the safety and efficacy of polymethylmethacrylate (PMMA) -augmented thoracolumbar pedicle screw fixation guided by three-dimensional (3D) navigation in the osteoporotic patients.Methods From January 2010 to January 2012,27 osteoporotic patients with a variety of spinal disorders underwent PMMA-augmented thoracolumbar pedicle screw fixation guided by 3D navigation.They were 3 men and 24 women,aged from 51 to 92 years (average,70.1 years).Their osteoporosis was all serious.PMMA leakage was evaluated intraoperatively and postoperatively.Screw loosening and bone fusion were evaluated radiographically after operation.The Japanese Orthopaedic Association (JOA) scores of the patients were compared between preoperation and one year postoperation.Results Altogether 149 pedicle screws were implanted in the 27 patients.One patient died of postoperative pneumonia and the rest 26 patients were followed up for more than 12 months.No pedicle cortex breach or cement leakage surrounding the pedicle cortex was observed.None of the patients complained of dyspnoea showing evidence of pulmonary embolism or iatrogenic neural injury.No obvious deterioration of related symptoms or functions was observed after operation.The pre-operative JOA score (18.2 ± 2.6 points) was significantly increased (25.1 ± 2.3 points) postoperation (t =16.996,P =0.000),with a mean therapeutic improvement rate of 39.6％.None of the patients showed loosening or displacement of the implants.Lateral X-ray films showed bone fusion in 20 patients (76.9％) at the 12-month follow-up Conclusion PMMA-augmented thoracolumbar pedicle screw fixation guided by 3D navigation is safe and effective for osteoporotic patients with a variety of spinal disorders,leading to favorable outcomes both clinically and radiologically. Key words: Surgery, computer-assisted; Osteoporosis; Vertebroplasty