Pedicle screw fixation augmented with bone cement benefits osteoporosis patients

doi:10.3969/j.issn.2095-4344.2013.17.006

Abstract

Abstract:

BACKGROUND: During the pedicle screw fixation for lumbar disease patients accompanied with osteoporosis, addition of bone cement in osteoporotic vertebral body can significantly increase the stability of internal fixation, but the effect on adjacent segments is not clear.
OBJECTIVE: To observe the effect on adjacent segments of osteoporosis patients after pedicle screw fixation augmented with bone cement in early and medium-term follow-up period.
METHODS: We reviewed the medical information of 87 patients suffering from lumbar disease accompanied with osteoporosis who underwent operation of pedicle screw fixation and posterior lumbar spinal decompression, and the patients were divided into three groups: conventional pedicle screw group, conventional pedicle screw+bone cement group, novel perfusional pedicle screw+bone cement group. The samples were followed-up for 6-18 months, averaged 9 months. The Oswestry disability index, intervertebral distance of the upper adjacent segments, deformation index of the upper adjacent vertebral body, concave angle of the fixed lumbar vertebrae superior end-plate and the upper adjacent vertebral body inferior end-plate, and Cobb angle were measured before operation, at 3 days postoperation and during final follow-up.
RESULTS AND CONCLUSION: The Oswestry disability index of the final follow-up in the three groups were decreased when compared with that before operation (P < 0.05), but there was no significant difference between any two groups (P > 0.05). This showed that in posterior spinal fixation operation, there was no significant difference in the early and medium-term subjective effect between addition of bone cement or not and different adding ways, and addition of bone cement or not and different adding ways could remarkably improve the life quality of the patients. The change of Cobb angle of fixed lumbar vertebrae between the final follow-up and 3 days after operation in conventional pedicle screw+bone cement group and novel perfusional pedicle screw+bone cement group was both less than that in the conventional pedicle screw group (P < 0.05), and there was no significant difference between conventional pedicle screw+bone cement group and novel perfusional pedicle screw+bone cement group (P > 0.05). This showed that the stability of internal fixation augmented with bone cement was much better than the routine operation without bone cement. The concave angle of upper end-plate was increased in conventional pedicle screw+bone cement group and novel perfusional pedicle screw+bone cement group at 3 days after operation when compared with that in the conventional pedicle screw group; the lower end-plate concave angle of adjacent centrum, the rectangular index and the adjacent intervertebral space of conventional pedicle screw+bone cement group and novel perfusional pedicle screw+bone cement group were all decreased in the final follow-up, and the change of the first two indicators was significantly bigger than those in the conventional pedicle screw group. This showed that addition of bone cement in internal fixation operation had no significant effect on the degeneration degree of adjacent intervertebral disc, but it obviously changed the modality of adjacent vertebral endplate and vertebral body, and increased the fracture risk of adjacent vertebral body.

Key words: bone tissue engineering, orthopedic implants, osteoporosis, bone cement, pedicle screw, adjacent segment, intervertebral space height, vertebral rectangular index, concave angle of vertebral end-plate, Oswestry disability index, Cobb angle

CLC Number:

R318

Yue Wen-feng, Xia Hong, Wang Jian-hua. Pedicle screw fixation augmented with bone cement benefits osteoporosis patients[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(17): 3081-3088.

Figures/Tables 2

2.6 椎体终板凹陷角度测量结果见表2。常规螺钉+骨水泥组和可灌注骨水泥螺钉+骨水泥组组内术后3天和末次随访的固定节段椎体上终板凹陷角度均较术前明显增大(P < 0.05)，常规螺钉+骨水泥组和可灌注骨水泥螺钉+骨水泥组组内末次随访的相邻上位椎体下终板凹陷角度均较术前明显减小(P < 0.05)，常规螺钉组术前术后终板凹陷角度均无明显变化(P > 0.05)。常规螺钉+骨水泥组、可灌注骨水泥螺钉+骨水泥组2组末次随访的固定节段椎体上终板凹陷角度大于常规螺钉组(P < 0.05)，常规螺钉+骨水泥组、可灌注骨水泥螺钉+骨水泥组2组末次随访的相邻上位椎体下终板凹陷角度小于常规螺钉组(P < 0.05)，常规螺钉+骨水泥组和可灌注骨水泥螺钉+骨水泥组组间差异无显著意义。表明添加骨水泥固定术后减小了固定节段椎体上终板凹陷程度，增加了相邻上位椎体下终板凹陷程度。 2.7 固定节段Cobb角测量结果常规螺钉组、常规螺钉+骨水泥组、可灌注骨水泥螺钉+骨水泥组末次随访与术后3 d的Cobb角度的变化值分别为(5.5±1.6) °，(2.1± 0.9)°，(2.3±0.9) °。常规螺钉+骨水泥组、可灌注骨水泥螺钉+骨水泥组2组末次随访与术后3 d Cobb角度的变化值均小于常规螺钉组(P < 0.05)，常规螺钉+骨水泥组和可灌注骨水泥螺钉+骨水泥组组间差异无显著性意义(P > 0.05)。 2.8 手术及不良反应常规螺钉组、常规螺钉+骨水泥组、可灌注骨水泥螺钉+骨水泥组平均手术时间分别为288，292，296 min，平均术中失血量分别为575，561，540 mL，单椎体平均骨水泥用量分别为0，3.4，3.8 mL，平均住院时间分别为18，22，21 d。所有患者均未出现骨水泥渗漏、放热效应引起的神经功能损伤、毒性反应等严重并发症，末次随访时均达到骨性融合。"

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