Clinical results of pedicle screws with cement augmentation for treating lumbar degenerative diseases in the elderly

doi:10.3969/j.issn.2095-4344.2014.35.016

Abstract

Abstract:

BACKGROUND: Elderly patients with degenerative lumbar degeneration often appear insufficient holding power of pedicle screw in spine surgery, which is prone to occur de-pinning and leads to insecure fixation. How to increase the holding power of screws has become a hot research.
OBJECTIVE: To observe the early clinical effect of pedicle screws with cement augmentation for treating lumbar degenerative diseases in elderly patients.
METHODS: A total of 65 old patients with lumbar degenerative diseases received a treatment between August 2012 and April 2014, and were divided into two groups according to the treatment strategy: treatment group (n=24; internal fixation of pedicle screws with cement augmentation) and control group (n=41; routine internal fixation of pedicle screws). General conditions of patients in two groups were observed and compared. Visual analog scale (VAS) and Japanese Orthopaedic Association (JOA) score system were used for evaluating the lumbar and back pain, and restoration of neurological function in lower limbs respectively.
RESULTS AND CONCLUSION: All of the patients successfully received the surgery and then were followed up from 3 to 20 months. The anterioposterior and lateral X-ray film revealed no loosening, loss, fracture of the screws, and no loss of intervetebral space height was found. There was no significant difference in the blood loss and hospital stay between two groups (P > 0.05). JOA at postoperative 3 and 6 months, and VAS score at postoperative 3 months were significantly improved after the treatment of pedicle screws with cement augmentation, when compared to control group (P < 0.05). VAS scores showed no difference at 6 months postoperatively in two groups (P > 0.05). Pedicle screws with cement augmentation for treating lumbar degenerative diseases have the advantages of improving the screws holding strength, reconstructing the stability of lumbar vertebra and obtaining clinical efficacy on degenerative spine.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: lumbar vertebra, internal fixators, osteoporosis, pain

CLC Number:

R318

Chen Rong-guo, Dai Feng-lei, Ou Xian-feng, Yang Chao, Qian Jian-ji, Zeng Yi, Ren Jia-yun, Yu Ze-long. Clinical results of pedicle screws with cement augmentation for treating lumbar degenerative diseases in the elderly[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(35): 5666-5670.

Figures/Tables 3

References

[1] Mathews HH, Long BH. Endoscopy assisten percutaneous anterior interbody fusion with subcutaneous suprafascial internal fixation : evolution for technique and surgical consideration. Orthop Int Ed. 1995;3:496.
[2] 殷建新.影响椎弓根螺钉固定强度的相关因素[J].中国组织工程研究,2013,17(43):7642-7647.
[3] 张旭辉,裴国献,魏宽海,等.复合磷酸钙骨水泥(CCPC)强化股骨颈空心螺钉扭转刚度的研究[J]. 中华创伤骨科杂志，2004,6(10):1144-1146.
[4] YasudawaY, Akizuki A, Ryuzawa T, et al. Influence of BMD and BMI on the clinical results of posterolateral fusion for degenerative lunbar spodylolisthesis. J spine Ressoc. 1999; 10:254-258.
[5] Soshi S,Shiba R,Kondo H, et al. An experimental study on transpedicular screw fixation in relation to osteoporosis of the lumbar spine.Spine. 1991;16(11):1335-1341.
[6] Okuyama K,Sato K,Abe E,et al.Stability of transpedicle screwing for the osteoporotic spine. An invitro study of the mechanical stability .Spine (Phila Pa 1976).1993;18(15): 2240-2245.
[7] Kiner DW, Wybo CD, Sterba W, et al. Biomechanical analysis of different techniques in revision spinal instrumentation: larger diameter screws versus cement augmentation. Spine (Phila Pa 1976). 2008;33(24): 2618-2622.
[8] Hasegawa T, Inufusa A, Imai Y, et al. Hydroxyapatite-coating of pedicle screws improves resistance against pull-out force in the osteoporotic canine lumbar spine model: a pilot study. Spine J. 2005;5(3):239-243.
[9] Brasiliense LB,Lazaro BC, Reyes M, et al. Characteristics of immediate and fatigue strength of a dual-threaded pedicle screw in cadaveric spines. Spine J. 2013;13(8): 947-956.
[10] Yazu M, Kin A, Kosaka R, et al. Efficacy of novel-concept pedicle screw fixation augmented with calcium phosphate cement in the osteoporotic spine. Orthop Sci. 2005;1: 56-61.
[11] Okuyama K,Sato K,Abe E,et al.Stability of transpedicle screwing for the osteoporotic spine. An in vitro study of the mechanical stability.Spine (Phila Pa1976).1993; 18(15): 2240-2245.
[12] Yamagata M,Kitahara H,Minami S,et al. Mechanical stability of the pedicle screw fixation systems for the lumbar spine. Spine (Phila Pa 1976).1992;17(3):51-54.
[13] 李增春,志玉,王以进.骨密度对椎弓根螺钉系统固定的影响之生物力学研究[J].中华骨科杂志,1998,18(5):293-297.
[14] Choma Theodore J, Pfeiffer Ferris M ,Swope Ryan W,et al. Pedicle Screw Design and Cement Augmentation in Osteoporotic Vertebrae. Spine. 2012;37(26):1628-1632.
[15] Kim YY, Choi WS, Rhyu KW. Assessment of pedicle screw pullout strength based on various screw designs and bone densities-an ex?vivo biomechanical study. Spine J. 2012; 12(2): 164-168.
[16] Linhardt O, Lüring C, Matussek J, et al. Stability of pedicle screws after kyphoplasty augmentation: an experimental study to compare transpedicular screw fi xation in soft and cured kyphoplasty cement. Spinal Disord Tech. 2006;19(2): 87-91.
[17] Evans AJ,Jensen ME, Kip KE,et al.Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology. 2003;226(2):366-372.
[18] Renner SM , Lim TH , Kim WJ , et al. Augmentation of pedicle screw fi xation strength using an injectable calcium phosphate cement as a function of injection timing and method. Spine. 2004;29:E212-216 .
[19] 刘欣春,朱悦.椎弓根钉骨水泥强化技术应用进展[J].中国修复重建外科杂志,2013,27(10):1267-1271.
[20] Chen LH, Hsieh MK, Liao JC, et al. Repeated percutaneous vertebroplasty for refracture of cemented vertebrae. Arch Orthop Trauma Surg. 2011;131(7):927-933.
[21] Korovessis P, Vardakastanis K, Repantis T, et al. Less invasive reduction and fusion of fresh A2 and A3 traumatic L1-L4 fractures with a novel vertebral body augmentation implant and short pedicle screw fixation and fusion. Eur J Orthop Surg Traumatol. 2014;24(3):297-304.
[22] 刘达,雷伟,王军,等.新型钉道固化方法增强椎弓根螺钉固定强度的体外实验研究[J].中国骨与关节损伤杂志, 2008,23(12): 995-998.
[23] 江泽华,朱如森,袁建军,等.腰椎内固定中两种椎弓根钉加强技术与骨水泥的应用[J].中国组织工程研究,2013,17(52): 8941- 8948.
[24] Paré PE, Chappuis JL, Rampersaud R, et al. Biomechanical evaluation of a novel fenestrated pedicle screw augmented with bone cement in osteoporotic spines. Spine (Phila Pa 1976). 2011;36(18):1210-1214.
[25] Liu D, Shi L, Lei W, et al. Biomechanical Comparison of Expansive Pedicle Screw and Polymethylmethacrylate- augmented Pedicle Screw in Osteoporotic Synthetic Bone in Primary Implantation: An Experimental Study. J Spinal Disord Tech. 2013. [Epub ahead of print]
[26] Hu MH, Wu HT, Chang MC, et al. Polymethylmethacrylate augmentation of the pedicle screw: the cement distribution in the vertebral body. Eur Spine J. 2011;20(8):1281-1288.
[27] 李国强,李任增,张永飞,等.短节段骨水泥强化椎弓根钉内固定治疗单椎体骨质疏松性压缩骨折的临床初步研究[J].中国骨与关节损伤杂志,2012,27(1):49-50.
[28] Chang MC,Liu CL,Chen TH. Polymethylmethacrylate augmentationof pedicle screw for osteoporotic spinal surgery: a novel technique. Spine. 2008;33(10): E317-E324.
[29] Nagad P, Rawall S, Kundnani V, et al. Postvertebroplasty instability. J Neurosurg Spine. 2012;16(4):387-393.
[30] 岳文峰,夏虹,王建华.骨水泥强化椎弓根螺钉固定对骨质疏松患者有利无弊[J].中国组织工程研究,2013,17(17):3081-3088.