Polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw for lumbar degenerative disease accompanied with osteoporosis: strengthening technical points

doi:10.3969/j.issn.2095-4344.2014.47.003

Abstract

Abstract:

BACKGROUND: Once lumbar degenerative diseases merge with lumbar spinal stenosis, lumbar instability and degenerative scoliosis, surgical therapy is required for corresponding clinical symptoms, and the usage of internal fixators cannot be inevitable. Osteoporosis is rather common in the elderly. Therefore, how to implant stable pedicle screw fixation system in serious osteoporosis patients will be a big difficulty. In recent years, some studies have proven the biomechanical stability of polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw in the vertebral body, so it becomes very hot in the spine surgery.
OBJECTIVE: To explore the clinical efficacy of the use of polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw fixation for the treatment of lumbar degenerative disease accompanied with osteoporosis.
METHODS: Thirty-one patients with lumbar degenerative disease accompanied with osteoporosis from Jun 2008 to Jan 2013 were selected, including 11 males and 20 females with an average age of 73.5 years (range, 65-86 years). There were 14 cases of lumbar degenerative stenosis, 9 of lumbar intervertebral disc herniation combined with segmental instability, 6 of lumbar degenerative spondylolisthesis, and 2 of lumbar degenerative scoliosis. The patients were treated with lumbar canal decompression, fusion and polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw fixation according to their clinical features and imaging data. Visual analog scale for pain evaluation was used before and after fixation, the Japanese Orthopaedic Association (JOA) scale was used for assessment of neurological function and life skills before internal fixation and during follow-up.
RESULTS AND CONCLUSION: All cases were followed up for 40 months (range, 36-48months). No screw breakage, rod breakage, screw extraction, loosening, pseudoarticulation formation, or incision infection was found. The postoperative visual analog scale score and the JOA score was remarkably improved (P < 0.05). For patients suffering from lumbar degenerative disease accompanied with osteoporosis, polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw fixation is helpful for increasing the stabilization of screw and preventing from loosening and dislocation of the screws, and thereby beneficial for improvement and maintenance of clinical efficacy.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: lumbar vertebrae, osteoporosis, internal fixators, follow-up studies

CLC Number:

R318

Jing Dan-feng, Xu Yi-ji, Sun Tai-cun, Tian Jin, Lu Biao, Cui Xue-wen. Polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw for lumbar degenerative disease accompanied with osteoporosis: strengthening technical points[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(47): 7556-7560.

Figures/Tables 2

References

[1] Ponnusamy KE, Iyer S, Gupta G, et al. Instrumentation of the osteoporotic spine: biomechanical and clinical considerations. Spine J. 2011; 11(1): 54-63.
[2] Amendola L, Gasbarrini A, Fosco M, et al. Fenestrated pedicle screws for cement-augmented purchase in patients with bone softening: a review of 21 cases. J Orthop Traumatol. 2011;12(4): 193-199.
[3] Zhuang XM, Yu BS, Zheng ZM, et al. Effect of the degree of osteoporosis on the biomechanical anchoring strength of the sacral pedicle screws: an in vitro comparison between unaugmented bicortical screws and polymethylmethacrylate augmented unicortical screws. Spine. 2010;35(19): E925- E931.
[4] Sengupta DK, Truumees E, Patel CK, et al. Outcome of Local Bone Versus Autogenous Iliac Crest Bone Graft in the Instrumented Posterolateral Fusion of the Lumbar Spine. Spine. 2006;31(9):985-991.
[5] Takigawa T,Tanaka M, Konishi H,et al. Comparative biomechanical analysis of an improved novel pedicle screw withsheath and bone cement. J Spinal Disord Tech. 2007; 20(6):462- 467.
[6] Tan JS, Bailey CS, Dvorak MF, et al. Cement augmentation ofvertebral screws enhances the interface strength between interbodydevice and vertebral body. Spine. 2007;32(3):334- 341.
[7] Moon BJ, Cho BY, Choi EY, et al. Polymethylmethacrylate- augmented screw fixation for stabilization of the osteoporotic spine : a three-year follow-up of 37 patients. J Korean Neurosurg Soc. 2009;46(4):305-311.
[8] Chang MC, Liu CL, Chen TH. Polymethylmethacrylate augmentation of pedicle screw for osteoporotic spinal surgery: a novel technique. Spine (Phila Pa 1976). 2008;33(10): E317-324.
[9] Aydogan M, Ozturk C, Karatoprak O, et al. The pedicle screw fixation with vertebroplasty augmentation in the surgical treatment of the severe osteoporotic spines. J Spinal Disord Tech. 2009;22(6):444-447.
[10] Lin B, Lin QY, He MC, et al. [Clinical study on unilateral pedicle screw fixation and interbody fusion for the treatment of lumbar degenerative diseases under Quadrant system]. Zhongguo Gu Shang. 2012;25(6):468-473.
[11] Yuan Q, Zhang G, Wu J, et al. Clinical evaluation of the polymethylmethacrylate-augmented thoracic and lumbar pedicle screw fixation guided by the three-dimensional navigation for the osteoporosis patients. Eur Spine J. 2013. [Epub ahead of print]
[12] 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]
[13] Liu D, Wu ZX, Pan XM, et al. Biomechanical comparison of different techniques in primary spinal surgery in osteoporotic cadaveric lumbar vertebrae: expansive pedicle screw versus polymethylmethacrylate-augmented pedicle screw. Arch Orthop Trauma Surg. 2011;131(9):1227-1232.

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