The Biomechanical Properties of Pedicle Screw Fixation Combined With Trajectory Bone Cement Augmentation in Osteoporotic Vertebrae

OBJECT In elderly patients with severe osteoporosis, instrumented lumbar interbody fusion may result in fixation failure or nonunion because of decreased pedicle screw pullout strength or increased interbody graft subsidence risk. Thus, given its many advantages, percutaneous pedicle screw fixation with cement augmentation can be an effective method to use in elderly patients. The authors report on an easy, safe, and economical technique for bone cement augmentation using a bone biopsy needle inserted into the disc space in 2 osteoporotic patients who were treated with posterior interbody fusion and percutaneous pedicle screw fixation. METHODS Two elderly patients who complained of back pain and intermittent neurological claudication underwent posterior interbody fusion with percutaneous pedicle screw fixation. After routinely assembling rods on the screws, a bone biopsy needle was inserted into the disc space via the operative field; the needle was then placed around the tips of the screws using fluoroscopic radiography for guidance. Bone cement was injected through the bone biopsy needle, also under fluoroscopic radiography guidance. RESULTS Both patients’ symptoms improved after the operation, and there was no evidence of cage subsidence or screw loosening at the 4-month follow-up. CONCLUSIONS The indirect technique of bone cement augmentation via the disc space for percutaneous screw fixation could be an easy, safe, and economical method.

Download Full-text

Long-term efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell diseaseLong-term efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell disease

10.21203/rs.2.22708/v1 ◽

2020 ◽

Author(s):

Guo-ye Mo ◽

Teng-peng Zhou ◽

Yong-xian Li ◽

Hui-zhi Guo ◽

Dan-qing Guo ◽

...

Keyword(s):

Cobb Angle ◽

Bone Cement ◽

Pedicle Screw ◽

Screw Fixation ◽

Operation Time ◽

Pedicle Screw Fixation ◽

Stage Iii ◽

Efficacy And Safety ◽

Sagittal Vertical Axis ◽

Term Efficacy

Abstract Purpose This study aimed to evaluate the efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell disease. Methods Twenty-five patients with stage III Kümmell disease who received bone cement-augmented pedicle screw fixation at the First Affiliated Hospital of Guangzhou University of Chinese Medicine between June 2009 and December 2015 were enrolled. All patients were females with a history of osteoporosis. The vertebral Cobb angle (V-Cobb angle), the fixed segment Cobb Angle (S-Cobb angle), pelvic parameters, visual Analogue Scale (VAS) score, and Oswestry Disability Index (ODI) were assessed preoperatively, postoperatively and at the final follow-up. Complications, loosening rate, operation time, and intraoperative bleeding were recorded. Results The average lumbar vertebral density T-value was -3.68 ± 0.71 SD, and the average age was 71.84 ± 5.39. The V-Cobb angle, S-Cobb angle, and Sagittal Vertical Axis（SVA） were significantly smaller postoperatively compared to the preoperative values. The VAS and ODI at 1 month after surgery were 3.60 ± 1.00 and 36.04 ± 6.12%, respectively, which were both significantly lower than before surgery (VAS: 8.56±1.04, ODI: 77.80 ± 6.57%). Conclusion Bone cement-augmented pedicle screw fixation is a safe and effective treatment for stage III Kümmell disease. It can effectively correct kyphosis, restore and maintain sagittal balance, and maintain spinal stability.

Download Full-text