J Korean Soc Spine Surg.  2002 Sep;9(3):223-229. 10.4184/jkss.2002.9.3.223.

Effect of Bone Cement Augmentation of Pedicular Screwing for Osteoporotic Lumbar Spine

• Cho KN
• Yoon HK
• Jeon HS
• Jeon SJ
• Cho HJ
• Hong JW
• Lee JY

• KMID: 2003229
• DOI: http://doi.org/10.4184/jkss.2002.9.3.223

Abstract

STUDY DESIGN: Eighteen patients undergoing bone cement augmentation of pedicular screwing for osteoporotic lumbar spine were reviewed retropectively.
OBJECTIVES
To assess the effectiveness of bone cement augmentation of pedicular screwing for osteoporotic lumbar spine. SUMMARY OF LITERATURE REVIEW: For the technical limit obtaining the dynamic stability in the bone-screw interface for osteoporotic lumbar spine, the additional device to enhance pedicular screw fixation strength needs.
MATERIALS AND METHODS
We reviewed 18 cases undergoing pedicular screwing and fusion for the osteoporotic (Jikei grade I, II, III/III) lumbar spine from Feb. 2000 to Mar. 2001 with an average follow-up of 1.5 years. Mean age was 69.5 years with 6 male and 12 female. Inclusion criteria was 9 degenerative spinal stenosis, 5 spinal stenosis associated with compression fracture, 2 Kummel's disease, 1 spondylolisthesis and 1 internal disc disruption. We performed bone cement injection around the screws showing significantly low insertion torque, screw pullout or cut-up during surgery. We asssessed the radiographic results of sagittal angle correction (SAC) of the fused segment and disc height restoration (DHR) on the preoperative, postoperative and last follow up lumbar lateral views. Clinical results were evaluated according to the Kumano's criteria.
RESULTS
Mean sagittal angle at preoperative, postoperative and last follow-up was 11.6-21.6-19.6 degrees with mean SAC gain 10 degrees (p<0.05) and gain loss 2 degrees (p>0.05). Mean disc height of each period was 33.3-49.8-43.5% with mean DHR gain 16.5% (p<0.05) and gain loss 6.3% (p>0.05). The clinical result was analyzed as 14 good, 3 fair and 1 poor. Fusion success was achieved in all. There were 2 perioperative complications of 1 superficial surgical site infection and 1 incomplete L4 root injury, and 6 complications during follow up of 3 compression fractures above fused segment, 1 screw pullout, 1 screw cut-up, and 1 bone cement extrava-sation into canal.
CONCLUSIONS
The bone cement augmentation of pedicular screwing for osteoporotic lumbar spine can be an alternative to enhance screw fixation strength.

Keyword

Lumbar spine; Osteoporosis; Pedicular screwing; Bone cement augmentation

MeSH Terms

Female
Follow-Up Studies
Fractures, Compression
Humans
Male
Osteoporosis
Spinal Stenosis
Spine*
Spondylolisthesis
Torque

Figure

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  Fig. 1. A 66-year-old female with spinal stenosis at L3-4-5 associated with compression fracture of L4 and L5 bodies. Preoperative AP and lateral radiographs show Jikei grade II/III osteoporosis with –4.1˚ of local L3 to L5 kyphosis (A). Postoperative radiographs after L3-4-5 cage-PLIF and PMMA augmentation for Rt L3 and L5 screws (black arrows) show satisfactory correction of L3 to L5 sagittal angle to 14.3˚ (B). The 1.5-year followup examination shows L1 compression fracture (white arrow) from slipped down accident (C). Two weeks after fracture we performed percutaneous L1-vertebroplasty (D), and 2.2-year followup radiograph shows only a minor loss of the correction and no device-related problems (E).

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