The mid-term and long-term efficacy of cement augmentation of pedicle screws in the treatment of thoracolumbar osteoporotic vertebral compression fractures complicated with spinal kyphosis deformity
10.3969/j.issn.1004-406X.2024.08.04
- VernacularTitle:应用钉道骨水泥强化椎弓根螺钉技术治疗胸腰椎骨质疏松压缩性骨折伴后凸畸形的中远期疗效
- Author:
Yuwei LI
1
;
Xiuzhi LI
;
Haijiao WANG
Author Information
1. 漯河市中心医院骨科 462000
- Keywords:
Spine;
Osteoporosis;
Kyphosis deformity;
Polymethyl methacrylate;
Pedicle screw
- From:
Chinese Journal of Spine and Spinal Cord
2024;34(8):812-818
- CountryChina
- Language:Chinese
-
Abstract:
Objectives:To evaluate the safety and mid-term clinical efficacy of cement augmentation of pedicle screws in the treatment of thoracolumbar osteoporotic vertebral compression fractures complicated with spinal kyphosis deformity.Methods:A retrospective study was conducted to analyze the clinical data of el-derly patients with osteoporotic vertebral compression fractures complicated with spinal kyphosis deformity ad-mitted and treated from January of 2017 to October of 2020.According to whether pedicle augmentation us-ing bone cement was used,the patients were divided into a cement-augmented group(22 cases,cement-augmented pedicle screws)and a control group(23 cases,pedicle screws without cement augmentation).In the reinforced group,there were 9 males and 13 females;age ranged from 70 to 91 years,with a mean of 78.68±7.12 years;disease duration ranged from 1.1 to 3.8 years,with a mean of 2.39±0.71 years.In the control group,there were 10 males and 13 females;age ranged from 70 to 89 years,with a mean of 77.73±5.83 years,and disease duration ranged from 0.8 to 3.3 years,with a mean of 2.38±0.67 years.The follow-up period was 36-69 months.The incidence of pedicle screw loosening,correction rate of kyphosis,and improvement rate of visual analogue scale(VAS)and Oswestry disability index(ODI)at final follow-up were compared between the two groups.Results:In the cement-augmented group,1-2 segments of surgical decompression were performed,6-9 segments were fixed and fused,and 14 cases underwent SPO and 8 cases underwent PSO.The operational time was 221±32mins,and the volume of blood loss was 939±113mL.In the control group,1-3 segments of surgical decompression were performed,6-8 segments were fixed and fused,and 16 cases underwent SPO and 7 cases underwent PSO.The operative time was 209±36mins,and the vol-ume of blood loss was 979±111mL.One case in the cement-augmented group and two cases in the control group complicated with cerebrospinal fluid leakage,which were treated with intraoperative repair of the dura mater,tight suturing of the incision,and postoperative Trendelenburg's position.There was no statistical differ-ence in the comparison of decompression segments(t=1.785,P=0.081),fusion segments(t=0.922,P=0.362),oper-ative time(t=1.162,P=0.252),bleeding(t=1.193,P=0.239),and CSF leak complications(x2=0.311,P=0.577)be-tween the two groups.There were no complications of incision infection or leakage of bone cement into the spinal canal causing neurological symptoms.At final follow-up,the screw loosening rate was 0％in the ce-ment-augmented group(0/268)and 18.6％in the control group(45/242).The difference in screw loosening rate between the two groups was statistically significant(x2=54.657,P=0.000).The correction rate of kyphosis defor-mity was(73.27±9.78)％in the cement-augmented group and(55.96±11.31)％in the control group.There was a significant difference in the correction rate of kyphosis between the two groups(t=5.480,P=0.000).The im-provement rate of VAS in the cement-augmented group was(67.94±14.72)％,while in the control group was(74.29±13.18)％.There was no significant difference in the improvement rate of VAS between the two groups(t=1.526,P=0.134).The improvement rate of ODI in the cement-augmented group was(82.01±3.11)％,while in the control group it was(81.96±3.58)％,there was no significant difference in the improvement rate of ODI between the two groups(t=0.41,P=0.968).Conclusions:The application of cement augmentation of pedicle screws in decompression,osteotomy,and long segment fixation fusion for the treatment of thoracolumbar osteo-porotic vertebral compression fractures with spinal kyphosis deformity can effectively reduce the loosening rate of pedicle screws and improve the correction rate,resulting in satisfactory clinical outcomes.
