The fates of pedicle screws and functional outcomes in a geriatric population following polymethylmethacrylate augmentation fixation for the osteoporotic thoracolumbar and lumbar burst fractures with mean ninety five month follow-up
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Polymethylmethacrylate (PMMA) augmentation is a common method to increase pullout strength fixed for osteoporotic spines. However, few papers evaluated whether these pedicle screws migrated with time and functional outcome in these geriatrics following PMMA-augmented pedicle screw fixation.
From March 2006 to September 2008, consecutive 64 patients were retrospectively enrolled. VAS and ODI were used to evaluate functional outcomes. Kyphotic angle at instrumented levels and horizontal and vertical distances (HD and VD) between screw tip and anterior and upper cortexes were evaluated. To avoid bias, we used horizontal and vertical migration index (HMI and VMI) to re-evaluate screw positions with normalization by the mean of superior and inferior endplates or anterior and posterior vertebral body height, respectively.
Forty-six patients with 282 PMMA-augmented screws were analyzed with mean follow-up of 95 months. Nine patients were further excluded due to bed-ridden at latest follow-up. Twenty-six females and 11 males with mean T score of − 2.7 (range, − 2.6 to − 4.1) and mean age for operation of 77.6 ± 4.3 years (range, 65 to 86). The serial HD and kyphotic angle statistically progressed with time. The serial VD did not statistically change with time (p = 0.23), and neither HMI nor VMI (p = 0.772 and 0.631). Pre-operative DEXA results did not correlate with kyphotic angle. Most patients (80.4%) maintained similar functional outcomes at latest follow-up. The incidence of screws loosening was 2.7% of patients and 1.4% of screws, respectively. The overall incidences of systemic post-operative co-morbidities were 24.3% with overall 20.2 days for hospitalization.
Most patients (80%) remained similar functional outcomes at latest follow-up in spite of kyphosis progression. The incidence of implant failure was not high, but the post-operative systemic co-morbidities were higher, which has to be informed before index surgery.
KeywordsOsteoporosis Polymethylmethacrylate augmentation Pedicle screw
The authors wish to thank Hsin-Yi Huang from the Biostatistics Task Force, Taipei Veterans General Hospital, for her statistical assistance.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Chang MC, Kao HC, Ying SH, Liu CL (2013) Polymethylmethacrylate augmentation of cannulated pedicle screws for fixation in osteoporotic spines and comparison of its clinical results and biomechanical characteristics with the needle injection method. J Spinal Disord Tech 26:305–315. https://doi.org/10.1097/BSD.0b013e318246ae8a CrossRefPubMedGoogle Scholar
- 3.Amendola L, Gasbarrini A, Fosco M, Simoes CE, Terzi S, De Iure F, Boriani S (2011) Fenestrated pedicle screws for cement-augmented purchase in patients with bone softening: a review of 21 cases. J Orthop Traumatol 12:193–199. https://doi.org/10.1007/s10195-011-0164-9 CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Kado DM, Miller-Martinez D, Lui LY, Cawthon P, Katzman WB, Hillier TA, Fink HA, Ensrud KE (2014) Hyperkyphosis, kyphosis progression, and risk of non-spine fractures in older community dwelling women: the study of osteoporotic fractures (SOF). J Bone Miner Res 29:2210–2216. https://doi.org/10.1002/jbmr.2251 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Chou PH, Ma HL, Wang ST, Liu CL, Chang MC, Yu WK (2014) Fusion may not be a necessary procedure for surgically treated burst fractures of the thoracolumbar and lumbar spines: a follow-up of at least ten years. J Bone Joint Surg Am 96:1724–1731. https://doi.org/10.2106/jbjs.m.01486 CrossRefPubMedGoogle Scholar
- 10.Roy-Camille R, Saillant G, Mazel C (1986) Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res 7–17Google Scholar
- 18.Wittenberg RH, Lee KS, Shea M, White AA 3rd, Hayes WC (1993) Effect of screw diameter, insertion technique, and bone cement augmentation of pedicular screw fixation strength. Clin Orthop Relat Res (296): 278–287Google Scholar
- 24.Ueno M, Imura T, Inoue G, Takaso M (2013) Posterior corrective fusion using a double-trajectory technique (cortical bone trajectory combined with traditional trajectory) for degenerative lumbar scoliosis with osteoporosis: technical note. J Neurosurg Spine 19:600–607. https://doi.org/10.3171/2013.7.spine13191 CrossRefPubMedGoogle Scholar