Advertisement

International Orthopaedics

, Volume 42, Issue 6, pp 1313–1320 | Cite as

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

  • Hsi-Hsien Lin
  • Ming-Chau Chang
  • Shih-Tien Wang
  • Chien-Lin Liu
  • Po-Hsin Chou
Original Paper

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Osteoporosis Polymethylmethacrylate augmentation Pedicle screw 

Notes

Acknowledgments

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.

References

  1. 1.
    Chang MC, Liu CL, Chen TH (2008) Polymethylmethacrylate augmentation of pedicle screw for osteoporotic spinal surgery: a novel technique. Spine 33:E317–E324.  https://doi.org/10.1097/BRS.0b013e31816f6c73 CrossRefPubMedGoogle Scholar
  2. 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. 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. 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
  5. 5.
    Ball JM, Cagle P, Johnson BE, Lucasey C, Lukert BP (2009) Spinal extension exercises prevent natural progression of kyphosis. Osteoporos Int 20:481–489.  https://doi.org/10.1007/s00198-008-0690-3 CrossRefPubMedGoogle Scholar
  6. 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
  7. 7.
    Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD (2004) Free hand pedicle screw placement in the thoracic spine: is it safe? Spine 29:333–342 discussion 342CrossRefPubMedGoogle Scholar
  8. 8.
    McAfee PC, Boden SD, Brantigan JW, Fraser RD, Kuslich SD, Oxland TR, Panjabi MM, Ray CD, Zdeblick TA (2001) Symposium: a critical discrepancy—a criteria of successful arthrodesis following interbody spinal fusions. Spine 26:320–334CrossRefPubMedGoogle Scholar
  9. 9.
    Wuisman PI, Van Dijk M, Staal H, Van Royen BJ (2000) Augmentation of (pedicle) screws with calcium apatite cement in patients with severe progressive osteoporotic spinal deformities: an innovative technique. Eur Spine J 9:528–533CrossRefPubMedPubMedCentralGoogle Scholar
  10. 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
  11. 11.
    Zindrick MR, Wiltse LL, Doornik A, Widell EH, Knight GW, Patwardhan AG, Thomas JC, Rothman SL, Fields BT (1987) Analysis of the morphometric characteristics of the thoracic and lumbar pedicles. Spine 12:160–166CrossRefPubMedGoogle Scholar
  12. 12.
    Lakshmanan P, Jones A, Mehta J, Ahuja S, Davies PR, Howes JP (2009) Recurrence of kyphosis and its functional implications after surgical stabilization of dorsolumbar unstable burst fractures. Spine J 9:1003–1009.  https://doi.org/10.1016/j.spinee.2009.08.457 CrossRefPubMedGoogle Scholar
  13. 13.
    Haschtmann D, Stoyanov JV, Gedet P, Ferguson SJ (2008) Vertebral endplate trauma induces disc cell apoptosis and promotes organ degeneration in vitro. Eur Spine J 17:289–299.  https://doi.org/10.1007/s00586-007-0509-5 CrossRefPubMedGoogle Scholar
  14. 14.
    Tarantino U, Scimeca M, Piccirilli E, Tancredi V, Baldi J, Gasbarra E, Bonanno E (2015) Sarcopenia: a histological and immunohistochemical study on age-related muscle impairment. Aging Clin Exp Res 27(Suppl 1):S51–S60.  https://doi.org/10.1007/s40520-015-0427-z CrossRefPubMedGoogle Scholar
  15. 15.
    Frobin W, Brinckmann P, Kramer M, Hartwig E (2001) Height of lumbar discs measured from radiographs compared with degeneration and height classified from MR images. Eur Radiol 11:263–269.  https://doi.org/10.1007/s003300000556 CrossRefPubMedGoogle Scholar
  16. 16.
    McLain RF, Sparling E, Benson DR (1993) Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am 75:162–167CrossRefPubMedGoogle Scholar
  17. 17.
    Hsu CC, Chao CK, Wang JL, Hou SM, Tsai YT, Lin J (2005) Increase of pullout strength of spinal pedicle screws with conical core: biomechanical tests and finite element analyses. J Orthop Res 23:788–794.  https://doi.org/10.1016/j.orthres.2004.11.002 CrossRefPubMedGoogle Scholar
  18. 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
  19. 19.
    Kim YY, Choi WS, Rhyu KW (2012) Assessment of pedicle screw pullout strength based on various screw designs and bone densities—an ex vivo biomechanical study. Spine J 12:164–168.  https://doi.org/10.1016/j.spinee.2012.01.014 CrossRefPubMedGoogle Scholar
  20. 20.
    Cook SD, Salkeld SL, Whitecloud TS 3rd, Barbera J (2000) Biomechanical evaluation and preliminary clinical experience with an expansive pedicle screw design. J Spinal Disord 13:230–236CrossRefPubMedGoogle Scholar
  21. 21.
    Patel PS, Shepherd DE, Hukins DW (2010) The effect of screw insertion angle and thread type on the pullout strength of bone screws in normal and osteoporotic cancellous bone models. Med Eng Phys 32:822–828.  https://doi.org/10.1016/j.medengphy.2010.05.005 CrossRefPubMedGoogle Scholar
  22. 22.
    Jiang L, Arlet V, Beckman L, Steffen T (2007) Double pedicle screw instrumentation in the osteoporotic spine: a biomechanical feasibility study. J Spinal Disord 20:430–435CrossRefGoogle Scholar
  23. 23.
    Santoni BG, Hynes RA, McGilvray KC, Rodriguez-Canessa G, Lyons AS, Henson MA, Womack WJ, Puttlitz CM (2009) Cortical bone trajectory for lumbar pedicle screws. Spine J 9:366–373.  https://doi.org/10.1016/j.spinee.2008.07.008 CrossRefPubMedGoogle Scholar
  24. 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

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Hsi-Hsien Lin
    • 1
    • 2
  • Ming-Chau Chang
    • 1
    • 2
    • 3
  • Shih-Tien Wang
    • 1
    • 2
  • Chien-Lin Liu
    • 1
    • 2
  • Po-Hsin Chou
    • 1
    • 2
  1. 1.Department of Orthopedics and TraumatologyTaipei Veterans General HospitalTaipei CityRepublic of China
  2. 2.School of MedicineNational Yang-Ming UniversityTaipei CityTaiwan, Republic of China
  3. 3.Institute of Anatomy and Cell Biology, School of MedicineNational Yang-Ming UniversityTaipei CityTaiwan, Republic of China

Personalised recommendations