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A comparative study on screw loosening in osteoporotic lumbar spine fusion between expandable and conventional pedicle screws

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The aim of this study is to compare the rate of screw loosening and clinical outcomes of expandable pedicle screws (EPS) with those of conventional pedicle screws (CPS) in patients treated for spinal stenosis (SS) combined with osteoporosis.

Methods

One hundred and fifty-seven consecutive patients with SS received either EPS fixation (n = 80) or CPS fixation (n = 77) to obtain lumbosacral stabilization. Patients were observed for a minimum of 24 months. Outcome measures included screw loosening, fusion rate, Japanese Orthopaedic Association (JOA) scores and Oswestry disability index (ODI) scoring system, and complications.

Results

In the EPS group, 20 screws became loose (4.1%) in 6 patients (7.5%), and two screws (0.4%) had broken. In the CPS group, 48 screws became loose (12.9%) in 15 patients (19.5%), but no screws were broken. The fusion rate in the EPS group (92.5%) was significantly higher than that of the CPS group (80.5%). The rate of screw loosening in the EPS group (4.1%) was significantly lower than that of the CPS group (12.9%). Six EPS (1.8%) screws were removed. In the EPS group, two screws had broken but without neural complications. Twelve months after surgeries, JOA and ODI scores in the EPS group were significantly improved. There were four cases of dural tears, which healed after corresponding treatment.

Conclusions

EPS can decrease the risk of screw loosening and achieve better fixation strength and clinical results in osteoporotic lumbar spine fusion.

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References

  1. Moore DC, Maitra RS, Farzo LA, Graziano GP, Goldstein SA (1997) Restoration of pedicle screw fixation with an in situ setting calcium phosphate cement. Spine 22:1696–1705

    Article  PubMed  CAS  Google Scholar 

  2. Dickman C, Fessler RG, MacMillan M, Haid RW (1992) Transpedicular screw-rod fixation of the lumbar spine: operative technique and outcome in 104 cases. J Neurosurg 77:860–870

    Article  PubMed  CAS  Google Scholar 

  3. Essens S, Sacs BL, Drezyin V (1993) Complications associated with the technique of pedicle screw fixation: a selected survey of ABC members. Spine 18:2231–2239

    Article  Google Scholar 

  4. Okuyama K, Abe E, Suzuki T, Tamura Y, Chiba M, Sato K (2000) Can insertional torque predict screw loosening and related failures? An in vivo study of pedicle screw fixation augmenting posterior lumbar interbody fusion. Spine 25:858–864

    Article  PubMed  CAS  Google Scholar 

  5. Wittenberg RH, Shea M, Schwartz DE, Lee KS, White AA III, Hayes WC (1991) Importance of bone mineral density in instrumented spine fusions. Spine 16:647–652

    Article  PubMed  CAS  Google Scholar 

  6. Bai B, Kummer FJ, Spivak J (2001) Augmentation of anterior vertebral body screw fixation by an injectable, biodegradable calcium phosphate bone substitute. Spine 26:2679–2683

    Article  PubMed  CAS  Google Scholar 

  7. Derincek A, Wu C, Mehbod A, Transfeldt EE (2006) Biomechanical comparison of anatomic trajectory pedicle screw versus injectable calcium sulfate graft-augmented pedicle screw for salvage in cadaveric thoracic bone. J Spinal Disord Tech 19:286–291

    Article  PubMed  Google Scholar 

  8. Kayanja M, Evans K, Milks R, Lieberman ICH (2006) The mechanics of polymethylmethacrylate augmentation. Clin Orthop Relat Res 443:124–130

    Article  PubMed  Google Scholar 

  9. Linhardt O, Luring C, Matussek J, Hamberger C, Plitz W, Grifka J (2006) Stability of pedicle screw after kyphoplasty augmentation–an experimental study to compare transpedicular screw fixation in soft and cured kyphoplasty cement. J Spinal Disord Tech 19:87–91

    Article  PubMed  Google Scholar 

  10. Lotz JC, Hu SS, Chiu DFM, Yu M, Colliou O, Poser RD (1997) Carbonated apatite cement augmentation of pedicle screw fixation in the lumbar spine. Spine 22:2716–2723

    Article  PubMed  CAS  Google Scholar 

  11. Renner SM, Lim TH, Kim WJ, Katolik L, An HS, Andersson GB (2004) Augmentation of pedicle screw fixation strength using an injectable calcium phosphate cement as a function of injection: timing and method. Spine 29(11):212–216

    Article  Google Scholar 

  12. Cook SD, Barbera J, Rubi M, Salkeld SL, Whitecloud TS III (2001) Lumbosacral fixation using expandable pedicle screws: an alternative in reoperation and osteoporosis. Spine J 1:109–114

    Article  PubMed  CAS  Google Scholar 

  13. Cook SD, Salkeld SL, Whitecloud TS III, Barberá J (2001) Biomechanical testing and clinical experience with the OMEGA-21 spinal fixation system. Am J Orthop 30:387–394

    PubMed  CAS  Google Scholar 

  14. Kettler A, SchmoelzW ShezifiY, Ohana N, Ben-Arye A, Claes L (2006) Biomechanical performance of the new BeadEx implant in the treatment of osteoporotic vertebral body compression fractures: restoration and maintenance of height and stability. Clin Biomech 21:676–682

    Article  CAS  Google Scholar 

  15. Lei W, Wu ZX (2006) Biomechanical evaluation of an expansive pedicle screw in calf vertebrae. Eur Spine J 15:321–326

    Article  PubMed  Google Scholar 

  16. Wu ZX, Cui G, Lei W, Fan Y, Wan SY, Ma ZS (2010) Application of an expandable pedicle screw in the severe osteoporotic spine: a preliminary study. Clin Invest Med 33:E1–E8

    Google Scholar 

  17. Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine 25(21):2940–2952

    Article  PubMed  CAS  Google Scholar 

  18. Sapkas GS, Papadakis SA, Stathakopoulos DP, Papagelopoulos PJ, Badekas AC, Kaiser JH (1999) Evaluation of pedicle screw position in thoracic and lumbar fixation using plain radiographs and computed tomography. A prospective study of 35 patients. Spine 24(18):1926–1929

    Article  PubMed  CAS  Google Scholar 

  19. Burkus JK, Foley K, Haid R, LeHuec JC (2001) Radiographic assessment of interbody fusion devices: fusion criteria for anterior interbody surgery. Neurosurg Focus 10:1–9

    Article  Google Scholar 

  20. Schatzker J, Sanderson R, Murnaghan JP (1975) The holding power of orthopedic screws in vivo. Clin Orthop 108:115–126

    Article  PubMed  Google Scholar 

  21. Kettler A, Schmoelz W, Shezifi Y, Ohana N, Ben-Arye A, Claes L (2006) Biomechanical performance of the new BeadEx implant in the treatment of osteoporotic vertebral body compression fractures: restoration and maintenance of height and stability. Clin Biomech 21(7):676–682

    Article  CAS  Google Scholar 

  22. Fogel GR, Reitman CA, Liu WQ, Esses SI (2003) Physical characteristics of polyaxial-headed pedicle screws and biomechanical comparison of load with their failure. Spine 28(5):470–473

    PubMed  Google Scholar 

  23. DeWald CJ, Stanley T (2006) Instrumentation-related complications of multi level fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality. Spine 31(19):144–151

    Article  Google Scholar 

  24. Turner AW, Gillies RM, Svehla MJ, Saito M, Walsh WR (2003) Hydroxyapatite composite resin cement augmentation of pedicle screw fixation. Clin Orthop 406:253–261

    Article  PubMed  Google Scholar 

  25. Dawson EG, DeWald CJ, Nattiv A (2003) Osteoporosis: evaluation and pharmacologic treatment. In: Spinal deformities: the comprehensive text. New York: Thieme 19–21

  26. Yilmaz C, Atalay B, Caner H, Altinors N (2006) Augmentation of a loosened sacral pedicle screw with percutaneous polymethyl methacrylate injection. J Spinal Disord Tech 19(5):373–375

    Article  PubMed  Google Scholar 

  27. Lee SH, Kang BU, Jeon SH, Park JD, Maeng DH, Choi YG (2006) Revision surgery of the lumbar spine: anterior lumbar interbody fusion followed by percutaneous pedicle screw fixation. J Neurosurg Spine 5(3):228–233

    Article  PubMed  Google Scholar 

  28. Chang MC, Liu CL, Chen TH (2008) Polymethylmethacrylate augmentation of pedicle screw for osteoporotic spinal surgery: a novel technique. Spine 33(10):317–324

    Article  Google Scholar 

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Acknowledgments

The devices are SFDA-approved or approved by corresponding national agency for this indication. National funds (the National 863 Hi-tech Project: No.2007AA02Z468) were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Institute of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi’an, 710032, Shaanxi Province, People’s Republic of China

    Zi-xiang Wu, Zhen-sheng Ma, Yang Zhang, Xiong Zhao, Min Yang, Wei Lei & Hong-xun Sang

  2. Department of Orthopedics, Xi’an Hospital of Traditional Chinese Medicine, Dongdai Street 183, Xi’an, 710001, Shaanxi Province, People’s Republic of China

    Fu-tai Gong

  3. Department of Orthopedics, Baoji Central Hospital, Jiangtan Street 8, Baoji, 721000, Shaanxi Province, People’s Republic of China

    Li Liu

Authors
  1. Zi-xiang Wu
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  2. Fu-tai Gong
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  3. Li Liu
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  4. Zhen-sheng Ma
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  5. Yang Zhang
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  6. Xiong Zhao
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  7. Min Yang
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  8. Wei Lei
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  9. Hong-xun Sang
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Corresponding authors

Correspondence to Wei Lei or Hong-xun Sang.

Additional information

H. Sang and L. Wei contributed equally to this work.

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Wu, Zx., Gong, Ft., Liu, L. et al. A comparative study on screw loosening in osteoporotic lumbar spine fusion between expandable and conventional pedicle screws. Arch Orthop Trauma Surg 132, 471–476 (2012). https://doi.org/10.1007/s00402-011-1439-6

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  • DOI: https://doi.org/10.1007/s00402-011-1439-6

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