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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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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.

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Acknowledgments

The authors wish to thank Hsin-Yi Huang from the Biostatistics Task Force, Taipei Veterans General Hospital, for her statistical assistance.

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan, Republic of China

    Hsi-Hsien Lin, Ming-Chau Chang, Shih-Tien Wang, Chien-Lin Liu & Po-Hsin Chou

  2. School of Medicine, National Yang-Ming University, Taipei City, Taiwan, Republic of China

    Hsi-Hsien Lin, Ming-Chau Chang, Shih-Tien Wang, Chien-Lin Liu & Po-Hsin Chou

  3. Institute of Anatomy and Cell Biology, School of Medicine, National Yang-Ming University, Taipei City, Taiwan, Republic of China

    Ming-Chau Chang

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Correspondence to Po-Hsin Chou.

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Lin, HH., Chang, MC., Wang, ST. et al. 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. International Orthopaedics (SICOT) 42, 1313–1320 (2018). https://doi.org/10.1007/s00264-018-3812-3

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  • DOI: https://doi.org/10.1007/s00264-018-3812-3

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