Ergotropic effect of bone cement on pedicle screw fixation in treatment of osteoporotic thoracolumbar fracture

Da LIU, Yang LUO, Jun SHENG, Chen HUANG, Xia KANG, Wei ZHENG, Wei GU, Jiang-jun ZHOU, Hong-hua WU

Abstract


Objective To evaluate the ergotropic effect of bone cement on pedicle screw fixation in treatment of osteopo¬rotic thoracolumbar fracture. Methods Fifty-three patients with osteoporotic thoracolumbar fracture, admitted from Jun. 2013 to Dec. 2014, were included for treatment by augmentation of pedicle screw fixation with bone cement. All patients underwent pre-operative examination of bone mineral density with T-score ≤-2.5 and augmentation of pedicle screw fixation with injection of 1.5 ml bone cement in adjacent to fractured vertebra. All patients were treated with anti-osteoporosis therapy pre- and post-operation, ob¬served and recorded with basic conditions and complications. At pre-operation, one-week post-operation and last follow-up, pain vi¬sual analogue scale (VAS) and neurological function score (ASIA) of all patients were recorded, and the compression rats of anterior and posterior edge of fractured vertebra, and compression rats of spinal canal and Cobb angel of all patients were measured. Results All the 53 patients were successfully undergone operation in about 90-140 min with blood loss of about 150-350 ml. No spinal cord or nerve injury, dural tear and obvious leakage of bone cement and screw loosening occurred during operation. All patients were followed up for 12 to 36 months and the neurological function obviously recovered contrasted with pre-operation. X-ray and CT examination at last follow-up showed good fractures healing, good position and non-loosening of internal fixation device and non-leakage of bone cement. At one week post-operation and last follow-up, VAS, compression rats of anterior edge and posterior edge of fractured vertebra, compression rats of spinal canal and Cobb angel were significantly lower than those at pre-operation (P0.05). Conclusions Augmentation of pedicle screw fixation with bone cement can effectively strengthen the initial stability of pedicle screw in osteo¬porosis, restore the height of fractured vertebra and reduce the compression of spinal canal, which will help the correction of spinal kyphosis and neurological function recovery. This method can well maintain long-term stability of internal fixation in osteoporosis and height of fractured vertebra, and significantly reduce the risks of long-term screw loosening and vertebral collapse.

DOI: 10.11855/j.issn.0577-7402.2017.01.06

Keywords


osteoporotic fractures; spinal fractures; bone cement; internal fixators

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