Application value of expansive pedicle screw in the lumbar short‑segment fixation and fusion for osteoporosis patients

Abstract

Clinical value of expansive pedicle screw in lumbar short-segment fixation and fusion for patients with osteoporosis was investigated. A total of 80 patients with lumbar compression fracture but without obvious nerve compression were selected and divided into the observation group (n=40) and the control group (n=40) using a random number table. The observation group used the expansive pedicle screw, and the control group received conventional pedicle screw fixation and bone graft fusion. In the observation group, the operation and hospitalization time after operation were shorter and the intraoperative bleeding amount was less than that in control group (p<0.05). At 1 week, 1, 3 and 6 months after operation, the observation group had better straight leg raising test (SLRT) scores, higher lower limb sensory scores but lower visual analogue scale (VAS) scores than control group (p<0.05). Besides, the proportions of postoperative infection, dural mater tear, nerve root injury and spinal cord injury during operation in the observation group were lower than those in the control group (p<0.05), and the bone graft fusion rates at 3 and 6 months after operation were obviously superior to those in control group (p<0.05). Moreover, after operation, the spinal stenosis rate in the observation group was lower than that in control group (p<0.05), the vertebral height ratio was larger than that in control group (p<0.05), and the Cobb's angle was smaller than that in the control group (p<0.05). In addition, there was a negative correlation between bone mineral density (BMD) and hospitalization time after operation in the observation group (p<0.05). In conclusion, the internal fixation with expansive pedicle screw for osteoporosis patients with lumbar compression fracture is characterized by short operation time, less intraoperative bleeding, few complications, quick recovery of postoperative neurological function and satisfactory surgical effect. However, reasonable intervention in osteoporosis is also necessary.

Prevention of Compression Fracture in Osteoporosis Patients under Minimally Invasive Trans-Foraminal Lumbar Interbody Fusion with Assistance of Bone-Mounted Robotic System in Two-Level Degenerative Lumbar Disease

“…Owing to the fragile characteristics of the elderly, complications, including screw-loosening events, pseudarthroses, and adjacent kyphosis resulting from compression fractures, may occur after spinal surgery in osteoporosis patients [ 1 ]. In spinal fixation and fusion surgery, screw-loosening events continue to remain a major complication [ 2 ], and cage subsidence is relevant to the severity of osteoporosis [ 3 ]. Recently, adjacent vertebral compression fractures have attracted attention after spinal fixation and fusion in osteoporosis patients [ 4 ].…”

Intracardiac, pulmonary cement embolism in a 67-year-old female after cement-augmented pedicle screw instrumentation: A case report and review of literature

“…Longer instrumented extending to the adjacent segment may lead to several complications such as proximal junctional kyphosis that undermine the effectiveness of surgery[ 1 , 2 ]. To enhance the anchoring strength, several techniques have been used, including bicortical screws, tricortical screws, expandable screws, iliac screws, and iliosacral screws[ 3 , 4 ]. While it is not recommended to extend the extra fixation segment, the strength of bicortical or tricortical screws are also limited and may lead to internal fixation failure in an osteoporotic patients[ 5 ].…”

Improved fixation stability for repairing pedicle screw loosening using a modified cement filling technique in porcine vertebrae

“…Increased screw size and augmentation of loose screws with polymethylmethacrylate (PMMA) cement are commonly used techniques in revision surgery 4,5 . However, screws with PMMAaugmented cement are preferable because screw stability cannot be achieved only by increasing the screw diameter in a halo screw hole [6][7][8][9][10] .Various PMMA augmentation techniques have been used in previous studies, including direct injection of PMMA into the hole of the vertebral body prior to screw insertion 8,11,12 . However, cement leakage along the broken pedicle hole can cause devastating results 11,12 .…”

“…Various PMMA augmentation techniques have been used in previous studies, including direct injection of PMMA into the hole of the vertebral body prior to screw insertion 8,11,12 . However, cement leakage along the broken pedicle hole can cause devastating results 11,12 . Other studies have included the use of perforated…”