Effect of a pedicle screw augmentation with bone cement perfusion on the long segment fixation and fusion in elderly patients with spinal deformity treated by osteotomy / 中华老年医学杂志

ABSTRACT

Objective To investigate the effect of pedicle screw augmentation with bone cement perfusion on the long segment fixation and fusion in the elderly patients with spinal deformity treated by osteotomy.Methods The cohort data of the older patients aged ≥70 years with spinal kyphosis were retrospectively analyzed in Beijing Hospital,Department of Orthopedic Surgery,Division of Spine Surgery from January 2012 to June 2014.32 cases with complete clinical date were included in this study.The kyphosis of all patients was secondary to thoracolumbar osteoporotic compression fracture.All patients were treated by posterior thoracolumbar spinal osteotomy with long segment fixation and fusion.The patients with fusions including sacral vertebral body fusion or the T score of BMD were less than-5 were excluded.Some patients with neurological compression symptoms also underwent selective decompression in spinal canal and nerve root foramen.All patients were divided into two groupswith (n=14)versus without(n=18)screw augmentation with bone cement perfusion(augmentation vs.non-augmentation/control group).The follow-up time was no less than 12 months.The data of age,gender,operative time,blood loss volume and preoperative bone mineral density were compared between two groups.Cobb angle of postoperative spinal surgery region,lordosis angle of postoperative lumbar,VAS and ODI improvement were analyzed.Data of surgical fixation and fusion segments were recorded.Pedicle screw loosening was compared between two groups.Results In the augmentation group,the pedicle screw loosening didn't occur.But control group showed screw loosening in 7 cases,a euphoric zone around screw in 4 cases,pedicle screw pullout in 2 cases,and vertebral cutting phenomenon with euphotic zone around screw in 1 case.There were no significant differences in ODI improvement rate and surgical satisfaction between the two groups.Conclusions When operative procedures of surgeon are in precision and skillful,bone cement augmentation technique for pedicle screw can reduce the occurrence of pedicle screw loosening in older patients during osteotomy and long segment fixation and fusion operation for spinal kyphosis.