Surgical Treatment of Osteoporotic Thoracolumbar Compressive Fractures with Open Vertebral Cement Augmentation of Expandable Pedicle Screw Fixation: A Biomechanical Study and a 2-Year Follow-up of 20 Patients

Nov 12, 2010The Journal of surgical research

Surgical repair of weak spine fractures using expandable screws and cement: mechanical tests and 2-year patient results

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Abstract

Cement augmentation of expandable pedicle screws (cemented-EPS) increased maximum pullout strength by 59% compared to conventional pedicle screws in osteoporotic vertebrae.

The maximum pullout strength of cemented-EPS was significantly higher than that of conventional pedicle screws, expandable pedicle screws, and cemented conventional screws.
In patients with severe osteoporosis, cemented-EPS showed no instances of screw loosening, while 4.2% of screws loosened in the cemented conventional screw group.
Clinical scores improved significantly in both cemented-EPS and cemented conventional screw groups after six months, indicating effective pain relief and functional enhancement.
The mean bone mineral density in the severe osteoporosis group was significantly lower than in the osteoporosis group, highlighting the severity of the condition.

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BACKGROUND: The incidence of screw loosening increases significantly in elderly patients with severe osteoporosis. Open vertebral cement augmentation of expandable pedicle screw fixation may improve fixation strength in the osteoporotic vertebrae.

MATERIALS AND METHODS: Twenty cadaveric vertebrae (L1-L5) were harvested from six osteoporotic lumbar spines. Axial pullout tests were performed to compare the maximum pullout strength (Fmax) of four methods: 1. Conventional pedicle screws (CPS), 2. Expandable pedicle screws (EPS), 3. Cement augmentation of CPS (cemented-CPS), 4. Cement augmentation of EPS (cemented-EPS). Thirty-six consecutive patients with single-vertebral osteoporotic compressive fractures received posterior decompression and spinal fusion with cemented-CPS (16 cases) or cemented-EPS (20 cases). Plain film and/or CT scan were conducted to evaluate the spinal fusion and fixation effectiveness.

RESULTS: The Fmax and energy absorption of cemented-EPS were significantly greater than three control groups. The mean BMD in the severe osteoporosis group was significantly lower than that in the osteoporosis group (t = 2.04, P = 0.036). In the osteoporosis group, cemented-EPS improved the Fmax by 43% and 21% over CPS and cemented-CPS group. In the severe osteoporosis group, cemented-EPS increased the Fmax by 59%, 22%, and 26% over CPS, EPS, and cemented-CPS, respectively. The clinical results showed that all patients suffered from severe osteoporosis. Six months after operation, the JOA and VAS scores in cemented-EPS group improved from 11.4 ± 2.6 and 7.0 ± 1.4 mm to 24.9 ± 1.6 and 2.1 ± 1.3 mm, respectively. No screw loosening occurred in the cemented-EPS group and spinal fusion was achieved. In the cemented-CPS group, four screws loosened (4.2%) according to the radiolucency. Six months after operation, the JOA and VAS scores improved from 13.1 ± 1.9 and 7.6 ± 1.5 mm to 22.8 ± 2.2 and 2.5 ± 1.6 mm, respectively. No cement leaked into the spinal canal in both groups.

CONCLUSIONS: Cemented-EPS could increase fixation strength biomechanically. It could reduce the risks of screw loosening in patients with severe osteoporosis, requiring instrumented arthrodesis.

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Surgical Treatment of Osteoporotic Thoracolumbar Compressive Fractures with Open Vertebral Cement Augmentation of Expandable Pedicle Screw Fixation: A Biomechanical Study and a 2-Year Follow-up of 20 Patients

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