Surgical Treatment of Osteoporotic Vertebral Compression Fractures at Thoraco-Lumbar Levels: Only Pedicle Screw Constructs with Polymethylmethacrylate Augmentation / 대한정형외과학회잡지

PURPOSE: To investigate the radiological efficacy of polymethylmethacrylate (PMMA) augmentation of pedicle screw operation in osteoporotic vertebral compression fractures (OVCF) patients. MATERIALS AND METHODS: Twenty OVCF patients, who underwent only posterior fusion using pedicle screws with PMMA augmentation, were included in the study. The mean follow-up period was 15.6 months. The demographic data, bone mineral density (BMD), fusion segments, number of pedicle screws, and amount of PMMA were reviewed as medical records. To analyze the radiological outcomes, the radiologic parameters were measured as the time serial follow-up (preoperation, immediately postoperation, postoperation 6 weeks, 3, 6 months, and 1 year follow-up). RESULTS: A total of 20 patients were examined (16 females [80.0%]; mean age, 69.1±8.9 years). The average BMD was −2.5±0.9 g/cm2. The average cement volume per vertebral body was 6.3 ml. The mean preoperative Cobb angle of focal kyphosis was 32.7°±7.0° and was improved significantly to 8.7°±6.9° postoperatively (p<0.001), with maintenance of the correction at the serial follow-up, postoperatively. The Cobb angle of instrumented kyphosis, wedge angle, and sagittal index showed similar patterns. In addition, the anterior part of fractured vertebral body height averaged 11.0±5.0 mm and was improved to 18.5±5.7 mm postoperatively (p=0.006), with maintenance of the improvement at the 3-month, 6-month, and 1-year follow-up. CONCLUSION: The reinforcement of pedicle screws using PMMA augmentation may be a feasible surgical technique for OVCF. Moreover, it appears to be appropriate for improving the focal thoracolumbar/lumbar kyphosis and is maintained well after surgery.

Comparison of the modified expanding suspended laminoplasty and posterior pedicle screw fixation for lumbar intraspinal tumors / 西安交通大学学报(医学版)

Objective To compare the modified expanding suspended laminoplasty and posterior pedicle screw fixation applied in lumbar intraspinal tumors and evaluate operation,complications,postoperative neurofunctional improvement and lumbar lumbar stability in the two groups.Methods We made a retrospective analysis of the clinical data of 1 14 cases of lumbar intraspinal tumors, including 66 cases of modified expanding suspended laminoplasty and 48 cases of posterior pedicle screw fixation.We compared the operation time,operation bleeding volume,and incidence of postoperative cerebrospinal fluid leakage in the two groups.We also analyzed the lumbar instability and spinal cord injury score standard by the Japanese Orthopedic Association (JOA)between the two groups at 3,6, 12,and 24 months after operation.Results The results of modified expanding suspended laminoplasty group were significantly better than those of posterior pedicle screw fixation group in operation time, operation bleeding volume and incidence of postoperative cerebrospinal fluid leakage (P 0.05).At 3,6 or 12 months after the operation, changes in the increase of JOA score of the two groups had no significant difference (P > 0.05 ).However,24 mouths after the operation,the group of posterior pedicle screw fixation had significantly improved JOA score compared with that in the modified expanding suspended laminoplasty group.Conclusion Both the modified expanding suspended laminoplasty and posterior pedicle screw fixation have a favorable outcome of postoperative lumbar instability and neurofunction.And posterior pedicle screw fixation is superior to modified expanding suspended laminoplasty in improving neurofunction.

Comparison of Posterior Fixation Alone and Supplementation with Posterolateral Fusion in Thoracolumbar Burst Fractures

OBJECTIVE: We compared the radiological and clinical outcomes between patients who underwent posterior fixation alone and supplemented with fusion following the onset of thoracolumbar burst fractures. In addition, we also evaluated the necessity of posterolateral fusion for patients treated with posterior pedicle screw fixation. METHODS: From January 2007 to December 2009, 46 consecutive patients with thoracolumbar burst fracture were included in this study. On the basis of posterolateral fusion, we divided our patients into the non-fusion group and the fusion group. The radiological assessment was performed according to the Cobb's method, and results were obtained at immediately, 3, 6, 12 months after surgery. The clinical outcomes were evaluated using the modified Mcnab criteria at the final follow-up. RESULTS: The demographic data and the mean follow-up period were similar between the two groups. Patients of both groups achieved satisfactory clinical outcomes. The mean loss of kyphosis correction showed that patients of both groups experienced loss of correction with no respect to whether they underwent the posterolateral fusion. There was no significant difference in the degree of loss of correction at any time points of the follow-up between the two groups. In addition, we also compared the effect of fixed levels (i.e., short versus long segment) on loss of correction between the two groups and there was no significant difference. There were no major complications postoperatively and during follow-up period. CONCLUSION: We suggest that posterolateral fusion may be unnecessary for patients with thoracolumbar burst fractures who underwent posterior pedicle screw fixation.

Evaluation of posterior pedicle fixation-based dynamic stabilization in treatment of degenerative lumbar disease: Recent progress / 第二军医大学学报

Posterior pedicle fixation-based dynamic stabilization is now densely studied in the non-fusion spine surgery. The method is characterized by the motion preservation of segmental lumbar, avoidance of the stress change after fusion surgery, and adjacent disc degeneration. Posterior pedicle fixation-based dynamic stabilization systems have undergone fast development and are now used for the treatment of degenerative lumbar spine disease. As an innovation of traditional fusion surgery, the clinical evaluation of its efficacy has become a focus of study among spine surgeons. In this paper, we review the recent progress in the clinical efficacy of posterior pedicle fixation-based dynamic stabilization.

Treatment of Lower Lumbar Instability with Posterior Pedicle Combined with Bone Graft / 医学研究杂志

Objective To investigate clinical results of lower lumbar degenerative instability for the treatment of lumbar posterior pedicle screw system instrumentation combined with bone graft. Methods 38 patinets suffering from lumbar instability were treated with laminectomy ,nerve root canal enlargement and posterior pedicle screw system instrumentate combined with bone graft by pressure.Results All cases were followed up for 7to 13months.According to the system made by Wong xishen and X-ray 13 months after operation,the excellent and good rate of posterior pedicle screw system instrumentate combined with bone graft by pressure was 94.7%,and the stability of fusion lumbar spine reserved. It's fusion rate was 100%.Conclusion Posterior pedicle screw system instrumentate combined with bone graft by pressure is a safe and effective treatment for lumbar instability.

Evaluation of posterior pedicle fixation-based dynamic stabilization in treatment of degenerative lumbar disease:recent progress / 第二军医大学学报

Posterior pedicle fixation-based dynamic stabilization is now densely studied in the non-fusion spine surgery.The method is characterized by the motion preservation of segmental lumbar,avoidance of the stress change after fusion surgery,and adjacent disc degeneration.Posterior pedicle fixation-based dynamic stabilization systems have undergone fast development and are now used for the treatment of degenerative lumbar spine disease.As an innovation of traditional fusion surgery,the clinical evaluation of its efficacy has become a focus of study among spine surgeons.In this paper,we review the recent progress in the clinical efficacy of posterior pedicle fixation-based dynamic stabilization.