Effect of Bone Cement Augmentation of Pedicular Screwing for Osteoporotic Lumbar Spine / 대한척추외과학회지

ABSTRACT

STUDY DESIGN: Eighteen patients undergoing bone cement augmentation of pedicular screwing for osteoporotic lumbar spine were reviewed retropectively. OBJECTIVES: To assess the effectiveness of bone cement augmentation of pedicular screwing for osteoporotic lumbar spine. SUMMARY OF LITERATURE REVIEW For the technical limit obtaining the dynamic stability in the bone-screw interface for osteoporotic lumbar spine, the additional device to enhance pedicular screw fixation strength needs. MATERIALS AND METHODS: We reviewed 18 cases undergoing pedicular screwing and fusion for the osteoporotic (Jikei grade I, II, III/III) lumbar spine from Feb. 2000 to Mar. 2001 with an average follow-up of 1.5 years. Mean age was 69.5 years with 6 male and 12 female. Inclusion criteria was 9 degenerative spinal stenosis, 5 spinal stenosis associated with compression fracture, 2 Kummel's disease, 1 spondylolisthesis and 1 internal disc disruption. We performed bone cement injection around the screws showing significantly low insertion torque, screw pullout or cut-up during surgery. We asssessed the radiographic results of sagittal angle correction (SAC) of the fused segment and disc height restoration (DHR) on the preoperative, postoperative and last follow up lumbar lateral views. Clinical results were evaluated according to the Kumano's criteria. RESULTS: Mean sagittal angle at preoperative, postoperative and last follow-up was 11.6-21.6-19.6 degrees with mean SAC gain 10 degrees (p0.05). Mean disc height of each period was 33.3-49.8-43.5% with mean DHR gain 16.5% (p0.05). The clinical result was analyzed as 14 good, 3 fair and 1 poor. Fusion success was achieved in all. There were 2 perioperative complications of 1 superficial surgical site infection and 1 incomplete L4 root injury, and 6 complications during follow up of 3 compression fractures above fused segment, 1 screw pullout, 1 screw cut-up, and 1 bone cement extrava-sation into canal. CONCLUSIONS: The bone cement augmentation of pedicular screwing for osteoporotic lumbar spine can be an alternative to enhance screw fixation strength.