Chang Ming-Chau, Liu Chien-Lin, Chen Tain-Hsiung
Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.
Spine (Phila Pa 1976). 2008 May 1;33(10):E317-24. doi: 10.1097/BRS.0b013e31816f6c73.
A retrospective study to evaluate the clinical results of patients with osteoporosis and various spinal diseases treated surgically with polymethylmethacrylate (PMMA) augmented pedicle screw.
To report a novel technique using PMMA for pedicle screw augmentation in osteoporotic spinal surgery.
Many studies have proved that the stiffness and strength of pedicle screw fixation can be significantly increased when the pedicle screw is augmented with various cements. However, most of those studies were experimental. Clinical reports using those materials for pedicle screw augmentation are rare and a practical and reliable technique for primary pedicle screw augmentation with cement has not yet been established.
Forty-one patients [23 female, 18 male, mean age 75.1 (50-90) years] with osteoporosis and various spinal diseases underwent spinal decompression and instrumentation with PMMA augmentation of pedicle screw. Pre-and postoperative scores for visual analogue scale for pain and Oswestry disability index questionnaire were analyzed. The screw migration, which is the distance from the screw tip to the anterior cortex and upper endplate of vertebra, was also evaluated immediately after the operation and at the mean 22.3 months final follow-up. RESULTS.: Totally 291 of 300 screws were augmented with PMMA. There was neither neurologic deterioration nor symptomatic cement leakage after surgery. The mean visual analogue scale pain score of these patients improved from 9.2 to 1.5 (P < 0.01) and the functional Oswestry disability index score improved from 77.5% to 44.2% (P < 0.01). Kyphotic deformity was improved from average 23.2 degrees to 11.9 degrees after surgery, and to 14.9 degrees at final follow-up (P < 0.01). The average loss of kyphosis correction was 3 degrees. There was no significant screw migration when the screws distances just after operation and at the final follow-up were compared (P > 0.01).
The presented technique of PMMA for augmentation of pedicle screw is a safe, reliable, and practical technique for osteoporotic patients who also had various spinal diseases and need spinal instrumentation.
一项回顾性研究，旨在评估采用聚甲基丙烯酸甲酯（PMMA）增强椎弓根螺钉手术治疗骨质疏松症及各种脊柱疾病患者的临床效果。
报告一种在骨质疏松性脊柱手术中使用PMMA进行椎弓根螺钉增强的新技术。
许多研究已证明，当用各种骨水泥增强椎弓根螺钉时，椎弓根螺钉固定的刚度和强度可显著提高。然而，这些研究大多是实验性的。使用这些材料进行椎弓根螺钉增强的临床报告很少，且尚未建立一种实用且可靠的骨水泥初次增强椎弓根螺钉的技术。
41例[23例女性，18例男性，平均年龄75.1（50 - 90）岁]患有骨质疏松症及各种脊柱疾病的患者接受了脊柱减压及PMMA增强椎弓根螺钉内固定术。分析术前和术后疼痛视觉模拟量表评分及Oswestry功能障碍指数问卷评分。还在术后即刻及平均22.3个月的最终随访时评估螺钉移位情况，即螺钉尖端至椎体前皮质和上端板的距离。结果：300枚螺钉中有291枚用PMMA进行了增强。术后既无神经功能恶化，也无症状性骨水泥渗漏。这些患者的平均疼痛视觉模拟量表评分从9.2改善至1.5（P < 0.01），功能Oswestry功能障碍指数评分从77.5%改善至44.2%（P < 0.01）。术后后凸畸形从平均23.2度改善至11.9度，最终随访时为14.9度（P < 0.01）。后凸畸形矫正的平均丢失为3度。比较术后即刻和最终随访时的螺钉距离，无明显螺钉移位（P > 0.01）。
所介绍的PMMA增强椎弓根螺钉技术对于患有各种脊柱疾病且需要脊柱内固定的骨质疏松症患者是一种安全、可靠且实用的技术。
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