Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea.
Spine J. 2021 Nov;21(11):1857-1865. doi: 10.1016/j.spinee.2021.05.005. Epub 2021 May 13.
There are few studies of the radio-clinical outcomes of cement-augmented cannulated pedicle screw (CPS) fixation in osteoporotic patients.
To compare the radiological and clinical outcomes between groups receiving cement-augmented CPS and solid pedicle screws (SPS) in lumbar fusion surgery.
STUDY DESIGN/SETTING: Retrospective comparative study PATIENT SAMPLE: A total of 187 patients who underwent lumbar fusion surgery for degenerative spinal stenosis or spondylolisthesis from 2014 to 2019.
Radiological evaluation included screw failure, cage failure, rod breakage, and fusion grade at postoperative 6 months and 1 year. Pre- and postoperative visual analog scales for back pain (VAS-BP), leg pain (VAS-LP), Korean Oswestry disability index (K-ODI), and postoperative complications were also compared.
Outcomes of patients with high risk factors for implant failure [old age, osteoporosis, autoimmune disease or chronic kidney disease (CKD)] who underwent open transforaminal lumbar interbody fusion with cement-augmented CPS fixation (Group C, n=55) or SPS fixation (Group S, n=132) were compared.
324 pedicle screws in Group C and 775 pedicle screws in Group S were analyzed. Group C had a significantly higher average age and lower T-score, and included more patients with autoimmune disease and CKD than group S (all p<.05). Clear zones, screw migration and loss of correction were significantly less frequent in Group C (all p<.05). Thirteen screw breakages were observed; they were only in Group C (4.0%) and all were in the proximal of the two holes. Interbody and posterolateral fusion rates were not significantly different. At last follow-up, all clinical parameters including VAS-BP, VAS-LP, and K-ODI scores had improved significantly in both groups. Postoperative complications were not significantly different in the two groups.
In lumbar fusion surgery, using cement-augmented CPS in high-risk groups for implant failure could be a useful technical option for reducing acute radiological complications and obtaining clinical results comparable to those obtained using SPS in patients with low risk of implant failure.
Level 4.
骨质疏松患者骨水泥增强型空心椎弓根螺钉（CPS）固定的放射临床结果研究较少。
比较骨水泥增强型 CPS 与实心椎弓根螺钉（SPS）在腰椎融合术中的放射学和临床结果。
研究设计/设置：回顾性比较研究
2014 年至 2019 年，187 例因退行性脊柱狭窄或脊椎滑脱行腰椎融合术的患者。
影像学评估包括术后 6 个月和 1 年时螺钉失败、 cage 失败、棒断裂和融合等级。还比较了术前和术后腰背疼痛视觉模拟评分（VAS-BP）、腿痛视觉模拟评分（VAS-LP）、韩国 Oswestry 残疾指数（K-ODI）以及术后并发症。
对有植入物失败高风险因素（高龄、骨质疏松症、自身免疫性疾病或慢性肾脏病（CKD））的患者，采用开放经椎间孔腰椎体间融合术，骨水泥增强型 CPS 固定（C 组，n=55）或 SPS 固定（S 组，n=132）。
C 组 324 枚椎弓根螺钉，S 组 775 枚椎弓根螺钉。C 组平均年龄较高，T 评分较低，自身免疫性疾病和 CKD 患者多于 S 组（均 P<.05）。C 组的透明带、螺钉迁移和矫正丢失明显较少（均 P<.05）。共观察到 13 例螺钉断裂，仅发生在 C 组（4.0%），且均在两个孔的近端。椎间融合和后外侧融合率无明显差异。末次随访时，两组的所有临床参数，包括 VAS-BP、VAS-LP 和 K-ODI 评分，均显著改善。两组术后并发症无显著差异。
在腰椎融合术中，对于植入物失败高风险的患者，使用骨水泥增强型 CPS 可能是一种减少急性放射学并发症并获得与低植入物失败风险患者使用 SPS 获得的临床结果相当的有用技术选择。
4 级。
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