Augmentation of Pedicle Screws Using Bone Grafting in Patients with Spinal Osteoporosis
| Autor: | S.Ya. Kalinina, A. E. Bokov, S. G. Mlyavykh, D. G. Anderson, I.S. Bratsev, A. A. Bulkin |
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| Rok vydání: | 2021 |
| Předmět: |
Bone Transplantation
Lumbar Vertebrae Polymethyl methacrylate business.industry medicine.medical_treatment Osteoporosis Dentistry General Medicine Bone grafting Bone cement medicine.disease General Biochemistry Genetics and Molecular Biology Spinal Fusion Pedicle Screws medicine Low bone density Humans In patient Prospective Studies Pedicle screw fixation business Pedicle screw |
| Zdroj: | Sovremennye tehnologii v medicine. 13:6 |
| ISSN: | 2076-4243 |
| Popis: | This prospective non-randomized study included 164 patients with degenerative pathologies or traumatic injuries of the lumbar spine and transitional thoracolumbar segments; 153 of the operated patients were followed up for 18 months. In these patients, radiodensity of the cancellous bone tissue was below 110 HU by the Hounsfield scale. Patients with degenerative spinal disorders underwent pedicle screw fixation using transforaminal interbody fusion; patients with traumatic spinal injuries underwent intermediate pedicle screw fixation, and those with a loss of vertebral body height by50% underwent anterior fusion.The patients were divided into three groups: in group 1 (n=39), bone tissue augmentation was performed using PMMA; in group 2 (n=21), augmentation was done with bone chips; in group 3 (n=93), no augmentation was performed (control group). The follow-up period was 12 months; cases with fixator breakage or loosening were recorded.After augmentation with PMMA, 11 cases (28.2%) of fixator destabilization were detected. With bone chips, fixator instability developed in 2 patients (9.5%) only, whereas in patients operated without augmentation, the instability was observed in 43 cases (46.2%). With PMMA augmentation, the incidence rate of fixator destabilization did not significantly differ from that in the control group (p=0.0801), while the use of bone chips resulted in a statistically significant decrease of this index compared to the control group (p=0.0023). A logistic regression analysis confirmed the superiority of the developed method over the PMMA-based vertebral augmentation.The use of bone chips for vertebral augmentation provides a statistically significant decrease in the incidence of pedicle screw fixator destabilization in the post-operative period. By reducing the risk of proximal loosening and eliminating the risk of bone cement drainage into the spinal canal and vascular bed, the proposed method may become especially effective in patients with impaired bone density. |
| Databáze: | OpenAIRE |
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