Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2012 Dec;19(4):131-137. Korean.
    Published online Dec 31, 2012.
    https://doi.org/10.4184/jkss.2012.19.4.131
    © Copyright 2012 Korean Society of Spine Surgery
    Original Article

    A Clinical Result of Pedicle Screw Fixation in Osteoporotic Spine - Complications and Prevention -

    Eung-Ha Kim, M.D., Hyun-Seok Song, M.D. and Chang-Geun Kim, M.D.
      • Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
    • Corresponding author: Eung-Ha Kim, M.D. Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, 1174 Jung-Dong, Wonmi-Gu, Bucheon-Si, Gyeonggi-Do, 420-767, Korea. TEL: 82-32-621-5259, FAX: 82-32-324-9577, Email: eungha@unitel.co.kr
    Received August 28, 2012; Revised November 27, 2012; Accepted December 10, 2012.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Study Design

    Retrospective study.

    Objectives

    To analyze the clinical results of patients who were treated by pedicle screw fixation in osteoporotic spine and suggest the methods for preventing a loss of fixation strength.

    Summary of the Literature Review

    There are some methods to decrease failure rate and increase fixation strength in the osteoporotic spine: use bicortical screw, cement augmentation and supporting anterior column by interbody fusion using cages.

    Materials and Methods

    Forty-four patients treated by spinal instrumentation using pedicle screw from 2004 to 2011 were followed for at least 12 months. Five men and 39 women were diagnosed as osteoporotic spine (T score <-3.0). Two hundred forty eight pedicle screws were included and statistically analyzed the correlation between the use of bicortical screw, cement augmentation, anterior column support and fixation loss of the pedicle screw. Radiologic results were evaluated to find out the mechanical complications, like loosening of the screw, fixation failure, and nonunion.

    Results

    There were 9 complications associated with mechanical strength, loosening of pedicle screws in 7, sinking down of cage in 4, and nonunion in 4 cases. Using bicortical pedicle screw, cement augmentation and anterior column support were significantly correlated with the increasing fixation strength (P=0.001, P=0.047, P=0.014). In addition, these three factors contribute to stabilize the instrumentation (Linear by linear association, P=0.012).

    Conclusions

    These 3 methods, using bicortical pedicle screw, cement augmentation and supporting anterior column, are effective to enhance the fixation strength and prevent loss of holding power in the osteoporotic spine.

    Keywords
    Osteoporosis; Pedicle screw; Fixation strength

    Figures

    Fig. 1
    Axial CT scan shows bicortical screw fixation purchasing through anterior cortex of vertebral body.

    Fig. 2
    Relationship between the numbers of cases and combined methods.

    Fig. 3
    (A) A 73 year-old woman underwent interbody fusion at L4-5 level in another hospital. (B) Bilateral foraminal stenosis and spinal canal narrowing occurred at L3-4 level. (C) We performed posterior lumbar interbody fusion using cages and pedicle screws at L3-4 level. (D, E) After 8 months, fixation loss of screw occurred at the left side of L3 pedicle. (F) Revisional surgery was performed using bicortical long pedicle screws.

    Tables

    Table 1
    Complications associated with mechanical strength.

    Table 2
    Data shows the relationship between screw loosening and methods of fixation.

    References

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    MeSH Terms
    Female
    Humans
    Male
    Osteoporosis
    Retrospective Studies
    Spine
    Metrics
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