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논문 기본 정보

자료유형
학술저널
저자정보
Tandon Vikas (Indian Spinal Injuries Center New Delhi India) Kalidindi Kalyan Kumar Varma (Indian Spinal Injuries Center New Delhi India) Pacha Sandesh (Indian Spinal Injuries Center New Delhi India) Bhat Mohd Rafiq (Indian Spinal Injuries Center New Delhi India)
저널정보
대한척추외과학회 Asian Spine Journal Asian Spine Journal Vol.14 No.3
발행연도
2020.1
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357 - 363 (7page)

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Study Design: Prospective case study.Purpose: Osteoporotic spine fixation by pedicle screw instrumentation is complicated by screw loosening, migration, or pullout with rates of up to 62% documented in the literature. Contemporary solutions have not adequately addressed these complications. We propose a modified surgical technique of cement augmentation with bicortical pedicle screw fixation to address the issue related to implant failure in osteoporotic spine.Overview of Literature: Zindrick and his colleagues described a “windshield wiper” effect owing to the shift of center of rotation to the distal tip of the screw in the bicortical purchase of screws. An increase in pullout strength from 119% to 250% with polymethyl methacrylate augmentation has been documented in the literature. This technique has not been described in the literature.Methods: A prospective study was conducted with 40 patients who underwent surgery by the modified technique. Intraoperative and postoperative complications directly related to the procedure were assessed. Improvement in pain and functional status were assessed. Follow-up radiographs were assessed to check for appreciable screw migration, loosening, or pullout.Results: This technique was used in inserting 364 screws in 40 patients. We did not encounter any difficulty in inserting the screws. A total of 19 screws failed to breach the anterior cortex owing to an error in measurement. There were no complications during the procedure in any of the patients, and the postoperative period was uneventful. The mean follow-up period was 18 months. There were two patients in whom proximal junctional failure with kyphosis was noted during follow-up, who were surgically managed by extension of the fixation levels.Conclusions: Bicortical fixation with cement augmentation is a technically feasible, safe, and effective technique to augment the strength of pedicle screws in osteoporotic spine fixation. It has the potential to be established as a standard of care in osteoporotic spine fixation.
#Osteoporosis surgery #Spine surgery #Pedicle screws #Bone cements #Surgical technique

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참고문헌 (18)

참고문헌 신청
Chin DK / 2007 / Prevalence of osteoporosis in patients requiring spine surgery : incidence and significance of osteoporosis in spine disease / Osteoporos Int 18:1219~1224 google schola Teng H / 2005 / Research progress in application of vertebral pedicle screw augmentation in treating osteoporotic spine / Chin J Trauma 21:392~394 google schola Halvorson TL / 1994 / Effects of bone mineral density on pedicle screw fixation / Spine 19:2415~2420 google schola Hu SS / 1997 / Internal fixation in the osteoporotic spine / Spine 22(24 Suppl):43S~48S google schola El Saman A / 2013 / Reduced loosening rate and loss of correction following posterior stabilization with or without PMMA augmentation of pedicle screws in vertebral fractures in the elderly / Eur J Trauma Emerg Surg 39:455~460 google schola

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