Two different procedures of bone cement augmentation with pedicle screw fixation for treatment of osteoporotic elderly patients with degenerative lumbar diseases

PAN Wei; LI Bo; OUYANG Beiping; JIAN Yuekui

doi:10.3969/j.issn.1674-666X.2024.02.003

Abstract：Objective To compare short-term effects of two different surgical techniques of bone cement augmentation with pedicle screw fixation for treatment of osteoporotic elderly patients with degenerative lumbar diseases,and to explore the effects of two bone cement augmentation procedures on adjacent segment degeneration.Methods Clinical data of 60 osteoporotic elderly patients with degenerative lumbar diseases treated by posterior lumbar fusion from October 2013 to October 2016 in Guizhou Orthopedic Hospital were retrospectively analyzed.According to different procedures,patients were divided into group A(conventional pedicle screw),Group B(bone cement augmentation with fenestrated pedicle screw)and Group C(bone cement augmentation with conventional pedicle screw),with 20 patients in each group.Oswestry disability index(ODI),Japanese Orthopaedic Association(JOA)score,intervertebral height(IH),deformation index(DI),concave angle of the fixed lumbar vertebral upper endplate(CAVUE)and the upper adjacent vertebral body inferior endplate(CAVIE),as well as Cobb angle of the fixed segment were measured at preoperation,30 days after operation and the final follow-up,and compared among three groups.Results The patients were followed up for 6-30 months,with average of 21 months.Internal fixation position of all cases was good,and no loosening,fracture or slip occurred within the follow-up period.There were 4 cases of bone cement leakage in group B and 5 cases of bone cement leakage in group C.Postoperative CT and 3D reconstruction showed that in group B,bone cement augmentaion focused on vertebral body,while little reinforcement was found in vertebral pedicle,while in group C,there presented certain augmentation effects in all vertebral bodies and pedicles.ODI and JOA score of the three groups at the latest follow-up were improved compared with those before the operation(P<0.05),but there were no statistical differences among the three groups(P>0.05).At the final follow-up,IH in the three groups were decreased than those at preoperation and 30 days after operation,furthermore,IH and DI in group B and group C were smaller than that in group A,the differences had statistical significances(P<0.05),but there was no statistical difference between group B and group C(P>0.05).At 30 d postoperatively and final follow-up,CAVUE was increased and CAVIE was decreased compared with preoperative ones,and CAVUE were larger,and CAVIE were smaller in group B and group C than those in group A(P<0.05),while there were no significant differences between group B and group C(P>0.05).Changes of Cobb angle in group B and group C were smaller than those in group A at 30 d postoperatively and the last follow-up(P<0.05),but there was no statistical difference between group B and group C(P>0.05).Conclusions For osteoporotic elderly patients with degenerative lumbar diseases,pedicle screw fixation can effectively relieve the clinical symptoms and improve the quality of life of patients.Compared with the conventional pedicle screw fixation,both two bone cement augmentation procedures could maintain the stability of postoperative osteoporotic vertebral body better,but at the same time,attention should be paid to the problems in complications of bone cement leakage,as well as the stress concentration and degeneration acceleration of adjacent segment.