The Efficacy Of Cement-augmented Pedicle Screw In The Treatment Of Osteoporotic Spine Combined With Lumbar Degenerative Disease

Objective To investigate the efficacy of pedicle screw of cement augmentation in the surgery of osteoporotic patients combined with lumbar degenerative disease.Methods Retrospective analysis of 76 patients with osteoporosis and lumbar spine degeneration who underwent modified transforaminal lumbar interbody fusion(TLIF)in the Department of Spinal Surgery,Subei People’s Hospital,Jiangsu Province from January 2014 to December 2017 All cases were followed up.The follow-up period was 15～55(24.76±5.06)months,and the regular anti-osteoporosis drugs were used to treat osteoporosis.According to the pedicle screw for cement augmentation or not,divided into two groups:cement-augmented pedicle screw group,33 cases,8 males and 25 females,age 64.77±4.97 years old.bone marrow density(BMD)--3.39±0.48SD;Ordinary pedicle screw group,43 cases,13 males and 30 females,aged 64.77±4.97 years old.BMD-3.41 ± 0.45SD.The data of intraoperative blood loss,operation time,hospitalization time,and surgical complications were collected.Oswestry disability index(ODI)was used to evaluate clinical efficacy;visual analogue score(VAS)was used to evaluate status of low back pain,the Japanese Orthopaedic Association of low back pain evaluation score(JOA)to clarify the recovery of lumbar nerve function,which was measured before operation.6 months and 12 months after surgery.Through X-ray or CT examination,before operation,6 months and 12 months after surgery record the disc space height(DSH),the follow-up of 12 months after surgery determined the fusion rate of the two groups,the incidence of screw loosening.Measurement data subjecting to a normal distribution were compared between the two groups use an independent sample t test.The count data(gender,disease diagnosis type,fusion segment,screw loosening rate,and fusion rate)were analyzed by the Pearson chi-square.Level of significance for analyses was set at P<0.05.The relevant indicators were used to evaluate the clinical efficacy of cement augnented pedicle screw fixation for lumbar degenerative diseases with osteoporosis.Results All patients in this study were successfully operated.In the cement-augmented pedicle screw group,the average operation time was 156.36 ± 17.47 min,the intraoperative blood loss was 250.91±59.18 ml,and the average hospitalization time was 10.94±2.75 d.In the ordinary pedicle screw group.The operation time was 150.35 ± 19.09min.the intraoperative blood loss was 255.8l±56.53ml,and the average hospitalization time was 11.74±2.68d.The operative time in the cement-augmented pedicle screw group is longer than the ordinary pedicle screw group(P<0.05).There was no significant difference in average hospital stay,intraoperative blood loss.fusion segment and disease type between the two groups(P>0.05).All screws(132 pieces)in the cement-augmented pedicle screw group were augmented with bone cement.The amount of bone cement injected per screw was about 2 ml.There were 19 screw around the nail path(14.4%)have cement leakage.At 12 screws,the cement leaked to the paravertebral soft tissue,and 7 screws were leaked into the vertebral basilar vein.But cement leakage do not cause spinal cord or nerve compression after operation.During the follow-up,there were no complications such as spinal cord or nerve injury,postoperative infection,deep venous thrombosis and pulmonary embolisn.The VAS score,ODI score and JOA score of the two groups at 6 months and 12 months after surgery were significantly improved compared with the preoperative indexes(P<0.05).There was no significant difference in VAS score,ODI index and JOA score at preoperative and 6 months after surgery,but the VAS score,ODI score and JOA score of the cement-augmented pedicle screw group were better than the ordinary pedicle screw group at 12 months after surgery.Statistical significance(F<0.05).DSH was measured before operation and the at 12 months after surgery.The DSH at 12 months after surgery was significantly different from that before operation(P<0.05),but the amount of DSH lost in 12 months after surgery of the cement-augmented pedicle screw group was less than the ordinary pedicle screw group,the difference was statistically significant(P<0.05).No screw loosening was found in the cement-augmented pedicle screw group.Twenty-eight(16.3%,28/172)screws in the ordinary pedicle screw group were loosened,and the difference were statistically significant(P=0.02)Two case(3.0%,1/33)unfused cases was found in the cement-augmented pedicle screw group There were 3 cases(7.0%,3/43)unfused cases in the ordinary pedicle screw group.But there was no statistically significant difference between the two groups(P>0.05)Conclusion In the treatnent of lumbar degenerative diseases with osteoporosis,on the basis of regular anti-osteoporosis,bone cement-augmented pedicle screw fixation and interbody fusion can obtain good clinical results,compared to ordinary pedicle screw fixation,it has a longer operative time,but a lower screw loosening rate and more reliable spine stability.