Clinical Safety And Effectiveness Of Pre-filling Cement Augmented Technique With Solid Pedicle Screw Fixation In The Patients With Spinal Degeneration And Osteoporosis

Background context:Cement augmented pedicle screw fixation(CAPSF)appears to be an effective method for enhancing pedicle screw fixation in osteoporotic patients and spine disease?However,paucity study focuses on effectiveness and complications of pre-filling cement augmented technique with solid pedicle screw fixation in the patients with spinal degeneration and osteoporosis.Objective:The purpose of this study to evaluate the clinical safety and effectiveness of pre-filling cement augmented technique with solid pedicle screw fixation in the treatment of patients with spinal degenerative diseases associated with osteoporosis.Methods:A retrospective study with prospective outcome was done from July 2012 to October 2017,Total of 74 patients with spinal degenerative diseases and osteoporosis who underwent spinal fixation surgery,admitted to the Department of Orthopedics at the Second Afiliated Hospital of Kunming Medical University.All the patients were divided into Group A and Group B.The mean age of the patients were 64.1±10.3 years(range 49.78 years)and 62.7±11.536 years(range 50-76 years),respectively.36 patients with osteoporosis in group A were treated with cement augmented solid pedicle screw fixation technology as the observation group.38 Patients were treated in group B were not accompanied by osteoporosis disease,using the traditional screw technique,as a control group.The two groups of patients had the same surgical methods such as decompression and fusion.The intraoperative and postoperative complications of the two groups were compared.The VAS?ODI and SF-36 were compared at preoperative,postoperative,and at the last follow-up.The complications related to cement distribution patterns in the vertebra,cement leakage,pulmonary cement embolism was also investigated.Radiologic findings were documented through computed tomography(CT)and plain X-ray films.Result:Both groups were followed up satisfactorily,the average follow-up time of the 2 groups were(22±6.4)months.In group A,279 screws were fixed in 36(36/74,48.6%)patients with an average screw of(7.8±3.8).Among 279 screws,195(69.8%)screw with an average of(5.4±2.7)augmented with PMMA cement prefilling solid pedicle screws fixation in 101 vertebral bodies.53 out of 101 vertebrae were detected with cement leakage.The incidence of cement leakage was 52.4%(53/101).In group B,38(51.3%)patients,210 traditional pedicle screws with an average screw of(5.5±3.2)without cement augmentation,underwent spinal fixation despite osteoporosis.At the last follow-up,the VAS,ODI,and SF-36 scores of the two groups were significantly improved compared with those before surgery.There was no statically significant difference between the two groups.In group A,11 out of 36 patients were detected with asymptomatic pulmonary cement embolism.The incidence of pulmonary cement embolism was 30.5%(11/36)and 2 patients were detected with cement leakage in the spinal canal intraoperative.Conclusion:Pre-filling cement augmented technique with solid pedicle screw fixation is an effective procedure for the treatment of patients with spinal degenerative diseases associated with osteoporosis,but it also has a high incidence of cement leakage(CL)and pulmonary cement embolism(PCE).It is necessary to prevent the complication during surgery.