Surgical Treatment of Osteoporotic Vertebral Compression Fractures at Thoraco-Lumbar Levels: Only Pedicle Screw Constructs with Polymethylmethacrylate Augmentation

Deuk Soo Jun; Jong-Min Baik; Ji Hyeon Park

doi:10.4055/jkoa.2019.54.4.327

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Jun, Baik, and Park: Surgical Treatment of Osteoporotic Vertebral Compression Fractures at Thoraco-Lumbar Levels: Only Pedicle Screw Constructs with Polymethylmethacrylate Augmentation

Original Article

Journal of the Korean Orthopaedic Association 2019; 54(4): 327-335.

Published online: 21 August 2019

DOI: https://doi.org/10.4055/jkoa.2019.54.4.327

Surgical Treatment of Osteoporotic Vertebral Compression Fractures at Thoraco-Lumbar Levels: Only Pedicle Screw Constructs with Polymethylmethacrylate Augmentation

Deuk Soo Jun, M.D., Ph.D., Jong-Min Baik, M.D.

, Ji Hyeon Park, M.D.

Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon, Korea.

Correspondence to: Jong-Min Baik, M.D. Department of Orthopedic Surgery, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea. TEL: +82-32-460-3384, FAX: +82-32-460-3114, bbaik@hanmail.net

Received 18 September 2018 Revised 24 October 2018 Accepted 12 November 2018

The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the radiological efficacy of polymethylmethacrylate (PMMA) augmentation of pedicle screw operation in osteoporotic vertebral compression fractures (OVCF) patients.

Materials and Methods

Twenty OVCF patients, who underwent only posterior fusion using pedicle screws with PMMA augmentation, were included in the study. The mean follow-up period was 15.6 months. The demographic data, bone mineral density (BMD), fusion segments, number of pedicle screws, and amount of PMMA were reviewed as medical records. To analyze the radiological outcomes, the radiologic parameters were measured as the time serial follow-up (preoperation, immediately postoperation, postoperation 6 weeks, 3, 6 months, and 1 year follow-up).

Results

A total of 20 patients were examined (16 females [80.0%]; mean age, 69.1±8.9 years). The average BMD was −2.5±0.9 g/cm². The average cement volume per vertebral body was 6.3 ml. The mean preoperative Cobb angle of focal kyphosis was 32.7°±7.0° and was improved significantly to 8.7°±6.9° postoperatively (p<0.001), with maintenance of the correction at the serial follow-up, postoperatively. The Cobb angle of instrumented kyphosis, wedge angle, and sagittal index showed similar patterns. In addition, the anterior part of fractured vertebral body height averaged 11.0±5.0 mm and was improved to 18.5±5.7 mm postoperatively (p=0.006), with maintenance of the improvement at the 3-month, 6-month, and 1-year follow-up.

Conclusion

The reinforcement of pedicle screws using PMMA augmentation may be a feasible surgical technique for OVCF. Moreover, it appears to be appropriate for improving the focal thoracolumbar/lumbar kyphosis and is maintained well after surgery.

Keywords: osteoporosis, vertebral compression fracture, posterior pedicle screw fixation, polymethylmethacrylate augmentation

Figures and Tables

Figure 1

Evaluation of the radiographic parameters. (A) Kyphosis angle (dotted lines): Most kyphotic Cobb's angle including fractured vertebra (°), instrumented angle (solid lines): Cobb's angle of instrumented vertebra (°). (B) Wedge angle: Angle of fractured vertebra between upper and lower endplate (°). (C) Sagittal index: Sagittal index of fractured vertebra (°). (D) Anterior fractured vertebra body height (mm).

Figure 2

Results of the radiologic parameters. Values related to the radiologic angle show the same trend (^*p=0.006; ^†p<0.001). Pre, preoperation; Imm, immediately; POP, postoperation.

Figure 3

Case number 20; the patient was male and 80 years old. He was diagnosed with a compression fracture L3 by low-energy trauma and a spine T score −1.9 on dual-energy X-ray absorptiometry. (A) The kyphosis angle (solid lines) of L3 was measured to be 26° and anterior body height (dotted line) was observed to 15.2 mm, preoperatively. (B) Immediately after surgery, these values were measured to be 5° and 25.8 mm, respectively. (C) Kyphosis angle, 6°; anterior body height, 25.3 mm at 1 year, postoperatively.

Table 1

Demographics of All Patients

BMD, bone mineral density; F, female; M, male.

Table 2

Radiologic Parameters of All Patients

Pre, preoperation; Imm, immediately; POP, postoperation.

Table 3

Radiologic Parameters; Vertebral Body Height (Anterior Part) (mm)

Pre, preoperation; Imm, immediately; POP, postoperation.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

References

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ORCID iDs: Jong-Min Baik
https://orcid.org/0000-0002-6646-2449
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Surgical Treatment of Osteoporotic Vertebral Compression Fractures at Thoraco-Lumbar Levels: Only Pedicle Screw Constructs with Polymethylmethacrylate Augmentation

Abstract

Purpose

Materials and Methods

Results

Conclusion

Figures and Tables

Figure 1

Figure 2

Results of the radiologic parameters. Values related to the radiologic angle show the same trend (*p=0.006; †p<0.001). Pre, preoperation; Imm, immediately; POP, postoperation.

Figure 3

Table 1

Demographics of All Patients

Table 2

Radiologic Parameters of All Patients

Table 3

Radiologic Parameters; Vertebral Body Height (Anterior Part) (mm)

Notes

References

Results of the radiologic parameters. Values related to the radiologic angle show the same trend (^*p=0.006; ^†p<0.001). Pre, preoperation; Imm, immediately; POP, postoperation.