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Mo GY, Zhou TP, Guo HZ, Li YX, Tang YC, Guo DQ, Luo PJ, Li DX, Yuan K, Mo L, Zhang SC. Long-term efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell disease. Sci Rep 2021; 11:13647. [PMID: 34211025 PMCID: PMC8249396 DOI: 10.1038/s41598-021-93013-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 06/14/2021] [Indexed: 01/13/2023] Open
Abstract
This study aimed to evaluate the efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell disease. Twenty-five patients with stage III Kümmell disease who received bone cement-augmented pedicle screw fixation at the First Affiliated Hospital of Guangzhou University of Chinese Medicine between June 2009 and December 2015 were enrolled. All patients were females with a history of osteoporosis. The vertebral Cobb angle (V-Cobb angle), the fixed segment Cobb Angle (S-Cobb angle), pelvic parameters, visual Analogue Scale (VAS) score, and Oswestry Disability Index (ODI) were assessed preoperatively, postoperatively and at the final follow-up. Complications, loosening rate, operation time, and intraoperative bleeding were recorded. The average lumbar vertebral density T-value was − 3.68 ± 0.71 SD, and the average age was 71.84 ± 5.39. The V-Cobb angle, S-Cobb angle, and Sagittal Vertical Axis (SVA) were significantly smaller postoperatively compared to the preoperative values. The VAS and ODI at 1 month after surgery were 3.60 ± 1.00 and 36.04 ± 6.12%, respectively, which were both significantly lower than before surgery (VAS: 8.56 ± 1.04, ODI: 77.80 ± 6.57%). Bone cement-augmented pedicle screw fixation is a safe and effective treatment for stage III Kümmell disease. It can effectively correct kyphosis, restore and maintain sagittal balance, and maintain spinal stability.
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Affiliation(s)
- Guo-Ye Mo
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Teng-Peng Zhou
- Guangdong Second Traditional Chinese Medicine Hospital, 60 Hengfu Road, Yuexiu District, Guangzhou, 510000, Guangdong, China
| | - Hui-Zhi Guo
- The First Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Yong-Xian Li
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Yong-Chao Tang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Dan-Qing Guo
- The First Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Pei-Jie Luo
- The First Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Dong-Xiao Li
- The First Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Kai Yuan
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Ling Mo
- The First Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Shun-Cong Zhang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
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Tang YC, Guo HZ, Guo DQ, Luo PJ, Li YX, Mo GY, Ma YH, Peng JC, Liang D, Zhang SC. Effect and potential risks of using multilevel cement-augmented pedicle screw fixation in osteoporotic spine with lumbar degenerative disease. BMC Musculoskelet Disord 2020; 21:274. [PMID: 32345282 PMCID: PMC7189525 DOI: 10.1186/s12891-020-03309-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background The increase of augmented level and bone cement dose are accompanied by the rising incidence of cement leakage (CL) of cement-augmented pedicle screw instrumentation (CAPSI). But the effect and potential risks of the application of CAPSI to osteoporotic lumbar degenerative disease (LDD) have not been studied in the case of multilevel fixation. This study aimed to investigate the effectiveness and potential complications of using multilevel CAPSI for patients with osteoporotic LDD. Methods A total of 93 patients with multilevel LDD were divided into the CAPSI group (46 subjects) and the conventional pedicle screw (CPS) group (47 subjects), including 75 cases for three levels and 18 cases for four levels. Relevant data were compared between two groups, including baseline data, clinical results, and complications. Results In the CAPSI group, a total of 336 augmented screws was placed bilaterally. The CL was observed in 116 screws (34.52%). Three cemented screws (0.89%) were found loosened during the follow-up and the overall fusion rate was 93.47%. For perioperative complications, two patients (4.35%) experienced pulmonary cement embolism (PCE), one patient augmented vertebral fracture, and three patients (6.52%) wound infection. And in the CPS group, thirty-three screws (8.46%) suffered loosening in cranial and caudal vertebra with a fusion rate of 91.49%. The operation time and hospital stay of CAPSI group were longer than the CPS group, but CAPSI group has a lower screw loosening percentage (P<0. 05). And in terms of blood loss, perioperative complications, fusion rate, and VAS and ODI scores at the follow-up times, there were no significant differences between the two groups. Conclusions Patients with osteoporotic LDD underwent multilevel CPS fixation have a higher rate of screw loosening in the cranial and caudal vertebra. The application of cemented pedicle screws for multilevel LDD can achieve better stability and less screw loosening, but it also accompanied by longer operating time, higher incidence of CL, PCE and wound infections. Selective cement augmentation of cranial and caudal pedicle screws may be a worthy strategy to decrease the complications.
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Affiliation(s)
- Yong-Chao Tang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Hui-Zhi Guo
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Dan-Qing Guo
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Pei-Jie Luo
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Yong-Xian Li
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Guo-Ye Mo
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Yan-Huai Ma
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Jian-Cheng Peng
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - De Liang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Shun-Cong Zhang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China. .,The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China.
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Guo HZ, Tang YC, Guo DQ, Luo PJ, Li YX, Mo GY, Ma YH, Peng JC, Liang D, Zhang SC. Stability Evaluation of Oblique Lumbar Interbody Fusion Constructs with Various Fixation Options: A Finite Element Analysis Based on Three-Dimensional Scanning Models. World Neurosurg 2020; 138:e530-e538. [PMID: 32156592 DOI: 10.1016/j.wneu.2020.02.180] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known about the biomechanical performance of various fixation constructs after oblique lumbar interbody fusion (OLIF). This study aimed to explore the stability of various fixation options for OLIF by using finite element analysis based on three-dimensional scanning models. METHODS Six validated finite element models of the L3-L5 segment were reconstructed via computed tomography images, including (1) intact model, (2) stand-alone model with no instrument, (3) lateral rod-screw model, (4) lateral rod-screw plus contralateral translaminar facet screw (LRS-CTLFS) model, (5) unilateral pedicle screw model, and (6) bilateral pedicle screw (BPS) model. Models of the OLIF cage and pedicle screw were created with three-dimensional scanning to improve the accuracy of finite element analysis. Range of motion, stress of the cage, and stress of fixation were evaluated in the different models. RESULTS Range of motion increased from least to greatest as follows: BPS, LRS-CTLFS, unilateral pedicle screw, lateral rod-screw, stand-alone. Differences in range of motion between BPS and LRS-CTLFS were not significant for all loading cases. Compared with the other 3 models, the stress of the cage was found to be lower in BPS and LRS-CTLFS under all loading conditions, especially in BPS. Stress exerted on the fixation was the greatest in LRS-CTLFS, and the stress experienced by the translaminar facet screw was concentrated in part of the facet joint. CONCLUSIONS The BPS model provided the best biomechanical stability for OLIF; the stand-alone model could not provide sufficient stability. The LRS-CTLFS procedure increases the approximate stability and reduces stress at the cage-endplate interface; however, it causes an increase in screw stress.
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Affiliation(s)
- Hui-Zhi Guo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China; Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong-Chao Tang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dan-Qing Guo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China
| | - Pei-Jie Luo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China
| | - Yong-Xian Li
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China
| | - Guo-Ye Mo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China
| | - Yan-Huai Ma
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China
| | - Jian-Cheng Peng
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China
| | - De Liang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shun-Cong Zhang
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China; Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Guo DQ, Yu M, Zhang SC, Tang YC, Tian Y, Li DX, Mo GY, Li YX, Guo HZ, Luo PJ, Zhou TP, Ma YH, Abdukodir Y, Liu PJ, Liang D. Novel Surgical Strategy for Treating Osteoporotic Vertebral Fractures with Cord Compression. Orthop Surg 2019; 11:1082-1092. [PMID: 31750626 PMCID: PMC6904606 DOI: 10.1111/os.12558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/02/2019] [Accepted: 09/18/2019] [Indexed: 12/27/2022] Open
Abstract
Objectives Treatment for osteoporotic vertebral fracture (OVF) with cord compression is challenging and it usually requires surgical interventions to decompress nerves and restore spinal sequences. To describe a novel surgical strategy for treating OVFs with cord compression. Methods This is a single‐center retrospective analysis. The inclusion criteria were Frankel grade C‐E, single level T10‐L2. Between January 2008 and December 2016, a total of 56 OVF patients (47 females and nine males, with an average age of 72 years (66–88 years), comprising of eight grade C, 23 grade D, and 25 grade E patients) were enrolled. The treatment algorithm included preoperative evaluation by MRI, extension CT, and radiography to classify the OVFs as type 1.1 (reducible, stable; n = 13), type1.2 (reducible, unstable; n = 16), type 2 (irreducible; n = 19) or type 2M (modifier; n = 8). Vertebroplasty (VP)/kyphoplasty (KP) was applied in type 1.1. VP/KP with posterior fixation and posterolateral fusion was applied in type 1.2. And additional laminectomy/osteotomy was used in type 2, except in a modifier group (2M) where same procedure as applied for type 1.2 was used. VAS, ODI, Cobb angle, Frankel functional grade, and complications were recorded. Results Thirteen cases were classified as type 1.1, 16 cases as type 1.2, 19 cases as type 2, and eight cases as type 2M. The follow‐up period was 38.9 months (range, 24–108 months). All patients were followed‐up in at least 24 months, in which time four patients died, two patients were lost at the last follow‐up, and 50 patients completed the full study. The total VAS and ODI improved from 8 (7, 9) and 75.5% (67.2%, 80.0%) preoperatively to 2 (1, 3) and 31% (24.0%, 37.0%) on conclusion, respectively (P < 0.01). The local kyphotic angle was corrected from 22.3° (17.1°, 33. 8°) preoperatively to 10.4° (6.4°, 15.3°) on conclusion (P < 0.01). Twenty‐three patients had achieved neurological recovery on conclusion (42E, 8D, P < 0.01). Asymptotic cement leakage was observed in 17/56 cases (30.4%), 6/56 in the affected vertebra (10.7%), and 24/330 in the screw trajectory (7.3%). At 2 years postoperatively, 11 new VFs had occurred in nine patients (16.1%), including VFs in nine adjacent segments that all occurred within 1 year after surgery. No cement migration or implant failure was noted. Conclusion The novel surgical strategy for treating OVFs with cord compression consists of the most tailored and least invasive treatment for each patient. The positive mid‐ and long‐term clinical and radiological outcomes observed could represent a step forward in devising the proposed algorithm.
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Affiliation(s)
- Dan-Qing Guo
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Miao Yu
- Spine Surgery Department, Foshan Hospital of Chinese Medicine, Foshan, China
| | - Shun-Cong Zhang
- Spine Surgery Department, 1st Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong-Chao Tang
- Spine Surgery Department, 1st Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yun Tian
- Orthopaedic Department, Pecking University 3rd Hospital, Beijing, China
| | - Da-Xing Li
- Orthopaedic Department, Orthopaedic Hospital of Guizhou Province, Guiyang, China
| | - Guo-Ye Mo
- Spine Surgery Department, 1st Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong-Xian Li
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hui-Zhi Guo
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Pei-Jie Luo
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Teng-Peng Zhou
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan-Huai Ma
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yusupov Abdukodir
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Pan-Jie Liu
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - De Liang
- Spine Surgery Department, 1st Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Luo PJ, Tang YC, Zhou TP, Guo HZ, Guo DQ, Mo GY, Ma YH, Liu PJ, Zhang SC, Liang D. Risk Factor Analysis of the Incidence of Subsequent Adjacent Vertebral Fracture After Lumbar Spinal Fusion Surgery with Instrumentation. World Neurosurg 2019; 135:e87-e93. [PMID: 31715415 DOI: 10.1016/j.wneu.2019.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to evaluate the risk factors for adjacent vertebral compression fractures after lumbar spinal fusion with instrumentation. METHODS A total of 669 patients who received lumbar instrumented spinal fusion between January 2012 and December 2015 were divided into 2 groups according to whether the adjacent vertebral body was fractured. The covariates recorded were age, sex, bone mineral density, and the number of fixed segments. The anatomic variables were pelvic incidence angle (PI), preoperative lumbar lordosis angle (Pre-LL), postoperative lumbar lordosis angle (Post-LL), Pre-LL minus Post-LL (Loss of LL), postoperative pelvic tilt (Post-PT), postoperative sacral slope, Pre-PI-LL mismatch (Pre-PI minus Pre-LL), and Post-PI-LL mismatch (Post-PI minus Post-LL). A 1-way analysis of variance (ANOVA) was performed with the aforementioned parameters, and binary logistic regression analysis was used to determine the relative risk factors. RESULTS The 669 patients were followed-up for a mean of 2.7 ± 1.1 years (range, 2-4 years). Twenty-seven patients demonstrated fractures in the adjacent vertebral body after surgery. Analysis by 1-way ANOVA demonstrated that age, PI, Pre-LL, Post-LL, Loss of LL, Post-PI-LL mismatch, Post-PT, and osteoporosis were potential risk factors (all parameters, P < 0.001). Furthermore, binary logistic regression analysis showed that a large Loss of LL, osteoporosis, and old age were also risk factors for adjacent vertebral compression fractures. CONCLUSIONS A greater Loss of LL, osteoporosis, and advanced age may be risk factors for fractures in the adjacent vertebral body of the fixed segment after lumbar fusion fixation.
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Affiliation(s)
- Pei-Jie Luo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Baiyun District, Guangdong, China; The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong-Chao Tang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Teng-Peng Zhou
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Baiyun District, Guangdong, China; The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hui-Zhi Guo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Baiyun District, Guangdong, China; The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dan-Qing Guo
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guo-Ye Mo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Baiyun District, Guangdong, China; The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan-Huai Ma
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Baiyun District, Guangdong, China; The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Pan-Jie Liu
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Baiyun District, Guangdong, China; The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shun-Cong Zhang
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Baiyun District, Guangdong, China; The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - De Liang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Mo GY, Guo HZ, Guo DQ, Tang YC, Li YX, Yuan K, Luo PJ, Zhou TP, Zhang SC, Liang D. Augmented pedicle trajectory applied on the osteoporotic spine with lumbar degenerative disease: mid-term outcome. J Orthop Surg Res 2019; 14:170. [PMID: 31171020 PMCID: PMC6555715 DOI: 10.1186/s13018-019-1213-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/22/2019] [Indexed: 01/24/2023] Open
Abstract
Purpose To compare the safety and efficiency of cement-augmented pedicle screw with traditional pedicle screw technique applied on the patients in the osteoporotic spine with lumbar degenerative diseases. Methods Fifty-six patients followed up at least 2 years were enrolled in our institute with retrospectively reviewed from January 2009 to June 2014, diagnosed as lumbar spondylolisthesis, or lumbar stenosis, with T score ≤− 2.5 SD of BMD, and received less than three-segment PLIF or TLIF. All patients were divided into 2 groups: 28 (2 males, 26 females) in polymethylmethacrylate-augmented pedicle screw group (PSA) group, the other 28 (3 males, 25 females) in traditional pedicle screw group (TPS). Surgical data including the operation time, intra-operative blood loss, hospitalization day and surgical complications were recorded, as well as the radiological parameters measured from the postoperative X-rays and CT scans containing the rates of fusion, screw loosening, and cage subsidence incidence. In addition, the visual analog scores (VAS) and Oswestry Disability Index (ODI) were evaluated preoperatively and postoperatively. Results The average follow-up period was 34.32 months (ranging from 24 months to 51 months). Compared with PSA group, operation time and average hospital stay in the TPS group decreased significantly (P < 0.05). While no statistical difference for blood loss between 2 groups (P > 0.05). At 2 years postoperation, from CT-scans, 2/172 screws loosening and 1/56 segment non-union occurred in PSA group, with significantly lower incidence than those in TPS group (8/152 screws loosening and 6/50 segments non-union occurred, P < 0.05). Regarding the cage subsidence, 24 segments found height loss (5.30 ± 1.92 mm) in PSA group without difference compared with that of 19 segments (4.78 ± 1.37 mm) in TPS group (P > 0.05). Besides, the number and the location of cages and the leakage of the cement were found out little related with the subsidence in the PSA group (P > 0.05). After surgeries, VAS and ODI at 1 month, 6 months, 12 months, and last follow-up improved significantly in two groups (P < 0.05). There were no significant differences in VAS and ODI preoperatively and postoperatively between 2 groups (P > 0.05). In addition, eight patients with asymptomatic trajectory PMMA leakages were detected. Conclusion Cement-augmented pedicle screw technique is effective and safe in the osteoporotic spine with lumbar degenerative diseases, with better fusion rates and less screw loosening incidence. There is no difference in the fusion rate and loosening rate between the two groups in the single segment patients; however, there are better fusion rate and lower pedicle screw loosening rate of the PSA group in the double or multiple group patients.
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Affiliation(s)
- Guo-Ye Mo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Hui-Zhi Guo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Dan-Qing Guo
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Yong-Chao Tang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Yong-Xian Li
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China.,The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Kai Yuan
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Pei-Jie Luo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China.,The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Ten-Peng Zhou
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China.,The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Shun-Cong Zhang
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China. .,The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.
| | - De Liang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
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Li YX, Mo GY, Zhang SC, De Liang, Guo DQ, Tang YC, Yuan K, Li DX, Guo HZ, Wen GW, Xu YR, Luo PJ, Ma YH, Yang ZD. Cement for Treating Osteoporotic Vertebral Compression Fractures: Finite Element Study and Clinical Outcomes. J BIOMATER TISS ENG 2018. [DOI: 10.1166/jbt.2018.1923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Guo HZ, Tang YC, Li YX, Yuan K, Guo DQ, Mo GY, Luo PJ, Zhou TP, Zhang SC, Liang D. The Effect and Safety of Polymethylmethacrylate-Augmented Sacral Pedicle Screws Applied in Osteoporotic Spine with Lumbosacral Degenerative Disease: A 2-Year Follow-up of 25 Patients. World Neurosurg 2018; 121:e404-e410. [PMID: 30266711 DOI: 10.1016/j.wneu.2018.09.121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/13/2018] [Accepted: 09/15/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND A high rate of instrumentation failure is frequently seen in osteoporotic spines, especially at the sacral segment because of the great shear stress. Several techniques of sacral pedicle screw placement, such as bicortical and tricortical fixation, have been developed; however, the problems of loosening and pulling out of the screws are still a concern. Recently, the polymethylmethacrylate (PMMA)-augmented pedicle screws have been shown to strengthen the purchase in osteoporotic spine, but there are few reports on the effect of S1 pedicle screw with PMMA augmentation. METHODS Seventy-five patients receiving cement-augmented pedicle screws at lumbosacral vertebra were enrolled and divided into 3 groups by different patterns of S1 pedicle screw placement: S1 pedicle screw with PMMA augmentation (group A, 25 patients), S1 bicortical pedicle screw fixation (group B, 25 patients), and S1 tricortical pedicle screw fixation (group C, 25 patients). The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores were assessed preoperatively and at the last follow-up. Besides, the complications, loosening rate, and fusion rate were recorded. RESULTS The VAS and ODI scores at the last follow-up were significantly improved in the 3 groups compared with preoperative results. Better pain relief and functional improvement at the last follow-up was seen in group A compared with the other 2 groups; however, no significant difference was detected between groups B and C. Although the lowest screws loosening rates and the highest fusion rate were found in group A, no significant difference among these 3 groups. Furthermore, longer fusion segments and larger postoperative pelvic incidence-lumbar lordosis (PL-LL) were found as risks related to S1 screw loosening without cement augmentation. CONCLUSIONS The S1 pedicle screws with PMMA augmentation achieved better stability with less screw loosening in the osteoporotic spine with lumbosacral degenerative diseases compared with bicortical/tricortical fixation at S1. This procedure is especially recommended for patients with long segment fixation and large postoperative PI-LL, but there is also a risk of bone cement leakage and a learning curve.
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Affiliation(s)
- Hui-Zhi Guo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China; First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong-Chao Tang
- First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong-Xian Li
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China; First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kai Yuan
- First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dan-Qing Guo
- First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guo-Ye Mo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China; First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Pei-Jie Luo
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China; First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ten-Peng Zhou
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China; First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shun-Cong Zhang
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China; First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - De Liang
- First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
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Mo GY, Zhang SC, Li YX, Guo HZ, Guo DQ, Li DX, Tang YC, Mo L, Luo PJ, Ma YH. [Establish mouse osteoblast -osteoclast cell co-culture system in a Transwell chamber]. Zhongguo Gu Shang 2018; 31:241-247. [PMID: 29600675 DOI: 10.3969/j.issn.1003-0034.2018.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To establish osteoblast-osteoclast cell co-culture system in a Transwell chamber, and detect cell viability of osteoblasts and osteoclasts in system. METHODS Osteoblast MC3T3-E1 and mouse monocytes RAW264.7 were cultivated in vitro. RANKL-induced mouse RAW264.7 monocytes differentiated into mature osteoclasts, osteoblast-osteoclast cell co-culture system was established in Transwell chamber. Cell activity of osteoblasts and osteoclasts were detected by CCK-8 experimenting, Alizarin Red staining, TRAP staining. The expression of OPG, ALP, RANKL, TGF-b1 gene and RANKL protein in osteoblast MC3T3-E1 were detected by PCR, Western-Blot methods. Also, the expression of RANK, NF-κB in gene and protein level in osteoclast were measured through the same method respectively. RESULTS The co-culture system of Mouse MC3T3-E1 cells and RAW264.7 cell were established in Transwell chamber. Co-culture system affected cell division activities of osteoblasts and osteoclasts. Differentiation of osteoblasts were increased, while differentiation of osteoclast division were slight decreased under microscope observation. OPG (0.65±0.08) and ALP (0.16±0.01) gene expression of co-culture system were less than single culture OPG(1.00±0.08) and ALP (1.01±0.16); TGF-b1(4.42±0.21) and RANKL(4.12±1.04) of osteoblasts in co-culture system were higher than TGF-b1(1.00±0.10) and RANKL(1.00±0.09) under single culture. However, gene expression of RANK(0.63±0.06) and NF-κB(0.64±0.08) in co-culture system were decreased than RANK(1.00±0.08) and NF-κB(1.00±0.09), in single culture, and had significant differences. Similarly, protein expression of OPG(0.43±0.05) and NF-κB(0.59±0.05) of co-culture system were less than OPG(0.84±0.06) and NF-κB(1.13±0.03) of single culture. While RANKL protein expression (0.54±0.03)of co-culture system was more than single culture RANKL(0.31±0.03), and had statistically differences, which was in agreement of the trend of gene expression change. CONCLUSIONS Co-culture system of mouse MC3T3-E1 cells and RAW264.7 cell was viable in Transwell chamber, and the activity of osteoblasts is higher than osteoclasts in co-culture system.
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Affiliation(s)
- Guo-Ye Mo
- Department of Orthopaedics, the Third Affiliated Hospital of Guangzhou University of China Medicine, Guangzhou 510100, Guangdong, China
| | - Shun-Cong Zhang
- Department of Orthopaedics, the Third Affiliated Hospital of Guangzhou University of China Medicine, Guangzhou 510100, Guangdong, China
| | - Yong-Xian Li
- Department of Orthopaedics, the Third Affiliated Hospital of Guangzhou University of China Medicine, Guangzhou 510100, Guangdong, China
| | - Hui-Zhi Guo
- Department of Orthopaedics, the Third Affiliated Hospital of Guangzhou University of China Medicine, Guangzhou 510100, Guangdong, China
| | - Dan-Qing Guo
- Department of Orthopaedics, the Third Affiliated Hospital of Guangzhou University of China Medicine, Guangzhou 510100, Guangdong, China
| | - Da-Xing Li
- Department of Orthopaedics, the Third Affiliated Hospital of Guangzhou University of China Medicine, Guangzhou 510100, Guangdong, China
| | - Yong-Chao Tang
- Department of Orthopaedics, the Third Affiliated Hospital of Guangzhou University of China Medicine, Guangzhou 510100, Guangdong, China
| | - Ling Mo
- Department of Orthopaedics, the Third Affiliated Hospital of Guangzhou University of China Medicine, Guangzhou 510100, Guangdong, China;
| | - Pei-Jie Luo
- Department of Orthopaedics, the Third Affiliated Hospital of Guangzhou University of China Medicine, Guangzhou 510100, Guangdong, China
| | - Yan-Huai Ma
- Department of Orthopaedics, the Third Affiliated Hospital of Guangzhou University of China Medicine, Guangzhou 510100, Guangdong, China
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Li YX, Guo DQ, Zhang SC, Liang D, Yuan K, Mo GY, Li DX, Guo HZ, Tang Y, Luo PJ. Risk factor analysis for re-collapse of cemented vertebrae after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). Int Orthop 2018; 42:2131-2139. [PMID: 29464371 DOI: 10.1007/s00264-018-3838-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/08/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Re-collapse of cemented vertebrae occasionally occurs after percutaneous augmentation. However, the potential risks still remain unclear. Several articles have reported some possible risk factors which were not consistent or comprehensive. This study aimed to make a retrospective review on patients with osteoporotic vertebral compression fracture (OVCF) after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) and to further analyse the risk factors for treated vertebral refracture. METHODS All patients receiving the PKP/PVP with bilateral approach were retrospectively reviewed from January 2014 to January 2016, among whom 230 patients with single level augmentation (30 in refracture group and 200 in the non-refracture group) were enrolled according to inclusion criteria. The following covariates were reviewed: gender, age, height, weight, body mass index (BMI), bone mineral density (BMD), serum bone turnover markers, surgical parameters including approach, cement volume, anterior height, and Cobb angle restoration. Binary logistic regression analysis was used to determine the relative risk of re-collapse of cemented vertebrae. RESULTS Regarding the patient data, weight, BMI, and BMD were of statistical significance in refracture group (P < 0.01), among which only low BMD was a risk factor to cemented vertebral re-collapse (P = 0.022, OR = 4.197). In respect of surgical variables, the better restoration of anterior height and Cobb angle was found in refracture group (P < 0.05), both of which might increase the refracture risk but not be risk factors (P = 0.065, OR = 0.891, and P = 0.937, OR = 0.996, respectively). Besides, less injected cement (3.30 ± 0.84 ml vs 4.46 ± 1.10 ml, P = 0.000, OR = 19.433) and PKP (P = 0.007, OR = 13.332) significantly boosted the potential risk of refracture (P < 0.001). CONCLUSION Patients with low BMD, or undergoing PKP, or receiving a low volume of injected cement might have a high risk of re-collapse in surgical vertebrae.
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Affiliation(s)
- Yong-Xian Li
- The First Clinical Academy, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Dan-Qing Guo
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Shun-Cong Zhang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China. .,Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China. .,First School of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China.
| | - De Liang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China. .,Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China. .,First School of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China.
| | - Kai Yuan
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Guo-Ye Mo
- The First Clinical Academy, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Da-Xing Li
- The First Clinical Academy, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Hui-Zhi Guo
- The First Clinical Academy, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Yongchao Tang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Pei-Jie Luo
- The First Clinical Academy, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.,Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
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