Application value of expansive pedicle screw in the lumbar short‑segment fixation and fusion for osteoporosis patients

Weng, Fengbiao; Wang, Jiazi; Yang, Li-wen; Zeng, Jincai; Chu, Yawei; Tian, Zhigang

doi:10.3892/etm.2018.6248

Cited by 5 publications

(6 citation statements)

References 24 publications

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“…Pedicle screw type. Data from 2 studies [50,52] suggested that there was a higher risk of fusion failure with CPS fixation than with expandable pedicle screw (EPS) fixation (OR, 4.77; 95% CI, 2.23 to 10.20; I 2 = 47.5%) (Fig 8). We used the trim-and-fill method to adjust the publication bias, and the OR corrected for publication bias was 2.98 (95% CI, 1.56 to 5.81), which was essentially in line with our results (S6 Table ).…”

Section: Plos Onementioning

confidence: 99%

Risk factors affecting spinal fusion: A meta-analysis of 39 cohort studies

Yang,

Zhou,

et al. 2024

PLoS ONE

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Purpose We performed a meta-analysis to identify risk factors affecting spinal fusion. Methods We systematically searched PubMed, Embase, and the Cochrane Library from inception to January 6, 2023, for articles that report risk factors affecting spinal fusion. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using fixed-effects models for each factor for which the interstudy heterogeneity I2 was < 50%, while random-effects models were used when the interstudy heterogeneity I2 was ≥ 50%. Using sample size, Egger’s P value, and heterogeneity across studies as criteria, we categorized the quality of evidence from observational studies as high-quality (Class I), moderate-quality (Class II or III), or low-quality (Class IV). Furthermore, the trim-and-fill procedure and leave-one-out protocol were conducted to investigate potential sources of heterogeneity and verify result stability. Results Of the 1,257 citations screened, 39 unique cohort studies comprising 7,145 patients were included in the data synthesis. High-quality (Class I) evidence showed that patients with a smoking habit (OR, 1.57; 95% CI, 1.11 to 2.21) and without the use of bone morphogenetic protein-2 (BMP-2) (OR, 4.42; 95% CI, 3.33 to 5.86) were at higher risk for fusion failure. Moderate-quality (Class II or III) evidence showed that fusion failure was significantly associated with vitamin D deficiency (OR, 2.46; 95% CI, 1.24 to 4.90), diabetes (OR, 3.42; 95% CI, 1.59 to 7.36), allograft (OR, 1.82; 95% CI, 1.11 to 2.96), conventional pedicle screw (CPS) fixation (OR, 4.77; 95% CI, 2.23 to 10.20) and posterolateral fusion (OR, 3.63; 95% CI, 1.25 to 10.49). Conclusions Conspicuous risk factors affecting spinal fusion include three patient-related risk factors (smoking, vitamin D deficiency, and diabetes) and four surgery-related risk factors (without the use of BMP-2, allograft, CPS fixation, and posterolateral fusion). These findings may help clinicians strengthen awareness for early intervention in patients at high risk of developing fusion failure.

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Section: Plos Onementioning

confidence: 99%

Risk factors affecting spinal fusion: A meta-analysis of 39 cohort studies

Yang,

Zhou,

et al. 2024

PLoS ONE

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“…Owing to the fragile characteristics of the elderly, complications, including screw-loosening events, pseudarthroses, and adjacent kyphosis resulting from compression fractures, may occur after spinal surgery in osteoporosis patients [ 1 ]. In spinal fixation and fusion surgery, screw-loosening events continue to remain a major complication [ 2 ], and cage subsidence is relevant to the severity of osteoporosis [ 3 ]. Recently, adjacent vertebral compression fractures have attracted attention after spinal fixation and fusion in osteoporosis patients [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Prevention of Compression Fracture in Osteoporosis Patients under Minimally Invasive Trans-Foraminal Lumbar Interbody Fusion with Assistance of Bone-Mounted Robotic System in Two-Level Degenerative Lumbar Disease

et al. 2022

Medicina

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Background and Objectives: Minimally invasive spine surgery reduces destruction of the paraspinal musculature and improves spinal stability. Nevertheless, screw loosening remains a challenging issue in osteoporosis patients receiving spinal fixation and fusion surgery. Moreover, adjacent vertebral compression fracture is a major complication, particularly in patients with osteoporosis. We assessed long-term imaging results to investigate the outcomes of osteoporosis patients with two-level degenerative spine disease receiving minimally invasive surgery with the assistance of a robotic system. Materials and Methods: We retrospectively analyzed consecutive osteoporosis patients who underwent minimally invasive surgery with the assistance of a robotic system at our institution during 2013–2016. All patients were diagnosed with osteoporosis according to the World Health Organization criteria. All patients were diagnosed with two levels of spinal degenerative disease, including L34, L45, or L5S1. The study endpoints included screw-loosening condition, cage fusion, and vertebral body heights of the adjacent, first fixation segment, and second fixation segments before and after surgery, including the anterior, middle, and posterior third parts of the vertebral body. Differences in vertebral body heights before and after surgery were evaluated using the F-test. Results: Nineteen consecutive osteoporosis patients were analyzed. A lower rate of screw loosening was observed in osteoporosis patients in our study. There were no significant differences between the preoperative and postoperative vertebral body heights, including adjacent and fixation segments. Conclusions: According to our retrospective study, we report that minimally invasive surgery with the assistance of a robotic system provided better screw fixation, a lower rate of screw loosening, and a lesser extent of vertebral compression fracture after spinal fixation and fusion surgery in osteoporosis patients.

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“…Longer instrumented extending to the adjacent segment may lead to several complications such as proximal junctional kyphosis that undermine the effectiveness of surgery[ 1 , 2 ]. To enhance the anchoring strength, several techniques have been used, including bicortical screws, tricortical screws, expandable screws, iliac screws, and iliosacral screws[ 3 , 4 ]. While it is not recommended to extend the extra fixation segment, the strength of bicortical or tricortical screws are also limited and may lead to internal fixation failure in an osteoporotic patients[ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Intracardiac, pulmonary cement embolism in a 67-year-old female after cement-augmented pedicle screw instrumentation: A case report and review of literature

Liang

Zhu

Gao

et al. 2021

WJCC

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BACKGROUND We report a case of Intracardiac, pulmonary, and intravenous cement embolism after cement-augmented pedicle screw instrumentation in treating spondylolisthesis underlying osteoporotic bone, which was successfully managed by conservative treatment. We describe the treatment and outcome of the patient, hoping to shed light on the management of bone cement embolism. CASE SUMMARY A 67-year-old female suffered from progressive low back pain and numbness in lower extremities for 30 years. She was diagnosed with L4 and L5 spondylolisthesis, spinal stenosis, and osteoporosis. The patient underwent spinal canal decompression, an interbody fusion of L4/5 and L5/S1, cement-augmented pedicle screw instrumentation in L4-L5 segments, and regular pedicle screw in S1 segments. Three days postoperatively, a sudden drop in oxygen saturation occurred. Computerized tomography scan confirmed Intracardiac, pulmonary, and intravenous embolism. The patient was treated conservatively by continuous low-flow oxygen inhalation, anti-coagulation, and antibiotic therapy for 1 mo and continued anticoagulation treatment for 6 mo. The patient showed no further symptoms in a 30-mo follow-up. CONCLUSION Intracardiac, pulmonary cement embolism after cement-augmented pedicle screw instrumentation is extremely rare. Careful clinical and radiographic evaluation is required in multiple sites of bone cement embolism. Conservative treatment may be a primary consideration in scattered emboli without life-threatening conditions, but a clinical decision should be made on an individualized basis.

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Application value of expansive pedicle screw in the lumbar short‑segment fixation and fusion for osteoporosis patients

Cited by 5 publications

References 24 publications

Risk factors affecting spinal fusion: A meta-analysis of 39 cohort studies

Risk factors affecting spinal fusion: A meta-analysis of 39 cohort studies

Prevention of Compression Fracture in Osteoporosis Patients under Minimally Invasive Trans-Foraminal Lumbar Interbody Fusion with Assistance of Bone-Mounted Robotic System in Two-Level Degenerative Lumbar Disease

Intracardiac, pulmonary cement embolism in a 67-year-old female after cement-augmented pedicle screw instrumentation: A case report and review of literature

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