Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis

Abstract

Background: Cannulated pedicle screw (CPS) augmented by polymethylmethacrylate (PMMA) can achieve satisfactory clinical efficacy in the treatment of lumbar spondylolisthesis with osteoporosis. However, accurate application of CPSs will help to avoid the difficulty of screw revision and reduce the incidence of PMMA-related complications. This study aimed to investigate the mid-term efficacy of CPS compared to unilateral and bilateral applications in this common lumbar degenerative disease.Methods: Between May 2011 and May 2018, 50 patients with lumbar spondylolisthesis with osteoporosis who underwent posterior fixation and fusion using traditional pedicle screws or CPSs were included in the study. Patients were divided into two groups based on the application: the unilateral PMMA-augmented CPS group (UC, n = 29) and the bilateral PMMA-augmented CPS group (BC, n = 21). Operation time, blood loss, average hospitalization time, PMMA leakage, and other complications were recorded. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were used to evaluate symptom recovery. Radiographic results were compared for intervertebral fusion and screw loosening.Results: There were no significant differences in the baseline data of the two groups.The VAS and ODI scores improved significantly after surgery (P < 0.05), with no significant differences between the groups (P > 0.05). The operation time and blood loss in the UC group were significantly lower than those in the BC group (P < 0.05). However, the loss of intervertebral disc height and Taillard index did not differ significantly between the groups. The rates of PMMA leakage in the UC and BC groups were 7.0% and 11.9%, respectively (P < 0.05). Bony fusion was achieved in all groups without screw loosening at the last follow-up. Only one patient experienced superficial infection in both groups, while cerebrospinal fluid leakage was observed in two patients in the BC group.Conclusions: Unilateral application of PMMA-augmented CPS may provide adequate clinical safety and effectiveness in the surgical treatment of lumbar spondylolisthesis with osteoporosis.

Beneficial influence of single-stage posterior surgery for the treatment of lumbar brucella spondylitis combined with spondylolisthesis

“…(preoperative slippage - postoperative slippage) / preoperative slippage × 100% [10]. The spondylolisthesis rate at 2 weeks and 1 year after operation was measured by Taillard’s measurement [11], and the reduction loss rate was also calculated. In addition, we observed the condition of the fusion of bone graft and checked the instrumentation 2 weeks and 1 year after the operation [12,13].…”

Surgical stabilization for degenerative lesions of the lumbar spine in patients with reduced bone mineral density: a systematic literature review

“…С учетом высокой частоты экстравазации ПММА (34,52 %) при увеличении числа оперированных уровней может быть полезна селективная цементная аугментация концевых позвонков [34]. При этом односторонняя цементная аугментация обеспечивает клинические исходы не хуже, чем двусторонняя, с меньшим временем операции, кровопотерей и частотой формирования затеков [35]. Клинический опыт применения ПММА при дегенеративных поражениях поясничного отдела позвоночника и сниженной МПКТ представлен в табл.…”

Commentary: Lumbar Fixation Using the Cortical Bone Trajectory Fixation: A Single Surgeon Experience With 3-Year Follow-Up

“…17,18 Polymethylmethacrylate (PMMA)-augmented cannulated pedicle screws (CPSs) have been established as a safe alternative to traditional techniques and are frequently implemented in this patient population. 19,20 Liu et al 21 reported outcome data from both unilateral and bilateral PMMAaugmented CPSs and demonstrated significant improvement in VAS (decrease from approx. 8 to 2) and ODI (decrease from approx.…”