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Instrumented lumbar arthrodesis in elderly patients: prospective study using cannulated cemented pedicle screw instrumentation

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Abstract

Introduction

Lumbar fusion in elderly patients is increasingly common. This study prospectively investigated the clinical and radiological outcome of osteoporotic patients >70 years with degenerative lumbar instability treated with fusion using a new cannulated, cemented, pedicle screw instrumentation augmented with PMMA.

Materials and Methods

The surgical protocols, patient records, densitometry, imaging studies, and pre- and postoperative patient-reported outcome questionnaires of 23 patients (mean age, 77 years) with a follow-up of 20–49 months were reviewed. All patients underwent postoperative 3D CT scan control to assess cement leakage and instrumentation position. Serial radiological controls were analyzed for secondary complications, i.e., adjacent fractures, hardware mobilization and radiological evidence of fusion.

Results

Pain and function improved at 6 months and were maintained at the final follow-up. No clinical complications secondary to PMMA leakage developed. No clinical or radiological cases of non-union were observed with a mean of 1.8 levels fused. No fractures occurred in adjacent segments. There were four cases of adjacent disc disease. Three deep infections required surgical revision without removal of material and one superficial infection, all with complete remission.

Conclusion

This new instrumentation for degenerative lumbar disease in elderly patients is safe and effective.

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References

  1. Bederman SS, Coyte PC, Kreder HJ, Mahomed NN, McIsaac WJ, Wright JG (2011) Who’s in the driver’s seat? The influence of patient and physician enthusiasm on regional variation in degenerative lumbar spinal surgery: a population-based study. Spine (Phila Pa 1976) 36(6):481–489

    Article  Google Scholar 

  2. Recommendation CM/Rec (2009) 6 of the Committee of Ministers to member states on ageing and disability in the 21st century: sustainable frameworks to enable greater quality of life in an inclusive society (Adopted by the Committee of Ministers on 8 July 2009 at the 1063rd meeting of the Ministers’ Deputies)

  3. Li G, Patil CG, Shivanand PL et al (2008) Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients. Spine 33(11):1250–1255

    Article  PubMed  Google Scholar 

  4. Raffo CS, Lauerman WC (2006) Predicting morbidity and mortality of lumbar spine arthrodesis in patients in their ninth decade. Spine 31(1):99–103

    Article  PubMed  Google Scholar 

  5. Daubs MD, Lenke LG, Cheh G et al (2007) Adult spinal deformity surgery. complications and outcomes in patients over age 60. Spine 32(20):2238–2244

    Article  PubMed  Google Scholar 

  6. Essens S, Sacs BL, Drezyin V (1993) Complications associated with the technique of pedicle screw fixation: a selected survey of ABC members. Spine 18:2231–2239

    Article  Google Scholar 

  7. Polly DW Jr, Orchowski JR, Ellenbogen RG (1998) Revision pedicle screws. Bigger, longer shims—what is best? Spine 23(12):1374–1379

    Article  PubMed  Google Scholar 

  8. von Strempel A, Kühle J, Plitz W (1994) Stability of pedicle screws. 2: maximum pullout force with reference to bone density. Z Orthop Ihre Grenzgeb 132(1):82–86 German

    Article  Google Scholar 

  9. Wittenberg RH, Lee KS, Shea M, White AA, Hayes WC 3rd (1993) Effect of screw diameter, insertion technique, and bone cement augmentation of pedicular screw fixation strength. Clin Orthop Relat Res 296:278–287

    PubMed  Google Scholar 

  10. Pfeifer BA, Krag MH, Johnson C (1994) Repair of failed transpedicle screw fixation. A biomechanical study comparing polymethylmethacrylate, milled bone, and matchstick bone reconstruction. Spine 19(3):350–353

    Article  PubMed  CAS  Google Scholar 

  11. Tan JS, Kwon BK, Dvorak MF et al (2004) Pedicle screw motion in the osteoporotic spine after augmentation with laminar hooks, sublaminar wires, or calcium phosphate cement: a comparative analysis. Spine 29(16):1723–1730

    Article  PubMed  Google Scholar 

  12. Renner SM, Lim T, Kim WJ et al (2004) Augmentation of pedicle screw fixation strength using an injectable calcium phosphate cement as a function of injection timing and method. Spine 29(11):E212–E216

    Article  PubMed  Google Scholar 

  13. Yi X, Wang Y, Lu H, Li C, Zhu T (2008) Augmentation of pedicle screw fixation strength using an injectable calcium sulfate cement: an in vivo study. Spine 33(23):2503–2509

    Article  PubMed  Google Scholar 

  14. Chang MC, Liu CL, Chen TH (2008) Polymethylmethacrylate augmentation of pedicle screw for osteoporotic spinal surgery: a novel technique. Spine 33(10):E317–E324

    Article  PubMed  Google Scholar 

  15. Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27

    Article  PubMed  CAS  Google Scholar 

  16. Yeom JS, Kim WJ, Choy WS, Lee CK, Chang BS, Kang JW (2003) Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg Br 85(1):83–89

    Article  PubMed  CAS  Google Scholar 

  17. Carreon LY, Glassman SD, Djurasovic M (2007) Reliability and agreement between fine-cut CT scans and plain radiography in the evaluation of posterolateral fusions. Spine 7(1):39–43 Epub 2006 Nov 20

    Article  Google Scholar 

  18. Flórez García M, García Pérez MA, García Pérez F (1995) Adaptación transcultural a la población española de la escala de incapacidad por dolor lumbar de Oswestry. Rehabilitación 29:138–145

    Google Scholar 

  19. Ferrer M, Pellisé F, Escudero O, Alvarez L, Pont A, Alonso J, Deyo R (2006) Validation of a minimum outcome core set in the evaluation of patients with back pain. Spine 20 31(12):1372–1379 (discussion 1380)

    Article  Google Scholar 

  20. Jackson SA (1999) The epidemiology of aging.In: Hazzart WR, Blass JP, Ettinger WH, Halter JB, Ouslander JP (eds) Principles of geriatric medicine and gerontology, 4th edn. McGraw-Hill Book Co 4, New York, pp 203–225

  21. Shabat S, Leitner Y, Nyska M et al (2002) Surgical treatment of lumbar spinal stenosis in patients aged 65 years and older. Arch Gerontol Geriatr 35:143–152

    Article  PubMed  CAS  Google Scholar 

  22. Yong-Hing K, Kirkaldy-Willis WH (1983) The pathophysiology of degenerative disease of the lumbar spine. Orthop Clin North Am 14:491–504

    PubMed  CAS  Google Scholar 

  23. Jonsson B, Stromqvist B (1993) Symptoms and signs of degeneration of the lumbar spine: a prospective, consecutive study of 300 operated patients. J Bone Joint Surg [Br] 75:381–385

    CAS  Google Scholar 

  24. Fischgrund JS, Mackay M, Herkowitz HN et al (1997) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22:2807–2812

    Article  PubMed  CAS  Google Scholar 

  25. Cavagna R, Tournier C, Aunoble S, Bouler JM, Antonietti P, Ronai M, Le Huec JC (2008) Lumbar decompression and fusion in elderly osteoporotic patients: a prospective study using less rigid titanium rod fixation. J Spinal Disord Tech 21(2):86–91

    Article  PubMed  Google Scholar 

  26. Alvarez L, Pérez-Higueras A, Granizo JJ, de Miguel I, Quiñones D, Rossi RE (2005) Predictors of outcomes of percutaneous vertebroplasty for osteoporotic vertebral fractures. Spine 30(1):87–92

    PubMed  Google Scholar 

  27. Uppin AA, Hirsch JA, Centenera LV et al (2003) Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 226:119–124

    Article  PubMed  Google Scholar 

  28. Videbaek TS, Christensen FB, Soegaard R, Hansen ES, Høy K, Helmig P, Niedermann B, Eiskjoer SP, Bünger CE (2006) Circumferential fusion improves outcome in comparison with instrumented posterolateral fusion: long-term results of a randomized clinical trial. Spine 31(25):2875–2880

    Article  PubMed  Google Scholar 

  29. Schaeren S, Broger I, Jeanneret B (2008) Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. Spine 33(18):E636–E642

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Spine Service. Fundación JimenezDiaz, Avenida Reyes Catolicos no. 2, 28040, Madrid, Spain

    Angel R. Piñera, Camen Duran, Belen Lopez, Isabel Saez, Emmanuel Correia & Luis Alvarez

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  1. Angel R. Piñera
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  2. Camen Duran
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  3. Belen Lopez
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  4. Isabel Saez
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  5. Emmanuel Correia
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  6. Luis Alvarez
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Correspondence to Angel R. Piñera.

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Piñera, A.R., Duran, C., Lopez, B. et al. Instrumented lumbar arthrodesis in elderly patients: prospective study using cannulated cemented pedicle screw instrumentation. Eur Spine J 20 (Suppl 3), 408 (2011). https://doi.org/10.1007/s00586-011-1907-2

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  • DOI: https://doi.org/10.1007/s00586-011-1907-2

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