Comparison of three sacral screw internal fixation techniques in the treatment of L4–S1 lumbar degenerative disease with osteoporosis: a retrospective observational study
Abstract Background Patients with L4–S1 lumbar degenerative disease (LDD) with osteoporosis are prone to sacral-screw loosening during spinal internal fixation. We aimed to compare the clinical efficacy and imaging results of sacral bicortical, tricortical, and polymethylmethacrylate (PMMA)-augmente...
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BMC
2024-11-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-024-05281-y |
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| author | Guo-ning Gu Teng Liu Jie Ding Hui-zhi Guo Guo-ye Mo Yong-xian Li Kai Yuan Zhi-dong Yang Shun-cong Zhang Yong-chao Tang |
| author_facet | Guo-ning Gu Teng Liu Jie Ding Hui-zhi Guo Guo-ye Mo Yong-xian Li Kai Yuan Zhi-dong Yang Shun-cong Zhang Yong-chao Tang |
| author_sort | Guo-ning Gu |
| collection | DOAJ |
| description | Abstract Background Patients with L4–S1 lumbar degenerative disease (LDD) with osteoporosis are prone to sacral-screw loosening during spinal internal fixation. We aimed to compare the clinical efficacy and imaging results of sacral bicortical, tricortical, and polymethylmethacrylate (PMMA)-augmented pedicle-screw fixation in the treatment of L4–S1 LDD with osteoporosis. Methods This is a retrospective study, 72 patients were enrolled and divided into three groups according to the S1-screw fixation method: PMMA-augmented pedicle-screw fixation (Group A, n = 26), bicortical fixation (Group B, n = 22), and tricortical fixation (Group C, n = 24). The visual analog scale (VAS) and Oswestry disability index (ODI) were recorded preoperatively and at the last follow-up, and the postoperative complications, screw-loosening rate, and fusion rate were compared between the three groups. Results Upon the last follow-up, the VAS and ODI scores of the three groups were significantly improved compared with those recorded preoperatively. The VAS and ODI scores of Group A were significantly smaller than those of Groups B and C (P < 0.05), with no significant difference between Groups B and C. Moreover, the screw-loosening rate of Group A was significantly lower than that of Groups B and C (P < 0.05), with no significant difference between Groups B and C. No significant difference was noted in postoperative complications, bone-cement leakage rates, and intervertebral fusion rates among the three groups. Furthermore, we found that osteoporosis and change of lumbar lordosis(LL) value were independent risk factors for sacral-screw loosening in patients with L4–S1 LDD with osteoporosis. Conclusions When patients with L4–S1 LDD with osteoporosis undergo lumbosacral fusion and fixation, the use of S1 pedicle screws with PMMA augmentation has better stability and less screw loosening. Furthermore, we recommend this surgery for patients with osteoporosis, and the LL should be increased as much as possible during the operation to restore the matching of lumbar and pelvic parameters. |
| format | Article |
| id | doaj-art-22ea8e647c8e4e75ae5e0efc53bcd699 |
| institution | OA Journals |
| issn | 1749-799X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-22ea8e647c8e4e75ae5e0efc53bcd6992025-08-20T02:33:31ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2024-11-011911910.1186/s13018-024-05281-yComparison of three sacral screw internal fixation techniques in the treatment of L4–S1 lumbar degenerative disease with osteoporosis: a retrospective observational studyGuo-ning Gu0Teng Liu1Jie Ding2Hui-zhi Guo3Guo-ye Mo4Yong-xian Li5Kai Yuan6Zhi-dong Yang7Shun-cong Zhang8Yong-chao Tang9The 1st Institute of Clinical Medicine, Guangzhou University of Chinese MedicineShenzhen Hospital, Beijing University of Chinese Medicine OrthopedicsThe 1st Institute of Clinical Medicine, Guangzhou University of Chinese MedicineSpine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese MedicineSpine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese MedicineSpine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese MedicineSpine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese MedicineSpine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese MedicineSpine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese MedicineSpine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese MedicineAbstract Background Patients with L4–S1 lumbar degenerative disease (LDD) with osteoporosis are prone to sacral-screw loosening during spinal internal fixation. We aimed to compare the clinical efficacy and imaging results of sacral bicortical, tricortical, and polymethylmethacrylate (PMMA)-augmented pedicle-screw fixation in the treatment of L4–S1 LDD with osteoporosis. Methods This is a retrospective study, 72 patients were enrolled and divided into three groups according to the S1-screw fixation method: PMMA-augmented pedicle-screw fixation (Group A, n = 26), bicortical fixation (Group B, n = 22), and tricortical fixation (Group C, n = 24). The visual analog scale (VAS) and Oswestry disability index (ODI) were recorded preoperatively and at the last follow-up, and the postoperative complications, screw-loosening rate, and fusion rate were compared between the three groups. Results Upon the last follow-up, the VAS and ODI scores of the three groups were significantly improved compared with those recorded preoperatively. The VAS and ODI scores of Group A were significantly smaller than those of Groups B and C (P < 0.05), with no significant difference between Groups B and C. Moreover, the screw-loosening rate of Group A was significantly lower than that of Groups B and C (P < 0.05), with no significant difference between Groups B and C. No significant difference was noted in postoperative complications, bone-cement leakage rates, and intervertebral fusion rates among the three groups. Furthermore, we found that osteoporosis and change of lumbar lordosis(LL) value were independent risk factors for sacral-screw loosening in patients with L4–S1 LDD with osteoporosis. Conclusions When patients with L4–S1 LDD with osteoporosis undergo lumbosacral fusion and fixation, the use of S1 pedicle screws with PMMA augmentation has better stability and less screw loosening. Furthermore, we recommend this surgery for patients with osteoporosis, and the LL should be increased as much as possible during the operation to restore the matching of lumbar and pelvic parameters.https://doi.org/10.1186/s13018-024-05281-yLumbar degenerative diseaseOsteoporosisSacral screwPolymethylmethacrylate -augmented |
| spellingShingle | Guo-ning Gu Teng Liu Jie Ding Hui-zhi Guo Guo-ye Mo Yong-xian Li Kai Yuan Zhi-dong Yang Shun-cong Zhang Yong-chao Tang Comparison of three sacral screw internal fixation techniques in the treatment of L4–S1 lumbar degenerative disease with osteoporosis: a retrospective observational study Journal of Orthopaedic Surgery and Research Lumbar degenerative disease Osteoporosis Sacral screw Polymethylmethacrylate -augmented |
| title | Comparison of three sacral screw internal fixation techniques in the treatment of L4–S1 lumbar degenerative disease with osteoporosis: a retrospective observational study |
| title_full | Comparison of three sacral screw internal fixation techniques in the treatment of L4–S1 lumbar degenerative disease with osteoporosis: a retrospective observational study |
| title_fullStr | Comparison of three sacral screw internal fixation techniques in the treatment of L4–S1 lumbar degenerative disease with osteoporosis: a retrospective observational study |
| title_full_unstemmed | Comparison of three sacral screw internal fixation techniques in the treatment of L4–S1 lumbar degenerative disease with osteoporosis: a retrospective observational study |
| title_short | Comparison of three sacral screw internal fixation techniques in the treatment of L4–S1 lumbar degenerative disease with osteoporosis: a retrospective observational study |
| title_sort | comparison of three sacral screw internal fixation techniques in the treatment of l4 s1 lumbar degenerative disease with osteoporosis a retrospective observational study |
| topic | Lumbar degenerative disease Osteoporosis Sacral screw Polymethylmethacrylate -augmented |
| url | https://doi.org/10.1186/s13018-024-05281-y |
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