Application of Cement-Injectable Cannulated Pedicle Screw in Treatment of Osteoporotic Thoracolumbar Vertebral Compression Fracture (AO Type A): A Retrospective Study of 28 Cases

OBJECTIVE: To evaluate safety and effectiveness of the novel polymethyl methacrylate-augmented bone cementinjectable cannulated pedicle screw (CICPS) in patients with thoracolumbar vertebral compression fractures (AO type A) associated with osteoporosis. METHODS: We conducted a retrospective cohort study of 28 patients treated for osteoporosis-related thoracolumbar vertebral body compression fracture at our facility between 2011 and 2015. Treatment involved posterior thoracolumbar fusion or lumbar fusion using CICPS. Treatment effectiveness was evaluated using visual analog scale and Oswestry Disability Index scores, degree of fracture reduction, and correction of kyphosis. The safety of CICPS was mainly assessed in terms of intraoperative and postoperative complications. Radiography, computed tomography, and magnetic resonance imaging outcomes were also assessed. RESULTS: All 28 patients had severe osteoporosis. The visual analog scale score at final follow-up (0.50 +/- 0.69) was significantly (P< 0.001) lower compared with before surgery (4.93 +/- 1.30). The Oswestry Disability Index score had also decreased from 57.39% +/- 14.46% to 6.83% +/- 15.38% at final follow-up (P < 0.001). Radiologic evaluation of vertebral height and Cobb angle showed good fracture reduction and satisfactory correction of kyphosis (preoperative vs. final follow-up P < 0.001). There were no instances of screw loosening or symptomatic complications except for a few cases of cement leakage from CICPS (10.3%; cement leakage most common in AO type A3.3). CONCLUSIONS: The use of CICPS and polymethyl methacrylate is an effective and safe surgical technique for management of osteoporosis-related vertebral fractures (AO type A), with good clinical outcomes and low complications rates.