Introduction: Osteoporosis is a major global health problem. Due to increasing life expectancy, the number of elderly patients with osteoporosis affected by degenerative and traumatic spinal diseases is increased. Low bone quality in osteoporosis can reduce the strength of pedicle screw and negative bone remodelling can cause delayed bone fusion. Pedicle screw instrumentation of the osteoporotic spine carries an increased risk of screw loosening, pull-out and fixation failure.
Our study aims to investigate the efficiency of expandable pedicle screws (Osseoscrew-Zodiac, Scient’x – Alphatec Spine) compared with standard titanium screws in osteoporotic spinal patients.
Methods: This is a prospective blinded randomized study.
Inclusion criteria: Osteoporotic patients,age over 50 y.o.. All osteoporotic patients with degenerative and traumatic spinal diseases admitted in our department performed a preoperative spinal X-Ray and MRI/CT.
Preoperative and postoperative clinical assessment of patients were based on VAS scale and SF36 questionnaire.
Group I: 25 patients treated with expandable pedicle screws. Group II: 25 patients treated with standard titanium pedicle screws. Postoperative radiological follow-up were performed at 3 days, 3, 6 and 12 months with CT and X-Ray.
Results: Group I: mean age 66 y.o. Levels treated: 10 lumbosacral , 11lumbar and 4 thoracolumbar. Mean Preoperative VAS 84.There was no failure of the device, all the screws expanded in the vertebral body. Mean postoperative VAS 32. Complications: in one case CSF leak not related to the implant, treated with lumbar drain.
Group II: mean age 62 y.o.. Levels treated 11 lumbo-sacral, 9 lumbar and 5 thoraco-lumbar. Mean preoperative VAS 81.Mean postoperative VAS 30.In one case screw breakage 4 months after surgery. We had two cases of screw loosening 8 and 10 months after surgery.
Conclusions: Expandable pedicle screws may improve pullout strength as compared to standard pedicle screws in osteoporotic patients with degenerative and traumatic spinal diseases.
Patient Care: spinal fixation with pedicle screws in osteoporotic patients once treated with external orthosis
Learning Objectives: spinal fixation with expandable screws in osteoporotic patients