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 will increase even further. Low bone quality 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) in osteoporotic spinal patients.
Methods: This is a prospective study. All osteoporotic patients with degenerative and traumatic spinal diseases performed a preoperative spinal X-Ray and MRI or CT.
Preoperative clinical assessment of patients were based on VAS scale and ODI questionnaire.
46 patients were treated with expandable pedicle screws (Osseoscrew-Zodiac, Scient’x – Alphatec Spine) performing open or percutaneous approach.
Post-operative clinical and radiological assessment of patients were based on VAS and ODI scale questionnaire and CT and X-Ray respectively at 6 montths and 1 year follow-up.
Results: 46 patients, mean age 68 y.o. Levels treated: 11 lumbosacral , 19 lumbar and 16 thoracolumbar. Mean Preoperative VAS 86.There was no failure of the device, all the screws expanded in the vertebral body. Mean postoperative VAS 34. Complications: we had one case of CSF leak not related to the implant, treated with lumbar drain for five days. In one case extension of the posterior fixation at the lower lumbar level was performed 1 year after first surgery secondary to disc degeneration at the adjacent segment.
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: expandable pedicle screws may decrease the risk of screw loosening, achieving better fixation
strength in osteoporotic spinal fusion.
Learning Objectives: By the conclusion of this session, the
partecipants should be able to
describe the importance of
expandable pedicle screws in
decreasing the risk of screw
loosening, achieving better fixation
strength in osteoporotic spinal fusion.