Abstract
Purpose: Instrumentation and cementoplasty have been used individually or synergistically to augment screw fixation for better stabilization. A pilot study was performed to develop a new way to use this relationship to solve problematic screw loosening in both healthy and osteoporotic bone. Results show there may be indication to use the following characterized method.
Methods: In 12 cases of patients, pedicle fixation was used for complex decompression. The ages range from 70–85 years and included 8 females and 4 males. All patients underwent a bone tamp bolus formation in cancellous bone through each pedicle at the superior level of construct (3–4 cc. in each site, injected under low pressure) followed by pedicle screw insertion into the bolus, and subsequent levels were fixated by only pedicle screws.
Results: The preoperative, postoperative, and 3 month follow-up plain x-ray films were evaluated for stable bone tamp implantation, cement leakage, and screw placement. In all 12 cases there was no evidence of screw migration, pull-out, fracture, spinal cord compression, nerve root compression, or complication with cement placement. There was no example of cement extrusion into spinal canal. All patients had uneventful recoveries which included physical therapy, mild analgesics, and bracing.
Conclusion: This new technique may solve the problem of loosening of screws in healthy and osteoporotic bone by providing a more secure anchorage system not yet seen in previous studies. Further study is needed to develop more specific outcomes to determine the best technique using the balloon bone tamp system.
Correspondence should be addressed to: Mr John O’ Dowd, SBPR, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
