Lumbosacral fixation using expandable pedicle screws. an alternative in reoperation and osteoporosis.
BACKGROUND
Pedicle screw fixation in osteoporotic bone and in revision of previous pedicle screw fixation cases presents a significant challenge to spine surgeons. Biomechanical tests have shown that a pedicle screw that expands within the vertebrae body can substantially improve fixation in the presence of compromised bone.


OBJECTIVE
To review the clinical and radiographic results with the use of expandable pedicle screws.


METHODS
One hundred forty-five patients received one or more expandable pedicle screws from the Omega21 spinal fixation system (EBI, L.P., Parsippany, NJ) to obtain thorocolumbar or lumbosacral stabilization.


METHODS
The indications for use of the expandable screws were osteoporosis (21 cases), reoperation of previous pedicle instrumentation (27 cases), intraoperative screw relocation (17 cases), construct reinforcement (23 cases), and sacral anchoring to avoid the necessity of anterior penetration of the sacral cortex (57 cases).


METHODS
The presence of radiographic fusion and complications arising from the instrumentation were reviewed at a mean follow-up period of 35 months (range, 24-72 months).


METHODS
A retrospective clinical and radiographic review was performed. Fusion was evaluated based on anterior-posterior and lateral radiographs as well as dynamic radiographs in flexion and extension.


RESULTS
Radiographic evidence of fusion was obtained in 125 of the 145 cases (86%). Eighty-six percent of patients with osteoporosis and 89% of reoperations fused. There were no instances of screw loosening or pullout of the expandable screws. Screw breakage occurred in four patients (2.8%), including three patients where fusion was not obtained. In six patients the expandable screws were removed without difficulty after fusion because of local discomfort.


CONCLUSIONS
The results of this study have shown that expandable pedicle screws can be efficacious in cases in which pedicle screw fixation is difficult and adds a valuable tool to the growing armamentarium of spinal instrumentation.
Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, SL-32, New Orleans, LA 70112, USA. scook2@tulane.edu
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Cook
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Barbera
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Rubi
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Salkeld
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Whitecloud
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery