title: Anterior bone cement augmentation in anterior lumbar interbody fusion and percutaneous pedicle screw fixation in patients with osteoporosis.
abstract: OBJECTIVE
  The purpose of the present study was to evaluate the efficacy of anterior polymethylmethacrylate (PMMA) cement augmentation in instrumented anterior lumbar interbody fusion (ALIF) for patients with osteoporosis.
  
  
  METHODS
  Sixty-two patients with osteoporosis who had undergone single-level instrumented ALIF for spondylolisthesis and were followed for more than 2 years were included in the study. The patients were divided into 2 groups: instrumented ALIF alone (Group I) and instrumented ALIF with anterior PMMA augmentation (Group II). Sixty-one patients were interviewed to evaluate the clinical results, and plain radiographs and 3D CT scans were obtained at the last follow-up in 46 patients.
  
  
  RESULTS
  The mean degree of cage subsidence was significantly higher in Group I (19.6%) than in Group II (5.2%) (p = 0.001). The mean decrease of vertebral body height at the index level was also significantly higher in Group I (10.7%) than in Group II (3.9%) (p = 0.001). No significant intergroup differences were observed in the incidence of radiographic adjacent-segment degeneration (ASD) or in terms of pain and functional improvement. The incidences of clinical ASD (23% in Group I and 10% in Group II) were not significantly different. There was 1 case of nonunion and 3 cases of screw migration in Group I, but none resulted in implant failure.
  
  
  CONCLUSIONS
  Anterior PMMA augmentation during instrumented ALIF in patients with osteoporosis was useful to prevent cage subsidence and vertebral body collapse. In addition, PMMA augmentation did not increase the nonunion rate and incidence of ASD.
authors.affiliation: Department of Orthopedic Surgery, Wooridul Spine Hospital, Seoul, Korea.
authors.forename: Kyeong Hwan
authors.initials: KH
authors.lastname: Kim
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: Dong Yeob
authors.initials: DY
authors.lastname: Lee
authors.forename: Chan Shik
authors.initials: CS
authors.lastname: Shim
authors.forename: Dae Hyeon
authors.initials: DH
authors.lastname: Maeng
mesh_terms: D000368:Aged; D001843:Bone Cements; D001863:Bone Screws; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications*; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications; D013123:Spinal Fusion / Q000295:instrumentation*; D013168:Spondylolisthesis / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate