Clinical study on short-segment bone cement reinforced pedicle screw fixation in separation surgeries for thoracolumbar spinal metastatic tumor

English Keywords:Spinal metastasis  Separation surgery  Bone cement reinforced pedicle screw  Clinical effect

English Abstract:

  【Abstract】 Objectives: To investigate the clinical efficacy of bone cement reinforced pedicle screw fixation in separation surgeries for the treatment of thoracolumbar spinal metastasis. Methods: A retrospective analysis was performed on the patients suffered from thoracolumbar metastasis with epidural spinal cord compression(ESCC) and received separation surgeries in our hospital from February 2018 to October 2019. A total of 59 patients were recruited, including 25 males and 34 females, aged 45-76 years(averaged 56.2±7.5 years). Bone cement reinforced pedicle screw fixation was applied in all the patients, and a total of 236 bone cement reinforced pedicle screws were implanted. The operative time, intraoperative blood loss, transfusion volume, postoperative hospitalization days and perioperative complications were recorded. Frankel grading at preoperation and postoperative 3 months, visual analogue scale(VAS) and Karnofsky score before surgery and at postoperative 7d and 3 months, and final follow-up were recorded and analyzed. The preoperative, postoperative 7d and final follow-up anteroposterior and lateral X-ray images of the operated segments were collected, and the status of internal fixation and sagittal Cobb angle changes were observed and recorded. Results: The follow-up period was 18.3±3.9 months(5-34 months); operative time was 169.0±23.7min(125-210min), intraoperative blood loss was 535±120.0ml(200-1300ml), transfusion of red blood cell and plasma was 1.2±0.6u(0-6u) and 105±32ml(0-400ml), respectively; the postoperative hospitalization days were 6.5±2.3d(5-11d). Bone cement leakage occurred in 2 cases, both were of small amount through the anterior vertebral vein, which stopped progressing once suspended injection with no adverse reactions after operation; CSF leakage occurred in 1 case, which was cured with prone position and fluid infusion; and impaired wound healing occurred in 2 cases, which healed after debridement and suture. VAS score, Frankel grading and Karnofsky score at different postoperative time were significantly improved compared with those before surgery(P<0.05). None internal fixation failure occured, and no significant difference was found between the Cobb angles of operative segments at final follow-up and immediate postoperatively(22.5°±2.1° vs 21.2°±1.8°, P>0.05). Conclusions: Bone cement reinforced pedicle screw fixation can provide much stronger spinal stability in separation surgeries for patients with thoracolumbar spinal metastatic tumors and ESCC.