Evaluating the Necessity of Screw Replacement in Sacral Bone Loosening: A Minimally Invasive Approach for Treatment with Local Anesthesia

IF 0.3 Q4 SURGERY
Murat Baloglu, Hakan Millet, S. Ercan
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Abstract

Abstract Background  This study aimed to investigate a minimally invasive approach to address the issue of bone loosening in patients who have undergone posterior spinal fusion surgery. If left untreated, sacral bone loosening can result in nerve damage, reduced mobility, and chronic pain. The standard surgical treatment involves replacing the loosened screw with a larger one, requiring significant surgical intervention and complete instrument disassembly. The use of polymethylmethacrylate (PMMA) to increase the strength of the vertebral body was also described, but the results were contradictory. We aim to evaluate the efficacy of filling just only the gap between bone and screw instead of the vertebral body. Methods  This study included patients who had undergone posterior transpedicular stabilization but showed signs of sacral bone loosening in follow-up. The gap between the screw and the bone was targeted instead of the vertebral body and filled using PMMA. The procedure was performed under local anesthesia and fluoroscopy, and the preoperative and postoperative visual analog scale (VAS) scores were compared at 1, 3, and 12 months after the procedure. Results  The study included 17 patients who underwent 28 procedures, with 11 patients receiving bilateral and 6 receiving unilateral approaches. The results showed a significant decrease in postoperative VAS scores compared to the preoperative scores, indicating reduced pain and discomfort. PMMA, as a bone filler, has been reported to provide good stability and support to the bone-implant interface, thereby reducing the risk of screw loosening and improving the outcome of spinal fusion surgery. Conclusion  In conclusion, the study demonstrates the efficacy of a minimally invasive approach using PMMA to treat sacral bone loosening in patients who have undergone posterior spinal fusion surgery. The procedure is safe, minimally invasive, and provides significant pain relief, making it a viable alternative to traditional surgical methods.
评估骶骨松动症螺钉置换的必要性:局部麻醉的微创治疗方法
摘要 背景 本研究旨在探讨一种微创方法,以解决脊柱后路融合手术患者的骨松动问题。如果不及时治疗,骶骨松动会导致神经损伤、活动度降低和慢性疼痛。标准的手术治疗包括用更大的螺钉替换松动的螺钉,这需要大量的手术干预和完全的器械拆卸。也有人描述过使用聚甲基丙烯酸甲酯(PMMA)来增加椎体的强度,但结果相互矛盾。我们的目的是评估仅填充骨与螺钉之间的间隙而非椎体的疗效。方法 本研究纳入了接受后路经椎体稳定术但在随访中出现骶骨松动迹象的患者。目标是螺钉与骨之间的间隙,而不是椎体,并使用 PMMA 填充。手术在局部麻醉和透视下进行,术前和术后视觉模拟量表(VAS)评分在术后 1、3 和 12 个月进行比较。结果 该研究包括 17 名患者,共进行了 28 次手术,其中 11 名患者接受了双侧手术,6 名患者接受了单侧手术。结果显示,与术前相比,术后 VAS 评分明显下降,表明疼痛和不适感减轻。据报道,PMMA 作为一种骨填充物,可为骨-植入物界面提供良好的稳定性和支撑力,从而降低螺钉松动的风险,改善脊柱融合手术的效果。结论 总之,该研究证明了使用 PMMA 微创方法治疗脊柱后路融合手术患者骶骨松动的有效性。该手术安全、微创、疼痛明显缓解,是传统手术方法的可行替代方案。
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来源期刊
CiteScore
0.40
自引率
0.00%
发文量
52
审稿时长
12 weeks
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