Osteoplasty of vertebral bone defects caused by pedicle screw loosening using orthobiological approaches: a pilot study of case series

Abstract

Objective. To analyze the effectiveness and safety of using an orthobiological product in osteoplasty of bone defects of the vertebrae with simultaneous reosteosynthesis. Material and Methods. The results of screw augmentation technology using thrombogel-enriched allogeneic bone were studied in a retrospective, single-center, non-randomized study, which included 17 patients (10 women, 7 men) with instability of the hardware in the form of screw loosening and osteolysis around screws. Results within 12 months were followed up in 17 patients (100 %). We compared preoperative and postoperative instrumental data, clinical parameters in dynamics. Results. The mean age of the patients was 59 (43–75) years. The distribution of patients, according to the primary pathology, was as follows: 11 patients (64.7 %) had a degenerative-dystrophic pathology of the spine, 4 patients (23.5 %) had a traumatic injury, and 2 patients had a kyphotic deformity on the background of Bechterew’s disease (11.8 %). The mean time from primary to revision surgery was 7.06 months (3.1–12.1), mean CRP was 4.48 (0.5–15.0). When observing patients for 12 months, all patients showed a positive trend in the form of a statistically significant regression of back pain according to VAS from 7.0 (6.0; 7.3) to 1.0 (0.0; 1.0) points (χ2 = 47.9, df 3, р < 0.0001). A positive trend was also noted in the form of a decrease in ODI indicators and an improvement in the quality of life of patients from 63.8 (57.1; 69.1) to 3.0 (2.0; 7.5) at 12 months. When comparing the parameters (VAS and ODI), the obtained differences before/after the operation were statistically significant, while these changes have a pronounced correlation. Postoperative CT studies (3, 6, 12 months) showed no instability of the screws. Conclusion. Osteoplasty of vertebral bone defects and screw augmentation using orthobiological approaches have demonstrated their primary efficacy and safety. Further studies with a large sample size are needed to confirm the obtained results.

Keywords

• instability of the hardware
• screw loosening
• osteoplasty
• orthobiology
• thrombogel
• platelet-rich plasma