Radiographic outcomes of transosseous intradiscal screw fixation in lumbar reconstruction—Imaging results of an experience with an alternative in fixation of the unexpectedly osteopenic spine

OBJECTIVE: To present the results of a new alternative in the technique lumbar pedicle screw reconstruction in osteopenic bone. Pedicle screw fixation is compromised in osteopenic bone and adjunct fixation commonly requires incremental technology that can increase cost and risk, and which may not commonly be available. Readily available low cost techniques are desirable. PATIENTS AND METHODS: This is a retrospective review of a prospectively accumulated case series of all patients presenting to the senior author's (DAB) practice for elective lumbar reconstruction at a tertiary spine referral center. All consecutive patients treated by the senior author 2002-2012 who were unexpectedly found to be severely osteopenic at surgery are reported. RESULTS: In seventy-four cases with imaging and clinical information available at an average of five years after surgery there was no screw lucency or accelerated disc degeneration observed despite these screws purposefully projecting into the suprajacent disc space within the limits of the construct. No patient had presented for instrumentation-related revision surgery of any sort. CONCLUSION: Transosseous intradiscal screw fixation is a potentially viable alternative in surgical stabilization of the unexpectedly osteopenic lumbar spine.