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Li CC, Yang XL, Wu WW, Zhou R, Jiang YF, Xiao J, Zhang YX, Song L, Dai F. Injectable bone cement cannulated pedicle screw for lumbar degenerative disease in osteoporosis - clinical follow-up of over 5 years. J Orthop Surg Res 2024; 19:440. [PMID: 39068450 PMCID: PMC11282736 DOI: 10.1186/s13018-024-04934-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the clinical efficacy of injectable cemented hollow pedicle screw (CICPS) in the treatment of osteoporotic lumbar degenerative diseases through a large sample long-term follow-up study. Additionally, we aim to explore the risk factors affecting interbody fusion. METHODS A total of 98 patients who underwent CICPS for transforaminal lumbar interbody fusion (TLIF) for osteoporotic lumbar degenerative disease from March 2011 to September 2017 were analyzed. X-ray and electronic computed tomography (CT) imaging data were collected during preoperative, postoperative, and follow-up periods. The data included changes in intervertebral space height (ΔH), screw failure, cement leakage (CL), and intervertebral fusion. The patients were divided into two groups based on their fusion status one year after surgery: satisfied group A and dissatisfied group B. Surgical data such as operation time, intraoperative bleeding volume and surgical complications were recorded, and visual analog scale (VAS) and Oswestry disability index (ODI) were used to evaluate the improvement of lumbar and leg pain. RESULTS The mean follow-up time was 101.29 months (ranging from 70 to 128 months). A total of 320 CICPS were used, with 26 screws (8.13%) leaking, 3 screws (0.94%) experiencing cement augmentation failure, and 1 screw (0.31%) becoming loose and breaking. The remaining screws were not loose or pulled out. Female gender, decreased bone density, and CL were identified as risk factors affecting interbody fusion (P < 0.05). Early realization of interbody fusion can effectively prevent the loss of intervertebral space height (P < 0.05) and maintain the surgical treatment effect. Both VAS and ODI scores showed significant improvement during the follow-up period (P < 0.05). Binary logistic regression analysis revealed that decreased bone density and cement leakage were risk factors for prolonged interbody fusion. CONCLUSIONS The results of long-term follow-up indicate that PMMA enhanced CICPS has unique advantages in achieving good clinical efficacy in the treatment of osteoporosis lumbar degenerative diseases. Attention should be paid to identify female gender, severe osteoporosis, and CL as risk factors affecting interbody fusion.
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Affiliation(s)
- Cong-Can Li
- Department of Orthopaedics, First Affiliated Hospital, Army Medical University, No. 30 Gaotanyanzheng street, Chongqing, 400038, China
| | - Xiu-Lun Yang
- Department of Orthopaedics, First Affiliated Hospital, Army Medical University, No. 30 Gaotanyanzheng street, Chongqing, 400038, China
| | - Wen-Wen Wu
- Chinese People's Liberation Army 132U, Tunchangxian, 571627, China
| | - Rui Zhou
- Department of Orthopaedics, First Affiliated Hospital, Army Medical University, No. 30 Gaotanyanzheng street, Chongqing, 400038, China
| | - Yi-Fan Jiang
- Fourth Department of Convalescence, Sanya Rehabilitation and Convalescent Center, Joint Logistics Support Force, Sanya, 572000, China
| | - Jun Xiao
- Department of Special Service Physiological Training, Guangzhou Special Service Recuperation Center, PLA Rocket Force, Guangzhou, Shantou, 515515, China
| | - Yu-Xuan Zhang
- Department of Special Service Physiological Training, Guangzhou Special Service Recuperation Center, PLA Rocket Force, Guangzhou, Shantou, 515515, China
| | - Lei Song
- Department of Orthopaedics, First Affiliated Hospital, Army Medical University, No. 30 Gaotanyanzheng street, Chongqing, 400038, China.
| | - Fei Dai
- Department of Orthopaedics, First Affiliated Hospital, Army Medical University, No. 30 Gaotanyanzheng street, Chongqing, 400038, China.
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Bereczki F, Turbucz M, Pokorni AJ, Hajnal B, Ronai M, Klemencsics I, Lazary A, Eltes PE. The effect of polymethylmethacrylate augmentation on the primary stability of stand-alone implant construct versus posterior stabilization in oblique lumbar interbody fusion with osteoporotic bone quality- a finite element study. Spine J 2024; 24:1323-1333. [PMID: 38307174 DOI: 10.1016/j.spinee.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND CONTEXT Oblique lumbar interbody fusion (OLIF) can provide an ideal minimally invasive solution for achieving spinal fusion in an older, more frail population where decreased bone quality can be a limiting factor. Stabilization can be achieved with bilateral pedicle screws (BPS), which require additional incisions and longer operative time. Alternatively, a novel self-anchoring stand-alone lateral plate system (SSA) can be used, where no additional incisions are required. Based on the relevant literature, BPS constructs provide greater primary biomechanical stability compared to lateral plate constructs, including SSA. This difference is further increased by osteoporosis. Screw augmentation in spinal fusion surgeries is commonly used; however, in the case of OLIF, it is a fairly new concept, lacking a consensus-based guideline. PURPOSE This comparative finite element (FE) study aimed to investigate the effect of PMMA screw augmentation on the primary stability of a stand-alone implant construct versus posterior stabilization in OLIF with osteoporotic bone quality. STUDY DESIGN The biomechanical effect of screw augmentation was studied inside an in-silico environment using computer-aided FE analysis. METHODS A previously validated and published L2-L4 FE model with normal and osteoporotic bone material properties was used. Geometries based on the OLIF implants (BPS, SSA) were created and placed inside the L3-L4 motion segment with increasing volumes (1-6 cm3) of PMMA augmentation. A follower load of 400 N and 10 Nm bending moment (in the three anatomical planes) were applied to the surgical FE models with different bone material properties. The operated L3-L4 segmental range of motion (ROM), the inserted cage's maximal caudal displacements, and L4 cranial bony endplate principal stress values were measured. RESULTS The nonaugmented values for the BPS construct were generally lower compared to SSA, and the difference was increased by osteoporosis. In osteoporotic bone, PMMA augmentation gradually decreased the investigated parameters and the difference between the two constructs as well. Between 3 cm3 and 4 cm3 of injected PMMA volume per screw, the difference between augmented SSA and standard BPS became comparable. CONCLUSIONS Based on this study, augmentation can enhance the primary stability of the constructs and decrease the difference between them. Considering leakage as a possible complication, between 3 cm3 and 4 cm3 of injected PMMA per screw can be an adequate amount for SSA augmentation. However, further in silico, and possibly in vitro and clinical testing is required to thoroughly understand the investigated biomechanical aspects. CLINICAL SIGNIFICANCE This study sheds light on the possible biomechanical advantage offered by augmented OLIF implants and provides a theoretical augmentation amount for the SSA construct. Based on the findings, the concept of an SSA device with PMMA augmentation capability is desirable.
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Affiliation(s)
- Ferenc Bereczki
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary; School of PhD Studies, Semmelweis University, Üllői Str. 26, Budapest, Hungary
| | - Mate Turbucz
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary; School of PhD Studies, Semmelweis University, Üllői Str. 26, Budapest, Hungary
| | - Agoston Jakab Pokorni
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary; School of PhD Studies, Semmelweis University, Üllői Str. 26, Budapest, Hungary
| | - Benjamin Hajnal
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary; School of PhD Studies, Semmelweis University, Üllői Str. 26, Budapest, Hungary
| | - Marton Ronai
- National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary
| | - Istvan Klemencsics
- National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary
| | - Aron Lazary
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Üllői Str. 78/b, Budapest, Hungary
| | - Peter Endre Eltes
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Királyhágó Str. 1-3, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Üllői Str. 78/b, Budapest, Hungary.
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Chen Z, Wang B, Yang C, Lv Z, Wei Y, Pan T, Xuan F, Zhou X, Chen H, Shen H, Wang L, Zhang Y. 3D Printed Pedicle Screws with Microarc Oxidation Ceramic Interfaces Enhance Osteointegration and Orthopedic Fixation Feasibility. ACS APPLIED MATERIALS & INTERFACES 2024; 16:31983-31996. [PMID: 38865688 DOI: 10.1021/acsami.4c03628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Effective osteointegration is of great importance for pedicle screws in spinal fusion surgeries. However, the lack of osteoinductive activity of current screws diminishes their feasibility for osteointegration and fixation, making screw loosening a common complication worldwide. In this study, Ti-6Al-4V pedicle screws with full through-hole design were fabricated via selective laser melting (SLM) 3D printing and then deposited with porous oxide coatings by microarc oxidation (MAO). The porous surface morphology of the oxide coating and the release of bioactive ions could effectively support cell adhesion, migration, vascularization, and osteogenesis in vitro. Furthermore, an in vivo goat model demonstrated the efficacy of modified screws in improving bone maturation and osseointegration, thus providing a promising method for feasible orthopedic internal fixation.
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Affiliation(s)
- Zehao Chen
- Department of Spine Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
- Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, China
| | - Binghao Wang
- Guangxi Zhuang Autonomous Region Engineering Research Center for Biomaterials in Bone and Joint Degenerative Diseases, Guangxi Key Laboratory for Preclinical and Translational Research on Bone and Joint Degenerative Diseases, Affiliated Hospital of Youjiang Medical University, Baise, Guangxi 533000, China
- State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Chengliang Yang
- Guangxi Zhuang Autonomous Region Engineering Research Center for Biomaterials in Bone and Joint Degenerative Diseases, Guangxi Key Laboratory for Preclinical and Translational Research on Bone and Joint Degenerative Diseases, Affiliated Hospital of Youjiang Medical University, Baise, Guangxi 533000, China
| | - Zhendong Lv
- Department of Spine Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Yu Wei
- Guangxi Zhuang Autonomous Region Engineering Research Center for Biomaterials in Bone and Joint Degenerative Diseases, Guangxi Key Laboratory for Preclinical and Translational Research on Bone and Joint Degenerative Diseases, Affiliated Hospital of Youjiang Medical University, Baise, Guangxi 533000, China
| | - Tianming Pan
- Danyang Hospital of Traditional Chinese Medicine, Jiangsu 212300, China
| | - Fuqing Xuan
- Department of Spine Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, China
| | - Xingdie Zhou
- Department of Spine Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
- School of Materials Science and Engineering, Shanghai University, Shanghai 200444, China
| | - Hao Chen
- Department of Spine Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Hongxing Shen
- Department of Spine Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Liqiang Wang
- State Key Laboratory of Metal Matrix Composites, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yuhui Zhang
- Department of Spine Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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Wang Y, Zhou C, Yin H, Song D. Comparison of cement-augmented pedicle screw and conventional pedicle screw for the treatment of lumbar degenerative patients with osteoporosis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1609-1617. [PMID: 38363348 DOI: 10.1007/s00590-024-03849-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To compare the safety and clinical efficacy between using cement-augmented pedicle screws (CAPS) and conventional pedicle screws (CPS) for the treatment of lumbar degenerative patients with osteoporosis. Management of lumbar degenerative patients with osteoporosis undergoing spine surgery is challenging. The clinical efficacy and potential complications of the mid-term performance of the CAPS technique in the treatment of lumbar degenerative patients with osteoporosis remain to be evaluated. PATIENTS AND METHODS The data of 131 lumbar degenerative patients with osteoporosis who were treated with screw fixation from May 2016 to December 2019 were retrospectively analyzed in this study. The patients were divided into the following two groups according to the type of screw used: (I) the CAPS group (n = 85); and (II) the CPS group (n = 46). Relevant data were compared between two groups, including the demographics data, clinical results and complications. RESULTS The difference in the VAS, ODI and JOA scores at three and 6 months after the operation between the two groups was statistically significant (P < 0.05). At 12 months after surgery and the final follow-up, a significant difference in the fusion rate was found between the two groups (P < 0.05). Four cemented screws loosening were observed in the CAPS group (loosening rate 4/384, 1.04%) and 15 screws loosening were observed in the CPS group (loosening rate 15/214, 7.01%). In the CAPS group, a total of 384 augmented screws were used, and cement leakage was observed in 25 screws (25/384, 6.51%), but no obvious clinical symptoms or serious complications were observed. Adjacent vertebral fractures occurred in six patients in the CAPS group and one in the CPS group. CONCLUSIONS CAPS technique is an effective strategy for the treatment of lumbar degenerative patients with osteoporosis, with a higher fusion rate and lower screw loosening rate than CPS.
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Affiliation(s)
- Yazhou Wang
- Department of Orthopedics, Shanghai Songjiang District Central Hospital, Shanghai, China
- Department of Orthopedics, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Chenghao Zhou
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 650 New Songjiang Road, Songjiang District, Shanghai, 200080, China
| | - Huabin Yin
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 650 New Songjiang Road, Songjiang District, Shanghai, 200080, China
| | - Dianwen Song
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 650 New Songjiang Road, Songjiang District, Shanghai, 200080, China.
- Department of Orthopedics, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.
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Weber M, Lenz M, Egenolf P, Prescher A, Walter S, Heck VJ, Eysel P, Scheyerer MJ. Increased stability due to symmetric cement volume in augmented pedicle screws? A biomechanical study. J Biomed Mater Res B Appl Biomater 2024; 112:e35339. [PMID: 37955803 DOI: 10.1002/jbm.b.35339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 08/01/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023]
Abstract
Pedicle screw instrumentation has become "state of the art" in surgical treatment of many spinal disorders. Loosening of pedicle screws due to poor bone mineral density is a frequent complication in osteoporotic patients. As prevalence of osteoporosis and spinal disorders are increasing with an aging demographic, optimizing the biomechanical properties of pedicle screw constructions and therefore outcome after spinal surgery in osteoporotic patients is a key factor in future surgical therapy. Therefore, this biomechanical study investigated the stability of polymethylmethacrylate (PMMA)-augmented pedicle screw-rod constructions under a deviating distribution of PMMA applied to the instrumentation in osteoporotic human cadaveric vertebrae. We showed that PMMA-augmented pedicle screw-rod constructions tend to be more stable than those with non-augmented pedicle screws. Further, there appears to be a larger risk of screw loosening in unilateral augmented pedicle screws than in non-augmented, therefore a highly asymmetrically distributed PMMA should be avoided.
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Affiliation(s)
- Maximilian Weber
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Maximilian Lenz
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Philipp Egenolf
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Andreas Prescher
- University Hospital RWTH, Institute of Molecular and Cellular Anatomy (MOCA), Aachen, Germany
| | - Sebastian Walter
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Vincent J Heck
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Peer Eysel
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Max Joseph Scheyerer
- Department of Trauma and Spine Surgery, Heinrich Heine University Hospital Düsseldorf, Düsseldorf, Germany
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Shafiekhani P, Darabi M, Jajin EA, Shahmohammadi M. Pedicle Screw Fixation With Cement Augmentation Versus Without in the Treatment of Spinal Stenosis Following Posterior Spinal Fusion Surgery, Superiority According to Bone Mineral Density: A Three-Arm Randomized Clinical Trial. World Neurosurg 2023; 180:e266-e273. [PMID: 37741334 DOI: 10.1016/j.wneu.2023.09.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE To investigate whether cement augmentation has an impact on clinical and radiologic outcomes following posterior spinal fusion (PSF) in low-density bones and whether its performance is comparable to regular bone density. METHODS Between 2017 and 2021, 114 patients with spinal canal stenosis were enrolled to undergo PSF. They were initially stratified based on their bone mineral density: T-score ≥ -1.5: Group I (n = 34), and T-score < -1.5: Group II (n = 80). Furthermore, group II was randomly subdivided: II-A (unaugmented, n = 35) and II-B (bone cement augmented, n = 45). The primary and secondary endpoints of the study were evaluated using visual analog scales (VAS) and radiologic parameters, including screw loosening, screw or rod fractures, proximal junctional kyphosis (PJK), proximal junctional vertebral fracture (PJVF), and adjacent segment disease (ASD), at 1 year postoperatively. RESULTS All 3 groups showed improvement in VAS scores, but the most significant improvements were seen in groups I and II-B. Group II-B had lower incidence rates of ASD, PJVF, PJK, rod, and screw fracture compared to group II-A, but only screw loosening was statistically significant (P < 0.0001). Contrary, there were statistically significant differences in all variables except for ASD and screw fracture (P = 0.0576 and 0.670, respectively) when comparing groups I and II-A. In both groups I and II-A, screw loosening was the most common complication following PSF, while only 5.41% of patients in group II-B experienced it. CONCLUSIONS The efficacy of cement augmentation in mitigating pain and screw loosening following PSF surgery in low-density bones is comparable to that of normal-density bone.
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Affiliation(s)
- Paria Shafiekhani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Darabi
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elnaz Amanzadeh Jajin
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shahmohammadi
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Boucas P, Mamdouhi T, Rizzo SE, Megas A. Cement Augmentation of Pedicle Screw Instrumentation: A Literature Review. Asian Spine J 2023; 17:939-948. [PMID: 37788974 PMCID: PMC10622820 DOI: 10.31616/asj.2022.0216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 10/05/2023] Open
Abstract
This literature review aimed to review the current understanding, indications, and limitations of pedicle screw instrumentation cement augmentation. Since they were first reported in the 1980s, pedicle screw cement augmentation rates have been increasing. Several studies have been published to date that describe various surgical techniques and the biomechanical changes that occur when cement is introduced through the screw-bone interface. This article provides a concise review of the uses, biomechanical properties, cost analysis, complications, and surgical techniques used for pedicle screw cement augmentation to help guide physician practices. A comprehensive review of the current literature was conducted, with key studies, and contributions from throughout history being highlighted. Patients with low bone mineral density are the most well-studied indication for pedicle screw cement augmentation. Many studies show that cement augmentation can improve pullout strength in patients with low bone mineral density; however, the benefit varies inversely with pathology severity and directly with technique. The various screw types are discussed, with each having its own mechanical advantages. Cement distribution is largely dependent on the filling method and volume of cement used. Cement composition and timing of cement use after mixing are critical considerations in practice because they can significantly alter the bone-cement and screw-cement interfaces. Overall, studies have shown that pedicle screw cement augmentation has a low complication rate and increased pullout strength, justifying its universal use in patients with a suboptimal bone-implant interface.
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Affiliation(s)
- Peter Boucas
- Department of Orthopaedic Surgery, Huntington Hospital Northwell Health, Huntington, NY,
USA
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,
USA
| | - Tania Mamdouhi
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,
USA
| | - Sarah E. Rizzo
- Department of Orthopaedic Surgery, Huntington Hospital Northwell Health, Huntington, NY,
USA
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY,
USA
| | - Andrew Megas
- Department of Orthopaedic Surgery, Grewal Orthopaedic and Spine Care, East Meadow, NY,
USA
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Costăchescu B, Niculescu AG, Grumezescu AM, Teleanu DM. Screw Osteointegration-Increasing Biomechanical Resistance to Pull-Out Effect. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5582. [PMID: 37629873 PMCID: PMC10456840 DOI: 10.3390/ma16165582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
Spinal disorders cover a broad spectrum of pathologies and are among the most prevalent medical conditions. The management of these health issues was noted to be increasingly based on surgical interventions. Spinal fixation devices are often employed to improve surgery outcomes, increasing spinal stability, restoring structural integrity, and ensuring functionality. However, most of the currently used fixation tools are fabricated from materials with very different mechanical properties to native bone that are prone to pull-out effects or fail over time, requiring revision procedures. Solutions to these problems presently exploited in practice include the optimal selection of screw shape and size, modification of insertion trajectory, and utilization of bone cement to reinforce fixation constructs. Nevertheless, none of these methods are without risks and limitations. An alternative option to increasing biomechanical resistance to the pull-out effect is to tackle bone regenerative capacity and focus on screw osteointegration properties. Osteointegration was reportedly enhanced through various optimization strategies, including use of novel materials, surface modification techniques (e.g., application of coatings and topological optimization), and utilization of composites that allow synergistic effects between constituents. In this context, this paper takes a comprehensive path, starting with a brief presentation of spinal fixation devices, moving further to observations on how the pull-out strength can be enhanced with existing methods, and further focusing on techniques for implant osteointegration improvement.
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Affiliation(s)
- Bogdan Costăchescu
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- “Prof. Dr. N. Oblu” Emergency Clinical Hospital, 700309 Iasi, Romania
| | - Adelina-Gabriela Niculescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania;
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
| | - Alexandru Mihai Grumezescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania;
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
- Academy of Romanian Scientists, Ilfov No. 3, 050044 Bucharest, Romania
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Schleifenbaum S, Vogl AC, Heilmann R, von der Hoeh NH, Heyde CE, Jarvers JS. Biomechanical comparative study of midline cortical vs. traditional pedicle screw trajectory in osteoporotic bone. BMC Musculoskelet Disord 2023; 24:395. [PMID: 37198565 PMCID: PMC10193652 DOI: 10.1186/s12891-023-06502-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION In lumbar spinal stabilization pedicle screws are used as standard. However, especially in osteoporosis, screw anchorage is a problem. Cortical bone trajectory (CBT) is an alternative technique designed to increase stability without the use of cement. In this regard, comparative studies showed biomechanical superiority of the MC (midline cortical bone trajectory) technique with longer cortical progression over the CBT technique. The aim of this biomechanical study was to comparatively investigate the MC technique against the not cemented pedicle screws (TT) in terms of their pullout forces and anchorage properties during sagittal cyclic loading according to the ASTM F1717 test. METHODS Five cadavers (L1 to L5), whose mean age was 83.3 ± 9.9 years and mean T Score of -3.92 ± 0.38, were dissected and the vertebral bodies embedded in polyurethane casting resin. Then, one screw was randomly inserted into each vertebra using a template according to the MC technique and a second one was inserted by freehand technique with traditional trajectory (TT). The screws were quasi-static extracted from vertebrae L1 and L3, while for L2, L4 and L5 they were first tested dynamically according to ASTM standard F1717 (10,000 cycles at 1 Hz between 10 and 110 N) and then quasi-static extracted. In order to determine possible screw loosening, there movements were recorded during the dynamic tests using an optical measurement system. RESULTS The pull-out tests show a higher pull-out strength for the MC technique of 555.4 ± 237.0 N compared to the TT technique 448.8 ± 303.2 N. During the dynamic tests (L2, L4, L5), 8 out of the 15 TT screws became loose before completing 10,000 cycles. In contrast, all 15 MC screws did not exceed the termination criterion and were thus able to complete the full test procedure. For the runners, the optical measurement showed greater relative movement of the TT variant compared to the MC variant. The pull-out tests also revealed that the MC variant had a higher pull-out strength, measuring at766.7 ± 385.4 N, while the TT variant measured 637.4 ± 435.6 N. CONCLUSION The highest pullout forces were achieved by the MC technique. The main difference between the techniques was observed in the dynamic measurements, where the MC technique exhibited superior primary stability compared to the conventional technique in terms of primary stability. Overall, the MC technique in combination with template-guided insertion represents the best alternative for anchoring screws in osteoporotic bone without cement.
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Affiliation(s)
- Stefan Schleifenbaum
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany
- ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Semmelweisstraße 14, D-04103, Leipzig, Germany
| | - Ann-Cathrin Vogl
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany
- ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Semmelweisstraße 14, D-04103, Leipzig, Germany
| | - Robin Heilmann
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany
- ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Semmelweisstraße 14, D-04103, Leipzig, Germany
| | - Nicolas Heinz von der Hoeh
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany
- ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Semmelweisstraße 14, D-04103, Leipzig, Germany
| | - Jan-Sven Jarvers
- Department of Orthopedic, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, D-04103, Leipzig, Germany.
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10
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Liu YY, Xiao J, He L, Yin X, Song L, Zhou R, Zeng J, Liu P, Dai F. Risk factor analysis of bone cement leakage for polymethylmethacrylate-augmented cannulated pedicle screw fixation in spinal disorders. Heliyon 2023; 9:e15167. [PMID: 37089395 PMCID: PMC10113860 DOI: 10.1016/j.heliyon.2023.e15167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
Objective To investigate the risk factors of cement leakage (CL) for polymethylmethacrylate-augmented cannulated pedicle screw (CPS) in spinal degenerative diseases and provided technical guidance for clinical surgery. Methods This study enrolled 276 patients with spinal degenerative disease and osteoporosis who were augmented using CPSs (835 screws in total) from May 2011 to June 2018 in our hospital. The patients' age, sex, bone mineral density (BMD), diagnosis, augmented positions, number of CPS implanted, and CL during surgery were recorded. CL was observed by postoperative computed tomography (CT) and was classified by Yeom typing. Results A total of 74 (74/835, 8.9%) CPSs in 64 patients leaked (64/276, 23.2%). CL was significantly correlated with the number and position of screws (P < 0.05), but not with sex, age, and BMD (P > 0.05). The position, number of CPSs, fracture, degenerative scoliosis, ankylosing spondylitis, and revision surgery were risk factors for CL (P < 0.05). Augmentation of the thoracic vertebral body, fracture, and ankylosing spondylitis were independent risk factors for Type S. Augmentation of the lumbar vertebral body, lumbar disc herniation, and lumbar spondylolisthesis were independent risk factors for Type B (P < 0.05). Conclusions CL has a high incidence in clinical practice. High-risk factors for leakage should be addressed to avoid serious complications. Particularly, it is necessary to develop alternative solutions once CPSs can't be used in surgery caused by CL.
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Affiliation(s)
- Yao-yao Liu
- Department of Spine Surgery, Daping Hospital, Army Medical Center of PLA, Chongqing, 400042, PR China
| | - Jun Xiao
- Guangzhou Rocket Force Special Service Convalescent Center, Guangzhou, 510515, PR China
| | - Lei He
- Department of Orthopedics, Southwest Hospital of Army Medical University, PLA, Chongqing, 400038, PR China
| | - Xiang Yin
- Department of Spine Surgery, Daping Hospital, Army Medical Center of PLA, Chongqing, 400042, PR China
| | - Lei Song
- Department of Orthopedics, Southwest Hospital of Army Medical University, PLA, Chongqing, 400038, PR China
| | - Rui Zhou
- Department of Orthopedics, Southwest Hospital of Army Medical University, PLA, Chongqing, 400038, PR China
| | - Jing Zeng
- Guangzhou Rocket Force Special Service Convalescent Center, Guangzhou, 510515, PR China
| | - Peng Liu
- Department of Spine Surgery, Daping Hospital, Army Medical Center of PLA, Chongqing, 400042, PR China
- Corresponding author. Department of Spine surgery, Daping Hospital, Army Medical Center of PLA, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, PR China.
| | - Fei Dai
- Department of Orthopedics, Southwest Hospital of Army Medical University, PLA, Chongqing, 400038, PR China
- Corresponding author. Department of Orthopedics, Southwest Hospital of Army Medical University, PLA, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, PR China.
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11
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Song L, Xiao J, Zhou R, Li CC, Zheng TT, Dai F. Clinical evaluation of the efficacy of a new bone cement-injectable cannulated pedicle screw in the treatment of spondylolysis-type lumbar spondylolisthesis with osteoporosis: a retrospective study. BMC Musculoskelet Disord 2022; 23:951. [PMID: 36329431 PMCID: PMC9632048 DOI: 10.1186/s12891-022-05904-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose To investigate the clinical efficacy and safety of a bone cement-injectable cannulated pedicle screw (CICPS) in the treatment of spondylolysis-type lumbar spondylolisthesis with osteoporosis. Methods A retrospective study was conducted on 37 patients (Dual-energy X-ray bone density detection showed different degrees of osteoporosis) with spondylolysis-type lumbar spondylolisthesis who underwent lumbar spondylolisthesis reduction and fusion using a new type of injectable bone cement screw from May 2011 to March 2015. Postoperative clinical efficacy was evaluated by the Visual Analogue Scale (VAS) scores and the Oswestry Disability Index (ODI). Imaging indexes were used to evaluate the stability of internal fixation of the devices 1, 3, 6, and 12 months after surgery and annually thereafter. The safety of the CICPS was assessed by the prevalence of intraoperative and postoperative complications. Results A total of 124 CICPS were implanted intraoperatively. Bone cement leakage occurred in 3 screws (2.42%), and no clinical discomfort was found in any patients. All 37 patients were followed up with an average follow-up time of 26.6 ± 13.4 months (12–58 months). In the evaluation of the clinical effects of the operation, the average postoperative VAS score of the patients decreased from 4.30 ± 1.58 before surgery to 0.30 ± 0.70 after surgery (P < 0.001), and the ODI decreased from 47.27% ± 16.97% before surgery to 3.36% ± 5.70% after surgery (P < 0.001). No screw was loose, broken or pulled out. Conclusion CICPS is safe and effective in the treatment of spondylolysis-type lumbar spondylolisthesis complicated by osteoporosis.
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Affiliation(s)
- Lei Song
- Department of Orthopaedics, First Affiliated Hospital, Army Medical University, Chongqing, 400038, People's Republic of China
| | - Jun Xiao
- Department of Special Service Physiological Training, Guangzhou Special Service Recuperation Center of PLA Rocket Force, Guangzhou, 515515, People's Republic of China
| | - Rui Zhou
- Department of Orthopaedics, First Affiliated Hospital, Army Medical University, Chongqing, 400038, People's Republic of China
| | - Cong-Can Li
- Department of Orthopaedics, First Affiliated Hospital, Army Medical University, Chongqing, 400038, People's Republic of China
| | - Ting-Ting Zheng
- Department of Orthopaedics, First Affiliated Hospital, Army Medical University, Chongqing, 400038, People's Republic of China.
| | - Fei Dai
- Department of Orthopaedics, First Affiliated Hospital, Army Medical University, Chongqing, 400038, People's Republic of China.
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12
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Cementless posterior spinal fusion for the treatment of OI patients with severe spine deformity-a case series. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1566-1572. [PMID: 35322283 DOI: 10.1007/s00586-022-07179-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/14/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study is to present the outcomes all patients with osteogenesis imperfecta (OI) who underwent cementless posterior spinal fusion for the treatment of severe spine deformity in our institution. METHODS All patients with OI who underwent surgical correction of their spine deformity in our institution between 2003 and 2020 were enrolled. The collected data included demographics, operative and follow-up findings, medical history, bisphosphonate therapy, HGT protocol, pre- and post-HGT and postoperative scoliosis and kyphosis curve measurements, hospitalization length, complications, and revision surgeries. General treatment strategies included cessation of bisphosphonate therapy around the surgery, 30-day HGT protocol, titanium rods, cementless screw technique, and a high implant density policy. RESULTS Eleven consecutive patients with OI who underwent surgery for spine deformity in our institution were identified. The mean age at surgery was 15.6 ± 2.3. Mean follow-up period was 6.6 ± 5.8 years. The mean pre- and postoperative scoliosis curves were 85.4 ± 19.3° and 43.1 ± 12.5°, respectively, representing a 49.5% correction rate. Five patients underwent HGT and achieved a mean correction of 27.6 ± 7.1° (31.6%) preoperatively. Implant density ratio was 1.5 (screw or hook/level). Mean postoperative hospitalization length was 5.9 ± 1.6 days. One patient had deep wound infection which resolved following treatment according to our protocol for surgical site infection, and one patient had skull penetration by one of the halo pins. CONCLUSION Surgical treatment of severe spine deformity in OI patients with cementless posterior spinal fusion is safe and effective after applying a specific preoperative strategy.
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13
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Prediction of Sacral Screw Loosening after Lumbosacral Surgeries Involving Rigid Fixation of Sacral Bone Using Preoperative Computed Tomography Scans. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7123139. [PMID: 35655477 PMCID: PMC9152424 DOI: 10.1155/2022/7123139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/04/2022] [Accepted: 04/30/2022] [Indexed: 11/21/2022]
Abstract
Objective To find a preoperative computed tomography-based method to predict the incidence of sacral screw loosening and assist surgical planning. Methods Surgically treated patients for degenerative lumbosacral disorders with rigid pedicle screw fixation of patients with L5-S1 vertebra in our center from January 2016 to January 2021 were retrospectively included in the current study. CT scan attenuation of the horizontal plane of the sacrum was measured with Hounsfield units (HU). Postoperative X-ray tests were used to diagnose screw loosening. The data was analyzed by independent sample t-tests, X2 analysis, Pearson correlation analysis, and ROC curve analysis. Results A total of 162 (114 male, 48 female, average age 63.7 ± 7.3 years) patients were included in the final analysis. Significant differences were found between the screw loosening group and nonloosening group concerning the HU value of the sacrum at the horizontal plane (P < 0.01). In ROC curve analysis, AUC was 0.674 (95% CI: 0.592-0.756). A cutoff of 200 HU provided 64.8% sensitivity and 62.4% specificity, and a cutoff of 150 HU provided 90.2% sensitivity. Conclusions Analyzing 162 patients with at least 12 months of follow-up, we propose cutoff CT attenuation values of 200 HU and 150 HU to take moderate and radical measures of screw augmentation to prevent screw loosening in the sacral bone.
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14
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Wang Y, Yang L, Li C, Sun H. The Biomechanical Properties of Cement-Augmented Pedicle Screws for Osteoporotic Spines. Global Spine J 2022; 12:323-332. [PMID: 33611971 PMCID: PMC8907649 DOI: 10.1177/2192568220987214] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
STUDY DESIGN This is a broad, narrative review of the literature. OBJECTIVE In this review, we describe recent biomechanics studies on cement-augmented pedicle screws for osteoporotic spines to determine which factors influence the effect of cement augmentation. METHODS A search of Medline was performed, combining the search terms "pedicle screw" and ("augmentation" OR "cement"). Articles published in the past 5 years dealing with biomechanical testing were included. RESULTS Several factors have been identified to impact the effect of cement augmentation in osteoporotic spines. These include the type of augmentation material, the volume of injected cement, the timing of augmentation, the severity of osteoporosis, the design of the pedicle screw, and the specific augmenting technique, among others. CONCLUSIONS This review elaborates the biomechanics of cement-augmented pedicle screws, determines which factors influence the augmentation effect, and identifies the risk factors of cement leakage in osteoporotic bone, which might offer some guidance when using this technique in clinical practice. Further, we provide information about newly designed screws and recently developed augmentation materials that provide higher screw stability as well as fewer cement-related complications.
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Affiliation(s)
- Yuetian Wang
- Department of Orthopedics, Peking University First
Hospital, Beijing, China
| | - Lei Yang
- Center for Health Science and
Engineering(CHSE), School of Materials Science and Engineering, Hebei University of
Technology, Tianjin, China
| | - Chunde Li
- Department of Orthopedics, Peking University First
Hospital, Beijing, China
| | - Haolin Sun
- Department of Orthopedics, Peking University First
Hospital, Beijing, China,Haolin Sun, Peking University First
Hospital, Beijing 100034, China.
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15
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Liu JB, Zuo R, Zheng WJ, Li CQ, Zhang C, Zhou Y. The accuracy and effectiveness of automatic pedicle screw trajectory planning based on computer tomography values: an in vitro osteoporosis model study. BMC Musculoskelet Disord 2022; 23:165. [PMID: 35189892 PMCID: PMC8862578 DOI: 10.1186/s12891-022-05101-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/08/2022] [Indexed: 05/31/2023] Open
Abstract
Background Pedicle screw placement in patients with osteoporosis is a serious clinical challenge. The bone mineral density (BMD) of the screw trajectory has been positively correlated with the screw pull-out force, while the computer tomography (CT) value has been linearly correlated with the BMD. The purpose of this study was to establish an in vitro osteoporosis model and verify the accuracy and effectiveness of automated pedicle screw planning software based on CT values in this model. Methods Ten vertebrae (L1-L5) of normal adult pigs were randomly divided into decalcification and control groups. In the decalcification group, the vertebral bodies were decalcified with Ethylenediaminetetraacetic acid (EDTA) to construct an in vitro osteoporosis model. In the decalcification group, automatic planning (AP) and conventional manual planning (MP) were used to plan the pedicle screw trajectory on the left and right sides of the pedicle, respectively, and MP was used on both sides of the control group. CT values of trajectories obtained by the two methods were measured and compared. Then, 3D-printed guide plates were designed to assist pedicle screw placement. Finally, the pull-out force of the trajectory obtained by the two methods was measured. Results After decalcification, the BMD of the vertebra decreased from − 0.03 ± 1.03 to − 3.03 ± 0.29 (P < 0.05). In the decalcification group, the MP trajectory CT value was 2167.28 ± 65.62 Hu, the AP trajectory CT value was 2723.96 ± 165.83 Hu, and the MP trajectory CT value in the control group was 2242.94 ± 25.80 Hu (P < 0.05). In the decalcified vertebrae, the screw pull-out force of the MP group was 48.6% lower than that of the control group (P < 0.05). The pull-out force of the AP trajectory was 44.7% higher than that of the MP trajectory (P < 0.05) and reached 97.4% of the MP trajectory in the control group (P > 0.05). Conclusion Automatic planning of the pedicle screw trajectory based on the CT value can obtain a higher screw pull-out force, which is a valuable new method of pedicle screw placement in osteoporotic vertebre. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05101-6.
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Affiliation(s)
- Jia Bin Liu
- Department of Orthopaedics, Xinqiao Hospital, Amy Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Rui Zuo
- Department of Orthopaedics, Xinqiao Hospital, Amy Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Wen Jie Zheng
- Department of Orthopaedics, Xinqiao Hospital, Amy Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Chang Qing Li
- Department of Orthopaedics, Xinqiao Hospital, Amy Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Chao Zhang
- Department of Orthopaedics, Xinqiao Hospital, Amy Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China.
| | - Yue Zhou
- Department of Orthopaedics, Xinqiao Hospital, Amy Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China.
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16
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Guo H, Huang H, Shao Y, Qin Q, Liang D, Zhang S, Tang Y. Risk Factors for Pulmonary Cement Embolism (PCE) After Polymethylmethacrylate Augmentation: Analysis of 32 PCE Cases. Neurospine 2022; 18:806-815. [PMID: 35000335 PMCID: PMC8752710 DOI: 10.14245/ns.2142616.308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
Objective Pulmonary cement embolism (PCE) is an underestimated but potentially fatal complication after cement augmentation. Although the treatment and follow-up of PCE have been reported in the literature, the risk factors for PCE are so far less investigated. This study aims to identify the preoperative and intraoperative risk factors for the development of PCE.
Methods A total of 1,373 patients treated with the polymethylmethacrylate (PMMA) augmentation technique were retrospectively included. Patients with PCE were divided into vertebral augmentation group and screw augmentation group. Possible risk factors were collected as follows: age, sex, bone mineral density, body mass index, diagnosis, comorbidity, surgical procedure, type of screw, augmented level, number of augmented vertebrae, fracture severity, presence of intravertebral cleft, cement volume, marked leakage in the paravertebral venous plexus, and periods of surgery. Binary logistic regression analyses were used to analyze independent risk factors for PCE.
Results PCE was identified in 32 patients, with an incidence rate of 2.33% (32 of 1,373). For patients who had undergone vertebral augmentation, marked leakage in the paravertebral venous plexus (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.1–10.3; p=0.000) and previous surgery (OR, 16.1; 95% CI, 4.2–61.0; p=0.007) were independent risk factors for PCE. Regarding patients who had undergone screw augmentation, the marked leakage in the paravertebral venous plexus (OR, 4.2; 95% CI, 0.5–37.3; p=0.004) was the main risk factor.
Conclusion Marked leakage in the paravertebral venous plexus and previous surgery were significant risk factors related to PCE. Paravertebral leakage and operator experience should be concerned when performing PMMA augmentation.
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Affiliation(s)
- Huizhi Guo
- The first Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.,Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huasheng Huang
- The first Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yang Shao
- The first Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiuli Qin
- The first Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - De Liang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuncong Zhang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongchao Tang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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17
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Kidwell RL, Tan LA. Commentary: Lumbar Fixation Using the Cortical Bone Trajectory Fixation: A Single Surgeon Experience With 3-Year Follow-Up. Oper Neurosurg (Hagerstown) 2021; 22:e117-e119. [DOI: 10.1227/ons.0000000000000066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
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18
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Jain M, Nayak M, Sahoo A, Mishra NM. Large intraspinal cement leak during multilevel cement-augmented screw fixation. BMJ Case Rep 2021; 14:e247466. [PMID: 34949584 PMCID: PMC8704977 DOI: 10.1136/bcr-2021-247466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mantu Jain
- Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Manmatha Nayak
- Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Auroshish Sahoo
- Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Nitasha Mishra Mishra
- Anaesthesia, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
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19
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Zhang J, Wang G, Zhang N. A meta-analysis of complications associated with the use of cement-augmented pedicle screws in osteoporosis of spine. Orthop Traumatol Surg Res 2021; 107:102791. [PMID: 33338677 DOI: 10.1016/j.otsr.2020.102791] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/30/2020] [Accepted: 08/20/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE Our study aimed to provide updated and comprehensive evidence on the complications associated with the use of cement-augmented pedicle screws (CAPS) in osteoporosis patients undergoing spinal instrumentation. METHODS Databases of PubMed, Embase, Ovoid, and Google Scholar were screened from January 2000-February 2020 for studies reporting complications of CAPS in osteoporosis patients. Pooled estimates (with 95% confidence intervals) were calculated. RESULTS Twenty studies were included. The pooled risk of screw loosening, screw breakage and screw migration was 2.0% (0.2%-4.9%), 0.6% (0%-2.0%) and 0.2% (0%-1.2%) respectively. On pooling of data from 1277 patients, we found the risk of all cement leakage to be 21.8% (6%-43.1%). However, data from 1654 patients indicated the risk of symptomatic cement leakage was 1.2% (0.6%-1.9%). The incidence of pulmonary embolism was 3.0% (0.5%-6.8%) while the risk of symptomatic pulmonary embolism was 0.8% (0.2%-1.5%). Pooled risk of neurovascular complications was 1.6% (0.3%-3.6%), adjacent compression fracture was 3.3% (1.2%-6.2%) and infectious complications was 3.1% (1.1%-5.7%). There were high heterogeneity and variability in the study outcomes. CONCLUSION The incidence of screw-related complications like loosening, breakage, and migration with the use of CAPS in spinal instrumentation of osteoporotic patients is low. The risk of cement leakage is high and variable but the incidence of symptomatic cement leakage and related neurovascular or pulmonary complications is low. Further studies using homogenous methods of reporting are needed to strengthen current evidence. LEVEL OF EVIDENCE II, Systematic Review and Meta-analysis.
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Affiliation(s)
- Jinlong Zhang
- Department of Orthopedics, Shengli Oilfield Central Hospital, No.31, Jinan Road, 257000 Dongying City, Shandong Province, China
| | - Guohua Wang
- Department of Orthopedics, Shengli Oilfield Central Hospital, No.31, Jinan Road, 257000 Dongying City, Shandong Province, China.
| | - Nannan Zhang
- Department of Orthopedics, Shengli Oilfield Central Hospital, No.31, Jinan Road, 257000 Dongying City, Shandong Province, China
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20
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Varshneya K, Bhattacharjya A, Jokhai RT, Fatemi P, Medress ZA, Stienen MN, Ho AL, Ratliff JK, Veeravagu A. The impact of osteoporosis on adult deformity surgery outcomes in Medicare patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:88-94. [PMID: 34655336 DOI: 10.1007/s00586-021-06985-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify the impact of osteoporosis (OS) on postoperative outcomes in Medicare patients undergoing ASD surgery. BACKGROUND Patients with OP and advanced age experience higher than average rates of ASD. However, poor bone density could undermine the durability of a deformity correction. METHODS We queried the MarketScan Medicare Supplemental database to identify patients Medicare patients who underwent ASD surgery from 2007 to 2016. RESULTS A total of 2564 patients met the inclusion criteria of this study, of whom n = 971 (61.0%) were diagnosed with osteoporosis. Patients with OP had a similar 90-day postoperative complication rates (OP: 54.6% vs. non-OP: 49.2%, p = 0.0076, not significant after multivariate regression correction). This was primarily driven by posthemorrhagic anemia (37.6% in OP, vs. 33.1% in non-OP). Rates of revision surgery were similar at 90 days (non-OP 15.0%, OP 16.8%), but by 2 years, OP patients had a significantly higher reoperation rate (30.4% vs. 22.9%, p < 0.0001). In multivariate regression analysis, OP increased odds for revision surgery at 1 year (OR 1.4) and 2 years (OR 1.5) following surgery (all p < 0.05). OP was also an independent predictor of readmission at all time points (90 days, OR 1.3, p < 0.005). CONCLUSION Medicare patients with OP had elevated rates of complications, reoperations, and outpatient costs after undergoing primary ASD surgery.
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Affiliation(s)
- Kunal Varshneya
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA. .,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.
| | - Anika Bhattacharjya
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Rayyan T Jokhai
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Parastou Fatemi
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Zachary A Medress
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Martin N Stienen
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Allen L Ho
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - John K Ratliff
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Anand Veeravagu
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA.,Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
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21
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Ehresman J, Pennington Z, Elsamadicy AA, Hersh A, Lubelski D, Lehner K, Cottrill E, Schilling A, Lakomkin N, Ahmed AK, Lo SF, Sciubba DM. Fenestrated pedicle screws for thoracolumbar instrumentation in patients with poor bone quality: Case series and systematic review of the literature. Clin Neurol Neurosurg 2021; 206:106675. [PMID: 34020324 DOI: 10.1016/j.clineuro.2021.106675] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To describe the results of a single-surgeon series and systematically review the literature on cement-augmented instrumented fusion with fenestrated pedicle screws. METHODS All patients treated by the senior surgeon using fenestrated screws between 2017 and 2019 with a minimum of 6-months of clinical and radiographic follow-up were included. For the systematic review, we used PRISMA guidelines to identify all prior descriptions of cement-augmented instrumented fusion with fenestrated pedicle screws in the English literature. Endpoints of interest included hardware loosening, cement leakage, and pulmonary cement embolism (PCE). RESULTS Our series included 38 patients (mean follow-up 14.8 months) who underwent cement-augmented instrumentation for tumor (47.3%), deformity/degenerative disease (39.5%), or osteoporotic fracture (13.2%). Asymptomatic screw lucency was seen in 2.6%, cement leakage in 445, and pulmonary cement embolism (PCE) in 5.2%. Our literature review identified 23 studies (n = 1526 patients), with low reported rates of hardware loosening (0.2%) and symptomatic PCE (1.0%). Cement leakage, while common (55.6%), produced symptoms in fewer than 1% of patients. Indications for cement-augmentation in this cohort included: spine metastasis with or without pathologic fracture (n = 18; 47.3%), degenerative spine disease or fixed deformity with poor underlying bone quality (n = 15; 39.5%), and osteoporotic fracture (n = 5; 13.2%). CONCLUSION Cement-augmented fusion with fenestrated screws appears to be a safe, effective means of treating patients with poor underlying bone quality secondary to tumor or osteoporosis. High-quality evidence with direct comparisons to non-augmented patients is needed.
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Affiliation(s)
- Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Neurosurgery, Mayo Clinic, Rochester, MN 55905, USA.
| | - Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Andrew Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Kurt Lehner
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Andrew Schilling
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Nikita Lakomkin
- Department of Neurosurgery, Mayo Clinic, Rochester, MN 55905, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Sheng-Fu Lo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY 11030, USA.
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22
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Jarvers JS, Schleifenbaum S, Pfeifle C, Oefner C, Edel M, von der Höh N, Heyde CE. Comparison of three different screw trajectories in osteoporotic vertebrae: a biomechanical investigation. BMC Musculoskelet Disord 2021; 22:418. [PMID: 33952236 PMCID: PMC8101169 DOI: 10.1186/s12891-021-04254-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/13/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Pedicle screw insertion in osteoporotic patients is challenging. Achieving more screw-cortical bone purchase and invasiveness minimization, the cortical bone trajectory and the midline cortical techniques represent alternatives to traditional pedicle screws. This study compares the fatigue behavior and fixation strength of the cement-augmented traditional trajectory (TT), the cortical bone trajectory (CBT), and the midline cortical (MC). METHODS Ten human cadaveric spine specimens (L1 - L5) were examined. The average age was 86.3 ± 7.2 years. CT scans were provided for preoperative planning. CBT and MC were implanted by using the patient-specific 3D-printed placement guide (MySpine®, Medacta International), TT were implanted freehand. All ten cadaveric specimens were randomized to group A (CBT vs. MC) or group B (MC vs. TT). Each screw was loaded for 10,000 cycles. The failure criterion was doubling of the initial screw displacement resulting from the compressive force (60 N) at the first cycle, the stop criterion was a doubling of the initial screw displacement. After dynamic testing, screws were pulled out axially at 5 mm/min to determine their remaining fixation strength. RESULTS The mean pull-out forces did not differ significantly. Concerning the fatigue performance, only one out of ten MC of group A failed prematurely due to loosening after 1500 cycles (L3). Five CBT already loosened during the first 500 cycles. The mean displacement was always lower in the MC. In group B, all TT showed no signs of failure or loosening. Three MC failed already after 26 cycles, 1510 cycles or 2144 cycles. The TT showed always a lower mean displacement. In the subsequent pull-out tests, the remaining mean fixation strength of the MC (449.6 ± 298.9 N) was slightly higher compared to the mean pull-out force of the CBT (401.2 ± 261.4 N). However, MC (714.5 ± 488.0 N) were inferior to TT (990.2 ± 451.9 N). CONCLUSION The current study demonstrated that cement-augmented TT have the best fatigue and pull-out characteristics in osteoporotic lumbar vertebrae, followed by the MC and CBT. MC represent a promising alternative in osteoporotic bone if cement augmentation should be avoided. Using the patient-specific placement guide contributes to the improvement of screws' biomechanical properties.
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Affiliation(s)
- J-S Jarvers
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.
| | - S Schleifenbaum
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.,ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - C Pfeifle
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany
| | - C Oefner
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.,ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - M Edel
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.,ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - N von der Höh
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany
| | - C-E Heyde
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103, Leipzig, Germany.,ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
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23
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Massaad E, Rolle M, Hadzipasic M, Kiapour A, Shankar GM, Shin JH. Safety and efficacy of cement augmentation with fenestrated pedicle screws for tumor-related spinal instability. Neurosurg Focus 2021; 50:E12. [PMID: 33932920 DOI: 10.3171/2021.2.focus201121] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Achieving rigid spinal fixation can be challenging in patients with cancer-related instability, as factors such as osteopenia, radiation, and immunosuppression adversely affect bone quality. Augmenting pedicle screws with cement is a strategy to overcome construct failure. This study aimed to assess the safety and efficacy of cement augmentation with fenestrated pedicle screws in patients undergoing posterior, open thoracolumbar surgery for spinal metastases. METHODS A retrospective review was performed for patients who underwent surgery for cancer-related spine instability from 2016 to 2019 at the Massachusetts General Hospital. Patient demographics, surgical details, radiographic characteristics, patterns of cement extravasation, complications, and prospectively collected Patient-Reported Outcomes Measurement Information System Pain Interference and Pain Intensity scores were analyzed using descriptive statistics. Logistic regression was performed to determine factors associated with cement extravasation. RESULTS Sixty-nine patients underwent open posterior surgery with a total of 502 cement-augmented screws (mean 7.8 screws per construct). The median follow-up period for those who survived past 90 days was 25.3 months (IQR 10.8-34.6 months). Thirteen patients (18.8%) either died within 90 days or were lost to follow-up. Postoperative CT was performed to assess the instrumentation and patterns of cement extravasation. There was no screw loosening, pullout, or failure. The rate of cement extravasation was 28.9% (145/502), most commonly through the segmental veins (77/145, 53.1%). Screws breaching the lateral border of the pedicle but with fenestrations within the vertebral body were associated with a higher risk of leakage through the segmental veins compared with screws without any breach (OR 8.77, 95% CI 2.84-29.79; p < 0.001). Cement extravasation did not cause symptoms except in 1 patient who developed a symptomatic thoracic radiculopathy requiring decompression. There was 1 case of asymptomatic pulmonary cement embolism. Patients experienced significant pain improvement at the 3-month follow-up, with decreases in Pain Interference (mean change 15.8, 95% CI 14.5-17.1; p < 0.001) and Pain Intensity (mean change 28.5, 95% CI 26.7-30.4; p < 0.001). CONCLUSIONS Cement augmentation through fenestrated pedicle screws is a safe and effective option for spine stabilization in the cancer population. The risk of clinically significant adverse events from cement extravasation is very low.
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24
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Rodriguez-Arguisjuela M, Martin-Piñeiro B, Cuéllar-Bobadilla C, Leal-Caramanzana V, Heili-Frades S, Mahíllo-Fernandez I, Mengis CL, Gallego-Bustos J, Peiro A, Garzon-Márquez FM, Tomé-Bermejo F, Alvarez-Galovich L. Lung injury in patients age 75 years and older with the use of polymethylmethacrylate fenestrated pedicle screws. Spine J 2021; 21:430-437. [PMID: 33259968 DOI: 10.1016/j.spinee.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/12/2020] [Accepted: 11/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Pulmonary complications in patients age 75 years and older who undergo spinal fusion may have catastrophic consequences. The use of augmentation techniques with polymethylmethacrylate (PMMA) have been associated with pulmonary damage. The use of fenestrated pedicle screws augmented with PMMA may increase the risk of lung injury in this population. PURPOSE To investigate whether the use of PMMA-augmented screws is correlated with increased lung injury in patients undergoing instrumented lumbar spinal fusion. STUDY DESIGN A nonrandomized, prospective, case-controlled clinical study was carried out. PATIENT SAMPLE We included 50 consecutive patients: 25 classifieds as patients who required PMMA-augmented screws in lumbar spinal fusion, and 25 classifieds as control participants because they underwent uncemented instrumented spinal fusion. OUTCOME MEASURES We compare the incidence of the event, lung damage, in both groups by measuring a series of parameters: arterial blood gas, transesophageal echocardiography, urinary desmosine, and chest radiograph. The epidemiological parameters analyzed were age, sex, body mass index, status as a smoker, and number of cement leaks. METHODS Changes in pulmonary damage markers were described in both groups of patients, comparing postsurgery values with baseline values. In control participants, each change was evaluated for the total number of patients. All changes are indicated in this report by mean differences for quantitative variables and by differing proportions for qualitative variables, with 95% confidence intervals provided for all values. RESULTS There was an increase in postinstrumentation PaO2 (arterial partial pressure of oxygen) in both groups, probably related to the use of mechanical ventilation and recruitment maneuvers. Even though the group that required augmentation had lower baseline levels, the difference between groups was not statistically significant. On transesophageal echocardiographs, we observed scattered small, snowflake-like emboli, and bright echo signals appeared in the right atrium during PMMA injection. Signal density was constant but gradually faded away when PMMA injection ended. No participants in the group without augmentation had radiological complications. Overall, desmosine levels increased in both groups, and the rise was similar in both. There was a slight average increase in urine desmosine levels after instrumentation and progressively continues to rise until 24 hours after instrumentation, with a subsequent decrease at 72 hours. Comparing the two groups, we found no statistically significant differences at any time. CONCLUSIONS We were not able to identify a significant difference in urine desmosine levels associated with the augmentation of with fenestrated pedicle screws with PMMA. Despite comparing patients age 75 years or older with a younger group, we found no clinical, analytical, or gasometric data indicating lung damage in patients who had augmentation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Felix Tomé-Bermejo
- Hospital General de Villalba, Orthopedic Department, Collado Villalba, 28400 Madrid, Spain
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25
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Moser M, Jost J, Nevzati E. Kyphoplasty versus percutaneous posterior instrumentation for osteoporotic vertebral fractures with posterior wall injury: a propensity score matched cohort study. JOURNAL OF SPINE SURGERY 2021; 7:68-82. [PMID: 33834130 DOI: 10.21037/jss-20-625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Osteoporotic vertebral fractures (OVFs) that present with posterior wall cortical injury pose a higher risk for instability. Surgical management includes standard cement augmentation techniques like balloon kyphoplasty (BKP) or percutaneous posterior instrumentation with pedicle screws (PS) or both. Neither treatment has yet demonstrated superiority, and posterior cement leakage is of special concern in these fractures. Methods At a single tertiary care center, 25 patients with 32 OVFs with posterior wall injury treated with percutaneous instrumentation and cement augmentation (PS group) were retrospectively included and matched (1:1) using propensity scores to 25 patients with 29 OVFs with posterior wall injury treated with standalone BKP (BKP group) from 2010 to 2018. Our primary study aim identified 30-day morbidity rates using a 4-point grading system by comparing BKP with and without percutaneous instrumentation with PS for the treatment of OVFs with posterior wall injury. Our secondary aims evaluated cement leakage, radiographic results, surgical time, length of stay (LOS), pain relief, and subsequent fractures. Results Overall 30-day morbidity was 34% and did not differ between groups (24% BKP vs. 44% PS groups, P=0.136). Most complications were mild (82.4%), requiring no interventions beyond drug treatment. In the PS group, a trend towards more mild complications was observed (16% vs. 40%, P=0.059). Moderate and severe complications affected 17.6% of all morbidity cases and were comparable between groups. Asymptomatic cement leakage into the spinal canal was noted in 2 (8%) BKP patients and symptomatic pulmonary cement embolism in 1 (4.8%) PS patient. Compared with baseline, all radiographic parameters significantly improved in both groups. In the BKP group, mean surgical times (52±32.9 vs. 164.9±48.4 minutes, P<0.001) and LOS (4.3±2.5 vs. 7±2.9 days, P<0.001) were significantly shorter, and use of opioids at discharge was significantly lower (52% vs. 84%, P=0.015). At 3-month follow-up, no differences between groups were seen in back pain, use of opioids, and occurrence of subsequent OVFs. Follow-up averaged 8.4 months. Conclusions Standalone BKP may be a viable option for the treatment of OVFs even in the presence of posterior wall cortical injury.
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Affiliation(s)
- Manuel Moser
- Department of Spine Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland.,Department of Neurosurgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland
| | - Julien Jost
- Department of Spine Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland.,Department of Neurosurgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland
| | - Edin Nevzati
- Department of Spine Surgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland.,Department of Neurosurgery, Cantonal Hospital of Lucerne, Spitalstrasse, 6000 Lucerne, Switzerland
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26
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Li Q, Chen H, Liu T, He L, Liu P, Zhao Y, Du J, Zou P, Zhang Z, He B, Yang J, Hao D. [Polymethylmethacrylate-augmented screw fixation in treatment of senile thoracolumbar tuberculosis combined with severe osteoporosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1526-1532. [PMID: 33319530 DOI: 10.7507/1002-1892.202006014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the safety and effectiveness of polymethylmethacrylate-augmented screw fixation (PASF) in the treatment of elderly thoracolumbar tuberculosis combined with severe osteoporosis. Methods The clinical data of 20 elderly patients with thoracolumbar tuberculosis and severe osteoporosis who underwent PASF after anterior or posterior debridement and bone grafting and met the selection criteria between December 2012 and December 2014 were retrospectively analyzed. There were 8 males and 12 females with an average age of 68.5 years (range, 65-72 years). T value of bone mineral density was -4.2 to -3.6, with an average of -3.9. There were 12 cases of thoracic tuberculosis, 3 cases of thoracolumbar tuberculosis, and 5 cases of lumbar tuberculosis. The diseased segments involved T 3-L 4, including 11 cases of single-segment disease, 6 cases of double-segment disease, and 3 cases of multi-segment disease. The disease duration was 3-9 months, with an average of 6 months. The preoperative spinal nerve function of the patients was evaluated by the American Spinal Injury Association (ASIA) grading. There were 2 cases of grade A, 5 cases of grade B, 6 cases of grade C, 4 cases of grade D, and 3 cases of grade E. Postoperative imaging examination was used to evaluate the bone graft fusion and paravertebral abscess absorption, and to measure the Cobb angle of the segment to evaluate the improvement of kyphosis. The levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were tested. The visual analogue scale (VAS) score, Oswestry disability index (ODI), and ASIA grading were used to evaluate the effectivreness before operation, at 1 month after operation, and at last follow-up. The clinical cure of tuberculosis was also evaluated. Results All operation successfully completed. The operation time was 154-250 minutes, with an average of 202 minutes; the intraoperative blood loss was 368-656 mL, with an average of 512 mL. All 20 patients were followed up 18-42 months, with an average of 26.8 months. The postoperative pain and symptoms of tuberculosis in all patients relieved, and the paravertebral abscess was absorbed, reaching the cure standard for spinal tuberculosis. All bone grafts fusion achieved within 1 year after operation. Only 1 case had asymptomatic bone cement leakage into the paravertebral veins, and the remaining patients had no serious complications such as bone cement leakage in the spinal canal, pulmonary embolism, and neurovascular injury. At last follow-up, spinal cord nerve function significantly improved when compared with preoperative one. Among them, ASIA grading were 7 cases of grade C, 8 cases of grade D, and 5 cases of grade E, showing significant difference when compared with preoperative one ( Z=2.139, P=0.000). VAS score, ODI score, segmental Cobb angle, ESR, and CRP at 1 month after operation and at last follow-up were significantly improved when compared with preoperative ones ( P<0.05); there was no significant difference between 1 month after operation and last follow-up ( P>0.05). During the follow-up, no complications such as failure of internal fixation, proximal junctional kyphosis, or tuberculosis recurrence occurred. Conclusion For elderly patients with thoracolumbar tuberculosis and severe osteoporosis, PASF treatment is safe and effective.
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Affiliation(s)
- Qingda Li
- Yan'an University, Yan'an Shaanxi, 716000, P.R.China;Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Hao Chen
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Tuanjiang Liu
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Limin He
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Peng Liu
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Yuanting Zhao
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Jinpeng Du
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Peng Zou
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Zhengping Zhang
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Baorong He
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Junsong Yang
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Dingjun Hao
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
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27
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Guo HZ, Guo DQ, Tang YC, Liang D, Zhang SC. Selective cement augmentation of cranial and caudal pedicle screws provides comparable stability to augmentation on all segments in the osteoporotic spine: a finite element analysis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1384. [PMID: 33313129 PMCID: PMC7723578 DOI: 10.21037/atm-20-2246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Cement-augmented pedicle screw instrumentation (CAPSI) has been proven to significantly increase the biomechanical stability in the osteoporotic lumbar spine. However, besides the merits, it is responsible for the inevitable cement leakage growing with more instrumented segments and volumes involved. This study aimed to compare the biomechanical performance of pedicle screws augmented on all segments with those augmented only on the cranial and caudal vertebrae selectively. Methods The finite element model of L3-S1 was modeled with the CT data of a healthy volunteer, the solid/fenestrated pedicle screws from micro-CT scans of physical screws, and bone cement from the CT scans of a postoperative patient with CAPSI. Three different augmented strategies for pedicle screws were taken into consideration: augmentation at each pedicle trajectory (Model A), selective augmentation at the cranial and caudal pedicle trajectories (Model B), and pedicle trajectories without augmentation (Model C). A total of six surgical models were constructed: Models A, B, and C were subdivided into double segmental fusion from L4 to S1 (Models A1, B1, and C1) and multi-segment fusion from L3 to S1 (Models A2, B2, and C2). The Range of motion (ROM), stress on the cage, and stress on the fixed segments were compared among the six models. Results The ROM at the fusion segments decreased in all instrumentation models. The ROMs of Model B and Model A are similar in each direction, while that of Model C is significantly larger. The differences in the ROMs between Model A and Model B were noted to be less than 0.1°. Compared with Models A1 and A2, the peak Von Mise stress on the cage-endplate interface and pedicle screws were slightly higher in Models B1 and B2. In contrast, the stress of Models C1 and C2 increased significantly. The compressive stress was concentrated in the screw head, the cranial and caudal screws, and rods. Conclusions The selective augmentation of pedicle screws is capable of providing reliable stability in short-segment posterior fixation (2- or 3-level). It could be a potential optimal procedure to minimize the associated complications of CAPSI.
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Affiliation(s)
- Hui-Zhi Guo
- The First Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.,Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dan-Qing Guo
- The First Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong-Chao Tang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - De Liang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shun-Cong Zhang
- The First Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.,Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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28
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Liu YY, Xiao J, Jin HJ, Wang Z, Yin X, Liu MY, Zhao JH, Liu P, Dai F. Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis. J Orthop Surg Res 2020; 15:446. [PMID: 32993741 PMCID: PMC7526218 DOI: 10.1186/s13018-020-01975-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022] Open
Abstract
Background Cannulated pedicle screw (CPS) augmented by polymethylmethacrylate (PMMA) can achieve satisfactory clinical efficacy in the treatment of lumbar spondylolisthesis with osteoporosis. However, accurate application of CPSs will help to avoid the difficulty of screw revision and reduce the incidence of PMMA-related complications. This study aimed to investigate the mid-term efficacy of CPS compared to unilateral and bilateral applications in this common lumbar degenerative disease. Methods May 2011 and May 2018, 50 patients with lumbar spondylolisthesis with osteoporosis who underwent posterior fixation and fusion using traditional pedicle screws or CPSs were included in the study. Patients were divided into two groups based on the application: the unilateral PMMA-augmented CPS group (UC, n = 29) and the bilateral PMMA-augmented CPS group (BC, n = 21). Operation time, blood loss, average hospitalization time, PMMA leakage, and other complications were recorded. The visual analog scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate symptom recovery. Radiographic results were compared for intervertebral fusion and screw loosening. Results There were no significant differences in the baseline data of the two groups. The VAS and ODI scores improved significantly after surgery (P < 0.05), with no significant differences between the groups (P > 0.05). The operation time and blood loss in the UC group were significantly lower than those in the BC group (P < 0.05). However, the loss of intervertebral disk height and Taillard index did not differ significantly between the groups. The rates of PMMA leakage in the UC and BC groups were 7.0% and 11.9%, respectively (P < 0.05). Bony fusion was achieved in all groups without screw loosening at the last follow-up. Only one patient experienced superficial infection in both groups, while cerebrospinal fluid leakage was observed in two patients in the BC group. Conclusions Unilateral application of PMMA-augmented CPS may provide adequate clinical safety and effectiveness in the surgical treatment of lumbar spondylolisthesis with osteoporosis.
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Affiliation(s)
- Yao-Yao Liu
- Department of Spine Surgery, Army Medical Center of PLA, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Jun Xiao
- Department of Orthopedics, Southwest Hospital of Army Medical University, PLA, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, People's Republic of China
| | - Huai-Jian Jin
- Department of Spine Surgery, Army Medical Center of PLA, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Zhong Wang
- Department of Spine Surgery, Army Medical Center of PLA, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Xiang Yin
- Department of Spine Surgery, Army Medical Center of PLA, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Ming-Yong Liu
- Department of Spine Surgery, Army Medical Center of PLA, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Jian-Hua Zhao
- Department of Spine Surgery, Army Medical Center of PLA, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, People's Republic of China
| | - Peng Liu
- Department of Spine Surgery, Army Medical Center of PLA, No. 10 Changjiang Road, Yuzhong District, Chongqing, 400042, People's Republic of China.
| | - Fei Dai
- Department of Orthopedics, Southwest Hospital of Army Medical University, PLA, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, People's Republic of China.
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Abstract
PURPOSE OF REVIEW To provide information on characteristics and use of various ceramics in spine fusion and future directions. RECENT FINDINGS In most recent years, focus has been shifted to the use of ceramics in minimally invasive surgeries or implementation of nanostructured surface modification features to promote osteoinductive properties. In addition, effort has been placed on the development of bioactive synthetics. Core characteristic of bioactive synthetics is that they undergo change to simulate a beneficial response within the bone. This change is based on chemical reaction and various chemical elements present in the bioactive ceramics. Recently, a synthetic 15-amino acid polypeptide bound to an anorganic bone material which mimics the cell-binding domain of type-I collagen opened a possibility for osteogenic and osteoinductive roles of this hybrid graft material. Ceramics have been present in the spine fusion arena for several decades; however, their use has been limited. The major obstacle in published literature is small sample size resulting in low evidence and a potential for bias. In addition, different physical and chemical properties of various ceramics further contribute to the limited evidence. Although ceramics have several disadvantages, they still hold a great promise as a value-based graft material with being easily available, relatively inexpensive, and non-immunogenic.
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Tang YC, Guo HZ, Guo DQ, Luo PJ, Li YX, Mo GY, Ma YH, Peng JC, Liang D, Zhang SC. Effect and potential risks of using multilevel cement-augmented pedicle screw fixation in osteoporotic spine with lumbar degenerative disease. BMC Musculoskelet Disord 2020; 21:274. [PMID: 32345282 PMCID: PMC7189525 DOI: 10.1186/s12891-020-03309-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background The increase of augmented level and bone cement dose are accompanied by the rising incidence of cement leakage (CL) of cement-augmented pedicle screw instrumentation (CAPSI). But the effect and potential risks of the application of CAPSI to osteoporotic lumbar degenerative disease (LDD) have not been studied in the case of multilevel fixation. This study aimed to investigate the effectiveness and potential complications of using multilevel CAPSI for patients with osteoporotic LDD. Methods A total of 93 patients with multilevel LDD were divided into the CAPSI group (46 subjects) and the conventional pedicle screw (CPS) group (47 subjects), including 75 cases for three levels and 18 cases for four levels. Relevant data were compared between two groups, including baseline data, clinical results, and complications. Results In the CAPSI group, a total of 336 augmented screws was placed bilaterally. The CL was observed in 116 screws (34.52%). Three cemented screws (0.89%) were found loosened during the follow-up and the overall fusion rate was 93.47%. For perioperative complications, two patients (4.35%) experienced pulmonary cement embolism (PCE), one patient augmented vertebral fracture, and three patients (6.52%) wound infection. And in the CPS group, thirty-three screws (8.46%) suffered loosening in cranial and caudal vertebra with a fusion rate of 91.49%. The operation time and hospital stay of CAPSI group were longer than the CPS group, but CAPSI group has a lower screw loosening percentage (P<0. 05). And in terms of blood loss, perioperative complications, fusion rate, and VAS and ODI scores at the follow-up times, there were no significant differences between the two groups. Conclusions Patients with osteoporotic LDD underwent multilevel CPS fixation have a higher rate of screw loosening in the cranial and caudal vertebra. The application of cemented pedicle screws for multilevel LDD can achieve better stability and less screw loosening, but it also accompanied by longer operating time, higher incidence of CL, PCE and wound infections. Selective cement augmentation of cranial and caudal pedicle screws may be a worthy strategy to decrease the complications.
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Affiliation(s)
- Yong-Chao Tang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Hui-Zhi Guo
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Dan-Qing Guo
- The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Pei-Jie Luo
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Yong-Xian Li
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Guo-Ye Mo
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Yan-Huai Ma
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Jian-Cheng Peng
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.,The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - De Liang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Shun-Cong Zhang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China. .,The 1st Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China.
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Biomechanical Assessment of Vertebroplasty Combined with Cement-Augmented Screw Fixation for Lumbar Burst Fractures: A Finite Element Analysis. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10062133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A hybrid fixation method, using a combination of vertebroplasty and cement-augmented screws, has been demonstrated as a useful technique for securing osteoporotic burst fractures. The purpose of this study was to assess changes in the range of motion (ROM) and stress in the spine after treating a lumbar burst fracture with this hybrid method. Five finite element models were developed: (a) intact lumbar spine (INT), (b) INT with vertebroplasty at L3 (AwC), (c) two-segment fixation of AwC (AwC-TSF), (d) AwC-TSF model with cement-augmented screws (AwC-TSF-S), and (e) INT with an L3 burst fracture treated with two-segment fixation (TSF). After loading, the models were evaluated in terms of the ROM of each motion segment, stiffness of fusion segments, and stresses on the endplates and screws. The results showed that the TSF model has a larger ROM at the instrumented segments than both the AwC-TSF and AwC-TSF-S models. The stiffness at L2–L4 under extension and lateral bending in AwC-TSF, AwC-TSF-S and TSF was approximately nine times greater than the INT model. In conclusion, the hybrid fixation method (AwC-TSF-S) results in a stiffer construct and lower ROM at instrumented segments, which may also reduce the risk of fracture of adjacent vertebrae.
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Liu YY, Xiao J, Yin X, Liu MY, Zhao JH, Liu P, Dai F. Clinical efficacy of Bone Cement-injectable Cannulated Pedicle Screw Short Segment Fixation for Lumbar Spondylolisthesis with Osteoporosise. Sci Rep 2020; 10:3929. [PMID: 32127607 PMCID: PMC7054412 DOI: 10.1038/s41598-020-60980-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/19/2020] [Indexed: 11/09/2022] Open
Abstract
Many clinical studies have shown a satisfactory clinical efficacy using bone cement-augmented pedicle screw in osteoporotic spine, however, few studies have involved the application of this type of screw in lumbar spondylolisthesis. This study aims to investigate the mid-term clinical outcome of bone cement-injectable cannulated pedicle screw (CICPS) in lumbar spondylolisthesis with osteoporosis. From 2011 to 2015, twenty-three patients with transforminal lumbar interbody fusion (TLIF) using CICPS for lumbar spondylolisthesis were enrolled in the study. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) were used to evaluate faunctional recovery and physical pain; and operation time, blood loss and hospitalization time were recorded, respectively. Radiograph and computed tomography of lumbar spine was performed to assess loss of the intervertebral disc space height, fixation loosening, and the rate of bony fusion. The average follow-up time of 23 patients was 22.5 ± 10.2 months (range, 6–36 months). According to VAS and ODI scores, postoperative pain sensation and activity function were significantly improved (p < 0.05). The height of the intervertebral disc space was reduced by 0.4 ± 1.1 mm, and the bone graft fusion rate was 100%. No cases of internal fixation loosening or screw pullout was observed. CICPS using cement augmentation may suggest as a feasible surgical technique in osteoporotic patients with lumbar spondylolisthesis.
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Affiliation(s)
- Yao-Yao Liu
- Department of Spine surgery, Army Medical Center of PLA, Chongqing, 400042, People's Republic of China
| | - Jun Xiao
- Department of Orthopedics, Southwest Hospital of Army Medical University, PLA, Chongqing, 400038, People's Republic of China
| | - Xiang Yin
- Department of Spine surgery, Army Medical Center of PLA, Chongqing, 400042, People's Republic of China
| | - Ming-Yong Liu
- Department of Spine surgery, Army Medical Center of PLA, Chongqing, 400042, People's Republic of China
| | - Jian-Hua Zhao
- Department of Spine surgery, Army Medical Center of PLA, Chongqing, 400042, People's Republic of China
| | - Peng Liu
- Department of Spine surgery, Army Medical Center of PLA, Chongqing, 400042, People's Republic of China.
| | - Fei Dai
- Department of Orthopedics, Southwest Hospital of Army Medical University, PLA, Chongqing, 400038, People's Republic of China.
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Singh V, Mahajan R, Das K, Chhabra HS, Rustagi T. Surgical Trend Analysis for Use of Cement Augmented Pedicle Screws in Osteoporosis of Spine: A Systematic Review (2000-2017). Global Spine J 2019; 9:783-795. [PMID: 31552160 PMCID: PMC6745638 DOI: 10.1177/2192568218801570] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES (1) Study indications for cement-augmented pedicle screws (CAPS) in patients with osteoporosis. Have they changed over the years (2000-2017)? Are there any differences in usage of CAPS based on the geographical region? (2) What were the outcome of the studies? (3) What are the complications associated with this technique? METHODS Electronic database and reference list of desired articles were searched from the database (2000-2017). Articles were selected discussing indications, clinical and radiological outcomes, and complications in cases of preexistent osteoporosis treated surgically using CAPS. RESULTS Seventeen studies were identified; 3 were comparative studies and had a control arm (cemented vs noncemented screws). Most studies originated from Europe (10) or Asia (7). Painful vertebral fracture with or without neurological deficit, Kummell's lesion, deformity and failure to respond to conservative treatment are the common indications for cement augmentation. Visual analogue scale score was the most commonly used to assess pain and average improvement after surgery was 6.1. Average improvement in kyphosis was 13.21° and average loss of correction at the end of the study was 3°. Cement leak was the most common complication observed and pulmonary cement embolism was the most dreaded complication. Nevertheless, majority of cement leaks discussed in studies were asymptomatic. CONCLUSION CAPS are being increasingly used in osteoporotic spine. Pain scores, functional quality of life, and neurological function indices were studied. CAPS improved anchorage in osteoporotic vertebra and helped improve/maintain clinical and radiological improvement. Common risks of cement leak were observed.
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Affiliation(s)
| | | | | | | | - Tarush Rustagi
- Indian Spinal Injuries Center, New Delhi, India,Tarush Rustagi, Indian Spinal Injuries
Center, Sector C, Vasant Kunj, New Delhi, 110070, India.
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Ishak B, Bajwa AA, Schneider T, Tubbs RS, Iwanaga J, Ramey WL, Unterberg AW, Kiening KL. Early Complications and Cement Leakage in Elderly Patients Who Have Undergone Intraoperative Computed Tomography (CT)-Guided Cement Augmented Pedicle Screw Placement: Eight-Year Single-Center Experience. World Neurosurg 2019; 128:e975-e981. [DOI: 10.1016/j.wneu.2019.05.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 12/12/2022]
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The cement leakage in cement-augmented pedicle screw instrumentation in degenerative lumbosacral diseases: a retrospective analysis of 202 cases and 950 augmented pedicle screws. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1661-1669. [DOI: 10.1007/s00586-019-05985-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/12/2019] [Accepted: 04/19/2019] [Indexed: 12/14/2022]
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Spicher A, Lindtner RA, Zimmermann S, Stofferin H, Schmoelz W. Ultrasound melted polymer sleeve for improved primary pedicle screw anchorage: A novel augmentation technique. Clin Biomech (Bristol, Avon) 2019; 63:16-20. [PMID: 30784786 DOI: 10.1016/j.clinbiomech.2019.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/06/2019] [Accepted: 02/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cement augmentation of pedicle screws to prevent screw loosening is associated with significant complications, such as cement leakage or bone necrosis. Therefore, an alternative strategy to improve pedicle screw anchorage has been recently developed: Polymer reinforcement of pedicle screws uses an in situ melted polymer sleeve in order to enhance screw anchorage. This biomechanical study evaluated the effect of polymer-reinforcement by comparing polymer-reinforced pedicle screws to non-augmented as well as cement-augmented screws under cyclic loading. METHODS For each of the two comparisons (polymer-reinforced vs. non-augmented screws and polymer-reinforced vs. cement-augmented screws), polymer-reinforced screws and control screws were placed into the left and right pedicle of seven vertebrae (mean age: 74.0 (SD 9.3) years) to allow for pairwise left-right comparisons. Each screw was subjected to cyclic cranio-caudal loading with an initial load ranging from -50 N to +50 N and with stepwise increasing compressive loads (5 N every 100 cycles) until screw loosening. FINDINGS Polymer-reinforced pedicle screws resisted a higher number of load cycles until loosening than the contralateral non-augmented control screws (4300 SD 2018 vs. 2457 SD 1116 load cycles, p = 0.015). Screw anchorage of polymer-reinforced pedicle screws was comparable to that of cement augmented control screws (3857 (SD2085) vs. 4300 (SD1257) load cycles until failure, p = 0.64). INTERPRETATION Our findings indicate that polymer-reinforcement significantly enhances pedicle screw anchorage in low quality bone and that its effect is similar in size than that of cement augmentation.
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Affiliation(s)
- Anna Spicher
- Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Richard A Lindtner
- Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Hannes Stofferin
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Schmoelz
- Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria.
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González SG, Bastida GC, Vlad MD, López JL, Caballero PB, Alvarez-Galovich L, Rodríguez-Arguisjuela M, Aguado EF. Analysis of bone cement distribution around fenestrated pedicle screws in low bone quality lumbosacral vertebrae. INTERNATIONAL ORTHOPAEDICS 2018; 43:1873-1882. [PMID: 30141139 DOI: 10.1007/s00264-018-4115-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/13/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the exact distribution of bone cement around augmented fenestrated pedicle screws in both lumbar and sacral vertebrae of patients with low bone quality. METHODS A total of 37 patients with instrumented lumbar fusion were investigated. 3D computed tomography virtual models of the injected cement and screws were obtained. The models were computed for their centroid (i.e. their average mass centre point), and their coordinates (x, y, z) were projected on their respective screw-transversal and screw-longitudinal planes for further analysis. RESULTS The results showed better bone cement homogeneous distribution around the screws in lumbar (L4 and L5) than in sacral (S1) vertebrae. In the lumbar region, the centroids were transversally projected near the transversal centre of symmetry of the screws. On the other hand, in the sacral region, the cement flowed preferentially outside the centre of symmetry of the screws, into the sacral ala. CONCLUSIONS The results confirm the different flow behaviours of bone cement in lumbar versus sacra vertebrae. The computer methodology followed in this study helps to understand the clinical monitoring observations and lays the foundations for better positioning of the screws and specific vertebrae-oriented screw designs.
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Affiliation(s)
- Sergio Gómez González
- Research Group of Interacting Surfaces in Bioengineering and Materials Science (InSup), Technical University of Catalonia (UPC), Avda. Diagonal 647, 08028, Barcelona, Spain
| | - Gerard Cabestany Bastida
- Research Group of Interacting Surfaces in Bioengineering and Materials Science (InSup), Technical University of Catalonia (UPC), Avda. Diagonal 647, 08028, Barcelona, Spain
| | - Maria Daniela Vlad
- Research Group of Interacting Surfaces in Bioengineering and Materials Science (InSup), Technical University of Catalonia (UPC), Avda. Diagonal 647, 08028, Barcelona, Spain.,Faculty of Medical Bioengineering, "Grigore T. Popa" University of Medicine and Pharmacy Iasi, Str. Kogalniceanu 9-13, 700454, Iasi, Romania
| | - José López López
- Research Group of Interacting Surfaces in Bioengineering and Materials Science (InSup), Technical University of Catalonia (UPC), Avda. Diagonal 647, 08028, Barcelona, Spain
| | - Pablo Buenestado Caballero
- Department of Mathematics, Technical University of Catalonia (UPC), Avda. Eduard Maristany 16, 08019, Barcelona, Spain
| | - Luis Alvarez-Galovich
- Spine Unit, Hospital Universitario Fundación Jimenez Díaz, Avda. Reyes Católicos 2, 28040, Madrid, Spain
| | | | - Enrique Fernández Aguado
- Research Group of Interacting Surfaces in Bioengineering and Materials Science (InSup), Technical University of Catalonia (UPC), Avda. Diagonal 647, 08028, Barcelona, Spain.
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Tassemeier T, Haversath M, Schutzbach M, Jäger M. Who benefits more in osteoporotic fractures: Pedicle screw instrumentation or kyphoplasty for American Society of Anesthesiologists II/III patients? JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2018; 9:232-237. [PMID: 30783345 PMCID: PMC6364364 DOI: 10.4103/jcvjs.jcvjs_55_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose: Osteoporotc fractures with posterior wall injury are commonly treated with a pedicle srcrew instrumentation (PSI) or a ballonkyphoplasty (BKP). A predictor for complications for these patients is the American Society of Anesthesiologists (ASA) class. Clinical results in ASA II/III patients who underwent BKP and PSI due to OF were evaluated to find the optimal treatment regimen. Materials and Methods: In a retrospective study design, ASA Class II and III patients with OF type OF 2 and OF 3 according to the German Society of Orthopedics and Trauma Surgery classification who underwent surgery between 2011 and 2016 were enrolled. Perioperative data such as time of surgery, cement leakage, adjacent level fractures, screw loosening, wound infections, and segmental kyphosis correction were measured and a statistical analysis was conducted. Results: Ninety-nine patients met the inclusion criteria, 17 were classified as ASA II and 82 patients were classified as ASA III. Twenty-eight individuals were treated by PSI, whereas 71 underwent BKP. Not only a longer average operation (120 min) and hospital stay (21 days) were documented in the PSI group but also a better kyphosis correction (7.5°). In comparison, the BKP group required an average operation time of 35.5 min with a mean kyphosis correction of 2.1°. A statistical analysis revealed the surgical procedure and not the ASA class to be a relevant factor for complication and revision surgery. Conclusions: BKP is a safe and effective therapy including also fractures with posterior wall defects while PSI showed advantages in restoring the sagittal realignment but higher complication and revision risk.
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Affiliation(s)
- Tjark Tassemeier
- Department of Orthopedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany
| | - Marcel Haversath
- Department of Orthopedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany
| | - Moritz Schutzbach
- Department of Orthopedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany
| | - Marcus Jäger
- Department of Orthopedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany
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