1
|
Long Z, Zhou J, Xiong L, Chen G, Wen J. Finite element study on three osteotomy methods for treating thoracolumbar osteoporotic fracture vertebral collapse complicated with neurological dysfunction. Medicine (Baltimore) 2024; 103:e36987. [PMID: 38363921 PMCID: PMC10869100 DOI: 10.1097/md.0000000000036987] [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: 06/05/2023] [Accepted: 09/27/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Surgical methods for patients with osteoporotic fracture vertebral collapse complicated with neurological dysfunction are still a topic of debate. We designed an improved osteotomy for the treatment of osteoporotic compression fracture patients with neurological dysfunction. Compared with traditional osteotomy methods such as pedicle subtraction osteotomy (PSO) and bone-disc-bone osteotomy (BDBO), the osteotomy range is reduced. Therefore, we use a finite element method to analyze the biomechanical conditions of these three osteotomy methods and provide a mechanical theoretical basis for the surgical treatment of these three osteotomy methods. METHODS Based on the CT scan of a patient with L1 osteoporotic fracture vertebral collapse and neurological dysfunction, the finite element model was constructed by importing Mimics software, and three different osteotomy models were established. The forces and displacements of internal fixation device, T1-L5 whole segment, T10 vertebral body, and T10/11 intervertebral disc were recorded under different working conditions. RESULTS The displacement levels of internal fixation device, T1-L5 spine, T10 vertebral body, and T10/11 intervertebral disc in the modified osteotomy group were between BDBO group and PSO group. The stress in BDBO group was concentrated in titanium mesh and its maximum stress was much higher than that in PSO group and modified osteotomy group. The mechanical distribution of T10/11 intervertebral disc showed that the maximum stress distribution of the three osteotomy methods was similar. CONCLUSION The relatively simple modified osteotomy has certain advantages in stress and displacement. In contrast, the stability of BDBO group was poor, especially in the lumbar intervertebral disc and lumbar body. For this type of osteotomy patients, it is recommended to avoid postoperative flexion so as not to increase the load.
Collapse
Affiliation(s)
- Zhisheng Long
- Department of Orthopedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
- Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Jingyu Zhou
- Medical College, Nanchang University, Nanchang, Jiangxi, China
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Long Xiong
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Gang Chen
- Department of Orthopedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Jiabin Wen
- Department of Orthopedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| |
Collapse
|
2
|
Sawada Y, Takahashi S, Terai H, Kato M, Toyoda H, Suzuki A, Tamai K, Yabu A, Iwamae M, Nakamura H. Short-Term Risk Factors for Distal Junctional Kyphosis after Spinal Reconstruction Surgery in Patients with Osteoporotic Vertebrae. Asian Spine J 2024; 18:101-109. [PMID: 38379382 PMCID: PMC10910134 DOI: 10.31616/asj.2023.0174] [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: 05/29/2023] [Revised: 10/01/2023] [Accepted: 10/30/2023] [Indexed: 02/22/2024] Open
Abstract
STUDY DESIGN Level 3 retrospective cohort case-control study. PURPOSE This study aimed to investigate the risk factors for distal junctional kyphosis (DJK) caused by osteoporotic vertebral fractures following spinal reconstruction surgery, with a focus on the sagittal stable vertebra. OVERVIEW OF LITERATURE Despite the rarity of reports on DJK in this setting, DJK was reported to reduce when the lower instrumented vertebra (LIV) was extended to the sagittal stable vertebra in the posterior corrective fixation for Scheuermann's disease. METHODS This study included 46 patients who underwent spinal reconstruction surgery for thoracolumbar osteoporotic vertebral fractures and kyphosis and were followed up for 1 year postoperatively. DJK was defined as an advanced kyphosis angle >10° between the LIV and one lower vertebra. The patients were divided into groups with and without DJK. The risk factors of the two groups, such as patient background, surgery-related factors, radiographic parameters, and clinical outcomes, were analyzed. RESULTS The DJK and non-DJK groups included 14 and 32 patients, respectively, without significant differences in patient background. Those with instability in the distal adjacent LIV disc had a significantly higher risk of DJK occurrence (28.6% vs. 3.2%, p=0.027). DJK occurrence significantly increased in those with the sagittal stable vertebra not included in the fixation range (57.1% vs. 18.8%, p=0.020). Other preoperative radiographic parameters were not significantly different. Instability in the distal adjacent LIV disc (adjusted odds ratio, 14.50; p=0.029) and the exclusion of the sagittal stable vertebra from the fixation range (adjusted odds ratio, 5.29; p=0.020) were significant risk factors for DJK occurrence. CONCLUSIONS Regarding spinal reconstruction surgery in patients with osteoporotic vertebral fractures, instability in the distal adjacent LIV disc and the exclusion of the sagittal stable vertebra from the fixation range were risk factors for DJK occurrence in the short term.
Collapse
Affiliation(s)
- Yuta Sawada
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Minori Kato
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Koji Tamai
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Akito Yabu
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Masayoshi Iwamae
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
3
|
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: 0] [Impact Index Per Article: 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.
Collapse
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
| |
Collapse
|
4
|
Wen Z, Mo X, Ma H, Li H, Liao C, Fu D, Cheung WH, Qi Z, Zhao S, Chen B. Study on the Optimal Surgical Scheme for Very Severe Osteoporotic Vertebral Compression Fractures. Orthop Surg 2022; 15:448-459. [PMID: 36444956 PMCID: PMC9891906 DOI: 10.1111/os.13609] [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: 09/05/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Therapy of very severe osteoporotic compression fractures (VSOVCF) has been a growing challenge for spine surgeons. Opinions vary regarding the optimal surgical procedure for the treatment of VSOVCF and which internal fixation method is more effective is still under debate, and research on this topic is lacking. This retrospective study was conducted to compare the efficacy and safety of various pedicle screw fixation methods for treating VSOVCF. METHODS This single-center retrospective comparative study was conducted between January 2015 and September 2020. Two hundred and one patients were divided into six groups according to different surgical methods: 45 patients underwent long-segment fixation (Group 1); 39 underwent short-segment fixation (Group 2); 30 received long-segment fixation with cement-reinforced screws (Group 3); 32 received short-segment fixation with cement-reinforced screws (Group 4); 29 had long-segment fixation combined with kyphoplasty (PKP) (Group 5); and 26 cases had short-segment fixation combined with PKP (Group 6). The clinical records were reviewed and the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) score were used for clinical evaluation. The vertebral height (VH), fractured vertebral body height (FVBH), and Cobb's angle were objectively calculated and analyzed on lateral plain radiographs. Student's t-tests and one-way ANOVA among groups were conducted to analyze the continuous, and the chi-squared test was used to compare the dichotomous or categorical variables. The difference was considered statistically significant when the P-value was less than 0.05. RESULTS The six groups had similar distributions in age, gender, course of the disease, follow-up period, and injured level. In the postoperative assessment of the VAS score, the surgical intervention most likely to rank first in terms of pain relief was the short-segment fixation with cement-reinforced screws (Group 4). For the functional evaluation, the surgical intervention that is most likely to rank first in terms of ODI score was a short-segment fixation with cement-reinforced screws (Group 4), followed by long-segment fixation (Group 1). The long-segment fixation with cement-reinforced screws was the first-ranked surgical intervention for the maintenance of Cobb's angle and vertebral height, whereas the short-segment fixation performed the worst. The highest overall complication rate was in Group 6 with an incidence of 42.3% (11/26), followed by Group 2 with an incidence of 38.5% (15/39). CONCLUSION For the treatment of VSOVCF, the short-segment fixation with cement-reinforced screws is the most effective and optimal procedure, and should be used as the preferred surgical method if surgeons are proficient in using cemented screws; otherwise, directly and unquestionably use long-segment fixation to achieve satisfactory clinical results.
Collapse
Affiliation(s)
- Zhenxing Wen
- Department of Spine Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Xiaoyi Mo
- Department of Spine Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Hangzhan Ma
- Department of Orthopedics, Panyu Hospital of Chinese MedicineGuangzhou University of Chinese MedicineGuangzhouChina
| | - Haonan Li
- Department of Spine Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Changhe Liao
- Department of Orthopedics, Panyu Hospital of Chinese MedicineGuangzhou University of Chinese MedicineGuangzhouChina
| | - Dan Fu
- Department of OrthopaedicsKiang Wu HospitalMacauChina
| | - Wing Hoi Cheung
- Department of Orthopaedics and Traumatology, Prince of Wales HospitalThe Chinese University of Hong KongHong KongChina
| | - Zhichao Qi
- Department of Spine Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Department of OrthopaedicsThe Seventh Affiliated Hospital of Sun Yat‐sen UniversityShenzhenChina
| | - Shengli Zhao
- Department of Spine Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Bailing Chen
- Department of Spine Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| |
Collapse
|
5
|
Wang Y, Zhu W, Sun K, Kong C, Wang W, Lu S. Selecting proper distal fusion level in severe thoracolumbar kyphosis secondary to late osteoporotic vertebral compression fracture to limit distal complications. J Orthop Sci 2022; 27:1177-1184. [PMID: 34531084 DOI: 10.1016/j.jos.2021.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/18/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Surgical treatment of severe thoracolumbar kyphosis (TLK) secondary to late osteoporotic vertebral compression fracture (OVCF) presents several challenges to spine surgeons. Proper selection of distal fusion level is an important issue in surgical planning to decrease the likelihood of distal mechanical complications. This study was designed to compare the clinical and radiographic outcomes in elderly patients suffering from severe TLK related with late OVCF between different distal fusion strategies and to recommend a superior distal fusion level for these patients. METHODS A total of 57 consecutive subjects with a minimum follow-up of two years were retrospectively reviewed. TLK was defined as the hyperkyphosis with an apex below T10. Severe TLK was defined as the Cobb angle of kyphosis ≥60°. Patients fused to sagittal stable vertebra (SSV) were assigned to Group SSV, while those fused to the vertebra above and below SSV were assigned to Groups SSV- and SSV+, respectively. Bone cement was used to enhance pedicle screw fixation. Clinical and radiographic results were collected and compared between different groups. RESULTS Deformity corrections and living quality improvements at the latest follow-up were superior in Group SSV than Group SSV- with shorter fusion levels, while to the equal extent with Group SSV+ with longer fusion levels. 7 cases of distal complications were observed in Group SSV-. Negatively balanced lowest instrumented vertebra was revealed to be the independent factor predicting distal complications. Patients' satisfaction of their surgical management was greater in Group SSV than Group SSV- (83.2 ± 4.4% vs. 70.5 ± 10.9%, P = 0.024), while comparable with Groups SSV + SSV+ (84.8 ± 5.7%). CONCLUSIONS Fusion to SSV with cement-augmented pedicle screws could limit the development of distal junctional mechanical complications after surgical treatment for severe TLK secondary to late OVCF in elderly patients, while achieves satisfactory deformity correction with the preservation of necessary lumbar motility.
Collapse
Affiliation(s)
- Yu Wang
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Weiguo Zhu
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Kang Sun
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Chao Kong
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Wei Wang
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Shibao Lu
- Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China; National Clinical Research Center for Geriatric Diseases, Beijing, China.
| |
Collapse
|
6
|
Biomechanical Comparison of Salvage Pedicle Screw Augmentations Using Different Biomaterials. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Allograft bone particles, hydroxyapatite/β-hydroxyapatite-tricalcium phosphate (HA/β-TCP), calcium sulfate (CS), and polymethylmethacrylate (PMMA) bone cement are biomaterials clinically used to fill defective pedicles for pedicle screw augmentation. Few studies have systematically investigated the effects of various biomaterials utilized for salvage screw stabilization. The aim of this study was to evaluate the biomechanical properties of screws augmented with these four different materials and the effect of different pilot hole sizes and bone densities on screw fixation strength. Commercially available synthetic bones with three different densities (7.5 pcf, 15pcf, 30 pcf) simulating different degrees of bone density were utilized as substitutes for human bone. Two different pilot hole sizes (3.2 mm and 7.0 mm in diameter) were prepared on test blocks to simulate primary and revision pedicle screw fixation, respectively. Following separate specimen preparation with these four different filling biomaterials, a screw pullout test was conducted using a material test machine, and the average maximal screw pullout strength was compared among groups. The average maximal pullout strength of the materials, presented in descending order, was as follows: bone cement, calcium sulfate, HA/β-TCP, allograft bone chips and the control. In samples in both the 3.2 mm pilot-hole and 7.0 mm pilot-hole groups, the average maximal pullout strength of these four materials increased with increasing bone density. The average maximal pullout strength of the bone cement augmented salvage screw (7.0 mm) was apparently elevated in the 7.5 pcf test block. Salvage pedicle screw augmentation with allograft bone chips, HA/β-TCP, calcium sulfate, and bone cement are all feasible methods and can offer better pullout strength than materials in the non-augmentation group. Bone cement provides the most significantly augmented effect in each pilot hole size and bone density setting and could be considered preferentially to achieve larger initial stability during revision surgery, especially for bones with osteoporotic quality.
Collapse
|
7
|
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: 1] [Impact Index Per Article: 0.5] [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.
Collapse
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.
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Effect of Fenestrated Pedicle Screws with Cement Augmentation in Osteoporotic Patients Undergoing Spinal Fusion. World Neurosurg 2020; 143:e351-e361. [PMID: 32771604 DOI: 10.1016/j.wneu.2020.07.154] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Osteoporosis is a well-known risk factor for instrumentation failure and subsequent pseudoarthrosis after spinal fusion. In the present systematic review, we analyzed the biomechanical properties, clinical efficacy, and complications of cement augmentation via fenestrated pedicle screws in spinal fusion. METHODS We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Reports appearing in the PubMed database up to March 31, 2020 were queried using the key words "cement," "pedicle screw," and "osteoporosis." We excluded non-English language studies, studies reported before 2000, studies that had involved use of cement without fenestrated pedicle screws, nonhuman studies, technical reports, and individual case reports. RESULTS Twenty-five studies met the inclusion criteria. Eleven studies had tested the biomechanics of cement-augmented fenestrated pedicle screws. The magnitude of improvement achieved by cement augmentation of pedicle screws increased with the degree of osteoporosis. The cement-augmented fenestrated pedicle screw was superior biomechanically to the alternative "solid-fill" technique. Fourteen studies had evaluated complications. Cement extravasation with fenestrated screw usage was highly variable, ranging from 0% to 79.7%. However, cement extravasation was largely asymptomatic. Thirteen studies had assessed the outcomes. The use of cement-augmented fenestrated pedicles decreased screw pull out and improved fusion rates; however, the clinical outcomes were similar to those with traditional pedicle screw placement. CONCLUSIONS The use of cement-augmented fenestrated pedicle screws can be an effective strategy for achieving improved pedicle screw fixation in patients with osteoporosis. A potential risk is cement extravasation; however, this complication will typically be asymptomatic. Larger comparative studies are needed to better delineate the clinical efficacy.
Collapse
|
10
|
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: 14] [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] [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.
Collapse
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.
| |
Collapse
|
11
|
Effect of surgical factors on the augmentation of cement-injectable cannulated pedicle screw fixation by a novel calcium phosphate-based nanocomposite. Front Med 2019; 13:590-601. [PMID: 31555965 DOI: 10.1007/s11684-019-0710-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/25/2019] [Indexed: 10/25/2022]
|
12
|
Jia C, Zhang R, Xing T, Gao H, Li H, Dong F, Zhang J, Ge P, Song P, Xu P, Zhang H, Shen C. Biomechanical properties of pedicle screw fixation augmented with allograft bone particles in osteoporotic vertebrae: different sizes and amounts. Spine J 2019; 19:1443-1452. [PMID: 31009768 DOI: 10.1016/j.spinee.2019.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A persistent challenge in spine surgery is improving screw fixation in patients with poor bone quality. Augmenting pedicle screw fixation with allograft bone appears to be a promising approach. PURPOSE To evaluate the biomechanical properties of screws augmented or revised with allograft bone particles (ABPs) and the effect of different sizes and amounts of ABP on screw-fixation strength. STUDY DESIGN Biomechanical in vitro study. METHODS Sixty vertebrae were separated randomly into six groups. Groups A1 and A2: one pedicle of each vertebra was selected randomly to be the original pedicle and implanted with a screw. Then, biomechanical tests were performed. Subsequently, the failed trajectory was revised with 1 mm ABP, and the contralateral pedicle was augmented with the same size and amount of ABP. Groups B1 and B2: two pedicles of each vertebra were augmented with different amounts of 1 mm ABP. Groups C1 and C2: one pedicle of each vertebra was augmented with 1 mm ABP to the maximum. The contralateral pedicle of each vertebra was augmented with the same amount of 2 mm ABP. After augmentation and screw insertion, groups A1, B1, and C1 were subjected to the pullout test, whereas groups A2, B2, and C2 the cyclic fatigue test. RESULTS Groups A1 and A2: screw augmentation increased the pullout strength by 47%, cycles to failure by 31%, and failure loads by 21% compared with the screw in the original pedicle (p<.05). Screw revision obtained 79% pullout strength, 97% cycles to failure, and 98% failure loads of the screw in the original pedicle (p<.05). Groups B1 and B2: full (100%) trajectory augmentation increased the pullout strength by 39%, cycles to failure by 18%, and failure loads by 12% compared with half (50%) trajectory augmentation (p<.05). Groups C1 and C2: the values of the pullout strength, cycles to failure, and failure loads of the screw augmented with 1 mm ABP were all greater than those in the 2 mm ABP. However, no significant differences were observed between the two treatments (p>.05). CONCLUSIONS Trajectory augmentation with ABP can significantly increase the strength of the augmented screws. Full trajectory augmentation can provide greater strength compared with half trajectory augmentation. In patients with osteoporosis, we recommend using 1 mm ABP in full trajectory augmentation (0.3 g ABP for 5.5 mm×40 mm and 0.5 g ABP for 6.5 mm×45 mm) before trajectory fails.
Collapse
Affiliation(s)
- Chongyu Jia
- Department of Orthopedic, Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui 230022, China
| | - Renjie Zhang
- Department of Orthopedic, Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui 230022, China
| | - Tao Xing
- Department of Orthopedic, Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui 230022, China
| | - Hai Gao
- Department of Orthopedic, Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui 230022, China
| | - Huimin Li
- Department of Orthopedic, Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui 230022, China
| | - Fulong Dong
- Department of Orthopedic, Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui 230022, China
| | - Jianxiang Zhang
- Department of Orthopedic, Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui 230022, China
| | - Peng Ge
- Department of Orthopedic, Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui 230022, China
| | - Peiwen Song
- Department of Orthopedic, Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui 230022, China
| | - Peng Xu
- Department of Orthopedic, Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui 230022, China
| | - Huaqing Zhang
- Department of Orthopedic, Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui 230022, China
| | - Cailiang Shen
- Department of Orthopedic, Spine Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui 230022, China.
| |
Collapse
|
13
|
O'Donnell C, Bloch N, Michael N, Erickson M, Garg S. Management of Scoliosis in Children with Osteogenesis Imperfecta. JBJS Rev 2019; 5:e8. [PMID: 28742716 DOI: 10.2106/jbjs.rvw.16.00063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
14
|
Afathi M, Mansouri N, Farah K, Benichoux V, Blondel B, Fuentes S. Use of Cement-Augmented Percutaneous Pedicular Screws in the Management of Multifocal Tumoral Spinal Fractures. Asian Spine J 2018; 13:305-312. [PMID: 30481979 PMCID: PMC6454290 DOI: 10.31616/asj.2018.0129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/13/2018] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Retrospective case series observational study. PURPOSE Cancer patients are often aged and are further weakened by their illness and treatments. Our goal was to evaluate the efficiency and safety of using minimally invasive techniques to operate on spinal fractures in these patients. OVERVIEW OF LITERATURE Vertebroplasty is now considered to be a safe technique that allows a significant reduction of the pain induced by a spinal tumoral fracture. However, few papers describe the kyphosis reduction that can be achieved by combining percutaneous fixation and anterior vertebral reconstruction. METHODS We studied 35 patients seen between December 2013 and October 2016 who had at least one pathological spinal fracture and multiple vertebral metastases. The population's mean age was 67 years, and no patients included had preoperative neurological deficits. The patients underwent a minimally invasive surgery consisting of a percutaneous pedicular fixation with cement-enhanced screws and anterior reconstruction comprising kyphoplasty when possible or corpectomy in cases of excessive damage to the vertebral body. Back pain, traumatic local and regional kyphosis, and Beck's Index were collected pre- and postoperatively, and at 3-, 6-, and 12-month follow-ups. RESULTS Mean follow-up time was 13.4 months. Significant reductions in back pain (p<0.001) and local (p<0.001) and regional kyphosis (p=0.006) were found at the 6-month follow-up (alpha risk level <0.05). Beck's Index was also significantly increased, indicating good restoration of the anterior vertebral height. By the final follow-up, no screws had fallen/pulled out. There were no infectious or neurological complications. CONCLUSIONS Percutaneous cement-enhanced fixation for pathological fractures has proven a safe and efficient technique in our experience, enabling weak patients to rapidly become ambulatory again without complications. Further follow-up of the patients is necessary to assess the long-term effects of this technique and the continued quality of life of our patients.
Collapse
Affiliation(s)
- Mehdi Afathi
- Neurochirurgie C-Chirurgie du Rachis, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civiles de Lyon, Bron, France
| | - Nacer Mansouri
- Unité Rachis, Hopital de La Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
| | - Kaissar Farah
- Unité Rachis, Hopital de La Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
| | - Victor Benichoux
- Unité de Génétique et Physiologie de l'Audition, INSERM, Institut Pasteur, Sorbonne Université, Paris, France
| | - Benjamin Blondel
- Unité Rachis, Hopital de La Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
| | - Stéphane Fuentes
- Unité Rachis, Hopital de La Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France
| |
Collapse
|
15
|
Li HM, Zhang RJ, Gao H, Jia CY, Xing T, Zhang JX, Dong FL, Shen CL. Biomechanical Fixation Properties of the Cortical Bone Trajectory in the Osteoporotic Lumbar Spine. World Neurosurg 2018; 119:e717-e727. [PMID: 30092463 DOI: 10.1016/j.wneu.2018.07.253] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/27/2018] [Accepted: 07/28/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Selecting optimal strategies for improving fixation in osteoporotic lumbar spine is an important issue in clinical research. Cortical bone trajectory (CBT) screws have been proven to enhance screw pullout strength, but biomechanical efficacy of these screws remains understudied. The aim of this study was to evaluate biomechanical efficacy of CBT screws in osteoporotic lumbar spine. METHODS Thirty-one vertebrae from 14 cadaveric lumbar spines were obtained. All specimens were measured by computed tomography; the diameter of pedicles, excluding those of vertebral bodies with very small pedicle developments, was calculated. After measuring bone mineral density, the CBT screw was randomly inserted into 1 side, and the traditional trajectory (TT) screw was inserted into the contralateral side. Maximum insertional torque was recorded after screw insertion. Of vertebrae, 21 were subjected to pullout testing at a rate of 5 mm/minute, and 10 were subjected to cyclic fatigue testing. Each construct was loaded until exceeding 5 mm. RESULTS Average bone mineral density was 0.567 ± 0.101 g/cm2. CBT screws had higher maximum insertional torque (degrees of freedom = 30, t = 5.78, P < 0.001, 0.333 N-m vs. 0.188 N-m) and higher axial pullout strength (degrees of freedom = 20, t = 7.41, P < 0.001, 394 N vs. 241 N) than TT screws. Increased bone mineral density was not significantly associated with higher pullout load. Compared with TT screws, CBT screws showed better resistance to fatigue testing and required more cycles to exceed 5 mm (degrees of freedom = 9, t = 5.62, P < 0.001, 6161 cycles vs. 3639 cycles). Failure load for displacing screws was also significantly greater for CBT screws than for TT screws (degrees of freedom = 9, t = 5.75, P < 0.001, 443 N vs. 317 N). CONCLUSIONS CBT screws had better biomechanical fixation in osteoporotic lumbar spine compared with standard pedicle screws.
Collapse
Affiliation(s)
- Hui-Min Li
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ren-Jie Zhang
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hai Gao
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chong-Yu Jia
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tao Xing
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jian-Xiang Zhang
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fu-Long Dong
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Cai-Liang Shen
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei, China.
| |
Collapse
|
16
|
Ulusoy OL, Kahraman S, Karalok I, Kaya E, Enercan M, Sever C, Abay B, Karadereler S, Hamzaoglu A. Pulmonary cement embolism following cement-augmented fenestrated pedicle screw fixation in adult spinal deformity patients with severe osteoporosis (analysis of 2978 fenestrated 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 2018; 27:2348-2356. [PMID: 29671110 DOI: 10.1007/s00586-018-5593-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 04/10/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION There is very limited information about pulmonary cement embolism (PCE) following cement-augmented fenestrated pedicle screw (CAFPS) fixation in the literature. The aim of this study to report the incidence of PCE following CAFPS fixation in adult deformity patients with severe osteoporosis and to identify risk factors such as; the number of levels, number of screws, and the cement volume used. METHODS 281 patients (204F, 77M) in whom CAFPS fixation was used during deformity surgery were included. All patients' routine postop 2 day chest X-rays and any available CT scans were reviewed by two radiologists. In patients with PCE, preop, early postop, and latest echocardiography studies were compared in terms of changes in pulmonary artery pressure (PAP) and right ventricular dilatation. Estimated cement volume used was calculated as: 2 cc (1 cc + 1 cc) per thoracic and 3 cc (1.5 cc + 1.5 cc) per lumbar levels, which are our routine protocol. Statistical analysis for risk factors was assessed with point biserial correlation test. RESULTS Average age is 70.5 (51-89) and average follow-up is 3.2 years (2-5). A total of 2978 CAFPS were instrumented with a mean of 10.5 levels (2-16) in 281 patients. PCE was diagnosed radiologically in 46 patients (16.3%). Among these 46 patients, PCE was clinically symptomatic in only 4 patients. Overall incidence of symptomatic PCE was 1.4% (4 of 281). Symptomatic PCE was statistically significant: when CAFPS fixation was performed > 7 levels; > 14 screws were used, and > 20-25 cc cement was used for augmentation (r = 0.378). In PCE group, mean preop PAP values of 27.40 (20-37) mm/Hg increased to 32.34 (20-50) mm/Hg in early postop and decreased to 28.29 (18-49) mm/Hg at final follow-up. In symptomatic PCE patients, mean preop PAP values of 30.75 (28-36) mm/Hg increased to 45.74 (40-50) mm/Hg in early postop and decreased to 38.75 (37-40) mm/Hg at final follow-up. CONCLUSION This study showed an overall 16.3% radiological PCE and 1.4% symptomatic PCE incidence when CAFPS were used due to severe osteoporosis. The symptomatic PCE risk was significant when CAFPS were > 7 levels; > 14 fenestrated screws; and > 20-25 cc cement volume is used and this may cause PAP increase and right ventricular dilatation.
Collapse
Affiliation(s)
- Onur Levent Ulusoy
- Department of Radiology, Istanbul Florence Nightingale Hospital, Abide-i Hurriyet Cad. No:166 Sisli, 34381, Istanbul, Turkey.
| | - Sinan Kahraman
- Department of Orthopaedics and Traumatology, Istanbul Bilim University Faculty of Medicine, Abide-i Hurriyet Cad. No:166 Sisli 34381, Istanbul, Turkey
| | - Isik Karalok
- Department of Radiology, Istanbul Bilim University Faculty of Medicine, Abide-i Hurriyet Cad. No:166 Sisli 34381, Istanbul, Turkey
| | - Emel Kaya
- Department of Radiology, Istanbul Bilim University Faculty of Medicine, Abide-i Hurriyet Cad. No:166 Sisli 34381, Istanbul, Turkey
| | - Meric Enercan
- Istanbul Spine Center at Florence Nightingale Hospital, Abide-i Hurriyet Cad. No:160 Sisli, 34381, Istanbul, Turkey
| | - Cem Sever
- Istanbul Spine Center at Florence Nightingale Hospital, Abide-i Hurriyet Cad. No:160 Sisli, 34381, Istanbul, Turkey
| | - Burak Abay
- Department of Orthopaedics and Traumatology, Istanbul Bilim University Faculty of Medicine, Abide-i Hurriyet Cad. No:166 Sisli 34381, Istanbul, Turkey
| | - Selhan Karadereler
- Istanbul Spine Center at Florence Nightingale Hospital, Abide-i Hurriyet Cad. No:160 Sisli, 34381, Istanbul, Turkey
| | - Azmi Hamzaoglu
- Istanbul Spine Center at Florence Nightingale Hospital, Abide-i Hurriyet Cad. No:160 Sisli, 34381, Istanbul, Turkey
| |
Collapse
|
17
|
Comparison of the Pullout Strength of Different Pedicle Screw Designs and Augmentation Techniques in an Osteoporotic Bone Model. Asian Spine J 2018; 12:3-11. [PMID: 29503676 PMCID: PMC5821930 DOI: 10.4184/asj.2018.12.1.3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/18/2017] [Accepted: 05/20/2017] [Indexed: 02/01/2023] Open
Abstract
Study Design Mechanical study. Purpose To compare the pullout strength of different screw designs and augmentation techniques in an osteoporotic bone model. Overview of Literature Adequate bone screw pullout strength is a common problem among osteoporotic patients. Various screw designs and augmentation techniques have been developed to improve the biomechanical characteristics of the bone–screw interface. Methods Polyurethane blocks were used to mimic human osteoporotic cancellous bone, and six different screw designs were tested. Five standard and expandable screws without augmentation, eight expandable screws with polymethylmethacrylate (PMMA) or calcium phosphate augmentation, and distal cannulated screws with PMMA and calcium phosphate augmentation were tested. Mechanical tests were performed on 10 unused new screws of each group. Screws with or without augmentation were inserted in a block that was held in a fixture frame, and a longitudinal extraction force was applied to the screw head at a loading rate of 5 mm/min. Maximum load was recorded in a load displacement curve. Results The peak pullout force of all tested screws with or without augmentation was significantly greater than that of the standard pedicle screw. The greatest pullout force was observed with 40-mm expandable pedicle screws with four fins and PMMA augmentation. Augmented distal cannulated screws did not have a greater peak pullout force than nonaugmented expandable screws. PMMA augmentation provided a greater peak pullout force than calcium phosphate augmentation. Conclusions Expandable pedicle screws had greater peak pullout forces than standard pedicle screws and had the advantage of augmentation with either PMMA or calcium phosphate cement. Although calcium phosphate cement is biodegradable, osteoconductive, and nonexothermic, PMMA provided a significantly greater peak pullout force. PMMA-augmented expandable 40-mm four-fin pedicle screws had the greatest peak pullout force.
Collapse
|
18
|
Pull-out strength of patient-specific template-guided vs. free-hand fluoroscopically controlled thoracolumbar pedicle screws: a biomechanical analysis of a randomized cadaveric study. 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 2017; 26:2865-2872. [DOI: 10.1007/s00586-017-5025-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/20/2016] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
|