Pulmonary cement embolism following cement-augmented fenestrated pedicle screw fixation in adult spinal deformity patients with severe osteoporosis (analysis of 2978 fenestrated screws)

2018 ◽  
Vol 27 (9) ◽  
pp. 2348-2356 ◽  
Author(s):  
Onur Levent Ulusoy ◽  
Sinan Kahraman ◽  
Isik Karalok ◽  
Emel Kaya ◽  
Meric Enercan ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Spinal Deformity ◽  
Screw Fixation ◽  
Adult Spinal Deformity ◽  
Pedicle Screw Fixation ◽  
Severe Osteoporosis ◽  
Cement Embolism ◽  
Fenestrated Pedicle Screw

scholarly journals Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws

2016 ◽  
Vol 25 (1) ◽  
pp. 103-109 ◽  
Author(s):  
Jan U. Mueller ◽  
Joerg Baldauf ◽  
Sascha Marx ◽  
Michael Kirsch ◽  
Henry W. S. Schroeder ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
High Volume ◽  
Cement Leakage ◽  
Pedicle Screw Fixation ◽  
Screw Loosening ◽  
Pedicle Screw Placement ◽  
Screw Augmentation ◽  
Cement Embolism

OBJECTIVE Loosening and pullout of pedicle screws are well-known problems in pedicle screw fixation surgery. Augmentation of pedicle screws with bone cement, first described as early as 1975, increases the pedicle-screw interface and pullout force in osteoporotic vertebrae. The aim of the present study was to identify cement leakage and pulmonary embolism rates in a large prospective single-center series of pedicle screw augmentations. METHODS All patients who underwent cement-augmented pedicle screw placement between May 2006 and October 2010 at the authors' institution were included in this prospective cohort study. Perivertebral cement leakage and pulmonary cement embolism were evaluated with a CT scan of the area of operation and with a radiograph of the chest, respectively. RESULTS A total of 98 patients underwent placement of cement-augmented pedicle screws; 474 augmented screws were inserted in 237 vertebrae. No symptomatic perivertebral cement leakage or symptomatic pulmonary cement embolism was observed, but asymptomatic perivertebral cement leakage was seen in 88 patients (93.6%) and in 165 augmented vertebrae (73.3%). Cement leakage most often occurred in the perivertebral venous system. Clinically asymptomatic pulmonary cement embolism was found in 4 patients (4.1%). CONCLUSIONS Perivertebral cement leakage often occurs in pedicle screw augmentation, but in most cases, it is clinically asymptomatic. Cement augmentation should be performed under continuous fluoroscopy to avoid high-volume leakage. Alternative strategies, such as use of expandable screws, should be examined in more detail for patients at high risk of screw loosening.

scholarly journals Pulmonary Cement Embolism during Cement Augmentation of Pedicle Screw Fixation: A Case Report

2010 ◽  
Vol 18 (3) ◽  
pp. 364-366 ◽  
Author(s):  
Bolarinwa Akinola ◽  
Lennel Lutchman ◽  
Paul Barker ◽  
Am Rai
Keyword(s):  
Case Report ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Cement Augmentation ◽  
Cement Embolism

scholarly journals Cement embolism into the venous system after pedicle screw fixation: case report, literature review, and prevention tips

2013 ◽  
Vol 5 (3) ◽  
pp. 24 ◽  
Author(s):  
Ghassan Kerry ◽  
Claus Ruedinger ◽  
Hans-Herbert Steiner
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Case Reports ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Venous System ◽  
Cement Embolism ◽  
Life Threatening ◽  
Prevention Methods ◽  
Term Performance

The strength of pedicle screws attachment to the vertebrae is an important factor affecting their motion resistance and long term performance. Low bone quality, <em>e.g</em>. in osteopenic patients, keeps the screw bone interface at risk for subsidence and dislocation. In such cases, bone cement could be used to augment pedicle screw fixation. But its use is not free of risk. Therefore, clinicians, especially spine surgeons, radiologists, and internists should become increasingly aware of cement migration and embolism as possible complications. Here, we present an instructive case of cement embolism into the venous system after augmented screw fixation with fortunately asymptomatic clinical course. In addition we discuss pathophysiology and prevention methods as well as therapeutic management of this potentially life-threatening complication in a comprehensive review of the literature. However, only a few case reports of cement embolism into the venous system were published after augmented screw fixation.

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