Effect and potential risks of using multilevel cement-augmented pedicle screw fixation in osteoporotic spine with lumbar degenerative disease

Objective: To evaluate the incidence of nerve injury and pedicle breach after pedicle screw fixation (PSF) with intraoperative triggered electromyography (tEMG) monitoring.Material and Methods: All patients who underwent PSF with intraoperative tEMG at Vajira Hospital between October 2018 and March 2020 were included. Patients with dysmorphic pedicle features, preoperative infection, or incomplete follow-up data were excluded. PSF was done with intraoperative tEMG. The stimulation threshold was recorded. Stimulation threshold <7 mA was not allowed to proceed with the procedure and required reposition of pedicle screw immediately. Post-operative nerve injury was evaluated by physical examination and computer tomography of the spine was done to detect any pedicle breaches. The sensitivity and specificity of intraoperative tEMG to detect pedicle breach were calculated. The risk factors associated with pedicle breach were analyzed.Results: The records of thirty-six patients with 278 pedicle screws were analyzed. No post-operative nerve injuries were found. The incidence of pedicle breach was 2.2%. The sensitivity and specificity were 83.0% and 91.0%, respectively. The risk factors associated with pedicle breach were degenerative disease and tumor(s) (odds ratio (OR) 3.05, 95% confidence interval (CI) 1.11-8.41, p-value=0.030) and stimulation threshold 7-10 mA (OR 0.02, 95% CI 0.00-0.19, p-value< 0.001). Conclusion: PSF with intraoperative tEMG was safe for neural integrity. Intraoperative tEMG had the ability to detect pedicle breaches with fair sensitivity and high specificity. Patients with degenerative disease, tumors, or stimulation threshold less than 11 mA had a higher risk of pedicle breach.

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Effect and potential risks of using multilevel cement-augmented pedicle screw fixation in osteoporotic spine with lumbar degenerative disease

10.21203/rs.2.19693/v4 ◽

2020 ◽

Author(s):

Yong-chao Tang ◽

Hui-zhi Guo ◽

Dan-qing Guo ◽

Pei-jie Luo ◽

Yong-xian Li ◽

...

Keyword(s):

Pedicle Screw ◽

Perioperative Complications ◽

Pedicle Screws ◽

Fusion Rate ◽

Degenerative Disease ◽

Screw Loosening ◽

Caudal Vertebra ◽

Lumbar Degenerative Disease ◽

Potential Risks

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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A Biomechanical Comparison of a Novel Thoracic Screw Fixation Method: Transarticular Screw Fixation vs Traditional Pedicle Screw Fixation

Yearbook of Neurology and Neurosurgery ◽

10.1016/j.yneu.2012.01.006 ◽

2012 ◽

Vol 2012 ◽

pp. 272-274

Author(s):

R. Riesenburger

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Fixation Method ◽

Transarticular Screw ◽

Transarticular Screw Fixation ◽

Biomechanical Comparison

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Comparison of Short Segment Mono-axial and Poly-axial Pedicle Screw Fixation for Thoracolumbar Fractures

Case Medical Research ◽

10.31525/ct1-nct04032054 ◽

2019 ◽

Author(s):

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Thoracolumbar Fractures ◽

Short Segment

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Modified posterior lumbar interbody fusion using unilateral pedicle screw fixation in lumbar spinal fusion

Academic Journal of Second Military Medical University ◽

10.3724/sp.j.1008.2010.01095 ◽

2010 ◽

Vol 30 (10) ◽

pp. 1095-1099 ◽

Cited By ~ 1

Author(s):

Yun-rong ZHU ◽

Xiao-jian YE ◽

Yu-quan JIANG ◽

Jiang-ming YU ◽

Guo-hua XU

Keyword(s):

Pedicle Screw ◽

Interbody Fusion ◽

Screw Fixation ◽

Posterior Lumbar Interbody Fusion ◽

Pedicle Screw Fixation ◽

Lumbar Interbody Fusion ◽

Lumbar Spinal Fusion ◽

Unilateral Pedicle Screw Fixation ◽

Unilateral Pedicle Screw ◽

Lumbar Spinal

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Thoracic spondylotic myelopathy presumably caused by diffuse idiopathic skeletal hyperostosis in a patient who underwent decompression and percutaneous pedicle screw fixation

SAGE Open Medical Case Reports ◽

10.1177/2050313x20987796 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2098779

Author(s):

Shota Miyoshi ◽

Tadao Morino ◽

Haruhiko Takeda ◽

Hiroshi Nakata ◽

Masayuki Hino ◽

...

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Diffuse Idiopathic Skeletal Hyperostosis ◽

Pedicle Screw Fixation ◽

Vertebral Bone ◽

Bone Bridge ◽

Percutaneous Pedicle Screw ◽

Bilateral Lower Limb ◽

Upper Thoracic ◽

Percutaneous Pedicle Screw Fixation

A 74-year-old man developed bilateral lower limb spastic paresis. He was diagnosed with thoracic spondylotic myelopathy presumably caused by mechanical stress that was generated in the intervertebral space (T1-T2) between a vertebral bone bridge (C5-T1) due to diffuse idiopathic skeletal hyperostosis after anterior fixation of the lower cervical spine and a vertebral bone bridge (T2-T7) due to diffuse idiopathic skeletal hyperostosis in the upper thoracic spine. Treatment included posterior decompression (T1-T2 laminectomy) and percutaneous pedicle screw fixation at the C7-T4 level. Six months after surgery, the patient could walk with a cane, and the vertebral bodies T1-T2 were bridged without bone grafting. For thoracic spondylotic myelopathy associated with diffuse idiopathic skeletal hyperostosis, decompression and percutaneous pedicle screw fixation are effective therapies.

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Posterior thoracolumbar hemivertebra resection and short-segment fusion in congenital scoliosis: surgical outcomes and complications with more than 5-year follow-up

BMC Surgery ◽

10.1186/s12893-021-01165-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Beixi Bao ◽

Qingjun Su ◽

Yong Hai ◽

Peng Yin ◽

Yaoshen Zhang ◽

...

Keyword(s):

Pedicle Screw ◽

Surgical Outcomes ◽

Screw Fixation ◽

Congenital Scoliosis ◽

Pedicle Screw Fixation ◽

Rigid Fixation ◽

Short Segment ◽

Hemivertebra Resection ◽

Main Curve

Abstract Background Treatment of congenital hemivertebra is challenging and data on long-term follow-up (≥ 5 years) are lacking. This study evaluated the surgical outcomes of posterior thoracolumbar hemivertebra resection and short-segment fusion with pedicle screw fixation for treatment of congenital scoliosis with over 5-year follow-up. Methods This study evaluated 27 consecutive patients with congenital scoliosis who underwent posterior thoracolumbar hemivertebra resection and short-segment fusion from January 2007 to January 2015. Segmental scoliosis, total main scoliosis, compensatory cranial curve, compensatory caudal curve, trunk shift, shoulder balance, segmental kyphosis, and sagittal balance were measured on radiographs. Radiographic outcomes and all intraoperative and postoperative complications were recorded. Results The segmental main curve was 40.35° preoperatively, 11.94° postoperatively, and 13.24° at final follow-up, with an average correction of 65.9%. The total main curve was 43.39° preoperatively, 14.13° postoperatively, and 16.06° at final follow-up, with an average correction of 60.2%. The caudal and cranial compensatory curves were corrected from 15.78° and 13.21° to 3.57° and 6.83° postoperatively and 4.38° and 7.65° at final follow-up, with an average correction of 69.2% and 30.3%, respectively. The segmental kyphosis was corrected from 34.30° to 15.88° postoperatively and 15.12° at final follow-up, with an average correction of 61.9%. A significant correction (p < 0.001) in segmental scoliosis, total main curve, caudal compensatory curves and segmental kyphosis was observed from preoperative to the final follow-up. The correction in the compensatory cranial curve was significant between preoperative and postoperative and 2-year follow-up (p < 0.001), but a statistically significant difference was not observed between the preoperative and final follow-up (p > 0.001). There were two implant migrations, two postoperative curve progressions, five cases of proximal junctional kyphosis, and four cases of adding-on phenomena. Conclusion Posterior thoracolumbar hemivertebra resection after short-segment fusion with pedicle screw fixation in congenital scoliosis is a safe and effective method for treatment and can achieve rigid fixation and deformity correction.

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