SEGMENTAL POLYMETHYLMETHACRYLATE-AUGMENTED PEDICLE SCREW FIXATION IN PATIENTS WITH BONE SOFTENING CAUSED BY OSTEOPOROSIS AND METASTATIC TUMOR INVOLVEMENT

Neurosurgery ◽  
2007 ◽  
Vol 61 (3) ◽  
pp. 531-538 ◽  
Author(s):  
Bruce M. Frankel ◽  
Tanya Jones ◽  
Chiang Wang
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Degenerative Spondylolisthesis ◽  
Spinal Instrumentation ◽  
Pedicle Screw Fixation ◽  
Screw Loosening ◽  
Cell Lung Carcinoma ◽  
Tumor Involvement ◽  
Pedicle Screw Loosening ◽  
Cement Extravasation

Abstract OBJECTIVE Instrumentation of the osteoporotic spine may result in bone failure because of pedicle screw loosening and pullout. A clinical evaluation of a novel fenestrated bone tap used in pedicle screw augmentation was performed to determine the performance and safety of this technique. METHODS Over a 2.5-year period, the clinical and radiographic results of 119 consecutive patients who underwent instrumented arthrodesis were reviewed. Of these patients, 23 had bone softening secondary to osteoporosis and/or metastatic spinal tumor involvement. These patients underwent surgical decompression and spinal instrumentation. RESULTS Six patients (26%) had metastatic spine disease (squamous cell lung carcinoma, renal cell carcinoma, bladder carcinoma, breast, prostate, and uterine adenocarcinoma); five patients (22%) had a degenerative spondylolisthesis; and 12 patients (52%) had burst fractures, eight as a result of benign causes and four as a result of metastatic disease. Four (17%) patients underwent revision surgery of previous pedicle screw failure resulting from bone softening and pseudarthrosis. A total of 98 levels were fused using 158 polymethylmethacrylate-augmented screws. None of the patients experienced operative death, myocardial infarction, hypoxemia, intraoperative hypotension, radiculopathy, or myelopathy. Asymptomatic anterior cement extravasation was observed in nine patients (39%). There was one asymptomatic polymethylmethacrylate pulmonary embolus and one wound infection. There was no significant relationship between cement extravasation and the quantity used, levels augmented, or location (P > 0.05). There were no construct failures. CONCLUSION Polymethylmethacrylate-augmented pedicle screw fixation reduces the likelihood of pedicle screw loosening and pullout in patients with osteoporosis requiring instrumented arthrodesis.

scholarly journals Computed tomography Hounsfield unit–based prediction of pedicle screw loosening after surgery for degenerative lumbar spine disease

2020 ◽  
Vol 32 (5) ◽  
pp. 716-721
Author(s):  
Da Zou ◽  
Aikeremujiang Muheremu ◽  
Zhuoran Sun ◽  
Woquan Zhong ◽  
Shuai Jiang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Hounsfield Unit ◽  
Pedicle Screw Fixation ◽  
Screw Loosening ◽  
Pedicle Screw Loosening ◽  
Spine Disease ◽  
Lumbar Pedicle

OBJECTIVEThe authors investigated the relation between Hounsfield unit (HU) values measured on CT and the risk of pedicle screw loosening in patients who underwent lumbar pedicle screw fixation for degenerative lumbar spine disease.METHODSPatients who were treated with lumbar pedicle screw fixation between July 2011 and December 2015 at the authors’ department were reviewed. Age, sex, BMI, smoking and diabetes histories, range of fixation, and fusion method were recorded as the basic patient information. The HU values for lumbar bone mineral density (BMD) for the L1, L2, L3, and L4 vertebra were measured on CT scans. Logistic regression analysis was used to identify the independent influencing factors of pedicle screw loosening.RESULTSA total of 503 patients were included in the final analysis. The pedicle screw loosening rate at the 12-month follow-up was 30.0% (151 of 503 patients). There were no significant differences in sex, BMI, or histories of smoking and diabetes between the patients with (loosening group) and those without (nonloosening group) screw loosening (p > 0.05). The mean HU value of L1–4 was lower in the loosening group than the nonloosening group (106.3 ± 33.9 vs 132.6 ± 42.9, p < 0.001). In logistic regression analysis, being male (OR 2.065; 95% CI 1.242–3.433), HU value (OR 0.977; 95% CI 0.970–0.985), length of fixation (OR 3.616; 95% CI 2.617–4.996), and fixation to S1 (OR 1.699; 95% CI 1.039–2.777) were the independent influencing factors for screw loosening.CONCLUSIONSHU value measured on CT was an independent predictor for pedicle screw loosening, and lower HU value was significantly correlated with higher risk of screw loosening.

INVESTIGATION INTO WHETHER OR NOT PMMA BONE CEMENT TRANSPEDICULAR SCREW AUGMENTATION STABILIZES PEDICLE SCREW LOOSENING

2019 ◽  
Vol 19 (02) ◽  
pp. 1940024
Author(s):  
PO-YI LIU ◽  
SHENG-CHIH LIN ◽  
PO-LIANG LAI ◽  
CHUN-LI LIN
Keyword(s):  
Bone Cement ◽  
Pedicle Screw ◽  
Fatigue Resistance ◽  
Fatigue Testing ◽  
Pedicle Screw Fixation ◽  
Screw Loosening ◽  
General Technique ◽  
Screw Augmentation ◽  
Pmma Bone Cement ◽  
Pedicle Screw Loosening

Pedicle screw loosening at the bone–screw interface is the main complication in pedicle screw fixation. The transpedicular polymethylmethacrylate screw augmentation technique has recently become the general technique used to re-operatively overcome pedicle screw loosening. This study investigates the fatigue resistance of PMMA bone cement augmentation. Twenty-seven porcine thoracic vertebral bodies were collected. The BMD was measured using dual X-ray absorptiometry. Each vertebral body was instrumented with one pedicle screw and mounted in a material testing system. Fatigue testing was performed by implementing a cranio-caudal sinusoidal, cyclic (5[Formula: see text]Hz) load. This study shows that transpedicular pedicle screw augmentation with PMMA exhibits similar fatigue resistance as traditional pedicle screw implantation. However, in histomophometrical analysis, the transpedicular pedicle screw augmentation with PMMA has greater anti-deformation capacity than traditional pedicle screw implantation. Transpedicular pedicle screw augmentation with PMMA improves more screw holding power to prevent pedicle screw loosening.

scholarly journals Effects of different pedicle screw insertion depths on sagittal balance of lumbar degenerative spondylolisthesis, a retrospective comparative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Quan Zhou ◽  
Jun-xin Zhang ◽  
Yi-fei Zheng ◽  
Yun Teng ◽  
Hui-lin Yang ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Sagittal Balance ◽  
Screw Fixation ◽  
Degenerative Spondylolisthesis ◽  
Leading Edge ◽  
Pedicle Screw Fixation ◽  
Screw Insertion ◽  
Lumbar Degenerative Spondylolisthesis ◽  
Screw Group

Abstract Background Few reports to date have evaluated the effects of different pedicle screw insertion depths on sagittal balance and prognosis after posterior lumbar interbody and fusion (PLIF) in patients with lumbar degenerative spondylolisthesis (LDS). Methods A total of 88 patients with single-level PLIF for LDS from January 2018 to December 2019 were enrolled. Long screw group (Group L): 52 patients underwent long pedicle screw fixation (the leading edge of the screw exceeded 80% of the anteroposterior diameter of vertebral body). Short screw group (Group S): 36 patients underwent short pedicle screw fixation (the leading edge of the screw was less than 60% of the anteroposterior diameter of vertebral body). Local deformity parameters of spondylolisthesis including slip degree (SD) and segment lordosis (SL), spino-pelvic sagittal plane parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL), Oswestry Disability Index (ODI), and Visual Analog Scale (VAS) for back pain of both groups were compared. Postoperative complications, including vertebral fusion rate and screw loosening rate, were recorded. Results Except that PI in Group S at the final follow-up was not statistically different from the preoperative value (P > 0.05), other parameters were significantly improved compared with preoperative values one month after surgery and at the final follow-up (P < 0.05). There was no significant difference in parameters between Group L and Group S before and one month after surgery (P > 0.05). At the final follow-up, SD, SL, LL, PT and PI-LL differed significantly between the two groups (P < 0.05). Compared with the preoperative results, ODI and VAS in both groups decreased significantly one month after surgery and at the final follow-up (P < 0.05). Significant differences of ODI and VAS were found between the two groups at the final follow-up (P < 0.05). Postoperative complications were not statistically significant between the two groups (P > 0.05). Conclusions PLIF can significantly improve the prognosis of patients with LDS. In terms of outcomes with an average follow-up time of 2 years, the deeper the screw depth is within the safe range, the better the spino-pelvic sagittal balance may be restored and the better the quality of life may be.

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 Percutaneous pedicle screw fixation combined with percutaneous vertebroplasty for the treatment of thoracic and lumbar metastatic tumor

2021 ◽  
Author(s):  
Xiaowei Ma ◽  
Yi Zhao ◽  
Jiazheng Zhao ◽  
Hongzeng Wu ◽  
Helin Feng
Keyword(s):  
Pedicle Screw ◽  
Percutaneous Vertebroplasty ◽  
Screw Fixation ◽  
Metastatic Tumor ◽  
Pedicle Screw Fixation ◽  
En Bloc ◽  
Percutaneous Pedicle Screw ◽  
Percutaneous Pedicle Screw Fixation ◽  
En Bloc Corpectomy ◽  
Pedicle Screw Loosening

Abstract Background Evaluation of the clinical efficacy of percutaneous pedicle screw fixation (PPSF) combined with percutaneous vertebroplasty (PVP) in the treatment of thoracic and lumbar metastatic tumor.Methods 20 patients with thoracic and lumbar metastatic tumor were treated with PPSF combined with PVP and followed up 6–25 months. Using the visual analog scale (VAS) and the Barthel Index of Activities of Daily Living (BIADL) to evaluate pain intensity and quality of life before surgery and at 7 days, 3 months, 6 months after treatment.Results In this study, a total of 20 patients were followed up for 6–25 months (mean time was 14.10 months). The VAS scores of all patients were significantly decreased, while the BIADL scores were significantly increased. No patients suffered from complications such as infection, pedicle screw loosening or PMMA oozing. Spine stability was observed in all the surviving patients during the follow-up.Conclusions PPSF combined with PVP is a potentially viable treatment for thoracolumbar metastases in patients with poor systemic condition or patients who refuse to undergo a conventional open procedure such as en bloc corpectomy, and in the presence of vertebral instability or pathological fracture without significant spinal compression.

Comparison of Pedicle Screw Fixation With or Without Cement Augmentation Combined With Single-segment Isthmic Spondylolisthesis in Osteoporotic Spine

2021 ◽  
Author(s):  
Jian-cheng Peng ◽  
Hui-zhi Guo ◽  
Chen-guang Zhan ◽  
Hua-sheng Huang ◽  
Yan-huai Ma ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Operation Time ◽  
Cement Leakage ◽  
Fusion Rate ◽  
Pedicle Screw Fixation ◽  
Isthmic Spondylolisthesis ◽  
Screw Loosening ◽  
Single Segment ◽  
Significant Difference

Abstract PurposeThis study aims to investigate the necessity of cement-augmented pedicle screw fixation in single-segment isthmic spondylolisthesis with osteoporosis.MethodFifty-nine cases were reviewed retrospectively. Thirty-three cases were in the polymethylmethacrylate-augmented pedicle screw (PMMA-PS) group, and the other 26 cases were in the conventional pedicle screw (CPS) group. Evaluation data included operation time, intraoperative blood loss,hospitalization cost, hospitalization days, rates of fusion, screw loosening, bone cement leakage, visual analog scores (VAS) , Oswestry disability index (ODI) , Lumbar Lordosis（LL）, Pelvic Tilt（PT） and Sacral Slope（SS）. ResultsThe operation time and blood loss in the CPS group decreased significantly compared to the PMMA-PS group (P < 0.05). The average hospitalization cost of the PMMA group was significantly higher than that of the CPS group (P < 0.05). There was no significant difference for the average hospital stay between the 2 groups (P > 0.05). The initial and the last follow-up postoperative VAS and ODI improved significantly in the two groups (P < 0.05). There were no significant differences in VAS and ODI at each time point between the 2 groups (P > 0.05). The last postoperative spine-pelvic parameters were significantly improved compared with preoperation (P < 0.05). In the PMMA-PS group, the fusion rate was 100%. The fusion rate was 96.15% in the CPS group. No significant difference was found between the two groups for the fusion rate (P > 0.05). Nine cases in the PMMA-PS group had bone cement leakage (27.27%). There was not screw loosening in the PMMA-PS group. There were 2 cases of screw loosening in the CPS group. There were no significant differences in screw loosening, postoperative adjacent segment fractures, postoperative infection or postoperative revision between the 2 groups (P > 0.05). ConclusionsThe use of PMMA-PS on a regular basis is not recommended for posterior lumbar interbody fusion for the treatment of single-segment isthmic spondylolisthesis with osteoporosis.

scholarly journals Comparison of radiological changes after single- position versus dual- position for lateral interbody fusion and pedicle screw fixation

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Akihiko Hiyama ◽  
Hiroyuki Katoh ◽  
Daisuke Sakai ◽  
Masato Sato ◽  
Masahiro Tanaka ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Degenerative Spondylolisthesis ◽  
Operation Time ◽  
Pedicle Screw Fixation ◽  
Position Change ◽  
Dural Sac ◽  
Significant Difference ◽  
Indirect Decompression

Abstract Background There have been few comparisons between dual positions, which require a position change, and a single position, which does not require position change, and it is not clear whether there is a difference in indirect decompression achieved by the two procedures. Therefore, the purpose of this study was to compare perioperative and radiographic outcomes following lateral lumbar interbody fusion (LLIF) in two cohorts of patients who underwent surgery in a single position or dual position. Methods This study involved 45 patients who underwent indirect decompression at 68 levels, with LLIF and percutaneous pedicle screw (PPS) fixation for lumbar degenerative spondylolisthesis with spinal canal stenosis. Patient demographics and perioperative data were compared between two groups: patients who remained in the lateral decubitus position for pedicle screw fixation (SP group) and those turned to the prone position (DP group). Results A total of 26 DP and 19 SP patients were analyzed. The operation time was approximately 31 min longer for the DP group (129.7 ± 36.0 min) than for the SP group (98.4 ± 41.3 min, P < 0.01). We also evaluated the pre- and postoperative image measurements, there was no significant difference for lumbar lordosis, segmental disc angle, slipping length, and disc height between the groups. The CSA of the dural sac (DP group, from 55.3 to 78.4 mm2; SP group, from 54.7 to 77.2 mm2) and central canal diameter (DP group, from 5.9 to 7.9 mm; SP group, from 5.6 to 7.7 mm) was significantly larger after surgery in both groups. However, there were no statistically significant differences between the two groups (P = 0.684). Conclusions SP surgery could reduce the average surgery time by about 31 min. We found that the effect of indirect decompression by SP-PPS fixation following LLIF was considered to be a useful technique with no difference in dural sac enlargement or disc angle obtained compared with DP-PPS fixation.

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