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

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

10.21203/rs.2.19693/v3 ◽

2020 ◽

Author(s):

Yong-chao Tang ◽

Hui-zhi Guo ◽

Dan-qing Guo ◽

Pei-jie Luo ◽

Yong-xian Li ◽

...

Keyword(s):

Perioperative Complications ◽

Pedicle Screws ◽

Operation Time ◽

Fusion Rate ◽

Screw Loosening ◽

Caudal Vertebra ◽

Lumbar Degenerative Disease ◽

Potential Risks ◽

Four Levels

Abstract Background: The effect and potential risks of CAPSI on osteoporotic lumbar degenerative disease (LDD) have not been investigated in the cases of multilevel fixation. This study was to investigate potential complications of using multilevel cement-augmented pedicle screws fixation (three or four levels) and its effectiveness of this method on treating LDD with low bone quality. Methods: A total of 93 patients with multilevel LDD were divided into the CAPSI group (46 subjects) and the CPS group (47 subjects), including 75 cases for three levels, 18 cases for four levels, and the average follow-up was 33.72±18.78 months (range: 24-108). Relevant data were recorded, including age, gender, body mass index (BMI), bone mineral density (BMD), diagnosis, fusion methods, bone graft, fusion level, lumbosacral fixation, different patterns of S1 pedicle screw placement, operation time, blood loss, hospital stay, perioperative complications, CL, pulmonary cement embolism (PCE), screw loosening, and nonunion patients. Furthermore, we also measured the VAS and ODI at pre-operation, post-operation, and follow-up time points. Results: In the CAPSI group, a total of 336 augmented screws was placed bilaterally, and the average injection dose of bone cement was 1.85±0.65 ml (range: 1-4). The CL was observed in 44 patients (95.65%) and 116 screws (34.52%). And in the CPS group, seventeen patients (36.17%) and thirty-three screws (8.46%) suffered loosening in cranial or caudal vertebra (seven cranial cases and twenty-six of caudal), four cases experienced nonunion, and thus the fusion rate was 91.49% in total. 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, VAS and ODI scores at the follow-up times, there were no significant differences between two groups. Conclusions: Patients with osteoporotic LDD underwent multilevel CPS fixation have a higher rate of screw loosening in 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.

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The effect and potential risks of using cement-augmented pedicle screw instrumentation on multiple segment fixation in osteoporotic spine with lumbar degenerative diseases

10.21203/rs.2.19693/v2 ◽

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 ◽

Operation Time ◽

Fusion Rate ◽

Screw Loosening ◽

Potential Risks ◽

Lumbar Degenerative Diseases ◽

Four Levels

Abstract Background: Cement-augmented pedicle screw instrumentation (CAPSI) has been found to significantly increase the pedicle screws anchorage in the osteoporotic vertebral body, however, with the increase of augmented level and bone cement dose, the incidence of cement leakage (CL) or side complication of CAPSI also increased. But the effect and potential risks of CAPSI for osteoporotic lumbar degenerative diseases (LDD) have not been investigated in the cases of multiple segment fixation. The purpose of this study was to investigate potential complications of using cement-augmented screws for multilevel fixation (three or four levels) and the effectiveness of this method for treating LDD with low bone quality.Methods: Our clinical database was reviewed for osteoporotic patients who using CAPSI or conventional pedicle screw (CPS) for multilevel fixation (three or four levels) between February 2010 to February 2017. A total of 93 patients with multilevel LDD were divided into the CAPSI group (46 subjects) and the CPS group (47 subjects), including 75 cases for three levels (L2-L5 21 cases、L3-S1 54 cases), 18 cases for four levels (L1-L5 2 cases、L2-S1 16 cases), and the average follow-up was 33.72±18.78 months (range: 24-108). Relevant data were recorded, including age, gender, body mass index (BMI), bone mineral density (BMD), diagnosis, fusion methods, bone graft, fusion level, lumbosacral fixation, different patterns of S1 pedicle screw placement, operation time, blood loss, hospital stay, complications, CL, pulmonary cement embolism (PCE), screw loosening and nonunion patients. Besides, the visual analogue scale (VAS) and Oswestry disability index (ODI) at pre-operation, post-operation, and follow-up were also assessed.Results: In the CAPSI group, a total of 336 augmented screws were placed bilaterally, and the average injection dose of bone cement was 1.85±0.65 ml (range: 1-4). The CL was observed in 44 patients (95.65%) and 116 screws (34.52%). Three cemented screws (0.89%) and twenty-four S1 conventional screws (44.44%) were found loosening during the follow-up and the overall fusion rate was 93.47%. For perioperative complications, two patients (4.35%) experienced PCE, one patient augmented vertebral fracture and three patients (6.52%) wound infection. And in the CPS group, seventeen patients (36.17%) and thirty-three screws (8.46%) suffered loosening in cranial or caudal segments (seven cranial cases and twenty-six of caudal), four cases experienced nonunion, the fusion rate was 91.49% in total. The operation time and hospital stay were longer in CAPSI group, but with a lower percentage of screw loosening (P＜0. 05). And in terms of blood loss, perioperative complications, fusion rate, VAS and ODI scores at the follow-up times, no significant differences were found between the two groups.Conclusions: Patients with osteoporotic LDD underwent CPS at multiple segments have a high rate of screw loosening in the cranial and caudal segment. The application of cemented pedicle screws on 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-augmenting the cranial and caudal pedicle screws may be a worthy strategy to decrease the complications.

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The Prevalence and Risk Factors for S2 Alar-Iliac Screw Loosening with a Minimum 2-Year Follow-up

Asian Spine Journal ◽

10.31616/asj.2019.0127 ◽

2020 ◽

Vol 14 (2) ◽

pp. 177-184 ◽

Cited By ~ 1

Author(s):

Hiroaki Nakashima ◽

Tokumi Kanemura ◽

Kotaro Satake ◽

Kenyu Ito ◽

Yoshimoto Ishikawa ◽

...

Keyword(s):

Risk Factors ◽

Lumbar Lordosis ◽

Pedicle Screws ◽

Fusion Rate ◽

Screw Loosening ◽

Screw Insertion ◽

Bony Fusion ◽

Iliac Screw ◽

Lumbosacral Fixation

Study Design: A retrospective cohort study.Purpose: The purpose of this study was to investigate the prevalence and risk factors for S2 alar-iliac (SAI) screw loosening following lumbosacral fixation, with a minimum 2-year follow-up.Overview of Literature: Although SAI screws allow surgeons to perform lumbosacral fixation with a low profile and enhanced biomechanical strength, screw loosening following surgery can occur in some cases. However, few studies have investigated the prevalence and risk factors for SAI screw loosening.Methods: This retrospective study included 35 patients (mean age, 72.8±8.0 years; male, 10; female, 25) who underwent lumbosacral fixation using SAI screws with at least 2 years of follow-up. SAI screw loosening and L5–S bony fusion were assessed using computed tomography. The period for which the screws appeared loose and the risk factors for SAI screw loosening were investigated 2 years after surgery.Results: A total of 70 SAI screws and 70 S1 pedicle screws were inserted. Loosening was observed 0.5, 1, and 2 years after surgery in 17 (24.3%), 35 (50.0%), and 35 (50.0%) SAI screws, respectively. Bony fusion rate at L5–S was significantly lower in patients with SAI screw loosening than in those without screw loosening (65.0% vs. 93.3%, p =0.048). The score for SAI screw contact with the iliac cortical bone and the bony fusion rate at L5–S were significantly lower in the loosening group than in the non-loosening group (1.8±0.5 vs. 2.2±0.3, p <0.001, respectively). Postoperative pelvic incidence–lumbar lordosis was significantly higher in the loosening group than in the non-loosening group (7.9°±15.4° vs. 0.5°±8.7°, p =0.02, respectively).Conclusions: SAI screw loosening is closely correlated with pseudoarthrosis at L5–S. Appropriate screw insertion and optimal lumbar lordosis restoration are important to prevent postoperative complications related to SAI screws.

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Efficacy of Biocage in treating single-segment lumbar degenerative disease in patients with high risk of non-fusion: a prospective controlled study with at least 2 years’ follow-up

Journal of International Medical Research ◽

10.1177/0300060520945500 ◽

2020 ◽

Vol 48 (9) ◽

pp. 030006052094550

Author(s):

Yang Li ◽

Yang Yu ◽

Tian-yong Hou ◽

Ze-hua Zhang ◽

Jun-chao Xing ◽

...

Keyword(s):

High Risk ◽

Clinical Efficacy ◽

Fusion Rate ◽

Degenerative Disease ◽

Controlled Study ◽

Allogeneic Bone ◽

Intervertebral Foramen ◽

Lumbar Degenerative Disease ◽

Single Segment

Objective To evaluate the clinical efficacy of an allogeneic bone cage (Biocage; Beijing Datsing Bio-Tech Co., Ltd., Beijing, China) for treatment of single-segment lumbar degenerative disease in patients with a high risk of non-fusion. Methods From January 2013 to December 2016, 67 patients who underwent lumbar fusion were divided into the Biocage group (n = 33) and polyether ether ketone (PEEK) group (n = 34). The patients were followed up for 24 to 48 months. The mean intervertebral height of the fusion level, fusion rate, height of the intervertebral foramen, visual analog scale score, and Oswestry disability index were compared. Results The PEEK group had a lower fusion rate than the Biocage group (88.24% vs. 90.91%), although the difference was not statistically significant. During follow-up, the height of the intervertebral space was similar between the Biocage and PEEK groups (12.88 ± 0.45 and 12.84 ± 1.01 mm, respectively). The height of the intervertebral foramen was larger in the Biocage than PEEK group (20.67 ± 1.34 vs. 20.00 ± 2.05 mm). Good clinical efficacy was achieved in both groups. Conclusion The Biocage is efficient and safe for treatment of single-segment lumbar degenerative disease in patients with a high risk of non-fusion.

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03309-y ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Yong-chao Tang ◽

Hui-zhi Guo ◽

Dan-qing Guo ◽

Pei-jie Luo ◽

Yong-xian Li ◽

...

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Degenerative Disease ◽

Lumbar Degenerative Disease ◽

Potential Risks

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Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01975-1 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Yao-yao Liu ◽

Jun Xiao ◽

Huai-jian Jin ◽

Zhong Wang ◽

Xiang Yin ◽

...

Keyword(s):

Blood Loss ◽

Pedicle Screw ◽

Pedicle Screws ◽

Operation Time ◽

Cerebrospinal Fluid Leakage ◽

Posterior Fixation ◽

Screw Loosening ◽

Superficial Infection ◽

Lumbar Degenerative Disease ◽

Lumbar Spondylolisthesis

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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