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

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.

Download Full-text

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

10.21203/rs.3.rs-1051822/v1 ◽

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.

Download Full-text

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

Orthopedic Reviews ◽

10.4081/or.2013.e24 ◽

2013 ◽

Vol 5 (3) ◽

pp. 24 ◽

Cited By ~ 12

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.

Download Full-text

A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation

Journal of Neurosurgery Spine ◽

10.3171/spi-07/07/047 ◽

2007 ◽

Vol 7 (1) ◽

pp. 47-53 ◽

Cited By ~ 91

Author(s):

Bruce M. Frankel ◽

Sabino D'Agostino ◽

Chiang Wang

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screws ◽

Pedicle Screw Fixation ◽

Screw Placement ◽

Pullout Strength ◽

Mineral Density ◽

Hardware Failure ◽

Screw Augmentation ◽

Valuable Adjunct

Object Instrumentation of the osteoporotic spine can be fraught with complications such as hardware failure. A cadaver study was performed to determine the biomechanical performance of polymethylmethacrylate (PMMA)–augmented pedicle screws. Methods Three osteoporotic human cadaveric specimens with a mean bone mineral density of 0.70 g/cm2 were used to evaluate the performance of a novel fenestrated bone tap in pedicle screw augmentation. On this device, tap threads serve a dual purpose in preventing backflow of cement toward neural elements while allowing for a custom form for subsequent screw placement. The tap was used to inject a mean volume of 3.7 ml PMMA/pedicle (range 2–8.0 ml PMMA/pedicle) followed by pedicle screw placement between L-5 and T-5, alternating between augmented and nonaugmented instrumentation. Axial pullout testing was then performed. Results Pedicle screw pullout strength was increased in both primary and salvage procedures by 119% (p = 0.001) and 162% (p = 0.01), respectively, after PMMA augmentation. Additionally, the injected cement volumes were divided into two groups, a low-cement group (≤ 2.8 ml/pedicle) and a high-cement group (≥ 5.5 ml/pedicle). Interestingly, the pullout strength did not significantly change with increased cement usage between the two groups (p > 0.05 for all comparisons). Conclusions Polymethylmethacrylate-augmented pedicle screw fixation results in a significant increase in the axial pullout strength of augmented pedicle screws in both primary and revision procedures. This technique may be a valuable adjunct in cases in which bolstering of the screw–bone interface is necessary.

Download Full-text

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

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519419400244 ◽

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.

Download Full-text

The Correlation between Insertion Torque of Pedicle Screws with Bone Mineral Density Values in Posterior Lumbar Pedicle Screw Fixation

The Spine Journal ◽

10.1016/j.spinee.2011.08.352 ◽

2011 ◽

Vol 11 (10) ◽

pp. S145-S146 ◽

Cited By ~ 2

Author(s):

Jae Hyup Lee ◽

Jae-Woo Park ◽

Ji-Ho Lee ◽

Hye Soo Lee

Keyword(s):

Bone Mineral Density ◽

Pedicle Screw ◽

Bone Mineral ◽

Screw Fixation ◽

Pedicle Screws ◽

Pedicle Screw Fixation ◽

Insertion Torque ◽

Mineral Density ◽

Density Values ◽

Lumbar Pedicle

Download Full-text

Posterior monoaxial screw fixation combined with distraction-compression technology assisted endplate reduction for thoracolumbar burst fractures: a retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-3038-6 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Xuhong Xue ◽

Sheng Zhao

Keyword(s):

Retrospective Study ◽

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screws ◽

Pedicle Screw Fixation ◽

Thoracolumbar Burst Fractures ◽

Correction Rate ◽

Burst Fractures ◽

The Mean

Abstract Background The management of thoracolumbar burst fractures traditionally involves posterior pedicle screw fixation, but it has some drawbacks. The aim of this study is to evaluate the clinical and radiological outcomes of patients with thoracolumbar burst fractures. They were treated by a modified technique that monoaxial pedicle screws instrumentation and distraction-compression technology assisted end plate reduction. Methods From March 2014 to February 2016, a retrospective study including 42 consecutive patients with thoracolumbar burst fractures was performed. The patients had undergone posterior reduction and instrumentation with monoaxial pedicle screws. The fractured vertebrae were also inserted screws as a push point. The distraction -compression technology was used as assisting end plate reduction. All patients were followed up at a minimum of 2 years. These parameters including segmental kyphosis, severity of fracture, neurological function, canal compromise and back pain were evaluated in preoperatively, postoperatively and at the final follow-up. Results The average follow-up period was 28.9 ± 4.3 months (range, 24-39mo). No patients had postoperative implant failure at recent follow-up. The mean Cobb angle of the kyphosis was improved from 14.2°to 1.1° (correction rate 92.1%). At final follow-up there was 1.5% loss of correction. The mean preoperative wedge angle was improved from 17.1 ± 7.9°to 4.4 ± 3.7°(correction rate 74.3%). The mean anterior and posterior vertebral height also showed significant improvements postoperatively, which were maintained at the final follow-up(P < 0.05). The mean visual analogue scale (VAS) scores was 8 and 1.6 in preoperation and at the last follow-up, and there was significant difference (p < 0.05). Conclusion Based on our experience, distraction-compression technology can assist reduction of collapsed endplate directly. Satisfactory fracture reduction and correction of segmental kyphosis can be achieved and maintained with the use of monoaxial pedicle screw fixation including the fractured vertebra. It may be a good treatment approach for thoracolumbar burst fractures.

Download Full-text

Treatment of thoracolumbar burst fractures by short-segment pedicle screw fixation using a combination of two additional pedicle screws and vertebroplasty at the level of the fracture: a finite element analysis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-017-1623-0 ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 11

Author(s):

Jen-Chung Liao ◽

Weng-Pin Chen ◽

Hao Wang

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screws ◽

Pedicle Screw Fixation ◽

Short Segment ◽

Element Analysis ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures

Download Full-text

Removal of broken pedicle screws

Journal of Neurosurgery Spine ◽

10.3171/spi.2001.95.1.0150 ◽

2001 ◽

Vol 95 (1) ◽

pp. 150-151 ◽

Cited By ~ 2

Author(s):

Kei Miyamoto ◽

Katsuji Shimizu ◽

Ken Kouda ◽

Hideo Hosoe

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screws ◽

Pedicle Screw Fixation ◽

New Method ◽

Content Type ◽

Screw Hole ◽

Narrow Slot ◽

Power Drill ◽

Diamond Burr

✓ The authors describe a simple, new method for removing broken pedicle screws. Under microscopic visualization a straight, narrow slot is etched in the broken surface of the pedicle screw by using a power drill with a 2-mm diamond burr. A minus screwdriver is then inserted into the slot, and the broken screw is rotated and removed. There is no need to enlarge the screw hole around the broken screw or to use any special devices. The authors succeeded in removing broken screws in two cases, and there were no complications. This method allows preservation of both the pedicle and the screw hole. Consequently, it is possible to insert new pedicle screws into the same hole without losing the strength and stability of pedicle screw fixation. The authors recommend this simple and new method for removal of broken pedicle screws.

Download Full-text