Increasing pedicle screw anchoring in the osteoporotic spine by cement injection through the implant

2007 ◽  
Vol 7 (3) ◽  
pp. 366-369 ◽  
Author(s):  
Patrick Fransen
Keyword(s):  
Pedicle Screw ◽  
Degenerative Spondylolisthesis ◽  
Elevated Risk ◽  
Severe Osteoporosis ◽  
Poor Bone Quality ◽  
Decompressive Laminectomy ◽  
Hardware Failure ◽  
Cement Injection ◽  
Fluoroscopic Control ◽  
Additional Stability

✓Instrumented spinal fusion in patients with osteoporosis is challenging because of the poor bone quality and is complicated by an elevated risk of delayed hardware failure. The author treated two patients presenting with severe osteoporosis, spinal stenosis, and degenerative spondylolisthesis. He performed decompressive laminectomy, posterolateral fusion, and pedicle screw (PS) fixation involving screws with side openings that allow cement to be injected through the implant. The cement injection was conducted under fluoroscopic control without complications. Although this technique needs validation in a larger population of patients, the author believes that the injection of cement through these PSs can be performed safely in carefully selected patients. This technique creates not only a vertebroplasty-like effect that strengthens the vertebral body but also provides the additional stability afforded by the immediate anchoring of the screw, which may allow a shorter-length construct, save mobile segments, and finally reduce the risk of hardware failure.

Anterior transvertebral interbody cage with posterior transdiscal pedicle screw instrumentation for high-grade spondylolisthesis

2006 ◽  
Vol 20 (3) ◽  
pp. 1-7 ◽  
Author(s):  
Will Forest Beringer ◽  
Jean-Pierre Mobasser ◽  
Dean Karahalios ◽  
Eric Alfred Potts
Keyword(s):  
Pedicle Screw ◽  
Degenerative Spondylolisthesis ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Technical Note ◽  
Slip Angle ◽  
Fibular Graft ◽  
High Grade ◽  
Shear Forces

✓Adult high-grade degenerative spondylolisthesis represents the extreme end of the spectrum for spondylolisthesis and is consequently rarely encountered. Surgical management of high-grade spondylolisthesis requires constructs capable of resisting the shear forces at the slipped L5–S1 interspace. The severity of the slip, sacral inclination, and slip angle may make conventional approaches to 360° fusion difficult or hazardous. Transdiscal pedicle screw fixation, transvertebral fibular graft fusion, and transvertebral cage fixation are techniques that have been developed to establish anterior column load sharing and to resist shear forces at the L5–S1 interspace, given the anatomical constraints accompanying high-grade spondylolisthesis. In this technical note the authors describe the procedure for implanting an in situ anterior L5–S1 transvertebral cage and performing L4–5 anterior lumbar interbody fusion, followed by placement of posterior S1–L5 vertebral body transdiscal pedicle screws for management of high-grade spondylolisthesis.

scholarly journals The complications associated with guidewire use in spine surgeries involving pedicle screw placement: A comprehensive literature review

2018 ◽  
Vol 5 (1) ◽  
pp. 14
Author(s):  
John B. Pracyk ◽  
Nicole Ferko ◽  
Adrian P. Turner ◽  
Sara N. Root ◽  
Heather Cannon ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Operating Time ◽  
Healthcare Resource Utilization ◽  
Screw Placement ◽  
Cerebrospinal Fluid Leakage ◽  
Metal Fatigue ◽  
Pedicle Screw Placement ◽  
Hardware Failure ◽  
Pull Out ◽  
Percutaneous Pedicle Screw

Guidewires (Kirschner or “K” wires) are often required during minimally invasive spine surgery to facilitate percutaneous pedicle screw placement. The use of guidewires involves a multi-step process that carries the risk of complications and their associated consequences. To date, the reporting of such information has been limited, and the literature has not been thoroughly evaluated. The objective of this study was to conduct a narrative review and assess the burden associated with guidewire use in spine surgeries. Databases searched included PubMed and Embase between the years of 1988 and 2017. In addition to databases, recent data from relevant trade journals were hand-searched. Inclusion criteria were broad to avoid potential exclusion of relevant publications. In total, 31 articles were included. This review found that the risk of complications associated with guidewire use in spine procedures ranged from 0.4% to 14.8%. Complication types included guidewire fracture, cerebrospinal fluid leakage, post-operative ileus, infection, and other spinal hardware failure (e.g., pedicle screw pull-out). Causes of complications typically included breakage and migration of the guidewire (metal fatigue), inexperience with guidewire use, or lack of tactile or visual feedback. Specific surgery types or patient populations may be more susceptible to guidewire-related complications (e.g., L5-S1 level operations). Complications associated with guidewire use may also lead to healthcare resource utilization, including additional operating time, radiation exposure, and re-operations. Solutions to help minimize the risk of such complications and associated consequences are required.

Finite Element Study to Evaluate the Biomechanical Performance of the Spine After Augmenting Percutaneous Pedicle Screw Fixation With Kyphoplasty in the Treatment of Burst Fractures

2018 ◽  
Vol 140 (6) ◽  
Author(s):  
Shady S. Elmasry ◽  
Shihab S. Asfour ◽  
Francesco Travascio
Keyword(s):  
Finite Element ◽  
Pedicle Screw ◽  
Fatigue Testing ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Burst Fractures ◽  
Hardware Failure ◽  
Burst Fractures ◽  
Percutaneous Pedicle Screw ◽  
Percutaneous Pedicle Screw Fixation

Percutaneous pedicle screw fixation (PPSF) is a well-known minimally invasive surgery (MIS) employed in the treatment of thoracolumbar burst fractures (TBF). However, hardware failure and loss of angular correction are common limitations caused by the poor support of the anterior column of the spine. Balloon kyphoplasty (KP) is another MIS that was successfully used in the treatment of compression fractures by augmenting the injured vertebral body with cement. To overcome the limitations of stand-alone PPSF, it was suggested to augment PPSF with KP as a surgical treatment of TBF. Yet, little is known about the biomechanical alteration occurred to the spine after performing such procedure. The objective of this study was to evaluate and compare the immediate post-operative biomechanical performance of stand-alone PPSF, stand-alone-KP, and KP-augmented PPSF procedures. Novel three-dimensional (3D) finite element (FE) models of the thoracolumbar junction that describes the fractured spine and the three investigated procedures were developed and tested under mechanical loading conditions. The spinal stiffness, stresses at the implanted hardware, and the intradiscal pressure at the upper and lower segments were measured and compared. The results showed no major differences in the measured parameters between stand-alone PPSF and KP-augmented PPSF procedures, and demonstrated that the stand-alone KP may restore the stiffness of the intact spine. Accordingly, there was no immediate post-operative biomechanical advantage in augmenting PPSF with KP when compared to stand-alone PPSF, and fatigue testing may be required to evaluate the long-term biomechanical performance of such procedures.

Hardware Failure in an Unconstrained Lumbar Pedicle Screw System

Spine ◽  
1999 ◽  
Vol 24 (11) ◽  
pp. 1138-1143 ◽  
Author(s):  
F. Todd Wetzel ◽  
Marshall Brustein ◽  
Frank M. Phillips ◽  
Suzanne Trott
Keyword(s):  
Pedicle Screw ◽  
Hardware Failure ◽  
Lumbar Pedicle

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.

The Evaluation of a Novel Three-Dimensional Printed Expandable Pedicle Screw Sleeve Insert

2019 ◽  
Vol 13 (3) ◽  
Author(s):  
Timothy A. Burkhart ◽  
Manjunath Sadashivaiah ◽  
Jacob Reeves ◽  
Paraham Rasounlinejad
Keyword(s):  
Pedicle Screw ◽  
Vertebral Body ◽  
Degenerative Spondylolisthesis ◽  
Three Dimensional ◽  
Area Under The Curve ◽  
Tensile Load ◽  
The Novel ◽  
Conflicting Information ◽  
Screw Augmentation ◽  
3D Printed

When used in combination with decompression, spinal fusion is a successful procedure for treating patients with spinal stenosis and degenerative spondylolisthesis. While a number of auxiliary devices have been proposed to enhance the fixation of the screw within the pedicle and vertebral body, there is conflicting information regarding the efficacy of their use. Therefore, the aim of this study was to determine the ability of a novel expandable pedicle screw to improve the fixation of the pedicle screw within the pedicle and vertebral body. A three-dimensional (3D) printed, screw sleeve was designed that expanded within the pedicle and vertebral body when a standard pedicle screw was inserted into it. The left and right pedicle of ten (N = 10) cadaveric lumbar spine specimens (L3–L5) were randomly assigned to be instrumented with either a pedicle screw and the sleeve or a pedicle screw only. Following instrumentation, the screws were exposed to tensile load at 5 mm/min until failure. The failure force, failure deformation, and area under the force–deformation curve were determined and compared between screw conditions. There were no significant differences between the screws and sleeve, and the screw only conditions for the failure force (p = 0.24), failure displacement (p = 0.10), and area under the curve (p = 0.38). While the novel screw sleeve presented here performed as well as a screw without a sleeve, it was better than other screw augmentation devices reported previously. In addition, it is likely that this device would prove useful as an enhancement to revision.

scholarly journals Biomechanical Comparison of Pedicle Screw Augmented with Different Volumes of Polymethylmethacrylate in Osteoporotic and Severely Osteoporotic Synthetic Bone Blocks in Primary Implantation: An Experimental Study

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Da Liu ◽  
Xiao-jun Zhang ◽  
Dong-fa Liao ◽  
Jiang-jun Zhou ◽  
Zhi-qiang Li ◽  
...  
Keyword(s):  
Experimental Study ◽  
Pedicle Screw ◽  
Severe Osteoporosis ◽  
Synthetic Bone ◽  
Pullout Tests ◽  
Positive Correlations ◽  
Biomechanical Comparison ◽  
Bone Condition ◽  
Primary Implantation ◽  
Optimum Volume

This study was designed to compare screw stabilities augmented with different volumes of PMMA and analyze relationship between screw stability and volume of PMMA and optimum volume of PMMA in different bone condition. Osteoporotic and severely osteoporotic synthetic bone blocks were divided into groups A0-A5 and B0-B5, respectively. Different volumes of PMMA were injected in groups A0 to A5 and B0 to B5. Axial pullout tests were performed andFmaxwas measured.Fmaxin groups A1-A5 were all significantly higher than group A0. Except between groups A1 and A2, A3 and A4, and A4 and A5, there were significant differences onFmaxbetween any other two groups.Fmaxin groups B1-B5 were all significantly higher than group B0. Except between groups B1 and B2, B2 and B3, and B4 and B5, there were significant differences onFmaxbetween any other two groups. There was significantly positive correlation betweenFmaxand volume of PMMA in osteoporotic and severely osteoporotic blocks. PMMA can significantly enhance pedicle screw stability in osteoporosis and severe osteoporosis. There were positive correlations between screw stability and volume of PMMA. In this study, injection of 3 mL and 4 mL PMMA was preferred in osteoporotic and severely osteoporotic blocks, respectively.

Minimally invasive unilateral approach for bilateral decompression of spinal stenosis and modified transforaminal lumbar interbody fusion for degenerative spondylolisthesis

2013 ◽  
Vol 35 (v2supplement) ◽  
pp. Video4 ◽  
Author(s):  
Kevin S. Chen ◽  
Khoi D. Than ◽  
Frank LaMarca ◽  
Paul Park
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Spinal Stenosis ◽  
Interbody Fusion ◽  
Degenerative Spondylolisthesis ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Invasive Approach ◽  
Unilateral Approach ◽  
Percutaneous Pedicle Screw

This video describes a minimally invasive approach for treatment of symptomatic grade I spondylolisthesis and high-grade spinal stenosis. In this procedure, a unilateral approach for bilateral decompression is utilized in conjunction with a modified transforaminal lumbar interbody fusion and percutaneous pedicle screw fixation. The key steps in the procedure are outlined, and include positioning, fluoroscopic positioning/guidance, exposure with tubular retractor system, technique for ipsilateral and contra-lateral decompression, disc space preparation and interbody grafting, percutaneous pedicle screw and rod placement, and closure.The video can be found here: http://youtu.be/QTymO4Cu4B0.

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