A Case of Pedicle Screw Loosening Treated by Modified Transpedicular Screw Augmentation with Polymethylmethacrylate

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.

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Comparison of Cortical Trajectory and Traditional Pedicle Screw Loosening with Cyclic Loading

The Spine Journal ◽

10.1016/j.spinee.2012.08.288 ◽

2012 ◽

Vol 12 (9) ◽

pp. S104-S105 ◽

Cited By ~ 1

Author(s):

Erkan Alci

Keyword(s):

Cyclic Loading ◽

Pedicle Screw ◽

Screw Loosening ◽

Pedicle Screw Loosening

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Hounsfield unit of screw trajectory as a predictor of pedicle screw loosening after single level lumbar interbody fusion

Journal of Orthopaedic Science ◽

10.1016/j.jos.2018.04.006 ◽

2018 ◽

Vol 23 (5) ◽

pp. 734-738 ◽

Cited By ~ 11

Author(s):

Yusuke Sakai ◽

Shota Takenaka ◽

Yohei Matsuo ◽

Hiroyasu Fujiwara ◽

Hirotsugu Honda ◽

...

Keyword(s):

Pedicle Screw ◽

Interbody Fusion ◽

Hounsfield Unit ◽

Lumbar Interbody Fusion ◽

Screw Loosening ◽

Single Level ◽

Pedicle Screw Loosening

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Pedicle screw loosening is correlated to chronic subclinical deep implant infection: a retrospective database analysis

European Spine Journal ◽

10.1007/s00586-018-5592-2 ◽

2018 ◽

Vol 27 (10) ◽

pp. 2529-2535 ◽

Cited By ~ 16

Author(s):

Lukas Leitner ◽

Isabella Malaj ◽

Patrick Sadoghi ◽

Florian Amerstorfer ◽

Mathias Glehr ◽

...

Keyword(s):

Pedicle Screw ◽

Screw Loosening ◽

Database Analysis ◽

Implant Infection ◽

Retrospective Database Analysis ◽

Pedicle Screw Loosening ◽

Retrospective Database

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Pedicle Screw Loosening After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis in Upper and Lower Instrumented Vertebrae Having Major Perforation

Spine ◽

10.1097/brs.0000000000002305 ◽

2017 ◽

Vol 42 (24) ◽

pp. 1895-1900 ◽

Cited By ~ 7

Author(s):

Masashi Uehara ◽

Jun Takahashi ◽

Shota Ikegami ◽

Shugo Kuraishi ◽

Masayuki Shimizu ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Pedicle Screw ◽

Posterior Spinal Fusion ◽

Screw Loosening ◽

Pedicle Screw Loosening

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The Role of Prophylactic Vertebroplasty at UIV+1 and Cement-augmented Fenestrated Pedicle Screw for Prevention of PJK/PJF in Patients With Osteoporosis: A Propensity Score–matched Analysis

10.21203/rs.3.rs-73483/v1 ◽

2020 ◽

Author(s):

Qi Wang ◽

Chi Wang ◽

Wenhao Hu ◽

Fanqi Hu ◽

Weibo Liu ◽

...

Keyword(s):

Propensity Score ◽

Pedicle Screw ◽

Adult Spinal Deformity ◽

Cement Leakage ◽

Cement Augmentation ◽

Screw Loosening ◽

Group A ◽

Pedicle Screw Loosening ◽

Fenestrated Pedicle Screw

Abstract Objective: To elucidate the role of prophylactic vertebroplasty (PV) at UIV+1 and cement-augmented fenestrated pedicle screw (CAFPS) in prevention of PJK and PJF.Background: Cement augmentation at UIV and UIV+1 was found to prevent PJK and PJF. But most studies are retrospective and have a selection bias due to multifactorial etiology of PJF, making it difficult to identify the efficacy of prophylactic cement augmentation. Methods: We enrolled 208 surgically treated adult spinal deformity (ASD) patients who were followed for at least 2 years, to elucidate whether prophylactic cement augmentation was truly minimizing the risk of PJK and PJF in a uniform population from one center database. Patients were classified into two groups. Two comparable groups were propensity-matched with one to one nearest neighbor matching. The main outcome variables including PJK, PJF, pedicle screw loosening and cement leakage were compared.Results：After propensity score matching, there were 58 propensity-matched patients in group A and B (n=29 in each group) whose parameters including age, BMI, BMD, number of instrumented vertebrae, SVA, spinal-pelvic parameters and the frequency of UIV and LIV were similar. The incidence of PJK showed no significantly statistical difference between group A and B (10.3% vs 13.8%, p >0.99). Compared to group A, group B had a higher proportion of patients developing PJF (24.1% vs 0%, p=0.01). Pedicle screw loosening at UIV and (or) LIV showed no difference (24.1% vs 3.4%, p=0.052) between two groups. In group A, cement leakage was detected in 5 cases via fluoroscopy, but none of them had neurological deficit or pulmonary cement embolism.Conclusion: Combined application of CAFPS and PV could reduce the incidence of PJF, but it could not prevent the development of PJK in the surgical management of ASD with low BMD or osteoporosis.

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

Journal of Neurosurgery Spine ◽

10.3171/2015.10.spine15511 ◽

2016 ◽

Vol 25 (1) ◽

pp. 103-109 ◽

Cited By ~ 17

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.

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