An Experimental Study on Transpedicular Screw Fixation in Relation to Osteoporosis of the Lumbar Spine

Soshi, Shigeru; Shiba, Ritu; Kondo, Hidemaru; Murota, Kagehisa

doi:10.1097/00007632-199111000-00015

Cited by 337 publications

(172 citation statements)

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“…A importân-cia desses parâmetros tem sido relatada e foi marcante a observação da alteração do comportamento do mesmo tipo de parafuso frente à alteração das outras variáveis (11,(18)(19)(20)(21)(22)(23)(24)(25) . Esses resultados demonstram que, para a obtenção máxima da propriedade mecânica do implante, relacionada com sua resistência ao arrancamento, não é suficiente a alteração isolada do desenho do parafuso.…”

Section: Uss I Uss Ii P Uss Iiunclassified

Torque de inserção e resistência ao arrancamento dos parafusos vertebrais com alma cilíndrica e cônica

et al. 2008

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Section: Uss I Uss Ii P Uss Iiunclassified

Torque de inserção e resistência ao arrancamento dos parafusos vertebrais com alma cilíndrica e cônica

et al. 2008

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“…Furthermore, various techniques have been developed to increase the fixation strength in the osteoporotic spine, such as the use of supplemental laminar hooks, fixation with bi-cortical screws, improved screw geometry, and the augmentation of screw fixation with bone cement [1-3, 7, 13, 15, 16, 19, 20, 23-25]. Polymethylmethacrylate (PMMA) is most commonly utilized to strengthen the pedicle screws, and the results have proven to be quite effective in both in vitro and clinical reports [6,18,[20][21][22]26]. Risks involved in the use of PMMA for pedicle screw augmentation include nerve injury and vascular damage caused by cement leakage [25].…”

Section: Introductionmentioning

confidence: 99%

Polymethylmethacrylate augmentation of the pedicle screw: the cement distribution in the vertebral body

Chang

et al. 2011

Eur Spine J

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Many studies have proven that the polymethylmethacrylate (PMMA) augmentation of the pedicle screw can significantly increase stiffness and strength of spinal fixation. Some major complications have also been reported. However, there are no reports discussing cement distribution and its morphology in the osteoporotic vertebral body, which is critical in the analysis of the biomechanical strength of the pedicle screw and the risk of cement leakage after pedicle screw augmentation. In this study, we used computed tomography (CT) to evaluate the cement distribution in the osteoporotic vertebral body after PMMA augmentation of a pedicle screw and to analyze the factors leading to cement leakage. Two groups of patients were studied. Group A consisted 25 osteoporotic patients (mean age of 73 years) with spinal instrumentation who had a total of 145 pedicle screws and cement augmentation with biopsy needles. Group B consisted of 23 osteoporotic patients (mean age of 74.6 years) with spinal instrumentation who had a total of 125 cannulated pedicle screws with cement augmentation. All patients had CT evaluation of the cement distribution in the vertebral body after the surgery. The cement distribution in the vertebrae was divided into four zones in the axial CT view: anterior onethird, middle third, and posterior third of vertebral body, and the pedicle. The morphology of the cement distribution around the pedicle screw was defined as scattered type or concentrate type. The leakage pattern was divided to anterior-lateral, posterior-lateral, and canal leakage. The correlations among bone mineral density (BMD), the cement leakage rate, and cement distribution morphology were also analyzed. The results showed that most augmented pedicle screws had cement extension into three of the four zones of the vertebral body (66.3%), followed by two zones (20%), all four zones (11.5%), and only one zone (2.2%). Overall, 123 screws (84.8%) in Group A and 108 screws (86.4%) in Group B had cement concentrate type distribution. The cement leakage rate in Group A is 18.3% and 13.6% in Group B. Patients with a BMD \0.6 g/cm 2 had significantly higher rates of cement leakage and tended toward a scattered cement distribution. There was only one patient who had a symptomatic leakage (sciatica) in Group B. We concluded that the cement distribution after pedicle screw augmentation with biopsy needle or cannulated screw technique was mostly localized in three zones of the vertebral body, and patients with lower BMD had a higher risk of cement leakage and scattered cement distribution.

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“…In addition, there are also methods of filling the space between vertebrae with hydroxyapatite or bone cement. [13][14][15][16] Even though these methods have displayed effectiveness experimentally, adequate results have not been reported clinically.…”

Section: Discussionmentioning

confidence: 99%

Posterior spinal shortening for paraparesis following vertebral collapse due to osteoporosis

et al. 2007

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Study design: Retrospective case series. Objectives: To assess the efficacy of posterior spinal shortening for paraparetic patients following vertebral collapse owing to osteoporosis, especially on instrumentation loosening. Setting: Department of orthopaedic surgery, Jichi Medical University Hospital and Omiya Medical Center in Japan. Methods:The clinical records and radiographs of 13 patients with paraparesis following vertebral collapse owing to osteoporosis treated with posterior spinal shortening were retrospectively reviewed to evaluate the usefulness of this method. Assessment of the clinical course was done by direct examination in all cases. Ambulatory ability was divided into four categories. Results: Upon final observation, nine cases were able to walk with a cane or crutch, one case remained in gait training, two cases remained unable to stand and one case with urinary incontinence improved in urinary function. In one case, paralysis deteriorated. Vertebral compression fracture of the end vertebrae that were fixed occurred in three cases complicated with rheumatoid arthritis. Conclusion: The posterior spinal shortening can be a choice for treating delayed paraparesis following vertebral collapse owing to osteoporosis.

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An Experimental Study on Transpedicular Screw Fixation in Relation to Osteoporosis of the Lumbar Spine

Cited by 337 publications

References 0 publications

Torque de inserção e resistência ao arrancamento dos parafusos vertebrais com alma cilíndrica e cônica

Torque de inserção e resistência ao arrancamento dos parafusos vertebrais com alma cilíndrica e cônica

Polymethylmethacrylate augmentation of the pedicle screw: the cement distribution in the vertebral body

Posterior spinal shortening for paraparesis following vertebral collapse due to osteoporosis

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