Anterior bone cement augmentation in anterior lumbar interbody fusion and percutaneous pedicle screw fixation in patients with osteoporosis

Kim, Kyeong Hwan; Lee, Sang-Ho; Lee, Dong Yeob; Shim, Chan Shik; Maeng, Dae Hyeon

doi:10.3171/2009.11.spine09264

Cited by 38 publications

(30 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Indeed, such efforts have boosted fusion rates. 2,13,14,16,32 Stand-alone cages with intrinsic plates and screws have also been developed to address needed restoration of the anterior tension band. 15 Cage stability in flexion, extension, and lateral bending now compares favorably with pedicle screw fixation and is superior with respect to rotation.…”

Section: Discussionmentioning

confidence: 99%

Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3–4 fixation

Y¹,

Jang

Lee³

et al. 2014

SPI

Self Cite

View full text Add to dashboard Cite

Many studies attest to the excellent results achieved using anterior lumbar interbody fusion (ALIF) for degenerative spondylolisthesis. The purpose of this report is to document a rare instance of L-4 vertebral body fracture following use of a stand-alone interbody fusion device for L3–4 ALIF. The patient, a 55-year-old man, had suffered intractable pain of the back, right buttock, and left leg for several weeks. Initial radiographs showed Grade I degenerative spondylolisthesis, with instability in the sagittal plane (upon 15° rotation) and stenosis of central and both lateral recesses at the L3–4 level. Anterior lumbar interbody fusion of the affected vertebrae was subsequently conducted using a stand-alone cage/plate system. Postoperatively, the severity of spondylolisthesis diminished, with resolution of symptoms. However, the patient returned 2 months later with both leg weakness and back pain. Plain radiographs and CT indicated device failure due to anterior fracture of the L-4 vertebral body, and the spondylolisthesis had recurred. At this point, bilateral facetectomies were performed, with reduction/fixation of L3–4 by pedicle screws. Again, degenerative spondylolisthesis improved postsurgically and symptoms eased, with eventual healing of the vertebral body fracture. This report documents a rare instance of L-4 vertebral body fracture following use of a stand-alone device for ALIF at L3–4, likely as a consequence of angular instability in degenerative spondylolisthesis. Under such conditions, additional pedicle screw fixation is advised.

show abstract

Section: Discussionmentioning

confidence: 99%

Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3–4 fixation

Y¹,

Jang

Lee³

et al. 2014

SPI

Self Cite

View full text Add to dashboard Cite

show abstract

“…20,25,33 Furthermore, the use of prophylactic anterior cement augmentation has been shown to decrease cage subsidence following ALIF and PSF in osteoporotic patients. 8 Cement augmentation does have associated risks that are particularly prone to occur in osteoporotic patients. Reports of failed cement-augmented instrumentation exist, and potential consequences can be more drastic than nonaugmented screws, as the intact cement-screw complex can be displaced through compromised bone.…”

Section: 18mentioning

confidence: 99%

“…6 Prior studies have described ALIF with cement augmentation and supplemental posterior fixation for these osteoporotic patients, but the two-site approach when using traditional techniques to place posterior instrumentation has been associated with longer operative time, increased blood loss, and increased complication rates. [7][8][9] Specifically with percutaneous pedicle screw placement, there is greater radiation exposure and violation of cranial facet joints, which can lead to altered biomechanics at the adjacent level. 10 Other studies have shown pseudoarthrosis rates from 0% to 49% in ALIFs without supplemental posterior fixation.…”

Section: Introductionmentioning

confidence: 99%

Anterior Lumbar Interbody Fusion With Cement Augmentation Without Posterior Fixation to Treat Isthmic Spondylolisthesis in an Osteopenic Patient—A Surgical Technique

et al. 2018

View full text Add to dashboard Cite

Background: Anterior lumbar interbody fusion (ALIF) has been well established as an effective surgical intervention for chronic back pain due to osteoporotic vertebral collapse. Historically, ALIF has consisted of an anterior approach to disc height restoration with a subsequent posterior pedicle screw fixation. Although the applications of cement augmentation with posterior fixation have been previously reported, treatment of patients with both isthmic spondylolisthesis and decreased bone mineral density using a stand-alone ALIF is controversial because of concerns for decreased fusion rates and increased subsidence risk, respectively. We report a case of stand-alone ALIF used to treat a low-grade isthmic spondylolisthesis in the setting of idiopathic thoraco-lumbar scoliosis in a patient with secondary degenerative changes and discuss the benefits of this surgical technique in a patient with several comorbidities.Methods: An osteopenic 66-year-old woman with multiple medical comorbidities and 2 years of left radicular leg pain was found to have a Myerding grade I isthmic spondylolisthesis in the setting of idiopathic thoraco-lumbar scoliosis with secondary changes. The patient underwent an L5-S1 stand-alone ALIF with anterior cement augmentation without posterior pedicle screw fixation.Results: The patient experienced immediate relief of radicular leg pain postoperatively and had an uneventful course. At 2 years follow-up, she remained symptom free, and radiographs showed excellent fusion and maintenance of intervertebral disc height.Conclusions: The use of stand-alone ALIF with anterior cement augmentation of the vertebral bodies is a surgical technique that could produce excellent improvement in patients with low-grade isthmic spondylolisthesis in the setting of osteopenia. The use of the all-anterior approach in similar patients with multiple medical comorbidities can also be a useful technique, as it decreases associated morbidity of surgery and complication risks associated with prolonged operative times.

show abstract

“…Subsidence of a stiff anterior spinal implant into the weaker vertebral body is often observed in clinical practice [1][2][3][4][5][6]. This alteration may occur shortly after surgery or can develop typically within approximately one year [4].…”

Section: Introductionmentioning

confidence: 99%

“…A single or a small number of high spinal loads that cause stress that exceeds the strength of the bone are most likely the reason for early subsidence, whereas long-term subsidence is caused by repeated loads that cause stresses that are below the ultimate static bone strength. Osteoporotic vertebral bodies are more vulnerable to implant subsidence than are normal ones owing to the reduced bone strength [3,6]. The amount of subsidence may vary widely.…”

Section: Introductionmentioning

confidence: 99%

Methods for Avoiding or Reducing High Spinal Loads in Everyday Life

Rohlmann¹

2014

J Nov Physiother Phys Rehabil

View full text Add to dashboard Cite

Background: High loads on an anterior spinal implant can cause an implant to subside into the vertebral body. This alteration may endanger the clinical output of the treatment and can result in back pain. The aim of this paper is to show the possibilities for avoiding or reducing high spinal loads in daily life. Methods:The loads on a telemeterized vertebral body replacement were measured in 5 patients for a variety of different activities. The effects of the ways an exercise was performed on implant loads were evaluated.

show abstract

Anterior bone cement augmentation in anterior lumbar interbody fusion and percutaneous pedicle screw fixation in patients with osteoporosis

Abstract: Anterior PMMA augmentation during instrumented ALIF in patients with osteoporosis was useful to prevent cage subsidence and vertebral body collapse. In addition, PMMA augmentation did not increase the nonunion rate and incidence of ASD.

Cited by 38 publications

References 35 publications

Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3–4 fixation

Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3–4 fixation

Anterior Lumbar Interbody Fusion With Cement Augmentation Without Posterior Fixation to Treat Isthmic Spondylolisthesis in an Osteopenic Patient—A Surgical Technique

Methods for Avoiding or Reducing High Spinal Loads in Everyday Life

Contact Info

Product

Resources

About