Application of Cement-Injectable Cannulated Pedicle Screw in Treatment of Osteoporotic Thoracolumbar Vertebral Compression Fracture (AO Type A): A Retrospective Study of 28 Cases

Rong, Zhigang; Zhang, Fei; Xiao, Jun; Wang, Zhengdong; Luo, Fei; Zhang, Zehua; Xu, Jianzhong; Dai, Fei

doi:10.1016/j.wneu.2018.08.045

Cited by 30 publications

(42 citation statements)

References 26 publications

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“…The biomechanical stability of pedicle screw xation systems is particularly important in patients with lumbar spondylolisthesis and osteoporosis (11,24). Studies have shown that the use of PMMAaugmented CPSs to reconstruct the displaced vertebral body and perform bony fusion is still the main surgical method for these patients (19,20,(24)(25)(26)(27)(28). Theoretically, more CPSs require a greater holding force by internal xation; however, overuse of CPSs may increase the risk of complications related to PMMA leakage, including allergic reactions, venous or pulmonary embolism, and di culty with revision.…”

Section: Discussionmentioning

confidence: 99%

“…A suitable cage was lled with crushed autologous bone for fusion, then rods were installed and nuts were locked. In this study, a new type of PMMA-augmented CPS, named 'bone cement injectable cannulated pedicle screw (CICPS)' was developed by the authors for reduction and xation, a detailed introduction of which was reported in detail in previous studies (17)(18)(19)(20).…”

Section: Patientsmentioning

confidence: 99%

“…Moreover, lumbar X-ray lms were obtained to evaluate bony fusion, screw loosening, or pull-out-related imaging indicators, including intervertebral disc height and screw displacement. Intervertebral disc height was de ned as the average distance between the anterior and posterior edges of the vertebral body and the endplates (H1/2 + H2/2) ( Figure 1A) (19). The Taillard index was determined to assess the degree of vertebral body slipping (L-x2/L-x1) ( Figure 1B) (21).…”

Section: Radiographic and Clinical Assessmentsmentioning

confidence: 99%

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Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis

Liu¹,

Xiao

Jin³

et al. 2020

Preprint

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Background: Cannulated pedicle screw (CPS) augmented by polymethylmethacrylate (PMMA) can achieve satisfactory clinical efficacy in the treatment of lumbar spondylolisthesis with osteoporosis. However, accurate application of CPSs will help to avoid the difficulty of screw revision and reduce the incidence of PMMA-related complications. This study aimed to investigate the mid-term efficacy of CPS compared to unilateral and bilateral applications in this common lumbar degenerative disease.Methods: Between May 2011 and May 2018, 50 patients with lumbar spondylolisthesis with osteoporosis who underwent posterior fixation and fusion using traditional pedicle screws or CPSs were included in the study. Patients were divided into two groups based on the application: the unilateral PMMA-augmented CPS group (UC, n = 29) and the bilateral PMMA-augmented CPS group (BC, n = 21). Operation time, blood loss, average hospitalization time, PMMA leakage, and other complications were recorded. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were used to evaluate symptom recovery. Radiographic results were compared for intervertebral fusion and screw loosening.Results: There were no significant differences in the baseline data of the two groups.The VAS and ODI scores improved significantly after surgery (P < 0.05), with no significant differences between the groups (P > 0.05). The operation time and blood loss in the UC group were significantly lower than those in the BC group (P < 0.05). However, the loss of intervertebral disc height and Taillard index did not differ significantly between the groups. The rates of PMMA leakage in the UC and BC groups were 7.0% and 11.9%, respectively (P < 0.05). Bony fusion was achieved in all groups without screw loosening at the last follow-up. Only one patient experienced superficial infection in both groups, while cerebrospinal fluid leakage was observed in two patients in the BC group.Conclusions: Unilateral application of PMMA-augmented CPS may provide adequate clinical safety and effectiveness in the surgical treatment of lumbar spondylolisthesis with osteoporosis.

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Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Section: Radiographic and Clinical Assessmentsmentioning

confidence: 99%

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Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis

Liu¹,

Xiao

Jin³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…A suitable cage was filled with crushed autologous bone for fusion, then rods were installed and nuts were locked. In this study, a new type of PMMA-augmented CPS, named "bone cement injectable cannulated pedicle screw (CICP S)" was developed by the authors for reduction and fixation, a detailed introduction of which was reported in detail in previous studies [17][18][19][20].…”

Section: Surgical Methodsmentioning

confidence: 99%

Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis

Liu¹,

Xiao

Jin³

et al. 2020

J Orthop Surg Res

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Background Cannulated pedicle screw (CPS) augmented by polymethylmethacrylate (PMMA) can achieve satisfactory clinical efficacy in the treatment of lumbar spondylolisthesis with osteoporosis. However, accurate application of CPSs will help to avoid the difficulty of screw revision and reduce the incidence of PMMA-related complications. This study aimed to investigate the mid-term efficacy of CPS compared to unilateral and bilateral applications in this common lumbar degenerative disease. Methods May 2011 and May 2018, 50 patients with lumbar spondylolisthesis with osteoporosis who underwent posterior fixation and fusion using traditional pedicle screws or CPSs were included in the study. Patients were divided into two groups based on the application: the unilateral PMMA-augmented CPS group (UC, n = 29) and the bilateral PMMA-augmented CPS group (BC, n = 21). Operation time, blood loss, average hospitalization time, PMMA leakage, and other complications were recorded. The visual analog scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate symptom recovery. Radiographic results were compared for intervertebral fusion and screw loosening. Results There were no significant differences in the baseline data of the two groups. The VAS and ODI scores improved significantly after surgery (P < 0.05), with no significant differences between the groups (P > 0.05). The operation time and blood loss in the UC group were significantly lower than those in the BC group (P < 0.05). However, the loss of intervertebral disk height and Taillard index did not differ significantly between the groups. The rates of PMMA leakage in the UC and BC groups were 7.0% and 11.9%, respectively (P < 0.05). Bony fusion was achieved in all groups without screw loosening at the last follow-up. Only one patient experienced superficial infection in both groups, while cerebrospinal fluid leakage was observed in two patients in the BC group. Conclusions Unilateral application of PMMA-augmented CPS may provide adequate clinical safety and effectiveness in the surgical treatment of lumbar spondylolisthesis with osteoporosis.

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“…Pedicle screw fixation is widely used in degenerative lumbosacral disease, secondary kyphosis or deformity, and thoracolumbar fractures due to a variety of indications, such as bony fusion promotion, deformity correction and fixation for vertebral fractures [1][2][3]. Although it is the gold standard for the treatment of degenerative and traumatic spinal diseases benefited from its solid fixation [2], it's purchase strength of low-quality bone still reduced significantly in rising osteoporotic patients [4,5].…”

Section: Introductionmentioning

confidence: 99%

The effect and potential risks of using cement-augmented pedicle screw instrumentation on multiple segment fixation in osteoporotic spine with lumbar degenerative diseases

Tang¹,

Guo²,

Guo³

et al. 2020

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Background: Cement-augmented pedicle screw instrumentation (CAPSI) has been found to significantly increase the pedicle screws anchorage in the osteoporotic vertebral body, however, with the increase of augmented level and bone cement dose, the incidence of cement leakage (CL) or side complication of CAPSI also increased. But the effect and potential risks of CAPSI for osteoporotic lumbar degenerative diseases (LDD) have not been investigated in the cases of multiple segment fixation. The purpose of this study was to investigate potential complications of using cement-augmented screws for multilevel fixation (three or four levels) and the effectiveness of this method for treating LDD with low bone quality.Methods: Our clinical database was reviewed for osteoporotic patients who using CAPSI or conventional pedicle screw (CPS) for multilevel fixation (three or four levels) between February 2010 to February 2017. A total of 93 patients with multilevel LDD were divided into the CAPSI group (46 subjects) and the CPS group (47 subjects), including 75 cases for three levels (L2-L5 21 cases、L3-S1 54 cases), 18 cases for four levels (L1-L5 2 cases、L2-S1 16 cases), and the average follow-up was 33.72±18.78 months (range: 24-108). Relevant data were recorded, including age, gender, body mass index (BMI), bone mineral density (BMD), diagnosis, fusion methods, bone graft, fusion level, lumbosacral fixation, different patterns of S1 pedicle screw placement, operation time, blood loss, hospital stay, complications, CL, pulmonary cement embolism (PCE), screw loosening and nonunion patients. Besides, the visual analogue scale (VAS) and Oswestry disability index (ODI) at pre-operation, post-operation, and follow-up were also assessed.Results: In the CAPSI group, a total of 336 augmented screws were placed bilaterally, and the average injection dose of bone cement was 1.85±0.65 ml (range: 1-4). The CL was observed in 44 patients (95.65%) and 116 screws (34.52%). Three cemented screws (0.89%) and twenty-four S1 conventional screws (44.44%) were found loosening during the follow-up and the overall fusion rate was 93.47%. For perioperative complications, two patients (4.35%) experienced PCE, one patient augmented vertebral fracture and three patients (6.52%) wound infection. And in the CPS group, seventeen patients (36.17%) and thirty-three screws (8.46%) suffered loosening in cranial or caudal segments (seven cranial cases and twenty-six of caudal), four cases experienced nonunion, the fusion rate was 91.49% in total. The operation time and hospital stay were longer in CAPSI group, but with a lower percentage of screw loosening (P＜0. 05). And in terms of blood loss, perioperative complications, fusion rate, VAS and ODI scores at the follow-up times, no significant differences were found between the two groups.Conclusions: Patients with osteoporotic LDD underwent CPS at multiple segments have a high rate of screw loosening in the cranial and caudal segment. The application of cemented pedicle screws on multilevel LDD can achieve better stability and less screw loosening, but it also accompanied by longer operating time, higher incidence of CL, PCE and wound infections. Selective cement-augmenting the cranial and caudal pedicle screws may be a worthy strategy to decrease the complications.

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Application of Cement-Injectable Cannulated Pedicle Screw in Treatment of Osteoporotic Thoracolumbar Vertebral Compression Fracture (AO Type A): A Retrospective Study of 28 Cases

Cited by 30 publications

References 26 publications

Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis

Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis

Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis

The effect and potential risks of using cement-augmented pedicle screw instrumentation on multiple segment fixation in osteoporotic spine with lumbar degenerative diseases

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