Augmentation of (pedicle) screws with calcium apatite cement in patients with severe progressive osteoporotic spinal deformities: an innovative technique

Wuisman, P.; Dijk, Martijn van; Staal, Heleen; Royen, Barend J. van

doi:10.1007/s005860000169

Cited by 79 publications

(52 citation statements)

References 18 publications

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“…Thus, combined anterior and posterior surgery is still the most secure method for treating this kind of complication. Otherwise, augmentation of pedicle screws fixation with various bone cements is recommended to provide initial and fatigue strength of instrumentation among severely osteoporotic patients [10,31,35].…”

Section: Discussionmentioning

confidence: 99%

Revision strategies for complications and failure of vertebroplasties

Yang

Chen

et al. 2008

Eur Spine J

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Percutaneous vertebroplasty is widely discussed in the management of osteoporotic spinal compression fracture, but few reports are available concerning salvage procedures after failure of this technique. We studied 22 percutaneous vertebroplasty patients who required revision surgery upon presentation of new symptoms postoperatively. The indications for revision surgery included recurrent intractable back pain with no response to medical treatment, infectious spondylitis, cement leakage with neurologic deficit, and cement dislodgement and/ or fragmentation. Five patients underwent repeated percutaneous vertebroplasty of the initially cemented vertebrae. Seventeen patients underwent anterior, posterior, or combined anterior and posterior surgery. Four patients required a third surgical procedure because of poor augmentation with cement, subsidence of the anterior bone graft, or pullout of the instrumentation. Finally, four (18%) patients underwent repeat vertebroplasty, two (9%) patients underwent anterior surgery only, one (5%) patient underwent posterior surgery only, and 15 (68%) patients underwent combined anterior and posterior surgery; all but one regained ambulatory status equivalent to that prior to surgery. In conclusion, percutaneous vertebroplasty is a simple and effective, but not risk-or complication-free procedure for the treatment of osteoporotic spinal compression fracture. The spine surgeon should be familiar with varied approaches and techniques for revision surgery. Combined anterior and posterior surgery seems to be the most secure salvage method to treat severely osteoporotic patients in whom percutaneous vertebroplasty initially failed.

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Section: Discussionmentioning

confidence: 99%

Revision strategies for complications and failure of vertebroplasties

Yang

Chen

et al. 2008

Eur Spine J

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“…In the osteoporotic spine, polymethylmethacrylate (PMMA) cement, one type of such bone cement, has also been shown to increase the holding power of screws in osteoporotic bone 6,19,29,35,36,42,47) . In spite of these benefits, reports concerning the clinical use of PMMA have been sparse 13,40,44) . This hesitancy for the employment of PMMA has been due to the undesirable exothermic reaction which accompanies it hardening and which occurs in close proximity to neural elements 41) .…”

Section: Introductionmentioning

confidence: 99%

Polymethylmethacrylate-Augmented Screw Fixation for Stabilization of the Osteoporotic Spine : A Three-Year Follow-Up of 37 Patients

Moon

Cho²,

Choi³

et al. 2009

J Korean Neurosurg Soc

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Objective : The purpose of this study was to determine the efficacy, radiological findings, clinical outcomes and complications in patients with lumbar stenosis and osteoporosis after the use of polymethylmethacrylate (PMMA) augmentation of a cannulated pedicle screw. Methods : Thirty-seven patients with degenerative spinal stenosis and osteoporosis (T-score < -2.5) underwent lumbar fusion using the Dream Technology Pedicle Screw (DTPS TM , Dream Spine Total Solutions, Dream STS, Seoul, Korea) between 2005 and 2007. The clinical outcomes were evaluated by using the visual analog scale (VAS) and the Prolo scale. Radiologic findings were documented through computed tomography (CT) and plain films. Results : Thirty-seven patients were evaluated and included, 2 males and 35 females with an average bone mineral density (BMD) of 0.47g/cm 2 . The average age of the patients was 68.7 (range, 57-88). The preoperative VAS for low back and leg pain (7.87 ± 0.95 and 8.82 ± 0.83) were higher as compared with postoperative VAS (2.30 ± 1.61 and 1.42 ± 0.73) with statistical significance (p = 0.006, p = 0.003). According to the Prolo scale, 11, 22, one and three patients were in excellent, good, fair and poor conditions, respectively. The average amount of the injected cement per one cannulated screw was 1.83 ± 0.11 mL. Conclusion : The results show favorable outcome both clinically and radiographically for 37 patients who underwent lumbar fusion using DTPS TM and PMMA. Based on the results, the use of this surgical method can be a safe and effective option for the operation on the osteoporotic spine.

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“…To prevent potential device loosening at the boneimplant interface, both cement augmentation and extension of instrumentation are techniques in use clinically [4][5][6][7]. To prevent potential adjacent-level disease at neighboring levels in the elderly patient, extension of the fixation to include multiple levels is also currently practised [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…To prevent potential adjacent-level disease at neighboring levels in the elderly patient, extension of the fixation to include multiple levels is also currently practised [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%