Biomechanical comparison of different techniques in primary spinal surgery in osteoporotic cadaveric lumbar vertebrae: expansive pedicle screw versus polymethylmethacrylate-augmented pedicle screw

Liu, Da; Wu, Zixiang; Pan, Xian-Ming; Fu, Shishun; Gao, Mingxuan; Shi, Lei; Lei, Wei

doi:10.1007/s00402-011-1290-9

Cited by 47 publications

(41 citation statements)

References 28 publications

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“…Incidence of screw loosening after PLIF is decreasing by introducing techniques such as screw augmentation with PMMA or expansive pedicle screws [9]. However, problems with screw loosening still develop, especially in osteoporotic patients [6]; a cyclic caudocephalad toggling at the bonescrew interface has been suggested as the primary cause [10].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous consolidation of loosened spine arthrodesis under CT and fluoroscopy guidance by radiologists: a new useful technique

et al. 2014

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• PLIF is one of the surgical techniques for spinal arthrodesis. • Treatment indications are degenerative disease or instability following trauma, tumour, or infection. • Screw loosening is a frequent complication that can occur after surgery. • Percutaneous facet consolidation under dual guidance seems to be a feasible technique. • The procedure is performed under local anaesthesia using a minimally invasive approach.

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Section: Discussionmentioning

confidence: 99%

Percutaneous consolidation of loosened spine arthrodesis under CT and fluoroscopy guidance by radiologists: a new useful technique

et al. 2014

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“…Many experimental studies have proved that the stiffness and strength of pedicle screw fixation can be increased when the pedicle screw is augmented with various cements. 9,16,17,21,24,40 The optimum augmentation method of pedicle screw fixation strength continues to be debated. Cement-augmented screws are reported to offer a higher resistance to pullout forces than standard screws, with the average pullout resistance ranging from 150% to 250% of that of standard screws.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of degenerative and traumatic spinal diseases with expandable screws in patients with osteoporosis: 2-year follow-up clinical study

Gazzeri

Roperto

Fiore

2016

SPI

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OBJECTIVE Pedicle screw instrumentation of the osteoporotic spine carries an increased risk of screw loosening, pullout, and fixation failure. A variety of techniques have been used clinically to improve pedicle screw fixation in the presence of compromised bone. Pedicle screws may be augmented with cement, but this may lead to cement leakage and result in disastrous consequences. To avoid these complications, a multiaxial expandable pedicle screw has been developed. This was a prospective, single-center study designed to evaluate the clinical results of patients with osteoporosis with traumatic and degenerative spinal diseases treated with expandable pedicle screws. METHODS Thirty-three patients (mean age 61.4 years) with osteoporosis and traumatic or degenerative spinal diseases underwent spinal posterior fixation with expandable screws. Preoperative and postoperative visual analog scale (VAS) for pain and Oswestry Disability Index (ODI) questionnaire scores were obtained. The immediate postoperative screw position was measured and compared with the final position on lateral plain radiographs and axial CT scans at the 1- and 2-year follow-up examinations. RESULTS A total of 182 pedicle screws were used, including 174 expandable and 8 regular screws. The mean preoperative patient VAS score improved from 8.2 to 3.6 after surgery. The mean ODI score improved from 83.7% before surgery to 29.7% after the operation and to 36.1% at the final follow-up. No screw migration had occurred at the 1-year follow-up, but 1 screw breakage/migration was visualized on spinal radiography at the 2-year follow-up. CONCLUSIONS The results of this study show that the multiaxial expandable pedicle screw is a safe and practical technique for patients with osteoporosis and various spinal diseases and adds a valuable tool to the armamentarium of spinal instrumentation.

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“…20,31 Among these approaches, the FPSs augmented by PMMA has achieved the highest fixation strength and best clinical outcomes 1,26 . However, disadvantages remain, such as bone-cement leakage, 3 exothermic damage, 19,28 and pulmonary embolism.…”

Section: 26mentioning

confidence: 99%

“…Therefore, the weak placement of the screw in osteoporotic vertebrae in the aging population remains a considerable challenge faced by spine surgeons. 6,15,20,23,26,27 Additionally, the risk of fixation failure due to screw loosening increases significantly in patients with osteoporotic bone. …”

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confidence: 99%

Augmented PMMA distribution: improvement of mechanical property and reduction of leakage rate of a fenestrated pedicle screw with diameter-tapered perforations

Tan

Peng

et al. 2016

SPI

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OBJECTIVE This study investigated the optimum injection volume of polymethylmethacrylate (PMMA) to augment a novel fenestrated pedicle screw (FPS) with diameter-tapered perforations in the osteoporotic vertebral body, and how the distribution characteristics of PMMA affect the biomechanical performance of this screw. METHODS Two types of FPSs were designed (FPS-A, composed of 6 perforations with an equal diameter of 1.2 mm; and FPS-B, composed of 6 perforations each with a tapered diameter of 1.5 mm, 1.2 mm, and 0.9 mm from tip to head. Each of 28 human cadaveric osteoporotic vertebrae were randomly assigned to 1 of 7 groups: FPS-A1.0: FPS-A+1.0 ml PMMA; FPS-A1.5: FPS-A+1.5 ml PMMA; FPS-A2.0: FPS-A+2.0 ml PMMA; FPS-B1.0: FPS-B+1.0 ml PMMA; FPS-B1.5: FPS-B+1.5 ml PMMA; FPS-B2.0: FPS-B+2.0 ml PMMA; and conventional pedicle screws (CPSs) without PMMA. After the augmentation, 3D CT was performed to assess the cement distribution characteristics and the cement leakage rate. Axial pullout tests were performed to compare the maximum pullout force thereafter. RESULTS The CT construction images showed that PMMA bone cement formed a conical mass around FPS-A and a cylindrical mass around FPS-B. When the injection volume was increased from 1.0 ml to 2.0 ml, the distribution region of the PMMA cement was enlarged, the PMMA was distributed more posteriorly, and the risk of leakage was increased. When the injection volume reached 2.0 ml, the risk of cement leakage was lower for screws having diameter-tapered perforations. The pullout strengths of the augmented FPS-A groups and FPS-B groups were higher than that of the CPS group (p < 0.0001). All FPS-B groups had a higher pullout strength than the FPS-A groups. CONCLUSIONS The diameter of the perforations affects the distribution of PMMA cement. The diameter-tapered design enabled PMMA to form larger bone-PMMA interfaces and achieve a relatively higher pullout strength, although statistical significance was not reached. Study results indicated 1.5-ml of PMMA was a conservative volume for PMMA augmentation; more cement injection would significantly increase the risk of cement leakage.

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Biomechanical comparison of different techniques in primary spinal surgery in osteoporotic cadaveric lumbar vertebrae: expansive pedicle screw versus polymethylmethacrylate-augmented pedicle screw

Cited by 47 publications

References 28 publications

Percutaneous consolidation of loosened spine arthrodesis under CT and fluoroscopy guidance by radiologists: a new useful technique

Percutaneous consolidation of loosened spine arthrodesis under CT and fluoroscopy guidance by radiologists: a new useful technique

Surgical treatment of degenerative and traumatic spinal diseases with expandable screws in patients with osteoporosis: 2-year follow-up clinical study

Augmented PMMA distribution: improvement of mechanical property and reduction of leakage rate of a fenestrated pedicle screw with diameter-tapered perforations

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