Bone Cement-Augmented Percutaneous Screw Fixation for Malignant Spinal Metastases : Is It Feasible?

Abstract

ObjectiveWe evaluated the validity of bone cement-augmented percutaneous screw fixation for treating malignant spinal metastases.MethodsBetween 2011 and 2015, 14 patients (eight men and six women) who underwent bone cement-augmented percutaneous screw fixation for malignant spinal metastases were enrolled in this study. Their life expectancy was considered to be more than one month and less than one year, based on the revised Tokuhashi scoring system. Clinical findings including the back pain scale score, functional outcome, procedure related complications, and survival were assessed preoperatively, postoperatively, and then six months after the procedure.ResultsTwelve of the patients (86%) survived up to six months after the procedure. Three required mini-open decompressive laminectomy for severe epidural compression. Bone cement-augmented percutaneous screw fixation was performed one level above, one level below, and at the pathologic level itself. The mean operation time was 60 minutes (45–180) and blood loss was less than 100 mL. Prior to surgery, the mean pain score on the visual analogue scale was 8.8, while one month after the procedure, it had reduced to 3.0; this improvement was maintained until the six-month assessment in the surviving patients. All patients were able to sit within the first two days after surgery, and no patient experienced neurological deterioration at the one-month follow up after the surgery. No patient experienced screw loosening during the six months of follow-up. Asymptomatic cement leakage into the epidural space was observed in two patients, but no major complications were observed.ConclusionFor selected patients with malignant spinal metastases, bone cement-augmented percutaneous screw fixation can provide significant pain relief and improve quality of life.

Comparing the efficacy and safety of cement-augmented fenestrated pedicle screws and conventional pedicle screw in surgery for spinal metastases: a retrospective comparative cohort study

“…Wu et al ( 29 ) implanted CAPS fixation with the assistance of a spinal robot in a patient with multiple spinal metastases of the breast, which effectively improved the patient’s quality of life. Kim ( 30 ) used percutaneous CAPS fixation in 14 patients with spinal metastases. Their results showed that patients’ pain was effectively relieved, which showed that CAPS fixation could provide obvious pain relief and improve the quality of life for some patients with spinal metastases.…”

Spinal metastasis: narrative reviews of the current evidence and treatment modalities

“… 98 A strategy for the prevention of hardware failure has been proposed by using fenestrated pedicle screw and PMMA augmentation in the vertebral body. 100 – 102 This augmentation is shown to decrease the risk of screw pull out in both open and minimal access spinal surgery. 100 – 102 …”

“…[100][101][102] This augmentation is shown to decrease the risk of screw pull out in both open and minimal access spinal surgery. [100][101][102]…”

Efficacy and Safety of Cement Augmented Fenestrated Screws in the Surgery With Posterior Approach for Spinal Metastases  

“…Wu et al [25] implanted cement augmented pedicle screw xation with the assistance of a spinal robot in a patient with multiple spinal metastases of the breast, which effectively improved the patient's quality of life. Kim [26] used percutaneous cement augmented pedicle screw xation in 14 patients with spinal metastases. Results showed that the pain of patients was effectively relieved, which showed that cement augmented pedicle screw xation can provide obvious pain relief and improve the quality of life for some patients with spinal metastases.…”