Correlation of pull-out strength of cement-augmented pedicle screws with CT-volumetric measurement of cement

Fölsch, Christian; Goost, H.; Figiel, Jens; Paletta, Jürgen R. J.; Schultz, W.; Lakemeier, Stefan

doi:10.1515/bmt-2012-0012

Cited by 47 publications

(25 citation statements)

References 38 publications

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“…The exact cement volume injected intra-operatively is triggered by fluoroscopy, showing its distribution around the screw. A clear mechanical advantage of increased pullout strength of high viscosity cements was not found in vitro [25].…”

Section: Discussionmentioning

confidence: 90%

“…A finite element analysis showed that volumes between 2 and 3 ml increased pullout resistance significantly compared to non-augmented screws, and volumes between 3 and 4 ml could theoretically further increase pullout strength [25]. In vitro, the realization of a balloon kyphoplasty, which concentrates a higher cement volume around the screw, did not increase pullout resistance in comparison to a fenestrated screw augmentation [4].…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Pullout characteristics of percutaneous pedicle screws with different cement augmentation methods in elderly spines: An in vitro biomechanical study

Charles¹,

Pelletier²,

Hydier³

et al. 2015

Orthopaedics & Traumatology: Surgery & Research

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 95%

Pullout characteristics of percutaneous pedicle screws with different cement augmentation methods in elderly spines: An in vitro biomechanical study

Charles¹,

Pelletier²,

Hydier³

et al. 2015

Orthopaedics & Traumatology: Surgery & Research

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“…2,45 The cement volume should be kept to the smallest volume needed and should not exceed 2.8 ml per pedicle screw. 17 High application pressure, liquidity of the cement, and special anatomical features of the perivertebral venous system are conducive to cement leakage.…”

Section: 4%mentioning

confidence: 99%

Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws

Mueller

Baldauf

Marx

et al. 2016

SPI

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OBJECTIVE Loosening and pullout of pedicle screws are well-known problems in pedicle screw fixation surgery. Augmentation of pedicle screws with bone cement, first described as early as 1975, increases the pedicle-screw interface and pullout force in osteoporotic vertebrae. The aim of the present study was to identify cement leakage and pulmonary embolism rates in a large prospective single-center series of pedicle screw augmentations. METHODS All patients who underwent cement-augmented pedicle screw placement between May 2006 and October 2010 at the authors' institution were included in this prospective cohort study. Perivertebral cement leakage and pulmonary cement embolism were evaluated with a CT scan of the area of operation and with a radiograph of the chest, respectively. RESULTS A total of 98 patients underwent placement of cement-augmented pedicle screws; 474 augmented screws were inserted in 237 vertebrae. No symptomatic perivertebral cement leakage or symptomatic pulmonary cement embolism was observed, but asymptomatic perivertebral cement leakage was seen in 88 patients (93.6%) and in 165 augmented vertebrae (73.3%). Cement leakage most often occurred in the perivertebral venous system. Clinically asymptomatic pulmonary cement embolism was found in 4 patients (4.1%). CONCLUSIONS Perivertebral cement leakage often occurs in pedicle screw augmentation, but in most cases, it is clinically asymptomatic. Cement augmentation should be performed under continuous fluoroscopy to avoid high-volume leakage. Alternative strategies, such as use of expandable screws, should be examined in more detail for patients at high risk of screw loosening.

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“…According to the literature, 17% of revision surgeries are associated with pedicle screw failure [5]. Thus, CAPSI has been widely used for patients with poor bone quality due to its reliable biomechanical stability [15,[24][25][26]. But the treatment of multilevel LDD with cement-augmented pedicle screws is more complicated and challenging compared with 1 or 2-level LDD because of the increase of CL and mechanical overload [27].…”

Section: Discussionmentioning

confidence: 99%

The effect and potential risks of using multilevel cement-augmented pedicle screw fixation in osteoporotic spine with lumbar degenerative disease

Tang

Guo

et al. 2020

Preprint

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Background: The effect and potential risks of CAPSI on osteoporotic lumbar degenerative disease (LDD) have not been investigated in the cases of multilevel fixation. This study was to investigate potential complications of using multilevel cement-augmented pedicle screws fixation (three or four levels) and its effectiveness of this method on treating LDD with low bone quality. Methods: 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, 18 cases for four levels, 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, perioperative complications, CL, pulmonary cement embolism (PCE), screw loosening, and nonunion patients. Furthermore, we also measured the VAS and ODI at pre-operation, post-operation, and follow-up time points. Results: In the CAPSI group, a total of 336 augmented screws was 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%). And in the CPS group, seventeen patients (36.17%) and thirty-three screws (8.46%) suffered loosening in cranial or caudal vertebra (seven cranial cases and twenty-six of caudal), four cases experienced nonunion, and thus the fusion rate was 91.49% in total. The operation time and hospital stay of CAPSI group were longer than the CPS group, but CAPSI group has a lower screw loosening percentage ( P ＜0. 05). And in terms of blood loss, perioperative complications, fusion rate, VAS and ODI scores at the follow-up times, there were no significant differences between two groups. Conclusions: Patients with osteoporotic LDD underwent multilevel CPS fixation have a higher rate of screw loosening in cranial and caudal vertebra. The application of cemented pedicle screws for 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.

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Correlation of pull-out strength of cement-augmented pedicle screws with CT-volumetric measurement of cement

Cited by 47 publications

References 38 publications

Pullout characteristics of percutaneous pedicle screws with different cement augmentation methods in elderly spines: An in vitro biomechanical study

Pullout characteristics of percutaneous pedicle screws with different cement augmentation methods in elderly spines: An in vitro biomechanical study

Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws

The effect and potential risks of using multilevel cement-augmented pedicle screw fixation in osteoporotic spine with lumbar degenerative disease

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