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

Abstract

Background: The increase of augmented level and bone cement dose are accompanied by the rising incidence of cement leakage (CL) of cement-augmented pedicle screw instrumentation (CAPSI). But the effect and potential risks of the application of CAPSI to osteoporotic lumbar degenerative disease (LDD) have not been studied in the case of multilevel fixation. This study aimed to investigate the effectiveness and potential complications of using multilevel CAPSI for patients with osteoporotic LDD. Methods: A total of 93 patients with multilevel LDD were divided into the CAPSI group (46 subjects) and the conventional pedicle screw (CPS) group (47 subjects), including 75 cases for three levels and 18 cases for four levels. Relevant data were compared between two groups, including baseline data, clinical results, and complications. Results: In the CAPSI group, a total of 336 augmented screws was placed bilaterally. The CL was observed in 116 screws (34.52%). Three cemented screws (0.89%) were found loosened during the follow-up and the overall fusion rate was 93.47%. For perioperative complications, two patients (4.35%) experienced pulmonary cement embolism (PCE), one patient augmented vertebral fracture, and three patients (6.52%) wound infection. And in the CPS group, thirtythree screws (8.46%) suffered loosening in cranial and caudal vertebra with a fusion rate of 91.49%. 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, and VAS and ODI scores at the follow-up times, there were no significant differences between the two groups.

Comparison of clinical effectiveness of fenestrated and conventional pedicle screws in patients undergoing spinal surgery: a systematic review and meta-analysis

“…Sixteen studies reported data on cement leakage [16,18,21,[27][28][29][30][31][32][33]56,[59][60][61][62][63] (Table 4 and Figure 5), 7 of which reported the number of patients who developed cement leakage with pooled prevalence of 34.36% (95% CI: 1.81%, 66.91%) [18,[27][28][29][30]59,60]. These studies exhibited high heterogeneity (I 2 = 99%; p < 0.0001).…”

“…The other secondary outcomes of our study (fusion rate, pulmonary embolism, proximal junctional kyphosis, infections) had less than 3 distinct data points in each group and pooled estimates for these outcomes were therefore not calculated. Fusion rates were reported in four studies [16,59,62,63], with only one comparative study showing higher rate for augmented FPS. Pulmonary embolism rate was reported in six studies [27,28,30,31,60,62], indicating a relatively low rate varying from zero to 4.65% in all studies.…”

“…Proximal junctional kyphosis rate was reported in one study, without difference between FPS and CPS [30]. Infections were reported in five studies [18,21,28,59,63], with rates between 3% and 10%.…”

The Safety and Effectiveness of Automatic Pedicle Screw Trajectory Planning Based on CT Values: An in Vitro Osteoporosis Model Study.

“…However, these methods all have their limitations. Bone cement leakage is a common complication of bone cement augmented screws, with a leakage rate of 11.6-82.4%, which can cause serious complications such as nerve injury, vascular injury, pulmonary cement embolism, cardiac embolism and anaphylactic shock 23 . In CBT, screws are inserted through the isthmus, and the screws can only be inserted into the posterior 1/3 of the vertebral body.…”

Pulmonary cement embolism following transpedicular screws placement for thoracolumbar fractures

“…Polymethylmethacrylate (PMMA) bone cement improves immediate stability and increases pullout resistance from 173% to 244% for patients with osteoporosis undergoing thoracic fracture transpedicular fixation. [ 4 , 14 , 19 ]…”