Instrumented lumbar arthrodesis in elderly patients: prospective study using cannulated cemented pedicle screw instrumentation

Piñera, Ángel R.; Duran, Camen; López, B. Belda; Sáez, Isabel; Correia, Emmanuel; Álvarez, Luis

doi:10.1007/s00586-011-1907-2

Cited by 57 publications

(47 citation statements)

References 26 publications

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“…This biomechanical mismatch creates shielding effects on adjacent vertebral bodies, eventually causing compressive fracture or adjacent disk disease. 16 Also, in cases where pedicle screws need to be retrieved or removed from the screw-cement-bone complex, this becomes extremely difficult or even impossible, due to the excessive bonding strength between screws and the cement. 17 Most importantly, due to its nondegradability and inertness, PMMA cannot form a biological bonding with bone, nor can it induce bone ingrowth or integration.…”

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confidence: 99%

“…In addition, when considering the cases of postoperation infection, the nondegradable PMMA becomes another risk factor for both deep infection and superficial infection. 16 These drawbacks associated with PMMA yield an unmet need of robust but bioactive or bioabsorbable bone cement for better biomechanical outcomes of cannulated pediclescrew fixation. In the present study, a novel injectable calcium phosphate-based nanocomposite (CPN) was designed and prepared to meet the needs of cannulated pedicle-screw fixation for improved efficacy and biomechanical stability.…”

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confidence: 99%

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A novel injectable calcium phosphate-based nanocomposite for the augmentation of cannulated pedicle-screw fixation

Sun¹,

Liu²,

Liu³

et al. 2017

IJN

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Polymethyl methacrylate (PMMA)-augmented cannulated pedicle-screw fixation has been routinely performed for the surgical treatment of lumbar degenerative diseases. Despite its satisfactory clinical outcomes and prevalence, problems and complications associated with high-strength, stiff, and nondegradable PMMA have largely hindered the long-term efficacy and safety of pedicle-screw fixation in osteoporotic patients. To meet the unmet need for better bone cement for cannulated pedicle-screw fixation, a new injectable and biodegradable nanocomposite that was the first of its kind was designed and developed in the present study. The calcium phosphate-based nanocomposite (CPN) exhibited better anti-pullout ability and similar fluidity and dispersing ability compared to clinically used PMMA, and outperformed conventional calcium phosphate cement (CPC) in all types of mechanical properties, injectability, and biodegradability. In term of axial pullout strength, the CPN-augmented cannulated screw reached the highest force of ~120 N, which was higher than that of PMMA (~100 N) and CPC (~95 N). The compressive strength of the CPN (50 MPa) was three times that of CPC, and the injectability of the CPN reached 95%. In vivo tests on rat femur revealed explicit biodegradation of the CPN and subsequent bone ingrowth after 8 weeks. The promising results for the CPN clearly suggest its potential for replacing PMMA in the application of cannulated pedicle-screw fixation and its worth of further study and development for clinical uses.

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confidence: 99%

mentioning

confidence: 99%

A novel injectable calcium phosphate-based nanocomposite for the augmentation of cannulated pedicle-screw fixation

Sun¹,

Liu²,

Liu³

et al. 2017

IJN

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“…4,5 Many studies have shown that when bone cement is used to augment pedicle screws, it can significantly increase the rigidity, stiffness, and strength of the screw. 3,8 Various systems and techniques for using cement to augment osteoporotic bone have been developed, such as expandable screws, partially or fully cannulated screws, 9,12 and direct 2 or indirect injections. In recent years, percutaneous pedicle screw fixation, which limits muscular damage and intraoperative bleeding, decreases postoperative pain and accelerates postoperative recovery.…”

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confidence: 99%

A new technique of bone cement augmentation via the disc space for percutaneous pedicle screw fixation

Park¹,

Park²,

Lee³

et al. 2016

SPI

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OBJECT In elderly patients with severe osteoporosis, instrumented lumbar interbody fusion may result in fixation failure or nonunion because of decreased pedicle screw pullout strength or increased interbody graft subsidence risk. Thus, given its many advantages, percutaneous pedicle screw fixation with cement augmentation can be an effective method to use in elderly patients. The authors report on an easy, safe, and economical technique for bone cement augmentation using a bone biopsy needle inserted into the disc space in 2 osteoporotic patients who were treated with posterior interbody fusion and percutaneous pedicle screw fixation. METHODS Two elderly patients who complained of back pain and intermittent neurological claudication underwent posterior interbody fusion with percutaneous pedicle screw fixation. After routinely assembling rods on the screws, a bone biopsy needle was inserted into the disc space via the operative field; the needle was then placed around the tips of the screws using fluoroscopic radiography for guidance. Bone cement was injected through the bone biopsy needle, also under fluoroscopic radiography guidance. RESULTS Both patients’ symptoms improved after the operation, and there was no evidence of cage subsidence or screw loosening at the 4-month follow-up. CONCLUSIONS The indirect technique of bone cement augmentation via the disc space for percutaneous screw fixation could be an easy, safe, and economical method.

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“…So far, the augmentation of pedicle screws with PMMA has demonstrated to be the most efficient solution to enhance screw strength in osteoporotic bone [2][3][4][5][6][7]. It has shown clinical efficacy in the management of degenerative disease [17] and fractures [18][19][20]. However, there is a concern about the ideal time for augmentation during the surgical procedure, especially if a restoration or a derotation maneuver of the instrumented vertebra is part of the surgery.…”

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confidence: 99%

Timing of PMMA cement application for pedicle screw augmentation affects screw anchorage

et al. 2017

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Introduction Cement augmentation is an established method to increase the pedicle screw (PS) anchorage in osteoporotic vertebral bodies. The ideal timing for augmentation when a reposition maneuver is necessary is controversial. While augmentation of the PS before reposition maneuver may increase the force applied it on the vertebrae, it bears the risk to impair PS anchorage, whereas augmenting the PS after the maneuver may restore this anchorage and prevent early screw loosening. The purpose of the present study was to evaluate the effect of cement application timing on PS anchorage in the osteoporotic vertebral body. Methods Ten lumbar vertebrae (L1-L5) were used for testing. The left and right pedicles of each vertebra were instrumented with the same PS size and used for pairwise comparison of the two timing points for augmentation. For the reposition maneuver, the left PS was loaded axially under displacement control (2 9 ±2 mm, 3 9 ±6 mm, 3 9 ±10 mm) to simulate a reposition maneuver.Subsequently, both PS were augmented with 2 ml PMMA cement. The same force as measured during the left PS maneuver was applied to the previously augmented right hand side PS [2 9 F (±2 mm), 3 9 F (±6 mm), 3 9 F (±10 mm)]. Both PS were cyclically loaded with initial forces of ?50 and -50 N, while the lower force was increased by 5 N every 100 cycles until total failure of the PS. The PS motion was measured with a 3D motion analysis system. After cyclic loading stress, X-rays were taken to identify the PS loosening mechanism. Results In comparison with PS augmented prior to the reposition maneuver, PS augmented after the reposition maneuver showed a significant higher number of load cycles until failure (5930 ± 1899 vs 3830 ± 1706, p = 0.015). The predominant loosening mechanism for PS augmented after the reposition maneuver was PS toggling with the attached cement cloud within the trabecular bone. While PS augmented prior to the reposition, maneuver showed a motion of the screw within the cement cloud. Conclusion The time of cement application has an effect on PS anchorage in the osteoporotic vertebral body if a reposition maneuver of the instrumented vertebrae is carried out. PS augmented after the reposition maneuver showed a significant higher number of load cycles until screw loosening.

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Instrumented lumbar arthrodesis in elderly patients: prospective study using cannulated cemented pedicle screw instrumentation

Cited by 57 publications

References 26 publications

A novel injectable calcium phosphate-based nanocomposite for the augmentation of cannulated pedicle-screw fixation

A novel injectable calcium phosphate-based nanocomposite for the augmentation of cannulated pedicle-screw fixation

A new technique of bone cement augmentation via the disc space for percutaneous pedicle screw fixation

Timing of PMMA cement application for pedicle screw augmentation affects screw anchorage

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