Potential risks of using cement-augmented screws for spinal fusion in patients with low bone quality

Martín-Fernández, Marta; López‐Herradón, Ana; Piñera, Ángel R.; Tomé-Bermejo, Félix; Duart, J.M.; Vlad, Maria; Rodríguez-Arguisjuela, M.G.; Álvarez-Galovich, Luis

doi:10.1016/j.spinee.2017.04.029

Cited by 56 publications

(62 citation statements)

References 52 publications

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“…For elderly patients with severe osteoporosis, whether the injection of bone cement into the vertebral body will increase the risk of cement leakage and whether it will have an impact on tuberculosis treatment is another focus of this study. In the study of Martín 25 , Philippe 26 , and Guo 27 , bone cement leakage is mostly asymptomatic vascular leakage, which was similar to our study. We believe that the bone cement leakage is related to cement viscosity, injection volume, and distribution location.…”

Section: Discussionsupporting

confidence: 90%

Long-term outcome of polymethylmethacrylate-augmented screw fixation in the treatment of thoracolumbar spinal tuberculosis in elderly patients with severe osteoporosis

Yang¹,

He²,

Wei³

et al. 2020

Preprint

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Background: to evaluate the safety and efficacy of Polymethylmethacrylate-augmented screw fixation (PASF) in the treatment of elderly patients with thoracolumbar spinal tuberculosis accompanied with severe osteoporosis.Methods: 34 elderly patients with thoracolumbar spinal tuberculosis accompanied with severe osteoporosis underwent PASF after anterior or posterior debridement and bone grafting in our hospital from January 2010 to January 2012. The follow-ups were performed at 1, 3, 6, and 12 months postoperatively and then annually thereafter. The segmental cobb angle was measured to evaluate kyphosis improvement. The laboratory examination including ESR and CRP was also monitored. The pre- and postoperative VAS score, ODI score, and neurological function of ASIA scale were also recorded.Results: The included 21 patients completed the operation successfully. In all patients with neurological dysfunction, the ASIA grade improved by at least 1 grade. One month postoperatively, the VAS score, ODI, segmental Cobb angle, ESR, and CRP were significantly improved compared with those preoperatively (P<0.05); there was no significant difference in the values at 1 month postoperatively and last follow-up (P＞0.05). There were no complications such as implant failure, proximal junctional kyphosis, or recurrence of tuberculosis at the minimum 5-year follow-up. Conclusion: For elderly patients with thoracolumbar spinal tuberculosis complicated with severe osteoporosis, after anterior or posterior debridement and bone grafting, together with postoperative systematic anti-tuberculosis and anti-osteoporosis treatments, PASF is safe and effective without catastrophic complications such as intraspinal cement leakage. During the 5-year follow-up, there was no tuberculosis recurrence or implant failure.

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Section: Discussionsupporting

confidence: 90%

Long-term outcome of polymethylmethacrylate-augmented screw fixation in the treatment of thoracolumbar spinal tuberculosis in elderly patients with severe osteoporosis

Yang¹,

He²,

Wei³

et al. 2020

Preprint

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“…Another 5 noncement cases needed to perform revision surgery reported by Seo et al 32 . Martín-Fernández et al 37 reported the highest revision rate (17.9%) of the patients using CAPS. However, the revision reason for these 56 cases was not fixation loosening, but the adjacent segment-related issues such as pseudo-arthrosis formation and adjacent vertebral fracture.…”

Section: Discussionmentioning

confidence: 97%

“…In symptomatic cases, 1.2% of the patients needed revision surgery to remove the screws and cement. Martín-Fernández et al 37 observed a 62.3% incidence of spinal leakage in 313 patients. 1.55% of the cases had symptoms which were presented as radicular pain of lower limbs.…”

Section: Discussionmentioning

confidence: 98%

Clinical efficacy of Bone Cement-injectable Cannulated Pedicle Screw Short Segment Fixation for Lumbar Spondylolisthesis with Osteoporosise

Liu

Xiao

Yin

et al. 2020

Sci Rep

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Many clinical studies have shown a satisfactory clinical efficacy using bone cement-augmented pedicle screw in osteoporotic spine, however, few studies have involved the application of this type of screw in lumbar spondylolisthesis. This study aims to investigate the mid-term clinical outcome of bone cementinjectable cannulated pedicle screw (CICPS) in lumbar spondylolisthesis with osteoporosis. From 2011 to 2015, twenty-three patients with transforminal lumbar interbody fusion (TLIF) using CICPS for lumbar spondylolisthesis were enrolled in the study. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) were used to evaluate faunctional recovery and physical pain; and operation time, blood loss and hospitalization time were recorded, respectively. Radiograph and computed tomography of lumbar spine was performed to assess loss of the intervertebral disc space height, fixation loosening, and the rate of bony fusion. The average follow-up time of 23 patients was 22.5 ± 10.2 months (range, 6-36 months). According to VAS and ODI scores, postoperative pain sensation and activity function were significantly improved (p < 0.05). The height of the intervertebral disc space was reduced by 0.4 ± 1.1 mm, and the bone graft fusion rate was 100%. No cases of internal fixation loosening or screw pullout was observed. CICPS using cement augmentation may suggest as a feasible surgical technique in osteoporotic patients with lumbar spondylolisthesis.

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“…The safety and effectiveness of CPSs have been partially con rmed in previous studies (4,5). However, PMMA-related complications that can arise in clinical application, such as PMMA leakage, allergic reactions, venous or pulmonary embolism, and di culty in CPS revision, have drawn increasing attention from surgeons (10)(11)(12)(13). Therefore, clear guidance should be provided for a reasonable application to decrease the risk of these complications.…”

Section: Introductionmentioning

confidence: 93%

Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis

Liu¹,

Xiao

Jin³

et al. 2020

Preprint

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Background: Cannulated pedicle screw (CPS) augmented by polymethylmethacrylate (PMMA) can achieve satisfactory clinical efficacy in the treatment of lumbar spondylolisthesis with osteoporosis. However, accurate application of CPSs will help to avoid the difficulty of screw revision and reduce the incidence of PMMA-related complications. This study aimed to investigate the mid-term efficacy of CPS compared to unilateral and bilateral applications in this common lumbar degenerative disease.Methods: Between May 2011 and May 2018, 50 patients with lumbar spondylolisthesis with osteoporosis who underwent posterior fixation and fusion using traditional pedicle screws or CPSs were included in the study. Patients were divided into two groups based on the application: the unilateral PMMA-augmented CPS group (UC, n = 29) and the bilateral PMMA-augmented CPS group (BC, n = 21). Operation time, blood loss, average hospitalization time, PMMA leakage, and other complications were recorded. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were used to evaluate symptom recovery. Radiographic results were compared for intervertebral fusion and screw loosening.Results: There were no significant differences in the baseline data of the two groups.The VAS and ODI scores improved significantly after surgery (P < 0.05), with no significant differences between the groups (P > 0.05). The operation time and blood loss in the UC group were significantly lower than those in the BC group (P < 0.05). However, the loss of intervertebral disc height and Taillard index did not differ significantly between the groups. The rates of PMMA leakage in the UC and BC groups were 7.0% and 11.9%, respectively (P < 0.05). Bony fusion was achieved in all groups without screw loosening at the last follow-up. Only one patient experienced superficial infection in both groups, while cerebrospinal fluid leakage was observed in two patients in the BC group.Conclusions: Unilateral application of PMMA-augmented CPS may provide adequate clinical safety and effectiveness in the surgical treatment of lumbar spondylolisthesis with osteoporosis.

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Potential risks of using cement-augmented screws for spinal fusion in patients with low bone quality

Cited by 56 publications

References 52 publications

Long-term outcome of polymethylmethacrylate-augmented screw fixation in the treatment of thoracolumbar spinal tuberculosis in elderly patients with severe osteoporosis

Long-term outcome of polymethylmethacrylate-augmented screw fixation in the treatment of thoracolumbar spinal tuberculosis in elderly patients with severe osteoporosis

Clinical efficacy of Bone Cement-injectable Cannulated Pedicle Screw Short Segment Fixation for Lumbar Spondylolisthesis with Osteoporosise

Comparison of unilateral and bilateral polymethylmethacrylate-augmented cannulated pedicle screw fixation for the management of lumbar spondylolisthesis with osteoporosis

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