Predictive validity of preoperative CT scans and the risk of pedicle screw loosening in spinal surgery

Bredow, Jan; Boese, Christoph Kolja; Werner, Clément M. L.; Siewe, Jan; Löhrer, L.; Zarghooni, Kourosh; Eysel, Peer; Scheyerer, Max J.

doi:10.1007/s00402-016-2487-8

Cited by 147 publications

(117 citation statements)

References 25 publications

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“…4,5 The complications and drawbacks of PMMA have also gradually been unveiled during clinical practice in the past few years. [1][2][3] Most drawbacks originate from the excessive mechanical strength or stiffness and nondegradability of PMMA, with its intrinsic material properties difficult to alter. This requires a new injectable material distinct from PMMA, but also be able to prevent pullout of screws from the vertebral body.…”

Section: Discussionmentioning

confidence: 99%

“…Fluidity and dispersion of cements in osteoporotic bone were evaluated by injecting the pastes into 4×4×2 cm 3 Sawbones blocks and measuring the geometry and volume of the dispersed and hardened pastes. The L:S ratio of PMMA cement was 0.45, as suggested by the manufacturer, while CPC and the CPN were tested for different L:S ratios of 0.8, 1, 1.2, 1.4, and 1.6.…”

Section: Fluidity and Dispersion Abilitymentioning

confidence: 99%

“…Both traditional (solid) and cannulated pedicle screws were implemented with different types of cements in the 3 Sawbones blocks. In the case of solid screws, a guiding screw of smaller diameter (6 mm) was prescrewed into the Sawbones block to create a canal and 1.5 mL PMMA, CPC (with or without BS), or CPN cement was injected into the bottom of the canal and the solid screw was then screwed in.…”

Section: Implementation Of Screw and Bone Cementmentioning

confidence: 99%

“…The reduction of bone mass in osteoporotic patients greatly decreases the fixation strength of pedicle screws, causing loosening or pullout of screws, cutout of the vertebral body, failure of fixation, and a number of potential risks or complications. [1][2][3] Augmentation with bone cement has been demonstrated to be an effective way to increase the fixation strength of pedicle screws in osteoporotic patients. Previous studies have reported that the pullout strength of pedicle screws can be dramatically increased by augmentation with nondegradable or bioabsorbable bone cements such…”

Section: Introductionmentioning

confidence: 99%

“…Pedicle screws, PMMa cement, and osteoporotic bone model 3 and 95% opencelled structure. The Sawbones mimicked human vertebrae with severe osteoporosis and provided a homogeneous and consistent material similar to human cancellous bone, as well as X-ray inspection capacity.…”

mentioning

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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Section: Discussionmentioning

confidence: 99%

Section: Fluidity and Dispersion Abilitymentioning

confidence: 99%

Section: Implementation Of Screw and Bone Cementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

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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Laser resonance frequency analysis of pedicle screw stability: A cadaveric model bone study

Nakashima

Mikami

Kikuchi

et al. 2021

Journal Orthopaedic Research

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There is no evaluation method currently available to assess intraoperative pedicle screw fixation (PSF) strength. In this study, we established a laser-based resonance frequency analysis (RFA) system with high-speed, noncontact, quantitative measurements of PSF. Clinical investigations in the future can assess surgical failure risk of implants. We investigated the characteristics of the laser RFA and compared them with the conventional methods. We inserted a pedicle screw in the vertebral pedicle of human cadaver or model bone, followed by screw pull-out, peak torque, implant stability quotient (ISQ) value obtained by the magnetic dental RFA system, and fixation force of laser RFA. We compared the outcomes using best-fit linear or logarithmic approximations. For the model bone study, the resonance frequency (RF) versus peak torque/pull-out force (POF) demonstrated strong correlations using logarithmic approximation (vs. peak torque: R = 0.931, p < .001, vs. POF: R = 0.931, p < .001). RF strongly correlated with the ISQ value using linear approximation (R = 0.981, p < .001). For the cadaveric vertebrae study, the correlation coefficients between RF and the peak torque/POF were significant regardless of approximation method (peak torque: logarithmic: R = 0.716 vs. linear: R = 0.811; p < .001) (POF: logarithmic: R = 0.644 vs. linear: R = 0.548; p < .05). Thus, the results of this study revealed a constant correlation between RFA and conventional methods as a measurement validation, predicting favorable support for intraoperative PSF. RFA has the potential to be a new index for evaluating the implant fixation force.

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The potential effect of romosozumab on perioperative management for instrumentation surgery

Ishikawa,

Tani,

Toyone

et al. 2024

JOR Spine

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BackgroundAge‐related changes in bone health increase the risk for complications in elderly patients undergoing orthopedic surgery. Osteoporosis is a key therapeutic target that needs to be addressed to ensure successful instrumentation surgery. The effectiveness of pharmacological interventions in orthopedic surgery, particularly the new drug romosozumab, is still unknown. We aim to evaluate the effect of 3‐month romosozumab treatment on biomechanical parameters related to spinal instrumentation surgery, using the Quantitative Computed Tomography (QCT)‐based Finite Element Method (FEM).MethodsThis open‐labeled, prospective study included 81 patients aged 60 to 90 years, who met the osteoporosis criteria and were scheduled for either romosozumab or eldecalcitol treatment. Patients were assessed using blood samples, dual‐energy absorptiometry (DXA), and QCT. Biomechanical parameters were evaluated using FEM at baseline and 3 months post‐treatment. The primary endpoints were biomechanical parameters at 3 months, while secondary endpoints included changes in regional volumetric bone mineral density around the pedicle (P‐vBMD) and vertebral body (V‐vBMD).ResultsRomosozumab treatment led to significant gains in P‐vBMD, and V‐vBMD compared to eldecalcitol at 3 months. Notably, the romosozumab group showed greater improvements in all biomechanical parameters estimated by FEM at 3 months compared to the eldecalcitol group.ConclusionRomosozumab significantly increased the regional vBMD as well as biomechanical parameters, potentially offering clinical benefits in reducing post‐operative complications in patients with osteoporosis undergoing orthopedic instrumentation surgery. This study highlights the novel advantages of romosozumab treatment and advocates further research on its effectiveness in perioperative management.

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Predictive validity of preoperative CT scans and the risk of pedicle screw loosening in spinal surgery

Abstract: The determination of bone density with preoperative CT scanning can predict the risk of screw loosening and inform the decision to use cement augmentation to reduce the incidence of screw loosening.

Cited by 147 publications

References 25 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

Laser resonance frequency analysis of pedicle screw stability: A cadaveric model bone study

The potential effect of romosozumab on perioperative management for instrumentation surgery

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