The cement leakage in cement-augmented pedicle screw instrumentation in degenerative lumbosacral diseases: a retrospective analysis of 202 cases and 950 augmented pedicle screws

Reduced cement volume does not affect screw stability in augmented pedicle screws

“…Overall, they described symptomatic complications in 5.5% of cases and a 30-day mortality rate of 1.8% [21]. Guo et al performed a retrospective analysis of 202 patients with 950 augmented pedicle screws and observed a cement leakage in 81.7% of patients [20]. They further investigated the factors influencing the occurrence of cement leakage and found a significant relation to the cement volume with an odds ratio of 0.75 (p = 0.013).…”

“…Biomechanical studies have shown an approximately twofold increase in pull-out force and an increase in load to failure in cyclic testing by 52% for augmented pedicle screws [16][17][18][19]. However, cement augmentation of pedicle screws is associated with relevant complications such as leakage and embolism [20,21]. Symptomatic complications are reported in 5.5%, asymptomatic cement leakage in 66.7% and anaphylactic reactions in 1.2% of patients treated with augmented pedicle screws [21].…”

“…Symptomatic complications are reported in 5.5%, asymptomatic cement leakage in 66.7% and anaphylactic reactions in 1.2% of patients treated with augmented pedicle screws [21]. It has been shown that reducing the cement volume during augmentation is able to significantly reduce the risk of cement leakage [20]. Nevertheless, there is still controversy regarding the sufficient cement volume for screw augmentation.…”

Influence of cement-augmented pedicle screw instrumentation in an osteoporotic lumbosacral spine over the adjacent segments: a 3D finite element study

“…Therefore, an internal fixation device is often used to maintain stability in the lumbar segment [1,2]. However, in patients with osteoporosis, conventional pedicle screws (CPS) have the disadvantage of insufficient holding power and bone cement needs to be used to strengthen the pedicle screw fixation to reduce the risk of screw loosening and pseudoarthrosis [3][4][5]. Cement-augmented pedicle screw instrumentation (CAPSI) has been proved to strengthen the mechanical force on the screw-bone interface so that to reduce implant failure rate by both vivo and vitro studies [3][4][5].…”

“…However, in patients with osteoporosis, conventional pedicle screws (CPS) have the disadvantage of insufficient holding power and bone cement needs to be used to strengthen the pedicle screw fixation to reduce the risk of screw loosening and pseudoarthrosis [3][4][5]. Cement-augmented pedicle screw instrumentation (CAPSI) has been proved to strengthen the mechanical force on the screw-bone interface so that to reduce implant failure rate by both vivo and vitro studies [3][4][5]. According to the current clinical investigation and biomechanical studies, CAPSI showed a significantly lower loosening rate (0-4.3%) and higher fusion rate (94.1-100%) compared to regular pedicle screws [4,[6][7][8].…”