Zementaugmentation an der Wirbelsäule

Purpose Open reduction and internal fixation using anterior plate osteosynthesis currently represents the gold standard for the treatment of symphyseal disruptions. Since postoperative screw loosening with consequent implant failure is frequently observed, this study aims to evaluate if and to what extent augmentation can increase the pull-out force of symphyseal screws to improve the constructs stability. Methods Twelve human cadaveric anterior pelvic rings were separated at the symphyseal joint for bilateral testing, consequently achieving comparable sites. First, one non-augmented screw was drilled into the superior pubic ramus, whereas the contralateral side was primarily augmented. The screws were then withdrawn with a constant speed of 10 mm/min and the fixation strengths determined by the force (N) displacement (mm) curve. Finally, the primary non-augmented site was secondary augmented, representing revision surgery after initial implant failure, and the corresponding fixation strength was measured again. Results Augmentation compared to non-augmented screws displayed significantly higher pull-out forces with an increase in pull-out force by 377% for primary and 353% for secondary augmentation (p < 0.01). There was no significant difference in the pull-out force comparing primary and secondary augmentation (p = 0.74). Conclusions Primary and secondary augmentation significantly increases the stability of symphyseal screws and, therefore, potentially decreases rates of implant failure.

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Thorakolumbale Wirbelsäulenfrakturen beim alten Menschen

Schnake

Bula

Spiegl

et al. 2017

Unfallchirurg

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Thoracolumbar fractures in the elderly are frequently associated with osteoporosis. Osteoporosis can cause fractures or be a significant comorbidity in traumatic fractures. The OF classification is based on conventional X‑ray, computed tomography (CT) scan and magnetic resonance imaging (MRI). It is easy to use and provides a clinically relevant classification of the fractures. Therapeutic decisions are made based on the clinical and radiological situation by using the OF score. The score takes the current clinical situation including patient-specific comorbidities into consideration. The treatment recommendations are based on an expert consensus opinion and include conservative and operative options. If surgery is indicated, vertebral body augmentation, percutaneous stabilization and even open surgery can be used.

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Zementaugmentation an der Wirbelsäule

Cited by 7 publications

References 25 publications

Percutaneous Pedicle Screw Instrumentation and Pedicle Screw Augmentation with Vertebral Body Stenting (VBS) in Cases with Unstable Osteoporotic Thoracolumbar Fractures

Percutaneous Pedicle Screw Instrumentation and Pedicle Screw Augmentation with Vertebral Body Stenting (VBS) in Cases with Unstable Osteoporotic Thoracolumbar Fractures

Does augmentation increase the pull-out force of symphyseal screws? A biomechanical cadaver study

Thorakolumbale Wirbelsäulenfrakturen beim alten Menschen

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