Clinical Effects and Complications of Pedicle Screw Augmentation with Bone Cement: Comparison of Fenestrated Screw Augmentation and Vertebroplasty Augmentation

Kim, Jin Hak; Ahn, Dong Ki; Shin, Won Shik; Kim, Myung Jin; Lee, Ho‐Young; Go, Young Rok

doi:10.4055/cios19127

Cited by 35 publications

(19 citation statements)

References 23 publications

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“…It is well known that spinal instrumentation failures occur more often in osteoporotic spines. 18 , 19 In the case of posterior fixation with pedicle screws, failure is a result of decreased fixation strength in poor bone quality. 20 This insufficient fixation leads to increased instrument failure, such as screw pullout and loosening, warranting revision surgery that can lead to additional complications.…”

Section: Discussionmentioning

confidence: 99%

Long-Segmental Posterior Fusion Combined With Vertebroplasty and Wiring: Alternative Surgical Technique for Kummell’s Disease With Neurologic Deficits – A Retrospective Case Series

Park

Kim

Ryu

et al. 2021

Geriatr Orthop Surg Rehabil

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Purpose: Various surgical methods have been reported for Kummell’s disease with neurologic deficits. The aim of this study was to introduce long-segmental posterior fusion (LPF) combined with vertebroplasty (VP) and wiring as an alternative surgical technique. Material and Methods: We retrospectively analyzed 10 patients undergoing posterior decompression and LPF combined with VP and wiring for Kummell’s disease with neurologic deficits from January 2011 to December 2014. The radiologic outcomes included the local kyphotic angle (LKA) and segmental kyphotic angle (SKA). Clinical outcomes, including the visual analog scale (VAS), the Oswestry Disability Index (ODI) and the Frankel grade were assessed. Surgery-related complications were also evaluated. Results: The mean age of the included patients was 77 ± 8 years with a mean follow-up period of 31.4 ± 4.9 months and a mean bone mineral density of −3.5 ± 0.7 (T-score). The mean operation time was 220 ± 32.3 minutes with a mean blood loss of 555 ± 125.7 mL. The preoperative LKA and SKA were significantly corrected postoperatively (37.9 ± 8.7° vs. 15.3 ± 5.3°, p = 0.005 for LKA; 21.3 ± 5.1° vs. 7.6 ± 2.8°, p = 0.005 for SKA) without a loss of correction at the last follow-up. The VAS and ODI were also significantly improved (7.7 ± 1.1 vs. 3.0 ± 1.6, p = 0.007 for VAS; 90.3 ± 8.9 vs. 49.6 ± 22.7, p = 0.007 for ODI). The Frankel grade of all patients was improved by at least 1 or 2 grades at the last follow-up. Surgery-related complications such as intraoperative cement leakage and implant loosening during the follow-up were not observed. Conclusions: LPF combined with VP and wiring might be an effective surgical option for Kummell’s disease with neurologic deficits, especially for the elderly patients with morbidities. Level of Evidence: level IV.

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Section: Discussionmentioning

confidence: 99%

Long-Segmental Posterior Fusion Combined With Vertebroplasty and Wiring: Alternative Surgical Technique for Kummell’s Disease With Neurologic Deficits – A Retrospective Case Series

Park

Kim

Ryu

et al. 2021

Geriatr Orthop Surg Rehabil

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“…Currently, the most common indication of VP is an osteoporotic vertebral compression fracture that has failed conservative treatment [ 9 , 17 ]. Moreover, bone cement augmentation of the pedicle screws has been increasingly used to decrease the incidence of screw loosening in osteoporotic patients [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Paraplegia due to intradural cement leakage after vertebroplasty: a case report and literature review

Baek

Park

Kim

et al. 2021

BMC Musculoskelet Disord

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Background Vertebroplasty (VP) is considered an alternative therapy in an osteoporotic compression fracture that failed conservative treatment. However, cement leakage into the intradural space can cause catastrophic complications. To the best of our knowledge, intradural cement leakage following VP has been reported only in 7 cases. We report here a case of intradural cement leakage following VP with a literature review. Case presentation An 84-year-old female with an L1 osteoporotic fracture underwent percutaneous VP at a local hospital. Immediately after the procedure, she complained of weakness, numbness, and pain in both legs, and her back pain aggravated. She was transferred to our hospital. The initial muscle power was grade 2 for the right leg and grade 4 for the left leg. Computed tomography (CT) scan showed intradural cement leakage from T10 to L2. Magnetic resonance imaging showed an intradural mass lesion. Although we performed total laminectomy with durotomy and removed intradural cement completely, the neurological deficit did not completely recover. The muscle power was grade 3 for the right leg and grade 4 for the left leg at the last follow-up. Conlcusions If a neurological deficit is found after VP, a CT scan should be taken to confirm the pattern of cement leakage. In case of intradural cement leakage, surgical decompression should be recommended to improve neurological deficit. To prevent intradural cement leakage during the VP, the needle tip should not perforate the medial wall of the pedicle with appropriate viscosity of cement.

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“…In theory, cement, as a bone adhesive, can rmly connect the implant material and bone to enhance its rmness. In recent years, many scholars and doctors carried out biomechanical and clinical research on the use of augmented-cement pedicle screws; They found that these screws could improve the stability and reliability of internal xation in patients with osteoporosis [20][21][22]. When we used the xation of cement-augmented pedicle screw, the bone-screw interface was transformed into the bone-cementscrew interface, and the screw and cement were closely combined so as to overcome the defect that the bone-screw interface was not rmly connected, resulting in the pulling out of the screw.…”

Section: Discussionmentioning

confidence: 99%

Screw Cutting Vertebrae After Short-Segment Fixation of Pedicle Screw Combined with Kyphoplasty for Kummell Disease ： A Case Report and Literature Review

Han

Xie

Bai

et al. 2021

Preprint

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Introduction: Kummell disease is also known as vertebral fracture nonunion, delayed vertebral collapse and vertebral ischemic necrosis. It often occurs in a delayed manner after spinal injury, and is a complex and rare spinal disease. This study, aimed to report a case of stage 3 Kummell disease, diagnosed using magnetic resonance imaging (MRI) of the lumbar spine.Methods: The subject underwent a short-segment fixation of the pedicle screw combined with kyphoplasty.Results: The patient was satisfied with the relief of back pain after the surgery, but the surgery was found to cause screw cutting vertebrae in the second lumbar vertebra (L2).Conclusion: Short-segment fixation of the pedicle screw combined with kyphoplasty can reconstruct spinal stability, maintain stability of bone cement mass in vertebrae, correct kyphosis deformity, and relieve pain. However, Kummell disease in elderly patients is always accompanied by severe osteoporosis. The common fixation of the pedicle screw is prone to cause screw cutting, loosening, and pulling out. Therefore, we advocate using cement-augmented pedicle screws.

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Clinical Effects and Complications of Pedicle Screw Augmentation with Bone Cement: Comparison of Fenestrated Screw Augmentation and Vertebroplasty Augmentation

Cited by 35 publications

References 23 publications

Long-Segmental Posterior Fusion Combined With Vertebroplasty and Wiring: Alternative Surgical Technique for Kummell’s Disease With Neurologic Deficits – A Retrospective Case Series

Long-Segmental Posterior Fusion Combined With Vertebroplasty and Wiring: Alternative Surgical Technique for Kummell’s Disease With Neurologic Deficits – A Retrospective Case Series

Paraplegia due to intradural cement leakage after vertebroplasty: a case report and literature review

Screw Cutting Vertebrae After Short-Segment Fixation of Pedicle Screw Combined with Kyphoplasty for Kummell Disease ： A Case Report and Literature Review

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