Outcomes of the use of cement-augmented cannulated pedicle screws in lumbar spinal fusion

Son, Hee Jung; Choi, Sung Hoon; Heo, Dong Ryul; Kook, Incheol; Lee, Myoung Keun; Ahn, Hyein; Kang, Chang Nam

doi:10.1016/j.spinee.2021.05.005

Cited by 18 publications

(11 citation statements)

References 39 publications

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“…[25] There have been recent reports on the clinical efficacy of cement augmentation using fenestrated screws. [26][27][28][29] Studies have reported the safety and effectiveness of fenestrated pedicle screws in not only osteoporosis but in other conditions, which can induce vertebral instability such as tumor. [30] We quantified the distribution of injected cement to predict the likelihood of cement leakage in real-world clinical settings.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Comparison and Three-Dimensional Analysis of Cement Distribution Patterns for Different Pedicle Screw Designs

Sung

Kwon

Park

et al. 2022

BioMed Research International

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The purpose of this study to explore strategies for reducing cement leakage during cement-augmented pedicle screw fixation, we compared the cement distribution patterns and biomechanical strengths of different types of cement-augmented fenestrated screws and traditional cement-augmented techniques. We compared five screw groups in this study: (1) Cannulated screws (Cann); (2) distal one-hole screws (D1); (3) distal two-hole screws (D2); (4) middle two-hole screws (M2); and (5) traditional screws with a traditional cement injection technique (Trad). The screws were inserted into cancellous bone blocks using a controlled, adequate cement injection pressure (1.6–2.0 kg), and an appropriate cement viscosity. Center to screw tip distance, three-dimensional distribution, and pull-out strength for cement were compared between groups. The average distance between the cement center and the screw tip was highest in the M2 group, suggesting a higher risk of cement leakage into the spinal canal. The Trad group had the highest migration distance in the z-axis, also reflecting a higher risk of leakage into the spinal canal. The D1 group had the highest pull-out strength ( 253 ± 48.82 N and 797 ± 58.31 N ) in bone blocks representing different degrees of osteoporosis, and the D2 group had the second highest pull-out strength in the severe osteoporosis model. Overall, D1 screws appeared to be the best option for optimizing biomechanical function and minimizing the risk of cement leakage into the spinal canal in patients with osteoporotic bone undergoing spinal surgery.

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Section: Discussionmentioning

confidence: 99%

Biomechanical Comparison and Three-Dimensional Analysis of Cement Distribution Patterns for Different Pedicle Screw Designs

Sung

Kwon

Park

et al. 2022

BioMed Research International

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“…Using a large-diameter screw, a long screw that penetrates the anterior cortex of the vertebral body and cement augmentation of the pedicle screw are considered to prevent screw backout attributed to bone non-union. [20][21][22] This must be evaluated in the postoperative follow-up period because 31to 90-day reoperation caused by screw loosening or pull out might be specific in patients who did not achieve early fixation based on this finding.…”

Section: Discussionmentioning

confidence: 99%

Implant-Related Complications after Spinal Fusion: A Multicenter Study

Koshimizu

Nakashima

Ohara

et al. 2022

Global Spine Journal

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Study Design Retrospective analysis of prospectively database Objective Implant-related complications are an extremely important issue because they pose a burden to patients who underwent surgery. An understanding of these complications can help improve the postoperative management of patients undergoing spinal surgery. The current large-scale multicenter study aimed to identify postoperative implant-related complications that may require revision surgery. Methods In total, 3447 patients who underwent spinal fusion surgery were included in the analysis. Data about age at surgery, sex, preoperative diagnosis, surgical level, type of implant-related complications, causes of reoperation, and time from the initial to revision surgery were reviewed. Moreover, the characteristics of reoperation in 3 periods (within 30, 31–90, and over 90 days) were assessed. Result The overall incidence of implant-related complications was 4.6%. Adult spinal deformity was the most common diagnosis (9.9%), and thoracic-lumbar-sacral (42.9%) was the most common surgical level among patients with implant-related complications. Further, screw malposition was the most frequent implant-related complication (42.8%). In total, 89 (2.6%) patients underwent reoperation due to implant-related complications. The main causes of reoperation within 30, 31–90, and over 90 days were screw malposition (72.2%), screw loosening or pull out (81.8%), and rod or screw fracture (60.9%), respectively. Conclusion To the best of our knowledge, this was the first large-scale multicenter study that assessed the characteristics of patients who underwent reoperation due to spinal implant-related complications. The study results could improve the preoperative informed consent procedure about spinal fusion.

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“…Based on the results of the study, it is recommended to complete the preoperative examination, such as DXA, and treat abnormal blood values and osteoporosis, before performing spinal surgery for patients with ESRD. When performing lumbar spine surgery for ESRD patients, cement augmentation should be considered to avoid short-term implant loosening [39].…”

Section: Discussionmentioning

confidence: 99%

Correlation between Preoperative Serum Levels of Calcium, Phosphate, and Intact Parathyroid Hormone and Radiological Outcomes in Spinal Interbody Fusion among End-Stage Renal Disease Patients

Shih

Tseng

et al. 2021

JCM

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Spinal fusion surgery for end-stage renal disease (ESRD) patients is a clinical challenge. This study aimed to investigate whether postoperative radiological outcomes are related to preoperative serum calcium, phosphate, or intact parathyroid hormone (iPTH) levels in patients with ESRD who underwent spinal interbody fusion surgery. This study included 62-consecutive patients with ESRD who underwent anterior cervical discectomy and fusion (ACDF) or transforaminal lumbar interbody fusion (TLIF) surgery for symptomatic spinal disorder. The most recent preoperative serum calcium, phosphate, and iPTH levels were recorded, and the postoperative radiographic outcomes were assessed. A significant correlation was found between the occurrence of cage subsidence and higher blood phosphate, calcium–phosphate product (Ca × P), and iPTH levels in the TLIF group. The occurrence of pedicle screw loosening was related to higher blood phosphate and Ca × P product in the TLIF group. However, no correlation was found between the fusion grades and the serum levels in either the TLIF or ACDF groups. These results indicated that higher preoperative serum phosphate and Ca × P product are risk factors for both cage subsidence and screw loosening in patients with ESRD who underwent TLIF surgery. Higher iPTH levels are also a possible risk factor for cage subsidence.

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Outcomes of the use of cement-augmented cannulated pedicle screws in lumbar spinal fusion

Cited by 18 publications

References 39 publications

Biomechanical Comparison and Three-Dimensional Analysis of Cement Distribution Patterns for Different Pedicle Screw Designs

Biomechanical Comparison and Three-Dimensional Analysis of Cement Distribution Patterns for Different Pedicle Screw Designs

Implant-Related Complications after Spinal Fusion: A Multicenter Study

Correlation between Preoperative Serum Levels of Calcium, Phosphate, and Intact Parathyroid Hormone and Radiological Outcomes in Spinal Interbody Fusion among End-Stage Renal Disease Patients

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