Pedicle screw augmentation with bone cement enforced Vicryl mesh

Abstract

Achieving sufficient mechanical purchase of pedicle screws in osteoporotic or previously instrumented bone is technically and biologically challenging. Techniques using different kinds of pedicle screws or methods of cement augmentation have been used to address this challenge, but are associated with difficult revisions and complications. The purpose of this biomechanical trial was to investigate the use of biocompatible textile materials in combination with bone cement to augment pullout strength of pedicle screws while reducing the risk of cement extrusion. Pedicle screws (6/40 mm) were either augmented with standard bone-cement (Palacos LV + G) in one group (BC, n = 13) or with bone-cement enforced by Vicryl mesh in another group (BCVM, n = 13) in osteoporosis-like saw bone blocks. Pullout testing was subsequently performed. In a second experimental phase, similar experiments were performed using human cadaveric lumbar vertebrae (n = 10). In osteoporosis-like saw bone blocks, a mean screw pullout force of 350 N (±125) was significantly higher with the Bone cement (BC) compared to bone-cement enforced by Vicryl mesh (BCVM) technique with 240 N (±64) (p = 0.030). In human cadaveric lumbar vertebrae the mean screw pullout force was 784 ± 366 N with BC and not statistically different to BCVM with 757 ± 303 N (p = 0.836). Importantly, cement extrusion was only observed in the BC group (40%) and never with the BCVM technique. In vitro textile reinforcement of bone cement for pedicle screw augmentation successfully reduced cement extrusion compared to conventionally delivered bone cement. The mechanical strength of textile delivered cement constructs was more reproducible than standard cementing. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:212-216, 2018.

Effect of bone cement-reinforced pedicle screws combined with fusion repositioning therapy on lumbar spine function and postoperative complications in patients with severe lumbar spondylolisthesis

“…By injecting bone cement, the bone cement can be squeezed into the bone around the screw evenly. The bone cement can increase the contact area with the bone, improve the grip between the bone and the pedicle screw bone cement, thus enhancing the stability of the screw, improving the anti-fatigue ability of spinal fixation stage and improving the surgical treatment effect [ [29] , [30] , [31] ]. There was no difference in the complication rate between the two groups, which showed that cement-reinforced pedicle screw combined with interbody fusion was safe and effective.…”

Bone density optimized pedicle screw insertion

“…The screw extraction speed was set at 5 mm/min in accordance with the ASTM standard (Tolunay et al, 2015;Aycan et al, 2016;F543-17, A, 2017). A preload of 5N was applied to eliminate initial slack and improve alignment (Schmid et al, 2018).…”

Efficacy and Safety of Posterior Long-Segment Fixation Versus Posterior Short-Segment Fixation for Kummell Disease: A Meta-Analysis

“…32 As the reinforced pedicle screws do not damage the anterior wall of the spinal cone, the probability of bone cement leakage is very low, and it can effectively prevent screw loosening after internal fixation. [33][34][35] Three of the studies we included compared the safety of long and short segments by reinforced pedicle screw fixation in the treatment of Kummell disease. The current meta-analysis results showed that there was no significant difference in postoperative bone cement leakage and postoperative screw loosening between LSF and SSF.…”