Pedicle screw loosening: a clinically relevant complication?

Galbusera, Fabio; Volkheimer, David; Reitmaier, Sandra; Berger-Roscher, Nikolaus; Kienle, Annette; Wilke, Hans–Joachim

doi:10.1007/s00586-015-3768-6

Cited by 314 publications

(289 citation statements)

References 71 publications

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“…In our series (approximately 2/3 survival at 24 months), 12.5 % of treated lesions with available follow-up imaging (mean 8.7 months) demonstrated poor osseous consolidation or screw loosening; and at least 1 patient was symptomatic. Despite limited sample size and data quality, local unfavourable evolution at imaging follow-up may be relatively frequent similar to surgical series [28,32]. Our non-consolidated case can be explained by poor osseous substrate in a post-ablation cavity.…”

Section: Discussioncontrasting

confidence: 44%

Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus

Cazzato

Koch

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et al. 2016

Cardiovasc Intervent Radiol

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Section: Discussioncontrasting

confidence: 44%

Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus

Cazzato

Koch

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et al. 2016

Cardiovasc Intervent Radiol

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“…4,5 The complications and drawbacks of PMMA have also gradually been unveiled during clinical practice in the past few years. [1][2][3] Most drawbacks originate from the excessive mechanical strength or stiffness and nondegradability of PMMA, with its intrinsic material properties difficult to alter. This requires a new injectable material distinct from PMMA, but also be able to prevent pullout of screws from the vertebral body.…”

Section: Discussionmentioning

confidence: 99%

“…The reduction of bone mass in osteoporotic patients greatly decreases the fixation strength of pedicle screws, causing loosening or pullout of screws, cutout of the vertebral body, failure of fixation, and a number of potential risks or complications. [1][2][3] Augmentation with bone cement has been demonstrated to be an effective way to increase the fixation strength of pedicle screws in osteoporotic patients. Previous studies have reported that the pullout strength of pedicle screws can be dramatically increased by augmentation with nondegradable or bioabsorbable bone cements such…”

Section: Introductionmentioning

confidence: 99%

A novel injectable calcium phosphate-based nanocomposite for the augmentation of cannulated pedicle-screw fixation

Sun¹,

Liu²,

Liu³

et al. 2017

IJN

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Polymethyl methacrylate (PMMA)-augmented cannulated pedicle-screw fixation has been routinely performed for the surgical treatment of lumbar degenerative diseases. Despite its satisfactory clinical outcomes and prevalence, problems and complications associated with high-strength, stiff, and nondegradable PMMA have largely hindered the long-term efficacy and safety of pedicle-screw fixation in osteoporotic patients. To meet the unmet need for better bone cement for cannulated pedicle-screw fixation, a new injectable and biodegradable nanocomposite that was the first of its kind was designed and developed in the present study. The calcium phosphate-based nanocomposite (CPN) exhibited better anti-pullout ability and similar fluidity and dispersing ability compared to clinically used PMMA, and outperformed conventional calcium phosphate cement (CPC) in all types of mechanical properties, injectability, and biodegradability. In term of axial pullout strength, the CPN-augmented cannulated screw reached the highest force of ~120 N, which was higher than that of PMMA (~100 N) and CPC (~95 N). The compressive strength of the CPN (50 MPa) was three times that of CPC, and the injectability of the CPN reached 95%. In vivo tests on rat femur revealed explicit biodegradation of the CPN and subsequent bone ingrowth after 8 weeks. The promising results for the CPN clearly suggest its potential for replacing PMMA in the application of cannulated pedicle-screw fixation and its worth of further study and development for clinical uses.

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“…Therefore, the difference for loosening between cranial and caudal screws should be discussed with care and have not been further reported. This may therefore be different in patients [6].…”

Section: Discussionmentioning

confidence: 98%

“…Pedicle screw systems are currently the most common technique for the stabilization of the spine, which requires a stable fixation in the bone [4,5]. But a poor bone mineral density in osteoporotic patients can result in a screw loosening [6][7][8][9]. Lamina hook systems have the advantage that they are connected directly to the lamina, which may have the advantage of a minimized injury risk for neural structures.…”

Section: Introductionmentioning

confidence: 99%

A pedicle screw system and a lamina hook system provide similar primary and long-term stability: a biomechanical in vitro study with quasi-static and dynamic loading conditions

et al. 2016

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Purpose For the stabilization of the thoracolumbar spine area, various stabilization techniques have been developed in recent decades. The aim of these techniques is to immobilize the treated segment to repositioning or correct the spine and guaranty long-term stability to achieve a reliable fusion. The aim of this study was to simulate in an in vitro experiment the postoperative long-term situation in elderly osteoporotic patients to compare two different stabilization principles; a pedicle screw system and a lamina hook system. Methods Two comparable groups with respect to age and bone mineral density with each n = 6 fresh-frozen human, bi-segmental thoracolumbar spine specimens (T11-L1) were used. Antero-posterior and lateral radiographs were taken before the test, to assess the spinal status. Then the intact specimens were biomechanically characterized with pure moments in the three anatomical planes in different states in terms of range of motion and neutral zone. After implantation of either, a pedicle screw system or a lamina hook system, the primary stability was determined under the same conditions. Subsequently the specimens were cyclically loaded under complex loading, using a custommade set-up in a dynamic materials testing machine with increasing moments from 3 to 66 Nm until 100,000 cycles or until one of the three defined ''failure'' criteria was reached.(1) A failure of a bony structure. (2) Exceeding of the threefold ROM of the primary stability after implantation in flexion plus extension. (3) Reaching of the ROM based on the intact state before implantation both in flexion plus extension.Results The results showed that the ROM was strongly reduced after instrumentation similar for both implant systems in all motion planes. The highest stabilization was found in flexion/extension. During cyclic loading with increasing moments, the ROM increased continuously for both systems. The number of load cycles until one of the failure criteria was reached varied only slightly between the two groups. In the pedicle screw group 30,000 (median) loading cycles (range 5000-80,000) with a corresponding moment of 24 Nm (range 9-54) could be reached. In the lamina hook group 32,500 load cycles (range 20,000-45,000) could be achieved with a corresponding moment of 25.5 Nm (range 18-33). There was a slight trend that the pedicle screw system is influenced more by bone mineral density. Conclusion Both implant systems provide similar primary stability and similar long-term stability. In the pedicle screw group, there was a stronger correlation between bone mineral density and the reached number of load cycles.

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Pedicle screw loosening: a clinically relevant complication?

Cited by 314 publications

References 71 publications

Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus

Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus

A novel injectable calcium phosphate-based nanocomposite for the augmentation of cannulated pedicle-screw fixation

A pedicle screw system and a lamina hook system provide similar primary and long-term stability: a biomechanical in vitro study with quasi-static and dynamic loading conditions

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