Polymethylmethacrylate Augmentation of Pedicle Screws Increases the Initial Fixation in Osteoporotic Spine Patients

Sawakami, Kimihiko; Yamazaki, A.; Ishikawa, Seiichi; Ito, Takui; Watanabe, Kei; Endo, Naoto

doi:10.1097/bsd.0b013e318228bbed

Cited by 118 publications

(96 citation statements)

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“…Therefore, we used a cyclic loading protocol, because this seems to best approximate the clinical loading scenario. Preliminary clinical studies showed a decrease in implant loosening rates with cement augmentation in the osteoporotic proximal femur [20] and spine [38]. Cement augmentation of sacroiliac screw fixation has been reported in small case reports and series [41,46], and few complications were reported.…”

Section: Discussionmentioning

confidence: 99%

Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model

Osterhoff

Dodd

Unno

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Sacroiliac screw fixation in elderly patients with pelvic fractures is prone to failure owing to impaired bone quality. Cement augmentation has been proposed as a possible solution, because in other anatomic areas this has been shown to reduce screw loosening. However, to our knowledge, this has not been evaluated for sacroiliac screws. Questions/purposes We investigated the potential biomechanical benefit of cement augmentation of sacroiliac screw fixation in a cadaver model of osteoporotic bone, specifically with respect to screw loosening, construct survival, and fracture-site motion. Methods Standardized complete sacral ala fractures with intact posterior ligaments in combination with ipsilateral upper and lower pubic rami fractures were created in osteoporotic cadaver pelves and stabilized by three fixation techniques: sacroiliac (n = 5) with sacroiliac screws in S1 and S2, cemented (n = 5) with addition of cement augmentation, and transsacral (n = 5) with a single transsacral screw in S1. A cyclic loading protocol was applied with torque (1.5 Nm) and increasing axial force (250-750 N). Screw loosening, construct survival, and sacral fracture-site motion were measured by optoelectric motion tracking. A sample-size calculation revealed five samples per group to be required to achieve a power of 0.80 to detect 50% reduction in screw loosening. Results Screw motion in relation to the sacrum during loading with 250 N/1.5 Nm was not different among the three groups (sacroiliac: 1.2 mm, range, 0.6-1.9; cemented: 0.7 mm, range, 0.5-1.3; transsacral: 1.1 mm, range, 0.6-2.3) (p = 0.940). Screw subsidence was less in the cemented group (3.0 mm, range, 1.2-3.7) compared with the sacroiliac (5.7 mm, range, 4.7-10

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Section: Discussionmentioning

confidence: 99%

Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model

Osterhoff

Dodd

Unno

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Several reports have demonstrated the effectiveness and success of this procedure in patients with primary spinal tumors, metastasis, trauma and infection [12][13][14][15][16]. Multiple anchor points distribute corrective forces over a greater number of segments associated with cemented screws minimize risk of loosening and pull out of conventional pedicle screw [17][18][19]. We noticed a previously non reported complication: a vertebral collapse in T12 without clinical relevance.…”

Section: Discussionmentioning

confidence: 81%

Management of Non-traumatic Thoracics Vertebral Fractures in Elderly Female with Previous Malignant Tumor

Ruiz-Picazo¹

2014

Osteopor Phys

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Volume 2 • Issue 1 • 1000109 deficit on lower limbs. She was treated for the osteoporosis previously. On her medical records, she had a left hip fracture treated with total hip artrhoplasty and she was diagnosed of an endometroid ovarian tumor five years before, which required radical surgery and chemotherapy. During the follow up she developed pulmonary and hepatic metastasis that resolved with treatment.In plain AP and lateral radiographs of the thoracolumbar spine, loss of vertebral height in T9 and T10 was seen (Figure 1 AbstractThe incidence of vertebral fractures in patients with osteoporosis is frequent. In elderly patients, the presence of vertebral fracture without history of trauma may be present. In addition, previous diagnosis of tumor pathology raises the suspicion of metastatic disease. The presence of known or unknown primary tumor raises the need for a correct diagnosis to tailor the best treatment. Mechanical pain and neurological compression have been described in both cases. Imaging tests, x-rays, CT and MRI may help the diagnosis. The existence of prior known tumor may not require the need of previous biopsy. Treatment can range from conservative treatment with bracing and analgesia, reinforcement techniques or decompression and stabilization in deformity or neurological deficit.

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“…20,31 Among these approaches, the FPSs augmented by PMMA has achieved the highest fixation strength and best clinical outcomes 1,26 . However, disadvantages remain, such as bone-cement leakage, 3 exothermic damage, 19,28 and pulmonary embolism.…”

Section: 26mentioning

confidence: 99%

Augmented PMMA distribution: improvement of mechanical property and reduction of leakage rate of a fenestrated pedicle screw with diameter-tapered perforations

Tan

Peng

et al. 2016

SPI

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OBJECTIVE This study investigated the optimum injection volume of polymethylmethacrylate (PMMA) to augment a novel fenestrated pedicle screw (FPS) with diameter-tapered perforations in the osteoporotic vertebral body, and how the distribution characteristics of PMMA affect the biomechanical performance of this screw. METHODS Two types of FPSs were designed (FPS-A, composed of 6 perforations with an equal diameter of 1.2 mm; and FPS-B, composed of 6 perforations each with a tapered diameter of 1.5 mm, 1.2 mm, and 0.9 mm from tip to head. Each of 28 human cadaveric osteoporotic vertebrae were randomly assigned to 1 of 7 groups: FPS-A1.0: FPS-A+1.0 ml PMMA; FPS-A1.5: FPS-A+1.5 ml PMMA; FPS-A2.0: FPS-A+2.0 ml PMMA; FPS-B1.0: FPS-B+1.0 ml PMMA; FPS-B1.5: FPS-B+1.5 ml PMMA; FPS-B2.0: FPS-B+2.0 ml PMMA; and conventional pedicle screws (CPSs) without PMMA. After the augmentation, 3D CT was performed to assess the cement distribution characteristics and the cement leakage rate. Axial pullout tests were performed to compare the maximum pullout force thereafter. RESULTS The CT construction images showed that PMMA bone cement formed a conical mass around FPS-A and a cylindrical mass around FPS-B. When the injection volume was increased from 1.0 ml to 2.0 ml, the distribution region of the PMMA cement was enlarged, the PMMA was distributed more posteriorly, and the risk of leakage was increased. When the injection volume reached 2.0 ml, the risk of cement leakage was lower for screws having diameter-tapered perforations. The pullout strengths of the augmented FPS-A groups and FPS-B groups were higher than that of the CPS group (p < 0.0001). All FPS-B groups had a higher pullout strength than the FPS-A groups. CONCLUSIONS The diameter of the perforations affects the distribution of PMMA cement. The diameter-tapered design enabled PMMA to form larger bone-PMMA interfaces and achieve a relatively higher pullout strength, although statistical significance was not reached. Study results indicated 1.5-ml of PMMA was a conservative volume for PMMA augmentation; more cement injection would significantly increase the risk of cement leakage.

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Polymethylmethacrylate Augmentation of Pedicle Screws Increases the Initial Fixation in Osteoporotic Spine Patients

Abstract: Reinforcement of pedicle screws using PMMA augmentation may be a feasible surgical technique for osteoporotic spines.

Cited by 118 publications

References 0 publications

Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model

Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model

Management of Non-traumatic Thoracics Vertebral Fractures in Elderly Female with Previous Malignant Tumor

Augmented PMMA distribution: improvement of mechanical property and reduction of leakage rate of a fenestrated pedicle screw with diameter-tapered perforations

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