Polymethylmethacrylate-Augmented Screw Fixation for Stabilization of the Osteoporotic Spine : A Three-Year Follow-Up of 37 Patients

Moon, Bong Ju; Cho, Bo Young; Choi, Eun Young; Zhang, Ho Yeol

doi:10.3340/jkns.2009.46.4.305

Cited by 81 publications

(70 citation statements)

References 43 publications

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“…9,22,24,32,36,44,48,49 The reason for high leakage rates in cadaver models might be the missing venous counter-pressure, 6 but this does not explain high leakage rates during surgery. The amount of applied cement in the literature varies between 1.8 ml and 2.9 ml per screw, 18,35 which is comparable to the amount used in the present study. Biomechanical capacity would not increase after raising the application above 2.8 ml per screw.…”

Section: 4%supporting

confidence: 61%

Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws

Mueller

Baldauf

Marx

et al. 2016

SPI

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OBJECTIVE Loosening and pullout of pedicle screws are well-known problems in pedicle screw fixation surgery. Augmentation of pedicle screws with bone cement, first described as early as 1975, increases the pedicle-screw interface and pullout force in osteoporotic vertebrae. The aim of the present study was to identify cement leakage and pulmonary embolism rates in a large prospective single-center series of pedicle screw augmentations. METHODS All patients who underwent cement-augmented pedicle screw placement between May 2006 and October 2010 at the authors' institution were included in this prospective cohort study. Perivertebral cement leakage and pulmonary cement embolism were evaluated with a CT scan of the area of operation and with a radiograph of the chest, respectively. RESULTS A total of 98 patients underwent placement of cement-augmented pedicle screws; 474 augmented screws were inserted in 237 vertebrae. No symptomatic perivertebral cement leakage or symptomatic pulmonary cement embolism was observed, but asymptomatic perivertebral cement leakage was seen in 88 patients (93.6%) and in 165 augmented vertebrae (73.3%). Cement leakage most often occurred in the perivertebral venous system. Clinically asymptomatic pulmonary cement embolism was found in 4 patients (4.1%). CONCLUSIONS Perivertebral cement leakage often occurs in pedicle screw augmentation, but in most cases, it is clinically asymptomatic. Cement augmentation should be performed under continuous fluoroscopy to avoid high-volume leakage. Alternative strategies, such as use of expandable screws, should be examined in more detail for patients at high risk of screw loosening.

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Section: 4%supporting

confidence: 61%

Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws

Mueller

Baldauf

Marx

et al. 2016

SPI

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“…The cement leakage was directly related to the volume of PMMA. A literature review indicated that the volume of PMMA used to augment the FPS ranges from 1.5 to 3.0 ml in clinical practice, 1,7,14,17,21,24 and the reported leakage rate of these clinical trials ranged from 0% to 23.8%. In the present study, 1.0, 1.5, and 2.0 ml of PMMA were chosen to investigate the optimal volume of PMMA for augmentation.…”

Section: Discussionmentioning

confidence: 99%

“…1,7,14,17,21,24 The main difference among these FPSs is the number of side perforations. Regardless of the different number of perforations, the pullout strength of PMMA-augmented FPSs is greater than that of nonaugmented conventional screws 3,5,9,10,12,26 or cannulated screws 8,16,18 in the osteoporotic condition.…”

Section: Discussionmentioning

confidence: 99%

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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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“…Several methods for enhancing the strength of pedicle screw fixation have been proposed, including using PMMAaugmented or expandable screws. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]42 However, the low osteoporotic bone quality can lead to less than ideal effects of augmentation. Nevertheless, using PMMA-augmented pedicle screws is considered to be a precise and effective method.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical and finite element analyses of bone cement‐Injectable cannulated pedicle screw fixation in osteoporotic bone

Liu

Sun

et al. 2015

J Biomed Mater Res

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The objectives of this study were to investigate the safety and biomechanical stability of a polymethylmethacrylate (PMMA)-augmented bone cement-injectable cannulated pedicle screw (CICPS) in cancellous bone model, and to analyze the stress distribution at the screw-cement-bone interface. The OMEGA cannulated pedicle screw (OPS) and conventional pedicle screw (CPS) were used as control groups. Safety of the CICPS was evaluated by the static bending and bending fatigue tests. Biomechanical stability was analyzed by the maximum axial pullout strength and maximum torque tests. Stress distribution at the screw-cement-bone interface was analyzed by the finite element (FE) method. The CICPS and CPS produced statistically similar values for bending stiffness, bending structural stiffness, and bending yield moment. The maximum pullout force was 53.47 ± 8.65 N in CPS group, compared to 130.82 ± 7.32 N and 175.45 ± 43.01 N in the PMMA-augmented OPS and CICPS groups, respectively (p < 0.05). The CICPS had a significantly greater torque than the OPS and CPS. The FE model did not reveal excessive stress at the screw-cement-bone interface in the CICPS group. In conclusion, PMMA-augmentation with CICPS may be a potentially useful method to increase the stability of pedicle screws in patients with osteoporosis. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 960-967, 2016.

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Polymethylmethacrylate-Augmented Screw Fixation for Stabilization of the Osteoporotic Spine : A Three-Year Follow-Up of 37 Patients

Cited by 81 publications

References 43 publications

Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws

Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws

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

Biomechanical and finite element analyses of bone cement‐Injectable cannulated pedicle screw fixation in osteoporotic bone

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