Pulmonary cement embolism following cement-augmented fenestrated pedicle screw fixation in adult spinal deformity patients with severe osteoporosis (analysis of 2978 fenestrated screws)

Ulusoy, Onur Levent; Kahraman, Sinan; Karalök, Işık; Kaya, Emel; Enercan, Meriç; Sever, Cem; Abay, Burak; Karadereler, Selhan; Hamzaoğlu, Azmi

doi:10.1007/s00586-018-5593-1

Cited by 45 publications

(41 citation statements)

References 22 publications

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“…Methods to reduce CL in LDD include: (1) Using high viscosity cement or toothpaste viscosity cement [28]. (2) Reducing the volume of cement and the number of augmented screws [29,30]. Experimental studies have indicated that the screw stability does not significantly improve when the volume of PMMA exceeded 2.8 ml each screw [25].…”

Section: Discussionmentioning

confidence: 99%

The effect and potential risks of using multilevel cement-augmented pedicle screw fixation in osteoporotic spine with lumbar degenerative disease

Tang

Guo

et al. 2020

Preprint

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Background: The effect and potential risks of CAPSI on osteoporotic lumbar degenerative disease (LDD) have not been investigated in the cases of multilevel fixation. This study was to investigate potential complications of using multilevel cement-augmented pedicle screws fixation (three or four levels) and its effectiveness of this method on treating LDD with low bone quality. Methods: A total of 93 patients with multilevel LDD were divided into the CAPSI group (46 subjects) and the CPS group (47 subjects), including 75 cases for three levels, 18 cases for four levels, and the average follow-up was 33.72±18.78 months (range: 24-108). Relevant data were recorded, including age, gender, body mass index (BMI), bone mineral density (BMD), diagnosis, fusion methods, bone graft, fusion level, lumbosacral fixation, different patterns of S1 pedicle screw placement, operation time, blood loss, hospital stay, perioperative complications, CL, pulmonary cement embolism (PCE), screw loosening, and nonunion patients. Furthermore, we also measured the VAS and ODI at pre-operation, post-operation, and follow-up time points. Results: In the CAPSI group, a total of 336 augmented screws was placed bilaterally, and the average injection dose of bone cement was 1.85±0.65 ml (range: 1-4). The CL was observed in 44 patients (95.65%) and 116 screws (34.52%). And in the CPS group, seventeen patients (36.17%) and thirty-three screws (8.46%) suffered loosening in cranial or caudal vertebra (seven cranial cases and twenty-six of caudal), four cases experienced nonunion, and thus the fusion rate was 91.49% in total. The operation time and hospital stay of CAPSI group were longer than the CPS group, but CAPSI group has a lower screw loosening percentage ( P ＜0. 05). And in terms of blood loss, perioperative complications, fusion rate, VAS and ODI scores at the follow-up times, there were no significant differences between two groups. Conclusions: Patients with osteoporotic LDD underwent multilevel CPS fixation have a higher rate of screw loosening in cranial and caudal vertebra. The application of cemented pedicle screws for multilevel LDD can achieve better stability and less screw loosening, but it also accompanied by longer operating time, higher incidence of CL, PCE and wound infections.

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Section: Discussionmentioning

confidence: 99%

The effect and potential risks of using multilevel cement-augmented pedicle screw fixation in osteoporotic spine with lumbar degenerative disease

Tang

Guo

et al. 2020

Preprint

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“…(2) Reducing the volume of cement and the number of augmented screws. The large volume of bone cement and augmented screw resulting in increasing possibility of secondary venous wall rupture and cement pressed in [29,30]. Experimental studies also have indicated that the screw stability doesn't significantly improve with the volumes of PMMA above 2.8 ml each screw [25].…”

Section: Discussionmentioning

confidence: 99%

The effect and potential risks of using cement-augmented pedicle screw instrumentation on multiple segment fixation in osteoporotic spine with lumbar degenerative diseases

Tang¹,

Guo²,

Guo³

et al. 2020

Preprint

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Background: Cement-augmented pedicle screw instrumentation (CAPSI) has been found to significantly increase the pedicle screws anchorage in the osteoporotic vertebral body, however, with the increase of augmented level and bone cement dose, the incidence of cement leakage (CL) or side complication of CAPSI also increased. But the effect and potential risks of CAPSI for osteoporotic lumbar degenerative diseases (LDD) have not been investigated in the cases of multiple segment fixation. The purpose of this study was to investigate potential complications of using cement-augmented screws for multilevel fixation (three or four levels) and the effectiveness of this method for treating LDD with low bone quality.Methods: Our clinical database was reviewed for osteoporotic patients who using CAPSI or conventional pedicle screw (CPS) for multilevel fixation (three or four levels) between February 2010 to February 2017. A total of 93 patients with multilevel LDD were divided into the CAPSI group (46 subjects) and the CPS group (47 subjects), including 75 cases for three levels (L2-L5 21 cases、L3-S1 54 cases), 18 cases for four levels (L1-L5 2 cases、L2-S1 16 cases), and the average follow-up was 33.72±18.78 months (range: 24-108). Relevant data were recorded, including age, gender, body mass index (BMI), bone mineral density (BMD), diagnosis, fusion methods, bone graft, fusion level, lumbosacral fixation, different patterns of S1 pedicle screw placement, operation time, blood loss, hospital stay, complications, CL, pulmonary cement embolism (PCE), screw loosening and nonunion patients. Besides, the visual analogue scale (VAS) and Oswestry disability index (ODI) at pre-operation, post-operation, and follow-up were also assessed.Results: In the CAPSI group, a total of 336 augmented screws were placed bilaterally, and the average injection dose of bone cement was 1.85±0.65 ml (range: 1-4). The CL was observed in 44 patients (95.65%) and 116 screws (34.52%). Three cemented screws (0.89%) and twenty-four S1 conventional screws (44.44%) were found loosening during the follow-up and the overall fusion rate was 93.47%. For perioperative complications, two patients (4.35%) experienced PCE, one patient augmented vertebral fracture and three patients (6.52%) wound infection. And in the CPS group, seventeen patients (36.17%) and thirty-three screws (8.46%) suffered loosening in cranial or caudal segments (seven cranial cases and twenty-six of caudal), four cases experienced nonunion, the fusion rate was 91.49% in total. The operation time and hospital stay were longer in CAPSI group, but with a lower percentage of screw loosening (P＜0. 05). And in terms of blood loss, perioperative complications, fusion rate, VAS and ODI scores at the follow-up times, no significant differences were found between the two groups.Conclusions: Patients with osteoporotic LDD underwent CPS at multiple segments have a high rate of screw loosening in the cranial and caudal segment. The application of cemented pedicle screws on multilevel LDD can achieve better stability and less screw loosening, but it also accompanied by longer operating time, higher incidence of CL, PCE and wound infections. Selective cement-augmenting the cranial and caudal pedicle screws may be a worthy strategy to decrease the complications.

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“…In surgical treatment of patients with osteoporosis, cement-augmented fenestrated pedicle screw (CAFPS) had been safely used 15,21 . CAFPS could provide comparable screw stability to solid pedicle screws augmented with high-viscosity cement 22 .…”

Section: Discussionmentioning

confidence: 99%

“…After con rmation of all screws position via AP and lateral uoroscopy, cement augmentation was performed via cement delivery cannulas. In all cases of group A, the same polymethylmethacrylate (PMMA) bone cement was applied in a standard fashion as described by previous report 15 . UIV and LIV of all patients were xed with CAFPS and other surgical segments were xed using conventional pedicle screws or CAFPS according to intraoperative assessment of poor bone quality.…”

Section: Surgical Protocol Of Group Amentioning

confidence: 99%

The Role of Prophylactic Vertebroplasty at UIV+1 and Cement-augmented Fenestrated Pedicle Screw for Prevention of PJK/PJF  in Patients With Osteoporosis: A Propensity Score–matched Analysis

Wang

et al. 2020

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Objective: To elucidate the role of prophylactic vertebroplasty (PV) at UIV+1 and cement-augmented fenestrated pedicle screw (CAFPS) in prevention of PJK and PJF.Background: Cement augmentation at UIV and UIV+1 was found to prevent PJK and PJF. But most studies are retrospective and have a selection bias due to multifactorial etiology of PJF, making it difficult to identify the efficacy of prophylactic cement augmentation. Methods: We enrolled 208 surgically treated adult spinal deformity (ASD) patients who were followed for at least 2 years, to elucidate whether prophylactic cement augmentation was truly minimizing the risk of PJK and PJF in a uniform population from one center database. Patients were classified into two groups. Two comparable groups were propensity-matched with one to one nearest neighbor matching. The main outcome variables including PJK, PJF, pedicle screw loosening and cement leakage were compared.Results：After propensity score matching, there were 58 propensity-matched patients in group A and B (n=29 in each group) whose parameters including age, BMI, BMD, number of instrumented vertebrae, SVA, spinal-pelvic parameters and the frequency of UIV and LIV were similar. The incidence of PJK showed no significantly statistical difference between group A and B (10.3% vs 13.8%, p >0.99). Compared to group A, group B had a higher proportion of patients developing PJF (24.1% vs 0%, p=0.01). Pedicle screw loosening at UIV and (or) LIV showed no difference (24.1% vs 3.4%, p=0.052) between two groups. In group A, cement leakage was detected in 5 cases via fluoroscopy, but none of them had neurological deficit or pulmonary cement embolism.Conclusion: Combined application of CAFPS and PV could reduce the incidence of PJF, but it could not prevent the development of PJK in the surgical management of ASD with low BMD or osteoporosis.

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Pulmonary cement embolism following cement-augmented fenestrated pedicle screw fixation in adult spinal deformity patients with severe osteoporosis (analysis of 2978 fenestrated screws)

Cited by 45 publications

References 22 publications

The effect and potential risks of using multilevel cement-augmented pedicle screw fixation in osteoporotic spine with lumbar degenerative disease

The effect and potential risks of using multilevel cement-augmented pedicle screw fixation in osteoporotic spine with lumbar degenerative disease

The effect and potential risks of using cement-augmented pedicle screw instrumentation on multiple segment fixation in osteoporotic spine with lumbar degenerative diseases

The Role of Prophylactic Vertebroplasty at UIV+1 and Cement-augmented Fenestrated Pedicle Screw for Prevention of PJK/PJF  in Patients With Osteoporosis: A Propensity Score–matched Analysis

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Pulmonary cement embolism following cement-augmented fenestrated pedicle screw fixation in adult spinal deformity patients with severe osteoporosis (analysis of 2978 fenestrated screws)

Cited by 45 publications

References 22 publications

The effect and potential risks of using multilevel cement-augmented pedicle screw fixation in osteoporotic spine with lumbar degenerative disease

The effect and potential risks of using multilevel cement-augmented pedicle screw fixation in osteoporotic spine with lumbar degenerative disease

The effect and potential risks of using cement-augmented pedicle screw instrumentation on multiple segment fixation in osteoporotic spine with lumbar degenerative diseases

The Role of Prophylactic Vertebroplasty at UIV+1 and Cement-augmented Fenestrated Pedicle Screw for Prevention of PJK/PJF&nbsp; in Patients With Osteoporosis: A Propensity Score–matched Analysis

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The Role of Prophylactic Vertebroplasty at UIV+1 and Cement-augmented Fenestrated Pedicle Screw for Prevention of PJK/PJF in Patients With Osteoporosis: A Propensity Score–matched Analysis