Bruce M Frankel1, Tanya Jones, Chiang Wang. 1. Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA. frankel@musc.edu
Abstract
OBJECTIVE: Instrumentation of the osteoporotic spine may result in bone failure because of pedicle screw loosening and pullout. A clinical evaluation of a novel fenestrated bone tap used in pedicle screw augmentation was performed to determine the performance and safety of this technique. METHODS: Over a 2.5-year period, the clinical and radiographic results of 119 consecutive patients who underwent instrumented arthrodesis were reviewed. Of these patients, 23 had bone softening secondary to osteoporosis and/or metastatic spinal tumor involvement. These patients underwent surgical decompression and spinal instrumentation. RESULTS: Six patients (26%) had metastatic spine disease (squamous cell lung carcinoma, renal cell carcinoma, bladder carcinoma, breast, prostate, and uterine adenocarcinoma); five patients (22%) had a degenerative spondylolisthesis; and 12 patients (52%) had burst fractures, eight as a result of benign causes and four as a result of metastatic disease. Four (17%) patients underwent revision surgery of previous pedicle screw failure resulting from bone softening and pseudarthrosis. A total of 98 levels were fused using 158 polymethylmethacrylate-augmented screws. None of the patients experienced operative death, myocardial infarction, hypoxemia, intraoperative hypotension, radiculopathy, or myelopathy. Asymptomatic anterior cement extravasation was observed in nine patients (39%). There was one asymptomatic polymethylmethacrylate pulmonary embolus and one wound infection. There was no significant relationship between cement extravasation and the quantity used, levels augmented, or location (P > 0.05). There were no construct failures. CONCLUSION: Polymethylmethacrylate-augmented pedicle screw fixation reduces the likelihood of pedicle screw loosening and pullout in patients with osteoporosis requiring instrumented arthrodesis.
OBJECTIVE: Instrumentation of the osteoporotic spine may result in bone failure because of pedicle screw loosening and pullout. A clinical evaluation of a novel fenestrated bone tap used in pedicle screw augmentation was performed to determine the performance and safety of this technique. METHODS: Over a 2.5-year period, the clinical and radiographic results of 119 consecutive patients who underwent instrumented arthrodesis were reviewed. Of these patients, 23 had bone softening secondary to osteoporosis and/or metastatic spinal tumor involvement. These patients underwent surgical decompression and spinal instrumentation. RESULTS: Six patients (26%) had metastatic spine disease (squamous cell lung carcinoma, renal cell carcinoma, bladder carcinoma, breast, prostate, and uterine adenocarcinoma); five patients (22%) had a degenerative spondylolisthesis; and 12 patients (52%) had burst fractures, eight as a result of benign causes and four as a result of metastatic disease. Four (17%) patients underwent revision surgery of previous pedicle screw failure resulting from bone softening and pseudarthrosis. A total of 98 levels were fused using 158 polymethylmethacrylate-augmented screws. None of the patients experienced operative death, myocardial infarction, hypoxemia, intraoperative hypotension, radiculopathy, or myelopathy. Asymptomatic anterior cement extravasation was observed in nine patients (39%). There was one asymptomatic polymethylmethacrylatepulmonary embolus and one wound infection. There was no significant relationship between cement extravasation and the quantity used, levels augmented, or location (P > 0.05). There were no construct failures. CONCLUSION:Polymethylmethacrylate-augmented pedicle screw fixation reduces the likelihood of pedicle screw loosening and pullout in patients with osteoporosis requiring instrumented arthrodesis.
Authors: Ori Barzilai; Lily McLaughlin; Eric Lis; Anne S Reiner; Mark H Bilsky; Ilya Laufer Journal: Oper Neurosurg (Hagerstown) Date: 2019-05-01 Impact factor: 2.703
Authors: Norman A Johanson; Jody Litrenta; Jay M Zampini; Frederic Kleinbart; Haviva M Goldman Journal: Clin Orthop Relat Res Date: 2011-08 Impact factor: 4.176
Authors: Ori Barzilai; Ilya Laufer; Adam Robin; Ran Xu; Yoshiya Yamada; Mark H Bilsky Journal: Oper Neurosurg (Hagerstown) Date: 2019-03-01 Impact factor: 2.703