Tips and tricks for using cement augmentation of pedicle screws and vertebral body replacements-A literature review supported by two case reports.

Background: The prevalence of osteoporosis is escalating alongside an aging global population, increasing the demand for spinal surgeries, including those necessitating cement augmentation for enhanced construct stability.

Objective: This article delves into the nuanced application of cement augmentation techniques for pedicle screws and vertebral body replacements (VBR), aimed at optimizing surgical outcomes in osteoporotic spines.

Method: Drawing from a comprehensive literature review according to important clinical and biomechanical studies and the authors' clinical experiences, we elucidate strategies to mitigate complications and improve surgical efficacy.

Tips and tricks for using cement augmentation of pedicle screws and vertebral body replacements-A literature review supported by two case reports.

Background: The prevalence of osteoporosis is escalating alongside an aging global population, increasing the demand for spinal surgeries, including those necessitating cement augmentation for enhanced construct stability.

Objective: This article delves into the nuanced application of cement augmentation techniques for pedicle screws and vertebral body replacements (VBR), aimed at optimizing surgical outcomes in osteoporotic spines.

Method: Drawing from a comprehensive literature review according to important clinical and biomechanical studies and the authors' clinical experiences, we elucidate strategies to mitigate complications and improve surgical efficacy.

Severity of spinal degeneration does not affect the pain reduction under continuous epidural analgesia.

Purpose: To outline clinical effectiveness of continuous epidural analgesia (CEA) in patients with failed back surgery syndrome (FBSS) or lumbar spinal stenosis (LSS) depending on severity of spinal degeneration.

Methods: In this retrospective cohort study, all patients with FBSS or LSS who underwent CEA within an inpatient rehabilitation program were evaluated. The pain reduction was measured by VAS on an hourly basis.

Biomechanical comparison of different rod-to-rod connectors to a conventional titanium- and cobalt chromium posterior spinal fixation system.

Introduction: Several types of rod-to-rod connectors are available for the extension of spinal fixation systems. However, scientific literature regarding the mechanical performance of different rod-to-rod connector systems is lacking.

Research Question: The goal of this study was to evaluate the mechanical characteristics of axial and lateral rod connectors in comparison to a conventional pedicle screw rod (titanium and cobalt chromium) construct.

Impact of Obesity on Perioperative Complications on Treatment of Spinal Metastases: A Multicenter Surveillance Study from the German Spine Registry (DWG-Register).

 The spine is a common location for the development of primary and metastatic tumors, spinal metastases being the most common tumor in the spine. Spinal surgery in obesity is challenging due to difficulties with anesthesia, intravenous access, positioning, and physical access during surgery. The objective was to investigate the effect of obesity on perioperative complications by discharge in patients undergoing surgery for spinal metastases.

Operative results of AO A3 and A4 traumatic injuries in the thoracic and lumbar spine. A multicenter surveillance study of 4230 patients from the German Spine Registry (DWG-Register).

Background: The diagnosis, classification and treatment of thoracolumbar burst fractures, continue to be controversial. Surgery is generally the preferred treatment for unstable fractures while stable fractures are managed conservatively. This study aims to describe surgical procedures, outcomes, complications, demography, clinical features and differences between A3 and A4 fractures (AO classification) of the thoracolumbar region.

Feasibility of continuous epidural analgesia in patients with failed back surgery syndrome and spinal stenosis.

Purpose: The purpose of this study was to outline the feasibility of continuous epidural analgesia in the treatment of failed back surgery syndrome (FBSS) or spinal stenosis.

Methods: We queried our prospective collected institutional database to include all consecutive patients, who underwent continuous epidural analgesia with accompanying intensive physiotherapeutic exercise within a timeframe of 4 years. Patients suffered from FBSS or spinal stenosis; protocolled continuous epidural analgesia was planned for 4 days within the framework of an inpatient multimodal pain therapy concept.

The effect of cement augmentation on pedicle screw fixation under various load cases : results from a combined experimental, micro-CT, and micro-finite element analysis.

Aims: Anchorage of pedicle screw rod instrumentation in the elderly spine with poor bone quality remains challenging. Our study aims to evaluate how the screw bone anchorage is affected by screw design, bone quality, loading conditions, and cementing techniques.

Methods: Micro-finite element (µFE) models were created from micro-CT (μCT) scans of vertebrae implanted with two types of pedicle screws (L: Ennovate and R: S).

Georg Schmorl Prize of the German Spine Society (DWG) 2020: new biomechanical in vitro test method to determine subsidence risk of vertebral body replacements.

Purpose: Prevention of implant subsidence in osteoporotic (thoraco)lumbar spines is still a major challenge in spinal surgery. In this study, a new biomechanical in vitro test method was developed to simulate patient activities in order to determine the subsidence risk of vertebral body replacements during physiologic loading conditions.

Methods: The study included 12 (thoraco)lumbar (T11-L1, L2-L4) human specimens.

A Prospective, Randomized Study Evaluating Clinical and Radiographic Efficacy of Lumbar Interbody Fusion Performed Using a Truss Technology-Based Interbody Fusion Device With Homologous Bone or Bone Marrow Aspirate.

Background: Our group used vertebral bone marrow aspirate (BMA) with an anterior truss-based interbody implant to promote fusion. This implant has biomechanical characteristics that may enhance bone on-growth and through-growth and allow for the use of BMA clot alone. The primary end point was comparison of the proportion of patients who achieved fusion with the implant packed with either crushed cancellous homologous bone chips (CCB) alone or with BMA clot alone.

Management of Deep Spinal Wound Infections Following Instrumentation Surgery with Subfascial Negative Pressure Wound Therapy.

Background And Study Aims:  The treatment of infections following a spine surgery continues to be a challenge. Negative pressure wound therapy (NPWT) has been an effective method in the context of infection therapy, and its use has gained popularity in recent decades. This study aims to analyze the impact of known risk factors for postoperative wound infection on the efficiency and length of NPWT therapy until healing.

Intra- and postoperative complications in the treatment of spinal metastases . A multicenter surveillance study from the German Spinal Registry (DWG-Register).

Background: The incidence of spinal column tumors is estimated to be 0.62 per 100,000 individuals in the USA. It is especially important to understand the incidence and predictive factors for adverse events of surgery in spinal oncology patients, as a single complication may be associated with morbidity, mortality, and costs.

Carbon fiber-reinforced pedicle screws reduce artifacts in magnetic resonance imaging of patients with lumbar spondylodesis.

The study investigated whether the use of carbon fiber-reinforced PEEK screw material (CF-PEEK) can reduce magnetic resonance imaging (MRI) artifact formation. Two consecutive groups of patients were treated for degenerative spinal disorders of the lumbar spine with dorsal transpedicular spinal fusion. The first group (n = 27) received titanium pedicle screws.

There is no difference in perioperative results between posterior instrumentation with and without interbody cage and debridement in primary spondylodiscitis in adults: a multicenter surveillance study from the German Spine Registry (DWG Register).

Background: Primary spondylodiscitis is a medically challenging disease that can lead to recurrent back pain, progressive kyphotic deformity, and neurologic deficits. The incidence rate of primary non-tuberculosis spondylodiscitis has been estimated from 2.2 to 2.

Development and current use of local antibiotic carriers in spondylodiscitis : Pilot study on reduction of duration of systemic treatment.

Background: The current study situation regarding the duration of systemic antibiotic treatment for spondylodiscitis is inhomogeneous and varies between 4-12 weeks. Due to the many undesirable side effects the aim is to achieve complete healing without recurrence or hematogenous scatter within the shortest possible period of time. The present pilot study investigated whether the additional application of a local antibiotic carrier to the surgically treated intervertebral disc space can contribute to a further reduction of treatment duration.

Invasiveness has no influence on the rate of incidental durotomies in surgery for multisegmental lumbar spinal canal stenosis (≥3 levels) with and without fusion: analysis from the German Spine Registry data (DWG-Register).

Background: Nowadays, perioperative complications as dural tear (DT) with subsequent neurological deficits are documented in independent registers. However, the relationship of these complications with the grade of invasiveness (≥3 levels) is still unclear. The aim of this study was to evaluate perioperative complications, particularly DT with subsequent neurological deficits, between patients undergoing laminotomy and decompression and decompression and fusion in ≥3 levels.

[The importance of interspinous spacers in the treatment of lumbar spinal stenosis].

Introduction: In the treatment of lumbar spinal stenosis, interspinous spacers can be used in a tissue and time sparing technique. Relief of low back pain might be achieved by stress reduction of facet joints and limitation of segmental mobility.

Aim: Presentation of dynamic stabilization by means of an interspinous spacer with and without decompression and to compare it with the outcome of decompression and fusion.

[Lumbar spinal canal stenosis : A historical perspective].

To know the history of a disease and its treatment is always instructive and helps us to understand the contexts better. It also shows what unbelievable preliminary work was necessary for us be able to treat patients today in the way we are used to. This article attempts to shed light on spinal canal stenosis from a historical perspective and to identify the pioneers who contributed to the understanding of the epidemiology, anatomy, pathogenesis, classification and diagnostic work-up of spinal canal stenosis.

[Lumbar synovial cysts: literature review and original long-term results after microsurgical resection].

Background: Intraspinal lumbar vertebral joint cysts are an unusual cause of nerve root compression symptoms and do not differ clinically from the symptoms of a herniated disc.

Pathogenesis: The cysts originate from the small vertebral joints and, depending on their size, compress the nerval structures. The affected vertebral joints typically show activated arthritic circumstances, which are associated with degenerative spondylolisthesis in about 50% of cases.

[Classification and diagnosis of lumbar spinal stenosis].

Background: Lumbar spinal stenosis is caused by various pathological conditions. With the diagnostic tools available, a precise classification of the condition should be made, which enables a consistent and appropriate therapeutic approach.

Objectives: In the present article, the currently used classifications of lumbar spinal stenosis are discussed and the diagnostic tools are presented, focussing on the imaging descriptions of morphological changes.

Clinical Outcome After Anterior Lumbar Interbody Fusion With a New Osteoinductive Bone Substitute Material: A Randomized Clinical Pilot Study.

Study Design: Pilot, single-center, single-blinded, parallel-group, randomized clinical study.

Objective: The aim of this study was to pilot a randomized clinical study to evaluate whether instrumented anterior lumbar interbody fusion (ALIF) with a new nanocrystalline hydroxyapatite embedded in a silica gel matrix (NH-SiO2) leads to superior radiologic and clinical outcomes at 12-month follow-up compared with instrumented ALIF with homologous bone.

Summary Of Background Data: ALIF completed with interbody cages is an established technique for performing arthrodesis of the lumbar spine.

Radiological evaluation of kyphoplasty with an intravertebral expander after osteoporotic vertebral fracture.

Spinal deformities due to osteoporotic vertebral compression fractures can be reduced by balloon kyphoplasty, but the correction may be partly lost when the balloon is deflated. The present study aimed to evaluate an intravertebral expander developed to reduce and maintain vertebral body height while cement is injected to correct spinal deformities due to osteoporotic vertebral fractures. The study included 31 osteoporotic vertebral body fractures in 31 patients, classified as A1 according to the AO classification, who underwent kyphoplasty using an intravertebral expander.