Study Design: Experimental, human cadaveric study.
Objective: To assess the fixation effects of injecting cement augmentation before screw insertion or after insertion of fenestrated screws; the effect of modulating cement viscosity; and the effects of these techniques on screw removal.
Summary Of Background Data: It seems clear that cement augmentation can enhance pedicle screw fixation in osteoporotic bone. What remains to be demonstrated is the aspects of optimal technique such that fixation is enhanced with the greatest safety profile.
Methods: Part I: Human osteoporotic vertebrae were instrumented with solid (nonaugmented) screws, solid screws with polymethylmethacrylate (PMMA), partially cannulated fenestrated (Pfen) screws, or fully cannulated fenestrated (Ffen) screws through which PMMA was injected. Screw fixation was tested in pullout. Part II: Ffen screws were augmented with standard low-viscosity PMMA versus high-viscosity PMMA. Part III: Sample cohorts were extracted from vertebrae to assess required torque and characterize difficulty of extraction.
Results: Part I: Pfen screws demonstrated the greatest fixation with mean failure force of 690 ± 182 N. All methods of cement augmentation demonstrated significant increases in screw fixation. Part II: Ffen screws did not demonstrate a significant difference in pullout strength when high-viscosity PMMA was used as compared with low-viscosity PMMA. Part III: Mean extraction torque values for solid augmented screws, Ffen screws, and Pfen screws were 1.167, 1.764, and 1.794 Nm, respectively, but these differences did not reach significance. None of the osteoporotic vertebrae sustained catastrophic failure during augmented screw extraction.
Conclusion: Polymethylmethacrylate cement augmentation clearly enhances pedicle screw fixation in osteoporotic vertebrae when tested in pure pullout. The technique used for cement injection and choice of specialty screws can have a significant impact on the magnitude of this effect. Fenestrated screws have the capacity to confine cement placement in the vertebral body and may provide enhanced safety from cement extrusion into the spinal canal. It is feasible to inject high-viscosity PMMA through this fenestration geometry, and higher-viscosity cement may enhance the fixation effect.
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http://dx.doi.org/10.1097/BRS.0b013e3182740e56 | DOI Listing |
J Formos Med Assoc
January 2025
Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University Cancer Center, Taipei, Taiwan.
Background And Purpose: Dual-energy computed tomography (DECT) pulmonary angiography can reliably detect cement pulmonary embolisms (CPEs) and parenchymal perfusion defects. This prospective observational study investigated CPEs in asymptomatic patients using DECT.
Methods: We enrolled 42 patients who underwent vertebroplasty or received cement screws for vertebral augmentation, examining them using spinal computed tomography and DECT pulmonary angiography.
Arthroplast Today
February 2025
Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, USA.
Management of periacetabular osteolysis is a challenging dilemma in revision total hip arthroplasty. When the acetabular shell is well-fixed, the surgeon may prefer to retain the cup to minimize further bone loss. However, filling the surrounding defect can be difficult if the area of involvement is massive.
View Article and Find Full Text PDFUnfallchirurgie (Heidelb)
January 2025
Klinik für Unfallchirurgie, Orthopädie, Hand- & Wiederherstellungschirurgie, München Klinik Harlaching, München, Deutschland.
Osteoporosis-related vertebral fractures are among the most frequent fracture entities in geriatric patients. They are associated with far-reaching individual and socioeconomic consequences. Adequate diagnostics and treatment are therefore essential.
View Article and Find Full Text PDFZhongguo Gu Shang
January 2025
Department of Orthopaedics, Sir Run Run Shaw Hospital, Hangzhou 310016, Zhejiang, China.
Objective: To observe the clinical outcomes of anterior approach for the revision surgery following unsuccessful bone cement augmentation in osteoporotic vertebral compression fractures.
Methods: A total of 10 patients who experienced unsuccessful bone cement augmentation underwent anterior revision surgery between January 2020 and December 2021. There were 2 males and 8 females.
Surg Pract Sci
December 2024
Spine Surgery Department, Vietduc University Hospital, Viet Nam.
This descriptive longitudinal study aims to assess the risk factors for severe thoracic and lumbar vertebral compression fractures before and after surgery, contributing to preventive knowledge enhancement in communities and effective treatment management. The study involved 34 patients diagnosed with thoracic and lumbar vertebral compression fractures requiring surgery with bio-cement-augmented pedicle screws between June 2021 and June 2022. Postoperative complications, notably adjacent segment injury, were monitored, and patients received osteoporosis management post-surgery.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!