Fenestrated Pedicle Screws for Cement-augmented Purchase in Patients with Bone Softening: a Review of 21 Cases

Overview

Journal J Orthop Traumatol

Specialties Emergency Medicine
Orthopedics

Date 2011 Nov 9

PMID 22065147

Citations 44

Authors

Luca Amendola

Alessandro Gasbarrini

Matteo Fosco

Christiano Esteves Simoes

Silvia Terzi

Federico De Iure

Stefano Boriani

Affiliations

Soon will be listed here.

Abstract

Background: This prospective mixed cohort study was designed to evaluate the middle- to long-term purchase of cement-augmented pedicular screws in patients with poor bone quality. The growing number of surgical procedures performed in the spine has highlighted the problem of screws loosening in patients with poor bone stock due to osteoporosis and/or tumors. Different methods of increasing screw purchase have been reported in the literature, including polymethylmethacrylate (PMMA) augmentation.

Materials And Methods: From September 2006 to April 2008, 21 patients with a poor bone stock condition due to osteoporosis or tumor underwent posterior stabilization by fenestrated pedicle screws and PMMA augmentation. Pain improvement and long-term clinical outcome were assessed by visual analogue scale (VAS) score and SF-36 health survey (SF-36) questionnaire. Implant stability was evaluated by plain radiography and CT scans performed three days after surgery and every three months thereafter. After the first 12 months, radiologic controls were taken once a year in all surviving patients. Complications were evaluated in all cases.

Results: All patients were clinically and radiographically followed up for a mean of 36 months. VAS scores and SF-36 questionnaires showed a statistically significant reduction in pain and improvement in the quality of life. No radiological loosening or pulling out of screws was observed. In two cases, cement leakage occurred intraoperatively: one patient who suffered from a transitory nerve root palsy improved spontaneously, while the surgeon immediately removed the excess cement before setting in the other case. In three cases, the post-op CT scan revealed a small amount of cement in the canal without clinical relevance.

Conclusions: Fenestrated screws for cement augmentation provided effective and lasting purchase in patients with poor bone quality due to osteoporosis or tumors. No case of loosening was recorded after a mean follow-up of 36 months. The only clinical complication strictly related to PMMA screw augmentation did not require further surgery.

Citing Articles

How to Avoid and Handle Problems in the Placement of Cement-Augmented Fenestrated Percutaneous Pedicle Screws?.

Padilla-Lichtenberger F, Landriel F, Guiroy A, Casimiro M, Silva A, Hem S Neurosurg Pract. 2025; 5(4):e00106.

PMID: 39959538 PMC: 11809992. DOI: 10.1227/neuprac.0000000000000106.

Injectable bone cement cannulated pedicle screw for lumbar degenerative disease in osteoporosis - clinical follow-up of over 5 years.

Li C, Yang X, Wu W, Zhou R, Jiang Y, Xiao J J Orthop Surg Res. 2024; 19(1):440.

PMID: 39068450 PMC: 11282736. DOI: 10.1186/s13018-024-04934-2.

Effects of anti-osteoporosis treatment in elderly patients with osteoporosis and lumbar discectomy and fusion.

Shi T, Shou F, Xia Q, Zhang T, Teng D, Jing W J Back Musculoskelet Rehabil. 2024; 37(5):1277-1287.

PMID: 38607748 PMC: 11495323. DOI: 10.3233/BMR-230381.

Osteoporotic Burst Fracture in a Young Male Adult as First Presentation of a Rare PLS3 Mutation: A Case Report.

Nikolaou S, Chatzikomninos I, Palavos I, Langourani-Kosteletou P, Vitoula K Cureus. 2024; 15(12):e51264.

PMID: 38283430 PMC: 10822049. DOI: 10.7759/cureus.51264.

Application of cement-augmented pedicle screws in elderly patients with spinal tuberculosis and severe osteoporosis: a preliminary study.

Gao S, Hu Y, Mamat F, Liang W, Mamat M, Xun C J Orthop Surg Res. 2023; 18(1):624.

PMID: 37626361 PMC: 10463792. DOI: 10.1186/s13018-023-04099-4.

References

Hirano T, Hasegawa K, Washio T, Hara T, Takahashi H . Fracture risk during pedicle screw insertion in osteoporotic spine. J Spinal Disord. 1999; 11(6):493-7. View

Cook S, Salkeld S, Stanley T, Faciane A, Miller S . Biomechanical study of pedicle screw fixation in severely osteoporotic bone. Spine J. 2004; 4(4):402-8. DOI: 10.1016/j.spinee.2003.11.010. View

Frankel B, Dagostino S, Wang C . A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation. J Neurosurg Spine. 2007; 7(1):47-53. DOI: 10.3171/SPI-07/07/047. View

RISEBOROUGH E . Irradiation induced kyphosis. Clin Orthop Relat Res. 1977; (128):101-6. View

Frankel B, Jones T, Wang C . Segmental polymethylmethacrylate-augmented pedicle screw fixation in patients with bone softening caused by osteoporosis and metastatic tumor involvement: a clinical evaluation. Neurosurgery. 2007; 61(3):531-7. DOI: 10.1227/01.NEU.0000290899.15567.68. View

Cook S, Salkeld S, Whitecloud 3rd T, Barbera J . Biomechanical evaluation and preliminary clinical experience with an expansive pedicle screw design. J Spinal Disord. 2000; 13(3):230-6. DOI: 10.1097/00002517-200006000-00006. View

Cook S, Barbera J, Rubi M, Salkeld S, Whitecloud 3rd T . Lumbosacral fixation using expandable pedicle screws. an alternative in reoperation and osteoporosis. Spine J. 2003; 1(2):109-14. DOI: 10.1016/s1529-9430(01)00020-1. View

Renner S, Lim T, Kim W, Katolik L, An H, Andersson G . Augmentation of pedicle screw fixation strength using an injectable calcium phosphate cement as a function of injection timing and method. Spine (Phila Pa 1976). 2004; 29(11):E212-6. DOI: 10.1097/00007632-200406010-00020. View

Hasegawa T, Inufusa A, Imai Y, Mikawa Y, Lim T, An H . Hydroxyapatite-coating of pedicle screws improves resistance against pull-out force in the osteoporotic canine lumbar spine model: a pilot study. Spine J. 2005; 5(3):239-43. DOI: 10.1016/j.spinee.2004.11.010. View

10.

Turner A, Gillies R, Svehla M, Saito M, Walsh W . Hydroxyapatite composite resin cement augmentation of pedicle screw fixation. Clin Orthop Relat Res. 2003; (406):253-61. DOI: 10.1097/01.blo.0000030166.56585.66. View

11.

Rohmiller M, Schwalm D, Glattes R, Elalayli T, Spengler D . Evaluation of calcium sulfate paste for augmentation of lumbar pedicle screw pullout strength. Spine J. 2003; 2(4):255-60. DOI: 10.1016/s1529-9430(02)00207-3. View

12.

Fransen P . Increasing pedicle screw anchoring in the osteoporotic spine by cement injection through the implant. Technical note and report of three cases. J Neurosurg Spine. 2007; 7(3):366-9. DOI: 10.3171/SPI-07/09/366. View

13.

Polly Jr D, Orchowski J, Ellenbogen R . Revision pedicle screws. Bigger, longer shims--what is best?. Spine (Phila Pa 1976). 1998; 23(12):1374-9. DOI: 10.1097/00007632-199806150-00015. View

14.

Coe J, Warden K, Herzig M, McAfee P . Influence of bone mineral density on the fixation of thoracolumbar implants. A comparative study of transpedicular screws, laminar hooks, and spinous process wires. Spine (Phila Pa 1976). 1990; 15(9):902-7. DOI: 10.1097/00007632-199009000-00012. View

15.

Zindrick M, Wiltse L, Widell E, Thomas J, Holland W, Field B . A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine. Clin Orthop Relat Res. 1986; (203):99-112. View

16.

Nicoli Aldini N, Fini M, Giavaresi G, Giardino R, Greggi T, Parisini P . Pedicular fixation in the osteoporotic spine: a pilot in vivo study on long-term ovariectomized sheep. J Orthop Res. 2002; 20(6):1217-24. DOI: 10.1016/S0736-0266(02)00069-4. View

17.

Wuisman P, van Dijk M, Staal H, van Royen B . Augmentation of (pedicle) screws with calcium apatite cement in patients with severe progressive osteoporotic spinal deformities: an innovative technique. Eur Spine J. 2001; 9(6):528-33. PMC: 3611429. DOI: 10.1007/s005860000169. View

18.

Yazu M, Kin A, Kosaka R, Kinoshita M, Abe M . Efficacy of novel-concept pedicle screw fixation augmented with calcium phosphate cement in the osteoporotic spine. J Orthop Sci. 2005; 10(1):56-61. DOI: 10.1007/s00776-004-0862-8. View

19.

Burval D, McLain R, Milks R, Inceoglu S . Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength. Spine (Phila Pa 1976). 2007; 32(10):1077-83. DOI: 10.1097/01.brs.0000261566.38422.40. View

20.

Glassman S, Alegre G . Adult spinal deformity in the osteoporotic spine: options and pitfalls. Instr Course Lect. 2003; 52:579-88. View