Artikel
Cement augmenting pedicle screws – reliability in patients with osteoporosis and tumour-related osteolysis
Zementierte Pedikelschrauben – Zuverlässigkeit bei Patienten mit Osteoporose und Osteolysen aufgrund von Tumoren
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Veröffentlicht: | 30. Mai 2008 |
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Objective: The use of pedicle screws in elderly patients with osteoporosis and tumour-related osteolysis is of high risk for secondary instability because of loosening of surgical implants. We report our data of a prospective study with an augmenting pedicle screw system (Tango RS, Ulrich Ulm Germany).
Methods: The prospective data of 27 patients with osteoporosis (spondylolisthesis: 3; fractures: 16) and tumour-related osteolysis (8) were collected. The surgeon decided on cement augmentation of pedicle screws or instrumentation of adjacent levels. Before application of cement an intraoperative three dimensional control scanning with the ISO C 3D unit (Siemens) was performed to evaluate the accurate positioning of screws. Postoperatively, thoracic x-ray or CT as well as a CT of the spine were done routinely to evaluate cement dissemination.
Results: The average age was 69.5 years. In all patients a cement augmentation of pedicle screws was done. No intraoperative complications occurred during the application of the cement via the cannulated screws. Postoperatively, thoracic x-ray or CT demonstrated pulmonary embolism due to cement particles in 6 patients without clinical value. In 9 patients cement was found whether in paravertebral or epidural veins, again without affection of the clinical status. There was no loosening of screws in early controls.
Conclusions: Augmentation of pedicle screws may be an additional approach for screw fixation within the vertebral bone that is already affected by a loss of the trabecular structure as known from osteoporosis as well as in osteolytic bone. A secondary screw loosening may be avoided with this technique. However, a greater amount of patients and a long follow-up will be necessary for the evaluation of this pedicle screw system.