gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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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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  • corresponding author D.T. Pillich - Klinik für Neurochirurgie, Klinikum der Ernst-Moritz-Arndt Universität, Greifswald
  • J. Baldauf - Klinik für Neurochirurgie, Klinikum der Ernst-Moritz-Arndt Universität, Greifswald
  • J. U. Müller - Klinik für Neurochirurgie, Klinikum der Ernst-Moritz-Arndt Universität, Greifswald
  • H. W. S. Schroeder - Klinik für Neurochirurgie, Klinikum der Ernst-Moritz-Arndt Universität, Greifswald

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocP 038

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc306.shtml

Published: May 30, 2008

© 2008 Pillich et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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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.