gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Pedicle screw augmentation – risk of local cement leakage and cement embolism

Meeting Abstract

  • J.U. Müller - Klinik für Neurochirurgie des Universitätsklinikums Greifswald
  • D.T. Pillich - Klinik für Neurochirurgie des Universitätsklinikums Greifswald
  • S. Fleck - Klinik für Neurochirurgie des Universitätsklinikums Greifswald
  • H.W.S. Schroeder - Klinik für Neurochirurgie des Universitätsklinikums Greifswald
  • J. Baldauf - Klinik für Neurochirurgie des Universitätsklinikums Greifswald

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.02.05

doi: 10.3205/11dgnc110, urn:nbn:de:0183-11dgnc1108

Published: April 28, 2011

© 2011 Müller et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The use of pedicle screws in elderly patients is of high risk for secondary instability because of loosening of implants. Therefore, screw augmentation with polymethyl methacrylate (PMMA) has become an accepted additional procedure. However, PMMA application may result in cement leakage. Our prospective study evaluates the clinical risk of screw augmentation in elderly patients.

Methods: Ninety-eight patients (60 female, 38 male, mean age 70.6 years) with osteoporotic fractures (68 patients), degenerative instability (12 patients) and tumour related fractures (18 patients) underwent instrumentation with PMMA augmentation of pedicle screws. Perioperative clinical data were analysed. Postoperative CT scans and conventional radiographs of the chest were obtained and reviewed regarding cement leakage and associated complications.

Results: 478 pedicle screws in 98 were augmented. No intraoperative complications occurred during the application of the cement via the cannulated screws. Postoperative spinal CT scans of 466 pedicle screws were analysed. In 76% of the augmented vertebrae a local cement leakage was observed. The leakage of cement was detected via segmental veins in 61.8%, basis vertebral veins in 41.2% and transosseous through a cortical defect in 11.6%. All leakages were without clinical signs. Postoperatively, thoracic x-ray or CT demonstrated pulmonary embolism due to cement particles in 4 patients without clinical sequelae.

Conclusions: There is a high percentage of 76% of cement leakage via veins or cortical bone defects without clinical sequelae. The risk of pulmonary cement related embolism was low and without clinical manifestation.