gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Cement augmented osteosynthesis in anterior cervical spine surgery in the presence of severe osteoporosis

Meeting Abstract

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  • A. Waschke - Klinik für Neurochirurgie, Universitätsklinikum Jena
  • J. Walter - Klinik für Neurochirurgie, Universitätsklinikum Jena
  • R. Kalff - Klinik für Neurochirurgie, Universitätsklinikum Jena
  • C. Ewald - Klinik für Neurochirurgie, Universitätsklinikum Jena

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.12.02

DOI: 10.3205/12dgnc107, URN: urn:nbn:de:0183-12dgnc1071

Published: June 4, 2012

© 2012 Waschke 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

Text

Objective: Cement augmentation of thoracolumbar pedicle screws nowadays is ubiquitously established, thereby providing a significantly more durable anchorage of implants in the presence of reduced bone quality. The experience with this kind of procedure in the cervical spine is relatively limited and confined to a few case reports. On the basis of 7 own cases the general feasibility, technical pitfalls, procedural safety and benefits are discussed.

Methods: 9 patients (5 female, 4 male, median age 64 years) were operated by cervical corpectomy, vertebral body replacement and anterior plating. Due to poor bone quality (median T-score: –3.2) as well as intraoperative evidence of insufficient screw anchoring an additional vertebroplasty of each vertebral body using a high viscosity cement was performed and screws were placed into the augmented area.

Results: There was no major perioperative complication. Cement leakage into spinal canal was not observed. In the routine check-ups 6 months and 1 year postoperatively a sufficient implant anchorage was documented in 6 out of 7 cases. Bony fusion was only seen in one patient. There was one case of cage subsidence into the adjacent vertebra but no surgical indication could be derived. A significant improvement of the physiological sagittal profile with enlargement of the bisegmental Cobb angle by an average of 7 ° was demonstrated one year after surgery.

Conclusions: Cement augmentation of anterior cervical screws is generally feasible and can be carried out safely in accordance with prudent planning. Our results suggest that a stable and durable osteosynthesis of vertebrae with significantly reduced bone quality is possible which seems to be especially useful in cases of severe genuine osteoporosis or multiple myeloma with affection of almost every adjacent vertebra. It appears difficult to establish boundaries or limits below which augmentation may be recommended.