Article
Early complications and cement leakage in elderly patients who have undergone intraoperative Computer Tomography (CT)-guided cement augmented pedicle screw placement – eight-year single-centre experience
Frühe Komplikationen und Zementaustritt bei älteren Patienten mitintraoperativer CT-gestützter Anlage vonzementaugmentierten Pedikelschrauben – Erfahrungen aus einem Zentrum über 8 Jahre
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Authors
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Awais Akbar Bajwa
- Universitätsklinikum Heidelberg, Klinik für Neurochirurgie, Heidelberg, Deutschland
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Basem Ishak
- Universitätsklinikum Heidelberg, Klinik für Neurochirurgie, Heidelberg, Deutschland
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Till Schneider
- Universitätsklinikum Heidelberg, Abteilung für Neuroradiologie, Heidelberg, Deutschland
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Andreas Unterberg
- Universitätsklinikum Heidelberg, Klinik für Neurochirurgie, Heidelberg, Deutschland
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Karl Kiening
- Universitätsklinikum Heidelberg, Klinik für Neurochirurgie, Heidelberg, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: Poor bone quality in elderly patients is still a big challenge among spine surgeons when stabilization procedures are indicated. Cement augmentation of pedicle screws has been introduced to anchor pedicle screws in osteopenic bone in order to improve biomechanical stability. However the use of cement has led to raised concerns caused by cement embolism or pulmonary embolism when cement remains in veins. The aim of this study was to assess early complications, mortality rate and cement leakage in elderly patients who underwent navigation-based pedicle screw placement.
Methods: 86 patients who underwent cement augmented pedicle screws for various conditions were retrospectively included between May 2008 and December 2016. We have defined patients over 65 years of age as inclusion criterion. Complications, mortality and cement leakage were determined. All patients have had an x-ray control; a CT scan was available in 57 of 86 patients (66%).
Results: Average age was 73.4 y (range 65–86 y). A total of 319 vertebral bodies with 637 screws were inserted of which 458 screws were cement augmented. 348 (76%) augmented screws were placed in the lumbar spine, and 110 (24 %) in the thoracic spine. In 52 of 86 patients (60 %) asymptomatic cement leakage occurred. Two patients (2%) developed dyspnea as a result of pulmonary cement embolism. One patient (1%) developed an anaphylactic shock intraoperatively most likely due to cement application and died within the next days. In all cases with cement leakage, cement could be found paravertebral (100%): 25% in the inferior caval vein, 7% in the epidural space, 5% in the azygos vein, and 7% in pulmonary arteries.
Conclusion: Our current study confirms that the use of cement correlates with a high risk of cement leakage in the elderly. Elderly patients with cement augmentation should be monitored after surgery. The remaining cement in big veins bears thrombogenic risks which could lead to pulmonary embolism. An adequate anticoagulation may be discussed.
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