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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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High rate of pulmonary cement embolism after cement-augmented pedicle screw fixation – a 12-year single centre study

Hohe Raten an Zementembolien nach zementaugmentierter Pedikelschraubenfixation: eine 12-jähringe monozentrische Studie

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  • presenting/speaker Pavlina Lenga - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Awais Akbar Bajwa - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Andreas W. Unterberg - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Till Schneider - Universitätsklinikum Heidelberg, Klinik für Neuroradiologie, Heidelberg, Deutschland
  • Joe Iwanaga - Tulane University School of Medicine, Department of Neurosurgery, New Orleans, LA, Vereinigte Staaten
  • Shane Tubbs - Tulane University School of Medicine, Department of Neurosurgery, New Orleans, LA, Vereinigte Staaten
  • Karl Kiening - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Basem Ishak - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV100

doi: 10.3205/22dgnc102, urn:nbn:de:0183-22dgnc1023

Published: May 25, 2022

© 2022 Lenga et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: With the global trend of increased life expectancy because of remarkable improvements in health care quality, osteoporotic fractures and degenerative spine diseases have been gaining increasing attention. Cement-augmented pedicle screw fixation has been established as the mainstay treatment for patients with poor bone quality. The aim of the present study was to determine the number of patients with cement leakage and pulmonary cement embolism (PCE) rates as detected on thoracic computer tomography (CT) scans, and to assess the potential risk factors for PCE.

Methods: This study included patients undergoing cement-augmented pedicle screw placement in our institution from May 2008 to December 2020. Data regarding baseline characteristics, complications, and cement leakage rates were collected. A CT scan was performed in patients with cement leakage on radiograph or upon surgeon’s request as part of the diagnostic workup for PCE. Other indications for thoracic CT-scan were analyzed.

Results: A total of 104 patients with a mean age of 72.8 years (SD 6.7) were included. Among 802 screws 573 were cement-augmented. Among 104 patients, 44 (42.3%) underwent thoracic CT scans to diagnose PCE; additionally, 67 (64.4%) demonstrated cement leakage, of whom 27 developed PCE, and four developed symptoms. Cement-augmented thoracic screws were risk factor for the occurrence of PCE (odds ratio 1.5, 95% confidence interval 1.2–2.1; p = 0.004).

Conclusion: This study showed a high prevalence of cement leakage after cement-augmented pedicle screw insertion, with a relatively frequent incidence of PCE, as tracked on thoracic CT scans. Over 40% of the total cohort received a thoracic CT to track the occurrence of PCE, hence substantiating the fidelity of our results. PCE seems to be a very frequent phenomenon (27/104, 26%); however, it remains mostly clinically asymptomatic. The indication for cement augmentation, especially in patients with thoracic instrumentation, should be defined with raised awareness.