TY - JOUR
T1 - Fenestrated pedicle screws for thoracolumbar instrumentation in patients with poor bone quality
T2 - Case series and systematic review of the literature
AU - Ehresman, Jeff
AU - Pennington, Zach
AU - Elsamadicy, Aladine A.
AU - Hersh, Andrew
AU - Lubelski, Daniel
AU - Lehner, Kurt
AU - Cottrill, Ethan
AU - Schilling, Andrew
AU - Lakomkin, Nikita
AU - Ahmed, A. Karim
AU - Lo, Sheng Fu
AU - Sciubba, Daniel M.
N1 - Publisher Copyright:
© 2021
PY - 2021/7
Y1 - 2021/7
N2 - Objective: To describe the results of a single-surgeon series and systematically review the literature on cement-augmented instrumented fusion with fenestrated pedicle screws. Methods: All patients treated by the senior surgeon using fenestrated screws between 2017 and 2019 with a minimum of 6-months of clinical and radiographic follow-up were included. For the systematic review, we used PRISMA guidelines to identify all prior descriptions of cement-augmented instrumented fusion with fenestrated pedicle screws in the English literature. Endpoints of interest included hardware loosening, cement leakage, and pulmonary cement embolism (PCE). Results: Our series included 38 patients (mean follow-up 14.8 months) who underwent cement-augmented instrumentation for tumor (47.3%), deformity/degenerative disease (39.5%), or osteoporotic fracture (13.2%). Asymptomatic screw lucency was seen in 2.6%, cement leakage in 445, and pulmonary cement embolism (PCE) in 5.2%. Our literature review identified 23 studies (n = 1526 patients), with low reported rates of hardware loosening (0.2%) and symptomatic PCE (1.0%). Cement leakage, while common (55.6%), produced symptoms in fewer than 1% of patients. Indications for cement-augmentation in this cohort included: spine metastasis with or without pathologic fracture (n = 18; 47.3%), degenerative spine disease or fixed deformity with poor underlying bone quality (n = 15; 39.5%), and osteoporotic fracture (n = 5; 13.2%). Conclusion: Cement-augmented fusion with fenestrated screws appears to be a safe, effective means of treating patients with poor underlying bone quality secondary to tumor or osteoporosis. High-quality evidence with direct comparisons to non-augmented patients is needed.
AB - Objective: To describe the results of a single-surgeon series and systematically review the literature on cement-augmented instrumented fusion with fenestrated pedicle screws. Methods: All patients treated by the senior surgeon using fenestrated screws between 2017 and 2019 with a minimum of 6-months of clinical and radiographic follow-up were included. For the systematic review, we used PRISMA guidelines to identify all prior descriptions of cement-augmented instrumented fusion with fenestrated pedicle screws in the English literature. Endpoints of interest included hardware loosening, cement leakage, and pulmonary cement embolism (PCE). Results: Our series included 38 patients (mean follow-up 14.8 months) who underwent cement-augmented instrumentation for tumor (47.3%), deformity/degenerative disease (39.5%), or osteoporotic fracture (13.2%). Asymptomatic screw lucency was seen in 2.6%, cement leakage in 445, and pulmonary cement embolism (PCE) in 5.2%. Our literature review identified 23 studies (n = 1526 patients), with low reported rates of hardware loosening (0.2%) and symptomatic PCE (1.0%). Cement leakage, while common (55.6%), produced symptoms in fewer than 1% of patients. Indications for cement-augmentation in this cohort included: spine metastasis with or without pathologic fracture (n = 18; 47.3%), degenerative spine disease or fixed deformity with poor underlying bone quality (n = 15; 39.5%), and osteoporotic fracture (n = 5; 13.2%). Conclusion: Cement-augmented fusion with fenestrated screws appears to be a safe, effective means of treating patients with poor underlying bone quality secondary to tumor or osteoporosis. High-quality evidence with direct comparisons to non-augmented patients is needed.
KW - Cannulated screws
KW - Cement augmentation
KW - Fenestrated screws
KW - Osteoporosis
KW - Polymethyl methacrylate
KW - Spinal metastasis
KW - Vertebral body augmentation
UR - http://www.scopus.com/inward/record.url?scp=85106242105&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85106242105&partnerID=8YFLogxK
U2 - 10.1016/j.clineuro.2021.106675
DO - 10.1016/j.clineuro.2021.106675
M3 - Article
C2 - 34020324
AN - SCOPUS:85106242105
SN - 0303-8467
VL - 206
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
M1 - 106675
ER -