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Journal of Orthopaedics and Traumatology

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Open Access 01-12-2011 | Original Article

Fenestrated pedicle screws for cement-augmented purchase in patients with bone softening: a review of 21 cases

Authors: Luca Amendola, Alessandro Gasbarrini, Matteo Fosco, Christiano Esteves Simoes, Silvia Terzi, Federico De Iure, Stefano Boriani

Published in: Journal of Orthopaedics and Traumatology | Issue 4/2011

Abstract

Background

This prospective mixed cohort study was designed to evaluate the middle- to long-term purchase of cement-augmented pedicular screws in patients with poor bone quality. The growing number of surgical procedures performed in the spine has highlighted the problem of screws loosening in patients with poor bone stock due to osteoporosis and/or tumors. Different methods of increasing screw purchase have been reported in the literature, including polymethylmethacrylate (PMMA) augmentation.

Materials and methods

From September 2006 to April 2008, 21 patients with a poor bone stock condition due to osteoporosis or tumor underwent posterior stabilization by fenestrated pedicle screws and PMMA augmentation. Pain improvement and long-term clinical outcome were assessed by visual analogue scale (VAS) score and SF-36 health survey (SF-36) questionnaire. Implant stability was evaluated by plain radiography and CT scans performed three days after surgery and every three months thereafter. After the first 12 months, radiologic controls were taken once a year in all surviving patients. Complications were evaluated in all cases.

Results

All patients were clinically and radiographically followed up for a mean of 36 months. VAS scores and SF-36 questionnaires showed a statistically significant reduction in pain and improvement in the quality of life. No radiological loosening or pulling out of screws was observed. In two cases, cement leakage occurred intraoperatively: one patient who suffered from a transitory nerve root palsy improved spontaneously, while the surgeon immediately removed the excess cement before setting in the other case. In three cases, the post-op CT scan revealed a small amount of cement in the canal without clinical relevance.

Conclusions

Fenestrated screws for cement augmentation provided effective and lasting purchase in patients with poor bone quality due to osteoporosis or tumors. No case of loosening was recorded after a mean follow-up of 36 months. The only clinical complication strictly related to PMMA screw augmentation did not require further surgery.

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Title: Fenestrated pedicle screws for cement-augmented purchase in patients with bone softening: a review of 21 cases
Authors: Luca Amendola
Alessandro Gasbarrini
Matteo Fosco
Christiano Esteves Simoes
Silvia Terzi
Federico De Iure
Stefano Boriani
Publication date: 01-12-2011
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 4/2011
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1007/s10195-011-0164-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Fenestrated pedicle screws for cement-augmented purchase in patients with bone softening: a review of 21 cases

Abstract

Background

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

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