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European Spine Journal
Published in: European Spine Journal 7/2019

01-07-2019 | Original Article

The cement leakage in cement-augmented pedicle screw instrumentation in degenerative lumbosacral diseases: a retrospective analysis of 202 cases and 950 augmented pedicle screws

Authors: Hui-zhi Guo, Yong-chao Tang, Dan-qing Guo, Shun-cong Zhang, Yong-xian Li, Guo-ye Mo, Pei-jie Luo, Ten-peng Zhou, Yan-huai Ma, De Liang, Xiao-bing Jiang

Published in: European Spine Journal | Issue 7/2019

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Abstract

Purpose

To evaluate the incidence, type and risk factors of cement leakage (CL) with cement-augmented pedicle screw instrumentation (CAPSI) in degenerative lumbosacral disease.

Methods

Two hundred and two patients using a total of 950 cement-augmented screws were enrolled. CL was classified into three types: type S: leakage via segmental veins; type B: leakage via basivertebral veins; and type I: leakage via pedicle screw instrumentation to paravertebral soft tissue. The age, gender, operation stage (primary or later stage), body mass index, bone mineral density, the number and type of augmented screw, the position of the tip of screw (lateral or internal part of vertebral body), the position of screw (left or right side), the volume of bone cement, location of the augmented vertebra (lumbar or sacrum), the type of CL and complications were recorded. Binary logistic regression correlation was used to analyze risk factors of veins leakage (type S and type B).

Results

The CL was observed in 165 patients (81.68%) and 335 screws (35.26%), leakage types of S, B and I were seen in 255 (76.12%), 77 (22.99%), and 30 (8.96%) of screws, respectively. Besides, double or multiple routes of leakage were seen in 27 screws. Number of augmented screw was a risk factor for vein leakage (OR 0.58; 95% CI 0.44–0.77; P = 0.000). Furthermore, the doses of cement (OR 0.79; 95% CI 0.61–0.99; P = 0.038) and the position of screw (OR 0.39; 95% CI 0.29–0.53; P = 0.000) were identified as risk factors for type S, and the doses of bone cement (OR 0.37; 95% CI 0.25–0.54; P = 0.000) and the position of the tip of screw (OR 0.07; 95% CI 0.04–0.13; P = 0.000) were risk factors for type B.

Conclusions

CAPSI bears a high risk of asymptomatic CL, with a higher rate of leakage into segmental veins and basivertebral veins. As is known, more augmented screws and larger doses of cement are risk factors for veins leakage (type S and type B), while the tip of screw approaching to the midline of the vertebral body is another risk factor to type B. Thus, the CL could be reduced by the amelioration of operative techniques and procedures.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.
Appendix
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Metadata
Title
The cement leakage in cement-augmented pedicle screw instrumentation in degenerative lumbosacral diseases: a retrospective analysis of 202 cases and 950 augmented pedicle screws
Authors
Hui-zhi Guo
Yong-chao Tang
Dan-qing Guo
Shun-cong Zhang
Yong-xian Li
Guo-ye Mo
Pei-jie Luo
Ten-peng Zhou
Yan-huai Ma
De Liang
Xiao-bing Jiang
Publication date
01-07-2019
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 7/2019
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-019-05985-4

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