[논문]Posterior Screw Fixation in Previously Augmented Vertebrae with Bone Cement : Is It Inapplicable?

Park, Jae Hoo; Ju, Chang Il; Kim, Seok Won

doi:10.3340/jkns.2017.0202.004

Posterior Screw Fixation in Previously Augmented Vertebrae with Bone Cement : Is It Inapplicable? 원문보기

Journal of Korean Neurosurgical Society = 대한신경외과학회지, v.61 no.1, 2018년, pp.114 - 119

Park, Jae Hoo (Department of Neurosurgery, Chosun University College of Medicine) , Ju, Chang Il (Department of Neurosurgery, Chosun University College of Medicine) , Kim, Seok Won (Department of Neurosurgery, Chosun University College of Medicine)

Abstract ▼ AI-Helper

Objective : The purpose of this study was to determine the feasibility of screw fixation in previously augmented vertebrae with bone cement. We also investigated the influence of cement distribution pattern on the surgical technique. Methods : Fourteen patients who required screw fixation at the level of the previous percutaneous vertebroplasty or balloon kyphoplasty were enrolled in this study. The indications for screw fixation in the previously augmented vertebrae with bone cement included delayed complications, such as cement dislodgement, cement leakage with neurologic deficits, and various degenerative spinal diseases, such as spondylolisthesis or foraminal stenosis. Clinical outcomes, including pain scale scores, cement distribution pattern, and procedure-related complications were assessed. Results : Three patients underwent posterior screw fixation in previously cemented vertebrae due to cement dislodgement or progressive kyphosis. Three patients required posterior screw fixation for cement leakage or displacement of fracture fragments with neurologic deficits. Eight patients underwent posterior screw fixation due to various degenerative spinal diseases. It was possible to insert screws in the previously augmented vertebrae regardless of the cement distribution pattern; however, screw insertion was more difficult and changed directions in the patients with cemented vertebrae exhibiting a solid pattern rather than a trabecular pattern. All patients showed significant improvements in pain compared with the preoperative levels, and no patient experienced neurologic deterioration as seen at the final follow-up. Conclusion : For patients with vertebrae previously augmented with bone cement, posterior screw fixation is not a contraindication, but is a feasible option.

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문제 정의

Screw fixation in previously augmented vertebrae is considered difficult or even a contraindication owing to the excessive reinforcement of stiffness and strength after VP or KP. The purpose of this study was to evaluate the clinical results of screw fixation in previously augmented vertebrae for osteoporotic compression fractures and to determine whether this technique is feasible.

가설 설정

A and B : Simple radiographs taken 2 months after percutaneous vertebroplasty reveal a solid pattern of cement distribution and cement leakage in the left L2 foramen. C : Computed tomography image shows a more prominent cement leakage. D and E : Postoperative simple radiographs show a complete removal of leaked cement with posterior instrumentation inserted in a superior direction.
C : Sagittal T2- weighted magnetic resonance image reveals severe stenosis at the L4–L5 levels.

제안 방법

However, patients with intraoperative complications and late spondylodiscitis requiring an anterior approach were excluded. All procedures were performed by a single surgeon. The augmented vertebral bodies were classified into two groups according to cement distribution pattern on simple radiographs.
3. Imaging studies of an 82-year-old woman who underwent percutaneous vertebroplasty for an L5 osteoporotic compression fracture. A and B : Simple radiographs show a good filling of the bone cement with a solid pattern at the L5 body and spondylolisthesis at the L4–L5 levels.
However, despite our excellent outcomes, this study is intrinsically limited owing to its retrospective review of a heterogeneous patient group. Moreover, since we did not know the exact amount of the injected cement volume, we could not analyze the correlation between the injected cement volume and surgical outcome. Thus, case-controlled studies on delayed complications of bone cement augmentation procedures with long-term follow-ups are crucial.
The patients were evaluated at the final follow-up using the visual analog scale (VAS) and a modified version of MacNab's criteria for characterizing the clinical outcomes after spine surgery.
The study also included revision surgeries for delayed complications of VP or KP, such as cement dislodgement or neurologic deficits due to cement leakage. Degenerative spinal diseases requiring decompression and screw fixation at augmented levels were also included.

대상 데이터

A total of 14 patients (3 men and 11 women) underwent screw fixation in the previously augmented vertebrae for osteoporotic compression fractures. Twelve patients underwent VP, and two underwent KP.
From 2010 to 2015, 14 patients (3 men and 11 women) who underwent screw fixation in the vertebrae previously augmented for osteoporotic compression fractures were enrolled in this study. The following were the inclusion criteria : 1) previous VP or KP for an osteoporotic compression fracture, 2) symptom-free period after VP or KP for more than1month, and 3) newly developed mechanical back pain or neurologic deficits requiring posterior screw fixation for structural stabilization.
2. Imaging studies of a 69-year-old woman who underwent percutaneous vertebroplasty at the L2 and L3 levels at a local clinic. A and B : Simple radiographs taken 2 months after percutaneous vertebroplasty reveal a solid pattern of cement distribution and cement leakage in the left L2 foramen.
1. Imaging studies of an 81-year-old woman who underwent percutaneous vertebroplasty at the L1level. A and B : Simple radiographs taken 5 months after percutaneous vertebroplasty show a trabecular pattern of cement distribution at the L1 level.

참고문헌 (10)

1 Graham J Ahn C Hai N Buch BD Effect of bone density on vertebral strength and stiffness after percutaneous vertebroplasty Spine (Phila Pa 1976) 32 505 511 2007
2 Ha KY Kim YH Chang DG Son IN Kim KW Kim SE Causes of late revision surgery after bone cement augmentation in osteoporotic vertebral compression fractures Asian Spine J 7 294 300 2013 24353846
3 Jung HJ Kim SW Ju CI Kim SH Kim HS Bone cement-augmented short segment fixation with percutaneous screws for thoracolumbar burst fractures accompanied by severe osteoporosis J Korean Neurosurg Soc 52 353 358 2012 23133724

원문보기 상세보기
4 Kim HS Kim SH Ju CI Kim SW Lee SM Shin H The role of bone cement augmentation in the treatment of chronic symptomatic osteoporotic compression fracture J Korean Neurosurg Soc 48 490 495 2010 21430974

원문보기 상세보기
5 Kim HS Park SK Joy H Ryu JK Kim SW Ju CI Bone cement augmentation of short segment fixation for unstable burst fracture in severe osteoporosis J Korean Neurosurg Soc 44 8 14 2008 19096650

원문보기 상세보기
6 Lee K Lee SG Kim WK Yoo CJ Park CW Comparison vertebroplasty with kyphoplasty in delayed post-traumatic osteonecrosis of a vertebral body(kummell’s disease) Korean J Spine 5 70 76 2008
7 Oka M Matsusako M Kobayashi N Uemura A Numaguchi Y Intravertebral cleft sign on fat-suppressed contrast-enhanced MR: correlation with cement distribution pattern on percutaneous vertebroplasty Acad Radiol 12 992 999 2005 16087094
8 Trout AT Kallmes DF Lane JI Layton KF Marx WF Subsequent vertebral fractures after vertebroplasty: association with intraosseous clefts AJNR Am J Neuroradiol 27 1586 1591 2006 16908586
9 Wang HS Kim HS Ju CI Kim SW Delayed bone cement displacement following balloon kyphoplasty J Korean Neurosurg Soc 43 212 214 2008 19096648

원문보기 상세보기
10 Yang SC Chen WJ Yu SW Tu YK Kao YH Chung KC Revision strategies for complications and failure of vertebroplasties Eur Spine J 17 982 988 2008 18446385

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Posterior Screw Fixation in Previously Augmented Vertebrae with Bone Cement : Is It Inapplicable? 원문보기

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Posterior Screw Fixation in Previously Augmented Vertebrae with Bone Cement : Is It Inapplicable? 원문보기

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