Minimally Invasive Screw Cement Augmentation in Pedicle Technique (MIS CAPT) for Spine Fixation in Osteoporosis Fragility Fracture and Non-Fracture Patient: Surgical Technique, Indication and 1-year Outcome Evaluation
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Abstract
OBJECTIVES: The aim of this study is to describe novo technique of cemented augmentation with percutaneous pedicle screws called “Minimally Invasive Screw Cement Augmentation in Pedicle Technique (MIS CAPT)” which can be used with ordinary percutaneous screws in both fracture and non-fracture osteoporotic fragile bone patients.
MATERIALS AND METHODS: Twenty-four patients were enrolled and data of perioperative and early postoperative through 1-year were recorded.
RESULTS: The patients were divided into the non-fracture group (n = 12) and the fracture group (n = 12). Mean ages of patient were over 70 years old. Mean estimated blood loss and the operative time were lower in the fracture group than those of the non-fracture group (107.5 vs. 758.3 ml and 174.7 vs. 405.5 min., respectively). All patients in the fracture group were discharged from intensive care unit within 24 hours, while 25% of the non-fracture were unable. The mean time to start ambulation in the fracture and the non-fracture group was 17.5 and 48.5 hours, respectively. The hospital stay was approximately 7–9 days in both groups. All patients had no postoperative neurological complications or infections. Minor cement leakage (9.4%) was found in the fracture group without any effect on health or outcome. Within 1-year follow-up, no loosening was found in all MIS CAPT screws and in the fracture group, only 2.8-degree loss of kyphosis reduction was presented in the fracture group.
CONCLUSION: It is concluded that MIS CAPT is an effective-versatile minimally invasive spinal fixation technique in osteoporotic or fragility bone conditions. The outcome is excellent in terms of successful operation, minimal complications, and rigid fixation in both fracture and non-fracture elderly fragility bone p
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References
Wittenberg RH, Shea M, Swartz DE, et al. Importance of bone mineral density in instrumented spine fusions. Spine (Phila Pa 1976) 1991;16(6):647-52. doi: 10.1097/00007632- 199106000-00009.
Halvorson TL, Kelley LA, Thomas KA, et al. Effects of bone mineral density on pedicle screw fixation. Spine (Phila Pa 1976)1994;19(21):2415–20. doi: 10.1097/00007632- 199411000-00008.
Rometsch E, Spruit M, Zigler JE, et al. Screw-related com plications after instrumentation of the osteoporotic spine: a systematic literature review with meta-analysis. Glob Spine J 2020;10(1):69–88. doi: 10.1177/2192568218818164.
Blattert TR, Schnake KJ, Gonschorek O, et al. Nonsurgical and Surgical Management of Osteoporotic Vertebral Body Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Glob Spine J 2 0 1 8 ; 8 ( 2 S u p p l ) : 5 0 S - 5 5 S . d o i : 10.1177/2192568217745823.
Elder BD, Lo SFL, Holmes C, et al. The biomechanics of pedicle screw augmentation with cement. Spine J 2015;15(6):1432–45. doi: 10.1016/j.spinee.2015.03.016.
Yi S, Rim DC, Park SW, et al. Biomechanical comparisons of pull out strengths after pedicle screw augmentation with hydroxyapatite, calcium phosphate, or polymethylmethacry late in the cadaveric spine. World Neurosurg 2015;83(6):976– 81. doi: 10.1016/j.wneu.2015.01.056.
Burval DJ, McLain RF, Milks R, et al. Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechani cal analysis of pedicle fixation strength. Spine (Phila Pa 1976) 2007;32(10):1077–83. doi: 10.1097/01. brs.0000261566.38422.40.
Frankel BM, D’Agostino S, Wang C. A biomechanical cadav eric analysis of polymethylmethacrylate-augmented pedicle screw fixation. J Neurosurg Spine 2007;7(1):47–53. doi: 10.3171/SPI-07/07/047.
Soshi S, Shiba R, Kondo H, et al. An experimental study on transpedicular screw fixation in relation to osteoporosis of the lumbar spine. Spine (Phila Pa 1976) 1991;16(11):1335–41. doi: 10.1097/00007632-199111000-00015.
Cameron HU, Jacob R, Macnab I, et al. Use of polymethyl methacrylate to enhance screw fixation in bone. J Bone Joint Surg Am 1975;57(5):655–6.
Cook SD, Salkeld SL, Stanley T, et al. Biomechanical study of pedicle screw fixation in severely osteoporotic bone. Spine J 2004;4(4):402–8. doi: 10.1016/j.spinee.2003.11.010.
Takigawa T, Tanaka M, Konishi H, et al. Comparative biomechanical analysis of an improved novel pedicle screw with sheath and bone cement. J Spinal Disord Tech 2007;20(6):462–67. doi: 10.1097/bsd.0b013e318030d2d6.
Tan JS, Bailey CS, Dvorak MF, et al. Cement augmentation of vertebral screws enhances the interface strength between interbody device and vertebral body. Spine (Phila Pa 1976) 2007;32(3):334–41. doi: 10.1097/01. brs.0000253645.24141.21.
Wuisman PI, Van Dijk M, Staal H, et al. Augmentation of (pedicle) screws with calcium apatite cement in patients with severe progressive osteoporotic spinal deformities: an innovative technique. Eur Spine J 2000;9(6):528–33. doi: 10.1007/s005860000169.
Piñera AR, Duran C, Lopez B, et al. Instrumented lumbar arthrodesis in elderly patients: prospective study using can nulated cemented pedicle screw instrumentation. Eur Spine J 2011;20(Suppl 3):408–14. doi: 10.1007/s00586-011-1907-2.
Sawakami K, Yamazaki A, Ishikawa S, et al. Polymethylmeth acrylate augmentation of pedicle screws increases the initial fixation in osteoporotic spine patients. J Spinal Disord Tech 2012;25(2): E28-35. doi: 10.1097/BSD.0b013e318228bbed.
Moon BJ, Cho BY, Choi EY, et al. Polymethylmethacrylate augmented screw fixation for stabilization of the osteoporotic spine: a three-year follow-up of 37 patients. J Korean Neurosurg Soc 2009;46(4):305–11. doi: 10.3340/ jkns.2009.46.4.305.
Wood KB, Li W, Lebl DR, et al. Management of thoracolum bar spine fractures. Spine J 2014;14(1):145–64. doi: 10.1016/j. spinee.2012.10.041.
Khare S, Sharma V. Surgical outcome of posterior short segment trans-pedicle screw fixation for thoracolumbar frac tures. J Orthop 2013;10(4):162–7. doi: 10.1016/j. jor.2013.09.010.
Rajasekaran S, Kanna RM, Shetty AP. Management of thoracolumbar spine trauma: an overview. Indian J Orthop 2015;49(1):72–82. doi: 10.4103/0019-5413.143914.
Ghobrial GM, Maulucci CM, Maltenfort M, et al. Operative and nonoperative adverse events in the management of traumatic fractures of the thoracolumbar spine: a systematic review. Neurosurg Focus 2014;37(1): E8. doi: 10.3171/2014.4.FOCUS1467.
Lee JK, Jang JW, Kim TW, et al. Percutaneous short-segment pedicle screw placement without fusion in the treatment of thoracolumbar burst fractures: is it effective? comparative study with open short-segment pedicle screw fixation with posterolateral fusion. A c t a N e u ro c h i r ( Wi e n ) 2013;155(12):2305–12. doi: 10.1007/s00701-013-1859-x.
Kim BG, Dan JM, Shin DE. Treatment of thoracolumbar fracture. Asian Spine J 2015 Feb;9(1):133–46. doi: 10.4184/ asj.2015.9.1.133.
Amendola L, Gasbarrini A, Fosco M, et al. Fenestrated pedicle screws for cement-augmented purchase in patients with bone softening: a review of 21 cases. J Orthop Traumatol 2011;12(4):193–9. doi: 10.1007/s10195-011-0164-9.
Fransen P. Increasing pedicle screw anchoring in the osteoporotic spine by cement injection through the implant. Technical note and report of three cases. J Neurosurg Spine 2007;7(3):366–9. doi: 10.3171/SPI-07/09/366.
Lubansu A, Rynkowski M, Abeloos L, et al. Minimally invasive spinal arthrodesis in osteoporotic population using a cannulated and fenestrated augmented screw: technical description and clinical experience. Minim Invasive Surg 2012;2012:507826. doi: 10.1155/2012/507826.
Klingler JH, Scholz C, Kogias E, et al. Minimally Invasive Technique for PMMA Augmentation of Fenestrated Screws. ScientificWorldJournal 2015;2015:979186. doi: 10.1155/2015/979186.
Chandra Vemula VR, Prasad BC, Jagadeesh MA, et al. Minimally invasive transforaminal lumbar interbody fusion using bone cement-augmented pedicle screws for lumbar spondylolisthesis in patients with osteoporosis. Case series and review of literature. Neurol India 2018;66(1):118–25. doi: 10.4103/0028-3886.222826.
Pesenti S, Blondel B, Peltier E, et al. Percutaneous cement-augmented screws fixation in the fractures of the aging spine: is it the solution? Biomed Res Int 2014;2014:610675. doi: 10.1155/2014/610675.
Chang MC, Kao HC, Ying SH, et al. Polymethylmethacrylate augmentation of cannulated pedicle screws for fixation in osteoporotic spines and comparison of its clinical results and biomechanical characteristics with the needle injection method. J Spinal Disord Tech 2013;26(6):305–15. doi: 10.1097/BSD.0b013e318246ae8a.
Barzilai O, McLaughlin L, Lis E, et al. Utility of cement augmentation via percutaneous fenestrated pedicle screws for stabilization of cancer-related spinal instability. Oper Neurosurg (Hagerstown) 2019;16(5):593–9. doi: 10.1093/ ons/opy186.
Bostelmann R, Keiler A, Steiger HJ, et al. Effect of augmentation techniques on the failure of pedicle screws under cranio-caudal cyclic loading. Eur Spine J 2017;26(1):181–8. doi: 10.1007/s00586-015-3904-3.
Choma TJ, Pfeiffer FM, Swope RW, et al. Pedicle screw design and cement augmentation in osteoporotic vertebrae: effects of fenestrations and cement viscosity on fixation and extraction. Spine (Phila Pa 1976) 2012;37(26):E1628-32. doi: 10.1097/BRS.0b013e3182740e56.
Costa F, Ortolina A, Galbusera F, et al. Pedicle screw cement augmentation. A mechanical pullout study on different cement augmentation techniques. Med Eng Phys 2016;38(2):181–6. doi: 10.1016/j.medengphy.2015.11.020.
Hoppe S, Keel MJB. Pedicle screw augmentation in osteoporotic spine: indications, limitations and technical aspects. Eur J Trauma Emerg Surg 2017 ;43(1):3–8. doi: 10.1007/s00068-016-0750-x.
Singh V, Mahajan R, Das K, et al. Surgical trend analysis for use of cement augmented pedicular screws in osteoporosis of spine: a systematic review (2000-2017). Global Spine J 2019;9(7):783-95. doi: 10.1177/2192568218801570.
Choi SH, Kim DY, Koo JW, et al. Incidence and management trends of osteoporotic vertebral compression fractures in South Korea: a nationwide population-based study. Asian Spine J 2020;14(2):220-8. doi: 10.31616/asj.2019.0051.
Trungu S, Ricciardi L, Forcato S, et al. Percutaneous instrumentation with cement augmentation for traumatic hyperextension thoracic and lumbar fractures in ankylosing spondylitis: a single-institution experience. Neurosurg Focus 2021;51(4):E8. doi: 10.3171/2021.7.FOCUS21308.
Gazzeri R, Panagiotopoulos K, Galarza M, et al. Minimally invasive spinal fixation in an aging population with osteoporosis: clinical and radiological outcomes and safety of expandable screws versus fenestrated screws augmented with polymethylmethacrylate. Neurosurg Focus 2020;49(2):E14. doi: 10.3171/2020.5.FOCUS20232.
Kanno H, Aizawa T, Hashimoto K, et al. Enhancing percutaneous pedicle screw fixation with hydroxyapatite granules: A biomechanical study using an osteoporotic bone model. PLoS One 2019;14(9):e0223106. doi: 10.1371/journal. pone.0223106.
Tanaka M, Fujiwara Y, Uotani K, et al. Percutaneous transdiscal pedicle screw fixation for osteoporotic vertebral fracture: a technical note. Interdiscipl Neurosurg 2021;23:100903. doi: 10.1016/j.inat.2020.100903.
Shea TM, Laun J, Gonzalez-Blohm SA, et al. Designs and techniques that improve the pullout strength of pedicle screws in osteoporotic vertebrae: current status. Biomed Res Int 2014;2014:748393. doi: 10.1155/2014/748393.
Kobayashi K, Imagama S, Ando K, et al. Complications associated with spine surgery in patients aged 80 years or older: Japan association of spine surgeons with ambition (JASA) multicenter study. Global Spine J 2017;7(7):636-41. doi: 10.1177/2192568217716144.