open access

Vol 46, No 6 (2012)
ARTYKUŁ ORYGINALNY
Submitted: 2012-03-25
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Augmentation of transpedicular screws by intraoperative vertebroplasty

Krzysztof Zapałowie, Bartosz Godlewski, Rustan Jekimov, Marek Grochal
DOI: 10.5114/ninp.2012.32098
·
Neurol Neurochir Pol 2012;46(6):560-568.

open access

Vol 46, No 6 (2012)
ARTYKUŁ ORYGINALNY
Submitted: 2012-03-25

Abstract

Background and purpose

The aim of the study was to determine the efficacy of posterior spinal stabilization, combined with intraoperative vertebroplasty defined as intraoperative filling of instrumented vertebral bodies (VB) with polymethylmethacrylate (PMMA).

Material and methods

Seventeen patients with osteoporosis or osteopenia underwent posterior spinal fusions. The surgical procedures included laminectomy, spondylodesis, insertion of pedicular screws, intraoperative vertebroplasty and correction of spinal deformity.

Results

Postoperative assessment showed improvement of pain in all cases. Motor deficit regressed in 2 of 3 afflicted patients. In 12 vertebrae (27.3%), the mass of PMMA extended from one endplate to another, filling 100% of VB height, in 7 (15.9%) it filled 90–99%, in 14 (31.8%) 80–89%, in 9 (20.4%) 70–79%, and in 2 (4.5%) it filled 50–60% of VB height. In the horizontal plane, PMMA filled central parts of 72.7% of vertebral bodies. PMMA completely surrounded 68.9% of screws, and partially surrounded 18.4% of screws, whereas 12.6% of screws had no contact with cement mass. Spinal stabilization reduced kyphotic deformity in 15 patients (range of reduction: 6°-25°; mean: 13.6°). During follow-up (3–32 months; mean: 16) implants of 11 patients were stable, 1 implant instability was diagnosed 7 months after surgery, 5 patients were lost to follow-up. Asymptomatic cement leaks occurred in 45% of vertebrae.

Conclusions

Intraoperative vertebroplasty performed after insertion of pedicular screws may be considered as a technical variation useful to stabilize osteoporotic spines. After PMMA hardening, intraoperative manoeuvres to correct spinal deformity were possible without any damage of instrumented vertebrae.

Abstract

Background and purpose

The aim of the study was to determine the efficacy of posterior spinal stabilization, combined with intraoperative vertebroplasty defined as intraoperative filling of instrumented vertebral bodies (VB) with polymethylmethacrylate (PMMA).

Material and methods

Seventeen patients with osteoporosis or osteopenia underwent posterior spinal fusions. The surgical procedures included laminectomy, spondylodesis, insertion of pedicular screws, intraoperative vertebroplasty and correction of spinal deformity.

Results

Postoperative assessment showed improvement of pain in all cases. Motor deficit regressed in 2 of 3 afflicted patients. In 12 vertebrae (27.3%), the mass of PMMA extended from one endplate to another, filling 100% of VB height, in 7 (15.9%) it filled 90–99%, in 14 (31.8%) 80–89%, in 9 (20.4%) 70–79%, and in 2 (4.5%) it filled 50–60% of VB height. In the horizontal plane, PMMA filled central parts of 72.7% of vertebral bodies. PMMA completely surrounded 68.9% of screws, and partially surrounded 18.4% of screws, whereas 12.6% of screws had no contact with cement mass. Spinal stabilization reduced kyphotic deformity in 15 patients (range of reduction: 6°-25°; mean: 13.6°). During follow-up (3–32 months; mean: 16) implants of 11 patients were stable, 1 implant instability was diagnosed 7 months after surgery, 5 patients were lost to follow-up. Asymptomatic cement leaks occurred in 45% of vertebrae.

Conclusions

Intraoperative vertebroplasty performed after insertion of pedicular screws may be considered as a technical variation useful to stabilize osteoporotic spines. After PMMA hardening, intraoperative manoeuvres to correct spinal deformity were possible without any damage of instrumented vertebrae.

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Keywords

osteoporosis, pedicle screw, PMMA, spinal stabilization, vertebral fracture

About this article
Title

Augmentation of transpedicular screws by intraoperative vertebroplasty

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 46, No 6 (2012)

Pages

560-568

DOI

10.5114/ninp.2012.32098

Bibliographic record

Neurol Neurochir Pol 2012;46(6):560-568.

Keywords

osteoporosis
pedicle screw
PMMA
spinal stabilization
vertebral fracture

Authors

Krzysztof Zapałowie
Bartosz Godlewski
Rustan Jekimov
Marek Grochal

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