Skip to main content
Erschienen in: European Journal of Trauma and Emergency Surgery 1/2017

19.12.2016 | Original Article

Pedicle screw augmentation in osteoporotic spine: indications, limitations and technical aspects

verfasst von: S. Hoppe, M. J. B. Keel

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 1/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The need for spinal instrumented fusion in osteoporotic patients is rising. In this review, we try to give an overview of the current spectrum of pedicle screw augmentation techniques, safety aspects and indications.

Methods

Review of literature and discussion of indications, limitations and technical aspects.

Results

Various studies have shown higher failure rates in osteoporotic patients, most probably due to reduced bone quality and a poor bone-screw interface. Augmentation of pedicle screws with bone cement, such as polymethylmethacrylate or calcium based cements, is one valid option to enhance fixation if required.

Conclusions

Crucial factors for success in the use of augmented screws are careful patient selection, a proper technique and choice of the ideal cement augmentation option.
Literatur
1.
Zurück zum Zitat Keen RW. Burden of osteoporosis and fractures. Curr Osteoporos Rep. 2003;1–2:66–70.CrossRef Keen RW. Burden of osteoporosis and fractures. Curr Osteoporos Rep. 2003;1–2:66–70.CrossRef
2.
Zurück zum Zitat Bernhardt M, Swartz DE, Clothiaux PL, Crowell RR, White Iii AA. Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation. Clin Orthop Relat Res. 1992;284:109–15. Bernhardt M, Swartz DE, Clothiaux PL, Crowell RR, White Iii AA. Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation. Clin Orthop Relat Res. 1992;284:109–15.
3.
Zurück zum Zitat Goldhahn J, Suhm N, Goldhahn S, Blauth M, Hanson B. Influence of osteoporosis on fracture fixation—a systematic literature review. Osteoporos Int. 2008;19–6:761–72.CrossRef Goldhahn J, Suhm N, Goldhahn S, Blauth M, Hanson B. Influence of osteoporosis on fracture fixation—a systematic literature review. Osteoporos Int. 2008;19–6:761–72.CrossRef
4.
Zurück zum Zitat Halvorson TL, Kelley LA, Thomas KA, Whitecloud Iii TS, Cook SD. Effects of bone mineral density on pedicle screw fixation. Spine. 1994;19–21:2415–20.CrossRef Halvorson TL, Kelley LA, Thomas KA, Whitecloud Iii TS, Cook SD. Effects of bone mineral density on pedicle screw fixation. Spine. 1994;19–21:2415–20.CrossRef
5.
Zurück zum Zitat Yamagata M, Kitahara H, Minami S, Takahashi K, Isobe K, Moriya H, Tamaki T. Mechanical stability of the pedicle screw fixation systems for the lumbar spine. Spine (Phila Pa 1976). 1992;17(3 Suppl):S51–4.CrossRef Yamagata M, Kitahara H, Minami S, Takahashi K, Isobe K, Moriya H, Tamaki T. Mechanical stability of the pedicle screw fixation systems for the lumbar spine. Spine (Phila Pa 1976). 1992;17(3 Suppl):S51–4.CrossRef
6.
Zurück zum Zitat Law M, Tencer AF, Anderson PA. Caudo-cephalad loading of pedicle screws: mechanisms of loosening and methods of augmentation. Spine. 1993;18–16:2438–43.CrossRef Law M, Tencer AF, Anderson PA. Caudo-cephalad loading of pedicle screws: mechanisms of loosening and methods of augmentation. Spine. 1993;18–16:2438–43.CrossRef
7.
Zurück zum Zitat Chao KH, Lai YS, Chen WC, Chang CM, McClean CJ, Fan CY, Chang CH, Lin LC, Cheng CK. Biomechanical analysis of different types of pedicle screw augmentation: a cadaveric and synthetic bone sample study of instrumented vertebral specimens. Med Eng Phys. 2013;35–10:1506–12.CrossRef Chao KH, Lai YS, Chen WC, Chang CM, McClean CJ, Fan CY, Chang CH, Lin LC, Cheng CK. Biomechanical analysis of different types of pedicle screw augmentation: a cadaveric and synthetic bone sample study of instrumented vertebral specimens. Med Eng Phys. 2013;35–10:1506–12.CrossRef
8.
Zurück zum Zitat Higashino K, Kim JH, Horton WC, Hutton WC. A biomechanical study of two different pedicle screw methods for fixation in osteoporotic and nonosteoporotic vertebrae. J Surg Orthop Adv. 2012;21–4:198–203.CrossRef Higashino K, Kim JH, Horton WC, Hutton WC. A biomechanical study of two different pedicle screw methods for fixation in osteoporotic and nonosteoporotic vertebrae. J Surg Orthop Adv. 2012;21–4:198–203.CrossRef
9.
Zurück zum Zitat Hamasaki T, Tanaka N, Kim J, Okada M, Ochi M, Hutton WC. Pedicle screw augmentation with polyethylene tape: a biomechanical study in the osteoporotic thoracolumbar spine. J Spinal Disord Technol. 2010;23–2:127–32.CrossRef Hamasaki T, Tanaka N, Kim J, Okada M, Ochi M, Hutton WC. Pedicle screw augmentation with polyethylene tape: a biomechanical study in the osteoporotic thoracolumbar spine. J Spinal Disord Technol. 2010;23–2:127–32.CrossRef
10.
Zurück zum Zitat Tsai KJ, Murakami H, Horton WC, Fei Q, Hutton WC. Pedicle screw fixation strength: a biomechanical comparison between 4.5- and 5.5-mm diameter screws in osteoporotic upper thoracic vertebrae. J Surg Orthop Adv. 2009;18–1:23–7. Tsai KJ, Murakami H, Horton WC, Fei Q, Hutton WC. Pedicle screw fixation strength: a biomechanical comparison between 4.5- and 5.5-mm diameter screws in osteoporotic upper thoracic vertebrae. J Surg Orthop Adv. 2009;18–1:23–7.
11.
Zurück zum Zitat Becker S, Chavanne A, Spitaler R, Kropik K, Aigner N, Ogon M, Redl H. Assessment of different screw augmentation techniques and screw designs in osteoporotic spines. Eur Spine J. 2008;17–11:1462–9.CrossRef Becker S, Chavanne A, Spitaler R, Kropik K, Aigner N, Ogon M, Redl H. Assessment of different screw augmentation techniques and screw designs in osteoporotic spines. Eur Spine J. 2008;17–11:1462–9.CrossRef
12.
Zurück zum Zitat Liu D, Wu ZX, Pan XM, Fu SC, Gao MX, Shi L, Lei W. Biomechanical comparison of different techniques in primary spinal surgery in osteoporotic cadaveric lumbar vertebrae: expansive pedicle screw versus polymethylmethacrylate-augmented pedicle screw. Arch Orthop Trauma Surg. 2011;131–9:1227–32.CrossRef Liu D, Wu ZX, Pan XM, Fu SC, Gao MX, Shi L, Lei W. Biomechanical comparison of different techniques in primary spinal surgery in osteoporotic cadaveric lumbar vertebrae: expansive pedicle screw versus polymethylmethacrylate-augmented pedicle screw. Arch Orthop Trauma Surg. 2011;131–9:1227–32.CrossRef
13.
Zurück zum Zitat Sarzier JS, Evans AJ, Cahill DW. Increased pedicle screw pullout strength with vertebroplasty augmentation in osteoporotic spines. J Neurosurg. 2002;96–3(Suppl):309–12. Sarzier JS, Evans AJ, Cahill DW. Increased pedicle screw pullout strength with vertebroplasty augmentation in osteoporotic spines. J Neurosurg. 2002;96–3(Suppl):309–12.
14.
Zurück zum Zitat Yu BS, Li ZM, Zhou ZY, Zeng LW, Wang LB, Zheng ZM, Lu WW. Biomechanical effects of insertion location and bone cement augmentation on the anchoring strength of iliac screw. Clin Biomech (Bristol, Avon). 2011;26–6:556–61.CrossRef Yu BS, Li ZM, Zhou ZY, Zeng LW, Wang LB, Zheng ZM, Lu WW. Biomechanical effects of insertion location and bone cement augmentation on the anchoring strength of iliac screw. Clin Biomech (Bristol, Avon). 2011;26–6:556–61.CrossRef
15.
Zurück zum Zitat Yu BS, Zhuang XM, Zheng ZM, Zhang JF, Li ZM, Lu WW. Biomechanical comparison of 4 fixation techniques of sacral pedicle screw in osteoporotic condition. J Spinal Disord Technol. 2010;23–6:404–9.CrossRef Yu BS, Zhuang XM, Zheng ZM, Zhang JF, Li ZM, Lu WW. Biomechanical comparison of 4 fixation techniques of sacral pedicle screw in osteoporotic condition. J Spinal Disord Technol. 2010;23–6:404–9.CrossRef
16.
Zurück zum Zitat Hoppe S, Loosli Y, Baumgartner D, Heini P, Benneker L. Influence of screw augmentation in posterior dynamic and rigid stabilization systems in osteoporotic lumbar vertebrae: a biomechanical cadaveric study. Spine (Phila Pa 1976). 2014;39(6):E384–9.CrossRef Hoppe S, Loosli Y, Baumgartner D, Heini P, Benneker L. Influence of screw augmentation in posterior dynamic and rigid stabilization systems in osteoporotic lumbar vertebrae: a biomechanical cadaveric study. Spine (Phila Pa 1976). 2014;39(6):E384–9.CrossRef
17.
Zurück zum Zitat Zindrick MR, Wiltse LL, Widell EH, Thomas JC, Holland WR, Field BT, Spencer CW. A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine. Clin Orthop Relat Res. 1986;203:99–112. Zindrick MR, Wiltse LL, Widell EH, Thomas JC, Holland WR, Field BT, Spencer CW. A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine. Clin Orthop Relat Res. 1986;203:99–112.
18.
Zurück zum Zitat Frankel BM, D’Agostino S, Wang C. A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation. J Neurosurg Spine. 2007;7–1:47–53.CrossRef Frankel BM, D’Agostino S, Wang C. A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation. J Neurosurg Spine. 2007;7–1:47–53.CrossRef
19.
Zurück zum Zitat Renner SM, Lim TH, Kim WJ, Katolik L, An HS, Andersson GB. Augmentation of pedicle screw fixation strength using an injectable calcium phosphate cement as a function of injection timing and method. Spine (Phila Pa 1976). 2004;29(11):E212–6.CrossRef Renner SM, Lim TH, Kim WJ, Katolik L, An HS, Andersson GB. Augmentation of pedicle screw fixation strength using an injectable calcium phosphate cement as a function of injection timing and method. Spine (Phila Pa 1976). 2004;29(11):E212–6.CrossRef
20.
Zurück zum Zitat Kiner DW, Wybo CD, Sterba W, Yeni YN, Bartol SW, Vaidya R. Biomechanical analysis of different techniques in revision spinal instrumentation: larger diameter screws versus cement augmentation. Spine (Phila Pa 1976). 2008;33(24):2618–22.CrossRef Kiner DW, Wybo CD, Sterba W, Yeni YN, Bartol SW, Vaidya R. Biomechanical analysis of different techniques in revision spinal instrumentation: larger diameter screws versus cement augmentation. Spine (Phila Pa 1976). 2008;33(24):2618–22.CrossRef
21.
Zurück zum Zitat Kueny RA, Kolb JP, Lehmann W, Puschel K, Morlock MM, Huber G. Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing. Eur Spine J. 2014;23–10:2196–202.CrossRef Kueny RA, Kolb JP, Lehmann W, Puschel K, Morlock MM, Huber G. Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing. Eur Spine J. 2014;23–10:2196–202.CrossRef
22.
Zurück zum Zitat Law M, Tencer AF, Anderson PA. Caudo-cephalad loading of pedicle screws: mechanisms of loosening and methods of augmentation. Spine (Phila Pa 1976). 1993;18–16:2438–43.CrossRef Law M, Tencer AF, Anderson PA. Caudo-cephalad loading of pedicle screws: mechanisms of loosening and methods of augmentation. Spine (Phila Pa 1976). 1993;18–16:2438–43.CrossRef
23.
Zurück zum Zitat Folsch C, Goost H, Figiel J, Paletta JR, Schultz W, Lakemeier S. Correlation of pull-out strength of cement-augmented pedicle screws with CT-volumetric measurement of cement. Biomed Technol (Berl). 2012;57–6:473–80. Folsch C, Goost H, Figiel J, Paletta JR, Schultz W, Lakemeier S. Correlation of pull-out strength of cement-augmented pedicle screws with CT-volumetric measurement of cement. Biomed Technol (Berl). 2012;57–6:473–80.
24.
Zurück zum Zitat Burval DJ, McLain RF, Milks R, Inceoglu S. Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength. Spine (Phila Pa 1976). 2007;32(10):1077–83.CrossRef Burval DJ, McLain RF, Milks R, Inceoglu S. Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength. Spine (Phila Pa 1976). 2007;32(10):1077–83.CrossRef
25.
Zurück zum Zitat Linhardt O, Luring C, Matussek J, Hamberger C, Herold T, Plitz W, Grifka J. Stability of anterior vertebral body screws after kyphoplasty augmentation. An experimental study to compare anterior vertebral body screw fixation in soft and cured kyphoplasty cement. Int Orthop. 2006;30–5:366–70.CrossRef Linhardt O, Luring C, Matussek J, Hamberger C, Herold T, Plitz W, Grifka J. Stability of anterior vertebral body screws after kyphoplasty augmentation. An experimental study to compare anterior vertebral body screw fixation in soft and cured kyphoplasty cement. Int Orthop. 2006;30–5:366–70.CrossRef
26.
Zurück zum Zitat Flahiff CM, Gober GA, Nicholas RW. Pullout strength of fixation screws from polymethylmethacrylate bone cement. Biomaterials. 1995;16–7:533–6.CrossRef Flahiff CM, Gober GA, Nicholas RW. Pullout strength of fixation screws from polymethylmethacrylate bone cement. Biomaterials. 1995;16–7:533–6.CrossRef
27.
Zurück zum Zitat Cho W, Wu C, Erkan S, Kang MM, Mehbod AA, Transfeldt EE. The effect on the pullout strength by the timing of pedicle screw insertion after calcium phosphate cement injection. J Spinal Disord Technol. 2011;24–2:116–20.CrossRef Cho W, Wu C, Erkan S, Kang MM, Mehbod AA, Transfeldt EE. The effect on the pullout strength by the timing of pedicle screw insertion after calcium phosphate cement injection. J Spinal Disord Technol. 2011;24–2:116–20.CrossRef
28.
Zurück zum Zitat Chen LH, Tai CL, Lee DM, Lai PL, Lee YC, Niu CC, Chen WJ. Pullout strength of pedicle screws with cement augmentation in severe osteoporosis: a comparative study between cannulated screws with cement injection and solid screws with cement pre-filling. BMC Musculoskelet Disord. 2011;12:33.CrossRefPubMedPubMedCentral Chen LH, Tai CL, Lee DM, Lai PL, Lee YC, Niu CC, Chen WJ. Pullout strength of pedicle screws with cement augmentation in severe osteoporosis: a comparative study between cannulated screws with cement injection and solid screws with cement pre-filling. BMC Musculoskelet Disord. 2011;12:33.CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Choma TJ, Pfeiffer FM, Swope RW, Hirner JP. 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.CrossRef Choma TJ, Pfeiffer FM, Swope RW, Hirner JP. 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.CrossRef
30.
Zurück zum Zitat Chang MC, Kao HC, Ying SH, Liu CL. 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 Technol. 2013;26–6:305–15.CrossRef Chang MC, Kao HC, Ying SH, Liu CL. 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 Technol. 2013;26–6:305–15.CrossRef
31.
Zurück zum Zitat Tan QC, Wu JW, Peng F, Zang Y, Li Y, Zhao X, Lei W, Wu ZX. Augmented PMMA distribution: improvement of mechanical property and reduction of leakage rate of a fenestrated pedicle screw with diameter-tapered perforations. J Neurosurg Spine. 2016;24(6):971–7. doi:10.3171/2015.10.SPINE141275.CrossRefPubMed Tan QC, Wu JW, Peng F, Zang Y, Li Y, Zhao X, Lei W, Wu ZX. Augmented PMMA distribution: improvement of mechanical property and reduction of leakage rate of a fenestrated pedicle screw with diameter-tapered perforations. J Neurosurg Spine. 2016;24(6):971–7. doi:10.​3171/​2015.​10.​SPINE141275.CrossRefPubMed
32.
Zurück zum Zitat Kobayashi H, Fujishiro T, Belkoff SM, Kobayashi N, Turner AS, Seim HB 3rd, Zitelli J, Hawkins M, Bauer TW. Long-term evaluation of a calcium phosphate bone cement with carboxymethyl cellulose in a vertebral defect model. J Biomed Mater Res A. 2009;88–4:880–8.CrossRef Kobayashi H, Fujishiro T, Belkoff SM, Kobayashi N, Turner AS, Seim HB 3rd, Zitelli J, Hawkins M, Bauer TW. Long-term evaluation of a calcium phosphate bone cement with carboxymethyl cellulose in a vertebral defect model. J Biomed Mater Res A. 2009;88–4:880–8.CrossRef
33.
Zurück zum Zitat Larsson S, Bauer TW. Use of injectable calcium phosphate cement for fracture fixation: a review. Clin Orthop Relat Res. 2002;395:23–32.CrossRef Larsson S, Bauer TW. Use of injectable calcium phosphate cement for fracture fixation: a review. Clin Orthop Relat Res. 2002;395:23–32.CrossRef
34.
Zurück zum Zitat Walsh WR, Morberg P, Yu Y, Yang JL, Haggard W, Sheath PC, Svehla M, Bruce WJ. Response of a calcium sulfate bone graft substitute in a confined cancellous defect. Clin Orthop Relat Res. 2003;406:228–36.CrossRef Walsh WR, Morberg P, Yu Y, Yang JL, Haggard W, Sheath PC, Svehla M, Bruce WJ. Response of a calcium sulfate bone graft substitute in a confined cancellous defect. Clin Orthop Relat Res. 2003;406:228–36.CrossRef
35.
Zurück zum Zitat McLachlin SD, Al Saleh K, Gurr KR, Bailey SI, Bailey CS, Dunning CE. Comparative assessment of sacral screw loosening augmented with PMMA versus a calcium triglyceride bone cement. Spine (Phila Pa 1976). 2011;36(11):E699–704.CrossRef McLachlin SD, Al Saleh K, Gurr KR, Bailey SI, Bailey CS, Dunning CE. Comparative assessment of sacral screw loosening augmented with PMMA versus a calcium triglyceride bone cement. Spine (Phila Pa 1976). 2011;36(11):E699–704.CrossRef
36.
Zurück zum Zitat Gao M, Lei W, Wu Z, Liu D, Shi L. Biomechanical evaluation of fixation strength of conventional and expansive pedicle screws with or without calcium based cement augmentation. Clin Biomech (Bristol, Avon). 2011;26–3:238–44.CrossRef Gao M, Lei W, Wu Z, Liu D, Shi L. Biomechanical evaluation of fixation strength of conventional and expansive pedicle screws with or without calcium based cement augmentation. Clin Biomech (Bristol, Avon). 2011;26–3:238–44.CrossRef
37.
Zurück zum Zitat Hashemi A, Bednar D, Ziada S. Pullout strength of pedicle screws augmented with particulate calcium phosphate: an experimental study. Spine J. 2009;9–5:404–10.CrossRef Hashemi A, Bednar D, Ziada S. Pullout strength of pedicle screws augmented with particulate calcium phosphate: an experimental study. Spine J. 2009;9–5:404–10.CrossRef
38.
Zurück zum Zitat Moore DC, Maitra RS, Farjo LA, Graziano GP, Goldstein SA. Restoration of pedicle screw fixation with an in situ setting calcium phosphate cement. Spine (Phila Pa 1976). 1997;22(15):1696–705.CrossRef Moore DC, Maitra RS, Farjo LA, Graziano GP, Goldstein SA. Restoration of pedicle screw fixation with an in situ setting calcium phosphate cement. Spine (Phila Pa 1976). 1997;22(15):1696–705.CrossRef
39.
Zurück zum Zitat El Saman A, Meier S, Sander A, Kelm A, Marzi I, Laurer H. Reduced loosening rate and loss of correction following posterior stabilization with or without PMMA augmentation of pedicle screws in vertebral fractures in the elderly. Eur J Trauma Emerg Surg. 2013;39–5:455–60.CrossRef El Saman A, Meier S, Sander A, Kelm A, Marzi I, Laurer H. Reduced loosening rate and loss of correction following posterior stabilization with or without PMMA augmentation of pedicle screws in vertebral fractures in the elderly. Eur J Trauma Emerg Surg. 2013;39–5:455–60.CrossRef
40.
Zurück zum Zitat Sawakami K, Yamazaki A, Ishikawa S, Ito T, Watanabe K, Endo N. Polymethylmethacrylate augmentation of pedicle screws increases the initial fixation in osteoporotic spine patients. J Spinal Disord Tech. 2012;25–2:E28–35.CrossRef Sawakami K, Yamazaki A, Ishikawa S, Ito T, Watanabe K, Endo N. Polymethylmethacrylate augmentation of pedicle screws increases the initial fixation in osteoporotic spine patients. J Spinal Disord Tech. 2012;25–2:E28–35.CrossRef
41.
Zurück zum Zitat Weiser L, Dreimann M, Huber G, Sellenschloh K, Puschel K, Morlock MM, Rueger JM, Lehmann W. Cement augmentation versus extended dorsal instrumentation in the treatment of osteoporotic vertebral fractures: a biomechanical comparison. Bone Jt J. 2016;98-B(8):1099–105.CrossRef Weiser L, Dreimann M, Huber G, Sellenschloh K, Puschel K, Morlock MM, Rueger JM, Lehmann W. Cement augmentation versus extended dorsal instrumentation in the treatment of osteoporotic vertebral fractures: a biomechanical comparison. Bone Jt J. 2016;98-B(8):1099–105.CrossRef
Metadaten
Titel
Pedicle screw augmentation in osteoporotic spine: indications, limitations and technical aspects
verfasst von
S. Hoppe
M. J. B. Keel
Publikationsdatum
19.12.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 1/2017
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-016-0750-x

Weitere Artikel der Ausgabe 1/2017

European Journal of Trauma and Emergency Surgery 1/2017 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.