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Minimally Invasive Technique for PMMA Augmentation of Fenestrated Screws.

Klingler JH, Scholz C, Kogias E, Sircar R, Krüger MT, Volz F, Scheiwe C, Hubbe U - ScientificWorldJournal (2015)

Bottom Line: One screw loosening was noted (0.6%) after a mean follow-up of 12.8 months.We observed no cementation-associated complication like pulmonary embolism or hemodynamic insufficiency.Nevertheless, the optimal injection technique and design of fenestrated screws have yet to be identified.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Freiburg University Medical Center, Breisacher Straße 64, 79106 Freiburg im Breisgau, Germany.

ABSTRACT

Purpose: To describe the minimally invasive technique for cement augmentation of cannulated and fenestrated screws using an injection cannula as well as to report its safety and efficacy.

Methods: A total of 157 cannulated and fenestrated pedicle screws had been cement-augmented during minimally invasive posterior screw-rod spondylodesis in 35 patients from January to December 2012. Retrospective evaluation of cement extravasation and screw loosening was carried out in postoperative plain radiographs and thin-sliced triplanar computed tomography scans.

Results: Twenty-seven, largely prevertebral cement extravasations were detected in 157 screws (17.2%). None of the cement extravasations was causing a clinical sequela like a new neurological deficit. One screw loosening was noted (0.6%) after a mean follow-up of 12.8 months. We observed no cementation-associated complication like pulmonary embolism or hemodynamic insufficiency.

Conclusions: The presented minimally invasive cement augmentation technique using an injection cannula facilitates convenient and safe cement delivery through polyaxial cannulated and fenestrated screws during minimally invasive screw-rod spondylodesis. Nevertheless, the optimal injection technique and design of fenestrated screws have yet to be identified. This trial is registered with German Clinical Trials DRKS00006726.

No MeSH data available.


Related in: MedlinePlus

Bone cement injection cannula. The injection cannula (b) can be filled with 1.5 mL of bone cement. With the pusher (a), the bone cement is poured in the cannulated screw and the surrounding vertebral body.
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fig2: Bone cement injection cannula. The injection cannula (b) can be filled with 1.5 mL of bone cement. With the pusher (a), the bone cement is poured in the cannulated screw and the surrounding vertebral body.

Mentions: After screwing in the cannulated and fenestrated screws (CD Horizon Fenestrated Screw Spinal System, Medtronic; Figure 1), the bone cement injection cannulas (bone cement metallic injection cannula, Tsunami Medical, San Possidonio, Italy, distributed by Maxxspine, Bad Schwalbach, Germany, Figure 2) were first inserted empty into the polyaxial screw heads to check the proper fit and entry trajectory (Figure 3). After removal of injection cannulas, the PMMA cement (VertaPlex 1/2 Dose, Stryker, Duisburg, Germany) was prepared and filled into the injection cannulas, which can hold 1.5 mL of cement. The filled injection cannulas were reinserted into the screw heads sealed to avoid cement emersion into the screw heads, which could preclude rod insertion. Injection was performed with a toothpaste-like consistency of the cement. Per screw, approximately 2 mL of cement was injected in the lumbar spine and 1.5 mL of cement in the thoracic spine. For every 0.3–0.5 mL of cement injection, cement distribution was checked with fluoroscopic images in lateral projection. In case of evidence of epidural, intradiscal, or prevertebral/intravenous cement extravasation, the injection of cement was stopped.


Minimally Invasive Technique for PMMA Augmentation of Fenestrated Screws.

Klingler JH, Scholz C, Kogias E, Sircar R, Krüger MT, Volz F, Scheiwe C, Hubbe U - ScientificWorldJournal (2015)

Bone cement injection cannula. The injection cannula (b) can be filled with 1.5 mL of bone cement. With the pusher (a), the bone cement is poured in the cannulated screw and the surrounding vertebral body.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4446514&req=5

fig2: Bone cement injection cannula. The injection cannula (b) can be filled with 1.5 mL of bone cement. With the pusher (a), the bone cement is poured in the cannulated screw and the surrounding vertebral body.
Mentions: After screwing in the cannulated and fenestrated screws (CD Horizon Fenestrated Screw Spinal System, Medtronic; Figure 1), the bone cement injection cannulas (bone cement metallic injection cannula, Tsunami Medical, San Possidonio, Italy, distributed by Maxxspine, Bad Schwalbach, Germany, Figure 2) were first inserted empty into the polyaxial screw heads to check the proper fit and entry trajectory (Figure 3). After removal of injection cannulas, the PMMA cement (VertaPlex 1/2 Dose, Stryker, Duisburg, Germany) was prepared and filled into the injection cannulas, which can hold 1.5 mL of cement. The filled injection cannulas were reinserted into the screw heads sealed to avoid cement emersion into the screw heads, which could preclude rod insertion. Injection was performed with a toothpaste-like consistency of the cement. Per screw, approximately 2 mL of cement was injected in the lumbar spine and 1.5 mL of cement in the thoracic spine. For every 0.3–0.5 mL of cement injection, cement distribution was checked with fluoroscopic images in lateral projection. In case of evidence of epidural, intradiscal, or prevertebral/intravenous cement extravasation, the injection of cement was stopped.

Bottom Line: One screw loosening was noted (0.6%) after a mean follow-up of 12.8 months.We observed no cementation-associated complication like pulmonary embolism or hemodynamic insufficiency.Nevertheless, the optimal injection technique and design of fenestrated screws have yet to be identified.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Freiburg University Medical Center, Breisacher Straße 64, 79106 Freiburg im Breisgau, Germany.

ABSTRACT

Purpose: To describe the minimally invasive technique for cement augmentation of cannulated and fenestrated screws using an injection cannula as well as to report its safety and efficacy.

Methods: A total of 157 cannulated and fenestrated pedicle screws had been cement-augmented during minimally invasive posterior screw-rod spondylodesis in 35 patients from January to December 2012. Retrospective evaluation of cement extravasation and screw loosening was carried out in postoperative plain radiographs and thin-sliced triplanar computed tomography scans.

Results: Twenty-seven, largely prevertebral cement extravasations were detected in 157 screws (17.2%). None of the cement extravasations was causing a clinical sequela like a new neurological deficit. One screw loosening was noted (0.6%) after a mean follow-up of 12.8 months. We observed no cementation-associated complication like pulmonary embolism or hemodynamic insufficiency.

Conclusions: The presented minimally invasive cement augmentation technique using an injection cannula facilitates convenient and safe cement delivery through polyaxial cannulated and fenestrated screws during minimally invasive screw-rod spondylodesis. Nevertheless, the optimal injection technique and design of fenestrated screws have yet to be identified. This trial is registered with German Clinical Trials DRKS00006726.

No MeSH data available.


Related in: MedlinePlus