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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

Intraoperative setting. The injection cannulas had been filled with bone cement and had been introduced through the screw extenders into the screw heads. The pushers were inserted to inject the bone cement through the cannulated screws and their fenestrations in the distal third of the thread into the vertebral body under fluoroscopic monitoring.
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fig4: Intraoperative setting. The injection cannulas had been filled with bone cement and had been introduced through the screw extenders into the screw heads. The pushers were inserted to inject the bone cement through the cannulated screws and their fenestrations in the distal third of the thread into the vertebral body under fluoroscopic monitoring.

Mentions: Performing percutaneous cement-augmentation of cannulated and fenestrated screws is a further development in minimally invasive spine surgery [12, 13]. Since the inserted polyaxial screws are mounted with screw extenders (Figure 4), a connection device has to be used for injecting bone cement. We investigated the application and results using an injection cannula in 157 minimally invasive cement-augmented screws in 35 patients. In our experience, the injection cannula warrants a proper fit of its tip in the screw head and, hence, minimizes the risk of cement extravasation in the screw head. This is important, since hardened cement in the screw head might preclude minimally invasive insertion of the rod. Accordingly, we did not experience this phenomenon in our series. A further advantage of the injection cannula is the compatibility with different spine fixation systems (e.g., CD Horizon Sextant II, CD Horizon Longitude, or CD Horizon Sextant Legacy (Medtronic, Minneapolis, USA)).


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)

Intraoperative setting. The injection cannulas had been filled with bone cement and had been introduced through the screw extenders into the screw heads. The pushers were inserted to inject the bone cement through the cannulated screws and their fenestrations in the distal third of the thread into the vertebral body under fluoroscopic monitoring.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig4: Intraoperative setting. The injection cannulas had been filled with bone cement and had been introduced through the screw extenders into the screw heads. The pushers were inserted to inject the bone cement through the cannulated screws and their fenestrations in the distal third of the thread into the vertebral body under fluoroscopic monitoring.
Mentions: Performing percutaneous cement-augmentation of cannulated and fenestrated screws is a further development in minimally invasive spine surgery [12, 13]. Since the inserted polyaxial screws are mounted with screw extenders (Figure 4), a connection device has to be used for injecting bone cement. We investigated the application and results using an injection cannula in 157 minimally invasive cement-augmented screws in 35 patients. In our experience, the injection cannula warrants a proper fit of its tip in the screw head and, hence, minimizes the risk of cement extravasation in the screw head. This is important, since hardened cement in the screw head might preclude minimally invasive insertion of the rod. Accordingly, we did not experience this phenomenon in our series. A further advantage of the injection cannula is the compatibility with different spine fixation systems (e.g., CD Horizon Sextant II, CD Horizon Longitude, or CD Horizon Sextant Legacy (Medtronic, Minneapolis, USA)).

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