Effect of Fenestrated Pedicle Screws with Cement Augmentation in Osteoporotic Patients Undergoing Spinal Fusion

Authors

Yamaan S. Saadeh, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Kevin N. Swong, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Timothy J. Yee, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Michael J. Strong, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Osama N. Kashlan, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Nicholas J. Szerlip, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Mark E. Oppenlander, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Paul Park, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA. Electronic address: ppark@med.umich.edu.

Document Type

Article

Abstract

OBJECTIVE: Osteoporosis is a well-known risk factor for instrumentation failure and subsequent pseudoarthrosis after spinal fusion. In the present systematic review, we analyzed the biomechanical properties, clinical efficacy, and complications of cement augmentation via fenestrated pedicle screws in spinal fusion. METHODS: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Reports appearing in the PubMed database up to March 31, 2020 were queried using the key words "cement," "pedicle screw," and "osteoporosis." We excluded non-English language studies, studies reported before 2000, studies that had involved use of cement without fenestrated pedicle screws, nonhuman studies, technical reports, and individual case reports. RESULTS: Twenty-five studies met the inclusion criteria. Eleven studies had tested the biomechanics of cement-augmented fenestrated pedicle screws. The magnitude of improvement achieved by cement augmentation of pedicle screws increased with the degree of osteoporosis. The cement-augmented fenestrated pedicle screw was superior biomechanically to the alternative "solid-fill" technique. Fourteen studies had evaluated complications. Cement extravasation with fenestrated screw usage was highly variable, ranging from 0% to 79.7%. However, cement extravasation was largely asymptomatic. Thirteen studies had assessed the outcomes. The use of cement-augmented fenestrated pedicles decreased screw pull out and improved fusion rates; however, the clinical outcomes were similar to those with traditional pedicle screw placement. CONCLUSIONS: The use of cement-augmented fenestrated pedicle screws can be an effective strategy for achieving improved pedicle screw fixation in patients with osteoporosis. A potential risk is cement extravasation; however, this complication will typically be asymptomatic. Larger comparative studies are needed to better delineate the clinical efficacy.

Medical Subject Headings

Biomechanical Phenomena (physiology); Bone Cements; Humans; Osteoporosis (physiopathology, surgery); Pedicle Screws; Retrospective Studies; Spinal Fusion (instrumentation, methods); Treatment Outcome

Publication Date

11-1-2020

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

143

First Page

e351

Last Page

e361

PubMed ID

32771604

Digital Object Identifier (DOI)

10.1016/j.wneu.2020.07.154

Recommended Citation

Saadeh, Yamaan S.; Swong, Kevin N.; Yee, Timothy J.; Strong, Michael J.; Kashlan, Osama N.; Szerlip, Nicholas J.; Oppenlander, Mark E.; and Park, Paul, "Effect of Fenestrated Pedicle Screws with Cement Augmentation in Osteoporotic Patients Undergoing Spinal Fusion" (2020). Neurosurgery. 1622.
https://scholar.barrowneuro.org/neurosurgery/1622