Comparison of Implant Failure between Cement Augmented Cannulated Pedicle Screws and Solid Pedicle Screws and Associated Risk Factors in Lumbar Fusion Surgery: A Pilot Study

Sung Hoon Choi; Jeong Min Hur; Joo Young You; Chang-Nam Kang

Study Design: Retrospective pilot study Objectives: To compare and analyze the rate and risk factors of implant failure according to the use of solid pedicle screws or cement augmented cannulated pedicle screws in lumbar fusion surgery. Summary of Literature Review: In previous studies, the use of cement augmented cannulated pedicle screws was found to improve the pull-out strength and to reduce the risk of implant failure in patients with osteoporosis. However, the clinical risk factors for implant failure have not been established. Materials and Methods: From January 2016 to December 2018, 177 patients with spine fracture and degenerative thoracolumbar disease were included in a retrospective study, and the patients underwent spinal fusion surgery using pedicle screws. Solid pedicle screws were used in 118 patients and cement augmented cannulated pedicle screws were used in 59 patients. During the follow-up period, simple radiography and computed tomography were performed to evaluate cases of implant failure, including pedicle screw loosening, migration, and pull-out, and to analyze risk factors for implant failure. Results: Implant failures were observed in 21 patients (11.9%, 21/177) during the follow-up period. Of the 21 patients with implant failure, 18 were in the solid pedicle screw group (15.3%, 18/118), and 3 patients were in the cement augmented cannulated pedicle screw group (5.1%, 3/59). The difference was statistically significant (p<0.05). Age over 65 years, osteoporosis, autoimmune disease (rheumatoid arthritis, systemic lupus erythematosus, etc.), chronic kidney disease, and steroid use (<0.05) were statistically significantly more common in patients who experienced implant failure. In a multiple logistic regression analysis, age over 65 (odds ratio, 4.47; p=0.032), osteoporosis (odds ratio, 3.68; p=0.017), autoimmune disease (odds ratio, 3.59; p=0.039), and chronic kidney disease (odds ratio, 4.67; p=0.043) were statistically significant risk factors for implant failure. Conclusions: Patients underwent thoracolumbar fusion who were over 65 years of age, had osteoporosis, chronic kidney disease, or autoimmune disease showed a high implant failure rate. The use of cement augmented cannulated pedicle screws might be an effective method to significantly decrease the likelihood of implant failure in patients with these risk factors.

Citation status

KCI Citation Counts (0)
REFERENCES (22)
열림/닫힘 버튼
* 2021년 이후 발행 논문의 참고문헌은 현재 구축 중입니다.

[journal] D. K. Chin / 2007 / Prevalence of osteoporosis in patients requiring spine surgery: incidence and significance of osteoporosis in spine disease / Osteoporosis International / Springer Science and Business Media LLC 18(9) : 1219~1224 / 10.1007/s00198-007-0370-8

[journal] Thomas L. Halvorson / 1994 / Effects of Bone Mineral Density on Pedicle Screw Fixation / Spine / Ovid Technologies (Wolters Kluwer Health) 19(21) : 2415~2420 / 10.1097/00007632-199411000-00008

[journal] Kosaku Higashino / 2012 / A Biomechanical Study of Two Different Pedicle Screw Methods for Fixation in Osteoporotic and Nonosteoporotic Vertebrae / Journal of Surgical Orthopaedic Advances / Data Trace Publishing Company 21(04) : 198~203 / 10.3113/jsoa.2012.0198

[journal] Tsai KJ / 2009 / Pedicle screw fixation strength: a biomechanical comparison between 4.5-mm and 5.5-mm diameter screws in osteoporotic upper thoracic vertebrae / J Surg Orthop Adv. 18(1) : 23~27

[journal] Yuanwu Cao / 2018 / Pedicle Screw with Cement Augmentation in Unilateral Transforaminal Lumbar Interbody Fusion: A 2-Year Follow-Up Study / World Neurosurgery / Elsevier BV 118 : e288~e295 / 10.1016/j.wneu.2018.06.181

[journal] Shea TM / 2014 / Designs and techniques that improve the pullout strength of pedicle screws in osteoporotic vertebrae : current status / Biomed Res Int 2014 : 748393~ / 10.1155/2014/748393

[journal] Tandon Vikas / 2020 / A Prospective Study on the Feasibility, Safety, and Efficacy of a Modified Technique to Augment the Strength of Pedicle Screw in Osteoporotic Spine Fixation / Asian Spine Journal / 대한척추외과학회 14(3) : 357~363 / 10.31616/asj.2019.0211

[journal] MASATSUNE YAMAGATA / 1992 / Mechanical Stability of the Pedicle Screw Fixation Systems for the Lumbar Spine / Spine / Ovid Technologies (Wolters Kluwer Health) 17 : 51~54 / 10.1097/00007632-199203001-00011

[journal] Wittenberg RH / 1993 / Effect of screw diameter, insertion technique, and bone cement augmentation of pedicular screw fixation strength / Clin Orthop Relat Res. 296 : 278~287

[journal] Daniel J. Burval / 2007 / Primary Pedicle Screw Augmentation in Osteoporotic Lumbar Vertebrae / Spine / Ovid Technologies (Wolters Kluwer Health) 32(10) : 1077~1083 / 10.1097/01.brs.0000261566.38422.40

[journal] A. El Saman / 2013 / Reduced loosening rate and loss of correction following posterior stabilization with or without PMMA augmentation of pedicle screws in vertebral fractures in the elderly / European Journal of Trauma and Emergency Surgery / Springer Science and Business Media LLC 39(5) : 455~460 / 10.1007/s00068-013-0310-6

[journal] Kimihiko Sawakami / 2012 / Polymethylmethacrylate Augmentation of Pedicle Screws Increases the Initial Fixation in Osteoporotic Spine Patients / Journal of Spinal Disorders & Techniques / Ovid Technologies (Wolters Kluwer Health) 25(2) : E28~E35 / 10.1097/BSD.0b013e318228bbed

[journal] Deodhar AA / 1996 / Bone mass measurement and bone metabolism in rheumatoid arthritis : a review / Br J Rheumatol 35(4) : 309~322 / 10.1093/rheumatology/35.4.309

[journal] Haugeberg G / 2000 / Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis : results from 394patients in the Oslo County Rheumatoid Arthritis register / Arthritis Rheum 43(3) : 522~530 / 10.1002/1529-0131(200003)43:3<522::Aidanr7>3.0.Co;2-y

[journal] Kosaku Nitta / 2017 / Management of Osteoporosis in Chronic Kidney Disease / Internal Medicine / Japanese Society of Internal Medicine 56(24) : 3271~3276 / 10.2169/internalmedicine.8618-16

[journal] S. Hoppe / 2017 / Pedicle screw augmentation in osteoporotic spine: indications, limitations and technical aspects / European Journal of Trauma and Emergency Surgery / Springer Science and Business Media LLC 43(1) : 3~8 / 10.1007/s00068-016-0750-x

[journal] Kuo-Hua Chao / 2013 / Biomechanical analysis of different types of pedicle screw augmentation: A cadaveric and synthetic bone sample study of instrumented vertebral specimens / Medical Engineering & Physics / Elsevier BV 35(10) : 1506~1512 / 10.1016/j.medengphy.2013.04.007

[journal] Rebecca A. Kueny / 2014 / Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing / European Spine Journal / Springer Science and Business Media LLC 23(10) : 2196~2202 / 10.1007/s00586-014-3476-7

[journal] Ming-Chau Chang / 2008 / Polymethylmethacrylate Augmentation of Pedicle Screw for Osteoporotic Spinal Surgery / Spine / Ovid Technologies (Wolters Kluwer Health) 33(10) : E317~E324 / 10.1097/BRS.0b013e31816f6c73

[journal] Philippe E. Paré / 2011 / Biomechanical Evaluation of a Novel Fenestrated Pedicle Screw Augmented With Bone Cement in Osteoporotic Spines / Spine / Ovid Technologies (Wolters Kluwer Health) 36(18) : E1210~E1214 / 10.1097/BRS.0b013e318205e3af

[journal] Frankel BM / 2007 / A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation / J Neurosurg Spine 7(1) : 47~53 / 10.3171/spi-07/07/047

[journal] Viola Bullmann / 2010 / Revision of Cannulated and Perforated Cement-Augmented Pedicle Screws / Spine / Ovid Technologies (Wolters Kluwer Health) 35(19) : E932~E939 / 10.1097/BRS.0b013e3181c6ec60

KJC Korea
Journal Central

Statistics

Tools

Sharing

Issue List

Citation status