Park Jae Hoo, Ju Chang Il, Kim Seok Won
Department of Neurosurgery, Chosun University College of Medicine, Gwangju, Korea.
J Korean Neurosurg Soc. 2018 Jan;61(1):114-119. doi: 10.3340/jkns.2017.0202.004. Epub 2017 Dec 29.
The purpose of this study was to determine the feasibility of screw fixation in previously augmented vertebrae with bone cement. We also investigated the influence of cement distribution pattern on the surgical technique.
Fourteen patients who required screw fixation at the level of the previous percutaneous vertebroplasty or balloon kyphoplasty were enrolled in this study. The indications for screw fixation in the previously augmented vertebrae with bone cement included delayed complications, such as cement dislodgement, cement leakage with neurologic deficits, and various degenerative spinal diseases, such as spondylolisthesis or foraminal stenosis. Clinical outcomes, including pain scale scores, cement distribution pattern, and procedure-related complications were assessed.
Three patients underwent posterior screw fixation in previously cemented vertebrae due to cement dislodgement or progressive kyphosis. Three patients required posterior screw fixation for cement leakage or displacement of fracture fragments with neurologic deficits. Eight patients underwent posterior screw fixation due to various degenerative spinal diseases. It was possible to insert screws in the previously augmented vertebrae regardless of the cement distribution pattern; however, screw insertion was more difficult and changed directions in the patients with cemented vertebrae exhibiting a solid pattern rather than a trabecular pattern. All patients showed significant improvements in pain compared with the preoperative levels, and no patient experienced neurologic deterioration as seen at the final follow-up.
For patients with vertebrae previously augmented with bone cement, posterior screw fixation is not a contraindication, but is a feasible option.
本研究的目的是确定在先前已用骨水泥强化的椎体中进行螺钉固定的可行性。我们还研究了骨水泥分布模式对手术技术的影响。
本研究纳入了14例需要在先前经皮椎体成形术或球囊后凸成形术的水平进行螺钉固定的患者。在先前已用骨水泥强化的椎体中进行螺钉固定的适应证包括延迟并发症，如骨水泥移位、伴有神经功能缺损的骨水泥渗漏，以及各种退行性脊柱疾病，如椎体滑脱或椎间孔狭窄。评估临床结果，包括疼痛评分、骨水泥分布模式和与手术相关的并发症。
3例患者因骨水泥移位或进行性后凸畸形而在先前已注入骨水泥的椎体中进行了后路螺钉固定。3例患者因骨水泥渗漏或伴有神经功能缺损的骨折碎片移位而需要进行后路螺钉固定。8例患者因各种退行性脊柱疾病而进行了后路螺钉固定。无论骨水泥分布模式如何，均可在先前已强化的椎体中插入螺钉；然而，在骨水泥呈致密模式而非小梁模式的椎体患者中，螺钉插入更困难且方向发生改变。与术前水平相比，所有患者的疼痛均有显著改善，且在最后随访时无患者出现神经功能恶化。
对于先前已用骨水泥强化椎体的患者，后路螺钉固定并非禁忌证，而是一种可行的选择。
