Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
Oper Neurosurg (Hagerstown). 2019 May 1;16(5):593-599. doi: 10.1093/ons/opy186.
Cancer patients experience pathological fractures and the typical poor bone quality frequently complicates stabilization. Methods for overcoming screw failure include utilization of fenestrated screws that permit the injection of bone cement into the vertebral body to augment fixation.
To evaluate the safety and efficacy of cement augmentation via fenestrated screws.
A retrospective chart review of patients with neoplastic spinal instability who underwent percutaneous instrumented stabilization with cement augmentation using fenestrated pedicle screws. Patient demographic and treatment data and intraoperative and postoperative complications were evaluated by chart review and radiographic evaluation. Prospectively collected patient reported outcomes (PRO) were evaluated at short (2- <6 mo) and long term (6-12 mo).
Cement augmentation was performed in 216 fenestrated pedicle screws in 53 patients. Three patients required reoperation. One patient had an asymptomatic screw fracture at 6 mo postoperatively that did not require intervention. No cases of lucency around the pedicle screws, rod fractures, or cement extravasation into the spinal canal were observed. Eight cases of asymptomatic, radiographically-detected venous extravasation were found. Systemic complications included a pulmonary cement embolism, a lower extremity deep vein thrombosis, and a postoperative mortality secondary to pulmonary failure from widespread metastatic pulmonary infiltration. Significant improvement in PRO measures was found in short- and long-term analysis.
Cement augmentation of pedicle screws is an effective method to enhance the durability of spinal constructs in the cancer population. Risks include cement extravasation into draining blood vessels, but risk of clinically significant extravasation appears to be exceedingly low.
癌症患者会出现病理性骨折，典型的骨质差常使稳定复杂化。克服螺钉失效的方法包括使用带孔螺钉，使骨水泥注入椎体以增强固定。
评估经皮骨水泥强化带孔螺钉的安全性和有效性。
对接受经皮带孔椎弓根螺钉固定骨水泥强化治疗的肿瘤性脊柱不稳定患者进行回顾性图表分析。通过图表回顾和影像学评估评估患者的人口统计学和治疗数据以及术中术后并发症。前瞻性收集的患者报告结局（PRO）在短期（2-<6 个月）和长期（6-12 个月）进行评估。
在 53 例患者的 216 枚带孔椎弓根螺钉中进行了骨水泥强化。3 例患者需要再次手术。1 例患者术后 6 个月无症状螺钉骨折，无需干预。未观察到椎弓根螺钉周围透亮、杆断裂或骨水泥向椎管内渗漏。发现 8 例无症状、影像学检测到的静脉外渗。全身并发症包括肺骨水泥栓塞、下肢深静脉血栓形成和因广泛转移性肺浸润导致的术后肺功能衰竭引起的死亡。在短期和长期分析中均发现 PRO 测量显著改善。
椎弓根螺钉骨水泥强化是增强癌症患者脊柱结构耐久性的有效方法。风险包括骨水泥向引流血管外渗，但临床上明显外渗的风险似乎极低。
