脊柱肿瘤中的开窗椎弓根螺钉：技术与比较性回顾性分析
Fenestrated Pedicle Screws in Spinal Oncology: Technique and Comparative Retrospective Analysis.
作者信息
Patel Saavan, Parola Rown, Rosinski Clayton L, Nunna Ravi S, Mehta Ankit I
机构信息
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.
出版信息
Int J Spine Surg. 2021 Feb;15(1):113-118. doi: 10.14444/8015. Epub 2021 Feb 12.
BACKGROUND
The use of spinal stabilization with decompression has been shown to improve survival, spinal stability, and ambulatory status in patients with metastatic spinal tumors. However, the poor bone quality typically seen in these patients can prevent adequate stabilization. Fenestrated pedicle screws permit augmented fixation via injection of bone cement into the vertebral body upon screw placement, potentially mitigating the difficulties in achieving adequate stabilization in these patients.
OBJECTIVE
To compare surgical outcomes of posterior spinal fusion in patients with cancerous spinal lesions between polymethyl methacrylate cement-augmented fenestrated screws and standard pedicle screws.
METHODS
A total of 19 consecutive patients with cancerous spinal lesions receiving posterior spinal fusion (PSF) with pedicle screws from a single surgeon were retrospectively reviewed for demographic information, comorbidities, surgical parameters, and outcomes.
RESULTS
Ten patients underwent PSF with cement augmentation, whereas 9 underwent standard PSF. There was no significant difference in demographics, comorbidities, or surgical characteristics. Operative time was significantly greater in the cement-augmented group (302 ± 100 minutes vs 203 ± 55 minutes; = .015). There was no significant difference in rates of operation or readmission between the cohorts nor was there any significant difference in discharge disposition. There was 1 case of surgical site infection (in a patient with a fenestrated screw) and no cases of cement extravasation. No instances of mechanical hardware failure were recorded.
CONCLUSIONS
Fenestrated screws confer similar risk profiles as nonfenestrated screws for posterior spinal fusion in patients with spinal cancer. However, fenestrated screws may affect operative time, radiation exposure, and impose risk of cement extravasation. Cement-augmented fenestrated pedicle screws may be a viable option for patients with poor bone quality associated with metastatic disease without significantly increased rates of surgical complications.
LEVEL OF EVIDENCE
背景
减压联合脊柱稳定术已被证明可提高转移性脊柱肿瘤患者的生存率、脊柱稳定性及行走能力。然而，这些患者通常骨质较差，可能无法实现充分的稳定。开窗椎弓根螺钉允许在置入螺钉时通过向椎体内注入骨水泥来增强固定，这有可能缓解在这些患者中实现充分稳定的困难。
目的
比较聚甲基丙烯酸甲酯骨水泥增强开窗螺钉与标准椎弓根螺钉用于癌性脊柱病变患者后路脊柱融合术的手术效果。
方法
回顾性分析了同一外科医生为19例连续的癌性脊柱病变患者行椎弓根螺钉后路脊柱融合术（PSF）的人口统计学信息、合并症、手术参数及手术效果。
结果
10例患者接受了骨水泥增强的PSF，9例接受了标准PSF。在人口统计学、合并症或手术特征方面无显著差异。骨水泥增强组的手术时间明显更长（302±100分钟对203±55分钟；P = 0.015）。两组之间的手术率或再入院率无显著差异，出院情况也无显著差异。有1例手术部位感染（发生在使用开窗螺钉的患者中），无骨水泥渗漏病例。未记录到机械性内固定失败病例。
结论
对于脊柱癌患者的后路脊柱融合术，开窗螺钉与非开窗螺钉的风险特征相似。然而，开窗螺钉可能会影响手术时间、辐射暴露，并存在骨水泥渗漏风险。对于与转移性疾病相关的骨质较差的患者，骨水泥增强开窗椎弓根螺钉可能是一种可行的选择，且手术并发症发生率不会显著增加。
证据级别
3级。
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