Neurosurg Focus. 2021 May;50(5):E12. doi: 10.3171/2021.2.FOCUS201121.
Achieving rigid spinal fixation can be challenging in patients with cancer-related instability, as factors such as osteopenia, radiation, and immunosuppression adversely affect bone quality. Augmenting pedicle screws with cement is a strategy to overcome construct failure. This study aimed to assess the safety and efficacy of cement augmentation with fenestrated pedicle screws in patients undergoing posterior, open thoracolumbar surgery for spinal metastases.
A retrospective review was performed for patients who underwent surgery for cancer-related spine instability from 2016 to 2019 at the Massachusetts General Hospital. Patient demographics, surgical details, radiographic characteristics, patterns of cement extravasation, complications, and prospectively collected Patient-Reported Outcomes Measurement Information System Pain Interference and Pain Intensity scores were analyzed using descriptive statistics. Logistic regression was performed to determine factors associated with cement extravasation.
Sixty-nine patients underwent open posterior surgery with a total of 502 cement-augmented screws (mean 7.8 screws per construct). The median follow-up period for those who survived past 90 days was 25.3 months (IQR 10.8-34.6 months). Thirteen patients (18.8%) either died within 90 days or were lost to follow-up. Postoperative CT was performed to assess the instrumentation and patterns of cement extravasation. There was no screw loosening, pullout, or failure. The rate of cement extravasation was 28.9% (145/502), most commonly through the segmental veins (77/145, 53.1%). Screws breaching the lateral border of the pedicle but with fenestrations within the vertebral body were associated with a higher risk of leakage through the segmental veins compared with screws without any breach (OR 8.77, 95% CI 2.84-29.79; p < 0.001). Cement extravasation did not cause symptoms except in 1 patient who developed a symptomatic thoracic radiculopathy requiring decompression. There was 1 case of asymptomatic pulmonary cement embolism. Patients experienced significant pain improvement at the 3-month follow-up, with decreases in Pain Interference (mean change 15.8, 95% CI 14.5-17.1; p < 0.001) and Pain Intensity (mean change 28.5, 95% CI 26.7-30.4; p < 0.001).
Cement augmentation through fenestrated pedicle screws is a safe and effective option for spine stabilization in the cancer population. The risk of clinically significant adverse events from cement extravasation is very low.
在患有癌症相关性不稳定的患者中，实现刚性脊柱固定可能具有挑战性，因为骨质疏松症、放射治疗和免疫抑制等因素会对骨质量产生不利影响。用骨水泥增强椎弓根螺钉是克服结构失败的一种策略。本研究旨在评估在接受后路、开放性胸腰椎转移癌手术的患者中，使用带孔椎弓根螺钉进行骨水泥增强的安全性和有效性。
对 2016 年至 2019 年在马萨诸塞州综合医院接受手术治疗癌症相关性脊柱不稳定的患者进行回顾性研究。使用描述性统计方法分析患者的人口统计学、手术细节、影像学特征、骨水泥外渗模式、并发症以及前瞻性收集的患者报告的结果测量信息系统疼痛干扰和疼痛强度评分。使用逻辑回归确定与骨水泥外渗相关的因素。
69 例患者接受后路开放性手术，共使用 502 枚骨水泥增强螺钉（每例平均 7.8 枚螺钉）。在 90 天内存活且随访时间超过 90 天的患者中位随访时间为 25.3 个月（IQR 10.8-34.6 个月）。13 例（18.8%）患者在 90 天内死亡或失访。术后进行 CT 检查以评估器械和骨水泥外渗的模式。未发生螺钉松动、拔出或失败。骨水泥外渗率为 28.9%（145/502），最常见于节段静脉（77/145，53.1%）。与没有任何突破的螺钉相比，突破椎弓根侧缘但在椎体中有开窗的螺钉与通过节段静脉渗漏的风险更高（OR 8.77，95%CI 2.84-29.79；p<0.001）。除 1 例发生症状性胸神经根病需要减压的患者外，骨水泥外渗均无任何症状。1 例患者出现无症状性肺水泥栓塞。患者在 3 个月随访时疼痛明显改善，疼痛干扰评分（平均变化 15.8，95%CI 14.5-17.1；p<0.001）和疼痛强度评分（平均变化 28.5，95%CI 26.7-30.4；p<0.001）降低。
通过带孔椎弓根螺钉进行骨水泥增强是癌症患者脊柱稳定的一种安全有效的选择。骨水泥外渗引起临床显著不良事件的风险非常低。
