Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China.
Neurosurgery. 2023 Jul 1;93(1):66-74. doi: 10.1227/neu.0000000000002373. Epub 2023 Feb 7.
Epidural cement leakage (CL) is a common complication in cement-augmented fenestrated pedicle screw fixation (CAFPSF) with the potential for neural injury. However, there are no reports discussing basivertebral vein morphology and pedicle screw placement, which are critical in the analysis of the risk of epidural CL after CAFPSF.
To identify the incidence and risk factors of epidural CL in osteoporotic patients during CAFPSF.
Two hundred and eighty-two osteoporotic patients using 1404 cement-augmented fenestrated screws were included. Preoperative computed tomography (CT) was used to characterize the morphology of posterior cortical basivertebral foramen. After CAFPSF, the severity of epidural CL, the implantation position of the screw tip, and cement extension within the vertebral body were determined by postoperative CT scans. In this study, significant risk factors for epidural CL were identified through logistic regression analysis.
In total, 28 patients (18.8%) and 108 screws (7.7%) had epidural CL and 7 patients (13 screws) experienced neurological symptoms. Although local epidural CL was generally not clinically significant, extensive epidural leakage posed a higher risk of neurological symptoms. Significant predictors for extensive epidural CL were a magistral type of basivertebral foramen and the smaller distance between the tip of the screw and the posterior wall of the vertebral body.
In osteoporotic patients receiving CAFPSF, epidural CL is relatively common. The morphology of basivertebral foramen should be taken into account when planning a CAFPSF procedure. It is important to try and achieve a deeper screw implantation, especially when a magistral type of basivertebral foramen is present.
硬脊膜外水泥渗漏（CL）是增强型经皮椎弓根螺钉固定（CAFPSF）的常见并发症，有潜在的神经损伤风险。然而，目前尚无关于椎基底静脉形态和椎弓根螺钉位置的报道，而这些因素在分析 CAFPSF 后硬脊膜外 CL 的风险中至关重要。
探讨骨质疏松患者行 CAFPSF 时硬脊膜外 CL 的发生率及相关危险因素。
纳入 282 例骨质疏松症患者，共使用 1404 枚增强型经皮椎弓根螺钉。术前采用计算机断层扫描（CT）对后皮质椎基底静脉孔形态进行特征分析。CAFPSF 后，通过术后 CT 扫描确定硬脊膜外 CL 的严重程度、螺钉尖端的植入位置以及椎体内部的水泥延伸情况。本研究通过 logistic 回归分析确定硬脊膜外 CL 的显著危险因素。
共 28 例（18.8%）和 108 枚螺钉（7.7%）出现硬脊膜外 CL，7 例（13 枚螺钉）出现神经症状。尽管局部硬脊膜外 CL 通常无临床意义，但广泛的硬脊膜外渗漏更有发生神经症状的风险。广泛硬脊膜外 CL 的显著预测因素为椎基底静脉孔的主型和螺钉尖端与椎体后壁之间的距离较小。
在接受 CAFPSF 的骨质疏松症患者中，硬脊膜外 CL 较为常见。在规划 CAFPSF 手术时应考虑椎基底静脉孔的形态。特别是在存在主型椎基底静脉孔时，应尽量实现更深的螺钉植入。
