Archie Adam T, Waldrop Raymond Paul, Kisinde Stanley, Lieberman Isador H
Department of Orthopaedic Surgery at the Medical College of Georgia at Augusta University, Augusta, GA, 30912, USA.
Department of Orthopaedic Surgery, JPS Health Network, Fort Worth, TX, 76104, USA.
Eur Spine J. 2025 Apr 26. doi: 10.1007/s00586-025-08792-2.
Cement-augmented pedicle screw instrumentation procedures are performed for stabilization in patients with surgical spinal conditions with poor bone quality at the target levels. Although this is done to combat the risk of failure due to loosening, cutting out or pulling out of the screws, failure may still occur. The purpose of this study was to identify the modalities and rates of failure of CAPSI constructs to better predict occurrence of failure.
We retrospectively reviewed clinical data of patients who underwent CAPSI fusion procedures between 2010 and 2022. We collected pre, intra and post-operative clinical and radiographic data.
621 pedicle screws in 319 levels were augmented out of 1333 screws in 809 instrumented levels in 120 patients. F:M = 3:1; mean age 68.6 years and mean BMI 27.10. The mean length of follow up overall was 2.2 years (Range 7 days-11 years). The most common surgical indications were degenerative scoliosis and osteoporotic fractures. Construct failure occurred in 32 cases; seven cases were associated with trauma and 11 cases presented with a neurologic deficit. The most common modality of failure was osteonecrotic collapse (20 cases); proximal construct failure occurred in 22 cases; there was evidence of haloing at the screw-bone-cement interfaces in 23 out 32 cases. 21 out of 32 cases required revision surgical procedures within an average of 453 days.
Failure of CAPSI constructs occurred in 26.7% of patients. High occurrence of osteonecrotic collapse and haloing at the screw-cement-bone interfaces likely represents a relationship with construct failure.
对于目标节段骨质质量较差的脊柱外科疾病患者，会采用骨水泥增强椎弓根螺钉内固定术来实现稳定。尽管这样做是为了应对因螺钉松动、穿出或拔出而导致失败的风险，但失败情况仍可能发生。本研究的目的是确定骨水泥增强椎弓根螺钉内固定术（CAPSI）结构失败的方式和发生率，以便更好地预测失败的发生情况。
我们回顾性分析了2010年至2022年间接受CAPSI融合手术患者的临床资料。收集了术前、术中和术后的临床及影像学资料。
120例患者的809个内固定节段共1333枚螺钉中，319个节段的621枚椎弓根螺钉进行了骨水泥增强。男女比例为3:1；平均年龄68.6岁，平均体重指数27.10。总体平均随访时间为2.2年（范围7天至11年）。最常见的手术指征是退行性脊柱侧凸和骨质疏松性骨折。32例发生了内固定结构失败；7例与创伤有关，11例出现神经功能缺损。最常见的失败方式是骨坏死塌陷（20例）；近端内固定结构失败22例；32例中有23例在螺钉-骨-骨水泥界面有晕圈迹象。32例中有21例平均在453天内需要翻修手术。
26.7%的患者发生了CAPSI结构失败。骨坏死塌陷的高发生率以及螺钉-骨水泥-骨界面的晕圈迹象可能与内固定结构失败有关。
