Spiegl Ulrich J A, Gomon Philipp, Osterhoff Georg, Heyde Christoph-E, Pieroh Philipp
Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
Brain Spine. 2025 Feb 28;5:104227. doi: 10.1016/j.bas.2025.104227. eCollection 2025.
Although cement augmentation of pedicle screws increases stability, complications, such as pulmonary embolism, must be considered. One possible approach to minimize complication risk is not augmenting all pedicle screws. It remains unclear whether full augmentation is necessary or if restricted cement augmentation is sufficient regarding cement-associated complications, implant failure, or adjacent fractures.
Is there a difference in cement-associated complications, implant failure rate, and revision rates in non-cemented, fully augmented, and restricted cement-augmented long-segment posterior stabilization of the thoracolumbar spine?
In a single-center retrospective observational study, patients aged ≥60 years who underwent pedicle screw fixation of ≥3 segments in the thoracic/lumbar spine treating an osteoporotic fracture, metastatic lesion, or ankylosing spondylitis fracture were enrolled and categorized into no, full, and restricted cementation groups. Demographics, cement-associated complications, revision surgeries, implant failures, adjacent fractures, and other complications were also recorded.
Cement leakage rate was significantly higher in the full than in the restricted cementation group (p < 0.05), with no sign of pulmonary embolism in either group. Patients with osteoporotic fractures experienced implant failure and adjacent fractures significantly more frequently than those with other pathologies (p < 0.05). In the full cementation group, the rate of screw cut-out with fractures of the last instrumented vertebra and adjacent fractures was the highest (p < 0.05).
Restricted cementation does not result in a higher rate of complications, particularly cement-associated complications, screw cut-out, or implant failure, and appears more favorable than full cementation.
尽管椎弓根螺钉骨水泥强化可增加稳定性，但必须考虑诸如肺栓塞等并发症。一种将并发症风险降至最低的可能方法是并非对所有椎弓根螺钉都进行强化。关于骨水泥相关并发症、植入物失败或相邻椎体骨折，全强化是否必要或有限的骨水泥强化是否足够仍不清楚。
在非骨水泥、全骨水泥强化和有限骨水泥强化的胸腰椎长节段后路稳定手术中，骨水泥相关并发症、植入物失败率和翻修率是否存在差异？
在一项单中心回顾性观察研究中，纳入年龄≥60岁、因骨质疏松性骨折、转移性病变或强直性脊柱炎骨折而接受胸腰椎≥3节段椎弓根螺钉固定的患者，并将其分为无骨水泥组、全骨水泥组和有限骨水泥组。还记录了人口统计学资料、骨水泥相关并发症、翻修手术、植入物失败、相邻椎体骨折及其他并发症。
全骨水泥组的骨水泥渗漏率显著高于有限骨水泥组（p<0.05），两组均无肺栓塞迹象。骨质疏松性骨折患者的植入物失败和相邻椎体骨折发生率明显高于其他病理情况的患者（p<0.05）。在全骨水泥组中，最后固定椎体骨折伴螺钉拔出及相邻椎体骨折的发生率最高（p<0.05）。
有限骨水泥强化不会导致更高的并发症发生率，尤其是骨水泥相关并发症、螺钉拔出或植入物失败，而且似乎比全骨水泥强化更具优势。
