Segmental polymethylmethacrylate-augmented pedicle screw fixation in patients with bone softening caused by osteoporosis and metastatic tumor involvement: a clinical evaluation.
OBJECTIVE
Instrumentation of the osteoporotic spine may result in bone failure because of pedicle screw loosening and pullout. A clinical evaluation of a novel fenestrated bone tap used in pedicle screw augmentation was performed to determine the performance and safety of this technique.


METHODS
Over a 2.5-year period, the clinical and radiographic results of 119 consecutive patients who underwent instrumented arthrodesis were reviewed. Of these patients, 23 had bone softening secondary to osteoporosis and/or metastatic spinal tumor involvement. These patients underwent surgical decompression and spinal instrumentation.


RESULTS
Six patients (26%) had metastatic spine disease (squamous cell lung carcinoma, renal cell carcinoma, bladder carcinoma, breast, prostate, and uterine adenocarcinoma); five patients (22%) had a degenerative spondylolisthesis; and 12 patients (52%) had burst fractures, eight as a result of benign causes and four as a result of metastatic disease. Four (17%) patients underwent revision surgery of previous pedicle screw failure resulting from bone softening and pseudarthrosis. A total of 98 levels were fused using 158 polymethylmethacrylate-augmented screws. None of the patients experienced operative death, myocardial infarction, hypoxemia, intraoperative hypotension, radiculopathy, or myelopathy. Asymptomatic anterior cement extravasation was observed in nine patients (39%). There was one asymptomatic polymethylmethacrylate pulmonary embolus and one wound infection. There was no significant relationship between cement extravasation and the quantity used, levels augmented, or location (P > 0.05). There were no construct failures.


CONCLUSIONS
Polymethylmethacrylate-augmented pedicle screw fixation reduces the likelihood of pedicle screw loosening and pullout in patients with osteoporosis requiring instrumented arthrodesis.
Frankel
Bruce M
BM
Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA. frankel@musc.edu
Jones
Tanya
T
Wang
Chiang
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D001863:Bone Screws / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators / Q000592:standards; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000601:surgery*; D019904:Polymethyl Methacrylate / Q000592:standards*; D013125:Spinal Neoplasms / Q000150:complications / Q000601:surgery*
D019904:Polymethyl Methacrylate