title: Augmentation of transpedicular screws by intraoperative vertebroplasty.
abstract: OBJECTIVE
  The aim of the study was to determine the efficacy of posterior spinal stabilization, combined with intraoperative vertebroplasty defined as intraoperative filling of instrumented vertebral bodies (VB) with polymethylmethacrylate (PMMA).
  
  
  METHODS
  Seventeen patients with osteoporosis or osteopenia underwent posterior spinal fusions. The surgical procedures included laminectomy, spondylodesis, insertion of pedicular screws, intraoperative vertebroplasty and correction of spinal deformity.
  
  
  RESULTS
  Postoperative assessment showed improvement of pain in all cases. Motor deficit regressed in 2 of 3 afflicted patients. In 12 vertebrae (27.3%), the mass of PMMA ex-tended from one endplate to another, filling 100% of VB height, in 7 (15.9%) it filled 90-99%, in 14 (31.8%) 80-89%, in 9 (20.4%) 70-79%, and in 2 (4.5%) it filled 50-60% of VB height. In the horizontal plane, PMMA filled central parts of 72.7% of vertebral bodies. PMMA completely surrounded 68.9% of screws, and partially surrounded 18.4% of screws, whereas 12.6% of screws had no contact with cement mass. Spinal stabilization reduced kyphotic deformity in 15 patients (range of reduction: 6°-25°; mean: 13.6°). During follow-up (3-32 months; mean: 16) implants of 11 patients were stable, 1 implant instability was diagnosed 7 months after surgery, 5 patients were lost to follow-up. Asymptomatic cement leaks occurred in 45% of vertebrae.
  
  
  CONCLUSIONS
  Intraoperative vertebroplasty performed after insertion of pedicular screws may be considered as a technical variation useful to stabilize osteoporotic spines. After PMMA hardening, intraoperative manoeuvres to correct spinal deformity were possible without any damage of instrumented vertebrae.
authors: Klinika Neurochirurgii i Chirurgii Nerwów Obwodowych, Uniwersytet Medyczny w Łodzi, Uniwersytecki Szpital Kliniczny WAM-CSW, Łódź. krzysztofzapalowicz@wp.pl
authors: Krzysztof
authors: K
authors: Zapałowicz
authors: Bartosz
authors: B
authors: Godlewski
authors: Rusłan
authors: R
authors: Jekimov
authors: Marek
authors: M
authors: Grochal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000601:surgery*; D010147:Pain Measurement; D019904:Polymethyl Methacrylate; D011859:Radiography; D020127:Recovery of Function; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D054854:Vertebroplasty / Q000295:instrumentation* / Q000379:methods
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate