title: Application of cement on strategic vertebrae in the treatment of the osteoporotic spine.
abstract: The application of pedicle screws with cement to strengthen the fixation of the osteoporotic spine has increasingly gained popularity. However, the technique has also led to an increase in cement-related complications.
  
  
  
  The aim of the present study was to compare the clinical and radiological results of the patients with degenerative spinal pathologies who were treated with pedicle screws and cement injections on all segments versus those who were treated with cement injections only on the strategic vertebrae selected.
  
  
  
  A retrospective clinical study.
  
  
  
  The sample consists of 31 patients who underwent spinal surgery due to degenerative spinal pathologies.
  
  
  
  Patients were assessed for the adequate spinal fusion and cement-related complication parameters.
  
  
  
  Thirty-one patients with a minimum follow-up period of 2 years were divided into two groups and evaluated. Group A consisted of 17 patients (14 females, 3 males; mean age: 68.1 years) with cemented pedicle screws and Group B consisted of 14 patients (12 females, 2 males; mean age: 67.2 years) with cemented screws on selected vertebrae alone. Selection of the strategic vertebrae was made by taking the most stressed regions in the fusion site into account. Prophylactic vertebroplasty was performed in all patients in Group A and on strategic segments in Group B to avoid an adjacent segment fracture. Early- and late-term complications during the follow-up period were recorded.
  
  
  
  Mean follow-up period was 51.8 (range: 31 to 80) months in Group A and 41.2 (range: 26 to 61) months in Group B. Cemented pedicle screws were bilaterally placed on 94 vertebrae in Group A. In Group B, cement was applied on 28 of 80 vertebrae. Including the prophylactic vertebroplasties, a total of 111 cement applications were performed in Group A and 38 in Group B. Cement embolism, symptomatic chest discomfort, and duration of surgery were significantly higher in Group A (p<.05). No adjacent segment fracture in the proximal or distal vertebra, implant failure, or loss of correction was seen throughout the follow-up period.
  
  
  
  The application of cemented pedicle screws on all segments of the osteoporotic spine increases the cement volume and rate of cement-related complications. Cementing the strategic vertebrae alone will enhance the fixation strength and endurance and decrease the complications caused by cement application.
authors.affiliation: Department of Orthopaedics and Traumatology, Hisar Intercontinental Hospital, Site Yolu Cad. No:7 34768, Umraniye, Istanbul, Turkey. Electronic address: mnerdem@yandex.com.
authors.forename: Mehmet Nuri
authors.initials: MN
authors.lastname: Erdem
authors.affiliation: Department of Orthopaedics and Traumatology, Fatih Sultan Mehmet Education and Research Hospital, E5 Karayolu 34752, Icerenkoy, Atasehir, Istanbul, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Karaca
authors.affiliation: Department of Orthopaedics and Traumatology, Memorial Hospital, Piyalepasa Bulvarı 34385, Sisli, Istanbul, Turkey.
authors.forename: Seckin
authors.initials: S
authors.lastname: Sarı
authors.affiliation: Department of Orthopaedics and Traumatology, Memorial Hospital, Piyalepasa Bulvarı 34385, Sisli, Istanbul, Turkey.
authors.forename: Feridun
authors.initials: F
authors.lastname: Yumrukcal
authors.affiliation: Bosphorus Spine Center, Yesil Cimen Sokak No:9, Besiktas, Istanbul, Turkey.
authors.forename: Ruhat
authors.initials: R
authors.lastname: Tanli
authors.affiliation: Bosphorus Spine Center, Yesil Cimen Sokak No:9, Besiktas, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Aydogan
mesh_terms: D000368:Aged; D001843:Bone Cements / Q000009:adverse effects / Q000627:therapeutic use*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000601:surgery*; D065289:Pedicle Screws; D019904:Polymethyl Methacrylate / Q000009:adverse effects / Q000627:therapeutic use*; D011859:Radiography; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D054854:Vertebroplasty / Q000295:instrumentation / Q000379:methods
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate
keywords: Cement augmentation; Cement complications; Osteoporosis; Pedicle screw augmentation; Spine surgery; Vertebroplasty