title: [Use of pedicle percutaneous cemented screws in the management of patients with poor bone stock].
abstract: BACKGROUND
  Management of patients with poor bone stock remains difficult due to the risks of mechanical complications such as screws pullouts. At the same time, development of minimal invasive spinal techniques using a percutaneous approach is greatly adapted to these fragile patients with a reduction in operative time and complications. The aim of this study was to report our experience with cemented percutaneous screws in the management of patients with a poor bone stock.
  
  
  METHODS
  Thirty-five patients were included in this retrospective study. In each case, a percutaneous osteosynthesis using cemented screws was performed. Indications were osteoporotic fractures, metastasis or fractures on ankylosing spine. Depending on radiologic findings, short or long constructs (2 levels above and below) were performed and an anterior column support (kyphoplasty or anterior approach) was added. Evaluation of patients was based on pre and postoperative CT-scans associated with clinical follow-up with a minimum of 6 months.
  
  
  RESULTS
  Eleven men and 24 women with a mean age of 73 years [60-87] were included in the study. Surgical indication was related to an osteoporotic fracture in 20 cases, a metastasis in 13 cases and a fracture on ankylosing spine in the last 2 cases. Most of the fractures were located between T10 and L2 and a long construct was performed in 22 cases. Percutaneous kyphoplasty was added in 24 cases and a complementary anterior approach in 3 cases. Average operative time was 86minutes [61-110] and blood loss was estimated as minor in all the cases. In the entire series, average volume of cement injected was 1.8 cc/screw. One patient underwent a major complication with a vascular leakage responsible for a cement pulmonary embolism. With a 9 months average follow-up [6-20], no cases of infection or mechanical complication was reported.
  
  
  CONCLUSIONS
  Minimal invasive spinal techniques are greatly adapted to the management of fragile patients. The use of percutaneous cemented screws is, in our experience, a valuable alternative for spinal fixation in patients with poor bone stock. This technique allows a good bony fixation with a low rate of complications. However, rigorous preoperative planning is necessary in order to avoid complications.
authors.affiliation: Unité de chirurgie du rachis, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Pesenti
authors.affiliation: Unité de chirurgie du rachis, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
authors.forename: T
authors.initials: T
authors.lastname: Graillon
authors.affiliation: Unité de chirurgie du rachis, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
authors.forename: N
authors.initials: N
authors.lastname: Mansouri
authors.affiliation: Unité de chirurgie du rachis, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
authors.forename: T
authors.initials: T
authors.lastname: Adetchessi
authors.affiliation: Unité de chirurgie du rachis, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
authors.forename: P
authors.initials: P
authors.lastname: Tropiano
authors.affiliation: Unité de chirurgie du rachis, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
authors.forename: B
authors.initials: B
authors.lastname: Blondel
authors.affiliation: Unité de chirurgie du rachis, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France. Electronic address: sfuentes@ap-hm.fr.
authors.forename: S
authors.initials: S
authors.lastname: Fuentes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000009:adverse effects; D015519:Bone Density; D001863:Bone Screws; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D058498:Kyphoplasty; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000601:surgery; D011183:Postoperative Complications / Q000139:chemically induced; D011655:Pulmonary Embolism / Q000139:chemically induced; D016103:Spinal Fractures / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary; D013167:Spondylitis, Ankylosing / Q000150:complications
chemical_list: D001843:Bone Cements
keywords: Aging spine; Augmented screw; Ostéoporose; Ostéosynthèse percutanée; Percutaneous osteosynthesis; Spine fixation; Vis à augmentation