Risk Factors for Adjacent Fractures After Cement-Augmented Thoracolumbar Pedicle Screw Instrumentation

Practical evaluation of risk factors in patients with osteoporosis-induced thoracic and lumbar vertebral compression fractures requiring surgery

This descriptive longitudinal study aims to assess the risk factors for severe thoracic and lumbar vertebral compression fractures before and after surgery, contributing to preventive knowledge enhancement in communities and effective treatment management. The study involved 34 patients diagnosed with thoracic and lumbar vertebral compression fractures requiring surgery with bio-cement-augmented pedicle screws between June 2021 and June 2022. Postoperative complications, notably adjacent segment injury, were monitored, and patients received osteoporosis management post-surgery. The majority of patients were female (61.8 %), with an average age of 66.4 ± 9.2 years. Daily life accidents were the most common cause of injuries (88.2 %). Most patients underwent surgery more than 3 months after injury (58.8 %), with a notable percentage seeking examination and treatment post-injury. Osteoporosis prevalence was high among patients at the time of spinal injury, indicating a need for improved osteoporosis management strategies post-surgery. Various comorbidities were observed, with a portion of patients having pre-existing conditions like diabetes, hypertension, and kidney failure. Changes in bone mineral density correlated with age, highlighting the increased fracture risk seen in older individuals. Two patients required vertebral body reconstruction due to adjacent vertebra damage post-surgery. A significant proportion of patients received osteoporosis treatment after the surgical intervention. Patients with lumbar-thoracic osteoporosis fractures need a comprehensive assessment of clinical and paraclinical factors to select appropriate and effective treatment methods. Postoperatively, these patients also require osteoporosis management, regular monitoring, and evaluations to reduce postoperative complications, including the risk of adjacent segment injury and other vertebral compression fractures.

Comparison of cement-augmented pedicle screw and conventional pedicle screw for the treatment of lumbar degenerative patients with osteoporosis

STUDY DESIGN

A retrospective cohort study.

OBJECTIVE

To compare the safety and clinical efficacy between using cement-augmented pedicle screws (CAPS) and conventional pedicle screws (CPS) for the treatment of lumbar degenerative patients with osteoporosis. Management of lumbar degenerative patients with osteoporosis undergoing spine surgery is challenging. The clinical efficacy and potential complications of the mid-term performance of the CAPS technique in the treatment of lumbar degenerative patients with osteoporosis remain to be evaluated.

PATIENTS AND METHODS

The data of 131 lumbar degenerative patients with osteoporosis who were treated with screw fixation from May 2016 to December 2019 were retrospectively analyzed in this study. The patients were divided into the following two groups according to the type of screw used: (I) the CAPS group (n = 85); and (II) the CPS group (n = 46). Relevant data were compared between two groups, including the demographics data, clinical results and complications.

RESULTS

The difference in the VAS, ODI and JOA scores at three and 6 months after the operation between the two groups was statistically significant (P < 0.05). At 12 months after surgery and the final follow-up, a significant difference in the fusion rate was found between the two groups (P < 0.05). Four cemented screws loosening were observed in the CAPS group (loosening rate 4/384, 1.04%) and 15 screws loosening were observed in the CPS group (loosening rate 15/214, 7.01%). In the CAPS group, a total of 384 augmented screws were used, and cement leakage was observed in 25 screws (25/384, 6.51%), but no obvious clinical symptoms or serious complications were observed. Adjacent vertebral fractures occurred in six patients in the CAPS group and one in the CPS group.

CONCLUSIONS

CAPS technique is an effective strategy for the treatment of lumbar degenerative patients with osteoporosis, with a higher fusion rate and lower screw loosening rate than CPS.

Analysis of complications and revisions after spine surgery in 270 multiple myeloma patients with spinal involvement

BACKGROUND CONTEXT

Patients with multiple myeloma (MM) are at increased risk of infections and suffer from poor bone quality due to their disseminated malignant bone disease. Therefore, postoperative complications may occur following surgical treatment of MM lesions.

PURPOSE

In this study, we aimed to determine the incidence of postoperative complications and retreatments after spinal surgery in MM patients. Additionally, we sought to identify risk factors associated with complications and retreatments.

STUDY DESIGN

Retrospective cohort study.

PATIENT SAMPLE

In total, 270 patients with MM who received surgical treatment for spinal involvement between 2008 and 2021 were included.

OUTCOME MEASURES

The incidence of perioperative complications within 6 weeks and reoperations within 2.5 years and individual odds ratios for factors associated with these complications and reoperations.

METHODS

Data were collected through manual chart review. Hosmer and Lemeshow's purposeful regression method was used to identify risk factors for complications and reoperations.

RESULTS

The median age of our cohort was 65 years (SD = 10.8), and 58% were male (n = 57). Intraoperative complications were present in 24 patients (8.9%). The overall 6-week complication rate after surgery was 35% (n = 95). The following variables were independently associated with 6-week complications: higher Genant grading of a present vertebral fracture (OR 1.41; 95% CI 1.04-1.95; p = .031), receiving intramuscular or intravenous steroids within a week prior to surgery (OR 3.97; 95% CI 1.79-9.06; p = .001), decompression surgery without fusion (OR 6.53; 95% CI 1.30-36.86; p = .026), higher creatinine levels (OR 2.18; 95% CI 1.19-5.60; p = .014), and lower calcium levels (OR 0.58; 95% CI 0.37-0.88; p = .013). A secondary surgery was indicated for 53 patients (20%), of which 13 (4.8%) took place within two weeks after the initial surgery. We additionally discovered factors associated with retreatments, which are elucidated within the manuscript.

CONCLUSION

The goal of surgical treatment for MM bone disease is to enhance patient quality of life and reduce symptom burden. However, postoperative complication rates remain relatively high after spine surgery in patients with MM, likely attributable to both inherent characteristics of the disease and patient comorbidities. The risk for complications and secondary surgeries should be explored and a multidisciplinary approach is crucial.

Postoperative Bildgebung der Wirbelsäule

Die Bildgebung der postoperativen Wirbelsäule hat im Wesentlichen zwei Aufgaben: Sie dient der Kontrolle des operativen Erfolgs und der Identifikation von Komplikationen. Dafür stehen die konventionelle Röntgenaufnahme, Computertomographie (CT), Myelographie und Magnetresonanztomographie (MRT) zur Verfügung. Unter Berücksichtigung der präoperativen Situation, der durchgeführten Operation und der postoperativen Beschwerdekonstellation ist es Aufgabe der Radiologinnen und Radiologen, die passende Modalität für eine suffiziente Diagnostik zu wählen. Insbesondere der Zustand nach Implantation von Fremdmaterial bedeutet eine technische Herausforderung im Rahmen der Bildakquisition. In der Befundung sehen sich die Radiologinnen und Radiologen mit der Aufgabe konfrontiert, zwischen natürlichen, zu erwartenden postoperativen Veränderungen und relevanten Komplikationen zu differenzieren. Ein reger Austausch mit Patientinnen und Patienten und zuweisenden Klinikerinnen und Klinikern ist dabei unerlässlich. Insbesondere klinische Hinweise auf einen Infekt, neue oder deutliche progrediente neurologische Ausfallserscheinungen und das Konus-Kauda-Syndrom erfordern eine zeitnahe Diagnosestellung, um eine rasche Therapieeinleitung zu gewährleisten.

Occurrence of adjacent segment fractures after surgical treatment of an osteoporotic vertebral fracture: a retrospective comparison between two different treatment methods

INTRODUCTION

Osteoporotic vertebral fractures are a major healthcare problem. Vertebral cement augmentation (VCA) is frequently used as a minimally invasive surgical approach to manage symptomatic fractures. However, there is a potential risk of adjacent segment fracture (ASF), which may require second surgery. The addition of transcutaneous screw-fixation with cement augmentation superior and inferior to the fracture [Hybrid transcutaneous screw fixation (HTSF)] might represent an alternative treatment option to reduce the incidence of ASF.

MATERIALS AND METHODS

We retrospectively compared surgery time, hospital stay, intraoperative complication rate and the occurrence of ASF with the need for a surgical treatment in a cohort of 165 consecutive patients receiving either VCA or HTSF in our academic neurosurgical department from 2012 to 2020. The median follow-up was 52.3 weeks in the VCA-group and 51.9 in the HTSF-group.

RESULTS

During the study period, 93 patients underwent VCA, and 72 had HTSF. Of all patients, 113 were females (64 VCA; 49 HTSF) and 52 were males (29 VCA; 23 HTSF). The median age was 77 years in both groups. Median surgery time was 32 min in the VCA-group and 81 min in the HTSF-group (p < 0.0001). No surgery-related complications occurred in the VCA-group with two in the HTSF-group (p = 0.19). ASF was significantly higher in the VCA-group compared to HTSF (24 [26%] vs. 8 [11%] patients; p < 0.02). The proportion of patients requiring additional surgery due to ASF was higher in the VCA-group (13 vs. 6%), but this difference was not statistically significant (p = 0.18). Median hospital stay was 9 days in the VCA-group and 11.5 days in the HTSF-group (p = 0.0001).

CONCLUSIONS

Based on this single-center cohort study, HTSF appears to be a safe and effective option for the treatment of osteoporotic vertebral compression fractures. Surgical time and duration of hospital stay were longer in the HTSF-group, but the rate of ASF was significantly reduced with this approach. Further studies are required to ascertain whether HTSF results in superior long-term outcomes or improved quality of life.

Comparison of clinical effectiveness of fenestrated and conventional pedicle screws in patients undergoing spinal surgery: a systematic review and meta-analysis

INTRODUCTION

Pedicle screws are commonly used for spinal procedures for fusion stability, which is particularly important in osteoporotic patients, who are at an increased risk of requiring revision procedures.

AREAS COVERED

A systematic review and meta-analysis were conducted to compare clinical effectiveness of conventional pedicle screws (CPS) vs fenestrated pedicle screws (FPS) in patients undergoing spinal surgery. Primary outcomes included screw loosening, revision surgeries (involving an implant) and reoperations (not involving intervention on an implant) in patients treated with CPS vs FPS, sub-stratified by with and without osteoporosis. Secondary outcomes included changes in pain scores. Forty-eight studies with 8,302 patients were included, with 1,565 (19.18%) treated with FPS and 6,710 (80.82%) treated with CPS. FPS was associated with a lower risk of screw loosening (p = 0.001) vs CPS. In the general population, there was a non-significant trend of lower revision rate, but no difference in reoperation rate, between patients treated with FPS vs CPS. In osteoporotic patients, revision rates were significantly lower for FPS vs CPS (p = 0.009).

EXPERT OPINION

This review suggests that FPS are effective for surgical fixation and reduce rates of screw loosening, and in osteoporotic patients, revision surgeries, compared to CPS.