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DOI: 10.1055/a-1926-0833
Limitierte Zementierung bei langstreckiger dorsaler Versorgung
Limited Cementaugmentation for Long Segmental Posterior Stabilizations![](https://www.thieme-connect.de/media/10.1055-s-00033104/202304/lookinside/thumbnails/10-1055-a-1926-0833-1.jpg)
Zusammenfassung
Die Zementaugmentation von Pedikelschrauben kann den Schraubenhalt im osteoporotischen Knochen relevant und signifikant verbessern. Die Zementaugmentation ist jedoch mit Zementaustritten und relevanten Komplikationen verbunden. Ziel muss es daher sein, die Zementaugmentation so effizient wie möglich einzusetzen. So ist es bei einer langstreckigen dorsalen Versorgung ausreichend, nur die biomechanisch am stärksten belasteten kranialen und kaudalen Pedikelschraubenpaare zu augmentieren. Dies geht in biomechanischen Tests ohne Stabilitätsverlust einher. Zudem konnte bisher keine höhere klinische Misserfolgsrate im Vergleich zur Versorgung mit Zementaugmentation aller Pedikelschrauben nachgewiesen werden. Die limitierte Zementaugmentation bietet somit eine gute Versorgungsalternative mit Reduktion der Zementmenge und damit geringerem Komplikationsrisiko bei gleicher Stabilität. Ziel dieses Übersichtsartikels ist es, die Hintergründe der limitierten Zementierung aufzuzeigen und zu beschreiben.
Abstract
Cementaugmentation of pedicle screws can significantly improve screw retention in osteoporotic bone. However, cement augmentation is associated with cement loss and significant complications. The aim must therefore be to use cement augmentation as efficiently as possible. In long-segmental posterior stabilizations, it is therefore sufficient to augment only the cranial and kaudal pedicle screw pairs that are most biomechanically stressed. This has been shown in biomechanical tests to result in no loss of stability. In addition, no higher clinical failure rates have been demonstrated in comparison to treatment with cement augmentation of all pedicle screws. Limited cement augmentation is therefore a good alternative for reducing the amount of cement and thus reducing the risk of complications while maintaining the same level of stability. The aim of this review is to present and describe the background to the technique of limited cementation.
Schlüsselwörter
Zementaugmentation - Pedikelschrauben - langstreckige posteriore Stabilisierung - Wirbelkörperfrakturen - OsteoporoseKeywords
cementaugementation - pedicle screws - vertebral body fracture - long segmental stabilization - osteoporosisPublication History
Article published online:
24 October 2023
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Literatur
- 1 Viezens L, Sellenschloh K, Puschel K. et al. Impact of Screw Diameter on Pedicle Screw Fatigue Strength-A Biomechanical Evaluation. World neurosurgery 2021; 152: e369-e376 DOI: 10.1016/j.wneu.2021.05.108. (PMID: 34087457)
- 2 von der Hoeh NH, Spiegl UJ, Jarvers JS. et al. Options for optimizing implant stabiity in osteoporotic vertebral fractures. Die Wirbelsläule 2018; 02: 203-212
- 3 Spiegl UJ, Holbing PL, Jarvers JS. et al. Midterm outcome after posterior stabilization of unstable Midthoracic spine fractures in the elderly. BMC musculoskeletal disorders 2021; 22: 188 DOI: 10.1186/s12891-021-04049-3. (PMID: 33588814)
- 4 Hoppe S, Loosli Y, Baumgartner D. et al. Influence of screw augmentation in posterior dynamic and rigid stabilization systems in osteoporotic lumbar vertebrae: a biomechanical cadaveric study. Spine (Phila Pa 1976) 2014; 39: E384-389 DOI: 10.1097/BRS.0000000000000198. (PMID: 24384660)
- 5 Wang Y, Yang L, Li C. et al. The Biomechanical Properties of Cement-Augmented Pedicle Screws for Osteoporotic Spines. Global spine journal 2022; 12: 323-332 DOI: 10.1177/2192568220987214. (PMID: 33611971)
- 6 Riesner HJ, Blattert TR, Krezdorn R. et al. Can cavity-based pedicle screw augmentation decrease screw loosening? A biomechanical in vitro study. Eur Spine J 2021; 30: 2283-2291 DOI: 10.1007/s00586-020-06676-1. (PMID: 33355707)
- 7 Spiegl UJ, Anemuller C, Jarvers JS. et al. Hybrid stabilization of unstable osteoporotic thoracolumbar vertebral body fractures: clinical and radiological outcome after a mean of 4 years. Eur Spine J 2019; DOI: 10.1007/s00586-019-05957-8. (PMID: 30900093)
- 8 Spiegl U, Jarvers JS, Heyde CE. et al. Osteoporotic vertebral body fractures of the thoracolumbar spine: indications and techniques of a 360 degrees -stabilization. European journal of trauma and emergency surgery : official publication of the European Trauma Society 2017; 43: 27-33 DOI: 10.1007/s00068-016-0751-9.
- 9 Blattert TR, Schnake KJ, Gonschorek O. et al. Nonsurgical and Surgical Management of Osteoporotic Vertebral Body Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global spine journal 2018; 8 (Suppl. 02) 50S-55S DOI: 10.1177/2192568217745823. (PMID: 30210962)
- 10 Morimoto T, Kobayashi T, Hirata H. et al. Cardiopulmonary Cement Embolism Following Cement-Augmented Pedicle Screw Fixation: A Narrative Review. Medicina (Kaunas) 2023; 59 DOI: 10.3390/medicina59020407. (PMID: 36837608)
- 11 Janssen I, Ryang YM, Gempt J. et al. Risk of cement leakage and pulmonary embolism by bone cement-augmented pedicle screw fixation of the thoracolumbar spine. The spine journal : official journal of the North American Spine Society 2017; 17: 837-844 DOI: 10.1016/j.spinee.2017.01.009. (PMID: 28108403)
- 12 Banno T, Hasegawa T, Yamato Y. et al. Assessment of the Change in Alignment of Fixed Segment After Adult Spinal Deformity Surgery. Spine (Phila Pa 1976) 2018; 43: 262-269 DOI: 10.1097/BRS.0000000000002310. (PMID: 28658032)
- 13 Spiegl UJ, Weidling M, Schleifenbaum S. et al. Comparison of Long Segmental Dorsal Stabilization with Complete Versus Restricted Pedicle Screw Cement Augmentation in Unstable Osteoporotic Midthoracic Vertebral Body Fractures: A Biomechanical Study. World neurosurgery 2020; 143: e541-e549 DOI: 10.1016/j.wneu.2020.08.002.
- 14 Spiegl UJ, Weidling M, Nitsch V. et al. Restricted cement augmentation in unstable geriatric midthoracic fractures treated by long-segmental posterior stabilization leads to a comparable construct stability. Scientific reports 2021; 11: 23816 DOI: 10.1038/s41598-021-03336-2. (PMID: 34893697)