The cement leakage in cement-augmented pedicle screw instrumentation in degenerative lumbosacral diseases: a retrospective analysis of 202 cases and 950 augmented pedicle screws
Purpose To evaluate the incidence, type and risk factors of cement leakage (CL) with cement-augmented pedicle screw instrumentation (CAPSI) in degenerative lumbosacral disease. Methods Two hundred and two patients using a total of 950 cement-augmented screws were enrolled. CL was classified into thr...
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| Veröffentlicht in: | European spine journal 2019-07, Vol.28 (7), p.1661-1669 |
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| creator | Guo, Hui-zhi Tang, Yong-chao Guo, Dan-qing Zhang, Shun-cong Li, Yong-xian Mo, Guo-ye Luo, Pei-jie Zhou, Ten-peng Ma, Yan-huai Liang, De Jiang, Xiao-bing |
| description | Purpose
To evaluate the incidence, type and risk factors of cement leakage (CL) with cement-augmented pedicle screw instrumentation (CAPSI) in degenerative lumbosacral disease.
Methods
Two hundred and two patients using a total of 950 cement-augmented screws were enrolled. CL was classified into three types: type S: leakage via segmental veins; type B: leakage via basivertebral veins; and type I: leakage via pedicle screw instrumentation to paravertebral soft tissue. The age, gender, operation stage (primary or later stage), body mass index, bone mineral density, the number and type of augmented screw, the position of the tip of screw (lateral or internal part of vertebral body), the position of screw (left or right side), the volume of bone cement, location of the augmented vertebra (lumbar or sacrum), the type of CL and complications were recorded. Binary logistic regression correlation was used to analyze risk factors of veins leakage (type S and type B).
Results
The CL was observed in 165 patients (81.68%) and 335 screws (35.26%), leakage types of S, B and I were seen in 255 (76.12%), 77 (22.99%), and 30 (8.96%) of screws, respectively. Besides, double or multiple routes of leakage were seen in 27 screws. Number of augmented screw was a risk factor for vein leakage (OR 0.58; 95% CI 0.44–0.77;
P
= 0.000). Furthermore, the doses of cement (OR 0.79; 95% CI 0.61–0.99;
P
= 0.038) and the position of screw (OR 0.39; 95% CI 0.29–0.53;
P
= 0.000) were identified as risk factors for type S, and the doses of bone cement (OR 0.37; 95% CI 0.25–0.54;
P
= 0.000) and the position of the tip of screw (OR 0.07; 95% CI 0.04–0.13;
P
= 0.000) were risk factors for type B.
Conclusions
CAPSI bears a high risk of asymptomatic CL, with a higher rate of leakage into segmental veins and basivertebral veins. As is known, more augmented screws and larger doses of cement are risk factors for veins leakage (type S and type B), while the tip of screw approaching to the midline of the vertebral body is another risk factor to type B. Thus, the CL could be reduced by the amelioration of operative techniques and procedures.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material. |
| doi_str_mv | 10.1007/s00586-019-05985-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2216770695</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2215721328</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-c9ea8beb3ae50ec2a10ceea6c75880277a9c24efa124adfa4a7c5d03a3e866c33</originalsourceid><addsrcrecordid>eNp9kc9u1DAQxi0EotvCC3BAlrhwCYzt2I65oQoKUiUu5RzNOpMlJX8WT1LUx-INcXYXkJDgNPLM7_tG40-IZwpeKQD_mgFs5QpQoQAbKluUD8RGlUYXEIx-KDYQSiicV-FMnDPfAigbwD0WZ0aBAe3URvy4-UIy0kDjLHvCr7gj2Y2nToHLbq3UyD01XexJckz0PRM8p2Ud4dxN46poaEcjpfy-I9kvw3ZijAl72XRMyMRvJMpEc5p4T_FA4Yj9PXcsp1Zq0DKuWO42MliQ_9jNT8SjFnump6d6IT6_f3dz-aG4_nT18fLtdRGNt3MRA2G1pa1BskBRo4JIhC56W1WgvccQdUktKl1i02KJPtoGDBqqnIvGXIiXR999mr4txHM9dByp73GkaeFaa-W8BxdsRl_8hd5OS8rXHSjrtTK6ypQ-UjH_ASdq633qBkz3tYJ6DbQ-BlrnQOtDoHWZRc9P1st2oOa35FeCGTBHgPNo3FH6s_s_tj8Bq3mvTQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2215721328</pqid></control><display><type>article</type><title>The cement leakage in cement-augmented pedicle screw instrumentation in degenerative lumbosacral diseases: a retrospective analysis of 202 cases and 950 augmented pedicle screws</title><source>SpringerLink Journals</source><creator>Guo, Hui-zhi ; Tang, Yong-chao ; Guo, Dan-qing ; Zhang, Shun-cong ; Li, Yong-xian ; Mo, Guo-ye ; Luo, Pei-jie ; Zhou, Ten-peng ; Ma, Yan-huai ; Liang, De ; Jiang, Xiao-bing</creator><creatorcontrib>Guo, Hui-zhi ; Tang, Yong-chao ; Guo, Dan-qing ; Zhang, Shun-cong ; Li, Yong-xian ; Mo, Guo-ye ; Luo, Pei-jie ; Zhou, Ten-peng ; Ma, Yan-huai ; Liang, De ; Jiang, Xiao-bing</creatorcontrib><description>Purpose
To evaluate the incidence, type and risk factors of cement leakage (CL) with cement-augmented pedicle screw instrumentation (CAPSI) in degenerative lumbosacral disease.
Methods
Two hundred and two patients using a total of 950 cement-augmented screws were enrolled. CL was classified into three types: type S: leakage via segmental veins; type B: leakage via basivertebral veins; and type I: leakage via pedicle screw instrumentation to paravertebral soft tissue. The age, gender, operation stage (primary or later stage), body mass index, bone mineral density, the number and type of augmented screw, the position of the tip of screw (lateral or internal part of vertebral body), the position of screw (left or right side), the volume of bone cement, location of the augmented vertebra (lumbar or sacrum), the type of CL and complications were recorded. Binary logistic regression correlation was used to analyze risk factors of veins leakage (type S and type B).
Results
The CL was observed in 165 patients (81.68%) and 335 screws (35.26%), leakage types of S, B and I were seen in 255 (76.12%), 77 (22.99%), and 30 (8.96%) of screws, respectively. Besides, double or multiple routes of leakage were seen in 27 screws. Number of augmented screw was a risk factor for vein leakage (OR 0.58; 95% CI 0.44–0.77;
P
= 0.000). Furthermore, the doses of cement (OR 0.79; 95% CI 0.61–0.99;
P
= 0.038) and the position of screw (OR 0.39; 95% CI 0.29–0.53;
P
= 0.000) were identified as risk factors for type S, and the doses of bone cement (OR 0.37; 95% CI 0.25–0.54;
P
= 0.000) and the position of the tip of screw (OR 0.07; 95% CI 0.04–0.13;
P
= 0.000) were risk factors for type B.
Conclusions
CAPSI bears a high risk of asymptomatic CL, with a higher rate of leakage into segmental veins and basivertebral veins. As is known, more augmented screws and larger doses of cement are risk factors for veins leakage (type S and type B), while the tip of screw approaching to the midline of the vertebral body is another risk factor to type B. Thus, the CL could be reduced by the amelioration of operative techniques and procedures.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.</description><identifier>ISSN: 0940-6719</identifier><identifier>EISSN: 1432-0932</identifier><identifier>DOI: 10.1007/s00586-019-05985-4</identifier><identifier>PMID: 31030261</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Body mass index ; Bone implants ; Bone mass ; Bone mineral density ; Cement ; Leakage ; Medicine ; Medicine & Public Health ; Neurosurgery ; Original Article ; Risk factors ; Sacrum ; Surgical Orthopedics ; Vertebrae</subject><ispartof>European spine journal, 2019-07, Vol.28 (7), p.1661-1669</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2019</rights><rights>European Spine Journal is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-c9ea8beb3ae50ec2a10ceea6c75880277a9c24efa124adfa4a7c5d03a3e866c33</citedby><cites>FETCH-LOGICAL-c375t-c9ea8beb3ae50ec2a10ceea6c75880277a9c24efa124adfa4a7c5d03a3e866c33</cites><orcidid>0000-0003-3952-0030</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00586-019-05985-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00586-019-05985-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31030261$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Guo, Hui-zhi</creatorcontrib><creatorcontrib>Tang, Yong-chao</creatorcontrib><creatorcontrib>Guo, Dan-qing</creatorcontrib><creatorcontrib>Zhang, Shun-cong</creatorcontrib><creatorcontrib>Li, Yong-xian</creatorcontrib><creatorcontrib>Mo, Guo-ye</creatorcontrib><creatorcontrib>Luo, Pei-jie</creatorcontrib><creatorcontrib>Zhou, Ten-peng</creatorcontrib><creatorcontrib>Ma, Yan-huai</creatorcontrib><creatorcontrib>Liang, De</creatorcontrib><creatorcontrib>Jiang, Xiao-bing</creatorcontrib><title>The cement leakage in cement-augmented pedicle screw instrumentation in degenerative lumbosacral diseases: a retrospective analysis of 202 cases and 950 augmented pedicle screws</title><title>European spine journal</title><addtitle>Eur Spine J</addtitle><addtitle>Eur Spine J</addtitle><description>Purpose
To evaluate the incidence, type and risk factors of cement leakage (CL) with cement-augmented pedicle screw instrumentation (CAPSI) in degenerative lumbosacral disease.
Methods
Two hundred and two patients using a total of 950 cement-augmented screws were enrolled. CL was classified into three types: type S: leakage via segmental veins; type B: leakage via basivertebral veins; and type I: leakage via pedicle screw instrumentation to paravertebral soft tissue. The age, gender, operation stage (primary or later stage), body mass index, bone mineral density, the number and type of augmented screw, the position of the tip of screw (lateral or internal part of vertebral body), the position of screw (left or right side), the volume of bone cement, location of the augmented vertebra (lumbar or sacrum), the type of CL and complications were recorded. Binary logistic regression correlation was used to analyze risk factors of veins leakage (type S and type B).
Results
The CL was observed in 165 patients (81.68%) and 335 screws (35.26%), leakage types of S, B and I were seen in 255 (76.12%), 77 (22.99%), and 30 (8.96%) of screws, respectively. Besides, double or multiple routes of leakage were seen in 27 screws. Number of augmented screw was a risk factor for vein leakage (OR 0.58; 95% CI 0.44–0.77;
P
= 0.000). Furthermore, the doses of cement (OR 0.79; 95% CI 0.61–0.99;
P
= 0.038) and the position of screw (OR 0.39; 95% CI 0.29–0.53;
P
= 0.000) were identified as risk factors for type S, and the doses of bone cement (OR 0.37; 95% CI 0.25–0.54;
P
= 0.000) and the position of the tip of screw (OR 0.07; 95% CI 0.04–0.13;
P
= 0.000) were risk factors for type B.
Conclusions
CAPSI bears a high risk of asymptomatic CL, with a higher rate of leakage into segmental veins and basivertebral veins. As is known, more augmented screws and larger doses of cement are risk factors for veins leakage (type S and type B), while the tip of screw approaching to the midline of the vertebral body is another risk factor to type B. Thus, the CL could be reduced by the amelioration of operative techniques and procedures.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.</description><subject>Body mass index</subject><subject>Bone implants</subject><subject>Bone mass</subject><subject>Bone mineral density</subject><subject>Cement</subject><subject>Leakage</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurosurgery</subject><subject>Original Article</subject><subject>Risk factors</subject><subject>Sacrum</subject><subject>Surgical Orthopedics</subject><subject>Vertebrae</subject><issn>0940-6719</issn><issn>1432-0932</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kc9u1DAQxi0EotvCC3BAlrhwCYzt2I65oQoKUiUu5RzNOpMlJX8WT1LUx-INcXYXkJDgNPLM7_tG40-IZwpeKQD_mgFs5QpQoQAbKluUD8RGlUYXEIx-KDYQSiicV-FMnDPfAigbwD0WZ0aBAe3URvy4-UIy0kDjLHvCr7gj2Y2nToHLbq3UyD01XexJckz0PRM8p2Ud4dxN46poaEcjpfy-I9kvw3ZijAl72XRMyMRvJMpEc5p4T_FA4Yj9PXcsp1Zq0DKuWO42MliQ_9jNT8SjFnump6d6IT6_f3dz-aG4_nT18fLtdRGNt3MRA2G1pa1BskBRo4JIhC56W1WgvccQdUktKl1i02KJPtoGDBqqnIvGXIiXR999mr4txHM9dByp73GkaeFaa-W8BxdsRl_8hd5OS8rXHSjrtTK6ypQ-UjH_ASdq633qBkz3tYJ6DbQ-BlrnQOtDoHWZRc9P1st2oOa35FeCGTBHgPNo3FH6s_s_tj8Bq3mvTQ</recordid><startdate>20190701</startdate><enddate>20190701</enddate><creator>Guo, Hui-zhi</creator><creator>Tang, Yong-chao</creator><creator>Guo, Dan-qing</creator><creator>Zhang, Shun-cong</creator><creator>Li, Yong-xian</creator><creator>Mo, Guo-ye</creator><creator>Luo, Pei-jie</creator><creator>Zhou, Ten-peng</creator><creator>Ma, Yan-huai</creator><creator>Liang, De</creator><creator>Jiang, Xiao-bing</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3952-0030</orcidid></search><sort><creationdate>20190701</creationdate><title>The cement leakage in cement-augmented pedicle screw instrumentation in degenerative lumbosacral diseases: a retrospective analysis of 202 cases and 950 augmented pedicle screws</title><author>Guo, Hui-zhi ; Tang, Yong-chao ; Guo, Dan-qing ; Zhang, Shun-cong ; Li, Yong-xian ; Mo, Guo-ye ; Luo, Pei-jie ; Zhou, Ten-peng ; Ma, Yan-huai ; Liang, De ; Jiang, Xiao-bing</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-c9ea8beb3ae50ec2a10ceea6c75880277a9c24efa124adfa4a7c5d03a3e866c33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Body mass index</topic><topic>Bone implants</topic><topic>Bone mass</topic><topic>Bone mineral density</topic><topic>Cement</topic><topic>Leakage</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurosurgery</topic><topic>Original Article</topic><topic>Risk factors</topic><topic>Sacrum</topic><topic>Surgical Orthopedics</topic><topic>Vertebrae</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Guo, Hui-zhi</creatorcontrib><creatorcontrib>Tang, Yong-chao</creatorcontrib><creatorcontrib>Guo, Dan-qing</creatorcontrib><creatorcontrib>Zhang, Shun-cong</creatorcontrib><creatorcontrib>Li, Yong-xian</creatorcontrib><creatorcontrib>Mo, Guo-ye</creatorcontrib><creatorcontrib>Luo, Pei-jie</creatorcontrib><creatorcontrib>Zhou, Ten-peng</creatorcontrib><creatorcontrib>Ma, Yan-huai</creatorcontrib><creatorcontrib>Liang, De</creatorcontrib><creatorcontrib>Jiang, Xiao-bing</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Guo, Hui-zhi</au><au>Tang, Yong-chao</au><au>Guo, Dan-qing</au><au>Zhang, Shun-cong</au><au>Li, Yong-xian</au><au>Mo, Guo-ye</au><au>Luo, Pei-jie</au><au>Zhou, Ten-peng</au><au>Ma, Yan-huai</au><au>Liang, De</au><au>Jiang, Xiao-bing</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The cement leakage in cement-augmented pedicle screw instrumentation in degenerative lumbosacral diseases: a retrospective analysis of 202 cases and 950 augmented pedicle screws</atitle><jtitle>European spine journal</jtitle><stitle>Eur Spine J</stitle><addtitle>Eur Spine J</addtitle><date>2019-07-01</date><risdate>2019</risdate><volume>28</volume><issue>7</issue><spage>1661</spage><epage>1669</epage><pages>1661-1669</pages><issn>0940-6719</issn><eissn>1432-0932</eissn><abstract>Purpose
To evaluate the incidence, type and risk factors of cement leakage (CL) with cement-augmented pedicle screw instrumentation (CAPSI) in degenerative lumbosacral disease.
Methods
Two hundred and two patients using a total of 950 cement-augmented screws were enrolled. CL was classified into three types: type S: leakage via segmental veins; type B: leakage via basivertebral veins; and type I: leakage via pedicle screw instrumentation to paravertebral soft tissue. The age, gender, operation stage (primary or later stage), body mass index, bone mineral density, the number and type of augmented screw, the position of the tip of screw (lateral or internal part of vertebral body), the position of screw (left or right side), the volume of bone cement, location of the augmented vertebra (lumbar or sacrum), the type of CL and complications were recorded. Binary logistic regression correlation was used to analyze risk factors of veins leakage (type S and type B).
Results
The CL was observed in 165 patients (81.68%) and 335 screws (35.26%), leakage types of S, B and I were seen in 255 (76.12%), 77 (22.99%), and 30 (8.96%) of screws, respectively. Besides, double or multiple routes of leakage were seen in 27 screws. Number of augmented screw was a risk factor for vein leakage (OR 0.58; 95% CI 0.44–0.77;
P
= 0.000). Furthermore, the doses of cement (OR 0.79; 95% CI 0.61–0.99;
P
= 0.038) and the position of screw (OR 0.39; 95% CI 0.29–0.53;
P
= 0.000) were identified as risk factors for type S, and the doses of bone cement (OR 0.37; 95% CI 0.25–0.54;
P
= 0.000) and the position of the tip of screw (OR 0.07; 95% CI 0.04–0.13;
P
= 0.000) were risk factors for type B.
Conclusions
CAPSI bears a high risk of asymptomatic CL, with a higher rate of leakage into segmental veins and basivertebral veins. As is known, more augmented screws and larger doses of cement are risk factors for veins leakage (type S and type B), while the tip of screw approaching to the midline of the vertebral body is another risk factor to type B. Thus, the CL could be reduced by the amelioration of operative techniques and procedures.
Graphical abstract
These slides can be retrieved under Electronic Supplementary Material.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31030261</pmid><doi>10.1007/s00586-019-05985-4</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-3952-0030</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0940-6719 |
| ispartof | European spine journal, 2019-07, Vol.28 (7), p.1661-1669 |
| issn | 0940-6719 1432-0932 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2216770695 |
| source | SpringerLink Journals |
| subjects | Body mass index Bone implants Bone mass Bone mineral density Cement Leakage Medicine Medicine & Public Health Neurosurgery Original Article Risk factors Sacrum Surgical Orthopedics Vertebrae |
| title | The cement leakage in cement-augmented pedicle screw instrumentation in degenerative lumbosacral diseases: a retrospective analysis of 202 cases and 950 augmented pedicle screws |
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