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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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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.

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Acknowledgements

This study supported by the Guangzhou Science and Technology Project (201707010460), Guangdong Science and Technology Project (2016A020215137). The funders had no role in study design, data collection or analysis, decision to publish, or preparation of the manuscript.

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Author notes

  1. Hui-zhi Guo and Yong-chao Tang contributed equally to this work.

Authors and Affiliations

  1. Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People’s Republic of China

    Hui-zhi Guo, Dan-qing Guo, Shun-cong Zhang, Yong-xian Li, Guo-ye Mo, Pei-jie Luo, Ten-peng Zhou & Yan-huai Ma

  2. The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China

    Hui-zhi Guo, Yong-chao Tang, Shun-cong Zhang, Yong-xian Li, Guo-ye Mo, Pei-jie Luo, Ten-peng Zhou, Yan-huai Ma, De Liang & Xiao-bing Jiang

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  1. Hui-zhi Guo
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Correspondence to Shun-cong Zhang.

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This study has been reviewed by the appropriate ethics committee of The First Affiliated Hospital of Guangzhou University of Chinese Medicine and performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki.

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Guo, Hz., Tang, Yc., Guo, Dq. et al. The cement leakage in cement-augmented pedicle screw instrumentation in degenerative lumbosacral diseases: a retrospective analysis of 202 cases and 950 augmented pedicle screws. Eur Spine J 28, 1661–1669 (2019). https://doi.org/10.1007/s00586-019-05985-4

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  • DOI: https://doi.org/10.1007/s00586-019-05985-4

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