The Risk of Intravenous Cement Leakage and Short-term Outcomes of Selective Cement-augmented Pedicle Screws: A Multicenter Retrospective Study

Shinji Takahashi; Daisuke Sakai; Shota Ogasawara; Ryo Sasaki; Masato Uematsu; Takahiko Hyakumachi; Akihiko Hiyama; Hiroyuki Katoh; Hidetomi Terai; Akinobu Suzuki; Koji Tamai; Hiroaki Nakamura; Mitsuru Yagi

doi:10.1097/BSD.0000000000001757

The Risk of Intravenous Cement Leakage and Short-term Outcomes of Selective Cement-augmented Pedicle Screws: A Multicenter Retrospective Study

Clin Spine Surg. 2024 Dec 30. doi: 10.1097/BSD.0000000000001757. Online ahead of print.

Authors

Affiliations

¹ Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka.
² Department of Orthopedic Surgery, Tokai University School of Medicine, Isehara.
³ Department of Orthopaedic Surgery, Wajokai Eniwa Hospital, Eniwa, Hokkaido.
⁴ Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjyuku, Tokyo.
⁵ Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba, Japan.

PMID: 39787382
DOI: 10.1097/BSD.0000000000001757

Abstract

Study design: Multicenter retrospective cohort study.

Objective: To evaluate the efficacy and safety of using cement-augmented pedicle screw (CAPS) fixation only for the cephalad and caudal vertebral bodies.

Summary of background data: Pedicle screw fixation is less effective in patients with low-quality bone. Although CAPS fixation has shown promise in improving stability and reducing screw loosening in such cases, cement leakage can have serious consequences.

Methods: This study included 65 patients who underwent spinal surgery using CAPS and were followed up for >3 months. Four CAPSs were used in each patient, and 254 CAPSs were included in the analysis.

Results: Of the 65 patients, 36.9% showed intravenous cement leakage, and a low bone mineral density (BMD) was associated with a higher risk of cement leakage. The use of a CAPS on the right side was also potentially associated with a higher risk of leakage. However, the shape and location of the leaked cement remained stable over time. Screw loosening occurred in 3.5% of the CAPSs and was associated with a lower cement volume.

Conclusion: Cement leakage was related to lower BMD. Using CAPS exclusively at the lower or upper instrumentation levels might minimize the risk of cement leakage in osteoporotic patients.