Volume 3 | Issue 1 | April-September 2022 | page: 20-23 | Subir N. Jhaveri, Shivam K. Kiri, Sharan S. Jhaveri
DOI: https://doi.org/10.13107/bbj.2022.v03i01.035
Authors: Subir N. Jhaveri [1], Shivam K. Kiri [1], Sharan S. Jhaveri [1]
[1] Department of Orthopaedics, Dr. Subir Jhaveri’s Spine Hospital, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Subir N. Jhaveri.
Department of Orthopaedics, Dr. Subir Jhaveri’s Spine Hospital, Ahmedabad, Gujarat, India.
E-mail: subirjhaveri@yahoo.com
Abstract
Background: Elderly patients with severe osteoporosis are prone to sustain osteoporotic vertebral compression fractures (OVCF’s). Sometimes, they undergo significant vertebral collapse and kyphosis, leading to significant canal compromise and neurological deterioration.
Case Description: We present a case series of three patients, of which two had OVCF’s of L1 and L3, respectively, while one patient had Koch’s spine D12 and L1. All three cases had severe vertebral collapse leading to kyphosis, severe pain, and canal compromise, neurological deterioration with paraparesis, and bowel bladder involvement. Surgery warranted total corpectomy of fractured vertebrae (anterior vertebral column resection) and reconstruction of the anterior column. Due to the significant degree of osteoporosis, fenestrated screws with bone cement (poly methyl acrylate) were used anteriorly along with vertebral body reconstruction with cage, through a purely anterior approach. This is the first instance of fenestrated screws being used anteriorly to reduce screw pull-out. In view of the strong anterior construct, a posterior surgery to supplement the fixation could be avoided in these thoracolumbar junctional cases.
Results: No patient experienced loosening of implants, nor did any patient experience cement-related complications. Although the present follow-up of these patients is short (12 months), the patients are pain free and independently ambulatory.
Conclusion: Using fenestrated screws in an anterior location allow vertebral reconstruction with a single surgery in elderly patients with severe osteoporosis, reducing chances of screw pull-out. Bone plugs at the tip to help prevent cement extravasation from the vertebral body.
Keywords: Anterior fenestrated screws, Bone cement, Corpectomy, Osteoporotic vertebral compression fracture, Koch’s spine, Screw pull-out.
References
1. Khadilkar AV, Mandlik RM. Epidemiology and treatment of osteoporosis in women: An Indian perspective. Int J Womens Health 2015;7:841-50.
2. Schlaich C, Minne HW, Bruckner T, Wagner G, Gebest HJ, Grunze M, et al. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 1998;8:261-7.
3. Leech JA, Dulberg C, Kellie S, Pattee L, Gay J. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis 1990;141:68-71.
4. Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR. Vertebral fractures and mortality in older women: A prospective study. Arch Intern Med 1999;159:1215-20.
5. Girardo M, Cinnella P, Gargiulo G, Viglierchio P, Rava A, Aleotti S, et al. Treatment of osteoporotic vertebral compression fractures: Applicability of appropriateness criteria in clinical practice. Pain Physician 2018;19:546-51
6. Schupfner R, Stoevelaar HJ, Blattert TR, Fagan D, Fransen P, Marcia S, et al. Treatment of osteoporotic vertebral compression fractures: Applicability of appropriateness criteria in clinical practice. Pain Physician 2016;19:E113-20.
7. Alpantaki K, Dohm M, Korovessis P, Hadjipavlou A. Surgical options for osteoporotic vertebral compression fractures complicated with spinal deformity and neurologic deficit. Injury 2017;49:261-71.
8. Girardo M, Cinnella P, Gargiulo G, Viglierchio P, Rava A, Aleotti S. Surgical treatment of osteoporotic thoraco-lumbar compressive fractures: The use of pedicle screw with augmentation PMMA. Eur Spine J 2017;26:546-51.
9. Tan JS, Bailey CS, Dvorak MF, Fisher CG, Cripton PA, Oxland TR. Cement augmentation of vertebral screws enhances the interface strength between interbody device and vertebral body. Spine (Phila Pa 1976) 2007;32:334-41.
10. Schultheiss M, Hartwig E, Claes L, Kinzl L, Wilke HJ. Influence of screw-cement enhancement on the stability of anterior thoracolumbar fracture stabilization with circumferential instability. Eur Spine J 2004;13:598-604.
11. Bai B, Kummer FJ, Spivak J. Augmentation of anterior vertebral body screw fixation by an injectable, biodegradable calcium phosphate bone substitute. Spine (Phila Pa 1976) 2001;26:2679-83.
12. Bong JM, Bo YC, Eun YC, Ho YZ. Polymethylmethacrylate-augmented screw fixation for stabilization of the osteoporotic spine: A three-year follow-up of 37 patients. J Korean Neurosurg Soc 2009;46:305-11.
13. Pingel A, Kandziora F, Hoffmann CH. Osteoporotic L1 burst fracture treated by short-segment percutaneous stabilization with cement-augmented screws and kyphoplasty (hybrid technique). Eur Spine J 2014;23:2022-3.
14. Afathi M, Mansouri N, Farah K, Benichoux V, Blondel B, Fuentes S. Use of cement-augmented percutaneous pedicular screws in the management of multifocal tumoral spinal fractures. Asian Spine J 2019;13:305-12.
15. Jung HJ, Kim SW, Ju CI, Kim SH, Kim HS. Bone cement-augmented short segment fixation with percutaneous screws for thoracolumbar burst fractures accompanied by severe osteoporosis. J Korean Neurosurg Soc 2012;52:353-8.
16. Pesenti S, Blondel B, Peltier E, Adetchessi T, Dufour H, Fuentes S. Percutaneous cement-augmented screws fixation in the fractures of the aging spine: Is it the solution? Biomed Res Int 2014;2014:610675.
17. Choma TJ, Pfeiffer FM, Swope RW, Hirner JP. Pedicle screw design and cement augmentation in osteoporotic vertebrae: Effects of fenestrations and cement viscosity on fixation and extraction. Spine (Phila Pa 1976) 2012;37:1628-32.
18. Yuan Q, Zhang G, Wu J, Xing Y, Sun Y, Tian W. Clinical evaluation of the polymethylmethacrylate-augmented thoracic and lumbar pedicle screw fixation guided by the three-dimensional navigation for the osteoporosis patients. Eur Spine J 2015;24:1043-50.
19. Frankel BM, D’Agostino S, Wang C. A biomechanical cadaveric analysis of polymethylmethacrylate-augmented pedicle screw fixation. J Neurosurg Spine 2007;7:47-53.
20. Access O. Clinical therapeutic effects of anterior decompression on spinal osteoporotic fracture and inflammatory cytokines. Pak J Med Sci 2014;30:931-5.
| How to Cite this Article: Jhaveri SN, Kiri SK, Jhaveri SS | Anterior Placement of Cemented Fenestrated Screws in Conjunction with Anterior Reconstruction in Elderly Patients with Severe Vertebral Collapse and Paraparesis | Back Bone: The Spine Journal | April-September 2022; 3(1): 20-23. https://doi.org/10.13107/bbj.2022.v03i01.035
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