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Postoperative and Intraoperative Cement Augmentation for Spinal Fusion
Joshua M Kolz1, Zachariah W Pinter1, Arjun S Sebastian1
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
World Neurosurgery
|January 20, 2022
Summary
Cement augmentation (CA) in spinal fusion shows high rates of proximal junctional kyphosis (PJK) but generally avoids revision surgery. This technique offers outcomes comparable to non-augmented fusions in patients without osteoporosis.
Area of Science:
- Orthopedic Surgery
- Spinal Fusion Techniques
- Biomaterials in Orthopedics
Background:
- Pedicle screw fixation is crucial in spinal fusion.
- Cement augmentation (CA) enhances screw stability.
- Understanding CA's impact on long-term outcomes is essential.
Purpose of the Study:
- To evaluate the outcomes of spinal fusion using prophylactic cement augmentation (CA) of pedicle screws.
- To compare CA techniques (intraoperative vs. postoperative).
- To assess CA's effect on proximal junctional kyphosis (PJK) and revision rates.
Main Methods:
- Retrospective case-control study of 59 patients undergoing spinal fusion with CA (2003-2018).
- Comparison of postoperative vs. intraoperative CA.
- Comparison of CA thoracolumbar fusions (n=51) with a non-CA cohort (n=39).
- Mean follow-up of 3 years.
Main Results:
- CA patients had 2, 5, and 10-year PJK-free survivorship of 94%, 60%, and 20%.
- Revision-free survivorship at 2, 5, and 10 years was 95%, 83%, and 83%.
- CA was associated with decreased PJK risk (OR 0.16), while osteoporosis and long fusion (>8 levels) increased PJK risk.
- PJK was linked to revision surgery (OR 12.65).
Conclusions:
- Cement augmentation (CA) is associated with significant radiographic PJK rates.
- However, CA typically does not necessitate revision surgery.
- CA outcomes are comparable to long segment fusions without osteoporosis.
