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Cement Augmented Pedicle Screw Instrumentation in Pediatric Spine Surgery.

Hamisi Mwarindano Mraja1, Halil Gök1, Inas Mohamed Fawzy Daadour1

  • 1Scoliosis-Spine Center Istanbul, Istanbul Florence Nightingale Hospital, Istanbul, Turkey.

World Neurosurgery
|March 9, 2023
PubMed
Summary

Cement augmentation of pedicle screws (PS) in pediatric osteoporosis patients undergoing spinal surgery prevents screw failure. This technique offers improved stability and satisfactory outcomes, reducing complications like pull-out and fractures.

Keywords:
Cement augmentationOsteoporosisPediatric scoliosisPedicle screwVertebroplasty

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Area of Science:

  • Pediatric Orthopedics
  • Spinal Surgery
  • Biomaterials

Background:

  • Osteoporosis and osteomalacia are rare in children but can occur with syndromic or neuromuscular scoliosis.
  • Spinal deformity surgery in these patients is challenging due to osteoporosis, leading to pedicle screw (PS) failure and fractures.
  • Cement augmentation of PS is a strategy to enhance screw fixation in osteoporotic vertebrae.

Purpose of the Study:

  • To evaluate the safety and efficacy of cement augmentation for pedicle screws (PS) in pediatric patients with osteoporosis undergoing spinal deformity surgery.
  • To assess radiological and clinical outcomes, specifically focusing on screw stability and fracture prevention.

Main Methods:

  • Retrospective analysis of pediatric patients (2010-2020) who underwent cement augmentation of PS.
  • Minimum follow-up of 2 years, with radiological and clinical evaluations.
  • Inclusion criteria focused on patients with osteoporosis and spinal deformities.

Main Results:

  • Study included 7 pediatric patients (mean age 13 years) with a mean follow-up of 3 years.
  • 52 cement-augmented PSs were used (average 7 per patient) with no instances of PS pull-out at augmented levels.
  • No neurological deficits or pulmonary cement embolisms were observed; however, fractures occurred in adjacent or uncemented segments in two patients.

Conclusions:

  • Cement augmentation of PS in pediatric osteoporotic spine surgery provides satisfactory radiological outcomes and prevents screw pull-out.
  • This technique is particularly beneficial for high-risk patients with conditions like osteogenesis imperfecta, neuromuscular scoliosis, and syndromic scoliosis.
  • Cement augmentation enhances screw purchase in patients with poor bone quality, improving surgical stability.