골다공증이 있는 척추수술에서 척추체 보강 및 척추경 나사못 고정 전략
Strategies for Vertebral Augmentation and Increasing Pedicle Screw Purchase in the Osteoporotic Spine Surgery
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
The surgical treatment of osteoporotic bone is remarkably increasing with aged population. The problem of osteoporotic bone surgery is bone-implant failure such as screw pullout or cutout due to poor bone quality. In the osteoporotic spine. pedicle screw fixation is highly correlated with the bone mineral density. In order to enhance the fixation stability at osteoporotic spine surgery, we need a systematic approach with meticulous preoperative planning, careful intraoperative procedure and detail postoperative management. A couple of principle to reduce stress on bone implant interface are extensive release for the deformity, avoiding forceful reduction, adding anterior structural graft, good sagittal balance and avoiding to increase strain at spinal transition zone. Meticulous insertion technique such as preservation of dorsal cortex at hole, untapping of hole, anterior cortex penetration and proper screw trajectory are important. The pedicle screw design and augmentation can also affect the fixation stability. The screw with larger diameter and expandable shape have some advantage for pullout strength. The most common method for vertebral body augmentation is adding with bone cement. The other techniques for augmentation are multiple point fixations with bone graft, additional laminar hook or sublaminar wire and additional polyethylene tape. Postoperative management with brace and medication can enhance the bone union.
Abstract
The surgical treatment of osteoporotic bone is remarkably increasing with aged population. The problem of osteoporotic bone surgery is bone-implant failure such as screw pullout or cutout due to poor bone quality. In the osteoporotic spine. pedicle screw fixation is highly correlated with the bone mineral density. In order to enhance the fixation stability at osteoporotic spine surgery, we need a systematic approach with meticulous preoperative planning, careful intraoperative procedure and detail postoperative management. A couple of principle to reduce stress on bone implant interface are extensive release for the deformity, avoiding forceful reduction, adding anterior structural graft, good sagittal balance and avoiding to increase strain at spinal transition zone. Meticulous insertion technique such as preservation of dorsal cortex at hole, untapping of hole, anterior cortex penetration and proper screw trajectory are important. The pedicle screw design and augmentation can also affect the fixation stability. The screw with larger diameter and expandable shape have some advantage for pullout strength. The most common method for vertebral body augmentation is adding with bone cement. The other techniques for augmentation are multiple point fixations with bone graft, additional laminar hook or sublaminar wire and additional polyethylene tape. Postoperative management with brace and medication can enhance the bone union.
참고문헌 (15)
- McLain RF, "The effect of bone quality on pedicle screw loading in axial instability. A synthetic model", Spine (Phila Pa 1976), 22(13), pp.1454~1460 (1997)
- Kim JH, "Long-term Follow-up of Percutaneous Vertebroplasty in Osteoporotic Compression Fracture:Minimum of 5 Years Followup", Asian Spine J, 6, pp.6~14 (2012)
- Suk SI, "Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis", Spine (Phila Pa 1976), 20(12), pp.1399~1405 (1995)
- Stauff MP, "The effect of pedicle screw redirection after lateral wall breach--a biomechanical study using human lumbar vertebrae", Spine J, 14(1), pp.98~103 (2014)
- Kuklo TR, "Effect of various tapping diameters on insertion of thoracic pedicle screws: a biomechanical analysis", Spine (Phila Pa 1976), 28(18), pp.2066~2071 (2003)
- Lehman RA Jr, "Straightforward versus anatomic trajectory technique of thoracic pedicle screw fixation: a biomechanical analysis", Spine (Phila Pa 1976), 28(18), pp.2058~2065 (2003)
- Cook SD, "Biomechanical evaluation and preliminary clinical experience with an expansive pedicle screw design", J Spinal Disord, 13(3), pp.230~236 (2000)
- Cook SD, "Biomechanical study of pedicle screw fixation in severely osteoporotic bone", Spine J, 4(4), pp.402~408 (2004)
- Santoni BG, "Cortical bone trajectory for lumbar pedicle screws", Spine J, 9(5), pp.366~373 (2009)
- Choma TJ, "Pedicle screw design and cement augmentation in osteoporotic vertebrae: effects of fenestrations and cement viscosity on fixation and extraction", Spine (Phila Pa 1976), 37(26), pp.E1628~E1632 (2012)
- Burval DJ, "Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength", Spine (Phila Pa 1976), 32(10), pp.1077~1083 (2007)
- Linhardt O, "Stability of pedicle screws after kyphoplasty augmentation: an experimental study to compare transpedicular screw fixation in soft and cured kyphoplasty cement", J Spinal Disord Tech, 19(2), pp.87~91 (2006)
- Zhu Q, "Enhancing pedicle screw fixation in the aging spine with a novel bioactive bone cement: an in vitro biomechanical study", Spine (Phila Pa 1976), 37(17), pp.E1030~E1037 (2012)
- Hamasaki T, "Pedicle screw augmentation with polyethylene tape: a biomechanical study in the osteoporotic thoracolumbar spine", J Spinal Disord Tech, 23(2) (2010)
- Ohtori S, "Comparison of Teriparatide and Bisphosphonate Treatment to Reduce Pedicle Screw Loosening After Lumbar Spinal Fusion Surgery in Postmenopausal Women With Osteoporosis from a Bone Quality Perspective", Spine (Phila Pa 1976), 38(8), pp.E487~E492 (2013)