Die Wirbelsäule 2023; 07(04): 221-226
DOI: 10.1055/a-1926-0718
Übersicht

Komplikationsmanagement im Rahmen von Zementaugmentation an der Wirbelsäule

Complication Management after Cement Augmentation in the Spine
Friederike Schömig
1   Centrum für Muskuloskeletale Chirurgie (CMSC), Charité – Universitätsmedizin Berlin, Berlin, Deutschland
,
Maximilian Müllner
1   Centrum für Muskuloskeletale Chirurgie (CMSC), Charité – Universitätsmedizin Berlin, Berlin, Deutschland
,
1   Centrum für Muskuloskeletale Chirurgie (CMSC), Charité – Universitätsmedizin Berlin, Berlin, Deutschland
› Author Affiliations

Zusammenfassung

Die Herausforderungen durch Osteoporose-assoziierte spinale Pathologien nehmen insbesondere aufgrund der steigenden Zahl betroffener Patient:innen zu. Der Einsatz von Knochenzement ist inzwischen essenzieller Bestandteil in der Versorgung dieses herausfordernden Patientenkollektivs und wird in der Behandlung sowohl von pathologischen sowie traumatischen Frakturen als auch vereinzelt bei degenerativen Erkrankungen eingesetzt. Nichtsdestotrotz ist er bis heute mit einem hohen Komplikationsrisiko assoziiert: neben den häufig asymptomatischen, jedoch teilweise auch lebensbedrohlichen Zementleckagen führt die Zementaugmentation zu biomechanischen Veränderungen der Wirbelsäule, welche den behandelnden Operateur:innen in der präoperativen Planung und intraoperativen Umsetzung zwingend bewusst sein müssen. Gleichzeitig ist die Anwendung spezifischer Strategien zur Vermeidung dieser Komplikationen essenziell.

Abstract

Due to a rising number of affected patients, challenges in the treatment of spinal pathologies associated with osteoporosis are steadily increasing. Bone cement plays an important role in therapeutic strategies for this challenging patient cohort and is used in both pathological and traumatic fractures as well as certain degenerative pathologies of the spine. However, to date, its use is associated with a high risk for complications: besides the mostly asymptomatic but in rare cases life-threatening cement leakages, cement augmentation causes biomechanical changes which the treating surgeon needs to be aware of both in the preoperative planning and the intraoperative implementation. At the same time, applying specific strategies to avoid these complications is essential.



Publication History

Article published online:
24 October 2023

© 2023. Thieme. All rights reserved.

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  • Literatur

  • 1 Wright NC, Looker AC, Saag KG. et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res 2014; 29: 2520-2526
  • 2 Bjerke BT, Zarrabian M, Aleem IS. et al. Incidence of Osteoporosis-Related Complications Following Posterior Lumbar Fusion. Global Spine J 2018; 8: 563-569
  • 3 Vaishya R, Chauhan M, Vaish A. Bone cement. J Clin Orthop Trauma 2013; 4: 157-163
  • 4 Galibert P, Deramond H, Rosat P. et al. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 1987; 33: 166-168
  • 5 Singh V, Mahajan R, Das K. et al. Surgical Trend Analysis for Use of Cement Augmented Pedicle Screws in Osteoporosis of Spine: A Systematic Review (2000–2017). Global Spine J 2019; 9: 783-795
  • 6 Mueller JU, Baldauf J, Marx S. et al. Cement leakage in pedicle screw augmentation: a prospective analysis of 98 patients and 474 augmented pedicle screws. J Neurosurg Spine 2016; 25: 103-109
  • 7 Tang B, Cui L, Chen X. et al. Risk Factors for Cement Leakage in Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: An Analysis of 1456 Vertebrae Augmented by Low-Viscosity Bone Cement. Spine (Phila Pa 1976) 2021; 46: 216-222
  • 8 Donaldson AJ, Thomson HE, Harper NJ. et al. Bone cement implantation syndrome. Br J Anaesth 2009; 102: 12-22
  • 9 Yeom JS, Kim WJ, Choy WS. et al. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg Br 2003; 85: 83-89
  • 10 Tomé-Bermejo F, Piñera AR, Duran-Álvarez C. et al. Identification of Risk Factors for the Occurrence of Cement Leakage During Percutaneous Vertebroplasty for Painful Osteoporotic or Malignant Vertebral Fracture. Spine (Phila Pa 1976) 2014; 39: E693-e700
  • 11 Zhu SY, Zhong ZM, Wu Q. et al. Risk factors for bone cement leakage in percutaneous vertebroplasty: a retrospective study of four hundred and eighty five patients. Int Orthop 2016; 40: 1205-1210
  • 12 Gao T, Chen ZY, Li T. et al. Correlation analysis of the puncture-side bone cement/vertebral body volume ratio and bone cement leakage in the paravertebral vein in vertebroplasty. BMC Musculoskelet Disord 2022; 23: 184
  • 13 Luo AJ, Liao JC, Chen LH. et al. High viscosity bone cement vertebroplasty versus low viscosity bone cement vertebroplasty in the treatment of mid-high thoracic vertebral compression fractures. Spine J 2022; 22: 524-534
  • 14 Wang B, Zhao CP, Song LX. et al. Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: a meta-analysis and systematic review. J Orthop Surg Res 2018; 13: 264
  • 15 Scheyerer MJ, Ullrich B, Osterhoff G. et al. Hounsfield units as a measure of bone density-applications in spine surgery. Unfallchirurg 2019; 122: 654-661
  • 16 Schnake KJ, Scheyerer MJ, Spiegl UJA. et al. Minimally invasive stabilization of thoracolumbar osteoporotic fractures. Unfallchirurg 2020; 123: 764-773
  • 17 Chen LH, Tai CL, Lee DM. et al. Pullout strength of pedicle screws with cement augmentation in severe osteoporosis: a comparative study between cannulated screws with cement injection and solid screws with cement pre-filling. BMC Musculoskelet Disord 2011; 12: 33
  • 18 Christodoulou E, Chinthakunta S, Reddy D. et al. Axial pullout strength comparison of different screw designs: fenestrated screw, dual outer diameter screw and standard pedicle screw. Scoliosis 2015; 10: 15
  • 19 Paré PE, Chappuis JL, Rampersaud R. et al. Biomechanical evaluation of a novel fenestrated pedicle screw augmented with bone cement in osteoporotic spines. Spine (Phila Pa 1976) 2011; 36: E1210-1214
  • 20 El Saman A, Kelm A, Meier S. et al. Intraoperative PEEP-ventilation during PMMA-injection for augmented pedicle screws: improvement of leakage rate in spinal surgery. Eur J Trauma Emerg Surg 2013; 39: 461-468
  • 21 Taylor RS, Fritzell P, Taylor RJ. Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis. Eur Spine J 2007; 16: 1085-1100
  • 22 Zhang J, Wang G, Zhang N. A meta-analysis of complications associated with the use of cement-augmented pedicle screws in osteoporosis of spine. Orthopaedics & Traumatology: Surgery & Research 2021; 107: 102791
  • 23 Ulusoy OL, Kahraman S, Karalok I. et al. Pulmonary cement embolism following cement-augmented fenestrated pedicle screw fixation in adult spinal deformity patients with severe osteoporosis (analysis of 2978 fenestrated screws). Eur Spine J 2018; 27: 2348-2356
  • 24 Krueger A, Bliemel C, Zettl R. et al. Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: a systematic review of the literature. Eur Spine J 2009; 18: 1257-1265
  • 25 Zhang T, Wang Y, Zhang P. et al. What Are the Risk Factors for Adjacent Vertebral Fracture After Vertebral Augmentation? A Meta-Analysis of Published Studies. Global Spine J 2022; 12: 130-141
  • 26 Groen RJ, du Toit DF, Phillips FM. et al. Anatomical and pathological considerations in percutaneous vertebroplasty and kyphoplasty: a reappraisal of the vertebral venous system. Spine (Phila Pa 1976) 2004; 29: 1465-1471
  • 27 Luo J, Adams MA, Dolan P. Vertebroplasty and Kyphoplasty Can Restore Normal Spine Mechanics following Osteoporotic Vertebral Fracture. J Osteoporos 2010; 2010: 729257
  • 28 Fölsch C, Goost H, Figiel J. et al. Correlation of pull-out strength of cement-augmented pedicle screws with CT-volumetric measurement of cement. Biomed Tech (Berl) 2012; 57: 473-480
  • 29 Lehman RA, Kang DG, Wagner SC. Management of osteoporosis in spine surgery. J Am Acad Orthop Surg 2015; 23: 253-263
  • 30 Erdem MN, Karaca S, Sarı S. et al. Application of cement on strategic vertebrae in the treatment of the osteoporotic spine. Spine J 2017; 17: 328-337
  • 31 Bullmann V, Schmoelz W, Richter M. et al. Revision of cannulated and perforated cement-augmented pedicle screws: a biomechanical study in human cadavers. Spine (Phila Pa 1976) 2010; 35: E932-939
  • 32 Blattert TR, Glasmacher S, Riesner HJ. et al. Revision characteristics of cement-augmented, cannulated-fenestrated pedicle screws in the osteoporotic vertebral body: a biomechanical in vitro investigation. Technical note. J Neurosurg Spine 2009; 11: 23-27
  • 33 Oberkircher L, Krüger A, Hörth D. et al. Anterior cement augmentation of adjacent levels after vertebral body replacement leads to superior stability of the corpectomy cage under cyclic loading—a biomechanical investigation. The Spine Journal 2018; 18: 525-531