Cement-Augmented Carbon Fiber-Reinforced Pedicle Screw Instrumentation for Spinal Metastases: Safety and Efficacy

TY - JOUR

T1 - Cement-Augmented Carbon Fiber-Reinforced Pedicle Screw Instrumentation for Spinal Metastases: Safety and Efficacy

AU - Wagner, Arthur

AU - Haag, Elena

AU - Joerger, Ann-Kathrin

AU - Gempt, Jens

AU - Krieg, Sandro M

AU - Wostrack, Maria

AU - Meyer, Bernhard

N1 - Copyright © 2021 Elsevier Inc. All rights reserved.

PY - 2021/10

Y1 - 2021/10

N2 - OBJECTIVE: To investigate the complication rates and long-term implant failure rates in a monocentric study of a consecutive cohort of patients with thoracolumbar spinal metastases after posterior instrumentation with a fenestrated carbon fiber-reinforced poly-ether-ether-ketone (CFRP) pedicle screw system.METHODS: We retrospectively reviewed demographics, Karnofsky Performance Status Scale scores, complications, and implant failure rates.RESULTS: Between June 2016 and November 2019, 51 consecutive patients underwent cement-augmented CFRP pedicle screw instrumentation at our institution. Mean age was 68 years (standard deviation 10.5), the median preoperative Karnofsky Performance Status Scale of 80 increased to 90 postoperatively (P = 0.471). Most common primary entities were breast (25.5%), lung (15.7%), and prostate (13.7%) cancers. Of 428 placed screws, 293 (68.5%) were augmented with polymethylmethacrylate, a mean 6 per patient (standard deviation ±2). Screws were inserted via a minimally invasive system technique in 54.9% of cases. In total, 11.8% of patients had immediate postoperative sequelae related to the cement. Pulmonary cement embolisms were noted in 3 patients, 2 had paravertebral extravasation, and 1 had an embolism into a segmental artery. Of these 6, 2 patients with pulmonary embolisms reported related symptoms. Follow-up was available for 80.4%. After a mean 9.8 months, screw loosening was noted in 11.8% of cases on computed tomography, although it was asymptomatic in all but 1 patient. Screw pull-out did not occur. Neither cement-related (P = 0.353) nor general complication rates (P = 0.507) differed significantly between open and minimally invasive system techniques.CONCLUSIONS: Percutaneous cement-augmented CFRP pedicle screw instrumentation facilitates artifact-reduced postoperative imaging, while maintaining a risk profile and implant failure rates comparable to conventional metallic instrumentation.

AB - OBJECTIVE: To investigate the complication rates and long-term implant failure rates in a monocentric study of a consecutive cohort of patients with thoracolumbar spinal metastases after posterior instrumentation with a fenestrated carbon fiber-reinforced poly-ether-ether-ketone (CFRP) pedicle screw system.METHODS: We retrospectively reviewed demographics, Karnofsky Performance Status Scale scores, complications, and implant failure rates.RESULTS: Between June 2016 and November 2019, 51 consecutive patients underwent cement-augmented CFRP pedicle screw instrumentation at our institution. Mean age was 68 years (standard deviation 10.5), the median preoperative Karnofsky Performance Status Scale of 80 increased to 90 postoperatively (P = 0.471). Most common primary entities were breast (25.5%), lung (15.7%), and prostate (13.7%) cancers. Of 428 placed screws, 293 (68.5%) were augmented with polymethylmethacrylate, a mean 6 per patient (standard deviation ±2). Screws were inserted via a minimally invasive system technique in 54.9% of cases. In total, 11.8% of patients had immediate postoperative sequelae related to the cement. Pulmonary cement embolisms were noted in 3 patients, 2 had paravertebral extravasation, and 1 had an embolism into a segmental artery. Of these 6, 2 patients with pulmonary embolisms reported related symptoms. Follow-up was available for 80.4%. After a mean 9.8 months, screw loosening was noted in 11.8% of cases on computed tomography, although it was asymptomatic in all but 1 patient. Screw pull-out did not occur. Neither cement-related (P = 0.353) nor general complication rates (P = 0.507) differed significantly between open and minimally invasive system techniques.CONCLUSIONS: Percutaneous cement-augmented CFRP pedicle screw instrumentation facilitates artifact-reduced postoperative imaging, while maintaining a risk profile and implant failure rates comparable to conventional metallic instrumentation.

KW - Aged

KW - Carbon Fiber

KW - Female

KW - Humans

KW - Male

KW - Neurosurgical Procedures/instrumentation

KW - Pedicle Screws

KW - Retrospective Studies

KW - Spinal Neoplasms/epidemiology

KW - Spine/surgery

KW - Treatment Outcome

U2 - 10.1016/j.wneu.2021.07.092

DO - 10.1016/j.wneu.2021.07.092

M3 - SCORING: Journal article

C2 - 34339894

VL - 154

SP - e536-e546

JO - WORLD NEUROSURG

JF - WORLD NEUROSURG

SN - 1878-8750

ER -