BACKGROUND: Cement-augmented pedicle screw instrumentation (CAPSI) of the thoracolumbar spine is indicated in @entity170 or @entity2331 to improve pullout strength and biomechanical stability of pedicle screws (PS). Only a few studies report on the incidence of @entity1151 or other complications associated with CAPSI. PURPOSE: The aim of this retrospective study was to assess the rate of CAPSI-associated complications. STUDY DESIGN: Retrospective cohort study. @entity1 SAMPLE: @entity1 who underwent CAPSI due to @entity5 or @entity179 . OUTCOME MEASURES: Cement leakage, @entity1151 ( @entity1151 ), mortality rate. METHODS: Our clinical database was reviewed for @entity1 who underwent CAPSI between January 2012 and June 2015. A total of 165 @entity1 (mean age 71  11.2; range: 46 to 93 years; m=62, f=103) were included. Indications were @entity3604 (n=40), spinal metastases (n=57), @entity179 (n=5), and traumatic @entity174 (n=14) with an associated @entity170 . Every @entity1 received between 2 and 21 (mean 8  3.3) cement-augmented pedicle screws in the thoracolumbar and lumbosacral spine. Both intraoperative cement leakage in prevertebral veins, the inferior vena cava, and/or pulmonary arteries, and leakage detected on postoperative imaging were evaluated. We assessed the incidence of clinically symptomatic and asymptomatic events. RESULTS: In 29 of 31 @entity1 with intraoperative suspicion of cement leakage into prevertebral veins or the inferior vena cava on lateral fluoroscopy, which were without hemodynamic relevance, cement extrusion was confirmed on postoperative X- @entity16039 or computed tomography (CT) scan. In three of eight @entity1 with suspicion of @entity1151 , @entity1151 was verified on thoracic CT. Four @entity1 experienced life-threatening intraoperative hemodynamic reactions, either due to cement @entity887 (n=2; 1.2%) or anaphylactic shock (n=2; 1.2%) with need for intraoperative cardiopulmonary resuscitation in three cases. Two @entity1 died due to fulminant @entity1151 . Three @entity1 with @entity1353 1 day after surgery were also confirmed with @entity1151 on chest CT. In five @entity1 , an asymptomatic @entity1151 was found incidentally on postoperative imaging. In addition, 68 @entity1 with cement leakage into prevertebral veins or the ascending cava vein were found incidentally on postoperative spine X- @entity16039 or CT. Two of 10 @entity1 with intraspinal epidural cement leakage required revision surgery. One hundred ten of 165 @entity1 (66.7%) had clinically asymptomatic cement leakage. Thirteen @entity1 had @entity1151 (7.9%), of whom five (3.0%) were symptomatic. Two @entity1 experienced intraoperative cement-induced @entity2021 (1.2%). The overall symptomatic complication rate was 5.5% (n=9). The 30-day mortality rate was 1.8% (n=3). CONCLUSIONS: CAPSI bears a high risk of asymptomatic cement leakage. The risk for associated severe complications was also relatively high and probably underestimated considering the retrospective nature of the present study. A strict indication for cement augmentation, especially in @entity1 with cardiac predisposition, should be the consequence. We doubt that technical aspects of cement application and/or different types of cement are capable of reducing the risk of these complications substantially.

Risk of cement leakage and XXXX by bone cement-augmented pedicle screw fixation of the thoracolumbar spine.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient', 'PATIENT'] @entity3604 :: ('MESH:D058866', 'Disease') :: ['osteoporotic fractures'] @entity16039 :: ('255564', 'Species') :: ['ray'] @entity174 :: ('MESH:D050723', 'Disease') :: ['vertebral fractures'] @entity1353 :: ('MESH:D004417', 'Disease') :: ['dyspnea'] @entity5 :: ('MESH:D009369', 'Disease') :: ['spinal tumors'] @entity170 :: ('MESH:D010024', 'Disease') :: ['osteoporosis'] @entity1151 :: ('MESH:D011655', 'Disease') :: ['PCE', 'pulmonary cement embolism'] @entity2331 :: ('MESH:D001851', 'Disease') :: ['osteopenia'] @entity887 :: ('MESH:D004617', 'Disease') :: ['embolism'] @entity179 :: ('MESH:D019636', 'Disease') :: ['degenerative (n=49) or infectious spine disease', 'degenerative spine disease'] @entity2021 :: ('MESH:D000707', 'Disease') :: ['anaphylaxis']
@entity1151 :: (MESH:D011655,Disease) :: ['pulmonary embolism']
