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Pedikelschraubenaugmentation aus biomechanischer Sicht

Pedicle screw augmentation from a biomechanical perspective

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Zusammenfassung

Die schwergradige Osteoporose stellt in der instrumentierenden Wirbelsäulenchirurgie ein großes Problem dar. Neben Anschlusskyphosierungen und -frakturen sind Schraubenlockerungen und Implantatausrisse ein alltägliches Problem bei der osteoporotischen Wirbelsäule. Es ist hinreichend bekannt, dass die Knochendichte neben Schraubendicke und -länge den größten Einfluss auf die Stabilität einer Schraube hat. Bei einer schweren Osteoporose kann durch die Zementaugmentierung die Ausrissfestigkeit einer Pedikelschraube um 96–278% verbessert werden. Bis heute haben sich zwei verschiedene Vorgehensweisen etabliert: Zementierung des Wirbelkörpers vor Einbringen der Schraube in den noch weichen Zement oder Zementaugmentierung nach Einbringung einer perforierten Schraube.

Das größte Problem der Augmentierung ist das Auftreten von Leckagen. Zementleckagen können bei beiden Techniken auftreten. Bei der Augmentation über die perforierte Schraube scheint aber das Problem eine geringere Rolle zu spielen, da die Zementierung bei einer beginnenden Leckage sofort beendet werden kann. Die Revision der zementierten Schrauben stellt nach aktuellen biomechanischen Erkenntnissen kein größeres klinisches Problem dar. Auch die initial zementierten Schrauben können im Revisionsfall 1 mm dicker gewählt werden und ebenfalls erneut zementiert werden.

Abstract

Severe osteoporosis is a serious problem in the instrumentation during spine surgery. Besides kyphosis, adjacent vertebral fractures and of course pedicle screw loosening and implant pullout are frequent challenges in instrumentation of the osteoporotic spine. In addition to screw diameter and length, bone mineral density has the most important impact on the stability of a pedicle screw. In cases of severe osteoporosis cement augmentation increases the stability of a pedicle screw. Pullout force can be increased with augmentation by 96–278%. Nowadays, there are two different procedures for augmentation: cement augmentation of the vertebra before inserting the screw into the soft, fresh cement or augmentation via a perforated screw that has already been inserted.

The main problem in augmentation techniques are cement leakages. In both techniques leakages may occur. The problem of leakages seems to be less severe in the augmentation technique via the perforated screw, because cement application can be stopped immediately if the onset of leakage is noticed. Even surgical revision of cement augmented screws is not a major clinical problem based on recent biomechanical studies. The revision screw can be chosen 1 mm thicker and can be cement augmented again without technical problems.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Frau PD Dr. V. Bullmann ist als Referentin für die Firma Ulrich medical® und Depuy Spine tätig.

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum Münster, Albert Schweitzer Straße 33, 48149, Münster, Deutschland

    V. Bullmann, R. Rödl & T.L. Schulte

  2. Orthopädische Klinik II – Wirbelsäulenchirurgie, St. Franziskus-Hospital Münster, Münster, Deutschland

    U.R. Liljenqvist

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  1. V. Bullmann
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  2. U.R. Liljenqvist
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  3. R. Rödl
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  4. T.L. Schulte
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Correspondence to V. Bullmann.

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Bullmann, V., Liljenqvist, U., Rödl, R. et al. Pedikelschraubenaugmentation aus biomechanischer Sicht. Orthopäde 39, 673–678 (2010). https://doi.org/10.1007/s00132-010-1602-8

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  • DOI: https://doi.org/10.1007/s00132-010-1602-8

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