{"title":"水泥增强椎弓根螺钉内固定中水泥渗漏的危险因素:一项140例患者和650枚螺钉的多中心研究。","authors":"Shota Tamagawa, Hidetoshi Nojiri, Hiromitsu Takano, Akira Itoi, Ryosuke Yokota, Takao Shiobara, Kentaro Ishii, Taishi Takeuchi, Tomoya Kojo, Yuya Ishii, Arihisa Shimura, Juri Teramoto, Hisashi Ishibashi, Yuta Sugawara, Kazuki Nakai, Yukoh Ohara, Takeshi Hara, Eiji Abe, Takatoshi Okuda, Ryosuke Takahashi, Yutaka Kono, Yoshio Sakuma, Shigemasa Takamiya, Muneaki Ishijima","doi":"10.1177/21925682251357826","DOIUrl":null,"url":null,"abstract":"<p><p>Study DesignMulticenter retrospective cohort study.ObjectivesCement-augmented pedicle screws (CAPS) enhance fixation in osteoporotic patients, but carry a risk of cement leakage (CL), potentially leading to pulmonary embolism and neurological deficits. This study aimed to investigate the incidence and classification of CL and identify risk factor.MethodsWe included 140 patients undergoing thoracic or lumbar spinal fusion with CAPS at 7 institutions. CL was assessed by postoperative CT and classified as type S (segmental vein), type B (basivertebral vein), or type I (malpositioned screws). Multivariate logistic regression was performed to identify independent risk factors for intravenous CL.ResultsCL was observed in 88/140 patients (62.9%) and 190/650 screws (29.2%). Type S leakage was most common (77.9%), followed by type B (11.6%) and type I (7.9%). No symptomatic pulmonary cement embolism occurred; however, 1 patient experienced CL-related nerve root injury. Lower femoral neck T-score (aOR: 0.61; <i>P</i> = 0.009) was an independent risk factor for intravenous CL, while diffuse idiopathic skeletal hyperostosis was protective (aOR: 0.24; <i>P</i> = 0.009). Type S leakage was associated with shorter distance from the cement hole to the vertebral sidewall (aOR: 0.77; <i>P</i> < 0.001) and smaller vertebral body cross-sectional area (aOR: 0.87; <i>P</i> = 0.030). Type B leakage was associated with shorter distance to the vertebral posterior wall (aOR: 0.71; <i>P</i> < 0.001) and lower pedicle Hounsfield units (aOR: 0.99; <i>P</i> = 0.041).ConclusionsAsymptomatic CL was frequently observed following CAPS fixation. Preoperative imaging assessments and precise screw placement may reduce the CL risk.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251357826"},"PeriodicalIF":2.6000,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209240/pdf/","citationCount":"0","resultStr":"{\"title\":\"Risk Factors for Cement Leakage in Cement-Augmented Pedicle Screw Fixation: A Multicenter Study of 140 Patients and 650 Screws.\",\"authors\":\"Shota Tamagawa, Hidetoshi Nojiri, Hiromitsu Takano, Akira Itoi, Ryosuke Yokota, Takao Shiobara, Kentaro Ishii, Taishi Takeuchi, Tomoya Kojo, Yuya Ishii, Arihisa Shimura, Juri Teramoto, Hisashi Ishibashi, Yuta Sugawara, Kazuki Nakai, Yukoh Ohara, Takeshi Hara, Eiji Abe, Takatoshi Okuda, Ryosuke Takahashi, Yutaka Kono, Yoshio Sakuma, Shigemasa Takamiya, Muneaki Ishijima\",\"doi\":\"10.1177/21925682251357826\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Study DesignMulticenter retrospective cohort study.ObjectivesCement-augmented pedicle screws (CAPS) enhance fixation in osteoporotic patients, but carry a risk of cement leakage (CL), potentially leading to pulmonary embolism and neurological deficits. This study aimed to investigate the incidence and classification of CL and identify risk factor.MethodsWe included 140 patients undergoing thoracic or lumbar spinal fusion with CAPS at 7 institutions. CL was assessed by postoperative CT and classified as type S (segmental vein), type B (basivertebral vein), or type I (malpositioned screws). Multivariate logistic regression was performed to identify independent risk factors for intravenous CL.ResultsCL was observed in 88/140 patients (62.9%) and 190/650 screws (29.2%). Type S leakage was most common (77.9%), followed by type B (11.6%) and type I (7.9%). No symptomatic pulmonary cement embolism occurred; however, 1 patient experienced CL-related nerve root injury. Lower femoral neck T-score (aOR: 0.61; <i>P</i> = 0.009) was an independent risk factor for intravenous CL, while diffuse idiopathic skeletal hyperostosis was protective (aOR: 0.24; <i>P</i> = 0.009). Type S leakage was associated with shorter distance from the cement hole to the vertebral sidewall (aOR: 0.77; <i>P</i> < 0.001) and smaller vertebral body cross-sectional area (aOR: 0.87; <i>P</i> = 0.030). Type B leakage was associated with shorter distance to the vertebral posterior wall (aOR: 0.71; <i>P</i> < 0.001) and lower pedicle Hounsfield units (aOR: 0.99; <i>P</i> = 0.041).ConclusionsAsymptomatic CL was frequently observed following CAPS fixation. Preoperative imaging assessments and precise screw placement may reduce the CL risk.</p>\",\"PeriodicalId\":12680,\"journal\":{\"name\":\"Global Spine Journal\",\"volume\":\" \",\"pages\":\"21925682251357826\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-06-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209240/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Global Spine Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/21925682251357826\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Global Spine Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/21925682251357826","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Risk Factors for Cement Leakage in Cement-Augmented Pedicle Screw Fixation: A Multicenter Study of 140 Patients and 650 Screws.
Study DesignMulticenter retrospective cohort study.ObjectivesCement-augmented pedicle screws (CAPS) enhance fixation in osteoporotic patients, but carry a risk of cement leakage (CL), potentially leading to pulmonary embolism and neurological deficits. This study aimed to investigate the incidence and classification of CL and identify risk factor.MethodsWe included 140 patients undergoing thoracic or lumbar spinal fusion with CAPS at 7 institutions. CL was assessed by postoperative CT and classified as type S (segmental vein), type B (basivertebral vein), or type I (malpositioned screws). Multivariate logistic regression was performed to identify independent risk factors for intravenous CL.ResultsCL was observed in 88/140 patients (62.9%) and 190/650 screws (29.2%). Type S leakage was most common (77.9%), followed by type B (11.6%) and type I (7.9%). No symptomatic pulmonary cement embolism occurred; however, 1 patient experienced CL-related nerve root injury. Lower femoral neck T-score (aOR: 0.61; P = 0.009) was an independent risk factor for intravenous CL, while diffuse idiopathic skeletal hyperostosis was protective (aOR: 0.24; P = 0.009). Type S leakage was associated with shorter distance from the cement hole to the vertebral sidewall (aOR: 0.77; P < 0.001) and smaller vertebral body cross-sectional area (aOR: 0.87; P = 0.030). Type B leakage was associated with shorter distance to the vertebral posterior wall (aOR: 0.71; P < 0.001) and lower pedicle Hounsfield units (aOR: 0.99; P = 0.041).ConclusionsAsymptomatic CL was frequently observed following CAPS fixation. Preoperative imaging assessments and precise screw placement may reduce the CL risk.
期刊介绍:
Global Spine Journal (GSJ) is the official scientific publication of AOSpine. A peer-reviewed, open access journal, devoted to the study and treatment of spinal disorders, including diagnosis, operative and non-operative treatment options, surgical techniques, and emerging research and clinical developments.GSJ is indexed in PubMedCentral, SCOPUS, and Emerging Sources Citation Index (ESCI).