RESEARCH PROGRESS OF FENESTRATED PEDICLE SCREW_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANQuanchang ¹ , JIANGJiliang ¹ , LIYing ¹ , ZHOUQiang ¹ , WANGFei ¹ ,  WUZixiang ² , LEI WeiWei ²

1. Department of Orthopedics, the 454th Hospital of Chinese PLA, Nanjing Jiangsu, 210001, P.R.China;
2. Department of Orthopedics, Xijing Hospital, the Forth Military Medical University;

Corresponding?author：

WUZixiang, Email: wuzixiang@fmmu.edu.cn

Keywords：

Fenestrated pedicle screw; Osteoporosis; Polymethyl methacrylate

DOI：

10.7507/1002-1892.20160158

Video：

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Objective To review the research background, biomechanical characteristics, and clinical application of fenestrated pedicle screw (FPS). Methods The recent literature about the study and application of FPS was reviewed, analyzed, and summarized. Results Compared with the technique of conventional pedicle screw augmentation, FPS can be augmented with polymethyl methacrylate (PMMA) through inner central pore and side holes. Hence, the augmentation process of FPS is more convenient during operation. The biomechanics of PMMA augmented FPS is strong enough for instrumentation in osteoporotic vertebra body and the way of FPS PMMA augmentation can reduce the risk of PMMA leakage. Conclusion FPS is an innovation in the technology of spinal instrumentation, which is expected to improve the clinical outcome of PMMA augmented pedicle screw in osteoporotic vertebra body fixation.

Citation： TANQuanchang, JIANGJiliang, LIYing, ZHOUQiang, WANGFei, WUZixiang, LEI WeiWei. RESEARCH PROGRESS OF FENESTRATED PEDICLE SCREW. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(6): 776-780. doi: 10.7507/1002-1892.20160158 Copy

1.	?Chen YL, Chen WC, Chou CW, et al. Biomechanical study of expandable pedicle screw fixation in severe osteoporotic bone comparing with conventional and cement-augmented pedicle screws. Med Eng Phys, 2014, 36(11): 1416-1420.
2.	Chao KH, Lai YS, Chen WC, et al. Biomechanical analysis of different types of pedicle screw augmentation: a cadaveric and synthetic bone sample study of instrumented vertebral specimens. Med Eng Phys, 2013, 35(10): 1506-1512.
3.	Lee JH, Lee JH, Park JW, et al. The insertional torque of a pedicle screw has a positive correlation with bone mineral density in posterior lumbar pedicle screw fixation. J Bone Joint Surg (Br), 2012, 94(1): 93-97.
4.	Ramaswamy R, Evans S, Kosashvili Y. Holding power of variable pitch screws in osteoporotic, osteopenic and normal bone: are all screws created equal? Injury, 2010, 41(2): 179-183.
5.	Chang MC, Liu CL, Chen TH. Polymethylmethacrylate augmentation of pedicle screw for osteoporotic spinal surgery: a novel technique. Spine (Phila Pa 1976), 2008, 33(10): E317-324.
6.	Yuan Q, Zhang G, Wu J, et al. Clinical evaluation of the polymethylmethacrylate-augmented thoracic and lumbar pedicle screw fixation guided by the three-dimensional navigation for the osteoporosis patients. Eur Spine J, 2015, 24(5): 1043-1050.
7.	中華醫學會骨質疏松和骨礦鹽疾病分會. 原發性骨質疏松癥診治指南(2011年). 中華骨質疏松和骨礦鹽疾病雜志, 2011, 4(1): 2-17.
8.	Chin DK, Park JY, Yoon YS, et al. Prevalence of osteoporosis in patients requiring spine surgery: incidence and significance of osteoporosis in spine disease. Osteoporos Int, 2007, 18(9): 1219-1224.
9.	Galbusera F, Volkheimer D, Reitmaier S, et al. Pedicle screw loosening: a clinically relevant complication? Eur Spine J, 2015, 24(5): 1005-1016.
10.	Becker S, Chavanne A, Spitaler R, et al. Assessment of different screw augmentation techniques and screw designs in osteoporotic spines. Eur Spine J, 2008, 17(11): 1462-1469.
11.	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.
12.	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(1): 23-27.
13.	Chen LH, Tai CL, Lai PL, et al. Pullout strength for cannulated pedicle screws with bone cement augmentation in severely osteoporotic bone: influences of radial hole and pilot hole tapping. Clin Biomech (Bristol, Avon), 2009, 24(8): 613-618.
14.	Chao KH, Lai YS, Chen WC, et al. Biomechanical analysis of different types of pedicle screw augmentation: a cadaveric and synthetic bone sample study of instrumented vertebral specimens. Med Eng Phys, 2013, 35(10): 1506-1512.
15.	Tan QC, Wu JW, Peng F, et al. Augmented PMMA distribution: improvement of mechanical property and reduction of leakage rate of a fenestrated pedicle screw with diameter-tapered perforations. J Neurosurg Spine, 2016. [Epub ahead of print].
16.	Choma TJ, Pfeiffer FM, Swope RW, et al. Pedicle screw design and cement augmentation in osteoporotic vertebrae: effects of fenestrations and cement viscosity on fixation and extraction. Spine (Phila Pa 1976), 2012, 37(26): E1628-1632.
17.	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(19): E932-939.
18.	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(18): E1210-1214.
19.	Kueny RA, Kolb JP, Lehmann W, et al. Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing. Eur Spine J, 2014, 23(10): 2196-2202.
20.	楊述華, 胡勇, 陳中海, 等. 空心側孔椎弓根螺釘添加聚甲基丙烯酸甲酯骨水泥的生物力學研究. 中華創傷雜志, 2002, 18(1): 17-32.
21.	Fransen P. Increasing pedicle screw anchoring in the osteoporotic spine by cement injection through the implant. Technical note and report of three cases. J Neurosurg Spine, 2007, 7(3): 366-369.
22.	Moon BJ, Cho BY, Choi EY, et al. Polymethylmethacrylate-augmented screw fixation for stabilization of the osteoporotic spine: a three-year follow-up of 37 patients. J Korean Neurosurg Soc, 2009, 46(4): 305-311.
23.	Hu MH, Wu HT, Chang MC, et al. Polymethylmethacrylate augmentation of the pedicle screw: the cement distribution in the vertebral body. Eur Spine J, 2011, 20(8): 1281-1288.
24.	Chang MC, Kao HC, Ying SH, et al. Polymethylmethacrylate augmentation of cannulated pedicle screws for fixation in osteoporotic spines and comparison of its clinical results and biomechanical characteristics with the needle injection method. J Spinal Disord Tech, 2013, 26(6): 305-315.
25.	Amendola L, Gasbarrini A, Fosco M, et al. Fenestrated pedicle screws for cement-augmented purchase in patients with bone softening: a review of 21 cases. J Orthop Traumatol, 2011, 12(4): 193-199.
26.	Lubansu A, Rynkowski M, Abeloos L, et al. Minimally invasive spinal arthrodesis in osteoporotic population using a cannulated and fenestrated augmented screw: technical description and clinical experience. Minim Invasive Surg, 2012, 2012: 507826.
27.	樊勇, 楊紅軍, 雷偉, 等. 普通椎弓根螺釘與骨水泥型椎弓根螺釘在骨質疏松脊柱手術中的比較研究. 中國骨與關節雜志, 2015, 4(8): 655-660.
28.	荊丹峰, 許藝薺, 孫太存, 等. 骨水泥注入中空側孔椎弓根螺釘內固定骨質疏松性腰椎退變: 強化技術要點. 中國組織工程研究, 2014, 18(47): 7556-7560.
29.	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. [Epub ahead of print].
30.	吳劍維, 李陽, 臧淵, 等. 空心側孔椎弓根螺釘側孔分布范圍對應用安全性及生物力學影響的實驗研究. 中國骨質疏松雜志, 2013, 19(3): 226-229.
31.	Goost H, Deborre C, Wirtz DC, et al. PMMA-augmentation of incompletely cannulated pedicle screws: A cadaver study to determine the benefits in the osteoporotic spine. Technol Health Care, 2014, 22(4): 607-615.

1. ?Chen YL, Chen WC, Chou CW, et al. Biomechanical study of expandable pedicle screw fixation in severe osteoporotic bone comparing with conventional and cement-augmented pedicle screws. Med Eng Phys, 2014, 36(11): 1416-1420.
2. Chao KH, Lai YS, Chen WC, et al. Biomechanical analysis of different types of pedicle screw augmentation: a cadaveric and synthetic bone sample study of instrumented vertebral specimens. Med Eng Phys, 2013, 35(10): 1506-1512.
3. Lee JH, Lee JH, Park JW, et al. The insertional torque of a pedicle screw has a positive correlation with bone mineral density in posterior lumbar pedicle screw fixation. J Bone Joint Surg (Br), 2012, 94(1): 93-97.
4. Ramaswamy R, Evans S, Kosashvili Y. Holding power of variable pitch screws in osteoporotic, osteopenic and normal bone: are all screws created equal? Injury, 2010, 41(2): 179-183.
5. Chang MC, Liu CL, Chen TH. Polymethylmethacrylate augmentation of pedicle screw for osteoporotic spinal surgery: a novel technique. Spine (Phila Pa 1976), 2008, 33(10): E317-324.
6. Yuan Q, Zhang G, Wu J, et al. Clinical evaluation of the polymethylmethacrylate-augmented thoracic and lumbar pedicle screw fixation guided by the three-dimensional navigation for the osteoporosis patients. Eur Spine J, 2015, 24(5): 1043-1050.
7. 中華醫學會骨質疏松和骨礦鹽疾病分會. 原發性骨質疏松癥診治指南(2011年). 中華骨質疏松和骨礦鹽疾病雜志, 2011, 4(1): 2-17.
8. Chin DK, Park JY, Yoon YS, et al. Prevalence of osteoporosis in patients requiring spine surgery: incidence and significance of osteoporosis in spine disease. Osteoporos Int, 2007, 18(9): 1219-1224.
9. Galbusera F, Volkheimer D, Reitmaier S, et al. Pedicle screw loosening: a clinically relevant complication? Eur Spine J, 2015, 24(5): 1005-1016.
10. Becker S, Chavanne A, Spitaler R, et al. Assessment of different screw augmentation techniques and screw designs in osteoporotic spines. Eur Spine J, 2008, 17(11): 1462-1469.
11. 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.
12. 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(1): 23-27.
13. Chen LH, Tai CL, Lai PL, et al. Pullout strength for cannulated pedicle screws with bone cement augmentation in severely osteoporotic bone: influences of radial hole and pilot hole tapping. Clin Biomech (Bristol, Avon), 2009, 24(8): 613-618.
14. Chao KH, Lai YS, Chen WC, et al. Biomechanical analysis of different types of pedicle screw augmentation: a cadaveric and synthetic bone sample study of instrumented vertebral specimens. Med Eng Phys, 2013, 35(10): 1506-1512.
15. Tan QC, Wu JW, Peng F, et al. Augmented PMMA distribution: improvement of mechanical property and reduction of leakage rate of a fenestrated pedicle screw with diameter-tapered perforations. J Neurosurg Spine, 2016. [Epub ahead of print].
16. Choma TJ, Pfeiffer FM, Swope RW, et al. Pedicle screw design and cement augmentation in osteoporotic vertebrae: effects of fenestrations and cement viscosity on fixation and extraction. Spine (Phila Pa 1976), 2012, 37(26): E1628-1632.
17. 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(19): E932-939.
18. 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(18): E1210-1214.
19. Kueny RA, Kolb JP, Lehmann W, et al. Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing. Eur Spine J, 2014, 23(10): 2196-2202.
20. 楊述華, 胡勇, 陳中海, 等. 空心側孔椎弓根螺釘添加聚甲基丙烯酸甲酯骨水泥的生物力學研究. 中華創傷雜志, 2002, 18(1): 17-32.
21. Fransen P. Increasing pedicle screw anchoring in the osteoporotic spine by cement injection through the implant. Technical note and report of three cases. J Neurosurg Spine, 2007, 7(3): 366-369.
22. Moon BJ, Cho BY, Choi EY, et al. Polymethylmethacrylate-augmented screw fixation for stabilization of the osteoporotic spine: a three-year follow-up of 37 patients. J Korean Neurosurg Soc, 2009, 46(4): 305-311.
23. Hu MH, Wu HT, Chang MC, et al. Polymethylmethacrylate augmentation of the pedicle screw: the cement distribution in the vertebral body. Eur Spine J, 2011, 20(8): 1281-1288.
24. Chang MC, Kao HC, Ying SH, et al. Polymethylmethacrylate augmentation of cannulated pedicle screws for fixation in osteoporotic spines and comparison of its clinical results and biomechanical characteristics with the needle injection method. J Spinal Disord Tech, 2013, 26(6): 305-315.
25. Amendola L, Gasbarrini A, Fosco M, et al. Fenestrated pedicle screws for cement-augmented purchase in patients with bone softening: a review of 21 cases. J Orthop Traumatol, 2011, 12(4): 193-199.
26. Lubansu A, Rynkowski M, Abeloos L, et al. Minimally invasive spinal arthrodesis in osteoporotic population using a cannulated and fenestrated augmented screw: technical description and clinical experience. Minim Invasive Surg, 2012, 2012: 507826.
27. 樊勇, 楊紅軍, 雷偉, 等. 普通椎弓根螺釘與骨水泥型椎弓根螺釘在骨質疏松脊柱手術中的比較研究. 中國骨與關節雜志, 2015, 4(8): 655-660.
28. 荊丹峰, 許藝薺, 孫太存, 等. 骨水泥注入中空側孔椎弓根螺釘內固定骨質疏松性腰椎退變: 強化技術要點. 中國組織工程研究, 2014, 18(47): 7556-7560.
29. 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. [Epub ahead of print].
30. 吳劍維, 李陽, 臧淵, 等. 空心側孔椎弓根螺釘側孔分布范圍對應用安全性及生物力學影響的實驗研究. 中國骨質疏松雜志, 2013, 19(3): 226-229.
31. Goost H, Deborre C, Wirtz DC, et al. PMMA-augmentation of incompletely cannulated pedicle screws: A cadaver study to determine the benefits in the osteoporotic spine. Technol Health Care, 2014, 22(4): 607-615.

Chinese Journal of Reparative and Reconstructive Surgery

RESEARCH PROGRESS OF FENESTRATED PEDICLE SCREW

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