Augmentation of transpedicular screws by intraoperative vertebroplasty.

BACKGROUND AND PURPOSE: The aim of the study was to determine the efficacy of posterior spinal stabilization, combined with intraoperative vertebroplasty defined as intraoperative filling of instrumented vertebral bodies (VB) with polymethylmethacrylate (PMMA). MATERIAL AND METHODS: Seventeen patients with osteoporosis or osteopenia underwent posterior spinal fusions. The surgical procedures included laminectomy, spondylodesis, insertion of pedicular screws, intraoperative vertebroplasty and correction of spinal deformity. RESULTS: Postoperative assessment showed improvement of pain in all cases. Motor deficit regressed in 2 of 3 afflicted patients. In 12 vertebrae (27.3%), the mass of PMMA ex-tended from one endplate to another, filling 100% of VB height, in 7 (15.9%) it filled 90-99%, in 14 (31.8%) 80-89%, in 9 (20.4%) 70-79%, and in 2 (4.5%) it filled 50-60% of VB height. In the horizontal plane, PMMA filled central parts of 72.7% of vertebral bodies. PMMA completely surrounded 68.9% of screws, and partially surrounded 18.4% of screws, whereas 12.6% of screws had no contact with cement mass. Spinal stabilization reduced kyphotic deformity in 15 patients (range of reduction: 6°-25°; mean: 13.6°). During follow-up (3-32 months; mean: 16) implants of 11 patients were stable, 1 implant instability was diagnosed 7 months after surgery, 5 patients were lost to follow-up. Asymptomatic cement leaks occurred in 45% of vertebrae. CONCLUSIONS: Intraoperative vertebroplasty performed after insertion of pedicular screws may be considered as a technical variation useful to stabilize osteoporotic spines. After PMMA hardening, intraoperative manoeuvres to correct spinal deformity were possible without any damage of instrumented vertebrae.

Evaluation of outcome after surgical treatment of cervical disc disease with DERO C-Disc PEEK cages.

BACKGROUND AND PURPOSE: To evaluate the efficacy of surgical treatment of cervical disc disease using a relatively novel type of cage, to assess the association between changes in cervical spine curvature and pain intensity as well as quality of life, to assess how often implants of different sizes were applied, and to analyze statistically the occurrence of surgical procedures performed on each spinal level. MATERIAL AND METHODS: The study group included 30 patients (19 [63%] women and 11 [37%] men), with a mean age of 48.8 years. Clinical assessment included, among other things, the visual analogue scale (VAS) for pain and the neck disability index (NDI). In addition to these questionnaires, each patient was neurologically examined pre- and postoperatively as well as during the follow-up visits one and three months after surgery. Radiological evaluation consisted of measurements of general and local lordosis of the cervical spine based on radiographs. RESULTS: Fifty-two cages were used during surgical procedures in the studied group of patients. Cages of seven out of ten different available sizes were used. Oblique cages (for lordosis correction) sized 4/6 mm (68%) and 5/7 mm (12%) were most often used. Implants of three sizes (8 mm, 10 mm, 7/9 mm) were not used. Surgical procedures most commonly involved levels C5/C6 (39%) and C6/C7 (33%). CONCLUSIONS: Surgical treatment of cervical disc disease with DERO C-Disc PEEK cages improved neurological condition of patients, decreased pain, improved quality of life and restored pathologically changed lordotic curvature of the cervical spine to near normal values. In the analyzed group of patients no significant correlations between changes in cervical spine curvature (general and local lordosis) and intensity of pain (VAS) as well as quality of life (NDI) were observed.