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Analysis of bone cement distribution around fenestrated pedicle screws in low bone quality lumbosacral vertebrae

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Abstract

Purpose

To study the exact distribution of bone cement around augmented fenestrated pedicle screws in both lumbar and sacral vertebrae of patients with low bone quality.

Methods

A total of 37 patients with instrumented lumbar fusion were investigated. 3D computed tomography virtual models of the injected cement and screws were obtained. The models were computed for their centroid (i.e. their average mass centre point), and their coordinates (x, y, z) were projected on their respective screw-transversal and screw-longitudinal planes for further analysis.

Results

The results showed better bone cement homogeneous distribution around the screws in lumbar (L4 and L5) than in sacral (S1) vertebrae. In the lumbar region, the centroids were transversally projected near the transversal centre of symmetry of the screws. On the other hand, in the sacral region, the cement flowed preferentially outside the centre of symmetry of the screws, into the sacral ala.

Conclusions

The results confirm the different flow behaviours of bone cement in lumbar versus sacra vertebrae. The computer methodology followed in this study helps to understand the clinical monitoring observations and lays the foundations for better positioning of the screws and specific vertebrae-oriented screw designs.

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Acknowledgments

The institutional support received through project 2017SGR253 is acknowledged (Agència de Gestiò d’Ajuts Universitaris i de Recerca, Generalitat de Catalunya, Spain).

Funding

This work received public funding through project DPI2016-77768-R (Ministerio de Economía y Competitividad, Spain).

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Authors and Affiliations

  1. Research Group of Interacting Surfaces in Bioengineering and Materials Science (InSup), Technical University of Catalonia (UPC), Avda. Diagonal 647, 08028, Barcelona, Spain

    Sergio Gómez González, Gerard Cabestany Bastida, Maria Daniela Vlad, José López López & Enrique Fernández Aguado

  2. Faculty of Medical Bioengineering, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Str. Kogalniceanu 9-13, 700454, Iasi, Romania

    Maria Daniela Vlad

  3. Department of Mathematics, Technical University of Catalonia (UPC), Avda. Eduard Maristany 16, 08019, Barcelona, Spain

    Pablo Buenestado Caballero

  4. Spine Unit, Hospital Universitario Fundación Jimenez Díaz, Avda. Reyes Católicos 2, 28040, Madrid, Spain

    Luis Alvarez-Galovich & Maria Rodríguez-Arguisjuela

Authors
  1. Sergio Gómez González
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  2. Gerard Cabestany Bastida
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  3. Maria Daniela Vlad
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  4. José López López
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  7. Maria Rodríguez-Arguisjuela
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  8. Enrique Fernández Aguado
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Corresponding author

Correspondence to Enrique Fernández Aguado.

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González, S.G., Bastida, G.C., Vlad, M.D. et al. Analysis of bone cement distribution around fenestrated pedicle screws in low bone quality lumbosacral vertebrae. International Orthopaedics (SICOT) 43, 1873–1882 (2019). https://doi.org/10.1007/s00264-018-4115-4

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  • DOI: https://doi.org/10.1007/s00264-018-4115-4

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