Intraoperative PEEP-ventilation during PMMA-injection for augmented pedicle screws: improvement of leakage rate in spinal surgery
| العنوان: | Intraoperative PEEP-ventilation during PMMA-injection for augmented pedicle screws: improvement of leakage rate in spinal surgery |
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| المؤلفون: | A. El Saman, A. Kelm, Katrin Eichler, Simon Meier, Ingo Marzi, H. Laurer, Anna Lena Sander |
| المصدر: | European Journal of Trauma and Emergency Surgery. 39:461-468 |
| بيانات النشر: | Springer Science and Business Media LLC, 2013. |
| سنة النشر: | 2013 |
| مصطلحات موضوعية: | musculoskeletal diseases, medicine.medical_specialty, business.industry, Leakage rate, Osteoporosis, technology, industry, and agriculture, Retrospective cohort study, equipment and supplies, Critical Care and Intensive Care Medicine, medicine.disease, Pulmonary embolism, Surgery, Embolism, Emergency Medicine, Medicine, Orthopedics and Sports Medicine, business, Pedicle screw, Prospective cohort study, Leakage (electronics) |
| الوصف: | Within the last two decades the use of polymethylmethacrylate (PMMA) in the treatment of osteoporotic vertebral fractures has been established widely. Several techniques of cement application in spinal surgery have been described. Besides classical vertebroplasty, kyphoplasty and related techniques that reinforce stability of the fractured vertebral body itself, augmentation of pedicle screws became an issue in the past 10 years. Aim of this technique is strengthening of the implant-bone-interface and the prevention of loosening and failure of posterior instrumentation in limited bone quality due to osteoporosis. PMMA use in spinal surgery always bears the risk of cement leakage and cement embolism. There are only few publications dealing with cement leakage in pedicle screw augmentation. We examined our cohort concerning incidence and type of leakage in comparison to the literature. In particular, we evaluated a possible role of intrathoracic pressure during cementation procedure. In this retrospective study 42 patients were included. Mean age was 74 (57–89) years. 311 fenestrated, augmented screws were analyzed postoperatively concerning leakage and subsequent pulmonary embolism of cement particles. Overall, there was a leakage rate of 38.3 %, and 28.6 % of patients showed pulmonary embolism of PMMA. During surgery, patients were in part ventilated with a positive end-expiratory pressure (PEEP) of 15 cmH2O during cement injection. These individuals showed significantly less leakage locally as well as less PMMA-emboli in the pulmonary circulation in contrast to patients ventilated without increased PEEP. PEEP elevation during administration of PMMA via fenestrated pedicle screws is reducing the leakage rate in spinal surgery. These beneficial effects warrant further evaluation in prospective studies. |
| تدمد: | 1863-9941 1863-9933 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::fbc810c5a96b87e2b85ed169430f0fd2 https://doi.org/10.1007/s00068-013-0319-x |
| حقوق: | CLOSED |
| رقم الأكسشن: | edsair.doi.dedup.....fbc810c5a96b87e2b85ed169430f0fd2 |
| قاعدة البيانات: | OpenAIRE |
Find this article in full text from Springer Verlag. | تدمد: | 18639941 18639933 |
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