Lung injury in patients age 75 years and older with the use of polymethylmethacrylate fenestrated pedicle screws.

Autor: Rodriguez-Arguisjuela M; Spine Unit, Av Reyes Catolicos 2, 28040 Madrid, Spain., Martin-Piñeiro B; Department of Anesthesiology, Av Reyes Catolicos 2, 28040 Madrid, Spain., Cuéllar-Bobadilla C; Department of Anesthesiology, Av Reyes Catolicos 2, 28040 Madrid, Spain., Leal-Caramanzana V; Department of Anesthesiology, Av Reyes Catolicos 2, 28040 Madrid, Spain., Heili-Frades S; Pulmonary Department, Av Reyes Catolicos 2, 28040 Madrid, Spain., Mahíllo-Fernandez I; Department of Statistics Fundación Jiménez Diaz, Av Reyes Catolicos 2, 28040 Madrid, Spain., Mengis CL; Spine Unit, Av Reyes Catolicos 2, 28040 Madrid, Spain., Gallego-Bustos J; Spine Unit, Av Reyes Catolicos 2, 28040 Madrid, Spain., Peiro A; Spine Unit, Av Reyes Catolicos 2, 28040 Madrid, Spain., Garzon-Márquez FM; Spine Unit, Av Reyes Catolicos 2, 28040 Madrid, Spain., Tomé-Bermejo F; Hospital General de Villalba, Orthopedic Department, Collado Villalba, 28400 Madrid, Spain., Alvarez-Galovich L; Spine Unit, Av Reyes Catolicos 2, 28040 Madrid, Spain. Electronic address: lalvarez@fjd.es.
Jazyk: angličtina
Zdroj: The spine journal : official journal of the North American Spine Society [Spine J] 2021 Mar; Vol. 21 (3), pp. 430-437. Date of Electronic Publication: 2020 Nov 28.
DOI: 10.1016/j.spinee.2020.11.006
Abstrakt: Background Context: Pulmonary complications in patients age 75 years and older who undergo spinal fusion may have catastrophic consequences. The use of augmentation techniques with polymethylmethacrylate (PMMA) have been associated with pulmonary damage. The use of fenestrated pedicle screws augmented with PMMA may increase the risk of lung injury in this population.
Purpose: To investigate whether the use of PMMA-augmented screws is correlated with increased lung injury in patients undergoing instrumented lumbar spinal fusion.
Study Design: A nonrandomized, prospective, case-controlled clinical study was carried out.
Patient Sample: We included 50 consecutive patients: 25 classifieds as patients who required PMMA-augmented screws in lumbar spinal fusion, and 25 classifieds as control participants because they underwent uncemented instrumented spinal fusion.
Outcome Measures: We compare the incidence of the event, lung damage, in both groups by measuring a series of parameters: arterial blood gas, transesophageal echocardiography, urinary desmosine, and chest radiograph. The epidemiological parameters analyzed were age, sex, body mass index, status as a smoker, and number of cement leaks.
Methods: Changes in pulmonary damage markers were described in both groups of patients, comparing postsurgery values with baseline values. In control participants, each change was evaluated for the total number of patients. All changes are indicated in this report by mean differences for quantitative variables and by differing proportions for qualitative variables, with 95% confidence intervals provided for all values.
Results: There was an increase in postinstrumentation PaO2 (arterial partial pressure of oxygen) in both groups, probably related to the use of mechanical ventilation and recruitment maneuvers. Even though the group that required augmentation had lower baseline levels, the difference between groups was not statistically significant. On transesophageal echocardiographs, we observed scattered small, snowflake-like emboli, and bright echo signals appeared in the right atrium during PMMA injection. Signal density was constant but gradually faded away when PMMA injection ended. No participants in the group without augmentation had radiological complications. Overall, desmosine levels increased in both groups, and the rise was similar in both. There was a slight average increase in urine desmosine levels after instrumentation and progressively continues to rise until 24 hours after instrumentation, with a subsequent decrease at 72 hours. Comparing the two groups, we found no statistically significant differences at any time.
Conclusions: We were not able to identify a significant difference in urine desmosine levels associated with the augmentation of with fenestrated pedicle screws with PMMA. Despite comparing patients age 75 years or older with a younger group, we found no clinical, analytical, or gasometric data indicating lung damage in patients who had augmentation.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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