Establishment and validation of nomograms and web calculators for different cement leakage risk types in pedicle screw augmentation for degenerative lumbar stenosis in osteoporotic vertebrae

BACKGROUND:The use of cement in pedicle screw augmentation (PSA) enhances the pullout force of pedicle screws in vertebrae affected by osteoporosis. Risks involved in the use of cement for PSA include nerve injury and vascular damage caused by cement leakage. METHODS:Our study included all individuals who received PSA for degenerative lumbar stenosis (DLS) in osteoporotic vertebrae from January 2014 to May 2022. Postoperative CT scan will be used to assess cement leakage. Correlation analysis and logistic regression analyses were utilized to establish the associated clinical or radiological factors, which were then used to construct Nomograms and web calculators. RESULTS:Our study included a total of 181 patients, with 886 screws being inserted into 443 vertebrae. Perivertebral cement leakage was significantly associated with female, decreased BMD, solid screws, and scattered cement distribution. The majority of cement leakage happened through segmental veins (type S, 72.1%), with basivertebral veins (type B, 23.9%) and instrument-related leakage (type I, 13.9%) following suit. Lower BMD and scattered cement distribution were more likely to experience type S or type B leakage. Our analysis data showed that cement augmentation with cannulated and fenestrated screws tended toward concentrated cement distribution. The creation and verification of each Nomogram additionally showcased the prognostic capability and medical significance of the corresponding model. CONCLUSION:Nomograms and web-based calculators can accurately forecast the probability of cement leakage. We should regularly perform the procedure using cannulated and fenestrated screws, along with a moderate amount of high-viscosity cement, while continuously monitoring with fluoroscopy during PSA.