Long-term clinical complications associated with the use of polymethyl methacrylate in spinal stabilization of dogs and cats: case series
DOI:
https://doi.org/10.5433/1679-0359.2020v41n5supl1p2453Keywords:
Bone cement, Postoperative complications, Adverse effects, Spinal column.Abstract
Vertebral and spinal cord trauma are common conditions in small animal practice and often result in vertebral fractures/luxation (VFL) with concomitant spinal cord laceration, concussion, compression, or ischemia. These lesions have several clinical presentations that may vary from moderate to severe pain and partial to total loss of motor, sensory, and visceral functions, which may result in death or euthanasia. Our purpose is to describe five cases (four dogs and one cat) of complications secondary to the use of bone cement for vertebral stabilization. The patients, between five months and four years of age and weighing between 1.4 and 12.2 kg, were referred to the Small Animal Orthopedics and Traumatology Service of the Veterinary Hospital of the College of Veterinary Medicine and Animal Science of the University of São Paulo. They had a history of post-operatory polymethyl methacrylate (PMMA) reactions (such as drainage or cement exposure due to infection or implant failure) in periods from 9 to 18 months after undergoing spinal osteosynthesis. Surgical implant removal occurred in 80% of the patients (4/5). Complete remission was not observed in the patient with residual implants. The association of pins/screws and PMMA is a versatile osteosynthesis technique and is applicable in all spinal regions. However, delayed complications can occur, which could require additional surgical procedures. Despite the small number of cases included in this study, one can infer that complications related to the use of bone cement in spinal surgery can occur in the long term and should be highlighted during the implant choosing process for vertebral osteosynthesis in small animals.Downloads
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References
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Masuda, S., Fujibayashi, S., Otsuki, B., Kimura, H., & Matsuda, S. (2017). Efficacy of target drug delivery and dead space reduction using antibiotic-loaded bone cement for the treatment of complex spinal infection. Clinical Spine Surgery, 30(9), E1246-E1250. doi: 10.1097/BSD.0000000000000567
Mok, J. M., Guillaume, T. J., Talu, U., Berven, S. H., Deviren, V., Kroeber, M., … Hu, S. S. (2009). Clinical Outcome of deep wound infection after instrumented posterior spinal fusion. Spine, 34(6), 578-583. doi: 10.1097/BRS.0b013e31819a827c
Núñez-Pereira, S., Pellisé, F., Rodríguez-Pardo, D., Pigrau, C., Bagó, J., Villanueva, C., & Cáceres, E. (2013). Implant survival after deep infection of an instrumented spinal fusion. The Bone & Joint Journal, 95-B(8), 1121-1126. doi:10.1302/0301-620X.95B8.30784
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Ramanathan, S., Vora, T., Gulia, A., Mahajan, A., & Desai, S. (2017). Pulmonary cement embolism in a child following total elbow replacement for primitive neuroectodermal tumour (PNET) of the humerus. Skeletal Radiology, 46(5), 715-718. doi: 10.1007/s00256-017-2602-0
Roberts, T. T., Haines, C. M., & Uhl, R. L. (2017). Allergic or hypersensitivity reactions to orthopaedic implants. Journal of the American Academy of Orthopaedic Surgeons, 25(10), 693-702. doi: 10.5435/ JAAOS-D-16-00007
Shores, A., Braund, K. G., & Brawner, W. R. Jr. (1990). Management of acute spinal cord trauma. Veterinary Medicine, 85(7), 724-739.
Sturges, B. K., Kapatkin, A. S., Garcia, T. C., Anwer, C., Fukuda, S., Hitchens, P. L., … Stover, S. M. (2016). Biomechanical Comparison of locking compression plate versus positive profile pins and polymethylmethacrylate for stabilization of the canine lumbar vertebrae. Veterinary Surgery, 45(3), 309-318. doi: 10.1111/vsu.12459
Vallefuoco, R., Manassero, M., Leperlier, D., Scotti, S., Viateau, V.,& Moissonnier, P. (2014). Surgical repair of thoraco-lumbar vertebral fracture-luxations in eight cats using screws and polymethylmethacrylate fixation. Veterinary and Comparative Orthopaedics and Traumatology, 27(04), 306-312. doi: 10.3415/VCOT-13-08-0098
Wu, C.-C., Lin, M.-H., Yang, S.-H., Chen, P.-Q., & Shih, T. T.-F. (2007). Surgical removal of extravasated epidural and neuroforaminal polymethylmethacrylate after percutaneous vertebroplasty in the thoracic spine. European Spine Journal, 16(S3), 32-331. doi: 10.1007/s00586-006-0237-2
DiFazio, J., & Fletcher, D. J. (2013). Updates in the management of the small animal patient with neurologic trauma. Veterinary Clinics of North America: Small Animal Practice, 43(4), 915-940. doi: 10.1016/j. cvsm.2013.03.002
Early, P., Mente, P., Dillard, S., & Roe, S. (2015). In vitro biomechanical evaluation of internal fixation techniques on the canine lumbosacral junction. PeerJ, 3(8), e1094. doi: 10.7717/peerj.1094
Hettlich, B. (2017). Vertebral fracture and luxation repair. dans A. shores et B. A. brisson (dir.), Current Techniques in Canine and Feline Neurosurgery (1st éd., p. 209-222). Hoboken : Wiley Blackwell.
Jeffery, N. D. (2010). Vertebral fracture and luxation in small animals. Veterinary Clinics of North America: Small Animal Practice, 40(5), 809-828. doi: 10.1016/j.cvsm.2010.05.004
Lewchalermwong, P., Suwanna, N., & Meij, B. (2018). Canine vertebral screw and rod fixation system: design and mechanical testing. Veterinary and Comparative Orthopaedics and Traumatology, 31(02), 95-101. doi: 10.3415/VCOT-17-03-0040
Masuda, S., Fujibayashi, S., Otsuki, B., Kimura, H., & Matsuda, S. (2017). Efficacy of target drug delivery and dead space reduction using antibiotic-loaded bone cement for the treatment of complex spinal infection. Clinical Spine Surgery, 30(9), E1246-E1250. doi: 10.1097/BSD.0000000000000567
Mok, J. M., Guillaume, T. J., Talu, U., Berven, S. H., Deviren, V., Kroeber, M., … Hu, S. S. (2009). Clinical Outcome of deep wound infection after instrumented posterior spinal fusion. Spine, 34(6), 578-583. doi: 10.1097/BRS.0b013e31819a827c
Núñez-Pereira, S., Pellisé, F., Rodríguez-Pardo, D., Pigrau, C., Bagó, J., Villanueva, C., & Cáceres, E. (2013). Implant survival after deep infection of an instrumented spinal fusion. The Bone & Joint Journal, 95-B(8), 1121-1126. doi:10.1302/0301-620X.95B8.30784
Petty, W., Spanier, S., Shuster, J. J., & Silverthorne, C. (1985). The Influence of skeletal on incidence of infection. The Journal of Bone and Joint Surgery, 67(8), 1236-1244.
Ramanathan, S., Vora, T., Gulia, A., Mahajan, A., & Desai, S. (2017). Pulmonary cement embolism in a child following total elbow replacement for primitive neuroectodermal tumour (PNET) of the humerus. Skeletal Radiology, 46(5), 715-718. doi: 10.1007/s00256-017-2602-0
Roberts, T. T., Haines, C. M., & Uhl, R. L. (2017). Allergic or hypersensitivity reactions to orthopaedic implants. Journal of the American Academy of Orthopaedic Surgeons, 25(10), 693-702. doi: 10.5435/ JAAOS-D-16-00007
Shores, A., Braund, K. G., & Brawner, W. R. Jr. (1990). Management of acute spinal cord trauma. Veterinary Medicine, 85(7), 724-739.
Sturges, B. K., Kapatkin, A. S., Garcia, T. C., Anwer, C., Fukuda, S., Hitchens, P. L., … Stover, S. M. (2016). Biomechanical Comparison of locking compression plate versus positive profile pins and polymethylmethacrylate for stabilization of the canine lumbar vertebrae. Veterinary Surgery, 45(3), 309-318. doi: 10.1111/vsu.12459
Vallefuoco, R., Manassero, M., Leperlier, D., Scotti, S., Viateau, V.,& Moissonnier, P. (2014). Surgical repair of thoraco-lumbar vertebral fracture-luxations in eight cats using screws and polymethylmethacrylate fixation. Veterinary and Comparative Orthopaedics and Traumatology, 27(04), 306-312. doi: 10.3415/VCOT-13-08-0098
Wu, C.-C., Lin, M.-H., Yang, S.-H., Chen, P.-Q., & Shih, T. T.-F. (2007). Surgical removal of extravasated epidural and neuroforaminal polymethylmethacrylate after percutaneous vertebroplasty in the thoracic spine. European Spine Journal, 16(S3), 32-331. doi: 10.1007/s00586-006-0237-2
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Published
2020-08-07
How to Cite
Diamante, G. A. C., Marinho, P. V. T., Dal-Bó, I. dos S., Bregadioli, T., Paes, F., Rego, R. O. D., … Ferrigno, C. R. A. (2020). Long-term clinical complications associated with the use of polymethyl methacrylate in spinal stabilization of dogs and cats: case series. Semina: Ciências Agrárias, 41(5supl1), 2453–2462. https://doi.org/10.5433/1679-0359.2020v41n5supl1p2453
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