Spinal Instrumentation Rescue with Cement Augmentation

Overview

Journal AJNR Am J Neuroradiol

Specialty Neurology

Date 2018 Sep 15

PMID 30213804

Citations 5

Authors

A Cianfoni

M Giamundo

M Pileggi

K Huscher

M Shapiro

M Isalberti

D Kuhlen

P Scarone

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Altered biomechanics or bone fragility or both contribute to spine instrumentation failure. Although revision surgery is frequently required, minimally invasive alternatives may be feasible. We report the largest to-date series of percutaneous fluoroscopically guided vertebral cement augmentation procedures to address feasibility, safety, results and a variety of spinal instrumentation failure conditions.

Materials And Methods: A consecutive series of 31 fluoroscopically guided vertebral augmentation procedures in 29 patients were performed to address screw loosening (42 screws), cage subsidence (7 cages), and fracture within (12 cases) or adjacent to (11 cases) the instrumented segment. Instrumentation failure was deemed clinically relevant when resulting in pain or jeopardizing spinal biomechanical stability. The main study end point was the rate of revision surgery avoidance; feasibility and safety were assessed by prospective recording of periprocedural technical and clinical complications; and clinical effect was measured at 1 month with the Patient Global Impression of Change score.

Results: All except 1 procedure was technically feasible. No periprocedural complications occurred. Clinical and radiologic follow-up was available in 28 patients (median, 16 months) and 30 procedures. Revision surgery was avoided in 23/28 (82%) patients, and a global clinical benefit (Patient Global Impression of Change, 5-7) was reported in 26/30 (87%) cases at 1-month follow-up, while no substantial change (Patient Global Impression of Change, 4) was reported in 3/30 (10%), and worsening status (Patient Global Impression of Change, 3), in 1/30 (3%).

Conclusions: Our experience supports the feasibility of percutaneous vertebral augmentation in the treatment of several clinically relevant spinal instrumentation failure conditions, with excellent safety and efficacy profiles, both in avoidance of revision surgery and for pain palliation.

Citing Articles

An Extended Follow-up of Spinal Instrumentation Rescue with Cement Augmentation.

Polinelli F, Pileggi M, Cabrilo I, Commodaro C, Van Kuijk S, Cardia A AJNR Am J Neuroradiol. 2024; 45(11):1805-1810.

PMID: 38914434 PMC: 11543086. DOI: 10.3174/ajnr.A8394.

When spinal instrumentation revision is not an option: Salvage vertebral augmentation with polymethylmethacrylate for mechanical complications: A systematic review.

Cawley D, Divani K, Shafafy R, Devitt A, Molloy S Brain Spine. 2023; 3:101726.

PMID: 37383448 PMC: 10293288. DOI: 10.1016/j.bas.2023.101726.

Intervertebral Body Implant Salvage: Stabilization by Bone Augmentation.

Amoretti N, Burns R, Ranc P, Elbaze S, Sala V, Pavan L Cardiovasc Intervent Radiol. 2023; 46(7):959-961.

PMID: 37316695 DOI: 10.1007/s00270-023-03480-4.

Cement Augmentation of Two-Level Lumbar Corpectomy Cage After Malposition: A Novel Salvage Procedure Technical Note.

Hamad M, Ryvlin J, Langro J, Obeidallah A, Marin J, De La Garza Ramos R Cureus. 2022; 14(9):e29074.

PMID: 36258926 PMC: 9558766. DOI: 10.7759/cureus.29074.

Efficacy of Antibiotic-Loaded Cement Augmentation for Correcting Low Grade Pedicle Screw Loosening.

Kim C, Ju C, Lee S, Kim S Korean J Neurotrauma. 2021; 17(1):41-47.

PMID: 33981642 PMC: 8093028. DOI: 10.13004/kjnt.2021.17.e2.

References

Amendola L, Gasbarrini A, Fosco M, Simoes C, Terzi S, De Iure F . Fenestrated pedicle screws for cement-augmented purchase in patients with bone softening: a review of 21 cases. J Orthop Traumatol. 2011; 12(4):193-9. PMC: 3225622. DOI: 10.1007/s10195-011-0164-9. View

Fransen P . Increasing pedicle screw anchoring in the osteoporotic spine by cement injection through the implant. Technical note and report of three cases. J Neurosurg Spine. 2007; 7(3):366-9. DOI: 10.3171/SPI-07/09/366. View

Clark W, Bird P, Gonski P, Diamond T, Smerdely P, McNeil H . Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2016; 388(10052):1408-1416. DOI: 10.1016/S0140-6736(16)31341-1. View

Fourney D, Schomer D, Nader R, Chlan-Fourney J, Suki D, Ahrar K . Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg. 2003; 98(1 Suppl):21-30. DOI: 10.3171/spi.2003.98.1.0021. View

Cianfoni A, Massari F, Ewing S, Persenaire M, Rumboldt Z, Bonaldi G . Combining percutaneous pedicular and extrapedicular access for tumor ablation in a thoracic vertebral body. Interv Neuroradiol. 2014; 20(5):603-8. PMC: 4243230. DOI: 10.15274/INR-2014-10018. View

Young P, Berquist T, Bancroft L, Peterson J . Complications of spinal instrumentation. Radiographics. 2007; 27(3):775-89. DOI: 10.1148/rg.273065055. View

Chang M, Liu C, Chen T . Polymethylmethacrylate augmentation of pedicle screw for osteoporotic spinal surgery: a novel technique. Spine (Phila Pa 1976). 2008; 33(10):E317-24. DOI: 10.1097/BRS.0b013e31816f6c73. View

Prodi E, Grassi R, Iacobellis F, Cianfoni A . Imaging in Spondylodiskitis. Magn Reson Imaging Clin N Am. 2016; 24(3):581-600. DOI: 10.1016/j.mric.2016.04.005. View

Zimmerli W . Clinical practice. Vertebral osteomyelitis. N Engl J Med. 2010; 362(11):1022-9. DOI: 10.1056/NEJMcp0910753. View

10.

DeWald C, Stanley T . Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality. Spine (Phila Pa 1976). 2006; 31(19 Suppl):S144-51. DOI: 10.1097/01.brs.0000236893.65878.39. View

11.

Radvany M, Murphy K, Millward S, Barr J, Clark T, Halin N . Research reporting standards for percutaneous vertebral augmentation. J Vasc Interv Radiol. 2009; 20(10):1279-86. DOI: 10.1016/j.jvir.2009.07.030. View

12.

Clerk-Lamalice O, Irani Z, Growney M, Beall D, Hirsch J . Republished: Parapedicular vertebral augmentation with polymethylmetacrylate for pedicle screw loosening. J Neurointerv Surg. 2018; 11(9):e7. DOI: 10.1136/neurintsurg-2017-013548.rep. View

13.

Burval D, McLain R, Milks R, Inceoglu S . Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength. Spine (Phila Pa 1976). 2007; 32(10):1077-83. DOI: 10.1097/01.brs.0000261566.38422.40. View

14.

Amoretti N, Bertrand A, Gallo G, Caudal A, Cornelis F, Hauger O . Percutaneous consolidation of loosened spine arthrodesis under CT and fluoroscopy guidance by radiologists: a new useful technique. Eur Radiol. 2014; 25(4):1135-9. DOI: 10.1007/s00330-014-3475-4. View

15.

Klazen C, Lohle P, de Vries J, Jansen F, Tielbeek A, Blonk M . Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010; 376(9746):1085-92. DOI: 10.1016/S0140-6736(10)60954-3. View

16.

Berenson J, Pflugmacher R, Jarzem P, Zonder J, Schechtman K, Tillman J . Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol. 2011; 12(3):225-35. DOI: 10.1016/S1470-2045(11)70008-0. View

17.

Yun D, Hwang B, Oh H, Kim J, Jeon S, Lee S . Salvage Percutaneous Vertebral Augmentation Using Polymethyl Methacrylate in Patients with Failed Interbody Fusion. World Neurosurg. 2016; 95:618.e13-618.e20. DOI: 10.1016/j.wneu.2016.08.036. View

18.

Puri A, Erdem E . Salvage percutaneous vertebral augmentation in failed spinal interbody fusions associated with multiple myeloma. Spine J. 2010; 10(8):e5-10. DOI: 10.1016/j.spinee.2010.06.008. View

19.

Theologis A, Miller L, Callahan M, Lau D, Zygourakis C, Scheer J . Economic Impact of Revision Surgery for Proximal Junctional Failure After Adult Spinal Deformity Surgery: A Cost Analysis of 57 Operations in a 10-year Experience at a Major Deformity Center. Spine (Phila Pa 1976). 2016; 41(16):E964-E972. DOI: 10.1097/BRS.0000000000001523. View

20.

Kang S, Kim K, Park S, Kim Y . A case of pedicle screw loosening treated by modified transpedicular screw augmentation with polymethylmethacrylate. J Korean Neurosurg Soc. 2011; 49(1):75-8. PMC: 3070902. DOI: 10.3340/jkns.2011.49.1.75. View