For symptomatic loosened pedicle screws and instrumentation-associated vertebral fracture, extensive surgery to remove the pedicle screws and extend the instrumentation, along with the reinsertion of more pedicle screws, is usually the treatment of choice. After such a surgery, however, similar complications will still be encountered. In this study the authors propose minimally invasive percutaneous cement augmentation under fluoroscopic guidance as a salvage procedure that eliminates the inherent risks of conventional extensive surgery.
The records for 10 consecutive patients who had undergone fluoroscopy-guided percutaneous cement augmentation for loosened pedicle screws and instrumentation-associated vertebral fractures were reviewed. The procedures, performed with the patients under local anesthesia, were basically similar to vertebroplasty except for the preexisting pedicle screws. The trocar was inserted under fluoroscopic guidance, along the path of the loosened pedicle screw, using the latero-pedicular approach. The visual analog scale (VAS) and radiographic images were used for clinical outcome assessment at 3, 6, and 12 months after surgery.
The mean follow-up period was 14.3 months. The mean postoperative hospital stay was 1.2 days. There was neither cement leakage into the posterior neuroforamen nor neurological complication in this series. The mean VAS score improved from 5.9 preoperatively to 2.5 at the last follow-up (p = 0.02). Eight patients obtained satisfactory results and 2 needed revision open surgery.
The results demonstrate that minimally invasive fluoroscopy-guided percutaneous vertebroplasty is technically feasible and can be performed safely and effectively for symptomatic loosened pedicle screws and instrumentation-associated vertebral fracture.