When spinal instrumentation revision is not an option: Salvage vertebral augmentation with polymethylmethacrylate for mechanical complications: A systematic review
Intoduction: Mechanical complications from spinal fusion including implant loosening or junctional failure result in poor outcomes, particularly in osteoporotic patients. While the use of percutaneous vertebral augmentation with polymethylmethacrylate (PMMA) has been studied for augmentation of junc...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-01-01
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| Series: | Brain and Spine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529423000140 |
| _version_ | 1827591495998242816 |
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| author | Derek T. Cawley Kiran Divani Roozbeh Shafafy Aiden Devitt Sean Molloy |
| author_facet | Derek T. Cawley Kiran Divani Roozbeh Shafafy Aiden Devitt Sean Molloy |
| author_sort | Derek T. Cawley |
| collection | DOAJ |
| description | Intoduction: Mechanical complications from spinal fusion including implant loosening or junctional failure result in poor outcomes, particularly in osteoporotic patients. While the use of percutaneous vertebral augmentation with polymethylmethacrylate (PMMA) has been studied for augmentation of junctional levels to offset against kyphosis and failure, its deployment around existing loose screws or in failing surrounding bone as a salvage percutaneous procedure has been described in small case series and merits review. Research Question: How effective and safe is the use of PMMA as a salvage procedure for mechanical complications in failed spinal fusion?. Materials and Methods: Systematic search of online databases for clinical studies using this technique. Results: 11 studies were identified, only consisting of two case reports and nine case series. Consistent improvements were observed in pre- to post-operative VAS and with sustained improvements at final follow-up. The extra- or para-pedicular approach was the most frequent access trajectory. Most studies cited difficulties with visibility on fluoroscopy, using navigation or oblique views as a solution for this. Discussion and Conclusions: Percutaneous cementation at a failing screw-bone interface stabilises further micromotion with reductions in back pain. This rarely used technique is manifested by a low but increasing number of reported cases. The technique warrants further evaluation and is best performed within a multidisciplinary setting at a specialist centre. Notwithstanding that underlying pathology may not be addressed, awareness of this technique may allow an effective and safe salvage solution with minimal morbidity for older sicker patients. |
| first_indexed | 2024-03-09T01:33:30Z |
| format | Article |
| id | doaj.art-bc1d7f251189474982389d4b23f9a1d1 |
| institution | Directory Open Access Journal |
| issn | 2772-5294 |
| language | English |
| last_indexed | 2024-03-09T01:33:30Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj.art-bc1d7f251189474982389d4b23f9a1d12023-12-09T06:08:51ZengElsevierBrain and Spine2772-52942023-01-013101726When spinal instrumentation revision is not an option: Salvage vertebral augmentation with polymethylmethacrylate for mechanical complications: A systematic reviewDerek T. Cawley0Kiran Divani1Roozbeh Shafafy2Aiden Devitt3Sean Molloy4Mater Private Hospital, Dublin, 1, Ireland; Dept of Spinal Surgery, University of Galway, Ireland; Corresponding author. Dept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UK.Royal London Hospital, Barts Health, London, UKDept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UKDept of Spinal Surgery, University of Galway, IrelandDept of Spinal Surgery, RNOH Stanmore, Brockley Hill, Stanmore, HA7 4LP, UKIntoduction: Mechanical complications from spinal fusion including implant loosening or junctional failure result in poor outcomes, particularly in osteoporotic patients. While the use of percutaneous vertebral augmentation with polymethylmethacrylate (PMMA) has been studied for augmentation of junctional levels to offset against kyphosis and failure, its deployment around existing loose screws or in failing surrounding bone as a salvage percutaneous procedure has been described in small case series and merits review. Research Question: How effective and safe is the use of PMMA as a salvage procedure for mechanical complications in failed spinal fusion?. Materials and Methods: Systematic search of online databases for clinical studies using this technique. Results: 11 studies were identified, only consisting of two case reports and nine case series. Consistent improvements were observed in pre- to post-operative VAS and with sustained improvements at final follow-up. The extra- or para-pedicular approach was the most frequent access trajectory. Most studies cited difficulties with visibility on fluoroscopy, using navigation or oblique views as a solution for this. Discussion and Conclusions: Percutaneous cementation at a failing screw-bone interface stabilises further micromotion with reductions in back pain. This rarely used technique is manifested by a low but increasing number of reported cases. The technique warrants further evaluation and is best performed within a multidisciplinary setting at a specialist centre. Notwithstanding that underlying pathology may not be addressed, awareness of this technique may allow an effective and safe salvage solution with minimal morbidity for older sicker patients.http://www.sciencedirect.com/science/article/pii/S2772529423000140Pedicle screwsPolymethylmethacrylateVertebroplastyNon-unionJunctional failureScrew loosening |
| spellingShingle | Derek T. Cawley Kiran Divani Roozbeh Shafafy Aiden Devitt Sean Molloy When spinal instrumentation revision is not an option: Salvage vertebral augmentation with polymethylmethacrylate for mechanical complications: A systematic review Brain and Spine Pedicle screws Polymethylmethacrylate Vertebroplasty Non-union Junctional failure Screw loosening |
| title | When spinal instrumentation revision is not an option: Salvage vertebral augmentation with polymethylmethacrylate for mechanical complications: A systematic review |
| title_full | When spinal instrumentation revision is not an option: Salvage vertebral augmentation with polymethylmethacrylate for mechanical complications: A systematic review |
| title_fullStr | When spinal instrumentation revision is not an option: Salvage vertebral augmentation with polymethylmethacrylate for mechanical complications: A systematic review |
| title_full_unstemmed | When spinal instrumentation revision is not an option: Salvage vertebral augmentation with polymethylmethacrylate for mechanical complications: A systematic review |
| title_short | When spinal instrumentation revision is not an option: Salvage vertebral augmentation with polymethylmethacrylate for mechanical complications: A systematic review |
| title_sort | when spinal instrumentation revision is not an option salvage vertebral augmentation with polymethylmethacrylate for mechanical complications a systematic review |
| topic | Pedicle screws Polymethylmethacrylate Vertebroplasty Non-union Junctional failure Screw loosening |
| url | http://www.sciencedirect.com/science/article/pii/S2772529423000140 |
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