Pedicle screw loosening is a major concern especially in the osteoporotic spine. It results from the loss of metal-bone interface integrity. Once a screw pullout occurs, the surgeon should revise the implant. Different salvage techniques exist such as using larger screws, screws with a larger thread depth and pitch, expandable screws, screws with bicortical purchase, milled bone graft impacted into the pilot hole, or PMMA augmented screws. We describe a new, minimally invasive salvage technique that could be an alternative to open revision surgeries. As an alternative to open, major revision surgeries for failed and/or loosened instrumentation systems, we suggest minimally invasive cement augmentation procedure under local anesthesia.
1. Akinola B, Lutchman L, Barker P, et al. Pulmonary cement embolism during cement augmentation of pedicle screw fixation: a case report. J Orthop Surg (Hong Kong) 2010; 18(3): 364-366.
2. Aydogan M, Ozturk C, Karatoprak O, Tezer M, Aksu N, Hamzaoglu A. The pedicle screw fixation with vertebroplasti augmentation in the surgical treatment of the severe osteoporotic spines. J Spinal Disord Tech 2009; 6: 444-447.
3. Fleischer GD, Kim YJ, Ferrara LA, et al. Biomechanical analysis of sacral screw strain and range of motion in long posterior spinal fixation constructs: effects of lumbosacral fixation strategies in reducing sacral screw strains. Spine 2011. [Epub ahead of print].
4. Frankel BM, Jones T, Wang C. Segmental polymethylmethacrylate-augmented pedicle screw fixation in patients with bone softening caused by osteoporosis and metastatic tumor involvement: a clinical evaluation. Neurosurgery 2007; 61: 531-537; discussion: 537-538.
5. Gautschi OP, Schatlo B, Schaller K, Tessitore E. Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws. Neurosurg Focus 2011; 31(4): E8.
6. Harrington PR, Tullos HS. Reduction of severe spondylolisthesis in children. South Med J 1969; 62: 1-7.
7. Hirabayashi S, Kumano K, Kuroki T. Cotrel-Dubousset pedicle screw system for various spinal disorders. Merits and problems. Spine 1991; 16: 1298-1304.
8. Hu MH, Wu HT, Chang MC, Yu W-K, Wang S-T, Liu C-L. Polymethylmethacrylate augmentation of the pedicle screw: the cement distribution in the vertebral body. Eur Spine J 2011; 20(8): 1281-1288.
9. Kang SH, Kim KT, Park SW, Kim YB. A case of pedicle screw loosening treated by modified transpedicular screw augmentation with polymethylmethacrylate. J Korean Neurosurg Soc 2011; 49(1): 75-78.
10. McLachlin SD, Al Saleh K, Gurr KR, et al. Comparative assessment of sacral screw loosening augmented with PMMA versus a calcium triglyceride bone cement. Spine 2011; 36(11): E699-704.
11. Pihlajamaki H, Myllynen P, Böstman O. Complications of transpedicular lumbosacral fixation for non-traumatic disorders. J Bone Joint Surg 1997; 79-B: 183-189.
12. Sanden B, Olerud C, Petren-Mallmin M, Johansson C, Larsson S. The significance of radiolucent zones surrounding pedicle screws: definition of screw loosening in spinal instrumentation. J Bone Joint Surg 2004; 86: 457-463.
13. Sonmez E, Yilmaz C, Caner H. Development of lumbar disc herniation following percutaneous vertebroplasty. Spine 2010; 35(3): E93-75.
14. Yilmaz C, Atalay B, Caner H, Altinors N. Augmentation of a loosened sacral pedicle screw with percutaneous polymethylmethacrylate injection. J Spinal Disord Tech 2006; 19(5): 373-375.
15. Yu BS, Zhuang XM, Zheng ZM, et al. Biomechanical comparison of 4 fixation techniques of sacral pedicle screw in osteoporotic condition. J Spinal Disord Tech 2010; 23:404-409.
16. Yuan HA, Garfin SR, Dickman CA, Mardjetko SM. A historical cohort study of pedicle screw fixation in thoracic, lumbar, and sacral spinal fusions. Spine 1994; 19: S2279-S2296.