Percutaneous Juxtapedicular Cement Salvage of Failed Spinal Instrumentation? Institutional Experience and Cadaveric Biomechanical Study

Author:

Kurland David B.1ORCID,Lendhey Matin2,Delavari Nader1,Winfield Jalen3,Mahoney Jonathan M.2,Becske Tibor4,Shapiro Maksim5,Raz Eytan5,Pacione Donato1,Bucklen Brandon S.2,Frempong-Boadu Anthony K.1

Affiliation:

1. Department of Neurosurgery, New York University Langone Medical Center, New York, New York, USA;

2. Musculoskeletal Education and Research Center, Globus Medical Inc., Audubon, Pennsylvania, USA;

3. School of Biomedical Engineering, Drexel University, Philadelphia, Pennsylvania, USA;

4. Departments of Neurology, University of North Carolina, Chapel Hill, North Carolina, USA;

5. Department of Radiology, New York University Langone Medical Center, New York, New York, USA

Abstract

BACKGROUND AND OBJECTIVES: Instrumented spinal fusion constructs sometimes fail because of fatigue loading, frequently necessitating open revision surgery. Favorable outcomes after percutaneous juxtapedicular cement salvage (perc-cement salvage) of failing instrumentation have been described; however, this approach is not widely known among spine surgeons, and its biomechanical properties have not been evaluated. We report our institutional experience with perc-cement salvage and investigate the relative biomechanical strength of this technique as compared with 3 other common open revision techniques. METHODS: A retrospective chart review of patients who underwent perc-cement salvage was conducted. Biomechanical characterization of revision techniques was performed in a cadaveric model of critical pedicle screw failure. Three revision cohorts involved removal and replacement of hardware: (1) screw upsizing, (2) vertebroplasty, and (3) fenestrated screw with cement augmentation. These were compared with a cohort with perc-cement salvage performed using a juxtapedicular trajectory with the failed primary screw remaining engaged in the vertebral body. RESULTS: Ten patients underwent perc-cement salvage from 2018 to 2022 to address screw haloing and/or endplate fracture threatening construct integrity. Pain palliation was reported by 8/10 patients. Open revision surgery was required in 4/10 patients, an average of 8.9 months after the salvage procedure (range 6.2-14.7 months). Only one revision was due to progressive hardware dislodgement. The remainder avoided open revision surgery through an average of 1.9 years of follow-up. In the cadaveric study, there were no significant differences in pedicle screw pullout strength among any of the revision cohorts. CONCLUSION: Perc-cement salvage of failing instrumentation is reasonably efficacious. The technique is biomechanically noninferior to other revision strategies that require open surgery for removal and replacement of hardware. Open revision surgery may be avoided by perc-cement salvage in select cases.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Surgery

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