Amoretti Nicolas, Bertrand Anne-Sophie, Gallo Giacomo, Caudal Amandine, Cornelis Francois, Hauger Olivier, Boileau Pascal
Centre Hospitalier Universitaire de Nice, Nice, France,
Eur Radiol. 2015 Apr;25(4):1135-9. doi: 10.1007/s00330-014-3475-4. Epub 2014 Oct 31.
The objective was to evaluate percutaneous computed tomography (CT) and fluoroscopy-guided injection of bone cement for consolidation of loosened posterior arthrodesis performed by radiologists.
A single-centre prospective study involving four consecutive patients (three women, one man) suffering from screw loosening (three at the vertebral level, one at the iliac wing level) after Posterior Lumbar Interbody Fusion (PLIF) treatment was done. The average age was 80 years. Surgical treatment was not indicated or not wished for by the patients. Institutional review board approval and informed consent were obtained. Percutaneous consolidation was performed by an interventional radiologist under CT and fluoroscopy guidance. The path of the trocars was made outside loosened screws bilaterally. Follow-up was assessed using the Visual Analog Scale (VAS).
In all cases, bone cement was successfully placed around the loosened screw. The mean volume of cement that was injected was 3 ml. No cement leakage was observed. No neurological complication occurred. Using VAS, pain decreased from more than 9/10 preoperatively to less than 2/10 the day after the procedure for all patients (p < 0.05).
This study suggests that loosening of spine arthrodesis could be successfully treated by percutaneous injection of bone cement under CT and fluoroscopy guidance.
• PLIF is one of the surgical techniques for spinal arthrodesis. • Treatment indications are degenerative disease or instability following trauma, tumour, or infection. • Screw loosening is a frequent complication that can occur after surgery. • Percutaneous facet consolidation under dual guidance seems to be a feasible technique. • The procedure is performed under local anaesthesia using a minimally invasive approach.
评估由放射科医生进行的经皮计算机断层扫描（CT）和透视引导下注射骨水泥以巩固松动的后路关节融合术。
一项单中心前瞻性研究，纳入了4例连续患者（3例女性，1例男性），这些患者在接受腰椎后路椎间融合术（PLIF）治疗后出现螺钉松动（3例在椎体水平，1例在髂骨翼水平）。平均年龄为80岁。患者未表明或不希望接受手术治疗。获得了机构审查委员会的批准并取得了知情同意。由介入放射科医生在CT和透视引导下进行经皮巩固治疗。套管针路径在双侧松动螺钉外侧制作。使用视觉模拟量表（VAS）进行随访评估。
在所有病例中，骨水泥均成功置于松动螺钉周围。注入的骨水泥平均体积为3 ml。未观察到骨水泥渗漏。未发生神经并发症。使用VAS评估，所有患者的疼痛从术前的超过9/10降至术后当天的低于2/10（p < 0.05）。
本研究表明，在CT和透视引导下经皮注射骨水泥可成功治疗脊柱关节融合术的松动。
• PLIF是脊柱关节融合术的手术技术之一。• 治疗适应症为创伤、肿瘤或感染后的退行性疾病或不稳定。• 螺钉松动是手术后可能发生的常见并发症。• 双重引导下的经皮小关节巩固术似乎是一种可行的技术。• 该手术在局部麻醉下采用微创方法进行。
