From the Departments of Neuroradiology (A.C., M.P., M.I.)
Department of Neuroradiology (A.C.), Inselspital, Bern, Switzerland.
AJNR Am J Neuroradiol. 2018 Oct;39(10):1957-1962. doi: 10.3174/ajnr.A5795. Epub 2018 Sep 13.
Altered biomechanics or bone fragility or both contribute to spine instrumentation failure. Although revision surgery is frequently required, minimally invasive alternatives may be feasible. We report the largest to-date series of percutaneous fluoroscopically guided vertebral cement augmentation procedures to address feasibility, safety, results and a variety of spinal instrumentation failure conditions.
A consecutive series of 31 fluoroscopically guided vertebral augmentation procedures in 29 patients were performed to address screw loosening (42 screws), cage subsidence (7 cages), and fracture within (12 cases) or adjacent to (11 cases) the instrumented segment. Instrumentation failure was deemed clinically relevant when resulting in pain or jeopardizing spinal biomechanical stability. The main study end point was the rate of revision surgery avoidance; feasibility and safety were assessed by prospective recording of periprocedural technical and clinical complications; and clinical effect was measured at 1 month with the Patient Global Impression of Change score.
All except 1 procedure was technically feasible. No periprocedural complications occurred. Clinical and radiologic follow-up was available in 28 patients (median, 16 months) and 30 procedures. Revision surgery was avoided in 23/28 (82%) patients, and a global clinical benefit (Patient Global Impression of Change, 5-7) was reported in 26/30 (87%) cases at 1-month follow-up, while no substantial change (Patient Global Impression of Change, 4) was reported in 3/30 (10%), and worsening status (Patient Global Impression of Change, 3), in 1/30 (3%).
Our experience supports the feasibility of percutaneous vertebral augmentation in the treatment of several clinically relevant spinal instrumentation failure conditions, with excellent safety and efficacy profiles, both in avoidance of revision surgery and for pain palliation.
生物力学改变或骨脆弱性或两者都可能导致脊柱内固定失败。尽管经常需要进行翻修手术，但微创替代方法可能是可行的。我们报告了迄今为止最大的一系列经皮透视引导椎体骨水泥增强手术，以解决可行性、安全性、结果以及各种脊柱内固定失败情况。
连续对 29 名患者的 31 例透视引导椎体增强手术进行了研究，以解决螺钉松动（42 个螺钉）、笼下沉（7 个笼）以及器械节段内（12 例）或相邻部位（11 例）骨折的问题。当导致疼痛或危及脊柱生物力学稳定性时，器械失效被认为具有临床相关性。主要研究终点是避免翻修手术的比例；通过前瞻性记录围手术期技术和临床并发症评估可行性和安全性；并在 1 个月时使用患者整体变化印象评分测量临床效果。
除 1 例外，所有手术均具有技术可行性。无围手术期并发症。28 名患者（中位数为 16 个月）和 30 例手术可获得临床和影像学随访。23/28（82%）名患者避免了翻修手术，26/30（87%）例在 1 个月随访时报告了总体临床获益（患者整体变化印象评分，5-7），而 3/30（10%）例报告无明显变化（患者整体变化印象评分，4），1/30（3%）例报告病情恶化（患者整体变化印象评分，3）。
我们的经验支持经皮椎体增强术治疗几种具有临床相关性的脊柱内固定失败情况的可行性，具有良好的安全性和疗效，既能避免翻修手术，又能缓解疼痛。
