Kurland David B, Lendhey Matin, Delavari Nader, Winfield Jalen, Mahoney Jonathan M, Becske Tibor, Shapiro Maksim, Raz Eytan, Pacione Donato, Bucklen Brandon S, Frempong-Boadu Anthony K
Department of Neurosurgery, New York University Langone Medical Center, New York , New York , USA.
Musculoskeletal Education and Research Center, Globus Medical Inc., Audubon , Pennsylvania , USA.
Oper Neurosurg (Hagerstown). 2024 Jan 1;26(1):38-45. doi: 10.1227/ons.0000000000000924. Epub 2023 Sep 25.
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.
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.
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.
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.
器械辅助脊柱融合结构有时会因疲劳负荷而失败，常常需要进行开放性翻修手术。经皮椎弓根旁骨水泥挽救术（perc-cement salvage）治疗失败的器械辅助融合结构后取得了良好的效果；然而，这种方法在脊柱外科医生中并不广为人知，其生物力学特性也未得到评估。我们报告了我们机构采用perc-cement salvage的经验，并研究了该技术与其他三种常见开放性翻修技术相比的相对生物力学强度。
对接受perc-cement salvage的患者进行回顾性病历审查。在关键椎弓根螺钉失败的尸体模型中对翻修技术进行生物力学特征分析。三个翻修队列包括取出并更换硬件：（1）螺钉增大尺寸，（2）椎体成形术，（3）带骨水泥强化的开窗螺钉。将这些与使用椎弓根旁入路进行perc-cement salvage且原失败螺钉仍留在椎体中的队列进行比较。
2018年至2022年期间，10例患者接受了perc-cement salvage以解决螺钉松动和/或终板骨折威胁结构完整性的问题。8/10的患者报告疼痛缓解。4/10的患者需要进行开放性翻修手术，平均在挽救手术后8.9个月（范围6.2 - 14.7个月）。只有一次翻修是由于硬件逐渐移位。其余患者通过平均1.9年的随访避免了开放性翻修手术。在尸体研究中，任何一个翻修队列的椎弓根螺钉拔出强度均无显著差异。
失败器械辅助融合结构的perc-cement salvage相当有效。该技术在生物力学上不劣于其他需要开放手术取出和更换硬件的翻修策略。在某些情况下，perc-cement salvage可避免开放性翻修手术。
