An extended follow-up of spinal instrumentation rescue with cement augmentation

Polinelli, F; Pileggi, M; Cabrilo, I; Commodaro, C; Van Kuijk, S M J; Cardia, A; Cianfoni, A (2024). An extended follow-up of spinal instrumentation rescue with cement augmentation (In Press). AJNR. American journal of neuroradiology American Society of Neuroradiology 10.3174/ajnr.A8394

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BACKGROUND AND PURPOSE

Percutaneous cement augmentation has been reported as an effective salvage procedure for frail patients suffering with spinal instrumentation failure, such as screw loosening, hardware breakage, cage subsidence, and fractures within or adjacent to stabilized segments. Favorable results were reported over a median follow-up period of 16 months in a retrospective analysis of 31 consecutive procedures performed in 29 patients. In the present study, the long-term effectiveness of this treatment in avoiding or postponing revision surgery is reported.

MATERIALS AND METHODS

Clinical and radiological data of our original cohort of patients were retrospectively collected and reviewed to provide an extended follow-up assessment. The need for revision spinal surgery was assessed as the primary outcome and the radiological stability of the augmented spinal implants was considered as the secondary outcome.

RESULTS

An extended radiological follow-up was available in 27/29 patients with an average of 50.9 months. Overall, 18/27 (66.7%) patients, originally candidates for revision surgery, avoided a surgical intervention after a cement augmentation rescue procedure. In the remaining patients, the average interval between the rescue cement augmentation and the revision surgery was 22.5 months. Implant mobilization occurred in 2/27 (7.4%) patients, rod breakage in 1/27 (3.7%), a new fracture within or adjacent to the instrumented segment occurred in 4/27 (14.8%) patients and screw loosening at rescued levels occurred in 5/27 (18.5%) patients.

CONCLUSIONS

In this cohort, cement augmentation rescue procedures were found to be effective in avoiding or postponing revision surgery during long-term follow up.

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