Using percutaneous parapedicle screw vertebroplasty to treat transpedicle screw loosening

Abstract

Background: Pedicle screw loosening (PSL) is a postsurgical complication of spinal fusion surgery that can result in morbidity. The aim of this study was to evaluate the efficacy and safety of percutaneous parapedicle screw vertebroplasty (PPSV) for pain reduction and motility improvement in patients with PSL. Methods: The postsurgical solid inter-body fusion with inter-body bone mass formation of 32 patients who underwent lumbar-sacrum spinal fusion surgery was confirmed with plain films and CT scans. Each patient had one or two screws with symptomatic PSL and was treated with PPSV. All the patients were then followed up for 12 to 24 months. The visual analog scale (VAS) and Roland-Morris Disability Questionnaire (RMDQ) were used to evaluate each patient before the operation, after the operation, and during the follow-up period. Results: A total of 32 patients with a total of 47 screws with PSL were treated with PPSV and experienced different results in terms of pain reduction (with the mean VAS score dropping from 7.97 ± 0.74 to 2.34 ± 1.59, p < 0.001) and motility improvement (with the mean RMDQ score dropping from 16.75 ± 1.84 to 7.21 ± 4.08, p < 0.001). The motility improvement was significantly correlated with pain reduction (r = 0.42, p = 0.018), with the mean follow-up period being 19.3 ± 6.2 months (range: 8-36 months). However, five patients who experienced moderate improvements had eventually received a revision operation after undergoing PPSV. Conclusion: The PPSV procedure is effective and safe for the reduction of pain and improvement of life quality in patients with PSL. It can thus be considered as a possible option for the revision of spinal fusion surgery.

When spinal instrumentation revision is not an option: Salvage vertebral augmentation with polymethylmethacrylate for mechanical complications: A systematic review

“…The series was too small for a metanalysis but collated data from all papers demonstrate a mean age of 70 years (38–80 years). The series included patients from China, France, Italy, Korea, Taiwan, Turkey, United Kingdom and United States ( Divani et al., 2018 ; Amoretti et al., 2015 ; Clerk-Lamalice et al., 2018 ; Fu and Li, 2018 ; Xu et al., 2014 ; Yılmaz et al., 2022 ; Yun et al., 2016 ; Cianfoni et al., 2018 ; Do et al., 2020 ; Prestat et al., 2021 ; Wang et al., 2021 ). Relevant investigations included plain radiography and CT ( Fu and Li, 2018 ; Yılmaz et al., 2022 ; Cianfoni et al., 2018 ; Do et al., 2020 ; Prestat et al., 2021 ; Wang et al., 2021 ), MRI and CT SPECT ( Divani et al., 2018 ; Amoretti et al., 2015 ), CT and MRI ( Xu et al., 2014 ) and additional dynamic radiographs ( Fu and Li, 2018 ).…”

“…The series included patients from China, France, Italy, Korea, Taiwan, Turkey, United Kingdom and United States ( Divani et al., 2018 ; Amoretti et al., 2015 ; Clerk-Lamalice et al., 2018 ; Fu and Li, 2018 ; Xu et al., 2014 ; Yılmaz et al., 2022 ; Yun et al., 2016 ; Cianfoni et al., 2018 ; Do et al., 2020 ; Prestat et al., 2021 ; Wang et al., 2021 ). Relevant investigations included plain radiography and CT ( Fu and Li, 2018 ; Yılmaz et al., 2022 ; Cianfoni et al., 2018 ; Do et al., 2020 ; Prestat et al., 2021 ; Wang et al., 2021 ), MRI and CT SPECT ( Divani et al., 2018 ; Amoretti et al., 2015 ), CT and MRI ( Xu et al., 2014 ) and additional dynamic radiographs ( Fu and Li, 2018 ). The pathology which accompanied the diagnosis of pedicle screw loosening was proximal junctional failure (PJF) with a long construct ( Divani et al., 2018 ; Clerk-Lamalice et al., 2018 ; Yun et al., 2016 ; Do et al., 2020 ), instrumented fusion for trauma ( Amoretti et al., 2015 ; Prestat et al., 2021 ), degenerative ( Fu and Li, 2018 ; Yılmaz et al., 2022 ), tumor ( Xu et al., 2014 ) or a combination ( Cianfoni et al., 2018 ).…”

“…The pathology which accompanied the diagnosis of pedicle screw loosening was proximal junctional failure (PJF) with a long construct ( Divani et al., 2018 ; Clerk-Lamalice et al., 2018 ; Yun et al., 2016 ; Do et al., 2020 ), instrumented fusion for trauma ( Amoretti et al., 2015 ; Prestat et al., 2021 ), degenerative ( Fu and Li, 2018 ; Yılmaz et al., 2022 ), tumor ( Xu et al., 2014 ) or a combination ( Cianfoni et al., 2018 ). The operated levels from 3 series included T11- S1 ( Fu and Li, 2018 ; Yılmaz et al., 2022 ; Wang et al., 2021 ). There was no patient lost to follow up.…”

“…There was no patient lost to follow up. In one series, cases had established solid fusion on plain radiography and CT, but with persistent pain requiring PMMA ( Wang et al., 2021 ).…”

“…Two studies received funding from a company responsible for manufacture of kyphoplasty equipment ( Xu et al., 2014 ) and spinal equipment ( Cianfoni et al., 2018 ). However, all but one included studies had consecutive VAS or PGIC scores and some also reported EQ-5D (EuroQol 5D), ODI (Oswestry Disability Index) and SRS22 (Scoliosis Research Society) outcomes ( Divani et al., 2018 ), Japanese Orthopedic Association (JOA) scores ( Yılmaz et al., 2022 ), Low Back Outcome Score (LBOS) ( Prestat et al., 2021 ) or Roland Morris (RMDQ) ( Wang et al., 2021 ).…”