Bone cement augmentation in the prevention of adjacent segment failure after multilevel adult deformity fusion.
METHODS
Prospective case report series and detailed description of technique.


OBJECTIVE
To describe a surgical procedure designed to prevent fracture and cutting-through and pullout of screws in the adjacent segment after multilevel deformity correction in adults.


BACKGROUND
Surgery of adult deformities has a high complication rate. One of the potential late complications is the development of fracture at the first mobile segment above a multilevel lumbar or thoracolumbar spinal fusion that necessitates further surgical intervention with extension of the instrumentation. Augmentation with bone cement of the last instrumented vertebra and the first mobile vertebra has the potential to prevent this pathology.


METHODS
Three patients with degenerative thoracolumbar kyphoscoliosis and 3 with adjacent segment failure after correction surgery were treated. Cannulated and perforated pedicle screws were placed in the uppermost-instrumented vertebra. A vertebroplasty tube was inserted from 1 side at the center of the first mobile vertebra. Under C-arm control, vertebroplasty was performed in both vertebrae.


RESULTS
Intraoperatively, there were no cement-related complications. Follow-ups at 6 and 12 (+/-2) months revealed there was no loss of correction, fracture or screw loosening in the augmented vertebrae.


CONCLUSIONS
Bone cement augmentation of the uppermost screws and the first mobile vertebra in multilevel adult deformity and revision surgery seems to be a safe and potentially effective method of preventing adjacent segment failure.
Lattig
Friederike
F
Spine Center, Schulthess Klinik, Lengghalde 2, 8008 Zürich, Switzerland. friederike.lattig@kws.ch
D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D001863:Bone Screws / Q000009:adverse effects; D004868:Equipment Failure; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011446:Prospective Studies; D011859:Radiography; D012086:Reoperation; D013121:Spinal Curvatures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016103:Spinal Fractures / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013904:Thoracic Vertebrae / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D054854:Vertebroplasty / Q000379:methods*
D001843:Bone Cements; D019904:Polymethyl Methacrylate