title: Salvage percutaneous vertebral augmentation in failed spinal interbody fusions associated with multiple myeloma.
abstract: BACKGROUND
  Failed posterior spinal interbody fusion is a known phenomenon with clinical consequences.
  
  
  OBJECTIVE
  This technical note of percutaneous vertebral augmentation in patients with failed posterior interbody construct can be used in patients at high risk for repeat surgery, like patients with multiple myeloma.
  
  
  METHODS
  Retrospective analysis of the two procedures was done. Clinical and radiologic follow-up was available for 1.5 years at the time of manuscript preparation.
  
  
  METHODS
  Both patients were referred to us after undergoing posterior spinal interbody fusion from outside institutions with persistent pain. The patients had a pain level requiring opioid analgesics and changes in the activities of daily living. The patients had active multiple myeloma at the time of the surgical intervention and vertebral augmentation procedure.
  
  
  METHODS
  Visual analog scales were used to gauge the pain relief after the procedure and during further follow-ups. In addition, radiologic follow-up was obtained by means of computed tomography and magnetic resonance imaging scans.
  
  
  METHODS
  Vertebral augmentation procedures in both patients were done under intravenous conscious sedation with the patient prone. High-quality biplane fluoroscopy was used for the procedure. No immediate- or long-term complications were noted.
  
  
  RESULTS
  Both patients had an appreciable relief from pain immediately after the procedure and on follow-up. Follow-up radiologic imaging revealed consistent cement distribution around the construct, no further collapse of the vertebra, with no new lucency surrounding the construct.
  
  
  CONCLUSIONS
  This modified technique of vertebral augmentation can be helpful in management of cases with clinical or radiologic evidence of failed posterior spinal interbody fusion. The cage construct can be stabilized with the injection of cement. The cement surrounding the construct provides strength to the axis and prevents further loosening.
authors.affiliation: Division of Interventional Neuroradiology, University of Arkansas for Medical Sciences, 4301 W. Markham St, Suite #556, Little Rock, AR 72205, USA.
authors.forename: Ajit S
authors.initials: AS
authors.lastname: Puri
authors.forename: Eren
authors.initials: E
authors.lastname: Erdem
mesh_terms: D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000601:surgery*; D010147:Pain Measurement; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*