title: Short-segment percutaneous pedicle screw fixation with cement augmentation for tumor-induced spinal instability.
abstract: BACKGROUND
  Pathologic vertebral compression fractures (VCFs) represent a major source of morbidity and diminished quality of life in the spinal oncology population. Procedures with low morbidity that effectively treat patients with pathologic fractures are especially important in the cancer population where life expectancy is limited. Vertebroplasty and kyphoplasty are often not effective for mechanically unstable pathologic fractures extending into the pedicle and facet joints. Combination of cement augmentation and percutaneous instrumented stabilization represents a minimally invasive treatment option that does not delay radiation and systemic therapy.
  
  
  OBJECTIVE
  The objective of the study was to evaluate the safety and efficacy of cement-augmented short-segment percutaneous posterolateral instrumentation for tumor-associated VCF with pedicle and joint involvement.
  
  
  METHODS
  Forty-four consecutive patients underwent cement-augmented percutaneous spinal fixation for unstable tumors between 2011 and 2014. Retrospective analysis of prospectively collected data, including visual analog pain scale (VAS) response score and procedural complications, was performed.
  
  
  RESULTS
  Patients with a median composite Spinal Instability Neoplastic Scale score of 10 (range=8-15) were treated with constructs spanning one to four disk spaces (median of two spaces, constituting 84% of all cases). The proportion of patients with severe pain decreased from 86% preoperatively to 0%; 65% of patients reported no referable instability pain postoperatively. There was one adjacent-level fracture responsive to kyphoplasty, and one case of asymptomatic screw pullout. Two patients subsequently required decompression in the setting of disease progression despite radiation; there was no perioperative morbidity.
  
  
  CONCLUSIONS
  Percutaneous cement-augmented posterolateral spinal fixation is a safe and effective option for palliation of appropriately selected mechanically unstable VCF that extends into pedicle and/or joint.
authors.affiliation: Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 E. 68th St, New York, NY 10065, USA.
authors.forename: Nelson
authors.initials: N
authors.lastname: Moussazadeh
authors.affiliation: Legacy Spine & Neurological Associates, 5800 W. 10th St, Little Rock, AR, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Rubin
authors.affiliation: Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA.
authors.forename: Lily
authors.initials: L
authors.lastname: McLaughlin
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Lis
authors.affiliation: Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 E. 68th St, New York, NY 10065, USA.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Bilsky
authors.affiliation: Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 E. 68th St, New York, NY 10065, USA. Electronic address: lauferi@mskcc.org.
authors.forename: Ilya
authors.initials: I
authors.lastname: Laufer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D005260:Female; D050815:Fractures, Compression / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws; D011788:Quality of Life; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000150:complications / Q000601:surgery*; D016103:Spinal Fractures / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements
keywords: Kyphoplasty; Percutaneous spinal fixation; Posterolateral instrumentation; Spinal metastases; Vertebral compression fracture; Vertebroplasty
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