title: Posterior transpedicular approach with circumferential debridement and anterior reconstruction as a salvage procedure for symptomatic failed vertebroplasty.
abstract: BACKGROUND
  Complications and failure of vertebroplasty, such as cement dislodgement, cement leakage, or spinal infection, usually result in spinal instability and neural element compression. Combined anterior and posterior approaches are the most common salvage procedure for symptomatic failed vertebroplasty. The purpose of this study is to evaluate the feasibility and efficacy of a single posterior approach technique for the treatment of patients with symptomatic failed vertebroplasty.
  
  
  METHODS
  Ten patients with symptomatic failed vertebroplasty underwent circumferential debridement and anterior reconstruction surgery through a single-stage posterior transpedicular approach (PTA) from January 2009 to December 2011 at our institution. The differences of visual analog scale (VAS), neurologic status, and vertebral body reconstruction before and after surgery were recorded. The clinical outcomes of patients were categorized as excellent, good, fair, or poor based on modified Brodsky's criteria.
  
  
  RESULTS
  The symptomatic failed vertebroplasty occurred between the T11 and L3 vertebrae with one- or two-level involvement. The average VAS score was 8.3 (range, 7 to 9) before surgery, significantly decreased to 3.2 (range, 2 to 4) after surgery (p < 0.01), and continued to decrease to 2.4 (range, 2 to 3) 1 year later (p < 0.01). The average correction of Cobb's angle after surgery was 17.3° (range, 4° to 35°) (p < 0.01). The mean loss of Cobb's angle correction after 1 year of follow-up was 2.7° (range, 0° to 5°). The average allograft subsidence at 1 year after surgery was 1 mm (range, 0 to 2). The neurologic status of Frankel's scale significantly improved after surgery (p = 0.014) and at 1 year after surgery (p = 0.046). No one experienced severe complications such as deep wound infection or neurologic deterioration. All patients achieved good or excellent outcomes after surgery based on modified Brodsky's criteria (p < 0.01).
  
  
  CONCLUSIONS
  Single-stage PTA surgery with circumferential debridement and anterior reconstruction technique provides good clinical outcomes and low complication rate, which can be considered as an alternative method to combined anterior and posterior approaches for patients with symptomatic failed vertebroplasty.
authors: Department of Orthopedic Surgery and Anesthesiology, E-Da Hospital/I-Shou University, 1, E-Da Road, Kaohsiung City, Taiwan. holiucancan@gmail.com.
authors: Yen-Chun
authors: YC
authors: Chiu
authors: Department of Orthopedic Surgery and Anesthesiology, E-Da Hospital/I-Shou University, 1, E-Da Road, Kaohsiung City, Taiwan. isuspine@gmail.com.
authors: Shih-Chieh
authors: SC
authors: Yang
authors: Department of Orthopedic Surgery and Anesthesiology, E-Da Hospital/I-Shou University, 1, E-Da Road, Kaohsiung City, Taiwan. edaspine@gmail.com.
authors: Hung-Shu
authors: HS
authors: Chen
authors: Department of Orthopedic Surgery and Anesthesiology, E-Da Hospital/I-Shou University, 1, E-Da Road, Kaohsiung City, Taiwan. liok@xuite.net.
authors: Yu-Hsien
authors: YH
authors: Kao
authors: Department of Orthopedic Surgery and Anesthesiology, E-Da Hospital/I-Shou University, 1, E-Da Road, Kaohsiung City, Taiwan. ed100130@edah.org.tw.
authors: Yuan-Kun
authors: YK
authors: Tu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement; D019299:Decompression, Surgical; D005240:Feasibility Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries; D008297:Male; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D016879:Salvage Therapy; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries; D017211:Treatment Failure; D054854:Vertebroplasty / Q000379:methods*