A novel use of cement as a salvage procedure in patients with complex spinal injuries with proximal junctional failure

Abstract

Long-construct fixations can be complicated by proximal junctional kyphosis. In elderly, high-risk patients with numerous comorbidities, lengthy surgical times and increased blood loss associated with revision osteotomies and extension of fusions are not often tolerated and pose serious life-threatening risks. We present a salvage technique used in a patient with proximal junctional failure and demonstrate its role in improving symptoms and functionality in those not deemed fit for major surgery. Pre- and postoperative pain scores in accordance with the visual analogue scale, walking distances and radiographs were reviewed in a patient who underwent the salvage technique to ascertain the subjective and objective difference in pain and functionality. The patient showed marked improvement in pain scores and walking distances postoperatively. Additionally, the degree of proximal junctional kyphosis was lower on postoperative radiographs. While holding risks of its own, our described technique can be performed in select cases and is a good salvage procedure in high-risk patients. It prevents their exposure to the risks that accompany large revision operations and fusion models with further potential to fail. We recommend that our technique is performed only at specialist centres.

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

“… Study, Year Design No. Of patients Initial Surgery to Cement Period Pre-op to Post-op VAS/PGIC Adverse Events Subsequent Revision Divani, 2018 ( Divani et al., 2018 ) Case Report 1 N A 9/10–1/10 No No Amoretti, 2014 ( Amoretti et al., 2015 )∗ Case Series 4 24 months 9/10–0/10 1 psoas hematoma No Clerk-Lamalice, 2018 ( Clerk-Lamalice et al., 2018 ) Case Report 1 5 weeks 9/10–2/10 No No Fu, 2018 ( Fu and Li, 2018 ) Case Series 10 N A 5.9–2.5 No 2/10, incidental trauma & osteoporosis Xu, 2014 ( Xu et al., 2014 ) ∗ Case Series 11 5 months 8.4–1.5 No 1/11, 5 months, unilateral rod fracture revised Yilmaz, 2006 ( Yılmaz et al., 2022 ) Case Series 15 2 months 7.5–2.4/10 No No Yun ( Yun et al., 2016 ) Case Series 8 NA 7.2–5.6 C...…”

“…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 ).…”

“…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 operated levels from 3 series included T11- S1 ( Fu and Li, 2018 ; Yılmaz et al., 2022 ; Wang et al., 2021 ).…”

Discoplasty as a salvage technique for pseudoarthrosis following multilevel TLIFS: A case report

“…It resulted in improvement of pain scores and walking distance postoperatively, and a lower degree of proximal junctional kyphosis. In patients with multiple comorbidities and very difficult deformities, the salvage technique could be used to prevent patient from being exposed to further high-risk revision operations [20] . Another case has been reported by Granville et al which they used Cortoss bone cement to stabilize a non-union after interbody fusion.…”