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Cement Salvage of Instrumentation-Associated Vertebral Fractures 2014

Category Interventional Ran Xu
Katelyn O'Connor
George Krol
Josh Yamada
Mark Bilsky
Ilya Laufer
Eric Lis, MD
Purpose Spinal instrumentation plays a key role in the treatment of spinal instability in patients with metastatic tumors; however, poor bone quality, radiation and diffuse osseous tumor involvement present significant challenges to spinal stabilization with instrumentation and occasionally result in compression fractures. The objective of this study was to describe cement augmentation options in the treatment of vertebral compression fractures associated with spinal instrumentation in patients with spinal metastatic tumors. Materials & Methods Patients who underwent vertebral cement augmentation in the treatment of instrumentation-associated vertebral compression fractures between 2005 and 2011 were included in the analysis. Only fractures that occurred within the construct or at an adjacent level were included. The changes in the visual analogue scale (VAS) score and need for further surgery were analyzed. Results Eleven patients met the inclusion criteria, with eight tumors located in the thoracic spine and three tumors in the lumbar spine. The median time between surgery and kyphoplasty was 5 months (1-30 months) and the median follow-up after kyphoplasty was 24 months (4-59 months). Eight kyphoplasty procedures were performed at the levels of the upper or lower level of the construct or immediately adjacent to these levels. All patients reported a decrease in their pain scores with a mean decrease of 6 VAS score points (p 2013-12-11 Figures.pdf 2013-12-11 Figures.pdf Conclusion Vertebral cement augmentation represents a safe and effective treatment option in patients with instrumentation-associated vertebral compression fractures. References 1. Fourney DR, Schomer DF, Nader R, et al. Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg 2003;98:21-30 2. Berenson J, Pflugmacher R, Jarzem P, et al. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol 2011;12:225-235 3. Amendola L, Gasbarrini A, Fosco M, et al. Fenestrated pedicle screws for cement-augmented purchase in patients with bone softening: a review of 21 cases. Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology 2011;12:193-199 4. Sawakami K, Yamazaki A, Ishikawa S, et al. Polymethylmethacrylate augmentation of pedicle screws increases the initial fixation in osteoporotic spine patients. Journal of spinal disorders & techniques 2012;25:E28-35 5. Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 2005;366:643-648 6. Falicov A, Fisher CG, Sparkes J, et al. Impact of surgical intervention on quality of life in patients with spinal metastases. Spine 2006;31:2849-2856 7. Finkelstein JA, Zaveri G, Wai E, et al. A population-based study of surgery for spinal metastases. Survival rates and complications. The Journal of bone and joint surgery British volume 2003;85:1045-1050 8. Wise JJ, Fischgrund JS, Herkowitz HN, et al. Complication, survival rates, and risk factors of surgery for metastatic disease of the spine. Spine 1999;24:1943-1951 9. Mendel E, Bourekas E, Gerszten P, et al. Percutaneous techniques in the treatment of spine tumors: what are the diagnostic and therapeutic indications and outcomes? Spine 2009;34:S93-100