![]() The trajectory of the introducer needles was dictated by the hardware and anatomy ( Fig 1). Both CT and fluoroscopy were used for placement of the introducer needles. The procedure was performed under general anesthesia in the interventional radiology suite that has both fluoroscopic and CT (conebeam as well as collimated) capabilities. This determined which vertebrae to augment and helped in the planning of the trajectory of the introducer needles for subsequent cement augmentation. We report a series of patients in whom percutaneous vertebral cement augmentation was used as an initial treatment of symptomatic instrumentation or junctional fractures in place of open hardware revision.Īll patients had cross-sectional imaging of the spine before the procedure usually consisting of MR imaging and often a CT scan. 6, 7 However, little information exists regarding its use as a salvage technique for instrumented patients who develop recurrent back pain secondary to new vertebral compression fractures within or adjacent to their surgical construct. 4, 5 Cement has also been used to reinforce screws at the time of insertion. ![]() Percutaneous vertebral cement augmentation (ie, balloon kyphoplasty/vertebroplasty) has been established as a safe and effective method of quickly achieving pain control in osteoporotic and tumor-related compression fractures. ![]() Vertebral compression fractures either within or adjacent to the surgical construct often result in either recurrent or progressive back pain. 1 ⇓– 3 Failure of fixation may require interruption or delay of systemic or radiation therapy, increasing the risk of local or systemic tumor progression. Prior spine radiation results in increased risk of vertebral compression fractures. Furthermore, chest wall resection may be required, further destabilizing the spine and increasing the risk of fixation failure. Spinal fixation in this patient population can be quite challenging because of extensive osteoporosis and lytic tumor destruction. In patients with metastatic spinal tumors, spinal instrumentation is required in most cases to provide spinal stability after circumferential spinal cord decompression. Tumor control is largely accomplished using radiation and chemotherapy. The goals of surgery for spinal metastases remain palliative and include preservation or restoration of neurologic function and pain control. The role of surgery in the treatment of metastatic spinal tumors has been firmly established as an effective and safe method for spinal cord decompression and stabilization of the spine. ABBREVIATIONS: VAS Visual Analog Scale SRS stereotactic radiosurgery
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