gms | German Medical Science

Objective: Cement augmentation of thoracolumbar pedicle screws nowadays is ubiquitously established, thereby providing a significantly more durable anchorage of implants in the presence of reduced bone quality. The experience with this kind of procedure in the cervical spine is relatively limited and confined to a few case reports. On the basis of 7 own cases the general feasibility, technical pitfalls, procedural safety and benefits are discussed.

Methods: 9 patients (5 female, 4 male, median age 64 years) were operated by cervical corpectomy, vertebral body replacement and anterior plating. Due to poor bone quality (median T-score: –3.2) as well as intraoperative evidence of insufficient screw anchoring an additional vertebroplasty of each vertebral body using a high viscosity cement was performed and screws were placed into the augmented area.

Results: There was no major perioperative complication. Cement leakage into spinal canal was not observed. In the routine check-ups 6 months and 1 year postoperatively a sufficient implant anchorage was documented in 6 out of 7 cases. Bony fusion was only seen in one patient. There was one case of cage subsidence into the adjacent vertebra but no surgical indication could be derived. A significant improvement of the physiological sagittal profile with enlargement of the bisegmental Cobb angle by an average of 7 ° was demonstrated one year after surgery.

Conclusions: Cement augmentation of anterior cervical screws is generally feasible and can be carried out safely in accordance with prudent planning. Our results suggest that a stable and durable osteosynthesis of vertebrae with significantly reduced bone quality is possible which seems to be especially useful in cases of severe genuine osteoporosis or multiple myeloma with affection of almost every adjacent vertebra. It appears difficult to establish boundaries or limits below which augmentation may be recommended.