A Case of Pedicle Screw Loosening Treated by Modified Transpedicular Screw Augmentation with Polymethylmethacrylate.
10.3340/jkns.2011.49.1.75
- Author:
Suk Hyung KANG
1
;
Kyoung Tae KIM
;
Seung Won PARK
;
Young Baeg KIM
Author Information
1. Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea. ybkim1218@cau.ac.kr
- Publication Type:Case Report
- Keywords:
Instrument failure;
Osteoporosis;
Pedicle screw loosening;
PMMA;
Pseudoarthrosis;
Surgical technique
- MeSH:
Back Pain;
Follow-Up Studies;
Humans;
Low Back Pain;
Middle Aged;
Osteoporosis;
Polymethyl Methacrylate;
Pseudarthrosis
- From:Journal of Korean Neurosurgical Society
2011;49(1):75-78
- CountryRepublic of Korea
- Language:English
-
Abstract:
We report a case of pedicle screw loosening treated by modified transpedicular screw augmentation technique using polymethylmethacrylate (PMMA), which used the anchoring effect of hardened PMMA. A 56-year-old man who had an L3/4/5 fusion operation 3 years ago complained of continuous low back pain after this operation. The computerized tomography showed a radiolucent halo around the pedicle screw at L5. We augmented the L5 pedicle screw with modified pedicle screw augmentation technique using PMMA and performed an L3/4/5 pedicle screw fixation without hook or operation field extension. This modified technique is a kind of transpedicular stiffness augmentation using PMMA for the dead space around the loosed screw. After filling the dead space with 1-2 cc of PMMA, we inserted a small screw. Once the PMMA hardened, we removed the small screw and inserted a thicker screw along the existing screw threading to improve the pedicle screws' pullout strength. At 10 months' follow-up, x-ray showed strong fusion of L3/4/5. The visual analogue scale (VAS) of his back pain was improved from 9 to 5. This modified transpedicular screw augmentation with PMMA using anchoring effect is a simple and effective surgical technique for pedicle screw loosening. However, clinical analyses of long-term follow-up and biomechanical studies are needed.
