Salvage percutaneous vertebral augmentation in failed spinal interbody fusions associated with multiple myeloma.

Abstract

Failed posterior spinal interbody fusion is a known phenomenon with clinical consequences. This technical note of percutaneous vertebral augmentation in patients with failed posterior interbody construct can be used in patients at high risk for repeat surgery, like patients with multiple myeloma. Retrospective analysis of the two procedures was done. Clinical and radiologic follow-up was available for 1.5 years at the time of manuscript preparation. Both patients were referred to us after undergoing posterior spinal interbody fusion from outside institutions with persistent pain. The patients had a pain level requiring opioid analgesics and changes in the activities of daily living. The patients had active multiple myeloma at the time of the surgical intervention and vertebral augmentation procedure. Visual analog scales were used to gauge the pain relief after the procedure and during further follow-ups. In addition, radiologic follow-up was obtained by means of computed tomography and magnetic resonance imaging scans. Vertebral augmentation procedures in both patients were done under intravenous conscious sedation with the patient prone. High-quality biplane fluoroscopy was used for the procedure. No immediate- or long-term complications were noted. Both patients had an appreciable relief from pain immediately after the procedure and on follow-up. Follow-up radiologic imaging revealed consistent cement distribution around the construct, no further collapse of the vertebra, with no new lucency surrounding the construct. This modified technique of vertebral augmentation can be helpful in management of cases with clinical or radiologic evidence of failed posterior spinal interbody fusion. The cage construct can be stabilized with the injection of cement. The cement surrounding the construct provides strength to the axis and prevents further loosening.