A novel use of cement as a salvage procedure in patients with complex spinal injuries with proximal junctional failure

• Published in: Annals of the Royal College of Surgeons of England Vol. 100; no. 6; pp. e154 - e157
• Main Authors: Divani, K, Selvadurai, S, Molloy, S
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-07-2018; Royal College of Surgeons
• Subjects: Bone Cements; Cement; Female; Fractures; Humans; Joint surgery; Kyphosis - complications; Lumbar Vertebrae - surgery; Metastasis; Middle Aged; Online Case Report; Pain; Pain, Postoperative - therapy; Patients; Salvage Therapy - instrumentation; Salvage Therapy - methods; Scoliosis; Spondylolisthesis - complications; Spondylolisthesis - surgery; Surgeons; Surgery; Thoracic Vertebrae - surgery; Vertebrae; Salvage procedure; Vertebroplasty; Cement; Kyphoplasty; Proximal junctional kyphosis
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/rcsann.2018.0076

Long-construct fixations can be complicated by proximal junctional kyphosis. In elderly, high-risk patients with numerous comorbidities, lengthy surgical times and increased blood loss associated with revision osteotomies and extension of fusions are not often tolerated and pose serious life-threatening risks. We present a salvage technique used in a patient with proximal junctional failure and demonstrate its role in improving symptoms and functionality in those not deemed fit for major surgery. Pre- and postoperative pain scores in accordance with the visual analogue scale, walking distances and radiographs were reviewed in a patient who underwent the salvage technique to ascertain the subjective and objective difference in pain and functionality. The patient showed marked improvement in pain scores and walking distances postoperatively. Additionally, the degree of proximal junctional kyphosis was lower on postoperative radiographs. While holding risks of its own, our described technique can be performed in select cases and is a good salvage procedure in high-risk patients. It prevents their exposure to the risks that accompany large revision operations and fusion models with further potential to fail. We recommend that our technique is performed only at specialist centres.