Intravertebral polymethylmethacrylate augmentation of anterior cervical discectomy fusion and plating in the setting of osteoporosis.

Abstract

Case report and review of the literature. The aim of this study was to describe a novel approach for anterior cervical fixation, which uses cement augmentation in a patient with osteoporosis. Osteoporotic bone presents a challenge for the treating spine surgeon, and techniques to overcome the difficulty of cervical spine fixation in these patients are lacking. A 75-year-old woman with osteoporosis presented with cervical myelopathy and was found to have multiple-level cervical stenosis and C3-4 degenerative instability. The patient underwent anterior cervical discectomy fusion and plating from C3-7, with vertebroplasty polymethylmethacrylate augmentation through the screw pilot holes. Because of the patient's grossly soft bone, she also underwent postoperative halo placement. No cement extravasation was observed. The halo was removed after 3 months. At 6 months follow-up, the patient had full resolution of her myelopathy. Imaging showed the cervical interbody fusions to be healed at all levels, with no screw pullout or graft subsidence. This represents the first comprehensive description of successful cement augmentation during anterior cervical discectomy fusion and plating in a patient with osteoporosis, accomplishing both an increase in screw pullout strength and a decreased likelihood of graft subsidence. With further study, this technique may represent a viable treatment option in patients with osteoporosis requiring cervical decompression and fusion.