Anterior vertebroplasty of adjacent levels after vertebral body replacement

The aim of this study was to evaluate the feasibility of a new method, which should help to avoid cage subsidence after vertebrectomy in short fusions. After implantation of an extendable vertebral body replacement (VBR) the two adjacent endplates to the fractured or destroyed vertebra were augmented with bone cement using the anterior approach in 20 patients with short circumferential fusion. All patients were followed up for 2 years clinically and radiographically. X-rays were reviewed for kyphosis, cage subsidence, presence of a solid fusion mass and instrumentation failure. Changes in every day activities (Oswestry Disability Index-ODI) and visual analogue scale (VAS), pain score, as well as technique-related complications were examined. The mean amount of kyphosis correction was 12.8° (±6.4°) and changed by only 0.3° (±0.4°) until last follow-up. Pain (VAS) and ODI scores were significantly improved and did not change until last follow-up. In all but two cases, the authors observed solid union with incorporation of the cage. No surgery-related complications were recorded. In one case revision was advised because of non-union due to septic loosening. The augmentation of the adjacent vertebras after anterior VBR provides an enhancement of the interface between cage and vertebra in cases with poor bone quality and in revision surgery. The technique is simple and safe, as the needles can be placed under visual control. Cement augmentation of the endplates may reduce interbody device subsidence.