Describing an old trick in posterior thoracal and lumbar implant removal surgery: follow-up results for at least 10 years.

STUDY DESIGN: Retrospective case series. OBJECTIVES: We aimed to describe with a novel surgical approach for the removal of posterior thoracolumbar implant in patients with symptomatic failure of the implant and present our preliminary results with this method. METHODS: This retrospective, single-center study was performed in the neurosurgery department of a university hospital. Data were gathered from the medical files of 314 patients (243 women, 77.39%; 71 men, 22.61%) with symptomatic thoracolumbar implant failure that underwent implant removal operation using our novel technique between 2010 and 2020. Symptoms, radiological findings, intraoperative findings as well as clinical outcomes were evaluated. RESULTS: In our series, the average age was 46.5 years (range: 21-84) with a mean follow-up duration of 7 years (range: 3 months to 10 years). Preoperatively, the most common symptoms were leg pain and numbness of the lower extremity. Postoperatively, no major complications were noted. Clinical progression of symptoms was avoided by surgery in all patients, while we came across removal difficulties due to screw-screwdriver mismatch in 15 of 314 surgeries (4.78%). Our novel approach allowed successful screw removal including these challenging cases. CONCLUSIONS: We suggest that our novel approach is a practical and effective for the removal of posterior thoracolumbar implant in cases with symptomatic failure attributed to screw-screwdriver mismatch. Further trials are warranted to assess the efficacy of this technique to overcome surgical problems associated with screw removal.

Transforaminal Vertebroplasty for Screwed Vertebrae: A New Minimally Invasive Technique.

OBJECTIVE: Pedicle screw loosening and fractures of instrumented vertebrae are not uncommon and require reoperations, which are an immense burden on the patient and health care system. We aimed to describe a novel, simple percutaneous technique on instrumented vertebrae for treating pedicle screw loosening and demonstrate that corpus with osteoporotic vertebral compression fractures can be managed with this simple technique. METHODS: This retrospective study was performed using data gathered from 15 patients who underwent transforaminal vertebroplasty due to symptomatic pedicle screw loosening and vertebral body fracture between 2020 and 2021. Patients' symptoms, radiologic findings, intraoperative findings, and clinical outcomes were noted. RESULTS: This series consisted of 5 male and 10 female patients, and the mean duration of follow-up was 8 months (range: 3 to 13). The average age was 66.67 ± 4.59 years (range: 55-72). Preoperatively, symptoms were leg pain, numbness of the lower extremity, and back pain. Postoperatively, no major complications were observed. Clinical progression of pedicle screw loosening and osteoporotic vertebral compression fractures were halted in all patients. None of the patients had permanent neurologic deficits. All the patients reported a dramatic decrease in pain immediately after the procedure. The vertebral fracture was detected in 3 patients, and screw loosening occurred in 12 patients. All symptoms resolved during follow-up. CONCLUSIONS: Our preliminary results imply that transforaminal vertebroplasty is a safe and easy percutaneous technique in symptomatic pedicle screw loosening and osteoporotic vertebral compression fractures in the instrumented vertebrae. Further trials on larger series are necessary to validate our data.