Cortical bone trajectory fixation in cemented vertebrae in lumbar degenerative disease: A case report

Abstract

BACKGROUND Percutaneous vertebroplasty (PVP) has been widely used in osteoporotic vertebral compression fracture (OVCF). Following surgery, the bone cement would be positioned permanently. However, in some cases of lumbar degenerative disease, the cemented vertebrae needs to be fixed after decompression and fusion procedure. It is difficult to implant traditional pedicle screws into the cemented vertebrae because of the bone cement filling. At present, the main treatment strategy is to skip the cemented vertebra and conduct a long segment fixation. This article presents a cortical bone trajectory (CBT) fixation technique for cemented vertebrae. CASE SUMMARY PVP involving the L3 and L4 was performed in an 82-year-old man due to OVCF. During the surgery, bone cement leakage occurred, resulting in compression of the root of the right L3 nerve. We performed a partial facetectomy to retrieve the leaked bone cement and to relieve the patient’s neurological symptoms. After 3 mo, the patient developed lumbar disc herniation in L3/4, potentially due to instability caused by the previous surgery. Therefore, it was necessary to perform intervertebral fusion and fixation. It was difficult to implant traditional trajectory pedicle screws in L3 and L4 because of the bone cement filling. Hence, we implanted CBT screws in the L3 and L4 vertebrae. As a result, the patient’s symptoms resolved and he reported satisfaction with the surgery at follow-up after 8 mo. CONCLUSION It is feasible to utilize CBT in cemented vertebrae for the treatment of lumbar degenerative disease.