Intravertebral Polymethylmethacrylate Augmentation of Anterior Cervical Discectomy Fusion and Plating in the Setting of Osteoporosis

Study design:Case report and review of the literature.Objective:The aim of this study was to describe a novel approach for anterior cervical fixation, which uses cement augmentation in a patient with osteoporosis.Summary of Background Data: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.Methods: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.Results: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.Conclusions: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.