Pedicle screw loosening is a major concern especially in the osteoporotic spine. It results from the loss of metal-bone interface integrity. Once a screw pullout occurs, the surgeon should revise the implant. Different salvage techniques exist such as using larger screws, screws with a larger thread depth and pitch, expandable screws, screws with bicortical purchase, milled bone graft impacted into the pilot hole, or PMMA augmented screws. We describe a new, minimally invasive salvage technique that could be an alternative to open revision surgeries. As an alternative to open, major revision surgeries for failed and/or loosened instrumentation systems, we suggest minimally invasive cement augmentation procedure under local anesthesia.
Keywords: pedicle screw, sacrum, augmentation, vertebroplasty, polymethlymethacrylate