Article Text

Parapedicular vertebral augmentation with polymethylmetacrylate for pedicle screw loosening
  1. Olivier Clerk-Lamalice1,
  2. Zubin Irani1,
  3. Marion Growney1,
  4. Douglas P Beall2,
  5. Joshua A Hirsch1
  1. 1NeuroInterventional Spine Service, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Interventional Musculoskeletal Radiology, Clinical Radiology of Oklahoma, Edmond, Oklahoma, USA
  1. Correspondence to Olivier Clerk-Lamalice, NeuroInterventional Spine Service, Massachusetts General Hospital, Boston, Massachusetts, USA; olivierclerk{at}


A 71-year-old man who had a L1/S1 posterior fusion revision surgery complained of increasing back pain 5 weeks after the open surgical procedure. The pain was initially estimated at 9/10 on the visual analog scale (VAS) and thought to be related to a right-sided L2 screw loosening. A right parapedicular vertebroplasty was performed and polymethylmethacrylate cement was instilled around the right pedicle screw, filling the anterior two-thirds of the vertebral body. On postvertebroplasty day 1, the patient had significant improvement in his low back pain. The pain further decreased at 1 and 3 months after the intervention (2/10 on the VAS). Vertebroplasty is a minimally invasive, accessible, effective, and long lasting treatment for compression fractures. We believe that this technique could also be indicated to treat pain related to low grade screw loosening in properly selected patients.

  • spine

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  • Republished with permission from BMJ Case Reports Published 24 January 2018; doi: 10.1136/bcr-2017-013548.rep

  • Contributors All authors contributed to the manuscript as follows: procedure, written case report, literature review, and discussion.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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