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Original research
Middle column Stent-screw Assisted Internal Fixation (SAIF): a modified minimally-invasive approach to rescue vertebral middle column re-fractures
  1. Fortunato Di Caterino1,
  2. Eva Koetsier2,3,
  3. Joshua A Hirsch4,
  4. Maurizio Isalberti5,
  5. Diego San Millan6,
  6. Francesco Marchi7,
  7. Luigi La Barbera8,9,
  8. Marco Pileggi5,
  9. Alessandro Cianfoni5,10
  1. 1 Department of Interventional Neuroradiology, University Hospital Centre Besancon, Besancon, France
  2. 2 Pain Management Center, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
  3. 3 Faculty of Biomedical Sciences, Università della Svizzera italiana Facoltà di scienze biomediche, Lugano, Switzerland
  4. 4 Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  5. 5 Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
  6. 6 Neuroradiology Unit, Service of Diagnostic and Interventional Radiology, Sion Hospital Valais Romand Hospital Center, Sion, Switzerland
  7. 7 Neurosurgery Department, Neurocenter of the Southern Switzerland EOC, Lugano, Switzerland
  8. 8 Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milano, Italy
  9. 9 IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
  10. 10 Department of Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland
  1. Correspondence to Dr Fortunato Di Caterino, Departement of Interventional Neuroradiology, University Hospital Centre Besancon, Besancon, 25030, France; dr.fortunatodicaterino{at}


Background There is limited literature regarding the re-fracture of a previously augmented vertebral compression fracture (VCF). These re-fractures may present as an asymptomatic remodeling of the vertebral body around the cement cast while in other cases they involve the middle column, at the transition zone between the cement-augmented and non-augmented vertebral body. In the latter, a posterior wall retropulsion is possible and, if left untreated, might progress to vertebral body splitting, central canal stenosis, and kyphotic deformity. There is no consensus regarding the best treatment for these re-fractures. There are cases in which a repeated augmentation relieves the pain, but this is considered an undertreatment in cases with middle column involvement, posterior wall retropulsion, and kyphosis.

Methods We report four cases of re-fracture with middle column collapse of a previously augmented VCF, treated with the stent-screw assisted internal fixation (SAIF) technique. A modified more postero-medial deployment of the anterior metallic implants was applied, to target the middle column fracture. This modified SAIF allowed the reduction and stabilization of the middle column collapse as well as the partial correction of the posterior wall retropulsion and kyphosis.

Results Complete relief of back pain with stable clinical and radiographic findings at follow-up was obtained in all cases.

Conclusions In selected cases, the middle column SAIF technique is safe and effective for the treatment of the re-fracture with middle column collapse of a previously cement-augmented VCF. This technique requires precision in trocar placement and could represent a useful addition to the technical armamentarium for VCF treatment.

  • Spine
  • Intervention
  • Technique

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors AC, FDC and MP contributed to conception and design of the study and analysis of data. AC, FDC, MP and DSM prepared the figures and drafted the text. All co-authors contributed to the acquisition of data, provided significant input to interpretation of data, reviewed the paper and revised it for important intellectual content. All co-authors approved the final version to be published. AC and FDC are responsible for the overall content as guarantors. MP and AC request joint last co-authorship.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JAH received consulting fees from Medtronic, Relievant, Agnovos and Spine Biopharma. JAH is a deputy editor of JNIS.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.