The Journal of Bone and Joint Surgery, Vol 68, Issue 8 1145-1157, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
Failure of stabilization of the spine with methylmethacrylate. A retrospective analysis of twenty-four cases
PC McAfee, HH Bohlman, T Ducker and FJ Eismont
Twenty-four patients who had a major complication after attempted
stabilization of the spine with methylmethacrylate were referred for
treatment. The initial instability that necessitated stabilization was
caused by a traumatic condition in fifteen of these patients and by a
metastatic tumor in nine. The average length of time before failure of
fixation was 208.3 days for the patients who had a traumatic condition and
193.7 days for those who had a neoplasm. In eleven patients a progressive
neural deficit developed postoperatively, and in six others the recovery of
neural function was possibly hindered by the cement. A deep wound infection
developed in six patients, and in five of them treatment by removal of the
methylmethacrylate and metal, followed by a prolonged period of cervical
traction, was required. Loosening and failure of fixation was the most
common complication--it occurred in twelve of the fifteen patients who had
a traumatic lesion and in eight of the nine who had a neoplasm. Salvage
operations that included removal of the cement and conventional
bone-grafting procedures were performed in eleven of the twelve patients
who had loosening associated with a traumatic lesion and in six of the
eight who had loosening and a tumor. Stability was restored in every
patient. Improved long-term results can be achieved by using grafts of
iliac bone and triple-wire stabilization methods (a midline wiring between
the spinous processes and two iliac-crest grafts, one on each side, wired
to the posterior elements) instead of methacrylate in the primary treatment
of traumatic injuries. The treatment of choice for instability caused by
neoplastic destruction of two or more vertebral bodies includes a construct
of methylmethacrylate anteriorly. However, if cement is used, early
augmentation with posterior fusion of the spine and stabilization should be
considered. As a rule, combined anterior and posterior stabilization is
recommended for the reconstruction of a spine that is unstable due to
neoplastic destruction. In general, whenever methylmethacrylate is used for
spinal stabilization, it should be augmented with grafts of iliac bone to
provide long-term stability.
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