Posterior spinal fusion using a pedicle nail system with polymethylmethacrylate in a paraplegic patient after vertebral collapse caused by osteoporosis

Background context: Because posterior decompression and fusion for vertebral collapse in an osteoporotic spine sometimes results in a pullout of the pedicle screw. Several authors reported that fixation of pedicle screws in severely osteoporotic bone could be improved by inserting polymethylmethacrylate (PMMA) into the hole before inserting the screw. However, pedicle screws were not designed to be used with PMMA. Purpose: To report a patient with vertebral collapse who were treated using a novel-concept, pedicle nail using with PMMA. Study design: Case report. Methods: The patient was a 74-year-old female who experienced back pain after some heavy lifting 3 months before. She was laid up for 2 months because of the back pain and weakness of her lower legs. Radiographs and magnetic resonance imaging showed vertebral collapse and neural severe compression from the posterior wall of vertebra T12. The pedicle nail consists of an outer sheath with evenly spaced holes and an internal, removable, threaded component. The outer sheath and the internal component were connected before insertion. The pedicle nail attaches to and is bound by the PMMA through the holes of the outer sheath. We performed a T11-L1 posterior fusion and laminectomy using the pedicle nail, and we used a hydroxyapatite block to perform a transpedicular vertebroplasty of T12. Results: Bone union was observed on a lateral radiograph without pedicle nail loosening. Conclusions: The authors speculate that posterior spinal fusion and vertebroplasty using the pedicle nail will be a reasonable choice for delayed paraplegia after osteoporotic vertebral fracture.