Augmentation of a loosened sacral pedicle screw with percutaneous polymethylmeth acrylate injection

Study Design: Case report describing augmentation of a loosened sacral screw with percutaneous injection of polymethylmethacrylate. Objective: To highlight the advantages of percutaneous injection of polymethylmethacrylate in treatment of loosened pedicle screws. Setting: Turkey. Summary of Background Data: Lumbosacral instrumentation with pedicle screws is a commonly used procedure for correcting deformity and stabilizing the spine until bony fusion occurs. Loosening of the screws is a complication of this procedure and is seen more frequently in multilevel instrumentation, particularly in those instrumentations using sacral screws. Method: We present the case of a woman who had had L3-L4-L5-S1 instrumentation with pedicle screws who developed severe low back pain radiating to the left hip 2 months after the operation. Radiologic and clinical examination revealed that the left pedicle screw of the sacrum had loosened, and revision surgery was planned. The left sacral screw was augmented with percutaneous injection of polymethylmethacrylate. Results: The patient was free of pain after the operation. Conclusions: We suggest that percutaneous polymethylmethacrylate injection around a loosened screw may be an alternative to major open revision surgery in cases of sacral screw failure in multisegmental instrumentation.