Lots of controversy here.  Not vascular either. What to do with loose screws?  Cement them.  Have all kinds of theoretical objections to it?  On biomechanical or other grounds.  Whatever they are, the theory needs some updating.  Because it works — and way better than extending fusions…

Very helpful to have an intraprocedural DYNA CT — this work is not for the C-arm — unless you’ve done a lot of them

Access — kyphoplasty kit — get some cement into the bone first and then have it fill the void around the screws

Use steep cranial or caudal views to get a pseudo-axial projection as cement moves back to make sure its not in the canal

Post — cement in disk space confirms pre-existing breech of superior endplate.  Good — less of a hole now, and of course we cement the junctional level

POST DYNAS

We got a ton more of these, and they work, more than 80% of the time, to avoid another fusion — music to all ears i’m sure

Check out

http://www.ajnr.org/content/39/10/1957.long