The Safety and Efficacy of CT-Guided, Fluoroscopy-Free Vertebroplasty in Adult Spinal Deformity Surgery

Objective: The goal of this study is to analyze the safety and efficacy of a novel technique of computed tomography–guided, fluoroscopy-free vertebroplasty as an adjunct to help prevent proximal junction kyphosis (PJK) in long-segment posterior spinal fusions. Methods: We performed a retrospective analysis of 118 consecutive patients with adult spinal deformity who underwent long-segment fusion with vertebroplasty augmentation from 2013–2016 at a single institution. For each patient, we collected demographics, surgical information, length of stay, discharge disposition, and complications, including reoperation, PJK, and PJK requiring reoperation. We reviewed all postoperative radiographs to assess for cement leakage from vertebroplasty. These patients were compared to a historical control of 253 patients who underwent adult spinal deformity surgery without vertebroplasty augmentation. Results: The PJK rate of 14% and the PJK requiring reoperation rate of 3% in the cohort of 118 patients who underwent vertebroplasty-augmented fusion was significantly lower than that of the 253 historical controls at our institution who did not undergo vertebroplasty (40% PJK rate, 17% PJK-rate requiring reoperation; both P < 0.001). After controlling for patient and other surgical factors in multivariate analyses, vertebroplasty was significantly associated with lower rates of PJK and PJK requiring reoperation (P < 0.001 and P = 0.003). Conclusions: Our novel vertebroplasty technique is safe, and it eliminates the need for additional fluoroscopy in cases already using the O-arm to verify screw placement. In addition, it is an effective technique for reducing PJK in adult spinal deformity surgery compared with historical institutional controls.