Is polymethyl methacrylate a viable option for salvaging lateral mass screw failure in the subaxial cervical spine?

Study Design Biomechanical analysis of lateral mass screw pullout strength. Objective We compare the pullout strength of our bone cement-revised lateral mass screw with the standard lateral mass screw. Methods In cadaveric cervical spines, we simulated lateral mass screw "cutouts" unilaterally from C3 to C7. We salvaged fixation in the cutout side with polymethyl methacrylate (PMMA) or Cortoss cement (Orthovita, Malvern, Pennsylvania, United States), allowed the cement to harden, and then drilled and placed lateral mass screws back into the cement-augmented lateral masses. On the contralateral side, we placed standard lateral mass screws into the native, or normal lateral, masses and then compared pullout strength of the cement-augmented side to the standard lateral mass screw. For pullout testing, each augmentation group was fixed to a servohydraulic load frame and a specially designed pullout fixture was attached to each lateral mass screw head. Results Quick-mix PMMA-salvaged lateral mass screws required greater force to fail when compared with native lateral mass screws. Cortoss cement and PMMA standard-mix cement-augmented screws demonstrated less strength of fixation when compared with control-side lateral mass screws. Attempts at a second round of cement salvage of the same lateral masses led to more variations in load to failure, but quick-mix PMMA again demonstrated greater load to failure when compared with the nonaugmented control lateral mass screws. Conclusion Quick-mix PMMA cement revision equips the spinal surgeon with a much needed salvage option for a failed lateral mass screw in the subaxial cervical spine.