An Innovative Use of Cortoss Bone Cement to Stabilize a Nonunion after Interbody Fusion

A 65-year-old male originally had surgery for spondylolisthesis at L5-S1 in 2008 and then went on to have an L4-5 transforaminal lumbar interbody fusion (TLIF) with pedicle screw fixation from L4 to S1 and interbody graft in 2010. Despite having two surgical procedures, he continued with intractable back pain and was told he had a failed lumbar fusion. When he was evaluated with a computerized tomography (CT) scan from April 2015, it demonstrated an erosive nonunion of the L4-5 interbody fusion without incorporation of the polyetheretherketone (PEEK) cage. In an attempt to perform a minimally invasive stabilization of the L4-5 nonunion, he underwent a percutaneous lateral foraminal approach with an injection of Cortoss® cement (Stryker®, Malvern, PA) into the L4-5 interspace and around the graft. The objective was to stabilize the nonunion, resulting in intermediate relief of pain.