Abstract
Post-vertebral augmentation infection is uncommon but clinically serious, especially in older patients with multiple comorbidities and fragile spinal bone stock. Revision surgery is challenging because surgeons must eradicate infection, decompress neural structures when needed, restore stability, and decide whether polymethylmethacrylate cement can be safely preserved. This article describes a posterior-only protocol for diagnosing and treating post-vertebral augmentation infection and illustrates the workflow with a retrospective representative cohort treated between January 2015 and December 2024. Among 48 surgically treated patients, 12 underwent cement removal, and 36 underwent selective cement preservation when all predefined preservation conditions were satisfied, and no mandatory removal or intraoperative conversion criterion was present. The protocol emphasizes diagnosis confirmation, compartment-focused debridement, staged cement-decision logic, microbiological sampling including metagenomic next-generation sequencing, posterior stabilization, and postoperative reassessment. The median follow-up duration in the representative cohort was 14.0 months (interquartile range, 12.0-28.5 months). In selected patients, the cement-preservation pathway was associated with lower unadjusted operative burden, whereas final infection control, computed tomography-confirmed fusion, pain improvement, and complication rates were descriptively similar between groups. This protocol is intended for spine surgeons managing post-PVA infection when a posterior-only corridor can address the active infected compartment and provide stable reconstruction.