Segmental ploymethylmethacrylate-augmented fenestrated pedicle screw fixation in patients with osteoporotic unstable thoracolumbar fractures

Objective
Osteoporosis has been implicated as a cause of hardware failure and, more specifically, pedicle screw loosening and pull-out. A clinical evaluation of results of augmented fenestrated pedicle screws was performed to determine the safety, performance, and effectiveness of this technique in the osteoporotic spine with an unstable thoracolumbar fracture.
Patients and methods
Over the past 2.5 years, the clinical and radiographic results of 11 consecutive patients with poor bone stock with osteoporotic spinal fractures were reviewed. These patients underwent instrumented spinal fixation using fenestrated pedicular screws with cement augmentation. Implant stability was evaluated by initial postoperative plain radiography and three months, thereafter. After the first 12 months, radiographic controls were taken every 6 months. Complications were evaluated in all cases.
Results
All patient were followed clinically and radiologically for a mean of 11.3 ms (range: 6–30 ms). None of the patients experienced serious intraoperative complications (hypotension, cement embolization, myocardial infarction, or cement leakage) nor postoperative complications (late postoperative implant failure, or kyphosis), with early safe postoperative mobilization.
Conclusion
Pedicular fixation using fenestrated pedicular screws with cement augmentation for treatment of osteoporotic spinal fractures reduces the likelihood of pedicular screw loosening with subsequent reduction of late postoperative sagittal instability with early safe mobilization.