Role of Cement-Augmented Pedicle Screws in the Osteoporotic Spine

Dr. Nishant

Abstract: Osteoporosis reduces pedicle screw fixation strength and increases loosening, pullout, pseudarthrosis, junctional failure, and revision risk. Polymethylmethacrylate (PMMA) augmentation increases the screw?bone contact area and improves pullout and cyclic fatigue resistance. Contemporary evidence- largely observational and heterogeneous- shows substantially lower screw-loosening rates and, in degenerative lumbar cohorts, higher fusion rates than conventional screws. A 2023 meta-analysis of 12 studies (881 patients) reported lower loosening with augmentation (odds ratio 0.13) and higher fusion (odds ratio 2.80). A 2026 meta-analysis in osteoporotic lumbar spondylolisthesis similarly found lower loosening (odds ratio 0.18) and higher fusion (odds ratio 3.98), with longer operating time. Benefits must be weighed against cement leakage, pulmonary cement embolism (PCE), thermal or neural injury, infection, difficult revision, and stress concentration. A complication meta-analysis reported any leakage in 21.8%, symptomatic leakage in 1.2%, PCE in 3.0%, and symptomatic PCE in 0.8%; detection rises with routine postoperative CT. Fenestrated screws provide controlled post-insertion injection and favorable cement distribution, whereas pre-injection around solid screws is versatile but more dependent on cement timing and screw insertion. Patient selection should integrate dual-energy X-ray absorptiometry, opportunistic CT Hounsfield units, fracture history, construct length, junctional risk, and intraoperative purchase. Cement should be used selectively at mechanically critical levels, with low-pressure fluoroscopic injection of the minimum effective volume. It complements-but does not replace- anabolic therapy, calcium/vitamin D correction, alignment goals, robust pelvic fixation, interbody support, and proximal-junctional protection.

Keywords: osteoporosis; cement augmentation; pedicle screw; fenestrated screw; PMMA; screw loosening; pulmonary cement embolism; spinal fusion

How to Cite?: Dr. Nishant, "Role of Cement-Augmented Pedicle Screws in the Osteoporotic Spine", Volume 15 Issue 8, August 2026, International Journal of Science and Research (IJSR), Pages: 2016-2019, https://www.ijsr.net/getabstract.php?paperid=SR26829094601, DOI: https://dx.doi.org/10.21275/SR26829094601

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