Cement leakage risk reduction and propensity score matching analysis of clinical efficacy for Cement-Augmented fenestrated pedicle screw in patients with osteoporosis.

PURPOSE

To identify risk factors for cement leakage (CL) in spinal fusion surgery using cement-augmented fenestrated pedicle screw (CAFPS). As a secondary objective, clinical outcomes were compared between CAFPS and conventional pedicle screw (CPS) in patients with osteoporosis.

METHODS

We included 67 patients (272 screws) who underwent spinal fusion surgery with CAFPS and 104 patients with CPS. In the CAFPS group, cement volume, leakage rate, and distance from the cement fenestration hole in the CAFPS to the vertebral wall were evaluated. Clinical outcomes including blood loss, operative time, number of fusion intervertebral segments, local kyphosis, screw loosening, pullout, pedicle fractures, adjacent vertebral fracture (AVF), proximal/distal junctional kyphosis (PJK/DJK), and reoperation were compared between groups. The primary outcome was identifying risk factors for CL. After propensity score matching (PSM) adjusted for age, sex, body mass index (BMI), surgical procedures, and the use of osteoanabolic agents, the secondary outcome was comparing clinical outcomes between the CAFPS and CPS groups.

RESULTS

CL occurred in 61.2% of patients and in 23.5% of screws. A shorter distance from the cement fenestration hole in CAFPS to the vertebral wall was a predictor for CL (odds ratio [OR] 0.75, 95% confidence interval [CI]: 0.64-0.88, P < 0.001). The CAFPS group had significantly lower operative time, fused segments, loss of kyphotic correction, screw loosening, and pullout rates.

CONCLUSION

Medial positioning of CAFPS may reduce CL. CAFPS use in osteoporotic spinal fusion may enhance stability, resulting in a less invasive surgery.