Cement-Augmented Pedicle Screw Fixation in Medically Unfit Patients Under Local Anesthesia Using the Minimally Invasive Surgery Technique

Objective: A high rate of implant failure is frequently observed in osteoporotic spines. The majority of patients with osteoporosis are relatively old and are often unfit for general anesthesia due to various systemic comorbidities. Cement-augmented pedicle screw fixation is designed to improve stability and fixation strength in patients with compromised bone quality.Methods: A total of 45 patients (23 women and 22 men), with a mean age of 71.37 years (range, 53–94 years), diagnosed with osteoporosis (T score > -2.5) and deemed unfit for general anesthesia, underwent instrumentation with polymethylmethacrylate augmentation of cannulated pedicle screws. In total, 214 pedicle screws were inserted: 28 patients received 4 screws and 17 patients received 6 screws, all with cement augmentation. Preoperative and postoperative visual analogue scale (VAS) scores for pain, as well as Oswestry Disability Index (ODI) questionnaire data, were analyzed. Screw migration, defined as the distance from the screw tip to the anterior cortex and the upper endplate of the vertebra, was also evaluated immediately after surgery. The mean follow-up period was 15.3 months.Results: The mean preoperative VAS was 8.76 (range, 7–10). As intractable pain was the most common complaint, significant improvement was observed postoperatively: the mean postoperative VAS decreased to 2.24 (range, 0–5) (p<0.001). ODI scores also showed significant improvement in quality of life as measured by the ODI (p<0.001).Conclusion: Our results support the use of cement-augmented pedicle screw fixation in medically unfit patients with osteoporosis. This technique appears effective in increasing stabilization of fixation and preventing screw loosening in this patient population. The main complication observed was cement leakage.