Long-Term Outcomes of Cement Augmented Percutaneous Pedicle Screw Fixation in Cancer-Related Vertebral Fractures

BACKGROUND AND OBJECTIVES: Pathological vertebral compression fractures (VCFs) are a common and debilitating complication of metastatic cancer. Percutaneous pedicle screw fixation (PPSF) with cement augmentation is increasingly used to stabilize these fractures, but long-term construct durability and associated clinical outcomes remain incompletely defined. We sought to characterize the long-term mechanical durability of cement-augmented PPSF for oncological VCFs, evaluate outcomes, and explore factors associated with revision surgery. METHODS: We conducted a retrospective review of patients with cancer who underwent cement-augmented PPSF at a tertiary cancer center between 2015 and 2020. The primary outcome was implant failure requiring return to the operating room for revision stabilization. Cumulative incidence of revision was estimated. Associations between clinical and radiographic variables and revision were evaluated using univariable competing-risks regression. Secondary outcomes included pain scores, functional status, strength, and neurological measures assessed pre- and post-operatively. RESULTS: A total of 240 patients with 241 surgeries were included (mean age 62.8 years). Median follow-up among surviving patients was 5.0 years. Five patients (2.1%) required revision surgery. Increasing age was associated with higher risk of revision in the univariable analysis (hazard ratio 1.12, 95% CI: 1.01-1.24, P = .046), while other investigated factors were not significantly associated with failure requiring revision. Significant improvements in pain and functional status were observed. CONCLUSION: Cement-augmented PPSF demonstrated long-term durability for stabilization of oncological VCFs, with a low rate of revision surgery. Mechanical stability was accompanied by improvements in pain and functional status. Increasing age demonstrated an association with increased revision rates, although the low number of events limits definitive identification of predictors of failure.