Comparative Outcomes of Cement-Augmented Fenestrated and Conventional Pedicle Screws in Transforaminal Lumbar Interbody Fusion: A Matched Cohort Study

Objective: This study aimed to compare perioperative parameters, radiographic fusion, and patient-reported outcomes (PROs) between transforaminal lumbar interbody fusion (TLIF) performed with cement-augmented fenestrated pedicle screws (CAFPSs) and TLIF performed with conventional noncemented pedicle screws (NCPSs) in patients with osteopenia or osteoporosis.Methods: Eighty patients who underwent TLIF for degenerative spinal stenosis and instability with radicular symptoms were reviewed retrospectively. Forty patients treated with CAFPS were matched 1:1 with 40 patients treated with NCPS according to age, sex, body mass index, number of fused levels. Perioperative parameters included operative time, blood loss, transfusion rate, and postoperative morphine consumption. Radiographic outcomes included interbody fusion assessed with the Bridwell classification. PROs included visual analog scale scores for back and leg pain, the Oswestry Disability Index, and neurogenic symptom score. All patients had at least 24 months of follow-up, with a mean follow-up duration of 28.6±6.3 months.Results: Operative time was significantly longer in the CAFPS group than in the NCPS group (334±106 minutes vs. 254.0±98.1 minutes, p<0.001). Postoperative morphine consumption was significantly lower in the CAFPS group than in the NCPS group (7.13±13.6 mg vs. 19.1±21.3 mg, p<0.01). Both groups showed significant postoperative improvement in PROs, with no significant between-group differences at any time point. Interbody fusion rates were comparable between groups throughout follow-up. At the 2-year follow-up, Bridwell grade I fusion was achieved in 38 patients (95.0%) in the CAFPS group and 36 patients (90.0%) in the NCPS group (p=0.396).Conclusions: In TLIF, CAFPSs provided radiographic and functional outcomes comparable to those of conventional pedicle screws and were associated with lower early postoperative opioid requirements. Cement augmentation may be an effective fixation strategy in patients with compromised bone quality, particularly when satisfactory fixation cannot be achieved with conventional techniques alone.