J Korean Neurosurg Soc.  2025 Mar;68(2):127-136. 10.3340/jkns.2024.0081.

Cement-Augmented Pedicle Screw Fixation in Patients with Osteoporosis : Safety, Efficacy and Complications

• Olbrycht T
• Latka K
• Kolodziej W
• Krzeszowiec T
• Latka D

• KMID: 2565271
• DOI: http://doi.org/10.3340/jkns.2024.0081

Abstract

Cement-augmented pedicle screw instrumentation is a widely accepted method for managing osteoporotic fractures, but it carries inherent risks, particularly related to cement leakage and embolism. This study aimed to analyze a clinical case of complications following cement fixation and provide a detailed review of relevant literature. A 70-year-old patient underwent transpedicular screw instrumentation from L2-L4 with polymethyl methacrylate augmentation, which resulted in cement leakage into the spinal canal and subsequent pulmonary embolism. After revision surgery and conservative treatment for the embolism, the patient’s condition stabilized, demonstrating that conservative measures can be effective in managing cement embolism. To complement this case, a comprehensive literature review was conducted to explore the causes, prevention, and treatment of complications related to cement augmentation. The findings support that while cement-augmented pedicle screw instrumentation remains a leading technique for osteoporotic fractures, the associated risks are manageable with proper treatment protocols. This study holds practical significance for healthcare professionals by highlighting both the risks and solutions associated with cement fixation, thus contributing to improved patient outcomes and the development of standardized treatment guidelines.

Keyword

Cementation; Spinal fusion; Osteoporotic fractures; Bone screws; Internal fixators; Spinal injuries

Figure

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  Fig. 1. Computed tomography scan showing the outflow of cement into the spinal canal on the left side (arrow).

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  Fig. 2. Intraoperative photo showing cement attached to the dural sac.

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  Fig. 3. Intraoperative photo showing a gently separation of the cement from the surface of the dural sac.

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  Fig. 4. Intraoperative photo showing the separation of the cement from the dural sac.

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  Fig. 5. Intraoperative photo showing the dural sac, after a successful cement separation.

Reference

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