Safety and efficacy of cement augmentation with fenestrated pedicle screws for tumor-related spinal instability

OBJECTIVE Achieving rigid spinal fixation can be challenging in patients with cancer-related instability, as factors such osteopenia, radiation, and immunosuppression adversely affect bone quality. Augmenting pedicle screws cement is a strategy to overcome construct failure. This study aimed assess the safety efficacy of augmentation fenestrated undergoing posterior, open thoracolumbar surgery for metastases. METHODS A retrospective review was performed who underwent spine instability from 2016 2019 at Massachusetts General Hospital. Patient demographics, surgical details, radiographic characteristics, patterns extravasation, complications, prospectively collected Patient-Reported Outcomes Measurement Information System Pain Interference Intensity scores were analyzed using descriptive statistics. Logistic regression determine associated extravasation. RESULTS Sixty-nine posterior total 502 cement-augmented (mean 7.8 per construct). The median follow-up period those survived past 90 days 25.3 months (IQR 10.8–34.6 months). Thirteen (18.8%) either died within or lost follow-up. Postoperative CT instrumentation There no screw loosening, pullout, rate extravasation 28.9% (145/502), most commonly through segmental veins (77/145, 53.1%). Screws breaching lateral border but fenestrations vertebral body higher risk leakage compared without any breach (OR 8.77, 95% CI 2.84–29.79; p < 0.001). Cement did not cause symptoms except 1 patient developed symptomatic thoracic radiculopathy requiring decompression. case asymptomatic pulmonary embolism. Patients experienced significant pain improvement 3-month follow-up, decreases change 15.8, 14.5–17.1; 0.001) 28.5, 26.7–30.4; CONCLUSIONS safe effective option stabilization cancer population. clinically adverse events very low.