Pedicle screw fixation in osteoporotic vertebrae remains challenging because of poor bone quality and limited screw purchase. Cement-augmented cannulated pedicle screws are widely used to improve fixation strength; however, the optimal workflow for screw insertion and cement augmentation remains variable. We describe a simplified extrapedicular workflow for cement-augmented cannulated pedicle screw fixation in osteoporotic vertebral collapse. The workflow emphasizes a lateral-to-medial trajectory from an entry point outside the pedicle isthmus, direct screw insertion without pilot hole preparation or pedicle tapping, dynamic lateral fluoroscopic guidance, and mandatory anteroposterior confirmation immediately before cement injection. This workflow minimizes operative steps, allows real-time trajectory adjustment in osteoporotic bone, and facilitates controlled cement augmentation. Preliminary clinical experience suggests reduced screw placement time without an increased risk of pedicle breach or cement-related complications. In selected patients with preserved pedicle anatomy, this simplified technique represents a safe and efficient alternative for cement-augmented pedicle screw fixation.
Nhã et al. (Wed,) studied this question.