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September 10, 2025Open Access

Minimally Invasive Short-Segment Cement-Augmented Pedicle Screw Fixation Without Fusion in Osteoporotic Vertebral Compression Fractures With Intravertebral Instability: A Retrospective Analysis

NVNiraj B. VasavadaStavya Spine Hospital & Research Institute BVBhavin VasavadaShalby Hospitals PLPrateek P. LodhaStavya Spine Hospital & Research Institute

Key Points

Median ODI scores improved from 91 preoperatively to 18 at 24 months, indicating significant functional improvement.
The median preoperative VAS score was 8, with postoperative scores reducing to 3, 2, and 1 at 1, 6, and 24 months, showing marked pain relief.
Out of 50 patients, complete 24-month data were available for 30, providing insights into treatment effects and patient demographics.
This technique may reduce the need for more invasive long-segment constructs in fragile, elderly patients with vertebral fractures.

Abstract

Objective: This study investigated the feasibility of minimally invasive short-segment cement-augmented percutaneous pedicle screw fixation without fusion for treating osteoporotic vertebral compression fractures (OVCFs) with intravertebral instability.Methods: We retrospectively analyzed patients treated by a single surgeon between November 2017 and December 2022 for OVCFs with intravertebral instability using minimally invasive short-segment cement-augmented pedicle screw fixation without fusion. Preoperative Oswestry Disability Index (ODI) scores were compared with scores at 24 months postsurgery. Visual analogue scale (VAS) scores were assessed preoperatively and at 1, 6, and 24 months postoperatively. Preoperative and postoperative kyphotic angles were measured on lateral radiographs. Postoperative kyphosis was assessed at a 24-month follow-up. The Shapiro-Wilk test, along with skewness and kurtosis analysis, was used to determine data normality. The Wilcoxon signed-rank test was conducted to compare preoperative and 24-month ODI scores, while the Friedman test evaluated VAS changes over time, with post hoc analysis via the Conover test. Statistical analysis was conducted using JASP ver. 0.18.Results: Out of 50 patients who underwent surgery, complete 24-month follow-up data were available for 30 patients (11 died of unrelated causes, and 9 had incomplete follow-up). The median age was 66.5 years, with 21 women and 9 men. T12 and L1 were the most common OVCF levels. Median ODI scores improved significantly from 91 preoperatively to 18 at 24 months (p<0.01). The median preoperative VAS was 8, with postoperative scores of 3, 2, and 1 at 1, 6, and 24 months, respectively, indicating significant improvement (p<0.01), with maximum improvement at 1 month sustained through 24 months. Two patients (6.6%) experienced additional fractures requiring surgery.Conclusion: Our findings suggest that the feasibility and safety of short-segment fixation may obviate the need for long-segment constructs in the majority of elderly, fragile patients. However, larger studies with extended follow-up are warranted to validate this observation.

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