Evaluation of Cement Leakage and Complications After Cement-augmented Pedicle Screw Fixation: A Retrospective Case Series.

BACKGROUND/AIM: Pedicle screw fixation is a standard technique for vertebral fractures but shows high loosening and pull-out rates, especially in osteoporotic bone. Cement augmentation can improve the screw-bone interface and construct stability. However, cement leakage rates of up to 94% have been reported, with rare but potentially serious complications such as pulmonary cement embolism. This study aimed to retrospectively evaluate the rate of cement leakage and serious complications after polymethylmethacrylate (PMMA)-augmented pedicle screw fixation. PATIENTS AND METHODS: We retrospectively reviewed 96 patients treated for thoracolumbar fractures with posterior stabilization and cement-augmented pedicle screws at LMU University Hospital Munich between July 2012 and August 2018. Demographic, operative, and imaging data were analyzed. Cement leakage detection rates were compared between intraoperative fluoroscopy, postoperative radiographs, and computed tomography. RESULTS: =0.0109). CONCLUSION: Cement leakage after PMMA-augmented pedicle screw fixation is common on postoperative imaging but was not associated with serious clinical complications in this cohort. Intraoperative fluoroscopy detects less than half of leakages, indicating limited sensitivity. Advanced intraoperative imaging techniques such as 3D imaging may improve detection.