Transdiscal Versus Cement-Augmented Pedicle Screw Fixation for Thoracolumbar Fractures in Patients with Diffuse Idiopathic Skeletal Hyperostosis (DISH)

Background/Objectives: Rigid internal fixation and early mobilization using pedicle screws have become a standard treatment option for vertebral fractures in patients with diffuse idiopathic skeletal hyperostosis. Poor bone quality and a long lever arm may result in a high rate of screw loosening, screw pullout, and implant failure in these patients. Therefore, researchers have developed various techniques to enhance fixation strength, including cement-augmented fenestrated pedicle screw (CAFPS) and transdiscal screw (TDS) fixation. This study compared the clinical and radiological outcomes of CAFPS and TDS fixation techniques for treating diffuse idiopathic skeletal hyperostosis (DISH)-associated thoracolumbar vertebral fractures. This study compared the clinical and radiological outcomes of CAFPS and TDS fixation techniques for DISH-associated thoracolumbar vertebral fractures. Methods: Retrospective comparative cohort study. An evaluation was conducted of patients who underwent posterior instrumentation for vertebral fractures accompanied by DISH, using CAFPS or TDS techniques, at our hospital between August 2019 and March 2025. We assessed preoperative, operative, and postoperative data, outcomes, and radiographic parameters. Results: We included 40 patients; 11 received CAFPS, and 29 received TDS fixation. Operative time (104 ± 19.6 min vs. 115 ± 29.4 min, p = 0.32), blood loss (87.7 ± 69.4 mL vs. 88.3 ± 64.8 mL, p = 0.95), and bone union rate (100% vs. 89.7%, p = 0.27) did not differ significantly. The incidence of screw loosening number was higher in the TDS group (5.68% vs. 13.4%, p = 0.049). However, patient-level analysis showed no difference (4/11 vs. 7/29, p = 0.455). Neither group had implant backouts, failures, or reoperations. Conclusions: Transdiscal screws and transdiscal and cement-augmented pedicle screws are useful techniques for treating thoracolumbar vertebral fractures in patients with DISH. These techniques can reduce the level of fixation in vulnerable patient populations.