Importance of polymethylmethacrylate augmentation in the treatment of thoracolumbar osteoporotic vertebral fractures

BACKGROUND: Nowadays osteoporosis is a real health problem that drive to an increased risk of veretebral fractures. The loss of bone stock is a real challenge for surgeons; solid screws, cannulated and fenestrated pedicle screws (CFS) and CFS augmented with polymethyl methacrylate cement (PMMA CSF) are the main approaches used for increasing bone grip. We hypothesized that augmented CFSs are a more stable implant with a lower needing of revision surgery instead of cannulated and fenestrated non-augmented screws. METHODS: Between 2012 and 2016, 62 patients affected by vertebral osteoporotic fractures were treated by the same spine surgery team. Patients were divided into 2 different groups: CFS without PMMA (group 1) and CSF with PMMA (group 2). Patients were radiologically evaluated with X-rays in pre- and postsurgery and at the follow-up (FU) in order to evaluate the loss of correction in sagittal plane with regional kyphotic angle. Clinical evaluations were made with Oswestry Disability Index. RESULTS: Group 2 resulted to have no signs of loosening, screws migration or implant mobilization while 6 cases were reported in group 1 (P=0.005). No differences were reported for ODI and RKA. In group 2 only 3 cases of cement leakage occurred. CONCLUSIONS: Even if both stabilization methods are valuable in the management of osteoporotic thoracolumbar vertebral fractures, PMMA CSF seems to provide better implant stability with the lowest rate of loosening or mobilization.