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

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.

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.

The cohort included 37 men (39%) and 59 women (61%). Most patients were ASA III (71%). Instrumentation involved two levels in 64% and four levels in 26% of cases. Mean operative time was 118±56 min. Cement leakage was identified in 71/93 patients (76%) on postoperative imaging. Intraoperative fluoroscopy detected leakage in 43% of cases, showing low sensitivity but high specificity. Postoperative radiographs detected leakage in 63%, while computed tomography showed the highest detection rate (91%). Increasing age was significantly associated with higher leakage risk (p=0.0109).

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.