Cement-augmented endplate-penetrating pedicle screws for osteoporotic vertebral collapse: a technical note

Osteoporotic vertebral collapse with a retropulsed posterior wall fragment may present with delayed neurological deficits. Although this condition is managed with short-segment posterior fixation, pedicle screw (PS) pullout is a major concern in patients with severe osteoporosis. Herein, we describe a preliminary salvage technique combining endplate-penetrating hollow PSs and cement augmentation to minimize intradiscal cement leakage. Two elderly women with osteoporotic vertebral fractures at L1/L2 with paraparesis underwent partial laminectomy at the collapsed level and short-segment posterior fixation spanning one level above and below. After the hollow PS's tip slightly penetrated the endplates, the screws were further advanced to draw disc tissue into the screw lumen as a biological "plug," and polymethyl methacrylate cement was injected through the lumen under continuous fluoroscopy. Postoperatively, both patients regained independent ambulation with maintained sagittal alignment. This technique is a feasible salvage option in highly selected patients; however, its safety and long-term efficacy require further investigation.