Comparison of Clinical and Radiological Outcomes Between Uncemented and Cement Augmented Screws in Short Segment Hybrid Fixation of Unstable Osteoporotic Vertebral Fractures

TL;DR

This study compared two surgical methods for treating osteoporotic spinal fractures and found similar clinical results but differences in long-term spinal alignment.

Contribution

The study provides a direct comparison of clinical and radiological outcomes between uncemented and cement-augmented screws in spinal fracture fixation.

Findings

Both groups showed significant clinical improvement in ODI and VAS scores at 6 weeks and 1 year post-surgery.

The uncemented screw group experienced a statistically significant loss of spinal correction at 1 year compared to the cement-augmented group.

No significant differences in clinical outcomes were observed between the two groups over the study period.

Abstract

Purpose: This study aimed to compare the clinical and radiological outcomes of treating unstable osteoporotic vertebral fractures using hybrid fixation with uncemented transpedicular screws (Group A) versus polymethylmethacrylate (PMMA) cement-augmented screws (Group B). Methods: A retrospective comparative study of 55 patients treated between 01/2017 and 03/2024. Group A included 35 patients (mean age 71.22 ± 6.12 years); Group B included 20 patients (mean age 72.9 ± 7.75 years). Clinical outcomes were compared preoperatively, 6 weeks and 1 year after surgery. For clinical evaluation, the ODI and VAS for back pain were used. Restoration of the sagittal spinal profile was evaluated using the sagittal Cobb angle and the height of the fractured vertebral body. Results: Both groups showed significant clinical improvement in ODI and VAS scores at 6 weeks and 1 year postoperatively (p < 0.001), without significant between-group differences. The ODI changed from a preoperative value of 75.07 ± 21.13 to 50.72 ± 17.7 at 6 weeks postoperatively, and to 28.83 ± 20.9 at 1 year postoperatively in Group A. In Group B, the preoperative ODI value of 66.8 ± 14.56 changed to 47.00 ± 11.72 at 6 weeks and to 19.8 ± 9.15 at 1 year postoperatively The VAS decreased from 7.55 ± 1.43 preoperatively to 3.50 ± 1.17 at 6 weeks and to 1.52 ± 1.18 at 1 year postoperatively in Group A, and from 7.53 ± 1.39 preoperatively to 2.53 ± 1.02 at 6 weeks and to 1.52 ± 1.18 at 1 year postoperatively in Group B. In Group A, preoperative Cobb angle values of 11.01 ± 13.85 improved to 7.33 ± 16.17 at 6 weeks, with subsequent loss to 12.96 ± 14.75 degrees at 1 year postoperatively. In Group B, preoperative values were 11.44 ± 17.84, corrected to 5.16 ± 8.33 at 6 weeks, and to 7.37 ± 9.28 degrees at 1 year postoperatively. Conclusions: Good clinical outcomes were achieved in both evaluated groups using uncemented or cement-augmented screws, without a statistically significant difference. Differences were noted in the radiological evaluation of the success of sagittal profile correction. While both groups showed initial radiological improvement, the uncemented screw group experienced a statistically significant loss of correction at the 1-year follow-up.

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