How to Avoid and Handle Problems in the Placement of Cement-Augmented Fenestrated Percutaneous Pedicle Screws?

Background and objectives: Pedicle screws with a central cannula and fenestrations allow cement augmentation, providing lower risk for screw loosening and pullout, especially in these patients with poor bone quality. This study aims to offer suggestions for resolving issues and reducing complications associated with the use of cement-augmented fenestrated pedicle screws.

Methods: A retrospective study was conducted across multiple centers on patients who received fenestrated pedicle screws with cement augmentation (CAFPS). Using 2-dimensional fluoroscopy guidance, we placed over 800 screws in 137 patients. Based on our analysis of common challenges and complications, 10 tips were compiled, that we believe are crucial for successfully implementing this technique, regardless of the brand or instrument used.

Results: The 10 tips included the following: (1) Indications of cement-augmented fenestrated pedicle screws; (2) use the K-wire blunt end in osteoporotic vertebrae; (3) know the longitude and diameter of the screw, by the measurement of the vertebrae to treat; (4) do not go bicortical; (5) clean the way of the screws fenestrae with saline; (6) protecting screw extensors with gauze; (7) measuring time and volume; (8) gently and smoothly introduce the cement; (9) do not panic. The presence of cement in the posterosuperior area adjacent to the pedicle does not necessarily indicate a leakage into the canal; and (10) fenestrated screw removal.

Conclusion: The implementation of these tips could enhance technique performance and minimize complications in cement-augmented fenestrated pedicle screw placement.