Posterior instrumentation for osteoporotic fractures in the thoracic or lumbar spine - Cement-augmented pedicle screws vs hybrid constructs

Sep 29, 2026

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Cement-augmented pedicle screws and hybrid constructs are widely used to fix osteoporotic thoracic or lumbar spine fractures, yet direct clinical comparison is limited. This retrospective cohort study evaluated 84 surgical patients treated with cement-augmented pedicle screws (n=43) or hybrid constructs (n=41), with a mean follow-up of 67 months. Radiographic, clinical, and neurologic outcomes were assessed. Operative time, blood loss, kyphosis change, ambulation, neurologic grade improvement, and implant failure were compared to determine equivalence of surgical results.

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J Chin MedAssoc Original article Posterior instrumentation for osteoporotic fractures in the thoracic or lumbar spine: Cementaugmented pedicle screws vs hybrid constructs Po-Hsin Choua,b, Hsi-Hsien Lina,b, Yu-Cheng Yaoa,b, Shih-Tien Wanga,b,c,* , Ming-Chau Changa,b, Chien-Lin Liua,b aSchool of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; bDepartment of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; cKinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan, ROC Abstract Background: Cement-augmented pedicle screws (CPS) and hybrid construct (HC), consisting of pedicle screws and additional hooks, are common fixation methods for osteoporotic spine fracture. No study has compared surgical results of CPS and HC for treating osteoporotic spine fracture. The aim of the study was to compare surgical results using CPS or HC for osteoporotic fractures of the thoracic or lumbar spine. Methods: This retrospective cohort study included 84 patients who received surgical treatment with CPS (n = 43) or HC (n = 41) for osteoporotic spine fractures from January 2011 to December 2015, with a mean follow-up of 67 months. Sixty-five patients with neurological deficits received long posterior instrumentation, short posterior decompression, and posterolateral fusion. The 19 patients without neurologic deficits received long posterior instrumentation without posterior decompression and fusion. Radiographic, clinical, and neurologic outcomes were evaluated. Results: The HC group had significantly shorter operative times (231 vs 258 minutes), greater blood loss (497 vs 427 mL), better immediate postoperative kyphosis reduction (10 .6° vs 9. 1°), and greater final reduction loss (9 .8° vs 7. 1°) than the CPS group. In both groups, significant loss of the kyphotic angle was apparent during follow-up. Improved ambulation after surgery occurred in 51.2% and 58.5% of patients in the CPS and HC groups, respectively. Neurologic function after surgery improved 0.5 and 0.7 grades in the CPS and HC groups, respectively. Implants failed in 2.3% and 2.4% of patients in the CPS and HC groups, respectively. The incidence of cement leakage from screw augmentation was 38.9% . Conclusion: The CPS and HC techniques for treating osteoporotic fractures of the thoracic or lumbar spine did not differ statistically in terms of improved radiologic and clinical outcomes, final neurologic and ambulatory function, or implant failure rates, making them equally comparable alternatives. Keywords: Burst fracture; Cement augmentation; Hook; Hybrid construct; Pedicle screws 1.INTRODUCTION Osteoporosis, the most common metabolic bone disease, leads to alteration in bone density that has been shown to compromise the strength of spinal instrumentation.1 With elderly populations growing, rates of spine surgery performed on osteoporotic patients have increased to treat a variety of conditions.1 Vertebral fracture is the most common osteoporotic fracture in the elderly, and surgical intervention is sometimes needed for patients diagnosed with nonunion, failure of vertebroplasty, and neurologic * Address correspondence. Dr. Shih-Tien Wang, Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: stwang@vghtpe.gov.tw](ROC. E-mail address: stwang@vghtpe.gov.tw) (S.-T. Wang). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2023) 86: 431-439. Received May 1, 2022; accepted December 2, 2022. doi: 10. 1097/JCMA.0000000000000880. Copyright © 2023, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by

FAQs

What was the study purpose regarding cement-augmented pedicle screws and hybrid constructs?

To compare surgical results of cement-augmented pedicle screws versus hybrid constructs for osteoporotic fractures in the thoracic or lumbar spine.

How was the study designed and who were the participants?

This retrospective cohort included 84 patients treated with either cement-augmented pedicle screws (n=43) or hybrid constructs (n=41) from January 2011 to December 2015.

Did cement-augmented pedicle screws and hybrid constructs differ in final clinical or neurologic outcomes?

The conclusion states there was no statistically significant difference in radiologic and clinical outcomes, final neurologic and ambulatory function, or implant failure rates, making them equally comparable alternatives.

Sep 29, 2026

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