Radiological evaluation and complications of percutaneous vertebroplasty and fenestrated pedicle screw fixation with bone cement augmentation: propensity-score matched cohort study

BACKGROUND: Osteoporotic vertebral fractures affect many elderly patients, and complications after common treatments such as vertebroplasty (VP) may reduce treatment satisfaction and radiographic stability. This study investigated whether the addition of posterior instrumentation with cement-augmented fenestrated pedicle screws (VP + PI) was associated with improved short-term radiographic outcomes compared with VP alone. METHODS: We retrospectively analyzed 153 patients with osteoporotic vertebral fractures treated between 2017 and 2022. Patients underwent either VP alone or VP + PI. To reduce treatment-selection bias, propensity score matching was performed. Vertebral collapse was assessed on serial radiographs at 1, 3, and 6 months postoperatively, and statistical analyses were performed using SAS software. RESULTS: After propensity score matching, the VP + PI group had significantly lower anterior column collapse rates at 3 and 6 months postoperatively. Multivariable logistic regression confirmed that VP + PI was independently associated with a reduced risk of anterior column collapse at 6 months (adjusted OR: 0.147, 95% CI: 0.043-0.502, p = 0.0022). At 6 months, screw loosening was observed in 6 of 75 patients in the VP + PI group, and none required revision surgery during the follow-up period. CONCLUSIONS: VP + PI may provide better short-term radiographic stability than VP alone in selected patients with osteoporotic vertebral fractures. However, given the longer operation time and hospital stay, lack of functional outcome assessment, and limited follow-up duration, the clinical benefit and long-term safety of VP + PI require further investigation. TRIAL REGISTRATION: Not applicable.