Long-Term Outcomes of Cement Augmented Percutaneous Pedicle Screw Fixation in Cancer-Related Vertebral Fractures
In brief
Cement-augmented spine fixation required revision in only 2.1% of cancer patients
In this retrospective study of 240 patients with cancer-related vertebral fractures, only 5 patients required revision surgery over a median 5-year follow-up among survivors. Pain and functional status also improved after surgery, but the small number of revisions limits confidence about which patients face greater risk; the findings support durability without proving how results compare with other treatments.
- Journal
- Neurosurgery (Q1)
- Published
- 30 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 4, Very Low (CEBM 4)
- Authors
- Graham M Winston, Rabih Bou Nassif, Jeffrey Shi, Amanda Cuastumal-Aguirre, Justiss A Kallos, Lily A McLaughlin, et al.
- PMID
- 42961054
- DOI
- 10.1227/neu.0000000000004271
Why clinicians should know about it
- Picked for Spine Surgery (paper of the day, 2 November 2026): Long-term outcomes of fixation for metastatic vertebral fractures
Abstract
BACKGROUND AND OBJECTIVES: Pathological vertebral compression fractures (VCFs) are a common and debilitating complication of metastatic cancer. Percutaneous pedicle screw fixation (PPSF) with cement augmentation is increasingly used to stabilize these fractures, but long-term construct durability and associated clinical outcomes remain incompletely defined. We sought to characterize the long-term mechanical durability of cement-augmented PPSF for oncological VCFs, evaluate outcomes, and explore factors associated with revision surgery. METHODS: We conducted a retrospective review of patients with cancer who underwent cement-augmented PPSF at a tertiary cancer center between 2015 and 2020. The primary outcome was implant failure requiring return to the operating room for revision stabilization. Cumulative incidence of revision was estimated. Associations between clinical and radiographic variables and revision were evaluated using univariable competing-risks regression. Secondary outcomes included pain scores, functional status, strength, and neurological measures assessed pre- and post-operatively. RESULTS: A total of 240 patients with 241 surgeries were included (mean age 62.8 years). Median follow-up among surviving patients was 5.0 years. Five patients (2.1%) required revision surgery. Increasing age was associated with higher risk of revision in the univariable analysis (hazard ratio 1.12, 95% CI: 1.01-1.24, P = .046), while other investigated factors were not significantly associated with failure requiring revision. Significant improvements in pain and functional status were observed. CONCLUSION: Cement-augmented PPSF demonstrated long-term durability for stabilization of oncological VCFs, with a low rate of revision surgery. Mechanical stability was accompanied by improvements in pain and functional status. Increasing age demonstrated an association with increased revision rates, although the low number of events limits definitive identification of predictors of failure.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.