Multilevel Percutaneous Fenestrated Screw Fixation with Bone Cement Augmentation in Adult Lumbar Spinal Deformity

Objective: Fenestrated screw fixation with bone cement augmentation has been demonstrated to increase the pullout strength. Bone cement augmentation is performed to prevent screw fail-ure. The study aimed to investigate the safety and efficacy of multilevel percutaneous fenestrated screw fixation with bone cement augmentation in the adult lumbar spinal deformity. Methods: We performed a retrospective study of 15 patients who underwent multilevel percutaneous fenestrated screw fixation (PFSF) with bone cement augmentation between January 2018 and December 2020. Visual analogue scale (VAS) score, Oswestry disability index (ODI), sagittal vertical axis (SVA), and lumbar lordosis (LL) were investigated in the patients. Results: Mean BMD was-2.0. The mean percutaneous fenestrated screw fixation level was 6. The mean VAS score changed from 7.14 preoperatively to 4.57 postoperatively, to 3.71 at the last follow-up. The mean ODI changed from 45.21 preoperatively to 32.5 postoperatively, to 27.0 at the last follow-up. The mean LL changed from 23.6 preoperatively to 32.96 postopera-tively, to 31.67 at the last follow-up. The mean SVA changed from 76.65 preoperatively to 46.15 postoperatively, to 48.46 at the last follow-up. The bony fusion rate was 73.3%. There were screw loosening in 4 patients and screw fracture in 3 patients. Cement leakage occurred to-wards the anterior body of the vertebrae in 2 patients but no symptoms were observed. Conclusion: Our study results demonstrate that multilevel PFSF with bone cement augmentation can result in good clinical and radiological outcomes for lumbar spinal deformity. However, larger size screws or smaller through-hole screws are required to prevent screw fracture.