Postoperative and Intraoperative Cement Augmentation for Spinal Fusion

Joshua M. Kolz, Zachariah W. Pinter, Arjun S. Sebastian, Brett A. Freedman, Benjamin D. Elder, Ahmad N. Nassr

Research output: Contribution to journalArticlepeer-review


Objective: To review outcomes of patients undergoing spinal fusion with prophylactic cement augmentation (CA) of pedicle screws and adjacent levels. Methods: In a retrospective case-control study, 59 patients underwent CA of pedicle screws for spinal fusion between 2003 and 2018. Most patients (83%) underwent postoperative CA, while 17% underwent intraoperative CA. Outcomes of CA techniques were compared, and patients undergoing CA for a thoracolumbar fusion (n = 51) were compared with a cohort not undergoing CA (n = 39). Mean follow-up was 3 years. Results: In patients receiving CA, survivorship free of proximal junctional kyphosis (PJK) was 94%, 60%, and 20% at 2, 5, and 10 years postoperatively. Survivorship free of revision was 95%, 83%, and 83% at 2, 5, and 10 years postoperatively. Development of PJK (P = 0.02, odds ratio [OR] 24.44) was associated with revision surgery. There were 4 (7%) cardiopulmonary complications. Patients who received CA for thoracolumbar fusion were older (70 years vs. 65 years) and were more likely to have osteoporosis (53% vs. 5%) than patients who did not receive CA. CA was associated with a decreased risk of PJK (P = 0.009, OR 0.16), while osteoporosis (P = 0.05, OR 4.10) and fusion length ≥8 levels (P = 0.06, OR 2.65) were associated with PJK. PJK was associated with revision surgery (P = 0.006, OR 12.65). Conclusions: CA allows for substantial rates of radiographic PJK; however, this typically does not result in a need for revision surgery and leads to revision and PJK rates that are comparable to patients undergoing long segment fusions without osteoporosis.

Original languageEnglish (US)
Pages (from-to)e454-e463
JournalWorld neurosurgery
StatePublished - Apr 2022


  • Adult spinal deformity
  • Complications
  • Osteoporosis
  • Proximal junctional kyphosis
  • Vertebral augmentation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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