title: Pedicle screw augmentation in osteoporotic spine: indications, limitations and technical aspects.
abstract: OBJECTIVE
  The need for spinal instrumented fusion in osteoporotic patients is rising. In this review, we try to give an overview of the current spectrum of pedicle screw augmentation techniques, safety aspects and indications.
  
  
  METHODS
  Review of literature and discussion of indications, limitations and technical aspects.
  
  
  RESULTS
  Various studies have shown higher failure rates in osteoporotic patients, most probably due to reduced bone quality and a poor bone-screw interface. Augmentation of pedicle screws with bone cement, such as polymethylmethacrylate or calcium based cements, is one valid option to enhance fixation if required.
  
  
  CONCLUSIONS
  Crucial factors for success in the use of augmented screws are careful patient selection, a proper technique and choice of the ideal cement augmentation option.
authors.affiliation: Department of Orthopedic and Trauma Surgery, Inselspital, University Hospital, University of Bern, Bern, Switzerland. sven.hoppe@insel.ch.
authors.forename: S
authors.initials: S
authors.lastname: Hoppe
authors.affiliation: Department of Orthopedic and Trauma Surgery, Inselspital, University Hospital, University of Bern, Bern, Switzerland.
authors.forename: M J B
authors.initials: MJ
authors.lastname: Keel
mesh_terms: D001843:Bone Cements; D019299:Decompression, Surgical; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D058866:Osteoporotic Fractures / Q000601:surgery*; D065289:Pedicle Screws; D019904:Polymethyl Methacrylate; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation*; D054854:Vertebroplasty / Q000295:instrumentation*
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate
keywords: Cement augmentation; Osteoporosis; Pedicle screw; Spine; Surgery; Vertebroplasty