• Hamisi Mwarindano Mraja, Halil Gök, DaadourInas Mohamed FawzyIMFScoliosis-Spine Center Istanbul, Istanbul Florence Nightingale Hospital, Istanbul, Turkey., Onur Levent Ulusoy, Tunay Şanlı, Selhan Karadereler, Meriç Enercan, and Azmi Hamzaoglu.
• Scoliosis-Spine Center Istanbul, Istanbul Florence Nightingale Hospital, Istanbul, Turkey. Electronic address: hmsmrj752@gmail.com.
• World Neurosurg. 2023 Jun 1; 174: e126e130e126-e130.

BackgroundOsteoporosis in pediatric patients is rare. Osteomalacia and osteoporosis are known to develop in syndromic or neuromuscular scoliosis children. Spinal deformity surgery for pediatric patients with osteoporosis is challenging, associated with pedicle screw (PS) failure and compression fractures. Cement augmentation of PS is one several measures to prevent screw failure. It provides additional pull-out strength to the PS in the osteoporotic vertebra.MethodsIn 2010-2020, an analysis of pediatric patients who had cement augmentation of PS with a minimum follow-up of 2 years was performed. Radiological and clinical evaluations were analyzed.ResultsThe study included 7 patients (4 girls, 3 boys) with a mean age of 13 years (range, 10-14 years) and mean follow-up of 3 years (range, 2-3 years). Only 2 patients underwent revision surgery. Total number of cement augmented PSs was 52 with an average of 7 per patient. Only 1 patient had lower instrumented vertebra vertebroplasty. There was no PS pull-out in the cement augmented levels, and there were no neurological deficits or pulmonary cement embolisms. One patient developed a PS pull-out in uncemented levels. Two patients developed compression fractures, one, with osteogenesis imperfecta, in the supra-adjacent levels (upper instrumented vertebra + 1 and upper instrumented vertebra + 2), and the other, with neuromuscular scoliosis, in the uncemented segments.ConclusionsIn this study, all cement augmented PSs provided satisfactory radiological outcomes without PS pull-out and adjacent vertebral compression fracture. In pediatric spine surgery, in osteoporotic patients with a poor bone purchase, cement augmentation may be used, especially in high-risk patients with osteogenesis imperfecta, neuromuscular scoliosis, and syndromic scoliosis.Copyright © 2023 Elsevier Inc. All rights reserved.

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