ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Cement augmentation of pedicle screw constructs as a modifier of hardware failure risk in instrumented metastatic spine surgery: a systematic review and meta-analysis.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
purposeHardware failure (HF) after instrumented fixation for spinal metastases affects 2-22% of patients. Despite growing adoption of cement-augmented pedicle screw fixation (CAPS), no meta-analysis has quantified its effect on HF rates. We aimed to provide pooled HF estimates for CAPS versus conventional fixation and explore the Spinal Instability Neoplastic Score (SINS) as a potential effect modifier.
methodsA systematic review and meta-analysis were conducted following PRISMA 2020 guidelines, searching five databases through April 2026. Pooled HF rates were computed using Freeman-Tukey double arcsine transformation with DerSimonian-Laird random-effects models. Sensitivity analysis was performed restricting to SINS-reporting studies. Certainty of evidence was assessed using GRADE.
resultsThirteen studies (n = 886) met eligibility criteria. The pooled HF rate was 4.3% (95% CI 1.8-7.9%; I² = 46.8%) in CAPS arms (k = 10, n = 349) versus 12.5% (95% CI 2.9-27.5%; I² = 93.3%) in non-augmented controls (k = 5, n = 537). The sole comparative study demonstrated OR 0.13 (95% CI 0.02-0.81; p = 0.029). Sensitivity analysis restricted to SINS-reporting studies confirmed stability (4.5%, I² = 23.4%). All outcomes were rated low to very low certainty.
conclusionCAPS was associated with a numerically lower pooled HF rate compared to conventional fixation in metastatic spine surgery (4.3% vs. 12.5%; indirect comparison). While certainty of evidence was low to very low, these findings may inform implant strategy decisions and highlight the need for standardised HF definitions. INPLASY registration: INPLASY202640045.
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