Case Study: MIS Cement Screw for L3 Compression Fracture

Vertebral compression fractures (VCFs) in middle-aged and elderly patients often present a dual challenge: the need for immediate structural restoration and the difficulty of achieving secure fixation in osteoporotic or degenerative bone. This case study explores the successful application of the XC Medico MIS 5.5 System Cement Augmented Fenestrated Screw in a clinical setting in Chile.

1. Pre-operative Assessment and Clinical Findings

A 54-year-old female presented with acute, debilitating lower back pain following a minor fall. Physical examination revealed localized tenderness over the lumbar spine and significantly restricted mobility.

Figure 1: Pre-operative imaging demonstrating an L3 vertebral body compression fracture (approximately 30% loss of height) and signs of lumbar degeneration.

Initial imaging (Figure 1) confirmed an L3 compression fracture involving approximately 30% of the vertebral height. The report also indicated lumbar degenerative changes, including bone hyperplasia at the vertebral margins and straightening of the physiological curvature. Due to the patient’s age and the degenerative nature of the bone, traditional pedicle screw fixation faced a high risk of "pull-out" or loosening.

2. Surgical Strategy: Why MIS Cement Augmentation?

Dr. Alejandro Silva opted for a Minimally Invasive Surgery (MIS) approach to minimize soft tissue trauma and accelerate recovery. The decision to use the XC Medico Cement Augmented Fenestrated Screw was based on two critical factors:

• Enhanced Anchoring: The fenestrated design allows for precise PMMA cement injection, creating a "bone-cement-screw" composite that significantly increases pull-out strength in degenerative bone.
• MIS Compatibility: The 5.5mm system is optimized for percutaneous delivery, reducing blood loss and post-operative pain.

3. Intra-operative Execution and Post-operative Results

The procedure was performed under fluoroscopic guidance. XC Medico fenestrated screws were placed at L2 and L4, flanking the fractured L3 vertebra. PMMA cement was carefully injected through the hollow screw shafts, achieving optimal interlacing with the surrounding cancellous bone.

Figure 2: Post-operative CT shows screws in an ideal position with the cement evenly distributed around the fenestrations, providing immediate stability.

Figure 3: Full spinal alignment restored. The internal fixation is stable, and the L3 height is maintained.

The post-operative CT and DR (Figures 2 & 3) confirmed that the internal fixation was perfectly positioned. The vertebral height was maintained, and the cement dispersion was uniform. The patient reported a 70% reduction in pain within 24 hours and was mobilized with a brace on the second post-operative day.

4. Conclusion

The collaboration between the surgical expertise of the Chilean medical team and XC Medico’s advanced spinal technology resulted in a superior clinical outcome. The MIS 5.5 System Cement Augmented Fenestrated Screw proves to be an essential tool for spine surgeons dealing with complex fractures in patients with compromised bone quality.