This study aims to compare the clinical and radiological outcomes of bone-cement-augmented transpedicular screw fixation versus cannulated pedicle screw fixation in patients with osteoporotic spines requiring posterior instrumentation, with respect to implant stability (loosening/pull-out), pain relief, functional recovery, and complication rates.

Osteoporosis of the spine presents a significant challenge in spine surgery, particularly when instrumentation is needed for stabilization. With declining bone mineral density, conventional pedicle screw purchase becomes unreliable, leading to increased rates of screw loosening, pull-out, and fixation failure.

A relevant development in instrumentation has been the use of cannulated pedicle screws, sometimes in combination with cement-injectable systems, designed to allow cement to flow through the screw to reinforce fixation. Such systems have shown improved implant stability and lower failure rates in osteoporotic bone compared with solid screws.

Inclusion Criteria:

• Age ≥18 years old.
• Both sexes.
• Patients with confirmed osteoporosis on dual-energy X-ray absorptiometry (DEXA) scan (T-score ≤ -2.5),
• Patients presented with painful osteoporotic vertebral fractures, degenerative instability, or traumatic compression fractures.
• Patients are unresponsive to conservative management and require surgical stabilization.

Exclusion Criteria:

• Patients with healed or stable fractures respond to medical treatment.
• Patients with uncontrolled coagulopathy, active spinal infections such as discitis or osteomyelitis.
• Patients with spinal deformity exceeding thirty degrees, or vertebral body collapse greater than seventy percent.

The data will be available upon a reasonable request from the corresponding author after the end of study for one year.

After the end of study for one year.

The data will be available upon a reasonable request from the corresponding author.