{
  "abstract": "Background Vertebral compression fractures (VCFs), characterized by middle column involvement, osteonecrotic clefts, split morphology, or pedicle fractures, pose biomechanical challenges that reduce the effectiveness of conventional vertebroplasty and kyphoplasty. We evaluated the feasibility, safety, and clinical outcomes of the Calibrated Screw Technique (CAST), a minimally invasive approach combining percutaneous pedicle screw fixation and targeted cement augmentation, in patients with complex VCFs.Methods We retrospectively analyzed 147 consecutive patients (155 vertebral levels; mean age 80.1 years), primarily with osteoporotic fractures (80.6%), treated using CAST. Demographic, clinical, and radiographic data were collected at baseline, and at 1 and 6 months. Pain intensity was measured by the numeric rating scale (NRS), and patient perceived outcomes were assessed using patient global impression of change (PGIC). Radiographic outcomes included refracture rates at treated vertebrae, incidence of new fractures, and kyphotic angle correction in mobile fractures.Results CAST was technically feasible in all cases without major complications. Mean NRS scores improved significantly from 7.7 before the procedure to 3.6 at 1 month and 2.7 at 6 months (P < 0.0001). At the 1 month follow-up, 55.3% of patients reported feeling ‘extremely’ or ‘much improved’ on PGIC, increasing to 69.8% at 6 months. Radiographically, only one asymptomatic refracture occurred at 1 month (0.8%) and none at 6 months. New fracture incidence decreased from 13.8% at 1 month to 4.2% at 6 months.Conclusions In this study, CAST provided a safe, technically feasible, and durable solution for stabilization and pain relief in complex VCFs unsuitable for conventional augmentation, highlighting its value for challenging VCFs.",
  "authors": [
    {
      "affiliations": [
        "Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland"
      ],
      "name": "Marco Pileggi"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Ospedale Civile S Agostino-Estense, Modena, Italy"
      ],
      "name": "Francesco Adduci"
    },
    {
      "affiliations": [
        "Shirley Ryan AbilityLab, Chicago, Illinois, USA",
        "Department of Physical Medicine and Rehabilitation, Northwestern University, Evanston, Illinois, USA"
      ],
      "name": "Andrea A Domenighetti"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland"
      ],
      "name": "Maurizio Isalberti"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland"
      ],
      "name": "Christian Commodaro"
    },
    {
      "affiliations": [
        "Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milano, Italy"
      ],
      "name": "Luigi La Barbera"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland"
      ],
      "name": "Andrea Cardia"
    },
    {
      "affiliations": [
        "Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milano, Italy"
      ],
      "name": "Tomaso Villa"
    },
    {
      "affiliations": [
        "NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Joshua A Hirsch"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland",
        "Inselspital University Hospital Bern Institute of Diagnostic and Interventional Neuroradiology, Bern, Switzerland"
      ],
      "name": "Alessandro Cianfoni"
    }
  ],
  "title": "Use of Calibrated Screw Technique (CAST) for complex vertebral compression fractures: retrospective evaluation of clinical outcomes and indications",
  "uid": "0b5f9bbe-9beb-5a7c-a944-698bff3eda8f"
}