Outcomes of Hybrid Cement-Augmented Pedicle Screw Fixation in Complicated Osteoporotic Thoracolumbar Fractures: A Single-Centre Experience

<i>Background and Objectives:</i> Complicated osteoporotic thoracolumbar fractures represent a major surgical challenge because compromised bone quality predisposes to progressive deformity, neurological deterioration, and fixation failure. This study aimed to evaluate the clinical and radiological outcomes of hybrid stabilization in patients with severe osteoporotic fractures classified as AO Spine-DGOU OF4-OF5. <i>Materials and Methods:</i> This single-center retrospective observational cohort study included 87 consecutively treated patients with complicated osteoporotic thoracolumbar fractures who underwent surgical treatment between 2012 and 2022. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Radiological outcomes included the regional kyphotic angle (RKA) and interbody fusion graded according to the Bridwell classification. Imaging was reviewed preoperatively, immediately postoperatively, and at follow-up, with 12-month outcomes used for the principal analysis. Additionally, a retrospective comparative analysis was undertaken between the two largest fixation subgroups within the cohort to explore outcome differences across the most representative construct patterns. <i>Results:</i> At 12 months, complete interbody fusion (Bridwell grade I) was achieved in 75.9% of patients. Mean RKA improved from 29.4° ± 14.1° preoperatively to 7.9° ± 8.0° immediately after surgery, with only minimal loss of correction during follow-up. Mean VAS improved from 7.0 ± 1.8 to 2.1 ± 1.2, while mean ODI decreased from 61.3% ± 6.8% to 9.8% ± 1.2% (both <i>p</i> < 0.001). Reoperation for implant-related mechanical failure was required in three patients (3.4%). <i>Conclusions:</i> Hybrid stabilization with cement augmentation was associated with marked improvement in pain, functional disability, and sagittal alignment, as well as a high rate of interbody fusion at 12 months, in patients with complicated osteoporotic thoracolumbar fractures. Given the retrospective observational design, these findings should be interpreted as associations within the treated cohort. Prospective comparative studies are warranted to further validate these results.