For decades, pedicle screws have been the gold standard for lumbar fusion surgery, providing rigid fixation and stability while bone grafts heal. But as spine surgery advances, so must our techniques. After developing the CemLIF cement-augmented lumbar fusion technique and seeing early results, I’ve decided to move away from pedicle screws in favor this technique. Here’s why.

The Limitations of Pedicle Screws

While pedicle screws have been the go-to solution for stabilization, they come with several drawbacks:

• A Painful Recovery – Placing pedicle screws requires extensive muscle dissection, increasing blood loss, surgical time, and postoperative pain. Even the newest robotic or minimally invasive techniques have similar downsides, usually just with multiple smaller incisions instead of one large one. CemLIF is a much more minimally invasive technique and we’re seeing much less postoperative pain in these patients.
• Screw Loosening – Screws can loosen, break, or cause adjacent segment disease, leading to potential reoperations. One recent study, looking at patients with degenerative scoliosis (my main patient population in Naples, Fl), found screw loosening in 55% of patients. Screws typically only loosen when a level fails to fuse, which means that at least 55% of these patients had one or more levels that failed to fuse. This is similar to my experience with pedicle screw-based lumbar fusions and is an unacceptably high complication rate.
• Prolonged Recovery – The invasiveness and pain of pedicle screw placement often extends recovery time, delaying a patient’s return to daily life.

• Complications – A very large study of over 26,000 patients who underwent adult spinal deformity surgery found a 34.5% complication rate, including screw loosening and adjacent segment disease. They had a 10.8% rate of neurologic complication, and the infection rate was 3.6%. Cardiac and pulmonary complications were about 4.8%.

The Benefits of CemLIF

Rather than relying on traditional screw-based fixation, I now focus on the CemLIF procedure. This approach offers significant advantages:

• Superior Fixation – By injecting bone cement directly into the vertebral body, we achieve immediate, rock-solid stabilization, even in osteoporotic bone.
• Minimally Invasive – Without the need for large incisions to place pedicle screws, patients experience less surgical trauma and quicker recovery times.
• Reduced Hardware-Related Complications – No screws mean no risk of loosening, breakage, or hardware-related adjacent segment disease.
• Faster Return to Function – Patients mobilize sooner, with less pain and a lower risk of long-term complications.

The Shift to CemLIF

When I performed the first CemLIF procedure, I hoped it would be a good addition to the tools in my toolbox. I had no expectation that it would one day replace pedicle screws in my practice. After seeing the postoperative courses of my first 30 patients, it became very obvious to myself and my team that these patients were doing better than pedicle screw patients. So much better, in fact, that I now view pedicle screws as barbaric and archaic.

CemLIF is still very much in it’s infancy, and is far from perfect. We’ve even had two failures: one patient needed screws and rods placed and one needed the surgery revised.  But even with a 93% success rate so far, CemLIF is performing much better than the published metrics for pedicle screw-based surgeries. Not only are we seeing less hardware failure, but we’re seeing a significantly less painful recovery in these patients.

A Future Without Pedicle Screws

The evolution of spine surgery is moving toward techniques that optimize outcomes while minimizing invasiveness. The CemLIF represents a paradigm shift in achieving spinal stability without the downsides of pedicle screws. By embracing this approach, I’m providing my patients with easier recoveries through a procedure that appears to be safer and more durable with a much less painful recovery.

The era of pedicle screws is coming to an end—at least in my practice. It’s time to rethink fixation and move forward with smarter, more patient-friendly alternatives.