Posterior spinal fusion generally successfully stabilizes the spine, reduces pain and prevents further deformity. Yet, in a considerable number of cases the mechanical loads placed on the instrumentation exceed the loading capacity of the surrounding bone inducing loosening of the pedicle screws [1]. The resulting improper fixation of the instrumentation may cause patient discomfort and may require revision surgery. The use of bone cement during the index surgery however, reduces the risk of screw loosening 25-fold and virtually eradicates the problem [2]. Unfortunately, bone cement introduces its own set of complication risks with pulmonary embolism due to cement leakage being among the most severe [3]. To date, the surgeon largely must rely on personal experience rather than well-founded quantitative  evidence when deciding on the optimal treatment strategy for the patient.