Anterior Height Research Articles

Effect of percutaneous vertebroplasty through UTPP approach on prognosis and quality of life in elderly patients with osteoporotic vertebral compression fractures: a retrospective study

BackgroundTo explore the clinical characteristics of percutaneous vertebroplasty (PVP) via unilateral transverse process-pedicular (UTPP) approach in the treatment of osteoporotic vertebral compression fracture (OVCF) in the elderly.MethodsA total of 120 elderly patients with lumbar OVCF who underwent PVP via unilateral pedicular (UTP) and UTPP approaches in our hospital from January 2022 to January 2024 were retrospectively analyzed. The postoperative VAS score (visual analog scale), ODI score (Oswestry disability index), surgical indicators, and imaging indicators were recorded in the two groups.ResultsThe VAS scores and ODI scores of the two groups of patients were lower than those before surgery 1 day, 6 months, and 12 months after surgery (P < 0.05). The amount of bone cement (BC) injected in the UTPP group was greater than that in the UTP group, the excellent BC distribution rate was higher than that in the UTP group, and the BC leakage rate was lower than that in the UTP group (all P < 0.05). The vertebral anterior edge height and Cobb angle of the UTPP group were significantly different from those of the UTP group 1 day after surgery (P < 0.05).ConclusionsAfter UTPP-PVP, BC is fully diffused, the BC leakage rate is low, and the analgesic effect is good, which can enable patients to get out of bed early and improve their quality of life.

An automated algorithm for quantitative morphometry of thoracic and lumbar vertebral bodies in lateral radiographs

Abstract This exploratory study developed and evaluated an AI-based algorithm for quantitative morphometry to assess vertebral body deformities indicative of fractures. To achieve this, 709 radiographs from 355 cases were utilized for algorithm development and performance evaluation. The proposed algorithm integrates a first-stage AI model to identify the positions of thoracic and lumber vertebral bodies in lateral radiographs and a second-stage AI model to annotate six landmarks for calculating vertebral body height ratios (C/A, C/P and A/P). The first-stage AI model achieved a sensitivity of 97.6%, a precision of 95.1%, and an average false-positive ratio of 0.43 per image for vertebral body detection. In the second stage, the algorithm’s performance was evaluated using an independent dataset of vertebrae annotated by two spine surgeons and one radiologist. The average landmark errors ranged from 2.9% to 3.3% on the X-axis and 2.9% to 4.0% on the Y-axis, with errors increasing in more severely collapsed vertebrae, particularly at central landmarks. Spearman’s correlation coefficients were 0.519–0.589 for C/A, 0.558–0.647 for C/P, and 0.735–0.770 for A/P, comparable to correlations observed among human evaluators. Bland–Altman analysis revealed systematic bias in some cases, indicating that the algorithm underestimated anterior and central height collapse in deformed vertebrae. However, the mean differences and limits of agreement between the algorithm and external evaluators were similar to those among the evaluators. Additionally, the algorithm processed each image within 10 seconds. These findings suggest that the algorithm performs comparably to human evaluators, demonstrating sufficient accuracy for clinical use. The proposed approach has the potential to enhance patient care by being widely adopted in clinical settings.

Relative anterior spinal overgrowth in mild and moderate adolescent idiopathic scoliosis: a retrospective study

To determine whether relative anterior spinal overgrowth (RASO) occurs regardless of scoliosis segments and severity, and to explore the pattern of vertebral body height changes in adolescent idiopathic scoliosis (AIS). A total of 125 AIS and 179 non-scoliotic adolescents were enrolled. The anterior vertebral body height (VBHa) and posterior vertebral body height (VBHp) were measured on lateral spine radiographs, and the VBHa/VBHp ratio was calculated. The ratios were compared between the two groups and across scoliosis segments in the AIS group. The correlation between scoliosis severity and vertebral ratios, as well as the relationship between the apex vertebra’s ratio and Cobb angle, was analyzed. Results showed that the VBHa/VBHp ratios were higher in the AIS group than the control group from T6 to L5 (P < 0.001), with increasing ratios from T7 to T10 and L1 to L5. No significant differences were found across scoliosis segments. Pearson analysis showed positive correlations between scoliosis severity and ratios at T7, T8, and T11 (P < 0.05), and a negative correlation at L5 (P < 0.05). No correlation was found between the apex vertebra’s ratio and the Cobb angle. In conclusion, RASO is common in mild to moderate AIS and may help maintain spinal function.

Vertebral augmentation plus pedicle screw fixation versus vertebral augmentation alone in the treatment of osteoporotic thoracolumbar fractures: A Meta-analysis.

This meta-analysis was conducted to compare the efficacy and safety of vertebral augmentation (VA) plus pedicle screw fixation (PSF) with VA for treating osteoporotic thoracolumbar fractures (OTLFs). A comprehensive search was conducted in PubMed, Embase, Cochrane Library and China National Knowledge Infrastructure (CNKI) to identify studies comparing PSF+VA with VA for treating OTLF. The primary outcomes were operation time, blood loss, length of stay, visual analogue scale (VAS) score, Oswestry disability index (ODI), Cobb angle, anterior vertebral height (AVH), bone cement leakage, secondary fracture and other adverse events. Standardized mean deviation (SMD) and risk ratio(RR) with 95% confidence interval (CI) were calculated. Totally 14 studies met the entire inclusion criteria for our meta-analysis. The PSF+VA group was associated with significantly more operation time (SMD 4.41, 95% CI 3.32-5.51), blood loss (SMD=6.72, 95%CI 4.50 - 8.95), and length of stay (SMD=2.05, 95%CI 1.02 - 3.07). There was no significant VAS or ODI score difference at early follow-up. No significant difference was found in AVH between the two groups before two years. The remaining outcomes (VAS at six months and two years; ODI at six months and 1 year; Cobb angle at all follow-up periods; AVH at two years; bone cement leakage and secondary fracture) favored the PSF+VA group. PSF+VA was superior to VA for the VAS score, ODI, Cobb angle, AVH and complications, especially in the long-term follow-up. However, more operation time, blood loss and length of stay were the disadvantages for PSF+VA.

Obesity and clinical, radiographic, and surgical outcomes after minimally invasive single-level transforaminal versus lateral lumbar interbody fusion.

To determine the effect of obesity on clinical, radiographic, and surgical outcomes after lateral lumbar interbody fusion (LLIF) versus minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF) and compare the effectiveness of LLIF versus MIS TLIF in treating obese patients. A retrospective comparative analysis of patients who underwent single-level L4-5 LLIF or MIS TLIF over a 7-year period was performed. Spinopelvic parameters were compared based on pre- and postoperative radiographs. Body mass index (BMI) ≥30 was deemed "high"; BMI <30 was deemed "low." In total, 154 patients underwent LLIF or MIS TLIF during the study period (33 TLIF high BMI, 45 TLIF low BMI, 28 LLIF high BMI, and 48 LLIF low BMI). Compared with TLIF high BMI patients, TLIF low BMI patients experienced superior posterior disc height (PDH) restoration (p=0.05), shorter operative duration (p=0.01), decreased revision surgery rate (p=0.02), reduced estimated blood loss (p=0.04), and shorter hospital length of stay (p=0.03). No differences in outcomes were seen in LLIF high BMI vs LLIF low BMI cohorts. Among obese patients, LLIF provided superior restoration in anterior disc height (p<0.001), PDH (p=0.003), and neuroforaminal height (p=0.002); shorter operative duration (p<0.001); and decreased estimated blood loss (p=0.008), compared with MIS TLIF. Obesity was associated with poorer overall radiographic and surgical outcomes after MIS TLIF but not LLIF. In obese patients in our cohort, LLIF provided superior improvements in spinopelvic parameters and surgical characteristics. BMI should be considered when deciding between LLIF and MIS TLIF.

Normative vertebral deformity measurements in a clinically relevant population using magnetic resonance imaging.

Osteoporosis is the leading cause of vertebral fractures. Dual-energy X-ray absorptiometry (DXA) and radiographs are traditionally used to detect osteoporosis and vertebral fractures/deformities. Magnetic resonance imaging (MRI) can be utilized to detect the relative severity of vertebral deformities using three-dimensional information not available in traditional DXA and lateral two-dimensional radiography imaging techniques. To generate normative vertebral parameters in women using MRI and DXA scans, determine the correlations between MRI-calculated vertebral deformities and age, DXA T-scores, and DXA Z-scores, and compare MRI vertebral deformity values with radiography values previously published in the literature. This study is a retrospective vertebral morphometric analysis conducted at our institution. The patient sample included MR images from 1638 female patients who underwent both MR and DXA imaging between 2005 and 2014. Biconcavity, wedge, crush, anterior height (Ha)/posterior height (Hp), and middle height (Hm)/posterior height values were calculated from the MR images of the patient's vertebrae. Associations between vertebral deformity values, patient age, and DXA T-scores were analyzed using Spearman correlation. The MRI-derived measurements were compared with radiograph-based calculations from population-based data compiled from multiple studies. Age was positively correlated with lumbar Hm/Hp (P = 0.04) and thoracic wedge (P = 0.03) and biconcavity (P = 0.001) and negatively correlated with thoracic Ha/Hp (P = 0.002) and Hm/Hp (P = 0.001) values. DXA T-scores correlated positively with lumbar Hm/Hp (P < 0.0001) and negatively with lumbar wedge (P = 0.046), biconcavity (P < 0.0001), and Ha/Hp (P = 0.046) values. Qualitative analysis revealed that Ha/Hp differed between MRI and radiography population-based data by no more than 0.3 and Hm/Hp by a maximum of 1.2. Compared with traditional imaging techniques, MRI detects vertebral deformities with high accuracy and reliability. It may be a sensitive, ionizing, radiation-free tool for use in clinical settings.

A contrastive analysis of two bone cement applicators for percutaneous vertebroplasty in the treatment of OVCF: A retrospective study

Background Percutaneous vertebroplasty (PVP) is the mainstream treatment for osteoporotic vertebral compression fractures (OVCF). In order to provide better clinical efficacy and reduce complications, various bone cement applicators are still being developed and gradually applied in clinical practice. However their clinical results are still to be reported. Objective To evaluate the clinical efficacy of the novel spiral cement applicators and the traditional push-rod applicators for the PVP treatment of osteoporotic vertebral compression fractures (OVCF). Methods A retrospective study, from February 2017 to May 2019, was conducted on 107 OVCF patients who received PVP surgeries respectively with spiral applicators (Observation group) and pushrod applicators (Control group). Perioperative indicators, imaging indicators, clinical efficacy, other indicators were collected and compared. Results The follow-up period was two years. The baseline data of the two groups were comparable ( P &gt; 0.05). The anterior edge height and kyphosis angle of the injured vertebrae after surgery compared with before surgery increased significantly in both groups ( P &lt; 0.05). The midline height in the observation group after surgery compared with before surgery increased significantly ( P &lt; 0.05). The kyphosis angle after surgery and these recovery rates of kyphosis angle, the anterior edge height, the midline height, the posterior edge height increased significantly in the observation group compared with the control group ( P &lt; 0.05). VAS and ODI in both groups were significantly lower on the 3rd day and 2nd year after surgery than before surgery, and decreased gradually over time ( P &lt; 0.05). The VAS and ODI on the 3rd day after surgery were significantly lower in the observation group than in the control group ( P &lt; 0.05). The number of fluoroscopy and operation time were significantly lower in the observation group than in the control group ( P &lt; 0.05). The rate of bone cement leakage, bone cement diffusion coefficient and cement volume in the observation group were significantly higher than that of the control group ( P &lt; 0.05). Conclusion The spiral applicator is better than the pushrod applicator in reducing the number of fluoroscopy and operation time, restoring vertebral height, correcting kyphosis, alleviating pain immediately, improving function, and facilitating dispersion of cement, with a higher rate of bone cement leakage.

Jaw Growth and Development in Class II Division I Malocclusion Children Using the Myobrace® Muscle Function Appliance.

Class II Division I malocclusion is common in pediatric orthodontics, and is often associated with malocclusion and poor muscle functionality. However, research on post-treatment changes in maxillomandibular dimensions, excluding normal development influences, is limited. Therefore, this study aimed to investigate the effects of Myobrace® appliance and targeted muscle functional training on maxillomandibular dimensions in children with Class II Division I malocclusion, compared to directed oral muscle training alone. This retrospective study included 96 children with Class II Division I malocclusion. Based on the treatment method, the patients were divided into two groups: the treatment group (patients who underwent treatment with the Myobrace® muscle function appliance combined with directed muscle functional training for one year) and the control group (patients who received only directive oral muscle training for one year). The growth changes in jaws in both groups were assessed through X-ray cephalometry and plaster casting. The Sella-Nasion to A point angle (SNA) had increased (p > 0.05), and the maxilla length increased, with significant differences between the two groups (p < 0.05). Furthermore, after intervention, there was a significant increase in mandibular length (p < 0.05). There was a slight decrease in the S-Co value indicating the position of the mandibula. However, this change was not significant, indicating that the mandibula didn't move forward after treatment. The angle between the Frankfort Horizontal Plane and mandibular planes (MP-FH) increased after treatment (p > 0.05), and there were increasing trends on the Y axis, posterior heights, and anterior heights, and these changes were statistically significant (p < 0.05). Additionally, we observed a significant increase in the dental arch (p < 0.05) in the treatment group compared to the control group. This finding suggested that the Myobrace® appliance can promote dental arch growth. Myobrace® appliance effectively boosts dental arch growth while correcting Class II Division I malocclusion. However, it may be limited in cases of Class II Division I with high-angle, maxillary protrusion, or severe mandibular retrusion, emphasizing the significance of assessing patient characteristics to ensure optimal improvement.

Precooling storage of bone cement in percutaneous vertebroplasty for osteoporotic vertebral compression fracture

PurposeThis study aimed to investigate the effect of precooling storage of bone cement in percutaneous vertebroplasty(PVP) for the patients with osteoporotic vertebral compression fracture (OVCF).MethodsA total of 207 OVCF patients who underwent PVP were included in this study. Two different storage methods for the bone cement were randomly utilized: an operating room (NT group, 23 °C) and a refrigerator (PC group, 4 °C). Clinical outcomes were evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. In addition, radiographic evaluations were performed using anterior vertebral height and Cobb angle.ResultsThe time of cement infusion was 10.8 ± 2.1 min in the PC group, which was significantly longer compared to the NT group (6.9 ± 1.8 min)(P < 0.0001). However, the postoperative VAS score was lower in the PC group than the NT group (P < 0.0001). Moreover, compared to the NT group, the cement distribution score and rate of cement touching both upper and lower vertebral endplates were higher in the PC group (P < 0.0001 and = 0.037, respectively). Additionally, the anterior vertebral height was higher in the PC group compared to the NT group at both the 2-day postoperative assessment and the final follow-up (P = 0.046 and 0.026, respectively). Lastly, the rates of cement leakage and re-compression were lower in the PC group (P = 0.016 and 0.034, respectively) compared with the NT group.ConclusionPrecooling storage of bone cement may prolong manipulation time in percutaneous vertebroplasty, optimize pain relief for patients, and mitigate the risk of bone cement leakage and re-compression.Trial registrationTrial registration number: ChiCTR2400092330. Retrospective registration date: 14/11/2024 (www.chictr.org.cn).

Surgical Management of Vertebral Body Fractures in Proximal Junctional Kyphosis: A Case Series Utilizing Intravertebral Reduction Devices and Hardware Extension

Vertebral body fracture is the most common manifestation of proximal junctional failure (PJF), a frequent complication following adult spinal deformity surgery and a leading cause of reoperation(1). In the absence of established consensus regarding optimal revision techniques for PJF, this case report presents two patients with non-traumatic vertebral fractures secondary to PJF, successfully managed with intravertebral reduction device (SpineJack®) and bone cement augmentation, combined with the extension of previous instrumentation. While the etiology of PJF in these two cases remains undetermined, this report aims to contribute to the evolving literature on surgical revision strategies for PJF, particularly in the context of vertebral fractures. The first case involves a 62-year-old female with degenerative scoliosis, flat back deformity, adult idiopathic scoliosis, coronal malalignment, and degenerative disc disease with lateral listhesis underwent lateral lumbar interbody fusion (LLIF) at L2-3, L3-4, and L4-5 with titanium interbody devices and posterior L1 to pelvis instrumentation and fusion. Following L1 compression fracture at the proximal end of the instrumentation, the patient underwent surgical revision at 6 weeks postoperative. The pedicle screws at L1 were explanted, and the pedicle tracks were utilized for open placement of SpineJack® implants under fluoroscopic guidance to reduce and elevate the compressed L1 vertebra, restoring anterior vertebral height. The postoperative course was unremarkable, and the patient exhibited significant clinical improvement. The second case involves a 60-year-old female patient with a history of painful thoracolumbar scoliosis who underwent a T8-Pelvis posterior spinal fusion (PSF) with multiple Smith-Petersen osteotomies (SPOs) and L4-S1 transforaminal lumbar interbody fusion (TLIF) with right-sided instrumentation. Following discovery of a T8 vertebral compression fracture at 8 weeks postoperative, existing hardware at the fracture level was removed, and SpineJack® implants were inserted bilaterally into T8, under fluoroscopic direction. The patient’s postoperative course was unremarkable with significant clinical improvement in pain and neurological function. This report aims to contribute to the literature on surgical strategies for managing vertebral fractures associated with PJF. The use of SpineJack® with cement augmentation appears effective in restoring vertebral body height and spinal alignment while offering a less invasive alternative to more extensive procedures like vertebral column resection (VCR). This technique may offer promising results for spine surgeons addressing vertebral fractures in the context of PJF. While the limitations inherent to case reports preclude establishment of intravertebral reduction devices with cement augmentation as a standard clinical practice guideline for vertebral fractures in the setting of proximal junctional kyphosis and/or failure (PJK/PJF), the successful treatment of two patients with this combined approach aims to contribute to the existing literature by presenting the safety and efficacy of such a technique. It suggests its potential utility for spine surgeons encountering this PJF vertebral fractures moving forward.

Evaluating Morphometric Character Variations in Diploid and Triploid Common Carp (Cyprinus carpio) during Early Developmental Stages

Numerous techniques have been put out to differentiate between diploid and triploid organisms, but they are all too complicated and expensive for everyday handling. This study investigated the possibility of distinguishing between diploid and triploid common carp by using simple and cost-effective morphometric variations. This study examines morphometric variations between diploid and triploid common carp (Cyprinus carpio) at three initial developmental stages at 15-, 45- and 75-days post-hatch (dph) to evaluate the morphometric variations during the early developmental stages. Assessments of 11 morphometric characteristics indicated no significant differences between both the ploidy groups at 15 and 45 dph (P &gt; .05), implying similar growth patterns during the early stages of development. However, by 75 dph, significant differences (P&lt;.05) were observed in standard length (SL), eye diameter (ED), anterior myotomal height (AMH), and middle myotomal height (MMH). Triploid fish exhibited higher values in these characteristics. The findings imply that the growth benefits in triploids could be related to metabolic or genetic alterations associated with triploidy, particularly as physiological differences become more pronounced over time. The similarities in early morphometric characteristics between diploids and triploids likely signify shared genetic lineages, whereas the differences at later developmental stages highlight the effect of triploidy on growth characteristics.

The Influence of Zero-Profile Implant Selection on the Outcomes of Anterior Cervical Discectomy and Fusion.

Anterior cervical discectomy and fusion (ACDF) has been widely used in the treatment of cervical degenerative disc disease (CDDD). Previous studies have demonstrated that the size of implants in ACDF determines radiological and clinical outcomes. However, the principles of choosing an appropriate implant size in ACDF remain controversial. The study aimed to elucidate the influence of the cage size of Zero-profile implant system and offer proposals on the selection of implant size during ACDF. This retrospective study analyzed 109 patients who underwent single-level ACDF from March 2011 to April 2020 with the Zero-profile implant system. The patients were categorized into two groups based on the preoperative mean height of adjacent segments (Hm). Clinical outcomes included the Japanese Orthopaedic Association scores (JOA), Neck Disability Index (NDI) and visual analog scale (VAS). In addition, radiographical analysis encompassed cervical lordosis (CL), functional spinal unit (FSU) angle, range of motion (ROM) of the total cervical spine and the FSU, anterior and posterior FSU height, C1-C7 sagittal vertical axis (SVA), C2-C7 SVA, the center of gravity of the head (CGH)-C7 SVA as well as T1 slope (T1S) measurements. Besides, bone fusion rates, anterior bone loss, subsidence, and adjacent segment degeneration were also recorded. Overall, 37 patients in Group A had an implant size ≥ Hm while 72 patients in Group B had an implant size < Hm. The preoperative general data and radiological parameters were comparable between the groups. At the last follow-up, both groups had satisfactory clinical outcomes. As for radiological outcomes, the anterior and posterior FSU heights were significantly higher in Group A compared to Group B (p < 0.05) after ACDF. Besides, both groups corrected and maintained the CL and FSU. However, the average C1-C7 SVA and C2-C7 SVA at the last follow-up were significantly higher in the Group B than in the Group A (C1-C7 SVA: 27.42 ± 9.23 mm vs. 31.76 ± 10.68 mm, p = 0.038; C2-C7 SVA: 14.65 ± 7.27 mm vs. 19.64 ± 8.68, p = 0.003). Additionally, the fusion rates weresignificantly higher in Group A at the first two follow-up visits. Our study showed that an appropriate size of Zero-profile implant system is crucial to achieving favorable clinical and radiological outcomes after performing ACDF. Implants with a larger height but not oversize could maintain the cervical sagittal balance and FSU height and achieve early bone fusion. Therefore, a larger height might be a better choice for achieving a satisfactory long-term prognosis if Zero-profile implants of adjacent size both fit the disc space properly.

Sequential Anterior Longitudinal Ligament Release With Expandable Spacers for Lordosis Correction in Anterior-to-Psoas Lumbar Interbody Fusion: A Radiographic and Biomechanical Study.

Anterior column realignment is an attractive minimally invasive treatment for sagittal imbalance. Expandable spacers offer controlled tensioning of the anterior longitudinal ligament (ALL) during release, which could optimize correction and anterior column stability. This study investigated the biomechanical and radiographic effects of single-level anterior-to-psoas lumbar interbody fusion (ATP-LIF) with expandable spacers and sequential ALL release. In vitro range of motion tests were performed on 7 fresh-frozen cadaveric spines (L2-L5) with a ±7.5 Nm load applied in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). After testing intact spines, single-level (L3-L4) ATP-LIFs were performed and supplemented with posterior screws, rods, and integrated lateral screws and tested after (1) no ALL release (ATP-LIF); (2) resection of 1/3 the ALL's width (1/3 ALL release); (3) resection of 2/3 the ALL's width (2/3 ALL release); and (4) complete ALL resection (3/3 ALL release). Following each partial ALL release, rods were removed, and spacers were expanded until the torque limit was reached. Rods were then reapplied, and lateral radiographs were taken to analyze changes in intervertebral angle (IVA), foraminal height, foraminal area, and posterior and anterior disc height (PDH and ADH). In ATP-LIF constructs, range of motion decreased in FE (18% intact), LB (14% intact), and AR (30% intact), while IVA, PDH, ADH, foraminal height, and foraminal area increased. PDH and ADH increased linearly with sequential ALL release and spacer expansion, while LB and AR remained stable. FE increased slightly (+15%-16% intact, <1°) following 2/3 ALL release but remained stable afterward. IVA increased exponentially with sequential ALL release, gaining 8.8° ± 3.2° with complete release. The present study found improved biomechanics and radiographic parameters following ATP-LIF with intact ALL, minimal biomechanical differences between partial and complete ALL release, and greater correction and height restoration with complete release. Future clinical testing is necessary to determine the impact of this finding on patient outcomes. Controlled tensioning of the ALL before and after ligament release allows for potential optimization between restoring sagittal balance and maximizing construct stability in a minimally invasive approach.

Comparison of Methods for Short-Segment Posterior Stabilization of Lumbar Spine Fractures and Thoracolumbar Junction.

Background: Thoracolumbar and lumbar spine injuries account for 30-60% of spinal fractures, especially at the thoracolumbar junction. Conservative treatment is recommended for stable fractures without neurological symptoms, but studies suggest surgical intervention may offer better outcomes. However, there is no consensus on the best stabilization method. Methods: This non-randomized, prospective study was conducted on 114 patients divided into groups based on the surgical technique selected: pedicle stabilization using Schanz screw constructs (Group One, n = 37) stabilization above and below the fractured vertebra using pedicle screws (Group Two, n = 32), and intermediate fixation with a pedicle screw additionally inserted into the fractured vertebra (Group Three, n = 45). Outcomes were assessed using the Cobb angle, anterior and posterior vertebral wall height, and patient quality of life via the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). X-ray imaging was performed before, during, and after surgery in the control group. Results: This statistical study showed that the location and type of injury significantly influenced the choice of short-segment stabilization method. In the case of measuring the Cobb angle and the high anterior wall, the statistical analysis showed that the best result was observed in the Schanz Group. Patients from this study group had the lowest pain and the highest efficiency. Conclusions: Schanz screw stabilization may offer superior outcomes for thoracolumbar spine injuries, providing better clinical and quality of life results compared to other methods.

Short-Term Outcomes of a Novel Non-Screw Based Expandable Posterior Interbody Fusion Cage

BackgroundLumbar interbody fusion is a well-established surgical technique for treating various lumbar degenerative pathologies. Expandable cages have been introduced to allow for insertion via the confined access and to improve disc height restoration, though concerns about the stability of the screw-based cages in the expanded state remains a concern. This study aims to evaluate the short-term clinical and radiographic outcomes of a novel non-screw based expandable TLIF cage. MethodsAdult patients who underwent posterior spinal fusion and were implanted the X-PAC TLIF-cage for degenerative lumbar conditions between September 2021 and April 2023 were retrospectively reviewed. Radiographic outcomes, including anterior disc height (ADH), posterior disc height (PDH), and segmental lordosis, were measured preoperatively, postoperatively, and at ≥6-month follow-up. Cage subsidence at follow-up was assessed according to the Marchi classification, along with cage collapse and complications requiring revision surgery. Radiographic outcomes were compared between timepoints using Wilcoxon signed-rank tests and paired t-test depending on distribution. ResultsThe study included 131 patients, implanted with 160 expandable cages. Significant increases in ADH and PDH were observed postoperatively and maintained at follow-up (ADH: 9.8 mm ± 5.4 versus 12.7 mm ± 4.0, and PDH: 3.1 mm (1.3 – 4.9) versus 5.0 mm (3.6 – 6.9) respectively, p < 0.001). Segmental lordosis showed an initial postoperative increase but was not significantly sustained at the 6-month follow-up. Cage subsidence was seen in 9.3% of cases, with no severe subsidence or complete cage collapse. Revision surgery was required in 6.1% of patients, none due to cage-related issues. ConclusionThe novel non-screw-based expandable cage effectively restored and maintained disc height with a low incidence of complications, suggesting it as a safe and effective alternative for lumbar interbody fusion. Further long-term studies are needed to confirm its efficacy and safety.

Impact of Intravertebral Clefts Sclerosis on Percutaneous Vertebroplasty Efficacy in Osteoporotic Vertebral Compression Fractures

To investigate the effect of intravertebral cleft sclerosis on the efficacy of percutaneous vertebroplasty (PVP) in osteoporotic vertebral compression fractures (OVCFs). We analyzed 68 OVCF patients with intravertebral clefts treated with PVP from January 2020 to June 2022. Patients were divided into 2 groups based on computed tomography findings: intravertebral clefts sclerosis (IVCs, 36 cases) and intravertebral clefts nonsclerosis (IVCns, 32 cases). Preoperative data included gender, age, bone mineral density, fractured vertebrae distribution, and disease duration. Excluding those with contraindications, all underwent PVP. Operation time, cement injection volume, leakage rate, and distribution patterns were recorded. Outcomes were evaluated using visual analog scale scores, oswestry disability index, anterior vertebral height, and Cobb angle preoperatively, and at 2 days and 1 year postoperatively. The IVCs group had a longer disease duration (P < 0.05). No significant differences in operation time, cement volume, or leakage rate were observed between groups (P > 0.05). Cement distribution was mass-like in IVCs and sponge-like in IVCns (P < 0.05). Both groups showed significant improvements postoperatively (P<0.05), but IVCns had better recovery in anterior vertebral height, Cobb angle, and oswestry disability index (P < 0.05). IVCs affect cement distribution and recovery outcomes, with IVCns achieving better results. Early treatment is advised for OVCF with intravertebral clefts.

A Comparative Study Between Posterolateral Lumbar Fusion and Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Spondylolisthesis.

Introduction Degenerative spondylolisthesis (DS) is a degenerative condition characterized by subluxation of one vertebral body anterior to the adjacent inferior vertebral body with an intact pars. Conservative treatment approaches, such as steroid injections and physical therapy, may work well at first, but in resistant situations, surgery is frequently necessary. Posterolateral lumbar fusion (PLF) has been widely used, but transforaminal lumbar interbody fusion (TLIF) offers theoretical advantages such as improved alignment and enhanced fusion rates. Methods This retrospective study examined patients with DS who underwent PLF or TLIF at R.L. Jalappa Hospital and Research Centre, Kolar, Karnataka, India, between January 2020 and January 2024. The inclusion criteria were planned one- or two-level fusion DS resistant to conservative treatment and at least one year of follow-up. Patients with prior lumbar fusion or uncontrolled comorbidities were not included. Details were taken from medical records and Picture Archiving and Communication System (PACS), and SPSS Version 22 was used for analysis. Continuous variables were compared using t-tests or Mann-Whitney U tests, and categorical variables were compared using chi-square tests. The non-inferiority of TLIF to PLF was assessed with predefined margins. The study included 56 patients (28 in each group), with outcomes measured via visual analogue scale (VAS), 12-Item Short Form Survey (SF-12) scores, and radiological outcomes. The threshold for clinical significance was p < 0.05. Results This research compared TLIF and PLF in a total of 56 DS patients. Demographic data, operative details, and pre-surgical parameters showed no significant differences. Clinical outcomes revealed comparable improvements in scores for leg and back pain (p > 0.05). SF-12 Physical Component Summary (PCS) scores were significantly higher post-surgery in the TLIF group (42.4 ± 5.1) compared to the PLF group (37.9 ± 4.5) (p = 0.01). Radiologically, the slippage was significantly lower in the TLIF cohort (2.1 ± 1.02) compared to the PLF cohort (3.1 ± 1.9) (p = 0.01). Both anterior and posterior disc heights were substantially increased in the TLIF group (11.3 ± 1.6 vs. 9.3 ± 1.5 in PLF unit, p < 0.01) compared to the PLF group (1.7 ± 0.9 vs. 0.8 ± 0.4, p < 0.01). There were no discernible variations in lumbar lordosis, sacral slope, or changes in the tilt of the pelvis. TLIF demonstrated better radiographic improvements but had clinical outcomes similar to those of PLF. Conclusion TLIF demonstrated superior radiographic improvements, particularly in disc height and slippage reduction, while clinical outcomes were comparable between TLIF and PLF, suggesting that both are effective options for managing DS.

The impact of different courses of osteoporotic vertebral compression fracture on the early efficacy of percutaneous vertebroplasty: a retrospective study.

Percutaneous vertebroplasty (PVP) is a frequently employed technique for treating osteoporotic vertebral compression fracture (OVCF). However, there is still controversy regarding whether PVP with different courses affects clinical efficacy. Therefore, this study aims to investigate the impact of different courses of OVCF on early clinical and radiological outcomes after PVP. OVCF with shorter course can obtain more satisfactory clinical efficacy and radiological results after PVP. A retrospective analysis was conducted on the clinical data of 100 patients undergoing PVP for OVCF. Patients were categorized into early group (n = 37, <2 weeks), intermediate group (n = 35, 2-4 weeks), and late group (n = 28, 4-6 weeks) according to the time from the occurrence of OVCF to undergoing PVP. The visual analogue scale (VAS) and oswestry disability index (ODI) were used to evaluate the clinical effect before, 1 day, and 12 months after surgery. Anterior vertebral height ratio (AVHR) and local kyphosis angle (LKA) were measured on plain radiographs to evaluate the radiographic changes. The cement volume, cement leakage, hospitalization time, new fractures, and outdoor activity (ODA) were compared among the three groups. Compared with preoperative, VAS and ODI of the three groups were significantly improved (p < 0.05). There was no difference in VAS at 1 day and 12 months after surgery among the three groups (3.3 vs. 3.2 vs. 3.2, 1.7 vs. 2.0 vs. 2.0, respectively). ODI was significantly better in the early and intermediate groups at 1 day and 12 months after surgery (33.49% vs. 32.37% vs. 35.24%, 31.86% vs. 30.73% vs. 34.56%, all p < 0.05), and without inter-group differences. Postoperative AVHR and LKA were improved in all three groups (p < 0.05). The improvement of AVHR and LKA at 1 day and 12 months after surgery was more significant in the early and intermediate groups (AVHR: 21.00% vs. 18.52% vs. 26.31%, 21.82% vs. 20.03% vs. 27.75%, LKA: 17.82º vs. 17.61º vs. 20.49º, 19.07º vs. 19.10º vs. 20.80º, all p < 0.05), and without inter-group differences. The cement volume in the late group was less (4.3 ml vs. 4.3 ml vs. 3.2 ml, p < 0.05), but there were no differences in cement leakage and new fractures. Patients in the late group had a longer hospitalization time (5.1d vs. 5.0d vs. 6.4d, p < 0.05) and poorer ODA (5/15/17 vs. 4/17/14 vs. 11/11/6, p < 0.05). OVCF with a course of less than 4 weeks can recover partial vertebral height and improve local kyphosis after PVP. The clinical and radiological outcomes are better than course of more than 4 weeks. We recommend performing PVP within 4 weeks of the occurrence of OVCF. III; retrospective comparative study.

Functional and Radiological Outcomes of Short-Segment Fixation With Intermediate Screws for Thoracolumbar Spine Fractures.

Introduction Thoracolumbar fractures, particularly burst fractures, represent a significant health concern due to their prevalence and functional impact. This study evaluates the efficacy of short-segment posterior fixation with intermediate screw instrumentation in treating unstable thoracolumbar fractures. Methods A prospective study was conducted from July 2022 to December 2023, including 26 patients with traumatic thoracolumbar fractures. Surgical intervention was indicated for patients with a thoracolumbar injury classification and severity (TLICS) score >4. Functional outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI), and the American Spinal Injury Association (ASIA) grading system. Radiological outcomes, including the local kyphotic angle (LKA) and anterior vertebral body height ratio (AVBHR), were evaluated preoperatively, postoperatively, and at follow-ups. Results Significant improvements in functional and radiological parameters were observed over 24 weeks. The mean VAS score reduced from 7.50 ± 0.58 preoperatively to 1.42 ± 0.50 (p < 0.001), and the mean ODI improved from 42.23 ± 3.54 to 16.12 ± 3.09 (p < 0.001). Neurological improvements were seen in ASIA grades B-D, with no new deficits. Radiologically, the mean LKA improved from 19.73 ± 1.59° preoperatively to 8.46 ± 1.33° at 24 weeks (p < 0.001), and the AVBHR increased from 34.08 ± 2.25% to 86.64 ± 0.83% (p < 0.001). No implant failures were reported. Conclusion Short-segment fixation with intermediate screws provides effective stabilization and significant functional and radiological improvements in thoracolumbar fractures. It minimizes intraoperative morbidity and preserves motion segments, making it a viable alternative to long-segment fixation, particularly for non-complex fractures. Further randomized controlled trials are recommended to validate these findings.

Clinical efficacy and biomechanical analysis of a novel hollow pedicle screw combined with kyphoplasty for the treatment of Kümmell disease.

Vertebral augmentation is the preferred treatment for Kümmell disease (KD), but there exists a risk of cement displacement resulting in severe back pain and exacerbation of kyphosis. The study aimed to investigate the efficacy and safety of a novel hollow pedicle screw combined with kyphoplasty (HPS-KP) for treating KD, effectively preventing postoperative bone cement displacement. The prospective study included 50 KD patients with no neurological deficit detected during clinical and radiological evaluation who underwent HPS-KP (n = 25) and PKP (n = 25) surgeries. The visual analogue scale (VAS) score, Oswestry dysfunction index (ODI), anterior vertebral height (AVH), wedge-shape affected vertebral Cobb angle (WCA), bisegmental Cobb angle (BCA), and complications were evaluated and compared in both groups. Besides, a finite element (FE) model of T11-L2 was constructed. The stress distributions, maximum von Mises stresses of vertebrae and bone cement, and maximum displacement of bone cement were compared and analyzed. The VAS and ODI scores at 3 days, 3 and 6 months, and 1 year after surgery significantly improved in both groups (p < 0.05). The AVH, BCA, and WCA significantly improved initially after the surgery in both groups (p < 0.05). The displacement of M2 was larger than other models, especially in flexion, right bending, and left and right rotation, while that of M6 was the lowest under all conditions. HPS-KP was a safe and effective treatment for KD, effectively relieving pain, restoring vertebral height, and correcting local kyphosis, and it had better biomechanical stability and safety than ordinary single PKP and PKP combined with pediculoplasty in avoiding cement loosening and displacement.