Vertebroplasty Research Articles

Biomechanical Effects of Different Spacing Distributions Between the Cemented Superior Boundary and Surgical Vertebral Superior Endplates After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Three-Dimensional Finite Element Analysis.

Patients with osteoporotic vertebral compression fractures (OVCF) treated with vertebroplasty (PVP) are experiencing an increasing number of problems such as pain recurrence, mainly due to recompression fractures of the operated vertebral body within a certain period of time after the operation, which is closely related to the distribution of intraoperative bone cement. The aim of this study is to investigate the effect of different spacing distributions between the upper boundary of the cement and the upper endplate of the operated vertebra on the biomechanics of the operated vertebra after percutaneous vertebroplasty for OVCF using finite element analysis (FEA). One patient with L1 vertebral body OVCF was selected, and computed tomography (CT) of the thoracolumbar segment was performed. The CT data were extracted to establish an FEA model of the T12-L2 vertebral bodies. Bone cement was injected into the L1 vertebral body. Based on the spacing between the upper boundary of the bone cement and the vertebral body's upper endplates, the model vertebrae were divided into 0, 2, 4, and 6 mm spacing groups, and the human body's upright, flexion-extension, lateral flexion, and rotational positions were simulated. The biomechanical effects of different spacing distributions on the postoperative L1 vertebral body and the injected bone cement were evaluated. In this paper, we found that the Von Mises stress of the L1 vertebrae was the smallest when the spacing between the upper boundary of the bone cement and the vertebral body's upper endplates was 0 mm. The larger the spacing in a certain range between the upper boundary of the bone cement and the vertebral body's upper endplates, the greater the Von Mises stress of the L1 vertebrae. However, in the stress comparison of the injected bone cement, the Von Mises stress of the bone cement was greatest when the spacing between the upper boundary of the bone cement and the upper endplate of the vertebral body was 0 mm; the larger the spacing, the smaller the Von Mises stress. When the contact spacing between the upper boundary of the bone cement and the upper endplate of the vertebral body is 0 mm, it can effectively eliminate and transfer the pressure caused by the load, thus reducing the stress on the cancellous bone and further reducing the risk of vertebral refracture after surgery.

Analysis of the Effect of Bone Cement Distribution Patterns on Surgical Outcomes of Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures

Objective: To evaluate the impact of bone cement distribution patterns on the surgical outcomes of percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF). Methods: Sixty-four patients with OVCF treated at our hospital from January 2022 to December 2023 were included and divided into two groups based on bone cement distribution patterns: the clustered group and the diffuse group. Both groups underwent PVP. We compared the incidence of bone cement leakage, operative time, blood loss, changes in Visual Analog Scale (VAS) pain scores, and Oswestry Disability Index (ODI) scores before and after treatment between the two groups. Results: The number of cases with bone cement leakage was significantly higher in the diffuse group compared to the clustered group (P < 0.05). There were no significant differences between the two groups in terms of volume of bone cement injected, intraoperative blood loss, or surgical time (P > 0.05). Post-treatment, both VAS and ODI scores were lower than pre-treatment scores in both groups, with the diffuse group showing significantly lower scores than the clustered group (P < 0.05). No postoperative adverse complications were observed in either group. Conclusion: PVP is highly effective for treating OVCF. A more uniform distribution of bone cement is associated with a greater reduction in postoperative pain and improved functional outcomes. However, careful attention is needed to prevent bone cement leakage.

Dual-Fluoroscopy vs. Single-Fluoroscopy in Balloon Kyphoplasty: A Study of Efficiency and Safety.

Background: Vertebral compression fractures (VCFs) are the most prevalent type of osteoporotic fractures, often causing significant pain, morbidity, and mortality. Vertebral augmentation procedures like balloon kyphoplasty (BK) are effective in treating VCFs. These procedures are typically performed using a single fluoroscopy machine (SF) for anteroposterior (AP) and lateral views. We have implemented a dual-fluoroscopy (DF) technique to reduce procedure time and radiation exposure. The goal of this study was to determine whether dual-fluoroscopy could optimize surgical efficiency without compromising safety, offering a more effective alternative to traditional single-fluoroscopy methods. Methods: This retrospective study included 126 patients who underwent BK with either SF (n = 74, 58.7%) or DF (n = 52, 41.3%) between 2020 and 2024. We collected data on procedure duration per pedicle (PDPP), radiation exposure (reference air kerma and dose-area product [DAP]), and radiation duration. A sub-analysis of post-learning phase cases was performed. Results: A learning curve was identified for the first 24 cases and 15 cases using the SF technique and DF technique, respectively, which was followed by a stabilization in procedure duration per pedicle (Levene's statistic = 10.623, p = 0.002 for SD difference, p < 0.001 for mean PDPP difference). After the completion of the learning phase for both techniques, the DF group demonstrated a significantly shorter PDPP (11.83 ± 4.3 vs. 14.03 ± 5.57 min, p = 0.049). No significant differences were found in radiation exposure, including radiation duration (p = 0.577), reference air kerma, or DAP. Conclusions: Dual-fluoroscopy significantly reduces procedure time after the learning curve is overcome, improving efficiency without increasing radiation exposure. This technique holds promise for optimizing kyphoplasty workflow and safety, supporting broader clinical adoption.

Is it safe to treat osteoporotic burst thoracolumbar fracture using percutaneous vertebroplasty? A minimum of five-year follow-up study

Percutaneous vertebroplasty for the treatment of osteoporotic burst fractures remains controversial. A previous study has shown that an osteoporotic burst fracture with asymptomatic spinal canal compromise is not a contraindication for percutaneous vertebroplasty. To determine whether these outcomes persist over a long term, we continued to observe patients in their short-term study over a long-term period. Prospective study. Patients with osteoporotic vertebral fractures were classified as Dennis type I and II and AO type A1-A4, and no neurological deficits were observed. Oswestry disability index and visual analog scale (VAS1) for pain were outcome measures. Radiological outcomes were vertebral body height and kyphotic angle. Complications included cement leakage, adjacent fractures, and transition to instrumented fusion. Between June 2015 and December 2016, 96 patients with osteoporotic vertebral fractures who met the inclusion criteria were prospectively enrolled. Preoperative, postoperative, and latest follow-up clinical outcomes were assessed using the Oswestry disability index and VAS. The radiological outcomes included vertebral body height, kyphotic angle, and adjacent fractures. Patients with intractable pain and neurological deficits during the follow-up were indicated for surgical treatment using decompression and instrumented fusion. Fifty-one patients with osteoporotic compression fractures and 45 with osteoporotic burst fractures were included in this study. Mean follow-up duration was 74 months, and posterior vertebral body height, kyphotic wedge angle, and VAS score were not altered during the follow-up period. Three (5.9%) patients in an osteoporotic compression fracture group and three (6.7%) in a osteoporotic burst fracture group developed persistent pain, further collapse, and neurological deficits, and were indicated for surgical treatment. No significant differences were observed in the rates of adjacent fractures. Percentage of patients who required surgical treatment was not significantly different between the groups. Osteoporotic burst fractures with asymptomatic spinal canal compromise treated with percutaneous vertebroplasty are safe and effective for pain management during long-term follow-up.

Towards optimized biopsy use in vertebral compression fractures: integrating risk assessment for better clinical decision-making.

Tissue biopsy is the gold standard for differentiating osteoporotic vertebral compression fractures from malignant lesions. However, the necessity of routine biopsies during percutaneous vertebroplasty and kyphoplasty is debated due to the low malignancy detection rates. This study aims to identify key predictors of positive biopsy outcomes in patients undergoing these procedures, with the goal of refining biopsy selection criteria to enhance diagnostic yield and improve clinical decision-making. We conducted a retrospective cohort study involving 295 patients who underwent percutaneous vertebroplasty and kyphoplasty with biopsy between June and December 2023. Clinical data, including age, gender, fracture aetiology, imaging findings, and biopsy results, were collected. Binary logistic regression analysis was employed to identify significant predictors of positive biopsy outcomes. The biopsy results revealed an overall malignancy rate of 1.01% (3/295). Among the 17 cases with abnormal (positive) biopsy findings, 17.6% were malignant, while the remainder were benign. Significant predictors included age (OR = 0.936), gender (OR = 0.307 for males), fracture aetiology (OR = 5.300 for fractures with no apparent cause), and imaging abnormalities (OR = 8.388). This study underscores the low malignancy detection rate in routine biopsies for vertebral compression fractures, advocating for a more selective approach by reserving biopsies for patients with specific high-risk factors. A targeted biopsy strategy, informed by enhanced pre-operative screening, could improve diagnostic accuracy and treatment outcomes, optimizing clinical management.

Low pelvic incidence as a risk factor for vertebral recollapse after percutaneous vertebroplasty in the thoracolumbar region

Background ContextPercutaneous vertebroplasty (PVP) is an effective procedure for treatment of osteoporotic vertebral compression fractures (OVCFs). Recollapse of the cemented vertebrae is not unusual and the thoracolumbar junction is the most common region. Nevertheless, not all patients suffering from OVCFs in this region develop recollapse after PVP. PurposeThe aim of this study was to investigate possible risk factors related to recollapse of the cemented vertebrae in the thoracolumbar region. Study Design/SettingRetrospective study. Patient SampleA total of 161 patients undergoing PVP. Outcome MeasuresClinical outcomes were assessed using Visual Analog Scale (VAS) scores. Radiographic parameters included pelvic incidence (PI), thoracolumbar kyphosis (TLK), kyphotic angle, compression rate, reduction rate, and occurrence of intravertebral cleft (IVC). MethodsPatients were divided into the recollapse group and control group. Patient characteristics, clinical and radiographic parameters were compared between the two groups. Univariate and multivariate logistic regression were used to evaluate the potential risk factors for recollapse. The correlations between the variables were examined. A receiver operating characteristic curve of PI was constructed to discriminate between patients with and without recollapse. ResultsThere were no significant differences in patient characteristics between the two groups except for bone mineral density (BMD). Occurrence rate of IVC was significantly higher in the recollapse group. VAS scores were significantly decreased after PVP. At last follow-up, they were increased in the recollapse group and maintained in the control group. PI was significantly lower in the recollapse group than in the control group. The univariate logistic regression found four possible risk factors for recollapse, including low PI, IVC, low BMD, and high TLK. Further multivariate logistic regression eliminated high TLK from them. The collinear analysis showed low tolerance and high variance inflation factor for preoperative and postoperative TLK, but not for PI, IVC and BMD. PI was a good predictor of recollapse, and the optimal cut-off value was 43°. The magnitude of preoperative and postoperative TLK was significantly correlated with the value of PI. ConclusionsRecollapse of the cemented vertebrae in the thoracolumbar region was related to low PI, IVC and low BMD. PI less than 43° was a good predictor of recollapse. TLK was dependent on PI and not a risk factor for recollapse. In addition to PVP, patients with low PI, IVC and low BMD may require personalized interventions such as combined internal fixation and trunk orthoses.

A novel unilateral extrapedicular approach applied to percutaneous vertebral augmentation to treat thoracic and lumbar Osteoporotic Vertebral Compression Fracture: a retrospective study

ObjectiveTo design and apply a novel puncture method, named P TO P technique, and to evaluate its efficacy and safety.MethodThe data of patients treated with PVA in medical institution from January 2020 to December 2022 were reviewed and analyzed. The degree of pain relief and recovery from daily activities were evaluated using VAS and LAS scores, and radiological parameters were evaluated using local kyphosis angle and excellent cement distribution. Complications such as cement leakage and recurrent vertebral fractures were also recorded.Results157 patients with thoracolumbar OVCF were successfully treated with novel puncture techniques. All postoperative clinical and radiological parameters significantly decreased in all patients, except for an increase in local kyphosis angle at the last follow-up compared to postoperative. All other above indicators remained statistically significant at the last follow-up compared to postoperative improvement. Except for 2 patients with poor cement distribution, the remaining 155 patients successfully achieved satisfactory results in unilateral puncture and bilateral cement distribution, achieving an excellent rate of 98.73%. In addition, 18 cases (11.46%) of cement leakage occurred during the operation, fortunately none of them were uncomfortable. During the postoperative follow-up period, 4 cases (2.55%) of recurrent fractures occurred. No other serious complications such as neurologic or named vascular injuries occurred.ConclusionThe application of P TO P technology in thoracolumbar OVCF patients is safe and effective. It can not only reduce pain and quickly recover daily activities, but also achieve the perfect effect of unilateral puncture and bilateral cement filling.

Romosozumab Versus Bisphosphonates for preventing subsequent vertebral fractures after Balloon Kyphoplasty: Comparison Using Data from Two Prospective Multicenter Studies

Abstract Preventing subsequent fractures after vertebral augmentation is a critical clinical concern. The purpose of this study was to compare the effect of romosozumab and bisphosphonate administration on the occurrence of subsequent vertebral fractures after balloon kyphoplasty (BKP) and to identify factors associated with the occurrence of subsequent vertebral fractures. The study compared 24 patients who underwent BKP and received romosozumab with 58 control patients who underwent BKP and received bisphosphonates, all within two months of acute osteoporotic vertebral fracture and showing unfavorable MRI prognostic factors. The primary outcome was the occurrence of subsequent fracture, and the secondary outcomes were improvement in back pain visual analog scale (VAS) score. Furthermore, logistic regression analysis was conducted to adjust for confounding factors and assess the effect of osteoporosis treatment type on subsequent vertebral fractures following BKP. Subsequent vertebral fractures occurred in 16 patients in the bisphosphonate group and in one patient in the romosozumab group (P=.02). There were no significant differences between the two groups in VAS scores and their change from preoperatively to 6 months after surgery. The multivariable logistic regression analysis identified the type of osteoporosis treatment as an independent factor associated with the occurrence of subsequent vertebral fractures (Odds ratio, 18.30, P=.02). This prospective, multicenter study demonstrates that romosozumab is more effective than bisphosphonates in preventing subsequent vertebral fractures within six months after BKP. Romosozumab’s superior efficacy in reducing subsequent vertebral fractures may lead to improved long-term outcomes and quality of life, potentially making it a preferred treatment option over bisphosphonates for patients undergoing BKP.

The Risk of Adjacent Vertebral Fracture Following Balloon Kyphoplasty in Patients With Previous Adjacent Vertebral Fracture

The Risk of Adjacent Vertebral Fracture Following Balloon Kyphoplasty in Patients With Previous Adjacent Vertebral Fracture

A biomechanical investigation comparing a novel bone cement bridging screw system with conventional treatment methods for Kummell’s disease

Based on the characteristics of Kummell’s disease (KD) and related anatomical structures of the thoracolumbar spine, a novel bone cement screw system has been designed to effectively avoid the cement loosening and displacement. This experiment aimed to assess the biological effects of the novel bone cement screw system in KD on fresh cadaveric thoracolumbar spine specimens, thereby discussing its potential application value and providing a foundation for clinical implementation. This study employed a total of 50 fresh female adult cadaver specimens. Each specimen underwent extraction of the T12 to L2 segment followed by the creation of an artificial KD model at the L1 segment and subsequent establishment of five distinct types of bone cement repair models. Model A represents the percutaneous vertebroplasty (PVP) model, Model B combines PVP with unilateral percutaneous pediculoplasty (PPP), Model C combines PVP with bilateral PPP, Model D introduces the novel bone cement screw combined with unilateral PVP, and Model E combines the novel screw with bilateral PVP, each group consists of 10 specimens. Subsequently, the six-axis spine robot was employed to execute cement three-dimensional biomechanical strength tests in six directions, including anterior flexion and posterior extension, left and right lateral bending, as well as left and right rotation. The novel bone cement screw, whether used unilaterally or bilaterally in combination with the PVP model, exhibits significantly reduced bone cement mobility and superior biomechanical stability during anterior flexion, posterior extension, left lateral bending, and right lateral bending (P<0.05).No significant differences were observed among the five models under both left and right rotation (P > 0.05).When comparing the novel bone cement screw combined with PVP unilaterally and bilaterally, no statistically significant difference was observed in the stability of bone cement across all six directions of motion (P>0.05). To conclude, this novel bone cement bridging screw system exhibits superior biomechanical stability compared to commonly used treatments. Furthermore, both unilateral and bilateral implementations of the novel bone cement screw system yield without significant differences observed. These findings present a reliable and innovative approach for clinical management of KD.

Enhanced bone cement distribution in percutaneous vertebroplasty using a curved guide wire: a propensity score matching analysis

BackgroundOsteoporotic vertebral compression fractures (OVCF) severely affect the quality of life in the aged population. Percutaneous vertebroplasty (PVP) alleviates pain and stabilizes vertebrae, but suboptimal bone cement distribution can cause complications. Hence, this study aimed to clarify whether a new technique for PVP, using a curved guide wire, enhances the distribution of bone cement and improves clinical outcomes in patients with OVCF.MethodsPatients with single-segment OVCF underwent PVP or curved guide wire percutaneous vertebroplasty (C-PVP). Propensity score matching (PSM) was employed to balanced the baseline characteristics. The primary outcomes were the visual analog scale (VAS) and Oswestry disability index (ODI) scores. The secondary outcomes included assessments of bone cement distribution, bone cement injection volume, radiological parameters, and general clinical results. Additionally, Complications and adverse events were documented.ResultsAfter PSM analysis, each group comprised 54 patients, which significantly reduced baseline differences. The C-PVP group showed better clinical outcomes compared to the traditional PVP group. One month after surgery, the C-PVP group had significantly lower VAS and ODI scores (p < 0.001). These improvements persisted at six months and the final follow-up. Additionally, bone cement distribution scores were better (p < 0.001), injection volume was higher (p = 0.03), leakage was less frequent (p = 0.02), and adjacent vertebral fractures occurred less frequently (p = 0.04) in the C-PVP group. Radiological parameters and overall clinical outcomes revealed no significant differences between the two groups.ConclusionThe use of curved guide wire in PVP significantly improves bone cement distribution and injection volume, resulting in better clinical efficacy in patients with OVCF.

Multi-level Percutaneous Vertebroplasty for Multiple Spinal Metastases With Asymptomatic Epidural Compression: A Case-Based Example of Minimally Invasive Patient Management

Multi-level Percutaneous Vertebroplasty for Multiple Spinal Metastases With Asymptomatic Epidural Compression: A Case-Based Example of Minimally Invasive Patient Management

Clinical Effect of Percutaneous Kyphoplasty and Percutaneous Vertebroplasty in Managing Osteoporotic Vertebral Compression Fractures: A Single-Center Propensity Score-Matched Study.

This study aims to evaluate the clinical effectiveness of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in managing osteoporotic vertebral compression fractures (OVCFs). This retrospective study included 268 elderly OVCF individuals, and 144 individuals were selected after propensity score matching. General patient information, perioperative conditions, vertebral height and Cobb angle, lumbar spinal function, degree of pain, incidence of complications, and fracture recurrence rates were compared and analyzed for the patients. The PKP group exhibited longer surgical duration, greater intraoperative blood loss, and more frequent X-ray fluoroscopy during the perioperative period compared to the PVP group (p < 0.05). However, there was no significant difference in the length of hospital stay between the two groups. Furthermore, PKP surgery significantly improved vertebral height, corrected spinal posture, and enhanced lumbar spinal function while mitigating pain levels within the 12-month postoperative period (p < 0.05). Additionally, the PKP group showed substantially lower rates of bone cement leakage, nerve injury, and fracture recurrence than the PVP group (p < 0.05). Compared to PVP, PKP demonstrates better clinical effectiveness with lower incidence of complications in managing OVCF. However, surgical time and intraoperative trauma should be considered.

Clinico-Radiological Outcome of Percutaneous Vertebroplasty in Dorso-Lumbar Osteoporotic Vertebral Compression Fractures (OVCFs)

Introduction: Vertebral compression fractures (VCFs) are the most common complication of osteoporosis where Percutaneous vertebroplasty is thought to immediately improve the pain and disability status via stabilization and reinforcement of the fractured body with polymethylmethacrylate (PMMA) injection. Purpose: To evaluate the clinical and radiological outcome of Percutaneous vertebroplasty in osteoporotic VCFs in Dorso-Lumbar (DL) Spine. Materials and methods: It is a prospective study carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU) and different private hospitals in Dhaka, from January 2010 to March 2023. Total number of patients was 121 i.e., 92 female 29 male patients (167 treated vertebrae), age ranged from 65-85 years with mean age 73.40 years. 10 cases at D10 and D11 each, 26 cases at D12, 21 cases at L1, 15 cases at L2, 16 cases at D12-L1, 03 case at D9,12, 05 cases at D10,11, 07 cases at L1,2 and 03 case at D9,12L1 and 05 cases at D12,L1,2. Follow up ranged from 24 to 36 months and outcome assessed regarding neurological status (Radiculopathy and Myelopathy), pain [Visual Analogue Score (VAS)] and disability [Oswestry Disability Index (ODI) questionnaire]. Radiological assessment of the treated spine was done to identify any vertebral height gain (McKiernan method), kyphosis correction (Cobb`s method). Results: The mean age was 73.40 ± 03.75 years. 74(60.97%) patients were in 65-74 years age group. 105(63.41%) cases had single vertebral level, 49(29.26%) with 02 levels and 12(07.32%) with 03 levels involvement. D12 (n=53, 31.17%) and L1 (n=52, 31.13%) were most frequent. The age, sex, occupation, and the level of involvement had no significant difference (p&gt;0.05, chi-squared test). VAS for pain had significantly improvement (p&lt;0.05, paired t test) from preoperative 08.50±0.50 to 03.50±0.30 postoperatively and 02.80± 0.50 at 1 year. The preoperative ODI 71.11±09.69 improved significantly (p&lt;0.05, paired t test) to 17.34±04.11 postoperatively and 09.76± 04.83% at 1 year. The kyphotic angle was corrected to 05°±02.50° at the 12 months follow up radiograph. One level (02.30%) had cement leakage which was evident on postoperative X-ray but was asymptomatic even on the last follow up. Conclusion: Percutaneous Vertebroplasty is a significantly effective technique for immediate and short-term pain relief, disability status improvement in Vertebral Compression Fractures (VCFs) with satisfactory radiological outcome in DL spine.

Effect of anti-osteoporotic drugs in reducing risk of refracture after percutaneous vertebroplasty

Purpose: To investigate the effectiveness of anti-osteoporotic drugs in lowering risk of refracture after percutaneous vertebroplasty. Methods: The study involved 80 patients who underwent percutaneous vertebroplasty in The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China between August 2020 and July 2022. The study group (n = 40) received postoperative rehabilitation in addition to anti-osteoporotic drugs for 6 months), while the control group (n = 40) received routine postoperative rehabilitation from the time of surgery completion to 3 months postoperative. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores were compared before surgery, 3 days, 3 months, and 6 months postoperative. Changes in the middle height of the vertebral body and bone density T-score of the surgical and adjacent vertebrae before and at end of follow-up, and refracture rates were compared.Results: The study group showed significantly lower VAS and ODI scores at 3 and 6 months after surgery compared to control group (p &lt; 0.05). Both groups showed significant increase in vertebral body height before surgery (p &lt; 0.05), with no significant difference at last follow-up (p &gt; 0.05). Also, the study group showed significant increase in bone density in the surgical and adjacent vertebrae compared to control group at last follow-up (p &lt; 0.05). Refracture rate was significantly lower in study group than in the control group (p &lt; 0.05). Conclusion: Administering anti-osteoporotic drugs after percutaneous vertebroplasty significantly alleviates pain, improves vertebral bone density, and reduces risk of refracture. However, a largesample, multicenter, randomized prospective study to validate these findings is recommended.

Percutaneous kyphoplasty combined with pediculoplasty (PKCPP) augments and internally fixates the severe osteoporotic vertebral fractures: a retrospective comparative study.

Vertebral augmentation (VA) has emerged as a satisfactory and minimally invasive surgical approach for severe osteoporotic vertebral fractures (OVFs). However, treating severe OVFs with advanced collapse, burst morphology with MC injury, posterior wall retropulsion, high degree of osseous fragmentation, pediculo-somatic junction fracture, and large vacuum cleft presents significant challenges. This study aimed to evaluate the effectiveness of percutaneous kyphoplasty combined with pediculoplasty (PKCPP) in reducing refracture, preventing further collapse and bone cement displacement, reconstructing vertebral body (VB) stability, and providing internal fixation of the anterior column (AC), middle column (MC), and the bilateral pedicles. The current study was designed as a retrospective review of clinical and radiologic parameters. From July 2018 to September 2021, ninety-six patients with severe OVFs and without neurological deficit were treated either with simple percutaneous kyphoplasty (simple PKP group, n = 54) or with percutaneous kyphoplasty combined with pediculoplasty (PKCPP group, n = 42). All patients were followed up for at least 1year, and clinical and radiological outcomes were assessed. Surgery duration and bone cement volume were compared between the two groups, as well as analgesic dosage and hospital stay. Anterior wall height (AWH), posterior wall height (PWH), and Cobb angle (CA) were measured and analyzed before and after surgery. The simple PKP group had significantly shorter surgery duration and lower bone cement volume compared to the PKCPP group (P < 0.05). Conversely, the simple PKP group had significantly higher analgesic dosage and longer hospital stay than the PKCPP group (P < 0.05). Both groups showed significant improvements in AWH, PWH, and CA after surgery (P < 0.05). At the final follow-up, the PWH in the simple PKP group was significantly lower than the preoperative measurement (P < 0.05), and the difference in PWH between the two groups was statistically significant (P > 0.05). Moreover, both groups demonstrated a significant reduction in CA after surgery, with the PKCPP group showing a greater reduction compared to the simple PKP group throughout the postoperative period to the final follow-up (P < 0.05). VAS and ODI scores significantly decreased in both groups after surgery (P < 0.05), with no significant difference between the groups at the final follow-up (P > 0.05). However, the PKCPP group achieved better VAS scores than the simple PKP group at postoperative 1day, 1month, and 3months (P < 0.05), and the ODI in the PKCPP group was lower than the simple PKP group at 1month after surgery (P < 0.05). Furthermore, the overall complication rate in the PKCPP group was significantly lower than that in the simple PKP group (P < 0.05). If performed by appropriately trained surgeons, both PKP and PKCPP are safe and effective treatments for patients with severe OVFs. However, PKCPP offers additional benefits in the setting of bothersome fractures, including rapid pain relief, improved spinal stability, satisfactory restoration of vertebral body height, and better correction of kyphotic deformity. These promising results have been tested in a single center but require further confirmation in multiple centers.

Age- and gender-dependent impact of titanium vertebral augmentation implants combined with cementing on subsequent vertebral fracture incidence: A comparative study with cementing alone.

To compare vertebroplasty (VP) and kyphoplasty (KP) with a titanium implantable vertebral augmentation device (TIVAD) in symptomatic subsequent vertebral compression fracture (SVCF) incidence among osteoporotic vertebral compression fracture (OVCF) patients stratified by age and sex. This retrospective cohort study involved OVCF patients aged ≥ 50, who underwent KP with TIVAD or VP in our hospital from 2014 to 2019. Subgroup analysis was conducted to evaluate the efficacy of KP with TIVAD and VP in patients stratified by age and sex. The study included 472 patients (VP group: 303; TIVAD group: 169). SVCF incidence rates were 15.2% for VP group and 14.8% for TIVAD group (P = 0.87). In subgroup analysis, TIVAD group showed significantly lower SVCF incidence than VP group in women aged 50-70 (2.1% vs 14.3%; P = 0.03) and had significantly higher SVCF incidence than VP group in women aged > 70 (24.2% vs 13.1%; P = 0.02). In men, adjacent SVCF incidence was significantly lower in TIVAD group than VP group (0% vs 14.1%; P = 0.03). Compared to VP, TIVAD is associated with lower symptomatic SVCF rate in men and younger women aged 50-70 but not in older women aged > 70. Age and gender may influence SVCF incidence. Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Clinical effect analysis of vertebroplasty with high viscosity and standard bone cement for Kummell disease.

This study aims to observe and compare the effects of high-viscosity bone cement versus standard bone cement on the postoperative outcomes of percutaneous vertebroplasty (PVP) in patients with Kummell disease. A retrospective analysis was conducted on 135 patients with Kummell disease who underwent PVP between January 2019 and May 2023. Patients were divided into 2 groups: the high-viscosity group (group H, 63 cases) received high-viscosity bone cement during surgery, while the standard group (group S, 72 cases) received standard bone cement. Surgery duration, bone cement volume, bone cement leakage rate, as well as preoperative and postoperative evaluations using the Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), anterior vertebral height, and kyphotic Cobb angle were recorded and compared between the 2 groups. In the group H, significant improvements were observed in VAS scores, ODI, anterior vertebral height, and Cobb angle at 24 hours, 3 months, and 1 year postoperatively compared to preoperative values (P < .01). In the group S, VAS scores and ODI showed significant improvement at 24 hours, 3 months, and 1 year postoperatively (P < .01), but there were no significant differences in anterior vertebral height or Cobb angle compared to preoperative values (P > .05). Comparatively, the group H demonstrated superior outcomes in terms of bone cement volume, leakage rate, recovery of anterior vertebral height, and Cobb angle correction at 24 hours, 3 months, and 1 year postoperatively (P < .05). However, there were no significant differences between the 2 groups in terms of surgery duration, VAS scores, and ODI at the same time points (P > .05). PVP is an effective treatment for Kummell disease, providing significant pain relief and improved spinal function. The use of high-viscosity bone cement allows for greater volume infusion, better restoration of vertebral height, and correction of deformities, while also reducing the risk of cement leakage.

Application of Low-Temperature Ice Saline Bone Cement in Percutaneous Vertebroplasty

Percutaneous vertebroplasty uses the traditional method of bone cement filler to inject bone cement, which is easy to solidify, we have found a new method to delay the solidification of bone cement: low temperature ice saline bone cement, which compares the advantages of the new method and the traditional method of injecting bone cement. 82 cases of osteoporotic vertebral compresion fracture(OVCF) were divided into two groups by retrospective study method, 40 patients in group A were treated with the traditional method, 42 patients in group B were treated with the new method.The leakage rate of bone cement, postoperative VAS score, amount of bone cement in each vertebral body, operation time of bone cement, and number of bone cement fillers used were compared between the two groups. There was no significant difference in the bone cement leakage rate, postoperative VAS score, the amount of bone cement in each vertebral body and the number of bone cement fillers used between the two groups; the operation time of bone cement in two groups was statistically significant, and the operation time in group B was significantly longer than that in group A. Low temperature ice saline water bone cement has significant advantages in multiple vertebral fractures, relatively large amount of bone cement injected into each vertebral body and long operation time, which is more suitable for beginners.

Interventional radiology procedures for metastatic spine tumors

ObjectiveInterventional radiology procedures can offer locoregional tumor control and palliative options for patients with metastatic disease to spine to relieve pain, to delay neurologic deficits, and to improve quality of life and daily function. FindingsMultiple thermal energies for percutaneous ablation of metastases to the spine exist and are chosen according to tumor characteristics, volume, and location. Vertebral augmentation is most often combined with ablation for structural stability. Intravascular embolization of metastases provides tumor palliative or presurgical devascularization. ConclusionAblation, vertebral augmentation, and intravascular embolization are efficacious minimally invasive options for the management of spinal tumors.