Local Kyphosis Angle Research Articles

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.

Bone density as a risk of early loss of correction after percutaneous posterior spinal fixation for traumatic thoracolumbar fracture: a study on the usefulness of Hounsfield unit values on computed tomography scan.

Vertebral Hounsfield unit values on computed tomography scan (CT values) have been found to be correlated with bone density measured using dual-energy X-ray absorptiometry. We hypothesized that low preoperative CT values are risk factors for early loss of correction after percutaneous posterior spinal fixation (PPSF). This study aimed to evaluate the usefulness of measuring preoperative CT values. In total, 104 patients underwent PPSF due to traumatic thoracolumbar fracture. Among them, 53 with a range of fixation that was within two vertebrae above and below the fractured vertebra were selected. CT values were measured preoperatively from the most cephalad vertebrae on the fixed vertebrae. Vertebral wedge angle (VWA) and local kyphosis angle (LKA) were measured before and after surgery. participants were classified into progression (P) and nonprogression (NP) groups. The P group comprised patients with LKA progressing > 10° from the immediate postoperative period to 3months postoperatively. Meanwhile, the NP group included patients without progression. Eight (15.1%) patients were included in the P group. The vertebral CT values were 102.2 ± 36.7 in the P group and 162.4 ± 59.7 in the NP group (p < 0.01). The pedicle CT values were 114.4 ± 45.9 in the P group and 170.8 ± 72.3 in the NP group (p < 0.05). At 2weeks postoperatively, VWA and LKA of the P group progressed to 9.8° ± 7.0° and 10.9° ± 7.6°, respectively. CT values can predict progressive loss of correction after PPSF.

Percutaneous functional spinal unit cementoplasty versus percutaneous kyphoplasty for severe osteoporotic vertebral compression fracture complicated with endplate-disc complex injury: A retrospective case-control study.

Severe osteoporotic vertebral compression fracture (SOVCF) is frequently complicated by endplatedisc complex (EDC) injury. While percutaneous kyphoplasty (PKP) can offer rapid analgesia and facilitate early activity, it does not restore vertebral height and may result in intervertebral leakage and untreated EDC injury. This study aimed to evaluate the clinical outcomes of percutaneous functional spinal unit cementoplasty (PFSUP) for SOVCF complicated by EDC injury and compare its clinical and imaging outcomes with PKP. This was a retrospective case-control study. Patients with SOVCF complicated with EDC injury between January 1, 2018, and December 31, 2019, were recruited and assigned to the PKP group and PFSUP group based on their treatment procedures Back pain was evaluated using the visual analog scale (VAS) and daily life activities were assessed using the Oswestry disability index (ODI). X-rays were employed to observe the presence and location of cement leakage, as well as to measure the sagittal vertical axis (SVA) and local kyphosis angle (LKA). Loss of correction was calculated by subtracting the LKA after surgery from that at the final follow-up visit Subsequent vertebral fracture (SVF) was confirmed using the Genant semi-quantitative method and/or MRI. A total of 64 patients were included in this study. Among them 41 cases were assigned to the PKP group (28 females, 74.8 years on average), while the remaining 23 cases were assigned to the PFSUP group (15 females, 76.3 years on average). All surgical interventions were successfully completed without major complications. Compared to the PKP group, the PFSUP group had longer operation time (70.28 ± 11.44 vs 44.5 ± 10.12, P< 0.001) higher frequencies of radiation exposure (97.6 ± 19.85 vs 38.6 ± 9.53, P< 0.001), and a lower cement leakage rate (26.1% vs. 41.5%, P< 0.001). One day after surgery and at the final follow-up the PFSUP group had lower VAS and ODI scores, as well as lower LKA and Sva values compared with the PKP group (all P< .001). At the final follow-up visit, the PFSUP group demonstrated a lower loss of correction (4.38 ± 2.71 vs. 10.19 ± 3.41 P< 0.001) and a lower SVF rate compared to the PKP group (21.7% vs. 31.7%, P< 0.001). PFSUP outperformed PKP in alleviating pain restoring and maintaining sagittal balance, and lowering the incidence of cement leakage and SVF for SOVCF with EDC injury However, PFSUP was associated with longer operation time and high radiation exposure frequencies.

Related factors of severe osteoporotic vertebral compression fracture and clinical outcomes of percutaneous kyphoplasty: A retrospective study.

Osteoporosis is the most common disease in postmenopausal women and the elderly, which can lead to vertebral compression fracture. To investigate the related factors of severe osteoporotic vertebral compression fracture (SOVCF) and evaluate the long-term outcomes of percutaneous kyphoplasty (PKP) for treating SOVCF through comparison with mild OVCF (MOVCF). From September 2015 to March 2019, 294 osteoporotic vertebral compression fracture (OVCF) patients treated with PKP were analyzed. Compression of the anterior margin of the fractured vertebral body beyond 2/3 of the original height was defined as SOVCF. Baseline data, clinical and imaging findings before and after surgery and at the last follow-up were recorded. Numerical Rating Scale (NRS) was used to evaluate low back pain, the Oswestry Disability Index (ODI) was used to evaluate activity of daily life. Anterior vertebral height (AVH) and local kyphosis angle (LKA) was used to evaluate radiographic outcomes. During the follow-up, patients with recurrent back pain were examined by MRI to identify new fractures and the incidence of adjacent vertebral fracture (AVF) was recorded. Age, sex, body mass index (BMI), dual energy X-ray absorptiometry based T value, duration of symptom, history of trauma, steroid use, and fracture site were collected for univariate logistic regression analysis Variables with a P-value of less than 0.05 were then included in multivariate analysis to determine the related factors for SOVCF. Logistic regression analysis indicated that longer duration of symptom (OR = 1.109, 95%CI: 1.038-1.185, P= 0.002), lower T value (OR = 0.332, 95%CI: 0.139-0.763, P= 0.001), and steroid use (OR = 31.294, 95%CI: 1.020-960.449, P= 0.049) were related factors of SOVCF. Compared with the MOVCF group, the SOVCF group had longer operation time (57.3 ± 13.51 minutes vs 44.9 ± 8.13 minutes, P< 0.001), more radiation exposure (39.9 ± 7.98 times vs 25.5 ± 4.01 times, P< 0.001), and higher cement leakage rate (55.81% vs 18.73%, P< 0.001). At the last follow-up, the SOVCF group had higher NRS (2.28 ± 0.85 vs 1.30 ± 0.71, P< 0.001), and ODI (16.23 ± 4.43 vs 12.88 ± 3.34, P< 0.001). After operation and at the last follow-up, the SOVCF group had higher LKA and lower AVH (all P< 0.05). The AVF rate at the last follow-up was higher in the SOVCF group at the last follow-up (4.78% vs 18.60%, P< 0.001). Lower T value, longer duration of disease, and steroid use were related factors of SOVCF. Compared with MOVCF, PKP for SOVCF had longer operation time, more radiation exposure, and higher cement leakage rate, and the long-term outcomes were worsen.

Investigation of the Usefulness of Implants With Locking Mechanisms for Diffuse Idiopathic Skeletal Hyperostosis (DISH)-Induced Thoracic and Lumbar Fractures in Patients Operated in the Prone Position.

Background Diffuse idiopathic skeletal hyperostosis (DISH) is a disease that causes bone growth in the spine and musculoskeletal system, and even minor trauma can cause fractures that often require surgery. DISH-induced fractures show a tendency for bone loss when operated in the prone position, which can lead to poor fusion and implant failure; therefore, surgery in the lateral recumbent position is often recommended. However, inserting a pedicle screw (PS) in the lateral recumbent position is technically difficult. This study examined the effectiveness of the repair and fixation of thoracic and lumbar spine fractures using implants with locking mechanisms in the prone position in patients with DISH. Methods We retrospectively analyzed the data from 11 patients (six males and five females; mean age: 87 years) who underwent surgery for thoracic and lumbar fractures caused by DISH between December 2023 and June 2024. Surgery was performed in the prone position using PSs or transdiscal screws (TSDs) for DISH. Ennovate® implants manufactured by B-BRAUN were used. The fixed range was three above-three below for PSs and two above-two below for TSDs. The evaluation parameters were the height/level of injury, operative time, blood loss, local kyphosis angle, anterior wall height ratio, and complications. The local kyphosis angle was measured as the angle between the upper and lower endplates of the fractured vertebrae. The ratio of the anterior wall height was evaluated. Results The average operative time was 87 min (52-172 min), and the average blood loss was 40ml (10-140 ml). The preoperative and postoperative local kyphosis angle was -8.7° and -2.4°, respectively, and the average local kyphosis angle improvement was 6.3° (0.1-14°). The preoperative and postoperative anterior wall height ratio was 132% and 110%, respectively, and the average anterior wall height ratio improvement was 22% (2-82%). No complications, such as screw deviation, implant loosening, loss of correction, or skin problems, were observed. Conclusion This study demonstrated that DISH-induced thoracic and lumbar spine fractures could be repaired and fixed using implants with locking mechanisms in the prone position. The prone position is familiar to spine surgeons and is considered safe. Additionally, screw migration may occur due to decreased bone density in the vertebral bodies with DISH; in such cases, it would be better to fix the screw without forcing it to be repositioned.

Surgical Outcomes of Adults with Spinal Caries from 1992 to 2019: A Single-Center Study-Risk Factors for the Progression of Kyphosis after Anterior Spinal Fixation Reveal Cases Needing Additional Posterior Instrumentation.

Background: This study aims to investigate the postoperative improvement of paralysis, fusion rate and risk factors for kyphosis progression in adults affected with spinal caries. Methods: Overall, 134 patients with spinal caries from the thoracic to lumbar spine from 1992 to 2021 were included in this study. Data concerning the affected level (thoracic, thoracolumbar, lumbar, and lumbosacral), bone fusion rate, and progression of the postoperative local kyphosis angle were collected. The risk factors for the progression of local kyphosis angle after anterior spinal fixation (ASF) were determined using linear regression analysis. Results: Preoperatively, the degree of spinal cord paralysis was D and E on Frankel classification. Improvement of paralysis was good with surgery, especially from C, D. The overall bone fusion rate was 83.2%. The only factor influencing the progression of local kyphosis angle after ASF was the level of the affected vertebra. Progression of kyphosis angle after ASF was very advanced in the thoracolumbar transition area. Conclusions: Surgical improvement in paraplegia and the fusion rate of ASF with only grafted bone was good. However, in patients affected in the thoracolumbar spine region, posterior instrumentation is desirable because of local kyphosis progression risk after surgery.

Surgical Treatment Outcomes of Anterior-Only Correction and Reconstruction for Severe Cervical Kyphotic Deformity with Neurofibromatosis-1: A Retrospective Study with a 5-Year Follow-Up.

Currently, anterior-only (AO), posterior-only, and combined anterior-posterior spinal fusions are common strategies for treating cervical kyphosis in patients with neurofibromatosis-1 NF-1. Nevertheless, the choice of surgical strategy remains a topic of controversy. The aim of our study is to evaluate the safety and effectiveness of anterior decompression and spinal reconstruction for the treatment of cervical kyphosis in patients with NF-1. Twelve patients with NF-1-associated cervical kyphotic deformity were reviewed retrospectively between January 2010 and April 2020. All patients underwent AO correction and reconstruction. The X-ray was followed up in all these patients to assess the preoperative and postoperative local kyphosis angle (LKA), the global kyphosis angle (GKA), the sagittal vertical axis, and the T1 slope. The visual analog scale score, Japanese Orthopedic Association (JOA) score, and neck disability index (NDI) score were used to evaluate the improvement inclinical symptoms. The results of the difference in improvement from preoperatively to the final follow-up assessment were assessed using a paired t-test or Mann-Whitney U-test. The LKA and GKA decreased from the preoperative average of 64.42 (range, 38-86) and 35.50 (range, 10-81) to an average of 16.83 (range, -2 to 46) and 4.25 (range, -22 to 39) postoperatively, respectively. The average correction rates of the LKA and GKA were 76.11% and 111.97%, respectively. All patients had achieved satisfactory relief of neurological symptoms (p < 0.01). JOA scores were improved from 10.42 (range, 8-16) preoperatively to 15.25 (range, 11-18) at final follow-up (p < 0.01). NDI scores were decreased from an average of 23.25 (range, 16-34) preoperatively to an average of 7.08 (range, 3-15) at the final follow-up (p < 0.01). Anterior-only correction and reconstruction is a safe and effective method for correcting cervical kyphosis in NF-1 patients. In fixed cervical kyphosis cases, preoperative skull traction should also be considered.

Percutaneous kyphoplasty through unilateral puncture on the convex side for the treatment of painful osteoporotic vertebral compression fracture with scoliosis

PurposeTo assess the clinical safety, accuracy, and efficacy of percutaneous kyphoplasty (PKP) surgery using an enhanced method of unilateral puncture on the convex side for the treatment of painful osteoporotic vertebral compression fractures (P-OVCF) with scoliosis.MethodsClinical and radiographic data of P-OVCF patients with scoliosis who underwent PKP via unilateral puncture on the convex side from January 2018 to December 2021 were retrospectively analyzed. This technique’s detailed surgical steps and tips were described. The local kyphosis angle (LKA), scoliosis Cobb angle (SCA), and local scoliosis Cobb angle (LSCA) were measured using X-ray and compared at pre-operation, post-operation, and the last follow-up. The width of pedicle (POW), inner inclination angle (IIA), lateral distance (LD), and puncture course length (PCL) were measured on the axial computed tomography image and compared between two sides. Postoperative computed tomography was employed to evaluate the condition of cement distribution and puncture. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back pain (BP).ResultsThirty-six patients, 23 women and 13 men, with an average age of 76.31 ± 6.28 years were monitored for 17.69 ± 4.70 months. The median surgical duration of single vertebrae was 35 min. The volume of bone cement for single vertebrae was 3.81 ± 0.87 ml and the proportion of sufficient cement distribution of the patients was 97.22. LKA was considerably improved from pre-operation to post-operation and sustained at the last follow-up. SCA and LSCA were not significantly modified between these three-time points. IIA, PCL, and LD were lower on the convex side than on the concave side. POW was considerably wider on the convex side. The ODI and VAS-BP scores were significantly improved after surgery and sustained during the follow-up.ConclusionsCombining with the proper assessment of the pre-injured life status of patients, PKP surgery using unilateral puncture on the convex side for the treatment of P-OVCF with scoliosis can achieve safe, excellent clinical, and radiographic outcomes.

Posterior vertebral column resection: Exploring practical uses in clinical settings.

The purpose of this study was to present our experience in patients who had been treated with posterior vertebral column resection (PVCR) for various spinal deformities. Thirty-seven patients who performed PVCR between 2015 and 2018 were evaluated retrospectively. The mean follow-up period was 24 months (range: 12-50 months). The demographic data of the patients, mean blood loss, amount of blood replacement, duration of operation, intensive care and hospitalization period, PVCR level, instrumentation level, amount of preoperative curvature, amount of postoperative curvature improvement, preoperative and postoperative neurological status, and complications were examined. Angular measurements were performed on X-ray. The mean age of the patients was 37.5 years (range: 3-80 years). PVCR was applied to patients due to different pathologies (congenital, tumor metastasis, posttraumatic kyphosis, revision scoliosis, and infection). The mean operation time was 445.5 min (260-720) with an average blood loss of 1903 ml (400-7000 ml). It was observed that the average local kyphosis angle decreased from 67.65° to 7.42° in 26 patients who were operated for advanced deformity (P < 0.001). When these values were compared in all 34 patients, the preoperative angle value decreased from 55.1° to 3.5° (P < 0.001) and decreased from 70° to 0° in 13 congenital kyphosis patients. PVCR is an effective method for correcting severe spinal deformities and can be used to correct curvature in different patient groups. Level 3.

Transpedicular Intravertebral Cage Augmentation Using Expandable Cage in Kummell Disease: Technical Note and Case Series

ObjectiveTo demonstrate the surgical techniques for transpedicular intravertebral cage augmentation (TPICA) using an expandable cage for Kummell disease, which requires posterior surgical stabilization, and provide the preliminary surgical outcomes. MethodsSix consecutive patients undergoing TPICA surgery using an expandable cage with a minimum 6-month follow-up were evaluated. Radiographic analysis to evaluate the local kyphosis angle (LKA), restoration ratio of anterior vertebral height (RAVH) of the index vertebra, and clinical outcomes including the Oswestry Disability Index (ODI), EuroQol 5-dimension instrument (EQ-5D), and visual analog scale (VAS) for back and leg pain, were compared between the preoperative and final follow-ups. ResultsAll patients showed improvements in all clinical outcomes and were able to walk independently without support at the last follow-up. In radiographic evaluation, the mean preoperative RAVH was 41.2 ± 15.6%, which increased postoperatively to 70.3 ± 20.5% (1.70 times) and 62.4 ± 20.0% at the last follow-up (1.51 times). The mean preoperative LKA was 10.5 ± 14.8 and was corrected to 6.0 ± 10.0 at the last follow-up. A slight loss of correction was observed between the postoperative period and the last follow-up; however, there was no clinical significance. ConclusionsExpandable cages in TPICA may allow easier surgical manipulation for cage insertion around the pedicle entrance, minimizing damage to the fractured vertebral body's endplates while achieving satisfactory height restoration compared to static cages, and may also provide wider indications for TPICA surgery.

Comparison of the clinical effect of unilateral transverse process extrapedicular and bilateral transpedicular percutaneous kyphoplasty for thoracolumbar osteoporotic vertebral compression fracture.

Osteoporosis vertebral compression fractures (OVCF) are common with the aging process. This study aimed to compare the effects of unilateral transverse process extrapedicular (UEPKP) and bilateral transpedicular percutaneous kyphoplasty (BTPKP) for patients with thoracolumbar OVCF. Data from 136 patients with OVCF treated with single-level PKP in our hospital between May 2019 and April 2021 were studied. Patients were grouped based on surgical procedure: there were 62 patients in the UEPKP group and 74 in the BTPKP group. All clinical and radiological data were collected from medical records. Clinical outcomes, including visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores of the lumbar spine, were evaluated preoperatively, postoperatively, and at the follow-up visit. The radiological evaluations (anterior vertebral height rate and local kyphosis angle) and complications were also collected. All patients had successfully improved after surgery. In the UEPKP group, patients showed a significantly shorter operating time and lower fluoroscopy frequency than patients in the BTPKP group (p < 0.05). However, a significantly better distribution score and cement volume were found in the BTPKP group (p < 0.05). The UEPKP group achieved a significantly better VAS score (0.6 ± 0.5 vs. 0.9 ± 0.8) and ODI (24.7 ± 3.1 vs. 27.5 ± 1.8) at the final follow-up visit than the BTPKP group (p < 0.05). The UEPKP group showed significantly worse radiological outcomes (anterior height rate and local kyphosis angle) at the 6- and 12-month follow-ups (p < 0.05). As for complications, the UEPKP group showed significantly fewer facet joint violations and intraspinal leakages (p < 0.05). UEPKP could be a safe and effective alternative procedure for patients with thoracolumbar osteoporotic vertebral compression fracture, which possesses an apparent advantage in reducing intraspinal leakage and facet joint violation over BTPKP.

A reduction method for anterior opening displacement in thoracolumbarvertebral fractures with diffuse idiopathic skeletal hyperostosis using the skull clamp-assisted position.

Diffuse idiopathic skeletal hyperostosis (DISH) frequently occurs in the spine, resulting in unstable fractures. Treating thoracolumbar fractures in patients with DISH is often difficult because the anterior opening of the vertebral body is exacerbated by dislocation in the prone position, making reduction difficult. In this study, we introduced a novel skull clamp-assisted positioning (SAP) technique. The patient is placed in a supine position with a skull clamp used in cervical spine surgery before surgery to prevent the progression of dislocation and to restore the patient's position. Using this method, the mean difference in local kyphosis angle improved from -2.9 (±8.4)° preoperatively to 10.9 (±7.7)° postoperatively. Furthermore, posterior displacement decreased from a preoperative mean of 5.5 (±4.3) mm to 0.3 (±0.7) mm postoperatively. Complications such as neurological sequelae, implant fracture, and surgical site infection were not observed through one year of postoperative follow-up. SAP may decrease invasiveness and complications. Longer-term studies and larger sample sizes are needed to establish long-term efficacy and benefits.

The Effectiveness of Vertebral Height Restoration Based on the Vertebroplasty Procedure Used to Treat Osteoporotic Vertebral Fractures.

Whether the use of a balloon or stent in vertebroplasty for vertebral fractures, such as balloon kyphoplasty (BKP) or vertebral body stenting (VBS), actually contributes to the restoration of postoperative vertebral height is unclear. The aim of the current study was to compare the effectiveness of percutaneous vertebroplasty (PVP), BKP, and VBS in the correction of collapsed vertebrae in patients with painful vertebral fractures. The cases studied involved 34 vertebrae in 28 patients treated with PVP, 43 vertebrae in 38 patients treated with BKP, and 20 vertebrae in 20 patients treated with VBS at Izinkai Takeda General Hospital. Changes in the vertebral height and local kyphosis angle were measured based on standing lumbar radiographs before and after surgery and were compared among the treatment groups. There were no differences in changes in the height of the anterior wall, middle body, or posterior wall of the treated vertebrae among the 3 treatment groups. The same was true for changes in the local kyphosis angle. The effectiveness of vertebral height restoration depended heavily upon preoperative vertebral instability in all the treatment groups. Correction loss due to balloon deflation effect or balloon sinking was noted with VBS or BKP. BKP and VBS have the advantage of reducing the risk of extravertebral leakage of injected bone cement, but they have a disadvantage in that they are no more effective than PVP in restoring collapsed vertebrae despite the use of a balloon or metal stent.

Percutaneous Functional Spinal Unit Cementoplasty versus Posterior Spinal Fixation with Vertebroplasty for Symptomatic Chronic Osteoporotic Vertebral Fractures: A Retrospective Study with a 2-Year Follow up

Purpose To compare the clinical efficacy of percutaneous functional spinal unit cementoplasty (PFSUP) and posterior spinal fixation combined with vertebroplasty (PSF + VP) for the treatment of symptomatic chronic osteoporotic vertebral fractures (SCOVFs). Method Thirty-one patients with SCOVFs were included in this retrospective study and divided into PFSUP (n = 14) and PSF + VP (n = 17) groups. Visual analog scores (VAS) and Oswestry Disability Index (ODI) were recorded before and after surgery and at the last follow-up. Besides, the local kyphosis angle (LKA) and sagittal vertical axis (SVA) were measured. The operation duration, number of X-ray exposures, amount of blood loss, bed rest duration, hospitalization duration, and presence of complications were recorded. Result The VAS, ODI, LKA, and SVA after surgery and at the last follow-up were significantly improved in both groups compared to preoperative measurements. The PFSUP group experienced shorter operation duration (78.2 ± 13.1 vs. 124.7 ± 14.7, p < 0.001), less blood loss (31.1 ± 8.1 vs. 334.7 ± 70.9, p < 0.001), more X-ray exposures (92.1 ± 14.3 vs. 29.4 ± 5.5, p < 0.001), shorter bed rest duration (12.4 ± 3.8 vs. 43.4 ± 10.0, p < 0.001), shorter hospitalization (6.6 ± 2.4 vs. 10.9 ± 2.7, p < 0.001), lower complication rate (28.5% vs. 64.7%, p < 0.05), and higher cement leakage rate (42.9% vs. 5.8%, p < 0.05) than the PSF + VP group. Conclusion During the treatment of SCOVFs, the combination of PFSUP and PSF + VP can restore spinal stability, improve kyphosis, and relieve pain. PFSUP can reduce blood loss and complications, early mobilization, and shorten the hospital stay, but it is associated with a higher cement leakage rate and more radiation exposure.

Comparison of the Clinical and Radiologic Outcomes of Two Treatment Methods in Patients with Thoracolumbar Junction Distraction Fracture: Short- versus Long-Segment Posterior Stabilization.

We compare the radiologic and clinical results between the short-segment fixation and the long-segment fixation in the thoracolumbar junction distraction fractures. We retrospectively reviewed the prospectively recorded data of patients who underwent posterior approach and pedicle fixation treatment for thoracolumbar distraction fracture (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association AO/OTA 5-B) with a minimum of 2 years of follow-up. A total of 31 patients were operated on; they were divided into two groups: (1) patients treated with short-level fixation (SLF; one level above and below the fracture level) and (2) patients treated with long-level fixation (LLF; two levels above and below the fracture level). The clinical outcomes were evaluated with the neurologic status, operation time, and time to surgery. The functional outcomes were evaluated with the Oswestry Disability Index (ODI) questionnaire and visual analog scale (VAS) at the final follow-up. Radiologic outcomes were measured with the local kyphosis angle, anterior body height, posterior body height, and sagittal index of the fractured vertebra. SLF was performed in 15 patients and LLF was performed in 16 patients. The average follow-up period was 30.13 ± 11.3 months for the SLF group and 35.3 ± 17.2 months for group 2 (p = 0.329). The two groups were similar in regard to age, gender, follow-up period, fracture level, fracture type, and pre- and postoperative neurologic status. The operating time was significantly shorter in the SLF group than in the LLF group. There were no significant differences between the groups in all radiologic parameters, ODI score, and VAS. SLF was associated with a shorter operation time and allowed the preservation of two or more segments of vertebral motion.

Comparison Between the Clinical Effect of Percutaneous Kyphoplasty for Osteoporosis Vertebral Compression Fracture Patient with or Without Sarcopenia: A Retrospective Cohort Study.

Sarcopenia and osteoporosis vertebral compression fractures (OVCF) are common diseases that increase with age. This study aimed to investigate the effects of sarcopenia on OVCF patients after percutaneous kyphoplasty (PKP). Data of 101 patients who were treated with single-level PKP between January 2021 and March 2022 at Ningbo No.6 Hospital were enrolled. Forty-five OVCF patients with sarcopenia who met our inclusion criteria were included in the Sarcopenia-PKP group (SPKP group), and 56 patients in the Normal-PKP group (NPKP group). All clinical and radiological data were collected from medical records. Baseline characteristics, operation-related parameters (operation time, time to ambulation, hospital stay, surgery segment), clinical outcomes (visual analog score [VAS], Oswestry Disability Index [ODI], Japanese Orthopaedic Association Scores [JOA] of lumber), radiological outcomes (vertebral anterior height rate and local kyphosis angle), Macnab score, and complications were evaluated and compared. There were no significant differences in age, sex, surgical segment preoperative VAS score, ODI, or JOA between the two groups (P > 0.05). The SPKP group had a significantly lower body mass index (BMI), bone mineral density (BMD), and smooth muscle index (SMI) than the NPKP group (P < 0.05). Significantly longer hospital stays and time to ambulation in SPKP group than NPKP group (3.7±0.8 vs 3.4±0.5 and 2.0±0.8 vs 1.6±0.5, P < 0.05). In SPKP group, significantly better clinical outcomes at 6- and 12-months follow-up were observed in NPKP group than SPKP group (P < 0.05), and NPKP group showed significantly better in vertebral anterior height rates than SPKP group after 6-month follow-up (P < 0.05). Moreover, there were significantly more cases of complications in the SPKP group (P < 0.05). Sarcopenia could reduce the clinical effect of percutaneous kyphoplasty, and furthermore. Related studies are needed to verify the effect of sarcopenia on OVCF patients.

The Influence of Percutaneous Vertebral Augmentation Techniques on Recompression in Patients with Osteoporotic Vertebral Compression Fractures. Percutaneous Vertebroplasty versus Balloon Kyphoplasty

The purpose of this study was to determine whether percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BK) have any mid-term to long-term effects on the structural integrity of augmented vertebrae. According to our hospital records, 351 patients underwent BK and PVP as a result of osteoporotic vertebral compression fractures between 2010 and 2020. The demographic, surgical, and radiologic characteristics of the patients were analyzed retrospectively using the electronic hospital records and PACS (picture archiving and communication system). In our study, 55 patients who had a single level of PVP or BK filled with at least 6 mL og polymethylmethacrylate (PMMA) for T11-L5 levels and 3 mL of PMMA for T6-T10 levels via a bipedicular approach and who had only 1 vertebral fracture in a 10-year follow-up period were included in our study. The patients were divided into 2 groups: BK (n= 40) and PVP (n= 15). All measurements were performed on standing lateral radiographs from the postoperative first day and the last radiographs that were obtained during the follow-up. The anterior and posterior heights of the fractured vertebral body and local kyphosis angles were measured. The mean follow-up time was 2.53 ± 1.78 years in the BK group and 3.07 ± 2.02 years in the PVP group. The decrease in the vertebral height and increasing kyphosis that develop from the early to late postoperative periods were found to be statistically significant in the BK group (P < 0.05). In the PVP group, vertebral height and kyphosis angle measurements did not differ significantly between the early and late postoperative periods. In addition, in terms of the percentage change, anterior parts of the vertebral bodies are more affected. However, the absolute difference for the measurement of the vertebral heights did not confirm this finding. To our knowledge, our study is unique because it has the longest follow-up in the literature comparing BK and PVP in terms of recollapse of the augmented vertebrae. Our study shows that BK does not prevent height loss of the augmented vertebral bodies in the mid- to long term.

Recurrence of Local Kyphosis After Percutaneous Kyphoplasty: The Neglected Injury of the Disc-Endplate Complex.

Recurrent of local kyphosis after percutaneous kyphoplasty (PKP) is rarely reported and discussed. Literatures reported that re-kyphosis is usually a consequence of refractures of augmented or adjacent vertebra. However, whether re-kyphosis should be considered as a complication of refractures and has an impact on clinical efficacy of PKP during follow-up time is unknown. The purpose of this study is to evaluate the related risk factors and clinical significance of the recurrent of local kyphosis in osteoporotic vertebral fracture (OVF) patients without refractures. A total of 143 patients who underwent single-level PKP were recruited and assigned into the re-kyphosis group and non-re-kyphosis group. Clinical and radiographic data were collected and compared between the two groups. Then, multivariate logistic regression analyses were conducted to identify the related risk factors. During follow-up, 16 of the 143 patients presented postoperative re-kyphosis. The average local kyphosis angle increased from 11.81±8.60° postoperatively to 25.13±8.91° at the final follow-up which showed a statistically significant difference (p<0.05). Both groups had significant improvements in postoperative visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores compared to their preoperative values (p<0.05). However, in the re-kyphosis group at final follow-up, the VAS and ODI scores showed worsening compared to the postoperative scores. Logistic regression analysis showed that disc-endplate complex injury (OR=17.46, p=0.003); local kyphosis angle correction (OR=1.84, p<0.001); and vertebral height restoration (OR=1.15, p=0.003) were risk factors for re-kyphosis. Re-kyphosis is not rare in patients with osteoporotic vertebral fracture and tends to have an inferior prognosis following PKP surgery. Patients with disc-endplate complex injury and more correction of vertebral height and kyphosis angle are at a higher risk for re-kyphosis after PKP surgery than others.

Comparison of Wiltse Approach of Pedicle Screw Fixation With or Without Vertebroplasty in the Treatment of Genant III Degree Osteoporotic Thoracolumbar Fractures: Analysis of Clinical Findings, Radiographic Parameters, and Follow-Up Complications.

A retrospective case-control study. This study aimed to compare the effects of the Wiltse approach of pedicle screw fixation (PSF) either in combination with or without vertebroplasty (VP) in the treatment of Genant III degree osteoporotic thoracolumbar fractures (Genant III-OTLFs). A retrospective study of Genant III-OTLFs was performed from January 2018 to December 2019, including 54 cases of PSF + VP and 56 cases of PSF. Clinical indicators [visual analog scale (VAS) score, Oswestry disability index (ODI)], radiographic parameters [local kyphosis angle (LKA), percentage of anterior, central, and posterior vertebral heights (AVH%, CVH%, and PVH%, respectively)] and follow-up complications [adjacent vertebral fracture (AVF), residual pain (RP), vertebral height loss (VHL), and internal fixation failure (IFF)] were compared between the 2 groups. No differences in surgical outcomes, clinical indicators, and radiographic parameters were observed between the 2 groups during the preoperation period and 7 days post-operatively (P > .05). However, the VAS score [2.0 (.6), 1.9 (.5)], ODI [23.7 (4.0), 22.6 (3.0)], LKA [9.5 (1.8), 10.6 (3.0)], AVH% [90.1 (2.7), 87.7 (6.0)], CVH% [92.5 (2.6), 91.3 (3.7)], and PVH% [93.4 (2.0), 92.7 (2.4)] at 1 year post-operatively and last follow-up of the PSF + VP group were better than those of the PSF group [2.5 (.8), 3.1 (1.1), 26.6 (3.8), 29.6 (4.6), 12.2 (1.6), 16.6 (3.2), 84.9 (4.0), 69.9 (6.6), 88.1 (3.1), 78.2 (5.1), 89.7 (2.3), 84.8 (4.6)], respectively (P < .001). During follow-up, the incidence of AVF had no difference (P > .05), while that of RP (32.1 vs 14.8%), VHL (33.9 vs 9.3%) and IFF (17.9 vs 5.6%) had statistical differences between them (P < .05). The Wiltse approach of PSF combined with VP for Genant III-OTLFs can not only effectively relieve pain, restore vertebral height, and correcte kyphosis, but also better maintain vertebral height, delay kyphosis progression, and reduce complications during follow-up.

Effect of different bone cement distributions in percutaneous kyphoplasty on clinical outcomes for osteoporotic vertebral compression fractures: A retrospective study.

Osteoporotic fractures and their complications are becoming increasingly harmful to the elderly. This study aimed to evaluate the clinical results of connected or unconnected bilateral cement after bilateral percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCF). The clinical data of 217 patients with single-segment OVCF were retrospectively collected. Patients were allocated into 2 groups according to the bilateral bone cement in the vertebrae was connected or unconnected after surgery. The surgery-related indexes of the 2 groups were compared, including operation time; bone cement injection volume; contact situation between bone cement and the upper and lower endplates of the vertebral body; visual analogue scale (VAS) scores before surgery, 1 week and 1 year after surgery; Oswestry disability index (ODI) before surgery, 1 week and 1 year after surgery; local kyphosis angle (LKA) before surgery, 1 week and 1 year after surgery; postoperative vertebral body height at 1 week and 1 year after surgery; vertebral body height restoration rate (HRR) at 1 week and 1 year after surgery. The follow-up results of all patients were recorded. The postoperative VAS, ODI, vertebral body height, LKA and other indexes of the 2 groups were significantly improved compared with those before the operation (P < .05), and there was no significant difference between the 2 groups (P > .05). At the same time, there were no significant difference in vertebral body HRR and bone cement leakage rate between the 2 groups (P > .05). X-ray examination showed that 21 of 217 patients (21/217, 9.8%) had a refracture of the injured vertebral body, including 16 cases (16/121, 13.2%) in the unconnected group and 5 cases (5/96, 5.2%) in the connected group (P < .05). Adjacent vertebrae fractures occurred in 25 cases (25/217, 11.5%), while 19 cases (19/121, 15.7%) were in the unconnected group and 6 cases (6/96, 6.3%) were in the connected group (P < .05). PKP has a good therapeutic effect on OVCF no matter whether the bilateral bone cement is connected or not. However, if the bilateral cement inside the vertebra was connected, the risk of recollapse of the injured vertebrae and the new fracture of adjacent vertebrae could be reduced.