Osteoporotic Compression Fractures Research Articles

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.

Percutaneous Mesh-Container-Plasty versus Percutaneous Kyphoplasty in the Treatment of Osteoporotic Compression Fractures with Up-Endplate Injury: A Retrospective Study

Percutaneous mesh-container-plasty(PMCP), a modified traditional percutaneous kyphoplasty(PKP)technique, is increasingly being used to treat osteoporotic vertebral compression fractures(OVCF) with up-endplate injury. This retrospective study aimed to compare the clinical and radiological results of PKP and PMCP for the treatment of this disease. We retrospectively analyzed the medical records of patients with osteoporotic compression fractures and upper endplate injuries treated at our hospital between January 2019 and December 2021. A total of 192 patients who met the inclusion and exclusion criteria were enrolled. Of these, 103 underwent PKP and 89 underwent PMCP. Key outcome measures included surgical safety, clinical efficacy, and radiological results. Both the PKP and PMCP groups showed significant improvements in VAS (Visual Analog Scale) and ODI (Oswestry Disability Index) scores postoperatively. Additionally, anterior vertebral body height ratio (AVBHr) and Cobb's angle improved in both groups, though no statistically significant difference was observed between them. The hospital stay duration was similar between the two cohorts. Notably, the PMCP group required a larger volume of bone cement injection, yet exhibited a significantly lower incidence of cement leakage and adjacent vertebral fractures (9/89 and 2/89, respectively) compared to the PKP group (24/103 and 11/103, respectively) (p < 0.05). Moreover, the PMCP group had shorter operation times (34.64 ± 9.88 minutes) and reduced fluoroscopy frequency (35.43 ± 5.46 instances) compared to the PKP group (27.23 ± 8.54 minutes and 23.87 ± 5.59 instances, respectively) (p < 0.05). PMCP provided superior clinical outcomes for the management of osteoporotic compression fractures with upper endplate injuries. It was associated with reduced operation and fluoroscopy times, as well as lower risks of adjacent vertebral fractures and cement leakage, compared to PKP.

Analysis of the impact of underlying diseases in the elderly on postoperative re-fractures after osteoporotic compression fractures

BackgroundPostoperative refracture of osteoporotic compression fractures in the elderly due to underlying illnesses is a complicated matter involving several variables. A multidisciplinary approach involving orthopedics, geriatrics, endocrinology, and rehabilitation medicine is necessary for an investigation of these issues. investigating the impact of older patients’ underlying medical conditions on the refracture of osteoporotic compression fractures following surgery.MethodsA retrospective analysis was conducted on 2383 patients between August 2013 and August 2023. 550 patients with comorbid geriatric underlying diseases were screened, 183 patients underwent refractories, and 367 patients were classified as non-refractories. The patients were then divided into two groups: those undergoing refractories and those not, and the underlying diseases of the patients in both groups were examined using ROC curves and unifactorial and multifactorial logistic regression analyses.ResultsAmong the patients gathered, the frequency of re-fracture was 33.3%. A statistically significant difference was observed when re-fracture was linked to patients with long-term alcohol consumption, operated vertebrae ≤ 1, hypertension, COPD, diabetes mellitus, stroke sequelae, conservative treatment of coronary heart disease, trauma, mental abnormality, scoliosis, and chronic renal disease. Having hypertension decreased the risk of re-fracture (P = 0.018, OR = 0.548), while alcohol intake ≥ 10years (P = 0.003, OR = 2.165), mental abnormality (P < 0.001, OR = 4.093), scoliosis (P < 0.001, OR = 6.243), chronic kidney disease (P = 0.002, OR = 2.208), and traumatic injuries (P = 0.029, OR = 3.512) were the risk factors examined in a binary logistic regression analysis. The results of multiple linear stepwise regression analysis indicated that re-fracture was more influenced by scoliosis.ConclusionsHypertensive disorders were protective factors against the formation of re-fracture, while alcohol intake usage for more than ten years, psychological abnormalities, scoliosis, chronic kidney disease, and trauma were risk factors. Scoliosis had the highest influence on re-fracture.

Pain Intervention for Osteoporotic Compression Fracture, From Physical Therapy to Surgery: A Literature Review.

Osteoporotic vertebral compression fractures (OVCF) significantly contribute to increased morbidity and mortality in aging populations. When adjusted for age, South Korea has the highest global prevalence of OVCF, with rates of 544 per 100,000 men and 1,575 per 100,000 women. Moreover, patients with OVCF are at a heightened risk of additional fractures, with the risk of new vertebral fractures being up to 5-fold higher. Therefore, in treating patients with OVCF, it is essential to address the current symptoms and take preventive measures against further fractures. Although pharmacological treatment is crucial, it may be insufficient for all patients with OVCF, with more severe cases often requiring physical therapy or surgical intervention. This review aimed to explore effective physical therapy methods for patients with OVCF and summarize surgical techniques for high-risk older patients with various underlying conditions.

Effects of different drugs in combination with PKP/PVP on postoperative pain in patients with osteoporotic compression fractures: a network meta-analysis.

This study was designed to evaluate the postoperative pain effect and clinical efficacy of different drugs combined with PKP or PVP in treating osteoporotic vertebral compression fractures (OVCFs) through a systematic review and network meta-analysis. We searched five electronic databases, namely, MEDLINE (PubMed), EMBASE, Web of Science, Google Scholar, and the Cochrane Central Register of Controlled Trials online, for the treatment of OVCFs through March 2023 with keywords zoledronic acid (ZOL), teriparatide (TPTD or PTH 1-34), and calcitonin (CT) combined with PKP/PVP. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were the primary outcomes of the network meta-analysis, and the secondary outcome was the diagnostic marker bone mineral density (BMD). Eighteen studies involving 2,374 patients were included in this study. The network meta-analysis revealed that, in terms of reducing VAS scores, compared with PVP surgery alone, PVP combined with TPTD was most likely to be the treatment associated with the greatest pain relief [MD = -4.99, 95% CI = (-7.45, -2.52)]. In terms of reducing the ODI dysfunction score, compared with PKP combined with Cal, PKP combined with ZOL had the highest probability of being the best treatment option [MD = -9.11, 95% CI = (-14.27, -3.95)]. In terms of protecting against bone density loss, compared with PKP surgery alone, treatment with PKP combined with ZOL had the best effect [MD = 0.39, 95% CI = (0.13,0.65)]. Based on the network meta-analysis and SUCRA rankings, this study concluded that adding teriparatide has the advantage of reducing VAS pain scores compared with PVP alone and that adding zoledronate is a more effective treatment for reducing ODI scores compared with PKP combined with Cal and preserving BMD compared with PKP alone. However, additional high-quality studies are needed to verify our findings. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=358445, identifier CRD42022358445.

Percutaneous unilateral vertebro-stentoplasty for painful osteoporotic compression fracture of lumbar vertebra

Osteoporosis is one of the common diseases in the elderly population which can cause compression fracture of the vertebral body due to loss of microarchitecture, loss of density, and deterioration of bone tissue leading to chronic pain, kyphotic deformity of the vertebra, and neurological complications. We report the case of a 68-year-old female, who presented to us with severe midback region pain for one year, which was increased over two months along with numbness in the right leg and difficulty in walking. The radiological investigation and magnetic resonance imaging spine revealed chronic compression fracture with the reduction in height of the L1 vertebra, which is seen with anterior wedging. The patient underwent vertebro-stentoplasty (VS) with bone cement, polymethyl-methacrylate. The patient was discharged well on third day of surgery. The VS for compression fracture of the lumbar vertebra demonstrated better results with improvement in pain and radiological finding in our patient.

A controlled clinical study of vertebroplasty for the treatment of osteoporotic vertebral compression fractures after self-made spinal positioner and manual reduction

To explore clinical effect of manipulation reduction combined with vertebral plasty on osteoporotic compression fractures (OVCFs). Totally 61 patients with OVCFs treated from January 2022 to March 2024 were randomly divided into self-made spinal locator positioning with manipulation reduction group (treatment group) and traditional Kirchner positioning group (control group). There were 30 patients in treatment group, including 4 males and 26 females, aged from 61 to 87 years old with an average of (73.61±7.17) years old;body mass index (BMI) ranged from 15.24 to 28.89 kg·m-2 with an average of (23.90±3.20) kg·m-2;bone mineral density T value ranged from -4.90 to -2.50 SD with an avergae of (-3.43±0.75) SD;fracture to operation time was 6.50 (4.00, 10.25) d;10 patients were gradeⅠ, 13 patients were gradeⅡ, and 7 patients were grade Ⅲ according to Genant classification of fracture compression. There were 31 patients in control group, including 7 males and 24 females, aged from 61 to 89 years old with an average of (73.63±8.77) years old;BMI ranged from 18.43 to 27.06 kg·m-2 with an average of (23.67±2.35) kg·m-2;bone mineral density T value ranged from -4.60 to -2.50 SD with an avergae of (-3.30±0.68) SD;fracture to operation time was 6.00 (3.00, 8.00) d;11 patients were gradeⅠ, 9 patients were gradeⅡ, and 11 patients were grade Ⅲ according to Genant classification of fracture compression. The puncture times, X-ray fluoroscopy times and puncture time between two groups were observed and compared. Visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) and timed up and go test (TUGT) were observed and compared before operation, 3 d and 1 month after operation. All patients were followed up for 1 to 3 months with an average of (2.10±0.80) months. Puncture times, X-ray fluorosecopy times and puncture time in treatment group were 5.00(4.00, 6.00) times, (29.53±5.89) times and 14.83(12.42, 21.20) min, respectively, while those in control group were 7.00(6.00, 8.00) times, (34.58±5.33) times, 22.19(17.33, 27.01) min, treatment group was better than those of control group (P<0.05). There were no significant differences in preoperative VAS, JOA and TUGT between two groups(P>0.05). VAS, JOA and TUGT in both groups were significantly improved after opeation(P<0.05). On the third day after operation, JOA score of treatment group was 23.00 (20.75, 25.00), which was higher than that of control group 20.00(19.00, 23.00)(P<0.05). TUGT of treatment group was 6.26(5.86, 6.57) s, which was better than that of control group 6.90(6.80, 7.14) s (P<0.05). Bone cement leakage occurred with 1 patient in treatment group and 2 patients in control group. The optimal scheme of self-made spinal locators for locating descending verteboplasty combined with traditional Chinese medicine reduction manipulation for OVCF patients could reduce the number of intraoperative puncture times, shorten puncture times and reduce number of X-ray fluoroscopy times, and have advantages over the simple positioning of Kirschn's needle in restoring short-term lumbar function and standing and walking ability of postoperative patients.

Does Early Treatment With Teriparatide Prevent the Need for Surgical Intervention in Osteoporotic Vertebral Compression Fractures.

Retrospective Cohort Study. The primary objective of this study is to evaluate the efficacy of early administration of Teriparatide in preventing the necessity of surgical intervention in individuals with osteoporotic vertebral compression fractures. In a 24-month follow-up retrospective analysis, 191 OVCF patients from January 2016 to October 2020 were randomly assigned to Non teriparatide Group A (n = 104) or Group B teriparatide (n = 87). At baseline, 6months, 1year, and 2years following treatment, demographic data and need of surgical intervention, VAS, ODI, union rates, and kyphosis development, were examined. Our study found that non-teriparatide group individuals had an 11.53% higher risk of non-union formation that required surgery. Only 8.63% of teriparatide group patients needed surgery. Both groups had significant VAS score reductions. Non-teriparatide group scores declined from 8.38 ± 0.74 to 3.15 ± 1.40, while teriparatide group scores decreased from 8.49 ± 0.73 to 1.11 ± 0.31. The 2-year follow-up ODI scores significantly decreased, with values of 25.02 ± 13.94 for non-teriparatide patients and 15.11 ± 2.17 for teriparatide patients. The kyphosis progression angles in the teriparatide group were considerably lower (4.97 ± 0.78°) compared to the other group (8.09 ± 1.25°). With increasing elderly populations, it is necessary to take measures to prevent surgical intervention in osteoporotic spinal compression fractures. Teriparatide can be employed as an early medication in the management of these fractures to avert non-union and the minimise the progression of kyphosis.

Novel Use of Fractal Analysis for Quantifying Polymethylmethacrylate Distribution Patterns in Osteoporotic and Malignant Vertebral Compression Fractures Following Vertebroplasty.

Purpose: Fractal analysis is a mathematical tool which allows the evaluation of complex microstructural features within materials that cannot be expressed in traditional geometric terms. The purpose of this study is to quantify the differences in polymethylmethacrylate intravertebral cement spatial distribution patterns following vertebroplasty using fractal analysis through the examination of osteoporotic and malignant compression fractures. Methods: Frontal and lateral post-vertebroplasty radiographs were evaluated from 29 patients with osteoporotic and malignant compression fractures who underwent vertebroplasty. The individually treated vertebra were divided into osteoporotic (n = 35) and malignant groups (n = 41). Images underwent segmentation, thresholding, and binarization prior to fractal analysis. Fractal dimension and lacunarity values were derived from the region of interest in treated vertebrae using the "box-counting" and "gliding-box" techniques respectively using ImageJ. The mean values of both parameters were compared between the 2 groups. Results: The mean fractal dimension was significantly higher in the malignant vertebral compression fracture group (1.53 ± 0.08) compared to the osteoporotic group (1.34 ± 0.17; P < .001). Similarly, mean lacunarity values were significantly higher in the malignant fracture group (0.50 ± 0.09) compared to the osteoporotic group (0.37 ± 0.10; P < .001). Conclusions: Fractal dimension and lacunarity values of cement spatial distribution patterns obtained from the post-vertebroplasty radiographs can differentiate between benign osteoporotic and malignant vertebral compression fractures. This novel technique may be useful for evaluating cement spatial distribution patterns in spine augmentation procedures, although further research is warranted in this area.

Evaluation of Sarcopenia by Psoas Muscle Measurements in Osteoporotic Patients with Vertebral Compression Fracture.

To examine the effect of sarcopenia on osteoporotic vertebral compression fracture with psoas muscle measurements. Cross-sectional study. Place and Duration of the Study: Department of Radiology, Sivas Cumhuriyet University, Sivas, Turkiye, from January 2020 to March 2023. Measurements evaluating psoas muscle area (PMA), psoas muscle index (PMI), and psoas muscle density (PMD) were made at L2 vertebral corpus level for the diagnosis of sarcopenia from muscle mass with computed tomography (CT). The association between sarcopenia and osteoporotic compression fracture was examined with significance at p <0.05. Osteoporotic patients with 37 compression fractures and 37 without compression fractures were examined. PMA and PMI were statistically significantly lower in the study group (p <0.01). PMD was also found to be statistically significantly lower in the study group (p <0.05). Diagnostic performance (DP) was good for the discrimination of patients and control groups for psoas area (AUC = 0.88; 95% confidence interval (CI) 0.807 - 0.956 and PMI (AUC = 0.83; 95% CI 0.734 - 0.917. It was poor for psoas density (AUC = 0.66, 95% CI 0.531 - 0.782). Sarcopenia is an important risk factor for osteoporotic compression fracture. Psoas measurements show a significant association with osteoporosis and vertebral fracture and can be easily determined on CT scan. Sarcopenia, Osteoporotic compression fracture, Psoas muscle.

An Automated Vertebrae Localization, Segmentation, and Osteoporotic Compression Fracture Detection Pipeline for Computed Tomographic Imaging.

Osteoporosis is the most common chronic metabolic bone disease worldwide. Vertebral compression fracture (VCF) is the most common type of osteoporotic fracture. Approximately 700,000 osteoporotic VCFs are diagnosed annually in the USA alone, resulting in an annual economic burden of ~$13.8B. With an aging population, the rate of osteoporotic VCFs and their associated burdens are expected to rise. Those burdens include pain, functional impairment, and increased medical expenditure. Therefore, it is of utmost importance to develop an analytical tool to aid in the identification of VCFs. Computed Tomography (CT) imaging is commonly used to detect occult injuries. Unlike the existing VCF detection approaches based on CT, the standard clinical criteria for determining VCF relies on the shape of vertebrae, such as loss of vertebral body height. We developed a novel automated vertebrae localization, segmentation, and osteoporotic VCF detection pipeline for CT scans using state-of-the-art deep learning models to bridge this gap. To do so, we employed a publicly available dataset of spine CT scans with 325 scans annotated for segmentation, 126 of which also graded for VCF (81 with VCFs and 45 without VCFs). Our approach attained 96% sensitivity and 81% specificity in detecting VCF at the vertebral-level, and 100% accuracy at the subject-level, outperforming deep learning counterparts tested for VCF detection without segmentation. Crucially, we showed that adding predicted vertebrae segments as inputs significantly improved VCF detection at both vertebral and subject levels by up to 14% Sensitivity and 20% Specificity (p-value = 0.028).

Construction of a nomogram to predict the probability of new vertebral compression fractures after vertebral augmentation of osteoporotic vertebral compression fractures: a retrospective study.

This study aimed to develop and validate a new nomogram model that can predict new vertebral fractures after surgery for osteoporotic compression fractures to optimize surgical plans and reduce the incidence of new vertebral compression fractures. 420 patients with osteoporotic vertebral compression fractures were randomly sampled using a computer at a fixed ratio; 80% of the patients were assigned to the training set, while the remaining 20% were assigned to the validation set. The least absolute shrinkage and selection operator (LASSO) regression method was applied to screen the factors influencing refracture and construct a predictive model using multivariate logistic regression analysis. The results of the multivariate logistic regression analysis showed a significant correlation between bone cement leakage, poor cement dispersion, the presence of fractures in the endplate, and refractures. The receiver operating characteristic curve (ROC) results showed that the area under the ROC curve (AUC) of the training set was 0.974 and the AUC of the validation set was 0.965, which proves that this prediction model has a good predictive ability. The brier score for the training set and validation set are 0.043 and 0.070, respectively, indicating that the model has high accuracy. Moreover, the calibration curve showed a good fit with minimal deviation, demonstrating the model's high discriminant ability and excellent fit. The decision curve indicated that the nomogram had positive predictive ability, indicating its potential as a practical clinical tool. Cement leakage, poor cement dispersion, and presence of fractures in the endplate are selected through LASSO and multivariate logistic regressions and included in the model development to establish a nomogram. This simple prediction model can support medical decision-making and maybe feasible for clinical practice.

Simultaneous assessment of renal function with hybrid SPECT/CT during whole-body bonescintigraphy (WbBS) in patients with prostate carcinoma (PC) and concomitant urological diseases with impaired renal drainage

Introduction: Whole-body bone scintigraphy (WbBS) is the „gold standard“ worldwide for early detection and evaluation of treatment of bone metastatic tumors, incl.PC.Due to the known renal excretion of the osteotropic RPh – 99mTc-methylene diphosphonate (99mTc-MDP), it is possible to perform an „early“ assessment of renal function, followed by a „late“ standard WbBS with SPECT/CT. Aim: The aim of the present study was to evaluate and indicate the diagnostic utility of a single administration of 99mTc-MDP with a dual protocol implemented in the CNM for sequential scintigraphic assessment of renal function and early detection, staging and evaluation of the treatment effect of bone metastases in patients with PCand concomitant urological diseases. Materials and methods: We present three patients with PC, referred for restaging of the oncological disease and performing WbBS in the CNM in USHATO, Sofia, Bulgaria. According to the indications and assessment of a nuclear medicine physician, a one-day protocol was carried out and introduced in the CNM, starting with dynamic renal scintigraphy (DRS) at the time of bo-lus i.v.injection of 99mTc-MDP and subsequent after the 2nd hour planar WbBS with hybrid target or wholebody SPECT/CT scan. Results: The first patient is with metastatic PC after complex treatment.Due to elevated levels of creatinine, „early“ DRS and „late“ restaging WbBS were performed, with reported full therapeutic effect of bone-metastatic disease and isosthenuric changes in right kidney, but with altered secretory-excretory phases and reduced total GFR.The second case is a patient with high-risk CP, who underwent hormonal and definitive radiation therapy, with episodes of renal colic. DRS revealed a hydronephrotic type nephrogram on the right, and a subsequent CT scan showed osteoporotic compression fractures of two vertebrae, without bon metastasis. An additional SPECT/CT finding is a calcium-dense calculus as a probable cause of the hydronephrotic changes. The third patient, is with high-risk CP and undergonetreatment. Initial DRSshowed secretory-excretory dysfunction of the right kidney with retention in the pyelocaliceal system. SubsequentWbBSand SPECT/CT revealed a complete therapeutic effect of a solitary bony lesion in the 6th right rib and malrotation of the right kidney with a staghorn calculus in the pyelon. All patients are referred for urological control. Conclusion: DRS performed with hybrid SPECT/ CT, in the course of routine WbBS, for re-staging of patients with CP, gives along with bone metastatic follow-up, valuable functional information about the separated renal function, drainage and morphological guidance for pathological changes from concomitant urological diseases.

Unilateral percutaneous vertebroplasty in osteoporotic vertebral compression fractures: A clinical efficacy evaluation.

Osteoporotic vertebral compression fractures, often resulting from low-energy trauma, markedly impair the quality of life of elderly individuals. The present retrospective study focused on the clinical efficacy of unilateral percutaneous vertebroplasty (PVP) in the treatment of osteoporotic compression fractures. A total of 68 patients, representing 92 vertebral bodies, who underwent the unilateral PVP technique from March 2020 to January 2023 were evaluated. Key parameters such as visual analogue scale (VAS) values, Oswestry disability index (ODI) scores, Cobb angle measurements, and anterior vertebral height (AVH) were documented pre- and post-surgery. The mean follow-up period was 15.41±3.74 months. The mean pre-operative VAS score was 8.08±0.79, which was significantly reduced to 2.25±0.71 by 24 h post-surgery and stabilized at 1.58±0.51 by the final follow-up. The ODI showed a significant improvement from a pre-operative average of 67.75±7.91 to 19.74±2.90 post-surgery, and was maintained at a low level of 28.00±4.89 at the last assessment. Radiological evaluations revealed significant alterations in Cobb angle and AVH post-operation. Notably, during the follow-up, eight patients developed new compression fractures in different vertebral segments. In conclusion, the unilateral PVP method is safe and efficient for the management of osteoporotic vertebral compression fractures.

Finite element study on three osteotomy methods for treating thoracolumbar osteoporotic fracture vertebral collapse complicated with neurological dysfunction.

Surgical methods for patients with osteoporotic fracture vertebral collapse complicated with neurological dysfunction are still a topic of debate. We designed an improved osteotomy for the treatment of osteoporotic compression fracture patients with neurological dysfunction. Compared with traditional osteotomy methods such as pedicle subtraction osteotomy (PSO) and bone-disc-bone osteotomy (BDBO), the osteotomy range is reduced. Therefore, we use a finite element method to analyze the biomechanical conditions of these three osteotomy methods and provide a mechanical theoretical basis for the surgical treatment of these three osteotomy methods. Based on the CT scan of a patient with L1 osteoporotic fracture vertebral collapse and neurological dysfunction, the finite element model was constructed by importing Mimics software, and three different osteotomy models were established. The forces and displacements of internal fixation device, T1-L5 whole segment, T10 vertebral body, and T10/11 intervertebral disc were recorded under different working conditions. The displacement levels of internal fixation device, T1-L5 spine, T10 vertebral body, and T10/11 intervertebral disc in the modified osteotomy group were between BDBO group and PSO group. The stress in BDBO group was concentrated in titanium mesh and its maximum stress was much higher than that in PSO group and modified osteotomy group. The mechanical distribution of T10/11 intervertebral disc showed that the maximum stress distribution of the three osteotomy methods was similar. The relatively simple modified osteotomy has certain advantages in stress and displacement. In contrast, the stability of BDBO group was poor, especially in the lumbar intervertebral disc and lumbar body. For this type of osteotomy patients, it is recommended to avoid postoperative flexion so as not to increase the load.

Clinical study of modified suspension reduction method combined with percutaneous vertebroplasty in the treatment of thoracolumbar osteoporotic compression fracture

To investigate the clinical effect of modified suspension reduction method combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures. From February 2020 to October 2021, 92 patients with thoracolumbar osteoporotic compression fracture were treated by percutaneous vertebroplasty. According to different treatment methods, they were divided into the observation group and the control group. The observation group was treated with modified suspension reduction and then percutaneous vertebroplasty, while the control group was treated with percutaneous vertebroplasty alone. The observation group (47 cases), including 20 males and 27 females, the age ranged from 59 to 76 years old with an average of (69.74±4.50) years old, fractured vertebral bodies:T10(2 cases), T11(7 cases), T12(19 cases), L1(14 cases), L2(5 cases);the control group(45 cases), including 21 males and 24 females, the age ranged from 61 to 78 years old with an average of (71.02±3.58) years old, fractured vertebral bodies:T10(3 cases), T11(8 cases), T12(17 cases), L1(12 cases), L2(5 cases);The leakage of bone cement were observed, the visual analogue scale (VAS), Oswestry lumbar dysfunction index (ODI), anterior vertebrae height (AVH), Cobb angle of kyphosis and the amount of bone cement injected before and after operation were recorded and compared between the two groups. All patients were followed up, ranged from 6 to10 with an average of (8.45±1.73) months. Two patients ocurred bone cement leakage in observation group and 3 patients in control group. AVH of observation group increased (P<0.05) and Cobb angle of injured vertebrae decreased (P<0.05). Cobb angle of injured vertebrae and AVH of the control group were not significantly changed (P>0.05). Cobb angle of injured vertebrae of the observation group was lower than that of control group (P<0.05) and AVH was higher than that of the control group (P<0.05). In the observation group, VAS before operation and 1 week, 3 and 6 months after operation respectively were(7.32±1.05) scores, (3.56±1.18) scores, (1.83±0.67) scores, (1.27±0.34) scores, and ODI were(40.12±14.69) scores, (23.76±10.19) scores, (20.15±6.39) scores, (13.45±3.46) scores. In the control group, VAS before operation and 1 week, 3 and 6 months after operation respectively were(7.11±5.26) scores, (3.82±0.68) scores, (1.94±0.88) scores, (1.36±0.52) scores, and ODI were(41.38±10.23) scores, (25.13±14.22) scores , (20.61±5.82) scores, (14.55±5.27) scores . The scores of VAS and ODI after operation were lower than those before operation (P<0.05), but there was no significant difference between the two groups (P<0.05). Modified suspension reduction method combined with PVP surgery for osteoporotic thoracolumbar compression fractures has achieved good clinical results, which can effectively relieve lumbar back pain, restore vertebral height, correct kyphosis, improve lumbar function and patients' quality of life.

Application value of bone cement containing rhbFGF and RHBMP-2 in PKP treatment of osteoporotic lumbar compression fracture

To investigate the effect of bone cement containing recombinant human basic fibroblast growth factor (rhbFGF) and recombinant human bone morphogenetic protein-2 (rhBMP-2) in percutaneous kyphoplasty(PKP)treatment of osteoporotic vertebral compression fracture(OVCF). A total of 103 OVCF patients who underwent PKP from January 2018 to January 2021 were retrospectively analyzed, including 40 males and 63 females, aged from 61 to 78 years old with an average of (65.72±3.29) years old. The injury mechanism included slipping 33 patients, falling 42 patients, and lifting injury 28 patients. The patients were divided into three groups according to the filling of bone cement. Calcium phosphate consisted of 34 patients, aged(65.1±3.3) years old, 14 males and 20 females, who were filled with calcium phosphate bone cement. rhBMP-2 consisted of 34 patients, aged (64.8±3.2) years old, 12 males and 22 females, who were filled with bone cement containing rhBMP-2. And rhbFGF+rhBMP-2 consisted of 35 patients, aged (65.1±3.6) years old, 14 males and 21 females, who were filled with bone cement containing rhbFGF and rhBMP-2. Oswestry disability index (ODI), bone mineral density, anterior edge loss height, anterior edge compression rate of injured vertebra, visual analog scale (VAS) of pain, and the incidence of refracture were compared between groups. All patients were followed for 12 months. Postoperative ODI and VAS score of the three groups decreased (P<0.001), while bone mineral density increased (P<0.001), anterior edge loss height, anterior edge compression rate of injured vertebra decreased first and then slowly increased (P<0.001). ODI and VAS of group calcium phosphate after 1 months, 6 months, 12 months were lower than that of rhBMP-2 and group rhbFGF+rhBMP-2(P<0.05), bone mineral density after 6 months, 12 months was higher than that of rhBMP-2 and group calcium phosphate(P<0.05), and anterior edge loss height, anterior edge compression rate of injured vertebra of group rhbFGF+rhBMP-2 after 6 months and 12 months were lower than that of group rhBMP-2 and group calcium phosphate(P<0.05). There was no statistical difference in the incidence of re-fracture among the three groups (P>0.05). Bone cement containing rhbFGF and rhBMP-2 could more effectively increase bone mineral density in patients with OVCF, obtain satisfactory clinical and radiological effects after operation, and significantly improve clinical symptoms.

Improved unilateral puncture PVP based on 3D printing technology for the treatment of osteoporotic vertebral compression fracture

To investigate the clinical effect of unilateral percutaneous vertebroplasty (PVP) combined with 3D printing technology for the treatment of thoracolumbar osteoporotic compression fracture. A total of 77 patients with thoracolumbar osteoporotic compression fractures from October 2020 to April 2022 were included in the study, all of which were vertebral body compression fractures caused by trauma. According to different treatment methods, they were divided into experimental group and control group. Thirty-two patients used 3D printing technology to improve unilateral transpedicle puncture vertebroplasty in the experimental group, there were 5 males and 27 females, aged from 63 to 91 years old with an average of (77.59±8.75) years old. Forty-five patients were treated with traditional bilateral pedicle puncture vertebroplasty, including 7 males and 38 females, aged from 60 to 88 years old with an average of(74.89±7.37) years old. Operation time, intraoperative C-arm X-ray times, anesthetic dosage, bone cement injection amount, bone cement diffusion good and good rate, complications, vertebral height, kyphotic angle (Cobb angle), visual analogue scale(VAS), Oswestry disability index (ODI) and other indicators were recorded before and after surgery, and statistically analyzed. All patients were followed up for 6 to 23 months, with preoperative imaging studies, confirmed for thoracolumbar osteoporosis compression fractures, two groups of patients with postoperative complications, no special two groups of patients' age, gender, body mass index (BMI), time were injured, the injured vertebral distribution had no statistical difference(P>0.05), comparable data. Two groups of patients with bone cement injection, bone cement dispersion rate, preoperative and postoperative vertebral body height, protruding after spine angle(Cobb angle), VAS, ODI had no statistical difference(P>0.05). The operative time, intraoperative fluoroscopy times and anesthetic dosage were statistically different between the two groups(P<0.05). Compared with the traditional bilateral puncture group, the modified unilateral puncture group combined with 3D printing technology had shorter operation time, fewer intraoperative fluoroscopy times and less anesthetic dosage. The height of anterior vertebral edge, kyphosis angle (Cobb angle), VAS score and ODI of the affected vertebrae were statistically different between two groups at each time point after surgery(P<0.05). In the treatment of thoracolumbar osteoporotic compression fractures, 3D printing technology is used to improve unilateral puncture PVP, which is convenient and simple, less trauma, short operation time, fewer fluoroscopy times, satisfactory distribution of bone cement, vertebral height recovery and kyphotic Angle correction, and good functional improvement.

Assessment of Cement Leakage in Decompressed Percutaneous Kyphoplasty.

Symptomatic osteoporotic compression fractures are commonly addressed through vertebroplasty and kyphoplasty. However, cement leakage poses a significant risk of neurological damage. We introduced "aspiration percutaneous kyphoplasty", also known as "decompressed kyphoplasty", as a method to mitigate cement leakage and conducted a comparative analysis with high viscosity cement vertebroplasty. We conducted a retrospective study that included 136 patients with single-level osteoporotic compression fractures. Among them, 70 patients underwent high viscosity cement vertebroplasty, while 66 patients received decompressed percutaneous kyphoplasty with low-viscosity cement. Comparison parameters included cement leakage rates, kyphotic angle alterations, and the occurrence of adjacent segment fractures. The overall cement leakage rate favored the decompressed kyphoplasty group (9.1% vs. 18.6%), although statistical significance was not achieved (p = 0.111). Nonetheless, the risk of intradiscal leakage significantly reduced in the decompressed kyphoplasty cohort (p = 0.011), which was particularly evident in cases lacking the preoperative cleft sign on X-rays. Kyphotic angle changes and the risk of adjacent segment collapse exhibited similar outcomes (p = 0.739 and 0.522, respectively). We concluded that decompressed kyphoplasty demonstrates efficacy in reducing intradiscal cement leakage, particularly benefiting patients without the preoperative cleft sign on X-rays by preventing intradiscal leakage.

Influence of sarcopenia on surgical efficacy and mortality of percutaneous kyphoplasty in the treatment of older adults with osteoporotic thoracolumbar fracture

BackgroundSarcopenia is an age-related condition that causes loss of skeletal muscle mass and disability. Sarcopenia is closely related to the prognosis of patients suffering osteoporotic thoraco-lumbar compression fractures (OTLCF). The purpose of this study was to investigate the effect of sarcopenia on the efficacy of percutaneous kyphoplasty (PKP) in the treatment of older adults with OTLCF surgery and postoperative mortality. MethodsFrom February 2016 to June 2019, 101 patients who met the inclusion and exclusion criteria were included in this study. The grip strength of the dominant hand was measured using an electronic grip tester. The diagnostic cutoff value of grip strength for sarcopenia was <27 kg for males and <16 kg for females. The cross-sectional area (cm2) of the musculature at the level of the pedicle of the thoracic 12th vertebra (T12) was measured by chest CT. The skeletal muscle index (SMI) was calculated by dividing the muscle cross-sectional area at the T12 pedicle level by the square of the height. The diagnostic cut-off value of SMI at T12 level is 42.6 cm2/m2 for males and 30.6 cm2/m2 for females. Sarcopenia was diagnosed when the grip strength and SMI values were both lower than the diagnostic cut-off value. All included patients received PKP treatment for OTLCF. The age, gender, operation time, bleeding volume, time to ground, length of hospital stay, visual analog scale (VAS) score before operation and one month after operation, Oswestry Disability Index (ODI) one month after operation and the incidence of refracture within 36 months after operation were compared between the two groups. The survival curves of the two groups were analyzed by Kaplan Meier. Chi-square test was used to compare the differences in survival rates between the two groups at 12, 24, and 36 months after operation. Univariate and multivariate Cox regression analysis compared multivariate factors on OTLCF postoperative mortality. ResultsThere was no significant difference in gender, operation time, blood loss and preoperative VAS score between the two groups (χ2 = 1.750, p = 0.186; t = 1.195, p = 0.235; t = −0.582, p = 0.562; t = −1.513, p = 0.133), respectively. The patients in the sarcopenia group were older (t = 3.708, p = 0.000), and had longer postoperative grounding time and hospitalization time (t = 4.360, p = 0.000; t = 6.458, p = 0.000). The VAS scores and ODI scores one month postoperatively were also higher in sarcopenia group (t = 5.900, p = 0.000; t = 7.294, p = 0.000), and there was a statistical difference between the two groups. Interestingly, there was no significant difference in the incidence of spinal refracture within 36 months between the two groups (χ2 = 1.510, p = 0.219). The sarcopenia group had a higher mortality rate at 36 months after operation, and the difference was statistically significant (p = 0.002). Sarcopenia is an independent risk factor for long-term mortality in OTLCF patients received PKP surgery. ConclusionsPatients with sarcopenia combined with OTLCF have poor postoperative recovery of limb function and a high risk of death in the long-term (36 months) after surgery. Active and effective intervention for sarcopenia is required during treatment.