Osteoporotic Thoracolumbar Compression Fractures Research Articles

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.

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.

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.

Can Over Six Months of Teriparatide Treatment Prevent the Progression of Osteoporotic Thoracolumbar Compression Fracture?

Osteoporosis is one of the most common causes of thoracolumbar compression fractures. Teriparatide is an anabolic agent used to treat osteoporosis. This study aimed to determine whether teriparatide treatment for over 6 months could be effective in patients with osteoporotic thoracolumbar compression fractures. Between July 2012 and June 2020, we reviewed 50 patients with thoracolumbar osteoporotic compression fractures who could be followed up for more than 1 year. Patients were divided into 3 groups: 11 patients who did not receive teriparatide (Group 0), 19 patients who received teriparatide for less than 5 months (Group 1), and 20 patients who received teriparatide for over 6 months (Group 2). Demographic data, visual analog scale (VAS) scores, and medical histories were reviewed. Radiographs were reviewed to evaluate the vertebral body compression ratio and kyphotic angles. VAS scores improved in all groups at each time point after injury. Score improvements at 6 months and 1 year between Group 0 and Groups 1 or 2 were significantly different. The compression ratio in all groups increased at each time point after injury, but the differences between Groups 0, 1, and 2 were statistically significant at 3 weeks and 6 months. While the kyphotic angle significantly increased at 1 year in all groups, the differences between the groups at each time point did not reach statistical significance. Over 6 months of teriparatide treatment had some effects on pain in patients with osteoporotic thoracolumbar compression fractures, but did not prevent the progression of vertebral collapse.

Comparison of percutaneous vertebroplasty and conservative treatment for one level thoracolumbar osteoporotic compression fracture in a 3-year study

The efficacy of Mesh optimized versus standard percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures. Grid optimization (102 cases; 38 men, 64 women aged 67.3 ± 8.5) and traditional PVP groups (94 cases) were identified from 196 PVP patients treated from May 2016 to 2019. The optimal puncture site and angle forced bone cement into both groups before surgery. The main indexes were operation time, X-ray fluoroscopy times, bone cement injection volume, leakage, VAS, and injured vertebrae height. Preoperative general data were equivalent between groups (P > 0.05). All patients survived surgery without spinal cord injury, incision infection, pulmonary embolism, or death. The mesh optimization group had improved operation time (34.8 ± 6.5 min), fluoroscopy times (29.5 ± 5.5), bone cement injection volume (5.3 ± 2.1 ml), and bone cement permeability greater (3.9 percent; 4/98) than the standard PVP group (P < 0.05). Similarly, the grid optimization group had superior VAS scores (1.1 ± 0.6; 1.0 ± 0.3; and 0.9 ± 0.2) than the standard PVP group at 3 days, 3 months, and the last follow-up visit (P < 0.05). On day three after surgery, both had similar heights of injured vertebra's anterior and middle edges (P > 0.05). However, in the mesh optimization group, measurements improved to 1.8 ± 0.4 mm and (1.8 ± 0.3) mm by month three and to 1.7 ± 0.3 mm at last follow-up (P < 0.05). Mesh-optimized PVP with a mesh locator treats osteoporotic vertebral compression fractures more safely and effectively than regular PVP.

Comparative Study of Percutaneous Kyphoplasty and Hyperextension Reduction Combined with Percutaneous Vertebroplasty in the Treatment of Osteoporotic Thoracolumbar Compression Fractures in the Elderly

Objective: This paper aims to explore the clinical effects of percutaneous kyphoplasty (PKP) and hyperextension reduction combined with percutaneous vertebroplasty (PVP) in elderly patients with osteoporotic thoracolumbar compression fractures (OVCF). Methods: A sample of 62 elderly OVCF patients was selected. The admission time was from June 2022 to June 2023. They were randomly divided into a study group (n = 31) and a control group (n = 31) using computer software lottery method. Patients in the control group were treated with PKP, while patients in the study group were treated with hyperextension reduction combined with PVP. The operation time, hospitalization time, the number of fluoroscopy, treatment costs, visual analog pain score (VAS), vertebral body height, and Cobb angle of the injured vertebra were compared between the two groups. Results: The operation time, hospitalization time, number of fluoroscopy, and treatment costs of the patients in the study group were all lower than those in the control group (P &lt; 0.05). The VAS scores of the two groups after surgery were lower than those before surgery, and there was no significant difference between the groups (P &gt; 0.05). After surgery, the vertebral body heights in both groups were more significant than before surgery, and the Cobb angle of the injured vertebra was smaller than before surgery. There was no significant difference between the groups (P &gt; 0.05). Conclusion: PKP and hyperextension reduction combined with PVP treatment in elderly patients with OVCF can relieve pain and restore vertebral body height and Cobb angle. However, hyperextension reduction combined with PVP treatment can shorten the operation time and hospitalization time, with low treatment cost, which has the potential value to be widely applied.

Predictive factors for conversion from conservatively to surgically treatment osteoporotic thoracolumbar compression fractures based on sagittal parameters and magnetic resonance imaging features.

To investigate the relationship between sagittal plane characteristics of the spinal column and conservative treatment failure in acute osteoporotic spinal fractures (OSFs). As a retrospective study of single-institute data, thoracolumbar OSF patients with similar propensities in terms of location of fractures and results of bone mineral density were analyzed. Among them, 43 patients (group I) who needed reconstructive surgical interventions and 39 patients (group II) who obtained successful treatment through conservative care were included. General demographic data, radiographic features of fractures, and magnetic resonance imaging (MRI) features of fractures were analyzed. To investigate the relationship between global sagittal alignment of the spine and occurrence of delayed complication following OSFs, radiological sagittal parameters were analyzed. The number of cases requiring reconstructive surgery was significantly higher when the index vertebra showed diffuse or mid-portion bone marrow changes in MRI. In terms of sagittal parameters, pelvic incidence (group I 59.1° ± 11.9°, group II 54.6° ± 9.8°) and thoracolumbar angle (group I 26.5° ± 14.1°, group II 17.4° ± 11.2°) were significantly higher in group I. Logistic regression analysis showed that higher pelvic incidence (OR 1.09, 95% CI 1.01-1.18, p value < 0.05) and higher thoracolumbar angle (OR 1.09, 95% CI 1.02-1.17, p value < 0.05) were significant risk factors for delayed complications requiring reconstructive surgery following OSFs. Delayed complications requiring reconstructive surgery following OSFs are related to sagittal plane parameters of the spine such as high pelvic incidences, in addition to previously known radiographic characteristics of fractures.

Effects of different puncture levels in bilateral percutaneous vertebroplasty on distribution of bone cement and effectiveness of osteoporotic thoracolumbar compression fractures

To investigate the effects of different puncture levels on bone cement distribution and effectiveness in bilateral percutaneous vertebroplasty for osteoporotic thoracolumbar compression fractures. A clinical data of 274 patients with osteoporotic thoracolumbar compression fractures who met the selection criteria between December 2017 and December 2020 was retrospectively analyzed. All patients underwent bilateral percutaneous vertebroplasty. During operation, the final position of the puncture needle tip reached was observed by C-arm X-ray machine. And 118 cases of bilateral puncture needle tips were at the same level (group A); 156 cases of bilateral puncture needle tips were at different levels (group B), of which 87 cases were at the upper 1/3 layer and the lower 1/3 layer respectively (group B1), and 69 cases were at the adjacent levels (group B2). There was no significant difference in gender, age, fracture segment, degree of osteoporosis, disease duration, and preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between groups A and B and among groups A, B1, and B2 ( P>0.05). The operation time, bone cement injection volume, postoperative VAS score, ODI, and bone cement distribution were compared among the groups. All operations were successfully completed without pulmonary embolism, needle tract infection, or nerve compression caused by bone cement leakage. There was no significant difference in operation time and bone cement injection volume between groups A and B or among groups A, B1, and B2 ( P>0.05). All patients were followed up 3-32 months, with an average of 7.8 months. There was no significant difference in follow-up time between groups A and B and among groups A, B1, and B2 ( P>0.05). At 3 days after operation and last follow-up, VAS score and ODI were significantly lower in group B than in group A ( P<0.05), in groups B1 and B2 than in group A ( P<0.05), and in group B1 than in group B2 ( P<0.05). Imaging review showed that the distribution of bone cement in the coronal midline of injured vertebrae was significantly better in group B than in group A ( P<0.05), in groups B1 and B2 than in group A ( P<0.05), and in group B1 than in group B2 ( P<0.05). In group A, 7 cases had postoperative vertebral collapse and 8 cases had other vertebral fractures. In group B, only 1 case had postoperative vertebral collapse during follow-up. Bilateral percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures can obtain good bone cement distribution and effectiveness when the puncture needle tips locate at different levels during operation. When the puncture needle tips locate at the upper 1/3 layer and the lower 1/3 layer of the vertebral body, respectively, the puncture sites are closer to the upper and lower endplates, and the injected bone cement is easier to connect with the upper and lower endplates.

Clinical effect of kyphoplasty in the treatment of osteoporotic thoracolumbar compression fractures in patients with diabetes.

To study the clinical effect and influencing factors of kyphoplasty in the treatment of osteoporotic thoracolumbar compression fractures (OTCF) complicated with type 2 diabetes mellitus (T2DM). A total of 472 patients with OTCF complicated with diabetes who were enrolled in our hospital from January to December 2019 were selected as the study subjects, and all patients were treated with percutaneous kyphoplasty (PKP). The effects of gender, age, smoking, drinking, body mass index (BMI), bone mass density (T score), fasting blood glucose level, fasting C-peptide, glycosylated hemoglobin, course of T2DM, vertebral segment and surgical instrument on postoperative improvement were analyzed. The quality of life was evaluated by visual analog score (VAS) and Oswestry disability index (ODI) before PKP and 7 days, and 6 months after PKP, and the patient satisfaction was assessed by the modified Macnab criteria at 6 months postoperatively. The overall excellent and good rate of evaluation result was satisfactory. In multivariate regression, independent risk factors for poor patient satisfaction included: age ≥70 years (odds ratio (OR) = 2.298, 95% confidence interval [CI] 1.290-4.245, P = 0.025), fasting blood glucose ≥8 mmol/L [OR = 2.657, 95%(CI) 1.288-4.121, P = 0.016], glycosylated hemoglobin ≥6.5 mmol/L [OR = 3.438, 95%(CI) 2.543-4.628, P = 0.001], duration ≥8 years [OR = 1.732, 95%(CI) 1.471-3.253, P = 0.019] and Kyphon instrument [OR = 1.472, 95%(CI) 1.112-2.228, P = 0.018] were independent influencing factors of OTCF complicated with DM. Kyphoplasty for patients with osteoporotic thoracolumbar compression fractures complicated with diabetes can achieve a satisfactory clinical effect, the curative effect is affected by many factors, attention to these factors can improve the clinical effect.

A prospective study of vertebroplasty with reverse designed unilateral targeted puncture for osteoporotic thoracolumbar compression fractures

To explore the feasibility and effectiveness of vertebroplasty with reverse designed unilateral targeted puncture in treatment of osteoporotic vertebral compression fracture (OVCF) by comparing with curved unilateral puncture. A total of 52 patients with OVCF met selection criteria and were admitted between January 2019 and June 2021 were selected as the research objects. According to the random number table method, they were divided into two groups ( n=26). In trial group, the reverse designed unilateral targeted puncture was used in the percutaneous vertebroplasty (PVP); while the control group used the curved unilateral puncture. There was no significant difference in gender, age, bone mineral density (T value), cause of injury, time from injury to operation, the level of responsible vertebral body, pedicle diameter of the planned puncture vertebral body, and preoperative visual analogue scale (VAS) score, anterior vertebral height, and Cobb angle between the two groups ( P>0.05). The operation time, bone cement injection volume and leakage, intraoperative radiation exposure times, and hospitalization costs in the two groups were recorded. VAS score was used to evaluate the relief degree of low back pain after operation. X-ray film was used to review the diffusion degree of bone cement in the responsible vertebral body, and Cobb angle and anterior vertebral height were measured. The operation was successfully completed in the two groups. Patients in the two groups were followed up 12-18 months, with an average of 13.6 months. The operation time, volume of injected bone cement, intraoperative radiation exposure times, and hospitalization costs in the trial group were significantly lower than those in the control group ( P<0.05). With the prolongation of time, the low back pain of the two groups gradually relieved, and the VAS score significantly decreased ( P<0.05). And there was no significant difference in VAS score between the two groups at each time point ( P>0.05). There were 2 cases (7.6%) of bone cement leakage in the trial group and 3 cases (11.5%) in the control group, and no significant difference was found in the incidence of bone cement leakage and the diffusion degree of bone cement between the two groups ( P>0.05). Imaging examination showed that compared with pre-operation, the anterior vertebral height of the two groups significantly increased and Cobb angle significantly decreased at 2 days and 1 year after operation ( P<0.05); while compared with 2 days before operation, the anterior vertebral height of the two groups significantly decreased and Cobb angle significantly increased at 1 year after operation ( P<0.05). There was no significant difference in the above indexes between the two groups at different time points after operation ( P>0.05). Compared with curved unilateral puncture, the use of reverse designed unilateral targeted puncture during PVP in the treatment of OVCF can not only achieve similar effectiveness, but also has the advantages of less radiation exposure, shorter operation time, and less hospitalization costs.

Study of Unilateral Extrapedicular and Bilateral Pedicle Approach Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fracture.

To determine the efficacy and complication of unilateral extrapedicular approach (UEA) and bilateral pedicle approach (BPA) percutaneous kyphoplasty (PKP) in treating thoracolumbar osteoporotic compression fractures. A descriptive study. Department of Orthopaedics, Bazhou district people Hospital, Sichuan, China, from December 2016 to March 2021. Patients with single-level thoracolumbar osteoporotic compression fractures, who underwent BPA and UEA PKP, were divided into the UEA (n=47) and BPA group (n=42). Index was recorded including operation duration, bone cement volume, intraoperative X-ray times, complication, visual analogue scale (VAS), Cobb angle, Oswestry dysfunction index (ODI), the recurrence rate of the injured vertebra and adjacent vertebral fractures within 12 months after operation. There were significant differences in operation duration, bone cement volume, and intraoperative X-ray time between the two groups (p<0.05). VAS, Cobb angle, and ODI significantly improved at 3 days and 12 months after the surgery in each group (p<0.05), but no significant statistical difference was found at each time point between the groups (p>0.05). Bone cement leaked 2 cases in UEA and 8 cases in the BPA group (p<0.05). No pulmonary embolism, neurovascular injury, and infection occurred. No significant difference was found in fracture recurrence rate within 12 months after operation (p>0.05). Unilateral extrapedicular percutaneous kyphoplasty is an effective and safe way in treating thoracolumbar osteoporotic fractures with relatively less duration of surgery, intraoperative X-ray exposure, bone cement volume, and leakage rate. Thoracolumbar osteoporotic compression fractures, Unilateral extrapedicular approach, Percutaneous kyphoplasty, Bilateral pedicle approach.

Clinical effect of unilateral balloon infusion of low dose bone cement in PKP for osteoporotic thoracolumbar compression fractures in the elderly.

The study was undertaken to determine the clinical effectiveness of percutaneous kyphoplasty (PKP) with unilateral balloon infusion of low dose of bone cement for treatment of osteoporotic vertebral compression fractures (OVCFs) in the elderly. A retrospective study was carried out. A total of 36 patients with OVCFs treated by PKP from August 2019 and August 2020 were included. Patients were divided into two groups according to the amount of bone cement infused into the vertebral body. The amount of cement in conventional-dose group was 3.5-6.0 mL and the amount of cement in small-dose group was 1.8-3.0 mL. Pain relief before and after the operation were evaluated, and the leakage of bone cement in the two groups was also observed. Two groups of patients have obtained a good clinical efficacy. Pain has significant differences before and after the operation (p < 0.05). More importantly, compared with conventional-dose group, small-dose group has lower bone cement leakage rate (p < 0.05). PKP with small-dose bone cement infusion can obtain the same clinical effects of conventional-dose, but the incidence of bone cement leakage is lower and safe.

Minimally invasive pedicle screw fixation, including the fractured vertebra, combined with percutaneous vertebroplasty for treatment of acute thoracolumbar osteoporotic compression fracture in middle-age and elderly individuals: A prospective clinical study.

To evaluate the feasibility, efficacy, and safety of minimally invasive pedicle screw (MIPS) fixation, including the fractured vertebra, combined with percutaneous vertebroplasty (PVP) for the treatment of acute thoracolumbar osteoporotic compression fracture in middle-age and elderly individuals.Between January 2016 and August 2019, a total of 30 patients, with a mean age of 69.4 years (range, 58–75 years), who experienced thoracic or lumbar fracture without neurological deficits, underwent the MIPS procedure combined with PVP. Preoperative and postoperative pain were assessed using a visual analog scale and Oswestry Disability Index. Cobb angles and anterior column height were measured on lateral radiographs before surgery and at 3 days, 1, 3, and 6 months, and 1 and 2 years at final follow-up after surgery.All patients underwent surgery successfully, with a mean follow-up of 18.2 ± 5.7 months (range, 12–45 months). Mean preoperative visual analog scale score decreased from 7.3 ± 2.2 to 1.4 ± 0.3 at the final follow-up (P < .05). Mean preoperative Oswestry Disability Index decreased from 84.2 ± 10.3 to 18.8 ± 7.5 (P < .05) at the final follow-up. The Kyphosis angle of operative segment was improved from preoperative (21.38 ± 1.68)° to (4.01 ± 1.38)° 3 days postoperatively and (5.02 ± 1.09)° at final follow-up (P < .05). The anterior vertebral height was improved from preoperative (49.86 ± 6.50)% to (94.01 ± 1.79)% 3 days postoperatively and (91.80 ± 1.88)% at final follow-up (P < .05). No significant changes in vertebral body height restoration were observed during 2 years of follow-up after surgery. In addition, there were no instrumentation failures or complications in any of the patients.MIPS, including the fractured vertebra, combined with PVP, was a reliable and safe procedure, with satisfactory clinical and radiological results for the treatment of thoracolumbar osteoporotic compression fracture in patients without neurological deficits.

Three-Dimensional Reconstruction of a CT Image under Deep Learning Algorithm to Evaluate the Application of Percutaneous Kyphoplasty in Osteoporotic Thoracolumbar Compression Fractures.

In order to investigate the therapeutic evaluation of percutaneous kyphoplasty (PKP) for the treatment of osteoporotic thoracolumbar compression fractures by three-dimensional (3D) reconstruction of computed tomography (CT) based on the deep learning V-Net network, the traditional V-Net was optimized first and a new and improved V-Net was proposed. The introduced U-Net, V-Net, and convolutional neural network (CNN) were compared in this study. Then, 106 patients with osteoporotic thoracolumbar compression fractures were enrolled, and 128 centrums were divided into the test group with 53 cases of PKP and the control group with 53 cases of percutaneous vertebroplasty (PVP) according to different surgical protocols. All patients underwent CT scan based on the improved V-Net, and data of centrum measurement indicators, pain score, and therapeutic evaluation results of the modified Macnab were collected. The Dice coefficient of the improved V-Net was observably higher than that of U-Net, V-Net, and CNN, while the Hausdorff distance was lower than that of U-Net, V-Net, and CNN (P < 0.05). The anterior height, central height, and posterior height of the centrum were significantly higher than those in the control group after operation (3, 5, and 7 days), while the Cobb angle of vertebral kyphosis was significantly lower than that in the control group (P < 0.05). The score of visual analog scale (VAS) and analgesic use score of patients in the test group were markedly lower than those in the control group (3, 5, and 7 days after operation), P < 0.05. Besides, the excellent and good rate of the test group was remarkably higher than that of the control group, P < 0.05. Hence, the improved V-Net had better quality of segmentation and reconstruction than the traditional deep learning network. Compared with PVP, PKP was helpful in restoring the height of the centrum in patients with osteoporotic thoracolumbar compression fractures and correct kyphosis, with better analgesic effect safety.

Use of Computed Tomography Compression Ratio in Diagnosis of Disc Injuries and Posterior Ligamentous Complex Injuries in Osteoporotic Thoracolumbar Compression Fractures

Background: Osteoporotic compression fractures are common among the elderly. It is important to predict the posterior ligamentous complex (PLC) and disc injuries in computed tomography (CT) scans of patients with magnetic resonance imaging (MRI) contraindications. Objectives: To determine the role of the CT compression ratio (CTCR) in diagnosing PLC and disc injuries and to compare it with the loss of vertebral body height (LOVBH) in osteoporotic thoracolumbar compression fractures. Patients and Methods: A total of 91 consecutive patients with vertebral fractures were included as the study population. The PLC and disc injuries were assessed using MRI, and the following radiological parameters were determined based on CT scans for further MRI examinations: CTCR, LOVBH, local kyphosis (LK), interspinous widening (ISW), vertebral translation (VBT), and posterior structures fractures (PSF). Statistical analysis was performed to identify the diagnostic value of CT features in PLC and disc injuries. Results: The PLC injuries were detected in 9/91 cases, and the number of disc injuries was 47/91. Neither CTCR nor LOVBH was associated with PLC injuries (P &gt; 0.05). However, the CTCR was associated with disc injuries (P &lt; 0.05), with an optimal threshold of 1.755 (sensitivity, 68.1%; specificity, 79.5%), while the LOVBH was not significantly associated with disc injuries. Based on the results, VBT was significantly related to PLC and disc injuries (P &lt; 0.05). Conclusion: The injured vertebral CTCR was associated with disc injuries rather than PLC injuries, suggesting that compression fractures are relatively stable with less PLC injury. Overall, CTCR is a useful indicator reflecting the compression degree of the injured vertebrae; it is also a valid predictor of disc injuries.

The analgesic efficacy of extracorporeal shock wave combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures in postmenopausal women

BackgroundTo explore the analgesic efficacy of extracorporeal shock wave (ESW) combined with percutaneous vertebroplasty (PVP) after reduction in overextension position in the treatment of osteoporotic thoracolumbar compression fractures in postmenopausal women.MethodsThe data of postmenopausal women with osteoporotic thoracolumbar compression fracture admitted in our department from January 2017 to October 2019 were analyzed retrospectively. They were divided into groups of unipedicular percutaneous kyphoplasty (U-PKP n = 21), bipedicular PKP (B-PKP n = 20), and ESW combined with PVP after reduction in overextension position (EP-PVP n = 18). The improvement of pain and vertebral height in three groups was compared.ResultsPostoperative compression rate and Cobb angle of vertebral fractures in the three groups were all lower than those before surgery, and the differences between pre-operation and post-operation were statistically significant (P < 0.05). The visual analog scale (VAS) and Oswestry dysfunction index (ODI) scores of the three groups decreased significantly after the operation (P < 0.05). The ODI scores of the EP-PVP group in the third months after the operation were significantly improved compared with the other two groups, and the difference was statistically significant (P < 0.05).ConclusionsIn our small-sample study, all three treatment schemes can treat osteoporotic compression fracture of thoracolumbar vertebrae in postmenopausal women, relieve pain, and improve quality of life. ESW combined with PVP after reduction in overextension position could achieve a good vertebral reduction rate and improve kyphosis, and may reduce the application of analgesic drugs.

To investigate the effect of Yougui Pill on bone density and the expression levels of β-CATENIN, DKK-1 and MMP-9 in patients with osteoporotic thoracolumbar compression fracture

To investigate the effect of Yougui Pill on bone density and the expression levels of β-CATENIN, DKK-1 and MMP-9 in patients with osteoporotic thoracolumbar compression fracture

Effectiveness of Tirobot-assisted vertebroplasty in treating thoracolumbar osteoporotic compression fracture

BackgroundPercutaneous kyphoplasty is the main method in the treatment of thoracolumbar osteoporotic compression fractures. However, much radiation exposure during the operation harms the health of surgeons and patients. In addition, the accuracy of this surgery still needs to be improved. This study aimed to assess the radiation exposure and clinical efficacy of Tirobot-assisted vertebroplasty in treating thoracolumbar osteoporotic compression fracture.MethodsIncluded in this retrospective cohort study were 60 patients (60–90 years) who had undergone unilateral vertebroplasty for thoracolumbar osteoporotic compression fracture at our hospital between June 2019 and June 2020. All showed no systemic diseases and were assigned to Tirobot group (treated with Tirobot-assisted approach) and control group (treated with traditional approach). Fluoroscopic frequency, operative duration, length of stay (LOS), post-operative complications (cement leakage, infection, and thrombosis), and pre-operative and pre-discharge indexes (VAS score, JOA score, and Cobb’s angle) were compared.ResultsThe fluoroscopic frequency (P < 0.001) and post-operative complications (P = 0.035) in Tirobot group were significantly lower than those in control group. The operative duration and LOS in the Tirobot group were shorter than those in the control group, but the differences were not statistically significant (P = 0.183). Pre-discharge VAS score and Cobb’s angle decreased, and JOA increased after surgeries in both groups. These three indexes showed a significant difference after surgery in each group (P < 0.001), but not between groups (PVAS = 0.175, PCobb’s = 0.585, PJOA = 0.448).ConclusionThe Tirobot-assisted vertebroplasty can reduce surgery-related trauma, post-operative complications, and patients’ and operators’ exposure to radiation. As a safe and effective strategy, this surgery can realize the quick recovery from thoracolumbar osteoporotic compression fracture.

探究老年骨质疏松性胸腰椎压缩骨折的微创治疗

探究老年骨质疏松性胸腰椎压缩骨折的微创治疗

Choice of osteotomy methods for old thoracolumbar osteoporotic fracture with kyphosis

To investigate the clinical outcome of single or double-segment pedicle subtraction osteotomy (PSO) for the treatment of old thoracolumbar osteoporotic compression fractures with kyphosis. The clinical data of 26 patients with old thoracolumbar osteoporotic compression fractures with kyphosis who underwent surgery from January 2015 to June 2017 were retrospectively analyzed. There were 12 males and 14 females, aged from 58 to 72 years old with an average of 65.6 years. The time interval from fracture to surgery was (8.2±1.5) years. According to different surgical methods, the patients were divided into single-segment PSO group (group A) and double-segment PSO group(groupB). The perioperative data, preoperative and postoperative imaging data and postoperative complications were recorded, and the Oswestry Disability Index (ODI) and visual analogue scale (VAS) were used before and after surgery to evaluate the clinical effect. All patients were followed up for 6-24 months with an average of 14.5 months. There was a statistically significant difference in operation time and intraoperative blood loss between the two groups (P<0.05). There was no significant difference in total drainage volume and length of hospital stay (P>0.05). The postoperative correction angle of the single segment PSO group was (33.3± 9.4) ° with the correction rate of 85.3% and the double segment PSO group was (41.0±13.5) ° with the correction rate of 92.7%, and there was statistical significance between two groups (P<0.05). There were no significant differences in postoperative lumbar lordosis (LL), sagittal vertical axis (SVA), and ODI, VAS between two groups (P>0.05). One case of cone injury occurred in the single-segment PSO group and recovered after treatment. There were no complications of spinal cord injury in the double segment group. Loose screws occurred during surgery in three patients in the single-segment PSO group and one patient in the double-segment PSO group (P<0.05). All 4 patients were re inserted with screws after using bone cement to reinforce the nail pathway. There were no complications such as anterior spinal vascular and nerve damage or osteotomy unfusion. Both single-segment PSO and double-segment PSO can achieve good orthopedic and clinical effects in the treatment of old thoracolumbar osteoporotic fractures with kyphosis. For patients with correction angles greater than 40° , the double-segment PSO provides a better correction angle and is safer, but it is with longer operation time and more intraoperative bleeding.