Treatment Of Compression Fractures Research Articles

Intelligent and Bioactive Osseointegration of the Implanted Piezoelectric Bone Cement with the Host Bone Is Realized by Biomechanical Energy.

Poly methyl methacrylate (PMMA) bone cement is widely used in orthopedic surgeries, including total hip/knee arthroplasty and vertebral compression fracture treatment. However, loosening due to bone resorption is a common mid-to-late complication. Therefore, developing bioactive bone cement that promotes bone growth and integration is key to reducing aseptic loosening. In this study, we developed a piezoelectric bone cement comprising PMMA and BaTiO3 with excellent electrobioactivity and further analyzed its ability to promote bone integration. Experiments demonstrate that the PMMA and 15 wt % BaTiO3 cement generated an open-circuit voltage of 37.109 V under biomimetic mechanical stress, which effectively promoted bone regeneration and interfacial bone integration. In vitro experiments showed that the protein expression levels of ALP and RUNX-2 in the 0.65 Hz and 20 min group increased by 1.74 times and 2.31 times. In vivo experiments confirmed the osteogenic ability of PMMA and 15 wt % BaTiO3, with the increment of bone growth in the non-movement and movement groups being 4.67 and 4.64 times, respectively, at the second month after surgery. Additionally, Fluo-4 AM fluorescence staining and protein blotting experiments verified that PMMA and 15 wt % BaTiO3 electrical stimulation promoted osteogenic differentiation of BMSCs by activating calcium-sensitive receptors and increasing calcium ion inflow by 1.41 times when the stimulation reached 30 min. Therefore, piezoelectric bioactive PMMA and 15 wt % BaTiO3 cement has excellent application value in orthopedic surgery systems where stress transmission is prevalent.

Robot-assisted percutaneous vertebroplasty for osteoporotic vertebral compression fracture treatment and risk factor screening for postoperative refracture.

Osteoporotic vertebral compression fracture (OVCF) is a serious complication of osteoporosis, and percutaneous vertebroplasty (PVP) is a major therapeutic method for OVCF. This study aimed to evaluate the clinical efficacy and postoperative complications of robot-assisted targeted PVP for the treatment of OVCF. The data from 202 OVCF patients were analyzed in this study, including 72 cases received traditional PVP (PVP group), 68 cases received robot-assisted PVP (R-PVP group), and 62 cases underwent robot-assisted PVP combined with targeted plugging (R-PVP + TP group). The fluoroscopic exposure conditions, operative duration, lengths of stay, postoperative bone cement leakage, refracture, Visual Analog Scale (VAS) score, and Oswestry Disability Index (ODI) score were obtained and compared between the three groups. The Kaplan-Meier method and logistic regression model were adopted to screen the risk factors related with postoperative refracture. R-PVP and R-PVP + TP group had significantly reduced fluoroscopic frequency and radiation dose, and reduced cement leakage compared with PVP group. R-PVP + TP not only showed more obvious advantages in these aspects, but also had a lower probability of postoperative refracture. In addition, BMD, fracture vertebral distribution, cement leakage, and surgery methods were independent related with refracture. All the results demonstrated robot assistance could improve the application of PVP in the treatment of OVCF, and robot-assisted PVP combined with targeted plugging showed significantly reduced fluoroscopic exposure, bone cement leakage, and rate of postoperative refracture. BMD, fracture vertebral distribution, cement leakage, and operation methods were identified as four risk factors for the onset of refracture after PVP.

Vertebral Augmentation in Spine Surgery.

Vertebral augmentation has been a well-studied adjunct percutaneous procedure in spine surgery. Cement augmentation has been used in the treatment of compression fractures through kyphoplasties or vertebroplasties. Historically, data have shown no difference between treating compression fractures conservatively versus with percutaneous cement augmentation procedures. Recent literature has shown improvement in patient outcomes and increase in mobility with percutaneous cement augmentation procedures. Cement augmentation has been used in treating patients with spinal column fractures in higher energy trauma. Cement augmentation has shown to have a reduction in local kyphosis, improved pain, and significant height restoration of the anterior column in patients with burst fractures. Augmentation has been used in spinal deformity surgery, specifically to attempt to reduce the risk of proximal junctional kyphosis and to decrease the risk of screw pullout with cement augmented fenestrated screws in patients with osteoporosis. In pathologic compression fractures, cement augmentation is a safe, viable intervention to improve pain control in these patients. This review will go into the new advances of vertebral augmentation and indications for use in treatment today.

Vertebral Compression Fractures in Very Early Onset Inflammatory Bowel Disease.

Patients with VEOIBD receiving care at a single tertiary center were prospectively enrolled in a longitudinal data repository. Retrospective chart review was performed to identify clinical characteristics and comorbidities. Those with clinically apparent vertebral compression fractures subsequently underwent an additional chart review focused on bone health. Three out of 216 (1.4%) patients with VEOIBD had symptomatic vertebral compression fractures. Of the 3 patients with vertebral compression fractures, all had Crohn's disease, 2 had monogenic inflammatory bowel disease, and all reported back pain. One patient notably had a normal dual-energy X-ray absorptiometry, highlighting a potential limitation of dual-energy X-ray absorptiometry to identify increased skeletal fragility in this population. Risk factors for suboptimal bone health included chronic inflammation secondary to poorly controlled inflammatory bowel disease, substantial glucocorticoid exposure, chronic use of other medications associated with suboptimal bone health including proton pump inhibitors and granulocyte colony-stimulating factor, and solid organ transplant. Patients treated with bisphosphonates had improved clinical outcomes, with resolution of back pain and increased bone mineral density. Vertebral compression fracture should be considered in the differential diagnosis of patients with VEOIBD and back pain, especially in those with other risk factors for suboptimal bone health. Treatment of compression fractures with bisphosphonates resulted in resolution of back pain and improved bone density.

Effect of Weekly Teriparatide Administration Followed by Percutaneous Balloon Kyphoplasty on Post-Menopausal Osteoporotic Compression Fracture Treatment

Effect of Weekly Teriparatide Administration Followed by Percutaneous Balloon Kyphoplasty on Post-Menopausal Osteoporotic Compression Fracture Treatment

Fracture behavior of cancellous bone and cancellous bone-PMMA bone cement interface: An experimental study using an integrated methodology (wedge splitting test and Heaviside-based digital image correlation)

Minimally invasive methods, such as balloon kyphoplasty (BKP) and percutaneous sacroplasty (PS), which are now widely used for the surgical treatment of compression fractures, involve injection of a bolus of poly (methyl methacrylate) bone cement (hereafter, “bone cement”) into the fractured tissue. Many of the common complications following these surgeries, such as cement leakage and adjacent-level fractures (in the case of BKP), have been postulated to be related to the quality of the cancellous bone–bone cement interface, which, in turn, is a function of its fracture resistance. It is common to use bovine cancellous bone or polyurethane foam (PF) as a substitute for human cancellous bone in biomechanical studies of these surgical methods. The literature is lacking in studies of determination of fracture properties of human cancellous bone–bone cement interface, bovine cancellous bone–bone cement interface, and PF–bone cement interface. In the present work, an integrated methodology (combination of wedge splitting test and Heaviside-based digital image correlation) was used to make these determinations as well as those for the bone cement, bones and the PF alone. The fracture properties determined were maximum fracture load (Fmax), fracture toughness (Kc), and specific fracture energy (Gf). For example, Gf values for human cancellous bone and human cancellous bone–bone interface were 0.48±0.14 N/mm and 0.38±0.05 N/mm, respectively, whereas in the case of bovine cancellous bone and bovine cancellous bone–bone cement interface, they were 1.08±0.11 N/mm and 0.22±0.05 N/mm, respectively, and for PF (Grades 12.5 and 15.0) and PF–bone cement interface, they were 0.81±0.12 and 0.55±0.06 N/mm, respectively. The same trends were seen in the Fmax and Kc results. These results suggest that it may not be justified to use either bovine cancellous bone or either of the PF grades as a substitute for human cadaveric cancellous bone in biomechanical studies of BKP, PS, and similar surgical methods.

Layered Double Hydroxide Modified Bone Cement Promoting Osseointegration via Multiple Osteogenic Signal Pathways.

Poly(methyl methacrylate) (PMMA) bone cement has been widely used in orthopedic surgeries including total hip/knee replacement, vertebral compression fracture treatment, and bone defect filling. However, aseptic loosening of the interface between PMMA bone cement and bone often leads to failure. Hence, the development of modified PMMA that facilitates the growth of bone into the modified PMMA bone cement is key to reducing the incidence of aseptic loosening. In this study, MgAl-layered double hydroxide (LDH) microsheets modified PMMA (PMMA&LDH) bone cement with superior osseointegration performance has been synthesized. The maximum polymerization reaction temperature of PMMA&LDH decreased by 7.0 and 11.8 °C, respectively, compared with that of PMMA and PMMA&COL-I (mineralized collagen I modified PMMA). The mechanical performance of PMMA&LDH decreased slightly in comparison with PMMA, which is beneficial to alleviate stress-shielding osteolysis, and indirectly promote osseointegration. The superior osteogenic ability of PMMA&LDH has been demonstrated in vivo, which boosts bone growth by 2.17- and 18.34-fold increments compared to the PMMA&COL-I and PMMA groups at 2 months, postoperatively. Moreover, transcriptome sequencing revealed four key osteogenic pathways: p38 MAPK, ERK/MAPK, FGF, and TGF-β, which were further confirmed by IPA, qPCR, and Western blot assays. Hence, LDH-modified PMMA bone cement is a promising biomaterial to enhance bone growth with potential applications in relevant orthopedic surgeries.

Traumatic compression fractures in thoracic-lumbar junction: vertebroplasty vs conservative management in a prospective controlled trial

BackgroundBoth surgery and conservative management are well established treatments for compression fractures of the thoraco-lumbar spine without neurological compromise. This article aims to compare the outcomes of conservative management to...

Vertebral fractures in children during the COVID-19 pandemic

Background. The COVID-19 pandemic has had a significant influence on the main epidemiological indicators of emergency trauma, as well as on the pediatric population.
 Aim. This study aimed to analyze the incidence of compression fractures of vertebral bodies in children between January and July 2020 (the first months of COVID-19 pandemic).
 Materials and methods. A comprehensive examination and treatment of 82 children and adolescents aged 317 years, who received compression fractures of the vertebral bodies in the period from January 1 to July 31, 2020, was carried out. A group of 96 children of the same age who sustained a similar type of injury at the same time in 2019 was studied as a control. To make a clinical diagnosis, we used methods of traditional research examination for emergency traumatology. The severity of vertebrogenic fractures was determined according to the AO/ASIF classification.
 Results. The total number of patients diagnosed with vertebral fractures during the COVID-19 pandemic was 14.58% less than that in the same period in 2019. Patients in the comparison groups were comparable in sex, average age of injury, and age group in which the spine was most often injured. The most frequent mechanism of spinal injuries in patients of the comparison groups was a fall from a height. More often than others, ThVI and ThVII vertebral bodies were broken. The severity of vertebral fractures in all cases corresponded to type A, subtypes A1 and A2. For treatment, conservative methods were used in most cases. During the period of strict self-isolation, in April 2020, no children of the main group had vertebral fracture because they were forbidden to leave their apartments unnecessarily. In May 2020, the number of children with vertebral fractures was half the number in the same month in 2019. In June 2020, the incidence of vertebral fractures was in line with the pre-crisis average.
 Conclusion. Strictly following restrictive anti-epidemic measures during a pandemic is an effective method of reducing the number of cases requiring emergency treatment for compression fractures of the vertebral bodies in children.

Clinical features of reparative regeneration of bone tissue and optimization of treatment for compression fractures of the thoracic and lumbar vertebral bodies against the background of postmenopausal and senile osteoporosis

Introduction. Bone-destructive processes and injuries of the vertebral bodies of the thoracic and lumbar localization are a significant part of the pathology of this localization. According to etiological factors, mechanisms of pathogenesis and the nature of the course, they are a very heterogeneous groups of diseases.Objective: to identify the main factors that determine the development of disorders in compression fractures of vertebral bodies of thoracic and lumbar localization against the background of postmenopausal and senile osteoporosis for improving the prognostic criteria of the disease on the basis of an integrated assessment of the clinical course of the disease and optimizing treatment by activating reparative bone tissue regeneration according to the literature sources analyzed.Material and research methods. Depending on the treatment method used, patients were divided into 3 groups: in group 1 (control group) were 20 patients with compression fractures of vertebrae of thoracic and lumbar localization against a background of postmenopausal and senile osteoporosis, where we used standard methods of therapy. Group 2 (main group) consisted of 20 patients with compression fractures of vertebrae of thoracic and lumbar localization against the background of postmenopausal and senile osteoporosis, in the treatment of which platelet-rich plasma was also used in addition to standard methods of therapy.Research results. Based on the obtained results of the study, we developed an algorithm for surgical treatment of patients with pathological vertebral fractures against the background of osteoporosis. The choice of the method of surgical treatment depends on: the type of fracture, the level of damage, the degree of loss of bone mineral density, the degree of deformation of the spine, the general somatic state of the patient, the presence of stenosis of the spinal canal and signs of neurological deficit, the severity of the pain syndrome.Conclusion. The introduction of platelet-rich plasma to the area of the bone wound shortens the duration of the healing process, in our opinion, by eliminating the phase of inflammation, low intensification of the phase of formation of tissue-specific elements that are present in large amount in platelet growth factors. In order to accelerate the restoration of damaged bone, we used a platelet-rich plasma in addition to standard therapy, and found a positive effect on compressive fractures of the thoracic and lumbar vertebrae against the background of postmenopausal and senile osteoporosis, which justifies the advisability of further use platelet-rich plasma in clinical practice.

Treatment of Compression Fracture of Tibial Condyle in Long-Distance Runners

Treatment of Compression Fracture of Tibial Condyle in Long-Distance Runners

Clinical analysis of bone filling pockets in percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fracture in the elderly

Objective To investigate the efficacy and safety of bone filling pockets(FP) in percutaneous vertebroplasty(PVP) of elderly osteoporotic vertebral compression fracture(OVCF). Methods A retrospective study was performed on 38 cases of elderly patients with OVCF who were performed FP in the PVP from January 2016 to December 2018.There were 8 males and 30 females, aged(76.32±2.43) years old, ranging from 62 to 82 years old, with a total of 42 vertebral segments.The height of vertebral body was measured before operation, 3 days after operation and 12 months after operation.The pain visual analogue score(VAS) and Oswestry dysfunction score(ODI) were used to observe the leakage of bone cement. Results All 38 patients were followed up for 10-12 months.During the follow-up period, there were no pulmonary embolism, 2 bone cement leakage, no spinal cord and nerve root injury, no adjacent vertebral body and operative vertebral body re-fracture.The height of vertebral body of patients[(1.1±0.4) cm, (0.8±0.1) cm, (2.4±0.5) cm]and 12 months after surgery[(1.3±0.4) cm, (1.4±0.2) cm, (2.6±0.3) cm]was significantly higher than those before surgery[(0.6±0.1) cm, (0.7±0.2) cm, (2.2±0.6) cm], with statistically significant differences(P<0.01). VAS scores[(3.50±1.33) scores, (1.55±1.26) scores]and ODI scores[(21.72±5.83) scores, (10.50±4.77) scores]of the patients 3 days after the operation and 12 months after the operation were significantly lower than those of the patients before the operation[(7.14±1.32) scores, (61.74±5.83) scores], and the difference was statistically significant(P<0.01). Conclusion FP applied in the treatment of OVCF by PVP can significantly relieve the pain of vertebral fracture, improve the quality of life of patients, maintain the height of the vertebral body, and effectively reduce bone cement leakage. Key words: Percutaneous vertebroplasty; Osteoporotic vertebral compression fractures; Filling pockets; Bone cement leakages

Compression fractures of the spine in children: isn’t it time to change something?

Objective . To analyze the efficacy of various methods for treatment of children with compression fractures of the thoracic and lumbar spine on the basis of literature data. Material and Methods. A systematic review of the literature on methods for the diagnosis and treatment of compression fractures of the spine in children was carried out. PubMed, Science Direct, and Google Scholar databases were searched for literature sources for analysis. Results. A significant number of discrepancies between the approaches used in the treatment of compression fractures in children and the available literature data were noted. In particular, not any diagnostic protocol includes MRI as a tool to confirm the presence of a fracture, due to the high cost of the method and its low influence on the treatment tactic choice. The data of biomechanical studies cast doubt on the feasibility of long-term bed rest compliance and restrictions on sitting. As for bracing of patients with compression fractures, it has been demonstrated that wearing of rigid brace does not allow achieving better results in comparison with its absence. The child’s ability to remodel residual deformations of vertebral bodies ensures the restoration of their height and shape in the vast majority of cases. Currently, there is no data confirming the fact of earlier development of degenerative diseases and back pain in children who sustained compression vertebral fractures. Conclusion. The review results allow to analyze the efficacy of various treatment methods and can be the basis for reviewing the existing treatment tactics for children with compression fractures of the vertebral bodies.

Efficacy comparison between simulated optimization methods combined with percutaneous vertebroplasty and percutaneous kyphoplasty for osteoporotic thoracolumbar fracture

Objective To compare the clinical efficacy of simulated optimal reduction combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of senile osteoporotic vertebral compression fractures (OVCF). Methods A retrospective case series study was conducted to analyze the clinical data of 136 patients with osteoporotic vertebral compression fractures admitted to the spine surgery department of Luoyang Orthopedic Hospital of Henan Province from January 2014 to January 2015. There were 54 males and 82 females, aged 55 to 83 years old, with an average age of 68.3 years. All the enrolled patients had single segment vertebral compression fractures, whose compression degree was ≥1/3 of adjacent normal vertebral bodies and ≤2/3 of adjacent normal vertebral bodies. Among them, 59 patients were treated with simulated optimal reduction combined with PVP (PVP group), and 77 patients were treated with PKP (PKP group). The operation time, intraoperative fluoroscopy time, incidence of bone cement leakage, hospitalization cost and length of stay were compared between the two groups. Postoperative X-ray and CT examination were performed to observe bone cement diffusion. Before surgery and after surgery (1 day, 1 week, 1 month, 6 months, 1 year, 2 years and 3 years), Visual analogue scale (VAS) score, Oswestry disability index (ODI) scores, Cobb's angle, ratio of anterior and middle height of the affected vertebrae, and the incidence of vertebral refractures within 3 years were compared between the two groups. Results All the patients were followed up for 29-43 months, averaging 36 months. One patient in the PVP group was lost to follow-up after one year. In the PKP group, two patients were lost to follow-up after one year and one patient was lost to follow-up after two years. In the PVP group, single vertebral body operation time [(28.9±5.7)seconds] and intraoperative fluoroscopy time [(54.0±13.4)seconds] were significantly less than those in the PKP group, with statistically significant differences (P 0.05). The hospitalization cost in the PVP group [(9.7±3.2)thousand yuan] was lower than that in the PKP group [(22.35±16.2)thousand yuan](P 0.05). In both groups, the VAS and ODI were significant decreased after operation (P 0.05). The three-year follow-up showed that the re-fracture rate of adjacent vertebral body in the PVP group was significantly lower than that in the PKP group (0 vs. 1.3%)(P<0.01). Conclusion For OVCF, the simulated manual reduction combined with PVP is easy for operation and has no significant difference in short-term analgesic effect compared with PKP, but the recovery of height of diseased vertebra and correction of kyphosis are better, with lower re-fracture rate of adjacent vertebra in the later stage. Key words: Osteoporotic fracture; Vertebroplasty; Percutaneous kyphoplasty

Unilateral approach painless vertebroplasty for osteoporotic vertebral compression fractures of critically ill patients under lateral decubitus position

Objective To investigate the clinical efficacy of unilateral approach painless vertebral augmentation in the treatment of severe osteoporotic vertebral compression fractures (OVCFs) in the critically ill patients under lateral decubitus postition. Methods A retrospective case series study was conducted to analyze 97 patients with severe vertebral fractures admitted to the Henan Provincial People's Hospital from April 2004 to January 2017. There were 27 males and 70 females, aged 59-99 years [(78.5±13.2)years]. There were 11 patients with three-segment fracture, nine patients with two-segment fracture and 77 patients with single fracture. All patients were treated with lateral decubitus unilateral approach for painless vertebral augmentation and received postoperative rehabilitation training guided by physicians. Preoperative and intraoperative blood loss were recorded. Preoperative and postoperative respiratory rate, heart rate, systolic pressure, oxygen saturation and acute physiology and chronic health evaluation score II (APACHE II) , height of vertebral compression site, and injured vertebrae Cobb angle were evaluated. The visual analogue scale (VAS) and Oswestry dysfunction index (ODI) were assessed to define function improvement. Meanwhile, the occurrence of re-fracture and complications were recorded. Results All patients were followed up for 3-8 months [(6.3±2.9)months]. The operation time was (69.2±25.9)minutes, and the amount of intraoperative bleeding was (7.5±2.6)ml. There were no significant differences in respiratory rate, heart rate, systolic blood pressure or oxygen saturation before operation and after operation (P>0.05). No surgical discontinuation or deterioration occurred. The APACHE II score was (15.2±3.7)points before operation and (8.4±0.7)points at 24 hours after operation (P 0.05). The Cobb angle was (25.6±9.3)° before operation, (20.7±2.5)° at one week after operation and (18.5±3.1)° at the last follow-up (P>0.05). The VAS score was (8.5±1.2)points before operation, (2.1±0.3)points at one week after operation, and (3.2±1.1)points at the last follow-up, respectively. The VAS scores at 1 week and the last follow-up were significantly improved compared with preoperative VAS (P 0.05). The ODI value was 39.9±3.4 before operation, 20.2±5.2 at one week after operation, and 17.2±2.0 at the last follow-up . The ODI values 1 week after operation and at the last follow-up were significantly improved compared with preoperative ODI (P<0.05), showing improvement trend during the follow-up (P<0.05). No re-fracture occurred during the follow-up. No serious complications such as nerve injury, pulmonary embolism or death occurred during the operation and postoperative follow-up. Conclusions The unilateral approach painless vertebral augmentation for the treatment of severe OVCFs in critically ill patients under lateral decubitus position can improve the patient's operative tolerance and satisfaction, shorten the operation time, relieve postoperative pain and promote functional recovery. It is an alternative surgical procedure for the treatment of severe OVCFs in internal medicine. Key words: Spinal fractures; Osteoporotic fractures; Vertebral augmentation

Therapeutic effect of unilateral and bilateral pedicle approach percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures

Objective To explore the efficacy of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods A retrospective analysis of 76 patients with OVCF treated with single and double pedicle approach PVP from April 2016 to June 2017 in the First Affiliated Hospital of He′nan University was conducted.According to the operation method, the patients were divided into unilateral group (42 patients, unilateral pedicle approach), and bilateral group (34 cases, bilateral pedicle approach). The operation time, number of intraoperative X-rays, amount of bone cement injection, height of the vertebral body and the complications were compared between the two groups.The visual analogue scale (VAS) and the Oswestry dysfunction index(ODI) score were used to assess the recovery of the patients. Results The unilateral group had less operative time[(33.01±3.78)min], intraoperative X-ray number[(22.06±3.85) times]and bone cement injection[(3.53±0.42) mL] compared with the bilateral group (t=8.54, 5.98, 4.74, all P 0.05). The postoperative VAS and ODI of the two groups were significantly improved compared with those before operation (all P<0.05). Conclusion In the case of reasonable indications, the unilateral approach PVP is better than bilateral, and unilateral approach PVP should be the first choice for OVCF. Key words: Spinal fractures; Vertebroplasty; Osteoporotic; Fractures, compression; Bone cement; Operative time; Comparative effectiveness research

Early efficacy of bone cement modified with mineralized collagen in the treatment of vertebral compression fractures

Objective To investigate the early clinical efficacy of bone cement modified with mineralized collagen in the treatment of osteoporotic vertebral compression fractures with percutaneous vertebroplasty(PVP). Methods All 98 cases of sin-gle vertebral osteoporotic compression fracture from June 2017 to August 2018 were studied. Forty-eight cases were treated with bone cement modified with mineralized collagen (modified group) and 50 cases were treated with traditional bone cement (traditional group). The basic clinical information including age, sex and bone mineral density of all patients were analyzed. The injectable time, volume, distribution (bone cement in the vertebra showing a whole mass without interruption or loss is known as type O while bone cement in the vertebra showing two masses with a small amount or none in the middle is known as type H) and leakage of bone cement during operation, visual analogue score(VAS), Oswestry disability index (ODI), height of anterior, middle and posterior columns of injured vertebrae and the incidence of adjacent vertebral fractures were compared between the two groups. Results There were no significant differences in age, sex, bone mineral density T value and bone ce-ment injection volume between the two groups. VSA score, ODI, anterior and middle column heights were significantly improved on the first day and 6 months after operation (P 0.05). In-traoperative cement injectable time was shorter in the traditional group than the modified group,and there was significant different between the two groups (t=3.428, P=0.002). The incidence of adjacent vertebral re-fracture was 12% in the traditional group and 2% in the modified group. There was significant different between the two groups (χ2=7.061, P=0.029). The leakage rate of bone cement was 10% in the traditional group and 6% in the modified group, andthere was significant difference between the two groups (χ2=7.963, P=0.019). The distribution of bone cement (O/H) in the traditional group was 20/30 and that in the modified group was 19/29, and there was significant difference between the two groups (χ2=38.992, P<0.001). Conclusion Modified bone cement has the same clinical effect as traditional bone cement in relieving pain and restoring the height of injured vertebra in the treat-ment of osteoporotic vertebral compression fractures with PVP. However, the injectable time of modified bone cement is longer. The leakage rate and the incidence of re-fracture of adjacent vertebrae are significantly reduced. Key words: Thoracic vertebrae; Lumbar vertebrae; Osteoporosis; Spinal fractures; Vertebroplasty; Methylmethacrylates

Percutaneous curved vertebroplasty in the treatment of thoracolumbar osteoporotic vertebral compression fractures: a prospective study

Objective To investigate the clinical effect of percutaneous curved vertebroplasty in the treatment of thoracolum-bar osteoporotic vertebral compression fractures (OVCFs). Methods All of 85 patients with single thoracolumbar vertebral OVCFs who met the admission criteria from January 2017 to July 2018 were divided into three groups according to the random dig-its table method. They were treated with percutaneous curved vertebroplasty, routine unipedicular PVP and routine bipedicular PVP respectively. There were 25 patients in the percutaneous curved vertebroplasty group, 6 males and 19 females; aged 56-80 years, with an average age of 70.6±9.7 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 3 cases, L1 9 cases, L2 3 cases, L3 1 case, L4 1 case and L5 2 cases. There were 32 patients in the routine unipedicular PVP group, 6 males and 26 fe-males; aged 58-75 years, with an average age of 69.5±9.3 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 5 cases, L1 11 cases, L2 6 cases, L3 1 case, L4 1 case and L5 2 cases. There were 28 patients in the routine bipedicular PVP group, 5 males and 23 females; aged 59-81 years, with an average age of 69.8±8.8 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 4 cases, L1 10 cases, L2 4 cases, L3 1 case, L4 1 case and L5 2 cases. The operation time, injected cement volume, in-traoperative blood loss were recorded and analyzed. Preoperative, postoperative 1 week and 3 months visual analogue scale scores and oswestry disability index were adopted to value the clinical improvements. Preoperative, postoperative 1 week and 3 months relative vertebral height and kyphosis correction, and the cement leakage rate were measured and analyzed. Results There was no significant difference in the data of gender, age, VAS scores, ODI and distribution of fracture vertebrae among the three groups (P>0.05), and the baseline data was comparable. The average VAS score in the percutaneous curved vertebroplasty group was 2.3±0.5 at 1 week after surgery, that of the routine unipedicular PVP group was 2.4±0.4 and that of the routine bipe-dicular PVP group was 2.4±0.4; the average ODI in the percutaneous curved vertebroplasty group was 19.8%±3.9%, that of the routine unipedicular PVP group was 20.0%±4.1% and that of the routine bipedicular PVP group was 19.9%±3.8%; they were lower than the preoperative data, which were statistically significant (P 0.05). Operation time 39.10±2.00 min vs 38.70±1.70 min, injected cement volume 3.60±0.11 ml vs 3.50±0.13 ml and blood loss 5.10±0.30 ml vs 5.00±0.40 ml of the percutaneous curved vertebroplasty group and the routine unipedicular PVP group were less than those of the routine bipedicular PVP group, which were statistically significant (P<0.05). Conclution Percutaneous curved vertebroplasty could achieve satisfactory clinical outcomes for OVCFs, with advantages of less operation time, less blood loss, limited X-ray expo-sure, less injected cement volume, and more balanced augmentation for stabilization of the affected vertebrae and total verte-bral column. Key words: Thoracic vertebrae; Lumbar vertebrae; Osteoporosis; Spinal fractures; Vertebroplasty

Efficacy comparison of multi-segment and single-segment osteotomy for old osteoporotic vertebral compression fracture combined with kyphosis

Objective To investigate the sagittal correction effect and clinical efficacy of multi-segment Smith-Peterson osteotomy (SPO) and single-segment pedicle subtraction osteotomy (PSO) in the treatment of old osteoporotic vertebral compression fracture (OVCF)combined with kyphosis. Methods A retrospective case control study was conducted to analyze the clinical data of 24 patients with old OVCF combined with kyphosis admitted to Traditional Chinese Medical Hospital of Xiaoshan from February 2014 to July 2016. There were 10 males and 14 females, aged 58-72 years, with an average of 65.6 years. Thirteen patients were treated with multi-segment SPO (Group A), six of whom underwent two-segment SPO and seven underwent three-segment SPO. Eleven patients were treated with single-segment PSO (Group B). The operation time, intraoperative bleeding volume, the number of cases using cement-reinforced nail track, postoperative drainage, hospitalization time and postoperative complications were compared between the two groups. Cobb angle, sagittal vertical axis (SVA), thoracic kyphosis angle (TK) and lumbar lordosis angle (LL) of kyphosis deformity were measured before operation, after operation and at the last follow-up. Oswestry Dysfunction Index (ODI) and Visual Analogue Scale (VAS) were used to evaluate the clinical efficacy at the last follow-up. Results All patients were followed up for 6-24 months, with an average of 15.4 months. The operation time of Group A was (198.1±27.3)minutes, while that of Group B was (237.6±36.1)minutes (P 0.05). Three patients in Group A and one patient in Group B had cerebrospinal fluid leakage (P 0.05). There was no significant difference in SVA, Cobb angle, TK and LL between the two groups at the last follow-up (P>0.05). There was no significant difference in ODI and VAS between the two groups after operation and at the last follow-up (P>0.05). No complications such as spinal cord injury, embolism caused by cement leakage, extraction or rupture of pedicle screw occurred in either group. Conclusion For old osteoporotic vertebrae compressed fractures combined with kyphosis, multi-segment SPO and single-segment PSO can achieve good sagittal correction and clinical efficacy. Single-segment PSO has better correction effect and lower incidence of cerebrospinal fluid leakage, yet accompanied with disadvantages of overcorrection, screw loosening, longer operation time and more blood loss. Key words: Osteoporotic fractures; Thoracic vertebrae; Lumbar vertebrae; Kyphosis; Osteotomy

Are CT Scans Overutilized in the Workup of Vertebral Compression Fractures?

This was a retrospective chart review. Computed tomography (CT) does not aid in determination of compression fracture chronicity and contributes to higher cost and radiation exposure. An examination of extraneous imaging will help to guide appropriate workup. Cost for osteoporotic fracture treatment has been estimated at $17 billion annually; future costs are anticipated to increase by at least 50%. A chart review evaluated patients who received kyphoplasty or vertebroplasty as part of compression fracture treatment. The primary end point of the study was analysis of unnecessary imaging obtained during workup. The secondary outcome was excess radiation exposure incurred from unneeded imaging studies. There were 104 instances (40.2% of n=259 workups) where patients underwent only magnetic resonance imaging (MRI) or bone scan after radiographs. There were 28 instances (10.8%) where patients underwent only radiographs with a comparison study. There were a total of 76 instances (29.3%) where patients underwent extraneous CT scans and 13 instances (5%) where patients underwent both MRI and bone scan, causing an average of 979.4 mGy cm additional radiation exposure. We recommend an algorithm that favors radiographs with comparison study or acquiring either MRI or bone scan to determine acuity. If these are available, CT scan becomes unnecessary and incurs increased costs and radiation exposure.