Search Results (59)

Background: With the global population aging, osteoporosis and associated vertebral compression fractures are increasingly prevalent. While bone mineral density (BMD) remains the standard clinical parameter for diagnosing osteoporosis, it provides an incomplete assessment of holistic spinal bone health. Paraspinal muscles are essential for spinal stability and movement. This narrative review aims to evaluate the interplay between paraspinal muscle status and lumbar spine BMD, thereby providing a scientific foundation for comprehensive bone health management. Methods: A comprehensive literature search was conducted in PubMed using relevant keywords to identify studies evaluating the functional and morphological interactions between paraspinal muscles and bone mineral density. Discussion: Current evidence demonstrates a significant negative correlation between paraspinal muscle FI and lumbar spine BMD. High FI is identified as an independent risk factor for osteoporotic vertebral fractures and a robust predictor of postoperative complications. The relationship between paraspinal muscle CSA and BMD remains debated. Nevertheless, targeted high-impact and resistance training generate substantial mechanical loading through muscle contraction, providing biological stimuli for trabecular BMD preservation. Conclusions: Evidence highlights a critical synergy between paraspinal muscle status and bone mineral density, with muscle fat infiltration acting as a key marker for bone loss and fracture susceptibility. Integrating these muscle parameters with traditional BMD measurements improves fracture risk stratification and osteoporosis management. Full article

Background: Osteoporotic vertebral compression fractures (OVCFs) are among the most 11 common fragility fractures in the elderly. Although vertebroplasty and kyphoplasty provide effective pain relief, new vertebral fractures remain a significant concern postoperatively. Imaging parameters associated with sarcopenia and systemic inflammatory markers have been individually associated with fracture risk, but their combined predictive value in the postoperative period has not been adequately defined. Methods: This retrospective cohort study included 166 patients who underwent vertebroplasty or kyphoplasty for OVCFs with a follow-up period of at least 12 months. Cross-sectional area (CSA) and density (HU) of the Psoas muscle were measured at the L3 mid vertebral level on preoperative CT. Preoperative hematological indices (NLR, PLR, LMR, SII, lymphocyte count, hemoglobin, and MPV) were recorded. The primary outcome was the development of a new vertebral fracture. Group comparisons were performed using Mann–Whitney U tests with Benjamini–Hochberg correction. Logistic regression identified independent predictors. Internal validation was performed using bootstrap optimism correction (1000 iterations) and 10-fold cross-validation. Calibration was assessed using the Hosmer–Lemeshow test and calibration plots. Results: Forty-nine patients (29.5%) developed a new fracture. After multiple comparison correction, Psoas 25 HU (BH-adj p < 0.001, r_rb = −0.810), Psoas CSA (BH-adj p < 0.001, r_rb = −0.622), NLR (BH-adj p = 0.016), lymphocyte count (BH-adj p = 0.009), and hemoglobin (BH-adj p = 0.033) showed significant differences between groups. SII did not remain significant after multiple-comparison correction (BH-adjusted p = 0.092). In multivariate logistic regression, only Psoas CSA (OR = 0.403, 95% CI 0.230–0.708, p = 0.002) and Psoas HU (OR = 0.825, 95% CI 0.770–0.885, p < 0.001) remained independently significant. The parsimonious model, with adequate calibration (Hosmer–Lemeshow p = 0.524), achieved an optimism-adjusted AUC of 0.918 (10-fold CV AUC = 0.924). A Psoas HU threshold of 20.50 yielded 79.6% sensitivity and 94.9% specificity. Conclusions: CT-derived Psoas muscle mass and quality are strongly associated with new vertebral fractures after percutaneous vertebral augmentation procedures in this retrospective cohort and showed stronger independent predictive performance than systemic inflammatory markers. These readily accessible imaging biomarkers can aid in risk stratification, although the proposed threshold requires externally validation before clinical implementation. Full article

Background and Objectives: Complicated osteoporotic thoracolumbar fractures represent a major surgical challenge because compromised bone quality predisposes to progressive deformity, neurological deterioration, and fixation failure. This study aimed to evaluate the clinical and radiological outcomes of hybrid stabilization in patients with severe osteoporotic fractures classified as AO Spine-DGOU OF4–OF5. Materials and Methods: This single-center retrospective observational cohort study included 87 consecutively treated patients with complicated osteoporotic thoracolumbar fractures who underwent surgical treatment between 2012 and 2022. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Radiological outcomes included the regional kyphotic angle (RKA) and interbody fusion graded according to the Bridwell classification. Imaging was reviewed preoperatively, immediately postoperatively, and at follow-up, with 12-month outcomes used for the principal analysis. Additionally, a retrospective comparative analysis was undertaken between the two largest fixation subgroups within the cohort to explore outcome differences across the most representative construct patterns. Results: At 12 months, complete interbody fusion (Bridwell grade I) was achieved in 75.9% of patients. Mean RKA improved from 29.4° ± 14.1° preoperatively to 7.9° ± 8.0° immediately after surgery, with only minimal loss of correction during follow-up. Mean VAS improved from 7.0 ± 1.8 to 2.1 ± 1.2, while mean ODI decreased from 61.3% ± 6.8% to 9.8% ± 1.2% (both p < 0.001). Reoperation for implant-related mechanical failure was required in three patients (3.4%). Conclusions: Hybrid stabilization with cement augmentation was associated with marked improvement in pain, functional disability, and sagittal alignment, as well as a high rate of interbody fusion at 12 months, in patients with complicated osteoporotic thoracolumbar fractures. Given the retrospective observational design, these findings should be interpreted as associations within the treated cohort. Prospective comparative studies are warranted to further validate these results. Full article

Background and Objectives: The optimal pharmacological strategy to mitigate progressive vertebral collapse during the acute phase of osteoporotic vertebral compression fractures (OVCFs) remains a subject of debate. This initial 3-month window is the most critical period for evaluating the structural stability of the fracture, as the majority of progressive height loss occurs before solid bone union is achieved, directly influencing the decision to continue conservative management or transition to surgical intervention. Materials and Methods: In this retrospective study, 123 patients were allocated to control (n = 26), denosumab (n = 35), teriparatide (n = 30), or romosozumab (n = 32) groups. Treatment choice was non-randomized, driven by clinical pragmatism and patient preference. Serial changes in vertebral compression rate (VCR) and pain (VAS) were analyzed over 3 months using linear mixed models (LMMs) specifically adjusted for baseline imbalances in initial VCR. Results: In the unadjusted analysis, DMAB appeared to show a slower progression of compression compared to the control group. However, after adjusting for the initial VCR, no significant structural benefit was observed in any medication group (p > 0.05), with all groups showing small effect sizes (Cohen’s d < 0.4). In contrast, unstable fracture morphology was identified as the most potent driver of vertebral collapse (β = 2.758, 95% CI: 1.51–4.01, p < 0.001). Clinically, the RM group showed significantly lower overall pain levels throughout the follow-up period compared to the control group (p = 0.014). Conclusions: Short-term osteoporosis medication does not significantly mitigate vertebral collapse during the acute phase of OVCFs. Practically, these findings suggest that unstable fracture morphology and the baseline VCR—reflecting a potential ‘floor effect’ where less initially collapsed vertebrae may undergo more significant progression—are more informative predictors of acute collapse than medication choice. Consequently, early imaging-based risk stratification is crucial to identify patients at high risk for progressive deformity, regardless of their pharmacological regimen. Full article

Background: Vertebral compression fractures are prevalent in elderly patients with osteoporosis. While the vertebral augmentation procedure is often used for symptom control and improving life quality, cement leakage is still a significant complication of vertebral augmentation procedures. This case report describes a 92-year-old man with a T8 compression fracture who underwent kyphoplasty with low-viscosity bone cement after failed conservative treatment. Methods: A previously developed decompressed kyphoplasty technique using dual portals was employed to reduce intravertebral pressure; however, fluoroscopy revealed posterior leakage toward the spinal canal. A case-specific intraoperative modification of this established technique was then applied, converting the injection portal into a suction channel to aspirate extravasated cement before it hardened. Results: This approach averted spinal cord compromise, obviated the need for additional decompression surgery, and preserved neurological function. The patient achieved rapid pain relief and early mobilization. Conclusions: This case demonstrates how a suction-assisted intraoperative maneuver may be used to manage posterior cement leakage during decompressed kyphoplasty. Full article

Bone cements based on polymethyl methacrylate (PMMA) remain the clinical standard for joint replacement and vertebral augmentation but suffer from several major challenges. These include excessive stiffness compared with cancellous bone, lack of resorption and osteoconductivity, and thermal necrosis during curing. Calcium phosphate cements (CPCs) are bioactive and resorbable but tend to exhibit low mechanical strength, poor injectability and brittle fracture. The work reported herein developed an injectable composite bone cement by combining spherical, porous, sintered β-tricalcium phosphate (β-TCP) particles with a cyanoacrylate adhesive. The β-TCP granules provided bioactivity and a favorable microarchitecture while the cyanoacrylate ensured strong adhesion and rapid setting. Ion substitution with Mg, Na and Si was found to modify the surface acidity of the material while also inhibiting cyanoacrylate polymerization, thereby extending the setting time and lowering the exotherm temperature. This composite exhibited high chemical stability, smooth injectability and early surface reactivity indicative of osteoconductivity. The compressive strength of the material stabilized at approximately 40 MPa and so exceeded that of cancellous bone. This new material also showed ductility, energy absorption and superior impact resistance, although its tensile and fatigue resistance remained limited. Importantly, the composite provided strength comparable to that of PMMA in cemented models during fixation tests and significantly outperformed CPCs in cementless tibial tray fixation experiments. These findings demonstrate that the present β-TCP/cyanoacrylate cement bridges the gap between PMMA and CPCs by combining injectability and mechanical reliability with bioactivity. This cement is therefore a promising next-generation option for minimally invasive osteoporotic fracture treatment and revision arthroplasty. Full article

Background and Objectives: Osteoporotic vertebral compression fractures (OVCFs) are a common cause of morbidity in the elderly, often resulting in pain, reduced mobility, and diminished quality of life. Treatment options include conservative management, vertebroplasty (VP), and kyphoplasty (KP). This study aimed to compare the clinical outcomes and complication rates of patients treated with kyphoplasty/vertebroplasty versus conservative methods and identify risk factors associated with the development of new fractures. Materials and Methods: This retrospective cohort study included patients diagnosed with OVCFs who were treated either surgically (KP/VP) or conservatively between January 2020 and January 2025. Inclusion criteria encompassed vertebral height loss on CT, STIR hyperintensity on MRI, and a T-score below −2.5. Patients were followed for at least one year. Clinical evaluations included pain scores (VAS), functional status (ODI), and quality of life assessments. Complications and new fracture rates were recorded. Logistic regression analysis was performed to identify risk factors influencing fracture recurrence. Results: A total of 132 patients were analyzed: 65 in the KP/VP group and 67 in the conservative treatment group. The KP/VP group achieved better postoperative pain results (3.2 ± 1.0 vs. 4.0 ± 1.2) with a significant difference of −0.8 (95% CI: −1.2 to −0.4, p = 0.032) and better mobility results (ODI: 4.5 ± 0.8 vs. 3.9 ± 0.9) with a significant difference of 0.6 (95% CI: 0.3–0.9, p = 0.047) and improved quality of life scores (6.7 ± 1.1 vs. 5.9 ± 1.3) with a significant difference of 0.8 (95% CI: 0.4–1.2, p = 0.041). The incidence of new fractures was similar between groups (15.4% vs. 17.9%, p = 0.678). Overall complication rates were 7.7% in the KP/VP group versus 11.9% in the conservative group (p = 0.435). The results from logistic regression analysis showed that age (adjusted OR: 2.48, 95% CI: 1.20–5.13), low bone mineral density (adjusted OR: 0.31, 95% CI: 0.15–0.63), and cement leakage (adjusted OR: 3.10, 95% CI: 1.21–7.99) were identified as risk factors for new fractures. The study found that outdoor activity (adjusted OR: 0.38, 95% CI: 0.20–0.73) and anti-osteoporosis treatment (adjusted OR: 0.17, 95% CI: 0.04–0.79) acted as protective factors against new fractures. The KP/VP group required half the time to recover from their injuries because they used their braces for 3.0 ± 0.5 months instead of 6.0 ± 1.0 months (p < 0.001). Conclusions: Kyphoplasty and vertebroplasty were more effective than conservative treatment in improving pain, mobility, and quality of life in patients with OVCFs. Although the incidence of new fractures did not differ significantly between groups, surgical treatment demonstrated lower complication rates and significantly faster recovery, as evidenced by reduced brace use duration. These findings support the use of KP/VP as a viable option for managing OVCFs in appropriately selected patients. Full article

Background and Objectives: Osteoporotic vertebral compression fractures (OVCFs) are a major cause of morbidity, disability, and loss of independence in the elderly population. The optimal management of these fractures remains debated, especially regarding the balance between conservative treatment and minimally invasive surgical techniques such as percutaneous vertebroplasty (VP). This study aimed to compare clinical and radiological outcomes of VP and conservative management in patients with acute OVCFs. Materials and methods: A retrospective observational cohort study was conducted on 120 patients with acute OVCFs treated either conservatively or through percutaneous VP using polymethylmethacrylate (PMMA) cement. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) for pain, Roland–Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI). Evaluations were performed at baseline and at 1, 3, 6, and 12 months post-treatment. Radiological follow-up assessed fracture healing and new vertebral fractures. Results: Patients treated with VP experienced significantly faster pain relief and functional improvement than those managed conservatively, with marked differences in VAS, RMDQ, and ODI scores within the first month (p < 0.01). By 12 months, outcomes converged between groups, with comparable pain and functional levels. No major complications were reported; cement leakage was asymptomatic, and no neurological or systemic adverse events occurred. Radiological healing was satisfactory in both groups, without increased risk of adjacent fractures in the VP group. Conclusions: Percutaneous vertebroplasty resulted in faster short-term improvement compared with conservative treatment, while functional outcomes converged over time. The retrospective, non-randomized design limits causal inference. Full article

Background/Objectives: Osteoporotic vertebral fractures (OVFs) are common in older adults. While surgery is generally reserved for unstable or painful fractures, some OVFs conceal underlying malignancies, including metastatic and hematologic cancers. This study aimed to determine the pooled prevalence of unsuspected malignancy in patients initially diagnosed with OVFs. Methods: A systematic search of PubMed and Scopus was conducted from inception to September 2025 in accordance with PRISMA guidelines. Eligible studies included adults with presumed OVFs who underwent vertebral biopsy and histopathological evaluation. Prevalence estimates were pooled using a random-effects model, and study quality was assessed with the Newcastle–Ottawa Scale. Results: Thirteen studies involving 3513 patients were included. The pooled prevalence of malignancy was 8.0% (95% CI: 5.4–10.6), comprising metastatic solid tumors (4.9%; 95% CI: 2.3–7.4) and multiple myeloma (2.6%; 95% CI: 1.3–3.9). Malignancy was detected in 2.7% (95% CI: 1.8–4.1) of routine biopsy cohorts versus 36.8% (95% CI: 22.1–54.4) of clinically suspected cases. Diagnostic yield exceeded 45% in patients selected by combined history, imaging, or known malignancy. No biopsy-related complications or procedure-related mortality were reported. Moderate heterogeneity was observed, mainly in suspected cohorts. Conclusions: Vertebral biopsy is a safe and diagnostically valuable procedure in vertebral compression fractures. Its yield ranges from about one in 30 patients in routine settings to nearly one in two in high-risk groups, underscoring the importance of structured patient selection to facilitate timely cancer detection and referral. Full article

Background/Objectives: Vertebroplasty (VP) and kyphoplasty (KP) are widely performed minimally invasive procedures for osteoporotic vertebral compression fractures and vertebral metastases. Although generally safe, postoperative surgical site infections (SSIs) can lead to severe complications. The true incidence of SSIs and optimal prophylactic antibiotic strategies remains unclear. This study evaluated SSI incidence and the impact of antibiotic timing and type using a nationwide quality assessment (QA) database in South Korea. Methods: We analyzed data from the 7th to 9th QA waves of the Health Insurance Review and Assessment (HIRA) Service, including 23,868 patients who underwent VP or KP. SSI incidence was compared across antibiotic timing groups (preoperative-only, postoperative-only, and combined) and antibiotic types. Multivariate logistic regression identified independent risk factors for SSIs. Results: SSI occurred in 47 patients (0.20% of 23,868 procedures). No infections were observed in the preoperative-only group, compared with 0.36% in the postoperative-only group and 0.19% in the pre- and postoperative group. The lowest incidence (0.16%) was seen with first- or second-generation cephalosporins. Multivariate analysis found no significant difference between the preoperative-only and the combined regimens, nor between first-/second-generation cephalosporins and broad-spectrum antibiotics. However, surgery at a tertiary hospital (aOR: 3.566) and malnutrition (aOR: 2.915) were independently associated with increased SSI risk. Conclusions: This nationwide study, the largest to date on VP and KP, demonstrated that SSIs are rare (0.2%). A single preoperative dose of first- or second-generation cephalosporins was as effective as combined or broader-spectrum regimens. Targeted preventive measures may be warranted for high-risk groups such as patients with malnutrition or those treated in tertiary hospitals. Full article

Percutaneous vertebroplasty (PVP) has emerged as a key intervention for painful vertebral compression fractures in osteoporotic and metastatic disease, but its safety profile warrants comprehensive evaluation. We conducted a PRISMA-compliant systematic review of studies published between 2009 and 2024, identifying 15 clinical studies (n ≈ 8500 patients) that reported PVP-related complications in adults with osteoporotic or neoplastic fractures. Data extraction focused on complication incidence, presentation, imaging findings, risk factors, and management strategies. Cement leakage was the most frequently detected event (20–70% of levels, higher in neo-plastic lesions), yet symptomatic neural or vascular sequelae occurred in <1%. Pulmonary cement embolism appeared on imaging in 2–26% of cases but was clinically evident in ≤0.5%, with conservative management or brief anticoagulation sufficing for most patients. New vertebral fractures developed in 8–20% of osteoporotic and up to 30% of metastatic cohorts, paralleling underlying bone fragility rather than PVP itself. Postprocedural infection (0.2–0.5%) and neurologic injury (<0.5%) were uncommon but required prompt surgical and antibiotic interventions. Overall, PVP’s benefits—rapid pain relief and mechanical stabilization—outweigh its risks when performed with meticulous technique, vigilant imaging, and multidisciplinary follow-up, confirming its favorable safety profile in both osteoporosis and spinal malignancy. Full article

Background/Objectives: The debate continues, despite numerous studies, on whether vertebroplasty (VP) or conservative treatment is more suitable for osteoporotic vertebral compression fractures (OVCFs). Meanwhile, teriparatide (TP) has shown promise in accelerating bone healing in OVCFs. This analysis aims to clarify the potential benefits of conservative treatment using TP over VP from several clinical studies on acute OVCFs. Methods: A literature search was performed, using the MEDLINE, Embase, Cochrane Review, Web of Science, and Google Scholar databases, for studies published up until September 2023. Five studies [one randomized controlled study (RCT) and four non-RCTs] were included in a qualitative and quantitative synthesis. Data were extracted and analyzed using a random-effects model to obtain the effect size. Results: Five studies with a total of 326 (TP = 147, VP = 179) patients were included. Within the first week of treatment, the VP group showed a significantly greater decrease in their visual analog scale (VAS) scores. There was no significant difference in VAS score reduction between the two groups from one to three months. However, after 6 months, the TP group exhibited significant superiority in VAS scores and bone mineral density (BMD). Furthermore, TP was associated with a reduced number of new-onset OVCFs, with a statistically significant estimated odds ratio of 0.15 (95% CI, 0.04–0.51, p < 0.01). Conclusions: Conservative treatment using TP for acute OVCF has been found to reduce subsequent fractures, provide equivalent or superior pain control, and increase BMD compared to VP. Nonetheless, the meta-analysis results are weak, due to the low level of evidence. Full article

Introduction: Vertebral Compression Fractures (VCF) are the most common vertebral fractures, usually osteoporotic, with rising incidence. The natural history of VCFs-related pain remains unclear, and treatment protocols are still being evaluated, ranging from conservative to surgical. Patient-reported measures have been proven inaccurate and carry significant biases. This study examines maximal tenderness location (MTL) to palpation and percussion on physical examination during VCF healing and the postoperative period. Methods: A prospective study included 40 patients treated for VCFs per the NICE guidelines (2013) from 2019 to 2021. Treatment was either conservative (n = 12) or surgical (n − 28), Balloon Kyphoplasty (BKP). All patients’ MTL were recorded in EMR (Electronic Medical Record) on every visit. BKP was offered for severe ongoing pain after a recent, unhealed vertebral fracture despite optimal pain management, progressive fracture collapse, or lack of union. Follow-up was six months. Pain evolution was analyzed using Kaplan–Meier survival curves, Log-Rank tests, Mann–Whitney U tests, t-tests, and logistic regression models. A p-value < 0.05 was considered statistically significant. Results: 12 patients were treated conservatively, and 28 underwent BKP for T12-L2 VCFs, accounting for 75% of fractures, mostly single-level fractures. All initially suffered MTL over the VCF; BKP patients showed local VCF pain resolution after 3.5 weeks following surgery while lasting seven weeks under conservative treatment. Lumbosacral pain was more prevalent following BKP (OR = 4, p = 0.05) and developed earlier. Conclusions: This study is novel in relating physical examination findings to fracture age and treatment provided, suggesting that VCFs-related pain is a time-related shift from local fracture pain to lumbosacral pain. Patient-reported pain scales may not reliably distinguish between these varying pain patterns. These findings suggest that only local VCF pain should be considered for surgical treatment. Future studies evaluating VCF outcomes should address physical examination and not rely solely on patient-reported metrics. Full article