Search Results (46)

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

Poly (methyl methacrylate) (PMMA) bone cement is widely used in percutaneous vertebroplasty to stabilize osteoporotic vertebral compression fractures. However, its clinical application is limited by its high compressive modulus, risk of thermal necrosis, and poor bone integration, unlike conventional PMMA formulations used in vertebrae or joint arthroplasty, which can reach polymerization temperatures exceeding 100 °C. Spine-specific PMMA is formulated to cure at a reduced polymerization temperature, thereby minimizing the rise in core temperature during the setting process. Consistent with our hypothesis, this moderate thermal output induces localized thermal injury that triggers osteogenic responses and extracellular matrix production, thereby enhancing osteoblast activity in the surrounding bone. This study aimed to evaluate bone remodeling following spine-specific PMMA injection in an osteoporotic Sprague-Dawley (SD) rat model. Twenty-four osteoporotic female SD rats were randomly assigned to three groups: Control (untreated), OVX + spine-specific PMMA (OVX + PMMA), and OVX (OVX + Defect). Bone regeneration was assessed using dual-energy X-ray absorptiometry (DXA), micro-computed tomography (Micro-CT), quantitative PCR (qPCR), immunohistochemistry (IHC), and Western blotting. At 12 weeks post-injection, the OVX + PMMA group exhibited significantly greater bone regeneration than the OVX group. Micro-CT analysis demonstrated a marked increase in trabecular thickness in the PMMA-treated group. Notably, bone formation was more pronounced in regions surrounding the cement compared to adjacent untreated areas. This suggests that spine-specific PMMA promotes osteogenesis via localized thermal necrosis and subsequent osteoblast recruitment. These findings highlight the dual role of spine-specific PMMA in both structural stabilization and biologically driven bone regeneration. Further research is warranted to optimize its clinical applications while minimizing potential adverse effects. Full article

Background: Cement leakage remains a significant challenge in percutaneous vertebroplasty (PVP). Leakage can lead to serious complications, including spinal cord compression, pulmonary embolism, and nerve root irritation. While several techniques have been proposed to minimize leakage, an effective and simple solution is still needed. This study investigates the impact of pre-washing vertebral bodies with cold saline before cement injection as a potential method to reduce leakage. Methods: A retrospective analysis was conducted on patients who underwent PVP for osteoporotic vertebral compression fractures. Patients were divided into three groups: (1) conventional PVP, (2) PVP with room-temperature saline pre-injection, and (3) PVP with cold saline (4 °C) pre-injection. Cement leakage was assessed using intraoperative fluoroscopy and postoperative computed tomography (CT), categorized into paravertebral, intervertebral, retrograde, spinal canal, and distant venous leakage. Statistical analysis was performed to compare leakage rates among the groups. Results: A total of 262 patients with 461 treated vertebrae were analyzed. Cold saline pre-treatment significantly reduced cement leakage rates compared to conventional PVP and room-temperature saline pre-injection (p < 0.05). CT imaging detected significantly more cement extravasation than fluoroscopy (p < 0.01). The incidence of spinal canal and intervertebral leakage was lowest in the cold saline group, suggesting improved cement containment and distribution. Conclusions: Pre-washing vertebral bodies with cold saline before cement injection in PVP significantly reduces cement leakage, particularly in the spinal canal and intervertebral spaces. This simple and cost-effective approach may enhance surgical safety and improve patient outcomes. Full article

Background and Objectives: Balloon kyphoplasty is one of the most commonly performed minimally invasive surgical procedures for the treatment of osteoporotic vertebral fractures, with the bipedicular technique being the conventional approach. However, the use of both pedicles may present certain disadvantages, including higher costs, longer operative times, increased radiation exposure, and a greater risk of bone cement leakage. This study aims to report the 3-year follow-up outcomes of double-pedicle and single-pedicle kyphoplasty performed at our institution. Materials and Methods: Between June 2016 and May 2019, a total of 136 patients who presented to our clinic with osteoporotic vertebral fractures and underwent balloon kyphoplasty were included in this retrospective study. Pain relief and quality of life indices were assessed preoperatively and postoperatively. During follow-up examinations, radiographs, VAS (Visual Analog Scale) scores, and ODI (Oswestry Disability Index) scores were evaluated. Radiation exposure was assessed using fluoroscopy time and dose area product (DAP) values. Additionally, total injected cement volume, operative time, and procedural complications were retrieved from patient records. Results: The procedure was successful in all patients. The mean bone cement volume used was 3.4 ± 1.4 mL in the unipedicular group and 5.3 ± 2.1 mL in the bipedicular group. Fluoroscopy time and DAP values were significantly higher in the bipedicular technique compared to the unipedicular technique. At the final follow-up, the average kyphosis correction and mean vertebral height correction ratio were greater in the bipedicular group. The mean reduction in VAS and ODI scores was superior in the bipedicular group at the 1-, 2-, and 6-month follow-ups. However, at the 1-, 2-, and 3-year follow-ups, there was no significant difference in VAS and ODI scores between the two groups. Conclusions: The unipedicular balloon kyphoplasty technique offers several advantages, including shorter operative time, lower cement leakage risk, reduced radiation exposure, and comparable pain score reductions at 1- to 3-year follow-ups. However, the bipedicular technique provides superior short-term pain relief and demonstrates better sagittal alignment correction in long-term follow-ups compared to the unipedicular approach. Full article

Background: The present study aims to investigate the influence of systematic radiological screening for silent vertebral fractures (VFs) on osteoporosis diagnosis, treatment decisions, and long-term clinical outcomes compared to standard care without routine screening in elderly patients hospitalised primarily for fractures requiring surgical treatment at sites other than the spine. Material/Methods: In a level 1 trauma centre, patients with fractures requiring surgical treatment after low-energy trauma were prospectively examined over a period of 12 months. Using radiographs of the thoracic and lumbar spine in two planes, previously unknown VFs were identified and categorised according to the classification for osteoporotic fractures (OFs) of the thoracolumbar spine. Results: A total of 106 patients with a mean age of 79.4 years participated in this study, and 112 previously unknown vertebral compression fractures were diagnosed in 57% (60/106) of the patients. In this group, lumbar vertebra 2 was the most frequently affected, and the majority of these VFs were classified as OF 2, which corresponds to an isolated endplate fracture with minimal involvement of the posterior wall. Furthermore, 26% (28/106) of the patients in the evaluation showed VFs at multiple levels. This study revealed no statistically significant difference in the prevalence of silent VFs between male and female patients (p = 0.055). Additionally, the analysis revealed that nearly 75% of patients exhibited vitamin D insufficiency. Conclusions: The high prevalence of silent VFs in elderly patients emphasises the necessity for systematic radiological investigations, irrespective of gender. Full article

Objectives: The aim of this study was to investigate the incidence of vertebral refractures following percutaneous kyphoplasty (PKP) and to explore risk factors for augmented vertebral refractures, thereby assisting spinal surgeons in clinical practice. Methods: We analyzed the records of 495 patients with single-segment osteoporotic vertebral compression fractures (OVCFs) who were treated with single-entry PKP at our institution from March 2016 to August 2022. Univariate analysis, binary logistic regression, and ROC curve analysis were performed to determine potential risk factors, independent risk factors, and discrimination ability. Results: A total of 168 patients were included in the study, with a median follow-up duration of 7.00 months. In total, 143 patients did not experience vertebral refracture after surgery, while 25 patients did, including 22 augmented vertebral fractures and 3 adjacent vertebral compression refractures. The correction rate of the Cobb angle (p < 0.001; OR = 1.070) and postoperative anti-osteoporosis treatment (p = 0.002; OR = 0.021) were independently associated with augmented vertebral refracture. The ROC curves showed that these variables demonstrated satisfactory predictive values for augmented vertebral refracture. Conclusions: A high degree of restoration of the Cobb angle was the factor contributing to vertebral refracture after PKP. Conversely, postoperative anti-osteoporosis treatment was observed to be a protective factor against subsequent vertebral refracture. Full article

Background/Objectives: Early studies have suggested that the SARS-CoV-2 virus has a deleterious effect on bone mineral density and may increase the risk of pathological fractures. This study characterized vertebral compression fractures in patients with and without a prior diagnosis of COVID-19. Methods: Using a nationwide claims database, this retrospective study used ICD-10 billing codes to identify patients with a diagnosis of vertebral compression fracture from January 2020 to April 2022. Two cohorts were created based on whether the patients had a concurrent diagnosis of COVID-19. Patient demographics, comorbidities, and outcome measures were characterized by descriptive analysis. Results: In total, 413,425 patients met the inclusion criteria. Among them, a total of 23,148 patients (5.60%) had a diagnosis of COVID-19 at the time of their compression fracture. Among the COVID-19 patients, the incidences of vertebral compression fracture were 0.42% in 2020 and 0.33% in 2021, in comparison to the historical average yearly incidence of 0.17% across all patients. The patients with COVID-19 at the time of compression fracture diagnosis had a higher rate of vitamin D deficiency (OR: 1.25) and a lower rate of routine healing (OR: 0.61). The patients without COVID-19 were more likely to be osteoporotic (OR: 0.88), experience additional compression fractures (OR: 0.38), and have kyphoplasty or vertebroplasty (OR: 0.73). Conclusions: Despite lower rates of osteoporosis, patients with a concomitant COVID-19 diagnosis exhibited a higher incidence of compression fractures. Although more research is needed, these results support increasing bone health surveillance in patients with a history of COVID-19 infection. Full article

Background: Vertebral compression fractures (VCFs) are the most prevalent type of osteoporotic fractures, often causing significant pain, morbidity, and mortality. Vertebral augmentation procedures like balloon kyphoplasty (BK) are effective in treating VCFs. These procedures are typically performed using a single fluoroscopy machine (SF) for anteroposterior (AP) and lateral views. We have implemented a dual-fluoroscopy (DF) technique to reduce procedure time and radiation exposure. The goal of this study was to determine whether dual-fluoroscopy could optimize surgical efficiency without compromising safety, offering a more effective alternative to traditional single-fluoroscopy methods. Methods: This retrospective study included 126 patients who underwent BK with either SF (n = 74, 58.7%) or DF (n = 52, 41.3%) between 2020 and 2024. We collected data on procedure duration per pedicle (PDPP), radiation exposure (reference air kerma and dose-area product [DAP]), and radiation duration. A sub-analysis of post-learning phase cases was performed. Results: A learning curve was identified for the first 24 cases and 15 cases using the SF technique and DF technique, respectively, which was followed by a stabilization in procedure duration per pedicle (Levene’s statistic = 10.623, p = 0.002 for SD difference, p < 0.001 for mean PDPP difference). After the completion of the learning phase for both techniques, the DF group demonstrated a significantly shorter PDPP (11.83 ± 4.3 vs. 14.03 ± 5.57 min, p = 0.049). No significant differences were found in radiation exposure, including radiation duration (p = 0.577), reference air kerma, or DAP. Conclusions: Dual-fluoroscopy significantly reduces procedure time after the learning curve is overcome, improving efficiency without increasing radiation exposure. This technique holds promise for optimizing kyphoplasty workflow and safety, supporting broader clinical adoption. Full article

Background/Objectives: Lumbar degenerative disease is a common age-related condition, with epidural steroid injection (ESI) being a widely employed conservative treatment approach. However, the potential effect of ESI on osteoporosis and fracture risk remains unclear. This study investigated the risk of osteoporotic vertebral compression fractures (OVCFs) in patients with lumbar degenerative disease who underwent ESI treatment. Methods: A cohort of 64 patients who received ESI treatment and a control group of 256 patients were included in this study. Demographic data, clinical characteristics, and follow-up information were collected. Cox proportional hazards models were used to analyze risk factors for OVCF, and subgroup analyses were conducted. Results: OVCF was more common in the ESI group than in the control group (hazard ratio [HR]: 3.49, 95% confidence interval [CI]: 1.06–11.43, p = 0.039). After confounding factors were adjusted for, ESI remained an independent risk factor for OVCF (HR: 4.60, 95% CI: 1.01–20.89, p = 0.048). In a subgroup analysis, lower socioeconomic status was associated with higher OVCF risk (HR: 11.82, 95% CI: 1.06–131.26, p = 0.044). The ESI group had improved short-term pain relief, with nonsignificant long-term effects. Conclusions: Patients with lumbar degenerative disease receiving ESI treatment are at an increased risk of OVCF, particularly those with lower socioeconomic status. These findings underscore the importance of regular bone density monitoring and fracture prevention following ESI treatment. Clinicians should carefully weigh the short-term benefits of ESI against the long-term risks and develop individualized follow-up plans for high-risk patients. Full article

Osteoporosis and low bone mineral density (BMD) pose significant challenges in adult spinal deformity surgery, increasing the risks of complications such as vertebral compression fractures, hardware failure, proximal junctional kyphosis/failure, and pseudoarthrosis. This narrative review examines the current evidence on bone health optimization strategies for spinal deformity patients. Preoperative screening and medical optimization are crucial, with vitamin D supplementation showing particular benefit. Among the pharmacologic agents, bisphosphonates demonstrate efficacy in improving fusion rates and reducing hardware-related complications, though the effects may be delayed. Teriparatide, a parathyroid hormone analog, shows promise in accelerating fusion and enhancing pedicle screw fixation. Newer anabolic agents like abaloparatide and romosozumab require further study but show potential. Romosozumab, in particular, has demonstrated significant improvements in lumbar spine BMD over a shorter duration compared to other treatments. Surgical techniques like cement augmentation and the use of larger interbody cages can mitigate the risks in osteoporotic patients. Overall, a multifaceted approach incorporating medical optimization, appropriate pharmacologic treatment, and tailored surgical techniques is recommended to improve outcomes in adult spinal deformity patients with compromised bone quality. Future research should focus on optimizing the treatment protocols, assessing the long-term outcomes of newer agents in the spine surgery population, and developing cost-effective strategies to improve access to these promising therapies. Full article

Introduction: Vertebral compression fractures (VCFs) pose a considerable healthcare burden and are linked to elevated morbidity and mortality. Despite available anti-osteoporotic treatments (AOTs), guideline adherence is lacking. This study aims to evaluate subsequent hip fracture incidence after index VCF and to elucidate AOT prescribing patterns in VCF patients, further assessing the impact of surgical interventions on these patterns. Materials and Methods: Patients with index VCFs between 2010 and 2021 were identified using the PearlDiver database. Diagnostic and procedural data were recorded using International Classification of Diseases (ICD-9, ICD-10) and Current Procedural Terminology (CPT) codes. Patients under age 50 and follow-up <one year following index VCF were excluded. Patients were categorized based on whether they received AOT within one year, preceding and after index VCF, and were subsequently propensity-matched 1:3 based on age, sex, and Elixhauser Comorbidity Index (ECI) score to compare hip fracture incidence following index VCF. Sub-analysis was performed for operatively managed VCFs (kyphoplasty/vertebroplasty). Statistical tests included Chi-squared for categorical outcomes, and Kruskal–Wallis for continuous measures. Results: Of 637,701 patients, 72.6% were female. The overall subsequent hip fracture incidence was 2.6% at one year and 12.9% for all-time follow-up. Propensity-matched analysis indicated higher subsequent hip fracture rates in patients initiated on AOT post-index VCF (one year: 3.8% vs. 3.5%, p = 0.0013; all-time: 14.3% vs. 13.0%, p < 0.0001). Conclusions: The study reveals an unexpected increase in subsequent hip fractures among patients initiated on AOT post-index VCF, likely due to selection bias. These findings highlight the need for refined osteoporosis-management strategies to improve guideline adherence, thereby mitigating patient morbidity and mortality. Full article

Background and Objectives: Osteoporotic vertebral compression fractures (OVCFs) are prevalent among the elderly, often leading to significant pain, morbidity, and mortality. Effective management of underlying osteoporosis is essential to prevent subsequent fractures. This study aimed to compare the clinical and radiographic outcomes of teriparatide and denosumab treatments in patients with OVCFs to determine their relative effectiveness in improving patient outcomes. Materials and Methods: This retrospective study included 78 patients diagnosed with an acute thoracolumbar OVCF who received either teriparatide (35 patients) or denosumab (43 patients) within three months of a fracture. Clinical outcomes were assessed using the visual analog scale (VAS) for back pain, Oswestry disability index (ODI), and EQ-5D quality of life scores at baseline, 6 months, and 12 months. Bone mineral density (BMD) and radiographic outcomes were evaluated initially and at 12 months post-treatment. Results: Both treatment groups demonstrated significant improvements in VAS, ODI, and EQ-5D scores over 12 months. No significant differences were observed between the teriparatide and denosumab groups in terms of clinical outcomes or radiographic measurements at any time point. Fracture union and BMD improvements were similarly observed in both groups. The teriparatide group had a lower baseline BMD, but this did not affect the overall outcomes. Conclusions: Both teriparatide and denosumab are effective in improving clinical and radiographic outcomes in patients with OVCFs. Despite concerns about denosumab’s potential to hinder fracture healing, our study found no significant differences between the two treatments. These findings support the use of denosumab for early treatment of OVCFs to prevent subsequent fractures without compromising fracture healing. Further prospective studies are needed to confirm these results. Full article

Background: The objective of our study was to biomechanically evaluate the use of kyphoplasty to stabilize post-traumatic segmental instability in incomplete burst fractures of the vertebrae. Methods: The study was performed on 14 osteoporotic spine postmortem samples (Th11–L3). First, acquisition of the native multisegmental kinematics in our robot-based spine tester with three-dimensional motion analysis was set as a baseline for each sample. Then, an incomplete burst fracture was generated in the vertebral body L1 with renewed kinematic testing. After subsequent kyphoplasty was performed on the fractured vertebral body, primary stability was examined again. Results: Initially, a significant increase in the range of motion after incomplete burst fracture generation in all three directions of motion (extension–flexion, lateral tilt, axial rotation) was detected as proof of post-traumatic instability. There were no significant changes to the native state in the adjacent segments. Radiologically, a significant loss of height in the fractured vertebral body was also shown. Traumatic instability was significantly reduced by kyphoplasty. However, native kinematics were not restored. Conclusions: Although post-traumatic segmental instability was significantly reduced by kyphoplasty in our in vitro model, native kinematics could not be reconstructed, and significant instability remained. Full article

Osteoporotic vertebral compression fractures (OVCFs) are the most prevalent fractures among patients with osteoporosis, leading to severe pain, deformities, and even death. This study explored the use of ectopic embryonic calvaria derived mesenchymal stem cells (EE-cMSCs), which are known for their superior differentiation and proliferation capabilities, as a potential treatment for bone regeneration in OVCFs. We evaluated the impact of EE-cMSCs on osteoclastogenesis in a RAW264.7 cell environment, which was induced by the receptor activator of nuclear factor kappa-beta ligand (RANKL), using cytochemical staining and quantitative real-time PCR. The osteogenic potential of EE-cMSCs was evaluated under various hydrogel conditions. An osteoporotic vertebral body bone defect model was established by inducing osteoporosis in rats through bilateral ovariectomy and creating defects in their coccygeal vertebral bodies. The effects of EE-cMSCs were examined using micro-computed tomography (μCT) and histology, including immunohistochemical analyses. In vitro, EE-cMSCs inhibited osteoclast differentiation and promoted osteogenesis in a 3D cell culture environment using fibrin hydrogel. Moreover, μCT and histological staining demonstrated increased new bone formation in the group treated with EE-cMSCs and fibrin. Immunostaining showed reduced osteoclast activity and bone resorption, alongside increased angiogenesis. Thus, EE-cMSCs can effectively promote bone regeneration and may represent a promising therapeutic approach for treating OVCFs. Full article