Managements of osteoporotic vertebral compression fractures:A narrative review

Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review of the management of OVCFs.The purpose of this study is to review background information,diagnosis,and surgical and non-surgical management of the OVCFs.A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed.Combinations of the following terms were used:compression fractures,vertebral compression fractures,osteoporosis,osteoporotic compression fractures,vertebroplasty,kyphoplasty,bisphosphonates,calcitonin,and osteoporosis treatments.Additional articles were also included by examining the reference list of articles found in the search.OVCFs,especially those that occur over long periods,can be asymptomatic.Symptoms of acute OVCFs include pain localized to the mid-line spine,a loss in height,and decreased mobility.The primary treatment regimens are pain control,medication management,vertebral augmentation,and anterior or posterior decompression and reconstructions.Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain.Bisphosphonates and denosumab are the first-line treatments for osteoporosis.Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief.Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications.Calcium and vitamin D supplementation can have a protective and therapeutic effect.Management of OVCFs must be combined with multiple approaches.Appropriate exercises and activity modification are important in fracture prevention.Medication with different mechanisms of action is a critical long-term causal treatment strategy.The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods.Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present.The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.

A Comparative Study of High-viscosity Cement Percutaneous Vertebroplasty vs. Low-viscosity Cement Percutaneous Kyphoplasty for Treatment of Osteoporotic Vertebral Compression Fractures

The clinical effects of two different methods–high-viscosity cement percutaneous vertebroplasty（PVP） and low-viscosity cement percutaneous kyphoplasty（PKP） in the treatment of osteoporotic vertebral compression fractures（OVCFs） were investigated. From June 2010 to August 2013, 98 cases of OVCFs were included in our study. Forty-six patients underwent high-viscosity PVP and 52 patients underwent low-viscosity PKP. The occurrence of cement leakage was observed. Pain relief and functional activity were evaluated using the Visual Analog Scale（VAS） and Oswestry Disability Index（ODI）, respectively. Restoration of the vertebral body height and angle of kyphosis were assessed by comparing preoperative and postoperative measurements of the anterior heights, middle heights and the kyphotic angle of the fractured vertebra. Nine out of the 54 vertebra bodies and 11 out of the 60 vertebra bodies were observed to have cement leakage in the high-viscosity PVP and low-viscosity PKP groups, respectively. The rate of cement leakage, correction of anterior vertebral height and kyphotic angles showed no significant differences between the two groups（P〉0.05）. Low-viscosity PKP had significant advantage in terms of the restoration of middle vertebral height as compared with the high-viscosity PVP（P〈0.05）. Both groups showed significant improvements in pain relief and functional capacity status after surgery（P〈0.05）. It was concluded that high-viscosity PVP and low-viscosity PKP have similar clinical effects in terms of the rate of cement leakage, restoration of the anterior vertebral body height, changes of kyphotic angles, functional activity, and pain relief. Low-viscosity PKP is better than high-viscosity PVP in restoring the height of the middle vertebra.

Diagnosis and Treatment and Infection Protection Strategy of Osteoporotic Vertebral Compression Fractures Minimally Invasive Percutaneous Kyphoplasty Surgery during the Prevention and Control of COVID-19

Background: As the global novel coronavirus pneumonia (NCP) remains severe, elderly people are at high risk for NCP and osteoporotic vertebral compression fractures, with high complications and mortality. How to treat patients and protect medical staff from infection, and at the same time strictly prevent the occurrence of clustered transmission events in the hospital, the establishment of perfect pre-hospital emergency measures and infection prevention and control strategy is the first element to ensure success. Objective: To establish the diagnosis and treatment and infection protection strategy for Osteoporotic vertebral compression fractures (OVCF) patients undergoing minimally invasive percutaneous kyphoplasty (PKP) surgery during the prevention and control of COVID-19, so as to ensure the stable, orderly and safe medical treatment. Methods: A total of 583 OVCF patients were admitted to the First Affiliated Hospital of Hebei North University during the epidemic prevention and control period from January 2020 to July 2022. After urgent and outpatient strict standardized screening, 382 patients met the inclusion criteria, including 112 males and 270 females, aged (70.50 ± 5.49) years. The preoperative visual analogue scale (VAS) score was 6.92 ± 1.86. Preoperative Oswestry disability index (ODI) was 74.67 ± 4.84. The satisfaction rate was (45.89 ± 3.67) %. According to the clinical diagnostic criteria and classification, 367 patients were diagnosed as ordinary OVCF, including 156 cases of mild compression and 226 cases of moderate compression. The clinical classification of 15 patients with OVCF diagnosed as COVID-19 was type I, including 10 cases of mild COVID-19 and 5 cases of common COVID-19. All patients were treated with PKP. Results: All patients were followed up at 1 day, 1 month and 3 months after operation, VAS (2.01 ± 0.56, 0.45 ± 0.11, 0 ± 0), ODI (45.41 ± 4.15, 10.22 ± 2.73, 4.03 ± 1.57) and satisfaction (90.12%, 95.57%, 99.23%) were significantly improved compared with those before operation (p < 0.05), and the original medical diseases were not aggravated. In this group, 15 cases of OVCF diagnosed with COVID-19 were given priority to treat COVID-19 under strict three-level protection in the designated isolation ward. PKP was carried out after the condition was stable, and the areas, items and personnel in contact with patients during the perioperative period must be strictly and thoroughly disinfected. The patient had a good prognosis, no complications, no cross-infection in the hospital, and no infection rate among medical staff. Conclusions: The implementation of the diagnosis and treatment and infection protection strategy for OVCF patients undergoing minimally invasive PKP surgery during the prevention and control of COVID-19 has a guiding role in preventing the spread of infection, improving the cure rate, promoting rapid recovery, reducing complications and reducing mortality.

Comment on “Outcomes of different minimally invasive surgical treatments for vertebral compression fractures: An observational study”

Recently we read the article entitled“Outcomes of different minimally invasive surgical treatments for vertebral compression fractures:An observational study”.This was an observational study that reviewed the safety and efficacy of different cement augmentation modalities for vertebral compression fractures under osteoporotic condition.Overall,this is a valuable study that can provide a reference for clinical practice.On the other hand,we also noticed some points in the article and are willing to share our views.Further studies with a higher level of evidence can add more knowledge regarding relevant concerns.

Outcome analysis of surgical interventions for osteoporotic vertebral compression fractures

Objective To compare the clinical outcomes of 2 surgical interventions for osteoporotic vertebral compression fractures(OVCF).Methods Sixty-five patients with OVGF from March 2005 to March 2009 were included in this clinical study.They

The impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity during treatment of osteoporotic vertebral compression fractures with balloon kyphoplasty

This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture （OVCF）, who received balloon kyphoplasty. Patients were divided into four groups： Group 1 had no superior endplate fracture, Group 2 had fractures on the anterior portion of the superior endplate, Group 3 had fractures on the posterior portion of the superior endplate, and Group 4 had complete superior endplate fractures. Anterior and middle vertebral body height, vertebral compression ratio, vertebral height loss rate, and kyphosis Cobb angle of each patient were measured and visual analogue scale （VAS） and Oswestry disability index （ODI） scores were recorded. The anterior vertebral height and kyphosis deformity of all groups significantly improved after the surgery, whereas substantial anterior vertebral height loss and increased Cobb angle were observed in all patients at the last follow-up. Although the vertebral height loss rate and the Cobb angle in Group 2, 3 and 4 were larger compared with Group 1 at the last follow-up, only the vertebral height loss rate in Group 4 and the increase in the Cobb angle in Group 2 and 4 were statistically different from those in Group 1. The VAS and ODI scores in all groups measured after the surgery and at the last follow-up were significantly lower compared with preoperative scores, but there was no significant difference among these groups. Balloon kyphoplasty significantly improved vertebral fracture height and kyphosis. Vertebral height loss and increased kyphotic deformity were observed in OVCF patients with endplate fractures after the surgery. Postoperative aggravation of kyphosis was observed in Group 2. Furthermore, severe vertebral height loss and increased kyphotic deformity were confirmed in Group 4 after the surgery. Our results suggested that postoperative vertebral height loss and aggravation of kyphosis may be associated with biomechanical changes in the vertebral body caused by endplate fracture. Therefore, surgery should not only restore compressed vertebral body height and correct kyphosis, but also correct the deformity of endplate to achieve an effective treatment of OVCF patients with endplate fracture.

Outcomes of different minimally invasive surgical treatments for vertebral compression fractures:An observational study

BACKGROUND Osteoporosis with vertebral compression fractures is increasingly common in the elderly population.Cement augmentation is one of the effective surgical treatments for these patients.Currently,there are several different types of cement augmentation treatments.No studies have compared the safety and efficacy of different cement augmentation types for the treatment of such fractures;thus,we retrospectively compared vertebroplasty,balloon kyphoplasty,and kyphoplasty with SpineJack or an intravertebral expandable pillar.AIM To compare the postoperative safety and efficacy of each surgical intervention in treating vertebral compression fractures.METHODS We retrospectively analyzed 354 patients with acute vertebral compression fractures,defined as signal changes in the T1 weighted magnetic resonance imaging,and randomly divided the patients into five groups.Their visual analog scale scores for pain,kyphotic angle,average body height,rate of cement leakage,and occurrence of adjacent vertebral compression fractures were followed for 1 year.One-way analysis of variance,the post hoc Bonferroni test,and Fisher exact probability test were used for statistical analyses.RESULTS All pain scores significantly improved 12 mo postoperatively;however,there was no significant difference between the groups(P=0.325).Kyphoplasty with SpineJack significantly reduced the kyphotic angle(P=0.028)and restored the height of the vertebral body(P=0.02).The rate of adjacent compression fractures was the highest in the vertebroplasty group,with a statistically significant difference according to the Fisher exact probability test(P=0.02).The treatment with the lowest cement leakage rate cannot be identified because of the small sample size;however,kyphoplasty with SpineJack,an IVEP,and vesselplasty resulted in lower rates of cement leakage than balloon kyphoplasty and vertebroplasty.CONCLUSION Kyphoplasty with SpineJack has good outcomes in kyphotic angle reduction and body height restoration.Vertebroplasty has the highest cement leakage rate and adjacent compression fracture occurrence.

Full-endoscopic spine surgery treatment of lumbar foraminal stenosis after osteoporotic vertebral compression fractures:A case report

BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral compression fractures.We herein report such a case,including the patient’s treatment process and doctor’s surgical experience.CASE SUMMARY A 79-year-old man presented with symptoms of radiculopathy after sustaining L4 vertebral compression fractures.Imaging and physical examination revealed L4 vertebral compression fractures combined with L3/4 Lumbar foraminal stenosis(LFS).The patient’s symptoms were low back pain with pain in the lateral left leg.Although many reports have described radiculopathy induced by osteoporotic vertebral compression fractures,the use of FESS combined with PVP has rarely been reported.This case report indicates that the combination of FESS and PVP is a safe and effective approach for the treatment of LFS-induced radiculopathy after vertebral compression fractures.This minimally invasive technique has great potential to replace traditional lumbar fixation and decompression surgery.Thus,we suggest the continued accumulation of similar cases to discuss the wider application of FESS.CONCLUSION For patients with osteoporotic vertebral compression fracture(OVCF)and LFS,PVP and FESS can be used to restore the vertebral height and reduce the pressure around the intervertebral foramen.Additionally,the combination of FESS and PVP can treat the pain or numbness of the low back and lower limbs and allow for recovery in a short time with excellent postoperative effects.In general,FESS is a good treatment for radiculopathy caused by foraminal stenosis after OVCF.

Comparative Analysis and Exploration of Clinical Value of Kyphoplasty and Conservative Treatment for Osteoporotic Vertebral Compression Fractures

Objective:To explore the clinical value of kyphoplasty and conservative treatment for osteoporotic vertebral compression fractures.Methods:40 patients with Osteoporotic vertebral compression fracture from May 2019 to November 2021 were selected.The control group was treated with conservative treatment and the experimental group was treated with kyphoplasty.Results:Compared with the control group,the experimental group had higher total effective rate(95.00%),better recovery of Cobb Angle and vertebral height,and higher quality of life score.The data was more meaningful(P<0.05).Conclusion:For patients with osteoporotic vertebral compression fractures,the application of kyphoplasty can improve the treatment effect,accelerate the recovery of vertebral body function and enhance the quality of life,which is worthy of popularization.

Kyphoplasty versus vertebroplasty for the treatment of malignant vertebral compression fractures caused by metastases： a retrospective study

Background There are few comparative studies regarding kyphoplasty （KP） and vertebroplasty （VP） for the treatment of painful vertebral compression fractures （VCF） in patients with cancer. The purpose of this study is to retrospectively compare KP with VP in pain improvement, cement leakage incidence, and the cost of treatment of malignant VCE Methods We performed a retrospective study of clinical data for 80 patients with multiple spinal metastases, treated with KP in 42 cases and VP in 38. Visual analog scale （VAS） scores were collected pre-operatively, post-operatively, at 1 month, 6 months, and 1 year after treatment. Cement leakage was identified using fluoroscopy and CT scan. Total cost per patient was also collected. Results There was a significant difference between the pre- and post-operative VAS scores （7.4＋2.0 to 3.8＋1.6, P 〈0.001 in the KP group; 6.7＋2.4 to 3.7＋1.4, P 〈0.001 in the VP group）, and was maintained at 1-year follow-up （3.2＋1.4 in the KP group, 3.1＋1.3 in the VP group）. However, the difference in VAS score between these two groups was insignificant at baseline and every follow-up assessment post-operatively （P 〉0.05）. The incidence of cement leakage in the KP group was lower than that of the VP group （16.9% （14/83） vs 30.3% （23/76）, P 〈0.05）. However, none of the patients developed any symptoms. The length of postoperative hospital stay in the VP group was shorter than that of the KP group （（2.4＋1.3） vs （5.3＋1.9） days, P 〈0.05）. Total hospital cost in the KP group was much higher than that of the VP group （RMB Yuan 8 492_＋3 332 vs RMB Yuan 3 173~1 341, P〈0.01）. Conclusions VP and KP are both effective in providing pain relief for patients with cancer-related VCF. KP provides no greater degree of pain improvement. KP is associated with a lower rate of cement leakage compared with VP. VP is associated with lower cost and shorter postoperative hospital stay in China.

Poly(methyl methacrylate) bone cement composited with mineralized collagen for osteoporotic vertebral compression fractures in extremely old patients

To examine the clinical effects of a new bone cement composed of poly(methyl methacrylate)(PMMA)and mineralized collagen(MC)compared with pure PMMA bone cement in treating osteoporotic vertebral compression fractures(OVCFs)in patients aged over 80.In all,32 cases using pure PMMA bone cement and 31 cases using MC-modified PMMA(MC-PMMA)bone cement for OVCFs between June 2014 and March 2016 were screened as PMMA group and MC-PMMA group,respectively,with an average age of over 80.The operation duration,intraoperative blood loss,hospital stay,oswestry disability index(ODI),visual analogue scale(VAS),anterior vertebral height(AVH),intermediate vertebral height(IVH)and posterior vertebral height(PVH)of injured vertebrae,vertebral computed tomography value,re-fracture rate of adjacent vertebrae,correction rate of spinal kyphotic angle and wedge-shaped vertebra angle and surgical complications were compared between the two groups.In the early post-operative period,the VAS,ODI,AVH and IVH in MC-PMMA group were comparable to those in the traditional PMMA group.Moreover,the MC-PMMA group showed better effects compared with the PMMA group 12months after surgery.Thus,this new bone cement has superior clinic effects in the long term.

Clinical observations of osteoporotic vertebral compression fractures by using mineralized collagen modified polymethylmethacrylate bone cement

To investigate the clinical outcomes of the treatment of osteoporotic vertebral compression fractures(OVCFs)by using mineralized collagen(MC)modified polymethylmethacrylate(PMMA)bone cement.52 cases(52 vertebras)who sustained OVCF treated with MC modified PMMA bone cement from July 2014 to December 2015 were reviewed retrospectively.All the cases(52 patients,52 vertebras)included 8 males and 44 females with an average age of 74.83(ranging from 57-to 90-years old).The visual analogue scale(VAS),vertebral body height,Cobb angle,CT values preand post-operation as well as incidence of complications were used to be observed.All the patients underwent the surgery were successfully followed-up with an average period of 13.54 months(ranging from 6 to 23 months).The patients can ambulate at the second day after the operation.The VAS scores 2 days after the operation and during the last follow-up were significantly decreased compared with that before the operation(P<0.05);the average vertebral height and local Cobb angle had significant recovery(P<0.05);the CT value of the treated vertebra significantly increased compared with that before the operation(P<0.05).MC with good osteogenic activity and degradation properties can effectively improve the mechanical properties and biocompatibility of the PMMA bone cement,thus obtain better clinical results.

Experimental Study on the Repair Effect of Xianlinggubao Capsule on Osteoporotic Vertebral Compression Fracture in Rabbits

[Objectives]To observe the effect of Xianlinggubao Capsule on osteoporotic vertebral compression fracture(OVCF)in rabbits and the influence mechanism of the repair of fractures.[Methods]Female June age 30 rabbits were randomly divided into control group,model control group and Xianlinggubao group.After bilateral ovariectomy,the model control group and Xianlinggubao group were injected with dexamethasone continuously for 4 weeks,and then the OVCF compound model was established by surgery.The Xianlinggubao group was treated with Xianlinggubao at a dose of 300 mg/(kg·d)for 60 d,while the blank control group and the model control group were treated with the same amount of normal saline for 60 d.The number of blood vessels and the expression of bone morphogenetic protein-2(BMP-2)were detected by immunohistochemical staining and the bone mineral density(BMD)in the callus of the third lumbar fracture area of rabbits was measured.The content of serum phosphorus(P),alkaline phosphatase(ALP)and total calcium(TCa)in rabbit venous blood were measured by automatic biochemical analyzer.The content of vascular endothelial growth factor(VEGF)and platelet-derived growth factor(PDGF)in rabbit venous blood were measured by ELISA kit.[Results]The number of blood vessels and the expression of BMP-2 in the callus of the third lumbar fracture area of rabbits was high in Xianlinggubao group,the content of serum P,ALP,TCa,VEGF and PDGF was obviously increased,BMD was obviously increased,the bone microstructure of the third lumbar vertebrae fracture area of rabbits was basically restored.Compared with the model control group(P<0.05),the difference was statistically significant.[Conclusions]Xianlinggubao Capsule can increase calcium and phosphorus deposition,promote the formation of blood vessels in the fracture area of OVCF in rabbits,and have a strong repair effect on OVCF in rabbits.

The Clinical Effect of Zoledronic Acid Combined with Teriparatide in Perverting Recurrent Fracture of Osteoporotic Vertebral Compressive Fractures in the Elderly after Percutaneous Kyphoplasty

Background: Zoledronic acid and teriparatide have been proved to be effective in improving bone metabolism and preventing fractures, but there is no clear clinical report on the efficacy of their combined application. Purpose: To discuss the clinical effect of zoledronic acid combined with teriparatide in perverting recurrent fracture of osteoporotic vertebral compressive fractures (OVCF) in the elderly after percutaneous kyphoplasty (PKP). Method: A randomized clinical trial was conducted at the First Affiliated Hospital of Hebei North University in China from September 2018 and September 2019. A total of 60 patients with OVCF were enrolled in the study (zoledronic acid: 20 cases;teriparatide: 20 cases;zoledronic acid + teriparatide: 20 cases). Observe and compare the changes of bone mineral density (BMD), pro-collagen type I N-terminal propeptide (PINP) and cross-linked C-terminal telopeptide of type I collagen (β-CTX) before surgery, 6 months and 1 year after surgery. At the same time, secondary fracture events and adverse reaction events were recorded during the follow-up period. Results: After normalized treatment, the bone metabolism indexes of PINP and β-CTX were improved and BMD was increased in three groups. Adverse Reactions: There was no statistical significance in the incidence of fever, gastrointestinal reactions and myalgia among the three groups (P > 0.05). The incidence of recurrent fractures in group A was higher than that in group C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). Conclusion: Zoledronic acid combined with teriparatide is superior to Zoledronic acid in preventing the risk of recurrent fracture after PKP for old patients with OVCF, but it has no significant advantage over teriparatide.

Clinical Research of Pre-Hospital Emergency Care, Nursing, Infection Prevention and Control for Senile Osteoporotic Vertebral Compression Fracture during Epidemic Period

Background: Novel coronavirus pneumonia (NCP) and osteoporotic vertebral compression fractures (OVCF) are the high incidences of diseases in the elderly. During the epidemic period, if not treated in time, the complications are high and the mortality is high. If we do not pay attention to infection prevention and control in pre-hospital emergency care, it will lead to the first time infection of medical staff and in-hospital cross infection in emergency outpatient receiving area. The correct consideration of both and the establishment of perfect pre-hospital emergency treatment and infection prevention and control synchronous strategy is an important premise to ensure the stable, orderly and safe medical treatment. Objective: To explore the effect of synchronous implementation of pre-hospital emergency care, nursing and infection pre-vention and control for senile OVCF during the epidemic. In order to improve the efficiency of pre-hospital emergency care and prevent the spread of infection. Method: A total of 92 elderly patients with OVCF who received pre-hospital treatment in 18 hospitals in Zhangjiakou City during the epidemic prevention and control period from January 2020 to November 2022 and met the inclusion criteria were selected as research objects, including 24 males and 68 females, aged 65 - 82 (74.2 ± 2.2) years. All patients were associated with concomitant injuries and underlying diseases. All patients in this group underwent predictive pre-hospital rescue and infection prevention and control procedures. Results: All the 92 elderly patients with OVCF received timely pre-hospital treatment during the epidemic period, and no aggravation occurred of the 92 patients, 35 were in the high risk area, 10 were in the medium risk area, and 47 were in the low risk area. Exclude OVCF for NCP Patients were treated according to the conventional diagnosis and treatment principles. Suspected and confirmed cases are transferred to designated surgical hospitals for treatment. All patients were followed up 3 months, 6 months and 12 months after treatment. There was no death rate, high satisfaction of pre-hospital first aid, high diagnostic accuracy, and good curative effect. None of the rescue personnel had any infection rate, and no hospital infection transmission and nosocomial cross infection occurred. Conclusion: It is the first step to safely treat patients and prevent cross infection to establish a perfect synchronous strategy of pre-hospital first aid and infection prevention and control.

Effect of Osteoporotic Vertebral Compression Fracture on Adjacent Intervertebral Disc Degeneration

Objective:The influence of vertebral compression fracture on the degeneration of adjacent disc was analyzed.Methods:88 patients with osteoporotic vertebral compression fractures admitted to the orthopedic pain department from July 2014 to July 2019 were selected as the research objects.According to the previous MRI and the improved MRI results of admission,the patients were converted into old fractures after conservative treatment.They were followed up in 3,6 and 12 months after discharge,and the VAS score at each time point(visual acuity score)was calculated We collected and analyzed the classifcation of intervertebral disc degeneration and MRI index.Results:The follow-up rate was 659%(58/88);There were 42 cases(72.4%)of degenerative disc adjacent to the diseased vertebra,and 16 cases(27.5%)of adjacent intervertebral disc did not degenerate;VAS scores were 1ower at 14 days,3 months,6 months and 12 months after admission;The number of grade 1 of disc degeneration was lower in 6 months and 12 months than that in admission(P<0.05),and the number of grade 2,3 and 4 was significantly higher than that in the follow-up in December(P<0.05).The difference between 6 and 12 months was not statistically significant(P>0.05);MRI index at 6 and 12 months follow-up was lower than that at admission(P<0.05).Conclusion:Through the research and analysis,we found that osteoporotic vertebral compression fracture will have a corresponding impact on the adjacent intervertebral disc,which can make the adjacent intervertebral disc degenerate.

Pedicle Screw Fixation with Kyphoplasty Decreases the Fracture Risk of the Treated and Adjacent Non-treated Vertebral Bodies:a Finite Element Analysis

Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures（OVCFs） after kyphoplasty.This finite element study was to examine whether short segment pedicle screw fixation（PSF） with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae after kyphoplasty for OVCFs.By simulating cement augmentation with or without short segment pedicle screw fixation（PSF）,two tridimensional,anatomically detailed finite element models of the T10–L2 functional spinal junction were developed.The insertion of pedicle screws into the intact vertebra apparently decreased the stress distribution of the treated vertebra in vertical compression and other load situations.The stress distribution in the bone structures of the intact vertebra adjacent to the intact-screwed vertebra was much less than that in the one adjacent to the treated vertebra.The insertion of pedicle screws into the intact vertebra greatly decreased the maximum displacement of the cortical bones and cancellous bones of the vertebrae.Our results indicated that short segment PSF with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae in the management of OVCFs.

Cemented vertebra and adjacent vertebra refractured in a chronic kidney disease-mineral and bone disorder patient: A case report

BACKGROUND Although percutaneous vertebral augmentation(PVA)is a commonly used procedure for treating vertebral compression fracture(VCF),the risk of vertebral refracture should be considered.Chronic kidney disease-mineral and bone disorder(CKD-MBD)is a systemic disease of mineral and bone metabolism.It is associated with an increased risk of fracture.Few studies have reported the use of PVA in patients with CKD-MBD.We herein report a rare case wherein the cemented vertebra and the adjacent vertebra refractured simultaneously in a CKD-MBD patient after PVA.CASE SUMMARY A 74-year-old man suffered from low back pain after taking a fall about 3 wk ago.According to physical examination,imaging and laboratory findings,diagnoses of T12 VCF,CKD-MBD,and chronic kidney disease stage 5 were established.He then received percutaneous vertebroplasty at T12 vertebra.Fourteen weeks later,he presented with T12 and L1 vertebral refractures caused by lumbar sprain.Once again,he was given PVA which was optimized for the refractured vertebrae.Although the short-term postoperative effect was satisfactory,he reported chronic low back pain again at the 3-month follow-up.CONCLUSION It is necessary that patients with CKD-MBD who have received PVA are aware of the adverse effects of CKD-MBD.It may increase the risk of vertebral refracture.Furthermore,the PVA surgical technique needs to be optimized according to the condition of the patient.The medium-and long-term effects of PVA remain uncertain in patients with CKD-MBD.

Predictive risk factors for recollapse of cemented vertebrae after percutaneous vertebroplasty: A meta-analysis

BACKGROUND As one of the most common complications of osteoporosis,osteoporotic vertebral compression fracture(OVCF)increases the risk of disability and mortality in elderly patients.Percutaneous vertebroplasty(PVP)is considered to be an effective,safe,and minimally invasive treatment for OVCFs.The recollapse of cemented vertebrae is one of the serious complications of PVP.However,the risk factors associated with recollapse after PVP remain controversial.AIM To identify risk factors for the recollapse of cemented vertebrae after PVP in patients with OVCFs.METHODS A systematic search in EMBASE,MEDLINE,the Cochrane Library,and PubMed was conducted for relevant studies from inception until March 2020.Studies investigating risk factors for the recollapse of cemented vertebrae after PVP without additional trauma were selected for analysis.Odds ratios(ORs)or standardized mean differences with 95%confidence interval(CI)were calculated and heterogeneity was assessed by both the chi-squared test and the I-squared test.The methodological quality of the included studies was assessed according to the Newcastle-Ottawa Scale.RESULTS A total of nine case-control studies were included in our meta-analysis comprising 300 cases and 2674 controls.The significant risk factors for the recollapse of cemented vertebrae after PVP in OVCF patients were fractures located at the thoracolumbar junction(OR=2.09;95%CI:1.30 to 3.38;P=0.002),preoperative intravertebral cleft(OR=2.97;95%CI:1.93 to 4.57;P<0.00001),and solid lump distribution pattern of the cement (OR = 3.11;95%CI: 1.91 to 5.07;P < 0.00001).The analysis did not support that age, gender, lumbar bone mineral density,preoperative visual analogue scale score, injected cement volume, intradiscalcement leakage, or vertebral height restoration could increase the risk forcemented vertebra recollapse after PVP in OVCFs.CONCLUSIONThis meta-analysis suggests that thoracolumbar junction fractures, preoperativeintravertebral cleft, and solid lump cement distribution pattern are associatedwith the recollapse of cemented vertebrae after PVP in OVCF patients.

Total spinal anesthesia caused by lidocaine during unilateral percutaneous vertebroplasty performed under local anesthesia:A case report

BACKGROUND Intradural anesthesia caused by anesthetic drug leakage during percutaneous vertebroplasty(PVP)has rarely been reported.We here report a 71-year-old woman who suffered this rare and life-threatening complication during PVP.CASE SUMMARY A 71-year-old woman,who suffered from 2 wk of severe back pain with a visual analog score of 8,came to our outpatient clinic.She was later diagnosed with a newly compressed L1 fracture and was then admitted in our department.PVP was initially attempted again under local anesthesia.However,serendipitous intradural anesthesia leading to total spinal anesthesia happened.Fortunately,after successful resuscitation of the patient,PVP was safely and smoothly performed.Great pain relief was achieved postoperatively,and she was safely discharged on postoperative day 4.The patient recovered normally at 3-mo follow-up.CONCLUSION Total spinal anesthesia secondary to PVP by anesthetic drug leakage rarely occurs.In cases of inadvertent wrong puncture leading to drug leakage when performing it under local anesthesia,surgeons should be highly vigilant during the whole procedure.Electrocardiogram monitoring,oxygen inhalation,intravenous cannula set prior to surgery,regular checking of motor activity and a meticulous imaging monitoring with slower pushing of anesthetic drugs,etc.should be highly recommended.