Vertebral Bone Drilling (Puncture) Attenuates the Intractable Pain Due to Vertebral Fractures without Collapse

Purpose: Osteoporotic vertebral fractures with no sign of vertebral collapse on initial radiographs, which is so-called occult vertebral fractures (VFs), exist. Occult VFs have a high rate of missed diagnosis, and the treatment of these fractures has rarely been discussed in the literature. We evaluated the effects of vertebral bone drilling for the pain due to occults VFs. Materials and Methods: Eighteen patients with painful osteoporotic occult VFs underwent the vertebral bone drilling. We evaluated the clinical outcome by comparing numerical rating scale (NRS) and activity of daily life (ADL) values between before and after the vertebral bone drilling. Comparisons were made by using Wilcoxon signed rank test. Results: The mean baseline NRS and ADL score, and the mean NRS and ALD score after the bone drilling were 8.4 ± 0.8, 2.2 ± 0.6, 2.4 ± 1.0, 4.6 ± 0.5, respectively. Among the patients, we detected significant improvements in NRS pain score and ADL score after the drilling compared with baseline score (p < 0.0002). Conclusion: Vertebral bone drilling at the site of painful vertebral compression fractures alleviated the intractable pain due to osteoporotic occult VFs.

Prevalence of osteoporosis and vertebral fractures and related factors in patients with ankylosing spondylitis

Background Osteoporosis and vertebral factures are well recognized features in patients with ankylosing spondylitis （AS）.The aim of this study was to investigate the prevalence and risk factors of osteoporosis and vertebral fractures in patients with AS.Methods Fifty-nine AS patients and 40 healthy controls were enrolled.Bone mineral density （BMD） was measured using dual-energy X-ray absorptiometry （DEXA） at posterior-anterior （PA） lumbar,lateral lumbar and hip regions.Thoracic and lumbar X-rays were obtained for morphometric measurements.Clinical,biological and radiological statuses were evaluated with Bath Ankylosing Spondylitis Disease Activity Index （BASDAI）,Bath Ankylosing Spondylitis Metrology Index （BASMI）,Bath Ankylosing Spondylitis Functional Index （BASFI）,Bath Ankylosing Spondylitis Radiology Index-total （BASRI-t）,erythrocyte sedimentation rate （ESR） and the C-reactive protein levels.Results Osteoporosis was present in 32% of patients and 5% of controls according to lateral vertebral BMD measurements.Fracture was present in 31% of patients.The effect of some clinical and laboratory parameters on BMD status and vertebral fractures was analyzed in the patient group.Osteoporosis in lateral lumbar DEXA was associated with higher BASMI,BASFI,BASRI-t scores and ESR level.Low hip BMD was associated with low BMI and high BASFI and BASRI-t scores.Vertebral fractures were associated with advanced age,longer disease duration,longer duration since diagnosis,higher BASMI and BASRI-t scores,higher ESR level,reduced femoral and lateral lumbar BMD.Logistic regression analysis revealed that only BASRI-t score was significantly associated with low lateral spinal BMD and BMI and BASFI score were independently associated with low hip BMD.The presence of compression fractures was independently associated with BASRI-t score and low lateral lumbar BMD.Conclusions Osteoporosis and vertebral fractures in AS seem to be related to the extent of radiological involvement.A low lateral lumbar BMD is an important risk factor for vertebral fractures.

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.

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.

Radiological features of traumatic vertebral endplate fracture:an analysis of 194 cases with 263 vertebral fractures

Background:The importance of identifying osteoporotic vertebral endplate or/and cortex fracture(ECF),which primarily includes endplate fracture(EPF)and vertebral anterior cortex buckling,has been recognized.However,some old traumatic ECFs with healing process in the elderly may be mistaken as osteoporotic.This study analyzes the radiological features of traumatic EPF.Methods:This was a retrospective analysis of 194 spine trauma patients with 263 vertebral fractures(mean age:42.11±9.82 years,118 males and 76 females).All patients had traumatic EPF identified by X-ray/CT/MRI.Results:The involved vertebra was mostly L1(29.7%),followed by T12 and L2.Except EPFs involved both superior and inferior endplates(12.6%),only 1.9%involved inferior endplate alone,with the majority involved superior endplate.If each endplate was divided into five segments of equal lengths(from anterior to posterior:a1,a2,m,p2,p1),the most depressed point of superior EPFs was mostly at segment-a2(approximately 45%),followed by segment-a1(approximately 20%)or segment-m(approximately 20%),and very rarely at segment-p1.The upper 1/3 of anterior vertebral wall was more likely to fracture,followed by middle 1/3 of anterior wall.For posterior vertebral wall fracture,68.5%broke the bony wall surrounding the basivertebral vain.58.6%,30.0%,and 11.4%of vertebral fractures had<1/5,1/5-1/3,and>1/3 vertebral body height loss.As the extent of vertebral height loss increased,the chance of having both superior and inferior EPFs also increased;however,the chance of having inferior EPF alone did not increase.Conclusion:Traumatic EPF features are characterized,which may help the differentiation of traumatic and osteoporotic EPFs.

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.

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.

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.

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.

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.

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.

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

Observation on Therapeutic Effect of Erxian Decoction on Relieving Low Back Pain after PVP of PMOP-derived Vertebral Fracture

[Objectives]To explore the clinical effect of Erxian decoction on relieving low back pain after percutaneous vertebroplasty(PVP)of vertebral compression fracture caused by postmenopausal osteoporosis(PMOP).[Methods]Ninety patients who were treated in Suzhou TCM Hospital from September 2021 to January 2023 were randomly divided into three groups:traditional Chinese medicine group(n=30),western medicine group(n=30)and blank group(n=30).The patients in all the three groups were treated with basic anti-osteoporosis drugs.The patients in the traditional Chinese medicine group were treated with Erxian decoction after PVP,and those in the western medicine group were treated with celecoxib to relieve pain after operation.The visual analogue(VAS)score,Oswestry dysfunction index(ODI)score,TCM syndrome score and serum indexes such as interleukin-6(IL-6)and estrogen E2 were recorded before treatment and 2 weeks,1 month and 3 months after treatment.[Results](i)In terms of pain relief,the VAS score of the western medicine group was lower than that of the traditional Chinese medicine group after 2 weeks of treatment,but there was no significant difference in VAS score between the two groups after 1 month and 3 months,and the pain improvement of the two groups was better than that of the blank group.(ii)After 3 months of treatment,the ODI score in the traditional Chinese medicine group was lower than that in the western medicine group,and the improvement of TCM syndrome in the traditional Chinese medicine group was better than that in the other two groups 1 and 3 months after treatment(P<0.05).(iii)The level of IL-6 in the western medicine group was lower than that in the other groups after 2 weeks,and there was no significant difference between the two groups after 3 months of treatment.After 3 months of treatment,the level of E2 in the traditional Chinese medicine group was higher than that before treatment and higher than that in the western medicine group and the blank group,but there was no significant difference between the two groups(P>0.05).[Conclusions]Both Erxian decoction and non-steroidal anti-inflammatory drugs can relieve residual low back pain after PVP,and their long-term effects are similar,but Erxian decoction has more advantages in alleviating pain,muscle and joint pain and sensory abnormalities in postmenopausal women.Moreover,it is safe and reliable,and is worthy of clinical application.

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.

“FISH VERTEBRA” about 3 Sickle Cell Patients Followed at Laquintinie Hospital, Douala

Vertebral involvement in particular is common in sickle cell patients. We report 3 cases of “fish vertebra” fractures in sickle cell patients aged 16, 18, and 24 years old respectively at Laquintinie Hospital, Douala. When the vertebral fractures were diagnosed, the 3 patients had back pain and kyphosis deformities of the dorsal spine. Treatment with an infusion of biphosphonates (zoledronic acid at a dose of 0.5 mg·per·kg) was offered to all three patients. Two out of three patients received treatment with biphosphonates with a successful outcome. Profound vitamin D deficiency is associated with increased bone remodeling and a history of fractures. In sickle cell anemia, vertebral fractures may also result from bone fragility, which is often overlooked as aseptic osteonecrosis and osteomyelitis, which are very often suspected.

Percutaneous kyphoplasty in the treatment of Kümmell disease in lumbar scoliosis:A case report

BACKGROUND Due to mechanical imbalance in the spine,elderly scoliosis patients tend to develop vertebral fracture nonunion,i.e.,Kümmell disease,when osteoporotic vertebral compression fractures occur.However,accompanying vertebral rotational deformities make surgical procedures challenging risky.Such patients are usually compelled to undergo conservative treatment and there are very few reports on minimally invasive surgeries for them.We first-time report a patient with Kümmell disease and lumbar scoliosis treated with percutaneous kyphoplasty(PKP)under O-arm guidance.CASE SUMMARY An 89-year-old female was admitted to the hospital due to delayed low back pain after a fall.She was diagnosed with Kümmell disease based on physical and radiologic examinations.The patient experienced severe scoliosis and subsequently underwent O-arm-guided kyphoplasty,resulting in a significant alleviation of low back pain.CONCLUSION PKP has good efficacy in treating Kümmell disease.However,surgical risks are elevated in scoliosis patients with Kümmell disease due to the abnormal anatomical structure of the spine.O-arm assisted operations play a crucial role in decreasing surgical risks.

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.

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.

Balloon Kyphoplasty to Thoracic Vertebral Fracture with Postoperative Treatment Difficulty: A Case Report

<span style="font-family:Verdana;line-height:1.5;">In this communication, we report our experience with a case of thoracic vertebral fracture which was treated by balloon kyphoplasty and which later developed an infection at the fracture site, causing treatment difficulty. The patient was a 74-year old female with a history of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome as well as diabetes mellitus. She had been diagnosed with mycoplasma pneumonia as well as a fracture of the T12 vertebral and was admitted to the Department of Internal Medicine to receive medical/non-surgical treatment. Medical treatment was carried out and the pneumonia symptoms improved but getting out of bed was impossible due to the continuing of back pain. Therefore, T12 balloon kyphoplasty was performed in order to allow for early ambulation. Back pain started to improve immediately after surgery, but at 2 months after surgery, the back pain relapsed, and fever developed. Imaging tests revealed a vertebral osteolysis of T11-T12 and, as a measure against vertebral collapse due to postoperative infection or osteomyelitis of the thoracic spine, the feasibility of balloon kyphoplasty was considered. Antibiotic treatment was carried out, and when findings showed that the infection had resolved, posterior fusion (T9-L2) was performed using percutaneous pedicle screws. When balloon kyphoplasty for the treatment of a vertebral fracture is performed in an immunocompromised patient early after injury, the treatment needs to be chosen carefully, and the possibility of a latent vertebral osteomyelitis should be kept in mind.