This study aimed to evaluate the clinical efficacy of percutaneous vertebroplasty (PVP) performed with a two-step fluoroscopy technique for treating thoracic osteoporotic vertebral compression fractures (OVCFs) in older patients.

A retrospective analysis was conducted on clinical and imaging data from 48 patients diagnosed with thoracic OVCFs, who underwent treatment with percutaneous vertebroplasty(PVP) utilizing a two-step fluoroscopy technique at Yangquan First People's Hospital between January 2019 and January 2022. The study assessed the clinical efficacy of this procedure by analyzing Visual Analog Scale(VAS) scores, Cobb angle values, and vertebral height measurements before surgery and at 2 days, 3 months, 6 months, and 12 months postoperatively.

Before treatment, the mean VAS score of patients was 7.5 ± 0.6. Subsequently, at 2 days, 3 months, 6 months, and 12 months after the procedure, these mean scores decreased to 2.3 ± 0.6, 2.2 ± 0.5, 2.2 ± 0.4, and 2.0 ± 0.3, respectively. This decline was statistically significant (P < 0.05) compared to the preoperative VAS score. The preoperative Cobb angle was 12.1° ± 0.9°, and the Cobb angle values at the corresponding time points were 12.2° ± 0.8°, 12.3° ± 1.1°, 12.3° ± 1.0°, and 12.2° ± 0.9°. Initially, the mean height of the vertebral body in these patients was 17.38 ± 1.56 mm. Postoperatively, at 2 days, 3 months, 6 months, and 12 months, these values were 19.30 ± 1.81 mm, 19. 12 ± 1.60 mm, 19.00 ± 1.45 mm, and 19.00 ± 1.20 mm, respectively. No significant difference was observed between postoperative and preoperative Cobb angle and vertebral height (P > 0.05).

Percutaneous vertebroplasty using a two-step fluoroscopy method not only has the therapeutic effect of traditional surgical methods, reducing pain from thoracic vertebral compression fractures in the elderly and enhancing their quality of life and mobility, but also streamlines the intraoperative fluoroscopy procedure. This method stand as an effective approach for managing osteoporotic compression fractures of the thoracic vertebrae in elderly.

Kyphoplasty-associated cement extravasation into surrounding tissue and vasculature can lead to life-threatening complications. We present a rare case of significant inferior vena cava cement burden that resulted in pulmonary embolism.

A 74-year-old Caucasian woman with a history of severe osteoporosis, recurrent falls, and spinal compression fracture status post-kyphoplasty of the L4-L5 vertebrae, presents to the emergency department 2 days post-vertebral kyphoplasty due to chest pain, back pain, and dyspnea. Computed tomography of the chest and abdomen showed a metallic density within the inferior vena cava extending superiorly approximately 10 cm from the vertebral L5 level. She was also found to have right lower lobe pneumonia. The patient finished a 10-day course of antibiotics and was discharged home with a 1-month long course of anticoagulation with apixaban per recommendations of a multidisciplinary team consisting of Hematology/Oncology, Interventional Radiology, Vascular Surgery, and Orthopedic Surgery. Unfortunately, the patient was readmitted a month later with shortness of breath. Work up was notable for an influenza type A infection and computed tomography findings of pulmonary cement embolism. The respiratory distress was resolved with supportive care. Despite pulmonary cement burden, the multidisciplinary care team recommended no further anticoagulation. Patient was discharged home with close clinical follow-up and 6 months has since passed at the time of this report without reported complications.

A large cement burden in the inferior vena cava leading to pulmonary cement embolism is a rare event. A high burden of cement predisposes development of pulmonary embolism. A short course of anticoagulation may only be needed for asymptomatic patients.

Percutaneous vertebroplasty (VP) progressed from a virtually unknown procedure to one performed on hundreds of thousands of patients annually. The development of VP provides a historically exciting case study into a rapidly adopted procedure. VP was the synthesis of information gained from spinal biopsy developments, the inception of biomaterials used in medicine, and the unique health care climate in France during the 1980s. It was designed as a revolutionary technique to treat vertebral body fractures with minimal side effects and was rapidly adopted and marketed in the United States. The impact of percutaneous vertebroplasty on spine surgery was profound.

Background Injection of cement during vertebroplasty and kyphoplasty can leak into surrounding structures and could be symptomatic. Purpose To identify the sites and incidence of cement extravasation after kyphoplasty and vertebroplasty, and to evaluate their impacts on clinical outcomes. Material and Methods A retrospective review of 316 patients treated with kyphoplasty and vertebroplasty; 411 cases were included (223 kyphoplasty and 188 vertebroplasty). Cement extravasation was evaluated postoperatively by computed tomography (CT) scan of the spine. Clinical outcomes were assessed by visual analog scale (VAS) and Oswestry Disability Index (ODI). Results There was a statistically significant difference in the incidence rate of cement extravasation between vertebroplasty and kyphoplasty groups ( P < 0.04). The most common site of cement extravasation was in paravertebral soft tissues for vertebroplasty (n = 33, 40.7%) and for kyphoplasty (n = 30, 30%). In the subgroup where cement leaked into the intradiscal space, adjacent vertebral body fractures occurred in 3/26 vertebrae (11.5%) in the vertebroplasty group and in 2/18 vertebrae (11.1%) in the kyphoplasty group. Both groups showed a statistically significant decrease in both VAS ( P < 0.001) and ODI scores ( P < 0.001). There was no significantly difference in patient satisfaction between those who had cement extravasation and those who did not, in both groups. Conclusion Kyphoplasty has an advantage in terms of less risk of cement extravasation. However, this factor did not reflect on subsequent sequelae or final clinical outcomes. This study did not find a distinct correlation between intradiscal cement extravasation and increased risk of adjacent vertebral fractures.

Osteoporotic vertebral fractures constitute at least 50% of the osteoporotic fractures that happen worldwide. Occurrence of osteoporotic fractures make the elderly patient susceptible for further fractures and increases the morbidity due to kyphosis and pain; the mortality risk is also increased in these patients. Most fractures occur in the thoracic and thoracolumbar region and are often stable. Different descriptive and prognostic classification systems have been described, but none are universally accepted. Radiographs, computed tomography, and magnetic resonance imaging are useful in imaging the fracture and evaluating the bone density. In acute stages, the fractures are well treated with conservative measures including short bed rest, analgesics, bracing, and exercises. Although most fractures heal well, up to 30% of fractures can develop painful nonunion, progressive kyphosis, and neurological deficit. For patients who develop severe pain not responding to nonoperative measures and painful nonunion, percutaneous cement augmentation procedures including vertebroplasty or kyphoplasty have been suggested. For fractures with severe collapse and that lead to neurological deficit and increasing kyphosis, instrumented stabilization is advised. Prevention and management of osteoporosis is the key element in the management of osteoporotic fractures in the elderly. Guidelines for essential adequate dietary and supplemental calcium and vitamin D, and antiosteoporotic medications have been described.

We compared the biomechanics between improved percutaneous vertebroplasty (improved PVP) and traditional percutaneous kyphoplasty (PKP) in the treatment of vertebral peripheral wall damage-type osteoporotic vertebral compression fracture (OVCF). A total of 15 vertebral peripheral wall damage-type OVCF models of new calves (12-14 weeks) were treated with a decalcifying agent (Shandon TBD-1) with the vertebral compression fracture. The vertebral volume and anterior height before modeling, and the vertebral BMD before and after modeling were measured. The models were randomly divided into three groups: the improved PVP group (Group A), the traditional PKP group (Group B) and the control group (Group C). BMD of Groups A, B and C after decalcification was significantly lower than that before decalcification (P<0.05). There were no significant differences in BMD before and after decalcification among Groups A, B and C (P>0.05). There was no significant difference in the initial strength and stiffness among the three groups (P>0.05). The postoperative strength of Groups A and B was 1.036±300 and 1.045±200 N, respectively, which was significantly higher than the initial strength (P<0.05). The postoperative stiffness of Groups A and B was 395±250 and 470±270 N/mm, respectively, which was slightly lower than the initial stiffness, however, the differences were not statistically significant (P>0.05). In the comparison of postoperative strength and stiffness between Groups A and B, the postoperative strength in Group A was lower than that in Group B; differences were not statistically significant (P>0.05); there was no significant difference in the postoperative stiffness between Groups A and B (P>0.05). There were no significant differences of injection of bone cement between the two groups (P>0.05). Therefore, an improved PVP can basically realize the curative effects of traditional PKP in the treatment of vertebral peripheral wall damage-type OVCF, which can be used as clinical reference.

Many previous studies have reported excellent clinical results with percutaneous kyphoplasty (PKP). In contrast, numerous complications and problems have also been reported, such as puncture difficulty, cement leakage, and adjacent vertebral fracture.

This study is to evaluate the application and clinical outcomes of unilateral transverse process-pedicle and bilateral PKP in the treatment of osteoporotic vertebral compression fractures (OVCF).

A total of 56 cases with two levels thoracolumbar OVCF were randomly assigned for treatment with unilateral transverse process-pedicle and bilateral PKP. The patients were followed up postoperatively and were assessed mainly with regard to clinical and radiologic outcomes. Clinical outcomes were evaluated with mainly the use of a visual analogue scale (VAS) for pain. Radiologic outcomes were assessed mainly on the basis of radiation dose and bone cement distribution.

The operation was completed successfully in 56 cases. In the unilateral level, the operation time, the volume of the injected cement, and radiation dose were significantly less than bilateral level. All patients had significantly improvement on VAS score after the procedures, compared with their preoperative period. In the bilateral level, 7 patients had obvious pain in the puncture sites at 1 month postoperatively caused by facet joint violation. With local block treatment, the pain disappeared in all patients at the last follow-up.

Both bilateral and unilateral PKP are relatively safe and effective treatments for patients with painful OVCF. But unilateral PKP received less radiation dose and operation time, offered a higher degree of deformity correction, and resulted in less complication than bilateral.

The aim of this review is to compare the effectiveness of percutaneous vertebroplasty and kyphoplasty to treat pain and improve functional outcome from vertebral fractures secondary to osteoporosis and tumor conditions. In 2009, two open randomized controlled trials published in the New England Journal of Medicine questioned the value of vertebroplasty in treating vertebral compression fractures. Nevertheless, the practice of physicians treating these conditions has barely changed. The objective of this review is to try to clarify the most important issues, based on our own experience and the reported evidence about both techniques, and to guide towards the most appropriate choice of treatment of vertebral fractures, although many questions still remain unanswered.

Balloon kyphoplasty is a minimally invasive surgical approach for treating vertebral compression fractures, including osteoporotic vertebral compression fractures. The purpose of this study was to determine the effect of balloon inflation and postural reduction on balloon kyphoplasty for the deformity correction of vertebral compression fractures and to explore the correlative factors affecting the deformity correction.

A retrospective study of 72 patients (75 levels) who had undergone balloon kyphoplasty was conducted. Imaging data and clinical features were collected and analyzed. Independent-samples t test analysis was used to find the possible factors affecting deformity correction.

Postural correction in the overextending position significantly increased anterior middle vertebral height, kyphotic angle, and Cobb angle (each P < .05). There was no significant difference in anterior, middle vertebral height, kyphotic angle, and Cobb angle between postural reduction and balloon dilation (each P > .05). The improvement on the Visual Analog Scale was notable (P < .05). Among a variety of factors, the fracture type (wedge type and biconcave type) affected both the height restoration (P = .003) and kyphotic angle reduction (P = .007). The bone cement injected volume was related to height restoration (P = .011) and kyphotic angle reduction (P = .018).

Balloon inflation was useless for deformity correction. The deformity correction was attributed to postural reduction with cement strengthening. The most significant factors affecting deformity correction were the fracture type and bone cement injected volume.

In 2009, two clinical trials that questioned the usefulness of vertebroplasty for the treatment of osteoporotic fractures compared with conservative treatment were reported in the New England Journal of Medicine, leading to wide debate in the literature. In this article, we provide a critical review of the scientific evidence in this field and discuss our own experience with this technique.

The advent of the use of kyphoplasty in 1998 was the result of the expected evolution of materials and methods related to the successful introduction of vertebroplasty as a valid treatment of painful vertebral compression fractures. Kyphoplasty introduced a method of creating bilateral bone voids and in many cases elevation (reduction) of depressed end plates with variable degrees of height restoration. This was achieved by using bilateral balloon bone tamps capable of pressures significantly higher than conventional angioplasty balloons. This allows creation of bilateral bone voids, resulting in the ability to apply a much thicker cement mixture. This is felt to be the reason for fewer cement-related complications compared with vertebroplasty including extravasation and embolization. Although the procedural cost presently is higher for kyphoplasty, this is expected to decrease as patents expire and industry competition increases. Kyphoplasty indications include all those of vertebroplasty plus additional ones either contraindicated or not recommended for treatment with vertebroplasty. Kyphoplasty achieves the same degree of pain relief as vertebroplasty but may offer additional benefits of fewer complications, more indications, better biopsy specimens, and potential for height restoration of compression fractures of the spine. Further studies regarding potential benefits are warranted to assess any added value of kyphoplasty compared with vertebroplasty.

Improvements in diagnosis and treatment have prolonged cancer survival, with a consequent increase in the incidence of spinal metastases and vertebral compression fractures with associated axial pain, progressive radiculomyelopathy, and mechanical instability. Pain relief in malignant vertebral compression fractures is key to achieving a better quality of life in patients under palliative care. The gold standard for pain relief is nonsteroidal anti-inflammatory drugs and opioids. Nonresponsive cases are then treated with radiotherapy, which may require 2-4 weeks to take effect and in most cases does not provide complete pain relief. Percutaneous vertebroplasty and percutaneous kyphoplasty can in particular give relief in patients with vertebral body compression fractures that do not cause neurological deficits but severely compromise quality of life because of intractable pain.

The correlative factors for complications resulting from cement leakage were retrospectively reviewed in 71 patients who underwent percutaneous kyphoplasty.

To explore the correlative factors affecting the complications of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures.

Over the past decade, percutaneous kyphoplasty has been increasingly used as treatment of choice for osteoporotic vertebral compression fractures. However, current literature contains less information about the correlative factors affecting the complications resulted from cement leakage.

In all, 71 patients with 171 vertebral compression fractures who were treated by percutaneous kyphoplasty in the department of spine surgery at our medical center were identified from the registry and were retrospectively reviewed. The treatment efficacy was determined by the assessment of change in vertebral body height, Cobb angle, visual analog scale and Oswestry functional score between preoperative, postoperative, and the latest follow-up. Complications were recorded and associated risk factors were determined and analyzed.

All patients had immediate and significant improvement in back pain after being treated with percutaneous kyphoplasty. Cement leakage occurred in 17 (9.94%) out of 171 vertebral bodies, including 7 paravertebral leaks, 6 leaks into intervertebral space, 3 leaks into channel of needling insertion, and 1 spinal canal leak. Four patients (5.63%) developed pulmonary complications postoperatively, one of them with confirmed diagnosis of pulmonary embolism directly caused by cement leakage. During the follow-up, we found 9 recurrence vertebral fractures in 6 patients (8.45%), including 6 adjacent vertebral bodies. Univariate analysis revealed a significant difference in preoperative vertebral body height, injected cement volume, and vertebral body wall incompetence between the cement leakage group and no cement leakage group (P<0.05). In contrast, there is no significant difference in the preoperative Cobb angle, freshness of vertebral fracture, location of operative vertebrae, and operative approach between the 2 groups (P>0.05). Multiple logistic regression analysis showed that the injected cement volume and vertebral body wall incompetence were the predominant variables associated with the complications resulting from cement leakage. The patients who had a history of pulmonary diseases were prone to develop lung-related complications after the surgery.

The cement viscosity, injected cement volume, vertebral body wall incompetence, and a history of pulmonary diseases were the factors affecting the complications resulting from cement leakage. The recognition of these risk factors is helpful in efforts to improve surgical technique to reduce the risk of complications after being treated by percutaneous kyphoplasty.

The aim of this study was to compare the effectiveness of percutaneous vertebroplasty and kyphoplasty to treat pain from non-neoplastic vertebral fractures and improve functional outcomes.

We compared 30 patients treated by vertebroplasty for non-neoplastic vertebral fractures with 30 patients treated by kyphoplasty for the same condition. Pain was measured with a visual analogue scale (VAS) and functional outcome with the Oswestry disability index (ODI). Baseline data were compared with measurements on the day after the procedure (for pain alone) and at 1 month, 6 months, and 1 year.

The VAS pain score was reduced by 4-5 points on the day after either type of treatment, a statistically significant improvement. The global ODI was significantly improved (by 13-18 points) at 1 month after either procedure. These improvements persisted at 6 months and 1 year. No significant differences in functional outcome were observed between the techniques.

Vertebroplasty and kyphoplasty obtain similar improvements in pain and functional outcomes in these patients. The choice of technique must therefore depend on other factors. An initial improvement with either technique is a good predictor of long-term improvement.

To provide an update on imaging of metabolic bone disease based on new developments, findings, and changing practices over the past 30 years.

Literature review of osteoporosis, osteomalacia, renal osteodystrophy, Paget's disease, bisphosphonates, with an emphasis on imaging.

Cited references and pertinent findings.

Significant developments have occurred in the imaging of metabolic bone disease over the past 30 years.

The absence of Level I evidence undermines the credibility of all clinical studies pertaining to percutaneous vertebral augmentation (ie, kyphoplasty and vertebroplasty). The powerful desire to relieve suffering in the frail elderly cannot substitute for a rigorously designed randomized controlled trial comparing vertebral augmentation with continued nonoperative care. Though the level of available evidence is currently inadequate, its quality is improving.

Among individuals aged 50-80 years, 5-20% have one or more vertebral crush fractures. One-third of these patients require treatment for acute or chronic pain. Vertebroplasty and kyphoplasty were introduced over the last two decades as treatments for incapacitating pain from osteoporotic vertebral fractures. Both techniques proved effective and safe in numerous retrospective and prospective studies. They now deserve to be incorporated into the standard treatment strategy for painful and incapacitating vertebral fractures. Kyphoplasty seeks not only to stabilize the vertebra, but also to correct the kyphosis induced by the vertebral body collapse. However, the correction is often limited (less than 15 degrees ) and has not been shown to increase the benefits in terms of pain relief or quality-of-life improvement, compared to vertebroplasty. Kyphoplasty is more costly than vertebroplasty, which is therefore emerging as the treatment of choice. However, a randomized double-blind trial comparing vertebroplasty and kyphoplasty is needed. Furthermore, a randomized comparison of vertebroplasty or kyphoplasty versus noninterventional treatment is needed in patients admitted for pain immediately after a vertebral crush fracture.