Study DesignRetrospective cohort study.ObjectivesTo investigate the incidence of neurological deficits associated with percutaneous vertebral augmentation (PVA) surgery and to identify related risk factors.MethodsWe performed a retrospective analysis of the clinical data of patients who underwent PVA surgery at our institution between 2017 and 2022. A range of clinical parameters, including age, sex, fracture cause, fracture segment, number of vertebrae treated, surgical approach and surgical method, were collected.ResultsThis study included a total of 1847 patients, including 422 (22.8%) men and 1425 (77.2%) women, with a total of 2319 diseased vertebrae. The mean age of the patients was 70.71 ± 8.80 years, with 211 (11.4%) patients aged under 60 years and 1636 (88.6%) patients aged over 60 years. Forty-six (2.5%) patients, accounting for 67 diseased vertebrae, were treated for tumors, whereas the remaining 1801 (97.5%) patients underwent surgery for fractures. Four hundred seventy-eight (20.6%) vertebrae underwent unilateral puncture, and the remaining 1841 (79.4%) vertebrae underwent bilateral puncture. Percutaneous vertebroplasty was performed on 1781 (76.8%) vertebrae, whereas percutaneous kyphoplasty was chosen for the remaining 538 (23.2%) vertebrae. Postoperative X-ray evaluations were conducted on the treated vertebrae, revealing that 403 (17.4%) vertebrae experienced polymethylmethacrylate (PMMA) leakage. Among the 1847 patients, 6 (7 diseased vertebrae) experienced nerve injuries postoperatively, and the incidence of neurological deficits after PVA surgery was 0.32%. Four of the 6 patients had nerve injuries due to PMMA leakage, and the other 2 patients had failed punctures. There was no statistically significant difference in terms of neurological complication rates according to patient age, sex, fracture segment, number of vertebrae treated, surgical approach or surgical method. However, the incidence of neurological complications was greater for patients with neoplastic fractures who underwent PVA surgery than for those with osteoporotic fractures.ConclusionsPVA is an effective minimally invasive procedure for treating osteoporotic and neoplastic vertebral fractures. However, PVA can lead to serious neurological deficits. The incidence of neurological deficits associated with PVA surgery is 0.32%. Compared with patients with osteoporotic fractures, patients with neoplastic vertebral fractures who undergo PVA have a greater risk of neurological complications.

There is limited literature regarding the re-fracture of a previously augmented vertebral compression fracture (VCF). These re-fractures may present as an asymptomatic remodeling of the vertebral body around the cement cast while in other cases they involve the middle column, at the transition zone between the cement-augmented and non-augmented vertebral body. In the latter, a posterior wall retropulsion is possible and, if left untreated, might progress to vertebral body splitting, central canal stenosis, and kyphotic deformity. There is no consensus regarding the best treatment for these re-fractures. There are cases in which a repeated augmentation relieves the pain, but this is considered an undertreatment in cases with middle column involvement, posterior wall retropulsion, and kyphosis.

We report four cases of re-fracture with middle column collapse of a previously augmented VCF, treated with the stent-screw assisted internal fixation (SAIF) technique. A modified more postero-medial deployment of the anterior metallic implants was applied, to target the middle column fracture. This modified SAIF allowed the reduction and stabilization of the middle column collapse as well as the partial correction of the posterior wall retropulsion and kyphosis.

Complete relief of back pain with stable clinical and radiographic findings at follow-up was obtained in all cases.

In selected cases, the middle column SAIF technique is safe and effective for the treatment of the re-fracture with middle column collapse of a previously cement-augmented VCF. This technique requires precision in trocar placement and could represent a useful addition to the technical armamentarium for VCF treatment.

A narrative review regarding percutaneous vertebroplasty (PVP) for osteoporotic vertebral fracture (OVF) is provided herein, addressing the epidemic of OVF in Japan, the latest response to the criticism of PVP for OVFs, the indications and potential risks of PVP for OVFs, and a future perspective for PVP. Each year in Japan, approximately 32,000 patients aged 55 years or older suffer from chronic low back pain for several months to several years due to a compression fracture. PVP is one of the surgical treatments for an OVF, and it is less invasive compared to the traditional open surgery. PVP is suitable for OVF patients who have difficulty walking as assessed by the modified Yokoyama's activities of daily living (ADL) scoring system, and for patients with Kummell's disease diagnosed by CT and MRI examinations. Serious adverse events related to PVP occur in 1.1-3.3% of the cases, but direct deaths from PVP are extremely rare at less than 1%. Recent studies demonstrated that OVF patients treated with PVP are less likely to die after the treatment than non-surgically treated patients, which conflicts with the Cochran reviews' conclusion not supporting PVP for OVFs. Novel robotic systems and procedure-support devices are being developed, providing a next step toward fully automated PVP procedures.

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.

To identify risk factors for the recollapse of cemented vertebrae after PVP in patients with OVCFs.

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.

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, intradiscal cement leakage, or vertebral height restoration could increase the risk for cemented vertebra recollapse after PVP in OVCFs.

This meta-analysis suggests that thoracolumbar junction fractures, preoperative intravertebral cleft, and solid lump cement distribution pattern are associated with the recollapse of cemented vertebrae after PVP in OVCF patients.

Due to the increase in osteoporosis accompanying the aging society in Japan, osteoporotic vertebral fractures (OVFs) are increasing. Percutaneous vertebral augmentation (PVA) has been widely used for OVFs because it reduces pain immediately with less invasiveness. Re-collapse of vertebral body after PVA is a rare, but important, complication. Once the re-collapse has occurred, patients should undergo an additional invasive salvage surgery.

We treated 5 patients with re-collapse after PVA in our hospital. For re-collapse after PVA, we performed anterior column reconstruction with video-assisted thoracoscopic surgery (VATS), posterior fixation with percutaneous pedicle screws (PPSs) and minimally invasive spine stabilization (MISt).

The mean postoperative follow-up was at 62.8 months. At the final follow-up, the patients were free of low back pain, and bony union was achieved in all cases. The postoperative correction loss was 6 degrees. Perioperative complications included aspiration pneumonia in one patient and bone fracture of an adjacent vertebral body in two patients. There were no reoperation cases.

We perform minimally invasive combined anterior and posterior surgery with VATS for re-collapse after PVA. This procedure is useful in elderly patients with less reserve capacity.

To investigate the clinical effect of percutaneous pedicle screw fixation (PPSF) combined with percutaneous vertebroplasty (PVP) in the treatment of osteoporotic compression vertebral fracture (OVCF) of the thoracolumbar vertebra with kyphosis.

One hundred sixty-six patients before June 2017 were retrospectively analyzed, and patients were divided into PPSF + PVP group A and PVP group B. Operative time, bone mineral density, postoperative bed time, high compression ratio, bone cement leakage rate, and bone cement dose were recorded. Comparison of vertebral anterior edge height, Cobb angle, visual analogue score (VAS), and low back pain dysfunction index (ODI) between the two groups in preoperative, postoperative 3 days, postoperative 6 months, postoperative 12 months, and postoperative 24 months, postoperative complications were observed in the two groups.

The operation time of group A was longer than that of group B (59.0 ± 8.6 min, 26.6 ± 5.2 min), longer postoperative bed rest time (3.3 ± 0.7 days, 1.2 ± 0.5 days), the differences were statistically significant (P < 0.01), there was no difference in the amount of bone cement between the two groups (5.4 ± 0.6 ml, 5.3 ± 0.8 ml) (P > 0.05). The height of the anterior edge and Cobb angle of the two groups recovered significantly in postoperative 3 days. The height of anterior edge (2.7 ± 0.3 cm, 2.6 ± 0.2 cm, 2.5 ± 0.7 cm; 2.3 ± 0.6 cm, 1.7 ± 0.5 cm, 1.6 ± 0.3 cm) and Cobb angle (4.9 ± 2.2, 5.5 ± 2.3, 5.7 ± 2.3; 12.4 ± 3.2, 17.2 ± 2.5, 13.2 ± 2.3) was statistically significant in postoperative 6 months, postoperative 12 months, and postoperative 24 months (P < 0.01). VAS and ODI scores of postoperative 6 months and 12 months were significantly different between the two groups (P < 0.05). Postoperative complications in group B were much higher than those in group A.

The efficacy of PVP alone was not satisfactory, and the rate of complications was high for OVCF patients with severe anterior edge compression with kyphosis. PPSF combined with PVP is recommended, the vertebral height loss was not obvious, the satisfaction was good, and the complication rate was lower during 2 years follow-up.

The aim of this study was to determine the relationship between filling proportion of bone cement in the vertical direction and incidence of recollapse in the augmented vertebrae after vertebral augmentation.

Fifty-one patients (51 vertebrae) who had operations between January 2014 and July 2016 with a mean age of 78.10 years were included. All patients in our department of spine surgery were advised to have follow-up care every 6 months. Patients characteristics, radiographic outcomes were evaluated.

The recollapse of augmented vertebral body occurred in 10 of 51 vertebrae (20%).

Patients with a high proportion rate of bone cement in the middle vertical direction have a low incidence of experiencing recollapse.