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Zoledronate administered every 12 to 18 months prevents fractures in older women. Ten years after initiation of this trial, zoledronate administered at baseline and 5 years prevented vertebral fracture.

SummaryThis study evaluated the use of low-dose chest computed tomography (LDCT) for detecting bone fragility. LDCT-measured vertebral bone attenuation by volumetric methods showed good correlation with bone mineral density (BMD) measured by dual-energy x-ray absorptiometry (DXA, and good diagnostic performance for identifying osteoporosis and compression fractures. The results of this study suggest the feasibility of obtaining comprehensive information on bone health in subjects undergoing LDCT.IntroductionOsteoporosis is a prevalent but underdiagnosed disease that increases fracture risk. This study evaluated the utility of vertebral attenuation derived from low-dose chest computed tomography (LDCT) compared to dual-energy x-ray absorptiometry (DXA) for detecting bone fragility.MethodsA total of 232 subjects (78 men and 154 women) aged above 50 years who underwent both LDCT and DXA within 30 days were evaluated. LDCT-measured bone attenuation in Hounsfield units (HU) of four vertebrae (T4, T7, T10, and L1) was evaluated using volumetric methods for correlation with DXA-measured bone mineral density (BMD) and for the diagnosis of compression fractures, osteoporosis, and low BMD (osteoporosis or osteopenia) in men and women, with DXA measurements as the reference standard.ResultsThe average attenuation of the four vertebrae showed strong correlation with DXA-measured BMD of the lumbar spine (r = 0.726, p < 0.05). In receiver-operating characteristic (ROC) analyses, the area under the curve (AUC) across LDCT-measured thresholds of the average attenuation to distinguish compression fractures was 0.827, and a threshold of 129.5 HU yielded 90.9 % sensitivity and 64.4 % specificity. Similarly, average attenuation showed high AUCs and good diagnostic performance for detecting osteoporosis and low BMD in both men and women. Among 44 subjects with compression fractures, the average bone attenuation showed strong negative correlation with both the worst fracture grade (r = −0.525, p < 0.05) and cumulative fracture grade score (r = −0.633, p < 0.05).ConclusionLDCT-measured bone attenuation by volumetric methods showed good correlation with BMD measured by DXA and good diagnostic performance for identifying bone fragility.

Objective To investigate the clinical effect of vertebroplasty through unilateral upper edge of transverse process in the treatment of lumbar osteoporotic vertebral compression fracture (OVCF), and to explore the surgical indications and operation points of this technique. Methods Ninety patients with osteoporotic vertebral compression fractures of the lumbar spine treated in our hospital from June 2020 to June 2021 were retrospectively analyzed and divided into the experimental group and the control group for vertebroplasty according to the principle of randomization; the experimental group was treated with a lateral pedicle approach through the upper edge of the unilateral transverse process, and the control group was treated with a unilateral pedicle approach. After more than 1 year of follow-up, the operation time, intraoperative fluoroscopy times, bone cement injection volume, Oswestry disability index (ODI), Visual analogue scale (VAS) were compared between the two groups to assess the functional recovery of the patients. Results There was no significant difference in the general data (age, gender, location and number of fractured vertebral bodies, and follow-up time) between the two groups before surgery. In the experimental group, there were 42 OVCF patients (15 males and 27 females), and the operated segments were L1 vertebral body in 17 cases, L2 vertebral body in 13 cases, L3 vertebral body in 8 cases, L4 vertebral body in 3 cases, and L5 vertebral body in 1 case. The control group consisted of 48 OVCF patients (16 males and 32 females), and the operated segments were L1 vertebral body in 21 cases, L2 vertebral body in 15 cases, L3 vertebral body in 8 cases, L4 vertebral body in 2 cases, and L5 vertebral body in 2 cases. In terms of operation time and intraoperative fluoroscopy times, the experimental group was less than the control group, and the difference had statistical significance ( P  < 0.05); in terms of bone cement injection volume, the difference between the two groups had no statistical significance ( P  > 0.05); in terms of pain VAS score and dysfunction index ODI score, the scores of the two groups were improved with the extension of follow-up time compared with those before surgery, but the difference between the two groups had no statistical significance ( P  > 0.05). Conclusion Compared with the traditional approach, PVP via the unilateral extrapedicular approach at the upper edge of the transverse process has the advantages of less operation time and fluoroscopy times, uniform diffusion of bone cement, and is comparable to the traditional surgical approach in relieving pain and improving patient function, but due to the limitation of the length of the puncture needle, careful operation is required during the operation.

Purpose This study aimed to investigate the effect of precooling storage of bone cement in percutaneous vertebroplasty(PVP) for the patients with osteoporotic vertebral compression fracture (OVCF). Methods A total of 207 OVCF patients who underwent PVP were included in this study. Two different storage methods for the bone cement were randomly utilized: an operating room (NT group, 23 °C) and a refrigerator (PC group, 4 °C). Clinical outcomes were evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. In addition, radiographic evaluations were performed using anterior vertebral height and Cobb angle. Results The time of cement infusion was 10.8 ± 2.1 min in the PC group, which was significantly longer compared to the NT group (6.9 ± 1.8 min)( P  < 0.0001). However, the postoperative VAS score was lower in the PC group than the NT group ( P  < 0.0001). Moreover, compared to the NT group, the cement distribution score and rate of cement touching both upper and lower vertebral endplates were higher in the PC group ( P  < 0.0001 and = 0.037, respectively). Additionally, the anterior vertebral height was higher in the PC group compared to the NT group at both the 2-day postoperative assessment and the final follow-up ( P  = 0.046 and 0.026, respectively). Lastly, the rates of cement leakage and re-compression were lower in the PC group ( P  = 0.016 and 0.034, respectively) compared with the NT group. Conclusion Precooling storage of bone cement may prolong manipulation time in percutaneous vertebroplasty, optimize pain relief for patients, and mitigate the risk of bone cement leakage and re-compression. Trial registration Trial registration number: ChiCTR2400092330. Retrospective registration date: 14/11/2024 ( www.chictr.org.cn ).

Summary This study demonstrated the predictive values of radiological findings for delayed union after osteoporotic vertebral fractures (OVFs). High-signal changes on T2WI were useful findings. Introduction The purpose of the present study is to determine predictive radiological findings for delayed union by magnetic resonance imaging (MRI) and plain X-rays at two time points in the acute phase of OVFs. Methods This multicenter cohort study was performed from 2012 to 2015. A total of 218 consecutive patients with OVFs ≤2 weeks old were enrolled. MRIs and plain X-rays were performed at the time of enrollment and at 1- and 6-month follow-ups. Signal changes on T1-weighted imaging (T1WI) were classified as diffuse low-, confined low-, or no-signal change; those on T2WI were classified as high (similar to the intensity of cerebrospinal fluid), confined low-, diffuse low-, or no-signal change. The angular motion of the fractured vertebral body was measured with X-rays. Results A total of 153 patients completed the 6-month follow-up. A high-signal change on T2WI was most useful in predicting delayed union. Sensitivity, specificity, and positive predictive values were 53.3, 87.8, and 51.6 % at enrollment and 65.5, 84.8, and 51.4 % at the 1-month follow-up, respectively. The positive predictive value increased to 62.5 % with observation of high- or diffuse low-signal changes at both enrollment and the 1-month follow-up. The cutoff value of vertebral motion was 5 degrees. Sensitivity and specificity at enrollment were 52.4 and 74.1 %, respectively. Conclusions This study demonstrated the radiological factors predicting delayed union after an OVF. T2 high-signal changes showed the strongest association with delayed union. Consecutive MRIs were particularly useful as a differential tool to predict delayed union following OVFs.

Background The purpose of this study was to assess the clinical outcome of percutaneous kyphoplasty (PKP) assisted with mixed reality (MR) technology in treatment of osteoporotic vertebral compression fracture (OVCF) with intravertebral vacuum cleft (IVC). Method Forty cases of OVCF with IVC undergoing PKP were randomized into a MR technology-assisted group (group A) and a traditional C-arm fluoroscopy group (group B). Both groups were performed PKP and evaluated by VAS scores, ODI scores, radiological evidence of vertebral body height, and kyphotic angle (KA) at pre-operation and post-operation. The volume of injected cement, fluoroscopy times, and operation time were recorded. And cases of non-PMMA-endplates-contact(NPEC) in radiological evidence was also recorded postoperatively. The clinical outcomes and complications were evaluated afterwards. All patients received 10 to 14 months follow-up, with an average of 12 months. Result This MR-assisted group (group A) acquired more about the amount of the polymethyl methacrylate (PMMA) injection and postoperative vertebral height and less about postoperative KA, fluoroscopy times, and operation time compared with the control group (group B) ( P < 0.05). The VAS scores and ODI scores in both groups have improved, but more significantly in group A ( P < 0.05). Also, more cases achieve both-endplates-touching of cement in group A ( P < 0.05). And there are less of the loss of vertebral height, KA, and occurrence of re-collapse of the vertebra in group A during the follow-up ( P < 0.05). Conclusion PKP assisted with MR technology can accurately orientate the position of IVC area, which can be augmented by the balloon leading to more satisfied vertebral height improvement, cement diffusion, and pain relief. Trial registration ClinicalTrials.gov Identifier: NCT03959059 . Registered 25 September 2016.

Background The aging of China's population has led to an increase in the incidence rate of osteoporosis, which indirectly increases the risk of OVCF in osteoporosis patients. Low back pain is the main symptom of OVCF, and severe patients can further develop kyphosis. Although the conservative treatment of OVCF can effectively control the patient's condition, long-term bed rest will increase the risk of OVCF complications. Minimally invasive surgery is a common solution for OVCF. Methods 100 OVCF patients admitted to our hospital from January 2021 to January 2022 are selected for analysis and randomly divided into PVP group and PKP group, 50 cases in each group. The PVP group and the PKP group undergo PVP and PKP operations respectively. The differences in efficacy indicators and adverse reactions are compared, and the multivariate Logistic regression method is used to analyze the influencing factors of postoperative secondary fractures in patients with vertebral compression fractures. Results Compared with the PVP group, the total effective rate of PKP group is significantly increased, and the VAS, ODI score, kyphotic Cobb Angle, lateral distribution rate of bone cement and bone cement leakage rate are significantly decreased ( P  < 0.05). Age ≥ 80 years old, female, glucocorticoid use, lateral distribution of bone cement and bone cement leakage are significantly higher in the proportion of secondary fractures and are independent risk factors for postoperative secondary fractures in patients with OVCF. Conclusion PKP surgery has a higher efficacy in the treatment of OVCF patients, which can reduce the incidence of pain, adverse reactions and promote the recovery of kyphotic Cobb Angle. PKP surgery has a higher value in the treatment of OVCF. In addition, the influencing factors of secondary fracture after minimally invasive surgery in OVCF patients include age, gender, glucocorticoid use, bone cement distribution pattern, bone cement leakage, etc.

Balloon kyphoplasty is a minimally invasive procedure for the treatment of painful vertebral fractures, which is intended to reduce pain and improve quality of life. We assessed the efficacy and safety of the procedure. Adults with one to three acute vertebral fractures were eligible for enrolment in this randomised controlled trial at 21 sites in eight countries. We randomly assigned 300 patients by a computer-generated sequence to receive kyphoplasty treatment (n=149) or non-surgical care (n=151). The primary outcome was the difference in change from baseline to 1 month in the short-form (SF)-36 physical component summary (PCS) score (scale 0–100) between the kyphoplasty and control groups. Quality of life and other efficacy measurements and safety were assessed up to 12 months. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00211211. 138 participants in the kyphoplasty group and 128 controls completed follow-up at 1 month. By use of repeated measures mixed effects modelling, all 300 randomised participants were included in the analysis. Mean SF-36 PCS score improved by 7·2 points (95% CI 5·7–8·8), from 26·0 at baseline to 33·4 at 1 month, in the kyphoplasty group, and by 2·0 points (0·4–3·6), from 25·5 to 27·4, in the non-surgical group (difference between groups 5·2 points, 2·9–7·4; p<0·0001). The frequency of adverse events did not differ between groups. There were two serious adverse events related to kyphoplasty (haematoma and urinary tract infection); other serious adverse events (such as myocardial infarction and pulmonary embolism) did not occur perioperatively and were not related to procedure. Our findings suggest that balloon kyphoplasty is an effective and safe procedure for patients with acute vertebral fractures and will help to inform decisions regarding its use as an early treatment option. Medtronic Spine LLC.

To evaluate the clinical efficacy of ZhuZheng robot-assisted versus C-arm fluoroscopy-guided percutaneous pedicle screw fixation (PPSF) in the treatment of thoracolumbar burst fractures. A retrospective analysis was conducted on 86 patients with thoracolumbar burst fractures treated at our institution between March 2022 and August 2023. The cohort included 46 males and 40 females, aged 27 to 69 years. Patients were assigned to either the robot-assisted group ( n  = 41) or the conventional C-arm fluoroscopy group ( n  = 45) according to intraoperative navigation method. Baseline characteristics, including gender ratio and body mass index (BMI), were comparable between the two groups ( P  > 0.05). All patients underwent segmental fixation. Intraoperative parameters such as fluoroscopy frequency, operative time, and estimated blood loss were recorded. The accuracy of screw placement was assessed using postoperative CT at day 3 and graded according to the Gertzbein-Robbins scale. Pain was evaluated using the Visual Analogue Scale (VAS) preoperatively and at 1 day, 3 days, and 1 month postoperatively. Radiological assessments included Cobb angle and anterior vertebral height ratio at baseline, 3 days, 1 month, and 6 months postoperatively. Statistical analyses were performed using the t-test and Mann-Whitney U test. The robot-assisted group had significantly shorter operative time, reduced intraoperative blood loss, lower radiation dose, and fewer fluoroscopy exposures compared to the conventional group (all P  < 0.05). No perioperative complications occurred in either group during follow-up. The screw placement accuracy (grades A + B) was significantly higher in the robot-assisted group (98.4%, 242/246) than in the conventional group (90.4%, 244/270; P  < 0.05). VAS pain scores at postoperative day 1 and day 3 were significantly lower in the robot-assisted group; no significant difference was observed at 1 month. There were no significant intergroup differences in the postoperative Cobb angle or anterior vertebral height ratio at any time point ( P  > 0.05). Robot-assisted orthopedic surgery demonstrates significant advantages in improving screw placement accuracy, reducing intraoperative blood loss, shortening operative time, and minimizing radiation exposure and fluoroscopy frequency, thereby offering improved clinical outcomes in the management of thoracolumbar burst fractures.

Summary 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. Introduction 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). Methods 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. Results 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. Conclusion 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.