Percutaneous kyphoplasty with or without temporary unipedicle screw reduction : A retrospective comparative study of osteoporotic vertebral fractures

Pedicle Screw Fixation Plus Cement Augmentation or Cement augmentation Only for Osteoporotic Vertebral Compression Fracture: A Systematic Review and Meta-Analysis

BACKGROUND

Osteoporotic vertebral compression fractures (OVCFs) are common fractures and pedicle screw system gains dissatisfactory results since bone mass loss. Cement augmentation (CA) is the most applied surgery modality for OVCFs but with shortcomings. Pedicle screw fixation plus CA (PSF + CA) has been reported superior to CA. This study aims to investigate the impact of PSF + CA on OVCFs.

METHODS

We approached databases of PubMed, Europe PMC, Web of Science, CENTRAL, and Embase for studies published up to November 2023. Clinical outcomes (hospital stay, blood loss, cement volume, cement leakage, secondary fracture), radiological outcomes (local kyphotic angle and anterior vertebral height), and subjective outcomes (visual analog scale and Oswestry Disability Index) were extracted. We tested the sensitivity and publication bias, rated evidence, calculated total effect sizes with prediction intervals, and explained heterogeneity.

RESULTS

Six studies were included with 255/339 patients in the PSF + CA group/CA-only group. The result is as follows: the PSF + CA group showed better in local kyphotic angle; anterior vertebral height claimed insufficient support favoring PSF + CA. The CA-only group showed better clinical outcome of hospital stay, blood loss, and operative time. Cement volume and cement leakage difference were not significant. Secondary fractures occurred more in the CA-only group. Visual analog scale scores favored the PSF + CA group, and Oswestry Disability Index results were too inaccurate to conclude.

CONCLUSIONS

PSF + CA and CA-only procedures achieved efficient clinical outcomes in OVCFs. PSF + CA showed better strength in deformity correction and long-term maintenance, less strength in incidence of secondary fracture, and more pain relief at the cost of length of hospital stay, blood loss, and operative time.

Vertebral Augmentation plus Pedicle Screw Fixation versus Vertebral Augmentation Alone in the Treatment of Osteoporotic Thoracolumbar Fractures: A Meta-Analysis

BACKGROUND

This meta-analysis was conducted to compare the efficacy and safety of vertebral augmentation (VA) plus pedicle screw fixation (PSF) with VA for treating osteoporotic thoracolumbar fractures (OTLFs).

METHODS

A comprehensive search was conducted in PubMed, Embase, Cochrane Library, and CNKI (China National Knowledge Infrastructure) to identify studies comparing PSF + VA with VA for treating OTLF. The primary outcomes were operation time, blood loss, length of stay, visual analog scale (VAS) score, Oswestry Disability Index (ODI), Cobb angle, anterior vertebral height (AVH), bone cement leakage, secondary fracture, and other adverse events. Standardized mean deviation (SMD) and risk ratio with 95% confidence interval (CI) were calculated.

RESULTS

Fourteen studies met the entire inclusion criteria for our meta-analysis. The PSF + VA group was associated with significantly more operation time (SMD, 4.41; 95% CI, 3.32-5.51), blood loss (SMD, 6.72; 95% CI, 4.50-8.95), and length of stay (SMD, 2.05; 95% CI, 1.02-3.07). There was no significant VAS score or ODI difference at early follow-up. No significant difference was found in AVH between the 2 groups before 2 years. The remaining outcomes (VAS at 6 months and 2 years; ODI at 6 months and 1 year; Cobb angle at all follow-up periods; AVH at 2 years; bone cement leakage and secondary fracture) favored the PSF + VA group.

CONCLUSIONS

PSF + VA was superior to VA for the VAS score, ODI, Cobb angle, AVH, and complications, especially in the long-term follow-up. However, more operation time, blood loss, and length of stay were the disadvantages for PSF + VA.

Novel bioactive glass based injectable bone cement with improved osteoinductivity and its in vivo evaluation

Recently, more and more attention has been paid to the development of a new generation of injectable bone cements that are bioactive, biodegradable and are able to have appropriate mechanical properties for treatment of vertebral compression fractures (VCFs). In this study, a novel PSC/CS composite cement with high content of PSC (a phytic acid-derived bioactive glass) was prepared and evaluated in both vitro and vivo. The PSC/CS cement showed excellent injectability, good resistance to disintegration, radiopacity and suitable mechanical properties. The in vitro test showed that the cement was bioactive, biocompatible and could maintain its shape sustainably, which made it possible to provide a long-term mechanical support for bone regeneration. Radiography, microcomputed tomography and histology of critical sized rabbit femoral condyle defects implanted with the cements proved the resorption and osteoinductivity of the cement. Compared with the PMMA and CSPC, there were more osteocyte and trabeculae at the Bone-Cement interface in the group PSC/CS cement. The volume of the residual bone cement suggested that PSC/CS had certain ability of degradation and the resorption rate was much lower than that of the CSPC cement. Together, the results indicated that the cement was a promising bone cement to treat the VCFs.