Clinical Study And Significance Of Osteoporotic Vertebral Compression Fractures

Part One Clinical correlation between osteoporotic thoracolumbar vertebral compression fractures and lumbar spondylo-listhesisObjective: In clinical,osteoporosis thoracolumbar compression fracture often associated with lumbar spondylolisthesis,and has a certain universality.But there is no study on the clinical correlation between osteoporosis vertebral compression fracture(OVCF)and lumbar spondylolisthesis at present,and there is no enough understanding of the internal relationship between the two diseases.This study was to explore the clinical correlation between osteoporosis thoracolumbar vertebral compression fracture and lumbar spondylolisthesis.Methods: From September 2018 to September 2020,208 patients with osteoporotic thoracolumbar vertebral compression fractures(fracture group,n=208)and 250 elderly patients with osteoporosis(non-fracture group,n=250)were retrospectively analyzed.At the same time,75 cases of elderly patients with osteoporosis in our department were included,including 25 patients with isthmic spondylolisthesis(IS group,n=25),25 patients with degenerative spondylolisthesis(DS group,n=25)and 25 patients without lumbar spondylolisthesis(non-LS group,n=25).All patients underwent full-length spine anteroposterior and lateral X-ray,and the spinal pelvic imaging parameters were collected for comparison.Results: There was no significant difference in age,gender,BMI,BMD between fracture group and non-fracture group(P>0.05).The incidence of lumbar spondylolisthesis in fracture group(10.1%,21/208)was significantly higher than that in non-fracture group(4.8%,12/250),the difference was statistically significant(χ2=4.763,P=0.029).The incidence of trauma in fracture group(51.0%,106/208)was significantly higher than that in non-fracture group(13.6%,34/250),the difference was statistically significant(χ2=74.673,P=0.000).The history of lumbar spondylolisthesis(OR=2.273,95%CI=1.030-5.017,P=0.042)and trauma(OR=6.622,95% CI=4.203-10.432,P=0.000)were independently associated with osteoporotic thoracolumbar vertebral compression fractures.There were no significant differences in age,gender,BMI,BMD,PT and SVA among the three groups(P>0.05).There were significant differences in PI,SS,LL,TLK and TK among the three groups(P<0.05).Among them,PI,SS,LL,TLK and TK of IS group and DS group were significantly higher than those of non-LS group(P<0.05);but PI and SS of IS group and DS group had no significant difference(P>0.05);LL,TLK and TK of IS group were significantly higher than those of DS group(P<0.05).Conclusions: Lumbar spondylolisthesis and a history of trauma were risk factors for osteoporotic thoracolumbar vertebral compression fractures.The possible mechanism of OVCF caused by lumbar spondylolisthesis is that when the elderly patients with osteoporosis combined with lumbar spondylolisthesis,it will change the spine pelvic parameters,and then lead to the changes of spine biomechanics such as the increase of local stress in thoracolumbar segment.At the same time,because of the existence of lumbar spondylolisthesis,it will also increase the thoracic vertebra and thoracolumbar kyphosis,which may have adverse effects on physical function,and poor physical function is also a high risk factor for falls.Part two Which one is more effective for the treatment of very severe osteoporotic vertebral compression fractures: PVP or PKP?Objective: At present,there are relatively few research on how to choose percutaneous vertebroplasty(PVP)or percutaneous kyphoplasty(PKP)for patients with very severe osteoporotic vertebral compression fractures(OVCFs),especially the lack of comparative studies.The safety and efficacy of PVP or PKP are still uncertain.The purpose of this study was to compare the clinical efficacy and safety of PVP and PKP in the treatment of the elderly with OVCFs.Methods: From September 2012 to September 2015,57 patients with very severe OVCFs who had undergone PVP and PKP surgeries at our medical center were reviewed retrospectively,at least 2 years follow-up.All patients were divided into PVP group(n=31)and PKP group(n=26).Clinical data including clinical and radiological evaluation results were performed preand postoperatively.The changes of anterior height of vertebrae fractured,local Cobb angle,visual analogue scale(VAS),Oswestry disability index(ODI)and postoperative complications such as bone cement leakage and adjacent-level fracture were compared between the two groups before operation,1 day after operation and at the last follow-up.Results: All operations were successfully completed.A total of 57 patients were followed up,including 31 patients in PVP group and 26 patients in PKP group.There were 23 males and 34 females with an average age of75.0 years(range,64-85 years).The average follow-up period was 2.7 years.The average compression rate of fractured vertebral body was 73.3%.There was no significant difference in age,gender,BMI,BMD,duration of disease,vertebral compression,operative levels,average length of stay and follow-up between PVP group and PKP group(P>0.05).The operation time of PVP group(29.6±3.3 minutes)was less than that of PKP group(37.4±4.2 minutes),with significant differences(t=7.851,P=0.000).Compared with preoperative data,the VAS scores,ODI scores and local kyphotic angle were improved with significant differences at 1 day after surgery and the last follow-up in two groups(P<0.05).However,there were no differences in VAS and ODI scores between the two groups(P>0.05).The local kyphotic angle of PVP group was more than PKP group after surgery,with significant differences(P<0.05).At 1day after surgery and the last follow-up,the anterior height of vertebrae fractured was significantly improved compared with preoperative in PKP group(P<0.05),and there was no statistical difference compared with preoperative in PVP group(P>0.05).However,there were no significant differences between two groups in the leakage rate of bone cement(χ2=0.489,P=0.484)and incidence of adjacent-level vertebra fracture(χ2=0.070,P=0.792).Conclusions: Both PVP and PKP can significantly relieve the pain of the patients with very severe OVCFs.Restoring the vertebral height and local kyphotic angle corrections of PKP are comparatively better than those of PVP.However,the operation time of PKP is significantly longer than that of PVP and PKP is not superior in the leakage rate of bone cement and incidence of adjacent-level vertebra fracture compared to PVP.Part three Application of Bone Cement Tailing Technique in Percu-taneous Kyphoplasty for Treatment of Osteoporotic Kummell’s DiseaseObjective: In recent years,more and more cases of delayed cement loosening or displacement after percutaneous vertebroplasty(PVP)and percutaneous kyphoplasty(PKP)for Kummell’s disease have been reported,which is a serious complication.The purpose of this study was to investigate whether bone cement tailing technology can reduce delayed bone cement loosening and displacement in PKP surgery for the treatment of Kummell’s disease.Methods: This was a retrospective study of 75 patients with single-level of stage I and II Kummell’s disease,which had undergone PKP surgery at our medical center from January 2015 to January 2019.According to whether there is bone cement tailing sign on the lateral X-ray after operation,these patients were divided into two groups: tailing group(n=39)and non-tailing group(n=36).All patients were followed up for at least one year.Clinical data including clinical and radiological evaluation results were performed pre-and postoperatively.The changes of anterior vertebral height,local kyphotic angle,visual analogue scale(VAS),Oswestry disability index(ODI)and postoperative complications such as bone cement leakage,adjacent-level fracture,bone cement loosening or displacement were compared between the two groups.Results: All operations were successfully completed.A total of 75 patients were followed up,including 29 males and 46 females.The average age of operation was 72 years.The average follow-up was 1.6 years.There were no significant differences in age,sex,BMI,BMD,duration of disease,vertebral compression,operative levels,average length of stay,cement volume and follow-up between the tailing and non-tailing groups(P>0.05).The operation time of the tailing group [(37.6±4.8)min] was longer than the non-tailing group [(34.9±4.3)min],with significant differences(t=2.558,P=0.013).Compared with preoperative data,the VAS scores,ODI scores,local kyphotic angle and anterior height of vertebrae fractured were improved with significant differences at 1 day after surgery and the last follow-up in two groups(P<0.05).However,there were no differences between the two groups(P>0.05).The delayed bone cement loosening or replacement of the tailing group(0/39)was less than the non-tailing group(4/36),with significant differences(P=0.048).However,there were no significant differences between two groups in the leakage rate of bone cement(χ2=0.699,P=0.403)and incidence of adjacent-level vertebra fracture(P=0.616).Conclusions: PKP is a safe and reliable treatment for Kummell’s disease,which can not only relieve pain,but also help to restore the height of fractured vertebral body and correct local kyphosis.The bone cement tailing technology can effectively reduce the incidence of delayed bone cement loosening and displacement after PKP treatment for Kummell’s disease.