Background/Objectives: Osteoporotic vertebral fractures (OVFs) are common in older adults. While surgery is generally reserved for unstable or painful fractures, some OVFs conceal underlying malignancies, including metastatic and hematologic cancers. This study aimed to determine the pooled prevalence of unsuspected malignancy in patients initially diagnosed with OVFs. Methods: A systematic search of PubMed and Scopus was conducted from inception to September 2025 in accordance with PRISMA guidelines. Eligible studies included adults with presumed OVFs who underwent vertebral biopsy and histopathological evaluation. Prevalence estimates were pooled using a random-effects model, and study quality was assessed with the Newcastle–Ottawa Scale. Results: Thirteen studies involving 3513 patients were included. The pooled prevalence of malignancy was 8.0% (95% CI: 5.4–10.6), comprising metastatic solid tumors (4.9%; 95% CI: 2.3–7.4) and multiple myeloma (2.6%; 95% CI: 1.3–3.9). Malignancy was detected in 2.7% (95% CI: 1.8–4.1) of routine biopsy cohorts versus 36.8% (95% CI: 22.1–54.4) of clinically suspected cases. Diagnostic yield exceeded 45% in patients selected by combined history, imaging, or known malignancy. No biopsy-related complications or procedure-related mortality were reported. Moderate heterogeneity was observed, mainly in suspected cohorts. Conclusions: Vertebral biopsy is a safe and diagnostically valuable procedure in vertebral compression fractures. Its yield ranges from about one in 30 patients in routine settings to nearly one in two in high-risk groups, underscoring the importance of structured patient selection to facilitate timely cancer detection and referral.

Purpose: The posterior dynamic distraction device (PDDD) is a fusionless implant for adolescent idiopathic scoliosis (AIS). We aimed to quantify pooled major-curve Cobb correction, complication, revision, and infection rates after primary PDDD implantation for Lenke 1 or 5 curves, and to place these outcomes in context alongside posterior spinal fusion (PSF) and vertebral body tethering (VBT). Methods: Following PRISMA guidance (PROSPERO: CRD420251074442), PubMed, Embase, Scopus, and Web of Science were searched to May 2025. Random-effects meta-analyses were performed for Cobb correction, complications, and revisions, with leave-one-out sensitivity analyses. Results: Five studies (148 unique patients; mean age 13.1–16.0 years) met the inclusion criteria. Pooled mean Cobb correction was 22.8° (95% CI: 14.2–31.4°), approximately 51% of the preoperative magnitude; however, heterogeneity was extreme (I²=98%; prediction interval − 14.5° to 60.1°), and this pooled figure should not be interpreted as a reliable estimate of expected correction. The pooled complication rate was 24% (95% CI: 12–40%, I²=76%) and revision rate was 30% (95% CI: 19–45%, I²=64%), rising to 35% when elective exchanges for device outgrowth were included, with mechanical failures predominating. Primary surgical site infection occurred in 6% (95% CI: 3–12%, I²=0%). Risk of bias was moderate to serious across all studies. Conclusion: PDDD provides moderate short-term curve correction, but approximately one in four patients experiences a complication and nearly one in three requires reoperation at short-term follow-up. Reported perioperative advantages derive from only two to three uncontrolled cohorts. PDDD does not yet match PSF for reliability or percentage correction, nor VBT for reoperation rates. Pending larger comparative studies with long-term follow-up, PDDD should be considered investigational and patients counselled accordingly.