Background: Percutaneous kyphoplasty (PKP) can effectively treat osteoporotic vertebral compression fractures (OVCFs). Although satisfactory clinical outcomes can be achieved, bone cement leakage remains a primary complication of PKP. Previous studies have found many high risk factors for bone cement leakage into the spinal canal; however, less attention to the posterior wall morphologies of different vertebral bodies may be one reason for the leakage. Here, we investigated the effect of posterior vertebral wall morphology in OVCF patients on bone cement leakage into the spinal canal during PKP. Methods: Ninety-eight OVCF patients with plain computed tomography (CT) scans and three-dimensional (3D) reconstruction images from T6 to L5 were enrolled. 3D-CT and multiplanar reconstructions (MPR) were used to measure the concave posterior vertebral wall depth (PVWCD) and the corresponding midsagittal diameter of the nonfractured vertebral body (VBSD), and the PVWCD/VBSD ratio was calculated. All subjects were divided into the thoracic or lumbar groups based on the location of the measured vertebrae to observe the value and differences in the PVWCD between both groups. The differences in PVWCD and PVWCD/VBSD between the thoracic and lumbar groups were compared. Three hundred fifty-seven patients (548 vertebrae) who underwent PKP within the same period were also divided into the thoracic and lumbar groups. The maximal sagittal diameter (BCSD), the area of the bone cement intrusion into the spinal canal (BCA), and the spinal canal encroachment rate (BCA/SCA × 100%) were measured to investigate the effect of the thoracic and lumbar posterior vertebral wall morphologies on bone cement leakage into the spinal canal through the Batson vein during PKP. Results: The PVWCDs gradually deepened from T6 to T12 (mean, 4.6 mm); however, the values gradually became shallower from L1 to L5 (mean, 0.6 mm). The PVWCD/VBSD ratio was approximately 16% from T6 to T12 and significantly less at 3% from L1 to L5 (P < 0.05). The rate of bone cement leakage into the spinal canal through the Batson vein was 10.1% in the thoracic group and 3.7% in the lumbar group during PKP. In the thoracic group, the BCSD was 3.1 ± 0.5 mm, the BCA was 30.2 ± 3.8 mm², and the BCA/SCA ratio was 17.2 ± 2.0%. In the lumbar group, the BCSD was 1.4 ± 0.3 mm, the BCA was 14.8 ± 2.2 mm², and the BCA/SCA ratio was 7.4 ± 1.0%. The BCSD, BCA and BCA/SCA ratio were significantly higher in the thoracic group than in the lumbar group (P < 0.05). Conclusions: The PVWCD in the middle and lower thoracic vertebrae can help reduce bone cement leakage into the spinal canal by enabling avoiding bone cement distribution over the posterior 1/6 of the vertebral body during PKP. The effect of the difference between the thoracic and lumbar posterior vertebral wall morphology on bone cement leakage into the spinal canal through the Batson vein in OVCF patients during PKP is one reason that the rate of bone cement leakage into the thoracic spinal canal is significantly higher than that into the lumbar spinal canal.

Background: Infection after vertebral augmentation (VA) often limits the daily activities of patients and even threatens their life. The operation may be one of the effective treatments if the patient suffers from intolerable severe pain, neurological deficits, and damage to spinal stability. This study aimed to investigate the clinical efficacy of the treatment of pyogenic spondylitis after vertebral augmentation (PSVA) with Single posterior debridement, vertebral body resection, and intervertebral bone graft fusion and internal fixation (sPVRIF). Methods: The study was performed on 19 patients with PSVA who underwent VA at 4 hospitals in the region between January 2010 and July 2020. Nineteen patients were included. Among them, 16 patients underwent sPVRIF to treat the PSVA. Results: A total of 2267 patients underwent VA at 4 hospitals in the region. Of the 19 patients with postoperative PSVA, suppurative spondylitis was misdiagnosed as an osteoporotic vertebral fracture(OVF) in 4 patients and they underwent VA. Besides osteoporosis, 18 patients had other comorbidities. The average interval between the first surgery and the diagnosis of PSVA was 96.4 days. Of the 19 patients, 16 received surgical treatment. The surgical time was 175.0±16.8 min, and the intraoperative blood loss was 465.6±166.0 mL. Pathogenic microorganisms were cultured in 12 patients. Conclusion: PSVA is a severe complication that can even threaten the life of the patients. sPVRIF may be one of the effective treatments if the patient suffers from intolerable severe pain, neurological deficits, and damage to spinal stability.

Background: Adolescent idiopathic scoliosis represents a complex three-dimensional spinal deformity of unknown etiology. It frequently results in visible deformities, decreased daily functional capacity, impaired pulmonary function, and psychological distress. Personalized treatment options for adolescent idiopathic scoliosis include exercise therapy, brace use, and surgical intervention, tailored to individual patient needs. Exercise therapy is often employed for patients with mild-to-moderate adolescent idiopathic scoliosis, those undergoing postoperative rehabilitation, or those ineligible for surgery because of its noninvasive nature, low cost, ease of application, and avoidance of prolonged brace use. However, a unified standard or guideline for the use of exercise therapy in managing adolescent idiopathic scoliosis is lacking. This study aimed to investigate the clinical efficacy of exercise therapy for adolescent idiopathic scoliosis and evaluate its therapeutic significance. Methods: We conducted a systematic review by searching several databases, including China National Knowledge Infrastructure, Wanfang, PubMed, Web of Science, Excerpta Medica Database, MEDLINE, Ovid, and Cochrane Library, with no language restriction, to retrieve randomized controlled trials on exercise therapy for scoliosis. Meta-analysis was performed using RevMan 5.4. The protocol was registered with PROSPERO (registry number: CRD420251106878). Results: A total of 9 studies involving 571 patients with adolescent idiopathic scoliosis were included. The pooled results revealed that the mean difference for the impact on Cobb angle was 3.31 (95% confidence interval: 2.56–4.05; P <  0.00001), indicating a statistically significant difference ( P  <   0.05). Regarding angulation of trunk rotation, the mean difference was 2.80 (95% confidence interval: 1.90–3.70; P <  0.00001), indicating a statistically significant difference ( P  <   0.05). For the Scoliosis Research Society-22 scores, the mean differences were as follows: pain, mean difference = 0.64 (95% confidence interval: 0.10–1.19; P  =   0.02); function/activity, mean difference = 0.83 (95% confidence interval: 0.20–1.45; P  =   0.009); self-image, mean difference = 0.51 (95% confidence interval: 0.10–0.91; P  =   0.01); mental health, mean difference = 0.18 (95% confidence interval: 0.13–0.48; P  =   0.25); and satisfaction with treatment, mean difference = 1.36 (95% confidence interval: 0.41–2.32; P  =   0.005). Statistically significant differences were observed in all scores except for mental health ( P  <   0.05). Conclusion: Specific spinal exercise therapy has demonstrated effectiveness in improving Cobb angle, correcting angulation of trunk rotation measurements, and positively impacting pain, functional activity, and self-image compared with other non-exercise conservative treatments, resulting in higher patient satisfaction with treatment outcomes.

Objective: To compare the clinical efficacy and long-term deformity correction retention of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods: We retrospectively analyzed clinical data from patients with OVCF admitted to our hospital between January 2020 and January 2023. Patients were allocated to either the PVP or PKP group. Baseline characteristics, intraoperative variables, deformity correction [anterior vertebral height (AVH) and local Cobb angle (CA)], and symptom relief [visual analog scale (VAS) scores for back pain] were compared. The incidence of bone cement leakage was assessed, and bone cement distribution patterns were compared between the procedures. In the PKP group, the correlation between cement distribution pattern and both deformity correction loss and symptom improvement were also analyzed. Results: Postoperatively, PKP demonstrated superior immediate anatomical restoration with greater AVH improvement (4.02 ± 0.34 mm vs. PVP 2.44 ± 0.21 mm, p = 0.005) and CA correction (-4.67° ± 0.32° vs. -3.02° ± 0.17°, p = 0.007). Both groups achieved comparable substantial symptom relief: median Oswestry Disability Index (ODI) decreased by 39.8 points in PVP and 39.7 points in PKP (p = 0.107), and median VAS decreased by 6.0 points in both groups (p = 0.420). However, at 2-year follow-up, PKP exhibited significant reversal: greater AVH correction loss (7.50% ± 0.97% vs. PVP 1.45% ± 0.57%, p < 0.001), CA correction loss (7.64% ± 1.12% vs. 1.10% ± 0.58%, p < 0.001), and worsened symptoms (VAS median 3.0 vs. 2.0, p =0.014; ODI 28.8% vs. 21.5%, p < 0.001). Critical to this divergence, PVP achieved superior cement distribution—reflected in higher Cement Distribution Score (CDS) (10.0 [IQR 9–10] vs. PKP 8.0 [8–9], p < 0.001) and Specific Surface Area (SSA) (5.66 ± 0.61 vs. 4.41 ± 0.67 cm²/cm³, p < 0.001)—with both parameters negatively correlating with loss of both AVH and CA correction, while positively correlating with improvement rates in VAS and ODI scores (all p < 0.001). PVP was associated with a significantly higher incidence of bone cement leakage compared to PKP (19.8% [20/101] vs. 8.42% [8/95], p = 0.024). PKP also incurred higher adjacent vertebral fractures (9.45% [9/95] vs. 1.98% [2/101], p = 0.023), augmented vertebra refractures (8.42% [8/95] vs. 1.98% [2/101], p = 0.041), longer operative time (44.15 ± 10.09 vs. 40.62 ± 11.71 min, p = 0.019), increased radiation exposure (24.26 ± 2.90 vs. 21.80 ± 3.35 exposures, p < 0.001), and doubled cost (8042 ± 1608 vs. 4316 ± 863 USD, p < 0.001). Conclusion: Both PVP and PKP are effective short-term treatments for OVCF. Therefore, PVP may be superior to PKP in maintaining long-term correction, particularly when bone cement distribution is optimized.

Since the first case report by Tsung-Ting Tsai, bone cement displacement (BCD) has emerged as a catastrophic complication. Factors contributing to this com