Study Design. Retrospective comparative study. Objective. This study aimed to compare the clinical effects and imaging features of polymethyl methacrylate (PMMA) bone cement with and without mineralized collagen (MC) in percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs). Summary of Background Data. PKP with PMMA is widely performed for OVCF. However, numerous complications have also been reported about the PMMA bone cement. Moreover, PMMA bone cement with and without MC have not been compared with respect to their postoperative efficacy and long-term follow-up. Methods. From July 2016 to July 2017, 105 OVCF patients were randomly divided into two groups based on their PKP treatment: MC-PMMA group and PMMA group. Clinical operation, cement leakage, Oswestry Disability Index, visual analog scale, height of the fractured vertebrae, Cobb angle, refracture of the adjacent vertebra, recompression, and computed tomography values of the injured vertebra were compared between the two groups postoperatively and after 1-year follow-up. Results. Clinical operation showed no differences between the two groups. Visual analog scale scores, Oswestry Disability Index scores, and Cobb angles showed statistically significant differences between the two groups after 1-year follow-up. The height of the vertebral body showed significant difference at 3 days postoperatively and preoperatively in each group and significant difference after 1 year between the two groups. The rate of refracture and leakage of the MC-PMMA group was lower than that of the PMMA group. The computed tomography value of the MC-PMMA group was obviously higher than that of the PMMA group after 1-year follow-up. Conclusion. MC-modified PMMA did not change the beneficial properties of PMMA. This new bone cement has better biocompatibility, can form a stable structure in the vertebral body, and improve the prognosis of patients by reducing pain and reoperation. Level of Evidence: 3

To examine the clinical effects of a new bone cement composed of poly(methyl methacrylate) (PMMA) and mineralized collagen (MC) compared with pure PMMA bone cement in treating osteoporotic vertebral compression fractures (OVCFs) in patients aged over 80. In all, 32 cases using pure PMMA bone cement and 31 cases using MC-modified PMMA (MC-PMMA) bone cement for OVCFs between June 2014 and March 2016 were screened as PMMA group and MC-PMMA group, respectively, with an average age of over 80. The operation duration, intraoperative blood loss, hospital stay, oswestry disability index (ODI), visual analogue scale (VAS), anterior vertebral height (AVH), intermediate vertebral height (IVH) and posterior vertebral height (PVH) of injured vertebrae, vertebral computed tomography value, re-fracture rate of adjacent vertebrae, correction rate of spinal kyphotic angle and wedge-shaped vertebra angle and surgical complications were compared between the two groups. In the early post-operative period, the VAS, ODI, AVH and IVH in MC-PMMA group were comparable to those in the traditional PMMA group. Moreover, the MC-PMMA group showed better effects compared with the PMMA group 12 months after surgery. Thus, this new bone cement has superior clinic effects in the long term.

Departmental sources Background: Annular fiber closure techniques have been proven effective in reducing short-term recurrence after discectomy. However, annular fiber closure devices are expensive and still fail at a low rate. We present a novel suture method, needle-guided annular closure suture (NGACS) that does not require a special device and can be performed for annular fiber closure following microendoscopic discectomy. Material/Methods: Twenty-five patients who underwent treatment with NGACS were reviewed by analysis of the medical records. The clinical outcomes were assessed and compared preoperatively and immediately, 1, 6, and 12 months postoperatively. The parameters included the Visual Analog Scale (VAS)-back and VAS-leg scores and the Oswestry Disability Index (ODI). Midsagittal T2WI images were obtained to evaluate lumbar disc degeneration using the Pfirrmann grade. Additional adverse events were also recorded and tracked. Results: The VAS-back and VAS-leg scores and the ODI were significantly different at each follow-up time point (P<0.001), and improvements in pain and disability were maintained well during the follow-up period. Lumbar disc reherniation or other serious adverse events were not observed in this series. There was no significant difference between the initial and final Pfirrmann grades (Z=-1.414, P=0.157). The preoperative average disc height was 9.94±1.97 mm, and the disc height at 12 months after surgery was 9.14±1.88 mm. The average decrease in disc height was 8.11±3.36%. Conclusions: This study demonstrates the feasibility and superior clinical outcomes of the NGACS technique. This method can be a good substitution when annular fiber closure devices are not available. Moreover, this technique can be easily popularized due to its low cost and few restrictions.

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Purpose Percutaneous vertebroplasty(PVP) has been widely used in treating symptomatic Schmorl’s nodes(SNs). However, there were still some patients with poor pain relief. At present, there is a lack of research to analyze the reasons for poor efficacy. Methods Review the SNs patients treated with PVP in our hospital from November 2019 to June 2022, collect their baseline data. Reverse reconstruction software was used to calculate the filling rate of bone edema ring(Rf). NRS score was used to evaluate pain and ODI to evaluate function. The patients were divided into remission group(RG) and non remission group(n-RG) according to symptom. In addition, according to the Rf, they were divided into excellent, good and poor groups. Differences between groups were investigated. Results A total of 26 vertebrae were included in 24 patients. When grouped according to symptoms, patients in n-RG were older, and surgical segments were tend to locate in lower lumbar spine. The proportion of Poor distribution was significantly higher. When grouped according to the cement distribution, the preoperative NRS and ODI of the three groups were comparable, but the NRS and ODI of Poor group were significantly worse than the Excellent and Good groups postoperatively and at the last follow-up. Conclusions The cement distribution may significantly affect the efficacy of PVP in treating symptomatic SNs. We suggest that the bone edema ring should be filled as fully as possible to ensure the efficacy. In addition, advanced age and low lumbar lesions are also adverse factors for clinical outcomes.

Study design: A retrospective cohort study.Objective: To detect the boundary of indications of fixation in OLIF surgery.Methods: Review patients undergoing stand-alone or combined OLIF. Measure the disc height increment (ΔDH), foraminal height (FH), cage subsidence (CS). VAS and the ODI was used to evaluate low back pain and functionality. Multiple linear regression were used to determine the risk factors of CS.Results: A totle of 66 consecutive patients included. The BMD in combined group was significantly lower than that of stand-alone group(p=0.005). The combined group showed better FH maintenance at 6 months (p= 0.049) and last follow-up (p= 0.019). In combined group, tCS was significantly lower at all post-operation point (p≤0.001). BMD was a mild negative correlated factor for CS in combined group (r= -0.602, p= 0.001)and a strongly negative correlated factor in stand-alone group (r= -0.797, p< 0.001). Greater mCS significantly associated with worse VAS (r=0.685, p<0.001) and ODI (r=0.616, p<0.001) in stand-alone group, and this effect was significantly weakened in the combined group as VAS (r=0.427, p=0.033) and ODI (r=0.594, p=0.002). Patients with stand-alone OLIF were at risk of severe CS when BMD <-1.38, while those with combined OLIF had an equal risk when BMD < -4.77.Conclusions: The long-term fusion rates and functionality improvements of OLIF with or without fixation are comparable. Patients with BMD < -1.38 may not suitable for stand-alone procedure due to higher risk of severe CS and worse clinical outcomes. Additional fixation can extends the applicable boundary to a BMD = -4.77.

Study design A retrospective cohort study. Objective To investigate the radiological and clinical outcomes of patients with or without pedicle-screw rod fixation (PSRF) in OLIF surgery. Methods Between June 2017 and December 2019, 66 consecutive patients who underwent OLIF surgery at two centers were divided into stand-alone and combined groups according to whether or not PSRF was used. Imaging and clinical data were collected preoperatively, postoperatively, 3 and 6 months postoperatively, and at the last follow-up. Related coefficient and multiple linear regression analysis was used to detect the influencing factors of cage subsidence (CS). Results There was a lower baseline BMD in the combined group (p = 0.005). The combined group showed superior VAS score at 3 months postoperatively, although there was no difference in long-term VAS and ODI scores between the two groups. The foraminal height (FH) of the two groups was comparable at preoperatively, postoperatively, and 3 months postoperatively, but the combined group showed better maintenance of FH at 6 months postoperatively (p = 0.049) and last follow-up (p = 0.019). The total CS (tCS) of the combined group was lower than that of the stand-alone group during the whole follow-up period (all p ≤ 0.001). Multiple linear regression suggested that lower BMD was the risk factor for main CS, and PSRF could significantly reduce the BMD threshold for severe CS (−4.77 vs −1.38). Conclusions OLIF combined with PSRF can effectively avoid foraminal height loss and prevent severe CS, which may be more suitable for patients with osteoporosis or osteopenia and improve clinical outcomes.

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