Objective Osteoporotic thoraco‐lumbar burst fractures with serious pain are very common, and the optimal treatment of burst fractures without any neurological deficits has not yet been properly codified. The objective of this study was to evaluate prospectively the clinical effects and pain relief of unilateral percutaneous kyphoplasty (PKP) on osteoporotic thoraco‐lumbar burst fractures. Methods Forty‐six patients with osteoporotic thoraco‐lumbar burst fractures were treated by PKP in our hospital from January 2016 to January 2017. The height of posterior wall (HPW), the height of anterior wall (HAW) and kyphotic angle (KA) were measured via x‐ray radiographs before surgery, one day after surgery and at final follow‐up. Visual analogue scale (VAS) score and the oswestry disability index (ODI) score were evaluated preoperatively, postoperatively and at final follow‐up. All the patients with osteoporotic thoraco‐lumbar burst fractures were treated by unilateral PKP. Radiological evaluation (anteroposterior and lateral x‐ray radiographs and CT) was performed. Results All patients were followed‐up, and the mean follow‐up was 28.8 ± 7.0 months. The preoperative HAW was 20.1 ± 2.3 mm, and the HAW was significantly improved to 22.9 ± 2.4 mm after operation (p < .05), and at the final follow‐up, the HAW was 19.9 ± 2.1 mm, which was lower than the postoperative HAW. The HPW was also significantly corrected after surgery (p < .05). There were no significant differences between postoperative HPW and HPW at the final follow‐up (p > .05). The KA was significantly corrected after operation (p < .05), but relapse occurred at the final follow‐up, and at the final follow‐up, the average of KA was 19.4 ± 1.6 degree. The VAS and ODI were significantly improved at the final follow‐up compared to the preoperative period (p < .05). Cement leakage was found in eight patients, and adjacent vertebral fracture (VF) was found in two patients. Conclusions Our results showed that unilateral PKP acquired satisfactory treatment effect and pain relief in the management of osteoporotic thoraco‐lumbar burst fractures. Meticulous evaluation of preoperative images and careful repetitious injection of cement are important to prevent cement leakage. Significance Our present results showed that unilateral PKP was an effective method to obtain satisfactory pain relief in the management of osteoporotic thoraco‐lumbar burst fractures. It may a good indication for the patients with osteoporotic thoraco‐lumbar burst fractures, and the patients could not tolerate the serious acute pain by conservative treatment.

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Purpose The surgical treatment of thoracic myelopathy is still controversial and also a challenge for spine surgeons. Therefore, the objective of this study was to review the related literature on the surgical treatment of thoracic myelopathy and try to define treatment guidelines for spine surgeons on thoracic myelopathy. Methods Relevant literatures were searched based on the PubMed, EMBASE, and Cochrane Library between January 2008 and December 2018. Some data on the characteristics of patients were extracted, including number of patients, mean age, surgical procedures, blood loss, complications, and pre-/post-operation modified JOA score. Recovery rate was used to assess the effect of surgery outcome, and the safety was evaluated by blood loss and incidence of complications. Results Thirty-five studies met the inclusion criteria and were retrieved. A total of 2183 patients were included in our systematic review, with the average age of 55.2 years. There were 69.8% patients diagnosed as ossification of ligamentum flavum (OLF), 20.0% as ossification of posterior longitudinal ligament (OPLL), 9.3% as disk herniation (DH), and 0.9% as others including diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS). The volume of blood loss was more in the treatment of circumferential decompression (CD) than posterior decompression (PD), and the incidence of complications was higher in CD (P < 0.05). The volume of blood loss in minimally invasive surgery (MIS) was lowest and the incidence of complications was 19.2%. Post-operation recovery rate was 0.49 in PD, 0.35 in CD, and 0.29 in MIS while the recovery rate was 0.54 in PD, 0.55 in CD, and 0.49 in MIS at the last follow-up. When focusing on the OLF specifically, incidence of complications in PD was much lower than CD, with less blood loss and higher recovery rate. Focusing on the OPLL specifically, incidence of complications in PD was much lower than CD, with less blood loss while there was no statistical difference in recovery rate between these two methods. Conclusions This systematic review showed that posterior decompression for thoracic myelopathy is safer and better than circumferential decompression according to the complication rate and surgical outcome. And we should also consider the location of compression before the operation.