Comparable 2-year functional outcomes following vertebroplasty for thoracic and lumbar osteoporotic vertebral compression fractures: a retrospective cohort study
Aug 2026· Asian Spine Journal· Vol 20, pp. 717 - 727· 0 citations· 20 references
Medicine
TL;DR
Thoracic and lumbar vertebroplasty yielded comparable 2-year PROMs with no statistically significant differences detected between cohorts, suggesting that the vertebral region may not be a major determinant of patient-reported recovery following vertebroplasty for OVCFs.
Abstract
Study Design Retrospective cohort study. Purpose To compare short- and medium-term patient-reported outcome measures (PROMs) between thoracic and lumbar percutaneous vertebroplasty (PVP) cohorts for osteoporotic vertebral compression fractures (OVCFs). Overview of Literature PVP is well-established for pain relief in OVCF; however, whether clinical outcomes vary by the anatomical location of the treated vertebrae, remains unclear. Methods Ninety patients who underwent PVP between January 2010 and August 2022 with complete 2-year PROM follow-up were included and stratified into thoracic (n=33) and lumbar (n=57) cohorts. Outcomes included the Oswestry Disability Index (ODI), North American Spine Society (NASS) Neurogenic Symptom score, Visual Analog Scale (VAS) pain score, and Short Form-36 (SF-36) domains. Between-group comparisons were assessed using Wilcoxon rank-sum tests, and effect sizes were summarized using Cliff’s delta. Minimal clinically important difference (MCID) achievement was assessed for ODI, VAS Back Pain, and VAS Leg Pain. Multivariable linear regression examined the independent effect of vertebral region after adjustment for age, sex, race, number of vertebral levels treated, and baseline PROMs, with Benjamini-Hochberg false-discovery-rate (FDR) correction applied for multiple comparisons. Results The mean age was 76.4±8.5 years, and 83.3% of patients were female. No significant between-group differences were observed in ODI, NASS score, VAS pain score, or any SF-36 domain at 6 months or 2 years (p>0.05). MCID achievement rates for ODI and VAS Back Pain were high and comparable between groups at both follow-up points, exceeding 87%. On adjusted regression, the vertebral region was not an independent predictor of any postoperative PROM after FDR correction. Conclusions Thoracic and lumbar vertebroplasty yielded comparable 2-year PROMs with no statistically significant differences detected between cohorts. These findings suggest that the vertebral region may not be a major determinant of patient-reported recovery following vertebroplasty for OVCFs. However, residual confounding, attrition, and absent radiographic variables preclude definitive conclusions regarding clinical equivalence.
ABSTRACT Purpose Vertebral compression fractures (VCFs) are common complications of osteoporosis in elderly patients. Percutaneous vertebroplasty (PVP) provides pain relief and functional improvement, but some patients require revision due to refracture, cement failure, or new symptomatic levels. While outcomes of primary and multilevel augmentation have been described, systematic data on multilevel revision PVP remain rare. The aim of this study was to evaluate pain relief, functional improvement, and perioperative safety after three‐ and four‐level revision PVP in elderly patients with osteoporotic thoracolumbar fractures. Methods This retrospective, single‐center cohort included patients aged 75–85 years who underwent revision PVP between August 2019 and November 2023. Eligible cases had a history of prior PVP and required repeat augmentation of three or four vertebral levels in a single session. Visual Analogue Scale (VAS) scores for pain and Oswestry Disability Index (ODI) for functional disability were recorded preoperatively and at 1‐, 3‐, 6‐, and 12‐month follow‐up. Results Nine patients were analyzed. Revision involved three levels in five patients and four levels in four patients, with a mean interval of 14.1 months after the index procedure. Mean VAS improved from 8.3 ± 0.7 preoperatively to 3.2 ± 0.6 at 12 months (61% reduction, p < 0.01). ODI improved from 75.2% ± 3.4% to 26.9% ± 2.7% (64% reduction, p < 0.01). All patients exceeded the minimal clinically important difference thresholds. No perioperative complications such as cement leakage, neurological deficits, or pulmonary events were observed. Conclusion Three‐ and four‐level revision PVP provided significant pain relief and functional improvement in elderly patients with osteoporotic fractures, without increased complication rates. To our knowledge, this represents one of the first reports addressing this topic, suggesting it is an effective option in carefully selected patients.
S. Kapetanakis, M. Chatzivasiliadis, N. Gkantsinikoudis et al.· Orthopaedic Surgery· 0 citations
Although gender had minimal influence on pain and functional recovery, marked differences in surgical strategies and the administration of anti-osteoporotic therapy underscore potential disparities in the surgical treatment of women and the management of osteoporosis in men.
P. Schenk, Helena Arias, U. Spiegl et al.· European spine journal· 0 citations
ABSTRACT Background and Aims Lumbar disc herniation (LDH), a leading cause of low back pain, necessitates effective conservative management to mitigate surgical interventions. This retrospective observational study evaluated the short‐term (6 months–2 years) and long‐term (3–6 years) efficacy of conservative therapies in 194 LDH patients from Iran. Methods Data were collected via medical records, demographic questionnaires, and the numerical rating scale (NRS) for pain, with analyses adjusting for covariates such as body mass index (BMI), comorbidities, and treatment modalities. Data were analyzed using SPSS 24 (Kolmogorov–Smirnov normality test), including descriptive (frequencies, means/SDs) and inferential statistics (t‐tests, ANOVA, chi‐square, Fisher's exact); ANCOVA and multivariate logistic regression (adjusted for confounders, 95% confidence interval CI) modeled pain/paresthesia outcomes. Results The significant pain reduction after treatment (mean NRS: 7.3 to 3.7, p < 0.001) was demonstrated with home exercise programs showing the largest improvement (adjusted β: −0.74, p = 0.010). Short‐term pharmacological therapy (≤ 24 months) also reduced pain (β = −0.96, p = 0.02), while long‐term use lacked efficacy. Higher BMI correlated with higher pain (p = 0.03) and paresthesia risk (p = 0.01), and water therapy unexpectedly increased paresthesia odds (odds ratio (OR) = 4.14, p = 0.03) compared to other treatments. Females reported higher paresthesia rates (52.7% vs. 33.3%, p = 0.03), and comorbidities like hypertension were associated with a higher rate of paresthesia. Satisfaction rates exceeded 66% across therapies, though adherence to acupuncture, yoga, and injections was low. Conclusion The findings suggest that home‐based exercise and short‐term pharmacological therapy were associated with more favorable pain outcomes in this cohort. However, due to the observational design, these findings should be interpreted as associations rather than evidence of causal treatment effectiveness.
Bina Eftekharsadat, Shadi Khodaei, Raha Markazi-Movaghar et al.· Health Science Reports· 0 citations
OBJECTIVE
The authors of this study aimed to compare the surgical outcomes and complication profiles of posterior vertebral column resection (pVCR) performed at the apical vertebra (AV) versus the subapical vertebra (SAV) in patients with rigid tuberculotic angular kyphosis (TAK). They hypothesized that an SAV resection would reduce the incidence of neurological complications without compromising radiographic correction.
METHODS
They conducted a retrospective analysis of patients with TAK who underwent single-level pVCR (Schwab grade 5 osteotomy) between June 2010 and June 2023. Patients were divided into 2 groups, an AV group and SAV group. Demographic, surgical, radiographic, and health-related quality of life (HRQOL) data were collected. Radiographic parameters included sagittal Cobb angle, pelvic incidence, lumbar lordosis, and sagittal vertical axis. HRQOL outcomes were assessed using the visual analog scale, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) functional assessment, and SF-36. Complications, including dural tears, intraoperative neuromonitoring (IONM) alerts, neurological deficits, etc., were recorded and compared.
RESULTS
One hundred patients were eligible for study inclusion, of whom 65 were included in the AV group and 35 in the SAV group. Both groups attained and maintained significant correction of the sagittal Cobb angle postoperatively, with no significant differences in radiographic outcomes between groups. However, the SAV group demonstrated significantly lower rates of dural tears (11.4% vs 29.2%, p = 0.044), IONM alerts (22.9% vs 44.6%, p = 0.032), and neurological complications (17.1% vs 36.9%, p = 0.040), particularly motor deficits (11.4% vs 29.2%, p = 0.044). HRQOL outcomes showed better ODI and JOA scores in the SAV group at the final follow-up (both p < 0.001).
CONCLUSIONS
This study provides clinical evidence that the SAV constitutes a safer and more strategic resection site, as it avoids the severely pathological kyphotic apex and facilitates a more physiologically tolerable correction. Therefore, the subapical VCR strategy is recommended as a viable alternative for managing severe TAK, one that prioritizes patient safety without substantially compromising deformity correction.
Yi-Lin Lu, Ze-Kun Li, Jun-Yu Li et al.· Journal of Neurosurgery : Sp...· 0 citations
PURPOSE
Cement-augmented pedicle screws (CPSCA) and cortical bone trajectory (CBT) screws are used to enhance the fixation strength in osteoporotic bone, but direct comparative clinical evidence remains limited. This study compared 24-month patient-reported outcomes, hospital stay, and complication profiles after CBT versus CPSCA instrumentation in osteoporotic patients undergoing lumbar fixation with interbody fusion.
METHODS
This retrospective cohort study included 134 patients with a bone mineral density T-score < - 2.5 who underwent one- to four-level lumbar fixation with interbody fusion between 2015 and 2021 (CPSCA, n = 63; CBT, n = 71). Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores were assessed preoperatively and at a standardized 24-month clinical assessment, conducted in outpatient clinics or by structured telephone follow-up. Primary multivariable models adjusted for age and number of fusion levels. Expanded sensitivity models additionally incorporated sex, bone mineral density, baseline outcome severity, surgical year, and radiographic follow-up duration where applicable. Complications, reoperations, and minimal clinically important difference (MCID) responder rates were also compared.
RESULTS
At 24 months, CBT was associated with comparative VAS improvement than CPSCA (adjusted β = 13.39% points, p < 0.001), comparative ODI improvement (adjusted β = 8.53% points, p = 0.003), and shorter hospital stay (adjusted β = -3.00 days, p = 0.020). These associations remained statistically significant in expanded sensitivity analyses. All CBT patients met the predefined MCID thresholds for VAS and ODI, compared with 90.5% and 87.3% of CPSCA patients, respectively; the exact 95% confidence interval for each 100% CBT responder rate was 94.9-100.0%. Recorded perioperative complications occurred in 5 of 63 CPSCA patients (7.9%) and 4 of 71 CBT patients (5.6%; p = 0.734), while reoperation rates were 7.9% and 5.6%, respectively (p = 0.734). Cement leakage occurred only after CPSCA, whereas screw loosening occurred only after CBT. No individual complication differed significantly between groups.
CONCLUSION
In this retrospective cohort, CBT instrumentation was associated with comparative 24-month improvement in pain and disability and shorter hospitalization than CPSCA after adjustment for measured covariates. Complication and reoperation rates did not differ statistically, although complication patterns varied between techniques. Because treatment allocation was non-randomised, surgeon and instrumentation effects could not be separated, and the study was underpowered for uncommon adverse events, these findings require cautious interpretation and prospective validation.
Chao-Hsuan Chen, Chun-Jen Chang, Hsiang-ming Huang et al.· European spine journal· 0 citations
Degenerative lumbar disorders are commonly treated with lumbar interbody fusion, but comparative evidence among ALIF, OLIF, and XLIF remains limited. This prospective multicenter observational cohort study compared perioperative outcomes, complications, and patient-reported outcomes (PROMs) after single- or multi-level ALIF, OLIF, or XLIF in 242 consecutive adults (108, 75, and 59, respectively) treated at Spanish centers. Age and surgical indications differed significantly across groups (p < 0.05), reflecting indication-based approach selection. Primary outcomes were intra- and postoperative complications through 6 months; secondary outcomes included operative time, blood loss, visual analog scale (VAS) pain scores, and the Oswestry Disability Index (ODI). XLIF had the shortest operative time (median, 63 min) and lowest blood loss. Overall intra- and postoperative complication rates were 3.3% and 7.8%, with no significant overall differences among techniques, although patterns differed: vascular injuries were associated with ALIF, cage subsidence was more frequent after XLIF, neurological deficits occurred with similar frequency in the XLIF and OLIF groups, and OLIF had the lowest intraoperative rate. All groups showed significant VAS and ODI improvements, with greater 6-month gains after ALIF and OLIF than after XLIF. These approaches are effective but have distinct risk–benefit profiles, supporting individualized selection.
J. Giner, Julián Castro, Isidro Marimón et al.· Complications· 0 citations
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