This study assesses the long-term outcomes of treating osteoporotic burst fractures with percutaneous vertebroplasty over a minimum of five years. Results indicate significant pain relief and functional improvement, demonstrating that vertebroplasty is safe and effective even in cases with asymptomatic spinal canal compromise. The findings suggest further research is needed to refine patient selection criteria and evaluate effectiveness across various subgroups.

1. A Minimum of Five-Year Follow-Up Study
IS IT SAFE TO TREAT OSTEOPOROTIC BURST
THORACOLUMBAR FRACTURE USING
PERCUTANEOUS VERTEBROPLASTY?
Authors:
Hsi-Hsien Lin, Pei-I Hung,
Kuan-Jung Chen,
Wei Hsiung, Ming-Chau Chang

2. • Published in: The Spine Journal, 2024
• DOI: https://doi.org/10.1016/
j.spinee.2024.10.019
• Institutions: Department of Orthopedics and
Traumatology, Taipei Veterans General
Hospital National Yang Ming Chiao
Tung University
• Contact: Dr. Hsi-Hsien Lin - Email:
hsihsienlin@gmail.com

3. 01 02
05 06
03 04
07
Table of contents
Abstract Introduction
Discussio
n
Limitations
Methodology Results
Conclusion

4. 01
Abstract

5. Abstract
• Background Context:
Percutaneous vertebroplasty for osteoporotic burst fractures is
controversial. Previous research suggests asymptomatic spinal canal
compromise is not a contraindication.
• Purpose:
To evaluate long-term outcomes of percutaneous
vertebroplasty in osteoporotic burst fractures.
• Study Design:
Prospective observational study with a minimum
of five-year follow-up.

6. Abstract
• Patient Sample:
- 96 patients with Dennis Type I/II and AO Type A1–A4 osteoporotic fractures.
• Outcome Measures:
- Clinical: Visual Analog Scale (VAS) for pain and Oswestry Disability
Index
(ODI).
- Radiological: Vertebral body height and kyphotic angle.
• Results:
Significant pain relief and functional improvement were observed in
both groups. No differences in long-term outcomes between
compression and burst fractures.
Conclusions:
Vertebroplasty is safe and effective for osteoporotic burst
fractures with asymptomatic spinal canal compromise.

7. 02
Introduction

8. Introduction
• Percutaneous vertebroplasty is a minimally invasive procedure for stabilizing
vertebral fractures after failure of conservative therapy. It involves injecting
polymethyl methacrylate (PMMA) cement into the fractured vertebra.
• Controversy arises in burst fractures where retropulsed fragments may
compromise the spinal canal, risking cement leakage and neurological deficits.
• Since 2005, percutaneous vertebroplasty has been used in the study
institution to treat osteoporotic burst fractures without neurological deficits.
• To determine whether vertebroplasty provides long-term
safety and effectiveness for osteoporotic burst fractures.
Objective

9. 03
Methodology

10. Methodology
Study Duration
Study Design and Sample
Patients were enrolled
between June 2015
and December 2016.
Follow-up period:
Minimum 5 years
(mean: 74 months).
Sample Size
Total of 96 patients: 51
with osteoporotic
compression fractures
and 45 with
osteoporotic burst
fractures.

11. Methodology
Inclusion Criteria
1. Pathological fractures.
2. Multiple-level fractures.
3. Previous vertebroplasty or
unrelated deaths.
1. Single-level fractures
classified as Dennis Type
I/II
or AO Type A1–A4.
2. Low-energy injury
mechanisms.
3. Persistent pain after failed
conservative treatment for
at least two weeks.
4. No neurological deficits,
infections, or neoplastic
Exclusion Criteria

12. Methodology
Procedure
1. Clinical Outcomes: VAS for
pain and ODI for functional
disability.
2. Radiological Outcomes:
Vertebral body height,
kyphotic angle, adjacent
fractures, and cement
leakage.
High-viscosity PMMA cement
was used under fluoroscopic
guidance. The procedure
followed a standardized
surgical protocol.
Postoperative Management:
- Rigid bracing for three
months.
- Standardized analgesics:
Oral acetaminophen for
four
Outcome Assessments

13. 04
Results

14. Patient Demographics
• Total Patients >> 120
- Osteoporotic compression fractures >> 64
- Osteoporotic burst fractures>> 56
- One patient from each group lost to follow-up due
to refusal during the COVID-19 pandemic
• Final Enrollment
- Total patients meeting inclusion/exclusion criteria 96
- Osteoporotic compression fractures ( OC): 51
- Osteoporotic burst fractures (OB) : 45

15. Patient Demographics
• Gender and Age: 96 patients (29 males, 67
females). Mean age: 79.1 years (range: 73–86
years).
• Fracture Location: Thoracolumbar transition
zone (T11–L2): 65% of cases.
• Follow-Up Rate: Mean follow-up duration: 74
months (range: 62–86 months).
• Dropouts: 12 patients in the compression group
and 10 in the burst group died due to unrelated
medical conditions.

16. Clinical Outcomes
• Pain Reduction (VAS)
- Compression fractures:
Preoperative: 7.9 ± 1.1
6 weeks postoperative: 3.1 ± 1.5
Final follow-up: 2.3 ± 1.0
- Burst fractures:
Preoperative: 7.8 ± 0.8
6 weeks postoperative: 3.1 ± 1.8
Final follow-up: 2.9 ± 1.4
Mean
VAS

17. Clinical Outcomes
•Disability Improvement (ODI):
- Compression fractures:
Preoperative: 84.9 ± 8.7
6 weeks postoperative : 41.1 ± 18.5
Final follow-up: 28.0 ± 10.9
- Burst fractures:
Preoperative: 85.1 ± 6.7
6 weeks postoperative: 42.5 ± 22.4
Final follow-up: 28.8 ± 16.9
Disability
Improvement
(ODI)

18. Radiological Outcomes
• Kyphosis Correction:
- Compression fractures:
Preoperative: 14.8° ± 5.7°
6 weeks postoperative: 8.2° ± 4.5°
Final follow-up: 10.7° ± 5.2°
- Burst fractures:
Preoperative: 11.8° ± 4.8°
6 weeks postoperative: 7.7° ± 4.8°
Final follow-up: 10.5° ± 5.1°
Kyphosis
Correction

19. Radiological Outcomes
• Vertebral Body Height:
- Compression fractures:
Preoperative: 26.3 mm ± 4.8 mm
Final follow-up: 28.2 mm ± 4.5 mm.
- Burst fractures:
Preoperative: 19.5 mm ± 5.3 mm
Final follow-up: 20.5 mm ± 4.5 mm.
Vertebral
Body
Height

20. • Cement Leakage
- Compression group: 9 patients (17.6%) - Burst group: 13 patients (28.9%)
- All leakages were minor, no neurological deficits reported.
- No significant difference between groups (p=0.19).
• Postoperative Adjacent Fractures
- Compression group: 3 patients (5.9%) - Burst group: 2 patients (4.4%)
- No significant difference (p=0.75).
• Further Surgical Interventions
- Compression group: 3 patients (5.9%)
- Burst group: 3 patients (6.7%)
- All required surgery for open decompression and instrumented fusion due to persistent back
pain and progressive neurological deficits.
- New collapses and neurological deficits occurred within three months
postoperatively.
- No significant difference between groups (p=0.87).
Outcomes of Cement Leakage and Surgical Interventions

21. Complications
• Cement Leakage: Compression fractures: 18%;
Burst fractures: 29%.
•Adjacent Fractures: Compression fractures:
6%;
Burst fractures: 4%.
• Surgical Conversion: 6 patients (3 in each
group) required decompression and
instrumented fusion.

22. 05
Discussion

23. Discussion
- Key Findings: Vertebroplasty significantly improves pain
and functional outcomes in both fracture types.
Radiological stability (kyphosis correction and vertebral
height maintenance) was sustained over five years.
- Safety in Burst Fractures: Asymptomatic spinal canal
compromise is not a contraindication.
- Comparison to Literature: Aligns with studies showing
vertebroplasty as a safe, minimally invasive alternative
to
open surgery in selected cases.

24. 06
Limitations

25. Limitations
Sample Size: Relatively small, limiting generalizability..
1
Follow-Up Challenges: High dropout rates due to advanced age
and
unrelated deaths.
Heterogeneity: Variability in fracture patterns and bone density
among patients.
2
3

26. 07
Conclusion

27. Conclusion
Summary: Vertebroplasty is safe and
effective for osteoporotic burst
fractures with asymptomatic spinal
canal compromise. Long-term
outcomes are comparable to
compression fractures.
Future Directions: Larger studies are
needed to refine selection criteria
and assess efficacy in different
subgroups.

28. Thank
you