Clinical application of percutaneous vertebral-intervertebral plasty in very severe osteoporotic vertebral compression fracture: A new technique

Abstract Safe and effective minimally invasive treatments are lacking for very severe osteoporotic vertebral compression fractures (vsOVCF) , especially in patients with upper and lower endplate fractures or nonunion of old fractures.This study introduces a minimally invasive approach for the treatment of vsOVCF and introduces a new concept called functional spinal unit height (FSUH) to assess biomechanical stability of the spine after surgery. From January 2020 to January 2022,forty patients with vsOVCF who received percutaneous vertebral-intervertebral plasty (PVIP) were retrospectively reviewed. The clinical and radiological assessments were reviewed. One patients had adjacent vertebral fractures(AVF) due to a trauma after the operation (rate of AVF, 2.9%).The mean course of patients was 56.2±40.3 d, bone mineral density (T-Score) was -3.6±-0.6, mean operation time was 81.8±12.1 min, mean blood loss was 42.5+12.9 mL, and mean hospital stay was 5.6±2.2 d. The average VAS, ODI, and TLK scores before operation were 6.9±0.8, (74.0±6.3)%, and (29.0±7.6)°, decreasing to 2.6±1.1, (32.3±3.9)%, and (21.8±4.1)° 1 week after operation, to 2.1±0.8，(28.1±4.0)%, and (19.9±3.7)° 6 months after operation, and further decreased to 1.0±0.7，(24.4±3.9)%, and (20.0±4.1)° at the last follow-up. Differences in VAS, ODI, and TLK scores were statistically significant postoperatively.The average FSUH increased from (64.1±7.6) mm before surgery to (75.1±7.8) mm 1 week after surgery, and no significant change in height at 6 months or at the final follow-up was observed, which was still statistically different from that before the surgery. PVIP is a minimally invasive surgical technique for the treatment of vsOVCF that can increase FSUH, improve partial kyphotic deformity, maintain spinal biomechanical stability, and reduce the occurrence of AVF.