Vertebral compression fractures(VCFs) are severe and common complications of osteoporosis. Most VCFs were caused by osteopenia or osteoporosis. Nevertheless, spinal metastases probably result in pathological fractures that easily confused with osteoporotic vertebral compression fractures(OVCFs). Using biopsy during vertebral augmentation(VA) is considered as the golden standard protocol to rule out pathological VCFs. Up to data, conventionally using biopsy during VA is suggested by more and more researchers to confirm the etiology of VCFs and to avoid missed diagnosis and misdiagnosis of spinal metastases with pathological vertebral fractures as the first manifestation. For patients with spinal metastases, histological evaluation of vertebral biopsy specimens is convenient for further treatment.

Vertebral compression fractures(VCFs) are severe and common complications of osteoporosis. Most VCFs were caused by osteopenia or osteoporosis. Nevertheless, spinal metastases probably result in pathological fractures that easily confused with osteoporotic vertebral compression fractures(OVCFs). Using biopsy during vertebral augmentation(VA) is considered as the golden standard protocol to rule out pathological VCFs. Up to data, conventionally using biopsy during VA is suggested by more and more researchers to confirm the etiology of VCFs and to avoid missed diagnosis and misdiagnosis of spinal metastases with pathological vertebral fractures as the first manifestation. For patients with spinal metastases, histological evaluation of vertebral biopsy specimens is convenient for further treatment.

Objectives:To explore the effect of preoperative traction on nerve injury complications in patients with severe spinal deformities undergoing correction surgery.Methods:A retrospective analysis was conducted on 196 patients with severe spinal deformities who underwent orthopedic surgery in our hospital from Decem-ber 2019 to December 2022.A total of 38 patients with severe stiff spinal deformity were treated with Halo-pelvic traction(HPT)before operation,including 17 males and 21 females,aged 20.12±7.82 years old(14 to 30 years),who were included into the HPT group.The other 158 patients with general severe spinal deformity undergone skin traction(ST)with occipital jaw and lower limb traction before operation were included into ST group,which included 61 males and 97 females,aged 15.55±10.38 years old(10-30 years).Posterior correc-tion,fixation and fusion were performed after traction on both groups of patients.The general data,operation-related data,and imaging data before and after treatment(before traction,after traction,and after oepration)were collected,and the contribution rates of preoperative traction and operation to deformity correction were calculated.The abnormal conditions of intraoperative neurophysiological monitoring(IONM)and postoperative nerve injury complications were collected and compared between the two groups.Results:The preoperative Cobb angle of the HPT group was 142.48°±18.77°,which improved to 72.56°±13.26° after HPT,with an im-provement rate of 49.07％;After corrective surgery,it was 55.76°±15.87°,with an improvement rate of 60.87％;5 cases were of＞Ⅳ grade osteotomy,accounting for 13.16％;There were 10 cases with abnormal IONM,accounting for 26.32％;And 3 cases of nerve damage,accounting for 7.90％.The preoperative Cobb angle of the patients in the ST group was 97.90°±19.25°,which was 76.51°±12.68° after traction,with an im-provement rate of 21.85％;After corrective surgery,it was 41.58°±15.84°,with an improvement rate of 57.53％;10 cases were of＞Ⅳ grade osteotomy,accounting for 6.33％;There were 21 cases with abnormal IONM,accounting for 13.29％;And 9 cases of nerve injury,accounting for 5.70％.There was no significant difference in high-grade spinal osteotomy between the two groups(P＞0.05).The difference in the incidence of abnormal IONM between the two groups was significant(P＜0.05),however,there was no significant difference in the incidence of postoperative nerve injury complications(P＞0.05).Conclusions:The applications of HPT and ST occipital jaw-lower limb traction before orthopedic surgery are both effective and safe in patients with spinal deformity,which can reduce the level of spinal osteotomy and reducing the risk of nerve injury compli-cations in severe spinal deformity patients undergoing correction surgery.

Objective:To evaluate the clinical effect of percutaneous curved kyphoplasty (PCK) for osteoporosis vertebral compression fractures (OVCF).Methods:This is a prospective study.Patients with OVCF who underwent PCK at the Department of Orthopedics,Beijing Chaoyang Hospital, Capital Medical University from June 2018 to June 2019 were included.All the operations were performed by the same surgeon.X-ray examination was performed before and after the operation to measure the vertebral height and Cobb angle.The visual analogue scale (VAS) and Oswestry disability index (ODI) scores were evaluated before and after the operation,and the amount of bone cement injected was record.The leakage rate and distribution of bone cement was observed by CT examination after the operation,and the postoperative complications was collected during the follow-up.Paired- t test was used to compare the related indexes before and after operation. Results:There were 32 patients in our study,including 8 males and 24 females,aged (74.9±9.9) years (range:64 to 81 years).The intraoperative bone cement injection volume was (4.2±1.5) ml(range:2 to 6 ml).According to the classification of distribution of bone cement,28 cases were rated as type Ⅰ and 4 cases were rated as type Ⅱ. Bone cement leakage was observed in 12 cases (37.5%),and there was no intraspinal leakage or venous leakage.The vertebral height was improved from (21.9±6.2) mm preoperatively to (24.3±4.3) mm postoperatively( t=-2.836, P=0.008),Cobb angle improved from( M( QR))14°(15°)preoperatively to 12.5°(12.75°)postoperatively( Z=-1.950, P=0.051),VAS improved from 6.8±0.7 preoperatively to 1.7±0.8 postoperatively ( t=28.946, P<0.01),ODI score improved from 73.4±7.3 preoperatively to 21.3±5.7 postoperatively ( t=32.250, P<0.01).The patients were followed up for (19.7±3.7) months (range:15 to 29 months).One patient had refracture (3.1%,1/32),and no other complications such as neurological dysfunction and pulmonary embolism occurred. Conclusions:The clinical effect of PCK in the treatment of OVCF was satisfactory.This technique could reduce the difficulty of puncture to a certain extent,and be beneficial to the distribution of bone cement.

Objective:To evaluate the clinical effect of percutaneous curved kyphoplasty (PCK) for osteoporosis vertebral compression fractures (OVCF).Methods:This is a prospective study.Patients with OVCF who underwent PCK at the Department of Orthopedics,Beijing Chaoyang Hospital, Capital Medical University from June 2018 to June 2019 were included.All the operations were performed by the same surgeon.X-ray examination was performed before and after the operation to measure the vertebral height and Cobb angle.The visual analogue scale (VAS) and Oswestry disability index (ODI) scores were evaluated before and after the operation,and the amount of bone cement injected was record.The leakage rate and distribution of bone cement was observed by CT examination after the operation,and the postoperative complications was collected during the follow-up.Paired- t test was used to compare the related indexes before and after operation. Results:There were 32 patients in our study,including 8 males and 24 females,aged (74.9±9.9) years (range:64 to 81 years).The intraoperative bone cement injection volume was (4.2±1.5) ml(range:2 to 6 ml).According to the classification of distribution of bone cement,28 cases were rated as type Ⅰ and 4 cases were rated as type Ⅱ. Bone cement leakage was observed in 12 cases (37.5%),and there was no intraspinal leakage or venous leakage.The vertebral height was improved from (21.9±6.2) mm preoperatively to (24.3±4.3) mm postoperatively( t=-2.836, P=0.008),Cobb angle improved from( M( QR))14°(15°)preoperatively to 12.5°(12.75°)postoperatively( Z=-1.950, P=0.051),VAS improved from 6.8±0.7 preoperatively to 1.7±0.8 postoperatively ( t=28.946, P<0.01),ODI score improved from 73.4±7.3 preoperatively to 21.3±5.7 postoperatively ( t=32.250, P<0.01).The patients were followed up for (19.7±3.7) months (range:15 to 29 months).One patient had refracture (3.1%,1/32),and no other complications such as neurological dysfunction and pulmonary embolism occurred. Conclusions:The clinical effect of PCK in the treatment of OVCF was satisfactory.This technique could reduce the difficulty of puncture to a certain extent,and be beneficial to the distribution of bone cement.