Preoperative planning of compact zone trajectory is necessary in treating osteoporotic vertebral compression fracture with endplate involvement - A prospective randomized controlled study

Sep 29, 2026

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This prospective randomized controlled study evaluates whether the presence of compact trabecular bone affects clinical and radiological outcomes when performing percutaneous kyphoplasty for osteoporotic vertebral compression fractures with endplate involvement. One hundred patients were assigned to group A (guide pin and balloon inserted directly into the fracture site) or group B (inserted away from the fracture site). Surgery duration, outcomes at follow-up, cement leakage, and adjacent fractures were recorded over 20.18 months. Elevating the collapsed endplate improved function and reduced intradiscal cement leakage.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Introduction

Background and rationale

Prior evidence on endplate and EDC injury

Methods

Results

Conclusion

J Chin MedAssoc Original article Preoperative planning of compact zone trajectory is necessary in treating osteoporotic vertebral compression fracture with endplate involvement: A prospective randomized controlled study Pei-I Hunga,b,c, Po-Hsin Choua,b, Yu-Cheng Yaoa,b, Kuan-Jung Chenb,d, Hsi-Hsien Lina,b,* , Shih-Tien Wanga,b, Ming-Chau Changa,b, Chien-Lin Liua,b aDepartment of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bSchool of Medicine, National Yang Ming Chiao Tung University, Taipei,Taiwan, ROC; cDepartment of Orthopedic Surgery, Taipei City Hospital, RenAi Branch, Taipei, Taiwan, ROC; dDepartment of Orthopedics, China Medical University Hsinchu Hospital, Hsinchu, Taiwan, ROC Abstract Background: This prospective randomized controlled study compares the clinical and radiological outcomes between reduction methods with or without compact trabecular bone during percutaneous kyphoplasty in osteoporotic vertebral fractures. Methods: The cohort of 100 patients who underwent percutaneous kyphoplasty was randomly divided into group A (guide pin and balloon introduced directly into fracture site) and group B (guide pin and balloon inserted away fracture site) . The surgery duration, clinical and radiological outcomes postoperatively and at follow-up, and complications of cement leakage and adjacent fracture were recorded. Patients were followed up for an average of 20.18 months. The clinical outcomes were assessed using the Oswestry Disability Index and visual analog scale. Results: The two groups had similar patient demographics, surgery times, and volume of cement injected. The method using elevation of the collapsed endplate indirectly had no significant influence on radiological outcomes but significantly decreased the occurrence of intradiscal cement leakage and improved 1-and 12-month postoperative functional outcomes. Conclusion: Elevating and reinforcing the collapsed endplate rather than just filling the defect during percutaneous kyphoplasty is safe and effective. This technique decreased pain and improved function with lower rates of further collapse of the osteoporotic vertebrae compared to defect-filling alone. Keywords: Endplate fracture; Kyphoplasty; Osteoporotic vertebral compression fracture; Percutaneous vertebroplasty 1. INTRODUCTION Osteoporotic vertebral fracture (OVF) is one of the most common sequelae of osteoporosis.1 The prevalence of OVF increases as the proportion of aging people in a population grows.2 OVF often leads to lower back pain and spinal deformity, which seriously affect the patients’ quality of life.3 Percutaneous kyphoplasty (PKP) offers significant pain relief for patients who respond poorly to conservative treatment.4 However, PKP mainly addresses the fractured vertebral body itself and does not include treatment of the adjacent injured endplate-disc complex (EDC) .5 The EDC plays important roles in maintaining the stability and integrity of the spine, protecting the spinal nerves, absorbing shocks, and dispersing axial load.6 When trauma acts on the vertebral body, it often * Address correspondence. Dr. Hsi-Hsien Lin, Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: hsihsienlin@gmail.com](ROC. E-mail address: hsihsienlin@gmail.com) (H.-H. Lin). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2023) 86: 985-990. Received September 29, 2022; accepted July 9, 2023. doi: 10. 1097/JCMA.0000000000000998 Copyright © 2023, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/)) causes simultan

FAQs

What was the main comparison in this randomized controlled study?

The study compared clinical and radiological outcomes between reduction methods with or without compact trabecular bone during percutaneous kyphoplasty.

How were the two treatment groups designed?

Group A had the guide pin and balloon introduced directly into the fracture site, while group B inserted them away from the fracture site.

What did the results show about endplate elevation and cement leakage?

Elevating the collapsed endplate did not significantly change radiological outcomes, but it reduced intradiscal cement leakage and improved functional outcomes at 1 and 12 months.

Sep 29, 2026

Uploaded by Liam