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.
Vertebral compression fractures (VCFs) represent the most prevalent osteoporotic fracture and constitute a growing cause of morbidity, mortality, and healthcare utilization worldwide. Although often considered benign, VCFs are associated with chronic pain, progressive spinal deformity, functional impairment, decreased pulmonary capacity, and increased short- and long-term mortality, especially in older adults. Despite their high prevalence, key challenges persist regarding appropriate diagnostic evaluation, optimal treatment selection, and integration of osteoporosis management following fracture. This narrative review consolidates current evidence on the epidemiology, pathophysiology, diagnostic evaluation, management strategies, and public health implications of VCFs, with a focus on emerging spine-focused care models. VCFs predominantly result from compromised vertebral strength secondary to osteoporosis-related deterioration of trabecular microarchitecture, although traumatic and pathologic etiologies should also be considered. Diagnosis involves careful clinical assessment combined with imaging, with magnetic resonance imaging serving as a key modality for distinguishing acute fractures from chronic deformities or malignancy. Despite advances in diagnostic techniques, VCFs remain underrecognized and undertreated, contributing to avoidable disability and recurrent fractures. This narrative review synthesizes contemporary evidence, highlighting practical considerations for clinical decisionmaking in VCF care. Particular emphasis is placed on differentiating acute symptomatic fractures from chronic deformities or pathologic collapse, identifying patients most likely to benefit from vertebral augmentation, and defining surgical indications in the setting of neurologic compromise, instability, or progressive deformity. Conservative management, incorporating analgesia, early mobilization, and rehabilitation, remains the first-line approach for most stable fractures. Vertebroplasty and balloon kyphoplasty may provide short-term pain relief in carefully selected patients with persistent symptoms. However, the long-term benefits of augmentation and optimal patient selection criteria remain under investigation. Treatment options range from conservative measures-including analgesia, bracing, mobilization, rehabilitation, and osteoporosis-directed pharmacotherapy-to minimally invasive vertebral augmentation procedures such as vertebroplasty and balloon kyphoplasty. Vertebral augmentation may provide short-term improvements in pain and function in appropriately selected patients, although its long-term benefits and optimal indications remain under investigation. Surgical decompression and stabilization are reserved for patients with neurological compromise, instability, or progressive deformity. From a public health perspective, deficiencies in osteoporosis screening, delayed diagnosis, and disparities in treatment access continue to affect diverse socioeconomic and racial groups. Emerging innovations, including fracture liaison services, risk stratification tools such as FRAX, and artificial intelligence-based predictive models, may enhance early detection and personalized care. VCFs represent sentinel manifestations of systemic skeletal fragility that warrant evaluation of underlying osteoporosis and implementation of secondary fracture prevention. Pharmacologic therapies, including antiresorptive and anabolic agents, play a key role in reducing recurrent fracture risk, although treatment selection should be individualized. Multidisciplinary, patient-centered strategies focused on early diagnosis, prevention, equitable care delivery, and standardized management are essential to address the growing global burden of VCFs. A structured, patient-centered approach to diagnosis, treatment selection, and post-fracture care may enhance outcomes and reduce the long-term burden associated with VCFs.
Study Design Systematic review with the proposal of a conceptual sarcopenia-integrated Global Alignment and Proportion modification (GAP-M) for future validation. Purpose This study aims to synthesize evidence on sarcopenia and paraspinal muscle degeneration in adults with spinal deformity (ASD) and evaluate whether current evidence supports incorporating muscle-related metrics into the Global Alignment and Proportion (GAP) score. Overview of Literature Alignment-based parameters alone cannot account for all mechanical complications following ASD correction. Regional paraspinal muscle degeneration, particularly near the upper instrumented vertebra (UIV), may weaken posterior dynamic support, whereas systemic sarcopenia reflects overall frailty and perioperative risk. Methods A systematic search of PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and Google Scholar was conducted through May 23, 2026. Eligible studies included adults with ASD, used quantifiable muscle metrics, and reported alignment, mechanical, functional, or perioperative outcomes. Because definitions, measurement levels, and effect estimates varied widely across studies, a quantitative meta-analysis was not performed, and instead a narrative evidence-mapping approach was employed. Results Of the 507 identified records, 229 were screened, and 50 full-text articles were examined for eligibility; 35 were excluded for documented reasons, leaving 15 primary studies (approximately 1,482 patients). No study directly evaluated whether adding sarcopenia metrics improves GAP score discrimination or reclassification. UIV-adjacent paraspinal muscle quality emerged as the most consistent predictor of proximal junctional kyphosis/failure (five of six studies), while psoas and systemic sarcopenia metrics demonstrated more mixed associations. Conclusions Paraspinal muscle degeneration appears to be a clinically relevant risk marker in ASD surgery, although current evidence does not yet validate GAP-M for routine clinical use. We therefore propose a provisional 0 to +2-point Muscle-Quality Modifier as a testable framework that requires prospective multicenter validation with standardized UIV-adjacent imaging metrics and direct comparisons of GAP and GAP-M before clinical adoption.
STUDY DESIGN:Retrospective single-center cohort study. PURPOSE:To investigate the inter- and intra-observer reliability of the osteoporotic fracture (OF) classification across different imaging protocols and levels of surgical experience in a large, consecutive cohort of patients with thoracolumbar osteoporotic vertebral fractures (OVFs). OVERVIEW OF LITERATURE:The OF classification provides a standardized morphological assessment of OVFs. Previous studies reported variable agreement (κ=0.49-0.63), and the influence of imaging modality and observer experience on reliability remains debated. METHODS:Patients aged ≥50 years with acute thoracolumbar OVFs diagnosed between 2017 and 2021 were included. Three neurosurgeons (two seniors, one junior) independently assessed fracture morphology using complete Picture Archiving and Communication System studies. Inter-observer agreement was evaluated with Fleiss's kappa and intra-observer agreement with Cohen's kappa from repeated assessments by one senior observer. Subgroup analyses used imaging protocol and observer experience. RESULTS:A total of 482 patients were included. The most common fracture types were OF 2 (43.2%), OF 4 (29.9%), and OF 3 (25.1%). Inter-observer agreement was substantial (κ=0.789; 95% confidence interval [CI], 0.75-0.83), whereas intra-observer agreement for a single senior rater was almost perfect (κ=0.917; 95% CI, 0.88-0.95). Substantial agreement was achieved across all imaging protocols (κ=0.773-0.824), although the magnetic resonance imaging (MRI)+X-ray subgroup (n=17) was underpowered. Among adequately powered subgroups, combined computed tomography (CT) and MRI provided the highest inter-observer consistency, particularly for OF 2 and OF 3 fractures, whereas CT alone was sufficient for OF 4 fractures. OF 1 (n=4) and OF 5 (n=5) cases were considered illustrative only. No significant differences were observed based on observer experience. CONCLUSIONS:The OF classification demonstrates substantial to almost perfect reliability across imaging protocols. Combined CT and MRI assessment improved agreement for intermediate fracture types in adequately powered subgroups, supporting their complementary use in clinical practice.
Study Design Retrospective cohort study. Purpose To investigate the association between preoperative nutritional status and postoperative in-hospital falls in patients undergoing surgery for cervical myelopathy. Overview of Literature In-hospital falls are common adverse events among surgical patients; however, the association between preoperative nutritional indices and postoperative in-hospital falls in patients undergoing spinal surgery for cervical myelopathy remains unclear. Methods We retrospectively reviewed clinical, laboratory, and surgical data of 649 patients who underwent surgery for cervical myelopathy at a single institution. Additionally, preoperative nutritional indices were assessed using the prognostic nutritional index (PNI), geriatric nutritional risk index, and controlling nutritional status score. Multivariable logistic regression and Cox proportional hazards regression analyses were performed to identify fall-related independent risk factors. Kaplan-Meier analysis was used to compare fall-free probability during hospitalization according to the PNI category. Results Among 649 patients, 48 (7.4%) experienced postoperative in-hospital falls. Patients who experienced falls had significantly lower nutritional status. PNI showed the strongest association with falls among the evaluated nutritional indices (odds ratio [OR], 0.91; p<0.001) and the highest predictive performance, although its discriminatory ability was modest (area under the curve=0.687). A PNI value of <50 (OR, 3.74; p=0.001) and cerebrovascular disease (OR, 5.22; p<0.001) were identified as independent risk factors of falls; this was confirmed in the Cox analysis (PNI <50: hazard ratio [HR], 3.11; p=0.008; cerebrovascular disease: HR, 4.82; p<0.001). Conclusions Preoperative PNI is a practical laboratory-based marker for identifying patients at high risk of postoperative falls, with low preoperative PNI (<50) associated with an increased risk of postoperative in-hospital falls in patients undergoing surgery for cervical myelopathy.
STUDY DESIGN:Retrospective cohort study. PURPOSE:Using latent profile analysis (LPA) to multidimensionally profile trunk muscles, we aimed to identify muscle phenotypes, compare LPA-based classification with sarcopenia definitions for explaining sagittal alignment, and examine malalignment patterns across LPA-derived subtypes. OVERVIEW OF LITERATURE:Paraspinal sarcopenia is closely associated with sagittal malalignment in adult spinal deformity (ASD), but traditional single-muscle or single-metric definitions fail to capture heterogeneous muscle degeneration. METHODS:This retrospective cohort study included 145 patients with ASD undergoing long-segment fusion (≥5 levels; upper instrumented vertebra T1-L1) with ≥1-year follow-up. We measured muscle quantity using the psoas vertebral body index (PVBI) and paralumbar vertebral body index (PLVBI), and muscle quality using fatty infiltration (FI) of the psoas and paralumbar (multifidus and erector spinae) muscles. LPA was applied to PVBI, PLVBI, and psoas and paralumbar FI to identify clusters. For comparison, sarcopenia was defined by each metric. We compared LPA with single-metric definitions for predicting sagittal measures and examined clinical, radiographic (pre/ post), and surgical outcomes across LPA subtypes. RESULTS:LPA explained sagittal alignment better than any single measure and revealed four phenotypes: Mild-Deg (high quantity, low FI; n=49), Mod-Deg (moderate; n=39), Seve-Deg (low quantity, high FI; n=34), and Hete-Deg (low quantity, high paralumbar FI but low psoas FI; n=23). Preoperative deformity progressively worsened from Mild-Deg to Seve-Deg, while Hete-Deg also showed pronounced malalignment. Postoperatively, most metrics were similar across groups. At last follow-up, however, Mod-Deg/Seve-Deg had greater pelvic incidence (PI)-lumbar lordosis (LL), and LL in Seve-Deg trended toward progressive worsening from postoperative to follow-up (PI-LL and T4 pelvic angle). CONCLUSIONS:Multidimensional LPA muscle phenotyping outperformed single-metric sarcopenia definitions in explaining sagittal alignment. It also identified a heterogeneous Hete-Deg subtype suggestive of functional compensation despite severe preoperative deformity, whereas Seve-Deg reflected irreversible muscle loss with progressive imbalance.
Study Design Retrospective study. Purpose To evaluate the influence of lipid parameters on vertebral bone quality (VBQ) scores in patients undergoing lumbar fusion surgery. Overview of Literature The MRI-derived VBQ score is a validated tool for assessing osteoporosis in patients undergoing lumbar fusion surgery. However, the effect of lipid parameters on its diagnostic performance remains unclear. Methods Consecutive patients who underwent lumbar fusion surgery over a 3-year period were retrospectively reviewed. Inclusion required the availability of lumbar T-scores, quantitative computed tomography, magnetic resonance imaging (MRI), and laboratory data obtained within a 1-month interval. Patients were stratified according to lipid levels and clinical characteristics. Correlation analysis and receiver operating characteristic (ROC) curve analysis evaluated the impact of lipid parameters on VBQ 1.5T, VBQ 3.0T, and the calibrated VBQ (C-VBQ) scores, which was developed to improve consistency across different MRI field strengths. Results This study included 294 patients (mean age, 67.1±6.5 years; 57.8% female; 56.8% with hyperlipidemia). Among the lipid parameters evaluated, only high-density lipoprotein cholesterol (HDLC) demonstrated a modest association with VBQ scores. Correlation analysis demonstrated significant positive correlations between HDLC and both VBQ 1.5T (p=0.003) and C-VBQ (p=0.001). After stratification by HDLC levels, C-VBQ differed significantly between normal and abnormal HDLC groups (p=0.046). Significant differences in VBQ 3.0T and C-VBQ across HDLC quintiles persisted even after T-score adjustment (p=0.037 and p=0.003). ROC analysis revealed minimal influence of lipid parameters or hyperlipidemia on VBQ diagnostic performance. Conclusions Among lipid parameters, only HDLC was positively associated with VBQ scores; however, this weak association did not significantly compromise the diagnostic performance of VBQ for osteoporosis.
STUDY DESIGN:Scoping review. PURPOSE:To map and summarize current evidence on acute-phase rehabilitation in patients with osteoporotic vertebral fractures (OVFs), with particular emphasis on intervention characteristics, safety, and clinical effectiveness. OVERVIEW OF LITERATURE:Existing reviews on osteoporotic vertebral compression fractures have predominantly focused on pharmacological or bracing strategies, whereas evidence regarding rehabilitation in the acute phase remains limited. METHODS:A literature search was performed using PubMed, Google Scholar, and the Physiotherapy Evidence Database to identify studies published between January 2015 and December 2025. Eligible studies included patients with vertebral compression fractures or OVFs who underwent rehabilitation or exercise-based interventions within 4 weeks of symptom onset. Extracted data were narratively synthesized. RESULTS:This review identified 1,034 records and included seven studies. The included studies were heterogeneous in design and enrolled between 34 and 40,743 participants. In most studies, rehabilitation was initiated within 2 weeks of onset, with several studies reporting initiation within 3 days of admission. Early initiation of rehabilitation within 3 days was associated with greater improvements in the Barthel index (BI) (p <0.001). Longer daily rehabilitation duration was associated with BI gains of 7.28-10.24 points. Provision of rehabilitation through the week, including weekends, was linked to higher BI scores at discharge (B =3.92, p <0.001) and reduced readmission rates (odds ratio, 0.907; p =0.008). No serious adverse events were reported. CONCLUSIONS:Acute-phase rehabilitation for patients with OVF appears to be safe and may contribute to improved functional recovery and favorable clinical outcomes, particularly when initiated within 2 weeks of onset and preferably within the first 3 days. Further prospective studies are warranted to establish the optimal rehabilitation program during the acute phase.
