Minimally Invasive Management of Collapsed of-4 Osteoporotic Vertebral Fractures: Preliminary Evidence for Vertebroplasty Combined with Pediculoplasty.

Abstract

Osteoporotic vertebral fractures (OVFs) with complete vertebral body collapse (A subtype within the OF4-type category, AO Spine-DGOU classification) represent a severe and unstable subtype of spinal injury in older adults. Owing to technical complexity and concerns over cement leakage, these fractures have traditionally been considered unsuitable for percutaneous vertebroplasty (PVP). However, open surgery carries substantial risks in elderly patients. Evidence regarding the safety and efficacy of PVP combined with pediculoplasty for the specific OF4-type OVFs remains limited. This study aimed to evaluate the feasibility, safety, and potential clinical value of PVP combined with pediculoplasty in the treatment of these complex osteoporotic fractures. A total of 18 patients with the collapsed OF4-OVFs presenting flattened vertebral bodies without neurological deficits were treated with PVP combined with pediculoplasty between May 2021 and December 2024. Vertebral height, local kyphotic angle, visual analog scale, and Oswestry Disability Index were assessed preoperatively, on postoperative day 1, and at the final follow-up. Significant improvements in visual analog scale and Oswestry Disability Index scores were observed 1 day after the procedure (P < 0.05), and these improvements were maintained at the final follow-up. Vertebral height was restored and local kyphotic angle significantly improved postoperatively (P < 0.05). No neurological deterioration was noted. Asymptomatic cement leakage occurred in 5 of 20 vertebrae (25.0%). Pediculoplasty-assisted percutaneous vertebroplasty appears technically feasible for selected patients with severely collapsed OF4 OVFs who are poor candidates for general anesthesia. Larger prospective studies are needed to further evaluate its clinical role.