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Simon Morr, Hakeem J. Shakir, Lindsay J. Lipinski, Vassilios G. Dimopoulos, Jody Leonardo and John Pollina

augmentation procedures, including vertebroplasty and balloon kyphoplasty, have been shown to effectively treat pain and significantly improve measured functional status 15 , 16 , 25 , 28 , 35 , 42 Vertebral fractures are the most common osteoporotic fracture and occur in 12%-25% of all persons aged 60 years or older. 10 , 12 Approximately 700,000 of the 1.5 million annual fractures attributed to osteoporosis are vertebral fractures, almost 3 times more than the number of fractures of the hip and distal radius. 37 Low bone mineral density, as measured with dual energy x

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Ching-yi Lee, She-Hung Chan, Hung-Yi Lai and Shih-Tseng Lee

independent parameter between 2 experimental groups. 34 It has been shown that the study of osteoporosis-related bone loss and instrumentation of osteoporotic vertebra is important in understanding bone mechanics and the development of new and improved implant designs. 14 , 20 Christensen et al. 7 have shown that porcine spines are frequently used as an alternate model to human specimens for in vivo and in vitro experiments involving spinal fusion and instrumentation techniques. 10 Porcine vertebrae are similar to those of humans in size, nutritional make-up, bone

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Kyeong Hwan Kim, Sang-Ho Lee, Dong Yeob Lee, Chan Shik Shim and Dae Hyeon Maeng

I nstrumented LIF, whether anterior or posterior, immediately produces a biomechanically stable postoperative spine, which facilitates arthrodesis and improves clinical outcomes. 5 , 16 , 18 , 21 However, in patients with severe osteoporosis, instrumented LIF may result in fixation failure or nonunion due to decreased pedicle screw pullout strength or an increased risk of interbody graft subsidence, which sometimes requires an additional surgery. 12 , 14 , 19 , 20 , 23 , 27 , 31 Among the various methods used to overcome these problems, PMMA cement

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Da Zou, Weishi Li, Fei Xu and Guohong Du

pseudarthrosis, especially for older patients with osteoporosis. 7 , 19 An S1 body with poor bone stock can cause screw loosening in the bone-implant interface, leading to the failure of fixation. 18 , 19 Therefore, preoperative measurement of the bone mineral density (BMD) of the S1 body is essential for surgical planning, which helps surgeons decide whether or not to use other techniques to prevent failure at S1. 9 , 18 Dual-energy x-ray absorptiometry (DXA) is a widely used method to evaluate BMD and diagnose osteoporosis, but it is routinely used to measure BMD of the

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Gen Inoue, Masaki Ueno, Toshiyuki Nakazawa, Takayuki Imura, Wataru Saito, Kentaro Uchida, Seiji Ohtori, Tomoaki Toyone, Naonobu Takahira and Masashi Takaso

have been tried, including altering screw design. 5 , 21 , 23 , 41 Screw augmentation, using bone cement or allograft, is reported to have biomechanical advantages. 1 , 3 , 27 , 42 , 43 Still, fixation in the osteoporotic spine remains a difficult challenge, with a risk of failure by loosening or pullout of the pedicle screw. Osteoporosis is a very important risk factor because bone mineral density (BMD) is reported to be highly correlated with the stability of the pedicle screw. 22 , 36 In the treatment of osteoporosis, bisphosphonates are the first

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Masaki Ueno, Takayuki Imura, Gen Inoue and Masashi Takaso

S antoni et al. recently reported on the use of a cortical bone trajectory (CBT) as a new insertion trajectory for pedicle screws. 12 Mechanical tests have shown that this trajectory provides greater pullout strength than does the traditional trajectory (TT). In patients with severe osteoporosis, however, it may not always be possible to achieve sufficient fixation strength solely with the CBT, and the initial fixation strength already obtained may be reduced by corrective operations. We performed posterior corrective fusion using a double

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Osa Emohare, Alison Dittmer, Robert A. Morgan, Julie A. Switzer and David W. Polly Jr.

common. The effect of aging is readily demonstrated in the cervical spine. As people get older and their bone density decreases, fractures of the C-2 vertebra, in particular, increase in frequency. 26 , 27 , 32 A review of older patients who sustained fractures of C-2 found, on the basis of subjective radiographic assessments of the C-2 vertebra, that more than half of the patients had osteoporosis. 11 , 12 Older patients also tend to sustain relatively severe cervical spine injury from seemingly minor trauma, which usually involves falling from standing height or

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Yutong Gu, Feng Zhang, Xiaoxing Jiang, Lianshun Jia and Robert McGuire

B ecause of an aging population, osteoporosis and its associated fractures have become an important health issue. Osteoporotic VCFs are associated with an increased incidence of death and morbidity, including back pain, loss of height, kyphotic deformity, and a reduction in quality of life. 20 Since the introduction of PVP by Galibert et al. in 1987, 15 this minimally invasive therapy that involves injection of bone cement in the fractured VB has gained popularity as a stabilizing treatment for osteoporotic VCFs, with resultant relief of associated local

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Atilla Akbay and Nejat Akalan

T o T he E ditor : We read the paper by Lee and colleagues 2 (Lee CY, Chan SH, Lai HY, et al: A method to develop an in vitro osteoporosis model of porcine vertebrae: histological and biomechanical study. Laboratory investigation. J Neurosurg Spine 14: 789–798, June 2011) with a great interest. The authors presented an in vitro model for porcine osteoporotic vertebrae in their article. They indicated that their model is that of an “osteoporotic” vertebra; however, we do not agree with their characterization. The vertebrae created with the proposed

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Patrick Fransen

osteoporotic screw. The small holes on the sides of this cannulated screw allow PMMA cement injection in the VB. Case Reports Case 1 History and Examination This 81-year-old man with severe osteoporosis due to long-term methylprednisolone treatment presented with a 3-year-old T-12 fracture treated conservatively until the time of consultation. He began to experience progressive gait instability, particularly during gait initiation and changes of direction. He had suffered numerous falls. Neurological examination confirmed signs of spinal cord compression