Ümit Mert

Background/Objectives: Osteoporotic vertebral fractures (OVFs) are a growing global health burden, often managed surgically with vertebroplasty or kyphoplasty. However, long-term outcomes such as refracture and mortality remain poorly characterized across heterogeneous studies. The study aims to determine the pooled rates of refracture and mortality following surgical treatment of OVFs, and to identify clinical and procedural predictors of these outcomes using meta-regression and reconstructed survival analysis. Methods: This systematic review and meta-analysis adhered to PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched up to 15 April 2025. Studies reporting refracture or mortality outcomes after surgical intervention for OVFs in adults were included. Data synthesis used random-effects meta-analysis. Subgroup and meta-regression analyses explored heterogeneity. Individual patient-level data (IPD) were reconstructed from Kaplan–Meier curves to generate survival estimates and Cox proportional hazards models. Results: Eighty-two studies (n = 1,174,092 patients) were included. The pooled refracture rate was 18% (95% CI: 15–21%), with significantly higher rates associated with cement leakage (p = 0.006). Meta-regression found no significant associations with BMD, age, or prior fracture history. Time-to-event analysis revealed a steep increase in refracture within the first 12–24 months. Patients receiving percutaneous vertebroplasty (PVP) had a significantly lower hazard of refracture compared to kyphoplasty (HR = 0.036, 95% CI: 0.033–0.040; p < 0.0001). The pooled postoperative mortality rate was 15% (95% CI: 9–22%). Diabetes was positively associated with mortality risk (p = 0.001), while prior fracture history showed a significant effect. Survival probability was significantly higher in patients treated with kyphoplasty compared to vertebroplasty (HR = 4.64, 95% CI: 3.55–6.07; p < 0.0001). Conclusions: Surgical treatment for OVFs is associated with substantial refracture and mortality risk, particularly within the first two years postoperatively. Cement leakage and diabetes significantly influence outcomes. Vertebroplasty appears protective against refracture, whereas kyphoplasty may confer a survival advantage; however, these associations should be interpreted as exploratory and hypothesis-generating due to high heterogeneity and methodological limitations.

Background/Objectives: To compare the radiographic, perioperative, and patient-reported outcomes between anterior vertebral body tethering (VBT) and posterior spinal fusion (PSF) in adolescents with idiopathic scoliosis. Methods: A systematic search of PubMed, Scopus, Web of Science, and Google Scholar was performed through May 2025. Studies directly comparing anterior VBT and PSF in skeletally immature patients with adolescent idiopathic scoliosis were included. Data were pooled using random-effects meta-analysis and expressed as mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs). The NIH quality assessment tool was used to evaluate risk of bias. Results: Ten studies comprising 1168 patients (573 VBT, 595 PSF) were included. At 2 years, VBT showed a significantly greater main thoracic curve (MD = 5.03°; 95% CI: 1.87–8.20) and proximal thoracic curve (MD = 3.27°; 95% CI: 1.16–5.38), but no difference in lumbar or main curve Cobb angles. VBT was associated with significantly reduced thoracic kyphosis (MD = −2.68°), increased T1 tilt (MD = 1.50°), shorter operative time (MD = −99.23 min), less blood loss (MD = −405.44 mL), and shorter hospital stay (MD = −1.34 days). However, VBT had a significantly higher revision rate (OR = 5.54; 95% CI: 2.81–10.94). No significant differences were noted in SRS-22 domains, except for higher mental health scores in the VBT group (MD = 0.56; 95% CI: 0.07–1.06). Conclusions: Anterior VBT offers perioperative advantages and comparable radiographic correction to PSF in selected adolescents with idiopathic scoliosis, but at the cost of higher revision rates.

Background and Objectives: Osteoporotic fractures in the thoracic/lumbar spine pose significant challenges in surgical management, with high risks of complications. This study investigates the role of preoperative CT scans and Hounsfield Units (HUs) in predicting postoperative outcomes. Materials and Methods: A retrospective study was conducted from November 2015 to January 2018. Sixty-one patients over 60 years of age with unstable osteoporotic thoracolumbar spine fractures (OF: 3–4) were included. Preoperative CT scans were performed to measure HU values. Postoperative standing X-rays were taken at 3–12 months to assess signs of loosening, adjacent fractures, or screw dislodgement. HU was divided into quartiles: Q1 (87.59). Results: Out of the 61 patients, 14 (23%) exhibited signs of screw loosening, adjacent fractures, or screw dislodgement within 3 to 12 months postoperatively. The mean HU value measured was 65.21, with a range from 21.43 to 140.7. Notably, all patients with observed loosening or dislodgement had HU values below 68. HU significantly predicted mortality, with the second quartile showing a markedly increased risk (adjusted odds ratio [aOR] = 8.12; p = 0.044). However, HU quartiles were not significant predictors of other outcomes. Other factors (fracture level and ASA classification) also influenced clinical outcomes, particularly mortality. Conclusions: HU values from preoperative CT scans are crucial in predicting the risk of screw loosening, dislodgement, and adjacent fractures in osteoporotic spinal fractures. Integrating HU assessment into clinical practice can improve preoperative planning, allowing for more targeted surgical interventions and better clinical outcomes.