{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:07:29Z","timestamp":1792598849730,"version":"4.5.0"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Vertebral compression fractures (VCFs) are common complications of osteoporosis in elderly patients. Percutaneous vertebroplasty (PVP) provides pain relief and functional improvement, but some patients require revision due to refracture, cement failure, or new symptomatic levels. While outcomes of primary and multilevel augmentation have been described, systematic data on multilevel revision PVP remain rare. The aim of this study was to evaluate pain relief, functional improvement, and perioperative safety after three\u2010 and four\u2010level revision PVP in elderly patients with osteoporotic thoracolumbar fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective, single\u2010center cohort included patients aged 75\u201385\u2009years who underwent revision PVP between August 2019 and November 2023. Eligible cases had a history of prior PVP and required repeat augmentation of three or four vertebral levels in a single session. Visual Analogue Scale (VAS) scores for pain and Oswestry Disability Index (ODI) for functional disability were recorded preoperatively and at 1\u2010, 3\u2010, 6\u2010, and 12\u2010month follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine patients were analyzed. Revision involved three levels in five patients and four levels in four patients, with a mean interval of 14.1\u2009months after the index procedure. Mean VAS improved from 8.3\u2009\u00b1\u20090.7 preoperatively to 3.2\u2009\u00b1\u20090.6 at 12\u2009months (61% reduction,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). ODI improved from 75.2%\u2009\u00b1\u20093.4% to 26.9%\u2009\u00b1\u20092.7% (64% reduction,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). All patients exceeded the minimal clinically important difference thresholds. No perioperative complications such as cement leakage, neurological deficits, or pulmonary events were observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Three\u2010 and four\u2010level revision PVP provided significant pain relief and functional improvement in elderly patients with osteoporotic fractures, without increased complication rates. To our knowledge, this represents one of the first reports addressing this topic, suggesting it is an effective option in carefully selected patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.70385","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T03:28:22Z","timestamp":1784863702000},"page":"1948-1957","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Multilevel Revision Percutaneous Vertebroplasty in Elderly Patients With Osteoporotic Thoracolumbar Fractures: A Retrospective Cohort Study"],"prefix":"10.1111","volume":"18","author":[{"given":"Stylianos","family":"Kapetanakis","sequence":"first","affiliation":[{"name":"Department of Spine and Deformities European Interbalkan Medical Center  Thessaloniki Greece"},{"name":"2nd Orthopaedic Department Aristotle University of Thessaloniki, G. Genimmatas Hospital  Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8677-4153","authenticated-orcid":false,"given":"Mikail","family":"Chatzivasiliadis","sequence":"additional","affiliation":[{"name":"Department of Spine and Deformities European Interbalkan Medical Center  Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Gkantsinikoudis","sequence":"additional","affiliation":[{"name":"Department of Spine and Deformities European Interbalkan Medical Center  Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krikor","family":"Gkoumousian","sequence":"additional","affiliation":[{"name":"Department of Spine and Deformities European Interbalkan Medical Center  Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Konstantinou","sequence":"additional","affiliation":[{"name":"2nd Orthopaedic Department Aristotle University of Thessaloniki, G. Genimmatas Hospital  Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lazaros","family":"Kostretzis","sequence":"additional","affiliation":[{"name":"2nd Orthopaedic Department Aristotle University of Thessaloniki, G. Genimmatas Hospital  Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iosafat","family":"Pinto","sequence":"additional","affiliation":[{"name":"Health Unit of Veria General Hospital of Imathia  Veria Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lazaros","family":"Poultsides","sequence":"additional","affiliation":[{"name":"Academic Orthopaedic Department Aristotle University Medical School, General Hospital Papageorgiou  Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paschalis","family":"Tsioulas","sequence":"additional","affiliation":[{"name":"Department of Spine and Deformities European Interbalkan Medical Center  Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Ditsios","sequence":"additional","affiliation":[{"name":"2nd Orthopaedic Department Aristotle University of Thessaloniki, G. 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