{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T18:07:57Z","timestamp":1776622077544,"version":"3.51.2"},"reference-count":33,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T00:00:00Z","timestamp":1670284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Kyphoplasty with the SpineJack system was able to restore vertebral height and stabilize the vertebra with an injection of bone cement. The goal of this study was to seek a reliable assessing method during the surgery in determining the minimum amount of bone cement required for the SpineJack system to restore vertebral height and stabilize the vertebra. We defined the \u201cdouble cross sign\u201d as bone cement that expanded vertically along the bilateral SpineJack system, and spread across the midline of the vertebral body as viewed in the anteroposterior (AP) view of the radiographic image. Sixty-five patients aged 74.5 \u00b1 8.5 years with vertebral compression fracture were included in the study. Patients with a positive double cross sign had better ODI score than those without the double cross sign (20.0 \u00b1 6.9 vs. 32.3 \u00b1 8.2; p &lt; 0.001). Postoperative regional kyphotic and local kyphotic angle were significantly better in the positive double cross sign group (11 \u00b1 8.8 degrees vs. 5.3 \u00b1 3.2 degrees; p = 0.001\/11.7 \u00b1 6.2 degrees vs. 6.6 \u00b1 4.1 degrees; p = 0.001, respectively). The more stable construct was built once the double cross sign was achieved during surgery. In this study, a convenient and intuitive method in identifying the minimum but sufficient quantity of injected cement during the SpineJack procedure was developed.<\/jats:p>","DOI":"10.3390\/diagnostics12123068","type":"journal-article","created":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T02:49:35Z","timestamp":1670381375000},"page":"3068","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["\u201cDouble Cross Sign\u201d Could Be an Indicator of an Adequate Amount of Bone Cement in Kyphoplasty with the SpineJack System: A Retrospective Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Chao-Jui","family":"Chang","sequence":"first","affiliation":[{"name":"Departments of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan"},{"name":"Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Dou-Liou Branch, Douliu 64043, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3231-1789","authenticated-orcid":false,"given":"Chih-Kai","family":"Hong","sequence":"additional","affiliation":[{"name":"Departments of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan"},{"name":"Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Dou-Liou Branch, Douliu 64043, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Che-Chia","family":"Hsu","sequence":"additional","affiliation":[{"name":"Departments of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1093\/gerona\/glt093","article-title":"Public health impact of osteoporosis","volume":"68","author":"Cauley","year":"2013","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.2147\/TCRM.S138000","article-title":"A comprehensive overview on osteoporosis and its risk factors","volume":"14","author":"Pouresmaeili","year":"2018","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1159\/000063449","article-title":"Epidemiology of osteoporotic fractures","volume":"54","author":"Dennison","year":"2000","journal-title":"Horm. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1586\/erd.12.27","article-title":"Balloon kyphoplasty in patients with osteoporotic vertebral compression fractures","volume":"9","author":"Wardlaw","year":"2012","journal-title":"Expert Rev. Med. Devices"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1359\/jbmr.061113","article-title":"Incidence and economic burden of osteoporosis-related fractures in the United States, 2005\u20132025","volume":"22","author":"Burge","year":"2007","journal-title":"J. Bone Min. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.1007\/s00198-014-2699-0","article-title":"The economic burden of fracture patients with osteoporosis in western China","volume":"25","author":"Qu","year":"2014","journal-title":"Osteoporos. Int."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Noguchi, T., Yamashita, K., Kamei, R., and Maehara, J. (2022). Current status and challenges of percutaneous vertebroplasty (PVP). Jpn. J. Radiol.","DOI":"10.1007\/s11604-022-01322-w"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E13","DOI":"10.36076\/ppj.2017.1.E13","article-title":"Does Percutaneous Vertebroplasty or Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fractures Increase the Incidence of New Vertebral Fractures? A Meta-Analysis","volume":"20","author":"Zhang","year":"2017","journal-title":"Pain Physician"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"564","DOI":"10.5312\/wjo.v13.i6.564","article-title":"Managements of osteoporotic vertebral compression fractures: A narrative review","volume":"13","author":"Patel","year":"2022","journal-title":"World J. Orthop."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2747","DOI":"10.1097\/01.brs.0000244639.71656.7d","article-title":"Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: A comparative systematic review of efficacy and safety","volume":"31","author":"Taylor","year":"2006","journal-title":"Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"928","DOI":"10.31616\/asj.2018.0329","article-title":"Kyphosis Progression after Balloon Kyphoplasty Compared with Conservative Treatment","volume":"13","author":"Iida","year":"2019","journal-title":"Asian Spine J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"13","DOI":"10.21037\/jss.2016.02.01","article-title":"Third-generation percutaneous vertebral augmentation systems","volume":"2","author":"Vanni","year":"2016","journal-title":"J. Spine Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/j.clinbiomech.2013.06.007","article-title":"Height restoration and maintenance after treating unstable osteoporotic vertebral compression fractures by cement augmentation is dependent on the cement volume used","volume":"28","author":"Kruger","year":"2013","journal-title":"Clin. Biomech"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1007\/s00264-014-2620-7","article-title":"Minimum cement volume for vertebroplasty","volume":"39","author":"Martincic","year":"2015","journal-title":"Int. Orthop."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"E761","DOI":"10.1097\/BRS.0b013e3181fc914e","article-title":"The volumetric analysis of cement in vertebroplasty: Relationship with clinical outcome and complications","volume":"36","author":"Jin","year":"2011","journal-title":"Spine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/j.clinbiomech.2015.04.015","article-title":"Minimum cement volume required in vertebral body augmentation\u2014A biomechanical study comparing the permanent SpineJack device and balloon kyphoplasty in traumatic fracture","volume":"30","author":"Rotter","year":"2015","journal-title":"Clin. Biomech."},{"key":"ref_17","first-page":"495","article-title":"Percutaneous Kyphoplasty Evaluated by Cement Volume and Distribution: An Analysis of Clinical Data","volume":"19","author":"He","year":"2016","journal-title":"Pain Physician"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"52","DOI":"10.15537\/smj.2015.1.9463","article-title":"The efficacy of a percutaneous expandable titanium device in anatomical reduction of vertebral compression fractures of the thoracolumbar spine","volume":"36","author":"Baeesa","year":"2015","journal-title":"Saudi Med. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"173872","DOI":"10.1155\/2015\/173872","article-title":"Clinical Performance and Safety of 108 SpineJack Implantations: 1-Year Results of a Prospective Multicentre Single-Arm Registry Study","volume":"2015","author":"Noriega","year":"2015","journal-title":"BioMed Res. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/j.otsr.2015.08.009","article-title":"Treatment of vertebral compression fractures with the cranio-caudal expandable implant SpineJack (R): Technical note and outcomes in 77 consecutive patients","volume":"101","author":"Renaud","year":"2015","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"637","DOI":"10.5144\/0256-4947.2012.637","article-title":"An epidemiological analysis of the incidence of osteoporosis and osteoporosis-related fractures among the Saudi Arabian population","volume":"32","author":"Azam","year":"2012","journal-title":"Ann. Saudi Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1001\/jama.2009.50","article-title":"Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women","volume":"301","author":"Bliuc","year":"2009","journal-title":"JAMA"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"227","DOI":"10.3174\/ajnr.A1385","article-title":"Urinary tract infections in the potential vertebroplasty patient: Incidence, significance, and management","volume":"30","author":"Popa","year":"2009","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s00198-018-4773-5","article-title":"Long-term safety and clinical performance of kyphoplasty and SpineJack (R) procedures in the treatment of osteoporotic vertebral compression fractures: A pilot, monocentric, investigator-initiated study","volume":"30","author":"Noriega","year":"2019","journal-title":"Osteoporos. Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4985","DOI":"10.1007\/s00330-018-5544-6","article-title":"Vertebral augmentation with the SpineJack (R) in chronic vertebral compression fractures with major kyphosis","volume":"28","author":"Premat","year":"2018","journal-title":"Eur. Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1007\/s00198-016-3494-x","article-title":"Safety and clinical performance of kyphoplasty and SpineJack (R) procedures in the treatment of osteoporotic vertebral compression fractures: A pilot, monocentric, investigator-initiated study","volume":"27","author":"Noriega","year":"2016","journal-title":"Osteoporos. Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.nec.2006.06.005","article-title":"Vertebroplasty and kyphoplasty","volume":"17","author":"Eichholz","year":"2006","journal-title":"Neurosurg. Clin. N. A."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1053\/j.sult.2005.02.003","article-title":"Complications of percutaneous vertebroplasty and their prevention","volume":"26","author":"Laredo","year":"2005","journal-title":"Semin. Ultrasound CT MR"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.2214\/ajr.173.6.10584820","article-title":"Acute osteoporotic vertebral collapse: Open study on percutaneous injection of acrylic surgical cement in 20 patients","volume":"173","author":"Cyteval","year":"1999","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/S1051-0443(07)61584-X","article-title":"Transient arterial hypotension induced by polymethylmethacrylate injection during percutaneous vertebroplasty","volume":"12","author":"Vasconcelos","year":"2001","journal-title":"J. Vasc. Interv. Radiol. JVIR"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1148\/radiol.2231010234","article-title":"Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures","volume":"223","author":"Peh","year":"2002","journal-title":"Radiology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.clineuro.2015.10.026","article-title":"The positive correlation between upper adjacent vertebral fracture and the kyphosis angle of injured vertebral body after percutaneous kyphoplasty: An in vitro study","volume":"139","author":"Lu","year":"2015","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_33","first-page":"e197","article-title":"Vertebroplasty and kyphoplasty for the treatment of thoracic fractures in osteoporotic patients: A finite element comparative analysis","volume":"14","author":"Ottardi","year":"2016","journal-title":"J. Appl. Biomater. Funct. 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