A Multicenter Prospective Randomized Controlled Non-Inferiority Trial Comparing Minimally Invasive SAIF Vertebral Reconstruction Technique Versus Spinal Fixation in Unstable Osteoporotic Vertebral Compression Fractures

Osteoporosis is an increasing health problem worldwide with an enormous economic burden for society. Osteoporotic vertebral fractures (OVF) represent a significant cause of morbidity, mortality, decreased level of function and quality of life. Stable fractures with controllable pain can be managed conservatively, and only those that remain painful despite conservative treatment can be treated with minimally-invasive measures of vertebral augmentation (VA). At the other end of the spectrum, the most severe OVFs are unstable. In these cases standard vertebral augmentation techniques are generally considered an under-treatment and surgical stabilization, with various techniques, is considered necessary to restore the physiological loading capacity of the spine, and allow fast and painless mobilization. Unfortunately, this elderly, osteoporotic patient population poses serious challenges to spinal surgery, due to tissue frailty and frequent comorbidities. More specifically, all the surgical stabilization techniques include rigid posterior fixation of multiple spinal segments, but the reduced bone mechanical properties of osteoporotic patients can lead to hardware implant failure, new fractures, complications, and need of re-intervention.

On the other hand, treatment and reinforcement of the anterior spinal column, that should enhance posterior stabilization, requires a more invasive surgical approach, which carries a significant rate of complications and prolonged recovery times in this elderly population.

A recently described minimally-invasive interventional technique, called Stent-screw Assisted Internal Fixation (SAIF), can reconstruct, stabilize and restore axial load capability of the vertebral body affected by severe fractures, potentially obviating the need of a surgical multi-level rigid construct.

The study seeks primarily to determine whether the SAIF intervention is not inferior to surgical stabilization in improving quality of life in subjects with unstable OVFs at one year follow-up.

The principle secondary objective of this study is to evaluate whether the effect of the SAIF intervention on the radiological outcome is not inferior to surgical stabilization in subjects with OVFs.