Vertebral augmentation with the SpineJack® in chronic vertebral compression fractures with major kyphosis. 
Osteoporotic vertebral compression fractures (OVCFs) are an important health issue for which minimally invasive techniques are a feasible treatment.  The SpineJack® (Vexim) is an intravertebral expandable system designed to improve the correction of the structural modifications caused by OVCFs.  Its ability to stabilise and reduce OVCFs at the acute phase being already well established, we sought to evaluate the feasibility of vertebral augmentation with the SpineJack® in chronic kyphotic OVCFs.  All consecutive patients treated with the SpineJack® were prospectively included if they met the following criteria: (1) OVCF considered unstable (grade A3 according to Magerl's classification). ( 2) Local kyphotic angle ≥ 20°. ( 3) OVCF older than 6 weeks. ( 4) Back pain with visual analogue scale (VAS) ≥ 4.  Nineteen consecutive patients (16 women [84.2%] and 3 men [15.8%]; mean age 73.2 ± 8.2 years) were included.  Treatment was performed after a mean delay of 5.8 months ± 2.9 (range 1.5-12).  Median visual analogue scale significantly improved from 7 preoperatively (IQR 6-9) to 2 (IQR 1-5) at 6 months (p < 0.01).  Significant kyphosis reduction (i.e. ≥ 30%) was obtained in 94.7% of cases.  Secondary adjacent level fractures (SALFs) were noted in 21.1% of cases and were correlated with the importance of the kyphosis reduction.  Vertebral augmentation with the SpineJack® is feasible and seems able to correct major structural deformities in chronic OVCFs.  SALFs were noted in a substantial amount of cases.  Preventive adjacent vertebroplasty might be useful in patients with several risk factors for SALFs. •  Vertebral augmentation with SpineJack® is effective to correct major structural deformities e.g. height loss and kyphosis. •  Successful reduction is reachable with SpineJack® in chronic (older than 6 weeks) OVCFs. •  Aggressive reduction of major kyphosis might promote SALFs and complementary adjacent vertebroplasties prevent their occurrence.