1
|
Takano H, Nojiri H, Shimura A, Teramoto J, Sugawara Y, Ishijima M. Early Balloon Kyphoplasty Treatment for Osteoporotic Vertebral Fracture Reduces Adjacent Vertebral Fractures. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1097. [PMID: 39064526 PMCID: PMC11278625 DOI: 10.3390/medicina60071097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: This study retrospectively examined whether the incidence rates of adjacent vertebral fractures (AVFs) can be reduced through balloon kyphoplasty (BKP) for osteoporotic vertebral fractures (OVFs) in the early stages, when there is little vertebral height variation. Materials and Methods: A total of 95 patients (22 males, 73 females, mean age: 80.7 years) who had undergone BKP were divided into two groups: the Early group (underwent BKP within 2 weeks after injury, n = 62), and the Non-early group (underwent BKP > 2 weeks after injury, n = 33). The following data were analyzed: patient characteristics; fracture level; the presence of old vertebral fractures, posterior wall injury, and intravertebral cleft; duration of surgery; duration of hospitalization; cement volume; the occurrence of AVF; the timing of AVF occurrence; Numerical Rating Scale (NRS) scores at the preoperative, postoperative, and final follow-up assessments; posterior vertebral kyphosis angle of the affected vertebra on plain lateral X-ray; vertebral wedge ratio; local kyphotic angle; and changes in posterior vertebral kyphosis angle, vertebral wedge ratio, and local kyphotic angle between preoperative and postoperative assessments. The patients were divided based on the occurrence or non-occurrence of AVF after BKP: the Non-AVF group, in which AVF did not occur, and the AVF group, in which AVF occurred. Results: The incidence of AVF was 15.8% (15/95 patients), with a notably lower incidence rate in the Early group at 6.5% (4/62 patients) compared to the Non-early group at 33.3% (11/33 patients). NRS scores significantly improved in both groups at the postoperative assessment and final follow-up. The changes in posterior vertebral kyphosis angle and vertebral wedge ratio were significantly lower in the Early group. In the Non-AVF group, the time from injury to surgery was significantly shorter. Conclusions: The Early group had a significantly lower incidence of AVF. The time from injury to surgery was a risk factor for AVF occurrence, suggesting that early BKP is recommended.
Collapse
Affiliation(s)
- Hiromitsu Takano
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
- Spine and Spinal Cord Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Hidetoshi Nojiri
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
- Spine and Spinal Cord Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Arihisa Shimura
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
- Spine and Spinal Cord Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Juri Teramoto
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
- Spine and Spinal Cord Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Yuta Sugawara
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
- Spine and Spinal Cord Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Muneaki Ishijima
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
| |
Collapse
|
2
|
Yao R, Yin P, Zhang Y, Li D, Zhang XN, Tao L, Zhou J, Su Q. Is there a risk of further displacement of the fractured fragment into the spinal canal in osteoporotic vertebral burst fractures after unilateral PKP? A prospective study. Spine J 2024; 24:1077-1086. [PMID: 38110090 DOI: 10.1016/j.spinee.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/14/2023] [Accepted: 12/14/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND CONTEXT The optimal treatment for osteoporotic vertebral burst fracture (OVBF) without neurological symptoms is still a matter of debate. PURPOSE To evaluate the safety and efficacy of percutaneous kyphoplasty (PKP) for OVBF. STUDY DESIGN The study is a prospective study and is registered in the China Clinical Trials Registry with the registration number ChiCTR-OOC-17013227. PATIENT SAMPLE The study involved 119 patients with 137 fractured vertebrae who underwent unilateral PKP for OVBF. OUTCOME MEASURES The measurements were carried out independently by two physicians and measured with picture archiving and communication system (PACS) and ImageJ software (National Institutes of Health, Bethesda, MD, USA). METHODS The change in the spinal canal area and posterior wall protrusions (PWP) were measured before and after surgery via three-dimensional computed tomographic imaging (CT). Preoperative, postoperative, and final follow-up standing X-rays were used to measure the height of the anterior wall (HAW), height of the posterior wall (HPW), and local kyphotic angle (LKA). Additionally, visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were also determined. RESULTS Among the 137 vertebrae assessed, 79 exhibited an increased postoperative canal area, while 57 showed a decrease, with mean values of 8.28±6.871 mm² and -9.04±5.991 mm², respectively. Notably, no significant change in postoperative canal area was identified on the entire dataset (p>.01). There was a significant decrease between median preoperative (3.9 [IQ1-IQ3=3.3-4.8] mm) and postoperative (3.7 [IQ1-IQ3=3.0-4.4] mm) PWP (p<.01). Preoperative and postoperative HAW measurements were 19.4±6.1 mm and 23.2±5.2 mm, respectively (p<.01). However, at the final follow-up, the HAW was lower than the postoperative value. The HPW was also significantly improved after surgery (p<.01), but at the final follow-up, it was significantly decreased compared with the postoperative measurement. Following surgery, KA was significantly corrected (p<.01); however, at the final follow-up, relapse was detected (average KA: 18.4±10.3°). At the final follow-up, both VAS and ODI were significantly improved compared with the preoperative period (p<.01). As for complications, 50 patients experienced cement leakage, and 16 patients experienced vertebral refracture. All patients did not develop neurological symptoms during the follow-up. CONCLUSIONS OVBF without neurological deficits showed significant improvement in symptoms during the postoperative period after PKP. There was no notable alteration in the spinal canal area, but a significant decrease in PWP was observed. Consequently, we posit that PKP stands as a secure and efficacious surgical intervention for treating OVBF cases devoid of neurological symptoms.
Collapse
Affiliation(s)
- Ruizhang Yao
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Peng Yin
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Yaoshen Zhang
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Dongyue Li
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Xi-Nuo Zhang
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Luming Tao
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Junlin Zhou
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Qingjun Su
- Beijing Chao-Yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China.
| |
Collapse
|
3
|
Cao DH, Gu WB, Zhao HY, Hu JL, Yuan HF. Advantages of unilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures-a systematic review and meta-analysis. Arch Osteoporos 2024; 19:38. [PMID: 38750277 DOI: 10.1007/s11657-024-01400-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/03/2024] [Indexed: 07/13/2024]
Abstract
Data from English randomized controlled trials comparing unilateral versus bilateral PKP for the treatment of OVCFs were retrieved and analyzed, and the results showed that unilateral PKP is a better choice for the treatment of patients with OVCFs, which will provide a reliable clinical rationale for the treatment of OVCFs. PURPOSE To investigate the advantages of unilateral percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures(OVCFs). METHODS The systematic evaluation program met all program requirements (CRD 42023422383) by successfully passing the PROSPERO International Prospective Systematic Evaluation Registry. Researchers searched the references of English-language randomized controlled trials comparing unilateral and bilateral PKP for the treatment of osteoporotic vertebral compression fractures published between 2010 and 2023 and manually searched for known primary and review articles. The study statistically analyzed data from all the included literature, which primarily included time to surgery, visual pain score(VAS) and Oswestry disability index(ODI) at postoperative follow-up time points, polymethylmethacrylate (PMMA, bone cement) injection dose, cement leakage, radiation dose, and improvement in kyphotic angle. RESULTS This meta-analysis searched 416 articles published from 2010 to 2023 based on keywords, and 18 articles were finally included in this study. The results of the forest plot showed that unilateral PKP operative time, amount of bone cement used, and radiation dose to the patient were significantly reduced (p < 0.01, p < 0.01, and p < 0.01, respectively), and unilateral and bilateral PKP had comparable cement leakage (p = 0.49, 95% CI = 0.58-1.30), and there was no significant difference in the kyphotic angle between unilateral and bilateral PKP (p = 0.42, 95% CI = - 2.29-0.96). During follow-up, there was no significant difference in pain relief between unilateral and bilateral PKP (p = 0.70, 95% CI = - 0.09-0.06), nor was there a significant difference in ODI (p = 0.27, 95% CI = - 0.35-1.24). CONCLUSIONS There is no difference in clinical efficacy between unilateral PKP and bilateral PKP, but unilateral PKP has a shorter operative time, a lower incidence of cement leakage, a lower amount of cement, and a lower radiation dose to the patient and operator. Unilateral PKP is a better option for patients with OVCFs.
Collapse
Affiliation(s)
- Dong-Hui Cao
- Department of Spinal Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, China
- Ningxia Medical University, Yinchuan, China
| | - Wen-Bo Gu
- Ningxia Medical University, Yinchuan, China
| | | | | | - Hai-Feng Yuan
- Department of Spinal Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, China.
| |
Collapse
|
4
|
Zheng HL, Li B, Jiang QY, Jiang LS, Zheng XF, Jiang SD. Optimizing percutaneous vertebroplasty: extra-facet puncture for osteoporotic vertebral compression fractures. J Orthop Surg Res 2023; 18:887. [PMID: 37993875 PMCID: PMC10664349 DOI: 10.1186/s13018-023-04368-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023] Open
Abstract
PURPOSE To assess the safety and efficacy of the extra-facet puncture technique applied in unilateral percutaneous vertebroplasty (PVP) for treating osteoporotic vertebral compression fractures. METHODS Demographics (age, gender, body mass index and underlying diseases) were recorded for analyzing. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores as well as their corresponding minimal clinically important difference (MCID) were used to evaluate clinical outcomes. The segmental kyphotic angle, the vertebral compression ratio and bone cement distribution pattern were evaluated by the plain radiographs. The facet joint violation (FJV) was defined by the postoperative computed tomography scan. Binary logistic regression analysis was performed to investigate relationships between multiple risk factors and residual back pain. RESULTS VAS and ODI scores in both traditional puncture group and extra-facet puncture group were significantly decreased after PVP surgery (p < 0.05). However, no significant difference was observed between the two groups according to VAS and ODI scores. The proportion of patients achieving MCID of VAS and ODI scores was higher in extra-facet puncture group as compared to traditional puncture group within a month (p < 0.05). Finally, multivariate logistic regression analysis showed that FJV (odds ratio 16.38, p < 0.001) and unilateral bone cement distribution (OR 5.576, p = 0.020) were significant predictors of residual back pain after PVP surgery. CONCLUSIONS Extra-facet puncture percutaneous vertebroplasty can decrease the risk of FJV and it also has the advantage of more satisfied bone cement distribution.
Collapse
Affiliation(s)
- Huo-Liang Zheng
- Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Bo Li
- Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Qin-Yu Jiang
- Shanghai Weiyu High School, Shanghai, 200231, China
| | - Lei-Sheng Jiang
- Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Xin-Feng Zheng
- Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China.
| | - Sheng-Dan Jiang
- Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China.
| |
Collapse
|
5
|
Shi X, Li P, Li J, Bao C, Xiang J, Lu Y. Comparative evaluation of an innovative deflectable percutaneous kyphoplasty versus conventional bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: a prospective, randomized and controlled trial. Spine J 2023; 23:585-598. [PMID: 36563860 DOI: 10.1016/j.spinee.2022.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND CONTEXT Osteoporotic vertebral compression fractures (OVCFs) can be treated with percutaneous kyphoplasty (PKP). In contrast to conventional PKP, the novel deflectable percutaneous kyphoplasty (DPKP), is a unilateral transpedicular approach procedure allowing a similar bilateral puncture effect, which owes to the deflectable curved bone expander creating a transcentral line cavity to achieve uniform distribution of cement and biomechanical balance while reducing operative time and radiation exposure. PURPOSE The purpose of this study was to prospectively compare and evaluate an innovative surgical procedure, DPKP, versus conventional bilateral percutaneous kyphoplasty (BPKP). STUDY DESIGN This is a prospective randomized controlled trial (RCT). SAMPLE The totality of the participants (n=90) suffering from OVCFs between May 2019 and October 2020, were randomized by SAS 9.3 to generate a block randomization sequence, which was utilized to randomize the groups in a 1:1 ratio, assigned to the DPKP group (n=45) and the BPKP group (n=45) to undergo accordingly procedures. OUTCOME MEASURES The primary outcome was the total operative time. The secondary outcomes included: comparative assessment of visual analog scale (VAS) scores, Oswestry disability index (ODI), kyphosis angle (KA), anterior border height (AH) of the injured vertebra, frequency of intraoperative X-ray fluoroscopy, the injection volume, distribution pattern and leakage rate of bone cement. METHODS All subjects underwent assessment by at least one senior orthopedist and radiologist for the VAS scores, ODI, KA, AH of the injured vertebra, total operative time, the injection volume, distribution pattern, leakage rate of bone cement at preoperative and 24 hours, 6 months, and 1 year postoperatively. Inclusion criteria for subjects in this prospective study were as follows: (1) 60 < age < 80 years old; (2) preoperative spinal X-ray, CT, and MRI confirmed as single-segment, fresh thoracolumbar OVCFs (T5-L5, 15% < collapse < 80%); MRI shows low signal on T1-WI and high signal on T2-WI, especially with STIR high signal characterized by vertebral edema; (3) painful OVCFs refractory to medical treatment, 2 weeks < Symptom duration < 3 months;(4) With significant physical signs of local tenderness; (5) T score of bone mineral density (BMD) < -2.5. RESULTS The total operative time was significantly reduced in the DPKP group (43.3±19.58 minutes, 95% CI: 37.23-49.37) compared to the BPKP group (55.16±11.56 minutes, 95% CI: 51.78-58.54) (p<.001). Compared to the BPKP group (frequency of intraoperative X-ray fluoroscopy: 43.42±8.64, 95% CI: 40.90-45.95; the volume of bone cement injected: 5.56±0.85 mL, 95% CI: 5.31-5.81), the frequency of intraoperative X-ray fluoroscopy (30.05±17.41, 95% CI: 24.66-35.45) and volume of bone cement injected (5.08±0.97 mL, 95% CI: 4.78-5.38) significantly reduced in the DPKP group compared to the (p<.001). In addition, compared to the preoperative period, both groups showed significant improvements in the postoperative VAS scores, ODI, KA, and AH (p<.001), but there was no statistical difference between the DPKP and BPKP groups (p>.05) at any time-point. Interestingly, although without statistical differences, a tendency towards a lower rate of bone cement leakage was observed in the DPKP group. CONCLUSION Our study results indicate that the innovative DPKP is as safe and effective as BPKP in relieving pain, improving the patient's quality of life, and reconstructing vertebral body height. Particularly, DPKP did reduce operative time and radiation exposure compared to BPKP, which correlated with unilateral and bilateral exposure procedures. Moreover, the final cement distribution was less predictable in DPKP, and further studies are warranted to clarify the advantages of DPKP versus conventional unilateral percutaneous kyphoplasty (UPKP) and BPKP.
Collapse
Affiliation(s)
- Xin Shi
- Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany.
| | - Panpan Li
- Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany.
| | - Jubao Li
- Department of Orthopedics, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming 650000, Yunnan, China
| | - Chaoyu Bao
- Department of Orthopedics, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming 650000, Yunnan, China
| | - Junyi Xiang
- Department of Orthopedics, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming 650000, Yunnan, China.
| | - Yu Lu
- Department of Orthopedics, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming 650000, Yunnan, China.
| |
Collapse
|
6
|
Wang YF, Bian ZY, Li XX, Hu YX, Jiang L. Total spinal anesthesia caused by lidocaine during unilateral percutaneous vertebroplasty performed under local anesthesia: A case report. World J Clin Cases 2022; 10:9050-9056. [PMID: 36157664 PMCID: PMC9477033 DOI: 10.12998/wjcc.v10.i25.9050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/07/2022] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intradural anesthesia caused by anesthetic drug leakage during percutaneous vertebroplasty (PVP) has rarely been reported. We here report a 71-year-old woman who suffered this rare and life-threatening complication during PVP.
CASE SUMMARY A 71-year-old woman, who suffered from 2 wk of severe back pain with a visual analog score of 8, came to our outpatient clinic. She was later diagnosed with a newly compressed L1 fracture and was then admitted in our department. PVP was initially attempted again under local anesthesia. However, serendipitous intradural anesthesia leading to total spinal anesthesia happened. Fortunately, after successful resuscitation of the patient, PVP was safely and smoothly performed. Great pain relief was achieved postoperatively, and she was safely discharged on postoperative day 4. The patient recovered normally at 3-mo follow-up.
CONCLUSION Total spinal anesthesia secondary to PVP by anesthetic drug leakage rarely occurs. In cases of inadvertent wrong puncture leading to drug leakage when performing it under local anesthesia, surgeons should be highly vigilant during the whole procedure. Electrocardiogram monitoring, oxygen inhalation, intravenous cannula set prior to surgery, regular checking of motor activity and a meticulous imaging monitoring with slower pushing of anesthetic drugs, etc. should be highly recommended.
Collapse
Affiliation(s)
- Yu-Fei Wang
- Department of Anesthesiology, Taizhou People’s Hospital, Taizhou 225300, Jiangsu Province, China
| | - Zhao-Yue Bian
- Department of Anesthesiology, Taizhou People’s Hospital, Taizhou 225300, Jiangsu Province, China
| | - Xin-Xian Li
- Department of Spine Surgery, The People’s Hospital of Liuyang City, Liuyang 410300, Hunan Province, China
| | - Yun-Xiang Hu
- Department of Orthopedics, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian 116021, Liaoning Province, China
- School of Graduates, Dalian Medical University, West Section, No.8 South Lvshun Road, Lvshun District, Dalian 116000, Liaoning Province, China
| | - Lin Jiang
- Department of Anesthesiology, Taizhou People’s Hospital, Taizhou 225300, Jiangsu Province, China
| |
Collapse
|
7
|
Liu Z, Zhang X, Liu H, Wang D. A nomogram for short-term recurrent pain after percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Osteoporos Int 2022; 33:851-860. [PMID: 34762140 DOI: 10.1007/s00198-021-06232-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/02/2021] [Indexed: 02/06/2023]
Abstract
UNLABELLED In clinical practice, it was found that some patients experienced short-term recurrent pain (SRP) in the original site after PVP treatment. This study was designed to develop and validate a nomogram for predicting the potential risks of SRP after PVP, which may help to provide a painless postoperative experience and personalized health management for patients with OVCF. INTRODUCTION With the aging of China's population, the incidence of osteoporotic vertebral compression fractures (OVCF) has increased significantly. Percutaneous vertebroplasty (PVP) has been widely accepted due to its minimally invasive, rapid, and effective characteristics. However, it has been found that some patients have short-term recurrent pain (SRP) in the original site after surgery in practical clinical work. METHODS We retrospectively reviewed the clinical data of OVCF patients who were treated with PVP in our center from January 1st, 2019, to December 30th, 2020. A total of 296 patients were enrolled in the study cohort, and patients were randomly divided into the training set (70%) and validation set (30%). Univariate and multivariate logistic regression analyses were used to determine the risk factors of SRP, and a nomogram predictive model was established accordingly. The model was evaluated by calibration curve, receiver operation characteristic (ROC) curve, and decision curve analysis (DCA). RESULTS Among the 296 patients, 83 (27.85%) patients experienced SRP after surgery. The independent risk factors included fracture segments (OR: 14.148, 95%CI: 1.532-130.661; p < 0.019), number of surgical vertebrae (OR: 7.896, 95%CI: 3.007-20.729; p < 0.001; (OR: 12.563, 95%CI: 2.223-70.993; p = 0.004), and smoking (OR: 3.833, 95%CI: 1.219-12.052; p = 0.022). The AUC of the prediction model was 0.819 in the training set and 0.794 in the validation set. The calibration curve and DCA indicated the good performance of this nomogram. CONCLUSION The nomogram prediction model had satisfactory accuracy and clinical utility, which may benefit clinical decision-making for the treatment of OVCF and strengthen patient education.
Collapse
Affiliation(s)
- Z Liu
- Department of Orthopedics, Affiliated Hospital of Beihua University, Jilin, 132000, China
| | - X Zhang
- Department of Orthopedics, Affiliated Hospital of Beihua University, Jilin, 132000, China
| | - H Liu
- Department of Orthopedics, Baicheng Central Hospital, Jilin, China
| | - D Wang
- Department of Orthopedics, Affiliated Hospital of Beihua University, Jilin, 132000, China.
| |
Collapse
|
8
|
Dai C, Liang G, Zhang Y, Dong Y, Zhou X. Risk factors of vertebral re-fracture after PVP or PKP for osteoporotic vertebral compression fractures, especially in Eastern Asia: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:161. [PMID: 35279177 PMCID: PMC8917756 DOI: 10.1186/s13018-022-03038-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/02/2022] [Indexed: 01/10/2023] Open
Abstract
Objective Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat osteoporotic vertebral compression fractures (OVCF), but the risk of vertebral re-fracture after PVP/PKP remains controversial. This study aims to investigate the incidence and risk factors of vertebral re-fracture after PVP/PKP. Methods Relevant literatures published up to November 2021 were collected from PubMed, Embase and Web of Science. A meta-analysis was performed to extract data associated with risk factors of SVCF following the PRISMA guidelines. Also, pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence interval (CI) was calculated. Results A total of 23 studies, encompassing 9372 patients with OVCF, met the inclusion criteria. 1255 patients (13.39%) suffered re-fracture after PVP/PKP surgery. A total of 22 studies were from Eastern Asia and only 1 study was from Europe. Female sex (OR = 1.34, 95%CI 1.09–1.64, P = 0.006), older age (WMD = 2.04, 95%CI 0.84–3.24, P = 0.001), lower bone mineral density (BMD, WMD = − 0.38, 95%CI − 0.49–0.26, P < 0.001) and bone cement leakages (OR = 2.05, 95% CI 1.40–3.00, P < 0.001) increased the risk of SVCF. The results of subgroup analysis showed the occurrence of re-fracture was significantly associated with gender (P = 0.002), age (P = 0.001) and BMD (P < 0.001) in Eastern Asia. Compared with the unfractured group, anterior-to-posterior vertebral body height ratio (AP ratio, WMD = 0.06, 95%CI 0.00–0.12, P = 0.037) and visual analog scale score (VAS, WMD = 0.62, 95%CI 0.09–1.15, P = 0.022) were higher in the refracture group, and kyphotic angle correction ratio (Cobb ratio, WMD = − 0.72, 95%CI − 1.26–0.18, P = 0.008) was smaller in Eastern Asia. In addition, anti-osteoporosis treatment (OR = 0.40, 95% CI 0.27–0.60, P < 0.001) could be a protective factor. Conclusion The main factors associated with re-fracture after PVP/PKP are sex, age, bone mineral density, AP ratio, Cobb ratio, VAS score, bone cement leakage and anti-osteoporosis treatment, especially in Eastern Asia.
Collapse
|
9
|
Roux C, Cortet B, Bousson V, Thomas T. Vertebroplasty for osteoporotic vertebral fracture. RMD Open 2021; 7:rmdopen-2021-001655. [PMID: 34193518 PMCID: PMC8246346 DOI: 10.1136/rmdopen-2021-001655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/11/2021] [Indexed: 12/15/2022] Open
Abstract
Appropriate care of patients with a recent painful osteoporotic vertebral fracture (VF) requires immobilisation, analgesics and spinal orthoses. Some VFs are however responsible for disabling pain and prolonged bed rest. In this context, vertebroplasty techniques have been proposed with a large benefit in case series and open-label randomised studies, but lack efficacy in three among four double-blind randomised studies. The objectives of the treatment of a recent painful VF are to relieve pain and to preserve mechanical conditions. With this in mind, we report an experts’ opinion paper on the indications for vertebroplasty and research agenda for clinical studies.
Collapse
Affiliation(s)
- Christian Roux
- INSERM U1153, APHP.Centre-Université de Paris, Service de Rhumatologie, Hôpital Cochin, Paris, France
| | - Bernard Cortet
- Department of Rheumatology, ULR 4490, Université de Lille, Lille University Hospital, Lille, France
| | - Valérie Bousson
- Service de Radiologie Ostéo-Articulaire, APHP.Nord-Université de Paris, Hôpital Lariboisière, Paris, France
| | - Thierry Thomas
- Service de Rhumatologie, and INSERM U 1059, Université de Lyon-Université Jean Monnet, CHU de St-Etienne, Saint-Etienne, France
| |
Collapse
|
10
|
Zheng BW, Zou MX, Niu HQ, Zheng BY, Liu FS, Wang XB, Li J. Letter: A Retrospective Analysis in 1347 Patients Undergoing Cement Augmentation for Osteoporotic Vertebral Compression Fracture: Is the Sandwich Vertebra at a Higher Risk of Further Fracture? Neurosurgery 2021; 88:E562-E563. [PMID: 33733681 DOI: 10.1093/neuros/nyab067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bo-Wen Zheng
- Department of Spine Surgery The Second Xiangya Hospital Central South University Changsha, China
| | - Ming-Xiang Zou
- Department of Spine Surgery The Second Xiangya Hospital Central South University Changsha, China
| | - Hua-Qing Niu
- Department of Orthopedics Surgery General Hospital of the Central Theater Command Wuhan, China
| | - Bo-Yv Zheng
- Faculty of Medicine and Health The University of Sydney Sydney, Australia
| | - Fu-Sheng Liu
- Department of Spine Surgery The Second Xiangya Hospital Central South University Changsha, China
| | - Xiao-Bin Wang
- Department of Spine Surgery The Second Xiangya Hospital Central South University Changsha, China
| | - Jing Li
- Department of Spine Surgery The Second Xiangya Hospital Central South University Changsha, China
| |
Collapse
|
11
|
Lu K, Yin Y, Li C, Jin Y, Shan HQ. Efficacy of annual zoledronic acid in initial percutaneous kyphoplasty patients with osteoporotic vertebral compression fractures: a 3-year follow-up study. Osteoporos Int 2021; 32:1429-1439. [PMID: 33462653 DOI: 10.1007/s00198-020-05816-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/30/2020] [Indexed: 12/30/2022]
Abstract
UNLABELLED This study investigated the efficacy of annual zoledronic acid (ZOL) administration against previously treated recompression vertebral fractures (RVF) and new vertebral fractures (NVF) in initial percutaneous kyphoplasty (PKP) patients with osteoporotic vertebral compression fractures (OVCF) over a 3-year follow-up period. INTRODUCTION Although PKP achieves a satisfactory outcome, previously treated RVF and NVF can limit its effectiveness. The annual infusion of ZOL over 3 years can improve fracture protection, particularly in the vertebrae. We hypothesized that ZOL can reduce the incidence of RVFs and/or NVFs, and improve the clinical outcomes of PKP. METHODS This was a placebo-controlled, double-blind prospective trial of 154 PKP patients (mean age: 70 years) with OVCFs. Patients were randomly assigned to receive a single infusion of ZOL (5 mg) or placebo (78 ZOL vs. 76 placebo) at 1 week, 12 months, and 24 months after surgery. Patients were followed-up for 36 months. RESULTS ZOL treatment lowered the risk of RVF by ~ 65% over the 36-month period when compared to placebo controls (6.41% in ZOL vs. 18.42% in placebo groups; relative risk, 0.35; 95% CI, 0.13 to 0.92). ZOL also reduced the risk of NVF by ~ 73% (3.85% in ZOL vs. 14.47% in placebo groups; relative risk, 0.27; 95% CI, 0.08 to 0.92). ZOL also significantly reduced the vertebral height lost rate (HLR) at 12, 24, and 36 months. ZOL also improved the visual analog scale (VAS), Oswestry disability index (ODI) scores, and bone mineral density (BMD). CONCLUSION Annual ZOL administration significantly lowers the risk of RVFs and NVFs, improving the clinical outcome of initial PKP in patients with OVCFs over a 3-year follow-up period. TRIAL REGISTRATION ChiCTR2000029307.
Collapse
Affiliation(s)
- K Lu
- Department of Joint Surgery, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, 215300, Jiangsu, China
| | - Y Yin
- Department of Spinal Surgery, Affiliated Kunshan Hospital of Jiangsu University, No. 91 West of Qianjin Road, Suzhou, 215300, Jiangsu, China
| | - C Li
- Department of Orthopaedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, 215300, Jiangsu, China
| | - Y Jin
- Department of Spinal Surgery, Affiliated Kunshan Hospital of Jiangsu University, No. 91 West of Qianjin Road, Suzhou, 215300, Jiangsu, China
| | - H-Q Shan
- Department of Spinal Surgery, Affiliated Kunshan Hospital of Jiangsu University, No. 91 West of Qianjin Road, Suzhou, 215300, Jiangsu, China.
| |
Collapse
|
12
|
Arana-Guajardo AC, Cavazos-Aranda AL. Asymptomatic pulmonary embolism secondary to cement leakage after vertebroplasty. REUMATOLOGIA CLINICA 2021; 17:302-303. [PMID: 32265158 DOI: 10.1016/j.reuma.2019.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/12/2019] [Accepted: 11/25/2019] [Indexed: 10/24/2022]
Affiliation(s)
- Ana Cecilia Arana-Guajardo
- Servicio de Reumatología, Instituto de Medicina Interna, Escuela Nacional de Medicina Sistema Tec Salud, Monterrey, Nuevo León, México.
| | | |
Collapse
|
13
|
Li K, Gong H, Xie R, Gu J, Wang S, Lin C, Yin J, Hou X, Zhang Q, Li L, Hao Y. Clinical efficacy of zoledronic acid combined with percutaneous kyphoplasty in the prevention and treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25215. [PMID: 33787604 PMCID: PMC8021281 DOI: 10.1097/md.0000000000025215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/23/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE: The aim of this study is to investigate the clinical efficacy of zoledronic acid (ZOL) in the treatment and prevention of osteoporotic vertebral compression fractures (OVCF) after percutaneous kyphoplasty (PKP) for elderly patients. METHODS: The PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and Embase were investigated through June 2020. All randomized controlled trials (RCT) involving ZOL injections for OVCF were enrolled. Outcome indicators included the bone mineral density (BMD), Visual Analog Scale (VAS), recompression vertebral fracture (RVF), Oswestry Disability Index (ODI), and bone metabolism (Procollagen type I N-terminal propeptide [PINP] and βcross-linked C-telopeptide of type I collagen [β-CTX]), bone cement leakage. Review Manager 5.3 was used to analyze these indicators. RESULTS: In this study, (1).. Eight studies had met the eligibility criteria, a total of 578 participants were involved (285 and 293 in the experimental (ZOL) group and control [no ZOL] group, respectively). (2).. The BMD scores of patients with OVCF in the experimental group were significantly higher than that in the control group (P < .05). The VAS scores were significantly different between the 2 groups at the 6, 12 months follow-up (P < .05). After PKP operation, ZOL injections reduced the rate of RVF (P < .05). In the comparison of ODI scores, the experimental group improved compared with the control group (P < .05). Respectively, the bone metabolism of patients with OVCF after ZOL was better than that of patients in control group (P < .05). CONCLUSION: Zoledronic acid had a significant effect on the treatment and prevention of OVCF in elderly osteoporotic patients after PKP. Due to the limited quality and data, more high-quality studies are needed to confirm the results of this meta-analysis.
Collapse
Affiliation(s)
- Kaiming Li
- Wangjing Hospital of CACMS, Beijing 100102
| | - Hao Gong
- Beijing Changping Hospital of Intergrated Chinese And Western Medicine, Beijing 102208
| | - Rui Xie
- Wangjing Hospital of CACMS, Beijing 100102
| | - Jinyu Gu
- Wangjing Hospital of CACMS, Beijing 100102
| | | | | | - Jing Yin
- Wangjing Hospital of CACMS, Beijing 100102
| | | | - Qing Zhang
- Wangjing Hospital of CACMS, Beijing 100102
| | - Linghui Li
- Wangjing Hospital of CACMS, Beijing 100102
| | - Yanke Hao
- Affiliated Hospital of Shandong University of TCM, Jinan 250000, China
| |
Collapse
|
14
|
Li K, Feng H, Luo D, Zhang W, Yang K, Ji C, Liu J, Xu H. Efficacy and safety of high-viscosity cement in percutaneous vertebroplasty for treatment of Osteoporotic vertebral compression fractures: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e20515. [PMID: 32502000 PMCID: PMC7306342 DOI: 10.1097/md.0000000000020515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 03/30/2020] [Accepted: 04/26/2020] [Indexed: 11/26/2022] Open
Abstract
To evaluate the efficacy and safety of high viscosity bone cement in the percutaneous vertebroplasty (PVP) for treatment of single-level osteoporotic vertebral compression fractures.Eighty patients were enrolled in this study. All patients were received PVP, and they were divided into 2 groups according to the viscosity of bone cement, either high viscosity bone cement (HV group) or low viscosity cement (LV group). Oswestry Disability Index questionnaire and visual analog scale as clinical assessments were quantified. The operative time and injected bone cement volume were recorded. The anterior vertebral height (AVH) and bone cement leakage were evaluated in the radiograph.No significant difference was observed in the operative time. Both groups showed significant improvements in pain relief and functional capacity status (visual analog scale and Oswestry disability index scores) after surgery. Less bone cement volume was injected into the the injured vertebra in the HV group and statistical significance was found between both groups. In the HV group, there was lower leakage rate and less patients of severe leakage compared with the LV group. However, the correction of AVH showed no significant differences between the 2 groups and no significant loss of AVH was observed in 2 groups.High-viscosity and low-viscosity PVP have the similar effects in improving quality of life and relieving pain. There were lower cement leakage rate and less patients of severe leakage in the PVP with high-viscosity bone cement.
Collapse
Affiliation(s)
| | | | | | - Wen Zhang
- Department of Ultrasonography, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | | | | | | | - Hui Xu
- Department of Orthopaedics
| |
Collapse
|
15
|
Li Z, Yu K, Chang X, Cai S, Gao J, Wang Y. Cement leakage following percutaneous kyphoplasty in a patient after a posterior lumbar fusion: a case report. BMC Surg 2020; 20:74. [PMID: 32295591 PMCID: PMC7160912 DOI: 10.1186/s12893-020-00733-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 04/05/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Percutaneous kyphoplasty (PKP) has become an important minimally invasive surgical technique for fracture stabilization and pain relief in patients with vertebral compression fractures. However, intraspinal cement leakage following PKP is a serious postoperative complication that can lead to morbidity and mortality. CASE PRESENTATION We describe an uncommon case of epidural leakage of bone cement in an 81-year-old woman who underwent posterior lumbar decompression and fusion from L3-5 4 years prior and had an unremarkable postoperative course. The patient was admitted to Peking Union Medical College Hospital with complaints of muscle weakness and severe low back pain radiating to the left thigh 1 week after PKP of L5 due to an acute osteoporotic compression fracture. Computed tomographic imaging revealed massive leakage of cement into the spinal canal at L5-S1, and therefore, surgical decompression and removal of epidural cement were performed carefully without causing a dural tear. She improved remarkably and no neurologic deterioration was observed in the postoperative period during the one-year follow-up. CONCLUSIONS We present the rare reported case, to our knowledge, of epidural cement leakage after PKP at the segment of internal fixation and discuss the most likely etiologies and preventive measures for this condition.
Collapse
Affiliation(s)
- Ziquan Li
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Keyi Yu
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing, Dongcheng District, Beijing, 100730, China.
| | - Xiao Chang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Siyi Cai
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Jun Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Yipeng Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No. 1, Wangfujing, Dongcheng District, Beijing, 100730, China
| |
Collapse
|
16
|
Yin P, Li Z, Zhu S, Zhang Y, Su Q, Hai Y. The treatment of osteoporotic thoraco-lumbar burst fractures by unilateral percutaneous kyphoplasty: A prospective observation study. Eur J Pain 2020; 24:659-664. [PMID: 31782863 DOI: 10.1002/ejp.1516] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/02/2019] [Accepted: 11/23/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Osteoporotic thoraco-lumbar burst fractures with serious pain are very common, and the optimal treatment of burst fractures without any neurological deficits has not yet been properly codified. The objective of this study was to evaluate prospectively the clinical effects and pain relief of unilateral percutaneous kyphoplasty (PKP) on osteoporotic thoraco-lumbar burst fractures. METHODS Forty-six patients with osteoporotic thoraco-lumbar burst fractures were treated by PKP in our hospital from January 2016 to January 2017. The height of posterior wall (HPW), the height of anterior wall (HAW) and kyphotic angle (KA) were measured via x-ray radiographs before surgery, one day after surgery and at final follow-up. Visual analogue scale (VAS) score and the oswestry disability index (ODI) score were evaluated preoperatively, postoperatively and at final follow-up. All the patients with osteoporotic thoraco-lumbar burst fractures were treated by unilateral PKP. Radiological evaluation (anteroposterior and lateral x-ray radiographs and CT) was performed. RESULTS All patients were followed-up, and the mean follow-up was 28.8 ± 7.0 months. The preoperative HAW was 20.1 ± 2.3 mm, and the HAW was significantly improved to 22.9 ± 2.4 mm after operation (p < .05), and at the final follow-up, the HAW was 19.9 ± 2.1 mm, which was lower than the postoperative HAW. The HPW was also significantly corrected after surgery (p < .05). There were no significant differences between postoperative HPW and HPW at the final follow-up (p > .05). The KA was significantly corrected after operation (p < .05), but relapse occurred at the final follow-up, and at the final follow-up, the average of KA was 19.4 ± 1.6 degree. The VAS and ODI were significantly improved at the final follow-up compared to the preoperative period (p < .05). Cement leakage was found in eight patients, and adjacent vertebral fracture (VF) was found in two patients. CONCLUSIONS Our results showed that unilateral PKP acquired satisfactory treatment effect and pain relief in the management of osteoporotic thoraco-lumbar burst fractures. Meticulous evaluation of preoperative images and careful repetitious injection of cement are important to prevent cement leakage. SIGNIFICANCE Our present results showed that unilateral PKP was an effective method to obtain satisfactory pain relief in the management of osteoporotic thoraco-lumbar burst fractures. It may a good indication for the patients with osteoporotic thoraco-lumbar burst fractures, and the patients could not tolerate the serious acute pain by conservative treatment.
Collapse
Affiliation(s)
- Peng Yin
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, China
| | - Zhe Li
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, China
| | - Shiqi Zhu
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, China
| | - Yaoshen Zhang
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, China
| | - Qingjun Su
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, China
| |
Collapse
|
17
|
Martikos K, Greggi T, Vommaro F, Boriani L, Scarale A, Zarantonello P, Carbone G, Stallone S, Zucchini R. Vertebroplasty in the treatment of osteoporotic vertebral compression fractures: patient selection and perspectives. Open Access Rheumatol 2019; 11:157-161. [PMID: 31308767 PMCID: PMC6613358 DOI: 10.2147/oarrr.s174424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/14/2019] [Indexed: 11/23/2022] Open
Abstract
Osteoporotic vertebral fractures represent a constantly increasing pathology that may compromise life quality and general health. Among various treatment options, percutaneous vertebroplasty has been used widely over the past 20 years. Although there is a vast amount of retrospective reports in the literature, high-level evidence has emerged only recently. In this paper, the authors provide a synopsis of the current literature on the efficacy and safety of percutaneous vertebroplasty while also presenting a step-by-step description of the surgical procedure, focusing on details that may help in optimizing quality and safety.
Collapse
Affiliation(s)
- Konstantinos Martikos
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Tiziana Greggi
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Francesco Vommaro
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Luca Boriani
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Antonio Scarale
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Paola Zarantonello
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Giuseppe Carbone
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Stefano Stallone
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Riccardo Zucchini
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| |
Collapse
|
18
|
Girardo M, Zenga F, Bruno LL, Rava A, Massè A, Maule M, Fusini F. Treatment of Aggressive Vertebral Hemangiomas with Poly Vinyl Alcohol (PVA) Microparticles Embolization, PMMA, and Short Segment Stabilization: Preliminary Results with at Least 5 Years of Follow-up. World Neurosurg 2019; 128:e283-e288. [PMID: 31028979 DOI: 10.1016/j.wneu.2019.04.138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Vertebral hemangiomas (VHs) are the most common incidental lesions of vertebral body, but they are very challenging to treat if they become symptomatic. Several treatments have been proposed but none was superior to others. The aim of this study is to analyze blood loss and long-term clinical and neurological results of aggressive VHs treated with arterial embolization the day before operation, followed by vertebroplasty, posterior decompression, and short segment stabilization. METHODS Ten patients (4 males and 6 females) were treated for aggressive VHs with polyvinyl alcohol microparticles embolization, posterior short segment stabilization, and poly methyl methacrylate. Clinical and neurological outcomes were assessed with visual analog, Nurick, and American Spinal Injury Association (ASIA) scales. RESULTS At last follow-up mean, visual analog scale was 1.8 ± 1.3, with a significant difference with preoperative values (P = 0.00018). Neurological deficits persisted in 4 patients (ASIA scale: C in 1 patient [10%], D in 3 patients [30%]), but they improved from baseline in all cases. Also, Nurick scale rating improved in all patients (0 in 3 patients [30%], 1 in 4 patients [40%], 2 in 2 patients [20%], and 3 in the last one [10%]). A statistically significant difference between pre- and postoperative values was observed for both scores (ASIA, P = 0.0102; Nurick, P = 0.026). Relapse of pathology was recorded in 2 patients. CONCLUSIONS Polyvinyl alcohol microparticles embolization, short segment fixation, and vertebroplasty is an effective treatment option for aggressive VHs, with a fast surgical time, poor blood loss, and improvement of preoperative clinical and neurological outcomes.
Collapse
Affiliation(s)
- Massimo Girardo
- Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesco Zenga
- Department of Neurosurgery, Molinette Hospital, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Laura Lorien Bruno
- Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Alessandro Rava
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
| | - Alessandro Massè
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Milena Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| |
Collapse
|
19
|
Goda A, Morishima Y, Yokohara N, Suzuki T, Ohgi S, Mizushima T. Validity and Reliability of a 2-Min Walk Test to Assess the Exercise Capacity in Vertebral Compression Fracture Patients: A Pilot Study. Phys Ther Res 2019; 22:26-30. [PMID: 31289709 DOI: 10.1298/ptr.e9958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 11/27/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND The 2-min walk test (2MWT) may be a simple and easy measurement of exercise tolerance for vertebral compression fracture (VCF) patients. But, the validity and reliability of the 2MWT in patients with VCFs have not been verified. The aim of this pilot study was to investigate the validity and reliability of the 2MWT in VCF patients. METHODS Ten patients with VCFs were selected from the inpatient convalescence rehabilitation ward. These patients were required to walk for a minimum of 6 minutes. The study was conducted over three test days. On the first and second test days, the participants completed one trial of the 2MWT each day. These data were used in the analyses for an intra-class correlation coefficient (ICC [1,1]). On the third test day, participants completed the 6-min walk test (6MWT). These data assessed the construct validity of the 2MWT. Participants completed testing on 3 days within a 5-day period. RESULTS A significant correlation was found between the 2MWT and the 6MWT (r=0.945; p<0.05), which suggested a high construct validity of the 2MWT. The intraclass correlation coefficient of the repeated 2MWTs was high (ICC=0.98; p<0.05), intimating that it had a high test-retest reliability. CONCLUSION The 2MWT is a valid test for the assessment of exercise capacity in patients with VCFs. It is practical, simple, and well tolerated by patients with VCFs.
Collapse
Affiliation(s)
- Akio Goda
- Department of Physical Therapy, Faculty of Health Science, Kyoto Tachibana University
| | | | | | | | - Shohei Ohgi
- Division of Rehabilitation Science, Seirei Christopher University Graduate School
| | - Takashi Mizushima
- Department of Rehabilitation, Hamamatsu University School of Medicine, University Hospital
| |
Collapse
|
20
|
Qi Y, Zeng Y, Jiang C, Liang B, Sui J, Zhao L, Wang D. Comparison of Percutaneous Kyphoplasty Versus Modified Percutaneous Kyphoplasty for Treatment of Osteoporotic Vertebral Compression Fractures. World Neurosurg 2019; 122:e1020-e1027. [DOI: 10.1016/j.wneu.2018.10.205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
|
21
|
Croissant Y, Zangos S, Albrecht MH, Eichler K, Schomerus C, Spandorfer A, Schoepf UJ, Vogl TJ, Czerny C. Robot-assisted percutaneous placement of K-wires during minimally invasive interventions of the spine. MINIM INVASIV THER 2018; 28:373-380. [PMID: 30428741 DOI: 10.1080/13645706.2018.1544567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose: To assess the accuracy and time requirements of image-guided percutaneous K-wire insertion in the spine using an advanced robot assistance device for needle guidance and to demonstrate a radiation-free workflow for the physician. Material and methods: A planning CT-scan was acquired of a cadaver specimen and analyzed using a 3D-interventional software integrated in the robotic device. The optimal needle path was simulated and the needle holder of the robot was used for guidance during K-wire insertion. Twenty-four K-wires were inserted percutaneously in a transpedicular approach in the following vertebrae: thoracic (T) 2, 7-12 and lumbar (L) 1-5. A post-procedural CT scan was performed to analyze the accuracy of the K-wire insertion. Results: All procedures were carried out without any perforation of the pedicle wall. The mean duration of planning the intervention path was 2:54 ± 2:22 min, mean positioning time was 2:04 ± 0:42 min and the mean time for K-wire insertion was 2:13 ± 0:54 min. In total, the average intervention time was 7:10 ± 3:06 min per pedicle. Compared to the planning, the K-wire position showed a mean deviation of 0.5 mm in the vertical-axis and 1.2 mm in the horizontal-axis. The average intervention path length was 8.1 cm. Conclusion: Our findings show a high accuracy in robot-assisted K-wire insertion during spinal interventions without any exposure of the operator to radiation.
Collapse
Affiliation(s)
- Yann Croissant
- Department of Orthopedic and Trauma Surgery, St Josefs-Hospital Wiesbaden, Wiesbaden, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stephan Zangos
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Moritz H Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Katrin Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christof Schomerus
- Institute of Anatomy, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Adam Spandorfer
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston SC, United States
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston SC, United States
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christoph Czerny
- Department of Trauma Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
22
|
Li HM, Zhang RJ, Gao H, Jia CY, Zhang JX, Dong FL, Shen CL. New vertebral fractures after osteoporotic vertebral compression fracture between balloon kyphoplasty and nonsurgical treatment PRISMA. Medicine (Baltimore) 2018; 97:e12666. [PMID: 30290650 PMCID: PMC6200511 DOI: 10.1097/md.0000000000012666] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Because of aging of population, osteoporotic vertebral compression fracture (OVCF) appears an increasing incidence rate. Conservative therapy (CT) and balloon kyphoplasty (BKP) have been used to treat OVCFs. However, an increase in new vertebral compression fractures at nontreated levels following BKP is of concern. It is still not clear whether new fractures were a result of BKP and the purpose of this meta-analysis was to evaluate the new fractures risk after BKP compared with CT. METHODS An exhaustive literature search of PubMed, EMBASE, and the Cochrane Library was conducted to identify randomized controlled trials and prospective nonrandomized controlled study that compared BKP with CT for patients suffering OVCF. A random-effect model was used. Results were reported as standardized mean difference or risk ratio with 95% confidence interval. RESULTS Twelve studies were included and there was no significant difference in total new fractures (P = .33) and adjacent fractures (P = .83) between 2 treatments. Subgroup analyses did not demonstrate significant differences in follow-up period, mean age, anti-osteoporosis therapy, and the proportion of women. CONCLUSION Our systematic review revealed that an increased risk of fracture of vertebral bodies was not associated with BKP compared with CT.
Collapse
Affiliation(s)
- Hui-Min Li
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Anhui
| | - Ren-Jie Zhang
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Anhui
| | - Hai Gao
- Department of Orthopedics, the First Affiliated Hospital of USTC (AnHui Provincial Hospital), China
| | - Chong-Yu Jia
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Anhui
| | - Jian-Xiang Zhang
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Anhui
| | - Fu-Long Dong
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Anhui
| | - Cai-Liang Shen
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Anhui
| |
Collapse
|
23
|
Gao C, Zong M, Wang WT, Xu L, Cao D, Zou YF. Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Acta Radiol 2018; 59:577-585. [PMID: 28782368 DOI: 10.1177/0284185117725368] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Percutaneous kyphoplasty (PKP) is a common treatment modality for painful osteoporotic vertebral compression fractures (OVCFs). Pre- and postoperative identification of risk factors for cement leakage and follow-up complications would therefore be helpful but has not been systematically investigated. Purpose To evaluate pre- and postoperative risk factors for the occurrence of short-term cement leakages and long-term complications after PKP for OVCFs. Material and Methods A total of 283 vertebrae with PKP in 239 patients were investigated. Possible risk factors causing cement leakage and complications during follow-up periods were retrospectively assessed using multivariate analysis. Cement leakage in general, three fundamental leakage types, and complications during follow-up period were directly identified through postoperative computed tomography (CT). Results Generally, the presence of cortical disruption ( P = 0.001), large volume of cement ( P = 0.012), and low bone mineral density (BMD) ( P = 0.002) were three strong predictors for cement leakage. While the presence of intravertebral cleft and Schmorl nodes ( P = 0.045 and 0.025, respectively) were respectively identified as additional risk factors for paravertebral and intradiscal subtype of cortical (C-type) leakages. In terms of follow-up complications, occurrence of cortical leakage was a strong risk factor both for new VCFs ( P = 0.043) and for recompression ( P = 0.004). Conclusion The presence of cortical disruption, large volume of cement, and low BMD of treated level are general but strong predictors for cement leakage. The presence of intravertebral cleft and Schmorl nodes are additional risk factors for cortical leakage. During follow-up, the occurrence of C-type leakage is a strong risk factor, for both new VCFs and recompression.
Collapse
Affiliation(s)
- Chang Gao
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Min Zong
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Wen-tao Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Lei Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Da Cao
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Yue-fen Zou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| |
Collapse
|
24
|
Leschinger T, Engel K, Brüggemann GP, Dederer V, Neiss WF, Scheyerer MJ, Müller LP, Wegmann K. Glass -polyalkenoate cement: An alternative material for kyphoplasty in osteoporotic vertebral compression fractures - An ex vivo study. J Mech Behav Biomed Mater 2018; 83:46-51. [PMID: 29677554 DOI: 10.1016/j.jmbbm.2018.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 02/27/2018] [Accepted: 03/05/2018] [Indexed: 12/27/2022]
Abstract
Adjacent vertebral body fracture is described as a risk after vertebroplasty and kyphoplasty. It may be true that this phenomenon is caused precisely because of the frequently used polymethylmethacrylate cement (PMMA), which shows a higher level of stiffness than bone material and may ultimately lead to shifting stress levels within the entire spine. The goal of the present study was to evaluate and compare the pressure distribution in the endplate of human vertebrae after kyphoplasty with PMMA and aluminum-free glass-polyalkenoate cement (gpc). For the present study, 8 fresh frozen human cadaveric vertebral bodies from the thoracolumbar junction were used. All vertebrae were augmented transpedicularly on one side with gpc and on the other side with PMMA. A loading of 600 N, 800 N and 1000 N was applied. In the data processing an individual region of interest (roi) was generated for each vertebra. The following parameters were determined for each roi: maximum force [N], maximum pressure [kPa], mean pressure [kPa], roi area [cm2]. We found significantly higher mean pressure values in the areas of the vertebrae augmented with PMMA, compared to the ones after augmentation with gpc (p = 0.012) when applying 1000 N. In the groups with lower forces there were no statistical relevant differences. The pressure distribution shows an advantage for gpc. A material, which does not create load concentration onto the cranial and caudal vertebral surface, could have major advantages concerning the risk of adjacent vertebral fractures. Thus the results of the 1000 N loading protocol suggest gpc being a possible alternative to ordinary PMMA cement, regarding its influence on stiffness in kyphoplasty. These and other general aspects like incorporation should be addressed and elaborated more detailed in further studies.
Collapse
Affiliation(s)
- Tim Leschinger
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany.
| | - Karsten Engel
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Gert Peter Brüggemann
- Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany; Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Viktoria Dederer
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
| | | | - Max Joseph Scheyerer
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Lars Peter Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
| |
Collapse
|
25
|
Wang X, Tan L, Lin X, Wu C, Zeng J, Hu H. [Photoelectric guided navigation unilateral puncture of the percutaneous kyphoplasty in treatment of thoracolumbar osteoporotic vertebral compression fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:203-209. [PMID: 29806413 PMCID: PMC8414082 DOI: 10.7507/1002-1892.201709115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/26/2017] [Indexed: 12/15/2022]
Abstract
Objective To evaluate the safety of photoelectric guided navigation unilateral puncture of the percutaneous kyphoplasty (PKP) in the treatment of thoracolumbar osteoporotic vertebral compression fracture (OVCF). Methods A randomized controlled clinical research was performed between June 2015 and January 2017. Eighty-five cases of OVCF were treated with photoelectric guided navigation unilateral puncture of the PKP (trial group, 43 cases) or C arm fluoroscopy unilateral puncture of the PKP (control group, 42 cases) respectively. There was no significant difference in gender, age, disease duration, segmental fracture, AO classification, bone mineral density, and preoperative visual analogue scale (VAS) score between 2 groups ( P>0.05). The concordance rate of puncture path and design path, the incidence of pedicle wall breaking, the incidence of bone cement leakage, and the rate of bone cement distribution center were observed and calculated on postoperative CT images; the intraoperative X-ray exposure frequency, frequency of puncture, operation time, VAS scores before operation and at 2 days after operation, and postoperative blood vessel or nerve injury were recorded and compared. Results The intraoperative X-ray exposure frequency and puncture frequency in trial group were significantly less than those in control group ( P<0.05), but there was no significant difference in operation time between 2 groups ( t=0.440, P=0.661). The VAS scores of 2 groups at 2 days after operation were significantly improved when compared with preoperative ones ( P<0.05), but there was no significant difference in VAS score at 2 days after operation between 2 groups ( t=0.406, P=0.685). All the patients were followed up 6-18 months (mean, 10 months). No blood vessel or nerve injury occurred in 2 groups. The incidence of pedicle wall breaking, the incidence of bone cement leakage, the concordance rate of puncture path and design path, and the rate of bone cement distribution center in trial group were 2.33% (1/43), 2.33% (1/43), 86.05% (37/43), and 88.37% (38/43) respectively, all showing significant differences when compared with those of control group [19.05% (8/42), 21.43% (9/42), 45.24% (19/42), and 50.00% (21/42) respectively] ( P<0.05). Conclusion Intraoperative photoelectric guided navigation unilateral puncture of the PKP can improve the success rate of target puncture and reduce the incidence of pedicle wall breaking effectively, and achieve better bone cement distribution and better security.
Collapse
Affiliation(s)
- Xiangyu Wang
- Departmen of Orthopedics, the Fourth People's Hospital of Zigong, Zigong Sichuan, 643000, P.R.China;Southwest Medical University, Luzhou Sichuan, 646000, P.R.China
| | - Lun Tan
- Departmen of Orthopedics, the Fourth People's Hospital of Zigong, Zigong Sichuan, 643000,
| | - Xu Lin
- Departmen of Orthopedics, the Fourth People's Hospital of Zigong, Zigong Sichuan, 643000, P.R.China
| | - Chao Wu
- Departmen of Orthopedics, the Fourth People's Hospital of Zigong, Zigong Sichuan, 643000, P.R.China
| | - Jun Zeng
- Departmen of Orthopedics, the Fourth People's Hospital of Zigong, Zigong Sichuan, 643000, P.R.China
| | - Haigang Hu
- Departmen of Orthopedics, the Fourth People's Hospital of Zigong, Zigong Sichuan, 643000, P.R.China
| |
Collapse
|
26
|
Reeves RA, DeWolf MC, Shaughnessy PJ, Ames JB, Henderson ER. Use of minimally invasive spine surgical instruments for the treatment of bone tumors. Expert Rev Med Devices 2017; 14:881-890. [PMID: 28958177 DOI: 10.1080/17434440.2017.1386549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Orthopedic oncologists often encounter patients with minor bony lesions that are difficult to access surgically and therefore require large exposures out of proportion to the severity of disease that confer significant patient morbidity. Minimally invasive surgical techniques offer the advantage of smaller incisions, shorter operative times, decreased tissue damage, and decreased costs. A variety of surgical procedures have emerged using minimally invasive technologies, particularly in the field of spine surgery. Areas covered: In this article, we describe the Minimal Exposure Tubular Retractor (METRxTM) System which is a minimally invasive surgical device that utilizes a series of dilators to permit access to a surgical site of interest. This system was developed for use in treatment of disc herniation, spinal stenosis, posterior lumbar interbody fusion, transforaminal lumbar interbody fusion and spinal cord stimulation implantation. We also describe novel uses of this system for minimally invasive biopsy and treatment of benign and metastatic bone lesions at our institution. Expert commentary: Minimally invasive surgical techniques will continue to expand into the field of orthopedic oncology. With a greater number of studies proving the safety and effectiveness of this technique, the demand for minimally invasive treatments will grow.
Collapse
Affiliation(s)
- Russell A Reeves
- a Department of Medical Education , Geisel School of Medicine at Dartmouth , Hanover , NH , USA
| | - Matthew C DeWolf
- b Department of Orthopedic Surgery , Dartmouth Hitchcock Medical Center , Lebanon , NH , USA
| | - Peter J Shaughnessy
- b Department of Orthopedic Surgery , Dartmouth Hitchcock Medical Center , Lebanon , NH , USA
| | - James B Ames
- b Department of Orthopedic Surgery , Dartmouth Hitchcock Medical Center , Lebanon , NH , USA
| | - Eric R Henderson
- b Department of Orthopedic Surgery , Dartmouth Hitchcock Medical Center , Lebanon , NH , USA
| |
Collapse
|
27
|
Liu B, Gan F, Ge Y, Yu H. Clinical Efficacy Analysis of Percutaneous Kyphoplasty Combined with Zoledronic Acid in the Treatment and Prevention of Osteoporotic Vertebral Compression Fractures. J INVEST SURG 2017; 31:425-430. [PMID: 28829670 DOI: 10.1080/08941939.2017.1339151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Bin Liu
- Department of Orthopaedics, Fuyang People's Hospital, Fuyang, Anhui Province, China
| | - Fusheng Gan
- Department of Orthopaedics, Fuyang People's Hospital, Fuyang, Anhui Province, China
| | - Yu Ge
- Department of Orthopaedics, Fuyang People's Hospital, Fuyang, Anhui Province, China
| | - Haiyang Yu
- Department of Orthopaedics, Fuyang People's Hospital, Fuyang, Anhui Province, China
| |
Collapse
|
28
|
Zhou T, Lin H, Wang H, Chen X, He F. Comparative study on the biomechanics between improved PVP and traditional PKP in the treatment of vertebral peripheral wall damage-type OVCF. Exp Ther Med 2017; 14:575-580. [PMID: 28672969 PMCID: PMC5488447 DOI: 10.3892/etm.2017.4542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/24/2017] [Indexed: 11/06/2022] Open
Abstract
We compared the biomechanics between improved percutaneous vertebroplasty (improved PVP) and traditional percutaneous kyphoplasty (PKP) in the treatment of vertebral peripheral wall damage-type osteoporotic vertebral compression fracture (OVCF). A total of 15 vertebral peripheral wall damage-type OVCF models of new calves (12-14 weeks) were treated with a decalcifying agent (Shandon TBD-1) with the vertebral compression fracture. The vertebral volume and anterior height before modeling, and the vertebral BMD before and after modeling were measured. The models were randomly divided into three groups: the improved PVP group (Group A), the traditional PKP group (Group B) and the control group (Group C). BMD of Groups A, B and C after decalcification was significantly lower than that before decalcification (P<0.05). There were no significant differences in BMD before and after decalcification among Groups A, B and C (P>0.05). There was no significant difference in the initial strength and stiffness among the three groups (P>0.05). The postoperative strength of Groups A and B was 1.036±300 and 1.045±200 N, respectively, which was significantly higher than the initial strength (P<0.05). The postoperative stiffness of Groups A and B was 395±250 and 470±270 N/mm, respectively, which was slightly lower than the initial stiffness, however, the differences were not statistically significant (P>0.05). In the comparison of postoperative strength and stiffness between Groups A and B, the postoperative strength in Group A was lower than that in Group B; differences were not statistically significant (P>0.05); there was no significant difference in the postoperative stiffness between Groups A and B (P>0.05). There were no significant differences of injection of bone cement between the two groups (P>0.05). Therefore, an improved PVP can basically realize the curative effects of traditional PKP in the treatment of vertebral peripheral wall damage-type OVCF, which can be used as clinical reference.
Collapse
Affiliation(s)
- Tao Zhou
- Department of Orthopaedics, The People's Hospital of Maanshan, Maanshan, Anhui 243000, P.R. China
| | - Hao Lin
- Clinical College of Maanshan, Anhui Medical University, Maanshan, Anhui 243000, P.R. China
| | - Hongliang Wang
- Department of Orthopaedics, The People's Hospital of Maanshan, Maanshan, Anhui 243000, P.R. China
| | - Xiaoqiang Chen
- Department of Orthopaedics, The People's Hospital of Maanshan, Maanshan, Anhui 243000, P.R. China
| | - Fang He
- Clinical College of Maanshan, Anhui Medical University, Maanshan, Anhui 243000, P.R. China
| |
Collapse
|
29
|
Risk Factors for Cement Leakage After Vertebroplasty or Kyphoplasty: A Meta-Analysis of Published Evidence. World Neurosurg 2017; 101:633-642. [DOI: 10.1016/j.wneu.2017.01.124] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 12/13/2022]
|
30
|
Lamy O, Gonzalez-Rodriguez E, Stoll D, Hans D, Aubry-Rozier B. Severe Rebound-Associated Vertebral Fractures After Denosumab Discontinuation: 9 Clinical Cases Report. J Clin Endocrinol Metab 2017; 102:354-358. [PMID: 27732330 DOI: 10.1210/jc.2016-3170] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/06/2016] [Indexed: 02/10/2023]
Abstract
CONTEXT Denosumab inhibits bone resorption, increases bone mineral density, and reduces fracture risk. Denosumab was approved for the treatment of osteoporosis and the prevention of bone loss in some oncological situations. Denosumab discontinuation is associated with a severe bone turnover rebound (BTR) and a rapid loss of bone mineral density. The clinical consequences of the BTR observed after denosumab discontinuation are not known. CASES DESCRIPTION We report 9 women who presented 50 rebound-associated vertebral fractures (RAVFs) after denosumab discontinuation. A broad biological and radiological assessment excluded other causes than osteoporosis. These 9 cases are unusual and disturbing for several reasons. First, all vertebral fractures (VFs) were spontaneous, and most patients had a high number of VFs (mean = 5.5) in a short period of time. Second, the fracture risk was low for most of these women. Third, their VFs occurred rapidly after last denosumab injection (9-16 months). Fourth, vertebroplasty was associated with a high number of new VFs. All the observed VFs seem to be related to denosumab discontinuation and unlikely to the underlying osteoporosis or osteopenia. We hypothesize that the severe BTR is involved in microdamage accumulation in trabecular bone and thus promotes VFs. CONCLUSION Studies are urgently needed to determine 1) the pathophysiological processes involved, 2) the clinical profile of patients at risk for RAVFs, and 3) the management and/or treatment regimens after denosumab discontinuation. Health authorities, physicians, and patients must be aware of this RAVF risk. Denosumab injections must be scrupulously done every 6 months but not indefinitely.
Collapse
Affiliation(s)
- Olivier Lamy
- Bone Unit, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | | | - Delphine Stoll
- Bone Unit, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Didier Hans
- Bone Unit, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | | |
Collapse
|
31
|
Behrbalk E, Uri O, Folman Y, Rickert M, Kaiser R, Boszczyk BM. Staged Correction of Severe Thoracic Kyphosis in Patients with Multilevel Osteoporotic Vertebral Compression Fractures. Global Spine J 2016; 6:710-720. [PMID: 27781192 PMCID: PMC5077718 DOI: 10.1055/s-0035-1569460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 10/05/2015] [Indexed: 12/12/2022] Open
Abstract
Study Design Technical report. Objective Multilevel osteoporotic vertebral compression fractures may lead to considerable thoracic deformity and sagittal imbalance, which may necessitate surgical intervention. Correction of advanced thoracic kyphosis in patients with severe osteoporosis remains challenging, with a high rate of failure. This study describes a surgical technique of staged vertebral augmentation with osteotomies for the treatment of advanced thoracic kyphosis in patients with osteoporotic multilevel vertebral compression fractures. Methods Five patients (average age 62 ± 6 years) with multilevel osteoporotic vertebral compression fractures and severe symptomatic thoracic kyphosis underwent staged vertebral augmentation and surgical correction of their sagittal deformity. Clinical and radiographic outcomes were assessed retrospectively at a mean postoperative follow-up of 34 months. Results Patients' self-reported back pain decreased from 7.2 ± 0.8 to 3.0 ± 0.7 (0 to 10 numerical scale; p < 0.001). Patients' back-related disability decreased from 60 ± 10% to 29 ± 10% (0 to 100% Oswestry Disability Index; p < 0.001). Thoracic kyphosis was corrected from 89 ± 5 degrees to 40 ± 4 degrees (p < 0.001), and the sagittal vertical axis was corrected from 112 ± 83 mm to 38 ± 23 mm (p = 0.058). One patient had cement leakage without subsequent neurologic deficit. Decreased blood pressure was observed in another patient during the cement injection. No correction loss, hardware failure, or neurologic deficiency was seen in the other patients. Conclusion The surgical technique described here, despite its complexity, may offer a safe and effective method for the treatment of advanced thoracic kyphosis in patients with osteoporotic multilevel vertebral compression fractures.
Collapse
Affiliation(s)
- Eyal Behrbalk
- The Spine Unit, Hillel-Yaffe Medical Center, Hadera, Israel,Address for correspondence Dr. Eyal Behrbalk The Spine Unit, Hillel-Yaffe Medical CenterHa-Shalom Street, Hadera, 38100Israel
| | - Ofir Uri
- The Spine Unit, Hillel-Yaffe Medical Center, Hadera, Israel
| | - Yoram Folman
- The Spine Unit, Hillel-Yaffe Medical Center, Hadera, Israel
| | - Marcus Rickert
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Radek Kaiser
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, United Kingdom
| | | |
Collapse
|
32
|
Song D, Meng B, Chen G, Niu J, Jiang W, Luo Z, Yang H. Secondary balloon kyphoplasty for new vertebral compression fracture after initial single-level balloon kyphoplasty for osteoporotic vertebral compression fracture. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1842-1851. [PMID: 27770334 DOI: 10.1007/s00586-016-4784-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 08/15/2016] [Accepted: 09/16/2016] [Indexed: 01/25/2023]
Abstract
PURPOSE To explore the efficacy of secondary balloon kyphoplasty (BKP) for new vertebral compression fracture (NVCF) of previously non-fractured, non-treated vertebrae after previous BKP and to compare the therapeutic effect between patients with single-level adjacent NVCF and remote NVCF. METHODS We retrospectively studied patients with single-level NVCF after initial BKP in our hospital from January 2007 to August 2014. The mean follow-up time from secondary BKP was 13.78 ± 3.18 (12-24) months. Visual analog scale (VAS) and Oswestry disability index (ODI) scores were assessed prior to the initial BKP, one day after initial BKP, prior to the secondary BKP, one day after the secondary BKP, and at last follow-up. Kyphotic angle and vertebral heights were also compared for secondary BKP. Data were compared between patients with adjacent NVCF and remote NVCF. RESULTS 36 patients were investigated. Compared with pre-operative value of initial and secondary BKP, patients in both groups gained statistical significant improvements for VAS and ODI after initial and secondary BKP, respectively (P < 0.05), and this improvement maintained at final follow-up. No statistical difference in VAS was found between the 2 groups after initial BKP and prior to the secondary BKP (P > 0.05), but patients in remote NVCF group achieved better VAS score than patients in adjacent NVCF group after the secondary BKP and at the final follow-up (P < 0.05). No statistical differences were detected in ODI between the 2 groups prior to the initial BKP, one day after initial BKP, prior to the secondary BKP and 1 day after the secondary BKP (P > 0.05), but the ODI scores were higher in adjacent NVCF group than in remote NVCF at last follow-up (P < 0.05). Kyphotic angle and vertebral heights were significantly restored and maintained after secondary BKP within groups, respectively. CONCLUSIONS Secondary BKP is an effective procedure for treating NVCF after initial BKP. Patients with new fracture in remote level gain slightly better pain relief than those in the adjacent level.
Collapse
Affiliation(s)
- Dawei Song
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, No.188, Shizi Street, Suzhou, 86-215006, Jiangsu, China
| | - Bin Meng
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, No.188, Shizi Street, Suzhou, 86-215006, Jiangsu, China
| | - Guangdong Chen
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, No.188, Shizi Street, Suzhou, 86-215006, Jiangsu, China
| | - Junjie Niu
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, No.188, Shizi Street, Suzhou, 86-215006, Jiangsu, China
| | - Weimin Jiang
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, No.188, Shizi Street, Suzhou, 86-215006, Jiangsu, China
| | - Zongping Luo
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, No.188, Shizi Street, Suzhou, 86-215006, Jiangsu, China.
| | - Huilin Yang
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, No.188, Shizi Street, Suzhou, 86-215006, Jiangsu, China.
| |
Collapse
|
33
|
Yuan WH, Hsu HC, Lai KL. Vertebroplasty and balloon kyphoplasty versus conservative treatment for osteoporotic vertebral compression fractures: A meta-analysis. Medicine (Baltimore) 2016; 95:e4491. [PMID: 27495096 PMCID: PMC4979850 DOI: 10.1097/md.0000000000004491] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Although the majority of available evidence suggests that vertebroplasty and kyphoplasty can relieve pain associated with vertebral compression fractures (VCFs) and improve function, some studies have suggested results are similar to those of placebo. The purpose of this meta-analysis was to compare the outcomes of vertebroplasty and kyphoplasty with conservative treatment in patients with osteoporotic VCFs. METHODS Medline, Cochrane, and Embase databases were searched until January 31, 2015 using the keywords: vertebroplasty, kyphoplasty, compression fracture, osteoporotic, and osteoporosis. Inclusion criteria were randomized controlled trials (RCTs) in which patients with osteoporosis, and VCFs were treated with vertebroplasty/kyphoplasty or conservative management. Outcome measures were pain, function, and quality of life. Standardized differences in means were calculated as a measure of effect size. MAIN RESULTS Ten RCTs were included. The total number of patients in the treatment and control groups was 626 and 628, respectively, the mean patient age ranged from 64 to 80 years, and the majority was female. Vertebroplasty/kyphoplasty was associated with greater pain relief (pooled standardized difference in means = 0.82, 95% confidence interval [CI]: 0.374-1.266, P < 0.001) and a significant improvement in daily function (pooled standardized difference in means = 1.273, 95% CI: 1.028-1.518, P < 0.001) as compared with conservative treatment. The pooled estimate indicated vertebroplasty/kyphoplasty was associated with higher quality of life (pooled standardized difference in means = 1.545, 95% CI: 1.293-1.798, P < 0.001). Subgroup analysis of 8 vertebroplasty studies and 2 kyphoplasty studies that reported pain data, however, indicated that vertebroplasty provided greater pain relief than conservative treatment but kyphoplasty did not. CONCLUSION Vertebroplasty may provide better pain relief than balloon kyphoplasty in patients with osteoporotic VCFs, both may improve function, and their effect on quality of life is less clear.
Collapse
Affiliation(s)
- Wei-Hsin Yuan
- Division of Radiology, Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital)
- School of Medicine, National Yang Ming University
- Department of Radiology, Taipei Veterans General Hospital
- Correspondence: Wei-Hsin Yuan, Division of Radiology, Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), No.12, 225 Lane, Zhi-Sing Road, Taipei 11260 Taiwan ROC (e-mail: )
| | - Hui-Chen Hsu
- Medical Imaging Department, Taipei Beitou Health Management Hospital
| | - Kaun-Lin Lai
- School of Medicine, National Yang Ming University
- Department of Neurology, Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan, ROC
| |
Collapse
|
34
|
Noriega DC, Ramajo RH, Lite IS, Toribio B, Corredera R, Ardura F, Krüger A. Safety and clinical performance of kyphoplasty and SpineJack(®) procedures in the treatment of osteoporotic vertebral compression fractures: a pilot, monocentric, investigator-initiated study. Osteoporos Int 2016; 27:2047-55. [PMID: 26856586 DOI: 10.1007/s00198-016-3494-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 01/14/2016] [Indexed: 12/27/2022]
Abstract
UNLABELLED Clinical performance and safety of two percutaneous vertebral cement augmentation (VA) procedures (SpineJack® and Kyphx Xpander® balloon) were compared in patients with osteoporotic compression fractures. Both techniques were safe, efficient, and led to a rapid and marked improvement in clinical signs; nevertheless, SpineJack showed better restoration of vertebral heights and angles, maintained over time. INTRODUCTION In patients with osteoporotic vertebral compression fractures (VCFs), both SpineJack® (SJ) and balloon kyphoplasty (BKP) led to a rapid and marked improvement in clinical signs. This pilot, monocentric, investigator-initiated, prospective study aimed to compare two percutaneous vertebral augmentation procedures in the painful osteoporotic VCF treatment. METHODS Thirty patients were randomized to receive SJ (n = 15) or BKP (n = 15). Analgesic consumption, back pain intensity (visual analog scale (VAS)), and Oswestry Disability Index (ODI) scores were recorded preoperatively, at 5 days and 1, 3, 6, and 12 months post-surgery. Quality of life (EQ-VAS score) was evaluated at 1, 3, 6, and 12 months. Spine X-rays were taken 48 h prior to procedure and 5 days and 6 and 12 months after. RESULTS SpineJack® led to a significantly shorter intervention period (23 vs 32 min; p < 0.001), a strong, rapid, and long-lasting decline in pain (94 vs 82 % at 12 months) and in functional disability (94 vs 90 % at 12 months), a greater and sustainable mean correction of anterior (12 ± 13 vs 0 ± 7 % for BKP, p = 0.003) and central height (12 ± 10 vs 2 ± 6 % for BKP, p = 0.001) at 12 months, and a larger restoration of the vertebral body angle still evident 12 months after implantation (-4.4° ± 5.8° vs 0.2° ± 3.0° for BKP; p = 0.012). CONCLUSIONS This pilot study showed that both techniques were safe and efficient for the osteoporotic VCF treatment. Radiological results indicate that the SpineJack® procedure has a higher potential for vertebral body height restoration and maintenance over time.
Collapse
Affiliation(s)
- D C Noriega
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008, Valladolid, Spain.
| | - R H Ramajo
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008, Valladolid, Spain
| | - I S Lite
- Servicio de Radiología, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008, Valladolid, Spain
| | - B Toribio
- Servicio de Radiología, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008, Valladolid, Spain
| | - R Corredera
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008, Valladolid, Spain
| | - F Ardura
- Unidad de Columna, Servicio Cirugía Ortopédica, Hospital Clínico Universitario de Valladolid, Calle Ramón y Cajal, 47008, Valladolid, Spain
| | - A Krüger
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Baldingerstraße, 35043, Marburg, Germany
| |
Collapse
|
35
|
An evaluation of the functional and radiological results of percutaneous vertebroplasty versus conservative treatment for acute symptomatic osteoporotic spinal fractures. Injury 2016; 47:865-71. [PMID: 26922648 DOI: 10.1016/j.injury.2016.01.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/29/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to compare the results of the two different treatment regimens (percutaneous vertebroplasty (PV) and conservative treatment (CT)) regarding to efficacy, quality of life, functional and radiological results in patients with acute osteoporotic vertebral compression fractures (OVF). METHODS The study comprised 83 patients who presented with complaints of OVF associated with osteoporosis and were treated with CT (37) or PV (46). All patients were evaluated according to preoperative and postoperative visual analogue scale (VAS), Oswestry disability index (ODI) and plain radiographs. RESULTS All patients in VP group reported a significant decrease in pain at 1st day postoperative. While Pain relief and functional outcomes were significantly better in PV group than CT at 1st and 3rd months according to VAS and ODI scores, there were no statistically significant differences between the groups at 6th months follow-up. The mean preoperative local sagittal Cobb angle (LSCA) and the mean vertebra corpus mid-level height (MVCH) were 42.3° and 14.6 mm in the PV group, while they were measured as 39.8° and 15.7 mm in CT group, respectively. 15.6° decreasing the LSCA and 10.2 mm increasing MVCH were noted in the PV group at the 6th month follow-up. While LSCA increased 19.1° and MVCH decreased 7.6mm in CT group at same time period (p<0.001). CONCLUSIONS Compared to the CT group, PV provides a rapid decrease of pain and an early return to daily life activities. Although improvement was observed on the radiological findings following treatment in the PV group, PV may not enhance the quality of life in patients with acute OVF at 6th months follow up.
Collapse
|
36
|
Modification of Mechanical Properties, Polymerization Temperature, and Handling Time of Polymethylmethacrylate Cement for Enhancing Applicability in Vertebroplasty. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7901562. [PMID: 27812530 PMCID: PMC5080464 DOI: 10.1155/2016/7901562] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/14/2016] [Indexed: 11/24/2022]
Abstract
Polymethylmethacrylate (PMMA) bone cement is a popular bone void filler for vertebroplasty. However, the use of PMMA has some drawbacks, including the material's excessive stiffness, exothermic polymerization, and short handling time. This study aimed to create an ideal modified bone cement to solve the above-mentioned problems. Modified bone cements were prepared by combining PMMA with three different volume fractions of castor oil (5%, 10%, and 15%). The peak polymerization temperatures, times to achieve the peak polymerization temperature, porosities, densities, modulus and maximum compression strengths of standard (without castor oil), and modified cements were investigated following storage at ambient temperature (22°C) or under precooling conditions (3°C). Six specimens were tested in each group of the aforementioned parameters. Increasing castor oil content and precooling treatment effectively decreased the peak polymerization temperatures and increased the duration to achieve the peak polymerization temperature (P < 0.05). Furthermore, the mechanical properties of the material, including density, modulus, and maximum compression strength, decreased with increasing castor oil content. However, preparation temperature (room temperature versus precooling) had no significant effect (P > 0.05) on these mechanical properties. In conclusion, the addition of castor oil to PMMA followed by precooling created an ideal modified bone cement with a low modulus, low polymerization temperature, and long handling time, enhancing its applicability and safety for vertebroplasty.
Collapse
|
37
|
SECOT-GEIOS guidelines in osteoporosis and fragility fracture. An update. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
38
|
Etxebarria-Foronda I, Caeiro-Rey JR, Larrainzar-Garijo R, Vaquero-Cervino E, Roca-Ruiz L, Mesa-Ramos M, Merino Pérez J, Carpintero-Benitez P, Fernández Cebrián A, Gil-Garay E. [SECOT-GEIOS guidelines in osteoporosis and fragility fracture. An update]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 59:373-93. [PMID: 26233814 DOI: 10.1016/j.recot.2015.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/13/2015] [Accepted: 05/29/2015] [Indexed: 12/12/2022] Open
Affiliation(s)
- I Etxebarria-Foronda
- Grupo de Estudio e Investigación de la Osteoporosis y la Fractura Osteoporótica de la Sociedad Española de Cirugía Ortopédica y Traumatología (GEIOS-SECOT), España; Servicio de Cirugía Ortopédica y Traumatología, Hospital Alto Deba, Arrasate-Mondragón, Gipuzkoa, España.
| | - J R Caeiro-Rey
- Grupo de Estudio e Investigación de la Osteoporosis y la Fractura Osteoporótica de la Sociedad Española de Cirugía Ortopédica y Traumatología (GEIOS-SECOT), España; Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario Santiago Compostela, Santiago de Compostela, A Coruña, España
| | - R Larrainzar-Garijo
- Grupo de Estudio e Investigación de la Osteoporosis y la Fractura Osteoporótica de la Sociedad Española de Cirugía Ortopédica y Traumatología (GEIOS-SECOT), España; Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - E Vaquero-Cervino
- Grupo de Estudio e Investigación de la Osteoporosis y la Fractura Osteoporótica de la Sociedad Española de Cirugía Ortopédica y Traumatología (GEIOS-SECOT), España; Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Pontevedra, Pontevedra, España
| | - L Roca-Ruiz
- Grupo de Estudio e Investigación de la Osteoporosis y la Fractura Osteoporótica de la Sociedad Española de Cirugía Ortopédica y Traumatología (GEIOS-SECOT), España; Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M Mesa-Ramos
- Grupo de Estudio e Investigación de la Osteoporosis y la Fractura Osteoporótica de la Sociedad Española de Cirugía Ortopédica y Traumatología (GEIOS-SECOT), España; Unidad de Gestión Clínica del Aparato Locomotor, Área Sanitaria Norte de Córdoba, Pozoblanco, Córdoba, España
| | - J Merino Pérez
- Grupo de Estudio e Investigación de la Osteoporosis y la Fractura Osteoporótica de la Sociedad Española de Cirugía Ortopédica y Traumatología (GEIOS-SECOT), España; Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Cruces, Barakaldo, Bizkaia, España
| | - P Carpintero-Benitez
- Grupo de Estudio e Investigación de la Osteoporosis y la Fractura Osteoporótica de la Sociedad Española de Cirugía Ortopédica y Traumatología (GEIOS-SECOT), España; Cátedra de Cirugía Ortopédica y Traumatología, Facultad de Medicina, Córdoba, España
| | - A Fernández Cebrián
- Grupo de Estudio e Investigación de la Osteoporosis y la Fractura Osteoporótica de la Sociedad Española de Cirugía Ortopédica y Traumatología (GEIOS-SECOT), España; Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario de Ourense, Ourense, España
| | - E Gil-Garay
- Grupo de Estudio e Investigación de la Osteoporosis y la Fractura Osteoporótica de la Sociedad Española de Cirugía Ortopédica y Traumatología (GEIOS-SECOT), España; Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz, Madrid, España
| |
Collapse
|
39
|
Chen LX, Li YL, Ning GZ, Li Y, Wu QL, Guo JX, Shi HY, Wang XB, Zhou Y, Feng SQ. Comparative efficacy and tolerability of three treatments in old people with osteoporotic vertebral compression fracture: a network meta-analysis and systematic review. PLoS One 2015; 10:e0123153. [PMID: 25874802 PMCID: PMC4395314 DOI: 10.1371/journal.pone.0123153] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 02/24/2015] [Indexed: 01/14/2023] Open
Abstract
PURPOSE The question which kind of methods is most suitable for treating the old people for osteoporotic vertebral compression fracture is still discussed and pairwise meta-analyses cannot get hierarchies of these treatments. Our aim is to integrate the evidence to provide hierarchies of the comparative efficacy measured by the change of VAS (Visual Analogue Scale) and tolerability measured by incidence of new fractures and risk of all-cause discontinuation on three treatments (percutaneous vertebroplasty (PVP)、balloon kyphoplasty (BK) and conservative treatment (CT)). METHODS We performed a Bayesian-framework network meta-analysis of randomized controlled trials (RCTs) to compare three treatments for the old people with osteoporotic vertebral compression fracture. The eligible RCTs were identified by searching Amed, British Nursing Index, Embase, Pubmed, the Cochrane Central Register of Controlled Trials (CENTRAL), Google scholar, SIGLE, the National Technical Information Service, the National Research Register (UK) and the Current Controlled Trials databases. Data from three outcomes (e.g. VAS, risk of all-cause discontinuation and incidence of new fractures) were independently extracted by two authors. RESULTS A total of five RCTs were finally included into this article. PVP and BK significantly decreased VAS when compared with CT. BK had a significantly lower risk of all-cause discontinuation contrast to CT. Three treatments (BK, PVP and CT) had no significant differences in the incidence of new fractures. CONCLUSIONS PVP may be the best way to relieve pain, CT might lead to the lowest incidence of new fractures and BK might had the lowest risk of all-cause discontinuation in old people with osteoporotic vertebral compression fracture. More large-scale and longer duration of follow-up studies are needed.
Collapse
Affiliation(s)
- Ling-Xiao Chen
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, People’s Republic of China
| | - Yu-Lin Li
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, People’s Republic of China
| | - Guang-Zhi Ning
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, People’s Republic of China
| | - Yan Li
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, People’s Republic of China
| | - Qiu-Li Wu
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, People’s Republic of China
| | - Jin-Xiu Guo
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, People’s Republic of China
| | - Hong-Yu Shi
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, People’s Republic of China
| | - Xiao-Bo Wang
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, People’s Republic of China
| | - Yong Zhou
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, People’s Republic of China
| | - Shi-Qing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, People’s Republic of China
| |
Collapse
|
40
|
Valliant EM, Gagnier D, Dickey BT, Boyd D, Joseph Filiaggi M. Calcium polyphosphate as an additive to zinc-silicate glass ionomer cements. J Biomater Appl 2015; 30:61-70. [DOI: 10.1177/0885328215568985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aluminum-free glass ionomer cements (GICs) are under development for orthopedic applications, but are limited by their insufficient handling properties. Here, the addition of calcium polyphosphate (CPP) was investigated as an additive to an experimental zinc-silicate glass ionomer cement. A 50% maximum increase in working time was observed with CPP addition, though this was not clinically significant due to the short working times of the starting zinc-silicate GIC. Surprisingly, CPP also improved the mechanical properties, especially the tensile strength which increased by ∼33% after 30 days in TRIS buffer solution upon CPP addition up to 37.5 wt%. This strengthening may have been due to the formation of ionic crosslinks between the polyphosphate chains and polyacrylic acid. Thus, CPP is a potential additive to future GIC compositions as it has been shown to improve handling and mechanical properties. In addition, CPP may stimulate new bone growth and provide the ability for drug delivery, which are desirable modifications for an orthopedic cement.
Collapse
Affiliation(s)
- Esther Mae Valliant
- Department of Applied Oral Sciences, Dalhousie University, 5981 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada
| | - David Gagnier
- Department of Applied Oral Sciences, Dalhousie University, 5981 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Brett Thomas Dickey
- Department of Applied Oral Sciences, Dalhousie University, 5981 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Daniel Boyd
- Department of Applied Oral Sciences, Dalhousie University, 5981 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Mark Joseph Filiaggi
- Department of Applied Oral Sciences, Dalhousie University, 5981 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada
| |
Collapse
|
41
|
Gan M, Zou J, Zhu X, Wang G, Yang H. Balloon kyphoplasty for osteoporotic spinal fractures with middle column compromise. Injury 2014; 45:1539-44. [PMID: 25022230 DOI: 10.1016/j.injury.2014.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 04/13/2014] [Accepted: 06/18/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Balloon kyphoplasty (BKP) is an effective method for osteoporotic vertebral compression fractures. However osteoporotic spinal fractures with middle column compromise are mentioned as a relative contraindication to BKP. Thus we investigated the safety and efficacy of BKP in the treatment of osteoporotic spinal fractures with middle column compromise but without neurological deficit. METHODS In this retrospective study, 45 patients who suffered osteoporotic fractures with middle column compromise but without neurological deficits were treated by BKP from May 2007 to December 2010. The final follow-ups were finished during the time of July 2011-September 2011. The mean follow-up period was 20.2 months. The height of the compromised vertebral body, the kyphotic angle and spinal canal compromise were measured before surgery, one day after surgery, and at the final follow-up. A visual analogue scale (VAS) and the Oswestry disability index (ODI) were chosen to evaluate pain and functional activity. RESULTS The mean VAS and ODI scores improved significantly from pre- to post-operation (p<0.05), and this improvement was sustained at the final follow-up. The mean anterior vertebral body height ratio improved from 57.6%± 11.8% preoperatively to 86.2%± 12.2% postoperatively (p<0.05), so did the mean middle vertebral body height ratio. The kyphotic angle improved from 16.3° ± 3.7° preoperatively to 9.3° ± 2.6° postoperatively (p<0.05). At final follow-up, BKP stabilised vertebral height and prevented further kyphotic deformity. While there were no differences in spinal canal compromise between pre-operation and one day after surgery (p>0.05), there was a significant difference from the measurement at the final follow-up (p<0.05). CONCLUSION BKP is a safe and effective method for osteoporotic spinal fractures with middle column compromise but without neurological deficit. Spontaneous remodelling of the spinal canal also occurs after BKP.
Collapse
Affiliation(s)
- Minfeng Gan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Jun Zou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Xuesong Zhu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Genlin Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China.
| |
Collapse
|