1
|
Vercoulen TF, Niemeyer MJ, Peuker F, Verlaan JJ, Oner FC, Sadiqi S. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: A systematic review. BRAIN & SPINE 2024; 4:102745. [PMID: 38510618 PMCID: PMC10951763 DOI: 10.1016/j.bas.2024.102745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 03/22/2024]
Abstract
Introduction The treatment of traumatic thoracic and lumbar spine fractures remains controversial. To date no consensus exists on the correct choice of surgical approach and technique. Research question to provide a comprehensive up-to-date overview of the available different surgical methods and their quantified outcomes. Methods PubMed and EMBASE were searched between 2001 and 2020 using the term 'spinal fractures'. Inclusion criteria were: adults, ≥10 cases, ≥12 months follow-up, thoracic or lumbar fractures, and surgery <3 weeks of trauma. Studies were categorized per surgical technique: Posterior open (PO), posterior percutaneous (PP), stand-alone vertebral body augmentation (SA), anterior scopic (AS), anterior open (AO), posterior percutaneous and anterior open (PPAO), posterior percutaneous and anterior scopic (PPAS), posterior open and anterior open (POAO) and posterior open and anterior scopic (POAS). The PO group was used as a reference group. Results After duplicate removal 6042 articles were identified. A total of 102 articles were Included, in which 137 separate surgical technique cohorts were described: PO (n = 75), PP, (n = 39), SA (n = 12), AO (n = 5), PPAO (n = 1), PPAS (n = 1), POAO (n = 2) and POAS (n = 2). Discussion and conclusion For type A3/A4 burst fractures, without severe neurological deficit, posterior percutaneous (PP) technique seems the safest and most feasible option in the past two decades. If needed, PP can be combined with anterior augmentation to prevent secondary kyphosis. Furthermore, posterior open (PO) technique is feasible in almost all types of fractures. Also, this technique can provide for an additional posterior decompression or fusion. Overall, no neurologic deterioration was reported following surgical intervention.
Collapse
Affiliation(s)
- Timon F.G. Vercoulen
- Diakonessenhuis, Department of Orthopedic Surgery, Bosboomstraat 1, 3582, KE, Utrecht, the Netherlands
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Menco J.S. Niemeyer
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Felix Peuker
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Jorrit-Jan Verlaan
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - F. Cumhur Oner
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Said Sadiqi
- University Medical Center Utrecht, Department of Orthopedic Surgery, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| |
Collapse
|
2
|
Moura DL, Gabriel JP. EXPANDABLE INTRAVERTEBRAL IMPLANTS IN POST-TRAUMATIC VERTEBRAL NECROSIS - NEW CLASSIFICATION SUGGESTION. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e262943. [PMID: 37547239 PMCID: PMC10400001 DOI: 10.1590/1413-785220233104e262943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 11/22/2022] [Indexed: 08/08/2023]
Abstract
The progressive evolution of post-traumatic vertebral necrosis and consequent loss of structural integrity of the vertebral body along with neurological risk, makes it one of the most feared and unpredictable pathologies in spine traumatology. Several studies have addressed the role of vertebroplasty, kyphoplasty, and corpectomy in its treatment; however, it remains a controversial concept without a defined therapeutic algorithm. The recent emergence of expandable intravertebral implants, which allow, by a percutaneous transpedicular application, the capacity for intrasomatic filling and maintenance of the height of the vertebral body, makes them a viable option, not only in the treatment of acute vertebral fractures, but also in non-union cases. In this study, we present a review of the current evidence on the application of expandable intravertebral implants in cases of post-traumatic vertebral necrosis. Based on the available scientific literature, including previous classifications of post-traumatic necrosis, and on the mechanical characteristics of the main expandable intravertebral implants currently available, we propose a simplified classification of this pathology, considering parameters that influence surgical therapeutic guidance, the morphology and the dynamics of the necrotic vertebra's mobility. According to its stages and based on authors' experience and on the scarce literature, we propose an initial therapeutic algorithm and suggest preventive strategies for this disease, considering its main risk factors, that is, fracture comminution and impairment of vertebral vascularity. Therefore, expandable intravertebral implants have a promising role in this condition; however, large prospective studies are needed to confirm their efficacy, to clarify the indications of each of these devices, and to validate the algorithm suggestion regarding treatment and prevention of post-traumatic vertebral necrosis. Level of Evidence III, Systematic Review/Actualization.
Collapse
Affiliation(s)
- Diogo Lino Moura
- Centro Hospitalar e Universitario de Coimbra, Serviço de Ortopedia, Setor de Coluna Vertebral, Coimbra, Portugal
- Universidade de Coimbra, Faculdade de Medicina, Instituto de Anatomia e Clinica Universitaria de Ortopedia, Coimbra, Portugal
- Grant Medical Center, Spine Institute of Ohio, Columbus, OH, United States
| | | |
Collapse
|
3
|
Giordan E, Del Verme J, Pastorello G, Gallinaro P, Zanata R, Canova G, Di Paola F, Marton E, Stafa A. Treatment of thoracolumbar burst fractures: SpineJack vs. posterior arthrodesis-comparison of clinical and radiological outcomes. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:242-253. [PMID: 35875619 PMCID: PMC9263732 DOI: 10.21037/jss-21-118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Thoracolumbar fractures sometimes require anterior support and post-traumatic deformity correction. SpineJack proved favorable results in cadaveric and clinical studies, with satisfactory pain relief, vertebral height restoration, and low rates of above adjacent fractures, in neurologically intact fractures. We compared patients' clinical and radiological outcomes of thoracolumbar fractures treated either with posterior arthrodesis or SpineJack. METHODS We prospectively collected A2 split and A3, and A4 burst fractures between 2017 and 2021. Patients were stratified in posterior arthrodesis (PA group) and SpineJack (SJ group) and included if age ≥18 years, T11-L3 level, emergent or elective surgery, single or multiple, and neurologically intact. Age, sex, type and level, pain, operative and discharge time, vertebral body heights (VBH), posterior wall retropulsion (PWR), vertebral kyphosis (VK) and local kyphosis (LK) angles, vertebral body (VB) volume, and complications were collected. We then compared clinical-radiographic outcomes between the two groups. RESULTS We found no significant differences in median postoperative pain while operative time and discharge time were shorter for SJ patients than PA ones (P<0.001). Mean anterior VBH increase was 20.7%, mid-VBH was 25.5%, and posterior VBH was 8.8%, while increase in VB volume was 26.2%. SJ patients had non-inferior VK e LK angles correction to PA ones. Mean PWR value between pre and post SJ implantation was 0.15±0.65 mm, and no adjacent above-level fractures occurred. CONCLUSIONS We showed satisfactory outcomes in a selected range of neurologically intact thoracolumbar split or burst fractures. SJ leads to shorter operative and discharge time and good VB angles and diameters restoration.
Collapse
Affiliation(s)
- Enrico Giordan
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy
| | - Jacopo Del Verme
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy
| | | | - Paolo Gallinaro
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy
| | - Roberto Zanata
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy
| | - Giuseppe Canova
- Neurosurgical Department, Aulss2 Marca Trevigiana, Treviso, Italy
| | - Francesco Di Paola
- Neuroradiology Department, Radiology, Aulss2 Marca Trevigiana, Treviso, Italy
| | | | - Altin Stafa
- Neuroradiology Department, Radiology, Aulss2 Marca Trevigiana, Treviso, Italy
| |
Collapse
|
4
|
Moura DFL, Gabriel JP. INTRAVERTEBRAL EXPANDABLE IMPLANTS IN THORACOLUMBAR VERTEBRAL COMPRESSION FRACTURES. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e245117. [PMID: 35694022 PMCID: PMC9150872 DOI: 10.1590/1413-785220223003e245117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/10/2021] [Indexed: 11/21/2022]
Abstract
Current scientific evidence enhances the importance of the anatomic restauration of vertebral bodies with compression fractures aiming, as with other human body joints, to obtain a biomechanic and functional spine as close as the one prior to the fracture as possible. We consider that anatomic reduction of these fractures is only completely possible using intravertebral expandable implants, restoring vertebral endplate morphology, and enabling a more adequate intervertebral disc healing. This enables avoiding disc and osteodegenerative changes to that vertebral segment and its adjacent levels, as well as the anterior overload of adjacent vertebral bodies in older adults - a consequence of post-traumatic vertebral flattening - thus minimizing the risk of adjacent vertebral fractures. The ability of vertebral body fracture reduction and height maintenance over time and its percutaneous transpedicular application make the intra-vertebral expandable implants a very attractive option for treating these fractures. The authors show the direct and indirect reduction concepts of vertebral fractures, review the biomechanics, characteristics and indications of intravertebral expandable implants and present a suggestion for updating the algorithm for the surgical treatment of vertebral compression fractures which includes the use of intravertebral expandable implants. Level of Evidence V, Expert Opinion.
Collapse
Affiliation(s)
- Diogo Filipe Lino Moura
- Centro Hospitalar e Universitário de Coimbra, Portugal; Universidade de Coimbra, Portugal; Grant Medical Center, United States of America
| | | |
Collapse
|
5
|
Boudissa M, Girard P, Kerschbaumer G, Ruatti S, Tonetti J. Does intraoperative 3D navigation improve SpineJack vertebral augmentation in thoracic and lumbar compression fracture? Orthop Traumatol Surg Res 2021; 107:103028. [PMID: 34329760 DOI: 10.1016/j.otsr.2021.103028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/12/2021] [Accepted: 02/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of this retrospective study was to evaluate the effect of navigation on the positioning of the SpineJack implant in the treatment of thoracic and lumbar compression fractures. METHODS Between January 2018 and December 2019, all patients operated on for thoracic or lumbar fracture using the SpineJack device in stand-alone were included in this single-center study. The positioning of the SpineJack implant was analyzed on axial CT views by measuring the angle between the axis of the pedicle and the axis of the final implant. The relationships between implant positioning and the use of navigation or fluoroscopy, pedicle dimensions and levels of injury were analyzed. Surgical time, radiation exposure, radiological findings and complications were assessed. RESULTS One hundred patients were included, for 103 fractured vertebrae and a total of 205 implants, 148 placed under standard fluoroscopy and 57 with the Surgivisio navigation system. For pedicle diameters≥5mm (165 implants), the positioning of the implant relative to the axis of the pedicle was significantly better in the navigation group: 2°±1.4° (range, 0-7°) in the fluoroscopy group versus 1.2°±1.1° (range, 0-5°) in the navigation group (p=0.04). There were no significant differences in reduction of vertebral kyphosis angle or mean operating time. Dose area product (DAP) was significantly higher with navigation: 4.43Gy.cm2 versus 0.47Gy.cm2 (p<0.001) and dose to the surgeon significantly lower: 0.5 versus 1.6μSv (p<0.001). No difference was found regarding complications. Subgroup analysis showed significantly greater operative time and patient irradiation in the fluoroscopy group when pedicle diameter was less than 5mm. CONCLUSION This study demonstrates the interest of navigation for positioning the SpineJack implant with respect to the pedicle axis in vertebrae with pedicle diameter≥5mm. This study also confirmed the reliability of navigation and lower radiation dose to the surgeon, regardless of the fracture level. Navigation reduced operating time and patient irradiation for vertebrae with pedicle diameter<5mm. LEVEL OF EVIDENCE IV; retrospective study.
Collapse
Affiliation(s)
- Mehdi Boudissa
- Service de chirurgie orthopédique et traumatologique, université Grenoble Alpes, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France; CNRS UMR 5525, TIMC-IMAG Lab, university Grenoble Alpes, 38700 La Tronche, France.
| | - Pierre Girard
- Service de chirurgie orthopédique et traumatologique, université Grenoble Alpes, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France
| | - Gaël Kerschbaumer
- Service de chirurgie orthopédique et traumatologique, université Grenoble Alpes, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France
| | - Sébastien Ruatti
- Service de chirurgie orthopédique et traumatologique, université Grenoble Alpes, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France
| | - Jérôme Tonetti
- Service de chirurgie orthopédique et traumatologique, université Grenoble Alpes, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France; CNRS UMR 5525, TIMC-IMAG Lab, university Grenoble Alpes, 38700 La Tronche, France
| |
Collapse
|
6
|
Moura DL, Gabriel JP. Expandable Intravertebral Implants: A Narrative Review on the Concept, Biomechanics, and Outcomes in Traumatology. Cureus 2021; 13:e17795. [PMID: 34660005 PMCID: PMC8496495 DOI: 10.7759/cureus.17795] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 01/22/2023] Open
Abstract
Expandable intravertebral implants are self-expanding devices applied percutaneously by the posterior transpedicular approach. These devices introduce the concept of anatomical restoration of vertebral body endplates and direct anatomical reduction performed from the interior of the vertebral body with a compression fracture. This paper aims to provide a narrative review on the concept, indications, biomechanical characteristics, as well as functional and radiographic outcomes of the main expandable intravertebral implants currently available, in terms of their application to thoracolumbar spine traumatology. To this end, we performed a search in July 2021 on the MEDLINE/PubMed platform with the words "expandable intravertebral implant", "armed kyphoplasty", "Vertebral Body Stenting" or "stentoplasty" and "SpineJack". The search yielded 144 papers, and of those, we included 15 in this review. We concluded that percutaneous transpedicular posterior access, the ability to reduce vertebral body fractures, particularly of the vertebral endplates and to maintain the vertebral body height, makes the application of expandable intravertebral implants an attractive option in the treatment of thoracolumbar vertebral compression fractures. However, more prospective, randomized, and large-scale blinded studies are still warranted, especially comparative studies between treatments and about the preferential use of an expansive implant over others, in order to gain definitive insights into the effectiveness and indications of each of these devices.
Collapse
Affiliation(s)
- Diogo L Moura
- Spine Surgery, Spine Unit, Orthopedics Department, Coimbra Hospital and University Center, Coimbra, PRT
- Spine Surgery, Spine Institute of Ohio, Grant Medical Center, Columbus, USA
| | - Josue P Gabriel
- Orthopedic Spine Surgery, Spine Institute of Ohio, Grant Medical Center, Columbus, USA
| |
Collapse
|
7
|
England RW, Gong A, Li T, Botros D, Manupipatpong S, Pang S, Hui F, Khan M. Clinical outcomes and safety of the SpineJack vertebral augmentation system for the treatment of vertebral compression fractures in a United States patient population. J Clin Neurosci 2021; 89:237-242. [PMID: 34119274 DOI: 10.1016/j.jocn.2021.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/13/2021] [Accepted: 04/25/2021] [Indexed: 12/25/2022]
Abstract
The SpineJack implant system was recently FDA approved for treatment of vertebral compression fractures (VCF), however United States-based outcomes data is lacking. We sought to examine the safety and clinical outcomes following vertebral augmentation using the SpineJack implant for treatment of VCF in a U.S. patient population. An IRB-approved, retrospective study of SpineJack implants used in vertebral augmentation was performed from 11/2018 to 2/2020. Outcome objectives included pain improvement, vertebral body height (VH) restoration, improvement in local kyphotic angle (LKA), and incidence of adjacent level fractures (ALF). Complications were reviewed to assess safety of the procedure. Thirty patients with VCF (60% female; mean [SD] age of 62.7 [±12.8] years) underwent a total of 53 vertebral augmentations with 106 SpineJack implants. Worst pain scores decreased significantly from 8.7 to 4.3 (95%CI of the change [Δ]: 4.3-4.4; p < 0.001). Middle and anterior VH significantly increased from 13.1 ± 0.2 to 15.9 ± 0.2 mm (95%CI Δ: 2.6-2.9 mm; p < 0.001) and 15.6 ± 0.2 to 16.8 ± 0.2 mm (95%CI Δ: 1.1-1.4 mm; p < 0.001), respectively. LKA was significantly decreased from 10.0 ± 2.1 to 7.4 ± 2.1 degrees (95%CI Δ: 2.4-2.8 degrees; p < 0.001). Four patients (13%) sustained ten ALF over a median (IQR) follow up period of 94 (17.5-203) days. There were no major adverse events during the follow up period. To summarize, vertebral augmentation with SpineJack implants of patients with VCF resulted in significantly decreased pain, restored VH, and improved LKA, without major adverse events. However, 13% of patients sustained ALF during a median follow up period of 3 months.
Collapse
Affiliation(s)
- Ryan W England
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, United States.
| | - Anna Gong
- The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
| | - Taibo Li
- The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
| | - David Botros
- The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
| | - Sasicha Manupipatpong
- The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
| | - Sharon Pang
- The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
| | - Ferdinand Hui
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, United States
| | - Majid Khan
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, United States; Department of Radiology, Thomas Jefferson University Hospital, 111 S 11(th) St, Philadelphia, PA 19107, United States
| |
Collapse
|
8
|
Dalili D, Isaac A, Cazzato RL, Åström G, Bergh J, Mansour R, Weber MA, Garnon J, Gangi A. Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part II. Stabilization. Semin Musculoskelet Radiol 2020; 24:710-725. [PMID: 33307586 DOI: 10.1055/s-0040-1719104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Percutaneous image-guided oncologic interventions have rapidly evolved over the last two decades as an independent strategy or used within a first-, second-, or even third-line strategy in the treatment of musculoskeletal (MSK) tumors. Abundant mostly nonrandomized publications have described the safety, efficacy, and reproducibility of implementing percutaneous therapies both with curative and palliative intent. In this article, we continue to share our experience in bone and MSK soft tissue interventions focusing on stabilization and combined ablation and stabilization. We propose a pathway and explore future directions of image-guided interventional oncology related to skeletal disease. We reflect on the advantages and limitations of each technique and offer guidance and pearls to improve outcomes. Representing patterns from our practices, we demonstrate the role of collaborative working within a multidisciplinary team, ideally within a dedicated tumor treatment center, to deliver patient-specific therapy plans that are value based and favored by patients when given the choice.
Collapse
Affiliation(s)
- Danoob Dalili
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Roberto Luigi Cazzato
- Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France
| | - Gunnar Åström
- Department of Immunology, Genetics and Pathology (Oncology) and Department of Surgical Sciences (Radiology), Uppsala University, Uppsala, Sweden
| | - Jonas Bergh
- Department of Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ramy Mansour
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
| | - Julien Garnon
- Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France
| | - Afshin Gangi
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom.,Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France
| |
Collapse
|
9
|
Manz D, Georgy M, Beall DP, Baroud G, Georgy BA, Muto M. Vertebral augmentation with spinal implants: third-generation vertebroplasty. Neuroradiology 2020; 62:1607-1615. [PMID: 32803337 DOI: 10.1007/s00234-020-02516-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/04/2020] [Indexed: 12/23/2022]
Abstract
This article is to review the different types of vertebral augmentation implants recently becoming available for the treatment of benign and malignant spinal compression fractures. After a detailed description of the augmentation implants, we review the available clinical data. We will conclude with a summary of the advantages and disadvantages of vertebral implants and how they can affect the future treatment options of compression fractures.
Collapse
Affiliation(s)
- Danielle Manz
- Liberty University College of Osteopathic Medicine, 219 Meadville St, Edinboro, PA, 16444, USA
| | - Mark Georgy
- The Ohio State University School of Medicine, 2713 Aschinger Blvd, Columbus, OH, 43212, USA
| | - Douglas P Beall
- Summit Medical Center, 1800 Renaissance Blvd, Suite 110, Edmond, OK, 73013, USA
| | - Gamal Baroud
- Biomechanics Laboratory, 500, boul. de l'Université, Sherbrooke, Québec, J1K 2R1, Canada
| | - Bassem A Georgy
- University of California San Diego, San Diego Imaging, 5458 Coach Lane, San Diego, CA, 92130, USA.
| | - Mario Muto
- Chairman diagnostic and interventional Neuroradiology, Cardarelli Hospital, Naples, Italy
| |
Collapse
|
10
|
Safety of vertebral augmentation with cranio-caudal expansion implants in vertebral compression fractures with posterior wall protrusion. Eur Radiol 2020; 30:5641-5649. [PMID: 32367420 DOI: 10.1007/s00330-020-06889-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/10/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Vertebral augmentation (VA) has become routinely used in vertebral compression fractures (VCFs). VCFs are often associated with posterior wall protrusions (PWPs), which theoretically contraindicates vertebroplasty due to a higher risk of neurological complications. The latest generation of VA devices uses intravertebral cranio-caudal expandable implants to improve the correction of structural deformities but could also be used to prevent further PWP during cement injection. The aim of this study was to evaluate the safety of VA with expandable implant for VCFs with PWP. METHODS All consecutive patients treated with expandable implants were considered eligible for inclusion if they met the following criteria: (1) non-neurological VCF, (2) considered unstable (A3-A4 in AOSpine classification), (3) significant PWP (> 2 mm), (4) back pain with a visual analogue scale (VAS) ≥ 4. PWPs were independently measured by two investigators; Pearson's statistics were used for interobserver reproducibility. RESULTS Fifty-one consecutive patients, with a mean age of 75 ± 8.3 years (range, 50-92), were included. There was a slight decrease between mean preoperative (6.7 mm ± 2.2 mm) and postoperative (6.5 mm ± 2.2 mm) PWP (p = 0.02), with an excellent interobserver reproducibility (Pearson correlation coefficient = 0.92). A mean kyphosis reduction of 34.9% (± 28.4) was observed (p < 0.001). Forty-two patients (82.4%) had significant pain improvements (mean preoperative VAS = 6.9 [± 1.7] versus 3.1 [± 2.0] postoperatively [p < 0.001]). Secondary adjacent level fractures were noted in 16 patients (31.4%), with a reduction of that risk down to 18.8% if a preventive adjacent vertebroplasty was performed, without reaching the significance threshold (p = 0.14). CONCLUSIONS VA with expandable implants appeared safe for non-neurological VCFs with PWP, while allowing satisfactory pain relief. KEY POINTS • Vertebral augmentation with cranio-caudal expandable implants is safe for non-neurological vertebral compression fractures with posterior wall protrusions. • Vertebral augmentation with cranio-caudal expandable implants might increase the occurrence of secondary adjacent level fractures. • Adjacent level vertebroplasty might be helpful to prevent secondary adjacent level fractures.
Collapse
|