Modified kyphoplasty with controllable balloon dilatation for treatment of thoracolumbar osteoporotic vertebral compression fractures

Continuous cement leakage along the posterior longitudinal ligament of the intraspinal epidural during a percutaneous vesselplasty: A case report and literature review

Objective

This study aims to report one case of intraspinal epidural cement leakage caused by a novel percutaneous vesselplasty.

Methods

A clinical case report from the Orthopedic center of our hospital and a literature review. A 63-year-old woman with an L₂ osteoporotic compression fracture underwent novel kyphoplasty, percutaneous vesselplasty. This rare complication was evaluated through a literature search, and its special types are classified in more detail.

Results

The patient was hospitalized with low back pain two weeks after a fall. After auxiliary examination, a new type of percutaneous vesselplasty was performed. After the intraoperative injection of bone cement, bone cement leakage extended along the posterior longitudinal ligament and epidural space. There were no special compression symptoms of the spinal cord, and the prognosis of conservative treatment was good.

Conclusion

Although percutaneous vesselplasty is relatively safe and frequent, intraspinal leakage may occur, so sufficient preoperative evaluation, intraoperative continuous fluoroscopic monitoring, and timely evaluation of postoperative images are extremely necessary.

Analysis of the Effect of Percutaneous Cone Shaping in Patients with Osteoporotic Vertebral Fractures

Objective. To study and analyze the clinical effect of percutaneous cone shaping in patients with osteoporotic vertebral fractures. Methods. A total of 100 patients with vertebral osteoporotic fracture treated in our hospital from June 2019 to September 2020 were selected, and there were 50 patients with vertebral osteoporotic fracture in each group. Patients could be divided into two groups according to different treatment plans: one group was vertebroplasty patients for group A, and the other group was nonsurgical treatment patients for group B. The incidence of complications during treatment and follow-up was recorded in both groups. Results. According to a study, both groups of patients completed the treatment and follow-up, no patients lost to follow-up or death, the VAS scores and ADL scores of patients before treatment were higher, and there was no significant difference at baseline ( $P>0.05$ ). After different treatment methods, the VAS score and ADL score of group A showed good improvement after treatment compared with that before treatment, and there were certain differences within the group, with statistical significance ( $P<0.05$ ). Intragroup comparison. The VAS scores of group B at 1 week, 1 month, 3 months, and 12 months after treatment were all superior to those before treatment, and the ADL scores at 1 month, 3 months, and 12 months after treatment were all superior to those before treatment, with statistically significant differences ( $P<0.05$ ). VAS scores and ADL scores showed good improvement 1 day, 1 week, and 1 month after treatment compared with those before treatment. However, there were no significant differences in the VAS score and ADL score between the two groups at 3 and 12 months after treatment. The incidence of complications in group A is lower than that in group B. The incidence of complications in group A is as follows: there was 1 case of recurrent vertebral fracture and 1 case of urinary tract infection, and the overall incidence of complications was 4.00%. In group B, there were 1 case of recurrent fracture, 3 cases of bedsore, 2 cases of urinary tract infection, and 2 cases of pulmonary infection, and the incidence of total complications was 16.00%. After comparison between groups, there was a significant difference in the incidence of complications between the two groups, and the difference was statistically significant ( $P<0.05$ ). Conclusions. Percutaneous cone plasty can provide rapid relief of pain symptoms in patients with osteoporotic vertebral fractures and significantly improve their daily activities. However, there was no significant difference in long-term recovery from group B. In terms of the incidence of complications, the incidence of complications in group A was lower than that in group B after certain treatment.

Multidisciplinary management of osteoporotic vertebral fractures. An overview

Vertebral fractures represent the most frequent complication associated with osteoporosis. Patients harboring a vertebral fracture complain physical impairment including low back pain and spine balance alteration, i.e., kyphosis, leading to subsequent systemic complication, with an increase in morbidity and mortality risk. Different strategies are available in the management of osteoporotic vertebral fractures: medical therapy acts as a prevention strategy while surgical vertebral augmentation procedures, when correctly indicated, aim to reduce pain and to restore the physiological vertebral height. Considering the growing prevalence and incidence of this condition and its socio-economic burden, prevention, diagnosis and treatment of osteoporotic vertebral fractures are of utmost importance. Our aim is to review the current strategies for the management of osteoporotic vertebral fractures providing an integrated multidisciplinary endocrinological, radiological and neurosurgical point of view.