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Kastler A, Carneiro I, Perolat R, Rudel A, Pialat JB, Lazard A, Isnard S, Krainik A, Amoretti N, Grand S, Stacoffe N. Combined vertebroplasty and pedicle screw insertion for vertebral consolidation: feasibility and technical considerations. Neuroradiology 2024; 66:855-863. [PMID: 38453715 DOI: 10.1007/s00234-024-03325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To assess the feasibility and technical accuracy of performing pedicular screw placement combined with vertebroplasty in the radiological setting. METHODS Patients who underwent combined vertebroplasty and pedicle screw insertion under combined computed tomography and fluoroscopic guidance in 4 interventional radiology centers from 2018 to 2023 were retrospectively assessed. Patient demographics, vertebral lesion type, and procedural data were analyzed. Strict intra-pedicular screw positioning was considered as technical success. Pain score was assessed according to the Visual Analogue Scale before the procedure and in the 1-month follow-up consultation. RESULTS Fifty-seven patients (38 men and 19 women) with a mean age of 72.8 (SD = 11.4) years underwent a vertebroplasty associated with pedicular screw insertion for the treatment of traumatic fractures (29 patients) and neoplastic disease (28 patients). Screw placement accuracy assessed by post-procedure CT scan was 95.7% (89/93 inserted screws). A total of 93 pedicle screw placements (36 bi-pedicular and 21 unipedicular) in 32 lumbar, 22 thoracic, and 3 cervical levels were analyzed. Mean reported procedure time was 48.8 (SD = 14.7) min and average injected cement volume was 4.4 (SD = 0.9) mL. A mean VAS score decrease of 5 points was observed at 1-month follow-up (7.7, SD = 1.3 versus 2.7, SD = 1.7), p < .001. CONCLUSION Combining a vertebroplasty and pedicle screw insertion is technically viable in the radiological setting, with a high screw positioning accuracy of 95.7%.
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Affiliation(s)
- Adrian Kastler
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France.
| | - Inês Carneiro
- Neuroradiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Romain Perolat
- Radiology Unit, Carémeau University Hospital, Nimes, France
| | - Alexandre Rudel
- Diagnostic and Interventional MSK Unit, Pasteur II Hospital, Nice, France
| | | | - Arnaud Lazard
- Neurosurgery Unit, Grenoble University Hospital, Grenoble, France
| | - Stephanie Isnard
- Neurosurgery Unit, Grenoble University Hospital, Grenoble, France
| | - Alexandre Krainik
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France
| | - Nicolas Amoretti
- Diagnostic and Interventional MSK Unit, Pasteur II Hospital, Nice, France
| | - Sylvie Grand
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France
| | - Nicolas Stacoffe
- Diagnostic and Interventional Radiology Unit, Lyon Sud Hospital, Lyon, France
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Yang Y, Yan BC, Huang ZL, Wei XE, Wu CG. Vesselplasty for C1 Osteolytic Lesions with Bone Wall Destruction. J Vasc Interv Radiol 2024; 35:796-798. [PMID: 38311292 DOI: 10.1016/j.jvir.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Affiliation(s)
- Yue Yang
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yi Shan Rd, Shanghai 200233, China
| | - Bi-Cong Yan
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yi Shan Rd, Shanghai 200233, China
| | - Zhi-Long Huang
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yi Shan Rd, Shanghai 200233, China
| | - Xiao-Er Wei
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yi Shan Rd, Shanghai 200233, China
| | - Chun-Gen Wu
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yi Shan Rd, Shanghai 200233, China.
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Cerny J, Soukup J, Petrosian K, Loukotova L, Novotny T. Efficacy and Complication Rates of Percutaneous Vertebroplasty and Kyphoplasty in the Treatment of Vertebral Compression Fractures: A Retrospective Analysis of 280 Patients. J Clin Med 2024; 13:1495. [PMID: 38592338 PMCID: PMC10933847 DOI: 10.3390/jcm13051495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/18/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are established methods in the treatment of vertebral compression fractures (VCFs). In our manuscript, the target was to evaluate the efficacy of PVPs/PKPs and to determine the implications of potential periprocedural complications. Methods: 280 patients, specifically 194 women (69.3%) and 86 men (30.7%), were enrolled. We used the AO spine fractures classification and the Yeom classification to determine the subtype of cement leakage. Only single-level VCFs of the thoracic or lumbar spine were included. Visual analogue scale (VAS) was assessed preoperatively and regularly after the surgery. Vertebral compression ratio (VBCR) was used to determine postoperative vertebral body collapse. Results: We recorded 54 cases (19.3%) of cement leakage. There was a significant decrease in mean VAS scores (6.82-0.76 in PVPs, 7.15-0.81 in PKPs). The decrease in VBCR was greater in the VP group (4.39%; 84.21-79.82) compared to the KP group (1.95%; 74.36-72.41). Conclusions: No significant difference in the risk of cement leakage when comparing KPs and VPs was found. VPs and KPs provide rapid and significant pain relief in patients with VCFs. Clinically relevant complications of VPs and KPs are rare. Kyphoplasties prevent further vertebral body collapse more effectively compared to vertebroplasties.
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Affiliation(s)
- Jan Cerny
- Department of Orthopaedics, Faculty of Health Studies, Jan Evangelista Purkyne University in Usti nad Labem and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic; (J.C.); (J.S.); (K.P.)
| | - Jan Soukup
- Department of Orthopaedics, Faculty of Health Studies, Jan Evangelista Purkyne University in Usti nad Labem and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic; (J.C.); (J.S.); (K.P.)
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, 150 06 Prague, Czech Republic
| | - Kadzhik Petrosian
- Department of Orthopaedics, Faculty of Health Studies, Jan Evangelista Purkyne University in Usti nad Labem and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic; (J.C.); (J.S.); (K.P.)
| | - Lucie Loukotova
- Department of Mathematics, Faculty of Science, Jan Evangelista Purkyne University in Usti nad Labem, 400 96 Usti nad Labem, Czech Republic;
| | - Tomas Novotny
- Department of Orthopaedics, Faculty of Health Studies, Jan Evangelista Purkyne University in Usti nad Labem and Masaryk Hospital, 401 13 Usti nad Labem, Czech Republic; (J.C.); (J.S.); (K.P.)
- Department of Orthopaedic Surgery, Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic
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Kang MS, Son IS, Kim TH, Lee SH, You KH, Lee WM, Hyun JT, Park HJ. Paravertebral Nerve Block for Procedural Pain in Percutaneous Vertebroplasty. Clin J Pain 2024; 40:92-98. [PMID: 37982510 DOI: 10.1097/ajp.0000000000001176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/30/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES This study aimed to unidimensionally measure procedural pain at each percutaneous vertebroplasty (PVP) stage and evaluate the effectiveness of paravertebral nerve block (PVNB) in reducing procedural pain. METHODS A retrospective study of prospectively collected data was conducted on 66 patients who underwent PVP for osteoporotic vertebral compression fractures. The patients were divided into 2 groups: group A (fluoroscopic-guided PVNB; 5 cm 3 of 0.75% ropivacaine on each side) and group B (local anesthesia). To investigate procedural pain associated with PVP, the visual analog scale score was assessed at each surgical stage: before the incision (stage 1), transpedicular approach (stage 2), and polymethylmethacrylate cement injection (stage 3). After the procedure, patients were asked about their surgical experience and satisfaction using the Iowa Satisfaction with Anesthesia Scale. Periprocedural complications were also recorded. RESULTS A total of 63 patients (78.65 y of age) were finally enrolled: 30 from group A and 33 from group B. In both groups, a significant ≥2-point increase in procedural pain was observed during PVP compared with that during stage 1 ( P < 0.001). In stages 2 and 3, the pain intensity was significantly lower in group A ( P < 0.001). Upon discharge, the visual analog scale score improved in all groups; however, the Iowa Satisfaction with Anesthesia Scale score was significantly higher in group A ( P < 0.001). There was no difference in periprocedural complications between the two groups ( P = 0.743). CONCLUSION PVP causes significant procedural pain, and PVNB is a potentially effective modality for enhancing patient satisfaction and reducing procedural pain.
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Affiliation(s)
- Min-Seok Kang
- Department of Orthopedic Surgery, Korea University College of Medicine, Anam Hospital
| | - In-Seok Son
- Department of Orthopedic Surgery, Jeju University Medical Center, Jeju, Republic of Korea
| | - Tae-Hoon Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine
| | - Suk-Ha Lee
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine
| | - Ki-Han You
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical College, Seoul
| | - Woo-Myung Lee
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical College, Seoul
| | - Jin-Tak Hyun
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical College, Seoul
| | - Hyun-Jin Park
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical College, Seoul
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Lavigne J, Stacoffe N, Heidelberg D, Wagner P, Pialat JB. A Feasibility Study of CT-Guided Osteosynthesis under Local Anesthesia. J Pers Med 2023; 13:1493. [PMID: 37888104 PMCID: PMC10608047 DOI: 10.3390/jpm13101493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Evaluation of local anesthesia for perioperative pain control in patients undergoing CT-guided percutaneous osteosynthesis. METHODS A total of 12 patients underwent percutaneous osteosynthesis under local anesthesia. Intraoperative pain was assessed after the procedure using numerical rating scale (NRS). Patients were also asked to rate their overall experience of the operation using the following scale: "highly comfortable, comfortable, hardly comfortable, uncomfortable" and, finally, "Would you be willing to repeat this intervention again under the same conditions if necessary?" Patients were also clinically followed up at 1 month, 3 months, and 6 months using the EQ5D5L scale to assess their pain and quality of life. RESULTS Patients underwent percutaneous osteosynthesis for osteoporotic (n = 9), pathological (n = 2), or traumatic fractures (n = 1), including the thoraco-lumbar spine (n = 8) or the pelvis (n = 4). The mean of NRS value experienced during the procedure was 3.4/10 (0-8). The overall feeling was highly comfortable (42%), comfortable (50%), hardly comfortable (8%), and uncomfortable (0%). Finally, 75% of patients answered "YES" to the question of repeating the operation under the same conditions if necessary. At follow-up, a significant reduction in pain was observed postoperatively. According to the EQ5D5L scale, there was a significant improvement in pain, mobility, self-activities, autonomy, and perceived quality of life at 3 and 6 months. CONCLUSION Radiological percutaneous osteosynthesis is an effective technique that can be performed under local anesthesia with a comfortable experience for most of the patients.
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Affiliation(s)
- Joris Lavigne
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (N.S.); (D.H.); (J.-B.P.)
| | - Nicolas Stacoffe
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (N.S.); (D.H.); (J.-B.P.)
| | - Damien Heidelberg
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (N.S.); (D.H.); (J.-B.P.)
| | - Philippe Wagner
- Centre D’étude des Maladies Osseuses, INSERM U1033, Université Lyon 1, 69008 Lyon, France;
| | - Jean-Baptiste Pialat
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (N.S.); (D.H.); (J.-B.P.)
- Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon 1, 69495 Pierre-Bénite, France
- Unité CNRS UMR 5220, INSERM U1294, Université Lyon 1, INSA Lyon, Université Jean Monnet, 42100 Saint-Etienne, France
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Liu T, Gu G, Zhan C, Zhang S, Tang Y. Comparison of percutaneous vertebroplasty and percutaneous vertebroplasty combined with pediculoplasty for Kümmell's disease: a retrospective observational study. J Orthop Surg Res 2023; 18:471. [PMID: 37386585 DOI: 10.1186/s13018-023-03957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/24/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND To investigate the clinical outcomes of percutaneous vertebroplasty (PVP) versus percutaneous vertebroplasty combined with pediculoplasty (PVP-PP) for Kümmell's disease (KD). METHODS Between February 2017 and November 2020, 76 patients with KD undergoing PVP or PVP-PP were included in this retrospective study. Based on the PVP whether combined with pediculoplasty, those patients were divided into PVP group (n = 39) and PVP-PP group (n = 37). The operation duration, estimated blood loss, cement volume, and hospitalization stays were recorded and analyzed. Meanwhile, the radiological variations including the Cobb's angle, anterior height of index vertebra, and middle height of index vertebra from X-ray were recorded preoperatively, at 1 days postoperatively and the final follow-up. The visual analogue scale (VAS) and Oswestry disability index (ODI) were also evaluated. Preoperative and postoperative recovery values of these data were compared. RESULTS The two groups showed no significant difference in demographic features (p > 0.05). The operation time, intraoperative blood loss, and time of hospital stay revealed no sharp statistical distinctions either (p > 0.05), except that PVP-PP used more bone cement than PVP (5.8 ± 1.5 mL vs. 5.0 ± 1.2 mL, p < 0.05). The anterior and middle height of vertebra, Cobb's angle, VAS, and ODI was observed a little without significant difference between the two groups before and 1 days postoperatively (p > 0.05). Nevertheless, ODI and VAS scores decreased significantly in the PVP-PP group than in the PVP group at follow-up (p < 0.001). The PVP-PP group exhibited a slight amelioration in Ha, Hm, and Cobb's angle when compared to the PVP group, displaying statistical significance (p < 0.05). No significant disparity in cement leakage was observed between the PVP-PP and PVP groups (29.4% vs. 15.4%, p > 0.05). It is worth noting that the prevalence of bone cement loosening displayed a remarkable decrement within the PVP-PP group, with only one case recorded, as opposed to the PVP group's seven cases (2.7% vs. 17.9%, p < 0.05). CONCLUSIONS Both PVP-PP and PVP can relieve pain effectively in patients with KD. Moreover, PVP-PP can achieve more satisfactory results than PVP. Thus, compared with PVP, PVP-PP is more suitable for KD without neurological deficit, from a long-term clinical effect perspective.
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Affiliation(s)
- Teng Liu
- The 1st institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - GuoNing Gu
- The 1st institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - ChenGuang Zhan
- The 1st institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - ShunCong Zhang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - YongChao Tang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Zhong X, Xia H, Li Y, Tang C, Tang X, He S. Effectiveness and safety of ultrasound-guided thoracic paravertebral block versus local anesthesia for percutaneous kyphoplasty in patients with osteoporotic compression fracture. J Back Musculoskelet Rehabil 2022; 35:1227-1235. [PMID: 35599464 DOI: 10.3233/bmr-210131] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Kyphoplasty for osteoporotic vertebral compression fractures (OVCF) is a short but painful intervention. Different anesthetic techniques have been proposed to control pain during kyphoplasty; however, all have limitations. OBJECTIVE To compare the effectiveness and safety of ultrasound-guided thoracic paravertebral block with local anesthesia for percutaneous kyphoplasty (PKP). METHODS In this prospective study, non-randomized patients with OVCF undergoing PKP received either ultrasound-guided thoracic paravertebral block (group P) or local anesthesia (group L). Perioperative pain, satisfaction with anesthesia, and complications were compared between the groups. RESULTS Mean intraoperative (T1-T4) perioperative visual analog scale (VAS) scores were significantly lower in group P than in group L (2 [1-3] vs. 3 [2-4], 2 [2-3] vs. 4 [2-4], 2 [2-3] vs. 5 [3-5], and 3 [2-3] vs. 5 [3-5], respectively; P< 0.05). Investigators' satisfaction scores, patients' anesthesia satisfaction scores, and anesthesia re-administration intention rate were significantly higher in group P than in group L (4 [3-5] vs. 3 [2-4], 2 [2-3] vs. 2 [1-3], 90.63% vs. 69.70%; P< 0.05). There was no significant intergroup difference in complications. CONCLUSIONS Ultrasound-guided thoracic paravertebral block has similar safety to and better effectiveness than local anesthesia in PKP.
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Affiliation(s)
- Xiqiang Zhong
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haijie Xia
- Department of Anesthesiology, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yimin Li
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chengxuan Tang
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaojun Tang
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shaoqi He
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Wang H, Lin F, Liang G, Lin Y. Percutaneous vertebroplasty in osteoporotic vertebral compression fracture with huge spinal epidural hematoma: A case report. Medicine (Baltimore) 2022; 101:e29340. [PMID: 35665733 PMCID: PMC9276412 DOI: 10.1097/md.0000000000029340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/04/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Osteoporotic vertebral compression fracture (OVCF) accompanying huge spinal epidural hematoma (SEH) is fairly rare. The aim of this report is to investigate the management strategies and treatment outcomes of OVCF accompanying SEH. PATIENT CONCERNS An 89-year-old female patient was admitted to hospital because of severe back pain and numbness of both lower limbs after a slight fall. The magnetic resonance imaging examination of the patient showed a fresh compression fracture at L2 accompanying a large dorsal SEH which extended from the T12 to L3 and deformed the spinal cord. DIAGNOSIS The patient was diagnosed with OVCF accompanying SEH. INTERVENTIONS Given mild neurologic deficits, the hematoma was not treated, and the patient underwent percutaneous vertebroplasty (PVP) only. OUTCOMES After the procedure, immediate pain relief was achieved and the numbness of both lower limbs disappeared 3 days later. Three months after the procedure, the follow-up magnetic resonance imaging revealed a complete resolution of the hematoma. LESSONS OVCF accompanying SEH is fairly rare, and the exact pathophysiological mechanisms are still not clear. In selected patients without or with only slight neurologic symptoms, it is reasonable to perform PVP alone in OVCF accompanying SEH. Moreover, intravertebral stability after PVP might have played a role in spontaneous resolution of SEH.
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MESH Headings
- Aged, 80 and over
- Female
- Fractures, Compression/complications
- Fractures, Compression/diagnostic imaging
- Fractures, Compression/surgery
- Hematoma, Epidural, Spinal/complications
- Hematoma, Epidural, Spinal/diagnostic imaging
- Hematoma, Epidural, Spinal/surgery
- Humans
- Hypesthesia
- Osteoporotic Fractures/complications
- Osteoporotic Fractures/diagnostic imaging
- Osteoporotic Fractures/surgery
- Spinal Fractures/complications
- Spinal Fractures/diagnostic imaging
- Spinal Fractures/surgery
- Treatment Outcome
- Vertebroplasty/methods
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Yang Y, Tian Q, Wang T, Lu Y, Li W, Wu C. Vessel-Plasty Using Bone-Filling Mesh Container for Treatment of Malignant Severe Compression Fractures in Cervical Vertebrae. J Pain Res 2022; 15:1173-1182. [PMID: 35478996 PMCID: PMC9037846 DOI: 10.2147/jpr.s360195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the feasibility, safety, and efficacy of vessel-plasty using bone-filling mesh container (BFMC) for malignant severe compression fractures of cervical vertebra. Methods This study prospectively recruited fifteen consecutive patients (eight men, seven women; mean age, 57.4 years) with severe malignant compression fractures of cervical vertebrae for vessel-plasty. Procedure duration, incidence of cement leakage and other complications, pain relief and improvement of neck function were analyzed. Pain was assessed using a visual analog scale (VAS) and function by the neck disability index (NDI), with scores recorded before the procedure and at 3 days and 1, 3, 6 and 12 months after the procedure. Results A total of 16 vertebrae were treated. All vertebrae had destruction of bone in more than one place as well as broken bone walls. Mean procedure duration was 42.9±13.6 minutes. Bone cement leakage occurred in two vertebrae without any symptoms. No procedure-related complications occurred. Mean VAS and NDI declined from 7.1 ± 1.4 and 63.6 ± 16.3, respectively, before the procedure to 3.5 ± 1.1 and 37.4 ± 11.0, respectively, at three days after the procedure (P < 0.01). CT images at three months after the procedure confirmed that there were no cases of refractures at the treated or adjacent levels, recurrence of vertebral collapse and mobilization of bone cement block. Conclusion Vessel-plasty using BFMC appears to be effective and safe for malignant severe compression fractures in cervical vertebrae. It is effective in stabilizing vertebral body, relieving pain.
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Affiliation(s)
- Yue Yang
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Qinghua Tian
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Tao Wang
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Yingying Lu
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Wenbin Li
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Chungen Wu
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
- Correspondence: Chungen Wu; Wenbin Li, Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yi Shan Road, Shanghai, People’s Republic of China, Tel +8618930177559; +8618930177524, Email ;
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Zhou F, Niu N, Liang Q, Chang Y, Shi J, Wang Z. Clinical application of a modified percutaneous vertebroplasty instrument in vertebral body biopsy in adults. BMC Musculoskelet Disord 2022; 23:163. [PMID: 35183155 PMCID: PMC8857814 DOI: 10.1186/s12891-022-05117-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Percutaneous vertebroplasty (PVP) has been widely used to treat vertebral pathological fractures in recent decades, and the modified PVP instrument is very suitable for percutaneous biopsy of diseases promoting vertebral bone destruction. The purpose of this study was to evaluate the relevance of the clinical application of the modified PVP instrument in computed tomography-guided (CT-guided) biopsies of the vertebral body. Methods Retrospective analysis of clinical data obtained by percutaneous biopsy using a modified PVP outer shell of a bone filler device (OSBF) from 161 patients presenting vertebral body destruction was conducted. The rate of correctly performed biopsy diagnosis was evaluated from three aspects: imaging performance, histological type, and vertebral segment. Results The results of 149 biopsy cases were consistent with the final clinical diagnosis. From those cases, 92 were diagnosed as vertebral body metastasis, 45 cases presented primary spinal tumors and tumor-like changes, 7 cases presented vertebral body infections, and 5 cases displayed normal bones or fractures. From the remaining 12 patients, whose biopsy results were inconsistent with the final clinical diagnosis, 4 presented vertebral metastases, 4 displayed primary vertebral tumors, and 4 presented vertebral infections. The diagnostic rate of the modified PVP OSBF biopsy was 92.5%. The rate of correct biopsy diagnosis for vertebral metastases was 95.8%. The rate of correct diagnosis of primary vertebral tumors and tumor-like biopsy was 91.8%, and the rate of correct diagnosis for vertebral infectious diseases was 63.6%. Conclusion The modified PVP OSBF allows obtaining more lesion tissue, in multiple directions and multiple angles, during the biopsy of vertebral bones presenting destructive lesions. The technique displays appropriate safety and high diagnostic accuracy and presents a desirable reference value for the preoperative diagnosis of diseases that yield vertebral bone destruction, especially for vertebral tumor lesions.
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Bao LS, Wu W, Wang X, Zhong XH, Wang LX, Wang H. Clinical Observation of Intraosseous Anesthesia in Percutaneous Kyphoplasty. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5528073. [PMID: 34122783 PMCID: PMC8189784 DOI: 10.1155/2021/5528073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
Objective Percutaneous kyphoplasty (PKP) is an effective minimally invasive technique in spine surgery in recent years. General anesthesia and local anesthesia are the main ways of anesthesia in PKP, and epidural anesthesia is also applied to PKP to some extent. However, all these three anesthetic methods have their respective advantages and disadvantages. It is essential to compare and evaluate the effects of different anesthesia methods on PKP for treating spinal fractures. Method A total of 45 patients (53 vertebral bodies were included) were divided into two groups. Group A included 24 patients (29 vertebral bodies) with an average of 71 years old and Group B included 21 patients (24 vertebral bodies) with an average of 74 years old. Visual analogue scale (VAS) scores were recorded preoperatively; balloon expansion and bone cement injection were conducted intraoperatively. Then, they were recorded immediately after operation, 6 h postoperatively, to assess the pain level of the patient. Moreover, hospitalization time (days), operation duration (minutes), and bone cement injection amount (mL) had also been recorded. Results There was no significant difference in preoperative general information and VAS score. However, the VAS scores were statistically significant at both the moment of balloon expansion and injection of bone cement. At the moment of immediate postoperation, the VAS scores showed no statistically significant difference, while it showed a statistically significant difference 6 h postoperatively. Conclusion The anesthesia method by injection of 1% lidocaine hydrochloride (5 ml) into vertebral body can effectively relieve patients' pain in intraoperation and postoperation.
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Affiliation(s)
- Li-Shuai Bao
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Wei Wu
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Xin Wang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu 610000, China
| | - Xi-Hong Zhong
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Lin-Xiu Wang
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Hong Wang
- The First Affiliated Hospital of Dalian Medical University, Dalian 116000, China
- Dalian Municipal Central Hospital, Dalian, China
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Prestat AJ, Gondim Teixeira PA, Rauch A, Loeuille D, Pretat PH, Louis M, Blum A. First intention vertebroplasty in fractures within an ankylosed thoracolumbar spinal segment. Diagn Interv Imaging 2021; 102:421-430. [PMID: 33549510 DOI: 10.1016/j.diii.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/10/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the outcome of percutaneous vertebral cementoplasty (PVC) as the first-line treatment for traumatic thoracolumbar fractures within an ankylosed spinal segment. MATERIALS AND METHODS Thirty-one patients (15 men, 16 women; mean age: 79.2±11 [SD] years; age range: 66-95 years) with thoracolumbar fractures within an ankylosed spine segment without neurological impairment treated with PVC were retrospectively evaluated. All patients were controlled at six weeks and one year after PVC. Ankylosing conditions, fractures sites and types, radiological consolidation, spinal complications were assessed. Anterior/posterior vertebral height ratios were measured before and after PVC. Postoperative pain relief and treatment success (radiological fracture consolidation) rates were considered. RESULTS The 31 patients had a total of 39 fractures (19 stable [49%], 20 unstable [51%]) treated with PVC. Primary success rate of PVC (initial fracture consolidation without complication) was 61% (19/31). Seven patients (7/31; 23%) exhibited new fractures, and the secondary success rate of PVC (global fracture consolidation one year after repeat PVC) was 87% (34/39). Global consolidation rates of unstable fractures were 85% (17/20) of treated levels. Pain score was null in 84% patients (26/31) one year after PVC. There were no significant differences between pre-PVC (0.62±0.18 [SD]; range: 0.22-0.88) and post-PVC (0.60±0.18 [SD]; range: 0.35-0.88) vertebral height ratios (P=0.94). CONCLUSION PVC conveys a high overall success rate and effectively controls pain in patients with vertebral fractures within ankylosed spine segments.
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Affiliation(s)
- Alexandre J Prestat
- Guilloz Imaging Department, Central Hospital, University Hospital of Nancy (CHRU-Nancy), 54035 Nancy cedex, France; Department of Musculoskeletal Radiology, Hôpital Pasteur 2, CHU de Nice, 06000 Nice, France.
| | | | - Aymeric Rauch
- Guilloz Imaging Department, Central Hospital, University Hospital of Nancy (CHRU-Nancy), 54035 Nancy cedex, France
| | - Damien Loeuille
- Department of Rheumatology, Central Hospital, University Hospital Center of Nancy (CHRU-Nancy), 54511 Vandoeuvre-Lès-Nancy, France
| | - Pierre-Henri Pretat
- Department of Neurosurgery, Central Hospital, University Hospital Center of Nancy (CHRU-Nancy), 54035 Nancy cedex, France
| | - Matthias Louis
- Guilloz Imaging Department, Central Hospital, University Hospital of Nancy (CHRU-Nancy), 54035 Nancy cedex, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital of Nancy (CHRU-Nancy), 54035 Nancy cedex, France
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Zhang Z, Jiao F, Feng Y, Xie C, Qin F, Zhang S, Liu D, Tang W. Evaluation of the analgesic effect of vertebral cancellous bone infiltration anaesthesia during vertebroplasty. J Orthop Surg Res 2020; 15:342. [PMID: 32819404 PMCID: PMC7441718 DOI: 10.1186/s13018-020-01872-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 08/09/2020] [Indexed: 12/14/2022] Open
Abstract
Objective To evaluate the analgesic effect of vertebral cancellous bone infiltration anaesthesia during percutaneous vertebroplasty (PVP). Methods Patients treated with vertebral cancellous bone infiltration anaesthesia (intervention group) or local anaesthesia alone (control group) during PVP at our institution during 2016–2018 were reviewed. The visual analogue scale (VAS) score before the operation, during establishment of the puncture channel, during pressure changes in the vertebral body (e.g., when removing or inserting pushers or needle cores), during bone cement injection, immediately after the operation, and at 2 h and 1 day postoperatively were compared between the groups. The patient’s satisfaction with the operation was recorded and compared between groups. Results A total of 112 patients were enrolled (59 cases in the intervention group and 53 cases in the control group). There was no difference in the VAS score between the groups before the operation or during establishment of the intraoperative puncture channel (P > 0.05). The VAS score in the intervention group was significantly lower than that in the control group during pressure changes in the vertebral body (removal or insertion of puncture needle cores or pushers) and bone cement injection (P < 0.05). Immediately after the operation and at 2 h postoperatively, the pain in the intervention group was also significantly lower than that in the control group (P < 0.05), but there was no significant difference between the groups at 1 day postoperatively (P > 0.05). The patient satisfaction rate was 88% (52/59) in the intervention group and 67% (35/53) in the control group (P < 0.05). Conclusions Vertebral cancellous bone infiltration anaesthesia may effectively relieve intraoperative pain and improve the surgical experience of patients without affecting the clinical effect of surgery.
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Affiliation(s)
- Zhaofei Zhang
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China.
| | - Feng Jiao
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Yonghui Feng
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Chunliang Xie
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Fengwei Qin
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Sineng Zhang
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Donghua Liu
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Wang Tang
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
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Jiang J, Gu FL, Li ZW, Zhou Y. The clinical efficacy and experience of bipedicular percutaneous vertebroplasty combined with postural reduction in the treatment of Kümmell's disease. BMC Musculoskelet Disord 2020; 21:82. [PMID: 32033554 PMCID: PMC7007684 DOI: 10.1186/s12891-020-3113-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background Kümmell’s disease is a special type of osteoporotic vertebral fracture that causes chronic low back pain and deformity, which seriously affects the living quality of patients. PVP is commonly used to treat osteoporotic vertebral fractures and can quickly relieve low back pain. So, the objective of this study was to analyze the clinical efficacy and experience of bipedicular percutaneous vertebroplasty combined with postural reduction for the treatment of Kümmell’s disease. Methods A retrospective analysis of patients with Kümmell’s disease who underwent bipedicular percutaneous vertebroplasty was conducted from February 2016 to May 2018. Operative time, VAS, bone cement injection volume, cement leakage rate, compression improvement of vertebral front edge and vertebral center, and correction degree of kyphosis were collected and analyzed meticulously. Results The operative time was 45.33 ± 7.64 min. The volume of bone cement injected was 5.38 ± 1.33 ml. The compression improvement of vertebral front edge was 7.31 ± 1.21%. The compression improvement of vertebral center was 10.34 ± 1.15% and the correction degree of kyphosis was − 2.73 ± 0.31゜. Bone cement leakage occurred in 6 of 39 patients (15.38%), but no clinical symptoms were observed. The VAS scores were significantly lower at 1 day after the surgery, 6 months and at the last follow-up than before the surgery (P = 0.000, respectively). The VAS score was lower at the last follow-up than at 1 day after the surgery (P = 0.001). Conclusion Bipedicular percutaneous vertebroplasty combined with postural reduction could achieve satisfactory analgesic effect in the treatment of Kümmell’s disease, and restore the height of the vertebral body and improve kyphosis to some extent.
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Affiliation(s)
- Jiang Jiang
- Department of Orthopedics and Traumatology, Nantong Hospital of Chinese Medicine, Room 502 of Building 1 of Sujian Garden City, Chongchuan District, Nantong, China.
| | - Fu-Long Gu
- Department of Orthopedics and Traumatology, Nantong Hospital of Chinese Medicine, Room 502 of Building 1 of Sujian Garden City, Chongchuan District, Nantong, China
| | - Zhong-Wei Li
- Department of Orthopedics and Traumatology, Nantong Hospital of Chinese Medicine, Room 502 of Building 1 of Sujian Garden City, Chongchuan District, Nantong, China
| | - Yi Zhou
- Department of Orthopedics and Traumatology, Nantong Hospital of Chinese Medicine, Room 502 of Building 1 of Sujian Garden City, Chongchuan District, Nantong, China
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Abstract
BACKGROUND Despite optimal drug-conservative therapy, a relevant percentage of patients with vertebral compression fractures (WKF) do not experience any relevant improvement in their pain symptoms. Vertebroplasty (VP) and kyphoplasty (KP) are described in the literature as percutaneous interventional procedures for the treatment of WKF. OBJECTIVE Assessment of the effectiveness of the VP and KP in the treatment of WKF and discussion of the procedures in the context of the current literature. MATERIAL AND METHODS Presentation of the fundamentals of VP and KP and their further developments. Description of indications and contraindications. Discussion of the current literature and recommendations of the individual professional associations. RESULTS In patients with vertebral compression fractures, VP or KP of the affected vertebral body leads to a pain reduction in more than 90% of cases. Clinically relevant complications occur in less than 1% of interventions. CONCLUSION VP and KP are a safe and effective method for treating painful WKF. Optimal patient selection improves the clinical outcome.
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Wei P, Yao Q, Xu Y, Zhang H, Gu Y, Wang L. Percutaneous kyphoplasty assisted with/without mixed reality technology in treatment of OVCF with IVC: a prospective study. J Orthop Surg Res 2019; 14:255. [PMID: 31395071 PMCID: PMC6686364 DOI: 10.1186/s13018-019-1303-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/30/2019] [Indexed: 02/18/2023] Open
Abstract
Background The purpose of this study was to assess the clinical outcome of percutaneous kyphoplasty (PKP) assisted with mixed reality (MR) technology in treatment of osteoporotic vertebral compression fracture (OVCF) with intravertebral vacuum cleft (IVC). Method Forty cases of OVCF with IVC undergoing PKP were randomized into a MR technology-assisted group (group A) and a traditional C-arm fluoroscopy group (group B). Both groups were performed PKP and evaluated by VAS scores, ODI scores, radiological evidence of vertebral body height, and kyphotic angle (KA) at pre-operation and post-operation. The volume of injected cement, fluoroscopy times, and operation time were recorded. And cases of non-PMMA-endplates-contact(NPEC) in radiological evidence was also recorded postoperatively. The clinical outcomes and complications were evaluated afterwards. All patients received 10 to 14 months follow-up, with an average of 12 months. Result This MR-assisted group (group A) acquired more about the amount of the polymethyl methacrylate (PMMA) injection and postoperative vertebral height and less about postoperative KA, fluoroscopy times, and operation time compared with the control group (group B) (P < 0.05). The VAS scores and ODI scores in both groups have improved, but more significantly in group A (P < 0.05). Also, more cases achieve both-endplates-touching of cement in group A (P < 0.05). And there are less of the loss of vertebral height, KA, and occurrence of re-collapse of the vertebra in group A during the follow-up (P < 0.05). Conclusion PKP assisted with MR technology can accurately orientate the position of IVC area, which can be augmented by the balloon leading to more satisfied vertebral height improvement, cement diffusion, and pain relief. Trial registration ClinicalTrials.gov Identifier: NCT03959059. Registered 25 September 2016.
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Affiliation(s)
- Peiran Wei
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, No. 68 of ChangLe Road, Nanjing, 210029, Jiangsu Province, China
| | - Qingqiang Yao
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, No. 68 of ChangLe Road, Nanjing, 210029, Jiangsu Province, China
| | - Yan Xu
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, No. 68 of ChangLe Road, Nanjing, 210029, Jiangsu Province, China
| | - Huikang Zhang
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, No. 68 of ChangLe Road, Nanjing, 210029, Jiangsu Province, China
| | - Yue Gu
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, No. 68 of ChangLe Road, Nanjing, 210029, Jiangsu Province, China
| | - Liming Wang
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, No. 68 of ChangLe Road, Nanjing, 210029, Jiangsu Province, China.
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Liu L, Wang H, Wang J, Wang Q, Pu Y, Wang Z, Wu Y, Xu Y, Jin W. A study on the puncture method of extrapedicular infiltration anesthesia applied during lumbar percutaneous vertebroplasty or percutaneous kyphoplasty. Medicine (Baltimore) 2019; 98:e16792. [PMID: 31415385 PMCID: PMC6831313 DOI: 10.1097/md.0000000000016792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Extrapedicular infiltration anesthesia (EPIA) was reported for percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) and provided good local anesthetic effects. Because of differences in anatomical morphology at each lumbar level, the puncture method of EPIA is not uniform in each lumbar vertebrae. To accurately insert the anesthetic needle into the extrapedicular region, we researched the puncture method of EPIA at each lumbar level.We retrospectively analyzed computed tomography (CT) images in 230 patients with lumbar osteoporotic fractures, including 59 L1 fractures, 54 L2 fractures, 50 L3 fractures, 36 L4 fractures, and 31 L5 fractures. The puncture of EPIA was simulated in every fractured vertebrae through CT, and the skin puncture point, puncture direction, and puncture depth of the anesthetic needle were observed. These specific parameters were the distance from the skin puncture point to the superior border of the pedicle projection on the skin (distance AD), distance from the skin puncture point to the lateral border of the pedicle projection on the skin (distance BC), sagittal section angle (SSA), transverse section angle (TSA), and depth of EPIA.As the lumbar ordinal number increased, the SSA, distance AD, TSA, and distance BC for each lumbar level gradually increased, and the puncture depth gradually decreased, all these parameters showed significant differences among the 5 lumbar levels (P < .001). The recommended puncture methods for EPIA at each lumbar level, including distance AD, distance BC, SSA, and TSA, were as follows: in L1, 4 mm, 8 mm, 9° and 8°; in L2, 6 mm, 10 mm, 11° and 10°; in L3, 9 mm, 13 mm, 12° and 12°; in L4, 12 mm, 18 mm, 16° and 18°; and in L5, 20 mm, 26 mm, 24° and 24°. The depth of EPIA was 13 mm in L1-L3 and 11 mm in L4-L5.By confirming the skin puncture point and puncture direction of the anesthetic needle, from an anatomical perspective, EPIA is feasible for lumbar PVP (PKP).
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Affiliation(s)
- Liehua Liu
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region
| | - Haoming Wang
- Department of Orthopedics, Three Gorges Central Hospital
| | - Jiangang Wang
- Department of Orthopedics, No. 13 People's Hospital of Chongqing, Chongqing, China
| | - Qian Wang
- Hillsborough Community College, Tampa, FL
| | - Yu Pu
- Chengdu Public Health Centre, Chengdu, Sichuan
| | - Zili Wang
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region
| | - Yuexiang Wu
- Outpatient Department, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region
| | - Yuan Xu
- Department of Orthopedics, Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Weidong Jin
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region
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Velonakis G, Filippiadis D, Spiliopoulos S, Brountzos E, Kelekis N, Kelekis A. Evaluation of pain reduction and height restoration post vertebral augmentation using a polyether ether ketone (PEEK) polymer implant for the treatment of split (Magerl A2) vertebral fractures: a prospective, long-term, non-randomized study. Eur Radiol 2019; 29:4050-4057. [PMID: 30511178 DOI: 10.1007/s00330-018-5867-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/05/2018] [Accepted: 10/25/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The purposes of the study were to evaluate the safety and long-term efficacy of augmented vertebroplasty using a polyether ether ketone (PEEK) implant, for the treatment of lumbar or thoracic vertebral fractures (A2 according to the Magerl's AO classification) and to analyze pain reduction, height restoration, and complications during a 2-year follow-up period. METHODS Prospective non-randomized evaluation was performed for 21 painful split vertebral fractures (20 patients, 14 females, 6 males; mean age 72.80 ± 10.991) treated with percutaneous vertebral augmentation using a PEEK device, under fluoroscopic guidance. Pain before the procedure and after 6, 12, and 24 months was evaluated using a numeric visual scale (NVS) questionnaire. Imaging was performed by CT and X-rays. The minimum craniocaudal diameter at the level of the fracture and the maximum craniocaudal diameter at the middle of the fractured vertebra were measured. Statistical analysis was performed to evaluate pain decrease and height restoration. RESULTS Successful implant positioning was achieved in all cases. No major clinical complications were observed. Comparing the mean pain scores at baseline (8.69 ± 1.138) and the first day after the treatment (1.19 ± 1.424), there was a decrease of 7.50 NVS units (p < 0.001). Minimum and maximum vertebral body heights were increased after the procedure 56.58% and 13.7% respectively (p < 0.001). Both pain relief and height restoration remained statistically significant (p < 0.001) during the follow-up period. CONCLUSION A2 Magerl thoracic or lumbar fractures could be successfully treated with PEEK implant-assisted vertebral augmentation. Randomized studies with larger sample sizes should be done to confirm the effectiveness of the technique. KEY POINTS • Vertebral augmentation using a PEEK implant for the treatment of A2 Magerl lumbar or thoracic vertebral fractures seems to be effective both in terms of pain reduction and height restoration. • Effects on pain reduction and height restoration have a long-term duration. • The technique seems to be safe for the treatment of A2 Magerl fractures, without major complications in our study group.
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Affiliation(s)
- Georgios Velonakis
- 2nd Department of Radiology, Attikon General University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, 12462, Athens, Greece.
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, Attikon General University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, 12462, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, Attikon General University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, 12462, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Attikon General University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, 12462, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Attikon General University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, 12462, Athens, Greece
| | - Alexis Kelekis
- 2nd Department of Radiology, Attikon General University Hospital, National and Kapodistrian University of Athens, Rimini 1, Haidari, 12462, Athens, Greece
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Symptomatic Schmorl’s nodes: role of percutaneous vertebroplasty. Open study on 52 patients. Neuroradiology 2019; 61:405-410. [DOI: 10.1007/s00234-019-02171-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
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Qi Y, Zeng Y, Wang D, Sui J, Wang Q. Clinical application of the pedicle in vitro restorer in percutaneous kyphoplasty. J Orthop Surg Res 2018; 13:268. [PMID: 30359276 PMCID: PMC6203289 DOI: 10.1186/s13018-018-0978-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/17/2018] [Indexed: 11/16/2022] Open
Abstract
Background Percutaneous kyphoplasty (PKP) is widely applied for the treatment of osteoporotic vertebral compression fractures (OVCFs) and has achieved satisfactory clinical results. With the accumulation of clinical cases and prolonged follow-up times, the inability to reconstruct vertebral height defects has attracted more and more attention. A comparison of clinical effects was retrospectively reviewed in 72 patients who underwent simple PKP or pedicle in vitro restorer (PIVR) combined with PKP to discuss the clinical application of self-developed PIVR used in PKP. Methods From August 2013 to August 2016, 72 patients with OVCFs were treated surgically, with 30 patients undergoing PKP (group A) and 42 undergoing PIVR combined with PKP (group B). Operation-related situations, radiological data, and related scores were compared between the two groups by corresponding statistical methods. Results Bone cement was successfully injected into 72 vertebral bodies. Sixty-three cases were followed up for an average of 14 months. There were significant differences between the two groups in the improvement of the height of the vertebral body, sagittal Cobb angle, and visual analogue scale (VAS) 1 week after the operation (P < 0.05), and the improvements of group B were better than those in group A. The cement leakage ratio was significantly different between the two groups (P < 0.05). The Oswestry Disability Index (ODI) at last follow-up was significantly different between the two groups (P < 0.05). There was no significant difference in the incidence of recurrent vertebral fractures between the two groups at the last follow-up (P > 0.05). Conclusion PIVR combined with PKP can overcome the limitations of PKP alone, that is, hardly restoring vertebral height and height being easily lost again with balloon removal. The combined method can also restore the vertebral fractures to a satisfactory height and effectively maintain the stability of the spine, which improves the long-term quality of life of patients. Thus, PIVR combined with PKP is a better choice for patients with OVCFs.
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Affiliation(s)
- Yimin Qi
- Nanjing Medical University, Nanjing, China
| | - Yiwen Zeng
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, #68 Changle Rd, Qinhuai District, Nanjing, 210000, Jiangsu, China.
| | - Dalin Wang
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, #68 Changle Rd, Qinhuai District, Nanjing, 210000, Jiangsu, China
| | - Jisheng Sui
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, #68 Changle Rd, Qinhuai District, Nanjing, 210000, Jiangsu, China
| | - Qiang Wang
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, #68 Changle Rd, Qinhuai District, Nanjing, 210000, Jiangsu, China
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Vertebral augmentation with the SpineJack® in chronic vertebral compression fractures with major kyphosis. Eur Radiol 2018; 28:4985-4991. [PMID: 29948067 DOI: 10.1007/s00330-018-5544-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/07/2018] [Accepted: 05/16/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Osteoporotic vertebral compression fractures (OVCFs) are an important health issue for which minimally invasive techniques are a feasible treatment. The SpineJack® (Vexim) is an intravertebral expandable system designed to improve the correction of the structural modifications caused by OVCFs. Its ability to stabilise and reduce OVCFs at the acute phase being already well established, we sought to evaluate the feasibility of vertebral augmentation with the SpineJack® in chronic kyphotic OVCFs. METHODS All consecutive patients treated with the SpineJack® were prospectively included if they met the following criteria: (1) OVCF considered unstable (grade A3 according to Magerl's classification). (2) Local kyphotic angle ≥ 20°. (3) OVCF older than 6 weeks. (4) Back pain with visual analogue scale (VAS) ≥ 4. RESULTS Nineteen consecutive patients (16 women [84.2%] and 3 men [15.8%]; mean age 73.2 ± 8.2 years) were included. Treatment was performed after a mean delay of 5.8 months ± 2.9 (range 1.5-12). Median visual analogue scale significantly improved from 7 preoperatively (IQR 6-9) to 2 (IQR 1-5) at 6 months (p < 0.01). Significant kyphosis reduction (i.e. ≥ 30%) was obtained in 94.7% of cases. Secondary adjacent level fractures (SALFs) were noted in 21.1% of cases and were correlated with the importance of the kyphosis reduction. CONCLUSIONS Vertebral augmentation with the SpineJack® is feasible and seems able to correct major structural deformities in chronic OVCFs. SALFs were noted in a substantial amount of cases. Preventive adjacent vertebroplasty might be useful in patients with several risk factors for SALFs. KEY POINTS • Vertebral augmentation with SpineJack® is effective to correct major structural deformities e.g. height loss and kyphosis. • Successful reduction is reachable with SpineJack® in chronic (older than 6 weeks) OVCFs. • Aggressive reduction of major kyphosis might promote SALFs and complementary adjacent vertebroplasties prevent their occurrence.
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Denoix E, Viry F, Ostertag A, Parlier-Cuau C, Laredo JD, Cohen-Solal M, Bousson V, Funck-Brentano T. What are the predictors of clinical success after percutaneous vertebroplasty for osteoporotic vertebral fractures? Eur Radiol 2018; 28:2735-2742. [DOI: 10.1007/s00330-017-5274-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
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Early percutaneous vertebroplasty helps motorsport professionals to resume competition soon after vertebral fracture. Eur Radiol 2018; 28:2870-2871. [DOI: 10.1007/s00330-017-5250-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
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Percutaneous Vertebroplasty and Kyphoplasty: Current Status, New Developments and Old Controversies. Cardiovasc Intervent Radiol 2017; 40:1815-1823. [DOI: 10.1007/s00270-017-1779-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 08/22/2017] [Indexed: 12/26/2022]
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Yu Q, Chen L, Yan Z, Chu L, Shi L, Deng Z. [Effectiveness of percutaneous endoscopic technique in treatment of intraspinal cement leakage after percutaneous vertebroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:690-695. [PMID: 29798650 PMCID: PMC8498310 DOI: 10.7507/1002-1892.201612139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/25/2017] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the feasibility and safety of percutaneous endoscopic technique in the treatment of intraspinal cement leakage after percutaneous vertebroplasty (PVP). Methods Between May 2014 and March 2016, 5 patients with lower limb pain and spinal cord injury caused by intraspinal cement leakage after PVP, were treated with percutaneous endoscopic spinal decompression. Of 5 cases, 3 were male and 2 were female, aged from 65 to 83 years (mean, 74.4 years). The course of disease was 10-30 days (mean, 16.2 days). Imageological examinations confirmed the levels of cement leakage at T 12, L 1 in 3 cases, and at L 1, 2 in 2 cases; bilateral sides were involved in 1 case and unilateral side in 4 cases. Two patients had lower limb pain, whose visual analogue scale (VAS) were 8 and 7; 3 patients had lower extremities weakness, whose Japanese Orthopedic Association (JOA) 29 scores were 18, 20, and 19. According to American Spinal Injury Association (ASIA) impairment scale, neural function was rated as grade E in 2 cases and grade D in 3 cases. Results The operation time was 55-119 minutes (mean, 85.6 minutes), and the blood loss was 30-80 mL (mean, 48 mL). CT scan and three-dimensional (3D) reconstruction at 1 day after operation showed that cement leakage was removed in all patients. Five cases were followed up 6-21 months (mean, 12 months). In 2 patients with lower limb pain, and VAS score was significantly decreased to 2 at last follow-up. In 3 patients with lower extremities weakness, the muscle strength was improved progressively, and the JOA29 scores at last follow-up were 21, 23, and 22. Conclusion Percutaneous endoscopic technique for intraspinal cement leakage after PVP is safe, effective, and feasible.
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Affiliation(s)
- Qingshuai Yu
- Department of Orthopedics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China
| | - Liang Chen
- Department of Orthopedics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China
| | - Zhengjian Yan
- Department of Orthopedics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China
| | - Lei Chu
- Department of Orthopedics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China
| | - Lei Shi
- Department of Orthopedics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China
| | - Zhongliang Deng
- Department of Orthopedics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010,
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CIRSE Guidelines on Percutaneous Vertebral Augmentation. Cardiovasc Intervent Radiol 2017; 40:331-342. [DOI: 10.1007/s00270-017-1574-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/04/2017] [Indexed: 01/07/2023]
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Zhang JJ, Zhou Y, Hu HY, Sun YJ, Wang YG, Gu YF, Wu CG, Shen Z, Yao Y. Safety and efficacy of multilevel vertebroplasty for painful osteolytic spinal metastases: a single-centre experience. Eur Radiol 2016; 27:3436-3442. [PMID: 27975147 DOI: 10.1007/s00330-016-4683-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/03/2016] [Accepted: 11/29/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To retrospectively assess the safety and efficacy of percutaneous vertebroplasty (PVP) for painful osteolytic spinal metastases when treating more than three vertebrae per session. METHODS A total of 153 patients with painful osteolytic spinal metastases underwent PVP. Group A patients (n = 93) underwent PVP at up to three vertebral levels per session. Group B patients (n = 60) underwent PVP at more than three levels in one session. Pain, quality of life (QoL), and mobility were assessed before and after PVP. Minor and major complications were systematically assessed. RESULTS Both groups experienced significant pain relief and QoL improvement after the intervention (p < 0.001). Mobility improvement was observed in both groups, despite worse mobility status before PVP in group B compared with group A. There was no significant difference between the two groups throughout the follow-up period in overall pain relief and improvement in QoL and mobility. There was also no significant difference between groups in minor and major complications. CONCLUSIONS Multilevel vertebroplasty is safe and effective for the treatment of multiple osteolytic spinal metastases. Multilevel PVP relieves pain and improves QoL and mobility. KEY POINTS • Percutaneous vertebroplasty is safe and effective for painful osteolytic spinal metastases. • Multilevel vertebroplasty does not cause more complications than single-level vertebroplasty. • Multiple spinal metastases patients may regain functional independence after multilevel vertebroplasty.
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Affiliation(s)
- Jian-Jun Zhang
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yan Zhou
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Hai-Yan Hu
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yuan-Jue Sun
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yong-Gang Wang
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yi-Feng Gu
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Chun-Gen Wu
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Zan Shen
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China
| | - Yang Yao
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, China.
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Premat K, Clarençon F, Cormier É, Mahtout J, Bonaccorsi R, Degos V, Chiras J. Long-term outcome of percutaneous alcohol embolization combined with percutaneous vertebroplasty in aggressive vertebral hemangiomas with epidural extension. Eur Radiol 2016; 27:2860-2867. [DOI: 10.1007/s00330-016-4664-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 11/11/2016] [Accepted: 11/17/2016] [Indexed: 12/19/2022]
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