1
|
Essibayi MA, Mortezaei A, Azzam AY, Bangash AH, Eraghi MM, Fluss R, Brook A, Altschul DJ, Yassari R, Chandra RV, Cancelliere NM, Pereira VM, Jennings JW, Gilligan CJ, Bono CM, Hirsch JA, Dmytriw AA. Risk of adjacent level fracture after percutaneous vertebroplasty and kyphoplasty vs natural history for the management of osteoporotic vertebral compression fractures: a network meta-analysis of randomized controlled trials. Eur Radiol 2024:10.1007/s00330-024-10807-3. [PMID: 38811388 DOI: 10.1007/s00330-024-10807-3] [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: 03/08/2024] [Revised: 03/08/2024] [Accepted: 04/06/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES Percutaneous vertebroplasty and kyphoplasty are common interventions for osteoporotic vertebral compression fractures. However, there is concern about an increased risk of adjacent-level fractures after treatment. This study aimed to compare the risk of adjacent-level fractures after vertebroplasty and kyphoplasty with the natural history after osteoporotic vertebral compression fractures. MATERIALS AND METHODS A network meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the risk of adjacent-level fractures after vertebroplasty and kyphoplasty compared to the natural history after osteoporotic vertebral compression fractures. Frequentist network meta-analysis was conducted using the "netmeta" package, and heterogeneity was assessed using Q statistics. The pooled risk ratio (RR) and 95% confidence intervals (CI) were calculated using random effects. RESULTS Twenty-three RCTs with a total of 2838 patients were included in the analysis. The network meta-analysis showed comparable risks of adjacent-level fractures between vertebroplasty, kyphoplasty, and natural history after osteoporotic vertebral compression fractures with a mean follow-up of 21.2 (range: 3-49.4 months). The pooled RR for adjacent-level fractures after kyphoplasty compared to natural history was 1.35 (95% CI, 0.78-2.34, p = 0.23) and for vertebroplasty compared to natural history was 1.16 (95% CI, 0.62-2.14) p = 0.51. The risk of bias assessment showed a low to moderate risk of bias among included RCTs. CONCLUSION There was no difference in the risk of adjacent-level fractures after vertebroplasty and kyphoplasty compared to natural history after osteoporotic vertebral compression fractures. The inclusion of a large patient number and network meta-analysis of RCTs serve evidence-based clinical practice. CLINICAL RELEVANCE STATEMENT The risk of adjacent-level fracture following percutaneous vertebroplasty or kyphoplasty is similar to that observed in the natural history after osteoporotic vertebral compression fractures. KEY POINTS RCTs have examined the risk of adjacent-level fracture after intervention for osteoporotic vertebral compression fractures. There was no difference between vertebroplasty and kyphoplasty patients compared to the natural disease history for adjacent compression fractures. This is strong evidence that interventional treatments for these fractures do not increase the risk of adjacent fractures.
Collapse
Affiliation(s)
- Muhammed Amir Essibayi
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Radiology, Mayo Clinic, Rochester, NY, USA
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ali Mortezaei
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ahmed Y Azzam
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ali Haider Bangash
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mohammad Mirahmadi Eraghi
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rose Fluss
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Allan Brook
- Department of Neuroradiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David J Altschul
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Reza Yassari
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ronil V Chandra
- Department of Interventional Neuroradiology, Monash Health, Clayton, VIC, Australia
- Department of Image, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, VIC, Australia
| | - Nicole M Cancelliere
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Vitor Mendes Pereira
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Jack W Jennings
- Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine, St. Louis, MO, USA
| | | | - Christopher M Bono
- Department of Orthopedics, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua A Hirsch
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Senior affiliate research fellow, The Harvey L. Neiman Health Policy Institute, Reston, Virginia, USA
| | - Adam A Dmytriw
- Neurovascular Centre, Divisions of Therapeutic Neuroradiology & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
2
|
Tang M, Zhang G, Zeng F, Chang X, Fang Q, He M, Yin S. Paraspinal muscle parameters' predictive value for new vertebral compression fractures post-vertebral augmentation: Nomogram development and validation. Front Med (Lausanne) 2024; 11:1379078. [PMID: 38813387 PMCID: PMC11133621 DOI: 10.3389/fmed.2024.1379078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024] Open
Abstract
Objective Prior research underscores the significance of paraspinal muscles in maintaining spinal stability. This study aims to investigate the predictive value of paraspinal muscle parameters for the occurrence of new vertebral compression fractures (NVCF) following percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCF). Methods Retrospectively collected data from October 2019 to February 2021 (internal validation, n = 235) and March 2021 to November 2021 (external validation, n = 105) for patients with OVCF treated with PVP/PKP at our institution. They were randomly divided into training (188 cases) and validation groups (47 cases) at an 8:2 ratio. Lasso regression and multivariable logistic regression identified independent risk factors in the training set, and a Nomogram model was developed. Accuracy was assessed using receiver operating characteristic curves (ROC), calibration was evaluated with calibration curves and the Hosmer-Lemeshow test, and clinical utility was analyzed using decision curve analysis (DCA) and clinical impact curve (CIC). Results Surgical approach, spinal computed tomography (CT) values, and multifidus skeletal muscle index (SMI) are independent predictors of postoperative NVCF in OVCF patients. A Nomogram model, based on the identified predictors, was developed and uploaded online. Internal validation results showed area under the curve (AUC) values of 0.801, 0.664, and 0.832 for the training set, validation set, and external validation, respectively. Hosmer-Lemeshow goodness-of-fit tests (χ2 = 7.311-14.474, p = 0.070-0.504) and calibration curves indicated good consistency between observed and predicted values. DCA and CIC demonstrated clinical net benefit within risk thresholds of 0.06-0.84, 0.12-0.23, and 0.01-0.27. At specificity 1.00-0.80, the partial AUC (0.106) exceeded that at sensitivity 1.00-0.80 (0.062). Conclusion Compared to the spinal CT value, the multifidus SMI has certain potential in predicting the occurrence of NVCF. Additionally, the Nomogram model of this study has a greater negative predictive value.
Collapse
Affiliation(s)
- Ming Tang
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
- The Fifth Clinical College of Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Guangdong Zhang
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Fanyi Zeng
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Xindong Chang
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Qingqing Fang
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Mingfei He
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Shiwu Yin
- Department of Interventional Vascular Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
- The Fifth Clinical College of Medicine, Anhui Medical University, Hefei, Anhui, China
| |
Collapse
|
3
|
Zhang S, Lee Y, Liu Y, Yu Y, Han I. Stem Cell and Regenerative Therapies for the Treatment of Osteoporotic Vertebral Compression Fractures. Int J Mol Sci 2024; 25:4979. [PMID: 38732198 PMCID: PMC11084822 DOI: 10.3390/ijms25094979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Osteoporotic vertebral compression fractures (OVCFs) significantly increase morbidity and mortality, presenting a formidable challenge in healthcare. Traditional interventions such as vertebroplasty and kyphoplasty, despite their widespread use, are limited in addressing the secondary effects of vertebral fractures in adjacent areas and do not facilitate bone regeneration. This review paper explores the emerging domain of regenerative therapies, spotlighting stem cell therapy's transformative potential in OVCF treatment. It thoroughly describes the therapeutic possibilities and mechanisms of action of mesenchymal stem cells against OVCFs, relying on recent clinical trials and preclinical studies for efficacy assessment. Our findings reveal that stem cell therapy, particularly in combination with scaffolding materials, holds substantial promise for bone regeneration, spinal stability improvement, and pain mitigation. This integration of stem cell-based methods with conventional treatments may herald a new era in OVCF management, potentially improving patient outcomes. This review advocates for accelerated research and collaborative efforts to translate laboratory breakthroughs into clinical practice, emphasizing the revolutionary impact of regenerative therapies on OVCF management. In summary, this paper positions stem cell therapy at the forefront of innovation for OVCF treatment, stressing the importance of ongoing research and cross-disciplinary collaboration to unlock its full clinical potential.
Collapse
Affiliation(s)
- Songzi Zhang
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Republic of Korea; (S.Z.); (Y.L.); (Y.Y.)
| | - Yunhwan Lee
- Department of Medicine, School of Medicine, CHA University, Seongnam-si 13496, Republic of Korea;
| | - Yanting Liu
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Republic of Korea; (S.Z.); (Y.L.); (Y.Y.)
| | - Yerin Yu
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Republic of Korea; (S.Z.); (Y.L.); (Y.Y.)
| | - Inbo Han
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam-si 13496, Republic of Korea; (S.Z.); (Y.L.); (Y.Y.)
| |
Collapse
|
4
|
Si X, Shan D, Huo L, Hu Y, Zou C, Wang B, Cao J, Wu W. Effect of percutaneous vertebroplasty versus percutaneous kyphoplasty on post-operative wound pain in patients with osteoporotic vertebral compression fractures. Int Wound J 2024; 21:e14745. [PMID: 38484743 PMCID: PMC10940009 DOI: 10.1111/iwj.14745] [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] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/21/2024] [Indexed: 03/18/2024] Open
Abstract
This research is intended to evaluate the efficacy of percutaneous vertebroplasty (PVP) versus percutaneous kyphoplasty (PKP) in osteoporotic vertebral compression fracture (OVCF), which is associated with post-operative pain. Eligible studies were screened by searching multiple databases and sources such as PubMed, Cochrane and EMBASE for search terms updated to October 2023, and relevant literature sources were searched. Randomized, controlled, prospective or retrospective, and cohort studies were eligible. For the analysis of the primary results, an analysis of the data was carried out, such as mean difference (MD) or odds ratio (OR), and 95% confidence interval (CI). In the present research, 1933 research was screened in 4 databases, and 30 articles were chosen to be examined under strict exclusion criteria. No statistical significance was found in the use of bone cement in the PVP group and PKP (MD, -0.60; 95% CI, -1.40, 0.21, p = 0.15); PKP was associated with a reduced risk of cement leak compared with PVP group (OR, 2.18; 95% CI, 1.38, 3.46, p = 0.0009); no statistical significance was found in the wound VAS score in PVP operation compared with that of PKP (MD, 0.16; 95% CI, -0.07, 0.40, p = 0.17); no statistical significance was found between the time of PVP operation and the time of PKP operation (MD, -2.65; 95% CI, -8.91, 3.60, p = 0.41). Compared with PVP technology, the PKP treatment of osteoporotic vertebral compression fractures reduces post-operative cement leakage, but there is no significant difference in the number of operative cement and wound VAS after operation. Nor did there appear to be a statistically significant difference in time between the two operations.
Collapse
Affiliation(s)
- Xiaojing Si
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Dongli Shan
- Department of Bone & Soft Tissue CancerChongqing University Cancer HospitalChongqingChina
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized TreatmentChongqing University Cancer HospitalChongqingChina
| | - li Huo
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Yongjun Hu
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Chuanqi Zou
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Boxin Wang
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Junxiong Cao
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Wenjie Wu
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| |
Collapse
|
5
|
Yoon SH, Park HG, Lee DH, Lee DU. Comparison of Clinical and Radiological Outcomes after Vertebroplasty and Balloon Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures. J Bone Metab 2024; 31:56-62. [PMID: 38485242 PMCID: PMC10940103 DOI: 10.11005/jbm.2024.31.1.56] [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: 12/31/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Vertebroplasty (VP) and balloon kyphoplasty (KP) are effective means with which to improve pain and function in osteoporotic vertebral compression fractures. However, the risk of complications after these procedures is poorly understood, with concerns regarding adjacent vertebral fractures. This study retrospectively investigated the clinical and radiological outcomes of these procedures. METHODS A total of 115 patients who experienced their first vertebral fracture were treated with VP (N=63) or KP (N=52) at the Dankook University Hospital between January 2013 and December 2022. The clinical outcomes were evaluated using the visual analog scale (VAS) preoperative and at 1-year follow-up. Radiological comparisons were performed for kyphosis correction, vertebral height restoration, and postoperative cement leakage. RESULTS KP was more effective than VP, especially for vertebral body height restoration and kyphotic angle reduction (P<0.05). However, the incidence of cement leakage, new adjacent vertebral fractures, and improvement in pain assessed by VAS did not differ statistically between the 2 groups (P>0.05). CONCLUSIONS Considering that KP was performed on fractures with severe deformity, no differences were observed in the clinical outcomes and incidence of adjacent vertebral fractures compared Considering that KP was performed for fractures with severe deformity, there was no difference in clinical outcomes and incidence of adjacent vertebral fractures compared to VP. Improvements in radiological measurements were demonstrated. Therefore, KP may be a good treatment option for pain relief and long-term prognosis in patients with high-compressive-rate vertebral fractures.
Collapse
Affiliation(s)
- Sung-Hyun Yoon
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Hee-Gon Park
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Dong-Uk Lee
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Zhan Z, Li R, Fu D, Han H, Wu Y, Meng B. Clinical efficacy and influencing factors of percutaneous kyphoplasty for osteoporotic vertebral compression fractures: a 10-year follow-up study. BMC Surg 2024; 24:29. [PMID: 38238715 PMCID: PMC10797895 DOI: 10.1186/s12893-024-02322-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 01/12/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND To date, few reports have evaluated the long-term outcome of percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) and the factors influencing the long-term outcome of this procedure are uncertain. METHODS A total of 91 patients underwent PKP for thoracolumbar OVCFs from June 2012 to December 2012. Pain Visual Analogue Scores (VAS) and Oswestry Disability Index (ODI) were recorded preoperatively and after 10-year follow-up. Factors that may affect surgical outcome, such as gender, age, height, weight, hypertension, diabetes, cause of injury, fracture segment, length of hospitalization, history of previous spinal surgery, preoperative bone mineral density (BMD), preoperative VAS and ODI scores, length of surgery, bone cement dosage, postoperative standardized anti-osteoporosis treatment, and other new vertebral fractures, were analyzed by multiple linear regression with VAS and ODI scores at the last follow-up. The correlation factors affecting the efficacy were analyzed. RESULTS The preoperative and final follow-up pain VAS was 7.9 ± 1.1 and 2.2 ± 1.1. ODI scores were 30.4 ± 4.2 and 10.7 ± 2.6. The difference was statistically significant (P < 0.05). Most of the patients were females aged 65-75 years who suffered low-energy injuries, with most of the fracture segments in the thoracolumbar region (T11-L2). At the final follow-up visit, 12 cases (13.19%) developed other new vertebral fractures, and 33 cases (36.26%) continued to adhere to anti-osteoporosis treatment after discharge. Multiple linear regression analysis showed that there was a statistical difference between gender and VAS score at the last follow-up (P < 0.05), and between age, cause of injury and postoperative standardized anti-osteoporosis treatment and ODI at the last follow-up (P < 0.05). There were no statistically significant differences between the other factors and the final follow-up VAS and ODI scores (P > 0.05). CONCLUSION The long-term outcome after PKP is satisfactory. Age, gender, cause of injury, and standardized postoperative anti-osteoporosis treatment may be factors affecting the long-term outcome.
Collapse
Affiliation(s)
- Zihao Zhan
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China, No.899 Pinghai Road
| | - Ran Li
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China, No.899 Pinghai Road
| | - Dongming Fu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China, No.899 Pinghai Road
| | - Hao Han
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China, No.899 Pinghai Road
| | - Yiang Wu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China, No.899 Pinghai Road
| | - Bin Meng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China, No.899 Pinghai Road.
| |
Collapse
|
8
|
Skjødt MK, Abrahamsen B. New Insights in the Pathophysiology, Epidemiology, and Response to Treatment of Osteoporotic Vertebral Fractures. J Clin Endocrinol Metab 2023; 108:e1175-e1185. [PMID: 37186550 DOI: 10.1210/clinem/dgad256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/27/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
CONTEXT Vertebral fractures (VFs) make up an important but challenging group of fractures often caused by osteoporosis. Osteoporotic fractures pose unique diagnostic challenges in generally requiring imaging for diagnosis. The objective of this narrative mini-review is to provide an overview of these recent advances in our knowledge of VF pathophysiology and epidemiology with particular focus on endocrine diseases, prevention, and treatment. EVIDENCE ACQUISITION We searched PubMed on May 23, 2022, for studies of VFs in humans. Results were limited to papers available as full-text publications in English, published from 2020 and onward. This yielded 3457 citations. This was supplemented by earlier publications selected to add context to the recent findings. EVIDENCE SYNTHESIS Studies addressed VF risk in hyperthyreosis, hyperparathyroidism, acromegaly, Cushing syndrome, primary aldosteronism, and diabetes. For pharmaceutical treatment, new studies or analyses were identified for romosozumab and for weekly teriparatide. Several studies, including studies in the immediate pipeline, were intervention studies with vertebroplasty or kyphoplasty, including combination with stem cells or pharmaceuticals. CONCLUSIONS Endocrinologists should be aware of the high likelihood of osteoporotic VFs in patients with endocrine diseases. Though licensed treatments are able to substantially reduce the occurrence of VFs in patients with osteoporosis, the vast majority of recent or ongoing randomized controlled trials in the VF area focus on advanced invasive therapy of the fracture itself.
Collapse
Affiliation(s)
- Michael Kriegbaum Skjødt
- Department of Medicine 1, Holbæk Hospital, DK-4300 Holbæk, Denmark
- OPEN-Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, DK-5000 Odense, Denmark
| | - Bo Abrahamsen
- Department of Medicine 1, Holbæk Hospital, DK-4300 Holbæk, Denmark
- OPEN-Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, DK-5000 Odense, Denmark
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford OX3 7LD, UK
| |
Collapse
|
9
|
Beall DP, Phillips TR. Vertebral augmentation: an overview. Skeletal Radiol 2023; 52:1911-1920. [PMID: 35761093 DOI: 10.1007/s00256-022-04092-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 02/02/2023]
Abstract
Vertebral compression fractures (VCFs) are a common pathologic process seen in 30-50% of individuals over the age of 50 years. Historically, VCFs were first treated with nonsurgical management while vertebral augmentation was reserved for severe cases resulting in deformity or significant disability. Current treatment algorithms based on established appropriateness criteria have changed recommendations towards supporting early vertebral augmentation for the VCFs causing the most clinically difficulty and taking into account the degree of vertebral body height loss, kyphotic deformity, and the degree of clinical progression. Percutaneous vertebroplasty (PVP) involves injecting primarily polymethacrylate (PMMA) bone cement directly into the cancellous bone of the vertebral body. There is recent literature showing the effectiveness of PVP including data comparing vertebroplasty to sham treatment. Vertebroplasty evolved into balloon kyphoplasty (BKP) where a balloon is first inserted into the vertebral body to create a cavity and reduce the fracture followed by an injection of bone cement. Both PVP and BKP have been shown to be significantly more effective at treatment of VCFs compared to nonsurgical management. The benefits shown in the literature have been demonstrated randomized control trials, cohort matched trials, post-market trials, registries, and many other data sources with approximately 250 manuscripts produced per year dedicated to the topic of vertebral augmentation.
Collapse
Affiliation(s)
- Douglas P Beall
- Comprehensive Specialty Care, 1700 S. State St, Edmond, OK, 73013, USA
| | - Tyler R Phillips
- Clinical Radiology of Oklahoma, 1700 S. State St, Edmond, OK, 73013, USA.
| |
Collapse
|
10
|
Matsumoto K, Hoshino M, Omori K, Igarashi H, Matsuzaki H, Sawada H, Saito S, Suzuki S, Miyanaga Y, Nakanishi K. The Relationship Between Global Sagittal Balance and the Incidence of Early Adjacent Vertebral Fractures Following Balloon Kyphoplasty. World Neurosurg 2023; 175:e818-e822. [PMID: 37068605 DOI: 10.1016/j.wneu.2023.04.027] [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: 03/20/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Recently, it is widely known that global sagittal balance (GSB) influences the postoperative outcome of the spine. The purpose of this study was to investigate the relationship between GSB and the incidence of early adjacent vertebral fracture (AVF) following balloon kyphoplasty (BKP). METHODS This study included 96 patients (19 males, 77 females, mean age 77.4 ± 5.5 years) who underwent BKP for osteoporotic vertebral fracture and who were over 60-years-old. We investigated the effect of GSB on early AVF within 2 months after surgery. Of the 96 patients, 76 patients (16 males, 60 females, mean age 77.0 ± 5.4) underwent BKP at the thoracolumbar junction (T11-L2) and were investigated independently. After the two-group comparison, logistic regression analysis was performed. RESULTS During the observation period (18.3 ± 14.7 months), 27 of 96 patients (28.1%) suffered AVF after BKP, and 24 of 96 patients (25.0%) suffered early AVF. In the logistic regression analysis, spinopelvic parameters were not detected as significant risk factors. In cases of BKP at the thoracolumbar junction (T11-L2), 24 of 76 patients (31.6%) suffered AVF after BKP during the observation period (15.3 ± 19.5 months), and 21 of 76 patients (27.6%) suffered early AVF. Logistic regression analysis detected pelvic tilt (PT): odds ratio 1.087 (P = 0.046∗) and local kyphosis: 1.147 (P = 0.003∗) as risk factors for early AVF. The cutoff value was PT≥29° from the receiver operating characteristics curve. CONCLUSIONS At the thoracolumbar junction (T11-L2), PT ≥29° is one of the risk factors of early AVF following BKP.
Collapse
Affiliation(s)
- Koji Matsumoto
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan.
| | - Masahiro Hoshino
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, Tokyo, Japan
| | - Keita Omori
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, Tokyo, Japan
| | - Hidetoshi Igarashi
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, Tokyo, Japan
| | - Hiromi Matsuzaki
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, Tokyo, Japan
| | - Hirokatsu Sawada
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Sosuke Saito
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Yuya Miyanaga
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| |
Collapse
|
11
|
Gao W, Chen Y, Wang X, Liu G, Cui K, Guo J, Zheng J, Hao Y. Establishment and Verification of a Predictive Nomogram for New Vertebral Compression Fracture Occurring after Bone Cement Injection in Middle-Aged and Elderly Patients with Vertebral Compression Fracture. Orthop Surg 2023; 15:961-972. [PMID: 36718651 PMCID: PMC10102309 DOI: 10.1111/os.13655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE New vertebral compression fracture (NVCF) occurring after bone cement injection in middle-aged and elderly patients with vertebral compression fracture is very common. Preoperative baseline characteristics and surgical treatment parameters have been widely studied as a risk factor, but the importance of the patients' laboratory indicators has not been thoroughly explored. We aimed to explore the relationship between laboratory indicators and NVCF, and attempt to construct a clinical prediction model of NVCF together with other risk factors. METHODS Retrospective analysis was performed for 200 patients who underwent bone cement injection (percutaneous kyphoplasty or vertebroplasty) for vertebral compression fractures between January 2019 and January 2020. We consulted the relevant literature and collated the factors affecting the occurrence of NVCF. Feature selection of patients with NVCF was optimized using the least absolute shrinkage and selection operator regression model, which was used to conduct multivariable logistic regression analysis, to create a predictive model incorporating the selected features. The discrimination, calibration, and clinical feasibility of the predictive model were assessed using the concordance index (C-index), calibration plots, and decision curve analysis. Internal validation was performed using Bootstrap resampling verification. RESULTS Time from injury to surgery exceeding 7 days, low osteocalcin levels, elevated homocysteine levels, osteoporosis, mode of operation (percutaneous vertebroplasty), lack of postoperative anti-osteoporosis treatment, and poor diffusion of bone cement were independent risk factors for NVCF in middle-aged and elderly patients with vertebral compression fracture after bone cement injection. The C-index of the nomogram constructed using these seven factors was 0.895, indicating good discriminatory ability. The calibration plot showed that the model was well calibrated. Bootstrap resampling verification yielded a significant C-index of 0.866. Decision curve analysis demonstrated that the greatest clinical net benefit for predicting NVCF after bone cement injection could be achieved with a threshold of 1%-91%. CONCLUSION This nomogram can effectively predict NVCF incidence after bone cement injection in middle-aged and elderly patients with vertebral compression fracture, thus aiding clinical decision-making and postoperative management, promoting effective postoperative rehabilitation, and improving the quality of life.
Collapse
Affiliation(s)
- Wenxin Gao
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yungang Chen
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | | | - Guoyan Liu
- Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Kaiying Cui
- Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Jinxing Guo
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jianhu Zheng
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yanke Hao
- Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| |
Collapse
|
12
|
Eneling J, Darsaut TE, Veilleux C, Raymond J. Understanding the choice of control group: A systematic review of vertebroplasty trials for osteoporotic vertebral compression fractures. Neurochirurgie 2023; 69:101401. [PMID: 36566694 DOI: 10.1016/j.neuchi.2022.101401] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To better understand the choice of the comparator intervention in the design of clinical trials and its impact on the meaning of results we review randomized trials on vertebroplasty. METHODS We conducted a systematic and narrative review of all randomized trials on vertebroplasty. Trials are categorized according to the comparator intervention (non-surgical management, placebo/sham vertebroplasty, and kyphoplasty). RESULTS All trials were too small to show a difference in objective clinical outcomes, and 20 of 23 RCTs used mean pain scores to compare interventions. Most trials comparing vertebroplasty with non-surgical management concluded that vertebroplasty was superior. Trials comparing kyphoplasty with vertebroplasty showed similar results for both interventions. However, 4 of 5 trials comparing vertebroplasty with placebo surgery failed to show a significant difference between groups. CONCLUSION The clinical results of an intervention cannot be interpreted without a comparison that involves a control group. The choice of comparator intervention can change the meaning of the trial. A large pragmatic trial, using hard clinical outcomes such as morbidity and mortality as a primary outcome measure, would be needed to assess the potential clinical benefits of vertebroplasty.
Collapse
Affiliation(s)
- J Eneling
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
| | - T E Darsaut
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - C Veilleux
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - J Raymond
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| |
Collapse
|
13
|
Sayed D, Grider J, Strand N, Hagedorn JM, Falowski S, Lam CM, Tieppo Francio V, Beall DP, Tomycz ND, Davanzo JR, Aiyer R, Lee DW, Kalia H, Sheen S, Malinowski MN, Verdolin M, Vodapally S, Carayannopoulos A, Jain S, Azeem N, Tolba R, Chang Chien GC, Ghosh P, Mazzola AJ, Amirdelfan K, Chakravarthy K, Petersen E, Schatman ME, Deer T. The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain. J Pain Res 2022; 15:3729-3832. [PMID: 36510616 PMCID: PMC9739111 DOI: 10.2147/jpr.s386879] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety. Objective The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders. Methods The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented. Results After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain. Conclusion The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.
Collapse
Affiliation(s)
- Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA,Correspondence: Dawood Sayed, The University of Kansas Health System, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA, Tel +1 913-588-5521, Email
| | - Jay Grider
- University of Kentucky, Lexington, KY, USA
| | - Natalie Strand
- Interventional Pain Management, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Steven Falowski
- Functional Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Christopher M Lam
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Vinicius Tieppo Francio
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Nestor D Tomycz
- AHN Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Rohit Aiyer
- Interventional Pain Management and Pain Psychiatry, Henry Ford Health System, Detroit, MI, USA
| | - David W Lee
- Physical Medicine & Rehabilitation and Pain Medicine, Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | - Hemant Kalia
- Rochester Regional Health System, Rochester, NY, USA,Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Soun Sheen
- Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Mark N Malinowski
- Adena Spine Center, Adena Health System, Chillicothe, OH, USA,Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Michael Verdolin
- Anesthesiology and Pain Medicine, Pain Consultants of San Diego, San Diego, CA, USA
| | - Shashank Vodapally
- Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI, USA
| | - Alexios Carayannopoulos
- Department of Physical Medicine and Rehabilitation, Rhode Island Hospital, Newport Hospital, Lifespan Physician Group, Providence, RI, USA,Comprehensive Spine Center at Rhode Island Hospital, Newport Hospital, Providence, RI, USA,Neurosurgery, Brown University, Providence, RI, USA
| | - Sameer Jain
- Interventional Pain Management, Pain Treatment Centers of America, Little Rock, AR, USA
| | - Nomen Azeem
- Department of Neurology, University of South Florida, Tampa, FL, USA,Florida Spine & Pain Specialists, Riverview, FL, USA
| | - Reda Tolba
- Pain Management, Cleveland Clinic, Abu Dhabi, United Arab Emirates,Anesthesiology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA, USA,Center for Regenerative Medicine, University Southern California, Los Angeles, CA, USA
| | | | | | | | - Krishnan Chakravarthy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, CA, USA,Va San Diego Healthcare, San Diego, CA, USA
| | - Erika Petersen
- Department of Neurosurgery, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA,Department of Population Health - Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| |
Collapse
|
14
|
Wang T, Si F, Zang L, Fan N, Yuan S, Du P, Wu Q, Wang A, Lu X. Radiographic adjacent segment degeneration and risk factors for osteoporotic vertebral compression fractures treated with percutaneous kyphoplasty. INTERNATIONAL ORTHOPAEDICS 2022; 46:2619-2628. [PMID: 35864260 DOI: 10.1007/s00264-022-05510-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE In this study, we aimed to clarify whether osteoporotic vertebral compression fracture (OVCF) following percutaneous kyphoplasty (PKP) was associated with a high risk for radiographic adjacent segment degeneration (ASD) and to identify the risk factors for radiographic ASD in these individuals. METHODS We retrospectively reviewed consecutive patients with OVCFs who underwent PKP at our institution between November 2015 and January 2021. The incidence of radiographic ASD was calculated and specific subgroups of ASD were identified. Univariate and multivariate analyses of demographic, clinical baseline, and radiologic data were performed to identify risk factors associated with radiographic ASD. RESULTS With a mean follow-up time of 27.3 months, a total of 95 eligible patients were enrolled. The incidence of radiographic ASD distinguished from natural degeneration was 52.6%. Patients with OVCFs who underwent PKP had a high risk of developing radiographic ASD, particularly disc degeneration. Intradiscal cement leakage (odds ratio [OR], 5.706; 95% confidence interval [CI], 2.039-15.970; P = 0.001) and preoperative disc height (OR, 0.681; 95% CI, 0.518-0.895; P = 0.006) were identified as independent risk factors. CONCLUSION Patients with OVCFs who underwent PKP were more likely to develop radiographic ASD, and their progression was distinguished from natural degeneration. Disc degeneration was the most common type of degeneration. Intradiscal cement leakage and preoperative disc height were identified as independent risk factors for developing radiographic ASD in these patients. Further validation through prospective multicenter studies is required.
Collapse
Affiliation(s)
- Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Fangda Si
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Qichao Wu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Xuanyu Lu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| |
Collapse
|
15
|
Fan N, Wang T, Wang A, Yuan S, Du P, Si F, Zhu W, Li J, Zang L. A predictive nomogram for intradiscal cement leakage in percutaneous kyphoplasty for osteoporotic vertebral compression fractures combined with intravertebral cleft. Front Surg 2022; 9:1005220. [PMID: 36277280 PMCID: PMC9581225 DOI: 10.3389/fsurg.2022.1005220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND For patients with osteoporotic vertebral compression fractures (OVCFs) treated with percutaneous kyphoplasty (PKP), the occurrence and risk factors of intradiscal cement leakage should be characteristic of the presence of intravertebral cleft (IVC). This study aimed to identify risk factors for intradiscal leakage in individuals with OVCFs combined with IVC treated with PKP and build a powered and well-calibrated predictive nomogram. METHODS This study retrospectively reviewed consecutive patients who underwent PKP at our center between January 2016 and May 2021. Patients diagnosed with OVCFs combined with IVC were identified, and the incidence of different types of bone cement leakage was recorded. Risk factors for intradiscal leakage among the demographic, perioperative baseline, and radiologic data were identified, following which a nomogram was developed and verified. RESULTS A total of 109 eligible patients were included, and the intradiscal leakage rate was 32.1%. Compression rate (odds ratio [OR] 0.025; 95% confidence interval [CI] 0.002-0.264; P = 0.002) and cemented vertebral body fraction (OR 44.122; 95% CI 2.790-697.740; P = 0.007) were identified as independent risk factors. A predictive nomogram with good predictive power (C-statistic = 0.786) and fitness of data (Hosmer-Lemeshow goodness-of-fit test, P = 0.092) was established to build a quantitative relationship between the risk factors and intradiscal leakage. CONCLUSION The incidence rate of intradiscal leakage in PKP for OVCFs combined with IVC was 32.1%. Compression rate and cemented vertebral body fraction were identified as independent risk factors. A powered and well-calibrated nomogram was established to accurately predict the probability of intradiscal leakage. Further prospective and multicenter studies are required to verify and calibrate our findings.
Collapse
|
16
|
Fan Z, Huang H, Lin Y, Zhou J, Lin F, Chen B, Wang H, Su H, Qi J, Huang Y, Huang Y. Do we have to pursue complete reduction after PVA in osteoporotic vertebral compression fractures: a finite element analysis. Injury 2022; 53:2754-2762. [PMID: 35760641 DOI: 10.1016/j.injury.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Consensus regarding the optimal amount of bone cement and vertebral height in the treatment of osteoporotic vertebral compression fractures (OVCFs) is lacking. Our purpose was to explore the optimal amount of bone cement and vertebral height in OVCF after percutaneous vertebral augmentation (PVA). METHODS A three-dimensional finite element model of the L1-L3 segments was constructed from CT scans of aging osteoporosis patients. Four different postoperative vertebral height models were simulated according to Genant semiquantitative grades 0, 1, 2, and 3. The volume of bone cement filling ranged from 3 ml to 6 ml. These models evaluated the von Mises stress of injured vertebral bodies, adjacent vertebral bodies and intervertebral discs under flexion, extension, left flexion, and right flexion after PVA. RESULTS When the bone cement content was held constant, as the height of the vertebral body decreased, the stress of the L2 vertebral body decreased during left flexion and right flexion, but the stress of the L2 vertebral body increased and decreased during flexion and extension. As the height of the vertebral body decreased, the stress of the L1-L2 intervertebral disc increased. There was no significant change in the stress of other adjacent vertebrae or intervertebral discs. When the Genant grade was 0, 1, or 2 (3 ml and 4 ml), the stress of the overall vertebral body was closest to normal. CONCLUSIONS When the height of the vertebral body is restored to the same height, a bone cement filling volume of 3 ml to 6 ml is suitable and will not produce a significant change in the stress of the vertebral body or adjacent vertebral body. As vertebral body height was lost, it may promote the degeneration of the intervertebral disc above the injury vertebrae after PVA. It is appropriate for the height of the vertebral body to return to Genant grade 0 or Genant grade 1 after surgery. When the height of the vertebral body has Genant grade 2 status, it was best to use 3 ml to 4 ml of bone cement filling. Therefore, when treating OVCFs, clinicians do not need to pursue complete reduction of the vertebral body. It is also important to verify the biomechanics results in clinical studies.
Collapse
Affiliation(s)
- Zhirong Fan
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Huida Huang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Yuewei Lin
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Junde Zhou
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Fangzheng Lin
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Bojian Chen
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Haizhou Wang
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Haitao Su
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Ji Qi
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Yongquan Huang
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Yongming Huang
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| |
Collapse
|
17
|
Pron G, Hwang M, Smith R, Cheung A, Murphy K. Cost-effectiveness studies of vertebral augmentation for osteoporotic vertebral fractures: a systematic review. Spine J 2022; 22:1356-1371. [PMID: 35257838 DOI: 10.1016/j.spinee.2022.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Osteoporotic vertebral fractures (OVF) dramatically increase with age and are serious life altering adverse events for seniors resulting in increased rates of institutionalization, morbidity and mortality. Given the expanding population of the elderly and increasing prevalence of OVFs, cost-effective treatment strategies need to be considered. Percutaneous vertebral augmentation (VA) procedures such as vertebroplasty (VP) or balloon kyphoplasty (BK) are increasingly employed to treat painful vertebral fractures not responding to conservative management (CM) of bedrest and analgesia. Both VA procedures have been shown to be effective treatments for OVFs in multiple systematic reviews of randomized controlled trials. In this systematic review, analytical strategies, designs and results were compared for health economic studies evaluating cost-effectiveness of VA procedures, VP or BK for OVFs. Furthermore, assessments of quality (risk of bias) were conducted for the systematic review and the individual studies with peer-reviewed checklists recommended for cost-effectiveness studies. PURPOSE To provide an up-to-date systematic review of peer-reviewed studies evaluating cost-effectiveness of VA procedures, VP or KP for OVFs to support treatment and health care funding decisions. STUDY DESIGN This study is a systematic literature review and structured narrative synthesis. STUDY SAMPLE Peer reviewed health economic studies reporting cost-effectiveness for VA procedures, VP or BK for OVFs OUTCOME MEASURES: The following information extracted from the studies included: report country and year, study design, comparators, population, perspective, health valuations, costing sources and cost-effectiveness measures. For economic studies involving modeling, information was also extracted for model type, time horizon, key model drivers, and handling of uncertainty. Incremental cost-effectiveness ratio (ICER), the ratio of differences between comparator treatment groups in costs and health benefits, was considered the main cost-effectiveness measure. METHODS A systematic review was conducted of MEDLINE, EMBASE, CINAHL, ECONLIT, Cochrane Library and DARE databases up to the review date May 2021. Studies were reviewed for those reporting cost-effectiveness analyses on VA procedures including VP or BK for OVFs. Studies including only costs, abstracts, editorials, methodologies and reviews were not included. The selection of articles was reported in line with PRISMA guidance. A descriptive framework was developed to classify types of cost-effectiveness studies based on methodological differences and a structured narrative synthesis was used to summarize studies. Quality assessments were made with British Medical Journal checklist for individual cost-effectiveness studies and the CiCERO checklist for systematic reviews of cost-effectiveness studies. RESULTS In this systematic review, 520 references were identified through database searching and 501 were excluded as ineligible by titles and abstract based on prior eligibility criteria. From full-text reviews of 19 reports, ten were identified as eligible for the systematic review evaluating cost-effectiveness of VA procedures for OVFs. All references were published between 2008 and 2020. The ten cost-effectiveness studies, three for VP, three for BK and four for both VP and BK, all involved CM for OVFs as a treatment comparator. The studies involved different methods of economic analysis, modeling assumptions, cost and health valuations conducted in different health care setting over different time periods. A framework for the review outlines key features of cost-effectiveness study designs consisting of unmatched, matched, or randomized controls involving cost-effectiveness or cost-utility) analyses. Both VP and BK were cost-effective alternatives to CM for OVFs with earlier health gains and significantly shorter hospital stays. Cost-effectiveness estimates, ICERs, remained relatively stable and within willingness-to-pay thresholds under a range of sensitivity analyses. Comparisons between VP and BK were variable depending on modeling assumptions, but generally the procedures had similar health benefit gains with VP having lower acute procedural costs. CONCLUSIONS Both VP and BK, have been shown to be cost-effective alternatives to CM for osteoporotic vertebral fractures in diverse cost-effectiveness studies conducted in multiple health care settings. Trial-based cost-utility contributed the strongest evidence supporting cost-effectiveness determination for VP and BK for OVFs.
Collapse
Affiliation(s)
- Gaylene Pron
- Institute Health Policy Management and Evaluation, University of Toronto, Ontario, Canada
| | - Matthew Hwang
- Department Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada
| | - Roger Smith
- Department Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada
| | - Angela Cheung
- Department Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kieran Murphy
- Department Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada.
| |
Collapse
|
18
|
Yuan W, Meng X, Cao W, Zhu Y. Robot-Assisted Versus Fluoroscopy-Assisted Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture: A Retrospective Study. Global Spine J 2022; 12:1151-1157. [PMID: 33375861 PMCID: PMC9210249 DOI: 10.1177/2192568220978228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES To compare the clinical and radiological outcomes of robot assisted (RA) and fluoroscopy assisted (FA) percutaneous kyphoplasty (PKP) in treating single/double segment osteoporotic vertebral compression fracture (OVCF). METHODS Patients with single/double segment OVCF receiving either RA or FA PKP were evaluated retrospectively at our spine center from April 2018 to October 2019. The operation time, fluoroscopy frequency, fluoroscopy exposure time, total radiation dose, visual analogue scale (VAS), local kyphosis angle (LKA), height of fractured vertebra (HFV) and complications were compared between the single/double RA group and the FA group. RESULTS A total of 96 cases were included in this study, with 59 cases of single segment OVCF and 37 cases of double segment OVCF. For single/double segment OVCF, both RA and FA PKP could relieve pain and reduce fracture. The RA group showed lower fluoroscopy frequency, shorter fluoroscopy exposure time during operation for surgeons, better correction in LKA and HFV, lower rate of cement leakage, but more fluoroscopy frequency, fluoroscopy exposure time and radiation dose for patients compared with the FA group (P < 0.05), while the single RA group showed longer operation time compared with the FA group (P < 0.05). CONCLUSIONS For single/double segment OVCF, RA has more advantages in correcting vertebra fracture, reducing intraoperative radiation exposure for surgeons, and reducing the cement leakage rate, but it increases intraoperative radiation for patients compared with FA PKP. And FA has shorter operation time in treating single segment OVCF than RA PKP.
Collapse
Affiliation(s)
- Wei Yuan
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China,Yue Zhu and Wei Yuan, Department of Orthopedics, The First Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang 110001, China. Emails: ;
| | - Xiaotong Meng
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China
| | - Wenhai Cao
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China
| | - Yue Zhu
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China,Yue Zhu and Wei Yuan, Department of Orthopedics, The First Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang 110001, China. Emails: ;
| |
Collapse
|
19
|
Zhang Y, Zhang T, Ge X, Ma Y, Cui Z, Wu S, Liang Y, Zhu S, Li Z. A Three-Dimensional Cement Quantification Method for Decision Prediction of Vertebral Recompression after Vertebroplasty. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2330472. [PMID: 35602341 PMCID: PMC9119757 DOI: 10.1155/2022/2330472] [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: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022]
Abstract
Objective Proposing parameters to quantify cement distribution and increasing accuracy for decision prediction of vertebroplasty postoperative complication. Methods Finite element analysis was used to biomechanically assess vertebral mechanics (n = 51) after percutaneous vertebroplasty (PVP) or kyphoplasty (PKP). The vertebral space was divided into 27 portions. The numbers of cement occupied portions and numbers of cement-endplate contact portions were defined as overall distribution number (oDN) and overall endplate contact number (oEP), respectively. And cement distribution was parametrized by oDN and oEP. The determination coefficients of vertebral mechanics and parameters (R 2) can validate the correlation of proposed parameters with vertebral mechanics. Results oDN and oEP were mainly correlated with failure load (R 2 = 0.729) and stiffness (R 2 = 0.684), respectively. oDN, oEP, failure load, and stiffness had obvious difference between the PVP group and the PKP group (P < 0.05). The regional endplate contact number in the front column is most correlated with vertebral stiffness (R 2 = 0.59) among all regional parameters. Cement volume and volume fraction are not dominant factors of vertebral augmentation, and they are not suitable for postoperative fracture risk prediction. Conclusions Proposed parameters with high correlation on vertebral mechanics are promising for clinical utility. The oDN and oEP can strongly affect augmented vertebral mechanics thus is suitable for postoperative fracture risk prediction. The parameters are beneficial for decision-making process of revision surgery necessity. Parametrized methods are also favorable for surgeon's preoperative planning. The methods can be inspirational for clinical image recognition development and auxiliary diagnosis.
Collapse
Affiliation(s)
- Yanming Zhang
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Tao Zhang
- Department of Orthopedic Surgery, Tianjin First Central Hospital, Tianjin 300190, China
| | - Xiang Ge
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering, Tianjin University, Tianjin 300354, China
| | - Yong Ma
- Pain Department, The Third People's Hospital of Yunnan Province, Kunming 650010, China
| | - Zhenduo Cui
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Shuilin Wu
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Yanqin Liang
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Shengli Zhu
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
| | - Zhaoyang Li
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300350, China
| |
Collapse
|
20
|
Kuo YR, Cheng TA, Chou PH, Liu YF, Chang CJ, Chuang CF, Su PF, Lin RM, Lin CL. Healing of Vertebral Compression Fractures in the Elderly after Percutaneous Vertebroplasty-An Analysis of New Bone Formation and Sagittal Alignment in a 3-Year Follow-Up. J Clin Med 2022; 11:jcm11030708. [PMID: 35160158 PMCID: PMC8836520 DOI: 10.3390/jcm11030708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Vertebral compression fractures, resulting in significant pain and disability, commonly occur in elderly osteoporotic patients. However, the current literature lacks long-term follow-up information related to image parameters and bone formation following vertebroplasty. PURPOSE To evaluate new bone formation after vertebroplasty and the long-term effect of vertebroplasty. METHODS A total of 157 patients with new osteoporotic compression fractures who underwent vertebroplasty were retrospectively analyzed. The image parameters, including wedge angles, compression ratios, global alignment, and new bone formation, were recorded before and after vertebroplasty up to three years postoperatively. RESULTS The wedge angle improved and was maintained for 12 months. The compression ratios also improved but gradually deteriorated during the follow-up period. New bone formation was found in 40% of the patients at 36 months, and the multivariate analysis showed that this might have been related to the correction of the anterior compression ratio. CONCLUSIONS Vertebroplasty significantly restored the wedge angles and compression ratios up to one year postoperatively, and new bone formation was noted on plain radiographs, which increased over time. Last, the restoration of vertebral parameters may contribute to new bone formation.
Collapse
Affiliation(s)
- Yuh-Ruey Kuo
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, Tainan City 704, Taiwan; (Y.-R.K.); (T.-A.C.); (C.-J.C.)
| | - Ting-An Cheng
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, Tainan City 704, Taiwan; (Y.-R.K.); (T.-A.C.); (C.-J.C.)
| | - Po-Hsin Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Yuan-Fu Liu
- Department of Orthopedic Surgery, National Cheng Kung University Hospital Douliu Branch, Douliu City 640, Taiwan;
| | - Chao-Jui Chang
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, Tainan City 704, Taiwan; (Y.-R.K.); (T.-A.C.); (C.-J.C.)
| | - Cheng-Feng Chuang
- Department of Statistics, National Cheng Kung University, Tainan City 701, Taiwan; (C.-F.C.); (P.-F.S.)
| | - Pei-Fang Su
- Department of Statistics, National Cheng Kung University, Tainan City 701, Taiwan; (C.-F.C.); (P.-F.S.)
| | - Ruey-Mo Lin
- Department of Orthopedic Surgery, An-Nan Hospital, China Medical University, Tainan City 709, Taiwan;
| | - Cheng-Li Lin
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, Tainan City 704, Taiwan; (Y.-R.K.); (T.-A.C.); (C.-J.C.)
- Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan City 701, Taiwan
- Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan City 701, Taiwan
- Medical Device Innovation Center (MDIC), National Cheng Kung University, Tainan City 701, Taiwan
- Correspondence:
| |
Collapse
|
21
|
Yang J, Ni P, Zhang L, Lu Z, Liu D, Mo F, Liu T. Clinical Application of a 3D-Printed Positioning Module and Navigation Template for Percutaneous Vertebroplasty. Surg Innov 2021; 29:760-768. [PMID: 34961370 DOI: 10.1177/15533506211062404] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aimed to evaluate a personalized 3D-printed percutaneous vertebroplasty positioning module and navigation template based on preoperative CT scan data that was designed to treat patients with vertebral compression fractures caused by osteoporosis. METHODS A total of 22 patients with vertebral compression fractures admitted to our hospital were included in the study. Positioning was performed with the new 3D-printed positioning module, and the navigation template was used for patients in the experimental group, and the traditional perspective method was used for patients in the control group. The experimental group consisted of 11 patients, 2 males and 9 females, with a mean age of 67.27 ± 11.86 years (range: 48 to 80 years), and the control group consisted of 11 patients, 3 males and 8 females, with a mean age of 74.27 ± 7.24 years (range: 63 to 89 years). The puncture positioning duration, number of intraoperative fluoroscopy sessions, and preoperative and postoperative visual analog scale (VAS) scores were statistically analyzed in both groups. RESULTS The experimental group had shorter puncture positioning durations and fewer intraoperative fluoroscopy sessions than the control group, and the differences were statistically significant (P < .05). There were no significant differences in age or preoperative or postoperative VAS scores between the two groups (P > .05). CONCLUSIONS The new 3D-printed vertebroplasty positioning module and navigation template shortened the operation time and reduced the number of intraoperative fluoroscopy sessions. It also reduced the difficulty in performing percutaneous vertebroplasty and influenced the learning curve of senior doctors learning this operation to a certain degree.
Collapse
Affiliation(s)
- Jing Yang
- Department of Orthopedics, 571957The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Orthopedics, The Fifth Affiliated Hospital, 74790Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Penghui Ni
- Department of Orthopedics, The First People's Hospital of Jingmen City, Jingmen, Hubei, China
| | - Lina Zhang
- Department of Psychiatry, 571957The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhanxin Lu
- Department of Orthopedics, The Fifth Affiliated Hospital, 74790Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Dapeng Liu
- Department of Orthopedics, The Fifth Affiliated Hospital, 74790Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Fuhao Mo
- 528787College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan, China
| | - Tang Liu
- Department of Orthopedics, 571957The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| |
Collapse
|
22
|
A Modified Transverse Process-Pedicle Approach Applied to Unilateral Extrapedicular Percutaneous Vertebroplasty. Pain Res Manag 2021; 2021:6493712. [PMID: 34721749 PMCID: PMC8556083 DOI: 10.1155/2021/6493712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/01/2021] [Accepted: 10/12/2021] [Indexed: 12/24/2022]
Abstract
Objective To introduce a modified transverse process-pedicle puncture technique applied to unilateral extrapedicular percutaneous vertebroplasty (PVP) for the treatment of osteoporotic lumbar vertebral compression fractures. Methods A retrospective study was performed on 91 patients with osteoporotic vertebral compression fractures (OVCFs) who underwent unilateral extrapedicular PVP from June 2016 to September 2018. Lumbar and back pain was assessed through the visual analogue scale (VAS). Function recovery was assessed through the Oswestry disability index (ODI). Radiologic outcomes were assessed mainly on the basis of bone cement distribution and anterior vertebral height. Results A total of 101 fractured vertebrae were successfully treated using the extrapedicular technique without any recognized clinical complications. The postoperative VAS and ODI values were significantly lower than the corresponding preoperative values (P < 0.01). Radiologic outcomes in all fractured vertebrae showed that the diffusion of bone cement could exceed the midline of the vertebral body. There was no significant difference between preoperative and postoperative anterior vertebral heights (P < 0.05). Conclusion The modified transverse process-pedicle approach applied to unilateral extrapedicular percutaneous vertebroplasty is a simple, safe, and effective surgical method.
Collapse
|
23
|
Jin M, Ge M, Lei L, Li F, Wu M, Zhang G, Pei S, Zheng B. Clinical and Radiologic Outcomes of Robot-Assisted Kyphoplasty versus Fluoroscopy-Assisted Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: A Retrospective Comparative Study. World Neurosurg 2021; 158:e1-e9. [PMID: 34637939 DOI: 10.1016/j.wneu.2021.10.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Making surgery as less aggressive as possible is best for elderly patients with osteoporotic vertebral compression fractures (OVCFs). Recently, we attempted a more precise, minimally invasive, and robot-assisted kyphoplasty in our clinical setting. OBJECTIVE We sought to compare the clinical and radiologic outcomes of robot-assisted percutaneous kyphoplasty (rPKP) with those of fluoroscopy-assisted percutaneous kyphoplasty (fPKP) in treating OVCFs. METHODS We retrospectively reviewed the clinical and radiologic data of patients with single-segment OVCF who received either rPKP or fPKP between January 2020 and December 2020 at our institution. The operation time, injected volume of cement, length of hospital stays, visual analog scale for back pain, Oswestry Disability Index, local kyphosis angle (LKA), height of fractured vertebra (HFV), and perioperative complications were compared between the 2 groups. RESULTS A total of 212 cases were included in this study, among whom 81 cases received rPKP and 131 cases received fPKP. Both techniques exhibited satisfying improvement in pain relief and radiologic outcomes. Specifically, the rPKP costed less operation time and achieved better correction and maintenance regarding LKA, HFV, and instant pain relief (P < 0.05). The length of hospital stays, incidence of cement leakage, visual analog scale for back pain, and Oswestry Disability Index at final follow-up were comparable between 2 groups. CONCLUSIONS rPKP provides a precise puncture and exhibits superiority in the correction and maintenance of LKA and HFV when compared with traditional fPKP. The cost-effectiveness and specific application scenarios of this technique shall be confirmed via further extensive studies.
Collapse
Affiliation(s)
- Mengran Jin
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Meng Ge
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Longyue Lei
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Fengqing Li
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Mujun Wu
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Guang Zhang
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Shaolong Pei
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Biao Zheng
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China.
| |
Collapse
|
24
|
Denaro L, Longo UG, Papalia R, De Salvatore S, Ruzzini L, Piergentili I, Denaro V. The burden of percutaneous vertebroplasty: an epidemiological nationwide study in Italy from 2009 to 2015. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3099-3106. [PMID: 34415447 DOI: 10.1007/s00586-021-06966-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 07/13/2021] [Accepted: 08/11/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Percutaneous vertebroplasty (PV) is a minimally invasive technique requiring the injection of polymethylmethacrylate cement into a collapsed or weakened vertebral body to stabilize the fracture. The present study aims to determine the trends in PV procedures over the recent years. The longitudinal analysis of national registers may help to understand the yearly trends and the economic burden of PV. The evaluation of the yearly national costs of this procedure is essential to surgeons, policymaker, hospital administrator and the healthcare system. Moreover, to observe possible variation in the trend of hospitalization between countries, the data of the present study were compared to the US population. METHODS Data of this study were collected from the National Hospital Discharge Reports reported at the Italian Ministry of Health regarding the years of this paper (2009-2015). The yearly number of hospital admission for PV, sex, age, days of hospitalization and primary diagnoses in the whole Italian population were calculated. RESULTS 31,887 vertebroplasties were performed in Italy, with an incidence of 8.8 procedures for every 100,000 inhabitants. Females represented the majority of patients undergoing PV. The median length of hospital stay was 4.15 days. The mean hospital reimbursement was 4,629€ for each PV hospitalization. CONCLUSION The burden of vertebral fracture is relevant in the Italian population, and PV constitutes a rapid and effective treatment. Compared to other countries, the costs of PV in Italy are relatively lower; however, it is important to define the incidence of this procedure to understand the economic trend of PV.
Collapse
Affiliation(s)
- Luca Denaro
- Department of Neuroscience (Padova Neuroscience Center), University of Padova, Padova, Italy
| | - Umile Giuseppe Longo
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Rocco Papalia
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sergio De Salvatore
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Laura Ruzzini
- Department of Surgery, Orthopedic Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Ilaria Piergentili
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| |
Collapse
|
25
|
An Z, Chen C, Wang J, Zhu Y, Dong L, Wei H, Wu L. Logistic regression analysis on risk factors of augmented vertebra recompression after percutaneous vertebral augmentation. J Orthop Surg Res 2021; 16:374. [PMID: 34116683 PMCID: PMC8194186 DOI: 10.1186/s13018-021-02480-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022] Open
Abstract
Objective To explore the high-risk factors of augmented vertebra recompression after percutaneous vertebral augmentation (PVA) in the treatment of osteoporotic vertebral compression fracture (OVCF) and analyze the correlation between these factors and augmented vertebra recompression after PVA. Methods A retrospective analysis was conducted on 353 patients who received PVA for a single-segment osteoporotic vertebral compression fracture from January 2017 to December 2018 in our department according to the inclusion criteria. All cases meeting the inclusion and exclusion criteria were divided into two groups: 82 patients in the recompression group and 175 patients in the non-compression group. The following covariates were reviewed: age, gender, body mass index (BMI), injured vertebral segment, bone mineral density (BMD) during follow-up, intravertebral cleft (IVC) before operation, selection of surgical methods, unilateral or bilateral puncture, volume of bone cement injected, postoperative leakage of bone cement, distribution of bone cement, contact between the bone cement and the upper or lower endplates, and anterior height of injured vertebrae before operation, after surgery, and at the last follow-up. Univariate analysis was performed on these factors, and the statistically significant factors were substituted into the logistic regression model to analyze their correlation with the augmented vertebra recompression after PVA. Results A total of 257 patients from 353 patients were included in this study. The follow-up time was 12–24 months, with an average of 13.5 ± 0.9 months. All the operations were successfully completed, and the pain of patients was relieved obviously after PVA. Univariate analysis showed that in the early stage after PVA, the augmented vertebra recompression was correlated with BMD, surgical methods, volume of bone cement injected, preoperative IVC, contact between bone cement and the upper or lower endplates, and recovery of anterior column height. The difference was statistically significant (P < 0.05). Among them, multiple factors logistic regression elucidated that more injected cement (P < 0.001, OR = 0.558) and high BMD (P = 0.028, OR = 0.583) were negatively correlated with the augmented vertebra recompression after PVA, which meant protective factors (B < 0). Preoperative IVC (P < 0.001, OR = 3.252) and bone cement not in contact with upper or lower endplates (P = 0.006, OR = 2.504) were risk factors for the augmented vertebra recompression after PVA. The augmented vertebra recompression after PVP was significantly less than that of PKP (P = 0.007, OR = 0.337). Conclusions The augmented vertebra recompression after PVA is due to the interaction of various factors, such as surgical methods, volume of bone cement injected, osteoporosis, preoperative IVC, and whether the bone cement is in contact with the upper or lower endplates.
Collapse
Affiliation(s)
- Zhongcheng An
- Department of Spinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| | - Chen Chen
- Department of Spinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China.,The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| | - Junjie Wang
- Department of Spinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| | - Yuchen Zhu
- Department of Spinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| | - Liqiang Dong
- Department of Spinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China.
| | - Hao Wei
- Department of Spinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| | - Lianguo Wu
- Department of Spinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| |
Collapse
|
26
|
Efficacy of Postural Reduction of Vertebral Compression Fracture with Extension Lateral Radiograph Before Vertebroplasty. World Neurosurg 2020; 143:e430-e441. [PMID: 32750516 DOI: 10.1016/j.wneu.2020.07.188] [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: 06/14/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This retrospective comparative study aimed to evaluate the efficacy of postural reduction of vertebral compression fracture (VCF) using the hyperextension posture before vertebroplasty (VP). METHODS Sixty-five consecutive patients who underwent VP were retrospectively reviewed. Thirty patients who underwent passive expansion of compression fracture before VP (postural reduction vertebroplasty [PRV] group) were compared with 35 patients who underwent in situ vertebroplasty (ISV group). Patient characteristics, complications, local kyphosis angle (LKA), Cobb angle, sagittal index (SI), anterior body height (ABH), and posterior body height were assessed. RESULTS LKA and SI significantly improved from preoperative measurements at the final follow-up in the ISV and PRV groups. ABH significantly improved only in the PRV group and ABH improvement at the final follow-up was significantly greater in the PRV group. However, there were no significant differences in LKA, Cobb angle, SI, ABH, and posterior body height at the final follow-up. Within the subgroup analysis of patients with preoperative ABH ≤15 mm, ABH and amount of ABH improvement at final follow-up were significantly greater in the PRV group. CONCLUSIONS Hyperextension postural reduction showed superior ABH improvement. It also showed higher ABH at the final follow-up when performed on patients with preoperative ABH ≤15 mm. Although routine hyperextension postural reduction should be carefully approached, postural reduction using supine extension lateral radiography would provide more effective vertebral body height restoration in patients with moderate collapse of vertebral compression fracture with ABH ≤15 mm.
Collapse
|