Trends in vertebroplasty and kyphoplasty after thoracolumbar osteoporotic fracture: A large database study from 2005 to 2012

Risk factors of adjacent segmental fractures when percutaneous vertebroplasty is performed for the treatment of osteoporotic thoracolumbar fractures

The study aimed to analyze the radiographic and magnetic resonance imaging (MRI) findings that might predict the risk for adjacent segmental fractures (ASFs) when percutaneous vertebroplasty (PV) is used for the treatment of osteoporotic thoracolumbar fractures (OTFs). A total of 92 OTFs patients who underwent PV between January 2013 and January 2015 were retrospectively reviewed. The visual analog scale (VAS), Oswestry-Disability Index (ODI) and radiolographic measurements were assessed. The VAS and ODI scores improved significantly at the final follow-up (FU) compared with the preoperation scores. Compared with the preoperative values, the fractured body alignment (FBA) significantly improved at the 3-month FU and the final FU, but the adjacent segment alignment (ASA) and thoracolumbar alignment (TLA) did not improve. According to the correlation analysis, the final FU TLA and the final FU ASA were correlated with the preoperative FBA, ASA, and TLA on plain radiography and were highly correlated on MRI. However, the final FU FBA was not correlated with the preoperative FBA, ASA, or TLA on plain radiography or MRI (P > 0.05). The ASFs were correlated with the 3-month FU TLA (r = 0.6044, P = 0.0037) and the final FU TLA (r = 0.5699, P = 0.007) on plain radiography, and the final TLA was more correlated with the preoperative FBA, ASA, and TLA on MRI than on plain radiography. In conclusion, the preoperative ASA and TLA on MRI were risk factors associated with ASFs in OTFs treated with PV.

The 100 most influential spine fracture publications

Background

Management of spine fractures has advanced considerably even over the past decade. A review of the current and historical literature can lead to a better appreciation of current management protocols. This is the first comprehensive review of the most influential articles related to spine fracture management. The purpose of this study is to identify and analyze the 100 most cited publications in spine fracture management.

Methods

Using the Clarivate Analytics Web of Science, search phrases were used to identify publications pertaining to spine fractures (110,809 publications). The 100 most cited articles were isolated. The frequency of citations, year of publication, country of origin, journal of publication, level-of-evidence (LOE), article type, and contributing authors/institutions were recorded. We also highlighted the ten most cited articles (per year) from the past decade.

Results

The publications included ranged from 1953-2010, with the majority published between 2000-2009 (n=41). Total citations ranged from 154 to 1,076. A LOE of IV had the plurality at 36%. The most cited article was "The 3 Column Spine and Its Significance in The Classification of Acute Thoracolumbar Spinal-Injuries" (Spine 1983) by F Denis. The majority of papers originated in the United States (n=65), and the highest number were published in Spine (n=27). Osteoporotic fractures were the specific topic in 34 publications. In the past decade, the article with the most citations/year was "A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures" by DF Kalmes in 2009.

Conclusions

Despite less time for citation than other decades, the 2000s contain the plurality of the influential publications. This may indicate that some of the most important changes to spine fracture management pertain to improved imaging modalities and surgical technologies. This review provides a guide for a comprehensive understanding of the historical and current literature pertaining to spine fracture management.

Cause Analysis of Open Surgery Used After Percutaneous Vertebroplasty and Kyphoplasty

BACKGROUND The aim of this study was to analyze reasons why open surgery was done after percutaneous vertebroplasty and kyphoplasty. MATERIAL AND METHODS Patients (587 vertebral bodies) treated with percutaneous vertebroplasty or kyphoplasty in the Xi'an Honghui Hospital of Shanxi Province from January 2008 to January 2012 were retrospectively analyzed and 13 patients were enrolled in the study. These 13 patients had serious adverse events after percutaneous vertebroplasty or kyphoplasty. Their average age was 64.5 years old. Nine patients had spinal cord injury and 4 had nerve root injury. All the patients underwent open surgery within 4-12 h after definitive diagnosis. RESULTS All 13 cases were followed up (average time 14.1 months, range 3-47 months). Reasons for open surgery included cement extravasation (6 cases, 46.2%), puncture mistake (3 cases, 23.1%), and false selection of indications (4 cases, 30.8%). At last follow-up, skin feeling was better than that before open surgery in 4 cases with nerve root injury, and muscle strength recovered to grade 5 (3 cases) and grade 4 (1 case). In 9 cases with spinal cord injury, 7 patients improved and 2 remained at the same ASIA level. CONCLUSIONS The main reasons for open surgery after percutaneous vertebroplasty and kyphoplasty were cement extravasation (the most common reason), puncture mistake, and false selection of indications.