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Metkar US, Lavelle WJ, Larsen K, Haddas R, Lavelle WF. Spinal alignment and surgical correction in the aging spine and osteoporotic patient. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 19:100531. [PMID: 39286293 PMCID: PMC11404170 DOI: 10.1016/j.xnsj.2024.100531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 09/19/2024]
Abstract
Background The aging spine often presents multifaceted surgical challenges for the surgeon because it can directly and indirectly impact a patient's spinal alignment and quality of life. Elderly and osteoporotic patients are predisposed to progressive spinal deformities and potential neurologic compromise and surgical management can be difficult because these patients often present with greater frailty. Methods This was a literature review of spinal alignment changes, preoperative considerations, and spinal alignment considerations for surgical strategies. Results Many factors impact spinal alignment as we age including lumbar lordosis flexibility, hip flexion, deformity, and osteoporosis. Preoperative considerations are required to assess the patient's overall health, bone mineral density, and osteoporosis medications. Careful radiographic assessment of the spinopelvic parameters using various classification/scoring systems provide the surgeon with goals for surgical treatment. An individualized surgical strategy can be planned for the patient including extent of surgery, surgical approach, extent of the constructs, fixation techniques, vertebral augmentation, ligamentous augmentation, and staging surgery. Conclusions Surgical treatment should only be considered after a thorough assessment of the patient's health, deformity, bone quality and corresponding age matched alignment goals. An individualized treatment approach is often required to tackle the deformity and minimize the risk of hardware related complications and pseudarthrosis. Anabolic agents offer a promising benefit in this patient population by directly addressing and improving their bone quality and mineral density preoperatively and postoperatively.
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Affiliation(s)
- Umesh S Metkar
- Department of Orthopedics and Rehabilitation, University of New Mexico School of Medicine, MSCO8 4720 1 UNM, Albuquerque, NM 87131-0001, United States
| | - W Jacob Lavelle
- Department of Chemistry, Colgate University, 13 Oak Drive, Hamilton, NY, 13346, United States
| | - Kylan Larsen
- Department of Orthopedics and Rehabilitation, University of New Mexico School of Medicine, MSCO8 4720 1 UNM, Albuquerque, NM 87131-0001, United States
| | - Ram Haddas
- Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elwood Ave., Rochester, NY 14627, United States
| | - William F Lavelle
- Department of Orthopedic Surgery and Department of Pediatrics, SUNY Upstate Medical University, 705 E. Adams St., Syracuse, NY 13201, United States
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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.
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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.
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Gao Q, Li Q, Wang L, Cen Y, Yang H. Percutaneous vertebroplasty versus percutaneous kyphoplasty for osteoporotic vertebral compression fractures: an umbrella review protocol of systematic reviews and meta-analyses. BMJ Open 2024; 14:e075225. [PMID: 38382955 PMCID: PMC10882401 DOI: 10.1136/bmjopen-2023-075225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 01/03/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Several systematic reviews and meta-analyses have confirmed that percutaneous vertebroplasty and percutaneous kyphoplasty showed safety and beneficial efficacy in patients with osteoporotic vertebral compression fractures. Whereas, there is wide variation among results, which are not conducive to the evaluation and use of clinicians. This study will investigate the efficacy and safety of percutaneous vertebroplasty and percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures, aiming to provide a more reliable evidence base for clinical practice in treating osteoporotic vertebral compression fractures. METHODS AND ANALYSIS We will retrieve the relevant articles using the five databases(PubMed, Scopus, EMBASE, Cochrane Library and Web of Science) from inception to March 2023 for systematic review and meta-analysis comparing the overall safety and efficacy of percutaneous vertebroplasty and percutaneous kyphoplasty in patients with osteoporotic vertebral compression fractures. Three reviewers will screen citation titles, abstracts and evaluate the full text of each relevant citation based on prespecified eligibility criteria. Any discrepancies in decisions between reviewers will be resolved through discussion. We will assess the methodological quality of the included studies according to A MeaSurement Tool to Assess systematic Reviews 2 checklist. ETHICS AND DISSEMINATION This umbrella review will inform clinical and policy decisions regarding the benefits and harms of percutaneous vertebroplasty versus percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Neither primary data nor individual patient information will be collected, thus ethics approval is not required. Findings will be reported through a peer-reviewed publication, conference presentations and the popular press. PROSPERO REGISTRATION NUMBER CRD42021268141.
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Affiliation(s)
- Qingyang Gao
- Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiujiang Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liang Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Cen
- Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huiliang Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Long-term outcome of treatment of vertebral body hemangiomas with direct ethanol injection and short-segment stabilization. Spine J 2019; 19:131-143. [PMID: 29890263 DOI: 10.1016/j.spinee.2018.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/13/2018] [Accepted: 05/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Vertebral body hemangiomas with myelopathy are difficult to manage. OBJECTIVE The objective of this study was to evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented short-segment fusion in vertebral hemangioma (VH) with myelopathy and long-term outcome (>24 months). CLINICAL MATERIALS AND METHODS This prospective study included symptomatic VH with cord compression with myelopathy. Pathologic fractures and deformity or multilevel pathologies were excluded from the study. Surgery consisted of intraoperative bilateral pedicular absolute alcohol (<1% hydrated ethyl alcohol) injection, laminectomy, and cord decompression at the level of pathology followed by a short-segment instrumented fusion using pedicle screws. RESULTS The study included 33 patients (mean 26.9±13.2, range: 10-68 years, 18 females). The clinical features of the study were myelopathy in all patients (5 paraplegic), sphincter involvement (13), and mid back or lower back pain (7). The preoperative American Spinal Injury Association (ASIA) scores were A (7), B (11), C (6), D (8), and E (1). Majority of the patients had single vertebral involvement (30) and three patients had multiple-level involvement. Six patients underwent surgery earlier (one underwent alcohol embolization). The mean surgical time was 124±39 minutes, and the average blood loss was 274±80 cc. The mean amount of absolute alcohol injected was 14.6±5.7 cc (two patients required 20 and 25 cc). Immediate embolization was achieved in all patients, allowing laminectomy and easy removal of soft-tissue hemangioma. Post surgery, one patient had transient deterioration, and the condition of the rest of the patients improved (sphincters improved in nine patients) at a follow-up ranging 28-103 months (mean 47.6±22.3). Follow-up ASIA scores were E (26), D (4), B (2), and C (1). All patients showed evidence of bone sclerosis and relief of cord compression on follow-up imaging. CONCLUSIONS This is the largest study in literature showing excellent improvement, low reoperation rates after ethanol embolization, and short-segment fixation.
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Jing Z, Dong J, Li Z, Nan F. Single balloon versus double balloon bipedicular kyphoplasty: a systematic review and meta-analysis. 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 2018; 27:2550-2564. [PMID: 29923019 DOI: 10.1007/s00586-018-5631-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/06/2018] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Kyphoplasty has been widely used to treat vertebral compression fractures (VCFs). In standard procedure of kyphoplasty, two balloons were inserted into the vertebral body through bipedicular and inflated simultaneously, while using a single balloon two times is also a common method in clinic to lessen the financial burden of patients. However, the effect and safety of single balloon versus double balloon bipedicular kyphoplasty are still controversy. METHODS In this systematic review and meta-analysis, eligible studies were identified through a comprehensive literature search of PubMed, Cochrane library EMBASE, Web of Science, Wanfang, CNKI, VIP and CBM until January 1, 2018. Results from individual studies were pooled using a random or fixed effects model. RESULTS Seven articles were included in the systematic review and five studies were consisted in meta-analysis. We observed no significant difference between single balloon and double balloon bipedicular kyphoplasty in visual analog scale (VAS), angle (kyphotic angle and Cobb angle), consumption (operation time, cement volume and volume of bleeding), vertebral height (anterior height, medium height and posterior height) and complications (cement leakage and new VCFs), while the cost of single balloon bipedicular kyphoplasty is lower than that of double balloon bipedicular kyphoplasty. The results of our meta-analysis also demonstrated that single balloon can significantly improve the VAS, angle and vertebral height of patients suffering from VCFs. CONCLUSION This systematic review and meta-analysis collectively concludes that single balloon bipedicular kyphoplasty is as effective as double balloon bipedicular kyphoplasty in improving clinical symptoms, deformity and complications of VCFs but not so expensive. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Zehao Jing
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning, China
| | - Jianli Dong
- Department of Joint Surgery, Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning, China
| | - Zhengwei Li
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning, China.
| | - Feng Nan
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning, China.
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Tsang RW, Campbell BA, Goda JS, Kelsey CR, Kirova YM, Parikh RR, Ng AK, Ricardi U, Suh CO, Mauch PM, Specht L, Yahalom J. Radiation Therapy for Solitary Plasmacytoma and Multiple Myeloma: Guidelines From the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 2018; 101:794-808. [PMID: 29976492 DOI: 10.1016/j.ijrobp.2018.05.009] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/16/2018] [Accepted: 05/02/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE To develop guidelines for the work-up and radiation therapy (RT) management of patients with plasma cell neoplasms. METHODS AND MATERIALS A literature review was conducted covering staging, work-up, and RT management of plasma cell neoplasms. Guidelines were developed through consensus by an international panel of radiation oncologists with expertise in these diseases, from the International Lymphoma Radiation Oncology Group. RT volume definitions are based on the International Commission on Radiation Units and Measurements. RESULTS Plasma cell neoplasms account for approximately one-fifth of mature B-cell neoplasms in the United States. The majority (∼95%) are diagnosed as multiple myeloma, in which there has been tremendous progress in systemic therapy approaches with novel drugs over the last 2 decades, resulting in improvements in disease control and survival. In contrast, a small proportion of patients with plasma cell neoplasms present with a localized plasmacytoma in the bone, or in extramedullary (extraosseous) soft tissues, and definitive RT is the standard treatment. RT provides long-term local control in the solitary bone plasmacytomas and is potentially curative in the extramedullary cases. This guideline reviews the diagnostic work-up, principles, and indications for RT, target volume definition, treatment planning, and follow-up procedures for solitary plasmacytoma. Specifically, detailed recommendations for RT volumes and dose/fractionation are provided, illustrated with specific case scenarios. The role of palliative RT in multiple myeloma is also discussed. CONCLUSIONS The International Lymphoma Radiation Oncology Group presents a standardized approach to the use and implementation of definitive RT in solitary plasmacytomas. The modern principles outlining the supportive role of palliative RT in multiple myeloma in an era of novel systemic therapies are also discussed.
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Affiliation(s)
- Richard W Tsang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Belinda A Campbell
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jayant S Goda
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Chris R Kelsey
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Youlia M Kirova
- Department of Radiation Therapy, Institut Curie, Paris, France
| | - Rahul R Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Andrea K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts
| | - Umberto Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Torino, Torino, Italy
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Peter M Mauch
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
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Lin J, Qian L, Jiang C, Chen X, Feng F, Lao L. Bone cement distribution is a potential predictor to the reconstructive effects of unilateral percutaneous kyphoplasty in OVCFs: a retrospective study. J Orthop Surg Res 2018; 13:140. [PMID: 29880007 PMCID: PMC5992789 DOI: 10.1186/s13018-018-0839-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/21/2018] [Indexed: 12/16/2022] Open
Abstract
Background Osteoporotic vertebral compression fracture (OVCF) is a common type of fracture, and percutaneous kyphoplasty (PKP) is an eligible solution to it. Previous studies have revealed that both the volume and filling pattern of bone cement correlate with the clinical outcomes after PKP procedure. However, the role of bone cement distribution remains to be illustrated. Methods To retrospectively evaluate the relationship between the bone cement distribution and the clinical outcomes of unilateral PKP, we enrolled 73 OVCF patients receiving unilateral PKP treatment. All the intervened vertebrae were classified into three groups based on the bone cement distribution observed on postoperative X-ray films. Preoperative and postoperative radiographic parameters including the vertebral height and kyphotic Cobb angle were recorded, and anterior vertebral height restoration rate (AVHRR) and Cobb angle correction (CR) were then calculated to assess the vertebral height reconstruction. Preoperative and postoperative Oswestry Disability Index (ODI) and visual analogue scale (VAS) were adopted by interviewing patients to assess the mobility improvement and pain relief. Demographic data, body mass index (BMI), lumbar bone mineral density (evaluated by BMD T-score) of each patient, bone cement volume (BV), and bone cement extravasation (BE) were also recorded. Between- and within-group comparisons and multivariable correlation analysis were carried out to analyze the data. Results VAS and ODI scores were both significantly improved in all of the enrolled cases with no significant differences between groups. Among the three groups, the average age, AVHRR, and BV were significantly different. Occurrence of BE was significantly different between two of the three groups. AVHRR was demonstrated to correlate negatively with preoperative anterior vertebral height ratio and positively with preoperative Cobb angle, CR, diffusion score, and ODI changes. Conclusions Bone cement distribution is a potential predictor to the reconstructive effects in unilateral PKP for OVCFs. Bone cement distribution is associated with AVHRR and BV, as well as the risk of BE occurrence. Greater bone cement distribution may indicate better vertebral restoration along with a higher BE risk.
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Affiliation(s)
- Jiachen Lin
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
| | - Lie Qian
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
| | - Changqing Jiang
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
| | - Xiuyuan Chen
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
| | - Fan Feng
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
| | - Lifeng Lao
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
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Jing Z, Sun Q, Dong J, Meng F, Song Y, Xia T, Luo J, Li Y, Nan F. Is it Beneficial to Reuse the Balloon in Percutaneous Kyphoplasty for the Treatment of Non-Neoplastic Vertebral Compression Fractures? Med Sci Monit 2017; 23:5907-5915. [PMID: 29236682 PMCID: PMC5737568 DOI: 10.12659/msm.905161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Percutaneous kyphoplasty (PKP) has been widely used to treat vertebral compression fractures (VCFs). Bilateral percutaneous punctures are always performed to access the fractured vertebrae. However, the procedure has expensive clinical costs, especially the cost for the device, which creates a heavy financial burden for patients. MATERIAL AND METHODS Data from 49 patients who have single-level non-neoplastic vertebral compression fracture (VCF) were collected for 12 months after treated by PKP, including 21 cases that used bilateral puncture with single balloon (S group) and 28 cases that used bilateral puncture with double balloon (D group). We assessed the clinical (visual analogue scale, VAS) and radiological (vertebral height and kyphotic angle, KA) outcomes. Cost data (gross medical cost, cost for the device and cost for drugs) were obtained from the medical bill of each patient. RESULTS Baseline patient variables were similar between the two groups except the compensation (S group <D group). No severe cement leakage and only one adjacent-level fracture were observed during the follow-ups. Each group showed significant improvements in the VAS, anterior height (AH) of vertebral body and KA after PKP, while no significant differences were observed when the VAS, vertebral height, and KA at the same time were compared between the S group and the D group. Costs in the S group were significantly lower than those in the D group. CONCLUSIONS Both single balloon and double balloon bilateral puncture PKP are relatively safe and efficient in non-neoplastic VCFs. However, reuse of the balloon in PKP can decrease the costs.
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Affiliation(s)
- Zehao Jing
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Qi Sun
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Jianli Dong
- Department of Joint Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Fanqi Meng
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Youzhi Song
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Tonglin Xia
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Jia Luo
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Yanqiang Li
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
| | - Feng Nan
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China (mainland)
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The filling proportion of bone cement affects recollapse of vertebrae after percutaneous vertebral augmentation: A retrospective cohort study. Int J Surg 2017; 47:33-38. [PMID: 28935530 DOI: 10.1016/j.ijsu.2017.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/27/2017] [Accepted: 09/13/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to determine the relationship between filling proportion of bone cement in the vertical direction and incidence of recollapse in the augmented vertebrae after vertebral augmentation. METHODS Fifty-one patients (51 vertebrae) who had operations between January 2014 and July 2016 with a mean age of 78.10 years were included. All patients in our department of spine surgery were advised to have follow-up care every 6 months. Patients characteristics, radiographic outcomes were evaluated. RESULTS The recollapse of augmented vertebral body occurred in 10 of 51 vertebrae (20%). CONCLUSION Patients with a high proportion rate of bone cement in the middle vertical direction have a low incidence of experiencing recollapse.
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Jia-Jia S, Zhi-Yong S, Zhong-Lai Q, Hui-Lin Y, Xiao-Yu Z. Tuberculous spondylitis after vertebral augmentation: A case report with a literature review. J Int Med Res 2017; 46:916-924. [PMID: 29239241 PMCID: PMC5971511 DOI: 10.1177/0300060517728008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tuberculous spondylitis of vertebral augmentation following percutaneous vertebroplasty or kyphoplasty is rare. We report an unusual case of tuberculous spondylitis diagnosed after percutaneous kyphoplasty (PKP). A 54-year-old woman presented to hospital complaining of back pain following a fall 20 days prior. Radiology showed an acute osteoporotic compression (L3 fracture). The patient denied a history of pulmonary tuberculosis and there were no signs of infection. The patient was discharged from hospital 2 days after undergoing L3 PKP with a dramatic improvement in her back pain. The patient was readmitted 10 months later with a history of recurrent back pain and low-grade fever for 3 months. Imaging examinations showed severe spondylitis at the L2-L3 level, with paravertebral abscess formation and bony destruction of L2 and L3. A positive result of the T-SPOT test preliminarily confirmed the diagnosis of tuberculous spondylitis. The tuberculosis test was positive, and serum C-reactive protein levels and erythrocyte sedimentation were relatively high. Treatment for tuberculous spondylitis was started. She underwent posterior fusion and instrumentation from T12-L5 after markers for infection returned to normal. After surgery, the patient continued antituberculous and anti-osteoporosis treatments. Her low back pain was relieved and low-grade fever and sweating disappeared.
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Affiliation(s)
| | | | | | | | - Zhu Xiao-Yu
- Zhu Xiao-Yu, Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, No. 188 Shizi Rd., Gusu District, Suzhou, Jiangsu 215006, China.
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Nam KY. Characterization and antimicrobial efficacy of Portland cement impregnated with silver nanoparticles. J Adv Prosthodont 2017; 9:217-223. [PMID: 28680554 PMCID: PMC5483409 DOI: 10.4047/jap.2017.9.3.217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 06/08/2017] [Accepted: 06/12/2017] [Indexed: 01/09/2023] Open
Abstract
PURPOSE This study investigated the effects of silver nanoparticle (SN) loading into hydraulic calcium silicate-based Portland cement on its mechanical, antibacterial behavior and biocompatibility as a novel dental bone substitute. MATERIALS AND METHODS Chemically reduced colloidal SN were combined with Portland cement (PC) by the concentrations of 0 (control), 1.0, 3.0, and 5.0 wt%. The physico-mechanical properties of silver-Portland cement nanocomposites (SPNC) were investigated through X-ray diffraction (XRD), setting time, compressive strength, solubility, and silver ion elution. Antimicrobial properties of SPNC were tested by agar diffusion against Streptococcus mutans and Streptococcus sobrinus. Cytotoxic evaluation for human gingival fibroblast (HGF) was performed by MTS assay. RESULTS XRD certified that SN was successfully impregnated in PC. SPNC at above 3.0 wt% significantly reduced both initial and final setting times compared to control PC. No statistical differences of the compressive strength values were detected after SN loadings, and solubility rates of SPNC were below 3.0%, which are acceptable by ADA guidelines. Ag ion elutions from SPNC were confirmed with dose-dependence on the concentrations of SN added. SPNC of 5.0 wt% inhibited the growth of Streptococci, whereas no antimicrobial activity was shown in control PC. SPNC revealed no cytotoxic effects to HGF following ISO 10993 (cell viability > 70%). CONCLUSION Addition of SN promoted the antibacterial activity and favored the bio-mechanical properties of PC; thus, SPNC could be a candidate for the futuristic dental biomaterial. For clinical warrant, further studies including the inhibitory mechanism, in vivo and long-term researches are still required.
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Affiliation(s)
- Ki Young Nam
- Department of Dentistry, Dongsan Medical Center, School of Medicine of Keimyung University, Daegu, Republic of Korea
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12
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Oliveira MT, Potes J, Queiroga MC, Castro JL, Pereira AF, Rehman S, Dalgarno K, Ramos A, Vitale-Brovarone C, Reis JC. Percutaneous vertebroplasty: a new animal model. Spine J 2016; 16:1253-1262. [PMID: 27374111 DOI: 10.1016/j.spinee.2016.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 05/25/2016] [Accepted: 06/21/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Percutaneous vertebroplasty (PVP) is a minimally invasive surgical procedure and is frequently performed in humans who need surgical treatment of vertebral fractures. PVP involves cement injection into the vertebral body, thereby providing rapid and significant pain relief. PURPOSE The testing of novel biomaterials depends on suitable animal models. The aim of this study was to develop a reproducible and safe model of PVP in sheep. STUDY DESIGN This study used ex vivo and in vivo large animal model study (Merino sheep). METHODS Ex vivo vertebroplasty was performed through a bilateral modified parapedicular access in 24 ovine lumbar hemivertebrae, divided into four groups (n=6). Cerament (Bone Support, Lund, Sweden) was the control material. In the experimental group, a novel composite was tested-Spine-Ghost-which consisted of an alpha-calcium sulfate matrix enriched with micrometric particles of mesoporous bioactive glass. All vertebrae were assessed by micro-computed tomography (micro-CT) and underwent mechanical testing. For the in vivo study, 16 sheep were randomly allocated into control and experimental groups (n=8), and underwent PVP using the same bone cements. All vertebrae were assessed postmortem by micro-CT, histology, and reverse transcription-polymerase chain reaction (rt-PCR). This work has been supported by the European Commission under the 7th Framework Programme for collaborative projects (600,000-650,000 USD). RESULTS In the ex vivo model, the average defect volume was 1,275.46±219.29 mm3. Adequate defect filling with cement was observed. No mechanical failure was observed under loads which were higher than physiological. In the in vivo study, cardiorespiratory distress was observed in two animals, and one sheep presented mild neurologic deficits in the hind limbs before recovering. CONCLUSIONS The model of PVP is considered suitable for preclinical in vivo studies, mimicking clinical application. All sheep recovered and completed a 6-month implantation period. There was no evidence of cement leakage into the vertebral foramen in the postmortem examination.
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Affiliation(s)
- Maria Teresa Oliveira
- Departamento de Medicina Veterinária (DMV), Escola de Ciências e Tecnologia (ECT), Instituto de Ciências Agrárias e Ambientais Mediterrânicas (ICAAM), University of Évora, Apartado 94, 7002-554 Évora, Portugal.
| | - José Potes
- Departamento de Medicina Veterinária (DMV), Escola de Ciências e Tecnologia (ECT), Instituto de Ciências Agrárias e Ambientais Mediterrânicas (ICAAM), University of Évora, Apartado 94, 7002-554 Évora, Portugal
| | - Maria Cristina Queiroga
- Departamento de Medicina Veterinária (DMV), Escola de Ciências e Tecnologia (ECT), Instituto de Ciências Agrárias e Ambientais Mediterrânicas (ICAAM), University of Évora, Apartado 94, 7002-554 Évora, Portugal
| | - José L Castro
- Departamento de Zootecnia, Escola de Ciências e Tecnologia, Instituto de Ciências Agrárias e Ambientais Mediterrânicas, Apartado 94, 7002-554 Évora, Portugal
| | - Alfredo F Pereira
- Departamento de Zootecnia, Escola de Ciências e Tecnologia, Instituto de Ciências Agrárias e Ambientais Mediterrânicas, Apartado 94, 7002-554 Évora, Portugal
| | - Sarrawat Rehman
- JRI Orthopaedics Limited, 18 Churchill Way, Sheffield, S35 2PY, UK
| | - Kenneth Dalgarno
- School of Mechanical and Systems Engineering, Newcastle University, Stephenson Building, Claremont Rd, Newcastle upon Tyne, NE1 7RU, UK
| | - António Ramos
- Biomechanics Research Group, Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering of the University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - Chiara Vitale-Brovarone
- Politecnico di Torino, Corso Duca degli Abruzzi, 24-10129, Torino, Italy; Consorzio per la Ricerca e l'Educazione Permanente (Corep), Sede legale Via Ventimiglia, 115-10126, Torino, Italy
| | - Joana C Reis
- Departamento de Medicina Veterinária (DMV), Escola de Ciências e Tecnologia (ECT), Apartado 94, 7002-554 Évora, Portugal; Complexo de Laboratórios Tecnológicos (CICECO), Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
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Omar EA, Pimentel DC, Amadera JED. Spinal Pathology. PATHOLOGY AND INTERVENTION IN MUSCULOSKELETAL REHABILITATION 2016:561-583. [DOI: 10.1016/b978-0-323-31072-7.00015-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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14
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Affiliation(s)
- Jong Won Kwon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Korea
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15
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Abstract
Percutaneous vertebroplasty has become widely accepted as a safe and effective minimally invasive procedure for the treatment of painful vertebral body compression fractures refractory to medical therapy. In this article, the authors review the indications and contraindications for vertebroplasty, principles of appropriate patient selection, useful techniques to achieve optimal outcomes, and the potential risks and complications of the procedure.
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Affiliation(s)
- Bryan Jay
- Division of Interventional Radiology, Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sun Ho Ahn
- Division of Interventional Radiology, Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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16
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Wynn-Jones G, Shelton RM, Hofmann MP. Injectable citrate-modified Portland cement for use in vertebroplasty. J Biomed Mater Res B Appl Biomater 2014; 102:1799-808. [PMID: 24711245 PMCID: PMC4657479 DOI: 10.1002/jbm.b.33160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/06/2014] [Accepted: 03/13/2014] [Indexed: 11/26/2022]
Abstract
The injectability of Portland cement (PC) with several citrate additives was investigated for use in clinical applications such as vertebroplasty (stabilization of a fractured vertebra with bone cement) using a syringe. A 2-wt % addition of sodium or potassium citrate with PC significantly improved cement injectability, decreased cement setting times from over 2 h to below 25 min, while increasing the compressive strength to a maximum of 125 MPa. Zeta-potential measurements indicated that the citrate anion was binding to one or more of the positively charged species causing charged repulsion between cement particles which dispersed aggregates and caused the liquefying effect of the anion. Analysis of the hydrating phases of PC indicated that the early strength producing PC phase (ettringite) developed within the first 2 h of setting following addition of the citrate anion, while this did not occur in the control cement (PC only). Within 24 h ettringite developed in PC as well as calcium–silicate–hydrate (C–S–H), the major setting phase of PC, whereas cements containing citrate did not develop this phase. The evidence suggested that in the presence of citrate the cements limited water supply appeared to be utilized for ettringite formation, producing the early strength of the citrate cements. The present study has demonstrated that it is possible to modify PC with citrate to both improve the injectability and crucially reduce the setting times of PC while improving the strength of the cement. © 2014 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 102B: 1799–1808, 2014.
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Affiliation(s)
- Gareth Wynn-Jones
- Biomaterials Unit, School of Dentistry, University of Birmingham, St Chad's Queensway, Birmingham, B4 6NN, UK
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Barr JD, Jensen ME, Hirsch JA, McGraw JK, Barr RM, Brook AL, Meyers PM, Munk PL, Murphy KJ, O'Toole JE, Rasmussen PA, Ryken TC, Sanelli PC, Schwartzberg MS, Seidenwurm D, Tutton SM, Zoarski GH, Kuo MD, Rose SC, Cardella JF. Position statement on percutaneous vertebral augmentation: a consensus statement developed by the Society of Interventional Radiology (SIR), American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS), American College of Radiology (ACR), American Society of Neuroradiology (ASNR), American Society of Spine Radiology (ASSR), Canadian Interventional Radiology Association (CIRA), and the Society of NeuroInterventional Surgery (SNIS). J Vasc Interv Radiol 2013; 25:171-81. [PMID: 24325929 DOI: 10.1016/j.jvir.2013.10.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 10/03/2013] [Accepted: 10/03/2013] [Indexed: 12/23/2022] Open
Affiliation(s)
- John D Barr
- California Center for Neurointerventional Surgery, La Jolla.
| | - Mary E Jensen
- Department of Radiology, University of Virginia Health System, Charlottesville, Virginia
| | - Joshua A Hirsch
- Division of Neurointerventional Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - J Kevin McGraw
- Riverside Interventional Consultants, Riverside Methodist Hospital, Columbus
| | - Robert M Barr
- Mecklenburg Radiology Associates, Charlotte, North Carolina
| | - Allan L Brook
- Department of Radiology, Montefiore Medical Center, Bronx
| | - Philip M Meyers
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons
| | - Peter L Munk
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia
| | - Kieran J Murphy
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Peter A Rasmussen
- Cerebrovascular Center and Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Pina C Sanelli
- Departments of Radiology and Public Health, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | | | | | - Sean M Tutton
- Department of Radiology, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
| | - Gregg H Zoarski
- Department of Neurointerventional Surgery, Christiana Care Health System, Newark, Delaware
| | - Michael D Kuo
- Department of Radiology, University of California, Los Angeles, Medical School, Los Angeles
| | - Steven C Rose
- Department of Radiology, University of California, San Diego, Medical Center, San Diego, California
| | - John F Cardella
- Department of Radiology, Geisinger Health System, Danville, Pennsylvania
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18
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Cementoplasty for managing painful bone metastases outside the spine. Eur Radiol 2013; 24:731-7. [DOI: 10.1007/s00330-013-3071-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/08/2013] [Accepted: 10/28/2013] [Indexed: 01/12/2023]
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Dalton BE, Kohm AC, Miller LE, Block JE, Poser RD. Radiofrequency-targeted vertebral augmentation versus traditional balloon kyphoplasty: radiographic and morphologic outcomes of an ex vivo biomechanical pilot study. Clin Interv Aging 2012. [PMID: 23204845 PMCID: PMC3508556 DOI: 10.2147/cia.s37025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Traditional balloon kyphoplasty (BK) is a common treatment for symptomatic vertebral compression fractures. The purpose of this study was to compare a novel vertebral augmentation technique, radiofrequency-targeted vertebral augmentation (RF-TVA), to BK for restoration of vertebral height, cavity creation, and polymethylmethacrylate (PMMA) delivery and interdigitation into the surrounding trabeculae. METHODS This ex vivo biomechanical pilot study utilized 16 osteoporotic cadaveric vertebral bodies in a standardized fracture model to compare unipedicular RF-TVA (n = 8) to bipedicular BK (n = 8). Four specimens from each group were tested in loaded and unloaded conditions. All specimens were imaged, assessed for height restoration, and sectioned to observe PMMA distribution. A subset of specimens underwent computed tomography scanning to assess cavity creation and trabecular architecture prior to cement delivery. RESULTS Anterior height restoration was greater with RF-TVA (median: 84%, interquartile range: 62%-95%) compared to BK (median: 69%, interquartile range: 60%-81%), although the difference did not achieve statistical significance (P = 0.16). Anterior height restoration was numerically greater under loaded (median: 70% versus 66%) and unloaded (median: 94% versus 77%) conditions with RF-TVA versus BK. RF-TVA produced more discrete cavities and less native trabecular destruction compared to marked trabecular destruction observed with BK. RF-TVA consistently showed a well-identified focal area of PMMA with an extensive peripheral zone of PMMA interdigitation, providing mechanical interlock into the adjacent intact trabecular matrix. In contrast, BK yielded little evidence of PMMA interdigitation beyond the boundaries created by the balloon tamp due to the crushed trabecular bone peripherally. CONCLUSION RF-TVA achieves favorable vertebral height restoration with targeted PMMA delivery and less trabecular destruction compared to BK. RF-TVA has potential clinical utility in the aging population with painful osteoporotic vertebral fracture.
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Tins BJ, Cassar-Pullicino VN, Lalam R, Haddaway M. Venous air embolism in consecutive balloon kyphoplasties visualised on CT imaging. Skeletal Radiol 2012; 41:1093-8. [PMID: 22252292 DOI: 10.1007/s00256-011-1348-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 12/01/2011] [Accepted: 12/11/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We noted a large amount of intravenous gas during balloon kyphoplasty on CT imaging. Formal assessment to understand the extent, possible causes and implications was undertaken. MATERIALS AND METHODS Ten consecutive cases of balloon kyphoplasty were performed under general anaesthesia in the prone position, on a single vertebral level using a two-step technique under combined fluoroscopic and CT guidance. CT of the affected vertebra was performed before, after, and intermittently during the procedure. In 2 cases delayed CT was carried out in the supine position. RESULTS Gas was seen on CT imaging, but not on conventional fluoroscopy. The gas is most likely to be air introduced during the procedure and was seen in the epidural and paravertebral venous plexus, posterior intercostal veins, renal veins, IVC and azygos vein. The average measured volume of gas seen on the post-procedure CT imaging was 1.07 mL, range 0.16-3.97 mL. There was no correlation of the measured amount of gas to the procedure duration or location, the use of a curette or the injected cement volume. Delayed CT in the supine position no longer showed air in the local venous system. CONCLUSIONS Balloon kyphoplasty is associated with the fluoroscopically invisible introduction of air into the vertebral and paravertebral veins and deep systemic veins and is likely to be much more extensive than identified on CT imaging. There is potential for serious air embolism in kyphoplasty and if there is a sudden deterioration in patient condition during the procedure the possibility of this complication needs to be considered.
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Affiliation(s)
- Bernhard J Tins
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Twmpath Lane, Oswestry, Shropshire, SY10 7AG, UK.
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21
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Wynn‐Jones G, Shelton RM, Hofmann MP. Development of Portland cement for orthopedic applications, establishing injectability and decreasing setting times. J Biomed Mater Res B Appl Biomater 2012; 100:2213-21. [DOI: 10.1002/jbm.b.32790] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 05/16/2012] [Accepted: 07/07/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Gareth Wynn‐Jones
- Biomaterials, School of Dentistry, University of Birmingham, St Chad's Queensway, Birmingham, B4 6NN, UK
| | - Richard M Shelton
- Biomaterials, School of Dentistry, University of Birmingham, St Chad's Queensway, Birmingham, B4 6NN, UK
| | - Michael P Hofmann
- Biomaterials, School of Dentistry, University of Birmingham, St Chad's Queensway, Birmingham, B4 6NN, UK
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Guglielmi G, Muscarella S, Bazzocchi A. Integrated imaging approach to osteoporosis: state-of-the-art review and update. Radiographics 2012; 31:1343-64. [PMID: 21918048 DOI: 10.1148/rg.315105712] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Osteoporosis is the most common of all metabolic bone disorders. It is characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fractures. Because of the increasing aging of the world population, the number of persons affected by osteoporosis is also increasing. Complications related to osteoporosis can create social and economic burdens. For these reasons, the early diagnosis of osteoporosis is crucial. Conventional radiography allows qualitative and semiquantitative evaluation of osteoporosis, whereas other imaging techniques allow quantification of bone loss (eg, dual-energy x-ray absorptiometry and quantitative computed tomography [CT]), assessment for the presence of fractures (morphometry), and the study of bone properties (ultrasonography). In recent years, new imaging modalities such as micro-CT and high-resolution magnetic resonance imaging have been developed in an attempt to help diagnose osteoporosis in its early stages, thereby reducing social and economic costs and preventing patient suffering. The correct diagnosis of osteoporosis results in better management in terms of prevention and adequate pharmacologic or surgical treatment.
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de Courcy J. Interventional Techniques for Cancer Pain Management. Clin Oncol (R Coll Radiol) 2011; 23:407-17. [DOI: 10.1016/j.clon.2011.04.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 12/13/2010] [Accepted: 04/05/2011] [Indexed: 12/11/2022]
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Biomechanical, histological and histomorphometric analyses of calcium phosphate cement compared to PMMA for vertebral augmentation in a validated animal model. 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 2011; 20 Suppl 3:376-82. [PMID: 21773815 DOI: 10.1007/s00586-011-1905-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 06/29/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Calcium phosphate cements (biocements) are alternative materials for use in vertebral augmentation procedures, and are a potential solution to problems associated with polymethylmethacrylate (PMMA) cements. The aim of this study is to demonstrate the utility of percutaneously injected biocements compared with PMMA in a validated animal model of osteoporosis. MATERIALS AND METHODS Fortyseven augmentation procedures were performed on 11 osteoporotic sheep. 9 vertebrae were augmented with PMMA and 38 with a biocement. The animals were killed in four groups: at 7 days, 3 months, 6 months, and 1 year after intervention. Radiological study and TC of the pieces were obtained to evaluate for leakage, cement diffusion, and integration. In total, 26 biomechanic studies and 27 histomorphometry analyses were performed, included control vertebrae. RESULTS In 20.9% of the vertebrae, the hole was empty at sacrifice. The pattern of fracture was heterogeneous, and cement augmentation did not increase vertebral strength or decrease vertebral stiffness compared to control vertebrae, with neither PMMA or biocement. The rate of remodeling of the biocement was not predictable. In the single majority, there is peripheral remodeling, staying the volume of injected biocement stable. CONCLUSIONS Even though this animal model may not be useful to analyze the biomechanical pattern of treated vertebrae, it demonstrates that the percutaneous use of biocements in vertebral augmentation techniques is not predictable. This is one reason not to recommend its use presently as a substitute for PMMA in vertebral reinforcement procedures.
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Abstract
Cementoplasty includes percutaneous procedures like vertebroplasty, kyphoplasty, osteoplasty, and sacroplasty. Bone packing with cement aims to treat or prevent vertebral and extraspinal pathological fractures and relieve pain in patients with osteoporosis and bone metastases. The authors outline the accepted and newer indications for patient selection and present the fundamentals of image-guided lesion access and cement injection. Practitioners should evaluate each patient carefully and have a thorough knowledge of the anatomy, the technique, the expected outcomes, and the potential complications. Detailed informed consent and multidisciplinary decision making are recommended. Understanding of the particular advantages and limitations of the various modern filler materials is also crucial for a successful and uncomplicated procedure. Future developments include new mechanical devices for effective restoration of vertebral height, as well as the introduction of osteoconductive and osteoinductive cements that will be able to promote more physiological bone healing.
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Affiliation(s)
- Konstantinos Katsanos
- Department of Interventional Radiology, Guy's and St. Thomas' Hospital, NHS Foundation Trust, London, United Kingdom
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26
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Vissers KCP, Besse K, Wagemans M, Zuurmond W, Giezeman MJMM, Lataster A, Mekhail N, Burton AW, van Kleef M, Huygen F. 23. Pain in Patients with Cancer. Pain Pract 2011; 11:453-75. [PMID: 21679293 DOI: 10.1111/j.1533-2500.2011.00473.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kris C P Vissers
- Department of Anesthesiology Pain Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Lai PL, Tai CL, Chen LH, Nien NY. Cement leakage causes potential thermal injury in vertebroplasty. BMC Musculoskelet Disord 2011; 12:116. [PMID: 21615939 PMCID: PMC3124425 DOI: 10.1186/1471-2474-12-116] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 05/26/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Percutaneous vertebroplasty by injecting PMMA bone cement into the fractured vertebrae has been widely accepted in treatment of spinal compression fracture. However, the exothermic polymerization of bone cement may cause osseous or neural tissue injury. This study is thus designed to evaluate the potential risk of thermal damage in percutaneous vertebroplasty. METHOD Twelve porcine vertebrae were immersed in 37°C saline for the experiment. In the first stage of the study, vertebroplasty without cement leakage (control group, n = 6) was simulated. The anterior cortex, foramen, posterior cortex and the center of the vertebral body were selected for temperature measurement. Parameters including peak temperature and duration above 45°C were recorded. In the second stage, a model (n = 6) simulating bone cement leaking into the spinal canal was designed. The methods for temperature measurement were identical to those used in the first stage. RESULTS In Stage 1 of the study (vertebroplasty of the porcine vertebral body in the absence of cement leakage), the average maximal temperature at the anterior cortex was 42.4 ± 2.2°C; at the neural foramen 39.5 ± 2.1°C; at the posterior cortex 40.0 ± 2.5°C and at the vertebral center, 68.1 ± 3.4°C. The average time interval above 45°C was 0 seconds at the anterior cortex; at the neural foramen, 0 seconds; at the posterior cortex, 0 seconds and at the vertebral center, 223 seconds. Thus, except at the core of the bone cement, temperatures around the vertebral body did not exceed 45°C. In Stage 2 of the study (cement leakage model), the average maximal temperature at the anterior cortex was 42.7 ± 2.4°C; at the neural foramen, 41.1 ± 0.4°C; at the posterior cortex, 59.1 ± 7.6°C and at the vertebral center, 77.3 ± 5.7°C. The average time interval above 45°C at the anterior cortex was 0 seconds; at the neural foramen, 0 seconds; at the posterior cortex, 329.3 seconds and at the vertebral center, 393.2 seconds. Based on these results, temperatures exceeded 45°C at the posterior cortex and at the vertebral center. CONCLUSIONS The results indicated that, for bone cement confined within the vertebra, curing temperatures do not directly cause thermal injury to the nearby soft tissue. If bone cement leaks into the spinal canal, the exothermic reaction at the posterior cortex might result in thermal injury to the neural tissue.
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Affiliation(s)
- Po-Liang Lai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan, Taiwan
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Kassamali R, Ganeshan A, Hoey E, Crowe P, Douis H, Henderson J. Pain management in spinal metastases: the role of percutaneous vertebral augmentation. Ann Oncol 2011; 22:782-786. [DOI: 10.1093/annonc/mdq605] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Beall DP, Datir A, D'Souza SL, D'Souza LS, Gunda D, Morelli J, Johnson MB, Nabavizadeh N. Percutaneous treatment of insufficiency fractures : principles, technique and review of literature. Skeletal Radiol 2010; 39:117-30. [PMID: 19504091 DOI: 10.1007/s00256-009-0722-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 05/06/2009] [Accepted: 05/14/2009] [Indexed: 02/02/2023]
Abstract
Insufficiency fractures of the pelvis, sacrum, spine, and long bones are painful, debilitating, and are common consequences of osteoporosis. Conventional treatment for these fractures varies from conservative therapy to surgery with plate and screw fixation. The former fails to address the underlying problem of fracture and frequently does not alleviate symptoms, while the latter is invasive and not always possible in older populations with low bone density and numerous co-morbidities. Osseous augmentation with polymethylmethacrylate (PMMA) has been used for over two decades to treat fractures related to osteoporosis, but has not been commonly used to treat fractures outside of the vertebral bodies. Osseous augmentation with PMMA is an image-guided procedure and various techniques have been utilized to treat fracture in different locations. We describe various techniques for image-guided osseous augmentation and treatment of insufficiency fractures with bothPMMA and allograft bone for fractures of the pelvis including sacrum, acetabulum, pubic symphysis, pubic rami ilium; appendicular skeleton including distal radius, proximal femur, and vertebral body. We also describe the potential risks and complications associated with percutaneous treatment of insufficiency fractures and techniques to avoid the pitfalls of the various procedures. We will present the process for patient follow-up and data regarding the pre- and postprocedure pain response in patients undergoing treatment for pelvic insufficiency fractures.
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Affiliation(s)
- Douglas P Beall
- University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA.
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Prevention of cardiopulmonary embolization of polymethylmethacrylate cement fragment after kyphoplasty with insertion of inferior vena cava filter. J Vasc Surg 2010; 51:210-3. [DOI: 10.1016/j.jvs.2009.07.110] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 07/28/2009] [Accepted: 07/29/2009] [Indexed: 11/22/2022]
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Lewis G, Towler MR, Boyd D, German MJ, Wren AW, Clarkin OM, Yates A. Evaluation of two novel aluminum-free, zinc-based glass polyalkenoate cements as alternatives to PMMA bone cement for use in vertebroplasty and balloon kyphoplasty. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2010; 21:59-66. [PMID: 19655232 DOI: 10.1007/s10856-009-3845-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Accepted: 07/27/2009] [Indexed: 05/28/2023]
Abstract
Vertebroplasty (VP) and balloon kyphoplasty (BKP) are now widely used for treating patients in whom the pain due to vertebral compression fractures is severe and has proved to be refractory to conservative treatment. These procedures involve percutaneous delivery of a bolus of an injectable bone cement either directly to the fractured vertebral body, VB (VP) or to a void created in it by an inflatable bone tamp (BKP). Thus, the cement is a vital component of both procedures. In the vast majority of VPs and BKPs, a poly(methyl methacrylate) (PMMA) bone cement is used. This material has many shortcomings, notably lack of bioactivity and very limited resorbability. Thus, there is room for alternative cements. We report here on two variants of a novel, bioactive, Al-free, Zn-based glass polyalkenoate cement (Zn-GPC), and how their properties compare to those of an injectable PMMA bone cement (SIMPL) that is widely used in VP and BKP. The properties determined were injectability, radiopacity, uniaxial compressive strength, and biaxial flexural modulus. In addition, we compared the compression fatigue lives of a validated synthetic osteoporotic VB model (a polyurethane foam cube with an 8 mm-diameter through-thickness cylindrical hole), at 0-2300 N and 3 Hz, when the hole was filled with each of the three cements. A critical review of the results suggests that the performance of each of the Zn-GPCs is comparable to that of SIMPL; thus, the former cements merit further study with a view to being alternatives to an injectable PMMA cement for use in VP and BKP.
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Affiliation(s)
- Gladius Lewis
- Department of Mechanical Engineering, The University of Memphis, Memphis, TN 38152, USA.
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Localized Osteoporosis and its Consequences. J Clin Rheumatol 2010; 16:51. [DOI: 10.1097/rhu.0b013e3181ca01c4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hurley MC, Kaakaji R, Dabus G, Shaibani A, Walker MT, Fessler RG, Bendok BR. Percutaneous Vertebroplasty. Neurosurg Clin N Am 2009; 20:341-59. [DOI: 10.1016/j.nec.2009.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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