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Xiang QQ, Chu B, Lu MQ, Shi L, Gao S, Wang YT, Fang LJ, Ding YH, Zhao X, Chen Y, Wang MZ, Hu WK, Wang LF, Sun K, Bao L. Risk-benefit ratio of percutaneous kyphoplasty and percutaneous vertebroplasty in patients with newly diagnosed multiple myeloma with vertebral fracture: a single-center retrospective study. Ann Hematol 2023; 102:1513-1522. [PMID: 36997718 PMCID: PMC10182123 DOI: 10.1007/s00277-023-05202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/25/2023] [Indexed: 04/01/2023]
Abstract
The indications for percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) are painful vertebral compression fractures. Our study is to assess the risk-benefit ratio of PKP/PVP surgery in the patients with newly diagnosed multiple myeloma (NDMM) without receiving antimyeloma therapy. The clinical data of 426 consecutive patients with NDMM admitted to our center from February 2012 to April 2022 were retrospectively analyzed. The baseline data, postoperative pain relief, the proportion of recurrent vertebral fractures, and survival time were compared between the PKP/PVP surgical group and the nonsurgical group in the NDMM patients. Of the 426 patients with NDMM, 206 patients had vertebral fractures (206/426, 48.4%). Of these, 32 (32/206, 15.5%) underwent PKP/PVP surgery for misdiagnosis of simple osteoporosis prior to diagnosis of MM (surgical group), and the other 174 (174/206, 84.5%) did not undergo surgical treatment prior to definitive diagnosis of MM (non-surgical group). The median age of patients in the surgical and nonsurgical groups was 66 and 62 years, respectively (p = 0.01). The proportion of patients with advanced ISS and RISS stages was higher in the surgical group (ISS stage II + III 96.9% vs. 71.8%, p = 0.03; RISS stage III 96.9% vs. 71%, p = 0.01). Postoperatively, 10 patients (31.3%) never experienced pain relief and 20 patients (62.5%) experienced short-term pain relief with a median duration of relief of 2.6 months (0.2-24.1 months). Postoperative fractures of vertebrae other than the surgical site occurred in 24 patients (75%) in the surgical group, with a median time of 4.4 months postoperatively (0.4-86.8 months). Vertebral fractures other than the fracture site at the first visit occurred in 5 patients (2.9%) in the nonoperative group at the time of diagnosis of MM, with a median time of 11.9 months after the first visit (3.5-12.6 months). The incidence of secondary fractures was significantly higher in the surgical group than in the nonsurgical group (75% vs. 2.9%, p = 0.001). The time interval between the first visit and definitive diagnosis of MM was longer in the surgical group than in the nonsurgical group (6.1 months vs. 1.6 months, p = 0.01). At a median follow-up of 32 months (0.3-123 months), median overall survival (OS) was significantly shorter in the surgical group than in the nonsurgical group (48.2 months vs. 66 months, p = 0.04). Application of PKP/PVP surgery for pain relief in NDMM patients without antimyeloma therapy has a limited effect and a high risk of new vertebral fractures after surgery. Therefore, patients with NDMM may need to have their disease controlled with antimyeloma therapy prior to any consideration for PKP/PVP surgery.
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Affiliation(s)
- Qiu-Qing Xiang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Bin Chu
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Min-Qiu Lu
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Lei Shi
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Shan Gao
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Yu-Tong Wang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Li-Juan Fang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Yue-Hua Ding
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Xin Zhao
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Yuan Chen
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Meng-Zhen Wang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Wei-Kai Hu
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Li-Fang Wang
- Department of Epidemiology and Statistics, Beijing Jishuitan Hospital, Beijing, China
| | - Kai Sun
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Li Bao
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China.
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Hopkins TJ, Eggington S, Quinn M, Nichols-Ricker CI. Cost-effectiveness of balloon kyphoplasty and vertebroplasty versus conservative medical management in the USA. Osteoporos Int 2020; 31:2461-2471. [PMID: 32656632 PMCID: PMC7661420 DOI: 10.1007/s00198-020-05513-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/19/2020] [Indexed: 12/13/2022]
Abstract
UNLABELLED The cost-effectiveness of surgical versus conservative medical management of vertebral compression fractures in the US was analyzed in the context of inpatient versus outpatient treatment. Surgical intervention (balloon kyphoplasty and vertebroplasty) was found to be cost-effective relative to conservative medical management at a US willingness-to-pay threshold. INTRODUCTION To date, only one published study has evaluated the cost-effectiveness (C/E) of balloon kyphoplasty (BKP) or vertebroplasty (VP) in US Medicare patients with osteoporotic vertebral compression fractures. This study further evaluates the C/E of surgical treatment vs. conservative medical management (CMM), expanding on prior modeling by accounting for quality-adjusted life-years gained. METHODS A Markov microsimulation model of 1000 patients was constructed. Cost data were based on an analysis of Medicare claims payments, with propensity-score matching performed for BKP and VP vs. controls (CMM). Mortality inputs were based on US life tables, modified to account for age at initial fracture, presence of subsequent fracture(s), and relative risk of mortality by treatment. Separate incremental cost-effectiveness ratios (ICERs) were calculated for BKP and VP in inpatient and outpatient surgical treatment locations to account for individual clinical profiles presenting to each. RESULTS The discounted ICER for inpatient BKP vs. CMM was $43,455 per QALY gained; for outpatient BKP vs. CMM, $10,922; for inpatient VP vs. CMM, $39,774; and for outpatient VP vs. CMM, $12,293. Probabilistic sensitivity analysis confirmed that both BKP and VP would be considered C/E vs. CMM at a US willingness-to-pay (WTP) threshold of $50,000/QALY in 80% and 100% of 500 model simulations, respectively. The most sensitive parameters included quality of life estimates and hazard ratios for mortality. CONCLUSION While VP and BKP are more expensive treatment options than CMM in the short term, model results suggest interventional treatment is cost-effective, among patients eligible for surgery, at a US WTP threshold. This conclusion supports those from economic analyses conducted in EU-member countries.
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Affiliation(s)
- T J Hopkins
- Department of Anesthesiology and Pain Medicine, Duke Health, Duke University, 201 Trent Drive, 4313 Duke South, Orange Zone, DUMC, Box 3094, Durham, NC, 27710, USA.
| | - S Eggington
- Medtronic Global Health Economics & Reimbursement, Tolochenaz, Switzerland
| | - M Quinn
- Medtronic Pain Therapies Health Economics & Reimbursement, Fridley, MN, USA
| | - C I Nichols-Ricker
- Medtronic Pain Therapies Health Economics & Reimbursement, Fridley, MN, USA
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Moser M, Schmassmann P, Noger M, Baur M, Nevzati E. Usefulness of Fat Suppression Magnetic Resonance Imaging of Osteoporotic Vertebral Fractures in Preventing Subsequent Fractures After Kyphoplasty. World Neurosurg 2019; 125:e764-e773. [PMID: 30735867 DOI: 10.1016/j.wneu.2019.01.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/17/2019] [Accepted: 01/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Preoperative magnetic resonance imaging with fat suppression (FS-MRI) is useful to detect bone marrow edema in osteoporotic vertebral fractures (OVFs) and thus can improve diagnostic accuracy and influence surgical strategy for percutaneous augmentation. The role of preoperative FS-MRI in preventing subsequent fractures after balloon kyphoplasty has not been investigated in initially subclinical fractures or fractures without obvious morphologic changes. METHODS From January 2010 to December 2017, 214 consecutive patients underwent balloon kyphoplasty for painful OVFs. We defined 2 groups based on preoperative imaging (100 patients had preoperative FS-MRI and 114 patients had no MRI) and then compared baseline and surgical characteristics. The primary end point was incidence of subsequent fractures within 12 months after treatment. RESULTS The 214 patients underwent kyphoplasty of 414 vertebrae. Comparing FS-MRI with no-MRI groups, spontaneous fractures occurred significantly more (58% vs. 26.3%; P < 0.001) and fractures were more often multilevel (≥ 4 levels) (15% vs. 2.6%; P = 0.001), respectively. Overall incidence of subsequent vertebral fractures was 25.7% (32% in FS-MRI, 20.2% in no-MRI groups; P = 0.048). Average time to diagnosis of subsequent fractures did not differ between the 2 groups (9.3 FS-MRI vs. 11.5 weeks no-MRI; P = 0.411). Age ≥80 years at the time of balloon kyphoplasty was associated with a higher odds ratio (2.3) for subsequent fractures within 12 months (P = 0.039). CONCLUSIONS Surgical treatment according to preoperative FS-MRI did not reduce occurrence of subsequent OVFs and did not prolong fracture-free intervals within 12 months after kyphoplasty.
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Affiliation(s)
- Manuel Moser
- Department of Spine Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland; Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
| | - Philip Schmassmann
- Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Markus Noger
- Department of Spine Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Martin Baur
- Department of Spine Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Edin Nevzati
- Department of Neurosurgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland; Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
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Carr D, Cook R, Tong D, Bahoura M, Kanack J, Sobilo A, Falatko S, Walters BC, Barrett R. Kyphoplasty patient-centered outcomes via questionnaire. JOURNAL OF SPINE SURGERY 2018; 4:328-332. [PMID: 30069525 DOI: 10.21037/jss.2018.05.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To assess patient centered outcomes among adults with compression fractures treated by kyphoplasty. Methods A 3-question survey was administered via telephone to patients who had a kyphoplasty procedure performed from 2008-2011. Results One hundred fifty-one patients completed the telephone satisfaction survey. Of these, 95.4% of respondents said the procedure was tolerable, 82.8% had full or partial pain relief and 66.2% would have the procedure again. Conclusions Large randomized and observational evidence support the use of kyphoplasty in osteoporotic and malignant compression fractures. Based on our survey, patients believe kyphoplasty is a tolerable procedure that produces full or partial pain relief and would undergo the procedure again if needed.
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Affiliation(s)
- Daniel Carr
- Department of Surgery, Section of Neurosurgery, St John Providence Hospital, Southfield, MI, USA
| | - Richard Cook
- Department of Surgery, Section of Neurosurgery, St John Providence Hospital, Southfield, MI, USA
| | - Doris Tong
- Department of Surgery, Section of Neurosurgery, St John Providence Hospital, Southfield, MI, USA.,Michigan Spine and Brain Surgeons, Southfield, MI, USA
| | | | - Jennifer Kanack
- Department of Surgery, Section of Neurosurgery, St John Providence Hospital, Southfield, MI, USA
| | - Alicja Sobilo
- Department of Surgery, Section of Neurosurgery, St John Providence Hospital, Southfield, MI, USA
| | - Stephanie Falatko
- Department of Surgery, Section of Neurosurgery, St John Providence Hospital, Southfield, MI, USA
| | - Beverly C Walters
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, USA
| | - Ryan Barrett
- Department of Surgery, Section of Neurosurgery, St John Providence Hospital, Southfield, MI, USA.,Michigan Spine and Brain Surgeons, Southfield, MI, USA
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Uei H, Tokuhashi Y, Maseda M, Nakahashi M, Nakayama E. Multiple vertebral fractures associated with glucocorticoid-induced osteoporosis treated with teriparatide followed by kyphosis correction fusion: a case report. Osteoporos Int 2018; 29:1211-1215. [PMID: 29476202 DOI: 10.1007/s00198-018-4425-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
Abstract
UNLABELLED Surgical treatment of multiple vertebral fractures in patients with glucocorticoid-induced osteoporosis is difficult because of a high rate of secondary fracture postoperatively. A case is described in which initial treatment with teriparatide to improve osteoporosis followed by treatment of kyphosis with correction fusion achieved a favorable outcome. INTRODUCTION Secondary fracture frequently occurs after treatment of vertebral fracture with vertebroplasty and balloon kyphoplasty in patients with glucocorticoid-induced osteoporosis, but effective treatment of multiple vertebral fractures has rarely been reported. Thus, a treatment of kyphosis following multiple vertebral fractures associated with glucocorticoid-induced osteoporosis is required. METHODS The patient was a 24-year-old woman diagnosed with glucocorticoid-induced osteoporosis who was under treatment with oral alendronate, vitamin D, and elcatonin injection. Secondary multiple vertebral fractures occurred despite these treatments and low back pain gradually aggravated. RESULTS Vertebroplasty or balloon kyphoplasty was not performed in the early phase. Instead, treatment with teriparatide was used for initial improvement of osteoporosis. Kyphosis in the center of the residual thoracolumbar junction was then treated with posterior correction fusion. At 2 years after surgery, the corrected position has been maintained and no new fracture has occurred. CONCLUSION There is no established method for treatment of multiple vertebral fractures caused by glucocorticoid-induced osteoporosis. Initial treatment with teriparatide to improve osteoporosis followed by treatment of kyphosis with correction fusion may result in a more favorable outcome.
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Affiliation(s)
- Hiroshi Uei
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masafumi Maseda
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masahiro Nakahashi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Enshi Nakayama
- Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
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Grelat M, Madkouri R, Comby PO, Fahed E, Lemogne B, Thouant P. Mid-Term Clinical and Radiological Outcomes After Kyphoplasty in the Treatment of Thoracolumbar Traumatic Vertebral Compression Fractures. World Neurosurg 2018; 115:e386-e392. [PMID: 29678706 DOI: 10.1016/j.wneu.2018.04.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 04/07/2018] [Accepted: 04/09/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The management of thoracolumbar posttraumatic compression fractures varies widely among centers, and there is no real consensus as to the optimum approach. The objective of our retrospective study was to detect the progression of vertebral kyphosis in nonosteoporotic patients treated by balloon kyphoplasty (KPB) who presented with recent compression fractures of the thoracolumbar region. METHODS In this retrospective study, we investigated the evolution of vertebral and regional kyphosis in 77 patients treated by KPB for compression vertebral fractures (Magerl A) between 2007 and 2011. All treated patients, even those lost to follow-up, were included in our statistical analysis. RESULTS In the 77 patients, a 2.4° deterioration of vertebral kyphosis (P = 0.0004) and a 4.5° worsening of regional kyphosis (P < 0.0001) were observed at the end of the follow-up period. No statistical correlation between the worsened kyphosis and the deterioration of long-term pain was identified. The mean visual analog scale score was 2.5, associated with very low disability on functional scores. A3-2 and A3-3 fractures are characterized by worsening vertebral and regional kyphosis. CONCLUSIONS The paucity of studies of posttraumatic vertebral compression fractures in the scientific literature explains the lack of consensus regarding the optimum treatment approach. Postoperative results with KPB favor vertebral and regional kyphosis stability. KPB remains indicated in this situation except in cases of for burst fracture.
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Affiliation(s)
- Michael Grelat
- Department of Neurosurgery, Dijon University Hospital, Dijon, France.
| | - Rachid Madkouri
- Department of Neurosurgery, Dijon University Hospital, Dijon, France
| | | | - Elie Fahed
- Department of Neurosurgery, Dijon University Hospital, Dijon, France
| | - Brivael Lemogne
- Department of Neuroradiology, Dijon University Hospital, Dijon, France
| | - Pierre Thouant
- Department of Neuroradiology, Dijon University Hospital, Dijon, France
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Jung HJ, Park YS, Seo HY, Lee JC, An KC, Kim JH, Shin BJ, Kang TW, Park SY. Quality of Life in Patients with Osteoporotic Vertebral Compression Fractures. J Bone Metab 2017; 24:187-196. [PMID: 28955695 PMCID: PMC5613024 DOI: 10.11005/jbm.2017.24.3.187] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This study aimed to evaluate quality of life (QOL) using the EuroQOL-5 dimensions (EQ-5D) index and to examine factors affecting QOL in patients with an osteoporotic vertebral compression fracture (OVCF). METHODS This ambispective study used a questionnaire interview. Patients over 50 years old with an OVCF at least 6 months previously were enrolled. Individual results were used to calculate the EQ-5D index. Statistical analysis was performed, and factors related to QOL were examined. RESULTS Of 196 patients in the study, 84.2% were female, with an average age of 72.7 years. There were 66 (33.7%) patients with multilevel fractures. Conservative management was used in 75.0% of patients, and 56.1% received anti-osteoporosis treatment. The mean EQ-5D index was 0.737±0.221 and was significantly correlated with the Oswestry disability index score (correlation coefficient -0.807, P<0.001). The EQ-5D index was significantly correlated with age (Spearman's rho=-2.0, P=0.005), treatment method (P=0.005), and history of fracture (P=0.044) on univariate analysis and with conservative treatment (P<0.001) and osteoporotic treatment (P=0.017) on multivariate analysis. CONCLUSIONS OVCF markedly lowers QOL in several dimensions for up to 12 months, even in patients who have healed. Treatment of osteoporosis and conservative treatment methods affect QOL and should be considered in OVCF management.
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Affiliation(s)
- Ho Jin Jung
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ye-Soo Park
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hyoung-Yeon Seo
- Department of Orthopaedic Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Jae-Chul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Ki-Chan An
- Department of Orthopaedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin-Hyok Kim
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byung-Joon Shin
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Tae Wook Kang
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Si Young Park
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Agarwal N, Choi PA, Sekula RF. Minimally Invasive Spine Surgery for Unstable Thoracolumbar Burst Fractures: A Case Series. Surg J (N Y) 2016; 2:e131-e138. [PMID: 28825006 PMCID: PMC5553496 DOI: 10.1055/s-0036-1594248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 10/19/2016] [Indexed: 11/03/2022] Open
Abstract
Introduction Traumatic thoracolumbar burst fracture is a common pathology without a clear consensus on best treatment approach. Minimally invasive approaches are being investigated due to potential benefits in recovery time and morbidity. We examine long-term resolution of symptoms of traumatic thoracolumbar burst fractures treated with percutaneous posterior pedicle screw fixation. Methods Retrospective clinical review of seven patients with spinal trauma who presented with thoracolumbar burst fracture from July 2012 to April 2013 and were treated with percutaneous pedicle screw fixation. Electronic patient charts and radiographic imaging were reviewed for initial presentation, fracture characteristics, operative treatment, and postoperative course. Results The patients had a median age of 29 years (range 18 to 57), and 57% were men. The median Thoracolumbar Injury Classification and Severity Scale score was 4 (range 2 to 9). All patients had proper screw placement and uneventful postoperative courses given the severity of their individual traumas. Five of seven patients were reached for long-term follow-up of greater than 28 months. Six of seven patients had excellent pain control and stability at their last follow-up. One patient required revision surgery for noncatastrophic hardware failure. Conclusion Percutaneous pedicle screw fixation for the treatment of unstable thoracolumbar burst fracture may provide patients with durable benefits and warrants further investigation.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Phillip A Choi
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Raymond F Sekula
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Ceyhan E, Gursoy S, Akkaya M, Ugurlu M, Koksal I, Bozkurt M. Toward the Turkish National Registry System: A Prevalence Study of Total Knee Arthroplasty in Turkey. J Arthroplasty 2016; 31:1878-84. [PMID: 27038864 DOI: 10.1016/j.arth.2016.02.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/20/2016] [Accepted: 02/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this pilot study was to analyze the data obtained from a retrospective examination of the records of the existing reimbursement system and through the identification of gaps in the data to create a foundation for a reliable, descriptive national registry system for our country. METHODS The Social Security Institution Medical Messenger (MEDULA) records were scanned for the years 2010-2014, and the numbers of total knee arthroplasty applied for a diagnosis of gonarthrosis and the numbers of revision knee arthroplasty were recorded for the country in general. The patients were classified according to age, gender, and bilateral or unilateral surgery. The institution where the surgery was applied, the geographic region and the province were also recorded. RESULTS A total of 283,400 primary and 9900 revision knee arthroplasty operations were applied in Turkey between 2010 and 2014. Numbers were recorded for each year, and there was found to be an increase between years. For primary knee arthroplasty, the female:male ratio was 67 of 33, and surgery was applied most often between the ages of 60-69 years. Both types of surgery were determined to have been applied most often in second-stage state hospitals. Geographically, both types of surgery were applied most in the Marmara region, with the highest frequency of primary knee arthroplasty in Istanbul and the highest frequency of revision surgery in Ankara. CONCLUSIONS The data obtained from this study will contribute to the creation of the basis for a National Registry System and thereby define more scientific treatment approaches.
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Affiliation(s)
- Erman Ceyhan
- Republic of Turkey Social Security Institution, General Directorate of General Health Insurance, Ankara, Turkey
| | - Safa Gursoy
- Department of Orthopedics and Traumatology, Yenimahalle Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Mustafa Akkaya
- Department of Orthopedics and Traumatology, Yenimahalle Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Mahmut Ugurlu
- Department of Orthopedics and Traumatology, Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Ismet Koksal
- Republic of Turkey Social Security Institution, General Directorate of General Health Insurance, Ankara, Turkey
| | - Murat Bozkurt
- Department of Orthopedics and Traumatology, Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
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Hoppe S, Budmiger M, Bissig P, Aghayev E, Benneker LM. Lordoplasty: midterm outcome of an alternative augmentation technique for vertebral fractures. J Neurosurg Spine 2016; 24:922-7. [PMID: 26895528 DOI: 10.3171/2015.10.spine151016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Vertebroplasty and balloon kyphoplasty are effective treatment options for osteoporotic vertebral compression fractures but are limited in correction of kyphotic deformity. Lordoplasty has been reported as an alternative, cost-effective, minimally invasive, percutaneous cement augmentation technique with good restoration of vertebral body height and alignment. The authors report on its clinical and radiological midterm results. METHODS A retrospective review was conducted of patients treated with lordoplasty from 2002 to 2014. Inclusion criteria were clinical and radiological follow-up evaluations longer than 24 months. Radiographs were accessed regarding initial correction and progressive loss of reduction. Complications and reoperations were recorded. Actual pain level, pain relief immediately after surgery, autonomy, and subjective impression of improvement of posture were assessed by questionnaire. RESULTS Sixty-five patients (46 women, 19 men, age range 38.9-86.2 years old) were treated with lordoplasty for 69 vertebral compression and insufficiency fractures. A significant correction of the vertebral kyphotic angle (mean 13°) and segmental kyphotic angle (mean 11°) over a mean follow-up of 33 months (range 24-108 months) was achieved (p < 0.001). On average, pain was relieved to 90% of the initial pain level. In 24% of the 65 patients a second spinal intervention was necessary: 16 distant (24.6%) and 7 adjacent (10.8%) new osteoporotic fractures, 4 instrumented stabilizations (6.2%), 1 new adjacent traumatic fracture (1.5%), and 1 distant microsurgical decompression (1.5%). Cement leakage occurred in 10.4% but was only symptomatic in 1 case. CONCLUSIONS Lordoplasty appeared safe and effective in midterm pain alleviation and restoration of kyphotic deformity in osteoporotic compression and insufficiency fractures. The outcomes of lordoplasty are consistent with other augmentation techniques.
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Affiliation(s)
- Sven Hoppe
- Department of Orthopedic Surgery, Inselspital, and
| | | | | | - Emin Aghayev
- Institute for Evaluative Research in Medicine, University of Bern, Switzerland
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Staub LP, Ryser C, Röder C, Mannion AF, Jarvik JG, Aebi M, Aghayev E. Total disc arthroplasty versus anterior cervical interbody fusion: use of the Spine Tango registry to supplement the evidence from randomized control trials. Spine J 2016; 16:136-45. [PMID: 26674445 DOI: 10.1016/j.spinee.2015.11.056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 11/27/2015] [Accepted: 11/29/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Several randomized controlled trials (RCTs) have compared patient outcomes of anterior (cervical) interbody fusion (AIF) with those of total disc arthroplasty (TDA). Because RCTs have known limitations with regard to their external validity, the comparative effectiveness of the two therapies in daily practice remains unknown. PURPOSE This study aimed to compare patient-reported outcomes after TDA versus AIF based on data from an international spine registry. STUDY DESIGN AND SETTING A retrospective analysis of registry data was carried out. PATIENT SAMPLE Inclusion criteria were degenerative disc or disc herniation of the cervical spine treated by single-level TDA or AIF, no previous surgery, and a Core Outcome Measures Index (COMI) completed at baseline and at least 3 months' follow-up. Overall, 987 patients were identified. OUTCOME MEASURES Neck and arm pain relief and COMI score improvement were the outcome measures. METHODS Three separate analyses were performed to compare TDA and AIF surgical outcomes: (1) mimicking an RCT setting, with admission criteria typical of those in published RCTs, a 1:1 matched analysis was carried out in 739 patients; (2) an analysis was performed on 248 patients outside the classic RCT spectrum, that is, with one or more typical RCT exclusion criteria; (3) a subgroup analysis of all patients with additional follow-up longer than 2 years (n=149). RESULTS Matching resulted in 190 pairs with an average follow-up of 17 months that had no residual significant differences for any patient characteristics. Small but statistically significant differences in outcome were observed in favor of TDA, which are potentially clinically relevant. Subgroup analyses of atypical patients and of patients with longer-term follow-up showed no significant differences in outcome between the treatments. CONCLUSIONS The results of this observational study were in accordance with those of the published RCTs, suggesting substantial pain reduction both after AIF and TDA, with slightly greater benefit after arthroplasty. The analysis of atypical patients suggested that, in patients outside the spectrum of clinical trials, both surgical interventions appeared to work to a similar extent to that shown for the cohort in the matched study. Also, in the longer-term perspective, both therapies resulted in similar benefits to the patients.
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Affiliation(s)
- Lukas P Staub
- Institute for Evaluative Research in Medicine, Stauffacherstrasse 78, 3014 Bern, Switzerland
| | - Christoph Ryser
- Institute for Evaluative Research in Medicine, Stauffacherstrasse 78, 3014 Bern, Switzerland
| | - Christoph Röder
- Institute for Evaluative Research in Medicine, Stauffacherstrasse 78, 3014 Bern, Switzerland
| | - Anne F Mannion
- Spine Centre Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, CH-8008 Zurich, Switzerland
| | - Jeffrey G Jarvik
- Comparative Effectiveness, Cost and Outcome Research Centre, University of Washington, 4333 Brooklyn Ave NE, Seattle, WA 98104, USA
| | - Max Aebi
- Department of Orthopaedic Surgery, Salem Spital, Schänzlistrasse 39, Bern 3025, Switzerland
| | - Emin Aghayev
- Institute for Evaluative Research in Medicine, Stauffacherstrasse 78, 3014 Bern, Switzerland.
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Aizawa T, Kokubun S, Ozawa H, Kusakabe T, Tanaka Y, Hoshikawa T, Hashimoto K, Kanno H, Morozumi N, Koizumi Y, Sato T, Hyodo H, Kasama F, Ogawa S, Murakami E, Kawahara C, Yahata JI, Ishii Y, Itoi E. Increasing Incidence of Degenerative Spinal Diseases in Japan during 25 Years: The Registration System of Spinal Surgery in Tohoku University Spine Society. TOHOKU J EXP MED 2016; 238:153-63. [DOI: 10.1620/tjem.238.153] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai
| | - Shoichi Kokubun
- Department of Orthopaedic Surgery, NHO Sendai-Nishitaga Hospital
| | - Hiroshi Ozawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai
| | | | | | | | - Ko Hashimoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai
| | - Haruo Kanno
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai
| | - Naoki Morozumi
- Department of Orthopaedic Surgery, NHO Sendai-Nishitaga Hospital
| | - Yutaka Koizumi
- Department of Orthopaedic Surgery, NHO Sendai-Nishitaga Hospital
| | - Tetsuro Sato
- Department of Orthopaedic Surgery, Sendai Orthopaedic Hospital
| | - Hironori Hyodo
- Department of Orthopaedic Surgery, Sendai Orthopaedic Hospital
| | - Fumio Kasama
- Department of Orthopaedic Surgery, Matsuda Hospital
| | - Shinji Ogawa
- Department of Orthopaedic Surgery, Sendai Medical Center
| | | | | | | | - Yushin Ishii
- Department of Orthopaedic Surgery, NHO Sendai-Nishitaga Hospital
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai
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13
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Elmallah RK, Krebs VE, Mont MA. National and Hospital Registries: An Invaluable Source and Wealth of Information. J Arthroplasty 2015; 30:1673-5. [PMID: 25936558 DOI: 10.1016/j.arth.2015.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 02/01/2023] Open
Affiliation(s)
- Randa K Elmallah
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Viktor E Krebs
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, Ohio
| | - Michael A Mont
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, Ohio
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14
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Lavage prior to vertebral augmentation reduces the risk for cement leakage. 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 2015; 25:3463-3469. [PMID: 26275998 DOI: 10.1007/s00586-015-4191-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/08/2015] [Accepted: 08/09/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE This study aimed at assessing the cement leakage rate and the filling pattern in patients treated with vertebroplasty, kyphoplasty and stentoplasty with and without a newly developed lavage technique. STUDY DESIGN Retrospective clinical case-control study. METHODS A newly developed bipedicular lavage technique prior to cement application was applied in 64 patients (45.1 %) with 116 vertebrae, ("lavage" group). A conventional bipedicular cement injection technique was used in 78 patients (54.9 %) with 99 levels ("controls"). The outcome measures were filling patterns and leakage rates. RESULTS The overall leakage rate (venous, cortical defect, intradiscal) was 37.9 % in the lavage and 83.8 % in the control group (p < 0.001). Venous leakage (lavage 12.9 % vs. controls 31.3 %; p = 0.001) and cortical defect leakage (lavage 17.2 % vs. controls 63.3 %; p < 0.001) were significantly lower in the lavage group compared to "controls," whereas intradiscal leakages were similar in both groups (lavage 12.1 % vs. controls 15.2 %; p = 0.51). For venous leakage multivariate logistic regression analysis showed lavage to be the only independent predictor. Lavage was associated with 0.33-times (95 % CI 0.16-0.65; p = 0.001) lower likelihood for leakage in compared to controls. CONCLUSIONS Vertebral body lavage prior to cement augmentation is a safe technique to reduce cement leakage in a clinical setting and has the potential to prevent pulmonary fat embolism. Moreover, a better filling pattern can be achieved.
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