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Brook AD, Clerk-Lamalice O, De Leacy RA, Brook AL, Hirsch JA. Armed kyphoplasty-the future? J Neurointerv Surg 2024; 16:435. [PMID: 38448228 DOI: 10.1136/jnis-2024-021575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Andrew D Brook
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Olivier Clerk-Lamalice
- Interventional Spine Service, Beam Interventional & Diagnostic Imaging, Calgary, Alberta, Canada
| | - Reade A De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Allan L Brook
- Interventional Neuroradiology, Montefiore Medical center, Bronx, New York, USA
| | - Joshua A Hirsch
- NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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Key BM, Callstrom MR, Filippiadis D. Musculoskeletal Interventional Oncology: A Contemporary Review. AJR Am J Roentgenol 2023; 221:503-516. [PMID: 37222277 DOI: 10.2214/ajr.23.29110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Musculoskeletal interventional oncology is an emerging field that addresses the limitations of conventional therapies for bone and soft-tissue tumors. The field's growth has been driven by evolving treatment paradigms, expanding society guidelines, mounting supportive literature, technologic advances, and cross-specialty collaboration with medical, surgical, and radiation oncology. Safe, effective, and durable pain palliation, local control, and stabilization of musculoskeletal tumors are increasingly achieved through an expanding array of contemporary minimally invasive percutaneous image-guided treatments, including ablation, osteoplasty, vertebral augmentation (with or without mechanical reinforcement via implants), osseous consolidation via percutaneous screw fixation (with or without osteoplasty), tumor embolization, and neurolysis. These interventions may be used for curative or palliative indications and can be readily combined with systemic therapies. Therapeutic approaches include the combination of different interventional oncology techniques as well as the sequential application of such techniques with other local treatments, including surgery or radiation. This article reviews the current practice of interventional oncology treatments for the management of patients with bone and soft-tissue tumors with a focus on emerging technologies and techniques.
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Affiliation(s)
- Brandon M Key
- Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Rm 2803, Milwaukee, WI 53226
| | - Matthew R Callstrom
- Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Rm 2803, Milwaukee, WI 53226
| | - Dimitrios Filippiadis
- Department of Diagnostic and Interventional Radiology, University General Hospital "Attikon" Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Zhan Y, Bao C, Yang H, Li L, Yan L, Kong L, Hao D, Wang B. Biomechanical analysis of a novel bone cement bridging screw system combined with percutaneous vertebroplasty for treating Kummell's disease. Front Bioeng Biotechnol 2023; 11:1077192. [PMID: 37274166 PMCID: PMC10233143 DOI: 10.3389/fbioe.2023.1077192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Kummell's Disease (KD) was originally proposed by Dr. Hermann Kummell in 1891 as a type of delayed posttraumatic vertebral collapse, which is a clinical phenomenon. The purpose of this experiment is to compare the strength of bone cement and the novel bone cement bridging screw in the treatment of thoracolumbar Kummell disease (KD) with other treatment methods. Thirty sheep spine specimens were selected. T12 to L2 segments were selected, and a KD intravertebral vacuum cleft model was made at the L1 segment. According to the ways of cement filling, the specimens were divided into percutaneous vertebroplasty (PVP), PVP combined with unilateral percutaneous pediculoplasty (PPP), PVP combined with bilateral PPP, unilateral novel bone cement bridging screw system combined with PVP, and bilateral cement bridging screw system combined with PVP groups. There were two experiments: three-dimensional biomechanical strength test and axial compression test. In the three-dimensional biomechanical strength test, we measured the strength of bone cement in specimens under six motion states, including flexion, extension, left bending, right bending, and left and right axial rotations. In the axial compression test, we detected the maximum axial pressure that the bone cement could withstand when it was under pressure until the bone cement was displaced. The unilateral or bilateral novel bone cement bridging screw with PVP groups had the best strength under flexion, extension, left bending, right bending, and had better biomechanical strength, with a significant difference from the other three groups (p < 0.05). There was no significant difference between the unilateral or bilateral novel bone cement bridging screw with PVP groups (p > 0.05). Unilateral and bilateral novel bone cement bridging screw could achieve similar bone cement strength. Compared with the other three groups, the unilateral or bilateral novel bone cement bridging screw with PVP groups are higher 136.35%, 152.43%; 41.93%, 51.58%; 34.37%, 43.50% respectively. The bilateral novel bone cement bridging screw with PVP could bear the largest pressure under vertical force. To conclude, the novel bone cement bridging screw can increase the strength of bone cement and avoid the loosening and displacement of bone cement in the treatment of KD of the thoracolumbar spine.
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Affiliation(s)
- Yi Zhan
- Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, China
- The Second Clinical Medical College of Shaanxi University of Chinese Medicine, Xi'an, Shaanxi, China
| | - Chang Bao
- The Second Clinical Medical College of Shaanxi University of Chinese Medicine, Xi'an, Shaanxi, China
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, PLA Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Huiming Yang
- Department of Orthopaedics, Shehong Municipal Hospital of TCM, Shehong, Sichuan, China
| | - Liang Li
- Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, China
| | - Liang Yan
- Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, China
| | - Lingbo Kong
- Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, China
| | - Dingjun Hao
- Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, China
| | - Biao Wang
- Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, China
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Hambli R, De Leacy R, Vienney C. Effect of a new transpedicular vertebral device for the treatment or prevention of vertebral compression fractures: A finite element study. Clin Biomech (Bristol, Avon) 2023; 102:105893. [PMID: 36682151 DOI: 10.1016/j.clinbiomech.2023.105893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND A finite element study was performed to investigate the biomechanical performance of a novel transpedicular implant (V-STRUT©, Hyprevention, France) made of PEEK (polyetheretherketone) material in terms of strengthening the osteoporotic vertebra and the thoraco-lumbar spine. The objective was to assess numerically the efficacy of the implant to reduce the stress distribution within bone and absorb part of the stress by the implant thanks to its optimized material selection close to that of normal bone. METHODS A numerical model was generated based on a scan of an osteoporotic patient. The model is composed of three consecutive vertebrae and intervertebral discs. A heterogeneous distribution of bone material properties was assigned to the bone. In order to investigate the rationale of the device material selection, three FE models were developed (i) without the device to serve a reference model, (ii) with device made in Titanium material and (iii) with device made in PEEK material. Stiffness and stress distribution within the spine segment were computed and compared in order to assess the implants' performances. FINDINGS The results obtained by the simulations indicated that the novel transpedicular implant made of PEEK material provided support to the superior vertebral endplate, restored the thoraco-lumbar spine segment stiffness and reduced the stress applied to the vertebrae under the compressive load. INTERPRETATION Implant geometry in combination with its material properties are very important factors to restore vertebral strength and stiffness and limiting the risk of fracture at the same vertebra or adjacent ones.
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Affiliation(s)
- Ridha Hambli
- Univ. Orléans, Univ. Tours, INSA CVL, LaMé, Orléans 45000, France.
| | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Di Caterino F, Koetsier E, Hirsch JA, Isalberti M, San Millan D, Marchi F, La Barbera L, Pileggi M, Cianfoni A. Middle column Stent-screw Assisted Internal Fixation (SAIF): a modified minimally-invasive approach to rescue vertebral middle column re-fractures. J Neurointerv Surg 2023; 15:jnis-2022-019752. [PMID: 36593116 DOI: 10.1136/jnis-2022-019752] [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: 10/13/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is limited literature regarding the re-fracture of a previously augmented vertebral compression fracture (VCF). These re-fractures may present as an asymptomatic remodeling of the vertebral body around the cement cast while in other cases they involve the middle column, at the transition zone between the cement-augmented and non-augmented vertebral body. In the latter, a posterior wall retropulsion is possible and, if left untreated, might progress to vertebral body splitting, central canal stenosis, and kyphotic deformity. There is no consensus regarding the best treatment for these re-fractures. There are cases in which a repeated augmentation relieves the pain, but this is considered an undertreatment in cases with middle column involvement, posterior wall retropulsion, and kyphosis. METHODS We report four cases of re-fracture with middle column collapse of a previously augmented VCF, treated with the stent-screw assisted internal fixation (SAIF) technique. A modified more postero-medial deployment of the anterior metallic implants was applied, to target the middle column fracture. This modified SAIF allowed the reduction and stabilization of the middle column collapse as well as the partial correction of the posterior wall retropulsion and kyphosis. RESULTS Complete relief of back pain with stable clinical and radiographic findings at follow-up was obtained in all cases. CONCLUSIONS In selected cases, the middle column SAIF technique is safe and effective for the treatment of the re-fracture with middle column collapse of a previously cement-augmented VCF. This technique requires precision in trocar placement and could represent a useful addition to the technical armamentarium for VCF treatment.
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Affiliation(s)
- Fortunato Di Caterino
- Department of Interventional Neuroradiology, University Hospital Centre Besancon, Besancon, France
| | - Eva Koetsier
- Pain Management Center, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana Facoltà di scienze biomediche, Lugano, Switzerland
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maurizio Isalberti
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
| | - Diego San Millan
- Neuroradiology Unit, Service of Diagnostic and Interventional Radiology, Sion Hospital Valais Romand Hospital Center, Sion, Switzerland
| | - Francesco Marchi
- Neurosurgery Department, Neurocenter of the Southern Switzerland EOC, Lugano, Switzerland
| | - Luigi La Barbera
- Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milano, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Marco Pileggi
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
| | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
- Department of Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland
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Salle H, Tran GV, Faure P, Mounayer C, Rouchaud A, Salle L, Caire F. Treatment of A3.2 and A2 traumatic thoracolumbar spine compression fractures using vertebral body stenting: a 63-patient series. J Neurointerv Surg 2023; 15:86-90. [PMID: 35292568 DOI: 10.1136/neurintsurg-2021-018628] [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: 12/30/2021] [Accepted: 02/22/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Percutaneous treatments for spinal injury are underused by neuroradiologists and spine surgeons, mainly owing to a lack of data on indications. OBJECTIVE To assess the safety and efficacy of vertebral body stenting (VBS) for post-traumatic A3.2 and A2 fractures (Magerl classification) and determine the factors that influence the improvements. METHODS We retrospectively reviewed patients who underwent VBS to treat a single traumatic thoracolumbar fracture from 2010 to 2019. Kyphosis, loss of vertebral body height (VBH), and clinical and functional outcomes (including the Visual Analog Scale pain score and Oswestry Disability Index) were assessed. We examined the overall effects of VBH in all patients by constructing a linear statistical model and evaluated whether the efficacy was dependent on the characteristics of the patients or fractures. RESULTS We included 63 patients comprising 44 A3.2 and 19 A2 fractures. No patient had worsening neurological symptoms or wound infection. The average rates of change were 67.1% (95% CI 59.1% to 75%) for kyphosis and 88.5% (95% CI 85.6% to 91.3%) for VBH (both p<0.0001). After 1 year, the VBS treatment was more effective for kyphosis in younger patients and at the L1 level, and for VBH in younger patients and cases of Magerl A3.2 fracture. CONCLUSIONS This large reported series on VBS validates this surgical treatment. All patients had improved kyphosis and restored VBH. We recommend using VBS rather than open surgery for A3.2 and A2 fractures at the thoracolumbar junction and in young patients.
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Affiliation(s)
- Henri Salle
- Department of Neurosurgery, CHU Limoges, Limoges, Limousin, France
| | - Gia van Tran
- Department of Neurosurgery, CHU Limoges, Limoges, Limousin, France
| | - Patrick Faure
- Department of Neurosurgery, CHU Limoges, Limoges, Limousin, France
| | - Charbel Mounayer
- Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Aymeric Rouchaud
- Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France.,Univ. Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | - Laurence Salle
- Unité Inserm UMR 1094 Neuroépidémiologie Tropicale, Limoges, France
| | - François Caire
- Department of Neurosurgery, CHU Limoges, Limoges, Limousin, France
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Guo LX, Zhang C. Development and Validation of a Whole Human Body Finite Element Model with Detailed Lumbar Spine. World Neurosurg 2022; 163:e579-e592. [PMID: 35436583 DOI: 10.1016/j.wneu.2022.04.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Investigations showed that low back pain of occupational drivers might be closely related to the whole-body vibration. Restricted by ethical concerns, the finite element method had become a viable alternative to invasive human experiments. Many mechanical behaviors of the human spine inside of the human body were unclear; therefore, a human whole-body finite element model might be required to better understand the lumbar behavior under whole-body vibration. METHODS In this study, a human whole-body finite element model with a detailed lumbar spine segment was developed. Several validations were performed to ensure the correctness of this model. RESULTS The results of anthropometry and geometry validation, static validation, and dynamic validation were presented in this study. The validation results showed that the whole human body model was reasonable and valid by comparing with published data. CONCLUSIONS The model developed in this study could reflect the biomechanical response of the human lumbar spine under vibration and could be used in further vibration analysis and offer proposals for protecting human body under whole-body vibration environment.
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Affiliation(s)
- Li-Xin Guo
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China.
| | - Chi Zhang
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China
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Zhang KR, Yang Y, Ma LT, Qiu Y, Wang BY, Ding C, Meng Y, Rong X, Hong Y, Liu H. Biomechanical Effects of a Novel Anatomic Titanium Mesh Cage for Single-Level Anterior Cervical Corpectomy and Fusion: A Finite Element Analysis. Front Bioeng Biotechnol 2022; 10:881979. [PMID: 35814021 PMCID: PMC9263189 DOI: 10.3389/fbioe.2022.881979] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The traditional titanium mesh cage (TTMC) has become common as a classical instrument for Anterior Cervical Corpectomy and Fusion (ACCF), but a series of complications such as cage subsidence, adjacent segment degeneration (ASD), and implant-related complications by using the TTMC have often been reported in the previous literature. The aim of this study was to assess whether a novel anatomic titanium mesh cage (NTMC) could improve the biomechanical condition after surgery. Methods: The NTMC model consists of two spacers located on both sides of the TTMC which match the anatomic structure between the endplates by measuring patient preoperative cervical computed tomography (CT) data. The ranges of motion (ROMs) of the surgical segments and the stress peaks in the C6 superior endplates, titanium mesh cage (TMC), screw–bone interface, anterior titanium plate, and adjacent intervertebral disc were compared. Results: Compared with the TTMC, the NTMC reduced the surgical segmental ROMs by 89.4% postoperatively. The C6 superior endplate stress peaks were higher in the TTMC (4.473–23.890 MPa), followed by the NTMC (1.923–5.035 MPa). The stress peaks on the TMC were higher in the TTMC (47.896–349.525 MPa), and the stress peaks on the TMC were lower in the NTMC (17.907–92.799 MPa). TTMC induced higher stress peaks in the screw–bone interface (40.0–153.2 MPa), followed by the NTMC (14.8–67.8 MPa). About the stress peaks on the anterior titanium plate, the stress of TTMC is from 16.499 to 58.432 MPa, and that of the NTMC is from 12.456 to 34.607 MPa. Moreover, the TTMC induced higher stress peaks in the C3/4 and C6/7 intervertebral disc (0.201–6.691 MPa and 0.248–4.735 MPa, respectively), followed by the NTMC (0.227–3.690 MPa and 0.174–3.521 MPa, respectively). Conclusion: First, the application of the NTMC can effectively decrease the risks of TMC subsidence after surgery. Second, in the NTMC, the stresses at the anterior screw-plate, bone–screw, and TMC interface are much less than in the TTMC, which decreased the risks of instrument-related complications after surgery. Finally, increases in IDP at adjacent levels are associated with the internal stresses of adjacent discs which may lead to ASD; therefore, the NTMC can effectively decrease the risks of ASD.
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Affiliation(s)
- Ke-rui Zhang
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
| | - Li-tai Ma
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
| | - Yue Qiu
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Bei-yu Wang
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
| | - Xin Rong
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Operation Room, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedic West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Hao Liu,
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Cianfoni A, Delfanti RL, Isalberti M, Scarone P, Koetsier E, Bonaldi G, Hirsch JA, Pileggi M. Minimally Invasive Stent Screw-Assisted Internal Fixation Technique Corrects Kyphosis in Osteoporotic Vertebral Fractures with Severe Collapse: A Pilot "Vertebra Plana" Series. AJNR Am J Neuroradiol 2022; 43:776-783. [PMID: 35450859 PMCID: PMC9089263 DOI: 10.3174/ajnr.a7493] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/09/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Fractures with "vertebra plana" morphology are characterized by severe vertebral body collapse and segmental kyphosis; there is no established treatment standard for these fractures. Vertebroplasty and balloon kyphoplasty might represent an undertreatment, but surgical stabilization is challenging in an often elderly osteoporotic population. This study assessed the feasibility, clinical outcome, and radiologic outcome of the stent screw-assisted internal fixation technique using a percutaneous implant of vertebral body stents and cement-augmented pedicle screws in patients with non-neoplastic vertebra plana fractures. MATERIALS AND METHODS Thirty-seven consecutive patients with vertebra plana fractures were treated with the stent screw-assisted internal fixation technique. Vertebral body height, local and vertebral kyphotic angles, outcome scales (numeric rating scale and the Patient's Global Impression of Change), and complications were assessed. Imaging and clinical follow-up were obtained at 1 and 6 months postprocedure. RESULTS Median vertebral body height restoration was 7 mm (+74%), 9 mm (+150%), and 3 mm (+17%) at the anterior wall, middle body, and posterior wall, respectively. Median local and vertebral kyphotic angles correction was 8° and 10° and was maintained through the 6-month follow-up. The median numeric rating scale score improved from 8/10 preprocedure to 3/10 at 1 and 6 months (P < .001). No procedural complications occurred. CONCLUSIONS The stent screw-assisted internal fixation technique was effective in obtaining height restoration, kyphosis correction, and pain relief in patients with severe vertebral collapse.
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Affiliation(s)
- A Cianfoni
- From the Department of Neuroradiology (A.C., R.L.D., M.I., M.P.)
- Department of Interventional and Diagnostic Neuroradiology (A.C.), Inselspital University Hospital of Bern, Bern, Switzerland
| | - R L Delfanti
- From the Department of Neuroradiology (A.C., R.L.D., M.I., M.P.)
| | - M Isalberti
- From the Department of Neuroradiology (A.C., R.L.D., M.I., M.P.)
| | | | - E Koetsier
- Pain Management Center (E.K.), Neurocenter of Southern Switzerland, Lugano, Switzerland
- Faculty of Biomedical Sciences (E.K.), Università della Svizzera Italiana, Lugano, Switzerland
| | - G Bonaldi
- Neurosurgical Department (G.B.), Casa di Cura Igea, Milan, Italy
| | - J A Hirsch
- Department of Radiology (J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Pileggi
- From the Department of Neuroradiology (A.C., R.L.D., M.I., M.P.)
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Yonezawa N, Yonezawa Y, Nishimura T, Yamashiro T, Shimozaki K, Sakaue A, Demura S, Tsuchiya H. Vertebra-pediculoplasty: a new approach to treatment of split type and delayed union osteoporotic vertebral fracture with a risk of cement dislodgment. World Neurosurg 2021; 155:e55-e63. [PMID: 34365045 DOI: 10.1016/j.wneu.2021.07.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Noritaka Yonezawa
- Department of Orthopedic Surgery, Saiseikai Kanazawa Hospital, 13-6 Akatsuchi-machi-ni, Kanazawa 920-0353, Japan.
| | - Yoshiro Yonezawa
- Yonezawa Hospital of Orthopedics, 1-30 Kyo-machi, Kanazawa 920-0848, Japan
| | - Tatsuya Nishimura
- Department of Orthopedic Surgery, Saiseikai Kanazawa Hospital, 13-6 Akatsuchi-machi-ni, Kanazawa 920-0353, Japan
| | - Teruhisa Yamashiro
- Department of Orthopedic Surgery, Saiseikai Kanazawa Hospital, 13-6 Akatsuchi-machi-ni, Kanazawa 920-0353, Japan
| | - Kengo Shimozaki
- Department of Orthopedic Surgery, Saiseikai Kanazawa Hospital, 13-6 Akatsuchi-machi-ni, Kanazawa 920-0353, Japan
| | - Akari Sakaue
- Department of Orthopedic Surgery, Saiseikai Kanazawa Hospital, 13-6 Akatsuchi-machi-ni, Kanazawa 920-0353, Japan
| | - Satoru Demura
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan
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Chen M, Wang R, Jia P, Bao L, Tang H. Stentoplasty with Resorbable Calcium Salt Bone Void Fillers for the Treatment of Vertebral Compression Fracture: Evaluation After 3 Years. Clin Interv Aging 2021; 16:843-852. [PMID: 34040361 PMCID: PMC8139642 DOI: 10.2147/cia.s308667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of the study is to investigate the clinical and radiological outcomes of vertebral compression fractures treated by stentoplasty with resorbable calcium salt bone void fillers compared with balloon kyphoplasty (BKP). Methods This prospective study included patients with fresh mono-thoracolumbar vertebral compression fractures. Patients enrolled were randomly divided into three groups. The patients in group A underwent stentoplasty with calcium sulfate/calcium phosphate (CSCP) composite filler and patients in group B with hydroxyapatite/collagen (HAP/COL) composite filler, while patients in group C underwent BKP with polymethylmethacrylate (PMMA). The clinical outcome was evaluated with visual analogue pain scale (VAS) and Oswestry disability score (ODI). The radiological results were evaluated with anterior height (AH) and Cobb angle of vertebral body. Computed tomography (CT) was used to assess osteogenesis effect. Results Each group included 14 patients. The VAS, ODI, Cobb angle and AH were statistically improved compared with preoperative and there was no significant difference between the three groups. However, the AH in group A and group B at 1-year follow-up presented slight loss compared with 1 day after surgery. CT results suggested both group A and group B presented obvious bone trabecula formation and variations of CT value. Conclusion The stentoplasty with resorbable calcium salt bone void fillers demonstrated clinical outcomes similar to traditional BKP for vertebral compression fractures. Both HAP/COL and CSCP performed certain osteogenesis. However, stentoplasty with studied fillers showed slight loss of AH within 1 year after surgery.
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Affiliation(s)
- Mengmeng Chen
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ruideng Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Pu Jia
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Li Bao
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hai Tang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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Salle H, Meynard A, Auditeau E, Gantois C, Rouchaud A, Mounayer C, Faure P, Caire F. Treating traumatic thoracolumbar spine fractures using minimally invasive percutaneous stabilization plus balloon kyphoplasty: a 102-patient series. J Neurointerv Surg 2021; 13:848-853. [PMID: 33758064 DOI: 10.1136/neurintsurg-2020-017238] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND There is no consensus on the treatment for spinal injuries resulting in thoracolumbar fractures without neurological impairment. Many trauma centers are opting for open surgery rather than a neurointerventional approach combining posterior percutaneous short fixation (PPSF) plus balloon kyphoplasty (BK). OBJECTIVE To assess the safety and efficacy of PPSF+BK and to estimate the expected improvement by clarifying the factors that influence improvement. METHODS We retrospectively reviewed patients who underwent PPSF+BK for the treatment of single traumatic thoracolumbar fractures from 2007 to 2019. Kyphosis, loss of vertebral body height (VBH), clinical and functional outcomes including visual analog scale and Oswestry disability index were assessed. We examined the overall effects in all patients by constructing a linear statistical model, and then examined whether efficacy was dependent on the characteristics of the patients or the fractures. RESULTS A total of 102 patients were included. No patient experienced neurological worsening or wound infections. The average rates of change were 74.4% (95% CI 72.6% to 76.1%) for kyphosis and 85.5% (95% CI 84.4% to 86.6%) for VBH (both p<0.0001). The kyphosis treatment was more effective on Magerl A3 and B2 fractures than on those classified as A2.3, as well as for fractures with slight posterior wall protrusion on the spinal canal. A higher postoperative visual analog scale score was predictive of poorer outcome at 1 year. CONCLUSIONS This is the largest series reported to date and confirms and validates this surgical treatment. All patients exhibited improved kyphosis and restoration of VBH. We advise opting for this technique rather than open surgery.
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Affiliation(s)
| | | | - Emilie Auditeau
- Epidemiology and Statistical Analysis, CHU Limoges, Limoges, France
| | | | - Aymeric Rouchaud
- Interventional Neuroradiology, CHU Limoges, Limoges, France.,University of Limoges, CNRS, XLIM, UMR 7252, Limoges, France
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13
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Beall DP. Response to: the 'armed concrete' approach: stent-screw-assisted internal fixation (SAIF) reconstructs and internally fixates the most severe osteoporotic vertebral fractures. J Neurointerv Surg 2020; 13:2-3. [PMID: 33122351 DOI: 10.1136/neurintsurg-2020-016894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Douglas P Beall
- Interventional Musculoskeletal Radiology, Summit Medical Center LLC, Edmond, Oklahoma, USA
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14
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Distefano D, Scarone P, Isalberti M, La Barbera L, Villa T, Bonaldi G, Hirsch JA, Cianfoni A. The 'armed concrete' approach: stent-screw-assisted internal fixation (SAIF) reconstructs and internally fixates the most severe osteoporotic vertebral fractures. J Neurointerv Surg 2020; 13:63-68. [PMID: 32938744 DOI: 10.1136/neurintsurg-2020-016597] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The treatment of severe osteoporotic vertebral compression fractures (VCFs) with middle-column (MC) involvement, high fragmentation, large cleft and/or pedicular fracture is challenging. Minimally invasive 'stent-screw-assisted internal fixation' (SAIF) can reduce the fracture, reconstruct the vertebral body (VB) and fix it to the posterior elements. OBJECTIVE To assess feasibility, safety, technical and clinical outcome of the SAIF technique in patients with severe osteoporotic VCFs. METHODS 80 treated vertebrae were analyzed retrospectively. Severe VCFs were characterized by advanced collapse (Genant grade 3), a high degree of osseous fragmentation (McCormack grade 2 and 3), burst morphology with MC injury, pediculo-somatic junction fracture, and/or large osteonecrotic cleft. VB reconstruction was evaluated on postprocedure radiographs and CT scans by two independent raters. Clinical and radiological follow-ups were performed at 1 and 6 months. RESULTS SAIF was performed at 28 thoracic and 52 lumbar levels in 73 patients. One transient neurological complication occurred. VB reconstruction was satisfactory in 98.8% of levels (inter-rater reliability 96%, κ=1). Follow-up at 1 month was available for 78/80 levels and at 6 months or later (range 6-24, mean 7.9 months) for 73/80 levels. Significant improvement in the Visual Analog Scale score was noted at 1 and 6 months after treatment (p<0.05). Patients reported global clinical benefit during follow-up (Patient's Global Impression of Change Scale 5.6±0.9 at 1 month and 6.1±0.9 at 6 months). Fourteen new painful VCFs occurred at different levels in 11 patients during follow-up, treated with vertebral augmentation or SAIF. Target-level stability was maintained in all cases. CONCLUSIONS SAIF is a minimally invasive, safe, and effective treatment for patients with severe osteoporotic VCFs with MC involvement.
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Affiliation(s)
- Daniela Distefano
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Pietro Scarone
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Maurizio Isalberti
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Luigi La Barbera
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Québec, Canada.,Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.,Sainte-Justine Clinical Hospital Center, Montréal, Quebec, Canada
| | - Tomaso Villa
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Giuseppe Bonaldi
- Department of Neurosurgery, Casa di Cura Igea, Milano, Lombardia, Italy
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland.,Department of Interventional and Diagnostic Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland
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15
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San Millán D. Letter to the Editor. Stent screw-assisted internal fixation and combined radiofrequency ablation and vertebroplasty for stabilization and local tumor control. J Neurosurg Spine 2020; 33:270-272. [PMID: 32276250 DOI: 10.3171/2020.1.spine2053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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16
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Cianfoni A, Distefano D, Scarone P, Pesce GA, Espeli V, La Barbera L, Villa T, Reinert M, Bonaldi G, Hirsch JA. Stent screw-assisted internal fixation (SAIF): clinical report of a novel approach to stabilizing and internally fixating vertebrae destroyed by malignancy. J Neurosurg Spine 2020; 32:507-518. [PMID: 31860813 DOI: 10.3171/2019.9.spine19711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Severe lytic cancerous lesions of the spine are associated with significant morbidity and treatment challenges. Stabilization and restoration of the axial load capability of the vertebral body (VB) are important to prevent or arrest vertebral collapse. Percutaneous stent screw-assisted internal fixation (SAIF), which anchors a VB stent/cement complex with pedicular screws to the posterior vertebral elements, is a minimally invasive, image-guided, 360° internal fixation technique that can be utilized in this patient cohort. The purpose of this study was to assess the feasibility, safety, and stabilization efficacy of VB reconstruction via the SAIF technique in a cohort of patients with extensive lytic vertebral lesions, who were considered to have an unstable or potentially unstable spine according to the Spinal Instability Neoplastic Score (SINS). METHODS This study was a retrospective assessment of a prospectively maintained database of a consecutive series of patients with neoplastic extensive extracompartmental osteolysis (Tomita type 4-6) of the VB treated with the SAIF technique. VB reconstruction was assessed on postprocedure plain radiographs and CT by two independent raters. Technical and clinical complications were recorded. Clinical and imaging follow-ups were assessed. RESULTS Thirty-five patients with extensive osteolytic metastatic lesions of the VB underwent 36 SAIF procedures. SAIF was performed as a stand-alone procedure in 31/36 cases and was associated with posterior surgical fixation in 5/36 (4/5 with decompressive laminectomy). In 1 case an epidural cement leak required surgical decompression. VB reconstruction was categorized as satisfactory (excellent or good rating) by the two raters in 34/36 cases (94.5%) with an interrater reliability of 94.4% (Cohen's kappa of 0.8). Follow-up, ranging from 1 to 30 months, was available for 30/36 levels. Long-term follow-up (6-30 months, mean 11.5 months) was available for 16/36 levels. Stability during follow-up was noted in 29/30 cases. CONCLUSIONS SAIF provides 360° nonfusion internal fixation that stabilizes the VB in patients with extensive lytic lesions that would otherwise be challenging to treat.
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Affiliation(s)
- Alessandro Cianfoni
- 1Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano
- 2Department of Interventional and Diagnostic Neuroradiology, Inselspital University Hospital of Bern
| | - Daniela Distefano
- 1Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano
| | - Pietro Scarone
- 3Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano
| | | | - Vittoria Espeli
- 5Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale Regionale di Bellinzona e Valli, San Giovanni, Bellinzona, Switzerland
| | - Luigi La Barbera
- 6Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
- 7Department of Mechanical Engineering, Polytechnique Montréal
- 8Sainte-Justine Clinical Hospital Center, Montréal, Quebec, Canada
| | - Tomaso Villa
- 6Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Michael Reinert
- 3Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano
- 9Department of Neurosurgery, Inselspital University Hospital of Bern, Switzerland
| | | | - Joshua A Hirsch
- 11Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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La Barbera L, Cianfoni A, Ferrari A, Distefano D, Bonaldi G, Villa T. Stent-Screw Assisted Internal Fixation of Osteoporotic Vertebrae: A Comparative Finite Element Analysis on SAIF Technique. Front Bioeng Biotechnol 2019; 7:291. [PMID: 31709250 PMCID: PMC6824407 DOI: 10.3389/fbioe.2019.00291] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/09/2019] [Indexed: 12/19/2022] Open
Abstract
Vertebral compression fractures are one of the most relevant clinical consequences caused by osteoporosis: one of the most common treatment for such fractures is vertebral augmentation through minimally invasive approaches (vertebroplasty or balloon-kyphoplasty). Unfortunately, these techniques still present drawbacks, such as re-fractures of the treated vertebral body with subsidence of the non-augmented portions or re-fracture of the non-augmented middle column at the junction with the augmented anterior column. A novel minimally-invasive augmentation technique, called Stent-Screw Assisted Internal Fixation, has been recently proposed for the treatment of severe osteoporotic and neoplastic fractures: this technique uses two vertebral body stents and percutaneous cannulated and fenestrated pedicular screws, through which cement is injected inside the expanded stents to achieve optimal stents' and vertebral body's filling. The role of the pedicle screws is to anchor the stents-cement complex to the posterior column, acting as a bridge across the middle column and preserving its integrity from possible collapse. In order to evaluate the potential of the new technique in restoring the load bearing capacity of the anterior and middle spinal columns and in reducing bone strains, a Finite Element model of an osteoporotic lumbar spine has been developed. Both standard vertebroplasty and Stent-Screw Assisted Internal Fixation have been simulated: simulations have been run taking into account everyday activities (standing and flexion) and comparison between the two techniques, in terms of strain distribution on vertebral endplates and posterior and anterior wall, was performed. Results show that Stent-Screw Assisted Internal Fixation significantly decrease the strain distribution on the superior EP and the cortical wall compared to vertebroplasty, possibly reducing the re-fracture risk of the middle-column at the treated level.
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Affiliation(s)
- Luigi La Barbera
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "G. Natta," Politecnico di Milano, Milan, Italy.,Department of Mechanical Engineering, Polytechnique Montréal, Montreal, QC, Canada.,Sainte-Justine University Hospital Centre, Montreal, QC, Canada
| | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland.,Department of Interventional and Diagnostic Neuroradiology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Andrea Ferrari
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "G. Natta," Politecnico di Milano, Milan, Italy
| | - Daniela Distefano
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | | | - Tomaso Villa
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "G. Natta," Politecnico di Milano, Milan, Italy
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