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Dai X, Liao W, Xu F, Lu W, Xi X, Fang X, Wu Q. External validation of predictive models for new vertebral fractures following percutaneous vertebroplasty. 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 2024:10.1007/s00586-024-08274-x. [PMID: 38713446 DOI: 10.1007/s00586-024-08274-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE To investigate the external validation and scalability of four predictive models regarding new vertebral fractures following percutaneous vertebroplasty. METHODS Utilizing retrospective data acquired from two centers, compute the area under the curve (AUC), calibration curve, and Kaplan-Meier plot to assess the model's discrimination and calibration. RESULTS In the external validation of Zhong et al.'s 2015 predictive model for the probability of new fractures post-vertebroplasty, the AUC for re-fracture at 1, 2, and 3 years postoperatively was 0.570, 0.617, and 0.664, respectively. The AUC for Zhong et al.'s 2016 predictive model for the probability of new fractures in neighboring vertebrae was 0.738. Kaplan-Meier plot results for both models indicated a significantly lower incidence of re-fracture in low-risk patients compared to high-risk patients. Li et al.'s 2021 model had an AUC of 0.518, and its calibration curve suggested an overestimation of the probability of new fractures. Li et al.'s 2022 model had an AUC of 0.556, and its calibration curve suggested an underestimation of the probability of new fractures. CONCLUSION The external validation of four models demonstrated that the predictive model proposed by Zhong et al. in 2016 exhibited superior external generalization capabilities.
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Affiliation(s)
- Xiangheng Dai
- Department of Spinal Surgery, Shaoguan First People's Hospital, Guangdong Medical University, Shaoguan, China
| | - Weibin Liao
- The First Clinical College of Guangdong Medical University, Zhanjiang, China
| | - Fuzhou Xu
- The First Clinical College of Guangdong Medical University, Zhanjiang, China
| | - Weiqi Lu
- The First Clinical College of Guangdong Medical University, Zhanjiang, China
| | - Xinhua Xi
- Department of Spinal Surgery, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, China
| | - Xiang Fang
- Department of Spinal Surgery, Shaoguan First People's Hospital, Guangdong Medical University, Shaoguan, China.
| | - Qiang Wu
- Department of Spinal Surgery, Shaoguan First People's Hospital, Guangdong Medical University, Shaoguan, China.
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Zhang TD, Cao S, Ren HY, Li YM, Yuan YM. Cemented vertebra and adjacent vertebra refractured in a chronic kidney disease-mineral and bone disorder patient: A case report. World J Clin Cases 2024; 12:1804-1809. [PMID: 38660087 PMCID: PMC11036482 DOI: 10.12998/wjcc.v12.i10.1804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/05/2024] [Accepted: 03/08/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Although percutaneous vertebral augmentation (PVA) is a commonly used procedure for treating vertebral compression fracture (VCF), the risk of vertebral refracture should be considered. Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a systemic disease of mineral and bone metabolism. It is associated with an increased risk of fracture. Few studies have reported the use of PVA in patients with CKD-MBD. We herein report a rare case wherein the cemented vertebra and the adjacent vertebra refractured simultaneously in a CKD-MBD patient after PVA. CASE SUMMARY A 74-year-old man suffered from low back pain after taking a fall about 3 wk ago. According to physical examination, imaging and laboratory findings, diagnoses of T12 VCF, CKD-MBD, and chronic kidney disease stage 5 were established. He then received percutaneous vertebroplasty at T12 vertebra. Fourteen weeks later, he presented with T12 and L1 vertebral refractures caused by lumbar sprain. Once again, he was given PVA which was optimized for the refractured vertebrae. Although the short-term postoperative effect was satisfactory, he reported chronic low back pain again at the 3-month follow-up. CONCLUSION It is necessary that patients with CKD-MBD who have received PVA are aware of the adverse effects of CKD-MBD. It may increase the risk of vertebral refracture. Furthermore, the PVA surgical technique needs to be optimized according to the condition of the patient. The medium- and long-term effects of PVA remain uncertain in patients with CKD-MBD.
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Affiliation(s)
- Ti-Dong Zhang
- Department of Orthopedics, Civil Aviation General Hospital, Beijing 100123, China
| | - Shuai Cao
- Department of Orthopedics, Civil Aviation General Hospital, Beijing 100123, China
| | - Hui-Yong Ren
- Department of Orthopedics, Civil Aviation General Hospital, Beijing 100123, China
| | - Yu-Min Li
- Department of Orthopedics, Civil Aviation General Hospital, Beijing 100123, China
| | - Yi-Ming Yuan
- Department of Orthopedics, Civil Aviation General Hospital, Beijing 100123, China
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Sahinturk F, Sonmez E, Ayhan S, Gulsen S, Yilmaz C. The Influence of Percutaneous Vertebral Augmentation Techniques on Recompression in Patients with Osteoporotic Vertebral Compression Fractures. Percutaneous Vertebroplasty versus Balloon Kyphoplasty. World Neurosurg 2023; 176:e447-e455. [PMID: 37257650 DOI: 10.1016/j.wneu.2023.05.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BK) have any mid-term to long-term effects on the structural integrity of augmented vertebrae. METHODS According to our hospital records, 351 patients underwent BK and PVP as a result of osteoporotic vertebral compression fractures between 2010 and 2020. The demographic, surgical, and radiologic characteristics of the patients were analyzed retrospectively using the electronic hospital records and PACS (picture archiving and communication system). In our study, 55 patients who had a single level of PVP or BK filled with at least 6 mL og polymethylmethacrylate (PMMA) for T11-L5 levels and 3 mL of PMMA for T6-T10 levels via a bipedicular approach and who had only 1 vertebral fracture in a 10-year follow-up period were included in our study. The patients were divided into 2 groups: BK (n = 40) and PVP (n = 15). All measurements were performed on standing lateral radiographs from the postoperative first day and the last radiographs that were obtained during the follow-up. The anterior and posterior heights of the fractured vertebral body and local kyphosis angles were measured. RESULTS The mean follow-up time was 2.53 ± 1.78 years in the BK group and 3.07 ± 2.02 years in the PVP group. The decrease in the vertebral height and increasing kyphosis that develop from the early to late postoperative periods were found to be statistically significant in the BK group (P < 0.05). In the PVP group, vertebral height and kyphosis angle measurements did not differ significantly between the early and late postoperative periods. In addition, in terms of the percentage change, anterior parts of the vertebral bodies are more affected. However, the absolute difference for the measurement of the vertebral heights did not confirm this finding. CONCLUSIONS To our knowledge, our study is unique because it has the longest follow-up in the literature comparing BK and PVP in terms of recollapse of the augmented vertebrae. Our study shows that BK does not prevent height loss of the augmented vertebral bodies in the mid- to long term.
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Affiliation(s)
- Fikret Sahinturk
- Department of Neurosurgery, Başkent University School of Medicine, Ankara, Turkey.
| | - Erkin Sonmez
- Department of Neurosurgery, Başkent University School of Medicine, Ankara, Turkey
| | - Selim Ayhan
- Department of Neurosurgery, Başkent University School of Medicine, Ankara, Turkey
| | - Salih Gulsen
- Department of Neurosurgery, Başkent University School of Medicine, Ankara, Turkey
| | - Cem Yilmaz
- Department of Neurosurgery, Başkent University School of Medicine, Ankara, Turkey
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Song Q, Zhao Y, Li D, Liu Z, Zhang Y, Shang D, Geng Z, Shi Z, Fan LH. Effect of different bone cement distributions in percutaneous kyphoplasty on clinical outcomes for osteoporotic vertebral compression fractures: A retrospective study. Medicine (Baltimore) 2023; 102:e33309. [PMID: 36961148 PMCID: PMC10036056 DOI: 10.1097/md.0000000000033309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 02/27/2023] [Indexed: 03/25/2023] Open
Abstract
Osteoporotic fractures and their complications are becoming increasingly harmful to the elderly. This study aimed to evaluate the clinical results of connected or unconnected bilateral cement after bilateral percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCF). The clinical data of 217 patients with single-segment OVCF were retrospectively collected. Patients were allocated into 2 groups according to the bilateral bone cement in the vertebrae was connected or unconnected after surgery. The surgery-related indexes of the 2 groups were compared, including operation time; bone cement injection volume; contact situation between bone cement and the upper and lower endplates of the vertebral body; visual analogue scale (VAS) scores before surgery, 1 week and 1 year after surgery; Oswestry disability index (ODI) before surgery, 1 week and 1 year after surgery; local kyphosis angle (LKA) before surgery, 1 week and 1 year after surgery; postoperative vertebral body height at 1 week and 1 year after surgery; vertebral body height restoration rate (HRR) at 1 week and 1 year after surgery. The follow-up results of all patients were recorded. The postoperative VAS, ODI, vertebral body height, LKA and other indexes of the 2 groups were significantly improved compared with those before the operation (P < .05), and there was no significant difference between the 2 groups (P > .05). At the same time, there were no significant difference in vertebral body HRR and bone cement leakage rate between the 2 groups (P > .05). X-ray examination showed that 21 of 217 patients (21/217, 9.8%) had a refracture of the injured vertebral body, including 16 cases (16/121, 13.2%) in the unconnected group and 5 cases (5/96, 5.2%) in the connected group (P < .05). Adjacent vertebrae fractures occurred in 25 cases (25/217, 11.5%), while 19 cases (19/121, 15.7%) were in the unconnected group and 6 cases (6/96, 6.3%) were in the connected group (P < .05). PKP has a good therapeutic effect on OVCF no matter whether the bilateral bone cement is connected or not. However, if the bilateral cement inside the vertebra was connected, the risk of recollapse of the injured vertebrae and the new fracture of adjacent vertebrae could be reduced.
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Affiliation(s)
- Qichun Song
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
| | - Yan Zhao
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
| | - Dong Li
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
| | - Zhaoying Liu
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Yuankai Zhang
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
| | - Donglong Shang
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
| | - Zilong Geng
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
| | - Zhibin Shi
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
| | - Li-Hong Fan
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
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Spiegl UJ, Jarvers JS, Osterhoff G, Kobbe P, Hölbing PL, Schnake KJ, Heyde CE. Effect of subsequent vertebral body fractures on the outcome after posterior stabilization of unstable geriatric fractures of the thoracolumbar spine. BMC Musculoskelet Disord 2022; 23:1064. [PMID: 36471332 PMCID: PMC9721076 DOI: 10.1186/s12891-022-06031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/25/2022] [Indexed: 12/09/2022] Open
Abstract
PURPOSE The purpose of this study was analyzing the effect of subsequent vertebral body fractures on the clinical outcome in geriatric patients with thoracolumbar fractures treated operatively. METHODS Retrospectively, all patients aged ≥ 60 with a fracture of the thoracolumbar spine included. Further inclusion parameters were acute and unstable fractures that were treated by posterior stabilization with a low to moderate loss of reduction of less than 10°. The minimal follow-up period was 18 months. Demographic data including the trauma mechanism, ASA score, and the treatment strategy were recorded. The following outcome parameters were analyzed: the ODI score, pain level, satisfaction level, SF 36 score as well as the radiologic outcome parameters. RESULTS Altogether, 73 patients were included (mean age: 72 years; 45 women). The majority of fractures consisted of incomplete or complete burst fractures (OF 3 + 4). The mean follow-up period was 46.6 months. Fourteen patients suffered from subsequent vertebral body fractures (19.2%). No trauma was recordable in 5 out of 6 patients; 42.8% of patients experienced a low-energy trauma (significant association: p < 0.01). There was a significant correlation between subsequent vertebral body fracture and female gender (p = 0.01) as well as the amount of loss of reduction (p = 0.02). Thereby, patients with subsequent vertebral fractures had significant worse clinical outcomes (ODI: 49.8 vs 16.6, p < 0.01; VAS pain: 5.0 vs 2.6, p < 0.01). CONCLUSION Patient with subsequent vertebral body fractures had significantly inferior clinical midterm outcome. The trauma mechanism correlated significantly with both the rate of subsequent vertebral body fractures and the outcome. Another risk factor is female gender.
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Affiliation(s)
- U. J. Spiegl
- grid.411339.d0000 0000 8517 9062Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - J.-S. Jarvers
- grid.411339.d0000 0000 8517 9062Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - G. Osterhoff
- grid.411339.d0000 0000 8517 9062Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - P. Kobbe
- grid.1957.a0000 0001 0728 696XDepartment of Trauma and Reconstructive Surgery, University of Aachen, Aachen, Germany
| | - P.-L. Hölbing
- grid.411339.d0000 0000 8517 9062Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - K. J. Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany ,Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - C.-E. Heyde
- grid.411339.d0000 0000 8517 9062Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
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Zhao Z, Deng L, Hua X, Liu H, Zhang H, Jia X, Wei R, Liu M, Lv N. A retrospective study on the efficacy and safety of bone cement in the treatment of endplate fractures. Front Surg 2022; 9:999406. [PMID: 36277290 PMCID: PMC9585934 DOI: 10.3389/fsurg.2022.999406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Endplate fractures is an important factor affecting the curative effect of percutaneous kyphoplasty for spinal fracture. The purpose of this study is to investigate the effect of sealing endplate fracture with bone cement on minimally invasive treatment of spinal fracture. Methods A total of 98 patients with osteoporotic vertebral fractures combined with endplate fractures treated with bone cement surgery in our hospital were retrospectively analyzed. They were grouped according to whether bone cement was involved in the endplate fractures. Group A: bone cement was not only distributed in the fractured vertebral body, but also dispersed into the endplate fractures. Group B: bone cement was confined to the fractured vertebra but did not diffuse into the cracks of the endplate. The basic information, imaging changes of the fractured vertebral body, VAS score, ODI score, bone cement distribution and postoperative complications of the two groups were analyzed and compared. Results The height of the injured vertebra and the kyphotic Cobb angle in the two groups were significantly improved after surgery, but the anterior height of the vertebra in group B was lower than that in group A and the kyphotic Cobb angle was higher than that in group A at the last follow-up (P < 0.05). VAS score and ODI score in 2 groups were significantly improved after operation (P < 0.05), but the VAS score and ODI score in group A were lower than those in group B at the last follow-up (P < 0.05). The incidence of bone cement leakage and adjacent vertebral fracture in group A was higher than that in group B (P < 0.05). Conclusion Diffusion of bone cement into the cracks of the endplate may also restore and maintain the height of the injured vertebra, relieve pain and restore lumbar function. However, diffusion of bone cement into the cracks of the endplate can increase the incidence of cement leakage and adjacent vertebral fractures.
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Affiliation(s)
- Zhijian Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Lei Deng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Xi Hua
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Haojun Liu
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Hao Zhang
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Xuejun Jia
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Rushuai Wei
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Mingming Liu
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China,Correspondence: Nanning Lv Mingming Liu
| | - Nanning Lv
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China,Correspondence: Nanning Lv Mingming Liu
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Injectable bioactive polymethyl methacrylate–hydrogel hybrid bone cement loaded with BMP-2 to improve osteogenesis for percutaneous vertebroplasty and kyphoplasty. Biodes Manuf 2022. [DOI: 10.1007/s42242-021-00172-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Li Y, Mao Y, Wang G, Sun J, Jiang Z, Ding Z, Cui X. Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures Associated with Spinal Canal Encroachment without Neurological Symptoms. Med Sci Monit 2021; 27:e930848. [PMID: 34785632 PMCID: PMC8607745 DOI: 10.12659/msm.930848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Percutaneous kyphoplasty (PKP) has been widely used for osteoporotic vertebral compression fractures (OVCFs). However, whether this approach is suitable for osteoporotic vertebral fractures with spinal canal encroachment remains controversial. Material/Methods Of 526 patients who underwent PKP at our hospital, 40 had conditions associated with spinal canal encroachment, and were enrolled in the study. Detailed physical, neurological, and radiological examinations were performed on each patient before and after surgery and at the followup. A visual analog scale (VAS) and the Oswestry Disability Index (ODI) were used for the clinical assessment. The vertebral body height, the local kyphosis, and the spinal canal width were used for the radiological evaluation. Results There were 11 male and 29 female patients, with a mean age of 71±8 years. The VAS score decreased from 6.4±0.7 preoperatively to 1.6±0.7 postoperatively and to 2.3±1.5 at the last followup visit. The ODI score was 78±9.5 before surgery, declined to 24±11.3 after surgery, and was 27.6±12.5 at the last followup visit. The vertebral body height increased from 11.7±4.3 mm to 14.6±4.4 mm. The local kyphosis decreased from 15.0±10.7 degrees preoperatively to 8.5±11.3 degrees postoperatively. The spinal canal width remained stable, at 8.5±2.0 mm before PKP and 8.7±1.9 after PKP. Conclusions PKP effectively relieved back pain in OVCF patients with spinal canal encroachment. Their social function improved as well.
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Affiliation(s)
- Yang Li
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China (mainland)
| | - Yi Mao
- Department of Orthopaedics, People's Hospital of Quzhou, Quzhou, Zhejiang, China (mainland)
| | - Guodong Wang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China (mainland)
| | - Jianmin Sun
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China (mainland)
| | - Zhensong Jiang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China (mainland)
| | - Zihai Ding
- Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Xingang Cui
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China (mainland)
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Cabrera JP, Camino-Willhuber G, Guiroy A, Carazzo CA, Gagliardi M, Joaquim AF. Vertebral augmentation plus short-segment fixation versus vertebral augmentation alone in Kümmell's disease: a systematic review and meta-analysis. Neurosurg Rev 2021; 45:1009-1018. [PMID: 34596773 DOI: 10.1007/s10143-021-01661-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/27/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022]
Abstract
Osteoporotic vertebral compression fractures of the thoracolumbar spine can progress to Kümmell's disease, an avascular vertebral osteonecrosis. Vertebral augmentation (VA)-vertebroplasty and/or kyphoplasty-is the main treatment modality, but additional short-segment fixation (SSF) has been recommended concomitant to VA. The aim is to compare clinical and radiological outcomes of VA + SSF versus VA alone. Systematic review, including comparative articles in Kümmell's disease, was performed. This study assessed the following outcome measurements: visual analog scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), local kyphotic angle (LKA), operative time, blood loss, length of stay, and cement leakage. Six retrospective studies were included, with 126 patients in the VA + SSF group and 152 in VA alone. Pooled analysis showed the following: VAS, non-significant difference favoring VA + SSF: MD -0.61, 95% CI (-1.44, 0.23), I2 91%, p = 0.15; ODI, non-significant difference favoring VA + SSF: MD -9.85, 95% CI (-19.63, -0.07), I2 96%, p = 0.05; AVH, VA + SSF had a non-significant difference over VA alone: MD -3.21 mm, 95% CI (-7.55, 1.14), I2 92%, p = 0.15; LKA, non-significant difference favoring VA + SSF: MD -0.85°, 95% CI (-5.10, 3.40), I2 95%, p = 0.70. There were higher operative time, blood loss, and hospital length of stay for VA + SSF (p < 0.05), but with lower cement leakage (p < 0.05). VA + SFF and VA alone are effective treatment modalities in Kümmell's disease. VA + SSF may provide superior long-term results in clinical and radiological outcomes but required a longer length of stay.
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Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, Concepción, Chile.
- Faculty of Medicine, University of Concepción, Concepción, Chile.
| | - Gastón Camino-Willhuber
- Department of Orthopaedic and Traumatology, Institute of Orthopedics "Carlos E. Ottolenghi" Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Alfredo Guiroy
- Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina
| | - Charles A Carazzo
- Department of Neurosurgery, São Vicente de Paulo Hospital, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Martin Gagliardi
- Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina
| | - Andrei F Joaquim
- Department of Neurosurgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Analysis on the Effect of Different Surgical Methods on the Treatment of Senile Osteoporotic Spinal Compression Fractures and the Influencing Factors of Complications. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:1599470. [PMID: 34512771 PMCID: PMC8426060 DOI: 10.1155/2021/1599470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/20/2021] [Indexed: 02/07/2023]
Abstract
Osteoporotic fractures are a common type of fractures in the elderly, among which spinal compression fractures are more common. After the occurrence of fractures, due to the compression and burst of the vertebral body, this will lead to local kyphosis deformity and even affect the balance of the sagittal spine. In the past, conservative treatments were used for osteoporotic spinal compression fractures. Although it can relieve pain symptoms, it can easily lead to complications such as aggravation of osteoporosis and deep vein thrombosis of the lower extremities. At present, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are the main clinical surgical treatments, both of which are minimally invasive surgery, short operation time, effective pain relief, and rapid postoperative recovery. Although both of them are effective, there is still controversy over the efficacy of both in the treatment of osteoporotic spinal compression fractures. The purpose of this study was to investigate the efficacy of PVP and PKP in the treatment of elderly osteoporotic spinal compression fractures and to analyze the related factors that affect the occurrence of postoperative complications. The results show that both PVP and PKP can effectively improve the pain and dysfunction of elderly patients with osteoporotic spinal compression fracture, restoration of vertebral height, and correct kyphosis, but PKP has better effect and higher safety and is worth promoting. Postoperative complications of patients are related to their age, bone mineral density, use of hormones, and antiosteoporosis treatment.
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Chiu PY, Kao FC, Hsieh MK, Tsai TT, Chen WJ, Niu CC, Lai PL. In Reply: A Retrospective Analysis in 1347 Patients Undergoing Cement Augmentation for Osteoporotic Vertebral Compression Fracture: Is the Sandwich Vertebra at a Higher Risk of Further Fracture? Neurosurgery 2021; 89:E74-E75. [PMID: 33822182 DOI: 10.1093/neuros/nyab109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ping-Yeh Chiu
- Department of Orthopedic Surgery Bone and Joint Research Center Chang Gung Memorial Hospital Chang Gung University Taoyuan, Taiwan
| | - Fu-Cheng Kao
- Department of Orthopedic Surgery Bone and Joint Research Center Chang Gung Memorial Hospital Chang Gung University Taoyuan, Taiwan
| | - Ming-Kai Hsieh
- Department of Orthopedic Surgery Bone and Joint Research Center Chang Gung Memorial Hospital Chang Gung University Taoyuan, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopedic Surgery Bone and Joint Research Center Chang Gung Memorial Hospital Chang Gung University Taoyuan, Taiwan
| | - Wen-Jer Chen
- Department of Orthopedic Surgery Bone and Joint Research Center Chang Gung Memorial Hospital Chang Gung University Taoyuan, Taiwan
| | - Chi-Chien Niu
- Department of Orthopedic Surgery Bone and Joint Research Center Chang Gung Memorial Hospital Chang Gung University Taoyuan, Taiwan
| | - Po-Liang Lai
- Department of Orthopedic Surgery Bone and Joint Research Center Chang Gung Memorial Hospital Chang Gung University Taoyuan, Taiwan
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Chiu PY, Kao FC, Hsieh MK, Tsai TT, Chen WJ, Niu CC, Lai PL. In Reply: A Retrospective Analysis in 1347 Patients Undergoing Cement Augmentation for Osteoporotic Vertebral Compression Fracture: Is the Sandwich Vertebra at a Higher Risk of Further Fracture? Neurosurgery 2021; 88:E564-E565. [PMID: 33822136 DOI: 10.1093/neuros/nyab087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Ping-Yeh Chiu
- Department of Orthopedic Surgery Bone and Joint Research Center Chang Gung Memorial Hospital Chang Gung University Taoyuan, Taiwan
| | - Fu-Cheng Kao
- Department of Orthopedic Surgery Bone and Joint Research Center Chang Gung Memorial Hospital Chang Gung University Taoyuan, Taiwan
| | - Ming-Kai Hsieh
- Department of Orthopedic Surgery Bone and Joint Research Center Chang Gung Memorial Hospital Chang Gung University Taoyuan, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopedic Surgery Bone and Joint Research Center Chang Gung Memorial Hospital Chang Gung University Taoyuan, Taiwan
| | - Wen-Jer Chen
- Department of Orthopedic Surgery Bone and Joint Research Center Chang Gung Memorial Hospital Chang Gung University Taoyuan, Taiwan
| | - Chi-Chien Niu
- Department of Orthopedic Surgery Bone and Joint Research Center Chang Gung Memorial Hospital Chang Gung University Taoyuan, Taiwan
| | - Po-Liang Lai
- Department of Orthopedic Surgery Bone and Joint Research Center Chang Gung Memorial Hospital Chang Gung University Taoyuan, Taiwan
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Comparison of Percutaneous Kyphoplasty with or without Pedicle Screw Fixation in Osteoporotic Thoracolumbar Vertebral Fractures: A Retrospective Study. DISEASE MARKERS 2021; 2021:4745853. [PMID: 34306254 PMCID: PMC8263273 DOI: 10.1155/2021/4745853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/21/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022]
Abstract
Background Osteoporotic thoracolumbar compression fractures have become a great social burden due to the aging tendency of population. This study is aimed at comparing the clinical and radiological outcomes of percutaneous kyphoplasty with or without pedicle screw fixation in patients with osteoporotic thoracolumbar fractures. Hypothesis. There is a difference in clinical outcomes between percutaneous kyphoplasty with pedicle screw fixation and percutaneous kyphoplasty. Methods This retrospective study included 87 patients who received percutaneous kyphoplasty with or without pedicle screw fixation between October 2015 and October 2017 at Ningbo No.6 Hospital and were followed for 2 years. A total of 40 patients received percutaneous kyphoplasty with pedicle screw fixation (PKPF group), and the other 47 patients had percutaneous kyphoplasty only (PKP group). The outcomes were measured using the visual analogue scale (VAS), Oswestry Disability Index (ODI), Cobb angle (CA), and anterior vertebra height rate (AVHr), which were calculated at preoperative admission and each follow-up visit. Complications including postoperative back pain, refracture, and fixation failure were collected from medical records. Results There was no significant difference in baseline characteristics or preoperative data between the two groups (p < 0.05) but significantly better improvements in VAS, ODI, CA, and AVHr at 12- and 24-month follow-up visits in the PKPF group compared with those of the PKP group. 23 (48.9%) patients in the PKP group had complications, whereas only 5 (12.5%) patients in the PKPF group presented complications including 2 postoperative back pain and 1 fixation failure (p = 0.04). Conclusions PKPF obtained longer correction and better improvement in VAS, ODI, and CA in patients with osteoporotic thoracolumbar vertebral fractures than PKP.
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An Z, Chen C, Wang J, Zhu Y, Dong L, Wei H, Wu L. Logistic regression analysis on risk factors of augmented vertebra recompression after percutaneous vertebral augmentation. J Orthop Surg Res 2021; 16:374. [PMID: 34116683 PMCID: PMC8194186 DOI: 10.1186/s13018-021-02480-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022] Open
Abstract
Objective To explore the high-risk factors of augmented vertebra recompression after percutaneous vertebral augmentation (PVA) in the treatment of osteoporotic vertebral compression fracture (OVCF) and analyze the correlation between these factors and augmented vertebra recompression after PVA. Methods A retrospective analysis was conducted on 353 patients who received PVA for a single-segment osteoporotic vertebral compression fracture from January 2017 to December 2018 in our department according to the inclusion criteria. All cases meeting the inclusion and exclusion criteria were divided into two groups: 82 patients in the recompression group and 175 patients in the non-compression group. The following covariates were reviewed: age, gender, body mass index (BMI), injured vertebral segment, bone mineral density (BMD) during follow-up, intravertebral cleft (IVC) before operation, selection of surgical methods, unilateral or bilateral puncture, volume of bone cement injected, postoperative leakage of bone cement, distribution of bone cement, contact between the bone cement and the upper or lower endplates, and anterior height of injured vertebrae before operation, after surgery, and at the last follow-up. Univariate analysis was performed on these factors, and the statistically significant factors were substituted into the logistic regression model to analyze their correlation with the augmented vertebra recompression after PVA. Results A total of 257 patients from 353 patients were included in this study. The follow-up time was 12–24 months, with an average of 13.5 ± 0.9 months. All the operations were successfully completed, and the pain of patients was relieved obviously after PVA. Univariate analysis showed that in the early stage after PVA, the augmented vertebra recompression was correlated with BMD, surgical methods, volume of bone cement injected, preoperative IVC, contact between bone cement and the upper or lower endplates, and recovery of anterior column height. The difference was statistically significant (P < 0.05). Among them, multiple factors logistic regression elucidated that more injected cement (P < 0.001, OR = 0.558) and high BMD (P = 0.028, OR = 0.583) were negatively correlated with the augmented vertebra recompression after PVA, which meant protective factors (B < 0). Preoperative IVC (P < 0.001, OR = 3.252) and bone cement not in contact with upper or lower endplates (P = 0.006, OR = 2.504) were risk factors for the augmented vertebra recompression after PVA. The augmented vertebra recompression after PVP was significantly less than that of PKP (P = 0.007, OR = 0.337). Conclusions The augmented vertebra recompression after PVA is due to the interaction of various factors, such as surgical methods, volume of bone cement injected, osteoporosis, preoperative IVC, and whether the bone cement is in contact with the upper or lower endplates.
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Affiliation(s)
- Zhongcheng An
- Department of Spinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| | - Chen Chen
- Department of Spinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China.,The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| | - Junjie Wang
- Department of Spinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| | - Yuchen Zhu
- Department of Spinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| | - Liqiang Dong
- Department of Spinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China.
| | - Hao Wei
- Department of Spinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
| | - Lianguo Wu
- Department of Spinal Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, People's Republic of China
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Selections of Bone Cement Viscosity and Volume in Percutaneous Vertebroplasty: A Retrospective Cohort Study. World Neurosurg 2021; 150:e218-e227. [PMID: 33727205 DOI: 10.1016/j.wneu.2021.02.133] [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: 11/09/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We sought to evaluate the efficacy and complications of percutaneous vertebroplasty with different viscosities and volumes of bone cement in treating osteoporotic vertebral compression fractures (OVCFs). METHOD We conducted a retrospective cohort study of 307 patients treated for a single thoracolumbar level (T12-L2) OVCF in our hospital between January 2014 and December 2019. The patients were divided into 6 groups according to different viscosities (I: low-viscosity bone cement, II: high-viscosity bone cement) and injection volumes (A, 2-4 mL; B, 4-6 mL; C, 6-8 mL) of bone cement. Clinical and radiologic characteristics including visual analog scale, local kyphotic angle, anterior vertebral height ratio, cement leakage, and vertebral body recollapse rate were collected preoperatively, 2 days postoperation, and at the last follow-up to assess the efficacy and complications of each group. RESULTS Regarding efficacy, there was no significant difference between the 2 kinds of bone cement. Injecting >4 mL of cement can provide patients with good improvements of clinical indicators and a low vertebral body recollapse rate. Injecting 6-8 mL of bone cement slightly improved the radiologic indicators. However, the leakage rate of low-viscosity bone cement increased significantly when the volume exceeded 6 mL. The leakage rate of high-viscosity bone cement did not increase significantly at the volume of 6-8 mL. CONCLUSIONS In summary, when treating single thoracolumbar level OVCFs, the recommended volume of low-viscosity bone cement is 4-6 mL while the optimal volume of high-viscosity bone cement is 6-8 mL.
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Spiegl UJ, Hölbing PL, Jarvers JS, V D Höh N, Pieroh P, Osterhoff G, Heyde CE. Midterm outcome after posterior stabilization of unstable Midthoracic spine fractures in the elderly. BMC Musculoskelet Disord 2021; 22:188. [PMID: 33588814 PMCID: PMC7885444 DOI: 10.1186/s12891-021-04049-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/04/2021] [Indexed: 12/22/2022] Open
Abstract
Background The evidence for the treatment of midthoracic fractures in elderly patients is weak. The aim of this study was to evaluate midterm results after posterior stabilization of unstable midthoracic fractures in the elderly. Methods Retrospectively, all patients aged ≥65 suffering from an acute unstable midthoracic fracture treated with posterior stabilization were included. Trauma mechanism, ASA score, concomitant injuries, ODI score and radiographic loss of reduction were evaluated. Posterior stabilization strategy was divided into short-segmental stabilization and long-segmental stabilization. Results Fifty-nine patients (76.9 ± 6.3 years; 51% female) were included. The fracture was caused by a low-energy trauma mechanism in 22 patients (35.6%). Twenty-one patients died during the follow-up period (35.6%). Remaining patients (n = 38) were followed up after a mean of 60 months. Patients who died were significantly older (p = 0.01) and had significantly higher ASA scores (p = 0.02). Adjacent thoracic cage fractures had no effect on mortality or outcome scores. A total of 12 sequential vertebral fractures occurred (35.3%). The mean ODI at the latest follow up was 31.3 ± 24.7, the mean regional sagittal loss of reduction was 5.1° (± 4.0). Patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral fractures during follow-up (p = 0.03). Conclusion Unstable fractures of the midthoracic spine are associated with high rates of thoracic cage injuries. The mortality rate was rather high. The majority of the survivors had minimal to moderate disabilities. Thereby, patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral body fractures during follow-up.
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Affiliation(s)
- U J Spiegl
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
| | - P-L Hölbing
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - J-S Jarvers
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - N V D Höh
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - P Pieroh
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - G Osterhoff
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - C-E Heyde
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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