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

The surgical management trends of osteoporotic vertebral compression fractures: 5-year experience in one institution

Osteoporotic vertebral compression fractures (OVCFs) have gradually become a health threat to elderly individuals. Treatment options are controversial, and many challenges remain. Our study aimed to investigate the management trends of OVCFs at a single institution, covering all cases of OVCFs between January 1, 2016, and December 31, 2020. A total of 938 OVCF patients were reviewed, and OVCFs were most common in patients over 70 years old. The hospital stay, surgery haemorrhage rate and total cost decreased year by year. The number of patients with previous OVCFs varied from 123 in 2016 to 83 in 2020. The average bone mineral density (BMD) of the patients generally decreased year by year. In OVCF treatments, the rate of PV or PK increased from 93.86% in 2016 to 98.98% in 2020, while the rate of PV combined with pedicle fixation decreased from 6.14% in 2012 to 1.12% in 2020. Most patients were treated with bisphosphonates, and only 2 patients were treated with teriparatide. The visual analogue scale scores significantly improved at the final follow-up compared with the preoperative values. The rate of previous fractures was correlated with BMD, while there were no correlations with sex, age, or anti-osteoporosis treatment. In conclusion, the 5-year incidence of OVCFs increased and average patient BMD worsened by year. Although the total cost is continuously decreasing, poor adherence to anti-osteoporosis treatments and the prevention of refracture create more severe challenges.

Comparison of the Effect of Different Local Analgesia Administration Methods in Percutaneous Vertebroplasty: A Retrospective Cohort Study

Objective

Although various studies have described the methods of administering anesthesia during percutaneous vertebroplasty (PV) for treating osteoporotic vertebral compression fractures (OVCFs), there is still no consensus on the optimal treatment regimen. Therefore, this study aimed to investigate the effects of three application methods of local analgesia administration in PV for treating OVCFs.

Methods

A total of 96 patients with OVCFs were reviewed and divided into three groups (A: lidocaine, B: ropivacaine, C: lidocaine + ropivacaine). The visual analog scale (VAS), blood pressure (BP), heart rate (HR), blood oxygen saturation (BOS), and surgery time were recorded during the following different points: before puncture, during the puncture, cement injection, and 4-h after surgery.

Results

The mean age of the patients was 74.13 ± 7.02 years in group A, 70.47 ± 5.50 years in group B, and 73.07 ± 7.51 years in group C, without significant difference. No significant differences were found in sex, age, hospital stay, surgery time, blood loss, and cement volume of the patients. In the periods of before puncture and 4-h after surgery, the VAS in group C decreased significantly than that in the periods of the puncture, cement injection, and immediately after surgery. Overall, there were no significant differences in systolic BP, diastolic BP, HR, and BOS during the different periods among the groups except HR in the period of the puncture in group C, which was slower than that in other groups, and HR in the period of cement injection in group A, which was faster than the other two groups. A correlation was observed between the VAS and the periods of cement injection (r = 0.5358) and after surgery (r = 0.5775) in group C.

Conclusion

Compared with the other two methods, the use of lidocaine in combination with ropivacaine could effectively relieve intraoperative pain, making the patients feel more comfortable and experience better recovery.

Impact of sarcopenia and sagittal parameters on the residual back pain after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fracture

Objective

The objective of this study was to explore the impact of sarcopenia and sagittal parameters on the residual back pain (RBP) after percutaneous vertebroplasty (PVP) for treatment of osteoporotic vertebral compression fracture (OVCF).

Methods

This retrospective study included elderly patients (age range 60–90 years) with OVCF treated with PVP from January 2015 and December 2020 in our hospital. The skeletal muscle mass index (SMI) was calculated by dividing the T12 pedicle level muscle cross-sectional area by the square of body height from chest CT to diagnose sarcopenia. The radiological parameters for measuring the sagittal alignment were included: C7-sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI).

Result

According to whether the VAS score > 4, patients were divided into RBP group (56 patients) and Control group (100 patients). There was no difference in age, gender, body mass index, BMD, surgical segment, bone cement usage between the groups (P > 0.05). The SMI in RBP group (27.3 ± 5.1) was significantly lower compared to that in Control group (36.8 ± 3.2) (P < 0.05). Sarcopenia was present in 19 patients (20.3%) in RBP group, which was significantly more than that in Control group (P < 0.05). C7-SVA and TPA was significantly larger in the RBP group than in the Control group (P < 0.05). PI and LL was significantly smaller in the RBP group compared to the Control group (P < 0.05). However, no significant differences between the two groups with respect to TK, SS and PT (P > 0.05).

Conclusion

Poor sagittal parameters and sarcopenia in OVCF patients after PVP were more prone to residual back pain. Larger C7-SVA, TPA and PI-LL mismatch could increase the incidence of RBP in elderly patients with single-segment osteoporotic compression fractures.

Clinical Outcomes of Fracture Haemorrhage Aspiration for Percutaneous Vertebroplasty in Treating Osteoporotic Vertebral Compression Fractures

Background

A retrospective study aimed to introduce a new method for improving the diffusion degree of bone cement and to observe its clinical efficacy in percutaneous vertebroplasty treating osteoporotic vertebral compression fractures (OVCFs).

Methods

From January 2019 to March 2020, a total of 83 patients were enrolled and reviewed. The patients were divided into two groups according to the operation method. The clinical and radiographic parameters were recorded and compared between these two groups. Those who received percutaneous vertebroplasty with haemorrhage aspiration were recorded as group A (n=42). In group A, the haemorrhage in the vertebral fracture was aspirated compared with conventional percutaneous vertebroplasty. Patients who underwent conventional percutaneous vertebroplasty were classified as group B (n=41).

Results

Visual analogue scale (VAS) values and Oswestry Disability Index (ODI) scores showed no significant difference between the two groups preoperatively, postoperatively or at the final follow-up (FU) (P>0.05). The intraoperative VAS score (bone cement injection) in group A was significantly lower than that in group B (3.83±0.79 vs 5.44±1.32, P < 0.01). The local kyphotic angle (LKA) (final follow-up), LKA loss, fractured vertebral anterior height loss (FVAHL) and anterior vertebral height loss ratio (AVHLR) were significantly lower in group A than in group B. The anterior vertebral height ratio (AVHR) at the final FU in group A was higher than that in group B (P=0.013). The distribution of bone cement was significantly different (P=0.034). By analysing the distribution pattern of bone cement, it was found that the values of LKA loss, FVAHL and AVHLR were superior in the type A bone cement distribution to those in types B and C.

Conclusion

Compared with traditional surgical methods, bone haemorrhage aspiration could improve the diffusion degree of bone cement and reduce the height loss and deformity of injured vertebrae. This method provides a feasible new scheme for improving the dispersion of bone cement.

Preparation and application of chitosan-based fluorescent probes

Biomass materials have abundant natural resources, renewability and good biochemical compatibility, so biomass-based fluorescent materials prepared from biomass materials have gradually become a research hotspot.

Effect of Artificial Tiger Bone Powder (Jintiange Capsule®) on Vertebral Height Ratio, Cobb's Angle, Bone Mineral Density, and Visual Analog Score

Objectives

To investigate the effect of Jintiange capsule on acute bone atrophy (vertebral height, Cobb's angle, bone mineral density, and visual analog score (VAS) in patients with osteoporotic vertebral compression fracture.

Methods

A total of 106 patients with osteoporotic vertebral compression fractures were selected and randomly divided into study and control group. Vertebral height ratio (VHR), Cobb's angle, bone mineral density (BMD), and VAS analyses were performed as study indexes. The study was performed from January 2019 to December 2019 as a double‐blind, randomized, controlled trial and all the participants were blinded throughout the study. There were 24 males and 29 females in the study group, with 14 cases of thoracic fractures and 39 cases of lumbar fractures. The age was 61–75 years, with an average of 67.5 ± 2.7 years, and the course of disease was 1–9 days, with an average of 2.7 ± 0.5 days. There were 22 males and 31 females in the control group, with 17 cases of thoracic fractures and 36 cases of lumbar fractures. Patients in the control group received conventional postoperative treatment, while patients in the study group were treated with Jintiange capsule. The treatment continued for 3 months. The ages of the participants were from 60 to 70 years, while the average ages of both groups were 67 ± 2.8 years and the study recruited participants of both sexes.

Results

The clinical efficacy, vertebral imaging indexes before and after treatment, as well as pain and daily activity dysfunction scores were compared. The effect of the Jintiange capsule was followed for 3 months and both the groups were compared. The total effective score of the study group was significantly increased (90.6%) in contrast to the control group (67.9) and the P value was less than the 0.5. The vertebral height and bone mineral density of the study group was significantly improved compared to the control group (P < 0.034) using t‐test. However, the Cobb's angle of the study group was significantly (P < 0.047) lower than the control group using t‐test after the treatment. On the other hand, the VAS score and Oswestry score of the study group were significantly lower than control group at 1 month and 3 months after treatment (P < 0.05). There was no significance difference (all P > 0.05) in term of gender and ages in both the recruited groups.

Conclusion

It can be concluded that Jintiange capsule can significantly improve the clinical efficacy rate, vertebral height, Cobb's angle, and bone mineral density, pain relief, and daily activity function.