1
|
Zhou M, Xu X, Chen H, Qi B. Comparing two surgical approaches for treating multilevel cervical spondylotic myelopathy: A meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3485-3496. [PMID: 37393420 DOI: 10.1007/s00586-023-07790-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE This meta-analysis aims to evaluate the therapeutic efficacy of anterior versus posterior surgical approaches for multisegment cervical spondylotic myelopathy (MCSM). METHODS Eligible studies published between the period of January 2001 and April 2022 and comparing the anterior and posterior surgical approaches for treating cervical spondylotic myelopathy were retrieved from the PubMed, Web of Science, Embase, and Cochrane databases. RESULTS A total of 17 articles were selected based on the inclusion and exclusion criteria. This meta-analysis failed to show any significant difference in the duration of surgery, the hospitalization time, or the improvement in the Japanese Orthopedic Association score between the anterior and posterior approaches. The anterior approach, however, exhibited increased efficacy in the improvement of the neck disability index, reduction in the visual analog scale for cervical pain, and improvement in the cervical curvature compared with the posterior approach. CONCLUSION Bleeding was also less with the anterior surgical approach. The posterior approach provided a significantly higher range of motion of the cervical spine and showed fewer postoperative complications compared with the anterior approach. While both the surgical approaches have good clinical outcomes and show postoperative neurological function improvement, the meta-analysis shows that both anterior and posterior approaches have certain merits and shortcomings. A meta-analysis of a larger number of randomized controlled trials with longer follow-up can conclusively determine which of the surgical approaches is more beneficial in the treatment of MCSM.
Collapse
Affiliation(s)
- Min Zhou
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Xin Xu
- Cardiovascular Medicine Department, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Hairen Chen
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Baiwen Qi
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
| |
Collapse
|
2
|
Chen Y, Sun X, Sui X, Li Y, Wang Z. Application of bone alkaline phosphatase and 25-oxhydryl-vitamin D in diagnosis and prediction of osteoporotic vertebral compression fractures. J Orthop Surg Res 2023; 18:739. [PMID: 37775805 PMCID: PMC10543335 DOI: 10.1186/s13018-023-04144-2] [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: 06/26/2023] [Accepted: 08/28/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Osteoporosis is a bone metabolic disease that usually causes fracture. The improvement of the clinical diagnostic efficiency of osteoporosis is of great significance for the prevention of fracture. The predictive and diagnostic values of bone alkaline phosphatase (B-ALP) and 25-oxhydryl-vitamin D (25-OH-VD) for osteoporotic vertebral compression fractures (OVCFs) were evaluated. METHODS 110 OVCFs patients undergoing percutaneous vertebroplasty were included as subjects and their spinal computed tomography (CT) images were collected. After that, deep convolutional neural network model was employed for intelligent fracture recognition. Next, the patients were randomly enrolled into Ctrl group (65 cases receiving postoperative routine treatment) and VD2 group (65 cases injected with vitamin D2 into muscle after the surgery). In addition, 100 healthy people who participated in physical examination were included in Normal group. The differences in Oswestry dysfunction indexes (ODI), imaging parameters, B-ALP and 25-OH-VD expressions, and quality of life (QOL) scores of patients among the three groups were compared. The values of B-ALP and 25-OH-VD in predicting and diagnosing OVCFs and their correlation with bone density were analyzed. RESULTS It was demonstrated that computer intelligent medical image technique was more efficient in fracture CT recognition than artificial recognition. In contrast to those among patients in Normal group, B-ALP rose while 25-OH-VD declined among patients in Ctrl and VD2 groups (P < 0.05). Versus those among patients in Ctrl group, ODI, Cobb angle, and B-ALP reduced, while bone density, the height ratio of the injured vertebrae, 25-OH-VD, and QOL score increased among patients in VD2 group after the treatment (P < 0.05). The critical values, accuracy, and areas under the curve (AUC) of the diagnosis of OVCFs by B-ALP and 25-OH-VD amounted to 87.8 μg/L versus 30.3 nmol/L, 86.7% versus 83.3%, and 0.86 versus 0.82, respectively. B-ALP was apparently negatively correlated with bone density (r = - 0.602, P < 0.05), while 25-OH-VD was remarkably positively correlated with bone density (r = 0.576, P < 0.05). CONCLUSION To sum up, deep learning-based computer CT image intelligent detection technique could improve the diagnostic efficacy of fracture. B-ALP rose while 25-OH-VD declined among patients with OVCFs and OVCFs could be predicted and diagnosed based on B-ALP and 25-OH-VD. Postoperative intramuscular injection of VD2 could effectively improve the therapeutic effect on patients with OVCFs and QOL.
Collapse
Affiliation(s)
- Yuelin Chen
- Spinal Surgery, Zibo First Hospital, Zibo, 255200, Shandong, China
| | - Xiaolin Sun
- Clinical Laboratory, Zibo First Hospital, Zibo, 255200, Shandong, China
| | - Xiaofei Sui
- Orthopedics and Traumatology Department II, Penglai Traditional Chinese Medicine Hospital, Yantai, 265600, Shandong, China
| | - Yan Li
- Nursing, Penglai Traditional Chinese Medicine Hospital, Yantai, 265600, Shandong, China
| | - Zhen Wang
- Spinal Surgery, Tai'an Central Hospital Affiliated to Qingdao University, Taian, 271000, Shandong, China.
| |
Collapse
|
3
|
Ju P, Jiang D. Effects of the obstruction of erector spinae plane in affected people undergoing percutaneous vertebroplasty. BMC Surg 2023; 23:149. [PMID: 37270470 DOI: 10.1186/s12893-023-02055-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND We aimed to compare the difference between the therapeutic effects of percutaneous vertebroplasty (PVP) as well as PVP combined with erector spinae plane blocked (ESPB) in osteoporotic vertebral compression fractures (OVCFs) therapy. METHODS After the reception, 100 affected people to OVCFs were randomly divided into the PVP group as a control as well as the PVP + ESPB group as the observation, which included fifty affected people per group. The visual analog scale (VAS) for pain as well as the Oswestry Disability Index (ODI) per group was assessed before the operation, two hours after the operation, and when patients were discharged from the hospital. Operating time was also evaluated on the charged bulk of bone cement during the surgery, blood loss during the surgery, as well as operating costs for each group. Additionally, to assess differences, comparisons have been done among available groups in terms of ambulation as well as defecation or stool after the operation at the earlier time. RESULTS The PVP + ESPB category acquired lower VAS and ODI scores when assessments were processed 2 h after the operation and when they were discharged from a hospital. They also had earlier postoperative ambulation and defecation time than the category of PVP (p < 0.05). Regarding the other indicators, there did not show significant differences. Besides, no complications occurred within both group, either after the operation or when they discharge from the hospital. CONCLUSION PVP + ESPB for OVCF is related to less VAS, further effective alleviation of pain, and fewer ODI values in affected people after the operation than only PVP. Besides, affected people can involve in ambulation more swiftly. The PVP + ESPB therapy improves the quicker recuperation of intestinal function as well as helps to improve the overall life quality of patients.
Collapse
Affiliation(s)
- Peng Ju
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Shuanghu Branch Road, Huixing Street, Yubei District, Chongqing, 401120, China
| | - Dianming Jiang
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Shuanghu Branch Road, Huixing Street, Yubei District, Chongqing, 401120, China.
| |
Collapse
|
4
|
Luo Y, Yang DM, Yang HM, Wu D, Xie FY. Innovative minimally invasive implants for osteoporosis vertebral compression fractures. Front Med (Lausanne) 2023; 10:1161174. [PMID: 37020680 PMCID: PMC10067727 DOI: 10.3389/fmed.2023.1161174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/06/2023] [Indexed: 03/22/2023] Open
Abstract
With increasing population aging, osteoporosis vertebral compression fractures (OVCFs), resulting in severe back pain and functional impairment, have become progressively common. Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) as minimally invasive procedures have revolutionized OVCFs treatment. However, PVP- and PKP-related complications, such as symptomatic cement leakage and adjacent vertebral fractures, continue to plague physicians. Consequently, progressively more implants for OVCFs have been developed recently to overcome the shortcomings of traditional procedures. Therefore, we conducted a literature review on several new implants for OVCFs, including StaXx FX, Vertebral Body Stenting, Vesselplasty, Sky Bone Expander, Kiva, Spine Jack, Osseofix, Optimesh, Jack, and V-strut. Additionally, this review highlights the individualized applications of these implants for OVCFs. Nevertheless, current clinical studies on these innovative implants remain limited. Future prospective, randomized, and controlled studies are needed to elucidate the effectiveness and indications of these new implants for OVCFs.
Collapse
|
5
|
Sun X, Wang J, Liu X, Tao H, Zhu T, Wang X, Shen K, Jin W. Lateral-Opening Injection Tool Used in Percutaneous Vertebroplasty to Treat Asymptomatic Osteoporotic Vertebral Burst Fractures: A Retrospective Study. Orthop Surg 2022; 14:2914-2924. [PMID: 36168984 DOI: 10.1111/os.13519] [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: 11/07/2021] [Revised: 08/14/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The adequate management of asymptomatic osteoporotic vertebral burst fractures (OVBFs) was still controversial. Percutaneous vertebroplasty (PVP) could achieve quick recovery with minor trauma, but there were certain safety problems by traditional bone cement injection method. Thus, the aim of this study was to assess the efficacy of lateral-opening injection tool used in PVP treating patients with asymptomatic OVBFs. METHODS This was a retrospective study of OVBFs treated in our institute from March 2016 to March 2020. A total of 66 patients (mean age 72.10 ± 7.98 years, with 21 men and 45 women) who were diagnosed with acute asymptomatic OVBFs with mild spinal canal compromise were treated with PVP by using a lateral-opening injection tool. Two puncture needles were simultaneously placed transpedicularly in the fractured vertebra, and the inner core was removed, and the lateral-opening injection tool was inserted. The adjustment of lateral hole was to improve the distribution height of bone cement and avoid the entry of bone cement into the posterior wall of vertebral body. Related clinical outcomes and images were assessed, including back pain (visual analog scale [VAS]), vertebral height ratio (fractured vertebral height/average adjacent nonfractured vertebral height), kyphosis Cobb angle, union of the fractured vertebral posterior wall, distribution of bone cement, surgical data, and complications. RESULTS The average follow-up time of all cases was 21.23 ± 9.35 months. The mean amount of bone cement was 3.28 ± 0.35 ml in the vertebrae and the mean operative time was 34.02 ± 5.23 min. There were 60 cases of bone cement that contacted the upper and lower endplates on at least one side. There was no cement leakage into the spinal canal or fracture displacement of the posterior wall of the vertebral body in all cases. The VAS scores were 3.78 ± 0.42 at 1 day postoperatively and 0.53 ± 0.40 at the last follow-up, significantly lower than 8.40 ± 0.48 preoperatively (p < 0.05). The average height ratio of anterior, middle, and posterior vertebral body after operation increased compared with that pre-operation (p < 0.05), and the postoperative kyphosis angle decreased (p < 0.05). At 6 months follow-up, there was no significant height loss of the vertebral body. Computed tomography examination 3 months postoperatively showed that the fracture of posterior vertebral wall healed well in all cases. There were seven cases of bone cement leakage without clinical symptoms and two adjacent vertebral fractures caused by falling. There were no cases of deep vein embolism, lower limb muscle atrophy, pneumonia, decubitus. CONCLUSION The lateral opening tool can be safely and effectively used in the PVP treatment on asymptomatic OVBFs with mild spinal canal compromise.
Collapse
Affiliation(s)
- Xin Sun
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jia Wang
- Department of Pathology, Shanghai Xin Hua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xingzhen Liu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hairong Tao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Tong Zhu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiang Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Kangping Shen
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Wenjie Jin
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| |
Collapse
|
6
|
Guo H, Huang H, Shao Y, Qin Q, Liang D, Zhang S, Tang Y. Risk Factors for Pulmonary Cement Embolism (PCE) After Polymethylmethacrylate Augmentation: Analysis of 32 PCE Cases. Neurospine 2022; 18:806-815. [PMID: 35000335 PMCID: PMC8752710 DOI: 10.14245/ns.2142616.308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
Objective Pulmonary cement embolism (PCE) is an underestimated but potentially fatal complication after cement augmentation. Although the treatment and follow-up of PCE have been reported in the literature, the risk factors for PCE are so far less investigated. This study aims to identify the preoperative and intraoperative risk factors for the development of PCE.
Methods A total of 1,373 patients treated with the polymethylmethacrylate (PMMA) augmentation technique were retrospectively included. Patients with PCE were divided into vertebral augmentation group and screw augmentation group. Possible risk factors were collected as follows: age, sex, bone mineral density, body mass index, diagnosis, comorbidity, surgical procedure, type of screw, augmented level, number of augmented vertebrae, fracture severity, presence of intravertebral cleft, cement volume, marked leakage in the paravertebral venous plexus, and periods of surgery. Binary logistic regression analyses were used to analyze independent risk factors for PCE.
Results PCE was identified in 32 patients, with an incidence rate of 2.33% (32 of 1,373). For patients who had undergone vertebral augmentation, marked leakage in the paravertebral venous plexus (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.1–10.3; p=0.000) and previous surgery (OR, 16.1; 95% CI, 4.2–61.0; p=0.007) were independent risk factors for PCE. Regarding patients who had undergone screw augmentation, the marked leakage in the paravertebral venous plexus (OR, 4.2; 95% CI, 0.5–37.3; p=0.004) was the main risk factor.
Conclusion Marked leakage in the paravertebral venous plexus and previous surgery were significant risk factors related to PCE. Paravertebral leakage and operator experience should be concerned when performing PMMA augmentation.
Collapse
Affiliation(s)
- Huizhi Guo
- The first Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.,Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huasheng Huang
- The first Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yang Shao
- The first Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiuli Qin
- The first Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - De Liang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuncong Zhang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongchao Tang
- Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|