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Zhai G, Li A, Liu B, Lv D, Zhang J, Sheng W, Yang G, Gao Y. A meta-analysis of the secondary fractures for osteoporotic vertebral compression fractures after percutaneous vertebroplasty. Medicine (Baltimore) 2021; 100:e25396. [PMID: 33879670 PMCID: PMC8078370 DOI: 10.1097/md.0000000000025396] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/14/2021] [Indexed: 01/04/2023] Open
Abstract
To identify the risk factors of the secondary fractures for osteoporotic vertebral compression fractures (OVCFs) after percutaneous vertebroplasty (PVP).We conducted a search of relevant articles using Cochrane Library, PubMed, Medline, Science Direct, Embase, the Web of Science and other databases. The time range we retrieved from establishment of the electronic database to November 2017. Gray studies were found in the references of included literature reports. STATA version 11.0 (Stata Corporation, College Station, Texas) was used to analyze the pooled data.Fourteen studies involving 1910 patients, 395 of whom had fracture secondary to the surgery were included in this meta-analysis. The result of meta-analyses showed the risk factors of the secondary fractures for OVCFs after PVP was related to bone mineral density (BMD) [95%CI (-0.650, -0.164), SMD=-0.407, P=.001], cement leakage ((RR=0.596, 95%CI (0.444,0.798), P = .001)), and kyphosis after primary operation ((SMD=0.741, 95%CI (0.449,1.032), P = .000)), but not to gender, age, body mass index, cement volume, thoracolumbar spine, and cement injection approaches.Bone mineral density, cement leakage, and kyphosis after primary operation are the risk factors closely correlative to the secondary fracture after PVP. There have not been enough evidences to support the association between the secondary fracture and gender, age, body mass index, cement volume, thoracolumbar spine, and cement injection approaches.
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Affiliation(s)
- Gongwei Zhai
- People's Hospital of Henan University of Chinese Medicine, People's Hospital of Zhengzhou
- Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, Henan Province Intelligent Orthopedic Technology Innovation and Transformation International Joint Laboratory, Henan Key Laboratory for Intelligent Precision Orthopedics, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Henan Zhengzhou
| | - Ang Li
- Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, Henan Province Intelligent Orthopedic Technology Innovation and Transformation International Joint Laboratory, Henan Key Laboratory for Intelligent Precision Orthopedics, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Henan Zhengzhou
| | - Binfeng Liu
- Zhengzhou University People's Hospital, Henan Provincial People's Hospital, China
| | - Dongbo Lv
- Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, Henan Province Intelligent Orthopedic Technology Innovation and Transformation International Joint Laboratory, Henan Key Laboratory for Intelligent Precision Orthopedics, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Henan Zhengzhou
| | - Jingyi Zhang
- Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, Henan Province Intelligent Orthopedic Technology Innovation and Transformation International Joint Laboratory, Henan Key Laboratory for Intelligent Precision Orthopedics, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Henan Zhengzhou
| | - Weichao Sheng
- Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, Henan Province Intelligent Orthopedic Technology Innovation and Transformation International Joint Laboratory, Henan Key Laboratory for Intelligent Precision Orthopedics, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Henan Zhengzhou
| | - Guang Yang
- Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, Henan Province Intelligent Orthopedic Technology Innovation and Transformation International Joint Laboratory, Henan Key Laboratory for Intelligent Precision Orthopedics, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Henan Zhengzhou
| | - YanZheng Gao
- Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, Henan Province Intelligent Orthopedic Technology Innovation and Transformation International Joint Laboratory, Henan Key Laboratory for Intelligent Precision Orthopedics, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Henan Zhengzhou
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An evaluation of the functional and radiological results of percutaneous vertebroplasty versus conservative treatment for acute symptomatic osteoporotic spinal fractures. Injury 2016; 47:865-71. [PMID: 26922648 DOI: 10.1016/j.injury.2016.01.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/29/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to compare the results of the two different treatment regimens (percutaneous vertebroplasty (PV) and conservative treatment (CT)) regarding to efficacy, quality of life, functional and radiological results in patients with acute osteoporotic vertebral compression fractures (OVF). METHODS The study comprised 83 patients who presented with complaints of OVF associated with osteoporosis and were treated with CT (37) or PV (46). All patients were evaluated according to preoperative and postoperative visual analogue scale (VAS), Oswestry disability index (ODI) and plain radiographs. RESULTS All patients in VP group reported a significant decrease in pain at 1st day postoperative. While Pain relief and functional outcomes were significantly better in PV group than CT at 1st and 3rd months according to VAS and ODI scores, there were no statistically significant differences between the groups at 6th months follow-up. The mean preoperative local sagittal Cobb angle (LSCA) and the mean vertebra corpus mid-level height (MVCH) were 42.3° and 14.6 mm in the PV group, while they were measured as 39.8° and 15.7 mm in CT group, respectively. 15.6° decreasing the LSCA and 10.2 mm increasing MVCH were noted in the PV group at the 6th month follow-up. While LSCA increased 19.1° and MVCH decreased 7.6mm in CT group at same time period (p<0.001). CONCLUSIONS Compared to the CT group, PV provides a rapid decrease of pain and an early return to daily life activities. Although improvement was observed on the radiological findings following treatment in the PV group, PV may not enhance the quality of life in patients with acute OVF at 6th months follow up.
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Barr JD, Jensen ME, Hirsch JA, McGraw JK, Barr RM, Brook AL, Meyers PM, Munk PL, Murphy KJ, O'Toole JE, Rasmussen PA, Ryken TC, Sanelli PC, Schwartzberg MS, Seidenwurm D, Tutton SM, Zoarski GH, Kuo MD, Rose SC, Cardella JF. Position statement on percutaneous vertebral augmentation: a consensus statement developed by the Society of Interventional Radiology (SIR), American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS), American College of Radiology (ACR), American Society of Neuroradiology (ASNR), American Society of Spine Radiology (ASSR), Canadian Interventional Radiology Association (CIRA), and the Society of NeuroInterventional Surgery (SNIS). J Vasc Interv Radiol 2013; 25:171-81. [PMID: 24325929 DOI: 10.1016/j.jvir.2013.10.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 10/03/2013] [Accepted: 10/03/2013] [Indexed: 12/23/2022] Open
Affiliation(s)
- John D Barr
- California Center for Neurointerventional Surgery, La Jolla.
| | - Mary E Jensen
- Department of Radiology, University of Virginia Health System, Charlottesville, Virginia
| | - Joshua A Hirsch
- Division of Neurointerventional Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - J Kevin McGraw
- Riverside Interventional Consultants, Riverside Methodist Hospital, Columbus
| | - Robert M Barr
- Mecklenburg Radiology Associates, Charlotte, North Carolina
| | - Allan L Brook
- Department of Radiology, Montefiore Medical Center, Bronx
| | - Philip M Meyers
- Department of Neurological Surgery, Columbia University College of Physicians and Surgeons
| | - Peter L Munk
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia
| | - Kieran J Murphy
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Peter A Rasmussen
- Cerebrovascular Center and Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Pina C Sanelli
- Departments of Radiology and Public Health, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | | | | | - Sean M Tutton
- Department of Radiology, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
| | - Gregg H Zoarski
- Department of Neurointerventional Surgery, Christiana Care Health System, Newark, Delaware
| | - Michael D Kuo
- Department of Radiology, University of California, Los Angeles, Medical School, Los Angeles
| | - Steven C Rose
- Department of Radiology, University of California, San Diego, Medical Center, San Diego, California
| | - John F Cardella
- Department of Radiology, Geisinger Health System, Danville, Pennsylvania
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Sun G, Tang H, Li M, Liu X, Jin P, Li L. Analysis of risk factors of subsequent fractures after 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 2013; 23:1339-45. [PMID: 24253933 DOI: 10.1007/s00586-013-3110-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 11/07/2013] [Accepted: 11/07/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study is to identify risk factors related to the development of subsequent fractures after vertebroplasty. METHOD A retrospective study was conducted to review 175 patients with a 1-year follow-up who underwent vertebroplasty for first-time and single-level osteoporotic vertebral fractures. Subsequent fractures were diagnosed as recurrent intractable back pain, post-operatively correlated with MR image. Clinical parameters, such as age, gender, baseline VAS-score, lumbar bone mineral density (BMD) T-score, history of use of steroids, bisphosphonate therapy, symptom-free interval, the amount of bone cement injected, vacuum clefts, leakage of cement into the disk space, treated level and the changes of spinal geometry were recorded. RESULTS During the follow-up period, subsequent fractures developed in 37 (21.1 %) of 175 patients. Significant differences (P < 0.05) were found between the patients with subsequent fractures and the patients without subsequent fractures in regard to their BMD T-score, and treated vertebrae location. Average BMD T-score was -3.4 ± 1.5 in patients with subsequent fractures and -2.9 ± 1.6 in patients without subsequent fractures. The percentage of subsequent fractures was 13.9 % (10 of 72) for treated vertebrae located in non-thoracolumbar junction, and 26.2 % (27 of 103) in the thoracolumbar junction. CONCLUSION The most important risk factors affecting subsequent fractures after vertebroplasty were osteoporosis and treated level at the thoracolumbar junction.
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Affiliation(s)
- Gang Sun
- Department of Medical Imaging, Jinan Military General Hospital, No. 25 Shifan Road, Jinan, Shandong, 250031, People's Republic of China,
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Liu WG, He SC, Deng G, Guo JH, Fang W, Zhu GY, Teng GJ. Risk factors for new vertebral fractures after percutaneous vertebroplasty in patients with osteoporosis: a prospective study. J Vasc Interv Radiol 2013; 23:1143-9. [PMID: 22920978 DOI: 10.1016/j.jvir.2012.06.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 06/12/2012] [Accepted: 06/14/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To determine the risk factors for new vertebral compression fractures (VCFs) following percutaneous vertebroplasty (PV) in patients with osteoporosis. MATERIALS AND METHODS This prospective study included 132 consecutive patients with osteoporosis treated with PV in a single institution over 46 months from March 2005 to December 2008. Multivariable logistic regression and univariate analysis were employed to identify risk factors for new VCFs after PV, including patient demographic data, parameters of the initial and new fractured vertebrae, procedure-related information, and follow-up data. RESULTS During the follow-up period (22.4 months ± 12.1), 80 new vertebral fractures occurred in 36 (27.3%) patients. Multivariate analysis showed that number of VCFs per time frame, computed tomography (CT) value of nonfractured vertebrae (T11-L2), activity level after discharge, duration of follow-up, and cement distribution in the inferior part of the vertebral body or close to the endplate were statistically correlated with new fractures (odds ratios, 2.63, 0.96, 3.59, 1.00, 0.30, and 0.05; P = .006, P = .001, P = .007, P = .004, P = .021 and P = .029). Univariate analysis showed preexisting old VCFs were correlated with new VCFs (P = .045). Subsequent compression fractures in adjacent vertebrae (45 of 80) occurred more frequently and sooner than nonadjacent vertebral fractures (both P < .05). CONCLUSIONS The incidence of new VCFs after PV is relatively high and affected by several risk factors that are related to both the PV procedure and the natural course of osteoporosis.
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Affiliation(s)
- Wen-Gui Liu
- Department of Radiology, Southeast University, Nanjing , China
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Shi MM, Cai XZ, Lin T, Wang W, Yan SG. Is there really no benefit of vertebroplasty for osteoporotic vertebral fractures? A meta-analysis. Clin Orthop Relat Res 2012; 470:2785-99. [PMID: 22729693 PMCID: PMC3442000 DOI: 10.1007/s11999-012-2404-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 05/16/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteoporotic vertebral compressed fractures (VCFs) are the most common osteoporotic fractures. Although percutaneous vertebroplasty (PVP) reportedly relieves pain and improves function, a recent pooled analysis from two multicenter randomized controlled trials concluded the improvement in pain and disability treated with PVP was similar to those with sham surgery. QUESTIONS/PURPOSE Using meta-analysis we therefore asked whether compared with either nonoperative therapy or a sham injection for patients with VCF, PVP would (1) better relieve pain, (2) provide greater improvement in pain-related disability, and (3) increase the recurrence of vertebral fractures. METHODS We searched PubMed, EMBASE, Medline, and the Cochrane library using the keywords "vertebroplasty AND osteoporosis OR fracture". We included nine of the 469 articles identified. Using a random effects model, we calculated the weighted mean differences to evaluate the pain reduction at different times as the primary outcome. Pain-related disability was assessed by a quality of life (QOL) measure. Improvement of QOL and recurrence of vertebral fractures were the secondary outcomes. We used subgroup analysis to reinvestigate pain relief and function improvement of PVP based on two different controls: nonoperative therapy and sham injection. The total number of patients was 886. RESULTS Pain scoring was similar between the PVP group and the sham injection group at 1 to 29 days and 90 days. However, compared with nonoperative therapy, PVP reduced pain at all times studied. QOL in the PVP group was improved or tended to be improved compared with QOL for both control groups. The risk of new fractures was similar between the PVP groups and both control groups. CONCLUSIONS Different control groups may have accounted for the different conclusions in the literature regarding the ability of PVP to relieve pain and restore function recovery. Compared with nonoperative treatment PVP relieved pain better and improved QOL. PVP did not increase the risk of new fractures. LEVEL OF EVIDENCE Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ming-Min Shi
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009 People’s Republic of China
| | - Xun-Zi Cai
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009 People’s Republic of China
| | - Tiao Lin
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009 People’s Republic of China
| | - Wei Wang
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009 People’s Republic of China
| | - Shi-Gui Yan
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009 People’s Republic of China
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Lu K, Liang CL, Hsieh CH, Tsai YD, Chen HJ, Liliang PC. Risk Factors of Subsequent Vertebral Compression Fractures After Vertebroplasty. PAIN MEDICINE 2012; 13:376-82. [DOI: 10.1111/j.1526-4637.2011.01297.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yen CH, Teng MMH, Yuan WH, Sun YC, Chang CY. Preventive vertebroplasty for adjacent vertebral bodies: a good solution to reduce adjacent vertebral fracture after percutaneous vertebroplasty. AJNR Am J Neuroradiol 2012; 33:826-32. [PMID: 22282447 DOI: 10.3174/ajnr.a2898] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Adjacent VCF frequently occurs after percutaneous vertebroplasty. Our aim was to evaluate PrVP in the prevention of PVNO-adjacent VCF. MATERIALS AND METHODS Radiographs of 68 patients who initially presented with a single-level unhealed fracture and underwent vertebroplasty were retrospectively reviewed for the occurrence of PVNO fracture. Patients in the nonpreventive group (n = 33) underwent TVP only for a vertebra with an unhealed fracture. The preventive group (n = 35) underwent PrVP combined with TVP. We injected bone cement into the caudal part of the superior adjacent vertebra and the cephalic part of the inferior adjacent vertebra to perform PrVP. RESULTS The incidences of PVNO fracture in adjacent vertebra next to a vertebra cemented at the patient's first vertebroplasty (within 6 months: 24% versus 3%, P = .012; within 1 year: 30% versus 3%, P = .006; >4 years: 39% versus 3%, P = .006) markedly decreased in the preventive group compared with the nonpreventive group. PVNO fracture was found in 26% of vertebrae adjacent to the first TVP level in the nonpreventive group and in 2% of vertebrae adjacent to a PrVP level in the preventive group after inclusion of all PrVP procedures. Approximately 33% of patients in the nonpreventive group underwent repeat vertebroplasty, mainly due to adjacent fractures. Only 3% of patients in the preventive group underwent repeated procedures. None of the vertebrae cemented for PrVP or TVP developed PVNO refracture. CONCLUSIONS Preventive vertebroplasty for the adjacent vertebra combined with TVP for the fractured vertebra is effective in the prevention of propagation of PVNO adjacent fractures, thus reducing the necessity of multiple repeat vertebroplasty procedures.
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Affiliation(s)
- C H Yen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
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Rad AE, Gray LA, Sinaki M, Kallmes DF. Role of physical activity in new onset fractures after percutaneous vertebroplasty. Acta Radiol 2011; 52:1020-3. [PMID: 21948598 DOI: 10.1258/ar.2011.110184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Increased mobility and physical activity after successful vertebral augmentation procedure might increase the risk of new-onset fractures. PURPOSE To determine whether new-onset fracture following vertebroplasty is associated with specific type of physical activity. MATERIAL AND METHODS A total of 107 patients underwent at least two procedures of percutaneous vertebroplasty. Among them, 30 patients who sustained a post-vertebroplasty fracture(s), were stratified by fracture-causing activity and examined the incidence of the initial and post-vertebroplasty fractures, time to post-vertebroplasty fractures, duration of anti-osteoporotic therapy, T-score, and body mass index. RESULTS The following percentages correspond to patients with fractures sustained pre- and post-vertebroplasty, respectively; spontaneous fractures in 17% and 7% (P = 0.20), sitting in 7% and 3% (P = 0.50), walking or standing in 7% and 20% (P = 0.10), housework in 3% and 3% (P > 0.99), coughing or sneezing in 0% and 20% (P = 0.003), exercise in 7% and 17% (P = 0.20), lifting in 10% and 17% (P = 0.40) and falling in 50% and 13% (P = 0.002). Different levels of activity were not significantly associated with time to incidence of post-vertebroplasty fractures. Anti-osteoporotic medications were administered to 33% of patients before vertebroplasty and 37% after the vertebroplasty (P = 0.78); medications were administered to these groups for 16 and 25 months, respectively (P = 0.39). CONCLUSION A significantly elevated risk of new onset fracture with increased physical activity was not identified. However, patients should be carefully counseled after vertebroplasty to optimize medical therapy for osteoporosis and also to use extreme care when engaging in even moderate physical activity.
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Affiliation(s)
| | | | - Mehrsheed Sinaki
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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Chen LH, Hsieh MK, Liao JC, Lai PL, Niu CC, Fu TS, Tsai TT, Chen WJ. Repeated percutaneous vertebroplasty for refracture of cemented vertebrae. Arch Orthop Trauma Surg 2011; 131:927-33. [PMID: 21191607 DOI: 10.1007/s00402-010-1236-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND Percutaneous vertebroplasty is an efficient procedure to treat painful osteoporotic vertebral compression fractures. However, refracture of cemented vertebrae occurs rarely after percutaneous vertebroplasty. This study was undertaken to investigate the incidence, characteristics, predisposing factors, and mistakes in technique associated with refracture of the same vertebra after percutaneous vertebroplasty. METHODS From 2001 to 2008, PVP with bone cement (polymethylmethacrylate, PMMA) was carried out in 2,291 patients with 2,581 PVP procedures. The etiologies including pathologic fracture (including metastasis, osteolytic tumor, hemangioma) in 299 patients, infectious spondylitis in 4 patients and osteoporotic compression fractures in 1,988 patients. A total of 1,988 patients with 2,110 VCFs underwent PVP with PMMA cement after failing conservative treatment for at least 3 months. New recollapsed vertebral fractures were diagnosed as recurrent intractable back pain, postoperatively correlated with serial plain radiography and MR image. Clinical parameters such as age, gender, body mass index, and fracture-free interval (from the date of the initial intervention with percutaneous vertebroplasty to the diagnosis of subsequent fractures) were recorded. Parameters related to imaging and technical characteristics, including the amount of bone cement injected per procedure, level, the presence of osteonecrosis in the vertebral body, and the surgical approach (uni- or bipedicles), the restoration of kyphosis angle and height of the anterior border of the collapsed vertebral body, and any leakage of cement into the disk space were also recorded. RESULTS In a 2-year follow-up, 1,800 patients with 1,820 VCFs were retrospectively reviewed and 10 patients with 10 VCFs developed refracture of the same vertebra after PVP with an incidence rate of 0.56% (10 in 1,800). The mean age of the ten patients (nine females and one male) was 79.6 years, and the mean BMI is 22.3. Levels of refracture after PVP were all located in the thoracolumbar junction (T12-L2): three in T12; four in L1; and three in L2. Osteonecrosis was present in all patients and intradiscal cement leakage was noted in five patients. The mean of the restoration of kyphosis angle was 7.7° and height of the anterior border was 26%. Osteonecrosis, greater anterior vertebral height restoration, lesser kyphosis angle correction and cystic filling pattern were statistically significant. CONCLUSIONS Our study suggests that larger height restoration and solid lump filling cement are risk factors of refracture of cemented vertebral bodies. Symmetric cement distribution and fluid aspiration would be the potential ways to avoid refracture of cemented vertebral bodies.
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Affiliation(s)
- Lih-Huei Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin Street, Kweishan Shiang, Taoyuan, Taiwan.
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Wang HK, Lu K, Liang CL, Weng HC, Wang KW, Tsai YD, Hsieh CH, Liliang PC. Comparing Clinical Outcomes Following Percutaneous Vertebroplasty with Conservative Therapy for Acute Osteoporotic Vertebral Compression Fractures. PAIN MEDICINE 2010; 11:1659-65. [PMID: 21044255 DOI: 10.1111/j.1526-4637.2010.00959.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hao-Kuang Wang
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
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Morphologic change in vertebral body after percutaneous vertebroplasty: follow-up with MDCT. AJR Am J Roentgenol 2010; 195:W207-12. [PMID: 20729417 DOI: 10.2214/ajr.10.4195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this prospective study was to evaluate maintenance of spinal canal size and restoration of vertebral height and wedge angle after percutaneous vertebroplasty. SUBJECTS AND METHODS This study included 27 patients (19 women, eight men) with osteoporotic compression fractures (52 vertebrae). MDCT with multiplanar reformation was performed within 1 day before and 1 hour after the procedure and 1 year after the procedure on a routine or as-needed basis. The degree of retropulsion, smallest size of the spinal canal, and vertebral height and wedge angle were measured. Statistical analyses were performed with the paired Student's t and Mann-Whitney U tests. RESULTS There were no statistically significant differences in degree of retropulsion or size of the spinal canal before and after treatment and at the follow-up evaluation (p > 0.05). Even in the 36 vertebrae with spinal canal compromise before the procedure, there was no significant change in spinal stenosis (p > 0.05). Vertebral height and wedge angle were restored immediately after treatment (1.2 mm and 2.8 degrees , p < 0.05). These restorations were more prominent in vertebrae with fracture clefts than in those without clefts (p < 0.05). Restoration of vertebral height and wedge angle were diminished, but the preprocedure results were maintained in follow-up (0.4 mm and 1.1 degrees , p > 0.05). CONCLUSION Vertebroplasty can maintain vertebral height and wedge angle and spinal canal size at least 1 year after treatment.
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Abstract
OBJECTIVE The purposes of this review are to summarize the causes of recurrent pain after percutaneous vertebroplasty and to discuss the incidence, clinical symptoms, risk factors, image findings, treatment and prognosis, and prevention of such pain. CONCLUSION Percutaneous vertebroplasty is widely used to treat patients with symptomatic osteoporotic compression fractures. Although the procedure relieves the pain of the compression fracture, recurrent back pain after percutaneous vertebroplasty is common.
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Qian Y. A New Challenge to Estimate the Rupturing Process of ICA Aneurysms. Interv Neuroradiol 2010. [DOI: 10.1177/15910199100160s114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Y Qian
- Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
- Neurosurgery Department, Jikei University School of Medicine, Tokyo, Japan
- Centre for Advanced Biomedical Science, Tokyo, Japan
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Hiwatashi A, Yoshiura T, Yamashita K, Kamano H, Dashjamts T, Honda H. Subsequent fracture after percutaneous vertebroplasty can be predicted on preoperative multidetector row CT. AJNR Am J Neuroradiol 2009; 30:1830-4. [PMID: 19643924 DOI: 10.3174/ajnr.a1722] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Subsequent fracture is often seen after percutaneous vertebroplasty. The purpose of this prospective study was to evaluate preoperative multidetector row CT (MDCT) for the prediction of subsequent fractures after vertebroplasty. MATERIALS AND METHODS This study included 26 consecutive patients (18 women and 8 men) with osteoporotic compression fractures (58 vertebrae). A 64-section MDCT with multiplanar reformation was obtained 1 day before the procedure. Subsequent MR imaging was used to evaluate new fractures at least 3 months after treatment on a routine basis or if there was recurrent pain. We used logistic regression analysis with MDCT findings and clinical data for statistical evaluation according to the location of new fractures. RESULTS Subsequent fractures were noted at 14 adjacent vertebrae (12.1%) in 13 patients and at 14 remote vertebrae in 6 patients (23.1%). Subsequent fractures in adjacent vertebrae tended to occur in small vertebrae before treatment (P < .05). Steroid medication and low CT value in nonfractured vertebrae were associated with subsequent fractures in remote vertebrae (P < .05). Further collapse of the treated vertebral bodies was noted in 10 patients (11 vertebrae [19.0%]) without specific findings (P > .05). CONCLUSIONS The small size of the treated vertebrae may relate to subsequent fractures in adjacent vertebrae. Steroid use and low CT value of nonfractured vertebrae on preoperative MDCT can be associated with subsequent fractures in remote vertebrae.
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Affiliation(s)
- A Hiwatashi
- Department of Clinical Radiology, Kyushu University, Fukuoka, Japan.
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Abstract
BACKGROUND Because the complications of vertebroplasty are serious and can include new fracture, we retrospectively evaluated potential risk factors for new fracture after vertebroplasty. Our hypothesis is that thoracolumbar vertebrae adjacent to a vertebroplasty site have a higher incidence of new compression fracture than do other vertebrae. METHODS Between March 2001 and December 2002, a total of 271 patients underwent vertebroplasty and a retrospective review of charts was performed. Patients reached 24 months of follow-up were included for analyses. Age, gender, bone mineral density, the numbers of prior vertebroplasty procedures, cement volume, postoperative kyphotic angle, the vertebral level, and kyphotic changes were assessed in relation to surgical outcome. RESULTS The 220 patients had a mean age of 72.7 years (range, 53-97 years) and a mean follow-up interval of 25.6 months (range, 24-36 months). A total of 15 patients had 18 new fractures, and 11 new fractures were at the thoracolumbar junction (T12-L1) (p = 0.61). New fractures were in vertebrae adjacent to a treated vertebra in 55.6% (10 of 18 cases) of cases. Analysis of potential predictors for new vertebral fracture failed to identify statistically significant risk factors, despite a large sample size. CONCLUSIONS Overall, 6.16% (18 of 292) of all treated vertebra developed associated new vertebral fractures. Cranial vertebrae were most likely to fracture at the adjacent level, whereas thoracic vertebrae were least likely to fracture at the adjacent level. Additional risk factors for new vertebral fracture are poorly understood.
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Affiliation(s)
- Yang-Pin Lo
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
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Rosselló L, Pallisó F, Ferrer J, Docampo E, Calvet J, Benito P, Serra J. [Vertebral osteonecrosis and percutaneous vertebroplasty]. REUMATOLOGIA CLINICA 2008; 4:162-165. [PMID: 21794524 DOI: 10.1016/s1699-258x(08)71827-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Accepted: 10/24/2007] [Indexed: 05/31/2023]
Abstract
Vertebral osteonecrosis is characterized by the presence of the intravertebral vacuum phenomenon. It is a relatively uncommon disease and although it may be caused by different pathologies, the most frequent cause is posttraumatic. The explanation for the presence of intravertebral gas is not known completely. We present the case of a 74-year-old patient who after suffering a vertebral traumatism, to complain of intense vertebral pain. A simple radiological study, CT scan, and magnetic resonance confirmed the presence of intravertebral vacuum phenomenon. We studied this radiological sign and then commented on its evolution after percutaneous vertebroplasty.
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Affiliation(s)
- Lluís Rosselló
- Unidad de Reumatología y Aparato Locomotor. Hospital de Santa María. Lleida. España
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Peh WC, Munk PL, Rashid F, Gilula LA. Percutaneous Vertebral Augmentation: Vertebroplasty, Kyphoplasty and Skyphoplasty. Radiol Clin North Am 2008; 46:611-35, vii. [DOI: 10.1016/j.rcl.2008.05.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lazáry A, Speer G, Varga PP, Balla B, Bácsi K, Kósa JP, Nagy Z, Takács I, Lakatos P. Effect of vertebroplasty filler materials on viability and gene expression of human nucleus pulposus cells. J Orthop Res 2008; 26:601-7. [PMID: 18176942 DOI: 10.1002/jor.20532] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Consequences of intradiscal cement leakage--often occurring after vertebral cement augmentation for the treatment of vertebral compression fractures--are still unknown. In this study, we have investigated the influences of vertebroplasty filler materials (polymethylmethacrylate-, calcium phosphate- and calcium sulfate-based bone cement) on isolated nucleus pulposus cells. Cell viability of cultured human nucleus pulposus cells were measured after treatment with vertebroplasty filler materials. Gene expression profile of selected genes was determined with quantitative real-time PCR. The widely used polymethylmethacrylate and calcium phosphate cement significantly decreased cell number in a dose- and time-dependent manner while calcium sulfate cement affected cell viability less. Expression of genes involved in matrix metabolism of nucleus pulposus--aggrecan, collagens, small proteoglycans--as well as important transcription factors have also significantly changed due to treatment (e.g., 2.5-fold decrease in aggrecan expression was determined in cultures due to polymethylmethacrylate treatment). Our results suggest that vertebroplasty filler materials--depending on the type of applied material--can accelerate the degeneration of nucleus pulposus cells resulting in a less flexible disc in case of intradiscal cement leakage. This process may increase the risk of a subsequent new vertebral fracture, the main complication of vertebral augmentation.
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Affiliation(s)
- Aron Lazáry
- 1st Department of Medicine, Semmelweis University, Korányi S. u. 2/a, Budapest, H-1083 Hungary.
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McDonald RJ, Trout AT, Gray LA, Dispenzieri A, Thielen KR, Kallmes DF. Vertebroplasty in multiple myeloma: outcomes in a large patient series. AJNR Am J Neuroradiol 2008; 29:642-8. [PMID: 18202234 DOI: 10.3174/ajnr.a0918] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Despite the literature supporting the efficacy of vertebroplasty for treatment of osteoporotic vertebral compression fractures, few reports exist documenting its use in the treatment of compression fractures in multiple myeloma patients. Accordingly, we sought to characterize the imaging characteristics, clinical course, and outcomes in myeloma patients treated with vertebroplasty. MATERIALS AND METHODS We performed a retrospective review of clinical outcome data from 67 multiple myeloma patients treated with vertebroplasty since October 2000. Quantitative outcome data including the Roland Morris Disability Questionnaire (RDQ) and Visual Analog Scales for pain and qualitative outcome data (self-reported pain, mobility, and narcotic use) were collected preoperatively, immediately after vertebroplasty, and at 1 week, 1 month, 6 months, and 1 year after treatment. RESULTS Significant improvements in all of the outcome measures were observed postoperatively and throughout the duration of follow-up. Quantitative outcome measures (RDQ, analog pain scale 0-10, with rest and activity) improved by 11.0 (48%; P < .0001), 2.7 (25%; P < .001), and 5.3 (48%; P < .0001) points, respectively, with persistent improvement at 1 year (P < .01; P < .03; P < .001). Eighty-two percent and 89% of patients experienced a significant improvement in subjective rest pain and activity pain, respectively. Subjective scores achieved durable improvements, with 65% of patients requiring fewer narcotics after vertebroplasty and 70% having improved mobility. CONCLUSION Vertebroplasty provides significant and durable pain relief for patients with intractable spinal pain secondary to compression fractures resulting from multiple myeloma.
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Affiliation(s)
- R J McDonald
- Medical Scientist Training Program, Mayo Clinic, Rochester, MN 55905, USA
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Day 2 — September 11, 2007. Interv Neuroradiol 2007. [DOI: 10.1177/15910199070130s207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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