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Xu B, Xue L, Jiang M, Qin D, Gao G, Zhang H. Evaluating somatosensory evoked potentials in predicting treatment outcomes for thoracolumbar spinal compression fractures using closed reduction and over-extension techniques. Am J Transl Res 2024; 16:3026-3035. [PMID: 39114723 PMCID: PMC11301508 DOI: 10.62347/dclg9825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/16/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To evaluate the predictive value of somatosensory evoked potentials (SEPs) for the efficacy of closed reduction combined with over-extension reduction technique (PVP) in managing thoracolumbar spinal compression fractures. METHODS Data were collected from 125 patients who underwent closed reduction with PVP and SEP monitoring from February 2021 to July 2023. We evaluated surgery success rates, incidence of bone cement leakage, and patient recovery outcomes including vertebral anterior height, Oswestry Disability Index (ODI), and Cobb angle restoration. SEP results were analyzed to categorize patients into effective and ineffective treatment groups. Differences in SEP waveforms between these groups were examined, and ROC analysis was used to assess the predictive value of these differences. Multivariate logistic regression was employed to identify risk factors affecting treatment efficacy. RESULTS Post-treatment assessments showed significant improvements in vertebral anterior height, ODI, and Cobb angle. SEP monitoring correlated well with intraoperative findings and physical examinations. During reduction, changes in SEP latency and amplitude were noted in 37 patients, with 7 patients meeting SEP amplitude alarm criteria, which normalized after adjustments. During PVP, 28 patients exhibited SEP amplitude fluctuations and 5 experienced a 30% reduction in amplitude following initial cement injection, with no significant latency changes. Treatment was deemed effective in 93 patients and ineffective in 32. SEP amplitudes during vertebral compression and PVP were significantly lower in the effective group (P<0.05). The AUC for predicting treatment efficacy was 0.819 and 0.859, respectively. Multivariate analysis revealed low preoperative vertebral compression ratio, number of fractures, and abnormal SEP amplitudes as independent risk factors for treatment outcomes. CONCLUSION SEP monitoring provides an accurate reflection of spinal cord function during closed reduction with PVP, aiding in predicting treatment safety and efficacy. The use of SEP monitoring is thus recommended for clinical application in this context.
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Affiliation(s)
- Bin Xu
- Clinical College of Traditional Chinese Medicine, Gansu University of Traditional Chinese MedicineNo. 35 Dingxi East Road, Lanzhou 730000, Gansu, China
| | - Lijun Xue
- Spine Surgery, Affiliated Hospital of Gansu University of Traditional Chinese MedicineNo. 732 Jiayuguan West Road, Lanzhou 730020, Gansu, China
| | - Minjian Jiang
- Spine Surgery, Affiliated Hospital of Gansu University of Traditional Chinese MedicineNo. 732 Jiayuguan West Road, Lanzhou 730020, Gansu, China
| | - Daping Qin
- Spine Surgery, Affiliated Hospital of Gansu University of Traditional Chinese MedicineNo. 732 Jiayuguan West Road, Lanzhou 730020, Gansu, China
| | - Guodong Gao
- Spine Surgery, Affiliated Hospital of Gansu University of Traditional Chinese MedicineNo. 732 Jiayuguan West Road, Lanzhou 730020, Gansu, China
| | - Hua Zhang
- Spine Surgery, Affiliated Hospital of Gansu University of Traditional Chinese MedicineNo. 732 Jiayuguan West Road, Lanzhou 730020, Gansu, China
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Gutierrez-Gonzalez R, Royuela A, Zamarron A. Vertebral compression fractures: pain relief, progression and new fracture rate comparing vertebral augmentation with brace. BMC Musculoskelet Disord 2023; 24:898. [PMID: 37980474 PMCID: PMC10656983 DOI: 10.1186/s12891-023-07041-1] [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: 04/23/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Osteoporotic vertebral compression fracture (VCF) is the third most frequent fragility fracture in the world. Conservative treatment, vertebroplasty, and kyphoplasty are all recognized therapies. However, diagnostic and therapeutic recommendations must be more consistent when comparing clinical guidelines. This study aims to compare the efficacy of vertebral augmentation therapy and conservative management for treating VCFs, the risk of subsequent complications, and the length of hospital stay. METHOD All patients over 50 years old with a diagnosis of thoracic or lumbar VCF without underlying oncological process, treated conservatively or surgically, and consecutively attended at our department from January 2017 to June 2021 were retrospectively selected for analysis. Patients who missed follow-up or died during the first three months were excluded. RESULTS A total of 573 cases were selected for analysis. Most patients were treated conservatively (85.3%). Both groups were homogenous regarding epidemiological and clinical features. The median time elapsed to achieve pain relief was significantly lower in the surgical cohort (4.5 vs. 10 weeks, p < 0.001), and the proportion of patients reporting pain at the first outpatient visit was also significantly lower with a vertebral augmentation procedure (p = 0.004). The new fracture rate and the adjacent level rate did not differ significantly when comparing both treatments, whereas the progression of the diagnosed fracture was more frequent in the conservative group (4.8% vs. 29.7%; p < 0.001). The median hospital stay was significantly lower in the conservative group (3 vs. 10 days; p < 0.001). CONCLUSION Surgical treatment (vertebroplasty/kyphoplasty) of VCFs was associated with sooner pain relief without an increased risk of new or adjacent fractures. Moreover, the progression of treated fractures was significantly lower in the surgical cohort. The only unfavorable aspect was the more extended hospital stay compared with the conservative treatment group.
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Affiliation(s)
- Raquel Gutierrez-Gonzalez
- Department of Neurosurgery, Puerta de Hierro University Hospital, IDIPHISA Manuel de Falla 1, Majadahonda-Madrid, 28222, Spain.
- Department of Surgery, Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo 4, 28029, Madrid, Spain.
| | - A Royuela
- Biostatistics Unit. Biomedical Research Institute, Puerta de Hierro University Hospital, IDIPHISA. CIBERESP, Manuel de Falla 1, Majadahonda-Madrid, 28222, Spain
| | - A Zamarron
- Department of Neurosurgery, Puerta de Hierro University Hospital, IDIPHISA Manuel de Falla 1, Majadahonda-Madrid, 28222, Spain
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Li J, Xu L, Liu Y, Sun Z, Wang Y, Yu M, Li W, Zeng Y. Open Surgical Treatments of Osteoporotic Vertebral Compression Fractures. Orthop Surg 2023; 15:2743-2748. [PMID: 37587622 PMCID: PMC10622270 DOI: 10.1111/os.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 08/18/2023] Open
Abstract
With an aging population, the osteoporotic vertebral compression fracture (OVCF) has become a constant concern for its physical and neurological complications, such as spinal kyphosis and refractory pains. Compared with traditional conservative treatments, the open surgery is more superior in some ways because of its direct decompression and correction. Various operation methods applying to different indications have been developed to deal with different fracture situations, including anterior, posterior, and combined surgery. In this review, we have concluded the latest developments of the surgery treating OVCF and the internal fixation as references for spinal surgeons of the choice of suitable treatments.
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Affiliation(s)
- Junyu Li
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Lizhi Xu
- School of Basic Medical SciencesPeking University Health Science CenterBeijingChina
| | - Yinhao Liu
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Zhuoran Sun
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yongqiang Wang
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Miao Yu
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Weishi Li
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yan Zeng
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
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Gutierrez-Gonzalez R, Ortega C, Royuela A, Zamarron A. Vertebral compression fractures managed with brace: risk factors for progression. 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; 32:3885-3891. [PMID: 37632559 DOI: 10.1007/s00586-023-07905-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/06/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE The aim of this study is to identify risk factors for vertebral compression fracture (VCF) progression in patients treated conservatively with a brace. Then, a case-control study was designed. METHODS All patients over 50 years old with diagnosis of thoracic or lumbar VCF (T5 to L5) in absence of underlying oncological process, treated conservatively with brace, and consecutively attended at our department from January 2017 to June 2021 were retrospectively selected for analysis. Patients missed for follow-up or dead during the first 3 months of follow-up were excluded. RESULTS Five hundred and eighty-two consecutive patients were recorded. Incomplete follow-up excluded 74 patients and other 19 died in the first three months after diagnosis, so 489 cases were finally analyzed. Median follow-up was 21 (IQR 13;30) weeks. Increased collapse of the vertebral body was found in 29.9% of VCFs with a median time to progression of 9 (IQR 7;13) weeks. Male gender (OR 1.6), type A3 fracture of the AOSpine classification (OR 2.7), thoracolumbar junction location (OR 1.7), and incorrect use of the brace (OR 3.5) were identified as independent risk factors for progression after multivariable analysis. CONCLUSION Male gender, type A3 fracture of the AOSpine classification, thoracolumbar junction location, and incorrect use of the brace were identified as independent risk factors for VCF progression, which resulted in worse pain control, when treated with brace. Thus, other treatments such as percutaneous vertebral augmentation could be considered to avoid progression in selected cases, since collapse rate has been demonstrated lower with these procedures.
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Affiliation(s)
- R Gutierrez-Gonzalez
- Department of Neurosurgery, IDIPHISA, Puerta de Hierro University Hospital, Manuel de Falla 1, 28222, Majadahonda, Madrid, Spain.
- Department of Surgery, Faculty of Medicine, Autonomous University of Madrid, Arzobispo Morcillo 4, 28029, Madrid, Spain.
| | - C Ortega
- Department of Neurosurgery, IDIPHISA, Puerta de Hierro University Hospital, Manuel de Falla 1, 28222, Majadahonda, Madrid, Spain
| | - A Royuela
- Biostatistics Unit, Biomedical Research Institute, IDIPHISA, CIBERESP, Puerta de Hierro University Hospital, Manuel de Falla 1, 28222, Majadahonda, Madrid, Spain
| | - A Zamarron
- Department of Neurosurgery, IDIPHISA, Puerta de Hierro University Hospital, Manuel de Falla 1, 28222, Majadahonda, Madrid, Spain
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Takahashi S, Inose H, Tamai K, Iwamae M, Terai H, Nakamura H. Risk of Revision After Vertebral Augmentation for Osteoporotic Vertebral Fracture: A Narrative Review. Neurospine 2023; 20:852-862. [PMID: 37798981 PMCID: PMC10562240 DOI: 10.14245/ns.2346560.280] [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: 05/17/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 10/07/2023] Open
Abstract
Osteoporotic vertebral fractures (OVFs) can hinder physical motor function, daily activities, and the quality of life in elderly patients when treated conservatively. Vertebral augmentation, which includes vertebroplasty and balloon kyphoplasty, is a commonly used procedure for OVFs. However, there have been reports of complications. Although serious complications are rare, there have been instances of adjacent vertebral fractures, cement dislocation, and insufficient pain relief due to cement failure, sometimes necessitating revision surgery. This narrative review discusses the common risks associated with vertebral augmentation for OVFs, such as cement leakage and adjacent vertebral fractures, and highlights the risk of revision surgery. The pooled incidence of revision surgery was 0.04 (0.02-0.06). The risks for revision are reported as follows: female sex, advanced age, diabetes mellitus, cerebrovascular disease, dementia, blindness or low vision, hypertension, hyperlipidemia, split type fracture, large angular motion, and large endplate deficit. Various treatment strategies exist for OVFs, but they remain a subject of controversy. Current literature underscores the lack of substantial evidence to guide treatment strategies based on the risks of vertebral augmentation. In cases with a high risk of failure, other surgeries and conservative treatments should also be considered as treatment options.
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Affiliation(s)
- Shinji Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroyuki Inose
- Department of Orthopaedic and Trauma Research, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Masayoshi Iwamae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Liu X, Tian J, Yu X, Sun Z, Wang H. Comparison of clinical effects of percutaneous vertebroplasty with two different puncture approaches on the treatment of thoracolumbar osteoporotic vertebral compression fractures with narrow pedicles: a retrospective controlled study. 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; 32:2594-2601. [PMID: 37069441 DOI: 10.1007/s00586-023-07714-4] [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: 01/20/2023] [Revised: 01/20/2023] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE To evaluate the effects of percutaneous vertebroplasty (PVP) with conventional transpedicle approach (CTA) or basal transverse process-pedicle approach (BTPA) on the treatment of thoracolumbar osteoporotic vertebral compression fractures (TL-OVCFs) with narrow pedicles. METHODS A retrospective study of TL-OVCFs with narrow pedicles was performed, including 78 cases of CTA and 84 cases of BTPA. The surgical outcomes, radiographic parameters [the width and height of the pedicle (PW, PH), the inclination angle of puncture (PIA)] and clinical indicators [visual analog scale (VAS) score, Oswestry Disability Index (ODI)] of two groups were compared. RESULTS In terms of surgical outcomes of them, there was no difference in operation time (P > 0.05), while the volume of bone cement, the incidence of bone cement leakage and rate of good bone cement distribution were significantly worse in the CTA group (4.4 ± 0.6 ml vs. 5.5 ± 0.5 ml, 37.2% vs. 20.2%, 52.6% vs. 79.8%, P < 0.05). As for radiographic parameters and clinical indicators of them, the differences were not observed in the PH, PW, preoperative VAS score and ODI (P > 0.05), whereas the PIA, VAS score and ODI at 1 day postoperatively were significantly better in the BTPA group (17.3 ± 2.1° vs. 29.6 ± 2.8°, 2.7 ± 0.7 vs. 2.1 ± 0.8, 32.8 ± 4.6 vs. 26.7 ± 4.0, P < 0.05). CONCLUSION The study provided solid evidence that PVP with BTPA had more advantages in the treatment of TL-OVCFs with narrow pedicles, which can better relieve postoperative pain.
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Affiliation(s)
- Xiaolei Liu
- Department of Orthopedics, The Fourth Affiliated Hospital of Nanjing Medical University, Nanpu road 298#, Jiangbei new District, Nanjing, 210000, China
| | - Jiwei Tian
- Department of Orthopedics, The BenQ Hospital affiliated to Nanjing Medical University, Hexidajie 76#, Jianye District, Nanjing, 210000, China
| | - Xiao Yu
- Department of Orthopedics, The Fourth Affiliated Hospital of Nanjing Medical University, Nanpu road 298#, Jiangbei new District, Nanjing, 210000, China
| | - Zhongyi Sun
- Department of Orthopedics, The BenQ Hospital affiliated to Nanjing Medical University, Hexidajie 76#, Jianye District, Nanjing, 210000, China.
| | - Haibin Wang
- Department of Orthopedics, The Fourth Affiliated Hospital of Nanjing Medical University, Nanpu road 298#, Jiangbei new District, Nanjing, 210000, China.
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Wang JN, Xie W, Song DW, Zou J, Yan Q, Feng T, Jin SY, Yang C, Luo ZP, Niu JJ. Recurrence of Local Kyphosis After Percutaneous Kyphoplasty: The Neglected Injury of the Disc-Endplate Complex. Clin Interv Aging 2023; 18:827-834. [PMID: 37229150 PMCID: PMC10202700 DOI: 10.2147/cia.s410992] [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: 03/19/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
Background Recurrent of local kyphosis after percutaneous kyphoplasty (PKP) is rarely reported and discussed. Literatures reported that re-kyphosis is usually a consequence of refractures of augmented or adjacent vertebra. However, whether re-kyphosis should be considered as a complication of refractures and has an impact on clinical efficacy of PKP during follow-up time is unknown. The purpose of this study is to evaluate the related risk factors and clinical significance of the recurrent of local kyphosis in osteoporotic vertebral fracture (OVF) patients without refractures. Patients and Methods A total of 143 patients who underwent single-level PKP were recruited and assigned into the re-kyphosis group and non-re-kyphosis group. Clinical and radiographic data were collected and compared between the two groups. Then, multivariate logistic regression analyses were conducted to identify the related risk factors. Results During follow-up, 16 of the 143 patients presented postoperative re-kyphosis. The average local kyphosis angle increased from 11.81±8.60° postoperatively to 25.13±8.91° at the final follow-up which showed a statistically significant difference (p<0.05). Both groups had significant improvements in postoperative visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores compared to their preoperative values (p<0.05). However, in the re-kyphosis group at final follow-up, the VAS and ODI scores showed worsening compared to the postoperative scores. Logistic regression analysis showed that disc-endplate complex injury (OR=17.46, p=0.003); local kyphosis angle correction (OR=1.84, p<0.001); and vertebral height restoration (OR=1.15, p=0.003) were risk factors for re-kyphosis. Conclusion Re-kyphosis is not rare in patients with osteoporotic vertebral fracture and tends to have an inferior prognosis following PKP surgery. Patients with disc-endplate complex injury and more correction of vertebral height and kyphosis angle are at a higher risk for re-kyphosis after PKP surgery than others.
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Affiliation(s)
- Jin-ning Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Wei Xie
- Department of Orthopaedics, Suzhou Ninth People’s Hospital, Suzhou, Jiangsu, People’s Republic of China
| | - Da-Wei Song
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jun Zou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Qi Yan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Tao Feng
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Sheng-yang Jin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Chao Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Zong-ping Luo
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Orthopedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jun-jie Niu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
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Wu G, Lin T, Chen D, Wang Z, Chen G, Liu W. Reply to letter to the editor: Does spinal sagittal imbalance lead to future vertebral compression fractures in osteoporosis patients? Spine J 2022; 22:508-509. [PMID: 35219497 DOI: 10.1016/j.spinee.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Guiqing Wu
- Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou 086-350001, China.
| | - Taotao Lin
- Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou 086-350001, China
| | - Dehui Chen
- Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou 086-350001, China
| | - Zhenyu Wang
- Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou 086-350001, China
| | - Gang Chen
- Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou 086-350001, China
| | - Wenge Liu
- Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou 086-350001, China
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Hu X, Jiang W, Chen Y, Wang Y, Ma W. Revision surgery after cement augmentation for osteoporotic vertebral fracture. Orthop Traumatol Surg Res 2021; 107:102796. [PMID: 33338678 DOI: 10.1016/j.otsr.2020.102796] [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: 03/12/2020] [Revised: 06/05/2020] [Accepted: 08/18/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Cement augmentation has been proven to be a safe procedure for the treatment of osteoporotic vertebral fracture, and the overall result is encouraging. However, failures caused by different complications are not uncommon, and a few patients even need revision surgery. This retrospective study aimed to investigate the primary causes of revision surgery after cement augmentation for osteoporotic vertebral fracture and how to prevent them, and the second objective was to evaluate the clinical results of revision surgery. HYPOTHESIS The main hypothesis is that infection and neurological dysfunction are the prime causes of revision surgery after cement augmentation for osteoporotic vertebral fracture, and the second hypothesis is that revision surgery is effective to improve the quality of daily life. MATERIALS AND METHODS Twenty-one patients who underwent unplanned revision surgery after cement augmentation were retrospectively analyzed. The initial radiographic and medical records were reviewed to re-evaluate whether the initial diagnosis and surgical procedure were correct and suitable. The primary causes of revision surgery and the details were recorded. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the efficacy of the revision surgery, and patients with neurological dysfunction were evaluated with the American Spinal Injury Association (ASIA). RESULTS A total of 47.6% (10/21) of patients were misdiagnosed initially or had an incorrect indication for cement augmentation surgery, including 3 pre-existing spondylitis cases that were misdiagnosed as osteoporotic vertebral fracture and 7 cases of three column fractures that were treated with cement augmentation. The primary causes and details of the revision surgeries were as follows: 7 patients with infection underwent anterior and/or posterior debridement and fixation; 9 patients with progressive kyphosis underwent posterior osteotomy and fixation; and 5 patients with neurological dysfunction underwent posterior decompression and fixation. The mean follow-up time was 30.6±8.7 months, the VAS score decreased from 7.3±1.1 preoperatively to 2.3±0.3 (p<0.05) at the last follow-up, the ODI decreased from 61.1%±16.3% preoperatively to 20.6%±6.2% (p<0.05) at the last follow-up, and 5 patients with neurological dysfunction improved by at least one grade. CONCLUSION Infection, progressive kyphosis and neurological dysfunction are the primary causes of revision surgery after cement augmentation for osteoporotic vertebral fracture. Avoiding misdiagnosis and ensuring suitable indications might be the key points to decreasing unplanned revision surgery for cement augmentation for osteoporotic vertebral fracture. The quality of daily life and neurological function can be improved through revision surgery.
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Affiliation(s)
- Xudong Hu
- Department of Spine Surgery, Ningbo No.6 Hospital, Zhong Shan East Road 1059#, Ningbo, Zhejiang Province, China
| | - Weiyu Jiang
- Department of Spine Surgery, Ningbo No.6 Hospital, Zhong Shan East Road 1059#, Ningbo, Zhejiang Province, China
| | - Yunlin Chen
- Department of Spine Surgery, Ningbo No.6 Hospital, Zhong Shan East Road 1059#, Ningbo, Zhejiang Province, China
| | - Yang Wang
- Department of Spine Surgery, Ningbo No.6 Hospital, Zhong Shan East Road 1059#, Ningbo, Zhejiang Province, China
| | - Weihu Ma
- Department of Spine Surgery, Ningbo No.6 Hospital, Zhong Shan East Road 1059#, Ningbo, Zhejiang Province, China.
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Surgical Outcomes After Minimally Invasive Direct Lateral Corpectomy with Percutaneous Pedicle Screws for Osteoporotic Thoracolumbar Vertebral Collapse with Neurologic Deficits in the Thoracolumbar Spine Compared with Those After Posterior Spinal Fusion with Vertebroplasty. Spine (Phila Pa 1976) 2021; 46:1271-1278. [PMID: 34435991 DOI: 10.1097/brs.0000000000003988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective observational study of a cohort of consecutive patients. OBJECTIVE The aim of this study was to compare surgical invasion, mechanical complications, and clinical and radiological outcomes 2 years after surgery between minimally invasive corpectomy following percutaneous pedicle screw placements (X-core/PPS) and posterior fixation with vertebroplasty (VP) for treating osteoporotic vertebral fractures (OVFs), which failed conservative treatment due to neurological deficits. SUMMARY OF BACKGROUND DATA Numerous studies have proposed surgical procedures to treat OVFs that fail conservative treatment. However, an optimal approach remains controversial because patients often have numerous comorbid medical complications, frequent instrumentation failure, and/or adjacent vertebral fracture (AVF). Recently, a minimally invasive lateral approach has attracted attention as an alternative procedure to the thoracolumbar junction for corpectomy and expandable cage replacement (X-Core Adjustable VBR System). However, its usefulness and validity is largely unknown. METHODS A cohort of 102 consecutive patients with OVF at T11-L1 who underwent surgery were followed up for >2 years after surgery. Ultimately 50 patients were included in the VP group and 45 in the X-core/PPS group. Surgical invasion, radiological examinations, and clinical outcomes between two procedures were compared. RESULTS Both X-core/PPS and VP procedures were safe and acceptable for neurological improvement and surgical invasion. The correction loss of local kyphotic angle (LKA) and occurrence of AVF were significantly less in the X-core/PPS group. Oswestry Disability Index in the X-core/PPS group at 2 years after surgery showed better recovery than that in the VP group, and no revision surgery was needed in the X-core/PPS group. Postoperative correction loss of LKA increased significantly when intraoperative endplate injury developed. CONCLUSION This next-generation minimally invasive anterior and posterior combined surgery was found to be a safe and useful procedure for OVF treatment to reduce correction loss, mechanical complication, and AVF, resulting in less postoperative low back pain.Level of Evidence: 3.
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Ma YH, Tian ZS, Liu HC, Zhang BY, Zhu YH, Meng CY, Liu XJ, Zhu QS. Predictive risk factors for recollapse of cemented vertebrae after percutaneous vertebroplasty: A meta-analysis. World J Clin Cases 2021; 9:2778-2790. [PMID: 33969060 PMCID: PMC8058688 DOI: 10.12998/wjcc.v9.i12.2778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/18/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND As one of the most common complications of osteoporosis, osteoporotic vertebral compression fracture (OVCF) increases the risk of disability and mortality in elderly patients. Percutaneous vertebroplasty (PVP) is considered to be an effective, safe, and minimally invasive treatment for OVCFs. The recollapse of cemented vertebrae is one of the serious complications of PVP. However, the risk factors associated with recollapse after PVP remain controversial.
AIM To identify risk factors for the recollapse of cemented vertebrae after PVP in patients with OVCFs.
METHODS A systematic search in EMBASE, MEDLINE, the Cochrane Library, and PubMed was conducted for relevant studies from inception until March 2020. Studies investigating risk factors for the recollapse of cemented vertebrae after PVP without additional trauma were selected for analysis. Odds ratios (ORs) or standardized mean differences with 95% confidence interval (CI) were calculated and heterogeneity was assessed by both the chi-squared test and the I-squared test. The methodological quality of the included studies was assessed according to the Newcastle-Ottawa Scale.
RESULTS A total of nine case-control studies were included in our meta-analysis comprising 300 cases and 2674 controls. The significant risk factors for the recollapse of cemented vertebrae after PVP in OVCF patients were fractures located at the thoracolumbar junction (OR = 2.09; 95%CI: 1.30 to 3.38; P = 0.002), preoperative intravertebral cleft (OR = 2.97; 95%CI: 1.93 to 4.57; P < 0.00001), and solid lump distribution pattern of the cement (OR = 3.11; 95%CI: 1.91 to 5.07; P < 0.00001). The analysis did not support that age, gender, lumbar bone mineral density, preoperative visual analogue scale score, injected cement volume, intradiscal cement leakage, or vertebral height restoration could increase the risk for cemented vertebra recollapse after PVP in OVCFs.
CONCLUSION This meta-analysis suggests that thoracolumbar junction fractures, preoperative intravertebral cleft, and solid lump cement distribution pattern are associated with the recollapse of cemented vertebrae after PVP in OVCF patients.
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Affiliation(s)
- Yi-Hang Ma
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Zhi-Sen Tian
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Hao-Chuan Liu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Bo-Yin Zhang
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Yu-Hang Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Chun-Yang Meng
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Xiang-Ji Liu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Qing-San Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
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Xu Z, Hao D, Dong L, Yan L, He B. Surgical options for symptomatic old osteoporotic vertebral compression fractures: a retrospective study of 238 cases. BMC Surg 2021; 21:22. [PMID: 33407356 PMCID: PMC7789173 DOI: 10.1186/s12893-020-01013-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022] Open
Abstract
Background Symptomatic osteoporotic vertebral compression fractures (OVCF) are increasing, as are acute and chronic pain episodes and progressive spinal deformities. However, there are no clear surgical treatment criteria for patients with these different symptoms. Therefore, this study aims to explore the surgical approaches for the treatment of OVCF with different symptoms and evaluate the feasibility of these surgical approaches. Methods We retrospectively analyzed 238 symptomatic OVCF patients who entered our hospital from June 2013 to 2016. According to clinical characteristics and imaging examinations, these patients were divided into I-V grades and their corresponding surgical methods were developed. I, old vertebral fracture with no apparent instability, vertebral augmentation; II, old vertebral fracture with local instability, posterior reduction fusion internal fixation; III, old fractures with spinal stenosis, posterior decompression and reduction fusion and internal fixation; IV, old vertebral fracture with kyphosis, posterior osteotomy with internal fixation and fusion; V, a mixture of the above types, posterior osteotomy (decompression) with internal fixation and fusion. Postoperative visual analog score (VAS), oswestry disability index (ODI) scores, sagittal index (SI) and ASIA grades of neurological function were observed. Results All 238 patients were followed up for 12–38 months, with an average follow-up of 18.5 months. After graded surgery, the VAS score, ODI score, and vertebral sagittal index SI of 238 patients were significantly improved, and the difference between the last follow-up results and the preoperative comparison was statistically significant (P ˂ 0.05). Besides, the postoperative ASIA grades of 16 patients with nerve injury were improved from 14 patients with preoperative grade C, 2 patients with grade D to 4 patients with postoperative grade D and 12 patients with postoperative grade E. Conclusion In this study, we concluded that graded surgery could better treat symptomatic old OVCF and restore spinal stability. This provides clinical reference and guidance for the treatment of symptomatic old OVCF in the future.
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Affiliation(s)
- Zhengwei Xu
- Department of Spine Sugery, Shanxi, Xi'an Jiaotong University Affiliated Honghui Hospital, No.555, Youyi Road, Beilin District, Xi'an, People's Republic of China
| | - Dingjun Hao
- Department of Spine Sugery, Shanxi, Xi'an Jiaotong University Affiliated Honghui Hospital, No.555, Youyi Road, Beilin District, Xi'an, People's Republic of China
| | - Liang Dong
- Department of Spine Sugery, Shanxi, Xi'an Jiaotong University Affiliated Honghui Hospital, No.555, Youyi Road, Beilin District, Xi'an, People's Republic of China
| | - Liang Yan
- Department of Spine Sugery, Shanxi, Xi'an Jiaotong University Affiliated Honghui Hospital, No.555, Youyi Road, Beilin District, Xi'an, People's Republic of China
| | - Baorong He
- Department of Spine Sugery, Shanxi, Xi'an Jiaotong University Affiliated Honghui Hospital, No.555, Youyi Road, Beilin District, Xi'an, People's Republic of China.
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Secondary thoracolumbar deformity and sagittal imbalance due to osteoporosis in a young man with Cushing's disease: A case report. Int J Surg Case Rep 2020; 76:134-138. [PMID: 33032043 PMCID: PMC7551976 DOI: 10.1016/j.ijscr.2020.09.182] [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] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 11/20/2022] Open
Abstract
Vertebral fractures are frequent due to osteoporosis in Cushing disease. Treating de primary cause of the disease reduces the risk of new fractures. Surgical treatment may be needed for secondary deformity.
Introduction To describe an unusual case of Cushing’s disease with spontaneous axial pain due to multiple consecutive vertebral fractures which led to secondary deformity that required surgical treatment. Presentation of case A 43-year-old man was referred to our service with back pain without previous trauma. He was diagnosed of refractory arterial hypertension and we observed centripetal obesity during exploration. With clinical findings and laboratory studies, ACTH-dependent Cushing’s syndrome due to a pituitary microadenoma was diagnosed and the patient underwent an endoscopic-assisted endonasal transsphenoidal resection. Dual energy X-ray absorptiometry (DXA) revealed spine and hip osteoporosis. Moreover, X-ray, MR and CT showed multiple vertebral osteoporotic compression fractures in thoracic and thoracolumbar area. Secondary kyphosis thoracolumbar deformity and sagittal imbalance was treated by two-level Smith-Petersen osteotomies (SPO) and instrumented posterolateral arthrodesis T10-L3 using fenestrated pedicles screws with polymethyl methacrylate (PMMA). At six years of follow-up dual energy X-ray absorptiometry (DXA) recovered normal values (T-score lumbar spine L2–L4 1.4 and T-score hip -1.9) and X-ray study showed an adequate sagittal vertebral axis. Discussion Osteoporosis is a common feature of CD and fractures occur in 30–50% of cases. Treating the underlying cause reduces the risk of new fractures. Medical therapy is usually enough but consecutive multiple vertebral fractures related to glucocorticoid excess may lead to secondary painful deformity. Conclusion Vertebral compression fractures result from secondary corticoid-induced osteoporosis in Cushing’s disease. Early detection and treatment of primary disease decreases the risk of new fractures. However, unusual secondary spinal deformity or disability may require surgery.
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Nakanishi K, Uchino K, Watanabe S, Hayashi N, Iba H, Hasegawa T. Video-Assisted Thoracoscopic Surgery for Re-Collapse of Vertebrae after Percutaneous Vertebral Augmentation (PVA). Spine Surg Relat Res 2020; 5:28-33. [PMID: 33575492 PMCID: PMC7870326 DOI: 10.22603/ssrr.2020-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/27/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Due to the increase in osteoporosis accompanying the aging society in Japan, osteoporotic vertebral fractures (OVFs) are increasing. Percutaneous vertebral augmentation (PVA) has been widely used for OVFs because it reduces pain immediately with less invasiveness. Re-collapse of vertebral body after PVA is a rare, but important, complication. Once the re-collapse has occurred, patients should undergo an additional invasive salvage surgery. METHODS We treated 5 patients with re-collapse after PVA in our hospital. For re-collapse after PVA, we performed anterior column reconstruction with video-assisted thoracoscopic surgery (VATS), posterior fixation with percutaneous pedicle screws (PPSs) and minimally invasive spine stabilization (MISt). RESULTS The mean postoperative follow-up was at 62.8 months. At the final follow-up, the patients were free of low back pain, and bony union was achieved in all cases. The postoperative correction loss was 6 degrees. Perioperative complications included aspiration pneumonia in one patient and bone fracture of an adjacent vertebral body in two patients. There were no reoperation cases. CONCLUSIONS We perform minimally invasive combined anterior and posterior surgery with VATS for re-collapse after PVA. This procedure is useful in elderly patients with less reserve capacity.
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Affiliation(s)
- Kazuo Nakanishi
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Kazuya Uchino
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Seiya Watanabe
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Norito Hayashi
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Hideaki Iba
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Toru Hasegawa
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
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Bayram S, Akgül T, Adıyaman AE, Karalar Ş, Dölen D, Aydoseli A. Effect of Sarcopenia on Mortality after Percutaneous Vertebral Augmentation Treatment for Osteoporotic Vertebral Compression Fractures in Elderly Patients: A Retrospective Cohort Study. World Neurosurg 2020; 138:e354-e360. [DOI: 10.1016/j.wneu.2020.02.121] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/30/2022]
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Zhang Z, Jiao F, Huang H, Feng Y, Xie C, Liu D, Qin F, Zhang S, Wu P, Tan W, Tang W. A second puncture and injection technique for treating osteoporotic vertebral compression fractures. J Orthop Surg Res 2019; 14:413. [PMID: 31806033 PMCID: PMC6894466 DOI: 10.1186/s13018-019-1498-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 11/27/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the clinical effect of the second puncture and injection technique during a percutaneous vertebroplasty (PVP) procedure. METHODS Patients treated with a second puncture and injection (group A) or a single puncture and injection (group B) during PVP at our institution during 2010-2017 were reviewed. Vertebral height loss, visual analogue scale (VAS) score, Oswestry disability index (ODI), adjacent vertebral fractures, and cement leakage were compared between the groups. RESULTS A total of 193 patients were enrolled (86 cases in group A, 107 cases in group B). The follow-up period was 15.64 (12-20) months. The loss of anterior (group A 0.01 ± 0.03; group B 0.14 ± 0.17) and middle (group A 0.13 ± 0.12; group B 0.16 ± 0.11) vertebral height in group B was significantly higher than that in group A (P < 0.05). The VAS score and ODI were also significantly higher in group B than in group A at the final follow-up; the VAS score and ODI in group B were 1.65 ± 0.70 and 14.50 ± 4.16, respectively, and those in group A were 1.00 ± 0.74 and 12.81 ± 4.02, respectively (P < 0.05). Three patients in group A and two in group B experienced adjacent vertebral fractures. Regarding mild, moderate, and severe cement leakage, there were 25 (29%), 5 (5%), and 0 cases, respectively, in group A and 28 (26%), 3 (2.8%), and 1 (0.009%) case, respectively, in group B (P > 0.05). CONCLUSIONS The second puncture and injection technique may effectively increase the dispersion of cement, thus preventing recompression of the cemented vertebral body, and it does not increase the risk of cement leakage or adjacent vertebral fracture.
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Affiliation(s)
- Zhaofei Zhang
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China.
| | - Feng Jiao
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - He Huang
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Yonghui Feng
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Chunliang Xie
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Donghua Liu
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Fengwei Qin
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Sineng Zhang
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Peiyu Wu
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Weiguang Tan
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Wang Tang
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
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The Evaluation of Different Radiological Measurement Parameters of the Degree of Collapse of the Vertebral Body in Vertebral Compression Fractures. Appl Bionics Biomech 2019; 2019:4021640. [PMID: 31205482 PMCID: PMC6530246 DOI: 10.1155/2019/4021640] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/03/2019] [Accepted: 04/21/2019] [Indexed: 01/04/2023] Open
Abstract
For compression fracture, vertebral body height loss (VBHL) and kyphotic angle (KA) are two important imaging parameters for determining the prognosis and appropriate treatment. This study used previous measurement methods to assess the degree of VBHL and KA, compare and examine differences between various measurement methods, and examine the correlation between relevant measurement parameters and intravertebral cleft (IVC) in the vertebral body. The radiographic images (lateral view of the T-L spine) of 18 patients with a single-level vertebral compression fracture were reviewed. We measured 9 characteristic lengths and angles on plain radiographs, including anterior vertebral height (AVH) and AVH of the adjacent upper and lower levels, middle vertebral height (MVH) and MVH of the adjacent upper and lower levels, posterior vertebral height (PVH), and vertebral body width, and assessed 6 parameters, including vertebral compression ratio (VBCR), percentage of anterior height compression (PAHC), percentage of middle height compression (PMHC), kyphotic angle (KA), calculated kyphotic angle (CKA), and IVC. The results showed that VBCR is a simple and rapid method of VBHL assessment, but it may result in an underestimation of the degree of VBHL compared to PAHC. When PMHC < 40% or kyphotic angle > 15°, the probability of IVC occurring on the vertebral body was higher which means the higher risk of vertebral body instability. The results of this study could provide a reference for surgeons when using imaging modalities to assess the degree of vertebral body collapse.
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Coronal Imaging Changes Associated with Recollapse of Injured Vertebrae After Percutaneous Vertebroplasty or Percutaneous Kyphoplasty Treatment for Osteoporotic Thoracolumbar Fracture. World Neurosurg 2018; 120:e737-e744. [PMID: 30170144 DOI: 10.1016/j.wneu.2018.08.154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/18/2018] [Accepted: 08/20/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To observe coronal imaging changes associated with recollapse of injured vertebrae after percutaneous vertebroplasty or percutaneous kyphoplasty for osteoporotic thoracolumbar fracture (OTLF). METHODS Fifty-four cases were retrospectively divided into 2 groups according to the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) classification of thoracolumbar fracture: group A, type A1 fracture (n = 26); group B, type A3.1 fracture (n = 28). Visual analog scale, Oswestry Disability Index, local scoliotic Cobb angle, and coronal wedge angle of the injured vertebrae were observed preoperatively, on postoperative day 3, and at final follow-up. RESULTS The average follow-up time was 19.17 ± 6.30 months. At final follow-up, the visual analog scale score and the Oswestry Disability Index score were significantly greater in group B than in group A (both P < 0.05). At final follow-up, loss of correction of scoliotic Cobb angle and coronal wedge angle was significantly higher in group B than in group A (P < 0.05). CONCLUSIONS Percutaneous vertebroplasty or percutaneous kyphoplasty was effective in both type A1 and type A3.1 OTLF. However, coronal imaging changes after percutaneous vertebroplasty or percutaneous kyphoplasty were more obvious in type A3.1 OTLF than in type A1. Moreover, clinical outcomes in type A3.1 OTLF were slightly inferior to those in type A1.
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He D, Lou C, Yu W, Zhu K, Wu Z, Liu F, Chen M, Zheng L, Chen Z, Fan S. Cement Distribution Patterns Are Associated with Recompression in Cemented Vertebrae After Percutaneous Vertebroplasty: A Retrospective Study. World Neurosurg 2018; 120:e1-e7. [PMID: 29945011 DOI: 10.1016/j.wneu.2018.06.113] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To reevaluate the cement distribution patterns and further investigate associations between cement distribution patterns and the occurrence rates of recompression in cemented vertebrae after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures. METHODS Two hundred twenty-four patients with a mean age of 71.9 years were enrolled and treated with single-level PVP between June 2012 and July 2015. The mean follow-up time was 16.5 months. Data from medical records and radiographs were collected and analyzed. Cement distribution patterns were divided into 4 cement distribution patterns extending from the traditional 2 patterns: interlocked solid pattern (LS) and uninterlocked solid pattern (ULS); contiguous trabecular pattern (CT) and discontiguous trabecular pattern (DCT). Differences in treatment efficacy and the occurrence rates of recompression in cemented vertebrae were compared for both groups using the Wilcoxon rank sum test and chi-squared test. RESULTS Thirty-seven patients who underwent PVP developed recompression in cemented vertebrae. Recompression in cemented vertebrae was significantly more frequent in the ULS and DCT groups than in the LS and CT groups (P < 0.05 or 0.001), with the Visual Analogue Scale score at the time of final follow-up was also significantly higher in the ULS and DCT groups (P < 0.001). CONCLUSIONS Significant associations were found between cement distribution patterns and recompression in cemented vertebrae, which affected the clinical outcome in patients after PVP. A higher incidence of recompression in cemented vertebrae was seen in patients with treated vertebrae exhibiting ULS pattern or DCT pattern.
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Affiliation(s)
- Dengwei He
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Chao Lou
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Weiyang Yu
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Kejun Zhu
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Zhongwei Wu
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Feijun Liu
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Minjiang Chen
- Department of Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Lin Zheng
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Zhenzhong Chen
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Shunwu Fan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Lee JM, Lee YS, Kim YB, Park SW, Kang DH, Lee SH. What Effects Does Necrotic Area of Contrast-Enhanced MRI in Osteoporotic Vertebral Fracture Have on Further Compression and Clinical Outcome? J Korean Neurosurg Soc 2017; 60:181-188. [PMID: 28264238 PMCID: PMC5365295 DOI: 10.3340/jkns.2016.0707.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/19/2016] [Accepted: 11/17/2016] [Indexed: 01/25/2023] Open
Abstract
Objective The objective of this study was to analyze the correlation between further compression and necrotic area in osteoporotic vertebral fracture (OVF) patients with contrast-enhanced magnetic resonance imaging (CEMRI). In addition, we investigated the radiological and clinical outcome according to the range of the necrotic area. Methods Between 2012 and 2014, the study subjects were 82 OVF patients who did not undergo vertebroplasty or surgical treatment. The fracture areas examined on CEMRI at admission were defined as edematous if enhancement was seen and as necrotic if no enhancement was seen. The correlation between further compression and the necrotic and edematous areas of CEMRI, age, and bone mineral density was examined. Also, necrotic areas were classified into those with less than 25% (non-necrosis group) and those with more than 25% (necrosis group) according to the percentages of the entire vertebral body. For both groups, further compression and the changes in wedge and kyphotic angles were examined at admission and at 1 week, 3 months, and 6 months after admission, while the clinical outcomes were compared using the visual analog scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status grade. Results Further compression was 14.78±11.11% at 1 month and 21.75±14.43% at 6 months. There was a very strong correlation between the necrotic lesion of CEMRI and further compression (r=0.690, p<0.001). The compression of the necrosis group was 33.52±12.96%, which was higher than that of the non-necrosis group, 14.96±10.34% (p<0.005). Also, there was a statistically significantly higher number of intervertebral cleft development and surgical treatments being performed in the necrosis group than in the non-necrosis group (p<0.005). Moreover, there was a statistical difference in the decrease in the height of the vertebral body, and an increase was observed in the kyphotic change of wedge angle progression. There was also a difference in the VAS and ECOG performance scales. Conclusion The necrotic area of CEMRI in OVF had a strong correlation with further compression over time. In addition, with increasing necrosis, intervertebral clefts occurred more frequently, which induced kyphotic changes and resulted in poor clinical outcomes. Therefore, identifying necrotic areas by performing CEMRI on OVF patients would be helpful in determining their prognosis and treatment course.
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Affiliation(s)
- Ja Myoung Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Seok Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Baeg Kim
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung Won Park
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dong Ho Kang
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Shin Heon Lee
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
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Nagoshi N, Fukuda K, Shioda M, Machida M. Anterior spinal fixation for recollapse of cemented vertebrae after percutaneous vertebroplasty. BMJ Case Rep 2016; 2016:bcr-2016-214510. [PMID: 26994051 DOI: 10.1136/bcr-2016-214510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Although recollapse after percutaneous vertebroplasty (PV) is a serious complication that needs salvage surgery, there is no consensus regarding the best operative treatment for this failure. We present cases of 3 patients, diagnosed as having thoracic osteoporotic vertebral fractures, who had undergone PV at other institutes. Within less than half a year, recollapse occurred at the cemented vertebrae in all 3 patients, and we conducted anterior spinal fixation (ASF) on them. In all cases, ASF relieved the patient's severe low back pain, and there was no recurrence of symptoms during the follow-up period of 6 years, on average. ASF is the optimal salvage procedure, since it allows for the direct decompression of nerve tissue with reconstruction of the collapsed spinal column, and preservation of the ligaments and muscles that stabilise the posterior spine. Surgeons who perform PV need to be able to assess this failure early and to perform spinal fixation.
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Affiliation(s)
- Narihito Nagoshi
- Department of Orthopedic Surgery, Murayama Clinical Center, Tokyo, Japan Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Fukuda
- Department of Orthopedic Surgery, Saiseikai Yokohama-shi Tobu Byoin, Yokohama, Japan
| | | | - Masafumi Machida
- Department of Orthopedic Surgery, Murayama Clinical Center, Tokyo, Japan
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Lin JH, Wang SH, Lin EY, Chiang YH. Better Height Restoration, Greater Kyphosis Correction, and Fewer Refractures of Cemented Vertebrae by Using an Intravertebral Reduction Device: a 1-Year Follow-up Study. World Neurosurg 2016; 90:391-396. [PMID: 26979922 DOI: 10.1016/j.wneu.2016.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE This study compared the radiologic and clinical outcomes of kyphoplasty with intravertebral reduction device (IRD) and vertebroplasty (VP) in treating osteoporotic vertebral compression fractures (OVCFs). MATERIALS AND METHODS We enrolled 75 patients with OVCFs who were aged >60 years and treated them through VP or kyphoplasty with IRD. The radiologic outcomes, namely the anterior and middle body heights (ABH and MBH, respectively) and kyphotic angle (KA), were measured preoperatively and at postoperative 1 week, 3 months, 6 months, and 1 year. The refracture was identified on the basis of a decrease in ABH, MBH, or KA compared with those at postoperative 1 week. Visual analog scale (VAS) for pain and complications were recorded. The incidence of adjacent and nonadjacent fractures was also recorded. RESULTS We treated 36 patients with kyphoplasty with IRD (IRD group) and 39 through VP (VP group). The patient characteristics were comparable in both groups. The KA and its restoration were more favorable after IRD than after VP. Although ABHs were not different in either group, their restoration was more efficient after IRD than after VP. MBHs, their restoration, and their refracture rates were better after IRD than after VP. VAS pain scores and complication rates were not different between the groups. The incidences of adjacent or nonadjacent fractures were not different between the 2 groups. CONCLUSION Our findings reveal significantly more efficient height restoration and kyphosis correction and fewer refractures in the IRD group. IRD may not increase the risk of adjacent or nonadjacent fractures.
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Affiliation(s)
- Jiann-Her Lin
- Department of Neurosurgery, Taipei Medical University, Taipei, Taiwan; Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, Taipei, Taiwan; Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Hao Wang
- Department of Neurosurgery, Taipei Medical University, Taipei, Taiwan
| | - En-Yuan Lin
- Department of Neurosurgery, Taipei Medical University, Taipei, Taiwan
| | - Yung-Hsiao Chiang
- Department of Neurosurgery, Taipei Medical University, Taipei, Taiwan; Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, Taipei, Taiwan; Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Donnelly DJ, Abd-El-Barr MM, Lu Y. Minimally Invasive Muscle Sparing Posterior-Only Approach for Lumbar Circumferential Decompression and Stabilization to Treat Spine Metastasis--Technical Report. World Neurosurg 2015; 84:1484-90. [PMID: 26100166 DOI: 10.1016/j.wneu.2015.06.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/09/2015] [Accepted: 06/11/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Palliative tumor resection and subsequent stabilization are important for maximizing function and quality of life for patients suffering from spinal metastases. However, traditional operative techniques for spinal metastases with vertebral body destruction involve extensive soft tissue dissection. In the lumbar spine, open 2-staged spine procedures are routinely required with an anterior retroperitoneal approach for corpectomy and cage insertion and posterior decompression and stabilization with pedicle screws and rods. Both stages require extensive soft tissue dissection that results in significant surgical morbidity, long recovery time, and subsequent delay in initiating postoperative chemoradiotherapy, as well as initially hampering patients' overall quality of life. A minimally invasive approach is desirable for achieving spinal stability, pain control, functional recovery, rapid initiation of adjuvant therapies, and overall patient satisfaction, especially in patients whose medical and surgical therapies are aimed at palliation rather than cure. PRESENTATION A 59-year-old man with renal cell carcinoma and a known L1 vertebral body metastasis presented with severe progressive low back pain and was found to have a pathologic L1 vertebral body fracture with focal kyphosis. INTERVENTION Here, we describe a minimally invasive muscle-sparing, posterior-only approach for L1 transpedicular hemicorpectomy and expandable cage placement, L1 laminectomy, and T11-L3 posterior instrumented stabilization. The surgical corridor was achieved through the Wiltse muscle plane between the multifidus and longissimus muscles so that minimal muscle detachment was required to achieve transpedicular access to the anterior and middle spinal columns. The L1 nerve root was completely skeletonized to allow adequate lumbar hemicorpectomy, tumor resection, and expandable titanium cage insertion. Lastly, percutaneous pedicle screws and rods were inserted from T11 to L3 for stabilization. RESULT The patient tolerated the procedure well with no complications and less than 200 mL estimated blood loss. Postoperative computed tomography revealed restoration of intervertebral height and adequate tumor resection with excellent placement of the expandable cage and posterior construct. The patient was discharged on postoperative day 4 and had nearly no back pain 3 weeks after surgery. Adjuvant therapies were started soon after. At the 6-month follow-up, the patient required minimal narcotic pain medication. Computed tomography scan demonstrated stable hardware with no evidence of failure. CONCLUSION A minimally invasive muscle-sparing, posterior-only approach is a promising surgical strategy for 360-degree decompression and stabilization for the treatment of lumbar spinal metastases with minimized blood loss, muscle detachment and postoperative pain, and fast postoperative recovery and initiation of adjuvant therapy.
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Affiliation(s)
- Dustin J Donnelly
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Muhammad M Abd-El-Barr
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yi Lu
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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