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Mondal S, MacManus DB, Banche-Niclot F, Vitale-Brovarone C, Fiorilli S, McCarthy HO, Dunne N. Finite element analysis of vertebroplasty in the osteoporotic T11-L1 vertebral body: Effects of bone cement formulation. J Biomed Mater Res B Appl Biomater 2024; 112:e35359. [PMID: 38247244 DOI: 10.1002/jbm.b.35359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 08/24/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024]
Abstract
Vertebral compression fractures are one of the most severe clinical consequences of osteoporosis and the most common fragility fracture afflicting 570 and 1070 out of 100,000 men and women worldwide, respectively. Vertebroplasty (VP), a minimally invasive surgical procedure that involves the percutaneous injection of bone cement, is one of the most efficacious methods to stabilise osteoporotic vertebral compression fractures. However, postoperative fracture has been observed in up to 30% of patients following VP. Therefore, this study aims to investigate the effect of different injectable bone cement formulations on the stress distribution within the vertebrae and intervertebral discs due to VP and consequently recommend the optimal cement formulation. To achieve this, a 3D finite element (FE) model of the T11-L1 vertebral body was developed from computed tomography scan data of the spine. Osteoporotic bone was modeled by reducing the Young's modulus by 20% in the cortical bone and 74% in cancellous bone. The FE model was subjected to different physiological movements, such as extension, flexion, bending, and compression. The osteoporotic model caused a reduction in the average von Mises stress compared with the normal model in the T12 cancellous bone and an increment in the average von Mises stress value at the T12 cortical bone. The effects of VP using different formulations of a novel injectable bone cement were modeled by replacing a region of T12 cancellous bone with the materials. Due to the injection of the bone cement at the T12 vertebra, the average von Mises stresses on cancellous bone increased and slightly decreased on the cortical bone under all loading conditions. The novel class of bone cements investigated herein demonstrated an effective restoration of stress distribution to physiological levels within treated vertebrae, which could offer a potential superior alternative for VP surgery as their anti-osteoclastogenic properties could further enhance the appeal of their fracture treatment and may contribute to improved patient recovery and long-term well-being.
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Affiliation(s)
- Subrata Mondal
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
| | - David B MacManus
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
- BRAIN Lab, School of Mechanical & Materials Engineering, University College Dublin, Dublin 4, Ireland
| | | | | | - Sonia Fiorilli
- Department of Applied Science and Technology, Politecnico di Torino, Turin, Italy
| | - Helen O McCarthy
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7 BL, UK
| | - Nicholas Dunne
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
- Centre for Medical Engineering Research, Dublin City University, Dublin 9, Ireland
- Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin 2, Ireland
- Advanced Manufacturing Research Centre (I-Form), School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), Trinity College Dublin, Dublin 2, Ireland
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
- Advanced Processing Technology Research Centre, Dublin City University, Dublin 9, Ireland
- Biodesign Europe, Dublin City University, Dublin 9, Ireland
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Hafezi-Nejad N, Bailey CR, Solomon AJ, Abou Areda M, Carrino JA, Khan M, Weiss CR. Vertebroplasty and kyphoplasty in the USA from 2004 to 2017: national inpatient trends, regional variations, associated diagnoses, and outcomes. J Neurointerv Surg 2020; 13:483-491. [PMID: 33334904 DOI: 10.1136/neurintsurg-2020-016733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND To explore the national inpatient trends, regional variations, associated diagnoses, and outcomes of vertebral augmentation (vertebroplasty and kyphoplasty) in the USA from 2004 to 2017. METHODS Data from the National Inpatient Sample were used to study hospitalization records for percutaneous vertebroplasty and kyphoplasty. Longitudinal projections of trends and outcomes, including mortality, post-procedural complications, length of stay, disposition, and total hospital charges were analyzed. RESULTS Following a period of decreased utilization from 2008 to 2012, hospitalizations for vertebroplasty and kyphoplasty plateaued after 2013. Total hospital charges and overall financial burden of hospitalizations for vertebroplasty and kyphoplasty increased to a peak of $1.9 billion (range $1.7-$2.2 billion) in 2017. Overall, 8% of procedures were performed in patients with a history of malignancy. In multivariable modeling, lung cancer (adjusted OR (aOR) 2.6 (range 1.4-5.1)) and prostate cancer (aOR 3.4 (range 1.2-9.4)) were associated with a higher risk of mortality. The New England region had the lowest frequency of routine disposition (14.1±1.1%) and the lowest average hospital charges ($47 885±$1351). In contrast, 34.0±0.8% had routine disposition in the West Central South region, and average hospital charges were as high as $99 836±$2259 in the Pacific region. The Mountain region had the lowest number of procedures (5365±272) and the highest mortality rate (1.2±0.3%). CONCLUSION National inpatient trends of vertebroplasty and kyphoplasty utilization remained stable after a period of decline from 2008 to 2012, while the financial burden of hospitalizations increased. Despite recent improvements in outcomes, significant regional variations persisted across the USA.
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Affiliation(s)
- Nima Hafezi-Nejad
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Alex J Solomon
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - John A Carrino
- Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Majid Khan
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Clifford R Weiss
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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van Munster JJCM, Zamanipoor Najafabadi AH, de Boer NP, Peul WC, van den Hout WB, van Benthem PPG. Impact of surgical intervention trials on healthcare: A systematic review of assessment methods, healthcare outcomes, and determinants. PLoS One 2020; 15:e0233318. [PMID: 32442235 PMCID: PMC7244162 DOI: 10.1371/journal.pone.0233318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/01/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Frameworks used in research impact evaluation studies vary widely and it remains unclear which methods are most appropriate for evaluating research impact in the field of surgical research. Therefore, we aimed to identify and review the methods used to assess the impact of surgical intervention trials on healthcare and to identify determinants for surgical impact. METHODS We searched journal databases up to March 10, 2020 for papers assessing the impact of surgical effectiveness trials on healthcare. Two researchers independently screened the papers for eligibility and performed a Risk of Bias assessment. Characteristics of both impact papers and trial papers were summarized. Univariate analyses were performed to identify determinants for finding research impact, which was defined as a change in healthcare practice. RESULTS Sixty-one impact assessments were performed in 37 included impact papers. Some surgical trial papers were evaluated in more than one impact paper, which provides a total of 38 evaluated trial papers. Most impact papers were published after 2010 (n = 29). Medical records (n = 10), administrative databases (n = 22), and physician's opinion through surveys (n = 5) were used for data collection. Those data were analyzed purely descriptively (n = 3), comparing data before and after publication (n = 29), or through time series analyses (n = 5). Significant healthcare impact was observed 49 times and more often in more recent publications. Having impact was positively associated with using medical records or administrative databases (ref.: surveys), a longer timeframe for impact evaluation and more months between the publication of the trial paper and the impact paper, data collection in North America (ref.: Europe), no economic evaluation of the intervention, finding no significant difference in surgical outcomes, and suggesting de-implementation in the original trial paper. CONCLUSIONS AND IMPLICATIONS Research impact evaluation receives growing interest, but still a small number of impact papers per year was identified. The analysis showed that characteristics of both surgical trial papers and impact papers were associated with finding research impact. We advise to collect data from either medical records or administrative databases, with an evaluation time frame of at least 4 years since trial publication.
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Affiliation(s)
- Juliëtte J. C. M. van Munster
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center (LUMC), Leiden University, Leiden, the Netherlands
- Leiden University Neurosurgical Center Holland (UNCH), LUMC and The Hague Medical Center (HMC), Leiden, the Netherlands
| | - Amir H. Zamanipoor Najafabadi
- Leiden University Neurosurgical Center Holland (UNCH), LUMC and The Hague Medical Center (HMC), Leiden, the Netherlands
| | - Nick P. de Boer
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center (LUMC), Leiden University, Leiden, the Netherlands
| | - Wilco C. Peul
- Leiden University Neurosurgical Center Holland (UNCH), LUMC and The Hague Medical Center (HMC), Leiden, the Netherlands
| | - Wilbert B. van den Hout
- Department of Biomedical Data Science–Medical Decision Making, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Peter Paul G. van Benthem
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center (LUMC), Leiden University, Leiden, the Netherlands
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Kim LH, Chen YR. Risk Adjustment Instruments in Administrative Data Studies: A Primer for Neurosurgeons. World Neurosurg 2019; 128:477-500. [DOI: 10.1016/j.wneu.2019.04.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 11/25/2022]
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Donnally CJ, Rivera S, Rush AJ, Bondar KJ, Boden AL, Wang MY. The 100 most influential spine fracture publications. JOURNAL OF SPINE SURGERY 2019; 5:97-109. [PMID: 31032444 DOI: 10.21037/jss.2019.01.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Management of spine fractures has advanced considerably even over the past decade. A review of the current and historical literature can lead to a better appreciation of current management protocols. This is the first comprehensive review of the most influential articles related to spine fracture management. The purpose of this study is to identify and analyze the 100 most cited publications in spine fracture management. Methods Using the Clarivate Analytics Web of Science, search phrases were used to identify publications pertaining to spine fractures (110,809 publications). The 100 most cited articles were isolated. The frequency of citations, year of publication, country of origin, journal of publication, level-of-evidence (LOE), article type, and contributing authors/institutions were recorded. We also highlighted the ten most cited articles (per year) from the past decade. Results The publications included ranged from 1953-2010, with the majority published between 2000-2009 (n=41). Total citations ranged from 154 to 1,076. A LOE of IV had the plurality at 36%. The most cited article was "The 3 Column Spine and Its Significance in The Classification of Acute Thoracolumbar Spinal-Injuries" (Spine 1983) by F Denis. The majority of papers originated in the United States (n=65), and the highest number were published in Spine (n=27). Osteoporotic fractures were the specific topic in 34 publications. In the past decade, the article with the most citations/year was "A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures" by DF Kalmes in 2009. Conclusions Despite less time for citation than other decades, the 2000s contain the plurality of the influential publications. This may indicate that some of the most important changes to spine fracture management pertain to improved imaging modalities and surgical technologies. This review provides a guide for a comprehensive understanding of the historical and current literature pertaining to spine fracture management.
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Affiliation(s)
- Chester J Donnally
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
| | - Sebastian Rivera
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
| | - Augustus J Rush
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
| | - Kevin J Bondar
- Department of Education, The University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Allison L Boden
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
| | - Michael Y Wang
- Department of Neurological Surgery, The University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
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Li P, Tang W, Che B, Wang K, Zou K, Jin Z, Zhou F, Zhuang Y. Analyses of the efficacy of percutaneous kyphoplasty and alendronate sodium on thoracolumbar vertebral fracture and the risk factors of fracture. Exp Ther Med 2018; 16:679-684. [PMID: 30116322 PMCID: PMC6090290 DOI: 10.3892/etm.2018.6247] [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: 11/16/2017] [Accepted: 05/29/2018] [Indexed: 11/06/2022] Open
Abstract
The present study investigated the efficacy of percutaneous kyphoplasty and alendronate sodium on thoracolumbar vertebral fracture, and the risk factors leading to the recurrence of fracture. In the present study, a total of 80 patients with thoracolumbar vertebral fracture who were admitted to the Affiliated Jiangyin Hospital of Southeast University Medical College between January 2014 and March 2016 for combination treatment of percutaneous kyphoplasty and alendronate sodium were enrolled. According to the recurrence of fracture, the patients were divided into two groups, the observation group (patients with fracture recurrence, n=40) and control group (patients with no fracture recurrence, n=40). All patients participated in a 1-year follow-up. The recurrence of fracture and the site of fracture were identified through the clinical symptoms and examination of the spine using magnetic resonance imaging. In addition, comparisons of the time of alleviation in numbness of lower limb and that in pains in waist and legs were carried out. Furthermore, statistics on the adverse reactions during intervention in the two groups were also collected; changes in visual analogue scale (VAS) and Oswestry Disability Index (ODI) of pains at different time points in two groups were also observed. One-way analysis and multivariate analysis were performed to identify the relevant risk factors. Alleviation time in numbness of lower legs in patients of the control group was significantly earlier than that in the observation group (P<0.05) and the alleviation time in pains of the waist and legs of patients in the control group was also significantly earlier than that in the observation group (P<0.05). Furthermore, the incidence rates of abdominal pain, diarrhea, constipation and hypocalcemiain in the control group were also significantly lower compared with those in the observation group (P<0.05). One week, one month and one year after operation, the scores of VAS of pains and ODI in the control group were significantly lower compared with those in the observation group in the same period (P<0.05). Lower preoperative bone density and exosmosis of bone cement in treatment were the independent risk factors leading to the recurrence of fracture. For patients with thoracolumbar vertebral fracture who received the combination treatment of percutaneous kyphoplasty and alendronate sodium, there underlies an important correlation between the recurrence rate of fracture and the preoperative bone density as well as the exosmosis of bone cement in operation.
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Affiliation(s)
- Pengbin Li
- Department of Orthopedics, General Hospital of The Yangtze River Shipping and Wuhan Brain Hospital, Wuhan, Hubei 430010, P.R. China
| | - Wenjuan Tang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430010, P.R. China
| | - Biao Che
- Department of Orthopedics, General Hospital of The Yangtze River Shipping and Wuhan Brain Hospital, Wuhan, Hubei 430010, P.R. China
| | - Kai Wang
- Department of Orthopedics, General Hospital of The Yangtze River Shipping and Wuhan Brain Hospital, Wuhan, Hubei 430010, P.R. China
| | - Kai Zou
- Department of Orthopedics, General Hospital of The Yangtze River Shipping and Wuhan Brain Hospital, Wuhan, Hubei 430010, P.R. China
| | - Zheng Jin
- Department of Orthopedics, The Affiliated Jiangyin Hospital of Southeast University Medical College, Wuxi, Jiangsu 214400, P.R. China
| | - Feng Zhou
- Department of Orthopedics, The Affiliated Jiangyin Hospital of Southeast University Medical College, Wuxi, Jiangsu 214400, P.R. China
| | - Yan Zhuang
- Department of Orthopedics, The Affiliated Jiangyin Hospital of Southeast University Medical College, Wuxi, Jiangsu 214400, P.R. China
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Nasuto M, Falcone M, Strizzi V, Florio L, Lauriola W, Ciccarese G, Guglielmi G, Florio F. Vertebroplasty in Elderly Patients: A Clinical Effectiveness Analysis. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0288-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Optimizing bone cement stiffness for vertebroplasty through biomechanical effects analysis based on patient-specific three-dimensional finite element modeling. Med Biol Eng Comput 2018; 56:2137-2150. [DOI: 10.1007/s11517-018-1844-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/09/2018] [Indexed: 12/24/2022]
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Degnan AJ, Hemingway J, Hughes DR. Medicare Utilization of Vertebral Augmentation 2001 to 2014: Effects of Randomized Clinical Trials and Guidelines on Vertebroplasty and Kyphoplasty. J Am Coll Radiol 2018; 14:1001-1006. [PMID: 28778222 DOI: 10.1016/j.jacr.2017.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/19/2017] [Accepted: 04/19/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Vertebral fractures have a substantial impact on the health and quality of life of elderly individuals as one of the most common complications of osteoporosis. Vertebral augmentation procedures including vertebroplasty and kyphoplasty have been supported as means of reducing pain and mitigating disability associated with these fractures. However, use of vertebroplasty is debated, with negative randomized controlled trials published in 2009 and divergent clinical guidelines. The effect of changing evidence and guidelines on different practitioners' utilization of both kyphoplasty and vertebroplasty in the years after these developments and publication of data supporting their use is poorly understood. METHODS Using national aggregate Medicare claims data from 2002 through 2014, vertebroplasty and kyphoplasty procedures were identified by provider type. Changes in utilization by procedure type and provider were studied. RESULTS Total vertebroplasty billing increased 101.6% from 2001 (18,911) through 2008 (38,123). Total kyphoplasty billing frequency increased 17.2% from 2006 (54,329) through 2008 (63,684). Vertebroplasty billing decreased 60.9% from 2008 through 2014 to its lowest value (14,898). Kyphoplasty billing decreased 8.4% from 2008 (63,684) through 2010 (58,346), but then increased 7.6% from 2010 to 2013 (62,804). CONCLUSIONS Vertebroplasty billing decreased substantially beginning in 2009 and continued to decrease through 2014 despite publication of more favorable studies in 2010 to 2012, suggesting studies published in 2009 and AAOS guidelines in 2010 may have had a persistent negative effect. Kyphoplasty did not decrease as substantially and increased in more recent years, suggesting a clinical practice response to favorable studies published during this period.
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Affiliation(s)
- Andrew J Degnan
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | | | - Danny R Hughes
- Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
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