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Tang C, Liu F. Effectiveness of bone-filled mesh bag technology and angle vertebroplasty in the treatment of osteoporotic thoracic vertebral compression fractures in the elderly. Am J Transl Res 2024; 16:3289-3297. [PMID: 39114704 PMCID: PMC11301485 DOI: 10.62347/ghnq5649] [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: 04/07/2024] [Accepted: 06/09/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To evaluate the effectiveness, pain level, and lung function in elderly patients with osteoporotic thoracic vertebral compression fractures using bone filling mesh bag technology compared to curved vertebroplasty. METHODS This retrospective analysis reviewed 72 elderly patients with osteoporotic thoracic vertebral compression fractures treated at Xindu District People's Hospital of Chengdu between February 2021 and January 2022. The patients were separated into two groups according to surgery approach: an observation group using bone filling mesh bag technology and a control group using curved vertebroplasty. The overall response rate, pain degree, pulmonary function, life quality grades, surgical indicators, and bone cement leakage rates of the two groups were evaluated. RESULTS The variation in overall response rate (P=0.420), pain degree (P=0.270), pulmonary function (peak expiratory flow: P=0.660, forced expiratory volume in the first second: P=0.775, forced vital capacity: 0.062), and life quality grades (physical health: P=0.949, social function: P=0.935, physiological function: P=0.970, vitality: P=0.778) between the observation group and the control group after treatment was not statistically meaningful. The Cobb angle (P<0.001) and vertebral height (P<0.001) of patients in the observation group were significantly higher than those in the control group after therapy. The leakage rates of bone cement (intervertebral disc leakage, paravertebral vein leakage, paravertebral soft tissue leakage) of patients in the observation group were notably lower than those in the control group after therapy (P=0.029). CONCLUSION Bone filling mesh bag technology offers significant improvements in Cobb angle and vertebral height for treating elderly patients with osteoporotic thoracic vertebral compression fractures, and reduced the leakage rate of bone cement. This technique achieves comparable therapeutic outcomes to curved vertebroplasty.
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Affiliation(s)
- Chenping Tang
- Xindu District People's Hospital of Chengdu Chengdu 610500, Sichuan, China
| | - Feiwen Liu
- Xindu District People's Hospital of Chengdu Chengdu 610500, Sichuan, China
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Ko W, Lee D, Kim SJ, Han GH, Lee D, Sheen SH, Sohn S. Injection of a PMMA-doped MSC spheroid gel for the treatment of painful osteoporotic vertebral compression fractures. Bioeng Transl Med 2023; 8:e10577. [PMID: 38023703 PMCID: PMC10658584 DOI: 10.1002/btm2.10577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 12/01/2023] Open
Abstract
We aimed to develop a biocompatible treatment to overcome the limitations of polymethyl methacrylate (PMMA) vertebroplasty for osteoporotic compression fracture patients. We synthesized an injectable hydrogel containing PMMA. Mesenchymal stem cell (MSC) spheroids were included in the injectable PMMA-doped gel (= PMMA-doped spheroid gel). In vitro, the osteogenic/anti-inflammatory effects of the embedded spheroids were investigated by the quantitative real-time polymerase chain reaction method. In vivo, we used ovariectomy (OVX)-induced osteoporotic rats with injured femurs to investigate the pain-relief effects. The OVX rats were divided into four groups according to the materials injected (non, PMMA, PMMA gel, and PMMA-spheroid gel) into the lesion. The immunofluorescence (IF) intensity levels of painful markers in dorsal root ganglia (DRG) were measured. In vitro, a volumetric ratio of the gel of 8 (gel):2 (PMMA) was non-cytotoxic for MSCs and promoted the expression of osteogenic/anti-inflammatory markers. In vivo, the values of several bone parameters in the PMMA-doped spheroid gel group showed remarkable increases compared to those in the PMMA group. In addition, the IF intensity levels of the painful markers were noticeably decreased in the PMMA-spheroid gel group. We, therefore, suggest that this treatment can be useful for osteoporotic vertebral compression fracture patients.
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Affiliation(s)
- Wan‐Kyu Ko
- Department of Neurosurgery, CHA Bundang Medical CenterCHA UniversitySeongnam‐siGyeonggi‐doRepublic of Korea
- Department of Life ScienceCHA UniversitySeongnam‐siGyeonggi‐doRepublic of Korea
| | - Daye Lee
- Department of Neurosurgery, CHA Bundang Medical CenterCHA UniversitySeongnam‐siGyeonggi‐doRepublic of Korea
- Department of Life ScienceCHA UniversitySeongnam‐siGyeonggi‐doRepublic of Korea
| | - Seong Jun Kim
- Department of Neurosurgery, CHA Bundang Medical CenterCHA UniversitySeongnam‐siGyeonggi‐doRepublic of Korea
- Department of Life ScienceCHA UniversitySeongnam‐siGyeonggi‐doRepublic of Korea
| | - Gong Ho Han
- Department of Neurosurgery, CHA Bundang Medical CenterCHA UniversitySeongnam‐siGyeonggi‐doRepublic of Korea
- Department of Life ScienceCHA UniversitySeongnam‐siGyeonggi‐doRepublic of Korea
| | - Donghyun Lee
- Preclinical Research CenterDaegu‐Gyeongbuk Medical Innovation Foundation (DGMIF)DaeguRepublic of Korea
| | - Seung Hun Sheen
- Department of Neurosurgery, CHA Bundang Medical CenterCHA UniversitySeongnam‐siGyeonggi‐doRepublic of Korea
| | - Seil Sohn
- Department of Neurosurgery, CHA Bundang Medical CenterCHA UniversitySeongnam‐siGyeonggi‐doRepublic of Korea
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Tartara F, Armocida D, Garbossa D, Meli F, Costantino G, Cofano F, Francaviglia N. Porous titanium microsphere kyphoplasty for augmentation treatment of osteoporotic vertebral fractures: Technical report and case series. Front Surg 2023; 10:1152995. [PMID: 37206353 PMCID: PMC10189281 DOI: 10.3389/fsurg.2023.1152995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/14/2023] [Indexed: 05/21/2023] Open
Abstract
Background Vertebral augmentation procedures (VAPs) are used in cases of persistent and unresponsive pain in patients with vertebral compression fractures (VCFs). Although VAPs are considered a safe procedure providing quick pain relief and improved physical function, some postoperative complications can occur, for example, bone cement leakage. The material used in this procedure is almost exclusively polymethyl methacrylate (PMMA), which appears to lack biological activity and osteointegration capabilities. In this study, we introduce a new filling system consisting of cannulas preloaded with titanium microspheres, which stabilizes and consolidates the structure of the vertebral body in treating VCFs after the performance of the kyphoplasty procedure. Methods We report a retrospective case series of six patients affected by osteoporotic vertebral fractures with worsening back pain, neurologic impairment, and failed conservative treatment who underwent the VAP at our institute, for which the SPHEROPLAST [MT ORTHO s.r.l., Aci Sant'Antonio (CT), Italy] system was used. Results The patients had failed an average conservative trial of 3.9 weeks before they presented to us with neurodeficit. There were two men and four women with a mean age of 74.5 years. The average hospital stay was 2 days. There were no reported perioperative complications related to cement injection, such as intraoperative hypoxia, hypotension, pulmonary embolization, myocardial infarction, neurovascular or viscera injury, or death. The VAS score significantly decreased from a mean preoperative of 7.5 (range 6-19) to 3.8 (range 3-5) immediately after surgery and 1.8 (range 1-3). Conclusion We report the first clinical results in a series of six patients treated for VCF using the microsphere system after analyzing the clinical results produced by, and the complications that arose from, this new device. In patients with VCF, the VAP using titanium microspheres appears to be a feasible and safe procedure with a low risk of material leakage.
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Affiliation(s)
- Fulvio Tartara
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, AOU Policlinico Umberto I, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
- Correspondence: Daniele Armocida
| | - Diego Garbossa
- Neurosurgery Division, Department of Neuroscience, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Meli
- Neurosurgery Division, Arnas Civico di Cristina, Palermo, Italy
| | | | - Fabio Cofano
- Neurosurgery Division, Department of Neuroscience, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
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Hirsch JA, Zini C, Anselmetti GC, Ardura F, Beall D, Bellini M, Brook A, Cianfoni A, Clerk-Lamalice O, Georgy B, Maestretti G, Manfré L, Muto M, Ortiz O, Saba L, Kelekis A, Filippiadis DK, Marcia S, Masala S. Vertebral Augmentation: Is It Time to Get Past the Pain? A Consensus Statement from the Sardinia Spine and Stroke Congress. Medicina (B Aires) 2022; 58:medicina58101431. [PMID: 36295591 PMCID: PMC9609022 DOI: 10.3390/medicina58101431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Vertebral augmentation has been used to treat painful vertebral compression fractures and metastatic lesions in millions of patients around the world. An international group of subject matter experts have considered the evidence, including but not limited to mortality. These considerations led them to ask whether it is appropriate to allow the subjective measure of pain to so dominate the clinical decision of whether to proceed with augmentation. The discussions that ensued are related below.
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Affiliation(s)
- Joshua A. Hirsch
- Department of Radiology Massachusetts General Hospital, Harvard Medical School Boston, Boston, MA 02114, USA
| | - Chiara Zini
- UOC Radiologia Firenze 1, USL Toscana Centro, 50100 Firenze, Italy
| | | | - Francisco Ardura
- Spine Unit, Orthopedics and Traumatology Department, University Clinical Hospital of Valladolid, 47005 Valladolid, Spain
| | - Douglas Beall
- Comprehensive Specialty Care, Oklahoma City, OK 7301, USA
| | - Matteo Bellini
- UOC Neuroimmagini, Neuroradiologia Clinica e Funzionale Dipartimento di Scienze Neurologiche e Motorie Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | - Allan Brook
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467-2490, USA
| | - Alessandro Cianfoni
- Department of Interventional and Diagnostic Neuroradiology, Neurocenter of Southern Switzerland, EOC, 6900 Lugano, Switzerland
| | - Olivier Clerk-Lamalice
- Beam Interventional & Diagnostic Imaging, Department of Interventional Pain Management, Calgary, AB 2500, Canada
| | - Bassem Georgy
- Department of Radiology, University of California, San Diego, CA 92025, USA
| | - Gianluca Maestretti
- Department of Orthopaedic Sugery and Traumatology, HFR Hôpital Cantonal, Unibversity of Fribourg, CH-1708 Fribourg, Switzerland
| | - Luigi Manfré
- Minimal Invasive Spine Department of Neurosurgery, Istituto Oncologico del Mediterraneo IOM, 95029 Viagrande, Italy
| | - Mario Muto
- UOC Neuroradiologia AO Cardarelli Naples Italy, 80131 Napoli, Italy
| | - Orlando Ortiz
- Department of Radiology, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 11501, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.) di Cagliari, 09100 Cagliari, Italy
| | - Alexis Kelekis
- 2nd Department of Radiology, University General Hospital “ATTIKON” Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Dimitrios K. Filippiadis
- 2nd Department of Radiology, University General Hospital “ATTIKON” Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Correspondence:
| | - Stefano Marcia
- UOC Radiologia SS, Trinità Hospital, 09121 Cagliari, Italy
| | - Salvatore Masala
- Diagnostica per Immagini e Radiologia Interventistica, Università di Roma Tor Vergata, 00148 Roma, Italy
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