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Kastler A, Carneiro I, Perolat R, Rudel A, Pialat JB, Lazard A, Isnard S, Krainik A, Amoretti N, Grand S, Stacoffe N. Combined vertebroplasty and pedicle screw insertion for vertebral consolidation: feasibility and technical considerations. Neuroradiology 2024; 66:855-863. [PMID: 38453715 DOI: 10.1007/s00234-024-03325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To assess the feasibility and technical accuracy of performing pedicular screw placement combined with vertebroplasty in the radiological setting. METHODS Patients who underwent combined vertebroplasty and pedicle screw insertion under combined computed tomography and fluoroscopic guidance in 4 interventional radiology centers from 2018 to 2023 were retrospectively assessed. Patient demographics, vertebral lesion type, and procedural data were analyzed. Strict intra-pedicular screw positioning was considered as technical success. Pain score was assessed according to the Visual Analogue Scale before the procedure and in the 1-month follow-up consultation. RESULTS Fifty-seven patients (38 men and 19 women) with a mean age of 72.8 (SD = 11.4) years underwent a vertebroplasty associated with pedicular screw insertion for the treatment of traumatic fractures (29 patients) and neoplastic disease (28 patients). Screw placement accuracy assessed by post-procedure CT scan was 95.7% (89/93 inserted screws). A total of 93 pedicle screw placements (36 bi-pedicular and 21 unipedicular) in 32 lumbar, 22 thoracic, and 3 cervical levels were analyzed. Mean reported procedure time was 48.8 (SD = 14.7) min and average injected cement volume was 4.4 (SD = 0.9) mL. A mean VAS score decrease of 5 points was observed at 1-month follow-up (7.7, SD = 1.3 versus 2.7, SD = 1.7), p < .001. CONCLUSION Combining a vertebroplasty and pedicle screw insertion is technically viable in the radiological setting, with a high screw positioning accuracy of 95.7%.
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Affiliation(s)
- Adrian Kastler
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France.
| | - Inês Carneiro
- Neuroradiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Romain Perolat
- Radiology Unit, Carémeau University Hospital, Nimes, France
| | - Alexandre Rudel
- Diagnostic and Interventional MSK Unit, Pasteur II Hospital, Nice, France
| | | | - Arnaud Lazard
- Neurosurgery Unit, Grenoble University Hospital, Grenoble, France
| | - Stephanie Isnard
- Neurosurgery Unit, Grenoble University Hospital, Grenoble, France
| | - Alexandre Krainik
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France
| | - Nicolas Amoretti
- Diagnostic and Interventional MSK Unit, Pasteur II Hospital, Nice, France
| | - Sylvie Grand
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France
| | - Nicolas Stacoffe
- Diagnostic and Interventional Radiology Unit, Lyon Sud Hospital, Lyon, France
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Yang Y, Yan BC, Huang ZL, Wei XE, Wu CG. Vesselplasty for C1 Osteolytic Lesions with Bone Wall Destruction. J Vasc Interv Radiol 2024; 35:796-798. [PMID: 38311292 DOI: 10.1016/j.jvir.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Affiliation(s)
- Yue Yang
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yi Shan Rd, Shanghai 200233, China
| | - Bi-Cong Yan
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yi Shan Rd, Shanghai 200233, China
| | - Zhi-Long Huang
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yi Shan Rd, Shanghai 200233, China
| | - Xiao-Er Wei
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yi Shan Rd, Shanghai 200233, China
| | - Chun-Gen Wu
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yi Shan Rd, Shanghai 200233, China.
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Bertulli L, Pileggi M, Marchi F, Scarone P, Cianfoni A. 'Armed kyphoplasty' with posterior stabilization avoids corpectomy in complex thoracolumbar spine fractures: a case series. J Neurointerv Surg 2024; 16:436-442. [PMID: 38262730 DOI: 10.1136/jnis-2023-021114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Complex thoracolumbar fractures require reduction and stabilization. Posterior instrumentation alone and standard cement augmentation may represent undertreatment, while corpectomy has significant morbidity. In a series of unstable thoracolumbar fractures, we assessed the feasibility, safety, and results of 'armed kyphoplasty' (AKP) and surgical posterior stabilization (PS). METHODS A total of 24 consecutive patients were treated with combined AKP and PS. Minimally invasive and open surgery techniques were used for PS. AKP was performed with C-arm or biplane fluoroscopic guidance, and screws were placed under navigation or fluoroscopic guidance. A postoperative CT scan and standing plain films were obtained. Patients were followed up according to clinical standards. Kyphosis correction (measured with regional Cobb angle), pain (measured with the Numeric Rating Scale), neurological status (measured with Frankel grade) were assessed. RESULTS A total of 25 fractures of neoplastic (40%), traumatic (32%), and osteoporotic (28%) nature were treated. Open surgery and minimally invasive techniques were applied in 16/24 and 8/24 patients, respectively. Decompressive laminectomy was performed in 13 cases. No intraprocedural complications occurred. Two patients (8%) died due to underlying disease complications and three complications (12%) required re-intervention (one surgical site infection, one adjacent fracture, and one screw pull-out) in the first month. The mean Cobb angle was 20.14±6.19° before treatment and 11.66±5.24° after treatment (P<0.0001). No re-fractures occurred at the treated levels. CONCLUSIONS Combined AKP and PS is feasible and effective in the treatment of complex thoracolumbar fractures of all etiologies. AKP avoided highly invasive corpectomy. Anterior and posterior support ensured stability, preventing implant failure and re-fracture. The complication rate was low compared with more invasive traditional 360° open surgical approaches.
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Affiliation(s)
- Lorenzo Bertulli
- Department of Neurosurgery, KSW Kantonsspital Winterthur, Winterthur, Zurich, Switzerland
| | - Marco Pileggi
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Ticino, Switzerland
| | - Francesco Marchi
- Department of Neurosurgery, Neurocenter of Southern Switzerland EOC, Lugano, Ticino, Switzerland
| | - Pietro Scarone
- Centre of Spine Surgery, Clinica Santa Chiara, Locarno, Switzerland
| | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Ticino, Switzerland
- Department of Neuroradiology, Inselspital Bern, University of Bern, Bern, Switzerland
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Oswald KAC, Kälin J, Tinner C, Deml MC, Bigdon SF, Hoppe S, Benneker LM, Albers CE. Anterior thoracolumbar column reconstruction with the vertebral body stent-safety and efficacy. 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; 32:934-949. [PMID: 36715755 DOI: 10.1007/s00586-023-07537-3] [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: 05/31/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of this study was to assess safety and efficacy of vertebral body stenting (VBS) by analyzing (1) radiographic outcome, (2) clinical outcome, and (3) perioperative complications in patients with vertebral compression fractures treated with VBS at minimum 6-month follow-up. METHODS In this retrospective cohort study, 78 patients (61 ± 14 [21-90] years; 67% female) who have received a vertebral body stent due to a traumatic, osteoporotic or metastatic thoracolumbar compression fracture at our hospital between 2012 and 2020 were included. Median follow-up was 0.9 years with a minimum follow-up of 6 months. Radiographic and clinical outcome was analyzed directly, 6 weeks, 12 weeks, 6 months postoperatively, and at last follow-up. RESULTS Anterior vertebral body height of all patients improved significantly by mean 6.2 ± 4.8 mm directly postoperatively (p < 0.0001) and remained at 4.3 ± 5.1 mm at last follow-up compared to preoperatively (p < 0.0001). The fracture kyphosis angle of all patients improved significantly by mean 5.8 ± 6.9 degrees directly postoperatively (p < 0.0001) and remained at mean 4.9 ± 6.9 degrees at last follow-up compared to preoperatively (p < 0.0001). The segmental kyphosis angle of all patients improved significantly by mean 7.1 ± 7.6 degrees directly postoperatively (p < 0.0001) and remained at mean 2.8 ± 7.8 degrees at last follow-up compared to preoperatively (p = 0.03). Back pain was ameliorated from a preoperative median Numeric Rating Scale value of 6.5 to 3.0 directly postoperatively and further bettered to 1.0 six months postoperatively (p = 0.0001). Revision surgery was required in one patient after 0.4 years. CONCLUSION Vertebral body stenting is a safe and effective treatment option for osteoporotic, traumatic and metastatic compression fractures.
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Affiliation(s)
- Katharina A C Oswald
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3010, Bern, Switzerland.
| | - Joel Kälin
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3010, Bern, Switzerland
| | - Christian Tinner
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3010, Bern, Switzerland
| | - Moritz C Deml
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3010, Bern, Switzerland
| | - Sebastian F Bigdon
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3010, Bern, Switzerland
| | - Sven Hoppe
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3010, Bern, Switzerland
- Spine Medicine Bern, Hirslanden Salem-Spital, Bern, Switzerland
| | - Lorin M Benneker
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3010, Bern, Switzerland
- Spine Service, Orthopaedic Department, Sonnenhofspital, Bern, Switzerland
| | - Christoph E Albers
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3010, Bern, Switzerland
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Salle H, Tran GV, Faure P, Mounayer C, Rouchaud A, Salle L, Caire F. Treatment of A3.2 and A2 traumatic thoracolumbar spine compression fractures using vertebral body stenting: a 63-patient series. J Neurointerv Surg 2023; 15:86-90. [PMID: 35292568 DOI: 10.1136/neurintsurg-2021-018628] [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: 12/30/2021] [Accepted: 02/22/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Percutaneous treatments for spinal injury are underused by neuroradiologists and spine surgeons, mainly owing to a lack of data on indications. OBJECTIVE To assess the safety and efficacy of vertebral body stenting (VBS) for post-traumatic A3.2 and A2 fractures (Magerl classification) and determine the factors that influence the improvements. METHODS We retrospectively reviewed patients who underwent VBS to treat a single traumatic thoracolumbar fracture from 2010 to 2019. Kyphosis, loss of vertebral body height (VBH), and clinical and functional outcomes (including the Visual Analog Scale pain score and Oswestry Disability Index) were assessed. We examined the overall effects of VBH in all patients by constructing a linear statistical model and evaluated whether the efficacy was dependent on the characteristics of the patients or fractures. RESULTS We included 63 patients comprising 44 A3.2 and 19 A2 fractures. No patient had worsening neurological symptoms or wound infection. The average rates of change were 67.1% (95% CI 59.1% to 75%) for kyphosis and 88.5% (95% CI 85.6% to 91.3%) for VBH (both p<0.0001). After 1 year, the VBS treatment was more effective for kyphosis in younger patients and at the L1 level, and for VBH in younger patients and cases of Magerl A3.2 fracture. CONCLUSIONS This large reported series on VBS validates this surgical treatment. All patients had improved kyphosis and restored VBH. We recommend using VBS rather than open surgery for A3.2 and A2 fractures at the thoracolumbar junction and in young patients.
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Affiliation(s)
- Henri Salle
- Department of Neurosurgery, CHU Limoges, Limoges, Limousin, France
| | - Gia van Tran
- Department of Neurosurgery, CHU Limoges, Limoges, Limousin, France
| | - Patrick Faure
- Department of Neurosurgery, CHU Limoges, Limoges, Limousin, France
| | - Charbel Mounayer
- Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Aymeric Rouchaud
- Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France.,Univ. Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | - Laurence Salle
- Unité Inserm UMR 1094 Neuroépidémiologie Tropicale, Limoges, France
| | - François Caire
- Department of Neurosurgery, CHU Limoges, Limoges, Limousin, France
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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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Dai H, Liu Y, Han Q, Zhang A, Chen H, Qu Y, Wang J, Zhao J. Biomechanical comparison between unilateral and bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures: A finite element analysis. Front Bioeng Biotechnol 2022; 10:978917. [PMID: 36159704 PMCID: PMC9495612 DOI: 10.3389/fbioe.2022.978917] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background and objective: The osteoporotic vertebral compression fracture (OVCF) has an incidence of 7.8/1000 person-years at 55–65 years. At 75 years or older, the incidence increases to 19.6/1000 person-years in females and 5.2–9.3/1000 person-years in males. To solve this problem, percutaneous vertebroplasty (PVP) was developed in recent years and has been widely used in clinical practice to treat OVCF. Are the clinical effects of unilateral percutaneous vertebroplasty (UPVP) and bilateral percutaneous vertebroplasty (BPVP) the same? The purpose of this study was to compare biomechanical differences between UPVP and BPVP using finite element analysis. Materials and methods: The heterogeneous assignment finite element (FE) model of T11-L1 was constructed and validated. A compression fracture of the vertebral body was performed at T12. UPVP and BPVP were simulated by the difference in the distribution of bone cement in T12. Stress distributions and maximum von Mises stresses of vertebrae and intervertebral discs were compared. The rate of change of maximum displacement between UPVP and BPVP was evaluated. Results: There were no obvious high-stress concentration regions on the anterior and middle columns of the T12 vertebral body in BPVP. Compared with UPVP, the maximum stress on T11 in BPVP was lower under left/right lateral bending, and the maximum stress on L1 was lower under all loading conditions. For the T12-L1 intervertebral disc, the maximum stress of BPVP was less than that of UPVP. The maximum displacement of T12 after BPVP was less than that after UPVP under the six loading conditions. Conclusion: BPVP could balance the stress of the vertebral body, reduce the maximum stress of the intervertebral disc, and offer advantages in terms of stability compared with UPVP. In summary, BPVP could reduce the incidence of postoperative complications and provide promising clinical effects for patients.
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Affiliation(s)
| | | | | | | | | | - Yang Qu
- *Correspondence: Yang Qu, ; Jincheng Wang,
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Yang Y, Tian Q, Wang T, Lu Y, Li W, Wu C. Vessel-Plasty Using Bone-Filling Mesh Container for Treatment of Malignant Severe Compression Fractures in Cervical Vertebrae. J Pain Res 2022; 15:1173-1182. [PMID: 35478996 PMCID: PMC9037846 DOI: 10.2147/jpr.s360195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the feasibility, safety, and efficacy of vessel-plasty using bone-filling mesh container (BFMC) for malignant severe compression fractures of cervical vertebra. Methods This study prospectively recruited fifteen consecutive patients (eight men, seven women; mean age, 57.4 years) with severe malignant compression fractures of cervical vertebrae for vessel-plasty. Procedure duration, incidence of cement leakage and other complications, pain relief and improvement of neck function were analyzed. Pain was assessed using a visual analog scale (VAS) and function by the neck disability index (NDI), with scores recorded before the procedure and at 3 days and 1, 3, 6 and 12 months after the procedure. Results A total of 16 vertebrae were treated. All vertebrae had destruction of bone in more than one place as well as broken bone walls. Mean procedure duration was 42.9±13.6 minutes. Bone cement leakage occurred in two vertebrae without any symptoms. No procedure-related complications occurred. Mean VAS and NDI declined from 7.1 ± 1.4 and 63.6 ± 16.3, respectively, before the procedure to 3.5 ± 1.1 and 37.4 ± 11.0, respectively, at three days after the procedure (P < 0.01). CT images at three months after the procedure confirmed that there were no cases of refractures at the treated or adjacent levels, recurrence of vertebral collapse and mobilization of bone cement block. Conclusion Vessel-plasty using BFMC appears to be effective and safe for malignant severe compression fractures in cervical vertebrae. It is effective in stabilizing vertebral body, relieving pain.
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Affiliation(s)
- Yue Yang
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Qinghua Tian
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Tao Wang
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Yingying Lu
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Wenbin Li
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Chungen Wu
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, People’s Republic of China
- Correspondence: Chungen Wu; Wenbin Li, Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yi Shan Road, Shanghai, People’s Republic of China, Tel +8618930177559; +8618930177524, Email ;
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Moura DL, Gabriel JP. Expandable Intravertebral Implants: A Narrative Review on the Concept, Biomechanics, and Outcomes in Traumatology. Cureus 2021; 13:e17795. [PMID: 34660005 PMCID: PMC8496495 DOI: 10.7759/cureus.17795] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 01/22/2023] Open
Abstract
Expandable intravertebral implants are self-expanding devices applied percutaneously by the posterior transpedicular approach. These devices introduce the concept of anatomical restoration of vertebral body endplates and direct anatomical reduction performed from the interior of the vertebral body with a compression fracture. This paper aims to provide a narrative review on the concept, indications, biomechanical characteristics, as well as functional and radiographic outcomes of the main expandable intravertebral implants currently available, in terms of their application to thoracolumbar spine traumatology. To this end, we performed a search in July 2021 on the MEDLINE/PubMed platform with the words "expandable intravertebral implant", "armed kyphoplasty", "Vertebral Body Stenting" or "stentoplasty" and "SpineJack". The search yielded 144 papers, and of those, we included 15 in this review. We concluded that percutaneous transpedicular posterior access, the ability to reduce vertebral body fractures, particularly of the vertebral endplates and to maintain the vertebral body height, makes the application of expandable intravertebral implants an attractive option in the treatment of thoracolumbar vertebral compression fractures. However, more prospective, randomized, and large-scale blinded studies are still warranted, especially comparative studies between treatments and about the preferential use of an expansive implant over others, in order to gain definitive insights into the effectiveness and indications of each of these devices.
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Affiliation(s)
- Diogo L Moura
- Spine Surgery, Spine Unit, Orthopedics Department, Coimbra Hospital and University Center, Coimbra, PRT
- Spine Surgery, Spine Institute of Ohio, Grant Medical Center, Columbus, USA
| | - Josue P Gabriel
- Orthopedic Spine Surgery, Spine Institute of Ohio, Grant Medical Center, Columbus, USA
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He Y, Zhao Y, Fan L, Wang X, Duan M, Wang H, Zhu X, Liu J. Injectable Affinity and Remote Magnetothermal Effects of Bi-Based Alloy for Long-Term Bone Defect Repair and Analgesia. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2100719. [PMID: 34014040 PMCID: PMC8292916 DOI: 10.1002/advs.202100719] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/30/2021] [Indexed: 05/05/2023]
Abstract
As alternatives, metallic/nonmetallic bone graft materials play significant roles in bone defect surgery to treat external trauma or bone disease. However, to date, there are rather limited long-term implantable materials owning to in situ molding incapability of metallics and poor mechanical property of nonmetallics. Here, Bi-based low melting point alloy, with unique properties of injectability, solid-liquid phase transition, mechanical capability, and biocompatibility, present obvious long-lasting bone affinity as the excellent artificial bone-substitute. It is particularly necessary to point out that the targeted injected Bi alloy remains in its original position for up to 210 days without moving, as well as, displays good osseointegration ability to resolve repeated revision trauma caused by losing bone repair material. Additionally, with outstanding electrical and thermal conductivity, an unconventional way using Bi alloy to realize very beneficial hyperthermia analgesia via non-invasive wireless energy delivery is first proposed, which avoids adverse effects on bone remodeling inflicted by traditional drugs. The significantly decreased expression of pain sensitizing factor, such as, interleukin-6, neuropeptide substance, and transient receptor potential vanilloid 1 reveals the potential mechanism of hyperthermia analgesia. The present findings suggest the combination therapy of Bi alloy in bone repair and analgesia, which owns far-reaching clinical application value.
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Affiliation(s)
- Yuanyuan He
- Department of Biomedical EngineeringSchool of MedicineTsinghua UniversityBeijing100084China
| | - Yu Zhao
- Orthopedic DepartmentSecond Hospital of Shanxi Medical UniversityTaiyuanShanxi030001China
| | - Linlin Fan
- Technical Institute of Physics and ChemistryChinese Academy of SciencesBeijing100190China
| | - Xuelin Wang
- School of Engineering MedicineBeihang UniversityBeijing100191China
- Interdisciplinary Institute for Cancer Diagnosis and TreatmentBeijing Advanced Innovation Center for Biomedical EngineeringBeihang UniversityBeijing100191China
| | - Minghui Duan
- Department of Biomedical EngineeringSchool of MedicineTsinghua UniversityBeijing100084China
| | - Hongzhang Wang
- Department of Biomedical EngineeringSchool of MedicineTsinghua UniversityBeijing100084China
| | - Xiyu Zhu
- Department of Biomedical EngineeringSchool of MedicineTsinghua UniversityBeijing100084China
| | - Jing Liu
- Department of Biomedical EngineeringSchool of MedicineTsinghua UniversityBeijing100084China
- Technical Institute of Physics and ChemistryChinese Academy of SciencesBeijing100190China
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11
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Hirsch JA, Chandra RV, Cianfoni A, De Leacy R, Marcia S, Manfre L, Regenhardt RW, Milburn JM. Spine 2.0 JNIS style. J Neurointerv Surg 2021; 13:683-684. [PMID: 33972459 DOI: 10.1136/neurintsurg-2021-017612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Joshua A Hirsch
- NeuroInterventional Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ronil V Chandra
- Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia.,Monash University Faculty of Medicine, Nursing, and Health Sciences, Clayton, Victoria, Australia
| | - Alessandro Cianfoni
- Neuroradiology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Ospedale Regionale Lugano, Lugano, Switzerland.,Neuroradiology, Inselspital of Bern, University of Bern, Bern, Switzerland
| | - Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,NeuroInterventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stefano Marcia
- Radiology, SS Trinita Hospital, Cagliari, Sardinia, Italy
| | - Luigi Manfre
- Radiology, IOM Mediterranean Oncology Institute, Viagrande, Sicily, Italy
| | - Robert W Regenhardt
- NeuroInterventional Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James M Milburn
- Radiology, Ochsner Medical System, New Orleans, Louisiana, USA
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12
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Salle H, Meynard A, Auditeau E, Gantois C, Rouchaud A, Mounayer C, Faure P, Caire F. Treating traumatic thoracolumbar spine fractures using minimally invasive percutaneous stabilization plus balloon kyphoplasty: a 102-patient series. J Neurointerv Surg 2021; 13:848-853. [PMID: 33758064 DOI: 10.1136/neurintsurg-2020-017238] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND There is no consensus on the treatment for spinal injuries resulting in thoracolumbar fractures without neurological impairment. Many trauma centers are opting for open surgery rather than a neurointerventional approach combining posterior percutaneous short fixation (PPSF) plus balloon kyphoplasty (BK). OBJECTIVE To assess the safety and efficacy of PPSF+BK and to estimate the expected improvement by clarifying the factors that influence improvement. METHODS We retrospectively reviewed patients who underwent PPSF+BK for the treatment of single traumatic thoracolumbar fractures from 2007 to 2019. Kyphosis, loss of vertebral body height (VBH), clinical and functional outcomes including visual analog scale and Oswestry disability index were assessed. We examined the overall effects in all patients by constructing a linear statistical model, and then examined whether efficacy was dependent on the characteristics of the patients or the fractures. RESULTS A total of 102 patients were included. No patient experienced neurological worsening or wound infections. The average rates of change were 74.4% (95% CI 72.6% to 76.1%) for kyphosis and 85.5% (95% CI 84.4% to 86.6%) for VBH (both p<0.0001). The kyphosis treatment was more effective on Magerl A3 and B2 fractures than on those classified as A2.3, as well as for fractures with slight posterior wall protrusion on the spinal canal. A higher postoperative visual analog scale score was predictive of poorer outcome at 1 year. CONCLUSIONS This is the largest series reported to date and confirms and validates this surgical treatment. All patients exhibited improved kyphosis and restoration of VBH. We advise opting for this technique rather than open surgery.
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Affiliation(s)
| | | | - Emilie Auditeau
- Epidemiology and Statistical Analysis, CHU Limoges, Limoges, France
| | | | - Aymeric Rouchaud
- Interventional Neuroradiology, CHU Limoges, Limoges, France.,University of Limoges, CNRS, XLIM, UMR 7252, Limoges, France
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13
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Distefano D, Scarone P, Isalberti M, La Barbera L, Villa T, Bonaldi G, Hirsch JA, Cianfoni A. The 'armed concrete' approach: stent-screw-assisted internal fixation (SAIF) reconstructs and internally fixates the most severe osteoporotic vertebral fractures. J Neurointerv Surg 2020; 13:63-68. [PMID: 32938744 DOI: 10.1136/neurintsurg-2020-016597] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The treatment of severe osteoporotic vertebral compression fractures (VCFs) with middle-column (MC) involvement, high fragmentation, large cleft and/or pedicular fracture is challenging. Minimally invasive 'stent-screw-assisted internal fixation' (SAIF) can reduce the fracture, reconstruct the vertebral body (VB) and fix it to the posterior elements. OBJECTIVE To assess feasibility, safety, technical and clinical outcome of the SAIF technique in patients with severe osteoporotic VCFs. METHODS 80 treated vertebrae were analyzed retrospectively. Severe VCFs were characterized by advanced collapse (Genant grade 3), a high degree of osseous fragmentation (McCormack grade 2 and 3), burst morphology with MC injury, pediculo-somatic junction fracture, and/or large osteonecrotic cleft. VB reconstruction was evaluated on postprocedure radiographs and CT scans by two independent raters. Clinical and radiological follow-ups were performed at 1 and 6 months. RESULTS SAIF was performed at 28 thoracic and 52 lumbar levels in 73 patients. One transient neurological complication occurred. VB reconstruction was satisfactory in 98.8% of levels (inter-rater reliability 96%, κ=1). Follow-up at 1 month was available for 78/80 levels and at 6 months or later (range 6-24, mean 7.9 months) for 73/80 levels. Significant improvement in the Visual Analog Scale score was noted at 1 and 6 months after treatment (p<0.05). Patients reported global clinical benefit during follow-up (Patient's Global Impression of Change Scale 5.6±0.9 at 1 month and 6.1±0.9 at 6 months). Fourteen new painful VCFs occurred at different levels in 11 patients during follow-up, treated with vertebral augmentation or SAIF. Target-level stability was maintained in all cases. CONCLUSIONS SAIF is a minimally invasive, safe, and effective treatment for patients with severe osteoporotic VCFs with MC involvement.
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Affiliation(s)
- Daniela Distefano
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Pietro Scarone
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Maurizio Isalberti
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Luigi La Barbera
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Québec, Canada.,Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.,Sainte-Justine Clinical Hospital Center, Montréal, Quebec, Canada
| | - Tomaso Villa
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Giuseppe Bonaldi
- Department of Neurosurgery, Casa di Cura Igea, Milano, Lombardia, Italy
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland.,Department of Interventional and Diagnostic Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland
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14
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Mohammed R, Lee M, Panikkar S, Yasin N, Hassan K, Mohammad S. Vertebral body cemented stents combined with posterior stabilization in the surgical treatment of metastatic spinal cord compression of the thoracolumbar spine. Surg Neurol Int 2020; 11:210. [PMID: 32874713 PMCID: PMC7451174 DOI: 10.25259/sni_315_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/30/2020] [Indexed: 11/04/2022] Open
Abstract
Background Extensile interventions to provide anterior spinal column support in metastatic spinal cord compression (MSCC) surgery incur added morbidity in this surgically frail group of patients. We present our preliminary results of posterior spinal decompression and stabilization coupled with vertebral body cemented stents for anterior column support in MSCC. Methods Fourteen patients underwent posterior spinal decompression and pedicle screw construct along with vertebral body stenting (VBS) technique for reconstruction and augmentation of the vertebral body. The primary in all except one was solid organ malignancy and 10 patients (71%) were treatment naïve. The mean revised Tokuhashi score was 10.7 ± 2.7 and the mean spinal instability neoplastic score was 9.6 ± 1.9. All vertebral body lesions were purely lytic and were associated with a cortical defect in the posterior wall. Results A mean 5.3 ± 2.7 ml low-viscosity polymethyl methacrylate bone cement was injected within the stent at each compression level. No cement extrusion posteriorly was noted in any case from intraoperative fluoroscopy or postoperative radiographs. Five patients died at a mean 6.8 months (range 1-15 months), while the remaining patients have a mean survival of 18 months. Neither further revision surgical intervention nor any neurological deterioration was noted in any patient, who all continued to be ambulatory. The mean postoperative Core Outcome Measures Index score for 11 patients was 4.03 (standard deviation 3.11, 95% confidence interval (1.93-6.12). Conclusion In lytic vertebral body lesions with posterior wall erosions, cemented VBS technique adds to the surgical armamentarium in MSCC surgery showing promising early results without added complications.
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Affiliation(s)
- Riaz Mohammed
- Department of Complex Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Manchester, United Kingdom
| | - Maggie Lee
- Department of Complex Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Manchester, United Kingdom
| | - Shrijit Panikkar
- Department of Complex Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Manchester, United Kingdom
| | - Naveed Yasin
- Department of Complex Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Manchester, United Kingdom
| | - Kamran Hassan
- Department of Complex Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Manchester, United Kingdom
| | - Saeed Mohammad
- Department of Complex Spinal Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Manchester, United Kingdom
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15
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Cianfoni A, Distefano D, Scarone P, Pesce GA, Espeli V, La Barbera L, Villa T, Reinert M, Bonaldi G, Hirsch JA. Stent screw-assisted internal fixation (SAIF): clinical report of a novel approach to stabilizing and internally fixating vertebrae destroyed by malignancy. J Neurosurg Spine 2020; 32:507-518. [PMID: 31860813 DOI: 10.3171/2019.9.spine19711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Severe lytic cancerous lesions of the spine are associated with significant morbidity and treatment challenges. Stabilization and restoration of the axial load capability of the vertebral body (VB) are important to prevent or arrest vertebral collapse. Percutaneous stent screw-assisted internal fixation (SAIF), which anchors a VB stent/cement complex with pedicular screws to the posterior vertebral elements, is a minimally invasive, image-guided, 360° internal fixation technique that can be utilized in this patient cohort. The purpose of this study was to assess the feasibility, safety, and stabilization efficacy of VB reconstruction via the SAIF technique in a cohort of patients with extensive lytic vertebral lesions, who were considered to have an unstable or potentially unstable spine according to the Spinal Instability Neoplastic Score (SINS). METHODS This study was a retrospective assessment of a prospectively maintained database of a consecutive series of patients with neoplastic extensive extracompartmental osteolysis (Tomita type 4-6) of the VB treated with the SAIF technique. VB reconstruction was assessed on postprocedure plain radiographs and CT by two independent raters. Technical and clinical complications were recorded. Clinical and imaging follow-ups were assessed. RESULTS Thirty-five patients with extensive osteolytic metastatic lesions of the VB underwent 36 SAIF procedures. SAIF was performed as a stand-alone procedure in 31/36 cases and was associated with posterior surgical fixation in 5/36 (4/5 with decompressive laminectomy). In 1 case an epidural cement leak required surgical decompression. VB reconstruction was categorized as satisfactory (excellent or good rating) by the two raters in 34/36 cases (94.5%) with an interrater reliability of 94.4% (Cohen's kappa of 0.8). Follow-up, ranging from 1 to 30 months, was available for 30/36 levels. Long-term follow-up (6-30 months, mean 11.5 months) was available for 16/36 levels. Stability during follow-up was noted in 29/30 cases. CONCLUSIONS SAIF provides 360° nonfusion internal fixation that stabilizes the VB in patients with extensive lytic lesions that would otherwise be challenging to treat.
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Affiliation(s)
- Alessandro Cianfoni
- 1Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano
- 2Department of Interventional and Diagnostic Neuroradiology, Inselspital University Hospital of Bern
| | - Daniela Distefano
- 1Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano
| | - Pietro Scarone
- 3Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano
| | | | - Vittoria Espeli
- 5Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale Regionale di Bellinzona e Valli, San Giovanni, Bellinzona, Switzerland
| | - Luigi La Barbera
- 6Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
- 7Department of Mechanical Engineering, Polytechnique Montréal
- 8Sainte-Justine Clinical Hospital Center, Montréal, Quebec, Canada
| | - Tomaso Villa
- 6Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Michael Reinert
- 3Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano
- 9Department of Neurosurgery, Inselspital University Hospital of Bern, Switzerland
| | | | - Joshua A Hirsch
- 11Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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16
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Venier A, Roccatagliata L, Isalberti M, Scarone P, Kuhlen DE, Reinert M, Bonaldi G, Hirsch JA, Cianfoni A. Armed Kyphoplasty: An Indirect Central Canal Decompression Technique in Burst Fractures. AJNR Am J Neuroradiol 2019; 40:1965-1972. [PMID: 31649154 DOI: 10.3174/ajnr.a6285] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/28/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Burst fractures are characterized by middle column disruption and may feature posterior wall retropulsion. Indications for treatment remain controversial. Recently introduced vertebral augmentation techniques using intravertebral distraction devices, such as vertebral body stents and SpineJack, could be effective in fracture reduction and fixation and might obtain central canal clearance through ligamentotaxis. This study assesses the results of armed kyphoplasty using vertebral body stents or SpineJack in traumatic, osteoporotic, and neoplastic burst fractures with respect to vertebral body height restoration and correction of posterior wall retropulsion. MATERIALS AND METHODS This was a retrospective assessment of 53 burst fractures with posterior wall retropulsion and no neurologic deficit in 51 consecutive patients treated with armed kyphoplasty. Posterior wall retropulsion and vertebral body height were measured on pre- and postprocedural CT. Clinical and radiologic follow-up charts were reviewed. RESULTS Armed kyphoplasty was performed as a stand-alone treatment in 43 patients, combined with posterior instrumentation in 8 and laminectomy in 4. Pre-armed kyphoplasty and post-armed kyphoplasty mean posterior wall retropulsion was 5.8 and 4.5 mm, respectively (P < .001), and mean vertebral body height was 10.8 and 16.7 mm, respectively (P < .001). No significant clinical complications occurred. Clinical and radiologic follow-up (1-36 months; mean, 8 months) was available in 39 patients. Three treated levels showed a new fracture during follow-up without neurologic deterioration, and no retreatment was deemed necessary. CONCLUSIONS In the treatment of burst fractures with posterior wall retropulsion and no neurologic deficit, armed kyphoplasty yields fracture reduction, internal fixation, and indirect central canal decompression. In selected cases, it might represent a suitable minimally invasive treatment option, stand-alone or in combination with posterior stabilization.
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Affiliation(s)
- A Venier
- From the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.)
| | - L Roccatagliata
- Neuroradiology (L.R., M.I., A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - M Isalberti
- Neuroradiology (L.R., M.I., A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - P Scarone
- From the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.)
| | - D E Kuhlen
- From the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.)
| | - M Reinert
- From the Departments of Neurosurgery (A.V., P.S., D.E.K., M.R.)
| | - G Bonaldi
- Department of Neuroradiology (G.B.), Papa Giovanni XXIII Hospital, Bergamo, Italy
- Department of Neurosurgery (G.B.), Clinica Igea, Milan, Italy
| | - J A Hirsch
- Department of Neuroradiology (J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - A Cianfoni
- Neuroradiology (L.R., M.I., A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland
- Department of Neuroradiology (A.C.), Inselspital, University Hospital of Bern, Bern, Switzerland
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17
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La Barbera L, Cianfoni A, Ferrari A, Distefano D, Bonaldi G, Villa T. Stent-Screw Assisted Internal Fixation of Osteoporotic Vertebrae: A Comparative Finite Element Analysis on SAIF Technique. Front Bioeng Biotechnol 2019; 7:291. [PMID: 31709250 PMCID: PMC6824407 DOI: 10.3389/fbioe.2019.00291] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/09/2019] [Indexed: 12/19/2022] Open
Abstract
Vertebral compression fractures are one of the most relevant clinical consequences caused by osteoporosis: one of the most common treatment for such fractures is vertebral augmentation through minimally invasive approaches (vertebroplasty or balloon-kyphoplasty). Unfortunately, these techniques still present drawbacks, such as re-fractures of the treated vertebral body with subsidence of the non-augmented portions or re-fracture of the non-augmented middle column at the junction with the augmented anterior column. A novel minimally-invasive augmentation technique, called Stent-Screw Assisted Internal Fixation, has been recently proposed for the treatment of severe osteoporotic and neoplastic fractures: this technique uses two vertebral body stents and percutaneous cannulated and fenestrated pedicular screws, through which cement is injected inside the expanded stents to achieve optimal stents' and vertebral body's filling. The role of the pedicle screws is to anchor the stents-cement complex to the posterior column, acting as a bridge across the middle column and preserving its integrity from possible collapse. In order to evaluate the potential of the new technique in restoring the load bearing capacity of the anterior and middle spinal columns and in reducing bone strains, a Finite Element model of an osteoporotic lumbar spine has been developed. Both standard vertebroplasty and Stent-Screw Assisted Internal Fixation have been simulated: simulations have been run taking into account everyday activities (standing and flexion) and comparison between the two techniques, in terms of strain distribution on vertebral endplates and posterior and anterior wall, was performed. Results show that Stent-Screw Assisted Internal Fixation significantly decrease the strain distribution on the superior EP and the cortical wall compared to vertebroplasty, possibly reducing the re-fracture risk of the middle-column at the treated level.
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Affiliation(s)
- Luigi La Barbera
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "G. Natta," Politecnico di Milano, Milan, Italy.,Department of Mechanical Engineering, Polytechnique Montréal, Montreal, QC, Canada.,Sainte-Justine University Hospital Centre, Montreal, QC, Canada
| | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland.,Department of Interventional and Diagnostic Neuroradiology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Andrea Ferrari
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "G. Natta," Politecnico di Milano, Milan, Italy
| | - Daniela Distefano
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | | | - Tomaso Villa
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "G. Natta," Politecnico di Milano, Milan, Italy
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18
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Piechowiak EI, Isalberti M, Pileggi M, Distefano D, Hirsch JA, Cianfoni A. Mechanical Cavity Creation with Curettage and Vacuum Suction (Q-VAC) in Lytic Vertebral Body Lesions with Posterior Wall Dehiscence and Epidural Mass before Cement Augmentation. MEDICINA-LITHUANIA 2019; 55:medicina55100633. [PMID: 31554335 PMCID: PMC6843440 DOI: 10.3390/medicina55100633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/16/2019] [Accepted: 09/19/2019] [Indexed: 12/30/2022]
Abstract
Background and Objectives: We describe a novel technique for percutaneous tumor debulking and cavity creation in patients with extensive lytic lesions of the vertebral body including posterior wall dehiscence prior to vertebral augmentation (VA) procedures. The mechanical cavity is created with a combination of curettage and vacuum suction (Q-VAC). Balloon kyphoplasty and vertebral body stenting are used to treat neoplastic vertebral lesions and might reduce the rate of cement leakage, especially in presence of posterior wall dehiscence. However, these techniques could theoretically lead to increased intravertebral pressure during balloon inflation with possible mobilization of soft tissue tumor through the posterior wall, aggravation of spinal stenosis, and resultant complications. Creation of a void or cavity prior to balloon expansion and/or cement injection would potentially reduce these risks. Materials and Methods: A curette is coaxially inserted in the vertebral body via transpedicular access trocars. The intravertebral neoplastic soft tissue is fragmented by multiple rotational and translational movements. Subsequently, vacuum aspiration is applied via one of two 10 G cannulas that had been introduced directly into the fragmented lesion, while saline is passively flushed via the contralateral cannula, with lavage of the fragmented solid and fluid-necrotic tumor parts. Results: We applied the Q-VAC technique to 35 cases of thoracic and lumbar extreme osteolysis with epidural mass before vertebral body stenting (VBS) cement augmentation. We observed extravertebral cement leakage on postoperative CT in 34% of cases, but with no clinical consequences. No patients experienced periprocedural respiratory problems or new or worsening neurological deficit. Conclusion: The Q-VAC technique, combining mechanical curettage and vacuum suction, is a safe, inexpensive, and reliable method for percutaneous intravertebral tumor debulking and cavitation prior to VA. We propose the Q-VAC technique for cases with extensive neoplastic osteolysis, especially if cortical boundaries of the posterior wall are dehiscent and an epidural soft tissue mass is present.
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Affiliation(s)
- Eike I Piechowiak
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland.
| | - Maurizio Isalberti
- Department of Neuroradiology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland.
| | - Marco Pileggi
- Department of Neuroradiology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland.
| | - Daniela Distefano
- Department of Neuroradiology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland.
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Alessandro Cianfoni
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland.
- Department of Neuroradiology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland.
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19
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Stent Screw−Assisted Internal Fixation (SAIF) of Severe Lytic Spinal Metastases: A Comparative Finite Element Analysis of the SAIF Technique. World Neurosurg 2019; 128:e370-e377. [DOI: 10.1016/j.wneu.2019.04.154] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 12/19/2022]
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20
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Innovative Spine Implants for Improved Augmentation and Stability in Neoplastic Vertebral Compression Fracture. ACTA ACUST UNITED AC 2019; 55:medicina55080426. [PMID: 31370309 PMCID: PMC6722751 DOI: 10.3390/medicina55080426] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/17/2019] [Accepted: 07/29/2019] [Indexed: 01/19/2023]
Abstract
Background and objectives: Tumor-related vertebral compression fractures often result in severe back pain as well as progressive neurologic impairment and additional morbidities. The fixation of these fractures is essential to obtain good pain relief and to improve the patients’ quality of life. Thus far, several spine implants have been developed and studied. The aims of this review were to describe the implants and the techniques proposed to treat cancer-related vertebral compression fractures and to compile their safety and efficacy results. Materials and Methods: A systematic MEDLINE/PubMed literature search was performed, time period included articles published between January 2000 and March 2019. Original articles were selected based on their clinical relevance. Results: Four studies of interest and other cited references were analyzed. These studies reported significant pain and function improvement as well as kyphotic angle and vertebral height restoration and maintain for every implant and technique investigated. Conclusions: Although good clinical performance is reported on these devices, the small numbers of studies and patients investigated draw the need for further larger evaluation before drawing a definitive treatment decision tree to guide physicians managing patients presenting with neoplastic vertebral compression fracture.
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21
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Cianfoni A, Distefano D, Hirsch J, Bonaldi G, Reinert M, Isalberti M. Minimally invasive non-fusion vertebral body stabilization in severe benign and malignant fractures. Stent-screw Assisted Internal Fixation: the SAIF technique. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2019. [DOI: 10.1177/2514183x19852920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This short review focuses on clinical and therapeutic issues posed by severe osteoporotic and neoplastic insufficiency vertebral fractures and on the potential use of a new technique to obtain minimally invasive vertebral body reconstruction, augmentation, and stabilization in such severe fractures, combining two preexisting procedures. The implant of vertebral body stents is followed by insertion of percutaneous, fenestrated, cement-augmented pedicular screws that act as anchors to the posterior elements for the cement–stent complex. This procedure results in a 360° nonfusion form of vertebral internal fixation that may empower vertebral augmentation and potentially avoid corpectomy in challenging osteoporotic and neoplastic fractures.
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Affiliation(s)
- Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano Lugano, Switzerland
- Department of Interventional and Diagnostic Neuroradiology, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Daniela Distefano
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano Lugano, Switzerland
| | - Joshua Hirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Giuseppe Bonaldi
- Department of Neurosurgery, Igea Clinic, via Marcona, Milan, Italy
| | - Michael Reinert
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano Lugano, Switzerland
- Department of Neurosurgery, Inselspital University Hospital of Bern, Freiburgstrasse
| | - Maurizio Isalberti
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano Lugano, Switzerland
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22
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Cianfoni A, Distefano D, Isalberti M, Reinert M, Scarone P, Kuhlen D, Hirsch JA, Bonaldi G. Stent-screw-assisted internal fixation: the SAIF technique to augment severe osteoporotic and neoplastic vertebral body fractures. J Neurointerv Surg 2018; 11:603-609. [DOI: 10.1136/neurintsurg-2018-014481] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 11/04/2022]
Abstract
ObjectivesTo describe a new technique to obtain minimally invasive but efficient vertebral body (VB) reconstruction, augmentation, and stabilization in severe osteoporotic and neoplastic fractures, combining two pre-existing procedures. The implant of vertebral body stents (VBS) is followed by insertion of percutaneous, fenestrated, cement-augmented pedicular screws that act as anchors to the posterior elements for the cement/stent complex. The screws reduce the risk of stent mobilization in a non-intact VB cortical shell and bridge middle column and pedicular fractures. This procedure results in a 360° non-fusion form of vertebral internal fixation that may empower vertebral augmentation and potentially avoid corpectomy in challenging fractures.Procedure detailsThis report provides step-by-step procedural details, rationale, and proposed indications for this procedure. The procedure is entirely percutaneous under fluoroscopic guidance. Through transpedicular trocars the VBS are inserted, balloon-expanded and implanted in the VB. Over k-wire exchange the transpedicular screws are inserted inside the lumen of the stents and cement is injected through the screws to augment the stents and fuse the screws to the stents.ApplicationsThis technique may find appropriate applications for the most severe osteoporotic fractures with large clefts, high-degree fragmentation and collapse, middle column and pedicular involvement, and in extensive neoplastic lytic lesions.ConclusionsStent-Screw-Assisted Internal Fixation (SAIF) might represent a minimally invasive option to obtain VB reconstruction and restoration of axial load capability in severe osteoporotic and neoplastic fractures, potentially obviating the need for more invasive surgical interventions in situations that would pose significant challenges to standard vertebroplasty or balloon kyphoplasty.
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