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Chen PW, Liu PC, Lee CC, Lam CT. Thoracic Pyogenic Spondylitis Misdiagnosed As Osteoporotic Compression Fracture Status Post Vertebral Augmentation With Resultant Paraplegia: A Case Report. Cureus 2024; 16:e63497. [PMID: 39081447 PMCID: PMC11287488 DOI: 10.7759/cureus.63497] [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] [Accepted: 06/30/2024] [Indexed: 08/02/2024] Open
Abstract
This paper describes a case of serious complications following vertebral augmentation resulting from a misdiagnosis of pyogenic spondylitis as osteoporotic compression fracture (OCF). A 56-year-old female with systemic lupus erythematosus underwent vertebral augmentation following a diagnosis of T10 OCF based on plain film analysis. Note that preoperative computed tomography (CT) and magnetic resonance imaging (MRI) were not performed. One day after vertebral augmentation, the patient experienced a recurrence of low back pain with fever and paraplegia. MRI findings revealed paravertebral and epidural soft tissue over T9 and T10 with cord compression. Subsequent laminectomy of T9 and T10 revealed devitalized lamina, epidural abscess, and granulation tissue. Pathological analysis indicated a combination of acute and chronic inflammation. A pus culture identified Staphylococcus aureus, indicative of pre-existing pyogenic spondylitis. Further revision surgery was performed at another hospital. The patient remained in a paraplegic state one year after surgery. Infectious spondylitis often manifests with nonspecific symptoms similar to those of compression fracture, and plain radiographs are insufficient to differentiate between the two, often leading to misdiagnosis and mistreatment. Nonetheless, many practitioners base preoperative planning solely on plain film imaging. We advocate the routine usage of CT and/or MRI for patients diagnosed with compression fractures, particularly for immunocompromised individuals.
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Affiliation(s)
- Po-Wei Chen
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, TWN
| | - Ping-Chuan Liu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, TWN
| | - Chin-Cheng Lee
- Department of Pathology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, TWN
| | - Chee-Tat Lam
- Department of Neurosurgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, TWN
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Jiang Y, Zhang W, Huang S, Huang Q, Ye H, Zeng Y, Hua X, Cai J, Liu Z, Liu Q. Preoperative Prediction of New Vertebral Fractures after Vertebral Augmentation with a Radiomics Nomogram. Diagnostics (Basel) 2023; 13:3459. [PMID: 37998595 PMCID: PMC10670105 DOI: 10.3390/diagnostics13223459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
The occurrence of new vertebral fractures (NVFs) after vertebral augmentation (VA) procedures is common in patients with osteoporotic vertebral compression fractures (OVCFs), leading to painful experiences and financial burdens. We aim to develop a radiomics nomogram for the preoperative prediction of NVFs after VA. Data from center 1 (training set: n = 153; internal validation set: n = 66) and center 2 (external validation set: n = 44) were retrospectively collected. Radiomics features were extracted from MRI images and radiomics scores (radscores) were constructed for each level-specific vertebra based on least absolute shrinkage and selection operator (LASSO). The radiomics nomogram, integrating radiomics signature with presence of intravertebral cleft and number of previous vertebral fractures, was developed by multivariable logistic regression analysis. The predictive performance of the vertebrae was level-specific based on radscores and was generally superior to clinical variables. RadscoreL2 had the optimal discrimination (AUC ≥ 0.751). The nomogram provided good predictive performance (AUC ≥ 0.834), favorable calibration, and large clinical net benefits in each set. It was used successfully to categorize patients into high- or low-risk subgroups. As a noninvasive preoperative prediction tool, the MRI-based radiomics nomogram holds great promise for individualized prediction of NVFs following VA.
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Affiliation(s)
- Yang Jiang
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518000, China; (Y.J.); (W.Z.); (J.C.)
| | - Wei Zhang
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518000, China; (Y.J.); (W.Z.); (J.C.)
| | - Shihao Huang
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China;
| | - Qing Huang
- Department of Endocrinology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518000, China;
| | - Haoyi Ye
- Department of Radiology, The Fourth Affiliated Hospital, Guangzhou Medical University, Guangzhou 511300, China;
| | - Yurong Zeng
- Department of Radiology, Huizhou Central People’s Hospital, Huizhou 516000, China;
| | - Xin Hua
- Department of Neurology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China;
| | - Jinhui Cai
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518000, China; (Y.J.); (W.Z.); (J.C.)
| | - Zhifeng Liu
- Department of Radiology, The Fourth Affiliated Hospital, Guangzhou Medical University, Guangzhou 511300, China;
| | - Qingyu Liu
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518000, China; (Y.J.); (W.Z.); (J.C.)
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Sun Y, Zhang Y, Ma H, Tan M, Zhang Z. Therapeutic Efficacy and Safety of Percutaneous Curved Vertebroplasty in Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis. Orthop Surg 2023; 15:2492-2504. [PMID: 37497571 PMCID: PMC10549840 DOI: 10.1111/os.13800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/10/2023] [Accepted: 04/15/2023] [Indexed: 07/28/2023] Open
Abstract
This systematic review and meta-analysis is aimed to provide higher quality evidence regarding the efficacy and safety between PCVP and PVP/KP in OVCFs. We searched the Cochrane Library, PubMed, Web of Science, and Embase databases for all randomized controlled trials (RCTs) and observational studies (cohort or case-control studies) that compare PCVP to PVP/KP for OVCFs. The Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the RCTs and non-RCTs, respectively. Meta-analysis was performed using RevMan 5.4 software. A total of seven articles consisting of 562 patients with 593 diseased vertebral bodies were included. Statistically significant differences were found in the postoperative visual analog scale (VAS) at 1 day (MD = -0.11; 95% CI: [-0.21 to -0.01], p = 0.03), but not at 3 months (MD = -0.21; 95% CI: [-0.41-0.00], p = 0.05) or 6 months (MD = 0.03; 95% CI: [-0.13-0.20], p = 0.70). There was no statistically significant difference in postoperative Oswestry disability index (ODI) at 1 day (MD = -0.28; 95% CI: [-0.62-0.05], p = 0.10), 3 months (MD = -1.52; 95% CI: [-3.11-0.07], p = 0.06), or 6 months (MD = 0.18; 95% CI: [-0.13-0.48], p = 0.25). Additionally, there were no statistically significant differences in Cobb angle (MD = 0.30; 95% CI: [-1.69-2.30], p = 0.77) or anterior vertebral body height (SMD = -0.01; 95% CI: [-0.26-0.23], p = 0.92) after surgery. Statistically significant differences were found in surgical time (MD = -8.60; 95% CI: [-13.75 to -3.45], p = 0.001), cement infusion volume (MD = -0.82; 95% CI: [-1.50 to -0.14], P = 0.02), and dose of fluoroscopy (SMD = -1.22; 95% CI: [-1.84 to -0.60], p = 0.0001) between curved and noncurved techniques, especially compared to bilateral PVP. Moreover, cement leakage showed statistically significant difference (OR = 0.40; 95% CI: [0.27-0.60], p < 0.0001). Compared with PVP/KP, PCVP is superior for pain relief at short-term follow-up. Additionally, PCVP has the advantages of significantly lower surgical time, radiation exposure, bone cement infusion volume, and cement leakage incidence compared to bilateral PVP, while no statistically significant difference is found when compared with unilateral PVP or PKP. In terms of quality of life and radiologic outcomes, the effects of PCVP and PVP/KP are not significantly different. Overall, this meta-analysis reveals that PCVP was an effective and safe therapy for patients with OVCFs.
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Affiliation(s)
- Yan Sun
- Department of OrthopaedicsGuang'an Men Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Yong Zhang
- Department of OrthopaedicsGuang'an Men Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Haoning Ma
- Department of OrthopaedicsChina‐Japan Friendship HospitalBeijingChina
| | - Mingsheng Tan
- Department of OrthopaedicsChina‐Japan Friendship HospitalBeijingChina
| | - Zhihai Zhang
- Department of OrthopaedicsGuang'an Men Hospital, China Academy of Chinese Medical SciencesBeijingChina
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Carli D, Venmans A, Lodder P, Donga E, van Oudheusden T, Boukrab I, Schoemaker K, Smeets A, Schonenberg C, Hirsch J, de Vries J, Lohle P. Vertebroplasty versus Active Control Intervention for Chronic Osteoporotic Vertebral Compression Fractures: The VERTOS V Randomized Controlled Trial. Radiology 2023; 308:e222535. [PMID: 37462495 DOI: 10.1148/radiol.222535] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Background Evidence regarding percutaneous vertebroplasty (PV) for chronic painful osteoporotic vertebral compression fractures (OVCFs) remains limited. Purpose To compare pain relief, quality of life, and disability between PV and active control (anesthetic infiltration) interventions for chronic OVCF. Materials and Methods This prospective randomized clinical trial was conducted between May 2013 and June 2019 in participants with pain due to OVCF lasting longer than 3 months with bone marrow edema present at MRI. Study participants were randomly assigned to undergo PV (n = 40) or active control intervention (n = 40). The primary outcome was pain severity, assessed with the visual analog scale (VAS) (range, 0-10) during 12 months after treatment. Secondary outcomes included Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) score (range, 0-100) and Roland Morris Disability Questionnaire (RMDQ) score (range, 0-100). Outcomes were analyzed according to a longitudinal multilevel model used to test the difference between groups in change from baseline across follow-up. Results The mean age of the 80 participants (54 women) was 69 years ± 10 (SD) in the PV group and 71 years ± 10 in the active control group. VAS score was 7.6 (95% CI: 7.0, 8.2) in the PV group and 7.3 (95% CI: 6.9, 7.8) in the active control group at baseline (P = .47) and 3.9 (95% CI: 3.1, 4.8) and 5.1 (95% CI: 4.3, 6.0), respectively, at month 12 (P = .045). At month 12, the group difference from baseline was 1.3 (95% CI: 0.1, 2.6; P = .02) for VAS, 5.2 (95% CI: 0.9, 9.4; P = .02) for QUALEFFO, and 7.1 (95% CI: -3.3, 17.5; P = .18) for RMDQ, favoring the PV group. Conclusion In the treatment of pain caused by chronic OVCFs, PV is more effective for pain relief and quality of life improvement than anesthetic injection alone, with similar improvement for disability between the groups. Clinical trial registration no. NCT01963039 © RSNA, 2023 See also the editorial by Beall and De Leacy in this issue.
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Affiliation(s)
- Dennis Carli
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Alexander Venmans
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Paul Lodder
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Esther Donga
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Thijs van Oudheusden
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Issam Boukrab
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Kees Schoemaker
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Albert Smeets
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Catharina Schonenberg
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Joshua Hirsch
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Jolanda de Vries
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
| | - Paul Lohle
- From the Departments of Radiology (D.C., A.V., T.v.O., I.B., K.S., A.S., C.S., P. Lohle), Internal Medicine (E.D.), and Medical Psychology (J.d.V.), ETZ Hospital (Elisabeth Tweesteden Ziekenhuis), Hilvarenbeekseweg 60, 5022GC, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Tilburg University, Warandelaan2, 5037AB, Tilburg, the Netherlands (P. Lodder, J.d.V.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (J.H.)
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Raymond J, Darsaut TE, Eneling J, Chagnon M. The small trial problem. Trials 2023; 24:426. [PMID: 37349843 DOI: 10.1186/s13063-023-07348-3] [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: 11/17/2022] [Accepted: 05/05/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Many randomized trials that aim to assess new or commonly used medical or surgical interventions have been so small that the validity of conclusions becomes questionable. METHODS We illustrate the small trial problem using the power calculation of five Cochrane-reviewed studies that compared vertebroplasty versus placebo interventions. We discuss some of the reasons why the statistical admonition not to dichotomize continuous variables may not apply to the calculation of the number of patients required for trials to be meaningful. RESULTS Placebo-controlled vertebroplasty trials planned to recruit between 23 and 71 patients per group. Four of five studies used the standardized mean difference of a continuous pain variable (centimeters on the visual analog scale (VAS)) to plan implausibly small trials. What is needed is not a mean effect at the population level but a measure of efficacy at the patient level. Clinical practice concerns the care of individual patients that vary in many more respects than the variation around the mean of a single selected variable. The inference from trial to practice concerns the frequency of success of the experimental intervention performed one patient at a time. A comparison of the proportions of patients reaching a certain threshold is a more meaningful method that appropriately requires larger trials. CONCLUSION Most placebo-controlled vertebroplasty trials used comparisons of means of a continuous variable and were consequently very small. Randomized trials should instead be large enough to account for the diversity of future patients and practices. They should offer an evaluation of a clinically meaningful number of interventions performed in various contexts. Implications of this principle are not specific to placebo-controlled surgical trials. Trials designed to inform practice require a per-patient comparison of outcomes and the size of the trial should be planned accordingly.
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Affiliation(s)
- Jean Raymond
- Department of Radiology, Service of Neuroradiology, Centre Hospitalier de L'Université de Montréal (CHUM), Montreal, QC, H2X 0C1, Canada.
| | - Tim E Darsaut
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, AB, Canada
| | - Johanna Eneling
- Department of Radiology, Service of Neuroradiology, Centre Hospitalier de L'Université de Montréal (CHUM), Montreal, QC, H2X 0C1, Canada
| | - Miguel Chagnon
- Department of Mathematics and Statistics, University of Montreal, Montreal, QC, Canada
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Jiang Y, Cai J, Zeng Y, Ye H, Yang T, Liu Z, Liu Q. Development and validation of a machine learning model to predict imminent new vertebral fractures after vertebral augmentation. BMC Musculoskelet Disord 2023; 24:472. [PMID: 37296426 PMCID: PMC10251538 DOI: 10.1186/s12891-023-06557-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Accurately predicting the occurrence of imminent new vertebral fractures (NVFs) in patients with osteoporotic vertebral compression fractures (OVCFs) undergoing vertebral augmentation (VA) is challenging with yet no effective approach. This study aim to examine a machine learning model based on radiomics signature and clinical factors in predicting imminent new vertebral fractures after vertebral augmentation. METHODS A total of 235 eligible patients with OVCFs who underwent VA procedures were recruited from two independent institutions and categorized into three groups, including training set (n = 138), internal validation set (n = 59), and external validation set (n = 38). In the training set, radiomics features were computationally retrieved from L1 or adjacent vertebral body (T12 or L2) on T1-w MRI images, and a radiomics signature was constructed using the least absolute shrinkage and selection operator algorithm (LASSO). Predictive radiomics signature and clinical factors were fitted into two final prediction models using the random survival forest (RSF) algorithm or COX proportional hazard (CPH) analysis. Independent internal and external validation sets were used to validate the prediction models. RESULTS The two prediction models were integrated with radiomics signature and intravertebral cleft (IVC). The RSF model with C-indices of 0.763, 0.773, and 0.731 and time-dependent AUC (2 years) of 0.855, 0.907, and 0.839 (p < 0.001 for all) was found to be better predictive than the CPH model in training, internal and external validation sets. The RSF model provided better calibration, larger net benefits (determined by decision curve analysis), and lower prediction error (time-dependent brier score of 0.156, 0.151, and 0.146, respectively) than the CPH model. CONCLUSIONS The integrated RSF model showed the potential to predict imminent NVFs following vertebral augmentation, which will aid in postoperative follow-up and treatment.
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Affiliation(s)
- Yang Jiang
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Jinhui Cai
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Yurong Zeng
- Department of Radiology, Huizhou Central People's Hospital, Huizhou, China
| | - Haoyi Ye
- Department of Radiology, The Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tingqian Yang
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Zhifeng Liu
- Department of Radiology, The Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Qingyu Liu
- Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.
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7
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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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Eneling J, Darsaut TE, Veilleux C, Raymond J. Understanding power in randomized trials: The example of vertebroplasty. Neurochirurgie 2023; 69:101402. [PMID: 36621210 DOI: 10.1016/j.neuchi.2022.101402] [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: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Randomized trials (RCTs) should include a sufficient number of patients to reduce the risk that the observed outcome is a result of chance rather than from a truly different treatment effect. Trials must be even larger to claim an absence of treatment effect in a placebo-controlled trial. To estimate the size of the trial and maximize power, it is often suggested to use a comparison between the means of a continuous variable. METHODS We examine the RCTs that have compared vertebroplasty and placebo for patients with osteoporotic fractures. Most trials compared the means of a continuous pain score to yield implausibly small trials, as small as 24 patients per group. RESULTS The minimally significant difference between groups has no precise clinical meaning for patients when it is based on a comparison of means of pain scores. A comparison of the proportions of patients reaching a per-patient outcome measure of treatment success is much more pertinent if the trial is to inform the care of future patients. The resulting trials will admittedly need to be larger, but they will be much less likely to fall prey to the 'evidence of absence' fallacy. Furthermore, trial size should also take into consideration harder clinical outcome measures, such as death and disability. CONCLUSION When the goal of a trial is to inform outcome-based medical care, comparing the proportions of patients reaching a clinically pertinent outcome is more appropriate than comparing the means of a continuous variable.
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Affiliation(s)
- J Eneling
- Department of radiology, service of neuroradiology, centre hospitalier de l'université de Montréal (CHUM), Montreal, Quebec, Canada
| | - T E Darsaut
- Division of neurosurgery, department of surgery, university of Alberta hospital, Mackenzie health sciences centre, Edmonton, Alberta, Canada
| | - C Veilleux
- Division of neurosurgery, department of clinical neurosciences, university of Calgary, Alberta, Canada
| | - J Raymond
- Department of radiology, service of neuroradiology, centre hospitalier de l'université de Montréal (CHUM), Montreal, Quebec, Canada.
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9
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Eneling J, Darsaut TE, Veilleux C, Raymond J. Understanding the choice of control group: A systematic review of vertebroplasty trials for osteoporotic vertebral compression fractures. Neurochirurgie 2023; 69:101401. [PMID: 36566694 DOI: 10.1016/j.neuchi.2022.101401] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To better understand the choice of the comparator intervention in the design of clinical trials and its impact on the meaning of results we review randomized trials on vertebroplasty. METHODS We conducted a systematic and narrative review of all randomized trials on vertebroplasty. Trials are categorized according to the comparator intervention (non-surgical management, placebo/sham vertebroplasty, and kyphoplasty). RESULTS All trials were too small to show a difference in objective clinical outcomes, and 20 of 23 RCTs used mean pain scores to compare interventions. Most trials comparing vertebroplasty with non-surgical management concluded that vertebroplasty was superior. Trials comparing kyphoplasty with vertebroplasty showed similar results for both interventions. However, 4 of 5 trials comparing vertebroplasty with placebo surgery failed to show a significant difference between groups. CONCLUSION The clinical results of an intervention cannot be interpreted without a comparison that involves a control group. The choice of comparator intervention can change the meaning of the trial. A large pragmatic trial, using hard clinical outcomes such as morbidity and mortality as a primary outcome measure, would be needed to assess the potential clinical benefits of vertebroplasty.
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Affiliation(s)
- J Eneling
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
| | - T E Darsaut
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - C Veilleux
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - J Raymond
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
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10
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Jang HD, Kim EH, Lee JC, Choi SW, Kim HS, Cha JS, Shin BJ. Management of Osteoporotic Vertebral Fracture: Review Update 2022. Asian Spine J 2022; 16:934-946. [PMID: 36573301 PMCID: PMC9827207 DOI: 10.31616/asj.2022.0441] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
A vertebral fracture is the most common type of osteoporotic fracture. Osteoporotic vertebral fractures (OVFs) cause a variety of morbidities and deaths. There are currently few "gold standard treatments" outlined for the management of OVFs in terms of quantity and quality. Conservative treatment is the primary treatment option for OVFs. The treatment of pain includes short-term bed rest, analgesic medication, anti-osteoporotic medications, exercise, and a brace. Numerous reports have been made on studies for vertebral augmentation (VA), including vertebroplasty and kyphoplasty. There is still debate and controversy about the effectiveness of VA in comparison with conservative treatment. Until more robust data are available, current evidence does not support the routine use of VA for OVF. Despite the fact that the majority of OVFs heal without surgery, 15%-35% of patients with an unstable fracture, persistent intractable back pain, or severely collapsed vertebra that causes a neurologic deficit, kyphosis, or chronic pseudarthrosis frequently require surgery. Because no single approach can guarantee the best surgical outcomes, customized surgical techniques are required. Surgeons must stay current on developments in the osteoporotic spine field and be open to new treatment options. Osteoporosis management and prevention are critical to lowering the risk of future OVFs. Clinical studies on bisphosphonate's effects on fracture healing are lacking. Teriparatide was intermittently administered, which dramatically improved spinal fusion and fracture healing while lowering mortality risk. According to the available literature, there are no standard management methods for OVFs. More multimodal approaches, including conservative and surgical treatment, VA, and medications that treat osteoporosis and promote fracture healing, are required to improve the quality of the majority of guidelines.
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Affiliation(s)
- Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eung-Ha Kim
- Department of Orthopaedic Surgery, Dongkang Hospital, Ulsan, Korea
| | - Jae Chul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea,Corresponding author: Jae Chul Lee Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea Tel: +82-32-621-5114, Fax: +82-32-621-5018, E-mail:
| | - Sung-Woo Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hak Soo Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Joong-Suk Cha
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Byung-Joon Shin
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
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11
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Lotan R, Smorgick Y, Anekstein Y, Rudik O, Prosso I, Hershkovich O. Kyphoplasty for Elderly Patients With Vertebral Compression Fractures-Do We Save Lives? Mortality Rates Analysis Comparison in a Long-Term Follow-Up Cohort. Global Spine J 2022; 12:1443-1448. [PMID: 33433244 PMCID: PMC9393975 DOI: 10.1177/2192568220982282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVES We aimed to compare a large cohort of patients with vertebral compression fractures (VCF) treated in 2 centers using different protocols (conservative vs BKP) and compare mortality rates on a long-term follow-up. METHODS Retrospective cohort held in 2 medical centers (W and AH). All patients admitted with VCF from November 2008 to January 2015 were enrolled in the study. Exclusion criteria were patients admitted with non-osteoporotic pathological fractures (such as metastatic or MM). RESULTS Our study included 208 patients treated for VCF, 127 were treated with BKP (88 females, 69.3%) and 81 were treated conservatively (59 females, 72.8%). Patients from Centre W were older and frailer compared to the patients from AH center (Average age 75.12 ± 11.16 vs 69.13 ± 9.61 years and Frailty score of 0.16 ± 0.1 vs 0.12 ± 0.1 respectively, T-test, p < 0.01 for both). Hazard ratios (HR) for age, female gender and frailty were significant for increased mortality, frailty had the highest HR of 182.42 (CI 29.05-1145.33, p < 0.01). Multivariate Cox model was fitted and after accounting for Gender, Age and Frailty, no significant difference was found between the 2 medical centers mortality rates (p = 0.59), thus no difference in mortality rates between BKP and conservative treatment in our study. CONCLUSION long-term follow-up following BKP treatment for VCF did not show a reduced mortality rate compared to conservative treatment after accounting for frailty, age and gender. Frailty was the most important factor in predicting mortality. Further RCTs are needed to compare the quality of life differences between the 2 treatment strategies.
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Affiliation(s)
- Raphael Lotan
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Smorgick
- Spine Unit, Assaf Harofeh Medical Center, Zerifin, Israel, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoram Anekstein
- Spine Unit, Assaf Harofeh Medical Center, Zerifin, Israel, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Rudik
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilia Prosso
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Hershkovich
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Oded Hershkovich, Ha-Lokhamim St 62, Holon, 5822012, Israel.
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12
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Manfre L, Gil I, Baptista T, Calvão Pires P, de Vivo AE, Masala S, Chandra RV, D'Anna G, Hirsch JA. Coccygeoplasty: preliminary experience with this new alternative treatment of refractory coccydynia in patients with coccyx hypermobility. J Neurointerv Surg 2022; 15:82-85. [PMID: 35882554 DOI: 10.1136/neurintsurg-2021-018149] [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: 09/23/2021] [Accepted: 02/09/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Coccydynia has many causes, including fracture, subluxation, and hypermobility of sacrococcygeal segments. Existing treatments are limited in their effectiveness. Coccygeoplasty (CP) is a relatively new, minimally invasive treatment that appears to address this difficult clinical challenge. OBJECTIVE To describe clinical results at the time of the procedure and at 3- and 12-months' follow-up of patients with coccydynia related to subluxation and coccyx hypermobility treated with the CP technique. Additionally, to determine if there is any correlation between the final imaging and clinical results at 3- and 12-months' follow-up. METHODS A prospectively maintained database was used, and all patients who underwent CP for chronic coccydynia between January 2005 and October 2018 were retrospectively reviewed. All the patients had painful hypermobility (greater than 25°) with anterior flexion confirmed on radiological imaging. Alternative causes of coccydynia were excluded using CT and MRI. Procedures were performed under local anesthesia with combined fluoroscopic and CT guidance. Clinical follow-up was performed at two time points: 3 and 12 months after treatment using the Visual Analogue Scale (VAS). RESULTS Twelve patients were treated in a single center. No procedural complications occurred. At 3- and 12-months' follow-up, the majority (75%) of patients had significantly lower VAS scores than at baseline, with mean changes of 3.5 and 4.9, respectively. There was no pain recurrence at 12 months and just one patient had no improvement of the pain. Follow-up CT images confirmed fixation of the sacrococcygeal bone segments in nine patients; however, no correlation was found between final imaging results and clinical outcome (p=0.1). CONCLUSIONS Patients with refractory painful coccyx subluxation and hypermobility undergoing CP have a favorable clinical response at 3- and 12-months' follow-up. Further studies are required to validate this technique and to identify predictors of treatment response. Coccygeoplasty may be considered a reasonable alternative to coccygectomy.
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Affiliation(s)
- Luigi Manfre
- Department of Radiology, IOM Mediterranean Oncology Institute, Viagrande, Italy
| | - Inês Gil
- Department of Neuroradiology, Centro Hospitalar do Algarve EPE, Faro, Portugal
| | - Tiago Baptista
- Department of Neuroradiology, Oxford University Hospitals NHS Trust, Oxford, UK.,Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Pedro Calvão Pires
- Department of Neuroradiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Aldo Eros de Vivo
- Department of Radiology, IOM Mediterranean Oncology Institute, Viagrande, Italy
| | - Salvador Masala
- Department of Diagnosis Imaging Interventional Radiology and Clinical Pathology, Ospedale San Giovanni Battista, Roma, Italy
| | - Ronil V Chandra
- Department of Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia.,Department of Image, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Gennaro D'Anna
- Department of Radiology, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Joshua A Hirsch
- NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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13
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Lotan R, Prosso I, Klatzkin L, Hershkovich O. The Covid 19 Pandemic Effect on the Epidemiology of Thoracolumbar Fractures Presenting to the Emergency Department in Patients Above 65 years Old. Geriatr Orthop Surg Rehabil 2022; 13:21514593221098828. [PMID: 35479652 PMCID: PMC9036375 DOI: 10.1177/21514593221098828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Studies investigating the Covid-19 Pandemic’s orthopedic aspects are accumulating, including reports on a 10-33% decrease in hip fracture incidence alongside shorter times to surgery. Osteoporotic vertebral compression fractures (VCF) have not yet been discussed. This study evaluated the effect of the Covid-19 pandemic’s first wave on VCF in the elderly. Method A retrospective cohort of elderly patients diagnosed with VCF between 2018-19 (Pre-Covid-19 pandemic) to 2020. Results The cohort included 172 patients above 65 years with VCF during 2018-2020. Patients’ age and gender were similar between the two study groups. We found a higher proportion of high-energy VCF during 2020 (10.5% vs 6.7%). Incidence of recurrent fractures was 7.5 times higher during 2020 (5.3% vs .7%, P =.06), and significantly higher rates of Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis in 2020 (7.9% vs 1.5%, P=.04). VCF ED admission rates were similar, with 60% treated conservatively. Admitted patients underwent more surgeries in 2020 (66.7% vs 60%, P =.71) and a tendency towards Precoutaneus Balloon Kyphoplasty (BKP) + fixation compared with BKP alone (15.8% in 2020 vs 7.5% in 2018-19, P =.29). RR for BKP + fixation vs BKP alone was 1.95, suggesting higher odds for a more complex surgery during the Covid-19 pandemic. The complication rate was significantly higher during 2020 (18.4% vs 3.7%, P <.001). Admission length was slightly longer during 2020 (12.2 days vs 9.9 days, P = .27), and time to surgery was marginally longer, 6.25 vs 5.3 days (P = .55). Many patients chose home over institutional rehabilitation during the Covid-19 pandemic (72.2% vs 58.8%). Conclusion The Covid-19 pandemic did not alter VCF incidence, but patients’ characteristics changed, affecting admissions, institutional rehabilitation, and a tendency towards complex surgery rather than BKP alone. It is still unclear if Covid-19 will remain an issue in the upcoming years, but its impact and lessons are still worthwhile.
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Affiliation(s)
- Raphael Lotan
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilia Prosso
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lev Klatzkin
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Hershkovich
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Ni W, Ricker C, Quinn M, Gasquet N, Janardhanan D, Gilligan CJ, Hirsch JA. Trends in opioid use following balloon kyphoplasty or vertebroplasty for the treatment of vertebral compression fractures. Osteoporos Int 2022; 33:821-837. [PMID: 34729624 PMCID: PMC8930950 DOI: 10.1007/s00198-021-06163-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/18/2021] [Indexed: 02/06/2023]
Abstract
UNLABELLED This retrospective analysis of insurance claims evaluated real-world trends in prescription fills among patients treated with balloon kyphoplasty (N = 6,656) or vertebroplasty (N = 2,189) following diagnosis of vertebral compression fracture. Among those with evidence of opioid use, nearly half of patients discontinued or reduced prescription fills relative to pre-operative levels. INTRODUCTION Vertebral compression fractures (VCF) are associated with debilitating pain, spinal misalignment, increased mortality, and increased healthcare-resource utilization in elderly patients. This study evaluated the effect of balloon kyphoplasty (BKP) or vertebroplasty (VP) on post-procedure opioid prescription fills and payer costs in patients with VCF. METHODS This was a retrospective analysis of a large, nationally representative insurance-claims database. Clinical characteristics, opioid prescription patterns, and payer costs for subjects who underwent either BKP or VP to treat VCF were evaluated beginning 6 months prior to surgery through 7-month follow-up that included a 30-day, postoperative medication washout. Patient demographics, changes in opioid utilization, and payer costs were analyzed. RESULTS A total of 8,845 patients met eligibility criteria (75.3% BKP and 24.7% VP) with a mean of age 77 and 74% female. Among the 75% of patients who used opioids, 48.7% of patients discontinued opioid medication and 8.4% reduced prescription fills versus preoperative baseline. Patients who reduced or discontinued prescriptions exhibited a decrease in all-cause payer costs relative to pre-intervention levels, which was a significantly greater change relative to patients with no change, increase, or new start of opioids. CONCLUSIONS Interventional treatment for VCF was associated with decreased or discontinued opioid prescription fills and reduced payer costs in follow-up in a significant proportion of the study population. Reduction of opioid-based harms may represent a previously unrecognized benefit of vertebral augmentation for VCF, especially in this elderly and medically fragile population.
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Affiliation(s)
- W Ni
- , Health Economics & Outcomes Research, Medtronic Plc., 710 Medtronic Parkway, Minneapolis, MN, 55432, USA
| | - C Ricker
- , Health Economics & Outcomes Research, Medtronic Plc., 710 Medtronic Parkway, Minneapolis, MN, 55432, USA
| | - M Quinn
- , Health Economics & Outcomes Research, Medtronic Plc., 710 Medtronic Parkway, Minneapolis, MN, 55432, USA
| | - N Gasquet
- , Health Economics & Outcomes Research, Medtronic Plc., 710 Medtronic Parkway, Minneapolis, MN, 55432, USA
| | - D Janardhanan
- Department of Anesthesiology, Perioperative and Pain Medicine Brigham & Women's Hospital, Boston, USA
| | - C J Gilligan
- Department of Anesthesiology, Perioperative and Pain Medicine Brigham & Women's Hospital, Boston, USA
| | - J A Hirsch
- Interventional Neuroradiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA.
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15
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Key BM, Symanski J, Scheidt MJ, Tutton SM. Vertebroplasty, Kyphoplasty, and Implant-Based Mechanical Vertebral Augmentation. Semin Musculoskelet Radiol 2021; 25:785-794. [PMID: 34937118 DOI: 10.1055/s-0041-1739531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Vertebral compression fractures are a global public health issue with a quantifiable negative impact on patient morbidity and mortality. The contemporary approach to the treatment of osteoporotic fragility fractures has moved beyond first-line nonsurgical management. An improved understanding of biomechanical forces, consequential morbidity and mortality, and the drive to reduce opioid use has resulted in multidisciplinary treatment algorithms and significant advances in augmentation techniques. This review will inform musculoskeletal radiologists, interventionalists, and minimally invasive spine surgeons on the proper work-up of patients, imaging features differentiating benign and malignant pathologic fractures, high-risk fracture morphologies, and new mechanical augmentation device options, and it describes the appropriate selection of devices, complications, outcomes, and future trends.
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Affiliation(s)
- Brandon M Key
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John Symanski
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew J Scheidt
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sean M Tutton
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Orthopedic Surgery, and Palliative Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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16
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Wu W, Zhang X, Li X, Liu H, Xu L, Liu T, Yu S. Comparison of the clinical outcomes of percutaneous kyphoplasty for the management of osteolytic and osteoblastic-related metastatic vertebral lesions. J Neurointerv Surg 2021; 14:938-941. [PMID: 34475252 DOI: 10.1136/neurintsurg-2021-018007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To retrospectively compare the clinical efficacy and safety of percutaneous kyphoplasty (PKP) for the management of osteolytic and osteoblastic-related metastatic vertebral lesions. METHODS A total of 117 patients with osteolytic (87 cases, 159 lesions, OL group) or osteoblastic-related (30 cases, 56 lesions, OB group) metastatic vertebral lesions underwent PKP. The clinical efficacy was assessed based on parameters including Visual Analog Scale (VAS), Oswestry Disability Index (ODI), vertebral body height (VBH) variation, and quality of life (QoL). Major and minor complications were systematically evaluated to assess the safety of the procedure. RESULTS No significant differences were found in the age, sex, or amount of bone cement between both groups (p>0.05). Compared with the OB group, the OL group was superior in operation duration (p<0.05) but was inferior in inflation pressure (p<0.05). Both groups experienced significant pain relief and improvement in the ODI, VBH, and QoL after PKP (p<0.05). The OB group had a better pain relief according to the VAS score but a poorer VBH restoration than the OL group throughout the follow-up period (p<0.05). No significant differences were observed in ODI and QoL between the two groups (p>0.05). The incidence of complications in the OL group was significantly higher than that in the OB group (p<0.05). CONCLUSIONS PKP can safely achieve pain relief, functional improvement, VBH restoration, and QoL improvement for patients with osteolytic or osteoblastic-related metastatic vertebral lesions. Patients with osteolytic metastatic vertebral lesions showed better VBH restoration and had a shorter operation time but experienced less pain relief and had a greater incidence of complications than patients with osteoblastic-related metastatic vertebral lesions after PKP.
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Affiliation(s)
- Wence Wu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinxin Zhang
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyang Li
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanmei Liu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Libin Xu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ting Liu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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17
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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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18
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Michalopoulos GD, Yolcu YU, Ghaith AK, Alvi MA, Carr CM, Bydon M. Diagnostic yield, accuracy, and complication rate of CT-guided biopsy for spinal lesions: a systematic review and meta-analysis. J Neurointerv Surg 2021; 13:841-847. [PMID: 33883210 DOI: 10.1136/neurintsurg-2021-017419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND CT-guided biopsy is a commonly used diagnostic procedure for spinal lesions. This meta-analysis aims to investigate its diagnostic performance and complications, as well as factors influencing outcomes. METHODS A systematic review of the literature was performed to identify studies reporting outcomes of CT-guided biopsies for spinal lesions. Diagnostic yield (ie, the rate of procedures resulting in a specific pathological diagnosis) and diagnostic accuracy (ie, the rate of procedures resulting in the correct diagnosis) were the primary outcomes of interest. Complications following biopsy procedures were also included. RESULTS Thirty-nine studies with 3917 patients undergoing 4181 procedures were included. Diagnostic yield per procedure was 91% (95% CI 88% to 94%) among 3598 procedures. The most common reason for non-diagnostic biopsies was inadequacy of sample. No difference in diagnostic yield between different locations and between lytic, sclerotic, and mixed lesions was found. Diagnostic yield did not differ between procedures using ≤13G and ≥14G needles. Diagnostic accuracy per procedure was 86% (95% CI 82% to 89%) among 3054 procedures. Diagnostic accuracy among 2426 procedures that yielded a diagnosis was 94% (95% CI 92% to 96%). Complication rate was 1% (95% CI 0.4% to 1.9%) among 3357 procedures. Transient pain and minor hematoma were the most common complications encountered. CONCLUSION In our meta-analysis of 39 studies reporting diagnostic performance and complications of CT-guided biopsy, we found a diagnostic yield of 91% and diagnostic accuracy of 86% with a complication rate of 1%. Diagnostic yield did not differ between different locations, between lytic, sclerotic and mixed lesions, and between wide- and thin-bore needles.
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Affiliation(s)
- Giorgos D Michalopoulos
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Yagiz Ugur Yolcu
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdul Karim Ghaith
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammed Ali Alvi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA .,Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
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19
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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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20
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D'Oria S, Dibenedetto M, Squillante E, Somma C, Hannan CJ, Giraldi D, Fanelli V. Traumatic compression fractures in thoracic-lumbar junction: vertebroplasty vs conservative management in a prospective controlled trial. J Neurointerv Surg 2021; 14:202-206. [PMID: 33758067 DOI: 10.1136/neurintsurg-2020-017141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/13/2021] [Accepted: 03/10/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Both surgery and conservative management are well established treatments for compression fractures of the thoraco-lumbar spine without neurological compromise. This article aims to compare the outcomes of conservative management to those of vertebroplasty, a relatively safe and simple procedure. METHODS 102 patients were admitted to our neurosurgical unit between January 2012 and February 2016, presenting with a single-level, post-traumatic A1 or A2 Mager l type fracture, affecting the thoracic-lumbar spine without any neurological deficits. After description of both treatment options, the patients were asked to choose between vertebroplasty or conservative treatment. Accordingly, the patients were allocated into two groups and a prospective non-randomized controlled trial was carried out. The first group (Group A) included 52 patients, treated with bed rest and an orthosis. The second group (Group B) of 50 patients underwent a percutaneous vertebroplasty. Pain intensity (assessed via visual analog scale (VAS)), disability degree (assessed via Oswestry Disability Index), ability to resume work (assessed via Denis work Scale), vertebral body height loss rate, regional kyphosis angle (Cobb's angle), duration of hospitalization and treatment-associated complications, were prospectively recorded in a database and analyzed. Follow ups were planned at 1, 6, and 12 months after the injury. RESULTS Group B, compared with group A, showed a faster improvement in VAS score as well as functional ability and return to work. Cobb's angle progression was significantly less in the surgical group. Morbidity, mortality, and complication rate were similar and comparable in both groups without a statistical difference (P<0.05) CONCLUSIONS: Vertebroplasty is a safe and effective treatment in post-traumatic thoracic-lumbar fractures compared with conservative management.
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Affiliation(s)
- Salvatore D'Oria
- Neurosurgery, Ente Ecclesiastico Ospedale Generale Regionale Francesco Miulli, Acquaviva delle Fonti, Italy
| | - Mariagrazia Dibenedetto
- Neurosurgery, Ente Ecclesiastico Ospedale Generale Regionale Francesco Miulli, Acquaviva delle Fonti, Italy
- Neurosurgery, Azienda Ospedaliera Policlinico di Bari, Bari, Italy
| | | | - Carlo Somma
- Neurosurgery, Ente Ecclesiastico Ospedale Generale Regionale Francesco Miulli, Acquaviva delle Fonti, Italy
| | | | - David Giraldi
- Neurosurgery, Ente Ecclesiastico Ospedale Generale Regionale Francesco Miulli, Acquaviva delle Fonti, Italy
| | - Vincenzo Fanelli
- Neurosurgery, Ente Ecclesiastico Ospedale Generale Regionale Francesco Miulli, Acquaviva delle Fonti, Italy
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21
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Roscop C, Gariel F, Kieser DC, Bouyer B, Gille O, Marnat G, Berge J. Doughnut vertebroplasty for circumferential aggressive vertebral hemangiomas. J Neurointerv Surg 2021; 14:neurintsurg-2020-016785. [PMID: 33632885 DOI: 10.1136/neurintsurg-2020-016785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND To assess the feasibility, safety and efficacy of a percutaneous doughnut vertebroplasty of circumferential aggressive vertebral hemangiomas (VHs). METHODS We retrospectively reviewed our prospectively collected database of patients with VHs treated with vertebroplasty between January 2009 and January 2018. Patient demographics, clinical presentations and procedural details were recorded. All patients underwent preoperative computed tomography (CT) and magnetic resonance imaging (MRI). All vertebroplasties were performed under conscious sedation in the prone position, predominantly using biplane fluoroscopic guidance. A clinical and imaging evaluation (early CT scan and MRI) as well as a final follow-up clinical assessment was performed. RESULTS Twenty-two patients with aggressive VHs who underwent circumferential vertebroplasty with cementation of the entire vertebral body and at least one posterior hemi-arch were included (six males, mean age 53 years). At 3 months follow-up, nine patients (41%) had complete, 11 (50%) had partial and two (9%) had no resolution of pain. Nine of 14 patients had a decrease in venous swelling on MRI. No complications were observed. Five patients (23%) underwent adjunctive surgery within 1 year for persistence or worsening of neurological symptoms. Clinical and radiographic improvements were maintained to final follow-up. CONCLUSIONS Doughnut vertebroplasty offers a mini-invasive, safe and effective treatment of aggressive circumferential VHs. This technique improves pain in over 90% of patients as well as a reduction in radicular and neurological symptoms associated with a tendency to regression of the compressive epidural venous component of these lesions.
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Affiliation(s)
- Cecile Roscop
- The Spine Institute, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Florent Gariel
- Interventional Neuroradiology, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - David Christopher Kieser
- Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Benjamin Bouyer
- The Spine Institute, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Olivier Gille
- The Spine Institute, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Gaultier Marnat
- Interventional Neuroradiology, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France.,Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Jerome Berge
- Interventional Neuroradiology, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
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22
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De Leacy R, Barr JD. Commentary: vertebroplasty and kyphoplasty in the United States 2004-2017: national trends, regional variations, associated diagnoses, and outcomes. J Neurointerv Surg 2021; 13:404-405. [PMID: 33479034 DOI: 10.1136/neurintsurg-2020-017147] [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: 12/12/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John D Barr
- Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
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23
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Liu J, Tang J, Gu Z, Zhang Y, Yu S, Liu H. Fracture-free probability and predictors of new symptomatic fractures in sandwich, ordinary-adjacent, and non-adjacent vertebrae: a vertebra-specific survival analysis. J Neurointerv Surg 2021; 13:1058-1062. [PMID: 33468608 DOI: 10.1136/neurintsurg-2020-016985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND It is unclear whether the sandwich vertebra, is at higher risk of new symptomatic fractures (NSFs), and whether prophylactic augmentation might benefit patients with sandwich vertebrae. OBJECTIVE To compare fracture-free probabilities of sandwich, ordinary-adjacent, and non-adjacent vertebrae, and identify predictors of NSFs. METHODS Data were retrospectively analyzed for patients who had undergone vertebral augmentation resulting in sandwich vertebrae. NSF rates were determined and predictors were identified using Cox proportional hazard models. RESULTS The analysis included 1408 untreated vertebrae (147 sandwich, 307 ordinary-adjacent, 954 non-adjacent vertebrae) in 125 patients. NSFs involved 19 sandwich, 19 ordinary-adjacent, and 16 non-adjacent vertebrae. The NSF rate was significantly higher in the patients with sandwich vertebrae (27.2%) than among all patients (14.8%). At the vertebra-specific level, the NSFs rate was 12.9% for sandwich vertebrae, significantly higher than 6.2% for ordinary-adjacent and 1.7% for non-adjacent vertebrae. The corresponding fracture-free probabilities of sandwich, ordinary-adjacent, and non-adjacent vertebrae were 0.89, 0.95, and 0.99 at 1 year, and 0.85, 0.92, and 0.98 at 5 years (p<0.05). Cox modeling identified the following as predictors for occurrence of an NSF in a given vertebra: vertebra location, type of vertebrae, number of augmented vertebrae, and puncture method. CONCLUSION Sandwich vertebrae are at higher risk of NSFs than ordinary-adjacent and non-adjacent vertebrae, and several NSF risk factors were identified. Since 85% of sandwich vertebrae are fracture-free for 5 years and NSF risk increases with the number of augmented vertebrae, prophylactic augmentation of every sandwich vertebra may be unnecessary.
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Affiliation(s)
- Jin Liu
- Department of Orthopaedics, Sichuan University West China Hospital, Chengdu, Sichuan, China.,Department of Orthopaedics, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Jing Tang
- Department of Radiology, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Zuchao Gu
- Department of Orthopaedics, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Yu Zhang
- Department of Orthopaedics, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Shenghui Yu
- Department of Orthopaedics, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Hao Liu
- Department of Orthopaedics, Sichuan University West China Hospital, Chengdu, Sichuan, China
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24
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Jang HD, Kim EH, Lee JC, Choi SW, Kim K, Shin BJ. Current Concepts in the Management of Osteoporotic Vertebral Fractures: A Narrative Review. Asian Spine J 2020; 14:898-909. [PMID: 33373513 PMCID: PMC7788360 DOI: 10.31616/asj.2020.0594] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Vertebral fractures are the most common type of osteoporotic fracture and can increase morbidity and mortality. To date, the guidelines for managing osteoporotic vertebral fractures (OVFs) are limited in quantity and quality, and there is no gold standard treatment for these fractures. Conservative treatment is considered the primary treatment option for OVFs and includes pain relief through shortterm bed rest, analgesics, antiosteoporotic drugs, exercise, and braces. Studies on vertebral augmentation (VA) including vertebroplasty and kyphoplasty have been widely reported, but there is still debate and controversy regarding the effectiveness of VA when compared with conservative treatment, and the routine use of VA for OVF is not supported by current evidence. Although most OVFs heal well, approximately 15%-35% of patients with unstable fractures, chronic intractable back pain, severely collapsed vertebra (leading to neurological deficits and kyphosis), or chronic pseudarthrosis frequently require surgery. Given that there is no single technique for optimizing surgical outcomes in OVFs, tailored surgical techniques are needed. Surgeons need to pay attention to advances in osteoporotic spinal surgery and should be open to novel thoughts and techniques. Prevention and management of osteoporosis is the key element in reducing the risk of subsequent OVFs. Bisphosphonates and teriparatide are mainstay drugs for improving fracture healing in OVF. The effects of bisphosphonates on fracture healing have not been clinically evaluated. The intermittent administration of teriparatide significantly enhanced spinal fusion and fracture healing and reduced mortality risk. Based on the current literature, there is still a lack of standard management strategies for OVF. There is a need for greater efforts through multimodal approaches including conservative treatment, surgery, osteoporosis treatment, and drugs that promote fracture healing to improve the quality of the guidelines.
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Affiliation(s)
- Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eung-Ha Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jae Chul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sung-Woo Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Kyungbum Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Byung-Joon Shin
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
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25
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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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26
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Albuquerque FC. Out with a bang. J Neurointerv Surg 2020; 13:1. [PMID: 33323468 DOI: 10.1136/neurintsurg-2020-017157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ 85013-440, USA
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27
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Beall D. Response to: The evidentiary basis of vertebral augmentation: a 2019 update. J Neurointerv Surg 2020; 12:439-440. [DOI: 10.1136/neurintsurg-2019-015507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 01/05/2023]
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