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Si X, Shan D, Huo L, Hu Y, Zou C, Wang B, Cao J, Wu W. Effect of percutaneous vertebroplasty versus percutaneous kyphoplasty on post-operative wound pain in patients with osteoporotic vertebral compression fractures. Int Wound J 2024; 21:e14745. [PMID: 38484743 PMCID: PMC10940009 DOI: 10.1111/iwj.14745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/21/2024] [Indexed: 03/18/2024] Open
Abstract
This research is intended to evaluate the efficacy of percutaneous vertebroplasty (PVP) versus percutaneous kyphoplasty (PKP) in osteoporotic vertebral compression fracture (OVCF), which is associated with post-operative pain. Eligible studies were screened by searching multiple databases and sources such as PubMed, Cochrane and EMBASE for search terms updated to October 2023, and relevant literature sources were searched. Randomized, controlled, prospective or retrospective, and cohort studies were eligible. For the analysis of the primary results, an analysis of the data was carried out, such as mean difference (MD) or odds ratio (OR), and 95% confidence interval (CI). In the present research, 1933 research was screened in 4 databases, and 30 articles were chosen to be examined under strict exclusion criteria. No statistical significance was found in the use of bone cement in the PVP group and PKP (MD, -0.60; 95% CI, -1.40, 0.21, p = 0.15); PKP was associated with a reduced risk of cement leak compared with PVP group (OR, 2.18; 95% CI, 1.38, 3.46, p = 0.0009); no statistical significance was found in the wound VAS score in PVP operation compared with that of PKP (MD, 0.16; 95% CI, -0.07, 0.40, p = 0.17); no statistical significance was found between the time of PVP operation and the time of PKP operation (MD, -2.65; 95% CI, -8.91, 3.60, p = 0.41). Compared with PVP technology, the PKP treatment of osteoporotic vertebral compression fractures reduces post-operative cement leakage, but there is no significant difference in the number of operative cement and wound VAS after operation. Nor did there appear to be a statistically significant difference in time between the two operations.
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Affiliation(s)
- Xiaojing Si
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Dongli Shan
- Department of Bone & Soft Tissue CancerChongqing University Cancer HospitalChongqingChina
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized TreatmentChongqing University Cancer HospitalChongqingChina
| | - li Huo
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Yongjun Hu
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Chuanqi Zou
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Boxin Wang
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Junxiong Cao
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Wenjie Wu
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
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Vieira RFS, Santana IG, Almeida DPRD, Barboza LE, Rosa FWFD. OSTEOPOROTIC SPINE FRACTURES TREATED WITH KYPHOPLASTY OR VERTEBROPLASTY: A META-ANALYSIS. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222102257080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Kyphoplasty (KP) and vertebroplasty (VP) are both widely adopted treatments for patients with osteoporotic vertebral fractures (OVF), however, which of these techniques is more effective has not yet been established. We performed a systematic review of articles, followed by meta-analysis, in an attempt to establish the differences between KP and VP. Initially, 187 articles were obtained, 20 of which were systematically reviewed and submitted to meta-analysis. Thus, 2,226 patients comprised the universe of the present article, 1202 of whom underwent KP and 1024 of whom underwent VP. The statistically significant results observed included lower mean bone cement leakage (ml) in the group submitted to kyphoplasty, with OR: 1.50 [CI95%: 1.16 - 1.95], p <0.05; shorter mean surgical time (minutes), 0.45 [CI90% 0.08 - 0.82], p <0.1, for the group submitted to VP as compared to the KP group; and a lower mean postoperative Oswestry Disability Index score in the KP group, OR: −0.14 [CI95%: −0.28 - 0.01], p <0.05. KP was more effective in improving physical function and had a lower frequency of cement leakage when compared to VP, although it requires longer surgical time. Level of evidence III; Systematic review of level III studies.
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Gandham S, Islim A, Alhamad S, Thambiraj S. The outcome of expandable titanium mesh implants for the treatment of multi-level vertebral compression fractures caused by multiple myeloma. SICOT J 2021; 7:28. [PMID: 33929312 PMCID: PMC8086425 DOI: 10.1051/sicotj/2021026] [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: 10/11/2020] [Accepted: 04/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Painful vertebral compression fractures (VCFs) in myeloma patients severely reduce quality of life. Currently, the International Myeloma Working Group (IMWG) and National Institute of Clinical Excellence NICE advocate the use of either balloon kyphoplasty or vertebroplasty in the management of these fractures. METHODS All patients with VCFs and myeloma who adhered to the IMWG indications for vertebral augmentation were treated with the Osseofix® implant. Visual analogue scores (VAS) and Oswestry disability index (ODI) were taken preoperatively and at least one year following surgery. Cobb angle and implant migration were measured on lateral standing radiographs. RESULTS Sixteen patients (average age 62, SD = 11.6) consisting of 82 levels (range 3-8) were stabilised with no perioperative complications or revisions at one year. There was an improvement in patient-reported outcomes with the median preoperative VAS of 8.6 (IQR 7.3-10.0) reducing to 3 (IQR 1.0-4.0) after one year (P < 0.001) whilst an average improvement of 31.4 (SD = 19.6) points in the ODI scores was reported (P < 0.001). There was no significant collapse or implant failure at one year with a greater improvement in the VAS/ODI score, when more implants were used (P = 0.049 and 0.008, respectively). The average length of stay was 2.2 days (SD = 1.7). CONCLUSION The use of the Osseofix® implant in VCFs caused by multiple myeloma has shown a statistically significant improvement in both pain and outcome scores. There were no complications or significant radiological deterioration of spinal alignment over the course of a year.
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Affiliation(s)
- Surya Gandham
- Department of Spinal Surgery, The Royal Liverpool University Hospital Trust, Prescot Street, L7 8XP Liverpool, United Kingdom
| | - Abdurrahman Islim
- Department of Spinal Surgery, The Royal Liverpool University Hospital Trust, Prescot Street, L7 8XP Liverpool, United Kingdom
| | - Saud Alhamad
- Department of Spinal Surgery, The Royal Liverpool University Hospital Trust, Prescot Street, L7 8XP Liverpool, United Kingdom
| | - Sathya Thambiraj
- Department of Spinal Surgery, The Royal Liverpool University Hospital Trust, Prescot Street, L7 8XP Liverpool, United Kingdom
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Kyphoplasty with intravertebral reduction devices associated with better height restoration and greater kyphosis correction than kyphoplasty with balloons. Sci Rep 2021; 11:5430. [PMID: 33686127 PMCID: PMC7940421 DOI: 10.1038/s41598-021-84856-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
Kyphoplasty (KP) with intravertebral reduction devices (IRD) was reported to be associated with better radiological outcomes than KP with balloons (BK) for osteoporotic vertebral compression fractures (OVCFs). However, the mechanical factors that contribute to the radiological benefits of IRDs require further investigation. To probe the mechanical factors, this retrospective matched cohort study was designed, including the older patients with painful OVCFs and treated with KP. We compared the clinical and radiological outcomes between KP with an IRD and BK, where vertebral body height and kyphotic angle of the cemented vertebrae were measured pre- and postoperatively; clinical outcomes were collected by telephone interviews. The restoration and maintenance ratio suggested that IRDs were associated with favorable effects long-term wise in anterior to middle vertebral body and kyphosis than BK in patients. The gathered results concluded the radiological benefits of IRD regarding both its efficient restoration and maintenance in vertebrae.
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Dai SQ, Qin RQ, Shi X, Yang HL. Percutaneous vertebroplasty versus kyphoplasty for the treatment of neurologically intact osteoporotic Kümmell's disease. BMC Surg 2021; 21:65. [PMID: 33514359 PMCID: PMC7846985 DOI: 10.1186/s12893-021-01057-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/11/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat neurologically intact osteoporotic Kümmell's disease (KD), but it is still unclear which treatment is more advantageous. Our study aimed to compare and investigate the safety and clinical efficacy of PVP and PKP in the treatment of KD. METHODS The relevant data that 64 patients of neurologically intact osteoporotic KD receiving PVP (30 patients) or PKP (34 patients) were analyzed. Surgical time, operation costs, intraoperative blood loss, volume of bone cement injection, and fluoroscopy times were compared. Occurrence of cement leakage, transient fever and re-fracture were recorded. Universal indicators of visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated separately before surgery and at 1 day, 6 months, 1 year, 2 years and the final follow-up after operation. The height of anterior edge of the affected vertebra and the Cobb's angle were assessed by imaging. RESULTS All patients were followed up for at least 24 months. The volume of bone cement injection, intraoperative blood loss, occurrence of bone cement leakage, transient fever and re-fracture between two groups showed no significant difference. The surgical time, the operation cost and fluoroscopy times of the PKP group was significantly higher than that of the PVP group. The post-operative VAS, ODI scores, the height of the anterior edge of the injured vertebrae and kyphosis deformity were significantly improved in both groups compared with the pre-operation. The improvement of vertebral height and kyphosis deformity in PKP group was significantly better than that in the PVP group at every same time point during the follow-up periods, but the VAS and ODI scores between the two groups showed no significant difference. CONCLUSION PVP and PKP can both significantly alleviate the pain of patients with KD and obtain good clinical efficacy and safety. By contrast, PKP can achieve better imaging height and kyphosis correction, while PVP has the advantages of shorter operation time, less radiation volume and operation cost.
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Affiliation(s)
- Shou-Qian Dai
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, Jiangsu, China.,Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, Jiangsu, China
| | - Rong-Qing Qin
- Department of Spinal Surgery, Gaoyou Hospital Affiliated Soochow University, 116 Fuqian St, Gaoyou, 225600, Jiangsu, China.,Department of Orthopedics, Gaoyou People's Hospital, 116 Fuqian St, Gaoyou, 225600, Jiangsu, China
| | - Xiu Shi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, Jiangsu, China
| | - Hui-Lin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, Jiangsu, China.
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Kushchayev SV, Wiener PC, Teytelboym OM, Arrington JA, Khan M, Preul MC. Percutaneous Vertebroplasty: A History of Procedure, Technology, Culture, Specialty, and Economics. Neuroimaging Clin N Am 2020; 29:481-494. [PMID: 31677725 DOI: 10.1016/j.nic.2019.07.011] [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] [Indexed: 01/09/2023]
Abstract
Percutaneous vertebroplasty (VP) progressed from a virtually unknown procedure to one performed on hundreds of thousands of patients annually. The development of VP provides a historically exciting case study into a rapidly adopted procedure. VP was the synthesis of information gained from spinal biopsy developments, the inception of biomaterials used in medicine, and the unique health care climate in France during the 1980s. It was designed as a revolutionary technique to treat vertebral body fractures with minimal side effects and was rapidly adopted and marketed in the United States. The impact of percutaneous vertebroplasty on spine surgery was profound.
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Affiliation(s)
- Sergiy V Kushchayev
- Department of Radiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA; Department of Radiology, Johns Hopkins Hospital, North Caroline Street, Baltimore, MD 21287, USA.
| | - Philip C Wiener
- Einstein Healthcare Network, 5501 Old York Road, Philadelphia, PA 19141, USA
| | - Oleg M Teytelboym
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19023, USA
| | - John A Arrington
- Department of Radiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Majid Khan
- Department of Radiology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA
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Percutaneous Vertebroplasty and Kyphoplasty: Current Status, New Developments and Old Controversies. Cardiovasc Intervent Radiol 2017; 40:1815-1823. [DOI: 10.1007/s00270-017-1779-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 08/22/2017] [Indexed: 12/26/2022]
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Comparing pain reduction following kyphoplasty and vertebroplasty : A meta-analysis of randomized and non-randomized controlled trials. DER ORTHOPADE 2017; 46:855-863. [PMID: 28821906 DOI: 10.1007/s00132-017-3455-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of the study was to compare the extent of pain reduction with kyphoplasty (KP) and vertebroplasty (VP) in the treatment of osteoporotic vertebral compression fractures (OVCF) using a visual analog scale (VAS). METHODS A computerized database search was performed to compare pain relief from VP and KP in OVCF. The available literature was analysed to quantify the amount of pain reduction using VAS as the primary outcome. RESULTS A total of 10 studies encompassing 902 patients met the inclusion criteria. Subgroup meta-analyses were performed according to the study design. VAS for the KP group was not significant compared with the VP group at 1 week, 1 month, and 6 months. Pain relief in the KP group was greater than that in the VP group at 12 months and 2 years. CONCLUSION KP is superior to VP in patients requiring pain relief. More large-scale, double-blinded controlled trials are necessary in order to quantify the pain relief afforded by VP more precisely.
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Zhang Y, Shi L, Tang P, Zhang L. Comparison of the Efficacy Between Two Micro‐Operative Therapies of Old Patients With Osteoporotic Vertebral Compression Fracture: A Network Meta‐Analysis. J Cell Biochem 2017; 118:3205-3212. [DOI: 10.1002/jcb.25966] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/28/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Yilong Zhang
- Department of Orthopaedics, Chinese PLA General HospitalMedical School of Chinese PLABeijing 100853China
| | - Litao Shi
- Department of Orthopaedics, Chinese PLA General HospitalMedical School of Chinese PLABeijing 100853China
| | - Peifu Tang
- Department of Orthopaedics, Chinese PLA General HospitalMedical School of Chinese PLABeijing 100853China
| | - Lihai Zhang
- Department of Orthopaedics, Chinese PLA General HospitalMedical School of Chinese PLABeijing 100853China
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Postoperative Functional Evaluation of Percutaneous Vertebroplasty Compared With Percutaneous Kyphoplasty for Vertebral Compression Fractures. Am J Ther 2017; 23:e1381-e1390. [PMID: 25844701 DOI: 10.1097/mjt.0000000000000223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Both percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) have shown their superiorities in the treatment of vertebral compression fractures (VCFs), yet, few studies have compared their postoperative functional outcomes in patients with VCFs; the authors therefore conducted this meta-analysis to explore the postoperative functional recovery efficacies of PVP and PKP in the treatment of VCFs. Computerized bibliographic databases were applied to identify relevant articles comparing the therapeutic effect of PVP and PKP in the treatment of VCFs. Standardized mean difference and its 95% confidence interval were calculated. Statistical analyses were conducted with the STATA statistical software. Postoperative Oswestry Disability Index investigation outcomes revealed a significant difference between the PVP group and PKP group. Subgroup analysis by the 8 dimensions of the SF-36 health survey presented a statistical significance in general health between the PVP group and PKP group. The application of PKP has the superiority in postoperative functional recovery of VCFs as compared with PVP, especially in efficaciously extending kyphosis angle, improving vertebral body height and decreasing complication rate.
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CIRSE Guidelines on Percutaneous Vertebral Augmentation. Cardiovasc Intervent Radiol 2017; 40:331-342. [DOI: 10.1007/s00270-017-1574-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/04/2017] [Indexed: 01/07/2023]
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Liang L, Chen X, Jiang W, Li X, Chen J, Wu L, Zhu Y. Balloon kyphoplasty or percutaneous vertebroplasty for osteoporotic vertebral compression fracture? An updated systematic review and meta-analysis. Ann Saudi Med 2016; 36:165-74. [PMID: 27236387 PMCID: PMC6074542 DOI: 10.5144/0256-4947.2016.165] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Both kyphoplasty (KP) and vertebroplasty (VP) are effective for patients with osteoporotic vertebral compression fracture (OVCF), but which approach might be more effective remains unclear, so we decided to update earlier systematic reviews. OBJECTIVE Review and analyze studies published as of August 2015 that compared clinical outcomes and complications of KP versus VP. DESIGN Systematic review and meta-analysis. SEARCH METHOD Published reports up to August 2015 were found in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). SELECTION CRITERIA Randomized controlled trials (RCTs) and prospective and retrospective cohort stud.ies comparing KP and VP in patients with OVCF. DATA COLLECTION AND ANALYSIS Two authors independently assessed the studies and extracted data. RESULTS Thirty-two studies involving 3274 patients fulfilled the inclusion criteria. There were significant differences between the two groups in short- and long-term postoperative changes in measures of pain intensity and dysfunction (P < .01), in anterior and middle height (P < .01), kyphotic angle (P < .01), and time to injury, but not in posterior height (P=.178). There were no significant differences in the rate of postoperative fractures including adjacent and total fractures, but cement leakage to the intraspinal space was greater in the VP group (P=.035). KP surgery took longer and required a greater volume of injected cement. CONCLUSIONS KR resulted in better pain relief, improvements in Oswestry dysfunction and radiographic outcomes with less cement leakage, but further RCTs are needed to verify this conclusion. LIMITATIONS Only four RCTs with a certain of risk of bias. Most studies were observational.
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Affiliation(s)
| | | | | | | | | | | | - Yangyi Zhu
- Prof. Yangyi Zhu, Department of Orthopaedics,, Shangyu People's Hospital, University,, No. 899 Pinghai Road, Suzhou 215006, China, Shaoxing 312000, China, F: 86057581266120, , ORCID ID: orcid.org/0000-0002-2654-8360
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Zhu T, Tian Y, Zhou F, Shang L, Guo Y, Lv Y. Percutaneous kyphoplasty with or without temporary unipedicle screw reduction : A retrospective comparative study of osteoporotic vertebral fractures. DER ORTHOPADE 2016; 45:607-15. [PMID: 26940825 PMCID: PMC4937075 DOI: 10.1007/s00132-016-3235-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Temporary unipedicle screw reduction with percutaneous kyphoplasty (TUSR-PKP) is a relatively new method for managing osteoporotic vertebral compression fractures (OVCFs). A clinical retrospective comparative study was conducted to verify whether TUSR-PKP was noninferior to simple PKP regarding the management of OVCFs. Methods A total of 38 consecutive patients who sustained OVCFs without neurological deficits and had undergone surgeries in our hospital from June 2012 to January 2014 were included in the study: 24 patients underwent simple PKP (control group) and the other 14 patients underwent TUSR-PKP (treatment group). All 38 patients were asked to participate in a long-term (>1 year) follow-up. Visual analog scale (VAS) pain scores and Oswestry Disability Index (ODI) were recorded, and the Cobb angles and the vertebral body heights were measured on the lateral radiographs before surgery and on day 1, as well as 1, 3, 6, and 12 months after surgery. Results The patients in the treatment group had better vertebral height gain and greater improvement on ODI compared with the control group (p < 0.05). The VAS scores of the two groups were similar at all points until the end of the 1‑year follow-up period. Two patients from the treatment group and 5 patients from the control group had cement leakage. In the control group, 3 patients suffered adjacent or nonadjacent vertebra fractures. Conclusion TUSR-PKP is a safe and effective surgical option for OVCFs. Compared with simple PKP, TUSR-PKP provided at least equal results for OVCFs. Moreover, during the postsurgery observations, TUSR-PKP showed potential advantages including vertebral height gain, ODI improvement, and fewer subsequent refractures.
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Affiliation(s)
- T Zhu
- Orthopedic Trauma, Peking University Third Hospital, No. 49 North Garden Road, HaiDian District, 100191, Beijing, China
| | - Y Tian
- Orthopedic Trauma, Peking University Third Hospital, No. 49 North Garden Road, HaiDian District, 100191, Beijing, China.
| | - F Zhou
- Orthopedic Trauma, Peking University Third Hospital, No. 49 North Garden Road, HaiDian District, 100191, Beijing, China.
| | - L Shang
- Orthopedic Trauma, Peking University Third Hospital, No. 49 North Garden Road, HaiDian District, 100191, Beijing, China
| | - Y Guo
- Orthopedic Trauma, Peking University Third Hospital, No. 49 North Garden Road, HaiDian District, 100191, Beijing, China
| | - Y Lv
- Orthopedic Trauma, Peking University Third Hospital, No. 49 North Garden Road, HaiDian District, 100191, Beijing, China
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Cementless Titanium Mesh Fixation of Osteoporotic Burst Fractures of the Lumbar Spine Leads to Bony Healing: Results of an Experimental Sheep Model. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4094161. [PMID: 27019848 PMCID: PMC4785241 DOI: 10.1155/2016/4094161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/04/2016] [Indexed: 01/12/2023]
Abstract
Introduction. Current treatment strategies for osteoporotic vertebral compression fractures (VCFs) focus on cement-associated solutions. Complications associated with cement application are leakage, embolism, adjacent fractures, and compromise in bony healing. This study comprises a validated VCF model in osteoporotic sheep in order to (1) evaluate a new cementless fracture fixation technique using titanium mesh implants (TMIs) and (2) demonstrate the healing capabilities in osteoporotic VCFs. Methods. Twelve 5-year-old Merino sheep received ovariectomy, corticosteroid injections, and a calcium/phosphorus/vitamin D-deficient diet for osteoporosis induction. Standardized VCFs (type AO A3.1) were created, reduced, and fixed using intravertebral TMIs. Randomly additional autologous spongiosa grafting (G1) or no augmentation was performed (G2, n = 6 each). Two months postoperatively, macroscopic, micro-CT and biomechanical evaluation assessed bony consolidation. Results. Fracture reduction succeeded in all cases without intraoperative complications. Bony consolidation was proven for all cases with increased amounts of callus development for G2 (58.3%). Micro-CT revealed cage integration. Neither group showed improved results with biomechanical testing. Conclusions. Fracture reduction/fixation using TMIs without cement in osteoporotic sheep lumbar VCF resulted in bony fracture healing. Intravertebral application of autologous spongiosa showed no beneficial effects. The technique is now available for clinical use; thus, it offers an opportunity to abandon cement-associated complications.
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15
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He P, Zhang Z, Li Y, Xu D, Wang H. Efficacy and Safety of Tranexamic Acid in Bilateral Total Knee Replacement: A Meta-Analysis and Systematic Review. Med Sci Monit 2015; 21:3634-42. [PMID: 26619817 PMCID: PMC4664225 DOI: 10.12659/msm.895027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Tranexamic acid (TXA) has been well documented to reduce blood loss and transfusion requirements in patients undergoing unilateral total knee arthroplasty (TKA). However, the efficacy and safety of TXA in simultaneous bilateral TKA have not been clearly defined. The aim of our study was to systematically review the existing evidence regarding the role of TXA in patients undergoing simultaneous bilateral TKA. Material/Methods A systematic search of all studies published through June 2014 was performed using Medline, EMBASE, OVID, and other databases. All studies that compared the efficacy and safety of TXA administration in simultaneous bilateral TKA patients were identified. The data from the included trials were extracted and analyzed regarding blood loss and transfusion rates. The evidence quality levels of the selected articles were evaluated using a grading system. Results Six studies were included, in which a total of 245 patients received TXA and 271 patients were controls. Overall, the results demonstrated that the use of TXA significantly reduced total blood loss by a mean of 371.1 ml (95% confidence interval (CI)=−412.12 to −330.09; p<0.001) and reduced the number of patients requiring blood transfusion (risk ratio (RR)=0.16; 95% CI=0.10 to 0.28; p<0.001). No significant differences in adverse effects such as deep vein thrombosis (DVT) or pulmonary embolism (PE) were noted in any group. Conclusions The intravenous use of TXA in patients undergoing simultaneous bilateral TKA is effective and safe and results in significantly reduced estimated blood loss and transfusion rates. No significant difference was observed in the incidence of side effects. Due to the limitations in the evidence quality of current meta-analyses, well-conducted, larger, high-quality randomized controlled trials (RCTs) are required.
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Affiliation(s)
- Peiheng He
- Department of Orthopedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Ziji Zhang
- Department of Orthopedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Yumin Li
- Department of Orthopedics, Nanning People's Hospital, Nanning, Guangxi, China (mainland)
| | - Dongliang Xu
- Department of Orthopedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Hua Wang
- Department of Orthopedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
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Eschler A, Röpenack P, Herlyn PKE, Roesner J, Pille K, Büsing K, Vollmar B, Mittlmeier T, Gradl G. The standardized creation of a lumbar spine vertebral compression fracture in a sheep osteoporosis model induced by ovariectomy, corticosteroid therapy and calcium/phosphorus/vitamin D-deficient diet. Injury 2015; 46 Suppl 4:S17-23. [PMID: 26542861 DOI: 10.1016/s0020-1383(15)30014-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Vertebral compression fractures (VCFs) are one of the most common injuries in the aging population presenting with an annual incidence of 1.4 million new cases in Europe. Current treatment strategies focus on cement-associated solutions (kyphoplasty/vertebroplasty techniques). Specific cement-associated problems as leakage, embolism and the adjacent fracture disease are reported adding to open questions like general fracture healing properties of the osteoporotic spine. In order to analyze those queries animal models are of great interest; however, both technical difficulties in the induction of experimental osteoporosis in animal as well as the lack of a standardized fracture model impede current and future in vivo studies. This study introduces a standardized animal model of an osteoporotic VCF type A3.1 that may enable further in-depth analysis of the afore mentioned topics. MATERIAL AND METHODS Twenty-four 5-year-old female Merino sheep (mean body weight: 67 kg; range 57-79) were ovariectomized (OP1) and underwent 5.5 months of weekly corticosteroid injections (dexamethasone and dexamethasone-sodium-phosphate), adding to a calcium/phosphorus/vitamin D-deficient diet. Osteoporosis induction was documented by pQCT and micro-CT BMD (bone mineral density) as well as 3D histomorphometric analysis postoperatively of the sheep distal radius and spine. Non osteoporotic sheep served as controls. Induction of a VCF of the second lumbar vertebra was performed via a mini-lumbotomy surgical approach with a standardized manual compression mode (OP2). RESULTS PQCT analysis revealed osteoporosis of the distal radius with significantly reduced BMD values (0.19 g/cm(3), range 0.13-0.22 vs. 0.27 g/cm(3), range 0.23-0.32). Micro-CT documented significant lowering of BMD values for the second lumbar vertebrae (0.11 g/cm(3), range 0.10-0.12) in comparison to the control group (0.14 g/cm(3), range 0.12-0.17). An incomplete burst fracture type A3.1 was achieved in all cases and resulted in a significant decrease in body angle and vertebral height (KA 4.9°, range: 2-12; SI 4.5%, range: 2-12). With OP1, one minor complication (lesion of small bowel) occurred, while no complications occurred with OP2. CONCLUSIONS A suitable spinal fracture model for creation of VCFs in osteoporotic sheep was developed. The technique may promote the development of improved surgical solutions for VCF treatment in the experimental and clinical setting.
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Affiliation(s)
- Anica Eschler
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Germany.
| | - Paula Röpenack
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Germany
| | - Philipp K E Herlyn
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Germany
| | - Jan Roesner
- Clinic for Anesthesiology and Critical Care Medicine, University of Rostock, Medical Center, Germany
| | - Kristin Pille
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Germany
| | - Kirsten Büsing
- Chair of Nutrition Physiology and Animal Nutrition, Faculty of Agricultural and Environmental Sciences, University of Rostock, Germany
| | - Brigitte Vollmar
- Rudolf-Zenker Institute for Experimental Surgery, University of Rostock, Medical Center, Germany
| | - Thomas Mittlmeier
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Germany
| | - Georg Gradl
- Dept. of Trauma, Orthopedic and Reconstructive Surgery, Munich Municipal Hospital Group, Clinic Harlaching, Germany
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Bony healing of unstable thoracolumbar burst fractures in the elderly using percutaneously applied titanium mesh cages and a transpedicular fixation system with expandable screws. PLoS One 2015; 10:e0117122. [PMID: 25706642 PMCID: PMC4338244 DOI: 10.1371/journal.pone.0117122] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 12/08/2014] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION There is a high incidence of vertebral burst fractures following low velocity trauma in the elderly. Treatment of unstable vertebral burst fractures using the same principles like in stable vertebral burst fractures may show less favourable results in terms of fracture reduction, maintenance of reduction and cement leakage. In order to address these shortcomings this study introduces cementless fixation of unstable vertebral burst fractures using internal fixators and expandable intravertebral titanium mesh cages in a one-stage procedure via minimum-invasive techniques. MATERIAL AND METHODS A total of 16 consecutive patients (median age 76 years, range 58-94) with unstable thoracolumbar burst fractures and concomitant osteoporosis were treated by an internal fixator inserted via minimum invasive technique one level above and below the fractured vertebra. Fracture reduction was achieved and maintained by transpedicular placement of two titanium mesh cages into the fractured vertebral body during the same procedure. Intra- and postoperative safety of the procedure as well as analysis of reduction quality was analysed by 3D C-arm imaging or CT, respectively. Clinical and radiographic follow-up averaged 10.4 months (range 4.5-24.5). RESULTS Stabilization of the collapsed vertebral body was achieved in all 16 cases without any intraoperative complication. Surgical time averaged 102 ± 6.6 minutes (71-194). The postoperative kyphotic angle (KA) and Cobb angle revealed significant improvements (KA 13.7° to 7.4°, p < 0.001; Cobb 9.6° to 6.0°, p < 0.002) with partial loss of reduction at final follow-up (KA 8.3°, Cobb 8.7°). VAS (Visual Analogue Scale) improved from 7.6 to 2.6 (p < 0.001). Adjacent fractures were not observed. One minor (malposition of pedicle screw) complication was encountered. CONCLUSION Cementless fixation of osteoporotic burst fractures revealed substantial pain relief, adequate maintenance of reduction and a low complication rate. Bony healing after unstable osteoporotic burst fractures is possible. TRIAL REGISTRATION www.germanctr.de DRKS00005657.
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Eschler A, Roepenack P, Herlyn PKE, Roesner J, Martin H, Vollmar B, Mittlmeier T, Gradl G. Intrabody application of eptotermin alpha enhances bone formation in osteoporotic fractures of the lumbar spine; however, fails to increase biomechanical stability - results of an experimental sheep model. Growth Factors 2015; 33:290-7. [PMID: 26365170 DOI: 10.3109/08977194.2015.1077827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study analyses the effect of eptotermin α application into fractured vertebrae. It is hypothesized that eptotermin α is capable to enhance bony healing of the osteoporotic spine. In 10 Merino sheep osteoporosis induction was performed by ovariectomy, corticosteroid therapy and calcium/phosphorus/vitamin D-deficient diet; followed by standardized creation of lumbar vertebral compression fractures (VCFs) type A3.1 and consecutive fracture reduction/fixation using expandable mesh cages. Randomly, intravertebral eptotermin α (G1) or no augmentation was added (G2). Macroscopic, micro-CT, and biomechanical evaluation assessed bony consolidation two months postoperatively: Micro-CT data revealed bony consolidation for all cases with significant increased callus development for G2 (60%) and BV/TV (bone volume/total volume 73.45%, osteoporotic vertebrae 35.76%). Neither group showed improved biomechanical stability. Eptotermin α enhanced mineralisation in VCFs in an experimental setup with use of cementless augmentation via an expandable cage. However, higher bone mineral density did not lead to superior biomechanical properties.
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Affiliation(s)
- Anica Eschler
- a Department of Trauma, Hand and Reconstructive Surgery , Rostock University, Medical Center , Rostock , Germany
| | - Paula Roepenack
- a Department of Trauma, Hand and Reconstructive Surgery , Rostock University, Medical Center , Rostock , Germany
| | - Philipp Karl Ewald Herlyn
- a Department of Trauma, Hand and Reconstructive Surgery , Rostock University, Medical Center , Rostock , Germany
| | - Jan Roesner
- b Clinic for Anesthesiology and Critical Care Medicine, Rostock University, Medical Center , Rostock , Germany
| | - Heiner Martin
- c Institute for Biomedical Engineering, Rostock University, Medical Center , Rostock , Germany
| | - Brigitte Vollmar
- d Rudolf-Zenker-Institute for Experimental Surgery, Rostock University, Medical Center , Rostock , Germany , and
| | - Thomas Mittlmeier
- a Department of Trauma, Hand and Reconstructive Surgery , Rostock University, Medical Center , Rostock , Germany
| | - Georg Gradl
- e Department of Trauma, Orthopedic and Reconstructive Surgery , Munich Municipal Hospital Group, Clinic Harlaching , Munich , Germany
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Percutaneous vertebral body augmentation: an updated review. Surg Res Pract 2014; 2014:815286. [PMID: 25379561 PMCID: PMC4208453 DOI: 10.1155/2014/815286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 04/14/2014] [Indexed: 12/02/2022] Open
Abstract
There are many medical conditions like osteoporosis, tumor, or osteonecrosis that weaken the structural strength of the vertebral body and prone it to fracture. Percutaneous vertebral augmentation that is usually applied by polymethylmethacrylate is a relatively safe, effective, and long lasting procedure commonly performed in these situations. In this paper, we updated a review of biomechanics, indications, contraindications, surgical techniques, complications, and overall prognosis of these minimally invasive spinal procedures.
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Vertebroplasty and kyphoplasty for the treatment of osteoporotic vertebral compression fractures. J Am Acad Orthop Surg 2014; 22:653-64. [PMID: 25281260 DOI: 10.5435/jaaos-22-10-653] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Vertebroplasty and kyphoplasty have been used to treat osteoporotic compression fractures for many years. In 2009, two randomized controlled trials demonstrated limited effectiveness of vertebroplasty over sham treatment; thus, the American Academy of Orthopaedic Surgeons published evidence-based guidelines recommending "against vertebroplasty for patients who present with an osteoporotic spinal compression fracture." However, several other trials have since been published that contradict these conclusions. A recent meta-analysis cited strong evidence in favor of cement augmentation in the treatment of symptomatic vertebral compression fractures.
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Chang X, Lv YF, Chen B, Li HY, Han XB, Yang K, Zhang W, Zhou Y, Li CQ. Vertebroplasty versus kyphoplasty in osteoporotic vertebral compression fracture: a meta-analysis of prospective comparative studies. INTERNATIONAL ORTHOPAEDICS 2014; 39:491-500. [DOI: 10.1007/s00264-014-2525-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 08/31/2014] [Indexed: 11/29/2022]
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Xiao H, Yang J, Feng X, Chen P, Li Y, Huang C, Liang Y, Chen H. Comparing complications of vertebroplasty and kyphoplasty for treating osteoporotic vertebral compression fractures: a meta-analysis of the randomized and non-randomized controlled studies. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25 Suppl 1:S77-85. [DOI: 10.1007/s00590-014-1502-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/18/2014] [Indexed: 12/26/2022]
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Cementless fixation of osteoporotic VCFs using titanium mesh implants (OsseoFix): preliminary results. BIOMED RESEARCH INTERNATIONAL 2014; 2014:853897. [PMID: 25110699 PMCID: PMC4119652 DOI: 10.1155/2014/853897] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Vertebral compression fractures (VCFs) affect 20% of people over the age of 70 with increasing incidence. Kypho-/vertebroplasty as standard operative procedures are associated with limitations like cement leakage, limited reduction capabilities, and risk for adjacent fractures. To address these shortcomings, we introduce a new minimal invasive cementless VCF fixation technique. METHODS Four patients (72.3 years, range 70-76) with VCFs type AO/Müller A1.3 and concomitant osteoporosis were treated by minimal invasive transpedicular placement of two intervertebral mesh cages for fracture reduction and maintenance. Follow-up included functional/radiological assessment and clinical scores and averaged 27.7 months (24-28). RESULTS Endplate reduction was achieved in all cases (mean surgery time: 28.5 minutes). Kyphotic (KA) and Cobb angle revealed considerable improvements postoperatively (KA 14.5° to 10.7°/Cobb 10.1° to 8.3°). Slight loss of vertebral reduction (KA: 12.6°) and segment rekyphosis (Cobb: 10.7°) were observed for final follow-up. Pain improved from 8.8 to 2.8 (visual analogue scale). All cases showed signs of bony healing. No perioperative complications and no adjacent fractures occurred. CONCLUSION Preliminary results in a small, selected patient collective indicate the ability of bony healing for osteoporotic VCFs. Cementless fixation using intravertebral titanium mesh cages revealed substantial pain relief, adequate reduction, and reduction maintenance without complications. Trial registration number is DRKS00005657, German Clinical Trials Register (DKRS).
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Controversial issues in kyphoplasty and vertebroplasty in osteoporotic vertebral fractures. BIOMED RESEARCH INTERNATIONAL 2014; 2014:934206. [PMID: 24724106 PMCID: PMC3960523 DOI: 10.1155/2014/934206] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/17/2014] [Indexed: 12/29/2022]
Abstract
Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed for many years for the treatment of osteoporotic vertebral fractures. The purpose of this review is to resolve the controversial issues raised by the two randomized trials that claimed no difference between VP and SHAM procedure. In particular we compare nonsurgical management (NSM) and KP and VP, in terms of clinical parameters (pain, disability, quality of life, and new fractures), cost-effectiveness, radiological variables (kyphosis correction and vertebral height restoration), and VP versus KP for cement extravasation and complications profile. Cement types and optimal filling are analyzed and technological innovations are presented. Finally unipedicular/bipedicular techniques are compared. Conclusion. VP and KP are superior to NSM in clinical and radiological parameters and probably more cost-effective. KP is superior to VP in sagittal balance improvement and cement leaking. Complications are rare but serious adverse events have been described, so caution should be exerted. Unilateral procedures should be pursued whenever feasible. Upcoming randomized trials (CEEP, OSTEO-6, STIC-2, and VERTOS IV) will provide the missing link.
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