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Pan H, Li H, Liu T, Xiao C, Li S. Finite element analysis of precise puncture vertebral augmentation in the treatment of different types of osteoporotic vertebral compression fractures. BMC Musculoskelet Disord 2024; 25:599. [PMID: 39080550 PMCID: PMC11287837 DOI: 10.1186/s12891-024-07735-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 07/25/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Osteoporosis vertebral compression fracture (OVCF) secondary to osteoporosis is a common health problem in the elderly population. Vertebral augmentation (VA) has been widely used as a minimally invasive surgical method. The transpedicle approach is commonly used for VA puncture, but sometimes, it is limited by the anatomy of the vertebral body and can not achieve good surgical results. Therefore, we propose the treatment of OVCF with precise puncture vertebral augmentation (PPVA). This study used finite element analysis to explore the biomechanical properties of PPVA in the treatment of osteoporotic vertebral compression fractures (OVCFs) with wedge, biconcave, and collapse deformities. METHOD Three-dimensional finite element models of the fractured vertebral body and adjacent superior and inferior vertebral bodies were established using Computed Tomography (CT) data from patients with OVCF, both before and after surgery. Evaluate the stress changes of the wedged deformed vertebral body, biconcave deformed vertebral body, collapsed deformed vertebral body, and adjacent vertebral bodies before and after PPVA. RESULT In vertebral bodies with wedge deformity and collapsed deformity, PPVA can effectively reduce the stress on the vertebral body but increases the stress on the vertebral body with biconcave deformity. PPVA significantly decreases the stress on the adjacent vertebral bodies of the wedge deformed vertebral body, and decreases the stress on the adjacent superior vertebral body of biconcave deformity and collapsed deformed vertebral bodies, but increases the stress on the adjacent inferior vertebral bodies. PPVA improves the stress distribution of the vertebral body and prevents high-stress areas from being concentrated on one side of the vertebral body. CONCLUSION PPVA has shown positive surgical outcomes in treating wedge deformed and collapsed deformed vertebral bodies. However, its effectiveness in treating biconcave vertebral body is limited. Furthermore, PPVA has demonstrated favorable results in addressing adjacent superior vertebral body in three types of fractures.
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Affiliation(s)
- Hongyu Pan
- Department of Spinal Surgery, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Hongtao Li
- Department of Spinal Surgery, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Tianzhu Liu
- Neurological Disease Center, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Changming Xiao
- Department of Spinal Surgery, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Sen Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
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Shi D, Li X, Huang F, Wei G, Lin Z. Unilateral percutaneous vertebroplasty in osteoporotic vertebral compression fractures: A clinical efficacy evaluation. Exp Ther Med 2024; 27:151. [PMID: 38476906 PMCID: PMC10928977 DOI: 10.3892/etm.2024.12439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/05/2024] [Indexed: 03/14/2024] Open
Abstract
Osteoporotic vertebral compression fractures, often resulting from low-energy trauma, markedly impair the quality of life of elderly individuals. The present retrospective study focused on the clinical efficacy of unilateral percutaneous vertebroplasty (PVP) in the treatment of osteoporotic compression fractures. A total of 68 patients, representing 92 vertebral bodies, who underwent the unilateral PVP technique from March 2020 to January 2023 were evaluated. Key parameters such as visual analogue scale (VAS) values, Oswestry disability index (ODI) scores, Cobb angle measurements, and anterior vertebral height (AVH) were documented pre- and post-surgery. The mean follow-up period was 15.41±3.74 months. The mean pre-operative VAS score was 8.08±0.79, which was significantly reduced to 2.25±0.71 by 24 h post-surgery and stabilized at 1.58±0.51 by the final follow-up. The ODI showed a significant improvement from a pre-operative average of 67.75±7.91 to 19.74±2.90 post-surgery, and was maintained at a low level of 28.00±4.89 at the last assessment. Radiological evaluations revealed significant alterations in Cobb angle and AVH post-operation. Notably, during the follow-up, eight patients developed new compression fractures in different vertebral segments. In conclusion, the unilateral PVP method is safe and efficient for the management of osteoporotic vertebral compression fractures.
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Affiliation(s)
- Dongdong Shi
- Department of Spine Surgery, People's Liberation Army Hospital No. 923, Nanning, Guangxi 530021, P.R. China
| | - Xiaoling Li
- Department of Spine Surgery, People's Liberation Army Hospital No. 923, Nanning, Guangxi 530021, P.R. China
| | - Fang Huang
- Department of Spine Surgery, People's Liberation Army Hospital No. 923, Nanning, Guangxi 530021, P.R. China
| | - Gejin Wei
- Department of Spine Surgery, People's Liberation Army Hospital No. 923, Nanning, Guangxi 530021, P.R. China
| | - Zhoudan Lin
- Department of Spine Surgery, People's Liberation Army Hospital No. 923, Nanning, Guangxi 530021, P.R. China
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Zhu D, Hu J, Wang L, Zhu J, Ma S, Liu B. A Comparison Between Modified Unilateral Extrapedicular and Bilateral Transpedicular Percutaneous Kyphoplasty in the Treatment of Lumbar Osteoporotic Vertebral Compression Fracture. World Neurosurg 2022; 166:e99-e108. [PMID: 35779757 DOI: 10.1016/j.wneu.2022.06.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few researchers have verified the clinical efficacy and safety of the modified unilateral extrapedicular approach (mUEP) applied to the percutaneous kyphoplasty (PKP) in comparative studies with other puncture techniques. Compared with the bilateral transpedicular approach (BTP), whether mUEP PKP is a preferred treatment for lumbar osteoporotic vertebral compression fracture (OVCF) remains unclear. METHODS Patients treated by PKP for single-level lumbar OVCF in our institution from September 2019 to December 2020 were retrospectively enrolled. Patients were grouped according to the puncture techniques. Clinical and radiologic outcomes were evaluated preoperatively, postoperatively, and at follow-up. The clinical evaluation was performed by using visual analog scale for pain relief and Oswestry Disability Index for health status. Radiologic measurements contained anterior vertebral height, kyphotic angle, and bone cement distribution. RESULTS In total, 76 patients with a mean follow-up duration of 16.6 months were enrolled, including 34 patients in the mUEP PK group and 42 patients in the BTP PKP group. In the mUEP group, operation time, fluoroscopy times, and injected cement volume were significantly less than that in the BTP group (P < 0.01). Both visual analog scale and Oswestry Disability Index scores of all patients decreased significantly after surgery (P < 0.01), with no significant differences between the 2 groups at each follow-up. Both mUEP PKP and BTP PKP showed significant anterior height restoration and kyphotic angle correction (P < 0.01), with no significant differences between the 2 groups at each follow-up. Meanwhile, the mUEP PKP reduced the incidence of intraspinal cement leakage (P < 0.05), and no facet joint violation was found in mUEP PKP. CONCLUSIONS mUEP PKP could be clinically and radiographically equivalent to BTP PKP. However, it has advantages in reducing operation time and fluoroscopy times, lowering the risk of intraspinal cement leakage, and preventing the presence of facet joint violation. Compared with BTP PKP, the mUEP PKP seems to be an effective and alternative puncture technique for the treatment of lumbar OVCF after appropriate patient selection.
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Affiliation(s)
- Di Zhu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junnan Hu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lei Wang
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jichao Zhu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Song Ma
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baoge Liu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Jiang Y, Li J, Yuan S, Zuo R, Liu C, Zhang J, Ma M. A modified trajectory of kyphoplasty via superior pedicle notch for osteoporotic vertebral compression fractures: Technique note and clinical result. Front Surg 2022; 9:1012160. [PMID: 36277295 PMCID: PMC9583662 DOI: 10.3389/fsurg.2022.1012160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background Percutaneous extra-pedicular kyphoplasty can achieve better clinical results than transpedicular kyphoplasty. However, lumbar segment artery injury as a disaster complication limits its clinical application. Objective To describe and evaluate a modified trajectory of kyphoplasty for the treatment of osteoporotic vertebral compression fractures (OVCF). Methods Eighty-one patients who underwent percutaneous kyphoplasty (PKP) for lumbar OVCF at our hospital between May 2017 and May 2021 were enrolled. The patients were divided into an observation group (via the superior pedicle approach) and a control group (via the transpedicular approach) according to the surgical trajectory. The surgical procedure was described in detail, and the imaging parameters were recorded. Preoperative and postoperative clinical data were collected for statistical analysis. Results PKP via the superior pedicle notch approach could offer large abduction and cranial inclination angles without serious complications. The rate of paravertebral leakage was significantly lower in the observation group than in the control group. Surgery with a superior pedicle notch approach had a shorter operative time and fewer fluoroscopies. Conclusions PKP via the superior pedicle notch approach is a modified extra-pedicular approach for lumbar osteoporotic vertebral compression fractures. This trajectory is an easy-to-use target position because it enters the vertebral body directly. A shorter operative time and lower radiation exposure can enhance recovery after surgery.
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Yan BC, Fan YF, Tian QH, Wang T, Huang ZL, Song HM, Li Y, Jiao L, Wu CG. Efficacy and Safety of the Safe Triangular Working Zone Approach in Percutaneous Vertebroplasty for Spinal Metastasis. Korean J Radiol 2022; 23:901-910. [PMID: 35926840 PMCID: PMC9434739 DOI: 10.3348/kjr.2021.0914] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 06/09/2022] [Accepted: 06/19/2022] [Indexed: 12/05/2022] Open
Abstract
Objective This study aimed to assess the technical feasibility, efficacy, and safety of the safe triangular working zone (STWZ) approach applied in percutaneous vertebroplasty (PV) for spinal metastases involving the posterior part of the vertebral body. Materials and Methods We prospectively enrolled 87 patients who underwent PV for spinal metastasis involving the posterior part of the vertebral body, with or without the STWZ approach, from January 2019 to April 2022. Forty-nine patients (27 females and 22 males; mean age ± standard deviation [SD], 57.2 ± 11.6 years; age range, 31–76 years) were included in group A (with STWZ approach), accounting for 54 vertebrae. Thirty-eight patients (18 females and 20 males; 59.1 ± 10.9 years; 29–81 years) were included in group B (without STWZ approach), accounting for 57 vertebrae. Patient demographics, procedure-related variables, and pain relief as assessed using the visual analog scale (VAS) were collected at different time points. Tumor recurrence in the vertebrae after PV was analyzed using Kaplan–Meier curves. Results The STWZ approach was successful from T1 to L5 without severe complications. Cement filling was satisfactory in 47/54 (87.0%) and 25/57 (43.9%) vertebrae in groups A and B, respectively (p < 0.001). Cement leakage was not significantly different between groups A and B (p = 1.000). Mean VAS score ± SD before and 1 week and 1, 3, 6, 9, and 12 months after PV were 7.6 ± 1.8, 4.2 ± 2.0, 2.7 ± 1.9, 1.9 ± 1.5, 1.7 ± 1.4, 1.7 ± 1.1, and 1.6 ± 1.3, respectively, in group A and 7.2 ± 1.7, 4.0 ± 1.3, 3.4 ± 1.6, 2.4 ± 1.2, 1.8 ± 1.0, 1.4 ± 0.5, and 1.7 ± 0.9, respectively, in group B. Kaplan–Meier analysis showed a lower tumor recurrence rate in group A than in group B (p = 0.001). Conclusion The STWZ approach may represent a new, safe, alternative/auxiliary approach to target the posterior part of the vertebral body in the PV for spinal metastases.
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Affiliation(s)
- Bi Cong Yan
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yan Feng Fan
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qing Hua Tian
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tao Wang
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhi Long Huang
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hong Mei Song
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Lei Jiao
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chun Gen Wu
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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陈 昊, 潘 文, 张 有, 邢 朝, 张 柏, 孙 宝, 甄 志, 龚 良, 徐 寒. [Epidemiological and clinical characteristics analysis of 681 cases of thoracolumbar osteoporotic vertebral compression fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:873-880. [PMID: 35848185 PMCID: PMC9288900 DOI: 10.7507/1002-1892.202204026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/24/2022] [Indexed: 01/24/2023]
Abstract
Objective To investigate the epidemiological and clinical characteristics of patients with thoracolumbar osteoporotic vertebral compression fracture (OVCF) treated by percutaneous vertebroplasty (PVP). Methods The clinical and imaging data of 681 patients with thoracolumbar OVCF treated with PVP between January 2017 and December 2021 were collected. The epidemiological and clinical characteristics of the patients with thoracolumbar OVCF in single center were summarized from the aspects of demographic distribution (mainly including gender, age), fracture characteristic analysis [including pathological segments, bone mineral density, and body mass index (BMI)], and operation related results (including the distribution of unilateral and bilateral puncture and bone cement injection, postoperative effectiveness analysis and refracture). Results Of the 681 patients, 134 (19.68%) were male and 547 (80.32%) were female, with a male-to-female ratio of 1∶4.08. The age ranged from 53 to 105 years, with an average of 75.3 years. The age group of 60-90 years old had the largest number of patients (91.04%); the high incidence age group of men was 70-90 years old (13.95%), and that of women was 60-80 years old (72.98%). A total of 836 vertebrae were involved, and the morbidity of thoracolumbar vertebrae (T 11-L 1) was the highest (56.34%, 471/836). The main type of fracture was compression fracture (92.58%, 774/836) and Kümmell disease (7.42%, 62/836). There were 489 cases (71.81%) of osteoporosis, including 66 males and 423 females, with a male-to-female ratio of 1∶6.42. There was significant difference in distribution of bone mineral density between male and female groups ( Z=-5.810, P<0.001). BMI showed 206 cases (30.25%) of underweight, 347 (50.95%) cases of normal, 58 cases (8.52%) of overweight, 42 cases (6.17%) of obese, and 28 cases (4.11%) of extremely obese. The difference in BMI distribution between male and female groups was significant ( Z=-2.220, P=0.026). Of 836 vertebral bodies, 472 (56.46%) were punctured unilaterally and 364 (43.54%) bilaterally. Most of the vertebral bodies (49.88%, 417/836) were injected with 5.0-6.9 mL bone cement, and most of them were distributed in thoracolumbar and lumbar vertebral bodies (T 11-L 3). The visual analogue scale (VAS) score and Oswestry disability index (ODI) of patients with unilateral puncture and bilateral puncture significantly improved at 6 months after operation ( P<0.001), and also the difference was significant between the two groups in the difference of pre- and post-operation ( P<0.001). There were 628 cases (92.22%) with the first occurrence of OVCF, and 53 cases (7.78%) with two or more times of OVCF, all of which were female patients, and 26 cases (49.06%) occurred in the adjacent segment of the previous PVP operation. Conclusion Female were more than male in OVCF patients. Thoracolumbar vertebral body has the highest morbidity. Patients with low BMI are more likely to have osteoporosis, and patients with high BMI have a higher risk of compression fracture. The amount of bone cement injected through bilateral puncture was greater than that through unilateral puncture.
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Affiliation(s)
- 昊 陈
- 北京德尔康尼骨科医院骨二科(北京 100143)The Second Department of Orthopedics, Beijing DCN Orthopedic Hospital, Beijing, 100143, P. R. China
| | - 文琦 潘
- 北京德尔康尼骨科医院骨二科(北京 100143)The Second Department of Orthopedics, Beijing DCN Orthopedic Hospital, Beijing, 100143, P. R. China
| | - 有磊 张
- 北京德尔康尼骨科医院骨二科(北京 100143)The Second Department of Orthopedics, Beijing DCN Orthopedic Hospital, Beijing, 100143, P. R. China
| | - 朝辉 邢
- 北京德尔康尼骨科医院骨二科(北京 100143)The Second Department of Orthopedics, Beijing DCN Orthopedic Hospital, Beijing, 100143, P. R. China
| | - 柏青 张
- 北京德尔康尼骨科医院骨二科(北京 100143)The Second Department of Orthopedics, Beijing DCN Orthopedic Hospital, Beijing, 100143, P. R. China
| | - 宝亭 孙
- 北京德尔康尼骨科医院骨二科(北京 100143)The Second Department of Orthopedics, Beijing DCN Orthopedic Hospital, Beijing, 100143, P. R. China
| | - 志雷 甄
- 北京德尔康尼骨科医院骨二科(北京 100143)The Second Department of Orthopedics, Beijing DCN Orthopedic Hospital, Beijing, 100143, P. R. China
| | - 良伟 龚
- 北京德尔康尼骨科医院骨二科(北京 100143)The Second Department of Orthopedics, Beijing DCN Orthopedic Hospital, Beijing, 100143, P. R. China
| | - 寒 徐
- 北京德尔康尼骨科医院骨二科(北京 100143)The Second Department of Orthopedics, Beijing DCN Orthopedic Hospital, Beijing, 100143, P. R. China
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