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Lotan R, Lan I, Sakhnini M, Klatzkin L, Hershkovich O. Hydraulic Polymethylmethacrylate Pressure Delivery System Versus Manual Balloon Tamp System in Balloon Kyphoplasty. Global Spine J 2024:21925682241261343. [PMID: 38825843 DOI: 10.1177/21925682241261343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Osteoporotic vertebral compression fractures (VCFs) are prevalent among the elderly population, and Balloon kyphoplasty (BKP) is a minimally invasive solution for these. However, Polymethylmethacrylate (PMMA) leakage is a significant complication with potentially severe consequences. This study compares the safety and efficacy of manual balloon tamp system (MTS) and hydraulic Polymethylmethacrylate pressure delivery system (HPDS) in BKP. METHODS A retrospective study involving 160 patients, comparing MTS (2008-2014) and HPDS (2016-2020) cohorts, assessed PMMA leakage, radiation exposure, and surgery duration. RESULTS PMMA leakage occurred in 52.8% of MTS and 62.5% of HPDS cases. Intradiscal leakage was the most common pattern in both groups. Multivariate logistic regression revealed that multilevel BKP and HPDS were associated with higher PMMA leakage rates. Radiation exposure was significantly lower with HPDS, while surgery duration was shorter. DISCUSSION This study provides novel insights into PMMA leakage and radiation exposure in BKP. HPDS was associated with a higher PMMA leakage rate. HPDS, however, offers advantages in terms of reduced radiation exposure and shorter surgery duration. Multilevel BKP also increased the risk of leakage. Further investigation is needed to better understand the impact of HPDS on PMMA leakage. CONCLUSION This study underscores that while HPDS offers advantages regarding radiation exposure and surgery duration, it is associated with a higher PMMA leakage rate.
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Affiliation(s)
- Raphael Lotan
- Department of Orthopedic Surgery, Wolfson Medical Center, Tel Aviv University School of Medicine, Tel Aviv, Israel
| | - Itzik Lan
- Department of Orthopedic Surgery, Wolfson Medical Center, Tel Aviv University School of Medicine, Tel Aviv, Israel
| | - Mojahed Sakhnini
- Department of Orthopedic Surgery, Rivka Ziv Medical Center, Maimonides, Ziv Medical Centre, Bar-Ilan University's Azrieli Faculty of Medicine, Safed, Israel
| | - Lev Klatzkin
- Department of Orthopedic Surgery, Wolfson Medical Center, Tel Aviv University School of Medicine, Tel Aviv, Israel
| | - Oded Hershkovich
- Department of Orthopedic Surgery, Wolfson Medical Center, Tel Aviv University School of Medicine, Tel Aviv, Israel
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Aregger FC, Gerber F, Albers C, Oswald K, Knoll C, Benneker L, Heini P, Berlemann U, Hoppe S. Long-term follow-up after vertebroplasty - A mean 10-years follow-up control study. BRAIN & SPINE 2024; 4:102783. [PMID: 38618227 PMCID: PMC11015514 DOI: 10.1016/j.bas.2024.102783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/18/2024] [Accepted: 03/01/2024] [Indexed: 04/16/2024]
Abstract
Objectives To evaluate the clinical 10 year outcome of patients treated with percutaneous vertebroplasty for vertebral compression fractures and to determine the incidence of new fractures in this time interval, as well as the mortality of the patients who underwent this procedure. Methods All patients undergoing vertebroplasty for vertebral compression fractures between May 2007 until July 2008 were prospectively followed up at 10 years postoperatively. Patients were assessed for radiologic outcome and self-reported outcome parameters (PROs). Gathered parameters remained unmodified to the initial ones analyzing QoL improvement (EQ5D 3L and NASS score) and pain alleviation (VAS, NRS). Mortality was defined as an additional endpoint. Exclusion criteria include additional instrumentation, use of additional devices such as kyphoplasty balloons/stentoplasty, cognitive impairment, insufficient radiological documentation or absent re-consent. Results Of 280 patients who underwent vertebroplasty, 49 (17.5%) were available for re-assessment with a mean follow-up of 10.5 years (9.9-11.1). Thirty patients (10.7%) were assessed clinically and radiologically, 16 (5.7%) in written form and three (1.1%) by phone only. A total of 186 (66.4%) died during the follow up period. Out of the remaining 45 patients, 27 patients declined participation, eight couldn't participate due to cognitive impairment, four had insufficient radiologic documentation. Six patients were lost to follow-up. At 10 years, patients reported a consistently improved quality of life (EQ-5D; p < 0.01) and global satisfaction. Vertebroplasty demonstrated a substantial and enduring effect on alleviating back pain over 10 years (p < 0.001). 26 (53%) patients experienced a new fracture since the initial procedure. Conclusion A decade following vertebroplasty, patients continue to demonstrate a quality of life and pain level comparable to short and medium-term assessments, with a significant difference from baseline measurements. More than half (53%) of the patients participating at last follow-up experienced new fractures during this interim period. The cohort as a whole has been impacted by an elevated mortality rate over the time period.
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Affiliation(s)
| | - Felix Gerber
- Inselspital Bern, Berne University Hospital, Berne, Switzerland
| | | | | | - Christian Knoll
- AO Foundation/ AO Innovation Translation Center, Dübendorf, Switzerland
| | - Lorin Benneker
- Inselspital Bern, Berne University Hospital, Berne, Switzerland
- Orthopädie Sonnenhof, Berne, Switzerland
| | - Paul Heini
- Orthopädie Sonnenhof, Berne, Switzerland
| | - Ulrich Berlemann
- Wirbelsäulenmedizin Bern, Hirslanden Salem-Spital, Berne, Switzerland
| | - Sven Hoppe
- Inselspital Bern, Berne University Hospital, Berne, Switzerland
- Wirbelsäulenmedizin Bern, Hirslanden Salem-Spital, Berne, Switzerland
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Lu HT, Lin JY, Tsuei YC, Hsu YF, Chen CY, Cheng SH, Chu W, Li C, Chu WC. Impact of Aspiration Percutaneous Vertebroplasty in Reducing Bone Cement Leakage and Enhancing Distribution-An Ex Vivo Study in Goat Vertebrae. Bioengineering (Basel) 2023; 10:795. [PMID: 37508822 PMCID: PMC10376675 DOI: 10.3390/bioengineering10070795] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
Osteoporosis-induced vertebral compression fracture (OVCF) occurs commonly in people over the age of 50, especially among menopausal women. Besides conservative therapy, minimally invasive percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used in clinical treatment and achieved good efficacy. However, the leakage of bone cement (CL) during vertebroplasty (PV) is a major risk that can cause (serious) complications such as compression of the spinal cord, pulmonary embolism, or even paraplegia. In this study, we introduced a new aspiration technique with standard PV procedures (APV) to ameliorate the risk of leakage with quantitative verifications of its effectiveness. APV intends to create a differential pressure to guide the direction of cement flow within the vertebrae. To test this technique, Nubian goats' ex vivo vertebral bodies (VBs) were used to simulate the PV surgical process in humans. Results show that the proposed APV has a lower leakage rate of 13% compared to the 53% of conventional PV. Additionally, the APV approach achieves more uniform cement distribution via the 9-score method with a value of 7 ± 1.30 in contrast to 4 ± 1.78 by conventional PV.
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Affiliation(s)
- Hsin-Tzu Lu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Jia-Yi Lin
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Yu-Chuan Tsuei
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - Yung-Fu Hsu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Chung-Yi Chen
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Shih-Hao Cheng
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - William Chu
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - Chuan Li
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Woei-Chyn Chu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
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Peng J, Qin J, Huang T, Luo X, Zhong W, Quan Z. Clinical Outcomes of Fracture Haemorrhage Aspiration for Percutaneous Vertebroplasty in Treating Osteoporotic Vertebral Compression Fractures. J Pain Res 2022; 14:3951-3959. [PMID: 35002314 PMCID: PMC8725857 DOI: 10.2147/jpr.s345760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/21/2021] [Indexed: 12/28/2022] Open
Abstract
Background A retrospective study aimed to introduce a new method for improving the diffusion degree of bone cement and to observe its clinical efficacy in percutaneous vertebroplasty treating osteoporotic vertebral compression fractures (OVCFs). Methods From January 2019 to March 2020, a total of 83 patients were enrolled and reviewed. The patients were divided into two groups according to the operation method. The clinical and radiographic parameters were recorded and compared between these two groups. Those who received percutaneous vertebroplasty with haemorrhage aspiration were recorded as group A (n=42). In group A, the haemorrhage in the vertebral fracture was aspirated compared with conventional percutaneous vertebroplasty. Patients who underwent conventional percutaneous vertebroplasty were classified as group B (n=41). Results Visual analogue scale (VAS) values and Oswestry Disability Index (ODI) scores showed no significant difference between the two groups preoperatively, postoperatively or at the final follow-up (FU) (P>0.05). The intraoperative VAS score (bone cement injection) in group A was significantly lower than that in group B (3.83±0.79 vs 5.44±1.32, P < 0.01). The local kyphotic angle (LKA) (final follow-up), LKA loss, fractured vertebral anterior height loss (FVAHL) and anterior vertebral height loss ratio (AVHLR) were significantly lower in group A than in group B. The anterior vertebral height ratio (AVHR) at the final FU in group A was higher than that in group B (P=0.013). The distribution of bone cement was significantly different (P=0.034). By analysing the distribution pattern of bone cement, it was found that the values of LKA loss, FVAHL and AVHLR were superior in the type A bone cement distribution to those in types B and C. Conclusion Compared with traditional surgical methods, bone haemorrhage aspiration could improve the diffusion degree of bone cement and reduce the height loss and deformity of injured vertebrae. This method provides a feasible new scheme for improving the dispersion of bone cement.
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Affiliation(s)
- Junmu Peng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.,Department of Orthopedic Surgery, The Ninth People's Hospital of Chongqing, Chongqing, 400799, People's Republic of China
| | - Jie Qin
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Tianji Huang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Xiaoji Luo
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Weiyang Zhong
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Zhengxue Quan
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
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Yan J, Liu Q, Zheng Y, Liu Z, Liu X, Guo X, Liu P, Chen P, Yuan S, Tian Y, Xu W. Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution. J Orthop Surg Res 2020; 15:259. [PMID: 32653022 PMCID: PMC7353696 DOI: 10.1186/s13018-020-01779-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022] Open
Abstract
Background Percutaneous vertebroplasty is the most common treatment for osteoporotic vertebral compression fracture. However, the morbidity of vertebroplasty-related complications, such as cement leakage, remains high. We tested a new technique of unilateral pulsed jet lavage and investigated its effect on the intravertebral pressure and bone cement distribution. Methods Thirty lumbar vertebrae (L1-L5) from six cadaver spines were randomly allocated into two groups (with and without irrigation). Prior to vertebroplasty, pulsed jet lavage was performed through one side of the pedicle by using a novel cannula with two concentric conduits to remove the fat and bone marrow of the vertebral bodies in the group with irrigation. The control group was not irrigated. Then, standardized vertebroplasty was performed in the vertebral bodies in both groups. Changes in the intravertebral pressure during injection were recorded. Computed tomography (CT) was performed to observe the cement distribution and extravasations, and the cement mass volume (CMV) was calculated. Results During cement injection, the average maximum intravertebral pressure of the unirrigated group was higher than that of the irrigated group (4.92 kPa versus 2.22 kPa, P < 0.05). CT scans showed a more homogeneous cement distribution with less CMV (3832 mm3 vs. 4344 mm3, P < 0.05) and less leakage rate (6.7% vs. 46.7%, P < 0.05) in the irrigated group than in the control group. Conclusions Unilateral pulsed jet lavage can reduce intravertebral pressure and lower the incidence of cement leakage during vertebroplasty. An enhanced bone cement distribution can also be achieved through this lavage system.
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Affiliation(s)
- Jun Yan
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Qiaohui Liu
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yanping Zheng
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
| | - Ziqun Liu
- Department of Spine Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Xun Guo
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, People's Republic of China
| | - Penghui Liu
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Peng Chen
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Wanlong Xu
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
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