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Takano H, Nojiri H, Shimura A, Teramoto J, Sugawara Y, Ishijima M. Early Balloon Kyphoplasty Treatment for Osteoporotic Vertebral Fracture Reduces Adjacent Vertebral Fractures. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1097. [PMID: 39064526 PMCID: PMC11278625 DOI: 10.3390/medicina60071097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: This study retrospectively examined whether the incidence rates of adjacent vertebral fractures (AVFs) can be reduced through balloon kyphoplasty (BKP) for osteoporotic vertebral fractures (OVFs) in the early stages, when there is little vertebral height variation. Materials and Methods: A total of 95 patients (22 males, 73 females, mean age: 80.7 years) who had undergone BKP were divided into two groups: the Early group (underwent BKP within 2 weeks after injury, n = 62), and the Non-early group (underwent BKP > 2 weeks after injury, n = 33). The following data were analyzed: patient characteristics; fracture level; the presence of old vertebral fractures, posterior wall injury, and intravertebral cleft; duration of surgery; duration of hospitalization; cement volume; the occurrence of AVF; the timing of AVF occurrence; Numerical Rating Scale (NRS) scores at the preoperative, postoperative, and final follow-up assessments; posterior vertebral kyphosis angle of the affected vertebra on plain lateral X-ray; vertebral wedge ratio; local kyphotic angle; and changes in posterior vertebral kyphosis angle, vertebral wedge ratio, and local kyphotic angle between preoperative and postoperative assessments. The patients were divided based on the occurrence or non-occurrence of AVF after BKP: the Non-AVF group, in which AVF did not occur, and the AVF group, in which AVF occurred. Results: The incidence of AVF was 15.8% (15/95 patients), with a notably lower incidence rate in the Early group at 6.5% (4/62 patients) compared to the Non-early group at 33.3% (11/33 patients). NRS scores significantly improved in both groups at the postoperative assessment and final follow-up. The changes in posterior vertebral kyphosis angle and vertebral wedge ratio were significantly lower in the Early group. In the Non-AVF group, the time from injury to surgery was significantly shorter. Conclusions: The Early group had a significantly lower incidence of AVF. The time from injury to surgery was a risk factor for AVF occurrence, suggesting that early BKP is recommended.
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Affiliation(s)
- Hiromitsu Takano
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
- Spine and Spinal Cord Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Hidetoshi Nojiri
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
- Spine and Spinal Cord Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Arihisa Shimura
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
- Spine and Spinal Cord Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Juri Teramoto
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
- Spine and Spinal Cord Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Yuta Sugawara
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
- Spine and Spinal Cord Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Muneaki Ishijima
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
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Spicher A, Lindtner RA, Zegg MJ, Schmid R, Hoermann R, Schmoelz W. Pedicle screw augmentation in posterior constructs of the thoracolumbar spine: How many pedicle screws should be augmented? Clin Biomech (Bristol, Avon) 2023; 106:106010. [PMID: 37245280 DOI: 10.1016/j.clinbiomech.2023.106010] [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] [Received: 02/10/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUNDS To evaluate the effects of different pedicle screw augmentation strategies on screw loosening and adjacent segment collapse at the proximal end of long-segment instrumentation. METHODS Eighteen osteoporotic (9 male, 9 female donors; mean age: 74.7 ± 10.9 [SD] years) thoracolumbar multi-segmental motion segments (Th11 - L1) were assigned as follows: control, one-level augmented screws (marginally), and two-level augmented screws (fully augmented) groups (3 × 6). Pedicle screw placement was performed in Th12 and L1. Cyclic loading in flexion started with 100-500 N (4 Hz) and was increased by 5 N every 500 cycles. Standardized lateral fluoroscopy images with 7.5 Nm loading were obtained periodically during loading. The global alignment angle was measured to evaluate the overall alignment and proximal junctional kyphosis. The intra-instrumental angle was used to evaluate screw fixation. FINDINGS Considering screw fixation as a failure criterion, the failure loads of the control (683 N), and marginally (858 N) and fully augmented (1050 N) constructs were significantly different (ANOVA p = 0.032).Taking the overall specimen alignment as failure criteria, failure loads of the three groups (control 933 ± 271.4 N, marginally 858 N ± 196 N, and full 933 ± 246.3 N were in the same range and did not show any significance (p = 0.825). INTERPRETATION Global failure loads were comparable among the three groups and unchanged with augmentation because the adjacent segment and not the instrumentation failed first. Augmentation of all screws showed significant improved in screw anchorage.
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Affiliation(s)
- Anna Spicher
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Austria
| | | | - Michael Josef Zegg
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Austria
| | - Rene Schmid
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Austria
| | - Romed Hoermann
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Schmoelz
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Austria.
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Song F, Wei Y, Feng W, Fu R, Li Z, Gao X, Cheng X, Yang H. Biomechanical CT-computed bone strength predicts the risk of subsequent vertebral fracture. Bone 2023; 166:116601. [PMID: 36336262 DOI: 10.1016/j.bone.2022.116601] [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: 06/18/2022] [Revised: 10/14/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
Following primary fractures and percutaneous kyphoplasty (PKP), patients have a high risk of incurring a subsequent vertebral fracture (SVF). Given that SVF is a consequence of mechanical deterioration of the vertebra, we sought to examine whether vertebral strength derived from QCT-based finite element analysis (i.e., BCT) can predict the risk of SVF. Sixty-six patients who underwent PKP were categorized into two groups: control or non-SVF group (age: 70 ± 7 years; n = 40) and SVF group (age: 69 ± 8 years; n = 26). BCT was performed on L4 or L3 vertebrae to noninvasively measure vertebral strength. Vertebral strength was also estimated based upon the geometry and material properties of the vertebra. Additionally, trabecular volumetric bone mineral density (vBMD) and L1 Hounsfield unit (HU) were measured. t-Test, χ2 test or Mann Whitney U test were used to compare differences in these parameters between the two groups. The predictive abilities of BCT strength and other measured parameters were evaluated using the receiver operating characteristic (ROC) analysis. Results showed no significant difference in either vBMD or L1 HU between the control and SVF groups (p > 0.05), whereas BCT-computed and estimated vertebral strength values were significantly reduced by 33 % and 24 % for the SVF group relative to the non-SVF group, respectively. ROC curve indicated that BCT strength had the largest area under the curve, compared to other parameters. These results suggest that BCT-computed vertebral strength may serve as a surrogate for assessing risk of SVF.
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Affiliation(s)
- Fei Song
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Yi Wei
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Wentian Feng
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Ruisen Fu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Zuchang Li
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xing Gao
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China.
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Yang B, Zhao Y, Zhao Y. Is percutaneous kyphoplasty safe and beneficial for patients aged 90 and over? Medicine (Baltimore) 2022; 101:e30138. [PMID: 35984140 PMCID: PMC9387994 DOI: 10.1097/md.0000000000030138] [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] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND At present, to a large extent, we do not know the safety and benefits of minimally invasive surgery for elderly patients, especially the focus population of patients aged 90 and over. METHODS We analyzed 189 consecutive patients with osteoporotic vertebral compression fractures who underwent percutaneous kyphoplasty (PKP) between January 2018 and June 2021 at our institution. We divided them into the advanced age group aged 90 years or over (group A, n = 14) and the younger group under 90 years (group Y, n = 175). Clinical and complication indicators were evaluated and compared between the 2 groups. RESULTS A significant difference was observed in the procedure time, bleeding volume, and bone mineral density between the 2 groups during an average follow-up of 22 months. However, no significant difference was revealed in clinical and complication indicators between the 2 groups, and the pain and activity function of the 2 groups were significantly improved compared with those before PKP. CONCLUSIONS Apparently, our results show that PKP is safe and beneficial for patients aged 90 years or older.
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Affiliation(s)
- Bo Yang
- Graduate School of Xi’an Medical University, Xi’an, China
- Department of Orthopaedics, the Ninth Hospital of Xi’an, Xi’an, China
| | - Yu Zhao
- Department of Orthopaedics, the Ninth Hospital of Xi’an, Xi’an, China
| | - Yangxue Zhao
- Department of Orthopaedics, the Ninth Hospital of Xi’an, Xi’an, China
- *Correspondence: Yangxue Zhao, Department of Orthopaedics, the Ninth Hospital of Xi’an, No. 151, East Section of South Second Ring Road, Xi’an China (e-mail:)
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Li J, Liu Y, Peng L, Liu J, Cao ZD, He M. Intervertebral bridging ossification after kyphoplasty in a Parkinson’s patient with Kummell’s disease: A case report. World J Clin Cases 2022; 10:677-684. [PMID: 35097094 PMCID: PMC8771369 DOI: 10.12998/wjcc.v10.i2.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/01/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The short-term therapeutic efficacy of kyphoplasty on Kummell’s disease is obvious. However, postoperative refracture and adjacent vertebral fracture occur occasionally and are difficult to treat. Parkinson's disease (PD) is a pathological disorder associated with heterotopic ossification. In a patient with PD, an intervertebral bridge was formed in a short period of time after postoperative refracture and adjacent vertebral fracture, providing new stability.
CASE SUMMARY A 78-year-old woman had been suffering from PD for more than 10 years. Three months before operation, she developed lower back pain and discomfort. The visual analog scale (VAS) score was 9 points. Preoperative magnetic resonance imaging indicated collapse of the L2 vertebra. Kyphoplasty was performed and significantly decreased the severity of intractable pain. The patient’s VAS score for pain improved from 9 to 2. Fifty days postoperatively, the patient suddenly developed severe back pain, and the VAS score was 9 points. X-ray showed L2 vertebral body collapse, slight forward bone cement displacement, L1 vertebral compression fracture, and severe L1 collapse. The patient was given calcium acetate capsules 0.6 g po qd and alfacalcidol 0.5ug po qd, and bed rest and brace protection were ordered. After conservative treatment for 2 mo, the patient's back pain was alleviated, and the VAS score improved from 9 to 2. Computed tomography at the 7-mo follow-up indicated extensive callus formation around the T12-L2 vertebrae and intervertebral bridging ossification, providing new stability.
CONCLUSION Kyphoplasty is currently a conventional treatment for Kummell's disease, with definite short-term effects. However, complications still occur in the long term, and these complications are difficult to address; thus, the treatment needs to be selected carefully. To avoid refracture, an interlaced structure of bone cement with trabeculae should be created to the greatest extent possible during the injection of bone cement. Surgical intervention may not be urgently needed when a patient with PD experiences refracture and adjacent vertebral fracture, as a strong bridge may help stabilize the vertebrae and relieve pain.
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Affiliation(s)
- Jie Li
- Department of Orthopaedic Surgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing 400010, China
| | - Yun Liu
- Department of Radiology, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing 400010, China
| | - Lei Peng
- Department of Orthopaedic Surgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing 400010, China
| | - Jian Liu
- Department of Orthopaedic Surgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing 400010, China
| | - Zhi-Dong Cao
- Department of Orthopaedic Surgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing 400010, China
| | - Miao He
- Department of Orthopaedic Surgery, Chongqing Emergency Medical Center (Chongqing University Central Hospital), Chongqing 400010, China
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Letter to the editor regarding: "a prospective, international, randomized, noninferiority study comparing an implantable titanium vertebral augmentation device versus balloon kyphoplasty in the reduction of vertebral compression fractures (SAKOS study)". Spine J 2020; 20:2037-2038. [PMID: 32890782 DOI: 10.1016/j.spinee.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 02/03/2023]
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