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Hakami IA. An Outline on the Advancements in Surgical Management of Osteoporosis-Associated Fractures. Cureus 2024; 16:e63226. [PMID: 39070522 PMCID: PMC11280975 DOI: 10.7759/cureus.63226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
Osteoporosis significantly impairs bone density and increases fracture risk, representing a substantial global health challenge. The effectiveness of traditional treatments such as calcium supplementation and exercise in completely preventing fractures is limited. This review explores recent advancements in surgical techniques and treatment modalities to manage osteoporotic fractures better and improve patient outcomes. Osteoporotic fractures demand specialized surgical techniques due to compromised bone quality. Vertebroplasty and kyphoplasty are minimally invasive procedures that provide rapid pain relief and structural support using bone cement. While vertebroplasty is effective, it carries risks of cement leakage and new fractures. Kyphoplasty, with added balloon inflation, reduces leakage risk and improves vertebral height restoration but is costlier. Cement-augmented screws enhance fixation but can increase adjacent fracture risk and pose long-term complications. Surgical advancements encompass robotic-assisted surgery, offering precision and accelerated recovery, alongside biologic agents like bone morphogenetic proteins (BMPs), which enhance bone healing while reducing secondary interventions and eliminating donor site morbidity. Bone graft substitutes such as calcium phosphate cements enhance biomechanical compatibility, decrease morbidity, and reduce fracture loss and pain. Balloon kyphoplasty aids in height restoration and pain relief and diminishes the risk of subsequent vertebral fractures. Bioglass scaffolds promote bone regeneration by improving bone mineral density and lowering the incidence of new fractures. Optimal perioperative care, including patient selection, nutritional management, and early mobilization strategies, is crucial for mitigating risks in vulnerable populations. While current surgical interventions provide significant pain relief and functional benefits, ongoing research and multidisciplinary collaboration are crucial to prospectively refine these techniques and reduce the burden of osteoporosis. New technologies, such as tissue engineering and gene editing, hold potential for future treatment paradigms.
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Affiliation(s)
- Ibrahim A Hakami
- Department of Orthopedic Surgery, College of Medicine, Shaqra University, Dawadmi, SAU
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Chen PW, Liu PC, Lee CC, Lam CT. Thoracic Pyogenic Spondylitis Misdiagnosed As Osteoporotic Compression Fracture Status Post Vertebral Augmentation With Resultant Paraplegia: A Case Report. Cureus 2024; 16:e63497. [PMID: 39081447 PMCID: PMC11287488 DOI: 10.7759/cureus.63497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 08/02/2024] Open
Abstract
This paper describes a case of serious complications following vertebral augmentation resulting from a misdiagnosis of pyogenic spondylitis as osteoporotic compression fracture (OCF). A 56-year-old female with systemic lupus erythematosus underwent vertebral augmentation following a diagnosis of T10 OCF based on plain film analysis. Note that preoperative computed tomography (CT) and magnetic resonance imaging (MRI) were not performed. One day after vertebral augmentation, the patient experienced a recurrence of low back pain with fever and paraplegia. MRI findings revealed paravertebral and epidural soft tissue over T9 and T10 with cord compression. Subsequent laminectomy of T9 and T10 revealed devitalized lamina, epidural abscess, and granulation tissue. Pathological analysis indicated a combination of acute and chronic inflammation. A pus culture identified Staphylococcus aureus, indicative of pre-existing pyogenic spondylitis. Further revision surgery was performed at another hospital. The patient remained in a paraplegic state one year after surgery. Infectious spondylitis often manifests with nonspecific symptoms similar to those of compression fracture, and plain radiographs are insufficient to differentiate between the two, often leading to misdiagnosis and mistreatment. Nonetheless, many practitioners base preoperative planning solely on plain film imaging. We advocate the routine usage of CT and/or MRI for patients diagnosed with compression fractures, particularly for immunocompromised individuals.
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Affiliation(s)
- Po-Wei Chen
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, TWN
| | - Ping-Chuan Liu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, TWN
| | - Chin-Cheng Lee
- Department of Pathology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, TWN
| | - Chee-Tat Lam
- Department of Neurosurgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, TWN
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Yuan H, Li Y, Wang J, Wang X, Lü G, Kuang L, Li J. Spinal infection after vertebral augmentation: a covert complication with serious havoc. Arch Orthop Trauma Surg 2024; 144:1461-1471. [PMID: 38273125 DOI: 10.1007/s00402-024-05205-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Vertebral augmentation, including percutaneous vertebroplasty (PVP) or kyphoplasty (PKP), is the current least invasive surgical option and has been widely used to treat the painful osteoporotic vertebral compression fractures (OVCF). However, the postoperative infections could be life-threatening, even though they rarely occur. Our studies aim to clarify the causation and outcomes of spinal infections following augmentation and meanwhile to identify the risk factors. METHODS A retrospective study was conducted on patients with OVCF who underwent PVP or PKP, and were subsequently admitted to our institution with postoperative spinal infection between January 2010 and December 2022. A total of 33 patients were finally included. RESULTS The rate of spinal infection after augmentation in our single institute was 0.05% (2/3893). In addition to these 2 patients, the remaining 31 were referred from other hospitals. All 33 patients exhibited elevated inflammatory parameters, 14 patients presented with fever, and 9 patients experienced neurological deficits. Additionally, 29 patients had comorbidity and risk factors. Pathogens were identified in 26 patients, while only 7 patients were examined as culture negative. 27 patients underwent revision surgery and 6 patients only received conservative therapy. Anterior surgery was performed in 2 patients, while posterior surgery was performed in 20 patients. A combined anterior-posterior surgery was performed in 5 patients. At the final follow-up, 18 patients had unrestricted mobility, 10 patients required assistance from crutches or a walker for ambulation, 4 patients needed a wheelchair, and 1 patients died after revision surgery. CONCLUSIONS Spinal infection after vertebral augmentation is rare, but it cannot be ignored. Surgeons should make every effort to detect the potential preoperative spondylitis or discitis. Once postoperative spinal infection is confirmed, a prompt intravenous antibiotic therapy is warranted. If medication therapy fails, revision surgery involving debridement and spinal reconstruction should be considered.
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Affiliation(s)
- Hui Yuan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, No. 139, RenMin Middle Road, Changsha, 410001, Hunan, People's Republic of China
| | - Yunchao Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, No. 139, RenMin Middle Road, Changsha, 410001, Hunan, People's Republic of China
| | - Jingyu Wang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, No. 139, RenMin Middle Road, Changsha, 410001, Hunan, People's Republic of China
| | - Xiaobin Wang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, No. 139, RenMin Middle Road, Changsha, 410001, Hunan, People's Republic of China
| | - Guohua Lü
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, No. 139, RenMin Middle Road, Changsha, 410001, Hunan, People's Republic of China
| | - Lei Kuang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, No. 139, RenMin Middle Road, Changsha, 410001, Hunan, People's Republic of China.
| | - Jing Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, No. 139, RenMin Middle Road, Changsha, 410001, Hunan, People's Republic of China.
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Takahashi S, Inose H, Tamai K, Iwamae M, Terai H, Nakamura H. Risk of Revision After Vertebral Augmentation for Osteoporotic Vertebral Fracture: A Narrative Review. Neurospine 2023; 20:852-862. [PMID: 37798981 PMCID: PMC10562240 DOI: 10.14245/ns.2346560.280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 10/07/2023] Open
Abstract
Osteoporotic vertebral fractures (OVFs) can hinder physical motor function, daily activities, and the quality of life in elderly patients when treated conservatively. Vertebral augmentation, which includes vertebroplasty and balloon kyphoplasty, is a commonly used procedure for OVFs. However, there have been reports of complications. Although serious complications are rare, there have been instances of adjacent vertebral fractures, cement dislocation, and insufficient pain relief due to cement failure, sometimes necessitating revision surgery. This narrative review discusses the common risks associated with vertebral augmentation for OVFs, such as cement leakage and adjacent vertebral fractures, and highlights the risk of revision surgery. The pooled incidence of revision surgery was 0.04 (0.02-0.06). The risks for revision are reported as follows: female sex, advanced age, diabetes mellitus, cerebrovascular disease, dementia, blindness or low vision, hypertension, hyperlipidemia, split type fracture, large angular motion, and large endplate deficit. Various treatment strategies exist for OVFs, but they remain a subject of controversy. Current literature underscores the lack of substantial evidence to guide treatment strategies based on the risks of vertebral augmentation. In cases with a high risk of failure, other surgeries and conservative treatments should also be considered as treatment options.
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Affiliation(s)
- Shinji Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroyuki Inose
- Department of Orthopaedic and Trauma Research, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Masayoshi Iwamae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Chen KJ, Huang YC, Yao YC, Yang TC, Lin HH, Wang ST, Chang MC, Chou PH. Investigation of preoperative asymptomatic bacteriuria as a risk factor for postvertebroplasty infection. J Chin Med Assoc 2023; 86:233-239. [PMID: 36652570 DOI: 10.1097/jcma.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Postvertebroplasty infection (PVI) is a catastrophic complication after vertebroplasty (VP). Although the urinary tract has been considered as a source of infectious pathogens, whether asymptomatic bacteriuria (ASB) is a risk factors for PVI remains unknown. METHODS This retrospective study included 716 patients (207 males; 509 females) treated with VP for osteoporotic vertebral fractures in a single medical center between May 2015 and December 2019. Clinical symptoms, urinalysis results, and culture data were collected preoperatively to identify patients with ASB. The primary outcome was PVI at the index level during follow-up. Demographic data and laboratory test results were compared between the PVI and non-PVI groups. RESULTS The mean age of the cohort was 78.6 ± 9.6 (range, 63-106). The prevalence of ASB was 14.1%, with female predominance (63.4%). The overall PVI rate was 1.26% (9/716). The PVI group had more patients with ASB (4/9, 44.4%) than did the non-PVI group (97/707, 13.7%) (p = 0.027). The rate of ASB treatment was similar between the PVI and non-PVI groups (25% vs. 23.7%, respectively). No case of PVI was caused by the urine culture pathogen. Multivariate analysis identified the following risk factors for PVI: ASB (odds ratio [OR], 5.61; 95% CI, 1.14-27.66; p = 0.034), smoking (OR, 16.26; 95% CI, 2.58-102.65; p = 0.003), and malignancy (OR 7.27; 95% CI, 1.31-40.31; p = 0.023). CONCLUSION ASB was not uncommon among patients admitted for VP and should be considered a marker of relatively poor host immunity. Preoperative ASB, a history of malignancy, and smoking were identified as significant risk factors for PVI.
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Affiliation(s)
- Kuan-Jung Chen
- Department of Orthopedics, China Medical University Hsinchu Hospital, Hsinchu, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yen-Chun Huang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Cheng Yao
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzu-Cheng Yang
- Department of Orthopedics, China Medical University Hsinchu Hospital, Hsinchu, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsi-Hsien Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Tien Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Chau Chang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Po-Hsin Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Rerikh VV, Sinyavin VD. Comparative analysis of hybrid stabilization methods in the treatment of burst fractures of the vertebral bodies associated with osteoporosis. HIRURGIÂ POZVONOČNIKA (SPINE SURGERY) 2022. [DOI: 10.14531/ss2022.4.40-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective. To perform comparative analysis of posterior stabilization methods combined with cement vertebroplasty and osteoplasty with deproteinized bone allograft in the treatment of uncomplicated burst fractures of the vertebral bodies associated with osteoporosis.Material and Methods. The study was a retrospective analysis. Two groups of patients were formed, inclusion and exclusion criteria were determined. The follow-up period was 12 months. The magnitude of kyphosis correction according to the Cobb method, the magnitude of residual postoperative kyphotic deformity, its recurrence in the long term postoperative period, and the length of transpedicular fixationwere assessed. Sagittal balance parameters and subjective assessments of the patient’s condition were not evaluated.Results. With a statistically significant difference, it can be said that the main predictors of recurrence of local kyphosis, incomplete correction of deformity and increased pain syndrome are the level of injury (T12 vertebra), the degree of initial kyphotic deformity, incomplete achievement of its correction after surgery (>10°), and the value of T-criterion according to densitometry. The length of fixation does notaffect the loss of correction and recurrence of kyphosis, however it may correlate with the severity of osteoporosis.Conclusions. When comparing posterior stabilization methods in combination with cement vertebroplasty or osteoplasty, there was no statistical difference in clinical and radiological outcomes.
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Affiliation(s)
- V. V. Rerikh
- Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
17 Frunze str., Novosibirsk, 630091, Russia
| | - V. D. Sinyavin
- Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
17 Frunze str., Novosibirsk, 630091, Russia
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Lee YH, Chen PQ, Wu CT. Delayed-onset radiculopathy caused by a retropulsed bone fragment after percutaneous kyphoplasty: report of four cases and literature review. BMC Musculoskelet Disord 2022; 23:529. [PMID: 35655255 PMCID: PMC9164374 DOI: 10.1186/s12891-022-05472-w] [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: 01/17/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Vertebral compression fractures caused by osteoporosis are common in elderly patients and are often encountered by clinical physicians. Percutaneous balloon kyphoplasty (PKP) is widely accepted as a minimally invasive procedure for effectively relieving pain and correcting deformities, but complications may occur. Radiculopathy with a delayed onset caused by a retropulsed bone fragment has not been adequately described in the literature. Thus, this article presents a case report of four cases of retropulsed bone fragment-related radiculopathy after PKP. Case presentation In this article, we reported that four out of 251 patients developed radiculopathy after PKP between January 2012 and January 2019 despite experiencing substantial improvements in back pain. All patients with radiculopathy were female and diagnosed with osteoporosis, and their ages ranged from 68 to 89 years. Radiculopathy occurred from 2 to 16 weeks after PKP. All four patients underwent another operation (posterior decompression and instrumentation). Three patients recovered completely, and one died of postoperative intracranial haemorrhage. A detailed imaging study with pre- and postoperative magnetic resonance imaging (MRI) revealed that retropulsed bone fragments that impinged on the corresponding root after PKP were responsible for this complication, and all four patients developed a disrupted posterior vertebral rim preoperatively. No leakage of cement or pedicle track violations were observed. Conclusion Although PKP is a safe and effective treatment for painful osteoporotic vertebral compression fractures, a risk of catastrophic neurological injury remains. Radiculopathy with delayed onset caused by a retropulsed bone fragment after kyphoplasty is rare and challenging to treat, and the integrity of the posterior vertebral cortex should be carefully evaluated preoperatively to prevent this complication.
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Affiliation(s)
- Yi-Hsuan Lee
- Department of Orthopaedics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist., (R.O.C.), Taipei City, 231, Taiwan
| | - Po-Quang Chen
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Chung Shan S. Rd., Zhongzheng Dist., (R.O.C.), Taipei City, 100225, Taiwan
| | - Chung-Ting Wu
- Kang-Ning General Hospital, No. 26, Ln. 420, Sec. 5, Cheng Gong Rd., Neihu Dist., (R.O.C.), 114, Taipei, Taiwan.
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Wang J, Zhang Q. Beware of Brucella Spondylitis Following Vertebroplasty: An Unusual Case of Osteoporotic Vertebral Compression Fracture. Infect Drug Resist 2022; 15:2565-2572. [PMID: 35611140 PMCID: PMC9124486 DOI: 10.2147/idr.s363208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
Abstract
There are two main types of infectious spondylitis reported in literature following kyphoplasty or vertebroplasty: tuberculous spondylitis and pyogenic spondylitis; no cases of Brucella spondylitis have been reported to date. We present a unique case of Brucella spondylitis with intraspinal abscess following vertebroplasty. The patient suffered from osteoporotic vertebral compression fracture (OVCF) of the L4 vertebra and received vertebroplasty; he ate mutton while traveling in the epidemic area a week before vertebroplasty. Two weeks after the procedure, the patient had recurrent low back pain and was finally diagnosed with Brucella spondylitis around the L4 vertebra four months later. This case report provides a warning that eating any undercooked food that may cause bacteremia—especially in orthopedic patients with joint or osseous abnormalities and especially those with intraosseous devices or injected substances.
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Affiliation(s)
- Jie Wang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Qiang Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
- Correspondence: Qiang Zhang, Email
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Lotan R, Prosso I, Klatzkin L, Hershkovich O. The Covid 19 Pandemic Effect on the Epidemiology of Thoracolumbar Fractures Presenting to the Emergency Department in Patients Above 65 years Old. Geriatr Orthop Surg Rehabil 2022; 13:21514593221098828. [PMID: 35479652 PMCID: PMC9036375 DOI: 10.1177/21514593221098828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Studies investigating the Covid-19 Pandemic’s orthopedic aspects are accumulating, including reports on a 10-33% decrease in hip fracture incidence alongside shorter times to surgery. Osteoporotic vertebral compression fractures (VCF) have not yet been discussed. This study evaluated the effect of the Covid-19 pandemic’s first wave on VCF in the elderly. Method A retrospective cohort of elderly patients diagnosed with VCF between 2018-19 (Pre-Covid-19 pandemic) to 2020. Results The cohort included 172 patients above 65 years with VCF during 2018-2020. Patients’ age and gender were similar between the two study groups. We found a higher proportion of high-energy VCF during 2020 (10.5% vs 6.7%). Incidence of recurrent fractures was 7.5 times higher during 2020 (5.3% vs .7%, P =.06), and significantly higher rates of Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis in 2020 (7.9% vs 1.5%, P=.04). VCF ED admission rates were similar, with 60% treated conservatively. Admitted patients underwent more surgeries in 2020 (66.7% vs 60%, P =.71) and a tendency towards Precoutaneus Balloon Kyphoplasty (BKP) + fixation compared with BKP alone (15.8% in 2020 vs 7.5% in 2018-19, P =.29). RR for BKP + fixation vs BKP alone was 1.95, suggesting higher odds for a more complex surgery during the Covid-19 pandemic. The complication rate was significantly higher during 2020 (18.4% vs 3.7%, P <.001). Admission length was slightly longer during 2020 (12.2 days vs 9.9 days, P = .27), and time to surgery was marginally longer, 6.25 vs 5.3 days (P = .55). Many patients chose home over institutional rehabilitation during the Covid-19 pandemic (72.2% vs 58.8%). Conclusion The Covid-19 pandemic did not alter VCF incidence, but patients’ characteristics changed, affecting admissions, institutional rehabilitation, and a tendency towards complex surgery rather than BKP alone. It is still unclear if Covid-19 will remain an issue in the upcoming years, but its impact and lessons are still worthwhile.
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Affiliation(s)
- Raphael Lotan
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilia Prosso
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lev Klatzkin
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Hershkovich
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zhang S, Wang S, Wang Q, Yang J, Xu S. Debridement and corpectomy via single posterior approach to treat pyogenic spondylitis after vertebral augmentation. BMC Musculoskelet Disord 2021; 22:591. [PMID: 34174863 PMCID: PMC8236162 DOI: 10.1186/s12891-021-04478-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/14/2021] [Indexed: 12/30/2022] Open
Abstract
Background Infection after vertebral augmentation (VA) often limits the daily activities of patients and even threatens their life. The operation may be one of the effective treatments if the patient suffers from intolerable severe pain, neurological deficits, and damage to spinal stability. This study aimed to investigate the clinical efficacy of the treatment of pyogenic spondylitis after vertebral augmentation (PSVA) with Single posterior debridement, vertebral body resection, and intervertebral bone graft fusion and internal fixation (sPVRIF). Methods The study was performed on 19 patients with PSVA who underwent VA at 4 hospitals in the region between January 2010 and July 2020. Nineteen patients were included. Among them, 16 patients underwent sPVRIF to treat the PSVA. Results A total of 2267 patients underwent VA at 4 hospitals in the region. Of the 19 patients with postoperative PSVA, suppurative spondylitis was misdiagnosed as an osteoporotic vertebral fracture(OVF) in 4 patients and they underwent VA. Besides osteoporosis, 18 patients had other comorbidities. The average interval between the first surgery and the diagnosis of PSVA was 96.4 days. Of the 19 patients, 16 received surgical treatment. The surgical time was 175.0±16.8 min, and the intraoperative blood loss was 465.6±166.0 mL. Pathogenic microorganisms were cultured in 12 patients. Conclusion PSVA is a severe complication that can even threaten the life of the patients. sPVRIF may be one of the effective treatments if the patient suffers from intolerable severe pain, neurological deficits, and damage to spinal stability.
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Affiliation(s)
- Shuai Zhang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Sichuan, 646000, Luzhou City, China
| | - Song Wang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Sichuan, 646000, Luzhou City, China.
| | - Qing Wang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Sichuan, 646000, Luzhou City, China
| | - Jin Yang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Sichuan, 646000, Luzhou City, China
| | - Shuang Xu
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Sichuan, 646000, Luzhou City, China
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Bao LS, Wu W, Wang X, Zhong XH, Wang LX, Wang H. Clinical Observation of Intraosseous Anesthesia in Percutaneous Kyphoplasty. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5528073. [PMID: 34122783 PMCID: PMC8189784 DOI: 10.1155/2021/5528073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
Objective Percutaneous kyphoplasty (PKP) is an effective minimally invasive technique in spine surgery in recent years. General anesthesia and local anesthesia are the main ways of anesthesia in PKP, and epidural anesthesia is also applied to PKP to some extent. However, all these three anesthetic methods have their respective advantages and disadvantages. It is essential to compare and evaluate the effects of different anesthesia methods on PKP for treating spinal fractures. Method A total of 45 patients (53 vertebral bodies were included) were divided into two groups. Group A included 24 patients (29 vertebral bodies) with an average of 71 years old and Group B included 21 patients (24 vertebral bodies) with an average of 74 years old. Visual analogue scale (VAS) scores were recorded preoperatively; balloon expansion and bone cement injection were conducted intraoperatively. Then, they were recorded immediately after operation, 6 h postoperatively, to assess the pain level of the patient. Moreover, hospitalization time (days), operation duration (minutes), and bone cement injection amount (mL) had also been recorded. Results There was no significant difference in preoperative general information and VAS score. However, the VAS scores were statistically significant at both the moment of balloon expansion and injection of bone cement. At the moment of immediate postoperation, the VAS scores showed no statistically significant difference, while it showed a statistically significant difference 6 h postoperatively. Conclusion The anesthesia method by injection of 1% lidocaine hydrochloride (5 ml) into vertebral body can effectively relieve patients' pain in intraoperation and postoperation.
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Affiliation(s)
- Li-Shuai Bao
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Wei Wu
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Xin Wang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu 610000, China
| | - Xi-Hong Zhong
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Lin-Xiu Wang
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Hong Wang
- The First Affiliated Hospital of Dalian Medical University, Dalian 116000, China
- Dalian Municipal Central Hospital, Dalian, China
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Sinha A, Maffulli N. Balloon tibioplasty for tibial plateau fractures. Surgeon 2020; 19:297-309. [PMID: 32958409 DOI: 10.1016/j.surge.2020.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/26/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Tibial plateau fractures are complex intra-articular injuries. The aim of treatment is to restore joint congruity and alignment. Balloon tibioplasty is a novel, minimally invasive technique to reduce the fracture and restore the continuity of the articular surface. A systematic review was performed according to the PRISMA guidelines in order to assess the outcomes from this procedure. SOURCES OF DATA The online databases of Pubmed, Google scholar, the Cochrane Library, EMBASE and CINAHL were searched. Articles of interest were retrieved and evaluated, including case series, randomised controlled trials and cadaver studies. AREAS OF AGREEMENT Eight studies (one randomised controlled trial, four case series and three cadaver studies) were included in the final review. The studies demonstrated adequate fracture reduction with favourable clinical and imaging outcomes from balloon tibioplasty. Very few complications were described. AREAS OF CONTROVERSY There is a small volume of literature currently available on balloon tibioplasty with an overall low level of evidence. The overall number of reported cases is also small. GROWING POINTS Further research is necessary, with adequately powered randomised controlled trials. Further areas of research include type of bone substitute and the use of arthroscopically assisted surgery.
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Affiliation(s)
- Amit Sinha
- Department of Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, SY10 7AG, UK; Wales Deanery, Ty Dysgu, Cefn Coed, Nantgarw, CF15 7QQ, UK
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.
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13
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Alvi MA, Zreik J, Yolcu YU, Goyal A, Kim DK, Kallmes DF, Freedman BA, Bydon M. Comparison of Costs and Postoperative Outcomes between Vertebroplasty and Kyphoplasty for Osteoporotic Vertebral Compression Fractures: Analysis from a State-Level Outpatient Database. World Neurosurg 2020; 141:e801-e814. [PMID: 32534264 DOI: 10.1016/j.wneu.2020.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Vertebral cement augmentation techniques are routinely used to treat osteoporotic vertebral compression fractures (VCFs). In the current study, we used a state-level outpatient database to compare costs and postoperative outcomes between vertebroplasty and kyphoplasty. METHODS We queried the 2016 Florida State-Ambulatory Surgery Database of the Healthcare Cost and Utilization Project for patients undergoing thoracolumbar vertebroplasty or kyphoplasty for osteoporotic VCFs. Demographic and clinical characteristics, as well as postoperative outcomes were compared between the 2 groups. RESULTS A total of 105 patients (11.6%) who underwent vertebroplasty and 801 patients (88.4%) who underwent kyphoplasty were identified. Patients undergoing kyphoplasty were more likely to stay overnight or longer, with the P value trending toward significance (kyphoplasty with >1 day stay: 7.4% vs. vertebroplasty with >1 day stay: 1.9%; P = 0.086). Patients undergoing vertebroplasty had a significantly higher rate of discharge to home routine compared with patients undergoing kyphoplasty (97.1% [n = 102] vs. 94.1% [n = 754]; P < 0.001). Undergoing kyphoplasty was also associated with higher index admission costs ($40,706 vs. $18,965; P < 0.001) and higher readmission costs ($27,038 vs. $11,341; P = 0.046). The rates of 30-day and 90-day readmission were similar between the 2 groups (all P > 0.05). The rates of 30-day, 90-day, and overall readmission because of a new-onset fracture were also similar (all P > 0.05). However, vertebroplasty had a higher rate of readmissions associated with a procedure within a year (21.9% [n = 23] vs. 14.5% [n = 116]; P = 0.047). CONCLUSIONS Our analyses from a state-level database of patients undergoing vertebroplasty and kyphoplasty for osteoporotic VCFs show similar postoperative outcomes for the 2 procedures but a higher cost for kyphoplasty.
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Affiliation(s)
- Mohammed Ali Alvi
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jad Zreik
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Yagiz U Yolcu
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anshit Goyal
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Dong Kun Kim
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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14
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Wang D, Li Z, Yin S, Liu R, Sun F, Hu Y, Li C, Xu R. Modified kyphoplasty with controllable balloon dilatation for treatment of thoracolumbar osteoporotic vertebral compression fractures. INTERNATIONAL ORTHOPAEDICS 2020; 44:1401-1408. [PMID: 32418017 DOI: 10.1007/s00264-020-04592-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the surgical effects of modified kyphoplasty with controllable balloon dilatation for treatment of thoracolumbar osteoporotic vertebral compression fractures (OVCF). METHODS From April 2013 to October 2017, a total of 53 patients with thoracolumbar OVCF were treated with controllable balloon percutaneous kyphoplasty (C-PKP). Peri-operative parameters including days from injury to operation, operation time, injected cement volume, cement leakage and complications were collected. Visual analogue scale (VAS) and Cobb angle before and after operation were applied to evaluate surgical effects. Moreover, a total of 53 cases treated with traditional balloon of percutaneous kyphoplasty were retrospectively analyzed and compared with C-PKP in above parameters. RESULTS C-PKP achieved significant fewer events of cement leakage (type C) than that of traditional PKP (5/53 vs 13/53, p < 0.01). The patients were followed up for 10.8 ± 4.2 months; VAS and Cobb angle of the injured vertebra in both two groups at three days and final follow-up were significantly improved compared with that before surgery (p < 0.05), while there were no significant differences between the two groups regarding the VAS and Cobb angle at corresponding time points (p > 0.05). CONCLUSIONS C-PKP technology is a safe and efficient way for the treatment of thoracolumbar OVCF, and it can reduce cement leakage.
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Affiliation(s)
- Dexin Wang
- Department of Orthopaedics, Haishu Branch of Ningbo First Hospital, Zhejiang University, Ningbo, 315012, Zhejiang, China
| | - Zheng Li
- Spinal Surgery Department, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, China
| | - Shaomeng Yin
- Spinal Surgery Department of AoYoung Hospital, Suzhou, 215600, Jiangsu, China.
| | - Rui Liu
- Department of Orthopaedics, Mingzhou Hospital of Zhejiang University, 168 Taian West Road, Ningbo, 315100, Zhejiang Province, China
| | - Fanggui Sun
- Department of Orthopaedics, Mingzhou Hospital of Zhejiang University, 168 Taian West Road, Ningbo, 315100, Zhejiang Province, China
| | - Yutong Hu
- Department of Orthopaedics, Mingzhou Hospital of Zhejiang University, 168 Taian West Road, Ningbo, 315100, Zhejiang Province, China
| | - Chunzhi Li
- Department of Orthopaedics, Mingzhou Hospital of Zhejiang University, 168 Taian West Road, Ningbo, 315100, Zhejiang Province, China
| | - Rongming Xu
- Department of Orthopaedics, Mingzhou Hospital of Zhejiang University, 168 Taian West Road, Ningbo, 315100, Zhejiang Province, China.
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15
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Nguyen DH, Vu DD, Doan TNH, Vo HL. Safety of Balloon Kyphoplasty in the Treatment of Thoracic Osteoporotic Vertebral Compression Fractures in Vietnamese Patients. Clin Orthop Surg 2020; 12:209-216. [PMID: 32489543 PMCID: PMC7237258 DOI: 10.4055/cios19160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/16/2019] [Indexed: 11/20/2022] Open
Abstract
Background The evidence for the efficacy and safety of balloon kyphoplasty (BKP) in treating the Vietnamese patients is sparse. There is no convincing evidence regarding BKP's efficacy in Vietnamese patients, especially in the patients with thoracic osteoporotic vertebral compression fractures (VCFs). This article aims to evaluate the outcomes of restoring the body height of the compressed thoracic vertebrae in patients undergoing BKP. Methods We prospectively enrolled 65 consecutive patients with thoracic VCFs (73 vertebrae) due to osteoporosis who were treated with BKP between June 2018 and May 2019. Results A trocar was inserted through the pedicle in 84.9% (62/73) and beside the pedicle in 15.1% (11/73). The mean amount of mixed cement injected was 4.1 ± 1.1 mL (range, 1.5–7 mL). Cement leakage was radiographically confirmed in 30.8% of 65 patients. Among patients with complications caused by cement extravasation, the leakage was through the anterior margin of the vertebrae in 15.4%, through the vertebral disc in 12.3%, and through the posterior margin of the vertebrae in 3.1%. In the last 3.1% of patients, there was no clinically notable lesions of the nerve roots or spinal cord. The mean visual analog scale score decreased significantly from 7.3 ± 1.1 preoperatively to 3.3 ± 0.6 at 24 hours after surgery, and then to 1.2 ± 1.1 at 3 months after surgery (p < 0.01). The mean reduction in Cobb angle measured on standing radiographs after treatment was 3.7°, showing statistical significance
(p < 0.01). Conclusions BKP is a minimally invasive treatment effective for immediate pain relief, early motor rehabilitation, and humpback correction. The present study provided convincing evidence to support the use of BKP by spine surgeons and clinical specialists in treating osteoporotic thoracic VCFs in Vietnamese patients.
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Affiliation(s)
- Dinh-Hoa Nguyen
- Institute of Orthopedic Trauma, Viet Duc Hospital, Hanoi, Vietnam.,Social Affair Department, Viet Duc Hospital, Hanoi, Vietnam.,Department of Surgery, Hai Duong Medical Technical University, Hai Duong, Vietnam
| | - Duc-Dat Vu
- Institute of Orthopedic Trauma, Viet Duc Hospital, Hanoi, Vietnam.,Department of Surgery, Hai Duong Medical Technical University, Hai Duong, Vietnam
| | - Thi-Ngoc-Ha Doan
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Hoang-Long Vo
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
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Sultan L, Abuznadah W, Al-Jifree H, Khan MA, Alsaywid B, Ashour F. An Experimental Study On Usefulness Of Virtual Reality 360° In Undergraduate Medical Education. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:907-916. [PMID: 31802964 PMCID: PMC6826194 DOI: 10.2147/amep.s219344] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/30/2019] [Indexed: 05/11/2023]
Abstract
PURPOSE Various smartphone-based virtual reality (VR) applications allow the users to view 360° videos of real or simulated places. A 360° VR is captured with a special camera that simultaneously records all 360° of a scene unlike the standard video recording. An experimental study was conducted where 4th-year medical students participated in a workshop. PATIENTS AND METHODS The study was conducted at College of Medicine (COM-J), King Saud bin Abdul-Aziz University for Health Sciences (KSAU-HS) in Jeddah, Saudi Arabia. 360° VR videos including, pre-briefing and debriefing sessions were held for the experimental group, whereas group two (control group) was provided with the interactive lecture. A total of 169 undergraduate medical students attend the 4th year at the College of Medicine (KSAU-HS) Jeddah. RESULTS The response rate was 88% for 169 participants, 57 (VR) and 112 (conventional method). The majority of students (93%) thought that VR can be used in medical education. Post-MCQs score (out of 20) was significantly higher in the VR group, when compared to the conventional group (17.4+2.1 vs 15.9+2.9, p-value <0.001). The OSCE score was also better with the VR group (12.9+4.1 vs 9.8+4.2, p-value <0.001). Overall rating of VR satisfaction experience showed a mean of 7.26 of 10. CONCLUSION VR provides a rich, interactive, and engaging educational context that supports experiential learning-by-doing. In fact, it raises interest and motivation for student and effectively supports knowledge retention and skills acquisition.
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Affiliation(s)
- Lama Sultan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Clinical Nutrition Department, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Wesam Abuznadah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Surgery, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Hatim Al-Jifree
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Gynecology/Oncology, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Muhammad Anwar Khan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Basim Alsaywid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Urology, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Faisal Ashour
- Department of Simulation, Postgraduate Training Center, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Alpantaki K, Koutserimpas C, Kofteridis DP, Papastefanou S, Samonis G. Late-onset spondylodiscitis and psoas abscess, 5 years after percutaneous balloon kyphoplasty: a case report. Br J Neurosurg 2019:1-4. [PMID: 31650866 DOI: 10.1080/02688697.2019.1672856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Postoperative infection following percutaneous balloon kyphoplasty (PBK) is a rare complication and delayed onset infection is very rare. We report the case of a 62-year-old male, who developed spondylodiscitis and psoas abscess 5 years after two-level, L2 and L3 PBK. He was initially treated with abscess aspiration and long term antimicrobial treatment. Eventually, due to failure of conservative treatment he underwent anterior decompression, radical debridement of the infected tissue and non-instrumented fusion with strut graft, with excellent results.
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Affiliation(s)
- Kalliopi Alpantaki
- Department of Orthopaedics and Traumatology, Venizeleio General Hospital Heraklion , Crete , Greece
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens , Athens , Greece
| | | | | | - George Samonis
- Department of Infectious diseases, University of Crete , Heraklion , Greece
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18
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Ko BS, Cho KJ, Park JW. Early Adjacent Vertebral Fractures after Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fractures. Asian Spine J 2018; 13:210-215. [PMID: 30481974 PMCID: PMC6454291 DOI: 10.31616/asj.2018.0224] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/07/2018] [Indexed: 12/11/2022] Open
Abstract
Study Design Retrospective cohort study. Purpose To evaluate the incidence and risk factors for early adjacent vertebral fractures following balloon kyphoplasty (KP). Overview of Literature KP is a safe and effective treatment for pain alleviation in patients with osteoporotic vertebral compression fractures (OVCF). However, some studies have reported that the risk of newly developed fractures increases at the adjacent vertebra after KP. Methods Total 123 consecutive patients with painful OVCF who underwent KP were enrolled from January 2009 to June 2016. Early adjacent vertebral fractures were defined as new fractures that had developed within 3 months after surgery. Sex, age, body mass index (BMI), bone mineral density (BMD), vertebral height, kyphotic angle, Visual Analog Scale score, cement amount, and leakage were evaluated as risk factors for adjacent vertebral fractures. Only cement leakage into the disc space was included in this study. Results Early adjacent vertebral fractures were identified in 20 (16.2%) of the 123 patients. The mean time to diagnosis of fractures was 1.7±0.7 months after KP. The average patient age was 78.0±0.7 years, average BMI was 23.06±3.83 kg/m2, and mean BMD was −3.61±1.22 g/m2. Cement leakage was present in 16 patients, and fractures developed in 11 (68.7%). In contrast, fractures developed in nine patients (8.2%) without cement leakage. There were no significant differences in terms of age, BMI, BMD, kyphotic angle, or vertebral body height ratio between the fracture and control groups. Conclusions Cement leakage into the disc increased the risk of early adjacent vertebral fractures after balloon KP.
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Affiliation(s)
- Bong-Seong Ko
- Department of Orthopedic Surgery, Inha University School of Medicine, Incheon, Korea
| | - Kyu-Jung Cho
- Department of Orthopedic Surgery, Inha University School of Medicine, Incheon, Korea
| | - Jae-Woo Park
- Department of Orthopedic Surgery, Inha University School of Medicine, Incheon, Korea
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19
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Liao JC, Lai PL, Chen LH, Niu CC. Surgical outcomes of infectious spondylitis after vertebroplasty, and comparisons between pyogenic and tuberculosis. BMC Infect Dis 2018; 18:555. [PMID: 30419832 PMCID: PMC6233540 DOI: 10.1186/s12879-018-3486-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/31/2018] [Indexed: 11/29/2022] Open
Abstract
Background Infection after vertebroplasty (VP) is a rare but serious complication. Previous literatures showed most pathogens for infection after VP were bacteria; tuberculosis (TB) induced infection after VP was extremely rare. We reported our treatment experiences of cases with infectious spondylitis after VP, and compared the differences between developed pyogenic and TB spondylitis. Methods From January 2001 to December 2015, 5749 patients had undergone VP at our department were reviewed retrospectively. The causative organisms were obtained from tissue culture of revision surgery. Parameters including type of surgery, the interval between VP and revision surgery, neurologic status, and visual analog scale (VAS) of back pain were recorded. Laboratory data at the time of VP and revision surgery were collected. Charlson comorbidity index (CCI), preoperative bacteremia, urinary tract infection (UTI), pulmonary TB history were also analyzed. Results Eighteen patients were confirmed with developed infectious spondylitis after VP (0.32%, 18/5749). Two were male and 16 were female. The median age at VP was 73.4 years. Nine patients were TB and the other nine patients were pyogenic. The interval between VP and revision surgery ranged from 7 to 1140 days (mean 123.2 days). The most common type of revision surgery was anterior combined with posterior surgery. Seven patients developed neurologic deficit before revision surgery. Three patients died within 6 months after revision surgery, with a mortality of 16.7%. Finally, VAS of back pain was improved from 7.4 to 3.1. Seven patients could walk normally, the other 8 patients had some degree of disability. Both pyogenic and TB group had similar age, sex, and CCI distribution. The interval between VP and revision surgery was shorter in the patients with pyogenic organisms (75.9 vs 170.6 days). At revision surgery, WBC and CRP were prominently elevated in the pyogenic group. Five in the pyogenic group had UTI and bacteremia; five in TB group had a history of lung TB. Conclusions Infection spondylitis after VP required major surgery for salvage with a relevant part of residual disability. Before VP, any bacteremia/UTI or history of pulmonary TB should be reviewed rigorously; any elevation of infection parameters should be scrutinized strictly.
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Affiliation(s)
- Jen-Chung Liao
- Department of Orthopedics Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, No.5, Fu-Shin Street Kweishian, Taoyuan, 333, Taiwan.
| | - Po-Liang Lai
- Department of Orthopedics Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, No.5, Fu-Shin Street Kweishian, Taoyuan, 333, Taiwan
| | - Lih-Hui Chen
- Department of Orthopedics Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, No.5, Fu-Shin Street Kweishian, Taoyuan, 333, Taiwan
| | - Chi-Chien Niu
- Department of Orthopedics Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, No.5, Fu-Shin Street Kweishian, Taoyuan, 333, Taiwan
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20
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Infection following percutaneous vertebral augmentation with polymethylmethacrylate. Arch Osteoporos 2018; 13:47. [PMID: 29704173 DOI: 10.1007/s11657-018-0468-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/20/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Although the incidence of infection following vertebroplasty or kyphoplasty is rare, postoperative infection and cement augmentation in preexistent spondylitis can cause life-threatening complications in frail patients with notable comorbidities. In such cases, urgent culture and biopsy and the long-term use of proper antibiotics are necessary. PURPOSE Infection following vertebral augmentation with polymethylmethacrylate (PMMA) is rare. We aimed to analyze 11 cases of pyogenic spondylitis and spondylodiscitis that occurred after vertebroplasty or kyphoplasty and to review similar cases in the literature. METHODS All cases of postoperative spinal infections in our institution between January 2005 and November 2016 that primarily underwent percutaneous vertebroplasty or kyphoplasty were retrospectively reviewed. Eleven patients (mean age 76.3 years) were included. RESULTS The incidence of infection following vertebroplasty/kyphoplasty was 0.36%. Postoperative infection occurred in 3 of 826 cases. All patients underwent combined surgical and antibiotic treatment because of neurologic deficit on the initial diagnosis of the infection or failure of prior medical treatment of the infection. The surgical procedure was thorough debridement of infected tissue and material including PMMA following anterior column reconstruction via anterior/posterior/combined approach in 10 patients and percutaneous pedicle screw fixation alone in 1 patient aged 96 years. The mean follow-up period was 21.1 months after the revision operation, excluding one patient who died 17 days after revision surgery. Ten patients recovered from infection. CONCLUSIONS Although the incidence of infection following vertebroplasty or kyphoplasty is rare, postoperative infection and cement augmentation in preexisting spondylitis can develop into a life-threatening complication in frail patients with notable comorbidities. In treating infected vertebroplasty and kyphoplasty, immediate culture and biopsy and the long-term use of proper antibiotics are critical. Prompt surgical treatment should be considered in case of significant neurologic deficit, severe instability due to infected fracture, and resistance to antibiotics.
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Jamjoom B, Patel S, Bommireddy R, Klezl Z. Impact of the quantity of intradiscal cement leak on the progression of intervertebral disc degeneration. Ann R Coll Surg Engl 2017; 99:529-533. [PMID: 28853606 DOI: 10.1308/rcsann.2017.0083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Introduction We aim to assess the impact of the quantity of intradiscal cement leak during kyphoplasty on the rate of progression of degenerative changes in the affected disc. Methods Of 316 kyphoplasty procedures, we identified 32 episodes of intradiscal cement leak in 26 patients. The quantity of cement leaked was graded from I to IV. Disc degenerative changes were assessed at presentation and follow-up using radiographical scoring and magnetic resonance imaging (MRI) grading systems. Data for low-grade leaks (grade I) were compared with the medium- and high-grade leaks (grades II-IV) using a chi-squared test. Results Median follow-up radiographic and MRI assessments were made at 18 and 21 months, respectively. Medium- and high-grade leaks were associated with a significantly higher radiographic disc degeneration scores compared with low-grade leaks (P = 0.04295) but no difference was found in MRI disc degeneration grades and in adjacent vertebral fracture rates. Conclusions Our findings indicate that the quantity of cement leaking into the disc space significantly influences the rate of progression of disc degeneration.
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Affiliation(s)
- B Jamjoom
- Department of Trauma and Orthopaedics, Royal Derby Hospital , Derby , UK
| | - S Patel
- Department of Trauma and Orthopaedics, Royal Derby Hospital , Derby , UK
| | - R Bommireddy
- Department of Trauma and Orthopaedics, Royal Derby Hospital , Derby , UK
| | - Z Klezl
- Department of Trauma and Orthopaedics, Royal Derby Hospital , Derby , UK.,Department of Surgery, Charles University , Prague , Czech Republic
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Comparison of Radiofrequency-targeted Vertebral Augmentation With Balloon Kyphoplasty for the Treatment of Vertebral Compression Fractures: 2-Year Results. Clin Spine Surg 2017; 30:E247-E251. [PMID: 28323707 DOI: 10.1097/bsd.0000000000000050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES The aim of this study was the evaluation of the safety and effectiveness of radiofrequency-targeted vertebral augmentation (RF-TVA) in comparison with balloon kyphoplasty (BK) for the treatment of acute painful vertebral compression fractures (VCFs) on the basis of matched pairs. SUMMARY OF BACKGROUND Vertebroplasty and BK are the common surgical interventions for the treatment of VCF. Both are effective and safe but pose some risks such as adjacent fractures and cement leakage. In 2009, RF-TVA was introduced as an innovative augmentation procedure for the treatment of VCF. MATERIALS AND METHODS A total of 192 patients (116 female; 51-90 y) with VCF (n=303) at 1 to 3 levels were treated with RF-TVA or BK. Functionality (Oswestry Disability Index), pain (visual analogue scale), vertebral height (anterior, middle), and kyphotic angle were evaluated over a 2-year period (postoperatively, 3-4 d, 3, 6, 12, and 24 mo). In addition, operating time and occurrence of cement leakage were recorded. RESULTS Pain and functionality were significantly improved after both treatments. In both groups, there was an increase in the vertebral height and a decrease in the kyphotic angle, which remained relatively consistent during 24 months. The incidence of cement leakage was 9.4% (n=9) in the RF-TVA group and 24.0% (n=25) in the BK group. The mean operating time with radiofrequency kyphoplasty was 25.9±9.9 minutes, and with balloon kyphoplasty 48.0±18.4 minutes. CONCLUSIONS RF-TVA is a safe and effective procedure for the treatment of vertebral compression fractures when compared with BK. Improvement in pain and functional scores after RF-TVA are durable through 24 months postprocedure and remained better than those after BK at long-term follow-up. Operating time for RF-TVA is shorter and the risk of cement leakage is lower. Both procedures provided similar results in vertebral height restoration and reduction in the kyphotic angle.
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Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine: Does it Correlate With Level-specific Bone Mineral Density Scores? Spine (Phila Pa 1976) 2015. [PMID: 26208228 DOI: 10.1097/brs.0000000000001066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case-control study. OBJECTIVE In this study, we investigated the correlation between level-specific preoperative bone mineral density and subsequent vertebral fractures. We also identified factors associated with subsequent vertebral fractures. SUMMARY OF BACKGROUND DATA Complications of cement augmentation of the spine include subsequent vertebral fractures, leading to unnecessary morbidity and more treatment. Ability to predict at-risk vertebra will help guide management. METHODS We studied all patients with osteoporotic compression fractures who underwent cement augmentation in a single institution from November 2001 to December 2010 by a single surgeon. Association between level-specific bone mineral density T-scores and subsequent fractures was assessed. Multivariable analysis was performed to identify significant factors associated with subsequent vertebral fractures. RESULTS 93 patients followed up for a mean duration of 25.1 months (12-96) had a mean age of 76.8 years (47-99). Vertebroplasty was performed in 58 patients (62.4%) on 68 levels and kyphoplasty in 35 patients (37.6%) on 44 levels. Refracture was seen in 16 patients (17.2%). The time to subsequent fracture post cement augmentation was 20.5 months (2-90). For refracture cases, 43.8% (7/16) fractured in the adjacent vertebrae. Subsequently fractured vertebra had a mean T-score of -2.860 (95% confidence interval -3.268 to -2.452) and nonfractured vertebra had a mean T-score of -2.180 (95% confidence interval -2.373 to -1.986). A T-score of -2.2 or lower is predictive of refracture at that vertebra (P = 0.047). Odds ratio increases with decreasing T-scores from -2.2 or lower to -2.6 or lower. A T-score of -2.6 or lower gives no additional predictive advantage. After multivariable analysis, age (P = 0.049) and loss of preoperative anterior vertebral height (P = 0.017) are associated with refracture. CONCLUSION Level-specific T-scores are predictive of subsequent fractures and the odds ratio increases with lower T-scores from -2.2 or less to -2.6 or less. They have a low positive predictive value, but a high negative predictive value for subsequent fractures. Other significant associations with subsequent refractures include age and anterior vertebral height. LEVEL OF EVIDENCE 4.
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Ender SA, Eschler A, Ender M, Merk HR, Kayser R. Fracture care using percutaneously applied titanium mesh cages (OsseoFix®) for unstable osteoporotic thoracolumbar burst fractures is able to reduce cement-associated complications--results after 12 months. J Orthop Surg Res 2015; 10:175. [PMID: 26568074 PMCID: PMC4644291 DOI: 10.1186/s13018-015-0322-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/08/2015] [Indexed: 01/07/2023] Open
Abstract
Background Despite the known demographic shift with expected doubled rate of vertebral body fractures by the year 2050, a standardized treatment concept for traumatic and osteoporotic incomplete burst fracture of the truncal spine does not exist. This study aims to determine whether minimally invasive fracture care for incomplete osteoporotic thoracolumbar burst fractures using intravertebral expandable titanium mesh cages is a suitable procedure and may provide improved safety in terms of cement-associated complications in comparison to kyphoplasty procedure. Methods In 2011/2012, 15 patients (10 women, 5 men; mean age 77) with 15 incomplete osteoporotic thoracolumbar burst fractures (T10 to L4) were stabilized using intravertebral expandable titanium mesh cages (OsseoFix®) as part of a prospective study. X-ray, MRI and bone density measurements (DXA) were performed preinterventionally. The clinical and radiological results were evaluated preoperatively, postoperatively and after 12 months according to the visual analogue scale (VAS), the Oswestry Disability Index (ODI), X-ray (Beck Index, Cobb angle) and CT analyses. Wilcoxon rank sum test, sign test and Fischer’s exact test were used for statistical evaluation. Results A significant reduction in pain intensity (VAS) from preoperative 8.0 to 1.6 after 12 months and significant improvement in activity level (ODI) from preoperative 79.0 to 30.5 % after 12 months were revealed. Radiologically, the mean kyphotic angle according to Cobb showed significant improvements from preoperative 9.1° to 8.0° after 12 months. A vertebral body subsidence was revealed in only one case (6.7 %). No changes in the position of the posterior wall were revealed. No cement leakage or perioperative complications were seen. Conclusion As a safe and effective procedure, the use of intravertebral expandable titanium mesh cages presents a valuable alternative to usual intravertebral stabilization procedures for incomplete osteoporotic burst fractures and bears the potential to reduce cement-associated complications. Trial registration German Clinical Trials Register (DKRS) DRKS00008833.
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Affiliation(s)
- Stephan Albrecht Ender
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch Straße, 17475, Greifswald, Germany.
| | - Anica Eschler
- Department of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, 18057, Rostock, Germany.
| | - Michaela Ender
- Department of Diagnostic Radiology and Neuroradiologie, University Medicine Greifswald, Ferdinand-Sauerbruch Straße, 17475, Greifswald, Germany.
| | - Harry Rudolf Merk
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch Straße, 17475, Greifswald, Germany.
| | - Ralph Kayser
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch Straße, 17475, Greifswald, Germany. .,Department of Orthopaedics, Trauma and Reconstructive Surgery, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
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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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Makary MS, Zucker IL, Sturgeon JM. Venous extravasation and polymethylmethacrylate pulmonary embolism following fluoroscopy-guided percutaneous vertebroplasty. Acta Radiol Open 2015; 4:2058460115595660. [PMID: 26331092 PMCID: PMC4548728 DOI: 10.1177/2058460115595660] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 06/18/2015] [Indexed: 12/27/2022] Open
Abstract
Percutaneous vertebroplasty has gained widespread popularity and demonstrated clinical efficacy in the treatment of spinal osteoporotic compression fractures and pathologic osteolytic lesions. Despite its rapid pain relief and safety, this minimally invasive intervention has exhibited some rare complications over the past decade. In this case study, we describe a patient with an uncommon complication of polymethylmethacrylate (PMMA) cement pulmonary embolism following fluoroscopy-guided percutaneous vertebroplasty for treatment of pain associated with an osteoporotic vertebral fracture. We present this case to highlight that vertebroplasty is not risk-free and that knowledge of such potentially severe complication is necessary for prevention and optimal operative outcomes.
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Affiliation(s)
- Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ivan L Zucker
- Department of Radiology, Mount Carmel West Medical Center, Columbus, Ohio, USA
| | - John M Sturgeon
- Department of Radiology, Mount Carmel West Medical Center, Columbus, Ohio, USA
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Morbidity and Mortality After Vertebral Fractures: Comparison of Vertebral Augmentation and Nonoperative Management in the Medicare Population. Spine (Phila Pa 1976) 2015; 40:1228-41. [PMID: 26020845 DOI: 10.1097/brs.0000000000000992] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Vertebral compression fracture (VCF) patients in the 100% US Medicare data set (2005-2009). OBJECTIVE To compare the mortality and morbidity risks for VCF patients undergoing conservative treatment (nonoperated), balloon kyphoplasty (BKP), and vertebroplasty (VP). SUMMARY OF BACKGROUND DATA Studies have reported lower mortality risk for BKP or VP cohorts than nonoperated cohorts, but it is uncertain whether there are any differences in morbidity risks. METHODS Survival and morbidity was estimated by the Kaplan-Meier method, and the differences in outcomes were assessed by Cox regression between BKP, VP, and nonoperated cohorts. A propensity matching analysis was used to account for potential bias. RESULTS A total of 1,038,956 VCF patients were identified, including 141,343 BKP patients and 75,364 VP patients. The nonoperated cohort was found to have a 55% higher adjusted risk of mortality (P < 0.001) than the BKP cohort and 25% higher adjusted risk of mortality (P < 0.001) than the VP cohort. The BKP cohort was also found to have a 19% lower adjusted risk of mortality (P < 0.001) than the VP cohort. The findings were similar for mortality with pneumonia diagnosed in the 90 days before death and also after propensity matching, as well as for subgroups of osteoporotic VCF patients, including those who survived at least 1 year and those with no cancer diagnosis. With propensity matching, the nonoperated cohort had significantly higher adjusted risks of pneumonia, myocardial infarction/cardiac complications, DVT, and urinary tract infection than the BKP cohort but lower adjusted risks of subsequent augmentation/fusion, subsequent augmentation, and pulmonary/respiratory complications. The BKP cohort also had significantly lower risks of morbidity than the VP cohort, except for deep venous thrombosis (DVT), infection, and myocardial infarction/cardiac complications, which were similar between both cohorts. CONCLUSION VCF patients in the Medicare population who received vertebral augmentation therapies, specifically BKP and VP, experienced lower mortality and overall morbidity than VCF patients who received conservative management. LEVEL OF EVIDENCE 3.
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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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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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Abdelrahman H, Siam AE, Shawky A, Ezzati A, Boehm H. Infection after vertebroplasty or kyphoplasty. A series of nine cases and review of literature. Spine J 2013; 13:1809-17. [PMID: 23880354 DOI: 10.1016/j.spinee.2013.05.053] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 03/11/2013] [Accepted: 05/28/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Percutaneous augmentation with bone cement is a widely accepted modality of treatment for thoracic and lumbar vertebral osteoporotic fractures. Infection after vertebroplasty or kyphoplasty is a serious, yet, rarely reported complication. PURPOSE To present a case series with a long-term follow-up of spinal infection after vertebroplasty/kyphoplasty with analysis of preoperative condition, risk factors, diagnostic findings, time before reoperation, causative organism, treatment, and outcome. STUDY DESIGN A retrospective, uncontrolled clinical case series in a single institution. PATIENT SAMPLE Between January 1997 and June 2012, 1,307 patients underwent percutaneous vertebroplasty or kyphoplasty. Six cases had postoperative infection (0.46%) and three additional cases were referred from other institutions for salvage treatment. OUTCOME MEASURES Perioperative assessment included visual analog scale, clinical, laboratory, and imaging findings, and activities of daily living at the end of the follow-up. METHODS Nine patients were included: six females and three males (mean age 73.8 years). Comorbidities were found in all patients. Kyphoplasty had been done in five patients and vertebroplasty in four. RESULTS The interval between augmentation and revision surgery ranged from 10 to 395 days with a mean of 118.4 days. Three cases with early infection presented within 1 month. Infection parameters were high in all patients at readmission. All patients were treated surgically except one case who died before the planned revision surgery. In all cases, debridement and corpectomy were done through anterior approaches combined with posterior instrumentation. The most common causative organism was Staphylococcus aureus in three cases. Mean follow-up period after the revision surgery was 26.68 months, excluding two patients who died early in the follow-up (within 4 months). This amounts to a mortality rate of 33.3% perioperatively. At the end of follow-up, two patients had unrestricted activities and one patient required a walker. Of three paraparetic patients, two improved functionally and could walk unassisted and one improved but still used a wheelchair. CONCLUSIONS Although vertebroplasty and kyphoplasty are minimally invasive interventions, postoperative infection can develop into life-threatening complications. This should be accounted for, in decision making in the elderly age group most commonly affected by osteoporotic fractures and especially in suspicious and high-risk immune-compromised patients.
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Affiliation(s)
- Hamdan Abdelrahman
- Department of Spinal Surgery, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99438 Bad Berka, Germany; Department of Orthopedics and Traumatology, Assiut University, Assiut, Egypt
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Ender SA, Wetterau E, Ender M, Kühn JP, Merk HR, Kayser R. Percutaneous Stabilization System Osseofix® for Treatment of Osteoporotic Vertebral Compression Fractures - Clinical and Radiological Results after 12 Months. PLoS One 2013; 8:e65119. [PMID: 23840316 PMCID: PMC3694101 DOI: 10.1371/journal.pone.0065119] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 04/22/2013] [Indexed: 11/21/2022] Open
Abstract
Study Design A prospective consecutive cohort study (follow-up study). Objective Our study investigated whether implantation of an expandable titanium mesh cage (Osseofix®) is a successful and safe minimally invasive therapy for osteoporotic vertebral compression fractures (VCF). Our experiences, clinical and radiological findings after 12 months follow-up are presented. Kypho- and vertebroplasty are well-established minimally invasive procedures for the treatment of osteoporotic VCF. The main complications associated with both procedures are uncontrolled bone cement leakage. Therefore a suitable alternative has been investigated. Methods During June 2010 to May 2011 24 patients were included with 32 osteoporotic VCF (T6 to L4). All of them were stabilized with the Osseofix® system. Preinterventionally we performed X-ray, MRI, and bone density measurements (DXA). Clinical and radiological results were evaluated preop., postop. and after 12 months postop. based on the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS), X-ray (Beck Index, Cobb-angle) and CT. Results There was a significant improvement in the mean ODI (70,6% to 30,1%) as well as a significant reduction in pain intensity (VAS) (7,7 to 1,4) after 12 month. The mean kyphotic angle according to Cobb showed significant improvements (11,7° to 10,4°) after 12 months. Postinterventional imaging showed only one case of loss of height in a stabilized vertebral body (3.1%). We saw no changes in posterior vertebral wall or adjacent fractures. Except for one pronounced postoperative hematoma we saw no surgical complications including no cement leakage. Conclusions Stabilization of symptomatic osteoporotic VCF with Osseofix® system is a safe and effective procedure, even in fractures with posterior wall involvement. The clinical mid-term results are good at a very low complication rate. The Osseofix® system is an interesting alternative to the established procedures of cement augmentation.
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Affiliation(s)
- Stephan Albrecht Ender
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
- * E-mail:
| | - Elmar Wetterau
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Michaela Ender
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Jens-Peter Kühn
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Harry Rudolf Merk
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Ralph Kayser
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Greifswald, Germany
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Wardlaw D, Van Meirhaeghe J, Ranstam J, Bastian L, Boonen S. Balloon kyphoplasty in patients with osteoporotic vertebral compression fractures. Expert Rev Med Devices 2013; 9:423-36. [PMID: 22905846 DOI: 10.1586/erd.12.27] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Balloon kyphoplasty (BKP) is a minimally invasive surgical procedure indicated for treatment of painful vertebral compression fractures. During BKP, cannulae are placed percutaneously into the vertebral body, allowing insertion of inflatable balloons. Inflating the balloons partially restores vertebral body height, compacts the bone and creates a cavity for placement of bone cement after balloon removal. Placement of the cement reduces and stabilizes the fracture. BKP differs from vertebroplasty in that it aims to restore vertebral height and reduce kyphotic deformity. Case reports and observational studies have consistently shown that BKP significantly reduces pain, increases mobility and functional capacity and improves quality of life for up to 3 years. Clinically significant adverse events have been rarely reported. These findings were confirmed in randomized and nonrandomized prospective controlled studies. The objective of this review is to describe the surgical procedures involved in BKP and to review the evidence supporting its use.
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Affiliation(s)
- Douglas Wardlaw
- Orthopaedic Department, Woodend Hospital, NHS Grampian, Aberdeen, UK.
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Mauffrey C, Fader R, Hammerberg EM, Hak DJ, Stahel PF. Incidence and pattern of technical complications in balloon-guided osteoplasty for depressed tibial plateau fractures: a pilot study in 20 consecutive patients. Patient Saf Surg 2013; 7:8. [PMID: 23452513 PMCID: PMC3605372 DOI: 10.1186/1754-9493-7-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 02/18/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Inflation bone tamps are becoming increasingly popular as a reduction tool for depressed tibial plateau fractures. A number of recent publications have addressed the technical aspects of balloon inflation osteoplasty. However, no study has yet been published to describe the technical limitations, intraoperative complications, and surgical bailout strategies for this new technology. METHODS Observational retrospective study of all patients managed with inflatable bone tamps for depressed tibial plateau fractures between October 1, 2010 and December 1, 2012. The primary outcome parameter was the rate of complications, which were stratified into "minor" and "major" depending on the necessity for altering the surgical plan intraoperatively, and based on the risk for patient harm. This study was approved by the Institutional Review Board of the State of Colorado. RESULTS A consecutive series of 20 patients were managed by balloon inflation osteoplasty for depressed tibial plateau fractures during the 15 months study period. The mean age was 42.8 years (range 20-79), with 9 females and 11 males. A total of 13 patients sustained an adverse intraoperative event (65%), with three patients sustaining multiple technical complications. Minor events (n = 8) included the burst of a balloon with extrusion of contrast dye, and the unintentional posterior wall displacement during balloon inflation. Major events (n = 5) included the intra-articular injection of calcium phosphate in the knee joint, and the inability to elevate the depressed articular fragment with the inflatable bone tamp. CONCLUSION The observed intraoperative complication rate of 65% reflects a steep learning curve for the use of inflation bone tamps to reduce depressed tibial plateau fractures. Specific surgical bailout options are provided in this article, based on our early anecdotal experience in a pilot series of 20 consecutive cases. Patients should be advised on the benefits and risks of this new technology as part of the shared decision-making process during the informed consent.
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Affiliation(s)
- Cyril Mauffrey
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA
| | - Ryan Fader
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA
| | - E Mark Hammerberg
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA
| | - David J Hak
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA
| | - Philip F Stahel
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA
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Abstract
Osteoporosis presents a dilemma for the orthopedic surgeon. Screw fixation within the bone is crucial for mechanical stabilization, maintenance of reduction, and ultimately, fracture healing. For the patient, soft bones and physiological fragility usually benefit from immediate weight bearing and mobility to avoid further disuse osteoporosis, deconditioning, and immobility. For implant companies, traditional screws, plates, and nails function for simple fractures and compliant patients. Locked plating has improved screw purchase in osteoporotic bone and has expanded fracture fixation capabilities but is not the panacea for all fractures. For orthopedic surgeons, traditional surgical augmentation for osteoporosis consisting of dual plating, augmentation with polymethyl methacrylate, joint replacement, and now locked plating are beneficial. In order to advance orthopedic care in the expanding population of elderly osteoporotic patients, modern solutions utilizing the dual properties of secure fixation and relatively flexible implants are required. Endosteal substitution, extraosteal substitution, and combined nail/plate combinations are methods of utilizing traditional implants in a nontraditional way. Nonsurgical augmentation of fracture fixation is also paramount.
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An SB, Yim J, Kim E, Shin JH, Park SY, Lee SC. Acute cholecystitis developed immediately after thoracic kyphoplasty -A case report-. Korean J Anesthesiol 2012; 63:266-9. [PMID: 23060986 PMCID: PMC3460158 DOI: 10.4097/kjae.2012.63.3.266] [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: 06/14/2011] [Revised: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 12/05/2022] Open
Abstract
Postoperative acute cholecystitis is a rare complication of orthopaedic surgery and is unrelated to the biliary tract. In particular, in the case of immediate postoperative state after surgery such as kyphoplasty at the thoracic vertebra, symptoms related to inflammation mimic those of abdominal origin, so the diagnosis and the treatment of acute cholecystitis can be delayed leading to a fatal outcome. It is important that physicians should be aware of the postoperative patient's condition in order to make an early diagnosis and determine treatment.
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Affiliation(s)
- Sang-Bum An
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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Hahnhaussen J, Hak DJ, Weckbach S, Heiney JP, Stahel PF. Percutaneous inflation osteoplasty for indirect reduction of depressed tibial plateau fractures. Orthopedics 2012; 35:768-72. [PMID: 22955384 DOI: 10.3928/01477447-20120822-04] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Anatomic reduction of articular depression tibial plateau fractures is challenging. The authors describe a new technique using percutaneous balloon-guided inflation osteoplasty for a depressed lateral tibial plateau fracture. The fluoroscopy-guided inflation osteoplasty restores the joint surface anatomically in a minimally invasive fashion. The metaphyseal void is filled with a fast-setting fluid-phase bone substitute, and a lateral buttress plate is applied with less invasive incisions. This technique is a valid alternative for indirect reduction of depressed articular tibial plateau fractures.
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Affiliation(s)
- Jens Hahnhaussen
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, Colorado, USA
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Robinson Y, Olerud C. Vertebroplasty and kyphoplasty--a systematic review of cement augmentation techniques for osteoporotic vertebral compression fractures compared to standard medical therapy. Maturitas 2012; 72:42-9. [PMID: 22425141 DOI: 10.1016/j.maturitas.2012.02.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 02/20/2012] [Indexed: 11/16/2022]
Abstract
After more than two decades the treatment effect of cement augmentation of osteoporotic vertebral compression fractures (VCF) has now been questioned by two blinded randomised placebo-controlled trials. Thus many practitioners are uncertain on the recommendation for cement augmentation techniques in elderly patients with osteoporotic VCF. This systematic review analyses randomised controlled trials on vertebroplasty and kyphoplasty to provide an overview on the current evidence. From an electronic database research 8 studies could be identified meeting our inclusion criteria of osteoporotic VCF in elderly (age>60 years), treatment with vertebroplasty or kyphoplasty, controlled with placebo or standard medical therapy, quality of life, function, or pain as primary parameter, and randomisation. Only two studies were properly blinded using a sham-operation as control. The other studies were using a non-surgical treatment control group. Further possible bias may be caused by manufacturer involvement in financing of three published RCT. There is level Ib evidence that vertebroplasty is no better than placebo, which is conflicting with the available level IIb evidence that there is a positive short-term effect of cement augmentation compared to standard medical therapy with regard to QoL, function and pain. Kyphoplasty is not superior to vertebroplasty with regard to pain, but with regard to VCF reduction (evidence level IIb). Kyphoplasty is probably not cost-effective (evidence level IIb), and vertebroplasty has not more than short-term cost-effectiveness (evidence level IV). Vertebroplasty and kyphoplasty cannot be recommended as standard treatment for osteoporotic VCF. Ongoing sham-controlled trials may provide further evidence in this regard.
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Affiliation(s)
- Yohan Robinson
- Uppsala University Hospital, Institute for Surgical Sciences, Department of Orthopaedics, Uppsala, Sweden.
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Li D, Huang Y, Yang H, Sun T, Wu Y, Li X, Chen L. Short-segment pedicle instrumentation with transpedicular bone grafting for nonunion of osteoporotic vertebral fractures involving the posterior edge. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2011; 23:21-6. [PMID: 23412404 DOI: 10.1007/s00590-011-0928-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 11/30/2011] [Indexed: 01/25/2023]
Abstract
Most osteoporotic vertebral fractures (OVFs) can be treated successfully with conservative methods. In about 10% of patients, nonunion develops and warrants surgical management with minimally invasive procedures such as vertebroplasty and kyphoplasty. Nevertheless, for patients with nonunion fractures that involve the posterior vertebral body wall, vertebroplasty and kyphoplasty are relatively contraindicated due to the risk of extravertebral polymethylmethacrylate cement leakage through vertebral fracture cracks. To this end, we developed a method for pedicle screw fixation combined with transpedicular bone grafting for such a condition. Briefly, after posterior pedicle screw fixation and reduction in the affected vertebra, the demineralized bone matrix was inserted into the vertebral body via a 'bone grafting funnel' created through the pedicle of the affected vertebra. The current retrospective study analysed the safety and efficacy of this approach. A total of 12 patients who fulfilled the criteria were treated with this procedure. Visual analogue scale scores for back pain and anterior vertebral heights were recorded. At 3-month follow-up, pain was significantly relieved compared with presurgery and the anterior vertebral heights were successfully restored and maintained. In conclusion, short-segment pedicle instrumentation combined with transpedicular bone grafting is a useful alternative in the treatment of nonunion of OVFs with loss of posterior edge integrity.
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Affiliation(s)
- Dapeng Li
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215006, Jiangsu, China.
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Robinson Y, Heyde CE, Försth P, Olerud C. Kyphoplasty in osteoporotic vertebral compression fractures--guidelines and technical considerations. J Orthop Surg Res 2011; 6:43. [PMID: 21854577 PMCID: PMC3170323 DOI: 10.1186/1749-799x-6-43] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 08/19/2011] [Indexed: 01/06/2023] Open
Abstract
Osteoporotic vertebral compression fractures are a menace to the elderly generation causing diminished quality of life due to pain and deformity. At first, conservative treatment still is the method of choice. In case of resulting deformity, sintering and persistent pain vertebral cement augmentation techniques today are widely used. Open correction of resulting deformity by different types of osteotomies addresses sagittal balance, but has comparably high morbidity. Besides conventional vertebral cement augmentation techniques balloon kyphoplasty has become a popular tool to address painful thoracic and lumbar compression fractures. It showed improved pain reduction and lower complication rates compared to standard vertebroplasty. Interestingly the results of two placebo-controlled vertebroplasty studies question the value of cement augmentation, if compared to a sham operation. Even though there exists now favourable data for kyphoplasty from one randomised controlled trial, the absence of a sham group leaves the placebo effect unaddressed. Technically kyphoplasty can be performed with a transpedicular or extrapedicular access. Polymethyl methacrylate (PMMA)-cement should be favoured, since calcium phosphate cement showed inferior biomechanical properties and less effect on pain reduction especially in less stable burst fractures. Common complications of kyphoplasty are cement leakage and adjacent segment fractures. Rare complications are toxic PMMA-monomer reactions, cement embolisation, and infection.
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Affiliation(s)
- Yohan Robinson
- Uppsala University Hospital, Institute for Surgical Sciences, Department of Orthopaedics, Uppsala, Sweden.
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Abstract
The advent of the use of kyphoplasty in 1998 was the result of the expected evolution of materials and methods related to the successful introduction of vertebroplasty as a valid treatment of painful vertebral compression fractures. Kyphoplasty introduced a method of creating bilateral bone voids and in many cases elevation (reduction) of depressed end plates with variable degrees of height restoration. This was achieved by using bilateral balloon bone tamps capable of pressures significantly higher than conventional angioplasty balloons. This allows creation of bilateral bone voids, resulting in the ability to apply a much thicker cement mixture. This is felt to be the reason for fewer cement-related complications compared with vertebroplasty including extravasation and embolization. Although the procedural cost presently is higher for kyphoplasty, this is expected to decrease as patents expire and industry competition increases. Kyphoplasty indications include all those of vertebroplasty plus additional ones either contraindicated or not recommended for treatment with vertebroplasty. Kyphoplasty achieves the same degree of pain relief as vertebroplasty but may offer additional benefits of fewer complications, more indications, better biopsy specimens, and potential for height restoration of compression fractures of the spine. Further studies regarding potential benefits are warranted to assess any added value of kyphoplasty compared with vertebroplasty.
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Affiliation(s)
- David M Kasper
- Division of Interventional Radiology, Mayo Hospital, Phoenix, Arizona
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Biomechanical comparison of kyphoplasty versus a titanium mesh implant with cement for stabilization of vertebral compression fractures. Spine (Phila Pa 1976) 2010; 35:1783-8. [PMID: 20098352 DOI: 10.1097/brs.0b013e3181b7cc5d] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In vitro biomechanical investigation. OBJECTIVE To evaluate differences in biomechanical stability of vertebral compression fractures repaired using balloon kyphoplasty versus a titanium mesh implant. SUMMARY OF BACKGROUND DATA Vertebral compression fractures may be stabilized using an expandable balloon followed by cement injection. There are small but finite risks of endplate fracture and cement extravasation with this procedure. Alternative techniques may affect cement injection volumes, height maintenance, and biomechanical stability but require investigation. METHODS Four male human cadaveric spines from T2 to L5 were used in this study. After determining bone mineral density, individual vertebral bodies were dissected and inspected for previous fractures or additional exclusion criteria. In the remaining vertebral bodies (n=48) anterior wedge fractures were created using a materials testing machine. Fractured vertebral bodies were systematically randomized to be repaired either with balloon kyphoplasty or with titanium mesh implant and polymethylmethacrylate bone cement, using image intensified fluoroscopy. Anterior vertebral body height (cm) was measured initially, after mechanically creating an anterior wedge fracture, after repairing the compression fracture with either technique, and after recompressing the vertebral body following a 24-hour cement polymerization period. Data for cement injection volume (mL) and height maintained following testing (cm) were compared between repair groups using a 1-way analysis of variance (P<0.05). Data for stiffness (N/mm), yield load (N), and ultimate load (N) were compared between intact bodies and repaired bodies using a 2-way analysis of variance (P<0.05). RESULTS There was significantly less cement injected (P<0.001) and significantly greater height maintained (P<0.025) with the titanium implant group compared to the kyphoplasty group. There were no significant differences in biomechanical stability between the 2 groups (P>0.05). CONCLUSION The titanium implant was biomechanically equivalent to the kyphoplasty repair while necessitating less cement and providing greater height maintenance in vitro. Improvements in pain and function could not be specifically addressed in this in vitro study and should be evaluated in a clinical case series.
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Park SY, Modi HN, Suh SW, Hong JY, Noh W, Yang JH. Epidural cement leakage through pedicle violation after balloon kyphoplasty causing paraparesis in osteoporotic vertebral compression fractures - a report of two cases. J Orthop Surg Res 2010; 5:54. [PMID: 20691094 PMCID: PMC2924303 DOI: 10.1186/1749-799x-5-54] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 08/06/2010] [Indexed: 11/10/2022] Open
Abstract
Kyphoplasty is advantageous over vertebroplasty in terms of better kyphosis correction and diminished risk of cement extravasations. Literature described cement leakage causing neurological injury mainly after vertebroplasty procedure; only a few case reports show cement leakage with kyphoplasty without neurological injury or proper cause of leakage. We present a report two cases of osteoporotic vertebral compression fracture treated with kyphoplasty and developed cement leakage causing significant neurological injury. In both cases CT scan was the diagnostic tool to identify cause of cement leakage. CT scan exhibited violation of medial pedicle wall causing cement leakage in the spinal canal. Both patients displayed clinical improvement after decompression surgery with or without instrumentation. Retrospectively looking at stored fluoroscopic images, we found that improper position of trocar in AP and lateral view simultaneously while taking entry caused pedicle wall violation. We suggest not to cross medial pedicle wall in AP image throughout the entire procedure and keeping the trocar in the center of pedicle in lateral image would be the most important precaution to prevent such complication. Our case reports adds the neurological complications with kyphoplasty procedure and suggested that along with other precautions described in the literature, entry with trocar along the entire procedure keeping the oval shape of pedicle in mind (under C-arm) will probably help to prevent such complications.
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Affiliation(s)
- Si-Young Park
- Scoliosis Research Institute, Department of Orthopedics, Korea University Guro Hospital, Seoul, Korea.
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Souvatzis X, Katonis PG, Licoudis SA, Marouli DG, Askitopoulou H. Subarachnoid Anesthesia for Kyphoplasty. Anesth Analg 2010; 111:238-40. [DOI: 10.1213/ane.0b013e3181e0574c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Minimal invasive short posterior instrumentation plus balloon kyphoplasty with calcium phosphate for burst and severe compression lumbar fractures. Spine (Phila Pa 1976) 2009; 34:2473; author reply 2473-5. [PMID: 19829263 DOI: 10.1097/brs.0b013e3181bb1577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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