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Cheng Y, Li Y, Cheng X, Mu J, Wu J, Wu H. Incidence and risk factors of adjacent vertebral fracture after percutaneous vertebroplasty or kyphoplasty in postmenopausal women: a retrospective study. Sci Rep 2024; 14:17999. [PMID: 39097669 PMCID: PMC11297947 DOI: 10.1038/s41598-024-68835-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024] Open
Abstract
Adjacent vertebral fracture (AVF) is a serious complication of percutaneous vertebroplasty (PVP) or kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF). This study aimed to explore the incidence and risk factors of AVF following PVP or PKP in postmenopausal women. The incidence of AVF was determined by spinal radiographic examinations. The potential risk factors of AVF were identified by univariate analysis, followed by multivariate logistic regression analyses to determine the independent risk factors. In total, 674 postmenopausal women who were treated with PVP or PKP from December 2019 to February 2022 were enrolled in the study. Among them, 58 (8.61%) women experienced an AVF following PVP or PKP. After adjusting for confounding factors, BMI (OR [95% CI] 0.863 [0.781-0.952]; p = 0.003), previous history of OVCF (OR [95% CI] 1.931 [1.044-3.571]; p = 0.036), and Hounsfield unit (HU) value (OR [95% CI] 0.979 [0.967-0.990]; p < 0.001) were found to be independent risk factors of AVF following PVP or PKP in postmenopausal women. The ROC analysis revealed that the BMI and HU thresholds were 21.43 and 65.15, respectively. In conclusion, the incidence of AVF was 8.61%. BMI, previous history of OVCF and HU value were independent risk factors of AVF following PVP or PKP in postmenopausal women.
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Affiliation(s)
- Yuanpei Cheng
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yongbo Li
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaokang Cheng
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Junhan Mu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Junzhen Wu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Han Wu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China.
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Takano H, Nojiri H, Shimura A, Teramoto J, Sugawara Y, Ishijima M. Early Balloon Kyphoplasty Treatment for Osteoporotic Vertebral Fracture Reduces Adjacent Vertebral Fractures. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1097. [PMID: 39064526 PMCID: PMC11278625 DOI: 10.3390/medicina60071097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: This study retrospectively examined whether the incidence rates of adjacent vertebral fractures (AVFs) can be reduced through balloon kyphoplasty (BKP) for osteoporotic vertebral fractures (OVFs) in the early stages, when there is little vertebral height variation. Materials and Methods: A total of 95 patients (22 males, 73 females, mean age: 80.7 years) who had undergone BKP were divided into two groups: the Early group (underwent BKP within 2 weeks after injury, n = 62), and the Non-early group (underwent BKP > 2 weeks after injury, n = 33). The following data were analyzed: patient characteristics; fracture level; the presence of old vertebral fractures, posterior wall injury, and intravertebral cleft; duration of surgery; duration of hospitalization; cement volume; the occurrence of AVF; the timing of AVF occurrence; Numerical Rating Scale (NRS) scores at the preoperative, postoperative, and final follow-up assessments; posterior vertebral kyphosis angle of the affected vertebra on plain lateral X-ray; vertebral wedge ratio; local kyphotic angle; and changes in posterior vertebral kyphosis angle, vertebral wedge ratio, and local kyphotic angle between preoperative and postoperative assessments. The patients were divided based on the occurrence or non-occurrence of AVF after BKP: the Non-AVF group, in which AVF did not occur, and the AVF group, in which AVF occurred. Results: The incidence of AVF was 15.8% (15/95 patients), with a notably lower incidence rate in the Early group at 6.5% (4/62 patients) compared to the Non-early group at 33.3% (11/33 patients). NRS scores significantly improved in both groups at the postoperative assessment and final follow-up. The changes in posterior vertebral kyphosis angle and vertebral wedge ratio were significantly lower in the Early group. In the Non-AVF group, the time from injury to surgery was significantly shorter. Conclusions: The Early group had a significantly lower incidence of AVF. The time from injury to surgery was a risk factor for AVF occurrence, suggesting that early BKP is recommended.
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Affiliation(s)
- Hiromitsu Takano
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
- Spine and Spinal Cord Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Hidetoshi Nojiri
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
- Spine and Spinal Cord Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Arihisa Shimura
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
- Spine and Spinal Cord Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Juri Teramoto
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
- Spine and Spinal Cord Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Yuta Sugawara
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
- Spine and Spinal Cord Center, Juntendo University Hospital, Tokyo 113-8421, Japan
| | - Muneaki Ishijima
- Department of Orthopedic Surgery, Juntendo University, Tokyo 113-8421, Japan; (H.T.); (A.S.); (J.T.); (Y.S.); (M.I.)
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Cheng Y, Chen X, Li Y, Tan Z, Yao X, Jiang R, Wu H. Incidence and risk factors of subsequent vertebral fracture following percutaneous vertebral augmentation in postmenopausal women. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08331-5. [PMID: 38853178 DOI: 10.1007/s00586-024-08331-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 03/19/2024] [Accepted: 05/23/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Subsequent vertebral fracture (SVF) is a severe advent event of percutaneous vertebral augmentation (PVA). However, the incidence and risk factors of SVF following PVA for OVCF in postmenopausal women remain unclear. This research aims to investigative the incidence and risk factors of SVF after PVA for OVCF in postmenopausal women. METHODS Women who underwent initial PVA for OVCF between August 2019 and December 2021 were reviewed. Univariate logistic regression analysis was performed to identify possible risk factors of SVF, and independent risk factors were determined by multivariate logistic regression. RESULTS A total of 682 women after menopause were enrolled in the study. Of these women, 100 cases had an SVF after PVA, with the incidence of 14.66%. Univariate logistic regression analysis demonstrated that age (p = 0.001), body mass index (BMI) (p < 0.001), steroid use (p = 0.008), history of previous vertebral fracture (p < 0.001), multiple vertebral fracture (p = 0.033), postoperative wedge angle (p = 0.003), and HU value (p < 0.001) were significantly correlated with SVF following PVA. Furthermore, BMI (OR [95%CI] = 0.892 [0.825 - 0.965]; p = 0.004), steroid use (OR [95%CI] = 3.029 [1.211 - 7.574]; p = 0.018), history of previous vertebral fracture (OR [95%CI] = 1.898 [1.148 - 3.139]; p = 0.013), postoperative wedge angle (OR [95%CI] = 1.036 [1.004 - 1.070]; p = 0.028), and HU value (OR [95%CI] = 0.980 [0.971 - 0.990]; p < 0.001) were identified as independent risk factors of SVF after PVA by multivariate logistic regression analysis. CONCLUSIONS The incidence of SVF following PVA for OVCF in postmenopausal women was 14.66%. BMI, steroid use, history of previous vertebral fracture, postoperative wedge angle, and HU value were independent risk factors of SVF after PVA for OVCF in postmenopausal women.
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Affiliation(s)
- Yuanpei Cheng
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130033, China
| | - Xipeng Chen
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130033, China
| | - Yongbo Li
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhe Tan
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130033, China
| | - Xingchen Yao
- The Third Bethune Hospital of Jilin University, Changchun, China
| | - Rui Jiang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130033, China.
| | - Han Wu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun, 130033, China.
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Tang Y, Li H, Ruan X, Yang H, Sun J, Chen K. Percutaneous kyphoplasty with or without posterior pedicle screw fixation for the management of severe osteoporotic vertebral compression fractures with nonunion. J Orthop Surg Res 2024; 19:240. [PMID: 38622736 PMCID: PMC11017672 DOI: 10.1186/s13018-024-04714-y] [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: 12/12/2023] [Accepted: 04/04/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE To assess the radiographic outcomes, clinical outcomes and complications of percutaneous kyphoplasty (PKP) with and without posterior pedicle screw fixation (PPSF) in the treatment of severe osteoporotic vertebral compression fractures (sOVCF) with nonunion. METHODS This study involved 51 patients with sOVCF with nonunion who underwent PKP or PPSF + KP. The operation time, intraoperative blood loss, volume of injected bone cement, operation costs and hospital stays were all recorded. In addition, the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were assessed separately for each patient before and after surgery. RESULTS Compared with the PPSF + KP group, the PKP group had shorter operation time, less intraoperative blood loss, shorter hospital stays and fewer operation costs. However, cobb's angle improvement (13.4 ± 4.3° vs. 21.4 ± 5.3°), VWR improvement ratio (30.4 ± 11.5% vs. 52.8 ± 12.7%), HA (34.9 ± 9.0% vs. 63.7 ± 7.6%) and HM (28.4 ± 11.2% vs. 49.6 ± 7.7%) improvement ratio were all higher in PPSF + KP group than that in PKP group. In addition, the ODI index and VAS score in both groups were significantly decreased at the postoperative and final follow-up. PKP group's postoperative VAS score was significantly lower than that in PPSF + KP group, but there was no statistically significant difference in VAS score at the last follow-up. CONCLUSION PKP and PPSF + KP can both effectively relieve the pain associated with sOVCF with nonunion. PPSF + KP can achieve more satisfactory vertebral reduction effects compared to PKP. However, PKP was less invasive and it has more advantages in shortening operation time and hospital stay, as well as decreasing intraoperative blood loss and operation costs.
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Affiliation(s)
- Yingchuang Tang
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hanwen Li
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xingbang Ruan
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huilin Yang
- First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Jiajia Sun
- First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Kangwu Chen
- First Affiliated Hospital of Soochow University, Suzhou, China.
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Wen D, Guo D. Spontaneous osteoporotic vertebral refractures after percutaneous vertebroplasty and kyphoplasty in a patient with rheumatoid arthritis: a case report and literature review. AME Case Rep 2024; 8:52. [PMID: 38711890 PMCID: PMC11071002 DOI: 10.21037/acr-23-112] [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: 07/14/2023] [Accepted: 02/08/2024] [Indexed: 05/08/2024]
Abstract
Background Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease, and one of the main complications of RA is osteoporosis, which can cause osteoporotic vertebral compression fractures (OVCFs) that lead to low back pain and spinal deformation. For RA patients with OVCFs, the symptoms of osteoporosis are more severe, if surgical treatment is to be carried out, it is important to focus on the treatment of osteoporosis caused by RA. Case Description We report a case of a 68-year-old woman with RA and successional osteoporotic vertebral body fractures treated by percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). The patient experienced spontaneous multiple OVCFs on three occasions: in the course of 5 months, she underwent one PKP and two PVP operations with five cement-augmented vertebrae from the first to fifth lumbar vertebrae. The mean interval between each operation was 75 days (range, 2-3 months). The case report makes us look into the treatment of each stage and think about the reasons, we reviewed the literatures on advancements in the treatment of OVCFs caused by RA, so that we can choose a better method for similar patients in the future. Conclusions For OVCFs secondary to RA without neurological damage, if we carry out surgical treatment, the systematic treatments, including RA treatment, pain management, brace treatment, and anti-osteoporosis measures are important. among them, anti-osteoporosis treatment has the highest priority because of the reversible nature of osteoporosis caused by RA.
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Affiliation(s)
- Dan Wen
- Department of Orthopedic, Yangzhou Clinical Medical College of Nanjing Medical University, Yangzhou, China
| | - Dan Guo
- Department of Orthopedic, Yangzhou Clinical Medical College of Nanjing Medical University, Yangzhou, China
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Cheng SH, Chou WH, Tsuei YC, Chu W, Chu WC. Assessment of Cement Leakage in Decompressed Percutaneous Kyphoplasty. J Clin Med 2024; 13:345. [PMID: 38256479 PMCID: PMC10816848 DOI: 10.3390/jcm13020345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/23/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Symptomatic osteoporotic compression fractures are commonly addressed through vertebroplasty and kyphoplasty. However, cement leakage poses a significant risk of neurological damage. We introduced "aspiration percutaneous kyphoplasty", also known as "decompressed kyphoplasty", as a method to mitigate cement leakage and conducted a comparative analysis with high viscosity cement vertebroplasty. We conducted a retrospective study that included 136 patients with single-level osteoporotic compression fractures. Among them, 70 patients underwent high viscosity cement vertebroplasty, while 66 patients received decompressed percutaneous kyphoplasty with low-viscosity cement. Comparison parameters included cement leakage rates, kyphotic angle alterations, and the occurrence of adjacent segment fractures. The overall cement leakage rate favored the decompressed kyphoplasty group (9.1% vs. 18.6%), although statistical significance was not achieved (p = 0.111). Nonetheless, the risk of intradiscal leakage significantly reduced in the decompressed kyphoplasty cohort (p = 0.011), which was particularly evident in cases lacking the preoperative cleft sign on X-rays. Kyphotic angle changes and the risk of adjacent segment collapse exhibited similar outcomes (p = 0.739 and 0.522, respectively). We concluded that decompressed kyphoplasty demonstrates efficacy in reducing intradiscal cement leakage, particularly benefiting patients without the preoperative cleft sign on X-rays by preventing intradiscal leakage.
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Affiliation(s)
- Shih-Hao Cheng
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-C.T.); (W.C.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan;
| | - Wen-Hsiang Chou
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan;
| | - Yu-Chuan Tsuei
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-C.T.); (W.C.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan;
| | - William Chu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-C.T.); (W.C.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan;
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11221, Taiwan
| | - Woei-Chyn Chu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-C.T.); (W.C.)
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Sun Y, Zhang Y, Ma H, Tan M, Zhang Z. Therapeutic Efficacy and Safety of Percutaneous Curved Vertebroplasty in Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis. Orthop Surg 2023; 15:2492-2504. [PMID: 37497571 PMCID: PMC10549840 DOI: 10.1111/os.13800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/10/2023] [Accepted: 04/15/2023] [Indexed: 07/28/2023] Open
Abstract
This systematic review and meta-analysis is aimed to provide higher quality evidence regarding the efficacy and safety between PCVP and PVP/KP in OVCFs. We searched the Cochrane Library, PubMed, Web of Science, and Embase databases for all randomized controlled trials (RCTs) and observational studies (cohort or case-control studies) that compare PCVP to PVP/KP for OVCFs. The Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the RCTs and non-RCTs, respectively. Meta-analysis was performed using RevMan 5.4 software. A total of seven articles consisting of 562 patients with 593 diseased vertebral bodies were included. Statistically significant differences were found in the postoperative visual analog scale (VAS) at 1 day (MD = -0.11; 95% CI: [-0.21 to -0.01], p = 0.03), but not at 3 months (MD = -0.21; 95% CI: [-0.41-0.00], p = 0.05) or 6 months (MD = 0.03; 95% CI: [-0.13-0.20], p = 0.70). There was no statistically significant difference in postoperative Oswestry disability index (ODI) at 1 day (MD = -0.28; 95% CI: [-0.62-0.05], p = 0.10), 3 months (MD = -1.52; 95% CI: [-3.11-0.07], p = 0.06), or 6 months (MD = 0.18; 95% CI: [-0.13-0.48], p = 0.25). Additionally, there were no statistically significant differences in Cobb angle (MD = 0.30; 95% CI: [-1.69-2.30], p = 0.77) or anterior vertebral body height (SMD = -0.01; 95% CI: [-0.26-0.23], p = 0.92) after surgery. Statistically significant differences were found in surgical time (MD = -8.60; 95% CI: [-13.75 to -3.45], p = 0.001), cement infusion volume (MD = -0.82; 95% CI: [-1.50 to -0.14], P = 0.02), and dose of fluoroscopy (SMD = -1.22; 95% CI: [-1.84 to -0.60], p = 0.0001) between curved and noncurved techniques, especially compared to bilateral PVP. Moreover, cement leakage showed statistically significant difference (OR = 0.40; 95% CI: [0.27-0.60], p < 0.0001). Compared with PVP/KP, PCVP is superior for pain relief at short-term follow-up. Additionally, PCVP has the advantages of significantly lower surgical time, radiation exposure, bone cement infusion volume, and cement leakage incidence compared to bilateral PVP, while no statistically significant difference is found when compared with unilateral PVP or PKP. In terms of quality of life and radiologic outcomes, the effects of PCVP and PVP/KP are not significantly different. Overall, this meta-analysis reveals that PCVP was an effective and safe therapy for patients with OVCFs.
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Affiliation(s)
- Yan Sun
- Department of OrthopaedicsGuang'an Men Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Yong Zhang
- Department of OrthopaedicsGuang'an Men Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Haoning Ma
- Department of OrthopaedicsChina‐Japan Friendship HospitalBeijingChina
| | - Mingsheng Tan
- Department of OrthopaedicsChina‐Japan Friendship HospitalBeijingChina
| | - Zhihai Zhang
- Department of OrthopaedicsGuang'an Men Hospital, China Academy of Chinese Medical SciencesBeijingChina
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Matsumoto K, Hoshino M, Omori K, Igarashi H, Matsuzaki H, Sawada H, Saito S, Suzuki S, Miyanaga Y, Nakanishi K. Preoperative Scoring System for Prediction of Early Adjacent Vertebral Body Fracture After Balloon Kyphoplasty Using X-Rays Taken in a Non-Weight-Bearing Position. World Neurosurg 2023; 178:e42-e47. [PMID: 37380052 DOI: 10.1016/j.wneu.2023.06.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Prevention of adjacent vertebral body fracture (AVF) following balloon kyphoplasty (BKP) is a key challenge. The objective of this study was to develop a scoring system that could be more extensively and effectively used to determine the surgical indications for BKP. METHODS The study involved 101 patients aged 60 years or older who had undergone BKP. Logistic regression analysis was used to identify risk factors for early AVF within 2 months following BKP. Scoring was based on the odds ratio for risk factors, and cut-off values were determined from the receiver operating characteristics curve. The correlation between the total scores and the incidence of early AVF, and the area under the curve for the logistic regression model predicting early AVF using the scoring system were investigated. RESULTS 29 cases (28.7%) experienced early AVF after BKP. The scoring system was created as follows: 1) age (<75 years: 0 points (P), ≥75 years: 1P), 2) number of previous vertebral fractures (0: 0P, 1 or more: 2P), and 3) local kyphosis (<7°: 0P, ≥7°: 1P). The total scores were found to be positively correlated with the incidence of early AVF (r = 0.976, P = 0.004). The area under the curve of the scoring system for predicting early AVF was 0.796. The incidence of early AVF was 4.2% at ≤1P and 44.3% at ≥2P (P < 0.001). CONCLUSIONS A scoring system which can be applied to a broader patient population was developed. In cases where the total score is 2P or more, alternatives to BKP should be considered.
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Affiliation(s)
- Koji Matsumoto
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan.
| | - Masahiro Hoshino
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, Tokyo, Japan
| | - Keita Omori
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, Tokyo, Japan
| | - Hidetoshi Igarashi
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, Tokyo, Japan
| | - Hiromi Matsuzaki
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, Tokyo, Japan
| | - Hirokatsu Sawada
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Sosuke Saito
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Yuya Miyanaga
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
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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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He Y, Yu Z, Yin J, Wang H, Xu N, Nong L, Jiang Y. Percutaneous Curved Vertebroplasty and Bilateral-Pedicle-Approach Percutaneous Vertebroplasty in the Treatment of Osteoporotic Vertebral Compression Fracture: A Meta-Analysis. Geriatr Orthop Surg Rehabil 2023; 14:21514593231182533. [PMID: 37325701 PMCID: PMC10262610 DOI: 10.1177/21514593231182533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Introduction The aim of this study was to evaluate the use of percutaneous curved vertebroplasty procedure (PCVP) and bilateral-pedicle-approach percutaneous vertebroplasty (bPVP) for the treatment of osteoporotic vertebral compression fractures (OVCFs) through a systematic review and meta-analysis of the scientific literature. Methods A systematic review of the scientific literature in PubMed, China National Knowledge Infrastructure (CNKI), Wanfang and other databases was conducted in conjunction with different keywords. Nine studies were included; all but 3 were randomised controlled studies and all were prospective or retrospective cohort studies. Results We observed statistically significant differences between the PCVP group and the bPCVP group in terms of postoperative visual analogue scale (VAS) scores (mean difference [MD]: -.08; 95% confidence intervals [CI]: -.15 to .00), bone cement leakage rates (OR = .33; 95%CI: .20 to .54), bone cement injection (MD: -1.52; 95%CI: -1.58 to 1.45), operative times (MD: -16.69; 95%CI: -17.40 to -15.99) and intraoperative fluoroscopies (MD: -8.16; 95%CI: -9.56 to -6.67), with the PCVP group being more dominant. There were no statistical differences in postoperative Oswestry Disability Index (ODI) scores (MD: -.72; 95%CI: -2.11 to .67) and overall bone cement distribution rates (MD: 2.14; 95%CI: .99 to 4.65) between the 2 groups. Conclusions Meta-analysis showed more favourable outcomes in the PCVP group compared to the bPVP group. PCVP might be effective and safe in the treatment of OVCFs because it relieves postoperative patient pain, reduces operative time and cement injection, and decreases the risk of cement leakage and radiation exposure to the surgeon and patient.
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Affiliation(s)
- Yanxing He
- Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital With Nanjing Medical University, Changzhou, China
- Dalian Medical University, Liaoning, China
| | - Zhentang Yu
- Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital With Nanjing Medical University, Changzhou, China
- Dalian Medical University, Liaoning, China
| | - Jianjian Yin
- Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital With Nanjing Medical University, Changzhou, China
| | - Hao Wang
- Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital With Nanjing Medical University, Changzhou, China
- Dalian Medical University, Liaoning, China
| | - Nanwei Xu
- Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital With Nanjing Medical University, Changzhou, China
| | - Luming Nong
- Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital With Nanjing Medical University, Changzhou, China
| | - Yuqing Jiang
- Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital With Nanjing Medical University, Changzhou, China
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11
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Yao G, Shen Y, Cai B, Li M. Analysis of the Curative Effect of Curved Angle Vertebroplasty in the Treatment of Osteoporotic Vertebral Compression Fracture. Indian J Orthop 2023; 57:481-489. [PMID: 36825269 PMCID: PMC9941387 DOI: 10.1007/s43465-023-00830-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 01/19/2023] [Indexed: 02/15/2023]
Abstract
Objective To evaluate the clinical efficacy of Percutaneous curved vertebroplasty (PCVP) for osteoporotic vertebral compression fracture of the thoracolumbar spine. Methods Retrospective analysis of 113 patients with osteoporotic vertebral compressive fractures (OVCFs) in our hospital from January 2017 to January 2020, a total of 120 diseased vertebrae, were divided into PCVP group (35 cases, 37 sections) and bilateral PVP(BVP) group (78 cases, 83 sections). To compare the distribution of baseline clinical data, pain relief (Visual Analog Scale, VAS), ODI (Oswestry Dability Index, ODI), operation time, intraoperative fluoroscopy, postoperative vertebral body re-fracture, and comparison of bone, and to compare the volume of cement penetration and the leakage rate of bone cement, etc. Results There was no significant difference in VAS and ODI before operation between the two groups (P > 0.05), and the VAS score and ODI after operation were significantly improved (P < 0.001). Compared with the bilateral PVP group, the operation time, the number of fluoroscopy, and the leakage rate of each layer of bone cement in the PCVP group were significantly reduced (P < 0.05); however, the amount of cement used in the two groups was similar (P > 0.05). There were no serious complications in both groups. In the bilateral PVP group, a total of seven patients had adjacent vertebral fractures or re-fractures of the original vertebral body. However, no patients in the PCVP group had re-fractures in any vertebral body segment. Conclusion Both PCVP and bilateral PVP are safe and effective methods for the treatment of osteoporotic vertebral compression fractures, but PCVP has a short operation time, fewer fluoroscopy times, and a low bone cement leakage rate.
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Affiliation(s)
- Gong Yao
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No.1055, Sanxiang Road, Suzhou, 215004 Jiangsu China
| | - Yixin Shen
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No.1055, Sanxiang Road, Suzhou, 215004 Jiangsu China
| | - Bing Cai
- Department of Orthopaedics, Huangpu Branch, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011 China
| | - Min Li
- Department of Orthopaedics, Huangpu Branch, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011 China
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12
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Benditz A, Jerosch J. [Osteoporotic vertebral fractures-From diagnosis to treatment]. Z Rheumatol 2023; 82:18-24. [PMID: 36006473 DOI: 10.1007/s00393-022-01255-9] [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: 05/30/2022] [Indexed: 02/07/2023]
Abstract
The aim of the present work is an overview of current concepts in the treatment of osteoporotic vertebral fractures, risk factors, clinical presentation and conservative and operative management. Osteoporotic vertebral fractures are a widespread problem, affecting between 700,000 and 1.5 million adults annually in the USA alone. Osteoporotic vertebral fractures can cause severe physical impairment, including back pain, dysfunction, and progressive thoracic kyphosis. Mortality after osteoporotic vertebral fractures is still increased compared to age-matched controls. In the reality of care, advocates of purely conservative therapy as well as advocates of surgical treatment can be found all over the world. In summary, understanding the risk factors, appropriate clinical evaluation and treatment strategies are crucial. When surgery is indicated, balloon kyphoplasty shows significantly better pain reduction and lower mortality compared to nonsurgical treatment.
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Affiliation(s)
- Achim Benditz
- Sektion Orthopädie und Wirbelsäulenchirurgie, Klinikum Fichtelgebirge, Schillerhain 1-8, 95615, Marktredwitz, Deutschland.
| | - Jörg Jerosch
- Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Johanna-Etienne-Krankenhaus, Neuss, Deutschland
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13
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Xinyu G, Na Z, Haihong Z, Dingjun H. Vertebral refracture after percutaneous vertebroplasty for osteoporotic vertebral compression fractures with and without brace wearing: A retrospective study of 300 patients. Front Surg 2023; 9:1056729. [PMID: 36704523 PMCID: PMC9871618 DOI: 10.3389/fsurg.2022.1056729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/08/2022] [Indexed: 01/12/2023] Open
Abstract
Background The aim of the study was to examine the clinical incidence rate of vertebral body fractures after percutaneous vertebroplasty (PVP) with and without brace wearing and provide a new guiding ideology for preventing vertebral fractures after clinical surgeries. Methods The retrospective analysis included 100 outpatients who underwent PVP between January 2017 and December 2018 without bracing after PVP surgeries (non-brace-wearing group). In total, 100 patients were paired into the rigid brace group and 100 patients were paired into the soft braces group according to propensity score matching. Seven independent variables were used in the soft and rigid brace group: age, sex, body mass index (BMI), visual analog scale (VAS), Oswestry Disability Index (ODI), and Cobb angle. The VAS, ODI, and Japanese Orthopaedic Association (JOA) scores were recorded preoperatively on the second day, after 1 month, after 3 months, and during the last follow-up postoperatively. We recorded the incidence of vertebral refracture in each of the three groups of patients and evaluated the effect of braces on postoperative fractures based on the ODI, VAS, and JOA scores. Results All patients were followed up for 8-24 months (mean 22.4 months). Compared with the preoperative values, the age, sex, BMI, bone density, ODI, VAS, and Cobb angle between refracture and non-refracture were not statistically significant. The VAS, ODI, and JOA scores significantly increased in the brace-wearing group compared with those of the non-brace-wearing group (p < 0.05). The incidence of vertebral refracture in the brace-wearing group was lower than that in the non-brace-wearing group, between which there was a significant difference (p < 0.05). Three months postoperatively, the JOA score of the soft brace group was significantly higher than that of the rigid brace group (p < 0.05). During the last follow-up, it was found that there was no difference in the VAS score, the incidence of refracture, or ODI between the soft brace group and the rigid brace group (p > 0.05). The improvement in the JOA score of the soft brace group was better than that of the rigid brace group, between which there was a significant difference (p < 0.05). Conclusion Braces can improve the prognosis of quality of life and postoperative subjective perception, whose presence can relieve postoperative residual pains. In contrast, patients can have a better medical experience wearing a soft brace.
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Affiliation(s)
- Guo Xinyu
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China,Shaanxi Key Laboratory of Spine Bionic Treatment, Xi’an Jiaotong University, Xi’an, China,Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Zhu Na
- Department of Imaging, Xianyang Center Hospital, Xianyang, China
| | - Zhang Haihong
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, China,Correspondence: Zhang Haihong Hao Dingjun
| | - Hao Dingjun
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China,Shaanxi Key Laboratory of Spine Bionic Treatment, Xi’an Jiaotong University, Xi’an, China,Correspondence: Zhang Haihong Hao Dingjun
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14
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Song F, Wei Y, Feng W, Fu R, Li Z, Gao X, Cheng X, Yang H. Biomechanical CT-computed bone strength predicts the risk of subsequent vertebral fracture. Bone 2023; 166:116601. [PMID: 36336262 DOI: 10.1016/j.bone.2022.116601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/14/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
Following primary fractures and percutaneous kyphoplasty (PKP), patients have a high risk of incurring a subsequent vertebral fracture (SVF). Given that SVF is a consequence of mechanical deterioration of the vertebra, we sought to examine whether vertebral strength derived from QCT-based finite element analysis (i.e., BCT) can predict the risk of SVF. Sixty-six patients who underwent PKP were categorized into two groups: control or non-SVF group (age: 70 ± 7 years; n = 40) and SVF group (age: 69 ± 8 years; n = 26). BCT was performed on L4 or L3 vertebrae to noninvasively measure vertebral strength. Vertebral strength was also estimated based upon the geometry and material properties of the vertebra. Additionally, trabecular volumetric bone mineral density (vBMD) and L1 Hounsfield unit (HU) were measured. t-Test, χ2 test or Mann Whitney U test were used to compare differences in these parameters between the two groups. The predictive abilities of BCT strength and other measured parameters were evaluated using the receiver operating characteristic (ROC) analysis. Results showed no significant difference in either vBMD or L1 HU between the control and SVF groups (p > 0.05), whereas BCT-computed and estimated vertebral strength values were significantly reduced by 33 % and 24 % for the SVF group relative to the non-SVF group, respectively. ROC curve indicated that BCT strength had the largest area under the curve, compared to other parameters. These results suggest that BCT-computed vertebral strength may serve as a surrogate for assessing risk of SVF.
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Affiliation(s)
- Fei Song
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Yi Wei
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Wentian Feng
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Ruisen Fu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Zuchang Li
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xing Gao
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China.
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15
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Wang W, Liu H, Wu Z, Teng Y, Huang Y, Liu T, Yang H. A Comparison of Percutaneous Kyphoplasty with High-Viscosity and Low-Viscosity Bone Cement for Treatment of Osteoporotic Vertebral Compression Fractures: A Retrospective Study. Geriatr Orthop Surg Rehabil 2022; 13:21514593221119625. [PMID: 36090795 PMCID: PMC9459459 DOI: 10.1177/21514593221119625] [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: 02/26/2022] [Revised: 07/13/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background Osteoporotic vertebral compression fracture (OVCF) has become a health issue
of worldwide concern. Percutaneous kyphoplasty (PKP) is one of the main
surgical methods for OVCFs. This study aimed to evaluate and compare the
clinical efficacy and safety of PKP with high- and low-viscosity bone cement
for OVCFs. Methods Totally 62 patients with single-level OVCF were enrolled in this study from
December 2018 to April 2021. Among them, 32 cases underwent PKP with
high-viscosity bone cement, while 30 cases underwent PKP with low-viscosity
bone cement. Visual analog scale (VAS) scores and Oswestry disability index
(ODI) scores were used in the pre- and post-operative period to assess
patients’ rehabilitation. Compression rates of anterior vertebra height
(AVH) and posterior vertebra height (PVH) were analyzed to evaluate the
restoration of vertebra height. Leakage rates and locations were recorded to
show clinical safety. Results VAS and ODI scores both significantly improved in 2 groups at 1 day, 1 month,
and 3 months after surgery. Compression rates of AVH and PVH at 1 day and
3 months after PKP were lower than those before surgery. However, there was
no significant difference in VAS scores, ODI scores, and compression rates
between both groups. However, PKP with high-viscosity bone cement achieved a
lower bone cement leakage rate significantly, which showed the safety of
high-viscosity bone cement in PKP. Conclusions PKP with high- and low-viscosity bone cement both improved the recovery of
patients and restored vertebra heights. Notably, PKP with high-viscosity
bone cement can achieve favorable clinical outcomes as well as lower bone
cement leakage rate.
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Affiliation(s)
- Wenhao Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhikai Wu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun Teng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yixue Huang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
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16
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Yamada Y, Toribatake Y, Okamoto S, Kato S, Kobayashi M, Tsuchiya H. Recompression of Augmented Vertebrae after Balloon Kyphoplasty Is a Risk of Adjacent Vertebral Fracture. Spine Surg Relat Res 2022; 7:89-95. [PMID: 36819632 PMCID: PMC9931404 DOI: 10.22603/ssrr.2022-0012] [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: 01/15/2022] [Accepted: 07/06/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction This study aimed to identify factors associated with adjacent vertebral fracture (AVF) incidence after balloon kyphoplasty (BKP). Methods To perform the analyses, 133 vertebrae of 128 patients who underwent BKP for osteoporotic vertebral compression fracture were retrospectively investigated. According to the presence of AVF throughout a 1-year period following BKP, patients were divided into AVF (n = 22) and non-AVF (n = 111) groups. The groups were compared with respect to pre- and postoperative parameters, including the incidence of recompression of augmented vertebrae (RAV). RAV was defined as a decrease in anterior vertebral body height of at least 5 mm within the 3 months that followed BKP. To identify factors associated with AVF incidence, univariate and multivariate analyses were performed. Results The univariate analysis revealed that the AVF group had a lower cement augmentation ratio, greater preoperative wedge angle, lower preoperative vertebral body height, lower postoperative vertebral body height 3 months post-BKP, and a greater change in vertebral body height and rate of RAV than the non-AVF group. Multivariate analysis revealed that low preoperative vertebral body height and RAV occurrence were associated with AVF incidence. Conclusions To the best of our knowledge, this study is the first to indicate that RAV is a risk factor for AVF. Study findings indicate that the incidence of AVF can be decreased if RAV development is avoided.
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Affiliation(s)
- Yohei Yamada
- Department of Orthopaedic Surgery, JA Toyama Kouseiren Takaoka Hospital, Takaoka, Japan,Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Yasumitsu Toribatake
- Department of Orthopaedic Surgery, JA Toyama Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Shumpei Okamoto
- Department of Orthopaedic Surgery, JA Toyama Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Motoya Kobayashi
- Department of Orthopaedic Surgery, JA Toyama Kouseiren Takaoka Hospital, Takaoka, Japan,Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
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17
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Bian F, Bian G, An Y, Wang D, Fang J. Establishment and Validation of a Nomogram for the Risk of New Vertebral Compression Fractures After Percutaneous Vertebroplasty in Patients With Osteoporotic Vertebral Compression Fractures: A Retrospective Study. Geriatr Orthop Surg Rehabil 2022; 13:21514593221098620. [PMID: 35529895 PMCID: PMC9073119 DOI: 10.1177/21514593221098620] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 03/29/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose New vertebral compression fractures(NVCFs) after minimally invasive surgery in patients with osteoporotic vertebral compression fracture (OVCF) is a challenging issue worldwide. Predicting the occurrence of NVCFs is key to addressing such questions. Therefore, we aimed to investigate the risk factors for patients who developed NVCFs after undergoing surgical treatment and establish a nomogram model to reduce the occurrence of NVCFs. Methods This study is a retrospective analysis that collected the general characteristics and surgical features of patients who underwent surgical treatment at 2 central institutions between January 2017 and December 2020. Patients were divided into training and testing sets based on the presence or absence of NVCFs. Independent risk factors for NVCFs were obtained in the training set of patients, and then a nomogram model was constructed. Internal and external validation of the nomogram model was performed using the consistency index (C index), receiver operating characteristic curve(ROC), calibration curves, and decision curve analysis (DCA). Results A total of 562 patients were included in this study. Patients from the first center were used for nomogram construction and internal validation, and patients from the second center were used as an external validation population. Multivariate regression analysis showed that age, Hounsfield unit (Hu) value, cement leakage, and thoracolumbar (TL) junction fracture were independent risk factors for NVCFs after minimally invasive surgery. The C index was .85, and the validation of internal and external validation shows that the predicted values of the established model is in good agreement with the actual values. Conclusions In this study, 4 independent risk factors were obtained by regression analysis, and a nomogram model was constructed to guide clinical work. The application of this model can help surgeons to make more accurate judgments to prevent the occurrence of NVCFs.
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Affiliation(s)
- FuCheng Bian
- Department of Endoscopic Diagnosis, Daqing Oilfield General Hospital, Daqing, China.,Department of Orthopaedic, Daqing Oilfield General Hospital, Daqing, China
| | - GuangYu Bian
- Department of Obstetrics, Daqing Oilfield General Hospital, Daqing, China
| | - YongSheng An
- Department of Orthopaedic, Chengde Medical University Affiliated Hospital, Chengde, China
| | - DaYong Wang
- Department of Orthopaedic, Daqing Oilfield General Hospital, Daqing, China
| | - JinHui Fang
- Department of Endoscopic Diagnosis, Daqing Oilfield General Hospital, Daqing, China
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18
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Lin S, Cai X, Cheng Q, Chen C, Cao X, Yang F, Fan Y. Association between bone turnover markers, BMD and height loss of cemented vertebrae after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. J Orthop Surg Res 2022; 17:202. [PMID: 35379274 PMCID: PMC8981862 DOI: 10.1186/s13018-022-03087-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/21/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction Percutaneous vertebroplasty (PVP) was recently performed for treating patients with osteoporotic vertebral compression fractures (OVCF). However, recompression of cemented vertebra with significant vertebral height loss occurred in the patients after PVP was observed during the follow-up period. The purpose is to explore the risk factors among several potential predictors for the height loss of treated vertebral bodies after PVP in patients with OVCF. Methods A study of 93 patients who had undergone PVP between May 1, 2016, and March 1, 2019, at the Spine Center of Huadong Hospital Affiliated to Fudan University was conducted. The fractured vertebral height loss ratio ≥ 15% at final follow-up were defined as cemented vertebra recompression. The following variables were measured and collected: age, gender, body mass index (BMI), bone mineral density (BMD), volume of bone cement injected, bone cement leakage, fractured vertebra segment, contact between bone cement and endplates, serum of calcium and phosphorus, and six kinds of bone turnover markers. Results Mann–Whitney U test and Univariate Logistic regression analysis showed that the cemented vertebra recompression was correlated with BMD, contact between bone cement and endplates, parathyroid hormone (PTH), and 25-hydroxy vitamin D3 (25-OH-D3). Following multivariate modeling, multiple factors logistic regression elucidated that high BMD (P < 0.001, OR = 0.089) and high level of serum 25-OH-D3 (P = 0.012, OR = 0.877) were negatively correlated with the cemented vertebra recompression after PVP. Conclusion Decreased BMD and lower level of serum 25-OH-D3 might be two critical and significant risk factors for the height loss of cemented vertebrae after PVP.
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Affiliation(s)
- Shangjin Lin
- Department of Orthopeadic, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Xiaoxi Cai
- Department of Orthopeadic, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Qun Cheng
- Department of Osteoporosis and Bone Disease, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Cong Chen
- Department of Orthopeadic, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Xuhai Cao
- Department of Orthopeadic, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Fengjian Yang
- Department of Orthopeadic, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Yongqian Fan
- Department of Orthopeadic, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China.
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Dai C, Liang G, Zhang Y, Dong Y, Zhou X. Risk factors of vertebral re-fracture after PVP or PKP for osteoporotic vertebral compression fractures, especially in Eastern Asia: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:161. [PMID: 35279177 PMCID: PMC8917756 DOI: 10.1186/s13018-022-03038-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/02/2022] [Indexed: 01/10/2023] Open
Abstract
Objective Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat osteoporotic vertebral compression fractures (OVCF), but the risk of vertebral re-fracture after PVP/PKP remains controversial. This study aims to investigate the incidence and risk factors of vertebral re-fracture after PVP/PKP. Methods Relevant literatures published up to November 2021 were collected from PubMed, Embase and Web of Science. A meta-analysis was performed to extract data associated with risk factors of SVCF following the PRISMA guidelines. Also, pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence interval (CI) was calculated. Results A total of 23 studies, encompassing 9372 patients with OVCF, met the inclusion criteria. 1255 patients (13.39%) suffered re-fracture after PVP/PKP surgery. A total of 22 studies were from Eastern Asia and only 1 study was from Europe. Female sex (OR = 1.34, 95%CI 1.09–1.64, P = 0.006), older age (WMD = 2.04, 95%CI 0.84–3.24, P = 0.001), lower bone mineral density (BMD, WMD = − 0.38, 95%CI − 0.49–0.26, P < 0.001) and bone cement leakages (OR = 2.05, 95% CI 1.40–3.00, P < 0.001) increased the risk of SVCF. The results of subgroup analysis showed the occurrence of re-fracture was significantly associated with gender (P = 0.002), age (P = 0.001) and BMD (P < 0.001) in Eastern Asia. Compared with the unfractured group, anterior-to-posterior vertebral body height ratio (AP ratio, WMD = 0.06, 95%CI 0.00–0.12, P = 0.037) and visual analog scale score (VAS, WMD = 0.62, 95%CI 0.09–1.15, P = 0.022) were higher in the refracture group, and kyphotic angle correction ratio (Cobb ratio, WMD = − 0.72, 95%CI − 1.26–0.18, P = 0.008) was smaller in Eastern Asia. In addition, anti-osteoporosis treatment (OR = 0.40, 95% CI 0.27–0.60, P < 0.001) could be a protective factor. Conclusion The main factors associated with re-fracture after PVP/PKP are sex, age, bone mineral density, AP ratio, Cobb ratio, VAS score, bone cement leakage and anti-osteoporosis treatment, especially in Eastern Asia.
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Zhang T, Wang Y, Zhang P, Xue F, Zhang D, Jiang B. What Are the Risk Factors for Adjacent Vertebral Fracture After Vertebral Augmentation? A Meta-Analysis of Published Studies. Global Spine J 2022; 12:130-141. [PMID: 33272041 PMCID: PMC8965299 DOI: 10.1177/2192568220978223] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVES To provide up-to-date evidence-based outcomes for the incidence and risk factors of adjacent vertebral fracture (AVF) after the vertebral augmentation. METHODS The MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies assessing the risk factors of adjacent vertebral fracture after vertebral augmentation until June 2020. The AVF incidence and factors potentially affecting AVF were extracted and pooled. RESULTS A total of 16 studies, encompassing 2549 patients were included in the meta-analysis. The pooled incidence of AVF was 14% after vertebral augmentation. Female, lower T-score, thoracolumbar junction fracture, intravertebral cleft, more injected cement volume, intradiscal cement leakage significantly increased the risk of AVF. Age, body mass index, steroid medication, Cobb angle change, postoperative Cobb angle showed no significant association with AVF. CONCLUSIONS Identifying the risk factors of AVF can facilitate prevention strategy to avoid the AVF. Female, T-score, thoracolumbar junction fracture, intravertebral cleft, more cement volume, and intradiscal cement leakage increased the risk of AVF.
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Affiliation(s)
- Tianyu Zhang
- Department of Traumatic Orthopaedics, Peking University People’s Hospital, Beijing, China
| | - Yanhua Wang
- Department of Traumatic Orthopaedics, Peking University People’s Hospital, Beijing, China
| | - Peixun Zhang
- Department of Traumatic Orthopaedics, Peking University People’s Hospital, Beijing, China,Institute of Trauma and Nerve Regeneration, Peking University People’s Hospital, Beijing, China
| | - Feng Xue
- Department of Traumatic Orthopaedics, Peking University People’s Hospital, Beijing, China,Feng Xue, Dianying Zhang, and Baoguo Jiang, Department of Traumatic Orthopaedics, Peking University People’s Hospital, No.11 South Avenue, Xi Zhi Men Xicheng District, Beijing 100044, China. Emails: ; ;
| | - Dianying Zhang
- Department of Traumatic Orthopaedics, Peking University People’s Hospital, Beijing, China,Institute of Trauma and Nerve Regeneration, Peking University People’s Hospital, Beijing, China,Department of Orthopaedics, Peking University Binhai Hospital, Tianjin, China,Feng Xue, Dianying Zhang, and Baoguo Jiang, Department of Traumatic Orthopaedics, Peking University People’s Hospital, No.11 South Avenue, Xi Zhi Men Xicheng District, Beijing 100044, China. Emails: ; ;
| | - Baoguo Jiang
- Department of Traumatic Orthopaedics, Peking University People’s Hospital, Beijing, China,Institute of Trauma and Nerve Regeneration, Peking University People’s Hospital, Beijing, China,Feng Xue, Dianying Zhang, and Baoguo Jiang, Department of Traumatic Orthopaedics, Peking University People’s Hospital, No.11 South Avenue, Xi Zhi Men Xicheng District, Beijing 100044, China. Emails: ; ;
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21
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Hijikata Y, Kamitani T, Nakahara M, Kumamoto S, Sakai T, Itaya T, Yamazaki H, Ogawa Y, Kusumegi A, Inoue T, Yoshida T, Furue N, Fukuhara SI, Yamamoto Y. Development and internal validation of a clinical prediction model for acute adjacent vertebral fracture after vertebral augmentation : the AVA score. Bone Joint J 2022; 104-B:97-102. [PMID: 34969274 DOI: 10.1302/0301-620x.104b1.bjj-2021-0151.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To develop and internally validate a preoperative clinical prediction model for acute adjacent vertebral fracture (AVF) after vertebral augmentation to support preoperative decision-making, named the after vertebral augmentation (AVA) score. METHODS In this prognostic study, a multicentre, retrospective single-level vertebral augmentation cohort of 377 patients from six Japanese hospitals was used to derive an AVF prediction model. Backward stepwise selection (p < 0.05) was used to select preoperative clinical and imaging predictors for acute AVF after vertebral augmentation for up to one month, from 14 predictors. We assigned a score to each selected variable based on the regression coefficient and developed the AVA scoring system. We evaluated sensitivity and specificity for each cut-off, area under the curve (AUC), and calibration as diagnostic performance. Internal validation was conducted using bootstrapping to correct the optimism. RESULTS Of the 377 patients used for model derivation, 58 (15%) had an acute AVF postoperatively. The following preoperative measures on multivariable analysis were summarized in the five-point AVA score: intravertebral instability (≥ 5 mm), focal kyphosis (≥ 10°), duration of symptoms (≥ 30 days), intravertebral cleft, and previous history of vertebral fracture. Internal validation showed a mean optimism of 0.019 with a corrected AUC of 0.77. A cut-off of ≤ one point was chosen to classify a low risk of AVF, for which only four of 137 patients (3%) had AVF with 92.5% sensitivity and 45.6% specificity. A cut-off of ≥ four points was chosen to classify a high risk of AVF, for which 22 of 38 (58%) had AVF with 41.5% sensitivity and 94.5% specificity. CONCLUSION In this study, the AVA score was found to be a simple preoperative method for the identification of patients at low and high risk of postoperative acute AVF. This model could be applied to individual patients and could aid in the decision-making before vertebral augmentation. Cite this article: Bone Joint J 2022;104-B(1):97-102.
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Affiliation(s)
- Yasukazu Hijikata
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Spine and Low Back Pain Center, Kitasuma Hospital, Hyogo, Japan
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Shinji Kumamoto
- Department of Spinal Surgery, Fukuoka Kinen Hospital, Fukuoka, Japan
| | - Tsubasa Sakai
- Department of Orthopaedic Surgery, Fukuoka Seisyukai Hospital, Fukuoka, Japan
| | - Takahiro Itaya
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Ogawa
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Kusumegi
- Department of Spine and Spine Surgery, Shinkomonji Hospital, Fukuoka, Japan
| | - Takafumi Inoue
- Department of Spine Surgery, Shintakeo Hospital, Takeo, Japan
| | | | - Naoya Furue
- Department of Orthopaedic Surgery, Fukuokawajiro Hospital, Fukuoka, Japan
| | - Shun-Ichi Fukuhara
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan.,Shirakawa STAR for General Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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22
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Kobayashi M, Toribatake Y, Okamoto S, Kato S, Tsuchiya H. Insufficient Augmentation of Bone Cement Causes Recompression of Augmented Vertebra after Balloon Kyphoplasty. Spine Surg Relat Res 2021; 5:375-380. [PMID: 34966863 PMCID: PMC8668209 DOI: 10.22603/ssrr.2020-0019] [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] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/26/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Balloon kyphoplasty (BKP) is one of the most frequently used clinical methods to relieve pain caused by osteoporotic vertebral compression fracture (OVCF); it can effectively improve the body height of the vertebra. However, recompression of the augmented vertebra (RAV) is often observed after BKP. This study aimed to report factors that are associated with RAV in terms of cement augmentation. Methods A total of 78 patients (women, 60; men, 18) were included in this study. RAV was defined as anterior vertebral height loss (VHL), between immediate postoperation and 3 or 6 months after BKP, of more than 5.0 mm. Cement augmentation ratio (CAR) was calculated as the ratio of the maximal height of polymethylmethacrylate (PMMA) to the maximal distance between both end plates. Age, gender, fracture age, CAR, presence of medication for osteoporosis, intervertebral cleft (IVC), and cement leakage were evaluated using Fisher's exact test or Mann-Whitney U test to compare between RAV and non-RAV groups. Aforementioned variables were also analyzed using multiple logistic regression test. A P<0.05 was considered statistically significant. Results The incidence rates for RAV at 3 and 6 months were 35.9% (28/78) and 38.5% (30/78), respectively. Age (80.1 vs 74.7) was significantly higher in the RAV group, whereas CAR (69.4% vs 77.6%) was lower in the non-RAV group. A multivariate regression analysis revealed that age (odds ratio (OR)=1.12, P=0.001) and CAR (OR=0.91, P=0.001) were independently associated with RAV. Conclusions RAV was observed in 38.5% of patients in this study. Older age and low CAR were independently associated with RAV. To prevent RAV, especially in the elderly, augmented PMMA should come in contact with both end plates.
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Affiliation(s)
- Motoya Kobayashi
- Department of Orthopaedic Surgery, JA Toyama Kouseiren Takaoka Hospital, Takaoka, Japan.,Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Yasumitsu Toribatake
- Department of Orthopaedic Surgery, JA Toyama Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Shunpei Okamoto
- Department of Orthopaedic Surgery, JA Toyama Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
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23
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Mao W, Dong F, Huang G, He P, Chen H, Qin S, Li A. Risk factors for secondary fractures to percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a systematic review. J Orthop Surg Res 2021; 16:644. [PMID: 34717682 PMCID: PMC8556988 DOI: 10.1186/s13018-021-02722-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/13/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Osteoporotic vertebral compression fracture (OVCF) is one of the most common fragile fractures, and percutaneous vertebroplasty provides considerable long-term benefits. At the same time, there are many reports of postoperative complications, among which fracture after percutaneous vertebroplasty is one of the complications after vertebroplasty (PVP). Although there are many reports on the risk factors of secondary fracture after PVP at home and abroad, there is no systematic analysis on the related factors of secondary fracture after PVP. METHODS The databases, such as CNKI, Wan Fang Database and PubMed, were searched for documents on secondary fractures after percutaneous vertebroplasty published at home and abroad from January 2011 to March 2021. After strictly evaluating the quality of the included studies and extracting data, a meta-analysis was conducted by using Revman 5.3 software. RESULTS A total of 9 articles were included, involving a total of 1882 patients, 340 of them diagnosed as secondary fractures after percutaneous vertebroplasty. CONCLUSION The additional history of fracture, age, bone mineral density (BMD), bone cement leakage, intravertebral fracture clefts and Cobb Angle might be risk factors related to secondary fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fractures. The height of vertebral anterior and body mass index (BMI) were not correlated.
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Affiliation(s)
- Wei Mao
- Guangzhou Institute of Traumatic Surgery, Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.,Department of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Fei Dong
- Department of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Guowei Huang
- Guangzhou Institute of Traumatic Surgery, Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Peiliang He
- Guangzhou Institute of Traumatic Surgery, Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China.,Department of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Huan Chen
- Guangzhou Institute of Traumatic Surgery, Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Shengnan Qin
- Guangzhou Institute of Traumatic Surgery, Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Aiguo Li
- Guangzhou Institute of Traumatic Surgery, Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China. .,Department of Clinical Medicine, Guizhou Medical University, Guiyang, China.
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24
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Fang SY, Dai JL, Min JK, Zhang WL. Analysis of risk factors related to the re-fracture of adjacent vertebral body after PKP. Eur J Med Res 2021; 26:127. [PMID: 34717767 PMCID: PMC8556983 DOI: 10.1186/s40001-021-00592-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to investigate the risk factors of vertebral re-fracture after percutaneous kyphoplasty (PKP) for osteoporosis vertebral compression fracture (OVCF), and to provide reference for clinical prevention. MATERIAL AND METHODS A retrospective analysis was performed on 228 OVCF patients admitted on November 6, 2013, solstice, December 14, 2018, which met the inclusion criteria. There were 35 males and 193 females, with a male-to-female ratio of 3:20, and an age of 61-89 years. All patients were treated with PKP surgery with complete clinical data, and the rate of re-fracture was calculated according to whether re-fracture occurred after surgery, divided into the re-fracture group (24 cases) and the non-refracture group (204 cases). May be associated with subsequent fracture factors (gender, age, number of surgical segment vertebral body, whether with degenerative scoliosis, whether to fight osteoporosis) into a single-factor research, then the single-factor analysis was statistically significant risk factors for multiple logistic regression analysis, further defined after PKP holds the vertebral body fracture independent risk factors. Survival analysis was performed using the time of vertebral re-fracture after PKP as the end time of follow-up, the occurrence of re-fracture after PKP as the endpoint event, and the presence or absence of degenerative lateral curvature as a variable factor. RESULTS All 228 vertebroplasty patients were followed up for a period of 1.8 to 63.6 months. The mean follow-up time was (28.8 ± 15.6) months, and the re-fracture rate was 10.5%. There were statistically significant differences between the re-fracture group and the non-refracture group in age, number of operative vertebral bodies, whether there was a combination of degenerative scoliosis and whether there was anti-osteoporosis treatment (P < 0.05). The results of univariate logistic regression analysis after excluding the mutual influence of various factors showed that the number of vertebral bodies and the group with lateral curvature might be the risk factors for PKP re-fracture after surgery. The above possible risk factors were included in multiple logistic regression analysis to show whether there were independent risk factors for scoliosis and vertebral re-fracture. Survival analysis showed that the mean survival time was 42.1 months, the P value was 0.00, and the mean 95% confidence interval was (34.4-49.7 months), indicating that the combination of degenerative lateral bending might be related to the occurrence of re-fracture. CONCLUSIONS Combined scoliosis is an independent risk factor for re-fracture after OVCF laminoplasty and a possible risk factor for re-fracture after surgery.
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Affiliation(s)
- Shen-Yun Fang
- Orthopedics Department, The First People Hospital of Huzhou, The First People's Hospital Affiliated to Huzhou Normal University, Huzhou, 313000, China
| | - Ji-Lin Dai
- Orthopedics Department, The First People Hospital of Huzhou, The First People's Hospital Affiliated to Huzhou Normal University, Huzhou, 313000, China
| | - Ji-Kang Min
- Orthopedics Department, The First People Hospital of Huzhou, The First People's Hospital Affiliated to Huzhou Normal University, Huzhou, 313000, China.
| | - Wei-Li Zhang
- Ophthalmology Department, The First People Hospital of Huzhou, The First People's Hospital Affiliated to Huzhou Normal University, Huzhou, 313000, China.
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25
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Kim WJ, Ma SB, Shin HM, Song DG, Lee JW, Chang SH, Park KY, Choy WS, Oh TH. Correlation of Sagittal Imbalance and Recollapse after Percutaneous Vertebroplasty for Thoracolumbar Osteoporotic Vertebral Compression Fracture: A Multivariate Study of Risk Factors. Asian Spine J 2021; 16:231-240. [PMID: 34407571 PMCID: PMC9066252 DOI: 10.31616/asj.2021.0062] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/02/2021] [Indexed: 12/15/2022] Open
Abstract
Study Design A retrospective case control study. Purpose This study aimed to assess the clinical significance of sagittal balance for predicting and managing the recollapse of cemented vertebra following percutaneous vertebroplasty (PVP) in patients with thoracolumbar osteoporotic vertebral fracture (OVF). Overview of Literature Recently, the recollapse of cemented vertebra following PVP for OVF has been reported. Although the risk factors for recollapse have been determined, the association between sagittal spinopelvic parameters and sagittal imbalance with recollapse has not been established. Methods Ambulatory patients who underwent single-level PVP for thoracolumbar OVF with a follow-up of at least 24 months were retrospectively reviewed. The patients were divided into two groups depending on the presence of symptomatic recollapse at the cemented vertebra: (1) recollapsed (RC) group and (2) noncollapsed (NC) group. The patient characteristics and radiographic measurements associated with sagittal imbalance were analyzed at each follow-up visit. Results Overall, 134 patients (RC group, n=28; NC group, n=106) were enrolled. The mean fracture-free interval was 3.2 months (range, 1.2–25.1 months). The multivariate binary logistic regression analysis identified low bone mineral density (p=0.047), degree of dynamic mobility within the vertebra (p=0.025), and sagittal imbalance as significant risk factors for recollapse (p=0.013; odds ratio, 5.405). The progression of sagittal imbalance and thoracolumbar kyphosis (T10–L2) was more significant in the RC and sagittal imbalance groups than in the NC group (both p=0.000). Conclusions Sagittal imbalance, lower bone mineral density, and dynamic mobility within the vertebra are associated with the recollapse of cemented vertebrae following PVP. Sagittal imbalance, rather than local kyphosis or thoracolumbar kyphosis, is particularly significant in that it results in more progressive collapse and sagittal deformity and is accompanied by substantial back pain and neurological deficits. Therefore, a stricter and more active management, including anti-osteoporosis medication, is required for the treatment of OVF with sagittal imbalance of the spine.
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Affiliation(s)
- Whoan Jeang Kim
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Sang Beom Ma
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Hyun Min Shin
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Dae Geon Song
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Jae Won Lee
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Shan Haw Chang
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Kun Young Park
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Won Sik Choy
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Tae Ho Oh
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
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26
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Survival analysis and risk factors of new vertebral fracture after vertebroplasty for osteoporotic vertebral compression fracture. Spine J 2021; 21:1355-1361. [PMID: 33971326 DOI: 10.1016/j.spinee.2021.04.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/23/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT Although risk factors of new adjacent vertebral fracture (AVF) and remote vertebral fracture (RVF) after vertebroplasty may differ, research on this topic is lacking. PURPOSE To determine the natural course of new vertebral fractures after vertebroplasty for osteoporotic vertebral compression fracture (OVCF) and to analyze each risk factor for understanding the incidence of AVF and RVF. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE The study subjects included 205 patients who received vertebroplasty for OVCF and were followed-up for at least 1-year. OUTCOME MEASURES Data on factors that could affect the occurrence of vertebral fractures, such as age, body mass index, and bone density, were collected from the patients' medical records. Fracture pattern, fracture location, sagittal imbalance, degree of segmental kyphosis after vertebroplasty, cement distribution, and cement leakage were radiologically examined. METHODS xDuring the follow-up period, any newly developed vertebral fractures were identified. We analyzed whether the time of occurrence differed between AVF and RVF by performing a survival analysis and each risk factor separately. RESULTS New vertebral fractures occurred in 47 patients (22.9%) after vertebroplasty, AVF occurred in 21 patients (10.2%), and RVF occurred in 26 patients (12.7%). The onset time of AVF was 6.2±1.8 months after vertebroplasty, showing a significant difference from that of RVF, which was 15.2±1.8 months (p<.001). In the univariate analysis, the risk factors of AVF included severe osteoporosis (T-score<-3.0), vertebroplasty in the thoracolumbar junction, sagittal imbalance, and segmental kyphosis angle >15° (p=0.029, p=0.033, p=0.001, and p=0.021, respectively). The risk factors of RVF included severe osteoporosis (T-score <-3.0) and sagittal imbalance (p=0.013 and p=0.004). In the multivariate analysis, the risk factors of AVF included vertebroplasty in the thoracolumbar junction and sagittal imbalance (hazard ratio=3.34, p=0.032 and hazard ratio=4.05, p=0.008), and those of RVF included only sagittal imbalance (hazard ratio=2.66, p=0.024). CONCLUSON After vertebroplasty for OVCF, a significant difference in the meantime of occurrence was found; it took 6 months for AVF and 15 months for RVF to develop. Vertebroplasty in the thoracolumbar junction was identified as a risk factor for AVF, whereas sagittal imbalance was a risk factor of both AVF and RVF.
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Matsumoto K, Hoshino M, Omori K, Igarashi H, Matsuzaki H, Tokuhashi Y. Preoperative scoring system for predicting early adjacent vertebral fractures after Balloon Kyphoplasty. J Orthop Sci 2021; 26:538-542. [PMID: 32709541 DOI: 10.1016/j.jos.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/21/2020] [Accepted: 06/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adjacent vertebral fracture (AVF) is a major complication following Balloon Kyphoplasty (BKP). There is no scoring system for predicting AVF using only preoperative elements. The purposes of this study were to develop a scoring system for predicting early AVF after BKP based on preoperative factors and to investigate the appropriate surgical indication for BKP. METHODS Of 220 patients who underwent BKP at a single institution since 2011, 65 patients over the age of 60 who had undergone a standing whole spine X-ray preoperatively were enrolled. Factors affecting the occurrence of early AVF were examined. A scoring system was created consisting of the factors exhibiting significant differences, and the correlation between the total score and the incidence of early AVF was investigated. RESULTS Twenty of the 65 patients (30.8%) had early AVF. In a univariate analysis, age, previous vertebral fracture, pelvic tilt, and Local kyphosis significantly influenced early AVF. In a multivariate logistic regression analysis, age had an odds ratio of 1.136 (95% CI 1.001-1.289), previous vertebral fractures 4.181 (1.01-17.309), and Local kyphosis 1.103 (1.021-1.191). The scoring system was set as follows: ①Age (<75 years: 0 points(P), 75years≦: 1P), ②The number of previous vertebral fractures (0: 0 P, 1: 1P, 2: 2P, 3 or more: 3P), and ③Local kyphosis (<10°: 0P, 10°≦: 1P). There was a correlation between the total score and the incidence of early AVF (r = 0.812, ∗P = 0.05). The incidence of early AVF was 6.4% (2 cases/31 cases) for a score of ≦1P and 54.5% (18 cases/33 cases) for a score of ≧2P. CONCLUSIONS There was a correlation between the total score and the incidence of early AVF. A score of 1 point or less may represent the appropriate surgical indication for BKP.
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Affiliation(s)
- Koji Matsumoto
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamimati, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Masahiro Hoshino
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, 2-5-10 Ikohoncyo Adati-ku, Tokyo, 121-0807, Japan
| | - Keita Omori
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, 2-5-10 Ikohoncyo Adati-ku, Tokyo, 121-0807, Japan
| | - Hidetoshi Igarashi
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, 2-5-10 Ikohoncyo Adati-ku, Tokyo, 121-0807, Japan
| | - Hiromi Matsuzaki
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, 2-5-10 Ikohoncyo Adati-ku, Tokyo, 121-0807, Japan
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamimati, Itabashi-ku, Tokyo, 173-8610, Japan
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28
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Fan X, Li S, Zeng X, Yu W, Liu X. Risk factors for thoracolumbar pain following percutaneous vertebroplasty for osteoporotic vertebral compression fractures. J Int Med Res 2021; 49:300060521989468. [PMID: 33513025 PMCID: PMC7871086 DOI: 10.1177/0300060521989468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To explore possible risk factors for poor outcomes following percutaneous vertebroplasty (PV) for painful osteoporotic compression fractures of thoracolumbar vertebra. METHODS This was a retrospective review of data from patients who underwent PV at our institution over a ten-year period to evaluate the association between possible risk factors and thoracolumbar pain (T11-L2). According to the difference between pre- and post-operative visual analogue scale (VAS) scores for pain, patients were separated into poor relief (PR; <4) and good relief (GR; ≥4) of pain. RESULTS Of the 750 patients identified, 630 (PR group, n =310; GR group, n = 320) fulfilled the eligibility criteria. Multivariate binary logistic analysis showed that bone mineral density (BMD), >2 fractured vertebral bodies, maldistribution of bone cement, <5 ml bone cement injected into a single vertebral body and thoracolumbar fascia injury prior to surgery were independent risk factors associated with thoracolumbar pain following PV. CONCLUSION Although prospective controlled studies are required to confirm our results, this review suggests that the above factors should be taken into account when selecting patients for PV.
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Affiliation(s)
- Xiaoguang Fan
- Department of Spinal Surgery, Yantaishan Hospital, Yantai, Shandong, China
| | - Sha Li
- Department of Obstetrics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiangzhen Liu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Robo C, Öhman-Mägi C, Persson C. Long-term mechanical properties of a novel low-modulus bone cement for the treatment of osteoporotic vertebral compression fractures. J Mech Behav Biomed Mater 2021; 118:104437. [PMID: 33706086 DOI: 10.1016/j.jmbbm.2021.104437] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/20/2021] [Accepted: 02/26/2021] [Indexed: 02/04/2023]
Abstract
In spite of the success of vertebroplasty (VP) and balloon kyphoplasty (BKP), which are widely used for stabilizing painful vertebral compression fractures, concerns have been raised about use of poly(methyl methacrylate) (PMMA) bone cements for these procedures since the high compressive modulus of elasticity (E) of the cement is thought to be one of the causes of the higher number of adjacent-level vertebral fractures. Therefore, bone cements with E comparable to that of cancellous bone have been proposed. While the quasi-static compressive properties of these so-called "low-modulus" cements have been widely studied, their fatigue performance remains underassessed. The purpose of the present study was to critically compare a commercial bone cement (control cement) and its low-modulus counterpart on the basis of quasi-static compressive strength (CS), E, fatigue limit under compression-compression loading, and release of methyl methacrylate (MMA). At 24 h, mean CS and E of the low-modulus material were 72% and 77% lower than those of the control cement, whereas, at 4 weeks, mean CS and E were 60% and 54% lower, respectively. The fatigue limit of the control cement was estimated to be 43-45 MPa compared to 3-5 MPa for the low-modulus cement. The low-modulus cement showed an initial burst release of MMA after 24 h followed by a plateau, similar to many other commercially available cements, whereas the control cement showed a much lower, stable release from day 1 and up to 1 week. The low-modulus cement may be a promising alternative to currently available PMMA bone cements, with the potential for reducing the incidence of adjacent fractures following VP/BKP.
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Affiliation(s)
- Céline Robo
- Division of Applied Materials Science, Department of Materials Science and Engineering, Uppsala University, Uppsala, Sweden
| | - Caroline Öhman-Mägi
- Division of Applied Materials Science, Department of Materials Science and Engineering, Uppsala University, Uppsala, Sweden
| | - Cecilia Persson
- Division of Applied Materials Science, Department of Materials Science and Engineering, Uppsala University, Uppsala, Sweden.
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Lee BJ, Koo HW, Yoon SW, Sohn MJ. Usefulness of Trabecular CT Attenuation Measurement of Lumbar Spine in Predicting Osteoporotic Compression Fracture: Is the L4 Trabecular Region of Interest Most Relevant? Spine (Phila Pa 1976) 2021; 46:175-183. [PMID: 33065695 DOI: 10.1097/brs.0000000000003756] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The aim of this study was to evaluate the usefulness of computed tomography (CT) attenuation in defining trabecular region-of-interest (t-ROI) at lumbar vertebral body in the assessment of osteoporotic compression fracture (OCF) compared to spinal dual x-ray absorptiometry (DXA). SUMMARY OF BACKGROUND DATA Even though osteoporosis was not diagnosed in the bone mineral density measurement using DXA, we often experienced cases where the screw was weakly inserted due to low bone quality during screw insertion. METHODS A total of 188 patients who met the inclusion criteria were enrolled. We determined best cutoff value of the simple t-ROI attenuation at the most relevant level for predicting OCF. We assessed correlations between the simple t-ROI attenuation at the most relevant level and OCF rate, and investigate the association between the number of compression fracture and simple t-ROI attenuation at the most relevant level. RESULTS L4 ROI attenuation is the most accurate measurement for predicting osteoporotic compression fracture with an area under the curve of 0.798. The optimal cutoff point of L4 ROI attenuation was measured at 90.5 HU with 88.8% and 60.6% sensitivity and specificity, respectively. L4 ROI attenuation was significantly correlated with the osteoporotic compression fracture rate (r = -0.545, P < 0.001). The number of compression fracture (coefficient of determination R2 = 0.286; P < 0.001) was independently correlated with L4 ROI attenuation. CONCLUSION Simple t-ROI computed tomography attenuation is an accurate measurement tool in predicting OCF compared to DXA T-score. The value of L4 t-ROI attenuation is the most relevant measurement for predicting osteoporotic compression fracture, is an alternative to DXA, and can predict the number and rate of compression fractures. Spine surgeons should be aware of L4 t-ROI attenuation to make successful fusion in spine surgery for elderly patients group.Level of Evidence: 3.
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Affiliation(s)
- Byung-Jou Lee
- Department of Neurosurgery, Neuroscience & Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, College of Medicine, Goyang, Korea
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Comparison of targeted percutaneous vertebroplasty and traditional percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures in the elderly. J Orthop Surg Res 2020; 15:359. [PMID: 32847593 PMCID: PMC7450568 DOI: 10.1186/s13018-020-01875-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/10/2020] [Indexed: 11/21/2022] Open
Abstract
Objective To investigate the clinical effect of precise puncture and low-dose bone cement in percutaneous vertebroplasty (PVP). Methods Sixty patients with osteoporotic vertebral compression fracture (OVCFs) who were treated with PVP in our hospital from July 2018 to June 2019. These included patients were divided into group A (N = 30) and group B (N = 30). Group A has punctured to the fracture area accurately and injected with a small dose of bone cement, the group B was injected with a conventional dose of bone cement. The operation time, the amount of bone cement injection, the number of X-rays, the VAS scores, the leakage rate of bone cement, and the incidence of adjacent vertebral fractures were compared between the two groups. Result The operation time, fluoroscopic times, and bone cement volume in group A are less than that in group B (P < 0.05). Patients in group A had a lower incidence of cement leakage and adjacent vertebral fracture than that in patients in group B. There was no significant difference in postoperative pain relief between the two groups. Conclusions Precise puncture and injection of small doses of bone cement can reduce the number of X-ray fluoroscopy, operation time, amount of bone cement injection, reduce the rate of bone cement leakage and the incidence of adjacent vertebral fractures, which is a safe and effective surgical approach for the treatment for the aged with OVCFs.
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Effect of Preoperative Zoledronic Acid Administration on Pain Intensity after Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures. Pain Res Manag 2020; 2020:8039671. [PMID: 32831984 PMCID: PMC7421713 DOI: 10.1155/2020/8039671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/07/2020] [Indexed: 02/04/2023]
Abstract
Introduction This study aimed to compare and analyze the effect of preoperative zoledronic acid (ZOL) administration on pain intensity after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). Methods The study included 242 patients with OVCFs who underwent PVP in our hospital between January 2015 and June 2018. The patients were randomly assigned to either a ZOL group (n = 121) or a control group (n = 121). The patients in the ZOL group were treated preoperatively with intravenous infusion of 5 mg ZOL. Those in the control group were treated without ZOL. All the patients were followed up for 1 year. Results No statistically significant differences in age, sex, weight, and body mass index (BMI) were found between the two groups. During the follow-up period, the visual analog scale score and Oswestry dysfunction index score in the ZOL group were lower than those in the control group. The bone mineral density at 6 or 12 months after treatment was significantly higher and the levels of the bone metabolism markers were significantly lower in the ZOL group than in the control group (P < 0.05 for both). Two patients in the treatment group had new vertebral fractures, whereas 13 patients in the control group had new vertebral fractures, which translate to recompression vertebral fracture incidence rates of 1.7% and 10.7%, respectively. The incidence rate of mild adverse reactions was significantly higher in the ZOL group than in the control group, but all the cases were endurable. Conclusion Intravenous infusion of ZOL before PVP can effectively reduce postoperative pain intensity, reduce bone loss, increase bone density, reduce the risk of refracture, and improve patient quality of life.
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Prophylactic Percutaneous Kyphoplasty Treatment for Nonfractured Vertebral Bodies in Thoracolumbar for Osteoporotic Patients. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8593516. [PMID: 32352011 PMCID: PMC7171633 DOI: 10.1155/2020/8593516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/06/2020] [Accepted: 02/29/2020] [Indexed: 02/05/2023]
Abstract
Purpose The occurrence of new vertebral compression fractures (VCFs) is a common complication after percutaneous kyphoplasty (PKP). Secondary VCFs after PKP occur predominantly in the thoracolumbar segment (T11 to L2). Prophylactic injections of cement into vertebral bodies in order to reduce new VCFs have rarely been reported. The main purpose of this study was to investigate whether prophylactically injecting cement into a nonfractured vertebral body at the thoracolumbar level (T11-L2) could reduce the occurrence of new VCFs. Methods From July 2011 to July 2018, PKP was performed in 86 consecutive patients with osteoporotic vertebral compression fractures (OVCFs) in the thoracolumbar region (T11-L2). All patients selected underwent PKP because of existing OVCFs (nonprophylactic group). Additionally, 78 consecutive patients with fractured vertebrae in the thoracolumbar region (T11-L2) with OVCFs underwent PKP and received prophylactic injections of cement into their nonfractured vertebrae in the thoracolumbar region (T11-L2) (prophylactic group). The visual analog scale (VAS) scores and incidence of new VCFs after PKP were compared between the two groups. Results The mean VAS scores improved from 8.00 ± 0.79 preoperatively to 1.62 ± 0.56 at the last follow-up in the nonprophylactic group and improved from 8.17 ± 0.84 to 1.76 ± 0.34 in the prophylactic group (P > 0.05). In the nonprophylactic group, 21 of 86 patients (24.4%) developed new VCFs within one year after PKP, of whom 15 patients (71.4%) developed VCFs within 3 months. In the prophylactic group, 8 of 78 patients (10.3%) developed new VCFs within one year, and 6 of these 8 patients (75%) developed new VCFs within 3 months. The incidence of new VCFs was significantly higher in the nonprophylactic group than that in the prophylactic group at one year (P = 0.018), but there were no statistically significant differences at three months (P = 0.847). Conclusions Prophylactic injections of cement into nonfractured (T11-L2) vertebral bodies reduced the incidence of secondary VCFs after PKP in patients with OVCFs, but there was no significant difference in local back pain (VAS) scores between the two groups.
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Abstract
PURPOSE OF REVIEW This comprehensive review of current concepts in the management of vertebral compression fractures is a manuscript of vertebral augmentation literature of risk factors, clinical presentation, and management. The objective of this review is to compare outcomes between multiple augmentation techniques and ongoing discussions of effectiveness of vertebral augmentation procedures. RECENT FINDINGS Vertebral compression fractures (VCFs) are a prevalent disease affecting approximately 1.5 million US adults annually. VCFs can cause severe physical limitations, including back pain, functional disability, and progressive kyphosis of the thoracic spine that ultimately results in decreased appetite, poor nutrition, impaired pulmonary function, and spinal cord compression with motor and sensory deficits. The deconditioning that affects patients with vertebral compression fractures leads to mortality at a far higher rate than age-matched controls. The management of vertebral compression fractures has been extensively discussed with opponents arguing in favor or restricting conservative management and against augmentation, while proponents argue in favor of augmentation. The literature is well established in reference to the effects on mortality when patients undergo treatment with vertebral augmentation; in over a million patients with vertebral compression fractures treated with vertebral augmentation as compared with patients treated with non-surgical management, the patients receiving augmentation performed well with a decrease in morbidity and mortality. Summary of the literature review shows that understanding the risk factors, appropriate clinical evaluation, and management strategies are crucial. Analysis of the evidence shows, based on level I and II studies, balloon kyphoplasty had significantly better and vertebroplasty tended to have better pain reduction compared with non-surgical management. In addition, balloon kyphoplasty tended to have better height restoration than vertebroplasty.
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Chen Z, Chen Z, Wu Y, Wu Y, Ning S, Ning S, Ma T, Ma T, Wu Z, Wu Z. Risk Factors of Secondary Vertebral Compression Fracture After Percutaneous Vertebroplasty or Kyphoplasty: A Retrospective Study of 650 Patients. Med Sci Monit 2019; 25:9255-9261. [PMID: 31740653 PMCID: PMC6911304 DOI: 10.12659/msm.915312] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background In this study, we aimed to investigate the risk factors contributing to secondary vertebral compression fractures (SVCF) in patients undergoing percutaneous vertebroplasty (PVP) or kyphoplasty (PKP) due to osteoporotic vertebral compression fracture (OVCF). Material/Methods Between January 2010 and December 2017, 650 patients with regular follow-up were identified and retrospectively analyzed in this study. Of these patients, 410 patients underwent PVP and 240 patients underwent PKP surgery. Patients were followed for 24 months on average, ranging from 6 months to 36 months follow-up. Possible risk factors screened for were age, gender, regional distribution, outdoor activity (ODA), bone mineral density (BMD), surgical methods (unilateral or bilateral), bone cement dose, bone cement leakage, chronic disease history, postoperative anti-osteoporosis treatment, and level of preoperative OVCF. Logistic regression analysis was applied to determine potential risk factors. Results As a result, 102 patients (15.7%) suffered SVCF after PVP/PKP surgery at the last follow-up. Binary logistic regression model showed that older age increased the risk of developing SVCF [odds ratio (OR)=2.48, P=0.031] while high-level BMD (OR=0.31, P<0.001) and ODA (OR=0.38, P=0.001) decreased the risk. Binary logistic regression model showed the following: Logit (P)=1.03+0.91X1–1.18X2–0.97X3 (X1=age, OR=2.48, P=0.031; X2=BMD, OR=0.31, P<0.001; X3=ODA, OR=0.38, P=0.001). Conclusions In conclusion, older age and lower BMD were identified as risk factors of SVCF for OVCF patients following PVP/PKP surgery, whereas more ODA played a protective role in SVCF development.
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Affiliation(s)
- Ziqi Chen
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Ziqi Chen
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Yanping Wu
- Department of Medical Service Management, The First Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Yanping Wu
- Department of Medical Service Management, The First Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Shenghua Ning
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Shenghua Ning
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Tianxiao Ma
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Tianxiao Ma
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Zhanyong Wu
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Zhanyong Wu
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
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Takahashi S, Hoshino M, Yasuda H, Hori Y, Ohyama S, Terai H, Hayashi K, Tsujio T, Kono H, Suzuki A, Tamai K, Toyoda H, Dohzono S, Sasaoka R, Kanematsu F, Nakamura H. Development of a scoring system for predicting adjacent vertebral fracture after balloon kyphoplasty. Spine J 2019; 19:1194-1201. [PMID: 30831317 DOI: 10.1016/j.spinee.2019.02.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The incidence of adjacent vertebral fracture (AVFs) is reported to be 10%-38% after balloon kyphoplasty. However, no reports have established a system for prediction of AVF occurrence. PURPOSE To establish a scoring system for predicting AVF occurrence after balloon kyphoplasty for osteoporotic vertebral fractures (OVFs). DESIGN A prospective cohort study. PATIENT SAMPLE Consecutive elderly patients aged 65 years and older who underwent balloon kyphoplasty for OVFs within 2 months after the onset. OUTCOME MEASURES AVF was confirmed by X-ray. METHODS From 2015 to 2017, 116 consecutive patients from 10 participating hospitals who underwent balloon kyphoplasty were enrolled in this study. Prior to study enrollment, each patient underwent plain X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) of the thoracic and lumbar spine. Severity of pain was subjectively assessed using a visual analog scale (VAS) based on the average level of back pain that the patient had experienced in the preceding week. After enrollment, subjects underwent balloon kyphoplasty. Quality of life was evaluated using SF-36. Patients were followed up for at least 6 months. RESULTS Of the 116 patients enrolled, 109 patients with all the required data at the time of enrolment and the 6-month follow-up were included in the study. A total of 32 patients (29%) showed AVFs within the 6-month follow-up. No significant differences were observed in each clinical outcome at 6-month follow-up, although higher VAS score for back pain at 1-month follow-up was observed in the AVF group (37.5) than in the non-AVF group (20.8, p<.001). Wedge angle of vertebrae before surgery was greater in the AVF group (21.6°) than in the non-AVF group (15.7°, p<.001). The change in wedge angle between pre- and postsurgery was greater in the AVF group than in the non-AVF group, whereas the change in local kyphosis was not significantly different. The multiple logistic regression model showed increased odds ratio (OR) of thoracic or thoracolumbar spine, old OVF presence, >25° kyphosis before surgery, and >10°correction for AVF. Based on this result, a simple scoring system for predicting AVF occurrence was developed. The total AVF score was calculated as the sum of the individual scores, which varied from 0 to 6. All patients with 5-6 points sustained AVF. CONCLUSIONS More severe wedge angle before surgery, correction degree, old OVF presence, and thoracolumbar level were predictive factors for AVF. All patients with AVF risk score of 5 or more showed AVF. This information may aid preoperative risk assessment, informed shared decision-making, and consideration of potential alternative management strategies.
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Affiliation(s)
- Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - Hiroyuki Yasuda
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Yusuke Hori
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shoichiro Ohyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazunori Hayashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan; Department of Orthopaedic Surgery, Shimada Hospital, Osaka, Japan
| | - Tadao Tsujio
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Nara, Japan
| | - Hiroshi Kono
- Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Sho Dohzono
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Ryuichi Sasaoka
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Fumiaki Kanematsu
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Wang P, Li J, Song Z, Peng Z, Wang G. Utilization of the directional balloon technique to improve the effectiveness of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures and reduction of bone cement leakage. Medicine (Baltimore) 2019; 98:e15272. [PMID: 31083158 PMCID: PMC6531054 DOI: 10.1097/md.0000000000015272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This article evaluates the effectiveness of a new directional balloon technique in the treatment of osteoporotic vertebral compression fractures (OVCFs). METHODS From September 2015 to April 2017, 100 patients with single-segment OVCFs treated using percutaneous kyphoplasty were available for complete data assessment. Among these, 51 cases were treated with the traditional nondirectional balloon technique (group 1) and 49 cases were treated with the directional balloon technique (group 2). Operative time, blood loss, and X-ray exposure time were compared between the 2 groups. The visual analogue score (VAS), Oswestry disability index (ODI), and Roland Morris disability (RMD) scores, and wedge-shaped and kyphosis angles were measured at 3 days and 1, 3, 6, and 12 months, respectively, after surgery. RESULTS There were no significant differences in blood loss or the amount of bone cement injected between the 2 groups; however, operative times, X-ray exposure times, and leakage rates of bone cement, especially type C in group 2, were significantly lower in group 2 than those in group 1. VAS, ODI, and RMD scores, and wedge-shaped and kyphosis angles at each time point after surgery were significantly higher than those before surgery. However, the improvement in VAS, ODI, and RMD scores in group 2 was only significantly better than those in group 1 at 3 days after surgery. CONCLUSION The utilization of the directional balloon technique in the treatment of OVCFs using percutaneous kyphoplasty can not only reduce the operation time, the radiation, and the bone cement leakage, but also improve the early curative effect.
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Liu J, Liu Z, Luo J, Gong L, Cui Y, Song Q, Xiao PF, Zhou Y. Influence of vertebral bone mineral density on total dispersion volume of bone cement in vertebroplasty. Medicine (Baltimore) 2019; 98:e14941. [PMID: 30896660 PMCID: PMC6709149 DOI: 10.1097/md.0000000000014941] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to investigate the influence of vertebral bone mineral density (BMD) on total diffusion volume of bone cement in percutaneous vertebroplasty (PVP). This study was a retrospective review of prospectively collected data of consecutive patients with A1.2 thoracolumbar compression fractures treated by PVP. Vertebral BMD was measured before surgery and participants were divided into 3 groups according to World Health Organization diagnostic criteria for osteoporosis: Group A (normal BMD), Group B (reduced BMD), and Group C (osteoporosis). All vertebrae were injected with 3 mL of bone cement via the unilateral pedicle and scanned by computed tomography after surgery. Actual injection volume (bone cement only) and total diffusion volume (bone cement plus trabeculae and space) were calculated. Pain severity was determined by the visual analog scale before surgery and at both 1 day and 1 month after surgery. There were no significant differences in injection volume among the groups (P > .05), but the total dispersion volume was greater than injection volume in all groups (P < .05). Pairwise comparison showed a significant difference in total diffusion volume of bone cement between groups, with Group A having the largest volume and Group C the smallest volume. Pain was significantly reduced 1 day after surgery in each group compared with before surgery, but there were no significant between-group differences at 1 day or 1 month. Increasing vertebral BMD was positively correlated with increasing total diffusion volume. BMD does not significantly affect pain relief, despite producing a significantly lower distribution volume in osteoporotic patients.
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Affiliation(s)
- Jun Liu
- Department of Orthopedic, Shaanxi Provincial People's Hospital
| | | | - Jing Luo
- Departments of Nursing Administration, Honghui Hospital, Xi’an Jiaotong University College of Medicine
| | - Liqun Gong
- Department of Orthopedic, Shaanxi Provincial People's Hospital
| | - Yaqing Cui
- Department of Surgery Center, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi, People's Republic of China
| | - Qichun Song
- Department of Orthopedic, Shaanxi Provincial People's Hospital
| | - Pei Fen Xiao
- Department of Orthopedic, Shaanxi Provincial People's Hospital
| | - Yongchun Zhou
- Department of Orthopedic, Shaanxi Provincial People's Hospital
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Rong Y, Luo Y, Liu W, Gong F, Tang P, Cai W. Clinical effects of the bridge-type ROI-C interbody fusion cage system in the treatment of cervical spondylosis with osteoporosis. Clin Interv Aging 2018; 13:2543-2551. [PMID: 30587947 PMCID: PMC6298882 DOI: 10.2147/cia.s182969] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective To investigate the early and mid-term efficacy and safety of the bridge-type ROI-C interbody fusion cage system in the treatment of cervical spondylosis with osteoporosis during anterior cervical discectomy and fusion (ACDF). Patients and methods The clinical data from 24 cervical spondylosis patients with osteoporosis treated with ACDF were retrospectively analyzed. All patients were treated with ROI-C cage. Double-energy X-ray absorptiometry (DEXA) was used to measure the bone mineral density (BMD). The cervical sagittal radiographic parameters were measured and compared using X-ray including C2–C7 Cobb angle, segmental angle (SA), cervical vertebral bow depth, and height of operation segment (HOS). Postoperative dysphagia was recorded according to the Bazaz score. The Japanese Orthopedic Association (JOA) scores and Neck Disability Index (NDI) scores were used to evaluate the clinical outcomes at different time points. Odom and Vaccaro criteria were used to assess the surgical effects and to evaluate the fusion of the bone graft. Results The mean duration of the postoperative follow-up was 27.4±5.7 months (ranging from 21 to 36 months). The JOA scores and NDI scores at 3 months post operation and at the time of final follow-up were significantly different from those before surgery (P<0.05). Two patients had mild dysphagia after surgery, but it disappeared after symptomatic treatment for 3–5 days. Sagittal radiographic outcomes were significantly improved at 3 months post operation (P<0.05). At the time of final follow-up, the radiographic parameters were well maintained and were not significantly different compared with 3 months post operation (P>0.05). Conclusion The ROI-C cage system is safe and effective for use in patients undergoing anterior cervical spondylosis surgery for osteoporosis treatment. It results in a positive effect on bone graft fusion, is able to effectively improve cervical curvature, restores intervertebral height, and reduces the incidence of postoperative dysphagia. The clinical effects were positive at the early and middle postoperative stages.
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Affiliation(s)
- Yuluo Rong
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China,
| | - Yongjun Luo
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China,
| | - Wei Liu
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China,
| | - Fangyi Gong
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China,
| | - Pengyu Tang
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China,
| | - Weihua Cai
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China,
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Borensztein M, Camino Willhuber GO, Posadas Martinez ML, Gruenberg M, Sola CA, Velan O. Analysis of Risk Factors for New Vertebral Fracture After Percutaneous Vertebroplasty. Global Spine J 2018; 8:446-452. [PMID: 30258749 PMCID: PMC6149051 DOI: 10.1177/2192568217732988] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
STUDY DESIGN Retrospective analysis. Level of evidence III. OBJECTIVES Low-energy vertebral compression fractures are an increasing socioeconomic problem among elderly patients. Percutaneous vertebroplasty has been extensively used for the treatment of painful fractures because of its effectiveness. However, some complications have been described; among them, new vertebral compression fractures, whether adjacent or not to the treated vertebra, are commonly reported complications (8% to 52%). METHODS We retrospectively analyzed epidemiological and technical variables presumably associated with new vertebral compression fractures. To determine the relationship between new vertebral compression fracture and percutaneous vertebroplasty, 30 patients (study group) with this complication were compared with 60 patients treated with percutaneous vertebroplasty without this condition (control group). RESULTS A higher cement percentage was found in the study group (40.3%) compared with the control group (30.5%). Initial vertebral kyphosis was significantly higher in the first group (15°) compared with the control group (9°). Epidemiological factors were similar in both groups. CONCLUSIONS In our study, increased cement percentage injected and a higher kyphosis were associated with new vertebral compression fractures.
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Affiliation(s)
| | - Gaston O. Camino Willhuber
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina,Gaston O. Camino Willhuber, Orthopaedic and
Traumatology Department, Institute of Orthopedics “Carlos E. Ottolenghi,” Italian Hospital
of Buenos Aires, Potosí 4215, C1199ACK Buenos Aires, Argentina.
| | | | | | - Carlos A. Sola
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Osvaldo Velan
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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The risk factors of vertebral refracture after kyphoplasty in patients with osteoporotic vertebral compression fractures: a study protocol for a prospective cohort study. BMC Musculoskelet Disord 2018; 19:195. [PMID: 29961425 PMCID: PMC6027566 DOI: 10.1186/s12891-018-2123-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 06/04/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Percutaneous kyphoplasty (PKP) is the first-line treatment for osteoporotic vertebral compression fractures (OVCFs) that can immediately relieve pain and allow the quick recovery of lost mobility. However, some studies reported that after PKP, the incidence of vertebral refracture, particularly adjacent vertebral fracture (AVF), was high. Our previous meta-analysis suggested that the risks for vertebral refracture and AVF did not increase after percutaneous vertebral augmentation in OVCF patients. Despite the negative results of our meta-analysis, there is still significant evidence regarding the relationship between kyphoplasty and AVF, so a new prospective cohort study is warranted. In addition, in our previous retrospective study, we found that advanced age, female sex and low oestradiol (E2) concentrations might be related to the occurrence of postoperative vertebral refracture after PKP. To sufficiently evaluate the probable factors involved in the occurrence of postoperative vertebral refracture, we designed this prospective study. METHODS This is a prospective cohort study of patients admitted for PKP to treat painful OVCFs. The baseline data, including demographic information, lifestyle, bone metabolic status, sex hormone and sex hormone-binding globulin (SHBG) levels, and clinical characteristics will be collected at the time of enrolment. Surgical features of PKP will be recorded on the operation day. Lifestyle, bone metabolic status, sex hormone levels, and SHBG levels will be assessed during the follow-up period at 1 m, 3 m, 12 m, and 24 m postoperatively. Patients suffering from acutely aggravated back pain will be referred to an orthopaedist, and refractured vertebrae will be confirmed by magnetic resonance imaging and computed tomography. The primary outcome will be the incidence of vertebral refracture. Multivariate analyses will be carried out to evaluate the variables that are independently correlated with vertebral refracture. DISCUSSION To evaluate the risk of postoperative refracture preoperatively and to identify the surgical points related to postoperative refracture, this study will explore the risk factors related to vertebral refracture after PKP. The results may provide new information about defining OVCF patients suitable for PKP treatment. TRIAL REGISTRATION ChiCTR-ROC-17011562 . Registered on July 4th, 2017.
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Li H, Yang DL, Ma L, Wang H, Ding WY, Yang SD. Risk Factors Associated with Adjacent Vertebral Compression Fracture Following Percutaneous Vertebroplasty After Menopause: A Retrospective Study. Med Sci Monit 2017; 23:5271-5276. [PMID: 29103064 PMCID: PMC5685033 DOI: 10.12659/msm.907364] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Clinically, percutaneous vertebroplasty (PVP) is frequently applied to treat osteoporotic vertebral compression fracture (OVCF). It is believed that new compression fractures are more likely to occur adjacent to the PVP-treated segment, typically within 1 month after PVP. The purpose of this study was to investigate risk factors for adjacent vertebral compression fractures (AVCF) after PVP in patients with OVCF after menopause. Material/Methods Between Jun 2012 and Dec 2016, 412 patients were initially identified. We enrolled 390 patients in this study, and 22 were lost to follow-up. The medical records of the patients were retrospectively collected. Patients were followed up for at least 6 months, with an average follow-up period of 18 months. The potential risk factors investigated in this study included age, duration of menopause (DoM), preoperative vertebral compression, number of preoperative vertebral fractures (NPVF), bone mineral density (BMD), surgical approach (unilateral or bilateral), anesthesia methods, bone cement dose, complications (including COPD), and anti-osteoporosis treatment. Logistic regression analysis was used to determine the risk factors. Results Sixty-eight patients were observed to have suffered from AVCF after PVP at the last follow-up. Univariate analysis showed that age, DoM, NPVF, BMD, COPD, and anti-osteoporosis treatment were the potential variables associated with the onset of AVCF (all P<0.05). Binary logistic regression analysis showed that the logistic regression equation was as follows: logit P=−3.10−1.07×X2+0.99×X3+2.15×X4 (where X2=BMD; X3=DoM; X4=NPVF), and “logit P” stands for the likelihood of developing an AVCF following PVP. Conclusions A long duration of menopause and preoperative multi-level vertebral fractures were the risk factors for AVCF in patients following PVP after menopause, while a high-level BMD acted in a protective role for AVCF development.
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Affiliation(s)
- Hua Li
- Department of Orthopedic Surgery, Harrison International Peace Hospital, Hengshui, Hebei, China (mainland)
| | - Da-Long Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Lei Ma
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Hui Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Shijiazhuang, Hebei, China (mainland)
| | - Si-Dong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
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Fu ZZ, Chen ZX, Qin Y, Feng ZQ, Jiang XJ, Xie QH, Liu YT. [Low cement distribution index is a risk factor for refracture of the adjacent segments after percutaneous vertebroplasty]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:947-951. [PMID: 28736374 PMCID: PMC6765512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To investigate the impact of cement distribution index on the occurrence of refracture in the adjacent segments after percutaneous vertebroplasty. METHODS This retrospective analysis was conducted among 143 patients who received percutaneous vertebroplasty for osteoporotic vertebral compression fracture between April, 2011 and April, 2014. Of the 134 patients with complete follow-up data, 18 had adjacent segment fracture within 1 year following the surgeries (re-fracture group), and 116 patients without new fracture served as the control group. All the patients underwent X-ray examinations after the surgery and according to the position and shape, the cement in the vertebrae were classified into 5 types (I to V), and the volume-cubage index was computed based on the cement volume and vertebral cubage. Age, gender, bone mineral density (BMD), cement distribution index, volume-cubage index, and cement leakage were evaluated in the 2 groups, and the variables with significant differences between the 2 groups were analyzed in Logistic regression analysis. RESULTS BMD was significantly lower and the rate of cement leakage was significantly higher in the re-fracture group than in the control group (P<0.05). Significant difference was found in cement distribution index between the 2 groups (P<0.05) but not in age, gender, cement volume or volume-cubage index (P>0.05). Logistic regression analysis indicated that BMD, cement leakage and cement distribution index all significantly affected the occurrence of adjacent vertebral fractures following percutaneous vertebroplasty. CONCLUSION A low BMD, cement leakage and a low cement distribution index are all risks factor of adjacent vertebral fracture after percutaneous vertebroplasty.
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Affiliation(s)
- Zhao-Zong Fu
- Department of Spine Surgery, Jiangmen Central Hospital, Jiangmen 529030, China.E-mail:
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Fu ZZ, Chen ZX, Qin Y, Feng ZQ, Jiang XJ, Xie QH, Liu YT. [Low cement distribution index is a risk factor for refracture of the adjacent segments after percutaneous vertebroplasty]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:947-951. [PMID: 28736374 PMCID: PMC6765512 DOI: 10.3969/j.issn.1673-4254.2017.07.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the impact of cement distribution index on the occurrence of refracture in the adjacent segments after percutaneous vertebroplasty. METHODS This retrospective analysis was conducted among 143 patients who received percutaneous vertebroplasty for osteoporotic vertebral compression fracture between April, 2011 and April, 2014. Of the 134 patients with complete follow-up data, 18 had adjacent segment fracture within 1 year following the surgeries (re-fracture group), and 116 patients without new fracture served as the control group. All the patients underwent X-ray examinations after the surgery and according to the position and shape, the cement in the vertebrae were classified into 5 types (I to V), and the volume-cubage index was computed based on the cement volume and vertebral cubage. Age, gender, bone mineral density (BMD), cement distribution index, volume-cubage index, and cement leakage were evaluated in the 2 groups, and the variables with significant differences between the 2 groups were analyzed in Logistic regression analysis. RESULTS BMD was significantly lower and the rate of cement leakage was significantly higher in the re-fracture group than in the control group (P<0.05). Significant difference was found in cement distribution index between the 2 groups (P<0.05) but not in age, gender, cement volume or volume-cubage index (P>0.05). Logistic regression analysis indicated that BMD, cement leakage and cement distribution index all significantly affected the occurrence of adjacent vertebral fractures following percutaneous vertebroplasty. CONCLUSION A low BMD, cement leakage and a low cement distribution index are all risks factor of adjacent vertebral fracture after percutaneous vertebroplasty.
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Affiliation(s)
- Zhao-Zong Fu
- Department of Spine Surgery, Jiangmen Central Hospital, Jiangmen 529030, China.E-mail:
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Guo D, Cai J, Zhang S, Zhang L, Feng X. Treating osteoporotic vertebral compression fractures with intraosseous vacuum phenomena using high-viscosity bone cement via bilateral percutaneous vertebroplasty. Medicine (Baltimore) 2017; 96:e6549. [PMID: 28383423 PMCID: PMC5411207 DOI: 10.1097/md.0000000000006549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Osteoporotic vertebral compression fractures with intraosseous vacuum phenomena could cause persistent back pains in patients, even after receiving conservative treatment. The aim of this study was to evaluate the efficacy of using high-viscosity bone cement via bilateral percutaneous vertebroplasty in treating patients who have osteoporotic vertebral compression fractures with intraosseous vacuum phenomena.Twenty osteoporotic vertebral compression fracture patients with intraosseous vacuum phenomena, who received at least 2 months of conservative treatment, were further treated by injecting high-viscosity bone cement via bilateral percutaneous vertebroplasty due to failure of conservative treatment. Treatment efficacy was evaluated by determining the anterior vertebral compression rates, visual analog scale (VAS) scores, and Oswestry disability index (ODI) scores at 1 day before the operation, on the first day of postoperation, at 1-month postoperation, and at 1-year postoperation.Three of 20 patients had asymptomatic bone cement leakage when treated via percutaneous vertebroplasty; however, no serious complications related to these treatments were observed during the 1-year follow-up period. A statistically significant improvement on the anterior vertebral compression rates, VAS scores, and ODI scores were achieved after percutaneous vertebroplasty. However, differences in the anterior vertebral compression rate, VAS score, and ODI score in the different time points during the 1-year follow-up period was not statistically significant (P > 0.05).Within the limitations of this study, the injection of high-viscosity bone cement via bilateral percutaneous vertebroplasty for patients who have osteoporotic vertebral compression fractures with intraosseous vacuum phenomena significantly relieved their back pains and improved their daily life activities shortly after the operation, thereby improving their life quality. In this study, the use of high-viscosity bone cement reduced the leakage rate and contributed to their successful treatment, as observed in patients during the 1-year follow-up period.
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Li D, Wu Y, Huang Y, Augustine B, Yue J. Risk factors of recompression of cemented vertebrae after kyphoplasty for osteoporotic vertebral compression fractures. INTERNATIONAL ORTHOPAEDICS 2016; 40:1285-90. [PMID: 27118375 DOI: 10.1007/s00264-016-3203-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/15/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the risk factors correlated with loss of cemented vertebral body height after kyphoplasty in patients with osteoporotic vertebral compression fractures. METHODS Thirty-four consecutive patients with single-level osteoporotic vertebral compression fractures who underwent kyphoplasty in the Affiliated Hospital of Jiangsu University between January 2012 and August 2014 were retrospectively analysed. Eight independent variables (age, gender, body mass index, pre-operative T-score in bone mineral density, the volume of polymethylmethacrylate injected, pre-operatively vertebral body height, the restoration of body height and the distance between polymethylmethacrylate and endplate) were assessed. The recompression of body height was the dependent variable. Multivariate linear regression analyses were used to determine the factors associated with recompression of body height. RESULTS Multiple linear regression analyses indicated that the recompression of cemented vertebral body height was correlated with the distance between polymethylmethacrylate and endplate (P = 0.008, b' = 0.489). The final multiple linear regression model, which included only the distance between polymethylmethacrylate and endplate, resulted in a formula that accounted for 41.02 % of the recompression of body height. CONCLUSIONS The distance between polymethylmethacrylate and endplate is an important risk factor of recompression of cemented vertebrae after kyphoplasty for patients with osteoporotic vertebral compression fractures.
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Affiliation(s)
- Dapeng Li
- Department of Orthopaedics, Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Zhenjiang City, 212001, Jiangsu Province, China.
| | - Yan Wu
- Department of Orthopaedics, Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Zhenjiang City, 212001, Jiangsu Province, China
| | - Yonghui Huang
- Department of Orthopaedics, Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Zhenjiang City, 212001, Jiangsu Province, China
| | - Balaara Augustine
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Jiawei Yue
- Department of Orthopaedics, Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Zhenjiang City, 212001, Jiangsu Province, China
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