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Shen H, Tang W, Yin X, Shao T, Liu X, Gu J, Hu Y, Yu L, Yu Z, Zhang Z. Comparison between percutaneous short-segment fixation and percutaneous vertebroplasty in treating Kummell's disease: A minimum 2-year follow-up retrospective study. J Back Musculoskelet Rehabil 2024; 37:195-203. [PMID: 37694352 PMCID: PMC10789354 DOI: 10.3233/bmr-230083] [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: 03/20/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Percutaneous kyphoplasty (PKP) or percutaneous short-segment fixation (PSSF) is often used to treat Kummell's disease. However, it is not clear which treatment is better for patients. OBJECTIVE To retrospectively compare the clinical efficacy of PVP and PSSF for the treatment of Kummell's disease. METHOD 60 patients were involved in this research and the period of follow-up was at least 2 years. 27 of them were treated with PVP (Group I) and the rest who received PSSF (Group II). The visual analog scale (VAS) and radiographic indexes of each participant had been measured preoperatively as well as 1 week, 3 months, and 2 years postoperatively. Additionally, the Oswestry Disability Index (ODI) scores were assessed at the last time point. RESULTS Comparing the two groups, no statistical significance was found among all parameters preoperatively. The time of operations and blood loss is less in Group I. At each time point after operation, the imaging indices in Group II are lower (P< 0.05). One week after treatments, the VAS scores are lower in Group I, and similarly, 3 months are the same (P< 0.05), while VAS are similar at the last time point. In the aspect of ODI scores, they are lower in Group II during long-term follow-up. CONCLUSION For the treatment of Kummell's disease, both PVP and PSSF have been found to be effective. PVP can provide rapid pain relief with a shorter operation time. However, in cases with severe kyphosis deformity, PSSF should be given priority.
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Affiliation(s)
| | | | - Xiaoyu Yin
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tuo Shao
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xing Liu
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jiaao Gu
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yuhang Hu
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Lei Yu
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhange Yu
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhenyu Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Hou J, Ren D, Chen Y, Geng L, Yao S, Wu H, Wang P. Effectiveness of the Endplate Reduction Technique Combined With Bone Grafting for the Treatment of Thoracolumbar Fractures by Using Posterior Short-Segment Fixation. Neurospine 2023; 20:353-364. [PMID: 37016884 PMCID: PMC10080432 DOI: 10.14245/ns.2244980.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/09/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: This study aimed to examine the effect of the endplate reduction (EPR) technique combined with bone grafting for treating thoracolumbar burst fractures using posterior short-segmental fixation.Methods: Patients with thoracolumbar fractures admitted between January 2018 and October 2021 were retrospectively analyzed, and those meeting the criteria were assigned to the EPR group and the intermediate screws (IS) group. The vertebral wedge angle (VWA), Cobb angle (CA), anterior vertebral body height (AVBH), middle vertebral body height (MVBH), upper endplate line (UEPL), upper intervertebral angle (UIVA), and upper intervertebral disc height (UIDH) indices were examined and compared preoperatively, first day postoperatively, as well as at 12 months postoperatively.Results: The result indicated that the EPR group achieved better MVBH reduction (p < 0.001), UEPL reduction (p < 0.001), vertebral body fracture healing (p = 0.006), as well as implant breakage (p = 0.04) than the IS group; VWA (p < 0.001), CA (p = 0.005), AVBH (p < 0.001), MVBH (p < 0.001), UEPL (p < 0.001), and UIDH (p < 0.001) were lost after reduction less than those in the IS group. There was no significant difference in operative time (p = 0.315) and intraoperative bleeding (p = 0.274) between the 2 groups.Conclusion: The EPR group achieved better results in repositioning and maintaining MVBH and endplate morphology, with less correction loss after the reduction of the VWA, CA, AVBH, and endplate morphology. The EPR group exhibited a better healing pattern after vertebral fracture and disc degeneration was better relieved.
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Affiliation(s)
- Jiguang Hou
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
- Department of Orthopaedics, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Dong Ren
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Yufeng Chen
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Lindan Geng
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Shuangquan Yao
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Haotian Wu
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Pengcheng Wang
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
- Corresponding Author Pengcheng Wang Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province 050051, China
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Vertebral Augmentation for Painful Type 4 Osteoporotic Compression Fractures: A Comparative Study. J Osteoporos 2023; 2023:1562892. [PMID: 36700240 PMCID: PMC9870678 DOI: 10.1155/2023/1562892] [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: 11/28/2022] [Revised: 12/20/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Type 4 osteoporotic fracture (OF4), according to the classification system of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU), is unstable and requires fixation as per the guidelines of the same group. We evaluated the use of stand-alone vertebral body augmentation (VBA) in pain control of OF4. METHODS This is a single-centre, in two hospitals, comparative study to evaluate the effectiveness of percutaneous vertebroplasty (PVP) and kyphoplasty (KP) in pain control of OF4. OF4 patients treated with VBA were compared to a conservatively treated control group. The two groups of OF4 were then compared to similar cohort of OF2 and OF3 patients who were treated by either VBA or expectantly. RESULTS A total of 78 cases were studied. VBA of OF4 showed a statistically significant better pain control than conservative treatment. The response of this group of fractures to VBA was similar to that of OF2 and 3. CONCLUSION VBA can provide satisfactory pain control for OF4 patients.
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Joshi D, Kakadiya G, Attar U. Time to revisit contraindications of vertebroplasty- A retrospective study of osteoporotic burst fracture operated with vertebroplasty and short segment fixation. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 10:100111. [PMID: 35399202 PMCID: PMC8987623 DOI: 10.1016/j.xnsj.2022.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/02/2022]
Abstract
Background Methods Results Conclusions
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Fiore G, Tariciotti L, Borsa S, Nicoli D, Schisano L, Bertani GA, Locatelli M, Pluderi M. Percutaneous Cement-Augmented Screws Short Fixation for the treatment of Severe Osteoporotic Vertebral Burst Fractures. World Neurosurg 2022; 163:e522-e531. [PMID: 35427793 DOI: 10.1016/j.wneu.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE (BACKGROUND) This study aims to evaluate the therapeutic reliability of posterior percutaneous cement-augmented screws short fixation(PASF) in patients with severe osteoporotic vertebral burst fractures(OVBFs). METHODS Single-level OVBFs with an anterior vertebral body height(VBH) reduction equal or superior to 60% were included. A frailty index was employed for preoperative frailty assessment. Back pain and related disability were assessed through the VAS scale and Oswestry low-back pain disability index(ODI), being administered at injury time, preoperative, postoperative, twelfth-month and last patient follow-up evaluations. The main radiological outcomes were represented by Cobb angle(CA) and anterior vertebral body compression percentage(AVBC%), being measured at injury time, preoperative, postoperative and twelfth-month examinations. Among the others, the incidence of cement leakages and hardware failures was assessed. RESULTS Thirty-three patients met the inclusion criteria. All patients resulted frail(76%) or semi-frail(24%). Significant VBH restoration and segmental kyphosis improvement after PASF was documented (AVBC%:-40(-43;-37) VS -67(-70;-65), P = 0.0001; CA: 10(8-12) VS 24(23-26), P = 0.0001). The mean VAS and ODI scores documented optimal and long-enduring pain relief and related disability reduction after PASF (VAS: 2(2-3) VS 8(7-8), P = 0.0001; ODI: 22(17-26) VS 64(60-69), P = 0.0001). Only one cement leakage (3%), asymptomatic, occurred. After a mean follow-up of 33 months, no early/late hardware failures were reported. CONCLUSIONS The clinical and radiological results of this study suggest that PASF could be a safe and effective treatment option for severe OVBFs when conservative treatments failed.
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Affiliation(s)
- Giorgio Fiore
- Department of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Milan, Italy.
| | - Leonardo Tariciotti
- Department of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Milan, Italy
| | - Stefano Borsa
- Department of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Nicoli
- Department of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigi Schisano
- Department of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Milan, Italy
| | - Giulio Andrea Bertani
- Department of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Locatelli
- Department of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Milan, Italy; "Aldo Ravelli" Research Center, Milan, Italy
| | - Mauro Pluderi
- Department of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Lai O, Zhang X, Hu Y, Sun X, Zhu B, Dong W, Yuan Z. Long-segment fixation VS short-segment fixation combined with kyphoplasty for osteoporotic thoracolumbar burst fracture. BMC Musculoskelet Disord 2022; 23:160. [PMID: 35177064 PMCID: PMC8855549 DOI: 10.1186/s12891-022-05109-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background To retrospectively compare clinical and radiological results of long-segment fixation (LF) and six-screw short-segment fixation combined with kyphoplasty (SSFK) for osteoporotic thoracolumbar burst fracture (OTBF). Methods Forty patients affected by OTBF with mean age of 61.85 years were included in this study. The mean follow-up period was 13.63 months. Twenty-four patients were treated by SSFK, and 16 patients were treated by LF. Clinical outcomes, radiological parameters and complications were assessed and compared. Results The mean operative time and blood loss were 89.71 ± 7.62 min and 143.75 ± 42.51 ml for SSFK group, respectively; 111.69 ± 12.25 min (P < 0.01) and 259.38 ± 49.05 ml (P < 0.01) for LF group, respectively. The two groups were similar in terms of preoperative radiological and clinical results. Compared with preoperative values, both groups achieved significant improvement in terms of VAS, ODI, Cobb angle and anterior vertebral body height (AVH) ratio at final follow-up. However, during the follow-up period, significant loss of Cobb angle and AVH ratio were observed for both groups. Five cases (20.83%) of asymptomatic cement leakage were observed in SSFK group. One case of implant failure and two cases of adjacent or non-adjacent vertebral fractures were observed in LF group. Conclusions Both SSFK and LF are safe and effective for treatment of OTBF. Comparatively, SSFK is less invasive and can preserve more motion segments, which may be a more valuable surgical option in some elderly patients. A high-quality randomized controlled study is required to confirm our finding in the future.
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Affiliation(s)
- Oujie Lai
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Xinliang Zhang
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Yong Hu
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China.
| | - Xiaoyang Sun
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Binke Zhu
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Weixin Dong
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Zhenshan Yuan
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
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