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Chao B, Jiao J, Yang L, Wang Y, Yu T, Liu H, Zhang H, Li M, Wang W, Cui X, Du S, Wang Z, Wu M. Comprehensive evaluation and advanced modification of polymethylmethacrylate cement in bone tumor treatment. J Mater Chem B 2023; 11:9369-9385. [PMID: 37712890 DOI: 10.1039/d3tb01494k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Bone tumors are invasive diseases with a tendency toward recurrence, disability, and high mortality rates due to their grievous complications. As a commercial polymeric biomaterial, polymethylmethacrylate (PMMA) cement possesses remarkable mechanical properties, injectability, and plasticity and is, therefore, frequently applied in bone tissue engineering. Numerous positive effects in bone tumor treatment have been demonstrated, including biomechanical stabilization, analgesic effects, and tumor recurrence prevention. However, to our knowledge, a comprehensive evaluation of the application of the PMMA cement in bone tumor treatment has not yet been reported. This review comprehensively evaluates the efficiency and complications of the PMMA cement in bone tumor treatment, for the first time, and introduces advanced modification strategies, providing an objective and reliable reference for the application of the PMMA cement in treating bone tumors. We have also summarized the current research on modifications to enhance the anti-tumor efficacy of the PMMA cement, such as drug carriers and magnetic hyperthermia.
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Affiliation(s)
- Bo Chao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Jianhang Jiao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Lili Yang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Yang Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Tong Yu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Han Zhang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Mufeng Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Wenjie Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Xiangran Cui
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Shangyu Du
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Zhonghan Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Minfei Wu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
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Pusceddu C, Marsico S, Derudas D, Ballicu N, Melis L, Zedda S, De Felice C, Calabrese A, Santucci D, Faiella E. Clinical Rationale of Using Steerable Technologies for Radiofrequency Ablation Followed by Cavity Creation and Cement Augmentation in the Treatment of Painful Spinal Metastases. Curr Oncol 2023; 30:4257-4268. [PMID: 37185437 PMCID: PMC10136743 DOI: 10.3390/curroncol30040324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: Cement distribution after radiofrequency ablation of spinal metastases can be unpredictable due to various tumor factors, and vertebral augmentation requires advanced devices to prevent cement leakage and achieve satisfactory filling. The purpose of this study is to evaluate the safety and efficacy of a platform of steerable technologies with an articulating radiofrequency ablation (RFA) probe and targeted cavity creation before vertebral augmentation in the treatment of painful spinal metastases. (2) Methods: Sixteen patients (mean age, 67 years) underwent RFA in conjunction with vertebral augmentation after the creation of a targeted balloon cavity for metastatic spinal disease and were followed up to 6 months. Pain and functional mobility were assessed before treatment and postoperatively using the Visual Analogue Score (VAS) and Functional Mobility Scale (FMS). Complications, predictability of cement distribution, anatomical restoration, and local recurrence were collected. Technical success was defined as successful intraoperative ablation and predictable cement distribution after cavity creation without major complications. (3) Results: Sixteen patients with 21 lesions were treated for tumors involving the thoracolumbar spine. All treatments were technically successful and were followed by targeted cavity creation and vertebral augmentation. A statistically significant reduction in median VAS score was observed before treatment and 1 week after RFA treatment (p < 0.001). A total of six of the seven patients who reported limited painful ambulation before treatment reported normal ambulation 1 month after treatment, while the remaining patient reported no improvement. Patients who reported wheelchair use before treatment improved to normal ambulation (four/eight) or limited painful ambulation (four/eight). The improvement in mobility before and after treatment was statistically significant (p = 0.002). Technical success was achieved in all the combined procedures. (4) Conclusions: The combined treatment of RFA and vertebral augmentation with a steerable platform that allows the creation of a targeted cavity prior to cement injection proved to be a safe and effective procedure in our patient sample, resulting in improved quality of life as assessed by the Visual Analogue Score (VAS) and Functional Mobility Scale (FMS).
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Affiliation(s)
- Claudio Pusceddu
- Department of Oncological and Interventional Radiology, Businco Hospital, 09121 Cagliari, Italy
| | | | - Daniele Derudas
- Department of Hematology, Businco Hospital, 09121 Cagliari, Italy
| | - Nicola Ballicu
- Department of Oncological and Interventional Radiology, Businco Hospital, 09121 Cagliari, Italy
| | - Luca Melis
- Nuclear Medicine Department, Businco Hospital, 09121 Cagliari, Italy
| | - Stefano Zedda
- Department of Oncological and Interventional Radiology, Businco Hospital, 09121 Cagliari, Italy
| | - Carlo De Felice
- Department of Radiological Sciences, Oncology and Pathology, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161 Rome, Italy
| | - Alessandro Calabrese
- Department of Radiological Sciences, Oncology and Pathology, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161 Rome, Italy
| | - Domiziana Santucci
- Department of Radiology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Eliodoro Faiella
- Department of Radiology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 21, 00128 Rome, Italy
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Yan J, Liu Q, Zheng Y, Liu Z, Liu X, Guo X, Liu P, Chen P, Yuan S, Tian Y, Xu W. Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution. J Orthop Surg Res 2020; 15:259. [PMID: 32653022 PMCID: PMC7353696 DOI: 10.1186/s13018-020-01779-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022] Open
Abstract
Background Percutaneous vertebroplasty is the most common treatment for osteoporotic vertebral compression fracture. However, the morbidity of vertebroplasty-related complications, such as cement leakage, remains high. We tested a new technique of unilateral pulsed jet lavage and investigated its effect on the intravertebral pressure and bone cement distribution. Methods Thirty lumbar vertebrae (L1-L5) from six cadaver spines were randomly allocated into two groups (with and without irrigation). Prior to vertebroplasty, pulsed jet lavage was performed through one side of the pedicle by using a novel cannula with two concentric conduits to remove the fat and bone marrow of the vertebral bodies in the group with irrigation. The control group was not irrigated. Then, standardized vertebroplasty was performed in the vertebral bodies in both groups. Changes in the intravertebral pressure during injection were recorded. Computed tomography (CT) was performed to observe the cement distribution and extravasations, and the cement mass volume (CMV) was calculated. Results During cement injection, the average maximum intravertebral pressure of the unirrigated group was higher than that of the irrigated group (4.92 kPa versus 2.22 kPa, P < 0.05). CT scans showed a more homogeneous cement distribution with less CMV (3832 mm3 vs. 4344 mm3, P < 0.05) and less leakage rate (6.7% vs. 46.7%, P < 0.05) in the irrigated group than in the control group. Conclusions Unilateral pulsed jet lavage can reduce intravertebral pressure and lower the incidence of cement leakage during vertebroplasty. An enhanced bone cement distribution can also be achieved through this lavage system.
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Affiliation(s)
- Jun Yan
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Qiaohui Liu
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yanping Zheng
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China.
| | - Ziqun Liu
- Department of Spine Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Xun Guo
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, People's Republic of China
| | - Penghui Liu
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Peng Chen
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Wanlong Xu
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, People's Republic of China
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Mattei TA, Perret CM. Should kyphoplasty curettes be used in nonosteoporotic patients? A cautionary tale. Clin Case Rep 2020; 8:453-460. [PMID: 32185035 PMCID: PMC7069849 DOI: 10.1002/ccr3.2670] [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: 09/20/2019] [Revised: 12/09/2019] [Accepted: 12/16/2019] [Indexed: 12/03/2022] Open
Abstract
The authors present the first report of a fracture of the tip of a kyphoplasty curette inside the vertebral body, which occurred during a procedure in a patient with non-osteoporotic fracture. This highlights the need of further biomechanical research focused on the shear load failure properties of such type of pre-bent curettes.
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Affiliation(s)
| | - Caio M. Perret
- Laboratory for Neuroprotection and Regenerative StrategiesFederal University of Rio de Janeiro (UFRJ)Fundação Osvaldo Cruz (FioCruz)Rio de JaneiroBrazil
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Piechowiak EI, Isalberti M, Pileggi M, Distefano D, Hirsch JA, Cianfoni A. Mechanical Cavity Creation with Curettage and Vacuum Suction (Q-VAC) in Lytic Vertebral Body Lesions with Posterior Wall Dehiscence and Epidural Mass before Cement Augmentation. MEDICINA-LITHUANIA 2019; 55:medicina55100633. [PMID: 31554335 PMCID: PMC6843440 DOI: 10.3390/medicina55100633] [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] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/16/2019] [Accepted: 09/19/2019] [Indexed: 12/30/2022]
Abstract
Background and Objectives: We describe a novel technique for percutaneous tumor debulking and cavity creation in patients with extensive lytic lesions of the vertebral body including posterior wall dehiscence prior to vertebral augmentation (VA) procedures. The mechanical cavity is created with a combination of curettage and vacuum suction (Q-VAC). Balloon kyphoplasty and vertebral body stenting are used to treat neoplastic vertebral lesions and might reduce the rate of cement leakage, especially in presence of posterior wall dehiscence. However, these techniques could theoretically lead to increased intravertebral pressure during balloon inflation with possible mobilization of soft tissue tumor through the posterior wall, aggravation of spinal stenosis, and resultant complications. Creation of a void or cavity prior to balloon expansion and/or cement injection would potentially reduce these risks. Materials and Methods: A curette is coaxially inserted in the vertebral body via transpedicular access trocars. The intravertebral neoplastic soft tissue is fragmented by multiple rotational and translational movements. Subsequently, vacuum aspiration is applied via one of two 10 G cannulas that had been introduced directly into the fragmented lesion, while saline is passively flushed via the contralateral cannula, with lavage of the fragmented solid and fluid-necrotic tumor parts. Results: We applied the Q-VAC technique to 35 cases of thoracic and lumbar extreme osteolysis with epidural mass before vertebral body stenting (VBS) cement augmentation. We observed extravertebral cement leakage on postoperative CT in 34% of cases, but with no clinical consequences. No patients experienced periprocedural respiratory problems or new or worsening neurological deficit. Conclusion: The Q-VAC technique, combining mechanical curettage and vacuum suction, is a safe, inexpensive, and reliable method for percutaneous intravertebral tumor debulking and cavitation prior to VA. We propose the Q-VAC technique for cases with extensive neoplastic osteolysis, especially if cortical boundaries of the posterior wall are dehiscent and an epidural soft tissue mass is present.
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Affiliation(s)
- Eike I Piechowiak
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland.
| | - Maurizio Isalberti
- Department of Neuroradiology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland.
| | - Marco Pileggi
- Department of Neuroradiology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland.
| | - Daniela Distefano
- Department of Neuroradiology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland.
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Alessandro Cianfoni
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland.
- Department of Neuroradiology, Neurocenter of Southern Switzerland, 6900 Lugano, Switzerland.
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Sun HB, Jing XS, Liu YZ, Qi M, Wang XK, Hai Y. The Optimal Volume Fraction in Percutaneous Vertebroplasty Evaluated by Pain Relief, Cement Dispersion, and Cement Leakage: A Prospective Cohort Study of 130 Patients with Painful Osteoporotic Vertebral Compression Fracture in the Thoracolumbar Vertebra. World Neurosurg 2018; 114:e677-e688. [PMID: 29555612 DOI: 10.1016/j.wneu.2018.03.050] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/04/2018] [Accepted: 03/06/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To probe the relationship among cement volume/fraction, imaging features of cement distribution, and pain relief and then to evaluate the optimal volume during percutaneous vertebroplasty. METHODS From January 2014 to January 2017, a total of 130 patients eligible for inclusion criteria were enrolled in this prospective cohort study. According to the different degrees of pain relief, cement leakage, and cement distribution, all patients were allocated to 2 groups. Clinical and radiologic characteristics were assessed to identify independent factors influencing pain relief, cement leakage, and cement distribution, including age, sex, fracture age, bone mineral density, operation time, fracture level, fracture type, modified semiquantitative severity grade, intravertebral cleft, cortical disruption in the vertebral wall, endplate disruption, type of nutrient foramen, fractured vertebral body volume, intravertebral cement volume, and volume fraction. A receiver operating characteristic curve was used to analyze the diagnostic value of the cement volume/fraction and then to obtain the optional cut-off value. RESULTS The preoperative visual analog scale scores in the responders versus nonresponders patient groups were 7.37 ± 0.61 versus 7.87 ± 0.92 and the postoperative VAS scores in the responders versus nonresponders were 2.04 ± 0.61 versus 4.33 ± 0.49 at 1 week. There were no independent factors influencing pain relief. There were 95 (73.08%) patients who experienced cement leakage, and cortical disruption in the vertebral wall and cement fraction percentage were identified as independent risk factors by binary logistic regression analysis (adjusted odds ratio [OR] 2.935, 95% confidence interval [95% CI] 1.214-7.092, P = 0.017); (adjusted OR 1.134, 95% CI 1.026-1.254, P = 0.014). The area under the receiver-operating characteristic curve of volume fraction (VF%) was 0.658 (95% CI 0.549-0.768, P = 0.006 < 0.05). The cut-off value of VF% for cement leakage was 21.545%, with a sensitivity of 69.50% and a specificity of 60.00%. The incidence of favorable cement distribution was 74.62% (97/130), and VF% were identified as independent protective factors (adjusted OR 1.185, 95% CI 1.067-1.317, P = 0.002) The area under the receiver-operating characteristic curve of VF% was 0.686 (95% CI 0.571-0.802, P = 0.001 < 0.05). The cut-off value of VF% to reach a favorable cement distribution was 19.78%, with a sensitivity of 86.60% and a specificity of 51.50%. CONCLUSIONS In osteoporotic vertebral compression fracture with mild/moderate fracture severity at the single thoracolumbar level, the intravertebral cement volume of 4-6 mL could relieve pain rapidly. The optimal VF% was 19.78%, which could achieve satisfactory cement distribution. With the increase of VF%, the incidence of cement leakage would also increase.
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Affiliation(s)
- Hai-Bo Sun
- Beijing Chao-Yang Hospital, Capital Medical University (BCYH-CMU), Chaoyang District, Beijing, China; Beijing Tongzhou Hospital of Integrated Chinese and Western Medicine, Tongzhou district, Beijing, China
| | - Xiao-Shan Jing
- Beijing Chuiyangliu Hospital, Chaoyang district, Beijing, China
| | - Yu-Zeng Liu
- Beijing Chao-Yang Hospital, Capital Medical University (BCYH-CMU), Chaoyang District, Beijing, China
| | - Ming Qi
- Beijing Tongzhou Hospital of Integrated Chinese and Western Medicine, Tongzhou district, Beijing, China
| | - Xin-Kuan Wang
- Beijing Tongzhou Hospital of Integrated Chinese and Western Medicine, Tongzhou district, Beijing, China
| | - Yong Hai
- Beijing Chao-Yang Hospital, Capital Medical University (BCYH-CMU), Chaoyang District, Beijing, China.
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