The clinical characteristics of lower lumbar osteoporotic compression fractures treated by percutaneous vertebroplasty : a comparative analysis of 120 cases

Treatment for Osteoporotic Vertebral Fracture - A Short Review of Orthosis and Percutaneous Vertebroplasty and Balloon Kyphoplasty

The management of osteoporotic vertebral fractures (OVFs) in the elderly includes nonoperative treatment and vertebroplasty, but has not been established due to the diversity of patient backgrounds. The purpose of this study was to compare the impact of 3 treatment modalities for the management of OVF: orthotic treatment, percutaneous vertebroplasty (PVP), and balloon kyphoplasty (BKP). The method was based on an analysis of the latest RCTs, meta-analyses, and systematic reviews on these topics. No study showed a benefit of bracing with high level of evidence. Trials were found that showed comparable outcomes without orthotic treatment. Only 1 randomized controlled trial (RCT) showed an improvement in pain relief up to 6 months compared with no orthosis. Rigid and nonrigid orthoses were equally effective. Four of 5 RCTs comparing vertebroplasty and sham surgery were equally effective, and one RCT showed superior pain relief with vertebroplasty within 3 weeks of onset. In open trials comparing vertebroplasty with nonoperative management, vertebroplasty was superior. PVP and BKP were comparable in terms of pain relief, improvement in quality of life, and adjacent vertebral fractures. BKP does not affect global sagittal alignment, although BKP may restore vertebral body height. An RCT was published showing that PVP was effective in chronic cases without pain relief. Vertebroplasty improved life expectancy by 22% at 10 years. The superiority of orthotic therapy for OVF was seen only in short-term pain relief. Soft orthoses proved to be a viable alternative to rigid orthoses. Vertebroplasty within 3 weeks may be useful. There is no significant difference in clinical efficacy between PVP and BKP. Vertebroplasty improves life expectancy.

Subsequent fractures after vertebroplasty in osteoporotic vertebral fractures: a meta-analysis

Percutaneous vertebroplasty (VP) provides substantial benefit to patients with painful osteoporotic vertebral compression fractures (OVCF). However, the reoccurrence of vertebral fracture after VP is a major concern. The purpose of this study is to conduct a meta-analysis on the incidence of subsequent fractures after VP in patients with OVCF. PubMed and EMBASE were searched. In addition, we scrutinized the reference list of all relevant articles to supplement the database search. We included original articles reporting on new fracture rates after VP in OVCF patients. Subsequent fracture rates were pooled across studies using a random-effects meta-analysis. Thirty-nine studies with a total of 8047 participants from 12 countries were included in this meta-analysis. Patients' age ranged from 64.2 to 94.6 years (reported by 31 studies). The median follow-up was 21 months (36 studies). Pooled estimate for subsequent fractures after VP was 23.4% (95% CI, 19.8-27.2%; I² = 93.0%, p < 0.01). New fractures after VP in 54.6% of cases occurred in the vertebral bodies adjacent to the treated vertebra (95% CI, 49.0-60.1%; I² = 66.0%, p < 0.01). A significant proportion of patients undergoing VP for OVCF experience new fractures after treatment, most of which are developed in the vertebral bodies adjacent to the treated vertebra.

Percutaneous Vertebroplasty with Side-Opening Cannula or Front-Opening Cannula in the Treatment of Kummell Disease?

Objective

To explore the effect of bone cement distribution, cement leakage, and clinical outcomes with side‐opening cannula for bone cement injection in percutaneous vertebroplasty (PVP) in treatment of Kummell disease.

Methods

A prospective study of patients with Kummell disease undergoing PVP was conducted from April 2012 to September 2017. In total, 43 patients (11 males, 32 females) with Kummell disease who received bilateral PVP were included in the study. The patients were divided into front‐opening cannulas (FOC) group with front‐opening cannulas and side‐opening cannulas (SOC) group with side‐opening cannulas. All patients were followed up for 6 months. The patient general information such as gender, age, bone density, compression ratio, operative time, and location of fracture vertebrae were recorded. Visual analogue scale (VAS), Oswestry Disability Index (ODI), bone cement distribution, radiation exposure time, bone cement leakage rate and vertebral height, and kyphosis angle were measured and compared for two groups before surgery, 1 day and 6 months after surgery.

Results

A total of 43 patients were enrolled, including 11 males and 32 females, aged 61–84 years. The bone density (T value) was 2.5 ± 0.6 in FOC group and 2.4 ± 0.6 in SOC group (P > 0.05). The compression ratio and operative time were 36.1% ± 13.0%, 39.3 ± 7.9 min in FOC group and 35.2% ± 13.7%, 40.0 ± 10.7 min in SOC group (P > 0.05). There was no significance between FOC and SOC groups in the location of fracture vertebrae. All patients underwent at least 6 months of follow‐up. At 6 months postoperatively, the VAS and ODI were significantly higher in the FOC group (3.0 ± 0.8, 35.7% ± 2.1%) than in the SOC group (1.3 ± 0.4, 18.6% ± 2.4%) (P < 0.05). The cement leakage rate of the SOC group was 4.8%, which was lower than that of the FOC group (31.8%, P < 0.05), and the bone cement distribution ratio was higher than that of the FOC group (63.1% ± 7.9% vs 40.5% ± 8.6%, P < 0.05). At 6 months after operation, the height of the anterior and posterior vertebral bodies of the patients in the SOC group restored better than the FOC group (anterior SOC: FOC 5.1 ± 0.5 mm vs 4.5 ± 0.5 mm; posterior SOC: FOC 0.6 ± 0.1 mm vs 0.3 ± 0.1 mm, P < 0.05), and the kyphosis correction was more obvious than patients in FOC group (SOC: FOC 8.5° ± 1.4° vs 4.6° ± 0.8°, P < 0.05).

Conclusion

Percutaneous vertebroplasty with side‐opening cannula is safe and effective in avoiding bone cement leakage, improving bone cement distribution, and restoring vertebral height.

The Effectiveness of Gelfoam Technique before Percutaneous Vertebroplasy: Is It Helpful for Prevention of Cement Leakage? A Prospective Randomized Control Study

Objective

Preinjection gelfoam embolization during percutaneous vertebroplasty (PVP) has been thought alternative technique to prevent the leakage of bone cement. The goal of this study was to evaluate whether the gelfoam techniques are useful to reduce bone cement leakage.

Methods

Total 100 PVPs of osteoporotic spine compression fractures were performed by 1 spine surgeon who experienced more than 500 PVP cases under prospective control study. Operation was done in T-L junction (T10-L2) fractures with bi-transpedicular approach. Preinjection gelfoam PVP was done in the 50 levels. As control group, PVP without gelfoam was done in the 50 levels. We did not perform preoperative venography. We inserted normal saline-mixed gelfoam to the anterior third of vertebral body via PVP needle, and then 3mL of polymethylmetacrylate (PMMA) was injected. We prospectively evaluated the incidence and leakage pattern of PMMA by postoperative computed tomography.

Results

Between gelfoam and control groups, there were 11 leaks (22%) versus 12 leaks (26%). The mean operation time was 7.00 minutes versus 6.30 minutes. In gelfoam group, there were 6 spinal canal leaks, 4 paravertebral venous leaks, and 1 soft tissue leaks. In control group, there were 4 spinal canal leaks, 8 paravertebral venous leaks, and 1 disc space leak. In spite of cement leakage, there was no symptomatic case in both groups. Statistically, gelfoam technique was not related to decrease the incidence of leakage (p=0.64).

Conclusion

Our prospective study showed that it did not significantly decrease cement leakage when vertebroplasty is performed by experienced spine surgeon.

Effects of handholding and providing information on anxiety in patients undergoing percutaneous vertebroplasty

AIMS AND OBJECTIVES

This study evaluated the effects of handholding and spoken information provided on the anxiety of patients undergoing percutaneous vertebroplasty under local anaesthesia.

BACKGROUND

A surgical intervention usually entails physical discomfort and psychological burden. Furthermore, patients under local anaesthesia are conscious during the surgical intervention, which leads to more anxiety, as patients are aware of their surroundings in the operating theatre.

DESIGN

A quasi-experimental design with a nonequivalent control group was utilised.

METHODS

Amsterdam preoperative anxiety scale assessed psychological anxiety, while blood pressure and pulse were measured to evaluate physiological anxiety. Participants were 94 patients undergoing percutaneous vertebroplasty in a spine hospital in Gwangju Metropolitan City, South Korea. Thirty patients were assigned to Experimental Group I, 34 to the Experimental Group II and 30 to the control group. During a surgical intervention, nurses held the hands of those in Experimental Group I and provided them with spoken information. Patients in Experimental Group II experienced only handholding.

RESULTS

Psychological anxiety in Experimental Group I was low compared to those in Experimental Group II and the control group. In addition, there were significant decreases in systolic blood pressure in both Experimental Groups compared to the control group.

CONCLUSIONS

Handholding and spoken information provided during a surgical intervention to mitigate psychological anxiety, and handholding to mitigate physiological anxiety can be used in nursing interventions with patients undergoing percutaneous vertebroplasty.

RELEVANCE TO CLINICAL PRACTICE

Handholding and providing nursing information are possibly very useful interventions that are easily implemented by circulating nurses during a surgical intervention. In particular, handholding is a simple, economical and appropriate way to help patient in the operating theatre.