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Feng ST, Yang Y, Li X, Zuo WY, Sun HB. Risk Factors of New Symptomatic Fractures After Vertebroplasty: A Retrospective Cohort Study of 268 Patients with Painful Osteoporotic Vertebral Compression Fracture. World Neurosurg 2024; 187:e890-e897. [PMID: 38734168 DOI: 10.1016/j.wneu.2024.05.007] [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: 04/24/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE To evaluate the risk factors of new osteoporotic vertebral compression fractures (OVCFs) after percutaneous vertebroplasty (PVP). METHODS From January 2016 to November 2019, patients suffering from OVCFs were retrospectively reviewed. The independent influence factors for new OVCFs after PVP were assessed, from following variables: age, sex, body mass index, bone mineral density (BMD), history of alcoholism, smoking, hypertension, diabetes, glucocorticoid use, and prior vertebral fractures, the number of initial fractures, mean cement volume, method of puncture, D-type of cement leakage, and regular antiosteoporosis treatment. RESULTS A total of 268 patients with 347 levels met the inclusion criteria and were finally included in this study. Forty-nine levels of new OVCFs among 33 patients (12.31%) were observed during the follow-up period. It indicated that female (adjusted odds ratio [OR]: 6.812, 95% confidence interval {CI}: [1.096, 42.337], P = 0.040), lower BMD (adjusted OR: 0.477, 95% CI: [0.300, 0.759], P = 0.002), prior vertebral fractures (adjusted OR: 16.145, 95% CI: [5.319, 49.005], P = 0.000), and regular antiosteoporosis treatment (adjusted OR: 0.258, 95% CI: [0.086, 0.774], P = 0.016) were independent influence factors for new OVCF. The cut-off value of BMD to reach new OVCF was -3.350, with a sensitivity of 0.660 and a specificity of 0.848. CONCLUSION Female, lower BMD (T-score of lumbar), prior vertebral fractures, and regular antiosteoporosis treatment were independent influencing factors. BMD (T-score of lumbar) lower than -3.350 would increase risk for new OVCF, and none osteoporotic treatment has detrimental effect on new onset fractures following PVP.
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Affiliation(s)
- Shi-Tong Feng
- Department of Orthopedics, Civil Aviation General Hospital, Beijing, China
| | - Yong Yang
- Department of Orthopedics, Beijing Friendship Hospital Capital Medical University, Beijing, China
| | - Xiang Li
- Department of Orthopedics, Beijing Friendship Hospital Capital Medical University, Beijing, China
| | - Wei-Yang Zuo
- Department of Orthopedics, Beijing Friendship Hospital Capital Medical University, Beijing, China
| | - Hai-Bo Sun
- Department of Orthopedics, Beijing Friendship Hospital Capital Medical University, Beijing, China.
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Huang S, Wu X, Zhou C, Zhang X, Tang Z, Qi X, Zhao S. Static study and numerical simulation of the influence of cement distribution in the upper and lower adjacent vertebrae on sandwich vertebrae in osteoporotic patients: Finite element analysis. JOR Spine 2024; 7:e1343. [PMID: 38911099 PMCID: PMC11191753 DOI: 10.1002/jsp2.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/13/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Objective We analyzed the influence of the location of the upper and lower cement on the sandwich vertebrae (SV) by computer finite element analysis. Materials and Methods A finite element model of the spinal segment of T11-L1 was constructed and 6 mL of cement was built into T11 and L1 simultaneously. According to the various distributions of bone cement at T11 and L1, the following four groups were formed: (i) Group B-B: bilateral bone cement reinforcement in both T11 and L1 vertebral bodies; (ii) Group L-B: left unilateral reinforcement in T11 and bilateral reinforcement in L1; (iii) Group L-R: unilateral cement reinforcement in both T11 and L1 (cross); (iv) Group L-L: unilateral cement reinforcement in both T11 and L1 (ipsilateral side). The maximum von Mises stress (VMS) and maximum displacement of the SV and intervertebral discs were compared and analyzed. Results The maximum VMS of T12 was in the order of size: group B-B < L-B < L-R < L-L. Group B-B showed the lowest maximum VMS values for T12: 19.13, 18.86, 25.17, 25.01, 19.24, and 20.08 MPa in six directions of load flexion, extension, left and right lateral bending, and left and right rotation, respectively, while group L-L was the largest VMS in each group, with the maximum VMS in six directions of 21.55, 21.54, 30.17, 28.33, 19.88, and 25.27 MPa, respectively. Conclusion Compared with the uneven distribution of bone cement in the upper and lower adjacent vertebrae (ULAV), the uniform distribution of bone cement in the ULAV reduced and uniformed the stress load on the SV and intervertebral disc. Theoretically, it can lead to the lowest incidence of sandwich vertebral fracture and the slowest rate of intervertebral disc degeneration.
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Affiliation(s)
- Shaolong Huang
- Department of Orthopedics The Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
- Graduate school of Xuzhou Medical University Xuzhou Jiangsu China
- Department of Orthopedics The Second Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Xue Wu
- Graduate School of Wenzhou Medical University Wenzhou Zhejiang China
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University Wenzhou, Zhejiang China
| | - Chengqiang Zhou
- Department of Orthopedics The Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
- Graduate school of Xuzhou Medical University Xuzhou Jiangsu China
- Department of Orthopedics The Second Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Xu Zhang
- Graduate school of Xuzhou Medical University Xuzhou Jiangsu China
- Department of Orthopedics The Second Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Zhongjian Tang
- Graduate school of Xuzhou Medical University Xuzhou Jiangsu China
- Department of Orthopedics The Second Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Xiangyu Qi
- Graduate school of Xuzhou Medical University Xuzhou Jiangsu China
- Department of Orthopedics The Second Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Shuai Zhao
- Department of Orthopedics The Affiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
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Mondal S, MacManus DB, Banche-Niclot F, Vitale-Brovarone C, Fiorilli S, McCarthy HO, Dunne N. Finite element analysis of vertebroplasty in the osteoporotic T11-L1 vertebral body: Effects of bone cement formulation. J Biomed Mater Res B Appl Biomater 2024; 112:e35359. [PMID: 38247244 DOI: 10.1002/jbm.b.35359] [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: 11/25/2022] [Revised: 08/24/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024]
Abstract
Vertebral compression fractures are one of the most severe clinical consequences of osteoporosis and the most common fragility fracture afflicting 570 and 1070 out of 100,000 men and women worldwide, respectively. Vertebroplasty (VP), a minimally invasive surgical procedure that involves the percutaneous injection of bone cement, is one of the most efficacious methods to stabilise osteoporotic vertebral compression fractures. However, postoperative fracture has been observed in up to 30% of patients following VP. Therefore, this study aims to investigate the effect of different injectable bone cement formulations on the stress distribution within the vertebrae and intervertebral discs due to VP and consequently recommend the optimal cement formulation. To achieve this, a 3D finite element (FE) model of the T11-L1 vertebral body was developed from computed tomography scan data of the spine. Osteoporotic bone was modeled by reducing the Young's modulus by 20% in the cortical bone and 74% in cancellous bone. The FE model was subjected to different physiological movements, such as extension, flexion, bending, and compression. The osteoporotic model caused a reduction in the average von Mises stress compared with the normal model in the T12 cancellous bone and an increment in the average von Mises stress value at the T12 cortical bone. The effects of VP using different formulations of a novel injectable bone cement were modeled by replacing a region of T12 cancellous bone with the materials. Due to the injection of the bone cement at the T12 vertebra, the average von Mises stresses on cancellous bone increased and slightly decreased on the cortical bone under all loading conditions. The novel class of bone cements investigated herein demonstrated an effective restoration of stress distribution to physiological levels within treated vertebrae, which could offer a potential superior alternative for VP surgery as their anti-osteoclastogenic properties could further enhance the appeal of their fracture treatment and may contribute to improved patient recovery and long-term well-being.
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Affiliation(s)
- Subrata Mondal
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
| | - David B MacManus
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
- BRAIN Lab, School of Mechanical & Materials Engineering, University College Dublin, Dublin 4, Ireland
| | | | | | - Sonia Fiorilli
- Department of Applied Science and Technology, Politecnico di Torino, Turin, Italy
| | - Helen O McCarthy
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7 BL, UK
| | - Nicholas Dunne
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
- Centre for Medical Engineering Research, Dublin City University, Dublin 9, Ireland
- Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin 2, Ireland
- Advanced Manufacturing Research Centre (I-Form), School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), Trinity College Dublin, Dublin 2, Ireland
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
- Advanced Processing Technology Research Centre, Dublin City University, Dublin 9, Ireland
- Biodesign Europe, Dublin City University, Dublin 9, Ireland
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Mounika C, Tadge T, Keerthana M, Velyutham R, Kapusetti G. Advancements in poly(methyl Methacrylate) bone cement for enhanced osteoconductivity and mechanical properties in vertebroplasty: A comprehensive review. Med Eng Phys 2023; 120:104049. [PMID: 37838402 DOI: 10.1016/j.medengphy.2023.104049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 10/16/2023]
Abstract
The evolution of polymethyl methacrylate (PMMA) based bone cement (BC) from plexiglass to a biomaterial has revolutionized the joint and vertebral arthroplasties field. This widely used grouting material possesses exceptional properties for medical applications, including excellent biocompatibility, impressive mechanical strength, and favorable handling characteristics. PMMA-based BC is preferred in challenging conditions such as osteoporotic vertebral compression fractures, scoliosis, vertebral hemangiomas, spinal metastases, and myelomas, where it is crucial in withstanding stress. This review aims to comprehensively analyze the available reports and guide further research toward enhanced formulations of vertebral BC, focusing on its osteoconductive and mechanical properties. Furthermore, the review emphasizes the significant impact of BC's mechanical properties and osteoconductivity on the success and longevity of vertebroplasty procedures.
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Affiliation(s)
- Choppadandi Mounika
- National Institute of Pharmaceutical Education and Research (NIPER)-Ahmedabad, Palaj, Gandhinagar, 382355, India
| | - Tejaswini Tadge
- National Institute of Pharmaceutical Education and Research (NIPER)-Ahmedabad, Palaj, Gandhinagar, 382355, India
| | - M Keerthana
- National Institute of Pharmaceutical Education and Research (NIPER)-Ahmedabad, Palaj, Gandhinagar, 382355, India
| | - Ravichandiran Velyutham
- National Institute of Pharmaceutical Education and Research (NIPER)-Kolkata, Bengal Chemicals, Kolkata, 700054, India
| | - Govinda Kapusetti
- National Institute of Pharmaceutical Education and Research (NIPER)-Kolkata, Bengal Chemicals, Kolkata, 700054, India.
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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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Zhang X, Chen T, Meng F, Li S, Xu G, Yan J, Zhao W. A finite element analysis on different bone cement forms and injection volumes injected into lumbar vertebral body in percutaneous kyphoplasty. BMC Musculoskelet Disord 2022; 23:621. [PMID: 35764978 PMCID: PMC9238241 DOI: 10.1186/s12891-022-05522-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background To investigate the stress changes between different bone cement forms and injection volumes in adjacent vertebrae after percutaneous kyphoplasty (PKP) by establishing a three-dimensional finite element model of osteoporosis. Methods A male healthy volunteer was selected. CT of scans L1 to L3 vertebrae were imported into Mimics 21.0 software.The vertebral model of osteoporosiswas established based on previous literature reference. The models were divided into three groups: unilateral, bilateral integration and bilateral separation groups, with each group injecting 2 ml, 4,ml and 6 ml of bone cement, respectively. In all models, a vertical compressive load of 500 N, anterior flexion/posterior extension, left/right bending, and left/right rotation were applied with a moment of 7.5 N/m, of which 85% was applied to the anterior mid-column and 15% to the posterior column. The stress changes between adjacent vertebrae under different conditions were calculated. Results After percutaneous kyphoplasty was applied to the L2 vertebral body, some differences can be found between the effects of different cement injection volumes and cement morphology on adjacent structures. There was no major difference between the groups when the bone cement injection volume was 2 ml. When the amount of bone cement injected was 4 ml, the bone cement morphology of the bilateral integration group (BIG) produced less stress between adjacent vertebral bodies. The minimum stress was 14.95 MPa in the L3 vertebral body in posterior extension. Whereas the stress levels on adjacent intervertebral structures, BIG shaped bone cement shows some superiority. In addition, the adjacent vertebrae and intervertebral structures are subjected to less stress during left and right rotation. Conclusions The present finite element study suggested that bilateral integration bone cement is a suitable form of cement injection, and when the injection volume is 4 ml, reduces stress on adjacent segments by approximately 15% while maintaining the stability of the injected vertebral body.
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Xiang J, Zhong W, Ou Y. Comparison of the Effect of Different Local Analgesia Administration Methods in Percutaneous Vertebroplasty: A Retrospective Cohort Study. Front Surg 2022; 9:769102. [PMID: 35402496 PMCID: PMC8990094 DOI: 10.3389/fsurg.2022.769102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Although various studies have described the methods of administering anesthesia during percutaneous vertebroplasty (PV) for treating osteoporotic vertebral compression fractures (OVCFs), there is still no consensus on the optimal treatment regimen. Therefore, this study aimed to investigate the effects of three application methods of local analgesia administration in PV for treating OVCFs. Methods A total of 96 patients with OVCFs were reviewed and divided into three groups (A: lidocaine, B: ropivacaine, C: lidocaine + ropivacaine). The visual analog scale (VAS), blood pressure (BP), heart rate (HR), blood oxygen saturation (BOS), and surgery time were recorded during the following different points: before puncture, during the puncture, cement injection, and 4-h after surgery. Results The mean age of the patients was 74.13 ± 7.02 years in group A, 70.47 ± 5.50 years in group B, and 73.07 ± 7.51 years in group C, without significant difference. No significant differences were found in sex, age, hospital stay, surgery time, blood loss, and cement volume of the patients. In the periods of before puncture and 4-h after surgery, the VAS in group C decreased significantly than that in the periods of the puncture, cement injection, and immediately after surgery. Overall, there were no significant differences in systolic BP, diastolic BP, HR, and BOS during the different periods among the groups except HR in the period of the puncture in group C, which was slower than that in other groups, and HR in the period of cement injection in group A, which was faster than the other two groups. A correlation was observed between the VAS and the periods of cement injection (r = 0.5358) and after surgery (r = 0.5775) in group C. Conclusion Compared with the other two methods, the use of lidocaine in combination with ropivacaine could effectively relieve intraoperative pain, making the patients feel more comfortable and experience better recovery.
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Affiliation(s)
- Jiangxia Xiang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Traumatology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Weiyang Zhong
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Weiyang Zhong
| | - Yunsheng Ou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Yunsheng Ou
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Subsequent fractures after vertebroplasty in osteoporotic vertebral fractures: a meta-analysis. Neurosurg Rev 2022; 45:2349-2359. [PMID: 35195800 DOI: 10.1007/s10143-022-01755-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/22/2022] [Accepted: 02/13/2022] [Indexed: 12/21/2022]
Abstract
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.
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Chen Z, Song C, Lin H, Sun J, Liu W. Does prophylactic vertebral augmentation reduce the refracture rate in osteoporotic vertebral fracture patients: a meta-analysis. 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 2021; 30:2691-2697. [PMID: 34132903 DOI: 10.1007/s00586-021-06899-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/09/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE In order to prevent the recurrent fracture after vertebral augmentation, the concept of prophylactic vertebral augmentation has been proposed, but its efficacy is still controversial. This study aimed to determine the efficacy of prophylactic vertebral augmentation for prevention of refracture in osteoporotic vertebral fracture patients. METHODS Following PRISMA guidelines, a literature search was performed using PubMed, Embase and Web of Science databases for relevant studies published until February 2021. A meta-analysis of randomized controlled trials and retrospective controlled trials comparing prophylactic group versus nonprophylactic group was conducted. The primary outcome was the incidence of new vertebral compression fracture (VCF), and secondary outcomes were incidence of adjacent vertebral fracture (AVF) and remote vertebral fracture (RVF). RESULTS A total of 6 studies encompassing 618 patients were included in the meta-analysis. The incidence of new VCF was reported in all six studies, and the result showed no significant difference between the two groups (OR: 0.509; 95% CI: 0.184-1.409). Four studies provided data on the incidence of AVF, and it was revealed that there was no significant difference between the two groups (OR: 0.689; 95% CI: 0.109-4.371). In view of the incidence of RVF, prophylactic group also did not differ significantly compared with nonprophylactic group (OR: 0.535; 95% CI: 0.167-1.709). CONCLUSIONS The current evidence suggested that prophylactic vertebral augmentation might not be appropriate to diminish the risk of new VCF. Therefore, there is a need to investigate the mechanism of refracture and explore other preventive regimens to reduce the risk.
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Affiliation(s)
- Zhi Chen
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Chenyang Song
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Hailin Lin
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Jun Sun
- Department of Emergency, Zhaotong Traditional Chinese Medicine Hospital, Zhaotong, 657000, Yunnan, China
| | - Wenge Liu
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China.
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Ahsan MK, Pandit OP, Khan MSI. Percutaneous vertebroplasty for symptomatic osteoporotic compression fractures: A single-center prospective study. Surg Neurol Int 2021; 12:176. [PMID: 34084604 PMCID: PMC8168791 DOI: 10.25259/sni_212_2021] [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: 03/02/2021] [Accepted: 03/18/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Osteoporotic vertebral compression fractures (OVCFs) increasingly occur with advancing age, and are associated with significant morbidity, mortality, and cost. We assessed the clinical efficacy, radiological, and functional outcomes for patients undergoing percutaneous vertebroplasty (PVP) due to OVCFs, with a special focus on the frequency of new vertebral compression fractures (VCFs). Methods: This study, carried from 2018 to 2020, included 22 females and 4 males. They averaged 60.15 years of age (range, 50–70) were followed an average of 14.5 months (range 12–36 months), and had 30 VCFs between the T7–L2 levels. Multiple variables were studied, including; anterior vertebral height (AVH) and kyphotic angle (KA), new VCFs, and functional outcomes. Results: The postoperative Visual Analog Scale and Oswestry Disability Index were significantly reduced at 12 months after PVP. Improvements for AVH and KA were also statistically significant; 23 patients (88.46%) had a dramatic decrease in pain on post-operative day 1, while 3 patients (11.53%) had no decrease in pain after PVP on post-operative day 1–1 postoperative month. No major complications were observed except high incidence of cement leakage at 8 levels (26.67%) in 6 patients. Additionally, new VCFs occurred in 10 vertebrae in 8 patients (30.76%), involving 6 adjacent (60%), and 4 nonadjacent vertebrae (40%). Conclusion: PVP is an effective procedure in the management of painful OVCFs refractory to medical treatment. These PVP procedures yield immediate vertebral stabilization, relieve pain, and restore function with minimal associated morbidity.
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Affiliation(s)
- Md Kamrul Ahsan
- Department Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Om Prakash Pandit
- Department Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
| | - Md Shahidul Islam Khan
- Department Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
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Abstract
Vertebral augmentation, including vertebroplasty and kyphoplasty, is a minimally invasive, image-guided procedure in which cement (typically polymethylmethacrylate (PMMA)) is injected into a vertebral body to treat painful fractures. The majority of vertebroplasty and kyphoplasty procedures are performed to treat symptomatic osteoporotic compression fractures refractory to conservative medical therapy; however, there is also evidence to suggest the benefits of augmentation in patients with refractory pain in the acute compression setting. The primary goal of augmentation is decreasing pain and improving a patient's functional status. The secondary goal of augmentation is vertebral body stabilization. This chapter outlines the indications, contraindications, techniques, and literature behind vertebral augmentation.
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YUEWAN SUN, DONGMEI WANG, JINGCHUAN SUN, ANMIN LIU, JIANGANG SHI. A COMPARATIVE ANALYSIS OF THE EFFECTS OF TWO AUGMENTERS ON THE SENSITIVITY OF VERTEBRAL BIOMECHANICAL BEHAVIOR IN VERTEBROPLASTY. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420500074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The treatment of osteoporotic vertebral compression fractures (OVCFS) by transvertebral bone graft and augmentation (TBGA) has achieved satisfactory clinical results, but its biomechanical effects are not clear. The purpose of this study was to investigate the biomechanical effects of TBGA and compare the biomechanical sensitivity of the augmenter used in TBGA — a cylindrical enhancement device (CED) with bone cement. The finite element (FE) model of healthy segments T11-L3 (M1) was built, and two other models with L1 augmentation (M2, M3) were established to simulate CED and bone cement treatment, respectively. The stress and displacement distribution of the three models under five physiological loads were calculated and analyzed by the FE method. Based on the results, the sensitivities of biomechanical parameters to the degree of osteoporosis (DO) and loads were analyzed by linear fitting method using dummy variables. With the increase of DO, the CED is superior to bone cement in preventing the fractures of the augmented vertebral and the adjacent vertebral under the set loading conditions. Simulating TBGA method, the model 2 with L1 reconstructed was closer to the normal T11-L3 model in terms of sensitivity of stress and displacement under different loading conditions.
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Affiliation(s)
- SUN YUEWAN
- School of Mechanical Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Minhang District, Shanghai, P. R. China
| | - WANG DONGMEI
- School of Mechanical Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Minhang District, Shanghai, P. R. China
| | - SUN JINGCHUAN
- Department of Orthopedics, Shanghai Changzheng, Hospital Affiliated to The Second Military Medical University, 415 Fengyang Road, Shanghai, P. R. China
| | - LIU ANMIN
- Centre for Centre for Health Science Research, Salford University Salford M6 6PU, UK
| | - SHI JIANGANG
- Department of Orthopedics, Shanghai Changzheng, Hospital Affiliated to The Second Military Medical University, 415 Fengyang Road, Shanghai, P. R. China
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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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Risk factors of adjacent segmental fractures when percutaneous vertebroplasty is performed for the treatment of osteoporotic thoracolumbar fractures. Sci Rep 2020; 10:399. [PMID: 31941997 PMCID: PMC6962453 DOI: 10.1038/s41598-019-57355-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/30/2019] [Indexed: 01/17/2023] Open
Abstract
The study aimed to analyze the radiographic and magnetic resonance imaging (MRI) findings that might predict the risk for adjacent segmental fractures (ASFs) when percutaneous vertebroplasty (PV) is used for the treatment of osteoporotic thoracolumbar fractures (OTFs). A total of 92 OTFs patients who underwent PV between January 2013 and January 2015 were retrospectively reviewed. The visual analog scale (VAS), Oswestry-Disability Index (ODI) and radiolographic measurements were assessed. The VAS and ODI scores improved significantly at the final follow-up (FU) compared with the preoperation scores. Compared with the preoperative values, the fractured body alignment (FBA) significantly improved at the 3-month FU and the final FU, but the adjacent segment alignment (ASA) and thoracolumbar alignment (TLA) did not improve. According to the correlation analysis, the final FU TLA and the final FU ASA were correlated with the preoperative FBA, ASA, and TLA on plain radiography and were highly correlated on MRI. However, the final FU FBA was not correlated with the preoperative FBA, ASA, or TLA on plain radiography or MRI (P > 0.05). The ASFs were correlated with the 3-month FU TLA (r = 0.6044, P = 0.0037) and the final FU TLA (r = 0.5699, P = 0.007) on plain radiography, and the final TLA was more correlated with the preoperative FBA, ASA, and TLA on MRI than on plain radiography. In conclusion, the preoperative ASA and TLA on MRI were risk factors associated with ASFs in OTFs treated with PV.
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Zhong W, Liang X, Luo X, Quan Z. Vertebroplasty and vertebroplasty in combination with intermediate bilateral pedicle screw fixation for OF4 in osteoporotic vertebral compression fractures: a retrospective single-Centre cohort study. BMC Surg 2019; 19:178. [PMID: 31771582 PMCID: PMC6880590 DOI: 10.1186/s12893-019-0646-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 11/14/2019] [Indexed: 12/18/2022] Open
Abstract
Background Although various studies have described the outcomes and complications of each treatment for OF 4 in osteoporotic vertebral compression fractures (OVCFs), there is still no consensus on the optimal treatment regimen. This study aimed to investigate the clinical effect of OF 4 in patients with OVCFs treated with percutaneous vertebroplasty (PV) compared with PV in combination with intermediate bilateral pedicle screw fixation (IBPSF). Methods A total of 110 patients with OF 4 in OVCFs from January 2011 to December 2013 were reviewed retrospectively and divided into two groups (group A: PV, group B: PV + IBPSF). According to the guidelines of the German Society for Orthopaedics and Trauma (DGOU), OF 4 consists of 3 fracture types. The clinical and radiographic assessments were observed preoperatively, postoperatively, and during follow-up. Results The patients were followed for an average of 60.50 ± 15.20 months (group A) and 58.20 ± 17.60 months (group B) without significant differences. No significant differences were found in BMD, BMI and cement volume between the two groups, but differences were found for operation time, blood loss, and hospitalization time. The VAS and ODI scores improved better significantly at the final follow-up in group B but not in group A. Compared with the preoperative values, the postoperative kyphosis angle and loss of fractured segment height significantly improved, but the difference between the groups was significant after 3 months postoperatively. The loss of angular correction and fractured segment height in group A were greater than those in group B. A total of 15 cases of cement leakage were observed in group A and 8 cases in group B, and no complications or revision surgeries were observed in either group. Thirteen new fractures occurred (11 in group A and 2 in group B), which was significant. Conclusion PV with IBPSF could provide effective restoration and maintenance of fractured segment height and segment alignment as well as a lower rate of complications of OF 4 in OVCFs.
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Affiliation(s)
- Weiyang Zhong
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinjie Liang
- Department of Pain Management, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoji Luo
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Zhengxue Quan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Kong M, Zhou C, Zhu K, Zhang Y, Song M, Zhang H, Tu Q, Ma X. 12-Month Teriparatide Treatment Reduces New Vertebral Compression Fractures Incidence And Back Pain And Improves Quality Of Life After Percutaneous Kyphoplasty In Osteoporotic Women. Clin Interv Aging 2019; 14:1693-1703. [PMID: 31631990 PMCID: PMC6778479 DOI: 10.2147/cia.s224663] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/15/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose Define the effectiveness of teriparatide (TPTD) treatment on reducing the incidence of new vertebral compression fractures (NVCFs) and back pain and improving quality of life after percutaneous kyphoplasty (PKP). Methods Two years of clinical follow-up data from primary osteoporotic women who had experienced initial osteoporotic vertebral compression fractures (OVCFs) and received PKP plus 12-month TPTD (n=113) or basic treatment (BT) of calcium and vitamin D supplements (n=208) were retrospectively collected. The risk of NVCFs over each 6-month period in the TPTD group was evaluated and compared with the BT group using a logistic regression. Health-related quality of life (HRQoL, EQ-5D questionnaire), back pain [100 mm visual analog scale (VAS)] and bone mineral density (BMD) of the spine were analyzed using linear mixed models for repeated measures (LMMRM). Results Logistic regression analysis adjusting for baseline characteristics showed that patients in the TPTD group had a lower risk of NVCFs compared with those receiving BT during the final three observation intervals (6-12 months, OR=0.189, 95% CI=0.030-0.681, p=0.046; 12-18 months, OR=0.009, 95% CI=0.0001-0.111, p=0.001; 18-24 months, OR=0.024, 95% CI=0.0009-0.264, p=0.009, respectively). Significant improvements in adjusted EQ-5D and back pain VAS scores were identified in the TPTD group compared with the BT group, and this improvement was sustained for at least 12 months after teriparatide treatment was discontinued (both p<0.001). The BMD of the spine also showed a higher T-value in the TPTD group compared with the BT group (p<0.001). Conclusion In routine clinical practice, for patients with OVCFs who receive the PKP procedure, TPTD treatment may be a preferable subsequent therapy because of its ability to reduce the incidence of NVCFs and sustain a high quality of life and back pain alleviation.
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Affiliation(s)
- Meng Kong
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China.,Department of Medicine, Qingdao University, Qing'dao, Shandong Province 266000, China
| | - Chuanli Zhou
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China
| | - Kai Zhu
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China
| | - Yiran Zhang
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China
| | - Mengxiong Song
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China
| | - Hao Zhang
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China
| | - Qihao Tu
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China
| | - Xuexiao Ma
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China.,Department of Medicine, Qingdao University, Qing'dao, Shandong Province 266000, China
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Effect of Vertebroplasty at the Upper Instrumented Vertebra and Upper Instrumented Vertebra +1 for Prevention of Proximal Junctional Failure in Adult Spinal Deformity Surgery: A Comparative Matched-Cohort Study. World Neurosurg 2019; 124:e436-e444. [PMID: 30610979 DOI: 10.1016/j.wneu.2018.12.113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study aimed to compare radiographic outcomes of adult spinal deformity (ASD) surgery with or without 2-level prophylactic vertebroplasty (PVP) at the uppermost instrumented vertebra (UIV) and the vertebra 1 level proximal to the UIV. METHODS This retrospective 1:2 matched-cohort comparative study enrolled 2 groups of patients undergoing ASD surgery, including 28 patients with PVP (PVP group) and 56 patients without PVP (non-PVP group), in 3 institutes between 2012 and 2015. The primary outcome measure was the incidence of proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and proximal junctional fracture (PJFX). The secondary outcome measure were radiologic outcomes between PVP segments and non-PVP segments. RESULTS Between the PVP group and non-PVP group, no significant differences were found in the incidence of PJK (13 [46.4%] vs. 26 [46.4%]; P = 1.000), PJF (11 [39.3%] vs. 18 [32.1%]; P = 0.516), and PJFX (11 [39.3%] vs. 18 [32.1%]; P = 0.516). The number of the PJFX segments was 16 and 33 in PVP segments and non-PVP segments, respectively. Until revision surgery or final follow-up, the PJFX had progressed in 24 non-PVP segments (82.7%), but not in PVP segments. The PJFX progression in all PVP segments stopped near the PVP mass at the final follow-up. Reoperation as a result of PJFX was performed in 1 patient (3.6%) and 8 patients (14.3%) in the PVP and non-PVP groups, respectively. CONCLUSIONS PVP at UIV and vertebra 1 level proximal to the UIV cannot prevent PJK, PJF, and PJFX; however, it plays a positive role by delaying their progression. Furthermore, PVP tends to lower the reoperation rate after PJFX in ASD surgery.
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Analysis of Adjacent Fractures after Two-Level Percutaneous Vertebroplasty: Is the Intervening Vertebral Body Prone to Re-fracture? Asian Spine J 2018; 12:524-532. [PMID: 29879781 PMCID: PMC6002168 DOI: 10.4184/asj.2018.12.3.524] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 09/05/2017] [Accepted: 09/30/2017] [Indexed: 11/29/2022] Open
Abstract
Study Design Retrospective study. Purpose This retrospective study aimed to determine the incidence of adjacent level new fractures in a sandwich constellation (one or two untreated vertebrae between two cemented vertebrae) compared with that in other constellations formed by two-level percutaneous vertebroplasty (PVP). It also aimed to investigate the potential factors contributing to adjacent new fractures in a sandwich constellation. Overview of Literature There are few studies regarding the intervening intact vertebral body between two cemented vertebrae. Clinical data from previous studies investigation this sandwich situation, too, have been vague. Methods Clinical data were obtained from 132 patients who had two cemented vertebral bodies, irrespective of whether they had undergone one or two PVP sessions between January 2013 and June 2016 at a single institution. Cases with one or two intact vertebral levels between the two cemented vertebrae were classified into group 1 (n=47), and cases with two consecutive cemented bodies or more than three levels of intervening configurations were classified into group 2 (n=85). Demographic data and radiological parameters for new fractures after PVP were compared between the two groups, and the rates of subsequent adjacent fractures were investigated. Results The incidence of single-level sandwich constellations was quite uncommon (7.7%). The overall incidences of adjacent fracture were 29.8% (14/47) in group 1 and 14.1% (12/85) in group 2. This difference was statistically significant (p =0.03). Approximately 80% (11/14) of the adjacent new fractures in group 1 developed at an intervening level. The patient demographics and radiological parameters for subsequent fractures after PVP did not statistically correlate with the risk of adjacent new fractures in group 1. Conclusions Because they were subjected to double-load shifts, sandwich constellations were prone to re-fractures after PVP. These vertebral configurations required more aggressive management for osteoporosis.
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Takahashi S, Hoshino M, Terai H, Toyoda H, Suzuki A, Tamai K, Watanabe K, Tsujio T, Yasuda H, Kono H, Sasaoka R, Dohzono S, Hayashi K, Ohyama S, Hori Y, Nakamura H. Differences in short-term clinical and radiological outcomes depending on timing of balloon kyphoplasty for painful osteoporotic vertebral fracture. J Orthop Sci 2018; 23:51-56. [PMID: 28988630 DOI: 10.1016/j.jos.2017.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Balloon kyphoplasty or vertebroplasty is widely performed as a surgical intervention for osteoporotic vertebral fracture (OVF) and the effects have been investigated in many previous studies. However, the influence of the timing of the procedure on patient outcomes has not been studied formally. The purpose of this study was to investigate differences in the surgical outcomes of OVFs according to the timing of balloon kyphoplasty. METHODS This was a multicenter cohort study. Participants comprised 72 consecutive patients who underwent balloon kyphoplasty between January 2012 and January 2016. Patients were analyzed in two groups according to the timing of kyphoplasty after onset (Early group: ≤2 months; Late group: >2 months). Follow-up continued for more than 6 months. RESULTS A total of 72 patients were effectively analyzed. Of these, 27 (38%) patients underwent kyphoplasty within 2 months after symptom onset. The Late group showed greater angular motion of fractured vertebrae (p = 0.005) and compression of anterior vertebral height (p = 0.001) before surgery. Final outcomes adjusted for age and preoperative outcome showed lower visual analog scale (VAS) scores for low back pain in the Early group than in the Late group (19.9 vs. 30.4, p = 0.049). Final relative anterior vertebral height and kyphotic angle were more preserved in the Early group than in the Late group (p = 0.002 and p = 0.020, respectively), although absolute differences were not significant. CONCLUSIONS Vertebral height and kyphotic angle before and after balloon kyphoplasty were greater in patients who underwent kyphoplasty within 2 months after onset, and the VAS score for low back pain at final follow-up was better. Our results support kyphoplasty within 2 months.
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Affiliation(s)
- Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Kyoei Watanabe
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Tadao Tsujio
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Nara, Japan
| | - Hiroyuki Yasuda
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Hiroshi Kono
- Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, Osaka, Japan
| | - Ryuichi Sasaoka
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Sho Dohzono
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Kazunori Hayashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Shoichiro Ohyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Yusuke Hori
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Lin HH, Chang MC, Chou PH, Hung PI, Wang ST, Liu CL. Preoperative Planning of the Lateral Entry Point Is Necessary in Percutaneous L5 Vertebroplasty. World Neurosurg 2017; 104:476-481. [PMID: 28512047 DOI: 10.1016/j.wneu.2017.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare treatment outcomes and complications between the computer-assisted preoperative planning of lateral entry approach and the traditional approach for L5 percutaneous vertebroplasty. METHODS In this prospective randomized clinical study performed from January 2008 to December 2014, 68 patients scheduled for L5 percutaneous vertebroplasty were divided at random into group A, in which the traditional transpedicle approach was used, and group B, in which the computer-assisted lateral entry point approach was used. A visual analog scale and Oswestry Disability Index were evaluated preoperatively, postoperatively, and at the latest follow-up. RESULTS Patient demographics were similar in the 2 groups. The mean duration of follow-up was 65 months. The mean distance between the entry point and the midline was 3.05 ± 0.5 cm in group A and 7.04 ± 0.7 cm in group B. The mean inclination angle measured on the preoperative axial image was 17.1 ± 3.4° in group A and 41 ± 3.8° in group B. Clinical outcomes were comparable in the 2 groups; however, cement leakage was significantly greater in group A (P < 0.001). CONCLUSIONS Owing to the hemispherical morphology and convergent pedicle axis of the L5 vertebrae, a more lateral skin entry point and convergent angle of the puncture needle should be emphasized to reach the optimal point according to the preoperative assessment. The approach involving computer-assisted preoperative planning of the lateral entry point was associated with a higher rate of bilateral cement infiltration with fewer complications.
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Affiliation(s)
- Hsi-Hsien Lin
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Ming-Chau Chang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Po-Hsin Chou
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Pei-I Hung
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Orthopedics and Traumatology, Taichung Veterans General Hospital, Chiayi, Taiwan, Republic of China.
| | - Shih-Tien Wang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Chien-Lin Liu
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
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Abstract
STUDY DESIGN Single-center, single-arm, prospective time-series study. OBJECTIVE To assess the cost-effectiveness and improvement in quality of life (QOL) of percutaneous vertebroplasty (PVP). SUMMARY OF BACKGROUND DATA PVP is known to relieve back pain and increase QOL for osteoporotic compression fractures. However, the economic value of PVP has never been evaluated in Japan where universal health care system is adopted. METHODS We prospectively followed up 163 patients with acute vertebral osteoporotic compression fractures, 44 males aged 76.4±6.0 years and 119 females aged 76.8±7.1 years, who underwent PVP. To measure health-related QOL and pain during 52 weeks observation, we used the European Quality of Life-5 Dimensions (EQ-5D), the Rolland-Morris Disability Questionnaire (RMD), the 8-item Short-Form health survey (SF-8), and visual analogue scale (VAS). Quality-adjusted life years (QALY) were calculated using the change of health utility of EQ-5D. The direct medical cost was calculated by accounting system of the hospital and Japanese health insurance system. Cost-effectiveness was analyzed using incremental cost-effectiveness ratio (ICER): Δ medical cost/Δ QALY. RESULTS After PVP, improvement in EQ-5D, RMD, SF-8, and VAS scores were observed. The gain of QALY until 52 weeks was 0.162. The estimated lifetime gain of QALY reached 1.421. The direct medical cost for PVP was ¥286,740 (about 3061 US dollars). Cost-effectiveness analysis using ICER showed that lifetime medical cost for a gain of 1 QALY was ¥201,748 (about 2154 US dollars). Correlations between changes in EQ-5D scores and other parameters such as RMD, SF-8, and VAS were observed during most of the study period, which might support the reliability and applicability to measure health utilities by EQ-5D for osteoporotic compression fractures in Japan as well. CONCLUSIONS PVP may improve QOL and ameliorate pain for acute osteoporotic compression fractures and be cost-effective in Japan.
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Wahlquist TC, Lee JJ, Brunfeldt A, Burns GT, Patel RD, Graziano GP. Biomechanical Analysis of Intervertebral Cement Extravasation in Vertebral Motion Segments. Orthopedics 2017; 40:e300-e304. [PMID: 27925638 DOI: 10.3928/01477447-20161128-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 10/10/2016] [Indexed: 02/03/2023]
Abstract
Kyphoplasty is a therapeutic option for pain relief in the setting of compression fractures. Cement extravasation into adjacent disks is a common occurrence. The biomechanical and clinical consequences of cement in the disks currently are unknown. This study investigated the biomechanical effects of cement extravasation into the intervertebral disk in a human cadaveric model. Seven thoracolumbar and lumbar embalmed human cadaveric motion segments were evaluated in axial rotation, right and left lateral bending, and flexion and extension. Stiffness was calculated at baseline and following injection of 1 mL of cement into the intervertebral disk. There was a 13.4% (P=.041) increase in stiffness in axial rotation compared with preinjection motion segments. No significant difference was observed in lateral bending or flexion and extension. In this model, cement extravasation into the disk space increased stiffness in axial rotation. [Orthopedics. 2017; 40(2):e300-e304.].
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Jia P, Tang H, Chen H, Bao L, Feng F, Yang H, Li J. Prophylactic vertebroplasty procedure applied with a resorbable bone cement can decrease the fracture risk of sandwich vertebrae: long-term evaluation of clinical outcomes. Regen Biomater 2016; 4:47-53. [PMID: 28149529 PMCID: PMC5274705 DOI: 10.1093/rb/rbw037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/18/2016] [Accepted: 09/27/2016] [Indexed: 12/11/2022] Open
Abstract
A sandwich vertebra is formed after multiple osteoporotic vertebral fractures treated by percutaneous vertebroplasty, which has a risk of developing new fractures. The purpose of our study was to (i) investigate the occurrence of new fractures in sandwich vertebra after cement augmentation procedures and to (ii) evaluate the clinical outcomes after prophylactic vertebral reinforcement applied with resorbable bone cement. From June 2011 to 2014, we analysed 55 patients with at least one sandwich vertebrae and treated with percutaneous vertebroplasty. Eighteen patients were treated by prophylactic vertebroplasty with a resorbable bone cement to strengthen the sandwich vertebrae as the prevention group. The others were the non-prevention group. All patients were examined by spinal radiographs within 1 day, 6 months, 12 months, 24 months and thereafter. The incidence of sandwich vertebra is 8.25% (55/667) in our study. Most sandwich vertebrae (69.01%, 49/71) are distributed in the thoracic–lumbar junction. There are 24 sandwich vertebrae (18 patients) and 47 sandwich vertebrae (37 patients) in either prevention group or non-prevention group, respectively. No significant difference is found between age, sex, body mass index, bone mineral density, cement disk leakage, sandwich vertebrae distribution or Cobb angle in the two groups. In the follow-up, 8 out of 37 (21.6%) patients (with eight sandwich vertebrae) developed new fractures in non-prevention’ group, whereas no new fractures were detected in the prevention group. Neither Cobb angle nor vertebral compression rate showed significant change in the prevention group during the follow-up. However, in the non-prevention group, we found that Cobb angle increased and vertebral height lost significantly (P < 0.05). Prophylactic vertebroplasty procedure applied with resorbable bone cement could decrease the rate of new fractures of sandwich vertebrae.
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Affiliation(s)
- Pu Jia
- Department of Orthopaedics
| | | | | | - Li Bao
- Department of Orthopaedics
| | | | - He Yang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Abouazza OA, Condon F, Hannigan A, Dunne C. In vitro comparative assessment of the mechanical properties of PMMA cement and a GPC cement for vertebroplasty. J Orthop 2016; 13:81-9. [PMID: 27053838 DOI: 10.1016/j.jor.2016.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/24/2016] [Indexed: 11/26/2022] Open
Abstract
AIMS To develop a Glass Polyalkenoate Cement that is suitable for vertebroplasty. METHODS Testing was carried out to assess the effect of gamma irradiation used for sterilisation, on the glass transition temperature as well as its mechanical properties, including compressive strength and biflexural strength in vivo as well as testing GPC and PMMA cements post injection in cadaveric human vertebral bone. RESULTS There was a trend to a higher failure load required for the GPC cement group compared to the current standard PMMA injected group but this was not statistically significant with this small sample size. CONCLUSION The results are encouraging for future research to continue on GPC cements for use in vertebroplasty.
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Affiliation(s)
- Omar Ali Abouazza
- University College Hospital Limerick (UCHL), Ireland; Centre for Active Management of Lifelong Ageing (CAMLA), Graduate Entry Medical School (GEMS), University of Limerick, Ireland
| | | | - Ailish Hannigan
- Centre for Active Management of Lifelong Ageing (CAMLA), Graduate Entry Medical School (GEMS), University of Limerick, Ireland
| | - Colum Dunne
- Centre for Active Management of Lifelong Ageing (CAMLA), Graduate Entry Medical School (GEMS), University of Limerick, Ireland
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Cao J, Kong L, Meng F, Zhang Y, Shen Y. Risk factors for new vertebral compression fractures after vertebroplasty: a meta-analysis. ANZ J Surg 2016; 86:549-54. [PMID: 26749512 DOI: 10.1111/ans.13428] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND The risk factors for new vertebral compression fractures (VCFs) after vertebroplasty are unclear. The aim of this meta-analysis was to identify potential risk factors. METHODS A systematic electronic literature search was performed using the following databases: PubMed, Embase and Cochrane Library; the databases were searched from the earliest available records in 1966 to May 2015. Pooled odds ratios (ORs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random- or fixed-effects models. The Newcastle-Ottawa scale was used to evaluate the methodological quality of the studies, and Stata 11.0 was used to analyse the data. RESULTS The primary factors that were associated with new fractures after vertebroplasty were low bone mineral density (SMD -0.375; 95% CI -0.579 to -0.171), steroid usage (OR 2.632; 95% CI 1.399 to 4.950) and the presence of multiple treated vertebrae (OR 2.027; 95% CI 1.442 to 2.851). The data did not support that age, sex, body mass index, non-steroidal anti-inflammatory drug usage, vacuum cleft, thoracolumbar junction, cement volume, kyphosis correction, or intradiscal cement leakage could lead to infection after vertebroplasty. CONCLUSIONS The present analysis demonstrated that low bone mineral density, the presence of multiple treated vertebrae and a history of steroid usage were associated with the new VCFs after vertebroplasty. Patients with these factors should be informed of the potential increased risk.
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Affiliation(s)
- Junming Cao
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lingde Kong
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Fantao Meng
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yingze Zhang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yong Shen
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Analysis of Risk Factors Causing New Symptomatic Vertebral Compression Fractures After Percutaneous Vertebroplasty for Painful Osteoporotic Vertebral Compression Fractures. ACTA ACUST UNITED AC 2015; 28:E578-83. [DOI: 10.1097/bsd.0000000000000043] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Results of Vertebral Augmentation Treatment for Patients of Painful Osteoporotic Vertebral Compression Fractures: A Meta-Analysis of Eight Randomized Controlled Trials. PLoS One 2015; 10:e0138126. [PMID: 26378444 PMCID: PMC4574925 DOI: 10.1371/journal.pone.0138126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/25/2015] [Indexed: 11/19/2022] Open
Abstract
Background In 2009 two RCTs were publicated to question the efficacy of vertebroplasty comparing with sham treatment (ST) in the New England Journal of Medicine (NEJM), which provoked an academic debate on the efficacy of PVA. The purposes of our study were to compare clinical differences in pain relief, spinal functional outcomes, and overall quality of life between PVA and CT for painful osteoporotic VCFs. Methods We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and Web of Knowledge from January 1980 to June 2013 with Medical Subject Headings terms and keywords. Risk of bias in the included studies was assessed in accordance with the Cochrane risk of bias tool. In this Meta-analysis dichotomous and continuous variables were calculated using the risk ratio (RR) and standardized mean difference (SMD), respectively. Results Eight studies involving 987 patients met the criteria for inclusion. The VAS SMD was favoring the experimental group significantly (p < 0.001). Subgroup analysis suggested that the patients performed PVA with mean fracture age less than 3 months would got pain relief earlier and more durable than the control group (P <0.05). The SMD of spinal function assessed with RDQ and Oswestry LBP data was in favor of the experimental groups. QOL outcome improvement was demonstrated statistically significant at early, middle and late-term follow-up for PVA than the control group (P <0.05). Conclusions In conclusion, this meta-analysis, which evaluated PVA for osteoporotic VCFs, demonstrated significant improvement regarding VAS, spinal function and QOL outcomes. The optimal fracture age was less than 12 weeks.
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Unilateral or bilateral percutaneous vertebroplasty for acute osteoporotic vertebral fracture: a prospective study. ACTA ACUST UNITED AC 2015; 28:E85-8. [PMID: 25099973 DOI: 10.1097/bsd.0000000000000147] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Percutaneous vertebroplasty (PVP) has been demonstrated to be effective in the treatment of acute osteoporotic vertebral fracture (AOVF). However, the matter of which surgical approach should be selected remains controversial. This research aims to compare the clinical results of unilateral and bilateral PVP for AOVF. METHODS From January 2008 to December 2011, 68 patients with AOVF were randomly assigned to the unilateral puncture group (n=36) or the bilateral group (n=32). These patients underwent percutaneous injection of polymethyl methacrylate into posterior pedicle by the unilateral or bilateral puncture approach. Visual analogue scale (VAS) and the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) were recorded on presentation, at 1 week, 3, 6, and 12 months after operation. The cement leakage was measured by x-ray and computed tomography scan. RESULTS Follow-up data showed there were no significant differences in VAS and QUALEFFO between 2 groups at 1 week after PVP and only significant difference was observed between 2 groups at 3, 6, and 12 months after operation. The cement leakage was 52.7% in the unilateral puncture group and 28.1% in the bilateral group. CONCLUSIONS Compared with unilateral puncture, use of bilateral approach during PVP may result in more superior long-term outcomes and less cement leakage for patients with AOVF.
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Ren HL, Jiang JM, Chen JT, Wang JX. Risk factors of new symptomatic vertebral compression fractures in osteoporotic patients undergone percutaneous vertebroplasty. 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 2015; 24:750-8. [PMID: 25645589 DOI: 10.1007/s00586-015-3786-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE This study evaluated the risk factors of new vertebral compression fractures (VCFs) following percutaneous vertebroplasty (PVP). METHODS From June 2005 to January 2011, patients with osteoporotic VCFs (OVCFs) who were treated with PVP and met this study's inclusion criteria were retrospectively reviewed. Observed parameters were age, sex, bone mineral density, body mass index, amount of bone cement, cement leakage into the disk, preoperative kyphosis, preoperative degree of anterior vertebral compression, preoperative degree of middle vertebral compression, kyphosis correction, anterior vertebral height restoration, middle vertebral height restoration, and number of initial symptomatic fractures (levels treated). The data were analyzed by univariate and multivariate analysis for the emergence of new fractures after PVP to determine related risk factors. RESULTS A total of 182 patients met the inclusion criteria. There were 155 female and 27 male patients with a mean age of 69.7 years (range 49-91 years). The follow-up period was 24-50 months (average 26.4 months). A total of 294 VCFs among 182 patients were observed, 28 new VCFs occurred in 21 patients (21/182, 11.5 %) during the follow-up period. Statistical analysis indicated that higher BMI (P = 0.004) and a greater number of initial symptomatic fractures (P = 0.017) were significantly associated with new VCFs after PVP. It is the most obvious that the risk of new fractures increased 2.518-fold (95 % CI 1.176-5.395), when the number of initial VCFs increased by one level. CONCLUSIONS The incidence of new symptomatic VCFs after PVP was higher in osteoporotic patients with initial multiple-level fractures.
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Affiliation(s)
- Hai-long Ren
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China,
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30
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Peris P, Blasco J, Carrasco JL, Martinez-Ferrer A, Macho J, San Román L, Monegal A, Guañabens N. Risk factors for the development of chronic back pain after percutaneous vertebroplasty versus conservative treatment. Calcif Tissue Int 2015; 96:89-96. [PMID: 25492165 DOI: 10.1007/s00223-014-9940-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
Abstract
In a recent randomized controlled trial comparing vertebroplasty (VP) versus conservative treatment (CT) in patients with symptomatic vertebral fractures (VF), we observed the development of chronic back pain (CBP) in nearly one-quarter of patients. The aim of this study was to identify the risk factors related to the development of severe CBP in these subjects. We evaluated risk factors including visual analog scale (VAS) at baseline and during the 1-year follow-up, age, gender, symptom onset time, number, type and severity of VF at baseline, number of vertebral bodies treated, incident VF, and antiosteoporotic treatment, among others. CBP was considered in patients with VAS ≥ 7 at 12 months. 91/125 patients completed the 12-months follow-up. CBP was observed in 23% of VP-treated patients versus 23% receiving CT. Patients developing CBP after VP showed a longer symptom onset time (82% ≥ 4 months in VP vs. 40% in CT, P = 0.03). On univariate analysis, female gender (OR 1.52; 95% CI 1.47-1.57, P < 0.0001), multiple acute VF (OR 1.79; 95% CI 1.71-1.87, P < 0.0001), VAS ≥ 7 two months after treatment (OR 11.04; 95% CI 6.71-18.17, P < 0.0001), and type of antiosteoporotic drug (teriparatide) (OR 0.12; 95% CI 0.03-0.60, P = 0.0236) were risk factors of CBP development in both groups. In the multivariate analysis, the main risk factors were baseline and post-treatment VAS ≥ 7, longer symptom onset time, and type of antiosteoporotic treatment. In conclusion, 23% of patients with symptomatic osteoporotic VF developed severe CBP independently of the type of treatment. Symptom onset time before VP and persistence of severe CBP after treatment were the main factors related to CBP with teriparatide treatment decreasing the risk of this complication.
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Affiliation(s)
- Pilar Peris
- Rheumatology Department, CIBERehd, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain,
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Staples MP, Howe BM, Ringler MD, Mitchell P, Wriedt CHR, Wark JD, Ebeling PR, Osborne RH, Kallmes DF, Buchbinder R. New vertebral fractures after vertebroplasty: 2-year results from a randomised controlled trial. Arch Osteoporos 2015; 10:229. [PMID: 26272712 PMCID: PMC4871145 DOI: 10.1007/s11657-015-0229-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 07/29/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED A randomised controlled trial of vertebroplasty (VP) versus placebo assessed the effect of VP on the risk of further vertebral fractures. While no statistically significant between-group differences for new or progressed fracture risk at 12 and 24 months were observed, we observed a consistent trend towards higher risk of any type of fracture in the group undergoing VP. Our analysis was underpowered, and further adequately powered studies are needed to be able to draw firm conclusions about further vertebral risk with vertebroplasty. PURPOSE This study seeks to assess the effect of VP on the risk of further radiologically apparent vertebral fracture within two years of the procedure. METHODS We conducted a randomised placebo-controlled trial of VP in people with acute osteoporotic vertebral fracture. Eligible participants were randomly assigned to VP (n = 38) or placebo (n = 40). Cement volume and leakage were recorded for the VP group. Plain thoracolumbar radiographs were taken at baseline, 12 and 24 months. Two independent radiologists assessed these for new and progressed fractures at the same, adjacent and non-adjacent levels. RESULTS At 12 and 24 months, radiographs were available for 45 (58 %) and 47 (60 %) participants, respectively. There were no between-group differences for new or progressed fractures: 32 and 40 in the VP group after 12 and 24 months compared with 21 and 33 in the placebo group (hazard ratio (HR) 1.80, 95 % confidence interval (CI) 0.82 to 3.94). Similar results were seen when considering only adjacent (HR (95 % CI) 2.30 (0.57 to 9.29)) and non-adjacent (HR (95 % CI) 1.45 (0.55 to 3.81) levels. In all comparisons, there was a consistent trend towards higher risk of any type of fracture in the group undergoing VP. Within the VP group, fracture risk was unrelated to total (HR (95 % CI) 0.91 (0.71 to 1.17)) or relative (HR (95 % CI) 1.31 (0.15 to 11.48)) cement volume or cement leakage (HR (95 % CI) 1.20 (0.63 to 2.31)). CONCLUSION For patients undergoing VP, our study did not demonstrate significant increases in subsequent fracture risk beyond that experienced by those with vertebral fractures who did not undergo the procedure. However, because of the non-significant numerical increases observed, studies with adequate power are needed to draw definite conclusions about fracture risk.
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Affiliation(s)
- MP Staples
- Cabrini Institute & Department of Clinical Epidemiology, Cabrini Hospital, 183 Wattletree Rd. Malvern, Victoria, 3144, Australia
| | - BM Howe
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - MD Ringler
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - P Mitchell
- Department of Radiology, The University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - CHR Wriedt
- MIA Radiology, 540 Springvale Rd, Glen Waverly, Victoria, 3150, Australia
| | - JD Wark
- Department of Medicine (Royal Melbourne Hospital), Royal Parade, Parkville, Victoria, 3050, Australia
| | - PR Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton 3168, Victoria, Australia
| | - RH Osborne
- School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
| | - DF Kallmes
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - R Buchbinder
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, Vic
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McConnell CT, Wippold FJ, Ray CE, Weissman BN, Angevine PD, Fries IB, Holly LT, Kapoor BS, Lorenz JM, Luchs JS, O'Toole JE, Patel ND, Roth CJ, Rubin DA. ACR appropriateness criteria management of vertebral compression fractures. J Am Coll Radiol 2014; 11:757-63. [PMID: 24935074 DOI: 10.1016/j.jacr.2014.04.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Abstract
This is an updated review of management of vertebral compression fracture for both benign osteoporotic and malignant causes. Vertebral compression fracture radiologic imaging evaluation is discussed. A literature review is provided of current indications for vertebral augmentation with percutaneous vertebroplasty and kyphoplasty as well as medical management. Limitations and potential benefits of these procedures are discussed. Variant tables describing various clinical situations are also provided to assist in determining appropriate use of these treatments for patient care. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to formulate recommendations for imaging or treatment.
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Affiliation(s)
| | | | - Charles E Ray
- University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | | | - Peter D Angevine
- Columbia University Medical Center, New York, New York; American Association of Neurological Surgeons, Rolling Meadows, Illinois/Congress of Neurological Surgeons, Schaumburg, Illinois
| | - Ian Blair Fries
- Bone, Spine and Hand Surgery, Chartered, Brick, New Jersey; American Academy of Orthopaedic Surgeons, Rosemont, Illinois
| | - Langston T Holly
- University of California Los Angeles Medical Center, Los Angeles, California; American Association of Neurological Surgeons, Rolling Meadows, Illinois/Congress of Neurological Surgeons, Schaumburg, Illinois
| | | | | | | | - John E O'Toole
- Rush University Medical Center, Chicago, Illinois; American Association of Neurological Surgeons, Rolling Meadows, Illinois/Congress of Neurological Surgeons, Schaumburg, Illinois
| | | | | | - David A Rubin
- Washington University School of Medicine, Saint Louis, Missouri
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Han S, Park HS, Pee YH, Oh SH, Jang IT. The clinical characteristics of lower lumbar osteoporotic compression fractures treated by percutaneous vertebroplasty : a comparative analysis of 120 cases. KOREAN JOURNAL OF SPINE 2014; 10:221-6. [PMID: 24891852 PMCID: PMC4040645 DOI: 10.14245/kjs.2013.10.4.221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 09/20/2013] [Accepted: 09/23/2013] [Indexed: 11/19/2022]
Abstract
Objective The purpose of this study is to provide accurate understanding of clinical presentations and surgical outcomes as well as to identify the unique characteristics of lower lumbar osteoporotic compression fracture (OCF). Methods Clinical data were collected from 120 patients who had L3, L4 or L5 percutaneous vertebroplasty (PVP) performed from 2008 to 2012 at the single institute. L4 or L5 PVP patients were classified into group 1 and group 2 was for L3 PVP patients. Medical records were retrospectively investigated at 1 month after PVP. Long term follow-up results were obtained at a median value of 22 months after PVP. Results 75% of the patients in group 1 were not associated with traumatic events, 71% presenting with leg radiating symptoms and 46% requiring an additional decompressive surgery, more often than those in group 2. These differences are statistically significant (p<0.05). The short term medical record review demonstrated that only 73% of patients in group 1 were ameliorated with regard to back motion pain, whereas those in group 2 reported 87.7% rates of amelioration in identical category (p<0.05). The long term follow up confirmed a significantly worse outcome in group 1, with only 55.7% of patients reporting amelioration in their pain or functional status, but 71.7% rate of amelioration in group 2. Conclusion The OCFs at the L4 or L5 level have different clinical characteristics from those at upper levels of the lumbar spine.
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Affiliation(s)
- Seok Han
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Korea
| | - Heung-Sik Park
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Korea
| | - Yong-Hun Pee
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Korea
| | - Seong-Hoon Oh
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Korea
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Korea
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Lin CH, Lee MH, Lin MHC, Wang TC, Cheng WC, Tsai YH, Hsu CH, Yang JT. Percutaneous dorsal root ganglion lysis with phenol for the treatment of pain associated with thoracic compression fracture. Acta Neurochir (Wien) 2013; 155:2313-20. [PMID: 24072426 DOI: 10.1007/s00701-013-1887-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/12/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Symptomatic thoracic compression fracture is one of the most common causes of back pain in elderly. Although vertebroplasty is widely utilized in patients when conservative treatment fails, we introduced an alternative percutaneous technique for the treatment of thoracic compression pain. METHODS This in a retrospective study. The analysis was performed on 28 consecutive patients who underwent undergoing percutaneous dorsal root ganglion lysis with phenol for the treatment of pain associated with thoracic compression fracture. An acceptable treatment outcome was operationally defined as a pain intensity numerical rating scale (NRS) score of 3 or lower or EQ-5D index of 0.672 or higher. The primary outcome was pain relief and acceptable treatment outcome at 1 day, 1 week, 1 month, and 1 year. RESULTS Of the 28 cases treated with our procedures, the change in mean NRS score between baseline and one day was -2.5 (95 % CI -1.6 ~ -3.4, p < 0.001), between baseline and one week was -4.7 (-4.1 to -5.3, p < 0.001), between baseline and one month was -5.8 (-5.2 to -6.5, p < 0.001), and between baseline and one year was -6.3 (-5.6 to -7.1, p < 0.001). An acceptable treatment outcome was 14 % one day after the procedure, 46 % at one week, 72 % at one month, and 84 % at one year. Complication rate was 3.6 %. CONCLUSIONS For thoracic compression fracture patients, percutaneous dorsal root ganglion lysis with phenol is an effective, and safe alternative treatment method worth considering. Pain relief is fast and persists for one year.
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Affiliation(s)
- Chun-Hsien Lin
- Department of Neurosurgery, Chang Gung Memorial Hospital, 6 section West, Chia Pu Road, Pu Tz City, Chia, Yi 613, Taiwan
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Martinez-Ferrer A, Blasco J, Carrasco JL, Macho JM, Román LS, López A, Monegal A, Guañabens N, Peris P. Risk factors for the development of vertebral fractures after percutaneous vertebroplasty. J Bone Miner Res 2013; 28:1821-9. [PMID: 23427068 DOI: 10.1002/jbmr.1899] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 02/06/2013] [Accepted: 02/10/2013] [Indexed: 11/06/2022]
Abstract
We have recently observed an increased risk for vertebral fractures (VF) in a randomized controlled trial comparing the analgesic effect of vertebroplasty (VP) versus conservative treatment in symptomatic VF. The aim of the present study was to evaluate the risk factors related to the development of VF after VP in these patients. We evaluated risk factors including age, gender, bone mineral density, the number, type, and severity of vertebral deformities at baseline, the number of vertebral bodies treated, the presence and location of disk cement leakage, bone remodeling (determining bone turnover markers) and 25 hydroxyvitamin D [25(OH)D] levels at baseline in all patients. Twenty-nine radiologically new VF were observed in 17 of 57 patients undergoing VP, 72% adjacent to the VP. Patients developing VF after VP showed an increased prevalence of 25(OH)D deficiency (<20 ng/mL) and higher P1NP values. The principal factor related to the development of VF after VP in multivariate analysis was 25(OH)D levels < 20 ng/mL (RR, 15.47; 95% CI, 2.99-79.86, p < 0.0001), whereas age >80 years (RR, 3.20; 95% CI, 1.70-6.03, p = 0.0007) and glucocorticoid therapy (RR, 3.64; 95% CI, 1.61-8.26, p = 0.0055) constituted the principal factors in the overall study population. Increased risk of VF after VP was also associated with cement leakage into the inferior disk (RR, 6.14; 95% CI, 1.65-22.78, p = 0.044) and more than one vertebral body treated during VP (RR, 4.19; 95% CI, 1.03-34.3, p = 0.044). In conclusion, nearly 30% of patients with osteoporotic VF treated with VP had a new VF after the procedure. Age, especially >80 years, the presence of inferior disk cement leakage after the procedure, the number of cemented vertebrae, and low 25(OH)D serum levels were related to the development of new VF in these patients, with the latter indicating the need to correct vitamin D deficiency prior to performing VP.
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Affiliation(s)
- Angeles Martinez-Ferrer
- Department of Rheumatology, Centro de Investigación Biomédica en Red Networked Biomedical Research Center de Enfermedades Hepáticas y Digestivas Hepatic and Digestive Diseases CIBERehd Hospital Clinic, Barcelona, Spain
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Risk factors for new vertebral compression fractures after percutaneous vertebroplasty: qualitative evidence synthesized from a systematic review. Spine (Phila Pa 1976) 2013; 38:E713-22. [PMID: 23429687 DOI: 10.1097/brs.0b013e31828cf15b] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Methodological systematic review. OBJECTIVE To identify the risk factors for new vertebral compression fractures (VCFs) in patients after percutaneous vertebroplasty (PVP) and to grade the evidence according to the quality of included studies. SUMMARY OF BACKGROUND DATA PVP is an effective procedure for the treatment of VCFs. A major concern after PVP in patients with osteoporosis is the occurrence of new VCFs in the untreated vertebrae. The risk factors for new VCFs after PVP reported thus far remain controversial. These risk factors have neither been well identified or summarized. This systematic review was performed to identify the risk factors for new VCFs after PVP. METHODS Noninterventional studies evaluating the risk factors for new VCFs of patients with osteoporosis after PVP were searched in MEDLINE, EMBASE, ScienceDirect, and OVID databases (all up to November 2012). Only observational studies with eligible data were included. Quality of included studies was assessed by a modified quality assessment tool, which was previously designed for observational study. The effects of studies were combined with the study quality score using a model of best-evidence synthesis. RESULTS Twenty-four observational studies involving 3789 patients were included. These articles were published between 2004 and 2012. According to the quality assessment criteria for included studies, 8 studies were deemed as high-quality studies, 6 as moderate-quality studies, and 10 as low-quality studies. There were strong evidences of 3 risk factors, including lower bone mineral density, lower body mass index, intradiscal cement leakage, and vertebral height restoration. We also identified 6 moderate-evidence factors including lower body mass index, number of pre-existing vertebral fractures, thoracolumbar junction in initial VCFs, cement distraction, older age, and number of treated vertebrae. Thirteen factors were classified into the limited-evidence risk factors. CONCLUSION Although there is no conclusive evidence for new VCFs of patients with osteoporosis after PVP procedure, these data provide evidence to guide the surgeon and develop optimal preventions for new VCFs after PVP. Special attention should be paid to the 3 strong-evidence risk factors. Further studies were still required to evaluate the effects of the earlier mentioned risk factors. LEVEL OF EVIDENCE 2.
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Daghigh MH, Safavi SS, Goldust M. Evaluation of magnetic resonance imaging signal changes in vertebral depressed fractures to determine the fracture time. Pak J Biol Sci 2013; 16:299-300. [PMID: 24498795 DOI: 10.3923/pjbs.2013.299.300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This research is based on studying MRI signal changes in depressive vertebra fractures in order to determine the time of damages. With this information, difficulty for both clinicians and insurance companies will be resolved. In this descriptive analytical study, the MRI of the patients with vertebral collapse was evaluated. In all cases, during the twelve month study, all fractured vertebras had complete isodense sequences in T1-W and T2-W. This study confirms that any fractured vertebra in contrast with its adjacent normal vertebra has a specific amount of signal change in determined time passing.
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Liu WG, He SC, Deng G, Guo JH, Fang W, Zhu GY, Teng GJ. Risk factors for new vertebral fractures after percutaneous vertebroplasty in patients with osteoporosis: a prospective study. J Vasc Interv Radiol 2013; 23:1143-9. [PMID: 22920978 DOI: 10.1016/j.jvir.2012.06.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 06/12/2012] [Accepted: 06/14/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To determine the risk factors for new vertebral compression fractures (VCFs) following percutaneous vertebroplasty (PV) in patients with osteoporosis. MATERIALS AND METHODS This prospective study included 132 consecutive patients with osteoporosis treated with PV in a single institution over 46 months from March 2005 to December 2008. Multivariable logistic regression and univariate analysis were employed to identify risk factors for new VCFs after PV, including patient demographic data, parameters of the initial and new fractured vertebrae, procedure-related information, and follow-up data. RESULTS During the follow-up period (22.4 months ± 12.1), 80 new vertebral fractures occurred in 36 (27.3%) patients. Multivariate analysis showed that number of VCFs per time frame, computed tomography (CT) value of nonfractured vertebrae (T11-L2), activity level after discharge, duration of follow-up, and cement distribution in the inferior part of the vertebral body or close to the endplate were statistically correlated with new fractures (odds ratios, 2.63, 0.96, 3.59, 1.00, 0.30, and 0.05; P = .006, P = .001, P = .007, P = .004, P = .021 and P = .029). Univariate analysis showed preexisting old VCFs were correlated with new VCFs (P = .045). Subsequent compression fractures in adjacent vertebrae (45 of 80) occurred more frequently and sooner than nonadjacent vertebral fractures (both P < .05). CONCLUSIONS The incidence of new VCFs after PV is relatively high and affected by several risk factors that are related to both the PV procedure and the natural course of osteoporosis.
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Affiliation(s)
- Wen-Gui Liu
- Department of Radiology, Southeast University, Nanjing , China
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Tsai YW, Hsiao FY, Wen YW, Kao YH, Chang LC, Huang WF, Peng LN, Liu CL, Chen LK. Clinical Outcomes of Vertebroplasty or Kyphoplasty for Patients With Vertebral Compression Fractures: A Nationwide Cohort Study. J Am Med Dir Assoc 2013; 14:41-7. [DOI: 10.1016/j.jamda.2012.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 09/03/2012] [Accepted: 09/05/2012] [Indexed: 11/16/2022]
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Joseph RN, Swift AJ, Maliakal PJ. Single centre prospective study of the efficacy of percutaneous cement augmentation in the treatment of vertebral compression fractures. Br J Neurosurg 2012; 27:459-64. [DOI: 10.3109/02688697.2012.752431] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Optimal intravertebral cement volume in percutaneous vertebroplasty for painful osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 2012; 37:1747-55. [PMID: 22433500 DOI: 10.1097/brs.0b013e318254871c] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective follow-up study. OBJECTIVE Assessment of the relation between accomplishment of pain relief through percutaneous vertebroplasty (PVP) in painful osteoporotic vertebral compression fractures (OVCFs) and the cemented fraction of the vertebral body and subsequent determination of the optimal intravertebral cement volume. SUMMARY OF BACKGROUND DATA The mechanism of pain relief of PVP as a treatment modality for painful OVCFs remains unclear. Generally, benefit of PVP is thought to result from stabilization of micromovements and collapse of the fractured vertebral body. However, studies indicating a relation between intravertebral cement volume and pain relief are lacking and an optimal value of the intravertebral cement volume is unknown. METHODS One hunderd six patients who received PVP for 196 painful OVCFs were prospectively followed on back pain (score 0-10) and occurrence of new OVCFs during the first postoperative year. Patients were classified as responders (average postoperative back pain ≤ 6) and nonresponders (average postoperative back pain >6). The cemented fraction of the vertebral body was determined using volumetric analysis of the postoperative CT scan of the treated levels. Analysis was performed using receiver-operating characteristic (ROC) analysis and multivariable regression techniques. RESULTS Twenty-nine patients (27.3%) were found to be nonresponders. Mean intravertebral cement volume in all 196 treated OVCFs was 3.94 mL (SD = 1.89, range 0.13-10.8). The mean cemented vertebral body fraction was significantly lower in nonresponders (0.15 vs. 0.21, P = 0.002). The ROC area-under-curve of the cemented fraction as a predictor of accomplishment of pain relief was 0.67 (95% CI: 0.57-0.78, P = 0.006). In subgroups without specific influential factors (new OVCFs, intravertebral clefts), significantly stronger associations were found. A vertebral body fraction of 24% was identified as the optimal fraction to be cemented. This fraction corresponded to a 93% to 100% specificity for accomplishment of pain relief (i.e., few to no cases without pain relief in the presence of adequate cementing) without being significantly associated with a higher risk of occurrence of cement leakage or new OVCFs. Corresponding values for the recommended (optimal) intravertebral cement volume were provided based on its governing characteristics (fracture level, fracture severity, and patient's sex). CONCLUSION An optimal intravertebral cement volume was identified for accomplishment of pain relief through PVP in painful OVCFs. Appropriate thresholds were provided to guide the operator.
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