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Bian C, Gu H, Chen G, Cheng X, Huang Z, Xu J, Yin X. A Retrospective Study of 91 Patients Treated with Percutaneous Kyphoplasty for Mild Osteoporotic Vertebral Compression Fractures and a New Evaluation Scale of Shape and Filling Effect of Cement. World Neurosurg 2024; 186:e134-e141. [PMID: 38522788 DOI: 10.1016/j.wneu.2024.03.089] [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: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Percutaneous kyphoplasty (PKP) is commonly used to treat severe osteoporotic vertebral compression fractures (OVCFs) by restoring vertebral height. However, its application in mild cases is not frequently discussed. METHODS The study retrospectively included 100 treated vertebral bodies of the 91 patients mentioned before, and efficacy was evaluated using visual analog scale (VAS) and Oswestry Disability Index (ODI) scores preoperatively, 2 days postoperatively, and at 1 and 6 months after treatment, as well as mean variation in vertebral body height. The study also examined complications such as pain recurrence, delayed vertebral fracture, and loss of vertebral height, and developed a scale to assess the shape and filling effect of cement (SFEC) and its impact on complications. RESULTS The results showed significant reductions in mean VAS and ODI scores from pre-to post-surgery and an increase in vertebral body height. However, complications occurred in 10 patients who received treatment for 11 vertebral bodies, including pain recurrence, fractures, and loss of vertebral height. Among the 10 patients with complications, 7 (63.6%) vertebral bodies had dissatisfied SFEC scores, compared with 22 (24.7%) vertebral bodies with dissatisfied SFEC scores in 81 patients without complications (89 vertebral bodies). CONCLUSIONS PKP is a safe and effective method for treating mild OVCFs, but attention should be paid to the shape and filling effects of cement during surgery to prevent later complications. The developed SFEC scale provides a specific and quantitative standards for evaluating the recovery status after PKP, which need further validations.
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Affiliation(s)
- Chong Bian
- Department of Orthopedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Huijie Gu
- Department of Orthopedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Guangnan Chen
- Department of Orthopedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Xiangyang Cheng
- Department of Orthopedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Zhongyue Huang
- Department of Orthopedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Jun Xu
- Department of Orthopedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Xiaofan Yin
- Department of Orthopedics, Minhang Hospital, Fudan University, Shanghai, China.
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Pedicle screw fixation of thoracolumbar fractures: conventional short segment versus short segment with intermediate screws at the fracture level-a systematic review and 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 2020; 29:2491-2504. [PMID: 32529525 DOI: 10.1007/s00586-020-06479-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/04/2020] [Accepted: 05/25/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Posterior short-segment fixation (4-screw construct = 4S) is the conventional surgical technique for thoracolumbar fractures. The effect of adding two intermediate pedicle screws at the fractured level (6-screw construct = 6S) is still a matter of debate. This review aims to compare the results between 4 and 6S pedicle screw fixation for thoracolumbar fractures. METHODS A systematic review and meta-analysis were performed. The databases PubMed, Embase and Google Scholar were searched until January 2020. Inclusion criteria were studies comparing 4S and 6S techniques in patients with thoracolumbar fractures. Non-comparative studies and studies without full text were excluded. Cochrane risk of bias was assessed, and the GRADE approach was used to present the quality of evidence. RESULTS Twenty-seven studies, of which 21 randomized controlled trials, with a total of 1890 patients (940 with 4S and 950 with 6S) were included. Meta-analysis showed that the 6S technique resulted in significantly lower pain scores, better short-term and long-term Cobb angles, less loss of correction and less implant failures. However, longer operation time and more blood loss were seen with the 6S technique. Length of hospital stay, Oswestry Disability Index scores and infections did not differ significantly between the 6S and 4S techniques. Quality of the evidence according to GRADE was moderate to low. CONCLUSION In the treatment of thoracolumbar fractures, adding intermediate screws at the fracture level (6S) results in less post-operative pain, better radiological outcomes and less implant failure at the cost of a longer operation time and higher blood loss.
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Chen Z, Chen Z, Wu Y, Wu Y, Ning S, Ning S, Ma T, Ma T, Wu Z, Wu Z. Risk Factors of Secondary Vertebral Compression Fracture After Percutaneous Vertebroplasty or Kyphoplasty: A Retrospective Study of 650 Patients. Med Sci Monit 2019; 25:9255-9261. [PMID: 31740653 PMCID: PMC6911304 DOI: 10.12659/msm.915312] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background In this study, we aimed to investigate the risk factors contributing to secondary vertebral compression fractures (SVCF) in patients undergoing percutaneous vertebroplasty (PVP) or kyphoplasty (PKP) due to osteoporotic vertebral compression fracture (OVCF). Material/Methods Between January 2010 and December 2017, 650 patients with regular follow-up were identified and retrospectively analyzed in this study. Of these patients, 410 patients underwent PVP and 240 patients underwent PKP surgery. Patients were followed for 24 months on average, ranging from 6 months to 36 months follow-up. Possible risk factors screened for were age, gender, regional distribution, outdoor activity (ODA), bone mineral density (BMD), surgical methods (unilateral or bilateral), bone cement dose, bone cement leakage, chronic disease history, postoperative anti-osteoporosis treatment, and level of preoperative OVCF. Logistic regression analysis was applied to determine potential risk factors. Results As a result, 102 patients (15.7%) suffered SVCF after PVP/PKP surgery at the last follow-up. Binary logistic regression model showed that older age increased the risk of developing SVCF [odds ratio (OR)=2.48, P=0.031] while high-level BMD (OR=0.31, P<0.001) and ODA (OR=0.38, P=0.001) decreased the risk. Binary logistic regression model showed the following: Logit (P)=1.03+0.91X1–1.18X2–0.97X3 (X1=age, OR=2.48, P=0.031; X2=BMD, OR=0.31, P<0.001; X3=ODA, OR=0.38, P=0.001). Conclusions In conclusion, older age and lower BMD were identified as risk factors of SVCF for OVCF patients following PVP/PKP surgery, whereas more ODA played a protective role in SVCF development.
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Affiliation(s)
- Ziqi Chen
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Ziqi Chen
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Yanping Wu
- Department of Medical Service Management, The First Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Yanping Wu
- Department of Medical Service Management, The First Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Shenghua Ning
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Shenghua Ning
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Tianxiao Ma
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Tianxiao Ma
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Zhanyong Wu
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
| | - Zhanyong Wu
- Department of Orthopedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China (mainland)
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Li H, Yang DL, Ma L, Wang H, Ding WY, Yang SD. Risk Factors Associated with Adjacent Vertebral Compression Fracture Following Percutaneous Vertebroplasty After Menopause: A Retrospective Study. Med Sci Monit 2017; 23:5271-5276. [PMID: 29103064 PMCID: PMC5685033 DOI: 10.12659/msm.907364] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Clinically, percutaneous vertebroplasty (PVP) is frequently applied to treat osteoporotic vertebral compression fracture (OVCF). It is believed that new compression fractures are more likely to occur adjacent to the PVP-treated segment, typically within 1 month after PVP. The purpose of this study was to investigate risk factors for adjacent vertebral compression fractures (AVCF) after PVP in patients with OVCF after menopause. Material/Methods Between Jun 2012 and Dec 2016, 412 patients were initially identified. We enrolled 390 patients in this study, and 22 were lost to follow-up. The medical records of the patients were retrospectively collected. Patients were followed up for at least 6 months, with an average follow-up period of 18 months. The potential risk factors investigated in this study included age, duration of menopause (DoM), preoperative vertebral compression, number of preoperative vertebral fractures (NPVF), bone mineral density (BMD), surgical approach (unilateral or bilateral), anesthesia methods, bone cement dose, complications (including COPD), and anti-osteoporosis treatment. Logistic regression analysis was used to determine the risk factors. Results Sixty-eight patients were observed to have suffered from AVCF after PVP at the last follow-up. Univariate analysis showed that age, DoM, NPVF, BMD, COPD, and anti-osteoporosis treatment were the potential variables associated with the onset of AVCF (all P<0.05). Binary logistic regression analysis showed that the logistic regression equation was as follows: logit P=−3.10−1.07×X2+0.99×X3+2.15×X4 (where X2=BMD; X3=DoM; X4=NPVF), and “logit P” stands for the likelihood of developing an AVCF following PVP. Conclusions A long duration of menopause and preoperative multi-level vertebral fractures were the risk factors for AVCF in patients following PVP after menopause, while a high-level BMD acted in a protective role for AVCF development.
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Affiliation(s)
- Hua Li
- Department of Orthopedic Surgery, Harrison International Peace Hospital, Hengshui, Hebei, China (mainland)
| | - Da-Long Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Lei Ma
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Hui Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland).,Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Shijiazhuang, Hebei, China (mainland)
| | - Si-Dong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
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Sun ZY, Li XF, Zhao H, Lin J, Qian ZL, Zhang ZM, Yang HL. Percutaneous Balloon Kyphoplasty in Treatment of Painful Osteoporotic Occult Vertebral Fracture: A Retrospective Study of 89 Cases. Med Sci Monit 2017; 23:1682-1690. [PMID: 28386056 PMCID: PMC5391800 DOI: 10.12659/msm.903997] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The definition of a vertebral fracture is usually based on the presence of a deformation of the vertebral body and this can be misleading in the presence of a fracture without radiologic collapse with the definition of occult osteoporotic vertebral fractures (OOVFs). STIR sequence of MRI images showing hyperintensity signal was the most confirmative screening examination used to determine the presence of painful OOVFs. To date, clinical management of OOVFs has been rarely discussed. MATERIAL AND METHODS Between 2011 and 2013, 89 patients suffering from painful OOVFs underwent 142 percutaneous balloon kyphoplasty (PKP) procedures. Outcome data (mean variation of anterior and middle vertebral body height, visual analog scale [VAS] scores, Oswestry Disability Index [ODI] scores, and SF-36 scores) were recorded preoperatively, postoperatively, and at 1 month, 6 months, and 2 year after treatment, to evaluate the results. RESULTS We successfully treated 89 patients (142 vertebral bodies) with PKP. Cement leakages were observed in 12 (8.45%) treated vertebral bodies and there were 5 new adjacent vertebral fractures during the follow-up period. The mean variation of anterior and middle vertebral body height changed from 96.5±3.4% preoperatively to 97.2±2.5% postoperatively (p>0.05) and from 96.3±2.8% preoperatively to 97.9±3.1% postoperatively (p>0.05), respectively. The mean VAS scores were reduced significantly from pre-surgery to post-surgery (8.3±1.2 to 2.9±0.7; p<0.05), as was the ODI score (76.4±12.5 to 26.7±5.6; p<0.05). The SF-36 scores, including Bodily Pain (BF), Vitality (VT), Physical Function (PF), and Social Functioning (SF), all showed notable improvement (P<0.05). These variations were maintained during the 2-year follow-up period. CONCLUSIONS PKP is a safe and effective method in the treatment of painful OOVFs.
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Affiliation(s)
- Zhi-Yong Sun
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Xue-Feng Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Huan Zhao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jun Lin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Zhong-Lai Qian
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Zhi-Ming Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Hui-Lin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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