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Zhu X, Wang Z, Bian J, Chen C, Huang A. Incidence of and Risk Factors for Neurological Deficits Associated With Percutaneous Vertebral Augmentation. Global Spine J 2025:21925682251333412. [PMID: 40205827 PMCID: PMC11985469 DOI: 10.1177/21925682251333412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Revised: 03/18/2025] [Accepted: 03/24/2025] [Indexed: 04/11/2025] Open
Abstract
Study DesignRetrospective cohort study.ObjectivesTo investigate the incidence of neurological deficits associated with percutaneous vertebral augmentation (PVA) surgery and to identify related risk factors.MethodsWe performed a retrospective analysis of the clinical data of patients who underwent PVA surgery at our institution between 2017 and 2022. A range of clinical parameters, including age, sex, fracture cause, fracture segment, number of vertebrae treated, surgical approach and surgical method, were collected.ResultsThis study included a total of 1847 patients, including 422 (22.8%) men and 1425 (77.2%) women, with a total of 2319 diseased vertebrae. The mean age of the patients was 70.71 ± 8.80 years, with 211 (11.4%) patients aged under 60 years and 1636 (88.6%) patients aged over 60 years. Forty-six (2.5%) patients, accounting for 67 diseased vertebrae, were treated for tumors, whereas the remaining 1801 (97.5%) patients underwent surgery for fractures. Four hundred seventy-eight (20.6%) vertebrae underwent unilateral puncture, and the remaining 1841 (79.4%) vertebrae underwent bilateral puncture. Percutaneous vertebroplasty was performed on 1781 (76.8%) vertebrae, whereas percutaneous kyphoplasty was chosen for the remaining 538 (23.2%) vertebrae. Postoperative X-ray evaluations were conducted on the treated vertebrae, revealing that 403 (17.4%) vertebrae experienced polymethylmethacrylate (PMMA) leakage. Among the 1847 patients, 6 (7 diseased vertebrae) experienced nerve injuries postoperatively, and the incidence of neurological deficits after PVA surgery was 0.32%. Four of the 6 patients had nerve injuries due to PMMA leakage, and the other 2 patients had failed punctures. There was no statistically significant difference in terms of neurological complication rates according to patient age, sex, fracture segment, number of vertebrae treated, surgical approach or surgical method. However, the incidence of neurological complications was greater for patients with neoplastic fractures who underwent PVA surgery than for those with osteoporotic fractures.ConclusionsPVA is an effective minimally invasive procedure for treating osteoporotic and neoplastic vertebral fractures. However, PVA can lead to serious neurological deficits. The incidence of neurological deficits associated with PVA surgery is 0.32%. Compared with patients with osteoporotic fractures, patients with neoplastic vertebral fractures who undergo PVA have a greater risk of neurological complications.
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Affiliation(s)
- Xianyang Zhu
- Department of Orthopedics, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu, China
| | - Zhaorui Wang
- Department of Orthopedics, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu, China
| | - Jian Bian
- Department of Orthopedics, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu, China
| | - Chunmao Chen
- Department of Orthopedics, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu, China
| | - Aibing Huang
- Department of Orthopedics, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu, China
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Aziz M, Kniep I, Ondruschka B, Püschel K, Hessler C. Cement Leakage after Augmentation of Osteoporotic Vertebral Bodies. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2025; 163:146-152. [PMID: 39134031 DOI: 10.1055/a-2343-4100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2025]
Abstract
Der Zementaustritt ist die häufigste Komplikation bei der Zementaugmentation von Wirbelkörpern. In der vorliegenden Studie wurden die Zementaustrittsraten bei Zementaugmentationen an der Wirbelsäule untersucht und potenzielle Risikofaktoren für einen Zementaustritt identifiziert.Es wurden 140 Fälle von 131 Patienten und Patientinnen und 9 Verstorbenen ausgewertet. Insgesamt wurden 258 zementaugmentierte Wirbelkörper untersucht. Die Daten dafür stammen aus den Krankenhausdokumentationen von 131 Patienten und Patientinnen, die sich in 2 orthopädisch-unfallchirurgischen Kliniken in der BRD solchen Operationen unterzogen, sowie aus den Untersuchungen von 9 Sterbefällen im Institut für Rechtsmedizin der Universitätsklinikums Hamburg-Eppendorf.Zementaustritte wurden in 64 der 140 Fälle (45,7%) ermittelt. Lokale Zementaustritte waren mit 73,4% (n = 47) die häufigste Austrittsart. Venöse Austritte wurden in 15 Fällen (23,4%) und Lungenzementembolisationen in 2 Fällen (3,1%) evaluiert. Innerhalb des Kollektivs der retrospektiv untersuchten Fälle (n = 131) erlitt lediglich 1 Patient (0,8%) einen symptomatischen Zementaustritt. Als Risikofaktoren für Zementaustritte konnten Zementaugmentationen von Frakturen an Lendenwirbelkörpern sowie eine hohe applizierte Zementmenge identifiziert werden.Sowohl die Daten in der assoziierten Literatur als auch die Ergebnisse dieser Arbeit belegen eine hohe Inzidenz von Zementaustritten nach Wirbelkörperaugmentationen. Trotz des geringen prozentualen Anteils symptomatischer Fälle sollten bei der Planung und Durchführung von Zementaugmentationen an Wirbelkörpern die möglichen Einflussfaktoren für einen Zementaustritt berücksichtigt und in die OP-Planung einbezogen werden.
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Affiliation(s)
- Mina Aziz
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Inga Kniep
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Benjamin Ondruschka
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Klaus Püschel
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Christian Hessler
- Orthopädie und Unfallchirurgie, Asklepios Klinik Birkenwerder, Birkenwerder, Deutschland
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Wang Z, Li L, Zhang T, Li R, Ren W, Zhang H, Tao Z, Ren Y. Evaluation of predictive performance for new vertebral compression fracture between Hounsfield units value and vertebral bone quality score following percutaneous vertebroplasty or kyphoplasty. Acad Radiol 2025; 32:1562-1573. [PMID: 39643469 DOI: 10.1016/j.acra.2024.11.039] [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: 09/13/2024] [Revised: 10/17/2024] [Accepted: 11/16/2024] [Indexed: 12/09/2024]
Abstract
RATIONALE AND OBJECTIVES New vertebral compression fractures (NVCF) are very common in patients following percutaneous vertebroplasty (PVP) or kyphoplasty (PKP). The study aims to evaluate the comparative predictive performance of vertebral bone quality (VBQ) score and Hounsfield units (HU) value in forecasting NVCF after surgery. MATERIALS AND METHODS This study retrospectively analyzed patients who underwent PVP/PKP at our institution between 2020 and 2021. The VBQ score and HU value were obtained from preoperative magnetic resonance imaging (MRI) and computed tomography (CT) scans, respectively. Subsequently, the forecasting capabilities of these two parameters were assessed by contrasting their receiver operating characteristic (ROC) curve. RESULTS A total of 303 eligible patients (56 with NVCF and 247 without) were identified in the study. Six relevant literature factors were identified and included in the multivariate analysis revealed that lower HU value (OR = 0.967, 95% CI = 0.953-0.981, P < 0.001) and higher VBQ score (OR = 3.964, 95% CI = 2.369-6.631, P < 0.001) emerged as independent predictors of NCVF occurrence. Compared to the ROC curve of the HU value, demonstrating a diagnostic accuracy of 83.2% (95% CI = 77.5%-88.9%, P < 0.001), the VBQ score was 85.8%. And, a statistically significant negative correlation was observed between the VBQ score and the T-score (r = -0.529, P < 0.001). CONCLUSION In patients undergoing PVP/PKP, VBQ score, and HU value are independently associated with the occurrence of NVCF. Assessing the HU value and the VBQ score could play an effective role in planning PVP/PKP operations.
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Affiliation(s)
- Zhengbo Wang
- Department of Orthopedics, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu, People's Republic of China (Z.W., L.L., T.Z., R.L., W.R., H.Z., Z.T., Y.R.).
| | - Lingzhi Li
- Department of Orthopedics, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu, People's Republic of China (Z.W., L.L., T.Z., R.L., W.R., H.Z., Z.T., Y.R.).
| | - Tianyou Zhang
- Department of Orthopedics, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu, People's Republic of China (Z.W., L.L., T.Z., R.L., W.R., H.Z., Z.T., Y.R.).
| | - Ruya Li
- Department of Orthopedics, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu, People's Republic of China (Z.W., L.L., T.Z., R.L., W.R., H.Z., Z.T., Y.R.).
| | - Wei Ren
- Department of Orthopedics, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu, People's Republic of China (Z.W., L.L., T.Z., R.L., W.R., H.Z., Z.T., Y.R.).
| | - Helong Zhang
- Department of Orthopedics, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu, People's Republic of China (Z.W., L.L., T.Z., R.L., W.R., H.Z., Z.T., Y.R.).
| | - Zhiwen Tao
- Department of Orthopedics, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu, People's Republic of China (Z.W., L.L., T.Z., R.L., W.R., H.Z., Z.T., Y.R.).
| | - Yongxin Ren
- Department of Orthopedics, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu, People's Republic of China (Z.W., L.L., T.Z., R.L., W.R., H.Z., Z.T., Y.R.).
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Yan W, Song H, Cao W, Ma D, Sun M. Vertebral Augmentation plus Pedicle Screw Fixation versus Vertebral Augmentation Alone in the Treatment of Osteoporotic Thoracolumbar Fractures: A Meta-Analysis. World Neurosurg 2025; 195:123688. [PMID: 39827956 DOI: 10.1016/j.wneu.2025.123688] [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: 12/21/2024] [Accepted: 01/09/2025] [Indexed: 01/22/2025]
Abstract
BACKGROUND This meta-analysis was conducted to compare the efficacy and safety of vertebral augmentation (VA) plus pedicle screw fixation (PSF) with VA for treating osteoporotic thoracolumbar fractures (OTLFs). METHODS A comprehensive search was conducted in PubMed, Embase, Cochrane Library, and CNKI (China National Knowledge Infrastructure) to identify studies comparing PSF + VA with VA for treating OTLF. The primary outcomes were operation time, blood loss, length of stay, visual analog scale (VAS) score, Oswestry Disability Index (ODI), Cobb angle, anterior vertebral height (AVH), bone cement leakage, secondary fracture, and other adverse events. Standardized mean deviation (SMD) and risk ratio with 95% confidence interval (CI) were calculated. RESULTS Fourteen studies met the entire inclusion criteria for our meta-analysis. The PSF + VA group was associated with significantly more operation time (SMD, 4.41; 95% CI, 3.32-5.51), blood loss (SMD, 6.72; 95% CI, 4.50-8.95), and length of stay (SMD, 2.05; 95% CI, 1.02-3.07). There was no significant VAS score or ODI difference at early follow-up. No significant difference was found in AVH between the 2 groups before 2 years. The remaining outcomes (VAS at 6 months and 2 years; ODI at 6 months and 1 year; Cobb angle at all follow-up periods; AVH at 2 years; bone cement leakage and secondary fracture) favored the PSF + VA group. CONCLUSIONS PSF + VA was superior to VA for the VAS score, ODI, Cobb angle, AVH, and complications, especially in the long-term follow-up. However, more operation time, blood loss, and length of stay were the disadvantages for PSF + VA.
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Affiliation(s)
- Wenshan Yan
- Department of Orthopaedics, Binhai Hospital of Tianjin Medical University General Hospital, Tianjin, China.
| | - Haiyu Song
- Department of Emergency, Tianjin Jinghai First-Aid subcenter, Tianjin, China
| | - Weili Cao
- The Clinic, Tianjin Binhai New Area Hangu Central Primary School, Tianjin, China
| | - Dengyue Ma
- Department of Orthopaedics, Binhai Hospital of Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Sun
- Department of Orthopaedics, Binhai Hospital of Tianjin Medical University General Hospital, Tianjin, China
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Luque R, Garríguez D, Checa Betegon P, Sanchez M, Perez Gonzalez JL, Dominguez Esteban I. Silicone kyphoplasty (elastoplasty) versus traditional cement kyphoplasty for osteoporotic vertebral fractures. Does this new technique reduce the complications? Rev Esp Cir Ortop Traumatol (Engl Ed) 2025:S1888-4415(25)00045-1. [PMID: 39984119 DOI: 10.1016/j.recot.2025.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 10/23/2024] [Accepted: 10/24/2024] [Indexed: 02/23/2025] Open
Abstract
INTRODUCTION Stiffness is increased in vertebrae after kyphoplasty with bone cement is performed, which cause an increase in subsequent fractures in adjacent levels. This has led to increased interest in alternative filling materials such as bioactive calcium phosphate ceramics or silicon-based polymers. This study's objective is to compare the results between kyphoplasty with bone cement and with the VK100 silicone. MATERIALS AND METHODS This is a comparative, prospective study involving 64 patients 64 patients, 23 treated using VK100 and 41 with PMMA. Clinical, radiological and functional results (Oswestry) and quality of life and (EQ-5D) were analyzed and compared between both groups, focusing on differences in subsequent fractures in adjacent levels. RESULTS There are no differences between the two treatments in terms of epidemiological factors (age and sex) or hospital management. A significant difference is observed in the gain of vertebral body height, with greater improvement in those treated with PMMA. There is also a higher fracture rate in the PMMA group, the difference is not significant. Finally, both treatments show similar outcomes in pain relief and quality of life. CONCLUSION Both VK100 elastoplasty and PMMA kyphoplasty are effective treatments for vertebral fractures. VK100 has a lower rate of complications and adjacent fractures. However, long-term results in terms of pain relief and quality of life are similar, making both treatments equally valid.
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Affiliation(s)
- R Luque
- Servicio Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain.
| | - D Garríguez
- Servicio Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain
| | - P Checa Betegon
- Servicio Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain
| | - M Sanchez
- Servicio Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain
| | - J L Perez Gonzalez
- Servicio Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain
| | - I Dominguez Esteban
- Servicio Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, Spain
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Marino V, Mungalpara N, Amirouche F. Re-evaluating vertebral height restoration assessment in osteoporotic compression fractures: 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 2025:10.1007/s00586-025-08707-1. [PMID: 39928136 DOI: 10.1007/s00586-025-08707-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 07/29/2024] [Accepted: 01/28/2025] [Indexed: 02/11/2025]
Abstract
PURPOSE Vertebral compression fractures (VCFs) are common among the elderly, causing significant morbidity, pain, and disability. This study quantitatively analyzes the vertebral height restoration via Kyphoplasty (KP) and Vertebroplasty (VP), along with the cement volume used and leakage percentage. Our meta-analysis of 14 randomized controlled trials (RCTs) compares these objective outcomes, considering cement volume and leakage in both procedures. METHODS Databases searched included Medline, PubMed, and Web of Science using MeSH keywords: 'Kyphoplasty,' 'Vertebroplasty,' 'Vertebral height restoration,' 'Bone cement volume,' and 'Vertebral compression fractures.' Fourteen RCTs were selected, focusing on outcomes such as anterior and central vertebral body height, kyphotic angle, cement volume, and leakage. Data analysis included mean values, standard deviations, ranges, Cohen's d-effect sizes, and standard errors, summarized in a forest plotQuery. RESULTS The review included 1456 patients (mean age 71.11 years). Follow-up ranged from 1 to 48 months (mean 15 months). KP showed a greater effect size in restoring anterior and central vertebral body height and kyphotic angle. Combined data from KP and VP showed increases of 3.48 mm (19.14%) in anterior vertebral heights, 4.38 mm in central vertebral heights, and a 2.85-degree correction in kyphotic angle. CONCLUSIONS Both KP and VP effectively restore vertebral height in VCF patients. KP is superior in restoring anterior and central vertebral body height and correcting kyphotic angle. VP, particularly unilateral, shows higher central vertebral height restoration but higher cement leakage. Standardized reporting and patient-specific volumetric assessments are crucial for optimizing vertebral augmentation procedures.
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Affiliation(s)
- Victoria Marino
- Department of Orthopaedic Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - Nirav Mungalpara
- Department of Orthopaedic Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - Farid Amirouche
- Department of Orthopaedic Surgery, University of Illinois Chicago, Chicago, IL, USA.
- Institute of Orthopaedics and Spine, Northshore University HealthSystem, Skokie, Chicago, IL, USA.
- UIC Biomechanical Lab, 835 South Wolcott Avenue, Office No E190, Chicago, IL, 60612, USA.
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Wu BS, Hsu MC, Yao YC, Lin HH, Chou PH, Wang ST, Chang MC, Hsiung W, Wang CY, Chen KJ. Efficiency and Safety of Repeated Vertebroplasty for Adjacent Segment Fractures. J Clin Med 2024; 14:166. [PMID: 39797249 PMCID: PMC11721890 DOI: 10.3390/jcm14010166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Revised: 12/11/2024] [Accepted: 12/27/2024] [Indexed: 01/13/2025] Open
Abstract
Objectives: To review the outcomes of patients who underwent repeated vertebroplasty (VP) surgery for adjacent segment fractures (ASF), defined as new osteoporotic vertebral fractures occurring at levels immediately above or below a previously treated vertebra. Methods: From 1 January 2018, to 31 December 2020, forty-one patients who developed ASF following initial VP and underwent repeated VP were enrolled in our study. Radiographic measurements included single and two-segment kyphotic angles (SKA and TKA), and anterior and mid-vertebral body height (AVH and MVH). Patient-reported outcomes included back pain assessed with the visual analog scale (VAS) and the Oswestry Disability Index (ODI). Results: The procedure significantly reduced the mean single kyphotic angle (SKA) by 4.8° ± 6.8° (p < 0.01) and the two-segment kyphotic angle (TKA) by 3.0° ± 7.9° (p = 0.02), along with increases in anterior and mid-body height by 0.3 ± 0.5 cm and 0.3 ± 0.6 cm (both p < 0.01). However, there was a slight restoration loss in SKA and TKA at a 20.1-month follow-up. Patient-reported outcomes revealed substantial pain reduction, with the VAS score dropping from 8 to 1 (p < 0.0001) and the mean ODI score improving from 59.7 to 28.9 (p < 0.0001). The complication rate was 34.1%, including nonunion, de novo fractures, cement leakage, and neurological deficits. Additionally, 7.3% of cases necessitated further surgical interventions. Conclusions: Repeated VP for ASF improves vertebral alignment parameters and patient-reported outcomes, but with a high rate of complications and reoperation.
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Affiliation(s)
- Bo-Sheng Wu
- Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
| | - Ming-Cheng Hsu
- Department of Medical Education, National Cheng Kung University Hospital, No.138, Sheng Li Road, North Dist., Tainan 11558, Taiwan;
| | - Yu-Cheng Yao
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-C.Y.); (H.-H.L.); (P.-H.C.); (S.-T.W.); (M.-C.C.)
- Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
| | - Hsi-Hsien Lin
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-C.Y.); (H.-H.L.); (P.-H.C.); (S.-T.W.); (M.-C.C.)
- Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
| | - Po-Hsin Chou
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-C.Y.); (H.-H.L.); (P.-H.C.); (S.-T.W.); (M.-C.C.)
- Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
| | - Shih-Tien Wang
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-C.Y.); (H.-H.L.); (P.-H.C.); (S.-T.W.); (M.-C.C.)
- Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
- Ministry of Health and Welfare, Kinmen Hospital, Kinmen County 89142, Taiwan
| | - Ming-Chao Chang
- Department of Orthopedics, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-C.Y.); (H.-H.L.); (P.-H.C.); (S.-T.W.); (M.-C.C.)
- Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
| | - Wei Hsiung
- Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
- Department of Orthopedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan
| | - Chien-Yuan Wang
- Department of Orthopedics, China Medical University Hsinchu Hospital, Hsinchu County 30058, Taiwan;
- Department of Orthopedics, College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Kuan-Jung Chen
- Department of Orthopedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
- Department of Orthopedics, China Medical University Hsinchu Hospital, Hsinchu County 30058, Taiwan;
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Wang J, Xie X, Gou Y, Wu Y, Pu H, Chen Q, He J. Forearm bone mineral density as a predictor of adjacent vertebral refracture after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fracture: a retrospective analysis. J Orthop Surg Res 2024; 19:788. [PMID: 39581973 PMCID: PMC11585950 DOI: 10.1186/s13018-024-05258-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Accepted: 11/10/2024] [Indexed: 11/26/2024] Open
Abstract
BACKGROUND The incidence of adjacent vertebral body re-fracture after percutaneous kyphoplasty (PKP) is associated with a number of variables, of which decreased bone mineral density is one of the major risk factors. Forearm bone mineral density (BMD) measurements are gaining attention because of their convenience and validity, but there is a lack of systematic research on the specific relationship between forearm BMD and the risk of adjacent vertebral re-fracture after PKP. PURPOSE To investigate the correlation between forearm BMD and the risk of adjacent vertebral re-fracture after PKP in osteoporotic vertebral compression fractures (OVCF) patients. METHODS Retrospective evaluation of 198 OVCF patients receiving PKP was conducted in this study. The patients were divided into two groups: the no-fracture group and the re-fracture group, according to whether or not they had undergone vertebral re-fracture. Obtain basic information about the patient's age, sex, body mass index, bone cement leakage, smoking history, diabetes history, and surgical segmentation. Using computed tomography, the mean Hounsfield unit (HU) values for the BMD of the L1 lumbar spine were determined. For the dual-energy X-ray BMD test, the distal one-third lengths of the patient's nondominant forearm's radius and ulna were chosen. Receiver operating characteristic curves were utilized to evaluate the predictive value of forearm BMD versus lumbar CT values for vertebral re-fracture, and univariate and multivariate logistic regression analyses were employed to identify characteristics related with vertebral re-fracture following PKP. RESULTS Re-fracture rate after PKP was 17.2% at a minimum 12-month follow-up. Significant differences were seen between the refracture and non-fracture groups in terms of hypertension, Cobb angle correction, vertebral height recovery rate, intradiscal cement leakage, forearm bone density, and vertebral HU values. In multifactorial logistic regression analysis, forearm bone density (OR 0.821; 95% CI 0.728-0.937, p = 0.008) and HU values (OR 0.815; 95% CI 0.733-0.906, p = 0.005) were independent risk factors for vertebral re-fracture. The area under the curve (AUC) for forearm BMD values and HU values predicting adjacent vertebral re-fracture were 0.956 and 0.967, respectively. CONCLUSIONS Forearm BMD is an independent risk factor for re-fracture of adjacent vertebrae after PKP. In addition, forearm BMD, as a valid indicator of postoperative re-fracture after PKP in patients with OVCF, and the HU value of lumbar spine CT were both powerful tools for predicting re-fracture.
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Affiliation(s)
- Jinzhou Wang
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiansong Xie
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yuwei Gou
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yucheng Wu
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hongyu Pu
- The Department of Orthopaedic Surgery, Fushun People's Hospital, Zigong, 643000, Sichuan Province, China
| | - Qian Chen
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
| | - Jiangtao He
- Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
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Luque R, Garríguez D, Checa Betegon P, Sanchez M, Olvera M, Perez Gonzalez JL, Dominguez Esteban I. Silicone kyphoplasty (elastoplasty) versus traditional cement kyphoplasty for osteoporotic vertebral fractures. Does this new technique reduce the complications? Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00174-7. [PMID: 39477013 DOI: 10.1016/j.recot.2024.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 10/23/2024] [Accepted: 10/24/2024] [Indexed: 11/30/2024] Open
Abstract
INTRODUCTION Stiffness is increased in vertebrae after kyphoplasty with bone cement is performed, which cause an increase in subsequent fractures in adjacent levels. This has led to increased interest in alternative filling materials such as bioactive calcium phosphate ceramics or silicon-based polymers. This study's objective is to compare the results between kyphoplasty with bone cement and with the VK100 silicone. MATERIALS AND METHODS This is a comparative, prospective study involving 64 patients, 23 treated using VK100 and 41 with PMMA. Clinical, radiological and functional results (Oswestry) and quality of life and (EQ-5D) were analyzed and compared between both groups, focusing on differences in subsequent fractures in adjacent levels. RESULTS There are no differences between the two treatments in terms of epidemiological factors (age and sex) or hospital management. A significant difference is observed in the gain of vertebral body height, with greater improvement in those treated with PMMA. There is also a higher fracture rate in the PMMA group, the difference is not significant. Finally, both treatments show similar outcomes in pain relief and quality of life. CONCLUSION Both VK100 Elastoplasty and PMMA Kyphoplasty are effective treatments for vertebral fractures. VK100 has a lower rate of complications and adjacent fractures. However, long-term results in terms of pain relief and quality of life are similar, making both treatments equally valid.
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Affiliation(s)
- R Luque
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España.
| | - D Garríguez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - P Checa Betegon
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - M Sanchez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - M Olvera
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - J L Perez Gonzalez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - I Dominguez Esteban
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
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10
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Seesala VS, Sheikh L, Basu B, Mukherjee S. Mechanical and Bioactive Properties of PMMA Bone Cement: A Review. ACS Biomater Sci Eng 2024; 10:5939-5959. [PMID: 39240690 DOI: 10.1021/acsbiomaterials.4c00779] [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] [Indexed: 09/08/2024]
Abstract
Over the past few decades, poly(methyl methacrylate) (PMMA) based bone cement has been clinically used extensively in orthopedics for arthroplasty and kyphoplasty, due to its biocompatibility and excellent primary fixation to the host bone. In this focused review, we discuss the use of various fillers and secondary chemical moieties to improve the bioactivity and the physicochemical properties. The viscosity of the PMMA blend formulations and working time are crucial to achieving intimate contact with the osseous tissue, which is highly sensitive to organic or inorganic fillers. Hydroxyapatite as a reinforcement resulted in compromised mechanical properties of the modified cement. The possible mechanisms of the additive- or filler-dependent strengthening or weakening of the PMMA blend are critically reviewed. The addition of layered double hydroxides with surface functionalization appears to be a promising approach to enhance the bonding of filler with the PMMA matrix. Such an approach consequently improves the mechanical properties, owing to enhanced dispersion as well as contributions from crack bridging. Finally, the use of emerging alternatives, such as nanoparticles, and the use of natural biomolecules were highlighted to improve bioactivity and antibacterial properties.
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Affiliation(s)
- Venkata Sundeep Seesala
- Advanced Materials and Characterization Group, Research and Development Division, Tata Steel Ltd, Jamshedpur 831001, India
| | - Lubna Sheikh
- Advanced Materials and Characterization Group, Research and Development Division, Tata Steel Ltd, Jamshedpur 831001, India
| | - Bikramjit Basu
- Laboratory for Biomaterials, Materials Research Centre, Indian Institute of Science, Bengaluru 560012, India
| | - Subrata Mukherjee
- Advanced Materials and Characterization Group, Research and Development Division, Tata Steel Ltd, Jamshedpur 831001, India
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11
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Hung HY, Chen SY. Tripod-Fix device for the treatment of painful osteoporotic vertebral compression fractures. Sci Rep 2024; 14:23877. [PMID: 39396082 PMCID: PMC11470962 DOI: 10.1038/s41598-024-75326-z] [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: 04/30/2024] [Accepted: 10/04/2024] [Indexed: 10/14/2024] Open
Abstract
Current vertebral augmentation procedures (VAPs) often involve devices associated with bone cement leakage. Tripod-Fix is designed to mitigate the risk of bone cement leakage by expanding in three dimensions to fit a narrower vertebral space. This study enrolled 12 patients diagnosed with osteoprorotic vertebral compression fractures (VCFs) for 12 month follow up. The primary outcomes assessed were changes in the Visual Analog Score (VAS) and Oswestry Disability Index (ODI) before and after treatment. Our results demonstrated significant pain relief with VAS decreasing from 8.58 ± 1.83 to 2.75 ± 1.54 cm and improved mobility with ODI decreasing from 73.67 ± 16.29 to 31.83 ± 23.33% post-treatment and sustained for 12 months. Follow-up radiographs revealed no device-related adverse events such as cement leakage, vertebral body collapse, or adjacent vertebral fractures (AVFs). In addition, the mean anterior height restoration ratio after treatment was 15.87 ± 5.13%. Our preliminary findings suggest that Tripod-Fix exhibits safety and efficacy comparable to the third-generation devices currently utilized for treating osteoporotic VCFs.
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Affiliation(s)
- Hsiang-Yi Hung
- Department of Neurosurgery, Hualien Tzu Chi Hospital, 707, Sec. 3, Chung-Yang Rd., Hualien, 970, Taiwan R.O.C
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Shin-Yuan Chen
- Department of Neurosurgery, Hualien Tzu Chi Hospital, 707, Sec. 3, Chung-Yang Rd., Hualien, 970, Taiwan R.O.C..
- School of Medicine, Tzu Chi University, Hualien, Taiwan.
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12
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Kapetanakis S, Chaniotakis C, Zavridis P, Kopsidas P, Apostolakis S, Gkantsinikoudis N. Vertebroplasty and kyphoplasty in the management of osteoporotic vertebral compression fractures in elderly individuals: evaluation of the health-related quality of life. Eur J Transl Myol 2024; 34:12274. [PMID: 39113643 PMCID: PMC11487666 DOI: 10.4081/ejtm.2024.12274] [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: 01/11/2024] [Accepted: 06/12/2024] [Indexed: 10/03/2024] Open
Abstract
Aim of this study is to investigate the safety, efficacy and impact on Health-Related Quality of Life (HRQoL) of Vertebroplasty (VP) and Kyphoplasty (KP) in the management of Osteoporotic Vertebral Compression Fractures (OVCFs) in elderly individuals. VP and KP represent Minimally Invasive Vertebral Augmentation (MIVA) procedures that are increasingly implemented for surgical treatment of OVCFs in recent years. These interventions have been associated with minimal traumatization and intraoperative hemorrhage, considerable analgesic effect and rapid postoperative recovery. Seventy-seven (77) consecutive individuals with OVCFs were subjected to VP/KP and recruited in this prospectively designed non-randomized study. Clinical evaluation was performed preoperatively and postoperatively at particular chronic intervals at 1, 6 weeks and at 3, 6, 12 months and 2 years. Assessment was conducted via the standardized Visual Analogue Scale (VAS) and Short-Form 36 (SF-36) Medical Health Survey Questionnaire for pain and HRQoL, respectively. No perioperative complications were observed. All studied indices were demonstrated to present a statistically significant amelioration following overall analysis. Pain intensity measured by the VAS score was depicted to be significantly reduced during the first 3 months, but continuous improvement of all indices of SF-36 and VAS was demonstrated to reach a plateau at 6 months, featuring no further clinical improvement.VP and KP represent safe and efficient options for interventional treatment of OVCFs in elderly and oldest-old patients, improving self-reported symptoms of pain as well as overall HRQoL.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki,Greece; Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens.
| | | | | | - Periklis Kopsidas
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki.
| | - Sotirios Apostolakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki.
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13
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Yuan H, Li Y, Wang J, Wang X, Lü G, Kuang L, Li J. Spinal infection after vertebral augmentation: a covert complication with serious havoc. Arch Orthop Trauma Surg 2024; 144:1461-1471. [PMID: 38273125 DOI: 10.1007/s00402-024-05205-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Vertebral augmentation, including percutaneous vertebroplasty (PVP) or kyphoplasty (PKP), is the current least invasive surgical option and has been widely used to treat the painful osteoporotic vertebral compression fractures (OVCF). However, the postoperative infections could be life-threatening, even though they rarely occur. Our studies aim to clarify the causation and outcomes of spinal infections following augmentation and meanwhile to identify the risk factors. METHODS A retrospective study was conducted on patients with OVCF who underwent PVP or PKP, and were subsequently admitted to our institution with postoperative spinal infection between January 2010 and December 2022. A total of 33 patients were finally included. RESULTS The rate of spinal infection after augmentation in our single institute was 0.05% (2/3893). In addition to these 2 patients, the remaining 31 were referred from other hospitals. All 33 patients exhibited elevated inflammatory parameters, 14 patients presented with fever, and 9 patients experienced neurological deficits. Additionally, 29 patients had comorbidity and risk factors. Pathogens were identified in 26 patients, while only 7 patients were examined as culture negative. 27 patients underwent revision surgery and 6 patients only received conservative therapy. Anterior surgery was performed in 2 patients, while posterior surgery was performed in 20 patients. A combined anterior-posterior surgery was performed in 5 patients. At the final follow-up, 18 patients had unrestricted mobility, 10 patients required assistance from crutches or a walker for ambulation, 4 patients needed a wheelchair, and 1 patients died after revision surgery. CONCLUSIONS Spinal infection after vertebral augmentation is rare, but it cannot be ignored. Surgeons should make every effort to detect the potential preoperative spondylitis or discitis. Once postoperative spinal infection is confirmed, a prompt intravenous antibiotic therapy is warranted. If medication therapy fails, revision surgery involving debridement and spinal reconstruction should be considered.
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Affiliation(s)
- Hui Yuan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, No. 139, RenMin Middle Road, Changsha, 410001, Hunan, People's Republic of China
| | - Yunchao Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, No. 139, RenMin Middle Road, Changsha, 410001, Hunan, People's Republic of China
| | - Jingyu Wang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, No. 139, RenMin Middle Road, Changsha, 410001, Hunan, People's Republic of China
| | - Xiaobin Wang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, No. 139, RenMin Middle Road, Changsha, 410001, Hunan, People's Republic of China
| | - Guohua Lü
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, No. 139, RenMin Middle Road, Changsha, 410001, Hunan, People's Republic of China
| | - Lei Kuang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, No. 139, RenMin Middle Road, Changsha, 410001, Hunan, People's Republic of China.
| | - Jing Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, No. 139, RenMin Middle Road, Changsha, 410001, Hunan, People's Republic of China.
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14
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Yoon SH, Park HG, Lee DH, Lee DU. Comparison of Clinical and Radiological Outcomes after Vertebroplasty and Balloon Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures. J Bone Metab 2024; 31:56-62. [PMID: 38485242 PMCID: PMC10940103 DOI: 10.11005/jbm.2024.31.1.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Vertebroplasty (VP) and balloon kyphoplasty (KP) are effective means with which to improve pain and function in osteoporotic vertebral compression fractures. However, the risk of complications after these procedures is poorly understood, with concerns regarding adjacent vertebral fractures. This study retrospectively investigated the clinical and radiological outcomes of these procedures. METHODS A total of 115 patients who experienced their first vertebral fracture were treated with VP (N=63) or KP (N=52) at the Dankook University Hospital between January 2013 and December 2022. The clinical outcomes were evaluated using the visual analog scale (VAS) preoperative and at 1-year follow-up. Radiological comparisons were performed for kyphosis correction, vertebral height restoration, and postoperative cement leakage. RESULTS KP was more effective than VP, especially for vertebral body height restoration and kyphotic angle reduction (P<0.05). However, the incidence of cement leakage, new adjacent vertebral fractures, and improvement in pain assessed by VAS did not differ statistically between the 2 groups (P>0.05). CONCLUSIONS Considering that KP was performed on fractures with severe deformity, no differences were observed in the clinical outcomes and incidence of adjacent vertebral fractures compared Considering that KP was performed for fractures with severe deformity, there was no difference in clinical outcomes and incidence of adjacent vertebral fractures compared to VP. Improvements in radiological measurements were demonstrated. Therefore, KP may be a good treatment option for pain relief and long-term prognosis in patients with high-compressive-rate vertebral fractures.
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Affiliation(s)
- Sung-Hyun Yoon
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Hee-Gon Park
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Dong-Uk Lee
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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15
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Wang Q, Liu J, Ji Q, Qiu Y, Min N, Wang L, Zhang Y. Percutaneous vertebroplasty versus percutaneous kyphoplasty in elderly patients with osteoporotic vertebral compression fractures: prospective controlled study. BJS Open 2024; 8:zrad162. [PMID: 38284400 PMCID: PMC10823769 DOI: 10.1093/bjsopen/zrad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/09/2023] [Accepted: 11/21/2023] [Indexed: 01/30/2024] Open
Affiliation(s)
- Qiang Wang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Junchuan Liu
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Quan Ji
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yudian Qiu
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Nan Min
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lin Wang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yawen Zhang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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16
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Malik MK, Wroblewski I, Darki A. Pulmonary Cement Embolism After Vertebroplasty. Cureus 2023; 15:e39194. [PMID: 37332403 PMCID: PMC10276658 DOI: 10.7759/cureus.39194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
Pulmonary cement embolism (PCE) is a known complication that can occur in the setting of vertebroplasty. The majority of these cases are asymptomatic and found incidentally on imaging. There are no current management recommendations regarding PCE. We present a case of a patient who underwent vertebroplasty complicated by a symptomatic sub-massive PCE.
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Affiliation(s)
- Muhammad K Malik
- Internal Medicine, Loyola University Medical Center, Maywood, USA
| | | | - Amir Darki
- Cardiology, Loyola University Medical Center, Maywood, USA
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17
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Wang H, Zheng B, Gu H, Zhao Y, Liu D, Yu H, Xiang L. O-Arm- and Guide-Device-Assisted Personalized Percutaneous Kyphoplasty for Thoracolumbar Osteoporotic Vertebral Compression Fractures. J Pers Med 2023; 13:jpm13040595. [PMID: 37108981 PMCID: PMC10141860 DOI: 10.3390/jpm13040595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
With the ageing of the global population, the incidence of osteoporotic vertebral compression fractures (OVCFs) is increasing. To assess the safety and efficacy of O-arm- and guide-device-assisted personalized percutaneous kyphoplasty (PKP) for treating thoracolumbar OVCFs, a total of 38 consecutive thoracolumbar OVCF patients who underwent bilateral PKP assisted with an O-arm and a guide device (O-GD group, n = 16) or traditional fluoroscopy (TF group, n = 22) from January 2020 to December 2021 were retrospectively reviewed, and their epidemiologic, clinical and radiological outcomes were analysed. The operation time was significantly decreased (p < 0.001) in the O-GD group (38.3 ± 12.2 min) compared with the TF group (57.2 ± 9.7 min). The number of intraoperative fluoroscopy exposures was significantly decreased (p < 0.001) in the O-GD group (31.9 ± 4.5) compared with the TF group (46.7 ± 7.2). Intraoperative blood loss was significantly decreased (p = 0.031) in the O-GD group (6.9 ± 2.5 mL) compared with the TF group (9.1 ± 3.3 mL). No significant difference (p = 0.854) in the volume of injected cement was observed between the O-GD group (6.8 ± 1.3 mL) and the TF group (6.7 ± 1.7 mL). Both the clinical and radiological outcomes, including the visual analogue scale score for pain, Oswestry Disability Index and anterior height and local kyphotic angle of the fractured vertebrae, were significantly improved at the postoperative and final follow-up but did not differ between the two groups. The incidence of cement leakage and refracture of the vertebral body was similar in the two groups (p = 0.272; p = 0.871). Our preliminary study demonstrated that O-GD-assisted PKP is a safe and effective procedure that presents a significantly shorter operation time, fewer intraoperative fluoroscopy exposures and less intraoperative blood loss than the TF technique.
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18
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Wu W, Zhang X, Li X, Yu S. Clinical analysis of percutaneous kyphoplasty for spinal metastases in older adults with comorbidities. J Geriatr Oncol 2023; 14:101410. [PMID: 36494262 DOI: 10.1016/j.jgo.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION We aimed to investigate the clinical outcomes of percutaneous kyphoplasty (PKP) for spinal metastases in older adult patients with comorbidities. MATERIALS AND METHODS Ninety-two older adults (age ≥ 60 years) with spinal metastases who underwent 148 PKP procedures were retrospectively analyzed. Tokuhashi scores, Tomita scores, age-adjusted Charlson Comorbidity Index (aCCI) scores, and American Society of Anesthesiologists (ASA) scores were evaluated before the procedure. The visual analog scale (VAS), Oswestry Disability Index (ODI), vertebral body height (VBH), and quality of life (QoL) were used to assess the efficacy of the procedure. Clinical safety was evaluated based on periprocedural complications. RESULTS Tokuhashi scores and Tomita scores were 7.3 ± 4.0 and 5.8 ± 2.1, respectively. Excluding cancer-related factors, twelve patients (13.0%) had aCCI scores ≥4. Forty-three patients (46.7%) had ASA status ≥ III. Compared to preoperative status, average VAS scores, ODI scores, VBH variation, and QoL scores significantly improved at each follow-up examination point after PKP (p < 0.001). No major complications occurred, nor was there decompensation of comorbidities in the perioperative period. Seventeen segments (11.5%) of twelve patients (13.0%) suffered bone cement leakage. Among them, one patient suffered intercostal neuralgia cured by steroid injection, and the other patient suffered hyperesthesia, which disappeared after taking gabapentin (0.3 g, bid) for five weeks. Another minor complication of local hematoma occurred in one patient, which spontaneously resolved without surgical intervention. DISCUSSION PKP serves as a safe approach to provide significant pain relief, vertebral body height restoration, and QoL improvements for spinal metastases in older adults, independent of underlying disease.
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Affiliation(s)
- Wence Wu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xinxin Zhang
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaoyang Li
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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19
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Noguchi T, Yamashita K, Kamei R, Maehara J. Current status and challenges of percutaneous vertebroplasty (PVP). Jpn J Radiol 2023; 41:1-13. [PMID: 35943687 DOI: 10.1007/s11604-022-01322-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/24/2022] [Indexed: 01/07/2023]
Abstract
A narrative review regarding percutaneous vertebroplasty (PVP) for osteoporotic vertebral fracture (OVF) is provided herein, addressing the epidemic of OVF in Japan, the latest response to the criticism of PVP for OVFs, the indications and potential risks of PVP for OVFs, and a future perspective for PVP. Each year in Japan, approximately 32,000 patients aged 55 years or older suffer from chronic low back pain for several months to several years due to a compression fracture. PVP is one of the surgical treatments for an OVF, and it is less invasive compared to the traditional open surgery. PVP is suitable for OVF patients who have difficulty walking as assessed by the modified Yokoyama's activities of daily living (ADL) scoring system, and for patients with Kummell's disease diagnosed by CT and MRI examinations. Serious adverse events related to PVP occur in 1.1-3.3% of the cases, but direct deaths from PVP are extremely rare at less than 1%. Recent studies demonstrated that OVF patients treated with PVP are less likely to die after the treatment than non-surgically treated patients, which conflicts with the Cochran reviews' conclusion not supporting PVP for OVFs. Novel robotic systems and procedure-support devices are being developed, providing a next step toward fully automated PVP procedures.
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Affiliation(s)
- Tomoyuki Noguchi
- Department of Radiology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, 810-8563, Japan.
- Department of Clinical Research, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, 810-8563, Japan.
- Education and Training Office, Department of Clinical Research, Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Koji Yamashita
- Department of Radiology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, 810-8563, Japan
| | - Ryotaro Kamei
- Department of Radiology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, 810-8563, Japan
| | - Junki Maehara
- Department of Radiology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, 810-8563, Japan
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20
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Tartara F, Armocida D, Garbossa D, Meli F, Costantino G, Cofano F, Francaviglia N. Porous titanium microsphere kyphoplasty for augmentation treatment of osteoporotic vertebral fractures: Technical report and case series. Front Surg 2023; 10:1152995. [PMID: 37206353 PMCID: PMC10189281 DOI: 10.3389/fsurg.2023.1152995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/14/2023] [Indexed: 05/21/2023] Open
Abstract
Background Vertebral augmentation procedures (VAPs) are used in cases of persistent and unresponsive pain in patients with vertebral compression fractures (VCFs). Although VAPs are considered a safe procedure providing quick pain relief and improved physical function, some postoperative complications can occur, for example, bone cement leakage. The material used in this procedure is almost exclusively polymethyl methacrylate (PMMA), which appears to lack biological activity and osteointegration capabilities. In this study, we introduce a new filling system consisting of cannulas preloaded with titanium microspheres, which stabilizes and consolidates the structure of the vertebral body in treating VCFs after the performance of the kyphoplasty procedure. Methods We report a retrospective case series of six patients affected by osteoporotic vertebral fractures with worsening back pain, neurologic impairment, and failed conservative treatment who underwent the VAP at our institute, for which the SPHEROPLAST [MT ORTHO s.r.l., Aci Sant'Antonio (CT), Italy] system was used. Results The patients had failed an average conservative trial of 3.9 weeks before they presented to us with neurodeficit. There were two men and four women with a mean age of 74.5 years. The average hospital stay was 2 days. There were no reported perioperative complications related to cement injection, such as intraoperative hypoxia, hypotension, pulmonary embolization, myocardial infarction, neurovascular or viscera injury, or death. The VAS score significantly decreased from a mean preoperative of 7.5 (range 6-19) to 3.8 (range 3-5) immediately after surgery and 1.8 (range 1-3). Conclusion We report the first clinical results in a series of six patients treated for VCF using the microsphere system after analyzing the clinical results produced by, and the complications that arose from, this new device. In patients with VCF, the VAP using titanium microspheres appears to be a feasible and safe procedure with a low risk of material leakage.
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Affiliation(s)
- Fulvio Tartara
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, AOU Policlinico Umberto I, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
- Correspondence: Daniele Armocida
| | - Diego Garbossa
- Neurosurgery Division, Department of Neuroscience, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Meli
- Neurosurgery Division, Arnas Civico di Cristina, Palermo, Italy
| | | | - Fabio Cofano
- Neurosurgery Division, Department of Neuroscience, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
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21
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Hu D, Liu H, Yuan B, Gu S, Xu K, Song F, Xiao S. Analysis of medical malpractice litigation following vertebral augmentation therapy in China from 2008 to 2018. Medicine (Baltimore) 2022; 101:e30972. [PMID: 36254049 PMCID: PMC9575726 DOI: 10.1097/md.0000000000030972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The first case of vertebral augmentation therapy in mainland China was reported in 2000. Since then, it has been widely used in China as a minimally invasive procedure to treat vertebral compression fractures. However, the characteristics of malpractice litigation involving vertebral augmentation therapy remains unclear. This study aims to analyze the characteristics of medical malpractice litigation involving vertebral augmentation therapy in mainland China for the past 10 years. Two online legal databases were queried for court verdicts involving vertebral augmentation therapy from Jan 2009 to Dec 2018 in mainland China. Each case file was then thoroughly reviewed and data pertaining to defendants, plaintiffs, case outcomes, allegations, and verdicts were abstracted, and descriptive analyses were performed. Level of evidence: LEVEL III. A total of 96 cases were enrolled for final analysis. The number of claims increased by five times during the past 10 years. More than two thirds (67.7%, n = 65) of the cases underwent percutaneous vertebroplasty, and 22.9% (n = 22) underwent percutaneous kyphoplasty, the rest (9.4%, n = 9) remained undefined. Paralysis was alleged in 35.4% of cases (n = 34), followed by significant physical injury (34.4%, n = 33). Cement leakage to spinal canal (44.8%, n = 43) is the most commonly cited reason for litigation, followed by incomplete informed consent (42.7%, n = 41), accidental dural puncture (20.8%, n = 20), unsatisfactory clinical outcome (18.8%, n = 18), and misdiagnosis (12.5%, n = 12). Acute pulmonary cement embolism (4.2%, n = 4), wrong-level vertebrae procedure (3.1%, n = 3) and postoperative infection (2.1%, n = 2) were less common causes for concern. Doctors successfully defended themselves only in 8 (8.3%) cases, which resulted in no indemnity payment. The rest 88 (91.7%) cases were closed with a mean verdict payout of 361,580 Yuan (51,654 US dollars). There is a quickly rising trend in the number of medical malpractice litigation involving vertebral augmentation therapy in China. Identifying the most common reasons for litigation and summarizing their characteristics may help decrease litigation rate and improve the patient experience.
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Affiliation(s)
- Dong Hu
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, P.R. China
- Institute for Precision Medicine, Tsinghua University, Beijing, P.R. China
| | - Huawei Liu
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, P.R. China
| | - Bei Yuan
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, P.R. China
| | - Suxi Gu
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, P.R. China
| | - Kai Xu
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, P.R. China
| | - Fei Song
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, P.R. China
| | - Songhua Xiao
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, P.R. China
- Institute for Precision Medicine, Tsinghua University, Beijing, P.R. China
- *Correspondence: Songhua Xiao, Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, 168 Li Tang Road, Beijing 102218, P.R. China (e-mail: )
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SHARIF S, ALI MY, COSTA F, ZILELI M, PARTHIBAN J. Vertebral augmentation in osteoporotic spine fractures: WFNS Spine Committee recommendations. J Neurosurg Sci 2022; 66:311-326. [DOI: 10.23736/s0390-5616.22.05642-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Zheng BW, Liu FS, Zheng BY, Niu HQ, Li J, Lv GH, Zou MX, Xu Z. Risk factors for tuberculous or nontuberculous spondylitis after percutaneous vertebroplasty or kyphoplasty in patients with osteoporotic vertebral compression fracture: A case-control study. Front Surg 2022; 9:962425. [PMID: 36061063 PMCID: PMC9433983 DOI: 10.3389/fsurg.2022.962425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives The contributing factors for spondylitis after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) remain unclear. Here, we sought to investigate the factors affecting spondylitis occurrence after PVP/PKP. We also compared the clinical characteristics between patients with tuberculous spondylitis (TS) and nontuberculous spondylitis (NTS) following vertebral augmentation. Methods Literature searches (from January 1, 1982 to October 16, 2020) using MEDLINE, EMBASE, Google Scholar and Web of science databases were conducted to identify eligible studies according to predefined criteria. The local database was also retrospectively reviewed to include additional TS and NTS patients at our center. Results Thirty studies from the literature and 11 patients from our local institute were identified, yielding a total of 23 TS patients and 50 NTS patients for analysis. Compared with NTS group, patients in the TS group were more likely to have a history of trauma before PVP/PKP treatment. Univariate analyses of risk factors revealed pulmonary tuberculosis and diabetes were significant factors for TS after PVP/PKP. Analyzing NTS, we found obesity, a history of preoperative trauma, urinary tract infection, diabetes and multiple surgical segments (≥2) were significantly associated with its occurrence following PVP/PKP treatment. Multivariate logistic analyses showed a history of pulmonary tuberculosis and diabetes were independent risk factors for TS after PVP/PKP, while diabetes and the number of surgically treated segments independently influenced NTS development. Conclusions A history of pulmonary tuberculosis and diabetes were independent risk factors for TS. For NTS, diabetes and the number of surgically treated segments significantly influenced the occurrence of postoperative spinal infection. These data may be helpful for guiding risk stratification and preoperative prevention for patients, thereby reducing the incidence of vertebral osteomyelitis after PVP/PKP.
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Affiliation(s)
- Bo-Wen Zheng
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Peking University, Beijing, China
| | - Fu-Sheng Liu
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bo-Yv Zheng
- Department of Orthopedics Surgery, General Hospital of the Central Theater Command, Wuhan, China
| | - Hua-Qing Niu
- Department of Orthopedics Surgery, General Hospital of the Central Theater Command, Wuhan, China
| | - Jing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guo-Hua Lv
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ming-Xiang Zou
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Zhun Xu
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Correspondence: Zhun Xu
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Wang S, Zheng L, Ma JX, Wang H, Sun ST, Zhang BH, Guo XL, Xiang LB, Chen Y. Analysis of the most influential publications on vertebral augmentation for treating osteoporotic vertebral compression fracture: A review. Medicine (Baltimore) 2022; 101:e30023. [PMID: 35945791 PMCID: PMC9351837 DOI: 10.1097/md.0000000000030023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aimed to analyze the most influential publications on vertebral augmentation for treating osteoporotic vertebral compression fracture. The Web of Science database was searched using the key words "percutaneous vertebroplasty," "percutaneous kyphoplasty," "balloon kyphoplasty," "vertebroplasty," "kyphoplasty," and "vertebral augmentation." The top 100 publications were arranged by citations per year and descriptively and visually analyzed. The top 100 publications were cited 25,482 times, with an average of 14.4 citations per paper per year. The corresponding authors of the publications represented 17 nations, with most authors being American (46 authors). Thirty-two journals were involved, with SPINE issuing the most publications (24 papers of the 100). Clinical research (73 of the 100 papers) outnumbered basic studies (14 papers) and systematic reviews (13 papers), and the most publications were published between 2000 and 2004. Co-citation analysis of the key words indicated that the top 5 focus areas were "complication," "balloon kyphoplasty," "vertebral compression fracture," "biomechanics," and "calcium phosphate cement." The top 3 keywords with the strongest citation bursts were "compression fracture," "cement," and "balloon kyphoplasty." The keywords with persistent strong citation bursts are "balloon kyphoplasty" and "augmentation." There are still contrary opinions about vertebral augmentation; new research should be conducted with more deliberate design and longer follow-up.
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Affiliation(s)
- Shuang Wang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Liang Zheng
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Jun-Xiong Ma
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Hong Wang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Shao-Tong Sun
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Bo-Hua Zhang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Xin-Lei Guo
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Liang-Bi Xiang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Yu Chen
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
- *Correspondence: Yu Chen, Department of Orthopedics, General Hospital of Northern Theater Command, No. 83, Wenhua Road, Shenhe District, Shenyang 110016, China ()
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Chen Z, Yao Z, Wu C, Wang G, Liu W. Assessment of clinical, imaging, surgical risk factors for subsequent fracture following vertebral augmentation in osteoporotic patients. Skeletal Radiol 2022; 51:1623-1630. [PMID: 35122489 DOI: 10.1007/s00256-022-04009-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Currently, the risk factors for subsequent fracture following vertebral augmentation remain incomplete and controversial. To provide clinicians with accurate information for developing a preventive strategy, we carried out a comprehensive evaluation of previously controversial and unexplored risk factors. METHODS We retrospectively reviewed patients with osteoporotic vertebral compression fracture in lumbar spine who received vertebral augmentation between January 2019 and December 2020. Based on whether refracture occurred, patients were assigned to refracture and non-refracture group. The clinical characteristics, imaging parameters (severity of vertebral compression, spinal sagittal alignment, degeneration of paraspinal muscles), and surgical indicators (cement distribution and leakage, correction of spinal sagittal alignment) were collected and analyzed. RESULTS There were 128 patients and 16 patients in non-refracture and refracture group. The incidence of previous fracture, multiple fractures, and cement leakage were notably higher, relative cross-sectional area of psoas (r-CSAPS) was significantly smaller, CSA ratio, fatty infiltration of erector spinae plus multifidus (FIES+MF), FIPS, postoperative lumbar lordosis (post-LL), correction of body angel (BA), and LL were significantly greater in refracture group. Binary logistic regression analysis revealed previous fracture, cement leakage, post-LL, and correction of BA were independent risk factors. According to the ROC curve, correction of BA showed the highest prediction accuracy, and the critical value was 3.45°. CONCLUSIONS The occurrence of subsequent fracture might be the consequence of multiple factors. Previous fracture, cement leakage, post-LL, and correction of BA were identified as independent risk factors. Furthermore, the correction of BA should not exceed 3.45°, especially in patients with risk factors.
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Affiliation(s)
- Zhi Chen
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Zhipeng Yao
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Chengjian Wu
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Guohua Wang
- Department of Orthopedics Surgery, Fuqing Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Wenge Liu
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China.
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Wu W, Zhang X, Li X, Yu S. The influence of diverse bone cement distribution patterns for metastatic vertebral lesions after bilateral percutaneous kyphoplasty. BMC Musculoskelet Disord 2022; 23:713. [PMID: 35883056 PMCID: PMC9316733 DOI: 10.1186/s12891-022-05680-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate the influence of diverse bone cement distribution patterns in patients with metastatic vertebral lesions after bilateral percutaneous kyphoplasty (PKP). Methods Fifty-nine patients with single-level metastatic vertebral lesions who received bilateral PKP were retrospectively reviewed. According to the different bone cement distribution patterns, patients were divided into confluent (n = 35, CF) and separated (n = 24, SP) groups. Indicators including visual analogue scale (VAS), Oswestry Disability Index (ODI), vertebral body height (VBH) variation, quality of life (QoL), and related complications were reviewed and compared between the two groups. Results No statistically significant differences were observed between the two groups in age, sex, types of lesions, locations of lesions, posterior vertebral body and/or pedicle involvement, percentage of vertebral invasion, procedure duration or cement volume (p > 0.05). There was significant improvement in VAS, ODI, VBH and QoL at any follow-up examination (p < 0.05) compared with those preoperatively. The CF group exhibited better pain relief in VAS scores than did the SP group just at 3 days and 1 month after PKP (p < 0.05). There were no significant differences between the two groups in VAS scores at 3 months or 1 year after PKP (p > 0.05). No statistically significant differences were observed between the two groups in terms of ODI, VBH or QoL (p > 0.05). There was no statistically significant difference in the incidence of complications between the two groups (p > 0.05). Conclusions More rapid pain relief was achieved with confluent rather than separated bone cement distribution patterns in PKP for patients with metastatic vertebral lesions.
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Affiliation(s)
- Wence Wu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xinxin Zhang
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaoyang Li
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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27
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Patel D, Liu J, Ebraheim NA. Managements of osteoporotic vertebral compression fractures: A narrative review. World J Orthop 2022; 13:564-573. [PMID: 35949707 PMCID: PMC9244957 DOI: 10.5312/wjo.v13.i6.564] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/26/2022] [Accepted: 06/14/2022] [Indexed: 02/06/2023] Open
Abstract
Osteoporotic vertebral compression fractures (OVCFs) are the most common fragility fracture and significantly influence the quality of life in the elderly. Currently, the literature lacks a comprehensive narrative review of the management of OVCFs. The purpose of this study is to review background information, diagnosis, and surgical and non-surgical management of the OVCFs. A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed. Combinations of the following terms were used: compression fractures, vertebral compression fractures, osteoporosis, osteoporotic compression fractures, vertebroplasty, kyphoplasty, bisphosphonates, calcitonin, and osteoporosis treatments. Additional articles were also included by examining the reference list of articles found in the search. OVCFs, especially those that occur over long periods, can be asymptomatic. Symptoms of acute OVCFs include pain localized to the mid-line spine, a loss in height, and decreased mobility. The primary treatment regimens are pain control, medication management, vertebral augmentation, and anterior or posterior decompression and reconstructions. Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain. Bisphosphonates and denosumab are the first-line treatments for osteoporosis. Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief. Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications. Calcium and vitamin D supplementation can have a protective and therapeutic effect. Management of OVCFs must be combined with multiple approaches. Appropriate exercises and activity modification are important in fracture prevention. Medication with different mechanisms of action is a critical long-term causal treatment strategy. The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods. Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present. The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.
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Affiliation(s)
- Devon Patel
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, United States
| | - Jiayong Liu
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Nabil A Ebraheim
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, United States
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Bian F, Bian G, An Y, Wang D, Fang J. Establishment and Validation of a Nomogram for the Risk of New Vertebral Compression Fractures After Percutaneous Vertebroplasty in Patients With Osteoporotic Vertebral Compression Fractures: A Retrospective Study. Geriatr Orthop Surg Rehabil 2022; 13:21514593221098620. [PMID: 35529895 PMCID: PMC9073119 DOI: 10.1177/21514593221098620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 03/29/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose New vertebral compression fractures(NVCFs) after minimally invasive surgery in patients with osteoporotic vertebral compression fracture (OVCF) is a challenging issue worldwide. Predicting the occurrence of NVCFs is key to addressing such questions. Therefore, we aimed to investigate the risk factors for patients who developed NVCFs after undergoing surgical treatment and establish a nomogram model to reduce the occurrence of NVCFs. Methods This study is a retrospective analysis that collected the general characteristics and surgical features of patients who underwent surgical treatment at 2 central institutions between January 2017 and December 2020. Patients were divided into training and testing sets based on the presence or absence of NVCFs. Independent risk factors for NVCFs were obtained in the training set of patients, and then a nomogram model was constructed. Internal and external validation of the nomogram model was performed using the consistency index (C index), receiver operating characteristic curve(ROC), calibration curves, and decision curve analysis (DCA). Results A total of 562 patients were included in this study. Patients from the first center were used for nomogram construction and internal validation, and patients from the second center were used as an external validation population. Multivariate regression analysis showed that age, Hounsfield unit (Hu) value, cement leakage, and thoracolumbar (TL) junction fracture were independent risk factors for NVCFs after minimally invasive surgery. The C index was .85, and the validation of internal and external validation shows that the predicted values of the established model is in good agreement with the actual values. Conclusions In this study, 4 independent risk factors were obtained by regression analysis, and a nomogram model was constructed to guide clinical work. The application of this model can help surgeons to make more accurate judgments to prevent the occurrence of NVCFs.
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Affiliation(s)
- FuCheng Bian
- Department of Endoscopic Diagnosis, Daqing Oilfield General Hospital, Daqing, China.,Department of Orthopaedic, Daqing Oilfield General Hospital, Daqing, China
| | - GuangYu Bian
- Department of Obstetrics, Daqing Oilfield General Hospital, Daqing, China
| | - YongSheng An
- Department of Orthopaedic, Chengde Medical University Affiliated Hospital, Chengde, China
| | - DaYong Wang
- Department of Orthopaedic, Daqing Oilfield General Hospital, Daqing, China
| | - JinHui Fang
- Department of Endoscopic Diagnosis, Daqing Oilfield General Hospital, Daqing, China
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Jia Y, Peng Z, Li J, Qin Y, Wang G. Unilateral Percutaneous Kyphoplasty with O-Arm Navigation for the Treatment of Kümmell’s Disease. J Pain Res 2022; 15:257-266. [PMID: 35140512 PMCID: PMC8818965 DOI: 10.2147/jpr.s337715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of unilateral O-arm navigation-assisted percutaneous kyphoplasty (PKP) for the treatment of Kümmell’s disease. Methods The clinical data from patients with Kümmell’s disease who attended our hospital between January 2015 and January 2019 were retrospectively analyzed. For each patient, the visual analog scale (VAS) score, anterior height of the vertebral body, sagittal kyphotic angle, Oswestry Disability Index (ODI), and postoperative cement leakage rate were recorded before and after surgery. Any surgical complications were documented. Results The patients were followed up for 12 to 18 months. The average preoperative VAS score, kyphotic angle, and ODI decreased from 8.6 ± 0.5, 18.0 ± 3.7°, and 86.027%, respectively, to 2.2 ± 0.2, 5.8 ± 0.8°, and 26.720% three days after surgery. The anterior height of the vertebral body increased significantly from 14.5 ± 1.2 mm preoperatively to 19.4 ± 1.2 mm three days after surgery, and this improvement was maintained until the last follow-up. After surgery, bone cement leakage occurred in one vertebral body; this patient exhibited leakage to the intervertebral disc space, a complete pedicle and spinal canal structure, no clinical symptoms, and required no treatment. Conclusion This study shows that unilateral PKP assisted by O-arm navigation is safe and effective. Moreover, the observed improvements can be maintained over the longer term.
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Affiliation(s)
- Yukun Jia
- Spine Surgery, Affiliated Baoan Hospital of Shenzhen, Southern Medical University; The Second School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong Province, People’s Republic of China
| | - Zhan Peng
- Spine Surgery, Affiliated Baoan Hospital of Shenzhen, Southern Medical University; The Second School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong Province, People’s Republic of China
- Correspondence: Zhan Peng; Guangye Wang, Email ;
| | - Jin Li
- Spine Surgery, Affiliated Baoan Hospital of Shenzhen, Southern Medical University; The Second School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yuantian Qin
- Teaching Department, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu Province, People’s Republic of China
| | - Guangye Wang
- Spine Surgery, Affiliated Baoan Hospital of Shenzhen, Southern Medical University; The Second School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong Province, People’s Republic of China
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Baek IH, Park HY, Kim KW, Jang TY, Lee JS. Paraplegia due to intradural cement leakage after vertebroplasty: a case report and literature review. BMC Musculoskelet Disord 2021; 22:741. [PMID: 34454446 PMCID: PMC8403441 DOI: 10.1186/s12891-021-04625-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/18/2021] [Indexed: 01/25/2023] Open
Abstract
Background Vertebroplasty (VP) is considered an alternative therapy in an osteoporotic compression fracture that failed conservative treatment. However, cement leakage into the intradural space can cause catastrophic complications. To the best of our knowledge, intradural cement leakage following VP has been reported only in 7 cases. We report here a case of intradural cement leakage following VP with a literature review. Case presentation An 84-year-old female with an L1 osteoporotic fracture underwent percutaneous VP at a local hospital. Immediately after the procedure, she complained of weakness, numbness, and pain in both legs, and her back pain aggravated. She was transferred to our hospital. The initial muscle power was grade 2 for the right leg and grade 4 for the left leg. Computed tomography (CT) scan showed intradural cement leakage from T10 to L2. Magnetic resonance imaging showed an intradural mass lesion. Although we performed total laminectomy with durotomy and removed intradural cement completely, the neurological deficit did not completely recover. The muscle power was grade 3 for the right leg and grade 4 for the left leg at the last follow-up. Conlcusions If a neurological deficit is found after VP, a CT scan should be taken to confirm the pattern of cement leakage. In case of intradural cement leakage, surgical decompression should be recommended to improve neurological deficit. To prevent intradural cement leakage during the VP, the needle tip should not perforate the medial wall of the pedicle with appropriate viscosity of cement.
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Affiliation(s)
- In-Hwa Baek
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-Ro, Eunpyeong-gu, 03312, Seoul, Republic of Korea
| | - Hyung-Youl Park
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-Ro, Eunpyeong-gu, 03312, Seoul, Republic of Korea
| | - Ki-Won Kim
- Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Yang Jang
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-Ro, Eunpyeong-gu, 03312, Seoul, Republic of Korea
| | - Jun-Seok Lee
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-Ro, Eunpyeong-gu, 03312, Seoul, Republic of Korea.
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Lucas LG, Lucas VPCL, Sylvain P, Agathe N, Marc-Antoine R, Laurie S, Wafa S. Biomechanical comparative evaluation of percutaneous fixations with vertebral expansion for vertebral compression fractures: an experimental and finite element study. Comput Methods Biomech Biomed Engin 2021; 25:487-498. [PMID: 34342248 DOI: 10.1080/10255842.2021.1959919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study uses in vitro experiments and validated finite element models (FEM) to analyze the effect of posterior fixation, alone or associated with expandable device (ED) and/or cement. 3-dimensional FEMs of intact, fractured and instrumented spine were built and compared with experimental load-displacement curves. FEM ranges of motion were within the experimental corridors. Stresses appeared sensitive to both implant configuration and fracture severity with a stress reduction up to 84%. The FEM highlighted that for a same instrumental strategy, different biomechanical performances were observed according to fracture severity. When bone continuity is altered, both ED and cement may be needed.
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Affiliation(s)
- Le Gallo Lucas
- Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - V P C Lima Lucas
- Institut de Biomecanique Humaine Georges Charpak, Paris, France.,Instituto Politécnico Rua Bonfim, Universidade Estadual do Rio de Janeiro, Nova Friburgo, RJ, Brazil
| | - Persohn Sylvain
- Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - Nérot Agathe
- Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - Rousseau Marc-Antoine
- Department of Orthopaedic Surgery, Hopital Bichat-Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Simon Laurie
- Department of Orthopaedic Surgery, Hopital Bichat-Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Skalli Wafa
- Institut de Biomecanique Humaine Georges Charpak, Paris, France
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Survival analysis and risk factors of new vertebral fracture after vertebroplasty for osteoporotic vertebral compression fracture. Spine J 2021; 21:1355-1361. [PMID: 33971326 DOI: 10.1016/j.spinee.2021.04.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/23/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT Although risk factors of new adjacent vertebral fracture (AVF) and remote vertebral fracture (RVF) after vertebroplasty may differ, research on this topic is lacking. PURPOSE To determine the natural course of new vertebral fractures after vertebroplasty for osteoporotic vertebral compression fracture (OVCF) and to analyze each risk factor for understanding the incidence of AVF and RVF. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE The study subjects included 205 patients who received vertebroplasty for OVCF and were followed-up for at least 1-year. OUTCOME MEASURES Data on factors that could affect the occurrence of vertebral fractures, such as age, body mass index, and bone density, were collected from the patients' medical records. Fracture pattern, fracture location, sagittal imbalance, degree of segmental kyphosis after vertebroplasty, cement distribution, and cement leakage were radiologically examined. METHODS xDuring the follow-up period, any newly developed vertebral fractures were identified. We analyzed whether the time of occurrence differed between AVF and RVF by performing a survival analysis and each risk factor separately. RESULTS New vertebral fractures occurred in 47 patients (22.9%) after vertebroplasty, AVF occurred in 21 patients (10.2%), and RVF occurred in 26 patients (12.7%). The onset time of AVF was 6.2±1.8 months after vertebroplasty, showing a significant difference from that of RVF, which was 15.2±1.8 months (p<.001). In the univariate analysis, the risk factors of AVF included severe osteoporosis (T-score<-3.0), vertebroplasty in the thoracolumbar junction, sagittal imbalance, and segmental kyphosis angle >15° (p=0.029, p=0.033, p=0.001, and p=0.021, respectively). The risk factors of RVF included severe osteoporosis (T-score <-3.0) and sagittal imbalance (p=0.013 and p=0.004). In the multivariate analysis, the risk factors of AVF included vertebroplasty in the thoracolumbar junction and sagittal imbalance (hazard ratio=3.34, p=0.032 and hazard ratio=4.05, p=0.008), and those of RVF included only sagittal imbalance (hazard ratio=2.66, p=0.024). CONCLUSON After vertebroplasty for OVCF, a significant difference in the meantime of occurrence was found; it took 6 months for AVF and 15 months for RVF to develop. Vertebroplasty in the thoracolumbar junction was identified as a risk factor for AVF, whereas sagittal imbalance was a risk factor of both AVF and RVF.
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Wittmer S, Küffer T, Gräni C, Reichlin T, Roten L. Catheter-Induced Cement Embolism During Attempted Ablation Procedure. JACC Case Rep 2021; 3:1114-1118. [PMID: 34471894 PMCID: PMC8314126 DOI: 10.1016/j.jaccas.2021.05.005] [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: 02/04/2021] [Revised: 04/21/2021] [Accepted: 05/06/2021] [Indexed: 11/27/2022]
Abstract
Pulmonary cement embolism is a well-described complication of cement vertebroplasty (1,2). We describe the case of a patient with acute cement embolism during catheter insertion for attempted pulmonary vein isolation 1 month after cement vertebroplasty. We discuss the mechanism of acute cement embolism, possible sequelae, and treatment considerations. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Severin Wittmer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Küffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Li D, Zhou Y, Cui H, Kong L, Zhu W, Chai X, Zhuo H. Analysis of the curative effect of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture with intravertebral clefts. Medicine (Baltimore) 2021; 100:e25996. [PMID: 34087844 PMCID: PMC8183815 DOI: 10.1097/md.0000000000025996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/25/2021] [Indexed: 01/04/2023] Open
Abstract
Kummell's disease is a delayed vertebral collapse fracture caused by posttraumatic osteonecrosis. It is a special type of osteoporotic vertebral fracture in the elderly. This study compares and analyzes the difference in the curative effect of 2 kinds of osteoporotic vertebral compression fracture (OVCF) in the presence of fracture or not in the vertebral body, and provides a clinical reference for the application of percutaneous kyphoplasty (PKP).This research is a kind of retrospective analysis from January 2012 to January 2015, PKP was used to treat 165 patients with osteoporotic vertebral compression fracture. The patients were divided into 2 groups: Intravertebral clefts group (group A) and none-intravertebral clefts group in vertebral body (group B). Bone mineral density (BMD), bone cement injection (BCI), Visual analogue scale (VAS) score before and after surgery, anterior, central and posterior height of vertebral body (before and after surgery) and Cobb angle of injured vertebra (before and after surgery) were compared between the 2 groups.Surgeries for 165 patients in the 2 groups were successfully completed, and 226 fractured vertebrae were performed through bilateral puncture approach to strengthen the vertebral body. Intraoperative injection of bone cement (ml) was 4.25 + 1.29 (range: 2.6-7.8). There were statistically significant differences in bone cement injection quantity between the 2 groups (P < .05), and in bone cement leakage (P > .05) as well as the Postoperative VAS score (P < .05). However, There was no statistical difference in VAS score before surgery between the 2 groups (P > .05). The results indicated that the pain relief degree of OVCF patients without intravertebral clefts is better than that in the vertebral body. No statistical difference was found in Cobb Angle before and after surgery (P > .05), as well as the correction rate of the injured vertebrae before and after surgery (P > .05). There was no statistical difference in the degree of recovery of the anterior, middle and posterior margins of the injured vertebrae after surgery (P > .05).PKP treatment led to better degree of pain relief in OVCF patients without intravertebral clefts, and less bone cement was injected into the surgery.
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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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Galivanche AR, Toombs C, Adrados M, David WB, Malpani R, Saifi C, Whang PG, Grauer JN, Varthi AG. Cement Augmentation of Vertebral Compression Fractures May Be Safely Considered in the Very Elderly. Neurospine 2021; 18:226-233. [PMID: 33819949 PMCID: PMC8021820 DOI: 10.14245/ns.2040620.310] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/11/2021] [Indexed: 12/31/2022] Open
Abstract
Objective The objective of the current study was to perform a retrospective review of a national database to assess the safety of cement augmentation for vertebral compression fractures in geriatric populations in varying age categories.
Methods The 2005–2016 National Surgical Quality Improvement Program databases were queried to identify patients undergoing kyphoplasty or vertebroplasty in the following age categories: 60–69, 70–79, 80–89, and 90+ years old. Demographic variables, comorbidity status, procedure type, provider specialty, inpatient/outpatient status, number of procedure levels, and periprocedure complications were compared between age categories using chi-square analysis. Multivariate logistic regressions controlling for patient and procedural variables were then performed to assess the relative periprocedure risks of adverse outcomes of patients in the different age categories relative to those who were 60–69 years old.
Results For the 60–69, 70–79, 80–89, and 90+ years old cohorts, 486, 822, 937, and 215 patients were identified, respectively. After controlling for patient and procedural variables, 30-day any adverse events, serious adverse events, reoperation, readmission, and mortality were not different for the respective age categories. Cases in the 80- to 89-year-old cohort were at increased risk of minor adverse events compared to cases in the 60- to 69-year-old cohort.
Conclusion As the population ages, cement augmentation is being considered as a treatment for vertebral compression fractures in increasingly older patients. These results suggest that even the very elderly may be appropriately considered for these procedures (level of evidence: 3).
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Affiliation(s)
- Anoop R Galivanche
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Courtney Toombs
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Murillo Adrados
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Wyatt B David
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Rohil Malpani
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Comron Saifi
- Penn Orthopaedics, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter G Whang
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Arya G Varthi
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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Advances in Vertebral Augmentation Systems for Osteoporotic Vertebral Compression Fractures. Pain Res Manag 2020; 2020:3947368. [PMID: 33376566 PMCID: PMC7738798 DOI: 10.1155/2020/3947368] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/15/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022]
Abstract
Osteoporotic vertebral compression fracture (OVCF) is a common cause of pain and disability and is steadily increasing due to the growth of the elderly population. To date, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are almost universally accepted as appropriate vertebral augmentation procedures for OVCFs. There are many advantages of vertebral augmentation, such as short surgical time, performance under local anaesthesia, and rapid pain relief. However, there are certain issues regarding the utilization of these vertebral augmentations, such as loss of vertebral height, cement leakage, and adjacent vertebral refracture. Hence, the treatment for OVCF has changed in recent years. Satisfactory clinical results have been obtained worldwide after application of the OsseoFix System, the SpineJack System, radiofrequency kyphoplasty of the vertebral body, and the Kiva VCF treatment system. The following review discusses the development of the current techniques used for vertebral augmentation.
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Anand A, Sharma R, Kohli R. The Effects of Operational and Financial Performance Failure on BI&A-Enabled Search Behaviors: A Theory of Performance-Driven Search. INFORMATION SYSTEMS RESEARCH 2020. [DOI: 10.1287/isre.2020.0936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract for Practice and Policy
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Affiliation(s)
- Abhijith Anand
- Department of Information Systems, Sam M. Walton College of Business, University of Arkansas, Fayetteville, Arkansas 72701
| | - Rajeev Sharma
- Waikato Management School, University of Waikato, Hillcrest, Hamilton 3240, New Zealand
| | - Rajiv Kohli
- Raymond A. Mason School of Business, William & Mary, Williamsburg, Virginia 23187
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Collinet A, Charles YP, Ntilikina Y, Tuzin N, Steib JP. Analysis of intervertebral discs adjacent to thoracolumbar A3 fractures treated by percutaneous instrumentation and kyphoplasty. Orthop Traumatol Surg Res 2020; 106:1221-1226. [PMID: 32888918 DOI: 10.1016/j.otsr.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 04/29/2020] [Accepted: 05/20/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Percutaneous instrumentation and kyphoplasty can be used to treat A3 fractures at T12-L1. However, the effect on adjacent intervertebral discs remains controversial. The purpose of this retrospective study was to analyze the degeneration of the discs adjacent to the fracture and to determine its relationship with age, vertebral body deformity and clinical scores. MATERIALS AND METHODS Twenty-nine patients (11 females, 18 males; average age 47 years, 27-63 years) were examined at 2.2 years' follow-up (2.0-2.5). Radiographic measurements were taken preoperatively, postoperatively, at follow-up: regional and local kyphosis, sagittal index, vertebral body compression ratio, and disc height index. The Pfirrmann grade was determined on an MRI taken at the final assessment. Clinical scores were the pain level (VAS), EQ-5D-3L, and ODI. The relationships between Pfirrmann grades, age and radiographic parameters were analyzed. RESULTS Local kyphosis decreased from 12.4° to 7.3° postoperatively (p<0.0001), increased to 8.4° after instrumentation removal (p=0.139) and remained stable at the last follow-up (p=0.891). The sagittal index decreased from 12.3° to 7.3° postoperatively (p<0.0001) increased to 8.3° before the instrumentation was removed (p=0.764) and increased to 10.6° (p<0.05) at the last follow-up. The vertebral body compression ratio decreased from 23% to 14% postoperatively (p<0.0001) and remained stable at 17% at the last follow-up (p=0.310). The cranial disc height index was 32% preoperatively, 31% postoperatively (p=0.073), 29% at 1year (p=0.650), and decreased again to 23% at 2 years (p<0.0001). There was a significant relationship between disc degeneration and age (p=0.015), local kyphosis (p=0.008) and vertebral body compression ratio (p=0.002). The disc adjacent to the fracture was more likely to have a higher Pfirrmann grade than the control disc above it (OR=269.5). At the final assessment, the average pain level was 2.3, the EQ-5D-3L was 0.862, and the ODI was 11.8%. There was no significant relationship between the Pfirrmann grades and the clinical scores. CONCLUSION The risk for cranial disc degeneration after percutaneous instrumentation and kyphoplasty of A3 fractures is low. The height of the cranial disc decreased after the instrumentation was removed. The risk for disc degeneration is related to age and vertebral body deformity. Disc degeneration does not appear to impact quality of life.
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Affiliation(s)
- Arnaud Collinet
- Spine surgery department, hôpitaux universitaires de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France.
| | - Yann Philippe Charles
- Spine surgery department, hôpitaux universitaires de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
| | - Yves Ntilikina
- Spine surgery department, hôpitaux universitaires de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
| | - Nicolas Tuzin
- Public health department, hôpitaux universitaires de Strasbourg Strasbourg, France
| | - Jean-Paul Steib
- Spine surgery department, hôpitaux universitaires de Strasbourg, hôpital Hautepierre 2, 1, avenue Molière, 67200 Strasbourg, France
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Unusual significant intrapsoas hematoma after three-level percutaneous balloon kyphoplasty for lumbar osteoporotic fractures: a case report. Should hemoglobin level be monitored even in percutaneous vertebral augmentation techniques? CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ho YS. Letter to the Editor Regarding "The Top 100 Most-Cited Articles on Kyphoplasty and Vertebroplasty". World Neurosurg 2020; 139:676-687. [PMID: 32689679 DOI: 10.1016/j.wneu.2020.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Yuh-Shan Ho
- Trend Research Centre, Asia University, Wufeng, Taichung, Taiwan.
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Zhou ZZ, Wang YM, Liang X, Ze X, Liu H, Chen KW, Zhu XY, Sun ZY, Qian ZL. Minimally Invasive Pedicle Screw Fixation Combined with Percutaneous Kyphoplasty Under O-Arm Navigation for the Treatment of Metastatic Spinal Tumors with Posterior Wall Destruction. Orthop Surg 2020; 12:1131-1139. [PMID: 32578396 PMCID: PMC7454212 DOI: 10.1111/os.12712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of O-arm-guided minimally invasive pedicle screw fixation combined with percutaneous kyphoplasty for metastatic spinal tumors with posterior wall destruction. METHODS Patients who underwent minimally invasive pedicle screw fixation combined with percutaneous kyphoplasty for pathological vertebral fractures with posterior wall defects from January 2015 to December 2017 were followed up for 1 year. Visual analogue scale (VAS), SF-36 scores, middle vertebral height, posterior vertebral height, and the accuracy of pedicle screws were assessed preoperatively, postoperatively, and 1 year after surgery. The operation time, time from operation to discharge, blood loss, volume of bone cement, and leakage of bone cement were recorded. RESULTS Twenty-three patients (13 females and 10 males) who met our criteria were followed up for 1 year. The operation time of these patients was 162.61 ± 33.47 min, the amount of bleeding was 230.87 ± 93.76 mL, the time from operation to discharge was 4.35 ± 2.42 days, and the volume of bone cement was 3.67 ± 0.63 mL. The VAS score decreased from 7.04 ± 1.07 to 2.65 ± 0.93 before surgery (P = 0.000) and remained at 2.57 ± 0.79 1 year after surgery. Compared with the preoperative SF-36 scores for physical pain, physiological function, energy, and social function, the postoperative scores were significantly improved (P = 0.000). The height of the middle vertebral body increased from 14.47 ± 2.96 mm before surgery to 20.18 ± 2.94 mm (P = 0.000), and remained at 20.44 to 3.01 mm 1 year after surgery. The height of the posterior vertebral body increased from 16.56 ± 3.07 mm before operation to 22.79 ± 4.00 mm (P = 0.000), and 22.45 ± 3.88 mm 1 year after surgery. The 23 patients had a total of 92 pedicle screws; 85 screws were Grade A and 7 screws were Grade B. There was no leakage of bone cement after surgery. CONCLUSION In the short term, O-arm-guided minimally invasive pedicle screw fixation combined with kyphoplasty is safe and effective in the treatment of metastatic spinal tumors with posterior wall destruction.
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Affiliation(s)
- Zhang-Zhe Zhou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi-Meng Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao Liang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao Ze
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hao Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Kang-Wu Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao-Yu Zhu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhi-Yong Sun
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhong-Lai Qian
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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Zhou Q, Wu C, Zha J, Ge J, Yan Q, Wang Y, Song D, Zou J. Calcium Phosphate Cement Causes Nucleus Pulposus Cell Degeneration through the ERK Signaling Pathway. Open Life Sci 2020; 15:209-216. [PMID: 33987477 PMCID: PMC8114789 DOI: 10.1515/biol-2020-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/10/2020] [Indexed: 11/15/2022] Open
Abstract
While calcium phosphate cement (CPC) is recognized as one of the most likely substitutes for the conventional Polymethylmethacrylate (PMMA), there are very few studies about its intradiscal leakage consequences. Herein, the goal of our study was to examine the effect of CPC particles on the ERK (extracellular regulatory kinase) pathway in human nucleus pulposus cell (HNPC) degeneration. Different concentrations of CPC particles (0.00‰, 0.01‰, 0.05‰, 0.1‰ v/v) were added to human nucleus pulposus cell cultures. After 10 days of treatment, HNPC biological behaviors and degeneration degree were analyzed by CCK-8 assay, crystal violet staining, flow cytometer and western blot. The effect of CPC on the ERK pathway was also analyzed by western blot. After activating the ERK path by overexpressing Ras, HNPCs’ biological behaviors and degeneration degree were analyzed again. We found that CPC particles had a negative effect on human nucleus pulposus cells (HNPCs), which are mainly reflected in cell growth and the cell cycle. After activation of the ERK signaling pathway, the negative effects of CPC on cell growth and the cell cycle were significantly reduced and the degeneration degree of HNPCs was reversed. CPC particles can probably block the activation of the ERK pathway, thus causing the HNPCs’ degeneration.
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Affiliation(s)
- Quan Zhou
- Department of Orthopaedic Surgery, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai’an, Jiangsu 223002, China
| | - Cenhao Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, China
| | - Jiali Zha
- Department of Orthopaedic Surgery, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai’an, Jiangsu 223002, China
| | - Jun Ge
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, China
| | - Qi Yan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, China
| | - Yingjie Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, China
| | - Dawei Song
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, China
| | - Jun Zou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, Jiangsu 215006, China
- E-mail:
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Beall DP, Chambers MR, Thomas S, Amburgy J, Webb JR, Goodman BS, Datta DK, Easton RW, Linville D, Talati S, Tillman JB. Prospective and Multicenter Evaluation of Outcomes for Quality of Life and Activities of Daily Living for Balloon Kyphoplasty in the Treatment of Vertebral Compression Fractures: The EVOLVE Trial. Neurosurgery 2020; 84:169-178. [PMID: 29547939 PMCID: PMC6354561 DOI: 10.1093/neuros/nyy017] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 02/06/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Osteoporotic and neoplastic vertebral compression fractures (VCF) are common and painful, threatening quality of life and increasing risk of morbidity and mortality. Balloon kyphoplasty is a percutaneous option for treating painful cancer- and osteoporosis-related VCFs, supported by 2 randomized trials demonstrating efficacy benefits of BKP over nonsurgical care. OBJECTIVE To investigate 12-mo disability, quality of life, and safety outcomes specifically in a Medicare-eligible population, representing characteristic patients seen in routine clinical practice. METHODS A total of 354 patients with painful VCFs were enrolled at 24 US sites with 350 undergoing kyphoplasty. Four coprimary endpoints—Numerical Rating Scale (NRS) back pain, Oswestry Disability Index (ODI), Short Form-36 Questionnaire Physical Component Summary (SF-36v2 PCS), EuroQol-5-Domain (EQ-5D)—were evaluated for statistically significant improvement 3 mo after kyphoplasty. Data were collected at baseline, 7 d, and 1, 3, 6, and 12 mo (www.clinicaltrials.gov registration NCT01871519). RESULTS At the 3-mo primary endpoint, NRS improved from 8.7 to 2.7 and ODI improved from 63.4 to 27.1; SF-36 PCS was 24.2 at baseline improving to 36.6, and EQ-5D improved from 0.383 to 0.746 (P < .001 for each). These outcomes were statistically significant at every follow-up time point. Five device-/procedure-related adverse events, intraoperative asymptomatic balloon rupture, rib pain, and aspiration pneumonia, and a new VCF 25 d postprocedure, and myocardial infarction 105 d postprocedure were reported and each resolved with proper treatment. CONCLUSION This large, prospective, clinical study demonstrates that kyphoplasty is a safe, effective, and durable procedure for treating patients with painful VCF due to osteoporosis or cancer.
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Affiliation(s)
- Douglas P Beall
- Department of Radiology, Clinical Radiology of Oklahoma, Edmond, Oklahoma.,Interventional Spine Services, The Spine Fracture Institute, Edmond, Oklahoma
| | - M R Chambers
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sam Thomas
- Allegheny College, Meadville, Pennsylvania
| | - John Amburgy
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - James R Webb
- Dr James Webb & Associates' Osteoporosis Institute, Tulsa, Oklahoma
| | - Bradly S Goodman
- Alabama Clinical Therapeutics, LLC, Birmingham, Alabama.,Alabama Ortho Spine and Sports, Birmingham, Alabama
| | | | | | - Douglas Linville
- Scoliosis & Spine Surgery Clinic of Memphis, PLLC, Memphis, Tennessee
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Hsieh MK, Kao FC, Chiu PY, Chen LH, Yu CW, Niu CC, Lai PL, Tsai TT. Risk factors of neurological deficit and pulmonary cement embolism after percutaneous vertebroplasty. J Orthop Surg Res 2019; 14:406. [PMID: 31783861 PMCID: PMC6884871 DOI: 10.1186/s13018-019-1459-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background The risk factors, incidence, and clinical management of pulmonary cement embolism and neurological deficit during percutaneous vertebroplasty (PVP) were evaluated. Methods Three thousand one hundred and seventy-five patients with symptomatic osteoporotic vertebral compression fractures (OVCFs) treated with PVP were retrospectively reviewed in a single institution. Clinical parameters such as age, gender, number of fractures, and time from fracture to vertebroplasty were recorded at the time of surgery. Image and surgical parameters including the amount of cement, the vertebral level, uni- or bipedicle surgical approach, and leakage pattern were recorded. Results Type-C leakage, including paraspinal (25%), intradiscal (26%), and posterior (0.7%) leakage, was more common than type-B (11.4%) and type-S leaks (4.9%). Cement leakage into the spinal canal (type-C posterior) occurred in 26 patients (0.7%), and four patients needed surgical decompression. Three in nine patients with leakage into thoracic spine needed decompressive surgery, but only one of 17 patients into lumbar spine needed surgery (p < 0.01). Age, gender, number of fractures, and time from fracture to vertebroplasty were not risk factors of pulmonary cement embolism or neurological deficit. The risk factor of pulmonary cement embolism was higher volume of PMMA injected (p < 0.001) and risk factor of neurological deficit was type-C posterior cement leakage into thoracic spine. The incidence of pulmonary cement embolism was significantly high in the volume of PMMA injected (PMMA injection < 3.5 cc: 0%; 3.5–7.0 cc: 0.11%; > 7.0 cc: 0.9%; p < 0.01) which needed postoperative oxygen support. Conclusions Cement leakage is relatively common but mostly of no clinical significance. Percutaneous vertebroplasty in thoracic spine and high amount of PMMA injected should be treated with caution in clinical practice.
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Affiliation(s)
- Ming-Kai Hsieh
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Fu-Cheng Kao
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ping-Yeh Chiu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lih-Huei Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Wei Yu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chien Niu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Liang Lai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Alpantaki K, Koutserimpas C, Kofteridis DP, Papastefanou S, Samonis G. Late-onset spondylodiscitis and psoas abscess, 5 years after percutaneous balloon kyphoplasty: a case report. Br J Neurosurg 2019:1-4. [PMID: 31650866 DOI: 10.1080/02688697.2019.1672856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Postoperative infection following percutaneous balloon kyphoplasty (PBK) is a rare complication and delayed onset infection is very rare. We report the case of a 62-year-old male, who developed spondylodiscitis and psoas abscess 5 years after two-level, L2 and L3 PBK. He was initially treated with abscess aspiration and long term antimicrobial treatment. Eventually, due to failure of conservative treatment he underwent anterior decompression, radical debridement of the infected tissue and non-instrumented fusion with strut graft, with excellent results.
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Affiliation(s)
- Kalliopi Alpantaki
- Department of Orthopaedics and Traumatology, Venizeleio General Hospital Heraklion , Crete , Greece
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens , Athens , Greece
| | | | | | - George Samonis
- Department of Infectious diseases, University of Crete , Heraklion , Greece
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Zhou Z, Wang Y, Sun Z, Qian Z. Safety of Cement Distribution Patterns in Metastatic Vertebral Tumors: A Retrospective Study. Med Sci Monit 2019; 25:7228-7234. [PMID: 31556404 PMCID: PMC6777383 DOI: 10.12659/msm.918212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Kyphoplasty (KP) is a palliative treatment for patients with metastatic vertebral tumors. The distribution pattern of cement affects safety and efficacy. The distribution pattern of cement has not been previously reported for patients with metastatic vertebral tumors. Material/Methods From January 2013 to December 2017, patients with metastatic vertebral tumors who met our criteria were divided into cement fusion (n=91) and separation (n=97) groups. Visual analogue scale (VAS) and middle vertebral height (MVH) were evaluated preoperatively, postoperatively, and 1 year after surgery. Spinal Instability Neoplastic Score, fluoroscopy time, operation time, cement volume, cement leakage, and vertebral fractures were recorded and evaluated. Results Compared with the fusion group, the separation group had significantly different (P<0.001) operation time, fluoroscopy time, and cement volume. Compared with preoperative status, VAS and MVH were significantly improved 3 days postoperatively and 1 year postoperatively in both groups (P<0.001). The difference in cement leakage between the 2 groups (P<0.05) and in the number of adjacent vertebral fractures between the 2 groups (P<0.05) were significant. Conclusions The distribution patterns of the bone cement had a good analgesic effect and preventive effect on vertebral collapse. However, the separation of bone cement may be safer.
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Affiliation(s)
- Zhangzhe Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Yimeng Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Zhiyong Sun
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Zhonglai Qian
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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Piao M, Darwono AB, Zhu K, Zhao K. Extrapendicular Approach of Unilateral Percutaneous Vesselplasty for the Treatment of Kummell Disease. Int J Spine Surg 2019; 13:199-204. [PMID: 31131221 DOI: 10.14444/6027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Our purpose was to evaluate the efficacy of the extrapendicular approach for unilateral percutaneous vesselplasty in dealing with Kummell disease patients. Methods Twenty-seven patients undergoing vesselplasty at our institution were enrolled in the study. Vesselplasty was performed using percutaneous extrapendicular technique. Pain, restoration of vertebral body height, and cement leakage were evaluated in the process. Results Substantial pain relief was attained in all the patients. The visual analogue scale improved significantly from pre- to postoperation (P < .05), and remained unchanged at every follow-up. The anterior vertebral body heights were significantly corrected after operation (P < .05). No cement leakage was found. Conclusion This new technique of vesselplasty offers statistically significant benefits in Kummell disease patients. It also makes vesselplasty feasible, safe, and effective.
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Affiliation(s)
- Minsheng Piao
- Department of Orthopedics, Jiaxing Banger Orthopaedic Hospital, Jiaxing, China
| | | | - Kelin Zhu
- Department of Orthopedics, Jiaxing Banger Orthopaedic Hospital, Jiaxing, China
| | - Kai Zhao
- Department of Orthopedics, Jiaxing Banger Orthopaedic Hospital, Jiaxing, China
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Liu H, Zhang J, Liang X, Qian Z, Zhou Z, Lu H, Bou EH, Meng B, Mao H, Yang H, Liu T. Distribution Pattern Making Sense: Patients Achieve Rapider Pain Relief with Confluent Rather Than Separated Bilateral Cement in Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures. World Neurosurg 2019; 126:e1190-e1196. [PMID: 30880212 DOI: 10.1016/j.wneu.2019.03.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND It has been reported the distribution of bone cement in percutaneous kyphoplasty (PKP) has an impact on the curative effect. No studies have compared between confluent and separated cement pattern of bilateral bone cement in PKP for patients with osteoporotic vertebral compression fractures. METHODS Between 2010 and 2016, 1341 patients were enrolled and divided into 2 groups. Group A (n = 723), bilateral cement was confluent; Group B (n = 618), bilateral cement was separated. The visual analogue scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), and local kyphotic angle (LKA) were obtained preoperatively, 2 days after surgery, and at the final follow-up to assess the functional and radiographic efficacy of the surgery. RESULTS The VAS, ODI, AVH, and LKA 2 days after operation and at the final follow-up were significantly improved compared with the preoperative for both groups (P < 0.05). There existed no significant difference between groups at various time point in ODI, AVH, and LKA (P > 0.05). Group A showed better VAS than group B 2 days after surgery (1.91 ± 0.98 vs. 2.35 ± 0.78, P < 0.001), also with better pre-postoperative VAS change (6.23 ± 0.76 vs. 5.75 ± 1.02, P < 0.001). Multiple linear regression for pain relief degree revealed group A (P < 0.001), older age (P < 0.001), and more cement volume (P < 0.001) contribute to rapid improvement of back pain. The cement leakage rate was 3.7% in group A and 2.9% in group B, with no significant difference (P = 0.405). CONCLUSIONS Patients achieved rapider pain relief with confluent rather than separated bilateral bone cement pattern in PKP for osteoporotic vertebral compression fracture.
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Affiliation(s)
- Hao Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Junxin Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiao Liang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhonglai Qian
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhangzhe Zhou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hui Lu
- Department of Orthopaedic Surgery, Integrated Traditional Chinese and Western Medicine Hospital, Suzhou, Jiangsu, China
| | - Emily Hong Bou
- Biochemistry Department, University of Waterloo, Waterloo, Canada
| | - Bin Meng
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Haiqing Mao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Tao Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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Liu L, Cheng S, Wang Q, Liang Q, Liang Y, Jin W, Zhou Q, Wang Z. An anatomical study on lumbar arteries related to the extrapedicular approach applied during lumbar PVP (PKP). PLoS One 2019; 14:e0213164. [PMID: 30835754 PMCID: PMC6400376 DOI: 10.1371/journal.pone.0213164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 02/12/2019] [Indexed: 11/25/2022] Open
Abstract
To observe the regional anatomy of the lumbar artery (LA) associated with the extrapedicular approach applied during percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP), we collected 78 samples of abdominal computed tomography angiography imaging data. We measured the nearest distance from the center of the vertebral body puncture point to the LA (distance VBPP-LA, DVBPP-LA). According to the DVBPP-LA, four zones, Zone I, Zone II, Zone III and Zone IV, were identified. LAs that passed through these zones were called Type I, Type II, Type III and Type IV LAs, respectively. A portion of the lumbar vertebrae had an intersegmental branch that originated from the upper segmental LA and extended longitudinally across the lateral wall of the pedicle; it was called Type V LA. Compared with the DVBPP-LA in L1, L2, L3 and L4, the overall difference and between-group differences were significant (P < 0.05). In L1, L2, L3, L4 and L5, there were 8, 4, 4, 0 and 1 Type I LAs, respectively. There were no Type V LAs in L1 and L2, but there were 2, 16 and 26 Type V LAs in L3, L4 and L5, respectively. In L1-L5, the numbers of Type I LA plus Type V LA were 8, 4, 6, 16 and 27, and the presence ratios were 5.1%, 2.6%, 5.6%, 10.3% and 17.3%, respectively. In L4 and L5, the male presence ratios of Type I LA plus Type V LA were 7.1% and 10.7%, respectively, and the female presence ratios were 13.9% and 25.0%, respectively. Thus, extrapedicular PVP (PKP) in lumbar vertebrae had a risk of LA injury and was not suggested for use in L4 and L5, especially in female patients.
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Affiliation(s)
- Liehua Liu
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
- Department of Spine Surgery, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Shiming Cheng
- Department of Orthopedics, Chongqing Dongnan Hospital, Chongqing, China
| | - Qian Wang
- Hillsborough Community College, Tampa, Florida, United States of America
| | - Qiang Liang
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Yong Liang
- Department of Radiology, Southwest Hospital, The Army (Third Military) Medical University, Chongqing, China
| | - Weidong Jin
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
- * E-mail: (ZW); (QZ); (WJ)
| | - Qiang Zhou
- Department of Spine Surgery, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
- * E-mail: (ZW); (QZ); (WJ)
| | - Zili Wang
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China
- * E-mail: (ZW); (QZ); (WJ)
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