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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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Meng X, Zhou C, Liao Y, Zhou H, Li H, Liu J, Tang X, Wang Y. Biomechanical Effects of Different Spacing Distributions Between the Cemented Superior Boundary and Surgical Vertebral Superior Endplates After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Three-Dimensional Finite Element Analysis. Orthop Surg 2025; 17:373-392. [PMID: 39529235 PMCID: PMC11787978 DOI: 10.1111/os.14292] [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: 05/09/2024] [Revised: 10/19/2024] [Accepted: 10/24/2024] [Indexed: 11/16/2024] Open
Abstract
OBJECTIVE Patients with osteoporotic vertebral compression fractures (OVCF) treated with vertebroplasty (PVP) are experiencing an increasing number of problems such as pain recurrence, mainly due to recompression fractures of the operated vertebral body within a certain period of time after the operation, which is closely related to the distribution of intraoperative bone cement. The aim of this study is to investigate the effect of different spacing distributions between the upper boundary of the cement and the upper endplate of the operated vertebra on the biomechanics of the operated vertebra after percutaneous vertebroplasty for OVCF using finite element analysis (FEA). METHODS One patient with L1 vertebral body OVCF was selected, and computed tomography (CT) of the thoracolumbar segment was performed. The CT data were extracted to establish an FEA model of the T12-L2 vertebral bodies. Bone cement was injected into the L1 vertebral body. Based on the spacing between the upper boundary of the bone cement and the vertebral body's upper endplates, the model vertebrae were divided into 0, 2, 4, and 6 mm spacing groups, and the human body's upright, flexion-extension, lateral flexion, and rotational positions were simulated. The biomechanical effects of different spacing distributions on the postoperative L1 vertebral body and the injected bone cement were evaluated. RESULTS In this paper, we found that the Von Mises stress of the L1 vertebrae was the smallest when the spacing between the upper boundary of the bone cement and the vertebral body's upper endplates was 0 mm. The larger the spacing in a certain range between the upper boundary of the bone cement and the vertebral body's upper endplates, the greater the Von Mises stress of the L1 vertebrae. However, in the stress comparison of the injected bone cement, the Von Mises stress of the bone cement was greatest when the spacing between the upper boundary of the bone cement and the upper endplate of the vertebral body was 0 mm; the larger the spacing, the smaller the Von Mises stress. CONCLUSION When the contact spacing between the upper boundary of the bone cement and the upper endplate of the vertebral body is 0 mm, it can effectively eliminate and transfer the pressure caused by the load, thus reducing the stress on the cancellous bone and further reducing the risk of vertebral refracture after surgery.
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Affiliation(s)
- Xiao Meng
- Department of OrthopedicsThe Second Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Graduate School of Xuzhou Medical UniversityXuzhouChina
| | - Chengqiang Zhou
- Department of OrthopedicsThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Yifeng Liao
- Department of OrthopedicsThe Second Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Graduate School of Xuzhou Medical UniversityXuzhouChina
| | - Haibin Zhou
- Department of OrthopedicsThe Second Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Graduate School of Xuzhou Medical UniversityXuzhouChina
| | - Hua Li
- Department of OrthopedicsThe Second Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Jiayuan Liu
- Department of OrthopedicsThe Second Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Xuebin Tang
- Department of OrthopedicsThe Second Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Yunqing Wang
- Department of OrthopedicsThe Second Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
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Chen T, Lin C, Wang Y, Yang H, Li X, Chu G, Jiang W, Liu Y. Bone Cement Reperfusion Revision Surgery for Symptomatic Recurrence of Kümmell's Disease After Percutaneous Kyphoplasty. Global Spine J 2024; 14:2279-2287. [PMID: 37194502 PMCID: PMC11529085 DOI: 10.1177/21925682231174189] [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] [Indexed: 05/18/2023] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES To demonstrate that repeat Percutaneous vertebroplasty (PVP) performed for the same cemented vertebrae in Kümmell's disease can offer therapeutic benefit for patients with recurrent symptoms after initial percutaneous kyphoplasty (PKP) treatment. METHODS From January 2019 to December 2021, we investigated 2932 patients with PKP. Among them, 191 patients were diagnosed Kümmell's disease. 33 patients upon presentation of recurrent symptoms underwent repeat PVP procedure. Radiologic outcomes and clinic indices were investigated. RESULTS Bone cement reperfusion surgery was successfully completed in 33 patients. The average age was 73.5 ± 8.2 years old. The kyphosis angle showed significant correction from pre-operation to the final follow-up, descending from pre-operation (20.6 ± 11.1°) to final follow-up (15.4 ± 7.9°). The vertebral heights at different follow-up appointments were significantly higher than the pre-operative appointments. The VAS and ODI scores at final follow-up were respectively 1.2 ± .8 and 27.3 ± 5.4%, which were both significantly lower than those before operation. No complications such as cement leakage into the spinal canal or cement displacement occurred during follow-up. CONCLUSIONS Bone cement reperfusion surgery can ameliorate kyphosis and restore vertebral height to some extent. Repeat PVP is a minimally invasive surgery that provides superior long-term results in clinical and radiological outcomes but is technically more difficult to perform.
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Affiliation(s)
- Tangyiheng Chen
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cheng Lin
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yujie Wang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huilin Yang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuefeng Li
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Genglei Chu
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weimin Jiang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Orthopaedic Surgery, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, China
| | - Yijie Liu
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
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Tang ZQ, He SB, Yu DY, Luo HM, Xing XH, Zhou YW. Factors influencing further vertebral height loss following percutaneous vertebroplasty in osteoporotic vertebral compression fractures: A 1-year follow-up study. World J Clin Cases 2024; 12:4609-4617. [PMID: 39070819 PMCID: PMC11235515 DOI: 10.12998/wjcc.v12.i21.4609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/13/2024] [Accepted: 06/05/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Osteoporotic vertebral compression fractures (OVCFs) contribute to back pain and functional limitations in older individuals, with percutaneous vertebroplasty (PVP) emerging as a minimally invasive treatment. However, further height loss post-PVP prompts investigation into contributing factors. AIM To investigate the factors associated with further height loss following PVP with cement augmentation in OVCF patients. METHODS A total of 200 OVCF patients who underwent successful PVP between January 2021 and December 2022 were included in this study. "Further height loss" during 1 year of follow-up in OVCF patients with bone edema was defined as a vertical height loss of ≥ 4 mm. The study population was divided into two groups for analysis: The "No Further Height Loss group (n = 179)" and the "Further Height Loss group (n = 21)." RESULTS In comparing two distinct groups of patients, significant differences existed in bone mineral density (BMD), vertebral compression degree, prevalence of intravertebral cleft (IVF), type of bone cement used, and cement distribution patterns. Results from binary univariate regression analysis revealed that lower BMD, the presence of IVF, cleft distribution of bone cement, and higher vertebral compression degree were all significantly associated with further height loss. Notably, the use of mineralized collagen modified-poly(methyl methacrylate) bone cement was associated with a significant reduction in the risk of further height loss. In multivariate regression analysis, lower BMD and the presence of IVF remained significantly associated with further height loss. CONCLUSION Further height loss following PVP in OVCF patients is influenced by a complex interplay of factors, especially lower BMD and the presence of IVF. These findings underscore the importance of assessing and managing these factors when addressing height loss following PVP in OVCF patients.
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Affiliation(s)
- Zhong-Qiu Tang
- Department of Spinal Surgery, Affiliated Hospital of Panzhihua University, Panzhihua 617000, Sichuan Province, China
| | - Shao-Bo He
- Department of Spinal Surgery, Affiliated Hospital of Panzhihua University, Panzhihua 617000, Sichuan Province, China
| | - Dong-Yang Yu
- Department of Spinal Surgery, Affiliated Hospital of Panzhihua University, Panzhihua 617000, Sichuan Province, China
| | - Hai-Mao Luo
- Department of Spinal Surgery, Affiliated Hospital of Panzhihua University, Panzhihua 617000, Sichuan Province, China
| | - Xue-Hong Xing
- Department of Spinal Surgery, Affiliated Hospital of Panzhihua University, Panzhihua 617000, Sichuan Province, China
| | - Yong-Wen Zhou
- Department of Shoulder and Elbow Surgery, Affiliated Hospital of Panzhihua University, Panzhihua 617000, Sichuan Province, China
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Shi D, Li X, Huang F, Wei G, Lin Z. Unilateral percutaneous vertebroplasty in osteoporotic vertebral compression fractures: A clinical efficacy evaluation. Exp Ther Med 2024; 27:151. [PMID: 38476906 PMCID: PMC10928977 DOI: 10.3892/etm.2024.12439] [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: 10/26/2023] [Accepted: 02/05/2024] [Indexed: 03/14/2024] Open
Abstract
Osteoporotic vertebral compression fractures, often resulting from low-energy trauma, markedly impair the quality of life of elderly individuals. The present retrospective study focused on the clinical efficacy of unilateral percutaneous vertebroplasty (PVP) in the treatment of osteoporotic compression fractures. A total of 68 patients, representing 92 vertebral bodies, who underwent the unilateral PVP technique from March 2020 to January 2023 were evaluated. Key parameters such as visual analogue scale (VAS) values, Oswestry disability index (ODI) scores, Cobb angle measurements, and anterior vertebral height (AVH) were documented pre- and post-surgery. The mean follow-up period was 15.41±3.74 months. The mean pre-operative VAS score was 8.08±0.79, which was significantly reduced to 2.25±0.71 by 24 h post-surgery and stabilized at 1.58±0.51 by the final follow-up. The ODI showed a significant improvement from a pre-operative average of 67.75±7.91 to 19.74±2.90 post-surgery, and was maintained at a low level of 28.00±4.89 at the last assessment. Radiological evaluations revealed significant alterations in Cobb angle and AVH post-operation. Notably, during the follow-up, eight patients developed new compression fractures in different vertebral segments. In conclusion, the unilateral PVP method is safe and efficient for the management of osteoporotic vertebral compression fractures.
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Affiliation(s)
- Dongdong Shi
- Department of Spine Surgery, People's Liberation Army Hospital No. 923, Nanning, Guangxi 530021, P.R. China
| | - Xiaoling Li
- Department of Spine Surgery, People's Liberation Army Hospital No. 923, Nanning, Guangxi 530021, P.R. China
| | - Fang Huang
- Department of Spine Surgery, People's Liberation Army Hospital No. 923, Nanning, Guangxi 530021, P.R. China
| | - Gejin Wei
- Department of Spine Surgery, People's Liberation Army Hospital No. 923, Nanning, Guangxi 530021, P.R. China
| | - Zhoudan Lin
- Department of Spine Surgery, People's Liberation Army Hospital No. 923, Nanning, Guangxi 530021, P.R. China
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Zhou C, Meng X, Huang S, Chen H, Zhou H, Liao Y, Tang Z, Zhang X, Li H, Sun W, Wang Y. Biomechanical study of different bone cement distribution on osteoporotic vertebral compression Fracture-A finite element analysis. Heliyon 2024; 10:e26726. [PMID: 38434291 PMCID: PMC10907677 DOI: 10.1016/j.heliyon.2024.e26726] [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: 10/10/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose This study aimed to compare the biomechanical effects of different bone cement distribution methods on osteoporotic vertebral compression fractures (OVCF). Patients and methods Raw CT data from a healthy male volunteer was used to create a finite element model of the T12-L2 vertebra using finite element software. A compression fracture was simulated in the L1 vertebra, and two forms of bone cement dispersion (integration group, IG, and separation group, SG) were also simulated. Six types of loading (flexion, extension, left/right bending, and left/right rotation) were applied to the models, and the stress distribution in the vertebra and intervertebral discs was observed. Additionally, the maximum displacement of the L1 vertebra was evaluated. Results Bone cement injection significantly reduced stress following L1 vertebral fractures. In the L1 vertebral body, the maximum stress of SG was lower than that of IG during flexion, left/right bending, and left/right rotation. In the T12 vertebral body, compared with IG, the maximum stress of SG decreased during flexion and right rotation. In the L2 vertebral body, the maximum stress of SG was the lowest under all loading conditions. In the T12-L1 intervertebral disc, compared with IG, the maximum stress of SG decreased during flexion, extension, and left/right bending and was basically the same during left/right rotation. However, in the L1-L2 intervertebral discs, the maximum stress of SG increased during left/right rotation compared with that of IG. Furthermore, the maximum displacement of SG was smaller than that of IG in the L1 vertebral bodies under all loading conditions. Conclusions SG can reduce the maximum stress in the vertebra and intervertebral discs, offering better biomechanical performance and improved stability than IG.
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Affiliation(s)
- Chengqiang Zhou
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiao Meng
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shaolong Huang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Han Chen
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Haibin Zhou
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yifeng Liao
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhongjian Tang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xu Zhang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hua Li
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wei Sun
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yunqing Wang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Zhou Q, Wan Y, Ma L, Dong L, Yuan W. Percutaneous Curved Vertebroplasty Decrease the Risk of Cemented Vertebra Refracture Compared with Bilateral Percutaneous Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures. Clin Interv Aging 2024; 19:289-301. [PMID: 38434576 PMCID: PMC10907131 DOI: 10.2147/cia.s438036] [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] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/21/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose The purpose of this study is to compare the refracture rate of the cemented vertebral body of percutaneous curved vertebroplasty (PCVP) and bilateral percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods Ninety-four patients with single segment thoracolumbar OVCF were randomly divided into two groups (47 patients in each) and underwent PCVP or bilateral PKP surgery, respectively. Refracture of cemented vertebral body, bone cement injection volume and cement pattern, cement leakage rate, total surgical time, intraoperative fluoroscopy time, preoperative and postoperative Cobb angles and anterior vertebral height, Oswestry disability index questionnaire (ODI) and visual analog scales (VAS) were recorded. Results The PCVP group had significantly lower refracture incidence of the cemented vertebral than the bilateral PKP group (p<0.05). There was a significant postoperative improvement in the VAS score and ODI in both group (p<0.01), and no significant difference was found between two groups. The operation time and intraoperative fluoroscopy times were significantly less in the PCVP group than in the bilateral PKP group (p<0.01). The mean kyphosis angle correction and vertebral height restoration in the PCVP group was significantly less than that in the bilateral PKP group (p<0.01). Conclusion Both PCVP and PKP were safe and effective treatments for OVCF. The PCVP had lower refracture rate of the cemented vertebral than the bilateral PKP group, and PCVP entailed less exposure to fluoroscopy and shorter operation time than bilateral PKP.
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Affiliation(s)
- Qiang Zhou
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, People’s Republic of China
| | - Yanlin Wan
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, People’s Republic of China
| | - Le Ma
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, People’s Republic of China
| | - Liang Dong
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, People’s Republic of China
| | - Weijian Yuan
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, People’s Republic of China
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Huang S, Zhou C, Zhang X, Tang Z, Liu L, Meng X, Xue C, Tang X. Biomechanical analysis of sandwich vertebrae in osteoporotic patients: finite element analysis. Front Endocrinol (Lausanne) 2023; 14:1259095. [PMID: 37900139 PMCID: PMC10600377 DOI: 10.3389/fendo.2023.1259095] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Objective The aim of this study was to investigate the biomechanical stress of sandwich vertebrae (SVs) and common adjacent vertebrae in different degrees of spinal mobility in daily life. Materials and methods A finite element model of the spinal segment of T10-L2 was developed and validated. Simultaneously, T11 and L1 fractures were simulated, and a 6-ml bone cement was constructed in their center. Under the condition of applying a 500-N axial load to the upper surface of T10 and immobilizing the lower surface of L2, moments were applied to the upper surface of T10, T11, T12, L1, and L2 and divided into five groups: M-T10, M-T11, M-T12, M-L1, and M-L2. The maximum von Mises stress of T10, T12, and L2 in different groups was calculated and analyzed. Results The maximum von Mises stress of T10 in the M-T10 group was 30.68 MPa, 36.13 MPa, 34.27 MPa, 33.43 MPa, 26.86 MPa, and 27.70 MPa greater than the maximum stress value of T10 in the other groups in six directions of load flexion, extension, left and right lateral bending, and left and right rotation, respectively. The T12 stress value in the M-T12 group was 29.62 MPa, 32.63 MPa, 30.03 MPa, 31.25 MPa, 26.38 MPa, and 26.25 MPa greater than the T12 stress value in the other groups in six directions. The maximum stress of L2 in M-T12 in the M-L2 group was 25.48 MPa, 36.38 MPa, 31.99 MPa, 31.07 MPa, 30.36 MPa, and 32.07 MPa, which was greater than the stress value of L2 in the other groups. When the load is on which vertebral body, it is subjected to the greatest stress. Conclusion We found that SVs did not always experience the highest stress. The most stressed vertebrae vary with the degree of curvature of the spine. Patients should be encouraged to avoid the same spinal curvature posture for a long time in life and work or to wear a spinal brace for protection after surgery, which can avoid long-term overload on a specific spine and disrupt its blood supply, resulting in more severe loss of spinal quality and increasing the possibility of fractures.
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Affiliation(s)
- Shaolong Huang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chengqiang Zhou
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xu Zhang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhongjian Tang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Liangyu Liu
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Xiao Meng
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Cheng Xue
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xianye Tang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Xue Y, Zhang J, Zhang Z, Dai W, Ma C. Clinical outcomes with second injection after insufficient bone cement distribution in unilateral kyphoplasty for osteoporotic vertebral compressive fracture: a cohort retrospective study. J Orthop Surg Res 2023; 18:530. [PMID: 37491307 PMCID: PMC10369772 DOI: 10.1186/s13018-023-03968-2] [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: 05/23/2023] [Accepted: 06/30/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Bone cement distribution is an important factor affecting pain relief and long-term prognosis of osteoporotic vertebral compression fracture (OVCF) treated with vertebral augmentation. Unilateral percutaneous kyphoplasty (PKP) is the most common procedure, and insufficient bone cement distribution is more common than bilateral PKP. However, effective remedies are remain lack. In this study, sufficient cement distribution was achieved by adjusting the working channel followed by second cement injection as a remedy in cases with insufficient cement distribution, and the purpose was to evaluate the clinical outcomes by a retrospective cohort study. METHODS From July 1, 2017 to July 31, 2020, OVCF patients treated with unilateral PKP were included in this retrospective cohort study. According to the bone cement distribution (insufficient cement distribution was confirmed when the cement did not exceed the mid line of the vertebral body in frontal film or/and the cement did not contact the upper/lower vertebral endplates in the lateral film.) and whether second injection was performed during surgery, the patients were divided into three groups. Insufficient group: patients with insufficient cement distribution confirmed by fluoroscopy or postoperative x-ray. Second injection group: patients with insufficient cement distribution was found during the procedure, and second injection was performed to improve the cement distribution. CONTROL GROUP patients with sufficient cement distribution in one injection. The Primary outcome was cemented vertebrae re-collapse rate. The secondary outcomes included operative time, radiation exposure, cement leakage rate, VAS, ODI, and adjacent vertebral fracture rate. RESULTS There are 34 cases in insufficient group, 45 cases in second injection group, and 241 cases in control group. There was no significant difference in baseline data and follow-up time among the three groups. PRIMARY OUTCOME The injured vertebrae re-collapse rate of insufficient group was significantly higher than that of second injection group (42.22% vs 20.59%, P = 0.000) and control group (42.22% vs. 18.26%, P = 0.000). Kaplan-Meier survival analysis showed that there was no significant difference in the survival time between second injection group and control group (P = 0.741, Log-rank test), both of which were significant less than that in insufficient group (P = 0.032 and 0.000, respectively). SECONDARY OUTCOMES There was no significant difference in VAS score and ODI after operation between second injection group and control group, both of which were superior to those in insufficient group (P = 0.000). At the final follow-up, there was no significant difference in VAS and ODI among the three groups (P > 0.05). The operation time of second injection group was significantly higher than that of insufficient group (53.41 ± 8.85 vs 44.18 ± 7.41, P = 0.000) and control group (53.41 ± 8.85 vs 44.28 ± 7.22, P = 0.000). The radiation exposure of the second injection group was significantly higher than that of insufficient group (40.09 ± 8.39 vs 30.38 ± 6.87, P = 0.000) and control group (40.09 ± 8.39 vs 31.31 ± 6.49, P = 0.000). The cement leakage rate of second injection group (20.59%) was comparable with that of insufficient group (24.44%) and control group (21.26%) (P = 0.877). The length of hospital stay of the second injection group (4.38 ± 1.72) was comparable with that of insufficient group (4.18 ± 1.60) and control group (4.52 ± 1.46) (P = 0.431). CONCLUSIONS When cement distribution is insufficient during unilateral PKP, second injection may relieve early pain, reduce the incidence of cemented vertebral re-collapse and adjacent vertebral fracture, without increasing the cement leakage rate, although this procedure may increase the operation time and radiation exposure.
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Affiliation(s)
- Youdi Xue
- Department of Orthopedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, Jiangsu Province, People's Republic of China
| | - Jianwei Zhang
- Department of Orthopedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, Jiangsu Province, People's Republic of China
| | - Zhaochuan Zhang
- Department of Orthopedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, Jiangsu Province, People's Republic of China
| | - Weixiang Dai
- Department of Orthopedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, Jiangsu Province, People's Republic of China
| | - Chao Ma
- Department of Orthopedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, Jiangsu Province, People's Republic of China.
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10
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Khan MA, Jennings JW, Baker JC, Smolock AR, Shah LM, Pinchot JW, Wessell DE, Kim CY, Lenchik L, Parsons MS, Huhnke G, Shek-Man Lo S, Lu Y, Potter C, Reitman C, Sahgal A, Sharma A, Yalla NM, Beaman FD, Kapoor BS, Burns J. ACR Appropriateness Criteria® Management of Vertebral Compression Fractures: 2022 Update. J Am Coll Radiol 2023; 20:S102-S124. [PMID: 37236738 DOI: 10.1016/j.jacr.2023.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Vertebral compression fractures (VCFs) can have a variety of etiologies, including trauma, osteoporosis, or neoplastic infiltration. Osteoporosis related fractures are the most common cause of VCFs and have a high prevalence among all postmenopausal women with increasing incidence in similarly aged men. Trauma is the most common etiology in those >50 years of age. However, many cancers, such as breast, prostate, thyroid, and lung, have a propensity to metastasize to bone, which can lead to malignant VCFs. Indeed, the spine is third most common site of metastases after lung and liver. In addition, primary tumors of bone and lymphoproliferative diseases such as lymphoma and multiple myeloma can be the cause of malignant VCFs. Although patient clinical history could help raising suspicion for a particular disorder, the characterization of VCFs is usually referred to diagnostic imaging. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Majid A Khan
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
| | - Jack W Jennings
- Research Author, Washington University, Saint Louis, Missouri
| | - Jonathan C Baker
- Mallinckrodt Institute of Radiology Washington University School of Medicine, St. Louis, Missouri
| | - Amanda R Smolock
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lubdha M Shah
- Panel Chair, University of Utah, Salt Lake City, Utah
| | | | | | - Charles Y Kim
- Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina
| | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Matthew S Parsons
- Panel Vice-Chair, Mallinckrodt Institute of Radiology, St. Louis, Missouri
| | - Gina Huhnke
- Deaconess Hospital, Evansville, Indiana American College of Emergency Physicians
| | - Simon Shek-Man Lo
- University of Washington School of Medicine, Seattle, Washington Commission on Radiation Oncology
| | - Yi Lu
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts American Association of Neurological Surgeons/Congress of Neurological Surgeons
| | - Christopher Potter
- Brigham & Women's Hospital, Boston, Massachusetts Committee on Emergency Radiology-GSER
| | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina North American Spine Society
| | - Arjun Sahgal
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Commission on Radiation Oncology
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida Commission on Nuclear Medicine and Molecular Imaging
| | - Naga M Yalla
- Mallinckrodt Institute of Radiology, Saint Louis, Missouri, Primary care physician
| | | | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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11
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Di Caterino F, Koetsier E, Hirsch JA, Isalberti M, San Millan D, Marchi F, La Barbera L, Pileggi M, Cianfoni A. Middle column Stent-screw Assisted Internal Fixation (SAIF): a modified minimally-invasive approach to rescue vertebral middle column re-fractures. J Neurointerv Surg 2023; 15:jnis-2022-019752. [PMID: 36593116 DOI: 10.1136/jnis-2022-019752] [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: 10/13/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is limited literature regarding the re-fracture of a previously augmented vertebral compression fracture (VCF). These re-fractures may present as an asymptomatic remodeling of the vertebral body around the cement cast while in other cases they involve the middle column, at the transition zone between the cement-augmented and non-augmented vertebral body. In the latter, a posterior wall retropulsion is possible and, if left untreated, might progress to vertebral body splitting, central canal stenosis, and kyphotic deformity. There is no consensus regarding the best treatment for these re-fractures. There are cases in which a repeated augmentation relieves the pain, but this is considered an undertreatment in cases with middle column involvement, posterior wall retropulsion, and kyphosis. METHODS We report four cases of re-fracture with middle column collapse of a previously augmented VCF, treated with the stent-screw assisted internal fixation (SAIF) technique. A modified more postero-medial deployment of the anterior metallic implants was applied, to target the middle column fracture. This modified SAIF allowed the reduction and stabilization of the middle column collapse as well as the partial correction of the posterior wall retropulsion and kyphosis. RESULTS Complete relief of back pain with stable clinical and radiographic findings at follow-up was obtained in all cases. CONCLUSIONS In selected cases, the middle column SAIF technique is safe and effective for the treatment of the re-fracture with middle column collapse of a previously cement-augmented VCF. This technique requires precision in trocar placement and could represent a useful addition to the technical armamentarium for VCF treatment.
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Affiliation(s)
- Fortunato Di Caterino
- Department of Interventional Neuroradiology, University Hospital Centre Besancon, Besancon, France
| | - Eva Koetsier
- Pain Management Center, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana Facoltà di scienze biomediche, Lugano, Switzerland
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maurizio Isalberti
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
| | - Diego San Millan
- Neuroradiology Unit, Service of Diagnostic and Interventional Radiology, Sion Hospital Valais Romand Hospital Center, Sion, Switzerland
| | - Francesco Marchi
- Neurosurgery Department, Neurocenter of the Southern Switzerland EOC, Lugano, Switzerland
| | - Luigi La Barbera
- Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milano, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Marco Pileggi
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
| | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
- Department of Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland
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12
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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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13
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Sun X, Wang J, Liu X, Tao H, Zhu T, Wang X, Shen K, Jin W. Lateral-Opening Injection Tool Used in Percutaneous Vertebroplasty to Treat Asymptomatic Osteoporotic Vertebral Burst Fractures: A Retrospective Study. Orthop Surg 2022; 14:2914-2924. [PMID: 36168984 DOI: 10.1111/os.13519] [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: 11/07/2021] [Revised: 08/14/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The adequate management of asymptomatic osteoporotic vertebral burst fractures (OVBFs) was still controversial. Percutaneous vertebroplasty (PVP) could achieve quick recovery with minor trauma, but there were certain safety problems by traditional bone cement injection method. Thus, the aim of this study was to assess the efficacy of lateral-opening injection tool used in PVP treating patients with asymptomatic OVBFs. METHODS This was a retrospective study of OVBFs treated in our institute from March 2016 to March 2020. A total of 66 patients (mean age 72.10 ± 7.98 years, with 21 men and 45 women) who were diagnosed with acute asymptomatic OVBFs with mild spinal canal compromise were treated with PVP by using a lateral-opening injection tool. Two puncture needles were simultaneously placed transpedicularly in the fractured vertebra, and the inner core was removed, and the lateral-opening injection tool was inserted. The adjustment of lateral hole was to improve the distribution height of bone cement and avoid the entry of bone cement into the posterior wall of vertebral body. Related clinical outcomes and images were assessed, including back pain (visual analog scale [VAS]), vertebral height ratio (fractured vertebral height/average adjacent nonfractured vertebral height), kyphosis Cobb angle, union of the fractured vertebral posterior wall, distribution of bone cement, surgical data, and complications. RESULTS The average follow-up time of all cases was 21.23 ± 9.35 months. The mean amount of bone cement was 3.28 ± 0.35 ml in the vertebrae and the mean operative time was 34.02 ± 5.23 min. There were 60 cases of bone cement that contacted the upper and lower endplates on at least one side. There was no cement leakage into the spinal canal or fracture displacement of the posterior wall of the vertebral body in all cases. The VAS scores were 3.78 ± 0.42 at 1 day postoperatively and 0.53 ± 0.40 at the last follow-up, significantly lower than 8.40 ± 0.48 preoperatively (p < 0.05). The average height ratio of anterior, middle, and posterior vertebral body after operation increased compared with that pre-operation (p < 0.05), and the postoperative kyphosis angle decreased (p < 0.05). At 6 months follow-up, there was no significant height loss of the vertebral body. Computed tomography examination 3 months postoperatively showed that the fracture of posterior vertebral wall healed well in all cases. There were seven cases of bone cement leakage without clinical symptoms and two adjacent vertebral fractures caused by falling. There were no cases of deep vein embolism, lower limb muscle atrophy, pneumonia, decubitus. CONCLUSION The lateral opening tool can be safely and effectively used in the PVP treatment on asymptomatic OVBFs with mild spinal canal compromise.
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Affiliation(s)
- Xin Sun
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jia Wang
- Department of Pathology, Shanghai Xin Hua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xingzhen Liu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hairong Tao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Tong Zhu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiang Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Kangping Shen
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Wenjie Jin
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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14
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Dai H, Liu Y, Han Q, Zhang A, Chen H, Qu Y, Wang J, Zhao J. Biomechanical comparison between unilateral and bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures: A finite element analysis. Front Bioeng Biotechnol 2022; 10:978917. [PMID: 36159704 PMCID: PMC9495612 DOI: 10.3389/fbioe.2022.978917] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background and objective: The osteoporotic vertebral compression fracture (OVCF) has an incidence of 7.8/1000 person-years at 55–65 years. At 75 years or older, the incidence increases to 19.6/1000 person-years in females and 5.2–9.3/1000 person-years in males. To solve this problem, percutaneous vertebroplasty (PVP) was developed in recent years and has been widely used in clinical practice to treat OVCF. Are the clinical effects of unilateral percutaneous vertebroplasty (UPVP) and bilateral percutaneous vertebroplasty (BPVP) the same? The purpose of this study was to compare biomechanical differences between UPVP and BPVP using finite element analysis. Materials and methods: The heterogeneous assignment finite element (FE) model of T11-L1 was constructed and validated. A compression fracture of the vertebral body was performed at T12. UPVP and BPVP were simulated by the difference in the distribution of bone cement in T12. Stress distributions and maximum von Mises stresses of vertebrae and intervertebral discs were compared. The rate of change of maximum displacement between UPVP and BPVP was evaluated. Results: There were no obvious high-stress concentration regions on the anterior and middle columns of the T12 vertebral body in BPVP. Compared with UPVP, the maximum stress on T11 in BPVP was lower under left/right lateral bending, and the maximum stress on L1 was lower under all loading conditions. For the T12-L1 intervertebral disc, the maximum stress of BPVP was less than that of UPVP. The maximum displacement of T12 after BPVP was less than that after UPVP under the six loading conditions. Conclusion: BPVP could balance the stress of the vertebral body, reduce the maximum stress of the intervertebral disc, and offer advantages in terms of stability compared with UPVP. In summary, BPVP could reduce the incidence of postoperative complications and provide promising clinical effects for patients.
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Affiliation(s)
| | | | | | | | | | - Yang Qu
- *Correspondence: Yang Qu, ; Jincheng Wang,
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15
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Li W, Ou H, Zhang L, Zhang C, Chen W, Wang H. Meta-Analysis of PKP or PVP Combined with Acupuncture in the Treatment of Osteoporotic Vertebral Compression Fractures. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:9721702. [PMID: 36034204 PMCID: PMC9392604 DOI: 10.1155/2022/9721702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/22/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
The efficacy of acupuncture combined with percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fracture is systematically evaluated. The clinical trials of acupuncture combined with PKP or PVP in the treatment of osteoporotic vertebral compression fracture published before July 2021 are searched in databases of CNKI, WF, VIP, CBM, PubMed, Cochrane Library, and Embase. The information of included studies is extracted, and the quality is assessed by two independent researchers. The meta-analysis is performed by using RevMan 5.3 software. A total of 9 trials are included, involving 851 patients. The experimental results show that the therapeutic effect of acupuncture combined with PKP/PVP in the treatment of osteoporotic vertebral compression fracture (OVCF) is superior to that of PKP/PVP alone, and both the VAS score and ODI score of PKP/PVP combined with ordinary acupuncture or silver needle acupuncture are better than those of the control group one month after the operation. The effect of ordinary acupuncture combined with PKP/PVP on the increase of bone mineral density is better than that of the control group. Acupuncture combined with PKP/PVP in the treatment of osteoporotic vertebral compression fracture has better efficacy than PKP/PVP, and it can effectively relieve patients' pain, improve bone density, and improve the quality of life.
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Affiliation(s)
- Wei Li
- Department of Acupuncture and Moxibustion, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing 100039, China
| | - Haiyan Ou
- Department of Rehabilitation, Tiancun Road Community Health Service Center, Haidian District, Beijing 100143, China
| | - Lianghua Zhang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing 100039, China
| | - Congcong Zhang
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Wei Chen
- Department of Acupuncture and Moxibustion, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing 100039, China
| | - Hao Wang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing 100039, China
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16
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Lacroix M, Ferrero E, Burns R, Guigui P, Clement O, Feydy A. Lumbar Spine Posttherapeutic Imaging. Semin Musculoskelet Radiol 2022; 26:314-328. [PMID: 35654097 DOI: 10.1055/s-0041-1740381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Management of patients after lumbar spine surgery or interventional radiology can be complex, and postoperative imaging patterns are often poorly understood by nonspecialized radiologists. This article focuses on postoperative imaging features of the lumbar spine in five clinical settings (with corresponding interventions): vertebral osteoporotic fractures (percutaneous vertebroplasty and vertebral augmentation), lumbar disk herniation (surgical diskectomy and percutaneous interventional radiology), lumbar spinal stenosis (surgical decompression), lumbar spondylolisthesis (surgical decompression and fusion), and degenerative scoliosis (techniques of osteotomies).For each intervention, we discuss imaging indications, depending if the patient is asymptomatic or if there are suspected complications, describe normal and pathologic imaging features, and present key points.
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Affiliation(s)
- Maxime Lacroix
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université de Paris, Paris, France.,Department of Radiology, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Emmanuelle Ferrero
- Department of Orthopaedic Surgery, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Robert Burns
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université de Paris, Paris, France
| | - Pierre Guigui
- Department of Orthopaedic Surgery, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Olivier Clement
- Department of Radiology, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université de Paris, Paris, France
| | - Antoine Feydy
- Department of Musculoskeletal Radiology, Hôpital Cochin, AP-HP Centre, Université de Paris, Paris, France
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17
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Hogan WB, Philips A, Alsoof D, McDonald CL, Anderson G, Zhang AS, Daniels AH. Kyphoplasty and Vertebroplasty Performed by Surgeons versus Nonsurgeons: Trends in Procedure Rates, Complications, and Revisions. World Neurosurg 2022; 164:e518-e524. [PMID: 35552034 DOI: 10.1016/j.wneu.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Vertebral compression fractures are the most common fragility fractures affecting osteoporotic patients. This study evaluated volume trends and outcomes across specialties performing cement augmentation procedures. METHODS Patients were identified using Current Procedural Terminology codes for vertebroplasty or kyphoplasty from 2010 to 2019. Patients were grouped by surgical providers (orthopedic surgery and neurological surgery) or nonsurgical providers (anesthesia, pain medicine, radiology, and physical medicine and rehabilitation). Outcomes recorded included reoperation rates and postoperative complications occurring within 30 days. Logistic regression was employed to account for potential confounding variables, and odds ratios were obtained. RESULTS Inclusion criteria were met by 80,864 patients who received cement augmentation. Surgeon specialists performed 51.7% of all procedures. Of procedures carried out by nonsurgeon specialists, radiologists performed the most. Despite a stable number of procedures performed over the period, the percentage of procedures performed by surgeons decreased from 58.8% to 49.9% (P < 0.001). Patients with procedures performed by surgeons experienced lower odds of reoperation at 30 days (P < 0.001) and 1 year (P < 0.001), but 5-year and overall rates were not significant (P > 0.05). Surgical patients had lower odds of acute kidney injury (P < 0.004) and pulmonary embolism (odds ratio = 0.62, P < 0.001), yet increased odds of surgical site infection (P < 0.001). CONCLUSIONS Kyphoplasties and vertebroplasties are increasingly performed by nonsurgeon specialists. Although early reoperation rates are higher for nonsurgeon specialists, 5-year and overall reoperation rates were similar. Differing complication rates may relate to patient selection rather than operative technique and can be investigated with future studies.
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Affiliation(s)
- William B Hogan
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Alexander Philips
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Christopher L McDonald
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - George Anderson
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Andrew S Zhang
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
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Dai C, Liang G, Zhang Y, Dong Y, Zhou X. Risk factors of vertebral re-fracture after PVP or PKP for osteoporotic vertebral compression fractures, especially in Eastern Asia: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:161. [PMID: 35279177 PMCID: PMC8917756 DOI: 10.1186/s13018-022-03038-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/02/2022] [Indexed: 01/10/2023] Open
Abstract
Objective Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat osteoporotic vertebral compression fractures (OVCF), but the risk of vertebral re-fracture after PVP/PKP remains controversial. This study aims to investigate the incidence and risk factors of vertebral re-fracture after PVP/PKP. Methods Relevant literatures published up to November 2021 were collected from PubMed, Embase and Web of Science. A meta-analysis was performed to extract data associated with risk factors of SVCF following the PRISMA guidelines. Also, pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence interval (CI) was calculated. Results A total of 23 studies, encompassing 9372 patients with OVCF, met the inclusion criteria. 1255 patients (13.39%) suffered re-fracture after PVP/PKP surgery. A total of 22 studies were from Eastern Asia and only 1 study was from Europe. Female sex (OR = 1.34, 95%CI 1.09–1.64, P = 0.006), older age (WMD = 2.04, 95%CI 0.84–3.24, P = 0.001), lower bone mineral density (BMD, WMD = − 0.38, 95%CI − 0.49–0.26, P < 0.001) and bone cement leakages (OR = 2.05, 95% CI 1.40–3.00, P < 0.001) increased the risk of SVCF. The results of subgroup analysis showed the occurrence of re-fracture was significantly associated with gender (P = 0.002), age (P = 0.001) and BMD (P < 0.001) in Eastern Asia. Compared with the unfractured group, anterior-to-posterior vertebral body height ratio (AP ratio, WMD = 0.06, 95%CI 0.00–0.12, P = 0.037) and visual analog scale score (VAS, WMD = 0.62, 95%CI 0.09–1.15, P = 0.022) were higher in the refracture group, and kyphotic angle correction ratio (Cobb ratio, WMD = − 0.72, 95%CI − 1.26–0.18, P = 0.008) was smaller in Eastern Asia. In addition, anti-osteoporosis treatment (OR = 0.40, 95% CI 0.27–0.60, P < 0.001) could be a protective factor. Conclusion The main factors associated with re-fracture after PVP/PKP are sex, age, bone mineral density, AP ratio, Cobb ratio, VAS score, bone cement leakage and anti-osteoporosis treatment, especially in Eastern Asia.
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Chien HY, Yang YC, Hsieh MH, Yang CC. Early Percutaneous Vertebroplasty Improves Bone-Cement Integration and Reduces Adjacent Fractures. World Neurosurg 2021; 156:e283-e290. [PMID: 34543733 DOI: 10.1016/j.wneu.2021.09.050] [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: 07/09/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Percutaneous vertebroplasty (PVP) is widely used for treatment of osteoporotic vertebral compression fractures (VCFs). However, the influence of PVP timing (early vs. late) on development of adjacent vertebral fractures has rarely been discussed. This retrospective cohort study aimed to evaluate bone-cement binding for thoracolumbar fractures (T8-L3) using a new assessment method to predict risk for adjacent vertebral fractures. METHODS Patients with a single-level T-score ≤ -1.0 of lumbar bone mineral density and a primary osteoporotic VCF in the thoracolumbar region (T8-L3) who underwent PVP from October 2016 to February 2018 at our medical university-affiliated hospital were included. Patients were divided into refracture and non-refracture groups. All patients underwent computed tomography after vertebroplasty. Bone-cement distribution patterns were evaluated using standardized axial computed tomography images of each cemented vertebra by 4 independent observers with ImageJ software. The smoothness index was calculated as a percentage of smooth margins. RESULTS Of 51 VCFs, 15 (29.4%) and 36 (70.6%) were refracture and non-refracture VCFs, respectively. The mean smoothness index (MSI) was higher in the refracture group than in the non-refracture group (P < 0.01), with an increased refracture risk that corresponded to increased MSI values (P = 0.004). Spearman correlation coefficient (0.375) showed a positive correlation between the fracture-vertebroplasty interval and MSI (P = 0.01). CONCLUSIONS Axial computed tomography images were used to characterize bone-cement binding properties. Patients who underwent early PVP had a lower MSI, better bone-cement integration, and fewer adjacent fractures.
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Affiliation(s)
- Hung Yang Chien
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
| | - Yao Chun Yang
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min Hong Hsieh
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
| | - Chang Chen Yang
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan; School of Medicine, Tzu Chi University, Haulien City, Taiwan.
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Therapeutic Efficacy of Transpedicular Impaction Bone Grafting with Long Segmental Posterior Instrumentation in Stage III Kümmell Disease. Spine (Phila Pa 1976) 2021; 46:907-914. [PMID: 34100844 DOI: 10.1097/brs.0000000000003995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review of clinical and radiological parameters. OBJECTIVE To evaluate the therapeutic efficacy of transpedicular impaction bone grafting (TIBG) with long segmental posterior instrumentation for the treatment of stage III Kümmell disease. SUMMARY OF BACKGROUND DATA The optimal treatment for stage III Kümmell disease remains controversial and unclear. Theoretically, transpedicular bone grafting can reconstruct anterior column support and reduce the failure of internal fixation, which is an intuitive method for the treatment of Kümmell disease. However, the use of this technique has rarely been reported for the treatment of this disease. This study reported the clinical and radiological results of TIBG with long segmental posterior instrumentation for the treatment of stage III Kümmell disease. METHODS Between August 2011 and December 2017, we retrospectively analyzed 24 patients with stage III Kümmell disease who underwent TIBG with long segmental posterior instrumentation. Anterior vertebral heights, kyphotic Cobb angle, visual analog scale (VAS), Oswestry disability index (ODI), and American Spinal Injury Association (ASIA) impairment scale were used to evaluate the effects of surgery. RESULTS The mean time to follow-up was 38.1 ± 10.2 months. The average operative duration was 136 ± 16.5 minutes, and the average intraoperative blood loss was 293 ± 41.3 mL. The VAS, ODI, anterior vertebral heights, and kyphotic Cobb angles were improved significantly at 1 week after surgery compared the preoperative examinations, and were well maintained at the final follow-up evaluation. Fourteen patients (58%) had mild neurological impairments before surgery, with neurological function returning to normal at the final follow-up evaluation. There was no instance of instrumentation failure. CONCLUSION TIBG combined with long segmental posterior instrumentation is a safe and effective surgical option for stage III Kümmell disease.Level of Evidence: 4.
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Minimally invasive thoracolumbar corpectomy with navigated expandable vertebral cage: A technical note. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Xiong YC, Guo W, Xu F, Zhang CC, Liang ZP, Wu L, Chen S, Zeng XW. Refracture of the cemented vertebrae after percutaneous vertebroplasty: risk factors and imaging findings. BMC Musculoskelet Disord 2021; 22:459. [PMID: 34011339 PMCID: PMC8136062 DOI: 10.1186/s12891-021-04355-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the related imaging findings and risk factors to refracture of the cemented vertebrae after percutaneous vertebroplasty (PVP) treatment. METHODS Patients who were treated with PVP for single vertebral compression fractures (VCFs) and met this study's inclusion criteria were retrospectively reviewed from January 2012 to January 2019. The follow-up period was at least 2 years. Forty-eight patients with refracture of the cemented vertebrae and 45 non-refractured patients were included. The following variates were reviewed: age, sex, fracture location, bone mineral density (BMD), intravertebral cleft (IVC), kyphotic angle (KA), wedge angle, endplate cortical disruption, cement volume, surgical approach, non-PMMA-endplate-contact (NPEC), cement leakage, other vertebral fractures, reduction rate (RR), and reduction angle (RA). Multiple logistic regression modeling was used to identify the independent risk factors of refracture. RESULTS Refracture was found in 48 (51.6%) patients. Four risk factors, including IVC (P = 0.005), endplate cortical disruption (P = 0.037), larger RR (P = 0.007), and NPEC (P = 0.006) were found to be significant independent risk factors for refracture. CONCLUSIONS Patients with IVC or larger RR, NPEC, or endplate cortical disruption have a high risk of refracture in the cemented vertebrae after PVP.
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Affiliation(s)
- Yu-Chao Xiong
- Department of Radiology, Guangzhou Red Cross Hospital, Jinan University, 396 Tongfu Road, Guangzhou, 510220, Guangdong Province, China
| | - Wei Guo
- Department of Radiology, Wuhan Third Hospital, Tongren Hospital of Wuhan University, 241 Liuyang Road, Wuhan, 430063, Hubei Province, China
| | - Fan Xu
- Department of Radiology, Guangzhou Red Cross Hospital, Jinan University, 396 Tongfu Road, Guangzhou, 510220, Guangdong Province, China
| | - Ci-Ci Zhang
- Department of Radiology, Guangzhou Red Cross Hospital, Jinan University, 396 Tongfu Road, Guangzhou, 510220, Guangdong Province, China
| | - Zhi-Ping Liang
- Department of Radiology, Guangzhou Red Cross Hospital, Jinan University, 396 Tongfu Road, Guangzhou, 510220, Guangdong Province, China
| | - Li Wu
- Department of Radiology, Guangzhou Red Cross Hospital, Jinan University, 396 Tongfu Road, Guangzhou, 510220, Guangdong Province, China
| | - Song Chen
- Department of Radiology, Guangzhou Red Cross Hospital, Jinan University, 396 Tongfu Road, Guangzhou, 510220, Guangdong Province, China
| | - Xu-Wen Zeng
- Department of Radiology, Guangzhou Red Cross Hospital, Jinan University, 396 Tongfu Road, Guangzhou, 510220, Guangdong Province, China.
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Li YD, Tsai TT, Niu CC, Lai PL. Cement bridging phenomenon in percutaneous vertebroplasty for adjacent vertebral compression fracture. Sci Rep 2021; 11:10184. [PMID: 33986345 PMCID: PMC8119941 DOI: 10.1038/s41598-021-89412-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/23/2021] [Indexed: 11/24/2022] Open
Abstract
In some cases of vertebroplasty for adjacent fractures, we observed a cement bridging phenomenon, in which the injected cement flowed from the newly fractured vertebra to the previously cement-augmented vertebra through the space between the abutting anterior longitudinal ligament and the vertebral column. The purpose of this retrospective study was to investigate this phenomenon. From January 2012 to December 2014, patients who sustained new-onset adjacent vertebral compression fracture and who were again treated with vertebroplasty were enrolled. We divided the patients into two groups, the bridging group and the nonbridging group, to analyze the difference between them. Results showed that the cement bridging phenomenon occurred in 18 (22.8%) of the 79 patients. Significant differences between the bridging and nonbridging groups were identified in the following 3 imaging features: severe loss of the anterior vertebral body height at the new-onset adjacent vertebra on plain film (odds ratio [OR] = 4.46, p = 0.014), fluid accumulation (OR = 36.27, p < 0.001) and hypointense signaling (OR = 15.67, p < 0.001) around the space anterior to the abutting vertebral bodies and the corresponding intervertebral disc on MRI. After a 2-year follow-up, both the mean value of the focal kyphotic angle and anterior body height ratio were significantly better in the cement bridging group than in the nonbridging group. The cement bridging phenomenon, which has never been reported in the literature, is not rare in clinical practice. This phenomenon was associated with better maintenance of focal kyphotic angle and anterior body height ratio during the 2-year follow-up.
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Affiliation(s)
- Yun-Da Li
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, No. 5, Fusing St., Guishan Dist., Taoyuan, 33305, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Orthopedic Surgery, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, No. 5, Fusing St., Guishan Dist., Taoyuan, 33305, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chien Niu
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, No. 5, Fusing St., Guishan Dist., Taoyuan, 33305, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Liang Lai
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, No. 5, Fusing St., Guishan Dist., Taoyuan, 33305, Taiwan. .,Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Ma YH, Tian ZS, Liu HC, Zhang BY, Zhu YH, Meng CY, Liu XJ, Zhu QS. Predictive risk factors for recollapse of cemented vertebrae after percutaneous vertebroplasty: A meta-analysis. World J Clin Cases 2021; 9:2778-2790. [PMID: 33969060 PMCID: PMC8058688 DOI: 10.12998/wjcc.v9.i12.2778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/18/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND As one of the most common complications of osteoporosis, osteoporotic vertebral compression fracture (OVCF) increases the risk of disability and mortality in elderly patients. Percutaneous vertebroplasty (PVP) is considered to be an effective, safe, and minimally invasive treatment for OVCFs. The recollapse of cemented vertebrae is one of the serious complications of PVP. However, the risk factors associated with recollapse after PVP remain controversial. AIM To identify risk factors for the recollapse of cemented vertebrae after PVP in patients with OVCFs. METHODS A systematic search in EMBASE, MEDLINE, the Cochrane Library, and PubMed was conducted for relevant studies from inception until March 2020. Studies investigating risk factors for the recollapse of cemented vertebrae after PVP without additional trauma were selected for analysis. Odds ratios (ORs) or standardized mean differences with 95% confidence interval (CI) were calculated and heterogeneity was assessed by both the chi-squared test and the I-squared test. The methodological quality of the included studies was assessed according to the Newcastle-Ottawa Scale. RESULTS A total of nine case-control studies were included in our meta-analysis comprising 300 cases and 2674 controls. The significant risk factors for the recollapse of cemented vertebrae after PVP in OVCF patients were fractures located at the thoracolumbar junction (OR = 2.09; 95%CI: 1.30 to 3.38; P = 0.002), preoperative intravertebral cleft (OR = 2.97; 95%CI: 1.93 to 4.57; P < 0.00001), and solid lump distribution pattern of the cement (OR = 3.11; 95%CI: 1.91 to 5.07; P < 0.00001). The analysis did not support that age, gender, lumbar bone mineral density, preoperative visual analogue scale score, injected cement volume, intradiscal cement leakage, or vertebral height restoration could increase the risk for cemented vertebra recollapse after PVP in OVCFs. CONCLUSION This meta-analysis suggests that thoracolumbar junction fractures, preoperative intravertebral cleft, and solid lump cement distribution pattern are associated with the recollapse of cemented vertebrae after PVP in OVCF patients.
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Affiliation(s)
- Yi-Hang Ma
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Zhi-Sen Tian
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Hao-Chuan Liu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Bo-Yin Zhang
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Yu-Hang Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Chun-Yang Meng
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Xiang-Ji Liu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Qing-San Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
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25
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Beall DP. Response to: the 'armed concrete' approach: stent-screw-assisted internal fixation (SAIF) reconstructs and internally fixates the most severe osteoporotic vertebral fractures. J Neurointerv Surg 2020; 13:2-3. [PMID: 33122351 DOI: 10.1136/neurintsurg-2020-016894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Douglas P Beall
- Interventional Musculoskeletal Radiology, Summit Medical Center LLC, Edmond, Oklahoma, USA
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26
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Bravo AE, Brasuell JE, Favre AW, Koenig BM, Khan AA, Beall DP. Treating Vertebral Compression Fractures: Establishing the Appropriate Diagnosis, Preoperative Considerations, Treatment Techniques, Postoperative Follow-Up and General Guidelines for the Treatment of Patients With Symptomatic Vertebral Compression Fractures. Tech Vasc Interv Radiol 2020; 23:100701. [PMID: 33308580 DOI: 10.1016/j.tvir.2020.100701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Vertebral compression fractures (VCFs) result from either trauma or a pathologic process that weakens the bone by conditions such as osteoporosis or tumor. The incidence of VCFs has been rising over the last few decades in accordance with the aging population. These fractures can result in severe pain, physical limitation and disability, as well as increased morbidity and mortality. Patients with VCFs are optimally treated by accurate and early diagnosis and treatment. An effective method to treat these fractures is percutaneous vertebral augmentation, which is a set of minimally invasive procedures that stabilizes osseous fractures, provides immediate pain relief, and improves quality of life. Vertebral augmentation procedures include vertebroplasty, kyphoplasty, and vertebral augmentation with implants. Each of these techniques is described in general terms in this article. The ideal candidate for vertebral augmentation is a patient with a symptomatic fracture seen on cross-sectional imaging in which nonsurgical management has failed and has positive signs on physical examination with no absolute contraindication. This procedure should be done with the appropriate equipment and personnel in a facility designed for this purpose. After the procedure, the patient should undergo the appropriate follow-up to ensure optimal recovery. Additionally, it is essential that the patient receives appropriate therapy for the underlying disorder that predisposed them to the vertebral fracture.
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Affiliation(s)
| | | | | | | | - Ali A Khan
- Clinical Radiology of Oklahoma, Edmond, OK
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Wei H, Dong C, Zhu Y, Ma H. Analysis of two minimally invasive procedures for osteoporotic vertebral compression fractures with intravertebral cleft: a systematic review and meta-analysis. J Orthop Surg Res 2020; 15:401. [PMID: 32912267 PMCID: PMC7488103 DOI: 10.1186/s13018-020-01938-6] [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: 06/30/2020] [Accepted: 09/01/2020] [Indexed: 12/16/2022] Open
Abstract
Background A systematic review and meta-analysis to assess the pros and cons of percutaneous vertebroplasty (PVP) versus kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral cleft (IVC) including all available evidence from controlled trials. Methods Databases including Pubmed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched to identify relevant studies comparing PVP and PKP for OVCFs with IVC. The outcomes mainly included visual analog scale (VAS), Oswestry Disability Index (ODI), local kyphotic angle (LKA), rate of vertebral height (VH%), and adverse events. Results Nine studies enrolling 688 patients were eligible for meta-analysis. The results indicated no significant differences between the two groups in the short-and long-term VAS, ODI, LKA, or VH% (P > 0.05). Compared with PVP, PKP was associated with significantly longer operation time (P < 0.05), higher cost (P > 0.05), and more injected cement volume (P < 0.05). In terms of adverse events, PKP has a lower risk of cement leakage (P < 0.05), while with no significant difference in adjacent-level fracture rates (P > 0.05). Conclusion The two procedures have similar short- and long-term pain relief, functional recovery, local kyphosis correction, and vertebral height maintenance in OVCFs with IVC. PKP is superior to PVP for the injected cement volume, and lower cement leakage rate, however, with longer operation time, more fluoroscopy times, and higher cost. Further randomized controlled trials (RCTs) should be conducted to confirm these results.
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Affiliation(s)
- Hongyu Wei
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Chunke Dong
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.,Beijing University of Chinese Medicine, 11 North Third Ring Road East, Chaoyang District, Beijing, 100029, China
| | - Yuting Zhu
- Beijing Tongzhou Integrative Medicine Hospital, 89 Chezhan Road, Tongzhou District, Beijing, 101100, China
| | - Haoning Ma
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
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Zhu S, Su Q, Zhang Y, Sun Z, Yin P, Hai Y. Risk factors of cemented vertebral refracture after percutaneous vertebral augmentation: a systematic review and meta-analysis. Neuroradiology 2020; 62:1353-1360. [PMID: 32683478 DOI: 10.1007/s00234-020-02495-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/08/2020] [Indexed: 02/07/2023]
Abstract
To evaluate the risk factors of cemented vertebral refracture after percutaneous vertebral augmentation (PVA) for patients with osteoporotic vertebral compression fractures (OVCFs). We performed a literature search on cemented vertebral refracture after PVA using the PubMed, EMBASE, and Cochrane Library medical databases. The clinical data, including literature information, basic patient information, observational factors, and interventional factors, were extracted by two authors. The pooled results and related heterogeneity of each factor between the refracture group and the non-refracture group were evaluated using Review Manager software 5.35. A total of 3185 patients from 10 studies were included, with 195 patients in the refracture group and 2990 patients in the non-refracture group. The mean follow-up duration was 18.9 months. According to the meta-analysis, age, low bone marrow density (BMD), intravertebral cleft (IVC), high anterior vertebral height (AVH) restoration/high Cobb angle restoration, and low cement dose were the risk factors of cemented vertebral refracture after PVA. Our results showed that age, low BMD, IVC, high AVH restoration, high Cobb angle restoration, and low cement dose were the risk factors for cemented vertebral refracture after PVA.
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Affiliation(s)
- Shiqi Zhu
- Departmen of Orthopedics, Affiliated Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinanlu, Beijing, 100020, People's Republic of China
| | - Qingjun Su
- Departmen of Orthopedics, Affiliated Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinanlu, Beijing, 100020, People's Republic of China
| | - Yaoshen Zhang
- Departmen of Orthopedics, Affiliated Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinanlu, Beijing, 100020, People's Republic of China
| | - Zhencheng Sun
- Departmen of Orthopedics, Affiliated Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinanlu, Beijing, 100020, People's Republic of China
| | - Peng Yin
- Departmen of Orthopedics, Affiliated Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinanlu, Beijing, 100020, People's Republic of China.
| | - Yong Hai
- Departmen of Orthopedics, Affiliated Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinanlu, Beijing, 100020, People's Republic of China
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Nakanishi K, Uchino K, Watanabe S, Hayashi N, Iba H, Hasegawa T. Video-Assisted Thoracoscopic Surgery for Re-Collapse of Vertebrae after Percutaneous Vertebral Augmentation (PVA). Spine Surg Relat Res 2020; 5:28-33. [PMID: 33575492 PMCID: PMC7870326 DOI: 10.22603/ssrr.2020-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/27/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Due to the increase in osteoporosis accompanying the aging society in Japan, osteoporotic vertebral fractures (OVFs) are increasing. Percutaneous vertebral augmentation (PVA) has been widely used for OVFs because it reduces pain immediately with less invasiveness. Re-collapse of vertebral body after PVA is a rare, but important, complication. Once the re-collapse has occurred, patients should undergo an additional invasive salvage surgery. METHODS We treated 5 patients with re-collapse after PVA in our hospital. For re-collapse after PVA, we performed anterior column reconstruction with video-assisted thoracoscopic surgery (VATS), posterior fixation with percutaneous pedicle screws (PPSs) and minimally invasive spine stabilization (MISt). RESULTS The mean postoperative follow-up was at 62.8 months. At the final follow-up, the patients were free of low back pain, and bony union was achieved in all cases. The postoperative correction loss was 6 degrees. Perioperative complications included aspiration pneumonia in one patient and bone fracture of an adjacent vertebral body in two patients. There were no reoperation cases. CONCLUSIONS We perform minimally invasive combined anterior and posterior surgery with VATS for re-collapse after PVA. This procedure is useful in elderly patients with less reserve capacity.
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Affiliation(s)
- Kazuo Nakanishi
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Kazuya Uchino
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Seiya Watanabe
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Norito Hayashi
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Hideaki Iba
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Toru Hasegawa
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
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Yang D, Zhang Y, Ma X, Huo L, Li L, Gao Y. Resources utilisation and economic burden of percutaneous vertebroplasty or percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures in China: a retrospective claim database study. BMC Musculoskelet Disord 2020; 21:255. [PMID: 32303207 PMCID: PMC7165412 DOI: 10.1186/s12891-020-03279-1] [Citation(s) in RCA: 9] [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: 09/05/2019] [Accepted: 04/07/2020] [Indexed: 12/12/2022] Open
Abstract
Background Osteoporotic vertebral compression fractures (OVCF) is a common and often debilitating complication of osteoporosis, leading to significant morbidity and increased mortality. Percutaneous vertebroplasty (PVP) and Percutaneous kyphoplasty (PKP) are recommendable surgical treatments for OVCF. Objective To evaluate PVP/PKP utilisation and their related direct medical costs for OVCF treatment in China from the payer perspective. Methods A population-based medical claims database of a metropolitan city in China was analysed from the payer perspective, which included all inpatient claims from 01/01/2015 to 31/12/2017. All vertebral fractures patients that met the eligibility criteria (aged ≥50 years old, having vertebral fracture diagnosis, without unrelated diseases diagnoses such as tumour and scoliosis, received PVP/PKP) were deemed as OVCF patients. Baseline characteristics, surgery rate, length of stay in hospital, time to re-surgery, and costs (including costs per hospitalisation and annual costs) were described. Survival analysis function was used to estimate the re-surgery rate. Results Of the 50,686 patients with OVCF identified, 14,527 (28.66%) received a total number of 15,599 records of PVP/PKP surgeries from 2015 to 2017. Mean age was 75 at the first surgery captured in the database analysis period; females accounted for 79.54% of all cases. The median length of surgery stay was 9 days. Cumulative re-surgery rates were 1.22% in 30 days, 2.58% in 90 days, 3.61% in 183 days, 5.42% in 1 year, and 7.95% in 2 years. There was no significant difference in re-surgery rate between PVP and PKP (p = 0.3897). The median time to the re-surgery was 139 days. Mean costs per PVP/PKP-related hospitalisation were 35,906 CNY/5122 USD (34,195 CNY/4878USD for PVP, 44,414 CNY/6336 USD for PKP, p < 0.01). The overall costs of hospitalisation averaged 186.61 million CNY (26.62 million USD) per year in this metropolitan city. Conclusion From 2015 to 2017, nearly one-third of OVCF inpatients received PVP/PKP and the re-surgery rate was 7.95%. PVP/PKP procedures for OVCF place a high economic burden for both the healthcare system and patients. Early detection and treatment of patients with osteoporosis are critical in China.
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Affiliation(s)
- Dehong Yang
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, AD: No.1838 North Guangzhou Avenue, Guangzhou, 510515, PR China.
| | - Yanlei Zhang
- Shanghai Branch, Lilly Suzhou Pharmaceutical Co.Ltd, AD: No. 288 Shimen No.1 Road, Jing'an District, Shanghai, 200041, PR China
| | - Xiao Ma
- Shanghai Branch, Lilly Suzhou Pharmaceutical Co.Ltd, AD: No. 288 Shimen No.1 Road, Jing'an District, Shanghai, 200041, PR China
| | - Li Huo
- Shanghai Branch, Lilly Suzhou Pharmaceutical Co.Ltd, AD: No. 288 Shimen No.1 Road, Jing'an District, Shanghai, 200041, PR China
| | - Liran Li
- Department of Health Economics, Shanghai Centennial Co. Ltd, AD: 702A, B Block, Fenglin International Center, No. 388 Fenglin Road, Shanghai, 200030, PR China
| | - Yue Gao
- Department of Health Economics, Shanghai Centennial Co. Ltd, AD: 702A, B Block, Fenglin International Center, No. 388 Fenglin Road, Shanghai, 200030, PR China
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Yang YS, Tsou YS, Lo WC, Chiang YH, Lin JH. Teriparatide Associated with Fewer Refractures and Higher Body Heights of Cemented Vertebrae after Vertebroplasty: A Matched Cohort Study. Sci Rep 2020; 10:6005. [PMID: 32265470 PMCID: PMC7138790 DOI: 10.1038/s41598-020-62869-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 03/16/2020] [Indexed: 01/28/2023] Open
Abstract
Refracture of cemented vertebrae occurs commonly after vertebroplasty (VP) for osteoporotic vertebral compression fracture (OVCF). It can result in severe pain or neurological deficit, but no preventive medication is available. Owing to the bone anabolic benefits of teriparatide (TP), this study was aimed to compare the outcomes of cemented vertebrae with TP to those without TP. Patients who received VP for OVCF with at least 1 year follow-up were included. The anterior body height (ABH) and middle body height (MBH) and kyphotic angle (KA) were measured before VP and 1 week and at least 1 year after VP. Refracture was defined as a 15% decrease in ABH or MBH and 8° decrease in KA compared with those at postoperative 1 week. The clinical outcomes were evaluated. 35 VP procedures in 21 patients treated with TP (TP group), and, matched to that, 29 out of 133 patients treated with VP alone (VP group) were included. One year after VP, ABH and MBH were significantly greater, except KA, in the TP group (VP group vs. TP group: KA - 4.97° ± 12.1 vs. -2.85° ± 12.21°, p = 0.462, ABH 1.56 ± 0.48 cm vs. 1.84 ± 0.56 cm, p = 0.027, MBH 1.49 ± 0.39 cm vs. 1.73 ± 0.41 cm, p = 0.017). The refracture rates of KA, ABH, and MBH were significantly lower in the TP group (VP group vs. TP group: KA 42.11% vs.8.57%, p < 0.001; ABH 76.32% vs. 28.57%, p < 0.0001; MBH 76.32% vs. 28.57%, p < 0.0001). In single-level subgroup comparison, TP was associated with better improvement of pain VAS and better radiological outcomes. TP was associated with higher BHs and fewer refractures than VP alone, with comparable clinical outcomes 1 year after VP. TP may be associated with better improvement of pain VAS in those with single-level VP procedure. Higher BH was due to the better maintenance effect of TP.
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Affiliation(s)
- Yi-Shan Yang
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Yi-Syue Tsou
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Wen-Cheng Lo
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Yung-Hsiao Chiang
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Jiann-Her Lin
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan.
- Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan.
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.
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Lin JH, Chi JE, Hsu JY, Chan RW, Lo WC, Chiang YH. Kyphoplasty with an intravertebral reduction device for osteoporotic vertebral compression fractures with spinal canal encroachment. FORMOSAN JOURNAL OF SURGERY 2020. [DOI: 10.4103/fjs.fjs_38_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rahimizadeh A. Kyphosis and canal compromise due to refracturing of an L1 cemented vertebra managed with posterior surgery alone. Surg Neurol Int 2019; 10:212. [PMID: 31768292 PMCID: PMC6826297 DOI: 10.25259/sni_456_2019] [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: 08/25/2019] [Accepted: 10/12/2019] [Indexed: 11/07/2022] Open
Abstract
Background: An already cemented vertebral body rarely refractures and its occurrence may be signaled by the reappearance of pain and/or significant vertebral collapse/kyphosis resulting in canal compromise and neurological deterioration. Case Description: An 81-year-old male originally underwent an L1 kyphoplasty for an osteoporotic compression fracture. Nine months later, he presented with the late onset of recurrent collapse of the cemented vertebral body, leading to pain, kyphosis, and canal compromise. Surgery warranted total L1 corpectomy, reconstruction of the anterior column, and a posterior fixation through a purely posterior approach (posterior vertebral column resection [pVCR]). Conclusion: Here, we presented the safety/efficacy of utilizing a purely posterior approach (e.g., including L1 corpectomy, reconstruction of the anterior column, and posterior fusion: pVCR) in the management of a repeated fracture of a cemented L1 vertebra resulting in kyphosis and canal compromise.
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Affiliation(s)
- Abolfazl Rahimizadeh
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
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Liu H, Zhang J, Chen W, Chen AC, Ji W, Meng B, Yang H, Liu T. Reperfusion Revision Surgery for Augmented Vertebral Nonunion with Movable Cement. World Neurosurg 2019; 132:429-433.e1. [PMID: 31394357 DOI: 10.1016/j.wneu.2019.07.212] [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] [Received: 03/07/2019] [Revised: 07/27/2019] [Accepted: 07/29/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Osteoporotic vertebral nonunion is a special type of osteoporotic vertebral fracture and can gain satisfactory clinical outcomes using vertebral augmentation. In the rare occurrence that augmented vertebral nonunion occurs postoperatively, pedicle screw fixation is the primary strategy. However, is a different method like the second shot of cement reliable? The purpose of this study is to introduce the reperfusion revision surgery strategy for treatment of osteoporotic vertebral nonunion. CASE DESCRIPTION An 80-year-old female patient experienced vertebral re-nonunion in situ after receiving kyphoplasty at the T11 vertebrae. During revision surgery, we tried a new, minimally invasive surgical method in which we inserted cement into the intravertebral cleft around the movable cement without obvious leakage. Special bone cement perfusion techniques (incremental temperature cement delivery and secondary cement preparation based-perfusion and blocking) were used. The cement tail was performed to increase the anchor and fastness between the cement and vertebral body. CONCLUSIONS The patient gained immediate pain relief and vertebral stability after the revision surgery. A 2-year postoperative radiograph and follow-up showed sufficient vertebral height and clinical outcomes. Using special puncture and bone cement perfusion techniques, reperfusion revision surgery in situ is an effective strategy for the treatment of vertebral re-nonunion.
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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
| | - Weikai Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | | | - Wei Ji
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Bin Meng
- 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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Sun HB, Jing XS, Zhang GQ, Hai Y, Liu YZ, Wang DC. Preliminary Study of Obese Patients with Chronic Obstructive Pulmonary Disease Suffering from Painful Osteoporotic Vertebral Compression Fracture Treated by Percutaneous Vertebroplasty in Improved Prone Position and Right Lateral Position. World Neurosurg 2019; 130:e933-e940. [PMID: 31302276 DOI: 10.1016/j.wneu.2019.07.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess outcomes in obese patients with chronic obstructive pulmonary disease (COPD) who sustained an osteoporotic vertebral compression fracture (OVCF) treated by percutaneous vertebroplasty (PVP) in the improved prone position and right lateral position. METHODS Between January 2015 and May 2016, a total of 60 patients were enrolled in this randomized controlled study. Patients in group A were placed in the improved prone position for a bilateral transpedicular technique, and those in group B were placed in the right lateral position for a left transverse process-pedicle approach. Clinical and radiologic outcomes were assessed and compared between the 2 groups during the 12-month follow-up period. RESULTS All operations were successfully completed without any serious sequelae. The operation time, fluoroscopic time, scores for respiratory condition during the operation, intravertebral cement volume, and incidence of cement leakage were significantly greater in group A compared with group B (P < 0.01). During the follow-up period, all patients in both groups experienced significant improvement in pain relief. Satisfactory functional improvement was obtained at 3 months postoperatively. CONCLUSIONS Treatment of obese patients with COPD suffering from painful OVCF by PVP in both the improved prone position with a bilateral technique and the right lateral position with a unilateral technique was relatively safe and effective. However, unilateral PVP in the right lateral position was associated with a shorter operation time, limited fluoroscopic time, and minimal cement leakage.
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Affiliation(s)
- Hai-Bo Sun
- Department of Orthopedics, Beijing Friendship Hospital Capital Medical University, Beijing, China.
| | - Xiao-Shan Jing
- Department of Emergency, Beijing Friendship Hospital Capital Medical University, Beijing, China
| | - Guo-Qiang Zhang
- Department of Orthopedics, Beijing Friendship Hospital Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopedics, Beijing Chaoyang Hospital Capital Medical University, Beijing, China
| | - Yu-Zeng Liu
- Department of Orthopedics, Beijing Chaoyang Hospital Capital Medical University, Beijing, China
| | - De-Cheng Wang
- Department of Orthopedics, Beijing Tongzhou Hospital of Integrated Chinese and Western Medicine, Beijing, China
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Deng H, Li Y, Zhou J, Wang X, Du J, Gao W, Hao D. Therapeutic efficacy of Transpedicular Intracorporeal cement augmentation with short segmental posterior instrumentation in treating osteonecrosis of the vertebral body: a retrospective case series with a minimum 5-year follow-up. BMC Musculoskelet Disord 2019; 20:305. [PMID: 31253156 PMCID: PMC6599253 DOI: 10.1186/s12891-019-2671-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 06/07/2019] [Indexed: 12/19/2022] Open
Abstract
Background Transpedicular intracorporeal cement augmentation (TCA) with short segmental posterior instrumentation (SSPI), which provides an ideal immediate analgesic effect and long-term reconstructive stability, is thought to be a sensible advancement to the operative strategy in treating osteonecrosis of the vertebral body (ONV). However, long-term follow-up studies about the treatment are scarce. Methods Forty-six ONV patients (22 males and 24 females, mean age of 62.8 ± 7.11 years) underwent TCA with SSPI were retrospectively analyzed. During follow-up, clinical outcomes, such as the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI) score, were evaluated, as well as radiologic outcomes, such as the average vertebral height and kyphotic angle. Results A total of 36 patients completed a follow-up period of at least 5 years (mean follow-up period of 67 ± 4.2 months). Among them, seven patients experienced complications, i.e., pneumonia (2/36, 5.56%), screw loosening (2/36, 5.56%), moderate hematoma in the subcutaneous tissue (1/36, 2.78%), and cement leakage (2/36, 5.56%). Compared to the preoperative score, the mean VAS score was significantly reduced 6 months postoperatively (P < 0.05), and it concluded being virtually identical to the preoperative score (P > 0.05). The mean ODI score exhibited a comparable trend. Regarding the radiologic evaluation, the mean kyphotic angle and average vertebral body height were significantly corrected postoperatively (both P < 0.05). However, these radiological parameters were maximally ameliorated during the direct postoperative period and slowly deteriorated over time. Conclusion The present study shows that TCA with SSPI may be only mildly effective for symptom relief and correction of kyphotic deformity during a relatively long follow-up, thus we do not recommend it for ONV.
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Affiliation(s)
- Hongli Deng
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yibing Li
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jinsong Zhou
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xiaodong Wang
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jinpeng Du
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Wenjie Gao
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
| | - Dingjun Hao
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
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Ji X, Xu F, Dong G, Jia C, Jia P, Chen H, Tang H. Loading necrostatin-1 composite bone cement inhibits necroptosis of bone tissue in rabbit. Regen Biomater 2019; 6:113-119. [PMID: 30967966 PMCID: PMC6447002 DOI: 10.1093/rb/rbz004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/19/2018] [Accepted: 01/01/2019] [Indexed: 01/16/2023] Open
Abstract
Bone necrosis after injecting of polymethylmethacrylate (PMMA) bone cement will lead to re-fracture of bone tissue. As a new type of necrosis, there is little research related to the necroptosis of surrounding bone tissue near the bone cement. The purpose of our study was to (i) investigate the presence of necroptosis in vivo and, (ii) established as a new type of bone cement containing PMMA, calcium phosphate cement (CPC) and Necrostatin-1 (Nec-1) to inhibit necroptosis of bone tissue. A total of 12 Japanese rabbits were used to establish the animal model and randomly divided into 4 groups signed as a control group, PMMA group, PMMA-CPC group and PMMA-CPC-Nec-1 group, respectively. We used scanning electron microscope to observe the structure of the samples, used HE staining to detect the necrosis, and used western blotting as well as ELISA test to examine the iconic molecule receptor interacting protein kinase-3 (RIP 3) protein and tumor necrosis factor α (TNF-α). After analyzing the results of our study, we found that the structure in both PMMA bone cement group and composite bone cement group was damaged and there was an evidence of necrosis, but it was absent in control group. Through molecule detection, the RIP 3 protein expression was decreased in PMMA-CPC-Nec-1 (P < 0.05). TNF-α expression was increased in bone cement groups with and without CPC (P < 0.05), but was inhibited in PMMA-CPC-Nec-1 group. We have concluded that the necroptosis could be confirmed in bone tissue necrosis induced by TNF-α after bone cement injection and also could be inhibited by composite bone cement with Nec-1.
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Affiliation(s)
- Xiang Ji
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong’an Road, Xicheng District, Beijing, China
| | - Feng Xu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong’an Road, Xicheng District, Beijing, China
| | - Guoling Dong
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong’an Road, Xicheng District, Beijing, China
| | - Chongzhe Jia
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong’an Road, Xicheng District, Beijing, China
| | - Pu Jia
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong’an Road, Xicheng District, Beijing, China
| | - Hao Chen
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong’an Road, Xicheng District, Beijing, China
| | - Hai Tang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong’an Road, Xicheng District, Beijing, China
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Yu WB, Jiang XB, Liang D, Xu WX, Ye LQ, Wang J. Risk factors and score for recollapse of the augmented vertebrae after percutaneous vertebroplasty in osteoporotic vertebral compression fractures. Osteoporos Int 2019; 30:423-430. [PMID: 30368576 DOI: 10.1007/s00198-018-4754-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/22/2018] [Indexed: 12/11/2022]
Abstract
UNLABELLED Our study demonstrated a high incidence of recollapse of the augmented vertebrae after PVP treatment for OVCFs. A risk score based on all significant factors can predict the rate of recollapse and gain clinical benefits to prevent recollapse in patients at high risk. BACKGROUND Recollapse of the augmented vertebrae after percutaneous vertebroplasty (PVP) treatment for osteoporotic vertebral compression fractures (OVCFs) has obtained much attention. However, little is known about risk factors and score for recollapse of the augmented vertebrae. OBJECTIVE To determine risk factors and furthermore develop a risk score related to recollapse of the augmented vertebrae after PVP treatment for OVCFs. METHODS Patients who were treated with PVP for single OVCFs and met this study's inclusion criteria were retrospectively reviewed. The follow-up period was at least 2 years. Associations of recollapse with co-variates (age, gender, bone mass density [BMD] with a T-score, fracture level, intravertebral cleft [IVC], fracture type, cement volume, cement leakage, leakage into a disc, cement distribution pattern, Non-PMMA-endplate-contact [NPEC], preoperative fracture severity, reduction rate [RR], reduction angle [RA]) were analyzed and a risk score for recollapse was further developed to predict recollapse. RESULTS A total of 152 patients were included. Recollapse group was found in 42 (27.6%) patients. Preoperative IVC, solid lump cement distribution pattern, more RR (a cutoff value of 7%) and larger RA (a cutoff value of 3°) was significantly associated with increased risk for recollapse of the augmented vertebrae. A risk score was developed based on the number of risk factors present in each patient. Patients with a score of 4 had an approximately ninefold increased risk of developing recollapse over patients with a score of 0. The receiver operating characteristic curve of the risk score generated an area under the curve of 0.899 (95% CI 0.642-0.836, P = 0.000). CONCLUSION A risk score based on preoperative IVC, cement distribution pattern, reduction rate, and reduction angle predicts the rate of recollapse. Additional studies should aim to validate this score and inspect clinical benefits of recollapse prophylaxis in patients at high risk.
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Affiliation(s)
- W B Yu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangxi University of Chinese Medicine, No 89-9 Dongge Road, Nanning, Guangxi, People's Republic of China
| | - X B Jiang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - D Liang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - W X Xu
- Department of Spinal Surgery, Tongde Hospital of Zhejiang Province, Gucui Road 234, Hangzhou, Zhejiang, People's Republic of China
| | - L Q Ye
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - J Wang
- Department of Spinal Surgery, Tongde Hospital of Zhejiang Province, Gucui Road 234, Hangzhou, Zhejiang, People's Republic of China.
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Long-term outcome of treatment of vertebral body hemangiomas with direct ethanol injection and short-segment stabilization. Spine J 2019; 19:131-143. [PMID: 29890263 DOI: 10.1016/j.spinee.2018.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/13/2018] [Accepted: 05/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Vertebral body hemangiomas with myelopathy are difficult to manage. OBJECTIVE The objective of this study was to evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented short-segment fusion in vertebral hemangioma (VH) with myelopathy and long-term outcome (>24 months). CLINICAL MATERIALS AND METHODS This prospective study included symptomatic VH with cord compression with myelopathy. Pathologic fractures and deformity or multilevel pathologies were excluded from the study. Surgery consisted of intraoperative bilateral pedicular absolute alcohol (<1% hydrated ethyl alcohol) injection, laminectomy, and cord decompression at the level of pathology followed by a short-segment instrumented fusion using pedicle screws. RESULTS The study included 33 patients (mean 26.9±13.2, range: 10-68 years, 18 females). The clinical features of the study were myelopathy in all patients (5 paraplegic), sphincter involvement (13), and mid back or lower back pain (7). The preoperative American Spinal Injury Association (ASIA) scores were A (7), B (11), C (6), D (8), and E (1). Majority of the patients had single vertebral involvement (30) and three patients had multiple-level involvement. Six patients underwent surgery earlier (one underwent alcohol embolization). The mean surgical time was 124±39 minutes, and the average blood loss was 274±80 cc. The mean amount of absolute alcohol injected was 14.6±5.7 cc (two patients required 20 and 25 cc). Immediate embolization was achieved in all patients, allowing laminectomy and easy removal of soft-tissue hemangioma. Post surgery, one patient had transient deterioration, and the condition of the rest of the patients improved (sphincters improved in nine patients) at a follow-up ranging 28-103 months (mean 47.6±22.3). Follow-up ASIA scores were E (26), D (4), B (2), and C (1). All patients showed evidence of bone sclerosis and relief of cord compression on follow-up imaging. CONCLUSIONS This is the largest study in literature showing excellent improvement, low reoperation rates after ethanol embolization, and short-segment fixation.
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Nakamae T, Yamada K, Tsuchida Y, Osti OL, Adachi N, Fujimoto Y. Risk Factors for Cement Loosening after Vertebroplasty for Osteoporotic Vertebral Fracture with Intravertebral Cleft: A Retrospective Analysis. Asian Spine J 2018; 12:935-942. [PMID: 30213178 PMCID: PMC6147866 DOI: 10.31616/asj.2018.12.5.935] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/04/2018] [Indexed: 12/19/2022] Open
Abstract
STUDY DESIGN Retrospective case-control study. PURPOSE To evaluate the primary outcomes and radiographic results of percutaneous vertebroplasty (PVP) in patients with singlelevel osteoporotic vertebral fracture (OVF) with intravertebral cleft (IVC) to identify the risk factors for cement loosening after PVP. OVERVIEW OF LITERATURE PVP is a widely accepted method for managing painful OVF; however, cement loosening occasionally occurs with poor outcomes. METHODS This retrospective study involved 195 patients treated with PVP for single-level OVF with IVC. Six months thereafter, the primary outcomes were evaluated using the Visual Analog Scale (VAS) for back pain and the modified Oswestry Disability Index. Computed tomography was conducted to detect cement loosening. Possible risk factors, such as age, sex, wedging angle, intravertebral instability, Parkinson's disease, spinous process fracture, ankylosing spinal hyperostosis, split vertebrae, and adjacent intervertebral vacuum, were assessed. RESULTS Forty-nine patients (25%) experienced cement loosening 6 months after PVP. The mean VAS scores were significantly higher in patients with cement loosening than in those without (50 vs. 26 mm, respectively; p <0.01). Cement loosening was closely associated with intravertebral instability (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.04-1.40; p =0.015), Parkinson's disease (OR, 54.31; 95% CI, 4.47-659.53; p =0.002), spinous process fracture (OR, 7.11; 95% CI, 1.65-30.60; p =0.009), and split vertebrae (OR, 11.59; 95% CI, 1.64-82.02; p =0.014). CONCLUSIONS Patients with cement loosening experienced worse back pain than those without cement loosening. The important risk factors that influenced cement loosening after PVP were high intravertebral instability, Parkinson's disease, spinous process fracture, and split vertebrae.
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Affiliation(s)
- Toshio Nakamae
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Kiyotaka Yamada
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Yasuyuki Tsuchida
- Department of Radiology, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Orso Lorenzo Osti
- Spinal Service, Calvary Health Care, North Adelaide Campus, North Adelaide, SA, Australia
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshinori Fujimoto
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
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Li YX, Guo DQ, Zhang SC, Liang D, Yuan K, Mo GY, Li DX, Guo HZ, Tang Y, Luo PJ. Risk factor analysis for re-collapse of cemented vertebrae after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). INTERNATIONAL ORTHOPAEDICS 2018; 42:2131-2139. [PMID: 29464371 DOI: 10.1007/s00264-018-3838-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/08/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Re-collapse of cemented vertebrae occasionally occurs after percutaneous augmentation. However, the potential risks still remain unclear. Several articles have reported some possible risk factors which were not consistent or comprehensive. This study aimed to make a retrospective review on patients with osteoporotic vertebral compression fracture (OVCF) after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) and to further analyse the risk factors for treated vertebral refracture. METHODS All patients receiving the PKP/PVP with bilateral approach were retrospectively reviewed from January 2014 to January 2016, among whom 230 patients with single level augmentation (30 in refracture group and 200 in the non-refracture group) were enrolled according to inclusion criteria. The following covariates were reviewed: gender, age, height, weight, body mass index (BMI), bone mineral density (BMD), serum bone turnover markers, surgical parameters including approach, cement volume, anterior height, and Cobb angle restoration. Binary logistic regression analysis was used to determine the relative risk of re-collapse of cemented vertebrae. RESULTS Regarding the patient data, weight, BMI, and BMD were of statistical significance in refracture group (P < 0.01), among which only low BMD was a risk factor to cemented vertebral re-collapse (P = 0.022, OR = 4.197). In respect of surgical variables, the better restoration of anterior height and Cobb angle was found in refracture group (P < 0.05), both of which might increase the refracture risk but not be risk factors (P = 0.065, OR = 0.891, and P = 0.937, OR = 0.996, respectively). Besides, less injected cement (3.30 ± 0.84 ml vs 4.46 ± 1.10 ml, P = 0.000, OR = 19.433) and PKP (P = 0.007, OR = 13.332) significantly boosted the potential risk of refracture (P < 0.001). CONCLUSION Patients with low BMD, or undergoing PKP, or receiving a low volume of injected cement might have a high risk of re-collapse in surgical vertebrae.
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Affiliation(s)
- Yong-Xian Li
- The First Clinical Academy, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
- Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Dan-Qing Guo
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
- Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Shun-Cong Zhang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.
- Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China.
| | - De Liang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.
- Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
- First School of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China.
| | - Kai Yuan
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
- Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Guo-Ye Mo
- The First Clinical Academy, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
- Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Da-Xing Li
- The First Clinical Academy, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
- Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Hui-Zhi Guo
- The First Clinical Academy, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
- Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Yongchao Tang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
- Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Pei-Jie Luo
- The First Clinical Academy, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
- Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
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He D, Lou C, Yu W, Zhu K, Wu Z, Liu F, Chen M, Zheng L, Chen Z, Fan S. Cement Distribution Patterns Are Associated with Recompression in Cemented Vertebrae After Percutaneous Vertebroplasty: A Retrospective Study. World Neurosurg 2018; 120:e1-e7. [PMID: 29945011 DOI: 10.1016/j.wneu.2018.06.113] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To reevaluate the cement distribution patterns and further investigate associations between cement distribution patterns and the occurrence rates of recompression in cemented vertebrae after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures. METHODS Two hundred twenty-four patients with a mean age of 71.9 years were enrolled and treated with single-level PVP between June 2012 and July 2015. The mean follow-up time was 16.5 months. Data from medical records and radiographs were collected and analyzed. Cement distribution patterns were divided into 4 cement distribution patterns extending from the traditional 2 patterns: interlocked solid pattern (LS) and uninterlocked solid pattern (ULS); contiguous trabecular pattern (CT) and discontiguous trabecular pattern (DCT). Differences in treatment efficacy and the occurrence rates of recompression in cemented vertebrae were compared for both groups using the Wilcoxon rank sum test and chi-squared test. RESULTS Thirty-seven patients who underwent PVP developed recompression in cemented vertebrae. Recompression in cemented vertebrae was significantly more frequent in the ULS and DCT groups than in the LS and CT groups (P < 0.05 or 0.001), with the Visual Analogue Scale score at the time of final follow-up was also significantly higher in the ULS and DCT groups (P < 0.001). CONCLUSIONS Significant associations were found between cement distribution patterns and recompression in cemented vertebrae, which affected the clinical outcome in patients after PVP. A higher incidence of recompression in cemented vertebrae was seen in patients with treated vertebrae exhibiting ULS pattern or DCT pattern.
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Affiliation(s)
- Dengwei He
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Chao Lou
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Weiyang Yu
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Kejun Zhu
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Zhongwei Wu
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Feijun Liu
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Minjiang Chen
- Department of Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Lin Zheng
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Zhenzhong Chen
- Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Shunwu Fan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Optimizing bone cement stiffness for vertebroplasty through biomechanical effects analysis based on patient-specific three-dimensional finite element modeling. Med Biol Eng Comput 2018; 56:2137-2150. [DOI: 10.1007/s11517-018-1844-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/09/2018] [Indexed: 12/24/2022]
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Is Redo Vertebroplasty an Effective Treatment on the Same Vertebra? Cardiovasc Intervent Radiol 2018; 41:1058-1066. [PMID: 29511869 DOI: 10.1007/s00270-018-1920-5] [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: 11/01/2017] [Accepted: 02/21/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Redo vertebroplasty is rarely reported. Previous studies on redo vertebroplasty included a small number of patients and lacked radiographic analysis. The purpose of this study was to assess the radiographic outcomes (restoration of vertebral body) and clinical outcomes (pain relief) in patients with recurrent or unrelieved pain after vertebroplasty with a minimum follow-up duration of 12 months. MATERIALS AND METHODS The records of 22 patients (23 cases), who underwent redo vertebroplasty between March 2001 and February 2014, were analyzed. Vertebral height loss (VHL) and wedge angle (WA) were measured before and after redo vertebroplasty. Subjective back pain was assessed via the numeric rating scale (NRS) score. RESULTS VHL after the initial vertebroplasty was 18.7%. Preoperative and final VHL of redo vertebroplasty were 32.3 and 18.3%, respectively. WA after initial vertebroplasty was 9.5°. Preoperative and final WA of redo vertebroplasty was 13.9° and 9°, respectively. Changes of VHL and WA values at each time point were significant (p < 0.01). The change of NRS pain score at each time point, including the period between post-initial vertebroplasty and final follow-up, was statistically significant (p < 0.01); 18 patients (82%) showed marked pain relief and 4 patients (18%) showed partial pain relief. CONCLUSIONS Redo vertebroplasty seems to be an effective way to achieve pain relief and vertebral body height restorations without major complications in patients with unrelieved or recurrent back pain after vertebroplasty. LEVEL OF EVIDENCE Level 4, case series.
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Yu W, Xu W, Jiang X, Liang D, Jian W. Risk Factors for Recollapse of the Augmented Vertebrae After Percutaneous Vertebral Augmentation: A Systematic Review and Meta-Analysis. World Neurosurg 2017; 111:119-129. [PMID: 29253703 DOI: 10.1016/j.wneu.2017.12.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/01/2017] [Accepted: 12/04/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Recollapse of the augmented vertebrae after percutaneous vertebral augmentation treatment for osteoporotic vertebral compression fractures has obtained much attention. Although many potential risk factors have been proposed, they are still disputed. The aim of our study was to identify the characteristics of the augmented vertebrae that had undergone a recollapse according to a systematic review from the earliest available records up to August 2017 and then conduct a meta-analysis based on eligible studies to assess significant potential risk factors for recollapse of the augmented vertebrae. METHODS Fourteen studies were identified for investigating recollapse of the augmented vertebrae. Of those studies, 9 studies were eligible for meta-analysis. RESULTS Pooled results showed that 5 primary factors were associated with recollapse of the augmented vertebrae, including preoperative intravertebral cleft, the affected vertebrae in the thoracolumbar region, preoperative severe kyphotic deformity, solid lump cement distribution pattern, and higher vertebral height restoration. It was possibly another risk factor that the distance between PMMA and superior end plate was relatively large. CONCLUSIONS Careful observation of patients with these risk factors and reasonable intervention could be useful to prevent deterioration of their clinical course.
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Affiliation(s)
- Weibo Yu
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Weixing Xu
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Xiaobing Jiang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - De Liang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Wang Jian
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China.
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Guo Z, Wang W, Gao WS, Gao F, Wang H, Ding WY. Comparison the clinical outcomes and complications of high-viscosity versus low-viscosity in osteoporotic vertebral compression fractures. Medicine (Baltimore) 2017; 96:e8936. [PMID: 29310386 PMCID: PMC5728787 DOI: 10.1097/md.0000000000008936] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To compare the clinical outcomes and complications of high viscosity and low viscosity bone cement percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF).From September 2009 to September 2015, 100 patients with OVCF were randomly divided into 2 groups: group H, using high viscosity cement (n = 50) or group L, using low viscosity cement (n = 50). The clinical outcomes were assessed by the visual analog scale (VAS), Oswestry Disability Index (ODI), kyphosis Cobb angle, vertebral height, and complications.Significant improvements in the VAS, ODI, kyphosis Cobb angle, and vertebral height were noted in both groups, and the VAS score in the H group showed greater benefit than in the L group. Cement leakage was observed less in group H. Postoperative assessment using computed tomography identified cement leakage in 27 of 98 (27.6%) vertebrae in group H and in 63 of 86 (73.3%) vertebrae in group L (P = .025).Compared with PVP using low viscosity bone cement, PVP using high viscosity bone cement can provide the same clinical outcomes with fewer complications and is recommended for routine clinical use.
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Affiliation(s)
- Zhao Guo
- Department of Spine Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang
| | - Wei Wang
- Department of Spine Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang
| | - Wen-shan Gao
- Department of Orthopedics, the Affiliated Hospital of Hebei University, Baoding, China
| | - Fei Gao
- Department of Orthopedics, the Affiliated Hospital of Hebei University, Baoding, China
| | - Hui Wang
- Department of Spine Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang
| | - Wen-Yuan Ding
- Department of Spine Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang
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Abstract
RATIONALE Balloon kyphoplasty is a widely accepted treatment of osteoporotic vertebral compression fractures (OVCFs) with good results and a low risk for complications. A refracture of previously treated vertebra is a relatively rare condition. PATIENT CONCERNS We reported our 3 cases and reviewed all relevant literatures of 11 cases with refracture of osteoporotic vertebral body after kyphoplasty. DIAGNOSES Follow-up radiographs or magnetic resonance imaging examination confirmed refractures of previously treated vertebrae after kyphoplasty. INTERVENTIONS One patient with 1 refracture of osteoporotic vertebral body after kyphoplasty was treated conservatively, but the other 2 patients were treated surgically because of multiple vertebral fractures or neurological deficits. OUTCOMES The average age of the patients was 76.8 years (range, 63-86 years). All the patients had severe osteoporosis with a mean T-score of -3.46 (range -5.0 to -3.0). The sites of refractures are in the lumbar and thoracolumbar regions. Severe osteoporosis, the presence of intravertebral cleft, and a solid lump injection pattern of polymethylmethacrylate would result in insufficient strengthening effects of cement augmentation and therefore increased the likelihood of refractures of the kyphoplasty vertibrae. LESSONS Patients with OVCFs and intravertebral cleft who did not obtain complete pain-relief at the treated vertebral level after kyphoplasty should be strictly followed up. Early finding of this condition and rapid intervention might contribute to avoiding the occurrence of the cemented vertebral refracture after kyphoplasty. Conservative treatments such as back brace and antiosteoporotic medications were strongly recommended.
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Jacobson RE, Palea O, Granville M. Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra. Cureus 2017; 9:e1776. [PMID: 29255655 PMCID: PMC5732011 DOI: 10.7759/cureus.1776] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
It is well recognized that patients can develop additional vertebral compression fractures (VCF) in an adjacent vertebra or at another vertebral level after successful vertebral augmentation. Factors such as the patient's bone mineral density, post procedure activity, and chronic corticosteroid use contribute to an increased risk of re-fracture or development of new fractures in the first three months after the initial procedure. However, there is a very small subgroup of patients that have unchanged or worse pain after the vertebral augmentation that may indicate continued progression of the treated compression fracture or a recurrent fracture at the previously treated level. This review examines the clinical findings, radiologic signs, and intraprocedural technical failures that may occur during the initial vertebral augmentation that can lead to a progressive fracture in a previously treated vertebra. Causes of failure of the initial vertebral augmentation procedure include inadequate or incomplete filling of the fracture site, the cement missing the actual fracture allowing continued osteoporotic compression, and persistent or worsened intravertebral fluid-filled clefts. The existence of an unfilled intravertebral fluid cleft on preoperative diagnostic studies is the most important indicator of risk for progression as is the later development of fluid at the bone cement interface.
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Affiliation(s)
| | - Ovidiu Palea
- Anesthesiology and Pain Management, Provita Hospital
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Chen YJ, Chen HY, Chen HT, Lin RM, Hsu HC. Diagnosis of painful cemented vertebrae from failed vertebroplasty: modified dynamic radiographs play an important role. 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 2017; 26:1953-1960. [PMID: 28364334 DOI: 10.1007/s00586-017-5056-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 02/10/2017] [Accepted: 03/21/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The diagnosis of painful cemented vertebrae resulting from failed PV is not clearly defined in literature. This report evaluates the effectiveness of modified dynamic radiographs in diagnosing painful cemented vertebrae resulting from failed PV. METHODS From January 2011 to June 2015, 345 patients with a total of 399 VCFs underwent PV at our institution. Among the 345 patients, 27 patients underwent repeated PV at the cemented vertebrae because of persisting or recurrent pain after vertebroplasty. The prevertebroplasty examinations included routine radiographs, modified dynamic radiographs, and MRI. Kyphotic angles and the anterior vertebral body height (AVBH) were measured. The image findings in routine radiographs, modified dynamic radiographs, and MRI were compared. Finally, a visual analog scale was used to measure the outcome. RESULTS The patients ranged in age from 67 to 90 years. MRI revealed a moderate amount of fluid (definite diagnosis of refracture) in the cemented vertebrae in seven patients, bone edema without fluid in nine patients, and bone edema with minimal fluid in ten patients. The rate of diagnosis of painful cemented vertebrae according to MRI was 27% (7/26). The difference in the kyphotic angle between sitting and supine cross-table lateral radiographs was -9.36° ± 5.20° (P < 0.001). The difference in AVBH was 8.08 ± 3.21 mm (P < 0.001). All 27 patients were confirmed to have dynamic mobility according to the modified dynamic radiographs. CONCLUSIONS When the diagnosis of painful cemented vertebrae is questionable, modified dynamic radiographs can help diagnose painful cemented vertebrae resulting from failed PV.
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Affiliation(s)
- Yen-Jen Chen
- Department of Orthopedic Surgery, School of Medicine, China Medical University, No. 91, Hsueh-Shuh Road, Taichung, 40402, Taiwan. .,Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, 40402, Taiwan. .,Department of Public Health, China Medical University, No. 91, Hsueh-Shuh Road, Taichung, 40402, Taiwan. .,Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shuh Road, Taichung, 40402, Taiwan.
| | - Hui-Yi Chen
- Department of Radiology, Children's Hospital, China Medical University Hospital, China Medical University, No. 2, Yuh-Der Road, Taichung, 40402, Taiwan
| | - Hsien-Te Chen
- Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, 40402, Taiwan.,School of Chinese Medicine, College of Chinese Medicine, China Medical University, No. 91, Hsueh-Shuh Road, Taichung, 40402, Taiwan
| | - Ruey-Mo Lin
- Department of Orthopedic Surgery, Tainan Municipal An-Nan Hospital, No. 66, Sec. 2, Changhe Rd., Annan Dist., Tainan, 709, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung, 40402, Taiwan.,School of Medicine, China Medical University, No. 91, Hsueh-Shuh Road, Taichung, 40402, Taiwan
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Zhang L, Wang Q, Wang L, Shen J, Zhang Q, Sun C. Bone cement distribution in the vertebral body affects chances of recompression after percutaneous vertebroplasty treatment in elderly patients with osteoporotic vertebral compression fractures. Clin Interv Aging 2017; 12:431-436. [PMID: 28260871 PMCID: PMC5327848 DOI: 10.2147/cia.s113240] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective Percutaneous vertebroplasty (PVP) is a surgical procedure that has been widely used to treat patients suffering from osteoporotic vertebral compression fractures (OVCFs). The procedure involves injection of bone cement into a fractured vertebra. In this study, we investigated whether the distribution of the cement in the vertebral body is related to the occurrence of recompression after surgery. Patients and methods A total of 172 patients diagnosed with OVCF, from January 2008 to June 2013, were retrospectively reviewed. Fifty of these patients experienced recompression after surgery during the follow-up period (recompression group), and 122 patients had no recompression observed during the follow-up period (control group). Statistical analysis was performed to compare clinical and operative parameters between these two groups. Results Differences were found in bone cement distribution between the recompression group and control group (P=0.001). Patients with bone cement distributed around both upper and lower endplates had a significantly less incidence of recompression (4/50 patients), when compared to other patterns of cement distribution (eg, below upper endplate, above lower endplate, and in the middle of vertebral body). The logistic multiple regression analysis also indicated that patients with bone cement distributed around both the upper and lower endplates had a lower risk of recompression when compared to patients with bone cement distributed in the middle of vertebral body (odds ratio =0.223, P=0.003). Conclusion We herein suggest that the control of bone cement distribution during surgery provides beneficial effects on reducing the risks of recompression after PVP treatment in patients with OVCF.
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Affiliation(s)
- Liang Zhang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, People's Republic of China
| | - Qiang Wang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, People's Republic of China
| | - Lin Wang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, People's Republic of China
| | - Jian Shen
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, People's Republic of China
| | - Qiwei Zhang
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, People's Republic of China
| | - Changtai Sun
- Department of Orthopedics, Beijing Hospital, National Center of Gerontology, People's Republic of China
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