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Sönmez E, Tekin A, Oğuzhanasiltürk DÜ, Anlı E, Ayhan L, Dilbaz S, Öztürk A, Baş NS, Işık S, Çevik S. The effect of paraspinal muscle morphology on the development of osteoporotic lumbar vertebral fractures. J Back Musculoskelet Rehabil 2025:10538127251340350. [PMID: 40375820 DOI: 10.1177/10538127251340350] [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] [Indexed: 05/18/2025]
Abstract
BackgroundVertebral compression fractures associated with osteoporosis reduce daily living activities. The primary risk factor for osteoporotic vertebral fractures (OVCFs) is the severity of osteoporosis, defined as low bone mineral density (BMD) in both peripheral and central regions. In addition to BMD, sarcopenia is also thought to affect OVCFs by reducing paraspinal muscle mass and strength.ObjectiveWe aimed to evaluate the association between vertebral compression fractures and paraspinal/psoas muscle characteristics, including muscle mass and fatty degeneration, using quantitative MRI measurements.MethodsWe retrospectively enrolled 77 patients aged ≥60 years who were diagnosed with acute OVCF between January 2019 and August 2023. The control group consisted of age- and sex-matched patients with osteoporosis (BMD > -2.5) who were followed up without fractures for at least six months. Demographic characteristics, relative total cross-sectional area (rTCSA) and relative functional CSA (rFCSA) of the multifidus (MF), erector spinae (ES), and psoas major (PS) were measured at the L4-5 and L5-S levels on MRI.ResultsThe TCSA and rTCSA of the multifidus (MF) and erector spinae (ES) muscles at both the L4-5 and L5-S1 levels did not show significant differences between the control and OVCF groups. (all p value > 0.05) The mean FCSAL4-5 of the MF 8.97 ± 2.81, ES 16.73 ± 6.49, the mean FCSAL5-1 of the MF 9.43 ± 3.27, ES 10.76 ± 5.79 in the fracture group, while the mean FCSAL4-5 of the MF 11.39 ± 2.6, ES 19.35 ± 4.04, the mean FCSAL5-1 of the MF 13.42 ± 2.56, ES 14.11 ± 4.6 in the non-fracture group. (PMFL4-5 < 0.001, PMFL5-1 < 0.001, PESL4-5 = 0.003, PESL5-1 < 0.001) The mean TCSA of the psoas muscle was significantly higher in the fracture group (17.65 ± 6.21) than in the control group (15.9 ± 4.14) (p = 0.042). Despite the significantly larger total psoas muscle mass in the fracture group, the rFCSA of the psoas muscle was lower in the fracture group (0.81 ± 0.27) compared to the control group (0.89 ± 0.25) (p = 0.046).ConclusionsThe study shows that the functional muscle mass of the paraspinal muscles is significantly lower in patients with osteoporotic vertebral compression fractures (OVCF) as compared to those without fractures. Quantitative measurement of the functional capacity of the paraspinal muscles using MRI can effectively predict the risk of OVCF and enable early intervention and adopt preventive measures to reduce the incidence of these fractures.
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Affiliation(s)
- Evren Sönmez
- Department of Neurosurgery, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| | - Abdurrahim Tekin
- Department of Neurosurgery, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| | - Dilek Ün Oğuzhanasiltürk
- Department of Physical Therapy and Rehabilitation, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| | - Ergin Anlı
- Department of Neurosurgery, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| | - Lokman Ayhan
- Department of Neurosurgery, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| | - Suna Dilbaz
- Department of Neurosurgery, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| | - Akın Öztürk
- Department of Neurosurgery, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| | - Nuri Serdar Baş
- Department of Neurosurgery, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| | - Semra Işık
- Department of Neurosurgery, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| | - Serdar Çevik
- Department of Neurosurgery, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
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Cho C, Hills J, Anderson P, Annaswamy T, Cassidy RC, Craig C, DeMicco R, Easa J, Kreiner S, Mazanec D, O'Toole J, Rappard G, Ravinsky R, Schoenfeld A, Shin J, Whitcomb G, Reitman C. Appropriate Use Criteria for Osteoporotic Compression Fractures. Spine J 2025:S1529-9430(25)00100-7. [PMID: 40049451 DOI: 10.1016/j.spinee.2025.02.007] [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: 10/01/2024] [Revised: 01/22/2025] [Accepted: 02/22/2025] [Indexed: 03/23/2025]
Abstract
BACKGROUND CONTEXT There is a lack of consensus regarding optimal indications for treatment of patients with osteoporotic vertebral fractures. An opportunity exists to improve outcomes if these indications can be clarified. PURPOSE The purpose of the North American Spine Society (NASS) Appropriate Use Criteria (AUC) was to determine the appropriate (i.e. reasonable) multidisciplinary treatment recommendations for patients with osteoporotic vertebral fractures across a spectrum of more common clinical scenarios. STUDY DESIGN A Modified Delphi process. PATIENT SAMPLE Modified consensus based guideline OUTCOME MEASURES: Final rating for treatment recommendations as either "Appropriate", "Uncertain", or "Rarely Appropriate" based on the median final rating among the raters. METHODS The methodology was based on the AUC development process established by the Research AND Development (RAND) Corporation. The topic of osteoporotic vertebral compression fracture was selected by NASS for its Clinical Practice Guideline development (CPG). In conjunction, the AUC committee determined key modifiers and adapted the standard definitions developed by the CPG with minimal modifications. A literature search and evidence analysis performed by the CPG were reviewed by the AUC work group. A separate multidisciplinary rating group was assembled. Clinical scenarios were generated based on a matrix of the modifiers, to rate the appropriateness of medical management, cement augmentation, or surgery. Based on the literature, provider experience, and group discussion, each scenario was scored on a nine-point scale on two separate occasions: once without discussion and again following discussion of the initial responses. The median rating for each scenario and level of agreement was then used to determine final indications as rarely appropriate with agreement (1 - 3), uncertain or disagreement (4-6), or appropriate with agreement (7-9). Consensus was not mandatory. RESULTS Medical management was appropriate across all scenarios. Cement augmentation was rarely appropriate in 60% of scenarios and uncertain or disagreement in 35% of scenarios. In the 5% of scenarios rated as appropriate with agreement for cement augmentation, high pain scores, acute duration, and simple fracture pattern were always present. Surgery was appropriate in 35% of scenarios and strongly influenced by instability and stenosis with neurological findings. Surgery was rarely appropriate in 18%, and uncertain or disagreement in 47% of scenarios. CONCLUSIONS Multidisciplinary appropriate treatment criteria for osteoporotic vertebral fractures were generated based on the RAND methodology. This document provides comprehensive evidence-based recommendations for evaluation and treatment of osteoporotic vertebral fractures. The document in its entirety will be found on the NASS website (https://www.spine.org/Research-Clinical-Care/Quality-Improvement/Appropriate-Use-Criteria).
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Affiliation(s)
| | | | | | | | | | | | | | - John Easa
- Center For Advanced Interventional Spine Treatment
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Cho CH, Hwang SW, Mazanec DJ, O'Toole JE, Watters WC, Annaswamy TM, Brook AL, Cheng DS, Christie SD, Cupler ZA, Enix DE, Eskay-Auerbach M, Goehl JM, Jones GA, Kalakoti P, Kasliwal MK, Kavadi NU, Kilincer C, Lantz JM, Rahmathulla G, Reinsel T, Shaw KA, Shawky Abdelgawaad A, Skuteris AM, Stone JA, Strayer AL, Vo AN. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of adults with osteoporotic vertebral compression fractures. Spine J 2025:S1529-9430(25)00066-X. [PMID: 39894268 DOI: 10.1016/j.spinee.2025.01.016] [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: 10/23/2024] [Revised: 12/19/2024] [Accepted: 01/09/2025] [Indexed: 02/04/2025]
Abstract
BACKGROUND CONTEXT The North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Adults with Osteoporotic Vertebral Compression Fractures features evidence-based recommendations for diagnosing and treating adult patients with osteoporotic vertebral compression fractures. The guideline is intended to reflect contemporary treatment concepts for osteoporotic vertebral compression fractures as reflected in the highest quality clinical literature available on this subject as of September 2020. PURPOSE The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with osteoporotic vertebral compression fractures. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition. STUDY DESIGN This is a guideline summary review. METHODS This guideline is the product of NASS' Clinical Practice Guidelines Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with a medical librarian. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guideline was submitted to an internal and external peer review process and ultimately approved by the NASS Board of Directors. RESULTS Twenty-nine clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature. CONCLUSIONS The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with osteoporotic vertebral compression fractures. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at http://www.spine.org/guidelines.
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Affiliation(s)
- Charles H Cho
- Mass General Brigham (MGB), Harvard Medical School, Boston, MA, USA.
| | - Steven W Hwang
- Department of Orthopedic Surgery, Shriners Children's Philadelphia, Philadelphia, PA, USA
| | | | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - William C Watters
- Department of Orthopedics, University of Texas Medical Branch, Galveston, TX, USA; Department of Orthopedics, Michael DeBakey VA Medical Center, Houston, TX, USA
| | - Thiru M Annaswamy
- Department of Physical Medicine & Rehabilitation, Penn State Health Milton S. Hershey Medical Center and Penn State College of Medicine, Hershey, PA, USA
| | | | - David S Cheng
- Department of Physical Medicine and Rehabilitation, Charles Drew University, Los Angeles, CA, USA
| | - Sean D Christie
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada; Department of Surgery (Neurosurgery), Nova Scotia Health, Halifax, NS, Canada
| | - Zachary A Cupler
- Physical Medicine & Rehabilitative Service, Butler VA Health Care System, Butler, PA, USA
| | - Dennis E Enix
- Department of Research, Logan University - retired, St. Louis, MO, USA
| | | | - Justin M Goehl
- Department of Community and Family Medicine, Dartmouth Health, Lebanon, NH, USA
| | | | - Piyush Kalakoti
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Manish K Kasliwal
- University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Niranjan U Kavadi
- Oklahoma City VA Medical Center, Department of Orthopedic Surgery University of Oklahoma Health Sciences, Oklahoma City, OK, USA
| | - Cumhur Kilincer
- Trakya University Faculty of Medicine, Neurosurgery Department, Edirne, Türkiye
| | - Justin M Lantz
- Division of Biokinesiology and Physical Therapy, Department of Family Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Tom Reinsel
- Cincinnati VA Medical Center, Cincinnati, OH, USA
| | - K Aaron Shaw
- Department of Pediatric Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Ahmed Shawky Abdelgawaad
- Spine Center, Helios Hospitals Erfurt, Erfurt, Germany; Department of Orthopedics and Trauma, Assiut University Hospitals, Assiut, Egypt
| | | | - Jeffrey A Stone
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Andrea L Strayer
- Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, IA, USA;; VA Quality Scholar, VA Iowa City Healthcare System, Iowa City, IA, USA
| | - Andrew N Vo
- Orthopaedic Associates of Wisconsin, Pewaukee, WI, USA
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Xiong Y, Zhang C, Chen X, Wu L, Liang S, Zhang Y, Huang J, Guo W, Zeng X, Xu F. Prediction of Subsequent Vertebral Fracture After Acute Osteoporotic Fractures from Clinical and Paraspinal Muscle Features. Calcif Tissue Int 2024; 114:614-624. [PMID: 38714533 PMCID: PMC11090933 DOI: 10.1007/s00223-024-01209-0] [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: 11/28/2023] [Accepted: 03/25/2024] [Indexed: 05/10/2024]
Abstract
To construct a nomogram based on clinical factors and paraspinal muscle features to predict vertebral fractures occurring after acute osteoporotic vertebral compression fracture (OVCF). We retrospectively enrolled 307 patients with acute OVCF between January 2013 and August 2022, and performed magnetic resonance imaging of the L3/4 and L4/5 intervertebral discs (IVDs) to estimate the cross-sectional area (CSA) and degree of fatty infiltration (FI) of the paraspinal muscles. We also collected clinical and radiographic data. We used univariable and multivariable Cox proportional hazards models to identify factors that should be included in the predictive nomogram. Post-OVCF vertebral fracture occurred within 3, 12, and 24 months in 33, 69, and 98 out of the 307 patients (10.8%, 22.5%, and 31.9%, respectively). Multivariate analysis revealed that this event was associated with percutaneous vertebroplasty treatment, higher FI at the L3/4 IVD levels of the psoas muscle, and lower relative CSA of functional muscle at the L4/5 IVD levels of the multifidus muscle. Area under the curve values for subsequent vertebral fracture at 3, 12, and 24 months were 0.711, 0.724, and 0.737, respectively, indicating remarkable accuracy of the nomogram. We developed a model for predicting post-OVCF vertebral fracture from diagnostic information about prescribed treatment, FI at the L3/4 IVD levels of the psoas muscle, and relative CSA of functional muscle at the L4/5 IVD levels of the multifidus muscle. This model could facilitate personalized predictions and preventive strategies.
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Affiliation(s)
- Yuchao Xiong
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Cici Zhang
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Xiaopei Chen
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Li Wu
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Shaohua Liang
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Ye Zhang
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Junbing Huang
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Wei Guo
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Xuwen Zeng
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China.
| | - Fan Xu
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China.
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Ma Y, Lu Q, Wang X, Wang Y, Yuan F, Chen H. Establishment and validation of a nomogram for predicting new fractures after PKP treatment of for osteoporotic vertebral compression fractures in the elderly individuals. BMC Musculoskelet Disord 2023; 24:728. [PMID: 37700293 PMCID: PMC10496219 DOI: 10.1186/s12891-023-06801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 08/16/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND To investigate the risk factors for new vertebral compression fractures (NVCFs) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) and to create a nomogram to predict the occurrence of new postoperative fractures. METHODS This was a retrospective analysis of the clinical data of 529 OVCF patients who received PKP treatment in our hospital from June 2017 to June 2020. Based on whether there were new fractures within 2 years after surgery, the patients were divided into a new fracture group and a nonnew fracture group. Univariate and multivariate analyses were used to determine the risk factors for the occurrence of NVCFs after surgery. The data were randomly divided into a training set (75%) and a testing set (25%). Nomograms predicting the risk of NVCF occurrence were created based on the results of the multivariate analysis, and performance was evaluated using receiver operating characteristic curves (ROCs), calibration curves, and decision curve analyses (DCAs). A web calculator was created to give clinicians a more convenient interactive experience. RESULTS A total of 56 patients (10.6%) had NVCFs after surgery. The univariate analysis showed significant differences in sex and the incidences of cerebrovascular disease, a positive fracture history, and bone cement intervertebral leakage between the two groups (P < 0.05). The multivariate analysis showed that sex [OR = 2.621, 95% CI (1.030-6.673), P = 0.043], cerebrovascular disease [OR = 28.522, 95% CI (8.749-92.989), P = 0.000], fracture history [OR = 12.298, 95% CI (6.250-24.199), P = 0.000], and bone cement intervertebral leakage [OR = 2.501, 95% CI (1.029-6.082), P = 0.043] were independent risk factors that were positively associated with the occurrence of NVCFs. The AUCs of the model were 0.795 (95% CI: 0.716-0.874) and 0.861 (95% CI: 0.749-0.974) in the training and testing sets, respectively, and the calibration curves showed high agreement between the predicted and actual states. The areas under the decision curve were 0.021 and 0.036, respectively. CONCLUSION Female sex, cerebrovascular disease, fracture history and bone cement intervertebral leakage are risk factors for NVCF after PKP. Based on this, a highly accurate nomogram was developed, and a webpage calculator ( https://new-fracture.shinyapps.io/DynNomapp/ ) was created.
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Affiliation(s)
- Yiming Ma
- Department of Orthopaedic Surgery, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
- Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Qi Lu
- Department of Orthopaedic Surgery, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
- Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Xuezhi Wang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
- Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Yalei Wang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
- Xuzhou Medical University, Xuzhou, 221004 Jiangsu China
| | - Feng Yuan
- Department of Orthopaedic Surgery, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
| | - Hongliang Chen
- Department of Orthopaedic Surgery, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
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Yu W, Zhang H, Yao Z, Zhong Y, Jiang X, Cai D. Prediction of subsequent vertebral compression fractures after thoracolumbar kyphoplasty: a multicenter retrospective analysis. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:949-956. [PMID: 37014374 DOI: 10.1093/pm/pnad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/15/2023] [Accepted: 03/17/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE Second fractures at the cemented vertebrae (SFCV) are often seen after percutaneous kyphoplasty, especially at the thoracolumbar junction. Our study aimed to develop and validate a preoperative clinical prediction model for predicting SFCV. METHODS A cohort of 224 patients with single-level thoracolumbar osteoporotic vertebral fractures (T11-L2) from 3 medical centers was analyzed between January 2017 and June 2020 to derive a preoperative clinical prediction model for SFCV. Backward-stepwise selection was used to select preoperative predictors. We assigned a score to each selected variable and developed the SFCV scoring system. Internal validation and calibration were conducted for the SFCV score. RESULTS Among the 224 patients included, 58 had postoperative SFCV (25.9%). The following preoperative measures on multivariable analysis were summarized in the 5-point SFCV score: bone mineral density (≤-3.05), serum 25-hydroxy vitamin D3 (≤17.55 ng/mL), standardized signal intensity of fractured vertebra on T1-weighted images (≤59.52%), C7-S1 sagittal vertical axis (≥3.25 cm), and intravertebral cleft. Internal validation showed a corrected area under the curve of 0.794. A cutoff of ≤1 point was chosen to classify a low risk of SFCV, for which only 6 of 100 patients (6%) had SFCV. A cutoff of ≥4 points was chosen to classify a high risk of SFCV, for which 28 of 41 (68.3%) had SFCV. CONCLUSION The SFCV score was found to be a simple preoperative method for identification of patients at low and high risk of postoperative SFCV. This model could be applied to individual patients and aid in the decision-making before percutaneous kyphoplasty.
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Affiliation(s)
- Weibo Yu
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Haiyan Zhang
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Zhensong Yao
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Yuanming Zhong
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, People's Republic of China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Daozhang Cai
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China
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Lin S, Cai X, Cheng Q, Chen C, Cao X, Yang F, Fan Y. Association between bone turnover markers, BMD and height loss of cemented vertebrae after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. J Orthop Surg Res 2022; 17:202. [PMID: 35379274 PMCID: PMC8981862 DOI: 10.1186/s13018-022-03087-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/21/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction Percutaneous vertebroplasty (PVP) was recently performed for treating patients with osteoporotic vertebral compression fractures (OVCF). However, recompression of cemented vertebra with significant vertebral height loss occurred in the patients after PVP was observed during the follow-up period. The purpose is to explore the risk factors among several potential predictors for the height loss of treated vertebral bodies after PVP in patients with OVCF. Methods A study of 93 patients who had undergone PVP between May 1, 2016, and March 1, 2019, at the Spine Center of Huadong Hospital Affiliated to Fudan University was conducted. The fractured vertebral height loss ratio ≥ 15% at final follow-up were defined as cemented vertebra recompression. The following variables were measured and collected: age, gender, body mass index (BMI), bone mineral density (BMD), volume of bone cement injected, bone cement leakage, fractured vertebra segment, contact between bone cement and endplates, serum of calcium and phosphorus, and six kinds of bone turnover markers. Results Mann–Whitney U test and Univariate Logistic regression analysis showed that the cemented vertebra recompression was correlated with BMD, contact between bone cement and endplates, parathyroid hormone (PTH), and 25-hydroxy vitamin D3 (25-OH-D3). Following multivariate modeling, multiple factors logistic regression elucidated that high BMD (P < 0.001, OR = 0.089) and high level of serum 25-OH-D3 (P = 0.012, OR = 0.877) were negatively correlated with the cemented vertebra recompression after PVP. Conclusion Decreased BMD and lower level of serum 25-OH-D3 might be two critical and significant risk factors for the height loss of cemented vertebrae after PVP.
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Affiliation(s)
- Shangjin Lin
- Department of Orthopeadic, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Xiaoxi Cai
- Department of Orthopeadic, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Qun Cheng
- Department of Osteoporosis and Bone Disease, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Cong Chen
- Department of Orthopeadic, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Xuhai Cao
- Department of Orthopeadic, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Fengjian Yang
- Department of Orthopeadic, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Yongqian Fan
- Department of Orthopeadic, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China.
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Hijikata Y, Kamitani T, Nakahara M, Kumamoto S, Sakai T, Itaya T, Yamazaki H, Ogawa Y, Kusumegi A, Inoue T, Yoshida T, Furue N, Fukuhara SI, Yamamoto Y. Development and internal validation of a clinical prediction model for acute adjacent vertebral fracture after vertebral augmentation : the AVA score. Bone Joint J 2022; 104-B:97-102. [PMID: 34969274 DOI: 10.1302/0301-620x.104b1.bjj-2021-0151.r3] [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] [Indexed: 11/05/2022]
Abstract
AIMS To develop and internally validate a preoperative clinical prediction model for acute adjacent vertebral fracture (AVF) after vertebral augmentation to support preoperative decision-making, named the after vertebral augmentation (AVA) score. METHODS In this prognostic study, a multicentre, retrospective single-level vertebral augmentation cohort of 377 patients from six Japanese hospitals was used to derive an AVF prediction model. Backward stepwise selection (p < 0.05) was used to select preoperative clinical and imaging predictors for acute AVF after vertebral augmentation for up to one month, from 14 predictors. We assigned a score to each selected variable based on the regression coefficient and developed the AVA scoring system. We evaluated sensitivity and specificity for each cut-off, area under the curve (AUC), and calibration as diagnostic performance. Internal validation was conducted using bootstrapping to correct the optimism. RESULTS Of the 377 patients used for model derivation, 58 (15%) had an acute AVF postoperatively. The following preoperative measures on multivariable analysis were summarized in the five-point AVA score: intravertebral instability (≥ 5 mm), focal kyphosis (≥ 10°), duration of symptoms (≥ 30 days), intravertebral cleft, and previous history of vertebral fracture. Internal validation showed a mean optimism of 0.019 with a corrected AUC of 0.77. A cut-off of ≤ one point was chosen to classify a low risk of AVF, for which only four of 137 patients (3%) had AVF with 92.5% sensitivity and 45.6% specificity. A cut-off of ≥ four points was chosen to classify a high risk of AVF, for which 22 of 38 (58%) had AVF with 41.5% sensitivity and 94.5% specificity. CONCLUSION In this study, the AVA score was found to be a simple preoperative method for the identification of patients at low and high risk of postoperative acute AVF. This model could be applied to individual patients and could aid in the decision-making before vertebral augmentation. Cite this article: Bone Joint J 2022;104-B(1):97-102.
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Affiliation(s)
- Yasukazu Hijikata
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Spine and Low Back Pain Center, Kitasuma Hospital, Hyogo, Japan
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Shinji Kumamoto
- Department of Spinal Surgery, Fukuoka Kinen Hospital, Fukuoka, Japan
| | - Tsubasa Sakai
- Department of Orthopaedic Surgery, Fukuoka Seisyukai Hospital, Fukuoka, Japan
| | - Takahiro Itaya
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Ogawa
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Kusumegi
- Department of Spine and Spine Surgery, Shinkomonji Hospital, Fukuoka, Japan
| | - Takafumi Inoue
- Department of Spine Surgery, Shintakeo Hospital, Takeo, Japan
| | | | - Naoya Furue
- Department of Orthopaedic Surgery, Fukuokawajiro Hospital, Fukuoka, Japan
| | - Shun-Ichi Fukuhara
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan.,Shirakawa STAR for General Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Li Q, Long X, Wang Y, Fang X, Guo D, Lv J, Hu X, Cai L. Development and validation of a nomogram for predicting the probability of new vertebral compression fractures after vertebral augmentation of osteoporotic vertebral compression fractures. BMC Musculoskelet Disord 2021; 22:957. [PMID: 34784910 PMCID: PMC8597210 DOI: 10.1186/s12891-021-04845-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/05/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION New vertebral compression fractures (NVCFs) are adverse events after vertebral augmentation of osteoporotic vertebral compression fractures (OVCFs). Predicting the risk of vertebral compression fractures (VCFs) accurately after surgery is still a significant challenge for spinal surgeons. The aim of our study was to identify risk factors of NCVFs after vertebral augmentation of OVCFs and develop a nomogram. METHODS We retrospectively reviewed the medical records of patients with OVCFs who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). Patients were divided into the NVCFs group and control group, base on the patients with or without NVCFs within 2 years follow-up period after surgery. A training cohort of 403 patients diagnosed in our hospital from June 2014 to December 2016 was used for model development. The independent predictive factors of postoperative VCFs were determined by least absolute shrinkage and selection operator (LASSO) logistic regression, univariate analysis and multivariate logistic regression analysis. We provided a nomogram for predicting the risk of NVCFs based on independent predictive factors and used the receiver operating characteristic curve (ROC), calibration curve, and decision curve analyses (DCA) to evaluated the prognostic performance. After internal validation, the nomogram was further evaluated in a validation cohort of 159 patients included between January 2017 and June 2018. RESULTS Of the 403 patients in the training cohort, 49(12.16%) were NVCFs at an average of 16.7 (1 to 23) months within the 2 years follow-up period. Of the 159 patients in the validation cohort, 17(10.69%) were NVCFs at an average of 8.7 (1 to 15) months within the 2 years follow-up period. In the training cohort, the proportions of elderly patients older than 80 years were 32.65 and 13.56% in the NVCFs and control group, respectively (p = 0.003). The percentages of patients with previous fracture history were 26.53 and 12.71% in the NVCFs and control group, respectively (p = 0.010). The volume of bone cement were 4.43 ± 0.88 mL and 4.02 ± 1.13 mL in the NVCFs and Control group, respectively (p = 0.014). The differences have statistical significance in the bone cement leakage, bone cement dispersion, contact with endplate, anti-osteoporotic treatment, post-op Cobb angle and Cobb angle restoration characteristics between the two groups. The model was established by multivariate logistic regression analysis to obtain independent predictors. In the training and validation cohort, the AUC of the nomogram were 0.882 (95% confidence interval (CI), 0.824-0.940) and 0.869 (95% CI: 0.811-0.927), respectively. The C index of the nomogram was 0.886 in the training cohort and 0.893 in the validation cohort, demonstrating good discrimination. In the training and validation cohort, the optimal calibration curves demonstrated the coincidence between prediction and actual status, and the decision curve analysis demonstrated that the full model had the highest clinical net benefit across the entire range of threshold probabilities. CONCLUSION A nomogram for predicting NVCFs after vertebral augmentation was established and validated. For patients evaluated by this model with predictive high risk of developing postoperative VCFs, postoperative management strategies such as enhance osteoporosis-related health education and management should be considered.
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Affiliation(s)
- Qiujiang Li
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Orthopedics,People's Hospital of Ningxia Hui Autonomous Region, No. 56, Zhengyuan Street, Yinchuan, 750002, Ningxia, China
| | - Xingxia Long
- West China Hospital, Sichuan University, Sichuan, China
| | - Yinbin Wang
- Department of Orthopedics,People's Hospital of Ningxia Hui Autonomous Region, No. 56, Zhengyuan Street, Yinchuan, 750002, Ningxia, China
| | - Xiaomin Fang
- Department of Orthopedics,People's Hospital of Ningxia Hui Autonomous Region, No. 56, Zhengyuan Street, Yinchuan, 750002, Ningxia, China
| | - Donggeng Guo
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Orthopedics,People's Hospital of Ningxia Hui Autonomous Region, No. 56, Zhengyuan Street, Yinchuan, 750002, Ningxia, China
| | - Jinhan Lv
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Orthopedics,People's Hospital of Ningxia Hui Autonomous Region, No. 56, Zhengyuan Street, Yinchuan, 750002, Ningxia, China
| | - Xuehua Hu
- Department of Orthopedics,People's Hospital of Ningxia Hui Autonomous Region, No. 56, Zhengyuan Street, Yinchuan, 750002, Ningxia, China
| | - Lijun Cai
- Department of Orthopedics,People's Hospital of Ningxia Hui Autonomous Region, No. 56, Zhengyuan Street, Yinchuan, 750002, Ningxia, China.
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Li Q, Shi L, Wang Y, Guan T, Jiang X, Guo D, Lv J, Cai L. A Nomogram for Predicting the Residual Back Pain after Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures. Pain Res Manag 2021; 2021:3624614. [PMID: 34760032 PMCID: PMC8575618 DOI: 10.1155/2021/3624614] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/07/2021] [Accepted: 10/19/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Current findings suggest that percutaneous vertebroplasty (PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs). However, a significant minority of patients still experience residual back pain after PVP. The present retrospective study was designed to determine the risk factors for residual back pain after PVP and provides a nomogram for predicting the residual back pain after PVP. METHODS We retrospectively reviewed the medical records of patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty. Patients were divided into group N and group R according to the postoperative VAS score. Group R is described as the VAS score of residual back pain ≥ 4. Pre- and postoperative factors that may affect back pain relief were evaluated between two groups. Univariate and multivariate logistic regression analysis were performed to identify risk factors affecting residual back pain after PVP. We provided a nomogram for predicting the residual back pain and used the receiver operating characteristic curve (ROC), concordance index (C-index), calibration curve, and decision curve analyses (DCA) to evaluate the prognostic performance. RESULTS Among 268 patients treated with PVP, 37 (13.81%) patients were classified postoperative residual back pain. The results of the multivariate logistical regression analysis showed that the presence of an intravertebral vacuum cleft (IVC) (OR 3.790, P=0.026), posterior fascia oedema (OR 3.965, P=0.022), severe paraspinal muscle degeneration (OR 5.804, P=0.01; OR 13.767, P < 0.001), and blocky cement distribution (OR 2.225, P=0.041) were independent risk factors for residual back pain after PVP. The AUC value was 0.780, suggesting that the predictive ability was excellent. The prediction nomogram presented good discrimination, with a C-index of 0.774 (0.696∼0.852) and was validated to be 0.752 through bootstrapping validation. The calibration curve of the nomogram demonstrated a good consistency between the probabilities predicted by the nomogram and the actual probabilities. The nomogram showed net benefits in the range from 0.06 to 0.66 in DCA. CONCLUSIONS The presence of IVC, posterior fascia oedema, blocky cement distribution, and severe paraspinal muscle degeneration were significant risk factors for residual back pain after PVP for OVCFs. Patients with OVCFs after PVP who have these risk factors should be carefully monitored for the possible development of residual back pain. We provide a nomogram for predicting the residual back pain after PVP.
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Affiliation(s)
- Qiujiang Li
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Lin Shi
- Traditional Chinese Medicine Hospital Dianjiang Chongqing, Chongqing, China
| | - Yinbin Wang
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Tao Guan
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Xiaocheng Jiang
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Donggeng Guo
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Jinhan Lv
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Lijun Cai
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
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Roux C, Cortet B, Bousson V, Thomas T. Vertebroplasty for osteoporotic vertebral fracture. RMD Open 2021; 7:rmdopen-2021-001655. [PMID: 34193518 PMCID: PMC8246346 DOI: 10.1136/rmdopen-2021-001655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/11/2021] [Indexed: 12/15/2022] Open
Abstract
Appropriate care of patients with a recent painful osteoporotic vertebral fracture (VF) requires immobilisation, analgesics and spinal orthoses. Some VFs are however responsible for disabling pain and prolonged bed rest. In this context, vertebroplasty techniques have been proposed with a large benefit in case series and open-label randomised studies, but lack efficacy in three among four double-blind randomised studies. The objectives of the treatment of a recent painful VF are to relieve pain and to preserve mechanical conditions. With this in mind, we report an experts’ opinion paper on the indications for vertebroplasty and research agenda for clinical studies.
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Affiliation(s)
- Christian Roux
- INSERM U1153, APHP.Centre-Université de Paris, Service de Rhumatologie, Hôpital Cochin, Paris, France
| | - Bernard Cortet
- Department of Rheumatology, ULR 4490, Université de Lille, Lille University Hospital, Lille, France
| | - Valérie Bousson
- Service de Radiologie Ostéo-Articulaire, APHP.Nord-Université de Paris, Hôpital Lariboisière, Paris, France
| | - Thierry Thomas
- Service de Rhumatologie, and INSERM U 1059, Université de Lyon-Université Jean Monnet, CHU de St-Etienne, Saint-Etienne, France
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Xiao Q, Zhao Y, Qu Z, Zhang Z, Wu K, Lin X. Association Between Bone Cement Augmentation and New Vertebral Fractures in Patients with Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis. World Neurosurg 2021; 153:98-108.e3. [PMID: 34139353 DOI: 10.1016/j.wneu.2021.06.023] [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: 04/30/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the association between bone cement augmentation and new vertebral fractures (VF) in patients with osteoporotic vertebral compression fractures (OVCFs). METHODS A literature search of PubMed, EMBASE, and the Cochrane Library was conducted from 1987 to December 31, 2020, to identify randomized controlled trials that compared bone cement augmentation with non-bone cement treatments in patients with OVCFs. The clinical incidence of new VF and the risk of new adjacent vertebral fractures (AVF) after treatment were calculated. The indexes of the risk ratio or odds ratio, and 95% confidence intervals were determined with RevMan 5.2 software. RESULTS A total of 13 randomized controlled trials involving 1949 participants were included in the final quantitative analysis. There was no significant association between bone cement augmentation and the clinical incidence of new VF during the 6-month and 12-month follow-ups or the whole follow-up period. However, there was a significantly lower clinical incidence of new VF in patients who received bone cement augmentation compared with non-bone cement treatments during 24 months or more of follow-up. Pooled data from the relevant trials demonstrated that the risk of new AVF in bone cement augmentation was significantly higher than that in non-bone cement treatments. CONCLUSIONS Although the use of bone cement augmentation in OVCFs significantly increased the risk of new AVF compared with non-bone cement treatments, it was not significantly associated with a higher clinical incidence of new VF.
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Affiliation(s)
- Qinghua Xiao
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, P. R. China; Department of Osteoporosis, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, P. R. China
| | - Ying Zhao
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, P. R. China
| | - Zhen Qu
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, P. R. China
| | - Zhen Zhang
- Department of Osteoporosis, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, P. R. China
| | - Keliang Wu
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, P. R. China
| | - Xiaosheng Lin
- Department of Osteoporosis, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, P. R. China.
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Fan X, Li S, Zeng X, Yu W, Liu X. Risk factors for thoracolumbar pain following percutaneous vertebroplasty for osteoporotic vertebral compression fractures. J Int Med Res 2021; 49:300060521989468. [PMID: 33513025 PMCID: PMC7871086 DOI: 10.1177/0300060521989468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To explore possible risk factors for poor outcomes following percutaneous vertebroplasty (PV) for painful osteoporotic compression fractures of thoracolumbar vertebra. METHODS This was a retrospective review of data from patients who underwent PV at our institution over a ten-year period to evaluate the association between possible risk factors and thoracolumbar pain (T11-L2). According to the difference between pre- and post-operative visual analogue scale (VAS) scores for pain, patients were separated into poor relief (PR; <4) and good relief (GR; ≥4) of pain. RESULTS Of the 750 patients identified, 630 (PR group, n =310; GR group, n = 320) fulfilled the eligibility criteria. Multivariate binary logistic analysis showed that bone mineral density (BMD), >2 fractured vertebral bodies, maldistribution of bone cement, <5 ml bone cement injected into a single vertebral body and thoracolumbar fascia injury prior to surgery were independent risk factors associated with thoracolumbar pain following PV. CONCLUSION Although prospective controlled studies are required to confirm our results, this review suggests that the above factors should be taken into account when selecting patients for PV.
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Affiliation(s)
- Xiaoguang Fan
- Department of Spinal Surgery, Yantaishan Hospital, Yantai, Shandong, China
| | - Sha Li
- Department of Obstetrics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiangzhen Liu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Clinical and radiological subsequent fractures after vertebral augmentation for treating osteoporotic vertebral compression fractures: a meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2576-2590. [PMID: 32776263 DOI: 10.1007/s00586-020-06560-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/02/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE This study aimed to identify all relevant randomized controlled trials (RCT) and prospective non-RCTs to further investigate whether percutaneous vertebral augmentation (PVA) was associated with clinical and radiological subsequent fractures on unoperated levels. METHODS We systematically searched PubMed, EMBASE, Cochrane library, Google Scholar, web of science, and ClinicalTrial.gov from the establishment of the database to January 2020. All eligible studies comparing subsequent fractures after PVA with those after conservative treatment (CT) were incorporated. The pooled risk ratio (RR) with its 95% confidence intervals (95% CIs) was used. Heterogeneity, sensitivity, and publication bias analyses were performed. RESULTS In all, 32 studies were included in the study: 82/512 patients (16.02%) and 58/433 patients (13.39%) had clinical subsequent fractures in the PVA group and CT group, respectively. No significant differences were observed between the two groups [RR = 1.22, 95% CI 0.70-2.12, P = 0.49]. Further, 175/837 patients (20.91%) in the PVA group and 160/828 patients (19.32%) in the CT group had radiological subsequent fractures. No significant difference was observed between groups [RR = 0.91, 95% CI 0.71-2.12, P = 1.16]. Further, no statistical difference was observed on subgroup analysis between RCTs and non-RCTs or PVP and PKP. CONCLUSION Our systematic review revealed that subsequent fractures on unoperated levels were not associated with PVA, regardless of whether they were clinical or radiological subsequent fractures.
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Wu HL, Zheng BW, Liu FS, Wang XB, Lv GH, Li J, Zou MX. Letter to the Editor Regarding: "Clinical, Radiographic, and Morphometric Risk Factors for Adjacent and Remote Vertebral Compression Fractures Over a Minimum Follow-up of 4 Years After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: Novel Three-dimensional Voxel-Based Morphometric Analysis". World Neurosurg 2020; 139:661-663. [PMID: 32689669 DOI: 10.1016/j.wneu.2020.03.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Hai-Lin Wu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bo-Wen Zheng
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fu-Sheng Liu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiao-Bin Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guo-Hua Lv
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
| | - Ming-Xiang Zou
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
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Geusens P, Kendler DL, Fahrleitner-Pammer A, López-Romero P, Marin F. Distribution of Prevalent and Incident Vertebral Fractures and Their Association with Bone Mineral Density in Postmenopausal Women in the Teriparatide Versus Risedronate VERO Clinical Trial. Calcif Tissue Int 2020; 106:646-654. [PMID: 32157334 DOI: 10.1007/s00223-020-00683-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/17/2020] [Indexed: 10/24/2022]
Abstract
Vertebral fractures (VFx) occur most frequently in the mid-thoracic and thoraco-lumbar regions, which experience the highest mechanical loading along the spine. The prevalence and incidence of VFx by their location and severity, and their relationship with bone mineral density (BMD), are seldom reported in randomized clinical trial cohorts. The VERO trial randomized 1360 postmenopausal women with at least two moderate or one severe VFx to receive either teriparatide or risedronate for up to 24 months. In this post hoc analysis, we describe the centrally read distribution and severity of prevalent and incident VFx, and the association of their location with the baseline BMD. At baseline, 21.4% of all evaluable vertebral bodies had a prevalent VFx; most commonly at L1, T12, L2 and T11 (38.5%, 37.4%, 25.3% and 23.5% of patients, respectively). Patients with prevalent VFx only at T12/L1 showed a higher baseline BMD compared to patients with VFx at other levels. At month 24, 100 patients had 126 incident VFx (teriparatide: 35; risedronate: 91). The most frequent incident VFx occurred at T12 (n = 17, 1.6% of patients), followed by L1 and T11 (n = 14, 1.3% both). The frequency of incident VFx was lower at all vertebral levels in patients given teriparatide. These results confirm prior reports that VFx occurs more frequently at mid-thoracic and thoraco-lumbar regions of the spine. Patients with these VFx locations have higher BMD than those who fracture at other sites, suggesting a role for mechanical stress in the etiology of VFx. Teriparatide is superior to risedronate in the prevention of VFx at these common fracture locations.Trial registration ClinicalTrials.gov Identifier: NCT01709110.
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Affiliation(s)
- Piet Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - David L Kendler
- Department of Medicine (Endocrinology), University of British Columbia, Vancouver, BC, V5Z 4E1, Canada
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Pedro López-Romero
- Department of Medical Research, Eli Lilly and Company, Avda. de la Industria 30, 28108, Alcobendas (Madrid), Spain
| | - Fernando Marin
- Department of Medical Research, Eli Lilly and Company, Avda. de la Industria 30, 28108, Alcobendas (Madrid), Spain
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Alhashash M, Shousha M, Barakat AS, Boehm H. Effects of Polymethylmethacrylate Cement Viscosity and Bone Porosity on Cement Leakage and New Vertebral Fractures After Percutaneous Vertebroplasty: A Prospective Study. Global Spine J 2019; 9:754-760. [PMID: 31552157 PMCID: PMC6745641 DOI: 10.1177/2192568219830327] [Citation(s) in RCA: 11] [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] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN A prospective randomized study. OBJECTIVES To evaluate the effect of bone cement viscosity as well as of bone porosity on cement leakage during vertebroplasty and to analyze the occurrence of new vertebral fractures after the procedure. METHODS Between April 2012 and December 2013, 60 patients suffering from osteoporotic vertebral fractures underwent vertebroplasty. The patients were randomly assigned into 2 equal groups. High-viscosity cement was used in group A, while low-viscosity cement was used in group B. Patients were followed-up for a minimum of 2 years. RESULTS Cement leakage occurred in 16 patients in group B (20 vertebral bodies) and in 6 patients in group A (9 vertebral bodies). The difference was statistically significant (χ2 = 2.3, P = .01). Lower T-scores were associated with significantly more cement leakage (t = 3.338, P = .002 in group A, and t = 4.329, P = .000 in group B). Patients with a T-score worse than -1.8 had a significantly higher risk of cement leakage if low-viscosity cement was used (χ2 = 3.25, P = .05). New vertebral fractures occurred in 14 (23%) patients, after a mean of 6.5 ± 5.5 months, 10 patients in group A and 4 in group B. The difference did not reach the statistical significance level (χ2 = 3.354, P = .067). Patients presenting with multiple fractures had a significantly more number of new vertebral fractures (χ2 = 7.464, P = .006). CONCLUSIONS The clinical outcome of vertebroplasty was not influenced by cement viscosity. However, lower cement viscosity and higher degree of osteoporosis were found to be significant risk factors for cement leakage. Furthermore, the number of vertebral body fractures on presentation was a predictor for the occurrence of new fractures postoperatively.
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Affiliation(s)
- Mohamed Alhashash
- Zentralklinik Bad Berka, Bad Berka, Germany,Alexandria University, Alexandria, Egypt,Mohamed Alhashash, Spine Surgery Department,
Zentralklinik Bad Berka, Robert-Koch-Allee 9 99437 Bad Berka, Germany.
| | - Mootaz Shousha
- Zentralklinik Bad Berka, Bad Berka, Germany,Alexandria University, Alexandria, Egypt
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Zhang L, Zhai P. A Comparison of Percutaneous Vertebroplasty Versus Conservative Treatment in Terms of Treatment Effect for Osteoporotic Vertebral Compression Fractures: A Meta-Analysis. Surg Innov 2019; 27:19-25. [PMID: 31423902 DOI: 10.1177/1553350619869535] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background. Osteoporotic vertebral compression fractures (OVCFs) are common in older patients, which can cause back pain and even increase morbidity. However, the optimal therapy for patients with OVCFs remains unknown. Percutaneous vertebroplasty (PVP), a minimally invasive procedure, has been a therapy option that is known to be effective in the pain management. Aim. The meta-analysis aims to summarize current best evidence on the efficacy of PVP and conservative treatment (CT) for pain management and functional results among OVCFs patients. Methods. We searched the publications on comparison of the efficacy of PVP versus CT for OVCFs patients up to November 2018. After rigorous reviewing on the quality, the data were extracted from eligible trials. All trials analyzed the summary hazard ratios of the endpoints of interest. Results. Moderate-strong evidence indicated that PVP had benefits on pain relief at 1 week and 1 month, but not at 3 months. With regard to the quality of life, no significant differences were found in the Roland-Morris Disability Questionnaire (RMDQ). However, there is significant difference in terms of EuroQol and Quality of Life Questionnaire of the European Foundation for Osteoporosis but not the RMDQ. Moreover, there were no any benefit in terms of vertebral fracture between groups. Conclusions. The meta-analysis showed that patients treated with vertebroplasty were associated with better pain relief and improved quality of life, without increasing the incidence of vertebral fracture compared with the CT group.
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Affiliation(s)
- Lin Zhang
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Pei Zhai
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Che H, Breuil V, Cortet B, Paccou J, Thomas T, Chapuis L, Debiais F, Mehsen-Cetre N, Javier RM, Loiseau Peres S, Roux C, Briot K. Vertebral fractures cascade: potential causes and risk factors. Osteoporos Int 2019; 30:555-563. [PMID: 30519756 DOI: 10.1007/s00198-018-4793-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/29/2018] [Indexed: 12/11/2022]
Abstract
UNLABELLED We performed a study to identify potential causes and risk factors of vertebral fracture cascade. Vertebral fracture cascade is a severe clinical event in patients with bone fragility. Only half of patients have an identified cause of secondary osteoporosis. INTRODUCTION Vertebral fracture (VF) is the most common osteoporotic fracture, and a strong risk factor of subsequent VFs leading to VF cascade (VFC). We prompted a study to identify potential causes and risk factors of VFC. METHODS VFC observations were collected retrospectively between January 2016 and April 2017. VFC was defined as an occurrence of at least three VFs within 1 year. RESULTS We included in 10 centers a total of 113 patients with VFC (79.6% of women, median age 73, median number of VFs in the cascade, 5). We observed 40.5% and 30.9% of patients with previous major fractures and a previous VF, respectively, and 68.6% with densitometric osteoporosis; 18.9% of patients were currently receiving oral glucocorticoids and 37.1% in the past. VFC was attributed by the physician to postmenopausal osteoporosis in 54% of patients. A secondary osteoporosis associated with the VFC was diagnosed in 52 patients: glucocorticoid-induced osteoporosis (25.7%), non-malignant hemopathies (6.2%), alcoholism (4.4%), use of aromatase inhibitors (3.6%), primary hyperparathyroidism (2.7%), hypercorticism (2.7%), anorexia nervosa (2.7%), and pregnancy and lactation-associated osteoporosis (1.8%). A total of 11.8% of cases were reported following a vertebroplasty procedure. A total of 31.5% patients previously received an anti-osteoporotic treatment. In six patients, VFC occurred early after discontinuation of an anti-osteoporotic treatment, in the year after the last dose effect was depleted: five after denosumab and one after odanacatib. CONCLUSION The results of this retrospective study showed that only half of VFC occurred in patients with a secondary cause of osteoporosis. Prospective studies are needed to further explore the determinants of this severe complication of osteoporosis.
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Affiliation(s)
- H Che
- Rheumatology Department, CHU Lapeyronie Montpellier, 371 avenue du Gaston Giraud, 34090, Montpellier, France.
| | - V Breuil
- Department of Rheumatology, BIAM - UMR E 4320 TIRO-MATOs CEA/UNS, Université Côte D'Azur, Centre Hospitalier Universitaire Nice, Nice, France
| | - B Cortet
- Service de rhumatologie, CHRU France et Université de Lille, Université Littoral Côte d'Opale, 59000 Lille, PMOI EA 4490 faculté de chirurgie dentaire, place de Verdun, 59000, Lille, France
| | - J Paccou
- Service de rhumatologie, CHRU France et Université de Lille, Université Littoral Côte d'Opale, 59000 Lille, PMOI EA 4490 faculté de chirurgie dentaire, place de Verdun, 59000, Lille, France
| | - T Thomas
- Rheumatology Department, CHU de Saint Etienne, INSERM U1059, Lab Biologie Intégrée du Tissu Osseux, Université de Lyon, 42055, Saint-Etienne Cedex 2, France
| | - L Chapuis
- Rheumatology Department, CH Simone Veil du Vitre, 30 route de Rennes, 35500, Vitre, France
| | - F Debiais
- Rheumatology Department, CHU La Miletrie Poitiers, 2 rue de la Miletrie, 86021, Poitiers Cedex, France
| | - N Mehsen-Cetre
- Rheumatology Department, CHU Pellegrin Bordeaux, Rue de la pelouse de Douet, 33000, Bordeaux, France
| | - R M Javier
- Rheumatology Department, Hôpitaux Universitaires de Strasbourg, 1 avenue Moliere, 67098, Strasbourg, France
| | - S Loiseau Peres
- Rheumatology Department, CHR Orléans, 14 avenue de l'Hopital, 45000, Orleans, France
| | - C Roux
- Rheumatology Department, INSERM 1153, CHU Paris Cochin, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - K Briot
- Rheumatology Department, INSERM 1153, CHU Paris Cochin, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
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Vertebral Augmentation is Superior to Nonoperative Care at Reducing Lower Back Pain for Symptomatic Osteoporotic Compression Fractures: A Meta-Analysis. Clin Spine Surg 2018; 31:339-344. [PMID: 29901504 DOI: 10.1097/bsd.0000000000000670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This is a systematic review and meta-analysis. OBJECTIVE This study's goal was to (i) assess the clinical outcomes with and without vertebral augmentation (VA) for osteoporotic vertebral compression fractures (VCFs) with versus without correlating signs and symptoms; and (ii) acute (symptoms <3 mo duration) and subacute VCFs (3-6 mo duration) versus chronic VCFs (>6 mo). SUMMARY OF BACKGROUND DATA Previously, a randomized controlled trial in the New England Journal of Medicine concluded that vertebroplasty for osteoporotic VCFs provided no clinical benefit over sham surgery. However, the VCFs examined had no clinical correlation with symptom, physical examination, or imaging (magnetic resonance imaging/bone scan) findings. Nonetheless, the randomized controlled trial resulted in a reduction in VA performed in the United States. Currently, no consensus exists on VA versus nonoperative care for symptomatic VCFs (SVFs). MATERIALS AND METHODS A literature search was conducted for studies on VA and conservative management for VCFs. Meta-analysis was performed using the random-effects model. The primary outcome was improvement in lower back pain visual analog score. SVFs were defined as radiographic VCF with clinical correlation. Radiographic-alone VCF (RVF) was defined as radiographic VCF without clinical correlation. RESULTS Thirteen studies totaling 1467 patients with minimum 6-month follow-up were found. Pain reduction was greater with VA over conservative management for SVFs (P<0.000001) and equivalent for RVFs (P=0.22). Subanalysis for acute/subacute SVFs and chronic SVFs showed that VA was superior to nonoperative care (P=0.0009 and 0.04, respectively). No difference was observed in outcomes between VA and nonoperative care for chronic RVF (P=0.22). CONCLUSIONS VA is superior to nonoperative care in reducing lower back pain for osteoporotic VCFs with correlating signs and symptoms. VA had no benefit over nonoperative care for chronic VCFs that lacked clinical correlation. Lower back pain has many etiologies and patients should be clinically assessed before recommending VA.
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The risk factors of vertebral refracture after kyphoplasty in patients with osteoporotic vertebral compression fractures: a study protocol for a prospective cohort study. BMC Musculoskelet Disord 2018; 19:195. [PMID: 29961425 PMCID: PMC6027566 DOI: 10.1186/s12891-018-2123-6] [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: 09/12/2017] [Accepted: 06/04/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Percutaneous kyphoplasty (PKP) is the first-line treatment for osteoporotic vertebral compression fractures (OVCFs) that can immediately relieve pain and allow the quick recovery of lost mobility. However, some studies reported that after PKP, the incidence of vertebral refracture, particularly adjacent vertebral fracture (AVF), was high. Our previous meta-analysis suggested that the risks for vertebral refracture and AVF did not increase after percutaneous vertebral augmentation in OVCF patients. Despite the negative results of our meta-analysis, there is still significant evidence regarding the relationship between kyphoplasty and AVF, so a new prospective cohort study is warranted. In addition, in our previous retrospective study, we found that advanced age, female sex and low oestradiol (E2) concentrations might be related to the occurrence of postoperative vertebral refracture after PKP. To sufficiently evaluate the probable factors involved in the occurrence of postoperative vertebral refracture, we designed this prospective study. METHODS This is a prospective cohort study of patients admitted for PKP to treat painful OVCFs. The baseline data, including demographic information, lifestyle, bone metabolic status, sex hormone and sex hormone-binding globulin (SHBG) levels, and clinical characteristics will be collected at the time of enrolment. Surgical features of PKP will be recorded on the operation day. Lifestyle, bone metabolic status, sex hormone levels, and SHBG levels will be assessed during the follow-up period at 1 m, 3 m, 12 m, and 24 m postoperatively. Patients suffering from acutely aggravated back pain will be referred to an orthopaedist, and refractured vertebrae will be confirmed by magnetic resonance imaging and computed tomography. The primary outcome will be the incidence of vertebral refracture. Multivariate analyses will be carried out to evaluate the variables that are independently correlated with vertebral refracture. DISCUSSION To evaluate the risk of postoperative refracture preoperatively and to identify the surgical points related to postoperative refracture, this study will explore the risk factors related to vertebral refracture after PKP. The results may provide new information about defining OVCF patients suitable for PKP treatment. TRIAL REGISTRATION ChiCTR-ROC-17011562 . Registered on July 4th, 2017.
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Zuo XH, Zhu XP, Bao HG, Xu CJ, Chen H, Gao XZ, Zhang QX. Network meta-analysis of percutaneous vertebroplasty, percutaneous kyphoplasty, nerve block, and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures (OVCFs) in short-term and long-term effects. Medicine (Baltimore) 2018; 97:e11544. [PMID: 30024546 PMCID: PMC6086478 DOI: 10.1097/md.0000000000011544] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/21/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Osteoporotic vertebral compression fractures (OVCFs) commonly afflicts most aged people resulting back pain, substantial vertebral deformity, functional disability, decreased quality of life, and increased adjacent spinal fractures and mortality. Percutaneous vertebral augmentation (PVA) included percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP), nerve block (NB), and conservative treatment (CT) are used for the nonsurgery treatment strategy of OVCFs, however, current evaluation of their efficacy remains controversial. METHODS AND ANALYSIS A systematic literature search was carried out in PubMed, EMBASE, Web of Knowledge, and the Cochrane Central Register of Controlled Trials up to October 31, 2017. Randomized controlled trials (RCTs) were compared PVP, PKP, NB, or CT for treating OVCFs. The risk of bias for each trial was rated according to the Cochrane Handbook. Mean differences (MDs) with 95% confidence intervals (CIs) were utilized to express VAS (visual analog scale) outcomes. The network meta-analysis (NMA) of the comparative efficacy measured by change of VAS on acute/subacute and chronic OVCFs was conducted for a short-term (<4 weeks) and long-term (≥6-12months) follow-up with the ADDIS software. RESULTS A total of 18 trials among 1994 patients were included in the NMA. The PVA (PVP and PKP) had better efficacy than CT. PKP was first option in alleviating pain in the case of the acute/subacute OVCFs for long term, and chronic OVCFs for short term and long term, while PVP had the most superiority in the case of the acute/subacute OVCFs for short term. NB ranks higher probability than PKP and PVP on acute/subacute OVCFs in short and long-term, respectively. CONCLUSIONS The present results suggest that PVA (PVP/PKP) had better performance than CT in alleviating acute/subacute and chronic OVCFs pain for short and long-term. NB may be used as an alternative or before PVA, as far as pain relief is concerned. Various nonsurgery treatments including CT, PVA (PVP/PKP), NB, or a combination of these treatments are performed with the goal of reducing pain, stabilizing the vertebrae, and restoring mobility.
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Affiliation(s)
- Xiao-Hua Zuo
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing
- Department of Pain Management, Huai’an Hospital Affiliated to Xuzhou Medical University, Second People's Hospital of Huai’an City, Huai’an, Jiangsu, China
| | - Xue-Piao Zhu
- Department of Pain Management, Huai’an Hospital Affiliated to Xuzhou Medical University, Second People's Hospital of Huai’an City, Huai’an, Jiangsu, China
| | - Hong-Guang Bao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing
| | - Chen-Jie Xu
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing
| | - Hao Chen
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing
| | - Xian-Zhong Gao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing
| | - Qian-Xi Zhang
- Department of Pain Management, Huai’an Hospital Affiliated to Xuzhou Medical University, Second People's Hospital of Huai’an City, Huai’an, Jiangsu, China
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Xie L, Zhao ZG, Zhang SJ, Hu YB. Percutaneous vertebroplasty versus conservative treatment for osteoporotic vertebral compression fractures: An updated meta-analysis of prospective randomized controlled trials. Int J Surg 2017; 47:25-32. [DOI: 10.1016/j.ijsu.2017.09.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 09/13/2017] [Indexed: 12/01/2022]
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Osteoporosis associated vertebral fractures-Health economic implications. PLoS One 2017; 12:e0178209. [PMID: 28542552 PMCID: PMC5439946 DOI: 10.1371/journal.pone.0178209] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 05/09/2017] [Indexed: 12/28/2022] Open
Abstract
Introduction Osteoporosis-associated vertebral fractures represent an increasing clinical and public health problem, one with important socioeconomic effects within western countries. The purpose of this study was to analyse demographic, medical, gender and socioeconomic aspects of osteoporotic vertebral fractures of the thoracic or lumbar spine over a period of at least 10-years. Material and methods Included for analysis were 694 patients who had suffered a vertebral fracture due to primary or secondary osteoporosis, and who were treated at our Level-I trauma center between 2000 and 2013. Collected data included demographic, medical and socioeconomic aspects. Results Clinical results revealed that 669 patients (96%) were treated conservatively. The remaining 25 patients (4%) underwent surgical therapy: 4 were treated with vertebroplasty, 15 with kyphoplasty and 6 patients with posterior stabilization. The mean age was 75.6 years (range: 50–98), with the vast majority of patients being female (n = 515). A statistically significant demographic difference (i.e., increase) in fractures was observed between the age groups 60–69 and 70–79 (p = 0.041). Concerning socioeconomic aspects, statistical analysis showed that the number of sick leaves and the need for professional domestic help was higher in female patients. Concerning treatment costs, statistical analysis did not reveal any significant differences between female and male patients. Conclusion Significant gender differences–to the detriment of the female population–could be demonstrated within this study. A regrettably low rate of adequate treatment after diagnosis of osteoporosis and its associated fractures–specifically relating to primary and secondary prevention–could also be identified. To prospectively avoid complications and consequential cost increases, more awareness of the necessity for prevention, early diagnosis and adequate treatment of osteoporosis and its related fractures should be considered.
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Letter to the Editor concerning "Risk factors of new symptomatic vertebral compression fractures in osteoporotic patients undergone percutaneous vertebroplasty" by HL. Ren et al. (Eur Spine J; 2015;24(4):750-758). 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; 26:1559-1560. [PMID: 28265763 DOI: 10.1007/s00586-017-5022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
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Zhong BY, He SC, Zhu HD, Wu CG, Fang W, Chen L, Guo JH, Deng G, Zhu GY, Teng GJ. Risk Prediction of New Adjacent Vertebral Fractures After PVP for Patients with Vertebral Compression Fractures: Development of a Prediction Model. Cardiovasc Intervent Radiol 2016; 40:277-284. [PMID: 27812782 DOI: 10.1007/s00270-016-1492-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/26/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE We aim to determine the predictors of new adjacent vertebral fractures (AVCFs) after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fractures (OVCFs) and to construct a risk prediction score to estimate a 2-year new AVCF risk-by-risk factor condition. MATERIALS AND METHODS Patients with OVCFs who underwent their first PVP between December 2006 and December 2013 at Hospital A (training cohort) and Hospital B (validation cohort) were included in this study. In training cohort, we assessed the independent risk predictors and developed the probability of new adjacent OVCFs (PNAV) score system using the Cox proportional hazard regression analysis. The accuracy of this system was then validated in both training and validation cohorts by concordance (c) statistic. RESULTS 421 patients (training cohort: n = 256; validation cohort: n = 165) were included in this study. In training cohort, new AVCFs after the first PVP treatment occurred in 33 (12.9%) patients. The independent risk factors were intradiscal cement leakage and preexisting old vertebral compression fracture(s). The estimated 2-year absolute risk of new AVCFs ranged from less than 4% in patients with neither independent risk factors to more than 45% in individuals with both factors. CONCLUSIONS The PNAV score is an objective and easy approach to predict the risk of new AVCFs.
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Affiliation(s)
- Bin-Yan Zhong
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Shi-Cheng He
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Hai-Dong Zhu
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Chun-Gen Wu
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yi Shan Road, Shanghai, 200233, China
| | - Wen Fang
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Li Chen
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Jin-He Guo
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Gang Deng
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Guang-Yu Zhu
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Gao-Jun Teng
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China.
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Cao J, Kong L, Meng F, Zhang Y, Shen Y. Risk factors for new vertebral compression fractures after vertebroplasty: a meta-analysis. ANZ J Surg 2016; 86:549-54. [PMID: 26749512 DOI: 10.1111/ans.13428] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND The risk factors for new vertebral compression fractures (VCFs) after vertebroplasty are unclear. The aim of this meta-analysis was to identify potential risk factors. METHODS A systematic electronic literature search was performed using the following databases: PubMed, Embase and Cochrane Library; the databases were searched from the earliest available records in 1966 to May 2015. Pooled odds ratios (ORs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random- or fixed-effects models. The Newcastle-Ottawa scale was used to evaluate the methodological quality of the studies, and Stata 11.0 was used to analyse the data. RESULTS The primary factors that were associated with new fractures after vertebroplasty were low bone mineral density (SMD -0.375; 95% CI -0.579 to -0.171), steroid usage (OR 2.632; 95% CI 1.399 to 4.950) and the presence of multiple treated vertebrae (OR 2.027; 95% CI 1.442 to 2.851). The data did not support that age, sex, body mass index, non-steroidal anti-inflammatory drug usage, vacuum cleft, thoracolumbar junction, cement volume, kyphosis correction, or intradiscal cement leakage could lead to infection after vertebroplasty. CONCLUSIONS The present analysis demonstrated that low bone mineral density, the presence of multiple treated vertebrae and a history of steroid usage were associated with the new VCFs after vertebroplasty. Patients with these factors should be informed of the potential increased risk.
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Affiliation(s)
- Junming Cao
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lingde Kong
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Fantao Meng
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yingze Zhang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yong Shen
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Abstract
Vertebral fractures are one of the most common fractures associated with skeletal fragility and can cause as much morbidity as hip fractures. However, the epidemiology of vertebral fractures differs from that of osteoporotic fractures at other skeletal sites in important ways, largely because only one quarter to one-third of vertebral fractures are recognized clinically at the time of their occurrence and otherwise require lateral spine imaging to be recognized. This article first reviews the prevalence and incidence of clinical and radiographic vertebral fractures in populations across the globe and secular trends in the incidence of vertebral fracture over time. Next, associations of vertebral fractures with measures of bone mineral density and bone microarchitecture are reviewed followed by associations of vertebral fracture with various textural measures of trabecular bone, including trabecular bone score. Finally, the article reviews clinical risk factors for vertebral fracture and the association of vertebral fractures with morbidity, mortality, and other subsequent adverse health outcomes.
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Affiliation(s)
- John T Schousboe
- Park Nicollet Osteoporosis Center, Park Nicollet Clinic, HealthPartners, Minneapolis, MN, USA; Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MD, USA.
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Lu J, Jiang G, Lu B, Shi C, Luo K, Yue B. The positive correlation between upper adjacent vertebral fracture and the kyphosis angle of injured vertebral body after percutaneous kyphoplasty: An in vitro study. Clin Neurol Neurosurg 2015; 139:272-7. [PMID: 26546886 DOI: 10.1016/j.clineuro.2015.10.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/19/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the correlation between the kyphosis angle of injured vertebral body and the risk of upper adjacent vertebral fracture after percutaneous kyphoplasty (PKP) using an osteoporotic vertebral compressed fracture model. MATERIALS AND METHODS 24 functional spinal units (FSUs, T9 to L4) were selected from 6 elderly formalin preserved vertebral specimens to build the vertebral compressed fracture model. According to the kyphosis angle between the upper plate of upper vertebral body and the horizontal plane, group A (0°) and group B (20°) were defined, with each group comprised with 12 FSUs. The stiffness and fracture load were measured in both groups. RESULTS After PKP, the stiffness was (571.513 ± 83.373)N/mm and the fracture load was (1751.659 ± 112.291)N in group A, with both significantly higher than those of group B (stiffness, (307.706 ± 46.723)N/mm; fracture load, (1128.011 ± 125.417)N). CONCLUSIONS To reduce the risk of upper adjacent vertebral fracture, it is better to restore the height of injured vertebral body and decrease the angle of kyphosis to increase the capability of upper adjacent vertebral body against fracture.
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Affiliation(s)
- Jiye Lu
- Department of Spinal Surgery, the Affiliated Hospital of School of Medicine of Ningbo University, 247 Renming Road, Ningbo 315020, Zhejiang, China
| | - Guoqiang Jiang
- Department of Spinal Surgery, the Affiliated Hospital of School of Medicine of Ningbo University, 247 Renming Road, Ningbo 315020, Zhejiang, China.
| | - Bin Lu
- Department of Spinal Surgery, the Affiliated Hospital of School of Medicine of Ningbo University, 247 Renming Road, Ningbo 315020, Zhejiang, China
| | - Chaolu Shi
- Department of Spinal Surgery, the Affiliated Hospital of School of Medicine of Ningbo University, 247 Renming Road, Ningbo 315020, Zhejiang, China
| | - Kefeng Luo
- Department of Spinal Surgery, the Affiliated Hospital of School of Medicine of Ningbo University, 247 Renming Road, Ningbo 315020, Zhejiang, China
| | - Bing Yue
- Department of Spinal Surgery, the Affiliated Hospital of School of Medicine of Ningbo University, 247 Renming Road, Ningbo 315020, Zhejiang, China
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Xie W, Jin D, Wan C, Ding J, Zhang S, Jiang X, Xu J. The Incidence of New Vertebral Fractures Following Vertebral Augmentation: A Meta-Analysis of Randomized Controlled Trials. Medicine (Baltimore) 2015; 94:e1532. [PMID: 26376401 PMCID: PMC4635815 DOI: 10.1097/md.0000000000001532] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/12/2015] [Accepted: 08/14/2015] [Indexed: 12/29/2022] Open
Abstract
A meta-analysis of randomized controlled trials was performed that compares the relationship between percutaneous vertebral augmentation (PVA) and conservative treatments with the incidence of new vertebral fractures. Using meta-analytic techniques, this study compares PVA and conservative treatment for incidence of new vertebral fractures, particularly incidence of adjacent fractures that occur following treatment.A focus of clinicians has been on whether PVA increases the risk of new vertebral fractures. Pubmed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to retrieve literature published from the establishment of the databases until April 28, 2015. Literature of related areas was searched manually. The main outcome indicator was the incidence of new vertebral fractures at final follow-up appointment. In addition, we evaluated the incidence of new vertebral fractures in different follow-up periods and the incidence of adjacent fractures. The RevMan 5.3 software program of the Cochrane Collaboration was used to analyze the data. For dichotomous variables, the risk ratio (RR) and a confidence interval (CI) of 95% were used to express the heterogeneity of the effect size. Seven randomized controlled trial studies were selected from the literature. The studies include 871 patients, 436 of whom received PVA treatment and the rest received conservative treatment. Combined analysis of the 7 studies showed that the numbers of new vertebral fractures in the 2 groups are not significantly different. Six studies reported the numbers of new adjacent fractures. Considering the heterogeneity among the studies, 2 subgroups were formed. The 5 studies in the European group showed that the incidence of new adjacent fractures in the PVA-treated group is higher than that in the conservatively treated group, and the difference is statistically significant. The one study in the Asian group showed no significant difference between the incidences of adjacent fractures in the 2 groups. PVA treatment does not increase the incidence of new vertebral fractures. Most studies reported that PVA increases the incidence of adjacent fractures, yet it is rarely stated that both PVA and conservative treatment lead to the same incidence of adjacent fractures.
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Affiliation(s)
- Weixing Xie
- From the Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Baiyun District, Guang Zhou City, Guangdong Province, China
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Lamy O, Uebelhart B, Aubry-Rozier B. Risks and benefits of percutaneous vertebroplasty or kyphoplasty in the management of osteoporotic vertebral fractures. Osteoporos Int 2014; 25:807-19. [PMID: 24264371 DOI: 10.1007/s00198-013-2574-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/06/2013] [Indexed: 01/22/2023]
Abstract
Vertebral fracture (VF) is the most common osteoporotic fracture and is associated with high morbidity and mortality. Conservative treatment combining antalgic agents and rest is usually recommended for symptomatic VFs. The aim of this paper is to review the randomized controlled trials comparing the efficacy and safety of percutaneous vertebroplasty (VP) and percutaneous balloon kyphoplasty (KP) versus conservative treatment. VP and KP procedures are associated with an acceptable general safety. Although the case series investigating VP/KP have all shown an outstanding analgesic benefit, randomized controlled studies are rare and have yielded contradictory results. In several of these studies, a short-term analgesic benefit was observed, except in the prospective randomized sham-controlled studies. A long-term analgesic and functional benefit has rarely been noted. Several recent studies have shown that both VP and KP are associated with an increased risk of new VFs. These fractures are mostly VFs adjacent to the procedure, and they occur within a shorter time period than VFs in other locations. The main risk factors include the number of preexisting VFs, the number of VPs/KPs performed, age, decreased bone mineral density, and intradiscal cement leakage. It is therefore important to involve the patients to whom VP/KP is being proposed in the decision-making process. It is also essential to rapidly initiate a specific osteoporosis therapy when a VF occurs (ideally a bone anabolic treatment) so as to reduce the risk of fracture. Randomized controlled studies are necessary in order to better define the profile of patients who likely benefit the most from VP/KP.
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Affiliation(s)
- O Lamy
- Center of Bone Diseases-Bone and Joint Department, Lausanne University Hospital, Av Pierre-Decker, 4, 1011, Lausanne, Switzerland,
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