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Si X, Shan D, Huo L, Hu Y, Zou C, Wang B, Cao J, Wu W. Effect of percutaneous vertebroplasty versus percutaneous kyphoplasty on post-operative wound pain in patients with osteoporotic vertebral compression fractures. Int Wound J 2024; 21:e14745. [PMID: 38484743 PMCID: PMC10940009 DOI: 10.1111/iwj.14745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/21/2024] [Indexed: 03/18/2024] Open
Abstract
This research is intended to evaluate the efficacy of percutaneous vertebroplasty (PVP) versus percutaneous kyphoplasty (PKP) in osteoporotic vertebral compression fracture (OVCF), which is associated with post-operative pain. Eligible studies were screened by searching multiple databases and sources such as PubMed, Cochrane and EMBASE for search terms updated to October 2023, and relevant literature sources were searched. Randomized, controlled, prospective or retrospective, and cohort studies were eligible. For the analysis of the primary results, an analysis of the data was carried out, such as mean difference (MD) or odds ratio (OR), and 95% confidence interval (CI). In the present research, 1933 research was screened in 4 databases, and 30 articles were chosen to be examined under strict exclusion criteria. No statistical significance was found in the use of bone cement in the PVP group and PKP (MD, -0.60; 95% CI, -1.40, 0.21, p = 0.15); PKP was associated with a reduced risk of cement leak compared with PVP group (OR, 2.18; 95% CI, 1.38, 3.46, p = 0.0009); no statistical significance was found in the wound VAS score in PVP operation compared with that of PKP (MD, 0.16; 95% CI, -0.07, 0.40, p = 0.17); no statistical significance was found between the time of PVP operation and the time of PKP operation (MD, -2.65; 95% CI, -8.91, 3.60, p = 0.41). Compared with PVP technology, the PKP treatment of osteoporotic vertebral compression fractures reduces post-operative cement leakage, but there is no significant difference in the number of operative cement and wound VAS after operation. Nor did there appear to be a statistically significant difference in time between the two operations.
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Affiliation(s)
- Xiaojing Si
- Department of Orthopedics, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Dongli Shan
- Department of Bone & Soft Tissue Cancer, Chongqing University Cancer Hospital, Chongqing, China
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Li Huo
- Department of Orthopedics, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Yongjun Hu
- Department of Orthopedics, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Chuanqi Zou
- Department of Orthopedics, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Boxin Wang
- Department of Orthopedics, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Junxiong Cao
- Department of Orthopedics, People's Hospital of Chongqing Banan District, Chongqing, China
| | - Wenjie Wu
- Department of Orthopedics, People's Hospital of Chongqing Banan District, Chongqing, China
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Yoon SH, Park HG, Lee DH, Lee DU. Comparison of Clinical and Radiological Outcomes after Vertebroplasty and Balloon Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures. J Bone Metab 2024; 31:56-62. [PMID: 38485242 PMCID: PMC10940103 DOI: 10.11005/jbm.2024.31.1.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Vertebroplasty (VP) and balloon kyphoplasty (KP) are effective means with which to improve pain and function in osteoporotic vertebral compression fractures. However, the risk of complications after these procedures is poorly understood, with concerns regarding adjacent vertebral fractures. This study retrospectively investigated the clinical and radiological outcomes of these procedures. METHODS A total of 115 patients who experienced their first vertebral fracture were treated with VP (N=63) or KP (N=52) at the Dankook University Hospital between January 2013 and December 2022. The clinical outcomes were evaluated using the visual analog scale (VAS) preoperative and at 1-year follow-up. Radiological comparisons were performed for kyphosis correction, vertebral height restoration, and postoperative cement leakage. RESULTS KP was more effective than VP, especially for vertebral body height restoration and kyphotic angle reduction (P<0.05). However, the incidence of cement leakage, new adjacent vertebral fractures, and improvement in pain assessed by VAS did not differ statistically between the 2 groups (P>0.05). CONCLUSIONS Considering that KP was performed on fractures with severe deformity, no differences were observed in the clinical outcomes and incidence of adjacent vertebral fractures compared Considering that KP was performed for fractures with severe deformity, there was no difference in clinical outcomes and incidence of adjacent vertebral fractures compared to VP. Improvements in radiological measurements were demonstrated. Therefore, KP may be a good treatment option for pain relief and long-term prognosis in patients with high-compressive-rate vertebral fractures.
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Affiliation(s)
- Sung-Hyun Yoon
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Hee-Gon Park
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Dong-Uk Lee
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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Matsumoto K, Hoshino M, Omori K, Igarashi H, Matsuzaki H, Sawada H, Saito S, Suzuki S, Miyanaga Y, Nakanishi K. Preoperative Scoring System for Prediction of Early Adjacent Vertebral Body Fracture After Balloon Kyphoplasty Using X-Rays Taken in a Non-Weight-Bearing Position. World Neurosurg 2023; 178:e42-e47. [PMID: 37380052 DOI: 10.1016/j.wneu.2023.06.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Prevention of adjacent vertebral body fracture (AVF) following balloon kyphoplasty (BKP) is a key challenge. The objective of this study was to develop a scoring system that could be more extensively and effectively used to determine the surgical indications for BKP. METHODS The study involved 101 patients aged 60 years or older who had undergone BKP. Logistic regression analysis was used to identify risk factors for early AVF within 2 months following BKP. Scoring was based on the odds ratio for risk factors, and cut-off values were determined from the receiver operating characteristics curve. The correlation between the total scores and the incidence of early AVF, and the area under the curve for the logistic regression model predicting early AVF using the scoring system were investigated. RESULTS 29 cases (28.7%) experienced early AVF after BKP. The scoring system was created as follows: 1) age (<75 years: 0 points (P), ≥75 years: 1P), 2) number of previous vertebral fractures (0: 0P, 1 or more: 2P), and 3) local kyphosis (<7°: 0P, ≥7°: 1P). The total scores were found to be positively correlated with the incidence of early AVF (r = 0.976, P = 0.004). The area under the curve of the scoring system for predicting early AVF was 0.796. The incidence of early AVF was 4.2% at ≤1P and 44.3% at ≥2P (P < 0.001). CONCLUSIONS A scoring system which can be applied to a broader patient population was developed. In cases where the total score is 2P or more, alternatives to BKP should be considered.
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Affiliation(s)
- Koji Matsumoto
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan.
| | - Masahiro Hoshino
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, Tokyo, Japan
| | - Keita Omori
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, Tokyo, Japan
| | - Hidetoshi Igarashi
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, Tokyo, Japan
| | - Hiromi Matsuzaki
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, Tokyo, Japan
| | - Hirokatsu Sawada
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Sosuke Saito
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Yuya Miyanaga
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
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Sahinturk F, Sonmez E, Ayhan S, Gulsen S, Yilmaz C. The Influence of Percutaneous Vertebral Augmentation Techniques on Recompression in Patients with Osteoporotic Vertebral Compression Fractures. Percutaneous Vertebroplasty versus Balloon Kyphoplasty. World Neurosurg 2023; 176:e447-e455. [PMID: 37257650 DOI: 10.1016/j.wneu.2023.05.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BK) have any mid-term to long-term effects on the structural integrity of augmented vertebrae. METHODS According to our hospital records, 351 patients underwent BK and PVP as a result of osteoporotic vertebral compression fractures between 2010 and 2020. The demographic, surgical, and radiologic characteristics of the patients were analyzed retrospectively using the electronic hospital records and PACS (picture archiving and communication system). In our study, 55 patients who had a single level of PVP or BK filled with at least 6 mL og polymethylmethacrylate (PMMA) for T11-L5 levels and 3 mL of PMMA for T6-T10 levels via a bipedicular approach and who had only 1 vertebral fracture in a 10-year follow-up period were included in our study. The patients were divided into 2 groups: BK (n = 40) and PVP (n = 15). All measurements were performed on standing lateral radiographs from the postoperative first day and the last radiographs that were obtained during the follow-up. The anterior and posterior heights of the fractured vertebral body and local kyphosis angles were measured. RESULTS The mean follow-up time was 2.53 ± 1.78 years in the BK group and 3.07 ± 2.02 years in the PVP group. The decrease in the vertebral height and increasing kyphosis that develop from the early to late postoperative periods were found to be statistically significant in the BK group (P < 0.05). In the PVP group, vertebral height and kyphosis angle measurements did not differ significantly between the early and late postoperative periods. In addition, in terms of the percentage change, anterior parts of the vertebral bodies are more affected. However, the absolute difference for the measurement of the vertebral heights did not confirm this finding. CONCLUSIONS To our knowledge, our study is unique because it has the longest follow-up in the literature comparing BK and PVP in terms of recollapse of the augmented vertebrae. Our study shows that BK does not prevent height loss of the augmented vertebral bodies in the mid- to long term.
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Affiliation(s)
- Fikret Sahinturk
- Department of Neurosurgery, Başkent University School of Medicine, Ankara, Turkey.
| | - Erkin Sonmez
- Department of Neurosurgery, Başkent University School of Medicine, Ankara, Turkey
| | - Selim Ayhan
- Department of Neurosurgery, Başkent University School of Medicine, Ankara, Turkey
| | - Salih Gulsen
- Department of Neurosurgery, Başkent University School of Medicine, Ankara, Turkey
| | - Cem Yilmaz
- Department of Neurosurgery, Başkent University School of Medicine, Ankara, Turkey
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Pron G, Hwang M, Nasralla M, Smith R, Cheung A, Murphy K. Cost-effectiveness and willing-to-pay thresholds for vertebral augmentation of osteoporotic vertebral fractures, what are they based on: a systematic review. BMJ Open 2023; 13:e062832. [PMID: 37491092 PMCID: PMC10373718 DOI: 10.1136/bmjopen-2022-062832] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE Although there is substantial clinical evidence on the safety and effectiveness of vertebral augmentation for osteoporotic vertebral fractures, cost-effectiveness is less well known. The objective of this study is to provide a systematic review of cost-effectiveness studies and policy-based willingness-to-pay (WTP) thresholds for different vertebral augmentation (VA) procedures, vertebroplasty (VP) and balloon kyphoplasty (BK), for osteoporotic vertebral fractures (OVFs). DESIGN A systematic review targeting cost-effectiveness studies of VA procedures for OVFs. DATA SOURCES Six bibliographic databases were searched from inception up to May 2021. ELIGIBILITY CRITERIA FOR STUDY SELECTION Studies were eligible if meeting all predefined criteria: (1) VP or BK intervention, (2) OVFs and (3) cost-effectiveness study. Articles not written in English, abstracts, editorials, reviews and those reporting only cost data were excluded. DATA EXTRACTION AND SYNTHESIS Information was extracted on study characteristics, cost-effective estimates, summary decisions and payer WTP thresholds. Incremental cost-effective ratio (ICER) was the main outcome measure. Studies were summarised by a structured narrative synthesis organised by comparisons with conservative management (CM). Two independent reviewers assessed the quality (risk of bias) of the systematic review and cost-effectiveness studies by peer-reviewed checklists. RESULTS We identified 520 references through database searching and 501 were excluded as ineligible by titles and abstract. Ten reports were identified as eligible from 19 full-text reviews. ICER for VP versus CM evaluated as cost per quality-adjusted life-year (QALY) ranged from €22 685 (*US$33 395) in Netherlands to £-2240 (*US$-3273), a cost-saving in the UK. ICERs for BK versus CM ranged from £2706 (*US$3954) in UK to kr600 000 (*US$90 910) in Sweden. ICERs were within payer WTP thresholds for a QALY based on historical benchmarks. CONCLUSIONS Both VP and BK were judged cost-effective alternatives to CM for OVFs in economic studies and were within WTP thresholds in multiple healthcare settings.
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Affiliation(s)
- Gaylene Pron
- Dalla Lana School of Public Health, Institute Health Policy Evaluation and Management, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Hwang
- Department Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Mehran Nasralla
- Department Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Roger Smith
- Department Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Angela Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Kieran Murphy
- Department Medical Imaging, University Health Network, Toronto, Ontario, Canada
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Benditz A, Jerosch J. [Osteoporotic vertebral fractures-From diagnosis to treatment]. Z Rheumatol 2023; 82:18-24. [PMID: 36006473 DOI: 10.1007/s00393-022-01255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 02/07/2023]
Abstract
The aim of the present work is an overview of current concepts in the treatment of osteoporotic vertebral fractures, risk factors, clinical presentation and conservative and operative management. Osteoporotic vertebral fractures are a widespread problem, affecting between 700,000 and 1.5 million adults annually in the USA alone. Osteoporotic vertebral fractures can cause severe physical impairment, including back pain, dysfunction, and progressive thoracic kyphosis. Mortality after osteoporotic vertebral fractures is still increased compared to age-matched controls. In the reality of care, advocates of purely conservative therapy as well as advocates of surgical treatment can be found all over the world. In summary, understanding the risk factors, appropriate clinical evaluation and treatment strategies are crucial. When surgery is indicated, balloon kyphoplasty shows significantly better pain reduction and lower mortality compared to nonsurgical treatment.
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Affiliation(s)
- Achim Benditz
- Sektion Orthopädie und Wirbelsäulenchirurgie, Klinikum Fichtelgebirge, Schillerhain 1-8, 95615, Marktredwitz, Deutschland.
| | - Jörg Jerosch
- Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Johanna-Etienne-Krankenhaus, Neuss, Deutschland
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Ren H, Feng T, Hu Y, Yao G, Yu D, Cao J. The Value of Dynamic Fracture Mobility in Determining the Optimum Operation Choice for Acute Osteoporotic Vertebral Compression Fracture. J Pain Res 2022; 15:2327-2336. [PMID: 35992249 PMCID: PMC9386056 DOI: 10.2147/jpr.s368493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This retrospective study aimed to verify whether the use of a balloon in balloon kyphoplasty (BKP) could offer a higher degree of vertebral height restoration and deformity correction than percutaneous vertebroplasty (PVP) after adjustment for preoperative dynamic fracture mobility. We expect that this research will help surgeons to determine the optimum operation choice (PVP or BKP) for treating osteoporotic vertebral compression fractures (OVCFs). Patients and Methods We evaluated retrospectively 262 patients who were treated by PVP or BKP for acute, single-level OVCF at our institution from July 2015 to July 2019. According to the presence or absence of dynamic fracture mobility, the patients were divided into two groups: mobile group and fixed group. We compared the changes in the vertebral height and kyphotic angle for PVP and BKP, respectively, within each group. Results In the mobile group, the anterior vertebral height restoration (BKP group, 8.73±5.27%; PVP group, 2.96±1.59%), middle vertebral height restoration (BKP group, 7.58±5.18%; PVP group, 2.74±1.24%) and kyphotic angle correction (BKP group, 4.41±4.46°; PVP group, 1.38±1.60°) due to percutaneous vertebral augmentation technique itself were more obvious in BKP group compared with PVP group (P < 0.05). The BKP group has lower incidence of bone cement leakage (BKP group, 10.17%; PVP group, 25.53%, P < 0.05). In the fixed group, differences from comparison of changes were not statistically significant between PVP and BKP (P > 0.05). Conclusion The use of a balloon in BKP could offer greater kyphosis correction, higher vertebral body height restoration, and lower cement leakage rate than PVP if a fractured vertebral body existed dynamic mobility. However, all these advantages of BKP over PVP are not obvious and could be overrated for a fixed fracture exhibited no mobility. BKP is recommended for a fractured vertebral body with dynamic mobility. PVP is suggested for a fixed fractured vertebral body with no mobility as it produces similar capability of vertebral height restoration, kyphosis correction, and cement leakage as BKP.
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Affiliation(s)
- Hu Ren
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, People's Republic of China
| | - Tao Feng
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, People's Republic of China
| | - Yaning Hu
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, People's Republic of China
| | - Guangqing Yao
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, People's Republic of China
| | - Dahai Yu
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, People's Republic of China
| | - Jianhui Cao
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, People's Republic of China
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Wang S, Zheng L, Ma JX, Wang H, Sun ST, Zhang BH, Guo XL, Xiang LB, Chen Y. Analysis of the most influential publications on vertebral augmentation for treating osteoporotic vertebral compression fracture: A review. Medicine (Baltimore) 2022; 101:e30023. [PMID: 35945791 PMCID: PMC9351837 DOI: 10.1097/md.0000000000030023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aimed to analyze the most influential publications on vertebral augmentation for treating osteoporotic vertebral compression fracture. The Web of Science database was searched using the key words "percutaneous vertebroplasty," "percutaneous kyphoplasty," "balloon kyphoplasty," "vertebroplasty," "kyphoplasty," and "vertebral augmentation." The top 100 publications were arranged by citations per year and descriptively and visually analyzed. The top 100 publications were cited 25,482 times, with an average of 14.4 citations per paper per year. The corresponding authors of the publications represented 17 nations, with most authors being American (46 authors). Thirty-two journals were involved, with SPINE issuing the most publications (24 papers of the 100). Clinical research (73 of the 100 papers) outnumbered basic studies (14 papers) and systematic reviews (13 papers), and the most publications were published between 2000 and 2004. Co-citation analysis of the key words indicated that the top 5 focus areas were "complication," "balloon kyphoplasty," "vertebral compression fracture," "biomechanics," and "calcium phosphate cement." The top 3 keywords with the strongest citation bursts were "compression fracture," "cement," and "balloon kyphoplasty." The keywords with persistent strong citation bursts are "balloon kyphoplasty" and "augmentation." There are still contrary opinions about vertebral augmentation; new research should be conducted with more deliberate design and longer follow-up.
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Affiliation(s)
- Shuang Wang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Liang Zheng
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Jun-Xiong Ma
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Hong Wang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Shao-Tong Sun
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Bo-Hua Zhang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Xin-Lei Guo
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Liang-Bi Xiang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Yu Chen
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
- *Correspondence: Yu Chen, Department of Orthopedics, General Hospital of Northern Theater Command, No. 83, Wenhua Road, Shenhe District, Shenyang 110016, China ()
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Pron G, Hwang M, Smith R, Cheung A, Murphy K. Cost-effectiveness studies of vertebral augmentation for osteoporotic vertebral fractures: a systematic review. Spine J 2022; 22:1356-1371. [PMID: 35257838 DOI: 10.1016/j.spinee.2022.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Osteoporotic vertebral fractures (OVF) dramatically increase with age and are serious life altering adverse events for seniors resulting in increased rates of institutionalization, morbidity and mortality. Given the expanding population of the elderly and increasing prevalence of OVFs, cost-effective treatment strategies need to be considered. Percutaneous vertebral augmentation (VA) procedures such as vertebroplasty (VP) or balloon kyphoplasty (BK) are increasingly employed to treat painful vertebral fractures not responding to conservative management (CM) of bedrest and analgesia. Both VA procedures have been shown to be effective treatments for OVFs in multiple systematic reviews of randomized controlled trials. In this systematic review, analytical strategies, designs and results were compared for health economic studies evaluating cost-effectiveness of VA procedures, VP or BK for OVFs. Furthermore, assessments of quality (risk of bias) were conducted for the systematic review and the individual studies with peer-reviewed checklists recommended for cost-effectiveness studies. PURPOSE To provide an up-to-date systematic review of peer-reviewed studies evaluating cost-effectiveness of VA procedures, VP or KP for OVFs to support treatment and health care funding decisions. STUDY DESIGN This study is a systematic literature review and structured narrative synthesis. STUDY SAMPLE Peer reviewed health economic studies reporting cost-effectiveness for VA procedures, VP or BK for OVFs OUTCOME MEASURES: The following information extracted from the studies included: report country and year, study design, comparators, population, perspective, health valuations, costing sources and cost-effectiveness measures. For economic studies involving modeling, information was also extracted for model type, time horizon, key model drivers, and handling of uncertainty. Incremental cost-effectiveness ratio (ICER), the ratio of differences between comparator treatment groups in costs and health benefits, was considered the main cost-effectiveness measure. METHODS A systematic review was conducted of MEDLINE, EMBASE, CINAHL, ECONLIT, Cochrane Library and DARE databases up to the review date May 2021. Studies were reviewed for those reporting cost-effectiveness analyses on VA procedures including VP or BK for OVFs. Studies including only costs, abstracts, editorials, methodologies and reviews were not included. The selection of articles was reported in line with PRISMA guidance. A descriptive framework was developed to classify types of cost-effectiveness studies based on methodological differences and a structured narrative synthesis was used to summarize studies. Quality assessments were made with British Medical Journal checklist for individual cost-effectiveness studies and the CiCERO checklist for systematic reviews of cost-effectiveness studies. RESULTS In this systematic review, 520 references were identified through database searching and 501 were excluded as ineligible by titles and abstract based on prior eligibility criteria. From full-text reviews of 19 reports, ten were identified as eligible for the systematic review evaluating cost-effectiveness of VA procedures for OVFs. All references were published between 2008 and 2020. The ten cost-effectiveness studies, three for VP, three for BK and four for both VP and BK, all involved CM for OVFs as a treatment comparator. The studies involved different methods of economic analysis, modeling assumptions, cost and health valuations conducted in different health care setting over different time periods. A framework for the review outlines key features of cost-effectiveness study designs consisting of unmatched, matched, or randomized controls involving cost-effectiveness or cost-utility) analyses. Both VP and BK were cost-effective alternatives to CM for OVFs with earlier health gains and significantly shorter hospital stays. Cost-effectiveness estimates, ICERs, remained relatively stable and within willingness-to-pay thresholds under a range of sensitivity analyses. Comparisons between VP and BK were variable depending on modeling assumptions, but generally the procedures had similar health benefit gains with VP having lower acute procedural costs. CONCLUSIONS Both VP and BK, have been shown to be cost-effective alternatives to CM for osteoporotic vertebral fractures in diverse cost-effectiveness studies conducted in multiple health care settings. Trial-based cost-utility contributed the strongest evidence supporting cost-effectiveness determination for VP and BK for OVFs.
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Affiliation(s)
- Gaylene Pron
- Institute Health Policy Management and Evaluation, University of Toronto, Ontario, Canada
| | - Matthew Hwang
- Department Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada
| | - Roger Smith
- Department Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada
| | - Angela Cheung
- Department Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kieran Murphy
- Department Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario Canada.
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10
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Zhou Y, Jiang J, Gu F, Mi D. Comparison of Therapeutic Effects of PVP and PKP Combined With Triple Medication on Mild and Moderate Osteoporotic Vertebral Compression Fracture in the Elderly. Front Surg 2022; 8:663099. [PMID: 35402473 PMCID: PMC8990093 DOI: 10.3389/fsurg.2021.663099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To compare and analyze the therapeutic effect of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) combined with triple therapy on elderly patients with mild to moderate osteoporotic vertebral compression fractures (OVCF). Methods A total of 114 cases of elderly patients with mild to moderate osteoporotic vertebral compression fractures were identified as research subjects in our hospital from January 2017 to January 2018, and a total of 136 vertebrae were included. The patients who underwent PVP operation were included as the control group with 67 injured vertebrae, and the patients who underwent PKP operation were included as the experimental group with 69 injured vertebrae. Results The operation time and bone cement injection volume of the experimental group were significantly higher than the control group. The visual analog scale (VAS) scores of the two groups at 3 months and 6 months after operation were lower than those before operation, with lower VAS scores observed in the experimental group at 3 months and 6 months after operation. The anterior height of the vertebral body in the experimental group was higher than that of the control group. The experimental group outperformed the control group in the incidence of postoperative complications. The postoperative Oswestry dysfunction index (ODI) scores of the two groups were lower before the operation, in which the experimental group had lower scores than the control group (P < 0.05). Conclusion PVP and PKP combined with postoperative triple therapy can achieve a promising analgesic effect. PKP has a higher volume of bone cement injection volume, and a lower incidence of complications, which gives rise to a better vertebral body recovery height than that of PVP, with rapid postoperative body function recovery and good quality of life.
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11
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Cumulative Incidence and Factors Associated with Subsequent Vertebral Compression Fractures: A Nationwide Population-based Study. World Neurosurg 2022; 161:e90-e100. [PMID: 35077893 DOI: 10.1016/j.wneu.2022.01.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Patients who experience vertebral compression fractures are vulnerable to subsequent vertebral compression fractures (SVCFs). The purpose of this nationwide population-based study was to determine the age-specific cumulative incidence and factors associated with SVCFs in South Korea. METHODS Diagnostic codes, medical costs, and comorbid diseases in patients who had a vertebral compression fracture in 2011 and 2012 were collected from the National Health Insurance Service database of South Korea from 2007 to 2018. Demographic data, mortality rate, medical cost, and frequency of vertebroplasty or kyphoplasty were compared between patients with an initial fracture (IF) and those with a subsequent fracture (SF). RESULTS The cumulative incidence of SVCFs over 4 years was 24.4% and increased rapidly within a few months after the IF. In 2011, SVCFs occurred in 17,004 patients, and the incidence rate per 100,000 people was 113.6 (84.9 in men vs. 138.5 in women). The odds ratio (OR) of SVCFs in units of 10 years was the highest in women in their 60s, at 2.89. However, in men in their 70s, the OR was the highest, at 2.51. The rates of vertebroplasty or kyphoplasty, medical expenses, and mortality rate were significantly higher in the SF group than in the IF group (p < 0.01). CONCLUSION The age-specific cumulative incidence of SVCFs per 100,000 people was 113.6. SVCFs were more frequent among women, the elderly, and patients who underwent vertebroplasty or kyphoplasty. Women in their 60s or above and men in their 70s or above were at highest risk.
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Tieppo Francio V, Gill B, Rupp A, Sack A, Sayed D. Interventional Procedures for Vertebral Diseases: Spinal Tumor Ablation, Vertebral Augmentation, and Basivertebral Nerve Ablation-A Scoping Review. Healthcare (Basel) 2021; 9:1554. [PMID: 34828599 PMCID: PMC8624649 DOI: 10.3390/healthcare9111554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 12/13/2022] Open
Abstract
Low back pain is consistently documented as the most expensive and leading cause of disability. The majority of cases have non-specific etiologies. However, a subset of vertebral diseases has well-documented pain generators, including vertebral body tumors, vertebral body fractures, and vertebral endplate injury. Over the past two decades, specific interventional procedures targeting these anatomical pain generators have been widely studied, including spinal tumor ablation, vertebral augmentation, and basivertebral nerve ablation. This scoping review summarizes safety and clinical efficacy and discusses the impact on healthcare utilization of these interventions. Vertebral-related diseases remain a top concern with regard to prevalence and amount of health care spending worldwide. Our study shows that for a subset of disorders related to the vertebrae, spinal tumor ablation, vertebral augmentation, and basivertebral nerve ablation are safe and clinically effective interventions to decrease pain, improve function and quality of life, and potentially reduce mortality, improve survival, and overall offer cost-saving opportunities.
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Affiliation(s)
- Vincius Tieppo Francio
- Department of Rehabilitation Medicine, The University of Kansas Medical Center (KUMC), Kansas City, KS 66160, USA;
| | - Benjamin Gill
- Department of Physical Medicine and Rehabilitation, The University of Missouri, Columbia, MO 65212, USA;
| | - Adam Rupp
- Department of Rehabilitation Medicine, The University of Kansas Medical Center (KUMC), Kansas City, KS 66160, USA;
| | - Andrew Sack
- Department of Anesthesiology, The University of Kansas Medical Center (KUMC), Kansas City, KS 66160, USA; (A.S.); (D.S.)
| | - Dawood Sayed
- Department of Anesthesiology, The University of Kansas Medical Center (KUMC), Kansas City, KS 66160, USA; (A.S.); (D.S.)
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13
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Matsumoto K, Hoshino M, Omori K, Igarashi H, Matsuzaki H, Tokuhashi Y. Preoperative scoring system for predicting early adjacent vertebral fractures after Balloon Kyphoplasty. J Orthop Sci 2021; 26:538-542. [PMID: 32709541 DOI: 10.1016/j.jos.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/21/2020] [Accepted: 06/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adjacent vertebral fracture (AVF) is a major complication following Balloon Kyphoplasty (BKP). There is no scoring system for predicting AVF using only preoperative elements. The purposes of this study were to develop a scoring system for predicting early AVF after BKP based on preoperative factors and to investigate the appropriate surgical indication for BKP. METHODS Of 220 patients who underwent BKP at a single institution since 2011, 65 patients over the age of 60 who had undergone a standing whole spine X-ray preoperatively were enrolled. Factors affecting the occurrence of early AVF were examined. A scoring system was created consisting of the factors exhibiting significant differences, and the correlation between the total score and the incidence of early AVF was investigated. RESULTS Twenty of the 65 patients (30.8%) had early AVF. In a univariate analysis, age, previous vertebral fracture, pelvic tilt, and Local kyphosis significantly influenced early AVF. In a multivariate logistic regression analysis, age had an odds ratio of 1.136 (95% CI 1.001-1.289), previous vertebral fractures 4.181 (1.01-17.309), and Local kyphosis 1.103 (1.021-1.191). The scoring system was set as follows: ①Age (<75 years: 0 points(P), 75years≦: 1P), ②The number of previous vertebral fractures (0: 0 P, 1: 1P, 2: 2P, 3 or more: 3P), and ③Local kyphosis (<10°: 0P, 10°≦: 1P). There was a correlation between the total score and the incidence of early AVF (r = 0.812, ∗P = 0.05). The incidence of early AVF was 6.4% (2 cases/31 cases) for a score of ≦1P and 54.5% (18 cases/33 cases) for a score of ≧2P. CONCLUSIONS There was a correlation between the total score and the incidence of early AVF. A score of 1 point or less may represent the appropriate surgical indication for BKP.
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Affiliation(s)
- Koji Matsumoto
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamimati, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Masahiro Hoshino
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, 2-5-10 Ikohoncyo Adati-ku, Tokyo, 121-0807, Japan
| | - Keita Omori
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, 2-5-10 Ikohoncyo Adati-ku, Tokyo, 121-0807, Japan
| | - Hidetoshi Igarashi
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, 2-5-10 Ikohoncyo Adati-ku, Tokyo, 121-0807, Japan
| | - Hiromi Matsuzaki
- Department of Orthopaedic Surgery, Sonoda Medical Institute Tokyo Spine Center, 2-5-10 Ikohoncyo Adati-ku, Tokyo, 121-0807, Japan
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamimati, Itabashi-ku, Tokyo, 173-8610, Japan
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14
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Park EJ, Lee HJ, Jang MG, Ahn JS, Kim SB. A novel vertebroplasty technique using a larger-diameter needle for thoracolumbar osteoporotic vertebral compression fracture. Medicine (Baltimore) 2021; 100:e26174. [PMID: 34087881 PMCID: PMC8183758 DOI: 10.1097/md.0000000000026174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
Percutaneous vertebroplasty (VP) and kyphoplasty (KP) are well-established minimally invasive surgical procedures for the treatment of osteoporotic vertebral compression fractures (OVCF). However, some drawbacks have been reported regarding these procedures, including height loss, cement leakage, and loss of the restored height after balloon deflation. We performed a novel VP technique to minimize these limitations of conventional procedures. This study aimed to compare radiological and clinical outcomes of our method using a larger-diameter needle versus conventional VP (using a smaller needle) for thoracolumbar OVCF.From April 2016 to May 2017, 107 consecutive patients diagnosed with thoracolumbar OVCF were enrolled. Patients were divided into two groups: group 1 underwent conventional VP, i.e., using a smaller diameter needle, and group 2 underwent VP through a modified method with a larger-diameter needle. For radiological evaluation, parameters related to anterior vertebral height (AVH) and segmental angle were assessed using plain standing radiographs, and patient-reported outcomes were evaluated using the visual analog scale. Cement injection amount and leakage pattern were also analyzed. Group 2 showed a larger anterior vertebral height change than group 1 immediately postoperatively and one year postoperatively. The 1-year postoperatively-AVH maintained better in group 2 than in group 1. Group 2 showed more significant improvement of segmental angle immediately postoperatively than group 1 (3.15° in group 1 vs 9.36° in group 2). IYPo-visual analog scale significantly improved in both groups, with greater improvement in group 2 (3.69 in group 1 vs 5.63 in group 2). A substantially larger amount of cement was injected, with a lower leakage rate in group 2 than in group 1.A novel VP technique using a larger-diameter needle showed superior radiological and clinical outcomes than conventional VP. Therefore, it can be considered a useful treatment option for OVCF.
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Affiliation(s)
- Eugene J. Park
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu
| | - Ho-Jin Lee
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine
| | - Min-Gu Jang
- Department of Orthopedic Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, Republic of Korea
| | - Jae-Sung Ahn
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine
| | - Sang Bum Kim
- Department of Orthopedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine
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15
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Bao LS, Wu W, Wang X, Zhong XH, Wang LX, Wang H. Clinical Observation of Intraosseous Anesthesia in Percutaneous Kyphoplasty. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5528073. [PMID: 34122783 PMCID: PMC8189784 DOI: 10.1155/2021/5528073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
Objective Percutaneous kyphoplasty (PKP) is an effective minimally invasive technique in spine surgery in recent years. General anesthesia and local anesthesia are the main ways of anesthesia in PKP, and epidural anesthesia is also applied to PKP to some extent. However, all these three anesthetic methods have their respective advantages and disadvantages. It is essential to compare and evaluate the effects of different anesthesia methods on PKP for treating spinal fractures. Method A total of 45 patients (53 vertebral bodies were included) were divided into two groups. Group A included 24 patients (29 vertebral bodies) with an average of 71 years old and Group B included 21 patients (24 vertebral bodies) with an average of 74 years old. Visual analogue scale (VAS) scores were recorded preoperatively; balloon expansion and bone cement injection were conducted intraoperatively. Then, they were recorded immediately after operation, 6 h postoperatively, to assess the pain level of the patient. Moreover, hospitalization time (days), operation duration (minutes), and bone cement injection amount (mL) had also been recorded. Results There was no significant difference in preoperative general information and VAS score. However, the VAS scores were statistically significant at both the moment of balloon expansion and injection of bone cement. At the moment of immediate postoperation, the VAS scores showed no statistically significant difference, while it showed a statistically significant difference 6 h postoperatively. Conclusion The anesthesia method by injection of 1% lidocaine hydrochloride (5 ml) into vertebral body can effectively relieve patients' pain in intraoperation and postoperation.
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Affiliation(s)
- Li-Shuai Bao
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Wei Wu
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Xin Wang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu 610000, China
| | - Xi-Hong Zhong
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Lin-Xiu Wang
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Hong Wang
- The First Affiliated Hospital of Dalian Medical University, Dalian 116000, China
- Dalian Municipal Central Hospital, Dalian, China
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16
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Toepfer ET, Rott J, Bartosova M, Kolevica A, Machuca-Gayet I, Heuser A, Rabe M, Shroff R, Bacchetta J, Zarogiannis SG, Eisenhauer A, Schmitt CP. Calcium isotope fractionation by osteoblasts and osteoclasts, across endothelial and epithelial cell barriers, and with binding to proteins. Am J Physiol Regul Integr Comp Physiol 2021; 321:R29-R40. [PMID: 33978493 DOI: 10.1152/ajpregu.00334.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Timely and accurate diagnosis of osteoporosis is essential for adequate therapy. Calcium isotope ratio (δ44/42Ca) determination has been suggested as a sensitive, noninvasive, and radiation-free biomarker for the diagnosis of osteoporosis, reflecting bone calcium balance. The quantitative diagnostic is based on the calculation of the δ44/42Ca difference between blood, urine, and bone. The underlying cellular processes, however, have not been studied systematically. We quantified calcium transport and δ44/42Ca fractionation during in vitro bone formation and resorption by osteoblasts and osteoclasts and across renal proximal tubular epithelial cells (HK-2), human vein umbilical endothelial cells (HUVECs), and enterocytes (Caco-2) in transwell systems and determined transepithelial electrical resistance characteristics. δ44/42Ca fractionation was furthermore quantified with calcium binding to albumin and collagen. Calcified matrix formed by osteoblasts was isotopically lighter than culture medium by -0.27 ± 0.03‰ within 5 days, while a consistent effect of activated osteoclasts on δ44/42Ca could not be demonstrated. A transient increase in δ44/42Ca in the apical compartment by 0.26‰ occured across HK-2 cells, while δ44/42Ca fractionation was small across the HUVEC barrier and absent with Caco-2 enterocytes, and with binding of calcium to albumin and collagen. In conclusion, δ44/42Ca fractionation follows similar universal principles as during inorganic mineral precipitation; osteoblast activity results in δ44/42Ca fractionation. δ44/42Ca fractionation also occurs across the proximal tubular cell barrier and needs to be considered for in vivo bone mineralization modeling. In contrast, the effect of calcium transport across endothelial and enterocyte barriers on blood δ44/42Ca should be low and is absent with physiochemical binding of calcium to proteins.
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Affiliation(s)
- Eva Teresa Toepfer
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jeremy Rott
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Maria Bartosova
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ana Kolevica
- GEOMAR, Helmholtz Center for Ocean Research Kiel, Kiel, Germany
| | | | | | - Michael Rabe
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Rukshana Shroff
- Renal Unit, University College of London Great Ormond Street Hospital for Children National Health Service Foundation Trust and Institute of Child Health, London, United Kingdom
| | | | - Sotirios G Zarogiannis
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Claus Peter Schmitt
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
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17
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Hafezi-Nejad N, Bailey CR, Solomon AJ, Abou Areda M, Carrino JA, Khan M, Weiss CR. Vertebroplasty and kyphoplasty in the USA from 2004 to 2017: national inpatient trends, regional variations, associated diagnoses, and outcomes. J Neurointerv Surg 2020; 13:483-491. [PMID: 33334904 DOI: 10.1136/neurintsurg-2020-016733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND To explore the national inpatient trends, regional variations, associated diagnoses, and outcomes of vertebral augmentation (vertebroplasty and kyphoplasty) in the USA from 2004 to 2017. METHODS Data from the National Inpatient Sample were used to study hospitalization records for percutaneous vertebroplasty and kyphoplasty. Longitudinal projections of trends and outcomes, including mortality, post-procedural complications, length of stay, disposition, and total hospital charges were analyzed. RESULTS Following a period of decreased utilization from 2008 to 2012, hospitalizations for vertebroplasty and kyphoplasty plateaued after 2013. Total hospital charges and overall financial burden of hospitalizations for vertebroplasty and kyphoplasty increased to a peak of $1.9 billion (range $1.7-$2.2 billion) in 2017. Overall, 8% of procedures were performed in patients with a history of malignancy. In multivariable modeling, lung cancer (adjusted OR (aOR) 2.6 (range 1.4-5.1)) and prostate cancer (aOR 3.4 (range 1.2-9.4)) were associated with a higher risk of mortality. The New England region had the lowest frequency of routine disposition (14.1±1.1%) and the lowest average hospital charges ($47 885±$1351). In contrast, 34.0±0.8% had routine disposition in the West Central South region, and average hospital charges were as high as $99 836±$2259 in the Pacific region. The Mountain region had the lowest number of procedures (5365±272) and the highest mortality rate (1.2±0.3%). CONCLUSION National inpatient trends of vertebroplasty and kyphoplasty utilization remained stable after a period of decline from 2008 to 2012, while the financial burden of hospitalizations increased. Despite recent improvements in outcomes, significant regional variations persisted across the USA.
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Affiliation(s)
- Nima Hafezi-Nejad
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Alex J Solomon
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - John A Carrino
- Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Majid Khan
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Clifford R Weiss
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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18
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Hopkins TJ, Eggington S, Quinn M, Nichols-Ricker CI. Cost-effectiveness of balloon kyphoplasty and vertebroplasty versus conservative medical management in the USA. Osteoporos Int 2020; 31:2461-2471. [PMID: 32656632 PMCID: PMC7661420 DOI: 10.1007/s00198-020-05513-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/19/2020] [Indexed: 12/13/2022]
Abstract
UNLABELLED The cost-effectiveness of surgical versus conservative medical management of vertebral compression fractures in the US was analyzed in the context of inpatient versus outpatient treatment. Surgical intervention (balloon kyphoplasty and vertebroplasty) was found to be cost-effective relative to conservative medical management at a US willingness-to-pay threshold. INTRODUCTION To date, only one published study has evaluated the cost-effectiveness (C/E) of balloon kyphoplasty (BKP) or vertebroplasty (VP) in US Medicare patients with osteoporotic vertebral compression fractures. This study further evaluates the C/E of surgical treatment vs. conservative medical management (CMM), expanding on prior modeling by accounting for quality-adjusted life-years gained. METHODS A Markov microsimulation model of 1000 patients was constructed. Cost data were based on an analysis of Medicare claims payments, with propensity-score matching performed for BKP and VP vs. controls (CMM). Mortality inputs were based on US life tables, modified to account for age at initial fracture, presence of subsequent fracture(s), and relative risk of mortality by treatment. Separate incremental cost-effectiveness ratios (ICERs) were calculated for BKP and VP in inpatient and outpatient surgical treatment locations to account for individual clinical profiles presenting to each. RESULTS The discounted ICER for inpatient BKP vs. CMM was $43,455 per QALY gained; for outpatient BKP vs. CMM, $10,922; for inpatient VP vs. CMM, $39,774; and for outpatient VP vs. CMM, $12,293. Probabilistic sensitivity analysis confirmed that both BKP and VP would be considered C/E vs. CMM at a US willingness-to-pay (WTP) threshold of $50,000/QALY in 80% and 100% of 500 model simulations, respectively. The most sensitive parameters included quality of life estimates and hazard ratios for mortality. CONCLUSION While VP and BKP are more expensive treatment options than CMM in the short term, model results suggest interventional treatment is cost-effective, among patients eligible for surgery, at a US WTP threshold. This conclusion supports those from economic analyses conducted in EU-member countries.
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Affiliation(s)
- T J Hopkins
- Department of Anesthesiology and Pain Medicine, Duke Health, Duke University, 201 Trent Drive, 4313 Duke South, Orange Zone, DUMC, Box 3094, Durham, NC, 27710, USA.
| | - S Eggington
- Medtronic Global Health Economics & Reimbursement, Tolochenaz, Switzerland
| | - M Quinn
- Medtronic Pain Therapies Health Economics & Reimbursement, Fridley, MN, USA
| | - C I Nichols-Ricker
- Medtronic Pain Therapies Health Economics & Reimbursement, Fridley, MN, USA
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Wu XF, Ping Y, Zeng XQ, Feng Y, Wang Z, Li T, Wu DJ. Percutaneous Vertebroplasty with Side-Opening Cannula or Front-Opening Cannula in the Treatment of Kummell Disease? Orthop Surg 2020; 12:1190-1198. [PMID: 32638545 PMCID: PMC7454207 DOI: 10.1111/os.12730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/22/2020] [Accepted: 05/17/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To explore the effect of bone cement distribution, cement leakage, and clinical outcomes with side‐opening cannula for bone cement injection in percutaneous vertebroplasty (PVP) in treatment of Kummell disease. Methods A prospective study of patients with Kummell disease undergoing PVP was conducted from April 2012 to September 2017. In total, 43 patients (11 males, 32 females) with Kummell disease who received bilateral PVP were included in the study. The patients were divided into front‐opening cannulas (FOC) group with front‐opening cannulas and side‐opening cannulas (SOC) group with side‐opening cannulas. All patients were followed up for 6 months. The patient general information such as gender, age, bone density, compression ratio, operative time, and location of fracture vertebrae were recorded. Visual analogue scale (VAS), Oswestry Disability Index (ODI), bone cement distribution, radiation exposure time, bone cement leakage rate and vertebral height, and kyphosis angle were measured and compared for two groups before surgery, 1 day and 6 months after surgery. Results A total of 43 patients were enrolled, including 11 males and 32 females, aged 61–84 years. The bone density (T value) was 2.5 ± 0.6 in FOC group and 2.4 ± 0.6 in SOC group (P > 0.05). The compression ratio and operative time were 36.1% ± 13.0%, 39.3 ± 7.9 min in FOC group and 35.2% ± 13.7%, 40.0 ± 10.7 min in SOC group (P > 0.05). There was no significance between FOC and SOC groups in the location of fracture vertebrae. All patients underwent at least 6 months of follow‐up. At 6 months postoperatively, the VAS and ODI were significantly higher in the FOC group (3.0 ± 0.8, 35.7% ± 2.1%) than in the SOC group (1.3 ± 0.4, 18.6% ± 2.4%) (P < 0.05). The cement leakage rate of the SOC group was 4.8%, which was lower than that of the FOC group (31.8%, P < 0.05), and the bone cement distribution ratio was higher than that of the FOC group (63.1% ± 7.9% vs 40.5% ± 8.6%, P < 0.05). At 6 months after operation, the height of the anterior and posterior vertebral bodies of the patients in the SOC group restored better than the FOC group (anterior SOC: FOC 5.1 ± 0.5 mm vs 4.5 ± 0.5 mm; posterior SOC: FOC 0.6 ± 0.1 mm vs 0.3 ± 0.1 mm, P < 0.05), and the kyphosis correction was more obvious than patients in FOC group (SOC: FOC 8.5° ± 1.4° vs 4.6° ± 0.8°, P < 0.05). Conclusion Percutaneous vertebroplasty with side‐opening cannula is safe and effective in avoiding bone cement leakage, improving bone cement distribution, and restoring vertebral height.
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Affiliation(s)
- Xi-Fa Wu
- Department of Spinal Surgery, Zibo Central Hospital, ZiBo, China
| | - Yong Ping
- Department of Orthopaedics, Rizhao Central Hospital, Rizhao, China
| | - Xiang-Qin Zeng
- Department of Radiology, Zibo Central Hospital, ZiBo, China
| | - Yong Feng
- Department of Orthopaedics, Chongqing University Central Hospital, Chongqing, China
| | - Zhen Wang
- Department of Spinal Surgery, Zibo Central Hospital, ZiBo, China
| | - Tao Li
- Department of Spinal Surgery, Zibo Central Hospital, ZiBo, China
| | - Dong-Jin Wu
- Department of Spinal Surgery, The Second Hospital of Shandong University, Jinan, China
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20
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Griffoni C, Lukassen JNM, Babbi L, Girolami M, Lamartina C, Cecchinato R, Gasbarrini A, Barbanti Brodano G. Percutaneous vertebroplasty and balloon kyphoplasty in the treatment of osteoporotic vertebral fractures: a prospective randomized comparison. 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; 29:1614-1620. [PMID: 32361843 DOI: 10.1007/s00586-020-06434-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/09/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study is to compare the efficacy and safety of percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP) in the treatment of osteoporotic vertebral compression fractures. MATERIALS AND METHODS Patients with osteoporotic vertebral body fractures (T4-L5) were randomized and not blinded to kyphoplasty (n = 69) or vertebroplasty (n = 70). The postoperative pain score (VAS) at 12 months was the primary end point. The radiographic results were evaluated in relation to the resolution of the fracture and the possible onset of further osteoporotic fractures during follow-up. RESULTS A total of one hundred and thirty-nine patients were eligible for randomization (n = 70 for PVP group and n = 69 for BKP), and twenty-six patients (twenty in the BKP group and six in the PVP group) were excluded. The mean average age of patients was 73 years, and 82% of the patients were females. VAS pain score was significantly reduced after surgery in both groups, and there were no significant differences between the two groups in postoperative VAS score. There was a significant reduction in kyphotic wedge angle and improvement of the sagittal index in both groups, but there was no significant difference between the two groups. There was a significant higher risk incidence of adjacent level fractures in the vertebroplasty group. CONCLUSIONS In terms of clinical outcomes, there were no differences between the two groups. Both showed a significant clinical improvement, vertebral body height restoration and reduction in the kyphotic angle. There was a significant higher risk of adjacent level fractures in the vertebroplasty group.
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Affiliation(s)
- C Griffoni
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli, 1, 40136, Bologna, Italy
| | - J N M Lukassen
- Department of Neurosurgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - L Babbi
- GSpine4, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - M Girolami
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli, 1, 40136, Bologna, Italy
| | - C Lamartina
- GSpine4, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - R Cecchinato
- GSpine4, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - A Gasbarrini
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli, 1, 40136, Bologna, Italy
| | - G Barbanti Brodano
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli, 1, 40136, Bologna, Italy.
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Hinde K, Maingard J, Hirsch JA, Phan K, Asadi H, Chandra RV. Mortality Outcomes of Vertebral Augmentation (Vertebroplasty and/or Balloon Kyphoplasty) for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis. Radiology 2020; 295:96-103. [PMID: 32068503 DOI: 10.1148/radiol.2020191294] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Osteoporotic vertebral compression fractures (OVCFs) are prevalent, with associated morbidity and mortality. Vertebral augmentation (VA), defined as either vertebroplasty and/or balloon kyphoplasty (BKP), is a minimally invasive surgical treatment to reduce pain and further collapse and/or renew vertebral body height by introducing bone cement into fractured vertebrae. Nonsurgical management (NSM) for OVCF carries inherent risks. Purpose To summarize the literature and perform a meta-analysis on the mortality outcomes of patients with OVCF treated with VA compared with those in patients treated with NSM. Materials and Methods A single researcher performed a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines. Online scientific databases were searched in April 2018 for English-language publications. Included studies investigated mortality in patients with OVCF with VA as the primary intervention and NSM as the comparator. A meta-analysis was performed for studies that reported hazard ratios (HRs) and 95% confidence intervals (CIs). HR was used as a summary statistic and was random-effect-models tested. The χ2 test was used to study heterogeneity between trials, and the I2 statistic was calculated to estimate variation across studies. Results Of the 16 included studies, eight reported mortality benefits in VA, seven reported no mortality difference, and one reported mixed results. Seven studies were included in a meta-analysis examining findings in more than 2 million patients with OVCF (VA = 382 070, NSM = 1 707 874). The pooled HR comparing VA to NSM was 0.78 (95% CI: 0.66, 0.92; P = .003), with mortality benefits across 2- and 5-year periods (HR = 0.70, 95% CI: 0.69, 0.71, P < .001; and HR = 0.79, 95% CI: 0.62, 0.9999, P = .05; respectively). Balloon kyphoplasty provided mortality benefits over vertebroplasty, with HRs of 0.77 (95% CI: 0.77, 0.78; P < .001) and 0.87 (95% CI: 0.87, 0.88; P < .001), respectively. Conclusion In a meta-analysis of more than 2 million patients, those with osteoporotic vertebral compression fractures who underwent vertebral augmentation were 22% less likely to die at up to 10 years after treatment than those who received nonsurgical treatment. © RSNA, 2020 See also the editorial by Jennings in this issue.
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Affiliation(s)
- Kenji Hinde
- From the Department of Radiology, Western Health, Western Hospital, Footscray, Melbourne, Victoria 3011, Australia (K.H.); Interventional Radiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); Interventional Neuroradiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); School of Medicine-Faculty of Health, Deakin University, Warrun Ponds, Australia (J.M., H.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.A.H.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia (H.A.); NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia (K.P.); Interventional Neuroradiology Unit, Monash Imaging, Melbourne, Australia (J.M., H.A., R.V.C.); and School of Medicine, Monash University, Melbourne, Australia (R.V.C.)
| | - Julian Maingard
- From the Department of Radiology, Western Health, Western Hospital, Footscray, Melbourne, Victoria 3011, Australia (K.H.); Interventional Radiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); Interventional Neuroradiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); School of Medicine-Faculty of Health, Deakin University, Warrun Ponds, Australia (J.M., H.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.A.H.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia (H.A.); NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia (K.P.); Interventional Neuroradiology Unit, Monash Imaging, Melbourne, Australia (J.M., H.A., R.V.C.); and School of Medicine, Monash University, Melbourne, Australia (R.V.C.)
| | - Joshua A Hirsch
- From the Department of Radiology, Western Health, Western Hospital, Footscray, Melbourne, Victoria 3011, Australia (K.H.); Interventional Radiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); Interventional Neuroradiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); School of Medicine-Faculty of Health, Deakin University, Warrun Ponds, Australia (J.M., H.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.A.H.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia (H.A.); NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia (K.P.); Interventional Neuroradiology Unit, Monash Imaging, Melbourne, Australia (J.M., H.A., R.V.C.); and School of Medicine, Monash University, Melbourne, Australia (R.V.C.)
| | - Kevin Phan
- From the Department of Radiology, Western Health, Western Hospital, Footscray, Melbourne, Victoria 3011, Australia (K.H.); Interventional Radiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); Interventional Neuroradiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); School of Medicine-Faculty of Health, Deakin University, Warrun Ponds, Australia (J.M., H.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.A.H.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia (H.A.); NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia (K.P.); Interventional Neuroradiology Unit, Monash Imaging, Melbourne, Australia (J.M., H.A., R.V.C.); and School of Medicine, Monash University, Melbourne, Australia (R.V.C.)
| | - Hamed Asadi
- From the Department of Radiology, Western Health, Western Hospital, Footscray, Melbourne, Victoria 3011, Australia (K.H.); Interventional Radiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); Interventional Neuroradiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); School of Medicine-Faculty of Health, Deakin University, Warrun Ponds, Australia (J.M., H.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.A.H.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia (H.A.); NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia (K.P.); Interventional Neuroradiology Unit, Monash Imaging, Melbourne, Australia (J.M., H.A., R.V.C.); and School of Medicine, Monash University, Melbourne, Australia (R.V.C.)
| | - Ronil V Chandra
- From the Department of Radiology, Western Health, Western Hospital, Footscray, Melbourne, Victoria 3011, Australia (K.H.); Interventional Radiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); Interventional Neuroradiology Service-Department of Radiology, Austin Hospital, Melbourne, Australia (J.M., H.A.); School of Medicine-Faculty of Health, Deakin University, Warrun Ponds, Australia (J.M., H.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (J.A.H.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia (H.A.); NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia (K.P.); Interventional Neuroradiology Unit, Monash Imaging, Melbourne, Australia (J.M., H.A., R.V.C.); and School of Medicine, Monash University, Melbourne, Australia (R.V.C.)
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Cai Z, Piao C, Sun M, Zhou H, Gao Z, Xiang L. Bone cement leaking into iliac vein during artificial femoral head replacement: A case report. Medicine (Baltimore) 2019; 98:e17547. [PMID: 31593135 PMCID: PMC6799880 DOI: 10.1097/md.0000000000017547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Leakage of bone cement from femoral medullary cavity is a rare complication after hip arthroplasty, and there is no report on the leaked bone cement entering into iliac vessels. PATIENT CONCERNS An 89-year-old woman presented with a fracture in the right femoral neck. She had well-fixed right femoral head replacement after careful preoperative examinations, and no adverse reactions appeared. She was able to get off bed to walk at the 2nd day after surgery. DIAGNOSES Postoperative radiograph showed leakage of bone cement into the joint through femoral medullary cavity entering into iliac vessels, but the patient complained no discomforts. She received a treatment with low-molecular weight heparin and rivaroxaban. OUTCOMES The patient was able to walk with normal gait, without swelling in both lower extremities and discomfort in the hip. There was no other complication concerning intravascular foreign bodies. LESSONS This case calls into the phenomenon of leakage of injected bone cement in femoral head replacement regardless of complete and nonfractured femur, which may be into the lower limb and pelvic veins, given that, dangerous consequences will not occur.
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Affiliation(s)
- Zhencun Cai
- Department of Orthopaedics Surgery, Central Hospital of Shenyang Medical College
- Department of Orthopaedics Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
| | - Chengzhe Piao
- Department of Orthopaedics Surgery, Central Hospital of Shenyang Medical College
| | - Ming Sun
- Department of Orthopaedics Surgery, Central Hospital of Shenyang Medical College
| | - Hongyu Zhou
- Department of Orthopaedics Surgery, Central Hospital of Shenyang Medical College
| | - Zhenhuai Gao
- Department of Orthopaedics Surgery, Central Hospital of Shenyang Medical College
| | - Liangbi Xiang
- Department of Orthopaedics Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China
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23
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Barker KL, Newman M, Stallard N, Leal J, Minns Lowe C, Javaid MK, Noufaily A, Adhikari A, Hughes T, Smith DJ, Gandhi V, Cooper C, Lamb SE. Exercise or manual physiotherapy compared with a single session of physiotherapy for osteoporotic vertebral fracture: three-arm PROVE RCT. Health Technol Assess 2019; 23:1-318. [PMID: 31456562 DOI: 10.3310/hta23440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A total of 25,000 people in the UK have osteoporotic vertebral fracture (OVF). Evidence suggests that physiotherapy may have an important treatment role. OBJECTIVE The objective was to investigate the clinical effectiveness and cost-effectiveness of two different physiotherapy programmes for people with OVF compared with a single physiotherapy session. DESIGN This was a prospective, adaptive, multicentre, assessor-blinded randomised controlled trial (RCT) with nested qualitative and health economic studies. SETTING This trial was based in 21 NHS physiotherapy departments. PARTICIPANTS The participants were people with symptomatic OVF. INTERVENTIONS Seven sessions of either manual outpatient physiotherapy or exercise outpatient physiotherapy compared with the best practice of a 1-hour single session of physiotherapy (SSPT). MAIN OUTCOME MEASURES Outcomes were measured at 4 and 12 months. The primary outcomes were quality of life and muscle endurance, which were measured by the disease-specific QUALEFFO-41 (Quality of Life Questionnaire of the European Foundation for Osteoporosis - 41 items) and timed loaded standing (TLS) test, respectively. Secondary outcomes were (1) thoracic kyphosis angle, (2) balance, evaluated via the functional reach test (FRT), and (3) physical function, assessed via the Short Physical Performance Battery (SPPB), 6-minute walk test (6MWT), Physical Activity Scale for the Elderly, a health resource use and falls diary, and the EuroQol-5 Dimensions, five-level version. RESULTS A total of 615 participants were enrolled, with 216, 203 and 196 randomised by a computer-generated program to exercise therapy, manual therapy and a SSPT, respectively. Baseline data were available for 613 participants, 531 (86.6%) of whom were women; the mean age of these participants was 72.14 years (standard deviation 9.09 years). Primary outcome data were obtained for 69% of participants (429/615) at 12 months: 175 in the exercise therapy arm, 181 in the manual therapy arm and 173 in the SSPT arm. Interim analysis met the criteria for all arms to remain in the study. For the primary outcomes at 12 months, there were no significant benefits over SSPT of exercise [QUALEFFO-41, difference -0.23 points, 95% confidence interval (CI) -3.20 to 1.59 points; p = 1.000; and TLS test, difference 5.77 seconds, 95% CI -4.85 to 20.46 seconds; p = 0.437] or of manual therapy (QUALEFFO-41, difference 1.35 points, 95% CI -1.76 to 2.93 points; p = 0.744; TLS test, difference 9.69 seconds (95% CI 0.09 to 24.86 seconds; p = 0.335). At 4 months, there were significant gains for both manual therapy and exercise therapy over SSPT in the TLS test in participants aged < 70 years. Exercise therapy was superior to a SSPT at 4 months in the SPPB, FRT and 6MWT and manual therapy was superior to a SSPT at 4 months in the TLS test and FRT. Neither manual therapy nor exercise therapy was cost-effective relative to a SSPT using the threshold of £20,000 per quality-adjusted life-year. There were no treatment-related serious adverse events. CONCLUSIONS This is the largest RCT to date assessing physiotherapy in participants with OVFs. At 1 year, neither treatment intervention conferred more benefit than a single 1-hour physiotherapy advice session. The focus of future work should be on the intensity and duration of interventions to determine if changes to these would demonstrate more sustained effects. TRIAL REGISTRATION Current Controlled Trials ISRCTN49117867. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 44. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Karen L Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Meredith Newman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nigel Stallard
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Catherine Minns Lowe
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Muhammad K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Angela Noufaily
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Anish Adhikari
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tamsin Hughes
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David J Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Varsha Gandhi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cyrus Cooper
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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The Effect of Intraoperative Vertebral Anesthesia on Osteoporotic Fractures Treated With Percutaneous Kyphoplasty: A Prospective Cohort Study. Clin Spine Surg 2019; 32:E289-E296. [PMID: 31021875 DOI: 10.1097/bsd.0000000000000823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN A prospective randomized cohort study. OBJECTIVE The objective of this study was to investigate the effect of intraoperative vertebral anesthesia on osteoporotic vertebral compression fractures (OVCFs) when treated with percutaneous kyphoplasty (PKP). SUMMARY OF BACKGROUND DATA Only a few studies have evaluated the intraoperative pain reducing strategies during PKP. MATERIALS AND METHODS A total of 64 patients with OVCFs were enrolled in the study. All of the patients were randomized into 2 groups: the traditional local anesthesia group (from the skin to the periosteum, group A) and the experimental group (from the skin to a vertebral body, group B). Visual Analogue Scale (VAS) score was used to evaluate the degree of pain at six time points, that is, VAS before surgery, VAS during balloon dilation, VAS during bone cement injection, VAS soon after surgery, and VAS 12 hours and 24 hours after surgery. In addition, we noted the patients' willingness to undergo reoperation if necessary, and the variations in surgical complications between the 2 groups. RESULTS There was no significant difference in VAS score before surgery between the 2 groups (t=1.694, P=0.095). The VAS scores during balloon dilatation, bone cement injection and soon after surgery were significantly different between the 2 groups (t=4.405, P=0.000; t=2.481, P=0.016; t=2.992, P=0.004, respectively). The willingness to undergo reoperation was significantly different between 2 groups (χ=6.020, P=0.049), whereas the complications showed no significant difference (χ=0.000, P=0.754). CONCLUSIONS Traditional local anesthesia combined with vertebral anesthesia was effective in alleviating perioperative pain during PKP. No serious complication was noted during the operation. LEVEL OF EVIDENCE Level I.
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25
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Cost-effectiveness of Balloon Kyphoplasty for Patients With Acute/Subacute Osteoporotic Vertebral Fractures in the Super-Aging Japanese Society. Spine (Phila Pa 1976) 2019; 44:E298-E305. [PMID: 30086080 DOI: 10.1097/brs.0000000000002829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A propensity score matching study. OBJECTIVE The aim of this study was to assess the cost-effectiveness of balloon kyphoplasty (BKP) in Japan. SUMMARY OF BACKGROUND DATA Osteoporotic vertebral fracture (OVF) is a common disease in elderly people. In Japan, the incidence of painful OVF in 2008 was estimated as 880,000, and approximately 40% of patients with painful OVF are hospitalized due to the severity of pain. Japan is the front runner among super-aged societies and rising health care costs are an economic problem. METHODS BKP and nonsurgical management (NSM) for acute/subacute OVF were performed in 116 and 420 cases, respectively. Quality-adjusted life years (QALY) and incremental costs were calculated on the basis of a propensity score matching study. QALY was evaluated using the SF-6D questionnaire. Finally, using a Markov model, incremental cost-effectiveness ratios (ICERs) were calculated for 71 matched cases. RESULTS In the comparison between BKP and NSM, mean patients age was 78.3 and 77.7 years, respectively (P = 0.456). The BKP procedure cost 402,988 JPY more than NSM and the gains in QALY at the 6-month follow-up were 0.153 and 0.120, respectively (difference = 0.033). ICERs for 3 and 20 years were 4,404,158 JPY and 2,416,406 JPY, respectively. According to sensitivity analysis, ICERs ranged from 652,181 JPY to 4,896,645 JPY (4418-33,168 GBP). CONCLUSION This study demonstrated that BKP is a cost-effective treatment option for OVF in Japan. However, the effect might be blunted in patients aged > 80 years. Further research is necessary to elucidate the cost-effectiveness of BKP in this population. LEVEL OF EVIDENCE 4.
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Clerk-Lamalice O, Beall DP, Ong K, Lorio MP. ISASS Policy 2018-Vertebral Augmentation: Coverage Indications, Limitations, and/or Medical Necessity. Int J Spine Surg 2019; 13:1-10. [PMID: 30805279 DOI: 10.14444/5096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The ISASS Policy Statement on vertebral augmentation has the objectives to provide a background and an update with the latest clinical evidence for the international spine community. A SpineLine Panel Review (2010) appropriately recommended an exploration of "the seeming disconnect between the conclusions of … two [Level I] PRCT's and previous experience and data" regarding vertebral augmentation. ISASS responded by supporting a comprehensive meta-analysis to help frame a cogent historical analysis of vertebral augmentation. This ISASS Policy 2018 is based on a thorough literature search for relevant studies, including systematic reviews and meta-analyses, that are subjected to thorough quality appraisal for the purpose of informing public opinion and decision making. Given the abundance of high-quality information, ISASS can confidently advocate that there is strong support for vertebral augmentation in the treatment of symptomatic vertebral compression fractures.
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Affiliation(s)
| | | | - Kevin Ong
- Exponent, Inc., Philadelphia, Pennsylvania
| | - Morgan P Lorio
- Hughston Clinic Orthopaedics-Centennial, Nashville, Tennessee
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Maruo K, Tachibana T, Arizumi F, Kusuyama K, Kishima K, Yoshiya S. Effect of Teriparatide on Subsequent Vertebral Fractures after Instrumented Fusion Surgery for Osteoporotic Vertebral Fractures with Neurological Deficits. Asian Spine J 2018; 13:283-289. [PMID: 30481980 PMCID: PMC6454279 DOI: 10.31616/asj.2018.0098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/22/2018] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Retrospective case review. PURPOSE To assess the incidence and effect of teriparatide (TP) on subsequent vertebral fractures following a long-instrumented fusion surgery for osteoporotic vertebral fractures (OVFs). OVERVIEW OF LITERATURE TP treatment may be a useful strategy for patients with OVFs treated with a long-instrumented surgery. METHODS Overall, 47 patients who underwent long-instrumented fusion surgery (≥3 levels) for OVFs with neurological deficits between 2010 and 2013 were enrolled. The mean age of the subjects was 76 years; the study population comprised 20 males and 27 females. The mean follow-up duration was 23 months. The average of fused vertebrae was 4.9. TP was used for 19 patients who comprised the TP group. The incidence of subsequent VFs was estimated with Kaplan-Meier analyses and compared between the TP and non-TP groups using the log-rank test. Risk factors were evaluated using a Cox proportional hazards model. RESULTS A total of 38% (18/47 cases) of the subjects were identified with subsequent VFs. There were no significant differences in the age, sex, fused levels, presence of prevalent fractures, and correction loss of the two groups. The occurrence of subsequent VFs was lower in the TP group than in the non-TP group (16% vs. 54%, p=0.014). The log-rank test revealed that the TP treatment significantly reduced the risk of subsequent VFs (p=0.048). A Cox proportional hazards model revealed that preoperative TP treatment is only a protective factor of subsequent VFs after instrumented fusion surgery for OVFs (hazard ratio, 0.281; p=0.047). CONCLUSIONS In this retrospective study, pre- and postoperative TP treatment significantly reduced the incidence of subsequent VFs after instrumented fusion surgery for OVFs. A prospective randomized study is warranted to determine the efficacy of TP treatments.
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Affiliation(s)
- Keishi Maruo
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Fumihiro Arizumi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuki Kusuyama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuya Kishima
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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Beall D, Lorio MP, Yun BM, Runa MJ, Ong KL, Warner CB. Review of Vertebral Augmentation: An Updated Meta-analysis of the Effectiveness. Int J Spine Surg 2018; 12:295-321. [PMID: 30276087 DOI: 10.14444/5036] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background To update vertebral augmentation literature by comparing outcomes between vertebroplasty (VP), balloon kyphoplasty (BKP), vertebral augmentation with implant (VAI), and nonsurgical management (NSM) for treating vertebral compression fractures (VCFs). Methods A PubMed literature search was conducted with keywords kyphoplasty, vertebroplasty, vertebral body stent, and vertebral augmentation AND implant for English-language articles from February 1, 2011, to November 22, 2016. Among the results, 25 met the inclusion criteria for the meta-analysis. Inclusion criteria were prospective comparative studies for mid-/lower-thoracic and lumbar VCFs enrolling at least 20 patients. Exclusion criteria included studies that were single arm, systematic reviews and meta-analyses, traumatic nonosteoporotic or cancer-related fractures, lack of clinical outcomes, or non-Level I and non-Level II studies. Standardized mean difference between baseline and end point for each outcome was calculated, and treatment groups were pooled using random effects meta-analysis. Results Visual analog scale pain reduction for BKP and VP was -4.05 and -3.88, respectively. VP was better than but not significantly different from NSM (-2.66), yet BKP showed significant improvement from both NSM and VAI (-2.77). The Oswestry Disability Index reduction for BKP showed a significant improvement over VAI (P < .001). There was no significant difference in changes between BKP and VP for anterior (P = .226) and posterior (P = .293) vertebral height restoration. There was no significant difference in subsequent fractures following BKP (32.7%; 95% confidence interval [CI]: 8.8%-56.6%) or VP (28.3%; 95% CI: 7.0%-49.7%) compared with NSM (15.9%; 95% CI: 5.2%-26.6%). Conclusions/Level of Evidence Based on Level I and II studies, BKP had significantly better and VP tended to have better pain reduction compared with NSM. BKP tended to have better height restoration than VP. Additionally, BKP had significant improvements in pain reduction and disability score as compared with VAI. Clinical Relevance This meta-analysis serves to further define and support the safety and efficacy of vertebral augmentation.
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Affiliation(s)
| | - Morgan P Lorio
- Hughston Clinic Orthopaedics-Centennial, Nashville, Tennessee
| | - B Min Yun
- Exponent, Inc, Philadelphia, Pennsylvania
| | | | | | - Christopher B Warner
- University of Colorado Anschutz Medical Campus, Department of Radiology, Aurora, Colorado
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Nasuto M, Falcone M, Strizzi V, Florio L, Lauriola W, Ciccarese G, Guglielmi G, Florio F. Vertebroplasty in Elderly Patients: A Clinical Effectiveness Analysis. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0288-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Osteoporosis is one of the costliest conditions managed by orthopaedic surgeons. This condition, which is characterized by decreased bone density and thinning of cortical bone, is strongly influenced by complex signaling in both the hormonal and mechanical environments. Osteoporosis cannot be cured; instead, it can only be managed to decrease patient morbidity. Current pharmacologic treatments are aimed at minimizing bone turnover and have substantial side effects. Therefore, much work remains to find safer and more effective agents to restore bone density. In addition to the high incidence of fracture in elderly patients, many of the traditional fixation constructs used for repair of these fractures are not suitable for use in osteoporotic bone. Increased use of fixed-angle locking plates, intramedullary devices, and bone substitutes has greatly improved outcomes in these patients.
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Percutaneous Vertebroplasty and Kyphoplasty: Current Status, New Developments and Old Controversies. Cardiovasc Intervent Radiol 2017; 40:1815-1823. [DOI: 10.1007/s00270-017-1779-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 08/22/2017] [Indexed: 12/26/2022]
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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: 2.6] [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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Postoperative Functional Evaluation of Percutaneous Vertebroplasty Compared With Percutaneous Kyphoplasty for Vertebral Compression Fractures. Am J Ther 2017; 23:e1381-e1390. [PMID: 25844701 DOI: 10.1097/mjt.0000000000000223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Both percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) have shown their superiorities in the treatment of vertebral compression fractures (VCFs), yet, few studies have compared their postoperative functional outcomes in patients with VCFs; the authors therefore conducted this meta-analysis to explore the postoperative functional recovery efficacies of PVP and PKP in the treatment of VCFs. Computerized bibliographic databases were applied to identify relevant articles comparing the therapeutic effect of PVP and PKP in the treatment of VCFs. Standardized mean difference and its 95% confidence interval were calculated. Statistical analyses were conducted with the STATA statistical software. Postoperative Oswestry Disability Index investigation outcomes revealed a significant difference between the PVP group and PKP group. Subgroup analysis by the 8 dimensions of the SF-36 health survey presented a statistical significance in general health between the PVP group and PKP group. The application of PKP has the superiority in postoperative functional recovery of VCFs as compared with PVP, especially in efficaciously extending kyphosis angle, improving vertebral body height and decreasing complication rate.
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The Effectiveness of Percutaneous Vertebroplasty Is Determined by the Patient-Specific Bone Condition and the Treatment Strategy. PLoS One 2016; 11:e0151680. [PMID: 27100630 PMCID: PMC4839558 DOI: 10.1371/journal.pone.0151680] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 03/02/2016] [Indexed: 01/20/2023] Open
Abstract
Purpose Vertebral fragility fractures are often treated by injecting bone cement into the collapsed vertebral bodies (vertebroplasty). The mechanisms by which vertebroplasty induces pain relief are not completely understood yet and recent debates cast doubt over the outcome of the procedure. The controversy is intensified by inconsistent results of randomized clinical trials and biomechanical studies that have investigated the effectiveness or the change in biomechanical response due to the reinforcement. The purpose of this study was to evaluate the effectiveness of vertebroplasty, by varying the relevant treatment parameters and (a) computationally predicting the improvement of the fracture risk depending on the chosen treatment strategy, and (b) identifying the determinants of a successful treatment. Methods A Finite Element model with a patient-specific failure criterion and direct simulation of PMMA infiltration in four lumbar vertebrae was used to assess the condition of the bone under compressive load before and after the virtual treatment, simulating in a total of 12000 virtual treatments. Results The results showed that vertebroplasty is capable of reducing the fracture risk by magnitudes, but can also have a detrimental effect. Effectiveness was strongly influenced by interactions between local bone quality, cement volume and injection location. However, only a moderate number of the investigated treatment strategies were able to achieve the necessary improvement for preventing a fracture. Conclusions We conclude that the effectiveness of vertebroplasty is sensitive to the patient’s condition and the treatment strategy.
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Abstract
Osteoporotic vertebral compression fractures (OVF) are an increasing public health problem. Cement augmentation (vertebroplasty of kyphoplasty) helps stabilize painful OVF refractory to medical treatment. This stabilization is thought to improve pain and functional outcome. Vertebroplasty consists of injecting cement into a fractured vertebra using a percutaneous transpedicular approach. Balloon kyphoplasty uses an inflatable balloon prior to injecting the cement. Although kyphoplasty is associated with significant improvement of local kyphosis and less cement leakage, this does not result in long-term clinical and functional improvement. Moreover, vertebroplasty is favored by some due to the high cost of kyphoplasty. The injection of cement increases the stiffness of the fracture vertebrae. This can lead, in theory, to adjacent OVF. However, many studies found no increase of subsequent fracture when comparing medical treatment to cement augmentation. Kyphoplasty can have a protective effect due to restoration of sagittal balance.
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[Spinal fractures]. Z Gerontol Geriatr 2016; 49:149-59; quiz 160-1. [PMID: 26790876 DOI: 10.1007/s00391-015-1009-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 11/10/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
Abstract
Osteoporotic spinal fractures are typical age-related fragility fractures. Their impact on the quality of life is often underestimated; therefore, anti-osteoporotic drug treatment according to the current guidelines is essential. Occult vertebral fractures may be difficult to detect and a differentiation between fresh and old fractures is often only possible with magnetic resonance imaging (MRI) to reveal cancellous bone edema. Treatment recommendations are predominantly based on traumatic fractures in younger adults and are thus not applicable in orthogeriatrics. A new classification currently under validation and presented in this article was developed in order to aid decision-making for operative interventions. Minimally invasive treatment options include vertebroplasty, kyphopasty and internal fixation. The application of cement provides additional stability but can be accompanied by cement-specific complications, such as extravasation and embolism.
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Martelli N, Devaux C, van den Brink H, Pineau J, Prognon P, Borget I. A Systematic Review of the Level of Evidence in Economic Evaluations of Medical Devices: The Example of Vertebroplasty and Kyphoplasty. PLoS One 2015; 10:e0144892. [PMID: 26661078 PMCID: PMC4675526 DOI: 10.1371/journal.pone.0144892] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/24/2015] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Economic evaluations are far less frequently reported for medical devices than for drugs. In addition, little is known about the quality of existing economic evaluations, particularly for innovative devices, such as those used in vertebroplasty and kyphoplasty. OBJECTIVE To assess the level of evidence provided by the available economic evaluations for vertebroplasty and kyphoplasty. DATA SOURCES A systematic review of articles in English or French listed in the MEDLINE, PASCAL, COCHRANE and National Health Service Economic Evaluation databases, with limits on publication date (up to the date of the review, March 2014). STUDY SELECTION We included only economic evaluations of vertebroplasty or kyphoplasty. Editorial and methodological articles were excluded. DATA EXTRACTION Data were extracted from articles by two authors working independently and using two analysis grids to measure the quality of economic evaluations. DATA SYNTHESIS Twenty-one studies met our inclusion criteria. All were published between 2008 and 2014. Eighteen (86%) were full economic evaluations. Cost-effectiveness analysis (CEA) was the most frequent type of economic evaluation, and was present in 11 (52%) studies. Only three CEAs complied fully with the British Medical Journal checklist. The quality of the data sources used in the 21 studies was high, but the CEAs conforming to methodological guidelines did not use high-quality data sources for all components of the analysis. CONCLUSIONS This systematic review shows that the level of evidence in economic evaluations of vertebroplasty and kyphoplasty is low, despite the recent publication of a large number of studies. This finding highlights the challenges to be faced to improve the quality of economic evaluations of medical devices.
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Affiliation(s)
- Nicolas Martelli
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015, Paris, France
- GRADES, Université Paris-Sud, Université Paris-Saclay, 5 rue Jean-Baptiste Clément, 92290, Châtenay-Malabry, France
- * E-mail:
| | - Capucine Devaux
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015, Paris, France
| | - Hélène van den Brink
- GRADES, Université Paris-Sud, Université Paris-Saclay, 5 rue Jean-Baptiste Clément, 92290, Châtenay-Malabry, France
| | - Judith Pineau
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015, Paris, France
| | - Patrice Prognon
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015, Paris, France
| | - Isabelle Borget
- GRADES, Université Paris-Sud, Université Paris-Saclay, 5 rue Jean-Baptiste Clément, 92290, Châtenay-Malabry, France
- Department of Health Economics, Gustave Roussy Institute, 114, rue Edouard-Vaillant, 94805, Villejuif, France
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García-Maroto R, García-Coiradas J, Milano G, Cebrián J, Marco F, López-Durán L. Safety and efficacy of kyphoplasty in the treatment of tumoral disease of the spine. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Goldstein CL, Chutkan NB, Choma TJ, Orr RD. Management of the Elderly With Vertebral Compression Fractures. Neurosurgery 2015; 77 Suppl 4:S33-45. [DOI: 10.1227/neu.0000000000000947] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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ASA III osteoporotic fracture in 62 patients treated with vertebroplasty under local anesthesia. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 26:47-52. [PMID: 26377662 DOI: 10.1007/s00590-015-1700-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 09/01/2015] [Indexed: 02/07/2023]
Abstract
Vertebroplasty is a minimally invasive procedure that may be performed under either local or general anesthesia. In this study, we aimed at assessing the outcomes of the vertebroplasty performed under local anesthesia in patients at high risk of general anesthesia. Vertebroplasty was performed under local anesthesia in the treatment of a total of 62 patients (68 vertebrae in total) with osteoporotic vertebral fractures between 2011 and 2013. None of the patients had a history of trauma. Patients who were classified as ASA III during the preoperative examinations were included in the study. VAS scores were evaluated before the surgery, on the first postoperative day, and in week 1 and in month 1 after the surgery. The average age was 77.5 years (age range 53-102). An average of 2 cc of cement was injected to 22 patients (35.5 %), and an average of 3 cc of cement was injected to 40 patients (64.5 %). The mean VAS scores were 7.52 (6-9) before the procedure, 3.55 (2-5) on the first day, 2.03 (0-4) in week 1 and 0.87 (0-2) in month 1 postoperatively. Asymptomatic cement embolism was detected in one patient. No other complications were observed in the study group. Vertebroplasty performed under local anesthesia is an effective and safe procedure in terms of pain control and early ambulation and is bereft of the complications associated with general anesthesia.
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Veizi E, Hayek S. Interventional therapies for chronic low back pain. Neuromodulation 2015; 17 Suppl 2:31-45. [PMID: 25395115 DOI: 10.1111/ner.12250] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/28/2014] [Accepted: 08/31/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Low back pain (LBP) is a highly prevalent condition and one of the leading causes of lost productivity and health-care costs. The objective of this review is to discuss the role of interventional pain procedures and evidence of their effectiveness in treatment of chronic LBP. METHODS This is a narrative review examining published studies on interventional procedures for LBP. The rationales, indications, technique, evidence, and complications for the interventional procedures are discussed. RESULTS Interventional pain procedures are used extensively in diagnosis and treatment of chronic pain. LBP is multifactorial, and while significant progress has been made in understanding its pathophysiology, this has not resulted in a proportional improvement of functional outcomes. For certain procedures, such as spinal cord stimulation, medical branch blocks and radiofrequency ablations, and epidural steroid injections for radiculopathy, safety, efficacy, and cost-effectiveness in treating LBP have been well studied. For others, such as interventions for discogenic pain, treatment successes have been modest at best. CONCLUSIONS Implementation of interventional pain procedures in the treatment framework of LBP has resulted in improvement of pain intensity in at least the short and medium terms, but equivocal results have been observed in functional improvement.
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Affiliation(s)
- Elias Veizi
- Department of Anesthesiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA; Pain Medicine & Spine Care, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
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Liu X, Yang Z, Xie L, Yuan Z, Ren M, Han L. Advances in the clinical research of the minimally invasive treatment for the posterior edge of vertebral-body defects by spinal metastases. Biomed Rep 2015; 3:621-625. [PMID: 26405535 DOI: 10.3892/br.2015.483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/22/2015] [Indexed: 12/16/2022] Open
Abstract
Spinal metastasis is one of the commonly observed complications in the advanced stages of cancer patients, and is a serious threat to human life and health. Malignant tumor invasion usually leads to defects in the posterior margins of the vertebral body, which caused significant cancer pains to patients and increased the risk of surgery. Currently, minimally invasive treatments of vertebral defects caused by spinal metastases include percutaneous vertebroplasty (PVP) combined with radiofrequency ablation and PVP combined with 125I seed implantation. These minimally invasive techniques have particular superiority to control pain in patients with spinal metastases, improve nerve function, reduce the incidence of fractures and surgical risk, and improve the quality of life. The present study reviewed the progress in clinical research on vertebral defects caused by spinal metastases, and the mechanisms and minimally invasive treatment.
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Affiliation(s)
- Xuefeng Liu
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, P.R. China
| | - Zuozhang Yang
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, P.R. China
| | - Lin Xie
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, P.R. China
| | - Zongqin Yuan
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, P.R. China
| | - Mingyan Ren
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, P.R. China
| | - Lei Han
- Bone and Soft Tissue Tumors Research Center of Yunnan Province, Department of Medical Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, P.R. China
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Evans AJ, Kip KE, Brinjikji W, Layton KF, Jensen ML, Gaughen JR, Kallmes DF. Randomized controlled trial of vertebroplasty versus kyphoplasty in the treatment of vertebral compression fractures. J Neurointerv Surg 2015; 8:756-63. [PMID: 26109687 DOI: 10.1136/neurintsurg-2015-011811] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/04/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND We present the results of a randomized controlled trial evaluating the efficacy of vertebroplasty versus kyphoplasty in treating vertebral body compression fractures. METHODS Patients with vertebral body compression fractures were randomly assigned to treatment with kyphoplasty or vertebroplasty. Primary endpoints were pain (0-10 scale) and disability assessed using the Roland-Morris Disability Questionnaire (RMDQ). Outcomes were assessed at 3 days, 1 month, 6 months, and 1 year following the procedure. RESULTS 115 subjects were enrolled in the trial with 59 (51.3%) randomly assigned to kyphoplasty and 56 (48.7%) assigned to vertebroplasty. Mean (SD) pain scores at baseline, 3 days, 30 days, and 1 year for kyphoplasty versus vertebroplasty were 7.4 (1.9) vs 7.9 (2.0), 4.1 (2.8) vs 3.7 (3.0), 3.4 (2.5) vs 3.6 (2.9), and 3.0 (2.8) vs 2.3 (2.6), respectively (p>0.05 at all time points). Mean (SD) RMDQ scores at baseline, 3 days, 30 days, 180 days, and 1 year were 17.3 (6.6) vs 16.3 (7.4), 11.8 (7.9) vs 10.9 (8.2), 8.6 (7.2) vs 8.8 (8.5), 7.9 (7.4) vs 7.3 (7.7), 7.5 (7.2) vs 6.7 (8.0), respectively (p>0.05 at all time points). For baseline to 12-month assessment in average pain and RMDQ scores, the standardized effect size between kyphoplasty and vertebroplasty was small at -0.36 (95% CI -1.02 to 0.31) and -0.04 (95% CI -1.68 to 1.60), respectively. CONCLUSIONS Our study indicates that vertebroplasty and kyphoplasty appear to be equally effective in substantially reducing pain and disability in patients with vertebral body compression fractures. TRIAL REGISTRATION NUMBER NCT00279877.
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Affiliation(s)
- Avery J Evans
- University of Virginia, Charlottesville, Virginia, USA
| | - Kevin E Kip
- University of South Florida, Tampa, Florida, USA
| | | | | | - Mary L Jensen
- University of Virginia, Charlottesville, Virginia, USA
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García-Maroto R, García-Coiradas J, Milano G, Cebrián JL, Marco F, López-Durán L. [Safety and efficacy of kyphoplasty in the treatment of tumoral disease of the spine]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 59:406-12. [PMID: 26100740 DOI: 10.1016/j.recot.2015.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 04/12/2015] [Accepted: 05/02/2015] [Indexed: 12/24/2022] Open
Abstract
UNLABELLED Vertebral fractures in oncology patients cause significant pain and disability, with decreased quality of life. The aim of the study is to assess the efficacy and safety of kyphoplasty in this type of vertebral fracture in the acute phase. MATERIALS AND METHODS A retrospective study was conducted on 75 consecutive oncology patients with 122 acute vertebral fractures, who underwent bilateral balloon kyphoplasty, with a mean follow up of 11 months. RESULTS Almost all (91%) of the patients improved their pain level. The mean improvement in the Visual Analogue Scale (VAS) was 4.28 points (preoperative value 7.49 [SD 1.19], postoperative 3.21 [SD 0.95]). Before surgery, 53% of patients needed major opioids (40 cases), and one month after surgery only 12% (9 patients) required them. Quality of life determined by the Karnofsky index improved from 60.2 (SD 10) to 80.7 (SD 12.1). Cement leaks were found in 5.7% (7 cases), all without neurological repercussions. New fractures appeared in 11 patients. This subgroup showed a slight worsening of the initially acquired clinical improvement. No neurological or pulmonary complications related to surgical technique were found. CONCLUSIONS Kyphoplasty is an effective and safe for treating vertebral fractures in patients with cancer. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- R García-Maroto
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España.
| | - J García-Coiradas
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - G Milano
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - J L Cebrián
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - F Marco
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
| | - L López-Durán
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España
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Gu CN, Brinjikji W, Evans AJ, Murad MH, Kallmes DF. Outcomes of vertebroplasty compared with kyphoplasty: a systematic review and meta-analysis. J Neurointerv Surg 2015; 8:636-42. [DOI: 10.1136/neurintsurg-2015-011714] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/15/2015] [Indexed: 11/03/2022]
Abstract
Background and purposeMany studies demonstrate that both kyphoplasty and vertebroplasty are superior to conservative therapy in the treatment of osteoporotic vertebral body compression fractures. We performed a systematic review and meta-analysis of studies comparing the outcomes of vertebroplasty and kyphoplasty, which included prospective non-randomized, retrospective comparative, and randomized studies.Materials and methodsWe searched MEDLINE, EMBASE, and the Web of Science databases for studies of kyphoplasty versus vertebroplasty from 1 January 1990 to 30 November 2014 and compared the following outcomes: procedure characteristics, pain and disability improvement, complications and anatomic outcomes. A subgroup analysis was performed comparing pain outcomes based on the risk of bias.Results29 studies enrolling 2838 patients (1384 kyphoplasty and 1454 vertebroplasty) were included. 16 prospective non-randomized studies, 10 retrospective comparative studies, and 3 randomized controlled studies were included. No significant differences were found in mean pain scores between the two groups postoperatively (2.9±1.5 kyphoplasty vs 2.9±1.7 vertebroplasty, p=0.39) and at 12 months (2.7±1.8 kyphoplasty vs 3.2±1.8 vertebroplasty, p=0.64). No significant differences were found in disability postoperatively (34.7±7.1 kyphoplasty group vs 36.3±7.8 vertebroplasty group, p=0.74) or at 12 months (28.3±16 kyphoplasty group vs 29.6±13.9 vertebroplasty group, p=0.70). Kyphoplasty was associated with lower odds of new fractures (p=0.06), less extraosseous cement leakage (p<0.01), and greater reduction in kyphotic angle (p<0.01).ConclusionsNo significant difference was found between vertebroplasty and kyphoplasty in short- and long-term pain and disability outcomes. Further studies are needed to better determine if any particular subgroups of patients would benefit more from vertebroplasty or kyphoplasty in the treatment of vertebral body compression fractures.
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Borgström F, Beall DP, Berven S, Boonen S, Christie S, Kallmes DF, Kanis JA, Olafsson G, Singer AJ, Åkesson K. Health economic aspects of vertebral augmentation procedures. Osteoporos Int 2015; 26:1239-49. [PMID: 25381046 DOI: 10.1007/s00198-014-2953-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 10/27/2014] [Indexed: 01/17/2023]
Abstract
We reviewed all peer-reviewed papers analysing the cost-effectiveness of vertebroplasty and balloon kyphoplasty for osteoporotic vertebral compression fractures. In general, the procedures appear to be cost effective but are very dependent upon model input details. Better data, rather than new models, are needed to answer outstanding questions. Vertebral augmentation procedures (VAPs), including vertebroplasty (VP) and balloon kyphoplasty (BKP), seek to stabilise fractured vertebral bodies and reduce pain. The aim of this paper is to review current literature on the cost-effectiveness of VAPs as well as to discuss the challenges for economic evaluation in this research area. A systematic literature search was conducted to identify existing published studies on the cost-effectiveness of VAPs in patients with osteoporosis. Only peer-reviewed published articles that fulfilled the criteria of being regarded as full economic evaluations including both morbidity and mortality in the outcome measure in the form of quality-adjusted life years (QALYs) were included. The search identified 949 studies, of which four (0.4 %) were identified as relevant with one study added later. The reviewed studies differed widely in terms of study design, modelling framework and data used, yielding different results and conclusions regarding the cost-effectiveness of VAPs. Three out of five studies indicated in the base case results that VAPs were cost effective compared to non-surgical management (NSM). The five main factors that drove the variations in the cost-effectiveness between the studies were time horizon, quality of life effect of treatment, offset time of the treatment effect, reduced number of bed days associated with VAPs and mortality benefit with treatment. The cost-effectiveness of VAPs is uncertain. In answering the remaining questions, new cost-effectiveness analysis will yield limited benefit. Rather, studies that can reduce the uncertainty in the underlying data, especially regarding the long-term clinical outcomes of VAPs, should be conducted.
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Reducing radiation exposure during kyphoplasty with the use of a remote control injection system: a prospective study. Spine (Phila Pa 1976) 2015; 40:E127-32. [PMID: 25569529 DOI: 10.1097/brs.0000000000000696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study. OBJECTIVE To compare surgeons' radiation exposure during kyphoplasty with and without the use of a remote control injection system. SUMMARY OF BACKGROUND DATA Distance from radiation sources is a critical factor for reducing radiation exposure during spine surgery. A newly designed device was used to minimize operators' radiation exposure during kyphoplasty. METHODS Forty-four patients admitted for single-level osteoporotic vertebral compression fracture were randomly divided into 2 groups (groups A and B) and treated with kyphoplasty. The remote control injection system was used only in group B. The radiation doses to the surgeon's eyes, thyroid, chest, and right wrist were recorded with 4 unprotected radiometers simultaneously. Operation time, fluoroscopic time, cement amount, patient-reported pre- and postoperative visual analogue scale scores for pain, and complications were recorded. RESULTS For group A, the radiation doses at the eyes, thyroid, and right wrist were 1.132 ± 0.104 mSv, 0.647 ± 0.049 mSv, 0.578 ± 0.056 mSv, and 1.877 ± 0.214 mSv, respectively; for Group B, these doses were 0.257 ± 0.067 mSv, 0.201 ± 0.049 mSv, 0.145 ± 0.033 mSv, and 0.353 ± 0.046 mSv, respectively (P < 0.05). Comparisons of the radiation doses the chief surgeon and the resident surgeon received showed that the resident surgeon received more radiation during group A procedures; during group B procedures, the surgeons received similar doses. The proportion of average fluoroscopic time devoted to the bone cement injection step for groups A and B was 64% and 63%, respectively, and the average proportion of the radiation doses that were received during the bone cement injection step was 66% for group A and 36% for group B. Compared with the preoperative visual analogue scale score, the postoperative visual analogue scale score was significantly reduced in both groups. CONCLUSION During kyphoplasty, the use of the remote control injection system can significantly reduce surgeons' radiation exposure without affecting the efficiency of procedures.
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The value of routine biopsy during percutaneous kyphoplasty for vertebral compression fractures. PLoS One 2014; 9:e115417. [PMID: 25526360 PMCID: PMC4272288 DOI: 10.1371/journal.pone.0115417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 10/29/2014] [Indexed: 11/28/2022] Open
Abstract
Objective Percutaneous kyphoplasty (PKP) is now widely performed to treat VCF, which is usually caused by osteoporosis. Previous researches have reported unsuspected malignancies found by biopsy. However, the safety and cost-effective profiles of routine biopsy during PKP are unclear. The purpose of this study was to evaluate the feasibility of routine biopsy during PKP in treatment of VCF. Methods Ninety-three patients (September 2007–November 2010) undergoing PKP without biopsy were reviewed as the control group. One hundred and three consecutive patients (November 2010–September 2013) undergoing PKP with biopsy of every operated vertebral level were prospectively enrolled as the biopsy group. The rate of unsuspected lesions was reported, and the severe adverse events, surgical duration, cement leakage rate and pain control were compared between the two groups. Results No statistically significant differences were found between the two groups, regarding the severe adverse events, surgical duration, cement leakage rate and pain control. Four unsuspected lesions were found in the biopsy group, three of which were malignancies with a 2.9% (3/103) unsuspected malignancy rate. The economic analysis showed that routine biopsy was cost-effective in finding new malignancies comparing with a routine cancer screening campaign. Conclusions Routine biopsy during PKP was safe and cost-effective in finding unsuspected malignancies. We advocate routine biopsy in every operated vertebral level during PKP for VCF patients.
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Dohm M, Black CM, Dacre A, Tillman JB, Fueredi G. A randomized trial comparing balloon kyphoplasty and vertebroplasty for vertebral compression fractures due to osteoporosis. AJNR Am J Neuroradiol 2014; 35:2227-36. [PMID: 25300981 DOI: 10.3174/ajnr.a4127] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Several trials have compared vertebral augmentation with nonsurgical treatment for vertebral compression fractures. This trial compares the efficacy and safety of balloon kyphoplasty and vertebroplasty. MATERIALS AND METHODS Patients with osteoporosis with 1-3 acute fractures (T5-L5) were randomized and treated with kyphoplasty (n = 191) or vertebroplasty (n = 190) and were not blinded to the treatment assignment. Twelve- and 24-month subsequent radiographic fracture incidence was the primary end point. Due to low enrollment and early withdrawals, the study was terminated with 404/1234 (32.7%) patients enrolled. RESULTS The average age of patients was 75.6 years (77.4% female). Mean procedure duration was longer for kyphoplasty (40.0 versus 31.8 minutes, P < .001). At 12 months, 7.8% fewer patients with kyphoplasty (50/140 versus 57/131) had subsequent radiographic fracture, and there were 8.6% fewer at 24 months (54/110 versus 64/111). The results were not statistically significant (P > .21). When we used time to event for new clinical fractures, kyphoplasty approached statistical significance in longer fracture-free survival (Wilcoxon, P = .0596). Similar pain and function improvements were observed. CT demonstrated lower cement extravasation for kyphoplasty (157/214 versus 164/201 levels treated, P = .047). For kyphoplasty versus vertebroplasty, common adverse events within 30 postoperative days were procedural pain (12/191, 9/190), back pain (14/191, 28/190), and new vertebral fractures (9/191, 17/190); similar 2-year occurrence of device-related cement embolism (1/191, 1/190), procedural pain (3/191, 3/190), back pain (2/191, 3/190), and new vertebral fracture (2/191, 2/190) was observed. CONCLUSIONS Kyphoplasty and vertebroplasty had similar long-term improvement in pain and disability with similar safety profiles and few device-related complications. Procedure duration was shorter with vertebroplasty. Kyphoplasty had fewer cement leakages and a trend toward longer fracture-free survival.
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Affiliation(s)
- M Dohm
- From the Department of Orthopaedic Surgery, University of Arizona College of Medicine (M.D.), Tucson, Arizona
| | - C M Black
- Utah Valley Interventional Associates and Utah Valley Regional Medical Center (C.M.B.), Provo, Utah
| | - A Dacre
- OrthoMontana (A.D.), Billings, Montana
| | - J B Tillman
- Medtronic Spine (J.B.T.), Sunnyvale, California
| | - G Fueredi
- Aurora Memorial Hospital of Burlington (G.F.), Burlington, Wisconsin
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