Interdisciplinary approach to balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures

[Atraumatic fractures of the spine : Current strategies for diagnosis and treatment]

Atraumatic fractures of the spine are a common orthopedic disease condition that can be asymptomatic or associated with complaints of varying intensity and quality. The risk factors for such fracture forms are often metabolic and genetic diseases, which have a direct or indirect effect on bone metabolism and therefore secondarily affect the stability of the spinal vertebrae. Furthermore, benign and malignant tumors as well as infectious diseases can also be causative for atraumatic spinal fractures; however, those factors that are attributable to lifestyle habits should also not be underestimated. The treatment of affected patients is complex and nearly always interdisciplinary. In addition to purely symptom-oriented treatment concepts, orthoses in particular and when indicated surgical treatment procedures can be implemented. This article summarizes the important clinical, diagnostic and therapeutic aspects of atraumatic spinal fractures.

Surgical Results of Patients with Myelopathy due to Ossification of the Ligamentum Flavum with Ossification of the Posterior Longitudinal Ligament or a Vertebral Fracture at the Same Level of the Thoracic Spine: A Retrospective Comparative Study

Study Design

Retrospective and comparative study.

Purpose

We assessed surgical treatment outcomes in patients with thoracic myelopathy due to ossification of the ligamentum flavum (OLF), and OLF combined with ossification of the posterior longitudinal ligament (OPLL) or vertebral fracture (VF) at the same level.

Overview of Literature

OLF and OPLL cause severe thoracic myelopathy. Osteoporotic VF commonly occurs at the thoracolumbar junction. There have been no investigations of thoracic myelopathy due to OLF and VF.

Methods

Forty patients were divided among three groups: the OLF group (n=23): myelopathy due to OLF, the OLF+OPLL group (n=12): myelopathy due to OLF and OPLL, and the OLF+VF group (n=5): myelopathy due to OLF and VF. We recorded OLF, OPLL, and VF sites and operative procedures. Each patient’s neurological status, according to the Japanese Orthopaedic Association (JOA) score, and walking ability were evaluated pre- and postoperatively.

Results

Patients in the OLF+OPLL group were significantly younger than those in the other two groups. The preoperative JOA score was significantly lower in the OLF+VF than OLF group. The final JOA score was significantly lower in the OLF+VF than OLF and OLF+OPLL groups. The JOA score recovery rate was significantly lower in the OLF+VF than OLF group. Final walking ability was significantly worse in the OLF+OPLL and OLF+VF groups than in the OLF group and significantly worse in the OLF+VF than OLF+OPLL group.

Conclusions

Thoracic myelopathy due to OLF+VF occurs primarily in older females, who also exhibit worse preoperative and postoperative neurological status, and worse walking ability, than patients with thoracic myelopathy due to OLF or OLF+OPLL.

Combination of conditional random field with a rule based method in the extraction of PICO elements

BACKGROUND

Extracting primary care information in terms of Patient/Problem, Intervention, Comparison and Outcome, known as PICO elements, is difficult as the volume of medical information expands and the health semantics is complex to capture it from unstructured information. The combination of the machine learning methods (MLMs) with rule based methods (RBMs) could facilitate and improve the PICO extraction. This paper studies the PICO elements extraction methods. The goal is to combine the MLMs with the RBMs to extract PICO elements in medical papers to facilitate answering clinical questions formulated with the PICO framework.

METHODS

First, we analyze the aspects of the MLM model that influence the quality of the PICO elements extraction. Secondly, we combine the MLM approach with the RBMs in order to improve the PICO elements retrieval process. To conduct our experiments, we use a corpus of 1000 abstracts.

RESULTS

We obtain an F-score of 80% for P element, 64% for the I element and 92% for the O element. Given the nature of the used training corpus where P and I elements represent respectively only 6.5 and 5.8% of total sentences, the results are competitive with previously published ones.

CONCLUSIONS

Our study of the PICO element extraction shows that the task is very challenging. The MLMs tend to have an acceptable precision rate but they have a low recall rate when the corpus is not representative. The RBMs backed up the MLMs to increase the recall rate and consequently the combination of the two methods gave better results.

Image-guided Spine Stabilization for Traumatic Or Osteoporotic Spine Injury: Radiological Accuracy and Neurological Outcome

Significant progress has been made in image-guided surgery (IGS) over the last few decades. IGS can be effectively applied to spinal instrumentation surgery. In the present study, we focused our attention on the feasibility and safety of image-guided spine stabilization for traumatic or osteoporotic spine injury. The IGS spine fixation with or without minimally invasive surgery (MIS) techniques such as percutaneous screw placement, balloon kyphoplasty (BKP), or vertebroplasty (VP) were accomplished in 80 patients with traumatic or osteoprotic spine injury between 2007 and 2015. The injured vertebral levels included the following: cervical spine, 41; thoracic spine, 22; and lumbar spine, 17. Neurological condition before and after surgery was assessed using the American Spinal Injury Association Impairment Scale (AIS). A total of 419 pedicle, lateral mass, or laminar screws were placed, and 399 screws (95.2%) were found to be placed correctly based on postoperative computed tomography scan. Although 20 screws (4.8%) were found to be unexpectedly placed incorrectly, no neural or vascular complications closely associated with screw placement were encountered. Neurological outcomes appeared to be acceptable or successful based on AIS. The IGS is a promising technique that can improve the accuracy of screw placement and reduce potential injury to critical neurovascular structures. The integration of MIS and IGS has proved feasible and safe in the treatment of traumatic or osteoporotic spine injury, although a thorough knowledge of surgical anatomy, spine biomechanics, and basic technique remain the most essential aspects for a successful surgery.

Vertebroplasty and kyphoplasty: complementary techniques for the treatment of painful osteoporotic vertebral compression fractures. A prospective non-randomised study on 154 patients

In a prospective study, we aimed to evaluate the potential use of kyphoplasty (KP) and vertebroplasty (VP) as complementary techniques in the treatment of painful osteoporotic vertebral compression fractures (VCFs). After 1 month of conservative treatment for VCFs, patients with intractable pain were offered treatment with KP or VP according to a treatment algorithm that considers time from fracture (Delta t) and amount of vertebral body collapse. Bone biopsy was obtained intra-operatively to exclude patients affected by malignancy or osteomalacia. 164 patients were included according to the above criteria. Mean age was 67.6 years. Mean follow-up was 33 months. 10 patients (6.1%) were lost to follow-up and 154 reached the minimum 2-year follow-up. 118 (69.5%) underwent VP and 36 (30.5%) underwent KP. Complications affected five patients treated with VP, whose one suffered a transient intercostal neuropathy and four a subsequent VCF (two at adjacent level). Results in terms of visual analogue scale and Oswestry scores were not different among treatment groups. In conclusion, at an average follow-up of almost 3 years from surgical treatment of osteoporotic VCFs, VP and KP show similar good clinical outcomes and appear to be complementary techniques with specific different indications.

Vertebroplasty and kyphoplasty: complementary tecniques for the treatment of painful osteoporotic vertebral compression fractures

OBJECTIVE: in a prospective study, we aimed to evaluate the potential use of kyphoplasty (KP) and vertebroplasty (VP) as complementary techniques in the treatment of painful osteoporotic vertebral compression fractures (VCFs). METHODS: after one month of conservative treatment for VCFs, patients with intractable pain were offered treatment with KP or VP according to a treatment algorithm that considers time from fracture (Ät) and amount of Vertebral Body Collapse (VBC). Bone biopsy was obtained intraoperatively to exclude patients affected by malignancy or osteomalacia. RESULTS: hundred and sixty-four patients were included according to the above criteria. Mean age was 67.6 years. Mean followup was 33 months. Ten patients (6.1%) were lost to follow-up and 154 reached the minimum two years follow-up. 118 (69.5%) underwent VP and 36 (30.5%) underwent KP. Complications affected five patients treated with VP, whose one suffered a transient intercostal neuropathy and four a subsequent VCF (two at adjacent level). Results in terms of VAS and Oswestry scores were not different among treatment groups. CONCLUSION: in conclusion, at an average follow-up of almost 3 years from surgical treatment of osteoporotic VCFs, VP and KP show similar good clinical outcomes and appear to be complementary techniques with specific different indications.

Avaliação da curvatura torácica e da presença de dor em mulheres de diferentes faixas etárias

OBJETIVO: demonstrar a utilização do método flexicurva para avaliação e comparação da cifose torácica em mulheres saudáveis de diferentes faixas etárias, além de detectar se há correlação entre dor e grau de cifose torácica utilizando-se a Escala Visual Analógica (EVA). MÉTODOS: o estudo foi composto por um grupo de mulheres G1 (n=24), com média de 20,67±1,69 anos e outro grupo G2 (n=24), com média de 65,63 ±8,07 anos, que foram submetidas à avaliação da curvatura torácica, com a utilização do método flexicurva, e dor nas costas, com a EVA. RESULTADOS: foi encontrada uma diferença estatisticamente significante no ângulo de cifose torácica no grupo 2 quando comparada ao grupo 1 e uma fraca correlação entre o ângulo de cifose torácica e a classificação da dor pela escala EVA nos grupos 1 e 2. CONCLUSÃO: o grupo 1 apresentou um grau de curvatura torácica dentro da normalidade e o grupo 2 apresentou um exacerbado grau de cifose torácica, caracterizando-se como hipercifose. Entretanto, não houve correlação entre dor e grau de cifose torácica em ambos os grupos.

Percutaneous vertebroplasty and kyphoplasty for the stand-alone augmentation of osteoporosis-induced vertebral compression fractures: Present status and future directions

Enormous research efforts are being expended on two minimally invasive procedures: percutaneous vertebroplasty (VP) and kyphoplasty (KP). The present report, which is a detailed critical review of VP and KP that emphasizes their biomechanics aspects, is divided into six parts. In the first two parts, succinct descriptions are given of osteoporosis-induced vertebral body (VB) compression fractures as the underlying pathology to be treated with VP and KP, the theory of VP and KP, and the techniques used in performing these procedures. Concerns about VP and KP, such as the high radiation exposure burden that may be imposed on both patient and medical personnel and extravasation of the injectable bone cement, are discussed in the third part. Detailed discussions of fourteen issues/questions, such as the extent to which VP or KP affects various biomechanical measures of the augmented VB and those adjacent to it and the appropriate volume of the cement to use, are presented in the fourth part. Ideas for future research, such as development of a new generation of injectable bone cements and identification of an appropriate animal model, are covered in the fifth part. The final section contains a summary of the most salient points/observations made in the report.

Sacral kyphoplasty for relieving pain caused by sacral hemangioma

STUDY DESIGN

Case report describing sacral kyphoplasty in a patient with sacral hemangioma; the first account of this procedure in a sacral hemangioma.

OBJECTIVES

To highlight the advantages of sacral kyphoplasty in the treatment of sacral tumors.

SETTING

This study is made in Baskent University in Turkey.

SUMMARY OF BACKGROUND DATA

Kyphoplasty and sacroplasty are new, minimally invasive techniques that are mostly used for treating osteoporotic vertebral body fractures. These techniques are very effective for achieving rapid pain relief and stabilizing the vertebra, and biopsy collection can be included in the procedure. The latter allows for informed treatment planning in patients with metastatic tumors.

METHOD

A 74-year-old woman with known metastatic renal cell carcinoma was investigated for pain in the left sacral region. A tumoral lesion was detected, and sacroplasty was performed at S1.

RESULTS

The sacral pain resolved completely after the procedure, and the patient was able to walk without assistance. The pathological diagnosis for the vertebral lesion was hemangioma.

CONCLUSIONS

Sacral kyphoplasty is a very effective, minimally invasive surgical procedure. Patients with debilitating diseases such as primary sacral tumors or metastases can be treated by this technique with no significant complications.

Pain Outcome and Vertebral Body Height Restoration in Patients Undergoing Kyphoplasty

INTRODUCTION

Kyphoplasty, a minimally invasive technique, has recently been developed to provide immediate pain relief, biomechanical stabilization, prevention of fracture progression, vertebral height restoration, and prevention or reversal of kyphosis to patients with osteoporotic vertebral compression fractures (VCF).

MATERIALS AND METHODS

We retrospectively reviewed 24 patients treated with kyphoplasty. A total of 37 vertebral levels were augmented. Visual analog scale (VAS) scores were documented in the immediate pre- and postoperative period, as well as 4, 12, and 72 weeks after the procedure. Vertebral body height restoration was assessed on postoperative x-rays.

RESULTS

Mean preoperative VAS score was 9.3 and improved to 5.4 in the immediate postoperative period. At 4, 12 and 72 weeks post-operatively, mean VAS scores were 5.1, 5.9, and 6.1 respectively. All patients returned to their daily activities within 24 hours. No significant restoration of vertebral body height was observed.

CONCLUSION

In regards to pain relief and postoperative functional outcome, kyphoplasty is a safe and effective treatment modality for osteoporotic VCFs, even when no significant restoration of vertebral body height is achieved.

Kyphoplasty: 2 years of experience in a neurosurgery department

BACKGROUND

Kyphoplasty is a new technique to treat collapsed vertebral body (VB) fractures. The technique is very effective for achieving rapid pain relief, restoring bone height,and consequent vertebral realignment,and thus stabilization of the vertebra.

METHODS

We reviewed 57 patients with vertebral compression fractures. All patients were neurologically intact and presented with severe low back pain or localized pain over the thoracolumbar region. Indications for kyphoplasty were osteoporotic and traumatic compression fractures, osteolytic tumor metastases, and aggressive hemangiomas without spinal canal compression.

RESULTS

In 57 patients, 77 levels were treated. Follow-up was 6.5 months. Patients were evaluated with a visual analog scale (VAS) preoperatively and postoperatively. The mean preoperative VAS score was 91.08 for pain, whereas the mean postoperative VAS score was 11.22. Percentage of mean pain relief was 87.9% during the first 6 months of follow-up. We achieved a 43.6% improvement in the height of the compressed VB and 6.3 degrees of improvement in the kyphotic angle. No serious complications occurred. Mean hospital stay was 24 hours.

CONCLUSIONS

Kyphoplasty carries significantly less morbidity than vertebroplasty or open surgery. Risk for embolization is low. Normal kyphotic angle can be restored or improved by this technique. In the hands of experienced surgeons, kyphoplasty is a safe and a minimally invasive technique for patients with neoplastic, traumatic, or osteoporotic lesions of the vertebra or sacrum.

Less invasive anterior column reconstruction in thoracolumbar fractures

Posterior short-segment pedicle screw constructs are commonly used for reduction and fixation of traumatic thoracolumbar spine fractures. Although this technique is usually simple and effective, complications such as loss of fixation or recurrence of deformity are common because of the insufficiency of the damaged anterior column. Anterior approaches to address this deficiency are associated with high morbidity and complications. We have developed a technique to reduce and support the fractured anterior column through a transpedicular approach. Balloon-assisted-endplate-reduction (BAER) followed by vertebroplasty (VTP) with calcium phosphate cement in combination with short segment pedicle screw construct seem to be a safe and effective technique to reconstruct the anterior column in a less invasive manner. In this article, the rationale behind this technique, experimental studies, and the first clinical results are discussed.