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Song KS, Yoon BI, Ham DW. Transpedicular Intravertebral Cage Augmentation Using Expandable Cage in Kummell Disease: Technical Note and Case Series. World Neurosurg 2024; 184:119-124. [PMID: 38266993 DOI: 10.1016/j.wneu.2024.01.079] [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: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To demonstrate the surgical techniques for transpedicular intravertebral cage augmentation (TPICA) using an expandable cage for Kummell disease, which requires posterior surgical stabilization, and provide the preliminary surgical outcomes. METHODS Six consecutive patients undergoing TPICA surgery using an expandable cage with a minimum 6-month follow-up were evaluated. Radiographic analysis to evaluate the local kyphosis angle, restoration ratio of anterior vertebral height of the index vertebra, and clinical outcomes including the Oswestry Disability Index, EuroQol 5-dimension instrument, and visual analog scale for back and leg pain, were compared between the preoperative and final follow-ups. RESULTS All patients showed improvements in all clinical outcomes and were able to walk independently without support at the last follow-up. In radiographic evaluation, the mean preoperative restoration ratio of anterior vertebral height was 41.2 ± 15.6%, which increased postoperatively to 70.3 ± 20.5% (1.70 times) and 62.4 ± 20.0% at the last follow-up (1.51 times). The mean preoperative local kyphosis angle was 10.5 ± 14.8 and was corrected to 6.0 ± 10.0 at the last follow-up. A slight loss of correction was observed between the postoperative period and the last follow-up; however, there was no clinical significance. CONCLUSIONS Expandable cages in TPICA may allow easier surgical manipulation for cage insertion around the pedicle entrance, minimizing damage to the fractured vertebral body's end plates while achieving satisfactory height restoration compared to static cages, and may also provide wider indications for TPICA surgery.
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Affiliation(s)
- Kwang-Sup Song
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
| | - Byung-Il Yoon
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Dae-Woong Ham
- Department of Orthopedic Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
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Xiao C, Wang H, Lei Y, Xie M, Li S. Percutaneous kyphoplasty combined with pediculoplasty for the surgical treatment of osteoporotic thoracolumbar burst fractures. J Orthop Surg Res 2024; 19:87. [PMID: 38254114 PMCID: PMC10804617 DOI: 10.1186/s13018-024-04562-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE This study introduces a minimally invasive technique for efficient three-column reconstruction, augmentation, and stabilization of osteoporotic thoracolumbar burst fractures (OTLBFs). METHODS Sixty-eight patients with OTLBFs and no neurological deficits were included from July 2019 to September 2020. The patients were divided into two groups: the simple percutaneous kyphoplasty (PKP) group (n = 32) and the percutaneous kyphoplasty combined with pediculoplasty (PKCPP) group (n = 36). The clinical and radiological outcomes were assessed during a minimum 1-year follow-up period. Clinical outcomes were assessed via the visual analog scale (VAS) and modified MacNab grading criteria. The radiological outcomes included the Cobb angle (CA), anterior wall height (AWH), and posterior wall height (PWH). The surgery duration, postoperative analgesic dosage, length of hospital stay, and complications were recorded. RESULTS Surgery duration was not significantly different between the two groups (P > 0.05). The PKCPP group had a lower analgesic dosage and shorter hospital stay (P < 0.05). Postoperatively, the PKCPP group exhibited better VAS scores and modified MacNab scale scores (P < 0.05), but the differences at the last follow-up assessment were not significant (P > 0.05). Postoperative CA, AWH, and PWH correction were not significantly different on the first postoperative day (P > 0.05). However, the PKCPP group had significantly less CA and PWH loss of correction at the last follow-up visit (P < 0.05). The PKCPP group had significantly fewer complications (P < 0.05). CONCLUSIONS The PKCPP technique complements simple PKP for OTLBFs. It quickly relieves pain, maintains the vertebral body height and Cobb angle, ensures cement stabilization, and offers more stable three-column support.
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Affiliation(s)
- Changming Xiao
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Haozhong Wang
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Yang Lei
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Mingzhong Xie
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China.
| | - Sen Li
- Spinal Surgery Department, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China.
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Schmiady MO, Possner M, Horisberger T, Ouda A. Intracardiac bone cement embolism resulting in ventricular perforation: an unusual cause of sudden chest pain. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 36:6976701. [PMID: 36802249 PMCID: PMC9931077 DOI: 10.1093/icvts/ivac292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 01/10/2023]
Abstract
Leakage of bone cement is a known complication after percutaneous kyphoplasty. In rare cases, bone cement can reach the venous system and cause life-threatening embolism. We present the case of a 73-year-old male, who was admitted to our hospital with new-onset chest pain and dyspnoea. He had a history of percutaneous kyphoplasty. Multimodal imaging showed intracardiac cement embolism in the right ventricle with penetration of the interventricular septum and perforation of the apex. The bone cement was successfully removed during open cardiac surgery.
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Affiliation(s)
- Martin O Schmiady
- Corresponding author. Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland. Tel: +41-44-255-95-82; fax: +41-44-255-44-67; e-mail: (M.O. Schmiady)
| | - Mathias Possner
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Thomas Horisberger
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Ahmed Ouda
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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Yin J, Zhang Y, Zhao X, Yan H, Liu J, Chang X, Wang J. Intraoperative analgesic effect of intravertebral lidocaine injection during percutaneous kyphoplasty in the treatment of thoracolumbar compression fractures in elderly patients. J Back Musculoskelet Rehabil 2023; 36:1095-1100. [PMID: 37458006 DOI: 10.3233/bmr-220174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND In recent years, percutaneous kyphoplasty (PKP) has been increasingly used in clinical settings. OBJECTIVE In this study, we aimed to determine the analgesic effect of intravertebral lidocaine injections in PKP. METHODS A total of 60 patients who were treated with PKP were enrolled in this study. Lidocaine hydrochloride was chosen as the medication for the experimental group. Patients were randomly assigned into three groups using a double-blind study design: In group A (20 cases), no drugs were injected into the vertebral body during surgery; group B (20 cases) received intravertebral injection of normal saline; and in group C (20 cases), lidocaine hydrochloride was administered into the vertebral body during surgery. The age of patients, operation time, balloon dilatation pressure, balloon dilatation volume, and amount of bone cement injected were compared across the three groups. A pain visual analog scale (VAS) was used to assess pain suffered by the patients before, during, and 24 hours after the surgery. RESULTS Age, operation time, balloon dilatation pressure, balloon dilatation volume, and amount of bone cement injected did not differ significantly among the three groups (P> 0.05). The differences in VAS scores 24 hours before and after surgery were not statistically significant (P> 0.05). Group C had lower intraoperative VAS scores than groups A and B, and the difference was statistically significant (P< 0.01). There was no statistically significant difference between group A and group B (P> 0.05). CONCLUSION Intravertebral injections of lidocaine during PKP can successfully reduce intraoperative pain.
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Affiliation(s)
- Jianshi Yin
- Department of Orthopedics, The 967th Hospital of Joint Logistic Support Force of PLA, Dalian, Liaoning, China
- Department of Orthopedics, The 967th Hospital of Joint Logistic Support Force of PLA, Dalian, Liaoning, China
| | - Yongzhao Zhang
- Department of Orthopedics, The 967th Hospital of Joint Logistic Support Force of PLA, Dalian, Liaoning, China
- Department of Orthopedics, The 967th Hospital of Joint Logistic Support Force of PLA, Dalian, Liaoning, China
| | - Xiangmei Zhao
- Department of Anesthesiology, The 967th Hospital of Joint Logistic Support Force of PLA, Dalian, Liaoning, China
| | - Han Yan
- Department of Orthopedics, The 967th Hospital of Joint Logistic Support Force of PLA, Dalian, Liaoning, China
| | - Jun Liu
- Department of Orthopedics, The 967th Hospital of Joint Logistic Support Force of PLA, Dalian, Liaoning, China
| | - Xiaohui Chang
- Department of Traditional Chinese Medicine, The 967th Hospital of Joint Logistic Support Force of PLA, Dalian, Liaoning, China
| | - Junsheng Wang
- Department of Orthopedics, The 967th Hospital of Joint Logistic Support Force of PLA, Dalian, Liaoning, China
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Huang C. Life-threatening intracardiac cement embolisms after percutaneous kyphoplasty: a case report and literature review. J Int Med Res 2022; 50:3000605221102088. [PMID: 35638519 PMCID: PMC9160901 DOI: 10.1177/03000605221102088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Percutaneous kyphoplasty is a popular technique in the treatment of osteoporotic vertebral fractures, but intracardiac cement embolism can be a life-threatening complication.Case presentation: The authors present a case involving a patient who developed dyspnea and chest tightness after percutaneous kyphoplasty. Echocardiography and chest computed tomography confirmed several foreign bodies in the right atrium and pulmonary arteries causing cardiac perforation and pericardial tamponade. Conservative treatment was administered, and the patient died of respiratory and heart failure. CONCLUSIONS The present case highlights that surgical removal may be the first-choice treatment for symptomatic intracardiac cement embolism.
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Affiliation(s)
- Chunneng Huang
- Department of Orthopedics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine
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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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Tsai PJ, Hsieh MK, Fan KF, Chen LH, Yu CW, Lai PL, Niu CC, Tsai TT, Chen WJ. Is additional balloon Kyphoplasty safe and effective for acute thoracolumbar burst fracture? BMC Musculoskelet Disord 2017; 18:393. [PMID: 28893205 PMCID: PMC5594435 DOI: 10.1186/s12891-017-1753-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 09/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Burst fracture is a common thoracolumbar injury that is treated using posterior pedicle instrumentation and fusion combined with transpedicular intracorporeal grafting after reduction. In this study, we compared the outcome of these two techniques by using radiologic imaging and functional outcome. METHODS Sixty-one patients with acute thoracolumbar burst fracture were operated with kyphoplasty (n = 31) or vertebroplasty (n = 30) and retrospectively reviewed in our institution between 2011 and 2014. All 61 patients underwent surgery within 5 days after admission to the hospital and then followed-up for 12 to 24 months after surgery. RESULTS Significant improvement was found in the anterior vertebral height (92 ± 8.9% in the kyphoplasty group, 85.6 ± 7.2% in the vertebroplasty group, p < 0.01) at 1 month post-operatively and (89 ± 7.9% in the kyphoplasty group, 78 ± 6.9% in the vertebroplasty group, p < 0.01) at the 24-month follow-up. Significant improvement was also observed in the kyphotic angle (1.2 ± 0.5° in the kyphoplasty group, 10.5 ± 1.2° in the vertebroplasty group, p < 0.01) at 1 month post-operatively and (5.4 ± 1.2° in the kyphoplasty group, 11.5 ± 8.5° in the vertebroplasty group, p < 0.01) at the 24-month follow-up. Both operations led to significant improvement of the patients' pain and the Oswestry disability index (p < 0.01). Cement leakage was noted in 29% of patients after kyphoplasty and 77% of patients after vertebroplasty (p < 0.01). Only one implant failure (3.3%), which required further surgical intervention, was reported in the vertebroplasty group. CONCLUSIONS Reduction with additional balloon at the fractured site is better than indirect reduction only by posterior instrumentation. The better reduction of kyphotic angle and the lower cement leakage rate in the kyphoplasty group indicate that additional balloon kyphoplasty is safe and effective for acute thoracolumbar burst fracture.
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Affiliation(s)
- Ping-Jui Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ming-Kai Hsieh
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. .,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. .,, 5, Fu-Hsin Street, Kweishan Shiang, Taoyuan ,333, Linkou, Taiwan.
| | - Kuo-Feng Fan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Lih-Huei Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chia-Wei Yu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Po-Liang Lai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chi-Chien Niu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wen-Jer Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
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Shridhar P, Chen Y, Khalil R, Plakseychuk A, Cho SK, Tillman B, Kumta PN, Chun Y. A Review of PMMA Bone Cement and Intra-Cardiac Embolism. MATERIALS (BASEL, SWITZERLAND) 2016; 9:E821. [PMID: 28773942 PMCID: PMC5456584 DOI: 10.3390/ma9100821] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 09/22/2016] [Indexed: 12/19/2022]
Abstract
Percutaneous vertebroplasty procedure is of major importance, given the significantly increasing aging population and the higher number of orthopedic procedures related to vertebral compression fractures. Vertebroplasty is a complex technique involving the injection of polymethylmethacrylate (PMMA) into the compressed vertebral body for mechanical stabilization of the fracture. Our understanding and ability to modify these mechanisms through alterations in cement material is rapidly evolving. However, the rate of cardiac complications secondary to PMMA injection and subsequent cement leakage has increased with time. The following review considers the main effects of PMMA bone cement on the heart, and the extent of influence of the materials on cardiac embolism. Clinically, cement leakage results in life-threatening cardiac injury. The convolution of this outcome through an appropriate balance of complex material properties is highlighted via clinical case reports.
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Affiliation(s)
- Puneeth Shridhar
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA.
| | - Yanfei Chen
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA 15213, USA.
| | - Ramzi Khalil
- Division of Cardiology, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
| | - Anton Plakseychuk
- Bone and Joint Center at Magee-Women's Hospital of UPMC, Pittsburgh, PA 15213, USA.
| | - Sung Kwon Cho
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA 15213, USA.
| | - Bryan Tillman
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213 USA.
| | - Prashant N Kumta
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA.
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA 15213, USA.
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA 15219, USA.
- Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, PA 15213, USA.
| | - YoungJae Chun
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA.
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA 15213, USA.
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA 15219, USA.
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Percutaneous vertebral body augmentation: an updated review. Surg Res Pract 2014; 2014:815286. [PMID: 25379561 PMCID: PMC4208453 DOI: 10.1155/2014/815286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 04/14/2014] [Indexed: 12/02/2022] Open
Abstract
There are many medical conditions like osteoporosis, tumor, or osteonecrosis that weaken the structural strength of the vertebral body and prone it to fracture. Percutaneous vertebral augmentation that is usually applied by polymethylmethacrylate is a relatively safe, effective, and long lasting procedure commonly performed in these situations. In this paper, we updated a review of biomechanics, indications, contraindications, surgical techniques, complications, and overall prognosis of these minimally invasive spinal procedures.
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Korovessis P, Vardakastanis K, Repantis T, Vitsas V. Less invasive reduction and fusion of fresh A2 and A 3 traumatic L 1-L 4 fractures with a novel vertebral body augmentation implant and short pedicle screw fixation and fusion. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:297-304. [PMID: 24170266 DOI: 10.1007/s00590-013-1339-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 10/12/2013] [Indexed: 12/01/2022]
Abstract
The aim of this clinical study was to report on the efficacy in reduction and safety in PMMA leakage of a novel vertebral augmentation technique with PEEK and PMMA, together with pedicle screws in the treatment of fresh vertebral fractures in young adults. Twenty consecutive young adults aged 45 ± 11 years with fresh burst A3/AO or severely compressed A2/AO fractures underwent via a less invasive posterior approach one-staged reduction with a novel augmentation implant and PMMA plus 3-vertebrae pedicle screw fixation and fusion. Radiologic parameters as segmental kyphosis (SKA), anterior (AVBHr) and posterior vertebral body height ratio (PVBHr), spinal canal encroachment (SCE), cement leakage and functional parameters as VAS, SF-36 were measured pre- and post-operatively. Hybrid construct restored AVBHr (P < 0.000), PVBHr (P = 0.02), SKA (P = 0.015), SCE (P = 0.002) without loss of correction at an average follow-up of 17 months. PMMA leakage occurred in 3 patients (3 vertebrae) either anteriorly to the fractured vertebral body or to the adjacent disc, but in no case to the spinal canal. Two pedicle screws were malpositioned (one medially, one laterally to the pedicle at the fracture level) without neurologic sequelae. Solid posterolateral spinal fusion occurred 8-10 months post-operatively. Pre-operative VAS and SF-36 scores improved post-operatively significantly. This study showed that this novel vertebral augmentation technique using PEEK implant and PMMA reduces and stabilizes via less invasive technique A2 and A3 vertebral fractures without loss of correction and leakage to the spinal canal.
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Affiliation(s)
- Panagiotis Korovessis
- Orthopaedic Department, General Hospital "Agios Andreas" Patras, Charalambi Str. 65-67, Patras, Greece,
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11
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Korovessis P, Vardakastanis K, Repantis T, Vitsas V. Transpedicular vertebral body augmentation reinforced with pedicle screw fixation in fresh traumatic A2 and A3 lumbar fractures: comparison between two devices and two bone cements. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24 Suppl 1:S183-91. [PMID: 23982115 DOI: 10.1007/s00590-013-1296-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 08/08/2013] [Indexed: 10/26/2022]
Abstract
This retrospective study compares efficacy and safety of balloon kyphoplasty (BK) with calcium phosphate (Group A) versus KIVA implant with PMMA (Group B) reinforced with three vertebrae pedicle screw constructs for A2 and A3 single fresh non-osteoporotic lumbar (L1-L4) fractures in 38 consecutive age- and diagnosis-matched patient populations. Extracanal leakage of both low-viscosity PMMA and calcium phosphate (CP) as well as the following roentgenographic parameters: segmental kyphosis (SKA), anterior (AVBHr) and posterior (PVBHr) vertebral body height ratio, spinal canal encroachment (SCE) clearance, and functional outcome measures: VAS and SF-36, were recorded and compared between the two groups. All patients in both groups were followed for a minimum 26 (Group A) and 25 (Group B) months. Extracanal CP and PMMA leakage was observed in four (18 %) and three (15 %) vertebrae/patients of group A and B, respectively. Hybrid fixation improved AVBHr, SKA, SCE, but PVBHr only in group B. VAS and SF-36 improved postoperatively in the patients of both groups. Short-segment construct with the novel KIVA implant restored better than BK-fractured lumbar vertebral body, but this had no impact in functional outcome. Since there was no leakage difference between PMMA and calcium phosphate and no short-term adverse related to PMMA use were observed, we advice the use of PMMA in fresh traumatic lumbar fractures.
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Affiliation(s)
- Panagiotis Korovessis
- Orthopaedic Department, General Hospital "Agios Andreas", Charalabi Str. 65-67, Patras, Greece,
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12
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Hsieh JY, Wu CD, Wang TM, Chen HY, Farn CJ, Chen PQ. Reduction of the domino effect in osteoporotic vertebral compression fractures through short-segment fixation with intravertebral expandable pillars compared to percutaneous kyphoplasty: a case control study. BMC Musculoskelet Disord 2013; 14:75. [PMID: 23452614 PMCID: PMC3598560 DOI: 10.1186/1471-2474-14-75] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 02/21/2013] [Indexed: 12/27/2022] Open
Abstract
Background Osteoporotic vertebral compression fracture is the leading cause of disability and morbidity in elderly people. Treatment of this condition remains a challenge. Osteoporotic vertebral compression fractures can be managed with various approaches, but each has limitations. In this study, we compared the clinical outcomes obtained using short-segment fixation with intravertebral expandable pillars (I-VEP) to those obtained with percutaneous kyphoplasty in patients who had suffered vertebral compression fractures. Methods The study included 46 patients with single-level osteoporotic thoracolumbar fractures. Twenty-two patients in Group I underwent short-segment fixation with I-VEP and 24 patients in Group II underwent kyphoplasty. All patients were evaluated pre- and postoperatively using a visual analogue scale, anterior height of the fractured vertebra, and kyphotic angle of the fractured vertebra. The latter 2 radiological parameters were measured at the adjacent segments as well. Results There was no significant difference between the groups in terms of gender or fracture level, but the mean age was greater in Group II patients (p = 0.008). At the 1-year follow-up, there were no significant differences in the visual analogue scale scores, anterior height of the fractured vertebra, or the value representing anterior height above the fractured vertebra and kyphotic angle below the fractured vertebra, after adjusting for the patients’ gender, fracture level, and age. When considered separately, the anterior height below the fractured vertebra was significantly higher and the kyphotic angle above the fractured vertebra was significantly smaller in Group I than in Group II (p = 0.029 and p = 0.008, respectively). The kyphotic angle of the fractured vertebra was significantly smaller in Group II than in Group I (p < 0.001). Conclusions In older individuals with vertebral compression fractures, kyphoplasty restored and maintained the collapsed vertebral body with less kyphotic deformity than that induced by short-segment fixation with I-VEP. Short-segment fixation with I-VEP was more effective in maintaining the integrity of adjacent segments, which prevented the domino effect often observed in patients with osteoporotic kyphotic spines.
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Affiliation(s)
- Jui-Yang Hsieh
- Department of Orthopedics, National Taiwan University & Hospital, Taipei, Taiwan.
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Does percutaneous kyphoplasty have better functional outcome than vertebroplasty in single level osteoporotic compression fractures? A comparative prospective study. J Osteoporos 2013; 2013:690329. [PMID: 23970997 PMCID: PMC3732604 DOI: 10.1155/2013/690329] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 06/25/2013] [Accepted: 06/25/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose. To evaluate the relative differences in surgical outcome of kyphoplasty (KP) versus vertebroplasty (VP) in the patients with single level refractory osteoporotic compression fractures (OCFs). Method. From August 2008 to May 2012, we intermittently treated 57 patients with single level OCF by PV and KP (Groups A and B, resp.). We used visual analogue scale (VAS) and short form 36 (SF36) questionnaire to measure functional recovery and followed them for six months. Independent samples t- and Kendall's tau-b tests were for statistics. Results. In terms of age, number, and bone mineral density of the patients, there were no significant differences between the two groups. In both groups, VAS and SF-36 scores improved significantly and remained relatively stable throughout the follow-up period. We had 9 and 6 asymptomatic cement extravasations and 5 and 8 new vertebral fractures in Group A and B, respectively. In comparing the two groups, the results indicated that KP almost failed to show any significant higher effect relative to VP during this period. Conclusions. In considering the high cost of KP relative to VP in the developing countries like Iran, there is no logical reason to use KP in a single level refractory OCF in these regions.
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Garnier L, Tonetti J, Bodin A, Vouaillat H, Merloz P, Assaker R, Court C. Kyphoplasty versus vertebroplasty in osteoporotic thoracolumbar spine fractures. Short-term retrospective review of a multicentre cohort of 127 consecutive patients. Orthop Traumatol Surg Res 2012; 98:S112-9. [PMID: 22939104 DOI: 10.1016/j.otsr.2012.03.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 03/19/2012] [Accepted: 03/28/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteoporotic spine fractures induce a heavy burden in terms of both general health and healthcare costs. The objective of this multicentre study by the French Society for Spine Surgery (SFCR) was to compare outcomes after vertebroplasty and kyphoplasty in the treatment of osteoporotic thoracolumbar vertebral fractures. HYPOTHESIS We hypothesised that differences existed between vertebroplasty and kyphoplasty, notably regarding operative time and reduction efficacy, from which criteria for patient selection might be inferred. MATERIAL AND METHODS We conducted a retrospective multicentre review of 127 patients with Magerl Type A low-energy fractures after a fall from standing height between 2007 and 2010; 85 were managed with vertebroplasty and 42 with kyphoplasty. Age was not a selection criterion. We recorded pain intensity, time to management, operative time, kyphosis angle, wedge angle, cement leakage rate, and degree of cement filling. RESULTS Operative time was 43 minutes with kyphoplasty and 24 minutes with vertebroplasty (P=0.0002). Both techniques relieved pain, with no significant difference. Kyphoplasty significantly improved the wedge angle, by +6°, versus +2° with vertebroplasty (P=0.002). With kyphoplasty, the volume injected was larger and cement distribution was less favourable. Leakage rates were similar. DISCUSSION Despite the heterogeneity of our study, our data confirm the effectiveness of kyphoplasty in alleviating pain and decreasing deformities due to osteoporotic vertebral fractures. Vertebroplasty is a faster and less costly procedure that remains useful; no detectable clinical complications occur with vertebroplasty, which ensures better anchoring of the cement in the cancellous bone.
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Affiliation(s)
- L Garnier
- Academic Orthopaedics and Trauma Surgery Unit, Michallon Hospital, 38043 Grenoble Cedex 09, France.
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Li A, Li KC, Hsieh CH. Transpedicle body augmenter for vertebral augmentation in symptomatic multiple osteoporotic compression fractures. Indian J Orthop 2010; 44:191-7. [PMID: 20419007 PMCID: PMC2856395 DOI: 10.4103/0019-5413.62016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Multiple osteoporotic vertebral compression fractures (VCFs) have been treated with polymethylmethacrylate augmentation; however, there are cement complications and long-term fracture healing that are unknown. Transpedicle body augmenter (a porous titanium spacer) has been reported as an internal support to reconstruct the vertebral body combining short-segment fixation in burst fracture and Kümmell's disease with cord compression. Transpedicle body augmenter for vertebral augmentation (TpBA) also has been reported successfully in treating single painful VCF and vertebral metastasis lesions including pending fractures and pathologic compression fractures. To test the hypothesis that TpBA can effectively and safely treat the symptomatic multiple VCFs, this retrospective study was done by analyzing the radiographic and clinical results. MATERIALS AND METHODS We retrospectively reviewed clinical and radiographic results of TpBA for symptomatic multiple (more than two levels) VCFs in 62 patients with a total of 236 levels, i.e. 3.8 VCFs per patient. Manual reduction and TpBA via paramedian incisions with blunt dissection were done. One incision was made for two continuous levels and alternative side was selected for next incision. Mean age was 74.3 years (range, 62-87 years), and female-male ratio was 5.2:1. Anterior vertebral height and wedge angle by radiographic findings were measured at preoperative, initial follow-up and final follow-up. Clinical results were assessed by questionnaires and clinical observations. By July 2008, 58 patients returned to answer the questionnaire including quantification of pain on the visual analog scale, the response to operations (better, same, or worse after operation), returned to their pre-fracture function (yes/no) and satisfaction (a scale of 0 = completely dissatisfied to 10 = completely satisfied). RESULTS The mean symptom duration was 7 months, and follow-up, 48 months. The average operation time was 21 min per level, blood loss was 74 cc per level and hospitalization was 4.4 days. No patient had neurological deterioration. There was no dislodgement of implant in the final visit. Forty-eight patients (77.4%) could walk within 6-8 h after operation and the others, within 24 h. The anterior vertebral restoration was 7.3 mm initially and 6.2 mm at final follow-up. Wedge angle correction was 10.4 degrees initially and was 9.3 degrees at final follow-up. Pain, by the visual analog scale, was 8.5 preoperatively, 2.7 at day 7 follow-up and 2.9 at final follow-up. By the questionnaire, 52 of 58 respondents reported a decrease in discomfort after TpBA and 48 of 58 patients reported a return to normal activity after operation. The final satisfaction rate was 89.7%. DISCUSSION The symptoms of multiple osteoporotic compression fracture may be due to unstable fracture, radiculopathy, and global traumatic kyphosis with posture changes, which can be corrected by multiple TpBA. The transpedicle body augmenter was initially stabilized by the sinking and locking mechanism and finally by bone ingrowth. CONCLUSIONS TpBA via a minimally invasive method led to early and medium-term clinical improvements and anatomic restoration of multiple symptomatic VCFs.
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Affiliation(s)
- Allen Li
- Department of Biology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Kung-Chia Li
- Department of Orthopedic Surgery, Chiayi Yang-Ming Hospital, Republic of China,Institute and Faculty of Physical Therapy, National Yang-Ming University, Taipei, Taiwan, Republic of China,Address for correspondence: Prof. Kung-Chia Li, No. 252, Wufong North Road, Chiayi, Taiwan, Republic of China. E-mail:
| | - Ching-Hsiang Hsieh
- Department of Orthopedic Surgery, Chiayi Yang-Ming Hospital, Republic of China
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Peh WC, Munk PL, Rashid F, Gilula LA. Percutaneous Vertebral Augmentation: Vertebroplasty, Kyphoplasty and Skyphoplasty. Radiol Clin North Am 2008; 46:611-35, vii. [DOI: 10.1016/j.rcl.2008.05.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Behandlungsmöglichkeiten bei thorakalen und lumbalen osteoporotischen Problemfrakturen. DER ORTHOPADE 2008; 37:307-20. [DOI: 10.1007/s00132-008-1227-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Minimal invasive short posterior instrumentation plus balloon kyphoplasty with calcium phosphate for burst and severe compression lumbar fractures. Spine (Phila Pa 1976) 2008; 33:658-67. [PMID: 18344860 DOI: 10.1097/brs.0b013e318166e0bb] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective consecutive series. OBJECTIVE To evaluate the efficacy of minimal invasive surgery for acute lumbar fractures by means of balloon kyphoplasty with calcium phosphate plus segmental short posterior instrumented fusion. SUMMARY OF BACKGROUND DATA In the surgical treatment of lumbar fractures with short pedicle screw instrumentation, the failure to support the anterior spinal column often results in loss of correction. Transpedicular augmentation techniques with bone and bone substitutes have been attempted whereas kyphoplasty has been increasingly used to augment fractured vertebral body. METHODS Eighteen consecutive patients with an average age of 64 +/- 15 years, who sustained lumbar (L1-L4) burst and severe compression fracture were included in this prospective study. On admission, 2 (11%) of 18 patients had incomplete neurologic impairment. All patients underwent bilateral balloon kyphoplasty with calcium phosphate bone cement to reduce segmental kyphosis and restore vertebral body height and segmental pedicle screw instrumentation and fusion. Gardner kyphosis angle, anterior (AVBHr) and posterior vertebral body height ratio (PVBHr), and spinal canal encroachment (SCE) were calculated before to after surgery. VAS and SF-36 were used to evaluate functional outcome. RESULTS All patients were operated within 24 hours after admission and were followed for an average 22 months (17-28 months) after index surgery. Operating time and blood loss averaged 45 minutes and 70 mL, respectively. VAS and SF-36 (role physical and bodily pain domains) were significantly improved after surgery. Both patients with incomplete neurologic lesions recovered, whereas no neurologic deterioration was observed in any case. Segmental kyphosis improved from an average preoperative kyphosis of 16 to 2 degrees after surgery (P < 0.000). AVBHr improved from an average before surgery 0.57 to 0.87 (P < 0.000) after surgery, whereas PVBHr improved from 0.93 before surgery to 0.98 (P < 0.05) after surgery. SCE was reduced from an average 25% before surgery to 19% (P < 0.07) after surgery. Bone cement leakage was observed anteriorly to the fractured vertebral body or to the adjacent superior disc in 4 patients without clinical sequelae, whereas 3 pedicle screws were malpositioned medially to the pedicle in 3 patients without neurologic impairment or associated complaints. Posterolateral radiologic fusion was achieved within 6 to 8 months after index operation. There was no instrumentation failure or loss of sagittal curve and vertebral height correction. CONCLUSION Balloon kyphoplasty with calcium phosphate cement combined with posterior segmental short minimal invasive fixation for fresh burst and severe compression lumbar fractures provided excellent immediate reduction of post-traumatic segmental kyphosis with simultaneous reduction of spinal canal encroachment and restoration of vertebral body height in the fracture level.
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