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Nian S, Zhao Y, Li C, Zhu K, Li N, Li W, Chen J. Development and validation of a radiomics-based model for predicting osteoporosis in patients with lumbar compression fractures. Spine J 2024:S1529-9430(24)00187-6. [PMID: 38679078 DOI: 10.1016/j.spinee.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Osteoporosis, a metabolic bone disorder, markedly elevates fracture risks, with vertebral compression fractures being predominant. Antiosteoporotic treatments for patients with osteoporotic vertebral compression fractures (OVCF) lessen both the occurrence of subsequent fractures and associated pain. Thus, diagnosing osteoporosis in OVCF patients is vital. PURPOSE The aim of this study was to develop a predictive radiographic model using T1 sequence MRI images to accurately determine whether patients with lumbar spine compression fractures also have osteoporosis. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE Patients over 45 years of age diagnosed with a fresh lumbar compression fracture. OUTCOME MEASURES Diagnostic accuracy of the model (area under the ROC curve). METHODS The study retrospectively collected clinical and imaging data (MRI and DEXA) from hospitalized lumbar compression fracture patients (L1-L4) aged 45 years or older between January 2021 and June 2023. Using the pyradiomics package in Python, features from the lumbar compression fracture vertebral region of interest (ROI) were extracted. Downscaling of the extracted features was performed using the Mann-Whitney U test and the least absolute shrinkage selection operator (LASSO) algorithm. Subsequently, six machine learning models (Naive Bayes, Support Vector Machine [SVM], Decision Tree, Random Forest, Extreme Gradient Boosting [XGBoost], and Light Gradient Boosting Machine [LightGBM]) were employed to train and validate these features in predicting osteoporosis comorbidity in OVCF patients. RESULTS A total of 128 participants, 79 in the osteoporotic group and 49 in the non-osteoporotic group, met the study's inclusion and exclusion criteria. From the T1 sequence MRI images, 1906 imaging features were extracted in both groups. Utilizing the Mann-Whitney U test, 365 radiologic features were selected out of the initial 1,906. Ultimately, the lasso algorithm identified 14 significant radiological features. These features, incorporated into six conventional machine learning algorithms, demonstrated successful prediction of osteoporosis in the validation set. The NaiveBayes model yielded an area under the receiver operating characteristic curve (AUC) of 0.84, sensitivity of 0.87, specificity of 0.70, and accuracy of 0.81. CONCLUSIONS A NaiveBayes machine learning algorithm can predict osteoporosis in OVCF patients using t1-sequence MRI images of lumbar compression fractures. This approach aims to obviate the necessity for further osteoporosis assessments, diminish patient exposure to radiation, and bolster the clinical care of patients with OVCF.
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Affiliation(s)
- Sunqi Nian
- The Affiliated Hospital of Kunming University of Science and Technology, Department of Orthopaedics, The First People's Hospital of Yunnan Province, 157 Jinbi Road, Kunming, Yunnan Province, China
| | - Yayu Zhao
- The Affiliated Hospital of Kunming University of Science and Technology, Department of Orthopaedics, The First People's Hospital of Yunnan Province, 157 Jinbi Road, Kunming, Yunnan Province, China
| | - Chengjin Li
- The Affiliated Hospital of Kunming University of Science and Technology, Department of Orthopaedics, The First People's Hospital of Yunnan Province, 157 Jinbi Road, Kunming, Yunnan Province, China
| | - Kang Zhu
- Affiliated Hospital of Yunnan University of Traditional Chinese Medicine, 104 Guanghua Street, Kunming, Yunnan Province, China
| | - Na Li
- Department of Anesthesiology, 920th Hospital of the Joint Logistics Support Force, 212 Daguan Road, Kunming, Yunnan Province, China
| | - Weichao Li
- The Affiliated Hospital of Kunming University of Science and Technology, Department of Orthopaedics, The First People's Hospital of Yunnan Province, 157 Jinbi Road, Kunming, Yunnan Province, China; Department of Orthopedics, Clinical Medical Centre for Yunnan Provincial Spinal Cord Disease, Yunnan Key Laboratory of Digital Orthopedics, 157 Jinbi Road, Kunming, Yunnan Province, China
| | - Jiayu Chen
- The Affiliated Hospital of Kunming University of Science and Technology, Department of Orthopaedics, The First People's Hospital of Yunnan Province, 157 Jinbi Road, Kunming, Yunnan Province, China; Department of Orthopedics, Clinical Medical Centre for Yunnan Provincial Spinal Cord Disease, Yunnan Key Laboratory of Digital Orthopedics, 157 Jinbi Road, Kunming, Yunnan Province, China.
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Zhang T, Deng Y, Yuan Z, Zhou M, Ma Z, Zhang M. What are the Risk Factors for Residual Pain After Percutaneous Vertebroplasty or Kyphoplasty? A Meta-Analysis. World Neurosurg 2024:S1878-8750(24)00533-3. [PMID: 38561033 DOI: 10.1016/j.wneu.2024.03.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Although many risk factors for residual pain following percutaneous vertebroplasty or kyphoplasty (PVP or PKP) have been reported in many studies, research methods and cohorts differ greatly. A previous meta-analysis identified patient- and operation-specific risk factors for residual pain. This study aimed to examine the available data and identify significant risk factors for residual pain after PVP or PKP. METHODS PubMed, EMBASE, Web of Science, and the Chinese Wanfang Database were searched for relevant research in English and Chinese, and full-text publications including patients with and without residual pain were compared. Only studies presenting odds ratios from multivariate analysis of residual pain data were considered. To evaluate the impact of the results of the selected articles, Review Manager 5.4 was used. RESULTS Twelve publications including a total of 3120 patients met the requirements. The meta-analysis examined 10 factors associated with residual pain and categorized them as either patient- or operation-associated factors. Thoracolumbar fascia injury, intravertebral vacuum cleft, depression, and number of fractured vertebrae were all significant patient-associated parameters for residual pain. Significant operation-associated risk factors included bone cement distribution and intraoperative facet joint injury. CONCLUSIONS In this meta-analysis, we identified several significant risk factors for residual pain after PVP or PKP. These findings may be helpful for patient counseling and surgical planning.
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Affiliation(s)
- Tao Zhang
- Department of Spine Surgery, Tongling People's Hospital, Tongling, Anhui, China
| | - Yinghu Deng
- Department of Spine Surgery, Tongling People's Hospital, Tongling, Anhui, China.
| | - Zhongshan Yuan
- Department of Spine Surgery, Tongling People's Hospital, Tongling, Anhui, China
| | - Minghao Zhou
- Department of Spine Surgery, Tongling People's Hospital, Tongling, Anhui, China
| | - Zhixiang Ma
- Department of Articular Surgery, Tongling People's Hospital, Tongling, Anhui, China
| | - Mingkai Zhang
- Department of Spine Surgery, Tongling People's Hospital, Tongling, Anhui, China
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Sun Y, Zhang Y, Ma H, Tan M, Zhang Z. Therapeutic Efficacy and Safety of Percutaneous Curved Vertebroplasty in Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis. Orthop Surg 2023; 15:2492-2504. [PMID: 37497571 PMCID: PMC10549840 DOI: 10.1111/os.13800] [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: 01/23/2023] [Revised: 04/10/2023] [Accepted: 04/15/2023] [Indexed: 07/28/2023] Open
Abstract
This systematic review and meta-analysis is aimed to provide higher quality evidence regarding the efficacy and safety between PCVP and PVP/KP in OVCFs. We searched the Cochrane Library, PubMed, Web of Science, and Embase databases for all randomized controlled trials (RCTs) and observational studies (cohort or case-control studies) that compare PCVP to PVP/KP for OVCFs. The Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the RCTs and non-RCTs, respectively. Meta-analysis was performed using RevMan 5.4 software. A total of seven articles consisting of 562 patients with 593 diseased vertebral bodies were included. Statistically significant differences were found in the postoperative visual analog scale (VAS) at 1 day (MD = -0.11; 95% CI: [-0.21 to -0.01], p = 0.03), but not at 3 months (MD = -0.21; 95% CI: [-0.41-0.00], p = 0.05) or 6 months (MD = 0.03; 95% CI: [-0.13-0.20], p = 0.70). There was no statistically significant difference in postoperative Oswestry disability index (ODI) at 1 day (MD = -0.28; 95% CI: [-0.62-0.05], p = 0.10), 3 months (MD = -1.52; 95% CI: [-3.11-0.07], p = 0.06), or 6 months (MD = 0.18; 95% CI: [-0.13-0.48], p = 0.25). Additionally, there were no statistically significant differences in Cobb angle (MD = 0.30; 95% CI: [-1.69-2.30], p = 0.77) or anterior vertebral body height (SMD = -0.01; 95% CI: [-0.26-0.23], p = 0.92) after surgery. Statistically significant differences were found in surgical time (MD = -8.60; 95% CI: [-13.75 to -3.45], p = 0.001), cement infusion volume (MD = -0.82; 95% CI: [-1.50 to -0.14], P = 0.02), and dose of fluoroscopy (SMD = -1.22; 95% CI: [-1.84 to -0.60], p = 0.0001) between curved and noncurved techniques, especially compared to bilateral PVP. Moreover, cement leakage showed statistically significant difference (OR = 0.40; 95% CI: [0.27-0.60], p < 0.0001). Compared with PVP/KP, PCVP is superior for pain relief at short-term follow-up. Additionally, PCVP has the advantages of significantly lower surgical time, radiation exposure, bone cement infusion volume, and cement leakage incidence compared to bilateral PVP, while no statistically significant difference is found when compared with unilateral PVP or PKP. In terms of quality of life and radiologic outcomes, the effects of PCVP and PVP/KP are not significantly different. Overall, this meta-analysis reveals that PCVP was an effective and safe therapy for patients with OVCFs.
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Affiliation(s)
- Yan Sun
- Department of OrthopaedicsGuang'an Men Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Yong Zhang
- Department of OrthopaedicsGuang'an Men Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Haoning Ma
- Department of OrthopaedicsChina‐Japan Friendship HospitalBeijingChina
| | - Mingsheng Tan
- Department of OrthopaedicsChina‐Japan Friendship HospitalBeijingChina
| | - Zhihai Zhang
- Department of OrthopaedicsGuang'an Men Hospital, China Academy of Chinese Medical SciencesBeijingChina
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Zhou C, Liao Y, Chen H, Wang Y. Analysis of optimal volume fraction percentage and influencing factors of bone cement distribution in vertebroplasty using digital techniques. J Orthop Surg Res 2023; 18:235. [PMID: 36959652 PMCID: PMC10035276 DOI: 10.1186/s13018-023-03719-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/15/2023] [Indexed: 03/25/2023] Open
Abstract
Purpose To explore the optimal volume fraction percentage (VF%) and influencing factors of bone cement distribution in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF) using digital techniques. Patients and methods From January 2019 to February 2021, 150 patients with 0VCF who underwent PVP surgery in our hospital were analyzed. Based on postoperative X-ray and CT, the spatial distribution score of the intravertebral cement was calculated and the patients were divided into two groups: 0–7 were divided into group A; 8–10 were divided into group B. The general data of the two groups of patients were compared, and Mimics three-dimensional reconstruction images were used to measure the cement dispersion volume (CDV), vertebral body volume (VBV), and VF%. Factors affecting bone cement distribution were included in a multifactorial logistic regression analysis to construct a receiver operating characteristic (ROC) curve, calculate a cut-off value for the extensive distribution of bone cement, and analyze the correlation between bone cement distribution scores and VF%. Results There were 60 patients in group A and 90 patients in group B. Univariate analysis showed that bone mineral density (BMD), cement leakage, CDV, and VF% were significantly lower in group A than in group B (p < 0.05). Multivariate logistic regression analysis showed that BMD and VF% were independent influencing factors on bone cement distribution. The area under the curve (AUC) of VF% was 84.7%, and the cut-off value for extensive distribution of bone cement was 28.58%, which corresponded to a sensitivity and specificity of 72.2% and 91.7%, respectively. There was a strong correlation between the cement distribution score and VF% (r = 0.895, p < 0.001). Conclusion BMD and VF% were important independent influencing factors of bone cement distribution. Extensive bone cement distribution can be achieved when the VF% reaches 28.58%.
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Affiliation(s)
- Chengqiang Zhou
- grid.413389.40000 0004 1758 1622Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, 32 Meijian Road, Xuzhou, 221000 Jiangsu China
- grid.417303.20000 0000 9927 0537Graduate School of Xuzhou Medical University, Xuzhou, 221000 Jiangsu China
| | - Yifeng Liao
- grid.413389.40000 0004 1758 1622Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, 32 Meijian Road, Xuzhou, 221000 Jiangsu China
- grid.417303.20000 0000 9927 0537Graduate School of Xuzhou Medical University, Xuzhou, 221000 Jiangsu China
| | - Han Chen
- grid.417303.20000 0000 9927 0537Graduate School of Xuzhou Medical University, Xuzhou, 221000 Jiangsu China
| | - Yunqing Wang
- grid.413389.40000 0004 1758 1622Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, 32 Meijian Road, Xuzhou, 221000 Jiangsu China
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Bazzocchi A, Isaac A, Dalili D, Fotiadou A, Kariki EP, Kirschke JS, Krestan CR, Messina C, Oei EHG, Phan CM, Prakash M, Sabir N, Tagliafico A, Aparisi F, Baum T, Link TM, Guglielmi G, Aparisi Gómez MP. Imaging of Metabolic Bone Diseases: The Spine View, Part I. Semin Musculoskelet Radiol 2022; 26:478-490. [PMID: 36103889 DOI: 10.1055/s-0042-1754340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Metabolic bone diseases comprise a wide spectrum. Of them, osteoporosis is the most frequent and the most commonly found in the spine, with a high impact on health care systems and on morbidity due to vertebral fractures (VFs).This article discusses state-of-the-art techniques on the imaging of metabolic bone diseases in the spine, from the well-established methods to the latest improvements, recent developments, and future perspectives.We review the classical features of involvement of metabolic conditions involving the spine. Then we analyze the different imaging techniques for the diagnosis, characterization, and monitoring of metabolic bone disease: dual-energy X-ray absorptiometry (DXA) and DXA-based fracture risk assessment applications or indexes, such as the geometric parameters, Bone Strain Index, and Trabecular Bone Score; quantitative computed tomography; and magnetic resonance and ultrasonography-based techniques, such as radiofrequency echographic multi spectrometry. We also describe the current possibilities of imaging to guide the treatment of VFs secondary to metabolic bone disease.
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Affiliation(s)
- Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Danoob Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Epsom, London, United Kingdom.,Department of Diagnostic and Interventional Radiology, Epsom and St. Helier University Hospitals NHS Trust, London, United Kingdom
| | | | - Eleni P Kariki
- Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Division of Informatics, Imaging & Data Sciences, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Jan S Kirschke
- Interventional und Diagnostic Neuroradiology, School of Medicine, Technical University Munich, Munich, Germany
| | | | | | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Catherine M Phan
- Service de Radiologie Ostéo-Articulaire, APHP, Nord-Université de Paris, Hôpital Lariboisière, Paris, France
| | - Mahesh Prakash
- Department of Radiodiagnosis & Imaging, PGIMER, Chandigarh, India
| | - Nuran Sabir
- Department of Radiology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Alberto Tagliafico
- DISSAL, University of Genova, Genoa, Italy.,Ospedale Policlinico San Martino, Genova, Italy
| | - Francisco Aparisi
- Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California
| | | | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology, IMSKE, Valencia, Spain
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Wu W, Zhang X, Li X, Yu S. The influence of diverse bone cement distribution patterns for metastatic vertebral lesions after bilateral percutaneous kyphoplasty. BMC Musculoskelet Disord 2022; 23:713. [PMID: 35883056 PMCID: PMC9316733 DOI: 10.1186/s12891-022-05680-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate the influence of diverse bone cement distribution patterns in patients with metastatic vertebral lesions after bilateral percutaneous kyphoplasty (PKP). Methods Fifty-nine patients with single-level metastatic vertebral lesions who received bilateral PKP were retrospectively reviewed. According to the different bone cement distribution patterns, patients were divided into confluent (n = 35, CF) and separated (n = 24, SP) groups. Indicators including visual analogue scale (VAS), Oswestry Disability Index (ODI), vertebral body height (VBH) variation, quality of life (QoL), and related complications were reviewed and compared between the two groups. Results No statistically significant differences were observed between the two groups in age, sex, types of lesions, locations of lesions, posterior vertebral body and/or pedicle involvement, percentage of vertebral invasion, procedure duration or cement volume (p > 0.05). There was significant improvement in VAS, ODI, VBH and QoL at any follow-up examination (p < 0.05) compared with those preoperatively. The CF group exhibited better pain relief in VAS scores than did the SP group just at 3 days and 1 month after PKP (p < 0.05). There were no significant differences between the two groups in VAS scores at 3 months or 1 year after PKP (p > 0.05). No statistically significant differences were observed between the two groups in terms of ODI, VBH or QoL (p > 0.05). There was no statistically significant difference in the incidence of complications between the two groups (p > 0.05). Conclusions More rapid pain relief was achieved with confluent rather than separated bone cement distribution patterns in PKP for patients with metastatic vertebral lesions.
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Affiliation(s)
- Wence Wu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xinxin Zhang
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaoyang Li
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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Zarza W, Astur N, Kim L, Miotto L, Mendonça RGMD, Gotfryd AO, Caffaro MFS, Meves R. KYPHOPLASTY VERSUS VERTEBROPLASTY IN VERTEBRAL COMPRESSION FRACTURES: A META-ANALYSIS. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222101250913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: Vertebral fracture is the main complication of osteoporosis and is common among the elderly. Conservative treatment is the first choice for osteoporotic vertebral compression fractures (OVCF) but for persistent painful cases, percutaneous vertebral cement augmentation techniques, such as vertebroplasty and kyphoplasty, are indicated. We performed a systematic review to compare clinical and radiological outcomes of both methods. Methods: A systematic review was performed according to the PRISMA and Cochrane Handbook for Systematic Reviews of Interventions. The PICO search strategy consisted of the following terms: Population- Patients with OVCFs; Intervention- Kyphoplasty; Control- Vertebroplasty; Outcomes- Pain, Cement Leakage, Vertebral Body Height, Adjacent level fractures, Oswestry (ODI) and SF36. Results: Seven articles were included in the qualitative analysis, selecting only randomized controlled trials. Four hundred and fifty patients were treated with vertebroplasty (VP) and 469 with kyphoplasty (KP). The leakage rate of the VP group was 63% versus 14% for the KP group. However, these results were without statistical significance. The Visual Analogue Scale (VAS), ODI and SF-36 outcomes were evaluated based on the 6-month and 1-year follow-up results, and we were unable to find any significant differences between treatments. For restoration of vertebral height, the values of the KP group were, on average, 0.71 cm higher than those of the VP group, with 95% CI. Conclusion: Based on this systematic review, kyphoplasty is superior to vertebroplasty for achieving gains in vertebral body height. As regards cement leakage and other clinical outcomes, neither method showed statistically significant superiority. Level of Evidence I; Systematic review.
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Affiliation(s)
- William Zarza
- Hospital de Misericórdia Santa Casa de São Paulo, Brazil
| | - Nelson Astur
- Hospital de Misericórdia Santa Casa de São Paulo, Brazil
| | - Leandro Kim
- Hospital de Misericórdia Santa Casa de São Paulo, Brazil
| | - Lucas Miotto
- Hospital de Misericórdia Santa Casa de São Paulo, Brazil
| | | | | | | | - Robert Meves
- Hospital de Misericórdia Santa Casa de São Paulo, Brazil
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Zaulet A, Nuez M, Sillanpää R, Teixidor F, Viñas C. Towards purely inorganic clusters in medicine: Biocompatible divalent cations as counterions of cobaltabis(dicarbollide) and its iodinated derivatives. J Organomet Chem 2021. [DOI: 10.1016/j.jorganchem.2021.121997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ong T, Sahota O, Gladman JRF. Management of patients admitted to hospital with acute vertebral fragility fractures: a modified Delphi study. Age Ageing 2021; 50:985-989. [PMID: 33951150 DOI: 10.1093/ageing/afaa225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Acute vertebral fragility fracture requiring hospital admission is common, painful and disabling. No comprehensive clinical guideline for their care exists. To support the development of such a guideline, we sought the views of experts in the field. METHODS A modified Delphi study was used. A total of 70 statements were presented, using an online platform, over three consensus-seeking rounds, to participants with experience in the hospital care of patients with acute vertebral fragility fractures from UK-based specialist societies. Participants rated the level of their agreement with each statement on a 5-point Likert scale. Consensus was defined at 70% of respondents choosing either agree/strongly agree or disagree/strong disagree. Over the first two rounds, statements not reaching consensus were modified in subsequent rounds, and new statements proposed by participants and agreed by the research team could be added. RESULTS There were 71 participants in the first round, 37 in the second round and 28 (most of whom were geriatricians) in the third round. Consensus was reached in 52 statements covering fracture diagnosis, second-line imaging, organisation of hospital care, pain management and falls and bone health assessment. Consensus was not achieved for whether vertebral fragility fractures should be managed in a specific clinical area. DISCUSSION These findings provide the basis for the development of clinical guidelines and quality improvement initiatives. They also help to justify research into the merits of managing acute vertebral fragility fracture patients in a specific clinical area.
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Affiliation(s)
- Terence Ong
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham NG7 2UH, UK
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham NG7 2UH, UK
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Opinder Sahota
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham NG7 2UH, UK
| | - John R F Gladman
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham NG7 2UH, UK
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham NG7 2UH, UK
- National Institute for Health Research (NIHR, Nottingham Biomedical Research Centre (BRC), Queens Medical Centre, Nottingham NG7 2UH, UK
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Lee S, Cho DC, Kim KT, Lee YS. Evidence-based treatment of osteoporotic vertebral compression fracture. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.3.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The prevalence and medical costs of osteoporotic vertebral compression fractures (OVCFs) are on the rise. However, a concrete evidence-based treatment guideline has not yet been established. Despite that numerous randomized controlled trials (RCTs) were performed, the study design and outcome measurement were heterogeneous, and the results were not unified. The purpose of this review is to compare the results of high level-evidence studies to provide a background for evidence-based OVCF treatment. Many reports showed that vertebroplasty has better clinical outcomes than non-surgical treatment for OVCF, but the results of three double-blinded RCTs with the highest level of evidence did not show a significant difference between vertebroplasty and sham procedure. Whether undergoing surgical or non-surgical treatment, OVCF patient management should be started by managing osteoporosis first. Meanwhile, in the results of RCTs related to the comparison of conservative treatment modalities, the benefit of braces and a specific analgesic prescription protocol was also unclear. The presented results of each clinical trial were generally inconsistent and may not be appropriate in all situations. Any decision by clinicians to apply this evidence must be made considering individual patients and available resources. At present, controversy remains about the best treatment modality for OVCF. Large, multicenter, placebo/sham-controlled trials are needed to address this gap and establish strong evidence-based guidelines.
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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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Xu HT, Zheng S, Kang MY, Yu T, Zhao JW. A novel computer navigation model guided unilateral percutaneous vertebroplasty for vertebral compression fracture: A case report. Medicine (Baltimore) 2020; 99:e22468. [PMID: 33126302 PMCID: PMC7598862 DOI: 10.1097/md.0000000000022468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONAL Vertebral compression fracture (VCF) is one of the most common diseases in spinal surgery. Traditional percutaneous vertebroplasty (PVP) under fluoroscopy is an effective method to treat vertebral compression fracture. However, there is still a risk of vascular nerve injury and infection caused by inaccurate or repeated puncture. Therefore, the purpose of this paper was to assess the accuracy of unilateral PVP guided by screw view model of navigation (SVMN) for VCF. PATIENT CONCERNS A 59-year-old female patient suffered high falling injury, and with back pain as its main clinical symptom. DIAGNOSES The patient was diagnosed with a L1 VCF. INTERVENTIONS We placed the puncture needle under the guidance of SVMN to reach the ideal position designed before operation, and then injected the bone cement to complete the percutaneous kyphoplasty (PKP). OUTCOMES The operative time was 29.5 minutes, the puncture time was 1 time, the fluoroscopy time was 2.9 minutes, and the bone cement distribution was satisfactory. VAS and ODI scores were significant improved postoperatively. No surgical complications, including neurovascular injury and infection, were observed during 28-month follow up. LESSONS The SVMN guided percutaneous puncture needle insertion in PKP operation for VCF is an effective and safety technique. Besides, the SVMN has also been a contributor to reduce radiation doses and replace conventional fluoroscopy.
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13
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Lindquester WS, Warhadpande S, Dhangana R. Trends of utilization and physician payments for vertebroplasty and kyphoplasty procedures by physician specialty and practice setting: 2010 to 2018. Spine J 2020; 20:1659-1665. [PMID: 32417502 DOI: 10.1016/j.spinee.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In 2010, the American Academy of Orthopedic Surgeons published guidelines strongly recommending against the use of vertebroplasty following the publication of randomized control trials that failed to show significant improvement in pain. Vertebroplasty has remained controversial since those findings. PURPOSE To study and provide an update on utilization of vertebroplasty and kyphoplasty procedures among Medicare beneficiaries by physician specialty and practice setting following publication of recommendations against vertebroplasty in 2010. STUDY DESIGN/SETTING This study uses Medicare Part B Physician/Supplier Procedure Summary Master File (PSPSMF) for the years 2010 to 2018 to determine trends in volume and reimbursement by physician specialty and practice setting. PATIENT SAMPLE All vertebral augmentation procedures with a physician reimbursement claims approved by Medicare Part B from 2010 to 2018. OUTCOME MEASURES This study analyzes trends in volume and physician payment of vertebroplasty and kyphoplasty procedures by physician specialty for the time period 2010 to 2018. METHODS Claims from the Medicare Part B PSPSMF for the years 2010 to 2018 were extracted using the Current Procedural Terminology codes for vertebroplasty and kyphoplasty. Total volumes, payment amounts (professional component), and trends were analyzed by physician specialty. RESULTS Between 2010 and 2018, the total volume of vertebroplasties decreased by 61.2% (29,995 to 11,654), whereas the volume of kyphoplasties increased modestly by 14.4% (59,691 to 68,294). Radiologists performed an increasing share of both procedures over this time period, from 68.5% to 75.1% for vertebroplasties and 28.9% to 37.1% for kyphoplasties. Total payment for vertebroplasties decreased by 74.3% from $14.8 million in 2010 to $3.8 million in 2018; whereas it increased by 235.3% for kyphoplasty procedures from $26.7 million to $89.7 million. This is driven in large part by a 6,833% increase in office based kyphoplasties which bill at the higher nonfacility rate that incorporates overhead, staff, and equipment. CONCLUSIONS Previous studies have demonstrated mixed evidence for benefits of vertebroplasty procedures and decreasing volumes over time. Data show continued downtrend in vertebroplasty and increased utilization of kyphoplasty among Medicare beneficiaries. In addition, the growing number of kyphoplasties correlated with a sharp rise in volume and increased reimbursement for office-based procedures. Radiologists have been performing an increasing share of both procedures.
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Affiliation(s)
| | | | - Rajoo Dhangana
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA
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14
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Wong SPY, Mok CC. Management of glucocorticoid-related osteoporotic vertebral fracture. Osteoporos Sarcopenia 2020; 6:1-7. [PMID: 32226826 PMCID: PMC7093682 DOI: 10.1016/j.afos.2020.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/15/2019] [Accepted: 02/08/2020] [Indexed: 12/11/2022] Open
Abstract
The vertebral column is the most common site of osteoporotic fractures in long-term users of glucocorticoids. Vertebral fracture leads to significant morbidities such as unrelenting pain, spinal deformities and reduced mobility, leading to diminished quality of life. Epidemiological data on the prevalence of glucocorticoid-induced vertebral fractures are limited. As vertebral fracture is a strong risk factor for further fragility fractures and mortality, it should be treated appropriately. This article reviews recent data on the prevalence of vertebral fractures in glucocorticoid users, fracture risk stratification, and evidence-based treatment options. The risk of osteoporotic fractures estimated by FRAX should be adjusted for glucocorticoid users. The first-line treatment of glucocorticoid-induced osteoporosis remains the bisphosphonates. Teriparatide and denosumab are alternative options. Percutaneous vertebroplasty and kyphoplasty may be considered for symptomatic control of acute vertebral fracture-related pain when conservative measures fail.
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Affiliation(s)
| | - Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong, China
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15
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Caitriona C, Mark MG, Elaine H, Claire G, Michelle F, Persson UM, Sherrington C, Blake C. Management of hospitalised osteoporotic vertebral fractures. Arch Osteoporos 2020; 15:14. [PMID: 32078057 DOI: 10.1007/s11657-020-0687-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/07/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Management of hospitalised osteoporotic vertebral fracture patients was explored across all major trauma orthopaedic hospitals in Ireland. Findings, based on a survey of orthopaedic doctors and physiotherapists, indicate a lack of standardised clinical care pathways. This study will inform development of clinical audit mechanisms and health service development for this large and growing fracture population in both Ireland and internationally. PURPOSE To explore the management of hospitalised vertebral fragility fracture (VFF) patients in Ireland. METHODS A cross-sectional survey of orthopaedic doctors (specialist registrar level) and physiotherapists was conducted across all hospitals with major orthopaedic trauma units in Ireland. Data were analysed using descriptive statistics in SPSS (V24). RESULTS Responses were achieved from 100% (n = 16) of the hospitals (42 individual physiotherapists and 47 orthopaedic doctors). Conservative management was usual with both orthopaedic doctors (n = 37, 79%) and physiotherapists (n = 40, 96%) reporting prescription of bracing as common practice despite a lack of underpinning evidence. A majority (87%) of the doctors believed osteoporosis medications should commence prior to discharge from the acute setting, but 68% did not agree that responsibility for coordination and delivery of bone health assessment and fracture risk management rested with them. A majority (72%) of physiotherapists reported an absence or were unsure regarding existence of fracture liaison services. 73% of physiotherapists reported prescribing an inpatient or home (78%) exercise programme, including mobility, strength and balance exercise though detail on dose and adherence remain unknown. Wide variance in referral patterns to multi-disciplinary team (MDT) members existed although 79% of orthopaedic doctors supported an MDT approach. CONCLUSION Clinical care pathways for the hospitalised VFF population lack standardisation in Ireland. Key challenges reported by orthopaedic doctors and physiotherapists relate to pain management, osteoporosis medication prescription, clarity on indications for bracing and a lack of fracture liaison services. Clinical guidelines, defined clinical care pathways and high-quality clinical research trials are required for VFF management.
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Affiliation(s)
- Cunningham Caitriona
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Mc Gowan Mark
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.,St James's Hospital, James's Street, Dublin 8, Ireland
| | - Hughes Elaine
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.,Tallaght University Hospital, Tallaght, Dublin 24, Ireland
| | - Gallagher Claire
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland.,City Physio, Chartered Physiotherapy Practice, Vesey Terrace, Lucan, County Dublin, Ireland
| | | | - Ulrik McCarthy Persson
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Cathie Sherrington
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
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Akisato K, Nishihara R, Okazaki H, Masuda T, Hironobe A, Ishizaki H, Shota K, Yamaguchi H, Funama Y. Dual-Energy CT of Material Decomposition Analysis for Detection with Bone Marrow Edema in Patients with Vertebral Compression Fractures. Acad Radiol 2020; 27:227-232. [PMID: 30876711 DOI: 10.1016/j.acra.2019.02.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES This study investigated detecting bone marrow edema (BME) in patients with vertebral compression fractures. We compared dual-energy material density analysis images to magnetic resonance imaging (MRI), which is considered the gold standard. MATERIALS AND METHODS In this retrospective study, 260 vertebral bodies from 30 patients (11 males, 19 females, mean age of 81) were assessed by MRI and dual-energy material density analysis. Diagnostic accuracy was assessed using the receiver operating characteristic (ROC) curve. Fifty-two of the 260 vertebral bodies were considered to have BME based on the dual-energy material density analysis images; 50 were deemed to have BME by MRI. RESULTS ROC analysis of the dual-energy material density analysis values revealed an area under the ROC curve of 0.95 for radiologist 1, 0.97 for radiologist 2, and 0.96 for radiologist 3. A mean cutoff value of 1032.6 mg/cm3 provided an overall sensitivity of 93.0% (95% confidence intervals [CI]: 86.0%-99.9%), specificity of 98.0% (95% CI: 95.5%-99.0%), accuracy of 97.0% (95% CI: 95.2%-99.0%), positive predictive value of 95.0% (95% CI: 81.0%-97.5%), and negative predictive value of 98.0% (95% CI: 93.0%-99.9%). CONCLUSION BME in patients with vertebral compression fractures can be detected using dual-energy material density analysis images.
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Abstract
BACKGROUND Despite optimal drug-conservative therapy, a relevant percentage of patients with vertebral compression fractures (WKF) do not experience any relevant improvement in their pain symptoms. Vertebroplasty (VP) and kyphoplasty (KP) are described in the literature as percutaneous interventional procedures for the treatment of WKF. OBJECTIVE Assessment of the effectiveness of the VP and KP in the treatment of WKF and discussion of the procedures in the context of the current literature. MATERIAL AND METHODS Presentation of the fundamentals of VP and KP and their further developments. Description of indications and contraindications. Discussion of the current literature and recommendations of the individual professional associations. RESULTS In patients with vertebral compression fractures, VP or KP of the affected vertebral body leads to a pain reduction in more than 90% of cases. Clinically relevant complications occur in less than 1% of interventions. CONCLUSION VP and KP are a safe and effective method for treating painful WKF. Optimal patient selection improves the clinical outcome.
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Wong SPY, Mok CC. Update on Symptomatic Treatment of Acute Vertebral Compression Fracture. JOURNAL OF CLINICAL RHEUMATOLOGY AND IMMUNOLOGY 2019. [DOI: 10.1142/s2661341719300039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The vertebral column is the most common site of osteoporotic fracture in older individuals and in those using long-term glucocorticoids. Vertebral compression fracture leads to significant morbidities such as acute and chronic pain, spinal deformities and neurological complications, resulting in reduced mobility and quality of life. As a previous vertebral compression fracture is a strong risk factor for further fragility fractures and mortality, it should be treated appropriately. This article reviews the management of osteoporotic vertebral compression fracture and provides evidence-based treatment options.
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Affiliation(s)
| | - Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China
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19
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Singh V, Taunk A, Phadke RV, Neyaz Z, Prasad SN. Analysis of percutaneous vertebroplasty—a prospective study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0018-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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20
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Ruziev KK, Baskov AV, Baskov VA, Dreval' ON, Drakin IA. [Treatment of uncomplicated vertebral compression fractures]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:66-70. [PMID: 31166319 DOI: 10.17116/neiro20198302166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
According to statistical studies in different countries, the annual incidence of spine and spinal cord injuries is 15-50 cases per 1 million people. In Russia, the incidence of this condition is 5% of the total number of all nonpenetrating traumatic injuries (Neurosurgery: Guidelines for Physicians, ed. by Prof. ON Dreval', 2013). According to the WHO reports, approximately 500,000 people annually experience spine injuries worldwide. Acute spine injuries make up 23.7% of all spinal traumas and include contusions (2.67%), injuries to the capsular ligamentous apparatus (3.88%), fractures and dislocations (7.63%), and muscle injury (9.52%). In males, the risk of experiencing a spine injury is the highest at the age of 20-29 and above 70 years, while in women this risk is the highest at an age of 15-19 and above 60 years. According to the studies, this risk is characterized by an at least 2:1 ratio between adult males and females. OBJECTIVE To compare the outcomes of surgical (vertebroplasty) and conservative treatment in management of pain syndrome in patients with uncomplicated spine injury. MATERIAL AND METHODS The study involved 60 patients with stable uncomplicated compression fractures of vertebral bodies in the thoracic and lumbosacral spine. These patients were subdivided into two groups. Group 1 consisted of 30 patients who had undergone unilateral transpedicular percutaneous vertebroplasty; Group 2 involved 30 patients who had undergone a course of conservative treatment. The medical records and the catamnestic follow-up data of patients treated at the Neurosurgery Department of the Research Clinical Center of JSC Russian Railways in 2015-2017 were analyzed for this purpose. RESULTS No statistically significant differences in sex, age, and level of injury were revealed between the study groups. A comparative analysis of treatment outcomes demonstrated that pain intensity assessed using the VAS scale was significantly reduced after one-year follow-up in both groups as compared to the baseline. A statistically significant decrease in pain intensity in the group of patients who had undergone vertebroplasty was observed as early as one month after the injury. No significant intergroup differences were observed in the long-term follow-up period (3 and 6 months) for this parameter. In five out of 60 patients, examination 12 months after the injury revealed that vertebral body height decreased by up to 10%. No statistically significant correlation with the treatment method was observed. CONCLUSION Vertebroplasty provides a statistically better pain relief during the first month after spine injury as compared to conservative treatment. For patients, this means earlier activization and quicker return to daily routines and work.
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Affiliation(s)
- Kh Kh Ruziev
- Division of Neurosurgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - A V Baskov
- Division of Neurosurgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russia; Research Clinical Center of JSC Russian Railways, Moscow, Russia
| | - V A Baskov
- Division of Neurosurgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russia; Research Clinical Center of JSC Russian Railways, Moscow, Russia
| | - O N Dreval'
- Division of Neurosurgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - I A Drakin
- Research Clinical Center of JSC Russian Railways, Moscow, Russia
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21
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Zhao J, Zhao X, Yang L, Qu Y, Dong R, Kang M, Zhang X, Zheng C, Yu T. Percutaneous vertebroplasty with granulated allogeneic bone grafting using screw-view model of navigation for thoracolumbar compressive fracture: A case report. Medicine (Baltimore) 2019; 98:e15715. [PMID: 31096524 PMCID: PMC6531076 DOI: 10.1097/md.0000000000015715] [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: 12/12/2022] Open
Abstract
RATIONALE The aim of this study was to assess the accuracy of percutaneous puncture needle with screw view model of navigation (SVMN) and the effect of periacetabular vertebroplasty (PVP) with granulated allogeneic bone grafting in thoracolumbar compressive fracture (TCF). PATIENT CONCERNS A 46-year-old female patient associated with high fall injury showed symptoms characterized by back pain and restricted movement of the right lower extremity. DIAGNOSES The patient was diagnosed with a TCF, right femoral neck fracture, and lumbar vertebrae hyperosteogeny. INTERVENTIONS A SVMN was used to guide our puncture needle insertion; and PVP was performed with granulated allogeneic bone grafting in this patient. OUTCOMES The follow-up lasted for 29 months. It took 2.4 minutes to design the trajectory of puncture needle, 2.1 minutes to implant the puncture needle, and 6.3 minutes to undergone fluoroscopy. Postoperative visual analog scale and Oswestry disability index scores were improved obviously compared with those before the operation. The Cobb angle of fractured vertebrae improved from 9.3° to 7.3° after treatment. The height ratio of fractured vertebrae increased from 79.5% to 90.6% postoperatively. Intraoperative blood loss amounted to 11 ml. No clinical complications were observed, including neurovascular injury and new fracture of adjacent vertebra. LESSONS Puncture needle placement under the guidance of SVMN is verified as a convenient, safe and reliable method, and PVP with granulated allogeneic bone grafting can effectively restore the height of anterior fractured vertebra, filling the gaps in the fractured vertebrae, and reconstructing the completeness of the fractured vertebrae.
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Affiliation(s)
| | | | | | | | | | | | - Xiwen Zhang
- Department of Gynaecology, The Second Hospital of Jilin University, Changchun, Jilin Province, China
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22
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ACR Appropriateness Criteria ® Management of Vertebral Compression Fractures. J Am Coll Radiol 2019; 15:S347-S364. [PMID: 30392604 DOI: 10.1016/j.jacr.2018.09.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 02/08/2023]
Abstract
Vertebral compression fractures (VCFs) have various causes, including osteoporosis, neoplasms, and acute trauma. As painful VCFs may contribute to general physical deconditioning, management of painful VCFs has the potential for improving quality of life and preventing superimposed medical complications. Various imaging modalities can be used to evaluate a VCF to help determine the etiology and guide intervention. The first-line treatment of painful VCFs has been nonoperative or conservative management as most VCFs show gradual improvement in pain over 2 to 12 weeks, with variable return of function. There is evidence that vertebral augmentation (VA) is associated with better pain relief and improved functional outcomes compared to conservative therapy for osteoporotic VCFs. A multidisciplinary approach is necessary for the management of painful pathologic VCFs, with management strategies including medications to affect bone turnover, radiation therapy, and interventions such as VA and percutaneous thermal ablation to alleviate symptoms. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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23
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Yu WB, Jiang XB, Liang D, Xu WX, Ye LQ, Wang J. Risk factors and score for recollapse of the augmented vertebrae after percutaneous vertebroplasty in osteoporotic vertebral compression fractures. Osteoporos Int 2019; 30:423-430. [PMID: 30368576 DOI: 10.1007/s00198-018-4754-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/22/2018] [Indexed: 12/11/2022]
Abstract
UNLABELLED Our study demonstrated a high incidence of recollapse of the augmented vertebrae after PVP treatment for OVCFs. A risk score based on all significant factors can predict the rate of recollapse and gain clinical benefits to prevent recollapse in patients at high risk. BACKGROUND Recollapse of the augmented vertebrae after percutaneous vertebroplasty (PVP) treatment for osteoporotic vertebral compression fractures (OVCFs) has obtained much attention. However, little is known about risk factors and score for recollapse of the augmented vertebrae. OBJECTIVE To determine risk factors and furthermore develop a risk score related to recollapse of the augmented vertebrae after PVP treatment for OVCFs. METHODS Patients who were treated with PVP for single OVCFs and met this study's inclusion criteria were retrospectively reviewed. The follow-up period was at least 2 years. Associations of recollapse with co-variates (age, gender, bone mass density [BMD] with a T-score, fracture level, intravertebral cleft [IVC], fracture type, cement volume, cement leakage, leakage into a disc, cement distribution pattern, Non-PMMA-endplate-contact [NPEC], preoperative fracture severity, reduction rate [RR], reduction angle [RA]) were analyzed and a risk score for recollapse was further developed to predict recollapse. RESULTS A total of 152 patients were included. Recollapse group was found in 42 (27.6%) patients. Preoperative IVC, solid lump cement distribution pattern, more RR (a cutoff value of 7%) and larger RA (a cutoff value of 3°) was significantly associated with increased risk for recollapse of the augmented vertebrae. A risk score was developed based on the number of risk factors present in each patient. Patients with a score of 4 had an approximately ninefold increased risk of developing recollapse over patients with a score of 0. The receiver operating characteristic curve of the risk score generated an area under the curve of 0.899 (95% CI 0.642-0.836, P = 0.000). CONCLUSION A risk score based on preoperative IVC, cement distribution pattern, reduction rate, and reduction angle predicts the rate of recollapse. Additional studies should aim to validate this score and inspect clinical benefits of recollapse prophylaxis in patients at high risk.
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Affiliation(s)
- W B Yu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangxi University of Chinese Medicine, No 89-9 Dongge Road, Nanning, Guangxi, People's Republic of China
| | - X B Jiang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - D Liang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - W X Xu
- Department of Spinal Surgery, Tongde Hospital of Zhejiang Province, Gucui Road 234, Hangzhou, Zhejiang, People's Republic of China
| | - L Q Ye
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - J Wang
- Department of Spinal Surgery, Tongde Hospital of Zhejiang Province, Gucui Road 234, Hangzhou, Zhejiang, People's Republic of China.
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Unwarranted regional variation in vertebroplasty and kyphoplasty in Switzerland: A population-based small area variation analysis. PLoS One 2018; 13:e0208578. [PMID: 30532141 PMCID: PMC6287855 DOI: 10.1371/journal.pone.0208578] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 11/20/2018] [Indexed: 12/30/2022] Open
Abstract
Background Percutaneous vertebroplasty (VP) and balloon kyphoplasty (BKP) for treating painful osteoporotic vertebral fractures are controversial. Objective We assessed the regional variation in the use of VP/BKP in Switzerland. Methods We conducted a population-based small area variation analysis using patient discharge data for VP/BKP from all Swiss hospitals and Swiss census data for calendar years 2012/13. We derived hospital service areas (HSAs) by analyzing patient flows, assigning regions from which most residents were discharged to the same VP/BKP specific HSA. We calculated age-/sex-standardized mean VP/BKP-rates and measures of regional variation (extremal quotient [EQ], systematic component of variation [SCV]). We estimated the reduction in variation of VP/BKP rates using negative binomial regression, with adjustment for patient demographic and regional socioeconomic factors (socioeconomic status, urbanization, and language region). We considered the residual, unexplained variation most likely to be unwarranted. Results Overall, 4955 VP/BKPs were performed in Switzerland in 2012/13. The age-/sex-standardized mean VP/BKP rate was 4.6/10,000 persons and ranged from 1.0 to 10.1 across 26 HSAs. The EQ was 10.2 and the SCV 57.6, indicating a large variation across VP/BKP specific HSAs. After adjustment for demographic and socioeconomic factors, the total reduction in variance was 32.2% only, with the larger part of the variation remaining unexplained. Conclusions We found a 10-fold variation in VP/BKP rates across Swiss VP/BKP specific HSAs. As only one third of the variation was explained by differences in patient demographics and regional socioeconomic factors, VP/BKP in the highest-use areas may, at least partially, represent overtreatment.
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Hirsch JA, Beall DP, Chambers MR, Andreshak TG, Brook AL, Bruel BM, Deen HG, Gerszten PC, Kreiner DS, Sansur CA, Tutton SM, van der Meer P, Stoevelaar HJ. Management of vertebral fragility fractures: a clinical care pathway developed by a multispecialty panel using the RAND/UCLA Appropriateness Method. Spine J 2018; 18:2152-2161. [PMID: 30096377 DOI: 10.1016/j.spinee.2018.07.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Vertebral fragility fractures (VFFs), mostly due to osteoporosis, are very common and are associated with significant morbidity and mortality. There is a lack of consensus on the appropriate management of patients with or suspected of having a VFF. PURPOSE This work aimed at developing a comprehensive clinical care pathway (CCP) for VFF. STUDY DESIGN/SETTING The RAND/UCLA Appropriateness Method was used to develop patient-specific recommendations for the various components of the CCP. The study included two individual rating rounds and two plenary discussion sessions. METHODS A multispecialty expert panel (orthopedic and neurosurgeons, interventional [neuro]radiologists and pain specialists) assessed the importance of 20 signs and symptoms for the suspicion of VFF, the relevance of 5 diagnostic procedures, the appropriateness of vertebral augmentation versus nonsurgical management for 576 clinical scenarios, and the adequacy of 6 aspects of follow-up care. RESULTS The panel identified 10 signs and symptoms believed to be relatively specific for VFF. In patients suspected of VFF, advanced imaging was considered highly desirable, with MRI being the preferred diagnostic modality. Vertebral augmentation was considered appropriate in patients with positive findings on advanced imaging and in whom symptoms had worsened and in patients with 2 to 4 unfavorable conditions (eg, progression of height loss and severe impact on functioning), dependent on their relative weight. Time since fracture was considered less relevant for treatment choice. Follow-up should include evaluation of bone mineral density and treatment of osteoporosis. CONCLUSIONS Using the RAND/UCLA Appropriateness Method, a multispecialty expert panel established a comprehensive CCP for the management of VFF. The CCP may be helpful to support decision-making in daily clinical practice and to improve quality of care.
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Affiliation(s)
- Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Douglas P Beall
- Department of Radiology, Oklahoma Spine Hospital, 1800 Renaissance Blvd, Suite 110, Edmond, OK 73013, USA
| | - M Renée Chambers
- Department of Neurosurgery, University of Alabama at Birmingham, 1720 2(nd) Avenue South, Birmingham, AL 35294, USA
| | - Thomas G Andreshak
- Consulting Orthopaedic Associates, 7640 W Sylvania Ave Ste B, Sylvania, OH 43560, USA
| | - Allan L Brook
- Department of Radiology, Montefiore Medical Center, 111 East 210(th) Street, Bronx, NY 10467, USA
| | - Brian M Bruel
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Building Tower West - McNair Campus, Houston, TX 77030, USA
| | - H Gordon Deen
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Peter C Gerszten
- Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - D Scott Kreiner
- Ahwatukee Sports & Spine, 4530 E Muirwood Dr # 110, Phoenix, AZ 85048, USA
| | - Charles A Sansur
- Department of Neurosurgery, University of Maryland Medical Center, 655 W. Baltimore Street, Baltimore, MD 21201, USA
| | - Sean M Tutton
- Department of Radiology, Vascular/Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA
| | - Peter van der Meer
- Southern New Hampshire Radiology Consultants, 703 Riverway Place, Bedford, NH 03110, USA
| | - Herman J Stoevelaar
- Centre for Decision Analysis & Support, Ismar Healthcare, Leopoldplein 39, 2500 Lier, Belgium.
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Single-source dual-energy computed tomography for the assessment of bone marrow oedema in vertebral compression fractures: a prospective diagnostic accuracy study. Eur Radiol 2018; 29:31-39. [DOI: 10.1007/s00330-018-5568-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/16/2018] [Accepted: 05/28/2018] [Indexed: 12/20/2022]
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Deib G, Johnson A, Unberath M, Yu K, Andress S, Qian L, Osgood G, Navab N, Hui F, Gailloud P. Image guided percutaneous spine procedures using an optical see-through head mounted display: proof of concept and rationale. J Neurointerv Surg 2018; 10:1187-1191. [PMID: 29848559 DOI: 10.1136/neurintsurg-2017-013649] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Optical see-through head mounted displays (OST-HMDs) offer a mixed reality (MixR) experience with unhindered procedural site visualization during procedures using high resolution radiographic imaging. This technical note describes our preliminary experience with percutaneous spine procedures utilizing OST-HMD as an alternative to traditional angiography suite monitors. METHODS MixR visualization was achieved using the Microsoft HoloLens system. Various spine procedures (vertebroplasty, kyphoplasty, and percutaneous discectomy) were performed on a lumbar spine phantom with commercially available devices. The HMD created a real time MixR environment by superimposing virtual posteroanterior and lateral views onto the interventionalist's field of view. The procedures were filmed from the operator's perspective. Videos were reviewed to assess whether key anatomic landmarks and materials were reliably visualized. Dosimetry and procedural times were recorded. The operator completed a questionnaire following each procedure, detailing benefits, limitations, and visualization mode preferences. RESULTS Percutaneous vertebroplasty, kyphoplasty, and discectomy procedures were successfully performed using OST-HMD image guidance on a lumbar spine phantom. Dosimetry and procedural time compared favorably with typical procedural times. Conventional and MixR visualization modes were equally effective in providing image guidance, with key anatomic landmarks and materials reliably visualized. CONCLUSION This preliminary study demonstrates the feasibility of utilizing OST-HMDs for image guidance in interventional spine procedures. This novel visualization approach may serve as a valuable adjunct tool during minimally invasive percutaneous spine treatment.
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Affiliation(s)
- Gerard Deib
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Alex Johnson
- Department of Orthopedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Mathias Unberath
- Computer Aided Medical Procedures, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Kevin Yu
- Computer Aided Medical Procedures, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Sebastian Andress
- Computer Aided Medical Procedures, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Long Qian
- Computer Aided Medical Procedures, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Gregory Osgood
- Department of Orthopedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Nassir Navab
- Computer Aided Medical Procedures, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Ferdinand Hui
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Philippe Gailloud
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Luthman S, Widén J, Borgström F. Appropriateness criteria for treatment of osteoporotic vertebral compression fractures. Osteoporos Int 2018; 29:793-804. [PMID: 29260290 DOI: 10.1007/s00198-017-4348-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 12/12/2017] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to review and summarise the literature on appropriateness criteria for treatment of osteoporotic vertebral compression fractures (OVCF), with appropriateness defined as a treatment where the expected benefits outweigh the expected harms, confirmed by available evidence and expert opinion. A comprehensive search of peer-reviewed publications (PubMed, EMBASE) and grey literature was performed. To be included for analysis, documents had to be a review article (e.g. clinical guideline or meta-analysis), focus on OVCF and make a statement on treatment appropriateness. Eleven publications fulfilled the eligibility criteria. Among the five publications that made recommendations about non-surgical management (NSM), there is agreement that conservative methods are appropriate in OVCF patients who have low level of pain, and that the majority of patients should be treated with conservative methods before other treatments are initiated. All publications made recommendations about vertebral augmentation procedures (VAP), i.e. vertebroplasty (VP) and/or balloon kyphoplasty (BKP). VAP are mostly considered appropriate in patients with high level of pain who do not respond to NSM. However, results cannot be generalised due to heterogeneity of treatment recommendations and patient selection. Although there is a consensus that NSM should be considered as the first-line treatment, there is more heterogeneity in treatment recommendations for VAP. This could most likely be explained by an insufficient clinical evidence base for VAP and heterogeneity of OVCF patients, leading to greater reliance on expert opinion affecting the quality of evidence in the primary sources.
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Affiliation(s)
- S Luthman
- Quantify Research, Hantverkargatan 8, SE-112 21, Stockholm, Sweden
| | - J Widén
- Quantify Research, Hantverkargatan 8, SE-112 21, Stockholm, Sweden.
| | - F Borgström
- Quantify Research, Hantverkargatan 8, SE-112 21, Stockholm, Sweden
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden
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Degnan AJ, Hemingway J, Hughes DR. Medicare Utilization of Vertebral Augmentation 2001 to 2014: Effects of Randomized Clinical Trials and Guidelines on Vertebroplasty and Kyphoplasty. J Am Coll Radiol 2018; 14:1001-1006. [PMID: 28778222 DOI: 10.1016/j.jacr.2017.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/19/2017] [Accepted: 04/19/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Vertebral fractures have a substantial impact on the health and quality of life of elderly individuals as one of the most common complications of osteoporosis. Vertebral augmentation procedures including vertebroplasty and kyphoplasty have been supported as means of reducing pain and mitigating disability associated with these fractures. However, use of vertebroplasty is debated, with negative randomized controlled trials published in 2009 and divergent clinical guidelines. The effect of changing evidence and guidelines on different practitioners' utilization of both kyphoplasty and vertebroplasty in the years after these developments and publication of data supporting their use is poorly understood. METHODS Using national aggregate Medicare claims data from 2002 through 2014, vertebroplasty and kyphoplasty procedures were identified by provider type. Changes in utilization by procedure type and provider were studied. RESULTS Total vertebroplasty billing increased 101.6% from 2001 (18,911) through 2008 (38,123). Total kyphoplasty billing frequency increased 17.2% from 2006 (54,329) through 2008 (63,684). Vertebroplasty billing decreased 60.9% from 2008 through 2014 to its lowest value (14,898). Kyphoplasty billing decreased 8.4% from 2008 (63,684) through 2010 (58,346), but then increased 7.6% from 2010 to 2013 (62,804). CONCLUSIONS Vertebroplasty billing decreased substantially beginning in 2009 and continued to decrease through 2014 despite publication of more favorable studies in 2010 to 2012, suggesting studies published in 2009 and AAOS guidelines in 2010 may have had a persistent negative effect. Kyphoplasty did not decrease as substantially and increased in more recent years, suggesting a clinical practice response to favorable studies published during this period.
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Affiliation(s)
- Andrew J Degnan
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | | | - Danny R Hughes
- Harvey L. Neiman Health Policy Institute, Reston, Virginia; Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
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30
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Parreira PCS, Maher CG, Megale RZ, March L, Ferreira ML. An overview of clinical guidelines for the management of vertebral compression fracture: a systematic review. Spine J 2017; 17:1932-1938. [PMID: 28739478 DOI: 10.1016/j.spinee.2017.07.174] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/07/2017] [Accepted: 07/17/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Vertebral compression fractures (VCFs) are the most common type of osteoporotic fracture comprising approximately 1.4 million cases worldwide. Clinical practice guidelines can be powerful tools for promoting evidence-based practice as they integrate research findings to support decision making. However, currently available clinical guidelines and recommendations, established by different medical societies, are sometimes contradictory. PURPOSE The aim of this study was to appraise the recommendations and the methodological quality of international clinical guidelines for the management of VCFs. STUDY DESIGN This is a systematic review of clinical guidelines for the management of VCF. METHODS Guidelines were selected by searching MEDLINE and PubMed, PEDro, CINAHL, and EMBASE electronic databases between 2010 and 2016. We also searched clinical practice guideline databases, including the National Guideline Clearinghouse and the Canadian Medical Association InfoBase. The methodological quality of the guidelines was assessed by two authors independently using the Appraisal of Guidelines, Research and Evaluation (AGREE) II Instrument. We also classified the strength of each recommendation as either strong (ie, based on high-quality studies with consistent findings for recommending for or against the intervention), weak (ie, based on a lack of compelling evidence resulting in uncertainty for benefit or potential harm), or expert consensus (ie, based on expert opinion of the working group rather than on scientific evidence). Guideline recommendations were grouped into diagnostic, conservative care, interventional care, and osteoporosis treatment and prevention of future fractures. Our study was prospectively registered on PROSPERO. RESULTS Four guidelines from three countries, published in the period 2010-2013, were included. In general, the quality was not satisfactory (50% or less of the maximum possible score). The domains scoring 50% or less of the maximum possible score were rigor of development, clarity of presentation, and applicability. The use of plain radiography or dual-energy X-ray absorptiometry for diagnosis was recommended in two of the four guidelines. Vertebroplasty or kyphoplasty was recommended in three of the four guidelines. The recommendation for bed rest, trunk orthoses, electrical stimulation, and supervised or unsupervised exercise was inconsistent across the included guidelines. CONCLUSIONS The comparison of clinical guidelines for the management of VCF showed that diagnostic and therapeutic recommendations were generally inconsistent. The evidence available to guideline developers was limited in quantity and quality. Greater efforts are needed to improve the quality of the majority of guidelines.
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Affiliation(s)
- Patrícia C S Parreira
- School of Public Health, Sydney Medical School, The University of Sydney, Level 10, King George V Building, Missenden Rd, Camperdown, NSW 2050, Australia.
| | - Chris G Maher
- School of Public Health, Sydney Medical School, The University of Sydney, Level 10, King George V Building, Missenden Rd, Camperdown, NSW 2050, Australia
| | - Rodrigo Z Megale
- Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, Level 7 Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Lyn March
- Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, Level 7 Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Manuela L Ferreira
- School of Public Health & Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, Level 7 Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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31
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Zhang Y, Shi L, Tang P, Zhang L. Comparison of the Efficacy Between Two Micro‐Operative Therapies of Old Patients With Osteoporotic Vertebral Compression Fracture: A Network Meta‐Analysis. J Cell Biochem 2017; 118:3205-3212. [DOI: 10.1002/jcb.25966] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/28/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Yilong Zhang
- Department of Orthopaedics, Chinese PLA General HospitalMedical School of Chinese PLABeijing 100853China
| | - Litao Shi
- Department of Orthopaedics, Chinese PLA General HospitalMedical School of Chinese PLABeijing 100853China
| | - Peifu Tang
- Department of Orthopaedics, Chinese PLA General HospitalMedical School of Chinese PLABeijing 100853China
| | - Lihai Zhang
- Department of Orthopaedics, Chinese PLA General HospitalMedical School of Chinese PLABeijing 100853China
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32
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Tomasian A, Wallace AN, Jennings JW. Benign Spine Lesions: Advances in Techniques for Minimally Invasive Percutaneous Treatment. AJNR Am J Neuroradiol 2017; 38:852-861. [PMID: 28183835 DOI: 10.3174/ajnr.a5084] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Minimally invasive percutaneous imaging-guided techniques have been shown to be safe and effective for the treatment of benign tumors of the spine. Techniques available include a variety of tumor ablation technologies, including radiofrequency ablation, cryoablation, microwave ablation, alcohol ablation, and laser photocoagulation. Vertebral augmentation may be performed after ablation as part of the same procedure for fracture stabilization or prevention. Typically, the treatment goal in benign spine lesions is definitive cure. Painful benign spine lesions commonly encountered in daily practice include osteoid osteoma, osteoblastoma, vertebral hemangioma, aneurysmal bone cyst, Paget disease, and subacute/chronic Schmorl node. This review discusses the most recent advancement and use of minimally invasive percutaneous therapeutic options for the management of benign spine lesions.
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Affiliation(s)
- A Tomasian
- From the Department of Radiology (A.T.), University of Southern California, Los Angeles, California
| | - A N Wallace
- Mallinckrodt Institute of Radiology (A.N.W., J.W.J.), St Louis, Missouri
| | - J W Jennings
- Mallinckrodt Institute of Radiology (A.N.W., J.W.J.), St Louis, Missouri
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Genev IK, Tobin MK, Zaidi SP, Khan SR, Amirouche FML, Mehta AI. Spinal Compression Fracture Management: A Review of Current Treatment Strategies and Possible Future Avenues. Global Spine J 2017; 7:71-82. [PMID: 28451512 PMCID: PMC5400164 DOI: 10.1055/s-0036-1583288] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/10/2016] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE Despite the numerous treatment options for vertebral compression fractures, a consensus opinion for the management of patients with these factures has not been established. This review is meant to provide an up-to-date overview of the most common treatment strategies for compression fractures and to suggest possible routes for the development of clearer treatment guidelines. METHODS A comprehensive database search of PubMed was performed. All results from the past 30 years were obtained and evaluated based on title and abstract. The full length of relevant studies was analyzed for level of evidence, and the strongest studies were used in this review. RESULTS The major treatment strategies for patients with compression fractures are conservative pain management and vertebral augmentation. Despite potential adverse effects, medical management, including nonsteroidal anti-inflammatory drugs, calcitonin, teriparatide, and bisphosphonates, remains the first-line therapy for patients. Evidence suggests that vertebral augmentation, especially some of the newer procedures, have the potential to dramatically reduce pain and improve quality of life. At this time, balloon-assisted kyphoplasty is the procedure with the most evidence of support. CONCLUSIONS Based on current literature, it is evident that there is a lack of standard of care for patients with vertebral compression fractures, which is either due to lack of evidence that a procedure is successful or due to serious adverse effects encountered with prolonged treatment. For a consensus to be reached, prospective clinical trials need to be formulated with potential new biomarkers to assess efficacy of treatment strategies.
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Affiliation(s)
- Ivo K. Genev
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, United Sates,Ivo Genev and Matthew Tobin equally contributed to this work
| | - Matthew K. Tobin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, United Sates,Ivo Genev and Matthew Tobin equally contributed to this work
| | - Saher P. Zaidi
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, United Sates
| | - Sajeel R. Khan
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, United Sates
| | - Farid M. L. Amirouche
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, Illinois, United Sates
| | - Ankit I. Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, United Sates,Address for correspondence Ankit I. Mehta, MD, Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, M/C 799, Chicago, IL 60612, United States (e-mail: )
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Richmond BJ. Vertebral Augmentation for Osteoporotic Compression Fractures. J Clin Densitom 2016; 19:89-96. [PMID: 26490134 DOI: 10.1016/j.jocd.2015.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/14/2015] [Indexed: 01/25/2023]
Abstract
Vertebral augmentation procedures such as vertebroplasty and kyphoplasty were developed to reduce pain and improve quality of life for patients with osteoporotic vertebral compression fractures. However, the use of vertebral augmentation has been debated and questioned since its inception. This article addresses some of these issues.
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Affiliation(s)
- Bradford J Richmond
- Department of Diagnostic Radiology, Section of Musculoskeletal Radiology, Cleveland Clinic, Cleveland, OH, USA.
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Guarnieri G, Izzo R, Muto M. Current trends in mini-invasive management of spine metastases. Interv Neuroradiol 2015; 21:263-72. [PMID: 25964441 DOI: 10.1177/1591019915582366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The spine is a frequent localization of primary tumours or metastasis involving posterior arch, pedicles and vertebra body, and often causing unsustainable pain. The management of spinal metastasis remains complex, including medical therapy (corticosteroids, chemotherapy), radiotherapy and surgical treatment, or the recent percutaneous mini-invasive approach. The target of all these treatments is to improve the quality of life of patients affected by this type of lesion. Diagnosis of spinal metastasis and then its treatment should be based on the combination of different elements: clinical evaluation, CT, MRI and nuclear medicine patterns, considering the age of the patient, known primary tumour, location of the lesions, single/multiple lesions, pattern of morphology (border, matrix, expansile character, soft tissue extension), density or signal intensity, oncologic instability and expectancy of life. The percutaneous mini-invasive approach for patients affected by secondary lesions involving the spine has as treatment goal of: (1) pain relief improving the quality of life; (2) stability treatment re-establishing the spinal biomechanics, alterated by bone destruction or deformity, preventing pathological fracture; and (3) an anti-neoplastic effect. The aim of this paper is to provide a comprehensive diagnostic and percutaneous approach to the bone metastatic spine lesions, identifying which metamer should be treated to improve patient quality of life, showing the importance of a multi-disciplinary approach to this problem.
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Affiliation(s)
| | - Roberto Izzo
- Neuroradiology Service, Cardarelli Hospital, Italy
| | - Mario Muto
- Neuroradiology Service, Cardarelli Hospital, Italy
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36
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Liang D, Ye LQ, Jiang XB, Yang P, Zhou GQ, Yao ZS, Zhang SC, Yang ZD. Biomechanical effects of cement distribution in the fractured area on osteoporotic vertebral compression fractures: a three-dimensional finite element analysis. J Surg Res 2015; 195:246-56. [PMID: 25634828 DOI: 10.1016/j.jss.2014.12.053] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 12/07/2014] [Accepted: 12/31/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND According to some clinical studies, insufficient cement distribution (ID) in the fractured area and asymmetrical cement distribution around the fractured area were thought to be the reasons for unrelieved pain and recollapse after percutaneous vertebral augmentation (PVA) in the treatment of symptomatic osteoporotic vertebral compression fractures. METHODS Finite element methods were used to investigate the biomechanical variance among three patterns of cement distribution (ID and sufficient cement distribution in the fractured area and asymmetrical cement distribution around the fractured area including upward [BU] and downward [BD] cement distribution). RESULTS Compared with fractured vertebra before PVA, distribution of von Mises stress in the cancellous bone was transferred to be concentrated at the cancellous bone surrounding cement after PVA, whereas it was not changed in the cortical bone. Compared with sufficient cement distribution group, maximum von Mises stress in the cancellous bone and cortical bone and maximum displacement of augmented vertebra increased significantly in the ID group, whereas asymmetrical cement distribution around the fractured area in BU and BD groups mainly increased maximum von Mises stress in the cancellous bone significantly. Similar results could be seen in all loading conditions. CONCLUSIONS ID in the fractured area may lead to unrelieved pain after PVA in the treatment of symptomatic osteoporotic vertebral compression fractures as maximum displacement of augmented vertebral body increased significantly. Both ID in the fractured area and asymmetrical cement distribution around the fractured area are more likely to induce recollapse of augmented vertebra because they increased maximum von Mises stress in the cancellous bone and cortical bone of augmented vertebra significantly.
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Affiliation(s)
- De Liang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Lin-Qiang Ye
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China; Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Xiao-Bing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China; Department of Digital Orthopaedics and Biomechanics, Laboratory Affiliated to National Key Discipline of Orthopaedics and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China.
| | - Pan Yang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China; Orthopaedics Hospital, Guangzhou General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong, People's Republic of China
| | - Guang-Quan Zhou
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China; Department of Digital Orthopaedics and Biomechanics, Laboratory Affiliated to National Key Discipline of Orthopaedics and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Zhen-Song Yao
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Shun-Cong Zhang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Zhi-Dong Yang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
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