Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral body compression fractures: clinical and radiological outcomes

A nomogram for predicting fracture of the sandwich vertebrae after percutaneous vertebral augmentation: a multicenter study with 1-year follow-up

PURPOSE

This work aimed to investigate the risk factors for fractures in sandwich vertebrae (SDV; an unfractured vertebra located between 2 cemented vertebrae) formed after percutaneous vertebral augmentation (PVA) and to construct a predictive model from this.

METHODS

This study retrospectively analyzed patients who underwent PVA with the formation of SDV from July 2018 to July 2023 at Affiliated Banan Hospital of Chongqing Medical University. Patients were divided into a fracture group and a control group according to the presence or absence of fracture of the SDV during the 1-year postoperative follow-up period. Independent predictors were confirmed using the least absolute shrinkage and selection operator (LASSO) method, and the nomogram was constructed and transformed into an online calculator. The discrimination, calibration, and clinical applicability of the model were assessed by Area under the receiver operating characteristic curve (AUC), calibration curve analysis, and Decision curve analysis (DCA). Finally, the model was externally validated using data from another centre and internally validated using Bootstrap.

RESULTS

A total of 259 patients were enrolled in this study, and 36 patients had fractures of SDV within one year. Multifactorial analyses showed that low bone mineral density (BMD) (OR = 4.264, 95% CI: 2.245-8.098, P < 0.001), number of PVA > 3 (OR = 3.703, 95% CI: 1.399-9.801, P = 0.008), lack of anti-osteoporosis (OR = 4.051, 95% CI: 1.573-10.430, P = 0.004), postoperative kyphosis angle of sandwich fracture segments (PKASFS) > 10° (OR = 8.273, 95% CI: 2.991-22.881, P < 0.001), and lumbar lordosis minus thoracic kyphosis (LL-TK) < 0° (OR = 3.701, 95% CI: 1.523-8.994, P = 0.004) were screened as independent risk factors. The AUC of the model constructed based on this was 0.881 (95% CI: 0.829-0.933). The calibration curves and DCA verified that the model had satisfactory practical consistency and clinical applicability. The externally validated AUC was 0.859 (95% CI: 0.788-0.930), validating the stability of the model.

CONCLUSIONS

BMD, number of PVA, anti-osteoporosis, PKASFS, and LL-TK are independent influencing factors for fractures in SDV within one year, and a model based on this had excellent predictive efficacy.

Prediction models for adjacent vertebral fractures after vertebral augmentation: a systematic review and meta-analysis

OBJECTIVE

To systematically review published studies on risk prediction models for adjacent vertebral fractures (AVF) after vertebral augmentation (VA), thereby providing a reference for constructing and improving such models.

METHODS

PubMed, Web of Science, The Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database, and SinoMed were searched from their inception to July 13, 2024. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was used to assess the risk of bias and applicability of the prediction model studies; STATA 15.0 software was used to perform a meta-analysis on the area under the curve (AUC) values of the model validation and the common predictors used in model construction.

RESULTS

A total of 13 studies were included, establishing 13 risk prediction models, with a total sample size of 3,083 patients. The AUC values of the included models ranged from 0.72 to 0.988. Of the included studies, 11 conducted internal validation, while two performed external validation. According to the PROBAST evaluation, all 13 studies exhibited a high risk of bias, yet demonstrated good applicability. The results of meta-analysis showed that the combined AUC value for the 5 validation models was 0.86 (95% CI: 0.76, 0.97). Notably, bone cement leakage (OR = 5.75, 95% CI: 3.43 ~ 9.60), age (OR = 1.20, 95% CI: 1.05 ~ 1.36), and a history of vertebral fractures (OR = 2.60, 95% CI: 1.64 ~ 4.13) were identified as significant high-risk factors for AVF after VA.

CONCLUSION

The risk prediction models for AVF after VA performed well, but exhibited a high risk of bias. It is recommended that future studies should consider selecting more appropriate machine learning algorithms and conducting large-sample, multicenter studies. Meanwhile, healthcare providers should focus on patients with bone cement leakage, advanced age, and a previous history of vertebral fractures, remaining vigilant for the potential occurrence of AVF.

Re-evaluating vertebral height restoration assessment in osteoporotic compression fractures: a systematic review and meta-analysis

PURPOSE

Vertebral compression fractures (VCFs) are common among the elderly, causing significant morbidity, pain, and disability. This study quantitatively analyzes the vertebral height restoration via Kyphoplasty (KP) and Vertebroplasty (VP), along with the cement volume used and leakage percentage. Our meta-analysis of 14 randomized controlled trials (RCTs) compares these objective outcomes, considering cement volume and leakage in both procedures.

METHODS

Databases searched included Medline, PubMed, and Web of Science using MeSH keywords: 'Kyphoplasty,' 'Vertebroplasty,' 'Vertebral height restoration,' 'Bone cement volume,' and 'Vertebral compression fractures.' Fourteen RCTs were selected, focusing on outcomes such as anterior and central vertebral body height, kyphotic angle, cement volume, and leakage. Data analysis included mean values, standard deviations, ranges, Cohen's d-effect sizes, and standard errors, summarized in a forest plotQuery.

RESULTS

The review included 1456 patients (mean age 71.11 years). Follow-up ranged from 1 to 48 months (mean 15 months). KP showed a greater effect size in restoring anterior and central vertebral body height and kyphotic angle. Combined data from KP and VP showed increases of 3.48 mm (19.14%) in anterior vertebral heights, 4.38 mm in central vertebral heights, and a 2.85-degree correction in kyphotic angle.

CONCLUSIONS

Both KP and VP effectively restore vertebral height in VCF patients. KP is superior in restoring anterior and central vertebral body height and correcting kyphotic angle. VP, particularly unilateral, shows higher central vertebral height restoration but higher cement leakage. Standardized reporting and patient-specific volumetric assessments are crucial for optimizing vertebral augmentation procedures.

Percutaneous vertebroplasty by two-step fluoroscopy: a treatment for osteoporotic compression fractures of thoracic vertebrae in older adults

OBJECTIVE

This study aimed to evaluate the clinical efficacy of percutaneous vertebroplasty (PVP) performed with a two-step fluoroscopy technique for treating thoracic osteoporotic vertebral compression fractures (OVCFs) in older patients.

METHODS

A retrospective analysis was conducted on clinical and imaging data from 48 patients diagnosed with thoracic OVCFs, who underwent treatment with percutaneous vertebroplasty(PVP) utilizing a two-step fluoroscopy technique at Yangquan First People's Hospital between January 2019 and January 2022. The study assessed the clinical efficacy of this procedure by analyzing Visual Analog Scale(VAS) scores, Cobb angle values, and vertebral height measurements before surgery and at 2 days, 3 months, 6 months, and 12 months postoperatively.

RESULTS

Before treatment, the mean VAS score of patients was 7.5 ± 0.6. Subsequently, at 2 days, 3 months, 6 months, and 12 months after the procedure, these mean scores decreased to 2.3 ± 0.6, 2.2 ± 0.5, 2.2 ± 0.4, and 2.0 ± 0.3, respectively. This decline was statistically significant (P < 0.05) compared to the preoperative VAS score. The preoperative Cobb angle was 12.1° ± 0.9°, and the Cobb angle values at the corresponding time points were 12.2° ± 0.8°, 12.3° ± 1.1°, 12.3° ± 1.0°, and 12.2° ± 0.9°. Initially, the mean height of the vertebral body in these patients was 17.38 ± 1.56 mm. Postoperatively, at 2 days, 3 months, 6 months, and 12 months, these values were 19.30 ± 1.81 mm, 19. 12 ± 1.60 mm, 19.00 ± 1.45 mm, and 19.00 ± 1.20 mm, respectively. No significant difference was observed between postoperative and preoperative Cobb angle and vertebral height (P > 0.05).

CONCLUSION

Percutaneous vertebroplasty using a two-step fluoroscopy method not only has the therapeutic effect of traditional surgical methods, reducing pain from thoracic vertebral compression fractures in the elderly and enhancing their quality of life and mobility, but also streamlines the intraoperative fluoroscopy procedure. This method stand as an effective approach for managing osteoporotic compression fractures of the thoracic vertebrae in elderly.

Application of Low-Temperature Ice Saline Bone Cement in Percutaneous Vertebroplasty

OBJECTIVE

Percutaneous vertebroplasty uses the traditional method of bone cement filler to inject bone cement, which solidifies easily. We have established a new method to delay the solidification of bone cement (low-temperature ice saline bone cement) and compared the advantages of the new method and the traditional method of injecting bone cement.

METHODS

Eighty-two patients with osteoporotic vertebral compression fracture were divided into 2 groups by a retrospective study method: 40 patients in group A were treated with the traditional method and 42 patients in group B were treated with the new method. The leakage rate of bone cement, postoperative visual analog scale score, amount of bone cement in each vertebral body, operation time of bone cement, and number of bone cement fillers used were compared between the 2 groups.

RESULTS

There was no significant difference in the bone cement leakage rate, postoperative visual analog scale score, the amount of bone cement in each vertebral body, and the number of bone cement fillers used between the 2 groups; the operation time of bone cement in the 2 groups was statistically significant, and the operation time in group B was significantly longer than that in group A.

CONCLUSIONS

Low-temperature ice saline water bone cement has significant advantages in multiple vertebral fractures, a relatively large amount of bone cement injected into each vertebral body, and a long operation time, which is more suitable for beginners.

Percutaneous Mesh-Container-Plasty versus Percutaneous Kyphoplasty in the Treatment of Osteoporotic Compression Fractures with Up-Endplate Injury: A Retrospective Study

BACKGROUND

Percutaneous mesh-container-plasty (PMCP), a modified traditional percutaneous kyphoplasty (PKP) technique, is increasingly being used to treat osteoporotic vertebral compression fractures with up-endplate injury. This retrospective study aimed to compare the clinical and radiological results of PKP and PMCP for the treatment of this disease.

METHODS

We retrospectively analyzed the medical records of patients with osteoporotic compression fractures and upper endplate injuries treated at our hospital between January 2019 and December 2021. A total of 192 patients who met the inclusion and exclusion criteria were enrolled. Of these, 103 underwent PKP and 89 underwent PMCP. Key outcome measures included surgical safety, clinical efficacy, and radiological results.

RESULTS

Both the PKP and PMCP groups showed significant improvements in visual analog scale and Oswestry Disability Index scores postoperatively. Additionally, anterior vertebral body height ratio and Cobb's angle improved in both groups, though no statistically significant difference was observed between them. The hospital stay duration was similar between the 2 cohorts. Notably, the PMCP group required a larger volume of bone cement injection yet exhibited a significantly lower incidence of cement leakage and adjacent vertebral fractures (9/89 and 2/89, respectively) compared to the PKP group (24/103 and 11/103, respectively) (P < 0.05). Moreover, the PMCP group had shorter operation times (34.64 ± 9.88 minutes) and reduced fluoroscopy frequency (35.43 ± 5.46 instances) compared to the PKP group (27.23 ± 8.54 minutes and 23.87 ± 5.59 instances, respectively) (P < 0.05).

CONCLUSIONS

PMCP provided superior clinical outcomes for the management of osteoporotic compression fractures with upper endplate injuries. It was associated with reduced operation and fluoroscopy times, as well as lower risks of adjacent vertebral fractures and cement leakage, compared to PKP.

Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture

Purpose

To investigate the risk factors associated with progressive kyphosis (PK) after percutaneous kyphoplasty (PKP) in osteoporotic vertebral compression fractures (OVCFs).

Methods

A single-center retrospective study (January 2020 to December 2022) analyzed 129 OVCF patients treated with PKP. Patients were divided into a PK group and a non-progressive kyphosis group. Clinical and radiological data were compared, and univariate and multivariate regression analyses identified independent risk factors for PK. A nomogram was then developed to predict the risk factors for PK after PKP.

Results

Of 129 patients, 47 (36.4%) experienced PK after PKP. Multivariate analysis identified independent risk factors for PK as preoperative kyphosis angle (OR = 1.26, P = 0.008), Type D magnetic resonance image (MRI) signal change on T2-weighted images (T2WI) (OR = 18.49, P = 0.003), black line signal (OR = 44.00, P < 0.001), intervertebral disc endplate complex (IDEC) injury (OR = 7.86, P = 0.021), and postoperative Oswestry Disability Index (ODI) score (OR = 1.18, P = 0.004). The nomogram, based on these factors, demonstrated strong discriminative performance (area under the curve = 0.953) and good calibration.

Conclusions

Preoperative kyphosis angle, Type D MRI signal change on T2WI, black line signal, IDEC injury, and higher postoperative ODI score are independent risk factors for PK after PKP. A nomogram based on these factors accurately predicts PK risk.

Clinical efficacy and biomechanical analysis of a novel hollow pedicle screw combined with kyphoplasty for the treatment of Kümmell disease

Background

Vertebral augmentation is the preferred treatment for Kümmell disease (KD), but there exists a risk of cement displacement resulting in severe back pain and exacerbation of kyphosis. The study aimed to investigate the efficacy and safety of a novel hollow pedicle screw combined with kyphoplasty (HPS-KP) for treating KD, effectively preventing postoperative bone cement displacement.

Methods

The prospective study included 50 KD patients with no neurological deficit detected during clinical and radiological evaluation who underwent HPS-KP (n = 25) and PKP (n = 25) surgeries. The visual analogue scale (VAS) score, Oswestry dysfunction index (ODI), anterior vertebral height (AVH), wedge-shape affected vertebral Cobb angle (WCA), bisegmental Cobb angle (BCA), and complications were evaluated and compared in both groups. Besides, a finite element (FE) model of T11-L2 was constructed. The stress distributions, maximum von Mises stresses of vertebrae and bone cement, and maximum displacement of bone cement were compared and analyzed.

Results

The VAS and ODI scores at 3 days, 3 and 6 months, and 1 year after surgery significantly improved in both groups (p < 0.05). The AVH, BCA, and WCA significantly improved initially after the surgery in both groups (p < 0.05). The displacement of M2 was larger than other models, especially in flexion, right bending, and left and right rotation, while that of M6 was the lowest under all conditions.

Conclusion

HPS-KP was a safe and effective treatment for KD, effectively relieving pain, restoring vertebral height, and correcting local kyphosis, and it had better biomechanical stability and safety than ordinary single PKP and PKP combined with pediculoplasty in avoiding cement loosening and displacement.

Pulmonary embolism and intracardiac foreign bodies caused by bone cement leakage: a case report and literature review

Percutaneous vertebroplasty (PVP) is a surgical procedure that involves injecting polymethylmethacrylate (PMMA) bone cement into the diseased vertebrae to rapidly relieve pain and strengthen the vertebrae. We reported a 73-year-old patient who underwent percutaneous vertebroplasty (PVP) surgery for thoracolumbar vertebral compression fracture. After the surgery, the patient experienced symptoms such as chest tightness and dyspnea. Further examination revealed multiple high-density foreign bodies in the blood vessels/heart and concomitant multi-organ dysfunction. It was considered that the multi-organ embolism was caused by bone cement leakage. The patient improved after undergoing surgical treatment and anticoagulant therapy.

Stem Cell and Regenerative Therapies for the Treatment of Osteoporotic Vertebral Compression Fractures

Osteoporotic vertebral compression fractures (OVCFs) significantly increase morbidity and mortality, presenting a formidable challenge in healthcare. Traditional interventions such as vertebroplasty and kyphoplasty, despite their widespread use, are limited in addressing the secondary effects of vertebral fractures in adjacent areas and do not facilitate bone regeneration. This review paper explores the emerging domain of regenerative therapies, spotlighting stem cell therapy's transformative potential in OVCF treatment. It thoroughly describes the therapeutic possibilities and mechanisms of action of mesenchymal stem cells against OVCFs, relying on recent clinical trials and preclinical studies for efficacy assessment. Our findings reveal that stem cell therapy, particularly in combination with scaffolding materials, holds substantial promise for bone regeneration, spinal stability improvement, and pain mitigation. This integration of stem cell-based methods with conventional treatments may herald a new era in OVCF management, potentially improving patient outcomes. This review advocates for accelerated research and collaborative efforts to translate laboratory breakthroughs into clinical practice, emphasizing the revolutionary impact of regenerative therapies on OVCF management. In summary, this paper positions stem cell therapy at the forefront of innovation for OVCF treatment, stressing the importance of ongoing research and cross-disciplinary collaboration to unlock its full clinical potential.

Biomechanical study of different bone cement distribution on osteoporotic vertebral compression Fracture-A finite element analysis

Purpose

This study aimed to compare the biomechanical effects of different bone cement distribution methods on osteoporotic vertebral compression fractures (OVCF).

Patients and methods

Raw CT data from a healthy male volunteer was used to create a finite element model of the T12-L2 vertebra using finite element software. A compression fracture was simulated in the L1 vertebra, and two forms of bone cement dispersion (integration group, IG, and separation group, SG) were also simulated. Six types of loading (flexion, extension, left/right bending, and left/right rotation) were applied to the models, and the stress distribution in the vertebra and intervertebral discs was observed. Additionally, the maximum displacement of the L1 vertebra was evaluated.

Results

Bone cement injection significantly reduced stress following L1 vertebral fractures. In the L1 vertebral body, the maximum stress of SG was lower than that of IG during flexion, left/right bending, and left/right rotation. In the T12 vertebral body, compared with IG, the maximum stress of SG decreased during flexion and right rotation. In the L2 vertebral body, the maximum stress of SG was the lowest under all loading conditions. In the T12-L1 intervertebral disc, compared with IG, the maximum stress of SG decreased during flexion, extension, and left/right bending and was basically the same during left/right rotation. However, in the L1-L2 intervertebral discs, the maximum stress of SG increased during left/right rotation compared with that of IG. Furthermore, the maximum displacement of SG was smaller than that of IG in the L1 vertebral bodies under all loading conditions.

Conclusions

SG can reduce the maximum stress in the vertebra and intervertebral discs, offering better biomechanical performance and improved stability than IG.