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Luo Y, Yang DM, Yang HM, Wu D, Xie FY. Innovative minimally invasive implants for osteoporosis vertebral compression fractures. Front Med (Lausanne) 2023; 10:1161174. [PMID: 37020680 PMCID: PMC10067727 DOI: 10.3389/fmed.2023.1161174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/06/2023] [Indexed: 03/22/2023] Open
Abstract
With increasing population aging, osteoporosis vertebral compression fractures (OVCFs), resulting in severe back pain and functional impairment, have become progressively common. Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) as minimally invasive procedures have revolutionized OVCFs treatment. However, PVP- and PKP-related complications, such as symptomatic cement leakage and adjacent vertebral fractures, continue to plague physicians. Consequently, progressively more implants for OVCFs have been developed recently to overcome the shortcomings of traditional procedures. Therefore, we conducted a literature review on several new implants for OVCFs, including StaXx FX, Vertebral Body Stenting, Vesselplasty, Sky Bone Expander, Kiva, Spine Jack, Osseofix, Optimesh, Jack, and V-strut. Additionally, this review highlights the individualized applications of these implants for OVCFs. Nevertheless, current clinical studies on these innovative implants remain limited. Future prospective, randomized, and controlled studies are needed to elucidate the effectiveness and indications of these new implants for OVCFs.
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Advances in Vertebral Augmentation Systems for Osteoporotic Vertebral Compression Fractures. Pain Res Manag 2020; 2020:3947368. [PMID: 33376566 PMCID: PMC7738798 DOI: 10.1155/2020/3947368] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/15/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022]
Abstract
Osteoporotic vertebral compression fracture (OVCF) is a common cause of pain and disability and is steadily increasing due to the growth of the elderly population. To date, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are almost universally accepted as appropriate vertebral augmentation procedures for OVCFs. There are many advantages of vertebral augmentation, such as short surgical time, performance under local anaesthesia, and rapid pain relief. However, there are certain issues regarding the utilization of these vertebral augmentations, such as loss of vertebral height, cement leakage, and adjacent vertebral refracture. Hence, the treatment for OVCF has changed in recent years. Satisfactory clinical results have been obtained worldwide after application of the OsseoFix System, the SpineJack System, radiofrequency kyphoplasty of the vertebral body, and the Kiva VCF treatment system. The following review discusses the development of the current techniques used for vertebral augmentation.
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Innovative Spine Implants for Improved Augmentation and Stability in Neoplastic Vertebral Compression Fracture. ACTA ACUST UNITED AC 2019; 55:medicina55080426. [PMID: 31370309 PMCID: PMC6722751 DOI: 10.3390/medicina55080426] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/17/2019] [Accepted: 07/29/2019] [Indexed: 01/19/2023]
Abstract
Background and objectives: Tumor-related vertebral compression fractures often result in severe back pain as well as progressive neurologic impairment and additional morbidities. The fixation of these fractures is essential to obtain good pain relief and to improve the patients’ quality of life. Thus far, several spine implants have been developed and studied. The aims of this review were to describe the implants and the techniques proposed to treat cancer-related vertebral compression fractures and to compile their safety and efficacy results. Materials and Methods: A systematic MEDLINE/PubMed literature search was performed, time period included articles published between January 2000 and March 2019. Original articles were selected based on their clinical relevance. Results: Four studies of interest and other cited references were analyzed. These studies reported significant pain and function improvement as well as kyphotic angle and vertebral height restoration and maintain for every implant and technique investigated. Conclusions: Although good clinical performance is reported on these devices, the small numbers of studies and patients investigated draw the need for further larger evaluation before drawing a definitive treatment decision tree to guide physicians managing patients presenting with neoplastic vertebral compression fracture.
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Vanni D, Galzio R, Kazakova A, Pantalone A, Grillea G, Bartolo M, Salini V, Magliani V. Third-generation percutaneous vertebral augmentation systems. JOURNAL OF SPINE SURGERY 2016; 2:13-20. [PMID: 27683690 DOI: 10.21037/jss.2016.02.01] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Currently, there is no general consensus about the management of osteoporotic vertebral fractures (OVF). In the past, conservative treatment for at least one month was deemed appropriate for the majority of vertebral fractures. When pain persisted after conservative treatment, it was necessary to consider surgical interventions including: vertebroplasty for vertebral fractures with less than 30% loss of height of the affected vertebral body and kyphoplasty for vertebral fractures with greater than 30% loss of height. Currently, this type of treatment is not feasible. Herein we review the characteristics and methods of operation of three of the most common percutaneous vertebral augmentation systems (PVAS) for the treatment of OVF: Vertebral Body Stenting(®) (VBS), OsseoFix(®) and Spine Jack(®). VBS is a titanium device accompanied by a hydraulic (as opposed to mechanical) working system which allows a partial and not immediate possibility to control the opening of the device. On the other hand, OsseoFix(®) and Spine Jack(®) are accompanied by a mechanical working system which allows a progressive and controlled reduction of the vertebral fracture. Another important aspect to consider is the vertebral body height recovery. OsseoFix(®) has an indirect mechanism of action: the compaction of the trabecular bone causes an increase in the vertebral body height. Unlike the Vertebral Body Stenting(®) and Spine Jack(®), the OsseoFix(®) has no direct lift mechanism. Therefore, for these characteristics and for the force that this device is able to provide. In our opinion, Spine Jack(®) is the only device also suitable for the treatment OVF, traumatic fracture (recent, old or inveterate) and primary or secondary bone tumors.
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Affiliation(s)
- Daniele Vanni
- Orthopaedic and Traumatology Department, "G. D'Annunzio" University, Chieti, Italy
| | - Renato Galzio
- Neurosurgery Department, "L'Aquila" University, L'Aquila, Italy
| | - Anna Kazakova
- Neurotraumatology and Vertebro-Medullary Surgery, "Renzetti Hospital", Lanciano, Italy
| | - Andrea Pantalone
- Orthopaedic and Traumatology Department, "G. D'Annunzio" University, Chieti, Italy
| | - Giovanni Grillea
- Diagnostic and Therapeutic Neuroradiology Unit, IRCCS INM Neuromed, Pozzilli, Isernia, Italy
| | - Marcello Bartolo
- Diagnostic and Therapeutic Neuroradiology Unit, IRCCS INM Neuromed, Pozzilli, Isernia, Italy
| | - Vincenzo Salini
- Orthopaedic and Traumatology Department, "G. D'Annunzio" University, Chieti, Italy
| | - Vincenzo Magliani
- Neurotraumatology and Vertebro-Medullary Surgery, "Renzetti Hospital", Lanciano, Italy
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Hui TCH, Tan GZL, Tan AKW, Pua U. The use of cone beam CT in achieving unipedicular spinal augmentation. Br J Radiol 2016; 89:20160030. [PMID: 27376703 DOI: 10.1259/bjr.20160030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the feasibility of cone beam CT (CBCT) in achieving unipedicular access during spinal cement augmentation. METHODS A retrospective review of all patients who underwent CBCT-guided unipedicular spinal augmentation procedures between 1 January 2012 and 15 June 2015 was performed. 59 patients (43 females 16 males; mean-age, 74.0 years; range, 52-90 years) underwent unipedicular spinal augmentation in 78 vertebral levels (T5-T9, n = 14; T10-L2, n = 42; L3-L5, n = 22). Degree of cross-over in contralateral hemivertebral body, complications and 30-day mortality were recorded. RESULTS 97% (76/78) of procedures were technically successful. Two procedures failed owing to vertebral sclerosis. For vertebroplasty, all cases (6/6) demonstrated cross-over filling of cement and 50% (3/6) showed cement cross-over >50% of contralateral half of the vertebral body. For kyphoplasty, 13 out of 15 procedures demonstrated balloon and cement cross-over >50% of contralateral half of the vertebral body. Two kyphoplasty procedures required the second pedicle after midline cross-over of cement failed. Of the kyphoplasty procedures that were successfully performed with the unipedicular approach, 76.9% (10/13) showed cement cross-over >50% of contralateral half of the vertebral body. For stentoplasty, all cases (55/55) showed midline stent-cement complex cross-over and 78.2% (43/55) exhibited stent-cement complex cross-over >50% of contralateral half of the vertebral body. There was no major complication or mortality. Minor complications included asymptomatic cement extravasation (6.4%, n = 5) and self-limiting haematoma (1.3%, n = 1). CONCLUSION Unipedicular access for spinal augmentation procedures is achieved at a high success rate with the use of CBCT. ADVANCES IN KNOWLEDGE This article describes the novel use of CBCT to achieve unipedicular spinal augmentation. Unipedicular spinal augmentation has the potential to reduce risk, duration, radiation and cost while achieving similar results.
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Affiliation(s)
| | - Gideon Z L Tan
- 2 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alvin K W Tan
- 2 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Uei Pua
- 1 Department of Radiology, Tan Tock Seng Hospital, Singapore
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Marcia S, Saba L, Marras M, Suri JS, Calabria E, Masala S. Percutaneous stabilization of lumbar spine: a literature review and new options in treating spine pain. Br J Radiol 2016; 89:20150436. [PMID: 27351691 DOI: 10.1259/bjr.20150436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Vertebral fracture (VF) is a common condition with >160,000 patients affected every year in North America and most of them with affected lumbar vertebrae. The management of VF is well known and defined by many protocols related to associated clinical neurological symptoms, especially in case of the presence or absence of myelopathy or radicular deficit. In this article, we will explore the percutaneous stabilization of the lumbar spine by showing the newest approaches for this condition.
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Affiliation(s)
- Stefano Marcia
- 1 Department of Radiology, SS Trinità Hospital, Cagliari, Italy
| | - Luca Saba
- 2 Department of Radiology, Azienda Ospedaliero, Universitaria (AOU) di Cagliari-Polo di Monserrato, Cagliari, Italy
| | | | - Jasjit S Suri
- 4 Diagnostic and Monitoring Division, AtheroPoint™ LLC, Roseville, CA, USA.,5 Department of Biomedical Engineering, University of Idaho (Affiliated), ID, USA
| | - Eros Calabria
- 6 Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome Tor Vergata, Rome, Italy
| | - Salvatore Masala
- 6 Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, University of Rome Tor Vergata, Rome, Italy
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Ender SA, Eschler A, Ender M, Merk HR, Kayser R. Fracture care using percutaneously applied titanium mesh cages (OsseoFix®) for unstable osteoporotic thoracolumbar burst fractures is able to reduce cement-associated complications--results after 12 months. J Orthop Surg Res 2015; 10:175. [PMID: 26568074 PMCID: PMC4644291 DOI: 10.1186/s13018-015-0322-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/08/2015] [Indexed: 01/07/2023] Open
Abstract
Background Despite the known demographic shift with expected doubled rate of vertebral body fractures by the year 2050, a standardized treatment concept for traumatic and osteoporotic incomplete burst fracture of the truncal spine does not exist. This study aims to determine whether minimally invasive fracture care for incomplete osteoporotic thoracolumbar burst fractures using intravertebral expandable titanium mesh cages is a suitable procedure and may provide improved safety in terms of cement-associated complications in comparison to kyphoplasty procedure. Methods In 2011/2012, 15 patients (10 women, 5 men; mean age 77) with 15 incomplete osteoporotic thoracolumbar burst fractures (T10 to L4) were stabilized using intravertebral expandable titanium mesh cages (OsseoFix®) as part of a prospective study. X-ray, MRI and bone density measurements (DXA) were performed preinterventionally. The clinical and radiological results were evaluated preoperatively, postoperatively and after 12 months according to the visual analogue scale (VAS), the Oswestry Disability Index (ODI), X-ray (Beck Index, Cobb angle) and CT analyses. Wilcoxon rank sum test, sign test and Fischer’s exact test were used for statistical evaluation. Results A significant reduction in pain intensity (VAS) from preoperative 8.0 to 1.6 after 12 months and significant improvement in activity level (ODI) from preoperative 79.0 to 30.5 % after 12 months were revealed. Radiologically, the mean kyphotic angle according to Cobb showed significant improvements from preoperative 9.1° to 8.0° after 12 months. A vertebral body subsidence was revealed in only one case (6.7 %). No changes in the position of the posterior wall were revealed. No cement leakage or perioperative complications were seen. Conclusion As a safe and effective procedure, the use of intravertebral expandable titanium mesh cages presents a valuable alternative to usual intravertebral stabilization procedures for incomplete osteoporotic burst fractures and bears the potential to reduce cement-associated complications. Trial registration German Clinical Trials Register (DKRS) DRKS00008833.
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Affiliation(s)
- Stephan Albrecht Ender
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch Straße, 17475, Greifswald, Germany.
| | - Anica Eschler
- Department of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, 18057, Rostock, Germany.
| | - Michaela Ender
- Department of Diagnostic Radiology and Neuroradiologie, University Medicine Greifswald, Ferdinand-Sauerbruch Straße, 17475, Greifswald, Germany.
| | - Harry Rudolf Merk
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch Straße, 17475, Greifswald, Germany.
| | - Ralph Kayser
- Department of Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch Straße, 17475, Greifswald, Germany. .,Department of Orthopaedics, Trauma and Reconstructive Surgery, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
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