Review of Percutaneous Kyphoplasty in China

Percutaneous kyphoplasty in the treatment of Kümmell disease in lumbar scoliosis: A case report

BACKGROUND

Due to mechanical imbalance in the spine, elderly scoliosis patients tend to develop vertebral fracture nonunion, i.e., Kümmell disease, when osteoporotic vertebral compression fractures occur. However, accompanying vertebral rotational deformities make surgical procedures challenging risky. Such patients are usually compelled to undergo conservative treatment and there are very few reports on minimally invasive surgeries for them. We first-time report a patient with Kümmell disease and lumbar scoliosis treated with percutaneous kyphoplasty (PKP) under O-arm guidance.

CASE SUMMARY

An 89-year-old female was admitted to the hospital due to delayed low back pain after a fall. She was diagnosed with Kümmell disease based on physical and radiologic examinations. The patient experienced severe scoliosis and subsequently underwent O-arm-guided kyphoplasty, resulting in a significant alleviation of low back pain.

CONCLUSION

PKP has good efficacy in treating Kümmell disease. However, surgical risks are elevated in scoliosis patients with Kümmell disease due to the abnormal anatomical structure of the spine. O-arm assisted operations play a crucial role in decreasing surgical risks.

Effects of robot-assisted percutaneous kyphoplasty on osteoporotic vertebral compression fractures: a systematic review and meta-analysis

This study systemically reviewed the effects of robot-assisted percutaneous kyphoplasty (R-PKP) on the clinical outcomes and complications of patients with osteoporotic vertebral compression fracture (OVCF). The articles published from the establishment of the database to 19 April 2024 were searched in PubMed, The Cochrane Library, Web of Science, Embase, Scopus, China National Knowledge Infrastructure (CNKI), and Chinese biomedical literature service system (SinoMed). Meta-analysis was employed to evaluate the status of pain relief and complications between the control and R-PKP groups. Standardized mean difference (SMD) or mean difference (MD), risk ratios (RR), and 95% confidence interval (CI) were selected for analysis, and a common or random effect model was adopted to merge the data. Eight studies involving 773 patients with OCVFs were included. R-PKP could effectively Cobb's angles (MD = -1.00, 95% CI -1.68 to -0.33, P = 0.0034), and decrease the occurrence of cement leakage (RR = 0.36, 95% CI 0.21 to 0.60, P < 0.0001). However, there was no significant effect on the results of visual analog scale (MD = -0.09, 95% CI -0.20 to 0.02, P = 0.1145), fluoroscopic frequency (SMD = 5.31, 95% CI -7.24 to 17.86, P = 0.4072), and operation time (MD = -0.72, 95% CI -7.47 to 6.03, P = 0.8342). R-PKP could significantly correct vertebral angle and reduce cement leakage. Thus, R-PKP maybe an effective choice for correction vertebral Angle and reducing postoperative complications, while its impact on relieving pain, decreasing fluoroscopic frequency, and shortening operation time need further exploration.

Percutaneous kyphoplasty through unilateral puncture on the convex side for the treatment of painful osteoporotic vertebral compression fracture with scoliosis

PURPOSE

To assess the clinical safety, accuracy, and efficacy of percutaneous kyphoplasty (PKP) surgery using an enhanced method of unilateral puncture on the convex side for the treatment of painful osteoporotic vertebral compression fractures (P-OVCF) with scoliosis.

METHODS

Clinical and radiographic data of P-OVCF patients with scoliosis who underwent PKP via unilateral puncture on the convex side from January 2018 to December 2021 were retrospectively analyzed. This technique's detailed surgical steps and tips were described. The local kyphosis angle (LKA), scoliosis Cobb angle (SCA), and local scoliosis Cobb angle (LSCA) were measured using X-ray and compared at pre-operation, post-operation, and the last follow-up. The width of pedicle (POW), inner inclination angle (IIA), lateral distance (LD), and puncture course length (PCL) were measured on the axial computed tomography image and compared between two sides. Postoperative computed tomography was employed to evaluate the condition of cement distribution and puncture. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back pain (BP).

RESULTS

Thirty-six patients, 23 women and 13 men, with an average age of 76.31 ± 6.28 years were monitored for 17.69 ± 4.70 months. The median surgical duration of single vertebrae was 35 min. The volume of bone cement for single vertebrae was 3.81 ± 0.87 ml and the proportion of sufficient cement distribution of the patients was 97.22. LKA was considerably improved from pre-operation to post-operation and sustained at the last follow-up. SCA and LSCA were not significantly modified between these three-time points. IIA, PCL, and LD were lower on the convex side than on the concave side. POW was considerably wider on the convex side. The ODI and VAS-BP scores were significantly improved after surgery and sustained during the follow-up.

CONCLUSIONS

Combining with the proper assessment of the pre-injured life status of patients, PKP surgery using unilateral puncture on the convex side for the treatment of P-OVCF with scoliosis can achieve safe, excellent clinical, and radiographic outcomes.

Percutaneous kyphoplasty with or without posterior pedicle screw fixation for the management of severe osteoporotic vertebral compression fractures with nonunion

OBJECTIVE

To assess the radiographic outcomes, clinical outcomes and complications of percutaneous kyphoplasty (PKP) with and without posterior pedicle screw fixation (PPSF) in the treatment of severe osteoporotic vertebral compression fractures (sOVCF) with nonunion.

METHODS

This study involved 51 patients with sOVCF with nonunion who underwent PKP or PPSF + KP. The operation time, intraoperative blood loss, volume of injected bone cement, operation costs and hospital stays were all recorded. In addition, the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were assessed separately for each patient before and after surgery.

RESULTS

Compared with the PPSF + KP group, the PKP group had shorter operation time, less intraoperative blood loss, shorter hospital stays and fewer operation costs. However, cobb's angle improvement (13.4 ± 4.3° vs. 21.4 ± 5.3°), VWR improvement ratio (30.4 ± 11.5% vs. 52.8 ± 12.7%), HA (34.9 ± 9.0% vs. 63.7 ± 7.6%) and HM (28.4 ± 11.2% vs. 49.6 ± 7.7%) improvement ratio were all higher in PPSF + KP group than that in PKP group. In addition, the ODI index and VAS score in both groups were significantly decreased at the postoperative and final follow-up. PKP group's postoperative VAS score was significantly lower than that in PPSF + KP group, but there was no statistically significant difference in VAS score at the last follow-up.

CONCLUSION

PKP and PPSF + KP can both effectively relieve the pain associated with sOVCF with nonunion. PPSF + KP can achieve more satisfactory vertebral reduction effects compared to PKP. However, PKP was less invasive and it has more advantages in shortening operation time and hospital stay, as well as decreasing intraoperative blood loss and operation costs.

Effects of Percutaneous Kyphoplasty for the Treatment of Thoracic Osteoporotic Vertebral Compression Fractures with or without Intravertebral Cleft in Elderly Patients

Background

Few studies have focused on percutaneous kyphoplasty (PKP) in the treatment of thoracic osteoporotic vertebral compression fractures (OVCFs) with intervertebral cleft (IVC). Hence, the objective of this retrospective study was to compare the clinical and radiographic outcomes of PKP in elderly patients with thoracic OVCFs, with or without IVC.

Methods

A total of 106 patients were enrolled in this study and divided into two groups: the IVC group and the NIVC group (without IVC). Radiographic measures included anterior vertebral height (AVH), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Clinical function measures included Oswestry disability index (ODI) and visual analog scale (VAS) scores.

Results

There were no significant differences in the preoperative basic data between the groups classified as IVC and NIVC. However, both groups showed significant improvements in AVH and TK throughout the follow-up periods compared to the preoperative measurements (P<0.05). The recovery of AVH in the IVC group was found to be inferior to that in the NIVC group at 3 years after operation (P<0.05). There were no significant differences in LL, PI, PT and SS in both groups compared with the preoperative results and no statistically significant differences between the two groups at the same follow-up time (P>0.05). The VAS and ODI scores during all follow-up periods were significantly lower than those before operation (P<0.05). At 3 years after operation, the VAS and ODI scores of the IVC group were higher than those of the NIVC group (P<0.05).

Conclusion

PKP is an adoptable measure to treat thoracic OVCFs with or without IVC. Our study revealed that the NIVC group was superior to the IVC group in terms of improved vertebral height and pain recovery at long-term follow-up (3 years).

Prediction model of adjacent vertebral compression fractures after percutaneous kyphoplasty: a retrospective study

OBJECTIVES

The purpose of this study was to develop a prediction model to assess the risk of adjacent vertebral compression fractures (AVCFs) after percutaneous kyphoplasty (PKP) surgery.

DESIGN

A retrospective chart review.

SETTING AND PARTICIPANTS

Patients were collected from the Quzhou People's Hospital, from March 2017 to May 2019. Patients were included if they suffered from osteoporotic vertebral compression fractures (OVCFs), underwent PKP surgery and were followed up for 2 years.

INTERVENTIONS

None.

METHODS

This was a retrospective cohort study of all PKP surgery procedures of the thoracic, lumbar and thoracolumbar (TL) spine that have been performed for OVCF from 1 March 2017 up to 1 May 2019. The least absolute shrinkage and selection operator (LASSO) regression model was used to optimise feature selection for the AVCF risk model. Multivariable logistic regression analysis was applied to build a predicting model incorporating the feature selected in the LASSO regression model. The C-index, calibration plot and decision curve analysis were applied to assess this model.

RESULTS

Gender, age, the number of surgical vertebrae, cement volume, bone mineral density, diabetes, hypertension, bone cement leakage, duration of anti-osteoporosis treatment after surgery and TL junction were identified as predictors. The model displayed good discrimination with a C-index of 0.886 (95% CI 0.828-0.944) and good calibration. High C-index value of 0.833 could still be reached in the interval validation. Decision curve analysis showed that the AVCF nomogram was clinically useful when intervention was decided at the AVCF possibility threshold of 1%.

CONCLUSIONS

This study developed a clinical prediction model to identify the risk factors for AVCF after PKP surgery, and this tool is of great value in sharing surgical decision-making among patients consulted before surgery.

TRIAL REGISTRATION NUMBER

researchregistry7716.

Effects of robot-assisted minimally invasive surgery on osteoporotic vertebral compression fracture: a systematic review, meta-analysis, and meta-regression of retrospective study

OBJECTIVE

To conduct a systematic review on the effect of robot-assisted minimally invasive surgery (R-MIS) on the clinical outcomes and complications of patients with osteoporotic vertebral compression fractures (OVCFs).

METHODS

The researchers searched the papers published on PubMed, The Cochrane Library, Web of Science, Embase, Scopus, Ovid MEDLINE, Wiley Online Library, China National Knowledge Infrastructure (CNKI), Chinese biomedical literature service system (SinoMed), and China Medical Association Data. The standardized mean difference (SMD) or mean difference (MD), relative risk (RR), and 95% confidence interval (CI) were calculated. Besides, the data was merged through the random-effect model or common-effect model. A meta-regression mixed-effects single-factor model was utilized to analyze the sources of heterogeneity.

RESULTS

Twelve studies were included, involving 1042 OVCFs cases. The prognosis of patients treated with R-MIS was significantly improved, such as Oswestry disability index (ODI) score (MD = -0.65, P = 0.0171), Cobb's angles (MD = -1.03, P = 0.0027), X-ray fluoroscopy frequency (SMD = -2.41, P < 0.0001), Length of hospital stay (MD = -0.33, P = 0.0002), and Cement leakage (RR = 0.37, P < 0.0001). However, no obvious improvement was found in the results of Visual analog scale (VAS) score (MD = -0.16, P = 0.1555), Volume of bone cement (MD = 0.22, P = 0.8339), and Operation time (MD = -3.20, P = 0.3411) after being treated by R-MIS. The meta-regression analysis demonstrated that R-MIS presented no significant impact on the covariates of VAS and Operation time.

CONCLUSION

R-MIS can significantly reduce the patients' ODI, Cobb's angles, X-ray fluoroscopy frequency, and Cement leakage ratio, and shorten the Length of hospital stay. Therefore, R-MIS may be an effective method to promote the patients' functional recovery, correct spinal deformity, reduce the X-ray fluoroscopy frequency, shorten the Length of hospital stay, and reduce the complications of OVCFs bone Cement leakage.

Early cement augmentation may be a good treatment option for pain relief for osteoporotic compression fractures: a systematic review and meta-analysis

PURPOSE

The incidence of osteoporotic compression fractures (VCFs) have been rising over the past decades. Presently, vertebral cement augmentation procedures such as balloon kyphoplasty and vertebroplasty are common treatments allowing pain relief and functional recovery. However, there is controversy on whether different timeframes for cement augmentation affects clinical outcomes. Hence, this study aimed to compare pain relief and complication rates between early versus late cement augmentation.

METHODS

A comprehensive systematic review of PubMed, EMBASE, Scopus and Cochrane Library was conducted, identifying studies that compared early versus late cement augmentation for VCFs. As the definitions of "early" and "late" phases across studies are heterogenous, we established the cut-off between early and late phase as intervals to accommodate as many studies as possible for analysis. We conducted two separate analyses with different cut-off intervals and included studies that reported interventions within these respective time intervals. In analysis 1, we included studies which grouped patients into "early" and "late" group based on a cut-off time frame of 2-4 weeks. On the other hand, in analysis 2, we included studies which grouped patients into "early" and "late" groups based on a cut-off time frame of 6-8 weeks. Meta-analysis was conducted via random-effect models, comparing outcomes of interest between early and late groups.

RESULTS

Eleven studies were included. The total cohort size was 712 and 775 patients in analysis 1 and 2 respectively. Mean follow-up was 12.9 ± 3.7 months and 11 ± 0.6 months respectively. VAS change at final follow-up was significantly greater in the early group for both analyses. (MD = - 0.66, p = 0.01; and MD = - 1.18, p < 0.005 respectively). There was no significant difference in post-operative absolute VAS score, number of cement leakage, number of adjacent compression fractures and local kyphotic angle, for both analyses. Patients in both groups experienced reductions in VAS score that exceeded the minimum clinically important difference.

CONCLUSION

Both early and late timeframes for cement augmentation offered significant improvement in pain relief, with similar post-operative absolute pain score, kyphotic angle, cement leakage and adjacent vertebral fractures. Early surgery may offer substantial pain relief in patients presenting with pain as early as < 2-4 weeks of VCFs.

Systematic Retrospective Analysis of Risk Factors and Preventive Measures of Bone Cement Leakage in Percutaneous Kyphoplasty

OBJECTIVE

In this study, we aimed to analyze the risk factors of bone cement leakage in percutaneous kyphoplasty (PKP) treatment of osteoporotic vertebral compression fractures (OVCFs), and provide suggestions for reducing bone cement leakage.

METHODS

A retrospective study of 517 cases of OVCFs treated with PKP were divided into 2 groups according to whether they had bone cement leakage or not, leakage group (n = 72) and non-leakage group (n = 445). The risk factors of leakage were systematically analyzed using clinical baseline data, imaging observation data, and surgery-related factors. To select the statistically significant results (P < 0.05) among the risk factors mentioned above, we used the binary logistic regression method to identify the main risk factors.

RESULTS

The univariate analysis of clinical baseline data，imaging observation data, and surgery-related factors showed that bone mineral density (BMD) (P < 0.001), hypertension (P < 0.05), injury factors (P < 0.01), cortical defect (P < 0.001), grade of vertebral compression (P < 0.001), surgical approach (P < 0.05), stage of bone cement injection (P < 0.01), and balloon pressure (P < 0.05) were the risk factors for bone cement leakage. The recovery rate of vertebral height, and the Cobb angle correction rate were lower in the bone cement leakage group (P < 0.001). The correction effect of kyphosis after operation was limited. Binary logistic analysis results showed that BMD (odds ratio [OR] 5.605), cortical defect (OR 3.115), and stage of bone cement injection (OR 2.385) were bone cement leakage-independent risk factors.

CONCLUSIONS

Impairment of BMD value, defects of cortical bone, and inappropriate stage of bone cement injection will increase the risk of bone cement leakage in PKP treatment and limit PKP effects.

Comparison of three techniques in the surgical management of metastatic vertebral fracture with posterior wall damage: a retrospective study

BACKGROUND

To retrospectively compare the safety and efficacy of percutaneous kyphoplasty (PKP), internal fixation (IF), and kyphoplasty combined with internal fixation (KP + IF) in treating metastatic vertebral fracture (MVF) with posterior wall damage.

METHODS

87 patients with MVF with posterior wall damage underwent surgery. In Group PKP, 36 patients underwent PKP; in Group IF, 20 patients underwent pedicle screw fixation; and in Group KP + IF, 31 patients underwent kyphoplasty combined with pedicle screw fixation. Operative time, intraoperative blood loss, clinical and radiological results, and complication rate in each group were evaluated and compared.

RESULTS

Significant improvement on the VAS, ODI scores, vertebral height and local kyphotic angle (LKA) was noted in each group (P < 0.001). Group PKP and Group KP + IF achieved better pain relief than Group IF (P < 0.05). At postoperative 3 days, Group PKP had better pain relief than Group KP + IF (P < 0.05). At other follow-up time points, there were no differences between Group PKP and KP + IF (P > 0.05). Group KP + IF and Group IF were more efficacious than Group PKP in terms of height restoration and LKA correction (P < 0.05). Group KP + IF had a higher incidence of postoperative complications than Group PKP and Group IF(P < 0.05).

CONCLUSIONS

PKP was safe and effective in treating MVF with posterior wall damage. It can achieve similar clinical outcomes compared to KP + IF, but associated with less operative time, less blood loss and fewer complications. IF alone should not be the first treatment option for its poorer analgesic effect.

Robot-assisted percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a retrospective matched-cohort study

PURPOSE

This study aims to introduce the principle, clinical efficacy, and learning curve of robot-assisted percutaneous vertebroplasty (PVP).

METHODS

Forty-two patients who underwent robot-assisted single-level PVP were analyzed retrospectively and 42 age-matched patients using freehand technique were selected as the control group. The visual analog scale, operation time, radiation exposure, accuracy, and learning curve were analyzed.

RESULTS

The puncture time and total operation time were significantly shorter, and the puncture and total fluoroscopy number were fewer in the robot group. The deviation between pre-operative planned and actual puncture trajectory well met clinical requirement. The puncture time, total operation time, and puncture fluoroscopy number were significantly more in early cases than in later cases in the robot group.

CONCLUSION

The robot-assisted pedicle puncture technique shortens the operation time and reduces radiation exposure, and the accuracy meets the clinical requirement in PVP. The learning curve is short and not steep.

Comparison of Efficacy of Percutaneous Vertebroplasty versus Percutaneous Kyphoplasty in the Treatment of Osteoporotic Vertebral Asymmetric Compression Fracture

BACKGROUND

This study aims to compare the clinical efficacy of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral asymmetric compression fracture (OVACF).

METHODS

This study retrospectively reviewed the patients who were diagnosed with OVACF between September 2015 and July 2019. Forty-one patients received PVP surgery (group A), and 44 patients received PKP surgery (group B). The visual analog scale, Oswestry Disability Index, scoliosis angle (SA), height of long side, height of short side (HS), and lateral height difference (LHD) before operation and 3 days and 1 year after operation were compared between both groups. The operation time, fluoroscopic time, hospital stay, cement volume, and complications were also compared between both groups.

RESULTS

The visual analog scale and Oswestry Disability Index differed significantly between the groups 1 year after operation (P < 0.05). Compared with the preoperative results, there were significant differences in SA, height of long side, HS, and LHD 3 days and 1 year after operation (P < 0.05). Compared with group A, group B showed significantly better in SA, HS, and LHD in group B 3 days and 1 year after operation (P < 0.05). More patients in group A suffered cement leakage and scoliosis than group B after operation (P < 0.05).

CONCLUSIONS

In our study, PVP and PKP are both effective in the treatment of OVACF, but PKP surgery had better long-term clinical efficacy.

Analysis of medical malpractice litigation following vertebral augmentation therapy in China from 2008 to 2018

The first case of vertebral augmentation therapy in mainland China was reported in 2000. Since then, it has been widely used in China as a minimally invasive procedure to treat vertebral compression fractures. However, the characteristics of malpractice litigation involving vertebral augmentation therapy remains unclear. This study aims to analyze the characteristics of medical malpractice litigation involving vertebral augmentation therapy in mainland China for the past 10 years. Two online legal databases were queried for court verdicts involving vertebral augmentation therapy from Jan 2009 to Dec 2018 in mainland China. Each case file was then thoroughly reviewed and data pertaining to defendants, plaintiffs, case outcomes, allegations, and verdicts were abstracted, and descriptive analyses were performed. Level of evidence: LEVEL III. A total of 96 cases were enrolled for final analysis. The number of claims increased by five times during the past 10 years. More than two thirds (67.7%, n = 65) of the cases underwent percutaneous vertebroplasty, and 22.9% (n = 22) underwent percutaneous kyphoplasty, the rest (9.4%, n = 9) remained undefined. Paralysis was alleged in 35.4% of cases (n = 34), followed by significant physical injury (34.4%, n = 33). Cement leakage to spinal canal (44.8%, n = 43) is the most commonly cited reason for litigation, followed by incomplete informed consent (42.7%, n = 41), accidental dural puncture (20.8%, n = 20), unsatisfactory clinical outcome (18.8%, n = 18), and misdiagnosis (12.5%, n = 12). Acute pulmonary cement embolism (4.2%, n = 4), wrong-level vertebrae procedure (3.1%, n = 3) and postoperative infection (2.1%, n = 2) were less common causes for concern. Doctors successfully defended themselves only in 8 (8.3%) cases, which resulted in no indemnity payment. The rest 88 (91.7%) cases were closed with a mean verdict payout of 361,580 Yuan (51,654 US dollars). There is a quickly rising trend in the number of medical malpractice litigation involving vertebral augmentation therapy in China. Identifying the most common reasons for litigation and summarizing their characteristics may help decrease litigation rate and improve the patient experience.

A modified trajectory of kyphoplasty via superior pedicle notch for osteoporotic vertebral compression fractures: Technique note and clinical result

Background

Percutaneous extra-pedicular kyphoplasty can achieve better clinical results than transpedicular kyphoplasty. However, lumbar segment artery injury as a disaster complication limits its clinical application.

Objective

To describe and evaluate a modified trajectory of kyphoplasty for the treatment of osteoporotic vertebral compression fractures (OVCF).

Methods

Eighty-one patients who underwent percutaneous kyphoplasty (PKP) for lumbar OVCF at our hospital between May 2017 and May 2021 were enrolled. The patients were divided into an observation group (via the superior pedicle approach) and a control group (via the transpedicular approach) according to the surgical trajectory. The surgical procedure was described in detail, and the imaging parameters were recorded. Preoperative and postoperative clinical data were collected for statistical analysis.

Results

PKP via the superior pedicle notch approach could offer large abduction and cranial inclination angles without serious complications. The rate of paravertebral leakage was significantly lower in the observation group than in the control group. Surgery with a superior pedicle notch approach had a shorter operative time and fewer fluoroscopies.

Conclusions

PKP via the superior pedicle notch approach is a modified extra-pedicular approach for lumbar osteoporotic vertebral compression fractures. This trajectory is an easy-to-use target position because it enters the vertebral body directly. A shorter operative time and lower radiation exposure can enhance recovery after surgery.

Percutaneous Kyphoplasty in Patients with Severe Osteoporotic Vertebral Compression Fracture with and without Intravertebral Cleft: A Retrospective Comparative Study

Purpose

To comparatively analyze the clinical and radiographic outcomes of percutaneous kyphoplasty (PKP) in patients with severe osteoporotic vertebral compression fracture (sOVCF) with or without intravertebral cleft (IVC).

Methods

We enrolled a total of 75 patients with sOVCF receiving PKP between January 2016 and December 2018. The patients were divided into the following two groups based on their radiographic findings: with IVC (IVC group) and without IVC (NIVC group). The following radiographic outcomes were determined: anterior vertebral height (AVH), kyphotic angle (KA), lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI), and pelvic tilt (PT). The clinical functional assessment included Oswestry disability index (ODI) and visual analog scale (VAS) scores.

Results

No significant difference was found between the demographic data of the two groups (P > 0.05). AVH, KA, and LL in both groups were significantly corrected one month after surgery (P < 0.05). There was statistical difference between the two groups in AVH and KA one year and three years after surgery, and in LL and PT three years after surgery (P < 0.05). Compared with the results one month after surgery, AVH, KA, and LL of the IVC group deteriorated significantly one year and three years after surgery, whereas AVH, KA, and LL of the NIVC group deteriorated significantly three years after surgery (P < 0.05). The VAS and ODI scores in both groups decreased significantly one month, one year, and three years after surgery than preoperative results (P < 0.05), and a statistical difference was observed between the two groups three years after surgery (P < 0.05).

Conclusion

PKP can give satisfactory outcomes for the treatment of sOVCF with or without IVC. However, the NIVC group showed better clinical outcomes and could maintain spinal sagittal balance better than the IVC group during long-term follow-up.

Robot-Assisted Kyphoplasty Improves Clinical and Radiological Features Better Than Fluoroscopy-Assisted Kyphoplasty in the Treatment of Vertebral Compression Fractures: A Meta-Analysis

Purpose

This meta-analysis aimed to determine whether patients treated with robot-assisted kyphoplasty for vertebral compression fractures have superior clinical and radiographic improvement than those treated with fluoroscopy.

Methods

A comprehensive search of the PubMed, Embase, Cochrane Library, Science Direct, and CNKI (China National Knowledge Infrastructure) databases was conducted to find randomized control trials (RCTs) or observational cohort studies that compared robotic-assisted kyphoplasty (RA-kyphoplasty) with fluoroscopy-assisted kyphoplasty (FA-kyphoplasty) in treating vertebral compression fractures. Preoperative, postoperative, and final follow-up data on vertebral height (VH), vertebral kyphosis angle (VKA), visual analog scale (VAS) for back pain, and cement leakage rate were collected from eligible studies for meta-analysis. Patients were divided into RA and FA groups depending on whether the operation was robotically or fluoroscopically guided.

Results

We included 6 cohort studies with 491 patients and 633 vertebrae. The results of the meta-analysis showed that the RA group had a higher VH than the FA group at both postoperation (p < 0.001) and final follow-up (p < 0.001); the VKA in the RA group was lower than that in the FA group at postoperation (p < 0.001) and final follow-up (p < 0.001); the back pain VAS score was lower in the RA group than in the FA group at postoperation (p = 0.01) and final follow-up (p = 0.03); and the cement leakage rate in the RA group was lower than those in the FA group (p < 0.001).

Conclusion

This meta-analysis demonstrated that RA-kyphoplasty outperformed FA-kyphoplasty in vertebral height restoration, kyphosis angle correction, VAS score reduction for back pain, and lower cement leakage rate in the treatment of vertebral compression fractures.

Robot-Assisted Versus Fluoroscopy-Assisted Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture: A Retrospective Study

STUDY DESIGN

A retrospective study.

OBJECTIVES

To compare the clinical and radiological outcomes of robot assisted (RA) and fluoroscopy assisted (FA) percutaneous kyphoplasty (PKP) in treating single/double segment osteoporotic vertebral compression fracture (OVCF).

METHODS

Patients with single/double segment OVCF receiving either RA or FA PKP were evaluated retrospectively at our spine center from April 2018 to October 2019. The operation time, fluoroscopy frequency, fluoroscopy exposure time, total radiation dose, visual analogue scale (VAS), local kyphosis angle (LKA), height of fractured vertebra (HFV) and complications were compared between the single/double RA group and the FA group.

RESULTS

A total of 96 cases were included in this study, with 59 cases of single segment OVCF and 37 cases of double segment OVCF. For single/double segment OVCF, both RA and FA PKP could relieve pain and reduce fracture. The RA group showed lower fluoroscopy frequency, shorter fluoroscopy exposure time during operation for surgeons, better correction in LKA and HFV, lower rate of cement leakage, but more fluoroscopy frequency, fluoroscopy exposure time and radiation dose for patients compared with the FA group (P < 0.05), while the single RA group showed longer operation time compared with the FA group (P < 0.05).

CONCLUSIONS

For single/double segment OVCF, RA has more advantages in correcting vertebra fracture, reducing intraoperative radiation exposure for surgeons, and reducing the cement leakage rate, but it increases intraoperative radiation for patients compared with FA PKP. And FA has shorter operation time in treating single segment OVCF than RA PKP.

Comparison of Percutaneous Kyphoplasty With or Without Posterior Pedicle Screw Fixation on Spinal Sagittal Balance in Elderly Patients With Severe Osteoporotic Vertebral Compression Fracture: A Retrospective Study

Objective

To compare the effects of percutaneous kyphoplasty (PKP) with or without posterior pedicle screw fixation (PPSF) on spinal sagittal balance in elderly patients with severe osteoporotic vertebral compression fracture (sOVCF).

Methods

From January 2016 to December 2018, 102 elderly patients with single-level thoracolumbar sOVCF were enrolled. Among them, 78 cases underwent PKP (Group A), and 24 cases underwent PPSF+KP (Group B). Clinical evaluation included perioperative parameters, Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back pain; Radiographic evaluation included anterior vertebral height (AVH) and rate (AVHr), local kyphotic angle (LKA), and spino-pelvic sagittal balance parameters.

Results

Perioperative parameters including operation time, blood loss, fluoroscopic time and hospital stay in Group A were less than those in Group B (p &lt; 0.05). Compared with the pre-operative results, the ODI and VAS scores of both groups decreased significantly in the three follow-ups after surgery (p &lt; 0.05). The post-operative ODI and VAS scores of Group A were significantly better than those of Group B, but the results were opposite at the final follow-up (p &lt; 0.05). Compared with the pre-operative values, except that there was no significant difference in pelvic incidence (PI) (p &gt; 0.05), other radiographic parameters of both groups were improved significantly in the three follow-ups after surgery (p &lt; 0.05). The AVH, AVHr, LKA and lumbar lordosis (LL) in Group B were better than those in Group A in the three follow-ups after surgery (p &lt; 0.05). At the final follow-up, the sacral slope (SS) and pelvic tilt (PT) differed significantly between the two groups (p &lt; 0.05).

Conclusions

Both PPSF+KP and PKP can achieve favorable clinical outcomes and maintain the spinal sagittal balance. Compared with PPSF+KP, PKP showed more significant advantages in the early post-operative period. However, in the long-term follow-up, PPSF+KP showed better clinical outcomes and may be better than PKP in maintaining spinal sagittal balance.

Effect of Different Anesthesia and Puncture Methods of Percutaneous Kyphoplasty on More Than 90-Year-Old Osteoporotic Vertebral Fracture: Advantages of the ERAS Concept

BACKGROUND

Percutaneous kyphoplasty (PKP) is an effective minimally invasive technique for the treatment of osteoporotic vertebral fracture (OVF) in recent years. This study focuses on the analysis of PKP surgery and anesthesia in osteoporotic vertebral facture patients over 90 years old with the concept of "enhanced recovery after surgery."

METHODS

This study reviewed 239 patients who were diagnosed with OVF retrospectively between October 2015 and June 2019. According to the method of anesthesia, these patients were divided into Group A (n = 125) and Group B (n = 114). According to the pedicle puncture approach, these patients were divided into Group C (n = 102) and Group D (n = 137). The anterior vertebral height (AVH) and local kyphosis angle (LKA) were used to evaluate the degree of vertebral damage and restoration. The visual analogue scale (VAS) and the Oswestry Disability Index (ODI) scores were used for assessing functional outcomes. Some parameters were used to assess the perioperative conditions such as operation time, amount of bone cement perfusion, intraoperative fluoroscopy times, anesthesia recovery time, time out of the bed, hospital stay, hospitalization cost, and complications.

RESULTS

The visual analogue scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), and local kyphosis angle (LKA) 1 day, 1 year after surgery, and at the last follow-up all showed significant improvement (P < 0.05) in comparison with those before surgery both in Groups A and B and Groups C and D. The ODI 1 day after surgery was significantly better in Group B than Group A (P < 0.05). Compared with Group B, Group A required longer time of anesthesia, operation time, anesthesia recovery time, time to get out of bed, and length of hospital stay and more hospitalization costs (P < 0.05). Group D required longer operation time, longer time to get out of bed, more bone cement volume, fluoroscopy time, and more operation hospitalization costs compared with Group C (P < 0.05).

CONCLUSION

We recommend unilateral puncture under local anesthesia for OVF in the patients aged over 90 from the perspective of rapid recovery.

Comparison of the effectiveness and safety of unilateral and bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures: A protocol for systematic review and meta-analysis

BACKGROUND

The objective of this study was to compare the efficacy of lateral and bilateral percutaneous vertebroplasty (PVP) in treating osteoporotic vertebral compression fractures (OVCFs).

METHODS

A comprehensive literature search was performed using PubMed, Cochrane Library, EMBASE, CMB, CNKI, Wanfang, and VIP databases between January 2014 and December 2020. The clinical efficacy of the 2 approaches was evaluated by comparing perioperative outcomes (operation time, X-ray exposure time, volume of injected cement), clinical outcomes (degree of vertebral height restoration, improvement of Cobb angle, visual analogue scale score, and Oswestry Disability Index scores), and operation-related complications (rate of cement leakage, adjacent vertebral fracture rate, and nerve root stimulation). Data were analyzed using RevMan 5.3.3 and Stata 15.1.

RESULTS

A total of 237 related articles were retrieved, and 17 randomized controlled trials were included. Meta-analysis results showed that compared to bilateral PVP, unilateral PVP led to decreased operation times (mean difference [MD] = -15.24, 95% confidence interval [CI]: [-17.77, -12.70], P < .05), decreased X-ray exposure time (MD-8.94, 95% CI[-12.08,-5.80]; P < .01), decreased volumes of injected cement (MD-1.57, 95% CI[-2.00,-1.14]; P < .05), and lower incidence of cement leakage (risk ratio [RR] = 0.6,95% CL[0.48,0.77], P < .01). Patients that underwent unilateral PVP experienced more effective pain relief at the last follow-up (MD-0.09, 95% CI [-0.15,-0.03];P=.006 < .05) and had a low degree of vertebral height restoration (MD-0.38, 95% CL [-0.71, -0.06]; P=.02 < .05). However, no differences in adjacent vertebral fractures (RR 1.19, 95% CI [0.78,1.82]; P = .41 > .01), nerve root stimulation (RR 1.98, 95% CI [0.22, 17.90]; P = .54 > .01), improvement of Cobb angle (MD = -0.18, 95% CI [-0.49, 0.13], P = .26 > .01), and improvement of ODI score (MD = 0.22, 95% CI[-0.37, 0.80], P > .05) were found between the 2 approaches.

CONCLUSIONS

Although both unilateral and bilateral PVP can improve the quality of life of this patient population by managing pain effectively, unilateral PVP offers more benefits, including shorter operation time and less fluoroscopy, and should be recommended in clinical practice for OVCFs.

Analysis of risk factors related to the re-fracture of adjacent vertebral body after PKP

BACKGROUND

This study aims to investigate the risk factors of vertebral re-fracture after percutaneous kyphoplasty (PKP) for osteoporosis vertebral compression fracture (OVCF), and to provide reference for clinical prevention.

MATERIAL AND METHODS

A retrospective analysis was performed on 228 OVCF patients admitted on November 6, 2013, solstice, December 14, 2018, which met the inclusion criteria. There were 35 males and 193 females, with a male-to-female ratio of 3:20, and an age of 61-89 years. All patients were treated with PKP surgery with complete clinical data, and the rate of re-fracture was calculated according to whether re-fracture occurred after surgery, divided into the re-fracture group (24 cases) and the non-refracture group (204 cases). May be associated with subsequent fracture factors (gender, age, number of surgical segment vertebral body, whether with degenerative scoliosis, whether to fight osteoporosis) into a single-factor research, then the single-factor analysis was statistically significant risk factors for multiple logistic regression analysis, further defined after PKP holds the vertebral body fracture independent risk factors. Survival analysis was performed using the time of vertebral re-fracture after PKP as the end time of follow-up, the occurrence of re-fracture after PKP as the endpoint event, and the presence or absence of degenerative lateral curvature as a variable factor.

RESULTS

All 228 vertebroplasty patients were followed up for a period of 1.8 to 63.6 months. The mean follow-up time was (28.8 ± 15.6) months, and the re-fracture rate was 10.5%. There were statistically significant differences between the re-fracture group and the non-refracture group in age, number of operative vertebral bodies, whether there was a combination of degenerative scoliosis and whether there was anti-osteoporosis treatment (P < 0.05). The results of univariate logistic regression analysis after excluding the mutual influence of various factors showed that the number of vertebral bodies and the group with lateral curvature might be the risk factors for PKP re-fracture after surgery. The above possible risk factors were included in multiple logistic regression analysis to show whether there were independent risk factors for scoliosis and vertebral re-fracture. Survival analysis showed that the mean survival time was 42.1 months, the P value was 0.00, and the mean 95% confidence interval was (34.4-49.7 months), indicating that the combination of degenerative lateral bending might be related to the occurrence of re-fracture.

CONCLUSIONS

Combined scoliosis is an independent risk factor for re-fracture after OVCF laminoplasty and a possible risk factor for re-fracture after surgery.

Clinical and Radiologic Outcomes of Robot-Assisted Kyphoplasty versus Fluoroscopy-Assisted Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: A Retrospective Comparative Study

BACKGROUND

Making surgery as less aggressive as possible is best for elderly patients with osteoporotic vertebral compression fractures (OVCFs). Recently, we attempted a more precise, minimally invasive, and robot-assisted kyphoplasty in our clinical setting.

OBJECTIVE

We sought to compare the clinical and radiologic outcomes of robot-assisted percutaneous kyphoplasty (rPKP) with those of fluoroscopy-assisted percutaneous kyphoplasty (fPKP) in treating OVCFs.

METHODS

We retrospectively reviewed the clinical and radiologic data of patients with single-segment OVCF who received either rPKP or fPKP between January 2020 and December 2020 at our institution. The operation time, injected volume of cement, length of hospital stays, visual analog scale for back pain, Oswestry Disability Index, local kyphosis angle (LKA), height of fractured vertebra (HFV), and perioperative complications were compared between the 2 groups.

RESULTS

A total of 212 cases were included in this study, among whom 81 cases received rPKP and 131 cases received fPKP. Both techniques exhibited satisfying improvement in pain relief and radiologic outcomes. Specifically, the rPKP costed less operation time and achieved better correction and maintenance regarding LKA, HFV, and instant pain relief (P < 0.05). The length of hospital stays, incidence of cement leakage, visual analog scale for back pain, and Oswestry Disability Index at final follow-up were comparable between 2 groups.

CONCLUSIONS

rPKP provides a precise puncture and exhibits superiority in the correction and maintenance of LKA and HFV when compared with traditional fPKP. The cost-effectiveness and specific application scenarios of this technique shall be confirmed via further extensive studies.

[Effectiveness of robot assisted percutaneous kyphoplasty for treatment of single/double-segment osteoporotic vertebral compression fractures]

Objective

To compare the effectiveness of robot assisted and C-arm assisted percutaneous kyphoplasty (PKP) in the treatment of single/double-segment osteoporotic vertebral compression fracture (OVCF).

Methods

The clinical data of 108 cases of single/double-segment OVCF who met the selection criteria between May 2018 and October 2019 were retrospectively analyzed. There were 65 cases of single-segment fractures, of which 38 cases underwent "TiRobot" orthopedic robot-assisted PKP (robot group), 27 cases underwent C-arm X-ray machine fluoroscopy-assisted PKP (C-arm group). There were 43 cases of double-segment fractures, including 21 cases in robot group and 22 cases in C-arm group. There was no significant difference in gender, age, T value of bone mineral density, fracture segment distribution, time from injury to operation, and preoperative visual analogue scale (VAS) score, vertebral kyphosis angle (VKA), and height of fractured vertebra (HFV) in the patients with single/double-segments fractures between robot group and C-arm group ( P>0.05). The operation time, the fluoroscopy frequency of the surgeons and the patient, the fluoroscopy exposure time of the surgeons and the patient, the radiation dose of the C-arm; the VAS scores, VKA, HFV before operation, at 1 day and 6 months after operation; and the complications in the two groups were recorded and compared.

Results

All patients underwent surgery successfully. The operation time of the single-segment robot group was significantly longer than that of the C-arm group ( t=5.514, P=0.000), while the operation time of the double-segment robot group was not significantly different from that of the C-arm group ( t=1.892, P=0.205). The single/double-segment robot group required three-dimensional scanning, so the fluoroscopy frequency, fluoroscopy exposure time, and radiation dose of C-arm received by the patient were significantly higher than those of the C-arm group ( P<0.05); the fluoroscopy frequency and the fluoroscopy exposure time received by the surgeons were significantly less than those of the C-arm group ( P<0.05). There was no infection, embolism, neurological injury, and adjacent segmental fractures. The single/double-segment robot group showed lower rate of cement leakage when compared with the C-arm group ( P<0.05), all the cases of cement leakage happened outside the spinal canal. The VAS score, VKA, and HFV of the single/double-segment robot group and the C-arm group were significantly improved at 1 day and 6 months after operation ( P<0.05), and the VAS score at 6 months after operation was further improved compared with that at 1 day after operation ( P<0.05). At 1 day and 6 months after operation, there was no significant difference in VAS score between the single/double-segment robot group and the C-arm group ( P>0.05). The VKA and HFV of robot group were significantly better than those of the C-arm group ( P<0.05).

Conclusion

For single/double-segment OVCF, robot assisted PKP has more advantages in correcting VKA and HFV, reducing fluoroscopy exposure of surgeons and bone cement leakage rate; C-arm assisted PKP has more advantages in reducing the operation time of single-segment OVCF and fluoroscopy exposure of patients during operation.

Clinical efficacy of zoledronic acid combined with percutaneous kyphoplasty in the prevention and treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis

OBJECTIVE:

The aim of this study is to investigate the clinical efficacy of zoledronic acid (ZOL) in the treatment and prevention of osteoporotic vertebral compression fractures (OVCF) after percutaneous kyphoplasty (PKP) for elderly patients.

METHODS:

The PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and Embase were investigated through June 2020. All randomized controlled trials (RCT) involving ZOL injections for OVCF were enrolled. Outcome indicators included the bone mineral density (BMD), Visual Analog Scale (VAS), recompression vertebral fracture (RVF), Oswestry Disability Index (ODI), and bone metabolism (Procollagen type I N-terminal propeptide [PINP] and βcross-linked C-telopeptide of type I collagen [β-CTX]), bone cement leakage. Review Manager 5.3 was used to analyze these indicators.

RESULTS:

In this study, (1).. Eight studies had met the eligibility criteria, a total of 578 participants were involved (285 and 293 in the experimental (ZOL) group and control [no ZOL] group, respectively). (2).. The BMD scores of patients with OVCF in the experimental group were significantly higher than that in the control group (P < .05). The VAS scores were significantly different between the 2 groups at the 6, 12 months follow-up (P < .05). After PKP operation, ZOL injections reduced the rate of RVF (P < .05). In the comparison of ODI scores, the experimental group improved compared with the control group (P < .05). Respectively, the bone metabolism of patients with OVCF after ZOL was better than that of patients in control group (P < .05).

CONCLUSION:

Zoledronic acid had a significant effect on the treatment and prevention of OVCF in elderly osteoporotic patients after PKP. Due to the limited quality and data, more high-quality studies are needed to confirm the results of this meta-analysis.

Characteristics of Osteoporotic Low Lumbar Vertebral Fracture and Related Lumbosacral Sagittal Imbalance

Osteoporotic vertebral fracture (OVF) usually occurs in the thoracolumbar region and rarely affects the low lumbar region. The characteristics of osteoporotic low lumbar fracture (OLLF) have not been reported. Lumbosacral sagittal balance plays an important role in preserving the normal physiologic function of the spine. However, it is unknown how lumbosacral parameters vary in patients with OLLF. The authors retrospectively analyzed the clinical and radiologic characteristics of patients with OLLF and osteoporotic thoracolumbar vertebral fracture (OTVF) who were treated at their institution. Vertebral height, local deformity angle, and visual analog scale and Oswestry Disability Index scores were assessed preoperatively and postoperatively for both groups. The changes in lumbosacral parameters were measured for patients with OLLF. The results showed that OLLF was more likely to occur at L3 (53.66%) and that the prevalence of severe trauma (29.27%) was higher among patients with OLLF (P<.05). The most common morphologic type of the vertebrae affected by OLLF was biconcave (58.54%, P<.05). Patients who had OLLF showed an apparent increase in pelvic tilt and a decrease in local lordosis and sacral slope. Postoperatively, vertebral height, local deformity angle, and visual analog scale and Oswestry Disability Index scores were significantly improved compared with preoperative values (P<.05). Among patients with OLLF, local lordosis and sacral slope increased significantly, whereas pelvic tilt decreased significantly after percutaneous kyphoplasty. Restoration of local lordosis had a mean value of 6.29°±4.80°. These results indicate that OLLF has unique characteristics compared with OTVF and that it results in lumbosacral sagittal imbalance. Percutaneous kyphoplasty is effective and safe for the treatment of OLLF and plays an important role in postoperative improvement of sagittal imbalance. [Orthopedics. 2021;44(1):e7-e12.].

Clinical efficacy and safety of bone cement combined with radiofrequency ablation in the treatment of spinal metastases

Background

To investigate the clinical efficacy and safety of bone cement combined with radiofrequency ablation (RFA) in the treatment of spinal metastases.

Methods

The medical records of patients with spinal metastatic tumor admitted to our hospital from January 2016 to December 2018 were retrospectively analyzed. Based on different surgical methods, the patients were divided into groups A (treated with RFA combined with bone cement) and B (treated with bone cement only). Group A included 35 patients with 47 segments of diseased vertebral bodies. Group B consisted of 52 patients with 78 vertebral segments. Pain, quality of life score, vertebra height, bone cement leakage, postoperative tumor recurrence, and complications were assessed 3 days and 1 and 6 months after surgery.

Results

All the patients had smooth operation without paraplegia, spinal cord injury, and perioperative death. Visual analogue scales (VAS) and Oswestry Disability Index (ODI) scores of the two groups significantly improved 3 days and 1 month after surgery compared with those before surgery (P < 0.05), but no significant difference was observed between the two groups (P > 0.05). Six months after surgery, the VAS and ODI scores of patients in group A were lower than those in group B, with statistically significant differences (P < 0.05). The postoperative vertebral body height of the two groups significantly increased compared with that before surgery, and the difference was statistically significant (P < 0.05). Meanwhile, no significant difference was observed between the two groups (P > 0.05). Postoperative bone cement permeability in group A was 6.4%, and postoperative tumor recurrence rate was 11.4%. The permeability of bone cement in group B was 20.5%, and the tumor recurrence rate was 30.8%. The bone cement permeability and tumor recurrence rate in group A were lower than those in group B, with statistically significant differences (P < 0.05).

Conclusions

Bone cement combined with RFA for the treatment of spinal metastases can achieve good efficacy, desirable analgesic effect, low incidence of complications, small surgical trauma, and high safety. The proposed method has the value of clinical popularization and application.

[Robot-guided percutaneous kyphoplasty in treatment of multi-segmental osteoporotic vertebral compression fracture]

Objective

To evaluate the safety and effectiveness of robot-guided percutaneous kyphoplasty (PKP) in treatment of multi-segmental thoracolumbar osteoporotic vertebral compression fracture (OVCF).

Methods

A clinical data of 63 cases with multi-segmental thoracolumbar OVCF without neurologic deficit treated with PKP between October 2017 and February 2019 were analyzed retrospectively. The patients were divided into robot-guided group (33 cases) and traditional fluoroscopy group (30 cases). There was no significant difference in gender, age, fracture segment, bone mineral density, and preoperative visual analogue scale (VAS) score, midline vertebral height, and Cobb angle between the two groups ( P>0.05). The time to establish the tunnel, the times of fluoroscopy, the dose of fluoroscopy, the deviation of puncture, the distribution of bone cement, the leakage of bone cement, the puncture angle, and the postoperative VAS score, midline vertebral height, and Cobb angle were recorded and compared.

Results

The patients in two groups were followed up 11-13 months (mean, 12 months). Compared with traditional fluoroscopy group, the time to establish the tunnel, the times and dose of fluoroscopy in robot-guided group were significantly lower, the deviation of puncture was slighter, the distribution of bone cement was better, and the puncture angle was larger, the differences between the two groups were significant ( P<0.05). There were 8 segments (9.3%, 8/86) of bone leakage in robot-guided group and 17 segments (22.6%, 17/75) in traditional fluoroscopy group, the difference between the two groups was significant ( χ ²=5.455, P=0.020). There was no significant difference in VAS score, the midline vertebral height, and Cobb angle between the two groups at 2 days after operation and last follow-up ( P>0.05).

Conclusion

Robot-guided PKP in treatment of multi-segmental thoracolumbar OVCF can shorten the operation time, improve the accuracy of puncture, reduce the times and dose of fluoroscopy, reduce the leakage of bone cement, and achieve better cement distribution.

Efficacy and safety of unilateral and bilateral percutaneous balloon kyphoplasty for AOspineA3/A4 osteoporotic thoracolumbar burst fractures

To retrospectively evaluate the efficacy and safety of unilateral and bilateral percutaneous balloon kyphoplasty (PKP) in the treatment of osteoporotic thoracolumbar burst fractures.Retrospectively collected clinical data of 138 patients with osteoporotic thoracolumbar burst fractures who underwent unilateral (n = 70) and bilateral (n = 68) PKP in our hospital from March 2015 to December 2018. The general conditions, operation time, radiation exposure time, intraoperative blood loss, bone cement dosage, hospitalization expenses, and complications were collected from the two groups. Visual analog scale (VAS) values, Cobb's angle changes, average vertebral height changes, and Oswestry Dysfunction Index (ODI) values before treatment, 1 month, and 6 months after treatment were collected.There was no significant difference in gender (male: 28 vs 22; female 42 vs 46) and age (70.25 ± 7.10 vs 69.82 ± 8.20, P > .05) distribution between the two groups. The VAS score (7.38 ± 1.34 vs 2.52 ± 0.99, P < .05), ODI (77.24 ± 6.98 vs 23.11 ± 3.54, P < .05), vertebral mean height (16.71 ± 2.18 vs 17.05 ± 1.94, P < .05) and Cobb's angle (20.26 ± 3.21 vs 11.58 ± 3.20, P < .05) of the two groups were significantly improved after operation, but there was no significant difference between the two groups (P > .05). There was no significant difference in the rate of cement leakage (10.29% vs 11.42%, P > .05), incision swelling (30.88% vs 19.71%, P > .05) and incidence of adjacent vertebrae (4.41% vs 5.71%, P > .05) between the two groups. Compared with bilateral PKP group, operation time (50.88 ± 7.38 vs 62.18 ± 8.01), intraoperative blood loss (14.54 ± 3.16 vs 22.03 ± 5.92), radiation exposure time (23.74 ± 3.41 vs 15.22 ± 3.70), bone cement dosage (4.36 ± 0.81 vs 5.16 ± 0.77) and hospitalization costs (2.38 ± 0.08 vs 2.74 ± 0.07) were significantly lower in the unilateral PKP group (P < .05).Bilateral PKP and unilateral PKP have the same efficacy and safety in the treatment of osteoporotic thoracolumbar burst fractures. However, the unilateral PKP has the characteristics of short operation time, small trauma, low cost and short radiation exposure time, and has clinical application value.

Minimally Invasive Pedicle Screw Fixation Combined with Percutaneous Kyphoplasty Under O-Arm Navigation for the Treatment of Metastatic Spinal Tumors with Posterior Wall Destruction

OBJECTIVE

To evaluate the safety and efficacy of O-arm-guided minimally invasive pedicle screw fixation combined with percutaneous kyphoplasty for metastatic spinal tumors with posterior wall destruction.

METHODS

Patients who underwent minimally invasive pedicle screw fixation combined with percutaneous kyphoplasty for pathological vertebral fractures with posterior wall defects from January 2015 to December 2017 were followed up for 1 year. Visual analogue scale (VAS), SF-36 scores, middle vertebral height, posterior vertebral height, and the accuracy of pedicle screws were assessed preoperatively, postoperatively, and 1 year after surgery. The operation time, time from operation to discharge, blood loss, volume of bone cement, and leakage of bone cement were recorded.

RESULTS

Twenty-three patients (13 females and 10 males) who met our criteria were followed up for 1 year. The operation time of these patients was 162.61 ± 33.47 min, the amount of bleeding was 230.87 ± 93.76 mL, the time from operation to discharge was 4.35 ± 2.42 days, and the volume of bone cement was 3.67 ± 0.63 mL. The VAS score decreased from 7.04 ± 1.07 to 2.65 ± 0.93 before surgery (P = 0.000) and remained at 2.57 ± 0.79 1 year after surgery. Compared with the preoperative SF-36 scores for physical pain, physiological function, energy, and social function, the postoperative scores were significantly improved (P = 0.000). The height of the middle vertebral body increased from 14.47 ± 2.96 mm before surgery to 20.18 ± 2.94 mm (P = 0.000), and remained at 20.44 to 3.01 mm 1 year after surgery. The height of the posterior vertebral body increased from 16.56 ± 3.07 mm before operation to 22.79 ± 4.00 mm (P = 0.000), and 22.45 ± 3.88 mm 1 year after surgery. The 23 patients had a total of 92 pedicle screws; 85 screws were Grade A and 7 screws were Grade B. There was no leakage of bone cement after surgery.

CONCLUSION

In the short term, O-arm-guided minimally invasive pedicle screw fixation combined with kyphoplasty is safe and effective in the treatment of metastatic spinal tumors with posterior wall destruction.

Perioperative prevalence of deep vein thrombosis in patients with percutaneous kyphoplasty: A retrospective study with routine ultrasonography

In recent years, deep venous thrombosis (DVT) after spine surgery has received extensive attention, but perioperative prevalence of DVT in patients undergoing percutaneous kyphoplasty (PKP) is lacking.To assess the perioperative prevalence of deep vein thrombosis (DVT) in patients undergoing PKP with routinely applied ultrasonography.We reviewed 1113 consecutive patients undergoing PKP from January 2014 to August 2017. The surgical procedure was bilateral PKP. All patients were routinely examined with ultrasonography when admitted to the hospital and on the first post-operative day. Clinical signs of DVT were checked and recorded before examination.Forty (3.6%) out of 1113 patients were diagnosed with DVT by ultrasonography. Of the 40 detected cases of DVT, only six (0.54%) patients presented with clinical signs of DVT, demonstrating that there were 34 (3.05%) asymptomatic cases. No patient presenting with clinically suspected pulmonary embolism (PE) was observed. Gender, body mass index (BMI), operative time, hypertension, diabetes, heart disease, and lower limb fracture were not significant risk factors for DVT (P > .05). In contrast, patient age, oncologic conditions, DVT history, and paraplegia appeared to be significant risk factors for DVT (P < .01). There was no significant difference in the incidence of DVT found between the three PKP surgical levels (P > .05).The total incidence of perioperative DVT diagnosed with ultrasonography in patients undergoing PKP was 3.6%, of which only 0.54% was symptomatic cases. It is necessary to assess DVT using ultrasonography during the perioperative procedure of PKP, especially for high-risk patients.Level of evidence: Level IV.

Kyphoplasty for occult and non-occult osteoporotic vertebral fractures: a retrospective study

Objective

To compare the safety and efficacy of kyphoplasty in the treatment of occult and non-occult osteoporotic vertebral compression fractures (OOVF).

Material and Methods

From 2015 to 2017, 82 OOVF and 105 non-occult osteoporotic vertebral compression fractures (N-OOVF) were evaluated with the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and vertebral height preoperatively, immediately postoperatively, and one year postoperatively. Operative time, fluoroscopy time, and cement injection volume were recorded.

Results

Compared with the preoperative VAS and ODI scores, the scores of both groups were significantly improved after surgery. Preoperative ODI and VAS scores of the OOVF were lower than those of the N-OOVF. The operative time, fluoroscopy time, and bone cement injection volume of the OOVF were significantly lower than those of the N-OOVF. Vertebral height of the N-OOVF improved significantly after surgery. There were differences in cement leakage and adjacent vertebral fractures between the two groups.

Conclusion

Compared with N-OOVF, OOVF are safer with kyphoplasty, and it is necessary to diagnose OOVF in a timely manner.

Therapeutic effect of percutaneous kyphoplasty combined with anti-osteoporosis drug on postmenopausal women with osteoporotic vertebral compression fracture and analysis of postoperative bone cement leakage risk factors: a retrospective cohort study

Background

The purpose of this study is to explore the therapeutic effect of percutaneous kyphoplasty (PKP) combined with anti-osteoporosis drug, zoledronic acid, on postmenopausal women with osteoporotic vertebral compression fracture (OVCF) and to perform an analysis of postoperative bone cement leakage risk factors.

Methods

A total of 112 OVCF patients, according to therapeutic regimens, were divided into control group (n = 52, treated with PKP) and observation group (n = 60, treated with PKP and zoledronic acid injection).

Results

Postoperative tumor necrosis factor-α and interleukin-6 levels were significantly decreased in the two groups, compared with those before treatment (both P < 0.05); bone mineral density (BMD), serum bone gla protein (BGP), and vertebral height ratio of injured vertebrae were significantly increased, and procollagen type I N-terminal propeptide (PINP), Cobb angle, visual analogue scale/score (VAS), and Oswestry disability index (ODI) were significantly decreased compared with those before treatment (all P < 0.05). There were significantly higher changes in difference value of BMD, PINP, BGP, vertebral height ratio of injured vertebrae, Cobb angle, VAS, and ODI levels and significantly better therapeutic effect in the observation group than those in the control group (all P < 0.05). Multivariate logistic regression analysis showed that the use of zoledronic acid, vertebral height ratio of injured vertebrae, and ODI were independent factors affecting the therapeutic effect, and that the dosage of bone cement, and peripheral vertebrae wall damage were independent risk factors causing postoperative bone cement leakage. There were no significant differences in postoperative bone cement leakage rate between the two groups.

Conclusions

Peripheral vertebrae wall damage and the dosage of bone cement are independent risk factors causing bone cement leakage in OVCF patients treated with PKP. PKP combined with zoledronic acid has an improvement effect on the condition of postmenopausal women with OVCF and reduces the inflammation and pain in patients, which is beneficial to clinical treatment.

Safety of Cement Distribution Patterns in Metastatic Vertebral Tumors: A Retrospective Study

Background

Kyphoplasty (KP) is a palliative treatment for patients with metastatic vertebral tumors. The distribution pattern of cement affects safety and efficacy. The distribution pattern of cement has not been previously reported for patients with metastatic vertebral tumors.

Material/Methods

From January 2013 to December 2017, patients with metastatic vertebral tumors who met our criteria were divided into cement fusion (n=91) and separation (n=97) groups. Visual analogue scale (VAS) and middle vertebral height (MVH) were evaluated preoperatively, postoperatively, and 1 year after surgery. Spinal Instability Neoplastic Score, fluoroscopy time, operation time, cement volume, cement leakage, and vertebral fractures were recorded and evaluated.

Results

Compared with the fusion group, the separation group had significantly different (P<0.001) operation time, fluoroscopy time, and cement volume. Compared with preoperative status, VAS and MVH were significantly improved 3 days postoperatively and 1 year postoperatively in both groups (P<0.001). The difference in cement leakage between the 2 groups (P<0.05) and in the number of adjacent vertebral fractures between the 2 groups (P<0.05) were significant.

Conclusions

The distribution patterns of the bone cement had a good analgesic effect and preventive effect on vertebral collapse. However, the separation of bone cement may be safer.

Reperfusion Revision Surgery for Augmented Vertebral Nonunion with Movable Cement

BACKGROUND

Osteoporotic vertebral nonunion is a special type of osteoporotic vertebral fracture and can gain satisfactory clinical outcomes using vertebral augmentation. In the rare occurrence that augmented vertebral nonunion occurs postoperatively, pedicle screw fixation is the primary strategy. However, is a different method like the second shot of cement reliable? The purpose of this study is to introduce the reperfusion revision surgery strategy for treatment of osteoporotic vertebral nonunion.

CASE DESCRIPTION

An 80-year-old female patient experienced vertebral re-nonunion in situ after receiving kyphoplasty at the T11 vertebrae. During revision surgery, we tried a new, minimally invasive surgical method in which we inserted cement into the intravertebral cleft around the movable cement without obvious leakage. Special bone cement perfusion techniques (incremental temperature cement delivery and secondary cement preparation based-perfusion and blocking) were used. The cement tail was performed to increase the anchor and fastness between the cement and vertebral body.

CONCLUSIONS

The patient gained immediate pain relief and vertebral stability after the revision surgery. A 2-year postoperative radiograph and follow-up showed sufficient vertebral height and clinical outcomes. Using special puncture and bone cement perfusion techniques, reperfusion revision surgery in situ is an effective strategy for the treatment of vertebral re-nonunion.

Influence of the distribution of bone cement along the fracture line on the curative effect of vertebral augmentation

Objective

The present study was performed to evaluate the effect of different bone cement distributions along the fracture line on clinical and imaging outcomes of vertebral augmentation.

Methods

In total, 84 patients who underwent vertebral augmentation for a single osteoporotic vertebral compression fracture from January 2016 to August 2018 were retrospectively reviewed. These patients were divided into two groups according to the relationship between the bone cement distribution and the fracture line: the unilateral group (n = 23) and the bilateral group (n = 61). Postoperative clinical and imaging parameters were compared between the two groups.

Results

Statistical analyses showed no significant difference in postoperative pain relief, bone cement leakage, nerve injury, or new vertebral fracture between the two groups. Significant recovery from vertebral compression was observed in the bilateral group after surgery, but there was no significant difference in vertebral compression after surgery in the unilateral group.

Conclusions

Pain relief was similar for different types of cement distributions along the fracture line, but a bilateral cement distribution exhibited better recovery from vertebral compression and did not increase bone cement leakage in the vertebral augmentation procedure.

Percutaneous kyphoplasty for a "centenarian": A case report and a summary of technical points

Objective

To present a case of 97-year-old patient performed by Percutaneous kyphoplasty (PKP) with the key technology of diagnosis and therapy.

Methods

To review literatures about super-aged patients suffering from osteoporotic vertebral compression fracture and summarize the treatment procedures and technical points.

Results

The centenarian patient received a satisfied follow-up efficacy using the diagnosis and key technology of PKP.

Conclusions

PKP is an effective surgical procedure for the treatment of super-aged patient using the diagnosis and key technology.

•

This work describes using Percutaneous kyphoplasty (PKP) for a “centenarian” for the very first time.

•

Whereby, we discuss and summarize the technique points of PKP.

•

This work summarize and discuss the treatment of vertebral compression fractures for super-aged patients.

Intervertebral Bridging Ossification After Percutaneous Kyphoplasty in Osteoporotic Vertebral Compression Fractures

BACKGROUND

Percutaneous kyphoplasty (PKP) is effective in treating osteoporotic vertebral compression fractures (OVCFs). Intervertebral bridging ossification can sometimes be detected after surgery, but studies related to its formation mechanism and its influence on outcome are few.

CASE DESCRIPTION

We reviewed patients' radiologic images and found 7 patients in whom intervertebral bridging ossification developed after PKP. Their personal and clinical information was recorded. The 7 patients had an average age of 63.43 ± 4.79 years. Injured levels included L1 (1 patients) and L2 (1 patient). GeneX and PMMA cement were respectively applied. Both the Cobb angle and the VAS scores were significantly improved after surgery, but all surgical vertebrae showed recollapse combined with larger Cobb angle at the last follow-up visits. In 1 patient the new-onset T11 fracture developed 29 months after surgery.

CONCLUSIONS

We deemed that spinal degeneration, mechanical instability, bone cement, and fracture pattern are all potential promoting factors for intervertebral bridging ossification. Solid bridging ossification may increase local spinal stability, but it also increases the risk of adjacent vertebral fractures.

Early versus late percutaneous kyphoplasty for treating osteoporotic vertebral compression fracture: A retrospective study

OBJECTIVE

Osteoporotic vertebral compression fracture (OVCF) is a common disease in the aged population that can greatly affect the quality of life. Percutaneous kyphoplasty (PKP) has become a mainstream approach for treating OVCF, but the optimal surgical timing for treating OVCF with PKP remains controversial. In the current study, we retrospectively studied patients with OVCF that underwent PKP, and aimed to find out whether surgical timing could affect the clinical and radiological outcomes.

PATIENTS AND METHODS

We retrospectively studied 62 patients who underwent PKP for OVCF. Patients were divided into 2 groups based on the timing of PKP: operation within 4 weeks (group A) and operation later than 4 weeks (group B). VAS, ODI, height of fracture vertebra, restored height rate, local kyphosis angle and complications were assessed preoperatively and throughout the follow-up.

RESULTS

There were 36 cases (58 fracture vertebra) in the group A and 26 cases (40 fracture vertebra) in the group B. There was no significant difference between the two groups regarding to the demographic data before surgery. In terms of the VAS and ODI, no statistical difference was observed before operation, after operation and at the 6th month follow-up between the two groups. The HRR after operation and at the 6^th month follow-up in the group A was 17.5 ± 5.3% and 10.5 ± 3.7%, and that in the group B was 7.2 ± 3.2% and 3.6 ± 1.1%, and there is significant difference between the two groups (p < 0.05). The LKA (preoperatively / post-operatively / 6th month follow-up) was -12.7°, -7.3°, -11.4° in the group A and -17.6°, -14.4°, -16.1° in the group B. There was significant difference between the two groups at all the time points for local kyphosis angle (p < 0.01), with a lower rate of subsequent vertebral fracture in the group A (p < 0.05).

CONCLUSION

Both surgical timings of PKP showed similar outcomes in terms of the VAS and ODI. Early PKP could result in better restoration of vertebral body height and reduced rate of subsequent fracture compared to late PKP.

Distribution Pattern Making Sense: Patients Achieve Rapider Pain Relief with Confluent Rather Than Separated Bilateral Cement in Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures

BACKGROUND

It has been reported the distribution of bone cement in percutaneous kyphoplasty (PKP) has an impact on the curative effect. No studies have compared between confluent and separated cement pattern of bilateral bone cement in PKP for patients with osteoporotic vertebral compression fractures.

METHODS

Between 2010 and 2016, 1341 patients were enrolled and divided into 2 groups. Group A (n = 723), bilateral cement was confluent; Group B (n = 618), bilateral cement was separated. The visual analogue scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), and local kyphotic angle (LKA) were obtained preoperatively, 2 days after surgery, and at the final follow-up to assess the functional and radiographic efficacy of the surgery.

RESULTS

The VAS, ODI, AVH, and LKA 2 days after operation and at the final follow-up were significantly improved compared with the preoperative for both groups (P < 0.05). There existed no significant difference between groups at various time point in ODI, AVH, and LKA (P > 0.05). Group A showed better VAS than group B 2 days after surgery (1.91 ± 0.98 vs. 2.35 ± 0.78, P < 0.001), also with better pre-postoperative VAS change (6.23 ± 0.76 vs. 5.75 ± 1.02, P < 0.001). Multiple linear regression for pain relief degree revealed group A (P < 0.001), older age (P < 0.001), and more cement volume (P < 0.001) contribute to rapid improvement of back pain. The cement leakage rate was 3.7% in group A and 2.9% in group B, with no significant difference (P = 0.405).

CONCLUSIONS

Patients achieved rapider pain relief with confluent rather than separated bilateral bone cement pattern in PKP for osteoporotic vertebral compression fracture.

Factors Associated with Perioperative Serum Calcium Levels in Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fracture: A Prospective Clinical Study

BACKGROUND Long-term hypocalcemia can result in osteoporotic vertebral compression fracture (OVCF). Transient paralysis and tetraplegia due to hypocalcemia is a rare but severe complication after kyphoplasty. The aims of this prospective clinical study were to investigate the clinical factors associated with serum calcium levels in patients undergoing percutaneous kyphoplasty (PKP). MATERIAL AND METHODS Sixty-eight patients with OVCF were clinically evaluated before and after PKP. Serum calcium was measured before surgery and 24 hours after surgery. Clinical information included the time between vertebral fracture and surgery, the number of involved vertebral bodies, the dose of bone cement required during surgery, and bone mineral density. Correlation coefficient and simple linear regression analysis were performed to identify the clinical factors associated with serum calcium levels. RESULTS Peri-operative serum calcium levels were significantly and positively associated with the dose of bone cement required during PKP and the number of affected vertebral bodies. There was a significant and negative correlation between the time from vertebral fracture to surgery and bone mineral density, which were shown by linear regression analysis to have a predictive value of 5.8% and 47.3%, respectively. CONCLUSIONS For patients undergoing PKP, the amount of bone cement required and the number of affected vertebral bodies were associated with low serum calcium levels. Surgeons should be aware of the importance of measuring and monitoring serum calcium levels in this patient group.

Intermediate screws or kyphoplasty: Which method of posterior short-segment fixation is better for treating single-level thoracolumbar burst fractures?

PURPOSE

To compare intermediate screws (IS) with kyphoplasty (KP) in posterior short-segment fixation (PSSF) for patients with single-level thoracolumbar burst fractures.

METHODS

Between 2010 and 2016, 1465 patients were retrospectively reviewed; 48 patients were enrolled with a minimal follow-up of 2 years. Perioperative and functional outcomes were compared. The regional Cobb angle (CA) was included in radiographic analysis. Implant failures or CA correction loss over 10° were regarded as surgical failures. Multiple linear regression was performed to investigate the risk factors of kyphosis recurrence.

RESULTS

Fluoroscopic time (23.7 ± 3.6 vs. 79.3 ± 12.1 s, p < 0.001), operative time (109.6 ± 13.1 vs. 123.8 ± 19.0 min, p = 0.006) and blood loss (104.6 ± 34.9 vs. 129.1 ± 21.7 ml, p = 0.005) were all lower in the IS group. The KP group had lower Visual Analogue Scale scores (3.3 ± 0.9 vs. 2.7 ± 0.8, p = 0.028) and greater anterior body height (ABH) (30.3 ± 9.0 vs. 36.3 ± 11.0%, p = 0.044) after surgery, and less correction loss (5.6 ± 2.7 vs. 0.4 ± 1.2%, p < 0.001). Both groups had a CA correction loss of 4° with a 10% failure rate. The A3 Magerl subclassification, smaller preoperative ABH and smaller postoperative CA had positive correlations with CA correction loss.

CONCLUSION

PSSF with KP provides better back pain relief, greater ABH reduction and less correction loss, while IS has the advantages of less operative time, fluoroscopic time and blood loss. Magerl subclassification of burst fracture is a potential predictor for recurrent kyphosis. Reducing fractured vertebral body height rather than segmental curvature may be more important in PSSF.

STUDY DESIGN

Retrospective, non-randomized controlled study. These slides can be retrieved under Electronic Supplementary Material.

Analyses of the efficacy of percutaneous kyphoplasty and alendronate sodium on thoracolumbar vertebral fracture and the risk factors of fracture

The present study investigated the efficacy of percutaneous kyphoplasty and alendronate sodium on thoracolumbar vertebral fracture, and the risk factors leading to the recurrence of fracture. In the present study, a total of 80 patients with thoracolumbar vertebral fracture who were admitted to the Affiliated Jiangyin Hospital of Southeast University Medical College between January 2014 and March 2016 for combination treatment of percutaneous kyphoplasty and alendronate sodium were enrolled. According to the recurrence of fracture, the patients were divided into two groups, the observation group (patients with fracture recurrence, n=40) and control group (patients with no fracture recurrence, n=40). All patients participated in a 1-year follow-up. The recurrence of fracture and the site of fracture were identified through the clinical symptoms and examination of the spine using magnetic resonance imaging. In addition, comparisons of the time of alleviation in numbness of lower limb and that in pains in waist and legs were carried out. Furthermore, statistics on the adverse reactions during intervention in the two groups were also collected; changes in visual analogue scale (VAS) and Oswestry Disability Index (ODI) of pains at different time points in two groups were also observed. One-way analysis and multivariate analysis were performed to identify the relevant risk factors. Alleviation time in numbness of lower legs in patients of the control group was significantly earlier than that in the observation group (P<0.05) and the alleviation time in pains of the waist and legs of patients in the control group was also significantly earlier than that in the observation group (P<0.05). Furthermore, the incidence rates of abdominal pain, diarrhea, constipation and hypocalcemiain in the control group were also significantly lower compared with those in the observation group (P<0.05). One week, one month and one year after operation, the scores of VAS of pains and ODI in the control group were significantly lower compared with those in the observation group in the same period (P<0.05). Lower preoperative bone density and exosmosis of bone cement in treatment were the independent risk factors leading to the recurrence of fracture. For patients with thoracolumbar vertebral fracture who received the combination treatment of percutaneous kyphoplasty and alendronate sodium, there underlies an important correlation between the recurrence rate of fracture and the preoperative bone density as well as the exosmosis of bone cement in operation.

[Photoelectric guided navigation unilateral puncture of the percutaneous kyphoplasty in treatment of thoracolumbar osteoporotic vertebral compression fracture]

Objective

To evaluate the safety of photoelectric guided navigation unilateral puncture of the percutaneous kyphoplasty (PKP) in the treatment of thoracolumbar osteoporotic vertebral compression fracture (OVCF).

Methods

A randomized controlled clinical research was performed between June 2015 and January 2017. Eighty-five cases of OVCF were treated with photoelectric guided navigation unilateral puncture of the PKP (trial group, 43 cases) or C arm fluoroscopy unilateral puncture of the PKP (control group, 42 cases) respectively. There was no significant difference in gender, age, disease duration, segmental fracture, AO classification, bone mineral density, and preoperative visual analogue scale (VAS) score between 2 groups ( P>0.05). The concordance rate of puncture path and design path, the incidence of pedicle wall breaking, the incidence of bone cement leakage, and the rate of bone cement distribution center were observed and calculated on postoperative CT images; the intraoperative X-ray exposure frequency, frequency of puncture, operation time, VAS scores before operation and at 2 days after operation, and postoperative blood vessel or nerve injury were recorded and compared.

Results

The intraoperative X-ray exposure frequency and puncture frequency in trial group were significantly less than those in control group ( P<0.05), but there was no significant difference in operation time between 2 groups ( t=0.440, P=0.661). The VAS scores of 2 groups at 2 days after operation were significantly improved when compared with preoperative ones ( P<0.05), but there was no significant difference in VAS score at 2 days after operation between 2 groups ( t=0.406, P=0.685). All the patients were followed up 6-18 months (mean, 10 months). No blood vessel or nerve injury occurred in 2 groups. The incidence of pedicle wall breaking, the incidence of bone cement leakage, the concordance rate of puncture path and design path, and the rate of bone cement distribution center in trial group were 2.33% (1/43), 2.33% (1/43), 86.05% (37/43), and 88.37% (38/43) respectively, all showing significant differences when compared with those of control group [19.05% (8/42), 21.43% (9/42), 45.24% (19/42), and 50.00% (21/42) respectively] ( P<0.05).

Conclusion

Intraoperative photoelectric guided navigation unilateral puncture of the PKP can improve the success rate of target puncture and reduce the incidence of pedicle wall breaking effectively, and achieve better bone cement distribution and better security.

Functional Recovery Following Early Kyphoplasty Versus Conservative Management in Stable Thoracuolumbar Fractures in Parachute Jumpers: A Randomized Clinical Trial

STUDY DESIGN

A randomized clinical trial.

OBJECTIVE

To compare the functional recovery between early kyphoplasty and conservative care in paratroopers with stable thoracolumbar fractures.

SUMMARY OF BACKGROUND DATA

Treatment of traumatic stable thoracolumbar fractures in young individuals is still a debate. Conservative management and kyphoplasty are options of therapy. But enough data are not available for supporting each.

METHODS

We included 70 paratroopers with stable thoracolumbar fractures (A1 and A2 classification according to AOSpine thoracolumbar spine injury classification system) presenting <60 days after trauma and hyperintensity in T2-weighted magnetic resonance imaging. Old fractures and those requiring fixation were excluded. Patients were randomly assigned to 2 study groups to undergo percutaneous balloon kyphoplasty (n=34) or conservative care (n=36) by applying orthosis for 2 months. Patients were followed for 12 months and were evaluated clinically using visual analogue scale (VAS) and Oswestry disability index (ODI).

RESULTS

The baseline characteristics were comparable between 2 study groups. The VAS score and ODI decreased significantly in both study groups after 12 months of treatment. The VAS score was significantly lower in kyphoplasty group after the intervention (P<0.001), 1 month (P<0.001), 3 months (P<0.001), 6 months (P<0.001), and 12 months (P<0.001) after the intervention. In addition, the ODI was significantly lower after the intervention (P<0.001), 1 month (P<0.001), 3 months (P<0.001), 6 months (P<0.001), and 12 months (P<0.001) after the intervention. Kyphoplasty was associated with shorter duration of returning to parachuting (P<0.001) and shorter duration of absence from work (P<0.001).

CONCLUSIONS

Early kyphoplasty in stable thoracolumbar fractures after parachute jumping is associated with less pain, better functional recovery, less days of absence from work, and shorter duration of returning to parachuting.

A Retrospective Study of Percutaneous Balloon Kyphoplasty for the Treatment of Symptomatic Schmorl's Nodes: 5-Year Results

BACKGROUND Despite literature supporting the efficiency of percutaneous balloon kyphoplasty (PKP) in treating osteoporotic and malignant vertebral compression fractures, few reports exist that document its use for treatment of symptomatic Schmorl's nodes (SNs) refractory to conservative treatment. Patients with symptomatic SNs could have pain in the vertebrae similar to an acute vertebral compression fracture. MRI is very helpful in diagnosing symptomatic SNs when x-ray and CT scan are unremarkable. In painful cases, the vertebrae bone marrow around the SNs is hyperintense on T2-weighted subsequence. We evaluated the long-term safety and effectiveness of PKP for the treatment of symptomatic SNs not responding to conservative therapy. MATERIAL AND METHODS From January 2008 to December 2012, 32 patients suffering from symptomatic SNs underwent 43 PKP procedures. Outcome data, including mean height ratio of anterior and middle vertebral body, Visual Analog Scale (VAS score) for pain measurement, Oswestry Disability Indexes (ODI score) and SF-36 questionnaires for function measurement were recorded preoperatively, postoperatively, and at one month, six months, two years, and five years after treatment. RESULTS Thirty-two patients were treated successfully with PKP. Clinically asymptomatic cement leakage was observed in three (6.98%) of the treated vertebral bodies. The mean height ratio of anterior and middle vertebral bodies changed from 98.2±1.6% preoperatively to 98.5±1.4% postoperatively (p>0.05) and 98.3±1.5% preoperatively to 98.8±1.9% postoperatively (p>0.05). The mean VAS scores, ODI score, and SF-36 scores for physical function (PF), bodily pain (BF), social functioning (SF), and vitality (VT) all showed significant improvements (p<0.05). During the 5-year follow-up, the stabilization of the height of the vertebral body and functional improvements were all maintained. CONCLUSIONS PKP is a safe and effective procedure for the treatment of symptomatic SNs refractory to conservative therapy.

Therapeutic effects analysis of percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A multicentre study

Background

Percutaneous kyphoplasty (PKP), a minimally invasive treatment, has been widely used for osteoporotic vertebral compression fractures (OVCFs).

Objective

To retrospectively analyse the therapeutic effects of PKP using a series of key techniques in a multicentre study.

Methods

From May 2000 to December 2016, PKP was performed using a series of key techniques (puncture, reduction, and perfusion techniques) for the treatment of 4532 OVCF patients. The pain visual analog scale (VAS) and the Oswestry Disability Index (ODI) questionnaire prior to the operation, at postoperative Day 2, and at the last follow-up were analysed by paired t-test analysis. The leakage of bone cement was evaluated by postoperative radiography and/or computed tomography. Four-year survival was calculated at the last follow-up.

Results

The average follow-up was 63 months (1–116 months). The VAS score decreased from 8.9 (preoperative) to 2.3 (2 days postoperative) to 1.9 (last follow-up). The ODI score of the patients decreased from 86.7 (preoperative) to 31.6 (2 days postoperative) to 25.3 (last follow-up). Both VAS score and ODI score improved significantly. The bone cement leakage rate was 3.5%, with no clinical symptoms. The 4-year survival rate was 77.5%.

Conclusion

This study suggests that PKP with key techniques would be an effective technique to treat OVCF with less risk and better therapeutic effect. Such diagnostic methods and surgical techniques lead to the development and progress of treatment for OVCF.

The translational potential of this article: PKP with key techniques would be an effective technique to treat and lead to the development and progress of treatment for OVCF.

Percutaneous Balloon Kyphoplasty in Treatment of Painful Osteoporotic Occult Vertebral Fracture: A Retrospective Study of 89 Cases

BACKGROUND The definition of a vertebral fracture is usually based on the presence of a deformation of the vertebral body and this can be misleading in the presence of a fracture without radiologic collapse with the definition of occult osteoporotic vertebral fractures (OOVFs). STIR sequence of MRI images showing hyperintensity signal was the most confirmative screening examination used to determine the presence of painful OOVFs. To date, clinical management of OOVFs has been rarely discussed. MATERIAL AND METHODS Between 2011 and 2013, 89 patients suffering from painful OOVFs underwent 142 percutaneous balloon kyphoplasty (PKP) procedures. Outcome data (mean variation of anterior and middle vertebral body height, visual analog scale [VAS] scores, Oswestry Disability Index [ODI] scores, and SF-36 scores) were recorded preoperatively, postoperatively, and at 1 month, 6 months, and 2 year after treatment, to evaluate the results. RESULTS We successfully treated 89 patients (142 vertebral bodies) with PKP. Cement leakages were observed in 12 (8.45%) treated vertebral bodies and there were 5 new adjacent vertebral fractures during the follow-up period. The mean variation of anterior and middle vertebral body height changed from 96.5±3.4% preoperatively to 97.2±2.5% postoperatively (p>0.05) and from 96.3±2.8% preoperatively to 97.9±3.1% postoperatively (p>0.05), respectively. The mean VAS scores were reduced significantly from pre-surgery to post-surgery (8.3±1.2 to 2.9±0.7; p<0.05), as was the ODI score (76.4±12.5 to 26.7±5.6; p<0.05). The SF-36 scores, including Bodily Pain (BF), Vitality (VT), Physical Function (PF), and Social Functioning (SF), all showed notable improvement (P<0.05). These variations were maintained during the 2-year follow-up period. CONCLUSIONS PKP is a safe and effective method in the treatment of painful OOVFs.