Clinical Performance and Safety of 108 SpineJack Implantations: 1-Year Results of a Prospective Multicentre Single-Arm Registry Study

Applications of the SpineJack device in the surgical management of type A4 lumbar burst fractures without neurological deficit: illustrative cases

BACKGROUND

Type A4 lumbar burst fractures are severe spinal injuries typically treated with posterior pedicle screw constructs, with or without corpectomy. However, traditional approaches can be highly invasive and are often limited in their ability to reconstruct the anterior column. The SpineJack device offers a minimally invasive alternative or complement to posterior fixation.

OBSERVATIONS

Four neurologically intact patients with lumbar type A4 fractures were treated using the SpineJack device, either alone or in combination with different posterior fixation techniques. Clinical and radiological outcomes were evaluated preoperatively, postoperatively, and at the 1-year follow-up. The procedure led to significant pain relief and rapid mobilization for all patients. Radiologically, it restored vertebral body height (VBH), increased spinal canal patency, and corrected preoperative deformities, with minimal loss of correction at follow-up.

LESSONS

The SpineJack device is a viable, less invasive alternative to traditional pedicle screw constructs and serves as an effective adjunct for stabilization, potentially replacing corpectomy in some cases. It restores VBH and alignment, maintains load-bearing capacity, and reduces the need for additional hardware. Further research is needed to evaluate long-term outcomes, especially in younger patients. https://thejns.org/doi/10.3171/CASE24821.

Short-term clinical outcomes and safety of the SpineJack implant system for the treatment of pathological vertebral compression fractures in cancer patients: A retrospective analysis

BACKGROUND

The SpineJack implant system is an FDA-approved treatment modality for vertebral compression fractures (VCFs) with reported clinical efficacy comparable to the gold-standard balloon kyphoplasty. Specifically, there is insufficient literature regarding the treatment and safety outcomes of the SpineJack when analyzing a specific subset of patients such as the cancer population.

METHODS

This is an institutional-level retrospective study at a cancer center on the SpineJack implant consisting of 67 cancer patients (mean age 64 ± 13 years) undergoing a total of 94 SpineJack implantations inserted at 15 thoracolumbar vertebral levels for the treatment of pathologic vertebral compression fractures. The primary outcome of the study was the change in pain score based on the Numeric Rating Scale (NRS) and the secondary outcome was the change in opioid requirement based on morphine milligram equivalents (MME). The average follow-up period was 2 weeks.

RESULTS

Post-procedure, a statistically significant decrease in pain severity was observed, with the mean pain score improving from 7.72 ± 2.29 points to 3.45 ± 2.55 points (p-value < 0.0001). Additionally, a reduction in opioid requirement was noted, with a decrease in MME from 66.42 ± 92.66 mg preoperatively to 43.1 ± 60.78 mg (p-value < 0.0001) postoperatively. There was a 1.5% (N = 1) incidence of adjacent level fracture (ALF) reported over an average of 2-week follow-up. The most common intraoperative complication reported was cement extravasation.

CONCLUSION

Overall, treatment of cancer patients with pathologic fractures using the SpineJack procedure resulted in remarkably decreased pain scores, overall decreased MME requirements, a significantly low incidence of ALF (s), and minor intraoperative complications without long-term consequences. The SpineJack procedure is a clinically effective, low-risk treatment option for cancer patients with symptomatic, pathologic VCFs.

An Algorithmic Overview of Advanced Pain Therapies: A Narrative Review

PURPOSE OF REVIEW

Quickly referenceable, streamlined, algorithmic approaches for advanced pain management are lacking for patients, trainees, non-pain specialists, and interventional specialists. This manuscript aims to address this gap by proposing a comprehensive, evidence-based algorithm for managing neuropathic, nociceptive, and cancer-associated pain. Such an algorithm is crucial for pain medicine education, offering a structured approach for patient care refractory to conservative management.

RECENT FINDINGS

A comprehensive literary review with PubMed and regulatory documents from the United States Food and Drug Administration were searched for a variety of interventions. Pain syndromes were categorized into nociceptive and neuropathic pain, and an algorithm was constructed. Serving as an educational tool for patients, trainees, and non-pain specialists, and as an accessible reference for pain specialists, this algorithm bridges knowledge gaps, promotes interdisciplinary collaboration, and streamlines the learning curve for new practitioners. The strength of this algorithm lies in integrating extensive clinical data, emphasizing the latest clinical evidence, and providing a structured decision-making pathway.

Tripod-Fix device for the treatment of painful osteoporotic vertebral compression fractures

Current vertebral augmentation procedures (VAPs) often involve devices associated with bone cement leakage. Tripod-Fix is designed to mitigate the risk of bone cement leakage by expanding in three dimensions to fit a narrower vertebral space. This study enrolled 12 patients diagnosed with osteoprorotic vertebral compression fractures (VCFs) for 12 month follow up. The primary outcomes assessed were changes in the Visual Analog Score (VAS) and Oswestry Disability Index (ODI) before and after treatment. Our results demonstrated significant pain relief with VAS decreasing from 8.58 ± 1.83 to 2.75 ± 1.54 cm and improved mobility with ODI decreasing from 73.67 ± 16.29 to 31.83 ± 23.33% post-treatment and sustained for 12 months. Follow-up radiographs revealed no device-related adverse events such as cement leakage, vertebral body collapse, or adjacent vertebral fractures (AVFs). In addition, the mean anterior height restoration ratio after treatment was 15.87 ± 5.13%. Our preliminary findings suggest that Tripod-Fix exhibits safety and efficacy comparable to the third-generation devices currently utilized for treating osteoporotic VCFs.

Surgical treatment of post-traumatic vertebral osteonecrosis including intravertebral expansive implants-clinical, functional and imaging outcomes and a center experience over 7 years

Background

The effective treatment of post-traumatic vertebral osteonecrosis continues to be an under discussion and controversial subject. Armed kyphoplasty with expansive intravertebral implants is an emerging procedure, which, in theory, allow for a more effective preservation of the restored vertebral height. The development of the indications for these recent devices has given rise to auspicious outcomes in vertebral non-union situations. The aim of this study is to evaluate the clinical, functional and imaging outcomes of the surgical treatment of situations of post-traumatic vertebral necrosis, following a therapeutic algorithm that includes armed kyphoplasty with intravertebral expansive implants and bridge pedicular stabilization, according to a predefined necrosis stage.

Methods

We present a retrospective observational study, in which 35 patients took part, including a total of 35 cases of post-traumatic vertebral osteonecrosis submitted to surgical treatment over 7 years (between 2016 and 2023) at the same center according to a defined therapeutic algorithm. The cases were staged according to vertebral morphology (non-plana or plana) and mobility (mobile or immobile)-stages 1m (mobile necrotic vertebra non-plana), 1i (immobile necrotic vertebra non-plana), 2m (mobile necrotic vertebra plana), and 2i (immobile necrotic vertebra plana)-and the following surgeries were performed: armed kyphoplasty with intravertebral expansive implants filled with bone cement, associated or not to adjacent pedicle instrumentation; or bridge pedicle fixation of the adjacent levels. Clinical results [Patient Global Impression of Change (PGIC), Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI)] as well as imaging outcomes (restoration and preservation of the heights of the vertebral body) were studied. The mean follow-up time corresponded to 3.17 years (range, 1-7.5 years).

Results

Most of the clinical-functional and imaging parameters showed important improvements after surgical treatment, with few complications. A statistically significant greater degree of functional improvement was found in plana vertebrae when compared to non-plana, which reflects that the first are quite symptomatic and disabling at the beginning and improve a lot with surgical treatment. Significant indirect correlations were found between the time from the initial fracture to surgical intervention after diagnosis of vertebral necrosis and the anterior sagittal height in the immediate postoperative time and at the ending of the follow-up. Also, a significant direct correlation was identified between this time and the VAS for pain at the end of the follow-up and the PGIC scale in the same period. It was also found that patients with surgical complications had a statistically significantly longer time between the initial fracture and surgery for post-traumatic necrosis.

Conclusions

We present the results of a surgical therapeutic algorithm that includes the use of recent expansive intravertebral implants at post-traumatic vertebral osteonecrosis, resulting in satisfactory clinical, functional and imaging results. This work shows a pioneering statistical demonstration of the clinical, functional and imaging importance of early detection of this condition (ideally in vertebrae non-plana morphology stages), so that there is still sufficient bone tissue in the vertebral body to permit the stabilization and restoration of its anatomy through a minimally invasive interior reconstruction, with percutaneous access and quicker convalescence, that is to say, armed kyphoplasty, avoiding the unwanted disease progression that will require more aggressive surgical solutions that doesn't allow anatomical restauration.

The role of kyphoplasty and expandable intravertebral implants in the acute treatment of traumatic thoracolumbar vertebral compression fractures: a systematic review

Purpose

The aim of the study was to assess the role of kyphoplasty and expandable intravertebral implants in the treatment of traumatic vertebral compression fractures.

Design

This is a systematic review.

Methods

A bibliographic search was carried out in the PubMed/MEDLINE database according to PRISMA guidelines regarding kyphoplasty and expandable intravertebral implants in the treatment of traumatic thoracolumbar vertebral fractures.

Results

A total of 611 records were screened. In total, 51 studies were obtained referring to traumatic vertebral fractures treated with kyphoplasty; however, of these, only studies addressing traumatic burst fractures were selected, resulting in 12 studies: 10 about kyphoplasty and 2 regarding armed kyphoplasty. In all studies, there was a statistically significant improvement in clinical and functional parameters, restoration of vertebral height and decreasing of vertebral and segmental kyphosis. Overall, there was only a residual loss of height and a slight increase in kyphosis throughout the follow-up period, while complications consisted essentially of cement leakage, all with no clinical repercussions.

Conclusion

After the discussion, where we address the concepts of direct and indirect reduction, the association of kyphoplasty with pedicle fixation, the potential advantages of expandable intravertebral implants, as well as the vertebral body type of filling in kyphoplasty, it is concluded that kyphoplasty demonstrates favorable outcomes as a method of posterior percutaneous transpedicular access for reconstruction of the anterior column in burst fractures. It allows for the reconstruction of the vertebral body closer to its original anatomy, carried out in a minimally invasive and safe way, which provides a clinical-functional and imaging improvement maintained at the medium-long term.

Multidisciplinary and Coordinated Management of Osteoporotic Vertebral Compression Fractures: Current State of the Art

Osteoporotic vertebral compression fractures (OVCFs) present a significant health concern, affecting a substantial portion of the older adult population worldwide. This narrative review explores the prevalence, diagnostic challenges and management strategies for OVCFs. Despite the increasing incidence and impact on morbidity and mortality, existing clinical guidelines lack consistency and clear diagnostic and therapeutic recommendations. The review addresses key questions faced by physicians dealing with older adult patients experiencing acute back pain, offering insights into triage, radiological assessments and classification systems. We propose a comprehensive algorithm for clearing OVCF, considering clinical presentation, radiological findings and morphological aspects. Emphasis is placed on the importance of medically treating osteoporosis alongside OVCF management. The review encompasses relevant literature from 1993 to 2023, provides a detailed discussion on triage issues and incorporates a clinically oriented classification system developed by the German Society for Orthopaedics and Trauma. The Material and Methods section outlines the extensive literature search carried out in PUBMED, encompassing clinical and experimental studies, systematic reviews and meta-analyses. The articles retained focused mainly on answering critical questions regarding radiological assessments, imaging modalities and the presence of a specific classification system for OVCFs. The review emphasises that the evaluation and management of OVCFs necessitates a multidisciplinary approach involving spine specialists and bone disease experts. It also addresses the role of conservative versus surgical treatments, with a focus on percutaneous vertebral augmentation. The conclusion summarises the algorithm derived for use in emergency departments and general practice, aiming to streamline OVCF management, reduce unnecessary examinations and ensure optimal patient care. The algorithm recommends primary diagnosis using computed tomography, with magnetic resonance imaging reserved for specific cases. The review advocates a holistic approach, integrating medical and surgical interventions to address the complex challenges posed by OVCFs in ageing populations.

EXPANDABLE INTRAVERTEBRAL IMPLANTS IN POST-TRAUMATIC VERTEBRAL NECROSIS - NEW CLASSIFICATION SUGGESTION

The progressive evolution of post-traumatic vertebral necrosis and consequent loss of structural integrity of the vertebral body along with neurological risk, makes it one of the most feared and unpredictable pathologies in spine traumatology. Several studies have addressed the role of vertebroplasty, kyphoplasty, and corpectomy in its treatment; however, it remains a controversial concept without a defined therapeutic algorithm. The recent emergence of expandable intravertebral implants, which allow, by a percutaneous transpedicular application, the capacity for intrasomatic filling and maintenance of the height of the vertebral body, makes them a viable option, not only in the treatment of acute vertebral fractures, but also in non-union cases. In this study, we present a review of the current evidence on the application of expandable intravertebral implants in cases of post-traumatic vertebral necrosis. Based on the available scientific literature, including previous classifications of post-traumatic necrosis, and on the mechanical characteristics of the main expandable intravertebral implants currently available, we propose a simplified classification of this pathology, considering parameters that influence surgical therapeutic guidance, the morphology and the dynamics of the necrotic vertebra's mobility. According to its stages and based on authors' experience and on the scarce literature, we propose an initial therapeutic algorithm and suggest preventive strategies for this disease, considering its main risk factors, that is, fracture comminution and impairment of vertebral vascularity. Therefore, expandable intravertebral implants have a promising role in this condition; however, large prospective studies are needed to confirm their efficacy, to clarify the indications of each of these devices, and to validate the algorithm suggestion regarding treatment and prevention of post-traumatic vertebral necrosis. Level of Evidence III, Systematic Review/Actualization.

Percutaneous Vertebral Reconstruction (PVR) Technique of Pathological Compression Fractures: An Innovative Combined Treatment of Microwave Ablation, Bilateral Expandable Titanium SpineJack Implants Followed by Vertebroplasty

(1) Background: to retrospectively evaluate safety and efficacy of combined microwave ablation (MWA) and bilateral expandable titanium SpineJack (SJ) implants followed by vertebroplasty (VP) for the treatment of painful thoracolumbar pathological vertebral compression fracture. (2) Methods: from July 2017 to October 2022, twenty-eight patients (13 women and 15 men; mean age 68 ± 11 years) with a history of primary neoplasm and thirty-six painful vertebral metastases with vertebral compression fracture underwent combined MWA and bilateral expandable titanium SpineJack implants with vertebroplasty. We analyzed safety through complications rate, and efficacy through vertebral height restoration and pain decrease, evaluated using a visual analogue scale (VAS), and Functional Mobility Scale (FMS), and local tumor control. Contrast-enhanced CT scans were performed at 1, 3, and 6 months and a contrast-enhanced spine MRI at 6 months after the procedure. (3) Results: Technical success rate was 100%. No procedure-related major complications or death occurred. Vertebral height restoration was observed in 22 levels (58%), with a mean anterior height restoration of 2.6 mm ± 0.6 and a mean middle height restoration of 4.4 mm ± 0.6 (p < 0.001). Mean VAS score of pain evaluation on the day before treatment was 6.3 ± 1.5 (range 4-9). At the 6-month evaluation, the median VAS score for pain was 0.4 ± 0.6 (range 0-2) with a mean reduction of 93.65% (6.8 ± 0.7 vs. 0.4 ± 0.6; p < 0.000) compared with baseline evaluation. Contrast-enhanced CT scans were performed at 1, 3, and 6 months and a contrast-enhanced spine MRI was performed at 6 months after the procedure, showing no local recurrence, implant displacement, or new fractures in the treated site. (4) Conclusions: combined microwave ablation and bilateral expandable titanium SpineJack implants with vertebroplasty is a safe and effective procedure for the treatment of pathological compressive vertebral fractures. The vertebral stabilization achieved early and persistent pain relief, increasing patient mobility, improving recovery of walking capacity, and providing local tumor control.

Re-expansion of vertebral compression fractures in patients with multiple myeloma with percutaneous vertebroplasty using spinejack implants: a preliminary and retrospective study

Objective

To retrospectively evaluate the feasibility and effectiveness of vertebroplasty using Spinejack implantation for the treatment and stabilization of painful vertebral compression fractures, in patients diagnosed with Multiple Myeloma (MM), to allow both an effective pain reduction and a global structural spine stabilization.

Materials and Methods

From July 2017 and May 2022 thirty-nine patients diagnosed MM, with forty-nine vertebral compression fractures underwent percutaneous Vertebroplasty using Spinejack Implants. We analyzed the feasibility and complications of the procedure, the decrease in pain using visual analogue scale (VAS) and Functional Mobility Scale (FMS).

Results

The technical success rate was 100%. No procedure-related major complications or death occurred. In the 6-month follow-up, the mean VAS score decreased from 5.4 ± 1.0 to 0.2 ± 0.5 with a mean reduction of 96.3%. FMS decreased from 2.3 ± 0.5 vs. 1.2 ± 0.4 with a mean reduction of -47.8%. There were no major complications related to incorrect positioning of the Expandable Titanium SpineJack Implants. In five patients, a cement leak was observed with no associated clinical manifestations. The average length of hospital stay was 6-8 Hours6.6 ± 1.2 h. No new bone fractures or local disease recurrence occurred during a median contrast-enhanced CT follow-up of 6 months.

Conclusions

Our results suggest that vertebroplasty, using Spinejack implantation for the treatment and stabilization of painful vertebral compression fractures, secondary to Multiple Myeloma is a safe and effective procedure with long - term pain relief and restoration of vertebral height.

Innovative minimally invasive implants for osteoporosis vertebral compression fractures

With increasing population aging, osteoporosis vertebral compression fractures (OVCFs), resulting in severe back pain and functional impairment, have become progressively common. Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) as minimally invasive procedures have revolutionized OVCFs treatment. However, PVP- and PKP-related complications, such as symptomatic cement leakage and adjacent vertebral fractures, continue to plague physicians. Consequently, progressively more implants for OVCFs have been developed recently to overcome the shortcomings of traditional procedures. Therefore, we conducted a literature review on several new implants for OVCFs, including StaXx FX, Vertebral Body Stenting, Vesselplasty, Sky Bone Expander, Kiva, Spine Jack, Osseofix, Optimesh, Jack, and V-strut. Additionally, this review highlights the individualized applications of these implants for OVCFs. Nevertheless, current clinical studies on these innovative implants remain limited. Future prospective, randomized, and controlled studies are needed to elucidate the effectiveness and indications of these new implants for OVCFs.

Sagittal correction after short percutaneous fixation for thoracolumbar compression fractures: comparison of the combination of SpineJack® kyphoplasty and fractured vertebra screw fixation

PURPOSE

The aim of this study was to compare two percutaneous pedicle fixations for the treatment of thoracolumbar fractures: one associating a jack kyphoplasty (SpineCut) and the other using intermediate screws (Trident).

METHODS

All adult patients treated for single-level Magerl/AO type A thoracolumbar traumatic fractures in four orthopaedic departments, with SpineCut or Trident, with a one year minimum follow-up, were retrospectively included. Neurological disorders and osteoporotic fractures were not included. The following data were collected: age, sex, Magerl/AO type, type of surgery, and complications. Radiological parameters were analyzed on pre-operative CT scan, and on standing X-rays before discharge, at three months and one year post-operative: vertebral wedge angle (VWA), regional kyphosis angle (RKA), and traumatic regional angulation (TRA: difference between RKA and physiological values for each vertebra).

RESULTS

Eighty patients were included, with 42 patients in SpineCut group and 38 in Trident group. Mean age was 41 ± 15.7 years. TRA correction did not differ between the groups: respectively 11.2 ± 8.1° in SpineCut versus 10.2 ± 9.1° in Trident group (p = 0.52). TRA loss of correction between early post-operative and three months was statistically higher in Trident group: -4 ± 5.1° versus -1.5 ± 3.8° (p = 0.03). After 3 months, TRA correction loss was comparable between the groups. Multivariate analysis demonstrated that pre-operative VWA was the only factor significantly associated with early TRA correction loss (p = 0.01). VWA correction and loss of correction did not differ significantly between the groups. No complications were observed.

CONCLUSION

Percutaneous pedicle fixations of traumatic thoracolumbar fractures associating jack kyphoplasty and intermediate screws are both safe and efficient techniques.

Biomechanical evaluation of a novel tri-blade titanium implantable vertebral augmentation device

BACKGROUND CONTEXT

Titanium implantable vertebral augmentation device (TIVAD) are regarded as having potential in the treatment of vertebral compression fractures (VCFs). However, improper design in current TIVADs results in the inability to effectively restore VCF height and maintain stability. There is still an unmet clinical need for improvement.

PURPOSE

The authors tested a newly developed a TIVAD (Tri-blade fixed system) that can provide enough endplate collapse support to restore the vertebral body height in a safe retraction mechanism for VCFs using minimally invasive surgery (MIS).

STUDY DESIGN

The performed biomechanical tests included blade expansion force, lifetime of cement embedded and vertebral height restoration efficiency of porcine osteoporosis VCFs for its feasibility.

METHODS

A cylinder with 3 surface cuts that form blades that can be expanded into a conical space was designed (Tri-blade fixed system). The 3 blades can be expanded outward with angles between blades as 105°/ 105°/150° for lower left/lower right/upper arms, respectively that reach 15mm in height and 14.8 mm in width. A frame was specifically designed to measure the contact force using force sensing resistors during blade expansion. The Tri-blade fixed system was embedded into a cement block to perform fatigue testing under 2000N pressure (5*10⁶ cycles) for understanding the device lifetime limitation. The Tri-blade system was then inserted into porcine osteoporosis VCFs to examine the vertebral height restoration efficiency.

RESULTS

The average maximum contact force for the top, bottom left and right blades were 299.0N, 283.5N and 279.3N, respectively with uniformly outward expansion forces. The fatigue test found that there were no obvious cracks or damage to the cement block. The porcine osteoporosis vertebral body at the anterior, middle, and posterior heights can be restored to 21.9%, 12.6% and 6.4%, respectively.

CONCLUSIONS

This study developed a novel TIVAD with conical shape that can provide a more stable structure with sufficient/uniform expansion force, passing the fatigue test with bone cement and high effective in vertebral height restoration tests for porcine osteoporosis VCFs.

CLINICAL SIGNIFICANCE

The new 3D Tri-blade TIVAD may offer a new treatment option for VCFs.

Advances in the management of spinal metastases: what the radiologist needs to know

Spine is the most frequently involved site of osseous metastases. With improved disease-specific survival in patients with Stage IV cancer, durability of local disease control has become an important goal for treatment of spinal metastases. Herein, we review the multidisciplinary management of spine metastases, including conventional external beam radiation therapy, spine stereotactic radiosurgery, and minimally invasive and open surgical treatment options. We also present a simplified framework for management of spinal metastases used at The University of Texas MD Anderson Cancer Center, focusing on the important decision points where the radiologist can contribute.

"Double Cross Sign" Could Be an Indicator of an Adequate Amount of Bone Cement in Kyphoplasty with the SpineJack System: A Retrospective Study

Kyphoplasty with the SpineJack system was able to restore vertebral height and stabilize the vertebra with an injection of bone cement. The goal of this study was to seek a reliable assessing method during the surgery in determining the minimum amount of bone cement required for the SpineJack system to restore vertebral height and stabilize the vertebra. We defined the “double cross sign” as bone cement that expanded vertically along the bilateral SpineJack system, and spread across the midline of the vertebral body as viewed in the anteroposterior (AP) view of the radiographic image. Sixty-five patients aged 74.5 ± 8.5 years with vertebral compression fracture were included in the study. Patients with a positive double cross sign had better ODI score than those without the double cross sign (20.0 ± 6.9 vs. 32.3 ± 8.2; p < 0.001). Postoperative regional kyphotic and local kyphotic angle were significantly better in the positive double cross sign group (11 ± 8.8 degrees vs. 5.3 ± 3.2 degrees; p = 0.001/11.7 ± 6.2 degrees vs. 6.6 ± 4.1 degrees; p = 0.001, respectively). The more stable construct was built once the double cross sign was achieved during surgery. In this study, a convenient and intuitive method in identifying the minimum but sufficient quantity of injected cement during the SpineJack procedure was developed.

Treatment of thoracolumbar burst fractures: SpineJack vs. posterior arthrodesis-comparison of clinical and radiological outcomes

BACKGROUND

Thoracolumbar fractures sometimes require anterior support and post-traumatic deformity correction. SpineJack proved favorable results in cadaveric and clinical studies, with satisfactory pain relief, vertebral height restoration, and low rates of above adjacent fractures, in neurologically intact fractures. We compared patients' clinical and radiological outcomes of thoracolumbar fractures treated either with posterior arthrodesis or SpineJack.

METHODS

We prospectively collected A2 split and A3, and A4 burst fractures between 2017 and 2021. Patients were stratified in posterior arthrodesis (PA group) and SpineJack (SJ group) and included if age ≥18 years, T11-L3 level, emergent or elective surgery, single or multiple, and neurologically intact. Age, sex, type and level, pain, operative and discharge time, vertebral body heights (VBH), posterior wall retropulsion (PWR), vertebral kyphosis (VK) and local kyphosis (LK) angles, vertebral body (VB) volume, and complications were collected. We then compared clinical-radiographic outcomes between the two groups.

RESULTS

We found no significant differences in median postoperative pain while operative time and discharge time were shorter for SJ patients than PA ones (P<0.001). Mean anterior VBH increase was 20.7%, mid-VBH was 25.5%, and posterior VBH was 8.8%, while increase in VB volume was 26.2%. SJ patients had non-inferior VK e LK angles correction to PA ones. Mean PWR value between pre and post SJ implantation was 0.15±0.65 mm, and no adjacent above-level fractures occurred.

CONCLUSIONS

We showed satisfactory outcomes in a selected range of neurologically intact thoracolumbar split or burst fractures. SJ leads to shorter operative and discharge time and good VB angles and diameters restoration.

Therapeutic Efficacy of Third-Generation Percutaneous Vertebral Augmentation System (PVAS) in Osteoporotic Vertebral Compression Fractures (OVCFs): A Systematic Review and Meta-analysis

Purpose

This study aimed to assess whether the third-generation PVAS was superior to percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) in treating patients with OVCFs.

Methods

Databases, including Pubmed, Embase, and Cochrane library, were searched to identify relevant interventional and observational articles in vivo or in vitro comparing the third-generation PVAS to PVP/PKP in OVCFs patients. A meta-analysis was performed under the guidelines of the Cochrane Reviewer's Handbook.

Results

11 in vivo articles involving 1035 patients with 1320 segments of diseased vertebral bodies and 8 in vitro studies enrolling 40 specimens with 202 vertebral bodies were identified. The vivo studies indicated no significant differences were found in visual analog scale (VAS), Oswestry Disability Index (ODI), operation time, or injected cement volume (P > 0.05). The third-generation PVAS was associated with significant improvement in vertebral height and Cobb angle (P < 0.05) and also with a significantly lower risk of cement leakages and new fractures (P < 0.05). The vitro studies suggest that the third-generation PVAS was associated with better anterior vertebral height (AVH) and kyphotic angle (KA) after deflation and cement. No significant differences were found in stiffness or failure load after cement between the two groups (P > 0.05).

Conclusion

Based on current evidence, although providing similar improvement in VAS and ODI, the third-generation PVAS may be superior to PVP/PKP in local kyphosis correction, vertebral height maintenance, and adverse events reduction. Further high-quality randomized studies are required to confirm these results.

Efficiency of a novel vertebral body augmentation system (Tektona™) in non-osteoporotic spinal fractures

BACKGROUND

The restauration of the local kyphosis is crucial to thoracolumbar fractures outcomes. Recently, the Tektona™ (Spine Art) system, constituted by a flexible lamella for corporeal reduction has emerged as a promising solution for osteoporotic fractures. However, no study has yet focused on its results on traumatic fractures.

METHODS

A retrospective longitudinal study on prospectively collected data was conducted on 53 patients that had a kyphoplasty by Tektona™, associated or not to percutaneous fixation. The data collected were clinical, surgical and scannographic (measurement of AVH, MVH and PVH (anterior/medium/posterior vertebral height), and RTA (regional traumatic angle) in°), preoperatively, post-operatively and at last follow-up.

RESULTS

Fractures were mainly located at the upper lumbar spine and were AOSpine A3 type for 74%. The mean RTA was 12° in pre-operative, 4° in post-operative (p = 2e- 9), and 8° at the last follow-up (p = 0,01). The mean correction of RTA for the fixation group was - 10 ± 6° versus - 7 ± 4° for the kyphobroplasty alone group (p = 0,006). The mean correction for fractures located at T10-T12 was - 9 ± 3°, - 9 ± 5° for L1, - 8 ± 3° for L2 and - 5 ± 3° for L3-L5 (p = 0,045).

CONCLUSIONS

The Tektona® system appears to be efficient for acute thoraco-lumbar fractures, comparable to other available systems, allowing a real intracorporeal reduction work. Its relevance, especially in the long term needs further investigation. The association of a percutaneous fixation allow to obtain a better correction of the RTA but did not seem to prevent the loss of correction at follow-up.

INTRAVERTEBRAL EXPANDABLE IMPLANTS IN THORACOLUMBAR VERTEBRAL COMPRESSION FRACTURES

Current scientific evidence enhances the importance of the anatomic restauration of vertebral bodies with compression fractures aiming, as with other human body joints, to obtain a biomechanic and functional spine as close as the one prior to the fracture as possible. We consider that anatomic reduction of these fractures is only completely possible using intravertebral expandable implants, restoring vertebral endplate morphology, and enabling a more adequate intervertebral disc healing. This enables avoiding disc and osteodegenerative changes to that vertebral segment and its adjacent levels, as well as the anterior overload of adjacent vertebral bodies in older adults - a consequence of post-traumatic vertebral flattening - thus minimizing the risk of adjacent vertebral fractures. The ability of vertebral body fracture reduction and height maintenance over time and its percutaneous transpedicular application make the intra-vertebral expandable implants a very attractive option for treating these fractures. The authors show the direct and indirect reduction concepts of vertebral fractures, review the biomechanics, characteristics and indications of intravertebral expandable implants and present a suggestion for updating the algorithm for the surgical treatment of vertebral compression fractures which includes the use of intravertebral expandable implants. Level of Evidence V, Expert Opinion.

Vertebroplasty, Kyphoplasty, and Implant-Based Mechanical Vertebral Augmentation

Vertebral compression fractures are a global public health issue with a quantifiable negative impact on patient morbidity and mortality. The contemporary approach to the treatment of osteoporotic fragility fractures has moved beyond first-line nonsurgical management. An improved understanding of biomechanical forces, consequential morbidity and mortality, and the drive to reduce opioid use has resulted in multidisciplinary treatment algorithms and significant advances in augmentation techniques. This review will inform musculoskeletal radiologists, interventionalists, and minimally invasive spine surgeons on the proper work-up of patients, imaging features differentiating benign and malignant pathologic fractures, high-risk fracture morphologies, and new mechanical augmentation device options, and it describes the appropriate selection of devices, complications, outcomes, and future trends.

Multilevel percutaneous vertebroplasty with the Spine Jack® system in a patient with Cushing disease

BACKGROUND

Percutaneous vertebroplasty (PV) is a minimally invasive procedure that requires the injection of cement into a fractured vertebral body. Spine Jack® is a vertebroplasty system with an intracorporal implant designed to restore the height of the vertebral body in osteoporotic vertebral fractures. There are no reported cases of PV with Spine Jack® system as treatment for multilevel compression fractures in patients with vertebral osteoporosis due to Cushing disease.

CASE PRESENTATION

A 55-year-old man with lumbago, impaired deambulation 6 weeks prior to presentation, with Oswestry score of 72% and a visual analogue scale (VAS) score of 9 points. Imaging studies showed osteoporotic fractures at T5, T8, T11, T12, and L1-L5 vertebrae secondary to Cushing disease. PV was performed with a Spine Jack® intracorporal implant device, in three sessions, and multiple levels were operated at each intervention. Post-operative course demonstrated improvement of pain, height, correction of the kyphotic angle and Oswestry score, without any neurological deficits despite having nine vertebral fractures.

CONCLUSION

Percutaneous vertebroplasty with the Spine Jack® system is a safe and effective procedure to treat multilevel vertebral fractures due to Cushing disease, improving the quality of life and allowing the patient to remain pain-free while avoiding major surgery.

Expandable Intravertebral Implants: A Narrative Review on the Concept, Biomechanics, and Outcomes in Traumatology

Expandable intravertebral implants are self-expanding devices applied percutaneously by the posterior transpedicular approach. These devices introduce the concept of anatomical restoration of vertebral body endplates and direct anatomical reduction performed from the interior of the vertebral body with a compression fracture. This paper aims to provide a narrative review on the concept, indications, biomechanical characteristics, as well as functional and radiographic outcomes of the main expandable intravertebral implants currently available, in terms of their application to thoracolumbar spine traumatology. To this end, we performed a search in July 2021 on the MEDLINE/PubMed platform with the words "expandable intravertebral implant", "armed kyphoplasty", "Vertebral Body Stenting" or "stentoplasty" and "SpineJack". The search yielded 144 papers, and of those, we included 15 in this review. We concluded that percutaneous transpedicular posterior access, the ability to reduce vertebral body fractures, particularly of the vertebral endplates and to maintain the vertebral body height, makes the application of expandable intravertebral implants an attractive option in the treatment of thoracolumbar vertebral compression fractures. However, more prospective, randomized, and large-scale blinded studies are still warranted, especially comparative studies between treatments and about the preferential use of an expansive implant over others, in order to gain definitive insights into the effectiveness and indications of each of these devices.

Biomechanical comparative evaluation of percutaneous fixations with vertebral expansion for vertebral compression fractures: an experimental and finite element study

This study uses in vitro experiments and validated finite element models (FEM) to analyze the effect of posterior fixation, alone or associated with expandable device (ED) and/or cement. 3-dimensional FEMs of intact, fractured and instrumented spine were built and compared with experimental load-displacement curves. FEM ranges of motion were within the experimental corridors. Stresses appeared sensitive to both implant configuration and fracture severity with a stress reduction up to 84%. The FEM highlighted that for a same instrumental strategy, different biomechanical performances were observed according to fracture severity. When bone continuity is altered, both ED and cement may be needed.

Is Kummell's Disease a Misdiagnosed and/or an Underreported Complication of Osteoporotic Vertebral Compression Fractures? A Pattern of the Condition and Available Treatment Modalities

This narrative review provides the outcomes of minimally invasive surgery (MIS) and describes the available conservative treatment options for patients with osteoporotic vertebral compression fractures (OVCFs) that have risk factors for Kummell's disease (KD). It aims to explore the evidence, emphasize the possible therapy complications, and aims to propose the most efficient clinical strategies for maintaining a good overall condition of individuals who may suffer from neurological deficits from a late-diagnosed OVCF complication. The secondary objective is to sum up the diagnostic particularities concerning individuals prone to OVCFs and KD, as the major risk factor for developing these severe conditions remains osteoporosis. Findings of our narrative review are based on the results found in PubMed, Embase, and Google Scholar from the beginning of their inception to December 2020, described independently by two authors. All of the studies included in the review focus on reporting the following treatment methods: conservative methods, vertebroplasty, kyphoplasty, targeted percutaneous vertebroplasty, frontal and side-opening cannula vertebroplasty, SpineJack, bone-feeling mesh container treatment, and the difference in the cement viscosity used (high vs. low) and the approach used (unilateral vs. bilateral). The comparison of randomized control trials (RCTs) as well as prospective and retrospective case series showed a comparable efficacy of kyphoplasty and vertebroplasty, and described cement-augmented screw fixation and the SpineJack system as effective and safe. Although it should be noted that several studies revealed inconsistent results in regards to the efficacy of using back braces and analgesics in patients who had vertebral fractures that were overlooked or not enrolled in any active surveillance program to track the patient's deterioration immediately. Nevertheless there are non-standardized guidelines for treating patients with OVCFs and their complications already established. Using these guidelines, a treatment plan can be planned that takes into consideration the patients' comorbidities and susceptibilities. However, the primary approach remains the management of osteoporosis and that is why prophylaxis and prevention play a crucial role. These measures reduce the risk of disease progression. Unfortunately, in the majority of cases these measures are not taken into account and KD develops.

Advances in Vertebral Augmentation Systems for Osteoporotic Vertebral Compression Fractures

Osteoporotic vertebral compression fracture (OVCF) is a common cause of pain and disability and is steadily increasing due to the growth of the elderly population. To date, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are almost universally accepted as appropriate vertebral augmentation procedures for OVCFs. There are many advantages of vertebral augmentation, such as short surgical time, performance under local anaesthesia, and rapid pain relief. However, there are certain issues regarding the utilization of these vertebral augmentations, such as loss of vertebral height, cement leakage, and adjacent vertebral refracture. Hence, the treatment for OVCF has changed in recent years. Satisfactory clinical results have been obtained worldwide after application of the OsseoFix System, the SpineJack System, radiofrequency kyphoplasty of the vertebral body, and the Kiva VCF treatment system. The following review discusses the development of the current techniques used for vertebral augmentation.

Efficacy of a Novel Vertebral Body Augmentation System in the Treatment of Patients with Symptomatic Vertebral Body Fractures

Purpose

To evaluate the safety and efficacy of a novel augmentation implant in the treatment of patients with symptomatic vertebral body fractures.

Materials and Methods

Thirty consecutive patients (seven males and 23 females), mean age of 70 years (range 56 to 89) with osteoporotic fractures and/or low-energy trauma fractures (osteoporosis confirmed by CT), were enrolled in an IRB-approved prospective study. The type of fracture was classified according to the Magerl classification. The patients were treated with the Tektona^® dedicated vertebral body augmentation system. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were obtained after 1, 6 and 12 months. Quality of life was assessed with the SF36 score.

Results

A total of 37 vertebral bodies, mostly from T6 to L5, were treated in the 30 enrolled patients. In 67.6% of the cases (n = 25), lumbar fractures were treated. Most of the fractures (43%; n = 16) were A1.1 according to the Magerl classification. A significant pain reduction evaluated by VAS scores (p < 0.0001) was observed on average 7.6 (before the procedure) to 2.8 (immediately post-treatment), 2.1 and 2.7 (after 6 and 12 months later, respectively). The mean ODI score was 55.5% before treatment, and this was statistically significant reduced to 22.3% and 26.9%, respectively, at 6 and 12 months after treatment (p < 0.0001). The SF36 scores, both physical and mental components, showed statistically significant variations (p < 0.0001) whose direction was subpopulation dependent.

Conclusion

Patients with confirmed osteoporosis, suffering from symptomatic vertebral body fractures (osteoporotic and/or low-energy traumatic), were treated safely and effectively using this novel implant.

Clinical and radiological evaluation of thoracic spine fractures with or without sternal fracture: is there a need for ventral stabilization?

OBJECTIVE

The treatment of thoracic spine (TS) fractures with additional sternal fractures compared to TS fractures without sternal fractures is discussed controversionally, because in some studies it was stated that sternal fractures decrease the thoracic stability. We hypothesized that both types of fractures can be treated the same way by posterior stabilization alone.

METHODS

A total number of 69 patients with thoracic fractures, with or without additional sternal fractures, were examined, regarding the angle of kyphosis after fracture, postoperatively and after 6 and 12 months. We also recorded the outcome using the Odom's score and the time until patients returned to work and the activity level.

RESULTS

It was found that the angle of kyphosis was nearly physiological after stabilization in both groups and a loss of reduction after 1 year was also comparable, either in the patients suffering from the additional sternal fracture or not. In addition, the Odom's score and the time until return to work and the activity level were comparable in both groups.

CONCLUSION

We did not find any arguments to preserve additional anterior stabilization or reasons for different treatment strategies either additional sternal fractures occur in thoracic spine fractures or not.

Vertebral Compression Fractures Treated in Acute by Instrumented Kyphoplasty: Early and Mid-Term Clinical and Radiological Results

The treatment of traumatic low-degree vertebral compression fracture remains in a wide range between functional treatment, bracing, vertebroplasty, kyphoplasty, and even surgical fixation. The objective was to assess the innovation of instrumented kyphoplasty and to report the early and mid-term functional and radiological results. This study is a retrospective review of patients enrolled from 2012 to 2017. 104 consecutive endovertebral implantations of instrumented kyphoplasty were reviewed for the study. There were 56 women and 48 men. 93 of 104 patients were evaluated, of whom 27 were evaluated only by retrospective medical record review and 66 with follow-up visit. Clinical parameters were the pain rating scale (VAS) and the Oswestry score questionnaire. The radiological parameters were the vertebral kyphosis, vertebral height, lumbar lordosis, and adjacent disc degeneration (UCLA scale). Statistical correlations between before/after surgery/last follow-up were performed. The average follow-up was 26.7 months (3 to 55). The average VAS decreased from 8.2 to 3.2 the day after surgery, allowing immediate standup. The average Oswestry score was 14.6 at follow-up. The average vertebral kyphosis decreased from 12.9° to 6.5° post-op and stabilized at 8.0° at the last follow-up, corresponding to 28% gain on vertebral height. The lumbar lordosis was restored (+6.6°). Adjacent disc degeneration increased by 1 UCLA grade in 17 patients (16.3%) at follow-up. The instrumented kyphoplasty in acute led to immediate and lasting pain relief, with no bracing or bed rest, short stay in hospital, and quick return to daily life including professional activities. The good clinical results were associated to a stable radiological restoration of the vertebral anatomy.

A prospective, international, randomized, noninferiority study comparing an implantable titanium vertebral augmentation device versus balloon kyphoplasty in the reduction of vertebral compression fractures (SAKOS study)

BACKGROUND CONTEXT

Balloon kyphoplasty (BKP) is a commonly performed vertebral augmentation procedure for painful osteoporotic vertebral compression fractures (OVCFs).

OBJECTIVE

This study aimed to support a non-inferiority finding for the use of a titanium implantable vertebral augmentation device (TIVAD) compared to BKP.

STUDY DESIGN

Prospective, parallel group, controlled comparative randomized study.

PATIENT SAMPLE

Patients who presented with one or two painful OVCFs located between T7 and L4 aged <3 months, failed conservative treatment, and had an Oswestry Disability Index (ODI) score ≥30/100 were eligible for the study.

OUTCOME MEASURES

The primary composite endpoint was defined as: reduction in VCF fracture-related pain at 12 months from baseline and maintenance or functional improvement (ODI) at 12 months from baseline, and absence of device-related adverse event or surgical reintervention. If the primary composite endpoint was successful, a fourth component (absence of adjacent level fracture) was added for analysis. If the analysis of this additional composite endpoint was successful, then midline target height restoration at 6 and 12 months was assessed. Secondary clinical outcomes included back pain intensity, ODI score, EQ-5D index score (range 0=death to 1=full health) and EQ-VAS score (range 0-100).

METHODS

Patients were recruited in 13 hospitals across 5 countries and were randomly assigned (1:1) to either TIVAD or BKP with electronic randomization as described in the protocol. A total of 152 patients with OVCFs were initially randomized. Eleven patients were excluded (six met exclusion criteria, one with evidence of tumor, and four patients had T score out of requested range). Anterior vertebral body height ratio, midline vertebral body height ratio, and Cobb angle were measured preoperatively and postoperatively by an independent imaging core lab. Adjacent and subsequent fractures and safety parameters were recorded throughout the study. Cement extravasation was evaluated on X-rays. All patients were followed at screening at 5 days, 1 month, 6 months, and 12 months postoperatively. This study was supported by Vexim SA. Seven authors received study-specific support less than $10,000 per year and seven authors received no study-specific support.

RESULTS

Among the 141 patients (78.7% female, mean age 73.3±9.5 years) who underwent surgery (TIVAD=68; BKP=73), 126 patients (89.4%) completed the 12-month follow-up period (TIVAD=61; BKP=65). The analysis of primary endpoint on the ITT population demonstrated non-inferiority of the TIVAD to BKP. The analysis of the additional composite endpoint demonstrated the superiority of TIVAD over BKP (p<0.0001) at 6 months (88.1% vs. 60.9%) and at 12 months (79.7% vs. 59.3%). Midline VB height restoration was more improved for TIVAD than for BKP at 6 months (1.14±2.61 mm vs. 0.31±2.22 mm); p=0.0246) and 12 months after surgery (1.31±2.58 mm vs. 0.10±2.34 mm; p=0.0035). No statistically significant differences were shown between procedures for improvement in functional capacity and quality of life. Pain relief was significantly more marked in the TIVAD group compared to the BKP group at 1 month (p=0.029) and at 6 months (p=0.021) after surgery. No patient required surgical reintervention or retreatment at the treated level. No symptomatic cement leakage was reported. Adverse events were similar for both groups (41.2% in the TIVAD group and 45.2% in the BKP group). The incidence of adjacent fractures was significantly lower after the TIVAD procedure than after BKP (12.9% vs. 27.3%; p=0.043).

CONCLUSIONS

Study results demonstrated non-inferiority of the TIVAD to the predicate BKP with an excellent risk/benefit profile for results up to 12 months.

Armed Kyphoplasty: An Indirect Central Canal Decompression Technique in Burst Fractures

BACKGROUND AND PURPOSE

Burst fractures are characterized by middle column disruption and may feature posterior wall retropulsion. Indications for treatment remain controversial. Recently introduced vertebral augmentation techniques using intravertebral distraction devices, such as vertebral body stents and SpineJack, could be effective in fracture reduction and fixation and might obtain central canal clearance through ligamentotaxis. This study assesses the results of armed kyphoplasty using vertebral body stents or SpineJack in traumatic, osteoporotic, and neoplastic burst fractures with respect to vertebral body height restoration and correction of posterior wall retropulsion.

MATERIALS AND METHODS

This was a retrospective assessment of 53 burst fractures with posterior wall retropulsion and no neurologic deficit in 51 consecutive patients treated with armed kyphoplasty. Posterior wall retropulsion and vertebral body height were measured on pre- and postprocedural CT. Clinical and radiologic follow-up charts were reviewed.

RESULTS

Armed kyphoplasty was performed as a stand-alone treatment in 43 patients, combined with posterior instrumentation in 8 and laminectomy in 4. Pre-armed kyphoplasty and post-armed kyphoplasty mean posterior wall retropulsion was 5.8 and 4.5 mm, respectively (P < .001), and mean vertebral body height was 10.8 and 16.7 mm, respectively (P < .001). No significant clinical complications occurred. Clinical and radiologic follow-up (1-36 months; mean, 8 months) was available in 39 patients. Three treated levels showed a new fracture during follow-up without neurologic deterioration, and no retreatment was deemed necessary.

CONCLUSIONS

In the treatment of burst fractures with posterior wall retropulsion and no neurologic deficit, armed kyphoplasty yields fracture reduction, internal fixation, and indirect central canal decompression. In selected cases, it might represent a suitable minimally invasive treatment option, stand-alone or in combination with posterior stabilization.

Association of high-sensitivity C-reactive protein in middle-aged and elderly Chinese people with hyperuricaemia and risk of coronary heart disease: a cross-sectional study

OBJECTIVES

Patients with hyperuricaemia are at relatively high risk of developing coronary heart disease (CHD). The purpose of this study was to examine the relationship between high-sensitivity C-reactive protein (hs-CRP) and CHD risk in a middle-aged and elderly population with hyperuricaemia.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

This study was conducted in a health examination centre of China. Participants were diagnosed with hyperuricaemia based on uric acid concentrations. Specifically, males with a uric acid concentration ≥416 μmol/L were included, as well as females with a concentration ≥360 μmol/L.

MAIN OUTCOME MEASURES

10-year CHD risk for each individual was evaluated using Framingham risk score based on the Adult Treatment Panel III charts.

RESULTS

A total of 517 patients with hyperuricaemia (438 males and 79 females) aged from 40 to 85 years old were included in the present study. 193 (37.3%) patients were defined with relatively high 10-year CHD risk. Compared with the lowest quintile, the crude ORs of relatively high 10-year CHD risks were 1.43 (95% CI 0.78 to 2.63, p=0.245), 2.05 (95% CI 1.14 to 3.67, p=0.016), 2.77 (95% CI 1.54 to 4.98, p=0.001), 2.12 (95% CI 1.18 to 3.80, p=0.012) in the second, third, fourth and fifth quintiles of serum hs-CRP level, respectively (p for trend=0.057). The multivariable-adjusted ORs of relatively high 10-year CHD risk were 1.40 (95% CI 0.75 to 2.61, p=0.291) in the second, 2.05 (95% CI 1.13 to 3.72, p=0.019) in the third, 2.69 (95% CI 1.47 to 4.89, p=0.001) in the fourth and 2.10 (95% CI 1.15 to 3.84, p=0.016) in the fifth quintile of serum hs-CRP level when compared with the lowest quintile (p for trend=0.068).

CONCLUSION

This study showed that ORs of relatively high 10-year CHD risk were raised in patients with hyperuricaemia with higher serum hs-CRP level; however, there was a not significant but borderline trend association and that more research is needed.

Utilisation of second-trimester spontaneous and induced abortion services in public hospitals in Mexico, 2007-2015

BACKGROUND

Data on utilisation of in-facility second-trimester abortion services are sparse. We describe temporal and geographical trends in utilisation of in-facility second-trimester abortion services across Mexico.

METHODS

We used 2007-2015 data from Mexico's Automated Hospital Discharge System (SAEH) to identify second-trimester abortive events (ICD O02-O08) in public hospitals across Mexico's 32 states. We described utilisation, calculated rates using population data, and used logistic regression to identify woman- and state-level factors (municipality-level marginalisation, state-level abortion law) associated with utilisation of second-trimester versus first-trimester services.

RESULTS

We identified 145 956 second-trimester abortions, or 13.4% of total documented hospitalizations for abortion between 2007 to 2015. The annual utilisation rate of second-trimester abortion remained constant, between 0.5 to 0.6 per 1000 women aged 15-44 years. Women living in highly marginalised municipalities had 1.43 higher odds of utilising abortions services in their second versus their first trimester, when compared with women in municipalities with low marginalisation (95% CI 1.18 to 1.73). Living in a state with a health or fetal anomaly exception to abortion restrictions was not associated with higher utilisation of second-trimester abortion services.

CONCLUSIONS

Our results suggest there is a need for all types of second-trimester abortion services in Mexico. To improve health outcomes for Mexican women, especially the most vulnerable, access to safe second-trimester abortion services must be ensured through the implementation of current legal exceptions and renewed attention to the training of healthcare providers.

Re-expansion of Osteoporotic Compression Fractures Using Bilateral SpineJack Implants: Early Clinical Experience and Biomechanical Considerations

Thoraco-lumbar osteoporotic compression fractures have a higher incidence of continued collapse with development of deformity and progression to vertebra plana when untreated and even after vertebral augmentation (VA) or balloon kyphoplasty (BKP). Even when there is the restoration of height and improvement in angulation, multiple long-term follow-up series have repeatedly documented that over time, many patients lose the initial height correction and in a smaller group the vertebral body re-collapses leading to the development of progressive deformity with an increased risk for adjacent level fractures. At first, larger balloons and more cement were used to try and avoid these problems, but it did not reduce the risk of adjacent fractures. Several procedures were developed to place various types of intervertebral implants combined with bone cement to maintain the initial height correction. Initial studies with these implants showed a reduction in adjacent level fractures but the systems did not proceed to market. The SpineJack^R (SJ) system (Stryker Corp, Kalamazoo, MI), consisting of bilateral expandable titanium implants supplemented with bone cement, was first used approximately 10 years ago in Europe and recently gained FDA approval in the United States. This system provides more symmetric and balanced lateral and anterior support and is effective with lesser amounts of bone cement compared to BKP. Follow-up studies have documented that there is equal or better pain control, with better long-term results based both on maintaining vertebral height restoration and deformity correction. Most importantly, statistically it clearly reduces the risk of adjacent level fractures by at least 60%. The biomechanical effects of intravertebral implants for osteoporotic fractures in regard to the risk of adjacent level fractures and preliminary experience with the use of the SJ is reviewed.

Vertebral augmentation with the SpineJack® in chronic vertebral compression fractures with major kyphosis

OBJECTIVES

Osteoporotic vertebral compression fractures (OVCFs) are an important health issue for which minimally invasive techniques are a feasible treatment. The SpineJack® (Vexim) is an intravertebral expandable system designed to improve the correction of the structural modifications caused by OVCFs. Its ability to stabilise and reduce OVCFs at the acute phase being already well established, we sought to evaluate the feasibility of vertebral augmentation with the SpineJack® in chronic kyphotic OVCFs.

METHODS

All consecutive patients treated with the SpineJack® were prospectively included if they met the following criteria: (1) OVCF considered unstable (grade A3 according to Magerl's classification). (2) Local kyphotic angle ≥ 20°. (3) OVCF older than 6 weeks. (4) Back pain with visual analogue scale (VAS) ≥ 4.

RESULTS

Nineteen consecutive patients (16 women [84.2%] and 3 men [15.8%]; mean age 73.2 ± 8.2 years) were included. Treatment was performed after a mean delay of 5.8 months ± 2.9 (range 1.5-12). Median visual analogue scale significantly improved from 7 preoperatively (IQR 6-9) to 2 (IQR 1-5) at 6 months (p < 0.01). Significant kyphosis reduction (i.e. ≥ 30%) was obtained in 94.7% of cases. Secondary adjacent level fractures (SALFs) were noted in 21.1% of cases and were correlated with the importance of the kyphosis reduction.

CONCLUSIONS

Vertebral augmentation with the SpineJack® is feasible and seems able to correct major structural deformities in chronic OVCFs. SALFs were noted in a substantial amount of cases. Preventive adjacent vertebroplasty might be useful in patients with several risk factors for SALFs.

KEY POINTS

• Vertebral augmentation with SpineJack® is effective to correct major structural deformities e.g. height loss and kyphosis. • Successful reduction is reachable with SpineJack® in chronic (older than 6 weeks) OVCFs. • Aggressive reduction of major kyphosis might promote SALFs and complementary adjacent vertebroplasties prevent their occurrence.

The Vertect Jack Device: A new method for augmentation of vertebral fractures. Clinical study with comparisons to kyphoplasty

BACKGROUND

Kyphoplasty is a proven minimally invasive procedure for the treatment of patients with osteoporotic fractures. By augmentation of fractured vertebral body, however, a very large portion of the intervertebral structures will be destroyed. With the help of a new device (Vertect Jack Device), the erection of the vertebral body will be carried out more gentle.

OBJECTIVE

In the present study, the new method should be clinically tested for efficacy and safety for the first time. As a comparison results of previous treatments with kyphoplasty were used.

METHODS

For Vertect Jack Device study patients with painful vertebral fractures were selected in which conservative treatment had not yielded sufficient results. For comparison random data from the records of patients who had been treated with kyphoplasty were selected. The Vertect Jack Device was placed under the central fractures and then erected. After having restorted the vertebral height the device was removed and cement injected. Clinical and radiological examinations were carried out before and after 1,3, and 6 months.

RESULTS

In the Vertect Jack Device Group the data of 40 patients were evaluated. For group 2 (kyphoplasty) 50 patients were selected. There was a significant difference in the duration of the surgery (Group 1: 27.4, Group 2: 45.9 minutes). A significant difference of 20 mm with regard to the reduction of VAS scores (0-100 mm pain intensity) was detected. Under the application of the Vertect Jack Device an average increase of 3.1 mm of vertebral height was achieved. In group 2, the erection averaged 0.4 mm. A correlation between the postoperative change of vertebral body height and VAS scores could not be detected in both groups.

CONCLUSIONS

The comparative analysis of this study shows that promising results can be achieved with the augmentation of vertebral fractures with the Vertect Jack Device. When compared with kyphoplasty, advantages show in terms of targeted and thus more gentle application possibility and better pain relief over a period of 6 months after surgery. Further study results should help to demonstrate the efficacy and tolerability of the new method.