Cement Leakage in Percutaneous Vertebroplasty for Multiple Osteoporotic Vertebral Compression Fractures: A Prospective Cohort Study

Modified versus conventional percutaneous kyphoplasty for osteoporotic vertebral compression fracture treatment: a systematic review and pilot meta-analysis

PURPOSE

This study compares the safety and clinical effectiveness of modified percutaneous kyphoplasty (PKP) approaches (transverse process-pedicle or extrapedicular) with the conventional transpedicular approach for treating osteoporotic vertebral compression fractures.

METHODS

We searched various databases, including PubMed, Cochrane Library, Web of Science, Embase, and Scopus. Safety outcomes included operative time, radiation dose, injected cement volume, and cement leakage rate, while efficacy outcomes were the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Cobb's angle, and vertebral body height. The quality of cohort studies was assessed using the Newcastle-Ottawa Score, and a meta-analysis was conducted using Review Manager 5.4.

RESULTS

Nine high-quality cohort studies involving 1,187 patients were included. Compared to conventional PKP, the modified approach resulted in significantly shorter operative time (mean differences [MD]: - 11.72, 95% confidence interval [CI]: - 16.56 to - 6.88, p < 0.00001), lower radiation dose (standardized mean differences: - 2.21, 95% CI: - 2.96 to - 1.45, p < 0.00001), reduced injected cement volume (MD: - 0.89, 95% CI: - 1.58 to - 0.21, p = 0.01), and a lower cement leakage rate (MD: 0.58, 95% CI: 0.41-0.80, p = 0.001). However, both groups had no significant differences in VAS score, ODI score, Cobb's angle, or vertebral body height.

CONCLUSION

No significant difference in pain relief or functional improvement was observed between modified and conventional PKP. However, modified PKP has a shorter operative time, a lower radiation dose, a lower injected cement volume, and a lower cement leakage rate than conventional PKP. These findings suggest that modified PKP is safer, with similar therapeutic outcomes to conventional PKP.

Radiation Exposure Analysis on 274 Patients With Vertebral Augmentation Using the Surgivisio Intraoperative Navigation System

BACKGROUND

Surgeons' reliance on intraoperative fluoroscopy during vertebroplasty procedures has raised concerns regarding the level of patient and surgeon radiation. Navigation systems have shown a potential to reduce the overall patient and medical staff exposure during dose exposure studies. The main objective of this study was to determine whether the Surgivisio platform (eCential Robotics, France), a unified imaging and navigation platform, lowers the patient dose during routine clinical usage as compared with published fluoroscopy and other navigation options that are published in the literature.

METHODS

To accomplish this, we evaluated the radiation exposure dose during routine vertebroplasty procedures in which the surgeon was not trying to limit radiation and then compared the results to best-case dose assessment studies. Since a decreased radiation dose can lead to decreased image quality, we also quantified the surgeon's perception of image quality and ease of use. Two hundred and seventy-four Surgivisio-assisted vertebral augmentations were pooled from a broader 1694-patient protocol (not focusing on radiation outcomes) and analyzed.

RESULTS

We measured a median dose-area product and effective dose equal to 3.47 Gy.cm² and 0.81 mSv. The 3-dimensional image acquisitions contributed to 56.3% of the total dose-area product. When screening the literature, fluoroscopy dose levels (8.37-15.1 Gy.cm²) and navigation dose levels (9.12-9.83 Gy.cm²) were generally higher than those delivered with the Surgivisio protocol. Surgeon satisfaction for image quality and overall system experience was 95.8% and 85% for ease of use.

CONCLUSIONS

The Surgivisio platform provided surgeons with high-quality images and ease of use. Since the surgeon is out of the room during the 3-dimensional image acquisition, this also substantially decreased their radiation exposure. This study demonstrates the efficiency of the Surgivisio platform to assist surgeons during vertebral augmentations, as the reported radiation levels are reduced in routine cases compared with published scenarios reported for other guidance methods.

Risk factors of new vertebral compression fracture after percutaneous vertebroplasty or percutaneous kyphoplasty

BACKGROUND

New vertebral compression fracture (VCF) may occur in patients who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF). However, the risk factors of new VCF remain controversial. The research aimed to analyze the risk factors of new VCF after PVP or PKP.

METHODS

From August 2019 to March 2021, we retrospectively analyzed the patients who underwent PVP or PKP for OVCF at our institution. Age, gender, body mass index (BMI), smoking, drinking, hypertension, diabetes, fracture location, surgical method, Hounsfield unit (HU) value, preoperative degree of anterior vertebral compression (DAVC), bisphosphonates, bone cement volume, bone cement leakage, and cement distribution were collected. The risk factors were obtained by univariate and multivariate analysis of the data.

RESULTS

A total of 247 patients were included in the study. There were 23 patients (9.3%) with new VCF after PVP or PKP. Univariate analysis showed that age (p < 0.001), BMI (p = 0.002), fracture location (p = 0.030), and a low HU value (p < 0.001) were significantly associated with new VCF after PVP or PKP. A low HU value was an independent risk factor for new VCF after PVP or PKP obtained by multivariate regression analysis (OR = 0.963; 95% CI, 0.943-0.984, p = 0.001).

CONCLUSIONS

In this study, a low HU value was an independent risk factor of new VCF after PVP or PKP.

Percutaneous Cementoplasty for the Pelvis in Bone Metastasis: 12-Year Experience

Background

In advanced cancer patients, pelvic bone metastasis often causes pain and gait disturbance. The use of percutaneous bone cement [polymethylmethacrylate (PMMA)] injection for pain management and strengthening in pelvic bone metastasis has rarely been reported. To evaluate this method, we aimed to determine surgical outcomes and complications over a long-term follow-up period using a large patient group.

Patients and Methods

We retrospectively collected data from 178 patients who underwent percutaneous cementoplasty for pelvic metastatic lesions, 201 in total. Surgical outcomes evaluated included pain reduction and improvement of ambulation. Mortality within 1 month after procedure and pulmonary embolism caused by thrombus, fat, tumor emboli, or bone cement were investigated as surgical complications. For long-term survivors, pain relapse and mechanical failure were analyzed. The mean follow-up period was 12.6 months, and there were 159 fatalities at last follow-up.

Results

The mean regional pain numerical rating scale scores decreased from 6.1 preoperatively to 2.4 1 month after procedure (p < 0.01). Gait function was maintained, worsened, and uncheckable in 68%, 24%, and 8% of patients, respectively, 1 month after procedure. Of long-term survivors followed up for > 12 months (n = 53), there were no significant changes in serial plain radiographs, and regional pain aggravation was observed in 9%. Pulmonary cement embolism and bone cement implantation syndrome was observed in 11% and 10%, respectively. However, all patients with these complications were asymptomatic.

Conclusions

Percutaneous cement injection into the pelvis is a feasible and safe palliative surgical option for patients with advanced malignancy in terms of pain reduction and maintenance of ambulatory function under regional anesthesia.

Unilateral percutaneous vertebroplasty for osteoporotic lumbar compression fractures: a comparative study between transverse process root-pedicle approach and conventional transpedicular approach

Purpose

Percutaneous vertebroplasty (PVP) is a routine operation for the treatment of osteoporotic lumbar compression fractures (OLCFs). As is well known, unilateral puncture is a common method. However, with the conventional transpedicular approach (CTPA), the cement may be asymmetrically dispersed, so some surgeons use the transverse process root-pedicle approach (TPRPA). The objective of this study was to compare the clinical results and bone cement distribution of PVP for OLCF with unilateral TPRPA and CTPA to identify the advantages and disadvantages of the two surgical options.

Patients and methods

From January 2016 to June 2019, seventy-two elderly patients who underwent unilateral PVP for single-level OLCF were retrospectively reviewed. Operation time, injection amount and type of bone cement distribution, and bone cement leakage and surgical complications were recorded. The visual analog scale (VAS) scores and Oswestry disability index (ODI) scores were used to evaluate the clinical results. All patients were followed up for more than 12 months, and the assessment was based primarily on clinical and radiological outcomes.

Results

There were significant differences in the surgical time and the volume and the type of bone cement distribution and the lost of operative vertebra height between the two groups. However, there was no significant difference in bone cement leakage. Moreover, there were no significant differences in VAS and ODI between the two groups at 2 days and 12 months after the operation.

Conclusions

Unilateral TPRPA and CTPA are practical and feasible methods in PVP for the treatment of OLCF, and they have similar clinical effects. However, TPRPA has the advantages of a better distribution of bone cement and a shorter operation time and a better maintenance effect of injured vertebra height, without increasing the rate of bone cement leakage.