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Cheng Z, Ren G, Li Z, Gao X, Zhang D, Chen G. Continuity and volume of bone cement and anti osteoporosis treatment were guarantee of good clinical outcomes for percutaneous vertebroplasty: a multicenter study. BMC Musculoskelet Disord 2025; 26:133. [PMID: 39920627 PMCID: PMC11806568 DOI: 10.1186/s12891-024-08153-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 12/04/2024] [Indexed: 02/09/2025] Open
Abstract
BACKGROUND As the most prevalent fragility fracture caused by osteoporosis, increasing attention was paid to vertebral compression fractures (VCF) day by day. Percutaneous vertebroplasty (PVP) had unique advantages in treatment of VCF and was used widely. However, there were still part patients suffering from residual or unrelieved pain after the surgery. The purpose of our study was to identified the associated factors for good clinical outcomes and provide evidence for surgical strategy. MATERIAL AND METHODS 186 patients who underwent PVP from January 2021 to January 2023 were reviewed retrospectively in the study. The patients were divided into two groups according to clinical outcomes. Preoperative general data and surgical data were collected for statistical analysis. Multivariate logistic regression analysis and the receiver operating characteristic curve were used to identify the associated factors with good clinical outcomes. RESULTS There were statistically significant differences between two groups in volume of bone cement (p = 0.012), standardized treatment for osteoporosis (p = 0.004) and bone cement continuity (p = 0.006). The associated factors with good clinical outcomes after PVP were continuous bone cement (OR = 2.237, 95% CI = 1.191-4.201, p = 0.012), standardized treatment for osteoporosis (OR = 2.105, 95% CI = 1.089-4.068, p = 0.027) and volume of bone cement > 5.5 ml (OR = 1.271, 95% CI = 1.023-1.579, p = 0.030). CONCLUSION PVP effectively released the back pain of patients and was worthy of promotion. However, postoperative residual pain was an important factor that reduced the clinical outcomes. Continuous bone cement and standardized treatment for osteoporosis were guarantee of good clinical outcomes for PVP and injected bone cement > 5.5 ml might be a guarantee.
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Affiliation(s)
- Zhen Cheng
- Department of Spine Surgery, Changzhi People's Hospital, No. 502 Changxingzhong Road, Changzhi, 046000, China
| | - Guangzong Ren
- Department of Spine Surgery, Changzhi People's Hospital, No. 502 Changxingzhong Road, Changzhi, 046000, China
| | - Ziyi Li
- Department of Spine Surgery, Changzhi People's Hospital, No. 502 Changxingzhong Road, Changzhi, 046000, China
| | - Xianda Gao
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Di Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
| | - Guiyue Chen
- Department of Spine Surgery, Changzhi People's Hospital, No. 502 Changxingzhong Road, Changzhi, 046000, China.
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Chen K, Gao T, Zhu Y, Lyu F, Jiang J, Zheng C. Augmented Central Pain Processing Occurs after Osteoporotic Vertebral Compression Fractures and Is Associated with Residual Back Pain after Percutaneous Vertebroplasty. Asian Spine J 2024; 18:380-389. [PMID: 38764226 PMCID: PMC11222882 DOI: 10.31616/asj.2023.0429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/24/2024] [Accepted: 02/14/2024] [Indexed: 05/21/2024] Open
Abstract
STUDY DESIGN A retrospective analysis. PURPOSE To investigate the occurrence of central sensitization (CS) in patients with osteoporotic vertebral compression fractures (OVCFs) and identify the association between CS and residual back pain (RBP). OVERVIEW OF LITERATURE RBP is a vexing complication that affects 6.3%-17.0% of patients with OVCFs who underwent percutaneous vertebroplasty (PVP). Given the negative effect of RBP on patients' psychological and physiological statuses, efforts to preoperatively select patients who are at risk for RBP development have a high priority to offer additional treatment and minimize this complication. METHODS Preoperatively, all 160 patients with OVCFs underwent pressure-pain threshold (PPT), temporal summation (TS), conditioned pain modulation (CPM), and imaging assessments. Pain intensity and pain-related disability were evaluated before and after PVP. RESULTS Preoperatively, patients with OVCFs had lower PPTs in both local pain and pain-free areas and lower CPM and higher TS in pain-free areas than healthy participants (p<0.05). Unlike patients with acute fractures, patients with subacute/chronic OVCFs showed higher TS with or without lower CPM in the pain-free area compared with healthy participants (p<0.05). Postoperatively, RBP occurred in 17 of 160 patients (10.6%). All preoperative covariates with significant differences between the RBP and non-RBP groups were subjected to multivariate logistic regression, showing that intravertebral vacuum cleft, posterior fascia edema, numeric rating pain scale scores for low back pain at rest, and TS were independently associated with RBP (p<0.05). CONCLUSIONS Augmented central pain processing may occur in patients with OVCFs, even in the subacute stage, and this preexisting CS may be associated with RBP. Preoperative assessment of TS in pain-free areas may provide additional information for identifying patients who may be at risk of RBP development, which may be beneficial for preventing this complication.
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Affiliation(s)
- Kaiwen Chen
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Tian Gao
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu Zhu
- Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY, USA
| | - Feizhou Lyu
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
- Department of Orthopaedics, The Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Jianyuan Jiang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Chaojun Zheng
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China
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Khan MA, Jennings JW, Baker JC, Smolock AR, Shah LM, Pinchot JW, Wessell DE, Kim CY, Lenchik L, Parsons MS, Huhnke G, Shek-Man Lo S, Lu Y, Potter C, Reitman C, Sahgal A, Sharma A, Yalla NM, Beaman FD, Kapoor BS, Burns J. ACR Appropriateness Criteria® Management of Vertebral Compression Fractures: 2022 Update. J Am Coll Radiol 2023; 20:S102-S124. [PMID: 37236738 DOI: 10.1016/j.jacr.2023.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Vertebral compression fractures (VCFs) can have a variety of etiologies, including trauma, osteoporosis, or neoplastic infiltration. Osteoporosis related fractures are the most common cause of VCFs and have a high prevalence among all postmenopausal women with increasing incidence in similarly aged men. Trauma is the most common etiology in those >50 years of age. However, many cancers, such as breast, prostate, thyroid, and lung, have a propensity to metastasize to bone, which can lead to malignant VCFs. Indeed, the spine is third most common site of metastases after lung and liver. In addition, primary tumors of bone and lymphoproliferative diseases such as lymphoma and multiple myeloma can be the cause of malignant VCFs. Although patient clinical history could help raising suspicion for a particular disorder, the characterization of VCFs is usually referred to diagnostic imaging. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Majid A Khan
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
| | - Jack W Jennings
- Research Author, Washington University, Saint Louis, Missouri
| | - Jonathan C Baker
- Mallinckrodt Institute of Radiology Washington University School of Medicine, St. Louis, Missouri
| | - Amanda R Smolock
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lubdha M Shah
- Panel Chair, University of Utah, Salt Lake City, Utah
| | | | | | - Charles Y Kim
- Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina
| | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Matthew S Parsons
- Panel Vice-Chair, Mallinckrodt Institute of Radiology, St. Louis, Missouri
| | - Gina Huhnke
- Deaconess Hospital, Evansville, Indiana American College of Emergency Physicians
| | - Simon Shek-Man Lo
- University of Washington School of Medicine, Seattle, Washington Commission on Radiation Oncology
| | - Yi Lu
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts American Association of Neurological Surgeons/Congress of Neurological Surgeons
| | - Christopher Potter
- Brigham & Women's Hospital, Boston, Massachusetts Committee on Emergency Radiology-GSER
| | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina North American Spine Society
| | - Arjun Sahgal
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Commission on Radiation Oncology
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida Commission on Nuclear Medicine and Molecular Imaging
| | - Naga M Yalla
- Mallinckrodt Institute of Radiology, Saint Louis, Missouri, Primary care physician
| | | | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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Deng Z, Feng T, Wu X, Xie H, Song D, Wang J, Yang H, Niu J. Thoracolumbar fascia injury in osteoporotic vertebral fracture: the important concomitant damage. BMC Musculoskelet Disord 2023; 24:166. [PMID: 36879207 PMCID: PMC9987111 DOI: 10.1186/s12891-023-06280-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Thoracolumbar fascia injury (FI) is rarely discussed in osteoporotic vertebral fracture (OVF) patients in previous literature and it is usually neglected and treated as an unmeaning phenomenon. We aimed to evaluate the characteristics of the thoracolumbar fascia injury and further discuss its clinical significance in the treatment of kyphoplasty for osteoporotic vertebral fracture (OVF) patients. METHODS Based on the presence or absence of FI, 223 OVF patients were divided into two groups. The demographics of patients with and without FI were compared. The visual analogue scale and Oswestry disability index scores were compared preoperatively and after PKP treatment between these groups. RESULTS Thoracolumbar fascia injuries were observed in 27.8% of patients. Most FI showed a multi-level distribution pattern which involved a mean of 3.3 levels. Location of fractures, severity of fractures and severity of trauma were significantly different between patients with and without FI. In further comparison, severity of trauma was significantly different between patients with severe and non-severe FI. In patients with FI, VAS and ODI scores of 3 days and 1 month after PKP treatment were significantly worse compared to those without FI. It showed the same trend in VAS and ODI scores in patients with severe FI when compared to those patients with non-severe FI. CONCLUSIONS FI is not rare in OVF patients and presents multiple levels of involvement. The more serious trauma suffered, the more severe thoracolumbar fascia injury presented. The presence of FI which was related to residual acute back pain significantly affected the effectiveness of PKP in treating OVFs. TRIAL REGISTRATION retrospectively registered.
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Affiliation(s)
- Zicheng Deng
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Tao Feng
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Xiexing Wu
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Haifeng Xie
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Dawei Song
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Jinning Wang
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Huilin Yang
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China.
| | - Junjie Niu
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China.
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Yu H, Luo G, Wang Z, Yu B, Sun T, Tang Q. Predictors of residual low back pain in patients with osteoporotic vertebral fractures following percutaneous kyphoplasty. Front Surg 2023; 10:1119393. [PMID: 36816002 PMCID: PMC9935818 DOI: 10.3389/fsurg.2023.1119393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023] Open
Abstract
Objective Patients with osteoporotic vertebral fractures (OVFs) often suffer from residual low back pain (LBP) after percutaneous kyphoplasty (PKP). The purpose of this study was to identify risk factors for postoperative residual LBP and to develop a nomogram to predict the occurrence of residual LBP. Methods We retrospectively reviewed 236 patients who underwent PKP for OVFs and had a minimum follow-up of 12 months. The mean age was 72.1 ± 6.3, 74.3% were female and 25.7% were male. Patients with LBP VAS scores ≥ 3.5 at the 12th month postoperatively were considered to have residual LBP. Risk factors for residual LBP were identified by univariate and multifactorial logistic regression analysis. Then, a predictive nomogram was constructed and validated using the bootstrap method. The discrimination, calibration, and clinical utility of the nomogram were assessed using a receiver operating characteristic curve (ROC), a calibration curve, and a decision curve analysis (DCA). Results univariate and multifactorial logistic regression analysis identified depression (P = 0.02), intravertebral vacuum cleft (P = 0.01), no anti-osteoporosis treatment (P < 0.001), cement volume <3 ml (P = 0.02), and cement distrubution (P = 0.01) as independent risk factors for residual LBP. The area under the ROC was 0.83 (0.74-0.93) and further validated by bootstrap method was 0.83 (0.73-0.92). The calibration curve illustrated the consistency between the predicted probability and the observed results. DCA showed that nomogram exhibits clinical utility and net benefit when the threshold probability is between 6% and 73%. Conclusions Our study found that depression, intravertebral vacuum cleft, no anti-osteoporosis treatment, cement volume <3 ml and cement distribution represent independent risk factors for residual LBP. The nomogram containing the above five predictors can accurately predict the risk of residual LBP after surgery.
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Affiliation(s)
- Hongwei Yu
- School of Medicine, Nankai University, Tianjin, China
| | - Gan Luo
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Ziqi Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Bin Yu
- Department of Spinal Surgery, Tian-jin Union Medical Centre, Nankai University People's Hospital, Tianjin, China
| | - Tianwei Sun
- Department of Spinal Surgery, Tian-jin Union Medical Centre, Nankai University People's Hospital, Tianjin, China,Correspondence: Tianwei Sun
| | - Qiong Tang
- Department of Respiratory Medicine, Tian-jin Union Medical Centre, Nankai University People's Hospital, Tianjin, China
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Dang SJ, Wei WB, Wei L, Xu J. Vertebroplasty combined with facet joint block vs. vertebroplasty alone in relieving acute pain of osteoporotic vertebral compression fracture: a randomized controlled clinical trial. BMC Musculoskelet Disord 2022; 23:807. [PMID: 35999526 PMCID: PMC9396809 DOI: 10.1186/s12891-022-05753-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/05/2022] [Indexed: 11/15/2022] Open
Abstract
Objective The study objective was to compare the efficacy and safety of percutaneous vertebroplasty (PVP) combined with facet joint block (FB) and vertebroplasty alone in relieving acute pain on osteoporotic vertebral compression fractures (OVCFs). Methods A prospective, randomized controlled study was conducted. One hundred ninety-eight patients of OVCFs undergoing surgery were randomly divided into two groups: Group P (PVP, n = 97), Group PF (PVP + FB, n = 101). The Visual analogue scale (VAS) and Oswestry disability index (ODI) were measured during pre-operation, 1 day, 1, 3, 6 and 12 months after the operation, respectively. The hospitalization time, operation time, complications, recurrence, the mean amount of cement injected and the number of patients who applied Cox-2 inhibitors within 3 days after operation were compared in the two groups. Results The VAS and ODI scores at each observation point of the post-operation were significantly decreased than that at the pre-operation in both groups (P < 0.05). The VAS and ODI scores in Group PF were significantly lower than that in Group P 1 day and 1 month after the operation (P < 0.05). The number of patients who applied Cox-2 inhibitors within 3 days after operation in group PF was significantly lower that in Group P (P < 0.001). There was no significant difference in hospitalization time, operation time, the mean amount of cement injected, complication rate, VAS and ODI scores at the pre-operation (P > 0.05). Conclusion Both PVP combined with FB and PVP alone are effective treatment methods for OVCFs. But PVP combined with FB showed better back pain relief than PVP alone in the short term after the operation for OVCFs.
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Affiliation(s)
- Sha-Jie Dang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.,Department of Anesthesia, Shaanxi Provincial Cancer Hospital, Xi'an, 710061, China
| | - Wen-Bo Wei
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.,Department of Orthopedics, Shaanxi Provincial people's Hospital, Xi'an, 710068, China
| | - Ling Wei
- Department of Pain, YangLing Demonstration Zone Hospital, Yang ling, 712100, China.
| | - Jin Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.
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Luo Y, Jiang T, Guo H, Lv F, Hu Y, Zhang L. Osteoporotic vertebral compression fracture accompanied with thoracolumbar fascial injury: risk factors and the association with residual pain after percutaneous vertebroplasty. BMC Musculoskelet Disord 2022; 23:343. [PMID: 35410277 PMCID: PMC8996573 DOI: 10.1186/s12891-022-05308-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/04/2022] [Indexed: 12/25/2022] Open
Abstract
Background To explore the risk factors involved in the induction of thoracolumbar fascia (TLF) injury by osteoporotic vertebral compression fracture (OVCF), and the association between the residual pain after percutaneous vertebroplasty (PVP) and fascial injury. Methods A total of 81 patients with single-segment OVCF, treated between January 2018 and January 2020 were included. The patients were grouped according to the existence of TLF injury. The patients’ general, clinical, and imaging data were accessed. Results There were 47 patients in the TLF group and 34 in the non-injury group (NTLF group). In the TLF group, BMI (Body mass index) was significantly lower, while the prevalence of hypertension and sarcopenia were significantly higher (P < 0.05). The vertebral compression degree was higher, and the kyphosis angle of the injured vertebra was greater in the TLF group (P < 0.05). Cobb’s angle was not significantly different between groups. At 3-d after the operation, the VAS (Visual analogue scale) was 4.64 ± 1.78 and 3.00 ± 1.71, and the ODI (Oswestry disability index) was 67.44 ± 11.37% and 56.73 ± 10.59% in TLF and NTLF group, respectively (P < 0.05). However, at 3-m after the operation, the differences in the VAS score and the ODI between groups were not statistically significant. The area of fascial edema was not significantly associated with the pre- and post-operative VAS or ODI, but was positively correlated with the vertebral body compression degree (R = 0.582, P = 0. 029). Conclusion Residual back pain after PVP is associated with TLF injury. Low BMI, hypertension and sarcopenia are risk factors of TLF injury, and sarcopenia may be the major factor.
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Affiliation(s)
- Yang Luo
- Department of Orthopedics, The First Medical Center of PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Tianyu Jiang
- Department of Rehabilitation, The Second Medical Center of PLA General Hospital, Beijing, 100853, P. R. China
| | - Hui Guo
- Department of Orthopedics, The First Medical Center of PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Faqin Lv
- Department of Ultrasound, The Third Medical Center of PLA General Hospital, Beijing, 100853, P. R. China
| | - Ying Hu
- Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, 518055, P. R. China
| | - Lihai Zhang
- Department of Orthopedics, The First Medical Center of PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, P. R. China.
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Bo J, Zhao X, Hua Z, Li J, Qi X, Shen Y. Impact of sarcopenia and sagittal parameters on the residual back pain after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fracture. J Orthop Surg Res 2022; 17:111. [PMID: 35184761 PMCID: PMC8859872 DOI: 10.1186/s13018-022-03009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022] Open
Abstract
Objective The objective of this study was to explore the impact of sarcopenia and sagittal parameters on the residual back pain (RBP) after percutaneous vertebroplasty (PVP) for treatment of osteoporotic vertebral compression fracture (OVCF). Methods This retrospective study included elderly patients (age range 60–90 years) with OVCF treated with PVP from January 2015 and December 2020 in our hospital. The skeletal muscle mass index (SMI) was calculated by dividing the T12 pedicle level muscle cross-sectional area by the square of body height from chest CT to diagnose sarcopenia. The radiological parameters for measuring the sagittal alignment were included: C7-sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI). Result According to whether the VAS score > 4, patients were divided into RBP group (56 patients) and Control group (100 patients). There was no difference in age, gender, body mass index, BMD, surgical segment, bone cement usage between the groups (P > 0.05). The SMI in RBP group (27.3 ± 5.1) was significantly lower compared to that in Control group (36.8 ± 3.2) (P < 0.05). Sarcopenia was present in 19 patients (20.3%) in RBP group, which was significantly more than that in Control group (P < 0.05). C7-SVA and TPA was significantly larger in the RBP group than in the Control group (P < 0.05). PI and LL was significantly smaller in the RBP group compared to the Control group (P < 0.05). However, no significant differences between the two groups with respect to TK, SS and PT (P > 0.05). Conclusion Poor sagittal parameters and sarcopenia in OVCF patients after PVP were more prone to residual back pain. Larger C7-SVA, TPA and PI-LL mismatch could increase the incidence of RBP in elderly patients with single-segment osteoporotic compression fractures.
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Ge C, Chen Z, Lin Y, Zheng Y, Cao P, Chen X. Preoperative prediction of residual back pain after vertebral augmentation for osteoporotic vertebral compression fractures: Initial application of a radiomics score based nomogram. Front Endocrinol (Lausanne) 2022; 13:1093508. [PMID: 36619583 PMCID: PMC9816386 DOI: 10.3389/fendo.2022.1093508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Most patients with osteoporotic vertebral compression fracture (OVCF) obtain pain relief after vertebral augmentation, but some will experience residual back pain (RBP) after surgery. Although several risk factors of RBP have been reported, it is still difficult to estimate the risk of RBP preoperatively. Radiomics is helpful for disease diagnosis and outcome prediction by establishing complementary relationships between human-recognizable and computer-extracted features. However, musculoskeletal radiomics investigations are less frequently reported. OBJECTIVE This study aims to establish a radiomics score (rad-score) based nomogram for the preoperative prediction of RBP in OVCF patients. METHODS The training cohort of 731 OVCF patients was used for nomogram development, and the validation cohort was utilized for performance test. RBP was determined as the score of visual analogue scale ≥ 4 at both 3 and 30 days following surgery. After normalization, the RBP-related radiomics features were selected to create rad-scores. These rad-scores, along with the RBP predictors initially identified by univariate analyses, were included in the multivariate analysis to establish a nomogram for the assessment of the RBP risk in OVCF patients preoperatively. RESULTS A total of 81 patients (11.2%) developed RBP postoperatively. We finally selected 8 radiomics features from 1316 features extracted from each segmented image to determine the rad-score. Multivariate analysis revealed that the rad-score plus bone mineral density, intravertebral cleft, and thoracolumbar fascia injury were independent factors of RBP. Our nomograms based on these factors demonstrated good discrimination, calibration, and clinical utility in both training and validation cohorts. Furthermore, it achieved better performance than the rad-score itself, as well as the nomogram only incorporating regular features. CONCLUSION We developed and validated a nomogram incorporating the rad-score and regular features for preoperative prediction of the RBP risk in OVCF patients, which contributed to improved surgical outcomes and patient satisfaction.
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Affiliation(s)
- Chen Ge
- Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Chen Ge,
| | - Zhe Chen
- Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yazhou Lin
- Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuehuan Zheng
- Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Cao
- Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyong Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Li Y, Yue J, Huang M, Lin J, Huang C, Chen J, Wu Y, Wang X. Risk factors for postoperative residual back pain after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2568-2575. [PMID: 32507918 DOI: 10.1007/s00586-020-06493-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/02/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the incidence of and risk factors for residual back pain in osteoporotic vertebral compression fracture (OVCF) patients after percutaneous kyphoplasty (PKP) treatment, we performed a retrospective analysis of prospective data. METHODS Patients who underwent bilateral PKP and met this study's inclusion criteria were retrospectively reviewed. Back pain intensity was assessed using a visual analogue scale (VAS) after surgery. Residual back pain was defined as the presence of postoperative moderate-severe pain (average VAS score ≥ 4), and the variables included patient characteristics, baseline symptoms, radiological parameters and surgical factors. Univariate and multivariate logistic regression analyses were performed to identify risk factors. RESULTS A total of 809 patients were included, and residual back pain was identified in 63 (7.8%) patients. Of these patients, 52 patients had complete data for further analysis. Multivariate logistic regression analysis showed that risk factors for back pain included the presence of an intravertebral vacuum cleft (OR 2.93, P = 0.032), posterior fascia oedema (OR 4.11, P = 0.014), facet joint violations (OR 12.19, P < 0.001) and a separated cement distribution (OR 2.23, P = 0.043). CONCLUSION The incidence of postoperative residual back pain was 7.8% among 809 OVCF patients following PKP. The presence of an intravertebral vacuum cleft, posterior fascia oedema, facet joint violations and a separated cement distribution were identified as independent risk factors for residual back pain.
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Affiliation(s)
- Yao Li
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinxin Yue
- Department of Orthopaedics, The First People's Hospital of Akesu District, Akesu, Xinjiang, China
| | - Mingyu Huang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jialiang Lin
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chongan Huang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiaoxiang Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yaosen Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Xiangyang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Hatgis J, Palea O, Ghomri Y, Granville M, Berti A, Jacobson RE. Radiologic Evaluation of Chronic Vertebral Compression Fractures and Role of Vertebral Augmentation. Cureus 2018; 10:e3208. [PMID: 30405984 PMCID: PMC6205884 DOI: 10.7759/cureus.3208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/27/2018] [Indexed: 12/31/2022] Open
Abstract
The literature has classified chronic vertebral compression fractures (VCF) as those still "symptomatic" four or more months after onset. Pain is regarded as the predominant chronic symptom; however, radiologic changes are important in evaluating fracture progression. This review examines a series of patients with chronic fractures and both persistence of spinal pain combined with radiologic changes, such as worsening collapse, spinal angulation, the development of vertebral edema and clefts, as well as the development of new fractures at adjacent spinal levels. In patients with clear progressive radiologic changes in addition to pain, vertebral augmentation on an average of 9.3 months after injury was effective in reducing the pain and stabilizing these more chronic osteoporotic fractures. A comparison of the pre- and post-procedure visual analog scale score (VAS) indicated an average of 66% reduction in pain. There are several reasons for the development of chronic symptomatic fractures. Most commonly, interventional treatment is delayed in a patient already diagnosed with VCF after a long period of conservative treatment, yet pain persists, or the initial clinical and radiologic evaluation misses the fracture, leading to a delay in diagnosis and treatment. In this report, management in these patients and the role of late vertebral augmentation for chronic symptomatic fractures is clarified based on the findings of various radiologic changes seen on both initial and follow-up radiologic studies.
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Affiliation(s)
- Jesse Hatgis
- Pain Management, Phoenix Neurological and Pain Institute, Chandler, USA
| | - Ovidiu Palea
- Anesthesiology and Pain Management, Centrul De Diagnostic Si Tratament Provita, Bucharest, ROU
| | - Yashar Ghomri
- Pain Managment, Nova Southeastern University, Los Angeles, USA
| | | | - Aldo Berti
- Neurosurgery, University of Miami Hospital, Miami, USA
| | - Robert E Jacobson
- Miami Neurosurgical Center, University of Miami Hospital, Miami, USA
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12
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Sabo A, Hatgis J, Granville M, Jacobson RE. Multilevel Contiguous Osteoporotic Lumbar Compression Fractures: The Relationship of Scoliosis to the Development of Cascading Fractures. Cureus 2017; 9:e1962. [PMID: 29492351 PMCID: PMC5820015 DOI: 10.7759/cureus.1962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Osteoporotic patients can present with either single or multiple fractures secondary to repeated falls and progressive osteoporosis. Multiple fractures often lead to additional spinal deformity and are a sign of more severe osteoporosis. In the thoracic spine, multiple fractures are associated with the development of gradual thoracic kyphosis but neurologic deficits are uncommon. In the lumbar spine, patients with multiple lumbar fractures have more constant lumbar pain, may have symptoms related to concurrent lumbar stenosis or degenerative scoliosis, and may present with radiculopathy, especially with fractures at L4 and L5. In a review of a series of patients with recurrent multiple lumbar fractures or 'cascading' fractures, it was found that all the patients were female, had severe osteoporosis, often untreated, had a previous history of multiple previous thoracic and lumbar fractures, and all had associated scoliotic spinal deformities ranging from 6o to 50o. It was found that if the curve progressed and the greater the degree of curvature, the more frequently subsequent multiple fractures developed, leading to recurrent acute episodes of pain. Forty percent also had additional sacral insufficiency fractures, an unusually high percentage. Biomechanically, the lumbar spine is both more mobile and supports a larger portion of the spinal load compared to the thoracic spine. The existence or worsening of a lumbar spinal deformity from degenerative lumbar scoliosis shifts the mechanical forces more to one side on already weakened osteoporotic lumbar vertebrae and sacrum, leading to an increased incidence of these fractures. Because of the chronic and uneven lower lumbar spinal load with severe vertebral osteoporosis in certain patients with repeat lumbar fractures and worsening degenerative lumbar scoliosis, there may be a rationale to add preventive vertebroplasty at adjacent vertebral endplates when treating acute recurrent lumbar fractures to decrease the incidence of recurrence in other vertebrae.
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Affiliation(s)
- Alex Sabo
- Neurology, Pain Management, Nova Southeast/larkin Community Hospital
| | - Jesse Hatgis
- Pain Management, Phoenix Neurological and Pain Institute
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13
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Jacobson RE, Palea O, Granville M. Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra. Cureus 2017; 9:e1776. [PMID: 29255655 PMCID: PMC5732011 DOI: 10.7759/cureus.1776] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
It is well recognized that patients can develop additional vertebral compression fractures (VCF) in an adjacent vertebra or at another vertebral level after successful vertebral augmentation. Factors such as the patient's bone mineral density, post procedure activity, and chronic corticosteroid use contribute to an increased risk of re-fracture or development of new fractures in the first three months after the initial procedure. However, there is a very small subgroup of patients that have unchanged or worse pain after the vertebral augmentation that may indicate continued progression of the treated compression fracture or a recurrent fracture at the previously treated level. This review examines the clinical findings, radiologic signs, and intraprocedural technical failures that may occur during the initial vertebral augmentation that can lead to a progressive fracture in a previously treated vertebra. Causes of failure of the initial vertebral augmentation procedure include inadequate or incomplete filling of the fracture site, the cement missing the actual fracture allowing continued osteoporotic compression, and persistent or worsened intravertebral fluid-filled clefts. The existence of an unfilled intravertebral fluid cleft on preoperative diagnostic studies is the most important indicator of risk for progression as is the later development of fluid at the bone cement interface.
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Affiliation(s)
| | - Ovidiu Palea
- Anesthesiology and Pain Management, Provita Hospital
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14
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Hatgis J, Granville M, Jacobson RE. Evaluation and Interventional Management of Pain After Vertebral Augmentation Procedures. Cureus 2017; 9:e1061. [PMID: 28382238 PMCID: PMC5370199 DOI: 10.7759/cureus.1061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction A small subset of patients who underwent successful vertebral compression fracture (VCF) augmentation procedures may develop subsequent pain requiring spinal injections. In a retrospective analysis, we determined whether the pain was related to the original fracture site or to another area within the lumbar or thoracic spine. The pain occurred either at the same/adjacent level and/or non-adjacent level as the VCF. Interventional treatments primarily targeted the facet joints, specifically in the form of facet joint blocks and/or radiofrequency ablation to the medial branches. The pattern of facet injections relative to the original fracture level was studied. Additionally, the elapsed time between the vertebral augmentation and the subsequent interventional blocks was also evaluated. Methods A total of 56 patients sustained VCFs. 12 of these patients underwent interventional procedures after vertebral augmentation procedures. The level(s) of same/adjacent level and non-adjacent level pain were determined via physical examination and/or imaging studies. These levels were subsequently treated with interventional procedures primarily focused on the facet joints. The time period of the injections varied from two weeks status post-vertebral augmentation to as late as 304 weeks (5.8 years) status post-vertebral augmentation. Results We performed 25 vertebral augmentation procedures on these 12 patients. 15 lumbar, eight lower thoracic, and two mid-thoracic VCFs were augmented. 9/14 cases of blocks included those performed at non-adjacent levels, whereas 5/14 cases of blocks were performed only at the same and/or adjacent levels as the VCF. For the events in which thoracic VCFs were augmented, 6/7 (or 86%) had developed non-adjacent level pain in areas of the lumbar spine. The time from vertebral augmentation procedure to subsequent pain procedure ranged from two weeks to five plus years. The average time elapsed was 83 weeks. Only one case required blocks performed within the first six weeks after vertebral augmentation. In this case, the blocks included those at non-adjacent levels. A total of 4/12 cases (33%) had a block within 12 weeks of the original vertebral augmentation procedure. Lumbar spine imaging showed that at least 9/12 patients had pre-existing significant lumbar pathology at the time of fracture treatment. This may have contributed to the later development of pain. Conclusion Pain after a successful vertebral augmentation is typically non-acute (i.e., beyond six weeks). Mechanisms other than the primary VCF are usually responsible for non-adjacent level pain, which are present a majority of the time on reviewing the patients' diagnostic studies. These mechanisms usually take many weeks to develop and subsequently elicit pain that requires additional interventional pain procedures. In our study, the pain is usually related to the pre-existing degenerative spondylosis and stenosis rather than the fracture site. This study shows that the facet joints in closely related lumbar degenerative changes are the cause of pain in this patient group. These procedures should be explored with pain after vertebral augmentation, especially in those patients with known or suspected spinal degeneration and/or poor biomechanics.
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Affiliation(s)
- Jesse Hatgis
- Larkin Hospital, Nova Southeastern University School of Osteopathic Medicine
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15
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Yan Y, Xu R, Zou T. Is thoracolumbar fascia injury the cause of residual back pain after percutaneous vertebroplasty? A prospective cohort study. Osteoporos Int 2015; 26:1119-24. [PMID: 25510580 DOI: 10.1007/s00198-014-2972-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/16/2014] [Indexed: 02/08/2023]
Abstract
UNLABELLED Some patients with osteoporotic vertebral compression fractures still suffer from back pain after percutaneous vertebroplasty. We have found that osteoporotic vertebral compression fractures with thoracolumbar fascia injury are common and that thoracolumbar fascia injury may account for the residual pain after percutaneous vertebroplasty. PURPOSE Osteoporotic vertebral compression fractures are successfully treated with percutaneous vertebroplasty (PVP). However, some patients still suffer from back pain after the procedure. We hypothesized that there is a relationship between thoracolumbar (TL) fascia injury and residual postoperative pain. METHODS This prospective study included 133 elderly patients (age range 55 - 92 years) with osteoporotic vertebral compression fractures treated with PVP from February 2010 to March 2012 in our hospital. The patients were divided into two groups based on the presence of TL fascia injury. A visual analog scale (VAS) and the Chinese modified Oswestry Disability Index were used to evaluate the pain before and after PVP. RESULTS The mean VAS score and the Chinese modified Oswestry Disability Index in the patients with TL fascia injury were reduced from 9.11 ± 0.76 to 6.4 ± 1.1 and 73.93 ± 1.46% to 44.6 ± 3.1%, respectively, and in the patients without TL fascia injury from 9.26 ± 0.82 to 8.0 ± 1.3 and 73.96 ± 1.38% to 51.7 ± 1.8%, respectively. Pain and disability were reduced more in patients without TL fascia injury than in those with TL fascia injury (both p < 0.05). CONCLUSIONS There may be a relationship between TL fascia injury and residual back pain after PVP.
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Affiliation(s)
- Y Yan
- Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo, 315010, China
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Choi SS, Hur WS, Lee JJ, Oh SK, Lee MK. Repeat vertebroplasty for the subsequent refracture of procedured vertebra. Korean J Pain 2013; 26:94-7. [PMID: 23342217 PMCID: PMC3546220 DOI: 10.3344/kjp.2013.26.1.94] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 10/16/2012] [Accepted: 10/19/2012] [Indexed: 01/11/2023] Open
Abstract
Vertebroplasty (VP) can effectively treat pain and immobility caused by vertebral compression fracture. Because of complications such as extravasation of bone cement (polymethylmethacrylate, PMMA) and adjacent vertebral fractures, some practitioners prefer to inject a small volume of PMMA. In that case, however, insufficient augmentation or a subsequent refracture of the treated vertebrae can occur. A 65-year-old woman visited our clinic complaining of unrelieved severe low back and bilateral flank pain even after she had undergone VP on the 1(st) and 4(th) (L1 and L4) lumbar vertebrae a month earlier. Radiologic findings showed the refracture of L1. We successfully performed the repeat VP by filling the vertebra with a sufficient volume of PMMA, and no complications occurred. The patient's pain and immobility resolved completely three days after the procedure and she remained symptom-free a month later. In conclusion, VP with small volume cement impaction may fail to relieve fracture-induced symptoms, and the refracture of an augmented vertebral body may occur. In this case, repeat VP can effectively resolve both the persistent symptoms and problems of new onset resulting from refracture of the augmented vertebral body due to insufficient volume of bone cement.
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Affiliation(s)
- Sang Sik Choi
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea
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18
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Tseng YY, Su CH, Lui TN, Yeh YS, Yeh SH. Prospective comparison of the therapeutic effect of teriparatide with that of combined vertebroplasty with antiresorptive agents for the treatment of new-onset adjacent vertebral compression fracture after percutaneous vertebroplasty. Osteoporos Int 2012; 23:1613-22. [PMID: 21769661 PMCID: PMC3332357 DOI: 10.1007/s00198-011-1730-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 06/17/2011] [Indexed: 01/25/2023]
Abstract
UNLABELLED Most post-vertebroplasty new-onset adjacent vertebral compression fractures (VCFs) occur within 2-3 months, and antiresorptive agents do not significantly reduce the risk of their occurrence. In opposite mechanism, teriparatide directly stimulates bone formation and improves bone strength and quality faster. The therapeutic effect of teriparatide is better than that of vertebroplasty combined with an antiresorptive treatment and is a potentially useful therapy for new-onset adjacent VCFs after vertebroplasty. INTRODUCTION Following vertebroplasty, patients are at increased risk of new-onset adjacent-level VCFs. The therapeutic effect of antiresorptive agents is too slow, and they are associated with the risk of new VCFs. Teriparatide markedly increases bone formation and strength and reduces the incidence of new-onset VCFs. This prospective cohort study compared the therapeutic effects of teriparatide with those of combined vertebroplasty and an anti-resorber for treating new-onset adjacent VCFs after vertebroplasty. METHODS Fifty patients with adjacent VCFs were randomly assigned to two groups: teriparatide only (group A) and additional vertebroplasty combined with an antiresorptive agent (group B). Relevant clinical data of the two groups were prospectively compared. RESULTS The 22 patients in group A were at higher risk of new VCFs than those in group B (22 patients); they were older and had more pre-existing fractures (p < 0.05). Patients treated with teriparatide had a significantly lower incidence of new-onset VCFs (odds ratio = 0.21; 95% confidence interval, 0.02-2.10). Teriparatide-mediated VCF reduction was 78.57%, which was markedly better than that of group B. The teriparatide group had a significant decrease in the visual analog scale and an increase in the Japanese Orthopedic Association low back pain score after 6 months of treatment (p < 0.05). The increase in lumbar spine BMD was marked in the teriparatide group (21.70% vs. 6.87%) after an 18-month treatment. CONCLUSIONS Treatment of post-vertebroplasty adjacent VCFs with teriparatide (no new vertebroplasty) was more effective than that of repeated vertebroplasties combined with an anti-resorber.
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Affiliation(s)
- Y-Y Tseng
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, No 291, Jhongjheng Rd, Jhonghe, New Taipei City, 23561 Taiwan, Republic of China.
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