Percutaneous balloon kyphoplasty of osteoporotic vertebral compression fractures with intravertebral cleft

Cemented vertebra and adjacent vertebra refractured in a chronic kidney disease-mineral and bone disorder patient: A case report

BACKGROUND

Although percutaneous vertebral augmentation (PVA) is a commonly used procedure for treating vertebral compression fracture (VCF), the risk of vertebral refracture should be considered. Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a systemic disease of mineral and bone metabolism. It is associated with an increased risk of fracture. Few studies have reported the use of PVA in patients with CKD-MBD. We herein report a rare case wherein the cemented vertebra and the adjacent vertebra refractured simultaneously in a CKD-MBD patient after PVA.

CASE SUMMARY

A 74-year-old man suffered from low back pain after taking a fall about 3 wk ago. According to physical examination, imaging and laboratory findings, diagnoses of T12 VCF, CKD-MBD, and chronic kidney disease stage 5 were established. He then received percutaneous vertebroplasty at T12 vertebra. Fourteen weeks later, he presented with T12 and L1 vertebral refractures caused by lumbar sprain. Once again, he was given PVA which was optimized for the refractured vertebrae. Although the short-term postoperative effect was satisfactory, he reported chronic low back pain again at the 3-month follow-up.

CONCLUSION

It is necessary that patients with CKD-MBD who have received PVA are aware of the adverse effects of CKD-MBD. It may increase the risk of vertebral refracture. Furthermore, the PVA surgical technique needs to be optimized according to the condition of the patient. The medium- and long-term effects of PVA remain uncertain in patients with CKD-MBD.

Evolution of vertebral posttraumatic necrosis to bone healing after self-stabilizing osteophytosis development-case report

Post-traumatic vertebral necrosis and pseudarthrosis at the thoracolumbar transition level usually progresses to bone resorption, leading to vertebral collapse, sometimes with retropulsion of the posterior wall and neurological deficit. As such, the therapeutic goal is the interruption of this evolution, seeking to stabilize the vertebral body, preventing collapse progression and the risk of neurological deficits. We present a clinical case regarding the evolution of a vertebral pseudarthrosis that self-stabilized with the development of an exuberant anterior osteophyte mass, joining the anterolateral surfaces of the adjacent vertebrae bodies. Vertebrae stabilization would have made it possible to minimize the pathological hypermobility that perpetuated pseudarthrosis and would have ensured sufficient stabilization to obtain clinically and imagiologically proven vertebrae bone healing. However, despite the unusually favorable evolution of this clinical case, in order to avoid highly disabling symptoms for several months, as occurred with the patient for 4 to 6 months, we consider that early percutaneous surgical stabilization of symptomatic vertebral pseudarthrosis is indicated, allowing for almost immediate pain relief and functional improvement, which is beneficial in terms of health and quality of life. This is a clinical case of unusual evolution of vertebral pseudarthrosis, which, however, is useful to confirm the prolonged duration and intensity of symptoms in the face of a conservative treatment for this disease.

[Effect of percutaneous kyphoplasty with different phases bone cement for treatment of osteoporotic vertebral compression fractures]

Objective

To compare the effect of percutaneous kyphoplasty (PKP) with different phases bone cement for treatment of osteoporotic vertebral compression fracture (OVCF).

Methods

The clinical data of 219 OVCF patients who treated with PKP and met the selection criteria between June 2016 and May 2018 were retrospectively analyzed. According to the different time of intraoperative injection of bone cement, they were divided into observation group [116 cases, intraoperative injection of polymethyl methacrylate (PMMA) bone cement in low-viscosity wet-sand phase)] and control group (103 cases, intraoperative injection of PMMA bone cement in low-viscosity wire-drawing phase). There was no significance in general date of gender, age, disease duration, body mass index, bone mineral density T value, fracture vertebral body, preoperative fracture severity of the responsible vertebral body, anterior height ratio of the responsible vertebral body, preoperative pain visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups ( P>0.05). The VAS score and ODI score were used to evaluate the improvement of patients' symptoms at immediate, 2 days, 3 months after operation and at last follow-up. At 1 day, 3 months after operation, and at last follow-up, X-ray film and CT of spine were reexamined to observe the distribution of bone cement in the vertebral body, bone cement leakage, and other complications. During the follow-up, the refracture rate of the responsible vertebral body and the fracture rate of the adjacent vertebral body were recorded.

Results

The injection amount of bone cement in the observation group and control group were (4.53±0.45) mL and (4.49±0.57) mL, respectively, showing no significant difference between the two groups ( t=1.018, P=0.310). Patients in both groups were followed up 6-18 months (mean, 13.3 months). There were 95 cases (81.9%) and 72 cases (69.9%) of the bone cement distribution range more than 49% of the cross-sectional area of the vertebral body in the observation group and the control group, respectively, showing significant difference in the incidence between the two groups ( χ ²=4.334, P=0.037). The VAS score and ODI score of the postoperative time points were significantly improved compared with those before operation ( P<0.05), and there were significant differences among the postoperative time points ( P<0.05). The VAS score and ODI score of the observation group were significantly better than those of the control group ( P<0.05) at immediate, 2 days, and 3 months after operation, and there was no significant difference between the two groups at last follow-up ( P>0.05). At 1 day after operation, the cement leakage occurred in 18 cases of the observation group (8 cases of venous leakage, 6 cases of paravertebral leakage, 4 cases of intradiscal leakage) and in 22 cases of the control group (9 cases of venous leakage, 8 cases of paravertebral leakage, 5 cases of intradiscal leakage). There was no significant difference between the two groups ( P>0.05). During the follow-up, 5 cases (4.3%) in the observation group, 12 cases (11.7%) in the control group had responsible vertebral refracture, and 6 cases (5.2%) in the observation group and 14 cases (13.6%) in the control group had adjacent vertebral fracture, the differences were significant ( χ ²=4.105, P=0.043; χ ²=4.661, P=0.031).

Conclusion

Bone cement injection with wet-sand phase in PKP is beneficial for the bone cement evenly distributed, strengthening the responsible vertebral, relieving the short-term pain after operation, decreasing the rate of responsible vertebral refracture and adjacent vertebral fracture without increasing the incidence of relevant complications and can enhance the effectiveness.

Efficacy and Safety of High-Viscosity Bone Cement Vertebroplasty in Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft

OBJECTIVE

To evaluate and compare clinical outcomes and cement leakage of high-viscosity bone cement versus low-viscosity bone cement vertebroplasty in treating osteoporotic vertebral compression fractures with intravertebral cleft.

METHODS

The study included 72 patients with osteoporotic vertebral compression fractures with intravertebral cleft, who were divided into high-viscosity cement (HVC) (38 cases) and low-viscosity cement (LVC) (34 cases) groups according to the viscosity of bone cement used. Cement leakage, visual analog scale score, Oswestry Disability Index, and kyphotic angle (KA) were evaluated.

RESULTS

All patients were followed for at least 12 months. Overall cement leakage rate was 18.4% in the HVC group, lower than the rate of 61.8% obtained in the LVC group. A statistically significant difference was found in the overall cement leakage rate between the groups (P < 0.05). Visual analog scale and Oswestry Disability Index scores were significantly improved after percutaneous vertebroplasty without significant differences between the HVC and LVC groups (P > 0.05). The KA of patients from both groups was also significantly corrected immediately after surgery. Although the KA gradually increased in both groups during the follow-up period, there was no statistically significant difference between the HVC and LVC groups in KA during follow-up (P > 0.05).

CONCLUSIONS

Percutaneous vertebroplasty using HVC to treat osteoporotic vertebral compression fractures with intravertebral cleft significantly reduces cement leakage and improves the safety of the operation. In terms of clinical efficacy and prevention of augmented vertebral recollapse, HVC may not have obvious advantages.

Extrapendicular Approach of Unilateral Percutaneous Vesselplasty for the Treatment of Kummell Disease

Background

Our purpose was to evaluate the efficacy of the extrapendicular approach for unilateral percutaneous vesselplasty in dealing with Kummell disease patients.

Methods

Twenty-seven patients undergoing vesselplasty at our institution were enrolled in the study. Vesselplasty was performed using percutaneous extrapendicular technique. Pain, restoration of vertebral body height, and cement leakage were evaluated in the process.

Results

Substantial pain relief was attained in all the patients. The visual analogue scale improved significantly from pre- to postoperation (P < .05), and remained unchanged at every follow-up. The anterior vertebral body heights were significantly corrected after operation (P < .05). No cement leakage was found.

Conclusion

This new technique of vesselplasty offers statistically significant benefits in Kummell disease patients. It also makes vesselplasty feasible, safe, and effective.

The therapeutic effects of percutaneous kyphoplasty on osteoporotic vertebral compression fractures with or without intravertebral cleft

PURPOSE

The purpose of this study was to investigate the clinical effects of percutaneous kyphoplasty (PKP) on osteoporotic vertebral compression fractures (OVCFs) with or without intravertebral cleft (IVC).

METHODS

From 2010 to 2016, 309 OVCFs patients (43 males, 266 females) treated with PKP were included in our study. All patients were divided into no intravertebral cleft (NIVC) group and intravertebral cleft (IVC) group according to pre-operative magnetic resonance imaging. Anterior wall height (AWH), posterior wall height (PWH), and kyphotic angle (KA) of the injured vertebral body were evaluated pre-operatively, post-operatively, and at final follow-up.

RESULTS

All patients were followed up for 12~34 months, with an average of 16.2 months. The incidence of IVC was associated with older age and lower bone mineral density (BMD). The anterior wall, posterior wall, and kyphotic angle of vertebral bodies of patients from both groups were significantly improved immediately after surgery. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) also improved significantly without significant difference between the two groups. At the final follow-up, compared to that immediately after surgery, the anterior wall height decreased and kyphotic angle increased significantly in both groups. Compared to the NIVC group, the kyphotic angle in the IVC group increased more significantly within 1 year after surgery. The volume of bone cement injected in the IVC group was larger and consequent. The IVC group had higher incidence of bone cement leakage than the NIVC group, but there was no statistic difference between two groups.

CONCLUSION

Our results suggested that unilateral PKP was a safe and reliable treatment for OVCFs with IVC. However, the IVC group had higher incidence of bone cement leakage during surgery and more severe KA rebound during the follow-up period. Therefore, to reduce the incidence of bone cement leakage, it is very important to evaluate the pre-operative imaging and inject the cement carefully and repetitiously. When cement leakages are found, injection should be stopped immediately. Longer rehabilitation interventions such as wearing suitable brace, doing exercise to strengthen low-back muscle, and replacing bending with squatting in ordinary living are essential to prevent KA rebound in patients with OVCFs with IVC. However, extended follow-up may be necessary for patients with OVCFs with IVC.

Comparison of Percutaneous Kyphoplasty and Bone Cement-Augmented Short-Segment Pedicle Screw Fixation for Management of Kümmell Disease

BACKGROUND The purpose of this study was to compare the efficacy of percutaneous kyphoplasty (PKP) and bone cement-augmented short segmental fixation (BCA+SSF) for treating Kümmell disease. MATERIAL AND METHODS Between June 2013 and December 2015, 60 patients were treated with PKP or BCA+SSF. All patients were followed up for 12-36 months. We retrospectively reviewed outcomes, including Oswestry Disability Index (ODI), visual analogue scale (VAS), and kyphotic Cobb angle. RESULTS VAS, ODI, and Cobb angle, measured postoperatively and at the final follow-up, were lower than those measured preoperatively in both groups (P<0.05). VAS, ODI, and Cobb angle measured postoperatively demonstrated no significant differences when compared with those measured at the final follow-up in the PKP group (P>0.05). In the BCA+SSF group, VAS and ODI at the final follow-up were lower than those measured postoperatively (P<0.05), but no significant difference was found in the Cobb angle (P>0.05). The PKP group had better VAS and ODI than the BCA+SSF group, postoperatively (P<0.05). No significant difference was found in VAS and ODI at the final follow-up (P>0.05) or the Cobb angle measured postoperatively and at the final follow-up (P>0.05) between the 2 groups. Operative time, blood loss, and hospital stay in the PKP group were lower than those in the BCA+SSF group (P<0.05). No significant difference was found in complications (P>0.05). CONCLUSIONS PKP patients had better early clinical outcomes, shorter operation times and hospital admission times, and decreased blood loss, but had similar complications, radiographic results, and long-term clinical outcomes compared with BCA+SSF patients.

Bone Cement-Augmented Short-Segment Pedicle Screw Fixation for Kümmell Disease with Spinal Canal Stenosis

Background

This study aimed to explore the feasibility and efficacy of bone cement-augmented short-segmental pedicle screw fixation in treating Kümmell disease.

Material/Methods

From June 2012 to June 2015, 18 patients with Kümmell disease with spinal canal stenosis were enrolled in this study. Each patient was treated with bone cement-augmented short-segment fixation and posterolateral bone grafting, and posterior decompression was performed when needed. All patients were followed up for 12–36 months. We retrospectively reviewed outcomes, including the Oswestry disability index (ODI), visual analog scale (VAS) score, anterior and posterior heights of fractured vertebrae, kyphotic Cobb angle, and neurological function by Frankel classification.

Results

The VAS grades, ODI scores, anterior heights of affected vertebrae, and kyphotic Cobb angles showed statistically significant differences between pre- and postoperative and between preoperative and final follow-up values (P<0.05), whereas the differences between postoperative and final follow-up values were not statistically significant (P>0.05). The differences between posterior vertebral heights at each time point were not statistically significant (P>0.05). Improved neurological function was observed in 12 cases at final follow-up. Three cases had complications, including asymptomatic cement leakage in 2 patients and delayed wound infection in 1 patient.

Conclusions

Bone cement-augmented short-segment pedicle screw fixation is safe and effective for treating Kümmell disease, and can achieve satisfactory correction of kyphosis and vertebral height, with pain relief and improvement in neurological function, with few complications.

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

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

Therapeutic effects of PKP on chronic painful osteoporotic vertebral compression fractures with or without intravertebral cleft

This study aims to investigate clinical effects of protruding after percutaneous vertebral plasty (PKP holds) for treatment of chronic painful osteoporotic vertebral compression fractures (CPOVCFs), and assess its safety and effectiveness. One hundred and eighteen CPOVCFs patients were included, and analyzed and followed up therapeutic effects of PKP holds. All of these patients were divided into NIVC (73 cases) and IVC (45 cases) group. Comparing operation time, bone cement perfusion, pain intensity modulus visual grading scoring, Oswestry disability index, fracture fanterior relative height, local convex Angle, and surgical complications between the two groups. There were no significant differences between two groups for operation time of PKP holds (P>0.05). Amount of bone cement injection in IVC groups was significantly higher compared to NIVC group (P<0.05). Pain intensity visual modulus ratings and Oswestry disability index were significantly improved in both groups after surgery and postoperative follow-up period compared to pre-operation (P<0.05). Fracture fanterior margin relative height and local convex angle were also significantly improved (P<0.05). Fracture fanterior margin relative height was also significantly improved for IVC compared to NIVC group (P<0.05). There were no differences for bone cement leakage rate and adjacent segment fracture between two groups (P>0.05). But there was a case of bone cement loose, which needs to be treated for further step. In conclusion, PKP holds is a kind of effective and safe method for the IVC and NIVC patients. Especially for the IVC patients, PKP holds can significantly improve the fracture fanterior margin relative height.