1
|
Seuvic FM, Gillet R, Louis M, Germain É, Lombard C, Blum A, Gondim Teixeira PA. Association between opportunistic vertebral bone density measurements and new vertebral fractures after percutaneous vertebral cementoplasty: a case-control study. Eur Radiol 2023; 33:106-15. [PMID: 35776181 DOI: 10.1007/s00330-022-08946-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/15/2022] [Accepted: 06/03/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To study the relationship between opportunistic CT bone density measurements and the occurrence of new vertebral fractures after percutaneous vertebral cementoplasty (PVC) of osteoporotic vertebral compression fractures (OVCF). METHODS A prospective analysis of retrospective data of 275 patients with OVCF treated by PVC between 2014 and 2019 with a clinico-radiological follow-up one year after treatment was conducted. Opportunistic bone density measurements were obtained at the trabecular bone of the L1 or an adjacent vertebra in Hounsfield units performed on the preoperative CT study. These density measurements values were then compared between patients with and without new OCVF and in various population subgroups. RESULTS There were 275 patients included, with 53 (19%) presenting a new OCVF and 24 (9%) developing a fracture cascade. The median opportunistic density measurements in patients with recurrent OCVF were lower than those without (median 52[40.5]) HU and 77[49] HU)(p < 0.00001). Among the patients with new OVCF the median opportunistic density measurements in patients with fracture cascades were also lower than those without (44 HU and 62 HU, respectively) (p < 0.0096). Patients with density measurements under 61 HU were 3.6 times more likely to present recurrent fractures and those with density under 54 HU were 9.8 times more likely to develop a fracture cascade. The 36 HU threshold yielded a high specificity (90-91%) for the prediction of recurrent fractures and fracture cascade but with low sensitivity (respectively 26% and 37%). CONCLUSION Low opportunistic vertebral density measurements are associated with a higher risk of OVCF and fracture cascades after PVC. KEY POINTS • Low opportunistic density measurements are associated with a higher risk of OVCF and fracture cascades after PVC. • Measuring bone density before performing a PVC could help predict the risk of new vertebral fracture after treatment • Patient management could be adapted according to bone density.
Collapse
|
2
|
Wang M, Li B, Wang Y, Jiang S, Wen G, Jiang L, Zheng X, Ding W. The Effects of Bone Cement Volume in Percutaneous Vertebroplasty for Thoracolumbar Junction Vertebral Compression Fractures: A Clinical Comparative Study. Mediators Inflamm 2022; 2022:1-7. [PMID: 35909661 PMCID: PMC9337957 DOI: 10.1155/2022/4230065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/21/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
We compared the outcomes of patients treated with different volumes of polymethyl methacrylate bone cement during percutaneous vertebroplasty (PVP) for thoracolumbar vertebral compression fractures. We performed a comparative, retrospective study of 316 patients who underwent PVP for a single-level thoracolumbar vertebral compression fracture. Patients were divided into two groups: group A (≤5 mL; n = 146) and group B (>5 mL; n = 170). The visual analogue scale (VAS) for pain and the Roland-Morris Disability Questionnaire (RDQ) scores were compared between the two groups at 1 week and at 1, 6, 12, and 24 months after PVP. The incidence of cement leakage into the intervertebral discs was evaluated by a postoperative lateral radiograph assessment. Patients were evaluated for new fractures 1 and 2 years after PVP or when new fractures were suspected. Among the 316 patients enrolled, 245 completed the clinical research. No difference between groups A and B in terms of the VAS, RDQ, and rate of complications at all time points after surgery was observed. The presence of intervertebral disc leakage was a relative risk (RR) for subsequent total vertebral fracture (RR, 6.42; 95% confidence interval (CI), 2.72-14.19; P < 0.0001) and adjacent vertebral fracture (RR, 8.03; 95% CI, 2.74-23.54; P = 0.0001). A high volume of bone cement may increase the rate of subsequent total and adjacent vertebral fractures. However, the occurrence of intervertebral disc leakage is the principal risk factor for these negative outcomes of PVP.
Collapse
|
3
|
Liu J, Tang J, Xia B, Gu Z, Yin H, Zhang H, Yang H, Song B. Novel Radiomics-Clinical Model for the Noninvasive Prediction of New Fractures After Vertebral Augmentation. Acad Radiol 2022; 30:1092-1100. [PMID: 35915030 DOI: 10.1016/j.acra.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/25/2022] [Accepted: 06/26/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the noninvasive prediction model for new fractures after percutaneous vertebral augmentation (PVA) based on radiomics signature and clinical parameters. METHODS Data from patients who were diagnosed with osteoporotic vertebral compression fracture (OVCF) and treated with PVA in our hospital between May 2014 and April 2019 were retrospectively analyzed. Radiomics features were extracted from T1-weighted magnetic resonance imaging (MRI) of the T11-L5 segments taken before PVA. Different radiomics models was developed by using linear discriminant analysis (LDA), multilayer perceptron (MLP), and stochastic gradient descent (SGD) classifiers. A nomogram was constructed by integrating clinical parameters and Radscore that calculated by the best radiomics model. The model performance was quantified in terms of discrimination, calibration and clinical usefulness. RESULT Four clinical parameters and 16 selected radiomics features were used for model development. The clinical model showed poor discrimination capability with area under the curves (AUCs) yielding of 0.522 in the training dataset and 0.517 in the validation dataset. The LDA, MLP and SGD classifier-based radiomics model had achieved AUCs of 0.793, 0.810, and 0.797 in the training dataset, and 0.719, 0.704, and 0.725 in the validation dataset, respectively. The nomogram showed the best performance with AUCs achieving 0.810 and 0.754 in the training and validation datasets, respectively. The decision curve analysis demonstrated the net benefit of the nomogram was higher than that of other models. CONCLUSION Our findings indicate that combining clinical features with radiomics features from pre-augmentation T1-weighted MRI can be used to develop a nomogram that can predict new fractures in patients after PVA.
Collapse
|
4
|
Ding JK, Zhao B, Zhai YF. Subsequent fractures after vertebroplasty in osteoporotic vertebral fractures: a meta-analysis. Neurosurg Rev 2022. [PMID: 35195800 DOI: 10.1007/s10143-022-01755-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/22/2022] [Accepted: 02/13/2022] [Indexed: 12/21/2022]
Abstract
Percutaneous vertebroplasty (VP) provides substantial benefit to patients with painful osteoporotic vertebral compression fractures (OVCF). However, the reoccurrence of vertebral fracture after VP is a major concern. The purpose of this study is to conduct a meta-analysis on the incidence of subsequent fractures after VP in patients with OVCF. PubMed and EMBASE were searched. In addition, we scrutinized the reference list of all relevant articles to supplement the database search. We included original articles reporting on new fracture rates after VP in OVCF patients. Subsequent fracture rates were pooled across studies using a random-effects meta-analysis. Thirty-nine studies with a total of 8047 participants from 12 countries were included in this meta-analysis. Patients' age ranged from 64.2 to 94.6 years (reported by 31 studies). The median follow-up was 21 months (36 studies). Pooled estimate for subsequent fractures after VP was 23.4% (95% CI, 19.8-27.2%; I2 = 93.0%, p < 0.01). New fractures after VP in 54.6% of cases occurred in the vertebral bodies adjacent to the treated vertebra (95% CI, 49.0-60.1%; I2 = 66.0%, p < 0.01). A significant proportion of patients undergoing VP for OVCF experience new fractures after treatment, most of which are developed in the vertebral bodies adjacent to the treated vertebra.
Collapse
|
5
|
Abstract
Appropriate care of patients with a recent painful osteoporotic vertebral fracture (VF) requires immobilisation, analgesics and spinal orthoses. Some VFs are however responsible for disabling pain and prolonged bed rest. In this context, vertebroplasty techniques have been proposed with a large benefit in case series and open-label randomised studies, but lack efficacy in three among four double-blind randomised studies. The objectives of the treatment of a recent painful VF are to relieve pain and to preserve mechanical conditions. With this in mind, we report an experts’ opinion paper on the indications for vertebroplasty and research agenda for clinical studies.
Collapse
Affiliation(s)
- Christian Roux
- INSERM U1153, APHP.Centre-Université de Paris, Service de Rhumatologie, Hôpital Cochin, Paris, France
| | - Bernard Cortet
- Department of Rheumatology, ULR 4490, Université de Lille, Lille University Hospital, Lille, France
| | - Valérie Bousson
- Service de Radiologie Ostéo-Articulaire, APHP.Nord-Université de Paris, Hôpital Lariboisière, Paris, France
| | - Thierry Thomas
- Service de Rhumatologie, and INSERM U 1059, Université de Lyon-Université Jean Monnet, CHU de St-Etienne, Saint-Etienne, France
| |
Collapse
|
6
|
Gan DH, Fang MZ, Xue HP, Tan GQ, Li NH, Li ZC, Xu ZW. Clinical Observations of Kümmell Disease Treatment Through Percutaneous Fixation Combined with Vertebroplasty. Orthop Surg 2021; 13:1505-1512. [PMID: 34075704 PMCID: PMC8313159 DOI: 10.1111/os.12935] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/25/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore the safety and efficacy of percutaneous pedicle screw fixation combined with vertebroplasty for the treatment of stage III Kümmell disease. METHODS The clinical data and follow-up results of 22 patients with Kümmell disease who were admitted to our department from 2014 to 2018 were analyzed. There were 14 females and eight males, and the Age range was 58-81 years. All patients were followed up for 24 months. The treatment method was percutaneous pedicle screw fixation combined with vertebroplasty. The patient general information such as age, gender, bedrest time and location of fracture vertebrae were recorded. The clinical symptoms and imaging data of visual analogue scale (VAS), bone cement leakage, Oswestry Disability Index (ODI), Cobb angle, anterior, middle and posterior height of the diseased vertebral body, and complications were recorded before operation and during follow-up. RESULTS For patients enrolled, no bone cement leakage was observed during the operation; no patients developed infections after operation. The operation was safe and resulted in a short bedrest time. The VAS score and ODI index at 3 and 24 months postoperative (2.86 ± 0.83, 31.68% ± 6.21%; 3.0 ± 0.82, 32.78% ± 6.05%) were significantly lower than that recoded preoperatively (7.59 ± 0.59, 71.5% ± 8.84%) (P < 0.05). Additionally, there was no significant difference between the records at 3 and 24 months after operation (P > 0.05). Imaging data showed that the bone cement and screws were in good position and did not move during postoperative and follow-up. The anterior, middle and posterior height of the diseased vertebral body measured 2 days after surgery (23.46 ± 4.72, 23.12 ± 3.05, 25.81 ± 2.22) and at last follow-up (20.83 ± 4.48, 21.78 ± 2.74, 24.74 ± 1.93) were higher than that recorded preoperatively (13.08 ± 4.49, 12.93 ± 3.53, 19.32 ± 2.73) (P < 0.05), and the Cobb angle measured 2 days and 24 months after operation (9.57 ± 4.63, 10.68 ± 3.97) were lower than that recorded preoperatively (28.24 ± 8.95) (P < 0.05), and no significant difference was found between the values recorded at 2 days and 24 months after operation (P > 0.05). Follow-up for 24 months, there was no re-fracture of the diseased vertebrae and internal fixation loosening, but two cases of adjacent vertebral refracture complications occurred, and the effect was good after PVP treatment. CONCLUSION Short-segment percutaneous pedicle screw fixation combined with vertebroplasty in the treatment of stage III Kümmel disease can effectively restore the height of the diseased vertebrae, kyphosis correction, reduce trauma, prevent the diseased vertebral body from collapsing again, and effectively improves clinical symptoms.
Collapse
Affiliation(s)
- Dong-Hao Gan
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Meng-Ze Fang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hai-Peng Xue
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.,Department of Orthopedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guo-Qing Tan
- Department of Orthopedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Nian-Hu Li
- Department of Orthopedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhi-Chao Li
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhan-Wang Xu
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.,Department of Orthopedics, Affilited Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| |
Collapse
|
7
|
Lee J, Kim JK, Oh M, Shin YH. The Characteristics of Women with Subsequent Distal Radius Fracture after Initial Distal Radius Fracture. J Bone Metab 2021; 28:123-129. [PMID: 34130364 PMCID: PMC8206611 DOI: 10.11005/jbm.2021.28.2.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/28/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the characteristics of women with subsequent distal radius fracture (DRF) and to compare bone fragility variables in women with initial and subsequent DRF. METHODS We enrolled 227 women who experienced DRF (203 women with initial DRF and 24 women with subsequent DRF) between September 2016 and April 2019. We compared demographic characteristics and bone fragility variables, including bone mineral density, trabecular bone score, hip geometry, bicortical thickness of the distal radius, and fracture risk assessment tool (FRAX) scores between the 2 groups. To reduce bias, patients with subsequent DRF were propensity score-matched in a 1:2 manner with patients affected by initial DRF, and additional comparisons were performed. RESULTS Patients in the subsequent DRF group were older than those in the initial DRF group, but this difference was not significant (P=0.091). The proportion of patients receiving treatment with osteoporosis medication was significantly higher in the subsequent DRF group (41.7% vs. 19.2%, P=0.011). Bone fragility variables did not differ significantly between the 2 groups. However, the ten-year probability of major osteoporotic fractures based on FRAX scores was significantly higher in patients with subsequent DRF (7.5% vs. 10.8%, P<0.001). Similar results were observed when comparing the propensity score-matched initial and subsequent DRF groups. CONCLUSIONS These findings suggest that the occurrence of subsequent DRF after initial DRF can be attributed to multiple factors rather than bone fragility alone. Systematic and multidisciplinary management would be helpful in preventing the occurrence of subsequent DRF after the initial DRF.
Collapse
Affiliation(s)
- Jongjin Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Kwang Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Minyoung Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Salle H, Meynard A, Auditeau E, Gantois C, Rouchaud A, Mounayer C, Faure P, Caire F. Treating traumatic thoracolumbar spine fractures using minimally invasive percutaneous stabilization plus balloon kyphoplasty: a 102-patient series. J Neurointerv Surg 2021; 13:848-853. [PMID: 33758064 DOI: 10.1136/neurintsurg-2020-017238] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND There is no consensus on the treatment for spinal injuries resulting in thoracolumbar fractures without neurological impairment. Many trauma centers are opting for open surgery rather than a neurointerventional approach combining posterior percutaneous short fixation (PPSF) plus balloon kyphoplasty (BK). OBJECTIVE To assess the safety and efficacy of PPSF+BK and to estimate the expected improvement by clarifying the factors that influence improvement. METHODS We retrospectively reviewed patients who underwent PPSF+BK for the treatment of single traumatic thoracolumbar fractures from 2007 to 2019. Kyphosis, loss of vertebral body height (VBH), clinical and functional outcomes including visual analog scale and Oswestry disability index were assessed. We examined the overall effects in all patients by constructing a linear statistical model, and then examined whether efficacy was dependent on the characteristics of the patients or the fractures. RESULTS A total of 102 patients were included. No patient experienced neurological worsening or wound infections. The average rates of change were 74.4% (95% CI 72.6% to 76.1%) for kyphosis and 85.5% (95% CI 84.4% to 86.6%) for VBH (both p<0.0001). The kyphosis treatment was more effective on Magerl A3 and B2 fractures than on those classified as A2.3, as well as for fractures with slight posterior wall protrusion on the spinal canal. A higher postoperative visual analog scale score was predictive of poorer outcome at 1 year. CONCLUSIONS This is the largest series reported to date and confirms and validates this surgical treatment. All patients exhibited improved kyphosis and restoration of VBH. We advise opting for this technique rather than open surgery.
Collapse
Affiliation(s)
| | | | - Emilie Auditeau
- Epidemiology and Statistical Analysis, CHU Limoges, Limoges, France
| | | | - Aymeric Rouchaud
- Interventional Neuroradiology, CHU Limoges, Limoges, France.,University of Limoges, CNRS, XLIM, UMR 7252, Limoges, France
| | | | | | | |
Collapse
|
9
|
Hu W, Wang H, Shi X, Song Y, Zhang G, Xing S, Zhang K, Gao Y. Effect of Preoperative Zoledronic Acid Administration on Pain Intensity after Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures. Pain Res Manag 2020; 2020:8039671. [PMID: 32831984 DOI: 10.1155/2020/8039671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/07/2020] [Indexed: 02/04/2023]
Abstract
Introduction This study aimed to compare and analyze the effect of preoperative zoledronic acid (ZOL) administration on pain intensity after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). Methods The study included 242 patients with OVCFs who underwent PVP in our hospital between January 2015 and June 2018. The patients were randomly assigned to either a ZOL group (n = 121) or a control group (n = 121). The patients in the ZOL group were treated preoperatively with intravenous infusion of 5 mg ZOL. Those in the control group were treated without ZOL. All the patients were followed up for 1 year. Results No statistically significant differences in age, sex, weight, and body mass index (BMI) were found between the two groups. During the follow-up period, the visual analog scale score and Oswestry dysfunction index score in the ZOL group were lower than those in the control group. The bone mineral density at 6 or 12 months after treatment was significantly higher and the levels of the bone metabolism markers were significantly lower in the ZOL group than in the control group (P < 0.05 for both). Two patients in the treatment group had new vertebral fractures, whereas 13 patients in the control group had new vertebral fractures, which translate to recompression vertebral fracture incidence rates of 1.7% and 10.7%, respectively. The incidence rate of mild adverse reactions was significantly higher in the ZOL group than in the control group, but all the cases were endurable. Conclusion Intravenous infusion of ZOL before PVP can effectively reduce postoperative pain intensity, reduce bone loss, increase bone density, reduce the risk of refracture, and improve patient quality of life.
Collapse
|
10
|
Meyblum L, Premat K, Elhorany M, Shotar E, Cormier É, Degos V, Pascal-Mousselard H, Rosenberg S, Clarençon F, Chiras J. Safety of vertebral augmentation with cranio-caudal expansion implants in vertebral compression fractures with posterior wall protrusion. Eur Radiol 2020; 30:5641-9. [PMID: 32367420 DOI: 10.1007/s00330-020-06889-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/10/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Vertebral augmentation (VA) has become routinely used in vertebral compression fractures (VCFs). VCFs are often associated with posterior wall protrusions (PWPs), which theoretically contraindicates vertebroplasty due to a higher risk of neurological complications. The latest generation of VA devices uses intravertebral cranio-caudal expandable implants to improve the correction of structural deformities but could also be used to prevent further PWP during cement injection. The aim of this study was to evaluate the safety of VA with expandable implant for VCFs with PWP. METHODS All consecutive patients treated with expandable implants were considered eligible for inclusion if they met the following criteria: (1) non-neurological VCF, (2) considered unstable (A3-A4 in AOSpine classification), (3) significant PWP (> 2 mm), (4) back pain with a visual analogue scale (VAS) ≥ 4. PWPs were independently measured by two investigators; Pearson's statistics were used for interobserver reproducibility. RESULTS Fifty-one consecutive patients, with a mean age of 75 ± 8.3 years (range, 50-92), were included. There was a slight decrease between mean preoperative (6.7 mm ± 2.2 mm) and postoperative (6.5 mm ± 2.2 mm) PWP (p = 0.02), with an excellent interobserver reproducibility (Pearson correlation coefficient = 0.92). A mean kyphosis reduction of 34.9% (± 28.4) was observed (p < 0.001). Forty-two patients (82.4%) had significant pain improvements (mean preoperative VAS = 6.9 [± 1.7] versus 3.1 [± 2.0] postoperatively [p < 0.001]). Secondary adjacent level fractures were noted in 16 patients (31.4%), with a reduction of that risk down to 18.8% if a preventive adjacent vertebroplasty was performed, without reaching the significance threshold (p = 0.14). CONCLUSIONS VA with expandable implants appeared safe for non-neurological VCFs with PWP, while allowing satisfactory pain relief. KEY POINTS • Vertebral augmentation with cranio-caudal expandable implants is safe for non-neurological vertebral compression fractures with posterior wall protrusions. • Vertebral augmentation with cranio-caudal expandable implants might increase the occurrence of secondary adjacent level fractures. • Adjacent level vertebroplasty might be helpful to prevent secondary adjacent level fractures.
Collapse
|
11
|
Lee EJ, Huang CC, Tai SH, Lai CH. Comparison of an intravertebral reduction device and percutaneous vertebroplasty for anatomical reduction with single-level vertebral compression fractures. Formos J Surg 2020. [DOI: 10.4103/fjs.fjs_5_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
12
|
Rommens PM, Arand C, Hopf JC, Mehling I, Dietz SO, Wagner D. Progress of instability in fragility fractures of the pelvis: An observational study. Injury 2019; 50:1966-1973. [PMID: 31492514 DOI: 10.1016/j.injury.2019.08.038] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/25/2019] [Indexed: 02/02/2023]
Abstract
UNLABELLED Fragility fractures of the pelvis (FFP) are an increasing entity among elderly persons. Characteristics are different from high-energy pelvic trauma. Little is known about the natural course of FFP in conservative and after operative treatment. MATERIALS AND METHODS Medical charts and radiologic data of 148 patients with an FFP, who were admitted in a 3-year period, were analysed retrospectively. Incidence and characteristics of fracture progression (FP) were noted. RESULTS Patients presenting early after a traumatic event had more often non-displaced fractures, fractures with lower FFP Type classification and were more frequently treated conservatively. FP was observed in 21 cases (14.2%), twenty times after conservative and once after operative treatment. FP under conservative treatment occurred in female patients only. Patients with FP were younger than patients without. FP occurred in all fracture types, most frequently in FFP Type I. A second CT scan was positive for FP in 39.2% of patients with prolonged pain or restricted mobility. CONCLUSION FP is a real phenomenon, occurring in a minority of FFP patients. Female patients are at highest risk. Repeated CT scan is positive in nearly 40% of patients with continuing pain or restricted mobility. Operative treatment is a good preventive measure of FP as FP does only exceptionally occur after operative fixation of FFP.
Collapse
Affiliation(s)
- P M Rommens
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - C Arand
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - J C Hopf
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - I Mehling
- Department of Orthopaedics, Traumatology, Hand Surgery and Sports Medicine, Saint-Vinzenz Hospital Hanau, Am Frankfurter Tor 25, 63450 Hanau, Germany.
| | - S O Dietz
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - D Wagner
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Langenbeckstrasse 1, 55131 Mainz, Germany.
| |
Collapse
|
13
|
Kong M, Zhou C, Zhu K, Zhang Y, Song M, Zhang H, Tu Q, Ma X. 12-Month Teriparatide Treatment Reduces New Vertebral Compression Fractures Incidence And Back Pain And Improves Quality Of Life After Percutaneous Kyphoplasty In Osteoporotic Women. Clin Interv Aging 2019; 14:1693-1703. [PMID: 31631990 PMCID: PMC6778479 DOI: 10.2147/cia.s224663] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/15/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose Define the effectiveness of teriparatide (TPTD) treatment on reducing the incidence of new vertebral compression fractures (NVCFs) and back pain and improving quality of life after percutaneous kyphoplasty (PKP). Methods Two years of clinical follow-up data from primary osteoporotic women who had experienced initial osteoporotic vertebral compression fractures (OVCFs) and received PKP plus 12-month TPTD (n=113) or basic treatment (BT) of calcium and vitamin D supplements (n=208) were retrospectively collected. The risk of NVCFs over each 6-month period in the TPTD group was evaluated and compared with the BT group using a logistic regression. Health-related quality of life (HRQoL, EQ-5D questionnaire), back pain [100 mm visual analog scale (VAS)] and bone mineral density (BMD) of the spine were analyzed using linear mixed models for repeated measures (LMMRM). Results Logistic regression analysis adjusting for baseline characteristics showed that patients in the TPTD group had a lower risk of NVCFs compared with those receiving BT during the final three observation intervals (6-12 months, OR=0.189, 95% CI=0.030-0.681, p=0.046; 12-18 months, OR=0.009, 95% CI=0.0001-0.111, p=0.001; 18-24 months, OR=0.024, 95% CI=0.0009-0.264, p=0.009, respectively). Significant improvements in adjusted EQ-5D and back pain VAS scores were identified in the TPTD group compared with the BT group, and this improvement was sustained for at least 12 months after teriparatide treatment was discontinued (both p<0.001). The BMD of the spine also showed a higher T-value in the TPTD group compared with the BT group (p<0.001). Conclusion In routine clinical practice, for patients with OVCFs who receive the PKP procedure, TPTD treatment may be a preferable subsequent therapy because of its ability to reduce the incidence of NVCFs and sustain a high quality of life and back pain alleviation.
Collapse
Affiliation(s)
- Meng Kong
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China.,Department of Medicine, Qingdao University, Qing'dao, Shandong Province 266000, China
| | - Chuanli Zhou
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China
| | - Kai Zhu
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China
| | - Yiran Zhang
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China
| | - Mengxiong Song
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China
| | - Hao Zhang
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China
| | - Qihao Tu
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China
| | - Xuexiao Ma
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, China.,Department of Medicine, Qingdao University, Qing'dao, Shandong Province 266000, China
| |
Collapse
|
14
|
Yang W, Song J, Liang M, Cui H, Chen H, Yang J. Functional Outcomes and New Vertebral Fractures in Percutaneous Vertebroplasty and Conservative Treatment of Acute Symptomatic Osteoporotic Vertebral Compression Fractures. World Neurosurg 2019; 131:e346-e352. [PMID: 31356973 DOI: 10.1016/j.wneu.2019.07.153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/19/2019] [Accepted: 07/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The present study compared the clinical functional outcomes and new vertebral compression fractures (NVCFs) between percutaneous vertebroplasty (PVP) and conservative treatment (CT) in patients with severe pain due to acute osteoporotic vertebral compression fractures (OVCFs). PVP has been increasingly used for the treatment of pain in patients with OVCFs. However, the effectiveness of the procedure and whether it causes NVCFs has remained controversial. METHODS A total of 544 eligible patients with OVCFs found on spinal radiographs and intractable back pain for ≤6 weeks were recruited from September 2012 to February 2018 and assigned to PVP (n = 280; 392 levels) or CT (n = 264; 366 levels). The visual analog scale and Oswestry Disability Index scores were determined before the intervention and at the 1-week and 1-, 3-, 6-, 12-, and 24-month follow-up examinations. In addition, monthly telephone follow-up interviews were performed. In the case of a sudden increase in back pain, the patient returned to the hospital for medical and magnetic resonance imaging examinations for NVCF detection. RESULTS The PVP group had significantly lower visual analog scale and Oswestry Disability Index scores than those for the CT group at 1 week and 1, 3, and 6 months (P < 0.05). However, the differences after 6 months were not statistically significant (P > 0.05). Similar numbers of NVCFs (total and adjacent fractures) were found at 24 months in both groups (P > 0.05). CONCLUSIONS Compared with CT, PVP provided a rapid decrease in pain and an early return to daily life activities, without an increase in the incidence of NVCFs.
Collapse
Affiliation(s)
- Wencheng Yang
- Zhengzhou Central Hospital, Affiliated with Zhengzhou University, Zhengzhou City, People's Republic of China.
| | - Jiangtao Song
- Zhengzhou Central Hospital, Affiliated with Zhengzhou University, Zhengzhou City, People's Republic of China
| | - Ming Liang
- Zhengzhou Central Hospital, Affiliated with Zhengzhou University, Zhengzhou City, People's Republic of China
| | - Hao Cui
- Zhengzhou Central Hospital, Affiliated with Zhengzhou University, Zhengzhou City, People's Republic of China
| | - Hengyi Chen
- Zhengzhou Central Hospital, Affiliated with Zhengzhou University, Zhengzhou City, People's Republic of China
| | - Jianyi Yang
- Zhengzhou Central Hospital, Affiliated with Zhengzhou University, Zhengzhou City, People's Republic of China
| |
Collapse
|
15
|
Lamanna A, Maingard J, Kok HK, Ranatunga D, Looby ST, Brennan P, Chua M, Owen A, Brooks DM, Chandra RV, Asadi H. Vertebroplasty for acute painful osteoporotic vertebral compression fractures: An update. J Med Imaging Radiat Oncol 2019; 63:779-785. [PMID: 31106977 DOI: 10.1111/1754-9485.12900] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/19/2019] [Indexed: 12/12/2022]
Abstract
Vertebral compression fractures (VCFs) are a common cause of back pain and disability and are usually osteoporotic in nature. Therapy aims to adequately control pain and allow early mobilisation and return of function while preventing additional fractures. A proportion of patients do not achieve adequate pain relief using conservative measures alone. Unwanted adverse effects from medications may also ensue. Vertebroplasty represents an alternative treatment option for VCFs. Patients with acute VCFs (≤6 weeks old) may gain the most benefit from vertebroplasty as healed fractures are not as amenable to cement injection. High-quality studies have reported conflicting results regarding the use of vertebroplasty in the treatment of acute VCFs. Despite high-quality evidence, varying study designs and heterogenous patient cohorts make interpretation of this data difficult. Only one sham-controlled randomised controlled trial (RCT) has evaluated vertebroplasty exclusively in patients with acute VCFs, reporting favourable results. Pooled data from RCTs also suggest vertebroplasty to be safe. This article provides a concise and critical review of the current literature regarding vertebroplasty for the treatment of acute VCFs.
Collapse
Affiliation(s)
- Anthony Lamanna
- Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Julian Maingard
- Department of Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Hong Kuan Kok
- Interventional Radiology Service, Northern Hospital Radiology, Melbourne, Victoria, Australia
| | - Dinesh Ranatunga
- Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Seamus T Looby
- Interventional Radiology Service - Department of Radiology, Beaumont Hospital, Dublin, Ireland.,Department of Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul Brennan
- Interventional Radiology Service - Department of Radiology, Beaumont Hospital, Dublin, Ireland.,Department of Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michelle Chua
- Department of Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Andrew Owen
- Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Duncan Mark Brooks
- Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia.,Interventional Neuroradiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Ronil V Chandra
- Department of Imaging, Monash Health, Melbourne, Victoria, Australia.,Interventional Neuroradiology Unit - Monash Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Hamed Asadi
- Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia.,Department of Imaging, Monash Health, Melbourne, Victoria, Australia.,Interventional Neuroradiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia.,Interventional Neuroradiology Unit - Monash Imaging, Monash Health, Melbourne, Victoria, Australia.,School of Medicine - Faculty of Health, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
16
|
Noriega DC, Rodrίguez-Monsalve F, Ramajo R, Sánchez-Lite I, Toribio B, Ardura F. Long-term safety and clinical performance of kyphoplasty and SpineJack® procedures in the treatment of osteoporotic vertebral compression fractures: a pilot, monocentric, investigator-initiated study. Osteoporos Int 2019; 30:637-645. [PMID: 30488273 DOI: 10.1007/s00198-018-4773-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/11/2018] [Indexed: 11/25/2022]
Abstract
UNLABELLED This pilot monocenter study in 30 patients with painful osteoporotic vertebral compression fractures compared two vertebral augmentation procedures. Over a 3-year post-surgery follow-up, pain/disability/quality of life remained significantly improved with both balloon kyphoplasty and SpineJack® techniques, but the latter allowed better vertebral body height restoration/kyphosis correction. INTRODUCTION Patient follow-up rarely exceed 2 years in trials comparing vertebral augmentation procedures for the treatment of painful osteoporotic vertebral compression fractures (VCFs). This pilot, investigator-initiated, prospective study aimed to compare long-term results of SpineJack® (SJ) and balloon kyphoplasty (BKP). Preliminary results showed that SJ resulted in a better restoration of vertebral heights and angles, maintained over 12 months. METHODS Thirty patients were randomized to SJ (n = 15) or BKP (n = 15). Clinical endpoints were analgesic consumption, back pain intensity (visual analog scale (VAS)), the Oswestry Disability Index (ODI), and quality of life (EQ-VAS score). They were recorded preoperatively, at 5 days (except EQ-VAS), 1, 3, 6, 12, and 36 months post-surgery. Spine X-rays were taken 48 h prior to the procedure and 5 days, 6, 12, and 36 months after. RESULTS Clinical improvements were observed with both procedures over the 3-year period without significant inter-group differences, but the final mean EQ-5Dindex score was significantly in favor of the SJ group (0.93 ± 0.11 vs 0.81 ± 0.09; p = 0.007). Vertebral height restoration/kyphotic correction was still evident at 36 months with a greater mean correction of anterior (10 ± 13% vs 2 ± 8% for BKP, p = 0.007) and central height (10 ± 11% vs 3 ± 7% for BKP, p = 0.034) and a larger correction of the vertebral body angle (- 5.0° ± 5.1° vs 0.4° ± 3.4°; p = 0.003) for SJ group. CONCLUSIONS In this study, both techniques displayed very good long-term clinical efficiency and safety in patients with osteoporotic VCFs. Over the 3-year follow-up, vertebral body height restoration/kyphosis correction was better with the SpineJack® procedure.
Collapse
Affiliation(s)
- D C Noriega
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain.
| | - F Rodrίguez-Monsalve
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain
| | - R Ramajo
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain
| | - I Sánchez-Lite
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain
| | - B Toribio
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain
| | - F Ardura
- Hospital Clinico Universitario de Valladolid, Calle Ramon y Cajal, 47008, Valladolid, Spain
| |
Collapse
|
17
|
Abstract
STUDY DESIGN This was a clinical retrospective study. OBJECTIVES This retrospective study aimed to investigate the incidence of new vertebral compression fractures (NVCFs) and analyze the risk factors that influence the secondary fractures in adjacent and nonadjacent levels after percutaneous vertebroplasty (PVP) and conservative treatment (CT). SUMMARY OF BACKGROUND DATA PVP is an effective procedure to alleviate the pain caused by osteoporotic vertebral compression fractures. NVCFs have been noted as a potential late sequela of the procedure. However, it remains unclear whether NVCFs are due to this augmentation or simply are the result of the natural progression of osteoporosis. METHODS A total of 290 patients who had undergone PVP and 270 patients who had undergone CT during the last 4 years were examined. They were followed-up on a monthly basis by telephone for >2 years. They were divided into 2 groups: NVCFs and non-NVCFs. The groups were statistically compared in terms of age, sex, body mass index, initial fracture levels, bone mineral density (BMD) score of the spine, original fracture levels, and new fracture levels. RESULTS After a mean follow-up of at least 24 months (range, 24-78 mo), 42 NVCFs occurred in 37 of 290 patients after PVP and 33 NVCFs in 30 of 270 patients after CT. Only BMD was significantly different between the groups. Lower BMD was a significant predictive factor for NVCFs. CONCLUSIONS PVP did not increase the incidence of NVCFs, especially those adjacent to the treated vertebrae, following augmentation with PVP compared with CT. The most important risk factor for NVCFs was osteoporosis.
Collapse
|
18
|
He X, Liu Y, Zhang J, Jia S, Meng Y, Huang Y, Wu Q, Hao D. An innovative technique for osteoporotic vertebral compression fractures - vertebral osteotome with side-opening cannula. J Pain Res 2018; 11:1905-1913. [PMID: 30271197 PMCID: PMC6151105 DOI: 10.2147/jpr.s169123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective This study is to assess an innovative technique - a vertebral osteotome (VO) combined with side-opening injection cannula for percutaneous vertebroplasty (PVP). Methods A retrospective study by propensity score matching. From January 2016 to April 2016, 63 patients who were diagnosed with monosegmental osteoporotic vertebral compression fracture received the innovative technique. The epidemiologic data, surgical indexes, and recovery outcomes were collected in the follow-up period. Propensity score matching identified 63 pairs form historical controls by traditional unilateral PVP approach in 2015 using six independent variables: age, sex, preoperative visual analog score (VAS), Oswestry Disability Index (ODI), body mass index, and bone mineral density. Results The surgical duration and cement distribution were longer and larger in patients by VO method. Besides, postoperative VAS and ODI in the VO group were lower than those in the control group. However, there were no differences in radiation exposure times, improvement of Cobb angle, cement leakage, or adjacent vertebral fracture between two groups. Cement volume in the VO group was less than that in the control group. Conclusion This new innovative technique makes PVP safe and effective. Although it lasts longer, the restoration rate of vertebral height and cement distribution can be improved, which contributes to a better pain relief.
Collapse
Affiliation(s)
- Xin He
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an 710054, Shaan'xi Province, China,
| | - Yang Liu
- Department of Bone Microsurgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an 710054, Shaan'xi Province, China
| | - JiaNan Zhang
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an 710054, Shaan'xi Province, China,
| | - ShuaiJun Jia
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an 710054, Shaan'xi Province, China,
| | - YiBin Meng
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an 710054, Shaan'xi Province, China,
| | - YunFei Huang
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an 710054, Shaan'xi Province, China,
| | - QiNing Wu
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an 710054, Shaan'xi Province, China,
| | - DingJun Hao
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an 710054, Shaan'xi Province, China,
| |
Collapse
|
19
|
Wu AM, Li XL, Li XB, Zhang K, Sun XJ, Zhao CQ, Wang S, Huang QS, Lin Y, Ni WF, Wang XY, Zhao J. The outcomes of percutaneous kyphoplasty in treatment of the secondary osteoporotic vertebral compression factures: a case-control study. Ann Transl Med 2018; 6:107. [PMID: 29707556 DOI: 10.21037/atm.2018.02.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background To investigate the outcomes of using percutaneous kyphoplasty in the treatment of the secondary osteoporotic vertebral compression fractures. Methods Eighty-one patients had the secondary single segmental osteoporotic vertebral compression fractures after the initial fractures and treated by percutaneous kyphoplasty were reviewed, 74 of them had minimum 2 years follow-up were included in this study. The 74 patients with primary osteoporotic vertebral compression fractures treated by percutaneous kyphoplasty at the same time period were matched as control group in 1:1 ratio. Visual Analogue Scales (VAS) and Oswestry Disability Index (ODI) were used to assess the back pain and functional outcomes. The kyphotic angulation (KA) and compression ratio (CR) of the fractured vertebra was measured too. Results Both the secondary fracture group and control group had significantly relieved back pain, improved functional outcomes, corrected KA and restored CR after operation, but no difference was found between two groups. Conclusions Our findings suggest that percutaneous kyphoplasty is an effective and safe procedure for patients with secondary single segmental osteoporotic vertebral compression fractures; it can achieve similar clinical outcomes to the primary osteoporotic vertebral compression fractures.
Collapse
Affiliation(s)
- Ai-Min Wu
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China.,Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325035, China
| | - Xun-Lin Li
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Xiao-Bin Li
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325035, China
| | - Kai Zhang
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Xiao-Jiang Sun
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Chang-Qing Zhao
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Shen Wang
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325035, China
| | - Qi-Shan Huang
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325035, China
| | - Yan Lin
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325035, China
| | - Wen-Fei Ni
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325035, China
| | - Xiang-Yang Wang
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, The key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325035, China
| | - Jie Zhao
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| |
Collapse
|
20
|
Xie L, Zhao ZG, Zhang SJ, Hu YB. Percutaneous vertebroplasty versus conservative treatment for osteoporotic vertebral compression fractures: An updated meta-analysis of prospective randomized controlled trials. Int J Surg 2017; 47:25-32. [DOI: 10.1016/j.ijsu.2017.09.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 09/13/2017] [Indexed: 12/01/2022]
|
21
|
Gasbarrini A, Ghermandi R, Akman YE, Girolami M, Boriani S. Elastoplasty as a promising novel technique: Vertebral augmentation with an elastic silicone-based polymer. Acta Orthop Traumatol Turc 2017; 51:209-214. [PMID: 28202221 PMCID: PMC6197590 DOI: 10.1016/j.aott.2017.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Percutaneous vertebroplasty with polymethylmethacrylate (PMMA) restores the stiffness and the strength of fractured vertebral bodies, but changes the pattern of the stress transfer. This effect may cause a secondary fracture of the adjacent vertebrae. Elastoplasty has emerged as a new technique to overcome this complication. The aim of this study is to retrospectively evaluate the clinical results of the elastoplasty procedure. MATERIALS AND METHODS Thirthy nine patients (9 males, 30 females, 87 spinal levels) were clinically evaluated pre and postoperatively in terms of pain relief, leakage and silicone embolism. The mean age was 67 (range 38-84) years. The mean follow up period was 12,5 months. The patients were evaluated radiologically for the presence of adjacent level fractures postoperatively. Complications were recorded. RESULTS The mean VAS score decreased from 7,5 to 3,5 during the last follow-up. Symptomatic silicone pulmonary embolism was not encountered in any patients. Leakage was observed in 5 (13%) cases. There was an adjacent level fracture in 1 case and another fracture which was not at the adjacent level in another one. A hematoma occurred in the needle entry site in a patient with trombocytopenia (<70,000). CONCLUSIONS Elastoplasty is a safe, promising technique in the treatment of vertebral compression fractures (VCFs). Symptomatic silicone pulmonary embolism is not observed. The material's stiffness is close to intact vertebrae. Therefore, elastoplasty may be a good viable option in the treatment of VCFs as it cause less complications and can prevent adjacent level fractures. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
Affiliation(s)
| | | | - Yunus Emre Akman
- Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey.
| | | | | |
Collapse
|
22
|
Abstract
BACKGROUND Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are effective procedures for the treatment of vertebral compression fractures (VCFs). However, recent studies have reported that secondary VCFs develop in patients after PVP or PKP treatment. This study aimed to investigate the clinical characteristics and management of secondary fractures after PVP or PKP. MATERIALS AND METHODS 599 cases who had vertebral compression fracture and underwent PVP or PKP between September 2008 and June 2014 were enrolled, including 121 males and 478 females. Secondary fractures were observed in 52 cases, including 3 males and 49 females, who were treated by re-operation with PVP or PKP. RESULTS The ratio of secondary fracture after PVP or PKP was 8.68% in all cases. The age ranged from 59 to 92 years (74.41 ± 6.83 average). A composition of 44.44% of the secondary fracture occurred near the initial fracture vertebrae. After re-operation with PVP or PKP, visual analog scale score significantly decreased to 2.72 ± 0.88 or 2.52 ± 1.12, respectively, anterior height of vertebral bodies increased to 24.69 ± 4.59 or 24.54 ± 5.97 mm, respectively, and middle height of vertebral bodies increased to 20.90 ± 3.72 or 20.36 ± 6.33 mm, respectively. CONCLUSIONS There is a high chance of secondary fracture near the initially operated vertebrae after PVP or PKP. Re-operation with PVP or PKP achieves satisfactory outcomes in these patients such as pain relief and the recovery of the vertebrae height.
Collapse
Affiliation(s)
- Jiang-jun Zhu
- Department of Orthopaedics, The No. 117 Hospital of PLA, Hangzhou, Zhejiang, China
| | - Dong-sheng Zhang
- Department of Orthopaedics, The No. 117 Hospital of PLA, Hangzhou, Zhejiang, China
| | - Su-liang Lou
- Department of Orthopaedics, The No. 117 Hospital of PLA, Hangzhou, Zhejiang, China
| | - Yong-hong Yang
- Department of Orthopaedics, The No. 117 Hospital of PLA, Hangzhou, Zhejiang, China,Address for correspondence: Dr. Yong-hong Yang, Department of Orthopedics, The No. 117 Hospital of PLA, Tian Cheng Road, Hangzhou, Zhejiang, 310013, China. E-mail:
| |
Collapse
|
23
|
Song D, Meng B, Chen G, Niu J, Jiang W, Luo Z, Yang H. Secondary balloon kyphoplasty for new vertebral compression fracture after initial single-level balloon kyphoplasty for osteoporotic vertebral compression fracture. Eur Spine J 2016; 26:1842-1851. [PMID: 27770334 DOI: 10.1007/s00586-016-4784-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 08/15/2016] [Accepted: 09/16/2016] [Indexed: 01/25/2023]
Abstract
PURPOSE To explore the efficacy of secondary balloon kyphoplasty (BKP) for new vertebral compression fracture (NVCF) of previously non-fractured, non-treated vertebrae after previous BKP and to compare the therapeutic effect between patients with single-level adjacent NVCF and remote NVCF. METHODS We retrospectively studied patients with single-level NVCF after initial BKP in our hospital from January 2007 to August 2014. The mean follow-up time from secondary BKP was 13.78 ± 3.18 (12-24) months. Visual analog scale (VAS) and Oswestry disability index (ODI) scores were assessed prior to the initial BKP, one day after initial BKP, prior to the secondary BKP, one day after the secondary BKP, and at last follow-up. Kyphotic angle and vertebral heights were also compared for secondary BKP. Data were compared between patients with adjacent NVCF and remote NVCF. RESULTS 36 patients were investigated. Compared with pre-operative value of initial and secondary BKP, patients in both groups gained statistical significant improvements for VAS and ODI after initial and secondary BKP, respectively (P < 0.05), and this improvement maintained at final follow-up. No statistical difference in VAS was found between the 2 groups after initial BKP and prior to the secondary BKP (P > 0.05), but patients in remote NVCF group achieved better VAS score than patients in adjacent NVCF group after the secondary BKP and at the final follow-up (P < 0.05). No statistical differences were detected in ODI between the 2 groups prior to the initial BKP, one day after initial BKP, prior to the secondary BKP and 1 day after the secondary BKP (P > 0.05), but the ODI scores were higher in adjacent NVCF group than in remote NVCF at last follow-up (P < 0.05). Kyphotic angle and vertebral heights were significantly restored and maintained after secondary BKP within groups, respectively. CONCLUSIONS Secondary BKP is an effective procedure for treating NVCF after initial BKP. Patients with new fracture in remote level gain slightly better pain relief than those in the adjacent level.
Collapse
Affiliation(s)
- Dawei Song
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, No.188, Shizi Street, Suzhou, 86-215006, Jiangsu, China
| | - Bin Meng
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, No.188, Shizi Street, Suzhou, 86-215006, Jiangsu, China
| | - Guangdong Chen
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, No.188, Shizi Street, Suzhou, 86-215006, Jiangsu, China
| | - Junjie Niu
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, No.188, Shizi Street, Suzhou, 86-215006, Jiangsu, China
| | - Weimin Jiang
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, No.188, Shizi Street, Suzhou, 86-215006, Jiangsu, China
| | - Zongping Luo
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, No.188, Shizi Street, Suzhou, 86-215006, Jiangsu, China.
| | - Huilin Yang
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, No.188, Shizi Street, Suzhou, 86-215006, Jiangsu, China.
| |
Collapse
|
24
|
Clark W, Bird P, Gonski P, Diamond TH, Smerdely P, McNeil HP, Schlaphoff G, Bryant C, Barnes E, Gebski V. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2016; 388:1408-1416. [PMID: 27544377 DOI: 10.1016/s0140-6736(16)31341-1] [Citation(s) in RCA: 246] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/24/2016] [Accepted: 07/28/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND We hypothesised that vertebroplasty provides effective analgesia for patients with poorly controlled pain and osteoporotic spinal fractures of less than 6 weeks' duration. The effectiveness of vertebroplasty, using an adequate vertebral fill technique, in fractures of less than 6 weeks' duration has not been specifically assessed by previously published masked trials. METHODS This was a multicentre, randomised, double-blind, placebo-controlled trial of vertebroplasty in four hospitals in Sydney, Australia. We recruited patients with one or two osteoporotic vertebral fractures of less than 6 weeks' duration and Numeric Rated Scale (NRS) back pain greater than or equal to 7 out of 10. We used an automated telephone randomisation service provided by the National Health and Medical Research Council to assign patients (1:1; stratified according to age, degree of vertebral compression, trauma, corticosteroid use, and hospital) to either vertebroplasty or placebo, immediately before the procedure. Patients received conscious sedation. Vertebroplasty was done with the adequate vertebral fill technique and the placebo procedure with simulated vertebroplasty. Follow-up was for 6 months. Outcome assessors and patients were masked to treatment allocation. The primary outcome was the proportion of patients with NRS pain below 4 out of 10 at 14 days post-intervention in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01482793. FINDINGS Between Nov 4, 2011, and Dec 5, 2014, 120 patients were enrolled. 61 patients were randomly assigned to vertebroplasty and 59 to placebo. 24 (44%) patients in the vertebroplasty group and 12 (21%) in the control group had an NRS pain score below 4 out of 10 at 14 days (between-group difference 23 percentage points, 95% CI 6-39; p=0·011). Three patients in each group died from causes judged unrelated to the procedure. There were two serious adverse events in each group, related to the procedure (vertebroplasty group) and the fracture (control group). INTERPRETATION Vertebroplasty is superior to placebo intervention for pain reduction in patients with acute osteoporotic spinal fractures of less than 6 weeks' in duration. These findings will allow patients with acute painful fractures to have an additional means of pain management that is known to be effective. FUNDING Education grant from CareFusion Corporation.
Collapse
Affiliation(s)
- William Clark
- Department of Radiology, St George Private Hospital, Kogarah, NSW, Australia.
| | - Paul Bird
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Peter Gonski
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia; Department of Aged Care, Sutherland Hospital, Caringbah, NSW, Australia
| | - Terrence H Diamond
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia; Department of Endocrinology, St George Hospital, Kogarah, NSW, Australia
| | - Peter Smerdely
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia; Department of Aged Care, St George Hospital, Kogarah, NSW, Australia
| | - H Patrick McNeil
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Glen Schlaphoff
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; Department of Interventional Radiology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Carl Bryant
- Department of Radiology, St George Private Hospital, Kogarah, NSW, Australia
| | - Elizabeth Barnes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
25
|
Sebaaly A, Nabhane L, Issa El Khoury F, Kreichati G, El Rachkidi R. Vertebral Augmentation: State of the Art. Asian Spine J 2016; 10:370-6. [PMID: 27114782 DOI: 10.4184/asj.2016.10.2.370] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/11/2015] [Accepted: 09/15/2015] [Indexed: 12/12/2022] Open
Abstract
Osteoporotic vertebral compression fractures (OVF) are an increasing public health problem. Cement augmentation (vertebroplasty of kyphoplasty) helps stabilize painful OVF refractory to medical treatment. This stabilization is thought to improve pain and functional outcome. Vertebroplasty consists of injecting cement into a fractured vertebra using a percutaneous transpedicular approach. Balloon kyphoplasty uses an inflatable balloon prior to injecting the cement. Although kyphoplasty is associated with significant improvement of local kyphosis and less cement leakage, this does not result in long-term clinical and functional improvement. Moreover, vertebroplasty is favored by some due to the high cost of kyphoplasty. The injection of cement increases the stiffness of the fracture vertebrae. This can lead, in theory, to adjacent OVF. However, many studies found no increase of subsequent fracture when comparing medical treatment to cement augmentation. Kyphoplasty can have a protective effect due to restoration of sagittal balance.
Collapse
|
26
|
Lin JH, Wang SH, Lin EY, Chiang YH. Better Height Restoration, Greater Kyphosis Correction, and Fewer Refractures of Cemented Vertebrae by Using an Intravertebral Reduction Device: a 1-Year Follow-up Study. World Neurosurg 2016; 90:391-396. [PMID: 26979922 DOI: 10.1016/j.wneu.2016.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE This study compared the radiologic and clinical outcomes of kyphoplasty with intravertebral reduction device (IRD) and vertebroplasty (VP) in treating osteoporotic vertebral compression fractures (OVCFs). MATERIALS AND METHODS We enrolled 75 patients with OVCFs who were aged >60 years and treated them through VP or kyphoplasty with IRD. The radiologic outcomes, namely the anterior and middle body heights (ABH and MBH, respectively) and kyphotic angle (KA), were measured preoperatively and at postoperative 1 week, 3 months, 6 months, and 1 year. The refracture was identified on the basis of a decrease in ABH, MBH, or KA compared with those at postoperative 1 week. Visual analog scale (VAS) for pain and complications were recorded. The incidence of adjacent and nonadjacent fractures was also recorded. RESULTS We treated 36 patients with kyphoplasty with IRD (IRD group) and 39 through VP (VP group). The patient characteristics were comparable in both groups. The KA and its restoration were more favorable after IRD than after VP. Although ABHs were not different in either group, their restoration was more efficient after IRD than after VP. MBHs, their restoration, and their refracture rates were better after IRD than after VP. VAS pain scores and complication rates were not different between the groups. The incidences of adjacent or nonadjacent fractures were not different between the 2 groups. CONCLUSION Our findings reveal significantly more efficient height restoration and kyphosis correction and fewer refractures in the IRD group. IRD may not increase the risk of adjacent or nonadjacent fractures.
Collapse
Affiliation(s)
- Jiann-Her Lin
- Department of Neurosurgery, Taipei Medical University, Taipei, Taiwan; Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, Taipei, Taiwan; Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Hao Wang
- Department of Neurosurgery, Taipei Medical University, Taipei, Taiwan
| | - En-Yuan Lin
- Department of Neurosurgery, Taipei Medical University, Taipei, Taiwan
| | - Yung-Hsiao Chiang
- Department of Neurosurgery, Taipei Medical University, Taipei, Taiwan; Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, Taipei, Taiwan; Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
27
|
Kolb JP, Weiser L, Kueny RA, Huber G, Rueger JM, Lehmann W. [Cement augmentation on the spine : Biomechanical considerations]. Orthopade 2015; 44:672-80. [PMID: 26193968 DOI: 10.1007/s00132-015-3134-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Vertebral compression fractures are the most common osteoporotic fractures. Since the introduction of vertebroplasty and screw augmentation, the management of osteoporotic fractures has changed significantly. AIMS The biomechanical characteristics of the risk of adjacent fractures and novel treatment modalities for osteoporotic vertebral fractures, including pure cement augmentation by vertebroplasty, and cement augmentation of screws for posterior instrumentation, are explored. MATERIALS AND METHODS Eighteen human osteoporotic lumbar spines (L1-5) adjacent to vertebral bodies after vertebroplasty were tested in a servo-hydraulic machine. As augmentation compounds we used standard cement and a modified low-strength cement. Different anchoring pedicle screws were tested with and without cement augmentation in another cohort of human specimens with a simple pull-out test and a fatigue test that better reflects physiological conditions. RESULTS Cement augmentation in the osteoporotic spine leads to greater biomechanical stability. However, change in vertebral stiffness resulted in alterations with the risk of adjacent fractures. By using a less firm cement compound, the risk of adjacent fractures is significantly reduced. Both screw augmentation techniques resulted in a significant increase in the withdrawal force compared with the group without cement. Augmentation using perforated screws showed the highest stability in the fatigue test. DISCUSSION AND CONCLUSION The augmentation of cement leads to a significant change in the biomechanical properties. Differences in the stability of adjacent vertebral bodies increase the risk of adjacent fractures, which could be mitigated by a modified cement compound with reduced strength. Screws that were specifically designed for cement application displayed greatest stability in the fatigue test.
Collapse
|