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Zhang Y, Ge J, Liu H, Niu J, Wang S, Shen H, Li H, Qian C, Song Z, Zhu P, Zhu X, Zou J, Yang H. Kyphoplasty is associated with reduced mortality risk for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. Eur Spine J 2024; 33:1490-1497. [PMID: 38062266 DOI: 10.1007/s00586-023-08032-5] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/15/2023] [Accepted: 10/25/2023] [Indexed: 04/06/2024]
Abstract
BACKGROUND Vertebral augmentation, such as vertebroplasty (VP) or kyphoplasty (KP), has been utilized for decades to treat OVCFs; however, the precise impact of this procedure on reducing mortality risk remains a topic of controversy. This study aimed to explore the potential protective effects of vertebral augmentation on mortality in patients with osteoporotic vertebral compression fractures (OVCFs) using a large-scale meta-analysis. MATERIALS AND METHODS Cochrane Library, Embase, MEDLINE, PubMed and Web of Science databases were employed for literature exploration until May 2023. The hazard ratios (HRs) and 95% confidence intervals (CIs) were utilized as a summary statistic via random-effect models. Statistical analysis was executed using Review Manager 5.3 software. RESULTS After rigorous screening, a total of five studies with substantial sample sizes were included in the quantitative meta-analysis. The total number of participants included in the study was an 2,421,178, comprising of 42,934 cases of vertebral augmentation and 1,991,244 instances of non-operative management. The surgical intervention was found to be significantly associated with an 18% reduction in the risk of mortality (HR 0.82; 95% CI 0.78, 0.85). Subgroup analysis revealed a remarkable 71% reduction in mortality risk following surgical intervention during short-term follow-up (HR 0.29; 95% CI 0.26, 0.32). Furthermore, KP exhibited a superior and more credible decrease in the risk of mortality when compared to VP treatment. CONCLUSIONS Based on a comprehensive analysis of large samples, vertebral augmentation has been shown to significantly reduce the mortality risk associated with OVCFs, particularly in the early stages following fractures. Furthermore, it has been demonstrated that KP is more reliable and effective than VP in terms of mitigating mortality risk.
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Affiliation(s)
- Yijian Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Jun Ge
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Hao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Junjie Niu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Shenghao Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Hao Shen
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Hanwen Li
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Chen Qian
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Zhuorun Song
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Pengfei Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Xuesong Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China.
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China.
| | - Jun Zou
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China.
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China.
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China.
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China.
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Wu Y, Xu LJ. Incidence of Cement Leakage and Potential Risk Factors in Surgery for Spinal Metastasis: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 184:e95-e110. [PMID: 38246530 DOI: 10.1016/j.wneu.2024.01.065] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVES The current meta-analysis was performed to gather available evidence regarding the incidence and risk factors of cement leakage (CL) in patients undergoing surgical procedures for spinal metastasis. METHODS Two authors independently searched the PubMed, Embase, and CENTRAL databases. Clinical studies reporting the incidence or risk factors of CL were included for analysis. The primary outcome analyzed was the incidence of various types of CL. Random-effects or fixed-effects single-proportion meta-analyses were conducted to pool the available evidence, based on the heterogeneity test. Subgroup analyses were conducted based on surgical procedures (percutaneous vertebroplasty, percutaneous kyphoplasty, and others). Risk factors of CL were synthesized narratively to identify the most commonly accepted factors. RESULTS A total of 26 studies, involving 2551 patients, were included. The number of operated spine segments was reported in 23 studies, accounting for 4101 vertebrae. The pooled incidences of general, intradiscal, paravertebral, spinal canal, and intravascular CLs were 0.18 (95% confidence interval [CI], 0.11-0.28), 0.14 (95% CI, 0.08-0.21), 0.13 (95% CI, 0.06-0.21), 0.11 (95% CI, 0.05-0.19), and 0.12 (95% CI, 0.08-0.17), respectively. Subgroup analyses revealed significantly different incidences of general CL (0.37 vs. 0.06 vs. 0.09, P < 0.01), intradiscal CL (0.22 vs. 0.06 vs. 0.12, P < 0.01), paravertebral CL (0.25 vs. 0.03 vs. 0.06, P < 0.01), and vascular CL (0.14 vs. 0.03 vs. 0.15, P < 0.01) among the three groups. Posterior wall disruption, pathologic fracture, and the number of treated vertebral levels were the most commonly identified independent risk factors for general CL. Posterior wall disruption was determined as a common significant risk factor for spinal canal CL. CONCLUSIONS This review provides insights into the incidence and risk factors associated with CL in surgical procedures for spinal metastasis. Understanding these risk factors can contribute to the development of tailored strategies aimed at minimizing CL occurrence and optimizing surgical outcomes for patients undergoing spinal metastatic surgery.
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Affiliation(s)
- Yong Wu
- Department of Neurosurgery, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Hubei, China
| | - Li-Jun Xu
- Department of Orthopedics, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Hubei, China.
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Yankov D, Bussarsky A, Karakostov V, Sirakov A, Ferdinandov D. Evaluation of multidetector CT Hounsfield unit measurements as a predictor of efficacy and complications in percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Front Med (Lausanne) 2023; 10:1333679. [PMID: 38098844 PMCID: PMC10720980 DOI: 10.3389/fmed.2023.1333679] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction More than 30 years after the initial experience of Galibert and Deramond with percutaneous vertebroplasty, the procedure has gone through countless refinements and clinical evaluations. Predictors for the success and failure of the procedure in the literature vary and are focused on the duration of complaints, type of fracture, presence of edema on MRI scans, etc. We propose using a quantitative method based on a standard CT examination of the thoracic or lumbar spine to assess the risks and potential success of performing vertebroplasty. Materials and methods This is a single-center prospective observational study on 139 patients treated with percutaneous vertebroplasty (pVPL) for a single symptomatic osteoporotic vertebral compression fracture (OVCF). We measured the levels of disability and pain preoperatively and again at the 3-, 6- and 12-month marks using the standardized VAS and ODI questionnaires. Every patient in the study was evaluated with postoperative multidetector CT (MDCT) to determine the presence, extent, and localization of vertebral cement leakage and to measure the adjacent vertebrae's minimal and mean density in Hounsfield units (HUmin and HUmean, respectively). Results We determined that a slight (r = -0.201) but statistically significant (p = 0.018) correlation existed between HU measurements taken from radiologically intact adjacent vertebrae and the procedure's effect concerning the pain levels at the 3-month follow-up. This correlation failed to reach statistical significance at 12 months (p = 0.072). We found no statistically significant relationship between low vertebral cancellous bone density and cement leakage on postoperative scans (p = 0.6 for HUmin and p = 0.74 for HUmean). Conclusion We have moderately strong data that show a negative correlation between the mean values of vertebral cancellous bone density in patients with OVCF and the effect of pVPL in reducing pain. Lower bone densities, measured this way, showed no increased risk of cement leakage.
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Affiliation(s)
- Dimo Yankov
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Assen Bussarsky
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Vasil Karakostov
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Alexander Sirakov
- Department of Radiology, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Dilyan Ferdinandov
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
- Department of Neurosurgery, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
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Song T, Sun F, Liu S, Ye T. Percutaneous lordoplasty for the treatment of severe osteoporotic vertebral compression fractures with kyphosis. Front Neurol 2023; 14:1132919. [PMID: 37576011 PMCID: PMC10416795 DOI: 10.3389/fneur.2023.1132919] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/05/2023] [Indexed: 08/15/2023] Open
Abstract
Objective The study aimed to explore the safety and effectiveness of percutaneous lordoplasty (PLP) in the treatment of severe osteoporotic vertebral compression fracture (OVCF). Methods Included in this prospective study were patients with single-segment acute severe OVCF who were treated with PLP in our institution from July 2016 to October 2019. Patients' back pain and quality of life were assessed using the visual analog scale (VAS) and SF-36 scores. Lateral X-ray radiography of the spine was performed to measure the vertebral height, vertebral kyphotic angle, and segmental kyphotic angle, and to evaluate the outcome of fracture reduction and kyphotic correction. Intra-and postoperative complications were recorded. Results Of the 51 included patients, 47 patients were followed up for 12 months. The VAS score decreased from preoperative 7.33 ± 1.92 to postoperative 1.76 ± 0.85 at the 12th month (p < 0.05), and the SF-36 score increased from preoperative 79.50 ± 9.22 to postoperative 136.94 ± 6.39 at the 12th month (p < 0.05). During the 1-year follow-up period, the anterior height of the vertebral body increased significantly from preoperative 10.49 ± 1.93 mm to 19.33 ± 1.86 mm (p < 0.05); the posterior height of the vertebral body increased insignificantly from preoperative 22.23 ± 2.36 mm to 23.05 ± 1.86 mm (p > 0.05); the vertebral kyphotic angle decreased significantly from preoperative 18.33° ± 11.49° to 8.73° ± 1.21° (p < 0.05); and the segmental kyphotic angle decreased significantly from preoperative 24.48° ± 4.64° to 11.70° ± 1.34° (p < 0.05). During the 1-year follow-up period, there was no significant difference in the radiologic parameters, VAS scores, and SF-36 scores, between the 1st day and the 12th month of post-operation (P > 0.05). No nerve damage occurred in any of the cases. Intraoperative cement leakage occurred in six cases, and the fracture of the adjacent vertebral body occurred in one case. Conclusion PLP can well reduce the risk of fracture and achieve good kyphotic correction and may prove to be a safe, cost-effective and minimally invasive alternative option for the treatment of severe OVCF with kyphotic deformity.
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Affiliation(s)
- Tengfei Song
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Fan Sun
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
- Department of Orthopedics, The Fourth Affiliated Hospital of Nangjing Medical University, Nanjing, Jiangsu, China
| | - Shu Liu
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Tianwen Ye
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
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Li M, Zhang T, Zhang R, Zhang H, Zhang D, Hu N, Wang Y. Systematic Retrospective Analysis of Risk Factors and Preventive Measures of Bone Cement Leakage in Percutaneous Kyphoplasty. World Neurosurg 2023; 171:e828-e836. [PMID: 36592691 DOI: 10.1016/j.wneu.2022.12.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE In this study, we aimed to analyze the risk factors of bone cement leakage in percutaneous kyphoplasty (PKP) treatment of osteoporotic vertebral compression fractures (OVCFs), and provide suggestions for reducing bone cement leakage. METHODS A retrospective study of 517 cases of OVCFs treated with PKP were divided into 2 groups according to whether they had bone cement leakage or not, leakage group (n = 72) and non-leakage group (n = 445). The risk factors of leakage were systematically analyzed using clinical baseline data, imaging observation data, and surgery-related factors. To select the statistically significant results (P < 0.05) among the risk factors mentioned above, we used the binary logistic regression method to identify the main risk factors. RESULTS The univariate analysis of clinical baseline data,imaging observation data, and surgery-related factors showed that bone mineral density (BMD) (P < 0.001), hypertension (P < 0.05), injury factors (P < 0.01), cortical defect (P < 0.001), grade of vertebral compression (P < 0.001), surgical approach (P < 0.05), stage of bone cement injection (P < 0.01), and balloon pressure (P < 0.05) were the risk factors for bone cement leakage. The recovery rate of vertebral height, and the Cobb angle correction rate were lower in the bone cement leakage group (P < 0.001). The correction effect of kyphosis after operation was limited. Binary logistic analysis results showed that BMD (odds ratio [OR] 5.605), cortical defect (OR 3.115), and stage of bone cement injection (OR 2.385) were bone cement leakage-independent risk factors. CONCLUSIONS Impairment of BMD value, defects of cortical bone, and inappropriate stage of bone cement injection will increase the risk of bone cement leakage in PKP treatment and limit PKP effects.
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Affiliation(s)
- Mi Li
- Harbin Medical University, Harbin, Heilongjiang, China; Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tao Zhang
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Rui Zhang
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Hanjun Zhang
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - DaPeng Zhang
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Naiwu Hu
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yansong Wang
- Harbin Medical University, Harbin, Heilongjiang, China; Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
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Abstract
A narrative review regarding percutaneous vertebroplasty (PVP) for osteoporotic vertebral fracture (OVF) is provided herein, addressing the epidemic of OVF in Japan, the latest response to the criticism of PVP for OVFs, the indications and potential risks of PVP for OVFs, and a future perspective for PVP. Each year in Japan, approximately 32,000 patients aged 55 years or older suffer from chronic low back pain for several months to several years due to a compression fracture. PVP is one of the surgical treatments for an OVF, and it is less invasive compared to the traditional open surgery. PVP is suitable for OVF patients who have difficulty walking as assessed by the modified Yokoyama's activities of daily living (ADL) scoring system, and for patients with Kummell's disease diagnosed by CT and MRI examinations. Serious adverse events related to PVP occur in 1.1-3.3% of the cases, but direct deaths from PVP are extremely rare at less than 1%. Recent studies demonstrated that OVF patients treated with PVP are less likely to die after the treatment than non-surgically treated patients, which conflicts with the Cochran reviews' conclusion not supporting PVP for OVFs. Novel robotic systems and procedure-support devices are being developed, providing a next step toward fully automated PVP procedures.
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Affiliation(s)
- Tomoyuki Noguchi
- Department of Radiology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, 810-8563, Japan.
- Department of Clinical Research, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, 810-8563, Japan.
- Education and Training Office, Department of Clinical Research, Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Koji Yamashita
- Department of Radiology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, 810-8563, Japan
| | - Ryotaro Kamei
- Department of Radiology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, 810-8563, Japan
| | - Junki Maehara
- Department of Radiology, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka City, Fukuoka Province, 810-8563, Japan
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Tartara F, Armocida D, Garbossa D, Meli F, Costantino G, Cofano F, Francaviglia N. Porous titanium microsphere kyphoplasty for augmentation treatment of osteoporotic vertebral fractures: Technical report and case series. Front Surg 2023; 10:1152995. [PMID: 37206353 PMCID: PMC10189281 DOI: 10.3389/fsurg.2023.1152995] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/14/2023] [Indexed: 05/21/2023] Open
Abstract
Background Vertebral augmentation procedures (VAPs) are used in cases of persistent and unresponsive pain in patients with vertebral compression fractures (VCFs). Although VAPs are considered a safe procedure providing quick pain relief and improved physical function, some postoperative complications can occur, for example, bone cement leakage. The material used in this procedure is almost exclusively polymethyl methacrylate (PMMA), which appears to lack biological activity and osteointegration capabilities. In this study, we introduce a new filling system consisting of cannulas preloaded with titanium microspheres, which stabilizes and consolidates the structure of the vertebral body in treating VCFs after the performance of the kyphoplasty procedure. Methods We report a retrospective case series of six patients affected by osteoporotic vertebral fractures with worsening back pain, neurologic impairment, and failed conservative treatment who underwent the VAP at our institute, for which the SPHEROPLAST [MT ORTHO s.r.l., Aci Sant'Antonio (CT), Italy] system was used. Results The patients had failed an average conservative trial of 3.9 weeks before they presented to us with neurodeficit. There were two men and four women with a mean age of 74.5 years. The average hospital stay was 2 days. There were no reported perioperative complications related to cement injection, such as intraoperative hypoxia, hypotension, pulmonary embolization, myocardial infarction, neurovascular or viscera injury, or death. The VAS score significantly decreased from a mean preoperative of 7.5 (range 6-19) to 3.8 (range 3-5) immediately after surgery and 1.8 (range 1-3). Conclusion We report the first clinical results in a series of six patients treated for VCF using the microsphere system after analyzing the clinical results produced by, and the complications that arose from, this new device. In patients with VCF, the VAP using titanium microspheres appears to be a feasible and safe procedure with a low risk of material leakage.
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Affiliation(s)
- Fulvio Tartara
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, “Sapienza” University, AOU Policlinico Umberto I, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
- Correspondence: Daniele Armocida
| | - Diego Garbossa
- Neurosurgery Division, Department of Neuroscience, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Francesco Meli
- Neurosurgery Division, Arnas Civico di Cristina, Palermo, Italy
| | | | - Fabio Cofano
- Neurosurgery Division, Department of Neuroscience, A.O.U. Città della Salute e della Scienza, University of Turin, Turin, Italy
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Zhang Y, Peng Q, Sun C, Kang X, Hu M, Zhao W, Liu X, Meng B, Yang S, Feng X, Zhang L. Robot Versus Fluoroscopy-Assisted Vertebroplasty and Kyphoplasty for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-analysis. World Neurosurg 2022; 166:120-129. [PMID: 35922006 DOI: 10.1016/j.wneu.2022.07.083] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to conduct a systematic review and meta-analysis to compare the clinical results and complications of robot-assisted (RA) versus fluoroscopy-assisted (FA) percutaneous vertebral augmentation (PVA) in the treatment of osteoporotic vertebral compression fractures (OVCFs). METHODS A comprehensive search of online databases including PubMed, Embase, Cochrane Library, web of science, and core journals of China National Knowledge Infrastructure were performed to identify related studies reporting the clinical results and complications of RA versus FA-assisted PVA in the treatment of OVCFs. The rate of bone cement leakage was used to assess the complications. After the surgery, the clinical findings were analyzed using the Visual Analog Scale scores and the Oswestry Disability Index scores. The surgical time, intraoperative fluoroscopy frequency, and x-ray exposure duration were used to evaluate the perioperative results. Forest plots were constructed to investigate the results. RESULTS RA-PVA had a significantly lower bone cement leakage rate, shorter fluoroscopy frequency, and shorter radiation exposure time of doctors compared with FA-PVA. However, no significant differences were found between RA-PVA and FA-PVA in operative time and radiation exposure time of patients. Furthermore, no statistically differences were found between the 2 groups in Visual Analog Scale and Oswestry Disability Index scores after surgery. CONCLUSIONS This meta-analysis showed that RA-PVA can reduce bone cement leakage rate, fluoroscopy frequency, and doctors' radiation exposure time. With the advancement of RA technology, we anticipate more high-quality randomized controlled trials of RA versus FA-PVA in the future to validate and update the results of this analysis.
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Affiliation(s)
- Yu Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Qing Peng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Chenhao Sun
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xiaohe Kang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Man Hu
- Graduate School of Dalian Medical University, Dalian, China
| | - Wenjie Zhao
- Graduate School of Dalian Medical University, Dalian, China
| | - Xin Liu
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Bo Meng
- Graduate School of Dalian Medical University, Dalian, China
| | - Sheng Yang
- Graduate School of Dalian Medical University, Dalian, China
| | - Xinmin Feng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China.
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Abstract
Management of cancer pain is challenging. Despite the poor evidence, opioid therapy still remains the cornerstone for the management of cancer-related pain. Opioids should be given according to the clinical presentation in the different stages of disease. There is no drug of choice, as most opioids are effective. Thus, the choice should be based on the individual characteristics of patients. Optimization of opioid therapy may allow individual treatment according to the patient's characteristics and pain syndromes, providing timely alternatives in the different stages of disease. While most patients respond to an appropriate treatment associated with a comprehensive assessment and symptom control, a high level of experience and knowledge is necessary in determining conditions to maximize the analgesic response, eventually adding adjuvants in some specific circumstances. Alternative opioids may improve the balance between analgesia and adverse effects in the presence of a poor response to the first opioid in a large number of patients. Finally, a selected population can benefit from some interventional procedures.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center of Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy.
- Regional Home Care Program, SAMOT, Palermo, Italy.
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Li W, Ou H, Zhang L, Zhang C, Chen W, Wang H. Meta-Analysis of PKP or PVP Combined with Acupuncture in the Treatment of Osteoporotic Vertebral Compression Fractures. Contrast Media Mol Imaging 2022; 2022:9721702. [PMID: 36034204 PMCID: PMC9392604 DOI: 10.1155/2022/9721702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/22/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
The efficacy of acupuncture combined with percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fracture is systematically evaluated. The clinical trials of acupuncture combined with PKP or PVP in the treatment of osteoporotic vertebral compression fracture published before July 2021 are searched in databases of CNKI, WF, VIP, CBM, PubMed, Cochrane Library, and Embase. The information of included studies is extracted, and the quality is assessed by two independent researchers. The meta-analysis is performed by using RevMan 5.3 software. A total of 9 trials are included, involving 851 patients. The experimental results show that the therapeutic effect of acupuncture combined with PKP/PVP in the treatment of osteoporotic vertebral compression fracture (OVCF) is superior to that of PKP/PVP alone, and both the VAS score and ODI score of PKP/PVP combined with ordinary acupuncture or silver needle acupuncture are better than those of the control group one month after the operation. The effect of ordinary acupuncture combined with PKP/PVP on the increase of bone mineral density is better than that of the control group. Acupuncture combined with PKP/PVP in the treatment of osteoporotic vertebral compression fracture has better efficacy than PKP/PVP, and it can effectively relieve patients' pain, improve bone density, and improve the quality of life.
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Affiliation(s)
- Wei Li
- Department of Acupuncture and Moxibustion, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing 100039, China
| | - Haiyan Ou
- Department of Rehabilitation, Tiancun Road Community Health Service Center, Haidian District, Beijing 100143, China
| | - Lianghua Zhang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing 100039, China
| | - Congcong Zhang
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Wei Chen
- Department of Acupuncture and Moxibustion, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing 100039, China
| | - Hao Wang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing 100039, China
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Wang S, Zheng L, Ma JX, Wang H, Sun ST, Zhang BH, Guo XL, Xiang LB, Chen Y. Analysis of the most influential publications on vertebral augmentation for treating osteoporotic vertebral compression fracture: A review. Medicine (Baltimore) 2022; 101:e30023. [PMID: 35945791 PMCID: PMC9351837 DOI: 10.1097/md.0000000000030023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aimed to analyze the most influential publications on vertebral augmentation for treating osteoporotic vertebral compression fracture. The Web of Science database was searched using the key words "percutaneous vertebroplasty," "percutaneous kyphoplasty," "balloon kyphoplasty," "vertebroplasty," "kyphoplasty," and "vertebral augmentation." The top 100 publications were arranged by citations per year and descriptively and visually analyzed. The top 100 publications were cited 25,482 times, with an average of 14.4 citations per paper per year. The corresponding authors of the publications represented 17 nations, with most authors being American (46 authors). Thirty-two journals were involved, with SPINE issuing the most publications (24 papers of the 100). Clinical research (73 of the 100 papers) outnumbered basic studies (14 papers) and systematic reviews (13 papers), and the most publications were published between 2000 and 2004. Co-citation analysis of the key words indicated that the top 5 focus areas were "complication," "balloon kyphoplasty," "vertebral compression fracture," "biomechanics," and "calcium phosphate cement." The top 3 keywords with the strongest citation bursts were "compression fracture," "cement," and "balloon kyphoplasty." The keywords with persistent strong citation bursts are "balloon kyphoplasty" and "augmentation." There are still contrary opinions about vertebral augmentation; new research should be conducted with more deliberate design and longer follow-up.
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Affiliation(s)
- Shuang Wang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Liang Zheng
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Jun-Xiong Ma
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Hong Wang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Shao-Tong Sun
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Bo-Hua Zhang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Xin-Lei Guo
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Liang-Bi Xiang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Yu Chen
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
- *Correspondence: Yu Chen, Department of Orthopedics, General Hospital of Northern Theater Command, No. 83, Wenhua Road, Shenhe District, Shenyang 110016, China ()
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Kim HJ, Zuckerman SL, Cerpa M, Yeom JS, Lehman RA, Lenke LG. Incidence and Risk Factors for Complications and Mortality After Vertebroplasty or Kyphoplasty in the Osteoporotic Vertebral Compression Fracture-Analysis of 1,932 Cases From the American College of Surgeons National Surgical Quality Improvement. Global Spine J 2022; 12:1125-1134. [PMID: 33380221 PMCID: PMC9210253 DOI: 10.1177/2192568220976355] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The purpose was to investigate the incidence of and risk factors for complications associated with vertebroplasty (VP) or kyphoplasty (KP) for osteoporotic vertebral compression fracture (OVCF) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS A cohort of patients undergoing VP/KP was constructed from the 2011-2013 ACS-NSQIP dataset using Current Procedural Terminology (CPT) codes. The incidences of minor complications (i.e. urinary tract infection, pneumonia, renal insufficiency, superficial infection, wound dehiscence), major complications (i.e. reoperation, deep vein thrombosis, pulmonary embolism, sepsis, dialysis, cardiac arrest, deep infection, stroke), and mortality within 30 days post-surgery were investigated, and their risk factors were assessed using logistic regression modeling. RESULTS Of 1932 patients undergoing VP/KP, 166 (8.6%) experienced a complication, including minor complications in 53 (2.7%), major complications in 95 (4.9%), and death in 40 (2.1%). Multivariate logistic regression analysis indicated that the adjusted odds ratios (95% confidence interval [CI]) of mortality was significantly associated with ASA 4: 16.604 (1.956-140.959) and increased creatinine (≥ 1.3 mg/dL): 3.494 (1.128-10.823). History of chronic obstructive pulmonary disease was associated with minor complications. Increased WBC count and hypoalbuminemia (<3.0 g/dL) were also associated with major complications. CONCLUSIONS The major complication and mortality rates associated with VP/KP were 4.9% and 2.1% respectively, higher than previous reports. Increased creatinine and ASA 4 were independently associated with mortality after VP/KP. Therefore, cautious monitoring and counseling is needed for elderly, patients with preexisting kidney disease or ASA 4 undergoing VP/KP.
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Affiliation(s)
- Ho-Joong Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, and Spine Center, Seongnam, Republic of Korea,Division of Spinal Surgery, Department of Orthopedic Surgery, Columbia University, The Spine Hospital at New York-Presbyterian/Allen Hospital, New York, NY, USA
| | - Scott L. Zuckerman
- Division of Spinal Surgery, Department of Orthopedic Surgery, Columbia University, The Spine Hospital at New York-Presbyterian/Allen Hospital, New York, NY, USA
| | - Meghan Cerpa
- Division of Spinal Surgery, Department of Orthopedic Surgery, Columbia University, The Spine Hospital at New York-Presbyterian/Allen Hospital, New York, NY, USA
| | - Jin S. Yeom
- Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, and Spine Center, Seongnam, Republic of Korea
| | - Ronald A. Lehman
- Division of Spinal Surgery, Department of Orthopedic Surgery, Columbia University, The Spine Hospital at New York-Presbyterian/Allen Hospital, New York, NY, USA
| | - Lawrence G. Lenke
- Division of Spinal Surgery, Department of Orthopedic Surgery, Columbia University, The Spine Hospital at New York-Presbyterian/Allen Hospital, New York, NY, USA,Lawrence G. Lenke, MD, Division of Spinal Surgery, Department of Orthopedic Surgery, Columbia University, The Spine Hospital at New York-Presbyterian/Allen Hospital 5141 Broadway, 3 Field West, New York, NY, USA.
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Suhr L, Eghbalzadeh K, Djordjevic I, Gaisendrees C, Avgeridou S, Kuhn-Régnier F, Wahlers T. “A Stab in the Heart” Caused by a Cement Fragment After Kyphoplasty. JACC Case Rep 2022; 4:906-910. [PMID: 35912319 PMCID: PMC9334150 DOI: 10.1016/j.jaccas.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Suhr
- Address for correspondence: Dr Laura Suhr, University Hospital Cologne, Department of Cardiothoracic Surgery, Kerpener Strasse 62, 50937 Cologne, Germany.
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Gumusay O, Huppert LA, Behr SC, Rugo HS. The role of percutaneous vertebral augmentation in patients with metastatic breast cancer: Literature review including report of two cases. Breast 2022; 63:149-156. [PMID: 35397256 PMCID: PMC8991318 DOI: 10.1016/j.breast.2022.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
Patients with metastatic breast cancer are at high risk for developing vertebral compression fractures due to underlying bone metastases and bone density loss. Vertebral augmentation techniques including percutaneous vertebroplasty and percutaneous balloon kyphoplasty are techniques used to stabilize compression fractures and improve pain. However, rare complications from these interventions have been observed, including spinal cord compression, nerve root compression, venous cement embolism, and pulmonary cement embolism. These complications pose unique potential challenges for patients with cancer who may already have decreased lung function and potential for venous thromboembolism. In this review, we first describe the role of percutaneous vertebral augmentations in patients with metastatic cancer, with a particular focus on patients with breast cancer. Then, we describe complications of vertebral augmentation in two patients with metastatic breast cancer including long-term symptomatic and radiographic follow-up. Balloon kyphoplasty and percutaneous vertebroplasty are used to stabilize compression fractures and improve pain. Leakage of bone cement can cause cement emboli which can depsit in locations such as the pulmonary and renal vasculature. Management of cement emboli depends on the amount of cement embolized and the severity of symptoms. Future studies are needed to better understand the long-term radiographic and clinical consequences of cement emboli.
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Noriega González DC, Ardura Aragón F, Crespo Sanjuan J, Santiago Maniega S, Labrador Hernández G, Bragado González M, Pérez-Valdecantos D, Caballero-García A, Córdova A. Restoration in Vertebral Compression Fractures (VCF): Effectiveness Evaluation Based on 3D Technology. J Funct Biomater 2022; 13:60. [PMID: 35645268 PMCID: PMC9149907 DOI: 10.3390/jfb13020060] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023] Open
Abstract
There are few studies about anatomical reduction of the fractured vertebral body before stabilization for treatment of vertebral compression fracture (VCF). Although restoration on vertebral height has been useful, the reduction of fractured endplates is limited. The vertebra is part of a joint, and vertebral endplates must be treated like other weight-bearing joint to avoid complications. The aim of this study was to evaluate the feasibility of anatomic reduction of vertebral compression fracture, in different bone conditions, fracture types, and ages (VCF). Under methodological point of view, we followed different steps: first was the placement of two expandable titanium implants just below the fracture. Later, to push the fractured endplates into a more anatomical position, the implants were expanded. Finally, with the implants perfectly positioned, PMMA cement was injected to avoid any loss of correction. To evaluate the effectiveness of this procedure in anatomical fracture reduction, a method based on 3D CT reconstructions was developed. In this paper, we have developed the procedure in three case studies. In all of them, we were able to demonstrate the efficacy of this procedure to reduce the VCF. The percentage of correction of the kyphotic angle varied range between 49% and 62% with respect to the value after the fracture preoperative value. This was accompanied by a reduction of the pain level on the VAS scale around 50%. In conclusion, this novel approach to the vertebral fracture treatment (VCF) associated with 3D assessment have demonstrated the possibility of reducing the vertebral kyphosis angle and the vertebral endplate fractures. However, given the few cases presented, more studies are necessaries to confirm these results.
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Affiliation(s)
- David C. Noriega González
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain;
| | - Francisco Ardura Aragón
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain;
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (G.L.H.); (M.B.G.)
| | - Jesús Crespo Sanjuan
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (G.L.H.); (M.B.G.)
| | - Silvia Santiago Maniega
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (G.L.H.); (M.B.G.)
| | - Gregorio Labrador Hernández
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (G.L.H.); (M.B.G.)
| | - María Bragado González
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (G.L.H.); (M.B.G.)
| | - Daniel Pérez-Valdecantos
- Department of Biochemistry, Molecular Biology and Physiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, University of Valladolid, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain; (D.P.-V.); (A.C.)
| | - Alberto Caballero-García
- Department of Anatomy and Radiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, University of Valladolid, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain;
| | - Alfredo Córdova
- Department of Biochemistry, Molecular Biology and Physiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, University of Valladolid, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain; (D.P.-V.); (A.C.)
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Kamei N, Yamada K, Nakamae T, Hiramatsu T, Hashimoto T, Maruyama T, Adachi N, Fujimoto Y. Radiographic Factors for Adjacent Vertebral Fractures and Cement Loosening Following Balloon Kyphoplasty in Patients with Osteoporotic Vertebral Fractures. Spine Surg Relat Res 2022; 6:159-166. [PMID: 35478985 PMCID: PMC8995113 DOI: 10.22603/ssrr.2021-0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/03/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Balloon kyphoplasty (BKP) is a minimally invasive surgical approach for the treatment of osteoporotic vertebral fractures (OVF). Some risks have been reported after treatment with BKP; therefore, it is necessary to determine when BKP does not work. Thus, in this study, we aim to clarify the radiographic predictors of secondary vertebral fractures and cement loosening after BKP for OVF. Methods This study enrolled patients with single-level OVF at the thoracolumbar junction (T11-L2) who underwent BKP for the first time between January 2011 and March 2014. The clinical outcomes were evaluated using the visual analog scale (VAS) and a modified Oswestry Disability Index (ODI) at 1 week and 1, 3, 6, and 12 months after surgery. Radiographic assessments were performed preoperatively and within 1 year after BKP using plain radiography and computed tomography. Results The 85 patients who met the inclusion criteria underwent BKP. The average age of participants (21 men, 64 women) was 77.8 years (range, 57-92 years). Postoperative VAS and ODI scores were all significantly better than preoperative scores. Polymethyl methacrylate (PMMA)-cement leakage was observed in 18 patients (21.2%) but was asymptomatic in all cases. Secondary vertebral fractures were detected in 20 patients (23.5%), including adjacent levels in 15 patients (17.6%) and non-adjacent levels in 5 patients (5.9%). Rostral bridging osteophyte formation was found to be significantly associated with the occurrence of adjacent vertebral fractures (odds ratio 12.746; p=0.010). PMMA-cement loosening was observed in three patients (3.5%). A high prevalence (100%) of bridging osteophytes, vacuum clefts, and spinous process fractures was observed in patients with PMMA-cement loosening. PMMA-cement loosening was found in 3 out of 10 patients with all three of these factors. Conclusions Rostral bridging osteophyte formation was determined to be a risk factor for both adjacent vertebral fractures and PMMA-cement loosening. Level of Evidence: 3
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Affiliation(s)
- Naosuke Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Kiyotaka Yamada
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital
| | - Toshio Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | | | | | - Toshiaki Maruyama
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
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Fu B, Dong Y, Xiang F, Xia G, Ning Z, Ding H. Different Associated Aspects That Influence Complication Rates on Clinical PKP Surgery Using Smart Medical Big Data. J Healthc Eng 2022; 2022:8432360. [PMID: 35356609 PMCID: PMC8959986 DOI: 10.1155/2022/8432360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/25/2022] [Accepted: 02/17/2022] [Indexed: 11/18/2022]
Abstract
Osteoporotic vertebral compression fractures are on the rise in modern society due to the aging population, and this often results in painful symptoms and kyphotic abnormalities in patients. Bone cement was injected into the vertebral body to reinforce the vertebral body and restore most of the damaged vertebrae's natural height. Percutaneous kyphoplasty is the name given to this type of procedure (PKP). Bone cement leakage has been linked to several problems, according to the research. Neurological problems might arise if bone cement leaks into the spinal canal or the nerve root canal during surgery. As a result, PKP surgeons must now deal with the issue of reducing bone cement leakage. Using smart medical big data, this paper examines a sample of PKP operations and then examines different associated aspects that influence complication rates in order to better advice clinical PKP surgery use. There were 172 vertebral bodies in total in 72 patients receiving PKP surgery at a Chinese hospital that were examined by smart medical big data for vertebral degeneration and fusion. Bone cement leakage and variations in preoperative average anterior vertebral column height, preoperative Cobb angle, and the volume of injected bone cement were considered when dividing the patients into leakage and nonleakage groups; then, we figure out what is causing the bone cement to leak. Five patients experienced lung-related problems out of the 18 vertebral bodies with bone cement leaking that were selected for study. That leakage rate was 10.5%. The differences between the two groups in terms of vertebral compression and bone cement injection were statistically significant based on a single-factor analysis. Bone cement leakage in PKP surgery has been linked to the amount of bone cement injected and whether the vertebral body's peripheral wall was injured, according to multivariate analysis. Lung-related problems are more common in patients with a prior history of illness. Osteoporotic vertebral compression fractures can be successfully treated with percutaneous kyphoplasty. An important risk factor for bone cement extravasation in PKP surgery is the amount of bone cement injected, as well as its viscosity and whether damage to the vertebral body's peripheral wall has occurred.
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Affiliation(s)
- Bin Fu
- Department of Spinal Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750000, China
| | - Yi Dong
- Department of Spinal Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750000, China
| | - Fang Xiang
- The Third People's Hospital of Ningxia Hui Autonomous Region, Yinchuan 750000, China
| | - Gen Xia
- Department of Spinal Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750000, China
| | - Zhaohao Ning
- Department of Spinal Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750000, China
| | - Huiqiang Ding
- Department of Spinal Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750000, China
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Zhang B, Chen G, Yang X, Fan T, Chen Z. Percutaneous Kyphoplasty Versus Percutaneous Vertebroplasty for Neurologically Intact Osteoporotic Kümmell's Disease: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:308-322. [PMID: 33541141 PMCID: PMC8907641 DOI: 10.1177/2192568220984129] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Indexed: 12/15/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are minimally invasive techniques widely used for the treatment of neurologically intact osteoporotic Kümmell's disease (KD), but which treatment is preferable remains controversial. Therefore, this study aimed to shed light on this issue. METHODS Six databases were searched for all relevant studies based on the PRISMA guidelines. Two investigators independently conducted a quality assessment, extracted the data and performed all statistical analyses. RESULTS Eight studies encompassing 438 neurologically intact osteoporotic KD patients met the inclusion criteria. Compared to PVP, PKP was associated with greater improvement in the short- and long-term Cobb angle [SMD = -0.37, P = 0.007; SMD = -0.34, P = 0.012], short-term anterior vertebral height [SMD = 0.43, P = 0.003] and long-term middle vertebral height [SMD = 0.57, P = 0.012] and a lower cement leakage rate [SMD = 0.50, P = 0.003] but produced more consumption (cement injection volume, operative time, fluoroscopy times, intraoperative blood loss and operation cost). However, there were no differences between the 2 procedures in the short- and long-term VAS and ODI scores, long-term anterior vertebral height, overall complications or new vertebral fractures. CONCLUSIONS Both procedures are equally effective for neurologically intact KD in terms of the clinical outcomes, with the exception of a lower cement leakage risk and better radiographic improvement for PKP but greater resource consumption. Based on the evidence available, good clinical judgment should be exercised in the selection of patients for these procedures.
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Affiliation(s)
- Baoliang Zhang
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Guanghui Chen
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Xiaoxi Yang
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Tianqi Fan
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Zhongqiang Chen
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Zhongqiang Chen, Orthopaedic Department,
Peking University Third Hospital, No. 49 North Garden Road, Haidian District,
Beijing 100191, China.
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Wu W, Zhang X, Li X, Liu H, Yu S. Clinical Evaluation of Percutaneous Kyphoplasty for the Management of Osteoblastic-Related Metastatic Vertebral Lesions. Acad Radiol 2022; 29 Suppl 3:S183-S187. [PMID: 34561162 DOI: 10.1016/j.acra.2021.08.015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES To retrospectively evaluate the clinical efficacy and safety of percutaneous kyphoplasty (PKP) for the management of osteoblastic-related metastatic vertebral lesions. MATERIALS AND METHODS A total of 31 patients with 58 osteoblastic-related metastatic vertebral lesions underwent PKP were reviewed. The clinical efficacy was assessed based on parameters including visual analogue scale, Oswestry Disability Index, vertebral body height variation and quality of life. Major and minor complications were systematically evaluated to assess the safety of the procedure. RESULTS Average follow-up period was 22.5 ± 11.1 months(range, 3 to 46 months). The procedure duration time ranged from 50 to 180 minutes (average 96.8 ± 36.9 minutes). Mean visual analogue scale scores decreased significantly from 6.1 ± 1.8 pre-operatively to 2.7 ± 1.5 at 3 days after PKP (p < 0.001), and remained largely immutable at 1 month (2.0 ± 0.7; 31 patients; p < 0.001), 3 months (2.4 ± 1.2; 30 patients; p < 0.001) and 1 year (3.0 ± 1.0; 27 patients; p < 0.001). Oswestry Disability Index scores and vertebral body height variation also changed after the procedure, with significant differences between pre-operative scores and at each follow-up examination (p < 0.001). Mean quality of life scores were 90.8 ± 12.9 pre-operatively and improved to 99.5 ± 12.1(27 patients, p < 0.001) at 1 year after PKP. The only minor encountered complication was bone cement leakage, which was seen in 6.5%(2 of 31) of patients. None of the patients experienced major complications. CONCLUSION PKP is a safe and effective treatment strategy for osteoblastic-related metastatic vertebral lesions from a variety of tumor etiologies.
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Affiliation(s)
- Wence Wu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, 100021 (W.W., X.Z., X.L., H.L., S.Y.), Beijing, People's Republic of China
| | - Xinxin Zhang
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, 100021 (W.W., X.Z., X.L., H.L., S.Y.), Beijing, People's Republic of China
| | - Xiaoyang Li
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, 100021 (W.W., X.Z., X.L., H.L., S.Y.), Beijing, People's Republic of China
| | - Huanmei Liu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, 100021 (W.W., X.Z., X.L., H.L., S.Y.), Beijing, People's Republic of China
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, 100021 (W.W., X.Z., X.L., H.L., S.Y.), Beijing, People's Republic of China.
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Agarwal A, Rastogi S, Litin Y, Singh N, Patel H. Percutaneous vertebroplasty in metastatic vertebral fracture: A retrospective cross-sectional study. Indian J Pain 2022. [DOI: 10.4103/ijpn.ijpn_103_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Patel Z, Sangani R, Lombard C. Cement pulmonary embolism after percutaneous kyphoplasty: An unusual culprit for non-thrombotic pulmonary embolism. Radiol Case Rep 2021; 16:3520-5. [PMID: 34539945 DOI: 10.1016/j.radcr.2021.08.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 01/03/2023] Open
Abstract
Non-thrombotic pulmonary embolism can occur from rare but diverse etiology and is not well understood. Increasing prevalence of osteoporosis in the aging population has contributed to increased utilization of percutaneous vertebral augmentation procedures of vertebroplasty and its recent modification, kyphoplasty. Though these procedures are relatively well tolerated, there is risk of potentially fatal complication of bone cement embolization to distant vasculature. We report a case of symptomatic pulmonary cement emboli developed 2 day's post kyphoplasty and its successful treatment with novel anticoagulant for 6 months. We also summarize evidence to assist clinicians and radiologists for early identification, treatment, and prevention of cement pulmonary emboli.
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Denaro L, Longo UG, Papalia R, De Salvatore S, Ruzzini L, Piergentili I, Denaro V. The burden of percutaneous vertebroplasty: an epidemiological nationwide study in Italy from 2009 to 2015. Eur Spine J 2021; 30:3099-3106. [PMID: 34415447 DOI: 10.1007/s00586-021-06966-2] [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] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 07/13/2021] [Accepted: 08/11/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Percutaneous vertebroplasty (PV) is a minimally invasive technique requiring the injection of polymethylmethacrylate cement into a collapsed or weakened vertebral body to stabilize the fracture. The present study aims to determine the trends in PV procedures over the recent years. The longitudinal analysis of national registers may help to understand the yearly trends and the economic burden of PV. The evaluation of the yearly national costs of this procedure is essential to surgeons, policymaker, hospital administrator and the healthcare system. Moreover, to observe possible variation in the trend of hospitalization between countries, the data of the present study were compared to the US population. METHODS Data of this study were collected from the National Hospital Discharge Reports reported at the Italian Ministry of Health regarding the years of this paper (2009-2015). The yearly number of hospital admission for PV, sex, age, days of hospitalization and primary diagnoses in the whole Italian population were calculated. RESULTS 31,887 vertebroplasties were performed in Italy, with an incidence of 8.8 procedures for every 100,000 inhabitants. Females represented the majority of patients undergoing PV. The median length of hospital stay was 4.15 days. The mean hospital reimbursement was 4,629€ for each PV hospitalization. CONCLUSION The burden of vertebral fracture is relevant in the Italian population, and PV constitutes a rapid and effective treatment. Compared to other countries, the costs of PV in Italy are relatively lower; however, it is important to define the incidence of this procedure to understand the economic trend of PV.
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Affiliation(s)
- Luca Denaro
- Department of Neuroscience (Padova Neuroscience Center), University of Padova, Padova, Italy
| | - Umile Giuseppe Longo
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Rocco Papalia
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sergio De Salvatore
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Laura Ruzzini
- Department of Surgery, Orthopedic Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Ilaria Piergentili
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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Lu K, Yin Y, Li C, Jin Y, Shan HQ. Efficacy of annual zoledronic acid in initial percutaneous kyphoplasty patients with osteoporotic vertebral compression fractures: a 3-year follow-up study. Osteoporos Int 2021; 32:1429-1439. [PMID: 33462653 DOI: 10.1007/s00198-020-05816-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/21/2020] [Accepted: 12/30/2020] [Indexed: 12/30/2022]
Abstract
UNLABELLED This study investigated the efficacy of annual zoledronic acid (ZOL) administration against previously treated recompression vertebral fractures (RVF) and new vertebral fractures (NVF) in initial percutaneous kyphoplasty (PKP) patients with osteoporotic vertebral compression fractures (OVCF) over a 3-year follow-up period. INTRODUCTION Although PKP achieves a satisfactory outcome, previously treated RVF and NVF can limit its effectiveness. The annual infusion of ZOL over 3 years can improve fracture protection, particularly in the vertebrae. We hypothesized that ZOL can reduce the incidence of RVFs and/or NVFs, and improve the clinical outcomes of PKP. METHODS This was a placebo-controlled, double-blind prospective trial of 154 PKP patients (mean age: 70 years) with OVCFs. Patients were randomly assigned to receive a single infusion of ZOL (5 mg) or placebo (78 ZOL vs. 76 placebo) at 1 week, 12 months, and 24 months after surgery. Patients were followed-up for 36 months. RESULTS ZOL treatment lowered the risk of RVF by ~ 65% over the 36-month period when compared to placebo controls (6.41% in ZOL vs. 18.42% in placebo groups; relative risk, 0.35; 95% CI, 0.13 to 0.92). ZOL also reduced the risk of NVF by ~ 73% (3.85% in ZOL vs. 14.47% in placebo groups; relative risk, 0.27; 95% CI, 0.08 to 0.92). ZOL also significantly reduced the vertebral height lost rate (HLR) at 12, 24, and 36 months. ZOL also improved the visual analog scale (VAS), Oswestry disability index (ODI) scores, and bone mineral density (BMD). CONCLUSION Annual ZOL administration significantly lowers the risk of RVFs and NVFs, improving the clinical outcome of initial PKP in patients with OVCFs over a 3-year follow-up period. TRIAL REGISTRATION ChiCTR2000029307.
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Affiliation(s)
- K Lu
- Department of Joint Surgery, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, 215300, Jiangsu, China
| | - Y Yin
- Department of Spinal Surgery, Affiliated Kunshan Hospital of Jiangsu University, No. 91 West of Qianjin Road, Suzhou, 215300, Jiangsu, China
| | - C Li
- Department of Orthopaedics, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, 215300, Jiangsu, China
| | - Y Jin
- Department of Spinal Surgery, Affiliated Kunshan Hospital of Jiangsu University, No. 91 West of Qianjin Road, Suzhou, 215300, Jiangsu, China
| | - H-Q Shan
- Department of Spinal Surgery, Affiliated Kunshan Hospital of Jiangsu University, No. 91 West of Qianjin Road, Suzhou, 215300, Jiangsu, China.
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Cai M, Xin Z, Kong W, Du Q, Ji W, Wu F, Li J, He J, Liao W. Clinical effect of a novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for thoracolumbar burst fractures. BMC Musculoskelet Disord 2021; 22:540. [PMID: 34126973 PMCID: PMC8204475 DOI: 10.1186/s12891-021-04423-1] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Short-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs),but this technique has many problems. Therefore,the purpose of this article is to observe and evaluate the clinical efficacy of a novel transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs. METHODS From July 2018 to November 2020, 70 cases of TBFs were included. Thirty-five patients were treated with the novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation (observation group), and 35 patients were treated with short-segment transpedicular screw fixation (control group). Before the operation, after reduction, and 3 days, 3 months,and 12 months after the operation, the two groups were assessed, and compared with respect to the anterior and middle heights of the injured vertebrae, the ratios of the anterior and middle heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of the patients. We compared the pain VAS score and quality of life GQOL-74 score at the last follow-up. Finally,we evaluated the distribution of bone grafts and bone healing 12 months after the operation. RESULTS The anterior height, middle height, AVBHr, MVBHr, and Cobb angle of the injured vertebral body in the observation after reduction, and 3 days, 3 months and 12 months post-operatively were compared with those of the injured vertebral body before operation. All of these parameters were improved, and the difference was statistically significant (p < 0.05). These parameters in the observation group at the above time points were significantly better than thoes in the control group at the corresponding time points (p < 0.05). The VAS scores at the last follow-up were significantly better than those of the control group (p < 0.05), but the GQOL-74 score differences were not statistically significant (p > 0.05). The observation group showed no obvious defects on CT at 12 months after the operation, and the bone healing was good. CONCLUSION The novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for TBFs has good clinical efficacy.
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Affiliation(s)
- Menghan Cai
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Zhijun Xin
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Weijun Kong
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Qian Du
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Wenjun Ji
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Fujun Wu
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Jin Li
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Jialin He
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China
| | - Wenbo Liao
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099, Guizhou, China.
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Abstract
In this article, assistance to bone cement injection is studied, with a focus on vertebroplasty, a procedure dedicated to the treatment of vertebral compression fractures. A robotic system that can remotely be operated at pressures up to 140 bar is presented. It improves cement polymerization control, combining a cold passive exchanger that slows down the cement curing in the syringe and an active exchanger that controls the injected cement temperature. The cement remote injection uses a rate control teleoperation strategy with force feedback to help monitoring the cement state. In addition to laboratory assessments, cadaver experiments were performed to illustrate the satisfactory operation of the whole system.
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Benhabib H, Meirovich H, David E. Evolving role of minimally invasive techniques in the management of symptomatic bone metastases. Curr Opin Support Palliat Care 2021; 15:91-8. [PMID: 33905381 DOI: 10.1097/SPC.0000000000000548] [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] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Bone metastases are responsible for considerable morbidity, which can significantly limit a patient's quality of life. This article aims to review minimally invasive, image-guided locoregional treatments for symptomatic bone metastases as an adjunct to conventional treatment modalities. RECENT FINDINGS Conservative therapy and radiation therapy (RT) can be effective at addressing pain, however, they require time to achieve optimal efficacy and do not address the instability and progressive collapse of pathological fractures. Vertebral and pelvic augmentation with cement enhances structural stability and can prevent progressive collapse and deformity. Ablative therapies, including radiofrequency ablation (RFA), cryoablation, and photodynamic therapy (PDT), induce cellular destruction of tumor tissue. RFA and PDT can be combined with cement augmentation in a single sitting. SUMMARY Minimally invasive image-guided treatments can provide rapid pain relief, enhance mechanical stability, and improve quality of life. These treatments are associated with low complication rates and are suitable for frail patients. They can be used as companion procedures to conventional treatments, or function as an alternative for patients with radioresistant biologies or those with dose limitations from prior RT sessions.
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Martinez-Moragón E, De Juana Izquierdo C, Dahmazi L. Pulmonary embolism due to vertebroplasty material: Another possible complication of severe asthmatics. Rev Clin Esp 2021; 221:428-9. [PMID: 34332705 DOI: 10.1016/j.rceng.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/31/2020] [Indexed: 11/23/2022]
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Hegmann KT, Travis R, Andersson GBJ, Belcourt RM, Carragee EJ, Eskay-Auerbach M, Galper J, Goertz M, Haldeman S, Hooper PD, Lessenger JE, Mayer T, Mueller KL, Murphy DR, Tellin WG, Thiese MS, Weiss MS, Harris JS. Invasive Treatments for Low Back Disorders. J Occup Environ Med 2021; 63:e215-e241. [PMID: 33769405 DOI: 10.1097/jom.0000000000001983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This abbreviated version of the American College of Occupational and Environmental Medicine's Low Back Disorders guideline reviews the evidence and recommendations developed for invasive treatments used to manage low back disorders. METHODS Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 47 high-quality and 321 moderate-quality trials were identified for invasive management of low back disorders. RESULTS Guidance has been developed for the invasive management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 49 specific recommendations. CONCLUSION Quality evidence should guide invasive treatment for all phases of managing low back disorders.
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Affiliation(s)
- Kurt T Hegmann
- American College of Occupational and Environmental Medicine, Elk Grove Village, Illinois
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Abstract
A 46-year-old woman presented with sudden onset of shortness of breath and pleuritic chest pain. A CT pulmonary angiogram identified a 5 cm cement pulmonary embolus within the right main pulmonary artery with a surrounding thrombus. She had undergone an L4 vertebroplasty 3 years prior to presentation for a benign lytic lesion. Cement embolus is a known complication of cement vertebroplasty with incidence rates of approximately 0.9%. Management is usually conservative and associated morbidity and mortality rates are low. It is not known whether a previous cement embolus could provide a nidus for thrombus formation.
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Affiliation(s)
- James Ross
- Swindon Academy, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Robin Bhatia
- Department of Trauma and Orthopaedics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Tom Hyde
- Department of Cardiology, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Giles Dixon
- Department of Respiratory Medicine, Great Western Hospitals NHS Foundation Trust, Swindon, UK
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Tang B, Cui L, Chen X, Liu Y. Risk Factors for Cement Leakage in Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: An Analysis of 1456 Vertebrae Augmented by Low-Viscosity Bone Cement. Spine (Phila Pa 1976) 2021; 46:216-22. [PMID: 33156285 DOI: 10.1097/BRS.0000000000003773] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To identify risk factors for cement leakage in percutaneous vertebroplasty (PVP) using low-viscosity bone cement for osteoporotic vertebral compression fractures (OVCFs). SUMMARY OF BACKGROUND DATA Cement leakage is the most common complication for PVP and its risk factors have been discussed. However, data in previous series were heterogeneous. Additionally, relative smaller patient sample or more types of cement leakage classified in those studies made the results conflicting. METHODS A total of 1090 patients who underwent PVP with low-viscosity bone cement for OVCFs in 1456 levels between January 2016 and June 2019 were retrospectively reviewed. Parameters potentially affecting the occurrence of cement leakage were assessed using univariate and multivariate analyses. Cement leakage was assessed using postoperative computed tomography scanning, and classified into two types (cortical leakage and venous leakage) considering the mechanism. RESULTS The incidence of cortical and venous leakage were 20.3% (295/1456) and 56.2% (819/1456), respectively. Cortical disruption, basivertebral foramen were the strongest risk factors for cortical leakage (P = 0.000), venous leakage (P = 0.000), respectively. Greater cement volume is one risk factor for both cortical leakage and venous leakage. The intravertebral cleft, solid type of cement distribution were significant risk factors for cortical leakage, and they both were protective factors for venous leakage. For cortical leakage, older age and trauma were another two risk factors. For venous leakage, female was another one risk factor, and higher grade of fracture severity is the strongest protective factor. CONCLUSION Both cortical leakage and venous leakage are prevalent. Adequate known of risk factors could help balance the incidence of two type leakage in unique vertebra and reduce the incidence of leakage in general in PVP for OVCFs.Level of Evidence: 3.
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Abstract
Vertebral augmentation, including vertebroplasty and kyphoplasty, is a minimally invasive, image-guided procedure in which cement (typically polymethylmethacrylate (PMMA)) is injected into a vertebral body to treat painful fractures. The majority of vertebroplasty and kyphoplasty procedures are performed to treat symptomatic osteoporotic compression fractures refractory to conservative medical therapy; however, there is also evidence to suggest the benefits of augmentation in patients with refractory pain in the acute compression setting. The primary goal of augmentation is decreasing pain and improving a patient's functional status. The secondary goal of augmentation is vertebral body stabilization. This chapter outlines the indications, contraindications, techniques, and literature behind vertebral augmentation.
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Hafezi-Nejad N, Bailey CR, Solomon AJ, Abou Areda M, Carrino JA, Khan M, Weiss CR. Vertebroplasty and kyphoplasty in the USA from 2004 to 2017: national inpatient trends, regional variations, associated diagnoses, and outcomes. J Neurointerv Surg 2020; 13:483-491. [PMID: 33334904 DOI: 10.1136/neurintsurg-2020-016733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/08/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND To explore the national inpatient trends, regional variations, associated diagnoses, and outcomes of vertebral augmentation (vertebroplasty and kyphoplasty) in the USA from 2004 to 2017. METHODS Data from the National Inpatient Sample were used to study hospitalization records for percutaneous vertebroplasty and kyphoplasty. Longitudinal projections of trends and outcomes, including mortality, post-procedural complications, length of stay, disposition, and total hospital charges were analyzed. RESULTS Following a period of decreased utilization from 2008 to 2012, hospitalizations for vertebroplasty and kyphoplasty plateaued after 2013. Total hospital charges and overall financial burden of hospitalizations for vertebroplasty and kyphoplasty increased to a peak of $1.9 billion (range $1.7-$2.2 billion) in 2017. Overall, 8% of procedures were performed in patients with a history of malignancy. In multivariable modeling, lung cancer (adjusted OR (aOR) 2.6 (range 1.4-5.1)) and prostate cancer (aOR 3.4 (range 1.2-9.4)) were associated with a higher risk of mortality. The New England region had the lowest frequency of routine disposition (14.1±1.1%) and the lowest average hospital charges ($47 885±$1351). In contrast, 34.0±0.8% had routine disposition in the West Central South region, and average hospital charges were as high as $99 836±$2259 in the Pacific region. The Mountain region had the lowest number of procedures (5365±272) and the highest mortality rate (1.2±0.3%). CONCLUSION National inpatient trends of vertebroplasty and kyphoplasty utilization remained stable after a period of decline from 2008 to 2012, while the financial burden of hospitalizations increased. Despite recent improvements in outcomes, significant regional variations persisted across the USA.
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Affiliation(s)
- Nima Hafezi-Nejad
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Alex J Solomon
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - John A Carrino
- Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Majid Khan
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Clifford R Weiss
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Lopez CD, Boddapati V, Lombardi JM, Cerpa MK, Lee NJ, Mathew J, Sardar ZM, Lenke LG, Lehman RA. Medicare Utilization and Reimbursement for Vertebroplasty and Kyphoplasty: A National Analysis From 2012-2017. Spine (Phila Pa 1976) 2020; 45:1744-50. [PMID: 32925685 DOI: 10.1097/BRS.0000000000003692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study OBJECTIVE.: This study seeks to identify recent trends in utilization and reimbursements of these procedures between 2012and 2017, a period which experienced a change in national guideline recommendations for these procedures. SUMMARY OF BACKGROUND DATA Minimally invasive vertebral augmentation procedures, including vertebroplasty and kyphoplasty, have been typically reserved for fractures associated with refractory pain, deformity, or progressive neurological symptoms. However, controversy exists regarding the safety and effectiveness of these procedures, in particular vertebroplasty. METHODS Annual Medicare claims and payments to surgeons were aggregated at the county level to assess regional trends. Descriptive statistics and multivariate regression models were used to evaluate trends in procedure volume, utilization rates, and reimbursement rates, and to examine associations between county-specific variables and outcome variables. RESULTS A total of 24,316 vertebroplasties and 138,778 kyphoplasties were performed in the Medicare population between 2012 and 2017. Annual vertebroplasty volume fell by 48.0% from 5744 procedures in 2012 to 2987 in 2017, with a compound annual growth rate (CAGR) of -12.3%. Annual kyphoplasty volume also declined by 12.7% (CAGR -2.7%), from 24,986 in 2012 to 21,681 in 2017. Surgeon reimbursements for vertebral augmentation procedures increased by a weighted average of 93.7% (inflation-adjusted increase of 78.2%) between 2012 and 2017, which was primarily driven by a dramatic 113.3% (inflation-adjusted increase of 96.2%) increase in mean reimbursements for kyphoplasty procedures from an average of $895 to $1764, between 2012 and 2017, respectively. CONCLUSION This large national Medicare database study found that vertebroplasty and kyphoplasty procedure volume and utilization of both procedures have declined significantly. Although average reimbursements to surgeons for vertebroplasties have significantly declined, payments for kyphoplasty procedures have risen significantly. Although vertebroplasty volume has significantly decreased, it is still being performed and being reimbursed for, in spite of its controversial role in its treatment of vertebral fractures. LEVEL OF EVIDENCE 3.
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Naud R, Guinde J, Astoul P. Pulmonary cement embolism complicating percutaneous kyphoplasty: A case report. Respir Med Case Rep 2020; 31:101188. [PMID: 32923362 PMCID: PMC7475197 DOI: 10.1016/j.rmcr.2020.101188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/12/2020] [Revised: 07/10/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023] Open
Abstract
Background Vertebral cement augmentation procedures, as kyphoplasty (KP) or percutaneous vertebroplasty (PVP), are commonly used for the management of pain of the vertebral column usually due to fractures related to traumatic injury, osteoporosis or metastatic lesion. It is a useful and safe technique with few complications. Among them, symptomatic pulmonary cement embolism (PCE) can happened, even rarely described in the literature, leading to severe cardio-respiratory manifestations depending on the location and size of the cement emboli. Case presentation A 55 yo woman presented with atypical chest pain and presyncope three weeks after a motor vehicle accident resulting in an L1 compression fracture treated with kyphoplasty. She was hemodynamically stable. Blood tests showed D-Dimer 0.29 μg/mL, troponin <5ng/mL, Brain Natriuretic Protein 14 ng/mL and a PaO2 of 99 mmHg on arterial blood gas analysis. A computed tomography scan of chest showed linear hyperdense foreign bodies in two segmental pulmonary arteries at the level of middle lobe and right lower lobe compatible with pulmonary cement embolism. Anticoagulation with rivaroxaban for sixth months resulted in resolution of symptoms. Conclusions In this case, the pulmonary cement embolism occurred after kyphoplasty, which is associated with less risk of PCE than vertebroplasty. The procedure was done under biplanar fluoroscopy and no leakage of cement was noted, which would raise suspicion for CPE. Repeat imagine after this procedure is not routinely done. This case demonstrates that systematic imaging post procedure should be considered. An anticoagulation with rivaroxaban seems to be effective in our patient.
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Affiliation(s)
- Romain Naud
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Marseille, France.,Aix-Marseille University, France
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Zhang Y, Yin P, Yang J, Hai Y. Percutaneous vertebroplasty (PVP) to treat specialized type of endplate fractures around the Schmorl's node: a prospective study of 65 patients. J Orthop Surg Res 2020; 15:397. [PMID: 32912241 PMCID: PMC7488090 DOI: 10.1186/s13018-020-01873-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/19/2020] [Accepted: 08/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Schmorl's nodes (SNs) are defined as the herniation of the intervertebral disc into the vertebral body. Endplate fractures around the Schmorl's node could result in severe back pain that is similar to vertebral compression fractures. The objective of this study was to prospectively analyze the surgical effectiveness and safety of percutaneous vertebroplasty (PVP) for endplate fractures around the SNs. METHODS Seventy-one consecutive patients with the fresh endplate fracture around SNs from October 2017 to February 2018 were enrolled in this study. The visual analog scale (VAS) and Oswestry disability index (ODI) scores of low back pain were evaluated in all patients preoperatively, postoperatively, and at 1 month, 6 months, and 1 year after primary single level PVP. Surgery-related data including duration of the operation, injected cement volumes, and surgical complications were recorded. RESULTS Sixty-five patients with fresh endplate fractures around the SNs were treated successfully via percutaneous vertebroplasty. Our study showed that the VAS scores and ODI scores of patients were obviously improved after operation. Cement leakage into the disc space occurred in 5 patients (7.7%), and adjacent segment refractures occurred in 2 patients (3.1%). No other surgical complications, including infections or nerve root injuries were encountered. CONCLUSIONS Based on the results of this prospective study, PVP was an effective and safe procedure for endplate fractures around the SNs. TRIAL REGISTRATION ChiCTR, ChiCTR1800016453 . Registered 2 June 2018-retrospectively registered, http://www.chictr.org.cn/com/25/historyversionpuben.aspx?regno=ChiCTR1800017602.
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Affiliation(s)
- Yaoshen Zhang
- Department of Orthopedics, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Peng Yin
- Department of Orthopedics, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jincai Yang
- Department of Orthopedics, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Yong Hai
- Department of Orthopedics, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
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Ho YS. Letter to the Editor Regarding "The Top 100 Most-Cited Articles on Kyphoplasty and Vertebroplasty". World Neurosurg 2020; 139:676-687. [PMID: 32689679 DOI: 10.1016/j.wneu.2020.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Yuh-Shan Ho
- Trend Research Centre, Asia University, Wufeng, Taichung, Taiwan.
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Nakanishi K, Uchino K, Watanabe S, Hayashi N, Iba H, Hasegawa T. Video-Assisted Thoracoscopic Surgery for Re-Collapse of Vertebrae after Percutaneous Vertebral Augmentation (PVA). Spine Surg Relat Res 2020; 5:28-33. [PMID: 33575492 PMCID: PMC7870326 DOI: 10.22603/ssrr.2020-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/22/2020] [Accepted: 05/27/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Due to the increase in osteoporosis accompanying the aging society in Japan, osteoporotic vertebral fractures (OVFs) are increasing. Percutaneous vertebral augmentation (PVA) has been widely used for OVFs because it reduces pain immediately with less invasiveness. Re-collapse of vertebral body after PVA is a rare, but important, complication. Once the re-collapse has occurred, patients should undergo an additional invasive salvage surgery. METHODS We treated 5 patients with re-collapse after PVA in our hospital. For re-collapse after PVA, we performed anterior column reconstruction with video-assisted thoracoscopic surgery (VATS), posterior fixation with percutaneous pedicle screws (PPSs) and minimally invasive spine stabilization (MISt). RESULTS The mean postoperative follow-up was at 62.8 months. At the final follow-up, the patients were free of low back pain, and bony union was achieved in all cases. The postoperative correction loss was 6 degrees. Perioperative complications included aspiration pneumonia in one patient and bone fracture of an adjacent vertebral body in two patients. There were no reoperation cases. CONCLUSIONS We perform minimally invasive combined anterior and posterior surgery with VATS for re-collapse after PVA. This procedure is useful in elderly patients with less reserve capacity.
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Affiliation(s)
- Kazuo Nakanishi
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Kazuya Uchino
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Seiya Watanabe
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Norito Hayashi
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Hideaki Iba
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Toru Hasegawa
- Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan
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Alvi MA, Zreik J, Yolcu YU, Goyal A, Kim DK, Kallmes DF, Freedman BA, Bydon M. Comparison of Costs and Postoperative Outcomes between Vertebroplasty and Kyphoplasty for Osteoporotic Vertebral Compression Fractures: Analysis from a State-Level Outpatient Database. World Neurosurg 2020; 141:e801-e814. [PMID: 32534264 DOI: 10.1016/j.wneu.2020.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Vertebral cement augmentation techniques are routinely used to treat osteoporotic vertebral compression fractures (VCFs). In the current study, we used a state-level outpatient database to compare costs and postoperative outcomes between vertebroplasty and kyphoplasty. METHODS We queried the 2016 Florida State-Ambulatory Surgery Database of the Healthcare Cost and Utilization Project for patients undergoing thoracolumbar vertebroplasty or kyphoplasty for osteoporotic VCFs. Demographic and clinical characteristics, as well as postoperative outcomes were compared between the 2 groups. RESULTS A total of 105 patients (11.6%) who underwent vertebroplasty and 801 patients (88.4%) who underwent kyphoplasty were identified. Patients undergoing kyphoplasty were more likely to stay overnight or longer, with the P value trending toward significance (kyphoplasty with >1 day stay: 7.4% vs. vertebroplasty with >1 day stay: 1.9%; P = 0.086). Patients undergoing vertebroplasty had a significantly higher rate of discharge to home routine compared with patients undergoing kyphoplasty (97.1% [n = 102] vs. 94.1% [n = 754]; P < 0.001). Undergoing kyphoplasty was also associated with higher index admission costs ($40,706 vs. $18,965; P < 0.001) and higher readmission costs ($27,038 vs. $11,341; P = 0.046). The rates of 30-day and 90-day readmission were similar between the 2 groups (all P > 0.05). The rates of 30-day, 90-day, and overall readmission because of a new-onset fracture were also similar (all P > 0.05). However, vertebroplasty had a higher rate of readmissions associated with a procedure within a year (21.9% [n = 23] vs. 14.5% [n = 116]; P = 0.047). CONCLUSIONS Our analyses from a state-level database of patients undergoing vertebroplasty and kyphoplasty for osteoporotic VCFs show similar postoperative outcomes for the 2 procedures but a higher cost for kyphoplasty.
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Affiliation(s)
- Mohammed Ali Alvi
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jad Zreik
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Yagiz U Yolcu
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anshit Goyal
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Dong Kun Kim
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Nikoobakht M, Gerszten PC, Shojaei SF, Shojaei H. Percutaneous balloon kyphoplasty in the treatment of vertebral compression fractures: a single-center analysis of pain and quality of life outcomes. Br J Neurosurg 2020; 35:166-169. [PMID: 32516010 DOI: 10.1080/02688697.2020.1777254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Vertebral body compression fractures are one of the most common causes of disability and morbidity, especially among the elderly population. The present study was performed in order to evaluate the effect of percutaneous balloon kyphoplasty (BKP) on patients' pain and quality of life (QOL) in Iran. METHODS The study was conducted on a consecutive series of 54 patients with symptomatic vertebral compression fractures who failed conservative management between 2014 and 2017. A quasi-experimental design was employed in which the pain severity, quality of life, and kyphotic angle were measured before and 3 and 12 months after the PBK procedure. Pain and quality of life outcomes were determined using a Visual Analogue Scale (VAS) for Pain and the 12-Item Short Form Health Survey (SF-12) for QOL. RESULTS Excellent improvement in VAS was documented at 3 and 12 months after the BKP procedure (p = 0.001). Improvement at 3 months was maintained through the 12 months follow-up period. A statistically significant improvement in QOL was documented at 3 months after BKP that continued to improve through 12 months follow-up. The mean kyphotic angle before PBK was 19.4 ± 5.3 degrees which after 3 months improved to 12.8 ± 3.1 degrees; this reduction was significant (p < 0.001). No new fractures occurred during the follow-up period. CONCLUSION Balloon kyphoplasty was determined to be a safe and successful method for treating symptomatic vertebral compression fractures. It leads to significant pain relief, an improvement in self-reported QOL measures, and correction in kyphotic deformity.
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Affiliation(s)
- Mehdi Nikoobakht
- Department of Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Peter C Gerszten
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Seyedeh Fahimeh Shojaei
- Firoozgar Clinical Research and Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Shojaei
- Department of Neurosurgery, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
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Martinez-Moragón E, De Juana Izquierdo C, Dahmazi L. Pulmonary embolism due to vertebroplasty material: another possible complication of severe asthmatics. Rev Clin Esp 2020; 221:S0014-2565(20)30115-6. [PMID: 32444103 DOI: 10.1016/j.rce.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/22/2020] [Accepted: 03/31/2020] [Indexed: 11/18/2022]
Affiliation(s)
- E Martinez-Moragón
- Servicio de Neumología, Hospital Universitario Doctor Peset Valencia, Valencia, España.
| | - C De Juana Izquierdo
- Servicio de Neumología, Hospital Universitario Doctor Peset Valencia, Valencia, España
| | - L Dahmazi
- Servicio de Neumología, Hospital Universitario Doctor Peset Valencia, Valencia, España
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41
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Nguyen DH, Vu DD, Doan TNH, Vo HL. Safety of Balloon Kyphoplasty in the Treatment of Thoracic Osteoporotic Vertebral Compression Fractures in Vietnamese Patients. Clin Orthop Surg 2020; 12:209-216. [PMID: 32489543 PMCID: PMC7237258 DOI: 10.4055/cios19160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/13/2019] [Accepted: 12/16/2019] [Indexed: 11/20/2022] Open
Abstract
Background The evidence for the efficacy and safety of balloon kyphoplasty (BKP) in treating the Vietnamese patients is sparse. There is no convincing evidence regarding BKP's efficacy in Vietnamese patients, especially in the patients with thoracic osteoporotic vertebral compression fractures (VCFs). This article aims to evaluate the outcomes of restoring the body height of the compressed thoracic vertebrae in patients undergoing BKP. Methods We prospectively enrolled 65 consecutive patients with thoracic VCFs (73 vertebrae) due to osteoporosis who were treated with BKP between June 2018 and May 2019. Results A trocar was inserted through the pedicle in 84.9% (62/73) and beside the pedicle in 15.1% (11/73). The mean amount of mixed cement injected was 4.1 ± 1.1 mL (range, 1.5–7 mL). Cement leakage was radiographically confirmed in 30.8% of 65 patients. Among patients with complications caused by cement extravasation, the leakage was through the anterior margin of the vertebrae in 15.4%, through the vertebral disc in 12.3%, and through the posterior margin of the vertebrae in 3.1%. In the last 3.1% of patients, there was no clinically notable lesions of the nerve roots or spinal cord. The mean visual analog scale score decreased significantly from 7.3 ± 1.1 preoperatively to 3.3 ± 0.6 at 24 hours after surgery, and then to 1.2 ± 1.1 at 3 months after surgery (p < 0.01). The mean reduction in Cobb angle measured on standing radiographs after treatment was 3.7°, showing statistical significance
(p < 0.01). Conclusions BKP is a minimally invasive treatment effective for immediate pain relief, early motor rehabilitation, and humpback correction. The present study provided convincing evidence to support the use of BKP by spine surgeons and clinical specialists in treating osteoporotic thoracic VCFs in Vietnamese patients.
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Affiliation(s)
- Dinh-Hoa Nguyen
- Institute of Orthopedic Trauma, Viet Duc Hospital, Hanoi, Vietnam.,Social Affair Department, Viet Duc Hospital, Hanoi, Vietnam.,Department of Surgery, Hai Duong Medical Technical University, Hai Duong, Vietnam
| | - Duc-Dat Vu
- Institute of Orthopedic Trauma, Viet Duc Hospital, Hanoi, Vietnam.,Department of Surgery, Hai Duong Medical Technical University, Hai Duong, Vietnam
| | - Thi-Ngoc-Ha Doan
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Hoang-Long Vo
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
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Griffoni C, Lukassen JNM, Babbi L, Girolami M, Lamartina C, Cecchinato R, Gasbarrini A, Barbanti Brodano G. Percutaneous vertebroplasty and balloon kyphoplasty in the treatment of osteoporotic vertebral fractures: a prospective randomized comparison. Eur Spine J 2020; 29:1614-1620. [PMID: 32361843 DOI: 10.1007/s00586-020-06434-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/09/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study is to compare the efficacy and safety of percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP) in the treatment of osteoporotic vertebral compression fractures. MATERIALS AND METHODS Patients with osteoporotic vertebral body fractures (T4-L5) were randomized and not blinded to kyphoplasty (n = 69) or vertebroplasty (n = 70). The postoperative pain score (VAS) at 12 months was the primary end point. The radiographic results were evaluated in relation to the resolution of the fracture and the possible onset of further osteoporotic fractures during follow-up. RESULTS A total of one hundred and thirty-nine patients were eligible for randomization (n = 70 for PVP group and n = 69 for BKP), and twenty-six patients (twenty in the BKP group and six in the PVP group) were excluded. The mean average age of patients was 73 years, and 82% of the patients were females. VAS pain score was significantly reduced after surgery in both groups, and there were no significant differences between the two groups in postoperative VAS score. There was a significant reduction in kyphotic wedge angle and improvement of the sagittal index in both groups, but there was no significant difference between the two groups. There was a significant higher risk incidence of adjacent level fractures in the vertebroplasty group. CONCLUSIONS In terms of clinical outcomes, there were no differences between the two groups. Both showed a significant clinical improvement, vertebral body height restoration and reduction in the kyphotic angle. There was a significant higher risk of adjacent level fractures in the vertebroplasty group.
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Affiliation(s)
- C Griffoni
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli, 1, 40136, Bologna, Italy
| | - J N M Lukassen
- Department of Neurosurgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - L Babbi
- GSpine4, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - M Girolami
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli, 1, 40136, Bologna, Italy
| | - C Lamartina
- GSpine4, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - R Cecchinato
- GSpine4, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - A Gasbarrini
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli, 1, 40136, Bologna, Italy
| | - G Barbanti Brodano
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli, 1, 40136, Bologna, Italy.
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Lin JH, Chi JE, Hsu JY, Chan RW, Lo WC, Chiang YH. Kyphoplasty with an intravertebral reduction device for osteoporotic vertebral compression fractures with spinal canal encroachment. Formos J Surg 2020. [DOI: 10.4103/fjs.fjs_38_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hsieh MK, Kao FC, Chiu PY, Chen LH, Yu CW, Niu CC, Lai PL, Tsai TT. Risk factors of neurological deficit and pulmonary cement embolism after percutaneous vertebroplasty. J Orthop Surg Res 2019; 14:406. [PMID: 31783861 PMCID: PMC6884871 DOI: 10.1186/s13018-019-1459-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 06/11/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background The risk factors, incidence, and clinical management of pulmonary cement embolism and neurological deficit during percutaneous vertebroplasty (PVP) were evaluated. Methods Three thousand one hundred and seventy-five patients with symptomatic osteoporotic vertebral compression fractures (OVCFs) treated with PVP were retrospectively reviewed in a single institution. Clinical parameters such as age, gender, number of fractures, and time from fracture to vertebroplasty were recorded at the time of surgery. Image and surgical parameters including the amount of cement, the vertebral level, uni- or bipedicle surgical approach, and leakage pattern were recorded. Results Type-C leakage, including paraspinal (25%), intradiscal (26%), and posterior (0.7%) leakage, was more common than type-B (11.4%) and type-S leaks (4.9%). Cement leakage into the spinal canal (type-C posterior) occurred in 26 patients (0.7%), and four patients needed surgical decompression. Three in nine patients with leakage into thoracic spine needed decompressive surgery, but only one of 17 patients into lumbar spine needed surgery (p < 0.01). Age, gender, number of fractures, and time from fracture to vertebroplasty were not risk factors of pulmonary cement embolism or neurological deficit. The risk factor of pulmonary cement embolism was higher volume of PMMA injected (p < 0.001) and risk factor of neurological deficit was type-C posterior cement leakage into thoracic spine. The incidence of pulmonary cement embolism was significantly high in the volume of PMMA injected (PMMA injection < 3.5 cc: 0%; 3.5–7.0 cc: 0.11%; > 7.0 cc: 0.9%; p < 0.01) which needed postoperative oxygen support. Conclusions Cement leakage is relatively common but mostly of no clinical significance. Percutaneous vertebroplasty in thoracic spine and high amount of PMMA injected should be treated with caution in clinical practice.
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Affiliation(s)
- Ming-Kai Hsieh
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Fu-Cheng Kao
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ping-Yeh Chiu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lih-Huei Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Wei Yu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chien Niu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Liang Lai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Abstract
The aim of this study was to compare and evaluate clinical results before and after vertebroplasty in the treatment of myeloma-induced vertebral fractures. Success of the surgery was defined by increased or reduced pain intensity before and after the treatment, as assessed using the visual analog scale (VAS). The study was designed as a retrospective-prospective study. The study included 26 patients, 14 women and 12 men. Data on patients treated for myeloma-induced vertebral fractures were collected at the Department of Orthopedics, Osijek University Hospital Centre. The following data were analyzed: gender, duration of illness, intensity of pain before and after treatment (using VAS), radiological changes before and after treatment, grade of vertebral fracture, and extracorporeal cement leakage from the vertebral body to the surrounding tissue during the procedure. Difference in pain intensity before and after the surgery was statistically significant. All patients complained of pain before the surgery (pain intensity median 8), whereas after the surgery, pain intensity decreased in all patients (pain intensity median 2). In conclusion, improvement in clinical results of the treatment of myeloma-induced vertebral fractures with vertebroplasty proved to be significant.
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Affiliation(s)
| | - Ivan Vidaković
- 1Department of Orthopedics, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2One Health Group, Sheffield, United Kingdom; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Marko Šutalo
- 1Department of Orthopedics, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2One Health Group, Sheffield, United Kingdom; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Vjeran Rapan
- 1Department of Orthopedics, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2One Health Group, Sheffield, United Kingdom; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Domagoj Rapan
- 1Department of Orthopedics, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2One Health Group, Sheffield, United Kingdom; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Saša Rapan
- 1Department of Orthopedics, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2One Health Group, Sheffield, United Kingdom; 3Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Xu K, Li YL, Song F, Liu HW, Yang HD, Xiao SH. Influence of the distribution of bone cement along the fracture line on the curative effect of vertebral augmentation. J Int Med Res 2019; 47:4505-4513. [PMID: 31364432 PMCID: PMC6753545 DOI: 10.1177/0300060519864183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/13/2022] Open
Abstract
Objective The present study was performed to evaluate the effect of different bone cement distributions along the fracture line on clinical and imaging outcomes of vertebral augmentation. Methods In total, 84 patients who underwent vertebral augmentation for a single osteoporotic vertebral compression fracture from January 2016 to August 2018 were retrospectively reviewed. These patients were divided into two groups according to the relationship between the bone cement distribution and the fracture line: the unilateral group (n = 23) and the bilateral group (n = 61). Postoperative clinical and imaging parameters were compared between the two groups. Results Statistical analyses showed no significant difference in postoperative pain relief, bone cement leakage, nerve injury, or new vertebral fracture between the two groups. Significant recovery from vertebral compression was observed in the bilateral group after surgery, but there was no significant difference in vertebral compression after surgery in the unilateral group. Conclusions Pain relief was similar for different types of cement distributions along the fracture line, but a bilateral cement distribution exhibited better recovery from vertebral compression and did not increase bone cement leakage in the vertebral augmentation procedure.
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Affiliation(s)
- Kai Xu
- Department of Orthopedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ya-Ling Li
- Department of Orthopedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Fei Song
- Department of Orthopedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Hua-Wei Liu
- Department of Orthopedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Hua-Dong Yang
- Department of Orthopedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Song-Hua Xiao
- Department of Orthopedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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47
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Affiliation(s)
| | - Sandeep Patri
- Internal Medicine, HSHS Saint Vincent Hospital, Green Bay, Wisconsin, USA
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48
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Abstract
Introduction: There is a growing recognition of the role of interventional techniques (IT) for the management of cancer pain (CP). However, there are many controversies on how and when to use such techniques. Areas covered: Patients who are unresponsive to systemic opioid analgesics or patients unable to tolerate systemic opioids may benefit from different IT for which the successful use depends on the selection of the right therapy for the right patient. The evidence regarding these techniques is often anecdotal and the potential risks, benefits, alternatives, and complications should be balanced to take a decision. Expert opinion: The successful use of IT depends on many factors, including a careful assessment of previous treatments, patient's characteristics, and the logistics. Risks, benefits, alternatives, and complications should be balanced to take a decision. Although IT have been described as effective in patients with CP, the evidence is still limited, unless for celiac plexus block, which has a high benefit-risk ratio. The intrathecal therapy should be chosen in patients who were poorly responding to opioid therapy, after an appropriate trial with different opioids. A careful selection of patients and techniques, a large experience in performing the procedures, sufficient logistics and staff skills, appropriate indications, and assessment of benefits and risks may help to achieve the best benefit for patients in individual cases.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center for Pain Relief & Supportive Care, La Maddalena Cancer Center , Palermo , Italy
| | - Kenneth D Candido
- Department of Anaesthesiology, Advocate Illinois Masonic Medical Center , Chicago , USA
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Barreau X, Palussiere J, Fauche C. La radiologie interventionnelle en pathologie rachidienne. Presse Med 2019; 48:696-705. [DOI: 10.1016/j.lpm.2019.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/02/2019] [Indexed: 10/26/2022] Open
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50
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Wang P, Li J, Song Z, Peng Z, Wang G. Utilization of the directional balloon technique to improve the effectiveness of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures and reduction of bone cement leakage. Medicine (Baltimore) 2019; 98:e15272. [PMID: 31083158 PMCID: PMC6531054 DOI: 10.1097/md.0000000000015272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This article evaluates the effectiveness of a new directional balloon technique in the treatment of osteoporotic vertebral compression fractures (OVCFs). METHODS From September 2015 to April 2017, 100 patients with single-segment OVCFs treated using percutaneous kyphoplasty were available for complete data assessment. Among these, 51 cases were treated with the traditional nondirectional balloon technique (group 1) and 49 cases were treated with the directional balloon technique (group 2). Operative time, blood loss, and X-ray exposure time were compared between the 2 groups. The visual analogue score (VAS), Oswestry disability index (ODI), and Roland Morris disability (RMD) scores, and wedge-shaped and kyphosis angles were measured at 3 days and 1, 3, 6, and 12 months, respectively, after surgery. RESULTS There were no significant differences in blood loss or the amount of bone cement injected between the 2 groups; however, operative times, X-ray exposure times, and leakage rates of bone cement, especially type C in group 2, were significantly lower in group 2 than those in group 1. VAS, ODI, and RMD scores, and wedge-shaped and kyphosis angles at each time point after surgery were significantly higher than those before surgery. However, the improvement in VAS, ODI, and RMD scores in group 2 was only significantly better than those in group 1 at 3 days after surgery. CONCLUSION The utilization of the directional balloon technique in the treatment of OVCFs using percutaneous kyphoplasty can not only reduce the operation time, the radiation, and the bone cement leakage, but also improve the early curative effect.
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