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Tang Y, Li H, Ruan X, Yang H, Sun J, Chen K. Percutaneous kyphoplasty with or without posterior pedicle screw fixation for the management of severe osteoporotic vertebral compression fractures with nonunion. J Orthop Surg Res 2024; 19:240. [PMID: 38622736 PMCID: PMC11017672 DOI: 10.1186/s13018-024-04714-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/04/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE To assess the radiographic outcomes, clinical outcomes and complications of percutaneous kyphoplasty (PKP) with and without posterior pedicle screw fixation (PPSF) in the treatment of severe osteoporotic vertebral compression fractures (sOVCF) with nonunion. METHODS This study involved 51 patients with sOVCF with nonunion who underwent PKP or PPSF + KP. The operation time, intraoperative blood loss, volume of injected bone cement, operation costs and hospital stays were all recorded. In addition, the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were assessed separately for each patient before and after surgery. RESULTS Compared with the PPSF + KP group, the PKP group had shorter operation time, less intraoperative blood loss, shorter hospital stays and fewer operation costs. However, cobb's angle improvement (13.4 ± 4.3° vs. 21.4 ± 5.3°), VWR improvement ratio (30.4 ± 11.5% vs. 52.8 ± 12.7%), HA (34.9 ± 9.0% vs. 63.7 ± 7.6%) and HM (28.4 ± 11.2% vs. 49.6 ± 7.7%) improvement ratio were all higher in PPSF + KP group than that in PKP group. In addition, the ODI index and VAS score in both groups were significantly decreased at the postoperative and final follow-up. PKP group's postoperative VAS score was significantly lower than that in PPSF + KP group, but there was no statistically significant difference in VAS score at the last follow-up. CONCLUSION PKP and PPSF + KP can both effectively relieve the pain associated with sOVCF with nonunion. PPSF + KP can achieve more satisfactory vertebral reduction effects compared to PKP. However, PKP was less invasive and it has more advantages in shortening operation time and hospital stay, as well as decreasing intraoperative blood loss and operation costs.
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Affiliation(s)
- Yingchuang Tang
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hanwen Li
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xingbang Ruan
- First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huilin Yang
- First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Jiajia Sun
- First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Kangwu Chen
- First Affiliated Hospital of Soochow University, Suzhou, China.
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Mao Z, Xiong ZH, Li JF. Thoracic spinal cord injury and paraplegia caused by intradural cement leakage after percutaneous kyphoplasty: A case report. World J Clin Cases 2024; 12:1837-1843. [PMID: 38660080 PMCID: PMC11036470 DOI: 10.12998/wjcc.v12.i10.1837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/28/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Percutaneous kyphoplasty (PKP) is a pivotal intervention for osteoporotic fractures, pathological vertebral compression fractures, and vertebral bone tumors. Despite its efficacy, the procedure presents challenges, notably complications arising from intradural cement leakage. Timely and accurate diagnosis, coupled with emergent intervention is imperative to improve patient prognosis. This case report illuminates the intricacies and potential complications associated with PKP, emphasizing the critical need for vigilant monitoring, prompt diagnosis, and immediate intervention to mitigate adverse outcomes. CASE SUMMARY A 58-year-old male patient, experiencing a T7 osteoporosis-related pathological compression fracture, underwent PKP at a local hospital. Two weeks post-procedure, the patient developed paraplegic and dysuric symptoms, necessitating emergency decompression surgery. Gradual improvement was achieved, marked by the restoration of muscle strength, sensation, and mobility. CONCLUSION PKP Intradural cement leakage following PKP is unusual and potentially fatal. Prompt imaging examinations, urgent evaluation, and the decompression surgery are essential, which help alleviate symptoms associated with spinal damage, markedly improving the overall prognosis.
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Affiliation(s)
- Zi Mao
- Department of Pain Management, The Affiliated Hospital of Yunnan University, Kunming 650000, Yunnan Province, China
| | - Zhi-Hong Xiong
- Department of Pain Management, The Affiliated Hospital of Yunnan University, Kunming 650000, Yunnan Province, China
| | - Jun-Feng Li
- Department of Medical Administration, The Affiliated Hospital of Yunnan University, Kunming 650000, Yunnan Province, China
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Zhang Y, Lu Y, Lin W, Yao M, Song J, Ding L. Surgical management of lower limb radiculopathy following acute singe-level osteoporotic vertebral fracture of lower lumbar spine in geriatric patient: a retrospective study. BMC Musculoskelet Disord 2024; 25:262. [PMID: 38570760 PMCID: PMC10988790 DOI: 10.1186/s12891-024-07314-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Radiculopathy of the lower limb after acute osteoporotic vertebral fractures (OVFs) in the lower lumbar spine is uncommon in geriatric patients. Moreover, surgical intervention is generally recommended in patients who are irresponsive to conservative treatment. Determining an optimum surgical strategy is challenging considering the poor general condition of this population. Thus, herein, we established an algorithm for surgically managing this clinical scenario, hoping to provide a reference for making a surgical decision. METHODS We retrospectively studied patients who suffered from new-onset radiculopathy of the lower limb after acute single-level OVFs in the lower lumbar spine and eventually underwent surgical intervention at our department. Information on the demographics, bone quality, AO spine classification of the vertebral fracture, pre-existing degenerative changes, including foraminal stenosis and lumbar disc herniation, and surgical intervention type was collected. Additionally, clinical outcomes, including preoperative and postoperative visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI), and MacNab criterion for response to surgery, were evaluated. RESULTS From September 2019 to December 2021, a total of 22 patients with a mean age of 68.59 ± 9.74 years were analyzed. The most involved vertebra was L5 (54.5%), followed by L4 (27.3%) and L3 (18.2%). Among the 22 patients, 15 (68.2%) were diagnosed with the A1 type fracture of AO classification, and among them, 11 (73.3%) were characterized by the collapse of the inferior end plate (IEP). Three patients (13.6%) suffered from A2-type fractures, whereas four patients (18.2%) suffered from A3-type fractures. Pre-existing degenerative changes were observed in 12 patients (54.5%) of the patients. A total of 16 patients (72.7%) were treated by percutaneous kyphoplasty (PKP). Additionally, three patients underwent posterior instrumentation and fusion, two patients underwent a secondary endoscopic foraminoplasty, and one patient underwent a secondary radiofrequency ablation. The mean follow-up period was 17.42 ± 9.62 months. The mean VAS scores for leg and back pain and ODI decreased significantly after the surgery (P < 0.05). The total satisfaction rate at the last follow-up was 90.9% per the Macnab criterion. CONCLUSION Patients with OVFs in the IEP are predisposed to suffer from radiculopathy of the lower limb. PKP alone or in combination with other minimally invasive surgical strategies is safe and effective in treating stable fractures. Additionally, aggressive surgical intervention should be considered in patients with unstable fractures or severe foraminal encroachment.
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Affiliation(s)
- Yao Zhang
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China
| | - Yuzheng Lu
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China
| | - Wancheng Lin
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China
| | - Mingtao Yao
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China
| | - Jipeng Song
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China.
| | - Lixiang Ding
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, tieyi road, Yangfangdian, Haidian district, Beijing, 100038, People's Republic of China.
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Zhang J, Xu Y, Lu W, Sun F, Li H. Changes of inflammatory cytokines in vertebral compression fractures patients with percutaneous balloon kyphoplasty. Br J Neurosurg 2024; 38:231-235. [PMID: 33136440 DOI: 10.1080/02688697.2020.1823941] [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: 04/08/2020] [Revised: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
Objective: To explore the changes of a series of cytokines before and after percutaneous balloon kyphoplasty (PKP) and prognostic markers for response to PKP.Methods: From 1 January 2019 to 31 May 2019, all single-level lumbar osteoporotic vertebral compression fracture (OVCF) patients diagnosed by MRI who matched the inclusion and exclusion criteria were enrolled in this study. They were classified into the effective group and the ineffective group based on the outcome after PKP. The levels of a series of inflammatory factors and indices of spinal functions were obtained before and after PKP.Results: A total of 72 patients were included in this study, 59 in the effective group and 13 in the ineffective group. The anterior height (AH) and posterior height (PH) were 77.3 ± 11.2% and 91.2 ± 9.3%, respectively, in the effective group after PKP, which were higher than that in the ineffective group (p<.001). While, the Kyphotic angle, visual analog scale (VAS), and Oswestry Disability Index (ODI) score were 9.1 ± 4.3°, 3.1 ± 1.9, and 19.2 ± 4.1 in the effective group, which was lower than that in ineffective group (p<.001). The serum levels of IL-1β, IL-6, and TNF-α were found significantly decreased after treatment in the effective group (p<.05). The logistic regression showed that the levels of IL-6 TNF-α and AH were significant predictor of outcome.Conclusions: Our results demonstrated that PKP can reduce the serum levels of IL-6, IL-1β, and TNF-α, moreover, the IL-6, TNF-α, and AH were significant predictors of outcome.
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Affiliation(s)
- Jian Zhang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch, Shanghai, PR China
| | - Yanchun Xu
- Department of Pathology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Weiwei Lu
- Department of Emergency, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
| | - Fengbin Sun
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch, Shanghai, PR China
| | - Hongbo Li
- The First Department of General Surgery, Qingdao Municipal Hospital Qingdao, Qingdao, PR China
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Jing C, Wang H, Liu P, Yang S, Zhang L, Yang P, Gan M. Effect of sarcopenia on refractures of adjacent vertebra after percutaneous kyphoplasty. BMC Musculoskelet Disord 2024; 25:210. [PMID: 38475772 DOI: 10.1186/s12891-024-07295-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE To explore the effect of sarcopenia on recurrent fractures of adjacent vertebra after percutaneous kyphoplasty (PKP). METHODS A total of 376 osteoporotic vertebral compression fractures (OVCFs) patients over 55 years old who were admitted to the Hospital from August 2020 to January 2021 were selected. Among them, 38 patients with recurrent fractures in adjacent vertebra after PKP were selected as the refracture group (RG), and the remaining 338 patients were selected as the non-refracture group (NRG). The age, gender, grip strength, body mass index (BMI), bone mineral density (BMD), visual analogue scale (VAS) of pain before and one month after surgery, Oswestry disability index (ODI) before and one month after surgery and the occurrence of sarcopenia were compared between the two groups. Logistic regression analysis was used to evaluate the effect of related risk factors on refracture after vertebral PKP. RESULTS The results of t-test and Chi-square test showed that there were no obvious differences in gender, BMI, preoperative VAS score (t=-0.996, P = 0.320) and ODI (t=-0.424, P = 0.671), one month postoperative VAS score (t=-0.934, P = 0.355) and ODI score (t=-0.461, P = 0.645). while the age and grip strength showed significant differences between the two groups. Logistic regression analysis showed that BMI and gender had no significant effect on refracture after PKP, while sarcopenia and advanced age were independent risk factors for refracture after PKP. Also, increased BMD was a protective factor for refracture after PKP. CONCLUSION Sarcopenia is an independent risk factor for recurrent fractures after PKP in OVCF patients. The screening and diagnosis of sarcopenia should be strengthened. At the same time, anti-sarcopenia treatment should be actively performed after surgery.
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Affiliation(s)
- Chengnan Jing
- The Department of Orthopaedics, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Huazheng Wang
- The Department of Orthopaedics, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Peng Liu
- The Department of Orthopaedics, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Shaofeng Yang
- The Department of Orthopaedics, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Linlin Zhang
- The Department of Orthopaedics, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Peng Yang
- The Department of Orthopaedics, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Minfeng Gan
- The Department of Orthopaedics, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, China.
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Cheng Y, Xie X. Analysis and comparison of the therapeutic effects of percutaneous kyphoplasty through single and bilateral approaches in osteoporotic compression fractures. Asian J Surg 2024:S1015-9584(24)00203-3. [PMID: 38341374 DOI: 10.1016/j.asjsur.2024.01.149] [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: 12/18/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
the clinical effectiveness of unilateral/bilateral percutaneous vertebral augmentation (PVA) for the treatment of osteoporotic vertebral compression fractures (OVCF) was assessed to provide guidance for clinical treatment.Through retrospective analysis of data from 107 patients, including preoperative and postoperative visual analogue scale scores, bone cement leakage, adjacent vertebral fractures, vertebral height, and infection.There was no significant difference in preoperative and postoperative scores, Cobb angle, anterior height, and bone cement leakage rate, but the vertebral body height in the bilateral percutaneous vertebral fusion surgery group was significantly higher than that in the unilateral group(P < 0.05).Grade I compression fractures, a unilateral PVA approach was recommended, while for Grade II and III compression fractures, a bilateral PVA approach was preferable.
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Affiliation(s)
- Yuan Cheng
- Gansu University of Chinese Medicine, Lanzhou, Gansu, China.
| | - Xingwen Xie
- Department of Orthopaedics, The Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, China.
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Xia YD, Zhang R, Liu Q, Chen JR. [Application value of bone cement containing rhbFGF and RHBMP-2 in PKP treatment of osteoporotic lumbar compression fracture]. Zhongguo Gu Shang 2024; 37:15-20. [PMID: 38286446 DOI: 10.12200/j.issn.1003-0034.20221048] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
OBJECTIVE To investigate the effect of bone cement containing recombinant human basic fibroblast growth factor (rhbFGF) and recombinant human bone morphogenetic protein-2 (rhBMP-2) in percutaneous kyphoplasty(PKP)treatment of osteoporotic vertebral compression fracture(OVCF). METHODS A total of 103 OVCF patients who underwent PKP from January 2018 to January 2021 were retrospectively analyzed, including 40 males and 63 females, aged from 61 to 78 years old with an average of (65.72±3.29) years old. The injury mechanism included slipping 33 patients, falling 42 patients, and lifting injury 28 patients. The patients were divided into three groups according to the filling of bone cement. Calcium phosphate consisted of 34 patients, aged(65.1±3.3) years old, 14 males and 20 females, who were filled with calcium phosphate bone cement. rhBMP-2 consisted of 34 patients, aged (64.8±3.2) years old, 12 males and 22 females, who were filled with bone cement containing rhBMP-2. And rhbFGF+rhBMP-2 consisted of 35 patients, aged (65.1±3.6) years old, 14 males and 21 females, who were filled with bone cement containing rhbFGF and rhBMP-2. Oswestry disability index (ODI), bone mineral density, anterior edge loss height, anterior edge compression rate of injured vertebra, visual analog scale (VAS) of pain, and the incidence of refracture were compared between groups. RESULTS All patients were followed for 12 months. Postoperative ODI and VAS score of the three groups decreased (P<0.001), while bone mineral density increased (P<0.001), anterior edge loss height, anterior edge compression rate of injured vertebra decreased first and then slowly increased (P<0.001). ODI and VAS of group calcium phosphate after 1 months, 6 months, 12 months were lower than that of rhBMP-2 and group rhbFGF+rhBMP-2(P<0.05), bone mineral density after 6 months, 12 months was higher than that of rhBMP-2 and group calcium phosphate(P<0.05), and anterior edge loss height, anterior edge compression rate of injured vertebra of group rhbFGF+rhBMP-2 after 6 months and 12 months were lower than that of group rhBMP-2 and group calcium phosphate(P<0.05). There was no statistical difference in the incidence of re-fracture among the three groups (P>0.05). CONCLUSION Bone cement containing rhbFGF and rhBMP-2 could more effectively increase bone mineral density in patients with OVCF, obtain satisfactory clinical and radiological effects after operation, and significantly improve clinical symptoms.
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Affiliation(s)
- Yu-Dong Xia
- Department of Spinal Trauma Surgery, Changshou District People's Hospital, Chongqing 401220, China
| | - Rong Zhang
- Department of Spinal Trauma Surgery, Changshou District People's Hospital, Chongqing 401220, China
| | - Qiong Liu
- Department of Spinal Trauma Surgery, Changshou District People's Hospital, Chongqing 401220, China
| | - Jia-Ru Chen
- Department of Emergency, Changshou District People's Hospital, Chongqing 401220, China
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Tu W, Niu Y, Su P, Liu D, Lin F, Sun Y. Establishment of a risk prediction model for residual low back pain in thoracolumbar osteoporotic vertebral compression fractures after percutaneous kyphoplasty. J Orthop Surg Res 2024; 19:41. [PMID: 38184651 PMCID: PMC10771681 DOI: 10.1186/s13018-024-04528-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVE This study aims to identify potential independent risk factors for residual low back pain (LBP) in patients with thoracolumbar osteoporotic vertebral compression fractures (OVCFs) following percutaneous kyphoplasty (PKP) treatment. Additionally, we aim to develop a nomogram that can accurately predict the occurrence of residual LBP. METHODS We conducted a retrospective review of the medical records of thoracolumbar OVCFs patients who underwent PKP treatment at our hospital between July 2021 and December 2022. Residual LBP was defined as the presence of moderate or greater pain (VAS score ≥ 4) in the low back one day after surgery, and patients were divided into two groups: the LBP group and the non-LBP group. These patients were then randomly allocated to either a training or a validation set in the ratio of 7:3. To identify potential risk factors for residual LBP, we employed lasso regression for multivariate analysis, and from this, we constructed a nomogram. Subsequently, the predictive accuracy and practical clinical application of the nomogram were evaluated through a receiver operating characteristic (ROC) curve, a calibration curve, and a decision curve analysis (DCA). RESULTS Our predictive model revealed that five variables-posterior fascial oedema, intravertebral vacuum cleft, time from fracture to surgery, sarcopenia, and interspinous ligament degeneration-were correlated with the presence of residual LBP. In the training set, the area under the ROC was 0.844 (95% CI 0.772-0.917), and in the validation set, it was 0.842 (95% CI 0.744-0.940), indicating that the model demonstrated strong discriminative performance. Furthermore, the predictions closely matched actual observations in both the training and validation sets. The decision curve analysis (DCA) curve suggested that the model provides a substantial net clinical benefit. CONCLUSIONS We have created a novel numerical model capable of accurately predicting the potential risk factors associated with the occurrence of residual LBP following PKP in thoracolumbar OVCFs patients. This model serves as a valuable tool for guiding specific clinical decisions for patients with OVCFs.
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Affiliation(s)
- Weiqiao Tu
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, Jiangsu, People's Republic of China
| | - Yanping Niu
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, Jiangsu, People's Republic of China
| | - Peng Su
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, Jiangsu, People's Republic of China
| | - Di Liu
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, Jiangsu, People's Republic of China
| | - Fanguo Lin
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, Jiangsu, People's Republic of China.
| | - Yongming Sun
- Department of Orthopedics, Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Suzhou, Jiangsu, People's Republic of China
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Fan CY, Wu XX, Ji ZW, Zhang LL, Zhou F, Mao HQ. Application of Enhanced Recovery After Surgery in Patients with Osteoporotic Vertebral Compression Fractures Undergoing Percutaneous Kyphoplasty. World Neurosurg 2024; 181:e339-e345. [PMID: 37839562 DOI: 10.1016/j.wneu.2023.10.052] [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: 05/18/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The enhanced recovery after surgery (ERAS) program helps patients recover faster and better, postoperatively. The aim of this retrospective study was to assess the clinical effectiveness of the ERAS program after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures. METHODS We enrolled patients with osteoporotic vertebral compression fracture who had undergone PKP between January 2019 and June 2021 and divided them into the control group (CG; n = 296), without the ERAS program, and the intervention group (IG; n = 306), with the ERAS program. The visual analog scale (VAS), Oswestry Disability Index (ODI), and Barthel Index scores of the 2 groups were compared on admission and 2 days and 1, 6, and 12 months postoperatively. Perioperative evaluation parameters included the mean surgery time, length of stay (LOS), and hospitalization expenses. In addition, postoperative complications were compared. RESULTS Regarding perioperative parameters, LOS and hospitalization expenses were significantly better in IG than in CG (P < 0.001), but the mean surgery time did not differ significantly (P > 0.05). The VAS, Barthel Index, and ODI scores were significantly better in IG than in CG at 2 days and 1 month postoperatively (P < 0.001). None of the clinical effectiveness parameters (VAS, Barthel Index, and ODI scores) differed between IG and CG at 6 or 12 months postoperatively. In addition, 141 patients in CG and 56 patients in IG experienced postoperative complications, including pressure ulcers, deep vein thrombosis, nausea and vomiting, and refracture (P = 0.970, P = 0.036, P < 0.001, P = 0.002 respectively). CONCLUSIONS For patients undergoing PKP, the ERAS program is a reliable and effective perioperative management method that can effectively reduce LOS, postoperative pain, and economic burden and promote recovery of patients.
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Affiliation(s)
- Chun-Yang Fan
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xie-Xing Wu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhong-Wei Ji
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Pain Management, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Lin-Lin Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Feng Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hai-Qing Mao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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Han F, Chen H, Zhao H. Comparing percutaneous kyphoplasty with bone cement augmented pedicle screw fixation in severe thoracolumbar osteoporotic vertebral compression fracture. Asian J Surg 2024; 47:558-559. [PMID: 37775383 DOI: 10.1016/j.asjsur.2023.09.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023] Open
Affiliation(s)
- Fei Han
- Department of Spinal Surgery, Yichang Central People's Hospital, China Three Gorges University, 183 Yiling Avenue, Yichang, 443003, China.
| | - Haidan Chen
- Department of Spinal Surgery, Yichang Central People's Hospital, China Three Gorges University, 183 Yiling Avenue, Yichang, 443003, China.
| | - Hongwei Zhao
- Department of Spinal Surgery, Yichang Central People's Hospital, China Three Gorges University, 183 Yiling Avenue, Yichang, 443003, China.
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Wang X, Zhu YH, Zhu QS. Efficacy and safety of robot-assisted versus fluoroscopy-assisted PKP or PVP for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. J Robot Surg 2023; 17:2597-2610. [PMID: 37632602 DOI: 10.1007/s11701-023-01700-0] [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: 05/01/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023]
Abstract
Percutaneous vertebral augmentation (PVA), which includes percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP). Robot-assisted (RA) and fluoroscopy-assisted (FA) are important methods for treating osteoporotic vertebral compression fractures (OVCFs), though it is still unclear which is superior. This analysis aimed to compare the efficacy and safety of RA and FA. PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure were systematically searched, the outcomes included surgical parameters (leakage rate, operation time, number of fluoroscopic, injection volume, inclination angle), and clinical indexes (hospital stays, Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Cobb angle, the midline height of vertebral). Thirteen articles involving 1094 patients were included. RA group produced better results than the FA group in the leakage rate (OR = 0.27; 95% CI 0.17-0.42; P < 0.00001), number of fluoroscopic (WMD = - 13.88; 95% CI - 18.47 to - 9.30; P < 0.00001), inclination angle (WMD = 5.02; 95% CI 4.42-5.61; P < 0.00001), hospital stays (WMD = - 0.32; 95% CI - 0.58 to - 0.05; P = 0.02), VAS within 3 days (WMD = - 0.19; 95% CI - 0.26 to - 0.12; P < 0.00001), Cobb angle within 3 days (WMD = - 1.35; 95% CI - 2.56 to - 0.14; P = 0.003) and Cobb angle after 1 month (WMD = - 1.02; 95% CI - 1.84 to - 0.20; P = 0.01). But no significant differences in operation time, injection volume, ODI, the midline height of vertebral, and VAS score after 1 month. Our analysis found that the RA group had lower cement leakage rates, number of fluoroscopic and hospital stays, a larger inclination angle, better short-term pain improvement, and Cobb angle improvement. It is worth acknowledging that robotic-assisted surgery holds promise for the development of spine surgery. The study was registered in the PROSPERO (CRD42023393497).
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Affiliation(s)
- Xu Wang
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, Jilin, China
| | - Yu-Hang Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, Jilin, China.
| | - Qing-San Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, Jilin, China.
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Zheng J, Gao Y, Yu W, Yu N, Jia Z, Hao Y, Chen Y. Development and validation of a nomogram for predicting new vertebral compression fractures after percutaneous kyphoplasty in postmenopausal patients. J Orthop Surg Res 2023; 18:914. [PMID: 38037128 PMCID: PMC10688465 DOI: 10.1186/s13018-023-04400-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Postmenopausal women face a heightened risk of developing new vertebral compression fractures (NVCFs) following percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs). This study aimed to develop and validate a visual nomogram model capable of accurately predicting NVCF occurrence post-PKP to optimize treatment strategies and minimize occurrence. METHODS This retrospective study included postmenopausal women diagnosed with OVCF who underwent PKP at the Affiliated Hospital of Shandong University of Traditional Chinese Medicine between January 2016 and January 2021. Patient data, including basic information, surgical details, imaging records, and laboratory findings, were collected. The patients were categorized into two groups based on NVCF occurrence within 2 years post-PKP: the NVCF group and the non-NVCF group. Following the utilization of least absolute shrinkage and selection operator (LASSO) regression for feature selection, a nomogram was constructed. Model differentiation, calibration, and clinical applicability were evaluated using receiver operating characteristic (ROC), calibration, and decision (DCA) curve analyses. RESULTS In total, 357 patients were included in the study. LASSO regression analysis indicated that cement leakage, poor cement diffusion, and endplate fracture were independent predictors of NVCF. The nomogram demonstrated excellent predictive accuracy and clinical applicability. CONCLUSIONS This study used LASSO regression to identify three independent predictors of NVCF and developed a predictive model that could effectively predict NVCF occurrence in postmenopausal women. This simple prediction model can support medical decision-making and is feasible for clinical practice.
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Affiliation(s)
- Jianhu Zheng
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yan Gao
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Wenlong Yu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ning Yu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 16369 Jingshi Road, Lixia District, Jinan, Shandong Province, China
| | - Zetao Jia
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yanke Hao
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 16369 Jingshi Road, Lixia District, Jinan, Shandong Province, China.
| | - Yungang Chen
- Shandong University of Traditional Chinese Medicine, Jinan, China.
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Liu L, Song F, Shang J, Zhang J, Ma C, Liu G, Han M. Bipedicular percutaneous kyphoplasty versus unipedicular percutaneous kyphoplasty in the treatment of asymmetric osteoporotic vertebral compression fractures: a case control study. BMC Surg 2023; 23:285. [PMID: 37726728 PMCID: PMC10510266 DOI: 10.1186/s12893-023-02180-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 09/01/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Bipedicular/unipedicular percutaneous kyphoplasty are common treatments for OVCF, and there are no studies to show which is more beneficial for AVCF. The purpose of this study was to investigate the clinical efficacy of BPKP or UPKP in the treatment of AVCF. METHODS The clinical data of AVCF patients treated by PKP were retrospectively analyzed. They were divided into two groups according to the surgical approach. General demographic data, perioperative complications, and general information related to surgery were recorded for both groups. The preoperative and postoperative vertebral height difference, vertebral local Cobb angle, lumbar pain VAS score and lumbar JOA score were counted for both groups. The above data were compared preoperatively, postoperatively and between the two groups. RESULTS 25 patients with AVCF were successfully included and all were followed up for at least 12 months, with no complications during the follow-up period. 10 patients in the BPKP group and 15 patients in the UPKP group, with no statistically significant differences in general information between the two groups. The VAS scores of patients in the BPKP group were lower than those in the UPKP group at 12 months after surgery, and the differences were statistically significant, and there were no statistically significant differences between the two groups at other follow-up time points. In the BPKP group, 80% of patients had symmetrical and more homogeneous bone cement dispersion. 50% of patients in the UPKP group had a lateral distribution of bone cement and uneven bone cement distribution, and the difference in bone cement distribution between the two groups was statistically significant. CONCLUSION For the treatment of AVCF, the clinical efficacy of both surgical approaches is basically the same. The distribution of cement is more symmetrical and uniformly diffused in the BPKP group, and the clinical efficacy VAS score is lower in the long-term follow-up. Bipedicular percutaneous kyphoplasty is recommended for the treatment of AVCF. THE ETHICAL REVIEW BATCH NUMBER XZXY-LJ-20161208-047.
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Affiliation(s)
- Lei Liu
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Feifei Song
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jie Shang
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jianwei Zhang
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chao Ma
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Guangpu Liu
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Meng Han
- Department of Spinal surgery, Xuzhou Central Hospital, 199 Jiefang South Road, Xuzhou, Jiangsu, China.
- Department of Spinal Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, China.
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Zhang A, Lin Y, Kong M, Chen J, Gao W, Fan J, Wang J, Chen Z. A nomogram for predicting the risk of new vertebral compression fracture after percutaneous kyphoplasty. Eur J Med Res 2023; 28:280. [PMID: 37563667 PMCID: PMC10416413 DOI: 10.1186/s40001-023-01235-y] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/16/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND New vertebral compression fractures (NVCFs) are common adverse events in percutaneous kyphoplasty (PKP). The present study aimed to investigate the risk factors for NVCFs in patients after PKP and to construct a nomogram for the prediction of the risk of re-fracture. METHODS We retrospectively analyzed the medical records of patients after PKP surgery between January 2017 and December 2020. Patients were divided into an NVCF group (n = 225) and a control group (n = 94) based on the presence or absence of NVCFs, respectively, at follow-up within 2 years after surgery. Lasso regression was used to screen for risk factors for re-fracture. Based on the results, a Lasso-logistic regression model was developed, and its prediction performance was evaluated using receiver operating characteristic curves, calibration, and decision curve analysis. The model was visualized, and a nomogram was constructed. RESULTS A total of eight potential predictors were obtained from Lasso screening. Advanced age, low body mass index, low bone mineral density, lack of anti-osteoporosis treatment, low preoperative vertebral body height, vertebral body height recovery ≥ 2, cement leakage, and shape D (lack of simultaneous contact of bone cement with the upper and lower plates) were included in the logistic regression model. CONCLUSIONS A nomogram for predicting postoperative NVCF in PKP was developed and validated. This model can be used for rational assessment of the magnitude of the risk of developing NVCFs after PKP, and can help orthopedic surgeons make clinical decisions aimed at reducing the occurrence of NVCFs.
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Affiliation(s)
- Aiqi Zhang
- The Second Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yichen Lin
- The Second Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, Zhejiang, China
| | - Mingxiang Kong
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | - Jiahao Chen
- The Second Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wei Gao
- The Second Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiajun Fan
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Junjie Wang
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhe Chen
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
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Xue Y, Zhang J, Zhang Z, Dai W, Ma C. Clinical outcomes with second injection after insufficient bone cement distribution in unilateral kyphoplasty for osteoporotic vertebral compressive fracture: a cohort retrospective study. J Orthop Surg Res 2023; 18:530. [PMID: 37491307 PMCID: PMC10369772 DOI: 10.1186/s13018-023-03968-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/30/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Bone cement distribution is an important factor affecting pain relief and long-term prognosis of osteoporotic vertebral compression fracture (OVCF) treated with vertebral augmentation. Unilateral percutaneous kyphoplasty (PKP) is the most common procedure, and insufficient bone cement distribution is more common than bilateral PKP. However, effective remedies are remain lack. In this study, sufficient cement distribution was achieved by adjusting the working channel followed by second cement injection as a remedy in cases with insufficient cement distribution, and the purpose was to evaluate the clinical outcomes by a retrospective cohort study. METHODS From July 1, 2017 to July 31, 2020, OVCF patients treated with unilateral PKP were included in this retrospective cohort study. According to the bone cement distribution (insufficient cement distribution was confirmed when the cement did not exceed the mid line of the vertebral body in frontal film or/and the cement did not contact the upper/lower vertebral endplates in the lateral film.) and whether second injection was performed during surgery, the patients were divided into three groups. Insufficient group: patients with insufficient cement distribution confirmed by fluoroscopy or postoperative x-ray. Second injection group: patients with insufficient cement distribution was found during the procedure, and second injection was performed to improve the cement distribution. CONTROL GROUP patients with sufficient cement distribution in one injection. The Primary outcome was cemented vertebrae re-collapse rate. The secondary outcomes included operative time, radiation exposure, cement leakage rate, VAS, ODI, and adjacent vertebral fracture rate. RESULTS There are 34 cases in insufficient group, 45 cases in second injection group, and 241 cases in control group. There was no significant difference in baseline data and follow-up time among the three groups. PRIMARY OUTCOME The injured vertebrae re-collapse rate of insufficient group was significantly higher than that of second injection group (42.22% vs 20.59%, P = 0.000) and control group (42.22% vs. 18.26%, P = 0.000). Kaplan-Meier survival analysis showed that there was no significant difference in the survival time between second injection group and control group (P = 0.741, Log-rank test), both of which were significant less than that in insufficient group (P = 0.032 and 0.000, respectively). SECONDARY OUTCOMES There was no significant difference in VAS score and ODI after operation between second injection group and control group, both of which were superior to those in insufficient group (P = 0.000). At the final follow-up, there was no significant difference in VAS and ODI among the three groups (P > 0.05). The operation time of second injection group was significantly higher than that of insufficient group (53.41 ± 8.85 vs 44.18 ± 7.41, P = 0.000) and control group (53.41 ± 8.85 vs 44.28 ± 7.22, P = 0.000). The radiation exposure of the second injection group was significantly higher than that of insufficient group (40.09 ± 8.39 vs 30.38 ± 6.87, P = 0.000) and control group (40.09 ± 8.39 vs 31.31 ± 6.49, P = 0.000). The cement leakage rate of second injection group (20.59%) was comparable with that of insufficient group (24.44%) and control group (21.26%) (P = 0.877). The length of hospital stay of the second injection group (4.38 ± 1.72) was comparable with that of insufficient group (4.18 ± 1.60) and control group (4.52 ± 1.46) (P = 0.431). CONCLUSIONS When cement distribution is insufficient during unilateral PKP, second injection may relieve early pain, reduce the incidence of cemented vertebral re-collapse and adjacent vertebral fracture, without increasing the cement leakage rate, although this procedure may increase the operation time and radiation exposure.
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Affiliation(s)
- Youdi Xue
- Department of Orthopedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, Jiangsu Province, People's Republic of China
| | - Jianwei Zhang
- Department of Orthopedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, Jiangsu Province, People's Republic of China
| | - Zhaochuan Zhang
- Department of Orthopedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, Jiangsu Province, People's Republic of China
| | - Weixiang Dai
- Department of Orthopedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, Jiangsu Province, People's Republic of China
| | - Chao Ma
- Department of Orthopedics, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, 199 Jiefang South Road, Xuzhou, 221009, Jiangsu Province, People's Republic of China.
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Qian Y, Li Y, Shen G, Zhong X, Tang C, He S. Comparison of unipedicular and bipedicular kyphoplasty for treating acute osteoporotic vertebral compression fractures in the lower lumbar spine: a retrospective study. BMC Musculoskelet Disord 2023; 24:410. [PMID: 37221523 PMCID: PMC10204226 DOI: 10.1186/s12891-023-06545-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/18/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Unipedicular and bipedicular approaches for percutaneous kyphoplasty are reportedly both effective in treating osteoporotic vertebral compression fractures (OVCFs). However, most studies have reported thoracolumbar fractures, with few reports describing the treatment of the lower lumbar spine. Here, we compared the clinical and radiological results of unipedicular and bipedicular approaches for percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures. METHODS We retrospectively reviewed the records of 160 patients who underwent percutaneous kyphoplasty for lower lumbar (L3-L5) osteoporotic vertebral compression fractures between January 2016 and January 2020. Patient characteristics, surgical outcomes, operation time, blood loss, clinical and radiological features, and complications were compared between two groups. Cement leakage, height restoration, and cement distribution were calculated from the radiographs. Visual pain analog scale (VAS) and Oswestry Disability Index (ODI) were calculated before surgery, immediately post-surgery, and 2 years after surgery. RESULTS The mean age, sex, body mass index, injury time, segmental distribution, and morphological classification of fractures before surgery did not differ significantly between the groups. The results showed significant improvements in the VAS score, ODI score, and vertebral height restoration in each group (p < 0.05), with no significant differences between the two groups (p > 0.05). The mean operation time and extent of blood loss were lower in the unipedicular group than those in the bipedicular group (p < 0.05). Different types of bone cement leakage were observed in both groups. Leakage rate was higher in the bipedicular group than in the unipedicular group. Patients in the bipedicular group showed greater improvement in bone cement distribution than those in the unipedicular group (p < 0.05). CONCLUSIONS The clinical and radiological results of unipedicular percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures in the lower lumbar region were similar to those of bipedicular percutaneous kyphoplasty. However, the unipedicular approach resulted in shorter surgical time, less blood loss, and less bone cement leakage. Thus, the unipedicular approach may be preferable owing to its several advantages.
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Affiliation(s)
- Yunfan Qian
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Yimin Li
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Guangjie Shen
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Xiqiang Zhong
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Chengxuan Tang
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Shaoqi He
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China.
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Wang H, Gu H, Zheng B, Zhao Y, Yuan H, Yu H, Xiang L. Efficacy and Safety of a 3D-printed Guide Device During Percutaneous Kyphoplasty for the Treatment of Osteoporotic Vertebral Compression Fractures. Pain Physician 2023; 26:E143-E153. [PMID: 37192237] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND During percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs), repeated fluoroscopic images to adjust the puncture needle and inject the polymethylmethacrylate (PMMA) are critical steps. A method to further reduce the radiation dose would be of great value. OBJECTIVES To assess the efficacy and safety of a 3D-printed guide device (3D-GD) for PKP in the treatment of OVCFs and compare the clinical efficacy and imaging outcomes of traditional bilateral PKP, bilateral PKP with 3D-GD and unilateral PKP with 3D-GD. STUDY DESIGN Retrospective study. SETTING General Hospital of Northern Theater Command of Chinese PLA. METHODS From September 2018 through March 2021, 113 patients diagnosed with monosegmental OVCFs underwent PKP. The patients were divided into 3 groups: traditional bilateral PKP (B-PKP group, 54 patients), bilateral PKP with 3D-GD (B-PKP-3D group, 28 patients) and unilateral PKP with 3D-GD (U-PKP-3D group, 31 patients). Their epidemiologic data, surgical indices, and recovery outcomes were collected during the follow-up period. RESULTS The operation time was significantly shorter in the B-PKP-3D group (52.5 ± 13.7 minutes) than in the B-PKP group (58.5 ± 9.5 minutes) (P = 0.044, t = 2.082). The operation time was significantly shorter in the U-PKP-3D group (43.6 ± 6.7 minutes) than in the B-PKP-3D group (52.5 ± 13.7 minutes) (P = 0.004, t = 3.109). The number of intraoperative fluoroscopy applications was significantly lower in the B-PKP-3D group (36.8 ± 6.1) than in the B-PKP group (44.8 ± 7.9) (P = 0.000, t = 4.621). The number of intraoperative fluoroscopy times was significantly lower in the U-PKP-3D group (23.2 ± 4.5) than in the B-PKP-3D group (36.8 ± 6.1) (P = 0.000, t = 9.778). The volume of injected PMMA was significantly lower in the U-PKP-3D group (3.7 ± 0.8 mL) than in the B-PKP-3D group (6.7 ± 1.7 mL) (P = 0.000, t = 8.766). The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were significantly decreased one day after surgery in each group. However, there were no differences in postoperative VAS and ODI scores, anterior height or local kyphotic angle of the fractured vertebrae, PMMA leakage, or refracture of the vertebral body. LIMITATIONS Relatively small sample size and short-term follow-up period. CONCLUSION This new innovative 3D technique makes PKP safe and effective. The bilateral PKP with 3D-GD technique, even unilateral PKP with 3D-GD, has the advantages of accurate positioning, a short operation time, and reduced intraoperative fluoroscopy times to the patient and surgeon.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, China
| | - Hongwen Gu
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, China
| | - Bin Zheng
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, China
| | - Yuanhang Zhao
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, China
| | - Hong Yuan
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, China
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, China
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning, China
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Ge C, Chen Z, Cao P. Efficacy of percutaneous kyphoplasty on vertebral compression fractures with different bone mineral densities: a retrospective study. BMC Musculoskelet Disord 2023; 24:276. [PMID: 37038169 PMCID: PMC10088266 DOI: 10.1186/s12891-023-06341-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/20/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND This study was performed to investigate the clinical efficacy of percutaneous kyphoplasty (PKP) for vertebral compression fractures with different bone mineral densities (BMD). METHODS We performed a retrospective analysis of 232 patients with single-segment vertebral compression fractures who underwent PKP. Patients were divided into the normal BMD, osteopenia, and osteoporosis groups according to their average lumbar BMD before surgery. The visual analog scale (VAS) was used to compare differences in pain relief before and after surgery in each group. Corrections of the wedge angle and kyphotic angle before and after surgery were observed using anteroposterior and lateral radiographs and compared among the groups, as was the incidence of bone cement leakage. RESULTS Patients were followed up for 6-12 months, with an average follow-up time of 9.12 ± 1.68 months. The VAS score, wedge angle, and kyphotic angle of the three groups of patients decreased significantly at the end of the follow-up (P < 0.05). The changes in VAS score and wedge angle correction in the osteoporosis group were significantly larger than those in the normal BMD and osteopenia groups (P < 0.05). There were no significant differences among the three groups in terms of kyphotic angle correction or bone cement leakage rates (P > 0.05). CONCLUSIONS PKP has a positive effect on vertebral compression fractures with different BMD, and is especially suitable for osteoporotic vertebral compression fractures.
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Affiliation(s)
- Chen Ge
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 999, Xiwang road, Jiading district, Shanghai, 201801, China.
| | - Zhe Chen
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 999, Xiwang road, Jiading district, Shanghai, 201801, China
| | - Peng Cao
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 999, Xiwang road, Jiading district, Shanghai, 201801, China
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Shi X, Li P, Li J, Bao C, Xiang J, Lu Y. Comparative evaluation of an innovative deflectable percutaneous kyphoplasty versus conventional bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: a prospective, randomized and controlled trial. Spine J 2023; 23:585-598. [PMID: 36563860 DOI: 10.1016/j.spinee.2022.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND CONTEXT Osteoporotic vertebral compression fractures (OVCFs) can be treated with percutaneous kyphoplasty (PKP). In contrast to conventional PKP, the novel deflectable percutaneous kyphoplasty (DPKP), is a unilateral transpedicular approach procedure allowing a similar bilateral puncture effect, which owes to the deflectable curved bone expander creating a transcentral line cavity to achieve uniform distribution of cement and biomechanical balance while reducing operative time and radiation exposure. PURPOSE The purpose of this study was to prospectively compare and evaluate an innovative surgical procedure, DPKP, versus conventional bilateral percutaneous kyphoplasty (BPKP). STUDY DESIGN This is a prospective randomized controlled trial (RCT). SAMPLE The totality of the participants (n=90) suffering from OVCFs between May 2019 and October 2020, were randomized by SAS 9.3 to generate a block randomization sequence, which was utilized to randomize the groups in a 1:1 ratio, assigned to the DPKP group (n=45) and the BPKP group (n=45) to undergo accordingly procedures. OUTCOME MEASURES The primary outcome was the total operative time. The secondary outcomes included: comparative assessment of visual analog scale (VAS) scores, Oswestry disability index (ODI), kyphosis angle (KA), anterior border height (AH) of the injured vertebra, frequency of intraoperative X-ray fluoroscopy, the injection volume, distribution pattern and leakage rate of bone cement. METHODS All subjects underwent assessment by at least one senior orthopedist and radiologist for the VAS scores, ODI, KA, AH of the injured vertebra, total operative time, the injection volume, distribution pattern, leakage rate of bone cement at preoperative and 24 hours, 6 months, and 1 year postoperatively. Inclusion criteria for subjects in this prospective study were as follows: (1) 60 < age < 80 years old; (2) preoperative spinal X-ray, CT, and MRI confirmed as single-segment, fresh thoracolumbar OVCFs (T5-L5, 15% < collapse < 80%); MRI shows low signal on T1-WI and high signal on T2-WI, especially with STIR high signal characterized by vertebral edema; (3) painful OVCFs refractory to medical treatment, 2 weeks < Symptom duration < 3 months;(4) With significant physical signs of local tenderness; (5) T score of bone mineral density (BMD) < -2.5. RESULTS The total operative time was significantly reduced in the DPKP group (43.3±19.58 minutes, 95% CI: 37.23-49.37) compared to the BPKP group (55.16±11.56 minutes, 95% CI: 51.78-58.54) (p<.001). Compared to the BPKP group (frequency of intraoperative X-ray fluoroscopy: 43.42±8.64, 95% CI: 40.90-45.95; the volume of bone cement injected: 5.56±0.85 mL, 95% CI: 5.31-5.81), the frequency of intraoperative X-ray fluoroscopy (30.05±17.41, 95% CI: 24.66-35.45) and volume of bone cement injected (5.08±0.97 mL, 95% CI: 4.78-5.38) significantly reduced in the DPKP group compared to the (p<.001). In addition, compared to the preoperative period, both groups showed significant improvements in the postoperative VAS scores, ODI, KA, and AH (p<.001), but there was no statistical difference between the DPKP and BPKP groups (p>.05) at any time-point. Interestingly, although without statistical differences, a tendency towards a lower rate of bone cement leakage was observed in the DPKP group. CONCLUSION Our study results indicate that the innovative DPKP is as safe and effective as BPKP in relieving pain, improving the patient's quality of life, and reconstructing vertebral body height. Particularly, DPKP did reduce operative time and radiation exposure compared to BPKP, which correlated with unilateral and bilateral exposure procedures. Moreover, the final cement distribution was less predictable in DPKP, and further studies are warranted to clarify the advantages of DPKP versus conventional unilateral percutaneous kyphoplasty (UPKP) and BPKP.
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Affiliation(s)
- Xin Shi
- Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany.
| | - Panpan Li
- Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany.
| | - Jubao Li
- Department of Orthopedics, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming 650000, Yunnan, China
| | - Chaoyu Bao
- Department of Orthopedics, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming 650000, Yunnan, China
| | - Junyi Xiang
- Department of Orthopedics, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming 650000, Yunnan, China.
| | - Yu Lu
- Department of Orthopedics, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming 650000, Yunnan, China.
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Xiang QQ, Chu B, Lu MQ, Shi L, Gao S, Wang YT, Fang LJ, Ding YH, Zhao X, Chen Y, Wang MZ, Hu WK, Wang LF, Sun K, Bao L. Risk-benefit ratio of percutaneous kyphoplasty and percutaneous vertebroplasty in patients with newly diagnosed multiple myeloma with vertebral fracture: a single-center retrospective study. Ann Hematol 2023; 102:1513-1522. [PMID: 36997718 PMCID: PMC10182123 DOI: 10.1007/s00277-023-05202-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/25/2023] [Indexed: 04/01/2023]
Abstract
The indications for percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) are painful vertebral compression fractures. Our study is to assess the risk-benefit ratio of PKP/PVP surgery in the patients with newly diagnosed multiple myeloma (NDMM) without receiving antimyeloma therapy. The clinical data of 426 consecutive patients with NDMM admitted to our center from February 2012 to April 2022 were retrospectively analyzed. The baseline data, postoperative pain relief, the proportion of recurrent vertebral fractures, and survival time were compared between the PKP/PVP surgical group and the nonsurgical group in the NDMM patients. Of the 426 patients with NDMM, 206 patients had vertebral fractures (206/426, 48.4%). Of these, 32 (32/206, 15.5%) underwent PKP/PVP surgery for misdiagnosis of simple osteoporosis prior to diagnosis of MM (surgical group), and the other 174 (174/206, 84.5%) did not undergo surgical treatment prior to definitive diagnosis of MM (non-surgical group). The median age of patients in the surgical and nonsurgical groups was 66 and 62 years, respectively (p = 0.01). The proportion of patients with advanced ISS and RISS stages was higher in the surgical group (ISS stage II + III 96.9% vs. 71.8%, p = 0.03; RISS stage III 96.9% vs. 71%, p = 0.01). Postoperatively, 10 patients (31.3%) never experienced pain relief and 20 patients (62.5%) experienced short-term pain relief with a median duration of relief of 2.6 months (0.2-24.1 months). Postoperative fractures of vertebrae other than the surgical site occurred in 24 patients (75%) in the surgical group, with a median time of 4.4 months postoperatively (0.4-86.8 months). Vertebral fractures other than the fracture site at the first visit occurred in 5 patients (2.9%) in the nonoperative group at the time of diagnosis of MM, with a median time of 11.9 months after the first visit (3.5-12.6 months). The incidence of secondary fractures was significantly higher in the surgical group than in the nonsurgical group (75% vs. 2.9%, p = 0.001). The time interval between the first visit and definitive diagnosis of MM was longer in the surgical group than in the nonsurgical group (6.1 months vs. 1.6 months, p = 0.01). At a median follow-up of 32 months (0.3-123 months), median overall survival (OS) was significantly shorter in the surgical group than in the nonsurgical group (48.2 months vs. 66 months, p = 0.04). Application of PKP/PVP surgery for pain relief in NDMM patients without antimyeloma therapy has a limited effect and a high risk of new vertebral fractures after surgery. Therefore, patients with NDMM may need to have their disease controlled with antimyeloma therapy prior to any consideration for PKP/PVP surgery.
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Affiliation(s)
- Qiu-Qing Xiang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Bin Chu
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Min-Qiu Lu
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Lei Shi
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Shan Gao
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Yu-Tong Wang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Li-Juan Fang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Yue-Hua Ding
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Xin Zhao
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Yuan Chen
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Meng-Zhen Wang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Wei-Kai Hu
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Li-Fang Wang
- Department of Epidemiology and Statistics, Beijing Jishuitan Hospital, Beijing, China
| | - Kai Sun
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Li Bao
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China.
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Li Y, Qian Y, Shen G, Tang C, Zhong X, He S. Percutaneous mesh-container-plasty versus percutaneous kyphoplasty for the treatment of Kümmell's disease: a retrospective cohort study. J Orthop Surg Res 2023; 18:260. [PMID: 36998039 PMCID: PMC10061694 DOI: 10.1186/s13018-023-03753-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Both percutaneous kyphoplasty (PKP) and percutaneous mesh-container-plasty (PMCP) were important procedures for the treatment of Kümmell's disease. This study aimed to compare the clinical and radiological results of PKP and PMCP for the treatment of Kümmell's disease. METHODS This study included patients with Kümmell's disease treated at our center between January 2016 and December 2019. A total of 256 patients were divided into two groups according to the surgical treatment they received. Clinical, radiological, epidemiological, and surgical data were compared between the two groups. Cement leakage, height restoration, deformity correction, and distribution were evaluated. The visual analog scale (VAS), Oswestry Disability Index (ODI), and short-form 36 health survey domains "role-physical" (SF-36 rp) and "bodily pain" (SF-36 bp) were calculated preoperatively, immediately after surgery, and 1-year postoperatively. RESULTS The VAS and ODI scores improved in the PKP [preoperative: 6 (6-7), 68.75 ± 6.64; postoperative: 2 (2-3), 23.25 ± 3.50, respectively] (p < 0.05) and the PMCP [preoperative: 6 (5-7), 67.70 ± 6.50; postoperative: 2 (2-2), 22.24 ± 3.55, respectively] groups (p < 0.05). There were significant differences between the two groups. The mean cost in the PKP group was lower than that in the PMCP group (3697 ± 461 vs. 5255 ± 262 USD, p < 0.05). The cement distribution in the PMCP group was significantly higher than that in the PKP group (41.81 ± 8.82% vs. 33.65 ± 9.24%, p < 0.001). Cement leakage was lower in the PMCP group (23/134) than in the PKP group (35/122) (p < 0.05). The anterior vertebral body height ratio (AVBHr) and Cobb's angle improved in the PKP (preoperative: 70.85 ± 16.62% and 17.29 ± 9.78°; postoperative: 80.28 ± 13.02% and 13.05 ± 8.40°, respectively) and PMCP (preoperative: 70.96 ± 18.01% and 17.01 ± 10.53°; postoperative: 84.81 ± 12.96% and 10.76 ± 9.23°, respectively) groups (p < 0.05). There were significant differences in vertebral body height recovery and segmental kyphosis improvement between the two groups. CONCLUSIONS PMCP had advantages over PKP in terms of pain relief and functional recovery for the treatment of Kümmell's disease. Moreover, PMCP is more effective than PKP in preventing cement leakage, increasing cement distribution, and improving vertebral height and segmental kyphosis, despite its higher cost.
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Affiliation(s)
- Yimin Li
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Yunfan Qian
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Guangjie Shen
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Chengxuan Tang
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Xiqiang Zhong
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Shaoqi He
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China.
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Deng Z, Feng T, Wu X, Xie H, Song D, Wang J, Yang H, Niu J. Thoracolumbar fascia injury in osteoporotic vertebral fracture: the important concomitant damage. BMC Musculoskelet Disord 2023; 24:166. [PMID: 36879207 PMCID: PMC9987111 DOI: 10.1186/s12891-023-06280-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Thoracolumbar fascia injury (FI) is rarely discussed in osteoporotic vertebral fracture (OVF) patients in previous literature and it is usually neglected and treated as an unmeaning phenomenon. We aimed to evaluate the characteristics of the thoracolumbar fascia injury and further discuss its clinical significance in the treatment of kyphoplasty for osteoporotic vertebral fracture (OVF) patients. METHODS Based on the presence or absence of FI, 223 OVF patients were divided into two groups. The demographics of patients with and without FI were compared. The visual analogue scale and Oswestry disability index scores were compared preoperatively and after PKP treatment between these groups. RESULTS Thoracolumbar fascia injuries were observed in 27.8% of patients. Most FI showed a multi-level distribution pattern which involved a mean of 3.3 levels. Location of fractures, severity of fractures and severity of trauma were significantly different between patients with and without FI. In further comparison, severity of trauma was significantly different between patients with severe and non-severe FI. In patients with FI, VAS and ODI scores of 3 days and 1 month after PKP treatment were significantly worse compared to those without FI. It showed the same trend in VAS and ODI scores in patients with severe FI when compared to those patients with non-severe FI. CONCLUSIONS FI is not rare in OVF patients and presents multiple levels of involvement. The more serious trauma suffered, the more severe thoracolumbar fascia injury presented. The presence of FI which was related to residual acute back pain significantly affected the effectiveness of PKP in treating OVFs. TRIAL REGISTRATION retrospectively registered.
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Affiliation(s)
- Zicheng Deng
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Tao Feng
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Xiexing Wu
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Haifeng Xie
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Dawei Song
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Jinning Wang
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China
| | - Huilin Yang
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China.
| | - Junjie Niu
- The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China.
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Lin M, Wen X, Huang Z, Huang W, Zhang H, Huang X, Yang C, Wang F, Gao J, Zhang M, Yu X. A nomogram for predicting residual low back pain after percutaneous kyphoplasty in osteoporotic vertebral compression fractures. Osteoporos Int 2023; 34:749-762. [PMID: 36738335 DOI: 10.1007/s00198-023-06681-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Abstract
UNLABELLED To establish a risk prediction model for residual low back pain after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures. We used retrospective data for model construction and evaluated the model using internal validation and temporal external validation and finally concluded that the model had good predictive performance. INTRODUCTION The cause of residual low back pain in patients with osteoporotic vertebral compression fractures (OVCFs) after PKP remains highly controversial, and our goal was to investigate the most likely cause and to develop a novel nomogram for the prediction of residual low back pain and to evaluate the predictive performance of the model. METHODS The clinical data of 281 patients with OVCFs who underwent PKP at our hospital from July 2019 to July 2020 were reviewed. The optimal logistic regression model was determined by lasso regression for multivariate analysis, thus constructing a nomogram. Bootstrap was used to perfomance the internal validation; receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to assess the predictive performance and clinical utility of the model, respectively. Temporal external validation of the model was also performed using retrospective data from 126 patients who underwent PKP at our hospital from January 2021 to October 2021. RESULTS Lasso regression cross-validation showed that the variables with non-zero coefficients were the number of surgical vertebrae, preoperative bone mineral density (pre-BMD), smoking history, thoracolumbar fascia injury (TLFI), intraoperative facet joint injury (FJI), and postoperative incomplete cementing of the fracture line (ICFL). The above factors were included in the multivariate analysis and showed that the pre-BMD, smoking history, TLFI, FJI, and ICFL were independent risk factors for residual low back pain (P < 0.05). The ROC and calibration curve of the original model and temporal external validation indicated a good predictive power of the model. The DCA curve suggested that the model has good clinical practicability. CONCLUSION The risk prediction model has good predictive performance and clinical practicability, which can provide a certain basis for clinical decision-making in patients with OVCFs.
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Affiliation(s)
- Miaoman Lin
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China
- Department of Orthopaedics, West China Xiamen Hospital of Sichuan University, No.699, West Jinyuan Road, Xingbin Street, Xiamen, Fujian Province, 361022, China
| | - Xuemei Wen
- Xinhua Clinical College, Dalian University, Dalian, 116622, China
| | - Zongwei Huang
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
- Department of Emergency, Beijing University of Chinese Medicine Shenzhen Hospital, Shenzhen, 518116, China
| | - Wei Huang
- Department of Orthopaedics, Dongguan Tungwah Hospital, Dongguan, 523000, China
| | - Hao Zhang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China
| | - Xingxing Huang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China
| | - Cunheng Yang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China
| | - Fuming Wang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China
| | - Junxiao Gao
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China
| | - Meng Zhang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China
| | - Xiaobing Yu
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China.
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Ma Y, Lu Q, Yuan F, Chen H. Comparison of the effectiveness of different machine learning algorithms in predicting new fractures after PKP for osteoporotic vertebral compression fractures. J Orthop Surg Res 2023; 18:62. [PMID: 36683045 PMCID: PMC9869614 DOI: 10.1186/s13018-023-03551-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The use of machine learning has the potential to estimate the probability of a second classification event more accurately than traditional statistical methods, and few previous studies on predicting new fractures after osteoporotic vertebral compression fractures (OVCFs) have focussed on this point. The aim of this study was to explore whether several different machine learning models could produce better predictions than logistic regression models and to select an optimal model. METHODS A retrospective analysis of 529 patients who underwent percutaneous kyphoplasty (PKP) for OVCFs at our institution between June 2017 and June 2020 was performed. The patient data were used to create machine learning (including decision trees (DT), random forests (RF), support vector machines (SVM), gradient boosting machines (GBM), neural networks (NNET), and regularized discriminant analysis (RDA)) and logistic regression models (LR) to estimate the probability of new fractures occurring after surgery. The dataset was divided into a training set (75%) and a test set (25%), and machine learning models were built in the training set after ten cross-validations, after which each model was evaluated in the test set, and model performance was assessed by comparing the area under the curve (AUC) of each model. RESULTS Among the six machine learning algorithms, except that the AUC of DT [0.775 (95% CI 0.728-0.822)] was lower than that of LR [0.831 (95% CI 0.783-0.878)], RA [0.953 (95% CI 0.927-0.980)], GBM [0.941 (95% CI 0.911-0.971)], SVM [0.869 (95% CI 0.827-0.910), NNET [0.869 (95% CI 0.826-0.912)], and RDA [0.890 (95% CI 0.851-0.929)] were all better than LR. CONCLUSIONS For prediction of the probability of new fracture after PKP, machine learning algorithms outperformed logistic regression, with random forest having the strongest predictive power.
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Affiliation(s)
- Yiming Ma
- Department of Orthopaedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
- Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221004 Jiangsu China
| | - Qi Lu
- Department of Orthopaedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
- Xuzhou Medical University, 209 Tongshan Road, Xuzhou, 221004 Jiangsu China
| | - Feng Yuan
- Department of Orthopaedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
| | - Hongliang Chen
- Department of Orthopaedic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 Huaihai Road, Xuzhou, 221006 Jiangsu China
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Zhou X, Liu Y, Cao X, Jin G, Li H. Comparison of a directional cement delivery device versus conventional device in unilateral percutaneous kyphoplasty for the therapy of osteoporotic thoracolumbar fracture in the elderly. J Orthop Surg Res 2023; 18:32. [PMID: 36631874 PMCID: PMC9832637 DOI: 10.1186/s13018-023-03506-0] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Percutaneous kyphoplasty (PKP) has been demonstrated to be effective in the treatment of osteoporotic vertebral compression fractures (OVCF). However, bilateral puncture techniques take more time to accept more X-ray radiation; some spinal surgeons apply unilateral puncture PKP, but the cement cannot be symmetrically distributed in the vertebral body, so we apply a directional bone cement delivery device that undergoes PKP through the unilateral pedicle puncture. This research aims to compare the clinical and radiological results of PKP via unilateral pedicle approach using a traditional bone cement delivery device and a directional bone cement delivery device and determine the value of a directional delivery device for the therapy of thoracolumbar compression fracture in the elderly. METHODS We undertook a retrospective analysis of patients with single-level OVCF treated with unilateral pedicle puncture PKP from Jan 2018 to Jan 2020. Operation time, radiation exposure, bone cement injection volume, and the incidence of bone cement leakage were recorded for presentation, and the cement leakage and bone cement distribution were measured by X-ray and computed tomography scan. The patients were followed up postoperatively and were assessed mainly with regard to clinical and radiological outcomes. RESULTS There was no significant difference in the operation time, radiation exposure time, and incidence of bone cement leakage between the two groups. A significant difference was observed in the volume of bone cement injection between the two groups. All patients in both groups had significantly less pain after the procedures, compared with their preoperative period pain. There were no significant differences in Visual Analogue Scale, the relative height of the vertebral body, Cobb angle, and Quality of Life Questionnaire of the European Foundation for Osteoporosis between the two groups at 1 week after PKP, significant difference was observed only 12 months after operation. CONCLUSION Application of directional bone cement delivery device is safe and feasible, compared with the application of traditional bone cement delivery device, without prolonging the operative time, radiation exposure time, and the incidence of bone cement leakage. It has the advantages of good short- and medium-term effect, excellent bone cement distribution, and low incidence of kyphosis recurrence.
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Affiliation(s)
- Xiaoji Zhou
- grid.186775.a0000 0000 9490 772XDepartment of Orthopedics, The 904Th Hospital of PLA, Wuxi Clinical College of Anhui Medical University, 101 Xing Yuan Rd, Wuxi, 214044 China
| | - Yongtao Liu
- grid.413389.40000 0004 1758 1622Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province China
| | - Xiaojian Cao
- grid.412676.00000 0004 1799 0784Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province China
| | - Genyang Jin
- grid.186775.a0000 0000 9490 772XDepartment of Orthopedics, The 904Th Hospital of PLA, Wuxi Clinical College of Anhui Medical University, 101 Xing Yuan Rd, Wuxi, 214044 China
| | - Hong Li
- grid.186775.a0000 0000 9490 772XDepartment of Orthopedics, The 904Th Hospital of PLA, Wuxi Clinical College of Anhui Medical University, 101 Xing Yuan Rd, Wuxi, 214044 China
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Schmiady MO, Possner M, Horisberger T, Ouda A. Intracardiac bone cement embolism resulting in ventricular perforation: an unusual cause of sudden chest pain. Interdiscip Cardiovasc Thorac Surg 2023; 36:6976701. [PMID: 36802249 PMCID: PMC9931077 DOI: 10.1093/icvts/ivac292] [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] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/13/2022] [Indexed: 01/10/2023]
Abstract
Leakage of bone cement is a known complication after percutaneous kyphoplasty. In rare cases, bone cement can reach the venous system and cause life-threatening embolism. We present the case of a 73-year-old male, who was admitted to our hospital with new-onset chest pain and dyspnoea. He had a history of percutaneous kyphoplasty. Multimodal imaging showed intracardiac cement embolism in the right ventricle with penetration of the interventricular septum and perforation of the apex. The bone cement was successfully removed during open cardiac surgery.
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Affiliation(s)
- Martin O Schmiady
- Corresponding author. Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland. Tel: +41-44-255-95-82; fax: +41-44-255-44-67; e-mail: (M.O. Schmiady)
| | - Mathias Possner
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Thomas Horisberger
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Ahmed Ouda
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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Wang W, Liu Y, Wan H, Zeng L, Peng Z, Yang D, Tian K. Effectiveness and prognostic factors of different minimally invasive surgeries for vertebral compression fractures. BMC Musculoskelet Disord 2023; 24:11. [PMID: 36609293 DOI: 10.1186/s12891-022-06125-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The aging of China's population has led to an increase in the incidence rate of osteoporosis, which indirectly increases the risk of OVCF in osteoporosis patients. Low back pain is the main symptom of OVCF, and severe patients can further develop kyphosis. Although the conservative treatment of OVCF can effectively control the patient's condition, long-term bed rest will increase the risk of OVCF complications. Minimally invasive surgery is a common solution for OVCF. METHODS 100 OVCF patients admitted to our hospital from January 2021 to January 2022 are selected for analysis and randomly divided into PVP group and PKP group, 50 cases in each group. The PVP group and the PKP group undergo PVP and PKP operations respectively. The differences in efficacy indicators and adverse reactions are compared, and the multivariate Logistic regression method is used to analyze the influencing factors of postoperative secondary fractures in patients with vertebral compression fractures. RESULTS Compared with the PVP group, the total effective rate of PKP group is significantly increased, and the VAS, ODI score, kyphotic Cobb Angle, lateral distribution rate of bone cement and bone cement leakage rate are significantly decreased (P < 0.05). Age ≥ 80 years old, female, glucocorticoid use, lateral distribution of bone cement and bone cement leakage are significantly higher in the proportion of secondary fractures and are independent risk factors for postoperative secondary fractures in patients with OVCF. CONCLUSION PKP surgery has a higher efficacy in the treatment of OVCF patients, which can reduce the incidence of pain, adverse reactions and promote the recovery of kyphotic Cobb Angle. PKP surgery has a higher value in the treatment of OVCF. In addition, the influencing factors of secondary fracture after minimally invasive surgery in OVCF patients include age, gender, glucocorticoid use, bone cement distribution pattern, bone cement leakage, etc.
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Lin F, Zhang Y, Song X, Niu Y, Su P, Hua J, Sun Y. Percutaneous Kyphoplasty to Relieve the Rib Region Pain in Osteoporotic Thoracic Vertebral Fracture Patients Without Local Pain of Fractured Vertebra. Pain Physician 2023; 26:53-59. [PMID: 36791294] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Osteoporotic vertebral compression fractures (OVCF) are common. A few patients with thoracic vertebral fracture show pain in the bilateral rib region but not at the fracture site. The point of specific tenderness in the rib region cannot be located. It is not clear whether percutaneous kyphoplasty (PKP) can relieve the pain in the bilateral rib region in these patients. OBJECTIVE To check whether PKP can alleviate the rib region pain in thoracic vertebral fracture patients without local pain at the fractured vertebra. STUDY DESIGN Retrospective study. SETTING The study was carried out at a university hospital. METHODS We performed a retrospective analysis of thoracic vertebral fracture patients admitted to our hospital for PKP surgery between January 2018 and June 2022. The main clinical manifestations of these patients were pain in the bilateral rib region but no local tenderness and percussion pain at the fractured vertebra. CT and MRI examinations of the thoracic vertebrae were performed after admission. PKP was performed under general anesthesia after no surgical contraindication. Visual analog scale (VAS) scores and heights of the anterior, middle, and posterior edges of the fractured vertebra before the surgery, one day after surgery, and one month after surgery were compared. Also, the Cobb angles formed by the upper and lower endplate of the fractured vertebra before the surgery, one day after surgery, and one month after surgery were compared. RESULTS A total of 50 patients were included in this study (3 men and 47 women, with an average age of 72.46 ± 8.15 years), of which 7 patients had 2 segmental fractures, so a total of 57 vertebrae were included. The VAS scores on day one and one month after the surgery were significantly lower than that before the surgery. The heights of the anterior, middle, and posterior edges of the fractured vertebra on day one after the surgery were significantly higher than those before the surgery. The Cobb angle of the fractured vertebra on day one after the surgery was lower than that before the surgery. The vertebrae of 23 patients were examined using x-ray one month after the surgery. The heights of the anterior, middle, and posterior edges of the fractured vertebra one month after the surgery were also significantly higher than those before the surgery but significantly lower than those one day after the surgery. Also, the Cobb angle of the fractured vertebra one month after the surgery was significantly lower than that before the surgery. LIMITATIONS This was a retrospective study, which may be prone to selection and recall bias. Single-center non-controlled studies may also introduce bias. CONCLUSION The exact location of the pain in the rib region caused by thoracic fracture cannot be identified usually. PKP can alleviate the rib region pain caused by the thoracic fracture.
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Affiliation(s)
- Fanguo Lin
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuye Zhang
- Department of Nursing, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaomei Song
- Department of Nursing, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yanping Niu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Peng Su
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Hua
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongming Sun
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Nogami R, Matsuoka H, Ohashi S, Narikiyo M, Nagasaki H, Tsuboi Y. Spinal subarachnoid hemorrhage after percutaneous kyphoplasty: a case report and literature review. J Spine Surg 2022; 8:491-496. [PMID: 36605992 PMCID: PMC9808104 DOI: 10.21037/jss-22-60] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/18/2022] [Indexed: 11/20/2022]
Abstract
Background Spinal intradural (subdural and subarachnoid) hematoma following percutaneous kyphoplasty is an extremely rare complication. In this report, we describe a case of subarachnoid hemorrhage with delayed paralysis after kyphoplasty and review the literature on similar cases to describe the complications of kyphoplasty and vertebroplasty (VP). Case Description An 80-year-old man underwent percutaneous kyphoplasty at a local hospital an osteoporotic vertebral fracture (OVF) at the T12 and L1 level. On the second day after kyphoplasty for T12 OVF, he developed paralysis of the lower limbs. At his initial visit to our clinic, he had a complete loss of sensation below T11 and complete paralysis of both lower extremities. Thoracolumbar magnetic resonance imaging revealed an intradural hematoma on the ventral side of the spinal cord, in the spinal canal from T5 to T12, compressing the spinal cord. Thoracolumbar computed tomography showed a fracture line in the medial cortex of the right pedicle at T12 and a tract from the spinal canal to the vertebral body. An emergency posterior decompression from T11 to L1 was performed. A small hole was found on the right side of the pedicle at T12, and tear of the nerve and subarachnoid hematoma were observed in the vicinity of the T11 nerve root. The subarachnoid hematomas were removed. Postoperatively, the neurological symptoms improved rapidly. Eventually, he was able to walk and was transferred for rehabilitation. Conclusions Percutaneous surgery through the pedicle might cause hematoma and bone cement leakage into the spinal canal. This can be a serious complication: hence prevention is important.
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Affiliation(s)
- Ryo Nogami
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Hidenori Matsuoka
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - So Ohashi
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | | | - Hirokazu Nagasaki
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Yoshifumi Tsuboi
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kawasaki, Japan
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Deng L, Lv N, Hu X, Guan Y, Hua X, Pan Z, Zhou Q, Wang C, Li B, Qian Z. Comparison of Efficacy of Percutaneous Vertebroplasty versus Percutaneous Kyphoplasty in the Treatment of Osteoporotic Vertebral Asymmetric Compression Fracture. World Neurosurg 2022; 167:e1225-e1230. [PMID: 36089275 DOI: 10.1016/j.wneu.2022.09.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND This study aims to compare the clinical efficacy of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral asymmetric compression fracture (OVACF). METHODS This study retrospectively reviewed the patients who were diagnosed with OVACF between September 2015 and July 2019. Forty-one patients received PVP surgery (group A), and 44 patients received PKP surgery (group B). The visual analog scale, Oswestry Disability Index, scoliosis angle (SA), height of long side, height of short side (HS), and lateral height difference (LHD) before operation and 3 days and 1 year after operation were compared between both groups. The operation time, fluoroscopic time, hospital stay, cement volume, and complications were also compared between both groups. RESULTS The visual analog scale and Oswestry Disability Index differed significantly between the groups 1 year after operation (P < 0.05). Compared with the preoperative results, there were significant differences in SA, height of long side, HS, and LHD 3 days and 1 year after operation (P < 0.05). Compared with group A, group B showed significantly better in SA, HS, and LHD in group B 3 days and 1 year after operation (P < 0.05). More patients in group A suffered cement leakage and scoliosis than group B after operation (P < 0.05). CONCLUSIONS In our study, PVP and PKP are both effective in the treatment of OVACF, but PKP surgery had better long-term clinical efficacy.
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Affiliation(s)
- Lei Deng
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Nanning Lv
- Department of Orthopedic Surgery, the Second People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Xiayu Hu
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Yuehong Guan
- Department of Orthopedic Surgery, Changsu No. 2 People's Hospital, Suzhou, Jiangsu, China
| | - Xi Hua
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Zejun Pan
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Quan Zhou
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Chengyue Wang
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China
| | - Baoxin Li
- Department of Orthopedic Surgery, Affiliated Hospital of Qinghai University, Qinghai University, Xining, Qinghai, China
| | - Zhonglai Qian
- Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University, Soochow University, Suzhou, Jiangsu, China.
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Wang T, Si F, Zang L, Fan N, Yuan S, Du P, Wu Q, Wang A, Lu X. Radiographic adjacent segment degeneration and risk factors for osteoporotic vertebral compression fractures treated with percutaneous kyphoplasty. Int Orthop 2022; 46:2619-2628. [PMID: 35864260 DOI: 10.1007/s00264-022-05510-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE In this study, we aimed to clarify whether osteoporotic vertebral compression fracture (OVCF) following percutaneous kyphoplasty (PKP) was associated with a high risk for radiographic adjacent segment degeneration (ASD) and to identify the risk factors for radiographic ASD in these individuals. METHODS We retrospectively reviewed consecutive patients with OVCFs who underwent PKP at our institution between November 2015 and January 2021. The incidence of radiographic ASD was calculated and specific subgroups of ASD were identified. Univariate and multivariate analyses of demographic, clinical baseline, and radiologic data were performed to identify risk factors associated with radiographic ASD. RESULTS With a mean follow-up time of 27.3 months, a total of 95 eligible patients were enrolled. The incidence of radiographic ASD distinguished from natural degeneration was 52.6%. Patients with OVCFs who underwent PKP had a high risk of developing radiographic ASD, particularly disc degeneration. Intradiscal cement leakage (odds ratio [OR], 5.706; 95% confidence interval [CI], 2.039-15.970; P = 0.001) and preoperative disc height (OR, 0.681; 95% CI, 0.518-0.895; P = 0.006) were identified as independent risk factors. CONCLUSION Patients with OVCFs who underwent PKP were more likely to develop radiographic ASD, and their progression was distinguished from natural degeneration. Disc degeneration was the most common type of degeneration. Intradiscal cement leakage and preoperative disc height were identified as independent risk factors for developing radiographic ASD in these patients. Further validation through prospective multicenter studies is required.
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Affiliation(s)
- Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Fangda Si
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Qichao Wu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Xuanyu Lu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
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Zhuang M, Cai B, Wang F. Effectiveness and safety of percutaneous kyphoplasty combined with zoledronic acid in treatment of osteoporotic vertebral compression fractures: a meta-analysis. Arch Orthop Trauma Surg 2022; 142:2435-43. [PMID: 33713186 DOI: 10.1007/s00402-021-03858-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION To investigate the clinical effectiveness of combination treatment of percutaneous kyphoplasty (PKP) and zoledronic acid (ZOL) in the treatment of osteoporotic vertebral compression fracture (OVCF). MATERIALS AND METHODS We searched studies investigating the PKP combined with ZOL in the treatment of OVCF. We used a fixed-effects or random-effects model to analyze the bone mineral density (BMD), visual analogue scale (VAS), Oswestry disability index (ODI), bone markers (N-MID, β-CTX, and P1NP) and adverse events, expressed as weight mean difference (WMD) and risk ratio (RR) with 95% confidence interval (95% CI). RESULTS We identified 5 cohort studies with a total of 440 patients. Compared with PKP alone, the combination treatment of PKP and ZOL significantly reduced the VAS score at 6 months (WMD = - 0.78, 95% CI - 1.42, - 0.14; P = 0.018), and 12 months (WMD = - 0.98, 95% CI - 1.46, - 0.51; P < 0.001). Moreover, the combination treatment also improved the BMD at 6 (WMD = 0.06, 95% CI 0.01, 0.11, P = 0.016) and 12 months (WMD = 0.20, 95% CI 0.03, 0.36, P = 0.018) after treatment. The ODI score in the combination group was significantly lower than in PKP group at 6, 12 and 24 months after treatment (at 6 months: WMD = - 9.25, 95% CI - 13.62, - 4.87 P < 0.001; at 12 months: WMD = - 9.21, 95% CI - 11.91, - 6.50, P < 0.001; at 24 months: WMD = - 7.26, 95% CI - 11.39, - 3.14, P = 0.001). The N-MID and P1NP values were found to be significantly lower in the combination group than the PKP group, but the β-CTX value was similar between the two groups. There was no significant difference in incidence of adverse events between the two groups, but more adjacent vertebral fractures and bone cement leakage occurred in PKP alone group. CONCLUSION In patients with OVCF, combination treatment of PKP and ZOL showed more effective than PKP alone in improving BMD and bone marker levels, relieving pain, as well as reducing the risk of new fractures. More large-scale RCTs are needed to verify our findings.
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Zhu D, Hu J, Wang L, Zhu J, Ma S, Liu B. A Comparison Between Modified Unilateral Extrapedicular and Bilateral Transpedicular Percutaneous Kyphoplasty in the Treatment of Lumbar Osteoporotic Vertebral Compression Fracture. World Neurosurg 2022; 166:e99-e108. [PMID: 35779757 DOI: 10.1016/j.wneu.2022.06.115] [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: 04/23/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few researchers have verified the clinical efficacy and safety of the modified unilateral extrapedicular approach (mUEP) applied to the percutaneous kyphoplasty (PKP) in comparative studies with other puncture techniques. Compared with the bilateral transpedicular approach (BTP), whether mUEP PKP is a preferred treatment for lumbar osteoporotic vertebral compression fracture (OVCF) remains unclear. METHODS Patients treated by PKP for single-level lumbar OVCF in our institution from September 2019 to December 2020 were retrospectively enrolled. Patients were grouped according to the puncture techniques. Clinical and radiologic outcomes were evaluated preoperatively, postoperatively, and at follow-up. The clinical evaluation was performed by using visual analog scale for pain relief and Oswestry Disability Index for health status. Radiologic measurements contained anterior vertebral height, kyphotic angle, and bone cement distribution. RESULTS In total, 76 patients with a mean follow-up duration of 16.6 months were enrolled, including 34 patients in the mUEP PK group and 42 patients in the BTP PKP group. In the mUEP group, operation time, fluoroscopy times, and injected cement volume were significantly less than that in the BTP group (P < 0.01). Both visual analog scale and Oswestry Disability Index scores of all patients decreased significantly after surgery (P < 0.01), with no significant differences between the 2 groups at each follow-up. Both mUEP PKP and BTP PKP showed significant anterior height restoration and kyphotic angle correction (P < 0.01), with no significant differences between the 2 groups at each follow-up. Meanwhile, the mUEP PKP reduced the incidence of intraspinal cement leakage (P < 0.05), and no facet joint violation was found in mUEP PKP. CONCLUSIONS mUEP PKP could be clinically and radiographically equivalent to BTP PKP. However, it has advantages in reducing operation time and fluoroscopy times, lowering the risk of intraspinal cement leakage, and preventing the presence of facet joint violation. Compared with BTP PKP, the mUEP PKP seems to be an effective and alternative puncture technique for the treatment of lumbar OVCF after appropriate patient selection.
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Affiliation(s)
- Di Zhu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junnan Hu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lei Wang
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jichao Zhu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Song Ma
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baoge Liu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Lv N, Feng X, Liu H, Jia X, Han S, Liu M. Study on the influence of balloon dilation mode on the intravertebral cleft of osteoporotic fracture. BMC Surg 2022; 22:351. [PMID: 36180849 PMCID: PMC9524084 DOI: 10.1186/s12893-022-01750-5] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intravertebral cleft is common in osteoporotic vertebral compression fracture, and the bone sclerosis around the fissure brings difficulties to the surgical treatment. It is not known whether the balloon dilatation mode of percutaneous kyphoplasty affects the distribution of bone cement in the fracture vertebral body and further affects the surgical effect. The purpose of this study was to discuss the effect of balloon dilatation mode on percutaneous kyphoplasty in the treatment of osteoporotic vertebral fractures with intravertebral cleft. METHODS According to the inclusion criteria and exclusion criteria, a retrospective analysis of patients with osteoporotic vertebral fracture combined with intravertebral cleft treated by percutaneous kyphoplasty in our hospital was conducted. All patients were divided into two groups based on way of balloon dilation. The mode of balloon dilatation, imaging changes of vertebral body, VAS score, ODI score, bone cement distribution and postoperative complications were analyzed. RESULTS A total of 96 patients with osteoporotic vertebral fracture combined with intravertebral cleft were included in the study, including 51 patients treated with single balloon bilateral alternating dilatation technique and 45 patients treated with double balloon bilateral dilatation technique. The vertebral height, Cobb's angle of kyphosis, VAS score and ODI score were significantly improved in both groups after operation (P < 0.05). The postoperative vertebral height and Cobb's angle of kyphosis in the double balloon bilateral dilatation group were better than those in single balloon bilateral alternating dilatation group (P < 0.05). The distribution of bone cement in the single balloon bilateral alternating dilatation group was more inclined to insert filling, while the double balloon bilateral dilatation group was more inclined to fissure filling. The VAS score and ODI score at the final follow-up in the single balloon bilateral alternating dilatation group were lower than those in the double balloon bilateral dilatation group (P < 0.05). CONCLUSION Double balloon bilateral dilatation technique can better restore the injured vertebral height in patients with osteoporotic vertebral fracture combined with intravertebral cleft. However, the distribution of injured vertebral cement in patients with single balloon bilateral alternating dilatation technique is more likely to be inserted and filled, and the long-term analgesia and lumbar function of patients are better.
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Affiliation(s)
- Nanning Lv
- Department of Orthopedic Surgery, Bengbu Medical College Lianyungang Clinical College, The Second People's Hospital of Lianyungang, 41 Hailian East Street, Lianyungang, 222003, Jiangsu, China
| | - Xiaoxiao Feng
- Department of Orthopedic Surgery, Bengbu Medical College, Bengbu, Anhui, China
| | - Haojun Liu
- Department of Orthopedic Surgery, Bengbu Medical College, Bengbu, Anhui, China
| | - Xuejun Jia
- Department of Orthopedic Surgery, Bengbu Medical College Lianyungang Clinical College, The Second People's Hospital of Lianyungang, 41 Hailian East Street, Lianyungang, 222003, Jiangsu, China
| | - Shanqin Han
- Science and Technology Department, Lianyungang Second People's Hospital Affiliated to Bengbu Medical College, The Second People's Hospital of Lianyungang, 41 Hailian East Street, Lianyungang, 222003, Jiangsu, China.
| | - Mingming Liu
- Department of Orthopedic Surgery, Bengbu Medical College Lianyungang Clinical College, The Second People's Hospital of Lianyungang, 41 Hailian East Street, Lianyungang, 222003, Jiangsu, China.
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Liu K, Tan G, Sun W, Lu Q, Tang J, Yu D. Percutaneous kyphoplasty combined with zoledronic acid for the treatment of primary osteoporotic vertebral compression fracture: a prospective, multicenter study. Arch Orthop Trauma Surg 2022. [PMID: 35933563 DOI: 10.1007/s00402-022-04557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/16/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION To explore the therapeutic efficacy of percutaneous kyphoplasty (PKP) combined with zoledronic acid (ZOL) in postmenopausal women and adult men with osteoporotic vertebral compression fracture (OVCF). MATERIALS AND METHODS A total of 238 patients with OVCF were randomly assigned to the control or ZOL group: 119 patients were treated with only PKP (control group), and 119 were treated with ZOL infusion after PKP (ZOL group). Clinical, radiological and laboratory indices were evaluated at follow-up. RESULTS The visual analog scale (VAS) score and Oswestry Disability Index (ODI) were significantly higher in both groups post-treatment than at baseline (all p < 0.01). The bone mineral density (BMD) of the proximal femoral neck and height of the injured vertebra were significantly increased after treatment compared with before treatment, and the Cobb angle of the injured vertebra was significantly decreased in both groups (all p < 0.01). However, the bone metabolism indices (type I procollagen amino-terminal peptide (PINP), beta type I collagen carboxy-terminal peptide (β-CTX), and osteocalcin in the N-terminal molecular fragment (NMID)) were significantly lower post-treatment than at baseline in only the ZOL group (all p < 0.01). The VAS score, ODI, BMD, PINP level, β-CTX level, NMID level, vertebral height and Cobb angle of the injured vertebra were significantly higher in the ZOL group than in the control group (all p < 0.01). There were no significant differences in the postoperative bone cement leakage rate between the two groups. At follow-up, new OVCFs were experienced by 16 patients in the control group and 2 patients in the ZOL group (p < 0.01). CONCLUSION The therapeutic efficacy of PKP combined with ZOL for primary OVCF is clinically beneficial and warrants further study.
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Zhao C, Liu X, Wang Y, Guo J, Han S, Zhang H, Chen M, Zhou C, Ma X. The effects of biomechanical factors on adjacent vertebral compression fractures after percutaneous kyphoplasty: a propensity score matching analysis. Osteoporos Int 2022; 33:1795-1806. [PMID: 35585277 DOI: 10.1007/s00198-022-06428-5] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/06/2022] [Indexed: 10/18/2022]
Abstract
UNLABELLED Adjacent vertebral compression fracture (AVCF) is the primary factor affecting satisfaction after PKP surgery. In addition to osteoporosis, certain structural characteristics of the vertebral body itself also increase their risk. The purpose of this study was to explore the impact of biomechanical changes on AVCF after balancing other factors. INTRODUCTION As a routine treatment of OVCF, the postoperative refracture of PKP is a serious problem. The aim of our study was to explore the impact of lumbar biomechanical changes on the risk of AVCF. A propensity score matching was performed to balance the interference of osteoporosis, which is the primary risk factor of AVCF. METHODS A retrospective, single-center case-control study was performed. From September 2013 to March 2020, 1752 patients were enrolled, and AVCF was assessed in 80 of these patients. A propensity score matching (PSM) analysis was performed, and 5 potential confounding factors were matched (age, BMI, number of fractured vertebral bodies, fracture region, and HDL). The preoperative and postoperative radiological factors were measured in the matched cohort of 48 pairs. A conditional logistic regression analysis to adjust the comparative risks. RESULTS The preoperative wedge angle and its postoperative recovery of the AVCF group were significantly higher than that of the non-AVCF group. The local kyphosis of the fractured vertebral body between the two groups was similar, but the recovery in the AVCF group was slightly higher than that in the non-AVCF group. The preoperative and postoperative relative anterior height (RAH) of the fractured vertebral body was familiar in two groups, so was the recovery of RAH. The preoperative spino-sacral angle (SSA) was significantly higher in the AVCF group than in the non-AVCF group. The preoperative wedge angle was identified as the only significant risk factor for AVCF in the multivariate analysis. CONCLUSION In conclusion, a larger preoperative fracture vertebral wedge angle is a risk factor for AVCF. For such high-risk patients, surgeons should be cautious about surgical decisions. The postoperative active measures and tailored surveillance should be attached to great importance as well.
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Affiliation(s)
- Chong Zhao
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Xiaojie Liu
- Department of Orthopedics Surgery, Weihai Branch of 970 Hospital of the PLA Joint Logistic Support Force, Weihai, Shandong, China
| | - Yan Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Jianwei Guo
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Shuo Han
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Hao Zhang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Mingrui Chen
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China
| | - Chuanli Zhou
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China.
| | - Xuexiao Ma
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, No.59 Haier Road, Qingdao, 266000, Shandong, China.
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Bian F, Bian G, Zhao L, Huang S, Fang J, An Y. Risk factors for recollapse of new vertebral compression fractures after percutaneous kyphoplasty in geriatric patients: establishment of a nomogram. BMC Musculoskelet Disord 2022; 23:458. [PMID: 35568857 PMCID: PMC9107663 DOI: 10.1186/s12891-022-05409-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 10/14/2021] [Accepted: 05/03/2022] [Indexed: 01/25/2023] Open
Abstract
Background The main objective of this study was to investigate the risk factors for recollapse of new vertebral compression fractures (NVCFs) after percutaneous kyphoplasty (PKP) treatment for osteoporotic vertebral compression fracture (OVCF) and to construct a new nomogram model. Methods We retrospectively analysed single-level OVCFs from January 2017 to June 2020, randomizing patients to a training set and a testing set. In the training set, independent risk factors for NVCFs in OVCF patients treated with PKP were obtained by univariate and multivariate regression analyses. These risk factors were then used as the basis for constructing a nomogram model. Finally, internal validation of the built model was performed in the testing set using the consistency index (C-index), receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA). Results In total, 371 patients were included in this study. NVCFs occurred in 21.7% of the training set patients, and multivariate regression analysis showed that a low Hounsfield unit (HU) value, cement leakage, and thoracolumbar (TL) junction fracture were independent risk factors for NVCF after PKP. The C-index was 0.81 (95% CI: 0.74–0.81), and the validation showed that the predicted values of the established model were in good agreement with the actual values. Conclusions In this study, three independent risk factors were obtained by regression analysis. A nomogram model was constructed to guide clinical work and to make clinical decisions relatively accurately to prevent the occurrence of vertebral recollapse fractures.
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Affiliation(s)
- FuCheng Bian
- Department of Endoscopic Diagnosis, Daqing Oilfield General Hospital, Heilongjiang, 163000, Daqing, China.,Department of Orthopaedic, Chengde Medical University Affiliated Hospital, Chengde, 067000, Hebei, China
| | - GuangYu Bian
- Department of Obstetrics, Daqing Oilfield General Hospital, Daqing, 163000, Heilongjiang, China
| | - Li Zhao
- Department of Cardiac Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, 510000, Guangdong, China
| | - Shuo Huang
- Department of Marketing and Tourism, Northeast Petroleum University, Daqing, 163000, Heilongjiang, China
| | - JinHui Fang
- Department of Endoscopic Diagnosis, Daqing Oilfield General Hospital, Heilongjiang, 163000, Daqing, China.
| | - YongSheng An
- Department of Orthopaedic, Chengde Medical University Affiliated Hospital, Chengde, 067000, Hebei, China.
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Lv NN, Hou MZ, Zhou ZZ, Feng XX, Liu HJ, Shan FR, Li EH, Guan BY, He SJ, Liu MM. Does the Relationship Between Bone Cement and the Intravertebral Cleft of Kummell Disease Affect the Efficacy of PKP? World Neurosurg 2022; 160:e430-e435. [PMID: 35051635 DOI: 10.1016/j.wneu.2022.01.050] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To study the relationship between distribution of bone cement and intravertebral cleft of patients with Kummell disease on the clinical effect of percutaneous kyphoplasty (PKP). METHODS According to the relationship between the distribution of bone cement and the cleft in the vertebrae, a total of 92 patients with Kummell disease who underwent PKP in our hospital were divided into 2 groups. Specifically, the bone cement of patients in group A was localized in the cleft of the vertebrae and did not infiltrate around the cleft, while that of group B patients not only filled the cleft of the vertebrae, but also distributed diffusely around the cleft of the vertebrae. The amount of bone cement injected, leakage rate, visual analogue scale (VAS) score, Oswestry Disability Index (ODI), and vertebral imaging changes before operation, and 2 days and 1 year after operation were compared between the 2 groups. RESULTS The amount of bone cement injected and the permeability of bone cement in group B were higher than those in group A (P < 0.05). The scores of VAS and ODI in both groups were significantly improved after operation, but the two scores in group B were better than those in group A one year after operation. The height of anterior vertebral body and Cobb's angle of kyphosis in the 2 groups were significantly improved after operation, but 1 year after operation, those in group B were better than those in group A. CONCLUSIONS PKP was an effective method for treating Kummell disease. At the same time, the relationship between the distribution of bone cement and the cleft in the vertebral body was an important factor affecting the curative effect after PKP. The effect of the distribution pattern of bone cement filled with intravertebral cleft and diffusely distributed around the fissures was better than that of bone cement confined in the vertebral cleft.
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Affiliation(s)
- Nan-Ning Lv
- Department of Orthopedic Surgery, Lianyungang Second People's Hospital Affiliated to Bengbu Medical College, The Second People's Hospital of Lianyungang, Lianyungang, Jiangsu, China; Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ming-Zhuang Hou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhang-Zhe Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiao-Xiao Feng
- Department of Orthopedic Surgery, Lianyungang Second People's Hospital Affiliated to Bengbu Medical College, The Second People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Hao-Jun Liu
- Department of Orthopedic Surgery, Lianyungang Second People's Hospital Affiliated to Bengbu Medical College, The Second People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Fa-Rong Shan
- Department of Orthopedic Surgery, Xining First Medical Group, Xining, Qinghai, China
| | - Er-Hu Li
- Department of Orthopedic Surgery, Xining First Medical Group, Xining, Qinghai, China
| | - Bing-Yu Guan
- Department of Orthopedic Surgery, Xining First Medical Group, Xining, Qinghai, China
| | - Shuang-Jun He
- Department of Orthopedic Surgery, Affiliated Danyang Hospital of Nantong University, The People's Hospital of Danyang, Danyang, Jiangsu, China
| | - Ming-Ming Liu
- Department of Orthopedic Surgery, Xining First Medical Group, Xining, Qinghai, China.
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Li Q, Long X, Wang Y, Fang X, Guo D, Lv J, Hu X, Cai L. Development and validation of a nomogram for predicting the probability of new vertebral compression fractures after vertebral augmentation of osteoporotic vertebral compression fractures. BMC Musculoskelet Disord 2021; 22:957. [PMID: 34784910 DOI: 10.1186/s12891-021-04845-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/05/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION New vertebral compression fractures (NVCFs) are adverse events after vertebral augmentation of osteoporotic vertebral compression fractures (OVCFs). Predicting the risk of vertebral compression fractures (VCFs) accurately after surgery is still a significant challenge for spinal surgeons. The aim of our study was to identify risk factors of NCVFs after vertebral augmentation of OVCFs and develop a nomogram. METHODS We retrospectively reviewed the medical records of patients with OVCFs who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). Patients were divided into the NVCFs group and control group, base on the patients with or without NVCFs within 2 years follow-up period after surgery. A training cohort of 403 patients diagnosed in our hospital from June 2014 to December 2016 was used for model development. The independent predictive factors of postoperative VCFs were determined by least absolute shrinkage and selection operator (LASSO) logistic regression, univariate analysis and multivariate logistic regression analysis. We provided a nomogram for predicting the risk of NVCFs based on independent predictive factors and used the receiver operating characteristic curve (ROC), calibration curve, and decision curve analyses (DCA) to evaluated the prognostic performance. After internal validation, the nomogram was further evaluated in a validation cohort of 159 patients included between January 2017 and June 2018. RESULTS Of the 403 patients in the training cohort, 49(12.16%) were NVCFs at an average of 16.7 (1 to 23) months within the 2 years follow-up period. Of the 159 patients in the validation cohort, 17(10.69%) were NVCFs at an average of 8.7 (1 to 15) months within the 2 years follow-up period. In the training cohort, the proportions of elderly patients older than 80 years were 32.65 and 13.56% in the NVCFs and control group, respectively (p = 0.003). The percentages of patients with previous fracture history were 26.53 and 12.71% in the NVCFs and control group, respectively (p = 0.010). The volume of bone cement were 4.43 ± 0.88 mL and 4.02 ± 1.13 mL in the NVCFs and Control group, respectively (p = 0.014). The differences have statistical significance in the bone cement leakage, bone cement dispersion, contact with endplate, anti-osteoporotic treatment, post-op Cobb angle and Cobb angle restoration characteristics between the two groups. The model was established by multivariate logistic regression analysis to obtain independent predictors. In the training and validation cohort, the AUC of the nomogram were 0.882 (95% confidence interval (CI), 0.824-0.940) and 0.869 (95% CI: 0.811-0.927), respectively. The C index of the nomogram was 0.886 in the training cohort and 0.893 in the validation cohort, demonstrating good discrimination. In the training and validation cohort, the optimal calibration curves demonstrated the coincidence between prediction and actual status, and the decision curve analysis demonstrated that the full model had the highest clinical net benefit across the entire range of threshold probabilities. CONCLUSION A nomogram for predicting NVCFs after vertebral augmentation was established and validated. For patients evaluated by this model with predictive high risk of developing postoperative VCFs, postoperative management strategies such as enhance osteoporosis-related health education and management should be considered.
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Ma JH, Li M, Zhang XQ, Yao X. Modified percutaneous kyphoplasty with better cement diffusion and improved biomechanics. Asian J Surg 2021; 44:1546-8. [PMID: 34627689 DOI: 10.1016/j.asjsur.2021.08.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/04/2021] [Indexed: 12/25/2022] Open
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Jin M, Ge M, Lei L, Li F, Wu M, Zhang G, Pei S, Zheng B. Clinical and Radiologic Outcomes of Robot-Assisted Kyphoplasty versus Fluoroscopy-Assisted Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: A Retrospective Comparative Study. World Neurosurg 2021; 158:e1-e9. [PMID: 34637939 DOI: 10.1016/j.wneu.2021.10.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 08/13/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Making surgery as less aggressive as possible is best for elderly patients with osteoporotic vertebral compression fractures (OVCFs). Recently, we attempted a more precise, minimally invasive, and robot-assisted kyphoplasty in our clinical setting. OBJECTIVE We sought to compare the clinical and radiologic outcomes of robot-assisted percutaneous kyphoplasty (rPKP) with those of fluoroscopy-assisted percutaneous kyphoplasty (fPKP) in treating OVCFs. METHODS We retrospectively reviewed the clinical and radiologic data of patients with single-segment OVCF who received either rPKP or fPKP between January 2020 and December 2020 at our institution. The operation time, injected volume of cement, length of hospital stays, visual analog scale for back pain, Oswestry Disability Index, local kyphosis angle (LKA), height of fractured vertebra (HFV), and perioperative complications were compared between the 2 groups. RESULTS A total of 212 cases were included in this study, among whom 81 cases received rPKP and 131 cases received fPKP. Both techniques exhibited satisfying improvement in pain relief and radiologic outcomes. Specifically, the rPKP costed less operation time and achieved better correction and maintenance regarding LKA, HFV, and instant pain relief (P < 0.05). The length of hospital stays, incidence of cement leakage, visual analog scale for back pain, and Oswestry Disability Index at final follow-up were comparable between 2 groups. CONCLUSIONS rPKP provides a precise puncture and exhibits superiority in the correction and maintenance of LKA and HFV when compared with traditional fPKP. The cost-effectiveness and specific application scenarios of this technique shall be confirmed via further extensive studies.
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Affiliation(s)
- Mengran Jin
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Meng Ge
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Longyue Lei
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Fengqing Li
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Mujun Wu
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Guang Zhang
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Shaolong Pei
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China
| | - Biao Zheng
- Department of Orthopaedics, Yuhang Bang·Er Hospital, Hangzhou, Zhejiang Province, China.
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Chen Y, Yin P, Hai Y, Su Q, Yang J. Is Osteoporotic Thoracolumbar Burst Fracture a Contraindication to Percutaneous Kyphoplasty? A Systematic Review. Pain Physician 2021; 24:E685-E692. [PMID: 34554685] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
BACKGROUND The management of pain after osteoporotic thoracolumbar burst fracture has not reached a treatment consensus. Percutaneous kyphoplasty has been shown to be efficient in reducing acute pain after burst fracture, although the topic remains highly controversial in this field. OBJECTIVE This study aimed to conduct a systematic review of the current literature to evaluate the effectiveness and safety of percutaneous kyphoplasty on the treatment of osteoporotic thoracolumbar burst fracture. STUDY DESIGN A systematic review. SETTING University hospital. METHODS A comprehensive literature search was performed through PubMed, EMBASE, Web of Science, and Cochrane library without time restriction. Among the studies meeting the eligible criteria, any study in which percutaneous kyphoplasty was utilized alone in the treatment of osteoporotic thoracolumbar burst fracture was included in the current review. For radiographic outcome evaluation, vertebral height and kyphotic angle were analyzed. VAS (Visual Analog Scale) and ODI (Oswestry Disability Index) were utilized for clinical outcome evaluation. Complications such as cement leakage and adjacent vertebral fracture or relapse were also analyzed. RESULTS In total, 289 patients (338 vertebral bodies) were included in the 8 studies. Clinical outcomes indicated that patients achieved pain relief (VAS) from 6.8 preoperatively to 1.1 postoperatively, and improvement of quality of life (ODI) ranged from 87.0 ± 6.0% to 23.9 ± 4.4%. The radiological outcome indicated that anterior vertebral height restoration ranged from 20.1 ± 2.3 to 85.3 ± 10.6, and posterior vertebral height restoration ranged from 27.3 ± 1.7 to 83.3 ± 7.4. Kyphotic angle achieved correction ranged from 21.7 ± 7.8° preoperatively to 3.17° postoperatively. The main complications after PKP were cement leakage and adjacent vertebral fracture or relapse, which had an incidence of 7.7% -45.4% and 4.3% -74.1%, respectively. LIMITATIONS Due to the good quality of the English publications, only English-language research searches were conducted, but they do not unduly affect our aggregate results impact. More prospective randomized controlled trials are needed to provide higher evidence for clinical practice. CONCLUSIONS To osteoporotic thoracolumbar burst fracture is absolutely not a contraindication to percutaneous kyphoplasty. Percutaneous kyphoplasty can obtain satisfactory effectiveness for the treatment of osteoporotic thoracolumbar burst fractures. Complications can be effectively decreased by meticulous evaluation, careful manipulation, and appropriate precautionary measures.
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Affiliation(s)
- Yuxiang Chen
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Chaoyang District, Beijing, China
| | - Peng Yin
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Chaoyang District, Beijing, China
| | - Yong Hai
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Chaoyang District, Beijing, China
| | - Qingjun Su
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Chaoyang District, Beijing, China
| | - Jincai Yang
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Chaoyang District, Beijing, China
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蒋 维, 牛 国, 周 功, 刘 涛, 张 青, 刘 路, 程 嘉. [Effectiveness of synchronous unilateral percutaneous kyphoplasty in the treatment of double noncontiguous thoracolumbar osteoporotic vertebral compression fractures]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021; 35:1155-1160. [PMID: 34523281 PMCID: PMC8444143 DOI: 10.7507/1002-1892.202103018] [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] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/12/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of synchronous unilateral percutaneous kyphoplasty (PKP) in the treatment of double noncontiguous thoracolumbar osteoporotic vertebral compression fracture (OVCF). METHODS Between December 2018 and September 2020, 27 patients with double noncontiguous thoracolumbar OVCF were treated by synchronous unilateral PKP. There were 11 males and 16 females, with an average age of 75.4 years (range, 66-92 years). The fractures were caused by falls in 22 cases and sprains in 5 cases. The time from injury to hospital admission was 0.5-7.0 days, with an average of 2.1 days. The fractured vertebrae located at T 9 in 2 cases, T 10 in 3 cases, T 11 in 10 cases, T 12 in 15 cases, L 1 in 12 cases, L 2 in 6 cases, L 3 in 4 cases, and L 4 in 2 cases. The volume of bone cement injected into each vertebral body, operation time, and intraoperative fluoroscopy times were recorded. Anteroposterior and lateral X-ray films of thoracolumbar spine were taken to observe the anterior height of the injured vertebra, the Cobb angle of kyphosis, and the diffusion and good distribution rate of bone cement in the thoracolumbar spine. Visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the pain and functional improvement. RESULTS All operations completed successfully. The operation time was 34-70 minutes, with an average of 45.4 minutes. The intraoperative fluoroscopy was 21- 60 times, with an average of 38.6 times. The volume of bone cement injected into each vertebral body was 2-9 mL, with an average of 4.3 mL. All patients were followed up 6-21 months, with an average of 11.3 months. X-ray film reexamination showed that the anterior height of the injured vertebra and Cobb angle at each time point after operation were significantly improved than those before operation ( P<0.05), and there was no significant difference between different time points after operation ( P>0.05). The distribution of bone cement was excellent in 40 vertebral bodies, good in 13 vertebral bodies, and poor in 1 vertebral body, and the excellent and good rate was 98.1% (53/54). The pain of all patients significantly relieved or disappeared, and the function improved. The VAS score and ODI at each time point after operation were significantly lower than those before operation ( P<0.05), and there was no significant difference between different time points after operation ( P>0.05). CONCLUSION For the double noncontiguous thoracolumbar OVCF, the synchronous unilateral PKP has the advantages of simple puncture, less trauma, less intraoperative fluoroscopy, shorter operation time, satisfactory distribution of bone cement, etc. It can restore the height of the vertebral body, correct the kyphotic angle, significantly alleviate the pain, and improve the function.
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Affiliation(s)
- 维利 蒋
- 蚌埠医学院第二附属医院脊柱外科(安徽蚌埠 233002)Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233002, P.R.China
| | - 国旗 牛
- 蚌埠医学院第二附属医院脊柱外科(安徽蚌埠 233002)Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233002, P.R.China
| | - 功 周
- 蚌埠医学院第二附属医院脊柱外科(安徽蚌埠 233002)Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233002, P.R.China
| | - 涛 刘
- 蚌埠医学院第二附属医院脊柱外科(安徽蚌埠 233002)Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233002, P.R.China
| | - 青波 张
- 蚌埠医学院第二附属医院脊柱外科(安徽蚌埠 233002)Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233002, P.R.China
| | - 路坦 刘
- 蚌埠医学院第二附属医院脊柱外科(安徽蚌埠 233002)Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233002, P.R.China
| | - 嘉伟 程
- 蚌埠医学院第二附属医院脊柱外科(安徽蚌埠 233002)Department of Spinal Surgery, the Second Affiliated Hospital of Bengbu Medical College, Bengbu Anhui, 233002, P.R.China
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Yuan W, Meng X, Liu X, Zhu H, Cong L, Zhu Y. [Effectiveness of robot assisted percutaneous kyphoplasty for treatment of single/double-segment osteoporotic vertebral compression fractures]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021; 35:1000-1006. [PMID: 34387429 DOI: 10.7507/1002-1892.202103151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the effectiveness of robot assisted and C-arm assisted percutaneous kyphoplasty (PKP) in the treatment of single/double-segment osteoporotic vertebral compression fracture (OVCF). Methods The clinical data of 108 cases of single/double-segment OVCF who met the selection criteria between May 2018 and October 2019 were retrospectively analyzed. There were 65 cases of single-segment fractures, of which 38 cases underwent "TiRobot" orthopedic robot-assisted PKP (robot group), 27 cases underwent C-arm X-ray machine fluoroscopy-assisted PKP (C-arm group). There were 43 cases of double-segment fractures, including 21 cases in robot group and 22 cases in C-arm group. There was no significant difference in gender, age, T value of bone mineral density, fracture segment distribution, time from injury to operation, and preoperative visual analogue scale (VAS) score, vertebral kyphosis angle (VKA), and height of fractured vertebra (HFV) in the patients with single/double-segments fractures between robot group and C-arm group ( P>0.05). The operation time, the fluoroscopy frequency of the surgeons and the patient, the fluoroscopy exposure time of the surgeons and the patient, the radiation dose of the C-arm; the VAS scores, VKA, HFV before operation, at 1 day and 6 months after operation; and the complications in the two groups were recorded and compared. Results All patients underwent surgery successfully. The operation time of the single-segment robot group was significantly longer than that of the C-arm group ( t=5.514, P=0.000), while the operation time of the double-segment robot group was not significantly different from that of the C-arm group ( t=1.892, P=0.205). The single/double-segment robot group required three-dimensional scanning, so the fluoroscopy frequency, fluoroscopy exposure time, and radiation dose of C-arm received by the patient were significantly higher than those of the C-arm group ( P<0.05); the fluoroscopy frequency and the fluoroscopy exposure time received by the surgeons were significantly less than those of the C-arm group ( P<0.05). There was no infection, embolism, neurological injury, and adjacent segmental fractures. The single/double-segment robot group showed lower rate of cement leakage when compared with the C-arm group ( P<0.05), all the cases of cement leakage happened outside the spinal canal. The VAS score, VKA, and HFV of the single/double-segment robot group and the C-arm group were significantly improved at 1 day and 6 months after operation ( P<0.05), and the VAS score at 6 months after operation was further improved compared with that at 1 day after operation ( P<0.05). At 1 day and 6 months after operation, there was no significant difference in VAS score between the single/double-segment robot group and the C-arm group ( P>0.05). The VKA and HFV of robot group were significantly better than those of the C-arm group ( P<0.05). Conclusion For single/double-segment OVCF, robot assisted PKP has more advantages in correcting VKA and HFV, reducing fluoroscopy exposure of surgeons and bone cement leakage rate; C-arm assisted PKP has more advantages in reducing the operation time of single-segment OVCF and fluoroscopy exposure of patients during operation.
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Affiliation(s)
- Wei Yuan
- Department of Orthopedics, the First Hospital of China Medical University, Shenyang Liaoning, 110001, P.R.China
| | - Xiaotong Meng
- Department of Orthopedics, the First Hospital of China Medical University, Shenyang Liaoning, 110001, P.R.China
| | - Xinchun Liu
- Department of Orthopedics, the First Hospital of China Medical University, Shenyang Liaoning, 110001, P.R.China
| | - Haitao Zhu
- Department of Orthopedics, the First Hospital of China Medical University, Shenyang Liaoning, 110001, P.R.China
| | - Lin Cong
- Department of Orthopedics, the First Hospital of China Medical University, Shenyang Liaoning, 110001, P.R.China
| | - Yue Zhu
- Department of Orthopedics, the First Hospital of China Medical University, Shenyang Liaoning, 110001, P.R.China
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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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Sun S, Xu B, Zhang Q, Zhao CS, Ma R, He J, Zhang Y. The Early Results of Vertebral Pathological Compression Fracture of Extra- nodal Lymphoma with HIV-positive Patients Treated by Percutaneous Kyphoplasty. Curr HIV Res 2021; 18:248-257. [PMID: 32386494 DOI: 10.2174/1570162x18666200510010207] [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: 01/10/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vertebral pathological compression fracture involving extra-nodal lymphoma impacts negatively on the quality of life of HIV-positive patients. The choice of a safe and effective approach to palliative care in this condition remains a challenge. OBJECTIVE The purpose of this study was to investigate the safety and efficacy of percutaneous kyphoplasty (PKP) in the treatment of vertebral pathological compression fracture of extra-nodal lymphoma in HIV-positive patients. METHODS A retrospective analysis, from January 2016 to August 2019, was performed on 7 HIVpositive patients, 3 males and 4 females, with extra-nodal lymphoma with a vertebral pathological compression fracture. The patients were treated using percutaneous kyphoplasty in our hospital. Preoperative assessment of the patients was conducted regarding their hematological profile, biochemical indicators, liver and kidney function, blood coagulation function, CD4+T lymphocyte count and viral load. Subsequently, the patients were placed on highly active antiretroviral therapy (HAART) and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP) regimen. Besides, antibiotics, nutritional support and immune-modulating drugs were also administered, rationally. Postoperatively, the height of the anterior edge of the injured vertebrae, Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) values were evaluated. Patients were also monitored for any complications related to the operation. RESULTS The average CD4+T cell count for the patients was 164 (range 114 ~247 / ul), while the viral load was 26,269 (range 5,765 ~82,321 copies/ul). All patients received nutritional and immune support and registered significant improvements in the levels of ALB and Hb (P<0.05). In all cases, the operation was uneventful with neither cement leakage nor toxic reactions observed. Similarly, no opportunistic infections, other complications or deaths were reported. The height of the anterior vertebral body and the ODI score of the injured vertebrae were significantly improved immediately after surgery (P<0.05). Compared to the preoperative VAS (7.71±1.11), postoperative values were significantly reduced immediately after surgery (3.85±0.90) and at 2 weeks, 1 month and 6 months post-surgery: 2.71±0.76, 3.29±1.11, and 4.00±0.82, respectively (P<0.01). CONCLUSION Supported with appropriate perioperative treatment measures, PKP is safe and effective in the treatment of pathological vertebral compression fracture due to extra-nodal lymphoma in HIV-positive patients.
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Affiliation(s)
- Sheng Sun
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing 100015, China
| | - Biao Xu
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing 100015, China
| | - Qiang Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing 100015, China
| | - Chang-Song Zhao
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing 100015, China
| | - Rui Ma
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing 100015, China
| | - Jie He
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing 100015, China
| | - Yao Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing 100015, China
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Wen Z, Mo X, Zhao S, Lin W, Chen Z, Huang Z, Cheung WH, Fu D, Chen B. Comparison of Percutaneous Kyphoplasty and Pedicle Screw Fixation for Treatment of Thoracolumbar Severe Osteoporotic Vertebral Compression Fracture with Kyphosis. World Neurosurg 2021; 152:e589-e596. [PMID: 34129986 DOI: 10.1016/j.wneu.2021.06.030] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pedicle screw fixation (PSF) has been considered the preferred surgery for the treatment of severe osteoporotic vertebral compression fracture (sOVCF), and sOVCF was traditionally regarded as a relative contraindication to minimally invasive percutaneous kyphoplasty (PKP). Debate has continued regarding the selection of the best surgical method for sOVCF. In the present study, we compared the efficacy and safety between PKP and PSF. METHODS PKP was performed in 376 patients in group 1 and PSF in 121 patients in group 2. The visual analog scale (VAS), Oswestry disability index (ODI), local kyphotic angle, fractured vertebral body height, and complications were evaluated. RESULTS In the immediate postoperative analysis, the mean VAS score for group 1 was 2.4, significantly lower than the VAS score of 4.7 for group 2. The mean ODI score was 44.4% for group 1, lower than the ODI score of 57.1% for group 2. In addition, group 1 had had a significantly better ODI score at 1 year of follow-up. The local kyphotic angle and fractured vertebral body height had recovered better in group 2. In group 1, 113 patients had experienced cement leakage, and 29 patients had undergone PKP for adjacent new vertebral fractures. In group 2, 2 patients had developed wound infections, 4 had developed pneumonia, 2 had developed urinary tract infection, 3 had experienced asymptomatic screw loosening, and 7 had undergone PKP to treat new vertebral fractures and 1 had undergone removal of internal fixation because of back pain. CONCLUSIONS The results of the clinical and radiological evaluations showed that PKP is comparable to PSF for the treatment of sOVCF with kyphosis, with PKP having the advantages of minimal invasion, quick postoperative pain relief, and functional recovery.
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Affiliation(s)
- Zhenxing Wen
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaoyi Mo
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shengli Zhao
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wei Lin
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhipeng Chen
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zifang Huang
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wing Hoi Cheung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Dan Fu
- Department of Orthopedics, Kiang Wu Hospital, Macau, People's Republic of China
| | - Bailing Chen
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
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Tao W, Hu Q, Nicolas YSM, Nuo X, Daoyu H, Zhen J, Jinpeng S, Jun L. Is unilateral transverse process-pedicle percutaneous kyphoplasty a better choice for osteoporotic thoracolumbar fractures in the old patients? BMC Surg 2021; 21:252. [PMID: 34020645 PMCID: PMC8139159 DOI: 10.1186/s12893-021-01246-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/11/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A few reports have shown that unilateral transverse process-pedicle percutaneous kyphoplasty is a good choice for patients with osteoporotic vertebral compression fracture (OVCF). However, this issue remains controversial and the related comprehensive research was lacked. METHODS A retrospective study was conducted on patients receiving PKP surgery for OVCF. Patients were divided into three groups according to surgical approach. Symptom and radiographical evaluation were performed preoperatively, 1-month postoperatively, 1-year postoperatively and follow-ups. And follow-ups were repeated every year. Visual Analogue Scale Score (VAS), Oswestry Disability Index (ODI) scores, anterior vertebral height, coronal Cobb angle and sagittal Cobb angle was determined and compared among three groups. RESULTS Totally 447 patients were included with an average age of 76.6 ± 7.2 years old. UTP showed significantly shorter surgical duration (p < 0.001), lower cement volume (p < 0.001) but higher cement leakage proportion (p = 0.044). No significant statistical difference was found in terms of improvement rates among three groups. Besides, it was notable that the a significantly higher coronal Cobb angle was observed in UTP group, and a about 4°coronal correction was found after UTP PKP. CONCLUSION UTTP PKP could achieve similar symptoms relief and kyphosis correction as UTP and BTP PKP. However, it had shorter surgical time and less radio exposure than BTP PKP, lower risk of cement leakage and higher proportion of bilaterally cement distribution than UTP PKP. It seemed to be a better choice for patients with OVCF. In addition, we found that UTP PKP was especially fit for OVCF patients with asymmetrical vertebral compression.
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Affiliation(s)
- Wu Tao
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China
| | - Qin Hu
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China
| | - Yap San Min Nicolas
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China
| | - Xu Nuo
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China
| | - Huang Daoyu
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China
| | - Jin Zhen
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China
| | - Sun Jinpeng
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China
| | - Liu Jun
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China.
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Tang J, Liu J, Gu Z, Song B. Outcomes of Augmentation in Osteoporotic Vertebral Compression Fractures Showing a Cleft Sign on MRI. Cardiovasc Intervent Radiol 2021; 44:428-435. [PMID: 33388869 DOI: 10.1007/s00270-020-02753-6] [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: 08/28/2020] [Accepted: 12/18/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Intravertebral clefts (IVCs) typically occur in association with osteoporotic vertebral compression fractures (OVCFs) and can be characterized based on magnetic resonance imaging (MRI). This study aimed to identify the clinical characteristics of IVCs with different MRI signals and assess their influence on outcomes of vertebral augmentation. MATERIALS AND METHODS We retrospectively recruited patients with OVCFs and associated IVCs who underwent vertebral augmentation. Patients were stratified into two groups based on whether the IVCs were full of liquid or gas, as determined by MRI signals. Patients were also stratified based on whether vertebral augmentation involved percutaneous kyphoplasty (PKP) or vertebroplasty (PVP). Pre- and postprocedural parameters were compared between groups. RESULTS A total of 194 fractured vertebrae (86 liquid-filled, 108 gas-filled) were examined. Scores for bone cement distribution were significantly higher in the gas group than in the liquid group, indicating broader cement distribution in the gas group. In both groups, intervention significantly improved pain and mobility scores. Among patients with gas-filled IVCs, the incidence of bone cement leakage and recollapse of treated vertebrae were significantly higher after PKP than after PVP. In the liquid group, incidence of bone cement leakage and recollapse of treated vertebrae did not differ significantly between patients who received PKP or PVP. CONCLUSION Vertebral augmentation is effective for treating OVCFs with gas- or liquid-filled IVCs. However, in patients with gas-filled IVCs, PKP may be associated with higher incidence of cement leakage and recollapse of treated vertebrae than PVP. Liquid-filled IVCs may not promote bone cement distribution.
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Affiliation(s)
- Jing Tang
- Department of Radiology, Sichuan University West China Hospital, Guoxue Xiang, No. 37, Chengdu, 610041, China
| | - Jin Liu
- Department of Orthopedics, Chengdu First People's Hospital, Wanxiang North Road, No.18, Chengdu, 610000, China.
| | - Zuchao Gu
- Department of Orthopedics, Chengdu First People's Hospital, Wanxiang North Road, No.18, Chengdu, 610000, China
| | - Bin Song
- Department of Radiology, Sichuan University West China Hospital, Guoxue Xiang, No. 37, Chengdu, 610041, China.
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Dai SQ, Qin RQ, Shi X, Yang HL. Percutaneous vertebroplasty versus kyphoplasty for the treatment of neurologically intact osteoporotic Kümmell's disease. BMC Surg 2021; 21:65. [PMID: 33514359 PMCID: PMC7846985 DOI: 10.1186/s12893-021-01057-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 10/09/2020] [Accepted: 01/11/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat neurologically intact osteoporotic Kümmell's disease (KD), but it is still unclear which treatment is more advantageous. Our study aimed to compare and investigate the safety and clinical efficacy of PVP and PKP in the treatment of KD. METHODS The relevant data that 64 patients of neurologically intact osteoporotic KD receiving PVP (30 patients) or PKP (34 patients) were analyzed. Surgical time, operation costs, intraoperative blood loss, volume of bone cement injection, and fluoroscopy times were compared. Occurrence of cement leakage, transient fever and re-fracture were recorded. Universal indicators of visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated separately before surgery and at 1 day, 6 months, 1 year, 2 years and the final follow-up after operation. The height of anterior edge of the affected vertebra and the Cobb's angle were assessed by imaging. RESULTS All patients were followed up for at least 24 months. The volume of bone cement injection, intraoperative blood loss, occurrence of bone cement leakage, transient fever and re-fracture between two groups showed no significant difference. The surgical time, the operation cost and fluoroscopy times of the PKP group was significantly higher than that of the PVP group. The post-operative VAS, ODI scores, the height of the anterior edge of the injured vertebrae and kyphosis deformity were significantly improved in both groups compared with the pre-operation. The improvement of vertebral height and kyphosis deformity in PKP group was significantly better than that in the PVP group at every same time point during the follow-up periods, but the VAS and ODI scores between the two groups showed no significant difference. CONCLUSION PVP and PKP can both significantly alleviate the pain of patients with KD and obtain good clinical efficacy and safety. By contrast, PKP can achieve better imaging height and kyphosis correction, while PVP has the advantages of shorter operation time, less radiation volume and operation cost.
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Affiliation(s)
- Shou-Qian Dai
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, Jiangsu, China.,Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, Jiangsu, China
| | - Rong-Qing Qin
- Department of Spinal Surgery, Gaoyou Hospital Affiliated Soochow University, 116 Fuqian St, Gaoyou, 225600, Jiangsu, China.,Department of Orthopedics, Gaoyou People's Hospital, 116 Fuqian St, Gaoyou, 225600, Jiangsu, China
| | - Xiu Shi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, Jiangsu, China
| | - Hui-Lin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi St, Suzhou, 215006, Jiangsu, China.
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