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Si X, Shan D, Huo L, Hu Y, Zou C, Wang B, Cao J, Wu W. Effect of percutaneous vertebroplasty versus percutaneous kyphoplasty on post-operative wound pain in patients with osteoporotic vertebral compression fractures. Int Wound J 2024; 21:e14745. [PMID: 38484743 PMCID: PMC10940009 DOI: 10.1111/iwj.14745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/21/2024] [Indexed: 03/18/2024] Open
Abstract
This research is intended to evaluate the efficacy of percutaneous vertebroplasty (PVP) versus percutaneous kyphoplasty (PKP) in osteoporotic vertebral compression fracture (OVCF), which is associated with post-operative pain. Eligible studies were screened by searching multiple databases and sources such as PubMed, Cochrane and EMBASE for search terms updated to October 2023, and relevant literature sources were searched. Randomized, controlled, prospective or retrospective, and cohort studies were eligible. For the analysis of the primary results, an analysis of the data was carried out, such as mean difference (MD) or odds ratio (OR), and 95% confidence interval (CI). In the present research, 1933 research was screened in 4 databases, and 30 articles were chosen to be examined under strict exclusion criteria. No statistical significance was found in the use of bone cement in the PVP group and PKP (MD, -0.60; 95% CI, -1.40, 0.21, p = 0.15); PKP was associated with a reduced risk of cement leak compared with PVP group (OR, 2.18; 95% CI, 1.38, 3.46, p = 0.0009); no statistical significance was found in the wound VAS score in PVP operation compared with that of PKP (MD, 0.16; 95% CI, -0.07, 0.40, p = 0.17); no statistical significance was found between the time of PVP operation and the time of PKP operation (MD, -2.65; 95% CI, -8.91, 3.60, p = 0.41). Compared with PVP technology, the PKP treatment of osteoporotic vertebral compression fractures reduces post-operative cement leakage, but there is no significant difference in the number of operative cement and wound VAS after operation. Nor did there appear to be a statistically significant difference in time between the two operations.
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Affiliation(s)
- Xiaojing Si
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Dongli Shan
- Department of Bone & Soft Tissue CancerChongqing University Cancer HospitalChongqingChina
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized TreatmentChongqing University Cancer HospitalChongqingChina
| | - li Huo
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Yongjun Hu
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Chuanqi Zou
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Boxin Wang
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Junxiong Cao
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
| | - Wenjie Wu
- Department of OrthopedicsPeople's Hospital of Chongqing Banan DistrictChongqingChina
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Zhou Q, Wan Y, Ma L, Dong L, Yuan W. Percutaneous Curved Vertebroplasty Decrease the Risk of Cemented Vertebra Refracture Compared with Bilateral Percutaneous Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures. Clin Interv Aging 2024; 19:289-301. [PMID: 38434576 PMCID: PMC10907131 DOI: 10.2147/cia.s438036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/21/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose The purpose of this study is to compare the refracture rate of the cemented vertebral body of percutaneous curved vertebroplasty (PCVP) and bilateral percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods Ninety-four patients with single segment thoracolumbar OVCF were randomly divided into two groups (47 patients in each) and underwent PCVP or bilateral PKP surgery, respectively. Refracture of cemented vertebral body, bone cement injection volume and cement pattern, cement leakage rate, total surgical time, intraoperative fluoroscopy time, preoperative and postoperative Cobb angles and anterior vertebral height, Oswestry disability index questionnaire (ODI) and visual analog scales (VAS) were recorded. Results The PCVP group had significantly lower refracture incidence of the cemented vertebral than the bilateral PKP group (p<0.05). There was a significant postoperative improvement in the VAS score and ODI in both group (p<0.01), and no significant difference was found between two groups. The operation time and intraoperative fluoroscopy times were significantly less in the PCVP group than in the bilateral PKP group (p<0.01). The mean kyphosis angle correction and vertebral height restoration in the PCVP group was significantly less than that in the bilateral PKP group (p<0.01). Conclusion Both PCVP and PKP were safe and effective treatments for OVCF. The PCVP had lower refracture rate of the cemented vertebral than the bilateral PKP group, and PCVP entailed less exposure to fluoroscopy and shorter operation time than bilateral PKP.
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Affiliation(s)
- Qiang Zhou
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, People’s Republic of China
| | - Yanlin Wan
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, People’s Republic of China
| | - Le Ma
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, People’s Republic of China
| | - Liang Dong
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, People’s Republic of China
| | - Weijian Yuan
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, People’s Republic of China
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Chen T, Chu G, Qu Y, Wang Y, Lin C, Hu N, Yang H, Li X, Jiang W, Liu Y. Risk factor analysis of refracture in the same cemented vertebra after percutaneous kyphoplasty for Kümmell's disease. J Neurosurg Spine 2024; 40:255-264. [PMID: 37948696 DOI: 10.3171/2023.8.spine23498] [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: 05/08/2023] [Accepted: 08/23/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the factors that affect refracture in the same cemented vertebra after percutaneous kyphoplasty (PKP) for Kümmell's disease (KD) and establish a risk prediction score. METHODS A total of 2932 patients who were treated with PKP for KD between January 2019 and December 2021 were retrospectively reviewed. After inclusion and exclusion criteria were applied, 191 patients were included in the study. According to the criteria for refracture, there were 50 patients in the refracture group and 141 patients in the no-refracture group. Twenty-five factors were analyzed. Patient demographics, medical history, imaging data, surgical data, and postoperative management were reviewed. Multivariate logistic regression modeling was used to identify the independent risk factors for refracture. Receiver operating characteristic (ROC) curve analysis was used to assess and establish a risk score system and further predict the risk of refracture. RESULTS In this study, 50 (26.2%) patients developed a refracture. Through univariate analysis, bone mineral density (BMD) (p < 0.001), compression rate (p = 0.007), classification (i.e., the stages determined by the compression ratios) (p < 0.001), bone cement volume (p < 0.001), volume fraction (p < 0.001), distribution pattern (p = 0.007), non-PMMA endplate contact (p < 0.001), and anti-osteoporosis therapy (p < 0.001) were found to be significant factors for post-cement vertebral refracture after PKP in patients with KD. Three independent risk factors were found to be significant for refracture: small volume fraction, low BMD, and no anti-osteoporosis therapy. One point was assigned for each factor. The incidence rates of refracture in patients with scores of 0, 1, 2, and 3 were 3.7%, 4.4%, 42.0%, and 100%, respectively. The area under the ROC curve for this risk prediction score was 0.888 (p < 0.001), indicating moderate accuracy. CONCLUSIONS Volume fraction, BMD, and osteoporosis therapy are the main factors influencing the refracture of the same cemented vertebra in KD. On the basis of these factors, the risk prediction score developed in this paper can be used to forecast the incidence of refracture.
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Affiliation(s)
- Tangyiheng Chen
- 1Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
- Departments of2Orthopaedic Surgery and
| | - Genglei Chu
- 1Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yimeng Qu
- 1Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yujie Wang
- 1Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cheng Lin
- 1Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Nan Hu
- 3Nephrology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Huilin Yang
- 1Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuefeng Li
- 1Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weimin Jiang
- 1Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
- Departments of2Orthopaedic Surgery and
| | - Yijie Liu
- 1Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
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He W, Zhou Q, Lv J, Shen Y, Liu H, Yang H, Yang P, Liu T. Effects of Percutaneous Kyphoplasty for the Treatment of Thoracic Osteoporotic Vertebral Compression Fractures with or without Intravertebral Cleft in Elderly Patients. Int J Gen Med 2024; 17:193-203. [PMID: 38268860 PMCID: PMC10807278 DOI: 10.2147/ijgm.s447623] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
Background Few studies have focused on percutaneous kyphoplasty (PKP) in the treatment of thoracic osteoporotic vertebral compression fractures (OVCFs) with intervertebral cleft (IVC). Hence, the objective of this retrospective study was to compare the clinical and radiographic outcomes of PKP in elderly patients with thoracic OVCFs, with or without IVC. Methods A total of 106 patients were enrolled in this study and divided into two groups: the IVC group and the NIVC group (without IVC). Radiographic measures included anterior vertebral height (AVH), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Clinical function measures included Oswestry disability index (ODI) and visual analog scale (VAS) scores. Results There were no significant differences in the preoperative basic data between the groups classified as IVC and NIVC. However, both groups showed significant improvements in AVH and TK throughout the follow-up periods compared to the preoperative measurements (P<0.05). The recovery of AVH in the IVC group was found to be inferior to that in the NIVC group at 3 years after operation (P<0.05). There were no significant differences in LL, PI, PT and SS in both groups compared with the preoperative results and no statistically significant differences between the two groups at the same follow-up time (P>0.05). The VAS and ODI scores during all follow-up periods were significantly lower than those before operation (P<0.05). At 3 years after operation, the VAS and ODI scores of the IVC group were higher than those of the NIVC group (P<0.05). Conclusion PKP is an adoptable measure to treat thoracic OVCFs with or without IVC. Our study revealed that the NIVC group was superior to the IVC group in terms of improved vertebral height and pain recovery at long-term follow-up (3 years).
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Affiliation(s)
- Wei He
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of China
| | - Quan Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of China
| | - Jiaheng Lv
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of China
| | - Yujie Shen
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of China
| | - Hao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of China
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of China
| | - Peng Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of China
| | - Tao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of China
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Zhang T, Peng Y, Li J. Comparison of clinical and radiological outcomes of vertebral body stenting versus percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis. Jt Dis Relat Surg 2024; 35:218-230. [PMID: 38108184 PMCID: PMC10746898 DOI: 10.52312/jdrs.2023.1356] [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: 08/02/2023] [Accepted: 09/05/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES The study aimed to compare the efficacy and safety of percutaneous kyphoplasty (PKP) and vertebral body stenting (VBS) in the treatment of osteoporotic vertebral compression fractures (OVCFs) and evaluate the clinical efficacy, Cobb angle correction, and cement leakage associated with both methods for OVCFs. PATIENTS AND METHODS A systematic search was conducted in PubMed, EMBASE, Cochrane Library, Medline, China National Knowledge, and Wanfang Data for clinical studies comparing VBS with PKP for OVCF up to May 2023. The meta-analysis was performed using Review Manager 5.3, with a focus on evaluating clinical and radiologic outcomes. RESULTS A total of eight eligible clinical studies were included in this meta-analysis. In terms of clinical outcomes, VBS was found to have a longer surgical time compared to PKP (standard mean difference [SMD]=1.06 min; 95% confidence interval [CI]: 0.20, 1.92; p=0.02). However, VBS demonstrated comparable blood loss to PKP (SMD =0.00 mL; 95% CI: -0.45, 0.45; p=0.99). Additionally, VBS showed slight superiority in alleviating back pain as measured by the Visual Analog Scale (VAS) (SMD=-0.38; 95% CI: -0.63, -0.12; p=0.004), as well as in improving functional disability based on the Oswestry Disability Index (ODI) (SMD= -0.28; 95% CI: -0.54, -0.03; p=0.03). Radiographically, VBS achieved better Cobb angle correction compared to PKP (SMD= -1.00; 95% CI: -1.48, -0.51; p<0.0001), while there was no significant difference in cement leakage between VBS and PKP (odds ratio=0.81; 95% CI: 0.21, 3.14; p=0.76). CONCLUSION The findings suggest that VBS has a comparable clinical outcome to PKP based on operation time, intraoperative blood loss, VAS, and ODI. Furthermore, VBS showed slightly better maintenance of Cobb angle correction, whereas VBS did not demonstrate a significant advantage over PKP in terms of cement leakage.
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Affiliation(s)
| | | | - Jun Li
- Department of Orthopaedic, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, 610031, China.
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Zhang A, Fu H, Wang J, Chen Z, Fan J. Establishing a nomogram to predict refracture after percutaneous kyphoplasty by logistic regression. Front Neuroinform 2023; 17:1304248. [PMID: 38187823 PMCID: PMC10767997 DOI: 10.3389/fninf.2023.1304248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Several studies have examined the risk factors for post-percutaneous kyphoplasty (PKP) refractures and developed many clinical prognostic models. However, no prior research exists using the Random Forest (RF) model, a favored tool for model development, to predict the occurrence of new vertebral compression fractures (NVCFs). Therefore, this study aimed to investigate the risk factors for the occurrence of post-PKP fractures, compare the predictive performance of logistic regression and RF models in forecasting post-PKP fractures, and visualize the logistic regression model. Methods We collected clinical data from 349 patients who underwent PKP treatment at our institution from January 2018 to December 2021. Lasso regression was employed to select risk factors associated with the occurrence of NVCFs. Subsequently, logistic regression and RF models were established, and their predictive capabilities were compared. Finally, a nomogram was created. Results The variables selected using Lasso regression, including bone density, cement distribution, vertebral fracture location, preoperative vertebral height, and vertebral height restoration rate, were included in both the logistic regression and RF models. The area under the curves of the logistic regression and RF models were 0.868 and 0.786, respectively, in the training set and 0.786 and 0.599, respectively, in the validation set. Furthermore, the calibration curve of the logistic regression model also outperformed that of the RF model. Conclusion The logistic regression model provided better predictive capabilities for identifying patients at risk for post-PKP vertebral fractures than the RF model.
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Affiliation(s)
- Aiqi Zhang
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hongye Fu
- The Fourth Clinical Medical College 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
| | - Jiajun Fan
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Zhang J, Zhou Q, Zhang Z, Liu G. Comparison between unilateral and bilateral percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture: A meta‑analysis and systematic review. Exp Ther Med 2023; 26:553. [PMID: 37941587 PMCID: PMC10628642 DOI: 10.3892/etm.2023.12252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/06/2023] [Indexed: 11/10/2023] Open
Abstract
The present study collected retrospective research data and compared the safety and efficacy of unilateral and bilateral percutaneous puncture kyphoplasty for the treatment of vertebral fractures caused by osteoporosis, to guide the selection of clinical surgical methods. In the present meta-analysis, PubMed, Embase and the Cochrane Library were searched from the establishment of the databases to March 2023. Studies that reported differences in the efficacy and safety between the unilateral and bilateral approaches in the treatment of osteoporotic vertebral compression fractures were included in the analysis. Duplicate published studies, unpublished studies, studies with incomplete data, animal experiments, literature reviews and systematic studies were excluded from the analysis. All data were processed using STATA 15.1 statistical software. The pooled results demonstrated that there were no significant differences between the unilateral and bilateral approaches in the visual analog scores, Oswestry disability index, height restoration rate or incidence of cement leakage. However, the post-kyphotic angle of the unilateral approach was significantly lower than that of the bilateral approach (standardized mean difference, -0.41; 95% confidence interval, -0.68 to -0.14; P=0.003). Furthermore, the pooled results demonstrated that the unilateral approach required less operative time and a lower volume of injected cement, which is safer for elderly patients who are more likely to have underlying diseases.
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Affiliation(s)
- Jinjie Zhang
- Orthopedics Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang 310000, P.R. China
| | - Qiujun Zhou
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, P.R. China
| | - Zhenxing Zhang
- Second Department of Orthopaedics, Haining People's Hospital, Haining, Zhejiang 314400, P.R. China
| | - Guoyan Liu
- Orthopedic Spine Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250000, P.R. China
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Yu W, Zhang H, Yao Z, Zhong Y, Jiang X, Cai D. Lower ratio of adjacent to injured vertebral bone quality scores can predict augmented vertebrae recompression following percutaneous kyphoplasty for osteoporotic vertebral fractures with intravertebral clefts. Pain Pract 2023; 23:892-903. [PMID: 37401521 DOI: 10.1111/papr.13266] [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: 11/21/2022] [Revised: 04/14/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Despite the favorable clinical outcome of percutaneous kyphoplasty (PKP) in symptomatic osteoporotic vertebral fractures (OVFs) patients with intravertebral clefts (IVCs), previous studies have demonstrated a high incidence of augmented vertebrae recompression (AVR). We aim to evaluate the usefulness of the adjacent and injured vertebral bone quality scores (VBQS) based on T1-weighted MRI images in AVR after PKP for OVFs with IVCs. METHODS Patients who underwent PKP for single OVFs with IVCs between January 2014 and September 2020 were reviewed and met the inclusion criteria. The follow-up period was at least 2 years. Relevant data affecting AVR were collected. Pearson and Spearman correlation coefficients were used to calculate the correlation between the injured and adjacent VBQS and BMD T-score. We determined independent risk factors and critical values using binary logistic regression analysis and receiver operating characteristic curves (ROC). RESULTS A total of 165 patients were included. Recompression group was found in 42 (25.5%) patients. The independent risk factors for AVR were lumbar BMD T-score (OR = 2.53, p = 0.003), the adjacent VBQS (OR = 0.79, p = 0.016), the injured VBQS (OR = 1.27, p = 0.048), the ratio of adjacent to injured VBQS (OR = 0.32, p < 0.001), and cement distribution pattern. Among these independent significant risk factors, the prediction accuracy of the ratio of adjacent to injured VBQS was the highest (Cutoff = 1.41, AUC = 0.753). Additionally, adjacent and injured VBQS were negatively correlated with lumbar BMD T-scores. CONCLUSION For the patients after PKP treatment for OVFs with IVCs, the ratio of adjacent to injured VBQS had the best prediction accuracy in predicting recompression and when the ratio of adjacent to injured VBQS was <1.41, the augmented vertebrae were more likely to have recompression in the future.
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Affiliation(s)
- Weibo Yu
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Haiyan Zhang
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Zhensong Yao
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuanming Zhong
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Daozhang Cai
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
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马 铭, 王 志, 叶 佳, 陈 曦. [Effectiveness of TiRobot-assisted and free-hand percutaneous kyphoplasty via pedicle of vertebra in treatment of osteoporotic vertebral compression fracture of thoracic vertebra]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:1106-1112. [PMID: 37718423 PMCID: PMC10505635 DOI: 10.7507/1002-1892.202305035] [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: 05/13/2023] [Revised: 08/05/2023] [Indexed: 09/19/2023]
Abstract
Objective To compare the effectiveness of TiRobot-assisted and C-arm X-ray fluoroscopy assisted percutaneous kyphoplasty (PKP) via pedicle of vertebra in the treatment of osteoporotic vertebral compression fracture (OVCF) of thoracic vertebrae. Methods The clinical data of 85 patients with OVCF of thoracic vertebrae who were admitted between January 2020 and March 2023 and met the selection criteria was retrospectively analyzed including 40 patients (50 vertebrae) undergoing PKP assisted by TiRobot (group A) and 45 patients (50 vertebrae) undergoing PKP assisted by C-arm X-ray fluoroscopy (group B). There was no significant difference in the comparison of baseline data such as gender, age, body mass index, bone mineral density T-value, fracture segment, trauma history, and preoperative numerical rating scale (NRS) score, Oswestry disability index (ODI), and Cobb angle of injured vertebra between the two groups ( P>0.05). The effectiveness evaluation indexes of the two groups, including the operation time, the volume of injected cement, the times of fluoroscopies, the length of hospital stay, and the occurrence of postoperative complications were collected and compared. Anteroposterior and lateral X-ray films and CT of the injured vertebra were reviewed at 1 day after operation to observe whether there was cement leakage and to evaluate the distribution of cement in the injured vertebra. Before and after operation, pain was assessed using the NRS score, dysfunction was assessed using the ODI, and vertebral height recovery was assessed by measuring the Cobb angle of the injured vertebrae by X-ray films. Results Both groups of patients successfully completed the operation, the operation time, the volume of injected cement, the times of fluoroscopies, and the length of hospital stay in group A were significantly less than those in group B ( P<0.05). The patients in two groups were followed up 4-12 months (mean, 9.6 months). Bone cement leakage occurred in 5 vertebrae in group A and 15 vertebrae in group B after operation, all of which leaked to the intervertebral space and around the vertebral body, and the patients had no obvious clinical symptoms. The difference of bone cement leakage between the two groups was significant ( P<0.05). No severe complication such as intraspinal leakage, infection, or vascular embolism was found in the two groups. At 1 day after operation, the distribution index of bone cement in group A was mostly grade Ⅴ, which was well dispersed; while in group B, it was mostly grade Ⅱ and grade Ⅴ; the difference of bone cement distribution index between the two groups was significant ( P<0.05). The NRS score, ODI, and Cobb angle of injured vertebra in both groups were significantly improved at 1 day after operation when compared with preoperative ones ( P<0.05). There was no significant difference in the difference of the above indexes between the two groups before and after operation ( P>0.05). Conclusion TiRobot-assisted unilateral PKP in the treatment of OVCF of thoracic vertebrae is safe and effective, which can reduce the X-ray transmission times during operation, shorten the operation time, reduce the volume of bone cement injection, and thus decrease incidence of bone cement leakage.
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Affiliation(s)
- 铭志 马
- 川北医学院(四川南充 637000)North Sichuan Medical College, Nanchong Sichuan, 637000, P. R. China
| | - 志聪 王
- 川北医学院(四川南充 637000)North Sichuan Medical College, Nanchong Sichuan, 637000, P. R. China
| | - 佳徽 叶
- 川北医学院(四川南充 637000)North Sichuan Medical College, Nanchong Sichuan, 637000, P. R. China
| | - 曦 陈
- 川北医学院(四川南充 637000)North Sichuan Medical College, Nanchong Sichuan, 637000, P. R. China
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Han B, Pang D, Hai Y, Yang J, Fan Z, Gao H, Yin P. Treatment of multisegmental vertebral compression, burst fractures, and sandwich vertebra with severe osteoporosis using the PKP technique: a case report and literature review. Front Neurol 2023; 14:1118891. [PMID: 37745651 PMCID: PMC10511751 DOI: 10.3389/fneur.2023.1118891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/11/2023] [Indexed: 09/26/2023] Open
Abstract
This study aimed to present a special case of treatment of a patient with multisegmental vertebral compression fracture, burst fracture, and sandwich vertebra and to review the literature on this condition. An 85 year-old female presented with severe low back pain but no radiating pain in the lower extremities. The patient was diagnosed with T12 and L5 vertebral compression fractures, fresh vertebral burst fractures in L2 and L3, and osteoporosis. The focus was on formulating a surgical treatment strategy. At the 12 month follow-up, no neurological deficits were observed, and the chosen surgical treatment approach yielded favorable clinical outcomes. A comprehensive literature review indicates that percutaneous kyphoplasty (PKP) can effectively alleviate pain and ensure safety in managing osteoporotic vertebral burst fractures. While complications remain a theoretical risk, they can be mitigated through meticulous assessment, careful surgical procedures, and appropriate preventive measures. PKP is an effective and safe treatment modality for osteoporotic vertebral burst fractures. Conservative management of sandwich vertebrae can yield positive clinical outcomes, but regular anti-osteoporosis treatment is necessary.
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Affiliation(s)
| | | | - Yong Hai
- Department of Orthopedics, Affiliated Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | | | | | | | - Peng Yin
- Department of Orthopedics, Affiliated Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
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Tang J, Liu J, Gu Z, Zhang Y, Yang H, Li Z. The temporal and spatial relationship between percutaneous vertebral augmentation and new symptomatic fractures. Diagn Interv Radiol 2023; 0:0-0. [PMID: 37554659 DOI: 10.4274/dir.2023.221424] [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] [Indexed: 08/10/2023]
Abstract
PURPOSE This study aimed to explore the relationship between the time from percutaneous vertebral augmentation (PVA) until subsequent fracture and the risk of new symptomatic fractures (NSFs) in untreated vertebrae at different distances from "augmented vertebrae". METHODS Patients who underwent PVA for the treatment of osteoporotic vertebral compression fractures at the West China Hospital of Sichuan University from May 2014 to April 2019 were retrospectively recruited. Vertebrae not treated during PVA were stratified based on their distance from the nearest augmented vertebra and the time elapsed since PVA. Survival curves were plotted to compare the risk of NSFs in untreated vertebrae at different distances from augmented vertebrae. The Cox proportional hazards model was used to identify risk factors of NSFs in untreated vertebrae. RESULTS total, 162 patients with 228 NSFs (2.760 vertebrae) were analyzed. More than half of the NSFs (56.6%) occurred within the first year after PVA. Rates and hazard ratios (HRs) of NSFs were higher in vertebrae located one segment away from the augmented vertebrae (21.0%, HR: 3.99, P < 0.001), two segments away (10.6%, HR: 1.97, P = 0.003), or three segments away (10.5%, HR: 2.26, P < 0.001) than in vertebrae located five or more segments away (3.81%, HR: 1.00). Similar results were observed regardless of whether the untreated vertebrae were located in the thoracolumbar junction. In addition to distance, other risk factors of NSFs were the thoracolumbar location of untreated vertebrae, the number of augmented vertebrae, and percutaneous vertebroplasty. CONCLUSION The risk of NSFs is greater for untreated vertebrae located closer to augmented vertebrae than for untreated vertebrae further away. This distance dependence occurs mainly within the three segments closest to the augmented vertebra. The risk of NSFs decreases with time after augmentation, and it is also related to the number of augmented vertebrae, the type of augmentation, and whether the untreated vertebrae are thoracolumbar or not.
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Affiliation(s)
- Jing Tang
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Jin Liu
- Department of Orthopaedics, Chengdu Seventh People's Hospital, Chengdu, China
| | - Zuchao Gu
- Department of Orthopaedics, Chengdu First People's Hospital, Chengdu, China
| | - Yu Zhang
- Department of Orthopaedics, Chengdu First People's Hospital, Chengdu, China
| | - Haosen Yang
- Department of Orthopaedics, Chengdu Seventh People's Hospital, Chengdu, China
| | - Zhenlin Li
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
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Yu W, Zhang H, Yao Z, Zhong Y, Jiang X, Cai D. Prediction of subsequent vertebral compression fractures after thoracolumbar kyphoplasty: a multicenter retrospective analysis. Pain Med 2023; 24:949-956. [PMID: 37014374 DOI: 10.1093/pm/pnad044] [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] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/15/2023] [Accepted: 03/17/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE Second fractures at the cemented vertebrae (SFCV) are often seen after percutaneous kyphoplasty, especially at the thoracolumbar junction. Our study aimed to develop and validate a preoperative clinical prediction model for predicting SFCV. METHODS A cohort of 224 patients with single-level thoracolumbar osteoporotic vertebral fractures (T11-L2) from 3 medical centers was analyzed between January 2017 and June 2020 to derive a preoperative clinical prediction model for SFCV. Backward-stepwise selection was used to select preoperative predictors. We assigned a score to each selected variable and developed the SFCV scoring system. Internal validation and calibration were conducted for the SFCV score. RESULTS Among the 224 patients included, 58 had postoperative SFCV (25.9%). The following preoperative measures on multivariable analysis were summarized in the 5-point SFCV score: bone mineral density (≤-3.05), serum 25-hydroxy vitamin D3 (≤17.55 ng/mL), standardized signal intensity of fractured vertebra on T1-weighted images (≤59.52%), C7-S1 sagittal vertical axis (≥3.25 cm), and intravertebral cleft. Internal validation showed a corrected area under the curve of 0.794. A cutoff of ≤1 point was chosen to classify a low risk of SFCV, for which only 6 of 100 patients (6%) had SFCV. A cutoff of ≥4 points was chosen to classify a high risk of SFCV, for which 28 of 41 (68.3%) had SFCV. CONCLUSION The SFCV score was found to be a simple preoperative method for identification of patients at low and high risk of postoperative SFCV. This model could be applied to individual patients and aid in the decision-making before percutaneous kyphoplasty.
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Affiliation(s)
- Weibo Yu
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Haiyan Zhang
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Zhensong Yao
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Yuanming Zhong
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, People's Republic of China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Daozhang Cai
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China
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Peng Y, Wu X, Ma X, Xu D, Wang Y, Xia D. Comparison Between the Clinical Effect of Percutaneous Kyphoplasty for Osteoporosis Vertebral Compression Fracture Patient with or Without Sarcopenia: A Retrospective Cohort Study. Int J Gen Med 2023; 16:3095-3103. [PMID: 37496597 PMCID: PMC10368018 DOI: 10.2147/ijgm.s423016] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/13/2023] [Indexed: 07/28/2023] Open
Abstract
Background Sarcopenia and osteoporosis vertebral compression fractures (OVCF) are common diseases that increase with age. This study aimed to investigate the effects of sarcopenia on OVCF patients after percutaneous kyphoplasty (PKP). Methods Data of 101 patients who were treated with single-level PKP between January 2021 and March 2022 at Ningbo No.6 Hospital were enrolled. Forty-five OVCF patients with sarcopenia who met our inclusion criteria were included in the Sarcopenia-PKP group (SPKP group), and 56 patients in the Normal-PKP group (NPKP group). All clinical and radiological data were collected from medical records. Baseline characteristics, operation-related parameters (operation time, time to ambulation, hospital stay, surgery segment), clinical outcomes (visual analog score [VAS], Oswestry Disability Index [ODI], Japanese Orthopaedic Association Scores [JOA] of lumber), radiological outcomes (vertebral anterior height rate and local kyphosis angle), Macnab score, and complications were evaluated and compared. Results There were no significant differences in age, sex, surgical segment preoperative VAS score, ODI, or JOA between the two groups (P > 0.05). The SPKP group had a significantly lower body mass index (BMI), bone mineral density (BMD), and smooth muscle index (SMI) than the NPKP group (P < 0.05). Significantly longer hospital stays and time to ambulation in SPKP group than NPKP group (3.7±0.8 vs 3.4±0.5 and 2.0±0.8 vs 1.6±0.5, P < 0.05). In SPKP group, significantly better clinical outcomes at 6- and 12-months follow-up were observed in NPKP group than SPKP group (P < 0.05), and NPKP group showed significantly better in vertebral anterior height rates than SPKP group after 6-month follow-up (P < 0.05). Moreover, there were significantly more cases of complications in the SPKP group (P < 0.05). Conclusion Sarcopenia could reduce the clinical effect of percutaneous kyphoplasty, and furthermore. Related studies are needed to verify the effect of sarcopenia on OVCF patients.
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Affiliation(s)
- Yujie Peng
- Orthopeadic Department, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Xiaochuan Wu
- Orthopeadic Department, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Xinyu Ma
- Emergency Department, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Dingli Xu
- Clinical Department, Health Science Center, Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Yang Wang
- Orthopeadic Department, Ningbo No.6 Hospital, Ningbo, Zhejiang, People’s Republic of China
| | - Dongdong Xia
- Orthopeadic Department, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
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Lu HT, Lin JY, Tsuei YC, Hsu YF, Chen CY, Cheng SH, Chu W, Li C, Chu WC. Impact of Aspiration Percutaneous Vertebroplasty in Reducing Bone Cement Leakage and Enhancing Distribution-An Ex Vivo Study in Goat Vertebrae. Bioengineering (Basel) 2023; 10:795. [PMID: 37508822 PMCID: PMC10376675 DOI: 10.3390/bioengineering10070795] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
Osteoporosis-induced vertebral compression fracture (OVCF) occurs commonly in people over the age of 50, especially among menopausal women. Besides conservative therapy, minimally invasive percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used in clinical treatment and achieved good efficacy. However, the leakage of bone cement (CL) during vertebroplasty (PV) is a major risk that can cause (serious) complications such as compression of the spinal cord, pulmonary embolism, or even paraplegia. In this study, we introduced a new aspiration technique with standard PV procedures (APV) to ameliorate the risk of leakage with quantitative verifications of its effectiveness. APV intends to create a differential pressure to guide the direction of cement flow within the vertebrae. To test this technique, Nubian goats' ex vivo vertebral bodies (VBs) were used to simulate the PV surgical process in humans. Results show that the proposed APV has a lower leakage rate of 13% compared to the 53% of conventional PV. Additionally, the APV approach achieves more uniform cement distribution via the 9-score method with a value of 7 ± 1.30 in contrast to 4 ± 1.78 by conventional PV.
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Affiliation(s)
- Hsin-Tzu Lu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Jia-Yi Lin
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Yu-Chuan Tsuei
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - Yung-Fu Hsu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Chung-Yi Chen
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Shih-Hao Cheng
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - William Chu
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - Chuan Li
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Woei-Chyn Chu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
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Wang JN, Xie W, Song DW, Zou J, Yan Q, Feng T, Jin SY, Yang C, Luo ZP, Niu JJ. Recurrence of Local Kyphosis After Percutaneous Kyphoplasty: The Neglected Injury of the Disc-Endplate Complex. Clin Interv Aging 2023; 18:827-834. [PMID: 37229150 PMCID: PMC10202700 DOI: 10.2147/cia.s410992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
Background Recurrent of local kyphosis after percutaneous kyphoplasty (PKP) is rarely reported and discussed. Literatures reported that re-kyphosis is usually a consequence of refractures of augmented or adjacent vertebra. However, whether re-kyphosis should be considered as a complication of refractures and has an impact on clinical efficacy of PKP during follow-up time is unknown. The purpose of this study is to evaluate the related risk factors and clinical significance of the recurrent of local kyphosis in osteoporotic vertebral fracture (OVF) patients without refractures. Patients and Methods A total of 143 patients who underwent single-level PKP were recruited and assigned into the re-kyphosis group and non-re-kyphosis group. Clinical and radiographic data were collected and compared between the two groups. Then, multivariate logistic regression analyses were conducted to identify the related risk factors. Results During follow-up, 16 of the 143 patients presented postoperative re-kyphosis. The average local kyphosis angle increased from 11.81±8.60° postoperatively to 25.13±8.91° at the final follow-up which showed a statistically significant difference (p<0.05). Both groups had significant improvements in postoperative visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores compared to their preoperative values (p<0.05). However, in the re-kyphosis group at final follow-up, the VAS and ODI scores showed worsening compared to the postoperative scores. Logistic regression analysis showed that disc-endplate complex injury (OR=17.46, p=0.003); local kyphosis angle correction (OR=1.84, p<0.001); and vertebral height restoration (OR=1.15, p=0.003) were risk factors for re-kyphosis. Conclusion Re-kyphosis is not rare in patients with osteoporotic vertebral fracture and tends to have an inferior prognosis following PKP surgery. Patients with disc-endplate complex injury and more correction of vertebral height and kyphosis angle are at a higher risk for re-kyphosis after PKP surgery than others.
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Affiliation(s)
- Jin-ning Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Wei Xie
- Department of Orthopaedics, Suzhou Ninth People’s Hospital, Suzhou, Jiangsu, People’s Republic of China
| | - Da-Wei Song
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jun Zou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Qi Yan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Tao Feng
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Sheng-yang Jin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Chao Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Zong-ping Luo
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Orthopedic Institute, Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jun-jie Niu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
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Chen T, Lin C, Wang Y, Yang H, Li X, Chu G, Jiang W, Liu Y. Bone Cement Reperfusion Revision Surgery for Symptomatic Recurrence of Kümmell's Disease After Percutaneous Kyphoplasty. Global Spine J 2023:21925682231174189. [PMID: 37194502 DOI: 10.1177/21925682231174189] [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] [Indexed: 05/18/2023] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES To demonstrate that repeat Percutaneous vertebroplasty (PVP) performed for the same cemented vertebrae in Kümmell's disease can offer therapeutic benefit for patients with recurrent symptoms after initial percutaneous kyphoplasty (PKP) treatment. METHODS From January 2019 to December 2021, we investigated 2932 patients with PKP. Among them, 191 patients were diagnosed Kümmell's disease. 33 patients upon presentation of recurrent symptoms underwent repeat PVP procedure. Radiologic outcomes and clinic indices were investigated. RESULTS Bone cement reperfusion surgery was successfully completed in 33 patients. The average age was 73.5 ± 8.2 years old. The kyphosis angle showed significant correction from pre-operation to the final follow-up, descending from pre-operation (20.6 ± 11.1°) to final follow-up (15.4 ± 7.9°). The vertebral heights at different follow-up appointments were significantly higher than the pre-operative appointments. The VAS and ODI scores at final follow-up were respectively 1.2 ± .8 and 27.3 ± 5.4%, which were both significantly lower than those before operation. No complications such as cement leakage into the spinal canal or cement displacement occurred during follow-up. CONCLUSIONS Bone cement reperfusion surgery can ameliorate kyphosis and restore vertebral height to some extent. Repeat PVP is a minimally invasive surgery that provides superior long-term results in clinical and radiological outcomes but is technically more difficult to perform.
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Affiliation(s)
- Tangyiheng Chen
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cheng Lin
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yujie Wang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huilin Yang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuefeng Li
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Genglei Chu
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weimin Jiang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Orthopaedic Surgery, Dushu Lake Hospital Affiliated of Soochow University, Suzhou, China
| | - Yijie Liu
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
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Yu W, Jiang X, Zhang H, Yao Z, Zhong Y, Tang F, Cai D. Establishment of a novel risk prediction model for recompression of augmented vertebrae at the thoracolumbar junction and modified puncture technique for prevention: a multicenter retrospective study. J Neurosurg Spine 2023:1-9. [PMID: 37119106 DOI: 10.3171/2023.3.spine2312] [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: 01/04/2023] [Accepted: 03/13/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE Recompression of augmented vertebrae (RCAV) is often seen after percutaneous kyphoplasty (PKP), especially at the thoracolumbar junction. The authors aimed to develop and validate a risk prediction model (nomogram) for RCAV and to evaluate the efficacy of a modified puncture technique for RCAV prevention after PKP for thoracolumbar osteoporotic vertebral fractures (OVFs). METHODS Patients who underwent PKP for single thoracolumbar OVFs (T10-L2) between January 2016 and October 2020 were reviewed and followed up for at least 2 years. All patients were randomly divided into a training group (70%) and a validation group (30%). Relevant potential data affecting recompression were collected. Predictors were screened by using binary logistic regression analysis to construct the nomogram. Calibration and receiver operating characteristic curves were used to evaluate the consistency of the prediction models. Finally, the efficacy of the modified puncture technique for prevention of RCAV in OVF patients with a preoperative intravertebral cleft (IVC) was further demonstrated through binary logistic regression analysis. RESULTS Overall, 394 patients were included and 116 of them (29.4%) sustained RCAV. The independent risk factors included decreased bone mineral density, lower level of serum 25-hydroxy vitamin D3, larger C7-S1 sagittal vertical axis (SVA), preoperative IVC, and solid-lump cement distribution. The area under the curve (AUC) of the prediction model was 0.824 in the training group and 0.875 in the validation group patients. The calibration curve indicated the predictive power of this nomogram, with the preoperative IVC having the highest prediction accuracy (AUC 0.705). The modified puncture technique significantly reduced the incidence of RCAV by enhancing bone cement distribution into a sufficiently diffused distribution in OVF patients with preoperative IVC. CONCLUSIONS The nomogram prediction model had satisfactory accuracy and clinical utility for identification of patients at low and high risk of postoperative RCAV. Patients at high risk of postoperative RCAV might benefit from the target puncture technique and vitamin D supplementation as well as effective antiosteoporotic therapies.
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Affiliation(s)
- Weibo Yu
- 1Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong
| | | | - Haiyan Zhang
- 1Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong
| | - Zhensong Yao
- 4Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong
| | - Yuanming Zhong
- 3Department of Orthopaedics, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Fubo Tang
- 3Department of Orthopaedics, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Daozhang Cai
- 1Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong
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Huang X, Jiao W, Zhai Y, Zhang W, Lu H, Jiang J, Ge Y, Yu H. [Effect of injury degree of osteoporotic vertebral compression fracture on bone cement cortical leakage after percutaneous kyphoplasty]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:452-456. [PMID: 37070313 PMCID: PMC10110738 DOI: 10.7507/1002-1892.202212066] [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] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Objective To analyze the correlation between bone cement cortical leakage and injury degree of osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP), and to provide guidance for reducing clinical complications. Methods A clinical data of 125 patients with OVCF who received PKP between November 2019 and December 2021 and met the selection criteria was selected and analyzed. There were 20 males and 105 females. The median age was 72 years (range, 55-96 years). There were 108 single-segment fractures, 16 two-segment fractures, and 1 three-segment fracture. The disease duration ranged from 1 to 20 days (mean, 7.2 days). The amount of bone cement injected during operation was 2.5-8.0 mL, with an average of 6.04 mL. Based on the preoperative CT images, the standard S/H ratio of the injured vertebra was measured (S: the standard maximum rectangular area of the cross-section of the injured vertebral body, H: the standard minimum height of the sagittal position of the injured vertebral body). Based on postoperative X-ray films and CT images, the occurrence of bone cement leakage after operation and the cortical rupture at the cortical leakage site before operation were recorded. The correlation between the standard S/H ratio of the injured vertebra and the number of cortical leakage was analyzed. Results Vascular leakage occurred in 67 patients at 123 sites of injured vertebrae, and cortical leakage in 97 patients at 299 sites. Preoperative CT image analysis showed that there were 287 sites (95.99%, 287/299) of cortical leakage had cortical rupture before operation. Thirteen patients were excluded because of vertebral compression of adjacent vertebrae. The standard S/H ratio of 112 injured vertebrae was 1.12-3.17 (mean, 1.67), of which 87 cases (268 sites) had cortical leakage. The Spearman correlation analysis showed a positive correlation between the number of cortical leakage of injured vertebra and the standard S/H ratio of injured vertebra ( r=0.493, P<0.001). Conclusion The incidence of cortical leakage of bone cement after PKP in OVCF patients is high, and cortical rupture is the basis of cortical leakage. The more severe the vertebral injury, the greater the probability of cortical leakage.
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Affiliation(s)
- Xubing Huang
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236003, P. R. China
| | - Wei Jiao
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236003, P. R. China
| | - Yunlei Zhai
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236003, P. R. China
| | - Wei Zhang
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236003, P. R. China
| | - Haitao Lu
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236003, P. R. China
| | - Jishi Jiang
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236003, P. R. China
| | - Yu Ge
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236003, P. R. China
| | - Haiyang Yu
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236003, P. R. China
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Song Q, Zhao Y, Li D, Liu Z, Zhang Y, Shang D, Geng Z, Shi Z, Fan LH. Effect of different bone cement distributions in percutaneous kyphoplasty on clinical outcomes for osteoporotic vertebral compression fractures: A retrospective study. Medicine (Baltimore) 2023; 102:e33309. [PMID: 36961148 PMCID: PMC10036056 DOI: 10.1097/md.0000000000033309] [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: 09/03/2022] [Accepted: 02/27/2023] [Indexed: 03/25/2023] Open
Abstract
Osteoporotic fractures and their complications are becoming increasingly harmful to the elderly. This study aimed to evaluate the clinical results of connected or unconnected bilateral cement after bilateral percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCF). The clinical data of 217 patients with single-segment OVCF were retrospectively collected. Patients were allocated into 2 groups according to the bilateral bone cement in the vertebrae was connected or unconnected after surgery. The surgery-related indexes of the 2 groups were compared, including operation time; bone cement injection volume; contact situation between bone cement and the upper and lower endplates of the vertebral body; visual analogue scale (VAS) scores before surgery, 1 week and 1 year after surgery; Oswestry disability index (ODI) before surgery, 1 week and 1 year after surgery; local kyphosis angle (LKA) before surgery, 1 week and 1 year after surgery; postoperative vertebral body height at 1 week and 1 year after surgery; vertebral body height restoration rate (HRR) at 1 week and 1 year after surgery. The follow-up results of all patients were recorded. The postoperative VAS, ODI, vertebral body height, LKA and other indexes of the 2 groups were significantly improved compared with those before the operation (P < .05), and there was no significant difference between the 2 groups (P > .05). At the same time, there were no significant difference in vertebral body HRR and bone cement leakage rate between the 2 groups (P > .05). X-ray examination showed that 21 of 217 patients (21/217, 9.8%) had a refracture of the injured vertebral body, including 16 cases (16/121, 13.2%) in the unconnected group and 5 cases (5/96, 5.2%) in the connected group (P < .05). Adjacent vertebrae fractures occurred in 25 cases (25/217, 11.5%), while 19 cases (19/121, 15.7%) were in the unconnected group and 6 cases (6/96, 6.3%) were in the connected group (P < .05). PKP has a good therapeutic effect on OVCF no matter whether the bilateral bone cement is connected or not. However, if the bilateral cement inside the vertebra was connected, the risk of recollapse of the injured vertebrae and the new fracture of adjacent vertebrae could be reduced.
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Affiliation(s)
- Qichun Song
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
| | - Yan Zhao
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
| | - Dong Li
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
| | - Zhaoying Liu
- School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Yuankai Zhang
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
| | - Donglong Shang
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
| | - Zilong Geng
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
| | - Zhibin Shi
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
| | - Li-Hong Fan
- The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, P.R. China
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Yu H, Luo G, Wang Z, Yu B, Sun T, Tang Q. Predictors of residual low back pain in patients with osteoporotic vertebral fractures following percutaneous kyphoplasty. Front Surg 2023; 10:1119393. [PMID: 36816002 PMCID: PMC9935818 DOI: 10.3389/fsurg.2023.1119393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023] Open
Abstract
Objective Patients with osteoporotic vertebral fractures (OVFs) often suffer from residual low back pain (LBP) after percutaneous kyphoplasty (PKP). The purpose of this study was to identify risk factors for postoperative residual LBP and to develop a nomogram to predict the occurrence of residual LBP. Methods We retrospectively reviewed 236 patients who underwent PKP for OVFs and had a minimum follow-up of 12 months. The mean age was 72.1 ± 6.3, 74.3% were female and 25.7% were male. Patients with LBP VAS scores ≥ 3.5 at the 12th month postoperatively were considered to have residual LBP. Risk factors for residual LBP were identified by univariate and multifactorial logistic regression analysis. Then, a predictive nomogram was constructed and validated using the bootstrap method. The discrimination, calibration, and clinical utility of the nomogram were assessed using a receiver operating characteristic curve (ROC), a calibration curve, and a decision curve analysis (DCA). Results univariate and multifactorial logistic regression analysis identified depression (P = 0.02), intravertebral vacuum cleft (P = 0.01), no anti-osteoporosis treatment (P < 0.001), cement volume <3 ml (P = 0.02), and cement distrubution (P = 0.01) as independent risk factors for residual LBP. The area under the ROC was 0.83 (0.74-0.93) and further validated by bootstrap method was 0.83 (0.73-0.92). The calibration curve illustrated the consistency between the predicted probability and the observed results. DCA showed that nomogram exhibits clinical utility and net benefit when the threshold probability is between 6% and 73%. Conclusions Our study found that depression, intravertebral vacuum cleft, no anti-osteoporosis treatment, cement volume <3 ml and cement distribution represent independent risk factors for residual LBP. The nomogram containing the above five predictors can accurately predict the risk of residual LBP after surgery.
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Affiliation(s)
- Hongwei Yu
- School of Medicine, Nankai University, Tianjin, China
| | - Gan Luo
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Ziqi Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Bin Yu
- Department of Spinal Surgery, Tian-jin Union Medical Centre, Nankai University People's Hospital, Tianjin, China
| | - Tianwei Sun
- Department of Spinal Surgery, Tian-jin Union Medical Centre, Nankai University People's Hospital, Tianjin, China,Correspondence: Tianwei Sun
| | - Qiong Tang
- Department of Respiratory Medicine, Tian-jin Union Medical Centre, Nankai University People's Hospital, Tianjin, China
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Tan B, Yang QY, Fan B, Li Q, Zhang XY. Digital Subtraction Angiography-Guided Percutaneous Kyphoplasty in Treatment of Multi-Segmental Osteoporotic Vertebral Compression Fracture: A retrospective single-Center study. J Pain Res 2023; 16:169-176. [PMID: 36711114 PMCID: PMC9879022 DOI: 10.2147/jpr.s388068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/17/2023] [Indexed: 01/23/2023] Open
Abstract
Purpose This study aimed to explore the effectiveness and safety of digital subtractionangiography (DSA)-guided percutaneous kyphoplasty (PKP) in treating multi-segmental osteoporotic vertebral compression fracture (OVCF). Methods We retrospectively reviewed 68 patients with multi-segmental OVCF who had unilateral PKP surgeries using DSA and C arm guiding at our hospital between October 2016 and June 2020 and were followed for at least two years. All patients were divided into two groups: DSA guidance (n = 31) and C-arm guidance (n=37). In addition, we collected the clinical and radiological evaluation results during postoperative and last follow-up periods. Results Our findings revealed that the DSA guidance group required lesser time for channel establishment and surgery than the C-arm guidance group at P < 0.05. The incidences of bone cement leakage, fluoroscopy times, and radiation dose of the DSA guidance group were significantly lesser than the C-arm guidance group (P < 0.05). Compared to the C-arm guidance group, the deviation of puncture in the DSA guidance group was significantly lower, the puncture angle in the DSA guidance group was significantly larger, and better bone cement distribution was obtained (P < 0.05). Compared to preoperative data, the VAS score, median vertebral height, and Cobb angle were significantly improved one day after surgery and the final follow-up in both groups (P < 0.05). However, the VAS score, the median vertebral height, average length of stay, and Cobb angle were not significantly different between the two groups (P > 0.05). Conclusion DSA-guided PKP in treating multi-segmental OVCF can shorten the operation time, improve puncture accuracy, reduce the times and dose of fluoroscopy, reduce the leakage of bone cement, and achieve better cement distribution.
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Affiliation(s)
- Bing Tan
- Department of Spine Surgery, The Third Hospital of MianYang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, People’s Republic of China
| | - Qi-Yuan Yang
- Department of Spine Surgery, The Third Hospital of MianYang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, People’s Republic of China,Correspondence: Qi-Yuan Yang, Department of Spine Surgery, The Third Hospital of MianYang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, People’s Republic of China, Tel +8615882889797, Email
| | - Bin Fan
- Department of Spine Surgery, The Third Hospital of MianYang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, People’s Republic of China
| | - Qin Li
- Department of Spine Surgery, The Third Hospital of MianYang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, People’s Republic of China
| | - Xiao-Yan Zhang
- Department of Spine Surgery, The Third Hospital of MianYang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, People’s Republic of China
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Lu W, Teng Z, Chen J, Shi R, Zou T, Gao M, Li W, Peng Z, Wang L, Zhao Y, Lu S. A Pain That is Easily Overlooked: Referred Pain Caused by OVCF. J Pain Res 2023; 16:961-971. [PMID: 36960463 PMCID: PMC10030002 DOI: 10.2147/jpr.s375966] [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] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 02/25/2023] [Indexed: 03/18/2023] Open
Abstract
Purpose The objective of this study was to analyze the clinical characteristics and the therapeutic effects of treatment at our spinal center in OVCF patients associated with referred pain. The underlying goals were to deepen the understanding of referred pain caused by OVCFs, improve the currently low early diagnosis rate of OVCFs, and improve the effectiveness of treatment. Methods The patients who had referred pain from OVCFs and met the inclusion criteria were retrospectively analyzed. All patients were treated with percutaneous kyphoplasty (PKP). Visual analog scale (VAS) scores and Oswestry Disability Index (ODI) were used to evaluate the therapeutic effect at different time points. Results There were 11 males (19.6%) and 45 females (80.4%). Their corresponding mean bone mineral density (BMD) value was -3.3 ± 0.4. The regression coefficient of BMD in the linear regression equation was -4.51 (P<0.001). According to the classification system for referred pain in OVCFs, there were 27 cases of type A (48.2%), 12 cases of type B (21.2%), 8 cases of type C (14.3%), 3 cases of type D (5.4%), and 6 cases of type E (10.7%). All patients were followed up for at least 6 months, and both VAS scores and ODI were found to be significantly better postoperatively than preoperatively (P<0.001). There was no significant difference in VAS scores and ODI between different types preoperatively or 6 months postoperatively (P > 0.05). Within each type, there were significant differences in VAS scores and ODI between the pre- and postoperative timepoints (P < 0.05). Conclusion Attention should be paid to referred pain in OVCF patients, which is not uncommon in clinical practice. Our summary of the characteristics of referred pain caused by OVCFs can improve the early diagnosis rate of OVCFs patients and provide a reference for their prognosis after PKP.
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Affiliation(s)
- Wei Lu
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Zhaowei Teng
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
| | - Jiayu Chen
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Rongmao Shi
- Department of Orthopedics, Clinical College of the 920th Hospital of Joint Logistics Support Force of Kunming Medical University, Kunming, People’s Republic of China
| | - Tiannan Zou
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Ming Gao
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Weichao Li
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Zhi Peng
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Long Wang
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Yonghui Zhao
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
| | - Sheng Lu
- Yunnan Key Laboratory of Digital Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, People’s Republic of China
- Correspondence: Sheng Lu, Department of Orthopedics, the First People’s Hospital of Yunnan Province, No. 157 Jinbi Road, Kunming, 650032, People’s Republic of China, Tel +86-0871-63633071, Fax +86-0871-63633071, Email
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Zhou C, Huang S, Liao Y, Chen H, Zhang Y, Li H, Zhu Z, Wang Y. Correlation analysis of larger side bone cement volume/vertebral body volume ratio with adjacent vertebral compression fractures during vertebroplasty. Front Endocrinol (Lausanne) 2023; 14:1072087. [PMID: 37033237 PMCID: PMC10076871 DOI: 10.3389/fendo.2023.1072087] [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: 10/17/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
OBJECTIVE To investigate the correlation analysis of larger side bone cement volume/vertebral body volume ratio (LSBCV/VBV%) with adjacent vertebral compression fracture (AVCF) in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). METHODS A retrospective analysis of 245 OVCF patients who underwent PVP treatment from February 2017 to February 2021, including 85 males and 160 females. The age ranged from 60 to 92 years, with a mean of (70.72 ± 7.03) years. According to whether AVCF occurred after surgery, they were divided into 38 cases in the AVCF group (fracture group) and 207 cases in the no AVCF group (non-fracture group). The correlation between gender, age, bone mineral density (BMD), body mass index (BMI), thoracolumbar segment fracture, bone cement disc leakage, LSBCV, bone cement volume (BCV), VBV, LSBCV/VBV ratio (LSBCV/VBV%), and BCV/VBV% and AVCF were analyzed in both groups. Risk factors for AVCF after PVP were analyzed by multifactorial logistic regression, and then the receiver operating characteristic curves (ROC curves) were plotted to identify the critical value of LSBCV/VBV%. RESULTS 38 patients (15.5%) developed AVCF postoperatively. Univariate analysis showed that BMD, bone cement disc leakage, LSBCV, and LSBCV/VBV% were risk factors for AVCF after PVP (P<0.05), while gender, age, BMI, thoracolumbar segment fracture, BCV, VBV, and BCV/VBV% were not significantly different in both groups (P>0.05). Multifactorial logistic regression analysis revealed that BMD, bone cement disc leakage, and LSBCV/VBV% were independent risk factors for AVCF after PVP (P<0.05). According to the ROC curve, the LSBCV/VBV% had an area under the curve of 71.6%, a sensitivity and specificity of 89.5% and 51.7%, respectively, and a critical value of 13.82%. CONCLUSION BMD, bone cement disc leakage and LSBCV/VBV% are independent risk factors for AVCF after PVP. With LSBCV/VBV at 13.82%, the incidence of AVCF significantly increased.
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Affiliation(s)
- Chengqiang Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shaolong Huang
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yifeng Liao
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Han Chen
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yazhong Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hua Li
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ziqiang Zhu
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yunqing Wang
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- *Correspondence: Yunqing Wang,
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Qi J, Hu Y, Yang Z, Dong Y, Zhang X, Hou G, Lv Y, Guo Y, Zhou F, Liu B, Tian Y. Incidence, Risk Factors, and Outcomes of Symptomatic Bone Cement Displacement following Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fracture: A Single Center Study. J Clin Med 2022; 11. [PMID: 36556143 DOI: 10.3390/jcm11247530] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/29/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
STUDY DESIGN Retrospective. BACKGROUND Symptomatic bone cement displacement (BCD) is a rare complication following percutaneous kyphoplasty (PKP) interventions for osteoporotic vertebral compression fracture (OVCF). This study aimed to investigate the incidence and the outcomes of symptomatic BCD comprehensively and identify its risk factors. METHODS The clinical data of patients treated with PKP for OVCF between January 2012 and December 2020 were extracted. Patients who developed BCD following PKP during follow-up were divided into the symptomatic and asymptomatic groups. Patients who did not develop BCD were assigned to the control group. Univariate and multiple logistic regression analyses were used to compare the three clinical groups' features to assess the independent risk factors for the symptomatic and asymptomatic groups. RESULTS A total of 896 patients were enrolled. Twenty-one patients (2.3%) were identified as having symptomatic BCD following PKP for OVCF, and 35 (3.9%) developed asymptomatic BCD. Compared with the control group, the symptomatic and asymptomatic groups had a higher incidence of anterior leakage, intravertebral vacuum cleft (IVC) signs, and a lower cement distribution score. The symptomatic group had a lower relative cross-sectional area (rCSA) of the paraspinal muscle (PSM), higher PSM fatty degeneration, and higher kyphotic angle (at the last follow-up) than the asymptomatic and control groups. For outcomes, the symptomatic group had a higher VAS/ODI score and a higher incidence of new vertebral fractures compared with the asymptomatic and control groups. Anterior leakage (OR: 1.737, 95% CI: 1.215-3.300), the IVC sign (OR: 3.361, 95% CI: 1.605-13.036), the cement distribution score (OR: 0.476, 95% CI: 0.225-0.904), PSM rCSA (OR: 0.953, 95% CI: 0.917-0.992), and PSM fatty degeneration (OR: 1.061, 95% CI: 1.005-1.119) were identified as independent risk factors for the symptomatic group. Anterior leakage (OR: 1.839, 95% CI: 1.206-2.803), the IVC sign (OR: 2.936, 95% CI: 1.174-9.018), and cement distribution score (OR: 0.632, 95% CI: 0.295-0.858) were independent risk factors for the asymptomatic group. CONCLUSION The incidence of symptomatic BCD is 2.3% in patients treated with PKP. Anterior leakage, the IVC sign, and the distribution score were independent risk factors for BCD, and paraspinal muscle degeneration was a specific risk factor for symptomatic BCD. Symptomatic BCD can lead to poor outcomes.
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Zhong X, Xia H, Li Y, Tang C, Tang X, He S. Effectiveness and safety of ultrasound-guided thoracic paravertebral block versus local anesthesia for percutaneous kyphoplasty in patients with osteoporotic compression fracture. J Back Musculoskelet Rehabil 2022; 35:1227-1235. [PMID: 35599464 DOI: 10.3233/bmr-210131] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Kyphoplasty for osteoporotic vertebral compression fractures (OVCF) is a short but painful intervention. Different anesthetic techniques have been proposed to control pain during kyphoplasty; however, all have limitations. OBJECTIVE To compare the effectiveness and safety of ultrasound-guided thoracic paravertebral block with local anesthesia for percutaneous kyphoplasty (PKP). METHODS In this prospective study, non-randomized patients with OVCF undergoing PKP received either ultrasound-guided thoracic paravertebral block (group P) or local anesthesia (group L). Perioperative pain, satisfaction with anesthesia, and complications were compared between the groups. RESULTS Mean intraoperative (T1-T4) perioperative visual analog scale (VAS) scores were significantly lower in group P than in group L (2 [1-3] vs. 3 [2-4], 2 [2-3] vs. 4 [2-4], 2 [2-3] vs. 5 [3-5], and 3 [2-3] vs. 5 [3-5], respectively; P< 0.05). Investigators' satisfaction scores, patients' anesthesia satisfaction scores, and anesthesia re-administration intention rate were significantly higher in group P than in group L (4 [3-5] vs. 3 [2-4], 2 [2-3] vs. 2 [1-3], 90.63% vs. 69.70%; P< 0.05). There was no significant intergroup difference in complications. CONCLUSIONS Ultrasound-guided thoracic paravertebral block has similar safety to and better effectiveness than local anesthesia in PKP.
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Affiliation(s)
- Xiqiang Zhong
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haijie Xia
- Department of Anesthesiology, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yimin Li
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chengxuan Tang
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaojun Tang
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shaoqi He
- Department of Orthopedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Abstract
OBJECTIVE To investigate the clinical efficacy of Percutaneous Kyphoplasty (PKP) in male and female patients. METHOD The clinical data of patients treated with PKP in our hospital from January 2018 to October 2020 were analyzed retrospectively. These patients were divided into female group and male group according to gender differences. The visual analogue scale (VAS) and activity function score (LAS) were recorded before operation, immediately after operation and 1 year after operation, and postoperative complications such as cement leakage and recurrent vertebral fracture were recorded. The above observation indexes between the 2 groups were statistically compared. RESULTS A total of 171 patients (118 in female group and 53 in male group) were included. There was no other difference between the 2 groups except that thoracic vertebral fracture was more common in women (P < .05). The VAS of female group and male group were (7.14 ± 0.61) and (7.11 ± 0.51) before operation, (3.05 ± 0.66) and (2.89 ± 0.64) after operation, 1 year after operation (1.10 ± 0.50) and (1.02 ± 0.37). There was no difference in each period between the 2 groups (P > .05). But there was a significant decrease after operation, which was recognized between the 2 groups (P < .05); The activity scores of female group and male group were (3.08 ± 0.48) and (3.07 ± 0.43) before operation, (1.86 ± 0.42) and (1.85 ± 0.50) after operation, 1 year after operation (1.01 ± 0.92) and (1.02 ± 0.14). There was no difference in each period between the 2 groups (P > .05). But there was a significant decrease after operation, which was recognized between the 2 groups (P < .05). Postoperative cement leakage was revealed in 21 cases (12.28%), 16 cases (13.56%) in female group and 5 cases (9.43%) in male group, which was no significant difference between the 2 groups. During the 1-year follow-up, postoperative recurrent vertebral fracture was revealed in 4 cases (2.34%), 2 cases (1.69%) in the female group and 2 case (3.77%) in the male group, which was also no significant difference between the 2 groups. CONCLUSION Patients treated with PKP can immediately get pain relief and activity function improvement. PKP is a safe and effective minimally invasive surgery for both female and male patients.
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Affiliation(s)
- Bo Yang
- Xi’an Medical University, Xi’an, China
- Department of Orthopaedics, the Ninth Hospital of Xi’an, Xi’an, China
| | - Yangxue Zhao
- Department of Orthopaedics, the Ninth Hospital of Xi’an, Xi’an, China
| | - Yu Zhao
- Department of Orthopaedics, the Ninth Hospital of Xi’an, Xi’an, China
- *Correspondence: Yu Zhao, Department of Orthopaedics, the Ninth Hospital of Xi’an, No. 151, east section of South Second Ring Road, Xi’an, China (e-mail: )
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Li Y, Qian Y, Shen G, Tang C, Zhong X, He S, He S. Percutaneous mesh-container-plasty versus percutaneous kyphoplasty in the treatment of malignant thoracolumbar compression fractures: a retrospective cohort study. Acta Orthop Traumatol Turc 2022; 56:395-401. [PMID: 36567543 PMCID: PMC9885624 DOI: 10.5152/j.aott.2022.22094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to compare the clinical and radiological results of percutaneous mesh-container-plasty versus percutaneous kyphoplasty in the treatment of malignant thoracolumbar compression fractures. METHODS Patients with malignant thoracolumbar compression fractures treated in a single tertiary care center between January 2011 and December 2020 were retrospectively reviewed and included in the study. Ninety-four patients who were diagnosed by pathological biopsy were divided into 2 groups according to the type of surgical treatment: the percutaneous kyphoplasty group (50 patients: 24 male, 26 female; mean age=73.02 ± 7.79 years) and the percutaneous mesh-container-plasty group (44 patients: 21 male, 23 female; mean age=74.68 ± 7.88 years). The epidemiological data, surgical outcomes, and clinical and radiological features were compared between the 2 groups. Cement leakage, height restoration, deformity correction, and cement distribution were calculated from the radiographs. The visual analog scale, Oswestry disability index, Karnofsky performance scale scores, and short-form 36 health survey domains role physi cal and bodily pain were calculated preoperatively, immediately, and 1 year postoperatively. RESULTS The visual analog scale score improved from 5 (range=4-6) preoperatively to 2 (range=2-3) immediately postoperatively in the percutaneous kyphoplasty group and from 5 (range=4-6) preoperatively to 2 (range=2-2) immediately postoperatively in the percutane ous mesh-container-plasty group; there was a significant difference between the 2 groups (P=.018). Although Oswestry disability index, Karnofsky performance scale, short-form 36 health survey domains bodily pain and role physical significantly improved in both groups after surgery compared to the preoperative period, there was no significant difference between the 2 groups (P > .05). The mean cost in the percutaneous kyphoplasty group was lower than that in the percutaneous mesh-container-plasty group (5563 ± 439 vs. 6569 ± 344 thousand dollars, P < .05). There was no difference between the cement volume in the 2 groups, and cement distribution in the percutaneous mesh-container-plasty group was higher than that in the percutaneous kyphoplasty group (44.30% ± 10.25% vs. 32.54% ± 11.76%, P < .05). Cement leakage was found to be lesser in the percutaneous mesh-container-plasty group (7/44) than in the percutane ous kyphoplasty group (18/50, P < .05). There were no statistically significant differences in the recovery of vertebral body height and improvement of segmental kyphosis between the 2 groups (P > .05). CONCLUSION Percutaneous kyphoplasty and percutaneous mesh-container-plasty both have significant abilities in functional recovery, height restoration, and segment kyphosis improvement in treating malignant thoracolumbar compression fractures. Percutaneous mesh container-plasty may be better able to relieve pain, inhibit cement leakage, and improve cement distribution than percutaneous kypho plasty. However, percutaneous mesh-container-plasty requires a relatively longer procedure and is more expensive than percutaneous kyphoplasty. LEVEL OF EVIDENCE Level III, Therapeutic Study.
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Zhao Z, Deng L, Hua X, Liu H, Zhang H, Jia X, Wei R, Liu M, Lv N. A retrospective study on the efficacy and safety of bone cement in the treatment of endplate fractures. Front Surg 2022; 9:999406. [PMID: 36277290 PMCID: PMC9585934 DOI: 10.3389/fsurg.2022.999406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Endplate fractures is an important factor affecting the curative effect of percutaneous kyphoplasty for spinal fracture. The purpose of this study is to investigate the effect of sealing endplate fracture with bone cement on minimally invasive treatment of spinal fracture. Methods A total of 98 patients with osteoporotic vertebral fractures combined with endplate fractures treated with bone cement surgery in our hospital were retrospectively analyzed. They were grouped according to whether bone cement was involved in the endplate fractures. Group A: bone cement was not only distributed in the fractured vertebral body, but also dispersed into the endplate fractures. Group B: bone cement was confined to the fractured vertebra but did not diffuse into the cracks of the endplate. The basic information, imaging changes of the fractured vertebral body, VAS score, ODI score, bone cement distribution and postoperative complications of the two groups were analyzed and compared. Results The height of the injured vertebra and the kyphotic Cobb angle in the two groups were significantly improved after surgery, but the anterior height of the vertebra in group B was lower than that in group A and the kyphotic Cobb angle was higher than that in group A at the last follow-up (P < 0.05). VAS score and ODI score in 2 groups were significantly improved after operation (P < 0.05), but the VAS score and ODI score in group A were lower than those in group B at the last follow-up (P < 0.05). The incidence of bone cement leakage and adjacent vertebral fracture in group A was higher than that in group B (P < 0.05). Conclusion Diffusion of bone cement into the cracks of the endplate may also restore and maintain the height of the injured vertebra, relieve pain and restore lumbar function. However, diffusion of bone cement into the cracks of the endplate can increase the incidence of cement leakage and adjacent vertebral fractures.
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Affiliation(s)
- Zhijian Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Lei Deng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Xi Hua
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Haojun Liu
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Hao Zhang
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Xuejun Jia
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Rushuai Wei
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Mingming Liu
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China,Correspondence: Nanning Lv Mingming Liu
| | - Nanning Lv
- Department of Orthopedic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China,Correspondence: Nanning Lv Mingming Liu
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Zheng BW, Liu FS, Zheng BY, Niu H, Li J, Lv GH, Zou MX, Xu Z. Corrigendum: Risk factors for tuberculous or nontuberculous spondylitis after percutaneous vertebroplasty or kyphoplasty in patients with osteoporotic vertebral compression fracture: A case-control study. Front Surg 2022; 9:1044417. [PMID: 36277277 PMCID: PMC9579864 DOI: 10.3389/fsurg.2022.1044417] [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: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 12/02/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fsurg.2022.962425.].
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Affiliation(s)
- Bo-Wen Zheng
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China,Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China,Musculoskeletal Tumor Center, Peking University People’s Hospital, Peking University, Beijing, China
| | - Fu-Sheng Liu
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China,Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bo-Yv Zheng
- Department of Orthopedics Surgery, General Hospital of the Central Theater Command, Wuhan, China
| | - HuaQing Niu
- Department of Orthopedics Surgery, General Hospital of the Central Theater Command, Wuhan, China
| | - Jing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guo-Hua Lv
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ming-Xiang Zou
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Zhun Xu
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China,Correspondence: Zhun Xu
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Fan N, Wang T, Wang A, Yuan S, Du P, Si F, Zhu W, Li J, Zang L. A predictive nomogram for intradiscal cement leakage in percutaneous kyphoplasty for osteoporotic vertebral compression fractures combined with intravertebral cleft. Front Surg 2022; 9:1005220. [PMID: 36277280 PMCID: PMC9581225 DOI: 10.3389/fsurg.2022.1005220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND For patients with osteoporotic vertebral compression fractures (OVCFs) treated with percutaneous kyphoplasty (PKP), the occurrence and risk factors of intradiscal cement leakage should be characteristic of the presence of intravertebral cleft (IVC). This study aimed to identify risk factors for intradiscal leakage in individuals with OVCFs combined with IVC treated with PKP and build a powered and well-calibrated predictive nomogram. METHODS This study retrospectively reviewed consecutive patients who underwent PKP at our center between January 2016 and May 2021. Patients diagnosed with OVCFs combined with IVC were identified, and the incidence of different types of bone cement leakage was recorded. Risk factors for intradiscal leakage among the demographic, perioperative baseline, and radiologic data were identified, following which a nomogram was developed and verified. RESULTS A total of 109 eligible patients were included, and the intradiscal leakage rate was 32.1%. Compression rate (odds ratio [OR] 0.025; 95% confidence interval [CI] 0.002-0.264; P = 0.002) and cemented vertebral body fraction (OR 44.122; 95% CI 2.790-697.740; P = 0.007) were identified as independent risk factors. A predictive nomogram with good predictive power (C-statistic = 0.786) and fitness of data (Hosmer-Lemeshow goodness-of-fit test, P = 0.092) was established to build a quantitative relationship between the risk factors and intradiscal leakage. CONCLUSION The incidence rate of intradiscal leakage in PKP for OVCFs combined with IVC was 32.1%. Compression rate and cemented vertebral body fraction were identified as independent risk factors. A powered and well-calibrated nomogram was established to accurately predict the probability of intradiscal leakage. Further prospective and multicenter studies are required to verify and calibrate our findings.
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林 书, 谭 科, 胡 豇, 万 仑, 王 跃. [Effectiveness of modified orthopedic robot-assisted percutaneous kyphoplasty in treatment of osteoporotic vertebral compression fracture]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022; 36:1119-1125. [PMID: 36111475 PMCID: PMC9626289 DOI: 10.7507/1002-1892.202204013] [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] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/17/2022] [Indexed: 01/24/2023]
Abstract
Objective To evaluate the effectiveness of orthopedic robot with modified tracer fixation (short for modified orthopedic robot) assisted percutaneous kyphoplasty (PKP) in treatment of single-segment osteoporotic vertebral compression fracture (OVCF). Methods The clinical data of 155 patients with single-segment OVCF who were admitted between December 2017 and January 2021 and met the selection criteria was retrospectively analyzed. According to the operation methods, the patients were divided into robot group (87 cases, PKP assisted by modified orthopedic robot) and C-arm group (68 cases, PKP assisted by C-arm X-ray fluoroscopy). There was no significant difference in gender, age, body mass index, T value of bone mineral density, therapeutic segment, grade of vertebral compression fracture, and preoperative visual analogue scale (VAS) score, midline vertebral height, and Cobb angle between the two groups (P>0.05). The effectiveness evaluation indexes of the two groups were collected and compared. The clinical evaluation indexes included the establishment time of working channel, dose of intraoperative fluoroscopy, the amount of injected cement, VAS score before and after operation, and the occurrence of complications. The imaging evaluation indexes included the degree of puncture deviation, the degree of bone cement diffusion, the leakage of bone cement, the midline vertebral height and the Cobb angle before and after operation. Results The establishment time of working channel in robot group was significantly shorter than that in C-arm group, and the dose of intraoperative fluoroscopy was significantly larger than that in C-arm group (P<0.001). There was no significant difference in the amount of injected cement between the two groups (t=1.149, P=0.252). The patients in two groups were followed up 10-14 months (mean, 12 months). Except that the intraoperative VAS score of the robot group was significantly better than that of the C-arm group (P<0.05), there was no significant difference between the two groups at other time points (P>0.05). No severe complication such as infection, spinal cord or nerve injury, and pulmonary embolism occurred in the two groups. Five cases (5.7%) in robot group and 7 cases (10.2%) in C-arm group had adjacent segment fracture, and the difference in incidence of adjacent segment fracture between the two groups was not significant (χ2=1.105, P=0.293). Compared with C-arm group, the deviation of puncture and the diffusion of bone cement at 1 day after operation, the midline vertebral height and Cobb angle at 1 month after operation and last follow-up were significantly better in robot group (P<0.05). Eight cases (9.1%) in the robot group and 16 cases (23.5%) in the C-arm group had cement leakage, and the incidence of cement leakage in the robot group was significantly lower than that in the C-arm group (χ2=5.993, P=0.014). There was no intraspinal leakage in the two groups. Conclusion Compared with traditional PKP assisted by C-arm X-ray fluoroscopy, modified orthopedic robot-assisted PKP in the treatment of single-segment OVCF can significantly reduce intraoperative pain, shorten the establishment time of working channel, and improve the satisfaction of patients with operation. It has great advantages in reducing the deviation of puncture and improving the diffusion of bone cement.
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Affiliation(s)
- 书 林
- 四川省医学科学院•四川省人民医院骨科(成都 610072)Department of Orthopedics, Sichuan Academy of Medical Science, People’s Hospital of Sichuan Province, Chengdu Sichuan, 610072, P. R. China
| | - 科 谭
- 四川省医学科学院•四川省人民医院骨科(成都 610072)Department of Orthopedics, Sichuan Academy of Medical Science, People’s Hospital of Sichuan Province, Chengdu Sichuan, 610072, P. R. China
| | - 豇 胡
- 四川省医学科学院•四川省人民医院骨科(成都 610072)Department of Orthopedics, Sichuan Academy of Medical Science, People’s Hospital of Sichuan Province, Chengdu Sichuan, 610072, P. R. China
| | - 仑 万
- 四川省医学科学院•四川省人民医院骨科(成都 610072)Department of Orthopedics, Sichuan Academy of Medical Science, People’s Hospital of Sichuan Province, Chengdu Sichuan, 610072, P. R. China
| | - 跃 王
- 四川省医学科学院•四川省人民医院骨科(成都 610072)Department of Orthopedics, Sichuan Academy of Medical Science, People’s Hospital of Sichuan Province, Chengdu Sichuan, 610072, P. R. China
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Wang W, Liu H, Wu Z, Teng Y, Huang Y, Liu T, Yang H. A Comparison of Percutaneous Kyphoplasty with High-Viscosity and Low-Viscosity Bone Cement for Treatment of Osteoporotic Vertebral Compression Fractures: A Retrospective Study. Geriatr Orthop Surg Rehabil 2022; 13:21514593221119625. [PMID: 36090795 PMCID: PMC9459459 DOI: 10.1177/21514593221119625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/13/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background Osteoporotic vertebral compression fracture (OVCF) has become a health issue
of worldwide concern. Percutaneous kyphoplasty (PKP) is one of the main
surgical methods for OVCFs. This study aimed to evaluate and compare the
clinical efficacy and safety of PKP with high- and low-viscosity bone cement
for OVCFs. Methods Totally 62 patients with single-level OVCF were enrolled in this study from
December 2018 to April 2021. Among them, 32 cases underwent PKP with
high-viscosity bone cement, while 30 cases underwent PKP with low-viscosity
bone cement. Visual analog scale (VAS) scores and Oswestry disability index
(ODI) scores were used in the pre- and post-operative period to assess
patients’ rehabilitation. Compression rates of anterior vertebra height
(AVH) and posterior vertebra height (PVH) were analyzed to evaluate the
restoration of vertebra height. Leakage rates and locations were recorded to
show clinical safety. Results VAS and ODI scores both significantly improved in 2 groups at 1 day, 1 month,
and 3 months after surgery. Compression rates of AVH and PVH at 1 day and
3 months after PKP were lower than those before surgery. However, there was
no significant difference in VAS scores, ODI scores, and compression rates
between both groups. However, PKP with high-viscosity bone cement achieved a
lower bone cement leakage rate significantly, which showed the safety of
high-viscosity bone cement in PKP. Conclusions PKP with high- and low-viscosity bone cement both improved the recovery of
patients and restored vertebra heights. Notably, PKP with high-viscosity
bone cement can achieve favorable clinical outcomes as well as lower bone
cement leakage rate.
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Affiliation(s)
- Wenhao Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhikai Wu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun Teng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yixue Huang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
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Si F, Yuan S, Zang L, Fan N, Wu Q, Wang T, Wang A. Paraspinal Muscle Degeneration: A Potential Risk Factor for New Vertebral Compression Fractures After Percutaneous Kyphoplasty. Clin Interv Aging 2022; 17:1237-1248. [PMID: 35990803 PMCID: PMC9385132 DOI: 10.2147/cia.s374857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background The paraspinal muscle is essential for maintaining normal spine function and structure, which degeneration is closely related to various spinal diseases. The main objective of this study was to identify the potential role of paraspinal muscle degeneration in the occurrence of new vertebral compression fractures (NVCF) and develop a clinically applicable nomogram for prospective NVCF risk prediction. Methods A total of 202 patients with single-level osteoporotic vertebral compression fractures (OVCF) who underwent percutaneous kyphoplasty treatment between January 2016 and March 2019 were included in this study. Demographic, clinical, radiological, and treatment data were collected and analyzed. The paraspinal muscle cross-sectional area (CSA) and fat signal fraction (FSF) were measured to quantify the extent of muscle degeneration. Multivariate binary logistic regression analysis was performed to select risk factors to build a nomogram that predicted the occurrence of NVCF. The concordance index (C-index) and calibration curve were used to evaluate the discriminative capacity and predictive accuracy of the nomogram. Results NVCF occurred in 54 of 202 patients (26.7%). The erector spinae FSF (OR = 1.064; P = 0.001), psoas major FSF (OR = 1.326; P < 0.001), and the difference index of the muscle CSA between multifidus and psoas major (OR = 1.048; P < 0.001) were independent risk factors for the occurrence of NVCF. The nomogram performance was good after evaluation using the calibration curves and C-index (95% confidence interval, 0.854–0.943). Conclusion Paraspinal muscle degeneration is a potential risk factor for NVCF occurrence. A nomogram was designed to precisely predict the risk of NVCF. This predictive nomogram may help clinicians to make better clinical decisions and provide more accurate functional exercise protocol for OVCF patients.
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Affiliation(s)
- Fangda Si
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
| | - Qichao Wu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
| | - Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
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Yang B, Zhao Y, Zhao Y. Is percutaneous kyphoplasty safe and beneficial for patients aged 90 and over? Medicine (Baltimore) 2022; 101:e30138. [PMID: 35984140 PMCID: PMC9387994 DOI: 10.1097/md.0000000000030138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND At present, to a large extent, we do not know the safety and benefits of minimally invasive surgery for elderly patients, especially the focus population of patients aged 90 and over. METHODS We analyzed 189 consecutive patients with osteoporotic vertebral compression fractures who underwent percutaneous kyphoplasty (PKP) between January 2018 and June 2021 at our institution. We divided them into the advanced age group aged 90 years or over (group A, n = 14) and the younger group under 90 years (group Y, n = 175). Clinical and complication indicators were evaluated and compared between the 2 groups. RESULTS A significant difference was observed in the procedure time, bleeding volume, and bone mineral density between the 2 groups during an average follow-up of 22 months. However, no significant difference was revealed in clinical and complication indicators between the 2 groups, and the pain and activity function of the 2 groups were significantly improved compared with those before PKP. CONCLUSIONS Apparently, our results show that PKP is safe and beneficial for patients aged 90 years or older.
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Affiliation(s)
- Bo Yang
- Graduate School of Xi’an Medical University, Xi’an, China
- Department of Orthopaedics, the Ninth Hospital of Xi’an, Xi’an, China
| | - Yu Zhao
- Department of Orthopaedics, the Ninth Hospital of Xi’an, Xi’an, China
| | - Yangxue Zhao
- Department of Orthopaedics, the Ninth Hospital of Xi’an, Xi’an, China
- *Correspondence: Yangxue Zhao, Department of Orthopaedics, the Ninth Hospital of Xi’an, No. 151, East Section of South Second Ring Road, Xi’an China (e-mail:)
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Yang B, Zhao Y, Zhao Y. Is the incidence of sandwich vertebral fracture higher than that of ordinary adjacent vertebral fracture after PKP? Medicine (Baltimore) 2022; 101:e29900. [PMID: 35801767 PMCID: PMC9259101 DOI: 10.1097/md.0000000000029900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To compare the incidence of fracture between sandwich vertebra and ordinary adjacent vertebra after percutaneous kyphoplasty (PKP). METHOD We analyzed 225 consecutive patients with osteoporotic vertebral compression fractures who underwent PKP between January 2016 and December 2020 at our medical institution. The sandwich vertebrae was located between 2 cement-augmented vertebra and was followed for at least 12 months. The clinical data of patients with sandwich vertebra and ordinary adjacent vertebra were recorded, and the incidence of postoperative fracture between sandwich vertebra and ordinary adjacent vertebra was compared. RESULTS The mean continuous follow-up time was 31.30 ± 18.04 months in patients with sandwich vertebra and 25.85 ± 7.96 months in patients with ordinary adjacent vertebra. It should be noted that the incidence of sandwich vertebral fractures was 10.00%, which was not statistically higher than 3.26% for ordinary adjacent vertebral fractures. However, a significant difference was observed in the cement volume of single vertebral body, procedure time, and bleeding. CONCLUSION Although the volume of cement in a single vertebral body is less and the procedure time and bleeding are more, the incidence of sandwich vertebral fracture is not higher than that of ordinary adjacent vertebral body.
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Affiliation(s)
- Bo Yang
- Graduate School of Xi’an Medical University, Xi’an, China
- Department of Orthopaedics, The Ninth Hospital of Xi’an, Xi’an, China
| | - Yu Zhao
- Department of Orthopaedics, The Ninth Hospital of Xi’an, Xi’an, China
| | - Yangxue Zhao
- Department of Orthopaedics, The Ninth Hospital of Xi’an, Xi’an, China
- * Correspondence: Yangxue Zhao, Department of Orthopaedics, The Ninth Hospital of Xi’an, No. 151, East Section of South 2nd Ring Road, Beilin District, Xi'an City, 710054, Xi'an, Shaanxi Province, China. (e-mail: )
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Yuan W, Meng X, Cao W, Zhu Y. Robot-Assisted Versus Fluoroscopy-Assisted Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture: A Retrospective Study. Global Spine J 2022; 12:1151-1157. [PMID: 33375861 PMCID: PMC9210249 DOI: 10.1177/2192568220978228] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES To compare the clinical and radiological outcomes of robot assisted (RA) and fluoroscopy assisted (FA) percutaneous kyphoplasty (PKP) in treating single/double segment osteoporotic vertebral compression fracture (OVCF). METHODS Patients with single/double segment OVCF receiving either RA or FA PKP were evaluated retrospectively at our spine center from April 2018 to October 2019. The operation time, fluoroscopy frequency, fluoroscopy exposure time, total radiation dose, visual analogue scale (VAS), local kyphosis angle (LKA), height of fractured vertebra (HFV) and complications were compared between the single/double RA group and the FA group. RESULTS A total of 96 cases were included in this study, with 59 cases of single segment OVCF and 37 cases of double segment OVCF. For single/double segment OVCF, both RA and FA PKP could relieve pain and reduce fracture. The RA group showed lower fluoroscopy frequency, shorter fluoroscopy exposure time during operation for surgeons, better correction in LKA and HFV, lower rate of cement leakage, but more fluoroscopy frequency, fluoroscopy exposure time and radiation dose for patients compared with the FA group (P < 0.05), while the single RA group showed longer operation time compared with the FA group (P < 0.05). CONCLUSIONS For single/double segment OVCF, RA has more advantages in correcting vertebra fracture, reducing intraoperative radiation exposure for surgeons, and reducing the cement leakage rate, but it increases intraoperative radiation for patients compared with FA PKP. And FA has shorter operation time in treating single segment OVCF than RA PKP.
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Affiliation(s)
- Wei Yuan
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China,Yue Zhu and Wei Yuan, Department of Orthopedics, The First Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang 110001, China. Emails: ;
| | - Xiaotong Meng
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China
| | - Wenhai Cao
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China
| | - Yue Zhu
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China,Yue Zhu and Wei Yuan, Department of Orthopedics, The First Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang 110001, China. Emails: ;
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Pan D, Chen D. Comparison of Unipedicular and Bipedicular Percutaneous Kyphoplasty for Kummell's Disease. Geriatr Orthop Surg Rehabil 2022; 13:21514593221099264. [PMID: 35557599 PMCID: PMC9087232 DOI: 10.1177/21514593221099264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To compare the clinical efficacy of unipedicular and bipedicular percutaneous kyphoplasty (PKP) for Kummell's disease. Methods A retrospective study was performed to review 40 patients with stage I and II Kummell's disease who underwent PKP in our hospital from January 2015 to June 2018. Based on the transpedicular approach of PKP, those patients were randomly divided into unipedicular group (n = 19) and bipedicular group (n = 21). Operative time, bone cement injection volume and cement leakage rate were compared in the two groups. Pre- and post-operative visual analogue score (VAS), local kyphotic angle and average vertebral height were also evaluated. Results All patients underwent surgery successfully. Compared with preoperative condition, VAS was significantly decreased at 1 day after operation and the last follow-up in both groups (P < .05), and local kyphotic angle and average vertebral height were restored markedly (P < .05). Operative time of both groups had no significant difference (P > .05). Bone cement injection volume was larger in bipedicular group (P < .05). At 1 day after operation and the last follow-up, the local kyphotic angle and average vertebral height in bipedicular group were restored better than those in unipedicular group (P < .05). There were 4 cases of cement leakage in both groups, with leakage rates of 21.1% and 19.0%, respectively, and the difference was not significant (P > .05). Conclusion Both unipedicular and bipedicular PKP are effective for treating patients with stage I and II Kummell's disease, while postoperative pain relief and imaging results in bipedicular group were better than those in unipedicular group.
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Affiliation(s)
- Dan Pan
- Department of Spinal Surgery, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou, China
| | - Dayong Chen
- Department of Spinal Surgery, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou, China
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Huang C. Life-threatening intracardiac cement embolisms after percutaneous kyphoplasty: a case report and literature review. J Int Med Res 2022; 50:3000605221102088. [PMID: 35638519 PMCID: PMC9160901 DOI: 10.1177/03000605221102088] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Percutaneous kyphoplasty is a popular technique in the treatment of osteoporotic vertebral fractures, but intracardiac cement embolism can be a life-threatening complication.Case presentation: The authors present a case involving a patient who developed dyspnea and chest tightness after percutaneous kyphoplasty. Echocardiography and chest computed tomography confirmed several foreign bodies in the right atrium and pulmonary arteries causing cardiac perforation and pericardial tamponade. Conservative treatment was administered, and the patient died of respiratory and heart failure. CONCLUSIONS The present case highlights that surgical removal may be the first-choice treatment for symptomatic intracardiac cement embolism.
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Affiliation(s)
- Chunneng Huang
- Department of Orthopedics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine
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Xu R, Li S, Chen G, Fan X. The effect of additional facet joint block for analgesia in patients with thoracolumbar compression fracture undergoing percutaneous kyphoplasty surgery: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29034. [PMID: 35451411 PMCID: PMC8913086 DOI: 10.1097/md.0000000000029034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There is currently no pooled data in the literature to support whether additional facet joint block results in better clinical analgesia after percutaneous kyphoplasty. We assessed the existing evidence on the safety and efficacy of facet joint block in the treatment of patients with thoracolumbar compression fractures undergoing percutaneous kyphoplasty based on qualified trials. METHODS We will search PubMed, Springer, ScienceDirect, Wanfang, and Cochrane Library databases through April, 2022. Cohort studies focusing on assessing and comparing the effect of facet joint block and control group will be included. The studies are screened and evaluated by 2 reviewers independently for eligibility. The following outcome measures must be showed: pain scores, Oswestry Disability Index, satisfaction, and complications observed within both groups from baseline to the end of follow-up period. Review Manager software (v 5.3; Cochrane Collaboration) is used for the meta-analysis. A P value of <.05 is considered to be statistically significant. Two independent reviewers will assess the risk of bias of the included studies at study level. RESULTS It is hypothesized that additional facet joint block is associated with better pain control. CONCLUSIONS This study expects to provide credible and scientific evidence for the efficacy and safety of facet joint block in the treatment of patients with thoracolumbar compression fractures undergoing percutaneous kyphoplasty. REGISTRATION NUMBER 10.17605/OSF.IO/ARY3C.
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Zhang B, Chen G, Yang X, Fan T, Chen Z. Percutaneous Kyphoplasty Versus Percutaneous Vertebroplasty for Neurologically Intact Osteoporotic Kümmell's Disease: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:308-322. [PMID: 33541141 PMCID: PMC8907641 DOI: 10.1177/2192568220984129] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are minimally invasive techniques widely used for the treatment of neurologically intact osteoporotic Kümmell's disease (KD), but which treatment is preferable remains controversial. Therefore, this study aimed to shed light on this issue. METHODS Six databases were searched for all relevant studies based on the PRISMA guidelines. Two investigators independently conducted a quality assessment, extracted the data and performed all statistical analyses. RESULTS Eight studies encompassing 438 neurologically intact osteoporotic KD patients met the inclusion criteria. Compared to PVP, PKP was associated with greater improvement in the short- and long-term Cobb angle [SMD = -0.37, P = 0.007; SMD = -0.34, P = 0.012], short-term anterior vertebral height [SMD = 0.43, P = 0.003] and long-term middle vertebral height [SMD = 0.57, P = 0.012] and a lower cement leakage rate [SMD = 0.50, P = 0.003] but produced more consumption (cement injection volume, operative time, fluoroscopy times, intraoperative blood loss and operation cost). However, there were no differences between the 2 procedures in the short- and long-term VAS and ODI scores, long-term anterior vertebral height, overall complications or new vertebral fractures. CONCLUSIONS Both procedures are equally effective for neurologically intact KD in terms of the clinical outcomes, with the exception of a lower cement leakage risk and better radiographic improvement for PKP but greater resource consumption. Based on the evidence available, good clinical judgment should be exercised in the selection of patients for these procedures.
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Affiliation(s)
- Baoliang Zhang
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Guanghui Chen
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Xiaoxi Yang
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Tianqi Fan
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
| | - Zhongqiang Chen
- Orthopaedic Department, Peking University Third Hospital, Beijing, China,Zhongqiang Chen, Orthopaedic Department,
Peking University Third Hospital, No. 49 North Garden Road, Haidian District,
Beijing 100191, China.
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Cheng Y, Cheng X, Wu H. Risk factors of new vertebral compression fracture after percutaneous vertebroplasty or percutaneous kyphoplasty. Front Endocrinol (Lausanne) 2022; 13:964578. [PMID: 36120447 PMCID: PMC9470857 DOI: 10.3389/fendo.2022.964578] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND New vertebral compression fracture (VCF) may occur in patients who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF). However, the risk factors of new VCF remain controversial. The research aimed to analyze the risk factors of new VCF after PVP or PKP. METHODS From August 2019 to March 2021, we retrospectively analyzed the patients who underwent PVP or PKP for OVCF at our institution. Age, gender, body mass index (BMI), smoking, drinking, hypertension, diabetes, fracture location, surgical method, Hounsfield unit (HU) value, preoperative degree of anterior vertebral compression (DAVC), bisphosphonates, bone cement volume, bone cement leakage, and cement distribution were collected. The risk factors were obtained by univariate and multivariate analysis of the data. RESULTS A total of 247 patients were included in the study. There were 23 patients (9.3%) with new VCF after PVP or PKP. Univariate analysis showed that age (p < 0.001), BMI (p = 0.002), fracture location (p = 0.030), and a low HU value (p < 0.001) were significantly associated with new VCF after PVP or PKP. A low HU value was an independent risk factor for new VCF after PVP or PKP obtained by multivariate regression analysis (OR = 0.963; 95% CI, 0.943-0.984, p = 0.001). CONCLUSIONS In this study, a low HU value was an independent risk factor of new VCF after PVP or PKP.
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Affiliation(s)
- Yuanpei Cheng
- Department of Orthopeadics, China-Japan Union Hospital of Jilin University, Jilin, China
| | - Xiaokang Cheng
- Department of Orthopaedics, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, China
| | - Han Wu
- Department of Orthopeadics, China-Japan Union Hospital of Jilin University, Jilin, China
- *Correspondence: Han Wu,
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Xue YD, Zhang ZC, Dai WX. Investigation of Preoperative Traction Followed by Percutaneous Kyphoplasty Combined with Percutaneous Cement Discoplasty for the Treatment of Severe Thoracolumbar Osteoporotic Vertebral Compression Fractures. Int J Gen Med 2021; 14:6563-6571. [PMID: 34675623 PMCID: PMC8520486 DOI: 10.2147/ijgm.s333532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/13/2021] [Accepted: 09/13/2021] [Indexed: 01/15/2023] Open
Abstract
Objective To evaluate the feasibility, clinical efficacy and imaging results of preoperative traction (PT) followed by percutaneous kyphoplasty (PKP) combined with percutaneous cement discoplasty (PCD) for treating severe thoracolumbar osteoporotic vertebral compression fractures (OVCFs). Methods A total of 13 patients with severe thoracolumbar OVCFs treated by PT followed by PKP combined with PCD were enrolled. General information, PT time, operation time, postoperative hospital stay, perioperative complications, visual analog scale (VAS) score, Oswestry disability index (ODI) score, local kyphosis angle, intervertebral angle (IVA), anterior vertebral height (AVH) and posterior vertebral height (PVH) were recorded. Results The average VAS score at admission was 7.4±3.5, decreased to 4.3±1.7 after PT and 2.3±0.7 three days after operation, and 1.5±0.9 at last follow-up. The average ODI score was 73.7±21.4 before operation, decreased to 26.6±9.3 three days after operation and 13.7±7.1 at last follow-up. Compared to VAS and ODI scores at admission, these at the third day after operation and last follow-up were significantly different. At admission, the IVA was 3.4°±6.8°, the disc height was 5.7±1.2mm, the AVH was 10.7±3.2mm, and the PVH was 25.7±4.2 mm, which, after PT, changed to 8.1°±7.3°, 8.6±2.6mm, 18.5±2.8mm, and 26.2±7.1mm, respectively, and the differences were significant. The average kyphotic angle was 43.4°±17.8° at admission, and decreased to 26.3°±6.7° after PT, 17.5°±8.4° three days after operation and 19.1°±10.3° at last follow-up, and the differences were significant. Conclusion PT followed by PKP combined with PCD for the treatment of severe thoracolumbar OVCFs was an effective and simple procedure with satisfactory short-term clinical outcomes by relieving pain and improving kyphosis.
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Affiliation(s)
- You-Di Xue
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou, Jiangsu Province, People's Republic of China
| | - Zhao-Chuan Zhang
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou, Jiangsu Province, People's Republic of China
| | - Wei-Xiang Dai
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou, Jiangsu Province, People's Republic of China
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Yang YJ, Chen YA, Chung MH, Hsieh CC, Huang KL, Ju DT. Cerebral air embolism after percutaneous kyphoplasty: a rare case report. Br J Neurosurg 2021:1-2. [PMID: 34410216 DOI: 10.1080/02688697.2021.1968343] [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: 06/13/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Cerebral air embolism (CAE) is considered as a rare complication during the routine medical procedures in the literature review. We reported a very rare complication of CAE after the percutaneous kyphoplasty (PKP) for the treatment of acute vertebral compression fracture.
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Affiliation(s)
- Yun-Ju Yang
- Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yi-An Chen
- Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ming-Hsuan Chung
- Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chih-Chuan Hsieh
- Department of Surgery, Zoying Branch, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, Republic of China
| | - Kun-Lun Huang
- Division of Pulmonary Medicine and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
- Hyperbaric Oxygen Treatment Center, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Da-Tong Ju
- Department of Neurological Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Pan H, Ding S, Zhao X, Lin Z, Ye H, Ni Z, Fu C, Xia J. [Bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture of lumbar]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021; 35:1007-1013. [PMID: 34387430 DOI: 10.7507/1002-1892.202103028] [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: 02/03/2023]
Abstract
Objective To evaluate the feasibility and short-term effectiveness of bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture (OVCF) of lumbar. Methods A retrospective analysis was made on the clinical data of 93 patients with OVCF of lumbar who met the selection criteria between January 2018 and June 2019. According to the different surgical methods, they were divided into group A (44 cases, treated with bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach) and group B [49 cases, treated with percutaneous kyphoplasty (PKP) via bilateral transpedicle approach]. There was no significant difference in gender, age, body mass index, T value of bone mineral density, injury cause, fractured level, time from injury to operation, comorbidities, and preoperative Cobb angle of injured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups ( P>0.05). The operation time, intraoperative fluoroscopy times, bone cement injection amount, and incidence of bone cement leakage were recorded and compared between the two groups; Cobb angle of the injured vertebrae, VAS score, and ODI were measured before operation, at 2 days and 1 year after operation. The contralateral distribution ratio of bone cement was calculated according to the anteroposterior X-ray film at 2 days after operation. Results The operation time and the intraoperative fluoroscopy times in group A were significantly less than those in group B ( P<0.05). There was no bone cement adverse reactions, cardiac and cerebrovascular adverse events, and no complications such as puncture needles erroneously inserted into the spinal canal and nerve injuries occurred in the two groups. Bone cement leakage occurred in 6 cases and 8 cases in groups A and B, respectively, all of which were asymptomatic paravertebral or intervertebral leakage, and no intraspinal leakage occurred; the bone cement injection amount and incidence of bone cement leakage between the two groups showed no significant differences ( P>0.05). The contralateral distribution ratio of bone cement in group A was significantly lower than that in group B ( t=2.685, P=0.009). Patients in both groups were followed up 12-20 months, with an average of 15.3 months. The Cobb angle of the injured vertebrae, VAS score, and ODI in the two groups were significantly improved at 2 days after operation, however, the Cobb angle of the injured vertebra at 1 year after operation was significantly lost when compared with the 2 days after operation, the VAS score and ODI at 1 year after operation were significantly further improved when compared with the 2 days after operation, the differences were all significant ( P<0.05). There was no significant difference in the Cobb angle of the injured vertebrae, VAS score, and ODI between the two groups at each time point after operation ( P>0.05). Conclusion Bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach is comparable to bilateral PKP in short-term effectiveness with regard to fracture reduction, reduction maintenance, pain relief, and functional improvement. It has great advantages in reducing operation time and radiation exposure, although it is inferior in bone cement distribution.
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Affiliation(s)
- Hong Pan
- Center of Orthopedics, the 903th Hospital of People's Liberation Army, Hangzhou Zhejiang, 310001, P.R.China
| | - Shuchen Ding
- Center of Orthopedics, the 903th Hospital of People's Liberation Army, Hangzhou Zhejiang, 310001, P.R.China
| | - Xinhua Zhao
- The Third Department of Orthopedics, Zhejiang Hospital, Hangzhou Zhejiang, 310001, P.R.China
| | - Zongyang Lin
- Center of Orthopedics, the 903th Hospital of People's Liberation Army, Hangzhou Zhejiang, 310001, P.R.China
| | - Hong Ye
- Center of Orthopedics, the 903th Hospital of People's Liberation Army, Hangzhou Zhejiang, 310001, P.R.China
| | - Zhiming Ni
- Center of Orthopedics, the 903th Hospital of People's Liberation Army, Hangzhou Zhejiang, 310001, P.R.China
| | - Chudi Fu
- Center of Orthopedics, the 903th Hospital of People's Liberation Army, Hangzhou Zhejiang, 310001, P.R.China
| | - Junjie Xia
- Center of Orthopedics, the 903th Hospital of People's Liberation Army, Hangzhou Zhejiang, 310001, P.R.China
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Li D, Zhou Y, Cui H, Kong L, Zhu W, Chai X, Zhuo H. Analysis of the curative effect of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture with intravertebral clefts. Medicine (Baltimore) 2021; 100:e25996. [PMID: 34087844 PMCID: PMC8183815 DOI: 10.1097/md.0000000000025996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/25/2021] [Indexed: 01/04/2023] Open
Abstract
Kummell's disease is a delayed vertebral collapse fracture caused by posttraumatic osteonecrosis. It is a special type of osteoporotic vertebral fracture in the elderly. This study compares and analyzes the difference in the curative effect of 2 kinds of osteoporotic vertebral compression fracture (OVCF) in the presence of fracture or not in the vertebral body, and provides a clinical reference for the application of percutaneous kyphoplasty (PKP).This research is a kind of retrospective analysis from January 2012 to January 2015, PKP was used to treat 165 patients with osteoporotic vertebral compression fracture. The patients were divided into 2 groups: Intravertebral clefts group (group A) and none-intravertebral clefts group in vertebral body (group B). Bone mineral density (BMD), bone cement injection (BCI), Visual analogue scale (VAS) score before and after surgery, anterior, central and posterior height of vertebral body (before and after surgery) and Cobb angle of injured vertebra (before and after surgery) were compared between the 2 groups.Surgeries for 165 patients in the 2 groups were successfully completed, and 226 fractured vertebrae were performed through bilateral puncture approach to strengthen the vertebral body. Intraoperative injection of bone cement (ml) was 4.25 + 1.29 (range: 2.6-7.8). There were statistically significant differences in bone cement injection quantity between the 2 groups (P < .05), and in bone cement leakage (P > .05) as well as the Postoperative VAS score (P < .05). However, There was no statistical difference in VAS score before surgery between the 2 groups (P > .05). The results indicated that the pain relief degree of OVCF patients without intravertebral clefts is better than that in the vertebral body. No statistical difference was found in Cobb Angle before and after surgery (P > .05), as well as the correction rate of the injured vertebrae before and after surgery (P > .05). There was no statistical difference in the degree of recovery of the anterior, middle and posterior margins of the injured vertebrae after surgery (P > .05).PKP treatment led to better degree of pain relief in OVCF patients without intravertebral clefts, and less bone cement was injected into the surgery.
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Tan B, Yang QY, Fan B, Lei C, Hu ZM. Is It Necessary to Approach the Severe Osteoporotic Vertebral Biconcave-Shaped Fracture Bilaterally During the Process of PKP? J Pain Res 2021; 14:1601-1610. [PMID: 34113167 PMCID: PMC8187090 DOI: 10.2147/jpr.s293528] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/03/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose The goal of this study was to explore the outcomes of unilateral and bilateral approach percutaneous kyphoplasty (PKP) using CT-guidance in the treatment of severe osteoporotic single-level vertebral biconcave-shaped fracture. Methods We retrospectively reviewed 89 patients with severe osteoporotic single-level vertebral biconcave-shaped fracture who had undergone unilateral and bilateral PKP surgeries using CT-guidance at our hospital between June 2013 and June 2019, and followed for at least 1 year. All patients were divided into unilateral (the transverse process-pedicle approach, n = 49) and bilateral (the pedicle approach, n = 40) groups. We collected the clinical and radiological evaluation results during postoperative and last follow-up periods. Results Our findings revealed that the surgery time for the unilateral group was significantly shorter than that of the bilateral group at P < 0.05. The amount of bone cement and radiation exposure of the unilateral group were significantly lesser than that of the bilateral group (P < 0.05). Relative to preoperative data, the values of the VAS score and Oswestry disability index (ODI) were significantly improved at 1 day after surgery and the last follow-up in the two groups (P < 0.05). Notably, the median height of vertebra at 1 day after surgery and the last follow-up in the unilateral group was significantly restored than that of preoperative data (P < 0.05). However, the median height of vertebra at the same time intervals in the bilateral group showed no significant change compared with preoperative data (P > 0.05). Furthermore, the rate of bone cement leakage and incidence of adjacent-level vertebra fracture were not significantly different in the two groups (P > 0.05). Finally, both groups can obtain an asymmetrical distribution of bone cement in the vertebra. Conclusion Compared to the bilateral PKP, unilateral PKP using CT-guidance in the treatment of the sOVBFs exhibits significantly shorter operation time, lesser radiation dose, and complications. Moreover, unilateral PKP can restore the median height of the vertebral body and eventually obtain a symmetrical distribution of bone cement in the vertebra.
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Affiliation(s)
- Bing Tan
- Department of Orthopedic, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Department of Spine Surgery, The Third Hospital of MianYang, Sichuan Mental Health Center, Mianyang, People's Republic of China
| | - Qi-Yuan Yang
- Department of Spine Surgery, The Third Hospital of MianYang, Sichuan Mental Health Center, Mianyang, People's Republic of China
| | - Bin Fan
- Department of Spine Surgery, The Third Hospital of MianYang, Sichuan Mental Health Center, Mianyang, People's Republic of China
| | - Chao Lei
- Department of Spine Surgery, The Third Hospital of MianYang, Sichuan Mental Health Center, Mianyang, People's Republic of China
| | - Zhen-Ming Hu
- Department of Orthopedic, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Tian P, Liu Y, Li ZJ, Xu GJ, Ma XL. Zoledronic Acid in Osteoporotic Vertebral Compression Fractures Treated With Percutaneous Kyphoplasty: A Meta-Analysis. Front Surg 2021; 8:668551. [PMID: 34095207 PMCID: PMC8176012 DOI: 10.3389/fsurg.2021.668551] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: We performed a meta-analysis to evaluate the efficacy and safety of zoledronic acid combined with percutaneous kyphoplasty (PKP) in treating osteoporotic vertebral compression fractures (OVCFs). Methods: Eligible scientific articles published prior to July 2020 were retrieved from the PubMed, Springer, ScienceDirect, and Cochrane Library databases. The statistical analysis was performed with RevMan 5.1. Results: Three randomized controlled trials (RCTs) and 2 non-RCTs met the inclusion criteria. The present meta-analysis revealed that zoledronic acid combined with PKP is associated with a higher BMD, a better quality of life, less severe low back pain, and fewer additional vertebral body fractures than is percutaneous vertebral augmentation alone. Conclusions: Compared with PKP only, zoledronic acid combined with percutaneous vertebral augmentation is beneficial for OVCFs.
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Affiliation(s)
- Peng Tian
- Department of Traumatic Orthopedics, Tianjin Hospital, Tianjin, China
| | - Yue Liu
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Zhi-Jun Li
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Gui-Jun Xu
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Xin-Long Ma
- Department of Traumatic Orthopedics, Tianjin Hospital, Tianjin, China
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Wang H, Wang C, Sun C, Liu XH, Gong G, Yin J. [Effect of Sarcopenia on the Efficacy of Percutaneous Kyphoplasty in the Treatment of Osteoporotic Spinal Compression Fractures in Elderly Patients]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2021; 43:153-158. [PMID: 33966691 DOI: 10.3881/j.issn.1000-503x.12818] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective To investigate the effect of sarcopenia on the efficacy of percutaneous kyphoplasty(PKP)in the treatment of osteoporotic spinal compression fracture(OSCF)in elderly patients. Methods From February 2017 to June 2018,a total of 77 elderly patients who met the inclusion and exclusion criteria were included in this study.Grip strength of dominant hand was measured by an electronic grip dynamometer with cut-off values of 27 kg for males and 16 kg for females.The cross-sectional area of the pedicle level muscle of the 12th thoracic vertebra(T12)was measured by chest CT.The skeletal muscle index(SMI)was calculated by dividing the T12 pedicle level muscle cross-sectional area by the square of body height.The SMI cut-off value used to diagnose sarcopenia was 42.6 cm2/m2for males and 30.6 cm2/m2 for females.Sarcopenia is confirmed when both grip strength and SMI are below the cut-off values.The patients with OSCF all received PKP.The patients in the sarcopenia and non-sarcopenia groups were compared in terms of age,gender,body weight,operation duration,the amount of bleeding,time to ambulation,hospital stay,visual analogue scale(VAS)before and 1 month after operation,Oswestry disability index(ODI)1 month after operation as well as the incidence of refracture within 1 year after operation. Results Gender,body weight,operation duration,the amount of bleeding and the preoperative VAS score showed no significant difference between the two groups(χ2=3.563,P=0.059;t=0.406,P=0.686;t=1.119,P=0.267;t=-0.166,P=0.868;z=-1.076,P=0.282).The patients in the sarcopenia group showed longer time to ambulation,longer hospital stay,higher VAS score and ODI 1 month after operation than those in the non-sarcopenia group(t=3.938,P<0.001;t=5.655,P<0.001;z=-4.562,P<0.001;z=-5.222,P<0.001).There was no significant difference in the incidence of refracture within 1 year after operation between the two groups(χ2=0.596,P=0.440).Linear regression results showed that age did not affect the hospital stay,rehabilitation duration,VAS score or ODI(P=0.519,P=0.870,P=0.332,P=0.126),whereas sarcopenia had significant effects(P<0.001,P=0.001,P<0.001,P<0.001). Conclusions Sarcopenia with OSCF has poorer limb function recovery.Reasonable rehabilitation exercise and dietary therapy are necessary for patients with sarcopenia.
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Affiliation(s)
- Hua Wang
- Department of Orthopedics,The Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 211100,China
| | - Chao Wang
- Department of Orthopedics,The Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 211100,China
| | - Chao Sun
- Department of Orthopedics,The Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 211100,China
| | - Xin Hui Liu
- Department of Orthopedics,The Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 211100,China
| | - Ge Gong
- Department of Geriatrics,Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China
| | - Jian Yin
- Department of Orthopedics,The Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 211100,China
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Li K, Gong H, Xie R, Gu J, Wang S, Lin C, Yin J, Hou X, Zhang Q, Li L, Hao Y. Clinical efficacy of zoledronic acid combined with percutaneous kyphoplasty in the prevention and treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25215. [PMID: 33787604 PMCID: PMC8021281 DOI: 10.1097/md.0000000000025215] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/23/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE: The aim of this study is to investigate the clinical efficacy of zoledronic acid (ZOL) in the treatment and prevention of osteoporotic vertebral compression fractures (OVCF) after percutaneous kyphoplasty (PKP) for elderly patients. METHODS: The PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and Embase were investigated through June 2020. All randomized controlled trials (RCT) involving ZOL injections for OVCF were enrolled. Outcome indicators included the bone mineral density (BMD), Visual Analog Scale (VAS), recompression vertebral fracture (RVF), Oswestry Disability Index (ODI), and bone metabolism (Procollagen type I N-terminal propeptide [PINP] and βcross-linked C-telopeptide of type I collagen [β-CTX]), bone cement leakage. Review Manager 5.3 was used to analyze these indicators. RESULTS: In this study, (1).. Eight studies had met the eligibility criteria, a total of 578 participants were involved (285 and 293 in the experimental (ZOL) group and control [no ZOL] group, respectively). (2).. The BMD scores of patients with OVCF in the experimental group were significantly higher than that in the control group (P < .05). The VAS scores were significantly different between the 2 groups at the 6, 12 months follow-up (P < .05). After PKP operation, ZOL injections reduced the rate of RVF (P < .05). In the comparison of ODI scores, the experimental group improved compared with the control group (P < .05). Respectively, the bone metabolism of patients with OVCF after ZOL was better than that of patients in control group (P < .05). CONCLUSION: Zoledronic acid had a significant effect on the treatment and prevention of OVCF in elderly osteoporotic patients after PKP. Due to the limited quality and data, more high-quality studies are needed to confirm the results of this meta-analysis.
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Affiliation(s)
- Kaiming Li
- Wangjing Hospital of CACMS, Beijing 100102
| | - Hao Gong
- Beijing Changping Hospital of Intergrated Chinese And Western Medicine, Beijing 102208
| | - Rui Xie
- Wangjing Hospital of CACMS, Beijing 100102
| | - Jinyu Gu
- Wangjing Hospital of CACMS, Beijing 100102
| | | | | | - Jing Yin
- Wangjing Hospital of CACMS, Beijing 100102
| | | | - Qing Zhang
- Wangjing Hospital of CACMS, Beijing 100102
| | - Linghui Li
- Wangjing Hospital of CACMS, Beijing 100102
| | - Yanke Hao
- Affiliated Hospital of Shandong University of TCM, Jinan 250000, China
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Zhang Z, Kong H, Zhang SY, Guan TT. Takotsubo syndrome triggered by change in position in a patient with thoracic vertebral fracture: A case report. Medicine (Baltimore) 2021; 100:e24088. [PMID: 33466170 PMCID: PMC10545422 DOI: 10.1097/md.0000000000024088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/26/2020] [Accepted: 12/08/2020] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Takotsubo syndrome (TTS) is characterized by recovery of wall motion abnormalities and acute left ventricular dysfunction, which are often caused by acute physical or emotional stressors. It is rarely reported that TTS can be precipitated by change in position in the patient in the operating room. We report a case of a patient with a thoracic vertebral fracture who presented with TTS precipitated by changing from a supine to a prone position before percutaneous kyphoplasty (PKP) under local anesthesia. PATIENT CONCERNS A 76-year-old man who was diagnosed with a fracture in a thoracic vertebra was sent to the operating room to undergo PKP under local anesthesia. Approximately 5 minutes after changing from a supine to a prone position, which is necessary for PKP, the patient experienced chest pain, headache, and sweating. DIAGNOSIS A fracture in a thoracic vertebra; TTS. INTERVENTIONS As a result of 12-lead electrocardiography, echocardiography, left ventriculogram, and cardiac catheterization, the diagnosis of TTS was retained, and supportive therapy was initiated. OUTCOMES Two hours later, the patient's symptoms mitigated significantly and the ST segment returned to baseline. Four days later, echocardiography showed normal systolic function without wall motion abnormalities and the patient returned to the orthopedics ward for further treatment. LESSONS It is necessary for anesthetists to recognize TTS which is life-threatening during monitored anesthetic care (MAC). We highlight the importance of being alerted to the possibility of TTS when managing patients with thoracic vertebral fractures undergoing surgery under local anesthesia.
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Affiliation(s)
| | | | - Si-Yu Zhang
- Department of Cardiac Surgery, Peking University First Hospital, Beijing, China
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