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Shi D, Li X, Huang F, Wei G, Lin Z. Unilateral percutaneous vertebroplasty in osteoporotic vertebral compression fractures: A clinical efficacy evaluation. Exp Ther Med 2024; 27:151. [PMID: 38476906 PMCID: PMC10928977 DOI: 10.3892/etm.2024.12439] [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: 10/26/2023] [Accepted: 02/05/2024] [Indexed: 03/14/2024] Open
Abstract
Osteoporotic vertebral compression fractures, often resulting from low-energy trauma, markedly impair the quality of life of elderly individuals. The present retrospective study focused on the clinical efficacy of unilateral percutaneous vertebroplasty (PVP) in the treatment of osteoporotic compression fractures. A total of 68 patients, representing 92 vertebral bodies, who underwent the unilateral PVP technique from March 2020 to January 2023 were evaluated. Key parameters such as visual analogue scale (VAS) values, Oswestry disability index (ODI) scores, Cobb angle measurements, and anterior vertebral height (AVH) were documented pre- and post-surgery. The mean follow-up period was 15.41±3.74 months. The mean pre-operative VAS score was 8.08±0.79, which was significantly reduced to 2.25±0.71 by 24 h post-surgery and stabilized at 1.58±0.51 by the final follow-up. The ODI showed a significant improvement from a pre-operative average of 67.75±7.91 to 19.74±2.90 post-surgery, and was maintained at a low level of 28.00±4.89 at the last assessment. Radiological evaluations revealed significant alterations in Cobb angle and AVH post-operation. Notably, during the follow-up, eight patients developed new compression fractures in different vertebral segments. In conclusion, the unilateral PVP method is safe and efficient for the management of osteoporotic vertebral compression fractures.
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Affiliation(s)
- Dongdong Shi
- Department of Spine Surgery, People's Liberation Army Hospital No. 923, Nanning, Guangxi 530021, P.R. China
| | - Xiaoling Li
- Department of Spine Surgery, People's Liberation Army Hospital No. 923, Nanning, Guangxi 530021, P.R. China
| | - Fang Huang
- Department of Spine Surgery, People's Liberation Army Hospital No. 923, Nanning, Guangxi 530021, P.R. China
| | - Gejin Wei
- Department of Spine Surgery, People's Liberation Army Hospital No. 923, Nanning, Guangxi 530021, P.R. China
| | - Zhoudan Lin
- Department of Spine Surgery, People's Liberation Army Hospital No. 923, Nanning, Guangxi 530021, P.R. China
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Williams TD, Adler T, Smokoff L, Kaur A, Rodriguez B, Prakash KJ, Redzematovic E, Baker TS, Rapoport BI, Yoon ES, Beall DP, Dordick JS, De Leacy RA. Bone Cements Used in Vertebral Augmentation: A State-of-the-art Narrative Review. J Pain Res 2024; 17:1029-1040. [PMID: 38505504 PMCID: PMC10949389 DOI: 10.2147/jpr.s437827] [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: 08/30/2023] [Accepted: 01/26/2024] [Indexed: 03/21/2024] Open
Abstract
Vertebral compression fractures (VCFs) are common in osteoporotic patients, with a frequency projected to increase alongside a growing geriatric population. VCFs often result in debilitating back pain and decreased mobility. Cement augmentation, a minimally invasive surgical technique, is widely used to stabilize fractures and restore vertebral height. Acrylic-based cements and calcium phosphate cements are currently the two primary fill materials utilized for these procedures. Despite their effectiveness, acrylic bone cements and calcium phosphate cements have been associated with various intraoperative and postoperative incidents impacting VCF treatment. Over the past decade, discoveries in the field of biomedical engineering and material science have shown advancements toward addressing these limitations. This narrative review aims to assess the potential pitfalls and barriers of the various types of bone cements.
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Affiliation(s)
- Tyree D Williams
- Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
- Sinai BioDesign, Mount Sinai Medical System, New York, NY, USA
- Department of Neurosurgery, Mount Sinai Medical System, New York, NY, USA
| | - Talia Adler
- Sinai BioDesign, Mount Sinai Medical System, New York, NY, USA
- Columbia University School of General Studies, New York, NY, USA
| | - Lindsey Smokoff
- Sinai BioDesign, Mount Sinai Medical System, New York, NY, USA
- Columbia University School of General Studies, New York, NY, USA
| | - Anmoldeep Kaur
- Sinai BioDesign, Mount Sinai Medical System, New York, NY, USA
- Department of Neuroscience, Smith College, Northampton, MA, USA
| | - Benjamin Rodriguez
- Sinai BioDesign, Mount Sinai Medical System, New York, NY, USA
- Department of Neurosurgery, Mount Sinai Medical System, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Turner S Baker
- Sinai BioDesign, Mount Sinai Medical System, New York, NY, USA
- Department of Neurosurgery, Mount Sinai Medical System, New York, NY, USA
- Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin I Rapoport
- Sinai BioDesign, Mount Sinai Medical System, New York, NY, USA
- Department of Neurosurgery, Mount Sinai Medical System, New York, NY, USA
| | | | | | | | - Reade A De Leacy
- Department of Neurosurgery, Mount Sinai Medical System, New York, NY, USA
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Chen SW, Wu WT, Lee RP, Yu TC, Chen IH, Wang JH, Yeh KT. Correlations between Sagittal Parameters and Functional Scores in 65-Year-Old Osteoporotic Females with Vertebral Body Fracture under Low-Energy Mechanism. J Clin Med 2024; 13:774. [PMID: 38337470 PMCID: PMC10856549 DOI: 10.3390/jcm13030774] [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: 01/02/2024] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Vertebral compression fractures (VCFs) are the most common fragility fractures associated with low-energy injury mechanisms in postmenopausal women with osteoporosis. No clear consensus is currently available on the optimal timing for surgical intervention in specific cases. Methods: This study examined the correlations between sagittal parameters, functional scores, and the appropriate timing for surgical intervention during the recovery stage in patients with osteoporosis with thoracolumbar (TL) vertebral body fractures. A total of 161 women aged ≥ 65 years with osteoporosis were included in the study. Spinal sagittal parameters from standing plain films and functional outcomes as the Oswestry disability index (ODI) and the visual analogue scale (VAS) were collected. Results: We found that TL junction Cobb angle was significantly correlated with ODI > 30 (p < 0.001) and VAS > 6 (p < 0.001) and the discriminative values for predicting ODI > 30 and VAS > 6 were a TL kyphotic angle of 14.5° and 13.5°, respectively. Among women aged ≥ 65 years with osteoporosis, the back pain and functional impairment observed within 6 months following a compression fracture are associated with a greater TL kyphosis angle. Conclusions: This suggests that a more proactive approach may be necessary when addressing the conditions of these patients.
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Affiliation(s)
- Szu-Wei Chen
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan; (S.-W.C.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
| | - Wen-Tien Wu
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan; (S.-W.C.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 970374, Taiwan;
| | - Ru-Ping Lee
- Institute of Medical Sciences, Tzu Chi University, Hualien 970374, Taiwan;
| | - Tzai-Chiu Yu
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan; (S.-W.C.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
| | - Ing-Ho Chen
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan; (S.-W.C.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan;
| | - Kuang-Ting Yeh
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan; (S.-W.C.); (W.-T.W.); (T.-C.Y.); (I.-H.C.)
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 970374, Taiwan;
- Department of Medical Education, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien 970374, Taiwan
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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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Rao SD. Unrecognized and Undertreated Vertebral Fractures: What Else We Must Do. J Endocr Soc 2023; 7:bvad139. [PMID: 38024649 PMCID: PMC10661655 DOI: 10.1210/jendso/bvad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Sudhaker D Rao
- Division of Endocrinology, Diabetes, and Metabolism, and Bone & Mineral Research Laboratory, Henry Ford Health, Detroit, MI 48202, USA
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Hammed A, Mahfoud M, Mohamad O. Effectiveness of unilateral percutaneous vertebroplasty for acute traumatic non-osteoporotic compression vertebral fractures. Medicine (Baltimore) 2023; 102:e35177. [PMID: 37713855 PMCID: PMC10508565 DOI: 10.1097/md.0000000000035177] [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: 12/28/2022] [Accepted: 08/21/2023] [Indexed: 09/17/2023] Open
Abstract
Although vertebroplasty is a well-known treatment for osteoporotic and neoplastic compression fractures, there is limited evidence to support its use in traumatic compression fractures without osteoporotic degeneration. The purpose of this study was to evaluate the correlation of kyphosis and wedge angles with pain relief and functional outcome after percutaneous vertebroplasty. 38 patients who harbored acute traumatic non-osteoporotic compression vertebral fractures without neurological complications refractory to at least 5 days of conservative treatment were included in this study. Follow-up evaluations included pain (assessed with the visual analog scale) and medication use. Functional outcome was measured using Oswestry low back pain disability questionnaire. Cobb angles, Gardner angles and kyphotic angles were measured on the full-spine radiographs preoperatively and postoperatively. The axial pain visual analog scale score (8.05 ± 1.23 pre-op vs 1.18 ± 1.09 post-op, P < .05) and The Oswestry low back pain disability questionnaire score (33.45 ± 6.97 pre-op vs 4.47 ± 2.41 post-op, P < .05). The Cobb's angle (19.66° ± 8.68° pre-op vs 15.08° ± 7.51° post-op, P < .05), the Gardner's angle (17.72° ± 6.52° pre-op vs 14.13° ± 7.13° post-op, P < .05) and the kyphotic angle (17.51° ± 5.8° pre-op vs 8.81° ± 4.14°post-op, P < .05) were significantly reduced postoperatively therefore, local kyphosis was markedly restored after vertebroplasty. Our findings show that vertebroplasty for patients with traumatic spinal compression fractures reduces pain, improves mobility, reduces the need for painkillers, and significantly affects kyphotic angles.
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Patel SK, Khan S, Dasari V, Gupta S. Beyond Pain Relief: An In-Depth Review of Vertebral Height Restoration After Balloon Kyphoplasty in Vertebral Compression Fractures. Cureus 2023; 15:e46124. [PMID: 37900521 PMCID: PMC10612383 DOI: 10.7759/cureus.46124] [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: 08/26/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
This comprehensive review delves into the intricate landscape of vertebral height restoration after balloon kyphoplasty in cases of vertebral compression fractures. With a comprehensive examination of procedural intricacies, radiological evaluations, clinical outcomes, and influential factors, a nuanced comprehension unfolds. Beyond its immediate alleviation of pain, vertebral height restoration emerges as a linchpin in enhancing spinal alignment, fostering functional recuperation, and augmenting the overall quality of life. This review underscores the pivotal role of balloon kyphoplasty, transcending its mere medical utility to become a conduit for renewed independence and well-being among individuals grappling with vertebral compression fractures. The ongoing advancements in medical science and the continued pursuit of research stand poised to amplify the significance of vertebral height restoration, manifesting a promising horizon for individuals seeking respite from pain, a revitalised capacity for movement, and a life unburdened by its constraints.
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Affiliation(s)
- Siddharth K Patel
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sohael Khan
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ventaktesh Dasari
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suvarn Gupta
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Xu F, Xiong Y, Ye G, Liang Y, Guo W, Deng Q, Wu L, Jia W, Wu D, Chen S, Liang Z, Zeng X. Deep learning-based artificial intelligence model for classification of vertebral compression fractures: A multicenter diagnostic study. Front Endocrinol (Lausanne) 2023; 14:1025749. [PMID: 37033240 PMCID: PMC10073698 DOI: 10.3389/fendo.2023.1025749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
OBJECTIVE To develop and validate an artificial intelligence diagnostic system based on X-ray imaging data for diagnosing vertebral compression fractures (VCFs). METHODS In total, 1904 patients who underwent X-ray at four independent hospitals were retrospectively (n=1847) and prospectively (n=57) enrolled. The participants were separated into a development cohort, a prospective test cohort and three external test cohorts. The proposed model used a transfer learning method based on the ResNet-18 architecture. The diagnostic performance of the model was evaluated using receiver operating characteristic curve (ROC) analysis and validated using a prospective validation set and three external sets. The performance of the model was compared with three degrees of musculoskeletal expertise: expert, competent, and trainee. RESULTS The diagnostic accuracy for identifying compression fractures was 0.850 in the testing set, 0.829 in the prospective set, and ranged from 0.757 to 0.832 in the three external validation sets. In the human and deep learning (DL) collaboration dataset, the area under the ROC curves(AUCs) in acute, chronic, and pathological compression fractures were as follows: 0.780, 0.809, 0.734 for the DL model; 0.573, 0.618, 0.541 for the trainee radiologist; 0.701, 0.782, 0.665 for the competent radiologist; 0.707,0.732, 0.667 for the expert radiologist; 0.722, 0.744, 0.610 for the DL and trainee; 0.767, 0.779, 0.729 for the DL and competent; 0.801, 0.825, 0.751 for the DL and expert radiologist. CONCLUSIONS Our study offers a high-accuracy multi-class deep learning model which could assist community-based hospitals in improving the diagnostic accuracy of VCFs.
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Affiliation(s)
- Fan Xu
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Yuchao Xiong
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Guoxi Ye
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Yingying Liang
- Department of Radiology, Guangzhou First People’s Hospital, Guangzhou, Guangdong, China
| | - Wei Guo
- Department of Radiology, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, Hubei, China
| | - Qiuping Deng
- Department of Radiology, Hubei 672 Integrated Traditional Chinese and Western Medicine Orthopedic Hospital, Wuhan, Hebei, China
| | - Li Wu
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Wuyi Jia
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Dilang Wu
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Song Chen
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Zhiping Liang
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
| | - Xuwen Zeng
- Department of Radiology, Guangzhou Red Cross Hospital (Guangzhou Red Cross Hospital of Jinan University), Guangzhou, China
- *Correspondence: Xuwen Zeng,
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Li Y, Tan Z, Cheng Y, Zhang J, Wu H. High-viscosity versus low-viscosity cement for the treatment of vertebral compression fractures: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e31544. [PMID: 36401370 PMCID: PMC9678585 DOI: 10.1097/md.0000000000031544] [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: 12/05/2022] Open
Abstract
BACKGROUND High viscosity cement (HVC) and low viscosity cement (LVC) have been used to treat osteoporotic vertebral compression fractures (OVCFs). Our study was to assess the safety and efficacy of HVC and LVC in treating OVCFs. METHODS We searched the electronic database for randomized controlled trials of HVC and LVC to treat OVCFs. Random-effects model was performed to pool the outcomes about operation time, visual analogue scale (VAS), bone cement injection volume, oswestry disability index (ODI), bone cement leakage and adjacent vertebral fractures. RESULTS Twelve randomized trials were included in the meta-analysis. The 2 groups had similar changes in terms of bone cement injection volume, ODI and adjacent vertebral fractures. The HVC group showed shorter operation time and better VAS score improvement. The bone cement leakage rate of the HVC group was significantly better than LVC group (P < .00001).According to the location of bone cement leakage, in the leakages of the veins (P < .00001), the intervertebral disc (P < .00001), the paravertebral area (P = .003) and the intraspinal space (P = .03), the HVC group were significantly better than the LVC group. CONCLUSIONS In terms of bone cement injection volume, ODI and adjacent vertebral fractures, the 2 group are equivalent. HVC had a shorter operation time, lower bone cement leakage rate and better VAS score improvement, compared with LVC.
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Affiliation(s)
- Yongbo Li
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhe Tan
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuanpei Cheng
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jixiang Zhang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Han Wu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
- * Correspondence: Han Wu, Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun 130000, China (e-mail: )
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McDonald CL, Alsoof D, Daniels AH. Vertebral Compression Fractures. R I Med J (2013) 2022; 105:40-45. [PMID: 36173908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Fragility fractures, particularly in the hip and spine, are the most common complication of osteoporosis. In the US, approximately 1-1.5 million vertebral compression fractures (VCFs) occur annually. While patients may present with sudden onset of low back pain and limited mobility, more than two-thirds of VCFs are asymptomatic and are detected incidentally. X-rays are the standard imaging modality for diagnosis, with CT and MRI indicated if neurological deficits are present or a malignant cause is considered. Initial management is often non-surgical, with medications, physical therapy, and bracing. Surgical management in the form of cement augmentation (kyphoplasty or vertebroplasty) or instrumented fusion can be considered after failure of non-operative treatment, cases of deformity, or neurologic deficits. Subsequent VCFs occur frequently, and risk factors for refracture include advanced age, low bone mineral density, and low BMI. Treatment of primary VCFs with anti-resorptive medication is essential to reduce the risk of subsequent fractures.
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Affiliation(s)
- Christopher L McDonald
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI
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Lotan R, Smorgick Y, Anekstein Y, Rudik O, Prosso I, Hershkovich O. Kyphoplasty for Elderly Patients With Vertebral Compression Fractures-Do We Save Lives? Mortality Rates Analysis Comparison in a Long-Term Follow-Up Cohort. Global Spine J 2022; 12:1443-1448. [PMID: 33433244 PMCID: PMC9393975 DOI: 10.1177/2192568220982282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVES We aimed to compare a large cohort of patients with vertebral compression fractures (VCF) treated in 2 centers using different protocols (conservative vs BKP) and compare mortality rates on a long-term follow-up. METHODS Retrospective cohort held in 2 medical centers (W and AH). All patients admitted with VCF from November 2008 to January 2015 were enrolled in the study. Exclusion criteria were patients admitted with non-osteoporotic pathological fractures (such as metastatic or MM). RESULTS Our study included 208 patients treated for VCF, 127 were treated with BKP (88 females, 69.3%) and 81 were treated conservatively (59 females, 72.8%). Patients from Centre W were older and frailer compared to the patients from AH center (Average age 75.12 ± 11.16 vs 69.13 ± 9.61 years and Frailty score of 0.16 ± 0.1 vs 0.12 ± 0.1 respectively, T-test, p < 0.01 for both). Hazard ratios (HR) for age, female gender and frailty were significant for increased mortality, frailty had the highest HR of 182.42 (CI 29.05-1145.33, p < 0.01). Multivariate Cox model was fitted and after accounting for Gender, Age and Frailty, no significant difference was found between the 2 medical centers mortality rates (p = 0.59), thus no difference in mortality rates between BKP and conservative treatment in our study. CONCLUSION long-term follow-up following BKP treatment for VCF did not show a reduced mortality rate compared to conservative treatment after accounting for frailty, age and gender. Frailty was the most important factor in predicting mortality. Further RCTs are needed to compare the quality of life differences between the 2 treatment strategies.
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Affiliation(s)
- Raphael Lotan
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Smorgick
- Spine Unit, Assaf Harofeh Medical Center, Zerifin, Israel, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoram Anekstein
- Spine Unit, Assaf Harofeh Medical Center, Zerifin, Israel, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Rudik
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilia Prosso
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Hershkovich
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Oded Hershkovich, Ha-Lokhamim St 62, Holon, 5822012, Israel.
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Aoki S, Koto M, Ikawa H, Imai R, Tokuhiko O, Shinoto M, Takiyama H, Yamada S, Tsuji H. Long-term outcomes of high dose carbon-ion radiation therapy for unresectable upper cervical (C1-2) chordoma. Head Neck 2022; 44:2162-2170. [PMID: 35734902 PMCID: PMC9544549 DOI: 10.1002/hed.27127] [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: 02/16/2022] [Revised: 05/12/2022] [Accepted: 06/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background Chordoma is a rare, locally invasive neoplasm of the axial skeleton. Complete resection is often difficult, especially for the upper‐cervical (C1‐2) spine. We evaluated the efficacy and safety of carbon‐ion radiotherapy (CIRT) for unresectable C1‐2 chordoma. Methods Patients with C1‐2 chordoma treated with definitive CIRT (60.8 Gy [RBE] in 16 fractions) were retrospectively analyzed. We evaluated OS, LC, PFS, and toxicity. Results Nineteen eligible patients all completed the planned course of CIRT. With the median follow‐up 68 months (range: 29–144), median OS was 126 months (range: 36‐NA). Five‐year OS, LC, and PFS were 68.4% (95% CI, 42.8%–84.4%), 75.2% (46.1%–90.0%), and 64.1% (36.3%–82.3%), respectively. Regarding acute toxicity of grade ≥3, there was only one grade 3 mucositis. Late toxicity included radiation‐induced myelitis (grade 3 in 1 patient; 5.3%), and compression fractures (n = 5; 26.3%). Conclusions High‐dose CIRT is a promising treatment option for unresectable upper cervical chordoma.
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Affiliation(s)
- Shuri Aoki
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan.,Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
| | - Masashi Koto
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Hiroaki Ikawa
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Reiko Imai
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Omatsu Tokuhiko
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Makoto Shinoto
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Hirotoshi Takiyama
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Shigeru Yamada
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Hiroshi Tsuji
- QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan
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13
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Lotan R, Haimovich Y, Schorr L, Goldstein AL, Hershkovich O. Double-Balloon Kyphoplasty Results in Better Radiographic Outcomes Than a Single-Balloon Kyphoplasty in Treating Osteo-Porotic Spinal Fractures. J Clin Med 2022; 11:3407. [PMID: 35743477 DOI: 10.3390/jcm11123407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Studies have found that unilateral and bilateral kyphoplasty have comparable clinical outcomes. Only a few studies have compared the radiographic results of using unilateral vs. simultaneous bilateral approaches. We aimed to examine and compare the radiographic results of unilateral (UKP) vs. bilateral simultaneous double-balloon kyphoplasty (DKP) for treating symptomatic vertebral compression fractures (VCF). Methods: A retrospective cohort of all patients treated for VCF by DKP and UKP over five years in a single medical center. From 2009 to 2012, we routinely performed UKP; from 2012, DKP was the routine due to potential benefits in vertebral realignment. We evaluated pre- and post-surgical fracture characteristics including vertebral height, sagittal and coronal Cobb angle, and fracture reduction. Statistical analysis included a t-test for independent variables and Pearson’s correlation. Results: The study cohort consisted of 81 patients (75.8 years ± 10.86) who underwent surgery, with a total of 119 vertebras. We performed 89 UKP on fractured vertebras and 30 DKP on 30 vertebrae. The UKP average fluoroscopy radiation exposure was 15.8 mGy (±11.5) per level compared to 11.2 mGy (±8.7) for DKP, p = 0.03. DKP showed significant fracture reduction, 2.8 degrees of Cobb angle, equaling the patient positioning effect on fracture reduction. Conclusion: DKP results in better fracture reduction than UKP, and equals the effect of patient positioning without increased radiation exposure or adverse events.
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14
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Robles LA, Guerrero-Maldonado A. Seizure-Induced Spinal Fractures: A Systematic Review. Int J Spine Surg 2022; 16:521-529. [PMID: 35772984 DOI: 10.14444/8244] [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: 11/20/2022] Open
Abstract
BACKGROUND Patients with epilepsy have a higher risk of skeletal injuries, and some of these fractures occur in the spine during a seizure. Seizure-induced spinal fractures (SISF) are unusual injuries that typically occur in the thoracolumbar spine. Because these skeletal injuries are not well described in the literature, this article aims to analyze the characteristics of this uncommon clinical entity. METHODS A PubMed and Scopus search adhering to preferred reporting items for systematic reviews and meta-analyses guidelines was performed to include studies reporting patients with SISF. The data gathered from this review were analyzed to characterize this condition. RESULTS The search yielded 34 articles with a total of 38 patients with SISF. All studies were case reports (level 5 evidence). Most fractures occurred in the thoracic and lumbar spine, and the most common injuries were type A1 and A4 fractures according to the AO spine classification system. Different characteristics of SISF are described including demographics, clinical findings, imaging, and treatment. CONCLUSIONS SISF should be ruled out in patients who have a recent history of seizures and who report persistent dorsolumbar pain or neurological deficit. SISF usually occurs in the thoracolumbar spine and less frequently in the cervical spine. This review shows that different patterns of neurological deficits, some of them severe, may occur in approximately a quarter of patients with SISF. CLINICAL RELEVANCE This study provides awareness of an uncommon spine condition. Physicians should suspect SISF in patients with persistent dorsolumbar pain after a seizure.
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Affiliation(s)
- Luis A Robles
- Section of Neurosurgery, Hospital Joya, Puerto Vallarta, Jalisco, Mexico
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15
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Lotan R, Prosso I, Klatzkin L, Hershkovich O. The Covid 19 Pandemic Effect on the Epidemiology of Thoracolumbar Fractures Presenting to the Emergency Department in Patients Above 65 years Old. Geriatr Orthop Surg Rehabil 2022; 13:21514593221098828. [PMID: 35479652 PMCID: PMC9036375 DOI: 10.1177/21514593221098828] [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: 09/18/2021] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Studies investigating the Covid-19 Pandemic’s orthopedic aspects are accumulating, including reports on a 10-33% decrease in hip fracture incidence alongside shorter times to surgery. Osteoporotic vertebral compression fractures (VCF) have not yet been discussed. This study evaluated the effect of the Covid-19 pandemic’s first wave on VCF in the elderly. Method A retrospective cohort of elderly patients diagnosed with VCF between 2018-19 (Pre-Covid-19 pandemic) to 2020. Results The cohort included 172 patients above 65 years with VCF during 2018-2020. Patients’ age and gender were similar between the two study groups. We found a higher proportion of high-energy VCF during 2020 (10.5% vs 6.7%). Incidence of recurrent fractures was 7.5 times higher during 2020 (5.3% vs .7%, P =.06), and significantly higher rates of Ankylosing Spondylitis or Diffuse Idiopathic Skeletal Hyperostosis in 2020 (7.9% vs 1.5%, P=.04). VCF ED admission rates were similar, with 60% treated conservatively. Admitted patients underwent more surgeries in 2020 (66.7% vs 60%, P =.71) and a tendency towards Precoutaneus Balloon Kyphoplasty (BKP) + fixation compared with BKP alone (15.8% in 2020 vs 7.5% in 2018-19, P =.29). RR for BKP + fixation vs BKP alone was 1.95, suggesting higher odds for a more complex surgery during the Covid-19 pandemic. The complication rate was significantly higher during 2020 (18.4% vs 3.7%, P <.001). Admission length was slightly longer during 2020 (12.2 days vs 9.9 days, P = .27), and time to surgery was marginally longer, 6.25 vs 5.3 days (P = .55). Many patients chose home over institutional rehabilitation during the Covid-19 pandemic (72.2% vs 58.8%). Conclusion The Covid-19 pandemic did not alter VCF incidence, but patients’ characteristics changed, affecting admissions, institutional rehabilitation, and a tendency towards complex surgery rather than BKP alone. It is still unclear if Covid-19 will remain an issue in the upcoming years, but its impact and lessons are still worthwhile.
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Affiliation(s)
- Raphael Lotan
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilia Prosso
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lev Klatzkin
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Hershkovich
- Department of Orthopedic Surgery, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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16
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Shimizu A, Maeda K, Fujishima I, Kayashita J, Mori N, Okada K, Uno C, Shimizu M, Momosaki R. Hospital Frailty Risk Score predicts adverse events in older patients with vertebral compression fractures: Analysis of data in a nationwide in-patient database in Japan. Geriatr Gerontol Int 2022; 22:233-239. [PMID: 35100663 DOI: 10.1111/ggi.14356] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/13/2021] [Accepted: 01/18/2022] [Indexed: 01/26/2023]
Abstract
AIMS This study investigated the usefulness of frailty for predicting adverse events in patients with vertebral compression fractures (VCFs) during hospitalization using data obtained from the Japanese health insurance system. METHODS This retrospective cohort study of patients with VCFs aged ≥65 years was conducted using a nationwide database in Japan. We examined the relationships between frailty risk, classified using the Hospital Frailty Risk Score (HFRS), in-hospital mortality, and complications such as pressure ulcers and pneumonia. Multivariate logistic regression analysis was used to estimate the association between the HFRS and the outcomes of patients with VCFs. RESULTS In this study, the data of 30 980 in-patients with VCFs were analyzed. Of these patients, 76.8%, 21.3%, and 1.9% had low, intermediate, and high risks of frailty, respectively. The higher the risk of frailty, the higher the rate of in-hospital mortality and the occurrence of all complications (P < 0.001 for trend). An intermediate risk of frailty was independently associated with in-hospital mortality (odds ratio [OR], 1.421; P < 0.001), whereas a high risk of frailty did not show statistical significance (OR, 1.385; P = 0.150). Each frailty risk was independently associated with the occurrence of all complications during hospitalization. CONCLUSIONS The HFRS, which can assess the risk of frailty based on routinely collected medical records, was predictive of adverse events in older patients with VCFs based on a nationwide database in Japan. Future studies need to assess approaches to preventing adverse events in frail VCF patients. Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan.,Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan.,Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan.,Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Nisshin, Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan.,Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Naoharu Mori
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Kiwako Okada
- Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Nisshin, Japan
| | - Chiharu Uno
- Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Nisshin, Japan.,Department of Community Health and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Miho Shimizu
- Department of Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Japan
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17
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Kang CN, Kim J, Ryu JI, Kim Y, Ahn S, Choi SH. Cumulative Incidence and Factors Associated with Subsequent Vertebral Compression Fractures: A Nationwide Population-based Study. World Neurosurg 2022:S1878-8750(22)00077-8. [PMID: 35077893 DOI: 10.1016/j.wneu.2022.01.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Patients who experience vertebral compression fractures are vulnerable to subsequent vertebral compression fractures (SVCFs). The purpose of this nationwide population-based study was to determine the age-specific cumulative incidence and factors associated with SVCFs in South Korea. METHODS Diagnostic codes, medical costs, and comorbid diseases in patients who had a vertebral compression fracture in 2011 and 2012 were collected from the National Health Insurance Service database of South Korea from 2007 to 2018. Demographic data, mortality rate, medical cost, and frequency of vertebroplasty or kyphoplasty were compared between patients with an initial fracture (IF) and those with a subsequent fracture (SF). RESULTS The cumulative incidence of SVCFs over 4 years was 24.4% and increased rapidly within a few months after the IF. In 2011, SVCFs occurred in 17,004 patients, and the incidence rate per 100,000 people was 113.6 (84.9 in men vs. 138.5 in women). The odds ratio (OR) of SVCFs in units of 10 years was the highest in women in their 60s, at 2.89. However, in men in their 70s, the OR was the highest, at 2.51. The rates of vertebroplasty or kyphoplasty, medical expenses, and mortality rate were significantly higher in the SF group than in the IF group (p < 0.01). CONCLUSION The age-specific cumulative incidence of SVCFs per 100,000 people was 113.6. SVCFs were more frequent among women, the elderly, and patients who underwent vertebroplasty or kyphoplasty. Women in their 60s or above and men in their 70s or above were at highest risk.
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18
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Gil‐Ortiz C, Ramírez‐Romero A, Bonifacio‐Delgadillo D, Lagos‐Servellon J. Multilevel percutaneous vertebroplasty with the Spine Jack® system in a patient with Cushing disease. Clin Case Rep 2021; 9:e05034. [PMID: 34765209 PMCID: PMC8572336 DOI: 10.1002/ccr3.5034] [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: 07/20/2021] [Accepted: 10/13/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Percutaneous vertebroplasty (PV) is a minimally invasive procedure that requires the injection of cement into a fractured vertebral body. Spine Jack® is a vertebroplasty system with an intracorporal implant designed to restore the height of the vertebral body in osteoporotic vertebral fractures. There are no reported cases of PV with Spine Jack® system as treatment for multilevel compression fractures in patients with vertebral osteoporosis due to Cushing disease. CASE PRESENTATION A 55-year-old man with lumbago, impaired deambulation 6 weeks prior to presentation, with Oswestry score of 72% and a visual analogue scale (VAS) score of 9 points. Imaging studies showed osteoporotic fractures at T5, T8, T11, T12, and L1-L5 vertebrae secondary to Cushing disease. PV was performed with a Spine Jack® intracorporal implant device, in three sessions, and multiple levels were operated at each intervention. Post-operative course demonstrated improvement of pain, height, correction of the kyphotic angle and Oswestry score, without any neurological deficits despite having nine vertebral fractures. CONCLUSION Percutaneous vertebroplasty with the Spine Jack® system is a safe and effective procedure to treat multilevel vertebral fractures due to Cushing disease, improving the quality of life and allowing the patient to remain pain-free while avoiding major surgery.
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Affiliation(s)
- Cuauhtemoc Gil‐Ortiz
- Department of NeuroscienceCentro Médico Nacional "20 de Noviembre"Mexico CityMexico
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19
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Lucas LG, Lucas VPCL, Sylvain P, Agathe N, Marc-Antoine R, Laurie S, Wafa S. Biomechanical comparative evaluation of percutaneous fixations with vertebral expansion for vertebral compression fractures: an experimental and finite element study. Comput Methods Biomech Biomed Engin 2021; 25:487-498. [PMID: 34342248 DOI: 10.1080/10255842.2021.1959919] [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: 10/20/2022]
Abstract
This study uses in vitro experiments and validated finite element models (FEM) to analyze the effect of posterior fixation, alone or associated with expandable device (ED) and/or cement. 3-dimensional FEMs of intact, fractured and instrumented spine were built and compared with experimental load-displacement curves. FEM ranges of motion were within the experimental corridors. Stresses appeared sensitive to both implant configuration and fracture severity with a stress reduction up to 84%. The FEM highlighted that for a same instrumental strategy, different biomechanical performances were observed according to fracture severity. When bone continuity is altered, both ED and cement may be needed.
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Affiliation(s)
- Le Gallo Lucas
- Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - V P C Lima Lucas
- Institut de Biomecanique Humaine Georges Charpak, Paris, France.,Instituto Politécnico Rua Bonfim, Universidade Estadual do Rio de Janeiro, Nova Friburgo, RJ, Brazil
| | - Persohn Sylvain
- Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - Nérot Agathe
- Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - Rousseau Marc-Antoine
- Department of Orthopaedic Surgery, Hopital Bichat-Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Simon Laurie
- Department of Orthopaedic Surgery, Hopital Bichat-Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Skalli Wafa
- Institut de Biomecanique Humaine Georges Charpak, Paris, France
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20
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Liu C, Shu C. Vertebral Compression Fractures-The First Manifestations in the Elderly Acute Lymphoblastic Leukemia. Geriatr Orthop Surg Rehabil 2021; 12:21514593211026803. [PMID: 34221539 PMCID: PMC8221693 DOI: 10.1177/21514593211026803] [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: 12/17/2020] [Revised: 02/25/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Acute lymphoblastic leukemia (ALL) is reported to be the most common malignancy in children, but is less common in adults. Though vertebral compression fractures have been reported as initial signs of ALL in children, to the best of our knowledge, there have not been any previous reports of vertebral compression fractures as an initial manifestation of ALL in elderly people. Case Presentation: Here we reported a 65-year-old man who was admitted with a 1-month history of progressive chest and back pain and worsening pain after heavy lifting. Considering the histories of osteoporosis, minor trauma and normal peripheral blood counts, it was firstly misdiagnosed as spinal osteoporotic compression fractures which were caused by low-energy injuries. The patient was definitely diagnosed as ALL after bone marrow biopsy. Conclusion: ALL must be considered in the differential diagnosis with acute vertebral compression fracture. Considering that bony lesions may precede clinical findings, knowledge of radiographic and orthopedic appearances of leukemia are important in order to initiate earlier treatment to avoid the progressive damage and improve their survival rates. we recommend bone marrow biopsy in vertebroplasty to avoid misdiagnosis.
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Affiliation(s)
- Cheng Liu
- Department of Orthopedics, Guangdong Clifford hospital, Guangzhou, Guangdong, China
| | - Cuili Shu
- Department of Orthopedics, Guangdong Clifford hospital, Guangzhou, Guangdong, China
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21
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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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22
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Purcell P, McEvoy F, Tiernan S, Sweeney D, Morris S. A combined experimental and computational study of mechanical properties after balloon kyphoplasty. Proc Inst Mech Eng H 2021; 235:897-906. [PMID: 33928812 DOI: 10.1177/09544119211013927] [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: 11/16/2022]
Abstract
Vertebral compression fractures rank among the most frequent injuries to the musculoskeletal system, with more than 1 million fractures per annum worldwide. The past decade has seen a considerable increase in the utilisation of surgical procedures such as balloon kyphoplasty to treat these injuries. While many kyphoplasty studies have examined the risk of damage to adjacent vertebra after treatment, recent case reports have also emerged to indicate the potential for the treated vertebra itself to re-collapse after surgery. The following study presents a combined experimental and computational study of balloon kyphoplasty which aims to establish a methodology capable of evaluating these cases of vertebral re-collapse. Results from both the experimental tests and computational models showed significant increases in strength and stiffness after treatment, by factors ranging from 1.44 to 1.93, respectively. Fatigue tests on treated specimens showed a 37% drop in the rate of stiffness loss compared to the untreated baseline case. Further analysis of the computational models concluded that inhibited PMMA interdigitation at the interface during kyphoplasty could reverse improvements in strength and stiffness that could otherwise be gained by the treatment.
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Affiliation(s)
- Philip Purcell
- Bioengineering Technology Centre, Technological University Dublin, Dublin, Ireland.,CADFEM Ireland, Dublin, Ireland.,Dundalk Institute of Technology, Dundalk, Co. Louth, Ireland
| | - Fiona McEvoy
- Bioengineering Technology Centre, Technological University Dublin, Dublin, Ireland
| | - Stephen Tiernan
- Bioengineering Technology Centre, Technological University Dublin, Dublin, Ireland
| | | | - Seamus Morris
- Mater Misericordiae University Hospital, National Spinal Injuries Unit, Dublin, Ireland
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23
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Okada K, Fujiwara H, Arimatsu T, Motomura Y, Kato T, Takezako N, Kumagai T. Efficacy and Safety of Balloon Kyphoplasty for Pathological Vertebral Fractures in Patients with Hematological Malignancies in Our Institution. Intern Med 2021; 60:1169-1174. [PMID: 33229801 PMCID: PMC8112972 DOI: 10.2169/internalmedicine.5466-20] [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: 11/06/2022] Open
Abstract
Objective Patients with hematological malignancies, particularly those with multiple myeloma, often suffer from pathological vertebral compression fractures (VCFs). Consequent and significant spinal pain and paralysis impair the activities of daily living and quality of life and delay subsequent chemotherapy. Balloon kyphoplasty (BKP), which is less invasive than conventional therapies, is a type of percutaneous vertebroplasty in which cement is injected into the broken vertebrae to stabilize the spinal column. The present study assessed the effect of BKP on hematological tumors. Methods We retrospectively analyzed five myeloma patients and one lymphoma patient who underwent BKP for pathological VCFs in our institution. Results The median age was 74 years old. The spinal operation level ranged from T2 to L4. BKP was performed at the diagnosis in two cases, after first-line chemotherapy in one case, and after subsequent chemotherapy in three cases. After approximately 1 month, the patients' average Eastern Cooperative Oncology Group performance status score rapidly improved from 3.2 to 1.3. The numeric rating scale score decreased from 8.8 to 2.0, and the Karnofsky Performance Status score increased from 35 to 75. No severe complications were observed. All patients became able to walk unassisted and underwent early subsequent chemotherapy. Conclusion BKP can be a safe and effective treatment option for pathological VCFs in patients with hematological malignancies and allows for rapid induction with subsequent chemotherapy.
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Affiliation(s)
- Keigo Okada
- Department of Hematology, Ome Municipal General Hospital, Japan
| | - Hiroki Fujiwara
- Department of Hematology, Ome Municipal General Hospital, Japan
| | | | - Yotaro Motomura
- Department of Hematology, Ome Municipal General Hospital, Japan
| | - Tsuyoshi Kato
- Department of Orthopedics, Ome Municipal General Hospital, Japan
| | - Naoki Takezako
- Department of Hematology, National Disaster Medical Center, Japan
| | - Takashi Kumagai
- Department of Hematology, Ome Municipal General Hospital, Japan
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24
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Purcell P, Tyndyk M, McEvoy F, Tiernan S, Sweeney D, Morris S. A Multiscale Finite Element Analysis of Balloon Kyphoplasty to Investigate the Risk of Bone-Cement Separation In Vivo. Int J Spine Surg 2021; 15:302-314. [PMID: 33900988 DOI: 10.14444/8040] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND During the past decade there has been a significant increase in the number of vertebral fractures being treated with the balloon kyphoplasty procedure. Although previous investigations have found kyphoplasty to be an effective treatment for reducing patient pain and lowering cement-leakage risk, there have been reports of vertebral recollapse following the procedure. These reports have indicated evidence of in vivo bone-cement separation leading to collapse of the treated vertebra. METHODS The following study documents a multiscale analysis capable of evaluating the risk of bone-cement interface separation during lying, standing, and walking activities following balloon kyphoplasty. RESULTS Results from the analysis found that instances of reduced cement interlock could initiate both tensile and shear separation of the interface region at up to 7 times the failure threshold during walking or up to 1.9 times the threshold during some cases for standing. Lying prone offered the best protection from interface failure in all cases, with a minimum safety factor of 2.95. CONCLUSIONS The results of the multiscale analysis show it is essential for kyphoplasty simulations to take account of the micromechanical behavior of the bone-cement interface to be truly representative of the in vivo situation after the treatment. The results further illustrate the importance of ensuring adequate cement infiltration into the compacted bone periphery during kyphoplasty through a combination of new techniques, tools, and biomaterials in a multifaceted approach to solve this complex challenge.
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Affiliation(s)
- Philip Purcell
- Bioengineering Technology Centre, Technological University Dublin, Tallaght Campus, Dublin, Ireland.,CADFEM Ireland, The Steelworks, Dublin, Ireland.,Department of Electronic and Mechanical Engineering, Dundalk Institute of Technology, Dundalk, Ireland
| | | | - Fiona McEvoy
- Bioengineering Technology Centre, Technological University Dublin, Tallaght Campus, Dublin, Ireland
| | - Stephen Tiernan
- Bioengineering Technology Centre, Technological University Dublin, Tallaght Campus, Dublin, Ireland
| | | | - Seamus Morris
- Mater Misericordiae University Hospital, National Spinal Injuries Unit, Ireland
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25
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Rudra S, Lauman MK, Stowe H, Henke LE, Wallace AN, Roach MC, Huang J, Tsien CI, Bradley JD, Santiago P, Buchowski JM, Jennings JW, Robinson CG. Evaluation of the Metastatic Spine Disease Multidisciplinary Working Group Algorithms as Part of a Multidisciplinary Spine Tumor Conference. Global Spine J 2020; 10:888-895. [PMID: 32905719 PMCID: PMC7485068 DOI: 10.1177/2192568219882649] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The Metastatic Spine Disease Multidisciplinary Working Group Algorithms are evidence and expert opinion-based strategies for utilizing radiation therapy, interventional radiology procedures, and surgery to treat 5 types of spine metastases: asymptomatic spinal metastases, uncomplicated spinal metastases, stable vertebral compression fractures (VCF), unstable VCF, and metastatic epidural spinal cord compression (MESCC). Evaluation of this set of algorithms in a clinical setting is lacking. The authors aimed to identify rate of treatment adherence to the Working Group Algorithms and, subsequently, update these algorithms based on actual patient management decisions made at a single-institution, multidisciplinary, spine tumor conference. METHODS Patients with metastatic spine disease from primary non-hematologic malignancies discussed at an institutional spine tumor conference from 2013 to 2016 were evaluated. Rates of Working Group Algorithms adherence were calculated for each type of metastasis. Based on the reasons for algorithm nonadherence, and patient outcomes in such cases, updated Working Group Algorithms recommendations were proposed. RESULTS In total, 154 eligible patients with 171 spine metastases were evaluated. Rates of algorithm adherence were as follows: asymptomatic (67%), uncomplicated (73%), stable VCF (20%), unstable VCF (32%), and MESCC (41%). The most common deviation from the Working Group Algorithms was surgery for MESCC despite poor prognostic factors, but this treatment strategy was supported based on median survival surpassing 6 months in these patients. CONCLUSIONS Adherence to the Working Group Algorithm was lowest for MESCC and VCF patients, but many nonadherent treatments were supported by patient survival outcomes. We proposed updates to the Working Group Algorithm based on these findings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Clifford G. Robinson
- Washington University, St Louis, MO, USA,Clifford G. Robinson, Department of Radiation Oncology, Washington University School of Medicine, 660 South Euclid Ave, Campus Box #8224, St Louis, MO 63110, USA. Portions of this work were presented as an oral presentation at the American Radium Society meeting in May 2018 in Orlando, FL
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26
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Huang CH, Wang WH, Kor CT, Hsiao CH, Chang CC. Risk of venous thromboembolism in elderly patients with vertebral compression fracture: A population-based case-control study. Medicine (Baltimore) 2020; 99:e20072. [PMID: 32358388 PMCID: PMC7440209 DOI: 10.1097/md.0000000000020072] [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: 11/26/2022] Open
Abstract
Vertebral compression fractures (VCFs) are common in elderly and are treated with immobilization. Moreover, immobilization and old age may increase venous thromboembolism (VTE) risk. However, the incidence of VCFs-related VTE is unknown in elderly. The purposes of this study were to determine the incidence of VTE among VCF patients, to explore whether percutaneous vertebroplasty (PV) intervention may reduce VTE risk in VCFs patients.We conducted a population-based case-control study by using the National Health Insurance Research Database. We identified 1407 patients aged ≥65 with VCF who received PV and 1407 VCFs patients who did not receive PV after developing a 1:1 propensity score-matched study cohort and were followed up for 5 years. Using PV intervention as the exposure factor, a cause-specific Cox's proportional hazards model was used to examine the association between PV and VTE.After propensity score matching, the mean age of the study participants was 78 years and ∼23% of the analyzed participants were men, incidence of VTE in the PV and control cohorts was 5.77 and 4.19 per 1000 person-years, respectively. Both groups were nonsignificant difference after examination with different adjustment models. Patients with VCF and a history of heart failure, coronary artery disease, receiving antihypertension medication were at a significantly increased VTE risk.Elderly patients with VCF who received PV had a neutral impact on risk of VTE. VCF patients with heart failure, coronary artery disease, and receiving antihypertension medication were prone to developing VTE should be monitored cautiously.
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Affiliation(s)
- Ching-Hui Huang
- Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
- Department of Beauty Science and Graduate Institute of Beauty Science Technology, Chienkuo Technology University
| | - Wei-Hsun Wang
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
- Department of Orthopedic, Changhua Christian Hospital, Changhua
| | - Chew-Teng Kor
- Medical Research Center, Department of Internal Medicine, Changhua Christian Hospital, Changhua
| | - Ching-Hua Hsiao
- Section of Joint Reconstruction, Department of Orthopedic, Kuang Tien General Hospital
| | - Chia-Chu Chang
- Department of Internal Medicine, Kuang Tien General Hospital
- Department of Nutrition, Hungkuang University, Taichung, Taiwan
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27
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Luo K, Jiang G, Zhu J, Lu B, Lu J, Zhang K, Wang X, Cui FZ. Poly(methyl methacrylate) bone cement composited with mineralized collagen for osteoporotic vertebral compression fractures in extremely old patients. Regen Biomater 2020; 7:29-34. [PMID: 32153989 PMCID: PMC7053255 DOI: 10.1093/rb/rbz045] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/12/2019] [Accepted: 12/16/2019] [Indexed: 12/14/2022] Open
Abstract
To examine the clinical effects of a new bone cement composed of poly(methyl methacrylate) (PMMA) and mineralized collagen (MC) compared with pure PMMA bone cement in treating osteoporotic vertebral compression fractures (OVCFs) in patients aged over 80. In all, 32 cases using pure PMMA bone cement and 31 cases using MC-modified PMMA (MC-PMMA) bone cement for OVCFs between June 2014 and March 2016 were screened as PMMA group and MC-PMMA group, respectively, with an average age of over 80. The operation duration, intraoperative blood loss, hospital stay, oswestry disability index (ODI), visual analogue scale (VAS), anterior vertebral height (AVH), intermediate vertebral height (IVH) and posterior vertebral height (PVH) of injured vertebrae, vertebral computed tomography value, re-fracture rate of adjacent vertebrae, correction rate of spinal kyphotic angle and wedge-shaped vertebra angle and surgical complications were compared between the two groups. In the early post-operative period, the VAS, ODI, AVH and IVH in MC-PMMA group were comparable to those in the traditional PMMA group. Moreover, the MC-PMMA group showed better effects compared with the PMMA group 12 months after surgery. Thus, this new bone cement has superior clinic effects in the long term.
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Affiliation(s)
- Kefeng Luo
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School of Ningbo University, Zhejiang, China
| | - Guoqiang Jiang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School of Ningbo University, Zhejiang, China
| | - Jinjin Zhu
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School of Ningbo University, Zhejiang, China.,Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Bin Lu
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School of Ningbo University, Zhejiang, China
| | - Jiye Lu
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School of Ningbo University, Zhejiang, China
| | - Kai Zhang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School of Ningbo University, Zhejiang, China
| | - Xiumei Wang
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Fu-Zhai Cui
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
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28
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Zhang HX, Shen Y, Chen J, Zhang L, Lin W. Risk Factors of Pulmonary Complications After Minimally Invasive Surgery for Elderly Patients with Vertebral Compression Fractures. Ther Clin Risk Manag 2020; 16:7-15. [PMID: 32021221 PMCID: PMC6970106 DOI: 10.2147/tcrm.s231383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To determine the risk factors for pulmonary complications after minimally invasive surgery in elderly patients with vertebral compression fractures (VCFs). Methods A total of 233 elderly patients (age ≥ 65 years) with VCFs, who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) surgery at Hebei General Hospital from January 2011 to December 2016, were retrospectively analyzed. Risk factors and the effects of the model were determined by univariate logistic regression analyses and the receiver operating characteristic (ROC) curve, respectively. A risk assessment scale was established based on the risk factors, as well as physiological and surgical scores for mortality and morbidity. The risk assessment scale prospectively evaluated risk factors of pulmonary complications after minimally invasive surgery for elderly patients with VCFs from January to June 2017. Results 27 patients were diagnosed with pulmonary complications (27/233, 11.59%). There were statistically significant differences between patients with and without pulmonary complications in terms of age, body mass index (BMI), smoking, cardiovascular diseases and old fractures between patients with and without pulmonary complications (P < 0.05). Logistic regression analysis showed that smoking, cardiovascular diseases and old fractures were risk factors (P < 0.05) and area under the curve was 0.738 (95% confidence intervals (CI): 0.648–0.828). 53 elderly patients with VCFs were assessed, 5 of them occurred pulmonary complications. Areas under the curve of preoperative and total risk assessment values were all 0.925. Conclusion Significant risk factors of pulmonary complications were BMI, cardiovascular diseases and old fractures for patients aged 65 years or elderly with VCFs after minimally invasive surgery. The risk assessment scale gained high accuracy.
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Affiliation(s)
- Hua-Xing Zhang
- Department of Graduate School, Graduate School of Hebei Medical University, Shijiazhuang, Hebei 050000, People's Republic of China.,Department of Orthopedics, Hebei General Hospital, Shijiazhuang, Hebei 050000, People's Republic of China
| | - Yong Shen
- Department of Spine Surgery, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, People's Republic of China
| | - Jia Chen
- Department of Orthopedics, Hebei General Hospital, Shijiazhuang, Hebei 050000, People's Republic of China
| | - Long Zhang
- Department of Orthopedics, Hebei General Hospital, Shijiazhuang, Hebei 050000, People's Republic of China
| | - Wei Lin
- Department of Graduate School, Graduate School of Hebei Medical University, Shijiazhuang, Hebei 050000, People's Republic of China
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Abstract
Objective To compare the safety and efficacy of kyphoplasty in the treatment of occult
and non-occult osteoporotic vertebral compression fractures (OOVF). Material and Methods From 2015 to 2017, 82 OOVF and 105 non-occult osteoporotic vertebral
compression fractures (N-OOVF) were evaluated with the Visual Analog Scale
(VAS), Oswestry Disability Index (ODI), and vertebral height preoperatively,
immediately postoperatively, and one year postoperatively. Operative time,
fluoroscopy time, and cement injection volume were recorded. Results Compared with the preoperative VAS and ODI scores, the scores of both groups
were significantly improved after surgery. Preoperative ODI and VAS scores
of the OOVF were lower than those of the N-OOVF. The operative time,
fluoroscopy time, and bone cement injection volume of the OOVF were
significantly lower than those of the N-OOVF. Vertebral height of the N-OOVF
improved significantly after surgery. There were differences in cement
leakage and adjacent vertebral fractures between the two groups. Conclusion Compared with N-OOVF, OOVF are safer with kyphoplasty, and it is necessary to
diagnose OOVF in a timely manner.
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Affiliation(s)
- Zhangzhe Zhou
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhiyong Sun
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yimeng Wang
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiaoyu Zhu
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhonglai Qian
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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30
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Martikos K, Greggi T, Vommaro F, Boriani L, Scarale A, Zarantonello P, Carbone G, Stallone S, Zucchini R. Vertebroplasty in the treatment of osteoporotic vertebral compression fractures: patient selection and perspectives. Open Access Rheumatol 2019; 11:157-161. [PMID: 31308767 PMCID: PMC6613358 DOI: 10.2147/oarrr.s174424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/08/2019] [Accepted: 06/14/2019] [Indexed: 11/23/2022] Open
Abstract
Osteoporotic vertebral fractures represent a constantly increasing pathology that may compromise life quality and general health. Among various treatment options, percutaneous vertebroplasty has been used widely over the past 20 years. Although there is a vast amount of retrospective reports in the literature, high-level evidence has emerged only recently. In this paper, the authors provide a synopsis of the current literature on the efficacy and safety of percutaneous vertebroplasty while also presenting a step-by-step description of the surgical procedure, focusing on details that may help in optimizing quality and safety.
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Affiliation(s)
- Konstantinos Martikos
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Tiziana Greggi
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Francesco Vommaro
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Luca Boriani
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Antonio Scarale
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Paola Zarantonello
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Giuseppe Carbone
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Stefano Stallone
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
| | - Riccardo Zucchini
- Spine Deformities Surgery Division, Istituto Ortopedico Rizzoli , Bologna 40136, Italy
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31
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Lamanna A, Maingard J, Kok HK, Ranatunga D, Looby ST, Brennan P, Chua M, Owen A, Brooks DM, Chandra RV, Asadi H. Vertebroplasty for acute painful osteoporotic vertebral compression fractures: An update. J Med Imaging Radiat Oncol 2019; 63:779-785. [PMID: 31106977 DOI: 10.1111/1754-9485.12900] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/19/2019] [Indexed: 12/12/2022]
Abstract
Vertebral compression fractures (VCFs) are a common cause of back pain and disability and are usually osteoporotic in nature. Therapy aims to adequately control pain and allow early mobilisation and return of function while preventing additional fractures. A proportion of patients do not achieve adequate pain relief using conservative measures alone. Unwanted adverse effects from medications may also ensue. Vertebroplasty represents an alternative treatment option for VCFs. Patients with acute VCFs (≤6 weeks old) may gain the most benefit from vertebroplasty as healed fractures are not as amenable to cement injection. High-quality studies have reported conflicting results regarding the use of vertebroplasty in the treatment of acute VCFs. Despite high-quality evidence, varying study designs and heterogenous patient cohorts make interpretation of this data difficult. Only one sham-controlled randomised controlled trial (RCT) has evaluated vertebroplasty exclusively in patients with acute VCFs, reporting favourable results. Pooled data from RCTs also suggest vertebroplasty to be safe. This article provides a concise and critical review of the current literature regarding vertebroplasty for the treatment of acute VCFs.
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Affiliation(s)
- Anthony Lamanna
- Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Julian Maingard
- Department of Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Hong Kuan Kok
- Interventional Radiology Service, Northern Hospital Radiology, Melbourne, Victoria, Australia
| | - Dinesh Ranatunga
- Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Seamus T Looby
- Interventional Radiology Service - Department of Radiology, Beaumont Hospital, Dublin, Ireland.,Department of Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul Brennan
- Interventional Radiology Service - Department of Radiology, Beaumont Hospital, Dublin, Ireland.,Department of Radiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michelle Chua
- Department of Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Andrew Owen
- Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Duncan Mark Brooks
- Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia.,Interventional Neuroradiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Ronil V Chandra
- Department of Imaging, Monash Health, Melbourne, Victoria, Australia.,Interventional Neuroradiology Unit - Monash Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Hamed Asadi
- Interventional Radiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia.,Department of Imaging, Monash Health, Melbourne, Victoria, Australia.,Interventional Neuroradiology Service - Department of Radiology, Austin Hospital, Melbourne, Victoria, Australia.,Interventional Neuroradiology Unit - Monash Imaging, Monash Health, Melbourne, Victoria, Australia.,School of Medicine - Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Wang F, Wang LF, Miao DC, Dong Z, Shen Y. Which one is more effective for the treatment of very severe osteoporotic vertebral compression fractures: PVP or PKP? J Pain Res 2018; 11:2625-2631. [PMID: 30464581 PMCID: PMC6209074 DOI: 10.2147/jpr.s179022] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the clinical efficacy and safety of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of the elderly with very severe osteoporotic vertebral compression fractures (vsOVCFs). METHODS From September 2012 to September 2015, 57 patients with vsOVCFs who had undergone PVP and PKP surgeries at our medical center were reviewed retrospectively, at least 2 years follow-up. All patients were divided into PVP group (n=31) and PKP group (n=26). Clinical data including clinical and radiological evaluation results were performed pre- and postoperatively. RESULTS The operation time of PVP group (29.6±3.3 minutes) was less than that of PKP group (37.4±4.2 minutes), with significant differences (P<0.05). Compared with preoperative data, the VAS scores, Oswestry disability index (ODI) scores, and local kyphotic angle were improved with significant differences at 1 day after surgery and the last follow-up in two groups (P<0.05). However, there were no differences in VAS and ODI scores between the two groups (P>0.05). The local kyphotic angle of PVP group was more than that of PKP group after surgery, with significant differences (P<0.05). At 1 day after surgery and the last follow-up, the anterior height of vertebrae fractured was significantly improved compared with preoperative in PKP group (P<0.05), and there was no statistical difference compared with preoperative in PVP group (P>0.05). However, there were no significant differences between the two groups in the leakage rate of bone cement (P>0.05) and incidence of adjacent-level vertebra fracture (P>0.05). CONCLUSION Both PVP and PKP can significantly relieve the pain of the patients with vsOVCFs. Restoring the vertebral height and local kyphotic angle corrections of PKP are comparatively better than those of PVP. However, the operation time of PKP is significantly longer than that of PVP and PKP is not superior in the leakage rate of bone cement and incidence of adjacent-level vertebra fracture compared to PVP.
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Affiliation(s)
- Feng Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 050051 Shijiazhuang, China,
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, 050051 Shijiazhuang, China,
| | - Lin-Feng Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 050051 Shijiazhuang, China,
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, 050051 Shijiazhuang, China,
| | - De-Chao Miao
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 050051 Shijiazhuang, China,
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, 050051 Shijiazhuang, China,
| | - Zhen Dong
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 050051 Shijiazhuang, China,
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, 050051 Shijiazhuang, China,
| | - Yong Shen
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, 050051 Shijiazhuang, China,
- The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, 050051 Shijiazhuang, China,
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Kurra S, Metkar U, Lieberman IH, Lavelle WF. The Effect of Kyphoplasty on Mortality in Symptomatic Vertebral Compression Fractures: A Review. Int J Spine Surg 2018; 12:543-548. [PMID: 30364815 DOI: 10.14444/5066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Vertebral compression fractures (VCFs) are common comorbidities encountered in the elderly, and they are on the rise. Kyphoplasty may be superior in VCF management compared with conservative management. A comprehensive review of literature was conducted, focusing on the effect of kyphoplasty on mortality and overall survivorship in patients with a diagnosis of symptomatic VCFs. Methods A comprehensive literature search was conducted to find recently published literature on kyphoplasty effects on mortality using the following keywords: "kyphoplasty," "mortality," "morbidity," "vertebral compression fractures," and "survivorship." We only included articles that listed one of their primary or secondary outcomes as morbidity and mortality after a kyphoplasty procedure in VCF patients. Results Of 27 articles, only 6 articles met the inclusion criteria. Studies have reported that surgical procedures have decreased the mortality rate in symptomatic VCF patients. Four studies concluded that the mortality rate was lower after kyphoplasty compared with vertebroplasty and nonoperative treatments. One study reported there was no significant difference between kyphoplasty and nonoperative management. One study summarized that the mortality rate was not significantly different between kyphoplasty and vertebroplasty. Conclusions Multicenter prospective and randomized control studies are required to fully evaluate the decreasing trend of mortality rates after a kyphoplasty procedure.
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Affiliation(s)
- Swamy Kurra
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Umesh Metkar
- The Spine Center at Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Isador H Lieberman
- Scoliosis and Spine Tumors, Orthopedic Spine Surgery, Texas Back Institute, Plano, Texas
| | - William F Lavelle
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
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34
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Xia YH, Chen F, Zhang L, Li G, Tang ZY, Feng B, Xu K. Percutaneous kyphoplasty treatment evaluation for patients with Kümmell disease based on a two-year follow-up. Exp Ther Med 2018; 16:3617-3622. [PMID: 30233717 DOI: 10.3892/etm.2018.6628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 07/06/2018] [Indexed: 11/06/2022] Open
Abstract
Percutaneous kyphoplasty (PKP) has been used in Kümmell disease treatment for years. The objective of the current study was to evaluate the efficacy and safety of PKP in the treatment of patients with Kümmell disease and to explore the association between cement injection volume and pain relief. A total of 50 patients were enrolled in the present study and follow-up was 2 years. Efficacy was evaluated using the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI) and the kyphotic angle (Cobb's angle). VAS and ODI were determined at the initial evaluation (prior to surgery), at 3 days, 3 months, and 1 and 2 years post surgery. Cobb's angle was measured prior to and 3 months, 1 year and 2 years following surgery. PKP safety was assessed by evaluating complications, including cement leakage and spinal cord compression. In the follow-ups, VAS significantly decreased from 7.00±0.78 pre-PKP to 3.14±0.67 at 2 years post-PKP (P<0.05). ODI significantly decreased from 73.88±8.60 prior to surgery to 22.84±8.85 at 1 year following surgery (P<0.05) and did not significantly change at the following 2-year measurement (26.44±8.63). The Cobb's angle, measured at 17.73±2.43° preoperatively, significantly decreased to 8.32±2.21° at 3 months following surgery (P<0.05). On subsequent follow-ups at 1 and 2 years, the Cobb's angle increased to 9.55±2.82 and 10.27±3.22°, respectively. A total of 8 patients exhibited signs of cement leakage during the PKP procedure. No patients experienced severe neurological deficits or complications. Spearman analysis demonstrated a positive correlation between cement injection volume and pain relief. The current study indicated that PKP was a safe and effective treatment for patients with Kümmell disease and that there was a positive correlation between cement injection volume and pain relief. The current study may be used a reference in cement dosing for the treatment of PKP.
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Affiliation(s)
- Yong-Hui Xia
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Feng Chen
- Department of Interventional Radiology, Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Liang Zhang
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Gang Li
- Department of Interventional Radiology, Jinhua Central Hospital, Jinhua, Zhejiang 321000, P.R. China
| | - Zhi-Yu Tang
- Department of Interventional Radiology, Nanchong Central Hospital, Nanchong, Sichuan 637900, P.R. China
| | - Bo Feng
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Ke Xu
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Beall D, Lorio MP, Yun BM, Runa MJ, Ong KL, Warner CB. Review of Vertebral Augmentation: An Updated Meta-analysis of the Effectiveness. Int J Spine Surg 2018; 12:295-321. [PMID: 30276087 DOI: 10.14444/5036] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background To update vertebral augmentation literature by comparing outcomes between vertebroplasty (VP), balloon kyphoplasty (BKP), vertebral augmentation with implant (VAI), and nonsurgical management (NSM) for treating vertebral compression fractures (VCFs). Methods A PubMed literature search was conducted with keywords kyphoplasty, vertebroplasty, vertebral body stent, and vertebral augmentation AND implant for English-language articles from February 1, 2011, to November 22, 2016. Among the results, 25 met the inclusion criteria for the meta-analysis. Inclusion criteria were prospective comparative studies for mid-/lower-thoracic and lumbar VCFs enrolling at least 20 patients. Exclusion criteria included studies that were single arm, systematic reviews and meta-analyses, traumatic nonosteoporotic or cancer-related fractures, lack of clinical outcomes, or non-Level I and non-Level II studies. Standardized mean difference between baseline and end point for each outcome was calculated, and treatment groups were pooled using random effects meta-analysis. Results Visual analog scale pain reduction for BKP and VP was -4.05 and -3.88, respectively. VP was better than but not significantly different from NSM (-2.66), yet BKP showed significant improvement from both NSM and VAI (-2.77). The Oswestry Disability Index reduction for BKP showed a significant improvement over VAI (P < .001). There was no significant difference in changes between BKP and VP for anterior (P = .226) and posterior (P = .293) vertebral height restoration. There was no significant difference in subsequent fractures following BKP (32.7%; 95% confidence interval [CI]: 8.8%-56.6%) or VP (28.3%; 95% CI: 7.0%-49.7%) compared with NSM (15.9%; 95% CI: 5.2%-26.6%). Conclusions/Level of Evidence Based on Level I and II studies, BKP had significantly better and VP tended to have better pain reduction compared with NSM. BKP tended to have better height restoration than VP. Additionally, BKP had significant improvements in pain reduction and disability score as compared with VAI. Clinical Relevance This meta-analysis serves to further define and support the safety and efficacy of vertebral augmentation.
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Affiliation(s)
| | - Morgan P Lorio
- Hughston Clinic Orthopaedics-Centennial, Nashville, Tennessee
| | - B Min Yun
- Exponent, Inc, Philadelphia, Pennsylvania
| | | | | | - Christopher B Warner
- University of Colorado Anschutz Medical Campus, Department of Radiology, Aurora, Colorado
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He X, Zhao L, Guo X, Zhao L, Wu J, Huang J, Sun L, Xie C, Chen H. Differential diagnostic value of 18F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging. Cancer Manag Res 2018; 10:2105-2115. [PMID: 30050321 PMCID: PMC6055832 DOI: 10.2147/cmar.s168374] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Indexed: 02/04/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the differential diagnostic value of 2-[fluorine-18]-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) for benign and malignant vertebral compression fractures (VCFs), where the diagnostic accuracy of 18F-FDG PET/CT was compared with magnetic resonance imaging (MRI). Patients and methods Between 2015 and 2017, we retrospectively evaluated 87 patients with 116 VCFs. MRI was performed in all the 87 patients, whereas 18F-FDG PET/CT was executed in 51 patients. Three malignant features (convex posterior cortex, epidural mass formation, and pedicle enhancement) from MRI and the maximum standardized uptake value (SUVmax) from 18F-FDG PET/CT were evaluated in benign and malignant VCFs, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of MRI and 18F-FDG PET/CT were compared in the differentiation of malignant from benign VCFs. Results The results of our investigation showed that the sensitivity and specificity for predicting malignant VCFs were 75.6% and 77.3% for convex posterior cortex, 82.9% and 813% for epidural mass formation, and 85.7% and 70.8% for pedicle enhancement. 18F-FDG PET/CT demonstrated higher sensitivity (100%) but lower specificity (38.9%) as compared to MRI with regard to differentiation between benign and malignant VCFs. A significant difference in the SUVmax values was observed between the benign and malignant fractures (2.9 ± 1.0 vs 5.0 ± 1.8, P < 0.01). Besides the value of SUVmax, it has been noticed that the FDG uptake pattern differed in malignant and benign fractures. Conclusion Significant MRI findings such as convex posterior cortex, epidural mass formation, and pedicle enhancement are highly suggestive of malignancy. 18F-FDG PET/CT reliably differentiated the fractures of malignant from benign based on both SUVmax and 18F-FDG uptake pattern. In a situation where MRI findings are not diagnostic, 18F-FDG PET/CT provides additional information as it has high sensitivity and is semiquantitative.
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Affiliation(s)
- Xiaojiang He
- Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital of the First Affiliated Hospital of Xiamen University, Xiamen 361003, China,
| | - Long Zhao
- Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital of the First Affiliated Hospital of Xiamen University, Xiamen 361003, China,
| | - Xiuyu Guo
- Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital of the First Affiliated Hospital of Xiamen University, Xiamen 361003, China,
| | - Liang Zhao
- Department of Radiation Oncology, Xiamen Cancer Hospital of the First Affiliated Hospital of Xiamen University, Xiamen 361003, China
| | - Jing Wu
- Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital of the First Affiliated Hospital of Xiamen University, Xiamen 361003, China,
| | - Jingxiong Huang
- Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital of the First Affiliated Hospital of Xiamen University, Xiamen 361003, China,
| | - Long Sun
- Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital of the First Affiliated Hospital of Xiamen University, Xiamen 361003, China,
| | - Chengrong Xie
- Department of Hepatobiliary Surgery, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen 361004, China
| | - Haojun Chen
- Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital of the First Affiliated Hospital of Xiamen University, Xiamen 361003, China,
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Schendel A, Mai J, Espinosa R, Tomcyzk CT, Laguna TA. Unexpected Height Loss in an Adolescent With Cystic Fibrosis. Glob Pediatr Health 2018; 5:2333794X18773662. [PMID: 29761141 PMCID: PMC5946352 DOI: 10.1177/2333794x18773662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/30/2018] [Indexed: 12/04/2022] Open
Abstract
This case report describes an adolescent with pancreatic insufficient cystic fibrosis, malnutrition, and cystic fibrosis–related diabetes found to have a loss in height at a routine outpatient clinic visit. He was subsequently admitted to the hospital for treatment of a pulmonary exacerbation and was found to have multiple, nontraumatic vertebral compression fractures. This report emphasizes the importance of routine review of growth charts and aggressive treatment of vitamin deficiencies and malnutrition in people with cystic fibrosis.
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Affiliation(s)
| | - Jillian Mai
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Rachel Espinosa
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Carlye T Tomcyzk
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Theresa A Laguna
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
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Aghyarian S, Hu X, Haddas R, Lieberman IH, Kosmopoulos V, Kim HKW, Rodrigues DC. Biomechanical behavior of novel composite PMMA-CaP bone cements in an anatomically accurate cadaveric vertebroplasty model. J Orthop Res 2017; 35:2067-2074. [PMID: 27891670 DOI: 10.1002/jor.23491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/18/2016] [Indexed: 02/04/2023]
Abstract
Vertebral compression fractures are caused by many factors including trauma and osteoporosis. Osteoporosis induced fractures are a result of loss in bone mass and quality that weaken the vertebral body. Vertebroplasty and kyphoplasty, involving cement augmentation of fractured vertebrae, show promise in restoring vertebral mechanical properties. Some complications however, are reported due to the performance characteristics of commercially available bone cements. In this study, the biomechanical performance characteristics of two novel composite (PMMA-CaP) bone cements were studied using an anatomically accurate human cadaveric vertebroplasty model. The study involves mechanical testing on two functional cadaveric spinal unit (2FSU) segments which include monotonic compression and cyclical fatigue tests, treatment by direct cement injection, and microscopic visualization of sectioned vertebrae. The 2FSU segments were fractured, treated, and mechanically tested to investigate the stability provided by two novel bone cements; using readily available commercial acrylic cement as a control. Segment height and stiffness were tracked during the study to establish biomechanical performance. The 2FSU segments were successfully stabilized with all three cement groups. Stiffness values were restored to initial levels following fatigue loading. Cement interdigitation was observed with all cement groups. This study demonstrates efficient reinforcement of the fractured vertebrae through stiffness restoration. The pre-mixed composite cements were comparable to the commercial cement in their performance and interdigitative ability, thus holding promise for future clinical use. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2067-2074, 2017.
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Affiliation(s)
- Shant Aghyarian
- Biomaterials for Osseointegration and Novel Engineering Laboratory (BONE Lab), Department of Bioengineering, University of Texas at Dallas, Richardson, Texas, 75080
| | - Xiaobang Hu
- Scoliosis and Spine Tumor Center, Texas Back Institute, Texas Health Plano Hospital, Plano, Texas, 75093
| | - Ram Haddas
- Texas Back Institute Research Foundation, Plano, Texas, 75093
| | - Isador H Lieberman
- Scoliosis and Spine Tumor Center, Texas Back Institute, Texas Health Plano Hospital, Plano, Texas, 75093
| | - Victor Kosmopoulos
- Department of Orthopaedic Surgery, University of North Texas Health Science Center (UNTHSC), Fort Worth, Texas, 76107.,Department of Materials Science and Engineering, University of North Texas, Denton, Texas, 76203
| | - Harry K W Kim
- Center of Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, Texas, 75219.,Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, 75390
| | - Danieli C Rodrigues
- Biomaterials for Osseointegration and Novel Engineering Laboratory (BONE Lab), Department of Bioengineering, University of Texas at Dallas, Richardson, Texas, 75080
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Hemama M, El Fatemi N, Gana R. Percutaneous vertebroplasty in Moroccan patients with vertebral compression fractures. Pan Afr Med J 2017; 26:225. [PMID: 28690739 PMCID: PMC5491720 DOI: 10.11604/pamj.2017.26.225.9872] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 03/06/2017] [Indexed: 11/12/2022] Open
Abstract
Incidence of vertebral compression fractures (VCFs) is increasing due to the increase in human life expectancy and prevalence of osteoporosis. Percutaneous vertebroplasty (PVP) has become a widely used alternative treatment for symptomatic VCFs refractory to medical therapy. It is a minimally invasive technique involving injection most frequently of polymethylmethacrylate (PMMA) directly into the vertebral body through the pedicles. Percutaneous vertebroplasty yields good results in terms of early vertebral stabilization and prompt pain relief. This study describes the experience of the Department of Neurosurgery at Ibn Sina University Hospital (Rabat, Morocco) and assesses short and long term clinical and radiological outcomes and complications of vertebroplasty in a retrospective assessment of 36 vertebral compression fractures in 35 patients (16 men and 19 women subjects) who had been treated with vertebroplasty from November 2006 to December 2014.
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Affiliation(s)
- Mustapha Hemama
- UFR d''Epidémiologie Clinique et Sciences Médico-Chirurgicale, Ertna-Mohammed V University- Souissi (UM5S)-Faculty of Medicine and Pharmacy, Rabat, Morocco.,Department of Neurosurgery, Ibn Sina University Hospital, Rabat, Morocco
| | - Nizar El Fatemi
- Department of Neurosurgery, Ibn Sina University Hospital, Rabat, Morocco
| | - Rachid Gana
- Department of Neurosurgery, Ibn Sina University Hospital, Rabat, Morocco
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Wali AR, Martin JR, Rennert R, Resnick DK, Taylor W, Warnke P, Chen CC. Vertebroplasty for vertebral compression fractures: Placebo or effective? Surg Neurol Int 2017; 8:81. [PMID: 28607815 PMCID: PMC5461565 DOI: 10.4103/sni.sni_2_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 01/01/2017] [Indexed: 01/25/2023] Open
Abstract
Vertebral compression fractures (VCFs) are a major cause of pain and disability. Here, we reviewed six randomized control trials (RCTs) focusing on the efficacy vs. placebo effect of vertebroplasty (VP) for symptomatic VCF. Four RCTs involved a nonsurgically treated control group. Two RCTs compared the use of VP vs. a sham surgery control group. Notably, RCTs comparing nonsurgically treated patients as a control group vs. those undergoing VP uniformly reported that VP contributed to improved pain relief. In contrast, RCTs comparing sham surgery vs. VP uniformly reported no significant differences between the two groups.
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Affiliation(s)
- Arvin R Wali
- Department of Neurosurgery, University of California, San Diego, California, USA
| | - Joel R Martin
- Department of Neurosurgery, University of California, San Diego, California, USA
| | - Robert Rennert
- Department of Neurosurgery, University of California, San Diego, California, USA
| | - Daniel K Resnick
- Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin, USA
| | - William Taylor
- Department of Neurosurgery, University of California, San Diego, California, USA
| | - Peter Warnke
- Division of Neurosurgery, University of Chicago, Chicago, Illinois, USA
| | - Clark C Chen
- Department of Neurosurgery, University of California, San Diego, California, USA
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Feng L, Shen JM, Feng C, Chen J, Wu Y. Comparison of radiofrequency kyphoplasty (RFK) and balloon kyphoplasty (BKP) in the treatment of vertebral compression fractures: A meta-analysis. Medicine (Baltimore) 2017. [PMID: 28640091 PMCID: PMC5484199 DOI: 10.1097/md.0000000000007150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/17/2022] Open
Abstract
BACKGROUND Balloon kyphoplasty (BKP) is a widely adopted minimally invasive treatment for vertebral compression fractures (VCFs), but leakage of cement is a main complication of BKP. A novel vertebral augmentation technique radiofrequency kyphoplasty (RFK) with high viscosity cement was developed in 2009. Here, we aim to evaluate whether RFK can relieve symptoms efficiently and reduce cement leakage. METHODS A literature search was performed using Pubmed, Embase, and Cochrane CENTRAL until September 30, 2016. Both randomized controlled trial (RCT) and non-RCT studies comparing RFK and BKP were included. The main outcomes included pain relief (VAS), functionality improvement (ODI), operation time, reduction of deformity (vertebral height and kyphosis angle), and incidence of cement leakage. The origin of heterogeneity was further explored by subgroup stratification. RESULTS A total of 6 studies involving 833 patients with VCFs were included. The reduction of VAS score in the RFK group was 3.96 points more than that in the BKP group (P = .0007) postoperatively, and the improvement persisted until 12 months after the surgery (P < .00001). The operation time was shorter in RFK group than that in BKP group (P = .01). The increase of anterior vertebral height shortly after the operation was 0.53 mm greater in RFK group (P = .01). The decrease of kyphotic angle after RFK was 0.63° and 0.92° greater than that after BKP, both immediately and 6 months after operation (P = .002 and P < .00001, respectively). There was no significant difference between the incidence of cement leakage after RFK and BKP (P = .06). Further subgroup analysis stratified by study design indicated that the incidence of leakage decreased 15% in RFK than BPK (P < .00001) in non-RCT subgroup, but RFK and BKP treatments were equivalent in the RCT studies (P = .86). CONCLUSION RFK appears to be more effective and safer than BKP in the present meta-analysis. The incidence of cement leakage diverges in RCT and non-RCT studies, so large-sample multicentered RCT studies are required to validate this new surgery system.
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Affiliation(s)
- Lei Feng
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University
| | - Jin-Ming Shen
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University
| | - Chun Feng
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jie Chen
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University
| | - Yu Wu
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medicine University
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Guo D, Cai J, Zhang S, Zhang L, Feng X. Treating osteoporotic vertebral compression fractures with intraosseous vacuum phenomena using high-viscosity bone cement via bilateral percutaneous vertebroplasty. Medicine (Baltimore) 2017; 96:e6549. [PMID: 28383423 PMCID: PMC5411207 DOI: 10.1097/md.0000000000006549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Osteoporotic vertebral compression fractures with intraosseous vacuum phenomena could cause persistent back pains in patients, even after receiving conservative treatment. The aim of this study was to evaluate the efficacy of using high-viscosity bone cement via bilateral percutaneous vertebroplasty in treating patients who have osteoporotic vertebral compression fractures with intraosseous vacuum phenomena.Twenty osteoporotic vertebral compression fracture patients with intraosseous vacuum phenomena, who received at least 2 months of conservative treatment, were further treated by injecting high-viscosity bone cement via bilateral percutaneous vertebroplasty due to failure of conservative treatment. Treatment efficacy was evaluated by determining the anterior vertebral compression rates, visual analog scale (VAS) scores, and Oswestry disability index (ODI) scores at 1 day before the operation, on the first day of postoperation, at 1-month postoperation, and at 1-year postoperation.Three of 20 patients had asymptomatic bone cement leakage when treated via percutaneous vertebroplasty; however, no serious complications related to these treatments were observed during the 1-year follow-up period. A statistically significant improvement on the anterior vertebral compression rates, VAS scores, and ODI scores were achieved after percutaneous vertebroplasty. However, differences in the anterior vertebral compression rate, VAS score, and ODI score in the different time points during the 1-year follow-up period was not statistically significant (P > 0.05).Within the limitations of this study, the injection of high-viscosity bone cement via bilateral percutaneous vertebroplasty for patients who have osteoporotic vertebral compression fractures with intraosseous vacuum phenomena significantly relieved their back pains and improved their daily life activities shortly after the operation, thereby improving their life quality. In this study, the use of high-viscosity bone cement reduced the leakage rate and contributed to their successful treatment, as observed in patients during the 1-year follow-up period.
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Dietrich O, Geith T, Reiser MF, Baur-Melnyk A. Diffusion imaging of the vertebral bone marrow. NMR Biomed 2017; 30:e3333. [PMID: 26114411 DOI: 10.1002/nbm.3333] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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: 02/20/2015] [Revised: 04/27/2015] [Accepted: 05/04/2015] [Indexed: 06/04/2023]
Abstract
Diffusion-weighted MRI (DWI) of the vertebral bone marrow is a clinically important tool for the characterization of bone-marrow pathologies and, in particular, for the differentiation of benign (osteoporotic) and malignant vertebral compression fractures. DWI of the vertebral bone marrow is, however, complicated by some unique MR and tissue properties of vertebral bone marrow. Due to both the spongy microstructure of the trabecular bone and the proximity of the lungs, soft tissue, or large vessels, substantial magnetic susceptibility variations occur, which severely reduce the magnetic field homogeneity as well as the transverse relaxation time T*2 , and thus complicate MRI in particular with echoplanar imaging (EPI) techniques. Therefore, alternative diffusion-weighting pulse sequence types such as single-shot fast-spin-echo sequences or segmented EPI techniques became important alternatives for quantitative DWI of the vertebral bone marrow. This review first describes pulse sequence types that are particularly important for DWI of the vertebral bone marrow. Then, data from 24 studies that made diffusion measurements of normal vertebral bone marrow are reviewed; summarizing all results, the apparent diffusion coefficient (ADC) of normal vertebral bone marrow is typically found to be between 0.2 and 0.6 × 10-3 mm2 /s. Finally, DWI of vertebral compression fractures is discussed. Numerous studies demonstrate significantly greater ADCs in osteoporotic fractures (typically between 1.2 and 2.0 × 10-3 mm2 /s) than in malignant fractures or lesions (typically 0.7-1.3 × 10-3 mm2 /s). Alternatively, several studies used the (qualitative) image contrast of diffusion-weighted acquisitions for differentiation of lesion etiology: a very good lesion differentiation can be achieved, particularly with diffusion-weighted steady-state free precession sequences, which depict malignant lesions as hyperintense relative to normal-appearing vertebral bone marrow, in contrast to hypointense or isointense osteoporotic lesions. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Olaf Dietrich
- Josef Lissner Laboratory for Biomedical Imaging, Institute for Clinical Radiology, Ludwig Maximilian University Hospital Munich, Germany
| | - Tobias Geith
- Institute for Clinical Radiology, Ludwig Maximilian University Hospital Munich, Germany
| | - Maximilian F Reiser
- Josef Lissner Laboratory for Biomedical Imaging, Institute for Clinical Radiology, Ludwig Maximilian University Hospital Munich, Germany
- Institute for Clinical Radiology, Ludwig Maximilian University Hospital Munich, Germany
| | - Andrea Baur-Melnyk
- Institute for Clinical Radiology, Ludwig Maximilian University Hospital Munich, Germany
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Mimata Y, Sato K, Oikawa R, Doita M. Non-traumatic Thoracic Vertebral Compression Fractures Occurred in a Young Epileptic Patient: A Case Report. J Orthop Case Rep 2017; 6:85-87. [PMID: 28116280 PMCID: PMC5245951 DOI: 10.13107/jocr.2250-0685.526] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The occurrence of non-traumatic vertebral compression fractures (VCFs) in a healthy young male is very rare. We present a rare case of non-traumatic thoracic VCFs in a young epileptic patient. CASE REPORT A 19-year-old healthy male experienced severe back pain. There had been no significant traumatic event. A radiograph of the spine showed collapsed vertebra at Th6 and Th7 and magnetic resonance image of the spine showed intensity changes at Th6, Th7 and Th8. Bone mineral density (BMD) at the radius was low and urine N-terminal telopeptide (NTx) was very high. The patient was diagnosed with VCFs caused by low BMD. The patient had a medical history of epilepsy and had taken valproate for thirteen years. We instructed the patient to stop taking valproate and to begin taking bisphosphonate. As a result, urine NTx became normal. CONCLUSION It was previously reported that valproate reduced BMD in epileptic children and reduction in BMD increased with the duration of valproate therapy. We propose that regular BMD screening and measurement of bone metabolic markers should be conducted for all patients taking long-term antiepileptic drugs to prevent BMD loss and associated fractures.
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Affiliation(s)
- Yoshikuni Mimata
- Department of Orthopaedic Surgery, Iwate Medical University, Morioka, Japan
| | - Kotaro Sato
- Department of Orthopaedic Surgery, Iwate Medical University, Morioka, Japan
| | - Ryunosuke Oikawa
- Department of Orthopaedic Surgery, Iwate Medical University, Morioka, Japan
| | - Minoru Doita
- Department of Orthopaedic Surgery, Iwate Medical University, Morioka, Japan
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Yaltirik K, Ashour AM, Reis CR, Özdoğan S, Atalay B. Vertebral augmentation by kyphoplasty and vertebroplasty: 8 years experience outcomes and complications. J Craniovertebr Junction Spine 2016; 7:153-60. [PMID: 27630477 PMCID: PMC4994147 DOI: 10.4103/0974-8237.188413] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and Context: Minimally invasive percutaneous vertebral augmentation techniques; vertebroplasty, and kyphoplasty have been treatment choices for vertebral compression fractures (VCFs). The purpose of this study is to evaluate the outcomes of the patients who underwent vertebroplasty or kyphoplasty regarding complications, correction of vertebral body height, kyphosis angle and pain relief assessment using visual analog score (VAS) for pain. Materials and Methods: A retrospective review of the hospital records for 100 consecutive patients treated with kyphoplasty or vertebroplasty in our department database. Patients with osteoporotic compression fractures, traumatic compressions, and osteolytic vertebral lesions, including metastases, hemangiomas, and multiple myeloma, were included in the study. Preoperative and postoperative VAS pain scores, percentages of vertebral compression and kyphotic angles were measured and compared as well as demographic characteristics and postoperative complications. Mobilization and length of stay (LOS) were recorded. Results: One hundred patients were treated by 110 procedures. 64 patients were operated on due to osteoporosis (72 procedures). Twelve patients were operated on because of metastasis (13 procedures), 8 patients were operated on because of multiple myeloma (9 procedures). Five patients had two surgeries, 1 patient had 3 surgeries, and 1 patient had 5 surgeries. The mean preoperative VAS was 74.05 ± 9.8. In total, 175 levels were treated, 46 levels by kyphoplasty and 129 by vertebroplasty. The mean postoperative VAS was 20.94 ± 11.8. Most of the patients were mobilized in the same day they of surgery. Mean LOS was 1.83 days. Six patients had nonsymptomatic leakage of polymethlymethacrylate, and patient had epidural hematoma, which was operated on performing hemi-laminectomy. Conclusions: Percutaneous vertebroplasty and balloon kyphoplasty are both effective and safe minimally invasive procedures for the stabilization of VCFs. However, complications should be kept in mind during decision making.
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Affiliation(s)
- Kaan Yaltirik
- Department of Neurosurgery, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Ahmed M Ashour
- Department of Neurosurgery, Saint Louis University, Saint Louis, MO, USA
| | - Conner R Reis
- Department of Neurosurgery, Saint Louis University, Saint Louis, MO, USA
| | - Selçuk Özdoğan
- Department of Neurosurgery, Lütfi Kırdar Education and Research Hospital, Istanbul, Turkey
| | - Başar Atalay
- Department of Neurosurgery, School of Medicine, Yeditepe University, Istanbul, Turkey
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Daffner SD, Karnes JM, Watkins CM. Surgeon Specialty Influences Referral Rate for Osteoporosis Management following Vertebral Compression Fractures. Global Spine J 2016; 6:524-8. [PMID: 27555992 PMCID: PMC4993620 DOI: 10.1055/s-0035-1569057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/17/2015] [Indexed: 11/10/2022] Open
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVE To evaluate the referral rate for long-term osteoporosis management following vertebral compression fracture treated by different specialties at a single academic institution. METHODS Patients undergoing vertebral cement augmentation for painful osteoporotic compression fractures from 2009 to 2014 were identified. Medical records were reviewed to determine if the treating surgeon discussed and/or referred the patient for long-term osteoporosis management. Any referral for or mention of medical long-term osteoporosis management was counted as a positive response. Results were statistically analyzed with chi-square test. RESULTS Two hundred fourteen patients underwent vertebral cement augmentation; 150 met inclusion criteria. Orthopedic surgeons treated 88 patients, neurosurgeons treated 39, and interventional radiology or pain management physicians treated 23. Orthopedic surgeons referred 82% of patients for osteoporosis management, neurosurgeons referred 36%, and interventional radiology/pain management referred 17%. The referral rate was significantly higher for orthopedic surgeons compared with either of the other two groups; there was no significant difference between neurosurgery and interventional radiology/pain management. CONCLUSIONS Among physicians who treat osteoporotic vertebral compression fractures, orthopedic surgeons more frequently address osteoporosis or refer patients for osteoporosis management compared with neurosurgeons and interventional radiologists or pain management physicians. The results of this study shed light on the disparity in how different specialties approach treatment of osteoporosis in patients with fractures painful enough to require surgery and highlight potential areas for improvement in osteoporosis awareness training.
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Affiliation(s)
- Scott D. Daffner
- Department of Orthopaedics, West Virginia University, Morgantown, West Virginia, United States,Address for correspondence Scott D. Daffner, MD Department of Orthopaedics, West Virginia UniversityPO Box 9196, Morgantown, WV 26506-9196United States
| | - Jonathan M. Karnes
- Department of Orthopaedics, West Virginia University, Morgantown, West Virginia, United States
| | - Colleen M. Watkins
- Department of Orthopaedics, West Virginia University, Morgantown, West Virginia, United States
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Hoff BA, Toole M, Yablon C, Ross BD, Luker GD, VanPoznak C, Galbán CJ. Potential for Early Fracture Risk Assessment in Patients with Metastatic Bone Disease using Parametric Response Mapping of CT Images. ACTA ACUST UNITED AC 2015; 1:98-104. [PMID: 26771006 PMCID: PMC4710140 DOI: 10.18383/j.tom.2015.00154] [Citation(s) in RCA: 9] [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] [Indexed: 01/09/2023]
Abstract
Pathologic vertebral compression fractures (PVCFs) cause significant morbidity in patients with metastatic bone disease. Limitations in existing clinical biomarkers leave clinicians without reliable metrics for predicting PVCF, thus impeding efforts to prevent this severe complication. To establish the feasibility of a new method for defining the risk of a PVCF, we retrospectively analyzed serial computed tomography (CT) scans from 5 breast cancer patients using parametric response mapping (PRM) to quantify dynamic bone miniral density (BMD) changes that preceded an event. Vertebrae segmented from each scan were registered to the same spatial frame and voxel classification was accomplished using a predetermined threshold of change in Hounsfield units (HU), resulting in relative volumes of increased (PRMHU+), decreased (PRMHU−), or unchanged (PRMHU0) attenuation. A total of 7 PVCFs were compared to undiseased vertebrae in each patient serving as controls. A receiver operator curve (ROC) analysis identified optimal imaging times for group stratification. BMD changes were apparent by an elevated PRMHU+ as early as 1 year before fracture. ROC analysis showed poor performance of PRMHU− in stratifying PVCFs versus controls. As early as 6 months before PVCF, PRMHU+ was significantly larger (12.9 ± 11.6%) than control vertebrae (2.3 ± 2.5%), with an area under the curve of 0.918 from an ROC analysis. Mean HU changes were also significant between PVCF (26.8 ± 26.9%) and control (−2.2 ± 22.0%) over the same period. A PRM analysis of BMD changes using standard CT imaging was sensitive for spatially resolving changes that preceded structural failure in these patients.
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Affiliation(s)
- Benjamin A Hoff
- Department of Radiology, University of Michigan, Center for Molecular Imaging, Ann Arbor, MI 48109, USA
| | - Michael Toole
- Department of Internal Medicine, University of Michigan, Center for Molecular Imaging, Ann Arbor, MI 48109, USA
| | - Corrie Yablon
- Department of Radiology, University of Michigan, Center for Molecular Imaging, Ann Arbor, MI 48109, USA
| | - Brian D Ross
- Department of Radiology, University of Michigan, Center for Molecular Imaging, Ann Arbor, MI 48109, USA
| | - Gary D Luker
- Department of Radiology, University of Michigan, Center for Molecular Imaging, Ann Arbor, MI 48109, USA
| | - Catherine VanPoznak
- Department of Internal Medicine, University of Michigan, Center for Molecular Imaging, Ann Arbor, MI 48109, USA
| | - Craig J Galbán
- Department of Radiology, University of Michigan, Center for Molecular Imaging, Ann Arbor, MI 48109, USA
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48
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Zhai W, Jia Y, Wang J, Cheng L. The clinical application and efficacy of percutaneous kyphoplasty via unilateral pedicular approach guided by CT image measurement. Int J Clin Exp Med 2015; 8:20861-20868. [PMID: 26885011 PMCID: PMC4723856] [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: 08/31/2015] [Accepted: 11/08/2015] [Indexed: 06/05/2023]
Abstract
This study aimed to investigate the clinical application and efficacy of percutaneous kyphoplasty via unilateral pedicular approach with the reference of preoperative CT image data. 73 cases (a total of 112 vertebrae) with thoracic and lumbar osteoporotic vertebral compression fractures (OVCF) received in our department were collected in this study and underwent percutaneous kyphoplasty via unilateral pedicular approach directed by CT image measurement with the operative time and fluoroscopic times recorded. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess the pain status and functional activity before and after operation and at the last follow-up, while X-ray and CT image were used to measure the height of the injured spinal middle column and kyphotic Cobb angle before and after operation. 73 cases (112 vertebrae) underwent percutaneous kyphoplasty successfully. Cement leakage occurred in 7 cases without obvious neurological symptoms, and they were followed up for 10 to 60 months with the average of 23 months; adjacent vertebral refractures occurred in 3 cases during the follow-up, and their symptoms were relieved after the second surgery. There was significant difference in the height of the injured spinal middle column and kyphotic Cobb angle before and after operation (P<0.05); there was significant difference in preoperative and postoperative VAS score and ODI values (P<0.05). Postoperative CT image data showed that puncture paths of the 110 vertebrae were consistent with preoperative ones sketched using the CT image, and the consistent rate of preoperative and postoperative measurement data was 98%. All patients could ambulate with brace within 2 days after operation without serious complications. In conclusion, percutaneous kyphoplasty via unilateral pedicular approach guided by preoperative CT image data is effective in treatment of osteoporotic vertebral compression fractures, and it is convenient and safe with high puncture accuracy, shorter operative time and less radiation exposure for patients and operators.
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Affiliation(s)
- Weifeng Zhai
- Department of Spine Surgery, Tongji Hospital, Tongji University Shanghai 200065, China
| | - Yongwei Jia
- Department of Spine Surgery, Tongji Hospital, Tongji University Shanghai 200065, China
| | - Jianjie Wang
- Department of Spine Surgery, Tongji Hospital, Tongji University Shanghai 200065, China
| | - Liming Cheng
- Department of Spine Surgery, Tongji Hospital, Tongji University Shanghai 200065, China
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Eschler A, Röpenack P, Herlyn PKE, Roesner J, Pille K, Büsing K, Vollmar B, Mittlmeier T, Gradl G. The standardized creation of a lumbar spine vertebral compression fracture in a sheep osteoporosis model induced by ovariectomy, corticosteroid therapy and calcium/phosphorus/vitamin D-deficient diet. Injury 2015; 46 Suppl 4:S17-23. [PMID: 26542861 DOI: 10.1016/s0020-1383(15)30014-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Vertebral compression fractures (VCFs) are one of the most common injuries in the aging population presenting with an annual incidence of 1.4 million new cases in Europe. Current treatment strategies focus on cement-associated solutions (kyphoplasty/vertebroplasty techniques). Specific cement-associated problems as leakage, embolism and the adjacent fracture disease are reported adding to open questions like general fracture healing properties of the osteoporotic spine. In order to analyze those queries animal models are of great interest; however, both technical difficulties in the induction of experimental osteoporosis in animal as well as the lack of a standardized fracture model impede current and future in vivo studies. This study introduces a standardized animal model of an osteoporotic VCF type A3.1 that may enable further in-depth analysis of the afore mentioned topics. MATERIAL AND METHODS Twenty-four 5-year-old female Merino sheep (mean body weight: 67 kg; range 57-79) were ovariectomized (OP1) and underwent 5.5 months of weekly corticosteroid injections (dexamethasone and dexamethasone-sodium-phosphate), adding to a calcium/phosphorus/vitamin D-deficient diet. Osteoporosis induction was documented by pQCT and micro-CT BMD (bone mineral density) as well as 3D histomorphometric analysis postoperatively of the sheep distal radius and spine. Non osteoporotic sheep served as controls. Induction of a VCF of the second lumbar vertebra was performed via a mini-lumbotomy surgical approach with a standardized manual compression mode (OP2). RESULTS PQCT analysis revealed osteoporosis of the distal radius with significantly reduced BMD values (0.19 g/cm(3), range 0.13-0.22 vs. 0.27 g/cm(3), range 0.23-0.32). Micro-CT documented significant lowering of BMD values for the second lumbar vertebrae (0.11 g/cm(3), range 0.10-0.12) in comparison to the control group (0.14 g/cm(3), range 0.12-0.17). An incomplete burst fracture type A3.1 was achieved in all cases and resulted in a significant decrease in body angle and vertebral height (KA 4.9°, range: 2-12; SI 4.5%, range: 2-12). With OP1, one minor complication (lesion of small bowel) occurred, while no complications occurred with OP2. CONCLUSIONS A suitable spinal fracture model for creation of VCFs in osteoporotic sheep was developed. The technique may promote the development of improved surgical solutions for VCF treatment in the experimental and clinical setting.
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Affiliation(s)
- Anica Eschler
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Germany.
| | - Paula Röpenack
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Germany
| | - Philipp K E Herlyn
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Germany
| | - Jan Roesner
- Clinic for Anesthesiology and Critical Care Medicine, University of Rostock, Medical Center, Germany
| | - Kristin Pille
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Germany
| | - Kirsten Büsing
- Chair of Nutrition Physiology and Animal Nutrition, Faculty of Agricultural and Environmental Sciences, University of Rostock, Germany
| | - Brigitte Vollmar
- Rudolf-Zenker Institute for Experimental Surgery, University of Rostock, Medical Center, Germany
| | - Thomas Mittlmeier
- Dept. of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Germany
| | - Georg Gradl
- Dept. of Trauma, Orthopedic and Reconstructive Surgery, Munich Municipal Hospital Group, Clinic Harlaching, Germany
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50
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Liu JT, Li CS, Chang CS, Liao WJ. Long-term follow-up study of osteoporotic vertebral compression fracture treated using balloon kyphoplasty and vertebroplasty. J Neurosurg Spine 2015; 23:94-8. [PMID: 25884343 DOI: 10.3171/2014.11.spine14579] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Long-term follow-up study is required for verifying whether the clinical outcomes of kyphoplasty and vertebroplasty are altered. The authors' findings showed only subtle differences between these operations within a 5-year period. However, they still suggest the use of vertebroplasty over kyphoplasty in view of the treatment costs. In their previous study, the authors performed a short-term prospective comparison between vertebroplasty and kyphoplasty. Vertebroplasty was recommended instead of kyphoplasty for the treatment of vertebral compression fractures (VCFs) because of the subtle differences between this procedure and kyphoplasty and the treatment costs. To determine whether these clinical outcomes persist in the long term, they continued to observe the patients from their short-term study over a longer-term period. METHODS :One hundred cases of VCF were assigned randomly to either the kyphoplasty or the vertebroplasty group. In cement augmentation, the authors used polymethylmethacrylate as bone filler. Pain was assessed by using a visual analog scale (VAS). For each patient, vertebral body height and wedge angle were measured from reconstructed CT images. RESULTS The duration of the follow-up period was 5 years. Vertebral body height, kyphotic wedge angle, and VAS score were not evidently altered. Eight patients in the kyphoplasty group had an adjacent fracture after the procedure, whereas 7 patients in the vertebroplasty group had an adjacent fracture after the procedure. These adjacent fractures occurred within 1 year of surgery in both treatment groups except in 1 kyphoplasty-treated patient in whom the adjacent fracture was noted 16 months after treatment. Three patients in the vertebroplasty group had a nonadjacent fracture, and 4 patients in the kyphoplasty group had a nonadjacent fracture. The link between angular correction and the occurrence of adjacent fracture was statistically significant in the vertebroplasty group. CONCLUSIONS Excessive angular correction is a critical concern in the risk of adjacent fracture after vertebroplasty. Given the subtle differences between vertebroplasty and kyphoplasty observed over the course of 5 years, vertebroplasty remains the preferred option in view of the costs.
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Affiliation(s)
- Jung-Tung Liu
- School of Medicine, Chung-Shan Medical University, and Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung, Taiwan
| | - Cho-shun Li
- School of Medicine, Chung-Shan Medical University, and Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung, Taiwan
| | - Cheng-Siu Chang
- School of Medicine, Chung-Shan Medical University, and Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung, Taiwan
| | - Wen-Jui Liao
- School of Medicine, Chung-Shan Medical University, and Department of Neurosurgery, Chung-Shan Medical University Hospital, Taichung, Taiwan
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