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Dai X, Liao W, Xu F, Lu W, Xi X, Fang X, Wu Q. External validation of predictive models for new vertebral fractures following percutaneous vertebroplasty. Eur Spine J 2024:10.1007/s00586-024-08274-x. [PMID: 38713446 DOI: 10.1007/s00586-024-08274-x] [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] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE To investigate the external validation and scalability of four predictive models regarding new vertebral fractures following percutaneous vertebroplasty. METHODS Utilizing retrospective data acquired from two centers, compute the area under the curve (AUC), calibration curve, and Kaplan-Meier plot to assess the model's discrimination and calibration. RESULTS In the external validation of Zhong et al.'s 2015 predictive model for the probability of new fractures post-vertebroplasty, the AUC for re-fracture at 1, 2, and 3 years postoperatively was 0.570, 0.617, and 0.664, respectively. The AUC for Zhong et al.'s 2016 predictive model for the probability of new fractures in neighboring vertebrae was 0.738. Kaplan-Meier plot results for both models indicated a significantly lower incidence of re-fracture in low-risk patients compared to high-risk patients. Li et al.'s 2021 model had an AUC of 0.518, and its calibration curve suggested an overestimation of the probability of new fractures. Li et al.'s 2022 model had an AUC of 0.556, and its calibration curve suggested an underestimation of the probability of new fractures. CONCLUSION The external validation of four models demonstrated that the predictive model proposed by Zhong et al. in 2016 exhibited superior external generalization capabilities.
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Affiliation(s)
- Xiangheng Dai
- Department of Spinal Surgery, Shaoguan First People's Hospital, Guangdong Medical University, Shaoguan, China
| | - Weibin Liao
- The First Clinical College of Guangdong Medical University, Zhanjiang, China
| | - Fuzhou Xu
- The First Clinical College of Guangdong Medical University, Zhanjiang, China
| | - Weiqi Lu
- The First Clinical College of Guangdong Medical University, Zhanjiang, China
| | - Xinhua Xi
- Department of Spinal Surgery, Yuebei People's Hospital Affiliated to Shantou University Medical College, Shaoguan, China
| | - Xiang Fang
- Department of Spinal Surgery, Shaoguan First People's Hospital, Guangdong Medical University, Shaoguan, China.
| | - Qiang Wu
- Department of Spinal Surgery, Shaoguan First People's Hospital, Guangdong Medical University, Shaoguan, China.
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Cheng Y, Xie X. Therapeutic effects of single versus bilateral approaches for percutaneous kyphoplasty in osteoporotic compression fractures. Asian J Surg 2024; 47:2272-2273. [PMID: 38341374 DOI: 10.1016/j.asjsur.2024.01.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
the clinical effectiveness of unilateral/bilateral percutaneous vertebral augmentation (PVA) for the treatment of osteoporotic vertebral compression fractures (OVCF) was assessed to provide guidance for clinical treatment.Through retrospective analysis of data from 107 patients, including preoperative and postoperative visual analogue scale scores, bone cement leakage, adjacent vertebral fractures, vertebral height, and infection.There was no significant difference in preoperative and postoperative scores, Cobb angle, anterior height, and bone cement leakage rate, but the vertebral body height in the bilateral percutaneous vertebral fusion surgery group was significantly higher than that in the unilateral group(P < 0.05).Grade I compression fractures, a unilateral PVA approach was recommended, while for Grade II and III compression fractures, a bilateral PVA approach was preferable.
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Affiliation(s)
- Yuan Cheng
- Gansu University of Chinese Medicine, Lanzhou, Gansu, China.
| | - Xingwen Xie
- Department of Orthopaedics, The Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, China.
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Zhang Y, Ge J, Liu H, Niu J, Wang S, Shen H, Li H, Qian C, Song Z, Zhu P, Zhu X, Zou J, Yang H. Kyphoplasty is associated with reduced mortality risk for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. Eur Spine J 2024; 33:1490-1497. [PMID: 38062266 DOI: 10.1007/s00586-023-08032-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/15/2023] [Accepted: 10/25/2023] [Indexed: 04/06/2024]
Abstract
BACKGROUND Vertebral augmentation, such as vertebroplasty (VP) or kyphoplasty (KP), has been utilized for decades to treat OVCFs; however, the precise impact of this procedure on reducing mortality risk remains a topic of controversy. This study aimed to explore the potential protective effects of vertebral augmentation on mortality in patients with osteoporotic vertebral compression fractures (OVCFs) using a large-scale meta-analysis. MATERIALS AND METHODS Cochrane Library, Embase, MEDLINE, PubMed and Web of Science databases were employed for literature exploration until May 2023. The hazard ratios (HRs) and 95% confidence intervals (CIs) were utilized as a summary statistic via random-effect models. Statistical analysis was executed using Review Manager 5.3 software. RESULTS After rigorous screening, a total of five studies with substantial sample sizes were included in the quantitative meta-analysis. The total number of participants included in the study was an 2,421,178, comprising of 42,934 cases of vertebral augmentation and 1,991,244 instances of non-operative management. The surgical intervention was found to be significantly associated with an 18% reduction in the risk of mortality (HR 0.82; 95% CI 0.78, 0.85). Subgroup analysis revealed a remarkable 71% reduction in mortality risk following surgical intervention during short-term follow-up (HR 0.29; 95% CI 0.26, 0.32). Furthermore, KP exhibited a superior and more credible decrease in the risk of mortality when compared to VP treatment. CONCLUSIONS Based on a comprehensive analysis of large samples, vertebral augmentation has been shown to significantly reduce the mortality risk associated with OVCFs, particularly in the early stages following fractures. Furthermore, it has been demonstrated that KP is more reliable and effective than VP in terms of mitigating mortality risk.
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Affiliation(s)
- Yijian Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Jun Ge
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Hao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Junjie Niu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Shenghao Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Hao Shen
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Hanwen Li
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Chen Qian
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Zhuorun Song
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Pengfei Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Xuesong Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China.
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China.
| | - Jun Zou
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China.
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China.
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China.
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China.
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Tang B, Liu L, Cui L, Wang Y, Yuan X, Liu Y, Chen X. Analysis of adjacent vertebral fracture after percutaneous vertebroplasty: do radiological or surgical features matter? Eur Spine J 2024; 33:1524-1532. [PMID: 38315225 DOI: 10.1007/s00586-023-08092-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE To report the incidence and risk factors of adjacent vertebral fracture (AVF) after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fractures (OVCFs). We focused to investigate effect of radiological or surgical features on AVF. METHODS All patients with OVCFs who were treated with PVP between January 2016 and December 2019 were retrospectively reviewed. Patients were followed up at least 12 months after procedure according to treatment protocol. AVF was defined as postoperatively recurrent intractable back pain and subsequently presence of fracture on magnetic resonance imaging (MRI) in adjacent levels. Clinical, radiological, and surgical factors potentially affecting occurrence of AVF were recorded and analyzed using univariate and multivariate analysis. RESULTS Totally, 1077 patients with 1077 fractured vertebrae who underwent PVP were enrolled in the study, after inclusion and exclusion criteria were met. Mean follow-up time was 24.3 ± 11.9 months (range, 12-59 months). AVF was identified in 98 (9.1%) patients. Univariate analysis showed that seven significant factors related to AVF were older age, non-traumatic fracture, cortical disruption on anterior wall, cortical disruption on lateral wall, basivertebral foramen, type-B leakage and type-C leakage. In multivariate analysis, two clinical factors, older age (P = 0.031) and non-traumatic fracture (P = 0.002), were significantly associated with AVF. However, any radiological or surgical factor did not reach significance in final model analysis. CONCLUSIONS Incidence of AVF after PVP in patients with OVCFs was 9.1% (98/1077). Older age and non-traumatic fracture were two clinical risk factors for AVF. Neither radiological nor surgical feature was significantly correlated with AVF.
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Affiliation(s)
- Benqiang Tang
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, China
| | - Liang Liu
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, China
| | - Libin Cui
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, China
| | - Yanhui Wang
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, China
| | - Xin Yuan
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, China
| | - Yadong Liu
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, China
| | - Xueming Chen
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, China.
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Wang R, Hao Y, Chen M, Jia P, Zhou F. Comparison of the Clinical Outcomes of Vesselplasty vs. Percutaneous Vertebroplasty for the Treatment of Neurologically Intact Osteoporotic Kümmell's Disease: A Retrospective Study. Calcif Tissue Int 2024; 114:360-367. [PMID: 38308720 DOI: 10.1007/s00223-024-01186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
Kummell's disease (KD) is a rare clinical complication of osteoporotic vertebral compression fractures (OVCFs). Minimally invasive surgery is an important way to treat KD. In this paper, we used Percutaneous Vertebroplasty (PVP) and Vesselplasty (VP) to treat KD. 125 patients with KD were admitted to our hospital. Among them, 89 patients received PVP and 36 received VP. All patients underwent operations successfully. VAS scores and ODI of both groups at each postoperative time point were lower than preoperatively. Postoperative Cobb angle of both groups postoperatively was lower than preoperatively (p < 0.05). The anterior height and ratio of vertebra compression of both groups postoperatively was lower than preoperatively (p < 0.05). Cement leakage occurred in 16 vertebrae (16/89) in PVP group and one (1/36) in VP group. Two patients suffered from transient paraplegia in PVP group immediately after operation. Adjacent vertebral fractures occurred in one patient in PVP group and one in VP group. Re-fracture of affected vertebra occurred in one patient in PVP group. Besides, four patients suffered from bone cement loosening in PVP group while one in VP group. Both PVP and VP play an important effect in pain relief and functional recovery for the treatment of KD. And VP is more effective than PVP in preventing cement leakage.
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Affiliation(s)
- Ruideng Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Youliang Hao
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Mengmeng Chen
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pu Jia
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People's Republic of China.
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Liu X, Zhou Q, Sun Z, Tian J, Wang H. Clinical effects of cocktail injection on the thoracolumbar fascia injury during percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a single-center, retrospective case-control study. BMC Musculoskelet Disord 2024; 25:18. [PMID: 38166954 PMCID: PMC10759409 DOI: 10.1186/s12891-023-07130-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Nowadays, there is a lack of effective intraoperative treatment for thoracolumbar fascia injury (TFI) of osteoporotic vertebral compression fractures (OVCFs), which may lead to postoperative residual pain. We aimed to evaluate the clinical effects of cocktail injection on the TFI during percutaneous vertebroplasty (PVP) for OVCFs. METHODS A retrospective study of OVCFs with TFI underwent PVP with cocktail injection (Cocktail group, 58 cases) or PVP (Routine group, 64 cases) was conducted. The surgical outcomes, visual analog scale (VAS) score, oswestry disability index (ODI), incidence of residual pain at 1 day and 7 days postoperatively, the rate and duration of taking painkillers during 7 days postoperatively after PVP were compared between them. RESULTS No differences in baseline data, volume of bone cement injected and bone cement leakage were observed between the two groups, while the operation time of the routine group (44.3 ± 7.8 min) was less than that (47.5 ± 9.1 min) of the cocktail group (P < 0.05). However, the VAS scores (2.4 ± 0.8, 2.2 ± 0.7), ODI (25.2 ± 4.2, 22.3 ± 2.9), the incidence of residual pain (8.6%, 3.4%) at 1 and 7 days postoperatively, the rate (6.9%) and duration ( 2.5 ± 0.6 ) of taking painkillers during 7 days postoperatively in the cocktail group were better than those (3.4 ± 1.0, 2.9 ± 0.7, 34.1 ± 4.7, 28.6 ± 3.6, 23.4%, 15.6%, 28.1%, 4.2 ± 1.4) in the routine group (P < 0.05), respectively. CONCLUSION PVP combined with cocktail injection increased the operation time in the treatment of OVCFs with TFI, but it can more effectively relieve pain, reduce the risk of residual pain at 1 day and 7 days postoperatively, and decrease the use and duration of taking painkillers.
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Affiliation(s)
- Xiaolei Liu
- Department of Orthopedics, the Fourth Affiliated Hospital of Nanjing Medical University, Nanpu road 298#, Jiangbei new District, Nanjing, 210000, China
| | - Qinqin Zhou
- Department of Anesthesiology, the BenQ Hospital affiliated to Nanjing Medical University, Nanjing, 210000, China
| | - Zhongyi Sun
- Department of Orthopedics, the BenQ Hospital affiliated to Nanjing Medical University, Nanjing, 210000, China
| | - Jiwei Tian
- Department of Orthopedics, the BenQ Hospital affiliated to Nanjing Medical University, Nanjing, 210000, China.
| | - Haibin Wang
- Department of Orthopedics, the Fourth Affiliated Hospital of Nanjing Medical University, Nanpu road 298#, Jiangbei new District, Nanjing, 210000, China.
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Liu Y, Liu J, Suvithayasiri S, Han I, Kim JS. Comparative Efficacy of Surgical Interventions for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Network Meta-analysis. Neurospine 2023; 20:1142-1158. [PMID: 38171285 PMCID: PMC10762416 DOI: 10.14245/ns.2346996.498] [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: 09/30/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE We aimed to comprehensively compare surgical methods for osteoporotic vertebral compression fracture (OVCF) using systematic review and network meta-analysis to understand their effectiveness and outcomes, as current research provides limited overviews. METHODS We followed PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, preregistering our protocol with PROSPERO. We analyzed Englishpublished randomized controlled trials (RCTs) on adults with OVCFs that evaluated pain intensity or functionality using tools like visual analogue scale (VAS) or Oswestry Disability Index (ODI). Exclusions included non-RCTs, malignancy-related fractures, and certain interventions. Using the RoB 2 tool, we assessed bias and visualized results with Robvis. Our primary outcome was pain intensity, with secondary outcomes including disability, new fractures, and cement leakage. Results were synthesized using Stata/MP. RESULTS Thirty-four RCTs from 10 countries, totaling 4,384 patients, were analyzed. Shortterm VAS indicated kyphoplasty with facet joint injection (KIJ) as the top treatment at 87.7%, while unipedicular kyphoplasty (UKP) led to long-term at 74.9%. Short-term ODI favored vertebroplasty with facet joint injection (VIJ) at 98.4%, with kyphoplasty (KP) leading longterm at 66.0%. All surgical techniques were superior to conservative treatment. Vertebral augmentation devices reported the fewest new fractures and curved vertebroplasty had the least cement leakage. SUCRA (surface under the cumulative ranking) analyses suggested UKP and VIJ as top choices for postoperative pain relief, with VIJ excelling in postoperative disability improvement. CONCLUSION Our analysis evaluates 12 OVCF interventions, underscoring KIJ for short-term pain relief and VIJ and UKP for long-term efficacy. Notably, VIJ stands out in disability outcomes, emphasizing the need for comprehensive OVCF management.
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Affiliation(s)
- Yanting Liu
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Liu
- Department of Orthopedics, Second Affiliated Hospital of Jilin University, Changchun, China
| | - Siravich Suvithayasiri
- Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
- Bone and Joint Excellence Center, Thonburi Hospital, Bangkok, Thailand
| | - Inbo Han
- Department of Neurosurgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Wang X, Zhu YH, Zhu QS. Efficacy and safety of robot-assisted versus fluoroscopy-assisted PKP or PVP for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. J Robot Surg 2023; 17:2597-2610. [PMID: 37632602 DOI: 10.1007/s11701-023-01700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023]
Abstract
Percutaneous vertebral augmentation (PVA), which includes percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP). Robot-assisted (RA) and fluoroscopy-assisted (FA) are important methods for treating osteoporotic vertebral compression fractures (OVCFs), though it is still unclear which is superior. This analysis aimed to compare the efficacy and safety of RA and FA. PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure were systematically searched, the outcomes included surgical parameters (leakage rate, operation time, number of fluoroscopic, injection volume, inclination angle), and clinical indexes (hospital stays, Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Cobb angle, the midline height of vertebral). Thirteen articles involving 1094 patients were included. RA group produced better results than the FA group in the leakage rate (OR = 0.27; 95% CI 0.17-0.42; P < 0.00001), number of fluoroscopic (WMD = - 13.88; 95% CI - 18.47 to - 9.30; P < 0.00001), inclination angle (WMD = 5.02; 95% CI 4.42-5.61; P < 0.00001), hospital stays (WMD = - 0.32; 95% CI - 0.58 to - 0.05; P = 0.02), VAS within 3 days (WMD = - 0.19; 95% CI - 0.26 to - 0.12; P < 0.00001), Cobb angle within 3 days (WMD = - 1.35; 95% CI - 2.56 to - 0.14; P = 0.003) and Cobb angle after 1 month (WMD = - 1.02; 95% CI - 1.84 to - 0.20; P = 0.01). But no significant differences in operation time, injection volume, ODI, the midline height of vertebral, and VAS score after 1 month. Our analysis found that the RA group had lower cement leakage rates, number of fluoroscopic and hospital stays, a larger inclination angle, better short-term pain improvement, and Cobb angle improvement. It is worth acknowledging that robotic-assisted surgery holds promise for the development of spine surgery. The study was registered in the PROSPERO (CRD42023393497).
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Affiliation(s)
- Xu Wang
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, Jilin, China
| | - Yu-Hang Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, Jilin, China.
| | - Qing-San Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, Jilin, China.
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Zheng J, Gao Y, Yu W, Yu N, Jia Z, Hao Y, Chen Y. Development and validation of a nomogram for predicting new vertebral compression fractures after percutaneous kyphoplasty in postmenopausal patients. J Orthop Surg Res 2023; 18:914. [PMID: 38037128 PMCID: PMC10688465 DOI: 10.1186/s13018-023-04400-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Postmenopausal women face a heightened risk of developing new vertebral compression fractures (NVCFs) following percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs). This study aimed to develop and validate a visual nomogram model capable of accurately predicting NVCF occurrence post-PKP to optimize treatment strategies and minimize occurrence. METHODS This retrospective study included postmenopausal women diagnosed with OVCF who underwent PKP at the Affiliated Hospital of Shandong University of Traditional Chinese Medicine between January 2016 and January 2021. Patient data, including basic information, surgical details, imaging records, and laboratory findings, were collected. The patients were categorized into two groups based on NVCF occurrence within 2 years post-PKP: the NVCF group and the non-NVCF group. Following the utilization of least absolute shrinkage and selection operator (LASSO) regression for feature selection, a nomogram was constructed. Model differentiation, calibration, and clinical applicability were evaluated using receiver operating characteristic (ROC), calibration, and decision (DCA) curve analyses. RESULTS In total, 357 patients were included in the study. LASSO regression analysis indicated that cement leakage, poor cement diffusion, and endplate fracture were independent predictors of NVCF. The nomogram demonstrated excellent predictive accuracy and clinical applicability. CONCLUSIONS This study used LASSO regression to identify three independent predictors of NVCF and developed a predictive model that could effectively predict NVCF occurrence in postmenopausal women. This simple prediction model can support medical decision-making and is feasible for clinical practice.
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Affiliation(s)
- Jianhu Zheng
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yan Gao
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Wenlong Yu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ning Yu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 16369 Jingshi Road, Lixia District, Jinan, Shandong Province, China
| | - Zetao Jia
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yanke Hao
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 16369 Jingshi Road, Lixia District, Jinan, Shandong Province, China.
| | - Yungang Chen
- Shandong University of Traditional Chinese Medicine, Jinan, China.
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Yang Y, Peng YX. Hidden blood loss and its risk factors in percutaneous vertebroplasty surgery for osteoporotic vertebral compression fractures. Arch Orthop Trauma Surg 2023; 143:5575-5581. [PMID: 37029796 DOI: 10.1007/s00402-023-04873-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/02/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES Percutaneous vertebroplasty (PVP) is a percutaneous interventional procedure for osteoporotic vertebral compression fractures (OVCFs). However, hidden blood loss (HBL) during the surgery is easily disregarded. This study aimed to evaluate HBL and its possible risk factors in the patients following PVP for OVCFs. METHODS Patients with OVCFs who underwent PVP surgery between January 2019 and November 2022 at our hospital were retrospectively analyzed. Patients' demographics, laboratory data, and imaging and clinical date were also collected. Preoperative and postoperative hematocrit were recorded, the hidden blood loss was calculated according to Sehat formula, and the risk factors were analyzed by multivariate linear regression analysis. RESULTS One hundred and fifty-five patients (26 males and 129 females) were retrospectively enrolled in this study. 85.2% of patients had one segment vertebral fracture and the mean surgical time was 30.5 ± 11.0 min. No intraspinal cement leakage occurred. The mean HBL was 204.0 ± 89.6 ml. Multivariate linear regression analysis revealed that HBL was positively associated with number of fracture segments (P = 0.001), degree of vertebral height restoration (P = 0.001), surgical time (P = 0.000), number of puncture (P = 0.002), and cement leakage (P = 0.038). CONCLUSIONS Multiple vertebral fractures, higher degree of vertebral height restoration, longer surgical time, more number of puncture, and cement leakage are independent risk factors for HBL. Therefore, HBL should not be neglected in the patients with OVCFs undergoing PVP surgery, especially in those with poor preoperative physical condition and presence of anemia.
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Affiliation(s)
- Yun Yang
- Department of Orthopaedics, The Third People's Hospital of Chengdu, Sichuan, People's Republic of China.
| | - Yin-Xiao Peng
- Department of Orthopaedics, The Third People's Hospital of Chengdu, Sichuan, People's Republic of China
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11
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Chen H, Li J, Wang X, Fu Y. Effects of robot-assisted minimally invasive surgery on osteoporotic vertebral compression fracture: a systematic review, meta-analysis, and meta-regression of retrospective study. Arch Osteoporos 2023; 18:46. [PMID: 37012510 DOI: 10.1007/s11657-023-01234-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 03/17/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To conduct a systematic review on the effect of robot-assisted minimally invasive surgery (R-MIS) on the clinical outcomes and complications of patients with osteoporotic vertebral compression fractures (OVCFs). METHODS The researchers searched the papers published on PubMed, The Cochrane Library, Web of Science, Embase, Scopus, Ovid MEDLINE, Wiley Online Library, China National Knowledge Infrastructure (CNKI), Chinese biomedical literature service system (SinoMed), and China Medical Association Data. The standardized mean difference (SMD) or mean difference (MD), relative risk (RR), and 95% confidence interval (CI) were calculated. Besides, the data was merged through the random-effect model or common-effect model. A meta-regression mixed-effects single-factor model was utilized to analyze the sources of heterogeneity. RESULTS Twelve studies were included, involving 1042 OVCFs cases. The prognosis of patients treated with R-MIS was significantly improved, such as Oswestry disability index (ODI) score (MD = -0.65, P = 0.0171), Cobb's angles (MD = -1.03, P = 0.0027), X-ray fluoroscopy frequency (SMD = -2.41, P < 0.0001), Length of hospital stay (MD = -0.33, P = 0.0002), and Cement leakage (RR = 0.37, P < 0.0001). However, no obvious improvement was found in the results of Visual analog scale (VAS) score (MD = -0.16, P = 0.1555), Volume of bone cement (MD = 0.22, P = 0.8339), and Operation time (MD = -3.20, P = 0.3411) after being treated by R-MIS. The meta-regression analysis demonstrated that R-MIS presented no significant impact on the covariates of VAS and Operation time. CONCLUSION R-MIS can significantly reduce the patients' ODI, Cobb's angles, X-ray fluoroscopy frequency, and Cement leakage ratio, and shorten the Length of hospital stay. Therefore, R-MIS may be an effective method to promote the patients' functional recovery, correct spinal deformity, reduce the X-ray fluoroscopy frequency, shorten the Length of hospital stay, and reduce the complications of OVCFs bone Cement leakage.
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Affiliation(s)
- Haoqian Chen
- Graduate Students' Affairs Department, Shenyang Sport University, No. 36 Jinqiansong East Road, Sujiatun District, Shenyang, 110102, China
- Sports Training College, Shenyang Sport University, No. 36 Jinqiansong East Road, Sujiatun District, Shenyang, 110102, China
| | - Jia Li
- Basic Research Department, Shenyang Sport University, No. 36 Jinqiansong East Road, Sujiatun District, Shenyang, 110102, China
| | - Xin Wang
- College of Exercise and Health, Shenyang Sport University, No. 36 Jinqiansong East Road, Sujiatun District, Shenyang, 110102, China
| | - Yanming Fu
- Laboratory Management Center, Shenyang Sport University, No. 36 Jinqiansong East Road, Sujiatun District, Shenyang, 110102, China.
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12
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Daher M, Kreichati G, Kharrat K, Sebaaly A. Vertebroplasty versus Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: A Meta-Analysis. World Neurosurg 2023; 171:65-71. [PMID: 36455843 DOI: 10.1016/j.wneu.2022.11.123] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 10/10/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND One of the most frequent consequences of osteoporosis is osteoporotic vertebral compression fractures, which makes it one of the most prevalent health care crises in the world. Two things are needed to manage them: 1) pain management, and 2) fracture stabilization. To take care of both, 2 methods are commonly used: 1) vertebroplasty and 2) kyphoplasty (KP) without a clear consensus on which is the better one. A meta-analysis was done comparing both techniques in the management of osteoporotic vertebral compression fractures. METHODS PubMed, Cochrane, and Google Scholar (page 1-20) were searched updated to October 2022. Two reviewers determined the eligibility of the studies independently. Only 8 studies were included in the meta-analysis. The clinical outcomes consisted of the complications (cement leakage, adjacent level fractures), the visual analog scale scores, Oswestry disability index, kyphotic wedge angle, and vertebral body height restoration. RESULTS KP was shown to be superior to vertebroplasty in terms of reducing cement leakage, and increasing postoperative vertebral body height. The comparison of the rest of the outcomes was statistically insignificant between both techniques. CONCLUSIONS Although KP could significantly increase postoperative vertebral body height and decrease the risk of cement leakage, the fact that it is more costly and has a longer operative time raises the question about the cost effectiveness of the procedure.
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Affiliation(s)
- Mohammad Daher
- School of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Gaby Kreichati
- School of Medicine, Saint Joseph University, Beirut, Lebanon; Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Khalil Kharrat
- School of Medicine, Saint Joseph University, Beirut, Lebanon; Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Amer Sebaaly
- School of Medicine, Saint Joseph University, Beirut, Lebanon; Orthopedic Department, Spine Unit, Hotel Dieu de France Hospital, Beirut, Lebanon.
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13
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Lin M, Wen X, Huang Z, Huang W, Zhang H, Huang X, Yang C, Wang F, Gao J, Zhang M, Yu X. A nomogram for predicting residual low back pain after percutaneous kyphoplasty in osteoporotic vertebral compression fractures. Osteoporos Int 2023; 34:749-762. [PMID: 36738335 DOI: 10.1007/s00198-023-06681-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Abstract
UNLABELLED To establish a risk prediction model for residual low back pain after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures. We used retrospective data for model construction and evaluated the model using internal validation and temporal external validation and finally concluded that the model had good predictive performance. INTRODUCTION The cause of residual low back pain in patients with osteoporotic vertebral compression fractures (OVCFs) after PKP remains highly controversial, and our goal was to investigate the most likely cause and to develop a novel nomogram for the prediction of residual low back pain and to evaluate the predictive performance of the model. METHODS The clinical data of 281 patients with OVCFs who underwent PKP at our hospital from July 2019 to July 2020 were reviewed. The optimal logistic regression model was determined by lasso regression for multivariate analysis, thus constructing a nomogram. Bootstrap was used to perfomance the internal validation; receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to assess the predictive performance and clinical utility of the model, respectively. Temporal external validation of the model was also performed using retrospective data from 126 patients who underwent PKP at our hospital from January 2021 to October 2021. RESULTS Lasso regression cross-validation showed that the variables with non-zero coefficients were the number of surgical vertebrae, preoperative bone mineral density (pre-BMD), smoking history, thoracolumbar fascia injury (TLFI), intraoperative facet joint injury (FJI), and postoperative incomplete cementing of the fracture line (ICFL). The above factors were included in the multivariate analysis and showed that the pre-BMD, smoking history, TLFI, FJI, and ICFL were independent risk factors for residual low back pain (P < 0.05). The ROC and calibration curve of the original model and temporal external validation indicated a good predictive power of the model. The DCA curve suggested that the model has good clinical practicability. CONCLUSION The risk prediction model has good predictive performance and clinical practicability, which can provide a certain basis for clinical decision-making in patients with OVCFs.
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Affiliation(s)
- Miaoman Lin
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China
- Department of Orthopaedics, West China Xiamen Hospital of Sichuan University, No.699, West Jinyuan Road, Xingbin Street, Xiamen, Fujian Province, 361022, China
| | - Xuemei Wen
- Xinhua Clinical College, Dalian University, Dalian, 116622, China
| | - Zongwei Huang
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
- Department of Emergency, Beijing University of Chinese Medicine Shenzhen Hospital, Shenzhen, 518116, China
| | - Wei Huang
- Department of Orthopaedics, Dongguan Tungwah Hospital, Dongguan, 523000, China
| | - Hao Zhang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China
| | - Xingxing Huang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China
| | - Cunheng Yang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China
| | - Fuming Wang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China
| | - Junxiao Gao
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China
| | - Meng Zhang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China
| | - Xiaobing Yu
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No.6, Jiefang Street, Dalian, Liaoning Province, 116001, China.
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14
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Lu J, Huang L, Chen W, Luo Z, Yang H, Liu T. Bilateral percutaneous kyphoplasty achieves more satisfactory outcomes compared to unilateral percutaneous kyphoplasty in osteoporotic vertebral compression fractures: A comprehensive comparative study. J Back Musculoskelet Rehabil 2023; 36:97-105. [PMID: 35938239 DOI: 10.3233/bmr-210225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Osteoporotic vertebral compression fractures (OVCFs) are the most common complication of osteoporosis, a worldwide disease that disturbs the elderly. OBJECTIVE The purpose of the study was to comprehensively compare the clinical efficacy of unilateral percutaneous kyphoplasty (UPKP) and bilateral percutaneous kyphoplasty (BPKP) when treating OVCFs and evaluate their ability to maintain the outcomes in a 2-year follow-up. METHODS From January 2015 to December 2016 a total of 79 patients with OVCFs were included in the study. They were divided into UPKP group and BPKP group. Subsequently, perioperative data, radiological outcomes, clinical outcomes, and complications were compared between two groups. The follow-up consultation was 3 months, 1 year, and 2 years after the operation. RESULTS 37 of patients (14 males, 23 females) were allocated to the UPKP group and 42 patients (13 males, 29 females) were treated with BPKP. The duration of operation and injected cement volume were significantly higher in the BPKP group than those of the UPKP group. BPKP achieved significantly higher improvement in middle height and volume of the fractured vertebral body than UPKP did. There were significantly higher losses of anterior, middle height and volume of the fractured vertebral body in the UPKP group at 2-year follow-up than in the BPKP group. At the final follow-up, Oswestry Disability Index (ODI) of BPKP group was lower than that of UPKP group. CONCLUSION Both UPKP and BPKP achieve satisfactory radiological and clinical outcomes when treating OVCFs. However, in a 2-year follow-up, BPKP maintains vertebral height restoration, volume of vertebral body, and ODI better than UPKP do.
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Affiliation(s)
- Jianhua Lu
- Department of Orthopaedic Surgery, Haimen People's Hospital Affiliated to Nantong University, Nantong, Jiangsu, China.,Department of Orthopaedic Surgery, Haimen People's Hospital Affiliated to Nantong University, Nantong, Jiangsu, China
| | - Li Huang
- Department of Orthopaedic Surgery, Haimen People's Hospital Affiliated to Nantong University, Nantong, Jiangsu, China.,Department of Orthopaedic Surgery, Haimen People's Hospital Affiliated to Nantong University, Nantong, Jiangsu, China
| | - Weikai Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zongping Luo
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Orthopaedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Tao Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Orthopaedic Institute, Medical College, Soochow University, Suzhou, Jiangsu, China
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15
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Li KC, Hsieh CH, Liao TH, Cheng BH. A novel classification of cement distribution patterns based on plain radiographs associated with cement filling rate and relevance to the clinical results of unipedicle vertebroplasty. Eur Spine J 2023; 32:101-9. [PMID: 36220958 DOI: 10.1007/s00586-022-07412-7] [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] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/21/2022] [Accepted: 09/27/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cement distribution pattern following unipedicle percutaneous vertebroplasty (UVP) for osteoporotic vertebral compression fractures (OVCFs) has been reported in association with clinical results. The present retrospective study aimed to classify the bone cement distribution types following UVP and investigate the differences in clinical efficacy and related complications. MATERIALS AND METHODS We retrospectively reviewed the medical records of the patients with single-segment OVCFs who underwent UVP. Cement distribution patterns were divided into the diffuse, block, double band, and single band types according to the plain radiographs and further by cement filling rate (CFR) based on a three-dimension reconstruction of post-operative CT. The cutoff values of CFR were > 34% for the diffuse, block between 34 and 20%, and each band of the double or single band < 20%. Clinical efficacy and related complications were compared among the four cement distribution types 24 h after the operation and the last follow-up. RESULTS A total of 155 patients with an average follow-up time of 20.3 months were included. The diffuse type included 26 patients; block, 87; double band, 18; and single band, 24. The VAS and ODI after operation improved significantly in all four groups. The diffuse and block types had similar clinical results. The clinical outcomes in the single band group were the poorest at the last follow-up. The patients with single band type also had the highest rates of body re-collapse and revision surgery for the index level. CONCLUSION Diffuse and block groups can better maintain the height of the vertebral body and reduce the risk of vertebral body recompression. The single band has the poorest results, and intraoperative immediate contralateral vertebroplasty was highly recommended.
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Eneling J, Darsaut TE, Patel M, Raymond J. Understanding explanatory and pragmatic trials: Examples from randomized controlled trials on vertebroplasty. Neurochirurgie 2023; 69:101403. [PMID: 36566693 DOI: 10.1016/j.neuchi.2022.101403] [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: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To better understand the explanatory-pragmatic distinction in the design and interpretation of randomized controlled trials (RCTs). METHODS We review the explanatory-pragmatic distinction in clinical trial design. We use the PRECIS-2 tool to evaluate the trial design of selected RCTs on percutaneous vertebroplasty for osteoporotic vertebral compression fractures. We discuss difficulties in the selection of criteria and in the construction of PRECIS diagrams. We also examine how inconsistency in the selection of various items of trial design can cause confusion in the interpretation of results. RESULTS The selection of criteria and the scoring of multiple PRECIS domains were subjective and thus debatable. The pragmascope patterns of various vertebroplasty trials were heterogeneous. Many trials had both pragmatic and explanatory components. Some placebo-controlled trial goals seem to have been explanatory, but their design actually included enough pragmatic items such that the meaning of negative trial results remains ambiguous. CONCLUSION The results of a trial cannot be interpreted without understanding the various design choices made along the explanatory-pragmatic spectrum.
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Affiliation(s)
- J Eneling
- Department of radiology, service of neuroradiology, centre hospitalier de l'université de Montréal (CHUM), Montreal, Quebec, Canada
| | - T E Darsaut
- Division of neurosurgery, department of surgery, university of Alberta hospital, Mackenzie health sciences centre, Edmonton, Alberta, Canada
| | - M Patel
- Division of neurosurgery, department of surgery, university of Alberta hospital, Mackenzie health sciences centre, Edmonton, Alberta, Canada
| | - J Raymond
- Department of radiology, service of neuroradiology, centre hospitalier de l'université de Montréal (CHUM), Montreal, Quebec, Canada.
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17
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Eneling J, Darsaut TE, Veilleux C, Raymond J. Understanding power in randomized trials: The example of vertebroplasty. Neurochirurgie 2023; 69:101402. [PMID: 36621210 DOI: 10.1016/j.neuchi.2022.101402] [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: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Randomized trials (RCTs) should include a sufficient number of patients to reduce the risk that the observed outcome is a result of chance rather than from a truly different treatment effect. Trials must be even larger to claim an absence of treatment effect in a placebo-controlled trial. To estimate the size of the trial and maximize power, it is often suggested to use a comparison between the means of a continuous variable. METHODS We examine the RCTs that have compared vertebroplasty and placebo for patients with osteoporotic fractures. Most trials compared the means of a continuous pain score to yield implausibly small trials, as small as 24 patients per group. RESULTS The minimally significant difference between groups has no precise clinical meaning for patients when it is based on a comparison of means of pain scores. A comparison of the proportions of patients reaching a per-patient outcome measure of treatment success is much more pertinent if the trial is to inform the care of future patients. The resulting trials will admittedly need to be larger, but they will be much less likely to fall prey to the 'evidence of absence' fallacy. Furthermore, trial size should also take into consideration harder clinical outcome measures, such as death and disability. CONCLUSION When the goal of a trial is to inform outcome-based medical care, comparing the proportions of patients reaching a clinically pertinent outcome is more appropriate than comparing the means of a continuous variable.
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Affiliation(s)
- J Eneling
- Department of radiology, service of neuroradiology, centre hospitalier de l'université de Montréal (CHUM), Montreal, Quebec, Canada
| | - T E Darsaut
- Division of neurosurgery, department of surgery, university of Alberta hospital, Mackenzie health sciences centre, Edmonton, Alberta, Canada
| | - C Veilleux
- Division of neurosurgery, department of clinical neurosciences, university of Calgary, Alberta, Canada
| | - J Raymond
- Department of radiology, service of neuroradiology, centre hospitalier de l'université de Montréal (CHUM), Montreal, Quebec, Canada.
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18
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Eneling J, Darsaut TE, Veilleux C, Raymond J. Understanding the choice of control group: A systematic review of vertebroplasty trials for osteoporotic vertebral compression fractures. Neurochirurgie 2023; 69:101401. [PMID: 36566694 DOI: 10.1016/j.neuchi.2022.101401] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To better understand the choice of the comparator intervention in the design of clinical trials and its impact on the meaning of results we review randomized trials on vertebroplasty. METHODS We conducted a systematic and narrative review of all randomized trials on vertebroplasty. Trials are categorized according to the comparator intervention (non-surgical management, placebo/sham vertebroplasty, and kyphoplasty). RESULTS All trials were too small to show a difference in objective clinical outcomes, and 20 of 23 RCTs used mean pain scores to compare interventions. Most trials comparing vertebroplasty with non-surgical management concluded that vertebroplasty was superior. Trials comparing kyphoplasty with vertebroplasty showed similar results for both interventions. However, 4 of 5 trials comparing vertebroplasty with placebo surgery failed to show a significant difference between groups. CONCLUSION The clinical results of an intervention cannot be interpreted without a comparison that involves a control group. The choice of comparator intervention can change the meaning of the trial. A large pragmatic trial, using hard clinical outcomes such as morbidity and mortality as a primary outcome measure, would be needed to assess the potential clinical benefits of vertebroplasty.
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Affiliation(s)
- J Eneling
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
| | - T E Darsaut
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - C Veilleux
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - J Raymond
- Department of Radiology, Service of Neuroradiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
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19
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Chen R, Wang Q, Li G, Chen S. Analysis of related risk factors of costal pain after thoracic osteoporotic vertebral compression fractures. Asian J Surg 2022:S1015-9584(22)01711-0. [PMID: 36509602 DOI: 10.1016/j.asjsur.2022.11.142] [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] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Runsen Chen
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, 646000, China
| | - Qing Wang
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, 646000, China
| | - Guangzhou Li
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, 646000, China.
| | - Si Chen
- Department of Orthopaedics, People's Hospital Banan District of Chongqing, Chongqing, 401320, China
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20
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Zhang Y, Peng Q, Sun C, Kang X, Hu M, Zhao W, Liu X, Meng B, Yang S, Feng X, Zhang L. Robot Versus Fluoroscopy-Assisted Vertebroplasty and Kyphoplasty for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-analysis. World Neurosurg 2022; 166:120-129. [PMID: 35922006 DOI: 10.1016/j.wneu.2022.07.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to conduct a systematic review and meta-analysis to compare the clinical results and complications of robot-assisted (RA) versus fluoroscopy-assisted (FA) percutaneous vertebral augmentation (PVA) in the treatment of osteoporotic vertebral compression fractures (OVCFs). METHODS A comprehensive search of online databases including PubMed, Embase, Cochrane Library, web of science, and core journals of China National Knowledge Infrastructure were performed to identify related studies reporting the clinical results and complications of RA versus FA-assisted PVA in the treatment of OVCFs. The rate of bone cement leakage was used to assess the complications. After the surgery, the clinical findings were analyzed using the Visual Analog Scale scores and the Oswestry Disability Index scores. The surgical time, intraoperative fluoroscopy frequency, and x-ray exposure duration were used to evaluate the perioperative results. Forest plots were constructed to investigate the results. RESULTS RA-PVA had a significantly lower bone cement leakage rate, shorter fluoroscopy frequency, and shorter radiation exposure time of doctors compared with FA-PVA. However, no significant differences were found between RA-PVA and FA-PVA in operative time and radiation exposure time of patients. Furthermore, no statistically differences were found between the 2 groups in Visual Analog Scale and Oswestry Disability Index scores after surgery. CONCLUSIONS This meta-analysis showed that RA-PVA can reduce bone cement leakage rate, fluoroscopy frequency, and doctors' radiation exposure time. With the advancement of RA technology, we anticipate more high-quality randomized controlled trials of RA versus FA-PVA in the future to validate and update the results of this analysis.
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Affiliation(s)
- Yu Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Qing Peng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Chenhao Sun
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xiaohe Kang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Man Hu
- Graduate School of Dalian Medical University, Dalian, China
| | - Wenjie Zhao
- Graduate School of Dalian Medical University, Dalian, China
| | - Xin Liu
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Bo Meng
- Graduate School of Dalian Medical University, Dalian, China
| | - Sheng Yang
- Graduate School of Dalian Medical University, Dalian, China
| | - Xinmin Feng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China.
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Zhu D, Hu J, Wang L, Zhu J, Ma S, Liu B. A Comparison Between Modified Unilateral Extrapedicular and Bilateral Transpedicular Percutaneous Kyphoplasty in the Treatment of Lumbar Osteoporotic Vertebral Compression Fracture. World Neurosurg 2022; 166:e99-e108. [PMID: 35779757 DOI: 10.1016/j.wneu.2022.06.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few researchers have verified the clinical efficacy and safety of the modified unilateral extrapedicular approach (mUEP) applied to the percutaneous kyphoplasty (PKP) in comparative studies with other puncture techniques. Compared with the bilateral transpedicular approach (BTP), whether mUEP PKP is a preferred treatment for lumbar osteoporotic vertebral compression fracture (OVCF) remains unclear. METHODS Patients treated by PKP for single-level lumbar OVCF in our institution from September 2019 to December 2020 were retrospectively enrolled. Patients were grouped according to the puncture techniques. Clinical and radiologic outcomes were evaluated preoperatively, postoperatively, and at follow-up. The clinical evaluation was performed by using visual analog scale for pain relief and Oswestry Disability Index for health status. Radiologic measurements contained anterior vertebral height, kyphotic angle, and bone cement distribution. RESULTS In total, 76 patients with a mean follow-up duration of 16.6 months were enrolled, including 34 patients in the mUEP PK group and 42 patients in the BTP PKP group. In the mUEP group, operation time, fluoroscopy times, and injected cement volume were significantly less than that in the BTP group (P < 0.01). Both visual analog scale and Oswestry Disability Index scores of all patients decreased significantly after surgery (P < 0.01), with no significant differences between the 2 groups at each follow-up. Both mUEP PKP and BTP PKP showed significant anterior height restoration and kyphotic angle correction (P < 0.01), with no significant differences between the 2 groups at each follow-up. Meanwhile, the mUEP PKP reduced the incidence of intraspinal cement leakage (P < 0.05), and no facet joint violation was found in mUEP PKP. CONCLUSIONS mUEP PKP could be clinically and radiographically equivalent to BTP PKP. However, it has advantages in reducing operation time and fluoroscopy times, lowering the risk of intraspinal cement leakage, and preventing the presence of facet joint violation. Compared with BTP PKP, the mUEP PKP seems to be an effective and alternative puncture technique for the treatment of lumbar OVCF after appropriate patient selection.
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Affiliation(s)
- Di Zhu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junnan Hu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lei Wang
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jichao Zhu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Song Ma
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baoge Liu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Dang SJ, Wei WB, Wei L, Xu J. Vertebroplasty combined with facet joint block vs. vertebroplasty alone in relieving acute pain of osteoporotic vertebral compression fracture: a randomized controlled clinical trial. BMC Musculoskelet Disord 2022; 23:807. [PMID: 35999526 PMCID: PMC9396809 DOI: 10.1186/s12891-022-05753-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/05/2022] [Indexed: 11/15/2022] Open
Abstract
Objective The study objective was to compare the efficacy and safety of percutaneous vertebroplasty (PVP) combined with facet joint block (FB) and vertebroplasty alone in relieving acute pain on osteoporotic vertebral compression fractures (OVCFs). Methods A prospective, randomized controlled study was conducted. One hundred ninety-eight patients of OVCFs undergoing surgery were randomly divided into two groups: Group P (PVP, n = 97), Group PF (PVP + FB, n = 101). The Visual analogue scale (VAS) and Oswestry disability index (ODI) were measured during pre-operation, 1 day, 1, 3, 6 and 12 months after the operation, respectively. The hospitalization time, operation time, complications, recurrence, the mean amount of cement injected and the number of patients who applied Cox-2 inhibitors within 3 days after operation were compared in the two groups. Results The VAS and ODI scores at each observation point of the post-operation were significantly decreased than that at the pre-operation in both groups (P < 0.05). The VAS and ODI scores in Group PF were significantly lower than that in Group P 1 day and 1 month after the operation (P < 0.05). The number of patients who applied Cox-2 inhibitors within 3 days after operation in group PF was significantly lower that in Group P (P < 0.001). There was no significant difference in hospitalization time, operation time, the mean amount of cement injected, complication rate, VAS and ODI scores at the pre-operation (P > 0.05). Conclusion Both PVP combined with FB and PVP alone are effective treatment methods for OVCFs. But PVP combined with FB showed better back pain relief than PVP alone in the short term after the operation for OVCFs.
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Affiliation(s)
- Sha-Jie Dang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.,Department of Anesthesia, Shaanxi Provincial Cancer Hospital, Xi'an, 710061, China
| | - Wen-Bo Wei
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.,Department of Orthopedics, Shaanxi Provincial people's Hospital, Xi'an, 710068, China
| | - Ling Wei
- Department of Pain, YangLing Demonstration Zone Hospital, Yang ling, 712100, China.
| | - Jin Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.
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23
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Fan Z, Huang H, Lin Y, Zhou J, Lin F, Chen B, Wang H, Su H, Qi J, Huang Y, Huang Y. Do we have to pursue complete reduction after PVA in osteoporotic vertebral compression fractures: a finite element analysis. Injury 2022; 53:2754-2762. [PMID: 35760641 DOI: 10.1016/j.injury.2022.06.013] [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: 02/13/2022] [Accepted: 06/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Consensus regarding the optimal amount of bone cement and vertebral height in the treatment of osteoporotic vertebral compression fractures (OVCFs) is lacking. Our purpose was to explore the optimal amount of bone cement and vertebral height in OVCF after percutaneous vertebral augmentation (PVA). METHODS A three-dimensional finite element model of the L1-L3 segments was constructed from CT scans of aging osteoporosis patients. Four different postoperative vertebral height models were simulated according to Genant semiquantitative grades 0, 1, 2, and 3. The volume of bone cement filling ranged from 3 ml to 6 ml. These models evaluated the von Mises stress of injured vertebral bodies, adjacent vertebral bodies and intervertebral discs under flexion, extension, left flexion, and right flexion after PVA. RESULTS When the bone cement content was held constant, as the height of the vertebral body decreased, the stress of the L2 vertebral body decreased during left flexion and right flexion, but the stress of the L2 vertebral body increased and decreased during flexion and extension. As the height of the vertebral body decreased, the stress of the L1-L2 intervertebral disc increased. There was no significant change in the stress of other adjacent vertebrae or intervertebral discs. When the Genant grade was 0, 1, or 2 (3 ml and 4 ml), the stress of the overall vertebral body was closest to normal. CONCLUSIONS When the height of the vertebral body is restored to the same height, a bone cement filling volume of 3 ml to 6 ml is suitable and will not produce a significant change in the stress of the vertebral body or adjacent vertebral body. As vertebral body height was lost, it may promote the degeneration of the intervertebral disc above the injury vertebrae after PVA. It is appropriate for the height of the vertebral body to return to Genant grade 0 or Genant grade 1 after surgery. When the height of the vertebral body has Genant grade 2 status, it was best to use 3 ml to 4 ml of bone cement filling. Therefore, when treating OVCFs, clinicians do not need to pursue complete reduction of the vertebral body. It is also important to verify the biomechanics results in clinical studies.
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Affiliation(s)
- Zhirong Fan
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Huida Huang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Yuewei Lin
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Junde Zhou
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Fangzheng Lin
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Bojian Chen
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Haizhou Wang
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Haitao Su
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Ji Qi
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Yongquan Huang
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Yongming Huang
- The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
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Patel D, Liu J, Ebraheim NA. Managements of osteoporotic vertebral compression fractures: A narrative review. World J Orthop 2022; 13:564-573. [PMID: 35949707 PMCID: PMC9244957 DOI: 10.5312/wjo.v13.i6.564] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/26/2022] [Accepted: 06/14/2022] [Indexed: 02/06/2023] Open
Abstract
Osteoporotic vertebral compression fractures (OVCFs) are the most common fragility fracture and significantly influence the quality of life in the elderly. Currently, the literature lacks a comprehensive narrative review of the management of OVCFs. The purpose of this study is to review background information, diagnosis, and surgical and non-surgical management of the OVCFs. A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed. Combinations of the following terms were used: compression fractures, vertebral compression fractures, osteoporosis, osteoporotic compression fractures, vertebroplasty, kyphoplasty, bisphosphonates, calcitonin, and osteoporosis treatments. Additional articles were also included by examining the reference list of articles found in the search. OVCFs, especially those that occur over long periods, can be asymptomatic. Symptoms of acute OVCFs include pain localized to the mid-line spine, a loss in height, and decreased mobility. The primary treatment regimens are pain control, medication management, vertebral augmentation, and anterior or posterior decompression and reconstructions. Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain. Bisphosphonates and denosumab are the first-line treatments for osteoporosis. Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief. Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications. Calcium and vitamin D supplementation can have a protective and therapeutic effect. Management of OVCFs must be combined with multiple approaches. Appropriate exercises and activity modification are important in fracture prevention. Medication with different mechanisms of action is a critical long-term causal treatment strategy. The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods. Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present. The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.
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Affiliation(s)
- Devon Patel
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, United States
| | - Jiayong Liu
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, United States
| | - Nabil A Ebraheim
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, United States
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25
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Qi H, Qi J, Sun Y, Gao J, Sun J, Wang G. Value of MRI in assessing back pain after thoracolumbar osteoporotic vertebral compression fractures and discussion on the underlying mechanisms by tissue biopsy. Eur Spine J 2022; 31:1147-57. [PMID: 35038034 DOI: 10.1007/s00586-021-07095-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/17/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The specific radiological feature of osteoporotic vertebral compression fractures (OVCFs) is bone marrow oedema (BME) on magnetic resonance imaging (MRI). However, the relationship between BME and back pain (BP) is unclear. We investigated the value of MRI in assessing BP and discussed the relevant mechanisms by tissue biopsy. METHODS One hundred nineteen patients with thoracolumbar OVCFs were included in this study. We divided all patients into two groups: the low-oedema group (BME ≤ 75%) and the high-oedema group (BME > 75%). To reduce the error generated in the acute phase of fracture, we separately analysed patients in phases I (within one month) and II (more than one month). We compared the differences between the groups using the Mann-Whitney U test and investigated the correlations using Spearman's correlation test. RESULTS The degree of BP was significantly correlated with BME (p < 0.001; p < 0.001) and fibrous tissue content (p = 0.006; p = 0.035) in both phases. Further, the fibrous tissue content in the low-oedema group (12.49 ± 7.37%; 15.25 ± 13.28%) was significantly lower than that in the high-oedema group (25.68 ± 20.39%, p = 0.014; 23.92 ± 14.61%, p = 0.022) in both phases. The lamellar bone content was significantly correlated with BP (p = 0.021) in phase II. CONCLUSIONS BME signals on MRI can accurately predict the degree of BP, and the main mechanisms are related to the stimulation of fibrous tissue.
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26
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Gold LS, O’Reilly MK, Heagerty PJ, Jarvik JG. Complications and healthcare utilization in commercially-insured osteoporotic vertebral compression fracture patients: a comparison of kyphoplasty versus propensity-matched controls. Spine J 2021; 21:1347-1354. [PMID: 33781968 PMCID: PMC8349787 DOI: 10.1016/j.spinee.2021.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Osteoporotic vertebral fractures (OVFs) can lead to severe pain and reduced function and quality-of-life, but the strength of evidence for treatments remains low, particularly in younger populations. PURPOSE To determine whether patients with OVFs who received kyphoplasty had different patterns of healthcare utilization compared to propensity-matched patients who did not receive vertebral augmentation. DESIGN Observational cohort study. PATIENT SAMPLE We identified patients with OVFs from 2007 to 2018 in the IBM MarketScan Commercial Claims and Encounters Databases who received kyphoplasty and compared them to propensity-matched controls who did not receive vertebral augmentation (either kyphoplasty or vertebroplasty). OUTCOME MEASURES Major medical complications within 30 days, fills of opioids from 1-week through 1-month postaugmentation, and spine-related gross covered payments from 3-days postkyphoplasty through 1-year post-OVF. METHODS We used logistic regression to obtain odds ratios (ORs) and 95% confidence intervals (95% CIs) to compare binary outcomes and median analysis to compare continuous outcomes. RESULTS Of the 15,197 OVF patients identified, 1,969 (13%) received kyphoplasty and 1,928 (98%) of these were propensity matched to nonaugmented controls. We did not observe differences in the odds of major medical complications within 30 days (adjusted OR [95% CI]: 1.0 [0.6, 1.8]) but patients who received kyphoplasty were more likely to have filled opioid medications within 30 days (adjusted OR [95% CI]: 1.3 [1.1, 1.5]) and had greater spine-related gross covered payments (kyphoplasty median [95% CI]: $1,340 [$240, $4,850]; nonaugmented: $7,870 [$7,480, $8,270]; adjusted difference in medians [95% CI]: $260 [$190, $2,050]). CONCLUSIONS In this cohort of patients <65 years, receipt of kyphoplasty was associated with greater likelihood of opioid fills and somewhat greater spine-related gross covered payments, but no difference in major medical complications. In this retrospective study of administrative data, we did not detect advantages of treatment with kyphoplasty compared with nonaugmentation for any of our outcomes.
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Affiliation(s)
- Laura S. Gold
- Department of Radiology, School of Medicine, University of Washington, Seattle, WA; USA,Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA; USA
| | - Michael K. O’Reilly
- Department of Radiology, School of Medicine, University of Washington, Seattle, WA; USA,Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA; USA
| | - Patrick J. Heagerty
- Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA; USA,Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Jeffrey G. Jarvik
- Department of Radiology, School of Medicine, University of Washington, Seattle, WA; USA,Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA; USA
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27
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Mo L, Wu Z, Liang D, Y L, Cai Z, Huang J, Lin S, Cui J, Zhang S, Yang Z, Yao Z, Jiang X. Influence of bone cement distribution on outcomes following percutaneous vertebroplasty: a retrospective matched-cohort study. J Int Med Res 2021; 49:3000605211022287. [PMID: 34233516 PMCID: PMC8755653 DOI: 10.1177/03000605211022287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the influence of insufficient bone cement distribution on outcomes following percutaneous vertebroplasty (PVP). Methods This retrospective matched-cohort study included patients 50–90 years of age who had undergone PVP for single level vertebral compression fractures (VCFs) from February 2015 to December 2018. Insufficient (Group A)/sufficient (Group B) distribution of bone cement in the fracture area was assessed from pre- and post-operative computed tomography (CT) images. Assessments were before, 3-days post-procedure, and at the last follow-up visit (≥12 months). Result Of the 270 eligible patients, there were 54 matched pairs. On post-operative day 3 and at the last follow-up visit, significantly greater visual analogue scale (VAS) pain scores and Oswestry Disability Index (ODI) scores were obtained in Group B over Group A, while kyphotic angles (KAs) and vertebral height (VH) loss were significantly larger in Group A compared with Group B. Incidence of asymptomatic cement leakage and re-collapse of cemented vertebrae were also greater in Group A compared with Group B. Conclusions Insufficient cement distribution may relate to less pain relief and result in progressive vertebral collapse and kyphotic deformity post-PVP.
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Affiliation(s)
- Ling Mo
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,The First School of Clinical Medicine of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zixian Wu
- The First School of Clinical Medicine of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - De Liang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Linqiang Y
- Department of Orthopaedics, Dongguan Hospital of traditional Chinese Medicine, Dongguan, Guangdong, China
| | - Zhuoyan Cai
- The First School of Clinical Medicine of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jinjing Huang
- Department of Orthopaedics, Jieyang Ciyun Hospital, Jieyang, Guangdong, China *These authors contributed equally to this work and hence should be considered as co-first authors
| | - Shunxin Lin
- Department of Orthopaedics, Jieyang Ciyun Hospital, Jieyang, Guangdong, China *These authors contributed equally to this work and hence should be considered as co-first authors
| | - Jianchao Cui
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Shuncong Zhang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhidong Yang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhensong Yao
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Li Q, Long X, Wang Y, Guan T, Fang X, Guo D, Lv J, Hu X, Jiang X, Cai L. Clinical observation of two bone cement distribution modes after percutaneous vertebroplasty for osteoporotic vertebral compression fractures. BMC Musculoskelet Disord 2021; 22:577. [PMID: 34167517 PMCID: PMC8223328 DOI: 10.1186/s12891-021-04480-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/14/2021] [Indexed: 02/08/2023] Open
Abstract
Background Current findings suggest that percutaneous vertebroplasty(PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs). The present retrospective study aimed to investigate the differences in clinical efficacy and related complications between the two bone cement distribution modes. Methods We retrospectively reviewed the medical records of the patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty. Patients were divided into blocky and spongy group according to the type of postoperative bone cement distribution. Clinical efficacy and related complications was compared between the two bone cement distribution modes on 24 h after the operation and last follow-up. Results A total of 329 patients with an average follow up time of 17.54 months were included. The blocky group included 131 patients, 109 females(83.2 %) and 22 males(16.8 %) with a median age of 72.69 ± 7.76 years, while the Spongy group was made up of 198 patients, 38 females(19.2 %) and 160 males(80.8 %) with a median age of 71.11 ± 7.36 years. The VAS and ODI after operation improved significantly in both two groups. The VAS and ODI in the spongy group was significantly lower than that in the blocky group, 24 h postoperatively, and at the last follow-up. There were 42 cases (12.8 %) of adjacent vertebral fractures, 26 cases (19.8 %) in the blocky group and 16 cases (8.1 %) in the spongy group. There were 57 cases (17.3 %) of bone cement leakage, 18 cases (13.7 %) in blocky group and 39 cases (19.7 %) in the spongy group. At 24 h postoperatively and at the last follow-up, local kyphosis and anterior vertebral height were significantly corrected in both groups, but gradually decreased over time, and the degree of correction was significantly higher in the spongy group than in the block group. The change of local kyphosis and loss of vertebral body height were also less severe in the spongy group at the last follow-up. Conclusions Compared with blocky group, spongy group can better maintain the height of the vertebral body, correct local kyphosis, reduce the risk of the vertebral body recompression, long-term pain and restore functions.
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Affiliation(s)
- Qiujiang Li
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China.,Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Lijun Cai, No. 56, Zhengyuan Street, Ningxia, 750002, Yinchuan, China
| | - Xingxia Long
- West China Hospital, Sichuan University, Sichuan, China
| | - Yinbin Wang
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Lijun Cai, No. 56, Zhengyuan Street, Ningxia, 750002, Yinchuan, China
| | - Tao Guan
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Lijun Cai, No. 56, Zhengyuan Street, Ningxia, 750002, Yinchuan, China
| | - Xiaomin Fang
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Lijun Cai, No. 56, Zhengyuan Street, Ningxia, 750002, Yinchuan, China
| | - Donggeng Guo
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China.,Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Lijun Cai, No. 56, Zhengyuan Street, Ningxia, 750002, Yinchuan, China
| | - Jinhan Lv
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China.,Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Lijun Cai, No. 56, Zhengyuan Street, Ningxia, 750002, Yinchuan, China
| | - Xuehua Hu
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Lijun Cai, No. 56, Zhengyuan Street, Ningxia, 750002, Yinchuan, China
| | - Xiaocheng Jiang
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China.,Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Lijun Cai, No. 56, Zhengyuan Street, Ningxia, 750002, Yinchuan, China
| | - Lijun Cai
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Lijun Cai, No. 56, Zhengyuan Street, Ningxia, 750002, Yinchuan, China.
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29
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Xiao Q, Zhao Y, Qu Z, Zhang Z, Wu K, Lin X. Association Between Bone Cement Augmentation and New Vertebral Fractures in Patients with Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis. World Neurosurg 2021; 153:98-108.e3. [PMID: 34139353 DOI: 10.1016/j.wneu.2021.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the association between bone cement augmentation and new vertebral fractures (VF) in patients with osteoporotic vertebral compression fractures (OVCFs). METHODS A literature search of PubMed, EMBASE, and the Cochrane Library was conducted from 1987 to December 31, 2020, to identify randomized controlled trials that compared bone cement augmentation with non-bone cement treatments in patients with OVCFs. The clinical incidence of new VF and the risk of new adjacent vertebral fractures (AVF) after treatment were calculated. The indexes of the risk ratio or odds ratio, and 95% confidence intervals were determined with RevMan 5.2 software. RESULTS A total of 13 randomized controlled trials involving 1949 participants were included in the final quantitative analysis. There was no significant association between bone cement augmentation and the clinical incidence of new VF during the 6-month and 12-month follow-ups or the whole follow-up period. However, there was a significantly lower clinical incidence of new VF in patients who received bone cement augmentation compared with non-bone cement treatments during 24 months or more of follow-up. Pooled data from the relevant trials demonstrated that the risk of new AVF in bone cement augmentation was significantly higher than that in non-bone cement treatments. CONCLUSIONS Although the use of bone cement augmentation in OVCFs significantly increased the risk of new AVF compared with non-bone cement treatments, it was not significantly associated with a higher clinical incidence of new VF.
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Affiliation(s)
- Qinghua Xiao
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, P. R. China; Department of Osteoporosis, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, P. R. China
| | - Ying Zhao
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, P. R. China
| | - Zhen Qu
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, P. R. China
| | - Zhen Zhang
- Department of Osteoporosis, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, P. R. China
| | - Keliang Wu
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, P. R. China
| | - Xiaosheng Lin
- Department of Osteoporosis, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, P. R. China.
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Tao W, Hu Q, Nicolas YSM, Nuo X, Daoyu H, Zhen J, Jinpeng S, Jun L. Is unilateral transverse process-pedicle percutaneous kyphoplasty a better choice for osteoporotic thoracolumbar fractures in the old patients? BMC Surg 2021; 21:252. [PMID: 34020645 PMCID: PMC8139159 DOI: 10.1186/s12893-021-01246-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/11/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A few reports have shown that unilateral transverse process-pedicle percutaneous kyphoplasty is a good choice for patients with osteoporotic vertebral compression fracture (OVCF). However, this issue remains controversial and the related comprehensive research was lacked. METHODS A retrospective study was conducted on patients receiving PKP surgery for OVCF. Patients were divided into three groups according to surgical approach. Symptom and radiographical evaluation were performed preoperatively, 1-month postoperatively, 1-year postoperatively and follow-ups. And follow-ups were repeated every year. Visual Analogue Scale Score (VAS), Oswestry Disability Index (ODI) scores, anterior vertebral height, coronal Cobb angle and sagittal Cobb angle was determined and compared among three groups. RESULTS Totally 447 patients were included with an average age of 76.6 ± 7.2 years old. UTP showed significantly shorter surgical duration (p < 0.001), lower cement volume (p < 0.001) but higher cement leakage proportion (p = 0.044). No significant statistical difference was found in terms of improvement rates among three groups. Besides, it was notable that the a significantly higher coronal Cobb angle was observed in UTP group, and a about 4°coronal correction was found after UTP PKP. CONCLUSION UTTP PKP could achieve similar symptoms relief and kyphosis correction as UTP and BTP PKP. However, it had shorter surgical time and less radio exposure than BTP PKP, lower risk of cement leakage and higher proportion of bilaterally cement distribution than UTP PKP. It seemed to be a better choice for patients with OVCF. In addition, we found that UTP PKP was especially fit for OVCF patients with asymmetrical vertebral compression.
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Affiliation(s)
- Wu Tao
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China
| | - Qin Hu
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China
| | - Yap San Min Nicolas
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China
| | - Xu Nuo
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China
| | - Huang Daoyu
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China
| | - Jin Zhen
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China
| | - Sun Jinpeng
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China
| | - Liu Jun
- Orthopedics Department, The Second Affiliated Hospital of Nanjing Medical University, Jiangjiayuan Road No. 121, Nanjing, 210000, Jiangsu Province, China.
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Hu PL, Lin JS, Meng H, Su N, Yang Y, Fei Q. A novel "three-dimensional-printed individual guide template-assisted percutaneous vertebroplasty" for osteoporotic vertebral compression fracture: a prospective, controlled study. J Orthop Surg Res 2021; 16:326. [PMID: 34016139 PMCID: PMC8136164 DOI: 10.1186/s13018-021-02471-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conventional percutaneous vertebroplasty (PVP) are mainly guided by C-arm fluoroscopy, and it usually leads to excessive X-ray radiation exposure to patients, surgeons, and anesthetists. Moreover, multi-time fluoroscope may prolong the operation time. 3D-printed template could help minimize fluoroscopy shot times and fluoroscopy dosage during operation, and shorten operation time. We perform this study to compare the efficacy and accuracy of PVP assisted by "three-dimensional printed individual guide template" versus conventional PVP. METHOD Patients who suffered acute painful single segment osteoporotic vertebral compression fracture(OVCF) needed operative treatment were randomly assigned into three-dimensional printing individual guide template-assisted percutaneous vertebroplasty group (group A) or conventional PVP guided by C-arm fluoroscopy group (group B) at a 1:1 ratio. Fluoroscopy times for puncture points (FTPP), total radiation dosages (TRD), total fluoroscopy time (TFT), and total operation time (TOT) were recorded as the main evaluation factors to evaluate the two operation procedures. RESULTS A total of 36 acute painful single segment OVCF patients were successfully operated on, and each group has 18 patients. None of the patients presented symptomatic complications. The surgical success rate in group A was 94.4%(17/18), one patient in the group A was failed and then operated by conventional procedure. FTPP (1.8 ± 0.8 in group A vs 5.2 ± 1.9 in group B, P < 0.05), TRD (4.9 ± 0.9 mGy vs 7.9 ± 1.6 mGy, P < 0.05), TFT (16.7 ± 2.9 vs 26.6 ± 5.3, P < 0.05), and total operation time (19.4 ± 2.4 min vs 27.8 ± 4.0 min, P < 0.05) were presented statistically difference in the two groups. The incidence of cement leakage occurred in group A (3/18, 16.7%) was less than that occurred in group B (7/18, 38.9%) (P > 0.05). CONCLUSIONS Compared with the conventional PVP, "three-dimensional-printed individual guide template-assisted PVP" could minimize fluoroscopy shot times during operation and fluoroscopy dosage, shorten operation time, and is a more precise and feasible operation method. TRIAL REGISTRATION The present study was registered with the Chinese Clinical Trial Registry (ChiCTR) ( http://www.chictr.org.cn ), and its registration no. is ChiCTR1900024283.
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Affiliation(s)
- Pei Lun Hu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Xicheng District, Beijing, People's Republic of China
| | - Ji Sheng Lin
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Xicheng District, Beijing, People's Republic of China
| | - Hai Meng
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Xicheng District, Beijing, People's Republic of China
| | - Nan Su
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Xicheng District, Beijing, People's Republic of China
| | - Yong Yang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Xicheng District, Beijing, People's Republic of China
| | - Qi Fei
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Xicheng District, Beijing, People's Republic of China.
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Wang M, Zhang L, Fu Z, Wang H, Wu Y. Selections of Bone Cement Viscosity and Volume in Percutaneous Vertebroplasty: A Retrospective Cohort Study. World Neurosurg 2021; 150:e218-27. [PMID: 33727205 DOI: 10.1016/j.wneu.2021.02.133] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We sought to evaluate the efficacy and complications of percutaneous vertebroplasty with different viscosities and volumes of bone cement in treating osteoporotic vertebral compression fractures (OVCFs). METHOD We conducted a retrospective cohort study of 307 patients treated for a single thoracolumbar level (T12-L2) OVCF in our hospital between January 2014 and December 2019. The patients were divided into 6 groups according to different viscosities (I: low-viscosity bone cement, II: high-viscosity bone cement) and injection volumes (A, 2-4 mL; B, 4-6 mL; C, 6-8 mL) of bone cement. Clinical and radiologic characteristics including visual analog scale, local kyphotic angle, anterior vertebral height ratio, cement leakage, and vertebral body recollapse rate were collected preoperatively, 2 days postoperation, and at the last follow-up to assess the efficacy and complications of each group. RESULTS Regarding efficacy, there was no significant difference between the 2 kinds of bone cement. Injecting >4 mL of cement can provide patients with good improvements of clinical indicators and a low vertebral body recollapse rate. Injecting 6-8 mL of bone cement slightly improved the radiologic indicators. However, the leakage rate of low-viscosity bone cement increased significantly when the volume exceeded 6 mL. The leakage rate of high-viscosity bone cement did not increase significantly at the volume of 6-8 mL. CONCLUSIONS In summary, when treating single thoracolumbar level OVCFs, the recommended volume of low-viscosity bone cement is 4-6 mL while the optimal volume of high-viscosity bone cement is 6-8 mL.
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Zuo XH, Chen YB, Xie P, Zhang WD, Xue XY, Zhang QX, Shan B, Zhang XB, Bao HG, Si YN. Finite element analysis of wedge and biconcave deformity in four different height restoration after augmentation of osteoporotic vertebral compression fractures. J Orthop Surg Res 2021; 16:138. [PMID: 33588890 PMCID: PMC7885256 DOI: 10.1186/s13018-021-02225-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Biomechanical comparison of wedge and biconcave deformity of different height restoration after augmentation of osteoporotic vertebral compression fractures was analyzed by three-dimensional finite element analysis (FEA). Methods Three-dimensional finite element model (FEM) of T11-L2 segment was constructed from CT scan of elderly osteoporosis patient. The von Mises stresses of vertebrae, intervertebral disc, facet joints, displacement, and range of motion (ROM) of wedge and biconcave deformity were compared at four different heights (Genant 0–3 grade) after T12 vertebral augmentation. Results In wedge deformity, the stress of T12 decreased as the vertebral height in neutral position, flexion, extension, and left axial rotation, whereas increased sharply in bending at Genant 0; L1 and L2 decreased in all positions excluding flexion of L2, and T11 increased in neutral position, flexion, extension, and right axial rotation at Genant 0. No significant changes in biconcave deformity. The stress of T11-T12, T12-L1, and L1-L2 intervertebral disc gradually increased or decreased under other positions in wedge fracture, whereas L1-L2 no significant change in biconcave fracture. The utmost overall facet joint stress is at Genant 3, whereas there is no significant change under the same position in biconcave fracture. The displacement and ROM of the wedge fracture had ups and downs, while a decline in all positions excluding extension in biconcave fracture. Conclusions The vertebral restoration height after augmentation to Genant 0 affects the von Mises stress, displacement, and ROM in wedge deformity, which may increase the risk of fracture, whereas restored or not in biconcave deformity.
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Affiliation(s)
- Xiao-Hua Zuo
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.,Department of Pain Management, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Yin-Bing Chen
- Department of Orthopedic Surgery, The Affiliated Haian Hospital of Nantong University, Haian, 226600, China
| | - Peng Xie
- Department of Neurosurgery, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Wen-Dong Zhang
- Department of Orthopedics, Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Xiang-Yun Xue
- Department of Pain Management, Yancheng No.1 People's Hospital, Yancheng, 224000, China
| | - Qian-Xi Zhang
- Department of Pain Management, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Ben Shan
- Department of Radiology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China
| | - Xiao-Bing Zhang
- Department of Radiology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, 223002, China.
| | - Hong-Guang Bao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| | - Yan-Na Si
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
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Nagaoka S, Yoshimura Y, Eto T, Kumagi M. Low handgrip strength is associated with reduced functional recovery and longer hospital stay in patients with osteoporotic vertebral compression fractures: a prospective cohort study. Eur Geriatr Med 2021; 12:767-75. [PMID: 33469814 DOI: 10.1007/s41999-020-00446-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM Despite the growing interest in sarcopenia in clinical medicine, there is little evidence to support the association between muscle strength and functional prognosis in patients with osteoporotic vertebral fractures. The aim of this study was to evaluate the impact of low handgrip strength (HGS) on functional outcomes in older patients with osteoporotic vertebral fractures. METHODS A prospective cohort study was performed between 2017 and 2019 on consecutive patients with conservatively treated vertebral compression fractures who were newly admitted for post-acute rehabilitation. HGS was measured on admission. Outcomes included the Functional Independence Measure-motor (FIM-motor) score at discharge and length of hospital stay. Multivariate linear regression analyses were utilized to determine whether HGS at baseline was significantly associated with these outcomes after adjustment for potential confounders. RESULTS Of the 207 patients admitted, 159 patients (mean age 83 years; 78% women) were enrolled in the analysis. The mean (standard deviation: SD) HGS was 15.9 (7.7) kg. Multivariate analysis showed that HGS at admission was independently associated with the FIM-motor score at discharge (β = 0.107, p = 0.006) and length of stay (β = - 0.118, p = 0.030). CONCLUSION Low HGS is commonly found and is associated with reduced functional recovery and prolonged hospital stay in older patients with osteoporotic vertebral fractures. Early detection and interventions for low HGS could help achieve improved outcomes. However, further studies are needed to validate our findings.
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Nagaoka S, Yoshimura Y, Eto T, Kumagi M. Low handgrip strength is associated with reduced functional recovery and longer hospital stay in patients with osteoporotic vertebral compression fractures: a prospective cohort study. Eur Geriatr Med 2021; 12:767-75. [PMID: 33469814 DOI: 10.1007/s41999-020-00446-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/28/2020] [Indexed: 01/22/2023]
Abstract
AIM Despite the growing interest in sarcopenia in clinical medicine, there is little evidence to support the association between muscle strength and functional prognosis in patients with osteoporotic vertebral fractures. The aim of this study was to evaluate the impact of low handgrip strength (HGS) on functional outcomes in older patients with osteoporotic vertebral fractures. METHODS A prospective cohort study was performed between 2017 and 2019 on consecutive patients with conservatively treated vertebral compression fractures who were newly admitted for post-acute rehabilitation. HGS was measured on admission. Outcomes included the Functional Independence Measure-motor (FIM-motor) score at discharge and length of hospital stay. Multivariate linear regression analyses were utilized to determine whether HGS at baseline was significantly associated with these outcomes after adjustment for potential confounders. RESULTS Of the 207 patients admitted, 159 patients (mean age 83 years; 78% women) were enrolled in the analysis. The mean (standard deviation: SD) HGS was 15.9 (7.7) kg. Multivariate analysis showed that HGS at admission was independently associated with the FIM-motor score at discharge (β = 0.107, p = 0.006) and length of stay (β = - 0.118, p = 0.030). CONCLUSION Low HGS is commonly found and is associated with reduced functional recovery and prolonged hospital stay in older patients with osteoporotic vertebral fractures. Early detection and interventions for low HGS could help achieve improved outcomes. However, further studies are needed to validate our findings.
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Qi H, Qi J, Gao J, Sun J, Wang G. The Impact of Bone Mineral Density on Bone Metabolism and the Fracture Healing Process in Elderly Chinese Patients With Osteoporotic Vertebral Compression Fractures. J Clin Densitom 2021; 24:135-145. [PMID: 33323310 DOI: 10.1016/j.jocd.2020.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to investigate the effect of bone mineral density (BMD) on bone histomorphological parameters and bone turnover markers (BTMs) following osteoporotic vertebral compression fracture (OVCF) and to determine the correlation between BMD and the percentage of middle height compression during the healing process. METHODS A total of 206 patients with OVCFs were included in this study. Bone biopsy specimens were acquired during surgery. Blood samples were obtained to determine the serum concentrations of BTMs. The patients were divided into 2 groups according to BMD. RESULTS The concentrations of N-terminal propeptide of type I collagen (PINP) in the T-score ≤ -2.5 group (50.92 ± 12.78 ng/ml) were significantly lower than those in the T-score > -2.5 group (68.75 ± 28.66 ng/ml, p = 0.025) 3-6 mo after fracture. Moreover, the volume of necrotic bone in the T-score ≤ -2.5 group (15.15 ± 5.44%) was higher than that (1.67 ± 0.79%, p < 0.001) in the T-score > -2.5 group during the same period. BMD was statistically correlated with cancellous bone content (RS = 0.761, p <0.001), PMHC (RS = 0.85, p < 0.001), fibrous tissue volume (RS = -0.376, p < 0.001), and necrotic bone content (RS = -0.487, p < 0.001). CONCLUSIONS The healing process of OVCFs in the setting of low bone mass frequently occurs in the presence of decreased bone formation abilities, severe vertebral body height loss and a large amount of necrotic bone.
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Affiliation(s)
- Haoran Qi
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China; School of Medicine, Shandong University, Jinan, China
| | - Jun Qi
- Laboratory Department, Jinan Infectious Diseases Hospital, Jinan, China
| | | | - Jianmin Sun
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China; School of Medicine, Shandong University, Jinan, China.
| | - Guodong Wang
- Department of Spine, Provincial Hospital Affiliated to Shandong First medical University, Jinan, China.
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Xu XY, Luo DM, Liu SL, Shen XT, Zhou ZY, Yuan GD. [Treatment of severely osteoporotic vertebral compression fractures with the vertebral body stent system and percutanous kyphoplasty combined with zoledronic acid]. Zhongguo Gu Shang 2020; 33:827-30. [PMID: 32959569 DOI: 10.12200/j.issn.1003-0034.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the clinical efficacy of vertebral body stent (VBS) system and percutanous kyphoplasty (PKP) combined with zoledronic acid for the treatment of severely osteoporotic compression vertebral fractures (OVCFs). METHODS The clinical data of 48 patients with osteoporotic thoracolumbar fractures treated from December 2017 to December 2018 were retrospectively analyzed, including 13 males and 35 females, aged 55 to 92 years old with an average (71.2±10.5) years. All patients were treated with VBS system PKP surgery, and zoledronic acid injection was used for anti-osteoporosis treatment after operation. The VAS scores ODI, the height of diseasedvertebral lost were compared before operation, 3 d and half a year after operation, and whether there was re-fracture of diseased or adjacent vertevrae after operation was observed. RESULTS Before operation, 3 d and half a year after operation, VAS scores were 7.60±0.12, 3.00±0.46, 1.20±0.23, ODI were(82.00±0.32)%, (30.00±1.50) %, (18.00±0.16) %, the height of diseased vertebral lost were (12.00±0.43) mm, (3.00± 0.15) mm, (3.60±0.51) mm respectively. Postoperative VAS score, ODI, the height of diseased vertebral lost were obviously improved (P<0.05), and there was no significant difference between 3 d and half a year after operation (P>0.05). All the 48 patients were followed up with an average time of (6.6±0.5) months. All the incisions healed at grade A after operation, and no re-fracture of diseased vertebrae or adjacent vertebrae was found at the final follow-up. CONCLUSION VBS system and PKP combined with zoledronic acid in the treatment of OVCFs not only may effectively relieve the pain in the thoracolumbar back, improve the mobility of the thoracolumbar, but also can restore the height of the vertebral body to the maximum extent, and prevent the re-fracture of the affected vertebrae and adjacent vertebrae, which is worthy to spread in clinic.
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Affiliation(s)
- Xiang-Yang Xu
- Department of Spinal Surgery, Dongguan Kanghua Hospital, Dongguan 523080, Guangdong, China
| | - De-Min Luo
- Department of Spinal Surgery, Dongguan Kanghua Hospital, Dongguan 523080, Guangdong, China
| | - Shang-Li Liu
- Department of Spinal Surgery, Dongguan Kanghua Hospital, Dongguan 523080, Guangdong, China
| | - Xiao-Tao Shen
- Department of Spinal Surgery, Dongguan Kanghua Hospital, Dongguan 523080, Guangdong, China
| | - Zu-Yan Zhou
- Department of Spinal Surgery, Dongguan Kanghua Hospital, Dongguan 523080, Guangdong, China
| | - Guo-Dong Yuan
- Department of Spinal Surgery, Dongguan Kanghua Hospital, Dongguan 523080, Guangdong, China
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Li ZK, Xu YJ, Xu W, Zhu XD, Li GF, Chen C, Li YF, Wang Y. [Percutaneous pedicle screw fixation combined with vertebroplasty for the treatment of Genant Ⅲ degree osteoporotic vertebral compression fractures]. Zhongguo Gu Shang 2020; 33:807-13. [PMID: 32959567 DOI: 10.12200/j.issn.1003-0034.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the clinical effect of percutaneous pedicle screw fixation(PPSF) combined with percutaneous vertebroplasty (PVP) in the treatment of Genant Ⅲ degree osteoporotic vertebral compression fractures (OVCFs). METHODS The hospitalized 83 patients with Genant Ⅲ degree OVCFs treated by PPSF combined with PVP from June 2015 to June 2017 were retrospectively analyzed, and 83 patients treated by PVP alone from January 2013 to June 2016 were randomly selected as the control group. There were 19 males and 64 females with an average age of (73.6±11.0) years in combined group with treatment of PPSF and PVP. There were 15 malesand 68 females with an average age of (75.5±10.6) years in control group. The anterior edge height of the vertebral body and Cobb angle before operation, 1 day, and 6, 12, 24 months after operation were compared between two groups. Visual analogue scale(VAS) and Oswestry Disability Index (ODI) were used to assess the pain level and daily lumbar dysfunction for patients, respectively. The complications were observed. RESULTS The follow-up time of all patients was more than 2 years. The combined group and control group were (24.3±10.2) months and (27.5±14.8) months, respectively. There were no statistically significant differences in the anterior edge height of the vertebral body and Cobb angle at 1 day after surgery between two groups (P>0.05), and there were statistically significant differences at 6, 12, 24 months after surgery between two groups (P<0.01). The difference in ODI and VAS scores at 6 and 12 months after operation between two groups was statistically significant (P<0.05). Postoperative complications incontrol group were higher than those in the combined group. CONCLUSION PPSF combined with PVP for the treatment of Genant Ⅲ degree OVCFs is superior to PVP alone in terms of vertebral height loss, patient satisfaction, and complications.
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Affiliation(s)
- Zhi-Kun Li
- Department of Orthopaedics, Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200336, China
| | - You-Jia Xu
- Department of Orthopaedics, Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200336, China
| | - Wei Xu
- Department of Orthopaedics, Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200336, China
| | - Xiao-Dong Zhu
- Department of Orthopaedics, Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200336, China
| | - Guang-Fei Li
- Department of Orthopaedics, Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200336, China
| | - Chao Chen
- Department of Orthopaedics, Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200336, China
| | - Yi-Fan Li
- Department of Orthopaedics, Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200336, China
| | - Yi Wang
- Department of Orthopaedics, Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200336, China
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Huang Y, Wu D. [Clinical application of zoledronic acid combined with vitamin K2 in percutaneous vertebroplasty for multi-segment osteoporotic vertebral compression fractures]. Zhongguo Gu Shang 2020; 33:820-6. [PMID: 32959568 DOI: 10.12200/j.issn.1003-0034.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To explore the clinical effect of zoledronic acid combined with vitamin K2 regimen in percutaneous vertebroplasty for multi-segment osteoporotic vertebral compression fractures(OVCFs). METHODS This study was a retrospective control study. A total of 364 patients with OVCFs who were admitted to our spinal surgery department from January 2014 to January 2017 were selected as the study subjects. According to whether zoledronic acid combined with vitamin K2 was used to treat osteoporosis after surgery, the patients were divided into control group and experimental group. Among them, 257 patients in the control group were treated with calcium carbonate and vitamin D regimen, while 107 patients in the experimental group were treated with zoledronic acid combined with vitamin K2 regimen on the basis of the control group. Visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were used to evaluate the clinical effect. Pre- and post-operative bone mineral density of lumbar spine and proximal femur, vertebral height ratio of responsible vertebral body and Cobb angle of vertebral body were observed by image data. Serological indicators related to bone metabolism were detected by laboratory. The complications such as fever, dizziness, osteoarthritis, muscular and soft tissue pain and adjacent vertebral re-fracture were compared between two groups. RESULTS There was no significant difference in general data between the two groups (P<0.05). There was no significant difference in VAS score between experimental group and control group before and 24 hours after operation (P>0.05);VAS score in the experimental group was significantly lower than that in the control group 1 month, 3 months and 1 year after operation(P<0.05). There was no significant difference in ODI between two groups before operation(P>0.05), and at the 24 hours, 3 months, 1 year after operation, the experimental group was significantly lower than the control group (P<0.05). There was no significant difference in the vertebral height ratio of the responsible vertebral body and the Cobb angle before operation between two groups (P>0.05). The vertebral height ratio of the responsible vertebral body in experimental group was significantly higher than that in control group and Cobb angle in experimental group was significantly lower than that in control group at 3 months and 1 year after operation (P<0.05). There was no significant difference in preoperative bone mineral density of lumbar spine and proximal femur between two groups (P>0.05), but at 3 months and 1 year after operation, the bone mineral density of lumbar spine and proximal femur in experimental group was significantly lower than that in control group (P< 0.05). There was no significant difference in preoperative bone metabolic markers such as total type I collagen amino-terminal elongation peptide, β-collagen degradation products and 25-hydroxyvitamin D between two groups (P>0.05). At 1 year after operation the total type I collagen amino-terminal elongation peptide and β-collagen degradation products in experimental group was significantly lower than that in the control group (P<0.05), but the 25-hydroxyvitamin D operation in experimental group was significantly higher than that in control group(P<0.05). The incidence of postoperative complications such as fever, dizziness, osteoarthritis, muscle and soft tissue pain and adjacent vertebral re-fracture in experimental group was significantly lower than that in control group (P<0.05). CONCLUSION Zoledronic acid injection combined with vitamin K2 regimen can be used for anti-osteoporosis treatment of OVCFs vertebroplasty. It has a definite curative effect and a high safety factor. It is worth popularizing.
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Affiliation(s)
- Yan Huang
- The Third Department of Orthopaedics, the Second People's Hospital of Nanyang, Nanyang 473000, Henan, China
| | - Di Wu
- The Third Department of Orthopaedics, the Second People's Hospital of Nanyang, Nanyang 473000, Henan, China
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Deng XG, Xiong XM, Cui W, Gu T, Wan D, Shi HG, Chen X, Song SM, Hou W, Mei GL, Jiang WB. [Preliminary application of CPC/PMMA composite bone cement in kyphoplasty for the elderly]. Zhongguo Gu Shang 2020; 33:831-6. [PMID: 32959570 DOI: 10.12200/j.issn.1003-0034.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE From the perspective of clinical application to analyze the effectiveness and reliability of CPC/PMMA bone cement in percutaneous kyphoplasty (PKP) for the treatment of elderly patients with osteoporotic thoracolumbar fractures. METHODS A retrospective analysis was performed on 62 patients with osteoporotic compression fracture of single-vertebral thoracic or lumbar segment who underwent PKP surgery and had a bone density less than or equal to -3.0 SD from February 2016 to December 2016. Among them, 23 patients were in CPC/PMMA group, with an average age of (77.6±2.2) years old, 39 patients in PMMA group, with an average age of (77.1±1.1) years old. The indexes between two groups were compared, including the visual analogue scale (VAS), height ratio of anterior vertebra (AVHR), local Cobb angle, cement leakage, new adjacent vertebral fracture(NAVF). RESULTS There were no significant difference in gender, age, follow-up time and preoperative VAS, AVHR, local Cobb angle between two groups (P>0.05), at the 1 day after operation, VAS, AVHR, local Cobb angle in all patients got obvious improvement (P<0.05), which was no significant difference at 1 day after operation and final follow-up (P>0.05). At the same time, there was no statistically significant difference in the incidence of new adjacent vertebral fracture and cement leakage (P>0.05). The pain in both groups continued to improve at follow up after operation (P<0.05), the local Cobb angle increased (P<0.05) and AVHR decreased slightly (P<0.05). However, the images of conventional methods (X-ray or CT) could not find signs about CPC degeneration and new bone ingrowth. CONCLUSION CPC/PMMA composite bone cement is safe and reliablein PKP for treatment of elderly patients with osteoporotic thoracolumbar fractures, which can effectively relieve pain and maintain vertebral body stability. It has the same curative effect as PMMA bone cement. It was worthy to research more in future, although no direct evidences support the CPC/PMMA composite bone cement can reduce the incidence of adjacent vertebral fracture, CPC degeneration or new bone ingrowth.
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Affiliation(s)
- Xuan-Geng Deng
- Department of Spine, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China
| | - Xiao-Ming Xiong
- Department of Spine, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China
| | - Wei Cui
- Department of Spine, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China
| | - Tao Gu
- Department of Spine, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China
| | - Dun Wan
- Department of Spine, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China
| | - Hua-Gang Shi
- Department of Spine, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China
| | - Xing Chen
- Department of Spine, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China
| | - Si-Mao Song
- Department of Spine, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China
| | - Wei Hou
- Department of Spine, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China
| | - Guo-Long Mei
- Department of Spine, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China
| | - Wen-Bing Jiang
- Department of Spine, Sichuan Orthopedic Hospital, Chengdu 610041, Sichuan, China
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Wei H, Dong C, Zhu Y, Ma H. Analysis of two minimally invasive procedures for osteoporotic vertebral compression fractures with intravertebral cleft: a systematic review and meta-analysis. J Orthop Surg Res 2020; 15:401. [PMID: 32912267 PMCID: PMC7488103 DOI: 10.1186/s13018-020-01938-6] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/01/2020] [Indexed: 12/16/2022] Open
Abstract
Background A systematic review and meta-analysis to assess the pros and cons of percutaneous vertebroplasty (PVP) versus kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral cleft (IVC) including all available evidence from controlled trials. Methods Databases including Pubmed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched to identify relevant studies comparing PVP and PKP for OVCFs with IVC. The outcomes mainly included visual analog scale (VAS), Oswestry Disability Index (ODI), local kyphotic angle (LKA), rate of vertebral height (VH%), and adverse events. Results Nine studies enrolling 688 patients were eligible for meta-analysis. The results indicated no significant differences between the two groups in the short-and long-term VAS, ODI, LKA, or VH% (P > 0.05). Compared with PVP, PKP was associated with significantly longer operation time (P < 0.05), higher cost (P > 0.05), and more injected cement volume (P < 0.05). In terms of adverse events, PKP has a lower risk of cement leakage (P < 0.05), while with no significant difference in adjacent-level fracture rates (P > 0.05). Conclusion The two procedures have similar short- and long-term pain relief, functional recovery, local kyphosis correction, and vertebral height maintenance in OVCFs with IVC. PKP is superior to PVP for the injected cement volume, and lower cement leakage rate, however, with longer operation time, more fluoroscopy times, and higher cost. Further randomized controlled trials (RCTs) should be conducted to confirm these results.
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Affiliation(s)
- Hongyu Wei
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Chunke Dong
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.,Beijing University of Chinese Medicine, 11 North Third Ring Road East, Chaoyang District, Beijing, 100029, China
| | - Yuting Zhu
- Beijing Tongzhou Integrative Medicine Hospital, 89 Chezhan Road, Tongzhou District, Beijing, 101100, China
| | - Haoning Ma
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
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Chang M, Zhang C, Shi J, Liang J, Yuan X, Huang H, Li D, Yang B, Tang S. Comparison Between 7 Osteoporotic Vertebral Compression Fractures Treatments: Systematic Review and Network Meta-analysis. World Neurosurg 2020; 145:462-470.e1. [PMID: 32891841 DOI: 10.1016/j.wneu.2020.08.216] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Vertebroplasty (VP), kyphoplasty (KP), SpineJack system (SJ), radiofrequency kyphoplasty (RFK), Kiva system (Kiva), Sky kyphoplasty system (SK), and conservative treatment are widely used in the treatment of osteoporotic vertebral compression fractures (OVCFs). However, it is still unknown which is the best intervention. The aim of the current study was to evaluate the effectiveness and safety of VP, KP, SJ, RFK, Kiva, SK, and CT in the treatment of OVCFs. METHODS Randomized controlled trials and cohort studies comparing VP, KP, SJ, RFK, Kiva, SK, or CT for the treatment of OVCFs were identified on the basis of databases including PubMed, the Cochrane Library, Web of Science, and Springer Link. A network meta-analysis was performed using STATA 15.1. RESULTS A total of 56 studies with 6974 patients and 7 interventions were included in this study. The results of the surface under the cumulative probability demonstrated that SK was the best intervention in decreasing VAS scores and recovering middle vertebral height, RFK was the best intervention in improving ODI scores and decreasing incidence of new fractures, SJ was the best intervention to restore kyphosis angle, and Kiva was the best intervention to reduce incidence of bone cement leakage. Cluster analysis showed that SK was the preferable intervention on the basis of the outcomes of VAS, ODI, middle vertebral height, and kyphotic angle, and RFK was the preferable treatment in decreasing the incidence of adverse events. In our network meta-analysis, node-splitting analysis and loop inconsistency analysis showed no significant inconsistencies. CONCLUSIONS SK may be the most effective treatment in relieving pain, improving the quality of life, and recovering vertebral body height and kyphotic angle, while RFK may be the safest intervention for OVCFs. However, considering the limitations of this study, more high-quality trials are needed in the future to confirm the current conclusion.
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Affiliation(s)
- Minmin Chang
- School of Chinese Medicine, Jinan University, Guangzhou, Guangdong Province, China
| | - Chenchen Zhang
- School of Chinese Medicine, Jinan University, Guangzhou, Guangdong Province, China
| | - Jing Shi
- School of Chinese Medicine, Jinan University, Guangzhou, Guangdong Province, China
| | - Jian Liang
- School of Chinese Medicine, Jinan University, Guangzhou, Guangdong Province, China
| | - Xin Yuan
- School of Chinese Medicine, Jinan University, Guangzhou, Guangdong Province, China
| | - Honghao Huang
- School of Chinese Medicine, Jinan University, Guangzhou, Guangdong Province, China
| | - Dong Li
- School of Chinese Medicine, Jinan University, Guangzhou, Guangdong Province, China
| | - Binbin Yang
- School of Chinese Medicine, Jinan University, Guangzhou, Guangdong Province, China
| | - Shujie Tang
- School of Chinese Medicine, Jinan University, Guangzhou, Guangdong Province, China.
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Cao P, Hao W, Zhang L, Zhang Q, Liu X, Li M. Safety and Efficacy Studies of Vertebroplasty with Dual Injections for the Treatment of Osteoporotic Vertebral Compression Fractures: Preliminary Report. Acad Radiol 2020; 27:e224-e231. [PMID: 31629626 DOI: 10.1016/j.acra.2019.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate the clinical safety and efficacies of percutaneous vertebroplasty (PVP), percutaneous vertebroplasty with dual injections (PVPDI), and percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs), a retrospective study of 90 patients with OVCFs who had been treated by PVP (n = 30), PVPDI (n = 30), and PKP (n = 30) was conducted in this work. METHODS The clinical efficacies of these three treatments were evaluated by comparing their PMMA cement leakages, cement patterns, height restoration percentages, wedge angles, visual analogue scales, and Oswestry disability index (ODI) at the pre- and postoperative time points. RESULTS Ten percent, 6.7%, and 0% of patients had PMMA leakage in PVP, PVPDI, and PKP groups, respectively. Three (solid, trabecular, and mixed patterns), two (trabecular and mixed patterns), and two (solid and mixed patterns) types of cement patterns were observed in PVP, PVPDI, and PKP groups, respectively. PVP and PVPDI treatments had similar and less height restoration ability than PKP treatment. All the PVP, PVPDI, and PKP treatments had significant and similar ability in pain relief and functional recovery ability for the treatment of OVCFs. Microfractures after the surgery occurred after PVP and PKP treatments. CONCLUSION These results indicate minimally invasive techniques were effective methods for the treatment of OVCFs. Moreover, these initial outcomes suggest PVPDI treatment has great value and is worth promoting vigorously in orthopedics clinics.
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Affiliation(s)
- Pijian Cao
- Department of Orthopedic Surgery, The Peony People's Hospital of Heze City (The Central Hospital of Heze City), Heze City, Shandong Province, People's Republic of China
| | - Weimin Hao
- Department of Spinal Surgery, Heze Municipal Hospital, Heze City, Shandong Province, People's Republic of China
| | - Lu Zhang
- Department of Orthopedic Surgery, The Peony People's Hospital of Heze City (The Central Hospital of Heze City), Heze City, Shandong Province, People's Republic of China
| | - Qinglin Zhang
- Department of Orthopedic Surgery, The Peony People's Hospital of Heze City (The Central Hospital of Heze City), Heze City, Shandong Province, People's Republic of China
| | - Xunwei Liu
- Department of Nuclear Medicine, 960 Hospital of PLA (The General Hospital of Jinan Command), No. 25, Shifan Road, Jinan City, Shandong Province 250031, People's Republic of China
| | - Min Li
- Department of Nuclear Medicine, 960 Hospital of PLA (The General Hospital of Jinan Command), No. 25, Shifan Road, Jinan City, Shandong Province 250031, People's Republic of China.
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Zhong R, Liu J, Wang R, Liu Y, Chen B, Jiang W, Mao K, Tang P. Unilateral curved versus bipedicular vertebroplasty in the treatment of osteoporotic vertebral compression fractures. BMC Surg 2019; 19:193. [PMID: 31830969 PMCID: PMC6909451 DOI: 10.1186/s12893-019-0653-y] [Citation(s) in RCA: 5] [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: 02/13/2019] [Accepted: 11/26/2019] [Indexed: 12/26/2022] Open
Abstract
Background Vertebral compression fracture is one of the most common complications of osteoporosis. In this study an unilateral curved vertebroplasty device was developed, and the safety, effectiveness, and surgical parameters of curved vertebroplasty (CVP) in the treatment of painful osteoporotic vertebral compression fractures was investigated and compared with traditional bipedicular vertebroplasty (BVP). Methods We investigated 104 vertebral augmentation procedures performed over 36 months. CVP and BVP procedures were compared for baseline clinical variables, pain relief (Visual Analog Scale, VAS), disability improvement (Oswestry Disability Index, ODI), operation time, number of fluoroscopic images, volume of cement per level, and cement leakage rate for each level treated. Complications and refracture incidence were also recorded in the two groups. Results The VAS and ODI in both group had no significant difference preoperative (P > 0.05), and a significant postoperative improvement in the VAS scores and ODI was found in both group (P < 0.001). However, the CVP group had significantly lower operation time, number of fluoroscopic images, and cement leakage rate per level than the BVP group (P < 0.05); however, the volumes of cement per level were similar in the two groups (P > 0.05). Neither group had any serious complications. Five and two patients in the BVP group developed refractures at non-adjacent and adjacent levels, respectively, with one patient developing refractures twice; however, none of the patients in the CVP group developed refractures at any level. Conclusions Our findings revealed that both CVP and BVP were safe and effective treatments for osteoporotic vertebral compression fractures, and CVP entails a shorter operation time, less exposure to fluoroscopy, and lower rate of cement leakage.
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Affiliation(s)
- Rui Zhong
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China.,Sports Hospital Affiliated to Chengdu Sport Institute, Chengdu, 610041, Sichuan, China
| | - Jianheng Liu
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Runsheng Wang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yihao Liu
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Binbin Chen
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Wei Jiang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Keya Mao
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Peifu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China.
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Zhang Z, Jiao F, Huang H, Feng Y, Xie C, Liu D, Qin F, Zhang S, Wu P, Tan W, Tang W. A second puncture and injection technique for treating osteoporotic vertebral compression fractures. J Orthop Surg Res 2019; 14:413. [PMID: 31806033 PMCID: PMC6894466 DOI: 10.1186/s13018-019-1498-x] [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: 06/01/2019] [Accepted: 11/27/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the clinical effect of the second puncture and injection technique during a percutaneous vertebroplasty (PVP) procedure. METHODS Patients treated with a second puncture and injection (group A) or a single puncture and injection (group B) during PVP at our institution during 2010-2017 were reviewed. Vertebral height loss, visual analogue scale (VAS) score, Oswestry disability index (ODI), adjacent vertebral fractures, and cement leakage were compared between the groups. RESULTS A total of 193 patients were enrolled (86 cases in group A, 107 cases in group B). The follow-up period was 15.64 (12-20) months. The loss of anterior (group A 0.01 ± 0.03; group B 0.14 ± 0.17) and middle (group A 0.13 ± 0.12; group B 0.16 ± 0.11) vertebral height in group B was significantly higher than that in group A (P < 0.05). The VAS score and ODI were also significantly higher in group B than in group A at the final follow-up; the VAS score and ODI in group B were 1.65 ± 0.70 and 14.50 ± 4.16, respectively, and those in group A were 1.00 ± 0.74 and 12.81 ± 4.02, respectively (P < 0.05). Three patients in group A and two in group B experienced adjacent vertebral fractures. Regarding mild, moderate, and severe cement leakage, there were 25 (29%), 5 (5%), and 0 cases, respectively, in group A and 28 (26%), 3 (2.8%), and 1 (0.009%) case, respectively, in group B (P > 0.05). CONCLUSIONS The second puncture and injection technique may effectively increase the dispersion of cement, thus preventing recompression of the cemented vertebral body, and it does not increase the risk of cement leakage or adjacent vertebral fracture.
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Affiliation(s)
- Zhaofei Zhang
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China.
| | - Feng Jiao
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - He Huang
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Yonghui Feng
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Chunliang Xie
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Donghua Liu
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Fengwei Qin
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Sineng Zhang
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Peiyu Wu
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Weiguang Tan
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
| | - Wang Tang
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, 510800, Guangdong, China
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Tang S, Fu W, Zhang H, Zhang H, Liang B. Efficacy and Safety of High-Viscosity Bone Cement Vertebroplasty in Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft. World Neurosurg 2019; 132:e739-45. [PMID: 31415893 DOI: 10.1016/j.wneu.2019.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/03/2019] [Accepted: 08/05/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate and compare clinical outcomes and cement leakage of high-viscosity bone cement versus low-viscosity bone cement vertebroplasty in treating osteoporotic vertebral compression fractures with intravertebral cleft. METHODS The study included 72 patients with osteoporotic vertebral compression fractures with intravertebral cleft, who were divided into high-viscosity cement (HVC) (38 cases) and low-viscosity cement (LVC) (34 cases) groups according to the viscosity of bone cement used. Cement leakage, visual analog scale score, Oswestry Disability Index, and kyphotic angle (KA) were evaluated. RESULTS All patients were followed for at least 12 months. Overall cement leakage rate was 18.4% in the HVC group, lower than the rate of 61.8% obtained in the LVC group. A statistically significant difference was found in the overall cement leakage rate between the groups (P < 0.05). Visual analog scale and Oswestry Disability Index scores were significantly improved after percutaneous vertebroplasty without significant differences between the HVC and LVC groups (P > 0.05). The KA of patients from both groups was also significantly corrected immediately after surgery. Although the KA gradually increased in both groups during the follow-up period, there was no statistically significant difference between the HVC and LVC groups in KA during follow-up (P > 0.05). CONCLUSIONS Percutaneous vertebroplasty using HVC to treat osteoporotic vertebral compression fractures with intravertebral cleft significantly reduces cement leakage and improves the safety of the operation. In terms of clinical efficacy and prevention of augmented vertebral recollapse, HVC may not have obvious advantages.
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Wang CS, Liu AG, Liu CZ, Tian J. [Application of three-dimensional CT and image classification in percutaneous vertebraplasty for osteoporotic vertebral compression fractures]. Zhongguo Gu Shang 2019; 32:635-640. [PMID: 31382722 DOI: 10.3969/j.issn.1003-0034.2019.07.010] [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] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the application of three-dimensional CT and image classification in the treatment of osteoporotic vertebral compression fracture(OVCFs) by percutaneous vertebroplasty(PVP). METHODS A total of 90 patients with OVCFs who were treated with PVP in Linqu People's Hospital of Shandong Province from April 2016 to March 2018 were selected as subjects. There were 31 males and 59 females, aged from 63 to 84 years old. Bone mineral density measurements were performed in all patients to confirm the presence of osteoporosis and imaging examinations were performed to confirm the presence of vertebral fractures. The fracture area was determined by MRI fat surpressed image before operation and three-dimensional modeling was performed to calculate the volume of fracture area. Three dimensional CT imaging of bone cement in fracture area was performed after PVP and the volume ratio of bone cement in fracture area was calculated by computer aided design software, by which patients were divided into groups for study. Forty-one patients whose volume ratio of bone cement in fracture area less than 50% are control group and the rest of 90 patients are observation group. Visual analogue scale (VAS) and Oswestry Disability Index(ODI) were collected in two groups before operation and 1 day, 3 months after operation. The amount of bone cement was recorded after operation. RESULTS All operations were successful. There were 3 cases of cement leakage in control group and 4 cases in observation group. All patients had no obvious clinical symptoms. After continuous observation and follow-up for 3 months, no complications such as adjacent vertebral fracture, infection, bone cement displacement were found. There was no significant difference in bone cement doses and bone cement leakage between two groups(P>0.05). There was no significant difference in preoperative VAS and ODI between two groups(P>0.05). All VAS and ODI obviously decreased(P<0.05) at 1 day after operation and in observation group the decrease was more significant (P<0.05). At 3 months after operation there was no significant difference between two groups. This may have been due to basically healing of vertebral fractures at 3 months after surgery and the pain was no longer significantly related. CONCLUSIONS PVP can significantly improve clinical symptoms of OVCFs and bone cement filling in fracture area is the key to the short-term effect of PVP.
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Affiliation(s)
| | | | - Cheng-Zhou Liu
- Linqu People's Hospital of Shandong, Linqu 262600, Shandong, China;
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Zhang J, He X, Fan Y, Du J, Hao D. Risk factors for conservative treatment failure in acute osteoporotic vertebral compression fractures (OVCFs). Arch Osteoporos 2019; 14:24. [PMID: 30806831 DOI: 10.1007/s11657-019-0563-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/16/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study aimed to identify risk factors for failure of conservative treatment of acute OVCFs. The results showed age, BMD, BMI, mFI, and IVC were high-risk factors for failure of conservative treatment of acute OVCFs. PURPOSE This study aimed to identify risk factors for failure of conservative treatment of acute osteoporotic vertebral compression fractures (OVCFs). METHODS This is a retrospective study of patients presenting with acute OVCFs who were initiated on conservative treatment for 3 weeks. Conservative treatment was considered to have failed if patients were not satisfied with pain relief or there were bed rest-related complications. These patients progressed to operation. Patients were divided into a conservative treatment failure group (group A) and a conservative treatment group (group B). X-ray, computed tomography and magnetic resonance imaging of two groups were performed on the first visit to our department due to OVCFs. Recorded data for comparison among groups included age, gender, fracture level, bone mineral density (BMD), body mass index (BMI), modified frailty index (mFI), whether the fractures were multiple (≥ 2 vertebral bodies was defined as multiple vertebral fractures) or combined with old fractures, and whether intervertebral cleft (IVC) was present. RESULTS We collected data from 173 patients who underwent conservative treatment of acute OVCF in our hospital. Of these, 71 had conservative treatment failure, while 102 patients succeeded in long-term conservative treatment. After logistic regression analysis, age, BMD, BMI, mFI, and IVC were identified as high-risk factors for conservative treatment failure (P < 0.05). Age, BMD, BMI, and mFI were included in receiver operating characteristic curve analysis, the result showed that the cutoff value of age was 73.5 years old, of BMI was 23.65 kg/m2, of BMD was - 3.45, and mFI was 2.5. CONCLUSION According to the results of this study, patients with high-risk factors should be actively observed during conservative treatment, especially for patients with all of the above risk factors, but further research would be required before considering early-stage treatment policy change.
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Zhu RS, Kan SL, Ning GZ, Chen LX, Cao ZG, Jiang ZH, Zhang XL, Hu W. Which is the best treatment of osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty, or non-surgical treatment? A Bayesian network meta-analysis. Osteoporos Int 2019; 30:287-298. [PMID: 30635698 DOI: 10.1007/s00198-018-4804-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/06/2018] [Indexed: 12/12/2022]
Abstract
UNLABELLED The aim of the current study was to use a Bayesian network meta-analysis to evaluate the relative benefits and risks of balloon kyphoplasty (BK), percutaneous vertebroplasty (PVP), and non-surgical treatment (NST) for patients with osteoporotic vertebral compression fractures (OVCFs). The results demonstrate that for pain and functional status, PVP was significantly better than NST, while the three treatments did not significantly differ in other outcomes. INTRODUCTION BK, PVP, and NST are widely used to treat OVCFs, but preferable treatment is unknown. The aim of the current study was to use a Bayesian network meta-analysis to evaluate the relative benefits and risks of BK, PVP, and NST for patients with OVCFs. METHODS PubMed, EMBASE, and the Cochrane Library were screened. Based on the preplanned eligibility criteria, we screened and included randomized controlled trials that compared BK, PVP, and NST in treating patients with OVCFs. The risk of bias for individual studies was appraised. The data were pooled using a Bayesian network meta-analysis and a traditional direct comparison meta-analysis. RESULTS Of the 1057 relevant studies, 15 were eligible and included. Compared with NST, PVP significantly reduced pain, Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RMDQ). The comparative efficacy of BK and PVP was similar for pain (mean difference (MD) 0.51, 95% credible interval (CrI) - 0.35 to 1.4), ODI (MD 0.11, 95% CrI - 13 to 13), and RMDQ (MD 1.2, 95% CrI - 2.7 to 5.4). The European Quality of Life-5 Dimensions (EQ-5D) and Physical Component Summary subscales of the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36 PCS) did not differ significantly. There were also no substantial differences in the risks of subsequent vertebral fractures, adjacent vertebral fractures, and re-fractures at the treated level across all comparators. The results of pairwise meta-analyses were almost consistent with those of network meta-analyses. The treatment ranking indicated that PVP had the highest probability of being the most effective for pain, ODI, RMDQ, and EQ-5D. BK had the highest probability of improving SF-36 PCS and of reducing the risk of subsequent vertebral fractures and re-fractures at the treated level. NST was ranked first in preventing adjacent vertebral fractures. CONCLUSION PVP was the most effective method for improving pain, functional status, and quality of life (based on EQ-5D). BK emerged as the best intervention for decreasing the risk of subsequent vertebral fractures and re-fractures at the treated level. NST could be ranked first in reducing adjacent vertebral fractures. The future directions of OVCFs treatment will depend on the outcomes of additional and larger randomized trials in comparing BK with PVP.
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Affiliation(s)
- R-S Zhu
- Department of Spine Surgery, Tianjin Union Medical Center, 190 Jieyuan Road, Hongqiao District, Tianjin, China
| | - S-L Kan
- Department of Spine Surgery, Tianjin Union Medical Center, 190 Jieyuan Road, Hongqiao District, Tianjin, China
| | - G-Z Ning
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, China
| | - L-X Chen
- Institute of Bone and Joint Research, The Kolling institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Z-G Cao
- Department of Spine Surgery, Tianjin Union Medical Center, 190 Jieyuan Road, Hongqiao District, Tianjin, China
| | - Z-H Jiang
- Department of Spine Surgery, Tianjin Union Medical Center, 190 Jieyuan Road, Hongqiao District, Tianjin, China
| | - X-L Zhang
- Department of Spine Surgery, Tianjin Union Medical Center, 190 Jieyuan Road, Hongqiao District, Tianjin, China.
| | - W Hu
- Department of Spine Surgery, Tianjin Union Medical Center, 190 Jieyuan Road, Hongqiao District, Tianjin, China.
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Pan C, Liu X, Li T, Wang G, Sun J. Kinetic of bone turnover markers after osteoporotic vertebral compression fractures in postmenopausal female. J Orthop Surg Res 2018; 13:314. [PMID: 30526635 PMCID: PMC6286497 DOI: 10.1186/s13018-018-1025-5] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/28/2018] [Indexed: 01/15/2023] Open
Abstract
Background Osteoporotic fracture occurs mostly at the spine, in which the commonest one is vertebral compression fracture. Bone turnover markers (BTMs) can be applied to assess bone formation and resorption activity. Nevertheless, there are few reports on BTMs changes after osteoporotic vertebral compression fracture. The aim of this study is to investigate the kinetics of bone turnover markers after osteoporotic vertebral compression fractures in postmenopausal female. Methods Three hundred nine postmenopausal female patients with osteoporotic vertebral compression fractures were included in the study. Fasting blood samples were obtained to analyze the serum concentration of bone turnover markers including osteocalcin (OC), β-isomerized type I collagen amino-terminal peptide (β-CTX), alkaline phosphatase (ALP), type I procollagen amino-terminal peptides (PINP), calcium, and phosphorus. According to periods long after vertebral fracture, all the cases were divided into seven phases: phase 1 (within 3 days), phase 2 (3 days to 1 week), phase 3 (1 to 2 weeks), phase 4 (2 to 4 weeks), phase 5 (4 to 12 weeks), phase 6 (12 to 24 weeks), and phase 7 (24 weeks to 1 year). Comparisons among the phases and kinetics during the phases were conducted. Results All the kinds of BTM’s serum concentration began to increase within 3 days after vertebral fracture in phase 1. Osteocalcin and β-CTX had two peaks, the first one in phase 2 (21.4 ± 6.0 ng/ml and 0.72 ± 0.17 ng/ml, respectively) and the second in phase 6 (25.8 ± 7.5 ng/ml and 0.89 ± 0.23 ng/ml, respectively). The peak of ALP arrived in phase 4 at the value of 123.9 ± 25.7 U/L. PINP reached its peak value (69.50 ± 16.82 ng/ml) in phase 6. Serum phosphorus arrived at its first peak (1.21 ± 0.13 mmol/L) in phase 2 and the second peak (1.23 ± 0.13 mmol/L) in phase 4. Serum calcium reached the first peak (2.30 ± 0.07 mmol/L) in phase 3 and the second peak (2.34 ± 0.08 mmol/L) in phase 5. Conclusion The time-dependent variations of BTMs based on the fracture healing process of inflammation, regeneration, and remodeling occur after vertebral fracture. Kinetics of BTMs after vertebral fracture as well as the reference value at each period were established in the present study. It is helpful to assess vertebral fracture healing process according to the kinetics of BTMs.
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Affiliation(s)
- Changyu Pan
- Department of Spine, Shandong Provincial hospital affiliated to Shandong University, No.9677 Jingshi road, Jinan, 250013, People's Republic of China
| | - Xiaoyang Liu
- Department of Spine, Shandong Provincial hospital affiliated to Shandong University, No.9677 Jingshi road, Jinan, 250013, People's Republic of China
| | - Tao Li
- Department of Spine, Shandong Provincial hospital affiliated to Shandong University, No.9677 Jingshi road, Jinan, 250013, People's Republic of China
| | - Guodong Wang
- Department of Spine, Shandong Provincial hospital affiliated to Shandong University, No.9677 Jingshi road, Jinan, 250013, People's Republic of China.
| | - Jianmin Sun
- Department of Spine, Shandong Provincial hospital affiliated to Shandong University, No.9677 Jingshi road, Jinan, 250013, People's Republic of China.
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