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European Spine Journal : Official... Apr 2024Osteoporotic vertebral compression fractures affect a large number of elderly people and cause significant issues with pain and mobility. Percutaneous vertebroplasty... (Review)
Review
BACKGROUND
Osteoporotic vertebral compression fractures affect a large number of elderly people and cause significant issues with pain and mobility. Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are employed to treat those who remain symptomatic, with comparable clinical outcomes. Although PVP is faster and less expensive, concerns around cement-leakage complications make PKP perceptively safer.
METHODS
By means of systematic review, we sought to ascertain whether PVP did carry a higher risk of cement-leakage and associated symptomatic complications (neural compromise, pulmonary embolism and need for emergency decompression surgery).
RESULTS
Our search of 138 articles returned six studies after shortlisting and manual review: three randomised-controlled trials, and three retrospective comparative studies which met our criteria and directly compared cement-leakage rates and complications between the two treatments. 532 PVPs and 493 PKPs recorded 213 (39.3%) and 143 (28.9%) leaks, respectively (p < 0.0005). Of these, no leaks resulted in any of the aforementioned leak-related complications. No meta-analysis was performed due to heterogeneity of the data.
CONCLUSIONS
We therefore concluded that whilst PVP does result in more cement leaks, this does not appear to be clinically significant. Further studies would add weight to this conclusion, and cost-effectiveness should be assessed to restore confidence in PVP.
LEVEL OF EVIDENCE
Level III Evidence.
Topics: Humans; Aged; Kyphoplasty; Fractures, Compression; Retrospective Studies; Clinical Relevance; Spinal Fractures; Osteoporotic Fractures; Treatment Outcome; Vertebroplasty; Bone Cements
PubMed: 37999769
DOI: 10.1007/s00586-023-08026-3 -
Diagnostic and Interventional Imaging Sep 2017Patients with early or metastatic cancer may suffer from pain of different origins. The vast majority of these patients are not adequately treated by means of systemic... (Review)
Review
Patients with early or metastatic cancer may suffer from pain of different origins. The vast majority of these patients are not adequately treated by means of systemic analgesia and radiotherapy. Percutaneous neurolysis is performed using chemical agents or thermal energy upon sympathetic nervous system plexus for pain reduction and life quality improvement. Ablation and vertebral augmentation are included in clinical guidelines for metastatic disease. As far as the peripheral skeleton is concerned bone augmentation and stabilization can be performed by means of cement injection either solely performed or in combination to cannulated screws or other metallic or peek implants. This review describes the basic concepts of interventional oncology techniques as therapies for cancer pain management. The necessity for a tailored-based approach applying different techniques for different cases and locations will be addressed.
Topics: Ablation Techniques; Cancer Pain; Cementoplasty; Fractures, Spontaneous; Humans; Kyphoplasty; Neoplasms; Nerve Block; Spinal Fractures; Vertebroplasty
PubMed: 28739433
DOI: 10.1016/j.diii.2017.06.015 -
World Neurosurgery Mar 2023One 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... (Meta-Analysis)
Meta-Analysis Review
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.
Topics: Humans; Kyphoplasty; Spinal Fractures; Fractures, Compression; Osteoporotic Fractures; Treatment Outcome; Vertebroplasty; Bone Cements
PubMed: 36455843
DOI: 10.1016/j.wneu.2022.11.123 -
Japanese Journal of Radiology Apr 2022To clarify the accuracy of vertebral puncture of the vertebral tertile area needling (VETERAN) method puncturing the pedicle superimposed on one-third of the width...
PURPOSE
To clarify the accuracy of vertebral puncture of the vertebral tertile area needling (VETERAN) method puncturing the pedicle superimposed on one-third of the width between the lateral vertebral line to the contralateral medial lamina line compared with Cathelin-needle-assisted puncture (CAP) method puncturing using the Cathelin needle as a guide in percutaneous vertebroplasty.
MATERIALS AND METHODS
449 punctures by CAP method and 125 punctures by VETERAN method were enrolled. We compared the puncture accuracy of both methods. We estimated a vertebral estimated tilting ratio (VET-ratio) defined as ratio of the distance between the lateral vertebral line and the contralateral medial laminal line to the distance between the vertebral lateral line and the puncture point measured by computed tomography. We also estimated the procedural items and clinical outcomes.
RESULTS
VETERAN method with 100% of punctures within safe zone (cortical breaches within 2 mm) had significantly higher accuracy than CAP method with 97.8% (p < 0.01) for the 2 mm incremental evaluation. No cases with a VET-ratio of 36% or less had cortical breaches. VETERAN method had shorter operative time per puncture (p < 0.01) and exposure time per puncture (p < 0.05).
CONCLUSION
VETERAN method reduced the occurrence of the inaccurate puncture, operative times, and exposure times. A VET-ratio with 36% or less is associated with a safe puncture using VETERAN method.
Topics: Fractures, Compression; Humans; Osteoporotic Fractures; Punctures; Spinal Fractures; Vertebroplasty
PubMed: 34739654
DOI: 10.1007/s11604-021-01216-3 -
World Neurosurgery Oct 2023We investigated the correlation between bone cement distribution and adjacent vertebral fractures (AVFs) after percutaneous vertebroplasty (PVP).
OBJECTIVE
We investigated the correlation between bone cement distribution and adjacent vertebral fractures (AVFs) after percutaneous vertebroplasty (PVP).
METHODS
We retrospectively analyzed patients who underwent single-segment PVP for osteoporotic compression fractures in our hospital from January 2016 to January 2021 and divided the patients into 2 groups, A and B, on the basis of the criterion of whether there were AVFs of the operated vertebrae within 1 year after surgery. We compared the general data of the 2 groups, assessed the ability of 3 simple X-ray-based evaluation methods to predict the occurrence of AVF within 1 year after surgery and derived a simple and accurate evaluation method.
RESULTS
A total of 570 patients were included in this study: 511 patients in group A and 59 patients in group B. There were no statistical differences in the general data such as age, gender, and fracture site between the 2 groups. The posterior-anterior (PA), lateral (LAT), and PA and LAT methods showed receiver operating characteristic curve (ROC) predicted postoperative AVF of 0.611, 0.691, and 0.714, respectively. The difference between the area under curve (AUC) of the PA method and LAT method was statistically significant (P = 0.0307), the difference between the AUC of PA method and PA and LAT method was statistically significant (P < 0.001), and the difference between the AUC of LAT method and PA and LAT method was not statistically significant (P = 0.3308).There was no statistical difference between the 2 groups of patients with PA method point of 1 and statistically different between patients with points of 2 and 3. There was statistical difference in points of 1, 2 and 3 in the LAT method between the 2 groups. There was a positive correlation between cement distribution scores and AVF by linear regression analysis of the 3 evaluation methods.
CONCLUSIONS
The 3 evaluation methods reliably predict AVF after PVP, with the LAT method, PA and LAT method being more predictive than the PA method, but the LAT method is simpler, with bone cement being widely distributed after crossing the midline in the PA method and contact with the upper and lower end plates in the LAT method being a risk factor for AVF.
Topics: Humans; Vertebroplasty; Bone Cements; Retrospective Studies; Correlation of Data; Osteoporotic Fractures; Spinal Fractures; Fractures, Compression; Treatment Outcome
PubMed: 37562680
DOI: 10.1016/j.wneu.2023.08.008 -
Current Treatment Options in Oncology Nov 2016Spinal metastases are a common and morbid condition in America. Of the 1.6 million new cases of cancer estimated to be diagnosed in the USA in 2015, approximately... (Review)
Review
Spinal metastases are a common and morbid condition in America. Of the 1.6 million new cases of cancer estimated to be diagnosed in the USA in 2015, approximately 5-10 % will develop spinal metastases. This number is expected to increase as the life expectancy of cancer patients increases. Patients with osteolytic spinal metastases experience severe and often debilitating pain, which significantly reduces quality of life. Due to the morbidity of open surgery, particularly in oncologic patients, the treatment paradigm has shifted towards minimally invasive therapy. The advent and evolution of percutaneous treatments of spinal metastases has shown progressive success in reducing pain, improving function, and providing mechanical stability. There are various currently available interventions including vertebroplasty, vertebral augmentation, and coblation and radiofrequency ablation systems. For more complex spinal metastases, combined treatments including vertebral augmentation in conjunction with radiofrequency ablation, external beam radiation, and the novel treatment of intraoperative radiotherapy are also available. Ultimately, the goal of treatment in this patient population is palliative with the intention of improving the remaining quality of life. There is no established algorithm or specific technique that has proved best for the many variations of vertebral compression fractures (VCFs), so treatment tends to be dependent on the operator and/or based on institution preference or bias. Each technique provides its own unique value in the various types of metastatic VCFs encountered, and understanding the uses, advantages, and safety profile of each specific treatment is imperative in providing the best patient care. Percutaneous treatment of metastatic spinal disease is an excellent alternative to medical and surgical management in carefully selected patients. We believe that a multidisciplinary approach and combination therapy allows for optimal pain reduction and improvement of function.
Topics: Ablation Techniques; Combined Modality Therapy; Humans; Kyphoplasty; Minimally Invasive Surgical Procedures; Radiotherapy; Spinal Neoplasms; Vertebroplasty
PubMed: 27627999
DOI: 10.1007/s11864-016-0433-1 -
Joint Diseases and Related Surgery 2022Vertebral compression fractures are more common in the elderly, particularly in postmenopausal women. Most of these people are accompanied by osteoporosis, which can... (Review)
Review
Vertebral compression fractures are more common in the elderly, particularly in postmenopausal women. Most of these people are accompanied by osteoporosis, which can easily lead to spinal deformities and fractures. Once a fracture occurs, the patient would have severe pain response, limited spinal movement, and need to stay in bed for a long time, resulting in a significant decrease in their quality of life. Percutaneous vertebroplasty (PVP) is a minimally invasive spinal surgery that injects bone cement into the diseased vertebrae for therapeutic purposes. It can quickly relieve pain and stabilize the spine. It is widely used in the treatment of vertebral compression fractures and is currently an ideal treatment method. There are many materials of bone cement used in clinical treatment, and each material has unique characteristics. Many scholars would modify the bone cement according to the advantages and disadvantages to make it more suitable for clinical use. In this review, we discuss the clinical application and modification of bone cement.
Topics: Aged; Bone Cements; Female; Fractures, Compression; Humans; Pain; Quality of Life; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 35852210
DOI: 10.52312/jdrs.2022.628 -
Neuroimaging Clinics of North America Nov 2019Percutaneous vertebroplasty (VP) progressed from a virtually unknown procedure to one performed on hundreds of thousands of patients annually. The development of VP... (Review)
Review
Percutaneous vertebroplasty (VP) progressed from a virtually unknown procedure to one performed on hundreds of thousands of patients annually. The development of VP provides a historically exciting case study into a rapidly adopted procedure. VP was the synthesis of information gained from spinal biopsy developments, the inception of biomaterials used in medicine, and the unique health care climate in France during the 1980s. It was designed as a revolutionary technique to treat vertebral body fractures with minimal side effects and was rapidly adopted and marketed in the United States. The impact of percutaneous vertebroplasty on spine surgery was profound.
Topics: Bone Cements; Humans; Polymethyl Methacrylate; Spinal Fractures; Vertebroplasty
PubMed: 31677725
DOI: 10.1016/j.nic.2019.07.011 -
World Neurosurgery Oct 2022This study aimed to conduct a systematic review and meta-analysis to compare the clinical results and complications of robot-assisted (RA) versus fluoroscopy-assisted... (Meta-Analysis)
Meta-Analysis Review
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.
Topics: Bone Cements; Fluoroscopy; Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Robotics; Spinal Fractures; Vertebroplasty
PubMed: 35922006
DOI: 10.1016/j.wneu.2022.07.083 -
World Neurosurgery Jul 2021Spine tumors encompass a wide range of diseases with a commensurately broad spectrum of available treatments, ranging from radiation for spinal metastases to highly... (Review)
Review
Spine tumors encompass a wide range of diseases with a commensurately broad spectrum of available treatments, ranging from radiation for spinal metastases to highly invasive en bloc resection for primary vertebral column malignancies. This high variability in treatment approaches stems both from variability in the goals of surgery (e.g., oncologic cure vs. symptom palliation) and from the significant advancements in surgical technologies that have been made over the past 2 decades. Among these advancements are improvements in surgical technique, namely minimally invasive approaches, increased availability of focused radiation modalities (e.g., proton therapy and linear accelerator devices), and new surgical technologies, such as carbon fiber-reinforced polyether ether ketone rods. In addition, several groups have described nonsurgical interventions, such as vertebroplasty and kyphoplasty for spinal instability secondary to pathologic fracture, and lesion ablation with spinal laser interstitial thermoablation, radiofrequency ablation, or cryoablation. We provide an overview of the latest technological advancements in spinal oncology and their potential usefulness for modern spinal oncologists.
Topics: Humans; Kyphoplasty; Minimally Invasive Surgical Procedures; Radiation Oncology; Spinal Neoplasms; Spine; Vertebroplasty
PubMed: 34023467
DOI: 10.1016/j.wneu.2021.05.032