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Pain Physician Dec 2022Approximately 700,000 individuals experience osteoporotic vertebral compression fractures (OVCF) every year in the United States. Chronic complications from patients and...
BACKGROUND
Approximately 700,000 individuals experience osteoporotic vertebral compression fractures (OVCF) every year in the United States. Chronic complications from patients and increasing economic burdens continue to be major problems with OVCFs. Multiple treatment options for OVCF are available, including conservative management, surgical intervention, and minimally invasive vertebral augmentation. Prior studies have investigated the utility of vertebral augmentation techniques such as percutaneous vertebroplasty (PVP), balloon vertebroplasty (BVP), and vertebral augmentation with the KivaTM implant on patient mortality with favorable results. The optimal time from OVCF occurrence to vertebral augmentation continues to be a topic of investigation.
OBJECTIVES
To further investigate the effect of the timing of vertebral augmentation on pain outcomes.
STUDY DESIGN
A retrospective cohort chart review study.
SETTING
A single academic center in Albuquerque, New Mexico.
METHODS
One hundred twenty-six consecutive patient encounters with OVCF diagnosed on imaging and treated with PVP, BVP, or vertebral augmentation with a KivaTM implant between 01/01/2004 and 11/28/2016 were analyzed. The time between fracture and intervention was categorized into < 6 weeks, 6-12 weeks, and >= 12 weeks. Pain scores were measured before and after treatment using the numeric pain rating scale. Statistical analysis using Wilcoxon-Mann-Whitney and Kruskal-Wallis tests were used as appropriate, and effect sizes were described with the Hodges-Lehmann estimates of difference.
RESULTS
The 3 vertebral augmentation procedures compared in this study did not demonstrate statistically significant differences in pain score reduction (P = 0.949). The < 12 weeks group had a median and interquartile range (IQR) pain improvement of 3 (IQR 1,6) versus 1 (IQR 0,4) in the >= 12 weeks group (P = 0.018). Further analysis showed that the median and IQR pain improvement for the < 6 weeks group was 3 (IQR 1,7), for the 6-12 weeks group was 3 (IQR 1,4), and for the >= 12 weeks group was 1 (IQR 0,4). The overall effect of the time category on pain improvement was statistically significant for these groups (P = 0.040). Comparisons between groups only showed differences between the < 6 weeks and >= 12 weeks groups (P = 0.013), with an estimated median difference of 2 (95% CI 0,3). There was no statistically significant relationship between fill percentage and pain relief (P = 0.291).
LIMITATIONS
This is a retrospective cohort study from a single academic center with a limited sample size that lacked a control group and procedural blinding. There was also substantial heterogeneity among patients, fractures, operators, and techniques. Pain relief outcomes are subjective and can be biased by patients as well as physician reporting.
CONCLUSIONS
Early intervention (< 12 weeks) with vertebral augmentation in patients with OVCF is associated with improved pain scores when compared to later intervention (> 12 weeks). Very early intervention (< 6 weeks) confers a greater advantage when compared to later intervention (> 12 weeks).
Topics: Humans; Retrospective Studies; Vertebroplasty; Fractures, Compression; Spinal Fractures; Pain; Kyphoplasty; Osteoporotic Fractures; Treatment Outcome
PubMed: 36608014
DOI: No ID Found -
Asian Journal of Surgery Jan 2020To review the efficacy and complications of I seeds combined with percutaneous vertebroplasty for the treatment of metastatic spinal tumors. We searched PubMed/MEDLINE... (Review)
Review
To review the efficacy and complications of I seeds combined with percutaneous vertebroplasty for the treatment of metastatic spinal tumors. We searched PubMed/MEDLINE from its inception to November 2018 for articles on metastatic spinal tumors treated with I seeds combined with percutaneous vertebroplasty. A total of 273 articles were identified in PubMed/MEDLINE based on the search criteria. After deleting duplicate articles including two retrospective studies and three case control studies, five studies were included in this systematic review. In total, 161 patients aged from 49.2 to 62 years were included. The operative levels consisted of the thoracic vertebrae and lumbar vertebrae. Bone cement leakage occurred in 7 cases. None of the patients developed radiation myelopathy. Percutaneous vertebroplasty plus I seeds implantation is an effective palliative treatment and can alleviate back pain and enhance vertebral body strength in patients with end-stage spinal metastatic tumors. In future research, the effective dosage of I seeds implantation, the anchoring of seeds with safe distance, and the bone cement distribution in the vertebral body will be next research hotspot.
Topics: Iodine Radioisotopes; Radiopharmaceuticals; Spinal Neoplasms; Spine; Treatment Outcome; Vertebroplasty
PubMed: 31221556
DOI: 10.1016/j.asjsur.2019.05.012 -
Clinics in Orthopedic Surgery Jun 2020Pedicle screw augmentation with bone cement has been experimentally demonstrated to increase the pullout strength. However, the mechanisms of screw loosening are... (Comparative Study)
Comparative Study Observational Study
BACKGROUND
Pedicle screw augmentation with bone cement has been experimentally demonstrated to increase the pullout strength. However, the mechanisms of screw loosening are complicated and interacting. Although vertebroplasty augmentation and fenestrated screw augmentation have been compared in many studies, there has been no comparative study on their clinical effects and complications in real clinical settings. We investigated clinical effects of bone cement augmentation of a pedicle screw and differences according to augmentation methods.
METHODS
Of the total 241 patients who had osteoporosis and underwent posterior pedicle screw fixation without anterior bone graft between January 2010 and December 2016, 132 patients with ≥2 years of radiological follow-up were included in this retrospective study. The patients were divided into group I (unaugmented) and group II (bone cement augmented). Group II was subdivided into II-S group (solid screw augmented) and II-F group (fenestrated screw augmented). The incidence of screw loosening was compared between groups I and II. Cement leakage, screw loosening, and screw fractures were investigated in the subgroups.
RESULTS
In total, 36 of 71 (52%, group I) unaugmented cases and 96 of 170 (56%, group II) augmented cases were followed up for ≥2 years. Of the total 78 solid screw augmented cases, 42 (56%) were in II-S group; 54 of the total 92 (59%) fenestrated screw augmented cases were in II-F group. Groups I and II were homogenous regarding demographic characteristics; II-S and II-F groups were also homogenous. The incidence of screw loosening was 50.0% (18/36) in group I and 7.3% (7/96) in group II ( < 0.001). Cement leakage developed in 2 of 42 (4.8%) cases in II-S group and in 5 of 54 (9.3%) cases in II-F group ( = 0.462). Screw loosening developed in 6 of 42 (14.3%) cases in II-S group and in 1 of 54 cases (1.9%) in II-F group ( = 0.041). Screw fracture developed in none of 42 cases in II-S group and in 3 of 54 cases (5.6%) in II-F group ( = 0.254).
CONCLUSIONS
In osteoporotic patients, bone cement augmentation of a pedicle screw decreased the incidence of screw loosening, and fenestrated screw augmentation was more effective than vertebroplasty augmentation.
Topics: Aged; Bone Cements; Female; Humans; Lumbar Vertebrae; Male; Materials Testing; Middle Aged; Osteoporotic Fractures; Pedicle Screws; Postoperative Complications; Retrospective Studies; Thoracic Vertebrae; Vertebroplasty
PubMed: 32489541
DOI: 10.4055/cios19127 -
The Spine Journal : Official Journal of... Aug 2022Osteoporotic vertebral fractures (OVF) dramatically increase with age and are serious life altering adverse events for seniors resulting in increased rates of... (Review)
Review
BACKGROUND CONTEXT
Osteoporotic vertebral fractures (OVF) dramatically increase with age and are serious life altering adverse events for seniors resulting in increased rates of institutionalization, morbidity and mortality. Given the expanding population of the elderly and increasing prevalence of OVFs, cost-effective treatment strategies need to be considered. Percutaneous vertebral augmentation (VA) procedures such as vertebroplasty (VP) or balloon kyphoplasty (BK) are increasingly employed to treat painful vertebral fractures not responding to conservative management (CM) of bedrest and analgesia. Both VA procedures have been shown to be effective treatments for OVFs in multiple systematic reviews of randomized controlled trials. In this systematic review, analytical strategies, designs and results were compared for health economic studies evaluating cost-effectiveness of VA procedures, VP or BK for OVFs. Furthermore, assessments of quality (risk of bias) were conducted for the systematic review and the individual studies with peer-reviewed checklists recommended for cost-effectiveness studies.
PURPOSE
To provide an up-to-date systematic review of peer-reviewed studies evaluating cost-effectiveness of VA procedures, VP or KP for OVFs to support treatment and health care funding decisions.
STUDY DESIGN
This study is a systematic literature review and structured narrative synthesis.
STUDY SAMPLE
Peer reviewed health economic studies reporting cost-effectiveness for VA procedures, VP or BK for OVFs OUTCOME MEASURES: The following information extracted from the studies included: report country and year, study design, comparators, population, perspective, health valuations, costing sources and cost-effectiveness measures. For economic studies involving modeling, information was also extracted for model type, time horizon, key model drivers, and handling of uncertainty. Incremental cost-effectiveness ratio (ICER), the ratio of differences between comparator treatment groups in costs and health benefits, was considered the main cost-effectiveness measure.
METHODS
A systematic review was conducted of MEDLINE, EMBASE, CINAHL, ECONLIT, Cochrane Library and DARE databases up to the review date May 2021. Studies were reviewed for those reporting cost-effectiveness analyses on VA procedures including VP or BK for OVFs. Studies including only costs, abstracts, editorials, methodologies and reviews were not included. The selection of articles was reported in line with PRISMA guidance. A descriptive framework was developed to classify types of cost-effectiveness studies based on methodological differences and a structured narrative synthesis was used to summarize studies. Quality assessments were made with British Medical Journal checklist for individual cost-effectiveness studies and the CiCERO checklist for systematic reviews of cost-effectiveness studies.
RESULTS
In this systematic review, 520 references were identified through database searching and 501 were excluded as ineligible by titles and abstract based on prior eligibility criteria. From full-text reviews of 19 reports, ten were identified as eligible for the systematic review evaluating cost-effectiveness of VA procedures for OVFs. All references were published between 2008 and 2020. The ten cost-effectiveness studies, three for VP, three for BK and four for both VP and BK, all involved CM for OVFs as a treatment comparator. The studies involved different methods of economic analysis, modeling assumptions, cost and health valuations conducted in different health care setting over different time periods. A framework for the review outlines key features of cost-effectiveness study designs consisting of unmatched, matched, or randomized controls involving cost-effectiveness or cost-utility) analyses. Both VP and BK were cost-effective alternatives to CM for OVFs with earlier health gains and significantly shorter hospital stays. Cost-effectiveness estimates, ICERs, remained relatively stable and within willingness-to-pay thresholds under a range of sensitivity analyses. Comparisons between VP and BK were variable depending on modeling assumptions, but generally the procedures had similar health benefit gains with VP having lower acute procedural costs.
CONCLUSIONS
Both VP and BK, have been shown to be cost-effective alternatives to CM for osteoporotic vertebral fractures in diverse cost-effectiveness studies conducted in multiple health care settings. Trial-based cost-utility contributed the strongest evidence supporting cost-effectiveness determination for VP and BK for OVFs.
Topics: Aged; Cost-Benefit Analysis; Humans; Kyphoplasty; Osteoporotic Fractures; Pain; Spinal Fractures; Vertebroplasty
PubMed: 35257838
DOI: 10.1016/j.spinee.2022.02.013 -
Acta Bio-medica : Atenei Parmensis Jun 2022Vertebroplasty consists of injection under image guidance of a cement polymer, commonly polymethylmethacrylate, into the vertebral body to improved stability....
Vertebroplasty consists of injection under image guidance of a cement polymer, commonly polymethylmethacrylate, into the vertebral body to improved stability. Vertebroplasty is essentially safety. However whether vertebral compression or (micro)fractures occur during the procedure, the high vascularization and the anatomic network of the paravertebral and extradural venous plexuses, can facilitate migration of cement fragments into the systemic venous circulation. We described the case of cement pulmonary embolism in a 75-year-old-female after vertebloplasty. A chest CT scan showed a multiple and spontaneus hyperdensities suggesting cement pulmonary-emboli. There are different therapeutic approach depending of the clinical severity. For asymptomatic patients clinical surveillance or prophylactic LMWH. Active treatment has been suggested only for symptomatic cases.
Topics: Aged; Bone Cements; Female; Heparin, Low-Molecular-Weight; Humans; Pulmonary Embolism; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 35674479
DOI: 10.23750/abm.v93iS1.9425 -
The Journal of International Medical... Dec 2021This study was performed to compare the effectiveness and safety of vesselplasty versus vertebroplasty in the treatment of osteoporotic compression fractures with...
OBJECTIVE
This study was performed to compare the effectiveness and safety of vesselplasty versus vertebroplasty in the treatment of osteoporotic compression fractures with posterior wall rupture.
METHODS
Patients who underwent treatment of a single osteoporotic vertebral compression fracture with posterior wall rupture from January 2016 to February 2020 were retrospectively reviewed. They were divided into a vesselplasty group (n = 17) and a vertebroplasty group (n = 43). Pain relief, radiographic outcomes, and bone cement leakage were compared between the two groups.
RESULTS
There were no significant differences in the operation time, postoperative pain relief, vertebral compression recovery, or local Cobb angle improvement between the two groups. However, the overall bone cement leakage rate (29.4% vs. 67.4%) and spinal canal leakage rate (0.0% vs. 30.2%) were significantly lower in the vesselplasty group than vertebroplasty group.
CONCLUSIONS
Vesselplasty offers similar pain relief and vertebral compression recovery but lower spinal canal leakage compared with vertebroplasty. Vesselplasty is thus a better option than vertebroplasty for patients with osteoporotic compression fractures with posterior wall rupture.
Topics: Bone Cements; Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Retrospective Studies; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 34939882
DOI: 10.1177/03000605211066303 -
Journal of Neurosurgical Sciences Aug 2022The aim of this study was to formulate the WFNS Spine Committee guidelines on indications, outcomes, and complications of vertebral augmentation in osteoporotic spine...
INTRODUCTION
The aim of this study was to formulate the WFNS Spine Committee guidelines on indications, outcomes, and complications of vertebral augmentation in osteoporotic spine fractures.
EVIDENCE ACQUISITION
Computerized literature was searched from 2010 to 2021 using keywords "vertebral augmentation," "osteoporotic fracture," "technique," "surgery," "complication," and "outcome." PubMed yielded 92 articles whereas Google scholar resulted in 120 articles. 29 articles were studied in detail. The studies comprised of seventeen RCT's, two prospective non-randomized studies, three retrospective studies, and seven systematic reviews. The statements were produced to reach a consensus in two separate meetings of WFNS Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method.
EVIDENCE SYNTHESIS
Drafted statements on "Vertebral Augmentation in osteoporotic Spine Fractures" were voted upon by expert panelists in Virtual WFNS Spine Committee Consensus Meetings conducted on January 11, 2021, and February 13, 2021. Statements reaching positive consensus provided the basis for the WFNS guidelines regarding vertebral augmentation in osteoporotic spine fractures.
CONCLUSIONS
WFNS Spine Committee recommendations on vertebral augmentation in osteoporotic spine fractures are summarized in this article. Vertebral augmentation is superior to conservative treatment for vertebral osteoporotic fractures but has conflicting results on comparison with placebo. Both vertebroplasty and kyphoplasty are equally effective. Most of the studies regarding the efficacy of vertebral augmentation procedures to reduce pain have been largely inconclusive. It is suggested that further high quality, better designed randomized controlled studies are required to establish the role of vertebral augmentation in spine osteoporotic compression fractures.
Topics: Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 36153881
DOI: 10.23736/S0390-5616.22.05642-9 -
Acta Clinica Croatica Sep 2019The aim of this study was to compare and evaluate clinical results before and after vertebroplasty in the treatment of myeloma-induced vertebral fractures. Success of... (Comparative Study)
Comparative Study
The aim of this study was to compare and evaluate clinical results before and after vertebroplasty in the treatment of myeloma-induced vertebral fractures. Success of the surgery was defined by increased or reduced pain intensity before and after the treatment, as assessed using the visual analog scale (VAS). The study was designed as a retrospective-prospective study. The study included 26 patients, 14 women and 12 men. Data on patients treated for myeloma-induced vertebral fractures were collected at the Department of Orthopedics, Osijek University Hospital Centre. The following data were analyzed: gender, duration of illness, intensity of pain before and after treatment (using VAS), radiological changes before and after treatment, grade of vertebral fracture, and extracorporeal cement leakage from the vertebral body to the surrounding tissue during the procedure. Difference in pain intensity before and after the surgery was statistically significant. All patients complained of pain before the surgery (pain intensity median 8), whereas after the surgery, pain intensity decreased in all patients (pain intensity median 2). In conclusion, improvement in clinical results of the treatment of myeloma-induced vertebral fractures with vertebroplasty proved to be significant.
Topics: Adult; Aged; Aged, 80 and over; Bone Cements; Croatia; Female; Humans; Male; Middle Aged; Multiple Myeloma; Pain Measurement; Plasmacytoma; Postoperative Period; Preoperative Period; Prospective Studies; Retrospective Studies; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 31969766
DOI: 10.20471/acc.2019.58.03.17 -
Pain Physician May 2021In clinical practice, we have found that the pain caused by thoracolumbar osteoporotic vertebral compression fracture (OVCF) is sometimes not limited to the level of the...
BACKGROUND
In clinical practice, we have found that the pain caused by thoracolumbar osteoporotic vertebral compression fracture (OVCF) is sometimes not limited to the level of the fractured vertebrae but instead occurs in areas far away from the injured vertebrae, such as the lower back, area surrounding the iliac crest, or buttocks, and this type of pain is known as distant lumbosacral pain. The pathogenesis of pain in distant regions caused by thoracolumbar OVCF remains unclear.
OBJECTIVES
To compare the clinical efficacy and imaging outcomes of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of distant lumbosacral pain accompanied by thoracolumbar OVCF and to explore the possible pathogenesis of distant lumbosacral pain caused by thoracolumbar OVCF.
STUDY DESIGN
Retrospective study.
SETTING
A university hospital spinal surgery departments.
METHODS
A total of 62 patients who underwent vertebral augmentation for thoracolumbar OVCF with lumbosacral pain were included and divided into the PVP group (28 cases) and the PKP group (34 cases). The Visual Analog Scale (VAS) was used to evaluate the severity of local and distant lumbosacral pain, and the Chinese modified Oswestry Disability Index (CMODI) was used for functional assessment. The anterior vertebral height (AVH) of the fractured vertebrae and local kyphotic angle were measured on plain radiographs. The average follow-up time was 28.62 ± 8.43 months in the PVP group and 29.22 ± 9.09 months in the PKP group.
RESULTS
Within the 2 groups, the VAS score of local pain, VAS score of distant lumbosacral pain, and CMODI score at 3 days postoperatively and at the last follow-up improved significantly compared with the scores before surgery. However, there was no significant difference between the 2 groups. At 3 days postoperatively and at last follow-up, the AVH and Cobb angle in the 2 groups improved significantly compared with those before surgery, but the magnitudes of AVH improvement and Cobb angle correction were significantly larger in the PKP group than in the PVP group.
LIMITATIONS
First, this study is retrospective and may be prone to selection bias. Second, because of cultural and linguistic differences, the original version of the Oswestry Disability Index could not be properly understood and completed by people in mainland China. Therefore in this study, the CMODI was used, but the correlation coefficients of the CMODI within and between groups were 0.953 and 0.912, respectively. Third, a pain diagram was not used to accurately reflect the location of pain in the distant lumbosacral region.
CONCLUSIONS
Both PVP and PKP can effectively alleviate pain in the distant lumbosacral region caused by thoracolumbar OVCF, and distant lumbosacral pain associated with thoracolumbar OVCF may be considered vertebrogenic referred pain.
Topics: Fractures, Compression; Humans; Kyphoplasty; Low Back Pain; Lumbosacral Region; Osteoporotic Fractures; Retrospective Studies; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 33988957
DOI: No ID Found -
International Journal of Computer... Jun 2019As the trend toward minimally invasive and percutaneous interventions continues, the importance of appropriate surgical data visualization becomes more evident....
PURPOSE
As the trend toward minimally invasive and percutaneous interventions continues, the importance of appropriate surgical data visualization becomes more evident. Ineffective interventional data display techniques that yield poor ergonomics that hinder hand-eye coordination, and therefore promote frustration which can compromise on-task performance up to adverse outcome. A very common example of ineffective visualization is monitors attached to the base of mobile C-arm X-ray systems.
METHODS
We present a spatially and imaging geometry-aware paradigm for visualization of fluoroscopic images using Interactive Flying Frustums (IFFs) in a mixed reality environment. We exploit the fact that the C-arm imaging geometry can be modeled as a pinhole camera giving rise to an 11-degree-of-freedom view frustum on which the X-ray image can be translated while remaining valid. Visualizing IFFs to the surgeon in an augmented reality environment intuitively unites the virtual 2D X-ray image plane and the real 3D patient anatomy. To achieve this visualization, the surgeon and C-arm are tracked relative to the same coordinate frame using image-based localization and mapping, with the augmented reality environment being delivered to the surgeon via a state-of-the-art optical see-through head-mounted display.
RESULTS
The root-mean-squared error of C-arm source tracking after hand-eye calibration was determined as [Formula: see text] and [Formula: see text] in rotation and translation, respectively. Finally, we demonstrated the application of spatially aware data visualization for internal fixation of pelvic fractures and percutaneous vertebroplasty.
CONCLUSION
Our spatially aware approach to transmission image visualization effectively unites patient anatomy with X-ray images by enabling spatial image manipulation that abides image formation. Our proof-of-principle findings indicate potential applications for surgical tasks that mostly rely on orientational information such as placing the acetabular component in total hip arthroplasty, making us confident that the proposed augmented reality concept can pave the way for improving surgical performance and visuo-motor coordination in fluoroscopy-guided surgery.
Topics: Calibration; Data Visualization; Fluoroscopy; Fracture Fixation, Internal; Fractures, Bone; Humans; Imaging, Three-Dimensional; Pelvic Bones; Surgery, Computer-Assisted; Vertebroplasty
PubMed: 30863981
DOI: 10.1007/s11548-019-01943-z