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Neurospine Sep 2023Osteoporotic vertebral fractures (OVFs) can hinder physical motor function, daily activities, and the quality of life in elderly patients when treated conservatively....
Osteoporotic vertebral fractures (OVFs) can hinder physical motor function, daily activities, and the quality of life in elderly patients when treated conservatively. Vertebral augmentation, which includes vertebroplasty and balloon kyphoplasty, is a commonly used procedure for OVFs. However, there have been reports of complications. Although serious complications are rare, there have been instances of adjacent vertebral fractures, cement dislocation, and insufficient pain relief due to cement failure, sometimes necessitating revision surgery. This narrative review discusses the common risks associated with vertebral augmentation for OVFs, such as cement leakage and adjacent vertebral fractures, and highlights the risk of revision surgery. The pooled incidence of revision surgery was 0.04 (0.02-0.06). The risks for revision are reported as follows: female sex, advanced age, diabetes mellitus, cerebrovascular disease, dementia, blindness or low vision, hypertension, hyperlipidemia, split type fracture, large angular motion, and large endplate deficit. Various treatment strategies exist for OVFs, but they remain a subject of controversy. Current literature underscores the lack of substantial evidence to guide treatment strategies based on the risks of vertebral augmentation. In cases with a high risk of failure, other surgeries and conservative treatments should also be considered as treatment options.
PubMed: 37798981
DOI: 10.14245/ns.2346560.280 -
Journal of Bone Metabolism Feb 2024Vertebroplasty (VP) and balloon kyphoplasty (KP) are effective means with which to improve pain and function in osteoporotic vertebral compression fractures. However,...
BACKGROUND
Vertebroplasty (VP) and balloon kyphoplasty (KP) are effective means with which to improve pain and function in osteoporotic vertebral compression fractures. However, the risk of complications after these procedures is poorly understood, with concerns regarding adjacent vertebral fractures. This study retrospectively investigated the clinical and radiological outcomes of these procedures.
METHODS
A total of 115 patients who experienced their first vertebral fracture were treated with VP (N=63) or KP (N=52) at the Dankook University Hospital between January 2013 and December 2022. The clinical outcomes were evaluated using the visual analog scale (VAS) preoperative and at 1-year follow-up. Radiological comparisons were performed for kyphosis correction, vertebral height restoration, and postoperative cement leakage.
RESULTS
KP was more effective than VP, especially for vertebral body height restoration and kyphotic angle reduction (P<0.05). However, the incidence of cement leakage, new adjacent vertebral fractures, and improvement in pain assessed by VAS did not differ statistically between the 2 groups (P>0.05).
CONCLUSIONS
Considering that KP was performed on fractures with severe deformity, no differences were observed in the clinical outcomes and incidence of adjacent vertebral fractures compared Considering that KP was performed for fractures with severe deformity, there was no difference in clinical outcomes and incidence of adjacent vertebral fractures compared to VP. Improvements in radiological measurements were demonstrated. Therefore, KP may be a good treatment option for pain relief and long-term prognosis in patients with high-compressive-rate vertebral fractures.
PubMed: 38485242
DOI: 10.11005/jbm.2024.31.1.56 -
Effect of vertebroplasty with bone cement on osteoporotic compression fractures in elderly patients.American Journal of Translational... 2023To explore the effect of vertebroplasty with bone cement on elderly patients with osteoporotic compression fractures.
OBJECTIVE
To explore the effect of vertebroplasty with bone cement on elderly patients with osteoporotic compression fractures.
METHODS
A retrospective study was conducted on 130 patients with osteoporotic compression fractures treated at the Second Hospital of Hebei Medical University from January 2018 to January 2022. According to different treatment methods, 50 patients who underwent conservative treatment were included in a control group (CG), and 80 patients who underwent vertebroplasty were included in a research group (RG). The anterior vertebral height, kyphotic Cobb angle, and Oswestry Disability Index (ODI) score in both groups were observed before and after treatment. The Visual Analogue Scale (VAS) scores were compared between the two groups before and after treatment. The quality of life and efficacy were evaluated in both groups.
RESULTS
After treatment, the anterior vertebral height in the RG exhibited a significant increase compared to that before treatment, and both groups showed a significant decrease in the Cobb angle and ODI (P<0.05). Furthermore, the RG exhibited notably higher anterior vertebral height, and significantly lower Cobb angle and ODI than the CG after treatment (P<0.05). The post-treatment VAS score decreased significantly in both groups (P<0.05), and was lower in the RG than that in CG (P<0.05). After treatment, the quality of life scores improved significantly in both groups (P<0.05), but the RG demonstrated significantly higher scores in the role-emotional, physical functioning, social functioning, and general health (GH) dimensions compared to the CG (P<0.05). The total response rate in the CG was significantly lower than that in the RG (P<0.05). Age, course of disease, underlying disease, distribution of bone cement, and leakage of bone cement were found to be risk factors affecting the prognosis of patients. Logistic regression analysis showed that course of disease, distribution of bone cement, and leakage of bone cement were independent risk factors affecting prognosis.
CONCLUSIONS
Vertebroplasty with bone cement is an effective treatment for elderly patients suffering from osteoporotic compression fractures. This intervention can improve anterior vertebral height, kyphotic Cobb angle, and ODI, while alleviating pain and enhancing the quality of life. Given its promising clinical outcomes, this treatment is highly recommended.
PubMed: 37854235
DOI: No ID Found -
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 -
Journal of Orthopaedic Research :... Dec 2023This meta-analysis investigated the effects of exercise on Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores following vertebroplasty or kyphoplasty... (Meta-Analysis)
Meta-Analysis
This meta-analysis investigated the effects of exercise on Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores following vertebroplasty or kyphoplasty in osteoporotic fractures. A literature search of PubMed, EMBASE (Elsevier), CiNAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science was conducted from database inception to October 6, 2022. Eligible studies reported osteoporosis patients over 18 years of age with a diagnosis of at least one vertebral fracture via radiography or clinical assessment. This review was registered in PROSPERO (ID: CRD42022340791). Ten studies met the eligibility criteria (n = 889). VAS scores at baseline were 7.75 (95% CI: 7.54, 7.97, I = 76.11%). Following initiation of exercise, VAS scores at the endpoint of 12 months were 1.91 (95% CI: 1.53, 2.29, I = 92.69%). ODI scores at baseline were 68.66 (95% CI: 56.19, 81.13, I = 85%). Following initiation of exercise, ODI scores at the endpoint of 12 months were 21.20 (95% CI: 14.52, 27.87, I = 99.30). A two-arm analysis demonstrated improved VAS and ODI for the exercise group compared to non-exercise control at 6 months (MD = -0.70, 95% CI: -1.08, -0.32, I = 87% and MD = -6.48, 95% CI: -7.52, -5.44, I = 46%, respectively) and 12 months (MD = -0.88, 95% CI: -1.27, -0.49, I = 85% and MD = -9.62, 95% CI: -13.24, -5.99, I = 93%). Refracture was the only adverse event reported and occurred almost twice as frequently in the non-exercise group than in the exercise group. Exercise rehabilitation post vertebral augmentation is associated with improved pain and functionality, particularly after 6 months of exposure, and may reduce refracture rate.
Topics: Humans; Adolescent; Adult; Fractures, Compression; Treatment Outcome; Spine; Kyphoplasty; Vertebroplasty; Spinal Fractures; Osteoporotic Fractures
PubMed: 37203781
DOI: 10.1002/jor.25631 -
Quantitative Imaging in Medicine and... Dec 2023
PubMed: 38106295
DOI: 10.21037/qims-23-606 -
International Journal of Spine Surgery Aug 2023Three-dimensional (3D) navigation has become routinely used in spine surgery, allowing more accurate and safe procedures. However, radiation exposure related to the use...
BACKGROUND
Three-dimensional (3D) navigation has become routinely used in spine surgery, allowing more accurate and safe procedures. However, radiation exposure related to the use of imaging is an unresolved issue, and information about it is relatively scarce. The "as low as reasonably achievable" (ALARA) principle aims to reduce the radiation exposure for the patients as low as possible. The objective of this study was to compare the effective dose related to the use of the O-arm in standard settings with adapted features for dose reduction during percutaneous cementoplasty.
METHODS
From March 2021 to October 2022, all consecutive patients who underwent navigated percutaneous cementoplasty with the use of the O-arm were prospectively included. Demographic, operative, irradiation, and radiological data were collected. The main outcome was the effective dose (E) in millisievert (mSv). Secondary outcomes were the absolute risk of cancer (AR) in percent equivalent to a whole-body exposition, operative time, and radiological results according to Garnier. In group A, patients were operated on with standard settings of the O-arm, whereas in group B, navigation on the field of view, collimation, and low-dose settings were used.
RESULTS
A total of 70 patients were included in the study: 43 in group A and 27 in group B. Also, 109 vertebrae were operated: 59 in group A and 50 in group B. Mean E was significantly higher in group A than in group B (9.94 and 4.34 mSv, respectively; < 0.01). The 3D-related E followed the same trend (7.82 and 3.97 mSv, respectively), as did 2-dimensional-related E (2.12 and 0.37 mSv, respectively; < 0.01). Average AR was also significantly higher in group A than in group B (5.10% and 2.10% respectively; < 0.01). Operative time was similar in both groups, but the rate of satisfactory radiological results was higher in group A than in group B (95% and 84%, respectively; = 0.11), and we found similar rates of cement leakage (22% and 24%, respectively; = 0.71).
CONCLUSIONS
The application of settings of the O-arm in accordance with the ALARA principle helped to significantly reduce the radiation exposure and should be routinely used for O-arm-assisted cementoplasty procedures.
CLINICAL RELEVANCE
This study details technical aspects and settings that may help users of the O-arm to decrease radiation exposure to patients and surgeons alike, especially in cementoplasty procedures, as well as in other procedures performed under O-arm guidance.
PubMed: 37253626
DOI: 10.14444/8477 -
[Intraoperative imaging with the mobile C-arm : Technique, image creation and radiation protection].Unfallchirurgie (Heidelberg, Germany) Dec 2023Imaging techniques in the discipline of orthopedics and trauma surgery are essential not only for making a diagnosis but also play a central role in the performance,... (Review)
Review
Imaging techniques in the discipline of orthopedics and trauma surgery are essential not only for making a diagnosis but also play a central role in the performance, documentation and monitoring of the corresponding treatment. Procedures such as open reduction and internal fixation (ORIF) and closed reduction and internal fixation (CRIF) of fractures, kyphoplasty and vertebroplasty as well as posterior stabilization of spinal fractures are carried out under X‑ray control. In the relevant operating rooms of emergency departments and operating theaters, mobile fluoroscopy devices are available, which due to their appearance are called C‑arms. These devices can be moved horizontally, vertically, and along the pivotal axis, enabling real-time imaging of joints and bones from various angles. This imaging enables minimally invasive surgical techniques as this often eliminates the need for extensive preparation and resulting in smaller wound defects compared to open surgical preparation. Additionally, surgeons can immediately assess and, if necessary, adjust the reduction outcome to achieve the best possible care and reduce the need for corrective interventions. With current C‑arms it is also possible to generate 3‑dimensional datasets, to enhance the assessment of implant positioning, particularly in complex intra-articular fractures. This availability helps avoid subsequent corrective interventions that would otherwise only be identified through postoperative computed tomography [1].
Topics: Humans; Radiation Protection; Fractures, Bone; Fracture Fixation, Internal; Radiography; Open Fracture Reduction
PubMed: 37861805
DOI: 10.1007/s00113-023-01379-w -
Journal of Neurological Surgery. Part... Nov 2023We investigate the pain relief and safety of microwave ablation (MWA) combined with percutaneous vertebroplasty (PVP) in the treatment of metastatic vertebral tumors. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
We investigate the pain relief and safety of microwave ablation (MWA) combined with percutaneous vertebroplasty (PVP) in the treatment of metastatic vertebral tumors.
METHODS
This prospective pilot study enrolled patients with metastatic vertebral tumors treated between January 2018 and October 2019. The participants were randomized to the PVP and MWA + PVP groups. Clinical parameters, pain visual analog scale (VAS), analgesic use scores (AUS), and quality-of-life score (QLS) were compared between groups.
RESULTS
Sixty-seven participants were enrolled (PVP: = 35; MWA + PVP: = 32). There were no differences in bone cement injection volume, extravasation, and X-ray exposure time between the two groups ( > 0.05), but treatment costs were higher for the MWA + PVP group (26,418 ± 194 vs. 15,606 ± 148 yuan; < 0.05). There were no significant improvements in VAS from baseline to 24 hours, 72 hours, 7 days, 1 month, and 3 months in the two groups ( > 0.05); at 6 and 12 months after the operation, the improvement from baseline was significant in the two groups ( < 0.05). The VAS was lower at 6 months (2.7 ± 0.7 vs. 3.2 ± 0.7) and 12 months (3.5 ± 0.8 vs. 4.0 ± 0.7) in the MWA + PVP group (both < 0.01 vs. PVP). The AUS and QLS were improved with PVP at 6 and 12 months ( < 0.05) and with MWA + PVP at 12 months ( < 0.05). The AUS was lower at 6 and 12 months in the MWA + PVP group ( < 0.05 vs. PVP).
CONCLUSION
MWA combined with PVP might be a safe and effective palliative treatment for pain from metastatic vertebral tumors.
Topics: Humans; Fractures, Compression; Microwaves; Neoplasms; Pain; Pilot Projects; Prospective Studies; Retrospective Studies; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 36495242
DOI: 10.1055/s-0042-1758121 -
Journal of Clinical Medicine Mar 2024: Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are established methods in the treatment of vertebral compression fractures (VCFs). In our manuscript, the...
Efficacy and Complication Rates of Percutaneous Vertebroplasty and Kyphoplasty in the Treatment of Vertebral Compression Fractures: A Retrospective Analysis of 280 Patients.
: Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are established methods in the treatment of vertebral compression fractures (VCFs). In our manuscript, the target was to evaluate the efficacy of PVPs/PKPs and to determine the implications of potential periprocedural complications. : 280 patients, specifically 194 women (69.3%) and 86 men (30.7%), were enrolled. We used the AO spine fractures classification and the Yeom classification to determine the subtype of cement leakage. Only single-level VCFs of the thoracic or lumbar spine were included. Visual analogue scale (VAS) was assessed preoperatively and regularly after the surgery. Vertebral compression ratio (VBCR) was used to determine postoperative vertebral body collapse. : We recorded 54 cases (19.3%) of cement leakage. There was a significant decrease in mean VAS scores (6.82-0.76 in PVPs, 7.15-0.81 in PKPs). The decrease in VBCR was greater in the VP group (4.39%; 84.21-79.82) compared to the KP group (1.95%; 74.36-72.41). : No significant difference in the risk of cement leakage when comparing KPs and VPs was found. VPs and KPs provide rapid and significant pain relief in patients with VCFs. Clinically relevant complications of VPs and KPs are rare. Kyphoplasties prevent further vertebral body collapse more effectively compared to vertebroplasties.
PubMed: 38592338
DOI: 10.3390/jcm13051495