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Medicine Nov 2023Vertebroplasty (VP) effectively treats vertebral compression fractures (VCFs). However, the issue of secondary new VCFs (SNVCFs) after VP is yet to be addressed....
Vertebroplasty (VP) effectively treats vertebral compression fractures (VCFs). However, the issue of secondary new VCFs (SNVCFs) after VP is yet to be addressed. Therefore, identification of risk factors for SNVCFs after VP may aid the development of strategies to minimize SNVCF risk. This study aimed to retrospectively evaluate risk factors for SNVCFs after VP, including those associated with the type of anti-osteoporotic treatment administered after VP. Data from 128 patients who underwent single-level VP were collected and reviewed. Patients were divided into 2 groups: those with (n = 28) and without (n = 100) SNVCF within 1 year of VP. We collected the following patient data: age, sex, site of compression fracture, medical history, bone mineral density (BMD), history of long-term steroid use, history of osteoporosis drug use, duration between fracture and VP, VP implementation method (unilateral or bilateral), cement usage in VP, cement leakage into the disc, compression ratio before VP, pre- and postoperative recovery ratio of the lowest vertebral body height, and kyphotic angle of fractured vertebrae. These data were analyzed to identify factors associated with SNVCFs after VP and to investigate the effects of the type of anti-osteoporotic treatment administered for SNVCFs. SNVCFs occurred in 28 patients (21.9%) within 1 year of VP. Logistic regression analysis identified BMD, cement leakage into the disc, and long-term steroid use to be significantly associated with the occurrence of SNVCFs. The group treated with zoledronate after VP had a significantly reduced SNVCF incidence compared with the group treated with calcium (P < .001). In addition, the zoledronate group had a lower SNVCF incidence compared with the groups treated with alendronate (P = .05), selective estrogen receptor modulators (P = .26), or risedronate (P = .22). This study showed that low BMD, presence of an intradiscal cement leak, and long-term steroid use were risk factors for developing SNVCFs following VP. Additionally, among osteoporosis treatments prescribed for VP, zoledronate may be the preferred choice to reduce the risk of SNVCFs.
Topics: Humans; Fractures, Compression; Retrospective Studies; Spinal Fractures; Osteoporotic Fractures; Zoledronic Acid; Osteoporosis; Vertebroplasty; Risk Factors; Bone Cements; Steroids; Treatment Outcome
PubMed: 38013362
DOI: 10.1097/MD.0000000000035042 -
Journal of Orthopaedic Surgery and... Nov 2023To assess the safety and efficacy of the extra-facet puncture technique applied in unilateral percutaneous vertebroplasty (PVP) for treating osteoporotic vertebral...
PURPOSE
To assess the safety and efficacy of the extra-facet puncture technique applied in unilateral percutaneous vertebroplasty (PVP) for treating osteoporotic vertebral compression fractures.
METHODS
Demographics (age, gender, body mass index and underlying diseases) were recorded for analyzing. Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores as well as their corresponding minimal clinically important difference (MCID) were used to evaluate clinical outcomes. The segmental kyphotic angle, the vertebral compression ratio and bone cement distribution pattern were evaluated by the plain radiographs. The facet joint violation (FJV) was defined by the postoperative computed tomography scan. Binary logistic regression analysis was performed to investigate relationships between multiple risk factors and residual back pain.
RESULTS
VAS and ODI scores in both traditional puncture group and extra-facet puncture group were significantly decreased after PVP surgery (p < 0.05). However, no significant difference was observed between the two groups according to VAS and ODI scores. The proportion of patients achieving MCID of VAS and ODI scores was higher in extra-facet puncture group as compared to traditional puncture group within a month (p < 0.05). Finally, multivariate logistic regression analysis showed that FJV (odds ratio 16.38, p < 0.001) and unilateral bone cement distribution (OR 5.576, p = 0.020) were significant predictors of residual back pain after PVP surgery.
CONCLUSIONS
Extra-facet puncture percutaneous vertebroplasty can decrease the risk of FJV and it also has the advantage of more satisfied bone cement distribution.
Topics: Humans; Spinal Fractures; Fractures, Compression; Vertebroplasty; Bone Cements; Treatment Outcome; Retrospective Studies; Back Pain; Osteoporotic Fractures; Kyphoplasty
PubMed: 37993875
DOI: 10.1186/s13018-023-04368-2 -
Orthopedics Apr 2024Vertebral augmentation including vertebroplasty and kyphoplasty may restore function without interfering with the therapeutic regimen of patients with multiple myeloma....
BACKGROUND
Vertebral augmentation including vertebroplasty and kyphoplasty may restore function without interfering with the therapeutic regimen of patients with multiple myeloma. We sought to evaluate the effects of adding multilevel vertebral augmentation to conventional therapy protocols for patients with multiple myeloma.
MATERIALS AND METHODS
Forty-four patients recently diagnosed with multiple myeloma were randomly assigned to two groups. One group received multilevel vertebral augmentation (kyphoplasty or vertebroplasty) in addition to conventional therapy (MVA), and the other group received conventional therapy alone (CTA). Patients were evaluated before treatment and at 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years after treatment by using the Oswestry Disability Index (ODI), the Stanford Score (SS), and the Spinal Instability Neoplastic Score (SINS).
RESULTS
The mean ODI, SS, and SINS were nearly equal before treatment, being 34.19 (68.38%), 4.58, and 12.30, respectively, for the MVA group and 32.29 (64.58%), 4.63, and 13.88, respectively, for the CTA group. There were significant differences in the ODI, SS, and SINS between the two groups at all follow-up intervals. The ODI and SINS were statistically significantly different between the two groups (=.020 and <.001, respectively). There was an insignificant difference in SS between the two groups.
CONCLUSION
This study found that performing kyphoplasty and vertebroplasty in addition to conventional therapy for patients with multiple myeloma resulted in enhanced morbidity and functional outcomes. [. 202x;4x(x):xx-xx.].
PubMed: 38568002
DOI: 10.3928/01477447-20240325-06 -
Neurospine Dec 2023We aimed to comprehensively compare surgical methods for osteoporotic vertebral compression fracture (OVCF) using systematic review and network meta-analysis to...
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.
PubMed: 38171285
DOI: 10.14245/ns.2346996.498 -
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 -
Pain Physician May 2024Numerous meta-analyses and systematic reviews have explored the differences between percutaneous vertebroplasty (PVP) and percutaneous balloon kyphoplasty (PKP) for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Numerous meta-analyses and systematic reviews have explored the differences between percutaneous vertebroplasty (PVP) and percutaneous balloon kyphoplasty (PKP) for treating osteoporotic vertebral compression fractures (OVCFs), however, their final conclusions have been inconsistent. The inconsistent conclusions drawn from these meta-analyses create uncertainty among clinicians about the best treatment approach for OVCFs.
OBJECTIVE
The aim of this study was to conduct a cross-sectional analysis of overlapping meta-analyses comparing PVP and PKP treatments for OVCF in order to help clinicians have access to the best available evidence and provide treatment recommendations based on the best available evidence.
STUDY DESIGN
A cross-sectional analysis of overlapping meta-analyses.
METHODS
We conducted a comprehensive search of meta-analyses published up to February 2023 in PubMed, Embase, Cochrane Library and Web of Science databases to identify relevant studies. The methodological quality of these studies was assessed using the Assessment of Multiple Systematic Reviews tool (original AMSTAR) and the Oxford Centre for Evidence-based Medicine Levels of Evidence. Two researchers independently extracted the data and assessed the quality of these meta-analyses. To determine which meta-analyses represented the best evidence, we employed the Jadad decision algorithm.
RESULTS
Seventeen meta-analyses were included in the study, with AMSTAR scores ranging from 4 to 9, with an average of 7. After rigorous scrutiny, the Zhu et al study was determined to provide the best evidence. According to their findings, both PVP and PKP effectively alleviate pain and improve function in the treatment of OVCFs, without any statistically significant differences between them. In addition, PKP can reduce the risk of polymethylmethacrylate leakage compared to PVP.
LIMITATIONS
This study analyzed published overlapping meta-analyses, inherently confining our investigation to the meta-analysis level. Furthermore, based on the AMSTAR scores, several included studies exhibited lower methodological quality.
CONCLUSIONS
Currently, the best evidence indicates that PVP and PKP are equally effective at alleviating pain and enhancing function in the treatment of OVCFs, but PKP had a lower incidence of polymethylmethacrylate leakage. However, there is still a need for high-quality randomized controlled trials to provide higher levels of evidence regarding other aspects of the differences between the 2 procedures.
Topics: Humans; Fractures, Compression; Kyphoplasty; Vertebroplasty; Osteoporotic Fractures; Spinal Fractures; Cross-Sectional Studies; Meta-Analysis as Topic
PubMed: 38805534
DOI: No ID Found -
Quantitative Imaging in Medicine and... Dec 2023
PubMed: 38106295
DOI: 10.21037/qims-23-606 -
Brain & Spine 2024To evaluate the clinical 10 year outcome of patients treated with percutaneous vertebroplasty for vertebral compression fractures and to determine the incidence of new...
OBJECTIVES
To evaluate the clinical 10 year outcome of patients treated with percutaneous vertebroplasty for vertebral compression fractures and to determine the incidence of new fractures in this time interval, as well as the mortality of the patients who underwent this procedure.
METHODS
All patients undergoing vertebroplasty for vertebral compression fractures between May 2007 until July 2008 were prospectively followed up at 10 years postoperatively. Patients were assessed for radiologic outcome and self-reported outcome parameters (PROs). Gathered parameters remained unmodified to the initial ones analyzing QoL improvement (EQ5D 3L and NASS score) and pain alleviation (VAS, NRS). Mortality was defined as an additional endpoint. Exclusion criteria include additional instrumentation, use of additional devices such as kyphoplasty balloons/stentoplasty, cognitive impairment, insufficient radiological documentation or absent re-consent.
RESULTS
Of 280 patients who underwent vertebroplasty, 49 (17.5%) were available for re-assessment with a mean follow-up of 10.5 years (9.9-11.1). Thirty patients (10.7%) were assessed clinically and radiologically, 16 (5.7%) in written form and three (1.1%) by phone only. A total of 186 (66.4%) died during the follow up period. Out of the remaining 45 patients, 27 patients declined participation, eight couldn't participate due to cognitive impairment, four had insufficient radiologic documentation. Six patients were lost to follow-up. At 10 years, patients reported a consistently improved quality of life (EQ-5D; p < 0.01) and global satisfaction. Vertebroplasty demonstrated a substantial and enduring effect on alleviating back pain over 10 years (p < 0.001). 26 (53%) patients experienced a new fracture since the initial procedure.
CONCLUSION
A decade following vertebroplasty, patients continue to demonstrate a quality of life and pain level comparable to short and medium-term assessments, with a significant difference from baseline measurements. More than half (53%) of the patients participating at last follow-up experienced new fractures during this interim period. The cohort as a whole has been impacted by an elevated mortality rate over the time period.
PubMed: 38618227
DOI: 10.1016/j.bas.2024.102783