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Turkish Neurosurgery 2024To compare the efficacy and feasibility of target area cement-enhanced percutaneous vertebroplasty (PVP) and conventional PVP in osteoporotic thoracolumbar non-total... (Comparative Study)
Comparative Study
Comparison Between Intraoperative Target Area Cement-Enhanced Percutaneous Vertebroplasty and Conventional Percutaneous Vertebroplasty for Osteoporotic Thoracolumbar Non-Total Vertebral Fractures.
AIM
To compare the efficacy and feasibility of target area cement-enhanced percutaneous vertebroplasty (PVP) and conventional PVP in osteoporotic thoracolumbar non-total vertebral fractures.
MATERIAL AND METHODS
Retrospective analysis of one hundred and two patients treated in our hospital from March 2020 to May 2021 and divided into groups A (targeted) and B (conventional PVP). The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height ratio, intraoperative bleeding, operative time, bone cement volume, complications, and refracture of the injured vertebra were evaluated in both groups.
RESULTS
The 2 days and 1-year post-operative VAS and ODI scores improved significantly in both groups (p < 0.05). The 2 days post-operative VAS and ODI scores were better in group A (p < 0.05), and there was no significant difference in the scores between the groups at the last follow-up (p > 0.05). The anterior vertebral height ratios were significantly higher in both groups 2 days postoperatively (p < 0.05); however, there was no significant difference in the 2 days and 1-year post-operative ratios in group A (p > 0.05). The anterior vertebral height ratio reduced in group B after 1 year compared to the 2 days post-operative value (p < 0.05). There was no statistical difference in intraoperative bleeding and the operative time between the groups (p > 0.05), and the bone cement volume was lesser in group A (p < 0.05). Six patients in group A and four patients in group B demonstrated cement leakage, the difference was not statistically significant (p > 0.05). Three patients in group A and 11 patients in group B demonstrated refracture, the difference was statistically significant (p < 0.05).
CONCLUSION
Target area cement-enhanced PVP can effectively relieve short-term pain and functional disability and reduce the long-term possibility of secondary collapse. Therefore, it is a technically feasible and efficacious method for the treatment of osteoporotic thoracolumbar non-total vertebral fractures.
Topics: Humans; Vertebroplasty; Female; Male; Bone Cements; Spinal Fractures; Osteoporotic Fractures; Aged; Retrospective Studies; Thoracic Vertebrae; Lumbar Vertebrae; Treatment Outcome; Middle Aged; Aged, 80 and over
PubMed: 38650561
DOI: 10.5137/1019-5149.JTN.43749-23.2 -
Neurospine Dec 2023
PubMed: 38171284
DOI: 10.14245/ns.2347266.633 -
The Spine Journal : Official Journal of... Jun 2024The optimal treatment for osteoporotic vertebral burst fracture (OVBF) without neurological symptoms is still a matter of debate.
Is there a risk of further displacement of the fractured fragment into the spinal canal in osteoporotic vertebral burst fractures after unilateral PKP? A prospective study.
BACKGROUND CONTEXT
The optimal treatment for osteoporotic vertebral burst fracture (OVBF) without neurological symptoms is still a matter of debate.
PURPOSE
To evaluate the safety and efficacy of percutaneous kyphoplasty (PKP) for OVBF.
STUDY DESIGN
The study is a prospective study and is registered in the China Clinical Trials Registry with the registration number ChiCTR-OOC-17013227.
PATIENT SAMPLE
The study involved 119 patients with 137 fractured vertebrae who underwent unilateral PKP for OVBF.
OUTCOME MEASURES
The measurements were carried out independently by two physicians and measured with picture archiving and communication system (PACS) and ImageJ software (National Institutes of Health, Bethesda, MD, USA).
METHODS
The change in the spinal canal area and posterior wall protrusions (PWP) were measured before and after surgery via three-dimensional computed tomographic imaging (CT). Preoperative, postoperative, and final follow-up standing X-rays were used to measure the height of the anterior wall (HAW), height of the posterior wall (HPW), and local kyphotic angle (LKA). Additionally, visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were also determined.
RESULTS
Among the 137 vertebrae assessed, 79 exhibited an increased postoperative canal area, while 57 showed a decrease, with mean values of 8.28±6.871 mm² and -9.04±5.991 mm², respectively. Notably, no significant change in postoperative canal area was identified on the entire dataset (p>.01). There was a significant decrease between median preoperative (3.9 [IQ1-IQ3=3.3-4.8] mm) and postoperative (3.7 [IQ1-IQ3=3.0-4.4] mm) PWP (p<.01). Preoperative and postoperative HAW measurements were 19.4±6.1 mm and 23.2±5.2 mm, respectively (p<.01). However, at the final follow-up, the HAW was lower than the postoperative value. The HPW was also significantly improved after surgery (p<.01), but at the final follow-up, it was significantly decreased compared with the postoperative measurement. Following surgery, KA was significantly corrected (p<.01); however, at the final follow-up, relapse was detected (average KA: 18.4±10.3°). At the final follow-up, both VAS and ODI were significantly improved compared with the preoperative period (p<.01). As for complications, 50 patients experienced cement leakage, and 16 patients experienced vertebral refracture. All patients did not develop neurological symptoms during the follow-up.
CONCLUSIONS
OVBF without neurological deficits showed significant improvement in symptoms during the postoperative period after PKP. There was no notable alteration in the spinal canal area, but a significant decrease in PWP was observed. Consequently, we posit that PKP stands as a secure and efficacious surgical intervention for treating OVBF cases devoid of neurological symptoms.
Topics: Humans; Spinal Fractures; Female; Male; Osteoporotic Fractures; Aged; Middle Aged; Kyphoplasty; Spinal Canal; Prospective Studies; Aged, 80 and over; Treatment Outcome
PubMed: 38110090
DOI: 10.1016/j.spinee.2023.12.005 -
Emergency Medicine International 2023[This retracts the article DOI: 10.1155/2022/2037185.].
[This retracts the article DOI: 10.1155/2022/2037185.].
PubMed: 37593425
DOI: 10.1155/2023/9836710 -
Clinical Interventions in Aging 2024The purpose of this study is to compare the refracture rate of the cemented vertebral body of percutaneous curved vertebroplasty (PCVP) and bilateral percutaneous... (Randomized Controlled Trial)
Randomized Controlled Trial
Percutaneous Curved Vertebroplasty Decrease the Risk of Cemented Vertebra Refracture Compared with Bilateral Percutaneous Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures.
PURPOSE
The purpose of this study is to compare the refracture rate of the cemented vertebral body of percutaneous curved vertebroplasty (PCVP) and bilateral percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF).
METHODS
Ninety-four patients with single segment thoracolumbar OVCF were randomly divided into two groups (47 patients in each) and underwent PCVP or bilateral PKP surgery, respectively. Refracture of cemented vertebral body, bone cement injection volume and cement pattern, cement leakage rate, total surgical time, intraoperative fluoroscopy time, preoperative and postoperative Cobb angles and anterior vertebral height, Oswestry disability index questionnaire (ODI) and visual analog scales (VAS) were recorded.
RESULTS
The PCVP group had significantly lower refracture incidence of the cemented vertebral than the bilateral PKP group (p<0.05). There was a significant postoperative improvement in the VAS score and ODI in both group (p<0.01), and no significant difference was found between two groups. The operation time and intraoperative fluoroscopy times were significantly less in the PCVP group than in the bilateral PKP group (p<0.01). The mean kyphosis angle correction and vertebral height restoration in the PCVP group was significantly less than that in the bilateral PKP group (p<0.01).
CONCLUSION
Both PCVP and PKP were safe and effective treatments for OVCF. The PCVP had lower refracture rate of the cemented vertebral than the bilateral PKP group, and PCVP entailed less exposure to fluoroscopy and shorter operation time than bilateral PKP.
Topics: Humans; Spinal Fractures; Fractures, Compression; Kyphoplasty; Spine; Kyphosis; Bone Cements
PubMed: 38434576
DOI: 10.2147/CIA.S438036 -
World Journal of Surgical Oncology Dec 2023Lumbosacral vertebral osteoblastic metastasis is treated with percutaneous vertebroplasty (PVP) combined with I seed implantation and PVP alone. Compared to PVP alone,... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Lumbosacral vertebral osteoblastic metastasis is treated with percutaneous vertebroplasty (PVP) combined with I seed implantation and PVP alone. Compared to PVP alone, we evaluated the effects of combination therapy with PVP and I seed implantation on pain, physical condition, and survival and evaluated the clinical value of PVP combined with I particle implantation.
METHODS
We retrospectively analyzed 62 patients with lumbosacral vertebral osseous metastases treated at our hospital between 2016 and 2019. All the patients met the inclusion criteria for I implantation, and they were randomly divided into a combined treatment group and a pure PVP surgery group. The visual analog pain scale (VAS), Karnofsky Performance Status (KPS), and survival time were recorded at different time points, including preoperative, postoperative 1 day, 1 month, 3 months, 6 months, 12 months, and 36 months in each group. The variation in clinical indicators and differences between the groups were analyzed using SPSS version 20.0. Correlations between different variables were analyzed using the nonparametric Spearman's rank test. The Kaplan-Meier method was used to estimate the relationship between survival time and KPS score, VAS score, or primary tumor progression, and survival differences were analyzed using the log-rank test. Multivariate analyses were performed using a stepwise Cox proportional hazards model to identify independent prognostic factors.
RESULTS
Compared to the PVP treatment group, the pain level in the combined treatment group was significantly reduced (P = 0.000), and the patient's physical condition in the combination treatment group significantly improved. Kaplan-Meier analysis showed that the survival rate of the PVP group was significantly lower than that of the combination group (P = 0.038). We also found that the median survival of patients in both groups significantly increased with an increase in the KPS score (14 months vs. 33 months) (P = 0.020). Patients with more than three transfer sections had significantly lower survival rates than those with one or two segments of the section (P = 0.001). Further, Cox regression analysis showed that age (P = 0.002), the spinal segment for spinal metastasis (P = 0.000), and primary tumor growth rate (P = 0.005) were independent factors that affected the long-term survival of patients with lumbosacral vertebral osseous metastases.
CONCLUSIONS
PVP combined I seeds implantation surgery demonstrated superior effectiveness compared to PVP surgery alone in treating lumbosacral vertebral osseous metastases, which had feasibility in the clinical operation. Preoperative KPS score, spine transfer section, and primary tumor growth rate were closely related to the survival of patients with lumbosacral vertebral osteoblastic metastasis. Age, spinal segment for spinal metastasis, and primary tumor growth can serve as prognostic indicators and guide clinical treatment.
Topics: Humans; Prognosis; Spinal Neoplasms; Vertebroplasty; Retrospective Studies; Pain
PubMed: 38124135
DOI: 10.1186/s12957-023-03268-3 -
Clinics in Orthopedic Surgery Dec 2023The objective of this study was to analyze the direct medical expenses of a vertebral fracture cohort (VC) and a matched cohort (MC) over 5 years preceding and following...
BACKGROUND
The objective of this study was to analyze the direct medical expenses of a vertebral fracture cohort (VC) and a matched cohort (MC) over 5 years preceding and following the fracture, analyze the duration of the rise in medical expenses due to the fracture, and examine whether the expenses vary with age group, utilizing a national claims database.
METHODS
Subjects with vertebral fractures and matched subjects were chosen from the National Health Insurance Service Sample cohort (NHIS-Sample) of South Korea. Patients with vertebral fractures were either primarily admitted to acute care hospitals (index admissions) or those who received kyphoplasty or vertebroplasty during the follow-up period (2002-2015). A risk-set matching was performed using 1 : 5 random sampling to simulate a real-world situation. Individual-level direct medical expenses per quarter were calculated for 5 years prior and subsequent to the vertebral fracture. In this analysis using a comparative interrupted time series design, we examined the direct medical expenses of a VC and an MC.
RESULTS
A total of 3,923 incident vertebral fracture patients and 19,615 matched subjects were included in this study. The mean age was 75.5 ± 7.4 years, and 69.5% were women. The mean difference in medical expenses between the two groups increased steadily before the fracture. The medical expenses of the VC peaked in the first quarter following the fracture. The cost changes were 1.82 times higher for the VC than for the MC (95% confidence interval, 1.62-2.04; < 0.001) in the first year. Subsequently, there were no differential changes in medical expenses between the two groups ( > 0.05). In the < 70-year subgroup, there were no differential changes in medical expenses between the two groups ( > 0.05). However, in the ≥ 80-year subgroup, the cost changes for the VC were higher than those for the MC up to 5 years after time zero.
CONCLUSIONS
Based on our study results, we suggest that health and medical policies for vertebral fractures should be designed to last up to approximately 1 year after the fracture. Health policies should be differentiated according to age group.
Topics: Humans; Female; Aged; Aged, 80 and over; Male; Spinal Fractures; Fractures, Bone; Vertebroplasty; Kyphoplasty; Republic of Korea; Osteoporotic Fractures; Fractures, Compression
PubMed: 38045582
DOI: 10.4055/cios23203 -
Orthopaedic Surgery Dec 2023Percutaneous vertebroplasty (PVP) is currently the primary minimally invasive surgical approach for treating vertebral compression fractures caused by senile...
OBJECTIVE
Percutaneous vertebroplasty (PVP) is currently the primary minimally invasive surgical approach for treating vertebral compression fractures caused by senile osteoporosis. The current existing problem is the lack of research on the application of a specific set of intraoperative C-arm fluoroscopy terminologies in PVP. Therefore, the purpose of this study is to explore the use of a specific set of intraoperative C-arm fluoroscopic terminologies in PVP in order to increase fluoroscopy accuracy, decrease fluoroscopy frequencies and ray protection, and minimize operation times through rapid preoperative training of surgeons and radiographers.
METHODS
Spine surgeons and radiographers with at least 5 years of experience from nine different hospitals were randomly selected for a series of specialized intraoperative C-arm fluoroscopy terminology training between October 2018 and December 2021. Before and after the training, they were surveyed using a five-point Likert scale to statistically compare their knowledge of the terminology. Simultaneously, 190 PVP cases completed by these surgeons and radiographers before and after the training were chosen for comparison and analysis of fluoroscopy times, effective fluoroscopy rate, fluoroscopy time, repeated puncture rate, and other indicators before and after receiving specialized terminology training. Two-sample tests were mainly used to investigate differences in answers between surgeons and radiographers.
RESULTS
After the training, there was a notable improvement in the fluency of intraoperative communication between professional spine surgeons and radiographers. By comparing the indicators of pre-training with post-training, the effective anteroposterior fluoroscopy rate increased from 46.5% to 75.7%; the effective lateral fluoroscopy rate increased from 59.8% to 76.9%. Moreover, a notable decrease in communication barriers, fluoroscopy frequencies, fluoroscopy time, and the rate of repeated punctures, and a notable increase in the effective fluoroscopy rate was observed.
CONCLUSION
Smooth intraoperative communication between professional spine surgeons and radiographers can significantly lower the communication barrier, reduce the fluoroscopy frequencies and time, the rate of repeated puncture, and increase the effective fluoroscopy rate, all of which are important in improving the fluoroscopy in PVP.
Topics: Humans; Spinal Fractures; Fractures, Compression; Vertebroplasty; Osteoporotic Fractures; Fluoroscopy; Treatment Outcome; Bone Cements
PubMed: 37814482
DOI: 10.1111/os.13824 -
Acta Orthopaedica Et Traumatologica... Sep 2023This study aimed to investigate the effect of osteosarcopenia on second fracture development and mortality in patients aged above 60 years undergoing vertebroplasty...
OBJECTIVE
This study aimed to investigate the effect of osteosarcopenia on second fracture development and mortality in patients aged above 60 years undergoing vertebroplasty because of osteoporotic vertebral compression fracture (OVCF).
METHODS
A retrospective evaluation was conducted on 104 patients treated by vertebroplasty because of OVF between 2016 and 2021. The L3 vertebra Hounsfield unit values and the psoas muscle index (PMI) values measured at the L3 vertebra level were obtained from the patients' medical data and computed tomography images. Using these measurements, the patients were divided into 3 groups: only osteoporosis (OO group), only sarcopenia (OS group), and osteosarcopenia (OSP group). Differences between the groups were evaluated regarding second OVCF development and mortality.
RESULTS
The study included 104 patients, comprising 30 males and 74 females aged 60-92 years. The OS group included 10 patients, the OO group included 54 patients, and the OSP group consisted of 40 patients. A single vertebral fracture occurred in 72 patients, and 2 vertebral fractures occurred in 32 patients. The chi-square test, Mann-Whitney U-test, Kruskal-Wallis test, and Kaplan-Meier survival analysis results showed no statistically significant difference between the 3 groups for the risk of second vertebral fracture. Sarcopenia, either alone or in combination with osteoporosis, was seen to have a negative effect on the survival of patients who underwent vertebro- plasty following a vertebral fracture.
CONCLUSION
This study has shown that osteosarcopenia did not increase the risk of developing a second vertebral fracture, but it increased mortality 2.8-fold for those who underwent vertebroplasty after vertebral fracture.
LEVEL OF EVIDENCE
Level III, Prognostic study.
Topics: Male; Aged; Female; Humans; Fractures, Compression; Spinal Fractures; Osteoporotic Fractures; Retrospective Studies; Sarcopenia; Vertebroplasty; Osteoporosis; Lumbar Vertebrae; Treatment Outcome; Bone Cements; Kyphoplasty
PubMed: 37909684
DOI: 10.5152/j.aott.2023.23099 -
Journal of Cancer Research and... Apr 2024To evaluate the safety and efficacy of microwave ablation (MWA) combined with percutaneous vertebroplasty (PVP) in the treatment of multisegmental (2-3 segments)...
OBJECTIVE
To evaluate the safety and efficacy of microwave ablation (MWA) combined with percutaneous vertebroplasty (PVP) in the treatment of multisegmental (2-3 segments) osteolytic spinal metastases.
MATERIALS AND METHODS
This study comprised a retrospective analysis of data from 20 patients with multisegmental (2-3 segments) osteolytic spinal metastases who received MWA combined with PVP. The visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, Quality of Life Questionnaire-Bone Metastases 22 (QLQ-BM22), and local recurrence before and after the operation were measured. The occurrence of complications was observed to evaluate safety.
RESULTS
All operations were completed successfully with no serious complications. Transient nerve injury occurred in two cases, but recovered after symptomatic treatment. The bone cement leakage rate was 13.9% (6/43). The mean baseline VAS scores were 7.25 ± 0.91 before treatment and 7.25 ± 0.91, 3.70 ± 1.12, 2.70 ± 0.73, 2.40 ± 0.68, 2.25 ± 0.71, and 2.70 ± 0.92 at 1 day, 1 week, 1, 3, and 6 months after treatment; all values were significantly lower (P < 0.001). The mean baseline ODI score decreased from 56.90 ± 9.74 before treatment to 41.90 ± 7.09, 38.10 ± 7.93, and 38.80 ± 10.59 at 1, 3, and 6 months after treatment, respectively; all values were significantly lower (P < 0.001). The average QLQ-BM22 baseline score decreased from 54.10 ± 5.36 before treatment to 44.65 ± 5.22, 43.05 ± 4.78, 42.30 ± 4.06, and 42.15 ± 5.47 at 1 week, 1, 3, and 6 months after treatment; all values were significantly lower (all P < 0.001). The postoperative survival time of all patients was >6 months. In three patients, four vertebral segments recurred 6 months after operation.
CONCLUSION
MWA combined with PVP is a safe and effective treatment for multisegmental osteolytic vertebral metastases that can effectively relieve pain, improve spinal function, improve quality of life, and delay tumor progression. However, it is a long operation, necessitating good preoperative preparation and effective intraoperative pain relief measures.
Topics: Humans; Vertebroplasty; Female; Male; Spinal Neoplasms; Middle Aged; Microwaves; Aged; Retrospective Studies; Treatment Outcome; Quality of Life; Combined Modality Therapy; Adult; Pain Measurement; Radiofrequency Ablation; Bone Cements; Neoplasm Recurrence, Local
PubMed: 38687944
DOI: 10.4103/jcrt.jcrt_558_23