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World Neurosurgery Aug 2023The purpose of this study was to determine whether percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BK) have any mid-term to long-term effects on the...
The Influence of Percutaneous Vertebral Augmentation Techniques on Recompression in Patients with Osteoporotic Vertebral Compression Fractures. Percutaneous Vertebroplasty versus Balloon Kyphoplasty.
OBJECTIVE
The purpose of this study was to determine whether percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BK) have any mid-term to long-term effects on the structural integrity of augmented vertebrae.
METHODS
According to our hospital records, 351 patients underwent BK and PVP as a result of osteoporotic vertebral compression fractures between 2010 and 2020. The demographic, surgical, and radiologic characteristics of the patients were analyzed retrospectively using the electronic hospital records and PACS (picture archiving and communication system). In our study, 55 patients who had a single level of PVP or BK filled with at least 6 mL og polymethylmethacrylate (PMMA) for T11-L5 levels and 3 mL of PMMA for T6-T10 levels via a bipedicular approach and who had only 1 vertebral fracture in a 10-year follow-up period were included in our study. The patients were divided into 2 groups: BK (n = 40) and PVP (n = 15). All measurements were performed on standing lateral radiographs from the postoperative first day and the last radiographs that were obtained during the follow-up. The anterior and posterior heights of the fractured vertebral body and local kyphosis angles were measured.
RESULTS
The mean follow-up time was 2.53 ± 1.78 years in the BK group and 3.07 ± 2.02 years in the PVP group. The decrease in the vertebral height and increasing kyphosis that develop from the early to late postoperative periods were found to be statistically significant in the BK group (P < 0.05). In the PVP group, vertebral height and kyphosis angle measurements did not differ significantly between the early and late postoperative periods. In addition, in terms of the percentage change, anterior parts of the vertebral bodies are more affected. However, the absolute difference for the measurement of the vertebral heights did not confirm this finding.
CONCLUSIONS
To our knowledge, our study is unique because it has the longest follow-up in the literature comparing BK and PVP in terms of recollapse of the augmented vertebrae. Our study shows that BK does not prevent height loss of the augmented vertebral bodies in the mid- to long term.
Topics: Humans; Kyphoplasty; Spinal Fractures; Fractures, Compression; Polymethyl Methacrylate; Retrospective Studies; Vertebroplasty; Kyphosis; Osteoporotic Fractures; Treatment Outcome; Bone Cements
PubMed: 37257650
DOI: 10.1016/j.wneu.2023.05.081 -
Transoral vertebroplasty for the treatment of C2 painful metastatic lesions; evaluation and outcome.Clinical Neurology and Neurosurgery Oct 2022A small number of studies supports vertebroplasty at the C2 vertebral body due to the documented technical challenges, the rarity of C2 osteolytic metastatic lesions,...
OBJECTIVE
A small number of studies supports vertebroplasty at the C2 vertebral body due to the documented technical challenges, the rarity of C2 osteolytic metastatic lesions, and the existence of potentially serious consequences linked to this particular anatomical area. Vertebroplasty, in such a situation, can be performed through a transoral, an anterolateral, or an open approach. All are supported by a limited number of studies with absence of a significant clinical trial assessing the efficacy, safety, and feasibility of vertebroplasty for the C2 vertebral body. We, herein, summarize a single-institution experience on C2 transoral vertebroplasty.
PATIENTS AND METHODS
This is a retrospective analysis of the records of a single tertiary institute hospital and the clinical visits of nine patients with C2 osteolytic metastatic lesions treated by transoral fluoroscopically guided vertebroplasty between May 2016 and May 2021.
RESULTS
The median period of the last clinical follow-up was 23 months (range, 9-60 months). The intraoperative amount of polymethyl methacrylate (PMMA) injected and recorded in the surgical report was 2 mL (1.5-2.5 mL). Postoperative immediate imaging showed that the cement filling percentage in relation to the C2 mass was 70% (40-85%). The PMMA leakage through the needle track and into the paravertebral spaces was observed in only one patient (11.1%), without significant vascular and neurological consequences. Stability was maintained during the follow-up period. The postoperative median pain rating scale (PRS) score was 1 (0-2) immediately after the end of the operation and 0 (0-2) at the last visit. The recorded postoperative Pain Rating Scale (PRS) score was correlated with the cement filling percentage (rs= -0.9, p = 0.0008; Spearman correlation).
CONCLUSION
Transoral vertebroplasty is considered feasible and efficient technique in the treatment of secondary osteolytic lesions in the C2 vertebra. Further long-term and larger comparative randomized studies are required to perform a more comprehensive analysis of this technique.
Topics: Bone Cements; Humans; Pain; Polymethyl Methacrylate; Retrospective Studies; Spinal Fractures; Tomography, X-Ray Computed; Treatment Outcome; Vertebroplasty
PubMed: 35985095
DOI: 10.1016/j.clineuro.2022.107410 -
Neuro-Chirurgie Jan 2023
Topics: Humans; Research Design; Vertebroplasty; Spinal Fractures
PubMed: 36608448
DOI: 10.1016/j.neuchi.2022.101400 -
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 -
World Neurosurgery May 2022Patients who experience vertebral compression fractures are vulnerable to subsequent vertebral compression fractures (SVCFs). The purpose of this nationwide...
OBJECTIVE
Patients who experience vertebral compression fractures are vulnerable to subsequent vertebral compression fractures (SVCFs). The purpose of this nationwide population-based study was to determine the age-specific cumulative incidence and factors associated with SVCFs in South Korea.
METHODS
Diagnostic codes, medical costs, and comorbid diseases in patients who had a vertebral compression fracture in 2011 and 2012 were collected from the National Health Insurance Service database of South Korea from 2007 to 2018. Demographic data, mortality rate, medical cost, and frequency of vertebroplasty or kyphoplasty were compared between patients with an initial fracture (IF) and those with a subsequent fracture (SF).
RESULTS
The cumulative incidence of SVCFs over 4 years was 24.4% and increased rapidly within a few months after the IF. In 2011, SVCFs occurred in 17,004 patients, and the incidence rate per 100,000 people was 113.6 (84.9 in men vs. 138.5 in women). The odds ratio (OR) of SVCFs in units of 10 years was the highest in women in their 60s, at 2.89. However, in men in their 70s, the OR was the highest, at 2.51. The rates of vertebroplasty or kyphoplasty, medical expenses, and mortality rate were significantly higher in the SF group than in the IF group (P < 0.01).
CONCLUSIONS
The age-specific cumulative incidence of SVCFs per 100,000 people was 113.6. SVCFs were more frequent among women, the elderly, and patients who underwent vertebroplasty or kyphoplasty. Women in their 60s or above and men in their 70s or above were at highest risk.
Topics: Aged; Female; Fractures, Compression; Humans; Incidence; Kyphoplasty; Male; Osteoporotic Fractures; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 35077893
DOI: 10.1016/j.wneu.2022.01.064 -
Medicine Aug 2022This study aimed to analyze the most influential publications on vertebral augmentation for treating osteoporotic vertebral compression fracture. The Web of Science... (Review)
Review
This study aimed to analyze the most influential publications on vertebral augmentation for treating osteoporotic vertebral compression fracture. The Web of Science database was searched using the key words "percutaneous vertebroplasty," "percutaneous kyphoplasty," "balloon kyphoplasty," "vertebroplasty," "kyphoplasty," and "vertebral augmentation." The top 100 publications were arranged by citations per year and descriptively and visually analyzed. The top 100 publications were cited 25,482 times, with an average of 14.4 citations per paper per year. The corresponding authors of the publications represented 17 nations, with most authors being American (46 authors). Thirty-two journals were involved, with SPINE issuing the most publications (24 papers of the 100). Clinical research (73 of the 100 papers) outnumbered basic studies (14 papers) and systematic reviews (13 papers), and the most publications were published between 2000 and 2004. Co-citation analysis of the key words indicated that the top 5 focus areas were "complication," "balloon kyphoplasty," "vertebral compression fracture," "biomechanics," and "calcium phosphate cement." The top 3 keywords with the strongest citation bursts were "compression fracture," "cement," and "balloon kyphoplasty." The keywords with persistent strong citation bursts are "balloon kyphoplasty" and "augmentation." There are still contrary opinions about vertebral augmentation; new research should be conducted with more deliberate design and longer follow-up.
Topics: Bone Cements; Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 35945791
DOI: 10.1097/MD.0000000000030023 -
Clinical Spine Surgery Jul 2022A meta-analysis. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
A meta-analysis.
OBJECTIVE
The aim is to compare the efficacy of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in treating Kümmell's disease (KD) without neurological deficits.
SUMMARY OF BACKGROUND DATA
PVP and PKP are routine methods for the treatment of KD without neurological deficits; however, whether PVP or PKP is superior is a matter of debate.
MATERIALS AND METHODS
According to the Cochrane Handbook for Systematic Reviews of Interventions, PubMed, Embase, the Cochrane Library, and Web of Knowledge were searched for eligible randomized controlled trials or cohort studies. Two authors independently collected data and assessed the methodologic quality of the included studies. Intraoperative and postoperative clinical outcomes, cement leakage, refracture rate, and the costs during hospitalization were evaluated.
RESULTS
Five observational studies comparing 119 PVP and 128 PKP patients were included in qualitative and quantitative reviews. All of the included s studies had evidence of good quality, as assessed by the Newcastle-Ottawa scale. On the basis of meta-analysis the operation time [weighted mean difference: -10.65; 95% confidence interval (95% CI): -11.94 to -9.35; P <0.00001] and hospitalization cost (weighted mean difference: -2.38; 95% CI: -2.87 to -1.89; P <0.00001) were less for PVP, while the cement leakage rate was lower for PKP (odds ratio: 3.03; 95% CI: 1.58-5.82; P <0.001). Together, the data indicated that the differences in cement volume, visual analog scale score, Oswestry disability index score, Cobb angle, anterior vertebral height, and refracture rate were not significantly different.
CONCLUSION
The findings of this study suggest that PVP and PKP are safe and effective for the treatment of KD. PVP required less operative time and was more affordable, but PKP was superior given the lower cement leakage rate. Additional high-quality randomized controlled trials designed to support these findings are warranted.
Topics: Bone Cements; Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Retrospective Studies; Spinal Fractures; Spondylosis; Systematic Reviews as Topic; Treatment Outcome; Vertebroplasty
PubMed: 34694259
DOI: 10.1097/BSD.0000000000001269 -
World Neurosurgery Dec 2021Percutaneous vertebroplasty (PVP) is widely used for treatment of osteoporotic vertebral compression fractures (VCFs). However, the influence of PVP timing (early vs....
BACKGROUND
Percutaneous vertebroplasty (PVP) is widely used for treatment of osteoporotic vertebral compression fractures (VCFs). However, the influence of PVP timing (early vs. late) on development of adjacent vertebral fractures has rarely been discussed. This retrospective cohort study aimed to evaluate bone-cement binding for thoracolumbar fractures (T8-L3) using a new assessment method to predict risk for adjacent vertebral fractures.
METHODS
Patients with a single-level T-score ≤ -1.0 of lumbar bone mineral density and a primary osteoporotic VCF in the thoracolumbar region (T8-L3) who underwent PVP from October 2016 to February 2018 at our medical university-affiliated hospital were included. Patients were divided into refracture and non-refracture groups. All patients underwent computed tomography after vertebroplasty. Bone-cement distribution patterns were evaluated using standardized axial computed tomography images of each cemented vertebra by 4 independent observers with ImageJ software. The smoothness index was calculated as a percentage of smooth margins.
RESULTS
Of 51 VCFs, 15 (29.4%) and 36 (70.6%) were refracture and non-refracture VCFs, respectively. The mean smoothness index (MSI) was higher in the refracture group than in the non-refracture group (P < 0.01), with an increased refracture risk that corresponded to increased MSI values (P = 0.004). Spearman correlation coefficient (0.375) showed a positive correlation between the fracture-vertebroplasty interval and MSI (P = 0.01).
CONCLUSIONS
Axial computed tomography images were used to characterize bone-cement binding properties. Patients who underwent early PVP had a lower MSI, better bone-cement integration, and fewer adjacent fractures.
Topics: Aged; Aged, 80 and over; Bone Cements; Bone Density; Female; Fractures, Compression; Humans; Lumbar Vertebrae; Male; Minimally Invasive Surgical Procedures; Osseointegration; Recurrence; Retrospective Studies; Spinal Fractures; Thoracic Vertebrae; Time-to-Treatment; Tomography, X-Ray Computed; Vertebroplasty
PubMed: 34543733
DOI: 10.1016/j.wneu.2021.09.050 -
Pain Physician May 2021In the aging population, osteoporosis and related complications have become a global public health problem. Osteoporotic vertebral compression fractures are among the...
BACKGROUND
In the aging population, osteoporosis and related complications have become a global public health problem. Osteoporotic vertebral compression fractures are among the most common type of osteoporotic fractures and patients are at risk of secondary vertebral compression fracture.
OBJECTIVES
To identify risk factors for secondary vertebral compression fracture following primary osteoporotic vertebral compression fractures.
STUDY DESIGN
Retrospective study.
SETTING
Department of Orthopedic, an affiliated hospital of a medical university.
METHODS
This retrospective cohort study evaluated the risk factors for secondary vertebral compression fracture in 317 consecutive patients with systematic osteoporotic vertebral compression fractures who received percutaneous vertebroplasty and kyphoplasty or conservative treatment. Patients were divided into secondary vertebral compression fracture (n = 43) and non- secondary vertebral compression fracture (n = 274) groups. We retrospectively analyzed clinical characteristics and radiographic parameters, including gender, age, body mass index, number of primary fractures, primary treatment (percutaneous vertebroplasty and kyphoplasty or conservative treatment), nonspinal fracture history before primary fracture, primary fracture at the thoracolumbar junction, steroid use, bisphosphonate therapy, and Hounsfield units value of L1.
RESULTS
Comparison between the groups showed significant differences in age (P = 0.001), nonspinal fracture history (P < 0.001), and Hounsfield units value of L1 (P < 0.001). The receiver operating characteristic curves demonstrated that the optimal thresholds for age and Hounsfield units value of L1 were 75 (sensitivity: 55.8%; specificity: 67.5%) and 50 (sensitivity: 88.3%; specificity: 67.4%), respectively. In multivariate logistic regression analysis, nonspinal fracture history (OR = 6.639, 95% CI = 1.809 - 24.371, P = 0.004) and Hounsfield units value of L1 < 50 (OR = 15.260, 95% CI = 6.957 - 33.473, P < 0.001) were independent risk factors for secondary vertebral compression fracture.
LIMITATIONS
The main limitation is the retrospective nature of this study.
CONCLUSION
Patients with low Hounsfield units value of L1 or non-spinal fracture history are an important population to target for secondary fracture prevention.
Topics: Aged; Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Retrospective Studies; Risk Factors; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 33988955
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... Nov 2021Cement augmentation has been proven to be a safe procedure for the treatment of osteoporotic vertebral fracture, and the overall result is encouraging. However, failures...
INTRODUCTION
Cement augmentation has been proven to be a safe procedure for the treatment of osteoporotic vertebral fracture, and the overall result is encouraging. However, failures caused by different complications are not uncommon, and a few patients even need revision surgery. This retrospective study aimed to investigate the primary causes of revision surgery after cement augmentation for osteoporotic vertebral fracture and how to prevent them, and the second objective was to evaluate the clinical results of revision surgery.
HYPOTHESIS
The main hypothesis is that infection and neurological dysfunction are the prime causes of revision surgery after cement augmentation for osteoporotic vertebral fracture, and the second hypothesis is that revision surgery is effective to improve the quality of daily life.
MATERIALS AND METHODS
Twenty-one patients who underwent unplanned revision surgery after cement augmentation were retrospectively analyzed. The initial radiographic and medical records were reviewed to re-evaluate whether the initial diagnosis and surgical procedure were correct and suitable. The primary causes of revision surgery and the details were recorded. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the efficacy of the revision surgery, and patients with neurological dysfunction were evaluated with the American Spinal Injury Association (ASIA).
RESULTS
A total of 47.6% (10/21) of patients were misdiagnosed initially or had an incorrect indication for cement augmentation surgery, including 3 pre-existing spondylitis cases that were misdiagnosed as osteoporotic vertebral fracture and 7 cases of three column fractures that were treated with cement augmentation. The primary causes and details of the revision surgeries were as follows: 7 patients with infection underwent anterior and/or posterior debridement and fixation; 9 patients with progressive kyphosis underwent posterior osteotomy and fixation; and 5 patients with neurological dysfunction underwent posterior decompression and fixation. The mean follow-up time was 30.6±8.7 months, the VAS score decreased from 7.3±1.1 preoperatively to 2.3±0.3 (p<0.05) at the last follow-up, the ODI decreased from 61.1%±16.3% preoperatively to 20.6%±6.2% (p<0.05) at the last follow-up, and 5 patients with neurological dysfunction improved by at least one grade.
CONCLUSION
Infection, progressive kyphosis and neurological dysfunction are the primary causes of revision surgery after cement augmentation for osteoporotic vertebral fracture. Avoiding misdiagnosis and ensuring suitable indications might be the key points to decreasing unplanned revision surgery for cement augmentation for osteoporotic vertebral fracture. The quality of daily life and neurological function can be improved through revision surgery.
Topics: Bone Cements; Fractures, Compression; Humans; Kyphoplasty; Lumbar Vertebrae; Osteoporotic Fractures; Reoperation; Retrospective Studies; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 33338678
DOI: 10.1016/j.otsr.2020.102796