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BMC Musculoskeletal Disorders Oct 2021The study aimed to investigate the effects and reliability of simultaneous vertebroplasty and radiofrequency ablation or radiofrequency ablation applied alone for pain...
BACKGROUND
The study aimed to investigate the effects and reliability of simultaneous vertebroplasty and radiofrequency ablation or radiofrequency ablation applied alone for pain control in patients with painful spine metastasis, and to investigate the effect of preventing tumor spread in long-term follow-up.
METHODS
Patients with painful vertebrae metastasis in the Afyonkarahisar Health Sciences University, Medical Faculty, Hospital Neurosurgery Clinic between 01.01.2015 and 01.06.2020 were recruited. They were divided into groups according to the surgical procedures applied. Group 1 included 26 patients who underwent radiofrequency ablation only, and group 2 included 40 patients who underwent vertebroplasty with radiofrequency ablation. Computed tomography and magnetic resonance imaging were performed in all patients pre-operation. The patients were followed for at least 6 months. Magnetic resonance imaging was performed at the end of the 6th month in neurologically stable patients. The metastatic lesion, pain, and quality of life were evaluated with Visual Analog Scale and Oswestry Disability Survey before and after the procedure.
RESULTS
The mean VAS score before the procedure was 8.3 ± 1.07 in the RFA group, and a statistically significant difference was observed in VAS scores at all post-procedural measurement time-points (p < 0.001). The pain scores decreased at a rate of 58.8 and 69.6% of patients showed significant improvements in the QoL in the RFA-only group. The mean VAS score was 7.44 ± 1.06 in group RFA + VP before the procedure; the difference in the mean VAS scores was statistically significant at all measurement time-points after the procedure (p < 0.001). The mean pre-treatment Oswestry Index (to assess the QoL) was 78.50% in the RFA + VP group, which improved to 14.2% after treatment.
CONCLUSION
Ablation + vertebroplasty performed to control palliative pain and prevent tumor spread in patients with painful vertebral metastasis is more successful than vertebroplasty performed alone.
Topics: Catheter Ablation; Humans; Pain; Quality of Life; Radiofrequency Ablation; Reproducibility of Results; Retrospective Studies; Spinal Neoplasms; Treatment Outcome; Vertebroplasty
PubMed: 34715849
DOI: 10.1186/s12891-021-04799-0 -
European Journal of Orthopaedic Surgery... Dec 2020Metastatic spinal lesions are diseases that impair the quality of life and require early diagnosis and treatment. The count of spinal metastasis patients rises day by...
BACKGROUND
Metastatic spinal lesions are diseases that impair the quality of life and require early diagnosis and treatment. The count of spinal metastasis patients rises day by day. Increased life expectancy has increased the incidence of cancer, making metastases more observable. The aim of our study was to investigate how the quality of life is affected in the patient group with vertebral fracture due to spinal metastases of multiple myeloma and undergoing vertebroplasty and kyphoplasty.
MATERIALS AND METHODS
Forty-two patients with fracture due to spinal metastasis and adequate follow-up between the years of 2011 and 2018 were included in the study. Patients were listed according to their primary malignancy and metastases. The effect of vertebroplasty and kyphoplasty was investigated by evaluating preoperative and postoperative VAS and Oswestry Disability Index scores. All patients' radiographic kyphosis angle, compression ratio and wedging index were calculated before operation and after operation.
RESULTS
A total of 76 vertebrae were operated in 42 patients. Significant differences were found in the comparison of preoperative and postoperative quality of life according to VAS and Oswestry Disability Index scores in the patients undergoing vertebroplasty, kyphoplasty or both procedures after spinal metastases (VAS; p = 0.0001, ODI; p = 0.002/0.0001). There were statistically significant differences in preoperative local kyphosis angle, compression ratio and wedging index and post-op local kyphosis angle, compression ratio and wedging index (p = 0.001).
CONCLUSION
Vertebroplasty and kyphoplasty, minimally invasive procedures performed after spinal metastases, improve the quality of life of the patients.
Topics: Fractures, Compression; Humans; Kyphoplasty; Lumbar Vertebrae; Multiple Myeloma; Osteoporotic Fractures; Pain Measurement; Quality of Life; Spinal Fractures; Spinal Neoplasms; Treatment Outcome; Vertebroplasty
PubMed: 32591912
DOI: 10.1007/s00590-020-02721-3 -
Zhongguo Gu Shang = China Journal of... Aug 2021Taking the classic bilateral puncture vertebroplasty as a reference, to evaluate the clinical efficacy of vertebroplasty of the curved-angle puncture device, analyze the...
OBJECTIVE
Taking the classic bilateral puncture vertebroplasty as a reference, to evaluate the clinical efficacy of vertebroplasty of the curved-angle puncture device, analyze the radiation exposure of patients and surgeons during the operation and summarize the protective measures.
METHODS
The clinical data of 49 patients with osteoporotic vertebral compression fractures admitted from March 2018 to September 2019 were retrospectively analyzed. According to the different surgical puncture methods, 49 patients were divided into vertebroplasty group (using classic bilateral puncture) and curved vertebroplasty group (using curved angle puncture). Among them, there were 26 cases in vertebroplasty group, including 7 males and 19 females, aged (73.25±6.36) years, 2 cases in thoracic segment, 21 cases in thoracolumbar segment, and 3 cases in lumbar segment. In curved vertebroplasty group, there were 23 cases, including 6 males and 17 females, aged (73.09±6.52) years, 3 cases in thoracic segment, 19 cases in thoracolumbar segment, and 1 case in lumbar segment. The operation time and the amount of injected bone cement in the two groups were recorded. Visual analogue scale (VAS) and modified Oswestry Disability Index (ODI) were respectively used to assess the pain degree and lumbar function, the postoperative bone cement leakage or other complications were observed. The radiation doses of the two groups of patients and surgeons were compared.
RESULTS
All 49 patients were followed up for 10-22 (14.55±3.83) months. Eleven cases in vertebroplasty group and 9 cases in curved vertebroplasty group occurred bone cement leakage after surgery, and there was no statistically significant difference between two groups. VAS scores of vertebroplasty group were 6.23±0.68 before operation and 1.69±0.47 at 1 day after operation, respectively, modified ODI were (72.59±3.25)% and (33.59±2.85)%. The preoperative and postoperative VAS scores of curved vertebroplasty group were 6.46±0.56 and 1.57±0.49, respectively, modified ODI were (73.21±3.18)% and (33.17±2.37)%. The postoperative pain degree and lumbar function of the two groups were significantly improved, but the difference between the groups was not statistically significant. The operation time of curved vertebroplasty group and vertebroplasty group were (17.27±9.58) min and(23.19±8.56) min, and the amount of injected bone cement were (4.91±1.49) ml and (6.58±1.42) ml. Obviously, curved vertebroplasty group has more advantages in operation time and the amount of injected bone cement. In curved vertebroplasty group, the radiation dose of the operator was (0.53±0.05) mSv and the patient was (10.64±1.65) mSv;in vertebroplasty group, the operator was (0.59±0.08) mSv andthe patient was (13.52±1.81) mSv. The radiation dose of patients in curved vertebroplasty group was significantly lower than that of the vertebroplasty group, but there was no statistically significant difference in the operator between two groups.
CONCLUSION
Both puncture methods can achieve satisfactory clinical results, but curved angle puncture can optimize the distribution of bone cement and reduce the radiation dose of patients.
Topics: Female; Fractures, Compression; Humans; Male; Radiation Exposure; Retrospective Studies; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 34423615
DOI: 10.12200/j.issn.1003-0034.2021.08.007 -
Orthopaedic Surgery Aug 2020To explore the effect of bone cement distribution, cement leakage, and clinical outcomes with side-opening cannula for bone cement injection in percutaneous... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To explore the effect of bone cement distribution, cement leakage, and clinical outcomes with side-opening cannula for bone cement injection in percutaneous vertebroplasty (PVP) in treatment of Kummell disease.
METHODS
A prospective study of patients with Kummell disease undergoing PVP was conducted from April 2012 to September 2017. In total, 43 patients (11 males, 32 females) with Kummell disease who received bilateral PVP were included in the study. The patients were divided into front-opening cannulas (FOC) group with front-opening cannulas and side-opening cannulas (SOC) group with side-opening cannulas. All patients were followed up for 6 months. The patient general information such as gender, age, bone density, compression ratio, operative time, and location of fracture vertebrae were recorded. Visual analogue scale (VAS), Oswestry Disability Index (ODI), bone cement distribution, radiation exposure time, bone cement leakage rate and vertebral height, and kyphosis angle were measured and compared for two groups before surgery, 1 day and 6 months after surgery.
RESULTS
A total of 43 patients were enrolled, including 11 males and 32 females, aged 61-84 years. The bone density (T value) was 2.5 ± 0.6 in FOC group and 2.4 ± 0.6 in SOC group (P > 0.05). The compression ratio and operative time were 36.1% ± 13.0%, 39.3 ± 7.9 min in FOC group and 35.2% ± 13.7%, 40.0 ± 10.7 min in SOC group (P > 0.05). There was no significance between FOC and SOC groups in the location of fracture vertebrae. All patients underwent at least 6 months of follow-up. At 6 months postoperatively, the VAS and ODI were significantly higher in the FOC group (3.0 ± 0.8, 35.7% ± 2.1%) than in the SOC group (1.3 ± 0.4, 18.6% ± 2.4%) (P < 0.05). The cement leakage rate of the SOC group was 4.8%, which was lower than that of the FOC group (31.8%, P < 0.05), and the bone cement distribution ratio was higher than that of the FOC group (63.1% ± 7.9% vs 40.5% ± 8.6%, P < 0.05). At 6 months after operation, the height of the anterior and posterior vertebral bodies of the patients in the SOC group restored better than the FOC group (anterior SOC: FOC 5.1 ± 0.5 mm vs 4.5 ± 0.5 mm; posterior SOC: FOC 0.6 ± 0.1 mm vs 0.3 ± 0.1 mm, P < 0.05), and the kyphosis correction was more obvious than patients in FOC group (SOC: FOC 8.5° ± 1.4° vs 4.6° ± 0.8°, P < 0.05).
CONCLUSION
Percutaneous vertebroplasty with side-opening cannula is safe and effective in avoiding bone cement leakage, improving bone cement distribution, and restoring vertebral height.
Topics: Aged; Aged, 80 and over; Disability Evaluation; Female; Fractures, Compression; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Osteoporotic Fractures; Pain Measurement; Prospective Studies; Spinal Fractures; Vertebroplasty
PubMed: 32638545
DOI: 10.1111/os.12730 -
Acta Orthopaedica Et Traumatologica... Jul 2022The aim of this study was to report the results of percutaneous vertebroplasty in managing symptomatic osteolytic cervical spine tumors.
OBJECTIVE
The aim of this study was to report the results of percutaneous vertebroplasty in managing symptomatic osteolytic cervical spine tumors.
METHODS
This study comprised a retrospective examination of patients who received percutaneous vertebroplasty between 2008 and 2020 for the treatment of tumor-induced symptomatic cervical vertebra involvement. The study summarized the demographics, vertebral levels, pain control rates, clinical results, and complications of percutaneous vertebroplasty using an anterolateral approach.
RESULTS
The study sample consisted of 6 female and 2 male patients aged between 20 and 56 (mean=41.37) years. Tumors were located at C2 in 6 cases, at C3 in 1 case, and at C5 in another. The mean volume of poly (methyl methacrylate) injected was 1.5 mL (range: 1-2 mL). Biopsy results showed the presence of metastasis in 5 cases and plasmacytoma in 3. No postoperative complications or mortality were observed after the procedure. Preoperative mean 7.75 visual analog scale score decreased to 2.62. Pain control was reported to be 66.2%.
CONCLUSION
Anterolateral cervical vertebroplasty seems to be a safe, effective, and helpful therapeutic alternative for the treatment of cervical spine tumors. It reduces the risk of infection compared to the transoral method.
LEVEL OF EVIDENCE
Level IV, Therapeutic Study.
Topics: Adult; Cervical Vertebrae; Female; Humans; Male; Middle Aged; Pain; Polymethyl Methacrylate; Retrospective Studies; Spinal Neoplasms; Vertebroplasty; Young Adult
PubMed: 35968618
DOI: 10.5152/j.aott.2022.22035 -
Current Pain and Headache Reports Apr 2020To review the utilization patterns of vertebral augmentation procedures in the US Medicare population from 2004 to 2017 surrounding concurrent developments in the... (Comparative Study)
Comparative Study Review
PURPOSE OF REVIEW
To review the utilization patterns of vertebral augmentation procedures in the US Medicare population from 2004 to 2017 surrounding concurrent developments in the literature and the enactment of the Affordable Care Act (ACA).
RECENT FINDINGS
The analysis of vertebroplasty and kyphoplasty utilization patterns was carried out using specialty utilization data from the Centers for Medicare and Medicaid Services Database. Of note, over the period of time between 2009 and 2017, the number of people aged 65 or older showed a 3.2% rate of annual increase, and the number of Medicare beneficiaries increased by 27.6% with a 3.1% rate of annual increase. Concurrently, vertebroplasty utilization decreased 72.8% (annual decline of 15% per 100,000 Medicare beneficiaries), and balloon kyphoplasty utilization decreased 19% (annual decline of 2.6% per 100,000 Medicare beneficiaries). This translates to a 38.3% decrease in vertebroplasty and balloon kyphoplasty utilization (annual decline of 5.9% per 100,000 Medicare beneficiaries) from 2009 to 2017. By contrast, from 2004 to 2009, there was a total 188% increase in vertebroplasty and balloon kyphoplasty utilization (annual increase rate of 23.6% per 100,000 Medicare beneficiaries). The majority of vertebroplasty procedures were done by radiologists, and the majority of kyphoplasties were done by aggregate groups of spine surgeons. These results illustrate a significant decline in vertebral augmentation procedures in the fee-for-service Medicare population between 2004 and 2017, with dramatic decreases following the publication of two 2009 trials that failed to demonstrate benefit of vertebroplasty over sham and the enactment of the ACA.
Topics: Fractures, Compression; Humans; Medicare; Patient Protection and Affordable Care Act; Randomized Controlled Trials as Topic; Spinal Fractures; United States; Vertebroplasty
PubMed: 32291587
DOI: 10.1007/s11916-020-00850-2 -
Orthopedics Jan 2021This study investigated the effect of bone mineral density (BMD) on the diffusion coefficient (DC) of bone cement in percutaneous vertebroplasty (PVP) and the...
This study investigated the effect of bone mineral density (BMD) on the diffusion coefficient (DC) of bone cement in percutaneous vertebroplasty (PVP) and the correlation between the DC and the efficacy after PVP. This was a retrospective study of PVP cases with follow-up longer than 12 months. The cases were assigned to 3 groups according to the BMD: BMD decrease group, osteoporosis group, and severe osteoporosis group. The 3 groups were compared regarding bone cement injection volume (IV), diffusion volume (DV), DC, visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, and vertebral height loss ratio (VHLR). The correlation between DC and BMD, IV, DV, and VHLR was analyzed. The least significant difference test was used for comparison among the 3 groups, and the Pearson correlation coefficient was used for correlation analysis. There were a total of 132 cases, including 34 males and 98 females with a mean age of 76.5±9.6 years. The DV was larger than the IV in each group (P<.05). There was no statistically significant difference in the IV, VAS score, and ODI among the 3 groups (P>.05). However, there were significant differences in the DC and VHLR among the 3 groups (P<.05). Correlation analysis showed that there were significant correlations between BMD and IV (-0.716), BMD and DC (0.754), IV and DV (0.502), and IV and DC (-0.666) (P<.01). Scatter plot showed that the correlation between IV and BMD was r=0.716, R=0.513, and the correlation between DC and BMD was r=0.754, R=0.568. The DV was larger than the IV in PVP, and BMD was closely related to the DC. The higher the BMD, the higher the DC. Short-term follow-up revealed that the DC was inversely proportional to the VHLR. [Orthopedics. 2021;44(1):e95-e100.].
Topics: Aged; Aged, 80 and over; Bone Cements; Bone Density; Female; Fractures, Compression; Humans; Male; Osteoporotic Fractures; Retrospective Studies; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 33089333
DOI: 10.3928/01477447-20201009-02 -
Scientific Reports Feb 2021Severe osteoporotic vertebral compression fractures (OVCFs) were considered as relative or even absolute contraindication for vertebroplasty and kyphoplasty and these...
Severe osteoporotic vertebral compression fractures (OVCFs) were considered as relative or even absolute contraindication for vertebroplasty and kyphoplasty and these relevant reports are very limited. This study aimed to evaluate and compare the efficacy of vertebroplasty with high-viscosity cement and conventional kyphoplasty in managing severe OVCFs. 37 patients of severe OVCFs experiencing vertebroplasty or kyphoplasty were reviewed and divided into two groups, according to the procedural technique, 18 in high-viscosity cement percutaneous vertebroplasty (hPVP) group and 19 in conventional percutaneous kyphoplasty (cPKP) group. The operative time, and injected bone cement volume were recorded. Anterior vertebral height (AVH), Cobb angle and cement leakage were also evaluated in the radiograph. The rate of cement leakage was lower in hPVP group, compared with cPKP group (16.7% vs 47.4%, P = 0.046). The patients in cPKP group achieved more improvement in AVH and Cobb angle than those in hPVP group postoperatively (37.2 ± 7.9% vs 43.0 ± 8.9% for AVH, P = 0.044; 15.5 ± 4.7 vs 12.7 ± 3.3, for Cobb angle, P = 0.042). At one year postoperatively, there was difference observed in AVH between two groups (34.1 ± 7.4 vs 40.5 ± 8.7 for hPVP and cPKP groups, P = 0.021), but no difference was found in Cobb angle (16.6 ± 5.0 vs 13.8 ± 3.8, P = 0.068). Similar cement volume was injected in two groups (2.9 ± 0.5 ml vs 2.8 ± 0.6 ml, P = 0.511). However, the operative time was 37.8 ± 6.8 min in the hPVP group, which was shorter than that in the cPKP group (43.8 ± 8.2 min, P = 0.021). In conclusion, conventional PKP achieved better in restoring anterior vertebral height and improving kyphotic angle, but PVP with high-viscosity cement had lower rate of cement leakage and shorter operative time with similar volume of injected cement.
Topics: Aged; Aged, 80 and over; Bone Cements; Female; Fractures, Compression; Humans; Kyphoplasty; Lumbar Vertebrae; Male; Operative Time; Osteoporotic Fractures; Retrospective Studies; Spinal Fractures; Thoracic Vertebrae; Vertebroplasty; Viscosity
PubMed: 33633366
DOI: 10.1038/s41598-021-84314-6 -
Zhongguo Gu Shang = China Journal of... May 2022To compare the efficacy between vesselplasty and percutanous kyphoplasty (PKP) in the treatment of Kümmell disease.
OBJECTIVE
To compare the efficacy between vesselplasty and percutanous kyphoplasty (PKP) in the treatment of Kümmell disease.
METHODS
The clinical data of patients with Kümmell disease from July 2018 to December 2019 were retrospectively analyzed. According to the different therapeutic methods, the patients were divided into vesselplasty group and PKP group. There were 20 patients in vesselplasty group, including 2 males and 18 females, aged from 54 to 83 years with an average of (67.40±7.44)years, 1 case of T fracture, 3 cases of T fracture, 9 cases of L fractures, 5 cases of L fractures and 2 cases of L fractures. There were 20 patients in PKP group, including 3 males and 17 females, aged from 56 to 81 with an average of(67.20±7.01) years, 2 cases of T fracture, 1 case of T fracture, 6 cases of T fracture, 10 cases of L fracture and 1 case of L fracture. Visual analogue scale(VAS), Cobb angle, anterior vertebral height were recorded before operation, 1 day after operation and 1 year after operation. Oswestry Disability Index(ODI) was recorded before operation, 1 month after operation and 1 year after operation. And bone cement leakage rate was compared between two groups after operation.
RESULTS
All the patient were followed up for more than 1 year. In vesselplasty group, VAS score was 1.20±0.41, ODI was(13.50±3.10)%, Cobb angle was(17.20±3.12)° and anterior vertebral height was(20.20±1.35) mm at 1 year after operation. In PKP group, VAS score was 1.15±0.40, ODI was (13.20±3.00)%, Cobb angle was (17.10±3.19)° and anterior vertebral height was (20.10±1.37) mm at 1 year after operation. These index was significantly better than pre-operation through intra-group comparison(<0.05), and there was no statistically difference between the two groups(>0.05). There were 20 cases (20 vertebrae) in vesselplasty group, of which 1 case had bone cement leakage at the upper endplate, with a leakage rate of 5%(1/20). In PKP group, there were 20 cases (20 vertebrae), 3 cases of upward endplate leakage(3/7), 1 case of downward endplate leakage(1/7), 1 case of leakage to the front of the vertebral body(1/7), 2 cases of leakage to the side of the vertebral body(2/7), with a leakage rate of 35% (7/20). The difference between two groups was statistically significant(<0.05).
CONCLUSION
Vesselplasty in the treatment of Kümmell disease can better reduce leakage rate of bone cement and reduce complications.
Topics: Bone Cements; Female; Fractures, Compression; Humans; Kyphoplasty; Male; Osteoporotic Fractures; Retrospective Studies; Spinal Fractures; Spondylosis; Treatment Outcome; Vertebroplasty
PubMed: 35535530
DOI: 10.12200/j.issn.1003-0034.2022.05.005 -
Radiology Apr 2020Background Osteoporotic vertebral compression fractures (OVCFs) are prevalent, with associated morbidity and mortality. Vertebral augmentation (VA), defined as either... (Meta-Analysis)
Meta-Analysis
Mortality Outcomes of Vertebral Augmentation (Vertebroplasty and/or Balloon Kyphoplasty) for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis.
Background Osteoporotic vertebral compression fractures (OVCFs) are prevalent, with associated morbidity and mortality. Vertebral augmentation (VA), defined as either vertebroplasty and/or balloon kyphoplasty (BKP), is a minimally invasive surgical treatment to reduce pain and further collapse and/or renew vertebral body height by introducing bone cement into fractured vertebrae. Nonsurgical management (NSM) for OVCF carries inherent risks. Purpose To summarize the literature and perform a meta-analysis on the mortality outcomes of patients with OVCF treated with VA compared with those in patients treated with NSM. Materials and Methods A single researcher performed a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines. Online scientific databases were searched in April 2018 for English-language publications. Included studies investigated mortality in patients with OVCF with VA as the primary intervention and NSM as the comparator. A meta-analysis was performed for studies that reported hazard ratios (HRs) and 95% confidence intervals (CIs). HR was used as a summary statistic and was random-effect-models tested. The χ test was used to study heterogeneity between trials, and the statistic was calculated to estimate variation across studies. Results Of the 16 included studies, eight reported mortality benefits in VA, seven reported no mortality difference, and one reported mixed results. Seven studies were included in a meta-analysis examining findings in more than 2 million patients with OVCF (VA = 382 070, NSM = 1 707 874). The pooled HR comparing VA to NSM was 0.78 (95% CI: 0.66, 0.92; = .003), with mortality benefits across 2- and 5-year periods (HR = 0.70, 95% CI: 0.69, 0.71, < .001; and HR = 0.79, 95% CI: 0.62, 0.9999, = .05; respectively). Balloon kyphoplasty provided mortality benefits over vertebroplasty, with HRs of 0.77 (95% CI: 0.77, 0.78; < .001) and 0.87 (95% CI: 0.87, 0.88; < .001), respectively. Conclusion In a meta-analysis of more than 2 million patients, those with osteoporotic vertebral compression fractures who underwent vertebral augmentation were 22% less likely to die at up to 10 years after treatment than those who received nonsurgical treatment. © RSNA, 2020 See also the editorial by Jennings in this issue.
Topics: Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Spinal Fractures; Vertebroplasty
PubMed: 32068503
DOI: 10.1148/radiol.2020191294