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BMJ (Clinical Research Ed.) Jun 2008Consensus on the indications is needed to avoid indiscriminate use
Consensus on the indications is needed to avoid indiscriminate use
Topics: Humans; Osteoporosis; Spinal Fractures; Vertebroplasty
PubMed: 18535035
DOI: 10.1136/bmj.a178 -
Current Opinion in Anaesthesiology Aug 2008Vertebroplasty, kyphoplasty and lordoplasty are minimally invasive procedures mainly performed for refractory pain due to osteoporotic vertebral body fractures. This... (Review)
Review
PURPOSE OF REVIEW
Vertebroplasty, kyphoplasty and lordoplasty are minimally invasive procedures mainly performed for refractory pain due to osteoporotic vertebral body fractures. This review summarizes recent findings on outcome, complications and their impact on anesthetic management.
RECENT FINDINGS
Despite an increasing number of publications on surgical technique, therapeutic efficacy and side effects of these interventions, anesthetic management per se is hardly investigated. All three treatments provide similar pain relief. Adverse effects include local cement leakage and new fractures adjacent to augmented vertebrae. Asymptomatic pulmonary cement embolism occurs in 4.6-6.8% of patients depending on cement viscosity, injection pressure and number of injected vertebrae. Potentially life-threatening embolism of cement or fat may occur. Kyphoplasty and lordoplasty aim at correcting vertebral deformity and are equally effective; lordoplasty is substantially less expensive, however. The incidence of systemic cement or fat embolism is similar to that in vertebroplasty. Whereas vertebroplasty is mostly performed under local anesthesia and sedation, general anesthesia is required for kyphoplasty and lordoplasty. The anesthetic regimen follows the principles of anesthesia in the elderly population.
SUMMARY
Vertebroplasty, kyphoplasty and lordoplasty are effective minimally invasive treatments for stable vertebral compression fractures without compression of the spinal canal. The anesthesiologist must be prepared to manage systemic cement or fat embolism.
Topics: Anesthesiology; Embolism; Fractures, Bone; Fractures, Compression; Humans; Minimally Invasive Surgical Procedures; Pain; Spine; Vertebroplasty
PubMed: 18660662
DOI: 10.1097/ACO.0b013e328303be62 -
World Neurosurgery May 2017Cement leakage is the most common complication of vertebroplasty and kyphoplasty. So far, the reported risk factors remain conflicting because of limited data and lack... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cement leakage is the most common complication of vertebroplasty and kyphoplasty. So far, the reported risk factors remain conflicting because of limited data and lack of uniform measurement and evaluation. Here, we performed a systematic review and meta-analysis of potential risk factors for cement leakage after vertebroplasty or kyphoplasty.
METHODS
Relevant literature was retrieved using PubMed, EMBASE, Cochrane Controlled Trial Register, and MEDLINE with no language restriction, supplemented by a hand search of the reference lists of selected articles. A fixed-effects model was used if homogeneity existed among included studies; otherwise, a random-effects model was used. The results were presented with weighted mean difference for continuous outcomes and odds ratio (OR) for dichotomous outcomes with a 95% confidence interval (CI).
RESULTS
Twenty-two studies consisting of 2872 patients with 4187 vertebrae were included in the meta-analysis. The incidences of cement leakage for percutaneous vertebroplasty and percutaneous balloon kyphoplasty were 54.7% and 18.4%, respectively. The significant risk factors for new vertebral compression fractures were intravertebral cleft (OR, 1.40; 95% CI, 1.09-1.78; P < 0.01), cortical disruption (OR, 5.56; 95% CI, 1.84-16.81; P < 0.01), cement viscosity (OR, 3.32; 95% CI, 1.36-8.07; P < 0.01) and injected cement volume (weighted mean difference, 0.59; 95% CI, 0.02-1.17; P < 0.05). Age, sex and fracture type, operation level, and surgical approach were not significant risk factors.
CONCLUSIONS
The results of this meta-analysis suggest that patients with intravertebral cleft, cortical disruption, low cement viscosity, and high volume of injected cement may be at high risk for cement leakage after vertebroplasty or kyphoplasty. Rigorous patient selection and individual therapeutic strategy irrespective of age, sex and fracture type, operation level, and surgical approach may reduce the occurrence of cement leakage. Given the inherent limitation of the meta-analysis, more large sample-sized randomized controlled trials are needed to further validate the present findings.
Topics: Bone Cements; Clinical Trials as Topic; Extravasation of Diagnostic and Therapeutic Materials; Fractures, Compression; Humans; Kyphoplasty; Risk Factors; Treatment Outcome; Vertebroplasty
PubMed: 28192270
DOI: 10.1016/j.wneu.2017.01.124 -
Ontario Health Technology Assessment... 2016Untreated vertebral compression fractures can have serious clinical consequences and impose a considerable impact on patients' quality of life and on caregivers. Since... (Review)
Review
BACKGROUND
Untreated vertebral compression fractures can have serious clinical consequences and impose a considerable impact on patients' quality of life and on caregivers. Since non-surgical management of these fractures has limited effectiveness, vertebral augmentation procedures are gaining acceptance in clinical practice for pain control and fracture stabilization. The objective of this analysis was to determine the cost-effectiveness and budgetary impact of kyphoplasty or vertebroplasty compared with non-surgical management for the treatment of vertebral compression fractures in patients with cancer.
METHODS
We performed a systematic review of health economic studies to identify relevant studies that compare the cost-effectiveness of kyphoplasty or vertebroplasty with non-surgical management for the treatment of vertebral compression fractures in adults with cancer. We also performed a primary cost-effectiveness analysis to assess the clinical benefits and costs of kyphoplasty or vertebroplasty compared with non-surgical management in the same population. We developed a Markov model to forecast benefits and harms of treatments, and corresponding quality-adjusted life years and costs. Clinical data and utility data were derived from published sources, while costing data were derived using Ontario administrative sources. We performed sensitivity analyses to examine the robustness of the results. In addition, a 1-year budget impact analysis was performed using data from Ontario administrative sources. Two scenarios were explored: (a) an increase in the total number of vertebral augmentation procedures performed among patients with cancer in Ontario, maintaining the current proportion of kyphoplasty versus vertebroplasty; and (b) no increase in the total number of vertebral augmentation procedures performed among patients with cancer in Ontario but an increase in the proportion of kyphoplasties versus vertebroplasties.
RESULTS
The base case considered each of kyphoplasty and vertebroplasty versus non-surgical management. Kyphoplasty and vertebroplasty were associated with an incremental cost-effectiveness ratio of $33,471 and $17,870, respectively, per quality-adjusted life-year gained. The budgetary impact of funding vertebral augmentation procedures for the treatment of vertebral compression fractures in adults with cancer in Ontario was estimated at about $2.5 million in fiscal year 2014/15. More widespread use of vertebral augmentation procedures raised total expenditures under a number of scenarios, with costs increasing by $67,302 to $913,386.
CONCLUSIONS
Our findings suggest that the use of kyphoplasty or vertebroplasty in the management of vertebral compression fractures in patients with cancer may be a cost-effective strategy at commonly accepted willingness-to-pay thresholds. Nonetheless, more widespread use of kyphoplasty (and vertebroplasty to a lesser extent) would likely be associated with net increases in health care costs.
Topics: Budgets; Cost-Benefit Analysis; Fractures, Compression; Humans; Kyphoplasty; Markov Chains; Models, Economic; Neoplasms; Ontario; Quality of Life; Quality-Adjusted Life Years; Vertebroplasty
PubMed: 27293494
DOI: No ID Found -
BMJ (Clinical Research Ed.) Jul 2011
Topics: Back Pain; Female; Fractures, Compression; Humans; Male; Spinal Fractures; Vertebroplasty
PubMed: 21750076
DOI: 10.1136/bmj.d3470 -
European Spine Journal : Official... Apr 2024Osteoporotic vertebral compression fractures affect a large number of elderly people and cause significant issues with pain and mobility. Percutaneous vertebroplasty... (Review)
Review
BACKGROUND
Osteoporotic vertebral compression fractures affect a large number of elderly people and cause significant issues with pain and mobility. Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are employed to treat those who remain symptomatic, with comparable clinical outcomes. Although PVP is faster and less expensive, concerns around cement-leakage complications make PKP perceptively safer.
METHODS
By means of systematic review, we sought to ascertain whether PVP did carry a higher risk of cement-leakage and associated symptomatic complications (neural compromise, pulmonary embolism and need for emergency decompression surgery).
RESULTS
Our search of 138 articles returned six studies after shortlisting and manual review: three randomised-controlled trials, and three retrospective comparative studies which met our criteria and directly compared cement-leakage rates and complications between the two treatments. 532 PVPs and 493 PKPs recorded 213 (39.3%) and 143 (28.9%) leaks, respectively (p < 0.0005). Of these, no leaks resulted in any of the aforementioned leak-related complications. No meta-analysis was performed due to heterogeneity of the data.
CONCLUSIONS
We therefore concluded that whilst PVP does result in more cement leaks, this does not appear to be clinically significant. Further studies would add weight to this conclusion, and cost-effectiveness should be assessed to restore confidence in PVP.
LEVEL OF EVIDENCE
Level III Evidence.
Topics: Humans; Aged; Kyphoplasty; Fractures, Compression; Retrospective Studies; Clinical Relevance; Spinal Fractures; Osteoporotic Fractures; Treatment Outcome; Vertebroplasty; Bone Cements
PubMed: 37999769
DOI: 10.1007/s00586-023-08026-3 -
Acta Bio-medica : Atenei Parmensis Jun 2022Vertebroplasty consists of injection under image guidance of a cement polymer, commonly polymethylmethacrylate, into the vertebral body to improved stability....
Vertebroplasty consists of injection under image guidance of a cement polymer, commonly polymethylmethacrylate, into the vertebral body to improved stability. Vertebroplasty is essentially safety. However whether vertebral compression or (micro)fractures occur during the procedure, the high vascularization and the anatomic network of the paravertebral and extradural venous plexuses, can facilitate migration of cement fragments into the systemic venous circulation. We described the case of cement pulmonary embolism in a 75-year-old-female after vertebloplasty. A chest CT scan showed a multiple and spontaneus hyperdensities suggesting cement pulmonary-emboli. There are different therapeutic approach depending of the clinical severity. For asymptomatic patients clinical surveillance or prophylactic LMWH. Active treatment has been suggested only for symptomatic cases.
Topics: Aged; Bone Cements; Female; Heparin, Low-Molecular-Weight; Humans; Pulmonary Embolism; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 35674479
DOI: 10.23750/abm.v93iS1.9425 -
Chang Gung Medical Journal 2011Vertebral compression fracture is the most common complication of osteoporosis. It may result in persistent severe pain and limited mobility, and significantly impact... (Review)
Review
Vertebral compression fracture is the most common complication of osteoporosis. It may result in persistent severe pain and limited mobility, and significantly impact the quality of life. Conservative therapy using external bracing, bed rest and analgesics is necessary for pain control in these patients. However, some patients may experience protracted or ongoing pain even with these measures. Surgical treatment is indicated when conservative treatment fails, or in patients with spinal instability or neurologic deficit. Elderly patients often have comorbilities, and because of osteoporosis, high risk of postoperative complications such as implant loosening, and further adjacent fractures. Vertebroplasty involves a percutaneous injection of bone cement into the collapsed vertebrae under fluroscopic imaging guidance. It was first reported in 1987 for the management of a painful, aggressive hemangioma of a vertebral body. Since then, vertebroplasty has been widely accepted for the treatment of vertebral osteoporotic compression fractures without neurological damage. This article summarizes the advances in vertebroplasty, and discusses the indications, technique, alternative methods, results and complications. The contents include a review of the supporting evidence to provide a comparison of the safety and efficacy of vertebroplasty and kyphoplasty.
Topics: Bone Cements; Contraindications; Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Prone Position; Spinal Fractures; Vertebroplasty
PubMed: 21880189
DOI: No ID Found -
JAMA Internal Medicine Feb 2014
Topics: Female; Humans; Kyphoplasty; Male; Osteoporotic Fractures; Spinal Fractures; Vertebroplasty
PubMed: 24493619
DOI: 10.1001/jamainternmed.2013.13025 -
Medical Engineering & Physics Oct 2023The evolution of polymethyl methacrylate (PMMA) based bone cement (BC) from plexiglass to a biomaterial has revolutionized the joint and vertebral arthroplasties field.... (Review)
Review
The evolution of polymethyl methacrylate (PMMA) based bone cement (BC) from plexiglass to a biomaterial has revolutionized the joint and vertebral arthroplasties field. This widely used grouting material possesses exceptional properties for medical applications, including excellent biocompatibility, impressive mechanical strength, and favorable handling characteristics. PMMA-based BC is preferred in challenging conditions such as osteoporotic vertebral compression fractures, scoliosis, vertebral hemangiomas, spinal metastases, and myelomas, where it is crucial in withstanding stress. This review aims to comprehensively analyze the available reports and guide further research toward enhanced formulations of vertebral BC, focusing on its osteoconductive and mechanical properties. Furthermore, the review emphasizes the significant impact of BC's mechanical properties and osteoconductivity on the success and longevity of vertebroplasty procedures.
Topics: Humans; Polymethyl Methacrylate; Bone Cements; Fractures, Compression; Spinal Fractures; Vertebroplasty
PubMed: 37838402
DOI: 10.1016/j.medengphy.2023.104049