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Current Pain and Headache Reports Aug 2009Percutaneous vertebroplasty is the injection of bone cement, usually polymethylmethacrylate into the vertebral body. This procedure is most often performed in a... (Review)
Review
Percutaneous vertebroplasty is the injection of bone cement, usually polymethylmethacrylate into the vertebral body. This procedure is most often performed in a percutaneous fashion on an outpatient (or short-stay) basis. Among other indications, the procedure is designated for painful vertebral compression fractures due to primary or metastatic spinal tumors. Published literature favors the use of this procedure in cancer pain management. The overall risk of the procedure is low, although serious complications (including spinal cord compression) can occur. Recent advances in technique and materials may reduce the incidence of adverse outcomes. Proper patient selection and meticulous technique are required to achieve best results and to avoid complications.
Topics: Animals; Disease Management; Humans; Pain; Pain Measurement; Spinal Neoplasms; Vertebroplasty
PubMed: 19586592
DOI: 10.1007/s11916-009-0046-5 -
Cancer Control : Journal of the Moffitt... Apr 2014Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed in the treatment of pathological vertebral fractures. (Review)
Review
BACKGROUND
Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed in the treatment of pathological vertebral fractures.
METHODS
A critical review of the medical literature was performed and controversial issues were analyzed.
RESULTS
Evidence supports KP as the treatment of choice to control fracture pain and the possible restoration of sagittal balance, provided that no overt instability or myelopathy is present, the fracture is painful and other pain generators have been excluded, and positive radiological findings are present. Unilateral procedures yield similar results to bilateral ones and should be pursued whenever feasible. Biopsy should be routinely performed and 3 to 4 levels may be augmented in a single operation. Higher cement filling appears to yield better results. Radiotherapy is complementary with KP and VP but must be individualized.
CONCLUSIONS
In cases of painful cancer fractures, if overt instability or myelopathy is not present, unilateral KP should be pursued, whenever feasible, followed by radiotherapy. The technological advances in hardware and biomaterials, as well as combining KP with other modalities, will help ensure a safe and more effective procedure. Address.
Topics: Humans; Kyphoplasty; Spinal Fractures; Spinal Neoplasms; Treatment Outcome; Vertebroplasty
PubMed: 24667402
DOI: 10.1177/107327481402100208 -
Ontario Health Technology Assessment... 2016Cancers that metastasize to the spine and primary cancers such as multiple myeloma can result in vertebral compression fractures or instability. Conservative strategies,... (Review)
Review
BACKGROUND
Cancers that metastasize to the spine and primary cancers such as multiple myeloma can result in vertebral compression fractures or instability. Conservative strategies, including bed rest, bracing, and analgesic use, can be ineffective, resulting in continued pain and progressive functional disability limiting mobility and self-care. Surgery is not usually an option for cancer patients in advanced disease states because of their poor medical health or functional status and limited life expectancy. The objectives of this review were to evaluate the effectiveness and safety of percutaneous image-guided vertebral augmentation techniques, vertebroplasty and kyphoplasty, for palliation of cancer-related vertebral compression fractures.
METHODS
We performed a systematic literature search for studies on vertebral augmentation of cancer-related vertebral compression fractures published from January 1, 2000, to October 2014; abstracts were screened by a single reviewer. For those studies meeting the eligibility criteria, full-text articles were obtained. Owing to the heterogeneity of the clinical reports, we performed a narrative synthesis based on an analytical framework constructed for the type of cancer-related vertebral fractures and the diversity of the vertebral augmentation interventions.
RESULTS
The evidence review identified 3,391 citations, of which 111 clinical reports (4,235 patients) evaluated the effectiveness of vertebroplasty (78 reports, 2,545 patients) or kyphoplasty (33 reports, 1,690 patients) for patients with mixed primary spinal metastatic cancers, multiple myeloma, or hemangiomas. Overall the mean pain intensity scores often reported within 48 hours of vertebral augmentation (kyphoplasty or vertebroplasty), were significantly reduced. Analgesic use, although variably reported, usually involved parallel decreases, particularly in opioids, and mean pain-related disability scores were also significantly improved. In a randomized controlled trial comparing kyphoplasty with usual care, improvements in pain scores, pain-related disability, and health-related quality of life were significantly better in the kyphoplasty group than in the usual care group. Bone cement leakage, mostly asymptomatic, was commonly reported after vertebroplasty and kyphoplasty. Major adverse events, however, were uncommon.
CONCLUSIONS
Both vertebroplasty and kyphoplasty significantly and rapidly reduced pain intensity in cancer patients with vertebral compression fractures. The procedures also significantly decreased the need for opioid pain medication, and functional disabilities related to back and neck pain. Pain palliative improvements and low complication rates were consistent across the various cancer populations and vertebral fractures that were investigated.
Topics: Fractures, Compression; Humans; Kyphoplasty; Neoplasm Metastasis; Neoplasms; Spinal Cord Compression; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 27298655
DOI: No ID Found -
Canadian Association of Radiologists... Aug 2012Vertebroplasty is a cost-effective procedure for the relief of pain in appropriately selected patients when performed by a skilled practitioner. The currently accepted... (Review)
Review
Vertebroplasty is a cost-effective procedure for the relief of pain in appropriately selected patients when performed by a skilled practitioner. The currently accepted indications and contraindications for vertebroplasty are reviewed. The techniques routinely used by the authors are presented, including a discussion of recognized complications. Recent controversy has highlighted weaknesses in the practice of technology evaluation, and more robust studies will be required to address these issues across the board in the future more scientifically than has been done in the past.
Topics: Catheter Ablation; Clinical Competence; Fluoroscopy; Humans; Patient Selection; Postoperative Complications; Radiography, Interventional; Spinal Diseases; Vertebroplasty
PubMed: 22717274
DOI: 10.1016/j.carj.2012.04.001 -
The Spine Journal : Official Journal of... Apr 2014Vertebroplasty is commonly performed for management of pain associated with vertebral compression fractures. There have been two previous reports of fatal fat embolism... (Review)
Review
BACKGROUND CONTEXT
Vertebroplasty is commonly performed for management of pain associated with vertebral compression fractures. There have been two previous reports of fatal fat embolism following vertebroplasty. Here we describe a case of fat embolism syndrome following this procedure, and also provide fluoroscopic video evidence consistent with this occurrence.
PURPOSE
The purpose of this study was to review the literature and report a case of fat embolism syndrome in a patient who underwent percutaneous vertebroplasty for compression fracture.
STUDY DESIGN/SETTING
The study design for this manuscript was of a clinical case report.
METHODS
A 68-year-old woman who developed sudden back pain with minimal trauma was found to have a T6 vertebral compression fracture on radiographs and bone scans. Percutaneous vertebroplasty of T5 and T6 was performed.
RESULTS
Fluoroscopic imaging during the procedure demonstrated compression and rarefaction of the fractured vertebra associated with changes in intrathoracic pressure. Immediately after the procedure, the patient's back pain resolved and she was discharged home. Two days later, she developed increasing respiratory distress, confusion, and chest pain. A petechial rash on her upper arms also appeared. No evidence of bone cement leakage or pulmonary filling defects were seen on computed tomography-pulmonary angiography. Brain magnetic resonance imaging demonstrated hyperintensities in the periventricular and subcortical white matter on T2/fluid-attenuated inversion recovery sequences. A diagnosis of fat embolism syndrome was made, and the patient recovered with conservative management.
CONCLUSIONS
Percutaneous vertebroplasty is a relatively safe and simple procedure, reducing pain and improving functional limitations in patients with vertebral fractures. This case demonstrates an uncommon yet serious complication of fat embolism syndrome. Clinicians must be aware of this complication when explaining the procedure to patients and provide prompt supportive care when it does occur.
Topics: Aged; Embolism, Fat; Female; Fluoroscopy; Fractures, Compression; Humans; Magnetic Resonance Imaging; Postoperative Complications; Spinal Fractures; Vertebroplasty
PubMed: 24314905
DOI: 10.1016/j.spinee.2013.09.021 -
Journal of Orthopaedic Surgery and... Sep 2019In recent years, short segment internal fixation combined with vertebroplasty (SSF + VP) has provided a new option for the treatment of Kummell disease (KD). The... (Review)
Review
BACKGROUND
In recent years, short segment internal fixation combined with vertebroplasty (SSF + VP) has provided a new option for the treatment of Kummell disease (KD). The purpose of this study is to evaluate the efficacy of percutaneous kyphoplasty (PKP) and SSF + VP, to provide evidence-based medical support for the decision-making process when treating KD patients without neurological deficits.
METHODS
Databases including MEDLINE (PubMed) and EMBASE (Ovid) (1947 to April 6, 2019) were searched for PKP and short-segmental fixation combined with vertebroplasty (SSF + VP) to treat Kummell disease in randomized controlled trials (RCTs) or cohort studies. Two investigators independently evaluated the eligibility of the studies retrieved from the databases based on the predetermined selection criteria. The postoperative evaluation indexes included operation time, bleeding volume, visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, local vertebral Cobb angle, and cement leakage. When the data were significant, a random-effects model was used for analysis. In contrast, when the results showed no statistical heterogeneity, a fixed-effects model was used to estimate the overall effect sizes.
RESULTS
Three retrospective case-control studies were included in the final analysis. The differences in the bleeding volume and operation time were statistically significant, and the combined weighted mean differences (WMDs) (95% CI) were - 0.204.46 (- 210.97, - 197.93) and - 98.98 (- 141.63, 56.32), respectively. The combined data showed that the differences in VAS score, ODI score, local vertebral Cobb angle, and cement leakage were not statistically significant.
CONCLUSIONS
This analysis demonstrates that the PKP and SSF + VP methods are safe and effective in treating Kummell disease patients without neurological symptoms. However, PKP can shorten the operation time and reduce the volume of blood loss.
Topics: Evidence-Based Medicine; Fracture Fixation, Internal; Fractures, Compression; Humans; Kyphoplasty; Operative Time; Osteoporotic Fractures; Research Design; Spinal Fractures; Vertebroplasty
PubMed: 31519177
DOI: 10.1186/s13018-019-1358-8 -
World Neurosurgery Jul 2023Hidden blood loss (HBL), as a perioperative complication of percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP), affects the quality of life of older... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Hidden blood loss (HBL), as a perioperative complication of percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP), affects the quality of life of older adults with poor health status, but it is often ignored by clinical surgeons. The purpose of this study was to discuss the risk factors for perioperative HBL through meta-analysis.
METHODS
We systematically searched PubMed, Embase, Cochrane Library, Web of Science, Scopus, Google Scholar, Chinese National Knowledge Infrastructure, and Wan Fang from establishment of the database to September 2022. All eligible studies regarding risk factors for HBL after PVP or PKP were included. Heterogeneity was assessed using the χ test and I statistic percentages. If I >50% or P < 0.1, the random-effect model was used; otherwise, the fixed-effect model was used. Data were analyzed with Revman 5.4 and Stata 16.0.
RESULTS
Eleven studies involving 1506 patients were included and the average HBL of PKP and PVP was 278.57 mL and 276.12mL. The results showed that bone cement leakage (P < 0.0001), thoracic vertebra (P < 0.00001), bilateral surgical approach (P = 0.0008), ≥2 fracture segments (P < 0.00001), vertebral body height loss rate (≥1/3) (P < 0.00001), and vertebral body height restoration rate (≥1/3) (P < 0.00001) were risk factors for increased HBL. Diabetes (P = 0.12) and hypertension (P = 0.52) were not significantly associated with HBL.
CONCLUSIONS
The findings of this meta-analysis suggested that fracture level, surgical approach, number of fracture levels, cement leakage, vertebral height loss and restoration rate were significant risk factors for HBL, which had certain guiding significance for clinical surgeons to take reasonable measures to deal with this complication.
Topics: Humans; Aged; Kyphoplasty; Fractures, Compression; Spinal Fractures; Quality of Life; Osteoporotic Fractures; Treatment Outcome; Vertebroplasty; Thoracic Vertebrae; Risk Factors; Retrospective Studies; Bone Cements
PubMed: 37044206
DOI: 10.1016/j.wneu.2023.03.114 -
Age and Ageing Jul 2012Vertebral compression fractures are a common clinical problem and the incidence of them will increase with the ageing population. Traditionally management has been... (Review)
Review
Vertebral compression fractures are a common clinical problem and the incidence of them will increase with the ageing population. Traditionally management has been conservative; however, there has been a growing trend towards vertebroplasty as an alternative therapy in patients with persisting severe pain. NICE produced guidance in 2003 recommending the procedure after 4 weeks of conservative management. Recent high-quality studies have been contradictory and there is currently a debate surrounding the role of the procedure with no agreement in the literature. We examine the evidence in both osteoporotic and malignant vertebral compression fractures; we also describe the benefits and side effects, alternative treatment options and the cost of the procedure. Finally, we recommend when vertebroplasty is most appropriately used based on the best available evidence.
Topics: Age Factors; Aged; Cost-Benefit Analysis; Evidence-Based Medicine; Female; Fractures, Compression; Health Care Costs; Humans; Male; Middle Aged; Osteoporosis; Patient Selection; Practice Guidelines as Topic; Radiography; Risk Assessment; Risk Factors; Spinal Fractures; Spinal Neoplasms; Treatment Outcome; Vertebroplasty
PubMed: 22417981
DOI: 10.1093/ageing/afs024 -
Zhongguo Gu Shang = China Journal of... Mar 2013Percutaneous vertebroplasty(PVP), among various other options,has become a mainstay in the management of osteoporotic compression vertebral fractures. The purpose of... (Review)
Review
Percutaneous vertebroplasty(PVP), among various other options,has become a mainstay in the management of osteoporotic compression vertebral fractures. The purpose of this article is to review complications arising from the procedure and describes methods to minimize them. Complications can be classified as mild,which may include a temporary increase in pain; transient hypotension and cement leakage in the intervertebral disc space or into paravertebral soft tissues, moderate, including infection; extravasation of cement into the foraminal or epidural space and severe such as cement leakage in the paravertebral veins, leading to pulmonary embolism, cardiac perforation, cerebral embolism or even death.
Topics: Humans; Postoperative Complications; Vertebroplasty
PubMed: 23795451
DOI: No ID Found -
Medical Science Monitor : International... Oct 2013Percutaneous vertebroplasty (PV) and kyphoplasty (PK) are the 2vertebral augmentation procedures that have emerged as minimally invasive surgical options to treat... (Review)
Review
Percutaneous vertebroplasty (PV) and kyphoplasty (PK) are the 2vertebral augmentation procedures that have emerged as minimally invasive surgical options to treat painful vertebral compression fractures (VCF) during the last 2 decades. VCF may either be osteoporotic or tumor-associated. Two hundred million women are affected by osteoporosis globally. Vertebral fracture may result in acute pain around the fracture site, loss of vertebral height due to vertebral collapse, spinal instability, and kyphotic deformity. The main goal of the PV and PK procedures is to give immediate pain relief to patients and restore the vertebral height lost due to fracture. In percutaneous vertebroplasty, bone cement is injected through a minimal incision into the fractured site. Kyphoplasty involves insertion of a balloon into the fractured site, followed by inflation-deflation to create a cavity into which the filler material is injected, and the balloon is taken out prior to cement injection. This literature review presents a qualitative overview on the current status of vertebral augmentation procedures,especially PV and PK, and compares the efficacy and safety of these 2 procedures. The review consists of a brief history of the development of these 2 techniques, a discussion on the current research on the bone cement, clinical outcome of the 2 procedures, and it also sheds light on ongoing and future research to maximize the efficacy and safety of vertebral augmentation procedures.
Topics: Bone Cements; Female; Fractures, Compression; Humans; Kyphoplasty; Minimally Invasive Surgical Procedures; Spinal Fractures; Vertebroplasty
PubMed: 24097261
DOI: 10.12659/MSM.889479