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Frontiers in Oncology 2024Multiple myeloma is diagnosed in 5,800 people in the United Kingdom (UK) each year with up to 64% having vertebral compression fractures at the time of diagnosis....
BACKGROUND
Multiple myeloma is diagnosed in 5,800 people in the United Kingdom (UK) each year with up to 64% having vertebral compression fractures at the time of diagnosis. Painful vertebral compression fractures can be of significant detriment to patients' quality of life. Percutaneous vertebroplasty aims to provide long-term pain relief and stabilize fractured vertebrae.
METHODS AND MATERIALS
Data was collected from all cases of percutaneous vertebroplasty performed on patients with multiple myeloma from November 2017 to January 2019. Pain scores were measured using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) pre-procedure, 2 months post procedure and 4 years post-procedure. Procedure related complications and analgesia use were also documented.
RESULTS
22 patients were included with a total of 119 vertebrae treated. Patients reported a significant improvement in overall pain score with a median pre-procedure VAS of 8 and a median post-procedure VAS of 3.5 (p<0.0001). There was a median pre-procedure ODI score of 60% and a median post-procedure ODI score of 36% (p<0000.1). There was improvement across all ODI domains and a 77% reduction in analgesic requirement. There were small cement leaks into paravertebral veins or endplates at 15 levels (12%) which were asymptomatic. There were 8 responders to the long-term follow-up questionnaire at 4 years. This demonstrated an overall stable degree of pain relief in responders with a median VAS of 3.5 and median ODI of 30%.
CONCLUSION
At this center, vertebroplasty has been shown to reduce both VAS and ODI pain scores and reduce analgesia requirements in patients with VCFs secondary to multiple myeloma with long lasting relief at 4 years post-procedure.
PubMed: 38665945
DOI: 10.3389/fonc.2024.1291055 -
Zhongguo Gu Shang = China Journal of... Apr 2024To investigate the clinical efficacy of body-surface guide plates for lateral segmental positioning in the thoracolumbar spine.
OBJECTIVE
To investigate the clinical efficacy of body-surface guide plates for lateral segmental positioning in the thoracolumbar spine.
METHODS
From March 2018 to March 2021, 768 gerontal patientss underwent percutaneous vertebroplasty with balloon dilatation due to thoracolumbar compression fracturess, 356 males and 412 females. aged from 64 to 92 years old with an average of (77.9±13.5) years old. All patients were treated in hospital within 1 week after injury. All patients underwent preoperative localization, and were divided into localization plate group and locator group according to different localization methods. There were 390 patients in the localization plate group, 180 males and 210 females, aged from 64 to 92 years old, with an average age of (78.4±14.3) years old. There were 378 patients in the locator group, 176 males and 202 females, aged from 64 to 90 years old, with an average age of (77.5±13.4) years old. After preliminary positioning with the above two methods, skin markers were made, cloth was routinely disinfected, and the spinal lateral position was fluoroscopically examined after the fine needle was inserted into the marked point and the vertical body at the near tail end. The accuracy of the original positioning method was evaluated. The number of times, time and accuracy of positioning of the two groups of patients were compared and analyzed.
RESULTS
The specific data of patient positioning in the two groups were collected for statistical analysis. The number of times of fluoroscopy in the positioning plate group and the locator group was(3.3±0.5) times and (5.0±1.2) times, and the positioning time was (60.4±9.4) s and (105.0±30.9) s, respectively. The accuracy of fluoroscopy was 97.5% (380/390) and 85.7% (324/378), respectively, with statistical significance (<0.05).
CONCLUSION
The lateral segmental positioning plate of the body surface spine has the advantages of simple operation, accurate positioning, and reducing X-ray radiation for patients, which is worthy of clinical application.
Topics: Humans; Male; Female; Aged; Middle Aged; Aged, 80 and over; Lumbar Vertebrae; Bone Plates; Thoracic Vertebrae; Vertebroplasty; Spinal Fractures; Patient Positioning; Fractures, Compression
PubMed: 38664205
DOI: 10.12200/j.issn.1003-0034.20221039 -
World Journal of Clinical Cases Apr 2024Although percutaneous vertebral augmentation (PVA) is a commonly used procedure for treating vertebral compression fracture (VCF), the risk of vertebral refracture...
BACKGROUND
Although percutaneous vertebral augmentation (PVA) is a commonly used procedure for treating vertebral compression fracture (VCF), the risk of vertebral refracture should be considered. Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a systemic disease of mineral and bone metabolism. It is associated with an increased risk of fracture. Few studies have reported the use of PVA in patients with CKD-MBD. We herein report a rare case wherein the cemented vertebra and the adjacent vertebra refractured simultaneously in a CKD-MBD patient after PVA.
CASE SUMMARY
A 74-year-old man suffered from low back pain after taking a fall about 3 wk ago. According to physical examination, imaging and laboratory findings, diagnoses of T12 VCF, CKD-MBD, and chronic kidney disease stage 5 were established. He then received percutaneous vertebroplasty at T12 vertebra. Fourteen weeks later, he presented with T12 and L1 vertebral refractures caused by lumbar sprain. Once again, he was given PVA which was optimized for the refractured vertebrae. Although the short-term postoperative effect was satisfactory, he reported chronic low back pain again at the 3-month follow-up.
CONCLUSION
It is necessary that patients with CKD-MBD who have received PVA are aware of the adverse effects of CKD-MBD. It may increase the risk of vertebral refracture. Furthermore, the PVA surgical technique needs to be optimized according to the condition of the patient. The medium- and long-term effects of PVA remain uncertain in patients with CKD-MBD.
PubMed: 38660087
DOI: 10.12998/wjcc.v12.i10.1804 -
Rinsho Shinkeigaku = Clinical Neurology May 2024A 70-year-old female presented with bilateral numbness in her upper limbs. She was diagnosed with cervical spondylotic myelopathy and underwent cervical laminoplasty....
A 70-year-old female presented with bilateral numbness in her upper limbs. She was diagnosed with cervical spondylotic myelopathy and underwent cervical laminoplasty. However, there was no significant improvement in sensory disturbance, and at 6 months after surgery, she developed subacute motor and gait disturbance in four extremities. Spinal MRI revealed a long lesion of the spinal cord with edema, and a part of the lesion showed gadolinium contrast enhancement. Bronchoscopy revealed an elevated CD4/8 ratio, and gallium scintigraphy demonstrated an accumulation in the hilar lymph nodes, leading to a diagnosis of neurosarcoidosis. In case of rapid deterioration during the course of cervical spondylotic myelopathy, neurosarcoidosis should be considered as a differential diagnosis, which can be assessed by contrast-enhanced MRI.
Topics: Humans; Female; Sarcoidosis; Aged; Magnetic Resonance Imaging; Contrast Media; Diagnosis, Differential; Central Nervous System Diseases; Gadolinium; Cervical Vertebrae; Spondylosis; Spinal Cord Diseases
PubMed: 38658329
DOI: 10.5692/clinicalneurol.cn-001921 -
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 -
Orthopaedic Surgery Jun 2024There is still controversy over the choice of treatment for end-stage spinal metastases. With the continuous development of microwave technology in spinal tumors,...
OBJECTIVES
There is still controversy over the choice of treatment for end-stage spinal metastases. With the continuous development of microwave technology in spinal tumors, related studies have reported that microwave combined with techniques such as pedicle screw fixation and percutaneous vertebroplasty can achieve the purpose of tumor ablation, relieving spinal cord compression, enhancing spinal stability, effectively relieving pain, and reducing recurrence rates. This study aimed to analyze the effectiveness of microwave ablation combined with decompression and pedicle screw fixation in the palliative management of spinal metastases with pathological fractures.
METHODS
This retrospective study enrolled 82 patients with spinal metastases and pathological fractures treated between January 2016 and July 2020, with 44 patients undergoing pedicle screw fixation along with laminectomy (fixation group) and the remaining 38 receiving microwave ablation in addition to the treatment provided to group fixation (MWA group). Before surgery, all patients underwent pain assessment using the visual analogue scale (VAS) and evaluation of spinal cord injury using the Frankel classification. After surgery, the patients' prognoses were assessed using the Tomita score, modified Tokuhashi score system, and progression-free survival. Additionally, we compared operative time and blood loss between the two groups. Survival analysis utilized the Kaplan-Meier method with a log-rank test for group comparisons. Paired t-tests and the Mann-Whitney U test were applied to metric and non-normally distributed data, respectively. Neurological function improvement across groups was evaluated using the χ test.
RESULTS
All patients were followed up for a median duration of 18 and 20 months in the fixation and MWA groups, respectively, with follow-up periods ranging from 6 to 36 months. Statistically significant reductions in postoperative VAS scores were observed in all patients compared with their preoperative scores. The MWA group exhibited reduced blood loss (t = 2.74, p = 0.01), lower VAS scores at the 1- and 3-month follow-ups (t = 2.34, P = 0.02; t = 2.83, p = 0.006), and longer progression-free survival than the fixation group (p = 0.03). Although the operation times in the MWA group were longer than those in the fixation group, this difference was not statistically significant (t = 6.06, p = 0.12). No statistically significant differences were found regarding improvements in spinal cord function between the two groups (p = 0.77).
CONCLUSION
Compared with decompression and pedicle screw fixation for treating spinal metastases with pathological fractures, microwave ablation combined with decompression and pedicle screw fixation showed better outcomes in terms of pain control, longer progression-free survival, and lower blood loss without increasing operative time, which has favorable implications for clinical practice.
Topics: Humans; Spinal Neoplasms; Male; Female; Retrospective Studies; Middle Aged; Microwaves; Pedicle Screws; Decompression, Surgical; Aged; Adult; Palliative Care; Pain Measurement; Laminectomy; Combined Modality Therapy; Ablation Techniques
PubMed: 38644512
DOI: 10.1111/os.14063 -
Revista Espanola de Cirugia Ortopedica... Apr 2024Osteoporosis, and the consequences derived from it, such as fragility fractures, constitute a growing public health problem. Suffering from a fracture of this nature is...
Osteoporosis, and the consequences derived from it, such as fragility fractures, constitute a growing public health problem. Suffering from a fracture of this nature is the main risk factor for suffering a new fracture. It is documented that vertebral compression fractures lead to significant morbidity and mortality, in the short and long term, as well as other complications, such as sagittal imbalance and hyperkyphosis of the segment. However, we have not found documentation that analyzes the medium and long-term consequences of these injuries, assessing the type of treatment used, and the economic impact they represent. The purpose of this review is to analyze the main recent literature on the subject and make a breakdown of the consequences of these fractures in various spheres, such as economic, quality of life, sagittal balance and radiographic parameters, pain or mortality; as well as a brief analysis of epidemiology and natural history. CONCLUSION: Osteoporotic fractures constitute an emerging problem, both in the medical and economic fields. The consequences and sequelae on the patient are multiple and although surgical options offer good long-term results, it is necessary to properly select the patient, through multidisciplinary teams, to try to minimize potential complications.
PubMed: 38642735
DOI: 10.1016/j.recot.2024.03.004 -
Medicine Apr 2024Aggressive vertebral hemangiomas (AVHs) destroy continuous vertebral bodies and intervertebral discs and resulting in spinal kyphosis is extremely rare. The very...
RATIONALE
Aggressive vertebral hemangiomas (AVHs) destroy continuous vertebral bodies and intervertebral discs and resulting in spinal kyphosis is extremely rare. The very aggressive behavior was attributable to its significant vascular component and contained no adipose tissue.
PATIENT CONCERNS
We report a case of thoracic spine kyphosis of AVHs with multiple vertebral bodies and intervertebral disc destruction in a 45-year-old woman.
DIAGNOSES
Based on the imaging studies, the patient underwent surgical removal of this lesion and spinal reconstruction. Histopathology consistent with vertebral hemangioma and contained no adipose.
INTERVENTIONS
The patient underwent surgical removal of the lesion and spinal reconstruction. After subperiosteal dissection of the paraspinal muscles and exposure of the laminae, the laminae of the T5-7 vertebrae were removed and exposing the lesion. The lesion was soft and showed cystic changes, completely curetted and autogenous bone was implanted. Vertebroplasty was performed through T3-T9 pedicles bilaterally. Pedicle screw fixation was performed for segmental fixation and fusion.
OUTCOMES
After 9 days of operation, the incision healed cleanly and free of pain. She was discharged in good general condition. The patient remained asymptomatic after follow-up 6 months of postoperative.
LESSONS
AVHs destroy multiple vertebral bodies and intervertebral discs and resulting in spinal kyphosis is extremely rare.
Topics: Female; Humans; Middle Aged; Lumbar Vertebrae; Kyphosis; Thoracic Vertebrae; Pedicle Screws; Hemangioma; Treatment Outcome; Spinal Fractures
PubMed: 38640290
DOI: 10.1097/MD.0000000000037885 -
BMC Musculoskeletal Disorders Apr 2024To assess the clinical safety, accuracy, and efficacy of percutaneous kyphoplasty (PKP) surgery using an enhanced method of unilateral puncture on the convex side for...
PURPOSE
To assess the clinical safety, accuracy, and efficacy of percutaneous kyphoplasty (PKP) surgery using an enhanced method of unilateral puncture on the convex side for the treatment of painful osteoporotic vertebral compression fractures (P-OVCF) with scoliosis.
METHODS
Clinical and radiographic data of P-OVCF patients with scoliosis who underwent PKP via unilateral puncture on the convex side from January 2018 to December 2021 were retrospectively analyzed. This technique's detailed surgical steps and tips were described. The local kyphosis angle (LKA), scoliosis Cobb angle (SCA), and local scoliosis Cobb angle (LSCA) were measured using X-ray and compared at pre-operation, post-operation, and the last follow-up. The width of pedicle (POW), inner inclination angle (IIA), lateral distance (LD), and puncture course length (PCL) were measured on the axial computed tomography image and compared between two sides. Postoperative computed tomography was employed to evaluate the condition of cement distribution and puncture. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back pain (BP).
RESULTS
Thirty-six patients, 23 women and 13 men, with an average age of 76.31 ± 6.28 years were monitored for 17.69 ± 4.70 months. The median surgical duration of single vertebrae was 35 min. The volume of bone cement for single vertebrae was 3.81 ± 0.87 ml and the proportion of sufficient cement distribution of the patients was 97.22. LKA was considerably improved from pre-operation to post-operation and sustained at the last follow-up. SCA and LSCA were not significantly modified between these three-time points. IIA, PCL, and LD were lower on the convex side than on the concave side. POW was considerably wider on the convex side. The ODI and VAS-BP scores were significantly improved after surgery and sustained during the follow-up.
CONCLUSIONS
Combining with the proper assessment of the pre-injured life status of patients, PKP surgery using unilateral puncture on the convex side for the treatment of P-OVCF with scoliosis can achieve safe, excellent clinical, and radiographic outcomes.
Topics: Male; Humans; Female; Aged; Aged, 80 and over; Kyphoplasty; Fractures, Compression; Scoliosis; Retrospective Studies; Spinal Fractures; Treatment Outcome; Spine; Bone Cements; Punctures; Kyphosis; Osteoporotic Fractures
PubMed: 38627655
DOI: 10.1186/s12891-024-07399-w -
Journal of Orthopaedic Surgery and... Apr 2024To assess the radiographic outcomes, clinical outcomes and complications of percutaneous kyphoplasty (PKP) with and without posterior pedicle screw fixation (PPSF) in...
OBJECTIVE
To assess the radiographic outcomes, clinical outcomes and complications of percutaneous kyphoplasty (PKP) with and without posterior pedicle screw fixation (PPSF) in the treatment of severe osteoporotic vertebral compression fractures (sOVCF) with nonunion.
METHODS
This study involved 51 patients with sOVCF with nonunion who underwent PKP or PPSF + KP. The operation time, intraoperative blood loss, volume of injected bone cement, operation costs and hospital stays were all recorded. In addition, the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were assessed separately for each patient before and after surgery.
RESULTS
Compared with the PPSF + KP group, the PKP group had shorter operation time, less intraoperative blood loss, shorter hospital stays and fewer operation costs. However, cobb's angle improvement (13.4 ± 4.3° vs. 21.4 ± 5.3°), VWR improvement ratio (30.4 ± 11.5% vs. 52.8 ± 12.7%), HA (34.9 ± 9.0% vs. 63.7 ± 7.6%) and HM (28.4 ± 11.2% vs. 49.6 ± 7.7%) improvement ratio were all higher in PPSF + KP group than that in PKP group. In addition, the ODI index and VAS score in both groups were significantly decreased at the postoperative and final follow-up. PKP group's postoperative VAS score was significantly lower than that in PPSF + KP group, but there was no statistically significant difference in VAS score at the last follow-up.
CONCLUSION
PKP and PPSF + KP can both effectively relieve the pain associated with sOVCF with nonunion. PPSF + KP can achieve more satisfactory vertebral reduction effects compared to PKP. However, PKP was less invasive and it has more advantages in shortening operation time and hospital stay, as well as decreasing intraoperative blood loss and operation costs.
Topics: Humans; Kyphoplasty; Fractures, Compression; Pedicle Screws; Blood Loss, Surgical; Spinal Fractures; Treatment Outcome; Osteoporotic Fractures; Bone Cements; Retrospective Studies
PubMed: 38622736
DOI: 10.1186/s13018-024-04714-y