Influence of operative timing on the early post-operative radiological and clinical outcome after kyphoplasty

Abstract Purpose To clarify the relationship between operative timing and the early post-operative radiological and clinical outcome after kyphoplasty. Methods We conducted a retrospective cohort study including patients who underwent kyphoplasty of a single vertebra. Patients were divided into three groups (acute [< 2 weeks], subacute [2–6 weeks] or chronic [6–51 weeks]) based on the interval between fracture and surgery. The relative vertebral body height (VBH) and local kyphotic angle (LKA) of the fractured vertebra (measured on plain radiographs) as well as pain and use of analgesics were compared pre- and post-operatively (day 2) and between the groups. Results A total of 230 patients (100 with acute, 91 with subacute and 39 with chronic fractures) with fractures from T4 to L5 were included. In all groups, there was a significant post-operative improvement in the anterior (8.9–12.9%) and middle (10.7–13.4%) VBH (all groups: p < 0.001), LKA (acute: 3.8°, p < 0.001; subacute: 4.3°, p < 0.001; chronic: 1.7°, p = 0.046) and pain. The use of analgesics significantly decreased post-operatively in the acute and subacute groups, but did not significantly change in the chronic group. Patients from acute (p = 0.042) and subacute (p = 0.027) groups showed significantly better post-operative correction of the LKA than the chronic group. Conclusion Kyphoplasty is effective for vertebral height restoration as well as pain relief for both acute, subacute and chronic fractures. However, the achievable correction of the fracture-related local kyphosis decreases significantly after 6 weeks. Therefore, we recommend making a final decision about conservative vs. operative treatment within 6 weeks to ensure better height restoration in surgically treated patients.

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Vertebral body height changes in acute symptomatic osteoporotic vertebral compression fractures treated with vertebral cement augmentation. Which factors affect vertebral body height?

10.21203/rs.3.rs-430234/v1 ◽

2021 ◽

Author(s):

Jesús Payo-Ollero ◽

Rafael Llombart-Blanco ◽

Carlos Villas ◽

Matías Alfonso

Keyword(s):

Vertebral Body ◽

Body Height ◽

Cement Augmentation ◽

Vertebral Compression Fractures ◽

Vertebral Augmentation ◽

Vertebral Height ◽

Vertebral Body Height ◽

Post Surgery ◽

Osteoporotic Vertebral Fractures

Abstract Changes in vertebral body height depend on various factors which were analyzed in isolation and not as a whole. The aim of this study is to analyze what factors might influence restoration of vertebral body height after vertebral augmentation. We analyzed 48 patients (108 vertebrae) with osteoporotic vertebral fractures underwent vertebral augmentation when conservative treatment proved unsatisfactory. Analyses were carried out at the time of the fracture, during surgery (pre-cementation and post-cementation), at first medical check-up (6 weeks post-surgery) and at last medical check-up. Average vertebral height was measured and differences from preoperative values calculated at each timepoint. Pearson correlation coefficient and linear multivariable regression were carried out at the different timepoints. The time since vertebral fracture was 60.4 ± 41.7 days. Patients’ average age was 70.9 ± 9.3-years. The total follow-up was 1.43 ± 1-year. After vertebral cementation there was an increase in vertebral body height of + 0.3cm (13.6%). During post-operative follow-up, there was a progressive collapse of the vertebral body and pre-surgical height was reached. The factors that most influenced vertebral height restoration were: grade III collapse, intervertebral-vacuum-cleft (IVVC), and use of a flexible trocar before cement augmentation. The factor that negatively influenced vertebral body height restoration was location in the thoracolumbar spine.

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Robot-assisted intravertebral augmentation corrects local kyphosis more effectively than a conventional fluoroscopy-guided technique

Journal of Neurosurgery Spine ◽

10.3171/2018.8.spine18197 ◽

2019 ◽

Vol 30 (2) ◽

pp. 289-295 ◽

Cited By ~ 1

Author(s):

Sultan Alsalmi ◽

Cyrille Capel ◽

Louis Chenin ◽

Johann Peltier ◽

Michel Lefranc

Keyword(s):

Hospital Stay ◽

Vertebral Body ◽

Body Height ◽

Length Of Hospital Stay ◽

Cement Leakage ◽

Vertebral Body Height ◽

Robot Assisted ◽

Vertebral Body Fractures ◽

Local Kyphosis ◽

The Mean

OBJECTIVEIntravertebral augmentation (IVA) is a reliable minimally invasive technique for treating Magerl type A vertebral body fractures. However, poor correction of kyphotic angulation, the risk of cement leakage, and significant exposure to radiation (for the surgeon, the operating room staff, and the patient) remain significant issues. The authors conducted a study to assess the value of robot-assisted IVA (RA-IVA) for thoracolumbar vertebral body fractures.METHODSThe authors performed a retrospective, single-center study of patients who had undergone RA-IVA or conventional fluoroscopy-guided IVA (F-IVA) for thoracolumbar vertebral body fractures. Installation and operating times, guidance accuracy, residual local kyphosis, degree of restoration of vertebral body height, incidence of cement leakage, rate of morbidity, length of hospital stay, and radiation-related data were recorded.RESULTSData obtained in 30 patients who underwent RA-IVA were compared with those obtained in 30 patients who underwent F-IVA during the same period (the surgical indications were identical, but the surgeons were different). The mean ± SD installation time in the RA-IVA group (24 ± 7.5 minutes) was significantly shorter (p = 0.005) than that in the F-IVA group (26 ± 8 minutes). The mean operating time for the RA-IVA group (52 ± 11 minutes) was significantly longer (p = 0.026) than that for the F-IVA group (30 ± 11 minutes). All RA-IVAs and F-IVAs were Ravi’s scale grade A (no pedicle breach). The mean degree of residual local kyphosis (4.7° ± 3.15°) and the percentage of vertebral body height restoration (63.6% ± 21.4%) were significantly better after RA-IVA than after F-IVA (8.4° ± 5.4° and 30% ± 34%, respectively). The incidence of cement leakage was significantly lower in the RA-IVA group (p < 0.05). The mean length of hospital stay after surgery was 3.2 days for both groups. No surgery-related complications occurred in either group. With RA-IVA, the mean radiation exposure was 438 ± 147 mGy × cm for the patient and 30 ± 17 mGy for the surgeon.CONCLUSIONSRA-IVA provided better vertebral body fracture correction than the conventional F-IVA. However, RA-IVA requires more time than F-IVA.

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Analysis of Related Factors on The Vertebral Height Restoration of Percutaneous Vertebral Augmentation

International Surgery ◽

10.9738/intsurg-d-15-00335.1 ◽

2019 ◽

Vol 104 (7-8) ◽

pp. 398-405

Author(s):

Weixing Xie

Keyword(s):

Vertebral Body ◽

Compression Ratio ◽

Univariate Analysis ◽

Body Height ◽

Height Loss ◽

Loss Ratio ◽

Vertebral Body Height ◽

Kyphosis Angle ◽

Local Kyphosis

Background Percutaneous vertebral augmentation (PVA) is widely applied for the treatment of osteoporotic vertebral fractures. The degree of vertebral body height restoration and deformity correction after the procedure is not consistent. Methods We retrospectively reviewed 97 patients who underwent PVA, because of osteoporotic vertebral compression fractures. The following data about the patients were recorded: age, sex, bone density, number of treated vertebrae, severity of fracture of the treated vertebrae, operative approach (PVP or PKP), volume of injected bone cement, preoperative vertebral compression ratio, preoperative local kyphosis angle, cement leakage, postoperative vertebral body height restoration ratio, follow-up period, and latest follow-up height loss ratio. Bivariate regression analysis and t-test were applied for univariate analysis, while multivariate linear regression analysis was applied for multivariate analysis. Results The postoperative vertebral body height restoration ratio was (14.7% ± 15.2%), and the last follow-up height loss ratio was (13.5% ± 11.5%). The multivariate analysis showed that the number of treated vertebrae, preoperative vertebral compression ratio, and preoperative local kyphosis angle are the main factors influencing the postoperative vertebral body height restoration. The univariate analysis also showed that only the postoperative vertebral body height restoration ratio is related to the last follow-up height loss ratio. Conclusions The number of treated vertebrae, preoperative vertebral compression ratio, and preoperative local kyphosis angle are the main influencing factors of patients' vertebral body height restoration after PVA, and the postoperative vertebral body height restoration ratio is the main factor influencing the last follow-up height loss ratio.

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REVIEW OF MCCORMACK CLASSIFICATION FOR THORACOLUMBAR SEGMENT FRACTURES

Coluna/Columna ◽

10.1590/s1808-185120171603166521 ◽

2017 ◽

Vol 16 (3) ◽

pp. 228-230

Author(s):

ANDRÉ LUÍS SEBBEN ◽

CARLOS AUGUSTO COSTA MARQUES ◽

XAVIER SOLER I GRAELLS ◽

MARCEL LUIZ BENATO ◽

PEDRO GREIN DEL SANTORO ◽

...

Keyword(s):

Vertebral Body ◽

Anterior Approach ◽

Body Height ◽

Epidemiological Data ◽

Load Sharing ◽

Posterior Fixation ◽

Thoracolumbar Fractures ◽

Vertebral Height ◽

Vertebral Body Height

ABSTRACT Objective: The aim of this study was to evaluate the success and complications rates of thoracolumbar fractures with a score equal or superior to 7 according to the load sharing classification (McCormack), surgically treated with short posterior fixation at three points. Methods: We evaluated 40 patients with thoracolumbar fractures and score by the load sharing classification greater than or equal to 7, treated exclusively by surgery by short posterior fixation. We assessed epidemiological data, increased kyphosis, loss of vertebral body height and complications at 2-year follow-up. Results: Although there was a statistically significant increase in kyphosis and a decrease in vertebral height, there was no clinical repercussion. Conclusion: We conclude that the McCormack classification is not a fundamental predictor for indication of anterior approach complementary to the short posterior fixation.

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The Evaluation of Different Radiological Measurement Parameters of the Degree of Collapse of the Vertebral Body in Vertebral Compression Fractures

Applied Bionics and Biomechanics ◽

10.1155/2019/4021640 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Wei-En Hsu ◽

Kuo-Chih Su ◽

Kun-Hui Chen ◽

Chien-Chou Pan ◽

Wen-Hsien Lu ◽

...

Keyword(s):

Vertebral Body ◽

Body Height ◽

Compression Fracture ◽

Lateral View ◽

Measurement Methods ◽

Vertebral Compression Fractures ◽

Height Loss ◽

Vertebral Height ◽

Kyphotic Angle ◽

Radiological Measurement

For compression fracture, vertebral body height loss (VBHL) and kyphotic angle (KA) are two important imaging parameters for determining the prognosis and appropriate treatment. This study used previous measurement methods to assess the degree of VBHL and KA, compare and examine differences between various measurement methods, and examine the correlation between relevant measurement parameters and intravertebral cleft (IVC) in the vertebral body. The radiographic images (lateral view of the T-L spine) of 18 patients with a single-level vertebral compression fracture were reviewed. We measured 9 characteristic lengths and angles on plain radiographs, including anterior vertebral height (AVH) and AVH of the adjacent upper and lower levels, middle vertebral height (MVH) and MVH of the adjacent upper and lower levels, posterior vertebral height (PVH), and vertebral body width, and assessed 6 parameters, including vertebral compression ratio (VBCR), percentage of anterior height compression (PAHC), percentage of middle height compression (PMHC), kyphotic angle (KA), calculated kyphotic angle (CKA), and IVC. The results showed that VBCR is a simple and rapid method of VBHL assessment, but it may result in an underestimation of the degree of VBHL compared to PAHC. When PMHC<40% or kyphotic angle>15°, the probability of IVC occurring on the vertebral body was higher which means the higher risk of vertebral body instability. The results of this study could provide a reference for surgeons when using imaging modalities to assess the degree of vertebral body collapse.

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The Retrospective Analysis of Posterior Short-Segment Pedicle Instrumentation without Fusion for Thoracolumbar Burst Fracture with Neurological Deficit

The Scientific World JOURNAL ◽

10.1155/2014/457634 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Zhouming Deng ◽

Hui Zou ◽

Lin Cai ◽

Ansong Ping ◽

Yongzhi Wang ◽

...

Keyword(s):

Blood Loss ◽

Vertebral Body ◽

Burst Fracture ◽

Body Height ◽

Operation Time ◽

Thoracolumbar Burst Fracture ◽

Vertebral Body Height ◽

Kyphotic Angle ◽

Short Segment ◽

The Mean

This study aims to investigate the efficacy of posterior short-segment pedicle instrumentation without fusion in curing thoracolumbar burst fracture. All of the 53 patients were treated with short-segment pedicle instrumentation and laminectomy without fusion, and the restoration of retropulsed bone fragments was conducted by a novel custom-designed repositor (RRBF). The mean operation time and blood loss during surgery were analyzed; the radiological index and neurological status were compared before and after the operation. The mean operation time was 93 min (range: 62–110 min) and the mean intraoperative blood loss was 452 mL in all cases. The average canal encroachment was 50.04% and 10.92% prior to the surgery and at last followup, respectively (P<0.01). The preoperative kyphotic angle was 17.2 degree (±6.87 degrees), whereas it decreased to 8.42 degree (±4.99 degrees) at last followup (P<0.01). Besides, the mean vertebral body height increased from 40.15% (±9.40%) before surgery to 72.34% (±12.32%) at last followup (P<0.01). 45 patients showed 1-2 grades improvement in Frankel’s scale at last followup. This technique allows for satisfactory canal clearance and restoration of vertebral body height and kyphotic angle, and it may promote the recovery of neurological function. However, further research is still necessary to confirm the efficacy of this treatment.

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Does Graft Position Affect Subsidence After Anterior Cervical Discectomy and Fusion?

Global Spine Journal ◽

10.1177/2192568220963061 ◽

2020 ◽

pp. 219256822096306

Author(s):

Hyun-Jun Jang ◽

Dong-Kyu Chin ◽

Kyung-Hyun Kim ◽

Jeong-Yoon Park

Keyword(s):

Posterior Margin ◽

Retrospective Cohort ◽

Body Height ◽

Clinical Results ◽

Anterior Cervical Discectomy ◽

Vertebral Body Height ◽

Cervical Discectomy ◽

Significant Difference ◽

Anterior Position ◽

Anterior Group

Study Design: Retrospective cohort study. Objective: Implant subsidence is an important prognostic factor after anterior cervical discectomy and fusion (ACDF). Our purpose in this study was to investigate whether graft position affects subsidence after ACDF and to determine if there is a difference in clinical results based on allograft subsidence and position. Methods: We reviewed 92 patients who underwent single-level ACDF with allograft and plate between January 2012 and October 2018. Treatment levels were divided based on allograft position within 2 mm of the posterior margin of the augmented plate (Anterior group) or at greater than 2 mm (Center group). Subsidence was defined as segmental vertebral body height decrease of 2 mm or more at 1 year compared to 1 week after surgery. Results: Overall subsidence prevalence was 15 (16%) cases. Subsidence was 11% in the Anterior group (8/73) and 39% in the Center group (7/19; P = .012). The subsidence group showed smaller graft footprint size (graft/endplate ratio) compared with the nonsubsidence group, and pseudarthrosis occurred frequently in the subsidence. There was no significant difference in clinical results according to graft position. These findings indicate that anterior graft position reduces risk of subsidence (95% confidence interval = 0.085-0.949). Conclusion: To minimize risk of subsidence, the graft should be positioned on the anterior position of the surgical-level endplate. In addition, using a graft appropriate for endplate size will further reduce subsidence.

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A study on the relationship between the rate of vertebral body height loss before balloon kyphoplasty and early adjacent vertebral fracture

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200121 ◽

2021 ◽

pp. 1-8

Author(s):

Hun Kyu Shin ◽

Jai Hyung Park ◽

In Gyu Lee ◽

Jin Hun Park ◽

Jun Hyoung Park ◽

...

Keyword(s):

Vertebral Body ◽

Vertebral Fractures ◽

Body Height ◽

Balloon Kyphoplasty ◽

Height Loss ◽

Vertebral Body Height ◽

Fracture Group ◽

Significant Difference ◽

Adjacent Vertebral Fracture ◽

The Relationship

BACKGROUND: The number of patients with an osteoporotic vertebral compression fracture, which is often accompanied by lower back pain and restrained activities, is growing. Balloon kyphoplasty involves the inflation of a balloon to restore height and reduce kyphotic deformity before stabilization with polymethylmethacrylate. However, there is a great deal of debate about whether balloon kyphoplasty also increases fracture morbidity by either inducing or facilitating subsequent adjacent vertebral fractures. OBJECTIVE: To evaluate the relationship between the rate of vertebral body height loss before balloon kyphoplasty and the etiology of early adjacent vertebral fracture after augmentation. METHODS: A total of 59 patients with osteoporotic vertebral compression fractures who underwent kyphoplasty were enrolled. This study defined early adjacent segmental fractures as new fractures occurring within three months after surgery. This study included the rate of vertebral body height loss. RESULTS: Early adjacent vertebral fractures were diagnosed in nine (15%) of the 59 patients. The patients were divided into two groups, with and without adjacent vertebral fractures. There was no significant difference in terms of age, body mass index, bone mineral density, local kyphotic angle, Cobb’s angle, cement volume, cement leakage, and percent height restored between the groups with fractures and without fractures. There was a statistically significant difference between the two groups in the rate of vertebral body height loss. The rate of vertebral body height loss was significantly higher in the fracture group than in the without fracture group. CONCLUSIONS: A high rate of vertebral body height loss increased the risk of early adjacent vertebral fractures after balloon kyphoplasty.

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Kyphoplasty with intravertebral reduction devices associated with better height restoration and greater kyphosis correction than kyphoplasty with balloons

Scientific Reports ◽

10.1038/s41598-021-84856-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Chi-Jung Chiang ◽

Jin-Wei Huang ◽

Shu-Mei Chen ◽

Jiann-Her Lin

Keyword(s):

Vertebral Body ◽

Body Height ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Vertebral Body Height ◽

Kyphotic Angle ◽

Compression Fractures ◽

Telephone Interviews ◽

Mechanical Factors

AbstractKyphoplasty (KP) with intravertebral reduction devices (IRD) was reported to be associated with better radiological outcomes than KP with balloons (BK) for osteoporotic vertebral compression fractures (OVCFs). However, the mechanical factors that contribute to the radiological benefits of IRDs require further investigation. To probe the mechanical factors, this retrospective matched cohort study was designed, including the older patients with painful OVCFs and treated with KP. We compared the clinical and radiological outcomes between KP with an IRD and BK, where vertebral body height and kyphotic angle of the cemented vertebrae were measured pre- and postoperatively; clinical outcomes were collected by telephone interviews. The restoration and maintenance ratio suggested that IRDs were associated with favorable effects long-term wise in anterior to middle vertebral body and kyphosis than BK in patients. The gathered results concluded the radiological benefits of IRD regarding both its efficient restoration and maintenance in vertebrae.

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The use of Body Surface Index as a Better Clinical Health indicators Compare to Body Mass Index and Body Surface Area for Clinical Application

International Journal of Scientific Research in Science Engineering and Technology ◽

10.32628/ijsrset2184117 ◽

2018 ◽

pp. 131-136

Author(s):

Shirazu I. ◽

Theophilus. A. Sackey ◽

Elvis K. Tiburu ◽

Mensah Y. B. ◽

Forson A.

Keyword(s):

Surface Area ◽

Body Surface Area ◽

Clinical Application ◽

Body Surface ◽

Body Height ◽

Health Indicators ◽

The Body ◽

Body Parameters ◽

The Relationship ◽

Individual Body

The relationship between body height and body weight has been described by using various terms. Notable among them is the body mass index, body surface area, body shape index and body surface index. In clinical setting the first descriptive parameter is the BMI scale, which provides information about whether an individual body weight is proportionate to the body height. Since the development of BMI, two other body parameters have been developed in an attempt to determine the relationship between body height and weight. These are the body surface area (BSA) and body surface index (BSI). Generally, these body parameters are described as clinical health indicators that described how healthy an individual body response to the other internal organs. The aim of the study is to discuss the use of BSI as a better clinical health indicator for preclinical assessment of body-organ/tissue relationship. Hence organ health condition as against other body composition. In addition the study is `also to determine the best body parameter the best predict other parameters for clinical application. The model parameters are presented as; modeled height and weight; modelled BSI and BSA, BSI and BMI and modeled BSA and BMI. The models are presented as clinical application software for comfortable working process and designed as GUI and CAD for use in clinical application.

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