A pictorial classification atlas of cement extravasation with vertebral augmentation

ObjectiveTo assess the efficacy of a semi-permeable mesh implant in the treatment of painful thoracic and lumbar osteoporotic vertebral compression fractures.MethodsPatients with painful thoracic and lumbar osteoporotic vertebral compression fractures which were refractory to conventional medical management and less than 3 months of age were considered possible candidates for this vertebral augmentation technique. Data recorded for the procedure included patient age, gender, fracture level and morphology, mesh implant size, amount of cement injected, cement extravasation, complications, and pre- and post-procedure numeric pain scores and Oswestry Disability Index (ODI) scores.Results17 patients were included in this retrospective study; 12 women and 5 men, with an average age of 78.6 years. Each patient had one level treated with the mesh implant; 4 thoracic levels and 13 lumbar levels. The 10×15 mm implant was used in 13 treated vertebrae, including the two thoracic vertebrae; the 10×20 mm implant was used to treat 3 lumbar vertebrae, and one 10×25 mm implant was used to treat an L1 vertebra. An average of 2.4 mL of acrylic bone cement was injected, and there was fluoroscopic evidence of a small amount of cement leakage in one case. No patient related complications were seen and there were no device failures. All patients, followed-up to at least 3 weeks, showed significant pain relief. The average pretreatment numeric pain score of 9 and ODI of 50 decreased to an average post-treatment score of 0.6 and 12, respectively (p<0.001).ConclusionsVertebral augmentation with a semi-permeable mesh stent implant can be used to effectively and safely treat osteoporotic vertebral compression fractures within the lower thoracic and lumbar spine.

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Abstract No. 184: Comparative analysis of cement extravasation in radiofrequency targeted vertebral augmentation, balloon kyphoplasty and high viscosity cement vertebroplasty

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2011.12.231 ◽

2012 ◽

Vol 23 (3) ◽

pp. S76 ◽

Cited By ~ 1

Author(s):

B. Georgy

Keyword(s):

Comparative Analysis ◽

Balloon Kyphoplasty ◽

High Viscosity ◽

Vertebral Augmentation ◽

Cement Extravasation

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Percutaneous Vertebral Augmentation Assisted by PEEK Implant in Painful Osteolytic Vertebral Metastasis Involving the Vertebral Wall: Experience on 40 Patients

January 2018 - Pain Physician ◽

10.36076/ppj.2013/16/e397 ◽

2013 ◽

Vol 4;16 (4;7) ◽

pp. E397-E404

Author(s):

Giovanni Carlo Anselmetti

Keyword(s):

Bone Cement ◽

Randomized Study ◽

Intractable Pain ◽

Vertebral Augmentation ◽

Vertebral Metastases ◽

Pain Palliation ◽

Invasive Treatment ◽

Fracture Stabilization ◽

Study Results ◽

Cement Extravasation

Background: Vertebral metastases are associated with significant pain, disability, and morbidity. Open surgery for fracture stabilization is often inappropriate in this cancer population due to a poor risk-benefit profile, particularly if life expectancy is short. Vertebroplasty and kyphoplasty are appealing adjunctive procedures in patients with malignancy for alleviation of intractable pain. However, these patients have a higher risk of serious complications, notably cement extravasation. Study Design: We prospectively evaluated clinical results of polyetheretherketone (PEEK) implant (Kiva) assisted vertebroplasty performed in malignant painful osteolytic lesions at risk for cement extravasation due to vertebral wall involvement. Setting: Department of Interventional Radiology, Institute for Cancer Research and Treatment, Candiolo, Turin, Italy Methods: Forty patients (22 women; mean age 66.8 ± 12.4), suffering from a painful spine malignancy with vertebral wall involvement not responding to conventional therapies and without surgical indications, underwent vertebral augmentation with Kiva intravertebral implant for pain palliation. The procedure was performed with moderate sedation and local anesthesia under combined digital fluoroscopy and computed tomography guidance. After the coil-shaped PEEK implant was deployed within the vertebral lesion, bone cement was injected under continuous digital fluoroscopic control. Patients were discharged from the hospital the next procedural day. The Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), analgesic requirement, and use of external brace support were evaluated to determine efficacy. The primary end-point was safety and efficacy at one month after the procedure. However, all the patients were scheduled to be followed-up at month 3, 6, and every 6 months thereafter. Follow-up was prospectively evaluated in all patients after Kiva with clinical interviews. The Institution’s Internal Review Board approved this study. Results: Median pre-treatment VAS of 10 (range 6 – 10) significantly (P < 0.001) dropped to one (range 0 – 3), with all patients achieving a clinically relevant benefit on pain at one month. Differences in pre- and post-treatment analgesic therapy were significant (P < 0.001). All patients no longer use an external brace after Kiva. In 7 out of 43 (16.3%) treated vertebrae a bone cement leakage was detected. Limitations: This is a not randomized study. Participants were limited to 40 patients. Conclusion: The Kiva System potentially represents a novel and effective minimally invasive treatment option for patients suffering from severe pain due to osteolytic vertebral metastases. Key words: Vertebroplasty, metastases, pain palliation, Kiva, spine

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Logistic regression analysis on risk factors of augmented vertebra recompression after percutaneous vertebral augmentation

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02480-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zhongcheng An ◽

Chen Chen ◽

Junjie Wang ◽

Yuchen Zhu ◽

Liqiang Dong ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Bone Cement ◽

Vertebral Compression Fracture ◽

Univariate Analysis ◽

Compression Fracture ◽

Osteoporotic Vertebral Compression Fracture ◽

Vertebral Augmentation ◽

Surgical Methods

Abstract Objective To explore the high-risk factors of augmented vertebra recompression after percutaneous vertebral augmentation (PVA) in the treatment of osteoporotic vertebral compression fracture (OVCF) and analyze the correlation between these factors and augmented vertebra recompression after PVA. Methods A retrospective analysis was conducted on 353 patients who received PVA for a single-segment osteoporotic vertebral compression fracture from January 2017 to December 2018 in our department according to the inclusion criteria. All cases meeting the inclusion and exclusion criteria were divided into two groups: 82 patients in the recompression group and 175 patients in the non-compression group. The following covariates were reviewed: age, gender, body mass index (BMI), injured vertebral segment, bone mineral density (BMD) during follow-up, intravertebral cleft (IVC) before operation, selection of surgical methods, unilateral or bilateral puncture, volume of bone cement injected, postoperative leakage of bone cement, distribution of bone cement, contact between the bone cement and the upper or lower endplates, and anterior height of injured vertebrae before operation, after surgery, and at the last follow-up. Univariate analysis was performed on these factors, and the statistically significant factors were substituted into the logistic regression model to analyze their correlation with the augmented vertebra recompression after PVA. Results A total of 257 patients from 353 patients were included in this study. The follow-up time was 12–24 months, with an average of 13.5 ± 0.9 months. All the operations were successfully completed, and the pain of patients was relieved obviously after PVA. Univariate analysis showed that in the early stage after PVA, the augmented vertebra recompression was correlated with BMD, surgical methods, volume of bone cement injected, preoperative IVC, contact between bone cement and the upper or lower endplates, and recovery of anterior column height. The difference was statistically significant (P < 0.05). Among them, multiple factors logistic regression elucidated that more injected cement (P < 0.001, OR = 0.558) and high BMD (P = 0.028, OR = 0.583) were negatively correlated with the augmented vertebra recompression after PVA, which meant protective factors (B < 0). Preoperative IVC (P < 0.001, OR = 3.252) and bone cement not in contact with upper or lower endplates (P = 0.006, OR = 2.504) were risk factors for the augmented vertebra recompression after PVA. The augmented vertebra recompression after PVP was significantly less than that of PKP (P = 0.007, OR = 0.337). Conclusions The augmented vertebra recompression after PVA is due to the interaction of various factors, such as surgical methods, volume of bone cement injected, osteoporosis, preoperative IVC, and whether the bone cement is in contact with the upper or lower endplates.

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Debridement and corpectomy via single posterior approach to treat pyogenic spondylitis after vertebral augmentation

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04478-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Shuai Zhang ◽

Song Wang ◽

Qing Wang ◽

Jin Yang ◽

Shuang Xu

Keyword(s):

Severe Pain ◽

Neurological Deficits ◽

Spinal Stability ◽

Vertebral Augmentation ◽

Pathogenic Microorganisms ◽

Surgical Time ◽

Pyogenic Spondylitis ◽

Single Posterior Approach ◽

Posterior Debridement ◽

Effective Treatments

Abstract Background Infection after vertebral augmentation (VA) often limits the daily activities of patients and even threatens their life. The operation may be one of the effective treatments if the patient suffers from intolerable severe pain, neurological deficits, and damage to spinal stability. This study aimed to investigate the clinical efficacy of the treatment of pyogenic spondylitis after vertebral augmentation (PSVA) with Single posterior debridement, vertebral body resection, and intervertebral bone graft fusion and internal fixation (sPVRIF). Methods The study was performed on 19 patients with PSVA who underwent VA at 4 hospitals in the region between January 2010 and July 2020. Nineteen patients were included. Among them, 16 patients underwent sPVRIF to treat the PSVA. Results A total of 2267 patients underwent VA at 4 hospitals in the region. Of the 19 patients with postoperative PSVA, suppurative spondylitis was misdiagnosed as an osteoporotic vertebral fracture(OVF) in 4 patients and they underwent VA. Besides osteoporosis, 18 patients had other comorbidities. The average interval between the first surgery and the diagnosis of PSVA was 96.4 days. Of the 19 patients, 16 received surgical treatment. The surgical time was 175.0±16.8 min, and the intraoperative blood loss was 465.6±166.0 mL. Pathogenic microorganisms were cultured in 12 patients. Conclusion PSVA is a severe complication that can even threaten the life of the patients. sPVRIF may be one of the effective treatments if the patient suffers from intolerable severe pain, neurological deficits, and damage to spinal stability.

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