Extrapedicular approach of percutaneous vertebroplasty in the treatment of upper and mid‐thoracic vertebral compression fracture

Purpose: To evaluate the clinical outcome of the extrapedicular approach of percutaneous vertebroplasty (PVP) for upper and mid‐thoracic vertebral compression fractures in patients. Material and Methods: Extrapedicular vertebroplasty was performed in painful compression fractures at T4–T8 levels. The assessment criteria were changes over time in visual analog scale (VAS) and mobility score. We evaluated the volume of cement injected, the size of needle required, and complications. Results: Procedures were performed in 27 patients with a total of 34 affected vertebral bodies. Early (within a week) and one year later, clinical follow‐ups showed that pain intensity had decreased by 50% one day after operation and later by 70–80%. Mobility scores of all patients were improved immediately after the procedure. Average volume of polymethylmethacrylate (PMMA) per vertebral body was 3.8±1.2 ml. Leakage of PMMA occurred in one vertebral level (intradiskal space), but did not cause clinical complications. Conclusion: PVP of upper and mid‐thoracic spine with an extrapedicular approach is an efficient and safe procedure for treating painful thoracic vertebral compression fracture under a cautious patient selection and meticulous technical procedure.

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Innovative Spine Implants for Improved Augmentation and Stability in Neoplastic Vertebral Compression Fracture

Medicina ◽

10.3390/medicina55080426 ◽

2019 ◽

Vol 55 (8) ◽

pp. 426 ◽

Cited By ~ 1

Author(s):

Cornelis ◽

Joly ◽

Nouri-Neuville ◽

Ben-Ammar ◽

Kastler ◽

...

Keyword(s):

Vertebral Compression Fracture ◽

Clinical Performance ◽

Compression Fracture ◽

Treatment Decision ◽

Definitive Treatment ◽

Vertebral Compression Fractures ◽

Compression Fractures ◽

Good Pain Relief ◽

Severe Back Pain ◽

And Function

Background and objectives: Tumor-related vertebral compression fractures often result in severe back pain as well as progressive neurologic impairment and additional morbidities. The fixation of these fractures is essential to obtain good pain relief and to improve the patients’ quality of life. Thus far, several spine implants have been developed and studied. The aims of this review were to describe the implants and the techniques proposed to treat cancer-related vertebral compression fractures and to compile their safety and efficacy results. Materials and Methods: A systematic MEDLINE/PubMed literature search was performed, time period included articles published between January 2000 and March 2019. Original articles were selected based on their clinical relevance. Results: Four studies of interest and other cited references were analyzed. These studies reported significant pain and function improvement as well as kyphotic angle and vertebral height restoration and maintain for every implant and technique investigated. Conclusions: Although good clinical performance is reported on these devices, the small numbers of studies and patients investigated draw the need for further larger evaluation before drawing a definitive treatment decision tree to guide physicians managing patients presenting with neoplastic vertebral compression fracture.

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Risk Factors for Refracture following Primary Osteoporotic Vertebral Compression Fractures

January 2018 - Pain Physician ◽

10.36076/ppj.2021/24/e335 ◽

2021 ◽

pp. E335-E340

Author(s):

Weihua Cai

Keyword(s):

Risk Factors ◽

Vertebral Compression Fracture ◽

Compression Fracture ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Hounsfield Units ◽

Secondary Fracture ◽

Compression Fractures ◽

Fracture History ◽

Primary Fracture

Background: In the aging population, osteoporosis and related complications have become a global public health problem. Osteoporotic vertebral compression fractures are among the most common type of osteoporotic fractures and patients are at risk of secondary vertebral compression fracture. Objectives: To identify risk factors for secondary vertebral compression fracture following primary osteoporotic vertebral compression fractures. Study Design: Retrospective study. Setting: Department of Orthopedic, an affiliated hospital of a medical university. Methods: This retrospective cohort study evaluated the risk factors for secondary vertebral compression fracture in 317 consecutive patients with systematic osteoporotic vertebral compression fractures who received percutaneous vertebroplasty and kyphoplasty or conservative treatment. Patients were divided into secondary vertebral compression fracture (n = 43) and non- secondary vertebral compression fracture (n = 274) groups. We retrospectively analyzed clinical characteristics and radiographic parameters, including gender, age, body mass index, number of primary fractures, primary treatment (percutaneous vertebroplasty and kyphoplasty or conservative treatment), nonspinal fracture history before primary fracture, primary fracture at the thoracolumbar junction, steroid use, bisphosphonate therapy, and Hounsfield units value of L1. Results: Comparison between the groups showed significant differences in age (P = 0.001), nonspinal fracture history (P < 0.001), and Hounsfield units value of L1 (P < 0.001). The receiver operating characteristic curves demonstrated that the optimal thresholds for age and Hounsfield units value of L1 were 75 (sensitivity: 55.8%; specificity: 67.5%) and 50 (sensitivity: 88.3%; specificity: 67.4%), respectively. In multivariate logistic regression analysis, nonspinal fracture history (OR = 6.639, 95% CI = 1.809 – 24.371, P = 0.004) and Hounsfield units value of L1 < 50 (OR = 15.260, 95% CI = 6.957 – 33.473, P < 0.001) were independent risk factors for secondary vertebral compression fracture. Limitations: The main limitation is the retrospective nature of this study. Conclusion: Patients with low Hounsfield units value of L1 or non-spinal fracture history are an important population to target for secondary fracture prevention. Key words: Risk factor, vertebral, secondary fracture, osteoporosis

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Efficacy of Postural Reduction in Osteoporotic Vertebral Compression Fractures Followed by Percutaneous Vertebroplasty

Neurosurgery ◽

10.1227/01.neu.0000204313.36531.79 ◽

2006 ◽

Vol 58 (4) ◽

pp. 695-700 ◽

Cited By ~ 32

Author(s):

Dong-Kyu Chin ◽

Young-Soo Kim ◽

Yong-Eun Cho ◽

Jun-Jae Shin

Keyword(s):

Cobb Angle ◽

Compression Ratio ◽

Vertebral Compression Fracture ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Vertebral Compression Fractures ◽

Significant Relation ◽

Osteoporotic Vertebral Fractures ◽

The Mean ◽

Postural Reduction

Abstract OBJECTIVE: Vertebroplasty in the symptomatic osteoporotic vertebral fracture has become increasingly popular. However, there have been some limitations in restoring the height of the collapsed vertebrae and in preventing the leaking of cement. In the severely collapsed vertebrae of more than two thirds of their original height, vertebroplasty is regarded as a contraindication. We tried postural reduction using a soft pillow under the compressed level. This study was undertaken to investigate the effectiveness of the combination of postural reduction and vertebroplasty for re-expansion and stabilization of the osteoporotic vertebral fractures. METHODS: A total of 75 patients with single level vertebral compression fracture were treated with postural reduction followed by vertebroplasty. In 30 patients, the vertebral body was severely collapsed more than two-thirds of its original height. We calculated the compression ratio (anterior height/posterior height) and measured the Cobb angle. We analyzed the degree of re-expansion according to the onset duration. RESULTS: The mean compression ratio was 0.60 ± 0.15 initially and increased to 0.75 ± 0.17 after vertebroplasty. The mean Cobb angle was 16.14 ± 11.29° and corrected to 10.71 ± 12.08°. The degree of re-expansion showed significant relation with the onset duration. Twenty-eight of 30 (93%) severely collapsed vertebrae re-expanded after postural reduction, which made vertebroplasty possible. CONCLUSION: This new method of vertebroplasty leads to significant restoration of height and correction of kyphosis. The re-expansion was closely related with onset duration. In cases of severely collapsed vertebrae which is able to be re-expanded by postural reduction, vertebroplasty could be applied safely.

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Risk Factors for the Occurrence of Insufficient Cement Distribution in the Fractured Area after Percutaneous Vertebroplasty in Osteoporotic Vertebral Compression Fractures

January 2018 - Pain Physician ◽

10.36076/ppj.2018.1.e33 ◽

2018 ◽

Vol 1 (21;1) ◽

pp. E33-E42

Author(s):

Xiaobing Jiang

Keyword(s):

Risk Factors ◽

Pain Relief ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Bone Mass Density ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Cement Distribution ◽

Superior Portion

Background: Insufficient cement distribution (ICD) in the fractured area has been advocated to be responsible for unsatisfied pain relief after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs). However, little is known about risk factors for the occurrence of ICD. Objective: The present study aimed to identify independent risk factors of the emergence of ICD. Study Design: A retrospective cohort study. Setting: Department of spinal surgery, an affiliated hospital of a medical university. Methods: Patients who underwent PVP for single-level OVCF from January 2012 to September 2014 and met this study’s inclusion criteria were retrospectively reviewed. Associations of ICD with co-variates (age, gender, bone mass density with a T-score, amount of injected cement, cement leakage, fracture level, fracture age, fracture severity grade, and location of the fractured area) and the influence of ICD on pain relief were analyzed. Results: A total of 225 patients were included. ICD was found in 26 (11.6%) patients. Fractured area located in the superior portion of the index vertebra was significantly associated with occurrence of ICD. No further significant associations between the studied co-variates and emergence of ICD were seen in the adjusted analysis. In addition, patients with ICD had significantly higher immediate postoperative visual analog scale scores of back pain compared with those with sufficient cement distribution in the fractured area. Limitation: Location of the fractured area and cement distribution in the fractured area could not be evaluated quantitatively. Conclusions: The incidence of ICD is higher in patients with the fractured area located in the superior portion of the index vertebra and ICD might be responsible for unsatisfied pain relief after PVP for OVCFs. Key words: Percutaneous vertebroplasty, insufficient cement distribution, fractured area, risk factor, osteoporosis, vertebral compression fracture, spine, unsatisfied pain relief, cement augmentation

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Interventional Treatments for Acute and Chronic Pain: Systematic Review

10.23970/ahrqepccer247 ◽

2021 ◽

Author(s):

Roger Chou ◽

Rongwei Fu ◽

Tracy Dana ◽

Miranda Pappas ◽

Erica Hart ◽

...

Keyword(s):

Usual Care ◽

Older Patients ◽

Interventional Procedures ◽

Vertebral Compression Fracture ◽

Compression Fracture ◽

Vertebral Compression Fractures ◽

Controlled Trials ◽

Compression Fractures ◽

Radiofrequency Denervation ◽

And Function

Objective. To evaluate the benefits and harms of selected interventional procedures for acute and chronic pain that are not currently covered by the Centers for Medicare & Medicaid Services (CMS) but are relevant for and have potential utility for use in the Medicare population, or that are covered by CMS but for which there is important uncertainty or controversy regarding use. Data sources. Electronic databases (Ovid® MEDLINE®, PsycINFO®, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews) to April 12, 2021, reference lists, and submissions in response to a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) for 10 interventional procedures and conditions that evaluated pain, function, health status, quality of life, medication use, and harms. Random effects meta-analysis was conducted for vertebral compression fracture; otherwise, outcomes were synthesized qualitatively. Effects were classified as small, moderate, or large using previously defined criteria. Results. Thirty-seven randomized trials (in 48 publications) were included. Vertebroplasty (13 trials) is probably more effective at reducing pain and improving function in older (>65 years of age) patients, but benefits are small (less than 1 point on a 10-point pain scale). Benefits appear smaller (but still present) in sham-controlled (5 trials) compared with usual care controlled trials (8 trials) and larger in trials of patients with more acute symptoms; however, testing for subgroup effects was limited by imprecision. Vertebroplasty is probably not associated with increased risk of incident vertebral fracture (10 trials). Kyphoplasty (2 trials) is probably more effective than usual care for pain and function in older patients with vertebral compression fracture at up to 1 month (moderate to large benefits) and may be more effective at >1 month to ≥1 year (small to moderate benefits) but has not been compared against sham therapy. Evidence on kyphoplasty and risk of incident fracture was conflicting. In younger (below age for Medicare eligibility) populations, cooled radiofrequency denervation for sacroiliac pain (2 trials) is probably more effective for pain and function versus sham at 1 and 3 months (moderate to large benefits). Cooled radiofrequency for presumed facet joint pain may be similarly effective versus conventional radiofrequency, and piriformis injection with corticosteroid for piriformis syndrome may be more effective than sham injection for pain. For the other interventional procedures and conditions addressed, evidence was too limited to determine benefits and harms. Conclusions. Vertebroplasty is probably effective at reducing pain and improving function in older patients with vertebral compression fractures; benefits are small but similar to other therapies recommended for pain. Evidence was too limited to separate effects of control type and symptom acuity on effectiveness of vertebroplasty. Kyphoplasty has not been compared against sham but is probably more effective than usual care for vertebral compression fractures in older patients. In younger populations, cooled radiofrequency denervation is probably more effective than sham for sacroiliac pain. Research is needed to determine the benefits and harms of the other interventional procedures and conditions addressed in this review.

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Vertebral Compression Fractures and Options for Treatment

10.2310/pm.15022 ◽

2016 ◽

Author(s):

Magdalena Anitescu ◽

Annie Layno-Moses

Keyword(s):

Vertebral Compression Fracture ◽

Compression Fracture ◽

Initial Step ◽

The United States ◽

Vertebral Compression Fractures ◽

Invasive Procedures ◽

First Line ◽

Compression Fractures ◽

Prompt Diagnosis

Vertebral compression fracture, a condition that affects almost one quarter of women in the United States, often presents as unrelenting pain with even minor movement. The condition has a significant effect on the decrease in quality of life of patients affected. Prompt diagnosis and treatment are key in the management of this condition. Although a conservative regimen with back braces and analgesics is the first initial step, invasive procedures, such as kyphoplasty and vertebroplasty, may be employed earlier in cases with severe debilitating pain, which is often not improved by first-line treatment.

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Role of percutaneous vertebroplasty with high-viscosity cement in the treatment of severe osteoporotic vertebral compression fractures

Scientific Reports ◽

10.1038/s41598-021-84314-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kunpeng Li ◽

Changbin Ji ◽

Dawei Luo ◽

Wen Zhang ◽

Hongyong Feng ◽

...

Keyword(s):

Cobb Angle ◽

Operative Time ◽

Percutaneous Vertebroplasty ◽

Cement Leakage ◽

High Viscosity ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Vertebral Height ◽

Compression Fractures ◽

One Year

AbstractSevere osteoporotic vertebral compression fractures (OVCFs) were considered as relative or even absolute contraindication for vertebroplasty and kyphoplasty and these relevant reports are very limited. This study aimed to evaluate and compare the efficacy of vertebroplasty with high-viscosity cement and conventional kyphoplasty in managing severe OVCFs. 37 patients of severe OVCFs experiencing vertebroplasty or kyphoplasty were reviewed and divided into two groups, according to the procedural technique, 18 in high-viscosity cement percutaneous vertebroplasty (hPVP) group and 19 in conventional percutaneous kyphoplasty (cPKP) group. The operative time, and injected bone cement volume were recorded. Anterior vertebral height (AVH), Cobb angle and cement leakage were also evaluated in the radiograph. The rate of cement leakage was lower in hPVP group, compared with cPKP group (16.7% vs 47.4%, P = 0.046). The patients in cPKP group achieved more improvement in AVH and Cobb angle than those in hPVP group postoperatively (37.2 ± 7.9% vs 43.0 ± 8.9% for AVH, P = 0.044; 15.5 ± 4.7 vs 12.7 ± 3.3, for Cobb angle, P = 0.042). At one year postoperatively, there was difference observed in AVH between two groups (34.1 ± 7.4 vs 40.5 ± 8.7 for hPVP and cPKP groups, P = 0.021), but no difference was found in Cobb angle (16.6 ± 5.0 vs 13.8 ± 3.8, P = 0.068). Similar cement volume was injected in two groups (2.9 ± 0.5 ml vs 2.8 ± 0.6 ml, P = 0.511). However, the operative time was 37.8 ± 6.8 min in the hPVP group, which was shorter than that in the cPKP group (43.8 ± 8.2 min, P = 0.021). In conclusion, conventional PKP achieved better in restoring anterior vertebral height and improving kyphotic angle, but PVP with high-viscosity cement had lower rate of cement leakage and shorter operative time with similar volume of injected cement.

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Kyphoplasty for the treatment of an atypical osteoporotic vertebral compression fracture of the lumbar spine: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x17744985 ◽

2017 ◽

Vol 5 ◽

pp. 2050313X1774498

Author(s):

Sanjeev Kumar ◽

Leon Anijar ◽

Rishi Agarwal

Keyword(s):

Older Patients ◽

Vertebral Compression Fracture ◽

Compression Fracture ◽

Osteoporotic Vertebral Compression Fracture ◽

Vertebral Compression Fractures ◽

Clinical Scenario ◽

Vertebral Augmentation ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Lumbar Vertebral Body

Vertebral augmentation is a minimally invasive but sometimes technically challenging intervention typically reserved for the treatment of older patients with painful vertebral compression fractures due to osteoporosis or neoplasms. We report the successful treatment of osteoporotic vertebral compression fractures of the first lumbar vertebral body (L1) using kyphoplasty in a paraplegic young patient with multiple comorbidities. Despite the unusual and complicated clinical scenario, kyphoplasty was nonetheless performed with immediate and lasting pain relief.

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Comparison between percutaneous vertebroplasty and percutaneous kyphoplasty in the treatment of posterior wall rupture and osteoporotic vertebral compression fractures-Case - based retrospective study

10.21203/rs.3.rs-19906/v1 ◽

2020 ◽

Author(s):

Yong-sheng Gou ◽

Yue Hu ◽

Hai-bo Li ◽

Bo-lin fu ◽

Zheng Che

Keyword(s):

Retrospective Study ◽

Clinical Efficacy ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Operation Time ◽

Posterior Wall ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Percutaneous Kyphoplasty

Abstract Background: Percutaneous kyphoplasty (PKP) or percutaneous vertebral plasty (PVP) has been widely applied in the treatment of osteoporotic vertebral compression fractures (osteoporotic vertebral compression will fracture, OVCF) because of its minimally invasive and effective. To compare the clinical efficacy and safety of percutaneous vertebroplasty versus percutaneous kyphoplasty for osteoporotic vertebral compression fractures with posterior wall broken. Methods: 82 patients with osteoporotic vertebral compression fracture with posterior wall broken were divided into PVP group(group A) and PKP group(group B)．The operation time, perspective times, bone cement volume injected. cement leakage, hospitalization expenses, preoperative visual analog score(VAS) and Oswestry disability index(ODI), restoration height of vertebral, the vertebrae height loss and new fracture of adjacent vertebra were evaluated during the follow-up. Results: The PVP group incurred significantly shorter operation time(40.37 ±8.26 min) and less perspective times (22.23 ±3.79 times)than the PKP group(46.74 ±9.58 min and 27.96 ±5.71 times respectively)( P<0.05). The PVP group incurred significantly less expenses than the PKP group(P<0.05). The VAS scores and ODI at 1 day and 6 months post-operation were significantly lower than pre-operation in both groups(P<0.05). Conclusion: Both PVP and PKP Can obtain satisfactory clinical efficacy for the treatment of osteoporotic vertebral compression fractures with posterior wall broken,but the former may have advantages of less expenses,shorter operation time. Trial registration: This retrospective study was approved by the ethics committee of the first people's hospital of shuangliu district, Chengdu, Moreover, this study was also registered in the Chinese clinical trial registry with the registration number of ChiCTR1900028176.

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Risk factors for secondary fractures to percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a systematic review

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02722-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Wei Mao ◽

Fei Dong ◽

Guowei Huang ◽

Peiliang He ◽

Huan Chen ◽

...

Keyword(s):

Risk Factors ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Mineral Density ◽

Secondary Fracture ◽

Compression Fractures ◽

Secondary Fractures ◽

At Home

Abstract Background Osteoporotic vertebral compression fracture (OVCF) is one of the most common fragile fractures, and percutaneous vertebroplasty provides considerable long-term benefits. At the same time, there are many reports of postoperative complications, among which fracture after percutaneous vertebroplasty is one of the complications after vertebroplasty (PVP). Although there are many reports on the risk factors of secondary fracture after PVP at home and abroad, there is no systematic analysis on the related factors of secondary fracture after PVP. Methods The databases, such as CNKI, Wan Fang Database and PubMed, were searched for documents on secondary fractures after percutaneous vertebroplasty published at home and abroad from January 2011 to March 2021. After strictly evaluating the quality of the included studies and extracting data, a meta-analysis was conducted by using Revman 5.3 software. Results A total of 9 articles were included, involving a total of 1882 patients, 340 of them diagnosed as secondary fractures after percutaneous vertebroplasty. Conclusion The additional history of fracture, age, bone mineral density (BMD), bone cement leakage, intravertebral fracture clefts and Cobb Angle might be risk factors related to secondary fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fractures. The height of vertebral anterior and body mass index (BMI) were not correlated.

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