Percutaneous tissue debulking and cement augmentation for advanced malignant vertebral compression fractures

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 9535-9535
Author(s):  
B. Georgy ◽  
W. Wong
Keyword(s):  
Bone Cement ◽  
Vertebral Body ◽  
Vertebral Compression Fractures ◽  
Intractable Pain ◽  
Compression Fractures ◽  
Complication Risk ◽  
Relieve Pain ◽  
Cortical Defect ◽  
Cement Extravasation ◽  
Oncologic Treatment

9535 Background: Percutaneous cement injection procedures (eg vertebroplasty, kyphoplasty) are used successfully to palliate patients with painful osteoporotic vertebral compression fractures (VCFs). When VCFs occur because of malignant lesions however, treatment can be challenging; often by the time symptoms occur, the tumor has extended into the epidural tissue and is associated with posterior cortical disruption. As a result, patients have a higher likelihood of cement extravasation outside the vertebral body, thought to be associated with increased complication risk. This study was to investigate clinical viability and effectiveness of a technique designed to improve control of bone cement placement over standard methods when treating patients with symptomatic VCFs caused by malignancy. Methods: All patients had intractable pain determined to be associated with VCFs caused by metastasized malignancy. The procedure involved using a plasma-mediated radiofrequency-based device to debulk tissue and etch a void within the affected vertebral body and then filling the void and adjacent interstices with bone cement to stabilize the vertebral body and relieve pain. Results: 28 patients (36 vertebral bodies) with various types of metastatic lesions were treated. No evidence of cement extravasation outside the vertebral boundary was detected in 34/36 (94%) cases, even in cases with severe posterior cortical compromise and prominent epidural involvement pre-operatively. In the 2 observed cases, cement extravasation was clinically inconsequential. All treated patients reported marked pain relief. No patients were prevented from continuing other oncologic treatments. Conclusions: Tissue removal to create a void before injecting bone cement into a vertebral body compromised by malignancy may reduce the complication rate observed when injecting cement. This technique may redirect cement away from the spinal canal, notably in cases with posterior cortical defect and epidural extension, while also improving interdigitation of cement and decreasing risk of metastatic embolization. The resulting palliation potentially improves functionality and quality of life during and does not appear to affect the effectiveness of continued oncologic treatment. [Table: see text]

Vertebral Augmentation for Compression Fractures Caused by Malignant Disease

2010 ◽  
Vol 8 (9) ◽  
pp. 1095-1102 ◽  
Author(s):  
Rahul Rastogi ◽  
Trusharth Patel ◽  
Robert A. Swarm
Keyword(s):  
Pain Relief ◽  
Bone Cement ◽  
Vertebral Body ◽  
Malignant Disease ◽  
Body Height ◽  
Vertebral Compression Fractures ◽  
Intractable Pain ◽  
Vertebral Augmentation ◽  
Vertebral Body Height ◽  
Compression Fractures

Vertebral compression fractures are common in malignant disease and frequently cause severe back pain. However, management of that pain with conventional medical, radiotherapy, or surgical modalities is often inadequate. Vertebral augmentation techniques, such as vertebroplasty and kyphoplasty, are minimally invasive techniques in which methylmethacrylate bone cement is percutaneously injected into compressed vertebral bodies. Vertebral augmentation often improves mechanical stability of compressed vertebrae, provides pain relief, and may prevent progression of vertebral collapse. Kyphoplasty may provide increased chance for vertebral body height restoration, but the clinical importance of slight change in vertebral body height is unclear. Vertebral augmentation can be used in conjunction with other treatment modalities, and associated pain relief may improve patient tolerance of needed antitumor therapies, such as radiation therapy. Vertebral augmentation is generally very well tolerated, and complications associated with bone cement extravasation beyond the vertebral body have rarely been reported. Because it often provides good to excellent relief of otherwise intractable pain and is generally well tolerated, vertebral augmentation is becoming a first-line agent for management of painful vertebral compression fractures, especially in the setting of malignant disease.

scholarly journals Vesselplasty for the treatment of osteoporotic vertebral compression fractures with peripheral wall damage: A retrospective study

2020 ◽  
Author(s):  
Chongqing Xu ◽  
Mengchen Yin ◽  
Wen Mo
Keyword(s):  
Cobb Angle ◽  
Bone Cement ◽  
Vertebral Body ◽  
Body Height ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Vertebral Body Height ◽  
Compression Fractures ◽  
Time Points ◽  
Postoperative Time

Abstract Background The clinical efficacy of vertebroplasty and kyphoplasty treating osteoporotic vertebral compression fractures (OVCF) has been widely recognized in recent years. However, there are also disadvantages of bone cement leakage (BCL), limited correction of kyphosis and recovery of vertebral height. Nowadays, in view of these shortcomings, vesselplasty has been widely used in clinical practice. The objective of this study is to assess its clinical effect and application value for the treatment of OVCF with peripheral wall damage. Methods/Design: All 62 patients (70 vertebrae) treated for OVCF with peripheral wall damage using vesselplasty were involved and retrospectively analyzed. The data collection included operation time, volume of bone cement, relevant surgical complications, visual analog scale (VAS), Oswestry disability index (ODI), vertebral body height and kyphosis Cobb angle. Results The time of operation was 20–65 (34.5 ± 10.5) minutes. The volume of bone cement was 3–8 (5.3 ± 1.3) ml. VAS and ODI at different time points after operation were decreased compared with before operation (all P < 0.05). There were no statistical differences between VAS or ODI at different postoperative time points (P > 0.05). Vertebral body height and Cobb angle at different time points after operation were improved compared with before operation (all P < 0.05). There were no statistical differences between vertebral body height or Cobb angle at different postoperative time points (all P > 0.05). Conclusion Vesselplasty can reduce the risk of BCL and better control the dispersion of bone cement in the treatment of OVCF. It has a definite effect in relieving pain, restoring the vertebral body height and correcting the kyphosis caused by injured vertebrae, especially in OVCF with peripheral wall damage. Therefore, vesselplasty is safe and worthy of clinical application.

Comparison of unilateral and bilateral percutaneous vertebroplasty in the treatment of severe vertebral compression fractures

2020 ◽  
Author(s):  
Juan Long ◽  
Chun Jing He ◽  
Zikun Duan ◽  
Xinguo Kang ◽  
Jinfeng Zou
Keyword(s):  
Bone Cement ◽  
Percutaneous Vertebroplasty ◽  
Operation Time ◽  
Cement Leakage ◽  
Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Needle Position ◽  
Relieve Pain ◽  
Group A ◽  
Group B

Abstract BACKGROUND The purpose of this study was to comparison of unilateral and bilateral percutaneous vertebroplasty in the treatment of severe vertebral compression fractures. METHODS Sixty-four severe vertebral compression fractures patients were treated in our hospital were randomly divided into group A and group B(n = 32). Group A received Percutaneous vertebroplasty (PVP) treatment by unilateral vertebral pedicle approach. Group B received PVP treatment by bilateral vertebralpedicle approach. Visual Analogue scale (VAS) score and Oswesty Disability Index (ODI) were recorded before surgery, and at 1d,1 month, and 6 months after operation. Also, the puncture path, needle position, intraoperative bone cement injection volume, bone cement dispersion, intra-operative and postoperative complications were observed. RESULTS Sixty-four vertebrae were successfully punctured.The postoperative VAS,ODI were lower than preoperative, showed statistical difference compared with the preoperative VAS, ODI, but there are no difference between Group A and Group B.The cement leakage and operation time is lower in group A than that in Group B. CONCLUSION PVP by unilateral vertebral pedicle approach in treating severe vertebral compression fractures can significantly relieve pain and promote functional recovery, which has advantages such as convenient operation and low complication rate.

Unilateral Versus Bilateral Kyphoplasty for Osteoporotic Vertebral Compression Fractures

2011 ◽  
Vol 393-395 ◽  
pp. 1064-1068 ◽  
Author(s):  
Bin Zhang ◽  
Min Dai ◽  
Ya Min Tang
Keyword(s):  
Vertebral Body ◽  
Randomized Study ◽  
Body Height ◽  
Vertebral Compression Fractures ◽  
Clinical Effects ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Vertebral Body Height ◽  
Compression Fractures ◽  
Cement Extravasation

Study Design A retrospective study of patients who underwent kyphoplasty at a single institute. Objective To examine and compare the safety and long-term radiographic and clinical effects of unilateral or bilateral kyphoplasty to treat symptomatic vertebral compression fractures (VCF). Summary of Background Data Kyphoplasty (KP) involves placement of inflatable bone tamp via unilateral and bilateral approaches. Few randomized study comparing the radiographic and clinical outcomes using unilateral and bilateral approaches was reported. Methods 50 patients with osteoporotic vertebral compression fractures (VCF) were allocated into two groups adopting unilateral or bilateral kyphoplasty. Preoperative and postoperative pain scores, Vertebral body height were compared and analyzed. Results Both unilateral and bilateral kyphoplasty resulted in significant pain reduction. Significant increases of midline vertebral body height were recorded for both groups after surgery and maintained for the period of follow-up. Asymptomatic cement extravasation occurred in 8 of 50 patients, and 2 patients developed additional fractures at untreated levels during the period of follow-up. Conclusions Both unilateral and bilateral KP can improve clinical effects of osteoporotic VCF and result in significant vertebral height restoration for at least 18 months after treatment.

Treatment of Osteoporotic Vertebral Compression Fracture with Target-Anchored Vertebral Body Plasty

2019 ◽  
Vol 9 (8) ◽  
pp. 1081-1085
Author(s):  
Liu Yang ◽  
Xiangbei Qi ◽  
Tao Lei ◽  
Jingtao Zhang ◽  
Junming Cao
Keyword(s):  
Bone Cement ◽  
Vertebral Body ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Target Group ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Traditional Group ◽  
Compression Fractures ◽  
Fracture Area

Objective: To analyze the clinical effect of target-anchored vertebroplasty and traditional percutaneous vertebroplasty on the treatment of osteoporotic vertebral compression fractures. Methods: 50 female New Zealand rabbits were selected for establishing the osteoporotic vertebral compression fracture model and divided into two groups, traditional group and target group followed by analysis of the anterior, posterior, and posterior vertebral body anterior height of the fracture and the injection volume of the bone cement at full filling, and to compare the ultimate compressive strength and stiffness differences between the two groups of specimens by biomechanical testing. Results: In traditional group, the operative time was significantly shorter than that of target group, and the intraoperative bleeding was significantly lower than that of target group (P < 0.05). The fracture area of target group was filled with sufficient bone cement, in the traditional group, 3 cases (12%) showed that bone cement was not filled in the fracture area (P < 0.05), but the total bone cement filling volume was not significantly different between the two groups, but the traditional group had more complete bone cement filling than the bone cement filling, the difference was statistically significant (P < 0.05). In addition, the anterior vertebral body height of each group was significantly higher than other observation points in the group (P < 0.05). However, the distribution of permeability and osmotic type of bone cement between the two groups was not significantly different (P > 0.05). Conclusion: Target-anchored vertebroplasty can improve the quality of clinical treatment of osteoporotic vertebral compression fractures, indicating that it might be a new surgical method.

scholarly journals Clinical observation of two bone cement distribution modes after percutaneous vertebroplasty for osteoporotic vertebral compression fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Qiujiang Li ◽  
Xingxia Long ◽  
Yinbin Wang ◽  
Tao Guan ◽  
Xiaomin Fang ◽  
...  
Keyword(s):  
Bone Cement ◽  
Clinical Efficacy ◽  
Vertebral Body ◽  
Percutaneous Vertebroplasty ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Cement Distribution ◽  
Local Kyphosis

Abstract Background Current findings suggest that percutaneous vertebroplasty(PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs). The present retrospective study aimed to investigate the differences in clinical efficacy and related complications between the two bone cement distribution modes. Methods We retrospectively reviewed the medical records of the patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty. Patients were divided into blocky and spongy group according to the type of postoperative bone cement distribution. Clinical efficacy and related complications was compared between the two bone cement distribution modes on 24 h after the operation and last follow-up. Results A total of 329 patients with an average follow up time of 17.54 months were included. The blocky group included 131 patients, 109 females(83.2 %) and 22 males(16.8 %) with a median age of 72.69 ± 7.76 years, while the Spongy group was made up of 198 patients, 38 females(19.2 %) and 160 males(80.8 %) with a median age of 71.11 ± 7.36 years. The VAS and ODI after operation improved significantly in both two groups. The VAS and ODI in the spongy group was significantly lower than that in the blocky group, 24 h postoperatively, and at the last follow-up. There were 42 cases (12.8 %) of adjacent vertebral fractures, 26 cases (19.8 %) in the blocky group and 16 cases (8.1 %) in the spongy group. There were 57 cases (17.3 %) of bone cement leakage, 18 cases (13.7 %) in blocky group and 39 cases (19.7 %) in the spongy group. At 24 h postoperatively and at the last follow-up, local kyphosis and anterior vertebral height were significantly corrected in both groups, but gradually decreased over time, and the degree of correction was significantly higher in the spongy group than in the block group. The change of local kyphosis and loss of vertebral body height were also less severe in the spongy group at the last follow-up. Conclusions Compared with blocky group, spongy group can better maintain the height of the vertebral body, correct local kyphosis, reduce the risk of the vertebral body recompression, long-term pain and restore functions.

scholarly journals Clinical Observation of Two Bone Cement Distribution Modes After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures

2021 ◽  
Author(s):  
Qiujiang Li ◽  
Xingxia Long ◽  
Yinbin Wang ◽  
Tao Guan ◽  
Xiaomin Fang ◽  
...  
Keyword(s):  
Bone Cement ◽  
Clinical Efficacy ◽  
Vertebral Body ◽  
Percutaneous Vertebroplasty ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Cement Distribution ◽  
Local Kyphosis

Abstract Background:Current findings suggest that percutaneous vertebroplasty(PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs).The present retrospective study aimed to investigate the differences in clinical efficacy and related complications between the two bone cement distribution modes. Methods:We retrospectively reviewed the medical records of the patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty.Patients were divided into blocky and spongy group according to the type of postoperative bone cement distribution. Clinical efficacy and related complications was compared between the two bone cement distribution modes on 24h after the operation and last follow-up.RESULTS: The mean follow-up time was 17.54 months. The VAS and ODI after operation improved significantly in both two groups. The VAS and ODI in the spongy group was significantly lower than that in the blocky group, 24h postoperatively, and at the last follow-up. There were 42 cases (12.8%) of adjacent vertebral fractures, 26 cases (19.8%) in the blocky group and 16 cases (8.1%) in the spongy group. There were 57 cases (17.3%) of bone cement leakage, 18 cases (13.7%) in blocky group and 39 cases (19.7%) in the spongy group. At 24 hour postoperatively and at the last follow-up, local kyphosis and anterior vertebral height were significantly corrected in both groups, but gradually decreased over time, and the degree of correction was significantly higher in the spongy group than in the block group. Loss of local kyphosis and loss of vertebral body height were also less severe in the spongy group at the last follow-up.Conclusions: Compared with blocky group, spongy group can better maintain the height of the vertebral body, correct local kyphosis, reduce the risk of the vertebral body recompression, long-term pain and restore functions.

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