Retrospective Review of Procedural Parameters and Outcomes of Percutaneous Vertebroplasty in 673 Patients

Percutaneous vertebroplasty (PVP) is a minimally invasive procedure to treat back pain secondary to osteoporotic vertebral compression fractures (VCF). This study aims to review our techniques and outcomes in patients with VCF. Outcomes of all patients who underwent PVP at our institution from 1998 to 2014 were retrospectively collected from medical records and follow-up telephone interviews. 1174 PVP procedures for VCF in 673 patients were identified to have complete follow-up data. Patients with inadequate data were excluded from the analysis. Procedural aspects such as unipedicular or bipedicular access, vertebral region treated, amount of cement injected into vertebrae, number of levels treated at a single session, refracture rates and location, presence of a necrotic cavity, and pain outcomes were examined. Excellent rates of improvement of back pain for both single level and multilevel PVP were achieved in 92% of patients. Unipedicular or bipedicular approach, cement volume, vertebral region treated, cement extravasation, and presence of a necrotic cavity did not affect pain outcomes or refracture rates. Fractures that did develop after PVP were often adjacent and occurred earlier than distant level fractures. Lumbar vertebrae required more cement than thoracic vertebrae. PVP provides excellent rates of pain relief in both single and multilevel procedures. The procedural aspects evaluated did not affect pain outcome or refracture rates. Adjacent refractures tended to occur sooner than distant ones.

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Use and evaluation of a semi-permeable mesh implant in vertebral augmentation for the treatment of painful osteoporotic vertebral compression fractures

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011512 ◽

2015 ◽

Vol 8 (3) ◽

pp. 328-332 ◽

Cited By ~ 1

Author(s):

A Orlando Ortiz

Keyword(s):

Lumbar Vertebrae ◽

Cement Leakage ◽

Vertebral Compression Fractures ◽

Thoracic Vertebrae ◽

Vertebral Augmentation ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Implant Size ◽

Mesh Implant ◽

Cement Extravasation

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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Balloon Kyphoplasty for Acute Osteoporotic Compression Fractures

Interventional Neuroradiology ◽

10.1177/159101991001600108 ◽

2010 ◽

Vol 16 (1) ◽

pp. 65-70 ◽

Cited By ~ 1

Author(s):

T. Yang ◽

S. Liu ◽

X. Lv ◽

Z. Wu

Keyword(s):

Invasive Procedure ◽

Balloon Kyphoplasty ◽

Cement Leakage ◽

Vertebral Compression Fractures ◽

Minimally Invasive Procedure ◽

Compression Fractures ◽

Low Incidence ◽

Initial Score ◽

Cement Extravasation

We reviewed the effectiveness of balloon kyphoplasty in the treatment of acute symptomatic vertebral compression fractures. We assessed radiographic and functional outcome in 11 patients with a 24.3 month follow-up from a retrospectively monitored series of 11 patients who underwent balloon kyphoplasty (BKP). A visual analogue scale (VAS) and the short McGill questionnaire (MPQ) were used to assess average symptoms. Eleven patients with 19 treated vertebrae completed the study. The VAS showed significant improvement after treatment: the initial score was 9.1 ± 0.6 (mean ± SD), falling to 2.7 ± 1.07 by 24.3 months (P<0.001). The MPQ also showed a significant improvement (P<0.001) at follow-up. A new fracture was seen in one patient affecting two vertebrae adjacent to the treated level. On CT following the procedure, there was cement leakage in the disc in 9% of cases. BKP is a minimally invasive procedure that has been shown to be effective in the treatment of acute symptomatic vertebral compression fractures. It appears that BKP is associated with a low incidence of procedure-related complications and cement extravasation.

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Influence of bone cement distribution on outcomes following percutaneous vertebroplasty: a retrospective matched-cohort study

Journal of International Medical Research ◽

10.1177/03000605211022287 ◽

2021 ◽

Vol 49 (7) ◽

pp. 030006052110222

Author(s):

Ling Mo ◽

Zixian Wu ◽

De Liang ◽

Linqiang Y ◽

Zhuoyan Cai ◽

...

Keyword(s):

Cohort Study ◽

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Vertebral Compression Fractures ◽

Matched Cohort ◽

Matched Cohort Study ◽

Cement Distribution ◽

Group A ◽

Group B

Objective To evaluate the influence of insufficient bone cement distribution on outcomes following percutaneous vertebroplasty (PVP). Methods This retrospective matched-cohort study included patients 50–90 years of age who had undergone PVP for single level vertebral compression fractures (VCFs) from February 2015 to December 2018. Insufficient (Group A)/sufficient (Group B) distribution of bone cement in the fracture area was assessed from pre- and post-operative computed tomography (CT) images. Assessments were before, 3-days post-procedure, and at the last follow-up visit (≥12 months). Result Of the 270 eligible patients, there were 54 matched pairs. On post-operative day 3 and at the last follow-up visit, significantly greater visual analogue scale (VAS) pain scores and Oswestry Disability Index (ODI) scores were obtained in Group B over Group A, while kyphotic angles (KAs) and vertebral height (VH) loss were significantly larger in Group A compared with Group B. Incidence of asymptomatic cement leakage and re-collapse of cemented vertebrae were also greater in Group A compared with Group B. Conclusions Insufficient cement distribution may relate to less pain relief and result in progressive vertebral collapse and kyphotic deformity post-PVP.

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Percutaneous vertebroplasty (PVP) to treat specialized type of endplate fractures around the Schmorl’s node: a prospective study of 65 patients

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01873-6 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Yaoshen Zhang ◽

Peng Yin ◽

Jincai Yang ◽

Yong Hai

Keyword(s):

Back Pain ◽

Prospective Study ◽

Surgical Complications ◽

Percutaneous Vertebroplasty ◽

Vertebral Compression Fractures ◽

Adjacent Segment ◽

Safe Procedure ◽

Link Type ◽

Schmorl's Node ◽

Schmorl’S Node

Abstract Background The Schmorl’s nodes (SNs) are defined as the herniation of the intervertebral disc into the vertebral body. Endplate fractures around the Schmorl’s node could result in severe back pain that is similar to vertebral compression fractures. The objective of this study was to prospectively analyze the surgical effectiveness and safety of percutaneous vertebroplasty (PVP) for endplate fractures around the SNs. Methods Seventy-one consecutive patients with the fresh endplate fracture around SNs from October 2017 to February 2018 were enrolled in this study. The visual analog scale (VAS) and Oswestry disability index (ODI) scores of low back pain were evaluated in all patients preoperatively, postoperatively, and at 1 month, 6 months, and 1 year after primary single level PVP. Surgery-related data including duration of the operation, injected cement volumes, and surgical complications were recorded. Results Sixty-five patients with fresh endplate fractures around the SNs were treated successfully via percutaneous vertebroplasty. Our study showed that the VAS scores and ODI scores of patients were obviously improved after operation. Cement leakage into the disc space occurred in 5 patients (7.7%), and adjacent segment refractures occurred in 2 patients (3.1%). No other surgical complications, including infections or nerve root injuries were encountered. Conclusions Based on the results of this prospective study, PVP was an effective and safe procedure for endplate fractures around the SNs. Trial registration ChiCTR, ChiCTR1800016453. Registered 2 June 2018—retrospectively registered, http://www.chictr.org.cn/com/25/historyversionpuben.aspx?regno=ChiCTR1800017602

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Efficacy of percutaneous vertebroplasty combined with radiotherapy in osteolytic metastatic spinal tumors

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.2.3.0243 ◽

2005 ◽

Vol 2 (3) ◽

pp. 243-248 ◽

Cited By ~ 59

Author(s):

Jee-Soo Jang ◽

Sang-Ho Lee

Keyword(s):

Pain Relief ◽

Percutaneous Vertebroplasty ◽

Invasive Procedure ◽

Spinal Tumors ◽

Percutaneous Injection ◽

Content Type ◽

Spinal Stabilization ◽

Before And After ◽

Fine Print

Object. Vertebroplasty involves the percutaneous injection of polymethylmethacrylate into collapsed vertebral bodies due to hemangioma, osteoporosis, or malignant tumor. The purpose of this study was to evaluate the merits and efficacy of percutaneous vertebroplasty (PVP) combined with radiotherapy in treating patients with osteolytic metastatic spinal tumors (OMSTs). Methods. Twenty-eight patients with OMSTs underwent PVP for the treatment of 72 vertebrae after administration of a local anesthetic or induction of general anesthesia for pain relief and spinal stabilization. Radiotherapy for suppressing tumor or inducing pain relief was performed immediately after PVP in 22 patients. Pain levels were assessed before and after the procedure by using a visual analog scale (VAS), and follow-up assessment was conducted at 1, 3, 6, and 9 months. On postoperative Day 3, marked-to-complete VAS score—based pain relief was achieved in 13 patients (48%) and moderate relief was demonstrated in 11 (41%). The mean VAS pain score was reduced from 8.2 to 3, and major complications were absent in all cases. Follow-up plain radiography was performed to assess vertebral column stability. Neither additional vertebral collapse in the treated vertebrae nor neurological deterioration was observed. Conclusions. Percutaneous vertebroplasty is a minimally invasive procedure and, when combined with radiotherapy, seems to be effective in providing pain relief and stabilization in patients with OMSTs.

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Pulmonary cement embolism: a complication of percutaneous vertebroplasty

Acta Radiologica ◽

10.1080/02841850701422153 ◽

2007 ◽

Vol 48 (8) ◽

pp. 854-859 ◽

Cited By ~ 69

Author(s):

C. Duran ◽

M. Sirvanci ◽

M. Aydoğan ◽

E. Ozturk ◽

C. Ozturk ◽

...

Keyword(s):

Percutaneous Vertebroplasty ◽

Imaging Finding ◽

Early Stage ◽

Chest Radiographs ◽

Vertebral Compression Fractures ◽

Common Procedure ◽

Compression Fractures ◽

Branching Patterns ◽

Cement Embolism

Background: Percutaneous vertebroplasty (PV) has recently become a very common procedure for vertebral compression fractures. Extravasation of cement, a common event associated with vertebroplasty, may lead to cement emboli in the lungs. Purpose: To determine the frequency of pulmonary cement embolism after percutaneous vertebroplasty. Material and Methods: Between 2002 and 2006, 128 percutaneous vertebroplasties were performed in 73 patients (56 women and 17 men) in our institution. Postprocedural chest radiographs were obtained for all patients and assessed for the presence of pulmonary cement emboli. Results: Pulmonary cement embolism was detected on chest radiographs and confirmed with chest computed tomography (CT) in four patients treated with percutaneous vertebroplasty for osteoporotic collapse and one patient treated for multiple myeloma. The imaging finding of pulmonary cement embolism was solitary or multiple fine radiodense lines with occasional branching patterns. The frequency of pulmonary cement embolism was 6.8%. Conclusion: An incidence of pulmonary cement embolism of 6.8% during PV was found. Close clinical follow-up, postprocedural chest radiographs, and chest CT scans, if necessary, are important for the detection of pulmonary cement embolism at an early stage.

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Multilevel percutaneous vertebroplasty: safety, efficacy and long-term outcomes

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214961 ◽

2021 ◽

Vol 8 (1) ◽

pp. 54

Author(s):

Sibasankar Dalai ◽

Aravind V. Datla

Keyword(s):

Percutaneous Vertebroplasty ◽

Invasive Procedure ◽

Cost Effective ◽

Cement Leakage ◽

Effective Procedure ◽

Vertebral Compression Fractures ◽

Rapid Restoration ◽

Reduced Mobility

Background: The pain in vertebral compression fractures is severe, leading to reduced mobility and quality of life. Percutaneous vertebroplasty is a minimally invasive procedure for treating various spinal pathologies. This study evaluated the usefulness and safety of multilevel PVP (two to three vertebrae) in managing VCF.Methods: This retrospective study evaluated 59 vertebral levels in 28 patients with VCF who had been operated on for multilevel PVP (two to three levels). There were 22 females and six males, and their ages ranged from 36 to 79 years, with a mean age of 68.95 years. We had injected two levels in 25 patients and three levels in 3 patients. The visual analogue scale was used for pain intensity measurement, and plain X-ray films, computed tomography scan and magnetic resonance imaging was used for radiological assessment. The mean follow-up period was 13.8 months (range, 11-19).Results: Significant pain improvement was recorded in 26 patients (92.85%). More remarkable improvement in pain was noticed in the immediate postoperative period than in the subsequent follow-ups. Asymptomatic bone cement leakage anteriorly and into the disk spaces in two patients. Isolated anterior leakage has occurred in one patient. There was no encounter of pulmonary embolism.Conclusions: Multilevel PVP for the treatment of VCF is a safe and effective procedure that can significantly reduce pain and improve patient condition without any significant morbidity. It is considered a cost-effective procedure allowing a rapid restoration of patient mobility.

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Clonazepam for pain due to muscle spasm in a patient with vertebral compression fractures caused by multiple myeloma: a case report

JA Clinical Reports ◽

10.1186/s40981-021-00477-1 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Kazuki Akita ◽

Yasutomo Kumakura ◽

Emi Nakajima ◽

Hiroki Ishiguro ◽

Tetsuya Iijima

Keyword(s):

Multiple Myeloma ◽

Low Back Pain ◽

Back Pain ◽

Muscle Relaxant ◽

Facet Joint ◽

Lumbar Vertebrae ◽

Muscle Spasm ◽

Vertebral Compression Fractures ◽

Low Back ◽

Compression Fractures

Abstract Background Vertebral compression fractures can cause severe back pain. Although many types of analgesics and interventional treatments are available, they are sometimes ineffective in mitigating the pain. We encountered a case where clonazepam was effective for the management of severe low back pain caused by lumbar vertebral compression fractures. Case presentation A 44-year-old male was diagnosed with multiple myeloma and had vertebral compression fractures of the first and second lumbar vertebrae. He had been suffering from severe low back pain on movement with muscle spasm and pain-associated anxiety. We considered this breakthrough low back pain to be caused by facet joint pain; thus, we prescribed clonazepam as a muscle relaxant and anxiolytic. Following this treatment, the intractable breakthrough pain was dramatically relieved. Conclusion Clonazepam, which has both muscle relaxant and anxiolytic effects, might be helpful in mitigating pain, associated anxiety, and muscle spasms due to vertebral compression fractures.

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CEMENT LEAKAGE FOLLOWING PERCUTANEOUS VERTEBRAL AUGMENTATION: CASE REPORT

Tạp chí Y học Việt Nam ◽

10.51298/vmj.v506i1-2.974 ◽

2021 ◽

Vol 506 (1-2) ◽

Author(s):

Tran Huy Hung ◽

Nguyen Minh Tien

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Percutaneous Vertebroplasty ◽

Clinical Signs ◽

Cement Leakage ◽

Vertebral Compression Fractures ◽

Low Back ◽

Urine Retention ◽

Compression Fractures ◽

Second Surgery

Background: Percutaneous vertebroplasty (PV) has become an important minimally invasive surgical technique for vertebral compression fractures. However, indications for PV in these cases due to trauma had many rivals and unclearly. These complications, especially cement leakage still common, has many severe consequent. Object and method research: A 60-years-old man, who underwent vertebroplasty in low medical level. He had complete paralised of two leg, urine retention, and severe low back pain. We examined clinical signs, imaging, find and compared with literatures. Case presentation and discussion: We present a case, 60-years-old man, had labor accident, after that he could returned to state of normality. At the second day, he went to local hospital, had diagnosis: compression fractures of L1-L2. He underwent percutaneous vertebroplasty of L1-2 under local anesthesia. Post-operative, he had complete paralised of two leg, urine retention, and severe low back pain. He had exmined again, MRI and took second surgery to removed part of cement leakage. After the second surgery, radiological showed they had complete removed cement leakage, but the patient’s recovery was uneventful and stable. The patient was hospitalized at our instituation after 03 day with complaints of severe low back pain, urine retention and complete paralised of two leg. Conclusion: This is basic technique, widely and rewarding; also has many severe incident, complications. Consequently, we suggest that this technique have to perform in right indications, in the modern medical centre and fully trained surgeon.

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