Percutaneous vertebroplasty with high- versus low-viscosity bone cement for osteoporotic vertebral compression fractures

2020 ◽  
Author(s):  
Feng Miao ◽  
Xiaojun Zeng ◽  
Wei Wang ◽  
Zhou Zhao
Keyword(s):  
Percutaneous Vertebroplasty ◽  
Body Height ◽  
Cement Leakage ◽  
High Viscosity ◽  
Vertebral Compression Fractures ◽  
Vertebral Body Height ◽  
Low Viscosity ◽  
Pain Scores ◽  
Group A ◽  
Group B

Abstract Background: There is no consensus on the best choice between high- and low-viscosity bone cement for percutaneous vertebroplasty (PVP). This study aimed to compare the clinical outcomes and leakage between three cements with different viscosities in treating osteoporotic vertebral compression fractures.Methods: This is a prospective study comparing patients who were treated with PVP: group A (n = 99, 107 vertebrae) with high-viscosity OSTEOPAL V cement, group B (n = 79, 100 vertebrae) with low-viscosity OSTEOPAL V cement, and group C (n = 88, 102 vertebrae) with low-viscosity Eurofix VTP cement. Postoperative pain severity was evaluated using the visual analog scale. Cement leakage was evaluated using radiography and computed tomography.Results: There was no significant difference in the incidence of cement leakage between the three groups (group A 20.6%, group B 24.2%, group C 20.6%, P = 0.767). All three groups showed significant reduction in postoperative pain scores but did not differ significantly in pain scores at postoperative 2 days (group A 2.01 ± 0.62, group B 2.15 ± 0.33, group C 1.92 ± 0.71, P = 0.646). During the 6 months after cement implantation, significantly less reduction in the fractured vertebral body height was noticed in group B and group C than in group A (group A 19.0%, group B 8.1%, group C 7.3%, P = 0.009).Conclusions: Low-viscosity cement has comparable incidence of leakage compared to high-viscosity cement in PVP for osteoporotic vertebral compression fractures. It also can better prevent postoperative loss of vertebral body height.

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.

scholarly journals Creation of a planned or central-clefted puncture combined with a second puncture during vertebroplasty to treat osteoporotic vertebral compression fractures with large clefts

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Chi Li ◽  
Yang Zhou ◽  
Min-yu Zhu ◽  
Yu Wang ◽  
Zheng-mao Zhang ◽  
...  
Keyword(s):  
Cement Leakage ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Pain Scores ◽  
Significant Difference ◽  
Dispersion Patterns ◽  
Group A ◽  
Group B

Abstract Background Cemented vertebrae frequently re-fracture after vertebroplasty to treat osteoporotic vertebral compression fractures (OVCFs) with large clefts. We compared the efficacy of planned and central-clefted puncture, both followed by a second puncture, as treatments for OVCFs with large clefts. Methods We retrospectively studied 38 patients. 18 of whom underwent planned puncture (group A) and 20 central-clefted puncture (group B). A second puncture was performed when the initially injected cement was restricted to the cleft. We recorded a visual analog scale (VAS) pain scores, vertebral kyphotic angles (KAs), and compression ratios (CRs) preoperatively and at 2 days and 6 months postoperatively. We recorded the cement dispersion patterns and complications. Results Second punctures succeeded in 15/18 and 7/20 patients of groups A and B, respectively. At 2 days postoperatively, the VAS score, KA, and CR were significantly better than the preoperative values (P < 0.01); no significant difference was found between the two groups (P > 0.05). At the 6-month follow-up, all scores were poorer than at 2 days postoperatively (all P < 0.05), significantly more so in group B than group A (P < 0.05). Significant differences in terms of the cement dispersion patterns, and the cemented vertebral re-fracture and cement leakage rates, were observed between the two groups (all P < 0.05). Conclusion The two-puncture techniques were initially effective when treating large-clefted OVCFs. However, compared to the central-clefted puncture, the planned puncture improved the success rate of the second puncture, allowed better cement dispersion, and reduced the incidence of vertebral re-fracture during follow-up.

scholarly journals Precise Puncture Combined With Simplified Percutaneous Vertebroplasty to Treat Osteoporotic Vertebral Compression Fractures: A Comparative Analysis With Conventional Percutaneous Vertebroplasty

2020 ◽  
Author(s):  
Ju-tao Pang ◽  
Hong Chen ◽  
Bin Liu ◽  
Xin-hu Zhang
Keyword(s):  
Bone Cement ◽  
Operative Time ◽  
Percutaneous Vertebroplasty ◽  
Cement Leakage ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Intraoperative Fluoroscopy ◽  
Group A ◽  
Group B

Abstract ObjectiveThis study aimed to investigate the feasibility and clinical efficacy of precise puncture combined with simplified percutaneous vertebroplasty (PVP) for treating osteoporotic vertebral compression fractures (OVCF).MethodsA total of 82 patients with single-segment osteoporotic vertebral compression fractures (OVCF) were treated with PVP from Dec. 2016 to Nov. 2018. Among the patients, 45 cases in group A and accepted precise puncture combined with simplified PVP, 37 cases in group B and underwent conventional PVP. The operative time, number of intraoperative fluoroscopy, vertebral height restoration, postoperative bone cement distribution and bone cement leakage were observed and compared. The pain relief and improvement of quality of life (QOL) were assessed by visual analog score (VAS) and Oswestry disability index (ODI).ResultsThere were no difference in injected cement volume and hospital stays in group A versus group B (P > 0.05). The operative time, number of intraoperative fluoroscopy and material cost were lower in group A compared with group B (P < 0.05). After surgery, both of the VAS scores and ODI had a significant decrease (P < 0.05). The average vertebral height and Cobb angle were significantly improved (P < 0.05), there was no statistically significant difference between groups at different time points (P > 0.05). The proportion of patients with bone cement dispersion exceeding the midline of vertebra in group A was significantly higher than that in group B (82.2% vs 62.1%) (P < 0.05), whereas the bone cement leakage rate was lower than group B (8.9% vs 27.0%) (P < 0.05). Patients were followed-up for 12-23 months (mean 17.6 months) after surgery, and 3 cases (6.6%) of adjacent vertebral fractures occurred in group A and 2 cases (5.4%) occurred in group B (P > 0.05).ConclusionPrecise puncture can improve the accuracy of puncture needle through pedicle to vertebral body. It conducive to obtain a better diffusion of bone cement across the midline with lower bone cement leakage rate. Simplified PVP can reduce the surgery procedures, shorten the operatige time, reduces the X-ray frequency, but also saves material cost.

scholarly journals Effect of cementing on pulmonary arterial pressure in vertebroplasty: A comparison of two techniques

2020 ◽  
Vol 28 (1) ◽  
pp. 230949901989765
Author(s):  
Alauddin Kochai ◽  
Meric Enercan ◽  
Sinan Kahraman ◽  
Cagatay Ozturk ◽  
Azmi Hamzaoglu
Keyword(s):  
Arterial Pressure ◽  
Pulmonary Arterial Pressure ◽  
High Viscosity ◽  
Vertebral Compression Fractures ◽  
Intraosseous Pressure ◽  
Low Viscosity ◽  
Group A ◽  
Pulmonary Arterial ◽  
Group B ◽  
D Dimer

Background: Increase in intraosseous pressure and displacement of bone marrow contents leading to fat embolism and hypotension during cement injection in vertebroplasty (VP). We aimed to compare the effect of low and high viscosity cements during VP on pulmonary arterial pressure (PAP) with different cannula. Materials and Methods: Fifty-two patients having multilevel VP due to osteoporotic vertebral compression fractures were randomly treated either by a high viscosity cement (group A, n = 27 patients) and 2.8 mm cannula or a low viscosity cement (group B, n = 25 patients) injected through 4.2 mm cannula. PAP was measured by standard echocardiography and blood d-dimer values were recorded preoperatively, 24 h and third day after operation. Results: Mean age was 69 (62–87) years in group A and 70 (64–88) years in group B, and sex and comorbidities were similar. Average number of augmented levels was 5.4 in group A and 5.7 in group B. Preoperative mean PAP was 33 mm/Hg in group A, elevated to 41 mm/Hg on first day, and decreased to 36 mm/Hg on third day. The mean PAP in group B was 35 mm/Hg preoperatively, 51 mm/Hg on first day and 46 mm/Hg on third day ( p < 0.05). The average blood d-dimer values in group A increased from 2.1 µg/mL to 2.3 µg/mL and in group B from 2.2 µg/mL to 4.2 µg/mL. Conclusion: The finding of this study showed that high viscosity cement injected through a narrower cannula results in lesser PAP increase and d-dimer levels when compared to low viscosity cement injected through a wider cannula. Higher PAP and d-dimer level may show possible thromboembolism. This finding may give spine surgeons to reconsider their choice of cement type and cannula size.

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

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.

scholarly journals The clinical efficacy of three application methods of local anesthesia in percutaneous vertebroplasty: A retrospective single-center cohort study

2020 ◽  
Author(s):  
Xinjie Liang ◽  
Weiyang Zhong ◽  
Tianji Huang ◽  
Xiaoji Luo
Keyword(s):  
Local Anesthesia ◽  
Percutaneous Vertebroplasty ◽  
Vertebral Compression Fractures ◽  
Blood Oxygen Saturation ◽  
Cement Injection ◽  
Significant Difference ◽  
Group A ◽  
Intraoperative Pain ◽  
Application Methods ◽  
Group B

Abstract Background: Although various studies have described the methods of anaesthesia in percutaneous vertebroplasty(PV) in treating osteoporotic vertebral compression fractures (OVCFs), there is still no consensus on the optimal treatment regimen.The study aims to investigate the efficacy of three application methods of local anesthesia in PV treating OVCFs.Methods：A total of 96 patients of OVCFs were reviewed and divided into three groups(A: lidocaine, B: ropivacaine, C: lidocaine+ropivacaine). The visual analog scale(VAS), blood pressure(BP), heart rate(HR), blood oxygen saturation(BOS), surgery time were recorded at the points of before puncture, puncture, cement injection, and after surgery.Results: The mean age of the patients was 74.13±7.02 years in group A, 70.47±5.50 years in group B, and 73.07±7.51 years respectively without significant difference. No significant differences were found in the sex, age, hospital stay, surgery time, blood loss, and cement volume. During the period of before surgery and 4-hour after surgery, the VAS in group C decreased significantly at the period of puncture, cement injection, immediately after surgery. Overall, the systolic BP, diastolic BP, HR, BOS during the different period among the groups, there were no significant differences except the HR in the period of the puncture in group C was slower than that in other groups and HR in the period of cement injection in the group A was faster than other two groups. A correlation was observed between the VAS and the period of cement injection(r=0.5358), after surgery(r=0.5775) in group C.Conclusion: In conclusion, the use of the lidocaine in combination with ropivacaine could relieve the effective intraoperative pain in PV treating OVCFs patients which is reliable and safe.

“Targeted Percutaneous Vertebroplasty” Versus Traditional Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fracture

2019 ◽  
Vol 26 (5) ◽  
pp. 551-559
Author(s):  
JunChuan Xu ◽  
JiSheng Lin ◽  
Jian Li ◽  
Yong Yang ◽  
Qi Fei
Keyword(s):  
Vertebral Compression Fracture ◽  
Percutaneous Vertebroplasty ◽  
Compression Fracture ◽  
Operation Time ◽  
Cement Leakage ◽  
Osteoporotic Vertebral Compression Fracture ◽  
Controlled Study ◽  
Radiation Doses ◽  
Group A ◽  
Group B

Objective. In this randomized, nonblinded, controlled study, the feasibility and precision of “targeted percutaneous vertebroplasty” (“targeted PVP”) for osteoporotic vertebral compression fracture (OVCF) was evaluated. Methods. A total of 42 patients, aged 50 to 87 years, with OVCF were randomly divided into 2 groups: A and B. Group A underwent “targeted PVP,” and group B underwent traditional PVP with the guidance of C-arm fluoroscopy. Fluoroscopy times for skin puncture points (FTSPP), total radiation doses (TRD), total fluoroscopy times (TFT), and operation time were set as the main evaluation indicators. Results. FTSPP (1.52 ± 0.51 in group A vs 6.62 ± 2.58 in group B, U < .001), TRD (6.26 ± 1.51 in group A vs 11.32 ± 4.21 in group B, P < .001), TFT (16.57 ± 2.79 in group A vs 26.05 ± 6.18 in group B, P < .001), and operation time (20.05 ± 3.38 in group A vs 25.43 ±5.11 in group B, U < .001) were statistically different in the 2 groups. The incidence of cement leakage that occurred in group A (1/21, 4.76%) was significantly less than that in group B (9/21, 42.9%, P < 0.05). Conclusions. “Targeted PVP” may achieve (1) less skin positioning fluoroscopy times, less total fluoroscopy times and dose, shorter operation time, which is more precise than traditional PVP; (2) less incidence of cement leakage; and (3) visualization of the fractured vertebra, which is probably more valuable for the treatment of complicated OVCF patients.

scholarly journals A second puncture and injection technique for treating osteoporotic vertebral compression fractures

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Zhaofei Zhang ◽  
Feng Jiao ◽  
He Huang ◽  
Yonghui Feng ◽  
Chunliang Xie ◽  
...  
Keyword(s):  
Vertebral Fractures ◽  
Cement Leakage ◽  
Vertebral Compression Fractures ◽  
Injection Technique ◽  
Vertebral Height ◽  
Vas Score ◽  
Injection Group ◽  
Group A ◽  
Group B

Abstract Objective To evaluate the clinical effect of the second puncture and injection technique during a percutaneous vertebroplasty (PVP) procedure. Methods Patients treated with a second puncture and injection (group A) or a single puncture and injection (group B) during PVP at our institution during 2010–2017 were reviewed. Vertebral height loss, visual analogue scale (VAS) score, Oswestry disability index (ODI), adjacent vertebral fractures, and cement leakage were compared between the groups. Results A total of 193 patients were enrolled (86 cases in group A, 107 cases in group B). The follow-up period was 15.64 (12–20) months. The loss of anterior (group A 0.01 ± 0.03; group B 0.14 ± 0.17) and middle (group A 0.13 ± 0.12; group B 0.16 ± 0.11) vertebral height in group B was significantly higher than that in group A (P < 0.05). The VAS score and ODI were also significantly higher in group B than in group A at the final follow-up; the VAS score and ODI in group B were 1.65 ± 0.70 and 14.50 ± 4.16, respectively, and those in group A were 1.00 ± 0.74 and 12.81 ± 4.02, respectively (P < 0.05). Three patients in group A and two in group B experienced adjacent vertebral fractures. Regarding mild, moderate, and severe cement leakage, there were 25 (29%), 5 (5%), and 0 cases, respectively, in group A and 28 (26%), 3 (2.8%), and 1 (0.009%) case, respectively, in group B (P > 0.05). Conclusions The second puncture and injection technique may effectively increase the dispersion of cement, thus preventing recompression of the cemented vertebral body, and it does not increase the risk of cement leakage or adjacent vertebral fracture.

scholarly journals High-viscosity bone cement for vertebral compression fractures: a prospective study on intravertebral diffusion of bone cement

2020 ◽  
Author(s):  
meiyong wang ◽  
qunhua jin
Keyword(s):  
Diffusion Coefficient ◽  
Bone Cement ◽  
Statistical Significance ◽  
Cement Leakage ◽  
High Viscosity ◽  
Vertebral Compression Fractures ◽  
Injection Time ◽  
Time Duration ◽  
Compression Fractures ◽  
Group B

Abstract Objective Bone cement leakage causes severe complication following percutaneous vertebroplasty. This study probed the diffusion and leakage status of bone cement injected within diverged time duration, so as to find the optimal injection time for bone cement. Methods A total of 70 patients with osteoporotic vertebral compression fractures with a symptom of low back pain, who underwent treatment at hospital were enrolled in this study. Patients were randomized into three groups: <180 s, 180-300, and >300 s of injection time duration from the beginning to the completion of the injection. The scenarios of vertebral bone cement leakage and diffusion were inspected using postoperative CT. Results The diffusion coefficient was higher in group A than in group B whereas it was higher in group B than in group C, but without statistical significance among the three groups. The leakage rate was without statistical significance among the three groups. The injection time of bone cement was negatively correlated with the diffusion coefficient, at the correlation coefficient of -0.253. Conclusions The diffusion coefficient of high-viscosity bone cement is likely negatively correlated with the injection time, and the leakage rate of high-viscosity bone cement probably does not reduce with the prolongation of injection time.

scholarly journals High-viscosity bone cement for vertebral compression fractures: a prospective study on intravertebral diffusion of bone cement

2020 ◽  
Author(s):  
meiyong wang ◽  
qunhua jin
Keyword(s):  
Diffusion Coefficient ◽  
Bone Cement ◽  
Statistical Significance ◽  
Cement Leakage ◽  
High Viscosity ◽  
Vertebral Compression Fractures ◽  
Injection Time ◽  
Time Duration ◽  
Compression Fractures ◽  
Group B

Abstract Objective: Bone cement leakage causes severe complication following percutaneous vertebroplasty. This study probed the diffusion and leakage status of bone cement injected within diverged time duration, so as to find the optimal injection time for bone cement. Methods: A total of 70 patients with osteoporotic vertebral compression fractures with a symptom of low back pain, who underwent treatment at hospital were enrolled in this study. Patients were randomized into three groups: <180 s, 180-300, and >300 s of injection time duration from the beginning to the completion of the injection. The scenarios of vertebral bone cement leakage and diffusion were inspected using postoperative CT.Results: The diffusion coefficient was higher in group A than in group B whereas it was higher in group B than in group C, but without statistical significance among the three groups. The leakage rate was without statistical significance among the three groups. The injection time of bone cement was negatively correlated with the diffusion coefficient, at the correlation coefficient of -0.253. Conclusions: The diffusion coefficient of high-viscosity bone cement is likely negatively correlated with the injection time, and the leakage rate of high-viscosity bone cement probably does not reduce with the prolongation of injection time.

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