Comparison of a flexible versus rigid bone cement injection system in unilateral percutaneous vertebroplasty.

Abstract Background: Percutaneous vertebroplasty (PVP) has been demonstrated to be effective in the treatment of acute osteoporotic vertebral fracture (AOVF). However, bilateral puncture takes more time to accept more X-ray irradiation; some scholars apply unilateral puncture PVP, but the cement cannot be symmetrically distributed in the vertebral body, so we use a flexible cement injector that undergoes PVP through the unilateral pedicle puncture. This research aims to compare the clinical results of PVP for AOVF with unilateral pedicle puncture using a straight bone cement injector and a bendable cement injector, determine the value of a bendable cement injector.Methods: We undertook a retrospective analysis of patients with thoracic and lumbar compression fracture treated with unilateral pedicle puncture Percutaneous vertebroplasty from our institution from June 2013 to July 2015. Operation time, radiation exposure, bone cement injection amount, and the incidence of bone cement leakage were recorded on presentation, the cement leakage was measured by x-ray and computed tomography scan. The patients were followed up postoperatively and were assessed mainly with regard to clinical and radiological outcomes.Results: There was no significant difference in the operation time, radiation exposure time and incidence of bone cement leakage between the two groups. There was significant difference in the amount of bone cement injection and the difference between the two groups. there were no significant differences in VAS and the relative height of the vertebral body and local Cobb angle and QUALEFFO between 2 groups at 1 week after PVP, only significant difference was observed between 12 months after operation.Conclusions: Application of flexible cement injector is safe and feasible,Compared with the application of straight bone cement injector, without prolonging the operative time, radiation exposure time and the incidence of bone cement leakage, it has the advantages of good long-term effect and low incidence of vertebral fracture recurrence.

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Comparison of a flexible versus rigid bone cement injection system in unilateral percutaneous vertebroplasty

10.21203/rs.3.rs-21372/v1 ◽

2020 ◽

Author(s):

yuwei li ◽

wei cui ◽

peng zhou ◽

cheng li ◽

yan wen ◽

...

Keyword(s):

Vertebral Fracture ◽

Radiation Exposure ◽

Bone Cement ◽

Vertebral Body ◽

Percutaneous Vertebroplasty ◽

Operation Time ◽

Cement Leakage ◽

X Ray ◽

Cement Injection ◽

Significant Difference

Abstract Background: Percutaneous vertebroplasty (PVP) has been demonstrated to be effective in the treatment of acute osteoporotic vertebral fracture (AOVF). However, bilateral puncture takes more time to accept more X-ray irradiation; some scholars apply unilateral puncture PVP, but the cement cannot be symmetrically distributed in the vertebral body, so we use a flexible cement injector that undergoes PVP through the unilateral pedicle puncture. This research aims to compare the clinical results of PVP for AOVF with unilateral pedicle puncture using a straight bone cement injector and a bendable cement injector, determine the value of a bendable cement injector. Methods: We undertook a retrospective analysis of patients with thoracic and lumbar compression fracture treated with unilateral pedicle puncture Percutaneous vertebroplasty from our institution from June 2013 to July 2015. Operation time, radiation exposure, bone cement injection amount, and the incidence of bone cement leakage were recorded on presentation, the cement leakage was measured by x-ray and computed tomography scan. The patients were followed up postoperatively and were assessed mainly with regard to clinical and radiological outcomes. Results: There was no significant difference in the operation time, radiation exposure time and incidence of bone cement leakage between the two groups. There was significant difference in the amount of bone cement injection and the difference between the two groups. there were no significant differences in VAS and the relative height of the vertebral body and local Cobb angle and QUALEFFO between 2 groups at 1 week after PVP, only significant difference was observed between 12 months after operation. Conclusions: Application of flexible cement injector is safe and feasible,Compared with the application of straight bone cement injector, without prolonging the operative time, radiation exposure time and the incidence of bone cement leakage, it has the advantages of good long-term effect and low incidence of vertebral fracture recurrence.

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Percutaneous vertebroplasty: a comparison between the procedure using the traditional and the new side-opening cannula for osteoporotic vertebral fracture

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2009000300001 ◽

2009 ◽

Vol 67 (2b) ◽

pp. 377-381 ◽

Cited By ~ 6

Author(s):

Nicandro Figueiredo ◽

Filipe Barra ◽

Laryssa Moraes ◽

Roger Rotta ◽

Luiz Augusto Casulari

Keyword(s):

Vertebral Fracture ◽

Vertebral Body ◽

Vertebral Fractures ◽

Pain Control ◽

Percutaneous Vertebroplasty ◽

Cement Leakage ◽

Osteoporotic Vertebral Fracture ◽

Cement Injection ◽

Osteoporotic Vertebral Fractures ◽

Good Improvement

A total of 47 percutaneous vertebroplasties (PVs) were performed for osteoporotic vertebral fractures in 31 patients, 25 PVs were performed using the frontal-opening cannula (FOC) and 22 using the new side-opening cannula (SOC), randomly distributed. The incidence of cement extrusion was 27% with the SOC, and 68% with the FOC, all asymptomatic (p<0.01). The pain control was similar for both groups, with good improvement of pain in most of the patients, and there were no clinical relevant complications. The cement leakage can be significantly reduced with this new SOC, which allows for a better cement injection toward the center of the vertebral body, increasing the safety of the procedure, with no increase in cost.

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Comparison of the clinical outcomes of percutaneous vertebroplasty vs. kyphoplasty for the treatment of osteoporotic Kümmell’s disease:a prospective cohort study

10.21203/rs.3.rs-15968/v1 ◽

2020 ◽

Author(s):

Jian-Zhong Chang ◽

Ming-Jian Bei ◽

Dong-Ping Shu ◽

Cheng-Jun Sun ◽

Ji-Bin Chen ◽

...

Keyword(s):

Blood Loss ◽

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Operation Time ◽

Cement Leakage ◽

Significant Difference ◽

Kummell’S Disease ◽

Adjacent Vertebra ◽

Kümmell’S Disease ◽

Time Point

Abstract Background Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are widely used in the treatment of Kümmell's disease. The purpose of this article is to investigate the clinical efficacy of PVP and PKP for Kümmell's disease. Methods The clinical data that 56 cases of OVCF treated with either PVP (28 cases) or PKP (28 cases) and met the selection criteria from December 2015 to December 2017 were prospectively analyzed. Gender, age, course of disease, injury segment, BMD, VAS, ODI, imaging measurement indexes before surgery between the two groups showed no significant difference (all P>0.05). The bone cement leakage rate, bone cement injection amount, operation time, VAS, ODI, the rate of vertebral compression, correction rate of kyphosis and refracture rate of adjacent vertebra in 2 years were compared between the two groups to calculate clinical efficacy. Results The two groups were followed up for 24-48 months. There was no significant difference in the follow-up time, amount of bone cement injected, incidence of bone cement leakage and refracture rate of adjacent vertebra between the two groups (all P > 0.05). The operation time, intraoperative blood loss and fluoroscopy times of the PVP group were significantly lower than those of the PKP group (all P = 0.000). VAS score and ODI of the two groups were significantly lower at 1 d, 1 year and 2 years after surgery than before surgery (all P <0.05), but there was not statistically significant difference between the two groups at each time point after surgery (all P> 0.05). The rate of vertebral compression and kyphosis correction in the two groups were significantly corrected (P <0.05, respectively) and decreased significantly with time (all P <0.05), But there was not significant difference between the two groups at any time point (all P> 0.05). Conclusion Both PVP and PKP can achieve similar effects in the treatment of Kümmell's disease. Because the cost, operation time, blood loss, radiation exposure and surgical procedure of PVP are less than those of PKP, PVP has more clinical priority value.

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Comparison of the clinical outcomes of percutaneous vertebroplasty vs. kyphoplasty for the treatment of osteoporotic Kümmell’s disease:a prospective cohort study

10.21203/rs.3.rs-15968/v2 ◽

2020 ◽

Author(s):

Jian-Zhong Chang ◽

Ming-Jian Bei ◽

Dong-Ping Shu ◽

Cheng-Jun Sun ◽

Ji-Bin Chen ◽

...

Keyword(s):

Blood Loss ◽

Bone Cement ◽

Clinical Efficacy ◽

Percutaneous Vertebroplasty ◽

Operation Time ◽

Cement Leakage ◽

Significant Difference ◽

Kummell’S Disease ◽

Kümmell’S Disease ◽

Time Point

Abstract Background Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are widely used in the treatment of Kümmell's disease. The purpose of this article is to investigate the clinical efficacy of PVP and PKP for Kümmell's disease. Methods The clinical data that 56 cases of Kümmell's disease treated with either PVP (28 cases) or PKP (28 cases) from December 2015 to December 2017 were prospectively analyzed. Gender, age, course of disease, injury segment, bone mineral density (BMD), visual analogue scale (VAS), Oswestry disability index (ODI), imaging measurement indexes before surgery between the two groups showed no significant difference (all P>0.05). The bone cement leakage rate, bone cement injection amount, operation time, VAS, ODI, the rate of vertebral compression, correction rate of kyphosis and refracture rate of adjacent vertebra in 2 years were compared between the two groups to calculate clinical efficacy. Results The two groups were followed up for 24-48 months. There was no significant difference in the follow-up time, amount of bone cement injected, incidence of bone cement leakage and refracture rate of adjacent vertebrae between the two groups (all P> 0.05). The operation time, intraoperative blood loss and fluoroscopy times of the PVP group were significantly lower than those of the PKP group (all P = 0.000). VAS score and ODI of the two groups were significantly lower at 1 day, 1 year and 2 years after surgery than before surgery (all P <0.05), but there was not statistically significant difference between the two groups at each time point after surgery (all P> 0.05). The rate of vertebral compression and kyphosis correction in the two groups were significantly corrected (P <0.05, respectively) and decreased significantly with time (all P <0.05), But there was not significant difference between the two groups at any time point (all P> 0.05). Conclusion Both PVP and PKP can achieve similar effects in the treatment of Kümmell's disease. Because the cost, operation time, blood loss, radiation exposure and surgical procedure of PVP are less than those of PKP, PVP has more clinical priority value.

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Percutaneous vertebroplasty versus kyphoplasty for the treatment of neurologically intact osteoporotic Kümmell’s disease

BMC Surgery ◽

10.1186/s12893-021-01057-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shou-qian Dai ◽

Rong-qing Qin ◽

Xiu Shi ◽

Hui-lin Yang

Keyword(s):

Blood Loss ◽

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Cement Leakage ◽

Intraoperative Blood Loss ◽

Surgical Time ◽

Significant Difference ◽

Neurologically Intact ◽

Operation Cost

Abstract Background Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat neurologically intact osteoporotic Kümmell’s disease (KD), but it is still unclear which treatment is more advantageous. Our study aimed to compare and investigate the safety and clinical efficacy of PVP and PKP in the treatment of KD. Methods The relevant data that 64 patients of neurologically intact osteoporotic KD receiving PVP (30 patients) or PKP (34 patients) were analyzed. Surgical time, operation costs, intraoperative blood loss, volume of bone cement injection, and fluoroscopy times were compared. Occurrence of cement leakage, transient fever and re-fracture were recorded. Universal indicators of visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated separately before surgery and at 1 day, 6 months, 1 year, 2 years and the final follow-up after operation. The height of anterior edge of the affected vertebra and the Cobb’s angle were assessed by imaging. Results All patients were followed up for at least 24 months. The volume of bone cement injection, intraoperative blood loss, occurrence of bone cement leakage, transient fever and re-fracture between two groups showed no significant difference. The surgical time, the operation cost and fluoroscopy times of the PKP group was significantly higher than that of the PVP group. The post-operative VAS, ODI scores, the height of the anterior edge of the injured vertebrae and kyphosis deformity were significantly improved in both groups compared with the pre-operation. The improvement of vertebral height and kyphosis deformity in PKP group was significantly better than that in the PVP group at every same time point during the follow-up periods, but the VAS and ODI scores between the two groups showed no significant difference. Conclusion PVP and PKP can both significantly alleviate the pain of patients with KD and obtain good clinical efficacy and safety. By contrast, PKP can achieve better imaging height and kyphosis correction, while PVP has the advantages of shorter operation time, less radiation volume and operation cost.

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Unilateral Transforaminal Approach (UTFA) in Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Novel Puncture Technique

10.21203/rs.3.rs-154379/v1 ◽

2021 ◽

Author(s):

wang yefeng ◽

Li suoyuan ◽

Cai xiaoqiang ◽

Shen jun ◽

Zou tianming

Keyword(s):

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Operation Time ◽

Vertebral Compression Fractures ◽

X Rays ◽

Osteoporotic Vertebral Compression Fractures ◽

Invasive Treatment ◽

X Ray ◽

Compression Fractures ◽

Transforaminal Approach

Abstract Background: Percutaneous vertebroplasty (PVP) via various puncture approaches was an effective minimally invasive treatment for osteoporotic vertebral compression fractures (OVCFs). In recent years, unilateral puncture techniques had been increasingly used with advantages of shorter operation time, lower X-ray exposure. The aim of this study was to explore the safety and efficacy of the unilateral transforaminal approach (UTFA) in PVP for the treatment of OVCFs. Methods: A retrospective study was designed to review 155 cases of single-level OVCFs from July 2018 to December 2019. We treated 77 patients with PVP via the UTFA and 78 via the bilateral transpedicular approach (BTPA). Operation time, number of intraoperative fluoroscopic X-rays, volume of bone cement injection and distribution of bone cement were recorded. We used Visual Analog Scale (VAS) score and Oswestry disability index (ODI) presurgery and at 1 day, 3 months and last follow-up after surgery to assess clinical outcomes. Results: The operation was successfully completed in both groups, with no complications of neurovascular injuries or bone cement embolism. UTFA group had significantly shorter operation time and less-frequent fluoroscopy than BTPA group (P < 0.05). There were no significant differences between the two groups in volume or distribution of injected bone cement (P > 0.05). Postoperative VAS scores and ODI of the two groups were significantly improved over their presurgical values (P < 0.05), but there were no significant differences in VAS or ODI at each time point between the two groups (P > 0.05). Conclusions: Both unilateral transforaminal PVP and bilateral transpedicular PVP were safe and effective treatments for OVCFs, but the former approach had the advantages of shorter operation time and less X-ray radiation exposure and therefore is worthy of greater clinical application.

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Comparison of sacroplasty with or without balloon assistance for the treatment of sacral insufficiency fractures

Journal of Orthopaedic Surgery ◽

10.1177/2309499018782575 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901878257 ◽

Cited By ~ 5

Author(s):

Shih-Chieh Yang ◽

Tsung-Ting Tsai ◽

Hung-Shu Chen ◽

Chi-Jung Fang ◽

Yu-Hsien Kao ◽

...

Keyword(s):

Clinical Outcomes ◽

Operation Time ◽

Cement Leakage ◽

Insufficiency Fractures ◽

Radiographic Findings ◽

Injection Volume ◽

Cement Injection ◽

Lower Back ◽

Significant Difference ◽

Sacral Insufficiency Fractures

Purpose: Sacral insufficiency fractures (SIFs) can cause severe lower back pain and immobility, which have limited therapeutic options. No previous studies have compared clinical outcomes and radiographic findings of sacroplasty with or without balloon assistance for the treatment of SIFs. Methods: Forty-five patients with SIFs were divided into two groups. One group had 18 patients treated using sacroplasty with balloon assistance, and the other had 27 patients treated without balloon assistance. The operation time and cement injection volume were compared between these two groups. Clinical outcomes were evaluated using visual analog scale (VAS), Oswestry Disability Index (ODI), and Odom’s criteria. Cement leakage rate was examined by postoperative radiography and computed tomography. Results: Sacroplasty with balloon assistance was associated with significantly longer operative time ( p = 0.003) and larger cement injection volume ( p = 0.038). Cement leakages were found in 4 of 18 patients (22.2%) with balloon assistance and 15 of 27 patients (55.6%) without balloon assistance, which showed significant difference ( p = 0.027). No significant differences were observed between sacroplasty with and without balloon assistance with regard to clinical outcomes including improvement in VAS, ODI, and Odom’s criteria. Conclusions: Sacroplasty with balloon assistance was shown to achieve greater cement injection with longer operation time and can decrease the risk of cement leakage. Both sacroplasty with and without balloon assistance showed good-to-excellent clinical outcomes for the treatment of SIFs.

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Unilateral percutaneous vertebroplasty for osteoporotic lumbar compression fractures: a comparative study between transverse process root-pedicle approach and conventional transpedicular approach

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02219-6 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Wenwu Zhang ◽

Shenpeng Liu ◽

Xianhua Liu ◽

Xiang Li ◽

Le Wang ◽

...

Keyword(s):

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Operation Time ◽

Transverse Process ◽

Cement Leakage ◽

Clinical Results ◽

Clinical Effects ◽

Compression Fractures ◽

Transpedicular Approach ◽

Cement Distribution

Abstract Purpose Percutaneous vertebroplasty (PVP) is a routine operation for the treatment of osteoporotic lumbar compression fractures (OLCFs). As is well known, unilateral puncture is a common method. However, with the conventional transpedicular approach (CTPA), the cement may be asymmetrically dispersed, so some surgeons use the transverse process root-pedicle approach (TPRPA). The objective of this study was to compare the clinical results and bone cement distribution of PVP for OLCF with unilateral TPRPA and CTPA to identify the advantages and disadvantages of the two surgical options. Patients and methods From January 2016 to June 2019, seventy-two elderly patients who underwent unilateral PVP for single-level OLCF were retrospectively reviewed. Operation time, injection amount and type of bone cement distribution, and bone cement leakage and surgical complications were recorded. The visual analog scale (VAS) scores and Oswestry disability index (ODI) scores were used to evaluate the clinical results. All patients were followed up for more than 12 months, and the assessment was based primarily on clinical and radiological outcomes. Results There were significant differences in the surgical time and the volume and the type of bone cement distribution and the lost of operative vertebra height between the two groups. However, there was no significant difference in bone cement leakage. Moreover, there were no significant differences in VAS and ODI between the two groups at 2 days and 12 months after the operation. Conclusions Unilateral TPRPA and CTPA are practical and feasible methods in PVP for the treatment of OLCF, and they have similar clinical effects. However, TPRPA has the advantages of a better distribution of bone cement and a shorter operation time and a better maintenance effect of injured vertebra height, without increasing the rate of bone cement leakage.

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A novel bone cement screw system combined with vertebroplasty for the treatment of Kummell disease with bone deficiency at vertebral anterior border: minimum 3-year follow-up study

10.21203/rs.3.rs-18781/v1 ◽

2020 ◽

Author(s):

Biao Wang ◽

Xinliang Zhang ◽

Lingbo Kong ◽

Li Yuan ◽

Simin He ◽

...

Keyword(s):

Bone Cement ◽

Vertebral Body ◽

Operation Time ◽

Anterior Border ◽

Body Angle ◽

Follow Up Study ◽

Bone Deficiency ◽

Sf 36 ◽

Significant Difference

Abstract Background: When vertebroplasty is used to treat Kummell disease with bone deficiency at vertebral anterior border, bone cement displacement often occurs intraoperative or postoperative. We designed and used a new bone cement screw system to avoid the serious complication. The purpose of this study is to evaluate the safety and effectiveness of this novel operation method through more than 3 years of follow-up. Methods: From January 2012 to August 2016, 27 patients suffering from single-segment Kummell disease with bone deficiency at vertebral anterior border were treated by vertebroplasty combined with novel bone cement screw. Bone cement is released into the diseased vertebrae through screw to fully fill the intravertebral vacuum cleft. Screw fixation of bone cement can avoid intraoperative or postoperative displacement. All patients were operated by unilateral technique, only one screw was implanted for each patient. The clinical efficacy was evaluated using Odom’s criteria and statistical analysis based on the results of vertebral body index (VBI), vertebral body angle (VBA), bisegmental Cobb angle (BCA), visual analogue scale (VAS), oswestry disability index (ODI), and the MOS 36-item short from health survey (SF-36). Results: The operation was completed successfully in 27 cases. The average operation time was 49.63±10.82 min, and the average volume of cement injected was 4.70±0.87 ml. The patients’ preoperative VBI, VBA, BCA, VAS and ODI scores were 43.11±5.94, 21.04±2.55, 45.00±6.26, 7.59±0.84, and 79.85±7.58, respectively. The postoperative measurements were 78.70±2.55, 12.70±2.11, 26.11±4.73, 3.22±0.93 and 50.04±9.28. At the last follow-up, the measurements were 78.04±2.30, 13.15±2.38, 27.07±4.87, 2.04±0.65, and 22.85±5.06, respectively. There was significant difference between the preoperative and postoperative data, as well as the preoperative and the last follow-up data (P<0.05). Compared the results of SF-36 preoperative and at the last follow-up, there were significant differences in physical function, role-physical, body pain, vitality, and social function these 5 items (P<0.05). However, there were no significant differences in general health, emotional function and mental health. Finally, 26 patients (96.3%) had good to excellent clinical outcomes according to Odom's criteria. Conclusions: This 3-year follow-up study shows that the novel bone cement screw system combined with vertebroplasty has a good short and medium-term therapeutic effect on patients with Kummell disease and bone deficiency at vertebral anterior border, while its long-term efficacy is subject to further studies.

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Clinical study of unilateral Percutaneous vertebra plasty(PVP) in the treatment of Osteoporotic vertebral compression fractures(OVCF) in the elderly

Medical Research ◽

10.6913/mrhk.202012_2(4).0001 ◽

2020 ◽

Vol 2 (4) ◽

pp. 1-9

Author(s):

Dongyan Lu ◽

Chuqiang Qin ◽

Bo Yang ◽

Huiyi Liu ◽

Chenxin Kou

Keyword(s):

Postoperative Complications ◽

Cobb Angle ◽

Bone Cement ◽

Vertebral Body ◽

Operation Time ◽

The Elderly ◽

X Ray ◽

Bilateral Group ◽

Clinical Recommendation ◽

Unilateral Group

Objective To study the clinical effect of unilateral percutaneous vertebra plasty (PVP) in the treatment of osteoporotic lumbar compression fracture (OVCF) in the elderly. Methods 84 elderly patients with OVCF who were treated in our hospital from January 2017 to December 2020 were included and divided into unilateral group (n=42) and bilateral group (n=42) according to the random number table method. Unilateral PVP treatment was performed in the unilateral group, and bilateral PVP treatment was performed in the bilateral group. Observed two groups of X-ray machine, bone cement dosage irradiation time and operation time indicators such as surgery, preoperative and postoperative and postoperative convex Cobb Angle, after 1 years of vertebral body lesions vertebral body height and body function, preoperative and postoperative 7d and postoperative pain degree and 1 year serum Norepinephrine (NE) and Serotonin (5-HT) and Substance P (SP) and so on pain factor levels, postoperative complications and other indicators; Results the time of X-ray machine irradiation, amount of bone cement and operation time in theunilateral group were all lower than those in the bilateral group (P<0.05). After surgery and 1 year after surgery, there was no difference in Cobb Angle of kyphotic vertebra, height of diseased vertebra and limb function between the two groups (P>0.05).There was no difference in VAS scores and 5-ht, SP and NE levels between the two groups after and 1 year after surgery(P>0.05).The incidence of postoperative complications in the unilateral group (19.05%) was lower than that in the bilateral group (47.62%) (P<0.05). Conclusion unilateral PVP can achieve the same effect as bilateral PVP in the treatment of elderly OVCF. Small trauma, easy to operate, can effectively relieve patients' pain, safe and reliable, worthy of clinical recommendation.

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