scholarly journals Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution

2020 ◽  
Author(s):  
Jun Yan ◽  
Qiaohui Liu ◽  
Yanping Zheng ◽  
Ziqun Liu ◽  
Xinyu Liu ◽  
...  
Keyword(s):  
Bone Cement ◽  
Lumbar Vertebrae ◽  
Compression Fracture ◽  
Cement Leakage ◽  
Control Group ◽  
Pulsed Jet ◽  
Jet Lavage ◽  
Average Maximum ◽  
Cement Distribution ◽  
Vertebral Bodies

Abstract Background: Percutaneous vertebroplasty is the most common treatment for osteoporotic vertebral compression fracture. However, the morbidity of vertebroplasty-related complications, such as cement leakage, remains high. We tested a new technique of unilateral pulsed jet lavage and investigated its effect on the intravertebral pressure and bone cement distribution.Methods: Thirty lumbar vertebrae (L1-L5) from six cadaver spines were randomly allocated into two groups (with and without irrigation). Prior to vertebroplasty, pulsed jet lavage was performed through one side of the pedicle by using a novel cannula with two concentric conduits to remove the fat and bone marrow of the vertebral bodies in the group with irrigation. The control group was not irrigated. Then, standardized vertebroplasty was performed in the vertebral bodies in both groups. Changes in the intravertebral pressure during injection were recorded. Computed tomography (CT) was performed to observe the cement distribution and extravasations, and the cement mass volume (CMV) was calculated. Results: During cement injection, the average maximum intravertebral pressure of the unirrigated group was higher than that of the irrigated group (4.92kPa versus 2.22kPa, P<0.05). CT scans showed a more homogeneous cement distribution with less CMV (3832 mm3 vs. 4344 mm3, P<0.05) and less leakage rate (6.7% vs. 46.7%, P<0.05) in the irrigated group than in the control group. Conclusions: Unilateral pulsed jet lavage can reduce intravertebral pressure and lower the incidence of cement leakage during vertebroplasty. An enhanced bone cement distribution can also be achieved through this lavage system.

scholarly journals Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution

2020 ◽  
Author(s):  
Jun Yan ◽  
Qiaohui Liu ◽  
Yanping Zheng ◽  
Ziqun Liu ◽  
Xinyu Liu ◽  
...  
Keyword(s):  
Bone Cement ◽  
Lumbar Vertebrae ◽  
Compression Fracture ◽  
Cement Leakage ◽  
Control Group ◽  
Pulsed Jet ◽  
Jet Lavage ◽  
Average Maximum ◽  
Cement Distribution ◽  
Vertebral Bodies

Abstract Background: Percutaneous vertebroplasty is the most common treatment for osteoporotic vertebral compression fracture. However, the morbidity of vertebroplasty-related complications, such as cement leakage, remains high. We tested a new technique of unilateral pulsed jet lavage and investigated its effect on the intravertebral pressure and bone cement distribution. Methods: Thirty lumbar vertebrae (L1-L5) from six cadaver spines were randomly allocated into two groups (with and without irrigation). Prior to vertebroplasty, pulsed jet lavage was performed through one side of the pedicle by using a novel cannula with two concentric conduits to remove the fat and bone marrow of the vertebral bodies in the group with irrigation. The control group was not irrigated. Then, standardized vertebroplasty was performed in the vertebral bodies in both groups. Changes in the intravertebral pressure during injection were recorded. Computed tomography (CT) was performed to observe the cement distribution and extravasations, and the cement mass volume (CMV) was calculated. Results: During cement injection, the average maximum intravertebral pressure of the unirrigated group was higher than that of the irrigated group (4.92kPa versus 2.22kPa, P<0.05). CT scans showed a more homogeneous cement distribution with less CMV (3832 mm 3 vs. 4344 mm 3 , P<0.05) and less leakage rate (6.7% vs. 46.7%, P<0.05) in the irrigated group than in the control group. Conclusions: Unilateral pulsed jet lavage can reduce intravertebral pressure and lower the incidence of cement leakage during vertebroplasty. An enhanced bone cement distribution can also be achieved through this lavage system.

scholarly journals Therapeutic effect of percutaneous kyphoplasty combined with anti-osteoporosis drug on postmenopausal women with osteoporotic vertebral compression fracture and analysis of postoperative bone cement leakage risk factors: a retrospective cohort study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Shuaihao Huang ◽  
Xiaowen Zhu ◽  
Dan Xiao ◽  
Jianxiong Zhuang ◽  
Guoyan Liang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Zoledronic Acid ◽  
Bone Cement ◽  
Postmenopausal Women ◽  
Therapeutic Effect ◽  
Compression Fracture ◽  
Cement Leakage ◽  
Control Group ◽  
Height Ratio ◽  
Vertebral Height

Abstract Background The purpose of this study is to explore the therapeutic effect of percutaneous kyphoplasty (PKP) combined with anti-osteoporosis drug, zoledronic acid, on postmenopausal women with osteoporotic vertebral compression fracture (OVCF) and to perform an analysis of postoperative bone cement leakage risk factors. Methods A total of 112 OVCF patients, according to therapeutic regimens, were divided into control group (n = 52, treated with PKP) and observation group (n = 60, treated with PKP and zoledronic acid injection). Results Postoperative tumor necrosis factor-α and interleukin-6 levels were significantly decreased in the two groups, compared with those before treatment (both P < 0.05); bone mineral density (BMD), serum bone gla protein (BGP), and vertebral height ratio of injured vertebrae were significantly increased, and procollagen type I N-terminal propeptide (PINP), Cobb angle, visual analogue scale/score (VAS), and Oswestry disability index (ODI) were significantly decreased compared with those before treatment (all P < 0.05). There were significantly higher changes in difference value of BMD, PINP, BGP, vertebral height ratio of injured vertebrae, Cobb angle, VAS, and ODI levels and significantly better therapeutic effect in the observation group than those in the control group (all P < 0.05). Multivariate logistic regression analysis showed that the use of zoledronic acid, vertebral height ratio of injured vertebrae, and ODI were independent factors affecting the therapeutic effect, and that the dosage of bone cement, and peripheral vertebrae wall damage were independent risk factors causing postoperative bone cement leakage. There were no significant differences in postoperative bone cement leakage rate between the two groups. Conclusions Peripheral vertebrae wall damage and the dosage of bone cement are independent risk factors causing bone cement leakage in OVCF patients treated with PKP. PKP combined with zoledronic acid has an improvement effect on the condition of postmenopausal women with OVCF and reduces the inflammation and pain in patients, which is beneficial to clinical treatment.

scholarly journals Influence of the distribution of bone cement along the fracture line on the curative effect of vertebral augmentation

2019 ◽  
Vol 47 (9) ◽  
pp. 4505-4513 ◽  
Author(s):  
Kai Xu ◽  
Ya-Ling Li ◽  
Fei Song ◽  
Hua-Wei Liu ◽  
Hua-Dong Yang ◽  
...  
Keyword(s):  
Pain Relief ◽  
Bone Cement ◽  
Compression Fracture ◽  
Cement Leakage ◽  
Fracture Line ◽  
Vertebral Augmentation ◽  
Bilateral Group ◽  
Significant Difference ◽  
Cement Distribution ◽  
Unilateral Group

Objective The present study was performed to evaluate the effect of different bone cement distributions along the fracture line on clinical and imaging outcomes of vertebral augmentation. Methods In total, 84 patients who underwent vertebral augmentation for a single osteoporotic vertebral compression fracture from January 2016 to August 2018 were retrospectively reviewed. These patients were divided into two groups according to the relationship between the bone cement distribution and the fracture line: the unilateral group (n = 23) and the bilateral group (n = 61). Postoperative clinical and imaging parameters were compared between the two groups. Results Statistical analyses showed no significant difference in postoperative pain relief, bone cement leakage, nerve injury, or new vertebral fracture between the two groups. Significant recovery from vertebral compression was observed in the bilateral group after surgery, but there was no significant difference in vertebral compression after surgery in the unilateral group. Conclusions Pain relief was similar for different types of cement distributions along the fracture line, but a bilateral cement distribution exhibited better recovery from vertebral compression and did not increase bone cement leakage in the vertebral augmentation procedure.

scholarly journals Radiological and clinical effect of balloon kyphoplasty for the management of rheumatoid arthritis patients with osteoporotic vertebral compression fracture

2020 ◽  
Author(s):  
Ji Guo ◽  
Weifeng Zhai ◽  
Licheng Wei ◽  
Jianpo Zhang ◽  
Lang Jin ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Balloon Kyphoplasty ◽  
Cement Leakage ◽  
Osteoporotic Vertebral Compression Fracture ◽  
Control Group ◽  
Compression Rate ◽  
Kyphotic Angle ◽  
Vertebral Bodies

Abstract Objective: This study was conducted to investigate the outcome of percutaneous balloon kyphoplasty (KP) for the treatment of osteoporotic vertebral compression fracture(OVCF) in patients with rheumatoid arthritis (RA) and analyze the influence of erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), injected cement volume and duration of taking glucocorticoid on the outcome of KP procedure. Methods: A total of 39 RA patients (63 vertebral bodies) and 38 patients (50 vertebral bodies) without RA received KP management for OVCF. Changes in vertebral compression rate, local kyphotic angle, conditions of bone cement leakage, visual analogue scale (VAS) and Oswestry disability index (ODI) scores were evaluated for radiological and clinical outcomes of KP procedure. In addition, 39 OVCF patients with RA were divided into different groups according to the value of ESR, CRP, injected cement volume and duration of taking glucocorticoid to evaluate their influence on the outcomes of KP procedure.Results: The KP procedure significantly improved the compression rate, local kyphotic angle, VAS and ODI scores in both RA group and control group. The compression rate increased 11.56±3.8% in RA group which is significantly larger than the control group(p<0.05). The change of local kyphotic angle in RA group was 3.77±1.9, which is also larger than that in control group(p<0.05). Whereas, the changes of VAS and ODI scores were not significantly different between the two groups. Besides, radiological and clinical outcomes were not significantly different among the groups of different ESR, CRP, injected cement volume and duration of taking glucocorticoid no matter before or 1 year after the KP procedure, but 44% RA patients who take glucocorticoid for over 10 years had cement leakage after the KP procedure which is significantly higher than the group of RA patients with less than 10 years glucocorticoid use(p<0.05). In addition, 7 intradiscal cement leakage occurred in patients take glucocorticoid over 10 years where as no intradiscal leakage showed up in its control group(p<0.01).Conclusion: KP procedure was effective for OVCF patients with or without RA, for restoring vertebral body height, reducing local kyphotic angle, relieving pain and recovering spinal function. Compared to the control group, RA patients received more improvement in compression rate and local kyphotic angle after the operation. Intradiscal leakage occurred more in patients who take glucocorticoid for over 10 years.

scholarly journals Treatment of Osteoporotic Vertebral Compression Fracture by Precise Injection and Staged Perfusion of Bone Cement Kyphoplasty: A Comparison Study

2021 ◽  
Author(s):  
Jian Huang ◽  
Jun Huang ◽  
Ming Chen ◽  
Zongbo Zhou ◽  
Zhifu Lu ◽  
...  
Keyword(s):  
Bone Cement ◽  
Vertebral Body ◽  
Compression Fracture ◽  
Cement Leakage ◽  
Osteoporotic Vertebral Compression Fracture ◽  
Control Group ◽  
The Third ◽  
Significant Difference ◽  
Experimental Group

Abstract Study design: Retrospective cohort study.Objective: To explore the clinical effect of precise injection and staged perfusion of bone cement kyphoplasty in the treatment of osteoporotic vertebral compression fracture.Methods: 110 patients treated with kyphoplasty from January 2020 to June 2021 were selected and divided into experimental group (n = 55) and control group (n = 55) according to different surgical methods. The experimental group was treated with precise injection and staged perfusion of bone cement kyphoplasty, while the control group was treated with traditional kyphoplasty. The operation time,intraoperative blood loss and amount of bone cement injection were recorded. The pain improvement was evaluated by VAS score. The operation effect were evaluated by anterior height of injured vertebral body, middle height of injured vertebral body, wedge angle of injured vertebral body and distribution grade of bone cement. The incidence of surgical complications was evaluated by the number of bone cement leakage.Results: There were no significant difference in the operation time, intraoperative blood loss and the amount of bone cement injection in two groups. There were no significant difference in VAS scores at 2h, 4h and 48h after operation between the two groups (P > 0.05); There were no significant difference in the ratio of anterior height of injured vertebral body between the two groups on the third day after operation and the last follow-up (P > 0.05); There were no significant difference in the ratio of middle height of injured vertebral body between the two groups on the third day after operation and the last follow-up (P > 0.05); There were no significant difference in wedge angle of injured vertebral body between the two groups at the third day after operation and the last follow-up (P > 0.05). There was significant difference in the distribution grade of bone cement between the two groups (P < 0.01); There was significant difference in the number of bone cement leakage between the two groups (P < 0.01), In cases of bone cement leakage, there were 1 case of type C, 1 case of type S in the experimental group, 7 cases of type C and 2 cases of type S in the control group.Conclusion: Precise injection and staged perfusion of bone cement kyphoplasty in the treatment of osteoporotic vertebral compression fracture can effectively reduce surgical complications and improve surgical efficacy.

scholarly journals Radiological and clinical outcomes of balloon kyphoplasty for osteoporotic vertebral compression fracture in patients with rheumatoid arthritis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ji Guo ◽  
Weifeng Zhai ◽  
Licheng Wei ◽  
Jianpo Zhang ◽  
Lang Jin ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Vertebral Fractures ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Balloon Kyphoplasty ◽  
Cement Leakage ◽  
Osteoporotic Vertebral Compression Fracture ◽  
Control Group ◽  
Compression Rate ◽  
Kyphotic Angle

Abstract Background This study was conducted to investigate the outcomes and complications of balloon kyphoplasty (KP) for the treatment of osteoporotic vertebral compression fracture (OVCF) in patients with rheumatoid arthritis (RA) and compare its radiological and clinical effects with OVCF patients without RA. Methods Ninety-eight patients in the RA group with 158 fractured vertebrae and 114 patients in the control group with 150 vertebrae were involved in this study. Changes in compression rate, local kyphotic angle, visual analog scale (VAS) and Oswestry disability index (ODI) scores, conditions of bone cement leakage, refracture of the operated vertebrae, and new adjacent vertebral fractures were examined after KP. In addition, patients in the RA group were divided into different groups according to the value of erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and whether they were glucocorticoid users or not to evaluate their influence on the outcomes of KP. Results KP procedure significantly improved the compression rate, local kyphotic angle, and VAS and ODI scores in both RA and control groups (p<0.05). Changes in compression rate and local kyphotic angle in the RA group were significantly larger than that in the control group (p<0.05), and patients with RA suffered more new adjacent vertebral fractures after KP. The outcomes and complications of KP from different ESR or CRP groups did not show significant differences. The incidence of cement leakage in RA patients with glucocorticoid use was significantly higher than those who did not take glucocorticoids. In addition, RA patients with glucocorticoid use suffered more intradiscal leakage and new adjacent vertebral fractures. Conclusions OVCF patients with RA obtained more improvement in compression rate and local kyphotic angle after KP when compared to those without RA, but they suffered more new adjacent vertebral fractures. Intradiscal leakage and new adjacent vertebral fractures occurred more in RA patients with glucocorticoid use. Trial registration Retrospectively registered.

scholarly journals Is Unilateral Transverse Process-Pedicle Percutaneous Kyphoplasty A Better Choice for Osteoporotic Thoracolumbar Fractures in the Old Patients

2021 ◽  
Author(s):  
Tao Wu ◽  
Hu Qin ◽  
Yap Nicolas ◽  
Nuo Xu ◽  
Daoyu Huang ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Compression Fracture ◽  
Transverse Process ◽  
Cement Leakage ◽  
Good Choice ◽  
Old Patients ◽  
Percutaneous Kyphoplasty ◽  
Cement Distribution ◽  
Coronal Correction ◽  
Surgical Duration

Abstract Background: A few reports have shown that unilateral transverse process-pedicle percutaneous kyphoplasty is a good choice for patients with osteoporotic vertebral compression fracture (OVCF). However, this issue remains controversial and the related comprehensive research was lacked.Methods: A retrospective study was conducted on patients receiving PKP surgery for OVCF. Patients were divided into three groups according to surgical approach. Symptom and radiographical evaluation were performed preoperatively, one-month postoperatively, one-year postoperatively and follow-ups. And follow-ups were repeated every year. Visual Analogue Scale Score (VAS), Oswestry Disability Index (ODI) scores, anterior vertebral height, coronal Cobb angle and sagittal Cobb angle was determined and compared among three groups.Results: Totally four hundred and forty-seven patients were included with an average age of 76.6±7.2 years old. UTP showed significantly shorter surgical duration (p<0.001), lower cement volume (p<0.001) but higher cement leakage proportion (p=0.044). No significant statistical difference was found in terms of improvement rates among three groups. Besides, it was notable that the a significantly higher coronal Cobb angle was observed in UTP group, and a about 4°coronal correction was found after UTP PKP.Conclusion: UTTP PKP could achieve similar symptoms relief and kyphosis correction as UTP and BTP PKP. However, it had shorter surgical time and less radio exposure than BTP PKP, lower risk of cement leakage and higher proportion of bilaterally cement distribution than UTP PKP. It seemed to be a better choice for patients with OVCF. In addition, we found that UTP PKP was especially fit for OVCF patients with asymmetrical vertebral compression.

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

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.

scholarly journals Risk factors of postoperative bone cement leakage on osteoporotic vertebral compression fracture: a retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Kui Zhang ◽  
Jiang She ◽  
Yandong Zhu ◽  
Wenji Wang ◽  
Erliang Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Cement ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Posterior Wall ◽  
Cement Leakage ◽  
Osteoporotic Vertebral Compression Fracture ◽  
Type B ◽  
Logistic Analysis ◽  
Type C

Abstract Purpose To investigate risk factors of bone cement leakage in percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fracture (OVCF). Methods A total of 236 patients (344 vertebrae) who underwent PVP between November 2016 and June 2020 were enrolled in the study. Clinical and radiological characteristics, including age, gender, course of disease, trauma, type of vertebral fracture, cortical continuity of vertebral body, intervertebral vacuum cleft (IVC), fracture severity, fracture level, basivertebral foramen, bone cement dispersion types, the cement injection volume, the type of cement leakage, puncture approach, and intrusion of the posterior wall, were considered as potential risk factors. Three types of leakage (type-B, type-C, and type-S) were defined and risk factors for each type were analyzed. Logistic analysis was used to study the relationship between each factor and the type of cement leakage. Results The incidences of the three types of leakage were 28.5%, 24.4%, and 34.3%. The multinomial logistic analysis revealed that the factors of type-B leakage were the shape of cement and basivertebral foramen. One significant factor related to type-C leakage was cortical disruption, and the factors of type-S leakage were bone cement dispersion types, basivertebral foramen, cleft, fracture severity, an intrusion of the posterior wall, and gender. Conclusion Different types of cement leakage have their own risk factors, and the analysis of risk factors of these might be helpful in reducing the rate of cement leakage.

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