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.

scholarly journals Relationship between pre-existing kyphosis and new vertebral compression fractures following percutaneous vertebroplasty in patients with osteoporotic thoracolumbar fracture.

2020 ◽  
Author(s):  
Chao Chen ◽  
Ronghua Yu ◽  
Liwei Chen ◽  
Silian Wang ◽  
Zhikun Li ◽  
...  
Keyword(s):  
Percutaneous Vertebroplasty ◽  
Thoracolumbar Spine ◽  
Vertebral Compression Fractures ◽  
Time Interval ◽  
Thoracolumbar Kyphosis ◽  
Ct Value ◽  
Significant Difference ◽  
Thoracolumbar Region ◽  
Group A ◽  
Group B

Abstract Background: Thoracolumbar kyphosis disrupts the overall balance of the spine, thus the stress on each segment of the spine is different from that of the normal sequence. This may affect the outcome after Percutaneous vertebroplasty (PVP). But few studies have examined the relationship between thoracolumbar kyphosis and new fractures after PVP. Methods: A cross-sectional was conducted to evaluate the effect of the thoracolumbar kyphosis angle on postoperative recurrent fractures in patients with osteoporotic thoracolumbar fractures. From 2013 to 2018, 486 patients were treated with PVP in our hospital, and 242 patients were included in the study. These patients were divided into groups A and B based on the Cobb angle (greater or less than 10 °) in the thoracolumbar region. Patients were followed up for 36 months. The average CT value of the thoracolumbar spine, BMD, and the time of recurrence of fractures were recorded. Results: A clear relationship was observed between thoracolumbar Cobb kyphosis and recurrent vertebral fractures (OR = 1.061, P = 0.003). In group A, the proportion of women was larger and the BMD values was lower than that in group B. But no difference was found in the average CT value. K-M survival analysis found no significant difference in the rate of fracture recurrence between the two groups, but the time interval of second fracture occured at adjacent levels was significantly shorter than that occurred at distant levels in group A, which was not found in group B. Conclusions: When patients have thoracolumbar kyphosis before surgery, PVP should not be a recommended treatment.

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.

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.

scholarly journals SPINAL STENOSIS

2018 ◽  
Vol 25 (09) ◽  
pp. 1323-1327
Author(s):  
Saeed Ahmad ◽  
Haseeb Hussain ◽  
Ashfaq Ahmed ◽  
Rizwan Akram ◽  
Ijaz Ahmed ◽  
...  
Keyword(s):  
Single Dose ◽  
Spinal Stenosis ◽  
Local Anesthesia ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Lower Back ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Epidural Steroid

Introduction: Spinal stenosis causing lower back pain and radiculopathy andit is the most common cause of patient admission at Spine centre as compared to other spinepathologies. Most common complaint in the Spine outpatient department or hospital admissionsDifferent modalities have been applied with time for its management. Among them Epiduralsteroid injection is also. Objectives: “To Compare three doses of epidural steroid injection withsingle dose of epidural steroid injection for Lumbar Radicular pain in spinal stenosis patients.”Study Design: Prospective study. Setting: Ghurki Trust Teaching Hospital, Lahore, Pakistan.Period: Jan 2016 to Dec 2016. Materials and Methods: 95 patients with lumbar radicular paindue to spinal stenosis were randomly allocated into 2 groups. In Group A, 42 patients were given120 mg of Depo-medrol (40 mg per day for 3 days) along with local anesthesia and in group B,43 patients were given 40 mg of Depo-medrol with local anesthesia as a single dose. Both GroupA and Group B were matched in terms of age and gender. On visual analogue scoring, pain wasassessed after 2 weeks, 3 months and 6 months. Results: In Group A (3 doses of depomedrol)VAS improvement at 2 weeks, 3 months and 6 months were more than group B (single dose ofdepomedrol) which was statistically significant (p < 0.05). There were no major complicationslike epidural hematoma or abscess formation in both groups. The overall minor complicationslike flushing, transient hyperglycemia and headache due to CSF hypotension were more inGroup A than Group B but statistics shows no significant difference. All the adverse eventsresolved within few days without any significant morbidity and subsequent hospitalizations.Conclusion: Epidural steroid injection is excellent modality in the treatment of lower back painwith radiculopathy. Moreover 3 doses have greater effect in relieving pain as compared to singledose. There is no increase risk of complications by increasing dose.

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 The Effect of Bone Cement Distribution on the Outcome of Percutaneous Vertebroplasty: A Case Cohort Study

2020 ◽  
Author(s):  
Lei Tan ◽  
Bingtao Wen ◽  
Zhaoqing Guo ◽  
Zhongqiang Chen
Keyword(s):  
Bone Cement ◽  
Vertebral Body ◽  
Percutaneous Vertebroplasty ◽  
Vertebral Height ◽  
Significant Difference ◽  
Cement Distribution ◽  
Post Operation ◽  
Group A ◽  
Group B

Abstract Background: To analyze the effect of different types of bone cement distribution after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fracture (OVCF). Methods: 137 patients withsinglelevelOVCF who underwent PVP were retrospectively analyzed. The patients were divided into two groups according to bone cementdistribution. Group A:bone cement contacted both upper and lower endplates; Group B: bone cement missed at least one endplate. Group Bwas divided into 3 subgroups. Group B1: bone cement only contacted the upper endplates; Group B2: bone cement only contacted the lower endplates; Group B3: bone cement only located in the middle of vertebral body. The visual analogue scale (VAS) scoreat 24 hours post operation and last follow-up, anterior vertebral height restoration ratio (AVHRR), anterior vertebral height loss ratio (AVHLR) and vertebral body recompression ratewere compared. Results: 24 hours post operation, the pain of all groups were significantly improved. At the last follow-up, the VAS score of group A was lower than that of group B. There were 9 cases (6.6%) of cement leakage, 4 cases (6.9%) in group A and 5 cases (6.3%) in group B. At the last follow-up, there were 16 cases (11.7%) of vertebral body recompression, including 3 cases (5.2%) in group A and 13 cases (16.5%) in group B. There was no significant difference in AVHRR between two groups. At the last follow-up, AVHLR in group B was higher than that in group A. In subgroup analysis, there was no significant difference in VAS score,vertebral recompression rate, AVHRR or AVHLR.Conclusions: If the bone cement fully contacted both the upper and lower endplates, it can better restore the strength of the vertebral bodyand maintain the height of the vertebral body, reduce the risk of the vertebral body recompression and long term pain.

scholarly journals Effectiveness of sedation in dacryocystorhinostomy surgery

1970 ◽  
Vol 1 (1) ◽  
pp. 25-31 ◽  
Author(s):  
S Taludhar ◽  
S Adhikari ◽  
BK Bhattarai
Keyword(s):  
Local Anesthesia ◽  
Definitive Treatment ◽  
Perioperative Outcome ◽  
Chronic Dacryocystitis ◽  
Number Of Patients ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Operative Complications ◽  
Group A ◽  
Group B

Background: Chronic dacryocystitis is a common ophthalmic problem almost always requiring surgery as the only definitive treatment. Aim: To compare the perioperative outcome of external DCR surgery under local anesthesia with and without sedation. Subjects and methods: One hundred consecutive patients with chronic dacryocystitis undergoing dacryocystorhinostomy (DCR) surgery were randomly divided into two groups using computer generated random table. Group A underwent DCR under local anesthesia (LA) without sedation and group B under LA with sedation. The outcome parameters were intra-operative pain, surgeon's comfort, intra-operative complications and duration of surgery. Statistical analysis: SPSS version 11.5 software was used. Chi square test was used to compare the difference between the groups. Results: There were 50 patients in each group. The mean age ± SD of the patients was 34.4±12.12 years (95% CI=28.89-38.55 years). Sixty-nine percent of them were female. Significantly higher number of patients experienced pain in Group A as compared to Group B (100% vs 50%, P<0.001) Surgeon's discomfort was significantly present in group A as compared to group B (70% vs 10%), (p=0.00001). Blood loss was significantly more in group A than in group B (p=0.017). There was no significant difference in the duration of surgery. The post operative success rate in both the groups was comparable after six months of followup. Conclusion: The use of sedation with LA improves the perioperative outcome of DCR surgery in terms of patient's pain, surgeon's comfort and intra-operative complications. Key words: dacryocystitis; dacryocystorhinostomy; sedation DOI: 10.3126/nepjoph.v1i1.3670 Nep J Oph 2009;1(1):25-31

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 Extrapedicular Infiltration Anesthesia as an Improved Method of Local Anesthesia for Unipedicular Percutaneous Vertebroplasty or Percutaneous Kyphoplasty

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Liehua Liu ◽  
Shiming Cheng ◽  
Rui Lu ◽  
Qiang Zhou
Keyword(s):  
Local Anesthesia ◽  
Nerve Root ◽  
Percutaneous Vertebroplasty ◽  
Visual Analogue Score ◽  
Vertebral Compression Fractures ◽  
Improved Method ◽  
Percutaneous Kyphoplasty ◽  
Significant Difference ◽  
Root Effects ◽  
Infiltration Anesthesia

Aim.This report introduces extrapedicular infiltration anesthesia as an improved method of local anesthesia for unipedicular percutaneous vertebroplasty or percutaneous kyphoplasty.Method.From March 2015 to March 2016, 44 patients (11 males and 33 females) with osteoporotic vertebral compression fractures with a mean age of71.4±8.8years (range: 60 to 89) received percutaneous vertebroplasty or percutaneous kyphoplasty. 24 patients were managed with conventional local infiltration anesthesia (CLIA) and 20 patients with both CLIA and extrapedicular infiltration anesthesia (EPIA). Patients evaluated intraoperative pain by means of the visual analogue score and were monitored during the procedure for additional sedative analgesia needs and for adverse nerve root effects.Results.VAS of CLIA + EPIA and CLIA group was2.5±0.7and4.3±1.0,respectively, and there was significant difference (P=0.001). In CLIA group, 1 patient required additional sedative analgesia, but in CLIA + EPIA group, no patients required that. In the two groups, no adverse nerve root effects were noted.Summary.Extrapedicular infiltration anesthesia provided good local anesthetic effects without significant complications. This method deserves further consideration for use in unipedicular percutaneous vertebroplasty and percutaneous kyphoplasty.

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