Treatment of subacute osteoporotic vertebral compression fractures with percutaneous vertebroplasty: A case report

Introduction. Percutaneous vertebroplasty (PVP), as a mini-invasive approach in the treatment of patients with osteoporotic vertebral compression fractures (OVCFs), provides stabilization of the spine and relives pain. The most commonly it is applied in the 3?6 weeks before bending of the spine. Complete cessation of pain is easier to achieve if you treat ?less mature? fractures. The aim of the report is to show that PVP is effective and safe for old fractures too. Case report. A 77-old patient suffered from a stable compression fracture of 3th lumbar (L3) vertebral body after minor trauma. This fracture was clinically and radiologically diagnosed. The conservative treatment that included lumbo-sacral orthosis (LSO), analgesic drugs and physical therapy, was primarily applied due to permanent pain and type of fracture. After a period of two months, pain persisted, but it was localized in a thoracic spinal segment with radiologically diagnosed fractured bodies of 8th (Th8) and 10th (Th10), thoracic vertebra without neurological deficit. Thoraco-lumbo-sacral orthosis (TLSO) was prescribed and after six months the indication for vertebroplasty of the Th8 and Th10 vertebral body was given. The pain relief had been achieved and the patient was discharged from the Clinic for Orthopedics on the postoperative day 2, and was symptom free during the follow-up period. Conclusion. In patients with stable OVCFs, PVP is an effective therapy for reducing pain and improving mobility of 6 months old fractures.

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Risk Factors for the Occurrence of Insufficient Cement Distribution in the Fractured Area after Percutaneous Vertebroplasty in Osteoporotic Vertebral Compression Fractures

January 2018 - Pain Physician ◽

10.36076/ppj.2018.1.e33 ◽

2018 ◽

Vol 1 (21;1) ◽

pp. E33-E42

Author(s):

Xiaobing Jiang

Keyword(s):

Risk Factors ◽

Pain Relief ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Bone Mass Density ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Cement Distribution ◽

Superior Portion

Background: Insufficient cement distribution (ICD) in the fractured area has been advocated to be responsible for unsatisfied pain relief after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs). However, little is known about risk factors for the occurrence of ICD. Objective: The present study aimed to identify independent risk factors of the emergence of ICD. Study Design: A retrospective cohort study. Setting: Department of spinal surgery, an affiliated hospital of a medical university. Methods: Patients who underwent PVP for single-level OVCF from January 2012 to September 2014 and met this study’s inclusion criteria were retrospectively reviewed. Associations of ICD with co-variates (age, gender, bone mass density with a T-score, amount of injected cement, cement leakage, fracture level, fracture age, fracture severity grade, and location of the fractured area) and the influence of ICD on pain relief were analyzed. Results: A total of 225 patients were included. ICD was found in 26 (11.6%) patients. Fractured area located in the superior portion of the index vertebra was significantly associated with occurrence of ICD. No further significant associations between the studied co-variates and emergence of ICD were seen in the adjusted analysis. In addition, patients with ICD had significantly higher immediate postoperative visual analog scale scores of back pain compared with those with sufficient cement distribution in the fractured area. Limitation: Location of the fractured area and cement distribution in the fractured area could not be evaluated quantitatively. Conclusions: The incidence of ICD is higher in patients with the fractured area located in the superior portion of the index vertebra and ICD might be responsible for unsatisfied pain relief after PVP for OVCFs. Key words: Percutaneous vertebroplasty, insufficient cement distribution, fractured area, risk factor, osteoporosis, vertebral compression fracture, spine, unsatisfied pain relief, cement augmentation

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Comparison between percutaneous vertebroplasty and percutaneous kyphoplasty in the treatment of posterior wall rupture and osteoporotic vertebral compression fractures-Case - based retrospective study

10.21203/rs.3.rs-19906/v1 ◽

2020 ◽

Author(s):

Yong-sheng Gou ◽

Yue Hu ◽

Hai-bo Li ◽

Bo-lin fu ◽

Zheng Che

Keyword(s):

Retrospective Study ◽

Clinical Efficacy ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Operation Time ◽

Posterior Wall ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Percutaneous Kyphoplasty

Abstract Background: Percutaneous kyphoplasty (PKP) or percutaneous vertebral plasty (PVP) has been widely applied in the treatment of osteoporotic vertebral compression fractures (osteoporotic vertebral compression will fracture, OVCF) because of its minimally invasive and effective. To compare the clinical efficacy and safety of percutaneous vertebroplasty versus percutaneous kyphoplasty for osteoporotic vertebral compression fractures with posterior wall broken. Methods: 82 patients with osteoporotic vertebral compression fracture with posterior wall broken were divided into PVP group(group A) and PKP group(group B)．The operation time, perspective times, bone cement volume injected. cement leakage, hospitalization expenses, preoperative visual analog score(VAS) and Oswestry disability index(ODI), restoration height of vertebral, the vertebrae height loss and new fracture of adjacent vertebra were evaluated during the follow-up. Results: The PVP group incurred significantly shorter operation time(40.37 ±8.26 min) and less perspective times (22.23 ±3.79 times)than the PKP group(46.74 ±9.58 min and 27.96 ±5.71 times respectively)( P<0.05). The PVP group incurred significantly less expenses than the PKP group(P<0.05). The VAS scores and ODI at 1 day and 6 months post-operation were significantly lower than pre-operation in both groups(P<0.05). Conclusion: Both PVP and PKP Can obtain satisfactory clinical efficacy for the treatment of osteoporotic vertebral compression fractures with posterior wall broken,but the former may have advantages of less expenses,shorter operation time. Trial registration: This retrospective study was approved by the ethics committee of the first people's hospital of shuangliu district, Chengdu, Moreover, this study was also registered in the Chinese clinical trial registry with the registration number of ChiCTR1900028176.

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Risk factors for secondary fractures to percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a systematic review

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02722-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Wei Mao ◽

Fei Dong ◽

Guowei Huang ◽

Peiliang He ◽

Huan Chen ◽

...

Keyword(s):

Risk Factors ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Mineral Density ◽

Secondary Fracture ◽

Compression Fractures ◽

Secondary Fractures ◽

At Home

Abstract Background Osteoporotic vertebral compression fracture (OVCF) is one of the most common fragile fractures, and percutaneous vertebroplasty provides considerable long-term benefits. At the same time, there are many reports of postoperative complications, among which fracture after percutaneous vertebroplasty is one of the complications after vertebroplasty (PVP). Although there are many reports on the risk factors of secondary fracture after PVP at home and abroad, there is no systematic analysis on the related factors of secondary fracture after PVP. Methods The databases, such as CNKI, Wan Fang Database and PubMed, were searched for documents on secondary fractures after percutaneous vertebroplasty published at home and abroad from January 2011 to March 2021. After strictly evaluating the quality of the included studies and extracting data, a meta-analysis was conducted by using Revman 5.3 software. Results A total of 9 articles were included, involving a total of 1882 patients, 340 of them diagnosed as secondary fractures after percutaneous vertebroplasty. Conclusion The additional history of fracture, age, bone mineral density (BMD), bone cement leakage, intravertebral fracture clefts and Cobb Angle might be risk factors related to secondary fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fractures. The height of vertebral anterior and body mass index (BMI) were not correlated.

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Treatment of Osteoporotic Vertebral Compression Fracture with Target-Anchored Vertebral Body Plasty

Journal of Biomaterials and Tissue Engineering ◽

10.1166/jbt.2019.2073 ◽

2019 ◽

Vol 9 (8) ◽

pp. 1081-1085

Author(s):

Liu Yang ◽

Xiangbei Qi ◽

Tao Lei ◽

Jingtao Zhang ◽

Junming Cao

Keyword(s):

Bone Cement ◽

Vertebral Body ◽

Vertebral Compression Fracture ◽

Compression Fracture ◽

Target Group ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Traditional Group ◽

Compression Fractures ◽

Fracture Area

Objective: To analyze the clinical effect of target-anchored vertebroplasty and traditional percutaneous vertebroplasty on the treatment of osteoporotic vertebral compression fractures. Methods: 50 female New Zealand rabbits were selected for establishing the osteoporotic vertebral compression fracture model and divided into two groups, traditional group and target group followed by analysis of the anterior, posterior, and posterior vertebral body anterior height of the fracture and the injection volume of the bone cement at full filling, and to compare the ultimate compressive strength and stiffness differences between the two groups of specimens by biomechanical testing. Results: In traditional group, the operative time was significantly shorter than that of target group, and the intraoperative bleeding was significantly lower than that of target group (P < 0.05). The fracture area of target group was filled with sufficient bone cement, in the traditional group, 3 cases (12%) showed that bone cement was not filled in the fracture area (P < 0.05), but the total bone cement filling volume was not significantly different between the two groups, but the traditional group had more complete bone cement filling than the bone cement filling, the difference was statistically significant (P < 0.05). In addition, the anterior vertebral body height of each group was significantly higher than other observation points in the group (P < 0.05). However, the distribution of permeability and osmotic type of bone cement between the two groups was not significantly different (P > 0.05). Conclusion: Target-anchored vertebroplasty can improve the quality of clinical treatment of osteoporotic vertebral compression fractures, indicating that it might be a new surgical method.

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Clinical observation of two bone cement distribution modes after percutaneous vertebroplasty for osteoporotic vertebral compression fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04480-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Qiujiang Li ◽

Xingxia Long ◽

Yinbin Wang ◽

Tao Guan ◽

Xiaomin Fang ◽

...

Keyword(s):

Bone Cement ◽

Clinical Efficacy ◽

Vertebral Body ◽

Percutaneous Vertebroplasty ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Cement Distribution ◽

Local Kyphosis

Abstract Background Current findings suggest that percutaneous vertebroplasty(PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs). The present retrospective study aimed to investigate the differences in clinical efficacy and related complications between the two bone cement distribution modes. Methods We retrospectively reviewed the medical records of the patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty. Patients were divided into blocky and spongy group according to the type of postoperative bone cement distribution. Clinical efficacy and related complications was compared between the two bone cement distribution modes on 24 h after the operation and last follow-up. Results A total of 329 patients with an average follow up time of 17.54 months were included. The blocky group included 131 patients, 109 females(83.2 %) and 22 males(16.8 %) with a median age of 72.69 ± 7.76 years, while the Spongy group was made up of 198 patients, 38 females(19.2 %) and 160 males(80.8 %) with a median age of 71.11 ± 7.36 years. The VAS and ODI after operation improved significantly in both two groups. The VAS and ODI in the spongy group was significantly lower than that in the blocky group, 24 h postoperatively, and at the last follow-up. There were 42 cases (12.8 %) of adjacent vertebral fractures, 26 cases (19.8 %) in the blocky group and 16 cases (8.1 %) in the spongy group. There were 57 cases (17.3 %) of bone cement leakage, 18 cases (13.7 %) in blocky group and 39 cases (19.7 %) in the spongy group. At 24 h postoperatively and at the last follow-up, local kyphosis and anterior vertebral height were significantly corrected in both groups, but gradually decreased over time, and the degree of correction was significantly higher in the spongy group than in the block group. The change of local kyphosis and loss of vertebral body height were also less severe in the spongy group at the last follow-up. Conclusions Compared with blocky group, spongy group can better maintain the height of the vertebral body, correct local kyphosis, reduce the risk of the vertebral body recompression, long-term pain and restore functions.

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Clinical Observation of Two Bone Cement Distribution Modes After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures

10.21203/rs.3.rs-468772/v1 ◽

2021 ◽

Author(s):

Qiujiang Li ◽

Xingxia Long ◽

Yinbin Wang ◽

Tao Guan ◽

Xiaomin Fang ◽

...

Keyword(s):

Bone Cement ◽

Clinical Efficacy ◽

Vertebral Body ◽

Percutaneous Vertebroplasty ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Cement Distribution ◽

Local Kyphosis

Abstract Background:Current findings suggest that percutaneous vertebroplasty(PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs).The present retrospective study aimed to investigate the differences in clinical efficacy and related complications between the two bone cement distribution modes. Methods:We retrospectively reviewed the medical records of the patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty.Patients were divided into blocky and spongy group according to the type of postoperative bone cement distribution. Clinical efficacy and related complications was compared between the two bone cement distribution modes on 24h after the operation and last follow-up.RESULTS: The mean follow-up time was 17.54 months. The VAS and ODI after operation improved significantly in both two groups. The VAS and ODI in the spongy group was significantly lower than that in the blocky group, 24h postoperatively, and at the last follow-up. There were 42 cases (12.8%) of adjacent vertebral fractures, 26 cases (19.8%) in the blocky group and 16 cases (8.1%) in the spongy group. There were 57 cases (17.3%) of bone cement leakage, 18 cases (13.7%) in blocky group and 39 cases (19.7%) in the spongy group. At 24 hour postoperatively and at the last follow-up, local kyphosis and anterior vertebral height were significantly corrected in both groups, but gradually decreased over time, and the degree of correction was significantly higher in the spongy group than in the block group. Loss of local kyphosis and loss of vertebral body height were also less severe in the spongy group at the last follow-up.Conclusions: Compared with blocky group, spongy group can better maintain the height of the vertebral body, correct local kyphosis, reduce the risk of the vertebral body recompression, long-term pain and restore functions.

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Percutaneous Vertebroplasty-Induced Adjacent Vertebral Compression Fracture

January 2018 - Pain Physician ◽

10.36076/ppj.2012/15/e527 ◽

2012 ◽

Vol 4;15 (4;8) ◽

pp. E527-E532

Author(s):

Ki Seong Eom

Keyword(s):

Case Report ◽

Vertebral Body ◽

Vertebral Compression Fracture ◽

Percutaneous Vertebroplasty ◽

Single Case ◽

Rare Complication ◽

Compression Fracture ◽

Fracture Line ◽

Compression Fractures ◽

First Case

Background: The risks associated with percutaneous vertebroplasty (PV) are low. Patients show marked improvement and are able to rapidly resume normal activities after PV. The sudden development of postoperative vertebral compression fracture (VCF) is a common complication, and additional PV is frequently performed in these cases. However, there have been no studies reporting acute compression fractures of an adjacent vertebra immediately after PV. Objective: This case report presents a rare case in which the patient had to undergo a second PV because of PV-induced adjacent VCF. Further, we review previous studies and discuss the possible pathogenesis of this rare complication. Study Design: Case report. Setting: Pain management clinic. Methods: A 62-year-old woman presented with a severe pain in the lower back, which started after she slipped. A radiograph showed severe vertebral collapse with a vertebral vacuum cleft in the T12 vertebral body. T1-weighted magnetic resonance imaging showed low signal intensity in T12, suggesting acute VCF, but the signals from the other vertebrae were normal. Results: The patient underwent PV at T12. When the cannula was inserted into the fracture line of the vertebral body, reduction of the collapsed T12 was developed. Although the postoperative course was uneventful, the patient’s pain did not resolve. Postoperative radiographic image obtained 4 hours after the PV showed reduction of T12 and adjacent acute VCF in T11. We performed a second PV at T11. However, 2 weeks later, adjacent acute VCF in L1 was developed and PV was performed. Limitations: This report describes a single case. Conclusion: To the best of our knowledge, this is the first case report of adjacent VCF that developed almost immediately after PV. Although the exact mechanism underlying this rare complication remains unclear, we assume that the VCF was induced by PV, although this was not proven. However, we suggest that the insertion of the cannula into the fracture line induced the iatrogenic dynamic mobility of the fractured vertebra. Reduction was caused by the cannula and positional gravity. The upward reduction may have had an effect on the upper and adjacent vertebrae. Key words: Compression fractures, vertebroplasty, cannula, complication.

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