Immediate and early postoperative pain relief after kyphoplasty without significant restoration of vertebral body height in acute osteoporotic vertebral fractures

Object Painful osteoporotic vertebral compression fractures (VCFs) are a significant cause of disability in the elderly population. Kyphoplasty, a recently developed minimally invasive procedure, has been advocated for the successful management of these fractures in terms of immediate pain relief, and also for restoration of the premorbid level of daily activities. In this retrospective study the authors report on their experience with the early management of VCFs with kyphoplasty. Methods A retrospective analysis was conducted in 13 patients (seven women and six men) whose ages ranged from 48 to 87 years (mean age 71.5 ± 11 years [mean ± standard deviation]). The interval between onset of symptoms and surgical intervention ranged from 4 to 9 weeks. Twenty levels (12 thoracic, eight lumbar) were treated in this cohort. Immediate and early postoperative (1-month follow-up visit) visual analog scale (VAS) pain scores, activity levels, and restoration of vertebral body (VB) height were assessed. The mean preoperative VAS score was 8 ± 1, whereas the immediate and early postoperative scores were 1 ± 1. These findings reflected a resolution of 90 to 100% of preoperative pain. All patients resumed routine activities within hours of the procedure, although improvement in VB height was not accomplished in this cohort. No major complications were encountered in this clinical series. Conclusions Kyphoplasty is a safe and effective method for the treatment of osteoporotic VCFs. Failure to restore VB height does not seem to interfere with the excellent pain management and good functional outcome provided by this procedure.

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Vertebral body height changes in acute symptomatic osteoporotic vertebral compression fractures treated with vertebral cement augmentation. Which factors affect vertebral body height?

10.21203/rs.3.rs-430234/v1 ◽

2021 ◽

Author(s):

Jesús Payo-Ollero ◽

Rafael Llombart-Blanco ◽

Carlos Villas ◽

Matías Alfonso

Keyword(s):

Vertebral Body ◽

Body Height ◽

Cement Augmentation ◽

Vertebral Compression Fractures ◽

Vertebral Augmentation ◽

Vertebral Height ◽

Vertebral Body Height ◽

Post Surgery ◽

Osteoporotic Vertebral Fractures

Abstract Changes in vertebral body height depend on various factors which were analyzed in isolation and not as a whole. The aim of this study is to analyze what factors might influence restoration of vertebral body height after vertebral augmentation. We analyzed 48 patients (108 vertebrae) with osteoporotic vertebral fractures underwent vertebral augmentation when conservative treatment proved unsatisfactory. Analyses were carried out at the time of the fracture, during surgery (pre-cementation and post-cementation), at first medical check-up (6 weeks post-surgery) and at last medical check-up. Average vertebral height was measured and differences from preoperative values calculated at each timepoint. Pearson correlation coefficient and linear multivariable regression were carried out at the different timepoints. The time since vertebral fracture was 60.4 ± 41.7 days. Patients’ average age was 70.9 ± 9.3-years. The total follow-up was 1.43 ± 1-year. After vertebral cementation there was an increase in vertebral body height of + 0.3cm (13.6%). During post-operative follow-up, there was a progressive collapse of the vertebral body and pre-surgical height was reached. The factors that most influenced vertebral height restoration were: grade III collapse, intervertebral-vacuum-cleft (IVVC), and use of a flexible trocar before cement augmentation. The factor that negatively influenced vertebral body height restoration was location in the thoracolumbar spine.

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Vertebral Augmentation for Compression Fractures Caused by Malignant Disease

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2010.0078 ◽

2010 ◽

Vol 8 (9) ◽

pp. 1095-1102 ◽

Cited By ~ 9

Author(s):

Rahul Rastogi ◽

Trusharth Patel ◽

Robert A. Swarm

Keyword(s):

Pain Relief ◽

Bone Cement ◽

Vertebral Body ◽

Malignant Disease ◽

Body Height ◽

Vertebral Compression Fractures ◽

Intractable Pain ◽

Vertebral Augmentation ◽

Vertebral Body Height ◽

Compression Fractures

Vertebral compression fractures are common in malignant disease and frequently cause severe back pain. However, management of that pain with conventional medical, radiotherapy, or surgical modalities is often inadequate. Vertebral augmentation techniques, such as vertebroplasty and kyphoplasty, are minimally invasive techniques in which methylmethacrylate bone cement is percutaneously injected into compressed vertebral bodies. Vertebral augmentation often improves mechanical stability of compressed vertebrae, provides pain relief, and may prevent progression of vertebral collapse. Kyphoplasty may provide increased chance for vertebral body height restoration, but the clinical importance of slight change in vertebral body height is unclear. Vertebral augmentation can be used in conjunction with other treatment modalities, and associated pain relief may improve patient tolerance of needed antitumor therapies, such as radiation therapy. Vertebral augmentation is generally very well tolerated, and complications associated with bone cement extravasation beyond the vertebral body have rarely been reported. Because it often provides good to excellent relief of otherwise intractable pain and is generally well tolerated, vertebral augmentation is becoming a first-line agent for management of painful vertebral compression fractures, especially in the setting of malignant disease.

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Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels

Journal of Neurosurgery Spine ◽

10.3171/spi.2003.98.1.0036 ◽

2003 ◽

Vol 98 (1) ◽

pp. 36-42 ◽

Cited By ~ 53

Author(s):

Jon T. Ledlie ◽

Mark Renfro

Keyword(s):

Back Pain ◽

Vertebral Body ◽

Functional Outcomes ◽

Body Height ◽

Balloon Kyphoplasty ◽

Vertebral Compression Fractures ◽

Activity Levels ◽

Vertebral Body Height ◽

Content Type ◽

Fine Print

Object. The authors assessed the safety of balloon kyphoplasty in the reduction and repair of osteopenic vertebral compression fractures and report functional outcomes (back pain and activity levels) in the first 96 patients (with 133 fractures) at their institution. Additionally they provide radiographic outcomes in the first 26 patients (41 fractures) treated and followed for 1 year. Methods. The authors conducted a retrospective chart review of functional outcomes and evaluated radiographs obtained at 1 week, 1 month, 3 months, 6 months, and 1 year postoperatively. Conclusions. Balloon kyphoplasty safely increases vertebral body height, decreases chronic back pain, and quickly returns geriatric patients to higher activity levels, leading to increased independence and quality of life.

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Vesselplasty for the treatment of osteoporotic vertebral compression fractures with peripheral wall damage: A retrospective study

10.21203/rs.3.rs-107453/v1 ◽

2020 ◽

Author(s):

Chongqing Xu ◽

Mengchen Yin ◽

Wen Mo

Keyword(s):

Cobb Angle ◽

Bone Cement ◽

Vertebral Body ◽

Body Height ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Vertebral Body Height ◽

Compression Fractures ◽

Time Points ◽

Postoperative Time

Abstract Background The clinical efficacy of vertebroplasty and kyphoplasty treating osteoporotic vertebral compression fractures (OVCF) has been widely recognized in recent years. However, there are also disadvantages of bone cement leakage (BCL), limited correction of kyphosis and recovery of vertebral height. Nowadays, in view of these shortcomings, vesselplasty has been widely used in clinical practice. The objective of this study is to assess its clinical effect and application value for the treatment of OVCF with peripheral wall damage. Methods/Design: All 62 patients (70 vertebrae) treated for OVCF with peripheral wall damage using vesselplasty were involved and retrospectively analyzed. The data collection included operation time, volume of bone cement, relevant surgical complications, visual analog scale (VAS), Oswestry disability index (ODI), vertebral body height and kyphosis Cobb angle. Results The time of operation was 20–65 (34.5 ± 10.5) minutes. The volume of bone cement was 3–8 (5.3 ± 1.3) ml. VAS and ODI at different time points after operation were decreased compared with before operation (all P < 0.05). There were no statistical differences between VAS or ODI at different postoperative time points (P > 0.05). Vertebral body height and Cobb angle at different time points after operation were improved compared with before operation (all P < 0.05). There were no statistical differences between vertebral body height or Cobb angle at different postoperative time points (all P > 0.05). Conclusion Vesselplasty can reduce the risk of BCL and better control the dispersion of bone cement in the treatment of OVCF. It has a definite effect in relieving pain, restoring the vertebral body height and correcting the kyphosis caused by injured vertebrae, especially in OVCF with peripheral wall damage. Therefore, vesselplasty is safe and worthy of clinical application.

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Kyphoplasty Technique for Thoraco-Lumbar Compression Fracture

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.114 ◽

2018 ◽

Vol 1 (2) ◽

pp. 36

Author(s):

Alfred Sutrisno Sim

Keyword(s):

Elderly Patients ◽

Vertebral Body ◽

Treatment Options ◽

Body Height ◽

Compression Fracture ◽

Vertebral Compression Fractures ◽

Compression Fractures ◽

Reduction Of Pain ◽

Surgical Fixation ◽

Osteoporotic Compression Fractures

Osteoporotic vertebral compression fracture (VCF) is a significant cause of morbidity and mortality among elderly patients. Fractures can happen because of osteoporosis, tumours, or other conditions.In the past two decades, kyphoplasty has emerged as surgical options that play a central role in the treatment of vertebral compression fractures. Before the common use of kyphoplasty, the principal surgical option for treatment of compression fractures was decompression and fusion. However, surgical fixation frequently failed in elderly patients because of osteopenia. Kyphoplasty has expanded to include treatment of osteoporotic compression fractures, traumatic compression fractures, and metastatic compression fractures. Osteoporotic compression fractures are now the most common indication for this procedure.Kyphoplasty utilizes an inflatable balloon to create a cavity for the cement with the additional potential goals of restoring height and reducing kyphosis. Kyphoplasty is an effective treatment options for the reduction of pain associated with vertebral body compression fractures. Biomechanical studies demonstrate that kyphoplasty is initially superior for increasing vertebral body height and reducing kyphosis, but these gains are lost with repetitive loading. Complications secondary to extravasation of cement include compression of neural elements and venous embolism. These complications are rare but more common with vertebroplasty. Kyphoplasty is a safe and effective procedure for the treatment of vertebral body compression fractures.

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Vertebroplasty and Kyphoplasty Can Restore Normal Spine Mechanics following Osteoporotic Vertebral Fracture

Journal of Osteoporosis ◽

10.4061/2010/729257 ◽

2010 ◽

Vol 2010 ◽

pp. 1-9 ◽

Cited By ~ 7

Author(s):

Jin Luo ◽

Michael A. Adams ◽

Patricia Dolan

Keyword(s):

Vertebral Body ◽

Normal Values ◽

Body Height ◽

Cement Leakage ◽

Future Research ◽

Vertebral Body Height ◽

Beneficial Effects ◽

Osteoporotic Vertebral Fractures ◽

Spine Mechanics ◽

Normal Spine

Osteoporotic vertebral fractures often lead to pain and disability. They can be successfully treated, and possibly prevented, by injecting cement into the vertebral body, a procedure known as vertebroplasty. Kyphoplasty is similar, except that an inflatable balloon is used to restore vertebral body height before cement is injected. These techniques are growing rapidly in popularity, and a great deal of recent research, reviewed in this paper, has examined their ability to restore normal mechanical function to fractured vertebrae. Fracture reduces the height and stiffness of a vertebral body, causing the spine to assume a kyphotic deformity, and transferring load bearing to the neural arch. Vertebroplasty and kyphoplasty are equally able to restore vertebral stiffness, and restore load sharing towards normal values, although kyphoplasty is better at restoring vertebral body height. Future research should optimise these techniques to individual patients in order to maximise their beneficial effects, while minimising the problems of cement leakage and adjacent level fracture.

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173 EVOLVE - Significant Improvements in Pain, Disability, Quality of Life and Overall Health with Use of Balloon Kyphoplasty for Vertebral Compression Fractures in Medicare-Eligible Patients Despite Minimal Improvements in Vertebral Body Height an

Neurosurgery ◽

10.1093/neuros/nyx417.173 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 244-245

Author(s):

John Amburgy ◽

Douglas Beall ◽

Richard Easton ◽

Douglas Linville ◽

Sanjay Talati ◽

...

Keyword(s):

Quality Of Life ◽

Vertebral Body ◽

Body Height ◽

Balloon Kyphoplasty ◽

Vertebral Compression Fractures ◽

Vertebral Body Height ◽

Compression Fractures ◽

Time Points ◽

Pain Disability

Abstract INTRODUCTION Osteoporotic and neoplastic vertebral compression fractures (VCF) are common and painful. In the U.S., there are more than 1.5 million vertebral fractures annually and 40% of those over the age of 80 will experience this pathology, threatening quality of life and increasing morbidity and mortality. Kyphoplasty is a minimally invasive surgery to stabilize the fracture and recent EVOLVE analysis demonstrated minimal improvement in kypohotic angulation or vertebral body height, however, patients demonstrated significant improvements in pain, disability, quality of life and overall health. METHODS Prospective, multicenter 12-month clinical study of outcomes pertaining to activities of daily living, pain, quality of life, and safety parameters in a Medicare-eligible population treated with kyphoplasty for painful acute or subacute VCFs associated with osteoporosis or cancer. RESULTS >NRS back pain improved from 8.7 (scale 0–10) by 5.2, 5.4, 6.0, 6.2 and 6.3 points, at the 7-day, and the 1, 3, 6 and 12-month time points, respectively. ODI improved from 63.4 (scale 0–100) by 30.5, 35.3, 36.3 and 36.2 points, at the 1, 3, 6 and 12-month time points, respectively. The SF-36 PCS was 24.2 at baseline (scale 0–100) and improved 10.7, 12.4, 13.4 and 13.8 points, at 1, 3, 6 and 12 months. The EQ-5D was 0.383 points (scale 0–1) and improved 0.316, 0.351, 0.356 and 0.358 points, at 1, 3, 6 and 12 months. All measures were statistically significant with P < 0.001 at every time point. Despite these significant improvements in pain, disability, qulity of life and overall health, there were only modest, but significant improvements in kyphotic angulation (1.1° improvement) and vertebral body height (4% improvement). CONCLUSION This large, prospective, multicenter study trial demonstrates that utilization of kyphoplasty for vertebral compression fractures provides significant improvements in pain, disability, quality of life, and overall health despite modest improvements in kyphotic angulation and vertebral body height in Medicare-eligible patients.

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Kyphoplasty in the Treatment of Osteolytic Vertebral Compression Fractures as a Result of Multiple Myeloma

Journal of Clinical Oncology ◽

10.1200/jco.2002.09.097 ◽

2002 ◽

Vol 20 (9) ◽

pp. 2382-2387 ◽

Cited By ~ 265

Author(s):

S. Dudeney ◽

I.H. Lieberman ◽

M-K. Reinhardt ◽

M. Hussein

Keyword(s):

Multiple Myeloma ◽

Vertebral Body ◽

Short Form ◽

Bodily Pain ◽

Body Height ◽

Bone Destruction ◽

Cement Leakage ◽

Vertebral Compression Fractures ◽

Duration Of Symptoms ◽

Compression Fractures

PURPOSE: We prospectively evaluated the safety and efficacy of kyphoplasty in the treatment of osteolytic vertebral compression fractures resulting from multiple myeloma. The principle symptoms in multiple myeloma result from bone destruction, especially the spine. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps (IBT) into the vertebral body. The purpose of the IBT is to restore the vertebral body back toward its original height, while creating a cavity that can be filled with highly viscous bone cement. PATIENTS AND METHODS: Fifty-five consecutive kyphoplasty procedures were performed in 18 patients with osteolytic vertebral compression fractures resulting from multiple myeloma. Cement leakage and any complications were recorded. Early objective analysis was made by comparing preoperative and latest Short Form 36 Health Survey scores. Height restoration was estimated by measuring vertebral height on lateral radiographs. RESULTS: The mean age of patients was 63.5 years, mean duration of symptoms was 11 months, and mean follow-up was 7.4 months. There were no major complications related directly to use of this technique. On average, 34% of height lost at the time of fracture was restored. Asymptomatic cement leakage occurred at two (4%) of 55 levels. Significant improvement in SF36 scores occurred for Bodily Pain (23.2 to 55.4, P = .0008), Physical Function (21.3 to 50.6, P = .0010), Vitality (31.3 to 47.5, P = .010), and Social Functioning (40.6 to 64.8, P = .014). CONCLUSION: Kyphoplasty was efficacious in the treatment of osteolytic vertebral compression fractures resulting from multiple myeloma. Kyphoplasty is associated with early clinical improvement of pain and function as well as some restoration of vertebral body height.

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Unilateral Versus Bilateral Kyphoplasty for Osteoporotic Vertebral Compression Fractures

Advanced Materials Research ◽

10.4028/www.scientific.net/amr.393-395.1064 ◽

2011 ◽

Vol 393-395 ◽

pp. 1064-1068 ◽

Cited By ~ 1

Author(s):

Bin Zhang ◽

Min Dai ◽

Ya Min Tang

Keyword(s):

Vertebral Body ◽

Randomized Study ◽

Body Height ◽

Vertebral Compression Fractures ◽

Clinical Effects ◽

Osteoporotic Vertebral Compression Fractures ◽

Vertebral Body Height ◽

Compression Fractures ◽

Cement Extravasation

Study Design A retrospective study of patients who underwent kyphoplasty at a single institute. Objective To examine and compare the safety and long-term radiographic and clinical effects of unilateral or bilateral kyphoplasty to treat symptomatic vertebral compression fractures (VCF). Summary of Background Data Kyphoplasty (KP) involves placement of inﬂatable bone tamp via unilateral and bilateral approaches. Few randomized study comparing the radiographic and clinical outcomes using unilateral and bilateral approaches was reported. Methods 50 patients with osteoporotic vertebral compression fractures (VCF) were allocated into two groups adopting unilateral or bilateral kyphoplasty. Preoperative and postoperative pain scores, Vertebral body height were compared and analyzed. Results Both unilateral and bilateral kyphoplasty resulted in signiﬁcant pain reduction. Signiﬁcant increases of midline vertebral body height were recorded for both groups after surgery and maintained for the period of follow-up. Asymptomatic cement extravasation occurred in 8 of 50 patients, and 2 patients developed additional fractures at untreated levels during the period of follow-up. Conclusions Both unilateral and bilateral KP can improve clinical effects of osteoporotic VCF and result in signiﬁcant vertebral height restoration for at least 18 months after treatment.

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Tridimensional Study of the Vertebral Body in Osteoporotic Vertebral Fractures Treated with Percutaneous Vertebroplasty.

10.21203/rs.3.rs-598124/v1 ◽

2021 ◽

Author(s):

Jesús Payo-Ollero ◽

Rafael Llombart-Blanco ◽

Carlos Villas ◽

Matías Alfonso

Keyword(s):

Vertebral Body ◽

Sagittal Plane ◽

Percutaneous Vertebroplasty ◽

Body Height ◽

Three Dimensional ◽

Dimensional Structure ◽

Volume Loss ◽

Volume Percentage ◽

Post Surgery ◽

Osteoporotic Vertebral Fractures

Abstract Many studies analyze the increase in vertebral body height after percutaneous vertebroplasty (PVP) in the sagittal plane. However, the vertebral body is a three-dimensional structure. The aim of this study is to determine if there is a volume change in the vertebral body after PVP, and to determine possible differences according to the spine segment treated. This prospective study included 25 patients (51 vertebrae, BMI 26.4kg/m2, T-score − 2.6) treated with PVP. The volumetric study was performed with MRI pre and post-surgery. We studied the amount of injected cement, the volume of cement inside the vertebral body, the fractured vertebra volume, percentage of volume loss, percentage of volume restoration and percentage of bone filling. Thoracolumbar fractures predominated. The average volume of injected cement was 3.6ml (range, 0.9–6.5). The volume loss was 4.1±3.3ml (16.2%). In the vertebral body, there was an increase in volume after PVP (difference + 1.6±1.6ml, 95% CI 1.1–2.03). Volume restoration was 1.6±1.6ml. Percentage of bone cement filling was 13.3%±4.5. There were no differences between the spine segments treated (P > 0.05). PVP increases the volume of the fractured vertebra approximately 40% of the volume loss. The volumetric changes after PVP were similar in the different spine segments treated.

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