scholarly journals Intra-Operative Complic atio n of Lumbar Kyphoplasty Instrumentatio n in Non-Osteoporotic Patients with Compression Fractures

2018 ◽  
pp. 221-226
Author(s):  
Calvin R. Chen
Keyword(s):  
Vertebral Body ◽  
Small Sample Size ◽  
Compression Fracture ◽  
Cord Compression ◽  
Distal Portion ◽  
Small Sample ◽  
Pain Clinic ◽  
Becton Dickinson ◽  
Compression Fractures ◽  
Instrumentation Failure

Background: Vertebral augmentation is a surgical procedure used to stabilize fractured vertebrae and reduce pain in patients with compression fractures. When intra-operative and post-operative complications do occur, they can have dire consequences. Some of the common risks associated with kyphoplasty are worsening of the fracture, infections, spinal cord compression, etc. Typically, we do not consider the risk of instrumentation failure. Objectives: In 2 cases, we describe patients who has undergone kyphoplasties with live fluoroscopic guidance. Both procedures used a unipedicular approach and the CareFusion system (Becton Dickinson, Franklin Lakes, NJ). The CareFusion AVAFlex curved augmentation needle was used, and intra-operatively the handle broke off at the neck making it difficult to remove the cannula and curved needle. To remove the system, an Arthrex Reamer (Arthrex Inc., Naples, NY).was used with Chuck Key (Arthrex Inc., Naples, NY). Study Design: Case report. Setting: Outpatient Interventional Pain Clinic. Methods: The vertebral body was accessed with an AVAFlex curved needle, a CareFusion AVAMax vertebral balloon, and Cement injection with polymethylmethacrylate, were used. The removal of the AVAFlex cannula was attempted with a gripping and pulling motion of the blue handle on the cannula, which resulted in the handle breaking at the most distal portion of the cannula. The cannula was then removed using the Arthrex Reamer with Chuck Key. The entire cannula was successfully removed from the vertebral body after cement had been delivered. Results: The density of bone tissue in a traumatic compression fracture of a nonosteoporotic individual will be higher and less porous when placing the needle and cannulas. Also, it is important to have an understanding of the different instruments that are available in the operative setting. Limitations: Small sample size. Conclusion: Instrumentation experience, understanding how to handle instrument failures, bone health of the patient, and the history of mechanism for compression fracture should all be considered when performing kyphoplasty. Key words: Kyphoplasty, vertebroplasty, compression fracture, instrumentation failure

scholarly journals The analgesic efficacy of extracorporeal shock wave combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures in postmenopausal women

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Xiaowei Liu ◽  
Hui Wang ◽  
Yang Zhang ◽  
Mingling Wang ◽  
Yujin Qiu ◽  
...  
Keyword(s):  
Shock Wave ◽  
Postmenopausal Women ◽  
Percutaneous Vertebroplasty ◽  
Reduction Rate ◽  
Compression Fracture ◽  
Analgesic Efficacy ◽  
Small Sample ◽  
Compression Fractures ◽  
Extracorporeal Shock Wave ◽  
Post Operation

Abstract Background To explore the analgesic efficacy of extracorporeal shock wave (ESW) combined with percutaneous vertebroplasty (PVP) after reduction in overextension position in the treatment of osteoporotic thoracolumbar compression fractures in postmenopausal women. Methods The data of postmenopausal women with osteoporotic thoracolumbar compression fracture admitted in our department from January 2017 to October 2019 were analyzed retrospectively. They were divided into groups of unipedicular percutaneous kyphoplasty (U-PKP n = 21), bipedicular PKP (B-PKP n = 20), and ESW combined with PVP after reduction in overextension position (EP-PVP n = 18). The improvement of pain and vertebral height in three groups was compared. Results Postoperative compression rate and Cobb angle of vertebral fractures in the three groups were all lower than those before surgery, and the differences between pre-operation and post-operation were statistically significant (P < 0.05). The visual analog scale (VAS) and Oswestry dysfunction index (ODI) scores of the three groups decreased significantly after the operation (P < 0.05). The ODI scores of the EP-PVP group in the third months after the operation were significantly improved compared with the other two groups, and the difference was statistically significant (P < 0.05). Conclusions In our small-sample study, all three treatment schemes can treat osteoporotic compression fracture of thoracolumbar vertebrae in postmenopausal women, relieve pain, and improve quality of life. ESW combined with PVP after reduction in overextension position could achieve a good vertebral reduction rate and improve kyphosis, and may reduce the application of analgesic drugs.

Kyphoplasty Technique for Thoraco-Lumbar Compression Fracture

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. 

MRI PATTERN OF VERTEBRAL FRACTURES DUE TO OSTEOPOROSIS, INFECTION, AND MALIGNANT TUMORS

2010 ◽  
Vol 13 (02) ◽  
pp. 57-63
Author(s):  
Mohamed El-Sayed Abdel-Wanis ◽  
Mohamed Tharwat Mahmoud Solyman ◽  
Nahla Mohamed Ali Hasan
Keyword(s):  
Vertebral Body ◽  
Vertebral Fractures ◽  
Malignant Tumors ◽  
Compression Fracture ◽  
Osteoporotic Fractures ◽  
Spinal Infection ◽  
Vertebral Compression Fractures ◽  
Vertebral Collapse ◽  
Compression Fractures ◽  
Vertebral Wedging

No previous studies discussed the significance of the MRI pattern of vertebral collapse in differentiation between vertebral compression fractures due to malignancy, osteoporosis, and infections. MRI was used in the evaluation of 152 atraumatic vertebral compression fractures in 80 patients: 85 malignant, 34 osteoporotic, and 33 infective. Central collapse of the fractured vertebral body was the commonest pattern in malignant fractures (57 vertebrae, 67%), followed by uniform collapse (21 vertebrae, 24.7%), then anterior wedging (5 vertebrae, 5.9%), and finally posterior wedging (2 vertebrae, 2.4%). In osteoporotic fractures, anterior wedging was the commonest pattern (18 vertebrae, 53%), followed by central collapse (11 vertebrae, 32.3%), then uniform collapse (4 vertebrae, 11.8%), and finally posterior wedging (1 vertebra, 2.9%). In vertebral compression fractures due to spinal infection, anterior wedging was the commonest pattern (20 vertebrae, 60.6%), followed by uniform collapse (12 vertebrae, 36.4%), while only one vertebra (3%) was centrally collapsed. Central collapse of the vertebral body is highly suggestive of malignant compression fracture while anterior vertebral wedging is highly suggestive of a benign compression fracture.

scholarly journals Radiculopathy Following Vertebral Body Compression Fracture: The Role of Percutaneous Cement Augmentation

2020 ◽  
Vol 3;23 (6;3) ◽  
pp. 315-323
Author(s):  
David Gimarc
Keyword(s):  
Cohort Study ◽  
Vertebral Body ◽  
Complete Resolution ◽  
Tertiary Care ◽  
Compression Fracture ◽  
Cement Augmentation ◽  
Common Symptom ◽  
Compression Fractures ◽  
Fracture Location ◽  
Relative Improvement

Background: Vertebral cement augmentation is a commonly used procedure in patients with vertebral body compression fractures from primary or secondary osteoporosis, metastatic disease, or trauma. Many of these patients present with radiculopathy as a presenting symptom, and can experience symptomatic relief following the procedure. Objectives: To determine the incidence of preprocedural radiculopathy in patients with vertebral body compression fractures presenting for cement augmentation, and present their postoperative outcomes. Study Design: Retrospective cohort study. Setting: Interventional pain practice in a tertiary care university hospital. Methods: In this cohort study, all patients who underwent kyphoplasty (KP) or vertebroplasty (VP) procedures in a 7-year period within our practice were evaluated through a search of the electronic medical records. The primary endpoint was to evaluate the prevalence of noncompressive preprocedural radiculopathy in our patients. Evaluation of each patient’s relative improvement following the procedure, respective to the initial presence or absence of radicular symptoms (including and above T10, above and below T10, and below T10) was included as a secondary endpoint. Additional subanalysis was performed with respect to patients demographics, fracture location, and primary indication for the procedure (osteoporosis, trauma, etc.). Results: A total of 302 procedures were performed during this time period, encompassing 544 total vertebral body levels. After exclusion criteria were applied to this cohort, 31.6% of patients demonstrated radiculopathy prior to the procedure that could not be explained by nerve impingement. Nearly half of patients demonstrated an optimal clinical outcome (48.5% nearly complete/complete resolution of symptoms, 40.1% partial resolution of symptoms, 11.4% little to no resolution of symptoms). Patients with fractures above T10 were more likely to see complete resolution, whereas patients with fractures above and below T10 were likely to not see any resolution. Men and women without initial radiculopathy symptoms were more likely to see little to no resolution, regardless of fracture location. Limitations: This retrospective study used an electronic chart review of clinicians’ notes to determine the presence of radiculopathy and their relative improvement following the procedure. Conclusions: Preprocedural radiculopathy is a common symptom of patients presenting for the evaluation of VP or KP. The presence of radiculopathy in the absence of nerve impingement may be an important marker for those patients who may experience greater benefit from the procedure. Key words: Radiculopathy, kyphoplasty, vertebroplasty, osteoporosis, compression fracture, spine, cement augmentation

scholarly journals Technical Strategies and Anatomic Considerations for an Extrapedicular Modified Inferior Endplate Access to Thoracic and Lumbar Vertebral Bodies

2016 ◽  
Vol 8;19 (8;11) ◽  
pp. 593-601
Author(s):  
Scott Burner
Keyword(s):  
Vertebral Body ◽  
Small Sample Size ◽  
Small Sample ◽  
Radiology Department ◽  
Vertebral Compression Fractures ◽  
Complication Rates ◽  
Cadaver Dissection ◽  
Percutaneous Access ◽  
Vertebral Bodies ◽  
Access Technique

Background: Percutaneous access to the vertebral bodies is commonly done via the transpedicular approach for both diagnoses and treatment of spinal pathology. While this approach is effective in most cases, it is difficult in certain situations such as a patient with obstructing hardware from prior surgery. Objectives: To investigate and illustrate an alternative to the typical percutaneous access to the vertebral body via an extrapedicular approach and to determine the complications associated with this approach. Study Design: Description of a novel percutaneous vertebral body access technique developed during cadaver dissection and a report of complication rates in cases that were performed using this technique. Setting: Radiology department at a private institution. Methods: An effective extrapedicular access technique that could safely and consistently allow the needle tip to be placed in the center of the vertebral body was developed from cadaver dissection observations for the purpose of clinical use. A total of 96 vertebral compression fractures from T5 to L5 were treated via the extrapedicular technique at our institution between July 2008 and August 2012. There were 72 patients between ages 27 and 98 (mean age 73.2 years) who underwent treatment. Results: Cadaver dissection revealed a relatively avascular and aneural portion of the inferior vertebral body just anterior to the pedicle. A total of 96 vertebral fractures were treated using the extrapedicular technique without any recognized clinical complications from the needle access or the instrumentation. Limitations: The trial included a relatively small sample size, representing 7.4 percent of total patients treated at our institution. This was likely the result of a smaller patient population with contraindications to typical transpedicular access. Conclusions: The thoracic and lumbar vertebral bodies may be accessed using a percutaneous extrapedicular access technique which represents a relatively avascular and aneural approach to the vertebral body. The technique presented allows access to the vertebral body around existing hardware and can accommodate the placement of large instruments. This technique was not associated with any known complications in our series of patients. Key words: Vertebral body, spine, extrapedicular, kyphoplasty, vertebroplasty, paraspinal, thoracic, lumbar

SURGICAL MANAGEMENT OF TRAUMATIC VERTEBRAL BODY COMPRESSION FRACTURE WITH CORD COMPRESSION IN A THALASSEMIC PATIENT. CASE REPORT

2021 ◽  
pp. 37-38
Author(s):  
Ashish Gupta ◽  
Rajesh Kumar Bharti ◽  
Bidyanand Kumar
Keyword(s):  
Spinal Cord ◽  
Vertebral Body ◽  
Rare Event ◽  
Compression Fracture ◽  
Extramedullary Hematopoiesis ◽  
Cord Compression ◽  
Spinal Decompression ◽  
Patient Case ◽  
Thalassemic Patient ◽  
Vertebral Body Compression Fracture

Extramedullary hematopoiesis associated with thalassemia causing spinal cord compression is a rare event in the course of the disease. Management of these patients remains controversial. We present a case of traumatic vertebral body compression fracture with cord compression in association with thalassemia, which was treated successfully with spinal decompression and fusion, xation using implants and bone graft.

VERTEBRAL COMPRESSION FRACTURES IN PATIENTS PRESENTING WITH METASTATIC EPIDURAL SPINAL CORD COMPRESSION

Neurosurgery ◽  
2009 ◽  
Vol 65 (2) ◽  
pp. 267-275 ◽  
Author(s):  
Kaisorn L. Chaichana ◽  
Courtney Pendleton ◽  
Jean-Paul Wolinsky ◽  
Ziya L. Gokaslan ◽  
Daniel M. Sciubba
Keyword(s):  
Spinal Cord ◽  
Regression Analysis ◽  
Vertebral Body ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Motor Deficit ◽  
Pathological Fractures ◽  
Compression Fractures ◽  
Ambulatory Status ◽  
Vertebral Body Fractures

Abstract OBJECTIVE Metastatic epidural spinal cord compression (MESCC) is a relatively common and debilitating complication of metastatic disease that often results in neurological deficits. Pathological fractures of the vertebral body in patients with MESCC are not uncommon. The goals of this study were to evaluate the effects of compression fractures on long-term neurological function, as well as understand the factors that predict the development of pathological fractures for patients with MESCC. METHODS One hundred sixty-two patients undergoing decompressive surgery for MESCC at an academic tertiary care institution from 1995 to 2007 were retrospectively reviewed. Multivariate proportional hazards regression analysis was used to assess the effects of pathological vertebral body fractures on ambulatory outcome, whereas multivariate logistical regression analysis was used to identify factors associated with preoperative compression fractures. RESULTS Sixty and 102 patients presented with and without pathological vertebral body fractures, respectively, and MESCC. Patients were followed for a mean of 9.7 ± 2.6 months. The presence of preoperative compression fractures was independently associated with decreased postoperative ambulatory status (odds ratio, 2.106; 95% confidence interval, 1.123–4.355; P = 0.03). This was independent of age, preoperative ambulatory status, preoperative motor deficit, duration of preoperative symptoms, immediate postoperative motor deficit, and lytic tumor appearance. The factors strongly associated with preoperative compression fractures in this study include lack of sensory deficits (P = 0.01), primary breast cancer (P = 0.008), anterior spine metastases (P = 0.005), thoracic spine involvement (P = 0.01), preoperative chemotherapy (P = 0.03), and, possibly, preoperative radiation therapy (P = 0.16). CONCLUSION The findings of this study may provide insight into risk stratifying as well as guiding surgical management for patients with MESCC.

scholarly journals Comparison of Rigid and Soft-Brace Treatments for Acute Osteoporotic Vertebral Compression Fracture: A Prospective, Randomized, Multicenter Study

2019 ◽  
Vol 8 (2) ◽  
pp. 198 ◽  
Author(s):  
Tsuyoshi Kato ◽  
Hiroyuki Inose ◽  
Shoichi Ichimura ◽  
Yasuaki Tokuhashi ◽  
Hiroaki Nakamura ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Back Pain ◽  
Outcome Measures ◽  
Vertebral Body ◽  
Compression Fracture ◽  
Secondary Outcome ◽  
Vertebral Compression Fractures ◽  
Brace Treatment ◽  
Compression Fractures

While bracing is the standard conservative treatment for acute osteoporotic compression fracture, the efficacy of different brace treatments has not been extensively studied. We aimed to clarify and compare the preventive effect of the different brace treatments on the deformity of the vertebral body and other clinical results in this patient cohort. This multicenter nationwide prospective randomized study included female patients aged 65–85 years with acute one-level osteoporotic compression fractures. We assigned patients within four weeks of injury to either a rigid-brace treatment or a soft-brace treatment. The main outcome measure was the anterior vertebral body compression percentage at 48 weeks. Secondary outcome measures included scores on the European Quality of Life-5 Dimensions (EQ-5D), visual analog scale (VAS) for lower back pain, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). A total of 141 patients were assigned to the rigid-brace group, whereas 143 patients were assigned to the soft-brace group. There were no statistically significant differences in the primary outcome and secondary outcome measures between groups. In conclusion, among patients with fresh vertebral compression fractures, the 12-week rigid-brace treatment did not result in a statistically greater prevention of spinal deformity, better quality of life, or lesser back pain than soft-brace.

scholarly journals Treatment of Old Vertebral Compression Fracture With Kyphosis by Different Reconstruction Methods: a Finite Element Analysis

2020 ◽  
Author(s):  
Han Ye ◽  
Wang Xiaodong ◽  
Wu Jincheng ◽  
Xu Hanpeng ◽  
Zhang Zepei ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Vertebral Body ◽  
Compression Fracture ◽  
Vertebral Compression Fractures ◽  
Lateral Bending ◽  
Short Segment ◽  
Compression Fractures ◽  
Reconstruction Methods ◽  
Short Segment Fixation ◽  
Vertebral Resection

Abstract Background: In repair of vertebral compression fractures, there is a lack of effective biomechanical verification as to whether only half of the vertebral body and the upper and lower intervertebral discs has any effect on spinal biomechanics; there also remains debate as to the appropriate length of fixation.Methods: A model of old vertebral compression fractures with kyphosis was established based on CT data. Vertebral column resection (VCR) and posterior unilateral vertebral resection and reconstruction (PUVCR) were performed at T12; long- and short-segment fixation methods were applied, and we analyzed biomechanical changes after surgery.Results: Range of motion (ROM) decreased in all fixed models, with lumbar VCR decreasing the most and short posterior unilateral vertebral resection and reconstruction (SPUVCR) decreasing the least; in the long posterior unilateral vertebral resection and reconstruction (LPUVCR) model, the internal fixation system produced the maximum VMS stress of 213.25 MPa in a lateral bending motion, and a minimum stress of 40.22 MPa in a lateral bending motion in the SVCR.Conclusion: There was little difference in thoracolumbar ROM between PUVCR and VCR models, while thoracolumbar ROM was smaller in long-segment fixation than in short-segment fixation. In all models, the VMS was greatest at the screw-rod junction and greatest at the ribcage–vertebral body interface, which partly explains the high probability of internal fixation failure and prosthesis migration in these two positions.

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

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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