BIOMECHANICAL EVALUATION OF LOW-MODULUS BONE CEMENT FOR ENHANCING APPLICABILITY IN VERTEBROPLASTY — AN EXPERIMENTAL STUDY IN PORCINE MODEL

2018 ◽  
Vol 30 (01) ◽  
pp. 1850002
Author(s):  
Mu-Yi Liu ◽  
Po-Liang Lai ◽  
Ching-Lung Tai
Keyword(s):  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Cement Augmentation ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Vertebral Height ◽  
Compression Fractures ◽  
Significant Difference ◽  
Compression Stiffness ◽  
Low Modulus

Polymethylmethacrylate (PMMA) bone cement has been widely used in vertebroplasty to treat osteoporotic vertebral compression fracture. However, the high compression stiffness of PMMA is suspected to induce adjacent vertebral fracture following vertebroplasty. In the current study, modified low-modulus cement was prepared by combining PMMA with castor oil to solve this problem. The percentage of height recovery and compression stiffness of vertebral bodies was compared after injection of standard PMMA or low-modulus cement. This study aims to investigate whether low-modulus cement is as effective as standard PMMA for storing the initial vertebral height; while lowering the compression stiffness in treatment of osteoporotic vertebral compression fractures. A total of 20 fresh porcine lumbar vertebrae were assigned into two groups (10 per group): standard and low-modulus. All specimens received a four-week decalcification to mimic human osteoporotic vertebrae. The standard and low-modulus groups received a simulated compression fracture followed by treatment of standard and low-modulus cement augmentation, respectively. The low-modulus cement was prepared by combining standard PMMA with 15% weight fractions of castor oil. For all the 20 specimens, vertebral compression fracture was created by reducing the vertebral height of 25% using a material testing machine. The compression stiffness determined from the creation of compression fracture was defined as the intact group (20 specimens). The fractured vertebrae were then treated with standard and low-modulus cement augmentation. The vertebral height was measured pre- and post-treatment, and the percentage of vertebral height recovery was compared between two cementing groups. Following cement augmentation, axial compression test was conducted to compare compression stiffness among three groups. The results indicated that there is no significant difference in percentage of vertebral height between standard (83.42[Formula: see text][Formula: see text][Formula: see text]11.60%) and low-modulus (88.50[Formula: see text][Formula: see text][Formula: see text]6.15%) groups ([Formula: see text]). Moreover, the compression stiffnesses were 1166.49[Formula: see text][Formula: see text][Formula: see text]392.91 N/mm, 1795.85[Formula: see text][Formula: see text][Formula: see text]247.45[Formula: see text]N/mm and 1362.57[Formula: see text][Formula: see text][Formula: see text]236.92[Formula: see text]N/mm for intact, standard and low-modulus groups, respectively. There is significant difference among three groups ([Formula: see text]). We concluded that the modified low-modulus cement is as effective as standard PMMA for storing the initial vertebral height while lowering the compression stiffness in treatment of osteoporotic vertebral compression fractures. These reduce the risks of adjacent vertebral body fracture following vertebroplasty.

scholarly journals Unilateral curved versus bipedicular vertebroplasty in the treatment of osteoporotic vertebral compression fractures

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Rui Zhong ◽  
Jianheng Liu ◽  
Runsheng Wang ◽  
Yihao Liu ◽  
Binbin Chen ◽  
...  
Keyword(s):  
Compression Fracture ◽  
Operation Time ◽  
Cement Leakage ◽  
Leakage Rate ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Significant Difference ◽  
Vas Scores ◽  
Postoperative Improvement

Abstract Background Vertebral compression fracture is one of the most common complications of osteoporosis. In this study an unilateral curved vertebroplasty device was developed, and the safety, effectiveness, and surgical parameters of curved vertebroplasty (CVP) in the treatment of painful osteoporotic vertebral compression fractures was investigated and compared with traditional bipedicular vertebroplasty (BVP). Methods We investigated 104 vertebral augmentation procedures performed over 36 months. CVP and BVP procedures were compared for baseline clinical variables, pain relief (Visual Analog Scale, VAS), disability improvement (Oswestry Disability Index, ODI), operation time, number of fluoroscopic images, volume of cement per level, and cement leakage rate for each level treated. Complications and refracture incidence were also recorded in the two groups. Results The VAS and ODI in both group had no significant difference preoperative (P > 0.05), and a significant postoperative improvement in the VAS scores and ODI was found in both group (P < 0.001). However, the CVP group had significantly lower operation time, number of fluoroscopic images, and cement leakage rate per level than the BVP group (P < 0.05); however, the volumes of cement per level were similar in the two groups (P > 0.05). Neither group had any serious complications. Five and two patients in the BVP group developed refractures at non-adjacent and adjacent levels, respectively, with one patient developing refractures twice; however, none of the patients in the CVP group developed refractures at any level. Conclusions Our findings revealed that both CVP and BVP were safe and effective treatments for osteoporotic vertebral compression fractures, and CVP entails a shorter operation time, less exposure to fluoroscopy, and lower rate of cement leakage.

scholarly journals Risk Factors for Refracture following Primary Osteoporotic Vertebral Compression Fractures

2021 ◽  
pp. E335-E340
Author(s):  
Weihua Cai
Keyword(s):  
Risk Factors ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Hounsfield Units ◽  
Secondary Fracture ◽  
Compression Fractures ◽  
Fracture History ◽  
Primary Fracture

Background: In the aging population, osteoporosis and related complications have become a global public health problem. Osteoporotic vertebral compression fractures are among the most common type of osteoporotic fractures and patients are at risk of secondary vertebral compression fracture. Objectives: To identify risk factors for secondary vertebral compression fracture following primary osteoporotic vertebral compression fractures. Study Design: Retrospective study. Setting: Department of Orthopedic, an affiliated hospital of a medical university. Methods: This retrospective cohort study evaluated the risk factors for secondary vertebral compression fracture in 317 consecutive patients with systematic osteoporotic vertebral compression fractures who received percutaneous vertebroplasty and kyphoplasty or conservative treatment. Patients were divided into secondary vertebral compression fracture (n = 43) and non- secondary vertebral compression fracture (n = 274) groups. We retrospectively analyzed clinical characteristics and radiographic parameters, including gender, age, body mass index, number of primary fractures, primary treatment (percutaneous vertebroplasty and kyphoplasty or conservative treatment), nonspinal fracture history before primary fracture, primary fracture at the thoracolumbar junction, steroid use, bisphosphonate therapy, and Hounsfield units value of L1. Results: Comparison between the groups showed significant differences in age (P = 0.001), nonspinal fracture history (P < 0.001), and Hounsfield units value of L1 (P < 0.001). The receiver operating characteristic curves demonstrated that the optimal thresholds for age and Hounsfield units value of L1 were 75 (sensitivity: 55.8%; specificity: 67.5%) and 50 (sensitivity: 88.3%; specificity: 67.4%), respectively. In multivariate logistic regression analysis, nonspinal fracture history (OR = 6.639, 95% CI = 1.809 – 24.371, P = 0.004) and Hounsfield units value of L1 < 50 (OR = 15.260, 95% CI = 6.957 – 33.473, P < 0.001) were independent risk factors for secondary vertebral compression fracture. Limitations: The main limitation is the retrospective nature of this study. Conclusion: Patients with low Hounsfield units value of L1 or non-spinal fracture history are an important population to target for secondary fracture prevention. Key words: Risk factor, vertebral, secondary fracture, osteoporosis

scholarly journals Kyphoplasty for the treatment of an atypical osteoporotic vertebral compression fracture of the lumbar spine: A case report

2017 ◽  
Vol 5 ◽  
pp. 2050313X1774498
Author(s):  
Sanjeev Kumar ◽  
Leon Anijar ◽  
Rishi Agarwal
Keyword(s):  
Older Patients ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Osteoporotic Vertebral Compression Fracture ◽  
Vertebral Compression Fractures ◽  
Clinical Scenario ◽  
Vertebral Augmentation ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Lumbar Vertebral Body

Vertebral augmentation is a minimally invasive but sometimes technically challenging intervention typically reserved for the treatment of older patients with painful vertebral compression fractures due to osteoporosis or neoplasms. We report the successful treatment of osteoporotic vertebral compression fractures of the first lumbar vertebral body (L1) using kyphoplasty in a paraplegic young patient with multiple comorbidities. Despite the unusual and complicated clinical scenario, kyphoplasty was nonetheless performed with immediate and lasting pain relief.

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.

Closed reduction vertebroplasty for the treatment of osteoporotic vertebral compression fractures

2004 ◽  
Vol 100 (4) ◽  
pp. 392-396 ◽  
Author(s):  
Shih-Tseng Lee ◽  
Jyi-Feng Chen
Keyword(s):  
Closed Reduction ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Osteoporotic Vertebral Compression Fracture ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Kyphotic Angle ◽  
Content Type ◽  
Compression Fractures ◽  
Fine Print

✓ The purpose of this study was to determine the efficacy and feasibility of closed reduction vertebroplasty for the treatment of osteoporotic vertebral compression fractures. Two hundred consecutive patients (183 women and 17 men) with single-level osteoporotic vertebral compression fracture were included in this study. After induction of general anesthesia, the patient was placed prone on an operating table. Closed reduction of the fractured and kyphotic spine was achieved by extending the table to restore the kyphotic angle and vertebral body (VB) height. Percutaneous vertebroplasty was then performed to treat the fractured vertebra. The results were quantitatively evaluated, according to the concept of estimated VB height. The anterior, middle, and posterior VB heights of the fractured vertebra were measured preoperatively and immediately after surgery by studying plain standing lateral radiographs. In 162 (81%) of the compression fractures the anterior VB height was restored (57.1 ± 24.8% of lost anterior VB height); in 152 (76%) of the compression fractures the middle VB height was restored (61.4 ± 20.6% of lost middle VB height); and in 52 (26%) of the compression fractures the posterior VB height was restored (51.3 ± 23.1% of lost posterior VB height). In 141 (71.5%) of the compression fractures kyphosis was corrected by 12.5 ± 3.8° [mean 61.6 ± 23.7%]). Closed reduction vertebroplasty is an efficacious and simple method in the treatment of osteoporotic vertebral compression fracture and was able to restore the VB height and kyphotic angle in postions of fractured vertebrae. Its associated, long-term effects on treated vertebrae, however, need further evaluation.

EVALUATION OF SHORT AND LONG TERM BENEFITS/SIDE EFFECTS OF CEMENT AUGMENTATION IN PATIENTS WITH NON INFECTIVE PATHOLOGICAL OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES

2020 ◽  
pp. 44-48
Author(s):  
Abhay Singh ◽  
Rahul Gupta ◽  
Shachi Shachi
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Pain Relief ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Cement Augmentation ◽  
Vertebral Compression Fractures ◽  
Hybrid Technique

BACKGROUND: Vertebral compression fracture usually occurs in old age population with osteoporosis. Due to severity of pain, quality of life becomes very poor. During the study period 67 patients fullling the eligibility cri METHODS: teria underwent vertebroplasty/ kyphoplasty/ cement augmented screw xation/ hybrid procedures were included. Short term and long term benets /side effects were evaluated in all patients. Patients were evaluated on visual analogue score and modied ranking scale. RESULTS: Vertebroplasty was performed in 26(38.8%) whereas kyphoplasty, cement augmented screw xation and hybrid procedure were performed in 18(26.8%), 17(25.4%) and 6(9.0%) respectively. Signicant pain relief occurred in all patients which were evaluated by Visual Analogue Scale. Quality of life also improved which was evaluated with Modied Rankin Scale. In our study, complications which occurred were local cement leak, hematoma formation, infection in 8 (11.9%), 3(4.5%) and 2(3.0%) patients respectively. Use of biological cement has revolutionized CONCLUSION: the management of vertebral compression fracture. Both vertebroplasty and kyphoplasty procedures which are minimal invasive, almost cure the non infective pathological fractures with instant pain relief and very low procedure related morbidity. In cases requiring xation, cement augmentation signicantly improves the purchase of the screw and makes the construct more reliable. Hybrid technique helps to prevent extensive long level xation.

scholarly journals Innovative Spine Implants for Improved Augmentation and Stability in Neoplastic Vertebral Compression Fracture

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 426 ◽  
Author(s):  
Cornelis ◽  
Joly ◽  
Nouri-Neuville ◽  
Ben-Ammar ◽  
Kastler ◽  
...  
Keyword(s):  
Vertebral Compression Fracture ◽  
Clinical Performance ◽  
Compression Fracture ◽  
Treatment Decision ◽  
Definitive Treatment ◽  
Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Good Pain Relief ◽  
Severe Back Pain ◽  
And Function

Background and objectives: Tumor-related vertebral compression fractures often result in severe back pain as well as progressive neurologic impairment and additional morbidities. The fixation of these fractures is essential to obtain good pain relief and to improve the patients’ quality of life. Thus far, several spine implants have been developed and studied. The aims of this review were to describe the implants and the techniques proposed to treat cancer-related vertebral compression fractures and to compile their safety and efficacy results. Materials and Methods: A systematic MEDLINE/PubMed literature search was performed, time period included articles published between January 2000 and March 2019. Original articles were selected based on their clinical relevance. Results: Four studies of interest and other cited references were analyzed. These studies reported significant pain and function improvement as well as kyphotic angle and vertebral height restoration and maintain for every implant and technique investigated. Conclusions: Although good clinical performance is reported on these devices, the small numbers of studies and patients investigated draw the need for further larger evaluation before drawing a definitive treatment decision tree to guide physicians managing patients presenting with neoplastic vertebral compression fracture.

scholarly journals Analysis of two minimally invasive procedures for osteoporotic vertebral compression fractures with intravertebral cleft: a systematic review and meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Hongyu Wei ◽  
Chunke Dong ◽  
Yuting Zhu ◽  
Haoning Ma
Keyword(s):  
Meta Analysis ◽  
Operation Time ◽  
Cement Leakage ◽  
Vertebral Compression Fractures ◽  
Controlled Trials ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Vertebral Height ◽  
Compression Fractures ◽  
Short And Long Term

Abstract Background A systematic review and meta-analysis to assess the pros and cons of percutaneous vertebroplasty (PVP) versus kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral cleft (IVC) including all available evidence from controlled trials. Methods Databases including Pubmed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched to identify relevant studies comparing PVP and PKP for OVCFs with IVC. The outcomes mainly included visual analog scale (VAS), Oswestry Disability Index (ODI), local kyphotic angle (LKA), rate of vertebral height (VH%), and adverse events. Results Nine studies enrolling 688 patients were eligible for meta-analysis. The results indicated no significant differences between the two groups in the short-and long-term VAS, ODI, LKA, or VH% (P > 0.05). Compared with PVP, PKP was associated with significantly longer operation time (P < 0.05), higher cost (P > 0.05), and more injected cement volume (P < 0.05). In terms of adverse events, PKP has a lower risk of cement leakage (P < 0.05), while with no significant difference in adjacent-level fracture rates (P > 0.05). Conclusion The two procedures have similar short- and long-term pain relief, functional recovery, local kyphosis correction, and vertebral height maintenance in OVCFs with IVC. PKP is superior to PVP for the injected cement volume, and lower cement leakage rate, however, with longer operation time, more fluoroscopy times, and higher cost. Further randomized controlled trials (RCTs) should be conducted to confirm these results.

scholarly journals Poly(methyl methacrylate) bone cement composited with mineralized collagen for osteoporotic vertebral compression fractures in extremely old patients

2020 ◽  
Vol 7 (1) ◽  
pp. 29-34
Author(s):  
Kefeng Luo ◽  
Guoqiang Jiang ◽  
Jinjin Zhu ◽  
Bin Lu ◽  
Jiye Lu ◽  
...  
Keyword(s):  
Methyl Methacrylate ◽  
Bone Cement ◽  
Vertebral Compression Fractures ◽  
Pure Pmma ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Vertebral Height ◽  
Poly Methyl Methacrylate ◽  
Compression Fractures ◽  
Pmma Bone Cement ◽  
Mineralized Collagen

Abstract To examine the clinical effects of a new bone cement composed of poly(methyl methacrylate) (PMMA) and mineralized collagen (MC) compared with pure PMMA bone cement in treating osteoporotic vertebral compression fractures (OVCFs) in patients aged over 80. In all, 32 cases using pure PMMA bone cement and 31 cases using MC-modified PMMA (MC-PMMA) bone cement for OVCFs between June 2014 and March 2016 were screened as PMMA group and MC-PMMA group, respectively, with an average age of over 80. The operation duration, intraoperative blood loss, hospital stay, oswestry disability index (ODI), visual analogue scale (VAS), anterior vertebral height (AVH), intermediate vertebral height (IVH) and posterior vertebral height (PVH) of injured vertebrae, vertebral computed tomography value, re-fracture rate of adjacent vertebrae, correction rate of spinal kyphotic angle and wedge-shaped vertebra angle and surgical complications were compared between the two groups. In the early post-operative period, the VAS, ODI, AVH and IVH in MC-PMMA group were comparable to those in the traditional PMMA group. Moreover, the MC-PMMA group showed better effects compared with the PMMA group 12 months after surgery. Thus, this new bone cement has superior clinic effects in the long term.

scholarly journals Kyphoplasty for occult and non-occult osteoporotic vertebral fractures: a retrospective study

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051989476
Author(s):  
Zhangzhe Zhou ◽  
Zhiyong Sun ◽  
Yimeng Wang ◽  
Xiaoyu Zhu ◽  
Zhonglai Qian
Keyword(s):  
Vertebral Fractures ◽  
Operative Time ◽  
Fluoroscopy Time ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Vertebral Height ◽  
Injection Volume ◽  
Compression Fractures ◽  
Cement Injection ◽  
Osteoporotic Vertebral Fractures

Objective To compare the safety and efficacy of kyphoplasty in the treatment of occult and non-occult osteoporotic vertebral compression fractures (OOVF). Material and Methods From 2015 to 2017, 82 OOVF and 105 non-occult osteoporotic vertebral compression fractures (N-OOVF) were evaluated with the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and vertebral height preoperatively, immediately postoperatively, and one year postoperatively. Operative time, fluoroscopy time, and cement injection volume were recorded. Results Compared with the preoperative VAS and ODI scores, the scores of both groups were significantly improved after surgery. Preoperative ODI and VAS scores of the OOVF were lower than those of the N-OOVF. The operative time, fluoroscopy time, and bone cement injection volume of the OOVF were significantly lower than those of the N-OOVF. Vertebral height of the N-OOVF improved significantly after surgery. There were differences in cement leakage and adjacent vertebral fractures between the two groups. Conclusion Compared with N-OOVF, OOVF are safer with kyphoplasty, and it is necessary to diagnose OOVF in a timely manner.

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