Clinical Application of a 3D-Printed Positioning Module and Navigation Template for Percutaneous Vertebroplasty

Background This study aimed to evaluate a personalized 3D-printed percutaneous vertebroplasty positioning module and navigation template based on preoperative CT scan data that was designed to treat patients with vertebral compression fractures caused by osteoporosis. Methods A total of 22 patients with vertebral compression fractures admitted to our hospital were included in the study. Positioning was performed with the new 3D-printed positioning module, and the navigation template was used for patients in the experimental group, and the traditional perspective method was used for patients in the control group. The experimental group consisted of 11 patients, 2 males and 9 females, with a mean age of 67.27 ± 11.86 years (range: 48 to 80 years), and the control group consisted of 11 patients, 3 males and 8 females, with a mean age of 74.27 ± 7.24 years (range: 63 to 89 years). The puncture positioning duration, number of intraoperative fluoroscopy sessions, and preoperative and postoperative visual analog scale (VAS) scores were statistically analyzed in both groups. Results The experimental group had shorter puncture positioning durations and fewer intraoperative fluoroscopy sessions than the control group, and the differences were statistically significant (P < .05). There were no significant differences in age or preoperative or postoperative VAS scores between the two groups (P > .05). Conclusions The new 3D-printed vertebroplasty positioning module and navigation template shortened the operation time and reduced the number of intraoperative fluoroscopy sessions. It also reduced the difficulty in performing percutaneous vertebroplasty and influenced the learning curve of senior doctors learning this operation to a certain degree.

Multilevel percutaneous vertebroplasty: safety, efficacy and long-term outcomes

<p><strong>Background:</strong> The pain in vertebral compression fractures is severe, leading to reduced mobility and quality of life. Percutaneous vertebroplasty is a minimally invasive procedure for treating various spinal pathologies. This study evaluated the usefulness and safety of multilevel PVP (two to three vertebrae) in managing VCF.</p><p><strong>Methods:</strong> This retrospective study evaluated 59 vertebral levels in 28 patients with VCF who had been operated on for multilevel PVP (two to three levels). There were 22 females and six males, and their ages ranged from 36 to 79 years, with a mean age of 68.95 years. We had injected two levels in 25 patients and three levels in 3 patients. The visual analogue scale was used for pain intensity measurement, and plain X-ray films, computed tomography scan and magnetic resonance imaging was used for radiological assessment. The mean follow-up period was 13.8 months (range, 11-19).</p><p><strong>Results:</strong> Significant pain improvement was recorded in 26 patients (92.85%). More remarkable improvement in pain was noticed in the immediate postoperative period than in the subsequent follow-ups. Asymptomatic bone cement leakage anteriorly and into the disk spaces in two patients. Isolated anterior leakage has occurred in one patient. There was no encounter of pulmonary embolism.</p><p><strong>Conclusions:</strong> Multilevel PVP for the treatment of VCF is a safe and effective procedure that can significantly reduce pain and improve patient condition without any significant morbidity. It is considered a cost-effective procedure allowing a rapid restoration of patient mobility.</p><p> </p>

Polymethylmethacrylate-augmented Cannulated Pedicle Screw Fixation for High-energy Vertebral Compression Fracture with Osteoporosis

Background: High-energy vertebral compression fractures (HVCFs) with osteoporosis puts forward higher requirement for the stability of pedicle screw internal fixation system. However, few studies have concentrated on the clinical outcomes of cannulated pedicle screw to augment fixation with polymethylmethacrylate (PMMA) under this condition. This study aims to investigate the mid-term efficacy of bone cement-injectable cannulated pedicle screw (CICPS) in HVCFs with osteoporosis.Methods: Eighteen patients with HVCFs (T < -2.5) were underwent spinal fixation by CICPS from 2012 to 2017. The operation time, blood loss, and hospitalization time were recorded. Pain and functional recovery were evaluated by Visual Analog Scale VAS) and Oswestry Disability Index (ODI), respectively. X-ray films were taken to evaluate the loss of vertebral height, kyphosis angle, pedicle screw loosening, and bony fusion. Surgical related complications were also recorded.Results: The average follow-up time was 18.5 ± 8.7 months (range, 6-54 months). VAS and ODI scores indicated significant improvements in postoperative pain and activity function (P < 0.05). Comparing the last follow-up with the postoperative imaging findings, the loss of vertebral height and kyphosis angle was 3.4 ± 1.2 mm and 7.8 ± 3.8°, respectively. The rate of bone graft fusion was 100% while no case was involved in screw loosening or extraction. 1 case of superficial infection, 2 cases of PMMA leakage, and 1 case of cerebrospinal fluid leakage were found.Conclusions: CICPS fixation using PMMA augmentation may be suggested as a feasible surgical technique in osteoporotic patients with HVCFs.

Characteristics of Lumbar Bone Density in Middle-Aged and Elderly Subjects: A Correlation Study between T-Scores Determined by the DEXA Scan and Hounsfield Units from CT

Purpose. To describe the characteristics of lumbar bone density in middle-aged and elderly subjects and explore whether there is a correlation between computed tomography (CT) values and the bone mineral density (BMD) T-scores of the lumbar vertebral cancellous bone. Methods. Forty-two subjects, including 25 males and 17 females, with a mean age of 56 years, who underwent BMD measurement and lumbar multislice spiral CT scan at the China Rehabilitation Research Center from January 2019 to December 2019 were selected. Dual-energy X-ray absorptiometry (DEXA) was applied to obtain the total BMD T-scores of the lumbar L1–L4 vertebrae. Results. The CT values decreased from L1 to L4 and were 145.91 ± 8.686 HU, 143.18 ± 8.598 HU, 137.39 ± 8.276 HU, and 135.23 ± 8.219 HU, respectively. The total CT value of L1–L4 was 140.43 ± 4.199 HU. The mean total BMD T-score of L1–L4 was −0.94. The CT values of the L1–L4 vertebrae were positively correlated with the total BMD T-scores of L1–L4 (r = 0.349, P < 0.001 ). The CT value of the left third of the same vertebrae was the highest, and there was a strong positive correlation between the regional CT value of the lumbar spine and the entire vertebra CT values (r > 0.7). Conclusion. The CT values of the lumbar spine can assist the measurement of the T-scores of lumbar BMD, which could aid in early opportunistic screening for osteopenia and preventing osteoporosis and vertebral compression fractures in middle-aged and elderly subjects. This trial is registered with ChiCTR2100049571.

Machine Learning Applications for the Prediction of Bone Cement Leakage in Percutaneous Vertebroplasty

Background: Bone cement leakage is a common complication of percutaneous vertebroplasty and it could be life-threatening to some extent. The aim of this study was to develop a machine learning model for predicting the risk of cement leakage in patients with osteoporotic vertebral compression fractures undergoing percutaneous vertebroplasty. Furthermore, we developed an online calculator for clinical application.Methods: This was a retrospective study including 385 patients, who had osteoporotic vertebral compression fracture disease and underwent surgery at the Department of Spine Surgery, Liuzhou People's Hospital from June 2016 to June 2018. Combing the patient's clinical characteristics variables, we applied six machine learning (ML) algorithms to develop the predictive models, including logistic regression (LR), Gradient boosting machine (GBM), Extreme gradient boosting (XGB), Random Forest (RF), Decision Tree (DT) and Multilayer perceptron (MLP), which could predict the risk of bone cement leakage. We tested the results with ten-fold cross-validation, which calculated the Area Under Curve (AUC) of the six models and selected the model with the highest AUC as the excellent performing model to build the web calculator.Results: The results showed that Injection volume of bone cement, Surgery time and Multiple vertebral fracture were all independent predictors of bone cement leakage by using multivariate logistic regression analysis in the 385 observation subjects. Furthermore, Heatmap revealed the relative proportions of the 15 clinical variables. In bone cement leakage prediction, the AUC of the six ML algorithms ranged from 0.633 to 0.898, while the RF model had an AUC of 0.898 and was used as the best performing ML Web calculator (https://share.streamlit.io/liuwencai0/pvp_leakage/main/pvp_leakage) was developed to estimate the risk of bone cement leakage that each patient undergoing vertebroplasty.Conclusion: It achieved a good prediction for the occurrence of bone cement leakage with our ML model. The Web calculator concluded based on RF model can help orthopedist to make more individual and rational clinical strategies.