Investigation structural settlement by Ground Penetrating Radar (Case study)

Electromagnetic wave is transferred by the GPR (ground penetrating radar), and A geotechnical application may benefit from this non-destructive test. This study is proposed to estimate the type and soil problem location that causes differential settlement of a structure (pumping station) by GPR surveying. The survey is achieved before and after the treatment by cement injection method to identify the locations that took cement injections as a full injection, partial or not at all using two types of antennas (160,450) MHz. The study also will estimate the thickness of the foundation by GPR and comparing it with actually executed. The results showed the creeping soil has occurred in some parts of the soil under the foundation, and after soil treatment, most of these parts were taken injection, and others did not. Also, it was found the relatively high accuracy of GPR for detecting the thickness of the raft foundation.

Successful treatment of a symptomatic unicameral calcaneus bone cyst by cement injection using a double needle technique under CT guidance: a case report

Simple bone cysts (SBCs) are benign cavitary lesions which most commonly affect adolescent males in the first two decades of life. They are mainly asymptomatic, but can manifest with pain or pathological fractures. A 16-year old girl presented with an 8-day history of pain and swelling over the right calcaneal region. On local examination, tenderness was the only noteworthy sign and all routine laboratory tests conducted revealed normal results. Despite numerous proposed methods for the management of calcaneus SBCs, the optimal approach towards these lesions remains controversial. Here, a novel method utilizing a minimally invasive technique is proposed to successfully manage these lesions. In an outpatient setting, under conscious sedation, two interosseous needles were simultaneously inserted into the cyst under the guidance of CT fluoroscopy. Without aspiration, a radiopaque bone cement mixture was injected into the cyst from one needle until the cessation of serosanguineous fluid efflux from the second needle. Over a one-year follow-up period, the patient recovered without any complications. Bone cement injection using a double needle technique under CT fluoroscopy guidance is a feasible and safe method to treat symptomatic unicameral calcaneal bone cysts.

Effects of Bone Cement Distribution On Adjacent Endplates After Percutaneous Vertebroplasty For Thoracolumbar Fractures: A Finite Element Analysis

BACKGROUND: Percutaneous vertebroplasty (PVP) is a common surgical method for the treatment of thoracolumbar compression fractures. Currently, no biomechanical analysis has been performed examining the effects of cement distribution and positioning on the overall thoracolumbar range of motion (ROM) and the stress applied to adjacent endplates.METHODS: A model of PVP following vertebral compression fracture was established based on computed tomography data. Cement was injected into the T12 vertebral body. Depending on the location of the injection site, the model was divided into a median cement model, a left cement model, an upper-left cement model, and a lower-left cement model. The postoperative thoracolumbar ROM and biomechanical changes to the adjacent endplates were analyzed.RESULTS: After cement injection, the overall ROM for the thoracolumbar region increased compared with that before cement injection. The maximum ROM of flexion was 9.28° for the left model; the maximum ROM of extension was 10.90° for the upper-left model; the maximum left and right rotations were 8.47° and 8.52°, respectively, for the left model; the maximum left bending was 13.10° for the left model; and the maximum right bending was 13.43° for the left model. The stress applied to the adjacent vertebral endplate in the median cement model increased compared with the intact model, and the von Mises stress (VMS) value changed with different cement positions.CONCLUSION: After cement injection, the overall stress value of the endplate adjacent to the vertebral body increased, and when the position of the cement shifts, the maximum VMS increased further for some positions, and the stress value for the endplate adjacent to the vertebral body increased, which may cause fractures in the relative position.

Comparison of percutaneous curved kyphoplasty and bilateral percutaneous kyphoplasty in osteoporotic vertebral compression fractures: a randomized controlled trial

Background Here we compared the clinical efficacy of bilateral percutaneous kyphoplasty (PKP) and percutaneous curved kyphoplasty (PCKP) in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods Seventy-two patients with single-level thoracolumbar OVCF were randomly divided into 2 groups (36 patients in each) and were subjected to either PCKP or bilateral PKP. The intraoperative fluoroscopy time, total surgical time, bone cement injection volume, bone cement leakage, preoperative and postoperative anterior vertebral height, Cobb angles, visual analog scales (VAS) and oswestry disability index questionnaire (ODI) were recorded. Results Both groups of patients had a trend towards improvements in VAS and ODI scores 24 h and 6 months after surgery, when compared to preoperative results, despite lack of statistical significance. The total surgical and intraoperative fluoroscopy times and intraoperative bone cement injection volume were significantly decreased in the PCKP group than those in the PKP group. The anterior edge height and Cobb angle of the injured vertebra were similarly improved after operation in both groups. Conclusion PCKP is safer, less invasive and quicker than traditional bilateral PKP despite similar short-term effects for the treatment of OVCF. Trial registration ChiCTR, ChiCTR2100042859. Registered 25 January 2021- Retrospectively registered.

Clinical Observation of Intraosseous Anesthesia in Percutaneous Kyphoplasty

Objective. Percutaneous kyphoplasty (PKP) is an effective minimally invasive technique in spine surgery in recent years. General anesthesia and local anesthesia are the main ways of anesthesia in PKP, and epidural anesthesia is also applied to PKP to some extent. However, all these three anesthetic methods have their respective advantages and disadvantages. It is essential to compare and evaluate the effects of different anesthesia methods on PKP for treating spinal fractures. Method. A total of 45 patients (53 vertebral bodies were included) were divided into two groups. Group A included 24 patients (29 vertebral bodies) with an average of 71 years old and Group B included 21 patients (24 vertebral bodies) with an average of 74 years old. Visual analogue scale (VAS) scores were recorded preoperatively; balloon expansion and bone cement injection were conducted intraoperatively. Then, they were recorded immediately after operation, 6 h postoperatively, to assess the pain level of the patient. Moreover, hospitalization time (days), operation duration (minutes), and bone cement injection amount (mL) had also been recorded. Results. There was no significant difference in preoperative general information and VAS score. However, the VAS scores were statistically significant at both the moment of balloon expansion and injection of bone cement. At the moment of immediate postoperation, the VAS scores showed no statistically significant difference, while it showed a statistically significant difference 6 h postoperatively. Conclusion. The anesthesia method by injection of 1% lidocaine hydrochloride (5 ml) into vertebral body can effectively relieve patients’ pain in intraoperation and postoperation.

Image in medicine: Cement pulmonary embolism

A 65-year-old woman was treated for vertebroplasty (cement injection). 24 hours after the procedure, she complains chest pain. A CT scan was performed which revealed on the same image section the presence of highly radiopaque material in a right basal segmental artery the density of which is strictly identical to that of the cement of the treated vertebra (yellow arrows). This cement pulmonary embolism canot be disolved by an anticoagulant treatment.

Could lateral decubitus position improve the cement distribution of unilateral percutaneous kyphoplasty in patients with osteoporotic vertebral compression fracture?

Background: To determine the influence of lateral decubitus position on cement distribution of unilateral percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fracture (OVCF).Methods: A retrospective review was performed on patients who underwent PKP for OVCF at the Spine Department of our hospital between January 2016 and January 2020. Unilateral PKP were performed by the same senior spinal surgeon team under local anesthesia. Patients were divided into two group according to positions with injecting cement. Complete symptom and radiographic evaluation information were gathered from each patient since the initial presentation. Then, the radiographic and symptomatic indexes between two groups were compared.Results: There were 190 patients included in this study. Ninety-four patients used to receive cement injection in lateral decubitus position while 96 patients were in prone position. A significantly longer surgical time (28.7±4.5 min vs. 26.8±4.3min) and more cement volume (6.14±0.66ml vs. 5.69±0.69ml) were found in lateral decubitus group. And visual analogue scale (VAS) scores were significantly lower (p <0.05) in lateral decubitus group one week after surgery. Compared with prone group, lateral decubitus group showed a significantly higher proportion of grade III cement distribution (18.2% vs. 7.3%, p<0.05) and a significantly lower cement leakage rate (13.8% vs. 26%, p<0.05).Conclusion: It is possible that lateral decubitus position can improve cement distribution, relieve acute pain more and decrease leakage incidence in OVCF patients with unilateral PKP，although it might be slightly time-consuming. It was recommended that position could be switched to lateral decubitus position during cement injection for unilateral PKP, especially when extraversion angle was small.

Effects of Bone Cement Distribution on Adjacent Endplates After Percutaneous Vertebroplasty for Thoracolumbar Fractures: A Finite Element Analysis

BACKGROUND: Percutaneous vertebroplasty (PVP) is a common surgical method for the treatment of thoracolumbar compression fractures. Currently, no biomechanical analysis has been performed examining the effects of cement distribution and positioning on the overall thoracolumbar range of motion (ROM) and the stress applied to adjacent endplates.METHODS: A model of PVP following vertebral compression fracture was established based on computed tomography data. Cement was injected into the T12 vertebral body. Depending on the location of the injection site, the model was divided into a median cement model, a left cement model, an upper-left cement model, and a lower-left cement model. The postoperative thoracolumbar ROM and biomechanical changes to the adjacent endplates were analyzed.RESULTS: After cement injection, the overall ROM for the thoracolumbar region increased compared with that before cement injection. The maximum ROM of flexion was 9.28° for the left model; the maximum ROM of extension was 10.90° for the upper-left model; the maximum left and right rotations were 8.47° and 8.52°, respectively, for the left model; the maximum left bending was 13.10° for the left model; and the maximum right bending was 13.43° for the left model. The stress applied to the adjacent vertebral endplate in the median cement model increased compared with the intact model, and the von Mises stress (VMS) value changed with different cement positions.CONCLUSION: After cement injection, the overall stress value of the endplate adjacent to the vertebral body increased, and when the position of the cement shifts, the maximum VMS increased further for some positions, and the stress value for the endplate adjacent to the vertebral body increased, which may cause fractures in the relative position.

Percutaneous Curved Kyphoplasty in the Treatment of Thoracolumbar Osteoporotic Vertebral Compression Fractures: A Randomized Controlled Trial

Background To evaluate the clinical efficacy of percutaneous curved kyphoplasty (PCKP) in treating thoracic and lumbar osteoporotic vertebral compression fractures (OVCFs).Methods Seventy-two patients with single-level thoracolumbar OVCFs were recruited and randomly divided into two treatment groups: percutaneous curved kyphoplasty (PCKP), bilateral percutaneous kyphoplasty (PKP). Bone cement dispersion in the fractured vertebrae was observed. Surgery duration, X-ray frequency, bone cement injection volume, bone cement leakage rate, oswestry disability index questionnaire (ODI)，visual analogue scale (VAS) scores，Cobb angle, and vertebral height were recorded.Results Both groups of patients at postoperative 24h and 6 months in postoperative VAS score and ODI were compared with preoperative significant improvement, but no statistical difference between two groups; The operative time, intraoperative fluoroscopy times, intraoperative bone cement injection amount and intraoperative bone cement leakage in the PCKP group were significantly less than those in the traditional PKP group, and the differences were statistically significant. The anterior edge height and Cobb angle of the injured vertebra were significantly improved after operation in both groups, but the differences between the two groups were not statistically significant. Conclusion PCKP has the same short-term effect as traditional bilateral PKP in the treatment of elderly osteoporotic compression fractures, both of which can significantly relieve pain and improve life function. However, PCKP is associated with reduced trauma, less complicated surgery with shorter duration, fewer X-rays, lower complication rate, and quicker postoperative recovery versus traditional bilateral PKP.Trial registration: ChiCTR, ChiCTR2100042859. Registered 25 January 2021- Retrospectively registered, http://www.chictr.org.cn/ ChiCTR2100042859

Shape-memory balloon offering simultaneous thermo/chemotherapies to improve anti-osteosarcoma efficacy

This paper proposes a shape-memory balloon (SMB) to improve bone cement injection efficiency and postoperative thermo/chemotherapy for bone tumors.