Factors influencing acute pain after percutaneous vertebroplasty in patients with thoracolumbar fractures and its predictive model creation and validation

Vertebral compression fractures in patients under treatment with denosumab: a contraindication for percutaneous vertebroplasty?

Risk Factors for New Vertebral Fractures after Percutaneous Vertebroplasty in Patients with Osteoporosis: A Prospective Study

We aimed to assess the effectiveness, benefits, and reliability of percutaneous vertebroplasty (PV) in patients with vertebral involvement of multiple myeloma. PV procedures performed on 166 vertebrae of 41 patients with multiple myeloma were retrospectively evaluated. Most of our patients were using level 3 (moderate to severe pain) analgesics. Magnetic resonance imaging was performed before the procedure to assess vertebral involvement of multiple myeloma. The following variables were evaluated: affected vertebral levels, loss of vertebral body height, polymethylmethacrylate (PMMA) cement amount applied to the vertebral body during PV, PMMA cement leakages, and pain before and after PV as assessed by a visual analogue scale (VAS). Median VAS scores of patients decreased from 9 one day before PV, to 6 one day after the procedure, to 3 one week after the procedure, and eventually to 1 three months after the procedure (P < 0.001). During the PV procedure, cement leakage was observed at 68 vertebral levels (41%). The median value of PMMA applied to the vertebral body was 6 mL. Being a minimally invasive and easily performed procedure with low complication rates, PV should be preferred for serious back pain of multiple myeloma patients.

This study retrospectively analysed the results of biopsies obtained during percutaneous vertebroplasty (PVP) in patients with presumed osteoporotic vertebral compression fractures, with a view to highlighting the importance of coaxial biopsy in determining the aetiology of vertebral fractures and planning subsequent treatment. Between November 2003 and March 2009, 98 patients (78 women; 20 men) with a clinical and imaging suspicion of osteoporotic vertebral compression fractures underwent coaxial biopsy in conjunction with PVP of the thoracic and lumbar vertebrae. Mean age at the time of the procedure was 72.6 years. A pathologist interpreted all the biopsy samples. In 83 patients, the biopsy results were consistent with the presumed osteoporotic aetiology. In two patients, a malignancy was identified. Biopsy samples from 13 patients were considered insufficient or unsuitable by the pathologist for evaluation. Despite the number of biopsy samples considered insufficient or unsuitable, coaxial biopsy during PVP is useful in verifying the presumed aetiology of vertebral compression fractures, which is often unclear on the basis of clinical and imaging examinations. It is therefore both convenient and advisable to perform a vertebral coaxial biopsy in all patients undergoing a PVP.

Percutaneous vertebroplasty in patients with osteoportic vertebral body fractures

To investigate the risk factors for cement leakage-related recurrent fractures in osteoporotic vertebral compression fractures and analyze their correlation with postoperative recurrent fractures in both operated and adjacent vertebrae following percutaneous vertebroplasty (PVP). We retrospectively screened 412 patients who underwent unilateral PVP at the Sixth Affiliated Hospital of Xinjiang Medical University between January 2019 and November 2024. Based on follow-up findings, patients were divided into two groups: (1) fracture group (n = 91) and (2) non-fracture group (n = 321). Univariate, LASSO regression, and multivariate logistic regression analyses were employed to identify risk factors for cement leakage after PVP.The dataset was randomly split into training and test sets (7:3 ratio), and a nomogram prediction model for cement leakage was constructed using multivariate logistic regression results. Model performance was evaluated using receiver operating characteristic (ROC) curves, Hosmer-Lemeshow calibration curves, and decision curve analysis. (i) Among the 412 included patients, significant differences were observed between the fracture and non-fracture groups in bone mineral density (BMD), preoperative Cobb angle, cement volume, vertebral cleft sign, fracture-to-surgery interval, and cement leakage (P < 0.05). (ii) LASSO regression identified six predictor variables for cement leakage, which were further analyzed using multivariate logistic regression. The results confirmed that BMD, preoperative Cobb angle, cement volume, vertebral cleft sign, fracture-to-surgery interval, and cement leakage were independent risk factors for recurrent fractures after PVP (P < 0.05). (iii) The ROC curve analysis demonstrated strong predictive performance, with an area under the curve of 0.839 (95% CI 0.780-0.897) for the training set and 0.846 (95% CI 0.759-0.932) for the test set. The Hosmer-Lemeshow calibration curves indicated good fit (training set, P = 0.062; validation set, P = 0.081). Decision curve analysis supported the clinical utility of the nomogram in predicting re-fracture risk. This study highlights multiple risk factors for recurrent fractures after PVP. A nomogram incorporating six key predictors was developed, offering a practical tool for assessing re-fracture risk in PVP patients.

Objective. To study the results of percutaneous vertebroplasty (PVP) in patients with compression fractures of vertebral bodies associated with multiple myeloma (MM) Material and methods. A retrospective observational cohort study was conducted. Medical records of patients who underwent PVP for compression fractures of vertebral bodies associated with MM were included. Clinical and instrumental data of the respondents were evaluated. Results. The study included 43 medical records of respondents (19 (44.1%) male patients, 24 (55.9%) female patients, aged 18 to 82 years). The analysis of the severity of pain syndrome on the visual analog scale (VAS) in the spine at 3, 6, and 9 months after PVP showed a significant decrease in this parameter in different sections of the spinal column (p&lt;0.05). In the 3-, 6-, and 9-month periods of postoperative observation, a significant improvement in the level of functionality according to the Oswestry Disability Index (ODI) was also noted (p&lt;0.05). Adverse clinical events in the postoperative period were identified in 4 (9.9%) respondents Conclusion. PVP is an effective and safe method of surgical treatment for patients with compression fractures of vertebral bodies associated with MM

Objective To investigate the treatment of early symptoms recurrence after percutaneous vertebroplasty in patients with osteoporotic vertebral fractures. Methods Twenty-three patients with recurrent symptoms within 2 weeks after PVP were selected, MRI and CT scans were performed to determine the recurrence of the same vertebral body fracture. Among the 23 patients, 18 patients underwent PVP procedures, and 5 patients received conservative treatments with traditional Chinese medicine. All patients’ standard registration forms were collected during hospitalization and follow-up of 1 year: clinical symptoms, visual analogue scale (VAS) score for pain, Oswestry disability index (ODI) score to evaluate functional activity. Results All patients had good results and no complications occurred during the treatment. Analysis of VAS and DOI scores showed significant differences in improvement between pre-treatment and follow-up. The VAS score was significantly improved (8.3±1.2 vs. 2.9±0.7, P<0.05), and the ODI score was also significantly improved (76.4±12.5 vs. 26.7±5.6, P<0.05). There was no significant loss of vertebral height at the end of follow-up. There was no complications and all patients with good function after 12 months follow-up. Conclusions Individual treatment techniques are greatly adapted to the management of early symptoms recurrence after percutaneous vertebroplasty. Careful evaluation has an important effect on re-operation or conservative treatments in patients with osteoporotic vertebral fractures. Key words: Percutaneous vertebroplasty; Symptoms recurrence; Reoperation; Traditional Chinese medicine treatment

Health service cost associated with percutaneous vertebroplasty in patients with spinal metastases

To investigate the characteristics of recurrent fracture of a new vertebral body after percutaneous vertebroplasty in patients with osteoporosis. 29 postmenopausal osteoporosis patients were divided into two groups: 14 patients with recurrent fracture of a new vertebral body after vertebroplasty comprised the new fracture group and there were 15 patients without recurrent fracture in the control group. The following variables were reviewed: age, body mass index (BMI), history of fractures, history of metabolic disease, anti-osteoporosis therapy, type of back brace used, bone mineral density (BMD) of the lumbar spine and hip, intact parathyroid hormone (iPTH), serum calcium and phosphorus, and time since vertebroplasty. Compared with the control group, patients in the new fracture group were statistically significantly different with respect to BMI (t = 2.538, P = 0.027), BMD of the lumbar spine (t = 2.761, P = 0.015), BMD of the hip (t = 2.367, P = 0.037) and iPTH (t = 2.711, P = 0.017). Twelve (86%) of the 14 patients' new vertebral fractures occurred within six months after treatment of the initial fracture, and 10 (71%) fractures were adjacent to those previously treated by percutaneous vertebroplasty. A substantial number of patients with osteoporosis develop new fractures after vertebroplasty; two-thirds of these new fractures occur in vertebrae adjacent to those previously treated. The following variables influence the outcome: BMI, history of fractures, history of metabolic diseases and medications, BMD of lumbar spine and hip, anti-osteoporosis therapy, and use of back brace.

PurposeThe aim of this work was to investigate the risk factors for cement leakage and new-onset OVCF after Percutaneous vertebroplasty (PVP) and to develop and validate a clinical prediction model (Nomogram).MethodsPatients with Osteoporotic VCF (OVCF) treated with PVP at Liuzhou People’s Hospital from June 2016 to June 2018 were reviewed and met the inclusion criteria. Relevant data affecting bone cement leakage and new onset of OVCF were collected. Predictors were screened using univariate and multi-factor logistic analysis to construct Nomogram and web calculators. The consistency of the prediction models was assessed using calibration plots, and their predictive power was assessed by tenfold cross-validation. Clinical value was assessed using Decision curve analysis (DCA) and clinical impact plots.ResultsHigher BMI was associated with lower bone mineral density (BMD). Higher BMI, lower BMD, multiple vertebral fractures, no previous anti-osteoporosis treatment, and steroid use were independent risk factors for new vertebral fractures. Cement injection volume, time to surgery, and multiple vertebral fractures were risk factors for cement leakage after PVP. The development and validation of the Nomogram also demonstrated the predictive ability and clinical value of the model.ConclusionsThe established Nomogram and web calculator (https://dr-lee.shinyapps.io/RefractureApp/) (https://dr-lee.shinyapps.io/LeakageApp/) can effectively predict the occurrence of cement leakage and new OVCF after PVP.

To elucidate the risk factors for a subsequent vertebral compression fracture following percutaneous vertebroplasty, we analyzed the potential predictors of vertebral compression fractures adjacent to or remote from fractures previously treated with percutaneous vertebroplasty. This is a retrospective cohort study. A major concern after percutaneous vertebroplasty in patients with osteoporosis is the occurrence of subsequent vertebral compression fractures in the untreated vertebral bodies. The risk factors for the development of subsequent vertebral compression fractures after percutaneous vertebroplasty are unclear. Two hundred four consecutive patients underwent percutaneous vertebroplasty for acute vertebral compression fractures between January 2007 and December 2008. Forty-nine patients were excluded. Subsequent vertebral compression fractures were diagnosed by bone edema changes on magnetic resonance imaging. Patient's demographic data were used for univariate and multivariable binary logistic regression analyses. Forty-three (27.7%) of the 155 patients had subsequent vertebral compression fractures within 2 years of percutaneous vertebroplasty, with 21 (48.8%) of these patients having fractures detected within 3 months. Adjacent vertebral compression fractures tended to occur sooner, although not significantly (log-rank test, P = 0.112). On multivariate analyses, only the T-score of bone mineral density was significantly associated with subsequent vertebral compression fractures (P < 0.0001; odds ratio = 0.27; 95% confidence interval, 0.15-0.49). The only risk factor significantly associated with subsequent vertebral compression fractures following percutaneous vertebroplasty was a low bone mineral density T-score. Patients with lower bone mineral density have a higher incidence of vertebral compression fractures and thus need more intensive clinical and radiological follow-up.

Analysis of Risk Factors for Secondary New Vertebral Compression Fracture Following Percutaneous Vertebroplasty in Patients with Osteoporosis.

Objective To analyze the refracture after percutaneous vertebroplasty (PVP) in patient with Glucocorticoid-induced osteoporosis (GIO), whether the rate of refracture of patients with GIO after PVP higher than patients with primary osteoporosis, whether the PVP are the optimum treatment for those patients with GIO. Methods A total of 34 fractured patients with GIO and 178 patients with primary osteoporosis were included our study. The association between initial fracture and refractures after PVP were evaluated. The mean number of refractures after initial PVP that developed within 1 year between GIO group and primary osteoporosis group were compared. Results Relative risk (RR) of refracture for the patients with GIO was 1.926 compared with the patients with primary osteoporosis within 1 year.21.9% of patients with primary osteoporosis refractured whereas 52.9% of patients with GIO refractured within 1 year of initial PVP. The patients who are in the GIO group have more chance to get refracture compared with the primary osteoporosis group within 1 year of initial PVP. Conclusion The patients with GIO were more likely to have refracture compared with patients with primary osteoporosis within 1 year of initial PVP. Therefore, whether the PVP are the optimum treatment for those patients with GIO is also a controversial issue. Key words: Glucocorticoid-induced osteoporosis; Percutaneous vertebroplasty; Refracture

We retrospectively compared the clinical and radiological results of percutaneous vertebroplasty with those of conservative treatment in the management of thoracolumbar osteoporotic compression fractures. Sixty-five patients who could be followed up for more than 2 years with thoracic and lumbar spine osteoporotic compression fractures, between January 2005 and October 2010, were reviewed. The patients were divided into 2 groups according to the type of management: group 1, non-operated group treated conservatively; group 2, operated group that underwent percutaneous vertebroplasty. We assessed the clinical and radiological changes at postoperative and follow-up periods in both groups. The male-to-female ratio and mean age of the patients were 11:54 and 73.04 years (range, 50 – 90 years), respectively. The location and number of treated vertebrae were as follows: T4 = 1, T6 = 1, T7 = 3, T8 = 1, T9 = 2, T10 = 1, T11 = 8, T12 = 11, L1 = 17, L2 = 10, L3 = 6, L4 = 3, and L5 = 1. The mean T-score was -3.37. The overall VAS score and the VAS score until 6 months post-injury were statistically more improved in group 2 than in group 1 (P &lt; 0.05 and P &lt; 0.005, respectively). Overall, the compression ratio was statistically more improved in group 2 than in group 1 (P &lt; 0.05). Early pain control and restoration of the compressed vertebral body are the beneficial and real effects of percutaneous vertebroplasty in patients with thoracolumbar osteoporotic compression fractures. Key words: Osteoporosis, compression fracture, vertebroplasty, osteoplasty, comparative study, thoracic spine, lumbar spine, polymethylmethacrylate (PMMA)