Abstract
BackgroundThe purpose of this study was to assess the clinical outcome of percutaneous kyphoplasty (PKP) assisted with mixed reality (MR) technology in treatment of osteoporotic vertebral compression fracture (OVCF) with intravertebral vacuum cleft (IVC).MethodForty cases of OVCF with IVC undergoing PKP were randomized into a MR technology-assisted group (group A) and a traditional C-arm fluoroscopy group (group B). Both groups were performed PKP and evaluated by VAS scores, ODI scores, radiological evidence of vertebral body height, and kyphotic angle (KA) at pre-operation and post-operation. The volume of injected cement, fluoroscopy times, and operation time were recorded. And cases of non-PMMA-endplates-contact(NPEC) in radiological evidence was also recorded postoperatively. The clinical outcomes and complications were evaluated afterwards. All patients received 10 to 14 months follow-up, with an average of 12 months.ResultThis MR-assisted group (group A) acquired more about the amount of the polymethyl methacrylate (PMMA) injection and postoperative vertebral height and less about postoperative KA, fluoroscopy times, and operation time compared with the control group (group B) (P < 0.05). The VAS scores and ODI scores in both groups have improved, but more significantly in group A (P < 0.05). Also, more cases achieve both-endplates-touching of cement in group A (P < 0.05). And there are less of the loss of vertebral height, KA, and occurrence of re-collapse of the vertebra in group A during the follow-up (P < 0.05).ConclusionPKP assisted with MR technology can accurately orientate the position of IVC area, which can be augmented by the balloon leading to more satisfied vertebral height improvement, cement diffusion, and pain relief.Trial registrationClinicalTrials.gov Identifier: NCT03959059. Registered 25 September 2016.
Highlights
The purpose of this study was to assess the clinical outcome of percutaneous kyphoplasty (PKP) assisted with mixed reality (MR) technology in treatment of osteoporotic vertebral compression fracture (OVCF) with intravertebral vacuum cleft (IVC)
PKP assisted with MR technology can accurately orientate the position of IVC area, which can be augmented by the balloon leading to more satisfied vertebral height improvement, cement diffusion, and pain relief
Previous studies have shown that intravertebral vacuum cleft (IVC) in acute OVCF was not a rare phenomenon [7,8,9,10] and it has been considered as an important risk factor for persistent back pain and severe vertebral collapse and might be the main reason responsible for unsatisfied outcome after PKP [11, 12]
Summary
The purpose of this study was to assess the clinical outcome of percutaneous kyphoplasty (PKP) assisted with mixed reality (MR) technology in treatment of osteoporotic vertebral compression fracture (OVCF) with intravertebral vacuum cleft (IVC). On magnetic resonance imaging (MRI), an IVC presents linear or cystic hypointensity similar to air on T1-weighted sequences and hyperintensity similar to cerebrospinal fluid on T2-weighted sequences [13, 14] It has been demonstrated [15, 16] that during the PKP procedure, instead of diffusing into the surrounding cancellous bone, the cement was formed into a solid lump that causes the fibrocartilaginous membrane at the periphery of IVC inhibited its dispersion. In order to break the fibrocartilaginous membrane of IVC by the balloon during PKP procedure, so as to make the cement sufficiently diffuse into surrounding cancellous bone, we attempted to acquire accurate navigation to the IVC area
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