Amount Of Bone Cement Injection Research Articles

Percutaneous pedicle screw anchored vertebral augmentation for the treatment of Kümmell disease without neurological symptoms

To explore the clinical effect of percutaneous pedicle screw anchored vertebral augmentation(PPSAVA) in the treatment of asymptomatic Kümmell disease without neurological symptoms. The clinical data of 20 patients with Kümmell disease without neurological symptoms treated with PPSAVA in our hospital from January 2019 to December 2021 were analyzed retrospectively, including 5 males and 15 females, aged 56 to 88 (74.95±9.93) years old. and the course of disease was 7 to 60 days with an average of (21.35±14.46) days. All patients were treated with PPSAVA. The time of operation, the amount of bone cement injected and the leakage of bone cement were recorded. The visual analogue scale(VAS), Oswestry disability index(ODI), vertebral body angle(VBA), anterior edge height and midline height of vertebral body were compared among the before operation, 3 days after operation and during the final follow-up. The loosening and displacement of bone cement were observed during the final follow-up. All the 20 patients completed the operation successfully. The operation time was 30 to 56 min with an average of (41.15±7.65) min, and the amount of bone cement injection was 6.0 to 12.0 ml with an average of (9.30±1.49) ml. Bone cement leakage occurred in 6 cases and there were no obvious clinical symptoms. The follow-up time was 6 to 12 months with an average of (8.43±2.82) months. The VBA, anterior edge height and midline height of of injured vertebral body were significantly improved 3 days after operation and the final follow-up(P<0.05), and the VBA, anterior edge height and midline height of of injured vertebral body were lost in different degrees at the final follow-up (P<0.05). The VAS and ODI at 3 days after operation and at the final follow-up were significantly lower than those at preoperatively(P<0.05), but the VAS score and ODI at the final follow-up were not significantly different from those at 3 d after operation(P>0.05). At the last follow-up, no patients showed loosening or displacement of bone cement. PPSAVA is highly effective in treating Kümmell disease without neurological symptoms, improving patients' pain and functional impairment, and reducing the risk of cement loosening and displacement postoperatively.

Improved unilateral puncture PVP based on 3D printing technology for the treatment of osteoporotic vertebral compression fracture

To investigate the clinical effect of unilateral percutaneous vertebroplasty (PVP) combined with 3D printing technology for the treatment of thoracolumbar osteoporotic compression fracture. A total of 77 patients with thoracolumbar osteoporotic compression fractures from October 2020 to April 2022 were included in the study, all of which were vertebral body compression fractures caused by trauma. According to different treatment methods, they were divided into experimental group and control group. Thirty-two patients used 3D printing technology to improve unilateral transpedicle puncture vertebroplasty in the experimental group, there were 5 males and 27 females, aged from 63 to 91 years old with an average of (77.59±8.75) years old. Forty-five patients were treated with traditional bilateral pedicle puncture vertebroplasty, including 7 males and 38 females, aged from 60 to 88 years old with an average of(74.89±7.37) years old. Operation time, intraoperative C-arm X-ray times, anesthetic dosage, bone cement injection amount, bone cement diffusion good and good rate, complications, vertebral height, kyphotic angle (Cobb angle), visual analogue scale(VAS), Oswestry disability index (ODI) and other indicators were recorded before and after surgery, and statistically analyzed. All patients were followed up for 6 to 23 months, with preoperative imaging studies, confirmed for thoracolumbar osteoporosis compression fractures, two groups of patients with postoperative complications, no special two groups of patients' age, gender, body mass index (BMI), time were injured, the injured vertebral distribution had no statistical difference(P>0.05), comparable data. Two groups of patients with bone cement injection, bone cement dispersion rate, preoperative and postoperative vertebral body height, protruding after spine angle(Cobb angle), VAS, ODI had no statistical difference(P>0.05). The operative time, intraoperative fluoroscopy times and anesthetic dosage were statistically different between the two groups(P<0.05). Compared with the traditional bilateral puncture group, the modified unilateral puncture group combined with 3D printing technology had shorter operation time, fewer intraoperative fluoroscopy times and less anesthetic dosage. The height of anterior vertebral edge, kyphosis angle (Cobb angle), VAS score and ODI of the affected vertebrae were statistically different between two groups at each time point after surgery(P<0.05). In the treatment of thoracolumbar osteoporotic compression fractures, 3D printing technology is used to improve unilateral puncture PVP, which is convenient and simple, less trauma, short operation time, fewer fluoroscopy times, satisfactory distribution of bone cement, vertebral height recovery and kyphotic Angle correction, and good functional improvement.

Percutaneous kyphoplasty assisted by three dimensional printing percutaneous guide plate for the treatment of osteoporotic vertebral compression fractures

To verify the safety of three dimensional printing percutaneous guide plate assisted percutaneous kyphoplasty(PKP) in the treatment of osteoporotic vertebral compression fractures(OVCFs). The clinical data of 60 patients with OVCFs treated by PKP from November 2020 to August 2021 were retrospectively analyzed. There were 24 males and 36 females, aged from 72 to 86 years old with an average of (76.5±7.9) years. Routine percutaneous kyphoplasty was performed in 30 cases (conventional group) and three dimensional printing percutaneous guide plate assisted PKP was performed in 30 cases (guide plate group). Intraoperative pedicle puncture time (puncture needle to posterior vertebral body edge) and number of fluoroscopy, total operation time, total number of fluoroscopy, amount of bone cement injection, and complication (spinal canal leakage of bone cement) were observed. The visual analogue scale (VAS) and the anterior edge compression rate of the injured vertebra were compared before operation and 3 days after operation between two groups. All 60 patients were successfully operated without complication of spinal canal leakage of bone cement. In the guide plate group, the pedicle puncture time was(10.23±3.15) min and the number of fluoroscopy was(4.77±1.07) times, the total operation time was (33.83±4.21) min, the total number of fluoroscopy was(12.27±2.61) times;and in the conventional group, the pedicle puncture time was (22.83±3.09) min and the number of fluoroscopy was (10.93±1.62) times, the total operation time was(44.33±3.57) min, the total number of fluoroscopy was(19.20±2.67) times. There were statistically significant differences in the pedicle puncture time, intraoperative number of fluoroscopy, the total operation time, and the total number of fluoroscopy between the two groups(P<0.05). There was no significant difference in amount of bone cement injection between the two groups(P>0.05). There were no significant differences in VAS and the anterior edge compression rate of the injured vertebra at 3 days after operation between two groups(P>0.05). Three dimensional printing percutaneous guide plate assisted percutaneous kyphoplasty is safe and reliable, which can reduce the number of fluoroscopy, shorten the operation time, and decrease the radiation exposure of patients and medical staff, and conforms to the concept of precise orthopaedic management.

Comparison of different approaches of percutaneous vertebroplasty in the treatment of osteoporotic spinal compression fractures and analysis of influencing factors of re-fracture.

To compare the functional and radiological outcome of different approaches of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures (OVCF), and to analyze the factors affecting postoperative re-fracture in patients with OVCF. Medical data of 76 patients with OVCF who underwent PVP in our hospital from January 2021 to December 2021 were analyzed retrospectively. Based on the different intraoperative approaches, patients were divided into Unilateral-group (n=36) and Bilateral-group (n=40). The perioperative indexes, clinical efficacy, and spinal nerve function of the two groups were compared. Logistic regression analysis was used to determine the risk factors of postoperative re-fracture in patients with OVCF. The functional outcome was assessed with Oswestry disability index (ODI), American Spinal Injury Association (ASIA) nerve function classification and pain with Visual analogue scale (VAS). The radiological outcome was assessed by noting change of anterior vertebral height and change of kyphosis Cobb angle. The amount of intraoperative bleeding, the number of X-ray irradiation and the volume of injected bone cement in the Unilateral-group were lower, and the operation time was shorter than Bilateral-group (all P<0.05). One week after the operation, the anterior height of the vertebral body was higher, the Cobb angle of kyphosis was lower, the VAS score was higher, and the ASIA grade was lower in the Unilateral-group compared to the Bilateral-group (P<0.05). Logistic regression analysis showed that the age, bone mineral density, volume of bone cement injection and PD were risk factors of postoperative re-fracture in patients with OVCF. Unilateral PVP treatment of OVCF has the advantages of less intraoperative bleeding, less X-ray irradiation and shorter operation time. At the same time, bilateral PVP is associated with improved bone cement dispersion, and the effect of improving patients' pain is better than that in the Unilateral PVP. Postoperative risk of re-fracture in OVCF patients correlated with age, bone mineral density, amount of bone cement injection and pedicle diameter.

Analysis of the causes of residual back pain in the early and late stages after percutaneous vertebral augmentation

To explore the influencing factors of the residual back pain in patient with osteoporotic vertebral compression fractures(OVCFs) in the early and late stages after percutaneous vertebral augmentation(PVA), and analyze the correlation between these factors and the residual back pain after PVA. From March 2018 to December 2019, 312 patients with OVCFs who treated with PVA were collected. According to the inclusion and exclusion criteria, a total of 240 patients were included in this retrospective study. There were 59 males and 181 females, aged from 50 to 95 years old with an average of (76.11±10.72) years old, and 50 cases of fractures located in the thoracic region (T5-T10), 159 cases in the thoracolumbar region (T11-L2), and 31 cases in the lumbar region (L3 and below). The first day after PVA was regarded as the early postoperative period, and the seventh day was regarded as the late postoperative period. According to the visual analogue scale (VAS), the patients were divided into 4 groups:early postoperative pain relief group(group A, VAS≤4 scores), there were 121 patients, including 29 males and 92 females, aged from 50 to 90 years with an average of (75.71±11.00) years;early postoperative pain relief was not an obvious group (group B, VAS >4 scores), there were 119 patients, including 30 males and 89 females, aged from 53 to 95 years with an average of (76.51±10.46) years; late postoperative pain relief group (group C, VAS≤ 4 scores), there were 172 patients, including 42 males and 130 females, aged from 50 to 95 years with an average of (76.20±10.68) years; late postoperative pain relief was not obvious group (group D, VAS>4 scores), there were 68 patients, including 17 males and 51 females, aged from 53 to 94 years old with an average of (75.88±10.91) years old. The age, gender, bone mineral density(BMD), injured vertebral segment, preoperative thoracolumbar fascial condition, surgical methods, single or bilateral puncture, the amount of bone cement injection, anterior vertebral height recovery rate and central vertebral height recovery rate in the 4 groups were analyzed by univariate analysis. The statistically significant factors were put into a Logistic regression to analyze the correlation between these factors and residual back pain after PVA. Univariate analysis showed that the residual back pain in the early stage after PVA was correlated with BMD, preoperative thoracolumbar fascial injury, single or bilateral puncture, the amount of bone cement injection, anterior vertebral height recovery rate and central vertebral height recovery rate(P<0.05). The residual back pain in the late postoperative period was related to BMD, injured vertebral segment, surgical methods, the amount of bone cement injection, anterior vertebral height recovery rate and central vertebral height recovery rate(P<0.05). Multivariate Logistic regression analysis showed that thoracolumbar fascial injury(OR=4.938, P=0.001), single or bilateral puncture(OR=5.073, P=0.002) were positively correlated with the residual back pain in the early stage after PVA(B>0), which were risk factors;the BMD (OR=0.211, P=0.000) and anterior vertebral height recovery rate (OR=0.866, P=0.001) were negatively correlated with the residual back pain in the early stage after PVA(B<0), which were protective factors. In the late stage after PVA, the BMD(OR=0.448, P=0.003), the amount of bone cement injection (OR=0.648, P=0.004) and anterior vertebral height recovery rate (OR=0.820, P=0.000) were negatively correlated with residual back pain(B<0), which were protective factors. The decrease of BMD, injury of the thoracolumbar fascia, single or bilateral puncture, poor recovery of anterior vertebral height and insufficient injection of bone cement are closely related to the occurrence of residual back pain after PVA, which affect the relief of residual back pain in the early and late postoperative periods.

Risk factors of adjacent vertebral refracture after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in super-old patients

To analyze the risk factors for refracture of adjacent vertebrae after percutaneous vertebroplasty (PVP) in super-old patients with osteoporotic vertebral compression fractures(OVCFs). A retrospective analysis was performed on 40 patients(age≥90 years) with OVCFs who underwent PVP between June 2012 and June 2019. There were 7 males and 33 females, age from 90 to 101 years old with an average of (94.6±1.6) years. Patients were divided into two groups according to whether adjacent vertebral refracture occurred after PVP. Among them, 20 patients occurred refracture after PVP (refracture group) and 20 patients did not occur it(control group). The general information, radiological data and pelvic parameters of the two groups were collected. The items included age, gender, body mass index (BMI), fracture site and bone mineral density(BMD) T-value, fracture to operation time, compression degree of injured vertebra, recovery degree of anterior edge of injured vertebra, bone cement injection amount, bone cement leakage, pelvic index(PI), pelvic tilt angle (PT), sacral angle(SS), et al. Factors that may be related to refracture were included in the single-factor study, and multivariate Logistic regression analysis was performed on the risk factors with statistical significance in the single-factor analysis to further clarify the independent risk factors for refracture of adjacent vertebral bodies after PVP. There were no significant differences in age, gender, fracture site, fracture to operation time, compression degree of injured vertebra and recovery degree of anterior edge of injured vertebra between two groups (P>0.05). There were significant differences in BMI, BMD T-value, bone cement injection amount and bone cement leakage rate between two groups(P<0.05). The PI and PT values of the refracture group were higher than those of the control group(P<0.05). There was no significant difference in SS between two groups (P>0.05). Multivariate Logistic regression analysis showed that decreased BMD T-value, bone cement leakage, increased PT and PI values increased the risk of recurrence of adjacent vertebral fractures in OVCFs (P<0.05). There are many risk factors for the recurrence of adjacent vertebral fractures in super-old patients with OVCFs. Patients with high PI and PT values may be one of the risk factors.

Combined Application of Grid Body Surface Locator and Preemptive Analgesia in Daytime Vertebroplasty.

Objective To explore the clinical advantages of grid body surface locator combined with preemptive analgesia in the treatment of osteoporotic lumbar fractures in daytime vertebroplasty. Methods A retrospective study was conducted on 120 patients who underwent lumbar vertebroplasty in the Department of Orthopedics of General Hospital of Northern Theater Command from January 2017 to January 2020. According to the preoperative planning and analgesic mode of treatment, they were divided into the daily operation experimental group and the traditional mode control group. Prone positioning of a patient under anesthetic is safe of ensuring optimum surgical access for many procedures, providing that the risks are fully understood. The general baseline data, intraoperative fluoroscopy times and operation time, bone cement injection volume, bone cement permeability, VAS score before operation, 1 day, and 3 months after operation, and the recovery of anterior vertebral height before and after operation were analyzed. Results There was no statistically significant difference in the preoperative general data between the two groups. One day after operation, the VAS score of the experimental group was lower than that of the control group, but there was no difference after 3 months. The permeability of bone cement in the experimental group was lower than that in the control group, the height of anterior edge of injured vertebra was better than that in the control group, and the operation time was less than that in the control group. Conclusion The daytime operation experimental group can significantly alleviate postoperative pain, increase the amount of bone cement injection, and reduce the permeability of bone cement through preoperative planning of puncture path and key puncture points, combined with advanced labor pain, but there is no significant difference in long-term pain relief.

Application of Curved Diffusion Needle in unilateral percutaneous vertebroplasty

To evaluate the effectiveness of Curved Diffusion Needle in unilateral percutaneous vertebroplasty (PVP) by compared with bilateral PVP. A clinical data of 93 patients with osteoporotic vertebral compression fracture (OVCF) treated with PVP between January 2020 and January 2021 was retrospectively analyzed, including 47 patients underwent unilateral PVP assisted with Curved Diffusion Needle (unilateral group) and 46 patients underwent bilateral PVP (bilateral group). There was no significant difference in gender, age, cause of injury, time from injury to operation, T value of bone mineral density, AO classification, distribution of injured vertebrae, and preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), relative height of injured vertebrae, and Cobb angle between the two groups ( P>0.05). The operation time, the amount of bone cement injection, the incidence of bone cement leakage, the bone cement diffusion distribution, VAS score, ODI, the relative height of injured vertebrae, and Cobb angle were recorded and compared between the two groups. All operations successfully completed. The operation time was significantly shorter in unilateral group than in bilateral group ( t=-13.936, P=0.000), and the amount of bone cement injection was significantly less in unilateral group than in bilateral group ( t=-13.237, P=0.000). The incidence of bone cement leakage in unilateral group was 19.14%, which was significantly lower than that in bilateral group (39.13%) ( χ 2=4.505, P=0.034). The score of bone cement distribution in unilateral group was 7.0±1.3, of which 41 cases were excellent and 6 cases were well. The score of bilateral group was 7.4±0.8, of which 43 cases were excellent and 3 cases were well. There was no significant difference in score and grading of bone cement distribution between the two groups ( t=-1.630, P=0.107; Z=-1.013, P=0.311). All patients were followed up and the follow-up time was 3-10 months (mean, 6.5 months) in unilateral group and 3-10 months (mean, 6.1 months) in bilateral group. The VAS score, ODI, the relative height of injured vertebrae, and Cobb angle at 24 hours after operation and last follow-up were significantly better than those before operation in the two groups ( P<0.05). There were significant differences in all indicators between 24 hours after operation and last follow-up ( P<0.05). There was no significant difference in all indexes between the two groups ( P>0.05) at the same time point after operation. During follow-up, there was no complication such as contralateral vertebral collapse, refracture, adjacent vertebral fracture, or local kyphosis in the two groups. Unilateral PVP assisted with Curved Diffusion Needle for OVCF is beneficial to the distribution of bone cement, which can not only achieve similar effectiveness to bilateral PVP, but also achieve shorter operation time, less bone cement injection, and lower risk of bone cement leakage.

Bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture of lumbar

To evaluate the feasibility and short-term effectiveness of bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture (OVCF) of lumbar. A retrospective analysis was made on the clinical data of 93 patients with OVCF of lumbar who met the selection criteria between January 2018 and June 2019. According to the different surgical methods, they were divided into group A (44 cases, treated with bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach) and group B [49 cases, treated with percutaneous kyphoplasty (PKP) via bilateral transpedicle approach]. There was no significant difference in gender, age, body mass index, T value of bone mineral density, injury cause, fractured level, time from injury to operation, comorbidities, and preoperative Cobb angle of injured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups ( P>0.05). The operation time, intraoperative fluoroscopy times, bone cement injection amount, and incidence of bone cement leakage were recorded and compared between the two groups; Cobb angle of the injured vertebrae, VAS score, and ODI were measured before operation, at 2 days and 1 year after operation. The contralateral distribution ratio of bone cement was calculated according to the anteroposterior X-ray film at 2 days after operation. The operation time and the intraoperative fluoroscopy times in group A were significantly less than those in group B ( P<0.05). There was no bone cement adverse reactions, cardiac and cerebrovascular adverse events, and no complications such as puncture needles erroneously inserted into the spinal canal and nerve injuries occurred in the two groups. Bone cement leakage occurred in 6 cases and 8 cases in groups A and B, respectively, all of which were asymptomatic paravertebral or intervertebral leakage, and no intraspinal leakage occurred; the bone cement injection amount and incidence of bone cement leakage between the two groups showed no significant differences ( P>0.05). The contralateral distribution ratio of bone cement in group A was significantly lower than that in group B ( t=2.685, P=0.009). Patients in both groups were followed up 12-20 months, with an average of 15.3 months. The Cobb angle of the injured vertebrae, VAS score, and ODI in the two groups were significantly improved at 2 days after operation, however, the Cobb angle of the injured vertebra at 1 year after operation was significantly lost when compared with the 2 days after operation, the VAS score and ODI at 1 year after operation were significantly further improved when compared with the 2 days after operation, the differences were all significant ( P<0.05). There was no significant difference in the Cobb angle of the injured vertebrae, VAS score, and ODI between the two groups at each time point after operation ( P>0.05). Bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach is comparable to bilateral PKP in short-term effectiveness with regard to fracture reduction, reduction maintenance, pain relief, and functional improvement. It has great advantages in reducing operation time and radiation exposure, although it is inferior in bone cement distribution.

Comparison of unilateral and bilateral puncture percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures.

Objectives:To compare the clinical efficacy of unilateral and bilateral puncture PKP in the treatment of OVCFs and explored whether there is a difference in the efficacy of unilateral and bilateral puncture PKP after surgery.Methods:A total of 98 patients with OVCFs treated by PKP from August 2016 to June 2018 were selected. There were 62 cases in the unilateral puncture group and 36 cases in the bilateral puncture group. The operation time, the amount of bone cement injection, the height of the anterior edge of the vertebral body and the visual analog scale (Visual Analog Scale, VAS) scores before and after the operation were analyzed, and whether the differences between the 2 groups were statistically significant was analyzed.Results:All patients were followed up completely. The operation time and the number of X-ray fluoroscopies of the unilateral puncture group were significantly reduced compared to those of the bilateral group, and the difference was statistically significant (p<0.05). In terms of the bone cement injection volume, the average injection volume of the bilateral group was greater than that of the unilateral group, and the difference was statistically significant (p<0.05); the postoperative VAS scores of the 2 groups of patients were significantly improved, and the difference was statistically significant compared with that before surgery (p<0.05) but that of the unilateral group was not statistically significant compared with that of the bilateral group (p>0.05). The height of the anterior edge of the vertebral body in both groups was significantly improved compared with that before the operation, and the difference was statistically significant (p<0.05).Conclusion:Unilateral and bilateral puncture PKP can achieve good clinical efficacy in the treatment of osteoporotic vertebral compression fractures, but unilateral PKP has the advantages of short operation time and low X-ray exposure.

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.

Comparison of targeted percutaneous vertebroplasty and traditional percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures in the elderly

ObjectiveTo investigate the clinical effect of precise puncture and low-dose bone cement in percutaneous vertebroplasty (PVP).MethodsSixty patients with osteoporotic vertebral compression fracture (OVCFs) who were treated with PVP in our hospital from July 2018 to June 2019. These included patients were divided into group A (N = 30) and group B (N = 30). Group A has punctured to the fracture area accurately and injected with a small dose of bone cement, the group B was injected with a conventional dose of bone cement. The operation time, the amount of bone cement injection, the number of X-rays, the VAS scores, the leakage rate of bone cement, and the incidence of adjacent vertebral fractures were compared between the two groups.ResultThe operation time, fluoroscopic times, and bone cement volume in group A are less than that in group B (P < 0.05). Patients in group A had a lower incidence of cement leakage and adjacent vertebral fracture than that in patients in group B. There was no significant difference in postoperative pain relief between the two groups.ConclusionsPrecise puncture and injection of small doses of bone cement can reduce the number of X-ray fluoroscopy, operation time, amount of bone cement injection, reduce the rate of bone cement leakage and the incidence of adjacent vertebral fractures, which is a safe and effective surgical approach for the treatment for the aged with OVCFs.

Comparison of a flexible versus rigid bone cement injection system in unilateral percutaneous vertebroplasty

BackgroundPercutaneous vertebroplasty (PVP) has been demonstrated to be effective in the treatment of acute osteoporotic vertebral fracture (AOVF). However, bilateral puncture takes more time to accept more X-ray irradiation; some scholars apply unilateral puncture PVP, but the cement cannot be symmetrically distributed in the vertebral body, so we use a flexible cement injector that undergoes PVP through the unilateral pedicle puncture. This research aims to compare the clinical results of PVP for AOVF with unilateral pedicle puncture using a straight bone cement injector and a bendable cement injector, determine the value of a bendable cement injector.MethodsWe undertook a retrospective analysis of patients with thoracic and lumbar compression fracture treated with unilateral pedicle puncture percutaneous vertebroplasty from our institution from June 2013 to July 2015. Operation time, radiation exposure, bone cement injection amount, and the incidence of bone cement leakage were recorded on presentation, the cement leakage was measured by X-ray and computed tomography scan. The patients were followed up postoperatively and were assessed mainly with regard to clinical and radiological outcomes.ResultsThere was no significant difference in the operation time, radiation exposure time and incidence of bone cement leakage between the two groups. There was significant difference in the amount of bone cement injection and the difference between the two groups. There were no significant differences in VAS and the relative height of the vertebral body and local Cobb angle and QUALEFFO between the two groups at 1 week after PVP, significant difference was observed only 12 months after operation.ConclusionsApplication of flexible cement injector is safe and feasible, compared with the application of straight bone cement injector, without prolonging the operative time, radiation exposure time and the incidence of bone cement leakage; it has the advantages of good long-term effect and low incidence of vertebral fracture recurrence.

Clinical Efficacy of Different Bone Cement Distribution Patterns in Percutaneous Kyphoplasty: A Retrospective Study

Bone cement distribution patterns in percutaneous kyphoplasty (PKP) is the key factor in keeping the vertebral stabilization and curative effect. However, the same cement volume can result in different bone cement distribution patterns and can thereby lead to different clinical outcomes. Therefore we investigated associations between cement distribution patterns and the occurrence rates of recompression in cemented vertebrae after PKP for patients with osteoporotic vertebral compression fractures (OVCFs). The study focuses attention on the influence of compact and dispersive cement distribution patterns in PKP for patients with OVCFs. A retrospective cohort study. An affiliated people's hospital of a university. According to different cement distribution patterns, patients were assigned to 4 groups. The demographic data, radiographic data, and clinical outcomes were compared between the 4 groups. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were evaluated before and 2 days after PKP. Moreover, the relationships between bone cement and clinical outcomes were analyzed. The epidemiologic data, clinical outcomes, and complications of the 4 groups were assessed. Comparisons of the radiologic and clinical results of the 4 groups were made pre- and postoperatively. Anterior height of fractured vertebrae (AH), the kyphotic Cobb angle, and the volumetric cubage index of the fractured vertebrae were measured. A total of 104 subjects were retrospectively analyzed and followed up (median age, 75.01 ± 8.42 years; age range, 56-94 years). The mean procedure duration was 61.26 ± 23.05 minutes (range, 30-140 minutes). The mean follow-up was 12.1 ± 2.2 months (range, 2-15 months). Statistically, there was no significant difference in terms of gender, age, body mass index, and bone mineral density (P > 0.05). The incidence of cement leakage was significantly lower in group A than those in the other groups. The total amount of bone cement injected into 104 cases (104 vertebral bodies in total) was 848.5 mL, and the amount of bone cement injected into a single vertebral body was 7.94 ± 1.38 mL. The amount of bone cement injection in each group was the lowest (6.80 ± 1.66 mL) in group D, followed by (7.94 ± 1.38 mL) group B, and the highest (8.96 ± 1.68 mL) in group A, with a statistically significant difference between the 4 groups (P < 0.05). No serious complications were observed during the follow-up periods. The AH and Cobb angle improved significantly for the 4 groups (P < 0.05). The VAS score decreased from 3.55 ± 0.54, 3.53 ± 0.65, 3.40 ± 0.58, and 3.40 ± 0.66 preoperatively to 0.18 ± 0.39, 0.23 ± 0.41, 0.20 ± 0.40, and 0.15 ± 0.36 at 48 hours postoperatively. The ODI score dropped from 35.65 ± 4.54, 36.45 ± 4.72, 34.12 ± 4.86, and 35.65 ± 4.34 preoperatively to 15.47 ± 1.32, 15.32 ± 1.34, 15.23 ± 1.26, and 15.73 ± 1.17 at 48 hours postoperatively. Our estimation of the vertebral body volume is imprecise. In addition, the number of subjects with OVCFs was small in this retrospective study. The volume of the fractured vertebra was not calculated accurately. Significant associations between cement distribution patterns and bone cement leakage affected the clinical outcome in patients after PKP. A higher incidence of bone cement leakage was observed in patients with treated vertebrae exhibiting a single-dispersive or single-compact pattern. Percutaneous kyphoplasty, osteoporotic vertebral compression fracture, bone cement distribution patterns.

Comparison of the clinical outcomes of percutaneous vertebroplasty vs. kyphoplasty for the treatment of osteoporotic K\xfcmmell\u2019s disease:a prospective cohort study

BackgroundPercutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are widely used in the treatment of Kümmell’s disease. The purpose of this article is to investigate the clinical efficacy of PVP and PKP for Kümmell’s disease.MethodsThe clinical data that 56 cases of Kümmell’s disease treated with either PVP (28 cases) or PKP (28 cases) from December 2015 to December 2017 were prospectively analyzed. Gender, age, course of disease, injury segment, bone mineral density (BMD), visual analogue scale (VAS), Oswestry disability index (ODI), imaging measurement indexes before surgery between the two groups showed no significant difference (all P > 0.05). The bone cement leakage rate, bone cement injection amount, operation time, VAS, ODI, the rate of vertebral compression, correction rate of kyphosis and refracture rate of adjacent vertebra in 2 years were compared between the two groups to calculate clinical efficacy.ResultsThe two groups were followed up for 24–48 months. There was no significant difference in the follow-up time, amount of bone cement injected, incidence of bone cement leakage and refracture rate of adjacent vertebrae between the two groups (all P > 0.05). The operation time, intraoperative blood loss and fluoroscopy times of the PVP group were significantly lower than those of the PKP group (all P = 0.000). VAS score and ODI of the two groups were significantly lower at 1 day, 1 year and 2 years after surgery than before surgery (all P < 0.05), but there was not statistically significant difference between the two groups at each time point after surgery (all P > 0.05). The rate of vertebral compression and kyphosis correction in the two groups were significantly corrected (P < 0.05, respectively) and decreased significantly with time (all P < 0.05), But there was not significant difference between the two groups at any time point (all P > 0.05).ConclusionBoth PVP and PKP can achieve similar effects in the treatment of Kümmell’s disease. Because the cost, operation time, blood loss, radiation exposure and surgical procedure of PVP are less than those of PKP, PVP has more clinical priority value.

Clinical study of temperature contrast injection procedure in prevention of bone cement leakage during vertebroplasty

To observe the effect of temperature contrast injection procedure on prevention and reduction of bone cement leakage in vertebroplasty (PVP). The clinical data of 42 patients(48 vertebral bodies) with osteoporotic vertebral compression fractures(OVCFs) treated from July 2014 to July 2018 were retrospectively analyzed. There were 19 males and 23 females, aged from 62 to 80 years old with an average of 72 years. The vertebral fracture segment was T₈-L₅, including 30 lumbar vertebrae and 18 thoracic vertebrae. The course of the disease ranged from 3 d to 2 months. Twenty cases (20 vertebral bodies) were treated by single vertebroplasty (group A) and 22 cases (28 vertebral bodies) were treated by temperature contrast injection procedure(group B). The operative time, amount of bone cement injection, VAS score at 3 days after surgery, leakage rate and refracture rate were compared between two groups. The operative time, amount of bone cement injection and VAS score at 3 days after surgery in group B were (40.05±7.78) min, (3.93±0.19) ml, (3.55±0.74) points, respectively, and in group A were(38.90±6.81) min, (4.03±0.24) ml, (4.05±1.00) points, there was no significant difference between two groups(P>0.05). The leakage rate in group B was lower than that in group A (9.1% vs 40.0%, P<0.05). The refracture rate in group B was 9.1%(2/22), in group A was 15.0%(3/20), there was no significant difference between two groups (P>0.05). Temperature contrast injection procedure is an effective method to reduce the bone cement leakage in vertebroplasty.

Manual reduction combined with percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures with intravertebral clefts

To explore the therapeutic efficacy of manual reduction combined with percutaneous vertebroplasty in treating osteoporotic vertebral compression fractures(OVCFs) with intravertebral clefts. The clinical data of 94 patients with osteoporotic vertebral compression fractures with intravertebral clefts treated from January 2014 to January 2017 were retrospectively analyzed. The patients were divided into group A and group B according to different operative methods. In group A, 45 patients were treated with unilateral approach PVP, including 17 males and 28 females, aged (75.35±11.82) years old, with a bone density T-value of (-4.28±0.65) g/cm³; in group B, 49 patients treated with manual reduction combined with unilateral approach PVP, including 19 males and 30 females, aged (76.79±9.64) years old, with a bone density T-value of (-4.33±0.72) g/cm³. The operation time, bone cement injection volume and postoperative complications of two groups were recorded. The VAS and ODI scores of two groups were analyzed respectively at 1, 12, 18 months after operation. Vertebral height and kyphosis Cobb angle of two groups were compared immediately after surgery and 12, 18 months after operation. The distribution of bone cement in the vertebral body was observed and its distribution excellent rate was calculated. There was no significant difference in operation time between two groups. The amount of bone cement injection was(8.42±1.24) ml in group A and(9.19±1.09) ml in group B, and the difference between two groups was statistically significant(P<0.05). No spinal nerve root injury during operation and no complications including pulmonary embolism, bone cement toxicity and infection were found in two groups. There were 5 cases of bone cement leakage in group A and 4 cases in group B, which did not cause corresponding clinical symptoms and were not treated additionally. The distribution of bone cement in group A was excellent in 25 cases, good in 19 cases, poor in 1 case and in group B was excellent in 45 cases, good in 4 cases. The distribution excellent rate of bone cement was higher in group B than in group A (P<0.05). The VAS and ODI scores before operation and 1, 12, 18 months after operation were 8.29±0.74, 2.59±0.14, 3.75±0.38, 3.84±0.88 and 40.04±3.16, 9.24±2.82, 12.27±2.64, 15.83±2.58 in group A, 8.22±0.82, 2.54±0.19, 2.81±0.23, 2.82±0.45 and 39.98±2.05, 9.16±2.10, 9.46±2.41, 9.76±2.46 in group B. There was no significant difference in VAS and ODI scores at 1 month after operation between two groups (P>0.05), but group A was higher than group B at 12 and 18 months after operation (P<0.05). The vertebral height and Cobb angle before surgery, immediately after surgery, and 12, 18 months after surgery in group A were(59.17±1.42)%, (85.95±2.19)%, (75.27±3.45)%, (68.34±2.24)% and(23.83±3.37)°, (15.26±2.61)°, (17.63±2.16)°, (19.46±2.54)°, and in group B were(59.31±1.87)%, (89.19±2.53)%, (88.62±2.51)%, (88.59±2.62)% and(24.72±3.78)°, (14.91±2.28)°, (15.48±2.55)°, (15.86±2.81)°. Vertebral height Immediately after surgery was greater in group B than in group A and Cobb angle in group B was smaller than in group A (P<0.05). During follow-up, there was no significant change in vertebral height in group B, while vertebral body recollapse in group A(P<0.05). In the treatment of osteoporotic vertebral compression fractures with intravertebral clefts, the manual reduction combined with PVP is more effective than single PVP, which can effectively prevent vertebral body recollapse and improve the long-term efficacy of patients.

Therapeutic effect of unilateral and bilateral pedicle approach percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures

Objective To explore the efficacy of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods A retrospective analysis of 76 patients with OVCF treated with single and double pedicle approach PVP from April 2016 to June 2017 in the First Affiliated Hospital of He′nan University was conducted.According to the operation method, the patients were divided into unilateral group (42 patients, unilateral pedicle approach), and bilateral group (34 cases, bilateral pedicle approach). The operation time, number of intraoperative X-rays, amount of bone cement injection, height of the vertebral body and the complications were compared between the two groups.The visual analogue scale (VAS) and the Oswestry dysfunction index(ODI) score were used to assess the recovery of the patients. Results The unilateral group had less operative time[(33.01±3.78)min], intraoperative X-ray number[(22.06±3.85) times]and bone cement injection[(3.53±0.42) mL] compared with the bilateral group (t=8.54, 5.98, 4.74, all P 0.05). The postoperative VAS and ODI of the two groups were significantly improved compared with those before operation (all P<0.05). Conclusion In the case of reasonable indications, the unilateral approach PVP is better than bilateral, and unilateral approach PVP should be the first choice for OVCF. Key words: Spinal fractures; Vertebroplasty; Osteoporotic; Fractures, compression; Bone cement; Operative time; Comparative effectiveness research

Efficacy evaluation of gelatin sponge in percutaneous vertebroplasty for lumbar osteoporosis compression fractures

Objective To evaluate the feasibility of using gelatin sponge to reduce bone cement leakage in percutaneous vertebroplasty (PVP). Methods A retrospective case control study was conducted to analyze the 191 patients (191 vertebrae) with lumbar osteoporosis vertebrae compression fractures (OVCF) who were treated by PVP from October 2014 to October 2017 in Xi'an Honghui Hospital. There were 52 males and 139 females, aged 65-91 years, with an average of 75.1 years. A total of 48 patients were treated with routine PVP, and bone cement was injected directly after puncture (Group A). A total of 47 patients, 49 patients and 47 patients were injected with 1/4, 1/3 and 1/2 gelatin sponge before bone cement injection respectively (Group B, Group C and Group D). Postoperative routine X-ray and CT scans were used to compare the amount of bone cement injection, the leakage of bone cement, the visual analogue score (VAS), neurological symptoms and complications before and after operation. Results All patients were followed up for 1-12 months, with an average of 3.6 months. There were no significant differences in the amount of bone cement injection after operation between groups (P>0.05). There was a significant difference in the cement leakage rate among the groups after operation [Group A: 42%(20/48); Group B: 40%(19/47); Group C: 14%(7/49); Group D: 13%(6/47)](P 0.008 3); significant differences were found between Group B and Group C as well as between Group B and Group D (P 0.05). There were no significant differences in VAS among the groups (P>0.05); VAS was significantly improved after operation within each group (P<0.05). After operation, two patients had persistent lower back pain and one patient had intraspinal leakage. Wound healing was found in all patients, with no neurological symptoms. Conclusion For OVCF, use of 1/3 or 1/2 gelatin sponge in PVP can reduce bone cement leakage. Key words: Osteoprotic fractures; Vertebroplasty; Gelatin sponge, absorbable; Bone cement leakage

Associated risk factors for cemented vertebral body re-wedge after percutaneous kyphoplasty

Objective To investigate the related risk factors of the previous cemented vertebral body re-wedge after percutaneous kyphoplasty (PKP). Methods In this retrospective case-control study, clinical data of 617 patients treated by PKP from December 2008 to November 2014 were analyzed. According to whether the cemented vertebra wedged again, the patients were divided into cemented vertebral re-wedge group (n=12) and non-cemented vertebral re-wedge group (n=605). The data of age, preoperative bone density, preoperative vertebral osteonecrosis, intraoperative bone cement injection amount, postoperative bone cement leakage, postoperative bone cement filling, postoperative recovery rate of vertebral wedge angle, and presence or absence of adjacent old vertebral wedging were recorded in two groups. All patients were followed up for one year, and the data were summarized and statistically analyzed. Results Single factor analysis showed the factors of whether there were adjacent old vertebral wedge, preoperative vertebral osteonecrosis, cystic bone cement filling, different wedge angle recovery rate, and emergence of previous cemented vertebral body re-wedge after PKP were statistically significant between two groups (P 0.05). Multivariate Logistic stepwise regression analysis showed cystic bone cement filling, preoperative vertebral osteonecrosis, adjacent old vertebral wedging, and higher recovery rate of vertebral wedge angle were prone to appear previous cemented vertebral body re-wedge (P<0.05). Conclusions Relatively higher recovery rate of vertebral wedge angle, previous adjacent old vertebral wedge, vertebral osteonecrosis, and cystic bone cement filling are risk factors closely related to cemented vertebral re-wedge after PKP, which gives a good reference to assess surgical risk, avoid risk factors and choose right surgical techniques. Key words: Fractures, compression; Thoracic vertebrae; Lumbar vertebrae; Percutaneous kyphoplasty