Vertebroplasty Research Articles

A Systematic Review on Outcomes of Vertebroplasty and/or Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fractures

With nearly 50% of all osteoporotic fractures, osteoporotic vertebral fractures are the most frequent consequence of osteoporosis. Vertebroplasty (VP) and balloon kyphoplasty (KP) are two distinct techniques that have been introduced for the therapy of symptomatic fractures without neurological disorders. The results for osteoporotic vertebral compression fractures (VCFs) from VP and/or balloon KP will be the focus of this study. An extended search was done in databases of PubMed, MEDLINE, Wiley library, and Google Scholar between 2001 and 2020. In this systematic review, 16 studies were cited. Studies, in which the outcomes for osteoporotic VCFs from VP and/or balloon KP were noted, were included in the study. These findings demonstrated that for the treatment of osteoporotic (VCFs, VP, and KP) appeared to be complementary procedures with particular indications and demonstrated similar good clinical outcomes. Balloon KP and VP are effective and beneficial methods for treating VCFs, with balloon KP being slightly more effective for osteoporotic fractures due to its advantages in minimizing fractures, controlled cement placement, deformity relief, and immediate pain relief.

CT-Guided Microwave Ablation with Vertebral Augmentation for Spinal Metastases with Posterior Wall Defects.

To evaluate the efficacy and safety of combined microwave ablation (MWA) and vertebral augmentation (VA) in the treatment of spinal metastases with posterior wall defects. A retrospective review was conducted for 67 patients (42 men, 25 women) with painful spine metastases and posterior wall defects who underwent MWA combined with VA. Among these patients, 52 vertebrae had no epidural invasion and 33 had mild invasion but did not compress the spinal cord. Procedural effectiveness was determined by comparing visual analog scale (VAS) scores and Oswestry disability index (ODI) scores before the procedure and during the follow-up period. The procedure was technically successful in all patients. The mean VAS score declined significantly from 6.85 ± 1.81 before the procedure to 3.27 ± 1.97 at 24 h, 1.96 ± 1.56 at 1 week, 1.84 ± 1.50 at 4 weeks, 1.73 ± 1.45 at 12 weeks, and 1.71 ± 1.52 at 24 weeks post-procedure (p < 0.01). The mean ODI score was lower post-procedure than before the procedure (p < 0.001). Transient nerve injury occurred in two patients (SIR classification D), and the incidence of asymptomatic bone cement (SIR classification A) was 43.5% (37/85). MWA combined with VA is an effective and safe treatment for painful spine metastases with posterior wall defects.

Hollow Screw Placement Combined with Percutaneous Vertebroplasty Serves as a Valuable Three-Column Intensive Treatment for Patients with Kummell's Disease and Pedicle Rupture.

To introduce the surgical methods and clinical results of percutaneous vertebroplasty (PVP) combined with hollow screw placement as a treatment for patients with Kummell's disease and pedicle rupture. From January 2020 to January 2023, a total of 10 patients with Kummell's disease and pedicle rupture confirmed via imaging underwent three-column intensive therapy using hollow screws combined with PVP. There were two males and eight females with an average age 75.7±6.11 years old. The time of operation, bone cement injection amount, bone cement leakage during operation were recorded. X-ray and CT were reexamined after operation. The improvement in quality of life was assessed using the Oswestry Disability Index (ODI), and the improvement in low back pain was assessed using the visual analogue scale (VAS). Hollow screw placement combined with PVP was successfully performed in all patients. The average operation time was 39.2±5.1 min, and the average volume of bone cement injected was 5.85±0.83mL. No leakage of bone cement into spinal canal occurred.The mean preoperative ODI score was 75.70±4.39, but this decreased significantly postoperatively(P<0.05), being 37.70±6.95 at 1 day and 26.40±4.90, 23.70±4.87, 21.70±5.46, and 20.50±4.21 at 1, 3, 6, and 12 months after the operation, respectively. The mean VAS pain score before the operation was 8.35±0.63, but the symptoms of back pain were significantly relieved after operation(P<0.05). The mean VAS scores 1 day and 1, 3, 6, and 12 months after the operation were 3.45±0.47, 2.55±0.60, 1.89±0.48, 1.50±0.27, and 1.12±0.20, respectively. Hollow screw placement combined with percutaneous vertebroplasty serves as a valuable three-column intensive treatment for patients with Kummell's disease and pedicle rupture. This procedure has the advantages of minimal trauma, less pain and quick recovery. The strong anchoring of bone cement and hollow screws provides stable and firm healing conditions for vertebral and pedicle fractures.

Finite element analysis of vertebroplasty in the osteoporotic T11-L1 vertebral body: Effects of bone cement formulation.

Vertebral compression fractures are one of the most severe clinical consequences of osteoporosis and the most common fragility fracture afflicting 570 and 1070 out of 100,000 men and women worldwide, respectively. Vertebroplasty (VP), a minimally invasive surgical procedure that involves the percutaneous injection of bone cement, is one of the most efficacious methods to stabilise osteoporotic vertebral compression fractures. However, postoperative fracture has been observed in up to 30% of patients following VP. Therefore, this study aims to investigate the effect of different injectable bone cement formulations on the stress distribution within the vertebrae and intervertebral discs due to VP and consequently recommend the optimal cement formulation. To achieve this, a 3D finite element (FE) model of the T11-L1 vertebral body was developed from computed tomography scan data of the spine. Osteoporotic bone was modeled by reducing the Young's modulus by 20% in the cortical bone and 74% in cancellous bone. The FE model was subjected to different physiological movements, such as extension, flexion, bending, and compression. The osteoporotic model caused a reduction in the average von Mises stress compared with the normal model in the T12 cancellous bone and an increment in the average von Mises stress value at the T12 cortical bone. The effects of VP using different formulations of a novel injectable bone cement were modeled by replacing a region of T12 cancellous bone with the materials. Due to the injection of the bone cement at the T12 vertebra, the average von Mises stresses on cancellous bone increased and slightly decreased on the cortical bone under all loading conditions. The novel class of bone cements investigated herein demonstrated an effective restoration of stress distribution to physiological levels within treated vertebrae, which could offer a potential superior alternative for VP surgery as their anti-osteoclastogenic properties could further enhance the appeal of their fracture treatment and may contribute to improved patient recovery and long-term well-being.

Effectiveness and Safety of Vertebral Body Stenting for Acute Spinal Compression Fractures due to Primary Osteoporosis: A Multicenter Prospective Clinical Study.

Segmental spinal deformity results from vertebral compression fracture (VCF) and progressive collapse of the fractured vertebral body (VB). The VB stenting (VBS) systemⓇ comprises a balloon-assisted, expandable, intrasomatic, metal stent that helps maintain the restored VB during balloon removal and cement injection, which minimizes cement leakage. We performed a prospective, multicenter, clinical trial of the VBS system in Japanese patients with acute VCF owing to primary osteoporosis. Herein, 88 patients, 25 men and 63 women aged 77.4±8.3 years, with low back pain, numerical rating scale (NRS) score of ≥4, and mean VB compression percentage (VBCP) of <60% were enrolled. The primary endpoints were the VBCP restoration rate and reduction in low back pain 1 month and 7 days after VBS surgery, respectively. Secondary endpoints included changes in VBCP, NRS pain score, Beck index, kyphosis angle, and quality of life according to the short form 36 (v2) score. Safety was assessed as adverse events, device malfunctions, and new vertebral fractures. Overall, 70 patients completed the study. VBS surgery increased the restoration rates of anterior and midline VBCP by 31.7%±26.5% (lower 95% confidence intervals (CI): 26.8) and 31.8%±24.6% (lower 95% CI: 27.2), respectively, and the reduction in NRS pain score was -4.5±2.4 (upper 95% CI: -4.0). As these changes were greater than the predetermined primary endpoint values (20% for VBCP and -2 for NRS score), they were judged clinically significant; these changes were maintained throughout the 12-month follow-up (p<0.001). Likewise, significant improvement was observed in the Beck index, kyphosis angle, and quality of life score, which were maintained throughout the follow-up. There were three serious adverse events. New fractures occurred in 12 patients-all in the adjacent VB. VBS surgery effectively restored the collapsed VB, relieved low back pain, and was tolerable in patients with acute osteoporotic VB fracture.

Comparison Between Intraoperative Target Area Cement-Enhanced Percutaneous Vertebroplasty and Conventional Percutaneous Vertebroplasty for Osteoporotic Thoracolumbar Non-Total Vertebral Fractures.

To compare the efficacy and feasibility of target area cement-enhanced percutaneous vertebroplasty (PVP) and conventional PVP in osteoporotic thoracolumbar non-total vertebral fractures. Retrospective analysis of one hundred and two patients treated in our hospital from March 2020 to May 2021 and divided into groups A (targeted) and B (conventional PVP). The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height ratio, intraoperative bleeding, operative time, bone cement volume, complications, and refracture of the injured vertebra were evaluated in both groups. The 2 days and 1-year post-operative VAS and ODI scores improved significantly in both groups (p < 0.05). The 2 days post-operative VAS and ODI scores were better in group A (p < 0.05), and there was no significant difference in the scores between the groups at the last follow-up (p > 0.05). The anterior vertebral height ratios were significantly higher in both groups 2 days postoperatively (p < 0.05); however, there was no significant difference in the 2 days and 1-year post-operative ratios in group A (p > 0.05). The anterior vertebral height ratio reduced in group B after 1 year compared to the 2 days post-operative value (p < 0.05). There was no statistical difference in intraoperative bleeding and the operative time between the groups (p > 0.05), and the bone cement volume was lesser in group A (p < 0.05). Six patients in group A and four patients in group B demonstrated cement leakage, the difference was not statistically significant (p > 0.05). Three patients in group A and 11 patients in group B demonstrated refracture, the difference was statistically significant (p < 0.05). Target area cement-enhanced PVP can effectively relieve short-term pain and functional disability and reduce the long-term possibility of secondary collapse. Therefore, it is a technically feasible and efficacious method for the treatment of osteoporotic thoracolumbar non-total vertebral fractures.

Short-term Treatment Comparison of Teriparatide and Percutaneous Vertebroplasty in Patients with Acute Osteoporotic Vertebral Compression Fractures

Short-term Treatment Comparison of Teriparatide and Percutaneous Vertebroplasty in Patients with Acute Osteoporotic Vertebral Compression Fractures

Estimated number of spine surgeries and related deaths in Japan from 2014 to 2020

BackgroundThe total number of spine surgeries per year and their related deaths in Japan has not been adequately estimated in the literature. MethodsWe retrospectively reviewed the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) between April 2014 to March 2021, which covers 99.9% of health insurance claim receipts by general practitioners. The annual number of surgeries was counted using K codes, a procedure classification unique to Japan, and classified into the following six categories; percutaneous vertebroplasty, endoscopic surgery, open discectomy, laminoplasty/laminectomy, instrumentation surgery, and others. The data distribution was also summarized by sex and age. Additionally, by reviewing DPC database-related papers for evaluation of the mortality rate after spine surgery in Japan, the number of spine surgery-related deaths was calculated. ResultsThe NDB showed that the number of spine surgeries analyzed in this study increased from 170,081 in 2014 to 193,903 in 2019, with a slight decrease in 2020. The ratio of instrumentation surgery increased from 33.0% in 2014 to 37.9% in 2020. The rate of patients aged 75 or older increased 31.6% to 39.6%. Combining these findings with DPC data showing a mortality rate of 0.1% to 0.4% revealed that the estimated number of deaths related to spine surgery in Japan ranged from 200 to 800 per year. ConclusionsApproximately 200,000 spine surgeries and 200 to 800 spine surgery-related inpatient deaths were estimated to have occurred in Japan around 2020.

Development of patient-tailored preoperative assessment of percutaneous vertebroplasty.

Percutaneous vertebroplasty (PVP), a minimally invasive surgery technique, has become the common treatment for osteoporotic vertebral compression fractures (OVCF). The complications of PVP will lead to severe damage to spinal neuro systems due to bone cement leakage. A patient tailored preoperative assessment approach was developed to reduce the risks of complications in this study. The porcine OVCF model was fabricated to mimic the patient vertebral fracture in vitro using decalcification process. The 3D reconstructed model based on the imagological examination data acquired from the porcine vertebral bone was implemented for finite element (FE) simulation. The vertebral body with bone cement injected was scanned using CT for comparison with the finite element simulation results. This study showed a practical method for predicting the flow of bone cement in OVCF, which enabled the surgeons to evaluate the bone cement flow during preoperative assessment to reduce the cement leakage risks.

Risk factors for low back pain following percutaneous vertebroplasty in patients with osteoporotic vertebral compression fracture.

To investigate the occurrence and risk factors for low back pain post-percutaneous vertebroplasty (PVP) in osteoporotic vertebral compression fractures (OVCF) patients. A retrospective analysis was conducted of 148 OVCF patients treated from March 2020 to 2023. The incidence of low back pain post-PVP was recorded, and logistic regression analysis was used to identify associated risk factors. Low back pain occurred in 34 out of 148 patients (22.97%). Logistic regression identified age (>75) (P=0.039), number of fractured vertebrae (≥2) (P=0.004), presence of lumbar spine comorbidity (P=0.019), emotional status (P=0.006), site of fracture (P=0.006), and preoperative fascial injury (P=0.039) as independent risk factors influencing the development of low back pain after PVP in OVCF patients. Receiver operating characteristic (ROC) curve analysis showed that age (>75), number of fractured vertebrae (≥2), lumbar spine comorbidities, and site of fracture had area under the curve (AUC) values of 0.626, 0.614, 0.623, and 0.667, respectively, in predicting low back pain post-PVP. Age, number of fractured vertebrae, presence of lumbar spine comorbidities, emotional status, site of fracture, and preoperative fascial injury are significant independent risk factors for the occurrence of low back pain after PVP in patients with OVCF. These findings are crucial for alleviating postoperative low back pain and provide valuable insight for postoperative pain management.

Cement Leakage Route in Balloon Kyphoplasty

Cement Leakage Route in Balloon Kyphoplasty

Vertebral augmentation by kyphoplasty in osteoporotic vertebral fractures: A clinical experience

Vertebral augmentation by kyphoplasty in osteoporotic vertebral fractures: A clinical experience

Efficacy of lumbar and abdominal muscle rehabilitation training on degree of osteoporosis, pain and anxiety in elderly patients with osteoporotic vertebral compression fracture after PKP and compliance analysis.

To explore the rehabilitation effect and compliance of lumbar and abdominal muscle rehabilitation training in patients with osteoporotic vertebral compression fracture (OVCF) after percutaneous balloon vertebroplasty (PKP). A total 177 elderly patients with OVCF were divided into rehabilitation group (n = 104) and control group (n = 73) according to whether they received psoas and abdominal muscle rehabilitation training for 3 months after PKP. The differences of general data, orthopaedic rehabilitation, prognosis and bone metabolism were compared between the two groups. All the patients were divided into compliance group (68 cases) and non-compliance group (36 cases) according to compliance. Orthopaedic rehabilitation indicators, prognostic indicators of PKP, and bone metabolism-related parameters were collected for analysis of Chi-square test and Logistic regression. ROC curve was used to analyze the predictive value of bone metabolism related indicators in the compliance of lumbar and abdominal muscle rehabilitation training. There was no significant difference in the general data between the rehabilitation training group and the control group (All p > 0.05). Compared with the control group, the Berg balance scale score was significantly increased, while the Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI) score and the proportion of new fractures were significantly decreased in the rehabilitation training group (All p < 0.05). Compared with the control group, the bone mineral density (BMD) T value, osteocalcin (OCN) and 25-hydroxyvitamin D (25 (OH) D) levels were significantly increased and the levels of type I N-propeptide (P1NP) and β-isomerized C-terminal telopeptides (β-CTX) were significantly decreased in the rehabilitation training group compared with the control group (All p < 0.05). Chi-square test and Logistic regression analysis showed that age > 75 years, severe anxiety, severe pain and postoperative complications were significantly associated with the compliance of psoas and abdominal muscle rehabilitation training in patients with OVCF after PKP. ROC curve analysis showed that BMD T value, OCN, P1NP, β-CTX, or 25-OH-D levels predicted the AUC of rehabilitation training compliance in patients with OVCF after PKP were 0.821, 0.835, 0.736, 0.715, and 0.748, respectively. Rehabilitation training of lumbar and abdominal muscles can significantly improve the efficacy of PKP, reduce the degree of osteoporosis and improve the prognosis of patients with OVCF. Age, anxiety, pain and postoperative complications were independent risk factors affecting the compliance of psoas and abdominal rehabilitation training in patients with OVCF after PKP.

Rate of unexpected malignancy in patients with vertebral compression fracture undergoing percutaneous vertebroplasty – six years after implementation of a new magnetic resonance imaging scanning protocol

Rate of unexpected malignancy in patients with vertebral compression fracture undergoing percutaneous vertebroplasty – six years after implementation of a new magnetic resonance imaging scanning protocol

Effect of percutaneous vertebroplasty on the treatment of osteoporotic spinal fractures in elderly patients and risk factors for postoperative lower extremity deep vein thrombosis.

To evaluate the effectiveness of PVP (PVP) in treating osteoporotic spinal fractures in the elderly and analyze the risk factors for postoperative deep vein thrombosis (DVT) in the lower extremities. A total of 100 elderly patients with osteoporotic spinal fractures, treated between August 2019 and July 2021, were divided into two groups: PVP (research group, n=50) and conservative treatment (control group, n=50). Outcome measures, including injured vertebrae, pain levels, and treatment outcomes, were retrospectively analyzed. Patients who underwent PVPs were further categorized based on the presence of lower extremity DVT one month post-surgery. Logistic regression analysis was used to identify risk factors for post-surgical lower limb DVT. PVP resulted in a significantly smaller posterior convexity angle of the injured spine and higher anterior, midline, and posterior edges of the injured spine compared to conservative treatment (P<0.001). Patients in the research group had significantly lower visual analogue scale (VAS) scores and higher treatment efficiency compared to those in the conservative treatment group (all P<0.05). Nine cases of lower extremity DVT were observed after PVP. Logistic regression analysis identified age, body mass, smoking, and diabetes as independent risk factors for post-surgical lower extremity DVT. PVP improves spinal function and relieves pain in elderly patients with osteoporotic fractures. However, age, body mass, smoking, and diabetes are independent risk factors for postoperative lower extremity DVT.

Efficacy of secondary targeted percutaneous vertebroplasty for the treatment of refracture of cemented vertebrae after percutaneous vertebral augmentation

Efficacy of secondary targeted percutaneous vertebroplasty for the treatment of refracture of cemented vertebrae after percutaneous vertebral augmentation

Effectiveness and safety of percutaneous vertebroplasty in patients with compression fractures of vertebral bodies associated with multiple myeloma

Effectiveness and safety of percutaneous vertebroplasty in patients with compression fractures of vertebral bodies associated with multiple myeloma

Risk factors for the outcome and prognosis of multiple myeloma patients with pathological fractures undergoing percutaneous vertebroplasty.

This study focuses on the clinical features affecting the outcome and prognosis of multiple myeloma (MM) associated with spinal fractures. We retrospectively analyzed the clinical data of 194 MM patients with pathologic thoracic or lumbar spine fractures admitted to Dongying People's Hospital from April 2005 to February 2021. Patients were categorized into effective and ineffective groups based on post-treatment pain scores and mobility to analyze the influencing factors on the efficacy. Univariate analysis showed that age ≥60 years, number of vertebral fractures ≥2, and conservative treatment were associated with the outcomes. The number of vertebral fractures ≥2 (OR=2.198, P=0.034) and conservative treatment (OR=1.685, P=0.012) were identified as independent risk factors. In addition, survival curves were depicted using the Kaplan-Meier method, and independent risk factors affecting 2-year survival included efficacy (HR=17.924, P<0.001), age (HR=3.544, P=0.003) and International Staging System staging (HR=10.770, P=0.001). Finally, we constructed a high-accuracy prognostic model for predicting 2-year survival of MM patients with pathologic fractures (AUC=0.756). In conclusion, this study identified independent risk factors affecting the outcome and survival of MM patients with morbid fractures by systematically analyzing clinical characteristics and constructing a survival prediction model, thus providing effective guideline for clinical treatment.

Double Balloon Kyphoplasty: Innovative vertebral fracture treatment, utilized standalone or in hybrid procedures. A 14-year follow-up on 500+ patients showcases its efficacy.

Double Balloon Kyphoplasty: Innovative vertebral fracture treatment, utilized standalone or in hybrid procedures. A 14-year follow-up on 500+ patients showcases its efficacy.

Efficacy of cement augmented screws for the treatment of re-collapse of cemented vertebrae after percutaneous vertebral augmentation

Efficacy of cement augmented screws for the treatment of re-collapse of cemented vertebrae after percutaneous vertebral augmentation