Kyphoplasty For Osteoporotic Vertebral Fractures Research Articles

Outcomes of kyphoplasty in osteoporotic vertebral fractures: A day care procedure

Outcomes of kyphoplasty in osteoporotic vertebral fractures: A day care procedure

Treatment of balloon kyphoplasty for osteoporotic vertebral fractures with middle column compromise

Treatment of balloon kyphoplasty for osteoporotic vertebral fractures with middle column compromise

Osteointegration and Resorption of Intravertebral and Extravertebral Calcium Phosphate Cement.

Eleven patients with painful osteoporotic vertebral fractures who underwent kyphoplasty using calcium phosphate (CaP) cement were followed up for 1 week, 1, 2, and 3 years in a monocentric, nonrandomized, noncontrolled retrospective trial. This study investigates long-term radiomorphologic features of intraosseous CaP cement implants and of extraosseous CaP cement leakages for up to 3 years after implantation by kyphoplasty. Kyphoplasty is frequently used for the treatment of painful osteoporotic fractures. Of the materials available, CaP is frequently used as a filling material. Resorption of this material is frequently observed, although clinical outcome is comparable with other cements. Kyphoplasty utilizing CaP cement was performed in 11 patients with painful osteoporotic vertebral fractures. All patients received a pharmacological antiosteoporosis treatment consisting of calcium, vitamin D, and a standard dose of oral bisphosphonates. Radiomorphologic measurements, pain, and mobility were assessed. Intraosseous and extraosseous CaP cement volumes decreased significantly over 3 years. However, vertebral stability as determined by a constant vertebral body height and the sagittal index was not impaired. Pain improved significantly 2 years after implantation and the mobility scores 1 year after kyphoplasty at least until the third year. Intravertebral CaP cement implants are resorbed slowly over time without jeopardizing stability and clinical outcomes most likely because of a slowly progressing osseous replacement. Extraosseous CaP cement material because of leakages during the kyphoplasty procedure is almost completely resorbed as early as 2 years after the leakage occurred. Therefore, CaP cement is an important alternative to PMMA-based cement materials utilized for kyphoplasty of osteoporotic vertebral fractures.

Decreased extrusion of calcium phosphate cement versus high viscosity PMMA cement into spongious bone marrow—an ex vivo and in vivo study in sheep vertebrae

Background ContextVertebroplasty or kyphoplasty of osteoporotic vertebral fractures bears the risk of pulmonary cement embolism (3.5%–23%) caused by leakage of commonly applied acrylic polymethylmethacrylate (PMMA) cement to spongious bone marrow or outside of the vertebrae. Ultraviscous cement and specific augmentation systems have been developed to reduce such adverse effects. Rapidly setting, resorbable, physiological calcium phosphate cement (CPC) may also represent a suitable alternative. PurposeThis study aimed to compare the intravertebral extrusion of CPC and PMMA cement in an ex vivo and in vivo study in sheep. Study Design/SettingA prospective experimental animal study was carried out. MethodsDefects (diameter 5 mm; 15 mm depth) were created by a ventrolateral percutaneous approach in lumbar vertebrae of female Merino sheep (2–4 years) either ex vivo (n=17) or in vivo (n=6), and injected with: (1) CPC (L3); (2) CPC reinforced with 10% poly(l-lactide-co-glycolide) (PLGA) fibers (L4); or (3) PMMA cement (L5; Kyphon HV-R). Controls were untouched (L1) or empty defects (L2). The effects of the cement injections were assessed in vivo by blood gas analysis and ex vivo by computed tomography (CT), micro-CT (voxel size: 67 µm), histology, and biomechanical testing. ResultsFollowing ex vivo injection, micro-CT documented significantly increased extrusion of PMMA cement in comparison to CPC (+/− fibers) starting at a distance of 1 mm from the edge of the defect (confirmed by histology); this was also demonstrated by micro-CT following in vivo cement injection. In addition, blood gas analysis showed consistently significantly lower values for the fraction of oxygenized hemoglobin/total hemoglobin (FO2Hb) in the arterial blood until 25 minutes following injection of the PMMA cement (p ≤ .05 vs. CPC; 7, 15 minutes). Biomechanical testing following ex vivo injection showed significantly lower compressive strength and Young modulus than untouched controls for the empty defect (40% and 34% reduction, respectively) and all three cement-injected defects (21%–27% and 29%–32% reduction, respectively), without significant differences among the cements. ConclusionsBecause of comparable compressive strength, but significantly lower cement extrusion into spongious bone marrow than PMMA cement, physiological CPC (+/− PLGA fibers) may represent an attractive alternative to PMMA for vertebroplasty or kyphoplasty of osteoporotic vertebral fractures to reduce the frequency or severity of adverse effects.

A case report of balloon kyphoplasty for osteoporotic vertebral fracture with lumbar radiculopathy

A case report of balloon kyphoplasty for osteoporotic vertebral fracture with lumbar radiculopathy

Factors affecting recompression of augmented vertebrae after successful percutaneous balloon kyphoplasty: a retrospective analysis.

The instantaneously recovered stability and strength following vertebral augmentation prevent continuous micro-motion and further collapse of fractured vertebrae. Despite this, during follow-up of our patients, we observed recompression of augmented vertebrae with significant vertebral height loss and aggravation of local kyphotic deformity. To identify the risk factors related to recompression and to evaluate the clinical significance of recompression. One hundred and twenty-one patients who underwent single-level kyphoplasty for osteoporotic vertebral fractures were retrospectively analyzed and classified into the following two groups: group 1 with recompression and group 2 without recompression. Characteristics of patients and fractured vertebrae were compared between the two groups. Univariate and multivariate regression analyses were performed to identify risk factors for recompression. We evaluated the visual analogue scale (VAS) and the Oswestry disability index (ODI) scores in both groups to elucidate the clinical impact. During an average of 20.75 ± 4.43 months of follow-up, 17 augmented vertebrae developed recompression. In the recompression group, vertebral height loss was accompanied by significantly aggravated local kyphotic deformity. The local kyphotic angle differed significantly between the two groups at final follow-up (P = 0.011). However, the VAS and ODI scores were maintained at final follow-up in both groups although the values were slightly higher in group 1. Solid lump distribution pattern (OR = 8.718; P = 0.003) and the degree of vertebral height restoration (OR = 1.260; P < 0.001) were identified as the most important risk factors for recompression. Fractured vertebrae containing solid lump cement and those with more vertebral height restoration are at higher risk of recompression. More attention should be given to these patients considering the aggravated local kyphotic deformity.

Percutaneous Vertebroplasty versus Balloon Kyphoplasty for Osteoporotic Vertebral Fracture with Intravertebral Cleft

Percutaneous Vertebroplasty versus Balloon Kyphoplasty for Osteoporotic Vertebral Fracture with Intravertebral Cleft

Vertebroplasty vs kyphoplasty in osteoporotic vertebral fractures: a finite element comparative analysis

Searchable abstracts of presentations at key conferences on calcified tissues ISSN 2052-1219 (online)

Complications and safety aspects of kyphoplasty for osteoporotic vertebral fractures: a prospective follow-up study in 102 consecutive patients

BackgroundKyphoplasty represents an established minimal-invasive method for correction and augmentation of osteoporotic vertebral fractures. Reliable data on perioperative and postoperative complications are lacking in the literature. The present study was designed to evaluate the incidence and patterns of perioperative complications in order to determine the safety of this procedure for patients undergoing kyphoplasty.Patients and MethodsWe prospectively enrolled 102 consecutive patients (82 women and 20 men; mean age 69) with 135 operatively treated fractured vertebrae who underwent a kyphoplasty between January 2004 to June 2006. Clinical and radiological follow-up was performed for up 6 months after surgery.ResultsPreoperative pain levels, as determined by the visual analogous scale (VAS) were 7.5 +/- 1.3. Postoperative pain levels were significantly reduced at day 1 after surgery (VAS 2.3 +/- 2.2) and at 6-month follow-up (VAS 1.4 +/- 0.9). Fresh vertebral fractures at adjacent levels were detected radiographically in 8 patients within 6 months. Two patients had a loss of reduction with subsequent sintering of the operated vertebrae and secondary spinal stenosis. Accidental cement extravasation was detected in 7 patients in the intraoperative radiographs. One patient developed a postoperative infected spondylitis at the operated level, which was treated by anterior corporectomy and 360 degrees fusion. Another patient developed a superficial wound infection which required surgical revision. Postoperative bleeding resulting in a subcutaneous haematoma evacuation was seen in one patient.ConclusionThe data from the present study imply that percutaneous kyphoplasty can be associated with severe intra- and postoperative complications. This minimal-invasive surgical procedure should therefore be performed exclusively by spine surgeons who have the capability of managing perioperative complications.

Traitements non médicamenteux de l'ostéoporose

Objectives Study the effectiveness of nonpharmacological treatments for osteoporosis. Method Review and qualitative analysis of the literature concerning the effectiveness of nonpharmacological treatments: physical exercise, rehabilitation aiming to prevent falls, spinal orthosis, and vertebro- and kyphoplasty. Results The level of evidence of the effectiveness of nonpharmacological treatment is unequal on the basis of randomized study. The practice of physical exercise by the ambulatory elderly people and home rehabilitation for those who have previously fallen prevent the occurrence of falls. For institutionalized people, the prevention of falls is achieved by multidisciplinary programs. The use of hip protectors to prevent fracture is controversial. Physical exercises prevent bone loss after menopause and during postmenopausaul and corticosteroid osteoporosis. The effectiveness of mobilization after fracture is not documented. Only one study concerning the use of spinal orthosis after vertebral fracture reports interesting results for pain and disability. No randomized study concerning vertebroplasty or kyphoplasty for osteoporotic vertebral fracture is described. Conclusion The nonpharmacological treatments of osteoporosis are considered therapeutic means of key importance. They aim at the prevention of falls and bone loss and the reduction of disability after fracture. Only physical exercise and rehabilitation have been shown to be effective in preventing falls or bone loss. Their ability to reduce the incidence of fractures remains to be evaluated.

A Comparative Biomechanical Study of HA Block Kyphoplasty for Osteoporotic Vertebral Fractures

We innovated a new technique and hydroxyapatite material “HA Block” in order to decrease complications such as pulmonary embolization and correct kyphosis due to osteoporosis. A cadaveric study of vertebroplasty was attempted to confirm accurate the efficacy for three materials in terms of restoration of vertebral height, strength and stiffness after packing HA Block as compared with Polymethylmethacrylate Cement (PMMA) and alpha-tri-calcium phosphate cement (Biopex-R) in cadaveric study. By using thoracolumber spines derived from elderly human cadavers, two kinds of vertebral fracture models: Flat and Wedge were made on MTS 858 Mini. Restoration rate after packing each material was best for HA Block. The strength of HA Block was somewhat lower than PMMA and Biopex-R. It is suggested that HA Block had moderate and optimal strength to reduce stress to adjuscent vertebra and was enable to correct kyphosis in osteoporotic spine.

Vertebroplasty and Kyphoplasty for Osteoporotic Vertebral Fractures

Percutaneous vertebroplasty and balloon kyphoplasty are increasingly popular new interventions for painful vertebral compression fractures. In percutaneous vertebroplasty, a trocar is inserted into the vertebral body, and polymethylmethacrylate cement is injected. In balloon kyphoplasty, a balloon is inflated inside the compressed vertebral body to restore height before cement is injected. In 2 reports, researchers described …