Osteoporotic Thoracolumbar Compression Fractures Research Articles

Modified percutaneous Kyphoplasty technique in the treatment of osteoporotic thoracolumbar burst fractures: could it reduce the odds of cement leakage?

BackgroundOsteoporotic thoracolumbar burst fracture (OTLBF) is common in seniors. Due to the fracture of the posterior vertebra and spinal canal occupancy, the risk of cement leakage and spine injury is high in OTLBF patients, thus the application of vertebroplasty and kyphoplasty is limited in these patients. This study aims to investigate the efficacy and safety of the modified percutaneous kyphoplasty (MPKP) in the treatment of OTLBF.MethodsClinical data of the OTLBF patients treated with MPKP and the osteoporotic thoracolumbar compression fracture (OTLCF) patients undergone PKP from January 2014 to June 2016 were collected. The key procedure of the MPKP was to fill the bone cavity with gel-foam by the first balloon inflation and to press the gel-foam by a second balloon inflation. Pain intensity, Oswestry disability index (ODI), and bone cement leakage of the patients in the two groups were analyzed.ResultsIn the burst fracture group, the overall spinal canal occupancy was relatively low, and the maximum occupancy was 1/3 of the sagittal diameter of the spinal canal. The surgical duration was longer in the burst fracture group (39.0 ± 5.0 min with 95% CI: 37.7, 40.3) than in the compression fracture group (31.7 ± 4.3 min with 95% CI: 31.1, 32.3), and the difference between the two groups was statistically significant (Z = -8.668 and P = 0.000). Both the Oswestry disability index (ODI) and the visual analog scales (VAS) were apparently improved, but there was no significant difference between the two groups. Cement leakage occurred in 13 out of the 53 cases (24.5%) in the burst fracture group and 35 out of the 193 cases (18.1%) in the compression fracture group, and there was no significant difference between the two groups (Z = − 1.038 and P = 0.299). Neither group had consequential symptoms, such as spinal cord lesion, pain, and numbness of the peripheral nerve.ConclusionSimilar to the efficacy of PKP in the treatment of OTLCF, MPKP efficiently reduced the cement leakage rate and improved the safety of the surgery, although it prolonged the surgical duration and introduced more surgical steps.

Application of ultrasound fusion imaging technique for unilateral percutaneous vertebroplasty in treatment of osteoporotic thoracolumbar compression fracture.

To evaluate application of a computed tomography (CT)-ultrasound fusion imaging technique to unilateral percutaneous vertebroplasty (PVP) for treating patients with osteoporotic thoracolumbar compression fracture. Fourteen patients with osteoporotic thoracolumbar compression fractures were included, randomly divided into CT-ultrasound fusion imaging (n = 7) and traditional X-ray fluoroscopy groups (n = 7). Patients in the first group underwent unilateral PVP using real-time CT-ultrasound fusion imaging. A body surface locator was placed on the side contralateral to the scheduled puncture site (2-3 cm from the spinous process). Patient CT image information was recorded in the ultrasound system for registration during real-time ultrasound and CT fusion imaging, and one-click automatic registration was then performed. The puncture point and target point at which the puncture needle arrived were determined on CT images, with the puncture being performed under ultrasound guidance. Patients in the second group underwent X-ray fluoroscopy-guided PVP. Bone cement injection was injected under monitoring using a C-arm X-ray system. Patients' X-ray exposure and puncture times were recorded and compared between the two groups. The average puncture times in the CT-ultrasound fusion imaging and traditional X-ray fluoroscopy groups were 2.50±0.31 min (without exposing patients and operators to radiation) and 5.00±0.65 min (with the same duration of radiation exposure), respectively. The average times for bone cement injection were 3.29±0.81 min and 3.50±0.86 min, respectively. The mean visual analog scale (VAS) scores were 2.10±0.11 and 2.20±0.21, respectively. The bone cement was evenly distributed without cement leakage in patients in the CT-ultrasound fusion imaging group, but a poor distribution of bone cement and bone cement leakage were found in one patient in the traditional X-ray fluoroscopy group. Real-time CT-ultrasound fusion imaging is easy to perform, and provides precise localization of the puncture point, path, and target point. The selected puncture path was reasonable, and the needle had reached the target point accurately, which increased the success rate of puncture without radiation exposure.

Gelfoam Embolization Technique to Prevent Bone Cement Leakage during Percutaneous Vertebroplasty: Comparative Study of Gelfoam only vs. Gelfoam with Venography.

ObjectivePercutaneous vertebroplasty (VP) has been used for the safe treatment of osteoporotic compression fracture. However, cement leakage is the most common complication. To reduce the leakage of bone cement, we did the gelfoam embolization during VP. The purpose of this study is to compare the safety and feasibility of different two gelfoam embolization technique during VP.MethodsTotal 127 patients (146 level) who had the thoracolumbar osteoporotic compression fracture were enrolled. Group A was treated by gelfoam-only technique and, Group B was treated by gelfoam with venography technique. We compared the incidence of bone cement leakage between two groups using post-operative computed tomography scan and X-ray.ResultsSeventy-four patients (81 levels) were treated with gelfoam-only technique (A), and 53 patients (65 levels) were treated with gelfoam with venography technique (B). There were 22 leakages on group A, and 19 leakages on group B. There was no statistical significant difference between two groups (Chi-square test, p-value =0.958). Incidence of leakage to spinal canal was 11 levels in Group A, 3 levels in group B, and there was statistical significant difference (Fisher's exact test, p-value=0.027).ConclusionComplication induced by the bone cement leakage are the most careful point during VP. Gelfoam embolization with venography is very easy and safe method. Gelfoam with venography technique could make lower the incidence of cement leakage to spinal canal.

Short-term Study of Bushen Jiangu Decoction Combined with PVP in the Treatment of Elderly Patients with Osteoporotic Thoracolumbar Vertebral Compression Fracture

To investigate the clinical effects of Bushen Jiangu Decoction combined with percutaneous vertebroplasty (PVP) in the treatment of elderly patients with osteoporotic thoracolumbar vertebral compression fracture (OVCF). Seventy-four elderly patients with OVCF were enrolled in our hospital and randomized by digital table method, 37 cases each. The control group received PVP treatment, and the observation group was treated with Bushen Jiangu Decoction on the basis of PVP treatment. Cobb angle, bone mineral density, Oswestry dysfunction index questionnaire (ODI) score, and visual analogue scale (VAS) were compared before and after treatment. After treatment, the Cobb angle of the observation group was smaller than that of the control group, and the bone density was higher than that of the control group (P<0.05). The ODI score of the observation group was lower than that of the control group after treatment (P<0.05); 1 month and 3 months after treatment, the VAS score of the 6-month observation group was lower than that of the control group (P<0.05). Bushen Jiangu Decoction combined with Western medicine in the treatment of elderly patients with OVCF can restore Cobb angle, increase bone density, reduce postoperative pain and improve thoracic and lumbar spine function.

Efficacy comparison of pedicle screw with vertebroplasty or intermediate screw for osteoporotic thoracolumbar compression fractures

Objective To compare the efficacy of pedicle screw with vertebroplasty (PSV) or intermediate screw (PSIS) for osteoporotic thoracolumbar compression fractures. Methods A retrospective case control study was conducted to analyze the clinical data of 141 patients with osteoporotic thoracolumbar vertebral compression fractures admitted to Honghui Hospital, College of Medicine, Xi'an Jiaotong University from January 1, 2012 to December 31, 2015. There were 59 males and 82 females, aged 60-75 years, with an average age of 65.4 years. All the fractures had bone mineral density (BMD) T value 15 degrees or anterior column compression > 40%. There were 65 patients with thoracic vertebral fractures (T10-T12) and 76 with lumbar vertebral fractures (L1-L4). Among all patients, 68 received PSV treatment (PSV group) and 73 received fixed PSIS treatment (PSIS group). The operation time, intraoperative blood loss, visual analogue scale (VAS), anterior height ratio, central height ratio, and segmental kyphosis angle at 3 days, 3 months, 6 months, 1 year and 2 years after operation were compared between the two groups. The complications were recorded. Results All patients were followed up for 25-31 months, with an average of 27.9 months. There were no significant differences in operation time and intraoperative blood loss between the two groups (P>0.05). VAS at each time point of postoperative follow-up was significantly lower than those before operation in both groups (P 0.05). Anterior height ratios of PSV group were higher than those of PSIP group at postoperative 3 months, 6 months, 1 year and 2 years (P<0.05) [(95.2±5.2) vs. (92.6±7.1), (93.8±5.2) vs. (91.4±3.2), (93.3±4.9) vs. (91.2±5.1), (92.6±5.5) vs. (90.1±4.7)]. The central height ratios of PSV group were higher than those of PSIP group at postoperative 6 months, 1 year and 2 years [(91.4 ±6.9) vs. (88.9±7.2), (90.8±7.4) vs. (88.4±5.9), (90.1±7.6) vs. (87.1±7.2)](P<0.05). Segmental kyphosis angle of PSV group was lower than that of PSIP group at postoperative 3 months, 6 months, 1 year and 2 years [(2.9±0.4)° vs. (3.2±0.9)°, (3.0±0.5)° vs. (3.2±0.3)°, (3.1±0.7)° vs. (3.4±0.4)°, (3.1±0.4)° vs. (3.4±0.7)°](P<0.05 or 0.01). Bone cement leakage from screws occurred in two patients in PSV group and three patients in PSIS group. Cement leakage occurred in the injured vertebra in four patients of PSV group, with no any symptom. In PSIS group, two patients suffered from one side rod breakage at 9 months and 1 year after surgery, respectively. CT showed sound bone healing, without any further management. Conclusion For osteoporotic thoracolumbar compression fractures, PSV can attain similar pain relief compared with PSIS, but the former is more conducive to reducing the loss of anterior and middle column height and correcting kyphosis deformity. Key words: Osteoporotic fractures; Spinal fractures; Bone cement

Therapeutic effect and imaging study of directional bone cement guide for the treatment of thoracolumbar vertebral compression fractures

To evaluate the therapeutic effects and bone cement distribution of unilateral percutaneous kyphoplasty (PKP) with oriented bone cement injector for thoracolumbar osteoporotic vertebral compression fractures (OVCFs). The clinical data of 211 patients (211 vertebrae) with thoracolumbar osteoporotic compression fractures underwent PKP between July 2016 to July 2018 were retrospectively analyzed. All punctures were performed unilaterally:102 patients in observation group used oriented bone cement injector including 30 males and 72 females with an average age of (68.4±8.9)years old; 109 patients in regular group used traditional bone cement injector including 32 males and 77 females with an average age of (70.4±9.2) years old. The two groups were compared in terms of duration of operation, cement volume, visual analogue scale(VAS), Oswestry Disability Index(ODI), distribution of bone cement, bone cement leakage and Cobb angle modified rate. There were no significant difference in gender, age and fracture vertebra between the two groups(P>0.05). No significant difference was found between two groups in duration of operation, cement volume, VAS, ODI and Cobb angle(P>0.05). In observation group, 10 cases occurred cement leakages, with leakage rate of 9.80%; and in regular group, 11 cases occurred cement leakage, with leakage rate of 10.09%. There was no significant difference in the cement leakage rate between two groups(P>0.05). In observation group, proportion rate of I-IV degree in cement distribution was 60.78%, 19.61%, 9.80%, 9.80%, respectively; while 39.45%, 22.93%, 22.93%, 14.68% in regular group. The I degree of cement cross-filling rate was better in observation group than in regular group(P<0.05). There was no significant difference between two groups in II degree distribution rate of bone cement(P>0.05). From T10 to L₅, I degree bone cement distribution rate of both groups showed decline trend. The I degree cement cross-filling rate in L₁-L₅ was 50% in observation group and 30.23% in regular group(P<0.05). Oriented bone cement injector can control the direction of bone cement dispersion and achieve effective distribution of bilateral bone cement using unilateral puncture and satisfactory surgical results. It is feasible and effective for unilateral PKP treatment of OVCFs.

Re-expansion of Osteoporotic Compression Fractures Using Bilateral SpineJack Implants: Early Clinical Experience and Biomechanical Considerations.

Thoraco-lumbar osteoporotic compression fractures have a higher incidence of continued collapse with development of deformity and progression to vertebra plana when untreated and even after vertebral augmentation (VA) or balloon kyphoplasty (BKP). Even when there is the restoration of height and improvement in angulation, multiple long-term follow-up series have repeatedly documented that over time, many patients lose the initial height correction and in a smaller group the vertebral body re-collapses leading to the development of progressive deformity with an increased risk for adjacent level fractures. At first, larger balloons and more cement were used to try and avoid these problems, but it did not reduce the risk of adjacent fractures. Several procedures were developed to place various types of intervertebral implants combined with bone cement to maintain the initial height correction. Initial studies with these implants showed a reduction in adjacent level fractures but the systems did not proceed to market. The SpineJackR (SJ) system (Stryker Corp, Kalamazoo, MI), consisting of bilateral expandable titanium implants supplemented with bone cement, was first used approximately 10 years ago in Europe and recently gained FDA approval in the United States. This system provides more symmetric and balanced lateral and anterior support and is effective with lesser amounts of bone cement compared to BKP. Follow-up studies have documented that there is equal or better pain control, with better long-term results based both on maintaining vertebral height restoration and deformity correction. Most importantly, statistically it clearly reduces the risk of adjacent level fractures by at least 60%. The biomechanical effects of intravertebral implants for osteoporotic fractures in regard to the risk of adjacent level fractures and preliminary experience with the use of the SJ is reviewed.

Application of G arm X-ray machine in minimally invasive treatment of thoracolumbar vertebral osteoporotic vertebral compression fractures

Objective To compare the clinical effects of G-arm X-ray machine and C-arm X-ray machine in percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) of thoracolumbar spine. Methods The clinical data of ninety-five patients with thoracolumbar OVCF treated with PKP from May 2016 to August 2017 in Yanan University Affiliated Hospital were retrospectively analyzed.They were divided into two groups according to the different guiding fluoroscopy methods used during the operation.Forty-six cases in G arm group completed PKP under the guidance of G arm X-ray machine, Forty-nine cases in C arm group completed PKP under the guidance of C arm X-ray machine.The operation time, fluoroscopy times, cement leakage cases, the height of injured vertebral leading edge, Cobb angle of kyphosis, visual analogue score and Oswestry dysfunction index were recorded before and after operation, and the related indexes were analyzed and compared. Results Two groups of patients were successfully completed surgery, no complications of vascular and nerve injury.The operation time and fluoroscopy times in G arm group were less than those in C arm group (operation time: (29.6±4.5) min vs.(42.5±5.3) min, and fluoroscopy times in G arm group: (9.1±2.0) vs.(16.9±3.2)); the difference was statistically significant (t=-12.747, 12.870, P 0.05). Conclusion Using G-arm X-ray machine to assist PKP in the treatment of thoracolumbar spine OVCF can effectively shorten the operation time, reduce the intraoperative fluoroscopy time, and the clinical effect is satisfactory. Key words: Osteoporotic vertebral compression fracture; G-arm X-ray machine; C-arm X-ray machine; Spinal thoracolumbar

Can Three Months of Teriparatide Be One of Treatment Options for Osteoporotic Vertebral Compression Fracture Patients?

ObjectiveOsteoporosis is one of the most common causes of vertebral compression fractures (VCFs). Teriparatide, a recombinant human parathyroid hormone, is the first anabolic agent for the treatment of osteoporosis. The aim of this study was to determine whether 3 months of teriparatide could be effective for patients with osteoporotic VCF at the thoracolumbar spine.MethodsWe reviewed 25 patients with thoracolumbar osteoporotic compression fractures between July 2012 and October 2016 who could be followed up for more than 1 year. Patients were divided into 2 groups depending on the use of teriparatide: 14 patients received teriparatide through subcutaneous injection (group I) and 11 patients did not receive teriparatide (group II). Demographic data, bone mineral density, hospitalization period, changes in the visual analogue scale (VAS) score, body mass index, and medical history such as smoking, alcohol, diabetes, and steroid usage were reviewed. Radiographs were also reviewed to evaluate vertebral body compression percentages and kyphotic angles.ResultsOverall changes of VAS score between injury and follow-up were statistically improved in both groups at 2 to 3 weeks post-injury. However, difference in VAS improvement at a specific time between the 2 groups was not statistically significant. Overall kyphotic angle and compression percentage between injury and follow-up time were increased in group II than those in group I, although the difference between the 2 groups was not statistically significant.ConclusionThree-month of teriparatide did not show protective effects on progression of fractured vertebral body collapse or kyphotic changes in patients with osteoporosis.

A Feasibility Study of Acupuncture for Chronic Pain in Patients with Osteoporotic Thoracolumbar Compression Fracture: A Prospective Case Series

A Feasibility Study of Acupuncture for Chronic Pain in Patients with Osteoporotic Thoracolumbar Compression Fracture: A Prospective Case Series

Percutaneous balloon kyphoplasty, a good minimally invasive surgical option for osteoporotic thoracolumbar compression fracture

The aim of this study is to evaluate balloon kyphoplasty as a surgical option for osteoporotic thoracolumbar compression fracture. The study was conducted on 30 patients from January 2014 to December 2017. The anterior vertebral height, kyphotic angle and functional evaluation by Oswestry disability index (ODI) and visual analogue scale (VAS) score were recorded preoperatively, immediate post-operatively at 3, 6, 12 months and yearly then on. All patients showed improvement in mean kyphotic angle from 16.4 ± 3.5 to 5.6 ± 1.7 post-operatively and 8.4 ± 1.6 at final follow-up. There was significant increase in mean anterior vertebral height from 51 ± 7.3% before surgery to 75.5 ± 7.4% at one day after surgery and 71.2 ± 3.2% at the last follow-up. There was significant improvement in mean VAS score from 8.1 ± 0.9 before surgery to 2.2 ± 0.4 at one day, and 2.4 ± 0.3 at final follow-up. The improvement in patients’ ODI score after surgery from 71.4 ± 3.4 to 26.0 ± 4.8 at one day and 21.2 ± 5.5 at final follow-up was noted. The mean operating time was 45.5 ± 15.5 min for each vertebra. Within first day of surgery improvement in pain relief and mobility was experienced by all patients. The orthopedic balloon ruptured in one patient and it was replaced then procedure was continued with no complications. There were no neurological complications in all cases and there was no infections and any occurrence of symptomatic pulmonary embolism. In conclusion, balloon kyphoplasty is a good minimally invasive procedure where along with reduction of pain and disability there is also restoration of sagittal alignment post-operatively.

Clinical outcome of bone cement-augmented pedicle screw fixation for thoracolumbar refractures after percutaneous kyphoplasty

Objective To investigate the clinical therapeutic effects of bone cement-augmented pedicle screw fixation for cement vertebrae refractures with lower limb neurological symptoms after percutaneous kyphoplasty (PKP) in elderly patients with osteoporotic thoracolumbar compression fractures. Methods A total of 123 elderly patients with osteoporotic thoracolumbar compression fractures underwent PKP from December 2013 to December 2016 were retrospectively analyzed by case series study. Twelve patients had vertebral refracture with compression of the spinal cord or cauda equina which resulted in lumbosacral and leg pain, numbness and disability of ambulation and there were five males and seven females, with age of (69.2±7.1)years. Injured vertebrae was located at T12in five cases, at L1 in five and at L2 in two. Bone cement-augmented pedicle screw fixation through a standard posterior approach was utilized to treat all the 12 patients. Visual analogue scale (VAS), Oswestry disability index (ODI), anterior vertebral height compression ratio, and kyphotic angle at the preoperative time, one week postoperatively and last follow-up were recorded and compared. Intraoperative and postope-rative complications were also recorded. Results The mean duration of follow-up in all the patients was 26.7 months (range, 12-36 months). Intraoperative nerve injury, dural tear, leakage of bone cement, bone cement toxicity reaction, and pulmonary embolism were not observed during the surgery. The postoperative radiographs for all the 12 patients showed that the bone cement was distributed in cancellous bone and around the screw appropriately where there was no cement leakage out of the vertebral body or pedicle. Compared with preoperative scores, the average low back pain VAS, leg pain VAS and ODI at postoperative one week were improved by (2.2±0.7)points, (2.2±0.4)points and (33.2±8.9)points, respectively (P 0.05). Conclusion For elderly patients with spinal cord or cauda equina nerve compression symptoms after PKP for osteoporotic thoracolumbar compression fractures, the usage of posterior approach bone cement-augmented pedicle screw fixation can effectively correct kyphosis, relieve neurological symptoms and restore spinal stability. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Internal fixators; Vertebral refracture

Research progress in kyphoplasty and vertebroplasty for treatment of thoracolumbar osteoporotic compression fracture

Research progress in kyphoplasty and vertebroplasty for treatment of thoracolumbar osteoporotic compression fracture

Percutaneous Pedicle Screw Fixation with Polymethylmethacrylate Augmentation for the Treatment of Thoracolumbar Intravertebral Pseudoarthrosis Associated with Kummell’s Osteonecrosis

Purpose. The purpose of our study is to evaluate the therapeutic efficacy of short-segment percutaneous pedicle screw fixation with polymethylmethacrylate (PMMA) augmentation for the treatment of osteoporotic thoracolumbar compression fracture with osteonecrosis. Methods. Osteoporotic thoracolumbar compression fractures with avascular necrosis were treated by short-segment PPF with PMMA augmentation. Eighteen were followed up for more than 2 years. The kyphotic angle, compression ratio, visual analog scale (VAS) score for back pain, and the Oswestry Disability Index (ODI) were analyzed. In addition, radiologic and clinical parameters of PPF group were compared with percutaneous vertebroplasty (PVP) group. Results. Vertebral height and kyphotic angle of the compressed vertebral bodies were significantly corrected after the operation (P < 0.05). Further, restored vertebral height was maintained during the 2 or more years of postoperative follow-up. Compared to the PVP group the postoperative compression ratio and kyphotic angle were significantly lower in the PPF group (P < 0.05). The postoperative ODI and VAS of the PVP group were significantly higher than the PPF (P < 0.05). Conclusions. According to our results, short-segment PPF with PMMA augmentation may be an effective minimally invasive treatment for osteoporosis in cases of osteoporotic vertebral compression fractures with Kummell's osteonecrosis.

Clinical efficacy of percutaneous kyphoplasty in management of osteoporotic thoracolumbar vertebral compression fracture in the elderly

Objective To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) in surgical treatment of osteoporotic thoracolumbar vertebral compression fracture in the elderly. Methods From March 2007 to February 2013, 210 cases (100 males and 110 females; 55-91 years of age, mean 72.5 years) of osteoporotic vertebral compression fracture were treated with PKP. Single-segment fracture was observed in 180 cases, two-segment fracture in 20 cases and three-segment fracture in 10 cases. Lesion involved in 250 vertebrae located in the T6-L5 segment. Bone cement injected into each vertebra was 3-5 ml (mean, 4 ml). Treatment effects were assessed with vertebral height, Cobb angle and visual analogue score (VAS). Results At the follow-up of 6-15 months (mean 11 months), thoracic back pain significantly alleviated or disappeared. After operation, improvements were observed in VAS[(8.7±1.2) points vs (2.6±0.7) points], anterior vertebral height loss [(11.0±3.2) mm vs(5.5±0.8) mm], central vertebral height loss [(8.6±1.1) mm vs (3.3±1.0) mm], and Cobb angle [(29.8±4. 5)° vs (16.7±3.4)°] (P <0.01). Four patients appeared no pain or numbness in lower limbs although cement leak into disc. Whereas two patients had lower extremity nerve irritation because of cement leak into the spinal canal and recovered after symptomatic treatment. Conclusion PKP is an effective method for treatment of osteoporotic vertebral compression fracture in the elderly, for it can rebuild vertebral height, increase vertebral rigidity as well as stability and relieve thoracic back pain. Key words: Spinal fractures; Osteoporosis; Percutaneous kyphoplasty

Clinical comparative study of percutaneous kyphoplasty in treatment of acute and chronic and nonunion osteoporotic vertebral compression fractures and the operative opportunity

Objective Clinical comparative study of percutaneous kyphoplasty in treatment of acute and chronic and nonunion osteoporotic vertebral compression fractures and the operative opportunity. Methods Totally 91 elderly with osteoporotic thoracolumbar vertebral compression fractures were treated by PKP and divided into acute and chronic and nonunion fracture group, acute fracture group 59 patients,chronic and nonunion fracture group 32 patients, the surgical outcomes were evaluated by using visual analogue scale(VAS), Oswestry disability index(ODI)system, kyphosis angle(cobb method), the height of vertebrae body before and after 1 week, 3 months after surgery. Results All patients had rapid and significant improvement in back pain following percutaneous kyphoplasty.and followed 6- 12 and 3 months after surgery(P 0.05). The kyphosis angle(cobb method), the height of vertebrae body were improved significantly at 1 week and 3 months after surgery(P<0.05), and the acute fracture group was improved significantly than the chronic and nonunion fracture group(P<0.05). Conclusion The curative effect of percutaneous kyphoplasty for the treatment of acute painful osteoporotic vertebral compression fracture(POVCFs) and chronic and nonunion POVCFs was satisfactory, the kyphosis angle(cobb method), the height of vertebrae body for the acute fracture group were superior to than the chronic and nonunion fracture group(P< 0.05). Key words: Osteoporotic vertebral compressive fracture; Percutaneous kyphoplasty; Chronic; Nonunion; Operative opportunity

Clinical study on vertebroplasty combined with zoledronic acid for osteoporotic thoracolumbar vertebral compression fractures

Objective To observe the clinical effects and safety of vertebroplasty combined with zoledronic acid for osteoporotic thoracolumbar vertebral compression fractures. Methods 56 osteoporotic thoracolumbar vertebral compression fractures patients were radomly divided into the two groups,each group had 28 cases.All patients had reset treatment including lying on the hard bed and Padded waist.The treatment group had the surgery of vertebroplasty,3 days after surgery these patients treated with 100m L Zoledronic acid by means of intravenous drip.The control group had the conservative treatment,these patients received the closed reduction,after operations the patients had the treatment of traction suspension,lying on the hard bed,padded the fractures.The two groups were compared at the time before treatment,24h after treatment and 6 months after treatment.The anterior height of vertebral body,kyphosis Cobb's angle,low back pain visual analog scale,Oswsetry dysfunction index score and complications were included into the study .Results (1)The anterior height of vertebral body: The difference of the anterior height of vertebral body at different time before or after the treatment was statistically significant,that showed the time effect[the treatment group:(13.81±2.09)mm,(20.14±2.26)mm,(21.89±2.60mm;the control group:(15.24±2.21)mm, (17.39±2.57)mm,(17.40±1.81)mm].The difference of the overall anterior height of vertebral body between the two groups was statistically significant,which showed the grouping effect.(2)Kyphosis Cobb's angle: The difference of Kyphosis Cobb's angle at different time was statistically significant,which showed the time effect [the treatment group:(26.18±2.03)°,(9.56±1.11)°,(9.57±1.08)°;the control group:(27.36±2.71)°,(14.59 ±1.28)°,(14.52±1.48)°],the difference of the overall Kyphosis Cobb's angle between the two groups was statistically significant,which showed the grouping effect.(3)Low back pain visual analog scale:The difference of low back pain visual analog scale at different time was statistically significant,which showed the time effect [the treatment group:(8.31±0.94)points,(1.86±0.74)points,(1.87±0.77)points;the control group:(8.12± 0.95)points,(3.85±1.07)points,(3.82±1.08)points].The difference of the overall low back pain visual analog scale between the two groups was statistically significant,which showed the grouping effect.(4)Oswsetry dysfunction index score: The difference of Oswsetry dysfunction index score at different time was statistically significant,which showed the time effect[the treatment group:(73.27±4.55)points,(32.11±2.57)points,(29.14 ±3.60)points; the control group:(75.49±4.20)points,(43.83±2.98)points,(38.67±5.28)points].The difference of the overall Oswsetry dysfunction index score between the two groups was statistically significant,which showed the grouping effect. Conclusion The treatment of vertebroplasty combined with zoledronic acid for osteoporotic thoracolumbar vertebral compression fractures was effective.It is able to relieve low back pain,improve bone density and quality,improve life quality,and prevent Osteoporosis from further development. Key words: Vertebroplasty; Spinal fracture; Osteoporosis; Lumbar Vertebrae; Thoracic Vertebrae; Zoledronic Acid

The clinical efficacy and impact factors analysis in patients with senile osteoporotic thoracolumbar vertebral compression fractures underwent PVP

Objective To explore the clinical efficacy of percutaneous vertebroplasty technique(PVP) in the patients with senile osteoporotic thoracolumbar compression fractures (OVCFs) and to explore the main factors of PVP.Methods PVP treatment of OVCFs 46 cases,in the perspective of C-arm X-ray,bone cement as a filling material,transpedicular puncture and injection of 59 vertebrae.Results The pain in 35 cases(76.09％) OVCFs patients apparent ease or disappear,the remaining 11 cases of moderate relief;follow-up period(3 to 15)months(mean 8.6months).After X-ray review,the patient' s bone cement dispersion was good and has improved vertebral height has not been lost,activity and quality of life significantly inproved.Conclusion PVP is simple,less invasive,etc.,which can quickly reduce pain and improve their quality of life. Key words: Percutaneous vertebroplasty; Fractores ; Oracicvertertebrae; Lambarrerteehre; Injectable calcium sulplmte cement

Vertebroplasty versus conservative treatment for severe thoracolumbar wedge-shaped osteoporotic vertebral compression fractures

Objective To compare the clinical outcomes of percutaneous vertebroplasty (PVP) and conservative treatment for patients with severe thoracolumbar wedge-shaped osteoporotic vertebral compression fracture (OVCF).Methods From January 2007 to January 2010,a total of 43 patients with severe thoracolumbar wedge-shaped OVCF were nonrandomly assigned to undergo PVP (19 cases) or conservative treatment (24 cases) according to their own will.The baseline clinical and radiological characteristics in both groups were comparable.Clinical outcomes were determined by pain visual analogue scale(VAS) and short form 36 health survey(SF-36).Vertebral height,kyphotic angle and cement leakage were assessed by radiography while new OVCFs by MRI.Results All the 43 patients obtained a follow-up of at least one year.The PVP group vas significantly superior to the conservative group regarding VAS score,physical component summary (PCS) score,anterior and central vertebral heights and kyphotic angle at all postoperative intervals( P ＜ 0.05),while no significant differences were found between the 2 groups regarding posterior vertebral height,new OVCF incidence or mental component summary (MCS) score at all postoperative intervals( P ＞ 0.05) except for the first month after treatment.New OVCFs were found 53 days earlier in the PVP group than in the conservative group,with a significant difference( P ＜ 0.05).Asymptomatic cement leakage occurred in 52.6％ (10/19) of the treated vertebrae in PVP group and 70.0％ of them (7/10) occurred in the intervertebral disc.Conclusions PVP is technically feasible for treatment of severe thoracolumbar wedge-shaped OVCF in spite of a high rate of asymptomatic leakage.PVP may lead to immediate and sustained pain relief and physical functional improvement,without increasing the risk of new OVCFs,which are significantly greater than what can be achieved by the conservative treatment. Key words: Spinal fractures; Osteoporosis; Vertebroplasty

Finite element analysis of cement volume affecting adjacent vertebral endplate in percutaneous kyphoplasty

Objective To analyze the stress contribution of different cement volume to the adjacent vertebral endplates in percutaneous kyphoplasty (PKP) so as to explore the possible mechanism of adjacent vertebral fractures after PKP. Methods The three-dimensional finite element model of osteoporotic thoracolumbar vertebral compression fractures was established to simulate vertebral body partial restoration (80％) with PKP.During the process,two doses of bone cement ( polymethylmethacrylate,PMMA) were filled in the vertebral body (4.0 ml bone cement filling 15％ of the vertebral body volume and 8.0 ml bone cement filling 30％ of the vertebral body volume).Endplate stress under conditions of axial compression,flexion and extension was analyzed. Results Regarding the two filling doses in PKP,the adjacent vertebral endplate stress under the above-mentioned conditions was all increased at T11 and L1 vertebral body compared with that before operation.Meanwhile,endplate stress had positive correlation with the cement volume and the stress concentrated largely in the anterior and middle parts of endplate. Conclusions The stress of adjacent vertebral endplate is positively correlated with cement volume,with anterior and middle parts of endplate as the stress concentration.The probability of adjacent vertebral fractures shows a rising trend with the increase of cement volume in PKP. Key words: Kyphosis; Arthroplasty; Finite element analysis