Treatment Of Osteoporotic Vertebral Compression Fractures Research Articles

The Relationship between Perivertebral Venous Cement Embolism and Balloon Expansion Pressure in Balloon Kyphoplasty.

Introduction: Osteoporotic vertebral compression fractures (OVCFs) are common fractures in the elderly suffering osteoporosis. Most patients have bone fusion with deformity of vertebral collapse; however, some patients suffer nonunion and persistent pain at the fracture site. Due to the limitations of conservative treatment, balloon kyphoplasty (BKP) has been recently performed for OVCFs. This study aimed to investigate the relationship between cement embolization and balloon expansion pressure (BEP) in patients who underwent BKP. Methods: We investigated 62 patients who underwent BKP for cement embolization into the perivertebral veins among the 155 patients admitted to our hospital due to thoracolumbar vertebral compression fractures between April 1, 2019, and March 31, 2020. Surgery was indicated for patients who had severe back or low back pain and whose daily life was severely impaired, and in whom the shape of the vertebral body was clearly changed on functional X-ray. Results: Intraoperative X-ray and postoperative CT revealed cement embolization into the perivertebral veins in three cases (4.83%). The BEP was significantly higher in the group with cement embolism than in the group without cement embolism (P < 0.001). Pulmonary cement embolism (PCE) and infection were not observed. One case of cement leakage into the spinal canal was observed (1.61%). Conclusions: While the surgical intervention of BKP can contribute to the treatment of OVCFs, careful attention should be paid to the prevention of complications, including cement embolization into the perivertebral veins, and such complications should be appropriately managed.

Vesselplasty for the treatment of osteoporotic vertebral compression fractures with peripheral wall damage: a retrospective study

Study design A retrospective study. Objective The clinical efficacy of vertebroplasty and kyphoplasty treating osteoporotic vertebral compression fractures (OVCF) has been widely recognized in recent years. However, there are also disadvantages of bone cement leakage (BCL), limited correction of kyphosis and recovery of vertebral height. Nowadays, in view of these shortcomings, vesselplasty has been widely used in clinical practice. The objective of this study is to assess its clinical effect and application value for the treatment of OVCF with peripheral wall damage. Methods 62 patients (70 vertebrae) treated for OVCF with peripheral wall damage using vesselplasty retrospectively reviewed. The data collection included operation time, volume of bone cement, relevant surgical complications, visual analog scale (VAS), Oswestry disability index (ODI), vertebral body height and kyphosis Cobb angle. Results The volume of bone cement was 3–8 (5.3 ± 1.3) ml. There were 3 vertebrae of BCL (4.3%). VAS and ODI at different time points after operation were decreased compared with before operation (all p < 0.05). There were no statistical differences between VAS or ODI at different postoperative time points (p > 0.05). Vertebral body height and Cobb angle at different time points after operation were improved compared with before operation (all p < 0.05). There were no statistical differences between vertebral body height or Cobb angle at different postoperative time points (all p > 0.05). Conclusions Vesselplasty may reduce the risk of BCL and better control the dispersion of bone cement in the treatment of OVCF. It relieves pain, restores vertebral body height and corrects kyphosis, especially in OVCF with peripheral wall damage. Therefore, vesselplasty is safe and worthy of clinical application.

Advances in Vertebral Augmentation Systems for Osteoporotic Vertebral Compression Fractures.

Osteoporotic vertebral compression fracture (OVCF) is a common cause of pain and disability and is steadily increasing due to the growth of the elderly population. To date, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are almost universally accepted as appropriate vertebral augmentation procedures for OVCFs. There are many advantages of vertebral augmentation, such as short surgical time, performance under local anaesthesia, and rapid pain relief. However, there are certain issues regarding the utilization of these vertebral augmentations, such as loss of vertebral height, cement leakage, and adjacent vertebral refracture. Hence, the treatment for OVCF has changed in recent years. Satisfactory clinical results have been obtained worldwide after application of the OsseoFix System, the SpineJack System, radiofrequency kyphoplasty of the vertebral body, and the Kiva VCF treatment system. The following review discusses the development of the current techniques used for vertebral augmentation.

Creation of a planned or central-clefted puncture combined with a second puncture during vertebroplasty to treat osteoporotic vertebral compression fractures with large clefts

BackgroundCemented vertebrae frequently re-fracture after vertebroplasty to treat osteoporotic vertebral compression fractures (OVCFs) with large clefts. We compared the efficacy of planned and central-clefted puncture, both followed by a second puncture, as treatments for OVCFs with large clefts.MethodsWe retrospectively studied 38 patients. 18 of whom underwent planned puncture (group A) and 20 central-clefted puncture (group B). A second puncture was performed when the initially injected cement was restricted to the cleft. We recorded a visual analog scale (VAS) pain scores, vertebral kyphotic angles (KAs), and compression ratios (CRs) preoperatively and at 2 days and 6 months postoperatively. We recorded the cement dispersion patterns and complications.ResultsSecond punctures succeeded in 15/18 and 7/20 patients of groups A and B, respectively. At 2 days postoperatively, the VAS score, KA, and CR were significantly better than the preoperative values (P < 0.01); no significant difference was found between the two groups (P > 0.05). At the 6-month follow-up, all scores were poorer than at 2 days postoperatively (all P < 0.05), significantly more so in group B than group A (P < 0.05). Significant differences in terms of the cement dispersion patterns, and the cemented vertebral re-fracture and cement leakage rates, were observed between the two groups (all P < 0.05).ConclusionThe two-puncture techniques were initially effective when treating large-clefted OVCFs. However, compared to the central-clefted puncture, the planned puncture improved the success rate of the second puncture, allowed better cement dispersion, and reduced the incidence of vertebral re-fracture during follow-up.

Short-term effectiveness comparison of unipedicular versus bipedicular percutaneous kyphoplasty for osteoporotic vertebral compression fractures with posterior wall broken

To compare the short-term effectiveness and safety of unipedicular versus bipedicular percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) with posterior wall broken. The clinical data of 68 patients with OVCF with posterior wall broken and without posterior ligament complex injury and spinal cord nerve injury between June 2013 and December 2018 were retrospectively analyzed. According to the different operative approaches, the patients were divided into two groups: group A (36 cases received PKP via bilateral pedicle puncture) and group B (32 cases received PKP via unilateral pedicle paracentesis). There was no significant difference between the two groups in gender, age, fracture vertebra distribution, time from injury to operation, preoperative pain visual analogue scale (VAS) score, Oswestry disability index (ODI), and height of injured vertebra ( P>0.05). The operation time, intraoperative fluoroscopy times, and bone cement volume were recorded and compared between the two groups. The VAS score and ODI score were used to evaluate the effectiveness before operation, at 1 day and 6 months after operation; the height of injured vertebra was measured on the lateral X-ray film, and the recovery height of injured vertebra at 1 day after operation and the loss height of injured vertebra at 6 months after operation were calculated; the intraoperative and postoperative complications of the two groups were recorded. The operation time, intraoperative fluoroscopy times, and bone cement volume of group B were significantly less than those of group A ( P<0.05). All patients were followed up 10-35 months, with an average of 18 months. During the operation, there were 2 cases (5.56%) of cement leakage in group A and 9 cases (28.13%) in group B, showing significant difference ( χ 2=4.808, P=0.028). There was no adverse reactions of bone cement, iatrogenic spinal cord injury, infection of puncture port, or other complications in the two groups. During the follow-up period, there were 3 cases (8.3%) of adjacent vertebral fractures in group A and 2 cases (6.3%) in group B, showing no significant difference between the two groups ( χ 2=0.027, P=0.869). The height of injured vertebra of the two groups at 1 day and 6 months after operation were significantly improved when compared with preoperative ones ( P<0.05). There was no significant difference in the height of injured vertebrae and the recovery height of injured vertebra at 1 day after operation between the two groups ( P>0.05). However, at 6 months after operation, the height of injured vertebra in group B was significantly lower than that in group A ( P<0.05), and the loss height of injured vertebra in group B was significantly higher than that in group A ( P<0.05). The VAS score and ODI score at 1 day and 6 months after operation were significantly improved when compared with preoperative ones in both groups ( P<0.05), but there was no significant difference between the two groups ( P>0.05). Both bipedicular and unipedicular PKP can obtain satisfactory effectiveness for the treatment of OVCF with posterior wall broken, but the former may have advantages of lower cement leakage rate and less height loss.

Comparison Between Hyperextension and Neutral Positions for Vertebroplasty and Kyphoplasty: Which is Best for Osteoporotic Vertebral Compression Fractures?

PurposeThis study aimed to compare the demographic features (including total cost), surgical effects, radiographic parameters, and complications of kyphoplasty (KP) and vertebroplasty (VP) in the hyperextension (HP) and neutral positions (NP) and to assess their efficacy and cost-effectiveness for treating single-level osteoporotic vertebral compression fractures (OVCF).Patients and MethodsThis was a retrospective analysis of 245 consecutive patients who underwent KP or VP from February 2018 to February 2019 with observation on postoperative day 2 and at the one-year follow-up. The first 122 patients (86 KP and 36 VP cases) were treated in the neutral position, and the remaining 123 in the hyperextension position (90 VP and 33 KP cases). Back pain and impact on daily life were evaluated. Cobb’s angle and the ratio of the anterior (AR) and middle vertebral (MR) bodies were the main radiographic parameters. The chi-square test, one-way analysis of variance (ANOVA), repeated measurement ANOVA, and post hoc tests (Bonferroni adjustments) were used for statistical analysis.ResultsThere were no significant differences in the demographic features, operation time, or rate of re-fracture at the one-year follow-up among the groups. The rate of cement leakage was significantly lower in the HPVP group than in the NPKP group. The total cost was significantly lower in the VP groups than in the KP groups. At the one-year follow-up, back pain was significantly lower in the HPVP group than in the NPKP group. The Oswestry Disability Index, Cobb’s angle, AR, and MR in the HPVP group were similar to those in the NPKP and HPKP groups, but better than those in the NPVP group.ConclusionHPVP can achieve better pain relief, and similar disability scores, Cobb’s angle, AR and MR recovery, with a lower total cost, compared with NPKP. HPVP is the most economically efficacious treatment for OVCF.

Clinical analysis of bone filling pockets in percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fracture in the elderly

Objective To investigate the efficacy and safety of bone filling pockets(FP) in percutaneous vertebroplasty(PVP) of elderly osteoporotic vertebral compression fracture(OVCF). Methods A retrospective study was performed on 38 cases of elderly patients with OVCF who were performed FP in the PVP from January 2016 to December 2018.There were 8 males and 30 females, aged(76.32±2.43) years old, ranging from 62 to 82 years old, with a total of 42 vertebral segments.The height of vertebral body was measured before operation, 3 days after operation and 12 months after operation.The pain visual analogue score(VAS) and Oswestry dysfunction score(ODI) were used to observe the leakage of bone cement. Results All 38 patients were followed up for 10-12 months.During the follow-up period, there were no pulmonary embolism, 2 bone cement leakage, no spinal cord and nerve root injury, no adjacent vertebral body and operative vertebral body re-fracture.The height of vertebral body of patients[(1.1±0.4) cm, (0.8±0.1) cm, (2.4±0.5) cm]and 12 months after surgery[(1.3±0.4) cm, (1.4±0.2) cm, (2.6±0.3) cm]was significantly higher than those before surgery[(0.6±0.1) cm, (0.7±0.2) cm, (2.2±0.6) cm], with statistically significant differences(P<0.01). VAS scores[(3.50±1.33) scores, (1.55±1.26) scores]and ODI scores[(21.72±5.83) scores, (10.50±4.77) scores]of the patients 3 days after the operation and 12 months after the operation were significantly lower than those of the patients before the operation[(7.14±1.32) scores, (61.74±5.83) scores], and the difference was statistically significant(P<0.01). Conclusion FP applied in the treatment of OVCF by PVP can significantly relieve the pain of vertebral fracture, improve the quality of life of patients, maintain the height of the vertebral body, and effectively reduce bone cement leakage. Key words: Percutaneous vertebroplasty; Osteoporotic vertebral compression fractures; Filling pockets; Bone cement leakages

Safety and Efficacy Studies of Vertebroplasty with Dual Injections for the Treatment of Osteoporotic Vertebral Compression Fractures: Preliminary Report

To evaluate the clinical safety and efficacies of percutaneous vertebroplasty (PVP), percutaneous vertebroplasty with dual injections (PVPDI), and percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs), a retrospective study of 90 patients with OVCFs who had been treated by PVP (n = 30), PVPDI (n = 30), and PKP (n = 30) was conducted in this work. The clinical efficacies of these three treatments were evaluated by comparing their PMMA cement leakages, cement patterns, height restoration percentages, wedge angles, visual analogue scales, and Oswestry disability index (ODI) at the pre- and postoperative time points. Ten percent, 6.7%, and 0% of patients had PMMA leakage in PVP, PVPDI, and PKP groups, respectively. Three (solid, trabecular, and mixed patterns), two (trabecular and mixed patterns), and two (solid and mixed patterns) types of cement patterns were observed in PVP, PVPDI, and PKP groups, respectively. PVP and PVPDI treatments had similar and less height restoration ability than PKP treatment. All the PVP, PVPDI, and PKP treatments had significant and similar ability in pain relief and functional recovery ability for the treatment of OVCFs. Microfractures after the surgery occurred after PVP and PKP treatments. These results indicate minimally invasive techniques were effective methods for the treatment of OVCFs. Moreover, these initial outcomes suggest PVPDI treatment has great value and is worth promoting vigorously in orthopedics clinics.

Efficacy comparison between simulated optimization methods combined with percutaneous vertebroplasty and percutaneous kyphoplasty for osteoporotic thoracolumbar fracture

Objective To compare the clinical efficacy of simulated optimal reduction combined with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of senile osteoporotic vertebral compression fractures (OVCF). Methods A retrospective case series study was conducted to analyze the clinical data of 136 patients with osteoporotic vertebral compression fractures admitted to the spine surgery department of Luoyang Orthopedic Hospital of Henan Province from January 2014 to January 2015. There were 54 males and 82 females, aged 55 to 83 years old, with an average age of 68.3 years. All the enrolled patients had single segment vertebral compression fractures, whose compression degree was ≥1/3 of adjacent normal vertebral bodies and ≤2/3 of adjacent normal vertebral bodies. Among them, 59 patients were treated with simulated optimal reduction combined with PVP (PVP group), and 77 patients were treated with PKP (PKP group). The operation time, intraoperative fluoroscopy time, incidence of bone cement leakage, hospitalization cost and length of stay were compared between the two groups. Postoperative X-ray and CT examination were performed to observe bone cement diffusion. Before surgery and after surgery (1 day, 1 week, 1 month, 6 months, 1 year, 2 years and 3 years), Visual analogue scale (VAS) score, Oswestry disability index (ODI) scores, Cobb's angle, ratio of anterior and middle height of the affected vertebrae, and the incidence of vertebral refractures within 3 years were compared between the two groups. Results All the patients were followed up for 29-43 months, averaging 36 months. One patient in the PVP group was lost to follow-up after one year. In the PKP group, two patients were lost to follow-up after one year and one patient was lost to follow-up after two years. In the PVP group, single vertebral body operation time [(28.9±5.7)seconds] and intraoperative fluoroscopy time [(54.0±13.4)seconds] were significantly less than those in the PKP group, with statistically significant differences (P 0.05). The hospitalization cost in the PVP group [(9.7±3.2)thousand yuan] was lower than that in the PKP group [(22.35±16.2)thousand yuan](P 0.05). In both groups, the VAS and ODI were significant decreased after operation (P 0.05). The three-year follow-up showed that the re-fracture rate of adjacent vertebral body in the PVP group was significantly lower than that in the PKP group (0 vs. 1.3%)(P<0.01). Conclusion For OVCF, the simulated manual reduction combined with PVP is easy for operation and has no significant difference in short-term analgesic effect compared with PKP, but the recovery of height of diseased vertebra and correction of kyphosis are better, with lower re-fracture rate of adjacent vertebra in the later stage. Key words: Osteoporotic fracture; Vertebroplasty; Percutaneous kyphoplasty

Unilateral approach painless vertebroplasty for osteoporotic vertebral compression fractures of critically ill patients under lateral decubitus position

Objective To investigate the clinical efficacy of unilateral approach painless vertebral augmentation in the treatment of severe osteoporotic vertebral compression fractures (OVCFs) in the critically ill patients under lateral decubitus postition. Methods A retrospective case series study was conducted to analyze 97 patients with severe vertebral fractures admitted to the Henan Provincial People's Hospital from April 2004 to January 2017. There were 27 males and 70 females, aged 59-99 years [(78.5±13.2)years]. There were 11 patients with three-segment fracture, nine patients with two-segment fracture and 77 patients with single fracture. All patients were treated with lateral decubitus unilateral approach for painless vertebral augmentation and received postoperative rehabilitation training guided by physicians. Preoperative and intraoperative blood loss were recorded. Preoperative and postoperative respiratory rate, heart rate, systolic pressure, oxygen saturation and acute physiology and chronic health evaluation score II (APACHE II) , height of vertebral compression site, and injured vertebrae Cobb angle were evaluated. The visual analogue scale (VAS) and Oswestry dysfunction index (ODI) were assessed to define function improvement. Meanwhile, the occurrence of re-fracture and complications were recorded. Results All patients were followed up for 3-8 months [(6.3±2.9)months]. The operation time was (69.2±25.9)minutes, and the amount of intraoperative bleeding was (7.5±2.6)ml. There were no significant differences in respiratory rate, heart rate, systolic blood pressure or oxygen saturation before operation and after operation (P>0.05). No surgical discontinuation or deterioration occurred. The APACHE II score was (15.2±3.7)points before operation and (8.4±0.7)points at 24 hours after operation (P 0.05). The Cobb angle was (25.6±9.3)° before operation, (20.7±2.5)° at one week after operation and (18.5±3.1)° at the last follow-up (P>0.05). The VAS score was (8.5±1.2)points before operation, (2.1±0.3)points at one week after operation, and (3.2±1.1)points at the last follow-up, respectively. The VAS scores at 1 week and the last follow-up were significantly improved compared with preoperative VAS (P 0.05). The ODI value was 39.9±3.4 before operation, 20.2±5.2 at one week after operation, and 17.2±2.0 at the last follow-up . The ODI values 1 week after operation and at the last follow-up were significantly improved compared with preoperative ODI (P<0.05), showing improvement trend during the follow-up (P<0.05). No re-fracture occurred during the follow-up. No serious complications such as nerve injury, pulmonary embolism or death occurred during the operation and postoperative follow-up. Conclusions The unilateral approach painless vertebral augmentation for the treatment of severe OVCFs in critically ill patients under lateral decubitus position can improve the patient's operative tolerance and satisfaction, shorten the operation time, relieve postoperative pain and promote functional recovery. It is an alternative surgical procedure for the treatment of severe OVCFs in internal medicine. Key words: Spinal fractures; Osteoporotic fractures; Vertebral augmentation

Percutaneous kyphoplasty assisted with/without mixed reality technology in treatment of OVCF with IVC: a prospective study

BackgroundThe purpose of this study was to assess the clinical outcome of percutaneous kyphoplasty (PKP) assisted with mixed reality (MR) technology in treatment of osteoporotic vertebral compression fracture (OVCF) with intravertebral vacuum cleft (IVC).MethodForty cases of OVCF with IVC undergoing PKP were randomized into a MR technology-assisted group (group A) and a traditional C-arm fluoroscopy group (group B). Both groups were performed PKP and evaluated by VAS scores, ODI scores, radiological evidence of vertebral body height, and kyphotic angle (KA) at pre-operation and post-operation. The volume of injected cement, fluoroscopy times, and operation time were recorded. And cases of non-PMMA-endplates-contact(NPEC) in radiological evidence was also recorded postoperatively. The clinical outcomes and complications were evaluated afterwards. All patients received 10 to 14 months follow-up, with an average of 12 months.ResultThis MR-assisted group (group A) acquired more about the amount of the polymethyl methacrylate (PMMA) injection and postoperative vertebral height and less about postoperative KA, fluoroscopy times, and operation time compared with the control group (group B) (P < 0.05). The VAS scores and ODI scores in both groups have improved, but more significantly in group A (P < 0.05). Also, more cases achieve both-endplates-touching of cement in group A (P < 0.05). And there are less of the loss of vertebral height, KA, and occurrence of re-collapse of the vertebra in group A during the follow-up (P < 0.05).ConclusionPKP assisted with MR technology can accurately orientate the position of IVC area, which can be augmented by the balloon leading to more satisfied vertebral height improvement, cement diffusion, and pain relief.Trial registrationClinicalTrials.gov Identifier: NCT03959059. Registered 25 September 2016.

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.

Percutaneous curved vertebroplasty in the treatment of thoracolumbar osteoporotic vertebral compression fractures: a prospective study

Objective To investigate the clinical effect of percutaneous curved vertebroplasty in the treatment of thoracolum-bar osteoporotic vertebral compression fractures (OVCFs). Methods All of 85 patients with single thoracolumbar vertebral OVCFs who met the admission criteria from January 2017 to July 2018 were divided into three groups according to the random dig-its table method. They were treated with percutaneous curved vertebroplasty, routine unipedicular PVP and routine bipedicular PVP respectively. There were 25 patients in the percutaneous curved vertebroplasty group, 6 males and 19 females; aged 56-80 years, with an average age of 70.6±9.7 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 3 cases, L1 9 cases, L2 3 cases, L3 1 case, L4 1 case and L5 2 cases. There were 32 patients in the routine unipedicular PVP group, 6 males and 26 fe-males; aged 58-75 years, with an average age of 69.5±9.3 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 5 cases, L1 11 cases, L2 6 cases, L3 1 case, L4 1 case and L5 2 cases. There were 28 patients in the routine bipedicular PVP group, 5 males and 23 females; aged 59-81 years, with an average age of 69.8±8.8 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 4 cases, L1 10 cases, L2 4 cases, L3 1 case, L4 1 case and L5 2 cases. The operation time, injected cement volume, in-traoperative blood loss were recorded and analyzed. Preoperative, postoperative 1 week and 3 months visual analogue scale scores and oswestry disability index were adopted to value the clinical improvements. Preoperative, postoperative 1 week and 3 months relative vertebral height and kyphosis correction, and the cement leakage rate were measured and analyzed. Results There was no significant difference in the data of gender, age, VAS scores, ODI and distribution of fracture vertebrae among the three groups (P>0.05), and the baseline data was comparable. The average VAS score in the percutaneous curved vertebroplasty group was 2.3±0.5 at 1 week after surgery, that of the routine unipedicular PVP group was 2.4±0.4 and that of the routine bipe-dicular PVP group was 2.4±0.4; the average ODI in the percutaneous curved vertebroplasty group was 19.8%±3.9%, that of the routine unipedicular PVP group was 20.0%±4.1% and that of the routine bipedicular PVP group was 19.9%±3.8%; they were lower than the preoperative data, which were statistically significant (P 0.05). Operation time 39.10±2.00 min vs 38.70±1.70 min, injected cement volume 3.60±0.11 ml vs 3.50±0.13 ml and blood loss 5.10±0.30 ml vs 5.00±0.40 ml of the percutaneous curved vertebroplasty group and the routine unipedicular PVP group were less than those of the routine bipedicular PVP group, which were statistically significant (P<0.05). Conclution Percutaneous curved vertebroplasty could achieve satisfactory clinical outcomes for OVCFs, with advantages of less operation time, less blood loss, limited X-ray expo-sure, less injected cement volume, and more balanced augmentation for stabilization of the affected vertebrae and total verte-bral column. Key words: Thoracic vertebrae; Lumbar vertebrae; Osteoporosis; Spinal fractures; Vertebroplasty

Efficacy comparison of multi-segment and single-segment osteotomy for old osteoporotic vertebral compression fracture combined with kyphosis

Objective To investigate the sagittal correction effect and clinical efficacy of multi-segment Smith-Peterson osteotomy (SPO) and single-segment pedicle subtraction osteotomy (PSO) in the treatment of old osteoporotic vertebral compression fracture (OVCF)combined with kyphosis. Methods A retrospective case control study was conducted to analyze the clinical data of 24 patients with old OVCF combined with kyphosis admitted to Traditional Chinese Medical Hospital of Xiaoshan from February 2014 to July 2016. There were 10 males and 14 females, aged 58-72 years, with an average of 65.6 years. Thirteen patients were treated with multi-segment SPO (Group A), six of whom underwent two-segment SPO and seven underwent three-segment SPO. Eleven patients were treated with single-segment PSO (Group B). The operation time, intraoperative bleeding volume, the number of cases using cement-reinforced nail track, postoperative drainage, hospitalization time and postoperative complications were compared between the two groups. Cobb angle, sagittal vertical axis (SVA), thoracic kyphosis angle (TK) and lumbar lordosis angle (LL) of kyphosis deformity were measured before operation, after operation and at the last follow-up. Oswestry Dysfunction Index (ODI) and Visual Analogue Scale (VAS) were used to evaluate the clinical efficacy at the last follow-up. Results All patients were followed up for 6-24 months, with an average of 15.4 months. The operation time of Group A was (198.1±27.3)minutes, while that of Group B was (237.6±36.1)minutes (P 0.05). Three patients in Group A and one patient in Group B had cerebrospinal fluid leakage (P 0.05). There was no significant difference in SVA, Cobb angle, TK and LL between the two groups at the last follow-up (P>0.05). There was no significant difference in ODI and VAS between the two groups after operation and at the last follow-up (P>0.05). No complications such as spinal cord injury, embolism caused by cement leakage, extraction or rupture of pedicle screw occurred in either group. Conclusion For old osteoporotic vertebrae compressed fractures combined with kyphosis, multi-segment SPO and single-segment PSO can achieve good sagittal correction and clinical efficacy. Single-segment PSO has better correction effect and lower incidence of cerebrospinal fluid leakage, yet accompanied with disadvantages of overcorrection, screw loosening, longer operation time and more blood loss. Key words: Osteoporotic fractures; Thoracic vertebrae; Lumbar vertebrae; Kyphosis; Osteotomy

Utilization of the directional balloon technique to improve the effectiveness of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures and reduction of bone cement leakage.

Background:This article evaluates the effectiveness of a new directional balloon technique in the treatment of osteoporotic vertebral compression fractures (OVCFs).Methods:From September 2015 to April 2017, 100 patients with single-segment OVCFs treated using percutaneous kyphoplasty were available for complete data assessment. Among these, 51 cases were treated with the traditional nondirectional balloon technique (group 1) and 49 cases were treated with the directional balloon technique (group 2). Operative time, blood loss, and X-ray exposure time were compared between the 2 groups. The visual analogue score (VAS), Oswestry disability index (ODI), and Roland Morris disability (RMD) scores, and wedge-shaped and kyphosis angles were measured at 3 days and 1, 3, 6, and 12 months, respectively, after surgery.Results:There were no significant differences in blood loss or the amount of bone cement injected between the 2 groups; however, operative times, X-ray exposure times, and leakage rates of bone cement, especially type C in group 2, were significantly lower in group 2 than those in group 1. VAS, ODI, and RMD scores, and wedge-shaped and kyphosis angles at each time point after surgery were significantly higher than those before surgery. However, the improvement in VAS, ODI, and RMD scores in group 2 was only significantly better than those in group 1 at 3 days after surgery.Conclusion:The utilization of the directional balloon technique in the treatment of OVCFs using percutaneous kyphoplasty can not only reduce the operation time, the radiation, and the bone cement leakage, but also improve the early curative effect.

Gait in patients with symptomatic osteoporotic vertebral compression fractures over 6\xa0months of recovery

BackgroundOne factor related to disability in people with spinal deformity is decreased postural control and increased risk of falling. However, little is known about the effect of osteoporotic vertebral compression fractures (OVCFs) and their recovery on gait and stability. Walking characteristics of older adults with and without vertebral fractures have not yet been compared.AimsThe purpose of the current study was to examine the spatiotemporal gait parameters and their variability in patients with an OVCF and healthy participants during treadmill walking at baseline and after 6 months of recovery.MethodsTwelve female patients suffering a symptomatic OVCF were compared to 11 matched controls. Gait analysis was performed with a dual-belt instrumented treadmill with a 180° projection screen providing a virtual environment (computer-assisted rehabilitation environment). Results of patients with an OVCF and healthy participants were compared. Furthermore, spatiotemporal gait parameters were assessed over 6 months following the fracture.ResultsPatients suffering from an OVCF appeared to walk with significantly shorter, faster and wider strides compared to their healthy counterparts. Although stride time and length improved over time, the majority of the parameters analysed remained unchanged after 6 months of conservative treatment.DiscussionSince patients do not fully recover to their previous level of mobility after 6 months of conservative treatment for OVCF, it appears of high clinical importance to add balance and gait training to the treatment algorithm of OVCFs.ConclusionsPatients suffering from an OVCF walk with shorter, faster and wider strides compared to their healthy counterparts adopt a less stable body configuration in the anterior direction, potentially increasing their risk of forward falls if perturbed. Although stride time and stride length improve over time even reaching healthy levels again, patients significantly deviate from normal gait patterns (e.g. in stability and step width) after 6 months of conservative treatment.

Effect of a semirigid thoracolumbar orthosis on gait and sagittal alignment in patients with an osteoporotic vertebral compression fracture.

BackgroundAn important goal in the treatment of osteoporotic vertebral compression fractures (OVCFs) is the prevention of new vertebral fractures and the subsequent progression to global sagittal malalignment. Current conservative treatment is multimodal and comprises analgesics, medication for osteoporosis, and physical therapy. However, little is known about the value of orthoses in the treatment of OVCFs.AimsThe primary purpose of this study was to examine the direct effect of a semirigid thoracolumbar orthosis on gait in patients suffering from an OVCF. The secondary purpose was to evaluate changes in gait, radiographic sagittal alignment, pain, and quality of life over time.MethodsFifteen postmenopausal patients with an OVCF were treated with a semirigid thoracolumbar orthosis. At baseline, after 6 weeks, and after 6 months, gait analysis was performed with a dual belt–instrumented treadmill with a 180° projection screen providing a virtual environment (computer-assisted rehabilitation environment) combined with clinical and radiographic assessments.ResultsAt baseline, bracing caused a significantly more upright posture during walking and patients walked faster, with larger strides, longer stride times, and lower cadence compared to walking without orthosis. After 6 weeks, radiographic and dynamic sagittal alignment had improved compared to baseline. The observed effect was gone after 6 months, when the orthosis was not worn anymore.ConclusionA semirigid thoracolumbar orthosis seems to have a positive effect on gait and stability in patients suffering from an OVCF, as was shown by a more upright posture, which may result in decreased compressive loading of the vertebrae. For studying the true effectiveness of dynamic bracing in the treatment of OVCFs, a prospective, randomized controlled trial will be needed.

Clinical effects of types of bone cement distribution in percutaneous kyphoplasty

Objective To investigate the impact of various distribution of bone cement on the early clinical outcomes in osteoporotic vertebral compression fracture (OVCF) patients treated with percutaneous kyphoplasty (PKP). Methods A total of 312 patients (54 males and 258 females, mean age 69.37 years) who diagnosed as OVCF and received PKP treatment from January 2015 to July 2017 were enrolled in the present study. All subjects were divided into two groups according to different distribution of bone cement: the shaped distribution (group O, 113 cases), in which bone cement in the vertebral body presented whole crumb, no separation or loss of bone cement, and the shaped distribution (group H, 199 cases), in which bone cement in the vertebral body presented two briquettes, connected with or without a small amount of bone cement. Demographic data, surgical details, radiographic data, and clinical outcomes (at preoperatively, two-days and one-year follow-up) were compared between the two groups. Results There was no significant difference in bone mineral density (BMD), operation duration, blood loss, and occurrence of leakage of bone cement between two groups. In comparison with group O, group H was accompanied with higher volume of injected bone cement and higher proportion of bilateral approach (P<0.05). Both groups achieved significant improvement of VAS scores after surgery, while the group H had a dramatical reduction of VAS scores at one-year follow-up compared with two-days follow-up (P<0.05). In addition, group H had a better restoration of VAS scores at one-year follow-up than group O (P<0.05), though no significant difference was observed at preoperative and two-days follow-up. Both groups achieved significant improvement of radiographic data after surgery (P<0.05) with similar effects of correction. Conclusion Either shaped or shaped distribution of bone cement can obtain satisfied early clinical effects of PKP for the treatment of OVCF. Compared with shaped distribution, shaped distribution can achieve better pain relief at early follow-up. Key words: Osteoporosis; Fractures, compression; Kyphoplasty

Unilateral Versus Bilateral Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fractures: A Systematic Review of Overlapping Meta-analyses

Background: There have been many meta-analyses and systematic reviews that have discussed the differences between unilateral and bilateral balloon kyphoplasty. However, their conclusions regarding the efficacy and safety of bilateral balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures (OVCFs) are discordant. Objective: We attempted to select the best evidence review to determine the differences between unilateral and bilateral balloon kyphoplasty, and we wanted to determine the best treatment approach for OVCFs. Study Design: A systematic review of overlapping meta-analyses Setting: The electronic databases of PubMed, Embase and The Cochrane Library were searched. The search extended through Sept. 30, 2017. Moreover, we manually searched the last 10 years of conference reports and papers from the Peking University Health Science Library and consulted 2 experts in the field for any additional relevant information. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement and used “A Measurement Tool to Assess Systematic Reviews” (AMTASR) and the Oxford Levels of Evidence to assess the methodological quality of the studies. We applied the Jadad decision algorithm to select the best evidence review. Results: Seven meta-analyses were included in this systematic review. The AMTASR scores of the studies ranged from 4 to 9, with an average of 6. Finally, Sun H et al was shown to represent the best evidence study. Sun H et al proposed that the unilateral kyphoplasty required less surgical time and consumed less cement, reduced cement leakage, and improved short-term general health compared with that of bilateral kyphoplasty. Limitations: The AMTASR scores indicated that some of the included studies were of low quality. In addition, not all of the studies used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) level. When used, the GRADE level indicated that most of the results consisted of studies of low quality. Conclusions: Unilateral kyphoplasty reduces the operative time, cement volume, and cement leakage rate compared with bilateral kyphoplasty. Therefore, we conclude that unilateral kyphoplasty is more advantageous, effective and safe, compared to bilateral kyphoplasty for the treatment of OVCFs. Key words: Osteoporotic vertebral compression fracture, kyphoplasty, unilateral, bilateral, unipedicular, bipedicular, systematic review

Cement Distribution Patterns in Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft: Effect on Therapeutic Efficacy

To determine cement distribution patterns on therapeutic efficacy after percutaneous vertebroplasty treatment of osteoporotic vertebral compression fractures (OVCFs) with intravertebral cleft (IVC). Patients who were treated with percutaneous vertebroplasty for single OVCFs with IVC and met this study's inclusion criteria were retrospectively reviewed. The follow-up period was at least 2 years. Distribution patterns of cement in the IVC area were respectively specified into 2 groups: group 1: solid lump distribution pattern (n= 22); group 2: the comparatively diffused pattern (n= 90). Radiologic and clinical parameters were analyzed and compared. Then, associations of recollapse with covariates and a risk score were further analyzed and developed to predict recollapse of the augmented vertebrae. At the immediate postoperative period, all patients benefited from significant improvement in vertebrae height and kyphotic angle correction. However, significant recollapse was observed at the 2 years postoperative follow-up for the patients in group 1. Furthermore, we found that preoperative severe kyphotic deformity (a cutoff value of 12.5°), solid lump cement distribution pattern, and larger reduction angle (a cutoff value of 8.3°) was significantly associated with increased risk for recollapse. A risk score was developed based on the number of risk factors present in each patient and the receiver operating characteristic curve of the risk score generated an area under the curve of 0.788 (95% confidence interval 0.702-0.873, P= 0.000). The comparatively diffused pattern shows better long-term radiologic and clinical outcomes for the treatment for OVCFs with IVC. A risk score can be used to predict the incidence of recollapse.