Treatment Of Osteoporotic Vertebral Compression Fractures Research Articles

Risk factors and score for recollapse of the augmented vertebrae after percutaneous vertebroplasty in osteoporotic vertebral compression fractures.

Recollapse of the augmented vertebrae after percutaneous vertebroplasty (PVP) treatment for osteoporotic vertebral compression fractures (OVCFs) has obtained much attention. However, little is known about risk factors and score for recollapse of the augmented vertebrae. To determine risk factors and furthermore develop a risk score related to recollapse of the augmented vertebrae after PVP treatment for OVCFs. Patients who were treated with PVP for single OVCFs and met this study's inclusion criteria were retrospectively reviewed. The follow-up period was at least 2years. Associations of recollapse with co-variates (age, gender, bone mass density [BMD] with a T-score, fracture level, intravertebral cleft [IVC], fracture type, cement volume, cement leakage, leakage into a disc, cement distribution pattern, Non-PMMA-endplate-contact [NPEC], preoperative fracture severity, reduction rate [RR], reduction angle [RA]) were analyzed and a risk score for recollapse was further developed to predict recollapse. A total of 152 patients were included. Recollapse group was found in 42 (27.6%) patients. Preoperative IVC, solid lump cement distribution pattern, more RR (a cutoff value of 7%) and larger RA (a cutoff value of 3°) was significantly associated with increased risk for recollapse of the augmented vertebrae. A risk score was developed based on the number of risk factors present in each patient. Patients with a score of 4 had an approximately ninefold increased risk of developing recollapse over patients with a score of 0. The receiver operating characteristic curve of the risk score generated an area under the curve of 0.899 (95% CI 0.642-0.836, P = 0.000). A risk score based on preoperative IVC, cement distribution pattern, reduction rate, and reduction angle predicts the rate of recollapse. Additional studies should aim to validate this score and inspect clinical benefits of recollapse prophylaxis in patients at high risk.

Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: a meta-analysis and systematic review

BackgroundThis meta-analysis was aimed to explore the overall safety and efficacy of balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture (OVCF) based on qualified studies.MethodsBy searching multiple databases and sources, including PubMed, Cochrane, and Embase by the index words updated to January 2018, qualified studies were identified and relevant literature sources were also searched. The qualified studies included randomized controlled trials, prospective or retrospective comparative studies, and cohort studies. The meta-analysis was performed including mean difference (MD) or relative risk (RR) and 95% confidence interval (95% CI) to analyze the main outcomes.ResultsA total of 16 studies were included in the meta-analysis to explore the safety and efficacy of kyphoplasty versus vertebroplasty for the treatment of OVCF. The results indicated that kyphoplasty significantly decreased the kyphotic wedge angle (SMD, 0.98; 95% CI 0.40–1.57), increased the postoperative vertebral body height (SMD, − 1.27; 95% CI − 1.86 to − 0.67), and decreased the risk of cement leakage (RR, 0.62; 95% CI 0.47–0.80) in comparison with vertebroplasty. However, there was no statistical difference in visual analog scale (VAS) scores (WMD, 0.04; 95% CI − 0.28–0.36) and Oswestry Disability Index (ODI) scores (WMD, − 1.30; 95% CI − 3.34–0.74) between the two groups.ConclusionsKyphoplasty contributes especially to decreasing the mean difference of kyphotic wedge angle and risk of cement leakage and increasing the vertebral body height when compared with vertebroplasty. But radiographic differences did not significantly influence the clinical results (no significant difference was observed in VAS scores and ODI scores between the two groups); thus, kyphoplasty and vertebroplasty are equally effective in the clinical outcomes of OVCF. In addition, more high-quality multi-center RCTs with a larger sample size and longer follow-up are warranted to confirm the current findings.

Treatment of severe osteoporotic vertebral compression fracture with 3D printing-assisted percutaneous vertebroplasty in the elderly

Objective To investigate the clinical effect of 3D printing assisted percutaneous vertebroplasty (PVP) in treating severe osteoporotic vertebral compression fracture (OVCF) in elder patients. Methods A retrospective case series study was conducted on the clinical data of 58 elderly patients (58 vertebrae) with severe OVCF who underwent PVP treatment in spinal surgery department of Henan Provincial People's Hospital from June 2014 to June 2016. According to the treatment method, the patients were divided into Group A which adopted 3D printing of injured vertebrae before PVP and Group B which adopted routine PVP operation. Group A consisted of 28 cases (28 vertebrae), including eight males and 20 females, aged 64-91 years [(78.1±8.5)years]. In terms of the distribution of injured vertebrae, there were four cases of T10, six cases of T11, eight cases of T12, four cases of L1, and six cases of L2 in Group A. Group B consisted of 30 cases (30 vertebrae), including 10 males and 20 females, aged 65-90 years[(77.8±8.2)years]. In terms of the distribution of injured vertebrae, there were three cases of T10, seven T11, nine T12, six L1, and five L2. The operation time, visual analogue scale (VAS) before operation, 1 day after operation and at the last follow up, Japanese Orthopedic Association (JOA) score, anterior compression ratio of injured vertebrae, and cement leakage rate were compared between the two groups. Results All the operations were completed successfully. The patients were followed up for 14-26 months [(18.7±3.4)months] in Group A and for 12-28 months[(20.0±5.4 )months] in Group B. The operation time was (28.0±3.4)min in Group A and (30.9±5.3)min in Group B (P 0.05). Both the JOA at day 1 after operation of Group A [(21.3±2.2)points] and Group B [(20.7±2.1)points] and the JOA at the last follow up of Group A [(24.7±2.3)points] and Group B [(24.1±2.0)points] were significantly higher than those before operation (P 0.05). The anterior compression ratio of injured vertebrae 1d after operation of Group A(59.4±7.9)% and Group B (59.1±6.8)% and that at the last follow up of Group A (59.1±7.8)% and Group B (58.7±5.4)% were significantly improved than those before operation (P 0.05). There were three cases of bone cement leakage in Group A (11%) and 11 cases of bone cement leakage in Group B (37%) after PVP, and the difference was statistically significant (P<0.05). Conclusion Compared with conventional PVP, 3D printing-assisted PVP has lower leakage rate, shorter operation time, and better clinical effect in treating severe OVCF in the elderly. Key words: Osteoporotic fractures; Vertebroplasty; 3D printing

Clinical outcome comparison of polymethylmethacrylate bone cement with and without mineralized collagen modification for osteoporotic vertebral compression fractures.

A retrospective study of consecutive patients.The purpose of this study was to compare the clinical effect of biomimetic mineralized collagen (MC) modified polymethylmethacrylate (PMMA) bone cement and traditional PMMA bone cement for the treatment of osteoporotic vertebral compression fractures (OVCF).New fracture on adjacent level is the major postoperative complication of percutaneous vertebroplasty (PVP). The clinical incidence was 12.4% to 27.7%. The increased stiffness of the treated vertebral body caused by filling bone cement is considered as one of the main reasons.A total of 30 patients treated with traditional PMMA bone cement from June 2013 to March 2016 were selected as the traditional group, while 50 patients treated with MC modified PMMA bone cement from July 2014 to March 2016 were selected as the modified group. The 2 groups were compared by injection time of the bone cements, postoperative pain relief effects, vertebral height restoration, CT value changes of the treated vertebral bodies, and postoperative complications in the clinical observations.The surgeries were successfully completed in both groups. In the treatment of OVCF, the MC modified bone cement was able to achieve the same pain relief and vertebral height restoration effects compared to traditional bone cement during the follow-ups, although the injection time of the cement was prolonged in the operation. MC modified bone cement significantly reduced the incidence of postoperative adjacent vertebral fracture from 13.3% to 2%, and significantly increased bone density of the treated vertebral bodies.The MC modified PMMA bone cement showed good clinical outcomes and better mechanical properties than the traditional bone cements.

Therapeutic effects of new-type hydraulic delivery vertebroplasty, balloon kyphoplasty and conventional pusher-type vertebroplasty on single segmental osteoporotic vertebral compression fracture.

This study aims to evaluate safety and practicality in clinical application for better guidance of single segmental osteoporotic vertebral compression fractures treatment. From May 2012 to September 2013, a total of 188 cases of patients with fractures, who received different treatment, were incorporated in the study and then divided into: group A (n=59), conventional pusher-type vertebroplasty; group B (n=54), balloon kyphoplasty; group C (n=60), new-type hydraulic delivery vertebroplasty treatment. The overall follow-up rate was 92.02%. Postoperative visual analogue scale (VAS) and Oswestry disability index (ODI) scores were significantly improved more than those of the preoperative scores in the three groups. Bone cement injection volumes in group A were significantly lower than those in group B and group C. Vertebral height recovery rates among groups were obviously different, showing statistical significance. After a year of follow-up, the vertebral height recovery outcome in group A was obviously poorer than that in group B and group C. A poorer outcome in group B was also found when compared with group C. In addition, the vertebral height restoration had a certain degree of loss, with the loss rate of 20.5, 14.0 and 7.5% in the three groups, respectively. Three operation methods have equivalent effects in the improvement of symptoms and functional recovery. Therefore, the new-type hydraulic delivery vertebroplasty provides a relatively more concise operation and shorter operation time, displaying more outstanding performance of clinical efficacy in spinal reconstruction and reduction of complications risks by evaluating the diffusion of the bone cement, vertebral height restoration rate and postoperative complications.

Wednesday, September 26, 2018 1:00 PM – 2:00 PM Spinal Trauma: 54. Nonsurgical management versus cement augmentation versus transpedicular instrumented stabilization for the treatment of osteoporotic compression fractures: a cost-effectiveness analysis

BACKGROUND CONTEXT Historically, despite the mainstay of osteoporotic vertebral compression fracture (OVCF) treatment being nonsurgical management (NSM), patients often had persistent symptoms with objective sequalae that continued to significantly impair their quality of life and activities of daily living. Cement augmentation (CA) subsequently emerged as a safe, and cost-effective alternative. However, morbidity and mortality, despite this treatment, remains high. Transpedicular instrumented stabilization (TPIS) has traditionally been advised against due to an unacceptably high failure rate in this elderly cohort; however, the efficacy of surgery has not been revisited following advances in surgical optimization and surgical techniques. PURPOSE We sought to perform a cost-effective analysis via a Markov model for the treatment of OVCF fracture with either NSM, CA, or TPIS. STUDY DESIGN/SETTING A Markov state-transition decision model was constructed to estimate the cumulative economic benefit of managing OVCF with NSM versus CA versus TPIS. PATIENT SAMPLE In the model, a hypothetical 70-year-old patient who sustained an OVCF was analyzed. OUTCOME MEASURES A cost-effectiveness analysis was performed that yielded: cost-effectiveness (cost per quality adjusted life years [QALY]), incremental cost-effectiveness ratio, net monetary benefit of each treatment compared to others, and a one-way and two-way sensitivity analysis. METHODS A Markov analysis was performed. Variables included in the model are: QALY, success rates, complication and mortality rates and costs. These variables were derived from recent peer-reviewed articles, mostly randomized controlled trials. RESULTS Assuming patients entered the cycle at age 70, NSM corresponded with a 5.02 QALY gain over the remainder of the patient's life, CA corresponded with an 8.04 QALY gain, and TPIS corresponded with a 0.31 QALY loss. CA was the most cost-effective treatment, followed by NSM. TPIS was not cost-effective. Additional cost per unit of effectiveness gained when comparing CA to NSM was $11,166.76. CONCLUSIONS In our study, TPIS was both less effective and more expensive compared to the cheapest treatment, hence it was dominated, and by definition, not cost-effective. However, CA may be a cost-effective alternative for the treatment of OVCF compared to NSM. The additional cost per unit of effectiveness gained from CA, compared to NSM, was five times lower than the WTP standard of $50,000. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Is Unilateral Percutaneous Kyphoplasty Superior to Bilateral Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures? Evidence from a Systematic Review of Discordant Meta-Analyses

Several meta-analyses have been performed to compare unilateral percutaneous kyphoplasty (PKP) and bilateral PKP in the treatment of osteoporotic vertebral compression fractures (OVCFs), but inconsistencies in the results have led to questions as to which technique is preferable. This study was designed to clarify the benefits and disadvantages of unilateral PKP versus bilateral PKP as found in numerous discordant meta-analyses and thereby present surgical treatment recommendations for OVCFs considering the current best evidence. Systematic review/Meta-analysis. Meta-analyses on unilateral and bilateral PKP for OVCFs were included by searching Pubmed, Embase, and Cochrane library. Meta-analysis quality was assessed using Oxford Levels of Evidence and Assessment of Multiple Systematic Reviews (AMSTAR). The Jadad decision algorithm was used to identify the best evidence. Eight eligible meta-analyses were included, 7 of which were Level-II evidence and one was Level-III evidence. The AMSTAR scores varied from 7 to 8. The Jadad decision algorithm suggested that the best meta-analysis should be selected depending upon publication characteristics and methodology of primary studies, language restrictions, and whether data analysis was performed on individual patients. The best available evidence indicated that both unilateral and bilateral PKP could receive similar good clinical and radiological outcomes. However, without increasing the risk of complications, unilateral PKP required shorter surgical time and less cement volume, offering better pain relief and quality of life at post-operative short term follow-ups. Primary studies had defects in their methodologies. Unilateral PKP appears to be superior to bilateral PKP in the treatment of OVCFs. Osteoporotic vertebral compression fractures, percutaneous kyphoplasty, meta-analysis.

Effect of percutaneous kyphoplasty on the quality of life in patients with osteoporotic vertebral compression fractures

Objective To study the effect of percutaneous kyphoplasty(PKP) in the treatment of patients with osteoporotic vertebral compression fractures(OVCF), and its influence on the quality of life of patients. Methods 100 cases with OVCF from January 2014 to January 2016 in Department of orthopedics, Shangyu District People's Hospital of Shaoxing city were selected as the research subjects.According to random number table method, the patients were divided into control group and observation group, with 50 cases in each group.The control group was treated by percutaneous vertebroplasty(PVP), the observation group was treated by PKP.The anterior vertebral height and kyphosis Cobb angle, the degree of pain, limb dysfunction, and quality of life score were compared between the two groups. Results After operation, the scores of VAS and ODI in the observation group were (2.27±1.25)points and (27.17±7.35)points, respectively, which were lower than those in the control group [(3.52±1.57)points, (44.28±8.63)points](t=4.404, 9.913, all P<0.05). After operation, the height of the anterior border of the observation group was (19.87±1.33)mm, which was higher than (19.22±1.30)mm of the control group, and the kyphosis Cobb angle of the observation group was (5.31±2.12)°, which was less than (6.34±2.78)°of the control group (t=2.471, 2.083, all P<0.05). After operation, the score of quality of life in the observation group was (78.69±13.77), which was higher than (65.46±12.67) in the control group (t=2.471, 2.083, all P<0.05). Conclusion The curative effect of PKP in the treatment of OVCF is positive, it can restore vertebral height, correct kyphosis, relieve pain, improve limb function of patients, and improve the quality of life of patients, it is worthy of clinical application. Key words: Osteoporotic fractures; Fractures, compression; Vertebroplasty; Quality of life

Correlation analysis between the magnetic resonance imaging characteristics of osteoporotic vertebral compression fractures and the efficacy of percutaneous vertebroplasty: a prospective cohort study

BackgroundTo explore the relationship between the magnetic resonance imaging (MRI) characteristics of osteoporotic vertebral compression fractures (OVCFs) and the efficacy of percutaneous vertebroplasty (PVP).MethodsA prospective study was conducted to analyze the clinical and imaging data of 93 patients with OVCFs treated via PVP. A visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the Medical Outcomes Study(MOS) 36-Item short-form health survey (SF-36) were completed before surgery as well as 1 day and 1, 6, and 12 months after surgery. In addition, postoperative complications were recorded. According to the degree and ranges of bone marrow edema on MRI, the patients were divided into three groups: the mild (group A), moderate (group B), and severe (group C) bone marrow edema groups. Pain and dysfunction scores were compared across the three groups of patients before surgery as well as 1 day and 1, 6, and 12 months after surgery.ResultsThe VAS, ODI, and SF-36 scores showed significant differences (P < 0.05) before and after surgery among the three groups. The ODI and SF-36 scores were significantly different (P < 0.05) at 1 day and 1 month after surgery among the three groups. Groups A and B showed significantly better pain relief than group C. Group B experienced better pain relief than group A. These results indicate that PVP was associated with better pain relief effects among patients with a greater extent of bone marrow edema. The edema ranges of the vertebral fractures were negatively correlated with the postoperative VAS and ODI scores 1 month after surgery, whereas the ranges were positively correlated with postoperative SF-36 scores 1 month after surgery.ConclusionsPVP is an effective treatment for OVCFs. Better outcomes were observed among patients with severe or moderate bone marrow edema rather than those with mild bone marrow edema. A greater degree of pain relief after PVP was correlated with faster recovery of the postoperative function. However, this correlation gradually became weak over time and disappeared 6 months after surgery. Therefore, PVP should be an option for early stage OVCFs, especially among patients with bone marrow edema signs on MRI.

Ultra-early injection of low-viscosity cement in vertebroplasty procedure for treating osteoporotic vertebral compression fractures: A retrospective cohort study

ObjectiveTo evaluate the clinical effect of ultra-early injection (before the phase of “tooth-paste-like”) of low-viscosity cement in percutaneous vertebroplasty (PVP) for treating osteoporotic vertebral compression fractures (OVCFs). MethodsTwo hundred sixty-one patients who had PVP procedures with low-viscosity cement (ultra-early injection: 145, normal injection: 135) were included from July 2010 to July 2016 in our hospital. Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Cobb angle, cement leakage, and adjacent vertebral fractures were evaluated. The follow-up period was over 12 months. ResultsVAS 3.0 d after surgery was significantly reduced in the ultra-early injection group compared to that in the control group (P = 0.00), but no difference was found at the final follow-up (P = 0.53). Similar results were found for ODI. The Cobb angle in both groups was recovered after PVP (P < 0.05); however, in the control group, the Cobb angle at the final follow-up was significantly increased compared with that 3.0 d after surgery (P = 0.00). There was a significant difference in the Cobb angle between the two groups at the final follow-up (P = 0.00). Regarding cement leakage, there were no significant differences in terms of mild (P = 0.58), moderate (P = 0.68), or severe leakage (P = 0.52). Seven patients in the control group had adjacent vertebral fractures, but only one patient in the ultra-early injection group experienced adjacent fractures (P = 0.03). ConclusionsUltra-early injection of low-viscosity cement during PVP procedures in the treatment of OVCFs not only quickly and significantly relieves pain, reduces the incidence of adjacent vertebral fractures, and prevents progressive kyphotic deformity, but also does not increase the risk of cement leakage when compared with that of the traditional injection procedure.

Analysis of Reporting Bias in Vertebral Augmentation

Osteoporotic vertebral compression fractures (OVCFs) are a significant cause of morbidity and mortality in the United States and worldwide, with estimates of 750,000 to 1.5 million occurring annually. As the elderly population continues to increase, the incidence of OVCFs will continue to rise, as will the morbidity and mortality associated with this condition. Vertebral augmentation (VA) was almost universally accepted as the appropriate treatment modality prior to 2 sham trials published in 2009 by the New England Journal of Medicine (NEJM). Subsequently, there is now significant controversy regarding the optimal treatment of OVCFs. Since 2009 there have been 6 prospective randomized controlled studies (PRCTs) and 2 meta-analyses on VA for the treatment of OVCFs. Five of the PRCTs and both of the meta-analyses have shown superior results with VA as compared with nonsurgical management (NSM). However, a recent health technology assessment and review article continue to overemphasize the 2 NEJM sham trials, despite the most current literature. These are examples of inconsistent or biased data reporting with overemphasis on certain trial types and exclusion of other types of data, resulting in the reporting of conclusions that are partially representative or not representative of the complete data. As clinical investigators, we have a responsibility to limit bias and ensure that the appropriate treatment modalities are made available to vulnerable populations. The aim of this perspective analysis is to examine sources of bias in reporting and some of the publications that contain it, along with comparing the publications to the current body of published literature relevant to this topic. Key words: Vertebral augmentation, vertebroplasty, kyphoplasty, bias, osteoporosis, compression fracture

Percutaneous kyphoplasty for treatment of osteoporotic vertebral body compression fractures in the elderly

Objectives To study the clinical effects of percutaneous kyphoplasty on senile osteoporotic vertebral body compression fractures. Methods The 87 elderly patients with osteoporotic vertebral body compression fractures were randomly grouped into control group (n=42) treated with percutaneous vertebroplasty and observation group (n=45) treated with percutaneous kyphoplasty in our hospital from June 2013-March 2016.And the clinical curative effect before and after treatment was compared and analyzed. Results The visual analog scale (VAS) pain score in observation group versus control group was (8.49±2.86) vs.(8.56±2.98), (t=0.11, P>0.05) before treatment, and[(2.58±1.34) vs.(3.34±2.01), t=2.09, P< 0.05], [(2.06±0.97) vs (3.87±1.96), t=5.51, P<0.05]and[(1.09±0.89) vs (2.37±1.29)], t=5.42, P<0.05]at 1 week, 4 weeks, and 12 weeks after treatment respectively, showing statistically significant improvement after treatment.The data of kyphosis angle by using Cobb angle, Oswestry lumbar dysfunction index (ODI), mean time of postoperative ambulation, and mean postoperative hospital stay were similar to that of the visual analog scale (VAS) pain score, showing statistically significant improvement after treatment (all P<0.05). The incidence[cases (%)]of bone cement leakage was lower in observation group[3(6.7)]than in control[9(21.4)](χ2=3.98, P<0.05). Conclusions Clinical treatment effects of percutaneous kyphoplasty on the elderly patients with osteoporotic vertebral body compression fractures are superior to that of percutaneous vertebroplasty.Percutaneous kyphoplasty can effectively relieve pain, and improve body function disorders and the quality of life. Key words: Percutaneous kyphoplasty; Osteoporosis in the elderly; Compressive fractures

Therapeutic effects analysis of percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A multicentre study

SummaryBackgroundPercutaneous kyphoplasty (PKP), a minimally invasive treatment, has been widely used for osteoporotic vertebral compression fractures (OVCFs).ObjectiveTo retrospectively analyse the therapeutic effects of PKP using a series of key techniques in a multicentre study.MethodsFrom May 2000 to December 2016, PKP was performed using a series of key techniques (puncture, reduction, and perfusion techniques) for the treatment of 4532 OVCF patients. The pain visual analog scale (VAS) and the Oswestry Disability Index (ODI) questionnaire prior to the operation, at postoperative Day 2, and at the last follow-up were analysed by paired t-test analysis. The leakage of bone cement was evaluated by postoperative radiography and/or computed tomography. Four-year survival was calculated at the last follow-up.ResultsThe average follow-up was 63 months (1–116 months). The VAS score decreased from 8.9 (preoperative) to 2.3 (2 days postoperative) to 1.9 (last follow-up). The ODI score of the patients decreased from 86.7 (preoperative) to 31.6 (2 days postoperative) to 25.3 (last follow-up). Both VAS score and ODI score improved significantly. The bone cement leakage rate was 3.5%, with no clinical symptoms. The 4-year survival rate was 77.5%.ConclusionThis study suggests that PKP with key techniques would be an effective technique to treat OVCF with less risk and better therapeutic effect. Such diagnostic methods and surgical techniques lead to the development and progress of treatment for OVCF.The translational potential of this article: PKP with key techniques would be an effective technique to treat and lead to the development and progress of treatment for OVCF.

Preliminary clinical research of vertebral body stenting combined with absorbable bone cements for osteoporotic vertebral compression fractures

Objective To observe the clinical effect and safety of using vertebral body stenting combined with absorbable bone cements during percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCF). Methods A prospective study was made on the patients managed with vertebral body stenting combined with absorbable bone cements for OVCF between January 2014 and January 2016. Visual analogue scale (VAS), Oswestry disability index (ODI), vertebral body height recovery, kyphotic cobb angle and surgical complications were measured before and after operation. Results A total of 15 patients (8 males and 7 females; aged 51-83 years, mean 68.6 years) were included. Mean period of follow-up was 6 months. All patients were operated successfully without intraoperative and postoperative complications. VAS was improved from preoperative (7.67±0.62)points to (2.60±0.63)points at 3 d, (2.00±0.65)points at 3 months and (1.26±0.80)points at 6 months (P 0.05). Cobb angle was improved from preoperative (8.93±6.58)° to (8.03±6.02)° at 3 d and (7.93±6.09)° at 6 months(P 0.05). Conclusion Vertebral body stenting combined with absorbable bone cements used in PKP in the treatment of OVCF can improve and maintain the front edge as well as middle height of the vertebral body and cobb angle, and the early follow-up results are satisfactory. Key words: Osteoporotic fractures; Vertebroplasty; Vertebral body stent

Effect of percutaneous vertebroplasty with high-viscosity bone cement in treatment of severe osteoporotic vertebral compression fractures

Objective To evaluate the clinical effects of percutaneous vertebroplasty (PVP) with high-viscosity bone cement in treatment of severe osteoporotic vertebral compression fracture (OVCF). Methods This study involved 176 patients with severe OVCF treated by PVP with high-viscosity bone cement between January 2013 and January 2015. There were 61 male and 115 female patients, aged 58-78 years (mean, 67.7 years). Ninety-four patients were injured in a fall, 31 patients in a bumping condition, and 61 patients with no obvious causes. A total of 204 vertebrae were involved, including 23 T10, 22 T11, 49 T12, 43 L1 and 29 L2. Thirty patients suffered vertebral posterior wall damage. All the vertebral bodies were compressed more than 2/3. Vertebral height, kyphotic Cobb angle, visual analogue scale (VAS) and Oswestry disability index (ODI) were recorded. Bone cement filling and leakage were detected. Results Bone cement leakage was detected in 64 patients, with a leakage rate of 36.3%.Seven patients were found with cement leakage in paravertebral veins, 38 patients in intervertebral spaces, and 19 patients in prevertebral soft tissues. Five patients with back pain got partial remission. Four patients experienced burning sensation in the lower extremity 5 minutes after bone cement filling and were relieved 10 minutes later. No severe adverse events were observed, including spinal cord compression, epidural hematoma, pulmonary infection, pulmonary embolism, bedsores, and cerebrovascular accident. After operation, improvements were observed in ODI [(31.73±7.98)% vs. (75.40±8.17)%] and VAS [(2.33±0.91)points vs. (7.23 ±0.88) points] (P<0.05). Conclusion PVP with high-viscosity bone cement can significantly relieve pain and improve motor function and hence is effective in the treatment of patients with severe OVCF. Key words: Osteoporotic fractures; Vertebroplasty; Complications

Effectiveness of kyphoplasty in the treatment of osteoporotic vertebral compression fracture patients with chronic kidney disease.

Kyphoplasty is a popular treatment option for osteoporotic vertebral compression fractures (OVCFs). However, there is still a lack of comprehensive clinical evidence demonstrating whether kyphoplasty is suitable for treatment of OVCFs complicated by chronic kidney disease (CKD). The purpose of this study was to evaluate the effectiveness and safety of kyphoplasty in the treatment of OVCFs in CKD. Twelve OVCF patients with CKD who received kyphoplasty were retrospectively reviewed. Visual analogue scale (VAS), painkiller score, and the Oswestry Disability Index (ODI) questionnaire were measured one day preoperatively, three days postoperatively, and at final follow-up to evaluate the functional outcomes of patients. Additionally, changes in the anterior, middle, and posterior vertebral heights of the fractured vertebral body (VB), as well as changes in the Cobb's angle of the thoracic spine were used to assess improvements in local kyphosis correction. A rapid improvement in pain and disability was achieved in our patients, which was manifested by a significant reduction in VAS, painkiller score, and ODI three days after kyphoplasty. In addition, the use of kyphoplasty offered the benefit of restoring vertebral body height and significantly improved the Cobb's angle. These findings support the value of kyphoplasty in the correction of local kyphosis for OVCF patients with CKD. Kyphoplasty can rapidly relieve pain and disability, and improve local kyphosis caused by fracture in OVCF patients accompanied by CKD. These findings provide new evidence that kyphoplasty may be a safe and effective option for the treatment of OVCFs in patients with CKD.

Cognizance on the re-fracture of the operated vertebra with cemented augmentation in osteoporotic vertebral compression fractures

One option with minimally invasive surgery for treatment of painful osteoporotic vertebral compression fracture is percutaneous vertebroplasty or percutaneous kyphoplasty via an inflatable balloon tamp followed by stabilization with polymethylmethacrylate cement. The vertebral height is restored and the decreased loading ability of the fractured vertebral body is restrengthened with pain relief. The effect of the method is widely demonstrated in those conditions. At the same time, the relative problems, such as the complications are being lucubrated and discussed. The reports on the re-fracture or height loss of the operated vertebrae with cemented augmentation are becoming more. By now, there are some unclear aspects on the problem: the definition of the re-fracture of the augmented vertebra is still unclear and not ascertained and the clinical manifestations are various. The mechanisms and correlative factors are still not clear-cut either. The rate of subsequent re-fractures after cemented augmentation from literature is fargoing, with a rate of 0% to 63%. The correlative factors on the re-fracture of the operated vertebrae chiefly include: osteoporosis, bone necrosis caused by the heat injury from cement solidification, failure to achieve endplate-to-endplate cement augmentation, intravertebral cleft or avascular bone necrosis, premature mobilization or excessive movement, overfull reduction of the vertebral height, the biological character of the spine column, and so on. Great controversy still exists on the correlation between those possible factors and the re-fractures. More attention should be paid to this problem to explore the true risk factors and mechanism, decrease the re-fracutre rate, and elevate the clinical outcome in osteoporotic compression fractures.

Relationship between MRI sign and outcome of percutaneous kyphoplasty in acute phase of osteoporotic vertebral compression fracture

Objective To observe the correlation of MRI findings with treatment outcome of percutaneous kyphoplasty (PKP) in the acute phase of osteoporotic vertebral compression fracture (OVCF). Methods A total of 101 patients with single-segment OVCF undergone PKP in the acute phase were included in the study. There were 19 males and 82 females, at age range of 61 to 89 years (mean, 69.3 years). According to the T2WI signal intensity, the patients were divided into low signal group (Group A), low-medium signal group (Group B), medium signal group (Group C), and medium-high signal group (Group D). visual analogue scale (VAS) was used to evaluating the pain relief. Correlations of MRI signal with vertebral height, vertebral compression ratio, Cobb's angle change in each group were determined. Results All MRI images were shown as low signal in T1WI and high signal in FS-T2WI. On the T2WI images, the signal was medium-high in 14 vertebrae, medium in 18 vertebrae, low-medium in 31 vertebrae, and low in 38 vertebrae. Among four groups, the VAS score, vertebral body height, vertebral compression ratio and Cobb's angle changes before operation showed no statistical difference compared with those after operation (P<0.05). Conclusions MRI findings are primarily low or medium signal on T2WI images in the acute phase of OVCF, which shows insignificant correlation with effect of PKP. However, PKP is effective in the treatment of OVCF. Key words: Osteoporotic fractures; Magnetic resonance spectroscopy; Percutaneous kyphoplasty

A painful, never ending story: older women's experiences of living with an osteoporotic vertebral compression fracture.

SummaryVertebral compression fractures (VCF) cause pain and decreased physical ability, with no known well-established treatment. The aim of this study was to illuminate the experience of living with a VCF. The results show that fear and concerns are a major part of daily life. The women’s initial contact with health-care providers should focus on making them feel acknowledged by offering person-centered and tailored support.IntroductionIn the past decade, osteoporotic-related fractures have become an increasingly common and costly public health problem worldwide. Vertebral compression fracture (VCF) is the second most common osteoporotic fracture, and patients with VCF describe an abrupt descent into disability, with a subsequent desire to regain independence in everyday life; however, little is known of their situation. The aim of this study was to illuminate the lived experience of women with an osteoporotic VCF.MethodsTen women were interviewed during 2012–2013, starting with an open-ended question: could you tell me what it is like to live with a vertebral compression fracture? The verbatim transcribed interviews were analyzed using a phenomenological hermeneutical approach.ResultsThe narrative provided descriptions of living in turmoil and chaos, unable to find stability in their life with little improvement regarding pain and physical function. Shifts from periods of constant pain to periods of fear of constant pain created a loss of confidence and an increased sense of confinement. The structural analysis revealed fear and concerns as the most prominent experience building on five themes: struggling to understand a deceiving body, breakthrough pain fueling fear, fearing a trajectory into isolation, concerns of dependency, and fearing an uncertain future.ConclusionsUntil researchers find a successful prevention or medical/surgical treatment for osteoporotic VCFs, health-care providers and society abandon these women to remain in a painful and never ending story.

Percutaneous kyphoplasty via the uni-extrapedicular approach for treatment of lower osteoporotic vertebral compression fractures

Objective To investigate the clinical efficacy and safety of the uni-extrapedicular percutaneous kyphoplasty (PKP) versus the unipedicular PKP in the treatment of lower osteoporotic vertebral compression fractures (OVCF). Methods From January 2011 to January 2013, 47 patients with lower OVCF were treated at our department. The uni-extrapedicular PKP was conducted for 25 of them (28 compressed vertebrae, group A) while the unipedicular PKP for the other 22 (24 compressed vertebrae, group B). The 2 groups were compatible, showing no significant differences in preoperative clinical data (P>0.05). The 2 groups were compared in terms of operation time, fluoroscopy frequency, volume of injected cement, cement leakage, and cobb angle, anterior vertebral height, visual analogue scale (VAS) score, Oswestry disability index (ODI), SF-36 score, and cement filling preoperatively, 3 days and one year postoperatively. Results All the patients had an uneventful operation and were followed up for at least one year. Compared with group B, group A reported significantly shorter operation time, lower fluoroscopy frequency, less cement leakage, better cement filling, and a lower rate of fracture of adjacent vertebra (all P 0.05). Conclusion Both of the 2 methods are safe and effective treatments of OVCF, but the uni-extrapedicular PKP may be more advantageous because it leads to shorter operation time and lower fluoroscopy frequency. Key words: Thoracic vertebrae; Fractures, bone; Osteoporosis; Vertebroplasty; Cement