Percutaneous Kyphoplasty In Treatment Research Articles

Percutaneous Kyphoplasty Guided by CT Images Based on SEPB Algorithm in the Treatment of Elderly Osteoporotic Thoracolumbar Vertebral Compression Fractures

The paper uses the SEPB algorithm to explore the value of X-ray and CT diagnosis in elderly patients with osteoporotic lumbar compressive fractures, while observing percutaneous kyphoplasty (PKP) in the treatment of elderly osteoporotic compression fractures with clinical efficacy. 38 elderly patients with fractured osteoporotic compression fractures who came to our hospital for treatment were included. All patients were diagnosed by X-ray and CT, the clinical data of all patients were analyzed, the imaging findings related to X-ray and CT diagnosis were clarified, and the diagnostic coincidence rate was analyzed. At the same time, PKP treatment was applied for clinical efficacy and Imaging analysis. And, follow-up was conducted for 2 months after operation. The results showed that compared with the X-ray diagnosis, the accuracy of CT diagnosis was 88.89% (32/38), and the difference between the groups was significant ( P < 0.05 ). 35 cases of low back pain disappeared after operation, and 3 cases of pain were significantly reduced without bone cement leakage. Postoperative imaging examination showed no space occupied in the spinal canal, and kyphosis deformity was significantly improved. The average height of the anterior vertebral column after injury was significantly increased ( P < 0.05 ). The Cobb angle returned to normal level, which was statistically significant compared with that before the operation ( P < 0.05 ). In conclusion, in the diagnosis of elderly patients with osteoporotic lumbar compression fractures, the coincidence rate of CT diagnosis is better than that of X-ray diagnosis. Therefore, the application rate of CT diagnostic methods in diagnosis is higher, which provides an effective basis for clinical diagnosis and treatment. PKP surgery is less invasive, safe, and has good clinical efficacy. It can quickly relieve pain and effectively restore the height of injured vertebrae. It is an ideal treatment method for elderly osteoporotic thoracolumbar vertebral compression fractures.

Analysis of the curative effect of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture with intravertebral clefts.

Kummell's disease is a delayed vertebral collapse fracture caused by posttraumatic osteonecrosis. It is a special type of osteoporotic vertebral fracture in the elderly. This study compares and analyzes the difference in the curative effect of 2 kinds of osteoporotic vertebral compression fracture (OVCF) in the presence of fracture or not in the vertebral body, and provides a clinical reference for the application of percutaneous kyphoplasty (PKP).This research is a kind of retrospective analysis from January 2012 to January 2015, PKP was used to treat 165 patients with osteoporotic vertebral compression fracture. The patients were divided into 2 groups: Intravertebral clefts group (group A) and none-intravertebral clefts group in vertebral body (group B). Bone mineral density (BMD), bone cement injection (BCI), Visual analogue scale (VAS) score before and after surgery, anterior, central and posterior height of vertebral body (before and after surgery) and Cobb angle of injured vertebra (before and after surgery) were compared between the 2 groups.Surgeries for 165 patients in the 2 groups were successfully completed, and 226 fractured vertebrae were performed through bilateral puncture approach to strengthen the vertebral body. Intraoperative injection of bone cement (ml) was 4.25 + 1.29 (range: 2.6–7.8). There were statistically significant differences in bone cement injection quantity between the 2 groups (P < .05), and in bone cement leakage (P > .05) as well as the Postoperative VAS score (P < .05). However, There was no statistical difference in VAS score before surgery between the 2 groups (P > .05). The results indicated that the pain relief degree of OVCF patients without intravertebral clefts is better than that in the vertebral body. No statistical difference was found in Cobb Angle before and after surgery (P > .05), as well as the correction rate of the injured vertebrae before and after surgery (P > .05). There was no statistical difference in the degree of recovery of the anterior, middle and posterior margins of the injured vertebrae after surgery (P > .05).PKP treatment led to better degree of pain relief in OVCF patients without intravertebral clefts, and less bone cement was injected into the surgery.

Robot-guided percutaneous kyphoplasty in treatment of multi-segmental osteoporotic vertebral compression fracture

To evaluate the safety and effectiveness of robot-guided percutaneous kyphoplasty (PKP) in treatment of multi-segmental thoracolumbar osteoporotic vertebral compression fracture (OVCF). A clinical data of 63 cases with multi-segmental thoracolumbar OVCF without neurologic deficit treated with PKP between October 2017 and February 2019 were analyzed retrospectively. The patients were divided into robot-guided group (33 cases) and traditional fluoroscopy group (30 cases). There was no significant difference in gender, age, fracture segment, bone mineral density, and preoperative visual analogue scale (VAS) score, midline vertebral height, and Cobb angle between the two groups ( P>0.05). The time to establish the tunnel, the times of fluoroscopy, the dose of fluoroscopy, the deviation of puncture, the distribution of bone cement, the leakage of bone cement, the puncture angle, and the postoperative VAS score, midline vertebral height, and Cobb angle were recorded and compared. The patients in two groups were followed up 11-13 months (mean, 12 months). Compared with traditional fluoroscopy group, the time to establish the tunnel, the times and dose of fluoroscopy in robot-guided group were significantly lower, the deviation of puncture was slighter, the distribution of bone cement was better, and the puncture angle was larger, the differences between the two groups were significant ( P<0.05). There were 8 segments (9.3%, 8/86) of bone leakage in robot-guided group and 17 segments (22.6%, 17/75) in traditional fluoroscopy group, the difference between the two groups was significant ( χ 2=5.455, P=0.020). There was no significant difference in VAS score, the midline vertebral height, and Cobb angle between the two groups at 2 days after operation and last follow-up ( P>0.05). Robot-guided PKP in treatment of multi-segmental thoracolumbar OVCF can shorten the operation time, improve the accuracy of puncture, reduce the times and dose of fluoroscopy, reduce the leakage of bone cement, and achieve better cement distribution.

Performance of Double-Arm Digital Subtraction Angiography (DSA)-Guided and C-Arm-Guided Percutaneous Kyphoplasty (PKP) to Treat Senile Osteoporotic Vertebral Compression Fractures.

BackgroundOsteoporotic vertebral compression fracture (OVCF) is a common fracture in the elderly. Conservative treatment requires prolonged bedding, which may lead to serious complications. To explore optimized use of percutaneous kyphoplasty (PKP) in the treatment of senile osteoporotic thoracolumbar vertebral compression fractures, in this study, we used C-arm-guided and double-arm digital subtraction angiography (DSA)-guided PKP to treat OVCF in elderly patients and analyzed the effective recovery.Material/MethodsIn all, 60 patients who presented with osteoporotic vertebral compression fractures at our hospital between July 2017 and February 2019 were analyzed. They were randomly divided into C-arm-guided group and the double-arm DSA-guided groups. Both groups were treated with percutaneous kyphoplasty.ResultsA pain VAS score analysis revealed that there was no significant difference between the two groups before surgery (P>0.05). After surgery, the VAS scores showed a significant difference between the C-arm-guided group and the double-arm DSA-guided PKP treatment group (P<0.01). Moreover, with respect to the bone cement dosage, vertebral correction height, operation time, cumulative radiation dose, percolation rate, and volume of bone cement, the double-arm DSA-guided PKP treatment showed significantly better results than the C-arm-guided PKP treatment (P<0.01).ConclusionsOur data revealed that double-arm DSA-guided PKP was more accurate in treatment of senile osteoporotic thoracolumbar vertebral compression fractures, producing excellent performance with more accurate intraoperative evaluation, shorter operative time, lower incidence of bone cement leakage, less intraoperative radiation dose, and higher safety, and thus, could be extensively applied to clinical surgery.

Percutaneous kyphoplasty for osteoporotic vertebral compression fractures improves spino-pelvic alignment and global sagittal balance maximally in the thoracolumbar region

Osteoporotic vertebral compression fractures (OVCFs) often cause local kyphosis. Percutaneous kyphoplasty (PKP) is a common method for the treatment of local kyphosis. However, the influence of kyphoplasty on spino-pelvic alignment and global sagittal balance when performed at specific treatment sites in the spine remains unclear. The purpose of the study is to investigate the influence of different fracture sites and PKP treatment on the spino-pelvic alignment and global sagittal balance in patients with OVCFs. 90 patients with OVCF who underwent PKP were included in the retrospective study. According to the site of the fractured vertebrae, all the cases were divided into 3 groups: Main thoracic (MT) group (T1 to T9), Thoracolumbar (TL) group (T10 to L2) and Lumbar (LU) group (L3 to L5). 26 healthy elderly volunteers (aged over 59) were enrolled as the control group. Sagittal spino-pelvic parameters were measured on the full-spine radiographs preoperatively and postoperatively. Information of sagittal spino-pelvic parameters and global sagittal balance was gathered. Compared with the Control group, TL group showed significant differences in almost all parameters, except pelvic incidence (PI) and lumbar lordosis (LL). While only local sagittal parameters (Thoracic kyphosis (TK), Thoracolumbar kyphosis (TLK), LL) were significantly different in MT group. There was no significant difference in almost all of the parameters except for PT and TPA in LU group. Correspondingly, the sagittal parameters of TL group improved best after PKP, except for thoracic kyphosis (TK) and sagittal vertical axis (SVA). In MT group, only TLK was significantly decreased, while in LU group, only local kyphosis Cobb angle and SSA were improved. OVCF mainly occurs in the thoracolumbar region. Compared with MT group and LU group, OVCF occurred in the thoracolumbar region had greater influence on the spino-pelvic alignment and global sagittal balance. When PKP was performed, the improvement of sagittal balance parameters of TL group was the best in the three groups.

The effect of bone cement distribution on clinical efficacy after percutaneous kyphoplasty for osteoporotic vertebral compression fractures.

To evaluate the influence of various distributions of bone cement on the clinical efficacy of percutaneous kyphoplasty (PKP) in treating osteoporotic vertebrae compression fractures.A total of 201 OVCF patients (30 males and 171 females) who received PKP treatment in our hospital were enrolled in this study. According to the characteristic of cement distribution, patients were divided into 2 groups: group A (“H” shaped group), the filling pattern in vertebral body were 2 briquettes and connected with / without cement bridge; and group B (“O” shaped group), the filling pattern in vertebral body was a complete crumb and without any separation. Bone mineral density, volume of injected cement, radiographic parameters, and VAS scores were recorded and analyzed between the 2 groups.All patients finished at least a 1-year follow-up and both groups had significant improvement in radiographic parameters and clinical results. No significant differences in BMD, operation time, bleeding volume, or leakage of cement were observed between the 2 groups. Compared with group B, group A had a larger use of bone cement, lower proportion of unipedicular approach, and better VAS scores at 1 year after surgery.Both “H” and “O” shaped distribution pattern can improve radiographic data and clinical outcomes effectively. However, “H” shaped distribution can achieve better clinical recovery at short-term follow-up.

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.

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.

Mineralized Collagen Modified Polymethyl Methacrylate Bone Cement for Osteoporotic Compression Vertebral Fracture at 1-Year Follow-up.

Retrospective comparative study. This study aimed to compare the clinical effects and imaging features of polymethyl methacrylate (PMMA) bone cement with and without mineralized collagen (MC) in percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs). PKP with PMMA is widely performed for OVCF. However, numerous complications have also been reported about the PMMA bone cement. Moreover, PMMA bone cement with and without MC have not been compared with respect to their postoperative efficacy and long-term follow-up. From July 2016 to July 2017, 105 OVCF patients were randomly divided into two groups based on their PKP treatment: MC-PMMA group and PMMA group. Clinical operation, cement leakage, Oswestry Disability Index, visual analog scale, height of the fractured vertebrae, Cobb angle, refracture of the adjacent vertebra, recompression, and computed tomography values of the injured vertebra were compared between the two groups postoperatively and after 1-year follow-up. Clinical operation showed no differences between the two groups. Visual analog scale scores, Oswestry Disability Index scores, and Cobb angles showed statistically significant differences between the two groups after 1-year follow-up. The height of the vertebral body showed significant difference at 3 days postoperatively and preoperatively in each group and significant difference after 1 year between the two groups. The rate of refracture and leakage of the MC-PMMA group was lower than that of the PMMA group. The computed tomography value of the MC-PMMA group was obviously higher than that of the PMMA group after 1-year follow-up. MC-modified PMMA did not change the beneficial properties of PMMA. This new bone cement has better biocompatibility, can form a stable structure in the vertebral body, and improve the prognosis of patients by reducing pain and reoperation. 3.

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

Percutaneous kyphoplasty treatment of osteoporotic vertebral compression fracture under the guidance of G-arm X-ray machine

Objective To explore the clinical application value of percutaneous kyphoplasty (PKP) under the guidance of G arm X ray machine in the treatment of osteoporotic vertebral compression fracture (OVCF). Methods The medical records of eighty-two patients (94 vertebral bodies) with OVCF treated with PKP were collected retrospectively.Thirty-nine cases (44 vertebral bodies) were guided by G-arm X-ray machine to implement PKP, which were recorded as G-arm group.Forty-three cases (50 vertebral bodies) were guided by C-arm X-ray machine to carry out PKP, which were recorded as C-arm group.The operation time, intraoperative fluoroscopy times, bone cement leakage cases, preoperative and postoperative anterior height of injured vertebrae, Cobb angle of injured vertebrae, visual analogue scale scores and Oswestry disability index of the two groups were recorded. Results There was significant difference in operation time and intraoperative fluoroscopy times between the G-arm group and C-arm group (the operation time: (31.6±5.2) vs.(45.8±6.7) min, the intraoperative fluoroscopy times: (9.5±2.3) times vs.(18.7±3.5) times, t=-10.64, -13.91, P 0.05). Compared postoperative and preoperative anterior height of injured vertebrae, Cobb angle of injured vertebrae, visual analogue scale scores and Oswestry disability index scores of G-arm group and C-arm group respectively, the differences were significant( t=-3.41 vs.-3.28, 6.67 vs.7.66, 26.63 vs.25.75 and 10.41 vs.11.90, P 0.05). Conclusion The treatment of OVCF with PKP guided by G-arm X-ray machine could significantly shorten operation time, reduce the intraoperative fluoroscopy times and the operative difficulty, and increase operation safety than PKP guided by traditional C-arm X-ray machine. Key words: Osteoporotic vertebral compression fracture; Percutaneous kyphoplasty; G-arm X-ray machine; C-arm X-ray machine

Coronal Imaging Changes Associated with Recollapse of Injured Vertebrae After Percutaneous Vertebroplasty or Percutaneous Kyphoplasty Treatment for Osteoporotic Thoracolumbar Fracture

To observe coronal imaging changes associated with recollapse of injured vertebrae after percutaneous vertebroplasty or percutaneous kyphoplasty for osteoporotic thoracolumbar fracture (OTLF). Fifty-four cases were retrospectively divided into 2 groups according to the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) classification of thoracolumbar fracture: group A, type A1 fracture (n= 26); group B, type A3.1 fracture (n= 28). Visual analog scale, Oswestry Disability Index, local scoliotic Cobb angle, and coronal wedge angle of the injured vertebrae were observed preoperatively, on postoperative day 3, and at final follow-up. The average follow-up time was 19.17 ± 6.30 months. At final follow-up, the visual analog scale score and the Oswestry Disability Index score were significantly greater in group B than in group A (both P < 0.05). At final follow-up, loss of correction of scoliotic Cobb angle and coronal wedge angle was significantly higher in group B than in group A (P < 0.05). Percutaneous vertebroplasty or percutaneous kyphoplasty was effective in both type A1 and type A3.1 OTLF. However, coronal imaging changes after percutaneous vertebroplasty or percutaneous kyphoplasty were more obvious in type A3.1 OTLF than in type A1. Moreover, clinical outcomes in type A3.1 OTLF were slightly inferior to those in type A1.

Percutaneous kyphoplasty treatment evaluation for patients with Kümmell disease based on a two-year follow-up.

Percutaneous kyphoplasty (PKP) has been used in Kümmell disease treatment for years. The objective of the current study was to evaluate the efficacy and safety of PKP in the treatment of patients with Kümmell disease and to explore the association between cement injection volume and pain relief. A total of 50 patients were enrolled in the present study and follow-up was 2 years. Efficacy was evaluated using the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI) and the kyphotic angle (Cobb's angle). VAS and ODI were determined at the initial evaluation (prior to surgery), at 3 days, 3 months, and 1 and 2 years post surgery. Cobb's angle was measured prior to and 3 months, 1 year and 2 years following surgery. PKP safety was assessed by evaluating complications, including cement leakage and spinal cord compression. In the follow-ups, VAS significantly decreased from 7.00±0.78 pre-PKP to 3.14±0.67 at 2 years post-PKP (P<0.05). ODI significantly decreased from 73.88±8.60 prior to surgery to 22.84±8.85 at 1 year following surgery (P<0.05) and did not significantly change at the following 2-year measurement (26.44±8.63). The Cobb's angle, measured at 17.73±2.43° preoperatively, significantly decreased to 8.32±2.21° at 3 months following surgery (P<0.05). On subsequent follow-ups at 1 and 2 years, the Cobb's angle increased to 9.55±2.82 and 10.27±3.22°, respectively. A total of 8 patients exhibited signs of cement leakage during the PKP procedure. No patients experienced severe neurological deficits or complications. Spearman analysis demonstrated a positive correlation between cement injection volume and pain relief. The current study indicated that PKP was a safe and effective treatment for patients with Kümmell disease and that there was a positive correlation between cement injection volume and pain relief. The current study may be used a reference in cement dosing for the treatment of PKP.

Bone cement distribution is a potential predictor to the reconstructive effects of unilateral percutaneous kyphoplasty in OVCFs: a retrospective study

BackgroundOsteoporotic vertebral compression fracture (OVCF) is a common type of fracture, and percutaneous kyphoplasty (PKP) is an eligible solution to it. Previous studies have revealed that both the volume and filling pattern of bone cement correlate with the clinical outcomes after PKP procedure. However, the role of bone cement distribution remains to be illustrated.MethodsTo retrospectively evaluate the relationship between the bone cement distribution and the clinical outcomes of unilateral PKP, we enrolled 73 OVCF patients receiving unilateral PKP treatment. All the intervened vertebrae were classified into three groups based on the bone cement distribution observed on postoperative X-ray films. Preoperative and postoperative radiographic parameters including the vertebral height and kyphotic Cobb angle were recorded, and anterior vertebral height restoration rate (AVHRR) and Cobb angle correction (CR) were then calculated to assess the vertebral height reconstruction. Preoperative and postoperative Oswestry Disability Index (ODI) and visual analogue scale (VAS) were adopted by interviewing patients to assess the mobility improvement and pain relief. Demographic data, body mass index (BMI), lumbar bone mineral density (evaluated by BMD T-score) of each patient, bone cement volume (BV), and bone cement extravasation (BE) were also recorded. Between- and within-group comparisons and multivariable correlation analysis were carried out to analyze the data.ResultsVAS and ODI scores were both significantly improved in all of the enrolled cases with no significant differences between groups. Among the three groups, the average age, AVHRR, and BV were significantly different. Occurrence of BE was significantly different between two of the three groups. AVHRR was demonstrated to correlate negatively with preoperative anterior vertebral height ratio and positively with preoperative Cobb angle, CR, diffusion score, and ODI changes.ConclusionsBone cement distribution is a potential predictor to the reconstructive effects in unilateral PKP for OVCFs. Bone cement distribution is associated with AVHRR and BV, as well as the risk of BE occurrence. Greater bone cement distribution may indicate better vertebral restoration along with a higher BE risk.

The outcomes of percutaneous kyphoplasty in treatment of the secondary osteoporotic vertebral compression factures: a case-control study.

To investigate the outcomes of using percutaneous kyphoplasty in the treatment of the secondary osteoporotic vertebral compression fractures. Eighty-one patients had the secondary single segmental osteoporotic vertebral compression fractures after the initial fractures and treated by percutaneous kyphoplasty were reviewed, 74 of them had minimum 2 years follow-up were included in this study. The 74 patients with primary osteoporotic vertebral compression fractures treated by percutaneous kyphoplasty at the same time period were matched as control group in 1:1 ratio. Visual Analogue Scales (VAS) and Oswestry Disability Index (ODI) were used to assess the back pain and functional outcomes. The kyphotic angulation (KA) and compression ratio (CR) of the fractured vertebra was measured too. Both the secondary fracture group and control group had significantly relieved back pain, improved functional outcomes, corrected KA and restored CR after operation, but no difference was found between two groups. Our findings suggest that percutaneous kyphoplasty is an effective and safe procedure for patients with secondary single segmental osteoporotic vertebral compression fractures; it can achieve similar clinical outcomes to the primary osteoporotic vertebral compression fractures.

Photoelectric guided navigation unilateral puncture of the percutaneous kyphoplasty in treatment of thoracolumbar osteoporotic vertebral compression fracture

To evaluate the safety of photoelectric guided navigation unilateral puncture of the percutaneous kyphoplasty (PKP) in the treatment of thoracolumbar osteoporotic vertebral compression fracture (OVCF). A randomized controlled clinical research was performed between June 2015 and January 2017. Eighty-five cases of OVCF were treated with photoelectric guided navigation unilateral puncture of the PKP (trial group, 43 cases) or C arm fluoroscopy unilateral puncture of the PKP (control group, 42 cases) respectively. There was no significant difference in gender, age, disease duration, segmental fracture, AO classification, bone mineral density, and preoperative visual analogue scale (VAS) score between 2 groups ( P>0.05). The concordance rate of puncture path and design path, the incidence of pedicle wall breaking, the incidence of bone cement leakage, and the rate of bone cement distribution center were observed and calculated on postoperative CT images; the intraoperative X-ray exposure frequency, frequency of puncture, operation time, VAS scores before operation and at 2 days after operation, and postoperative blood vessel or nerve injury were recorded and compared. The intraoperative X-ray exposure frequency and puncture frequency in trial group were significantly less than those in control group ( P<0.05), but there was no significant difference in operation time between 2 groups ( t=0.440, P=0.661). The VAS scores of 2 groups at 2 days after operation were significantly improved when compared with preoperative ones ( P<0.05), but there was no significant difference in VAS score at 2 days after operation between 2 groups ( t=0.406, P=0.685). All the patients were followed up 6-18 months (mean, 10 months). No blood vessel or nerve injury occurred in 2 groups. The incidence of pedicle wall breaking, the incidence of bone cement leakage, the concordance rate of puncture path and design path, and the rate of bone cement distribution center in trial group were 2.33% (1/43), 2.33% (1/43), 86.05% (37/43), and 88.37% (38/43) respectively, all showing significant differences when compared with those of control group [19.05% (8/42), 21.43% (9/42), 45.24% (19/42), and 50.00% (21/42) respectively] ( P<0.05). Intraoperative photoelectric guided navigation unilateral puncture of the PKP can improve the success rate of target puncture and reduce the incidence of pedicle wall breaking effectively, and achieve better bone cement distribution and better security.

Percutaneous kyphoplasty for treatment of distant pain associated with osteoporotic vertebral compression fracture

Objective To explore the clinical characteristics of the distant pain associated with osteoporotic vertebral compression fracture (OVCF) and the effect of percutaneous kyphoplasty (PKP) on the distant pain. Methods Ninety-eight patients with OVCF were treated with PKP at our department from June 2013 to October 2016. They were divided into 2 groups according the their pain associated with OVCF. There were 34 patients in the distant pain group and 64 ones in the non-distant pain group. The sites of distant pain were recorded. The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess the pain and disability severities preoperatively and postoperatively. Results The incidence of distant pain was 34.7% (34/98) . The distant pain was located at the lumbosacral area in 24 cases, at the hip in 14 cases, at the iliac crest in 14 cases, at the thigh in 14 cases, and at the calf in 2 cases. The distant pain group had a significantly longer course of preoperative disease (15.3±12.9 d) than the non-distant pain group (10.3±7.0 d) (P 0.05) . Conclusions The incidence of distant pain may be high in OVCF patients. The most common sites for distant pain are the lumbosacral area, hip, iliac crest and thigh. PKP can effectively relieve the distant pain associated with OVCF. Key words: Osteoporosis; Spinal fractures; Pain; Vertebroplasty

Three methods for reducing back pain in older adults with age-related osteoporotic vertebral compression fractures of the thoracolumbar spine: protocol for a non-randomized controlled trial with 2-year follow-up and preliminary results

Background and objectives: Osteoporotic vertebral compression fracture of the thoracolumbar spine manifests clinically as back pain. Percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) are the preferred treatment methods for this disorder. Our previous studies have shown that both procedures effectively reduce back pain at 6 months post-surgery in older adults with age-related osteoporotic vertebral compression fractures of the thoracolumbar spine. Little is documented about longer-term pain relief after PKP and PVP. The aim of this prospective, single-center, non-randomized, controlled trial is to investigate long-term and medium-term back pain relief after PKP, PVP, and non-surgical treatment of this condition and to analyze risk factors for ongoing back pain. Design: A prospective, single-center, non-randomized, controlled trial. Methods: This study will include 900 patients with age-related osteoporotic vertebral compression fracture of the thoracolumbar spine scheduled to receive treatment at Qinghai Provincial People’s Hospital. Patients will be assigned to receive PKP, PVP, or nonsurgical treatment (rehabilitation and traditional Chinese medicine; n = 300 per treatment method). Patients will have follow-up evaluation at 1 week and 1, 3, 6, 12, and 24 months. Outcome measures and preliminary results: The primary outcome measure is the prevalence of back pain 24 months post-surgery. Secondary outcome measures are prevalence of back pain at other time points; Visual Analogue Score, Oswestry Disability Index, Japanese Orthopedic Association score, and X-ray morphology before surgery and at all postoperative time points; and incidence of adverse events at each postoperative time point. A pilot study of 621 patients with osteoporotic vertebral compression fracture of the thoracolumbar spine revealed that Visual Analogue Score and Oswestry Disability Index were significantly lower 6 months postoperatively than prior to PKP or PVP, with only 15% of patients having ongoing back pain. Risk factors for back pain were bone cement leakage (direction, volume, and scope) and adverse reactions (P Ethics and dissemination: The study protocol was approved by Medical Ethics Committee, Qinghai Provincial People’s Hospital of China in April 2017 (approval No. RM006G). This study will be performed in strict accordance with the Declaration of Helsinki developed by the World Medical Association. Written informed consent will be obtained from each patient. The study protocol was designed in March 2017. Patient recruitment and data collection will begin in September 2018. Patient recruitment will end in September 2019. Data analysis will be performed in October 2021. The whole study will end in November 2021. Results will be disseminated through presentations at scientific meetings and/or by publication in a peer-reviewed journal. Trial registration: This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800016493). Protocol version: 1.0.

Curative effect of percutaneous kyphoplasty for treatment of vertebral compression fractures in perimenopausal women

Objective To investigate the clinical outcomes of percutaneous kyphoplasty (PKP) for treatment of vertebral compression fractures in perimenpausal women. Methods A total of 53 perimenopausal patients (70 vertebrae) undergone PKP for vertebral compression fractures from January 2007 to May 2014 were analyzed retrospectively by case-control study. Thirty-six patients had single vertebral fractures and 17 two-level vertebral fractures. The fracture segments included 5 T11 vertebrae, 14 T12 vertebrae, 30 L1 vertebrae, 12 L2 vertebrae and 9 L3 vertebrae. Ratio of vertebral compression was 10%-30%. According to treatment difference, the patients were divided into PKP group and non-operation group. In PKP group, there were 30 patients with age range of 44-54 years (mean, 51.0 years), and the fracture segments included 13 T11vertebrae, 11 T12vertebrae, 17 L1vertebrae, 7 L2 vertebrae, 3 L3 vertebrae. In non-operation group, there were 23 patients with age range of 44-54 years (mean, 50.5 years), and the fracture segments included 2 T11vertebrae, 3 T12 vertebrae, 13 L1 vertebrae, 5 L2 vertebrae, 6 L3 vertebrae. Visual analogue scale (VAS), Oswesty disability index (ODI), vertebral compression rate, Cobb angle and bone mineral density change were compared preoperatively, 2 weeks, 6 months and 3 years after operation. Results All patients were followed up for 6-36 months. VAS and ODI were improved compared with preoperative status in two groups at 2 weeks, 6 months and 3 years (P 0.05). The Cobb angle and vertebral compression rate in PKP group were reduced at 6 months compared with preoperative status (P 0.05). The Cobb angle and vertebral compression rate in PKP group did not increase at 6 months and 3 years, but they had significant increase in non-operation group (P 0.05). The body mass index reduction in PKP group was less than that in non-operation group at 3 years (P 0.05). The body mass index reduction in non-operation group was fast and had significant decrease compared with preoperative status (P<0.05). Conclusion PKP can relieve pain for vertebral compression fractures in perimenopausal women in short term and long term, and PKP can also improve spinal kyphosis and prohibit the decline of bone mineral density. Key words: Osteoporotic fractures; Kyphoplasty; Perimenopausal

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