Percutaneous Kyphoplasty Surgery Research Articles

RETRACTED ARTICLE: Analysis of risk factors related to the re-fracture of adjacent vertebral body after PKP

BackgroundThis study aims to investigate the risk factors of vertebral re-fracture after percutaneous kyphoplasty (PKP) for osteoporosis vertebral compression fracture (OVCF), and to provide reference for clinical prevention.Material and methodsA retrospective analysis was performed on 228 OVCF patients admitted on November 6, 2013, solstice, December 14, 2018, which met the inclusion criteria. There were 35 males and 193 females, with a male-to-female ratio of 3:20, and an age of 61–89 years. All patients were treated with PKP surgery with complete clinical data, and the rate of re-fracture was calculated according to whether re-fracture occurred after surgery, divided into the re-fracture group (24 cases) and the non-refracture group (204 cases). May be associated with subsequent fracture factors (gender, age, number of surgical segment vertebral body, whether with degenerative scoliosis, whether to fight osteoporosis) into a single-factor research, then the single-factor analysis was statistically significant risk factors for multiple logistic regression analysis, further defined after PKP holds the vertebral body fracture independent risk factors. Survival analysis was performed using the time of vertebral re-fracture after PKP as the end time of follow-up, the occurrence of re-fracture after PKP as the endpoint event, and the presence or absence of degenerative lateral curvature as a variable factor.ResultsAll 228 vertebroplasty patients were followed up for a period of 1.8 to 63.6 months. The mean follow-up time was (28.8 ± 15.6) months, and the re-fracture rate was 10.5%. There were statistically significant differences between the re-fracture group and the non-refracture group in age, number of operative vertebral bodies, whether there was a combination of degenerative scoliosis and whether there was anti-osteoporosis treatment (P < 0.05). The results of univariate logistic regression analysis after excluding the mutual influence of various factors showed that the number of vertebral bodies and the group with lateral curvature might be the risk factors for PKP re-fracture after surgery. The above possible risk factors were included in multiple logistic regression analysis to show whether there were independent risk factors for scoliosis and vertebral re-fracture. Survival analysis showed that the mean survival time was 42.1 months, the P value was 0.00, and the mean 95% confidence interval was (34.4–49.7 months), indicating that the combination of degenerative lateral bending might be related to the occurrence of re-fracture.ConclusionsCombined scoliosis is an independent risk factor for re-fracture after OVCF laminoplasty and a possible risk factor for re-fracture after surgery.

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 &lt; 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 &lt; 0.05 ). The Cobb angle returned to normal level, which was statistically significant compared with that before the operation ( P &lt; 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.

Is It Necessary to Approach the Severe Osteoporotic Vertebral Biconcave-Shaped Fracture Bilaterally During the Process of PKP?

PurposeThe goal of this study was to explore the outcomes of unilateral and bilateral approach percutaneous kyphoplasty (PKP) using CT-guidance in the treatment of severe osteoporotic single-level vertebral biconcave-shaped fracture.MethodsWe retrospectively reviewed 89 patients with severe osteoporotic single-level vertebral biconcave-shaped fracture who had undergone unilateral and bilateral PKP surgeries using CT-guidance at our hospital between June 2013 and June 2019, and followed for at least 1 year. All patients were divided into unilateral (the transverse process-pedicle approach, n = 49) and bilateral (the pedicle approach, n = 40) groups. We collected the clinical and radiological evaluation results during postoperative and last follow-up periods.ResultsOur findings revealed that the surgery time for the unilateral group was significantly shorter than that of the bilateral group at P < 0.05. The amount of bone cement and radiation exposure of the unilateral group were significantly lesser than that of the bilateral group (P < 0.05). Relative to preoperative data, the values of the VAS score and Oswestry disability index (ODI) were significantly improved at 1 day after surgery and the last follow-up in the two groups (P < 0.05). Notably, the median height of vertebra at 1 day after surgery and the last follow-up in the unilateral group was significantly restored than that of preoperative data (P < 0.05). However, the median height of vertebra at the same time intervals in the bilateral group showed no significant change compared with preoperative data (P > 0.05). Furthermore, the rate of bone cement leakage and incidence of adjacent-level vertebra fracture were not significantly different in the two groups (P > 0.05). Finally, both groups can obtain an asymmetrical distribution of bone cement in the vertebra.ConclusionCompared to the bilateral PKP, unilateral PKP using CT-guidance in the treatment of the sOVBFs exhibits significantly shorter operation time, lesser radiation dose, and complications. Moreover, unilateral PKP can restore the median height of the vertebral body and eventually obtain a symmetrical distribution of bone cement in the vertebra.

Preliminary application of CPC/PMMA composite bone cement in kyphoplasty for the elderly

From the perspective of clinical application to analyze the effectiveness and reliability of CPC/PMMA bone cement in percutaneous kyphoplasty (PKP) for the treatment of elderly patients with osteoporotic thoracolumbar fractures. A retrospective analysis was performed on 62 patients with osteoporotic compression fracture of single-vertebral thoracic or lumbar segment who underwent PKP surgery and had a bone density less than or equal to -3.0 SD from February 2016 to December 2016. Among them, 23 patients were in CPC/PMMA group, with an average age of (77.6±2.2) years old, 39 patients in PMMA group, with an average age of (77.1±1.1) years old. The indexes between two groups were compared, including the visual analogue scale (VAS), height ratio of anterior vertebra (AVHR), local Cobb angle, cement leakage, new adjacent vertebral fracture(NAVF). There were no significant difference in gender, age, follow-up time and preoperative VAS, AVHR, local Cobb angle between two groups (P>0.05), at the 1 day after operation, VAS, AVHR, local Cobb angle in all patients got obvious improvement (P<0.05), which was no significant difference at 1 day after operation and final follow-up (P>0.05). At the same time, there was no statistically significant difference in the incidence of new adjacent vertebral fracture and cement leakage (P>0.05). The pain in both groups continued to improve at follow up after operation (P<0.05), the local Cobb angle increased (P<0.05) and AVHR decreased slightly (P<0.05). However, the images of conventional methods (X-ray or CT) could not find signs about CPC degeneration and new bone ingrowth. CPC/PMMA composite bone cement is safe and reliablein PKP for treatment of elderly patients with osteoporotic thoracolumbar fractures, which can effectively relieve pain and maintain vertebral body stability. It has the same curative effect as PMMA bone cement. It was worthy to research more in future, although no direct evidences support the CPC/PMMA composite bone cement can reduce the incidence of adjacent vertebral fracture, CPC degeneration or new bone ingrowth.

Unilateral percutaneous kyphoplasty for lumbar spine: A comparative study between transverse process-pedicle approach and conventional transpedicular approach.

Anatomical differences of unilateral percutaneous kyphoplasty (PKP) between transverse process-pedicle approach (TPPA) and conventional transpedicular approach (CTPA) are not well discussed. To investigate the anatomical distinctions of unilateral PKP between TPPA and CTPA, we have discussed the unilateral PKP through a 3-dimensional-computed tomography database.Five hundred lumbar spines from 100 patients have been retrospectively collected and unilateral CTPA and TPPA were simulated. Distance between the entry point and the midline of the vertebral body (DEM), the puncture inclination angle (PIA), and the success rate (SR) of puncture were measured and compared.The male presented with significantly larger DEM than the female. The TPPA group presented with larger DEM than the CTPA group according to different level, the difference was 1.5 ± 1.1 mm to 3.8 ± 2.3 mm. The PIAs in the TPPA group were larger than that in the CTPA group. The SR including 1 side SR and bilateral SR was 72.0% in the CTPA group and 98.0% in the TPPA group. Compared with CTPA group, the SR in TPPA group was significantly higher for L1 to L4 no matter in the left, right side and female patients.The TPPA group presented with more lateral entry point, larger PIAs and higher SRs than that in the CTPA group. PKP surgery through a TPPA was safer and could provide a more symmetrical distribution of bone cement than the CTPA group.

Surface degradation–enabled osseointegrative, angiogenic and antiinfective properties of magnesium-modified acrylic bone cement

ObjectiveThis work focuses on tackling the inadequate bone/implant interface strength of acrylic bone cements, which is a formidable problem diminishing their clinical performance, especially in percutaneous kyphoplasty surgery. MethodsA new strategy of incorporating magnesium particles into clinically used poly(methylmethacrylate) (PMMA) bone cement to prepare a surface-degradable bone cement (SdBC) is proposed and validated both in vitro and in vivo. ResultsThis surface degradation characteristic enables osseointegrative, angiogenic and antiinfective properties. SdBC showed fast surface degradation and formed porous surfaces as designed, while the desirable high compressive strengths (≥70 MPa) of the cement were preserved. Besides, the SdBC with proper Mg content promoted osteoblast adhesion, spreading, proliferation and endothelial cell angiogenesis capacity compared with PMMA. Also, SdBC demonstrated clear inhibitory effect on Staphylococcus aureus and Escherichia coli. In vivo evaluation on SdBC by the rat femur defect model showed that the bone/implant interface strength was significantly enhanced in SdBC (push-out force of 11.8 ± 1.5 N for SdBC vs 7.0 ± 2.3N for PMMA), suggesting significantly improved osseointegration and bone growth induced by the surface degradation of the cement. The injectability, setting times and compressive strengths of SdBC with proper content of Mg particles (2.8 wt% and 5.4 wt%) were comparable with those of the clinical acrylic bone cement, while the heat release during polymerization was reduced (maximum temperature 78 ± 1 °C for PMMA vs 73.3 ± 1.5 °C for SdBC). ConclusionsThis work validates a new concept of designing bioactive bone/implant interface in PMMA bone cement. And this surface-degradable bone cement possesses great potential for minimally invasive orthopaedic surgeries such as percutaneous kyphoplasty. The translational potential of this articleThis work reports PMMA/Mg surface-degradable acrylic bone cements that possess enhanced osseointegrative, angiogenic and antiinfective properties that are lacking in the clinically used acrylic bone cements. This new kind of bone cements could improve the treatment outcome of many orthopaedic surgeries such as percutaneous kyphoplasty and arthroplasty.

Which one is more effective for the treatment of very severe osteoporotic vertebral compression fractures: PVP or PKP?

PurposeThe purpose of this study was to compare the clinical efficacy and safety of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of the elderly with very severe osteoporotic vertebral compression fractures (vsOVCFs).MethodsFrom September 2012 to September 2015, 57 patients with vsOVCFs who had undergone PVP and PKP surgeries at our medical center were reviewed retrospectively, at least 2 years follow-up. All patients were divided into PVP group (n=31) and PKP group (n=26). Clinical data including clinical and radiological evaluation results were performed pre- and postoperatively.ResultsThe operation time of PVP group (29.6±3.3 minutes) was less than that of PKP group (37.4±4.2 minutes), with significant differences (P<0.05). Compared with preoperative data, the VAS scores, Oswestry disability index (ODI) scores, and local kyphotic angle were improved with significant differences at 1 day after surgery and the last follow-up in two groups (P<0.05). However, there were no differences in VAS and ODI scores between the two groups (P>0.05). The local kyphotic angle of PVP group was more than that of PKP group after surgery, with significant differences (P<0.05). At 1 day after surgery and the last follow-up, the anterior height of vertebrae fractured was significantly improved compared with preoperative in PKP group (P<0.05), and there was no statistical difference compared with preoperative in PVP group (P>0.05). However, there were no significant differences between the two groups in the leakage rate of bone cement (P>0.05) and incidence of adjacent-level vertebra fracture (P>0.05).ConclusionBoth PVP and PKP can significantly relieve the pain of the patients with vsOVCFs. Restoring the vertebral height and local kyphotic angle corrections of PKP are comparatively better than those of PVP. However, the operation time of PKP is significantly longer than that of PVP and PKP is not superior in the leakage rate of bone cement and incidence of adjacent-level vertebra fracture compared to PVP.

Comparison of the clinical effects of percutaneous vertebroplasty and percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures

Objective To investigate the effect and safety of percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP) in the treatment of osteoporotic vertebral compression fractures, thus to provide reference for clinical treatment. Methods 67 patients with osteoporotic vertebral compression fractures were selected as study subjects.According to the different operation type, the patients were divided into PVP group(n=32) and PKP group(n=35). The operation condition, pain degree, relative height of vertebral body, Cobb angle and incidence of cement leakage were compared between the two groups. Results The operation time, X-ray times, bone cement injection volume, postoperative injury vertebral height of the PKP group were significantly higher than those of the PVP group(all P 0.05). Conclusion PVP and PKP are the effective methods for the treatment of osteoporotic vertebral compression fractures, which can significantly improve the degree of pain in patients, but PKP surgery is more conducive to promote the restoration of vertebral height, and can reduce the occurrence of bone cement leakage. Key words: Fractures, compression; Osteoporotic fractures; Percutaneous vertebroplasty; Percutaneous kyphoplasty; Clinical effect

Hidden blood loss and its influencing factors after percutaneous kyphoplasty surgery: A retrospective study.

Percutaneous kyphoplasty (PKP) surgery is generally accepted as a minimally invasive treatment for osteoporotic vertebral compression fractures (OVCFs). However, hidden blood loss (HBL) caused by this procedure is usually disregarded. This study aimed to investigate the amount of HBL and its influencing factors after PKP surgery.A total of 160 patients were retrospectively examined from January 2014 to January 2016, and their clinical and radiological data were recorded and analyzed. Preoperative and postoperative hematocrit (Hct) and hemoglobin (Hb) levels were also documented. HBL was calculated using Gross formula. Different factors, including gender, age, bone mineral density (BMD), number of fracture levels, hypertension, diabetes mellitus, operative time, percentage of vertebral height loss, percentage of vertebral height restoration, and cement leakage, were examined. Multivariate linear regression analysis was performed to elucidate the related clinical or radiological factors of HBL.A total of 122 patients with 169 levels were eligible for inclusion in the study. The mean HBL was 279 ± 120 mL, and the postoperative Hb loss was 8.2 ± 3.9 g/L. Multivariate linear regression analysis revealed that HBL was positively associated with operative time (P = .000), percentage of vertebral height loss (P = .037), and percentage of vertebral height restoration (P = .000). By contrast, HBL was not associated with gender (P = .874), age (P = .148), BMD (P = .134), number of fracture levels (P = .079), hypertension (P = .259), diabetes mellitus (P = .495), and cement leakage (P = .975). The postoperative incidence of anemia significantly increased by 39.3% compared with that of the preoperative incidence (χ2 = 21.432, P = .000).For patients with OVCFs, the amount of HBL after PKP is much larger than that observed perioperatively. Operative time, percentage of vertebral height loss, and percentage of vertebral height restoration are influencing factors of HBL.

Hidden blood loss and the influential factors after percutaneous kyphoplasty surgery.

Percutaneous kyphoplasty (PKP) is a minimally invasive procedure for the treatment of osteoporotic vertebral compression fractures (OVCFs). It is generally considered that there is little blood loss during the surgery. However, a significant perioperative hidden blood loss (HBL) is neglected. This study was to examine the amount of HBL and determine the influential factors during PKP. From January 2015 to January 2016, 115 patients with OVCFs who were scheduled to have a PKP were enrolled in this study. The factors analyzed included gender, age, body mass index (BMI), percentage of vertebral height loss, percentage of vertebral height restoration, number of fracture levels, bone mineral density (BMD), duration of symptom, cement leakage, and other internal diseases (hypertension, diabetes mellitus). According to Gross's formula, each patient's height, weight, and pre-operative and post-operative hematocrit were recorded and used for calculating the blood loss. Influential factors were further analyzed by multivariate linear regression analysis and t test. The mean HBL was 282±162mL (mL) and the post-operative Hb loss was 8.7±5.4g per liter (g/L). According to multivariate linear regression analysis, patients with severe vertebral height loss (P=0.016), better vertebral height restoration (P=0.038), and multi-segmental vertebral fractures (P=0.000) had a higher amount of HBL. Fresh fractures (P=0.008) and cement leakage (P=0.004) were also important factors to increase HBL, whereas gender (P=0.642), age (P=0.203), BMI (P=0.075), hypertension (P=0.099), diabetes mellitus (P=0.905), and BMD (P=0.521) were not correlate with HBL. When we compared the incidence of anemia between pre-operative and post-operative, we found that the incidence of anemia was significantly associated with HBL (P=0.000). HBL cannot be ignored in perioperative period, especially for poor physical condition and multiple fractures patients. Having a correct understanding of HBL can help improve clinical assessment capabilities, ensuring patients' safety.

Mechanical Properties and Cytocompatibility Improvement of Vertebroplasty PMMA Bone Cements by Incorporating Mineralized Collagen

Polymethyl methacrylate (PMMA) bone cement is a commonly used bone adhesive and filling material in percutaneous vertebroplasty and percutaneous kyphoplasty surgeries. However, PMMA bone cements have been reported to cause some severe complications, such as secondary fracture of adjacent vertebral bodies, and loosening or even dislodgement of the set PMMA bone cement, due to the over-high elastic modulus and poor osteointegration ability of the PMMA. In this study, mineralized collagen (MC) with biomimetic microstructure and good osteogenic activity was added to commercially available PMMA bone cement products, in order to improve both the mechanical properties and the cytocompatibility. As the compressive strength of the modified bone cements remained well, the compressive elastic modulus could be significantly down-regulated by the MC, so as to reduce the pressure on the adjacent vertebral bodies. Meanwhile, the adhesion and proliferation of pre-osteoblasts on the modified bone cements were improved compared with cells on those unmodified, such result is beneficial for a good osteointegration formation between the bone cement and the host bone tissue in clinical applications. Moreover, the modification of the PMMA bone cements by adding MC did not significantly influence the injectability and processing times of the cement.

Application of Jintian'ge capsule in treatment of vertebral compression fracture in senile osteoporosis patients

To study the clinical application of Jintian'ge capsule in treatment of vertebral compression fracture in senile osteoporosis patients. In the study, 69 senile osteoporotic vertebral compression fracture patients hospitalized in our hospital between January 2012 and June 2014 were selected and randomly divided into the control group and the treatment group. Patients in the control group were treated by percutaneous kyphoplasty (PKP), while those in the treatment group were given Jintian'ge capsule in addition to PKP. Efforts were made to visit the patients before the surgery and in three month after that, observe and compared the vertebral height, Cobb's angle, bone density, visual analogue scale (VAS) and Oswestry disability index between patients in the two groups. According to the findings, compared with before the treatment, patients in the two groups showed significant improvements in the vertebral height, Cobb's angle, bone density, VAS and Oswestry disability index three months after the surgery (P < 0.05); During the visit three months after the treatment, compared with the control group, the treatment group showed notable increases in all parameters (P < 0.05), particularly in the vertebral height, VAS and Oswestry disability index (P < 0.05). Based on the above findings, Jintian'ge capsule is applicable in adjuvant therapy after the osteoporotic vertebral compression facture PKP surgery.