Restoration Of Vertebral Body Height Research Articles

Minimally Invasive Techniques for the Treatment of Osteoporotic Vertebral Fractures

Osteoporotic vertebral compression fractures are a leading cause of disability and morbidity in the elderly. The consequences of these fractures include pain, progressive vertebral collapse with resultant spinal kyphosis, and systemic manifestations. Nonsurgical measures have proved unsuccessful in a portion of this population and for this group, minimally invasive vertebral augmentation can be beneficial. Vertebroplasty is designed to address vertebral fracture pain. It involves percutaneous injection of polymethylmethacrylate (PMMA) directly into a fractured vertebral body with the goals of pain relief and prevention of further collapse of the fractured vertebra. Kyphoplasty is designed to address the kyphotic deformity as well as the fracture pain. It involves the percutaneous insertion of an inflatable bone tamp into a fractured vertebral body. Bone tamp inflation works to elevate the end plates and create a cavity to be filled with PMMA with the goals of pain relief, restoration of vertebral body height, and reduced kyphotic deformity. Optimizing surgical technique can improve outcomes and decrease complication rates, and decrease radiation exposure to the patient and surgical team. Obtaining a biopsy prior to cement injection has proved efficacious and may result in the diagnosis of occult pathology underlying a seemingly routine vertebral fracture. As competence and surgical success are acquired, the indications will continue to expand to encompass more challenging pathologies. Recently, vertebral augmentation during spinal decompression and instrumented fusion for burst fracture with neurologic insult has been reported to be successful.

Vertebroplasty and Kyphoplasty: A Systematic Review of 69 Clinical Studies

Systematic literature review. To evaluate the safety and efficacy of vertebroplasty and kyphoplasty using the data presented in published clinical studies, with respect to patient pain relief, restoration of mobility and vertebral body height, complication rate, and incidence of new adjacent vertebral fractures. Vertebroplasty and kyphoplasty have been gaining popularity for treating vertebral fractures. Current reviews provide an overview of the procedures but are not comprehensive and tend to rely heavily on personal experience. This article aimed to compile all available data and evaluate the clinical outcome of the 2 procedures. This is a systematic review of all the available data presented in peer-reviewed published clinical trials. The methodological quality of included studies was evaluated, and data were collected targeting specific standard measurements. Where possible, a quantitative aggregation of the data was performed. A large proportion of subjects had some pain relief, including 87% with vertebroplasty and 92% with kyphoplasty. Vertebral height restoration was possible using kyphoplasty (average 6.6 degrees ) and for a subset of patients using vertebroplasty (average 6.6 degrees ). Cement leaks occurred for 41% and 9% of treated vertebrae for vertebroplasty and kyphoplasty, respectively. New fractures of adjacent vertebrae occurred for both procedures at rates that are higher than the general osteoporotic population but approximately equivalent to the general osteoporotic population that had a previous vertebral fracture. The problem with stating definitely that vertebroplasty and kyphoplasty are safe and effective procedures is the lack of comparative, blinded, randomized clinical trials. Standardized evaluative methods should be adopted.

Lordoplasty: report on early results with a new technique for the treatment of vertebral compression fractures to restore the lordosis

Cement augmentation using PMMA cement is known as an efficient treatment for osteoporotic vertebral compression fractures with a rapid release of pain in most patients and prevention of an ongoing kyphotic deformity of the vertebrae treated. However, after a vertebroplasty there is no chance to restore vertebral height. Using the technique of kyphoplasty a certain restoration of vertebral body height can be achieved. But there is a limitation of recovery due to loss of correction when deflating the kyphoplastic ballon and before injecting the cement. In addition, the instruments used are quite expensive. Lordoplasty is another technique to restore kyphosis by indirect fracture reduction as it is used with an internal fixateur. The fractured and the adjacent vertebrae are instrumented with bone cannulas bipediculary and the adjacent vertebrae are augmentated with cement. After curing of the cement the fractured vertebra is reduced by applying a lordotic moment via the cannulas. While maintaining the pretension the fractured vertebra is reinforced. We performed a prospective trial of 26 patients with a lordoplastic procedure. There was a pain relief of about 87% and a significant decrease in VAS value from 7.3 to 1.9. Due to lordoplasty there was a significant and permanent correction in vertebral and segmental kyphotic angle about 15.2 degrees and 10.0 degrees , respectively and also a significant restoration in anterior and mid vertebral height. Lordoplasty is a minimal invasive technique to restore vertebral body height. An immediate relief of pain is achieved in most patients. The procedure is safe and cost effective.

Pain Outcome and Vertebral Body Height Restoration in Patients Undergoing Kyphoplasty

Kyphoplasty, a minimally invasive technique, has recently been developed to provide immediate pain relief, biomechanical stabilization, prevention of fracture progression, vertebral height restoration, and prevention or reversal of kyphosis to patients with osteoporotic vertebral compression fractures (VCF). We retrospectively reviewed 24 patients treated with kyphoplasty. A total of 37 vertebral levels were augmented. Visual analog scale (VAS) scores were documented in the immediate pre- and postoperative period, as well as 4, 12, and 72 weeks after the procedure. Vertebral body height restoration was assessed on postoperative x-rays. Mean preoperative VAS score was 9.3 and improved to 5.4 in the immediate postoperative period. At 4, 12 and 72 weeks post-operatively, mean VAS scores were 5.1, 5.9, and 6.1 respectively. All patients returned to their daily activities within 24 hours. No significant restoration of vertebral body height was observed. In regards to pain relief and postoperative functional outcome, kyphoplasty is a safe and effective treatment modality for osteoporotic VCFs, even when no significant restoration of vertebral body height is achieved.

Vertebroplasty and kyphoplasty: filler materials

Over 700,000 osteoporotic compression fractures occur each year in the United States, twice the number of hip fractures. These vertebral fractures, most of which occur in the elderly, represent significant personal and societal burdens. Percutaneous vertebroplasty (PVP) is a minimally invasive method that involves the percutaneous injection of polymethylmethacrylate (PMMA) into a collapsed vertebral body to stabilize the vertebra. Kyphoplasty is an advanced minimally invasive technique with a number of potential advantages over PVP, including lower risk of cement extravasation and better restoration of vertebral body height and spinal biomechanics. The filling materials used for both these techniques require good biocompatibility, good biomechanical strength and stiffness, and good radiopacity for the fluoroscopy guided procedures. New filler materials (synthetic bone substitutes, e.g., composite resin materials, calcium phosphate or calcium sulfate cements) in addition to new PMMA formulations are now available for clinical use. In this review paper, we will focus on the issues and characteristics of these filler materials as they pertain to vertebral augmentation procedures.

Vertebroplasty and Kyphoplasty for Treatment of Painful Osteoporotic Compression Fractures

To review the pathophysiology of osteoporosis and describe vertebroplasty and kyphoplasty, which are minimally invasive procedures to treat the pain associated with vertebral compression fractures (VCFs). Extensive literature review of osteoporosis, vertebroplasty, and kyphoplasty supplemented by case study and clinical experience in the minimally invasive interventional neuroradiology interventions. Osteoporosis is a progressive debilitating process that destroys the cancellous bone, weakening the overall integrity and stability of the bone. The loss of bone mass places the individual at increased risk for vertebral body, hip, and wrist fractures. In the past, there was no treatment option to repair vertebral body deformity or instability after osteoporotic VCFs. Management solely relied on the use of nonsteroidal anti-inflammatory drugs, narcotics, muscle relaxants, and/or orthotic bracing to provide pain relief. VCFs alter the stability of the vertebral body and column, and the lack of stabilization can lead to chronic pain syndrome, immobility, pulmonary compromise, progression of spinal deformity, increase in the risk for additional VCFs, and increase in the risk for comorbidities and mortality related to immobility. Vertebroplasty and kyphoplasty are minimally invasive procedures aimed at pain control, stabilization of the vertebral body, and with kyphoplasty, the ability to provide some correction of deformity with partial restoration of vertebral body height. Providing pain control and stabilization of the vertebral column improves mobility, thus decreasing the potential risks associated with immobility.

Immediate and early postoperative pain relief after kyphoplasty without significant restoration of vertebral body height in acute osteoporotic vertebral fractures

Painful osteoporotic vertebral compression fractures (VCFs) are a significant cause of disability in the elderly population. Kyphoplasty, a recently developed minimally invasive procedure, has been advocated for the successful management of these fractures in terms of immediate pain relief, and also for restoration of the premorbid level of daily activities. In this retrospective study the authors report on their experience with the early management of VCFs with kyphoplasty. A retrospective analysis was conducted in 13 patients (seven women and six men) whose ages ranged from 48 to 87 years (mean age 71.5 +/- 11 years [mean +/- standard deviation]). The interval between onset of symptoms and surgical intervention ranged from 4 to 9 weeks. Twenty levels (12 thoracic, eight lumbar) were treated in this cohort. Immediate and early postoperative (1-month follow-up visit) visual analog scale (VAS) pain scores, activity levels, and restoration of vertebral body (VB) height were assessed. The mean preoperative VAS score was 8 +/- 1, whereas the immediate and early postoperative scores were 1 +/- 1. These findings reflected a resolution of 90 to 100% of preoperative pain. All patients resumed routine activities within hours of the procedure, although improvement in VB height was not accomplished in this cohort. No major complications were encountered in this clinical series. Kyphoplasty is a safe and effective method for the treatment of osteoporotic VCFs. Failure to restore VB height does not seem to interfere with the excellent pain management and good functional outcome provided by this procedure.

Vertebroplasty and kyphoplasty

Vertebral compression fractures are common in elderly populations and in particular in postmenopausal women as a consequence of osteoporosis. Percutaneous vertebroplasty and kyphoplasty are minimally invasive procedures that are increasingly used to treat persistent or severe acute pain from these fractures. Vertebroplasty works by augmenting the weak osteopenic vertebrae with polymethylmethacrylate (PMMA) bone cement and thus preventing further microfractures and associated pain. The aim of kyphoplasty is pain relief combined with restoration of vertebral body height and reduction in kyphosis. This is achieved by 'expanding' the fractured vertebra with a balloon and then filling of the resultant cavity with PMMA cement. Vertebroplasty and kyphoplasty are undertaken under local and general anaesthesia, respectively. Both procedures have a very low complication rate if properly performed by well trained clinicians using appropriate cement and technique and highquality imaging. Patient selection and the selection of the level at which the percutaneous vertebroplasty is to be done are of utmost importance for maximal therapeutic benefit. Additional trials are required to establish conclusively the effectiveness of both procedures compared with conservative medical therapy and each other.

Titanium Cage-assisted Polymethylmethacrylate Reconstruction for Cervical Spinal Metastasis: Technical Note

Reconstruction and stabilization of the cervical spine after vertebrectomy is an important goal in the surgical management of spinal metastasis. The authors describe their reconstruction technique using a titanium cage-Silastic tube construct injected with polymethylmethacrylate (PMMA) augmented by an anterior cervical plate. The surgical results using this technique are reviewed. Six patients ranging from 43 to 70 years of age underwent resection of metastatic tumor in the cervical spine followed by cage-assisted PMMA reconstruction of the anterior spinal column. The following reconstruction technique was performed. A Silastic tube is incised longitudinally and placed circumferentially around a titanium cage with the opening facing anteriorly. The cage-Silastic tube construct is carefully tapped into the corpectomy defect and filled with PMMA. The final construct is then augmented with anterior cervical plate fixation. Two patients required additional posterior stabilization with lateral mass screws and rods. All patients achieved immediate stabilization, restoration of vertebral body height and normal lordosis, and preservation of the ability to walk independently. Five patients experienced significant palliation of biomechanical neck pain. There were no complications of neurological worsening, postoperative hematoma, wound infection, subsidence, graft dislodgement, or construct failure during a follow-up period of 1 to 19 months (mean, 6.8 mo). Titanium cage-assisted PMMA reconstruction augmented with an anterior cervical plate is an effective means of reconstruction after tumor resection in patients with cervical spinal metastasis. The Silastic tube holds the PMMA within the cage and protects the spinal cord from potential thermal injury.

Biomechanical Comparison of Unipedicular Versus Bipedicular Kyphoplasty

A cadaveric study comparing the biomechanics of unipedicular versus bipedicular kyphoplasty in the treatment of osteoporotic vertebral compression fractures. The objectives of this study were to compare unipedicular kyphoplasty to bipedicular kyphoplasty in restoring strength, stiffness, and height to osteoporotic vertebral compression fractures and to study the degree of unilateral wedging when using a unipedicular versus bipedicular approach to kyphoplasty. Osteoporotic vertebral compression fractures are a common ailment of the elderly that can lead to chronic pain and deformity. Recently developed treatments known as vertebroplasty and kyphoplasty provide pain relief by percutaneously augmenting the fractured vertebral body with polymethyl methacrylate via a transpedicular approach. Vertebroplasty via a unipedicular approach has been shown to provide comparable restoration of vertebral body stiffness when compared to a bipedicular approach. The anticipated benefits of a unipedicular approach include reduction in patient risk, operative time, radiation exposure, and cost. No studies have evaluated the efficacy of unipedicular kyphoplasty. Two fresh-frozen human cadaveric spines (T3-L5) were disarticulated, and the vertebral bodies (n = 30) were compressed using an Instron 8521 machine, recording load versus displacement. The fractured vertebral bodies then underwent kyphoplasty via either a unipedicular or bipedicular approach. The augmented vertebral bodies were then recompressed. The strength, stiffness, and height restoration of the groups were compared. Following recompression, the risk for lateral wedging was evaluated by comparing lateral height measurements. Following fracture and subsequent kyphoplasty augmentation, the mean strength of the bipedicular group was 1.40 kN (+/- 0.38) versus 1.57 kN (+/- 0.55) in the unipedicular group. Average stiffness in the bipedicular group was 0.4387 kN/mm (+/- 0.2095) compared to 0.6880 kN/mm (+/- 0.3179) in the unipedicular group. Postcompression vertebral body height was restored to 96% of prefracture height in the bipedicular group and 94% of prefracture height in the unipedicular group. The mean absolute value of the difference in height between right and left side of the vertebral bodies was 1.06 mm (+/- 1.01) in the bipedicular group, whereas the unipedicular group had a mean of 1.78 mm (+/- 1.84). Statistical analysis using 1-way analysis of variance revealed no significant difference in any of the outcome measurements between the unipedicular and bipedicular groups (P < 0.05). Unipedicular kyphoplasty is comparable to bipedicular kyphoplasty in the restoration of vertebral body strength, stiffness, and height in experimentally induced vertebral compression fractures. There was no greater risk for lateral wedging in the unipedicular group compared to the bipedicular group. Given the advantages of a unipedicular approach with respect to vertebral pedicle cannulation risk, operative time, radiation exposure, and cost, this study would support the use of a unipedicular approach to kyphoplasty in the treatment of vertebral compression fractures.

The current treatment--a survey of osteoporotic fracture treatment. Osteoporotic spine fractures: the spine surgeon's perspective.

For the spine surgeon the problems of the osteoporotic spine can be a painful simple compression fracture, the persisting instability after a fracture, the silent loss of posture due to progressive collapse of multiple vertebrae, and neurological complications related to an osteoporotic fracture. The use of polymethylmethacrylate (PMMA) for the reinforcement of osteoporotic vertebral bodies has turned out to be extremely efficient. Although the natural course of pain due to vertebral fractures decreases within the first weeks in the majority of patients, there remains a number of them with persistent pain and/or ongoing vertebral collapse. With percutaneous cement injection one can achieve fast and lasting pain reduction in 80% to 93% of patients. With multilevel injections it is possible to address the severe osteoporotic spine as a whole where we can halt the ongoing collapse and preserve posture efficiently. Rectification of lordosis can be achieved in fresh fractures with the kyphoplasty technique and, even more efficiently, with the lordoplasty procedure. Kyphosis correction ranges from 8.5 degrees to 14 degrees , and restoration of vertebral body (VB) height goes up to 90%. When surgical stabilization is required, the combination of PMMA reinforcement and fixation with screws appears the only alternative in order to anchor the implants in the severely osteoporotic bone.

Kyphoplasty enhances function and structural alignment in multiple myeloma.

We prospectively evaluated 19 patients with multiple myeloma who had kyphoplasty for vertebral compression fractures. Functional status was assessed preoperatively and 3 months postoperatively using the Oswestry Disability Index. Restoration of anterior and midvertebral height was assessed using lateral radiographs. Meaningful improvement occurred in 16 of 19 patients, with a reduction of the average Oswestry Disability Index from 49 +/- 16.6 to 32.6 +/- 13.6. Partial restoration of anterior vertebral body height was achieved in 76% of levels with an average of 37.8% restoration of the defect. Partial restoration of midvertebral body height was achieved in 91% of levels with an average restoration of 53.4% of the defect. There were no significant complications. These results were compared with results of a cohort of 26 patients with osteoporotic compression fractures treated with kyphoplasty at 37 levels. There was no difference between the groups in terms of Oswestry Disability Index improvement and midvertebral height restoration after 3 months. Greater anterior vertebral height restoration was achieved in the osteoporotic group (51.2% versus 37.8%). Kyphoplasty is a safe treatment modality for myeloma-related vertebral compression fractures. Efficacy in terms of pain relief and functional outcome is comparable with the results in patients with osteoporosis.

Vertebroplasty and kyphoplasty for osteolytic vertebral collapse.

As many as 70% of patients with cancer and multiple myeloma initially present with osteolytic involvement of the spine. These vertebral fractures are associated with significant morbidity and mortality and represent a tremendous personal and societal burden. Traditional medical and surgical options often are inadequate or too invasive for this population debilitated by cancer. Vertebroplasty involves the injection of polymethylmethaerylate to strengthen a vertebra. This minimally invasive method, which has been adopted by practitioners during the past decade to treat symptomatic osteoporotic compression fractures is reported to provide quick pain relief in 90% of patients, with only infrequent, mostly minor, complications. In patients with osteolytic fractures, vertebroplasty is associated with an increased rate of cement leak and less predictable pain relief. Kyphoplasty is an extension of vertebroplasty that uses an inflatable bone tamp to restore the vertebral body toward its original height while creating a cavity to be filled with bone cement. Preliminary data indicate that kyphoplasty is a safe procedure associated with a lower risk of cement leak, restoration of vertebral body height, and sagittal spinal alignment. In patients with osteolytic fractures secondary to multiple myeloma, kyphoplasty yields quick pain relief, and is associated with a statistically significant improvement in generic health outcome measures.

Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels.

The authors assessed the safety of balloon kyphoplasty in the reduction and repair of osteopenic vertebral compression fractures and report functional outcomes (back pain and activity levels) in the first 96 patients (with 133 fractures) at their institution. Additionally they provide radiographic outcomes in the first 26 patients (41 fractures) treated and followed for 1 year. The authors conducted a retrospective chart review of functional outcomes and evaluated radiographs obtained at 1 week, 1 month, 3 months, 6 months, and 1 year postoperatively. Balloon kyphoplasty safely increases vertebral body height, decreases chronic back pain, and quickly returns geriatric patients to higher activity levels, leading to increased independence and quality of life.

Balloon kyphoplasty for the treatment of painful spinal deformity resulting from osteoporotic vertebral compression fractures

Purpose of study: Treatments for vertebral compression fractures (VCFs) have historically focused on pain control, but the kyphotic deformity as a result of VCF is also a cause of significant medical morbidity. The ideal treatment of VCFs should thus address both the fracture-related pain and associated spinal deformity. Balloon kyphoplasty is a recently developed minimally invasive procedure that aims to address both the pain and deformity resulting from the fracture. To date, there have been no reports on the effect of kyphoplasty on the sagittal alignment of the spine. The goals of this prospective study were to measure the effects of kyphoplasty on spinal deformity, activity levels and pain in patients with osteoporotic VCFs.Methods used: Sixty-one vertebral compression fractures between T6 and L5 were treated with balloon kyphoplasty in 29 patients (mean age, 71 years). The mean interval between fracture and kyphoplasty was 3.8 months. Clinical follow-up with measurement of pain scores and activity levels was obtained from patient questionnaires. Alterations in sagittal alignment were assessed by measuring Cobb angles in pre- and postkyphoplasty standing radiographs.of findings: Mean improvement in local sagittal alignment for the 28 patients treated with kyphoplasty was 8.8 degrees (range, 0 to 29 degrees). When separately analyzed, the mean improvement in sagittal alignment in treated thoracic fractures was 9.7 degrees, and the mean improvement in sagittal alignment in lumbar fractures was 7.9 degrees. If only fractures that were considered reducible (at least 5-degree improvement in sagittal alignment) were considered, 30 fractures in 17 patients showed an improvement in sagittal alignment of 14.2 degrees (range, 8 to 29 degrees). At the 1-week postoperative visit, 23 of 25 patients reported an improvement in pain. By 6 weeks after the procedure, 18 of 28 patients reported a return to prefracture activity, and 90% stated they would have another kyphoplasty for further fractures. Evaluation of intra- and postoperative radiographs revealed extravertebral cement leaks in 7 or 61 vertebral fractures treated, but no clinical consequences attributable to the bone tamp or cement occurred.Relationship between findings and existing knowledge: Prior studies have reported successful pain relief and vertebral body height restoration achieved with kyphoplasty in the treatment of osteoporotic VCFs. The effect on kyphoplasty on sagittal angulation, which we believe is more significant, has not previously been reported. The magnitude of correction of deformity achieved with kyphoplasty is comparable to that reported for open reduction and internal fixation of thoracolumbar fractures.Overall significance of findings: The results of this study indicate that kyphoplasty can rapidly provide pain relief and improve the kyphotic deformity resulting from osteoporotic VCFs. This study is the first to quantify the effects of kyphoplasty on sagittal angulation of the spine.Disclosures: Device or drug: KyphX bone tamp apparatus. Status: approved. Device or drug: polymethylmethacrylate in the spine. Status: not approved.Conflict of interest: Frank Phillips, consultant.

Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma.

We prospectively evaluated the safety and efficacy of kyphoplasty in the treatment of osteolytic vertebral compression fractures resulting from multiple myeloma. The principle symptoms in multiple myeloma result from bone destruction, especially the spine. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps (IBT) into the vertebral body. The purpose of the IBT is to restore the vertebral body back toward its original height, while creating a cavity that can be filled with highly viscous bone cement. Fifty-five consecutive kyphoplasty procedures were performed in 18 patients with osteolytic vertebral compression fractures resulting from multiple myeloma. Cement leakage and any complications were recorded. Early objective analysis was made by comparing preoperative and latest Short Form 36 Health Survey scores. Height restoration was estimated by measuring vertebral height on lateral radiographs. The mean age of patients was 63.5 years, mean duration of symptoms was 11 months, and mean follow-up was 7.4 months. There were no major complications related directly to use of this technique. On average, 34% of height lost at the time of fracture was restored. Asymptomatic cement leakage occurred at two (4%) of 55 levels. Significant improvement in SF36 scores occurred for Bodily Pain (23.2 to 55.4, P =.0008), Physical Function (21.3 to 50.6, P =.0010), Vitality (31.3 to 47.5, P =.010), and Social Functioning (40.6 to 64.8, P =.014). Kyphoplasty was efficacious in the treatment of osteolytic vertebral compression fractures resulting from multiple myeloma. Kyphoplasty is associated with early clinical improvement of pain and function as well as some restoration of vertebral body height.

Kyphoplasty in the treatment of vertebral fractures secondary to multiple myeloma

Sean Dudeney, MD, Mohamed Hussein, MD, Isador H. Lieberman, MD, Cleveland, OH, USABackground context: We prospectively evaluated the safety and efficacy of kyphoplasty in the treatment of vertebral compression fractures resulting from multiple myeloma. The principle symptoms in multiple myeloma result from bone destruction. The spine is the most affected skeletal structure. Vertebral involvement results in compression fractures that give rise to severe pain and progressive kyphosis. Present treatment includes bed rest, analgesics and bracing, which result in further bone resorption. Antimyeloma therapy controls the disease but does not provide significant structural relief. Augmentation of vertebral compression fractures with polymethylmethacrylate, that is, vertebroplasty, has been used with success to treat pain. This technique does not attempt to restore the height of the collapsed vertebral body and has high cement leakage rates. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps into the vertebral body. Once inflated, the bone tamps restore the vertebral body back toward its original height, while creating a cavity that can be filled with highly viscous bone cement, resulting in lower leakage rates.Methods: Forty-five consecutive kyphoplasty procedures were performed in 15 patients with vertebral compression fractures resulting from multiple myeloma over 22 sessions. Comparing preoperative and latest SF36 scores made objective analysis. Height restoration was estimated by measuring vertebral height on pre- and postoperative lateral radiographs. Cement leakage and any complications were recorded prospectively.Results: The mean age of patients was 63 years (range, 48 to 79 years), and the mean duration of symptoms was 5.8 months, mean follow-up of 4.9 months. Levels treated ranged from T6 to L5 (T11=6, T12=6, L1=7). There were no major complications related directly to use of this technique or use of the inflatable bone tamp. On average, 28% of height lost at the time of fracture was restored. Asymptomatic cement leakage occurred at 2 of 45 levels (4%). Significant improvement in SF36 scores occurred for bodily pain (22.6 to 55.0; p=.002) and physical function (19.3 to 50.7; p=.0023), as well as vitality (30.7 to 48.9; p=.022), social functioning (38.4 to 64.3; p=.016) and mental health (59.1 to 76.3; p=.048).Conclusion: The kyphoplasty balloon bone tamp was efficacious in the treatment of vertebral compression fractures resulting from multiple myeloma. Kyphoplasty is a well-tolerated procedure associated with early clinical improvement of pain and function as well as some restoration of vertebral body height in these patients. Restoration of a functional spine is of ever increasing importance as improvements in medical management increases survival in multiple myeloma.

An ex vivo biomechanical evaluation of an inflatable bone tamp used in the treatment of compression fracture.

Ex vivo biomechanical study using osteoporotic cadaveric vertebral bodies. To determine if the inflatable bone tamp (tamp) restores height to compressed vertebral bodies and to compare the biomechanical properties of isolated, fractured osteoporotic vertebral bodies treated by kyphoplasty (tamp) or vertebroplasty. Previous biomechanical studies have shown that vertebroplasty increases vertebral body strength and restores vertebral body stiffness, but does not restore vertebral body height lost as a result of compression fracture. Compression fractures were experimentally created in 16 osteoporotic VBs assigned to either the tamp or percutaneous vertebroplasty group. The tamp treatment consisted of inserting balloon-like devices into the vertebral body, inflating the bone tamp, and filling the void with Simplex P (Howmedica, Rutherford, NJ) bone cement. The percutaneous vertebroplasty treatment consisted of directly injecting Cranioplastic bone cement (CMW, Blackpool, UK) into the vertebral body. Pre- and posttreatment heights were measured, and the repaired vertebral bodies were recompressed to determine posttreatment strength and stiffness values. The tamp treatment resulted in significant restoration (97%) of vertebral body height lost after compression, whereas percutaneous vertebroplasty treatment resulted in a significantly lower restoration of lost height (30%) (P < 0.05). Both treatments resulted in significantly stronger vertebral bodies relative to their initial state (P < 0.05). The tamp treatment restored vertebral body stiffness to initial values, but the percutaneous vertebroplasty treatment did not (P < 0.05). Tamp treatment resulted in significantly greater height restoration than did percutaneous vertebroplasty, without loss of vertebral body strength or stiffness.

Mechanics of Anatomic Reduction of Thoracolumbar Burst Fractures| Comparison of Distraction Versus Distraction Plus Lordosis, in the Anatomic Reduction of the Thoracolumbar Burst Fracture

The adequate reduction of vertebral burst fractures is dependent on successful application of distractive forces in combination with the restoration of normal spinal lordosis. However, the optimal sequence of distraction in comparison to distraction plus lordosis in the anatomic restoration of the fractured thoracolumbar spine has not been described. Burst fractures of the L1 vertebra were first created and the reduced in vitro using three differing reduction techniques. In six fresh human cadaver spine specimens, the mean fracture severity based on the degree of canal compromise was 31% (SD +/- 20%) after fracture. Reductions were performed using the AO Fixator Intern, the Reduction Fixation (RF) Device, and the Steffee plate systems following standard clinical techniques. The AO Fixator Intern provided independent but variable control of distraction and lordosis, the RF device provided variable distraction with independent, but preset, correction of lordosis and the Steffee system provided set distraction and stabilization. Both the AO and RF devices restored the lordosis (7.6 degrees +/- 5.2 degrees and 9.7 degrees +/- 4.5 degrees, respectively) better than the Steffee plate system (0 degrees +/- 1.6 degrees). However, the AO device provided poorest restoration of the posterior vertebral body height (92% vs 96% for the RF device and 99% for the Steffee plate). The RF device, which restored both lordosis and posterior vertebral body height to the near anatomic prefracture level, provided significantly better canal clearance (9% +/- 8%) than the other techniques, P < 0.05. The study demonstrates that instrumentation systems that provide independent correction of distraction and lordosis can best restore anatomic alignment, with indirect neurodecompression of the compromised spinal canal.(ABSTRACT TRUNCATED AT 250 WORDS)