Role Of Vertebroplasty Research Articles

Role of vertebroplasty and balloon kyphoplasty in pathological fracture in myeloma: a narrative review

Up to 70% of multiple myeloma (MM) patients develop vertebral metastasis and subsequent pathological vertebral fractures (PVF). With contemporary systemic therapies, life expectancy of MM patients has improved drastically, and the need to manage pain and associated disability from PVF is increasingly a high priority. The aim of this review is to provide an updated comprehensive synthesis of evidence in the use of vertebral augmentation, including percutaneous vertebroplasty (PV) and balloon kyphoplasty (BKP), to treat MM-related PVF. A comprehensive multi-database search in accordance with PRISMA guidelines was performed up to 10 February 2021. Relevant English language articles were selected and critically reviewed. A total of 23 clinical studies have been included in the review. PV and BKP showed significant pain and functional improvements in terms of analgesia requirements, Cervical Spine Function Score, Eastern Cooperative Oncology Group scale, EQ-5D score, Karnofsky score, Neck Pain Disability Index, Oswestry Disability Index, Short form-36 (SF-36) questionnaire and VAS pain scale. Both procedures also reported promising radiographic outcomes in terms of vertebral height improvement, maintenance and restoration, as well as kyphotic deformity correction. Asymptomatic cement leakage was commonly reported. There was no significant difference between the two procedures. PV and BKP are safe and effective procedure that offers pain relief, reduction in pain associated disability and reduction of fracture incidence. Its minimally invasive approach is associated with minimal morbidity risk, making it a viable option in frail patients. Narrative review.

The role of vertebroplasty in steroid-induced vertebral osteoporotic fractures

Abstract Background Data: Glucocorticoid-induced osteoporosis is a well-known significant health problem worldwide that causes morbidity and mortality. Glucocorticoid-induced vertebral compression fracture is one of the most common types of osteoporotic fractures associated with significant morbidities such as severe agonizing pain, limited mobility, and spinal deformity. Percutaneous vertebroplasty (PV) can be performed in the treatment of refractory back pain in these cases of osteoporotic vertebral fractures (OVFs) without significant complication when conservative treatment fails. Purpose: To evaluate the clinical and radiographic outcomes of thoracolumbar OVFs treated with PV in adult osteoporotic patients with long-term corticosteroid therapy. Study Design: Retrospective clinical case series. Patients and Methods: Twenty-eight patients with painful steroid-induced OVFs underwent vertebroplasty in 61 vertebral levels. Inclusion and exclusion criteria were applied. Preoperatively, all patients were subjected to intensive diagnostic workups, including history taking and clinical and radiological examinations, such as CT scan and MRI. The procedure was guided by C-arm and considered complete when the unfilled area was less than 25% of the vertebral body height in the lateral radiograph. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess pre- and postoperative back pain and functional status of our patients. Results: Seventeen patients (60.71%) were males and eleven patients (39.28%) were females. The mean age was 57 ± 5.04 (range, 49–68) years. The mean follow-up of the patients was 38.4 2± 11.16 (range, 24–60) months. Overall, 61 levels were reported including 10 patients (39%) with a single level and 18 patients (61%) with two levels or more as follows: two levels in eight patients, three levels in six patients, four levels in three patients, and one patient with five levels. The most common affected region was the thoracolumbar junction (T11, T12, and L1) in 38.69%. Back pain VAS decreased from 7.29 ± 1.04 before vertebroplasty to 3.25 ± 0.75 one week after vertebroplasty, 1.68 + −0.66 at 12 months postoperatively, and 3.11 ± 1.13 at final follow-up 24 months postoperatively (p < 0.00) Conclusion: This study suggests that fast and substantial pain relief and quality of life improvement could be achieved after percutaneous vertebroplasty in most patients of glucocorticoid induced osteoporotic vertebral fractures. These improvements could be maintained up to one year, however this effect decline with time due to the progressive nature of the underlying disease. (2020ESJ209) Abstract: Background Data: Glucocorticoids induced osteoporosis (G-OP) is a well-known significant health problem worldwide that causes morbidity and mortality. Glucocorticoids induced vertebral compression fracture (G-VCF) is one of the most common types of osteoporotic fractures that associated with significant morbidities as severe agonizing pain, limited mobility and spinal deformity. Percutaneous vertebroplasty (PV) can be performed in treatment of refractory back pain in cases of G-VFs without significant complication when the conservative treatment failed. Purpose: Clinical and radiographical evaluation of thoracolumbar osteoporotic vertebral fractures treated by percutaneous vertebroplasty in adult osteoporotic patients with long time of corticosteroid therapy. Study design: Retrospective clinical case series. Patients and methods: Twenty-eight patients with painful steroid induced VCFs underwent vertebroplasty in sixty-one vertebral levels. Inclusion and exclusion criteria were applied. Preoperatively, intensive diagnostic workups were performed in all patients including history, clinical, radiological examination, and CT scanning. Sometimes, MRI thoracolumbar spine had been done. The procedure was guided by the C-arm and considered complete when the unfilled area was less than 25% of the vertebral body height in the lateral radiograph. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess pre and postoperative back pain and functional status of our patients. Results: Seventeen patients (60.71%) were males and eleven patients (39.28%) were female. The Mean age was 57±5.04 (range: 49-68) years. Over-all 61 levels reported including 10 patients (39%) with single level and 18 patients (61%) with two levels or more as follows (two levels in eight patients, three levels in six patients, four levels in three patients and only one patient with five levels). Most common region affected was thoracolumbar junction (T11, T12, L1) in (38.69%). Back pain VAS decreased from 7.29 ± 1.04 before vertebroplasty to VAS 3.25±0.75 one week after vertebroplasty, 1.68 ± 0.66 at 12 months postoperative, and 3.11±1.13 at final follow up 24 months postoperative (P<0.001). ODI improved from 40.82±12.32 (14-66) preoperative to 16.68±3.19 (10-24) at 12 months postoperatively and to 20.92±4.66(10-30) at final follow 24 months postoperatively (P<0.000). Conclusion: This study suggest that fast and substantial pain relief and quality of life improvement could be achieved after percutaneous vertebroplasty (PV) and these improvements could be maintained up to one year in most patients. PV can be performed efficiently and effectively in patients of glucocorticoids OVFs for treatment of refractory back pain without significant complication. (2020ESJ209) Key words: Osteoporotic Vertebral Fractures (OVFs), Glucocorticoids, Vertebroplasty. Thoracolumbar spine.

The role of vertebroplasty in cases of wedge compression fracture of spine

The role of vertebroplasty in cases of wedge compression fracture of spine

Percutaneous vertebroplasty: Current controversy

Percutaneous vertebroplasty: Current controversy

Effect of Systemic Therapies on Outcomes following Vertebroplasty among Patients with Multiple Myeloma.

The role of vertebroplasty in patients with myeloma remains relatively undefined. Accordingly, we sought to better define the efficacy of vertebroplasty for myeloma-associated fractures and determine the effect of procedure timing relative to the initiation of systemic therapy on outcomes and complication rates. Clinical, laboratory, and medication data were retrieved for 172 patients with multiple myeloma treated with vertebroplasty since October 2000. Quantitative outcome data (Roland-Morris Disability Questionnaire [scale, 0-24] and the Numeric Rating Scale [0-10] for pain at rest and with activity) were collected immediately pre- and postoperatively and at 1 week, 1 month, 6 months, and 1 year following vertebroplasty. Patients with ≥50% improvement on the Numeric Rating Scale and ≥40% improvement on the Roland-Morris Disability Questionnaire were classified as "responders." Peri- and postoperative complications were also collected. Significant median improvement in the Roland-Morris Disability and rest and activity Numeric Rating Scale scores (15, 2, and 6 points, respectively; P < .0001) persisted at 1 year without significant change from the immediate postoperative scores (P > .36). Patients on systemic therapy at the time of vertebroplasty were more likely to achieve "responder status," compared with patients not on systemic therapy, for the Numeric Rating Scale pain at rest score (P < .01) and the Roland-Morris Disability Questionnaire score (P < .003), with no difference in complication rates (χ2 = 0.17, P = .68). Vertebroplasty is an effective therapy for patients with myeloma with symptomatic compression fractures. Favorable outcomes are more likely to be achieved when spinal augmentation is performed after systemic therapy is initiated. Complication rates were not affected by the timing of systemic therapy.

Impact of Sham-Controlled Vertebroplasty Trials on Referral Patterns at Two Academic Medical Centers

Debate persists regarding the merit of vertebroplasty following publication of blinded vertebroplasty trials in 2009, one of which was the Investigational Vertebroplasty Efficacy and Safety Trial (INVEST). This study was performed to determine whether referring physicians at two academic medical centers were aware of the trial results and to assess if this awareness prompted a change in their treatment of osteoporotic fractures. E-mail surveys were distributed to physicians within the Mayo Clinic and Baylor Health Care System (BHCS). Of 1390 surveys sent, 194 (14%) were returned. Results showed that 92 of 158 respondents (58%) reported familiarity with INVEST; 66 of 92 (72%) agreed that INVEST changed their understanding of vertebroplasty efficacy; and 64 of 92 (70%) agreed that INVEST diminished their enthusiasm to refer patients for vertebroplasty. However, 105 of 159 respondents (66%) felt vertebroplasty was an effective procedure in appropriate patients. Mayo physicians were more likely than BHCS physicians to be aware of INVEST (73% vs 67%, P < .0001), respond that INVEST changed their understanding of the appropriate treatment for osteoporotic compression fractures (79% vs 57%, P = 0.026), view vertebroplasty less favorably (45% vs 21%, P = 0.005), and treat osteoporotic compression fractures with medical therapy/pain management alone (73% vs 48%, P = 0.003). INVEST changed referring physicians' understanding of the role of vertebroplasty and diminished their willingness to refer osteoporotic compression fracture patients; the impact varied by location.

The role of vertebroplasty and kyphoplasty for the treatment of osteoporotic compression fractures

Vertebral compression fractures are the most common fractures in patients with osteoporosis. They often are a significant source of morbidity in this population. Vertebroplasty and kyphoplasty are procedures frequently done to obtain pain relief. The procedure has been shown to be generally safe, but serious complications have been reported in the literature. Initial studies have shown significant benefit to patients as a result of this procedure. Recent randomized trials comparing vertebroplasty to sham procedures or conservative care have failed to show either long-term or short-term benefit of the procedure. This review will present the recent literature regarding the efficacy and lack of efficacy of the procedure.

The Influence of Endplate-to-Endplate Cement Augmentation on Vertebral Strength and Stiffness in Vertebroplasty

Controlled in vitro trial. To study vertebral strength in relation to cement augmentation technique after vertebroplasty and to assess the influence of the biomechanical compression model on postoperative results. In the treatment of osteoporotic vertebral fractures, the role of vertebroplasty has been well established. Biomechanical compression models thus far used, compressing vertebrae by only 25% of their initial height, did not show a correlation between cement augmentation volumes and postoperative compression strength. In these studies, even very small volumes of cement seem effective. However, these models may not realistically simulate clinically relevant osteoporotic wedge fractures. We hypothesize that, in clinically relevant osteoporotic wedge fractures, postoperative vertebral body strength is strongly dependent on endplate-to-endplate cement augmentation. Twenty-five intact osteoporotic cadaver vertebrae were obtained (10 lumbar, 15 thoracic). In 21 vertebrae, anterior wedge fractures (AO type A1.2) were created by controlled external force, with preset height reduction by 35%. After height reconstruction, 9 vertebrae were augmented endplate-to-endplate and 12 vertebrae were partially augmented with polymethylmethacrylate (PMMA). Another 4 vertebrae were compressed by only 25%. Posttreatment strength and stiffness of the vertebrae were determined by a compression test identical to the pretreatment compression protocol. In the 35% compression group, posttreatment strength was significantly decreased in vertebrae that were partially augmented with cement compared with the endplate-to-endplate augmented group (767 +/- 257 N vs. 1141 +/- 325 N, P < 0.01). Postoperative strength amounted 106% +/- 27% of preoperative strength values in the endplate-to-endplate augmented vertebrae, compared with 65% +/- 18% in the partially augmented vertebrae (P < 0.001). In the 25% compression group, results in height restored and augmented vertebrae were similar to the nontreated vertebrae. Endplate-to-endplate PMMA augmentation restores the biomechanical properties of vertebrae in clinically relevant anterior wedge fractures. Our preliminary data suggest that biomechanical models with only 25% compressive deformation unlikely form a good model to assess the mechanical effects of cement augmentation in osteoporotic fractures.

Role of vertebroplasty in non infective vertebral collapse - a review article

Role of vertebroplasty in non infective vertebral collapse - a review article

Burst fracture of the spine involving vertebrae presenting no other lesions: The role of vertebroplasty

We report our experience on percutaneous vertebroplasty performed on five patients who presented with history of trauma to the spine and secondary burst fracture, but with stable fractures, and on whom the medical and orthopedical therapies had been unsuccessful in the relief of the intractable pain and in the treatment of their functional status. Four cases have benefitted from the intervention, with complete disappearance of the symptomatology in two and incomplete in the other two. In one case, the improvement in the persistent painful symptoms was of no significance. Controls by computed tomography (CT). Which were performed after 3 months showed a satisfactory consolidation of the fractured vertebrae.