Treatment Of Compression Fractures Research Articles

SAFETY AND EFFICACY OF BALLOON KYPHOPLASTY FOR COMPRESSION FRACTURES IN THE VERY ELDERLY

Introduction Balloon kyphoplasty is a well-accepted treatment for symptomatic compression fractures. Concern has been raised regarding unacceptable morbidity and poor outcomes in very elderly patients who undergo the procedure. This study was undertaken to evaluate the safety and efficacy of a series of very elderly patients who underwent balloon kyphoplasty. Materials Methods A retrospective cohort evaluation was performed of a consecutive series of 162 patients over age 80 who underwent treatment for compression fractures between 2006 and 2013 using the balloon kyphoplasty technique. The indication for treatment included pain unresponsive to non-surgical management in all cases. Results All procedures were successfully completed under general anesthesia. There were 43 men and 119 women (mean age 88, range 80-99 years). One hundred forty-two fractures were osteoporotic (23 had history of trauma), and 20 were pathologic. Fifty patients were treated in an outpatient setting. A total of 253 levels were treated, most common being L1 (n=38) and T12, L2 (n=35 each). Ninety- one patients had a single level treated, 56 had 2 levels treated, and 15 had 3 levels treated. The range of levels treated spanned from T4 (n=2) through L5 (n=11). Back pain improvement was used as the primary outcome measure. The mean VAS score for back pain improved from 9 to 3.5 (p<0.0001). There were no cases of surgical site infections, cement extravasation, or new neurologic deficit for the entire cohort. Twenty-nine patients expired due to causes unrelated to the procedure during the follow-up period. Twenty- two (14%) patients underwent a second procedure for a new compression fracture after the index treatment at a mean interval of 7 weeks; 15 of these (68%) were performed at a level adjacent to the index level. Conclusion Balloon kyphoplasty is a safe and highly effective treatment for symptomatic compression fractures, even for very elderly patients. The procedure can be performed in an outpatient setting. Age alone should not be an exclusion criterion for candidate patients. Keywords: Balloon kyphoplasty, fracture, osteoporosis, surgery in the elderly, compression fractures

Thoracolumbar compression fractures – experimental study and clinical case analysis

Epiphyseal stabilisation and reduction with the use of ligamentotaxis are employed in the surgical treatment of compression fractures of the spine. The mechanism of ligamentotaxis has not been fully elucidated. Therefore, it is fundamental to analyse various clinical data to determine the study area relevant to the elucidation of this mechanism. We developed criteria for data selection from patient medical records for a newly-created database regarding cases of thoracolumbar vertebral body fractures. We also developed rules for assigning cases to a specific group according to the AO/Magerl classification. The methodology of fracture assessment involved the results of visualization of the spinal segment including the injured vertebral bodies and their virtual and material models. To this end, preoperative CT images were processed with specialised computer software. A biomechanically-oriented classification of clinical cases in the database was carried out based on 3D-CAD virtual models of spinal segments and models of individual injured vertebral bodies and RP material models in FDM technology. We indicated cases in which ligamentotaxis could be of use. Our analysis of ligamentotaxis research shows that the focus should be on cases of comminuted and nonosteoporotic fractures. Supporting work-up with 3D-CAD virtual and RP material models of spinal structures appears to be useful not only for the purposes of the present study but also in medical practice.

Kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fractures

Background The incidence of osteoporotic vertebral compression fractures increases with advancing age and is associated with significant healthcare expenditure. Patients who have sustained fractures from osteoporosis are at increased risk of additional fractures because of loss of bone strength caused by osteoporosis. Vertebroplasty is a minimally invasive vertebral augmentation procedure to relieve pain; it stabilizes the vertebral body. Kyphoplasty is a minimally invasive method for correction and augmentation of osteoporotic vertebral fractures. Materials and methods This study included two groups of patients suffering from painful osteoporotic vertebral compression fractures: the first group comprised 26 patients with 33 vertebral compression fractures treated by percutaneous vertebroplasty between April 2007 and October 2008. The results of this group were compared with those of another group of 18 patients (24 vertebrae) who were treated by kyphoplasty between November 2008 and July 2011. The visual analog scale (VAS) and the Oswestry Disability Index (ODI) were applied for the assessment of patients preoperatively and postoperatively. Results In the vertebroplasty group, the mean VAS score improved from 7.8 to 2.4 according to VAS and from 69 to 15 according to ODI. Cement leakage was noted in four patients (15.4%), without clinical consequence. Ten vertebrae (30.3%) revealed a mean improvement in vertebral height of 11% (8–14%). No patient showed progression of vertebral angles of the augmented vertebrae during the follow-up period. In the kyphoplasty group, the mean pain score improved from 8 to 2.1 according to VAS and from 71 to 17 according to ODI. Cement leakage was noted in two patients (11.11%), without clinical consequence. No thoracolumbar back pain was reported after kyphoplasty. Nineteen vertebrae (79.16%) revealed a mean improvement in vertebral height of 22% (range, 18–38%). No patient showed progression of vertebral angles of the augmented vertebrae during the follow-up period. Conclusion Both vertebroplasty and kyphoplasty resulted in significant improvement in VAS pain scores. Vertebroplasty, although less expensive than kyphoplasty, had a statistically greater risk for cement leakage and adjacent vertebral fracture.

Novel biodegradable electrospun nanofibrous P(DLLA-CL) balloons for the treatment of vertebral compression fractures

Significant interest has been expressed by the spinal surgeon community for the use of calcium phosphate cement (CPC) in the treatment of vertebral compression fractures (VCFs), but the water-induced collapsibility and poor mechanical properties limit its clinical use. Here we fabricated novel electrospun nanofibrous P(DLLA-CL) balloons (ENPBs) using the nanotechnique of electrospinning. The ENPBs could separate the cements from the surrounding environment, and therefore can prevent the water-induced collapsibility of CPC and eliminate cement leakage. The ENPBs filling with CPC had enough load-bearing ability to restore the height of the fractured vertebral body and had no obvious effects on the initial strength and stiffness of natural bones. Further, the ENPBs had good biodegradability and cell proliferation ability. Calcium can be released from ENPBs filling with CPC. All these results strongly demonstrate ENPBs can be potentially used as CPC filling containers that keep the advantages and eliminate the disadvantages of CPC. From the Clinical EditorCalcium phosphate cement (CPC) is a promising modality in vertebral compression fracture treatment, but its water-induced collapsibility limits clinical applications. This team of investigators fabricated novel nanofibrous balloons using electrospinning, which enabled the separation of CPC from its surrounding environment, and therefore prevented water-induced collapsibility of CPC and eliminated cement leakage while maintaining all the advantages of CPC treatment.

Comparative study on the period of absolute bed rest of vertebral compression fracture.

ObjectiveAs a conservative treatment of compression fractures, absolute bed rest (ABR) for a certain period has been recommended, but no guideline on the period has yet been established. Considering that a long ABR period may adversely affect patients, the difference in prognosis according to the ABR period was investigated in this study.MethodsA prospective study was conducted who were diagnosed with compression fracture. Groups A and B were put on ABR (one week for group A and two weeks for group B). X-ray images at baseline, 1, 2, 4, and 8 weeks were obtained from both groups, for assessment purposes.ResultsThe compression rates of both groups were no significant difference at baseline, 1, 2, 4, and 8 weeks. The conditions of 25.9% and 21.2% of the subjects deteriorated in groups A and B, showing no significant difference. Between the groups of age and bone mineral densities (BMD), no significant difference was observed in the incidence of deterioration. In terms of complications development including constipation and other Gastrointestinal problems, voiding difficulty, etc., group A reported 57.4%, and group B, 84.8%, showing a significant difference (p-value=0.001).ConclusionNo significant difference in the conservative period was observed between the groups. Group B, however, reported a higher complications development rate than group A. Therefore, a short ABR period may be helpful in the early stage of conservative treatment.

Comparative analysis on curative effects of percutaneous vertebroplesty and kyphoplasty in the treat-ment for thoracolumbar vertebral compression fracture

[Objective]To explore and compare the clinical efficacy of treatment of thoracolumbar vertebral compression fracture by percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP).[Methods]46 cases of thoracolumbar vertebral compression fractures in patients with surgical Methods were divided into vertebral angioplasty group and kyphoplasty group,intraoperative blood loss of two groups,operative time,the bone cement injected volume,bone cement leakagerate and clinical efficacy before and after surgery were compared in two groups.Resrlts Patients were successfully completed with surgery,infection,complications of hematoma,nerve root injury,and vertebral body fractures.There was no statistical significant difference in operative time and blood loss in two groups(P＞ 0.05).But there was significant differences in the injection volume of hone cement,bone cement leakage rate between the two groups (P＜0.05).Two groups' restoring vertebral height extent had significant improvement in VAS score than the preoperative group,difference was statistically significant (P＜ 0.05) but no significant difference found between two groups (P＞ 0.05).Mter 2weeks in PVP group,and the PKP group,1 year after the efficiency difference was not significant (P＞ 0.05).[Conclusion]s PVP and PKP treatment of thoracic and lumbar vertebral compression fracture may derive significant clinical efficacy,with less trauma,shorter operative time,less bleeding,fewer complications,minimally invasive characteristics.PKP can effectively correct the kyphosis,greatly reduce the occurrence of bone cement leakage than PVP increased security,hut the cost is higher; PVP operation is relatively simple,inexpensive,hut the bone cement leakage rate is relatively high.It should be combined with a vasiety of factors to select the appropriate surgical clinical. Key words: Percutaneous vertebroplasty(PVP); Percutaneous kyphoplasty(PKP); Compression fracture; Osteoporosis; Bone cement; Curative effect

Improved percutaneous vertebroplasty for osteoporotic vertebral compression fractures

Objective To evaluate the curative efficacy of improved percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures (OVCF) in comparison with conventional PVP and percutaneous kyphoplasty (PKP). Methods Between June 2007 and July 2010,97 senior OVCF patients were surgically treated and followed up in our department.They were 36 men and 61 women,with an average age of 68.3 years (ranging from 56 to 89 years).Altogether 124 vertebral bodies were treated,including 73 thoracic vertebrae and 51 lumbar vertebrae.Seventy-four patients had a single vertebra fractured,19 had 2 vertebrae fractured and 4 had 3 vertebrae fractured.The patients received improved PVP,conventional PVP and PKP respectively.The visual analogue scale (VAS) scores and the cobb angles of the injured vertebra before operation,one week and 6 months after operation and the postoperative cement leakage as well were compared between the 3 groups of patients. Results The patients obtained an average follow-up of 13 months (from 7 to 20 months).Mild radicular symptoms were observed in 3 patients.No spinal injury,infection or vascular embolism occurred.There was a significant difference between the preoperative and postoperative VAS scores in all the 3 groups( P ＜ 0.05) but there was no significant difference among the 3 groups regarding the VAS score at the same time point ( P ＞ 0.05). PKP and improved PVP were significantly better than conventional PVP in correction of the cobb angle ( P ＜ 0.05).Moreover,PKP and improved PVP resulted in significantly fewer events of cement leakage than conventional PVP ( P ＜ 0.05). Conclusions Compared with conventional PVP,improved PVP makes a significant improvement in correction of vertebral kyphosis and reduction of cement leakage while it can also rapidly relieve pain in patients with OVCF.Improved PVP is as therapeutically effective as PKP,but much less expensive than PKP. Key words: Spinal fractures; Osteoporosis; Vertebroplasty

Nursing of PVP and PKP in the treatment of osteoporotic vertebral compression fractures

Objective To explore the effect and reasonable nursing methods of percutancous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures.Methods Totally 156 patients with osteoporotic vertebral compression fractures were randomly selected in the third hospital of Hebei Medical University from December 2004 to December 2010.According to the surgical methods,all the patients were divided into two groups:PVP group ( n =89) and PKP group ( n =67 ).The hospital stay,hospitahzation costs,bed time,postoperative recovery time,VAS scores before and after treatment,cement leakage rate of both PVP group and PKP group were analyzed.Results Group PVP:hospital stay (4.85 ±0.81)d,bedtime (1.48 ±0.68)d,postoperative recovery time (2.36 ±0.84)d,VAS scores after treatment (2.19 ± 0.77) ; Group PKP:hospital stay (4.71 ± 0.77 ) d,bed time ( 1.53 ± 0.52) d,postoperative recovery time (2.40 ±0.64)d,VAS scores after treatment (2.26 ±0.63 ).There were no significant differences in the aspects of the hospital stay,bed time,postoperative recovery time,VAS scores after treatment between PVP group and PKP group (t =0.702,0.355,0.491,0.348,respectively; P ＞0.05).Group PVP:hospitalization costs (1.30 ±0.19) ten thousand yuan; Group PKP:hospitalization costs (4.79 ±0.22) ten thousand yuan,there was significant difference in the hospitalization costs(t =79.163,P＜0.01).There was significant difference in the aspects of cement leakage rate between PVP group and PKP group (30.34％ vs 13.43％ ;x2 =6.153 1,P＜0.05).Conclusions Both PVP and PKP can effectively ease the pain in patients with osteoporotic vertebral compression fractures.Hospitalization costs is lower in PVP group than that in PKP group.However,cement leakage rate is higher. Key words: Osteoporosis; Vertebroplasty; Fractures,compreasion

An ex vivo biomechanical comparison of a novel vertebral compression fracture treatment system to kyphoplasty

BackgroundVertebral compression fracture repair aims to relieve pain and improve function by restoring vertebral structure and biomechanics, but is still associated with risks arising from polymethylmethacrylate cement extravasation. The Kiva® Vertebral Compression Fracture Treatment System, a stacked coil implant made of polyetheretherketone and delivered over a guide-wire, is a novel device designed to provide height restoration and mechanical stabilization, while improving cement containment and minimizing disruption of cancellous bone. The objective of this study was to determine whether the Kiva system is as effective as balloon kyphoplasty at restoring mechanical properties in osteoporotic vertebral compression fractures. MethodsWedge fractures were created in the middle vertebra of fourteen osteoporotic three-vertebra spine segments and then repaired with either the Kiva or kyphoplasty procedure. Height, stiffness and displacement under compression of the spine segments were measured for four conditions: intact, fractured, augmented, and post-cyclic eccentric loading (50,000cycles, 200–500N, 30mm anterior lever arm). FindingsNo significant differences were seen between the two procedures for height restoration, stiffness at high or low loads, or displacement under compression. However, the Kiva System required an average of 66% less cement than kyphoplasty to achieve these outcomes (mean 2.6 (SD 0.4) mL v. mean 7.5 (SD 0.8) mL 0; P<0.01). Extravasations and excessive posterior cement flow were also significantly lower with Kiva (0/7 v. 4/7; P<.05). InterpretationKiva exhibits similar biomechanical performance to balloon kyphoplasty, but may reduce the risk of extravasation through the containment mechanism of the implant design and by reducing cement volume.

Vertebral Compression Fracture Treatment with Vertebroplasty and Kyphoplasty: Experience in 407 Patients with 1,156 Fractures in a Tertiary Cancer Center

Painful vertebral compression fractures (VCFs), whether pathologic or osteoporotic, are a source of morbidity in cancer patients. At our tertiary cancer center, over the past decade we have used vertebroplasty (VP) and kyphoplasty (KP) to treat painful VCFs. More data are needed on the treatment of VCFs in cancer patients with these techniques. We retrospectively reviewed the medical records of cancer patients with painful VCFs that had been treated at our institution between January 1, 2001 and May 31, 2008. Information was collected on demographic and clinical characteristics, features of the fractures, procedural details, and complications. Pre- and post-procedural pain and related symptoms were assessed using a subset of patients who had responded to the Brief Pain Inventory and the Edmonton Symptom Assessment Scale. A total of 407 cancer patients had 1,156 fractures that had been treated with VP or KP during 536 surgical procedures. Patients had an average of 2.8 fractures (range, 1-10). The majority of patients had pathologic fractures due to multiple myeloma (43%) or osteoporotic fractures (35%). Most fractures occurred in the thoracolumbar region. Adjacent-level fractures occurred in 18% of patients. Surgery provided significant relief from pain and several related symptoms. Symptomatic, serious complications requiring open surgery occurred in two cases (<0.01%) in our series. Our single-center experience revealed that a large number of cancer patients suffer from painful VCFs. The use of VP or KP in treating painful VCFs in cancer patients has good efficacy and an acceptably low complication rate.

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

Objective To investigate and compare the efficacy, safety, and cost effectiveness in the treatment of painful osteoporotic vertebral compression fractures ( OVCFs ) with percutaneous vertebroplasty (PVP) and kyphoplasty(PKP). Methods Seventy-two patients (96 vertebrae) with painful OVCFs were treated by PVP (n ＝34) or PKP (n ＝38) under radiological monitoring. After bone biopsy needle into the compressed vertebra, bone cement (polymethylmethacrylate) was injected in PVP group, and that was inserted followed by the inflation of vertebra to create cavities in PKP group. The fluoroscopy time, total amount of bone cement injected, and cost were recollected respectively. The score of visual analogue scale point( VAS, 10-point scale)was determined at before the procedures, and 24 hours, one week, and one month after the procedures. Pain relief and complications were observed. The Cobb angle and vertebral heights of the anterior, middle, and posterior border were measured pre-and post-operative. Results The two procedures were technically successful in all patients. The follow-up ranged from 1. 0 to 34. 0 months [mean time, (8. 9 ±3.2) months]. The Mean fluoroscopy time of treating per vertebra in PVP group was ( 11. 1 ± 10. 6 ) min, which was significant shorter than that ( 23.5 ± 13. 0) min in PKP group( P ＜0. 05 ).The mean total cost per patient was (5127. 2 ± 502.3 ) yuan in PVP group, which were strikingly lower than that(32 301.4 ±3204. 6) yuan in PKP group (P ＜0. 05). (3)There was no significant difference( P ＞0. 05 ) in average cement volumes in PVP group [ (4. 9 ± 1.1 ) ml]and PKP group [ (5.4 ± 1.7 ) ml]. Pain relief of was observed in 94. 1％ (32/34) of PVP group and in 92. 1％ (35/38) of PKP group. The score of VAS at pre-operation was (8. 3 ±0. 4 vs 7.9 ±0. 8) ,and at post-operative 24 h (2. 9 ±0. 9 vs 2. 8 ± 1. 2),1 week (2.6 ± 0. 9 vs 2.6 ± 1. 1 ), and 1 month (2.6 ± 0. 9 vs 2. 5 ± 1.3 ) were no difference at PKP and PVP group(P ＜0.05). There was significant difference between pre- and post-operative time point in each group. The Cobb angle, anterior and middle height of vertebra was corrected in both PVP and PKP group. In PVP group, the preoperative Cobb angle, anterior and middle height of vertebra was (24. 2 ± 3.8 )°,( 19. 1 ± 1.4) mm, (25. 2 ± 1.0) mm, which was significant different ( P ＜ 0. 05 ) from that of ( 19.4 ±3.9)°, (21.0 ± 1.5) mm, (27.0 ± 1.2) mm at pre-operation. In PKP group,there was significant difference (P ＜ 0. 05 ) in the preoperative Cobb angle, anterior and middle height of vertebra [(25. 1 ±5.0)°vs(10.7 ±2.8)°, (19.5 ± 1.5) mm vs (24.3 ± 1.9) mm, (25.4 ± 1.1) mm vs (29.7 ±1.3) mm, respectively]. As to the above index, the overall correcting effect in PKP was much better than that in PVP( P ＜0. 05 ). Cement leakage occurred in 9 cases in PVP group and 3 cases in PKP group ( P ＜0. 05 ) but no symptoms. There were no major complications during operation in the two groups. Conclusion PVP and PKP are effective and safe in the treatment of painful OVCFs but PVP is more cost effective than PKP. Key words: Percutaneous vertebroplasty; Spine; Osteoporosis; Fracture,compression

Early and long-term outcomes of vertebroplasty for single osteoporotic fractures

Background and purposePercutaneous vertebroplasty (PVP) is a minimally invasive vertebral augmentation procedure for the treatment of recent, osteoporotic vertebral compression fractures. The aim of the study was to determine the early and late outcomes of PVP for osteoporotic vertebral compression fractures. Material and methodsWe prospectively assessed outcomes of PVP in 200 patients with single, osteoporotic vertebral compression fracture. Follow-up assessment was made 12 hours after surgery as well as after 7 days, 30 days, 3 months, 6 months, and 1 year after surgery. A subgroup of 80 patients was evaluated also 2 years after PVP. A 100-mm visual analogue scale of pain was used for outcome measurement. ResultsTwelve hours after PVP, very significant relief of pain was obtained in 85% of patients; on the 7th and 30th day a very good result of treatment was noted in 96%. The same result was noted in 92% of patients at the 6th month, and in 90% of patients at the 12th month. Among the 80 patients followed for 2 years, 3 patients reported recurrence of pain and were subsequently diagnosed with new osteoporotic fractures. ConclusionsPercutaneous vertebroplasty is a minimally invasive method of treatment for fresh osteoporotic fractures, which provides a significant and sizeable reduction of pain in the short as well as long term after surgery. Complete relief of pain was noted 12 hours after PVP in 94% of patients, and was noted in 90% two years after treatment. Despite some literature data suggesting no beneficial effect of PVP, it can be concluded that PVP is the most effective and the safest method for fresh vertebral compression fracture treatment.

Treatment of osteoporotic compression fracture of thoracic/lumbar vertebrae by kyphoplasty with SKY bone expander system

Objective To investigate prospectively the effectiveness of kyphoplasty with SKY bone expander system in treatment of compression fracture of thoracic/lumbar vertebrae and correction of the deformity. Methods Twenty-five patients with thoracic/lumbar vertebral osteoporotic compression fracture were admitted to our hospital between March 2007 and March 2008, and treated by kyphoplasty with SKY bone expander system. Patient's pain status was rated with Visual Analogue Scale (VAS) score system 1 day before and 1 hour, 48 hours, 6 months, 12 months after surgery. In addition, Rolland-Morris and Oswestry disability questionnaires (RDQ and ODI) were used for survey 1 day before and 1, 6, 12 months after surgery. Pre- and post-operative vertebral heights and Cobb's angles were measured based on the X-ray films and statistically analyzed. Results There were 27 fractured vertebrae in these 25 patients. After SKY kyphoplasty, the Cobb's angles (9.8°±9.76°) were significantly reduced compared with preoperative angles (17.18°±9.35°, P<0.05), and the average improvement rate was 39%. Patients' pain VAS scores were also greatly improved after operation ( P<0.05). Moreover, postoperative RDQ and ODI scores were significantly smaller than preoperative values ( P<0.05). Conclusion Kyphoplasty with SKY bone expander system provides an effective method for treating thoracic/lumbar vertebral osteoporotic compression fracture, with the advantages of small surgical wound and short duration. It can effectively recover the anterior and medial heights of fractured vertebrae (33% and 50%, respectively), reduce the Cobb's angle, quickly alleviate pain and improve patients' quality of life in a relatively short time period.

Minimally invasive treatment of chronic osteoporotic vertebral compression fractures in the elderly

Objective To study a new method of minimally invasive balloon kyphoplasty (PKP)for treatment of chronic osteoporotic vertebral compression fractures. Methods The study involved 27 patients with chronic osteoporotic vertebral compression fractures treated with PKP in our hospital from February 2007 to February 2009. There were 11 males and 16 females, at mean age of 72.4 years (range 55-86 years). The history of chronic osteoporotic vertebral compression fractures ranged 3-17 months (mean 7.6 months). The pathological changes were determined at one stage in 25 patients and at two stage in two. According to the Genant classification, there were 10 patients (11 vertebrae) at grade two and 17 patients (18 vertebrae) at grade three. Before operation, the visual analog scale (VAS) score was average 8.3, the ratio of compression height of the anterior vertebral body to the posterior vertebral body was 39% by X-ray measurement and the kyphosis angle was average 15.60°. All patients received PKP under local anesthesia. Results Patients were followed up for average 11.2 months, which showed that all the patients achieved significant pain relief and ambulation at days 3 or 4 after operation. Cardiorespiratory function was significantly improved, with no reoccurrence of pain or severe complications found.After operation, the VAS score was average 2.8, ratio of compression height of the anterior vertebral body to the posterior vertebral body was average 47.6% and the kyphosis angle was average 15.60°. Conclusions Minimally invasive PKP can achieve rapid relief of pain, help early ambulation, decrease various complications resulting from long-term confinement to bed and improve cardiorespiratory function for elderly patients with chronic osteoporotic vertebral compression fractures of the vertebral body mainly with pain but without nerve injury. Key words: Spinal fractures, aged; Osteoporosis

A summary of the treatment of compression fractures of the thoracic and lumbar vertebrae after menopause

A summary of the treatment of compression fractures of the thoracic and lumbar vertebrae after menopause

Cooperation and nursing of percutaneous vertebroplasty

Objective To discuss the nursing experience of percutaneous vertebroplasty in the treatment of vertebral body compression fracture (VCF). Methods 58 patients with VCF received percutaneous vertebroplasty under the guidance of c-arm X-ray. Before the operation, mental nursing as well as body position guidance were administered in each case, vital symptom monitoring and in-time intraoperative communication between patients and medical staff were performed. Results 58 patients all lived through the operation without any complications. All patients were satisfied with their clinical outcome. Conclusions Preoperative mental nursing and preparation plus intra-operative vital symptom monitoring can guarantee a successful operation. Key words: Percutaneous vertebroplasty; Vertebral body compression fracture; Nursing

A comparison between dilator-kyphoplasty and SKy-bone expander kyphoplasty

Objective To compare the clinical results of dilator-kyphoplasty (DKP) and SKy-bone expander kyphoplasty (EKP) . Methods From October 2004 to May 2008, 51 patients with vertebral osteoporotic compression fracture received DKP (29 vertebras) and EKP (27 vertebras). The operation time,bleeding volume, cement injection volume were recorded during operation. The patients' visual analogue scale (VAS) and Oswestry disability index (ODI) scores were evaluated before and after operation. The cement distribution and restoration of vertebral height and Cobb angle were observed post-operation. Results There were no significant differences in operation time or bleeding volume at every vertebra between the 2 groups ( P > 0. 05). The DKP group had a significantly larger cement injection volume of (5.7 ±0. 5) mL than the EKP group [(3.6 ± 1.6) mL] ( P < 0.05). The VAS and ODI scores were decreased significantly in both groups after operation ( P < 0.05) . The vertebral height and Cobb angle were restored in both groups after operation. Nine cases ( 11 vertebras, 40. 7% ) had cement leakage in the EKP group, but one case (one vertebrae, 3.4% ) did in the DKP group. Conclusions Both DKP and EKP are efficacious and safe in the treatment of vertebral compression fractures. The vertebral anterior height, middle vertebral body height, and Cobb angle can be all restored by both procedures. DKP may be better in restoration of the vertebral anterior height, middle vertebral body height, and Cobb angle. DKP may lead to less cement leakage than EKP. Key words: Osteoporosis; Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Surgical instruments

A comparison study of clinical application between dilator-kyphoplasty and balloon-kyphoplasty

Objective To compare the clinical outcomes of dilator-kyphoplasty (DKP) and balloonkyphoplasty (BKP) in treatment of osteoporotic vertebral compression fractures. Methods From May 2007 to March 2009, 23 cases with 26 vertebrae were treated with DKP, while 29 cases with 29 vertebrae were treated with BKP procedures. The operating time, bleeding volume and injecting volume of cement were recorded during operation. The distribution of cement, the restoration of vertebral height and Cobb angle were observed. The patients' visual analogue scales (VAS) score and Oswestry disability index (ODI) score were evaluated after operation. Results There were no differences in operative time, bleeding volume of every vertebrae and cement injected volume between these two groups (P＞0.05). The vertebral height, Cobb angle, VAS and ODI scores were significantly improved than those of pre-operation in these two groups (P＜0.05). The height of the anterior vertebrae and Cobb angle in DKP groups were restored significantly than those in BKP groups (P＜ 0.05). There were 1 case (1 vertebra, 3.8%) underwent cement leakage in DKP groups and 5 cases (5 vertebrae, 17.2%) in BKP groups. Conclusion DKP and BKP were effective in the treatment of osteoporotic vertebral compression fractures. The height of the anterior vertebrae and Cobb angle in DKP groups were restored significantly than those in BKP groups. Key words: Osteoporosis; Spinal fractures; Surgical procedures, operative

Prevention of thoracolumbar osteoporotic compression fracture with transpedicular intracorporeal bone graft with allogenic bone

Objective To evaluate the clinical efficacy of transpedicular intracorporeal bone graft with allogenic bone in treatment of thoracolumbar osteoporotic compression fracture. Methods A total of 45 patients with thoracolumbar osteoporotic compression fractures were treated with posterior short segment pedicle screw fixation and transpedicular intracorporeal bone graft with allogenic bone. Anteroposte-rior and lateral X-ray photographs were taken before and after operation and at follow up period to determine the ratio of anterior and middle compressed body height to the normal height, the vertebral angle and the superior-inferior endplate angle. The extent of local pain was measured by VAS score. The implant failure was also recorded during follow-up. Results The operative reduction and interbody bone grafting exerted a satisfactory effect on the ratio of anterior and middle body height to the normal height, the vertebral angle and the superior-inferior endplate angle. Local back pain disappeared immediately after surgery in 34 patients out of 38 patients followed up for more than two years. No implant failure was found during follow-up. Conclusions Early treatment with posterior short segment pedicle screw fixation and transpedicular intracorporeal bone graft with allogenic bone can effectively correct local deformity, prevent late vertebral collapse and implant failure and is an ideal treatment method for thoracolumbar osteoporotic compression fracture. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Osteoporosis; Allogenic bone

The Treatment of Compression Fractures by the Anesthesiologist

The Treatment of Compression Fractures by the Anesthesiologist