Treatment Of Osteoporotic Vertebral Compression Research Articles

Efficacy and safety of high-viscosity cement in percutaneous vertebroplasty for treatment of Osteoporotic vertebral compression fractures: A retrospective cohort study.

To evaluate the efficacy and safety of high viscosity bone cement in the percutaneous vertebroplasty (PVP) for treatment of single-level osteoporotic vertebral compression fractures.Eighty patients were enrolled in this study. All patients were received PVP, and they were divided into 2 groups according to the viscosity of bone cement, either high viscosity bone cement (HV group) or low viscosity cement (LV group). Oswestry Disability Index questionnaire and visual analog scale as clinical assessments were quantified. The operative time and injected bone cement volume were recorded. The anterior vertebral height (AVH) and bone cement leakage were evaluated in the radiograph.No significant difference was observed in the operative time. Both groups showed significant improvements in pain relief and functional capacity status (visual analog scale and Oswestry disability index scores) after surgery. Less bone cement volume was injected into the the injured vertebra in the HV group and statistical significance was found between both groups. In the HV group, there was lower leakage rate and less patients of severe leakage compared with the LV group. However, the correction of AVH showed no significant differences between the 2 groups and no significant loss of AVH was observed in 2 groups.High-viscosity and low-viscosity PVP have the similar effects in improving quality of life and relieving pain. There were lower cement leakage rate and less patients of severe leakage in the PVP with high-viscosity bone cement.

Using side-opening injection cannulas to prevent cement leakageinpercutaneous vertebroplasty for osteoporotic vertebralcompression fractures, does it really work?

Percutaneous vertebroplasty has been widely applied in the treatment of osteoporotic vertebral compression fractures over the past two decades. However as one of the major complications, the rate of cement leakage seems not to be decreased significantly. In this study, the rate of cement leakage was compared between two groups using two different cement injection cannulas. The purpose was to determine the efficacy of side-opening cannula on preventing cement leakage in vertebroplasty for the treatment of osteoporotic vertebral compression fractures. A retrospective study was conducted from January 2013 to December 2015. Totally 225 patientswho received bilateral vertebroplasty due to osteoporotic vertebral compression fractures wereincluded in the study. The patients were divided into test group who received vertebroplasty with side-opening cannulas and control group who received vertebroplasty with front-opening cannulas. The patients' medical records were reviewed to determine the bone marrow density, preoperative vertebral compression ratio, preoperative and postoperative VAS, operation time, volume of injected bone cement, rate of cement leakage. Post-operative X-rays and CT scans were utilized to assess the degree of Cement leakage. Comparisons between groups and clinical results on VAS in each group were analyzed with appropriate test. All the patients were performed successfully without symptomatic complications. The back pain was significantly relieved after operation in both groups (P<0.05). At 6 days and 6 months follow-up, there was no significant difference in the mean VAS score between the two groups (P>0.05). The rate of cement leakage in the test group was significantly lower than that in the control group (P<0.05). Percutaneous vertebroplasty with side-opening cannula is a safe and effective minimally invasive method in the treatment of osteoporotic vertebral compression fractures, the rate of cement leakage can be significantly reduced by redirecting the cement flow.

Cement Leakage in Percutaneous Vertebral Augmentation for Osteoporotic Vertebral Compression Fractures: Analysis of Risk Factors.

The risk factors for cement leakage were retrospectively reviewed in 192 patients who underwent percutaneous vertebral augmentation (PVA). To discuss the factors related to the cement leakage in PVA procedure for the treatment of osteoporotic vertebral compression fractures. PVA is widely applied for the treatment of osteoporotic vertebral fractures. Cement leakage is a major complication of this procedure. The risk factors for cement leakage were controversial. A retrospective review of 192 patients who underwent PVA was conducted. The following data were recorded: age, sex, bone density, number of fractured vertebrae before surgery, number of treated vertebrae, severity of the treated vertebrae, operative approach, volume of injected bone cement, preoperative vertebral compression ratio, preoperative local kyphosis angle, intraosseous clefts, preoperative vertebral cortical bone defect, and ratio and type of cement leakage. To study the correlation between each factor and cement leakage ratio, bivariate regression analysis was employed to perform univariate analysis, whereas multivariate linear regression analysis was employed to perform multivariate analysis. The study included 192 patients (282 treated vertebrae), and cement leakage occurred in 100 vertebrae (35.46%). The vertebrae with preoperative cortical bone defects generally exhibited higher cement leakage ratio, and the leakage is typically type C. Vertebrae with intact cortical bones before the procedure tend to experience type S leakage. Univariate analysis showed that patient age, bone density, number of fractured vertebrae before surgery, and vertebral cortical bone were associated with cement leakage ratio (P<0.05). Multivariate analysis showed that the main factors influencing bone cement leakage are bone density and vertebral cortical bone defect, with standardized partial regression coefficients of -0.085 and 0.144, respectively. High bone density and vertebral cortical bone defect are independent risk factors associated with bone cement leakage.

Perioperative nursing care of ercutaneous vertebral plasty in the treatment of osteoporotic vertebral compression

Objective To summarize perioperative care based on 18 cases of PVP(Percutaneous vertebroplasty)in treatment of OVCF(Osteoporotic vertebral compression fractures), for improving the life quality of patients. Methods Preoperative, postoperative nursing, preventing complication and discharged guidance were done carefully. Results Except one case hadn't became PVP because of too much contrast medium going into the canales spinalis, the rest of 18 cases of PVP in treatment of OVCF came over perioperative period sucessfully. Conclusions To strengthen perioperative care based on PVP in treatment of OVCF can ease the pain, improve the life quality, prolong life and improve patients' and their families' satisfaction. Key words: Osteoporotic; Vertebral compression fractures; Percutaneous vertebroplasty; Perioperative care

Investigational Vertebroplasty Safety and Efficacy Trial (INVEST): Patient-reported Outcomes through 1 Year

To evaluate 1-year outcomes of the Investigational Vertebroplasty Safety and Efficacy Trial (INVEST), a blinded, randomized, controlled trial to investigate the effectiveness of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures. Patients were enrolled at 11 sites in the United States, the United Kingdom, and Australia by using an institutional review board-approved protocol and HIPAA compliance, and all patients provided written informed consent. Patients were randomized to undergo vertebroplasty or a control procedure. After 1 month, patients were allowed to cross over and undergo the alternate procedure. Coprimary outcomes were patient-reported function, measured with the modified Roland-Morris Disability Questionnaire (RDQ), and pain (on a scale of one to 10) at 1 year. Intention-to-treat (ITT) and as-treated (AT) analyses were used to compare outcomes. One hundred thirty-one participants (68 in the vertebroplasty group and 63 in the control group) were included in the analyses. Patients in both groups showed improvements in pain and function at 1 year. In ITT analyses, patients randomized to vertebroplasty did not differ from control subjects in terms of RDQ results (difference, 1.37 points; 95% confidence interval [CI]: -0.88, 3.62; P = .231) but reported lower levels of pain (difference, 1.02 points; 95% CI: 0.04, 2.01; P = .042). Eleven of 68 patients who underwent vertebroplasty (16%) and 38 of 63 control subjects (60%) crossed over and elected to undergo the alternate procedure (P < .001). In AT analyses, patients treated with vertebroplasty did not differ from control subjects in terms of RDQ results (difference, 0.66 points; 95% CI: -1.98, 3.30; P = .625) or pain (difference, 0.85 points; 95% CI: -0.35, 2.05; P = .166). Vertebroplasty may provide a modest reduction in pain at 1 year compared with a control procedure; however, no difference in functional disability was observed. Clinical trial registration no. NCT00068822.

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

Correlative Factor Analysis on the Complications Resulting From Cement Leakage After Percutaneous Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture

The correlative factors for complications resulting from cement leakage were retrospectively reviewed in 71 patients who underwent percutaneous kyphoplasty. To explore the correlative factors affecting the complications of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures. Over the past decade, percutaneous kyphoplasty has been increasingly used as treatment of choice for osteoporotic vertebral compression fractures. However, current literature contains less information about the correlative factors affecting the complications resulted from cement leakage. In all, 71 patients with 171 vertebral compression fractures who were treated by percutaneous kyphoplasty in the department of spine surgery at our medical center were identified from the registry and were retrospectively reviewed. The treatment efficacy was determined by the assessment of change in vertebral body height, Cobb angle, visual analog scale and Oswestry functional score between preoperative, postoperative, and the latest follow-up. Complications were recorded and associated risk factors were determined and analyzed. All patients had immediate and significant improvement in back pain after being treated with percutaneous kyphoplasty. Cement leakage occurred in 17 (9.94%) out of 171 vertebral bodies, including 7 paravertebral leaks, 6 leaks into intervertebral space, 3 leaks into channel of needling insertion, and 1 spinal canal leak. Four patients (5.63%) developed pulmonary complications postoperatively, one of them with confirmed diagnosis of pulmonary embolism directly caused by cement leakage. During the follow-up, we found 9 recurrence vertebral fractures in 6 patients (8.45%), including 6 adjacent vertebral bodies. Univariate analysis revealed a significant difference in preoperative vertebral body height, injected cement volume, and vertebral body wall incompetence between the cement leakage group and no cement leakage group (P<0.05). In contrast, there is no significant difference in the preoperative Cobb angle, freshness of vertebral fracture, location of operative vertebrae, and operative approach between the 2 groups (P>0.05). Multiple logistic regression analysis showed that the injected cement volume and vertebral body wall incompetence were the predominant variables associated with the complications resulting from cement leakage. The patients who had a history of pulmonary diseases were prone to develop lung-related complications after the surgery. The cement viscosity, injected cement volume, vertebral body wall incompetence, and a history of pulmonary diseases were the factors affecting the complications resulting from cement leakage. The recognition of these risk factors is helpful in efforts to improve surgical technique to reduce the risk of complications after being treated by percutaneous kyphoplasty.

Treatment of osteoporotic vertebral compression fractures with PVP

Objective To explore the effect of pain relief using the visual analog scale (VAS) with PVP in the treatment of osteoporotic vertebral compression fractures.Methods 18 cases (21 vertebrae) of osteoporotic compression fracture of spine were treated with PVP.The effect of pain relief was followed and quantified using VAS and the height of vertebrae between the preoperative and the postoperative was measured.Resuits The VAS before operation was 7.944±0.938;3 days after operation was 2.778±1.003;1 month was 2.667±0.767;3 months was 2.611±0.850.The difference of the early and later follow-up VAS for PVP is significant when compared to the preoperative VAS(P＜0.05),but between the early and later,the difference in pain relief was not significant(P＞0.05).And the difference in the height of vertebrae between the preoperative and the postoperative was not significant(P＞0.05).Conclusion PVP relieve the pain of osteopomtic vertebral compression fractures in the postoperative periods. Key words: Percutaneous vertebroplasty; Osteoporosis; Spine fracture

Application of over-extending reduction position in vertebroplasty

目的 观察椎体成形术治疗骨质疏松性椎体压缩骨折手术过程中采用过伸体位矫正脊柱后凸畸形的效果.方法 2000年11月～2004年7月34例患者39个骨质疏松性椎体压缩骨折采用椎体成形术治疗.术中采用过伸体位闭合复位矫正脊柱后凸畸形,然后再经皮穿刺行椎体成形术,测量压缩骨折椎体高度恢复率和后凸畸形角度恢复率.结果 利用过伸体位闭合复位后再行椎体成形术,压缩骨折椎体高度恢复率达到(40.1±23.5)%,后凸畸形角度恢复率达到(42.5±29.3)%.结论 骨质疏松性椎体压缩骨折椎体成形术中利用过伸体位闭合复位可有效恢复椎体高度和矫正后凸畸形。

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.