Treatment Of Osteoporotic Vertebral Fractures Research Articles

Treatment of severe osteoporotic vertebral compression fracture with 3D printing-assisted percutaneous vertebroplasty in the elderly

Objective To investigate the clinical effect of 3D printing assisted percutaneous vertebroplasty (PVP) in treating severe osteoporotic vertebral compression fracture (OVCF) in elder patients. Methods A retrospective case series study was conducted on the clinical data of 58 elderly patients (58 vertebrae) with severe OVCF who underwent PVP treatment in spinal surgery department of Henan Provincial People's Hospital from June 2014 to June 2016. According to the treatment method, the patients were divided into Group A which adopted 3D printing of injured vertebrae before PVP and Group B which adopted routine PVP operation. Group A consisted of 28 cases (28 vertebrae), including eight males and 20 females, aged 64-91 years [(78.1±8.5)years]. In terms of the distribution of injured vertebrae, there were four cases of T10, six cases of T11, eight cases of T12, four cases of L1, and six cases of L2 in Group A. Group B consisted of 30 cases (30 vertebrae), including 10 males and 20 females, aged 65-90 years[(77.8±8.2)years]. In terms of the distribution of injured vertebrae, there were three cases of T10, seven T11, nine T12, six L1, and five L2. The operation time, visual analogue scale (VAS) before operation, 1 day after operation and at the last follow up, Japanese Orthopedic Association (JOA) score, anterior compression ratio of injured vertebrae, and cement leakage rate were compared between the two groups. Results All the operations were completed successfully. The patients were followed up for 14-26 months [(18.7±3.4)months] in Group A and for 12-28 months[(20.0±5.4 )months] in Group B. The operation time was (28.0±3.4)min in Group A and (30.9±5.3)min in Group B (P 0.05). Both the JOA at day 1 after operation of Group A [(21.3±2.2)points] and Group B [(20.7±2.1)points] and the JOA at the last follow up of Group A [(24.7±2.3)points] and Group B [(24.1±2.0)points] were significantly higher than those before operation (P 0.05). The anterior compression ratio of injured vertebrae 1d after operation of Group A(59.4±7.9)% and Group B (59.1±6.8)% and that at the last follow up of Group A (59.1±7.8)% and Group B (58.7±5.4)% were significantly improved than those before operation (P 0.05). There were three cases of bone cement leakage in Group A (11%) and 11 cases of bone cement leakage in Group B (37%) after PVP, and the difference was statistically significant (P<0.05). Conclusion Compared with conventional PVP, 3D printing-assisted PVP has lower leakage rate, shorter operation time, and better clinical effect in treating severe OVCF in the elderly. Key words: Osteoporotic fractures; Vertebroplasty; 3D printing

Radiofrequency kyphoplasty for the treatment of osteoporotic vertebral fractures: A review of the literature

Radiofrequency kyphoplasty for the treatment of osteoporotic vertebral fractures: A review of the literature

Sarcopenia affects conservative treatment of osteoporotic vertebral fracture

ObjectivesSarcopenia and osteoporosis affects activities of daily living and quality of elderly people. However, little is known about its impact on elderly locomotor diseases, such as osteoporotic vertebral fracture (OVF). There is no report investigating the influence of both sarcopenia and osteoporosis on outcomes of OVF. This study aimed to evaluate the clinical outcomes of OVF in elderly patients from sarcopenic perspectives. MethodsThis prospective study was conducted with 396 patients, aged 65 years or more, hospitalized for the treatment of OVF (mean age, 81.9 ± 7.1 years; 111 males, 285 females). The primary outcome was the Japanese Orthopaedic Association (JOA) score for lumbar disease (at first visit, hospital discharge, and 1 year after treatment) and Barthel index (at the same time and before hospitalization). The second outcome was living place after discharge. Susceptibility to sarcopenia and osteoporosis were evaluated and clinical results of conservative treatment were compared. ResultsSarcopenia significantly affected Barthel index at first visit and discharge. Sarcopenia patients had significantly higher rate for discharge to nursing home and living in nursing home after 1 year than patients without sarcopenia. Osteoporosis significantly affected the JOA score at the first visit and the Barthel index before hospitalization, at the first visit, discharge, and after 1 year. Osteoporosis did not affect the living place at discharge and after 1 year. ConclusionsSarcopenia and osteoporosis affected outcomes of conservative treatment for OVF; moreover, sarcopenia affected the living place of OVF patients at discharge and after 1 year.

Delayed Height Loss After Kyphoplasty in Osteoporotic Vertebral Fracture with Severe Collapse: Comparison with Vertebroplasty

To compare clinical and radiographic outcomes and complications after vertebroplasty (VP) and kyphoplasty (KP) for osteoporotic vertebral fractures with severe collapse. Patients >65 years old with single osteoporotic vertebral fracture (T10-L2) with severe collapse (>40%) were prospectively enrolled and allocated to either KP or VP. Visual analog scale and Oswestry Disability Index were used for clinical assessment. Vertebral height loss (HL) and segmental kyphotic angle were measured radiographically at preoperative; postoperative; and 1-, 3-, 6-, and 12-month postoperative time points. Procedure-related and postoperative complications were recorded. Forty-six patients (27 with VP, 19 with KP) were enrolled. Visual analog scale and Oswestry Disability Index scores were similar at all time points in the 2 groups. Complication rates were also similar. HL and kyphotic angle were restored significantly in both groups. KP showed a better result in HL (KP group HL 20.5% ± 5.6% vs. VP group HL 29.8% ± 4.6%, P < 0.001). Progressive vertebral HL was observed, and patients with KP showed a greater collapse in height. At 1-year follow-up, there was no significant difference in vertebral height (KP group HL 29.8% ± 6.3% vs. VP group HL 33.0% ± 5.2%, P= 0.075). KP and VP showed similar improvements in pain and disability during treatment for osteoporotic vertebral fractures. Although vertebral height and segmental kyphotic angle were restored significantly in both groups, progressive vertebral HL was inevitable, especially after KP. This likely resulted from the difference of bone-cement interface as a consequence of balloon tamping in KP. Surgeons must consider the respective features of vertebral augmentations.

Deep neural networks for automatic detection of osteoporotic vertebral fractures on CT scans

Osteoporotic vertebral fractures (OVFs) are prevalent in older adults and are associated with substantial personal suffering and socio-economic burden. Early diagnosis and treatment of OVFs are critical to prevent further fractures and morbidity. However, OVFs are often under-diagnosed and under-reported in computed tomography (CT) exams as they can be asymptomatic at an early stage. In this paper, we present and evaluate an automatic system that can detect incidental OVFs in chest, abdomen, and pelvis CT examinations at the level of practicing radiologists. Our OVF detection system leverages a deep convolutional neural network (CNN) to extract radiological features from each slice in a CT scan. These extracted features are processed through a feature aggregation module to make the final diagnosis for the full CT scan. In this work, we explored different methods for this feature aggregation, including the use of a long short-term memory (LSTM) network. We trained and evaluated our system on 1432 CT scans, comprised of 10,546 two-dimensional (2D) images in sagittal view. Our system achieved an accuracy of 89.2% and an F1 score of 90.8% based on our evaluation on a held-out test set of 129 CT scans, which were established as reference standards through standard semiquantitative and quantitative methods. The results of our system matched the performance of practicing radiologists on this test set in real-world clinical circumstances. We expect the proposed system will assist and improve OVF diagnosis in clinical settings by pre-screening routine CT examinations and flagging suspicious cases prior to review by radiologists.

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

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

Effects of reinforcing materials on durability of bone cement: in vitro experimental study

Bone cement is one of the most commonly used products in orthopedic surgery. Among common indications for its use are total joint replacement, bone and joint reconstructions, fracture fixation, treatment of bone infections, and treatment of osteoporotic vertebral fractures. Endurance is still questionable. The aim of our study is to find out the effect of structure strengtheners on compression pressure measurements of bone cement. There were four groups in this study: group 1, 40 cm3 pure bone cement (PMMA); group 2, 40 cm3 bone cement with %25 titanium dust; group 3, 40 cm3 bone cement with %25 steel dust; and group 4, 40 cm3 bone cement with %25 silica fume mixtures were prepared. These mixtures were frozen in 6-mm-width, 12-mm-height molds in cylindrical shape. Axial compression was made to these molds. Compression pressure measurements of the pure cement group ranged between 79.2 and 81.1 MPa; average was 80.25 ± 0.42 MPa. Measurements of titanium-added group ranged from 79.5 to 81.2 MPa; average was 80.46 ± 0.68 MPa. Steel-added group ranged from 79 to 82.2 MPa; average was 80.73 ± 0.57 MPa. For silica fume, measurements ranged from 89.1 to 91.4 MPa and average was 90.41 ± 0.57 MPa. The highest compression pressure values were gathered from the silica fume (p = 0.001). The construction reinforcer silica fume could be mixed with PMMA homogeneously and was superior to the other biocompatible materials that we had used in compression pressure tests. Beyond dispute, silica fume is a reinforcer which also increases the strength of the bone cement.

Extrapedicular unilateral percutaneous vertebroplasty via transverse process for osteoporotic vertebral compression fractures of upper lumbar

Objective To investigate the effect of transverse extrapedicular unilateral percutaneous vertebroplasty (PVP) via transverse process in treating the osteoporotic vertebral compression fractures. Methods A retrospective study was performed on 16 patients with osteoporotic vertebral compression fractures of upper lumbar treated from August 2016 through December 2016. There were seven males and nine females, at a mean age of 73.5 years (range, 62-90 years). All the patients reported severe back pain, with an average history of 2 weeks (range, 1-24 weeks). MRI confirmed the diagnosis of osteoporotic vertebral compression fractures, and the compression degree of the affected vertebral body was (25.4±5.3)%. All the patients were treated with extrapedicular unilateral PVP via transverse process under local anesthesia. The operation time, fluoroscopy frequency, bone cement injection volume, and bone cement dispersion were recorded. Back pain and function recovery were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI), respectively. Results All patients were followed up for 6-12 months (mean, 8 months). All operations were successful without complications. The average operation time was 20 min (range, 15-30 minutes), and there were 3-6 times of fluoroscopy with successful incubation. The average volume of bone cement injected to each injured vertebral body was 6.2 ml (range, 5-9 m1). The bone cement dispersed satisfactorily in the vertebral body. Complete relief of lumbar and back pain was achieved in 14 patients, and remarkable relief in two patients. The postoperative VAS and ODI at 24 hours, 72 hours, and 6 months were significantly lower than those before operation (P<0.01). Conclusion Extrapedicular unilateral percutaneous vertebroplasty via transverse process has the advantages of uniform fractured bone cement perfusion, significant pain relief, and rapid recovery, and hence is a simple, safe and effective treatment for osteoporotic vertebral compression fractures of the upper lumbar vertebrae. Key words: Spinal fractures; Osteoporotic fractures; Vertebroplasty; Spinal puncture

In vivo response to a low-modulus PMMA bone cement in an ovine model

Poly(methyl methacrylate) (PMMA) is the most commonly used material for the treatment of osteoporosis-induced vertebral compression fractures. However, its high stiffness may introduce an increased risk of adjacent vertebral fractures post-surgery. One alternative in overcoming this concern is the use of additives. This presents its own challenge in maintaining an adequate biocompatibility when modifying the base cement. The aim of this study was to evaluate the in vivo biocompatibility of linoleic acid (LA)-modified acrylic bone cement using a large animal model for the first time, in order to further advance towards clinical use. A worst-case approach was used, choosing a slow-setting base cement. The in vitro monomer release from the cements was also assessed. Additional material characterization, including mechanical tests, are summarized in Appendix A. Unmodified and LA-modified cements were injected into a total of 56 bone defects created in the femur and humerus of sheep. Histopathologic and histomorphometric analysis indicated that LA-modified cement showed a harmless tissue response similar to that of the unmodified cement. Adjacent bone remodeling was observed microscopically 4 weeks after implantation, suggesting a normal healing process of the bone tissues surrounding the implant. LA-modified cement exhibited lower mechanical properties, with a reduction in the elastic modulus of up to 65%. The handling properties were slightly modified without negatively affecting the injectability of the base cement. LA-modified bone cement showed good biocompatibility as well as bone compliant mechanical properties and may therefore be a promising material for the treatment of osteoporotic vertebral fractures. Statement of SignificanceThe benefits of using linoleic acid to reduce the stiffness of poly(methyl methacrylate) bone cement has been demonstrated previously, with the in vitro and in vivo response of the modified cement in small animals reported as comparable to the base cement. However, biocompatibility evaluation of modified cement in large animal models for future clinical use has yet to be performed. In this study, modified and unmodified cements were injected into bone defects created in sheep. We showed that the inflammatory response of the modified cement was similar to the base cement, allowing remodelling of the bone surrounding the implant. This demonstrates the potential of low-modulus PMMA cement in the field of bone augmentation.

Clinical effect of kyphoplasty in the treatment of osteoporotic vertebral fracture

Objective To investigate the clinical effect of kyphoplasty in treatment of osteoporotic vertebral fractures. Methods 100 patients with osteoporotic vertebral fractures were randomly divided into the observation group and the control group, 50 cases in each group.The control group was treated with percutaneous vertebroplasty, kyphoplasty was used in the observation group.The clinical effect was compared between the two groups. Results In the observation group, postoperative 1 week the NRS(pain number) score was (3.98±1.42)points, and the final follow-up NRS score was (1.06±0.24)points, 1 week after surgery the ODI was (32.18±5.15)%, and the final follow-up ODI was (25.48±5.32)%, 1 week after operation, the Cobb angle was (25.48±2.35)°, the final follow-up Cobb angle was (3.78±2.12)°, ambulation time was (15.36±5.48)h, the incidence rate of adverse reaction was 4.00%, the hospitalization time was (39.85±5.48)d, the operation time was (59.63±5.48)min, the amount of bleeding was (78.96±3.12)mL, which were all better than those of the control group[1 week after operation, the NRS score was (4.86±1.55)points, the last follow-up NRS score was (2.98±0.45), 1 week after operation ODI was (37.95±6.23)%, the last follow-up ODI was (36.48±6.17)%, 1 week after operation the Cobb angle was (34.81±2.63)°, at last follow-up, Cobb angle was (10.85±3.69)°, the ambulation time was (27.96±8.63)h, the incidence rate of adverse reactions was 24.00%, hospitalization time was (48.63±6.52)d, the operation time was (74.18±8.63)min, the amount of bleeding was (132.42±5.89)mL](t=4.457, 26.620, 5.047, 9.547, 18.705, 11.747, 8.715, χ2=8.305, t=7.289, 10.064, 56.714, all P<0.05). Conclusion Kyphoplasty is effective in the treatment of osteoporotic vertebral fracture and can reduce the risk of operation. Key words: Vertebroplasty; Osteoporosis; Spinal fractures

Vertebroplasty Using Allograft Bone Chips with Posterior Instrumented Fusion in the Treatment of Osteoporotic Vertebral Fractures with Neurological Deficits.

Introduction In general, osteoporotic vertebral fractures with neurological deficits require surgery. However, the ideal surgical method remains controversial. We evaluated the efficacy of combining posterior instrumented fusion and vertebroplasty using allograft bone chips. Methods Twelve patients (five men, seven women; age 68-84 years, mean age 75.9 years) with osteoporotic vertebral fractures with neurological deficits were reviewed retrospectively. They underwent posterior instrumented fusion and vertebroplasty, using allograft bone, at our institution between January 2007 and June 2016. We assessed the surgical results, radiologically and neurologically, after a mean follow-up of 37.3 months. Results The mean local kyphosis angle was 10° before surgery, −3.3° immediately after surgery, and 4.4° at follow-up. The average spinal canal compromise was 26.9% before surgery and 19.5% at follow-up. All patients achieved bony fusion and none needed additional surgery. All patients improved by at least one grade on the modified Frankel grading system. Conclusions Combining vertebroplasty, using allograft bone chips, and posterior instrumented fusion appears to be an effective option for osteoporotic vertebral fractures with neurological deficits.

Percutaneous vertebroplasty with hydroxyapatite under local anesthesia for the treatment of osteoporotic vertebral fractures

Percutaneous vertebroplasty with hydroxyapatite under local anesthesia for the treatment of osteoporotic vertebral fractures

Two cases report of surgical treatment for osteoporotic vertebral fracture with spinal canal stenosis in elderly patients with multiple comorbidities

Two cases report of surgical treatment for osteoporotic vertebral fracture with spinal canal stenosis in elderly patients with multiple comorbidities

Effect of transcutaneous unilateral vertebroplasty in the treatment of osteoporotic vertebral compression fractures

Objective To analyze the efficacy of transcutaneous unilateral vertebroplasty in the treatment of osteoporotic vertebral compression fractures. Methods 90 cases (113 vertebrae) with osteoporotic vertebral compression fractures were treated, and the patients were treated with minimally invasive percutaneous unilateral vertebroplasty.The follow-up time was 6 months, and the changes of VAS pain score, Cobb angle and adverse reactions were analyzed. Results The VAS scores of postoperative 7d and 30d were (2.02±0.11)points and (1.11±0.36)points, respectively, which were significantly lower than before treatment [(5.38±1.72)points, t=18.494 and 23.051, all P 0.05). There were 15 cases (16.67%) of postoperative leakage of bone cement, 5 cases died after operation, including 2 cases of pulmonary embolism, 1 case of cardiogenic diseases, 2 cases of cerebrovascular related diseases.6 months after surgery, review X-ray was lateral radiographs, the results showed that adjacent vertebral compression fractures in 1 case, accounting for 1.11%. Conclusion The patients with osteoporotic compression fractures treated by unilateral vertebroplasty minimally invasive surgery can effectively relieve pain and cause some vertebral bodies to return to normal height and reduce the risk of vertebral instability. Key words: Osteoporosis; Fractures, compression; Vertebroplasty

Kyphoplasty for osteoporotic vertebral fractures with posterior wall injury

Background ContextCement augmentation techniques are standard treatments for osteoporotic vertebral fractures. Compared with vertebroplasty, kyphoplasty is associated with lower rates of cement leak and better deformity correction; however, posterior wall fractures are relative, but not absolute; contraindications for both techniques and hence treatment practices vary among spine centers. PurposeThe primary aim of this study was to assess our center's incidence of posterior cement leakage in osteoporotic vertebral fractures with posterior wall injury treated by balloon kyphoplasty (BKP). Secondarily, physiological results, pain relief, complication rates, and non-posterior cement leakage were also evaluated. Study DesignThis is a prospective cohort study done in a high-volume spine center in Germany. Patient SampleEighty-two patients with 98 osteoporotic vertebral fractures with posterior wall cortical injury were studied from 2012 to 2016. Outcome MeasuresThe following were the outcome measures: (1) physiological measures: standing plain x-rays (anteroposterior and lateral views), with the following parameters evaluated: cement leak behind the posterior vertebral body border, Cobb angle for local sagittal deformity, vertebral wedge angle, and anterior vertebral height; (2) cement volume injected in each vertebra; and (3) self-report measures: visual analog scale (VAS). MethodsAll patients underwent BKP using a bipedicular approach. Preoperative clinical and neurologic evaluations were done. Radiological evaluations included plain X-ray images, computed tomography scans and magnetic resonance imaging. The average follow-up period was 18 months. ResultsNo cement leakage into the spinal canal occurred in any of the patients. Asymptomatic leakage into other sites was seen in 22 vertebrae (22.45%). There was significant improvement in the Cobb angle, the vertebral wedge angle, and the anterior vertebral height in all cases. The mean preoperative VAS was 8.1, and this improved to 2.3 on the third postoperative day. ConclusionBalloon kyphoplasty is a viable option for the treatment of osteoporotic vertebral fractures even with posterior wall involvement.

Effect of Kyphoplasty in the Treatment of Osteoporotic Vertebral Fractures Compared to Vertebroplasty – Overview of Systematic Reviews

Introduction Vertebroplasty and kyphoplasty are possible options for vertebral augmentation after osteoporotic fractures. Both are percutaneous techniques with specific advantages and disadvantages. Our aim is to compare the clinical and radiological results of these two procedures. Methods An overview of published systematic reviews in the literature on the effects of kyphoplasty compared with vertebroplasty was performed. Results After short and long follow-up, the kyphoplasty group had lower pain scores on the visual analogue scale (VAS), lower scores in the Oswestry Disability index (ODI), greater restoration of the vertebral body height and lower kyphosis angle in the immediate postoperative period. There was less leakage of cement to the vertebral canal and extraspinal spaces. Conclusions Compared with vertebroplasty, kyphoplasty achieved better results in pain relief, quality of life, correction of spinal deformity and lower risk of cement leakage.

Clinical research of minimally invasive spine surgery with Vesselplasty

Objective: To evaluate the efficacy and safety of Vesselplasty in the treatment of osteoporotic vertebral fractures and vertebral metastases. Methods: From June 2010 to December 2016, data of 81 patients with spinal diseases treated with Vesselplasty in Department of Spinal Surgery, Beijing Friendship hospital, Capital Medical University were retrospectively analyzed. There are 49 cases of vertebral fractures with age (70.2±8.2) years. Among them, 16 cases have posterior vertebral wall breakage, but no symptoms of nerve injury. Clinical result were evaluated with Visual Analogue Scale(VAS) , the kyphotic angle(Cobb's angle) and Oswestry disability index(ODI) was measured preoperatively, postoperatively and follow-up. At the same time, the operation time and cement leakage were recorded. There were 32 patients with vertebral metastases, with age of (69.6±11.1) years old. The posterior wall of the vertebral body was damaged in 22 cases. The VAS scores were recorded and compared preoperatively and postoperatively. The operation time was recorded also. Results: All patients were completed the operation safely and with no complications. Compared with preoperative VAS, postoperative VAS was significantly decreased in all subjects(P<0.05). The average operation time of each vertebral body was 16.2±4.6 min, and the postoperative VAS score significantly decreased (P<0.05), Cobb 's angle from preoperative (13.9±6.0) ° to( 5.2±4.0) ° (P<0.05) in 49 cases of vertebral fracture(58 vertebrae). The clinical results were still satisfied in follow-up . In 32 cases of vertebral metastases(38 vertebrae), the average operation time was (17.6±5.4) min. The postoperative VAS score was obviously decreased also(P<0.05). A small amount of bone cement leakage occurred in 4 cases of 4 vertebrae. The rate of bone cement leakage was 4.2%, but there were no clinical symptoms in these cases. Conclusion: Vesselplasty is a safe and effective treatment of osteoporotic vertebral fractures and vertebral metastases. It can lead to satisfactory clinical effect, partial recovery of vertebral height. Besides, the bone filling mesh can reduce the risk of bone cement leakage, which can provide a new choice for minimally invasive treatment of vertebral fracture and metastases.

Effect of osteoporosis induced by ovariectomy on vertebral bone defect/fracture in rat.

Osteoporotic vertebral fracture (OVF) is a worldwide health concern and lacks sufficient basic studies. Suitable animal models should be the foundation for basic study and treatment of OVF. There have been few studies on the development of animal models of osteoporotic vertebral bone defects. OVF models using various animal species should be developed to evaluate the therapeutic strategy in preclinical testing. We developed an OVF model in rats. Rat osteoporosis was induced by ovariectomy (OVX), and 3 months after OVX, a 3 mm diameter hemispheric vertebral bone defect was developed in lumbar vertebra 6 (L6). Sagittal plain X-rays of the rats, their bone quantity, bone microarchitecture, and histomorphology were analyzed: 3 months after OVX, rats showed significantly lower bone quantity, relative bone volume, and total volume bone mineral density. After the vertebral bone defect had developed for 16 weeks, no significant indication of self-healing could be observed from the sagittal plain X-rays, three-dimensional images, and histomorphology. These results indicate that the rat model of osteoporotic vertebral bone defect, induced by OVX and a 3 mm diameter hemispheric vertebral bone defect, can sufficiently mimic OVF patients in clinic and provide a sound basis for subsequent studies.

Percutaneous kyphoplasty for treatment of osteoporotic vertebral body compression fractures in the elderly

Objectives To study the clinical effects of percutaneous kyphoplasty on senile osteoporotic vertebral body compression fractures. Methods The 87 elderly patients with osteoporotic vertebral body compression fractures were randomly grouped into control group (n=42) treated with percutaneous vertebroplasty and observation group (n=45) treated with percutaneous kyphoplasty in our hospital from June 2013-March 2016.And the clinical curative effect before and after treatment was compared and analyzed. Results The visual analog scale (VAS) pain score in observation group versus control group was (8.49±2.86) vs.(8.56±2.98), (t=0.11, P>0.05) before treatment, and[(2.58±1.34) vs.(3.34±2.01), t=2.09, P< 0.05], [(2.06±0.97) vs (3.87±1.96), t=5.51, P<0.05]and[(1.09±0.89) vs (2.37±1.29)], t=5.42, P<0.05]at 1 week, 4 weeks, and 12 weeks after treatment respectively, showing statistically significant improvement after treatment.The data of kyphosis angle by using Cobb angle, Oswestry lumbar dysfunction index (ODI), mean time of postoperative ambulation, and mean postoperative hospital stay were similar to that of the visual analog scale (VAS) pain score, showing statistically significant improvement after treatment (all P<0.05). The incidence[cases (%)]of bone cement leakage was lower in observation group[3(6.7)]than in control[9(21.4)](χ2=3.98, P<0.05). Conclusions Clinical treatment effects of percutaneous kyphoplasty on the elderly patients with osteoporotic vertebral body compression fractures are superior to that of percutaneous vertebroplasty.Percutaneous kyphoplasty can effectively relieve pain, and improve body function disorders and the quality of life. Key words: Percutaneous kyphoplasty; Osteoporosis in the elderly; Compressive fractures

GDF5 significantly augments the bone formation induced by an injectable, PLGA fiber-reinforced, brushite-forming cement in a sheep defect model of lumbar osteopenia

Background contextBiodegradable calcium phosphate cement (CPC) represents a promising option for the surgical treatment of osteoporotic vertebral fractures. Because of augmented local bone catabolism, however, additional targeted delivery of bone morphogenetic proteins with the CPC may be needed to promote rapid and complete bone regeneration. PurposeIn the present study, an injectable, poly(l-lactide-co-glycolide) acid (PLGA) fiber-reinforced, brushite-forming cement (CPC) containing the bone morphogenetic protein GDF5 was tested in a sheep lumbar osteopenia model. Study Design/SettingThis is a prospective experimental animal study. MethodsDefined bone defects (diameter 5 mm) were placed in aged, osteopenic female sheep. Defects were treated with fiber-reinforced CPC alone (L4; CPC+fibers) or with CPC containing different dosages of GDF5 (L5; CPC+fibers+GDF5; 1, 5, 100, and 500 µg GDF5; n=5 or 6 each). The results were compared with those of untouched controls (L1). Three and 9 months postoperation, structural and functional effects of the CPC (±GDF5) were assessed ex vivo by measuring (1) bone mineral density (BMD); (2) bone structure, that is, bone volume/total volume (assessed by micro-computed tomography and histomorphometry), trabecular thickness, and trabecular number; (3) bone formation, that is, osteoid volume/bone volume, osteoid surface/bone surface, osteoid thickness, mineralized surface/bone surface, mineral apposition rate, and bone formation rate/bone surface; (4) bone resorption, that is, eroded surface/bone surface; and (5) compressive strength. ResultsCompared with untouched controls (L1), both CPC+fibers (L4) and CPC+fibers+GDF5 (L5) numerically or significantly improved all parameters of bone formation, bone resorption, and bone structure. These significant effects were observed both at 3 and 9 months, but for some parameters they were less pronounced at 9 months. Compared with CPC without GDF5, additional significant effects of CPC with GDF5 were demonstrated for BMD and parameters of bone formation and structure (bone volume/total volume, trabecular thickness, and trabecular number, as well as mineralized surface/bone surface). The GDF5 effects were dose-dependent (predominantly in the 5–100 µg range) at 3 and 9 months. ConclusionsGDF5 significantly enhanced the bone formation induced by a PLGA fiber-reinforced CPC in sheep lumbar osteopenia. The results indicated that a local dose as low as ≤100 µg GDF5 may be sufficient to augment middle to long-term bone formation. The novel CPC+GDF5 combination may thus qualify as an alternative to the bioinert, supraphysiologically stiff poly(methyl methacrylate) cement currently applied for vertebroplasty/kyphoplasty of osteoporotic vertebral fractures.