Treatment Of Severe Compression Fractures Research Articles

Unilateral approach painless vertebroplasty for osteoporotic vertebral compression fractures of critically ill patients under lateral decubitus position

Objective To investigate the clinical efficacy of unilateral approach painless vertebral augmentation in the treatment of severe osteoporotic vertebral compression fractures (OVCFs) in the critically ill patients under lateral decubitus postition. Methods A retrospective case series study was conducted to analyze 97 patients with severe vertebral fractures admitted to the Henan Provincial People's Hospital from April 2004 to January 2017. There were 27 males and 70 females, aged 59-99 years [(78.5±13.2)years]. There were 11 patients with three-segment fracture, nine patients with two-segment fracture and 77 patients with single fracture. All patients were treated with lateral decubitus unilateral approach for painless vertebral augmentation and received postoperative rehabilitation training guided by physicians. Preoperative and intraoperative blood loss were recorded. Preoperative and postoperative respiratory rate, heart rate, systolic pressure, oxygen saturation and acute physiology and chronic health evaluation score II (APACHE II) , height of vertebral compression site, and injured vertebrae Cobb angle were evaluated. The visual analogue scale (VAS) and Oswestry dysfunction index (ODI) were assessed to define function improvement. Meanwhile, the occurrence of re-fracture and complications were recorded. Results All patients were followed up for 3-8 months [(6.3±2.9)months]. The operation time was (69.2±25.9)minutes, and the amount of intraoperative bleeding was (7.5±2.6)ml. There were no significant differences in respiratory rate, heart rate, systolic blood pressure or oxygen saturation before operation and after operation (P>0.05). No surgical discontinuation or deterioration occurred. The APACHE II score was (15.2±3.7)points before operation and (8.4±0.7)points at 24 hours after operation (P 0.05). The Cobb angle was (25.6±9.3)° before operation, (20.7±2.5)° at one week after operation and (18.5±3.1)° at the last follow-up (P>0.05). The VAS score was (8.5±1.2)points before operation, (2.1±0.3)points at one week after operation, and (3.2±1.1)points at the last follow-up, respectively. The VAS scores at 1 week and the last follow-up were significantly improved compared with preoperative VAS (P 0.05). The ODI value was 39.9±3.4 before operation, 20.2±5.2 at one week after operation, and 17.2±2.0 at the last follow-up . The ODI values 1 week after operation and at the last follow-up were significantly improved compared with preoperative ODI (P<0.05), showing improvement trend during the follow-up (P<0.05). No re-fracture occurred during the follow-up. No serious complications such as nerve injury, pulmonary embolism or death occurred during the operation and postoperative follow-up. Conclusions The unilateral approach painless vertebral augmentation for the treatment of severe OVCFs in critically ill patients under lateral decubitus position can improve the patient's operative tolerance and satisfaction, shorten the operation time, relieve postoperative pain and promote functional recovery. It is an alternative surgical procedure for the treatment of severe OVCFs in internal medicine. Key words: Spinal fractures; Osteoporotic fractures; Vertebral augmentation

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

Effect of percutaneous vertebroplasty with high-viscosity bone cement in treatment of severe osteoporotic vertebral compression fractures

Objective To evaluate the clinical effects of percutaneous vertebroplasty (PVP) with high-viscosity bone cement in treatment of severe osteoporotic vertebral compression fracture (OVCF). Methods This study involved 176 patients with severe OVCF treated by PVP with high-viscosity bone cement between January 2013 and January 2015. There were 61 male and 115 female patients, aged 58-78 years (mean, 67.7 years). Ninety-four patients were injured in a fall, 31 patients in a bumping condition, and 61 patients with no obvious causes. A total of 204 vertebrae were involved, including 23 T10, 22 T11, 49 T12, 43 L1 and 29 L2. Thirty patients suffered vertebral posterior wall damage. All the vertebral bodies were compressed more than 2/3. Vertebral height, kyphotic Cobb angle, visual analogue scale (VAS) and Oswestry disability index (ODI) were recorded. Bone cement filling and leakage were detected. Results Bone cement leakage was detected in 64 patients, with a leakage rate of 36.3%.Seven patients were found with cement leakage in paravertebral veins, 38 patients in intervertebral spaces, and 19 patients in prevertebral soft tissues. Five patients with back pain got partial remission. Four patients experienced burning sensation in the lower extremity 5 minutes after bone cement filling and were relieved 10 minutes later. No severe adverse events were observed, including spinal cord compression, epidural hematoma, pulmonary infection, pulmonary embolism, bedsores, and cerebrovascular accident. After operation, improvements were observed in ODI [(31.73±7.98)% vs. (75.40±8.17)%] and VAS [(2.33±0.91)points vs. (7.23 ±0.88) points] (P<0.05). Conclusion PVP with high-viscosity bone cement can significantly relieve pain and improve motor function and hence is effective in the treatment of patients with severe OVCF. Key words: Osteoporotic fractures; Vertebroplasty; Complications

Abstract No. 386: Percutaneous vertebroplasty performed with an 18 G needle for the treatment of severe compression fracture of cervical vertebral body due to malignancy

No. 386 Percutaneous vertebroplasty performed with an 18 G needle for the treatment of severe compression fracture of cervical vertebral body due to malignancy L. Chen, R. Ni; Interventional Radiology, The First Affiliated Hospital of Suzhou University, SuZhou, China Purpose: Percutaneous vertebroplasty (PVP) provides pain relief and strengthening of the bone of vertebrae weakened by disease. It is increasingly accepted as one of the treatment options in the management of intractable pain due to vertebral compression. Severe vertebral compression, refers to vertebral body collapse to less than one-third of its original height and is considered to be a situation in which PVP is technically difficult to perform, especially for the treatment of cervical vertebral body. The purpose of this study was to investigate the clinical feasibility and efficacy of PVP performed with an 18G needle for the treatment of severe compression fractures of cervical vertebral body due to malignancy. Materials and Methods: PVP was performed in 4 patients with severe compression fractures of cervical vertebral body due to malignanc. A total of 5 diseased vertebral bodies were detected, which distributed in the C5 (n 1), C6 (n 3), C7 (n 1) vertebral bodies. Under fluoroscopic guidance an 18G needle was punctured into the target vertebral body and then polymethylmethacrylate bone cement was in. A follow-up lasting for one month was conducted. Results: The technical success of both needle puncturing and bone cement injection was achieved in all patients. The mean amount of bone cement injected in each diseased vertebra was 2.2 ml (1.5 3.2)m1. Marked pain relief was quickly obtained in all 4 patients. No major complications occurred in this series, except for asymptomatic bone cement leaking around vertebra which appeared in one vertebral bodies. Conclusion: PVP with 18G needle is a safe, effective technique in treating the malignant severe cervical vertebral body compression fractures. Educational Exhibit Abstract No. 387 Simulation training in percutaneous image-guided interventions J. Ghassemi, B. Jeun, B.B. Pua; Radiology, Weill Cornell Medical Center, New York, NY Learning Objectives: Users will gain familiarity with key technical aspects and necessary steps required for percutaneous imageguided interventions, namely the placement of an abscess drainage catheter. Background: Current limitations in resident work hours, though essential for physician health and decision-making, has unfortunately resulted in decreased hands on procedural and operative experience. This paradigm shift has resulted in the need for accurate simulation modules to allow the training physician to both learn the steps of procedures as well as develop comfort in its technical aspects. We have developed a software application that simulates the sequential steps required for percutaneous image-guided interventions. The program was written in the Adobe Flash environment to construct an interactive graphical display interface (GUI) to enhance the user experience. Clinical Findings/Procedure Details: Our training module simulates the deployment of a CT-guided drainage catheter. Briefly, a video of an actual abscess drainage case was recorded after obtaining patient consent. The video was subsequently edited and imported into our software program, which also utilizes a list of images that a user can select from the computer screen. Each image, which represents a key step in the procedure, is temporally synchronized to its appropriate position in the video. For instance, an image of a biopsy grid may be associated with video playback demonstrating the technique of localizing proper site of percutaneous access. The list of images is randomized, and the simulation will only proceed forward if the end user selects the correct chronologic sequence of steps. Lastly, a narrative is provided throughout the video to provide more details on each step. Conclusion and/or Teaching Points: Simulation technologies play an integral role in medical training and practice. We have developed a training module that simulates the sequential steps required in the placement of a CT-guided percutaneous drainage catheter. Educational Exhibit Abstract No. 388 Complications of percutaneous radiological gastrostomy/gastrojejunostomy tube insertions: S154 Poster Sessions JVIR Po st er Se ss io ns