Treatment Of Vertebral Compression Fractures Research Articles

Tratamiento de fracturas vertebrales por compresión con implante intramedular expandible SpineJack®: primera experiencia en Ecuador

Las fracturas vertebrales por compresión han sido tratadas con cemento óseo en el interior de las mismas, con técnicas como la cifoplastía y vertebroplastía; lo que afecta al paciente, pues hay una fuga del cemento a los tejidos aledaños; como consecuencia, una afección a la altura vertebral. Lo óptimo es una adecuada reducción de la fractura, ya que la altura vertebral influye directamente en la calidad de vida de los pacientes. La investigación evalúa la aplicación del método implante intramedular expandible SpineJack® para este el tratamiento de este tipo de fracturas; la cual se efectuó por primera vez en Ecuador a una paciente de 65, en junio de 2016. El resultado dio valores similares a los reportados por otros investigadores, en otros países, por lo tanto, el incremento de este uso no solo mejorá la calidad de vida de los pacientes, sino, presentará un avance en lo anatomo-funcional de la vértebra fracturada. Con este estudio, se evidencia la necesidad del seguimiento de otras experiencias con este dispositivo en Ecuador, lo que permitiría evaluar de manera más completa su aplicación como tratamiento.

Percutaneous kyphoplasty treatment of osteoporotic vertebral compression fracture under the guidance of G-arm X-ray machine

Objective To explore the clinical application value of percutaneous kyphoplasty (PKP) under the guidance of G arm X ray machine in the treatment of osteoporotic vertebral compression fracture (OVCF). Methods The medical records of eighty-two patients (94 vertebral bodies) with OVCF treated with PKP were collected retrospectively.Thirty-nine cases (44 vertebral bodies) were guided by G-arm X-ray machine to implement PKP, which were recorded as G-arm group.Forty-three cases (50 vertebral bodies) were guided by C-arm X-ray machine to carry out PKP, which were recorded as C-arm group.The operation time, intraoperative fluoroscopy times, bone cement leakage cases, preoperative and postoperative anterior height of injured vertebrae, Cobb angle of injured vertebrae, visual analogue scale scores and Oswestry disability index of the two groups were recorded. Results There was significant difference in operation time and intraoperative fluoroscopy times between the G-arm group and C-arm group (the operation time: (31.6±5.2) vs.(45.8±6.7) min, the intraoperative fluoroscopy times: (9.5±2.3) times vs.(18.7±3.5) times, t=-10.64, -13.91, P 0.05). Compared postoperative and preoperative anterior height of injured vertebrae, Cobb angle of injured vertebrae, visual analogue scale scores and Oswestry disability index scores of G-arm group and C-arm group respectively, the differences were significant( t=-3.41 vs.-3.28, 6.67 vs.7.66, 26.63 vs.25.75 and 10.41 vs.11.90, P 0.05). Conclusion The treatment of OVCF with PKP guided by G-arm X-ray machine could significantly shorten operation time, reduce the intraoperative fluoroscopy times and the operative difficulty, and increase operation safety than PKP guided by traditional C-arm X-ray machine. Key words: Osteoporotic vertebral compression fracture; Percutaneous kyphoplasty; G-arm X-ray machine; C-arm X-ray machine

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

Radiological and Clinical Outcomes of Balloon Kyphoplasty versus Radiofrequency Kyphoplasty in the Treatment of Vertebral Compression Fractures.

Study DesignRetrospective cohort analysisPurposeComparison of balloon kyphoplasty (BKP) and radiofrequency kyphoplasty (RFK) with respect to height restoration of the fractured vertebral bodies and the pain relief experienced after the surgical procedure.Overview of LiteratureBKP and RFK both offer safe, time-saving, and potent treatment options for vertebral compression fractures, but neither of these methods demonstrated any key advantage over the other yet.MethodsWe performed a retrospective analysis of a cohort of 156 patients (mean age, 73±11 years) with 252 fractured vertebral bodies treated with kyphoplasty. Pain intensity was measured using a Visual Analogue Scale. Preoperative and postoperative computed tomography images were analyzed and gauged using modified bisegmental Cobb angle, vertebral angle, as well as anterior (Ha), middle (Hm), and posterior (Hp) vertebral body heights.ResultsThe mean postoperative pain relief was 5.1±1.8, which was maintained over the entire follow-up period. There were no significant differences in the pain relief between BKP and RFK. Postoperative changes in the vertebral angle (−1.3°±3.3°, p<0.001) and Ha, Hm, and Hp vertebral body heights (Ha, 1.5±2.9 mm; Hm, 2.1±2.9 mm; Hp, 0.9±2.1 mm; p<0.001) were significant. However, the initial height restoration could not be maintained by the 6-week and 1-year follow-up. Neither BKP nor RFK could achieve a clinically relevant advantage over each other. There was no correlation between pain relief and height restoration after kyphoplasty.ConclusionsBoth BKP and RFK had comparable beneficial clinical and radiological effects in the treatment of vertebral compression fractures. However, neither the actual extent of height restoration nor its loss seems to affect the marked pain relief.

Therapeutic effects of new-type hydraulic delivery vertebroplasty, balloon kyphoplasty and conventional pusher-type vertebroplasty on single segmental osteoporotic vertebral compression fracture.

This study aims to evaluate safety and practicality in clinical application for better guidance of single segmental osteoporotic vertebral compression fractures treatment. From May 2012 to September 2013, a total of 188 cases of patients with fractures, who received different treatment, were incorporated in the study and then divided into: group A (n=59), conventional pusher-type vertebroplasty; group B (n=54), balloon kyphoplasty; group C (n=60), new-type hydraulic delivery vertebroplasty treatment. The overall follow-up rate was 92.02%. Postoperative visual analogue scale (VAS) and Oswestry disability index (ODI) scores were significantly improved more than those of the preoperative scores in the three groups. Bone cement injection volumes in group A were significantly lower than those in group B and group C. Vertebral height recovery rates among groups were obviously different, showing statistical significance. After a year of follow-up, the vertebral height recovery outcome in group A was obviously poorer than that in group B and group C. A poorer outcome in group B was also found when compared with group C. In addition, the vertebral height restoration had a certain degree of loss, with the loss rate of 20.5, 14.0 and 7.5% in the three groups, respectively. Three operation methods have equivalent effects in the improvement of symptoms and functional recovery. Therefore, the new-type hydraulic delivery vertebroplasty provides a relatively more concise operation and shorter operation time, displaying more outstanding performance of clinical efficacy in spinal reconstruction and reduction of complications risks by evaluating the diffusion of the bone cement, vertebral height restoration rate and postoperative complications.

Is vertebral body stenting in combination with CaP cement superior to kyphoplasty?

In the evolution of the minimally invasive treatment of vertebral compression fractures, vertebral body stenting (VBS) was developed to reduce intraoperative and secondary loss of vertebral height. Particularly in combination with the usage of biodegradable cement, the influence of VBS on the rate of intraoperative complications and long-term outcome is unclear. The purpose of this study was to investigate the differences between balloon kyphoplasty (BKP) and VBS regarding their long-term clinical and radiological outcome in combination with calcium phosphate (CaP) application instead of polymethyl methacrylate (PMMA). This retrospective study included 49 patients with fresh mono-segmental thoracolumbar fractures without neurological signs treated with VBS or BKP and CaP cement (Calcibone). The outcome was evaluated with the visual analogue pain scale (VAS), the Oswestry disability score (ODI), and radiologically assessed. In the course of the radiological follow-up, the VBS group showed statistically significant less vertebral height loss than the BKP group. However, with respect to VAS and ODI scores there were no statistically significant differences between the VBS and BKP group in the clinical follow-up. The rate of cement leakage was comparable in both groups. Both techniques facilitated good clinical results in combination with absorbable cement augmentation. In particular, the VBS enabled us to benefit from the advantages of the resorbable isothermic CaP cement with an improved radiological outcome in the long term compared to BKP. However, there was a mentionable loss of reduction in the follow-up in both groups compared to previously published data with PMMA cement. These slides can be retrieved under Electronic Supplementary Material.

Kyphoplasty Technique for Thoraco-Lumbar Compression Fracture

Osteoporotic vertebral compression fracture (VCF) is a significant cause of morbidity and mortality among elderly patients. Fractures can happen because of osteoporosis, tumours, or other conditions.In the past two decades, kyphoplasty has emerged as surgical options that play a central role in the treatment of vertebral compression fractures. Before the common use of kyphoplasty, the principal surgical option for treatment of compression fractures was decompression and fusion. However, surgical fixation frequently failed in elderly patients because of osteopenia. Kyphoplasty has expanded to include treatment of osteoporotic compression fractures, traumatic compression fractures, and metastatic compression fractures. Osteoporotic compression fractures are now the most common indication for this procedure.Kyphoplasty utilizes an inflatable balloon to create a cavity for the cement with the additional potential goals of restoring height and reducing kyphosis. Kyphoplasty is an effective treatment options for the reduction of pain associated with vertebral body compression fractures. Biomechanical studies demonstrate that kyphoplasty is initially superior for increasing vertebral body height and reducing kyphosis, but these gains are lost with repetitive loading. Complications secondary to extravasation of cement include compression of neural elements and venous embolism. These complications are rare but more common with vertebroplasty. Kyphoplasty is a safe and effective procedure for the treatment of vertebral body compression fractures.

Kyphoplasty with purified silicone VK100 (Elastoplasty) to treat spinal lytic lesions in cancer patients: A retrospective evaluation of 41 cases

ObjectivesBalloon Kyphoplasty (BKP) for vertebral compression fractures (VCFs) in cancer patients is more challenging than for osteoporotic ones. Cord compressions are frequent and the incidence of complications ten-fold greater. Polymethylmetacrylate (PMMA) is the gold standard material for BKP but has disadvantages: exothermic reaction, short working time, rapid solidification, absence of osteoconduction. VK100 is a mixture of Dimethyl Methylvinyl siloxane and Barium Sulphate. It is elastic, adhesive to bone, leaves 30 min before solidification without exothermic reaction, and shows a stiffness close to the intact vertebrae. The surgical procedure, called elastoplasty, is similar to a BKP. Clinical results obtained with this new silicone in pathological VCFs have been investigated. Patients and Methods41 cancer patients with symptomatic VCFs (70 vertebral bodies), underwent percutaneous and open elastoplasties. Post-operative leakages, pulmonary embolism (PE) and adjacent fractures were carefully evaluated with neuroimaging. KPS, VAS and Dennis Pain Score were calculated pre- post-operatively and at the last follow-up. ResultsThe mean volume of silicone inserted in each vertebra was 3.8 cc. Complications included seven leakages (17%), two asymptomatic PE (4.3%) and 3 post-operative adjacent fractures (7.3%). Median follow-up was 29 months. A significant improvement was observed in KPS, VAS and Dennis Pain Score (p < .0001). The 1-yr survival rate was 76.9%. ConclusionsElastoplasty appears a safe and effective palliative treatment of VCFs in oncologic patients. Useful qualities of VK100 are the lack of exothermic reaction and the wider working window. The influence of biomechanical properties of silicone on reduction of adjacent level fractures requires further investigations.

What is the role of vertebral augmentation for osteoporotic fractures? A review of the recent literature.

Vertebral augmentation procedures such as vertebroplasty and kyphoplasty are utilized in the treatment of vertebral compression fractures (VCFs). However, their capacity for providing analgesia, reducing disability, and improving quality of life in patients with osteoporotic VCFs remains a topic of debate. The objective of this narrative review is to summarize the latest evidence for the safety and efficacy of vertebral augmentation for osteoporotic vertebral compression fractures (VCFs). A systematic literature search was conducted using the PubMed and Cochrane electronic databases for systematic reviews, review articles, meta-analyses, and randomized clinical trials prior to May 2017. The keywords were "vertebroplasty," "kyphoplasty," and "vertebral augmentation." Thirty-three papers (7 systematic reviews, 6 cohort studies, 15 randomized clinical trials, and 5 international guidelines) were included in this narrative review. Vertebral augmentation is a safe procedure, with low rates of serious complications and no increase in subsequent post-treatment fracture risk.

Minimally Invasive Translaminar Endoscopic Approach to Percutaneous Vertebroplasty Cement Leakage: Technical Note

Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty are 2 common procedures that could be applied simply in treatment of vertebral compression fractures. Despite simplicity and safe application of these procedures, there are some drawbacks as well. Cement leakage into the spinal canal is the most common complication of PVP and PKV procedures. The aim of this article is to present a minimally invasive alternative technique for removing cement leakage fragment after thePVP. A 44-year-old female patient began to complain of L4 radiculopathy after L4 PVP. The lumbar computed tomography demonstrated cement fragment closed to upper medial aspect of the left L4 pedicle. A minimally invasive translaminar endoscopic procedure was performed to remove the cement fragment. Following the endoscopic procedure, the patient's complaints resolved completely and she was discharged on postoperative day 1. The minimally invasive intervention provided shorter operation time, minimal blood loss, and reduced complication rate due to its simplicity. In particular, there was no need to undergo general anesthesia. Endoscopic translaminar approach could be safely performed in patients with symptomatic cement leakage after PVP or a percutaneous kyphoplasty procedure.

KYPHOPLASTY AND VERTEBROPLASTY IN THE TREATMENT OF OSTEOPOROTIC VERTEBRAL FRACTURES

ABSTRACT Objective: To compare these procedures in the treatment of osteoporotic vertebral compression fractures. Methods: Patients who underwent vertebral augmentation procedures between March 2010 and October 2016 were selected for the study. Kyphosis, anterior vertebral height, Oswestry Disability Index (ODI), Visual Analog Scale (VAS), number of portals, cement volume, and complications were recorded. The results were analyzed by difference of the means. Results: Sixty-eight patients were selected, accounting for 105 procedures. A statistically significant improvement was observed in VAS and ODI with both procedures (p&lt;0.001) without statistically significant difference between them, regardless of the number of portals or cement applied. There was a high correlation between kyphosis correction and ODI improvement (p =0.012). Conclusions: Both vertebroplasty and kyphoplasty are effective procedures for the treatment of vertebral compression fractures. We found no significant difference between both procedures. The high correlation between improvement of kyphosis and ODI suggests that these procedures are better than conservative treatment to improve the quality of life of patients, however more studies are required to reach a final conclusion. Level of Evidence III; Retrospective comparative study.

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

Observation of clinical effects of percutaneous vertebroplasty in the treatment of vertebral compression fractures complicated with intravertebral clefts

To explore the clinical effects of percutaneous vertebroplasty(PVP)in the treatment of osteoporotic vertebral compression fractures complicated with intravertebral clefts. The clinical data of 176 patients with osteoporotic vertebral compression fractures underwent treatment from January 2013 to May 2016 were retrospectively analyzed. All the patients were treated by unilateral PVP procedure, 37 patients with intravertebral clefts. Seven cases were excluded according to the standard and 30 patients were internalized in the study. There were 14 males and 16 females, aged from 60 to 93 years old with an average of (77.73±9.33) years. The mean bone mineral density was (-3.16±0.48) SD (ranged from -2.3 to -4.1 SD). The Oswestry Disability Index(ODI), visual analogue scale (VAS) were analyzed before operation and 1 day, 3 months, 1 year after operation. The compression ratio of injured vertebrae was measured by X-ray before operation and 3 days, 3 months after operation. All the operations were successful and all the patients were followed up more than 1 year. Postoperative at 1 d, 3 months, 1 year, VAS scores were obviously released (2.93±0.83, 2.07±0.58, 1.57±0.68, respectively) than preoperative 7.00±1.41(P<0.01);and ODI scores were obviously improved (36.2±4.1, 22.9±6.7, 18.8±5.9, respectively) than preoperative 40.5±3.9(P<0.01). Postoperative at 3 days, 3 months, vertebral height percent of injured vertebrae were (79.26±8.57)% , (77.68±8.96)% , respectively, which had obviously improvement compared to preoperative (72.00±12.14)% (P<0.05). PVP is an effective and reliable method in the treatment of osteoporotic vertebral compression fractures complicated with intravertebral clefts. It can effectively restore the height of the vertebral body, obviously improve the patient's pain and functional status.

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

Comparison of high- and low-viscosity cement in the treatment of vertebral compression fractures

Background:High-viscosity cement (HVC) has been gradually applied in percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). Although HVC has been reported to reduce cement leakage, different opinions exist. To assess the complications of HVC in cement leakage in the treatment of vertebral compression fractures and to evaluate the clinical effect of HVC compared with low-viscosity cement (LVC).Methods:EMBASE, PubMed, Science Direct, Google Scholar and Cochrane Library databases were comprehensively searched from their inception to August 2017. Two researchers independently searched for articles and reviewed all retrieved studies. Forest plots were used to illustrate the results. The Q-test and I2 statistic were employed to evaluate between-study heterogeneity. Potential publication bias was assessed by funnel plot.Results:HVC reduced the occurrence of cement leakage (risk ratio (RR) = 0.38, 95% confidence interval (CI) = 0.29 to 0.51, P < 0.00001), especially in the disc space (RR = 0.45, 95% CI = 0.45 to 0.80, P = 0.007) and the vein (RR = 0.54, 95% CI = 0.35 to 0.85, P = 0.008) but not in the intraspinal space (RR = 0.48, 95% CI = 0.19 to 1.23, P = 0.13) or the paravertebral area (RR = 0.63, 95% CI = 0.32 to 1.22, P = 0.17). No significant differences in the visual analogue scale (VAS), Oswestry Disability Index (ODI), injected cement volume or adjacent vertebral fracture were noted between HVC and LVC (P > 0.05).Conclusion:Compared with LVC, HVC results in a reduced incidence of cement leakage for the treatment of vertebral compression fractures, especially in the disc space and vein but not in the intraspinal space or the paravertebral area. In addition, HVC yields the same satisfactory clinical effect as LVC.

Incidence of unexpected positive histology in kyphoplasty.

Kyphoplasty and vertebroplasty have become one of the most frequent surgical procedures in the treatment of vertebral compression fractures. Often, the cause of compression fractures is lowered bone mineral density as in osteoporosis. In the differential workup, also pathologic vertebral compression fractures need to be ruled out. Importantly, imaging techniques alone cannot safely differentiate between invasive lymphatic and osteoporotic vertebral fracture. Our goal was to identify the degree of unexpected positive histology in kyphoplasty for presumed osteoporotic vertebral compression fracture. We retrospectively analyzed all kyphoplasties performed between 2007 and 2015 at our institution. The data were acquired by reviewing our medical documentation system. The data analysis was done using Microsoft Excel. The statistical analysis was done using the Chi-squared test. We performed 130 kyphoplasties/vertebroplasties. A biopsy was taken in 97 (74.6%) cases. In 10 (10.3%) cases, the histology revealed a pathological fracture. From these patients, only in 3 (30%) cases, a positive histology was not expected. Meaning that there was no history of cancer and the radiological findings presumed an osteoporotic fracture. Therefore, we could demonstrate that the incidence of unexpected positive histology in vertebral compression fracture treated with kyphoplasty is significant (3.1%). As a conclusion, if a kyphoplasty is performed due to assumed osteoporotic vertebral compression fracture, a biopsy should be taken to safely rule out a pathological fracture caused by lymphatic bony invasion.

Curative effect of percutaneous kyphoplasty for treatment of vertebral compression fractures in perimenopausal women

Objective To investigate the clinical outcomes of percutaneous kyphoplasty (PKP) for treatment of vertebral compression fractures in perimenpausal women. Methods A total of 53 perimenopausal patients (70 vertebrae) undergone PKP for vertebral compression fractures from January 2007 to May 2014 were analyzed retrospectively by case-control study. Thirty-six patients had single vertebral fractures and 17 two-level vertebral fractures. The fracture segments included 5 T11 vertebrae, 14 T12 vertebrae, 30 L1 vertebrae, 12 L2 vertebrae and 9 L3 vertebrae. Ratio of vertebral compression was 10%-30%. According to treatment difference, the patients were divided into PKP group and non-operation group. In PKP group, there were 30 patients with age range of 44-54 years (mean, 51.0 years), and the fracture segments included 13 T11vertebrae, 11 T12vertebrae, 17 L1vertebrae, 7 L2 vertebrae, 3 L3 vertebrae. In non-operation group, there were 23 patients with age range of 44-54 years (mean, 50.5 years), and the fracture segments included 2 T11vertebrae, 3 T12 vertebrae, 13 L1 vertebrae, 5 L2 vertebrae, 6 L3 vertebrae. Visual analogue scale (VAS), Oswesty disability index (ODI), vertebral compression rate, Cobb angle and bone mineral density change were compared preoperatively, 2 weeks, 6 months and 3 years after operation. Results All patients were followed up for 6-36 months. VAS and ODI were improved compared with preoperative status in two groups at 2 weeks, 6 months and 3 years (P 0.05). The Cobb angle and vertebral compression rate in PKP group were reduced at 6 months compared with preoperative status (P 0.05). The Cobb angle and vertebral compression rate in PKP group did not increase at 6 months and 3 years, but they had significant increase in non-operation group (P 0.05). The body mass index reduction in PKP group was less than that in non-operation group at 3 years (P 0.05). The body mass index reduction in non-operation group was fast and had significant decrease compared with preoperative status (P<0.05). Conclusion PKP can relieve pain for vertebral compression fractures in perimenopausal women in short term and long term, and PKP can also improve spinal kyphosis and prohibit the decline of bone mineral density. Key words: Osteoporotic fractures; Kyphoplasty; Perimenopausal

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

P94 - Kyphoplasty vs Orthosis for Treatment of Thoracolumbar Vertebral Fractures in the Workers' Compensation Population

BACKGROUND CONTEXT: Kyphoplasty, a minimally invasive vertebral augmentation procedure for fracture reduction and stabilization, has been used to minimize pain from vertebral compression fractures (VCFs), while also restoring vertebral height and local spinal lordosis. Although several studies have suggested the efficacy of kyphoplasty for the treatment of painful VCFs, kyphoplasty remains a controversial treatment modality for VCFs. Interestingly, no studies have analyzed kyphoplasty in the clinically distinct workers' compensation (WC) population.

Recent advances in Vertebral Augmentation for the treatment of Vertebral body compression fractures

Osteoporotic and pathologic vertebral compression fractures (VCFs) result in significant pain, reduced quality of life, and patient morbidity. Vertebral augmentation procedures (VAPs), which include vertebroplasty and kyphoplasty, have been extensively studied. Here, we review the evidence for the effectiveness of these techniques with an emphasis on recent clinical trials. There has been controversy regarding the effectiveness of VAPs in the treatment of painful VCFs. Recent high-quality clinical trials have demonstrated that with proper patient selection, which includes identification of (1) pain referable to a fracture, (2) acute or subacute fracture (less than 6 weeks), and (3) evidence of bone edema or intravertebral clefts on magnetic resonance imaging or high radiotracer uptake on bone scintigraphy, patients are highly likely to achieve significant improvements in long-term pain control and reduced pain-related disability with low procedural risk. Both vertebroplasty and kyphoplasty are effective VAPs, and no high-quality, recent study has found a substantial difference in the relative effectiveness of these techniques. VAPs are safe and effective in the management of acute, painful osteoporotic, and pathologic VCFs given appropriate clinical and imaging-based patient selection. Developing evidence suggests a role for VAPs in the management of painful chronic osteoporotic fractures, and as part of a multimodal approach toward both pain and local tumor control in patients with pathologic VCFs.