Treatment Of Vertebral Compression Fractures Research Articles

Pain, Quality of Life, and Safety Outcomes of Kyphoplasty for Vertebral Compression Fractures: Report of a Task Force of the American Society for Bone and Mineral Research.

The relative efficacy and harms of balloon kyphoplasty (BK) for treating vertebral compression fractures (VCF) are uncertain. We searched multiple electronic databases to March 2016 for randomized and quasi-randomized controlled trials comparing BK with control treatment (nonsurgical management [NSM], percutaneous vertebroplasty [PV], KIVA VCF treatment system [Benvenue Medical, Inc., Santa Clara, CA, USA], vertebral body stenting, or other) in adults with VCF. Outcomes included back pain, back disability, quality of life, new VCF, and adverse events (AEs). One reviewer extracted data, a second checked accuracy, and two rated risk of bias (ROB). Mean differences and 95% confidence intervals (CIs) were calculated using inverse-variance models. Risk ratios of new VCF and AE were calculated using Mantel-Haenszel models. Ten unique trials enrolled 1837 participants (age range, 61 to 76 years; 74% female), all rated as having high or uncertain ROB. Versus NSM, BK was associated with greater reductions in pain, back-related disability, and better quality of life (k = 1 trial) that appeared to lessen over time, but were less than minimally clinically important differences. Risk of new VCF at 3 and 12 months was not significantly different (k = 2 trials). Risk of any AE was increased at 1 month (RR = 1.73; 95% CI, 1.36 to 2.21). There were no significant differences between BK and PV in back pain, back disability, quality of life, risk of new VCF, or any AE (k = 1 to 3 trials). Limitations included lack of a BK versus sham comparison, availability of only one RCT of BK versus NSM, and lack of study blinding. Individuals with painful VCF experienced symptomatic improvement compared with baseline with all interventions. The clinical importance of the greater improvements with BK versus NSM is unclear, may be due to placebo effect, and may not counterbalance short-term AE risks. Outcomes appeared similar between BK and other surgical interventions. Well-conducted randomized trials comparing BK with sham would help resolve remaining uncertainty about the relative benefits and harms of BK. © 2017 American Society for Bone and Mineral Research.

Comparison of Radiofrequency-targeted Vertebral Augmentation With Balloon Kyphoplasty for the Treatment of Vertebral Compression Fractures

A retrospective study. The aim of this study was the evaluation of the safety and effectiveness of radiofrequency-targeted vertebral augmentation (RF-TVA) in comparison with balloon kyphoplasty (BK) for the treatment of acute painful vertebral compression fractures (VCFs) on the basis of matched pairs. Vertebroplasty and BK are the common surgical interventions for the treatment of VCF. Both are effective and safe but pose some risks such as adjacent fractures and cement leakage. In 2009, RF-TVA was introduced as an innovative augmentation procedure for the treatment of VCF. A total of 192 patients (116 female; 51-90 y) with VCF (n=303) at 1 to 3 levels were treated with RF-TVA or BK. Functionality (Oswestry Disability Index), pain (visual analogue scale), vertebral height (anterior, middle), and kyphotic angle were evaluated over a 2-year period (postoperatively, 3-4 d, 3, 6, 12, and 24 mo). In addition, operating time and occurrence of cement leakage were recorded. Pain and functionality were significantly improved after both treatments. In both groups, there was an increase in the vertebral height and a decrease in the kyphotic angle, which remained relatively consistent during 24 months. The incidence of cement leakage was 9.4% (n=9) in the RF-TVA group and 24.0% (n=25) in the BK group. The mean operating time with radiofrequency kyphoplasty was 25.9±9.9 minutes, and with balloon kyphoplasty 48.0±18.4 minutes. RF-TVA is a safe and effective procedure for the treatment of vertebral compression fractures when compared with BK. Improvement in pain and functional scores after RF-TVA are durable through 24 months postprocedure and remained better than those after BK at long-term follow-up. Operating time for RF-TVA is shorter and the risk of cement leakage is lower. Both procedures provided similar results in vertebral height restoration and reduction in the kyphotic angle.

Controversies in Spinal Trauma and Evolution of Care.

Management of spinal trauma is a complex and rapidly evolving field. To optimize patient treatment algorithms, an understanding of and appreciation for current controversies and advancing technologies in the field of spinal trauma is necessary. Therefore, members of the AOSpine Knowledge Forum Trauma initiative used a modified Delphi method to compile a list of controversial issues and emerging technologies in the field of spinal trauma, and a list of the 14 most relevant topics was generated. A total of 45440 manuscripts covering the breadth of spine and spinal trauma were initially identified. This broad search was then refined using the 14 categories felt to be most relevant to the current field of spinal trauma. The results were further pared down using inclusion criteria to select for the most relevant topics. The 8 remaining topics were classification schemes, treatment of vertebral compression fractures, treatment of burst fractures, timing of surgery in spinal trauma, hypothermia, the importance of global sagittal balance, lumbar subarachnoid drainage, and diffusion magnetic resonance imaging. These 8 topics were felt to be the most relevant, controversial, rapidly evolving, and most deserving of inclusion in this summary. In summary, despite recent advances, the field of spinal trauma has many ongoing points of controversy. We must continue to refine our ability to care for this patient population through education, research, and development. It is anticipated that the new AOSpine fracture classification system will assist with prospective research efforts.

Elastoplasty as a promising novel technique: Vertebral augmentation with an elastic silicone-based polymer

ObjectivePercutaneous vertebroplasty with polymethylmethacrylate (PMMA) restores the stiffness and the strength of fractured vertebral bodies, but changes the pattern of the stress transfer. This effect may cause a secondary fracture of the adjacent vertebrae. Elastoplasty has emerged as a new technique to overcome this complication. The aim of this study is to retrospectively evaluate the clinical results of the elastoplasty procedure. Materials and methodsThirthy nine patients (9 males, 30 females, 87 spinal levels) were clinically evaluated pre and postoperatively in terms of pain relief, leakage and silicone embolism. The mean age was 67 (range 38–84) years. The mean follow up period was 12,5 months. The patients were evaluated radiologically for the presence of adjacent level fractures postoperatively. Complications were recorded. ResultsThe mean VAS score decreased from 7,5 to 3,5 during the last follow-up. Symptomatic silicone pulmonary embolism was not encountered in any patients. Leakage was observed in 5 (13%) cases. There was an adjacent level fracture in 1 case and another fracture which was not at the adjacent level in another one. A hematoma occurred in the needle entry site in a patient with trombocytopenia (<70,000). ConclusionsElastoplasty is a safe, promising technique in the treatment of vertebral compression fractures (VCFs). Symptomatic silicone pulmonary embolism is not observed. The material's stiffness is close to intact vertebrae. Therefore, elastoplasty may be a good viable option in the treatment of VCFs as it cause less complications and can prevent adjacent level fractures. Level of evidenceLevel IV, therapeutic study.

Vertebral Compression Fractures

Fragility fractures, particularly in the hip and spine, are the most common complication of osteoporosis. In the US, approximately 1-1.5 million vertebral compression fractures (VCFs) occur annually. While patients may present with sudden onset of low back pain and limited mobility, more than two-thirds of VCFs are asymptomatic and are detected incidentally. X-rays are the standard imaging modality for diagnosis, with CT and MRI indicated if neurological deficits are present or a malignant cause is considered. Initial management is often non-surgical, with medications, physical therapy, and bracing. Surgical management in the form of cement augmentation (kyphoplasty or vertebroplasty) or instrumented fusion can be considered after failure of non-operative treatment, cases of deformity, or neurologic deficits. Subsequent VCFs occur frequently, and risk factors for refracture include advanced age, low bone mineral density, and low BMI. Treatment of primary VCFs with anti-resorptive medication is essential to reduce the risk of subsequent fractures.

P194 - One-Year Follow-Up Clinical and Radiological Results of Two Different Percutaneous Procedures for the Treatment of Vertebral Compression Fractures: A Randomized Comparative Prospective Study

P194 - One-Year Follow-Up Clinical and Radiological Results of Two Different Percutaneous Procedures for the Treatment of Vertebral Compression Fractures: A Randomized Comparative Prospective Study

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

Influencing factors of recurrence of fracture after percutaneous vertebral augmentation

Objective To evaluate the influencing factors of recurrence of fracture after percutaneous vertebral augmentation. Methods From January 2007 to December 2013, 256 cases patients with percutaneous vertebral augmentation in treatment of osteoporotic vertebral compression fractures in the Central Hospital of Chaoyang were retrospectively reviewed.After operation, the patients were divided into recurrent fracture group(59 cases) and no recurrence group(197 cases) according to whether postoperative recurrence of vertebral fracture.The age, sex, body mass index(BMI), bone mineral density, operation mode, bone cement injection volume, the existence of bone cement leakage and vertebral body height recovery rate were compared between the two groups respectively.Multi factor Logistic regression analysis was performed to analyze the correlation between the factors and the recurrence of vertebral body fractures. Results The age((75.9±4.6) years old vs. (69.9±5.0) years old), BMI((23.5±0.6) kg/m2 vs. (25.4±0.7) kg/m2), bone mineral density((-3.67±0.68) vs. (-2.75 ±0.98)), the existence of bone cement leakage rate(22.0% vs. 5.1%) and vertebral body height recovery rate((24.1±2.9)% vs. (14.9±3.0)%) between recurrent fracture group and no recurrence group had statistically significant differences(P=0.046, 0.047, 0.046, 0.026, 0.023). Multi factor Logistic regression analysis showed that age, BMI were not related to postoperative recurrence of fracture(P=0.140, 0.137), and bone density, bone cement leakage and vertebral body height recovery rate were related to recurrence of fracture(P=0.018, 0.000, 0.000). Conclusion Low bone mineral density, existence of bone cement leakage and high body height recovery rate are the risk factors of recurrence of fracture after percutaneous vertebral augmentation. Key words: Thoracic and lumbar vertebrae fracture; Percutaneous vertebral angioplasty; Percutaneous kypho-plasty; Recurrence of vertebral fracture; Bone mineral density; Bone cement leakage; Vertebral body height recovery rate

Efficacy of percutaneous kyphoplasty for osteoporosis vertebral compression fractures

Objective To conclude the technology and clinical outcomes of percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Methods From June 2011 to June 2014, 29 cases of osteoporoticthoracic and lumbar vertebral compression fractures patients, who were diagnosed by ultrasonic bone mineral density measurement. X-ray, CT and MRI were treated with percutaneous kyphoplasty in Beijing 401 Hospital of China Nuclear Industry. Observed and recorded the degree of pain, patient's activity and the recovery of vertebral height in patients with 24 hours, 3 months and 6 months after operation. The index data were analyzed by SPSS17.0 statistical software, and the measurement data were analyzed by paired t test. Results Twenty-nine patients were operated successfully, 17 cases (58.62%)of back pain disappeared and 12 cases (41.38%) of back pain significantly reduced. Twenty-seven cases (93.1%) were allowed to get off bed after 24 hours of operation and 2 cases (6.9%) after 3 days. Three cases (10.34%) occurred PMMA leakage. After 24 hours, 3 months and 6 months VAS and vertebral height of the original vertebral height percentages are much better than before surgery (P 0.05). Compared after surgery 3-month and 6-month with after surgery 24 hours, the vertebral height have lost, but the lost height of the vertebral was no statistical significance (P>0.05). No infection, hematoma, spinal nerve injury and PMMA poisoning complications occurred. Conclusions Percutaneous kyphoplasty can relieve the pain and restore part of the vertebral height satisfactory with better outcomes. Key words: Percutaneous kyphoplasty; Fractures, compression; Osteoporosis; Lumbar vertebrae

Clinical efficacy of improved percutaneous kyphoplasty in treatment of osteoporotic vertebral compression fracture

Objective To compare the curative effect of improved percutaneous kyphoplasty (IPKP) with conventional PKP in the treatment of osteoporotic vertebral compression fracture (OVCF). Methods A retrospective analysis was made on 103 senile patients with OVCF undergone IPKP (57 cases, 72 vertebras) or PKP (46 cases, 58 vertebras) between September 2009 and September 2014. Preoperative vertebral compression, vertebral height restoration, height loss, bone cement leakage and adjacent vertebral refracture were compared between the two groups. Curative effect was evaluated using the visual analogue score (VAS) and Oswestry disability index (ODI). Results Duration of follow-up was 6-38 months (mean, 16 months). Between-group differences were insignificant with respect to the rate of preoperative vertebral compression, rate of postoperative height restoration and height loss rate at the final follow-up (P>0.05). PKP versus IPKP was associated with a higher rate of cement leakage (14% vs. 8%) (P>0.05) and refracture (20% vs. 5%) (P 0.05). VAS and ODI within the group showed significant differences after operation and at the final follow-up compared to these before operation (P 0.05). Conclusions Both procedures can restore vertebral height, alleviate pain and improve mobility. By contrast, IPKP provides long-term benefits in vertebral height loss and refracture rate. Key words: Vertebroplasty; Thoracic vertebrae; Lumbar vertebrae; Osteoporotic fractures

Balloon Kyphoplasty Is a Safe and Effective Option for the Treatment of Vertebral Compression Fractures in Solid-Organ Transplant Recipients

Solid-organ transplant recipients are at great risk for osteoporotic vertebral compression fractures because of both underlying pretransplant bone diseases and posttransplant immunosuppressive treatments. Balloon kyphoplasty is a minimally invasive procedure that is used to treat painful osteoporotic vertebral compression fractures. It involves injection of polymethylmethacrylate into the vertebral body to stabilize the fracture and to alleviate the pain immediately. In this study, we report the results of balloon kyphoplasty for treatment of vertebral compression fractures in solid-organ transplant recipients. We retrospectively reviewed 512 liver transplant and 2248 kidney transplant procedures that were performed in our center between 1985 and 2015. Seven transplant recipients with a total of 10 acute, symptomatic vertebral compression fractures who were unresponsive to conservative treatment for 3 weeks underwent balloon kyphoplasty. Clinical outcome was graded using the visual analog scale. Radiographic evaluation included measurement of the segmental kyphosis by the Cobb method. There were 4 female and 3 male patients in our study group. Ages of patients ranged from 56 to 63 years with an average age of 58.8 years. The affected vertebral levels varied from T12 to L4. Mean follow-up after balloon kyphoplasty was 3.4 years, and mean time interval from transplant to balloon kyphoplasty was 8.6 years. Statistically significant difference is evident 3 years after transplant surgery (P < .05). Sagittal alignment improved (> 5 degrees) in 2 of 7 patients (28%). Transplant recipients are at great risk in terms of vertebral compression fracture development, especially within 1 year after transplant. Although conservative treatment has been the first treatment choice for vertebral compression fracture, long treatment time and high costs may be needed to achieve cure. Experience with our small patient population showed that balloon kyphoplasty was effective and safe for obtaining rapid pain relief and earlier mobilization with fewer complications.

Treatment of Thoracolumbar Osteoporotic Vertebral Compression Fractures with Vertebral Body Stenting: A Prospective Study

IntroductionBalloon kyphoplasty is a procedure to stabilize osteoporotic and/or cancer related VCFs. However, there is a technique inherent problem with the amount of reduction; when filling the balloons, an acceptable reduction is achieved. However, the resulting final reduction after cementing is ~25% lower due to the partial collapse after balloons deflation. To avoid loss of reduction, a newer technique has been introduced, based on the principles of balloon kyphoplasty and vascular stenting. MethodsA prospective cohort study of clinical and radiographic results after vertebral body stenting(VBS) for treatment of vertebral compression fractures(VCFs). To evaluate effectiveness of VBS as a new technique to treat symptomatic VCFs. A total of 33 patients with 52 symptomatic VCFs were enrolled in a prospective study of VBS. Clinical outcomes were measured pre- and postoperatively using the visual analogue scale (VAS), Oswestry Disability Index (ODI) and ambulatory status (AS). All outcomes were assessed before the procedure, and at 1, 12, 24, and 36 weeks after the procedure. ResultsThe median VAS scores went from 10.0 preoperatively to 1.0 at last follow-up. The pre-operative ODI score was 80 preoperatively, improved to 18 at last follow up. The ability to move independently and ease of ambulation significantly improved after the procedure (P ˂ 0.001). The median kyphosis angle was 15.0 degrees preoperatively and decreased by a median of 4.5 degrees postoperatively. ConclusionsPatients with symptomatic VCFs had significant improvements in back pain, function, and quality of life following VBS. The results of percutaneous vertebral body stenting in osteoporotic fractures may encourage surgeons in future to widen the indications and use these techniques to successfully restore anterior column in traumatic non-osteoporotic fractures in conjunction with posterior instrumentation.

Safety and Efficacy Studies of Vertebroplasty, Kyphoplasty, and Mesh-Container-Plasty for the Treatment of Vertebral Compression Fractures: Preliminary Report.

To evaluate the clinical safety and efficacies of percutaneous vertebroplasty (PVP), percutaneous kyphoplasty (PKP), and percutaneous mesh-container-plasty (PMCP) for the treatment of vertebral compression fractures (VCFs), a retrospective study of 90 patients with VCFs who had been treated by PVP (n = 30), PKP (n = 30), and PMCP (n = 30) was conducted. The clinical efficacies of these three treatments were evaluated by comparing their PMMA cement leakages, cement patterns, height restoration percentages, wedge angles, visual analogue scales (VAS), and oswestry disability index (ODI) at the pre- and post-operative time points. 6.67%, 3.33%, and 0% of patients had PMMA leakage in PVP, PKP, and PMCP groups, respectively. Three (solid, trabecular, and mixed patterns), two (solid and mixed patterns), and one (mixed patterns) types of cement patterns were observed in PVP, PKP, and PMCP groups, respectively. PKP and PMCP treatments had better height restoration ability than PVP treatment. PVP, PKP, and PMCP treatments had significant and similar ability in pain relief and functional recovery ability for the treatment of VCFs. These results indicate minimally invasive techniques were effective methods for the treatment of VCFs. Moreover, these initial outcomes suggest PMCP treatment may be better than both PVP treatment and PKP treatment.

Cognizance on the re-fracture of the operated vertebra with cemented augmentation in osteoporotic vertebral compression fractures

One option with minimally invasive surgery for treatment of painful osteoporotic vertebral compression fracture is percutaneous vertebroplasty or percutaneous kyphoplasty via an inflatable balloon tamp followed by stabilization with polymethylmethacrylate cement. The vertebral height is restored and the decreased loading ability of the fractured vertebral body is restrengthened with pain relief. The effect of the method is widely demonstrated in those conditions. At the same time, the relative problems, such as the complications are being lucubrated and discussed. The reports on the re-fracture or height loss of the operated vertebrae with cemented augmentation are becoming more. By now, there are some unclear aspects on the problem: the definition of the re-fracture of the augmented vertebra is still unclear and not ascertained and the clinical manifestations are various. The mechanisms and correlative factors are still not clear-cut either. The rate of subsequent re-fractures after cemented augmentation from literature is fargoing, with a rate of 0% to 63%. The correlative factors on the re-fracture of the operated vertebrae chiefly include: osteoporosis, bone necrosis caused by the heat injury from cement solidification, failure to achieve endplate-to-endplate cement augmentation, intravertebral cleft or avascular bone necrosis, premature mobilization or excessive movement, overfull reduction of the vertebral height, the biological character of the spine column, and so on. Great controversy still exists on the correlation between those possible factors and the re-fractures. More attention should be paid to this problem to explore the true risk factors and mechanism, decrease the re-fracutre rate, and elevate the clinical outcome in osteoporotic compression fractures.

Pain and Functional Outcomes Following Vertebroplasty for Vertebral Compression Fractures

Introduction: There is a dearth of comparative outcome data on vertebroplasty for the treatment of vertebral compression fractures (VCF) according to vertebral level, number of levels, and etiology. The aim of this study was to investigate improvement of pain and function following vertebroplasty for a heterogenous cohort of patients with medically refractory VCF. Materials and Methods: A prospective observational study was conducted on a cohort of consecutive patients undergoing vertebroplasty following at least 4 weeks of failed medical management, between April 2007 and March 2012 at a single Neurosurgical center. Pain Visual Analogue Scale (VAS) scores, Oswestry Disability Index (ODI) scores, analgesic usage, and complications were recorded preoperatively and at 1 day, 1 week, 1 month, 6 months, and 1 year postoperatively. Intraoperative vertebral body biopsy was performed routinely. Results: 202 levels were augmented in 147 patients. The most common levels augmented were T12 (17%), L1 (18%), and L4 (10%). Significant reductions in pain VAS and ODI scores were evident at day 1 and sustained at up to 1 year postoperatively (P<0.001). They were not dependent on the level of fracture (T3-10, T11-L2, L3-S1) (P>0.05), number of levels treated (single level, 2 levels, >2 levels) (P>0.05), or etiology of VCF (P>0.05). At 1 year postoperatively, 79% (113/142) had no or reduced analgesic usage. The complication rate was 6% (9/147). There were 5 mortalities, none of which were directly related to surgery. Conclusions: Vertebroplasty for medically refractory VCF may offer sustained improvement in pain and function. The procedure is associated with low morbidity and mortality.

A novel injecable composite cement for vertebroplasty

Event Abstract Back to Event A novel injecable composite cement for vertebroplasty Mehran Dadkhah1, Lucia Pontiroli1, 2, Sonia Fiorilli1, Ion Tcacencu3 and Chiara Vitale-Brovarone1 1 Politecnico di Torino, Department of Applied Science and Technology, Italy 2 University of Leeds, Oral Biology, School of Dentistry, United Kingdom 3 Karolinska Institutet, Department of Dental Medicine, Sweden Introduction: In the past two decades, vertebroplasty has been considered as a safe, efficient and common surgical procedure that plays a main role in the treatment of vertebral compression fractures. This technique has been applied in pain reduction and for preventing further loss of vertebral body height in osteoporosis[1]. Calcium sulphate cements (CSC) are nontoxic, osteoconductive, bioresorbable and have been applied in clinical practice for over 100 years. However, their degradation rate is faster than the formation of new bone, which has limited their application[2],[3]. This study aimed to overcome the drawbacks of calcium sulphate by developing an injectable material containing three phases. Materials and Methods: The injectable cement formulation included: calcium sulphate hemihydrate (CSH-type III), a radiopaque glass ceramic and mesoporous bioactive glass particles. The glass-ceramic particles (mol. composition: SiO2 =57%, CaO=30%, Na2O=6% and ZrO2=7%) were prepared by melting, casting and ceramisation treatment. Mesoporous glass particles were synthesized by spray-drying technique using a water-based synthesis. In order to obtain a cement, the three phases were combined with an optimized liquid to powder ratio, which ensured that the paste remained injectable and completely set in proper time. The new cement was studied in vitro both in simulated body fluid (SBF) and by culturing rat bone marrow stromal cells (BMSC). The behaviour of the calcium sulphate-based composite cement (setting time, injectability, compressive strength) was evaluated with respect to type III calcium sulphate and Cerament® (as a commercial reference). Results: It was found that the new composite cement possessed slightly higher initial (48 min) and final (56 min) setting times, respectively (table 1). Moreover, the injectable cement showed a better compressive strength in both wet (13.8MPa) and dry (18.6MPa) conditions with respect to the commercial reference (table 1). The new cement samples were biodegradable and significantly improved bioactivity during the first week in vitro and this may enhance new bone formation in vivo (figure 1). The in vitro cell culture results proved that the new cement are cytocompatible, and might enhance osteogenic differentiations of the BMSC by increasing alkaline phosphatase activity. The new formulation of the injectable cement for vertebroplasty showed good setting times and compressive strength, and in vitro osteogenic properties which are comparable or better than Cerament®. This composite cement might has significant clinical advantages compared to the traditional CSH. Fig. 1. FESEM micrograph of the composite cement after 24 hr of SBF soaking showing with hydroxyapatite crystals. The research leading to these results has received funding from the European Union Seventh Framework Programme (FP7/2007-2013) under grant agreement n°[280575]-Restoration

Gradual Height Decrease of Augmented Vertebrae after Vertebroplasty at the Thoracolumbar Junction

ObjectiveVertebroplasty is an effective treatment for vertebral compression fracture, but may progress gradual vertebral height decrease in spite of vertebroplasty. Gradual vertebral height decrease also may induce aggravation of kyphotic change without severe pain. The purpose of this study was to evaluate risk factors for gradual vertebral height decrease in the absence of recurrent severe back pain.MethodsA retrospective analysis was performed on 44 patients who were diagnosed with a first osteoporotic compression fracture at a single level at the thoracolumbar junction. All patients were taken vertebroplasty. Possible risk factors for gradual vertebral height decrease, such as sex, age, bone mineral density, body mass index, level of compression fracture, volume of injected cement, cement leakage into disc space, and air clefts within fractured vertebrae, were analyzed.ResultsGradual vertebral height decrease of augmented vertebrae occurred commonly when more than 4 cc of injected cement was used, and when air clefts within fractured vertebrae were seen on admission. In addition, the sagittal Cobb angle more commonly increased during the follow-up period in such cases.ConclusionInjection of more than 4 cc of cement during vertebroplasty and air cleft within fractured vertebrae on admission induced gradual vertebral height decrease in augmented vertebrae. Thus, longer follow-up will be needed in such cases, even when patients do not complain of recurrent severe back pain.

A painful, never ending story: older women's experiences of living with an osteoporotic vertebral compression fracture.

SummaryVertebral compression fractures (VCF) cause pain and decreased physical ability, with no known well-established treatment. The aim of this study was to illuminate the experience of living with a VCF. The results show that fear and concerns are a major part of daily life. The women’s initial contact with health-care providers should focus on making them feel acknowledged by offering person-centered and tailored support.IntroductionIn the past decade, osteoporotic-related fractures have become an increasingly common and costly public health problem worldwide. Vertebral compression fracture (VCF) is the second most common osteoporotic fracture, and patients with VCF describe an abrupt descent into disability, with a subsequent desire to regain independence in everyday life; however, little is known of their situation. The aim of this study was to illuminate the lived experience of women with an osteoporotic VCF.MethodsTen women were interviewed during 2012–2013, starting with an open-ended question: could you tell me what it is like to live with a vertebral compression fracture? The verbatim transcribed interviews were analyzed using a phenomenological hermeneutical approach.ResultsThe narrative provided descriptions of living in turmoil and chaos, unable to find stability in their life with little improvement regarding pain and physical function. Shifts from periods of constant pain to periods of fear of constant pain created a loss of confidence and an increased sense of confinement. The structural analysis revealed fear and concerns as the most prominent experience building on five themes: struggling to understand a deceiving body, breakthrough pain fueling fear, fearing a trajectory into isolation, concerns of dependency, and fearing an uncertain future.ConclusionsUntil researchers find a successful prevention or medical/surgical treatment for osteoporotic VCFs, health-care providers and society abandon these women to remain in a painful and never ending story.

Treatment of vertebral compression fractures with the cranio-caudal expandable implant SpineJack®: Technical note and outcomes in 77 consecutive patients

In vertebral compression fractures, the potential of kyphoplasty for restoring vertebral height is limited by the loss of restored height that occurs when the balloon is deflated and removed. SpineJack® is also inserted percutaneously but is then left within the vertebral body after its expansion to reduce the fracture, thus avoiding loss of correction before the injection of cement. SpineJack® was used in 77 patients to treat 83 recent VCFs (55.4% at L1–L2) due to trauma (59.7%) or osteoporosis (40.3%). Three (3.9%) complications were recorded, but none was related to SpineJack®: there was one case each of symptomatic cement leakage along a secondary pedicular fracture line; infection; and incipient device migration at the beginning of the learning curve. The rate of adjacent fractures was only 2.6%. The 5-year outcomes demonstrate that SpineJack® provides both immediate and long-term benefits in terms of pain relief, functional recovery, and maintenance of vertebral height restoration. Level of evidenceIV, retrospective study.

Pain and functional outcomes following vertebroplasty for vertebral compression fractures – A tertiary centre experience

Objectives: There is a dearth of comparative outcome data on vertebroplasty for the treatment of vertebral compression fractures (VCF) according to vertebral level, the number of levels and aetiology. The aim of this study was to investigate the improvement of pain and function following vertebroplasty for a heterogeneous cohort of patients with medically refractory VCF. Methods: A prospective observational study was conducted on a cohort of consecutive patients undergoing vertebroplasty following at least 4 weeks of failed medical management, between April 2007 and March 2012 at a single neurosurgical centre. Pain visual analogue scale (VAS) scores, Oswestry Disability Index (ODI) scores, analgesic usage and complications were recorded preoperatively and at day 1, week 1, 1 month, 6 months and 1 year postoperatively. Intraoperative vertebral body biopsy was performed routinely. Results: Two hundred and two levels were augmented in 147 patients. The most common levels augmented were T12 (17%), L1 (18%) and L4 (10%). Significant reductions in pain VAS and ODI scores were evident at day 1 and sustained at up to 1 year postoperatively (p < 0.001). They were not dependent on the level of fracture (T3-10, T11-L2 and L3-S1) (p > 0.05), the number of levels treated (single level, two-level and > two level) (p > 0.05) or aetiology of VCF (p > 0.05). At 1 year postoperatively, 79% (113/142) had no or reduced analgesic usage. The complication rate was 6% (9/147). There were five mortalities, none of which was directly related to surgery. Conclusion: Vertebroplasty for medically refractory VCF may offer sustained improvement in pain and function. The procedure is associated with low morbidity and mortality.