Treatment Of Vertebral Compression Fractures Research Articles

Lordoplasty: report on early results with a new technique for the treatment of vertebral compression fractures to restore the lordosis

Cement augmentation using PMMA cement is known as an efficient treatment for osteoporotic vertebral compression fractures with a rapid release of pain in most patients and prevention of an ongoing kyphotic deformity of the vertebrae treated. However, after a vertebroplasty there is no chance to restore vertebral height. Using the technique of kyphoplasty a certain restoration of vertebral body height can be achieved. But there is a limitation of recovery due to loss of correction when deflating the kyphoplastic ballon and before injecting the cement. In addition, the instruments used are quite expensive. Lordoplasty is another technique to restore kyphosis by indirect fracture reduction as it is used with an internal fixateur. The fractured and the adjacent vertebrae are instrumented with bone cannulas bipediculary and the adjacent vertebrae are augmentated with cement. After curing of the cement the fractured vertebra is reduced by applying a lordotic moment via the cannulas. While maintaining the pretension the fractured vertebra is reinforced. We performed a prospective trial of 26 patients with a lordoplastic procedure. There was a pain relief of about 87% and a significant decrease in VAS value from 7.3 to 1.9. Due to lordoplasty there was a significant and permanent correction in vertebral and segmental kyphotic angle about 15.2 degrees and 10.0 degrees , respectively and also a significant restoration in anterior and mid vertebral height. Lordoplasty is a minimal invasive technique to restore vertebral body height. An immediate relief of pain is achieved in most patients. The procedure is safe and cost effective.

Comment on: efficacy and safety of balloon kyphoplasty in the treatment of vertebral compression fractures: a systematic review (C. Bouza et al.)

In their work C. Bouza and coauthors present the results from a systematic review conducted to ‘analyze the collected body of evidence regarding the efficacy and safety on balloon kyphoplasty in the treatment of vertebral compression fractures’. The authors conclude from their work that balloon kyphoplasty seems effective and safe. It is generally accepted that, in the absence of conclusive results from methodological rigorous studies, a systematic review can increase the accuracy of estimated treatment effect by pooling previously published data [1]. The authors have chosen to evaluate a relatively new minimal invasive technique using a systematic review as research tool, which makes good sense since large-scale randomized controlled trials on this subject are absent while interest in balloon kyphoplasty is considerable, having led to lively debate on multiple occasions. One of the most interesting topics under discussion is the difference of kyphoplasty versus vertebroplasty versus medical therapy for the treatment of vertebral compression fractures in terms of indications, outcome, complications and cost effectiveness. Following preliminary publications reporting success with kyphoplasty and vertebroplasty compared to medical therapy for vertebral compression fractures, both techniques seem to have been embraced and promoted by their respective advocates with uncontrolled case-series and anecdotes put forward as evidence. Although preliminary data from new techniques obtained from low level of evidence studies can certainly be interesting to discover potential benefits and/or pitfalls, it will not lead to proof of effectiveness. The spine community is unfortunate to have witnessed the introduction of numerous (surgical) techniques without proper controlled unbiased investigation of their merits. The ongoing controversy about the optimal treatment of traumatic thoracolumbar fractures, initiated more than 20 years ago and unlikely to be solved in the coming twenty, serves as a good example of what can happen without careful early evaluation of a new type of treatment. Vertebroplasty and kyphoplasty are recent examples of this practice and, with respect to the availability of evidence of their effectiveness and/or safety, we are in the dark. Conclusive statements on the performance of these new techniques must be regarded invalid if not backed up by solid data from methodological sound studies. Acknowledging the lack of good quality clinical trials, the present authors have taken a different route to find evidence and combined data from existing material to achieve better estimates of effect. The quality of a systematic review, and therewith the strength of its conclusions and recommendations, is directly dependent on the methodological quality of the studied material. Some limitations of the present study become apparent after close review of the primary papers. Critical quality parameters such as study design, duration of follow up, number of patients lost to follow up, validation of outcome parameters point to grade IV level of evidence instead of the grade II–III as suggested by the authors (http://www.cebm.net/levels_of_evidence.asp). The authors seem to have overestimated the quality of the material under investigation which is surprising for a study aiming to find evidence. Although the authors do an excellent job of recognizing the limitations of their work in the discussion section, they do not succeed in eliminating all bias when assessing the papers their manuscript is based on. This is something the reader should keep in mind when reading the article and contemplating the conclusions. In the end, I think this work is a good summary of the available papers describing balloon kyphoplasty for vertebral compression fractures but I am not sure if it has advanced the field besides stressing once more the necessity of high quality clinical research.

Mechanical characterisation of three percutaneous vertebroplasty biomaterials

Percutanous vertebroplasty (PVP) is gaining popularity for the treatment of vertebral compression fractures. The need of obtaining low viscosity materials for injection through small bore needles and the necessity of visualising the fluid flow during injection have led users to the formulation of a number of ad-hoc recipes aimed at adapting PMMA cements for this use. Industry, on its part, has addressed these requirements by developing specific products for this application. This study aimed at providing a direct comparison of a wide range of mechanical properties between three commercially available biomaterials developed for PVP: two PMMA based materials, Osteopal V (Merck Biomaterial GMBH, Dermstedt, D) and Verterbroplastic (DePuy Acromed, Inc, MA, USA), and a Bis-GMA composite, Cortoss (Orthovita, PA, USA). Cortoss consistently exhibited higher values for compressive strength, bending modulus and shear strength to both Osteopal V and Vertebroplastic. The creep behaviour of Cortoss was also different from that of the two PMMA cements.PVP can take advantage from the development of new injectable biomaterials in response to the problems associated with the use of PMMA in a highly vascularised area such as the vertebral body. In addition careful modulation of the mechanical properties of the material has the potential to further improve the outcome of PVP, possibly reducing the risk of adjacent level fractures associated with the procedure.

Pulmonary Embolization of Acrylic Cement During Vertebroplasty

A 79-year-old man with a history of diastolic left ventricular dysfunction, atrial fibrillation, and low back pain underwent vertebroplasty. The procedure was uneventful except for the development of low-grade fever 1 day after the procedure. The patient denied any cough, dyspnea, or chest pain. Initial physical examination revealed that he was not in respiratory distress. His temperature was 38.3°C, respiratory rate was 20/min, blood pressure was …

PROSPECTIVE MEASUREMENT OF FUNCTION AND PAIN IN PATIENTS WITH NON- NEOPLASTIC COMPRESSION FRACTURES TREATED WITH VERTEBROPLASTY

Background: There has been an increasing number of reports regarding the benefits of vertebroplasty for the treatment of vertebral compression fractures. In this investigation, validated outcome tools were utilized to document the impact of vertebroplasty on pain and function. Methods: Fifty patients were recruited at a tertiary university hospital. Patients had been treated for intractable pain due to osteoporotic compression fracture(s) for at least four weeks. The vertebroplasty procedures were performed by a radiologist. The subjects were followed prospectively for one year and received conservative treatment in conjunction with the vertebroplasty. Validated outcome tools, including a visual analog scale, the Oswestry scale, and the Roland-Morris functional activity questionnaire, were used to evaluate changes in pain and functional capabilities. Results: Fifty patients, thirty-one women and nineteen men (mean age, 68.6 years), were followed prospectively for one year. One hundred and three fractures (fifty-nine thoracic and forty-four lumbar) were treated. The visual analog scale showed the greatest improvement between the baseline score (mean, 7.76) and the score at one month (mean, 2.9), and the score remained improved at one year (mean, 2.9). The Oswestry and Roland-Morris questionnaires demonstrated significant (p < 0.0001) functional improvement between the baseline and one-month scores. With the numbers available, there were no significant changes in any variable from one month to one year (p > 0.05). Conclusions: Vertebroplasty is an effective treatment for patients with intractable pain due to osteoporotic vertebral compression fractures. Improvement in pain scores and functional capabilities that were found at one month were maintained at one year. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Prospective Measurement of Function and Pain in Patients with Non-Neoplastic Compression Fractures Treated with Vertebroplasty

There has been an increasing number of reports regarding the benefits of vertebroplasty for the treatment of vertebral compression fractures. In this investigation, validated outcome tools were utilized to document the impact of vertebroplasty on pain and function. Fifty patients were recruited at a tertiary university hospital. Patients had been treated for intractable pain due to osteoporotic compression fracture(s) for at least four weeks. The vertebroplasty procedures were performed by a radiologist. The subjects were followed prospectively for one year and received conservative treatment in conjunction with the vertebroplasty. Validated outcome tools, including a visual analog scale, the Oswestry scale, and the Roland-Morris functional activity questionnaire, were used to evaluate changes in pain and functional capabilities. Fifty patients, thirty-one women and nineteen men (mean age, 68.6 years), were followed prospectively for one year. One hundred and three fractures (fifty-nine thoracic and forty-four lumbar) were treated. The visual analog scale showed the greatest improvement between the baseline score (mean, 7.76) and the score at one month (mean, 2.9), and the score remained improved at one year (mean, 2.9). The Oswestry and Roland-Morris questionnaires demonstrated significant (p < 0.0001) functional improvement between the baseline and one-month scores. With the numbers available, there were no significant changes in any variable from one month to one year (p > 0.05). Vertebroplasty is an effective treatment for patients with intractable pain due to osteoporotic vertebral compression fractures. Improvement in pain scores and functional capabilities that were found at one month were maintained at one year.

Osteoporosis and skeletal fractures.

Osteoporosis affects millions of individuals worldwide, rendering them susceptible to fragility fractures of the spine, hip, and wrist and leading to significant morbidity, mortality, and economic cost. Given the substantial impact of osteoporosis on both patients and the medical community, it is imperative that physicians improve awareness and knowledge of osteoporosis in the setting of low-energy fractures. In this review, we provide information on effective means of preventing fragility fractures and introduce clinicians to issues pertinent to the patient who suffers an osteoporotic fracture. Prevention of fragility fractures centers around adequate mineral nutrition, including daily calcium and vitamin D supplementation, as well as prescription antiresorptive medications such as bisphosphonates or teriparatide therapy in severe cases, both of which have been shown to decrease future fracture risk. Balance and strength training also play important roles in the management of the osteoporotic patient, particularly following a low-energy fracture, and external hip protectors may be useful for certain patients. Kyphoplasty and vertebroplasty are two minimally invasive techniques that show great promise in the treatment of vertebral compression fractures, although questions regarding long-term biomechanical effects still exist. Traditionally, osteoporosis has been underdiagnosed and undertreated following a low-energy fracture in an elderly patient. Although treatment rates may be improving through public health initiatives, the majority of patients with osteoporosis remain inadequately treated. Perioperative intervention programs that focus on patient education about osteoporosis and treatment options lead to significant increases in intervention and treatment. Reducing the risk of skeletal fractures in patients susceptible to osteoporosis involves improved physician education on the risk factors and management of osteoporosis, as well as informing patients on the significance of dual-energy X-ray absorptiometry testing and medical treatment so that they may serve as their own healthcare advocates in this often-undertreated disease.

Efficacy and safety of balloon kyphoplasty in the treatment of vertebral compression fractures: a systematic review.

The aim of this study is to evaluate the efficacy and safety of balloon kyphoplasty (BK) in the management of vertebral compression fractures (VCFs). This study is based on a systematic review of the literature (until October 2004) and meta-analysis of clinical studies assessing the efficacy and safety of BK in the treatment of VCFs. Estimates of effect were based on a random effects model. Meta-regression analyses were carried out where required. A total of 26 studies met the inclusion criteria. Although studies displayed considerable methodological limitations, the results of the clinical series indicate significant improvements in pain intensity, vertebral height, sagittal alignment, functional capacity, and quality of life. Compared with conventional medical management, BK afforded significant improvement in pain intensity and mobility. Likewise, a significant reduction was observed in vertebral collapse, kyphotic deformity, the development of new vertebral fractures, and hospital stay. Compared with vertebroplasty, the technique reduced the loss of height and the degree of kyphotic deformity, and afforded a significantly lower leakage rate-with no differences in relation to other variables. Regarding adverse effects, leakage affected 7% of all levels treated, while complications were recorded in 2% of the patients, and new vertebral fractures in 16%. The available evidence suggests that BK can be effective and safe in application to VCFs. However, existing studies evince substantial methodological limitations and relatively short follow-up periods. Better clinical research is required to determine the capacity of BK to avoid the functional and physiological sequelae of VCFs and to define the true role of the technique among the existing therapeutic options.

Percutaneous vertebroplasty for treatment of osteoporotic thoracolumbar vertebral compression fracture by filling auto-solidification calcium phosphate cement

目的 探讨应用经皮椎体成形术(PVP)自固化磷酸钙人工骨(CPC)充填治疗骨质疏松性胸腰椎压缩性骨折的临床疗效.方法自2004年1月起,对26例29个椎体骨质疏松性胸腰椎压缩骨折患者,采用术中手法复位、PVP 自固化CPC充填治疗.结果 26例患者经单侧或双侧椎弓根穿刺椎体成形术成功治愈.胸腰椎自固化CPC平均充填量为4.6 mL.术中CPC渗漏者5例5个椎体.无一例出现严重并发症.经3～8个月(平均4.6个月)随访,术后所有患者疼痛消失.除3例椎体高度丢失15%外,其余椎体高度平均恢复达正常的80%.结论 PVP自固化CPC充填治疗骨质疏松性胸腰椎压缩性骨折是一种安全、简单、有效的方法。

Balloon Kyphoplasty for the Treatment of Vertebral Compression Fractures

척추의 압박골절은 대부분의 경우 골다공증의 합병증으 로 오며, 척추의 전이암이나 다발성골수종(multiple myeloma) 등에 의해서도 유발된다. 일반적인 보존적인 치료에도 불구 하고 통증을 동반하는 척추 압박골절은 전체 척추 압박골 절의 약 30% 정도라고 추정되며, 이러한 환자들은 특징적 으로 자세의 움직임에 따라 통증이 악화되기 때문에 환자 의 대부분이 보호자의 도움을 받아야 일상생활이 가능한 경우가 발생하고 따라서 환자뿐만 아니라 환자의 가족들까 지도 생활에 큰 지장을 받게 된다. 척추 압박골절에 대한 치료로는 침상안정, 진통제 복용, 척추 용 보조기착용 및 다양한 물리치료법 등이 사용되어 오고 있으 나 침상안정은 골소실을 가속화시키며 근육의 부조화상태 (deconditioning)를 유발하여 결과적으로 통증을 감소시키지 못 한다. 또한 이러한 통증뿐만 아니라 척추의 변형, 폐기능의 감소, 식욕감퇴, 수면장애, 운동력의 감소 등과 우울증 및 독 립적 생활의 박탈 등의 척추 압박골절과 연관된 연속적인 합병증을 가져온다. 통증을 동반하는 척추 압박골절에 대한 치료로 풍선을 이용한 척추체 복원술은 1987년 이후 시술되어 오던 경피 적 척추체성형술(percutaneous vertebroplasty)의 단점을 보완한 방법으로 시멘트의 추체외로의 유출을 줄이고, 감소된 척추 체의 높이를 복원시킴으로써 증가된 척추 후만 각도를 감 소시킬 수 있다는 장점을 가지고 소개된 새로운 시술법이 척추 압박골절 환자에서의 풍선 척추체 복원술의 치료 효과

Clinical Results of Percutaneous Kyphoplasty on Vertebral Compression Fractures

patients were women and 10 patients were men, with mean age of 65.2 years. Results: The clinical results after the procedure were improved. The visual analogue scale score reduced from 8.27 to 2.95 and the midline vertebral body height was increased. The clinically significant complication was not developed. Conclusion: Percutaneous kyphoplasty is a safe and easy technique for the treatment of vertebral compression fractures. It can reduce pain and restore the midline vertebral body height statistically. However long-term follow-up study is necessary.

Long-Term Effects of Vertebroplasty: Adjacent Vertebral Fractures

In today's aging population, osteoporosis-related fractures are an ever-growing concern. Vertebroplasty, a promising yet cost-effective treatment for vertebral compression fractures, has an increasing role. The first vertebroplasty procedures were reported by Deramond and Galibert in France in 1987, and international interest grew with continued development of clinical techniques and augmentation materials in Europe and the United States. Initial publications and presentations at peer review meetings demonstrated 60-90% success rates in providing immediate and significant pain relief. The objective of this review is to assemble experimental and computational biomechanical research whose goal is determining and preventing the negative long-term effects ofvertebroplasty, with a specific focus on adjacent vertebral fractures. Biomechanical studies using isolated cancellous bone cylinders have shown that osteoporotic cancellous bone samples augmented by the rigid bone cement were at least 12 times stiffer and 35 times stronger than the untreated osteoporotic cancellous bone samples. The biomechanical efficacy of the procedure to repair the fractured vertebrae and prevent further collapse is determined using single-vertebra models. The strength or load-bearing capacity of a single vertebra is significantly increased following augmentation when compared to the intact strength. However, there is no dear result regarding the overall stiffness of the single vertebra, with studies reporting contradictorily that the stiffness increases, decreases, or does not significantly alter following augmentation. The effects of vertebroplasty on adjacent structures are studied via multisegment models, whose results plainly oppose the findings of the single-vertebra and intravertebral models. Here, augmentation was shown to decrease the overall segment strength by 19% when compared to the matched controls. As well, there is a significant increase in disc pressure compared to the pre-augmentation measurements. This translates to a high hydrostatic pressure adjacent to the augmented vertebra, representing the first evidence of increased loading. Computational finite element (FE) models have found that the rigid cement augmentation results in an increase in loading in the structures adjacent to the augmented vertebra. The mechanism of the increase of the loading is predicted to be the pillar effect of the rigid cement. The cement inhibits the normal endplate bulge into the augmented vertebra and thus pressurizes the adjacent disc, which subsequently increases the loading of the untreated vertebra. The mechanism for adjacent vertebral fractures is still unclear, but from experimental and computational studies, it appears that the change in mechanical loading following augmentation is responsible. The pillar effect of injected cement is hypothesized to decrease the endplate bulge in the augmented vertebra causing an increase in adjacent disc pressure that is communicated to the adjacent vertebra. To confirm the viability of the pillar effect as the responsible mechanism, endplate bulge and disc pressure should be directly measured before and after augmentation. Future studies should be concerned with quantifying the current and ideal mechanical response of the spine and subsequently developing cements that can achieve this optimum response.

CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures

The purpose of this study was to determine the efficacy and safety of CT-guided percutaneous vertebroplasty in the treatment of vertebral compression fractures. The primary objectives were pain reduction and bone-cement leakage during a long-term follow-up in patients with osteoporotic vertebral compression fractures. CT-guided percutaneous vertebroplasty was carried out in 61 patients (mean age 71.4 years; range 42-83; female ratio: 73.8%) with vertebral compression fractures. Treatment was carried out on an outpatient basis. Pain, bone-cement leakage and complications were monitored and recorded. The mean follow-up time was 19.8 months (range 3-52). Paired comparison procedures were used for the analysis of the results, which showed that all patients had a significant reduction of pain. The mean visual-analogue scale (VAS) before treatment was 8.8 points (range 6.5-9.8 points). The mean VAS score after treatment was significantly reduced to 2.6 points (range 1.5-4.1 points; p<0.01). No clinical or neurological complications were documented. Minor and asymptomatic bone-cement leakage was observed in 54% of the cases. Percutaneous vertebroplasty is an efficient and safe interventional procedure which rapidly improves the mobility and quality of life of patients with vertebral compression fractures. CT-guidance is a reasonable upgrade in the treatment procedure which reduces the amount of bone-cement leakage.

Percutaneous Vertebroplasty for Vertebral Compression Fracture

Background: Percutaneous vertebroplasty is a less invasive method for the treatment of vertebral compression fractures. Several studies have reported the occurrence of severe complications caused by leakage of the injected materials after percutaneous vertebroplasty, however. Objectives: Safe and accurate procedures of percutaneous vertebroplasty were examined, and the short-term results were evaluated. Methods for the prevention of complications were also evaluated. Methods and Results: The subjects were 24 patients (30 vertebrae), consisting of 8 men and 16 women with a mean age of 78.4 years. Neurologic or systemic complications, such as pulmonary embolism, were not observed. After surgery, no aggravation of pain was observed, and pain was alleviated in 22 patients. The mean visual analog scale (VAS) score was 6.9 points before surgery and 1.2 points after surgery. Before surgery, 8 patients could walk by themselves, 4 patients could walk with a little help, and 12 patients could not walk, whereas after surgery, 20 patients could walk by themselves. Of these 20 patients, 14 could walk by themselves on the day of or next day after surgery and 6 could walk within 4 days after surgery. Conclusions: Percutaneous vertebroplasty for the treatment of compression fractures removed pain in more than 90% of the patients, indicating good short-term results. To obtain good results without complications by this method, accurate determination of the vertebrae to be treated, the body position, needling under the guidance of fluoroscopy and computed tomography (CT), and cement injection based on venographic findings by CT and fluoroscopy are important.

Anterior spinal column augmentation with injectable bone cements

A vertebral fracture, whether originating from osteoporosis or trauma, can be the cause of pain, disability, deformation and neurological deficit. The treatment of vertebral compression fractures has, for many years until the advent of vertebroplasty, consisted of bedrest and analgesics. Vertebroplasty is a percutaneous technique during which bone cement is injected in a vertebral body to provide immediate pain relief by stabilization. Inflatable bone tamps can, prior to the injection of cement, be used to create a void in the vertebral body, in which case the technique is known as balloon vertebroplasty (or kyphoplasty). The chance of extracorporal cement leakage is smaller for balloon vertebroplasty than for vertebroplasty. Some authors also claim to have gained some correction in vertebral body height or angulation. Both interventions can be used for several indications, including osteoporotic compression fractures and osteolytic lesions of the vertebral body such as myeloma, hemangioma or metastasis, and also for traumatic burst fractures in combination with pedicle screw instrumentation. Polymethyl methacrylate cement is the bone void filler that is used most frequently, although the application of calcium phosphate cements has been studied widely in vitro, in vivo and also in small-scale clinical series. The clinical results of (balloon-) vertebroplasty are favorable with 85–95% of all patients experiencing immediate and long-lasting relief of pain. Serious complications are relatively rare but include neurological deficit and pulmonary embolism. In this paper, both vertebroplasty and balloon vertebroplasty and their respective indications, techniques and results are described in relation with the application and limitations of permanent and resorbable injectable bone cements.

Immediate and early postoperative pain relief after kyphoplasty without significant restoration of vertebral body height in acute osteoporotic vertebral fractures

Painful osteoporotic vertebral compression fractures (VCFs) are a significant cause of disability in the elderly population. Kyphoplasty, a recently developed minimally invasive procedure, has been advocated for the successful management of these fractures in terms of immediate pain relief, and also for restoration of the premorbid level of daily activities. In this retrospective study the authors report on their experience with the early management of VCFs with kyphoplasty. A retrospective analysis was conducted in 13 patients (seven women and six men) whose ages ranged from 48 to 87 years (mean age 71.5 +/- 11 years [mean +/- standard deviation]). The interval between onset of symptoms and surgical intervention ranged from 4 to 9 weeks. Twenty levels (12 thoracic, eight lumbar) were treated in this cohort. Immediate and early postoperative (1-month follow-up visit) visual analog scale (VAS) pain scores, activity levels, and restoration of vertebral body (VB) height were assessed. The mean preoperative VAS score was 8 +/- 1, whereas the immediate and early postoperative scores were 1 +/- 1. These findings reflected a resolution of 90 to 100% of preoperative pain. All patients resumed routine activities within hours of the procedure, although improvement in VB height was not accomplished in this cohort. No major complications were encountered in this clinical series. Kyphoplasty is a safe and effective method for the treatment of osteoporotic VCFs. Failure to restore VB height does not seem to interfere with the excellent pain management and good functional outcome provided by this procedure.

Preliminary results of balloon kyphoplasty for vertebral compression fractures in organ transplant recipients

Organ transplant recipients are at risk for vertebral compression fractures (VCFs). The goal of this study was to determine whether kyphoplasty is an effective treatment for VCFs that develop in this patient population. Six consecutive patients who had undergone an organ transplant (five liver and one kidney transplant) had a total of 13 symptomatic VCFs that were treated with balloon kyphoplasty. Postprocedure follow-up duration ranged from 6 to 12 months. The mean visual analog scale pain score was 9.3 before treatment and declined to 1.8 after treatment. This improvement was highly significant (p < 0.001). Intake of narcotic drugs decreased or was eliminated in all patients, and there were no complications related to the procedure. There was one instance of clinically insignificant extraosseous cement extravasation. Sagittal alignment was improved by 5 degrees in one patient and was unchanged in the remaining five. During the follow-up period, a new fracture developed adjacent to a treated level in one patient. This was successfully treated with an additional kyphoplasty procedure. Kyphoplasty can be performed safely in organ transplant recipients with VCF, in whom results are just as favorable as those seen in patients with no history of organ transplantation.

Acute Pericarditis Caused by Acrylic Bone Cement After Percutaneous Vertebroplasty

Acute pericarditis caused by foreign material without trauma is rare. In the following case, acrylic bone cement penetrated the right ventricle (RV) after percutaneous vertebroplasty (PVP). A 66-year-old woman presented with chest pain exacerbated by deep inspiration and recumbency. She had received PVP 8 days earlier to treat a vertebral compression fracture. Her chest radiograph showed fractured vertebra filled with bone cement in …

Spinal canal stenosis after vertebroplasty

Percutaneous vertebroplasty is a minimally invasive treatment for vertebral compression fractures to relieve pain and provide strength. It achieves excellent results regarding pain relief and quality of life. Complications related to the procedure are rated infrequent and mostly minor. However, the long-term consequences are unclear. The generally accepted indications for vertebroplasty include pain associated with osteoporotic vertebral compression fractures, lytic vertebral infiltration or tumour invasion, and vertebral haemangioma. The following case report documents a rare complication where the injected polymethylmethacrylate (PMMA) failed to sustain permanent pain relief. The unstable vertebral fracture finally led to symptomatic spinal canal stenosis demonstrated 4 months after the procedure.

Biomechanical Comparison of Unipedicular Versus Bipedicular Kyphoplasty

A cadaveric study comparing the biomechanics of unipedicular versus bipedicular kyphoplasty in the treatment of osteoporotic vertebral compression fractures. The objectives of this study were to compare unipedicular kyphoplasty to bipedicular kyphoplasty in restoring strength, stiffness, and height to osteoporotic vertebral compression fractures and to study the degree of unilateral wedging when using a unipedicular versus bipedicular approach to kyphoplasty. Osteoporotic vertebral compression fractures are a common ailment of the elderly that can lead to chronic pain and deformity. Recently developed treatments known as vertebroplasty and kyphoplasty provide pain relief by percutaneously augmenting the fractured vertebral body with polymethyl methacrylate via a transpedicular approach. Vertebroplasty via a unipedicular approach has been shown to provide comparable restoration of vertebral body stiffness when compared to a bipedicular approach. The anticipated benefits of a unipedicular approach include reduction in patient risk, operative time, radiation exposure, and cost. No studies have evaluated the efficacy of unipedicular kyphoplasty. Two fresh-frozen human cadaveric spines (T3-L5) were disarticulated, and the vertebral bodies (n = 30) were compressed using an Instron 8521 machine, recording load versus displacement. The fractured vertebral bodies then underwent kyphoplasty via either a unipedicular or bipedicular approach. The augmented vertebral bodies were then recompressed. The strength, stiffness, and height restoration of the groups were compared. Following recompression, the risk for lateral wedging was evaluated by comparing lateral height measurements. Following fracture and subsequent kyphoplasty augmentation, the mean strength of the bipedicular group was 1.40 kN (+/- 0.38) versus 1.57 kN (+/- 0.55) in the unipedicular group. Average stiffness in the bipedicular group was 0.4387 kN/mm (+/- 0.2095) compared to 0.6880 kN/mm (+/- 0.3179) in the unipedicular group. Postcompression vertebral body height was restored to 96% of prefracture height in the bipedicular group and 94% of prefracture height in the unipedicular group. The mean absolute value of the difference in height between right and left side of the vertebral bodies was 1.06 mm (+/- 1.01) in the bipedicular group, whereas the unipedicular group had a mean of 1.78 mm (+/- 1.84). Statistical analysis using 1-way analysis of variance revealed no significant difference in any of the outcome measurements between the unipedicular and bipedicular groups (P < 0.05). Unipedicular kyphoplasty is comparable to bipedicular kyphoplasty in the restoration of vertebral body strength, stiffness, and height in experimentally induced vertebral compression fractures. There was no greater risk for lateral wedging in the unipedicular group compared to the bipedicular group. Given the advantages of a unipedicular approach with respect to vertebral pedicle cannulation risk, operative time, radiation exposure, and cost, this study would support the use of a unipedicular approach to kyphoplasty in the treatment of vertebral compression fractures.