Vertebral Body Augmentation Research Articles

Cement Leakage after Augmentation of Osteoporotic Vertebral Bodies.

Cement leakage is the most common complication of vertebral cement augmentation. The present study investigated cement leakage rates in spinal cement augmentation procedures and identified potential risk factors for cement leakage.140 cases (258 vertebrae) in 131 consecutive patients and nine postmortem cases were evaluated. A total of 258 cement-augmented vertebrae were studied. The data for this were obtained from the hospital records of 131 patients who underwent such operations in 2 orthopaedic trauma surgery clinics in the FRG and from the examinations of 9 postmortem cases at the Institute of Forensic Medicine of the University Medical Centre Hamburg-Eppendorf.Cement leaks were identified in 64 of the 140 cases (45.7%). Local cement leaks were the most common type of leak, accounting for 73.4% of leaks (n=47). Venous leaks were evaluated in 15 cases (23.4%) and pulmonary embolisations in 2 cases (3.1%). Within the group of retrospectively studied cases (n=131), only one patient (0.8%) suffered a symptomatic cement leak. Cement augmentation of fractures to lumbar vertebrae and application of large doses of cement were identified as risk factors for cement leakage.Both the data in the literature relevant to the topic and the results of this work demonstrate a high incidence of cement leakage after vertebral body augmentation procedures. Risk factors for cement leakage are described. Despite the low percentage of symptomatic cases, the possible factors influencing cement leakage should be considered and included in the surgical planning when planning and performing cement augmentations on vertebral bodies.

Mechanical Vertebral Body Augmentation Versus Conventional Balloon Kyphoplasty for Osteoporotic Thoracolumbar Compression Fractures: A Systematic Review and Meta-Analysis of Outcomes.

Systematic review and meta-analysis. Surgical management of osteoporotic vertebral compression fractures (OVCFs) has traditionally consisted of vertebroplasty or kyphoplasty procedures. Mechanical percutaneous vertebral body augmentation (MPVA) systems have recently been introduced as alternatives to traditional methods. However, the effectiveness of MPVA systems vs conventional augmentation techniques for OVCFs remains unclear. This serves as the premise for this study. A systematic review and meta-analysis was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies of interest included randomized controlled trials (RCTs) which directly compared patient outcomes following kyphoplasty to patients treated with MPVA systems. Clinical and radiological findings were collated and compared for significance between cohorts. 6 RCTs were identified with 1024 patients total. The mean age of all patients was 73.5years. 17% of the cohort were male, 83% were female. 515 patients underwent kyphoplasty and 509 underwent mechanical vertebral body augmentation using MPVA systems. MPVAs showed similar efficacy for restoration of vertebral body height (P = .18), total complications (P = .36), cement extravasation (P = .58) and device-related complications (P = .06). MPVAs also showed reduced rates of all new fractures (16.4% vs 22.2%; P = .17) and adjacent fractures (14.7% vs 18.9%; P = .23), with improved visual analogue scale (VAS) scores at 6-month (P = .13). The results of this meta-analysis highlight no significant improvement in clinical or radiological outcomes for MPVA systems when compared to balloon kyphoplasty for vertebral body augmentation. Further research is needed to establish a true benefit over traditional operative methods.

Long-term efficacy of balloon-assisted endplate augmentation combined with transforaminal pedicle screw fixation in the treatment of thoracolumbar burst fractures

Objectives: To investigate the long-term efficacy of balloon assisted endplate reduction with vertebral augmentation combined with pedicle screw fixation in the treatment of thoracolumbar burst fractures, and to compare the clinical efficacy of calcium sulfate cement (CSC) and calcium phosphate cement(CPC). Methods: This study is a retrospective cohort study.The clinical data of 39 patients with thoracolumbar burst fractures admitted to Hefei Hospital Affiliated to Anhui Medical University from November 2013 to December 2017 were retrospectively analyzed.All patients were treated with pedicle screw reduction and fixation of the injured vertebra,balloon-assisted reduction of the collapsed endplate of the injured vertebra,and artificial bone vertebral body augmentation,and the follow-up time was >5 years.There were 24 males and 15 females,aged (42.9±13.3) years (range: 29 to 56 years).According to the Frankel spinal nerve dysfunction grading standard, there were 4 cases of grade C, 7 cases of grade D and 28 cases of grade E. There were 21 cases of CSC augmentation(CSC group) and 18 cases of CPC augmentation (CPC group). X-ray and CT were performed at 1 week, 1-, 2-, 5-year after surgery and at the last follow-up, and the imaging indicators were measured, including the injured vertebra anterior edge height ratio,the injured vertebra middle height ratio,the injured vertebra wedge angle,and the sagittal plane Cobb angle. The pain visual analogue scale (VAS) and the Oswestry disability index (ODI) was used for functional evaluation, nervous function was evaluated according to the Frankel spinal nerve dysfunction grading standard.Independent sample t test was used for inter-group comparison, and paired sample t test and repeated measure ANOVA were used for intra-group comparison. Results: All operative procedures were successfully completed, no spinal nerve function damage occurred. The postoperative imaging indexes of the patients were significantly improved compared with those before surgery (all P<0.01). The follow-up time of patients was (6.7±2.8)years (range: 5 to 9 years). Among the 11 patients with symptoms of neurological impairment before surgery, 9 patients completely recovered at the last follow-up, and 2 patients recovered from Frankel grade C to D. There were no significant differences in imaging indexes between the first week after surgery and the last follow-up in the CPC group (all P>0.05), while there were significant differences in imaging indexes between the CSC group and the last follow-up (all P<0.05). CPC group was superior to CSC group in frontal height ratio, middle height ratio, wedge angle variation and sagittal Cobb angle correction loss at 2 year, 5 year after surgery and the last follow-up, with statistical significance (all P<0.05). At the last follow-up, there were no differences in VAS and ODI between the two groups (all P>0.05). After absorption of CSC in the filling area, a hardened zone was formed around the area, and the central cavity remained without bone tissue filling. CPC absorption was very slow, and the CPC group was still filled satisfactorily at the last follow-up. Conclusions: Balloon assisted endplate reduction and vertebral augmentation combined with pedicle screw fixation through the injured vertebra have good long-term efficacy in the treatment of thoracolumbar burst fractures. Compared with CSC, CPC vertebral augmentation can better maintain the shape and spinal sequence of the injured vertebra in the long term, and can effectively reduce the collapse of the space above the injured vertebra.

NCMP-09. THE CURRENT LANDSCAPE OF SPINE ONCOLOGY SURGICAL TRIALS AND FUTURE OPPORTUNITIES

Abstract BACKGROUND Clinical trials have allowed the discovery of successful therapeutic intervention for cancer patients. The current number of cancer patients in the US has increased with an incidence of 442/100,000 population and yet with decreased yearly mortality rate. Spine metastatic disease occurs in approximately 90% of patients with cancer. The aim of this study is to analyze the current landscape of spine oncology trials to identify future opportunities. METHODS To assess active and ongoing clinical trials in the treatment of metastatic spinal disease, the authors queried https://clinicaltrials.gov/ under the searches “Spine Metastases” and “Spine Tumor.” Only clinical trials designated as “Recruiting” were included. Parametric and non-parametric statistical analysis was performed. RESULTS Our initial search yielded to 100 total studies; 18 clinical trials met entry criteria. Trial type was 16/18 therapeutic, 2/18 observational and trial design 6/18 (33%) randomized. All 18 trials were single center. Trials were were based in the United States (90%) and British Columbia, Canada. Across US geographical quadrants, a significant higher number of therapeutic trials was found in the South quadrant (12/16) compared to the other quadrants, (p&amp;lt; 0.001; Midwest: N=3/16, Northeast: N=1). The most common therapeutic focus included radiosurgery, followed by vertebral body augmentation and/or radiofrequency ablation, and laser interstitial thermal therapy (LITT). CONCLUSION Clinical trials are a cornerstone for the advancement oncological treatment. Our study shows that currently there is an ample opportunity to design clinical trials for our growing population of metastatic spine disease patients. Successful strategies to enhance the needed portfolio of spinal oncology trials, include focusing on including all US geographic quadrants. As new trials are designed, continued efforts devoted to data entry in national registry remains important.

Minimally Invasive Fixation in Osteoporotic Vertebral Fractures: A Review Article

here are several surgical strategies which have been proposed to treat the osteoporotic patient with vertebral fracture, ranging from vertebral body cement augmentation, percutaneous/mini-open short segment pedicle screw fixation, and cortical bone trajectory screw to kyphotic deformity correction surgery. Minimally invasive spine surgery has the potential benefits of faster recovery, reduced blood loss, less postoperative wound pain, lower infection risk, and shorter length of hospital stay. Novel surgical techniques such as percutaneous instrumentation fixation, cortical bone trajectory technique, screw cement augmentation, and vertebral body augmentation are developed. However, various complications have been reported, including pedicle fracture, instrumentation loosening, adjacent-level disc degeneration with herniation, and progressive junctional kyphosis. The purpose of this review was to outline various advancements in minimally invasive spinal surgery for patients with osteoporosis. Minimally invasive surgical techniques for fixation including percutaneous instrumentation, cortical bone trajectory technique, screw cement augmentation, and vertebral body augmentation have benefited patient with osteoporosis. Studies and discussions about short-segment pedicle screw fixation (one level above and below the fracture level) have shown that it provides enough stability for thoracolumbar burst fractures. There are also complications, including cement embolism, adjacent vertebral fracture, neuraxial anesthesia, and infection, which have been observed with the above technique. With the advancement of instrument and technique, the complication rate decreased in recent studies. Minimally invasive fixation still has many advantages for patients with osteoporosis. Many of these studies and strategies only have evidence from biomechanical and cadaveric studies and require further clinical trials to establish their clinical efficacy.

Vertebral Augmentation for Painful Type 4 Osteoporotic Compression Fractures: A Comparative Study.

Type 4 osteoporotic fracture (OF4), according to the classification system of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU), is unstable and requires fixation as per the guidelines of the same group. We evaluated the use of stand-alone vertebral body augmentation (VBA) in pain control of OF4. This is a single-centre, in two hospitals, comparative study to evaluate the effectiveness of percutaneous vertebroplasty (PVP) and kyphoplasty (KP) in pain control of OF4. OF4 patients treated with VBA were compared to a conservatively treated control group. The two groups of OF4 were then compared to similar cohort of OF2 and OF3 patients who were treated by either VBA or expectantly. A total of 78 cases were studied. VBA of OF4 showed a statistically significant better pain control than conservative treatment. The response of this group of fractures to VBA was similar to that of OF2 and 3. VBA can provide satisfactory pain control for OF4 patients.

Spinal brachytherapy

Brachytherapy remains an underrecognized and underutilized radiation therapy modality for the treatment of spinal tumors. This article summarizes the existing body of medical literature on the usage, indications, techniques, and outcomes of brachytherapy for the treatment of spine tumors. The disease pathology most commonly treated with brachytherapy is metastatic spine cancer, rather than primary bone tumors of the spine. Brachytherapy can be used alone, as percutaneous needle injections; however, it is more often used in conjunction with open surgery or cement vertebral body augmentation. Although the data are still relatively sparse, studies show consistent benefit from brachytherapy in terms of improvements in pain, function, local recurrence rate, and overall survival. Brachytherapy is also associated with a favorable complication profile.

Efficiency of a novel vertebral body augmentation system (Tektona\u2122) in non-osteoporotic spinal fractures

BackgroundThe restauration of the local kyphosis is crucial to thoracolumbar fractures outcomes. Recently, the Tektona™ (Spine Art) system, constituted by a flexible lamella for corporeal reduction has emerged as a promising solution for osteoporotic fractures. However, no study has yet focused on its results on traumatic fractures.MethodsA retrospective longitudinal study on prospectively collected data was conducted on 53 patients that had a kyphoplasty by Tektona™, associated or not to percutaneous fixation. The data collected were clinical, surgical and scannographic (measurement of AVH, MVH and PVH (anterior/medium/posterior vertebral height), and RTA (regional traumatic angle) in°), preoperatively, post-operatively and at last follow-up.ResultsFractures were mainly located at the upper lumbar spine and were AOSpine A3 type for 74%. The mean RTA was 12° in pre-operative, 4° in post-operative (p = 2e− 9), and 8° at the last follow-up (p = 0,01). The mean correction of RTA for the fixation group was − 10 ± 6° versus − 7 ± 4° for the kyphobroplasty alone group (p = 0,006). The mean correction for fractures located at T10-T12 was − 9 ± 3°, − 9 ± 5° for L1, − 8 ± 3° for L2 and − 5 ± 3° for L3-L5 (p = 0,045).ConclusionsThe Tektona® system appears to be efficient for acute thoraco-lumbar fractures, comparable to other available systems, allowing a real intracorporeal reduction work. Its relevance, especially in the long term needs further investigation. The association of a percutaneous fixation allow to obtain a better correction of the RTA but did not seem to prevent the loss of correction at follow-up.

A biomechanical study of ligament tethers strengthening for the prevention of proximal junctional kyphosis after posterior long-segment spinal fusion

BackgroundProximal junctional kyphosis is a known complication of posterior long-segment thoracolumbar fusion. Here, the biomechanical effectiveness of ligament tethers strengthening and vertebral body augmentation, in proximal junctional kyphosis prevention was explored using the finite element analysis. MethodsBased on a validated model of T1-L5 with the pedicle screw system instrumented T8-L5, strengthening models with different strategies were created to assess the range of motion in proximal vertebrae, vertebrae stress, pedicle screw stress, and pressure on intervertebral discs during extension, flexion, lateral bending, and axial rotation motions. Strengthening strategies included two- and three-level posterior ligament tethers (TE-T7-T9 and TE-T6-T9), and tethers with T7 &T8 vertebral body augmentation (TECE-T7-T9 and TECE-T6-T9). FindingsCompared to the spinal fusion model, the ligament tethers strengthening significantly reduced the flexion-extension range of motion difference among the proximal vertebrae. During the flexion-extension motion, the T8 vertebra stresses in the TE-T7-T9, TE-T6-T9, TECE-T7-T9, and TECE-T6-T9 models were distinctively reduced, the values decreased by 26.8%, 28.3%, 28.8%, and 9.6%, respectively, during flexion, and by 21.9%, 35.2%, 23%, and 18.6%, respectively, during extension. In the strengthening models, the maximum stresses on the T7/T8 intervertebral disc in the TE-T6-T9 model were reduced by 13.8% during flexion and by 14.7% during extension. InterpretationBased on our results, the ligament strengthening configuration of the three-level posterior tethers produced a more gradual transition in range of motion, vertebrae stresses, and intervertebral discs stress between the fused and non-fused segments, especially during flexion-extension, which may significantly decrease the proximal junctional kyphosis biomechanical risk.

364 A Novel Preparation of Bone Cement for Vertebroplasty: Can Strontium Folate Improve the Mechanical and Biological Properties of Calcium Phosphate Cement?

Abstract Aim Bone cements currently used for vertebral body augmentation procedures lack biological properties that allow them to osseointegrate. Strontium folate (SrFo) has been shown to increase the viability of human osteoblast (HOb) cells. The potential of a novel preparation of calcium phosphate cement (CPC) with added SrFo is explored to investigate whether SrFo can increase its biocompatibility. Method Brushite-forming CPCs with 0% (negative control) and 5% and 10% weight-weight additions of SrR (positive control) and SrFo were formulated. Initial (Ti) and final (Tf) setting times were measured. Mechanical analyses included ultimate compressive strength and plane strain fracture toughness. Topography and distribution analyses occurred during materials characterisation and in vitro analysis using scanning electron microscopy (SEM). Results There was no significant difference in the Ti between the CPCs, but significantly greater Tf for all SrFo-CPCs. There was no significant difference in the compressive strength between the CPCs, but a significantly decreased fracture toughness in all SrFo-CPCs. SEM revealed non-homogeneous structures in all SrFo-CPCs. Whilst the pH of the HOb cell culture medium remained the same for all CPCs, the proportion of dead cells was significantly higher than that of alive cells. Conclusions The addition of SrFo did not produce any significant differences in the material characteristics of the cements, nor the in vitro properties, except for a prolonged setting time. Future studies should seek to determine the osteogenic nature of SrFo by altering the formulation of the CPCs to a non-toxic preparation, such as apatite-forming cements which are known to have superior mechanical properties.

A biomechanical study of proximal junctional kyphosis after posterior long segment fusion with vertebral body augmentation

BackgroundProximal junction kyphosis is a common clinical complication of posterior long-segment spinal fusion and vertebral body augmentation method is one of the effective approaches to prevent it. The purpose of this study was to explore the biomechanical effect of proximal junction kyphosis after posterior long-segment thoracolumbar fusion with different vertebral augmentation schemes using finite element analysis.Methods3D nonlinear finite element models of T1-L5 spine posterior long-segment T8-L5 thoracolumbar fusion combined with T7, T8 and T7&T8 vertebral bone cement augmentation were constructed from human spine CT data and clinical surgical operation scheme to analyze the von Mises stress in the vertebrae, intervertebral discs pressure and pedicle screws system loads under the flexion, extension, lateral bending and axial rotation motion.FindingsCompared with thoracolumbar posterior long-segment fusion model, T7 maximum stress in T7, T8 and T7&T8 vertebrae augmentation models were reduced by 8.64%, 7.17%, 8.51%;0.79%, −3.88%,1.67%;4.02%, 5.30%, 4.27% and 3.18%, 3.06%, −6.38% under the flexion, extension, lateral bending and axial rotation motion. T7/T8 intervertebral disc pressure in T7, T8, T7&T8 vertebral augmentation models were 36.71Mpa,29.78Mpa,36.47Mpa;22.25Mpa,18.35Mpa,22.06Mpa;84.27Mpa,68.17Mpa, 83.89Mpa and 52.23Mpa, 38.78Mpa,52.10Mpa under the same condition. The maximum stress 178.2Mpa of pedicle screws is mainly distributed at the root of screw.InterpretationThoracolumbar posterior long-segment fusion with proximal double-segment vertebral augmentation should be recommended to prevent proximal junction kyphosis than single-segment augmentation. Simulation results can provide theoretical foundations and assist surgeons in selecting the appropriate operation scheme.

Efficacy of a Novel Vertebral Body Augmentation System in the Treatment of Patients with Symptomatic Vertebral Body Fractures

PurposeTo evaluate the safety and efficacy of a novel augmentation implant in the treatment of patients with symptomatic vertebral body fractures.Materials and MethodsThirty consecutive patients (seven males and 23 females), mean age of 70 years (range 56 to 89) with osteoporotic fractures and/or low-energy trauma fractures (osteoporosis confirmed by CT), were enrolled in an IRB-approved prospective study. The type of fracture was classified according to the Magerl classification. The patients were treated with the Tektona® dedicated vertebral body augmentation system. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were obtained after 1, 6 and 12 months. Quality of life was assessed with the SF36 score.ResultsA total of 37 vertebral bodies, mostly from T6 to L5, were treated in the 30 enrolled patients. In 67.6% of the cases (n = 25), lumbar fractures were treated. Most of the fractures (43%; n = 16) were A1.1 according to the Magerl classification. A significant pain reduction evaluated by VAS scores (p < 0.0001) was observed on average 7.6 (before the procedure) to 2.8 (immediately post-treatment), 2.1 and 2.7 (after 6 and 12 months later, respectively). The mean ODI score was 55.5% before treatment, and this was statistically significant reduced to 22.3% and 26.9%, respectively, at 6 and 12 months after treatment (p < 0.0001). The SF36 scores, both physical and mental components, showed statistically significant variations (p < 0.0001) whose direction was subpopulation dependent.ConclusionPatients with confirmed osteoporosis, suffering from symptomatic vertebral body fractures (osteoporotic and/or low-energy traumatic), were treated safely and effectively using this novel implant.

Minimally invasive stabilization of thoracolumbar osteoporotic fractures

Minimally invasive stabilization of thoracolumbar osteoporotic fractures (OF) in neurologically intact patients is well established. Various posterior and anterior surgical techniques are available. The OF classification and OF score are helpful for defining the indications and choice of operative technique. This article gives an overview of the minimally invasive stabilization techniques, typical complications and outcome. Selective literature search and description of surgical techniques and outcome. Vertebral body augmentation alone can be indicated in painful but stable fractures of types OF1 and OF2 and to some extent for type OF3. Kyphoplasty has proven to be an effective and safe procedure with a favorable clinical outcome. Unstable fractures and kyphotic deformities (types OF3-5) should be percutaneously stabilized from posterior. The length of the pedicle screw construct depends on the extent of instability and deformity. Bone cement augmentation of the pedicle screws is indicated in severe osteoporosis but increases the complication rate. Restoration of stability of the anterior column can be achieved through additional vertebral body augmentation or rarely by anterior stabilization. Clinical and radiological short and mid-term results of the stabilization techniques are promising; however, the more invasive the surgery, the more complications occur. Minimally invasive stabilization techniques are safe and effective. The specific indications for the individual procedures are guided by the OF classification and the individual clinical situation of the patient.

Vertebral Compression Fractures: Evaluation and Management.

Painful vertebral body compression fractures are prevalent in elderly patients. Two-thirds of patients will have spontaneous resolution of pain in 4 to 6 weeks and initial management is nonoperative with pain management and bracing. A focused history and exam can identify patients likely to benefit from vertebral body augmentation (e.g., vertebroplasty or kyphoplasty). Patients with persistent back pain and bone marrow edema on magnetic resonance imaging may benefit from injection of cement into the fractured vertebral body with either vertebroplasty or kyphoplasty. Patients most likely to benefit are those with severe pain refractory to nonoperative management who are offered intervention within 3 weeks. The procedure is usually performed as an outpatient with rare complications. Most patients report immediate, durable pain relief.

Research advances in complications and risk factors of bone cement leakage after vertebral body augmentation

Vertebral body augmentation for spine-related diseases has the advantages of minimally invasive surgery, obvious postoperative pain relief, and quick postoperative recovery compared with open surgery. It can quickly reconstruct spinal stability, relieve pain, and improve patients' quality of life. Intraoperative injection of bone cement into the diseased vertebral body carries the risk of bone cement leakage during the process. Knowing well the complications is helpful to the timely clinical treatment so as to avoid delays, and understanding the risk factors can facilitate targeted measures to prevent leakage during surgery. Therefore, to understand the consequences of bone cement leakage, leakage incidence rate, related risks factors and preventative measures is conducive to clinical treatment and surgery safety. The authors discuss the complications and risk factors related to bone cement leakage after vertebral body augmentation, in order to deepen the understanding of bone cement leakage, provide reference for clinical work, and improve the safety of surgery. Key words: Vertebroplasty; Kyphoplasty; Complications; Risk factors; Bone cement leakage

Minimally invasive non-fusion vertebral body stabilization in severe benign and malignant fractures. Stent-screw Assisted Internal Fixation: the SAIF technique

This short review focuses on clinical and therapeutic issues posed by severe osteoporotic and neoplastic insufficiency vertebral fractures and on the potential use of a new technique to obtain minimally invasive vertebral body reconstruction, augmentation, and stabilization in such severe fractures, combining two preexisting procedures. The implant of vertebral body stents is followed by insertion of percutaneous, fenestrated, cement-augmented pedicular screws that act as anchors to the posterior elements for the cement–stent complex. This procedure results in a 360° nonfusion form of vertebral internal fixation that may empower vertebral augmentation and potentially avoid corpectomy in challenging osteoporotic and neoplastic fractures.

Vertebral Body Lavage Reduces Hemodynamic Response to Vertebral Body Augmentation With PMMA.

Study Design:Retrospective comparative study.Objectives:To assess the effect of vertebral body lavage (VBL) on (1) systemic blood pressure, (2) heart rate, and (3) oxygen saturation following cement augmentation procedures for acute vertebral compression fractures (VCFs).Methods:A total of 145 consecutive patients undergoing cement augmentation for acute VCF (mean age 74 ± 12 years, age range 42-96 years; 70% female; 475 levels treated) were allocated to the “lavage group” (n = 61 patients; VBL prior to cement application) and to the “control group” (n = 84 patients, no VBL). Mean arterial blood pressure (MAP), heart rate, and oxygen saturation were monitored immediately prior and 3 minutes after cement injection. Logistic regression analysis was performed with ΔMAP ≥10 mm Hg before and after cement injection as the dependent outcome variable and demographic, radiographic, and procedural factors as independent variables.Results:MAP decreased by mean 3 ± 7.3 mm Hg before and after cement injection in the “lavage group” and 9 ± 10.5 mmHg in the control group (P < .001). There were no significant differences in terms of heart rate and oxygen saturation before and after cement application within each group, or between the 2 groups. Multivariate logistic regression analyses revealed VBL as an independent factor influencing MAP (adjusted odds ratio: 3.49 [confidence interval, 1.16-10.50], P = .03).Conclusion:VBL prior to cement augmentation procedures reduces the hemodynamic response, most likely resulting from decreased amounts of bone marrow substance displaced into the circulation thereby decreasing the risk of pulmonary fat embolism syndrome.

Surgical management of spinal metastatic disease.

Spinal metastatic disease is a common occurrence in oncology. Spinal metastases may result in pain, spinal deformity, and neurologic deterioration. Surgical intervention is a key component in the effective management of spinal metastatic disease. The principles of neural decompression and spinal stabilization are hallmarks of the surgical care for patients with metastatic spinal disease. Several classification systems exist for spinal metastatic disease to aid in assessing preoperative spinal instability and the need for operative intervention. Treatment modalities include separation surgery, stereotactic radiosurgery, conventional radiotherapy, vertebral body augmentation, and laser-interstitial thermal therapy. Various open surgical approaches exist that may be employed to achieve operative goals during separation surgery. The spinal surgeon should be intimately involved in the overall care of patients with spinal metastatic disease to ensure the best clinical outcomes.

Abstract No. 549 - Institutional experience using percutaneous thermal ablation as an adjunct to vertebral body augmentation in the treatment of metastatic disease

Abstract No. 549 - Institutional experience using percutaneous thermal ablation as an adjunct to vertebral body augmentation in the treatment of metastatic disease

Minimum cement volume required in vertebral body augmentation—A biomechanical study comparing the permanent SpineJack device and balloon kyphoplasty in traumatic fracture

BackgroundMinimally invasive treatment of vertebral fractures is basically characterized by cement augmentation. Using the combination of a permanent implant plus cement, it is now conceivable that the amount of cement can be reduced and so this augmentation could be an attractive opportunity for use in traumatic fractures in young and middle-aged patients.The objective of this study was to determine the smallest volume of cement necessary to stabilize fractured vertebrae comparing the SpineJack system to the gold standard, balloon kyphoplasty. Methods36 fresh frozen human cadaveric vertebral bodies (T11-L3) were utilized. After creating typical compression wedge fractures (AO A1.2.1), the vertebral bodies were reduced by SpineJack (n=18) or kyphoplasty (n=18) under preload (100N). Subsequently, different amounts of bone cement (10%, 16% or 30% of the vertebral body volume) were inserted. Finally, static and dynamic biomechanical tests were performed. FindingsFollowing augmentation and fatigue tests, vertebrae treated with SpineJack did not show any significant loss of intraoperative height gain, in contrast to kyphoplasty. In the 10% and 16%-group the height restoration expressed as a percentage of the initial height was significantly increased with the SpineJack (>300%). Intraoperative SpineJack could preserve the maximum height gain (mean 1% height loss) better than kyphoplasty (mean 16% height loss). InterpretationIn traumatic wedge fractures it is possible to reduce the amount of cement to 10% of the vertebral body volume when SpineJack is used without compromising the reposition height after reduction, in contrast to kyphoplasty that needs a 30% cement volume.