|
1
|
Lin HH, Hung PI, Chen KJ, Hsiung W, Chang MC. Is it safe to treat osteoporotic burst thoracolumbar fracture using percutaneous vertebroplasty? A minimum of 5-year follow-up study. Spine J 2025; 25:727-733. [PMID: 39505015 DOI: 10.1016/j.spinee.2024.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 09/25/2024] [Accepted: 10/27/2024] [Indexed: 11/08/2024]
Abstract
BACKGROUND CONTEXT Percutaneous vertebroplasty for the treatment of osteoporotic burst fractures remains controversial. A previous study has shown that an osteoporotic burst fracture with asymptomatic spinal canal compromise is not a contraindication for percutaneous vertebroplasty. PURPOSE To determine whether these outcomes persist over a long term, we continued to observe patients in their short-term study over a long-term period. STUDY DESIGN Prospective study. PATIENT SAMPLE Patients with osteoporotic vertebral fractures were classified as Dennis type I and II and AO type A1-A4, and no neurological deficits were observed. OUTCOME MEASURES Oswestry disability index and visual analog scale (VAS1) for pain were outcome measures. Radiological outcomes were vertebral body height and kyphotic angle. Complications included cement leakage, adjacent fractures, and transition to instrumented fusion. METHODS Between June 2015 and December 2016, 96 patients with osteoporotic vertebral fractures who met the inclusion criteria were prospectively enrolled. Preoperative, postoperative, and latest follow-up clinical outcomes were assessed using the Oswestry disability index and VAS. The radiological outcomes included vertebral body height, kyphotic angle, and adjacent fractures. Patients with intractable pain and neurological deficits during the follow-up were indicated for surgical treatment using decompression and instrumented fusion. RESULTS Fifty-one patients with osteoporotic compression fractures and 45 with osteoporotic burst fractures were included in this study. Mean follow-up duration was 74 months, and posterior vertebral body height, kyphotic wedge angle, and VAS score were not altered during the follow-up period. Three (5.9%) patients in an osteoporotic compression fracture group and three (6.7%) in a osteoporotic burst fracture group developed persistent pain, further collapse, and neurological deficits, and were indicated for surgical treatment. No significant differences were observed in the rates of adjacent fractures. Percentage of patients who required surgical treatment was not significantly different between the groups. CONCLUSIONS Osteoporotic burst fractures with asymptomatic spinal canal compromise treated with percutaneous vertebroplasty are safe and effective for pain management during long-term follow-up.
Collapse
Affiliation(s)
- Hsi-Hsien Lin
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; National Yang Ming Chiao Tung University, School of Medicine, Taiwan, Republic of China.
| | - Pei-I Hung
- National Yang Ming Chiao Tung University, School of Medicine, Taiwan, Republic of China; Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan, Republic of China
| | - Kuan-Jung Chen
- National Yang Ming Chiao Tung University, School of Medicine, Taiwan, Republic of China; Department of Orthopedics, China Medical University Hsinchu Hospital, Hsinchu, Taiwan, Republic of China
| | - Wei Hsiung
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; National Yang Ming Chiao Tung University, School of Medicine, Taiwan, Republic of China
| | - Ming-Chau Chang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; National Yang Ming Chiao Tung University, School of Medicine, Taiwan, Republic of China
| |
Collapse
|
|
2
|
Riesenbeck O, Czarnowski N, Raschke MJ, Oeckenpöhler S, Hartensuer R. Primary Stability of Kyphoplasty in Incomplete Vertebral Body Burst Fractures in Osteoporosis: A Biomechanical Investigation. Bioengineering (Basel) 2024; 11:798. [PMID: 39199756 PMCID: PMC11352168 DOI: 10.3390/bioengineering11080798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/02/2024] [Accepted: 08/05/2024] [Indexed: 09/01/2024] Open
Abstract
Background: The objective of our study was to biomechanically evaluate the use of kyphoplasty to stabilize post-traumatic segmental instability in incomplete burst fractures of the vertebrae. Methods: The study was performed on 14 osteoporotic spine postmortem samples (Th11-L3). First, acquisition of the native multisegmental kinematics in our robot-based spine tester with three-dimensional motion analysis was set as a baseline for each sample. Then, an incomplete burst fracture was generated in the vertebral body L1 with renewed kinematic testing. After subsequent kyphoplasty was performed on the fractured vertebral body, primary stability was examined again. Results: Initially, a significant increase in the range of motion after incomplete burst fracture generation in all three directions of motion (extension-flexion, lateral tilt, axial rotation) was detected as proof of post-traumatic instability. There were no significant changes to the native state in the adjacent segments. Radiologically, a significant loss of height in the fractured vertebral body was also shown. Traumatic instability was significantly reduced by kyphoplasty. However, native kinematics were not restored. Conclusions: Although post-traumatic segmental instability was significantly reduced by kyphoplasty in our in vitro model, native kinematics could not be reconstructed, and significant instability remained.
Collapse
Affiliation(s)
- Oliver Riesenbeck
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - Niklas Czarnowski
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - Michael Johannes Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - Simon Oeckenpöhler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
| | - René Hartensuer
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, Waldeyerstraße 1, 48149 Münster, Germany
- Center for Orthopaedic, Traumatology, Handsurgery, and Sportsmedicine, Klinikum Aschaffenburg-Alzenau, 63739 Aschaffenburg, Germany
| |
Collapse
|
|
3
|
Wang H, Xie J, Liu Y, Chen G, Jiang W. Comparison of three techniques in the surgical management of metastatic vertebral fracture with posterior wall damage: a retrospective study. J Orthop Surg Res 2023; 18:135. [PMID: 36823644 PMCID: PMC9948350 DOI: 10.1186/s13018-023-03608-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/12/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND To retrospectively compare the safety and efficacy of percutaneous kyphoplasty (PKP), internal fixation (IF), and kyphoplasty combined with internal fixation (KP + IF) in treating metastatic vertebral fracture (MVF) with posterior wall damage. METHODS 87 patients with MVF with posterior wall damage underwent surgery. In Group PKP, 36 patients underwent PKP; in Group IF, 20 patients underwent pedicle screw fixation; and in Group KP + IF, 31 patients underwent kyphoplasty combined with pedicle screw fixation. Operative time, intraoperative blood loss, clinical and radiological results, and complication rate in each group were evaluated and compared. RESULTS Significant improvement on the VAS, ODI scores, vertebral height and local kyphotic angle (LKA) was noted in each group (P < 0.001). Group PKP and Group KP + IF achieved better pain relief than Group IF (P < 0.05). At postoperative 3 days, Group PKP had better pain relief than Group KP + IF (P < 0.05). At other follow-up time points, there were no differences between Group PKP and KP + IF (P > 0.05). Group KP + IF and Group IF were more efficacious than Group PKP in terms of height restoration and LKA correction (P < 0.05). Group KP + IF had a higher incidence of postoperative complications than Group PKP and Group IF(P < 0.05). CONCLUSIONS PKP was safe and effective in treating MVF with posterior wall damage. It can achieve similar clinical outcomes compared to KP + IF, but associated with less operative time, less blood loss and fewer complications. IF alone should not be the first treatment option for its poorer analgesic effect.
Collapse
Affiliation(s)
- Heng Wang
- grid.429222.d0000 0004 1798 0228Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Jile Xie
- grid.429222.d0000 0004 1798 0228Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Yijie Liu
- grid.429222.d0000 0004 1798 0228Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Guangdong Chen
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China.
| | - Weimin Jiang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China. .,Department of Orthopaedic Surgery, Dushu Lake Hospital Affiliated to Soochow University, 9 Chongwen Road, Suzhou, China.
| |
Collapse
|
|
4
|
Sun X, Wang J, Liu X, Tao H, Zhu T, Wang X, Shen K, Jin W. Lateral-Opening Injection Tool Used in Percutaneous Vertebroplasty to Treat Asymptomatic Osteoporotic Vertebral Burst Fractures: A Retrospective Study. Orthop Surg 2022; 14:2914-2924. [PMID: 36168984 DOI: 10.1111/os.13519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 08/14/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The adequate management of asymptomatic osteoporotic vertebral burst fractures (OVBFs) was still controversial. Percutaneous vertebroplasty (PVP) could achieve quick recovery with minor trauma, but there were certain safety problems by traditional bone cement injection method. Thus, the aim of this study was to assess the efficacy of lateral-opening injection tool used in PVP treating patients with asymptomatic OVBFs. METHODS This was a retrospective study of OVBFs treated in our institute from March 2016 to March 2020. A total of 66 patients (mean age 72.10 ± 7.98 years, with 21 men and 45 women) who were diagnosed with acute asymptomatic OVBFs with mild spinal canal compromise were treated with PVP by using a lateral-opening injection tool. Two puncture needles were simultaneously placed transpedicularly in the fractured vertebra, and the inner core was removed, and the lateral-opening injection tool was inserted. The adjustment of lateral hole was to improve the distribution height of bone cement and avoid the entry of bone cement into the posterior wall of vertebral body. Related clinical outcomes and images were assessed, including back pain (visual analog scale [VAS]), vertebral height ratio (fractured vertebral height/average adjacent nonfractured vertebral height), kyphosis Cobb angle, union of the fractured vertebral posterior wall, distribution of bone cement, surgical data, and complications. RESULTS The average follow-up time of all cases was 21.23 ± 9.35 months. The mean amount of bone cement was 3.28 ± 0.35 ml in the vertebrae and the mean operative time was 34.02 ± 5.23 min. There were 60 cases of bone cement that contacted the upper and lower endplates on at least one side. There was no cement leakage into the spinal canal or fracture displacement of the posterior wall of the vertebral body in all cases. The VAS scores were 3.78 ± 0.42 at 1 day postoperatively and 0.53 ± 0.40 at the last follow-up, significantly lower than 8.40 ± 0.48 preoperatively (p < 0.05). The average height ratio of anterior, middle, and posterior vertebral body after operation increased compared with that pre-operation (p < 0.05), and the postoperative kyphosis angle decreased (p < 0.05). At 6 months follow-up, there was no significant height loss of the vertebral body. Computed tomography examination 3 months postoperatively showed that the fracture of posterior vertebral wall healed well in all cases. There were seven cases of bone cement leakage without clinical symptoms and two adjacent vertebral fractures caused by falling. There were no cases of deep vein embolism, lower limb muscle atrophy, pneumonia, decubitus. CONCLUSION The lateral opening tool can be safely and effectively used in the PVP treatment on asymptomatic OVBFs with mild spinal canal compromise.
Collapse
Affiliation(s)
- Xin Sun
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jia Wang
- Department of Pathology, Shanghai Xin Hua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xingzhen Liu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hairong Tao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Tong Zhu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiang Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Kangping Shen
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Wenjie Jin
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| |
Collapse
|
|
5
|
Comparison between Percutaneous Kyphoplasty and Posterior Fixation Combined with Vertebroplasty in the Treatment of Stage III Kümmell’s Disease without Neurological Deficit. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2193895. [PMID: 36119933 PMCID: PMC9477635 DOI: 10.1155/2022/2193895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/30/2022] [Accepted: 08/11/2022] [Indexed: 11/18/2022]
Abstract
Objective. To evaluate the clinical and radiological outcomes of percutaneous kyphoplasty (PKP) versus posterior fixation combined with vertebroplasty PF+VP for treating stage III Kümmell’s disease (KD) patients without neurological deficits. Methods. From April 2016 to February 2020, a total of 88 patients with single-level stage III KD without neurological deficits, including 45 patients treated by PKP and 43 patients who underwent posterior fixation combined with vertebroplasty PF+VP, were retrospectively studied. The outcome parameters, including blood loss, operative time, kyphotic Cobb angle, height of vertebrae, Oswestry Disability Index (ODI), and visual analog scale (VAS) score, were compared between the PKP group and the PF+VP group. Results. The mean follow-up time was
months, ranging from 24 to 48 months. The kyphotic angle and vertebral height in both groups were significantly improved compared with those before surgery at three days, 3 months and the final follow-up. The estimated blood loss, operative time, and length of stay were significantly lower in the PKP group than in the PF+VP group (
). The FP+VP group showed better results in kyphotic angle correction than the PKP group (
). In the short-term follow-up (up to 3 months), the PKP group had lower VAS and ODI scores than the PF+VP group. In contrast, there were no significant differences between the two groups (
) at the final follow-up. The average cost of PKP was lower than that of PF+VP. Conclusion. The results of our study showed that both PKP and PF+VP were safe and effective for stage III KD patients without neurological deficits. Although PF+VP presents better performance in kyphotic angle correction, PKP was associated with less surgical trauma, quicker pain relief, and lower expense than PF+VP. Therefore, it can be considered an alternative option for patients with advanced KD.
Collapse
|
|
6
|
Wang H, Lin F, Liang G, Lin Y. Percutaneous vertebroplasty in osteoporotic vertebral compression fracture with huge spinal epidural hematoma: A case report. Medicine (Baltimore) 2022; 101:e29340. [PMID: 35665733 PMCID: PMC9276412 DOI: 10.1097/md.0000000000029340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/04/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Osteoporotic vertebral compression fracture (OVCF) accompanying huge spinal epidural hematoma (SEH) is fairly rare. The aim of this report is to investigate the management strategies and treatment outcomes of OVCF accompanying SEH. PATIENT CONCERNS An 89-year-old female patient was admitted to hospital because of severe back pain and numbness of both lower limbs after a slight fall. The magnetic resonance imaging examination of the patient showed a fresh compression fracture at L2 accompanying a large dorsal SEH which extended from the T12 to L3 and deformed the spinal cord. DIAGNOSIS The patient was diagnosed with OVCF accompanying SEH. INTERVENTIONS Given mild neurologic deficits, the hematoma was not treated, and the patient underwent percutaneous vertebroplasty (PVP) only. OUTCOMES After the procedure, immediate pain relief was achieved and the numbness of both lower limbs disappeared 3 days later. Three months after the procedure, the follow-up magnetic resonance imaging revealed a complete resolution of the hematoma. LESSONS OVCF accompanying SEH is fairly rare, and the exact pathophysiological mechanisms are still not clear. In selected patients without or with only slight neurologic symptoms, it is reasonable to perform PVP alone in OVCF accompanying SEH. Moreover, intravertebral stability after PVP might have played a role in spontaneous resolution of SEH.
Collapse
MESH Headings
- Aged, 80 and over
- Female
- Fractures, Compression/complications
- Fractures, Compression/diagnostic imaging
- Fractures, Compression/surgery
- Hematoma, Epidural, Spinal/complications
- Hematoma, Epidural, Spinal/diagnostic imaging
- Hematoma, Epidural, Spinal/surgery
- Humans
- Hypesthesia
- Osteoporotic Fractures/complications
- Osteoporotic Fractures/diagnostic imaging
- Osteoporotic Fractures/surgery
- Spinal Fractures/complications
- Spinal Fractures/diagnostic imaging
- Spinal Fractures/surgery
- Treatment Outcome
- Vertebroplasty/methods
Collapse
|
|
7
|
Lai O, Zhang X, Hu Y, Sun X, Zhu B, Dong W, Yuan Z. Long-segment fixation VS short-segment fixation combined with kyphoplasty for osteoporotic thoracolumbar burst fracture. BMC Musculoskelet Disord 2022; 23:160. [PMID: 35177064 PMCID: PMC8855549 DOI: 10.1186/s12891-022-05109-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background To retrospectively compare clinical and radiological results of long-segment fixation (LF) and six-screw short-segment fixation combined with kyphoplasty (SSFK) for osteoporotic thoracolumbar burst fracture (OTBF). Methods Forty patients affected by OTBF with mean age of 61.85 years were included in this study. The mean follow-up period was 13.63 months. Twenty-four patients were treated by SSFK, and 16 patients were treated by LF. Clinical outcomes, radiological parameters and complications were assessed and compared. Results The mean operative time and blood loss were 89.71 ± 7.62 min and 143.75 ± 42.51 ml for SSFK group, respectively; 111.69 ± 12.25 min (P < 0.01) and 259.38 ± 49.05 ml (P < 0.01) for LF group, respectively. The two groups were similar in terms of preoperative radiological and clinical results. Compared with preoperative values, both groups achieved significant improvement in terms of VAS, ODI, Cobb angle and anterior vertebral body height (AVH) ratio at final follow-up. However, during the follow-up period, significant loss of Cobb angle and AVH ratio were observed for both groups. Five cases (20.83%) of asymptomatic cement leakage were observed in SSFK group. One case of implant failure and two cases of adjacent or non-adjacent vertebral fractures were observed in LF group. Conclusions Both SSFK and LF are safe and effective for treatment of OTBF. Comparatively, SSFK is less invasive and can preserve more motion segments, which may be a more valuable surgical option in some elderly patients. A high-quality randomized controlled study is required to confirm our finding in the future.
Collapse
Affiliation(s)
- Oujie Lai
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Xinliang Zhang
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Yong Hu
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China.
| | - Xiaoyang Sun
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Binke Zhu
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Weixin Dong
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Zhenshan Yuan
- Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang, People's Republic of China
| |
Collapse
|
|
8
|
A New Technique That Percutaneous Endoscopic Decompression and Vertebroplasty in a Patient With Osteoporotic Vertebral Fracture: A Case Report. Spine (Phila Pa 1976) 2020; 45:E967-E971. [PMID: 32675618 DOI: 10.1097/brs.0000000000003470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Technique note. OBJECTIVE To evaluate the feasibility of endoscopy in various spinal pathologies. SUMMARY OF BACKGROUND DATA Osteoporotic vertebral fractures are a common pathology in the elderly. These fractures are often accompanied by serious complications such as neurological deficits due to the compression of the spinal cord or nerve roots. METHODS A 78-year-old female patient presented to our hospital with a severe pain in her left leg and back. Lumbar magnetic resonance imaging and computed tomography scan revealed an osteoporotic L3 burst fracture compressing the left L3 nerve root. A minimally invasive translaminar endoscopic approach was used to remove the fractured fragment and cement was injected into the L3 vertebra. The patient was mobilized the same evening and was relieved of her pain. CONCLUSION Minimally invasive endoscopy is a safe and effective alternative to conventional major decompression with or without posterior stabilization, particularly in elderly patients with serious comorbidities. LEVEL OF EVIDENCE 4.
Collapse
|
|
9
|
Liao JC. Impact of Osteoporosis on Different Type of Short-Segment Posterior Instrumentation for Thoracolumbar Burst Fracture-A Finite Element Analysis. World Neurosurg 2020; 139:e643-e651. [PMID: 32325261 DOI: 10.1016/j.wneu.2020.04.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In Taiwan (my country), the proportion of people 65 years or older was over 14% in 2018, which is known as entering "aged society." More and more thoracolumbar burst fractures in the setting of osteoporosis happen nowadays. In this study, a finite element model on thoracolumbar burst fracture was established and 4 types of posterior short-segment fixations were tested under normal bone quality and osteoporotic conditions. METHODS The intact T11-L1 spine finite element model was created, and one-half of the spongy bone of the T12 vertebra was removed to simulate burst fracture. Four fixation models with posterior fusion devices were established: 1) a link (S-L); 2) intermediate bilateral screws (S-I); 3) a link and calcium sulfate cement (S-L-C); and 4) intermediate bilateral screws and calcium sulfate cement (S-I-C). The Young modulus of the osteoporotic cancellous bone was set at 70 MPa. Range of motion, as well as the maximum value and distribution of the implant stress on T11 and L1, were compared between normal bone and osteoporotic status. RESULTS The strongest construct was the S-I-C group of both normal bone and osteoporosis condition. In osteoporotic status, the range of motion of construct in 4 types would be increased when comparing with normal bone. The stress on pedicle screws at the T11 and L1 level would also be increased in osteoporosis. The value of the maximal von Mises stress on the superior vertebral body (T11) for all loading conditions was larger than that on the inferior vertebral body (L1) in both normal bone and osteoporosis. CONCLUSIONS The S-I-C provided the strongest construct even in osteoporosis status. But osteoporosis would result in weakness for spinal construct, which might lead to implant failure.
Collapse
Affiliation(s)
- Jen-Chung Liao
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
|
10
|
Lin JH, Chi JE, Hsu JY, Chan RW, Lo WC, Chiang YH. Kyphoplasty with an intravertebral reduction device for osteoporotic vertebral compression fractures with spinal canal encroachment. FORMOSAN JOURNAL OF SURGERY 2020. [DOI: 10.4103/fjs.fjs_38_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
|
11
|
Wang H, Zhang Z, Liu Y, Jiang W. Percutaneous kyphoplasty for the treatment of very severe osteoporotic vertebral compression fractures with spinal canal compromise. J Orthop Surg Res 2018; 13:13. [PMID: 29343287 PMCID: PMC5773161 DOI: 10.1186/s13018-018-0719-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/09/2018] [Indexed: 11/24/2022] Open
Abstract
Background Very severe osteoporotic vertebral compression fractures (vsOVCFs) are osteoporotic vertebral compression fractures with vertebral body collapse to less than one third of their original height. Few data are available about the use of percutaneous kyphoplasty (PKP) in treating vsOVCFs with spinal canal compromise. The aim of this study was to evaluate the safety and efficacy of percutaneous kyphoplasty (PKP) for the treatment of vsOVCFs with spinal canal compromise. Methods Thirty-five patients who suffered vsOVCFs with spinal canal compromise but without neurological deficits were treated by PKP between January 2009 and October 2014. The vertebral height, local kyphotic angle (LKA), visual analogue scale (VAS) and Oswestry Disability Index (ODI) values were assessed before the operation, 1 day after the operation and at the final follow-up. Results Significant improvements on the VAS and ODI were noted 1 day post-operatively (p < 0.01), and these results were preserved at the final follow-up. The vertebral height was restored and the LKA was improved after surgery (p < 0.01). No neurological deterioration was found. Five of 35 vertebrae (14.3%) of cement leakages were all asymptomatic. Four new OVCFs in three patients were identified. Conclusion PKP is a safe and effective procedure for the treatment of vsOVCFs with spinal canal compromise, achieving significant vertebral height restoration and kyphotic angle reduction and leading to a significant pain relief and improvement in function.
Collapse
Affiliation(s)
- Heng Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Zongyu Zhang
- Department of Orthopaedic Surgery, Lianyungang Affiliated Hospital of Nanjing University of Chinese Medicine, 148 Chaoyang Road, Lianyungang, China
| | - Yijie Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China
| | - Weimin Jiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, China.
| |
Collapse
|
|
12
|
Thick cement usage in percutaneous vertebroplasty for malignant vertebral fractures at high risk for cement leakage. Diagn Interv Imaging 2017; 98:721-728. [DOI: 10.1016/j.diii.2017.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/22/2017] [Accepted: 02/03/2017] [Indexed: 12/31/2022]
|
|
13
|
Abstract
STUDY DESIGN Review article. OBJECTIVE The article mainly reviewed the development and current situation of percutaneous kyphoplasty (PKP) in China, aiming to introduce native efforts and progress for PKP procedure on the exploring road. SUMMARY OF BACKGROUND DATA Since PKP was first reported in China in 2002, Chinese orthopedic researchers have performed lots of clinical applications and studies on the treatment of osteoporotic vertebral compression fracture, spinal metastatic tumor, hemangioma, myeloma, vertebral nonunion, and so on. METHODS We reviewed the papers on PKP published by native researchers in English and Chinese via Pubmed, EMBASE, the Scopus database, and a series of Chinese databases including Wanfang Data, China National Knowledge Infrastructure (CNKI), and the China Science and Technology Journal Database. The large sample capacity researches, convictive systematic analysis, and overviews were mainly elected as convictive evidence to describe the overall situation of clinical outcomes, complications, and the various technical aspects used to improve conventional surgical management and clinical applications of PKP in China. RESULTS Until October 2015, 211 articles in English and 2352 studies in Chinese about PKP were reported by 1443 Chinese institutions from 22 provinces around China. More than 50976 patients reported through published articles have received the treatment of PKP. With the technique gradually improved, including puncture, bone cement infusion, vertebral expander instruments, diagnosis, and treatment of special type of vertebral fractures, PKP is performed with the better efficacy and less complication. CONCLUSION With the progression of minimally invasive spinal surgery around the world, PKP in China has been performed with a trend towards a rapid, safe, and effective treatment. Digital, real-time and artificial intelligence are the directions of future development of PKP. LEVEL OF EVIDENCE 4.
Collapse
|
|
14
|
Yuk-Chuen S, Man-Hong C, Chun-Man M. Intraspinal Leakage of Cement during Vertebroplasty for an Elderly Woman with Osteoporotic Burst Fracture: A Case Report and Short Review of Prevention and Management. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2015. [DOI: 10.1016/j.jotr.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Osteoporotic spine fracture is very common nowadays due to the aging population. It may result in prolonged immobilization due to significant back pain. Cement vertebroplasty helps to relieve pain, provides immediate stability and allows early mobilization. Intraspinal leakage of cement is a rare complication but it may lead to catastrophic neurological injuries. Evidence-based management guidelines for this complication are lacking. This is a case report about intraspinal leakage of cement during vertebroplasty for an 85-year-old woman with osteoporotic burst fractures over the lumbar spine. Urgent exploration and decompression was performed. No neurological injury was found after the operation and the patient recovered from osteoporotic back pain uneventfully.
Collapse
Affiliation(s)
- Siu Yuk-Chuen
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, New Territories, Hong Kong
| | - Cheung Man-Hong
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, New Territories, Hong Kong
| | - Ma Chun-Man
- Department of Orthopaedics and Traumatology, North District Hospital, Sheung Shui, New Territories, Hong Kong
| |
Collapse
|
|
15
|
Gan M, Zou J, Zhu X, Wang G, Yang H. Balloon kyphoplasty for osteoporotic spinal fractures with middle column compromise. Injury 2014; 45:1539-44. [PMID: 25022230 DOI: 10.1016/j.injury.2014.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 04/13/2014] [Accepted: 06/18/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Balloon kyphoplasty (BKP) is an effective method for osteoporotic vertebral compression fractures. However osteoporotic spinal fractures with middle column compromise are mentioned as a relative contraindication to BKP. Thus we investigated the safety and efficacy of BKP in the treatment of osteoporotic spinal fractures with middle column compromise but without neurological deficit. METHODS In this retrospective study, 45 patients who suffered osteoporotic fractures with middle column compromise but without neurological deficits were treated by BKP from May 2007 to December 2010. The final follow-ups were finished during the time of July 2011-September 2011. The mean follow-up period was 20.2 months. The height of the compromised vertebral body, the kyphotic angle and spinal canal compromise were measured before surgery, one day after surgery, and at the final follow-up. A visual analogue scale (VAS) and the Oswestry disability index (ODI) were chosen to evaluate pain and functional activity. RESULTS The mean VAS and ODI scores improved significantly from pre- to post-operation (p<0.05), and this improvement was sustained at the final follow-up. The mean anterior vertebral body height ratio improved from 57.6%± 11.8% preoperatively to 86.2%± 12.2% postoperatively (p<0.05), so did the mean middle vertebral body height ratio. The kyphotic angle improved from 16.3° ± 3.7° preoperatively to 9.3° ± 2.6° postoperatively (p<0.05). At final follow-up, BKP stabilised vertebral height and prevented further kyphotic deformity. While there were no differences in spinal canal compromise between pre-operation and one day after surgery (p>0.05), there was a significant difference from the measurement at the final follow-up (p<0.05). CONCLUSION BKP is a safe and effective method for osteoporotic spinal fractures with middle column compromise but without neurological deficit. Spontaneous remodelling of the spinal canal also occurs after BKP.
Collapse
Affiliation(s)
- Minfeng Gan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Jun Zou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Xuesong Zhu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Genlin Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China.
| |
Collapse
|
|
16
|
Abstract
BACKGROUND CONTEXT Traumatic fractures of the spine are most common at the thoracolumbar junction and can be a source of great disability. PURPOSE To review the most current information regarding the pathophysiology, injury pattern, treatment options, and outcomes. STUDY DESIGN Literature review. METHODS Relevant articles, textbook chapters, and abstracts covering thoracolumbar spine fractures with and without neurologic deficit from 1960 to the present were reviewed. RESULTS The thoracolumbar spine represents a unique system from a skeletal as well as neurological standpoint. The rigid rib-bearing thoracic spine articulates with the more mobile lumbar spine at the thoracolumbar junction (T10 - L2), the site of most fractures. A complete examination includes a careful neurologic examination of both motor and sensory systems. CT scans best describe bony detail while MRI is most efficient at describing soft tissues and neurological structures. The most recent classification system is that of the new Thoracolumbar Injury Classification and Severity Score. The different fracture types include compression fractures, burst fractures - both stable and unstable -, flexion-distraction injuries and fracture dislocations. Their treatment, both operative and non-operative depends on the degree of bony compromise, neurological involvement, and the integrity of the posterior ligamentous complex. Minimally invasive approaches to the care of thoracolumbar injuries have become more popular, thus, the evidence regarding their efficacy is presented. Finally, the treatment of osteoporotic fractures of the thoracolumbar spine is reviewed, including vertebroplasty and kyphoplasty, their risks and controversies, and senile burst fractures, as well. CONCLUSIONS Thoracolumbar spine fractures remain a significant source of potential morbidity. Advances in treatment have minimized the invasiveness of our surgery and in certain stable situations, eliminated it all together.
Collapse
|
|
17
|
Hartensuer R, Gehweiler D, Schulze M, Matuszewski L, Raschke MJ, Vordemvenne T. Biomechanical evaluation of combined short segment fixation and augmentation of incomplete osteoporotic burst fractures. BMC Musculoskelet Disord 2013; 14:360. [PMID: 24359173 PMCID: PMC3878408 DOI: 10.1186/1471-2474-14-360] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 12/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treating traumatic fractures in osteoporosis is challenging. Multiple clinical treatment options are found in literature. Augmentation techniques are promising to reduce treatment-related morbidity. In recent years, there have been an increasing number of reports about extended indication for augmentation techniques. However, biomechanical evaluations of these techniques are limited. METHODS Nine thoracolumbar osteoporotic spinal samples (4 FSU) were harvested from postmortem donors and immediately frozen. Biomechanical testing was performed by a robotic-based spine tester. Standardized incomplete burst fractures were created by a combination of osteotomy-like weakening and high velocity compression using a hydraulic material testing apparatus. Biomechanical measurements were performed on specimens in the following conditions: 1) intact, 2) fractured, 3) bisegmental instrumented, 4) bisegmental instrumented with vertebroplasty (hybrid augmentation, HA) and 5) stand-alone vertebroplasty (VP). The range of motion (RoM), neutral zone (NZ), elastic zone (EZ) and stiffness parameters were determined. Statistical evaluation was performed using Wilcoxon signed-rank test for paired samples (p = 0.05). RESULTS Significant increases in RoM and in the NZ and EZ (p < 0.005) were observed after fracture production. The RoM was decreased significantly by applying the dorsal bisegmental instrumentation to the fractured specimens (p < 0.005). VP reduced fractured RoM in flexion but was still increased significantly (p < 0.05) above intact kinematic values. NZ stiffness (p < 0.05) and EZ stiffness (p < 0.01) was increased by VP but remained lower than prefracture values. The combination of short segment instrumentation and vertebroplasty (HA) showed no significant changes in RoM and stiffness in NZ in comparison to the instrumented group, except for significant increase of EZ stiffness in flexion (p < 0.05). CONCLUSIONS Stand-alone vertebroplasty (VP) showed some degree of support of the anterior column but was accompanied by persistent traumatic instability. Therefore, we would advocate against using VP as a stand-alone procedure in traumatic fractures. HA did not increase primary stability of short segment instrumentation. Some additional support of anterior column and changes of kinematic values of the EZ may lead one to suppose that additive augmentation may reduce the load of dorsal implants and possibly reduce the risk of implant failure.
Collapse
Affiliation(s)
- René Hartensuer
- Department of Trauma-, Hand-, and Reconstructive Surgery, Westfälische Wilhelms-University Münster, Albert-Schweitzer-Campus 1, W1, Münster 48149, Germany.
| | | | | | | | | | | |
Collapse
|
|
18
|
Hirata H, Hiwatashi A, Yoshiura T, Togao O, Yamashita K, Kamano H, Kikuchi K, Honda H. Resolution of epidural hematoma related to osteoporotic fracture after percutaneous vertebroplasty. World J Radiol 2013; 5:325-327. [PMID: 24003359 PMCID: PMC3758501 DOI: 10.4329/wjr.v5.i8.325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/09/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
We are the first to report a case that showed spontaneous resolution of epidural hematoma which was related to a steroid-induced osteoporotic compression fracture. The patient had a painful fracture with an intravertebral cleft at L1 accompanying an epidural hematoma posteriorly. Immediate pain relief was achieved after percutaneous vertebroplasty. Complete resolution of hematoma was noted three months after procedure. We theorized that intravertebral stability after treatment might have played a role in this patient.
Collapse
|
|
19
|
The Differences of Radiological Results after Percutaneous Vertebroplasty according to the Degree of Preoperative Canal Encroachment due to Bony Fragments. Korean J Neurotrauma 2012. [DOI: 10.13004/kjnt.2012.8.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|