• Minimally invasive treatment
• Radiotherapy
• Spinal metastasis
• Surgical treatment

• Humans
• Spinal Neoplasms/secondary
• Quality of Life
• Pain/etiology
• Palliative Care
• Spinal Cord
• Spinal Cord Compression/etiology
• Spinal Cord Compression/surgery

• aging spine
• back pain
• osteoporotic fracture
• spine surgery
• vertebroplasty

• Kyphoplasty
• Local recurrence
• Metastatic spinal fractures
• Radiofrequency ablation

• Breast Neoplasms/surgery
• Female
• Fractures, Compression/surgery
• Humans
• Kyphoplasty
• Neoplasm Recurrence, Local
• Pain
• Radiofrequency Ablation
• Retrospective Studies
• Spinal Fractures/surgery
• Spinal Neoplasms/surgery

Background: The most common type of fracture of the lateral tibial plateau is the Schatzker type II split-depressed fracture. Minimally invasive surgery using balloon reduction appears to be very promising compared to the gold standard using a bone tamp. This surgery aims to have the best reduction and stabilization to benefit from an early passive and active rehabilitation to avoid stiffening and muscle wasting. Using a balloon for fracture reduction has allowed the use of semi-liquid Injectable Bone Cement (IBC) fillers. These fillers can be phosphocalcic or polymethyl methacrylate (PMMA). The latest recommendations on these IBCs in spinal surgery increasingly rule out phosphocalcic fillers because of their low mechanical strength.

Questions/purposes: 1) What is the mechanical influence of IBC filling (PMMA) regarding the split and depression components of a Schatzker type II fracture? 2) What is the mechanical influence of osteosynthesis regarding the split and depression components of a Schatzker type II fracture with or without PMMA filing in three different kinds of percutaneous fixations?

Methods: This biomechanical study was performed on 36 fresh frozen tibia/fibula specimens. Six groups were formed according to the type of percutaneous osteosynthesis or possible PMMA filling. Mechanical strength tests were carried out using a Unicompartmental Knee prosthesis and displacement components were measured on either side of the separation on the anterolateral facet by optical method.

Results: We found a significant difference between cementless and cemented osteosynthesis for depression fracture stabilization (difference −507.56N with 95% confidence interval [−904.17; −110.94] (p-value = 0.026)). The differences between the different types of osteosynthesis were not significant (p-value = 0.58). There was a significant difference between osteosynthesis without cement and osteosynthesis with cement on separation (difference −477.72N [−878.52; −76.93] (p-value = 0.03)). The differences between the different types of fixations were not significant regarding separation (p-value = 0.99).

Conclusion: PMMA cement significantly improves primary stability, regardless of the type of osteosynthesis for a Schatzker type II plateau fracture. Filling with PMMA cement during tuberoplasty seems to be a very promising strategy in association with percutaneous osteosynthesis to allow rapid recovery after surgery.

• PMMA
• augmented vertebra
• balloon kyphoplasty
• cement
• osteoporotic vertebral compression fracture
• recompression

• Osteoporotic vertebral compression fracture
• adjacent vertebral fracture
• balloon kyphoplasty
• vertebral body height loss

• Chronic Disease
• Humans
• United States

• Fractures, Compression
• Humans
• Kyphoplasty
• Vertebroplasty

• Bone cement
• Bone-filling container
• Neoplasm metastasis
• Spinal fracture
• Vesselplasty
• Visual analog scale

• PKP
• back pain
• osteoporosis vertebral fractures
• quality of life
• teriparatide

• Aged
• Aged, 80 and over
• Bone Density Conservation Agents/therapeutic use
• Female
• Fractures, Compression/drug therapy
• Fractures, Compression/surgery
• Humans
• Kyphoplasty/methods
• Middle Aged
• Osteoporosis, Postmenopausal/drug therapy
• Osteoporosis, Postmenopausal/surgery
• Osteoporotic Fractures/diet therapy
• Osteoporotic Fractures/surgery
• Quality of Life
• Retrospective Studies
• Teriparatide/therapeutic use
• Treatment Outcome

• Osteoporotic vertebral compression fracture
• bone cement distribution
• bone cement leakage
• pain relief
• vertebral augmentation
• vertebral compression

• Kummell disease
• extrapendicular
• percutaneous
• percutaneous vesselplasty

• balloon kyphoplasty
• conservative treatment
• kyphoplasty
• meta-analysis
• new osteoporotic compression vertebral fracture

• Clinical Trials as Topic
• Conservative Treatment
• Fractures, Compression/complications
• Fractures, Compression/surgery
• Fractures, Compression/therapy
• Humans
• Kyphoplasty/adverse effects
• Kyphoplasty/methods
• Osteoporotic Fractures/complications
• Osteoporotic Fractures/surgery
• Osteoporotic Fractures/therapy
• Spinal Fractures/complications
• Spinal Fractures/surgery
• Spinal Fractures/therapy

• Kummell disease
• Osteoporosis
• Osteoporotic vertebral fracture
• Spinal epidural hematoma

• Cement leakage
• Endoscopes
• Minimally invasive surgery
• Percutaneous vertebroplasty
• Polymethylmethacrylate

• Most anterior line
• cement leakage
• lateral radiograph
• percutaneous kyphoplasty
• percutaneous vertebroplasty
• safety line
• spinal canal

• Cancer pain
• Cervical
• Conscious sedation
• Ultrasound
• Vertebroplasty

• Aged
• Analgesia/methods
• Cervical Vertebrae/pathology
• Cervical Vertebrae/surgery
• Conscious Sedation/methods
• Fluoroscopy/methods
• Humans
• Male
• Neck Pain/etiology
• Neck Pain/surgery
• Spinal Neoplasms/complications
• Spinal Neoplasms/secondary
• Spinal Neoplasms/surgery
• Surgery, Computer-Assisted/methods
• Ultrasonography/methods
• Vertebroplasty/methods

In nearly 30% of patients with myeloma, pathological fractures are found to occur in the spine. If the patients are not treated promptly and satisfactorily, the quality of their lives diminishes. Currently, the standard treatment for metastatic lesions of the spine is radiotherapy, but surgical intervention is becoming more frequent. It is very important to quickly identify metastases and implement surgical treatment before any fracture/s occur.

Over the period of 2010–2014 in our department, a total of 129 patients were treated for metastatic spinal myeloma. 73 patients underwent vertebroplasty and 56 patients were operated on through various methods. Indications for the surgery, its course, technique and outcome were subsequently evaluated. The majority of patients (76%) admitted for treatment, exhibited vertebral fractures. Most lesions were multiplace and involved the vertebral bodies. In 42% of the patients, radiological examinations showed symptoms of compression of the nervous structures, while clinical signs were observed in only 16% of the patients. The functional status of the patients was assessed using the Karnofsky scale, while pain intensity was measured in a VAS score, before and after the surgery. The oncological results were assessed as a survival rate and local recurrence rate.

The average follow-up was conducted within 31 months (min 18, max 48). The patients after vertebroplasty survived 42 months, and the patients after surgery 23 months. Local recurrence of the disease was observed in 12 patients. In 10 patients, among a group of 21 with paresis, their neurological conditions improved. The average results of both their VAS score and Karnofsky performance score in patients after surgery was seen to have improved. Only sporadic postoperative complications after vertebroplasty and surgery were reported.

Early diagnosis of myeloma spine metastasis is essential to achieve the desired results of treatment. Vertebroplasty, as advised, should be performed as early as possible. Both the functional and oncological results after vertebroplasty are beneficial and the complication rates are low. Three relevant factors were found in our study: patient’s age over 65 years, initial diagnosis over 3 years and stage III of disease were related, significantly and statistically to survival.

• Metastases
• Multiple myeloma
• Resections
• Spinal tumours
• Spine surgery
• Stabilization

Vertebroplasy is considered an alternative and effective treatment of painful oncologic spine disease. Major complications are very rare, but with high morbidity and occur in less than 1% of patients who undergo vertebroplasty. Spinal subdural hematoma (SDH) is an extremely rare complication, usual developing within 12 h to 24 h after the procedure. We report the case of a tardive SDH in an oncologic patient who underwent VP for Myxoid Liposarcoma metastasis. Trying to explain the pathogenesis, we support the hypothesis that both venous congestion of the vertebral venous plexus of the vertebral body and venous congestion due to a traumatic injury can provoke SDH. To our best knowledge, only 4 cases of spinal subdural hematoma following a transpedicular vertebroplasty have been previously described in International literature and only one of them occurred two weeks after that surgical procedures. Percutaneous verteboplasty is a well-known treatment of pain oncologic spine disease, used to provide pain relief and improvement of quality life and is considered a simple surgical procedure, involving a low risk of complications, but related to high morbidity, such as SDH. Therefore it has to be performed by experienced and skilled surgeons, that should also recognize possible risk factors, making SDH more risky.

• Subdural hematoma
• Liposarcoma
• Surgery
• Radiotherapy
• Vertebroplasty

• Aneurysmal bone cyst
• Antibiotics
• Axis
• Stability
• Transoral
• Vertebroplasty

The aim of this study was to investigate the clinical efficacy of pedicle fixation combined with ¹²⁵I brachytherapy in treating metastatic thoracolumbar tumors.

A retrospective analysis of the clinical data of seven metastatic thoracolumbar tumor patients who received pedicle fixation combined with radioactive ¹²⁵I seed implantation brachytherapy in our department between January 2009 and December 2013 was performed. The visual analog scale (VAS) for pain and the Karnofsky performance status (KPS) score before the operation and 1, 6, and 12 months after the operation were observed and recorded. The changes in the scores at each time point were compared.

All the patients underwent a successful operation, without any complications during their hospitalization. All the patients received postoperative follow-up, and the duration of follow-up was 15–50 months, with an average of 32.2 months. One pancreatic cancer patient died of liver failure and hypoproteinemia 28 months post surgery. The VAS scores of patients before the operation and 1, 6, and 12 months after the operation were 7.43±0.98, 2.71±0.49, 3.00±0.82, and 4.29±0.98, respectively; the KPS scores were 52.9±9.5, 84.3±5.3, 75.7±5.3, and 72.9±4.9, respectively. These results suggest that the VAS score at each time point was significantly decreased compared with that before the operation, while the KPS score was significantly increased compared with that before the operation. Both differences had statistical significance (P<0.05).

As a therapy for advanced malignant tumors with thoracolumbar metastasis, pedicle fixation combined with ¹²⁵I brachytherapy can effectively relieve short-term pain and improve patient’s quality of life.

• iodine-125
• metastatic spinal tumor
• pedicle fixation
• radioactive particles

• Distance between polymethylmethacrylate and endplate
• Kyphoplasty
• Osteoporotic vertebral compression fractures
• Recompression

This study aimed to evaluate the safety and efficacy of percutaneous vertebroplasty (PVP) combined with intensity-modulated radiotherapy (IMRT) for metastatic lesions of patients with non-small-cell lung cancer (NSCLC) at centrum vertebrae.

A total of 39 patients with spinal metastatic NSCLC (stage IV) were treated with PVP followed by IMRT (30 Gy/10F/2 W) for metastatic lesion at centrum vertebrae under local anesthesia. Retrospective analysis was done with medical records and radiological data. The change of visual analog scale (VAS), activities of daily living, and kyphotic angle was measured preoperatively. The presence of complications was assessed preoperatively (baseline) at 24 hours, 1 week, and 1, 3, 6, 12, and 24 months postoperatively, or until the patient died or was lost to follow-up. Survival was assessed in the group.

A total of 39 consecutive patients were successfully treated with PVP via a translateral approach and IMRT. Their mean VAS score decreased from 7.93±1.09 preoperatively to 4.14±1.15 by the 24-hour postoperative time point and was 3.92±1.23 at 1 week, 4.27±1.93 at 1 month, 3.24±1.35 at 3 months, 2.27±0.96 at 6 months, and 2.59±1.55 at 12 months after the procedure. The mean VAS score at all of the postoperative time points was decreased significantly from the preoperative baseline score (P<0.05). Activities of daily living evaluation showed that the patients had a significantly high life quality after the combined approach (50.9±11.7 vs 82.3±9.9, P<0.05). No severe complications were observed. Mild complications included two cases (5.13%) of asymptomatic cement leakage into the epidural space and one case (2.56%) of paravertebral leakage. Median survival time was extended to 13 months.

The safety and efficacy of PVP combined with IMRT in patients with NSCLC with metastatic lesions at centrum vertebrae and the ability to prevent the diseased vertebrae from further deformation and tumor infiltration into the vertebral body were demonstrated. PVP combined with IMRT should be the optimal technique for treatment of vertebral compression pain resulting from spinal metastatic NSCLC.

• IMRT
• NSCLC
• percutaneous vertebroplasty
• spinal metastases

• Kyphoplasty
• Utilization
• Vertebral augmentation procedures
• Vertebral compression fractures
• Vertebroplasty

• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Kyphoplasty/adverse effects
• Kyphoplasty/statistics & numerical data
• Kyphoplasty/trends
• Male
• Middle Aged
• Postoperative Complications/epidemiology
• Retrospective Studies
• Spinal Fractures/surgery
• United States

Vertebral compression fractures (VCFs) constitute a major health care problem, not only because of their high incidence but also because of their direct and indirect negative impacts on both patients’ health-related quality of life and costs to the health care system. Two minimally invasive surgical approaches were developed for the management of symptomatic VCFs: balloon kyphoplasty and vertebroplasty. The purpose of this study was to evaluate the effectiveness and safety of balloon kyphoplasty in the treatment of symptomatic VCFs.

Between July 2011 and June 2012, one hundred and eighty-seven patients with two hundred and fifty-one vertebras received balloon kyphoplasty in our hospital. There were sixty-five male and one hundred and twenty-two female patients with an average age of 74.5 (range, 61 to 95 years). The pain symptoms and quality of life, were measured before operation and at one day, three months, six months and one year following kyphoplasty. Radiographic data including restoration of kyphotic angle, anterior vertebral height, and any leakage of cement were defined.

The mean visual analog pain scale decreased from a preoperative value of 7.7 to 2.2 at one day (p < .05) following operation and the Oswestry Disability Index improved from 56.8 to 18.3 (p < .05). The kyphotic angle improved from a mean of 14.4° before surgery to 6.7° at one day after surgery (p < .05). The mean anterior vertebral height increased significantly from 52% before surgery to 74.5% at one day after surgery (p < .05) and 70.2% at one year follow-up. Minor cement extravasations were observed in twenty-nine out of two hundred and fifty-one procedures, including six leakage via basivertebral vein, three leakage via segmental vein and twenty leakage through a cortical defect. None of the leakages were associated with any clinical consequences.

Balloon kyphoplasty not only rapidly reduced pain and disability but also restored sagittal alignment in our patients at one-year follow-up. The treatment of osteoporotic vertebral compression fractures with balloon kyphoplasty is a safe, effective, and minimally invasive procedure that provides satisfactory clinical results.

Vertebroplasty (VP) is a well-known therapeutic modality used to treat pain associated with vertebral compression fractures. Major complications such as cord or root compression, epidural and subdural hematomas (SDH) and pulmonary emboli, occur in less than 1% of patients who undergo VP after compression fracture. Spinal SDH is an extremely rare complication that usually happens a few hours after the procedure. We report a case of spinal SDH that developed at two weeks after a successful VP. We also reviewed related literatures and discussed its possible pathogenesis.

• Complication
• Spine
• Subdural hematoma
• Vertebroplasty