Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Hu L, Sun H, Wang H, Cai J, Tao Y, Feng X, Wang Y. Cement injection and postoperative vertebral fractures during vertebroplasty. J Orthop Surg Res 2019;14:228. [PMID: 31324196 DOI: 10.1186/s13018-019-1273-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 07/09/2019] [Indexed: 11/10/2022] Open

For:	Hu L, Sun H, Wang H, Cai J, Tao Y, Feng X, Wang Y. Cement injection and postoperative vertebral fractures during vertebroplasty. J Orthop Surg Res 2019;14:228. [PMID: 31324196 DOI: 10.1186/s13018-019-1273-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 07/09/2019] [Indexed: 11/10/2022] Open

Number

Cited by Other Article(s)

Yuntao L, Haibier A, Kayierhan A, Liang M, Abudukelimu Y, Aximu A, Abudurexiti T, Xiangyu M. Clinical effect analysis of unilateral percutaneous vertebral cement distribution in the repair of osteoporotic thoracolumbar vertebral compression fractures. BMC Surg 2025;25:90. [PMID: 40045301 PMCID: PMC11881425 DOI: 10.1186/s12893-025-02820-0] [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] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 02/19/2025] [Indexed: 03/09/2025] Open

Abstract

BACKGROUND

Osteoporotic vertebral fractures and their complications pose increasing risks to the elderly. The purpose of this study was to evaluate the clinical efficacy of unilateral percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures (OVCF) by assessing postoperative cement distribution.

OBJECTIVE

This study aimed to investigate the impact of cement distribution on the efficacy of vertebral compression fracture repair to provide effective preventive and therapeutic measures, prevent postoperative vertebral re-fracture, and improve surgical outcomes.

METHODS

A total of 170 patients who underwent unilateral percutaneous vertebroplasty at our hospital from January 2020 to December 2022 were selected. Based on the postoperative X-ray cement distribution morphology, they were divided into the good distribution group (n = 87) and the poor dispersion group (n = 83). The basic information of patients, surgery-related indicators including operation time, total hospitalization costs, postoperative hospitalization time, cement injection volume, visual analog scale (VAS) for back pain, Oswestry Disability Index (ODI) for back pain, vertebral height restoration rate, local kyphotic angle of the vertebra, and incidence of re-fracture of injured and adjacent vertebrae were compared between the two groups, and the follow-up results of all patients were recorded.

RESULTS

There were no significant differences in age, gender, body mass index, fracture days, menopausal age of female patients, bone density T value, medical history, smoking history, alcohol history, and surgical segments between the two groups (P > 0.05). The VAS scores for back pain at 1 month and 1 year postoperatively were significantly lower in the good distribution group than in the poor dispersion group, with statistical significance (P < 0.05). The good distribution group had a significantly lower incidence of re-fracture of injured vertebrae and overall fracture incidence than the poor dispersion group (P < 0.05). There were no statistically significant differences in operation time, cement dosage, cement leakage, postoperative hospitalization time, adjacent vertebral fractures, postoperative vertebral height restoration rate, VAS scores for back pain at preoperative and 1 week postoperative, and ODI at preoperative, 1 week, 1 month, and 1 year postoperative between the two groups (P > 0.05).

CONCLUSION

Compared with the poor dispersion group, patients in the cement distribution group achieved better short-term clinical efficacy, and long-term prognosis effects are still under observation. Moreover, the cement good distribution group significantly reduced the incidence of re-fracture of injured vertebrae and overall fracture incidence, thereby achieving better surgical outcomes.

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Affiliation(s)

Liu Yuntao Minimally Invasive Spine Surgery, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, Xinjiang Uygur Autonomous Region, 830002, People's Republic of China
Abuduwupuer Haibier Minimally Invasive Spine Surgery, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, Xinjiang Uygur Autonomous Region, 830002, People's Republic of China
Aiben Kayierhan Minimally Invasive Spine Surgery, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, Xinjiang Uygur Autonomous Region, 830002, People's Republic of China
Ma Liang Minimally Invasive Spine Surgery, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, Xinjiang Uygur Autonomous Region, 830002, People's Republic of China
Yimuran Abudukelimu Minimally Invasive Spine Surgery, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, Xinjiang Uygur Autonomous Region, 830002, People's Republic of China
Alimujiang Aximu Minimally Invasive Spine Surgery, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, Xinjiang Uygur Autonomous Region, 830002, People's Republic of China
Tuerhongjiang Abudurexiti Minimally Invasive Spine Surgery, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, Xinjiang Uygur Autonomous Region, 830002, People's Republic of China
Meng Xiangyu Minimally Invasive Spine Surgery, Sixth Afliated Hospital of Xinjiang Medical University, Orthopaedic Hospital of Xinjiang Uygur Autonomous Region, No.39 Wuxing Road, Urumqi, Xinjiang Uygur Autonomous Region, 830002, People's Republic of China.

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Cho C, Hills J, Anderson P, Annaswamy T, Cassidy RC, Craig C, DeMicco R, Easa J, Kreiner S, Mazanec D, O'Toole J, Rappard G, Ravinsky R, Schoenfeld A, Shin J, Whitcomb G, Reitman C. Appropriate Use Criteria for Osteoporotic Compression Fractures. Spine J 2025:S1529-9430(25)00100-7. [PMID: 40049451 DOI: 10.1016/j.spinee.2025.02.007] [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: 10/01/2024] [Revised: 01/22/2025] [Accepted: 02/22/2025] [Indexed: 03/23/2025]

Abstract

BACKGROUND CONTEXT

There is a lack of consensus regarding optimal indications for treatment of patients with osteoporotic vertebral fractures. An opportunity exists to improve outcomes if these indications can be clarified.

PURPOSE

The purpose of the North American Spine Society (NASS) Appropriate Use Criteria (AUC) was to determine the appropriate (i.e. reasonable) multidisciplinary treatment recommendations for patients with osteoporotic vertebral fractures across a spectrum of more common clinical scenarios.

STUDY DESIGN

A Modified Delphi process.

PATIENT SAMPLE

Modified consensus based guideline OUTCOME MEASURES: Final rating for treatment recommendations as either "Appropriate", "Uncertain", or "Rarely Appropriate" based on the median final rating among the raters.

METHODS

The methodology was based on the AUC development process established by the Research AND Development (RAND) Corporation. The topic of osteoporotic vertebral compression fracture was selected by NASS for its Clinical Practice Guideline development (CPG). In conjunction, the AUC committee determined key modifiers and adapted the standard definitions developed by the CPG with minimal modifications. A literature search and evidence analysis performed by the CPG were reviewed by the AUC work group. A separate multidisciplinary rating group was assembled. Clinical scenarios were generated based on a matrix of the modifiers, to rate the appropriateness of medical management, cement augmentation, or surgery. Based on the literature, provider experience, and group discussion, each scenario was scored on a nine-point scale on two separate occasions: once without discussion and again following discussion of the initial responses. The median rating for each scenario and level of agreement was then used to determine final indications as rarely appropriate with agreement (1 - 3), uncertain or disagreement (4-6), or appropriate with agreement (7-9). Consensus was not mandatory.

RESULTS

Medical management was appropriate across all scenarios. Cement augmentation was rarely appropriate in 60% of scenarios and uncertain or disagreement in 35% of scenarios. In the 5% of scenarios rated as appropriate with agreement for cement augmentation, high pain scores, acute duration, and simple fracture pattern were always present. Surgery was appropriate in 35% of scenarios and strongly influenced by instability and stenosis with neurological findings. Surgery was rarely appropriate in 18%, and uncertain or disagreement in 47% of scenarios.

CONCLUSIONS

Multidisciplinary appropriate treatment criteria for osteoporotic vertebral fractures were generated based on the RAND methodology. This document provides comprehensive evidence-based recommendations for evaluation and treatment of osteoporotic vertebral fractures. The document in its entirety will be found on the NASS website (https://www.spine.org/Research-Clinical-Care/Quality-Improvement/Appropriate-Use-Criteria).

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Lin YH, Lin J, Xu JY, Lai BX, He MH, Zhu YR, Pang YL, Dong L, Li JH, Zhao SS, Lin YZ, Li RZ, Yao HY, Liang DC. What Risk Factors Are Associated With Recurrent Osteoporotic Vertebral Compression Fractures After Percutaneous Vertebral Augmentation? A Meta-analysis. Clin Orthop Relat Res 2025:00003086-990000000-01921. [PMID: 40036060 DOI: 10.1097/corr.0000000000003430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 02/03/2025] [Indexed: 03/06/2025]

Abstract

BACKGROUND

Osteoporotic vertebral compression fracture (OVCF) has been extensively treated clinically using percutaneous vertebral augmentation (PVA), which includes percutaneous kyphoplasty and percutaneous vertebroplasty. Postoperative refracture is a common complication after PVA, but the associated factors and specific mechanisms behind these fractures are not entirely clear.

QUESTIONS/PURPOSES

In a systematic review and meta-analysis, we asked: What factors were associated with increased or decreased odds of refracture after PVA for OVCF?

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, we conducted a comprehensive search of the Cochrane Library, PubMed, Web of Science, and Embase for the time period from database inception to August 31, 2024 (which also was when we last searched). We included case-control studies in which participants were patients with OVCF and were treated with PVA, grouped into refracture versus non-refracture groups based on the presence or absence of refracture. We excluded studies published on preprint servers, conference reports, case reports, and systematic reviews or meta-analyses. We collected 2398 records in the database. After excluding studies that were duplicates and did not meet the inclusion criteria, we included 22 studies involving 7132 participants, 75% (5368) of whom were women, with a mean age of 76 years for patients in the refracture group and 74 years for patients in the non-refracture group. Quality assessment was performed using the Newcastle-Ottawa Scale, with which we assessed three aspects of the study; the mean ± SD score for the included studies was 7.3 ± 0.7 of 9 total (on this scale, higher scores are better), representing generally high study quality. The determination of heterogeneity relied on I2 and chi-square test, and we used a random-effects model when the I2 was > 50% and p ≤ 0.05; otherwise, a fixed-effects model was chosen. According to the Egger test and trim and fill method, publication bias did not significantly affect most of our results.

RESULTS

The combined results showed that older age (mean difference 2.24 [95% confidence interval (CI) 1.25 to 3.23]; p < 0.001), lower bone mineral density (BMD) (standardized mean difference [SMD] -0.72 [95% CI -0.99 to -0.45]; p < 0.001), greater preoperative AP vertebral height ratio (SMD 0.26 [95% CI 0.07 to 0.45]; p = 0.01), greater preoperative kyphotic angle (KA) (SMD 0.47 [95% CI 0.10 to 0.83]; p = 0.01), bone cement leakage (OR 1.39 [95% CI 1.05 to 1.84]; p = 0.02), multivertebral fractures (OR 3.58 [95% CI 2.53 to 5.07]; p < 0.001), smoking (OR 1.53 [95% CI 1.16 to 2.02]; p = 0.003), use of glucocorticoids (OR 3.18 [95% CI 2.09 to 4.84]; p < 0.001), and previous osteoporotic vertebral fracture (OR 2.55 [95% CI 1.58 to 4.13]; p < 0.001) were associated with increased odds of refractures after surgery. Use of antiosteoporosis therapy was associated with a decreased odds of postoperative refracture (OR 0.39 [95% CI 0.24 to 0.64]; p < 0.001).

CONCLUSION

Based on the results of our meta-analysis, surgeons can identify those who are more likely to have refracture by knowing basic information about their patients preoperatively, such as advanced age, lower BMD, greater preoperative AP ratio, greater preoperative KA, and the presence of multivertebral fractures or previous osteoporotic vertebral fracture. Also, intraoperative reduction of bone cement leakage and postoperative counseling of patients to quit smoking, reduce glucocorticoid use, and administration of antiosteoporosis therapy were used to reduce the probability of refracture. The association between some factors and refracture is uncertain, such as BMI and thoracolumbar fracture, and further studies are needed.

LEVEL OF EVIDENCE

Level III, therapeutic study.

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Meng X, Zhou C, Liao Y, Zhou H, Li H, Liu J, Tang X, Wang Y. Biomechanical Effects of Different Spacing Distributions Between the Cemented Superior Boundary and Surgical Vertebral Superior Endplates After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Three-Dimensional Finite Element Analysis. Orthop Surg 2025;17:373-392. [PMID: 39529235 PMCID: PMC11787978 DOI: 10.1111/os.14292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 10/19/2024] [Accepted: 10/24/2024] [Indexed: 11/16/2024] Open

Abstract

OBJECTIVE

Patients with osteoporotic vertebral compression fractures (OVCF) treated with vertebroplasty (PVP) are experiencing an increasing number of problems such as pain recurrence, mainly due to recompression fractures of the operated vertebral body within a certain period of time after the operation, which is closely related to the distribution of intraoperative bone cement. The aim of this study is to investigate the effect of different spacing distributions between the upper boundary of the cement and the upper endplate of the operated vertebra on the biomechanics of the operated vertebra after percutaneous vertebroplasty for OVCF using finite element analysis (FEA).

METHODS

One patient with L1 vertebral body OVCF was selected, and computed tomography (CT) of the thoracolumbar segment was performed. The CT data were extracted to establish an FEA model of the T12-L2 vertebral bodies. Bone cement was injected into the L1 vertebral body. Based on the spacing between the upper boundary of the bone cement and the vertebral body's upper endplates, the model vertebrae were divided into 0, 2, 4, and 6 mm spacing groups, and the human body's upright, flexion-extension, lateral flexion, and rotational positions were simulated. The biomechanical effects of different spacing distributions on the postoperative L1 vertebral body and the injected bone cement were evaluated.

RESULTS

In this paper, we found that the Von Mises stress of the L1 vertebrae was the smallest when the spacing between the upper boundary of the bone cement and the vertebral body's upper endplates was 0 mm. The larger the spacing in a certain range between the upper boundary of the bone cement and the vertebral body's upper endplates, the greater the Von Mises stress of the L1 vertebrae. However, in the stress comparison of the injected bone cement, the Von Mises stress of the bone cement was greatest when the spacing between the upper boundary of the bone cement and the upper endplate of the vertebral body was 0 mm; the larger the spacing, the smaller the Von Mises stress.

CONCLUSION

When the contact spacing between the upper boundary of the bone cement and the upper endplate of the vertebral body is 0 mm, it can effectively eliminate and transfer the pressure caused by the load, thus reducing the stress on the cancellous bone and further reducing the risk of vertebral refracture after surgery.

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Cho CH, Hwang SW, Mazanec DJ, O'Toole JE, Watters WC, Annaswamy TM, Brook AL, Cheng DS, Christie SD, Cupler ZA, Enix DE, Eskay-Auerbach M, Goehl JM, Jones GA, Kalakoti P, Kasliwal MK, Kavadi NU, Kilincer C, Lantz JM, Rahmathulla G, Reinsel T, Shaw KA, Abdelgawaad AS, Skuteris AM, Stone JA, Strayer AL, Vo AN. Guideline summary review: An evidence-based clinical guideline for the diagnosis and treatment of adults with osteoporotic vertebral compression fractures. Spine J 2025:S1529-9430(25)00066-X. [PMID: 39894268 DOI: 10.1016/j.spinee.2025.01.016] [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: 10/23/2024] [Revised: 12/19/2024] [Accepted: 01/09/2025] [Indexed: 02/04/2025]

Abstract

BACKGROUND CONTEXT

The North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Adults with Osteoporotic Vertebral Compression Fractures features evidence-based recommendations for diagnosing and treating adult patients with osteoporotic vertebral compression fractures. The guideline is intended to reflect contemporary treatment concepts for osteoporotic vertebral compression fractures as reflected in the highest quality clinical literature available on this subject as of September 2020.

PURPOSE

The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with osteoporotic vertebral compression fractures. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition.

STUDY DESIGN

This is a guideline summary review.

METHODS

This guideline is the product of NASS' Clinical Practice Guidelines Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with a medical librarian. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guideline was submitted to an internal and external peer review process and ultimately approved by the NASS Board of Directors.

RESULTS

Twenty-nine clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature.

CONCLUSIONS

The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with osteoporotic vertebral compression fractures. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at http://www.spine.org/guidelines.

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Affiliation(s)

Charles H Cho Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Steven W Hwang Shriners Children's Philadelphia, Philadelphia, PA, USA
Daniel J Mazanec Cleveland Clinic, Cleveland, OH, USA
John E O'Toole Rush University Medical Center, Chicago, IL, USA
William C Watters University of Texas Medical Branch, Houston, TX, USA
Thiru M Annaswamy Penn State Health Milton S. Hershey Medical Center and Penn State College of Medicine, Hrshey, PA, USA
Allan L Brook Montefiore Medical Center, Bronx, NY, USA
David S Cheng VA Long Beach Healthcare System, Long Beach, CA, USA
Sean D Christie Dalhousie University and Nova Scotia Health, Halifax, NS, Canada
Zachary A Cupler Butler VA Health Care System, Butler, PA, USA
Dennis E Enix St. Louis, MO, USA
Marjorie Eskay-Auerbach Tucson, AZ, USA
Justin M Goehl Dartmouth Health, Lebanon, NH, USA
G Alexander Jones Endeavor Health, Elmhurst, IL, USA
Piyush Kalakoti Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Surgery, Yale School of Medicine, New Haven, CT, USA
Manish K Kasliwal University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA
Niranjan U Kavadi Oklahoma City VA Medical Center, Department of Orthopedic Surgery University of Oklahoma Health Sciences, Oklahoma City, OK, USA
Cumhur Kilincer Trakya University Faculty of Medicine, Neurosurgery Department, Edirne, Turkey
Justin M Lantz Division of Biokinesiology and Physical Therapy, Department of Family Medicine, University of Southern California, Los Angeles, CA, USA
Gazanfar Rahmathulla Mayo Clinic Health System, WI, Eau Claire, WI, USA
Tom Reinsel Cincinnati VA Medical Center, Cincinnati, OH, USA
K Aaron Shaw Children's Mercy Kansas City, Kansas City, MO, USA
Ahmed Shawky Abdelgawaad Spine Center, Helios Hospitals Erfurt, Erfurt, Germany; Department of Orthopedics and Trauma, Assiut University Hospitals, Assiut, Egypt
Amy M Skuteris North American Spine Society, Burr Ridge, IL, USA
Jeffrey A Stone Mayo Clinic Florida, Jacksonville, FL, USA
Andrea L Strayer Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, IA, USA;; VA Quality Scholar, VA Iowa City Healthcare System, Iowa City, IA, USA
Andrew N Vo Orthopaedic Associates of Wisconsin, Pewaukee, WI, USA

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Zhu Y, Chen H, Li L, Yang Y, Jia Y, Liu C, Xu X, Ruan J, Wang B, Liu J. A relevant investigation of the degree of cement diffusion after robot-assisted percutaneous vertebroplasty. BMC Musculoskelet Disord 2025;26:77. [PMID: 39844119 PMCID: PMC11753145 DOI: 10.1186/s12891-025-08315-6] [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: 05/15/2024] [Accepted: 01/09/2025] [Indexed: 01/24/2025] Open

Shen S, You X, Ren Y, Ye S. Adjacent Vertebral Refracture Prediction Model Based on Imaging Data After Vertebroplasty for Osteoporotic Vertebral Compression Fracture. World Neurosurg 2024;190:e548-e553. [PMID: 39074585 DOI: 10.1016/j.wneu.2024.07.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024]

Xu H, Tian F, Liu Y, Liu R, Li H, Gao X, Ju C, Lu B, Wu W, Wang Z, Zhu L, Hao D, Jia S. Magnesium malate-modified calcium phosphate bone cement promotes the repair of vertebral bone defects in minipigs via regulating CGRP. J Nanobiotechnology 2024;22:368. [PMID: 38918787 PMCID: PMC11197294 DOI: 10.1186/s12951-024-02595-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open

Abstract

Active artificial bone substitutes are crucial in bone repair and reconstruction. Calcium phosphate bone cement (CPC) is known for its biocompatibility, degradability, and ability to fill various shaped bone defects. However, its low osteoinductive capacity limits bone regeneration applications. Effectively integrating osteoinductive magnesium ions with CPC remains a challenge. Herein, we developed magnesium malate-modified CPC (MCPC). Incorporating 5% magnesium malate significantly enhances the compressive strength of CPC to (6.18 ± 0.49) MPa, reduces setting time and improves disintegration resistance. In vitro, MCPC steadily releases magnesium ions, promoting the proliferation of MC3T3-E1 cells without causing significant apoptosis, proving its biocompatibility. Molecularly, magnesium malate prompts macrophages to release prostaglandin E2 (PGE2) and synergistically stimulates dorsal root ganglion (DRG) neurons to synthesize and release calcitonin gene-related peptide (CGRP). The CGRP released by DRG neurons enhances the expression of the key osteogenic transcription factor Runt-related transcription factor-2 (RUNX2) in MC3T3-E1 cells, promoting osteogenesis. In vivo experiments using minipig vertebral bone defect model showed MCPC significantly increases the bone volume fraction, bone density, new bone formation, and proportion of mature bone in the defect area compared to CPC. Additionally, MCPC group exhibited significantly higher levels of osteogenesis and angiogenesis markers compared to CPC group, with no inflammation or necrosis observed in the hearts, livers, or kidneys, indicating its good biocompatibility. In conclusion, MCPC participates in the repair of bone defects in the complex post-fracture microenvironment through interactions among macrophages, DRG neurons, and osteoblasts. This demonstrates its significant potential for clinical application in bone defect repair.

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Affiliation(s)

Hailiang Xu Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China Shaanxi Key Laboratory of Spine Bionic Treatment, Xi'an, Shaanxi, 710054, China
Fang Tian Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China Shaanxi Key Laboratory of Spine Bionic Treatment, Xi'an, Shaanxi, 710054, China
Youjun Liu Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China Shaanxi Key Laboratory of Spine Bionic Treatment, Xi'an, Shaanxi, 710054, China
Renfeng Liu Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China Shaanxi Key Laboratory of Spine Bionic Treatment, Xi'an, Shaanxi, 710054, China
Hui Li Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China Shaanxi Key Laboratory of Spine Bionic Treatment, Xi'an, Shaanxi, 710054, China
Xinlin Gao Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China Shaanxi Key Laboratory of Spine Bionic Treatment, Xi'an, Shaanxi, 710054, China
Cheng Ju Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China Shaanxi Key Laboratory of Spine Bionic Treatment, Xi'an, Shaanxi, 710054, China
Botao Lu Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China Shaanxi Key Laboratory of Spine Bionic Treatment, Xi'an, Shaanxi, 710054, China
Weidong Wu Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China Shaanxi Key Laboratory of Spine Bionic Treatment, Xi'an, Shaanxi, 710054, China
Zhiyuan Wang Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China Shaanxi Key Laboratory of Spine Bionic Treatment, Xi'an, Shaanxi, 710054, China
Lei Zhu Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China. Shaanxi Key Laboratory of Spine Bionic Treatment, Xi'an, Shaanxi, 710054, China.
Dingjun Hao Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China. Shaanxi Key Laboratory of Spine Bionic Treatment, Xi'an, Shaanxi, 710054, China.
Shuaijun Jia Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, 710054, China. Shaanxi Key Laboratory of Spine Bionic Treatment, Xi'an, Shaanxi, 710054, China.

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Chen H, Li J, Wang X, Fu Y. Effects of robot-assisted percutaneous kyphoplasty on osteoporotic vertebral compression fractures: a systematic review and meta-analysis. J Robot Surg 2024;18:243. [PMID: 38847956 DOI: 10.1007/s11701-024-01996-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/26/2024] [Indexed: 06/13/2024]

Zhang TD, Cao S, Ren HY, Li YM, Yuan YM. Cemented vertebra and adjacent vertebra refractured in a chronic kidney disease-mineral and bone disorder patient: A case report. World J Clin Cases 2024;12:1804-1809. [PMID: 38660087 PMCID: PMC11036482 DOI: 10.12998/wjcc.v12.i10.1804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/05/2024] [Accepted: 03/08/2024] [Indexed: 04/02/2024] Open

Sui P, Yu T, Sun S, Chao B, Qin C, Wang J, Wang E, Zheng C. Advances in materials used for minimally invasive treatment of vertebral compression fractures. Front Bioeng Biotechnol 2023;11:1303678. [PMID: 37954022 PMCID: PMC10634476 DOI: 10.3389/fbioe.2023.1303678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open

Patel SK, Khan S, Dasari V, Gupta S. Beyond Pain Relief: An In-Depth Review of Vertebral Height Restoration After Balloon Kyphoplasty in Vertebral Compression Fractures. Cureus 2023;15:e46124. [PMID: 37900521 PMCID: PMC10612383 DOI: 10.7759/cureus.46124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open

An Y, Li L, Lin X, Zhang Z, Zheng Z, Wang C. Risk assessment for sandwich vertebral fractures in the treatment of osteoporosis vertebral compression fractures using two methods of bone cement reinforcement. J Orthop Surg Res 2023;18:524. [PMID: 37481567 PMCID: PMC10363326 DOI: 10.1186/s13018-023-04006-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023] Open

Abstract

PURPOSE

Bone cement augmentation surgery includes percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). In this study, we aimed to investigate the risk of sandwich vertebral fractures in the treatment of osteoporotic vertebral compression fractures via PVP and PKP.

METHODS

We performed a retrospective analytical study and included 61 patients with osteoporotic vertebral compression fractures who underwent PVP and PKP at the Spinal Surgery Department of The Second Hospital of Liaocheng Affiliated with Shandong First Medical University from January 2019 to January 2022. These patients were divided into the following two groups by simple random sampling: group A (N = 30) underwent PVP treatment and group B (N = 31) underwent PKP treatment. The surgical time, fluoroscopy frequency, visual analog scale (VAS) score, amount of bone cement, the leakage rate of bone cement in intervertebral space, Cobb angle, and the incidence of fractures in both groups of sandwich vertebral were recorded after 1 year of follow-up.

RESULTS

No statistically significant difference was found in terms of surgical time, fluoroscopy frequency, and VAS score between the two groups (P > 0.05). However, a statistically significant difference was found in terms of the amount of bone cement, the leakage rate of bone cement intervertebral space, Cobb angle, and the incidence of vertebral body fractures in both groups (P < 0.05). The amount of bone cement, the leakage rate of bone cement in intervertebral space, Cobb angle, and sandwich vertebral fractures were higher in Group A than in Group B.

CONCLUSIONS

When PVP and PKP were performed to treat osteoporotic vertebral compression fractures, the sandwich vertebral exhibited a risk of fracture. PVP exhibited a greater relative risk than PKP, which may be due to the relatively larger amount of bone cement, higher rate of bone cement leakage in the intervertebral space, and larger Cobb angle.

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Spicher A, Lindtner RA, Zegg MJ, Schmid R, Hoermann R, Schmoelz W. Pedicle screw augmentation in posterior constructs of the thoracolumbar spine: How many pedicle screws should be augmented? Clin Biomech (Bristol, Avon) 2023;106:106010. [PMID: 37245280 DOI: 10.1016/j.clinbiomech.2023.106010] [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: 02/10/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]

Chen H, Li J, Wang X, Fu Y. Effects of robot-assisted minimally invasive surgery on osteoporotic vertebral compression fracture: a systematic review, meta-analysis, and meta-regression of retrospective study. Arch Osteoporos 2023;18:46. [PMID: 37012510 DOI: 10.1007/s11657-023-01234-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 03/17/2023] [Indexed: 04/05/2023]

Abstract

OBJECTIVE

To conduct a systematic review on the effect of robot-assisted minimally invasive surgery (R-MIS) on the clinical outcomes and complications of patients with osteoporotic vertebral compression fractures (OVCFs).

METHODS

The researchers searched the papers published on PubMed, The Cochrane Library, Web of Science, Embase, Scopus, Ovid MEDLINE, Wiley Online Library, China National Knowledge Infrastructure (CNKI), Chinese biomedical literature service system (SinoMed), and China Medical Association Data. The standardized mean difference (SMD) or mean difference (MD), relative risk (RR), and 95% confidence interval (CI) were calculated. Besides, the data was merged through the random-effect model or common-effect model. A meta-regression mixed-effects single-factor model was utilized to analyze the sources of heterogeneity.

RESULTS

Twelve studies were included, involving 1042 OVCFs cases. The prognosis of patients treated with R-MIS was significantly improved, such as Oswestry disability index (ODI) score (MD = -0.65, P = 0.0171), Cobb's angles (MD = -1.03, P = 0.0027), X-ray fluoroscopy frequency (SMD = -2.41, P < 0.0001), Length of hospital stay (MD = -0.33, P = 0.0002), and Cement leakage (RR = 0.37, P < 0.0001). However, no obvious improvement was found in the results of Visual analog scale (VAS) score (MD = -0.16, P = 0.1555), Volume of bone cement (MD = 0.22, P = 0.8339), and Operation time (MD = -3.20, P = 0.3411) after being treated by R-MIS. The meta-regression analysis demonstrated that R-MIS presented no significant impact on the covariates of VAS and Operation time.

CONCLUSION

R-MIS can significantly reduce the patients' ODI, Cobb's angles, X-ray fluoroscopy frequency, and Cement leakage ratio, and shorten the Length of hospital stay. Therefore, R-MIS may be an effective method to promote the patients' functional recovery, correct spinal deformity, reduce the X-ray fluoroscopy frequency, shorten the Length of hospital stay, and reduce the complications of OVCFs bone Cement leakage.

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Correlation Analysis between Residual Pain after Vertebral Augmentation and the Diffusion Distribution of Bone Cement: A Retrospective Cohort Study. Pain Res Manag 2023;2023:1157611. [PMID: 36643939 PMCID: PMC9833933 DOI: 10.1155/2023/1157611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/04/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023]

Yang B, Zhao Y, Zhao Y. Analysis of clinical efficacy after PKP in patients of different genders. Medicine (Baltimore) 2022;101:e31785. [PMID: 36397329 PMCID: PMC9666168 DOI: 10.1097/md.0000000000031785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open

Abstract

OBJECTIVE

To investigate the clinical efficacy of Percutaneous Kyphoplasty (PKP) in male and female patients.

METHOD

The clinical data of patients treated with PKP in our hospital from January 2018 to October 2020 were analyzed retrospectively. These patients were divided into female group and male group according to gender differences. The visual analogue scale (VAS) and activity function score (LAS) were recorded before operation, immediately after operation and 1 year after operation, and postoperative complications such as cement leakage and recurrent vertebral fracture were recorded. The above observation indexes between the 2 groups were statistically compared.

RESULTS

A total of 171 patients (118 in female group and 53 in male group) were included. There was no other difference between the 2 groups except that thoracic vertebral fracture was more common in women (P < .05). The VAS of female group and male group were (7.14 ± 0.61) and (7.11 ± 0.51) before operation, (3.05 ± 0.66) and (2.89 ± 0.64) after operation, 1 year after operation (1.10 ± 0.50) and (1.02 ± 0.37). There was no difference in each period between the 2 groups (P > .05). But there was a significant decrease after operation, which was recognized between the 2 groups (P < .05); The activity scores of female group and male group were (3.08 ± 0.48) and (3.07 ± 0.43) before operation, (1.86 ± 0.42) and (1.85 ± 0.50) after operation, 1 year after operation (1.01 ± 0.92) and (1.02 ± 0.14). There was no difference in each period between the 2 groups (P > .05). But there was a significant decrease after operation, which was recognized between the 2 groups (P < .05). Postoperative cement leakage was revealed in 21 cases (12.28%), 16 cases (13.56%) in female group and 5 cases (9.43%) in male group, which was no significant difference between the 2 groups. During the 1-year follow-up, postoperative recurrent vertebral fracture was revealed in 4 cases (2.34%), 2 cases (1.69%) in the female group and 2 case (3.77%) in the male group, which was also no significant difference between the 2 groups.

CONCLUSION

Patients treated with PKP can immediately get pain relief and activity function improvement. PKP is a safe and effective minimally invasive surgery for both female and male patients.

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Luo AJ, Liao JC, Chen LH, Lai PL. High viscosity bone cement vertebroplasty versus low viscosity bone cement vertebroplasty in the treatment of mid-high thoracic vertebral compression fractures. Spine J 2022;22:524-534. [PMID: 34958934 DOI: 10.1016/j.spinee.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 02/03/2023]

Abstract

BACKGROUND CONTEXT

As science and technology have advanced, novel bone cements with numerous formulated ingredients have greatly evolved and been commercialized for vertebroplasty. Recently, viscosity has been a focus to achieve better clinical outcomes and fewer complications. Meanwhile, the experience in the treatment of mid (T7-9) to high (T4-6) thoracic vertebral compression fractures is limited.

PURPOSE

The objective of this study was to identify the different outcomes between high-viscosity bone cement (HVBC) and low-viscosity bone cement (LVBC) used to repair mid (T7-9)- and high (T4-6)- thoracic vertebral compression fractures.

STUDY DESIGN/SETTING

This study was a single-center, retrospective cohort study PATIENT SAMPLE: A consecutive series of 107 patients with a total of 144 vertebrae was included.

OUTCOME MEASURES

The anterior vertebral height (AVH), middle vertebral height (MVH), posterior vertebral height (PVH), local kyphotic angle (KA), Cobb angle (CA), and other associated parameters were evaluated radiologically at several time points-preoperative, surgery day 0, postoperative day 1, and 6-month follow-up. Pain evaluation was assessed by using a visual analog scale (VAS) before and 6 months after the procedure.

METHODS

The patients were divided into two groups according to the viscosity of the bone cement used, and plain film and magnetic resonance imaging (MRI) of the vertebrae were used to calculate parameters. The patient characteristics; bone cement brand; changes in AVH, MVH, PVH, KA, CA, and VAS; and complications of each patient were recorded and then analyzed.

RESULTS

Both groups showed increased vertebral body height, corrected KA, and CA after vertebroplasty. There were no significant differences between the HVBC and LVBC groups (ΔAVH: 2.19±2.60 vs. 2.48±3.09, p=.555; ΔMVH: 1.25±3.15 vs. 1.89±2.58, p=.192; ΔKA: -5.46±4.58 vs -5.37±4.47, p=.908; and ΔCA: -4.22±4.23 vs. -4.56±5.17, p=.679). There were significant preoperative to postoperative and preoperative to follow-up changes in AVH (HVBC, p=.012 and .046, respectively; LVBC, p=.001 and .015, respectively); a significant preoperative to postoperative change in MVH (HVBC, p=.045; LVBC, p=.001); and significant preoperative to postoperative and preoperative to follow-up changes in KA and CA (KA: HVBC, p=0.000 and .003, respectively; LVBC, p=.000 and .000, respectively; CA: HVBC, p=.017 and .047, respectively; LVBC, p=.006 and .034, respectively). The volume of cement injected was significantly higher with HVBC (3.66±1.36 vs. 3.11±1.53, p=.024), and the use of HVBC was associated fewer cases with cement leakage (26 vs. 45, p=.002). Furthermore, there was no difference between the groups in the incidence of adjacent fracture. Both groups showed an improved VAS score at follow-up, with statistically greater improvement in the HVBC group (2.40±1.53 vs. 3.07±1.69, p=.014). Moreover, significantly fewer patients with a VAS score ≥ 3 were found in the HVBC group (22 vs. 39, p=.004) CONCLUSIONS: HVBC and LVBC are safe and effective to treat mid-to-high level thoracic vertebral compression fractures. Compared with LVBC, HVBC shows less cement leakage, a greater injection volume, and better postoperative pain relief.

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Dai C, Liang G, Zhang Y, Dong Y, Zhou X. Risk factors of vertebral re-fracture after PVP or PKP for osteoporotic vertebral compression fractures, especially in Eastern Asia: a systematic review and meta-analysis. J Orthop Surg Res 2022;17:161. [PMID: 35279177 PMCID: PMC8917756 DOI: 10.1186/s13018-022-03038-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/02/2022] [Indexed: 01/10/2023] Open

Abstract

Objective

Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat osteoporotic vertebral compression fractures (OVCF), but the risk of vertebral re-fracture after PVP/PKP remains controversial. This study aims to investigate the incidence and risk factors of vertebral re-fracture after PVP/PKP.

Methods

Relevant literatures published up to November 2021 were collected from PubMed, Embase and Web of Science. A meta-analysis was performed to extract data associated with risk factors of SVCF following the PRISMA guidelines. Also, pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence interval (CI) was calculated.

Results

A total of 23 studies, encompassing 9372 patients with OVCF, met the inclusion criteria. 1255 patients (13.39%) suffered re-fracture after PVP/PKP surgery. A total of 22 studies were from Eastern Asia and only 1 study was from Europe. Female sex (OR = 1.34, 95%CI 1.09–1.64, P = 0.006), older age (WMD = 2.04, 95%CI 0.84–3.24, P = 0.001), lower bone mineral density (BMD, WMD = − 0.38, 95%CI − 0.49–0.26, P < 0.001) and bone cement leakages (OR = 2.05, 95% CI 1.40–3.00, P < 0.001) increased the risk of SVCF. The results of subgroup analysis showed the occurrence of re-fracture was significantly associated with gender (P = 0.002), age (P = 0.001) and BMD (P < 0.001) in Eastern Asia. Compared with the unfractured group, anterior-to-posterior vertebral body height ratio (AP ratio, WMD = 0.06, 95%CI 0.00–0.12, P = 0.037) and visual analog scale score (VAS, WMD = 0.62, 95%CI 0.09–1.15, P = 0.022) were higher in the refracture group, and kyphotic angle correction ratio (Cobb ratio, WMD = − 0.72, 95%CI − 1.26–0.18, P = 0.008) was smaller in Eastern Asia. In addition, anti-osteoporosis treatment (OR = 0.40, 95% CI 0.27–0.60, P < 0.001) could be a protective factor.

Conclusion

The main factors associated with re-fracture after PVP/PKP are sex, age, bone mineral density, AP ratio, Cobb ratio, VAS score, bone cement leakage and anti-osteoporosis treatment, especially in Eastern Asia.

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Li J, Liu Y, Peng L, Liu J, Cao ZD, He M. Intervertebral bridging ossification after kyphoplasty in a Parkinson’s patient with Kummell’s disease: A case report. World J Clin Cases 2022;10:677-684. [PMID: 35097094 PMCID: PMC8771369 DOI: 10.12998/wjcc.v10.i2.677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/01/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open

Abstract

BACKGROUND

The short-term therapeutic efficacy of kyphoplasty on Kummell’s disease is obvious. However, postoperative refracture and adjacent vertebral fracture occur occasionally and are difficult to treat. Parkinson's disease (PD) is a pathological disorder associated with heterotopic ossification. In a patient with PD, an intervertebral bridge was formed in a short period of time after postoperative refracture and adjacent vertebral fracture, providing new stability.

CASE SUMMARY

A 78-year-old woman had been suffering from PD for more than 10 years. Three months before operation, she developed lower back pain and discomfort. The visual analog scale (VAS) score was 9 points. Preoperative magnetic resonance imaging indicated collapse of the L2 vertebra. Kyphoplasty was performed and significantly decreased the severity of intractable pain. The patient’s VAS score for pain improved from 9 to 2. Fifty days postoperatively, the patient suddenly developed severe back pain, and the VAS score was 9 points. X-ray showed L2 vertebral body collapse, slight forward bone cement displacement, L1 vertebral compression fracture, and severe L1 collapse. The patient was given calcium acetate capsules 0.6 g po qd and alfacalcidol 0.5ug po qd, and bed rest and brace protection were ordered. After conservative treatment for 2 mo, the patient's back pain was alleviated, and the VAS score improved from 9 to 2. Computed tomography at the 7-mo follow-up indicated extensive callus formation around the T12-L2 vertebrae and intervertebral bridging ossification, providing new stability.

CONCLUSION

Kyphoplasty is currently a conventional treatment for Kummell's disease, with definite short-term effects. However, complications still occur in the long term, and these complications are difficult to address; thus, the treatment needs to be selected carefully. To avoid refracture, an interlaced structure of bone cement with trabeculae should be created to the greatest extent possible during the injection of bone cement. Surgical intervention may not be urgently needed when a patient with PD experiences refracture and adjacent vertebral fracture, as a strong bridge may help stabilize the vertebrae and relieve pain.

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Zhang T, Wang Y, Zhang P, Xue F, Zhang D, Jiang B. What Are the Risk Factors for Adjacent Vertebral Fracture After Vertebral Augmentation? A Meta-Analysis of Published Studies. Global Spine J 2022;12:130-141. [PMID: 33272041 PMCID: PMC8965299 DOI: 10.1177/2192568220978223] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open

Xu Z, Hao D, Dong L, Yan L, He B. Surgical options for symptomatic old osteoporotic vertebral compression fractures: a retrospective study of 238 cases. BMC Surg 2021;21:22. [PMID: 33407356 PMCID: PMC7789173 DOI: 10.1186/s12893-020-01013-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022] Open

Abstract

Background

Symptomatic osteoporotic vertebral compression fractures (OVCF) are increasing, as are acute and chronic pain episodes and progressive spinal deformities. However, there are no clear surgical treatment criteria for patients with these different symptoms. Therefore, this study aims to explore the surgical approaches for the treatment of OVCF with different symptoms and evaluate the feasibility of these surgical approaches.

Methods

We retrospectively analyzed 238 symptomatic OVCF patients who entered our hospital from June 2013 to 2016. According to clinical characteristics and imaging examinations, these patients were divided into I-V grades and their corresponding surgical methods were developed. I, old vertebral fracture with no apparent instability, vertebral augmentation; II, old vertebral fracture with local instability, posterior reduction fusion internal fixation; III, old fractures with spinal stenosis, posterior decompression and reduction fusion and internal fixation; IV, old vertebral fracture with kyphosis, posterior osteotomy with internal fixation and fusion; V, a mixture of the above types, posterior osteotomy (decompression) with internal fixation and fusion. Postoperative visual analog score (VAS), oswestry disability index (ODI) scores, sagittal index (SI) and ASIA grades of neurological function were observed.

Results

All 238 patients were followed up for 12–38 months, with an average follow-up of 18.5 months. After graded surgery, the VAS score, ODI score, and vertebral sagittal index SI of 238 patients were significantly improved, and the difference between the last follow-up results and the preoperative comparison was statistically significant (P ˂ 0.05). Besides, the postoperative ASIA grades of 16 patients with nerve injury were improved from 14 patients with preoperative grade C, 2 patients with grade D to 4 patients with postoperative grade D and 12 patients with postoperative grade E.

Conclusion

In this study, we concluded that graded surgery could better treat symptomatic old OVCF and restore spinal stability. This provides clinical reference and guidance for the treatment of symptomatic old OVCF in the future.

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Chen XS, Jiang JM, Sun PD, Zhang ZF, Ren HL. How the clinical dosage of bone cement biomechanically affects adjacent vertebrae. J Orthop Surg Res 2020;15:370. [PMID: 32867845 PMCID: PMC7457480 DOI: 10.1186/s13018-020-01906-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/20/2020] [Indexed: 01/29/2023] Open

Wu HL, Zheng BW, Liu FS, Wang XB, Lv GH, Li J, Zou MX. Letter to the Editor Regarding: "Clinical, Radiographic, and Morphometric Risk Factors for Adjacent and Remote Vertebral Compression Fractures Over a Minimum Follow-up of 4 Years After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: Novel Three-dimensional Voxel-Based Morphometric Analysis". World Neurosurg 2020;139:661-663. [PMID: 32689669 DOI: 10.1016/j.wneu.2020.03.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 10/23/2022]