Objective To evaluate the effectiveness of Confidence high viscosity bone cement system and postural reduction in treating acute severe osteoporotic vertebral compression fracture (OVCF). Methods Between June 2004 and June2009, 34 patients with acute severe OVCF were treated with Confidence high viscosity bone cement system and postural reduction. There were 14 males and 20 females with an average age of 72.6 years (range, 62-88 years). All patients had single thoracolumbar fracture, including 4 cases of T11, 10 of T12, 15 of L1, 4 of L2, and 1 of L3. The bone density measurement showed that T value was less than —2.5. The time from injury to admission was 2-72 hours. All cases were treated with postural reduction preoperatively. The time of reduction in over-extending position was 7-14 days. All patients were injected unilaterally. The injected volume of high viscosity bone cement was 2-6 mL (mean, 3.2 mL). Results Cement leakage was found in 3 cases (8.8%) during operation, including leakage into intervertebral space in 2 cases and into adjacent paravertebral soft tissue in 1 case. No cl inical symptom was observed and no treatment was pearformed. No pulmonary embolism, infection, nerve injury, or other complications occurred in all patients. All patients were followed up 12-38 months (mean, 18.5 months). Postoperatively, complete pain rel ief was achievedin 31 cases and partial pain refief in 3 cases; no re-fracture or loosening at the interface occurred. At 3 days after operation and last follow-up, the anterior and middle vertebral column height, Cobb angle, and visual analogue scale (VAS) score were improved significantly when compared with those before operation (P lt; 0.05)；and there was no significant difference between 3 days and last follow-up (P gt; 0.05). Conclusion Confidence high viscosity bone cement system and postural reduction can be employed safely in treating acute severe OVCF, which has many merits of high viscosity, long time for injection, and easy-to-control directionally.
ObjectiveEvaluating the clinical efficacy of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) for osteoporotic vertebral compressive fracture (OVCF). MethodsPatients with OVCF were retrospectively analyzed from Feb. 2008 to Feb. 2013 in Department of Orthopaedics, Tianjin Medical University General Hospital. Patients were divided into the PVP group and the PKP group. The VAS, vertebral kyphosis angle, vertebral height and bone cement leakage of both groups were compared, and the SPSS13.0 software was used for data analysis. ResultsA total of 55 patients were included. Of which, 25 patients were in the PVP group and 30 patients were in the PKP group. All patients were followed up from 5 to 20 months, with an average time of 15.5 months. The VAS scores in both groups were all improved after the operation (P<0.05), but no significant difference was found between both groups. The vertebral kyphosis angle in both groups were improved after the operation (P<0.05), and the PKP group was better than the PVP group. Six patients in the PVP group occurred the leakage of bone cement, and 4 patients in the PKP group. Five patients in the PVP groups occurred vertebral fracture again, while 7 patients in the PKP group. ConclusionUsing PVP and PKP for the treatment of OVCF can quickly relieve pain and increase the stability of the vertebral body. PKP can restore vertebral body height better and reduce the incidence of cement leakage.
ObjectiveTo investigate the risk factors of adjacent fractures after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF).MethodsA total of 2 216 patients who received PVP due to symptomatic OVCF between January 2014 and January 2017 and met the selection criteria were selected as study subjects. The clinical data was collected, including gender, age, height, body mass, history of smoking and drinking, whether the combination of hypertension, diabetes, coronary arteriosclerosis, chronic obstructive pulmonary disease (COPD), bone mineral density, the number of fractured vertebrae, the amount of cement injected into single vertebra, the cement leakage, and whether regular exercise after operation, whether regular anti-osteoporosis treatment after operation. Firstly, single factor analysis was performed on the observed indicators to preliminarily screen the influencing factors of adjacent fractures after PVP. Then, logistic regression analysis was carried out for relevant indicators with statistical significance to screen risk factors.ResultsAll patients were followed up 12-24 months, with an average of 15.8 months. Among them, 227 patients (10.24%) had adjacent fractures. The univariate analysis showed that there were significant differences between the fracture group and non-fracture group in age, gender, preoperative bone density, history of smoking and drinking, COPD, the number of fractured vertebrae and the amount of bone cement injected into the single vertebra, as well as regular exercise after operation, regular anti-osteoporosis treatment after operation (P<0.05). Further multivariate logistic regression analysis showed that the elderly and female, history of smoking, irregular exercise after operation, irregular anti-osteoporosis treatment after operation, low preoperative bone density, large number of fractured vertebrae, and small amount of bone cement injected into the single vertebra were risk factors for adjacent fractures after PVP in OVCF patients (P<0.05).ConclusionThe risk of adjacent fractures after PVP increases in elderly, female patients with low preoperative bone mineral density, large number of fractured vertebrae, and insufficient bone cement injection. The patients need to quit smoking, regular exercise, and anti-osteoporosis treatment after PVP.
ObjectiveTo analyze the correlation between bone cement cortical leakage and injury degree of osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP), and to provide guidance for reducing clinical complications. Methods A clinical data of 125 patients with OVCF who received PKP between November 2019 and December 2021 and met the selection criteria was selected and analyzed. There were 20 males and 105 females. The median age was 72 years (range, 55-96 years). There were 108 single-segment fractures, 16 two-segment fractures, and 1 three-segment fracture. The disease duration ranged from 1 to 20 days (mean, 7.2 days). The amount of bone cement injected during operation was 2.5-8.0 mL, with an average of 6.04 mL. Based on the preoperative CT images, the standard S/H ratio of the injured vertebra was measured (S: the standard maximum rectangular area of the cross-section of the injured vertebral body, H: the standard minimum height of the sagittal position of the injured vertebral body). Based on postoperative X-ray films and CT images, the occurrence of bone cement leakage after operation and the cortical rupture at the cortical leakage site before operation were recorded. The correlation between the standard S/H ratio of the injured vertebra and the number of cortical leakage was analyzed. Results Vascular leakage occurred in 67 patients at 123 sites of injured vertebrae, and cortical leakage in 97 patients at 299 sites. Preoperative CT image analysis showed that there were 287 sites (95.99%, 287/299) of cortical leakage had cortical rupture before operation. Thirteen patients were excluded because of vertebral compression of adjacent vertebrae. The standard S/H ratio of 112 injured vertebrae was 1.12-3.17 (mean, 1.67), of which 87 cases (268 sites) had cortical leakage. The Spearman correlation analysis showed a positive correlation between the number of cortical leakage of injured vertebra and the standard S/H ratio of injured vertebra (r=0.493, P<0.001). ConclusionThe incidence of cortical leakage of bone cement after PKP in OVCF patients is high, and cortical rupture is the basis of cortical leakage. The more severe the vertebral injury, the greater the probability of cortical leakage.
ObjectiveTo compare the refracture risk between sandwich vertebrae and ordinary adjacent vertebrae, and to explore the risk factors related to refracture.MethodsRetrospective analysis was performed on the data of patients who received percutaneous vertebral augmentation (PVA) and formed sandwich vertebrae between April 2015 and October 2019. Of them, 115 patients were enrolled in the study. There were 27 males and 88 females with an average age of 73.9 years (range, 53-89 years). Univariate analysis was performed to analyzed the patients’ general data, vertebral augmentation related indexes, and sandwich vertebrae related indexes. Survival analysis was performed for all untreated vertebrae at T4-L5 of the included patients at the vertebra-specific level, and risk curves of refracture probability of untreated vertebrae between sandwich vertebrae and ordinary adjacent vertebrae were compared. Cox’s proportional hazards regression model was used to analyze risk factors for refracture.ResultsThe 115 patients were followed up 12.6-65.9 months (mean, 36.2 months). Thirty-seven refractures involving 51 vertebral bodies occurred in 31 patients. The refracture rate of 27.0% (31/115) in patients with sandwich vertebrae was significantly higher than that of 15.2% (187/1228) in all patients who received PVA during the same period (χ2=10.638, P=0.001). Univariate analysis results showed that there was a significant difference in the number of augmented vertebrae between patients with and without refractures (Z=0.870, P=0.004). However, there was no significant difference in gender, age, body mass index, whether had clear causes of fracture, whether had dual energy X-ray absorptiometry testing, whether the sandwich vertebra generated through the same PVA, puncture method, method of PVA, number of PVA procedures, number of vertebrae with old fracture, whether complicated with spinal deformity, bone cement distribution, and kyphosis angle of sandwich vertebral area (P>0.05). Among the 1 293 untreated vertebrae, there were 136 sandwich vertebrae and 286 ordinary adjacent vertebrae. The refracture rate of sandwich vertebrae was 11.3% which was higher than that of ordinary adjacent vertebrae (6.3%)(χ2=4.668, P=0.031). The 1- and 5-year fracture-free probabilities were 0.90 and 0.87 for the sandwich vertebrae, and 0.95 and 0.93 for the ordinary adjacent vertebrae, respectively. There was a significant difference between the two risk curves of refracture (χ2=4.823, P=0.028). Cox’s proportional hazards regression model analysis results showed that the sandwich vertebrae, thoracolumbar location, the number of the augmented vertebrae, and the unilateral puncture were significant risk factors for refracture (P<0.05).ConclusionThe sandwich vertebrae has a higher risk of refracture when compared with the ordinary adjacent vertebrae, and its 1- and 5-year fracture-free probabilities are lower than those of the ordinary adjacent vertebrae. However, the 5-year fracture-free probability of sandwich vertebrae is still 0.87, so prophylactic enhancement is not recommended for all sandwich vertebrae. In addition, the sandwich vertebrae, thoracolumbar location, the number of the augmented vertebrae, and the unilateral puncture were important risk factors for refracture.
Objective To explore the feasibility and effectiveness of vertebroplasty with reverse designed unilateral targeted puncture in treatment of osteoporotic vertebral compression fracture (OVCF) by comparing with curved unilateral puncture. Methods A total of 52 patients with OVCF met selection criteria and were admitted between January 2019 and June 2021 were selected as the research objects. According to the random number table method, they were divided into two groups (n=26). In trial group, the reverse designed unilateral targeted puncture was used in the percutaneous vertebroplasty (PVP); while the control group used the curved unilateral puncture. There was no significant difference in gender, age, bone mineral density (T value), cause of injury, time from injury to operation, the level of responsible vertebral body, pedicle diameter of the planned puncture vertebral body, and preoperative visual analogue scale (VAS) score, anterior vertebral height, and Cobb angle between the two groups (P>0.05). The operation time, bone cement injection volume and leakage, intraoperative radiation exposure times, and hospitalization costs in the two groups were recorded. VAS score was used to evaluate the relief degree of low back pain after operation. X-ray film was used to review the diffusion degree of bone cement in the responsible vertebral body, and Cobb angle and anterior vertebral height were measured. Results The operation was successfully completed in the two groups. Patients in the two groups were followed up 12-18 months, with an average of 13.6 months. The operation time, volume of injected bone cement, intraoperative radiation exposure times, and hospitalization costs in the trial group were significantly lower than those in the control group (P<0.05). With the prolongation of time, the low back pain of the two groups gradually relieved, and the VAS score significantly decreased (P<0.05). And there was no significant difference in VAS score between the two groups at each time point (P>0.05). There were 2 cases (7.6%) of bone cement leakage in the trial group and 3 cases (11.5%) in the control group, and no significant difference was found in the incidence of bone cement leakage and the diffusion degree of bone cement between the two groups (P>0.05). Imaging examination showed that compared with pre-operation, the anterior vertebral height of the two groups significantly increased and Cobb angle significantly decreased at 2 days and 1 year after operation (P<0.05); while compared with 2 days before operation, the anterior vertebral height of the two groups significantly decreased and Cobb angle significantly increased at 1 year after operation (P<0.05). There was no significant difference in the above indexes between the two groups at different time points after operation (P>0.05). Conclusion Compared with curved unilateral puncture, the use of reverse designed unilateral targeted puncture during PVP in the treatment of OVCF can not only achieve similar effectiveness, but also has the advantages of less radiation exposure, shorter operation time, and less hospitalization costs.
ObjectiveTo compare the effectiveness of percutaneous kyphoplasty (PKP) between by unilateral approach and by bilateral approaches for treating mid-thoracic osteoporotic vertebral compression fracture (OVCF). MethodA prospective randomized controlled study was performed on 22 patients with mid-thoracic OVCF between September 2012 and June 2014. PKP was performed by unilateral approach in 11 cases (group A) and by bilateral approaches in 11 cases (group B). There was no significant difference in gender, age, causes of injury, disease duration, affected segment, preoperative bone mineral density, Cobb angle, compression rate of the anterior verterbral height, and Visual analogue scale (VAS) score between 2 groups (P>0.05) . The operation time, perspective times, hospitalization expenses, the leakage of cement, the sagittal Cobb angle, compression rate of the anterior vertebral height, and VAS scores were compared between 2 groups. ResultsThe operation time, perspective times, and hospitalization expenses of group A were significantly less than those of group B (P<0.05) . Twenty-two patients were followed up 13-34 months (mean, 15.3 months). Primary healing of incision was obtained in all patients, and no early complication of cement leakage, hypostatic pneumonia, or deep vein thrombosis occurred. At last follow-up, no new fracture occurred at the adjacent segments. The Cobb angle, compression rate of anterior verterbral height, and VAS score at 1 week and last follow-up were significantly improved when compared with preoperative ones in 2 groups (P<0.05) , but no significant difference was found between at 1 week and at last follow-up (P>0.05) . There was no significant difference in Cobb angle, compression rate of the anterior vertebral height, and VAS score between 2 groups at each time point (P>0.05) . ConclusionsPKP by both unilateral approach and bilateral approaches has the same effectiveness, but unilateral approach has shorter operation time, less perspective times, and less hospitalization expenses than bilateral approaches.
Osteoporotic vertebral compression fractures (OVCFs) are common in elderly patients with reduced bone density. Pain and loss of function after fractures have a serious impact on the patient's activities of daily living and quality of life. Management of patients with early OVCFs who choose non-surgical treatment is necessary to prevent complications, relieve pain, and improve functional status. This paper focuses on the development of OVCFs non-surgical management in many aspects, which may provide reference for the rapid recovery of OVCFs patients in the process of non-surgical management.
ObjectiveTo review the latest progress in minimally invasive treatment of osteoporotic vertebral compression fracture (OVCF). MethodsRelevant literature on minimally invasive treatment of OVCF was reviewed, different minimally invasive technologies were analyzed, compared, and future prospected. ResultsThere are various minimally invasive technologies for treatment of OVCF to aim at analgesia, deformity correction, and vertebral stabilization, thus improving the patients' quality of life. Percutaneous vertebroplasty as the classical technology has a good effectiveness on analgesia, while percutaneous kyphoplasty has a better performance in vertebral height restoration and a lower complication of cement leakage. Obvious deformity correction can be achieved by skyphoplasty, with a risk of endplate damage and uncertain vertebral height maintenance. With OptiMesh vertebroplasty, physiological environment within the fractured vertebra is less likely to be disturbed, but paravertebral tissues are more vulnerable due to a bigger working cannal. Compared with traditional bone cement, Cortoss has advantages of less toxicity, less heat release, and proper stiffness. In addition, the combination use of different minimally invasive technologies has greatly extended the surgical indications of OVCF and improved the success rate. ConclusionMinimally invasive treatment of OVCF is becoming more safety and efficacy with the development of new material and technology, however, further studies are required for quality confirmation and better improvement.
Objective To investigate the epidemiological and clinical characteristics of patients with thoracolumbar osteoporotic vertebral compression fracture (OVCF) treated by percutaneous vertebroplasty (PVP). MethodsThe clinical and imaging data of 681 patients with thoracolumbar OVCF treated with PVP between January 2017 and December 2021 were collected. The epidemiological and clinical characteristics of the patients with thoracolumbar OVCF in single center were summarized from the aspects of demographic distribution (mainly including gender, age), fracture characteristic analysis [including pathological segments, bone mineral density, and body mass index (BMI)], and operation related results (including the distribution of unilateral and bilateral puncture and bone cement injection, postoperative effectiveness analysis and refracture). ResultsOf the 681 patients, 134 (19.68%) were male and 547 (80.32%) were female, with a male-to-female ratio of 1∶4.08. The age ranged from 53 to 105 years, with an average of 75.3 years. The age group of 60-90 years old had the largest number of patients (91.04%); the high incidence age group of men was 70-90 years old (13.95%), and that of women was 60-80 years old (72.98%). A total of 836 vertebrae were involved, and the morbidity of thoracolumbar vertebrae (T11-L1) was the highest (56.34%, 471/836). The main type of fracture was compression fracture (92.58%, 774/836) and Kümmell disease (7.42%, 62/836). There were 489 cases (71.81%) of osteoporosis, including 66 males and 423 females, with a male-to-female ratio of 1∶6.42. There was significant difference in distribution of bone mineral density between male and female groups (Z=–5.810, P<0.001). BMI showed 206 cases (30.25%) of underweight, 347 (50.95%) cases of normal, 58 cases (8.52%) of overweight, 42 cases (6.17%) of obese, and 28 cases (4.11%) of extremely obese. The difference in BMI distribution between male and female groups was significant (Z=–2.220, P=0.026). Of 836 vertebral bodies, 472 (56.46%) were punctured unilaterally and 364 (43.54%) bilaterally. Most of the vertebral bodies (49.88%, 417/836) were injected with 5.0-6.9 mL bone cement, and most of them were distributed in thoracolumbar and lumbar vertebral bodies (T11-L3). The visual analogue scale (VAS) score and Oswestry disability index (ODI) of patients with unilateral puncture and bilateral puncture significantly improved at 6 months after operation (P<0.001), and also the difference was significant between the two groups in the difference of pre- and post-operation (P<0.001). There were 628 cases (92.22%) with the first occurrence of OVCF, and 53 cases (7.78%) with two or more times of OVCF, all of which were female patients, and 26 cases (49.06%) occurred in the adjacent segment of the previous PVP operation. ConclusionFemale were more than male in OVCF patients. Thoracolumbar vertebral body has the highest morbidity. Patients with low BMI are more likely to have osteoporosis, and patients with high BMI have a higher risk of compression fracture. The amount of bone cement injected through bilateral puncture was greater than that through unilateral puncture.