BACKGROUND:Diffusion conditions of bone cement in vertebral fracture line may be one of the main factors affecting the therapeutic effect of percutaneous vertebroplasty, but there are less related studies. OBJECTIVE:To study the effect of diffusion conditions of bone cement in vertebral fracture line on the therapeutic outcomes of percutaneous vertebroplasty. METHODS: CR and MRI data of 77 patients with T1-L2 osteoporotic vertebral compression fractures, 28 males and 49 females, aged 55-86 years, undergoing percutaneous vertebroplasty were analyzed. Al the patients were divided into test group (n=53, bone cement diffused wel in the vertebral fracture line) and control group (n=24, bone cement dispersion was unsatisfactory). Visual analogue scale, Oswestry disability index and Cobb angle change in the two groups were measured and compared before and after operation. RESULTS AND CONCLUSION:There was no difference in the visual analogue scale score, Oswestry disability index and Cobb angle between the two groups before operation, but these parameters were al improved significantly in the two groups after 2 days and 6 months of operation (P< 0.05). The visual analogue scale score and Oswestry disability index were significantly lower in the test group than the control group at 2 days after operation (P < 0.05), but there was no difference between the two groups at 6 months after operation. The Cobb angle and vertebral colapse rate became lower in the test group than the control group at 6 months after operation (P < 0.05), but there was no difference in the re-fracture rate between the two groups. These findings indicate that poor bone cement dispersion in the fracture line can affect the relief of short-term pain and dysfunction and it can increase the possibility of long-term secondary vertebral colapse.

BACKGROUND:Whether there is a necessary connection or internal patterns between the amount of bone cement-recovery of vertebral height-clinical efficacy has no evidence-based medicine findings in the treatment of osteoporotic vertebral compression fractures using percutaneous vertebroplasty with high-viscosity bone cement injection.
OBJECTIVE: To observe the change of vertebral height in the elderly with osteoporotic vertebral compression fractures after percutaneous vertebroplasty with high-viscosity bone cement injection.
METHODS:A total of 110 elderly patients with osteoporotic vertebral compression fractures (139 vertebrae) were admitted at the Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region from January 2011 to December 2012. Al the patients received percutaneous vertebroplasty by the same group of surgeons. Bone cement at drawing stage was injected into the fractured vertebra. During the 12-month folow-up, visual analogue scale, Barthel index and vertebral height restoration were observed as evaluation indexes.
RESULTS AND CONCLUSION:The surgical treatment was done successfuly in the 110 patients (139 vertebrae). The amount of bone cement per vertebra was 3-6 mL, with a mean of 3.5 mL. At 12 months after surgery, the visual analog scale scores were decreased from 7.9 to 1.8, Barthel index was increased from 40.25 to 82.21, both of which were improved significantly (P < 0.05). After surgery, the vertebral heights at the anterior and middle parts were increased by (81.25±9.26)% and (78.22±10.65)%, respectively, and there was significant differences before ant at 24 hours, 3 months and 12 months after surgery (P < 0.05). During the folow-up, there were five vertebrae with bone cement leakage, but no clinical symptoms occurred, and no nerve injury or pulmonary embolism happened. These findings indicate that percutaneous vertebroplasty with high-viscosity bone cement injection can effectively relieve pain, restore the vertebral height, reduce the incidence of complications and shorten the recovery time in patients with osteoporotic vertebral compression fractures.

Objective Retrospective study and report on cases of "symptomatic facet of residual bone mass" caused by percutaneous transforaminal endoscopic discectomy (PTED),to analysis of its causes and revision strategies.Methods Seven cases of "symptomatic facet of residual bone mass" after PTED were found in six medical centers from July 2015 to November 2017.Weintroduced the course of diagnosis and treatment,to analysis of the causes,clinical features and revision strategies of the rare complication.Results Seven patients came from different medical centers (2 cases in Ningbo No.6 Hospital and 1 case in each of the other medical centers).The average age of the subject is 67.29±9.64 years (range from 57-83 years).Among them there were 1 male and 6 female.PTED was performed for all cases with lumbar disc herniation or stenosis.The operative segments were 1 of L2,3,2 of L3,4,3 of L4,5,1 of L5S1.Symptoms occurred immediately after surgery in all cases except one after a week of operation and another one month later.Two cases were appeared symptom of contralateral irritation,and the rest were aggravated by the original symptoms.Two cerebrospinal fluid leakage caused by bone mass piercing the dural sac.The bone mass compressed the nerve root and caused 1 case of lower limb muscle weakness.Foraminoplasty was performed during PTED in all patients.After CT scan,5 cases of bone mass were found on the same side of operation,and 2 cases were in the contralateral side.The shortest time for revision was 2 days and the longest 3 months.After conservative treatment,the symptoms were relieved in only one case.Revision surgeries were performed for all the other 6 cases,2 with microendoscopic discectomy (MED),1 mobile microendoscopic discectomy (MMED),1 small incision operation,1 PTED and 1 with minimal invasive surgery of transforaminal lumbar intervertebral fusion (MIS-TLIF).The VAS scores of low back pain and leg pain was significantly relieved from 8.67±0.52 to 1.50±0.55.Conclusion FTED may lead to residual bone mass in lumbar foraminoplasty.The penetration of the bone mass block into the spinal canal can cause the compression symptoms of the corresponding segment.The patients showed the corresponding spinal canal stenosis and nerve root irritation symptoms.A revision operation is required to remove the oppressed bone mass to relieve the symptoms as soon as possible if the conservative treatment not effective.