OBJECTIVE: To evaluate the analgesic effect and application advantage of acupuncture combined with local anesthesia of lidocaine in percutaneous vertebroplasty (PVP) for the patients with osteoporotic vertebral compression fracture (OVCF). METHODS: A total of 60 patients with OVCF and receiving PVP at single vertebra under local anesthesia were selected and randomized into an acupuncture plus medication group and a simple medication group, 30 cases in each one. In the simple medication group, the local laying infiltration anesthesia with 1% lidocaine 30 mL was used. In the acupuncture plus medication group, firstly, filiform needles were used to stimulate Hegu (LI 4), Neiguan (PC 6), Jinmen (BL 63) and Yintang (GV 29) with reducing technique, and then the epidermal infiltration anesthesia was followed with 1% lidocaine 4 mL. The needles were retained till the end of operation. Successively, before operation (T RESULTS: In the acupuncture plus medication group, MAP and HR were lower than those in the simple medication group at T CONCLUSION Acupuncture combined with medication reduces the dose and adverse reactions of anesthetics, alleviates pain degree of patients, shortens the duration of operation and improves patients' subjective satisfaction in PVP for OVCF.
Analgesics ; Fractures, Compression/therapy* ; Humans ; Osteoporotic Fractures ; Spinal Fractures/therapy* ; Spine ; Treatment Outcome

Humans ; Fractures, Compression/surgery* ; Spinal Fractures/surgery* ; Multiple Myeloma/drug therapy* ; Vertebroplasty ; Osteoporotic Fractures/therapy* ; Treatment Outcome ; Bone Cements

OBJECTIVETo evaluate the clinical efficacy of manipulative reduction combined with percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) in treating osteoporotic vertebral compression fracture (OVCF) using meta-analysis method, in order to provide a reference for clinical treatment.

METHODSA systematic computer-based search (from January 1987 to April 2014) from CNKI, Wanfang database, Web of Science and PubMed were performed for the collection of controlled clinical researches on manipulative reduction combined with PVP or PKP in treating OVCF. The quality of selected researches was evaluated. Meta-analysis was adopted to evaluate visual analog scale, Cobb angle, anterior height ratio of the injured vertebra.

RESULTSA total of 7 researches of 410 patients were included in the present analysis, there were 5 RCTs and 2 non-RCTs and all come from China. Manipulative reduction combined with PVP could got better improvement in Cobb angle (WMD=-7.35; 95%CI: -12.15, -2.54) and anterior height ratio of the injured vertebra (P<0.01) than simple PVP, but no significant difference was found in improvement of visual analog scale (WMD=-0.01; 95%CI: -0.45, 0.42). There were no significant differences in the improvement of visual analog scale, Cobb angle, anterior height ratio of the injured vertebra between manipulative reduction combined with PKP and simple PKP (P>0.05).

CONCLUSIONCompared with simple PVP, manipulative reduction combined with PVP may result in more clinical efficacy on the improvement of Cobb angle and anterior ratio of the injured vertebra. And compared with simple PKP, manipulative reduction combined with PKP has no obvious advantages on the improvement of visual analog scale, Cobb angle, anterior height ratio of the injured vertebra. However, the number and quality of the literatures, may resulted in the effect of mistrust, so more large sample and high-quality RCTs are needed in future.

Combined Modality Therapy ; Fractures, Compression ; therapy ; Humans ; Manipulation, Spinal ; methods ; Minimally Invasive Surgical Procedures ; methods ; Osteoporotic Fractures ; therapy ; Spinal Fractures ; therapy

OBJECTIVE: Spinal myeloma has been treated with radiation therapy and chemotherapy. However, the role of surgery was not fully evaluated. This study is performed to evaluate the efficacy of surgery in the treatment of spinal myeloma. METHODS: 22 patients who were treated with surgery for spinal myeloma from August 1999 to April 2003 were analyzed. Radiological finding, surgical methods and result were reviewed in retrospective study. For compression fracture due to myeloma infiltration, percutaneous vertebroplasy(PVP) was done. Decompression surgery with or without fixation was performed for patients with neurologic deficit. The modalities of surgery consist of PVP (14 cases), corpectomy and fixation (7 cases), and laminectomy and epidural mass removal (3 cases). To evaluate clinical outcome, visual analogue pain score and Frankel neurological scale were used. RESULTS: In 14 cases of PVP, total 57 vertebral segments were treated including 21 thoracic vertebral bodies and 36 lumbar vertebral bodies. Pain relief was achieved in all cases. The pain score changed from 7.7 (preoperatively) to 2.5 (postoperatively). And pain relief effect was maintained over than one year. Frankel grade improved in decompression cases. CONCLUSION: Surgical treatment can alleviate pain and improve neurologic deficit immediately in spinal myeloma patients.
Decompression ; Drug Therapy ; Fractures, Compression ; Humans ; Laminectomy ; Neurologic Manifestations ; Retrospective Studies

OBJECTIVETo explore the methods and therapeutic efficacy of restitution combined with percutaneous vertebroplasty (PVP) for treating osteoporosis vertebral compression fracture (OVCF).

METHODSRecruited were 132 senile patients with OVCF who were willing to receive minimally invasive therapy were assigned to the comprehensive treatment group and the percutaneous kyphoplasty (PKP) group. The 89 vertebral bodies in the 68 cases of the comprehensive treatment group received restitution combined with PVP, while the 81 vertebral bodies in the 64 cases of the control PKP group received PKP alone. All patients completed the follow-ups for more than 3 years. The therapeutic efficacy was assessed using visual analogue scale (VAS), Oswestry disability index (ODI), Cobb's angle, the height ratios of the diseased vertebral anterior edge and middle edge. The operation time for a single centrum, the perspective time during the operation, the incidence of bone cement leakage, the injection rate of the bone cement, the cost of hospitalization, and the hospital days were compared between t he comprehensive treatment group and the PKP group.

RESULTSCompared with before treatment in the same group, the VAS and ODI were significantly lower, the height ratios of the diseased vertebral anterior edge and middle edge, and the Cobb's angle were obviously improved in the two groups, showing statistical difference (P < 0.01). There was no significant difference in the aforesaid indices between the two groups after treatment at the same time point (P > 0.05). There was no significant difference in the incidence of bone cement leakage, th e injection rate of the bone cement, or the hospital days between the two groups (P > 0.05). But the operation time f or individual vertebral body, the perspective time during the operation, and the cost of hospitalization were obviously less in the comprehensive treatment group than in the PKP group (P < 0.01).

CONCLUSIONSRestitution combined PVP could achieve the same therapeutic efficacy as that of the PKP. It could effectively restore the diseased vertebral height and correct the spinal kyphosis. Besides, there was no statistical difference in the incidence of bone cement leakage.

Aged ; Aged, 80 and over ; Female ; Fractures, Compression ; etiology ; therapy ; Humans ; Kyphoplasty ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Osteoporosis ; complications ; Posture ; Spinal Fractures ; etiology ; therapy ; Vertebroplasty ; methods

OBJECTIVETo compare the clinical efficacy of percutaneous kyphoplasty (PKP) with pedicle screw system (PS) in the treatment of vertebral compression fracture(VCF).

METHODSEighty-six patients with VCF were treated either by PKP (Group A, n equal to 30) or PS (Group B, n equal to 56). The anterior, intermediate, and posterior heights of the vertebrae body, visual analogue pain scale (VAS) before and after operation, the duration of operation, and amount of blood loss between two groups were compared.

RESULTSNo statistical difference was noted regarding the vertebral height between two groups. Significant difference was seen in VAS, duration of operation and amount of blood loss between the two groups (P less than 0.01).

CONCLUSIONSPercutaneous kyphoplasty has the similar therapeutic efficacy with pedicle screw system in treatment of VCF with a minimal invasion, less operation time and blood loss. For those with posterior wall destruction, PS is deemed favorable.

Adult ; Aged ; Bone Cements ; therapeutic use ; Bone Screws ; Female ; Fractures, Compression ; therapy ; Humans ; Internal Fixators ; Male ; Middle Aged ; Orthopedic Procedures ; Polymethyl Methacrylate ; therapeutic use ; Spinal Fractures ; therapy

Bone is a common metastatic site of cancer. Bone metastasis reduces life expectancy and results in serious symptoms and complications such as bone pain, pathological fractures, and spinal cord compression, decreasing quality of life by restricting sleep and mobility. Treatment for bone metastasis includes drugs (pure analgesics, hormones, cytotoxic chemotherapy, and bisphosphonates, among others), external radiation therapy, surgery, and radionuclide therapy using bone-targeting radiopharmaceuticals. Particulate radiation with α- or β-rays is used as a bone-targeting radiopharmaceutical in radionuclide therapy. β-Emitters have lower energy and a longer range than α-emitters and have less tumoricidal activity and deliver more radiation to adjacent normal tissue. Therefore, the main therapeutic effect of bone-targeting β-emitters such as ⁸⁹Sr-dichloride is bone pain palliation rather than enhanced survival. In contrast, α-emitters such as ²²³Ra-dichloride have high energy and a short range, resulting in greater tumoricidal activity and less radiation damage to adjacent normal tissue. Treatment with bone-targeting α-emitters can improve survival and decrease bone pain. This review focuses on the principles and clinical utility of several clinically available bone-targeting radiopharmaceuticals in metastatic bone disease.
Analgesics ; Bone Diseases ; Diphosphonates ; Drug Therapy ; Fractures, Spontaneous ; Life Expectancy ; Neoplasm Metastasis ; Quality of Life ; Radiopharmaceuticals ; Spinal Cord Compression

OBJECTIVETo evaluate the efficacy of conservative treatment with teriparatide for promoting bone fracture healing in patients with osteoporotic vertebral fracture.

METHODSTwelve postmenopausal patients (aged 73±4.8 years) with osteoporotic spinal fracture confirmed by MRI or CT scanning received conservative treatment with teriparatidesc injection supplemented with calcium and analgesics for 6 months. At the beginning and at the end of the therapy, VAS score, Oswestry Disability Index (ODI), bone mass densitometry, and X-ray of the thoracic and lumbar spine, and serum P1NP and beta-CTX levels were measured. Six of the patients received a second MRI scan after the therapy to evaluate the bone healing.

RESULTSAll the 12 patients completed the treatment, during which no new fractures or adverse events occurred. At the end of the first month of treatment, analgesic was withdrawn for all the patients. The average VAS score decreased from 8±2 to 1±2 at 1 month during the therapy, and ODI was reduced from (76±12)% to (20±5)% at 1 month and further to (5±4)% at 6 month. After the 6-month therapy, the height of the fractured vertebrae (presented as the anterior to posterior wall height ratio) was insignificantly decreased from (75±20)% to (61±20)%, the BMD was increased by (20±5)%, P1NP increased significantly from 20.9±11.4 ng/mL to 80.0±41.2 ng/mL, and beta-CTX increased from 0.30±0.17 ng/mL to 0.51±0.3 ng/mL. The 6 patients re-examined with MRI demonstrated complete bone healing after the therapy.

CONCLUSIONTeriparatide is effective for conservative treatment of osteoporotic spinal fracture and can promote bone fracture healing, improve the quality of life, and prevents vertebral collapse, and can be therefore an alternative treatment to PVP or BV.

Aged ; Analgesics ; therapeutic use ; Bone Density ; Calcium ; therapeutic use ; Fractures, Compression ; drug therapy ; Humans ; Lumbar Vertebrae ; pathology ; Magnetic Resonance Imaging ; Osteoporotic Fractures ; drug therapy ; Pain Measurement ; Quality of Life ; Spinal Fractures ; drug therapy ; Teriparatide ; therapeutic use ; Treatment Outcome

To study the clinical application of Jintian'ge capsule in treatment of vertebral compression fracture in senile osteoporosis patients. In the study, 69 senile osteoporotic vertebral compression fracture patients hospitalized in our hospital between January 2012 and June 2014 were selected and randomly divided into the control group and the treatment group. Patients in the control group were treated by percutaneous kyphoplasty (PKP), while those in the treatment group were given Jintian'ge capsule in addition to PKP. Efforts were made to visit the patients before the surgery and in three month after that, observe and compared the vertebral height, Cobb's angle, bone density, visual analogue scale (VAS) and Oswestry disability index between patients in the two groups. According to the findings, compared with before the treatment, patients in the two groups showed significant improvements in the vertebral height, Cobb's angle, bone density, VAS and Oswestry disability index three months after the surgery (P < 0.05); During the visit three months after the treatment, compared with the control group, the treatment group showed notable increases in all parameters (P < 0.05), particularly in the vertebral height, VAS and Oswestry disability index (P < 0.05). Based on the above findings, Jintian'ge capsule is applicable in adjuvant therapy after the osteoporotic vertebral compression facture PKP surgery.
Drugs, Chinese Herbal ; administration & dosage ; Female ; Fractures, Compression ; drug therapy ; etiology ; Humans ; Male ; Middle Aged ; Osteoporosis ; complications ; Osteoporotic Fractures ; drug therapy ; etiology ; Spinal Fractures ; drug therapy ; etiology ; Treatment Outcome

OBJECTIVETo evaluate the therapeutic effects of conservative treatment of refracture in cemented vertebrae after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in elderly patients.

METHODSBetween January, 2012 and August, 2014, a total of 324 elderly patients (381 vertebrae) received percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Of these patients, 12 patients (14 vertebrae) complained of recurrence of back pain and were confirmed to have refracture in the cemented vertebrae by imaging examination. Seven of these 12 patients (9 vertebrae), who were all female with an average refracture time of 8±6.7 weeks (range 2-20 weeks), received conservative treatments with analgesics, osteoporosis medication, bracing and physical therapy, and their visual analogue scale (VAS) scores and Oswestry disability index (ODI) at 7 days and 1, 3 and 12 months after the treatment were measured.

RESULTSThe 7 patients were followed up for 21.3±11.2 months (range 13-29 months) after conservative treatments. Their VAS score and ODI decreased significantly over time after the treatment (P<0.05) and showed significant differences between the measurements at 7 days, 1 and 3 months (P<0.05) but not between 3 and 12 months (P>0.05). The average VAS score and ODI before treatments were 8.3±0.8 and (88.3±3.2)%, 3.1±1.2 and (56.3±7.7)% at 1 month, and 0.8±0.7 and (5.9±2.8)% at 3 months during the follow-up, respectively.No such complications as phlebothrombosis of the leg, decubitus, or hypostatic pneumonia occurred in these cases.

CONCLUSIONThough with a relatively low incidence rate, refracture in the cemented vertebrae is one of the important causes of recurrence of back pain following percutaneous vertebroplasty. Conservative treatment is effective in relieving pain and improving the spine function in such cases without obvious complications.

Aged ; Analgesics ; therapeutic use ; Back Pain ; therapy ; Bone Cements ; Female ; Fractures, Compression ; surgery ; therapy ; Humans ; Osteoporosis ; surgery ; therapy ; Pain Management ; Pain Measurement ; Recurrence ; Spinal Fractures ; surgery ; therapy ; Spine ; pathology ; Treatment Outcome ; Vertebroplasty