PURPOSE: We are to find the method to objectify postoperative prognosis, analyzing the factors confluencing the result of kyphoplasty in osteoporotic vertebral compression fracture (OVCF). MATERIALS AND METHODS: Our study included 50 patients (55 vertebral bodies) who have undergone kyphoplasty from Sep. 2004 until Oct. 2005. We divided in the group according to bone mineral density (BMD), compression rate, recovery rate and cement leakage. We verified the significance of each group, using independent t-test, and ANOVA test among observers. RESULTS: We performed kyphoplasty on 55 vertebral bodies, 12 cases with more than 0.4 g/cm2 in BMD (mean: 0.53 g/cm2) and their mean preoperative compression rate (CR), immediate postoperative recovery rate (RR-IPO), and recovery rate after 6 months (RR-6M) was each 30.58%, 12.35%P, 9.93%P. 15 cases under 0.4 g/cm2 (mean 0.31 g/cm2), and their CR, RR-IPO and RR-6M was 26.73%, 11.77%P, 5.26%P respectively. The p-value was 0.004. Another studies according to CR, RR-IPO and leakage of cement revealed the better results in the cases of the lower CR, the smaller reduction and abscecnce of cement leakage, but statistically insignificant (p=0.309, 0.069, 0.356). CONCLUSION: Preoperative BMD was most important factor that confluencing postoperative radiological result in OVCF. Other factors were also thought to be confluencing factors, but statistically insignificant..
Bone Density ; Fractures, Compression* ; Humans ; Kyphoplasty* ; Methods ; Osteoporosis ; Prognosis

Bone Cements ; adverse effects ; Humans ; Kyphoplasty ; methods ; Spinal Fractures ; therapy ; Vertebroplasty ; methods

BACKGROUNDPercutaneous vertebroplasty (PKP) has proved its effectiveness regarding minimal invasion, rapid pain reduction, safe cement augmentation, restoring vertebral height, and accelerating complete recovery of osteoporotic vertebral compression fractures (OVCFs). Whether unipedicular or bipedicular PKP provides a better outcome is controversial.

METHODSWe searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Knowledge, Chinese Biomedical Literature Database, and Wanfang Data from January 1980 to March 2013 with "kyphoplasty", "unipedicular", "bipedicular", "compression fracture", and "randomized controlled trial". Risk of bias in the included studies was assessed according to a 12-item scale. Meta-analysis was performed. Dichotomous and continuous variables were calculated using the odds ratio (OR) and standardized mean difference (SMD), respectively.

RESULTSSeven studies involving 440 patients and 559 vertebral bodies met the criteria for inclusion. Among them, one randomized controlled trial had a high risk of bias and six a low risk. The pain visual analogue scale (VAS) SMDs were -0.02 (P = 0.88) for short-term follow-up (≤3 months) and 0.03 (P = 0.82) for long-term follow-up (≥ 1 year). Oswestry Disability Index (ODI) SMDs at short- and long-term follow-up were not statistically significant (-0.04, P = 0.77 and -0.07, P = 0.74, respectively). This meta-analysis showed greater polymethylmethacrylate volume (SMD -1.08, P = 0.00) and operation time (SMD -2.40, P = 0.00), favoring unipedicular PKP. Radiographic outcomes-preoperative kyphosis angle, restoration rate, reduction angle, loss of reduction angle-were not statistically different between the groups. Pooled analyses of cement leakage and subsequent adjacent OVCFs showed no significant differences between the groups, with OR = 0.82 (P = 0.79) and OR = 1.41 (P = 0.70), respectively.

CONCLUSIONSThis meta-analysis comparing unipedicular and bipedicular PKP demonstrated no significant differences regarding VAS, ODI, radiographic outcomes, or complications. Considering the longer operation time and radiation exposure with bipedicular PKP, we recommend unipedicular PKP over bipedicular PKP for treating OVCFs.

Fractures, Compression ; surgery ; Humans ; Kyphoplasty ; methods ; Osteoporotic Fractures ; surgery ; Spinal Fractures ; surgery

PURPOSE: To analyze the physical properties of demineralized bone matrix (DBM) and self-setting calcium phosphate cement (CPC) composite for its compatibility to percutaneous kyphoplasty. MATERIALS AND METHODS: According to tap volume method, DBM was mixed with CPC in variable ratio 0%, 20%, 30%, 40% and 50%. Distilled water was used as a hardening fluid. Its properties, including injectability, mold applicability, setting time and its behavior, maximum temperature, and mechanical strength, were analyzed. RESULTS: The DBM-CP composites has a good injectability and mold applicability, a maximum temperature of less than 5oC, a initial setting time of 3 to 10 minutes. The outer surface of DBM-CP composites showed their even distribution in optical microscopy. Injectability, mold applicability and compressive strength were in inverse proportion to the amounts of DBM. CONCLUSION: This study suggests that the DBM-CP composites has a good injectability and mold applicability with a low setting temperature and even distribution of compound. Therefore this composite might be used as a substitute of PMMA in kyphoplasty.
Bone Matrix ; Calcium ; Compressive Strength ; Fungi ; Kyphoplasty* ; Methods ; Microscopy ; Polymethyl Methacrylate ; Water

OBJECTIVETo explore the clinical efficacy of the percutaneous kyphoplasty for the treatment of osteoporotic Kummell's disease.

METHODSFrom May 2010 to February 2012, 8 patients with osteoporotic Kummell's disease were treated with percutaneous balloon kyphoplasty. There were 2 males and 6 females, with a mean age of 73.4 years. All the patients suffered from lower back pain for 4.7 months, which affected seriously the patient's quality of life. The anterior vertebral height and Cobb angel was measured on standing lateral radiograph at pre- and post-operatively (2 days after operation) and during the final follow-up. Visual analog scale (VAS), Japanese Orthopedic Association (JOA) and Oswestry disability index (ODI) were used to evaluate pain and function.

RESULTSIncision of all patients healed normally without infection. The level of back pain decreased remarkably after surgery. The mean time of ambulation was 4.3 days (ranged, 1 to 10 days). Cement leakage occurred in 1 case with no symptom. The anterior vertebral height and Cobb angel of the fractured vertebra recovered respectively from preoperative (30.4 +/- 7.4)% and (31.3 +/- 9.9) degree to (70.3 +/- 3.3)% and (9.1 +/- 3.0) degree at the 2nd day after operation. VAS and JOA scores, ODI improved from preoperative 8.7 +/- 1.2, 12.3 +/- 1.7 and (93.3 +/- 4.6)% to 3.1 +/- 1.1, 24.9 +/- 1.6 and (32.2 +/- 5.4)% respectively at the 2nd day after operation. All the patients were followed up, and the duration ranged from 3 to 24 months, with a mean of 4.7 months. At the latest follow-up, the anterior vertebral height and Cobb angel of the fractured vertebra were (69.9 +/- 3.2)% and (10.9 +/- 2.4) degree; the VAS and JOA scores and ODI were 2.2 +/- 1.0, 26.4 +/- 1.4 and (29.2 +/- 4.5)% respectively, which had no obvious difference compared to those results at the 2nd day after operation.

CONCLUSIONBalloon kyphoplasty is safe and effective treatment for osteoporotic Kummell's disease.

Aged ; Aged, 80 and over ; Female ; Humans ; Kyphoplasty ; methods ; Male ; Osteoporosis ; surgery ; Treatment Outcome

STUDY DESIGN: A multicenter retrospective study. OBJECTIVES: To compare the incidence and pattern of subsequent vertebral fractures following conservative treatment versus vertebroplasty or kyphoplasty for acute osteoporotic vertebral compression fractures. SUMMARY OF LITERATURE REVIEW: Previous studies suggest that new vertebral fractures may increase following vertebroplasty or kyphoplasty because bony cement inserted into the vertebral body of a fractured bone can elevate its strength and stiffness, which in turn, may increase the probability of the compression fractures. MATERIALS AND METHODS: From three hospitals, we recruited 135 patients who had been treated for acute osteoporotic compression fractures and had available spine images taken at their 1-year follow-up. The patients were divided into two groups according to treatment methods. Group C had been managed conservatively, and Group VK had undergone vertebroplasty or kyphoplasty. The two groups were compared for subsequent vertebral fractures. RESULTS: Group C consisted of 76 patients, and Group VK had 59. There were no significant differences between the two groups in terms of age, sex, medical comorbidity, body mass index (BMI), bone mineral density, presence of prior vertebral fracture or acute fracture level (p>0.05). New vertebral fractures were detected in 25 patients (19% of total subjects): 6 (8%) from Group C, and 19 (32%) from Group VK, demonstrating a significantly higher incidence in the VK group (p=0.0007). In the subgroup analysis, there was no significant difference between vertebroplasty and kyphoplasty (p>0.05). While four of the six patients (67%) in Group C had subsequent fractures in nonadjacent vertebrae, 14 of the 19 patients (74%) in Group VK had subsequent fractures in adjacent vertebrae. CONCLUSIONS: Subsequent vertebral fractures were found in 19% of subjects at one year after treatment for acute osteoporotic compression fractures. Compared with conservative treatment, vertbroplasty or kyphoplasty significantly increased the occurrence of subsequent vertebral fractures, which appeared more often in adjacent vertebrae.
Body Mass Index ; Bone Density ; Comorbidity ; Follow-Up Studies ; Fractures, Compression* ; Humans ; Incidence ; Kyphoplasty ; Methods* ; Retrospective Studies ; Spine ; Vertebroplasty

OBJECTIVETo compare clinical outcomes of bilateral transpedicular balloon kyphoplasty for the treatment of ordinary osteoporotic vertebral compressive fracture (OVCF) and severe osteoporotic vertebral compressive fracture.

METHODSFrom Junary 2009 to Febuary 2011, 60 patients (70 vertebrae) with osteoporotic vertebral compressive fracture were included. All patients were treated by bilateral transpedicular balloon kyphoplasty combined with postural reduction, including 10 males and 50 females aged from 59 to 90 years old with an average of 72.1 years old. In ordinary osteoporotic vertebral compressive fracture group, there were 38 patients (44 vertebrae) including 7 males and 31 females aged from 59 to 87 years old with an average of (71.8±6.1) years old. There were 6 patients with two vertebral fractures, 1 vertebra in T9, 5 vertebrae in T10, 7 vertebrae in T11, 13 vertebrae in T12, 9 vertebrae in L1, 4 vertebrae in L2, 4 vertebrae in L3, 1 vertebra in L4. While in severe osteoporotic vertebral compressive fracture group, there were 22 patients (26 vertebrae) including 3 males and 19 females aged from 63 to 90 years old with an average of (72.6±7.2) years old. There were 4 patients with two vertebral fractures, 1 vertebra in T9, 2 vertebrae in T10, 3 vertebrae in T11, 9 vertebrae in T12, 6 vertebrae in L1, 3 vertebrae in L2, 2 vertebrae in L3. Operative time, volume of bone cement injection, and vertebral height and changes of Cobb angle before and after operation were observed and compared. Postoperative average recovery rate of vertebral height and correct degree of Cobb angle were caculated and compared, VAS scoring were used to evaluate therapeutic effect.

RESULTSAll operations were completed sucessfully, and pain were relieved at 72 h after operation. All patients were followed up from 6 to 13 months with an average of 10.1 months. Postoperative vertebral height, Cobb angle and VAS score were improved better than that of before operation (P<0.05). Operative time in ordinary group was shorter than severe group, while volume of bone cement injection was more than that of severe group. Average recovery rate of vertebral height and correct degree of Cobb angle in ordinarty group was better than that of in severe group (P<0.05). There was no significant differences between two groups in VAS scores before and after operation (P> 0.05). Three cases (3 vertebrae) ocurred bone cement leakage in ordinarty group, while 5 cases (5 vertebrae) ocurred bone cement leakage in severe group, and there was no meaning between two groups (P>0.05).

CONCLUSIONKyphoplasty could receive satisfied curative effect in treating ordinary and servere patients with osteoporotic vertebral compressive fracture, but recovery of vertebral height and correct degree of Cobb angle in ordinary gourp was better than that of in servere group.

Aged ; Aged, 80 and over ; Female ; Fractures, Compression ; surgery ; Humans ; Kyphoplasty ; methods ; Male ; Middle Aged ; Osteoporotic Fractures ; surgery ; Spinal Fractures ; surgery

STUDY DESIGN: Retrospective study. PURPOSE: The study aims to assess the effectiveness and safety of radiofrequency (RF) kyphoplasty in the treatment of vertebral compression fractures (VCFs) in osteoporotic patients. OVERVIEW OF LITERATURE: Vertebroplasty and balloon kyphoplasty are established procedures for the treatment of osteoporotic VCFs. However, RF kyphoplasty is a new method which controls cement viscosity. METHODS: We reviewed the results of 41 consecutive patients with 23 thoracic and 38 lumbar VCFs who underwent RF kyphoplasty. The study population included 14 males (34%) and 27 females (66%). The mean patients age was 78 years (range, 51–89 years), and the follow-up period was 1 year. Clinical and radiographic analyses were performed during follow-up at 6 weeks, 6 months, and 1 year. All patients were assessed clinically pre- and postoperative using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Radiological assessment with X-ray in two views preoperatively, postoperatively, and during follow-up visits. RESULTS: The mean preoperative VAS was 8.7 (range, 5–10; standard deviation [SD], 1.2). Postoperatively, VAS decreased by 3.3 (range, 2–5; SD, 0.9). At the end of the follow-up, VAS decreased by 1.22 (range, 0–7; SD, 1.6). The mean preoperative ODI score was 85.9, decreasing to 9.6 postoperatively and improving to 18.4 during the 1-year follow-up. The mean local kyphotic angle was 9.04° before the procedure and decreased by a mean of 6.16° after the operation and at the end of the follow-up. The mean increase in vertebral body height was 3.3 mm postoperatively and after 1-year follow-up. The rate of cement leakage was 8% (five out of 61 levels of fracture). CONCLUSIONS: RF kyphoplasty is a safe and effective augmentation technique with an advantage of controlling the cement viscosity to minimize the risk of cement leakage. It also shortens operation time.
Body Height ; Female ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphoplasty ; Male ; Methods ; Osteoporosis ; Retrospective Studies ; Vertebroplasty ; Viscosity ; Visual Analog Scale

STUDY DESIGN: Retrospective case-control study. OBJECTIVES: We analyzed the radiological results of the double-balloon inflation technique in terms of its ability to reduce cement leakage, to increase bone cement bonding, and to promote anterior column height recovery. SUMMARY OF LITERATURE REVIEW: Various methods, such as the egg-shell technique, have been proposed to prevent leakage of cement during kyphoplasty in cases of osteoporotic compression fracture. MATERIALS AND METHODS: This study analyzed 18 patients diagnosed with osteoporotic compression fracture of the lumbar spine who underwent the double-balloon inflation technique after April 2015, and 30 consecutive patients with the same diagnosis who were treated using the conventional method prior to April 2015. We analyzed the radiological results on immediate postoperative simple X-rays in the anteroposterior and lateral views, 6-week postoperative lateral X-rays, and 6-month postoperative lateral X-rays to detect changes in anterior vertebral height and the cement leakage rate. RESULTS: The average anterior vertebral height increased by 7.58 mm in the double-balloon inflation group, and by 5.8 mm in the conventional group on the immediate postoperative radiographs (p=0.044). On average, a decrease of 3.08 mm was observed at 6 weeks postoperatively in the double-balloon inflation group, in contrast to a decrease of 4.68 mm in the conventional group (p=0.149). At the 6-month postoperative follow-up, an average decrease of 1.45 mm was found in the double-balloon inflation technique group, while a decrease of 1.40 mm was found in the conventional group (p=0.9110). The cement leakage rate was 22% in the double-balloon inflation group and 27% in the conventional group (p=0.730). CONCLUSIONS: Compared to the conventional method, the double-balloon inflation technique can be done more safely, and also promotes a greater recovery of anterior vertebral height.
Case-Control Studies ; Diagnosis ; Follow-Up Studies ; Fractures, Compression ; Humans ; Inflation, Economic ; Kyphoplasty ; Methods ; Osteoporosis ; Retrospective Studies ; Spine

Osteoporosis vertebral compression fractures seriously affect the life and health of the elderly,indicating the elderly life health begin to decline. Therefore, aggressive treatment is particularly important. Traditional surgical method,such as laminectomy and internal fixation has large trauma,more blood loss and high failure rate. However, conservative treatment cannot early reduce pain symptoms and improve functional status,it can lead delayed union and severe ossification and form chronic OVCF,make more difficult to treat. In treatment of vertebral body fracture,there was a new way with the development of minimally invasive spinal surgery technology. Percutaneous vertebroplasty and percutaneous kyphoplasty has become the commonly used method in treating OVCF. With rapid and significant analgesic effect,vertebral body height recovered ideally, the patients can early load activities and preoperative complications is rare. Effective rehabilitation exercise is also important in treating OVCF by surgery at the same time.
Fracture Fixation, Internal ; Fractures, Compression ; surgery ; Humans ; Kyphoplasty ; methods ; Minimally Invasive Surgical Procedures ; methods ; Osteoporotic Fractures ; surgery ; Spinal Fractures ; surgery ; Tomography, X-Ray Computed ; Vertebroplasty ; methods