Contraindications ; Humans ; Vertebroplasty ; adverse effects ; methods

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

STUDY DESIGN: Prospective cohort study. PURPOSE: To evaluate the clinical and radiological results of percutaneous selective vertebroplasty (PSV) as first-line treatment options in the setting of well-confined spinal metastases. OVERVIEW OF LITERATURE: Recent technological advances combined with innovative interventional techniques enable an alternative less invasive treatment option for many patients with malignant vertebral body infiltration. Percutaneous vertebral augmentation procedures offer less invasive but effective pain relief to many patients with symptomatic spinal metastatic disease. METHODS: Eleven patients with 21 well-confined metastatic vertebral lesions that had been treated with PSV were included. Pain was evaluated one week, one month, 3 months and 6 months post-procedure using a 10-point visual analogue scale (VAS). A statistical analysis including repeated measures analysis of variance test was used to collectively indicate the presence of any significant differences between different time sequences. Medication usage and range of mobility were also evaluated. RESULTS: The 11 patients had an average age of 42 years and 54.5% were male. Highly significant improvements in VAS scores at rest and with activity (p<0.001) were evident. There was a significant decrease in rate of medication consumption post-procedure (p<0.05). CONCLUSIONS: PSV can be used successfully as the first-line treatment for well-confined metastatic vertebral lesions. It is also an effective method to decrease pain, increase mobility, and decrease narcotic administration in such patients.
Cohort Studies ; Humans ; Male ; Methods ; Neoplasm Metastasis ; Pain Measurement ; Prospective Studies ; Vertebroplasty*

STUDY DESIGN: Retrospective study. OBJECTIVES: To compare the treatment outcomes of conservative treatment, early vertebroplasty (EVP), and delayed VP (DVP) of patients with osteoporotic compression fractures. SUMMARY OF LITERATURE REVIEW: VP is regarded as an effective treatment for osteoporotic compression fractures. Few studies have compared the outcomes of each of the following treatments: conservative treatment, EVP, and DVP. MATERIALS AND METHODS: A total of 202 patients who presented with thoracolumbar osteoporotic vertebral compression fractures between January 2008 and December 2013 were divided into three groups: group 1 (conservative treatment), group 2 (VP within three weeks), and group 3 (VP after three weeks). We compared the collapse rate and the visual analog scale (VAS) score immediately after the trauma and at the 1-week, 3-week, 6-week, and 1-year follow-ups. RESULTS: The three abovementioned groups consisted of 89 patients, 60 patients, and 53 patients, respectively. The bone mass density (BMD) score of group 1 was statistically significantly higher than that of the others (p<0.05). In group 2, the average VAS score was high immediately after the trauma and low at the 1-year follow-up. Only group 2 showed a significantly high vertebral compression rate immediately after the trauma (p<0.05). Although there were no statistically significant differences in the incidence between the adjacent and the non-adjacent vertebral compression fractures, more patients underwent additional VP in groups 2 and 3 (p=0.980). CONCLUSION: The treatment method of performing EVP seems to yield the best clinical outcomes for patients with osteoporotic compression fractures who exhibit a relatively low BMD, high collapse rate, and high VAS score. Conservative management is the treatment of choice for osteoporotic compression fracture patients with a relatively high BMD, low collapse rate, and low VAS score.
Follow-Up Studies ; Fractures, Compression* ; Humans ; Incidence ; Methods ; Osteoporosis ; Retrospective Studies ; Vertebroplasty* ; Visual Analog Scale

BACKGROUNDPrevious studies have suggested that percutaneous vertebroplasty might alter vertebral stress transfer, leading to adjacent vertebral failure. However, no three-dimensional finite element study so far accounted for the stress distributions on different cement volumes. The purpose of this study was to evaluate the stress distributions on the endplate under different loading conditions after augmentation with various volumes of bone cement.

METHODSL2-L3 motion segment data were obtained from CT scans of the lumbar spine from a cadaver of a young man who had no abnormal findings on roentgenograms. Three-dimensional model of L2-L3 was established using Mimics software, and finite element model of L2-L3 functional spinal unit (FSU) was established using Ansys10.0 software. For simulating percutaneous vertebral augmentation, polymethylmethacrylate (PMMA) was deposited into the bipedicle of the L2 vertebra. The percentage of PMMA volume varied between 15% and 30%. The stress distributions on the endplate of the augmented vertebral body were calculated under three different loading conditions.

RESULTSIn general, the stress level monotonically increased with bone cement volume. Under each loading condition, the stress change on the L2 superior and inferior endplates in three kinds of finite element models shows monotonic increase. Compared with the stress-increasing region of the endplate, the central part of the L2 endplate was subject to the greatest stress under three kinds of loading conditions, especially on the superior endplate and under flexion.

CONCLUSIONSThe finite element models of FSU are useful to optimize the planning for vertebroplasty. The bone cement volume might have an influence on the endplate of the augmentation, especially the superior endplate. It should be noted that the optimization of bone cement volume is patient specific; the volume of the bone cement should be based on the size, body mineral density, and stiffness of the vertebrae of individual patients.

Bone Cements ; therapeutic use ; Finite Element Analysis ; Humans ; Osteoporosis ; Spinal Fractures ; surgery ; Stress, Mechanical ; Vertebroplasty ; methods

Aged ; Female ; Fractures, Compression ; surgery ; Humans ; Male ; Middle Aged ; Spinal Fractures ; surgery ; Vertebroplasty ; methods

OBJECTIVETo compare the clinical efficacy and safety of percutaneous vertebroplasty by unipedicular and bipedicular approach for treatment of Kummell's disease.

METHODSThe clinical data of patients with Kummell's disease undergoing percutaneous vertebroplasty via unilateral or bilateral approach between January, 2006 and January, 2011 were reviewed. The clinical efficacy, operation time, bone cement injection volume, incidence of cement leakage, degree of vertebral height restoration, and degree of kyphosis correction were compared between the patients receiving surgery via the two approaches.

RESULTSThe operation time was shorter in the unipedicular group than in the bipedicular group (P<0.05), but bone cement injection volume, incidence of cement leakage, degree of anterior vertebral height restoration, degree of middle vertebral height restoration, degree of kyphosis correction, and VAS scores were all comparable between the two groups (P>0.05). In both groups, the VAS scores at 24 h, 3 months and at the last follow-up after the surgery were lowered compared to the preoperative scores (P<0.05).

CONCLUSIONBoth unipedicular and bipedicular percutaneous vertebroplasty can achieve satisfactory analgesia in the treatment of Kummell's disease with similar clinical efficacy. The unipedicular approach is sufficient for treatment of Kummell's disease.

Bone Cements ; Humans ; Spinal Fractures ; surgery ; Spine ; Treatment Outcome ; Vertebroplasty ; methods

STUDY DESIGN: Case report. OBJECTIVES: To document unilateral biportal endoscopy (UBE) as a treatment for acute radiculopathy after osteoporotic vertebral fracture. SUMMARY OF LITERATURE REVIEW: Acute radiculopathy after osteoporotic vertebral fracture leads to claudication. Treatment of osteoporotic vertebral fractures with accompanying radiating pain is challenging. MATERIALS AND METHODS: A 74-year-old woman was diagnosed with an osteoporotic vertebral fracture at L3 after slipping and falling. Vertebroplasty was performed for the osteoporotic vertebral fracture at L3. She still complained of right lower extremity radiating pain. UBE was performed to treat acute radiculopathy. RESULTS: Foraminal decompression using UBE was performed at the L3–4 right foraminal area. Her symptoms resolved after surgery. CONCLUSIONS: UBE is a useful treatment method for acute radiculopathy after osteoporotic vertebral fracture.
Accidental Falls ; Aged ; Decompression ; Endoscopy ; Female ; Fractures, Compression ; Humans ; Lower Extremity ; Methods ; Radiculopathy ; Vertebroplasty

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 explore the clinical efficacy and safety of balloon kyphoplasty for the aged osteoporotic vertebral compression fractures.

METHODSFrom June 2006 to August 2009, balloon kyphoplasty was performed on 26 patients (30 vertebral bodies), who presented painful vertebral compression fractures. They were 10 males and 16 femals, with an average age of 70 years ranging from 59 to 78 years. The operative segments were 4 cases in T11 vertebraes, T12 in 10, L1 in 12, L2 in 3, L4 in 1. The reduction of compressed vertebrae was displayed by X-ray, and the patients were followed up by observation of the visual analog scale and complications.

RESULTSAll cases had rapid, significant and sustained improvements in postoperative pain following balloon kyphoplasty. Visual analog scale was reduced from (8.6 +/- 0.2) to (2.0 +/- 0.3) points. The anterior and midline vertebral body heights in 30 fractured vertebral bodies increased from pre-operative (18.34 +/- 3.25) mm, (14.36 +/- 2.56) mm up to pro-operative (20.51 +/- 1.34) mm, (19.66 +/- 1.28) mm (P < 0.05) respectively. No severe leakage occured.

CONCLUSIONBalloon kyphoplasty in treatment of osteoporotic vertebral compression fractures can restore the height of fractured vertebra, relieve pain and improve the spinal function with satisfactory clinical outcomes.

Aged ; Bone Cements ; Female ; Fractures, Compression ; surgery ; Humans ; Male ; Middle Aged ; Osteoporosis ; complications ; Pain Measurement ; Spinal Fractures ; surgery ; Vertebroplasty ; methods