OBJECTIVE: To evaluate the short-and medium-term efficacy of posterior medial branch block in the treatment of persistent pain after percutaneous vertebral augmentation. METHODS: From January 2018 to January 2023, a total of 1, 062 patients with osteoporotic vertebral compression fractures underwent percutaneous vertebral augmentation. Among them, 32 elderly patients who experienced persistent low back pain after surgery and subsequently received posterior medial branch block and cryoablation were included. Six patients died during follow-up, leaving 26 patients for final analysis (1 male, 25 females). The mean age was (82.96±5.66) years (ranged, 76 to 94 years). The mean body mass index was (23.76±3.08) kg·m^-2(ranged 18.1 to 27.2 kg·m^-2). The bone mineral density T-value ranged from -2.5 to -4.3 with a mean of (-3.09±0.56). The mean volume of bone cement injected was 6.00 (5.38, 7.00) ml. Fracture locations were T₁₁ (2 cases), T₁₂ (7 cases), L₁ (10 cases), L₂ (6 cases), and L₃ (1 case). The mean interval from vertebral augmentation to block treatment was (7.12±2.22) months (rangd 6 to 12 months). The vertebral augmentation procedures were percutaneous kyphoplasty(PKP) in 12 cases and percutaneous vertebroplasty (PVP) in 14 cases. At the 2nd week, 3rd month, and 6th month after the block, the numerical rating scale(NRS), Oswestry disability index(ODI), patient satisfaction, and pain relief rate at the 6th month were evaluated. Relationships between pain relief rate at the 6th month after the last treatment and possible influencing factors were analyzed. RESULTS: Compared with X-ray films after percutaneous vertebral augmentation, the X-ray films before block showed an increase in kyphotic angle and vertebral compression rate, with statistically significant differences(P<0.05). At the 2nd week, 3rd month, and 6th month after posterior medial branch block and cryoablation, NRS and ODI scores were significantly lower than before the block(P<0.05). Among the 26 patients, 5 received additional cryoablation. At the 6th month after the last treatment, 19 patients reported excellent or good satisfaction. Univariate binary Logistic analysis showed all P>0.05, and no independent factor affecting final satisfaction or pain relief at 6 months after the last treatment was identified. CONCLUSION Posterior medial branch block(with cryoablation) can effectively improve short-and medium-term symptoms and function in patients with persistent axial low back pain after percutaneous vertebral augmentation for osteoporotic vertebral fractures.
Humans ; Male ; Female ; Aged ; Spinal Fractures/surgery* ; Aged, 80 and over ; Osteoporotic Fractures/surgery* ; Vertebroplasty/adverse effects* ; Nerve Block/methods*

OBJECTIVE: To explore the risk factors of hidden blood loss in osteoporosis vertebral compression fractures during percutaneous vertebral augmentation. METHODS: From October 2018 to December 2019, 360 patients with osteoporosis vertebral compression fractures who received percutaneous vertebral augmentation were enrolled in this study. The factors analyzed included gender, age, surgical methods, disease course, height, weight, the operative segment, bone mineral density, amount of bone cement, operative time, percentage of height loss, percentage of vertebral height restoration, cement leakage, blood clotting function, preoperative and postoperative hemoglobin and hematocrit and other internal diseases. Total blood loss was calculated by Gross's formula, influential factors of the hidden blood loss were further analyzed by t-test, multivariate linear regression and one-way ANOVA analysis. RESULTS: Surgical methods, the operative segment, disease course, cement leakage, preoperative hemoglobin, cement leakage via the basivertebral and segmental vein were significantly correlated with hidden blood loss(P<0.05). CONCLUSION Patients with percutaneous kyphoplasty, two-level and multi-level surgery, the course of the disease beyond 6 weeks, cement leakage via the basivertebral and segmental vein, and lower preoperative hemoglobin had more perioperative hidden blood loss.
Bone Cements/adverse effects* ; Fractures, Compression/etiology* ; Humans ; Kyphoplasty/methods* ; Osteoporosis/complications* ; Osteoporotic Fractures/surgery* ; Retrospective Studies ; Risk Factors ; Spinal Fractures/etiology* ; Treatment Outcome ; Vertebroplasty/adverse effects*

BACKGROUND: Vertebroplasty is not free from cement related complications. If an allograft is used as a filler, most of them can be averted. METHODS: Forty consecutive cases of osteoporotic vertebral fracture were divided into two groups by self-selection. The study and the control groups underwent vertebroplasty with fresh frozen allogeneic bone chips and bone cement, respectively. Clinical results were assessed at preoperation, postoperative day 1 and months 3, 6, and 12 by 10-grade visual analog scale (VAS), and radiological results were assessed at the same time by vertebral kyphotic angle (VKA) and local kyphotic angle (LKA). The results were compared within and between the groups. Survival function was analyzed. The criteria of an event were clinical or radiological deterioration versus pre-index surgery state. RESULTS: VAS was improved in the study group from 8.4 +/- 0.8 to 5.2 +/- 1.4, 6.4 +/- 1.2, 5.5 +/- 2.7, and 3.7 +/- 1.4 at postoperative day 1 and months 3, 6, and 12, respectively, and in the control group from 8.4 +/- 1.2 to 3.2 +/- 1.1, 3.2 +/- 1.7, 3.2 +/- 2.7, and 2.5 +/- 1.7, respectively (within group, p < 0.001; between groups, p < 0.001). VKA was improved in the study group from 18.9degrees +/- 8.0degrees to 15.2degrees +/- 6.1degrees (p = 0.046) and in the control group from 14.7degrees +/- 5.2degrees to 10.3degrees +/- 4.7degrees (p < 0.001) at postoperative day 1. LKA was not improved in the study group but was improved in the control group from 16.8degrees +/- 11.7degrees to 14.3degrees +/- 9.6degrees (p = 0.015). Correction angle was 2.7degrees +/- 4.6degrees, -7.9degrees +/- 5.3degrees, -7.2degrees +/- 5.2degrees, and -7.4degrees +/- 6.3degrees at postoperative day 1 and months 3, 6, and 12, respectively, in the study group and 4.3degrees +/- 3.7degrees, 0.7degrees +/- 3.6degrees, 0.7degrees +/- 4.2degrees, and 0.1degrees +/- 4.4degrees, respectively, in the control group. Correction loss was significant in both groups (p < 0.001) and more serious in the study group (p < 0.001). The 6-month survival rate was 16.7% in the study group and 64.3% in the control group (p = 0.003; odds ratio, 5.250). CONCLUSIONS: In treatment of osteoporotic vertebral fracture, fresh frozen allogeneic bone chips are not recommendable as a filler for its worse results than bone cement.
Aged ; Bone Cements/adverse effects ; Bone Substitutes/adverse effects ; Case-Control Studies ; Female ; Humans ; Male ; Osteoporotic Fractures/epidemiology/*surgery ; Pain Measurement ; Transplantation, Homologous/adverse effects/instrumentation/*methods ; Vertebroplasty/adverse effects/instrumentation/*methods

We report a case of pulmonary bone cement embolism in a female who presented with dyspnea following multiple sessions of vertebroplasty. She underwent spectral CT pulmonary angiography and the diagnosis was made based on enhanced visualization of radiopaque cement material in the pulmonary arteries and a corresponding decrease in the parenchymal iodine content. Here, we describe the CT angiography findings of bone cement embolism with special emphasis on the potential benefits of spectral imaging, providing additional information on the material composition.
Angiography/methods ; Bone Cements/*adverse effects ; Dyspnea/etiology ; Female ; Humans ; Hypotension/etiology ; Lung/radiography ; Middle Aged ; Pulmonary Artery/radiography ; Pulmonary Embolism/etiology/*radiography ; Tomography, X-Ray Computed/*methods ; *Vertebroplasty

A 58-year-old female patient, diagnosed with adenocarcinoma of the lung, underwent percutaneous vertebroplasty at the L4 vertebral body due to painful spinal metastases. Because of deep venous thrombosis of the left femoral and iliac veins, an inferior vena cava filter had been placed before vertebroplasty. Bone cement migrated into the venous bloodstream and then was being trapped within the previously placed filter. This case illustrates that caval filter could capture the bone cement and prevent it from migrating to the pulmonary circulation.
Adenocarcinoma/secondary ; Bone Cements/*adverse effects ; Embolism/*etiology ; Female ; Humans ; Iliac Vein ; Lumbar Vertebrae/surgery ; Lung Neoplasms/pathology ; Middle Aged ; Pulmonary Embolism/prevention & control ; Spinal Neoplasms/secondary ; *Vena Cava Filters ; *Vena Cava, Inferior ; Venous Thrombosis/radiography ; Vertebroplasty/*adverse effects/methods

BACKGROUNDOlder patients with malignant spinal tumors are difficult to treat because they have many co-morbidities including osteoporosis. The purpose of this research is to discuss the technique and clinical outcome of bone cement enhanced pedicle screw fixation combined with vertebroplasty (the Sandwich Procedure) for elderly patients with severe osteoporosis and malignant spinal tumors.

METHODSThis study includes 28 consecutive elderly patients with malignant thoracic or lumbar spinal tumors. There were nine patients with myelomas, and 19 patients with metastatic bone tumors. The Sandwich Procedure began with curettage of the tumor and a vertebroplasty with bone cement (polymethyl methacrylate, PMMA), followed by PMMA enhanced pedicle screw fixation. Patients were evaluated with the visual analogue scale (VAS), oswestry disability index (ODI), American Spinal Cord Injury Association (ASIA) neurological function classification, and the radiographic degree of kyphosis (Cobb angle). Data were analyzed using paired t-test to compare the pre- and post-operative values. The complications, local recurrences, and the survival status were also recorded.

RESULTSThere was no operative mortality, and the mean operative time was 210 minutes (range 150 - 250 minutes). The average blood loss was 1550 ml (range 650 - 3300 ml). The average amount of cement for vertebroplasty was 3.6 ml (range 3 -5 ml). The VAS, ODI, and ASIA scores were significantly improved after surgery (P < 0.05). However, we found no differences between the pre and post-operative Cobb angles. The shortest survival time was 3 months, and we found no evidence of local recurrence in this group of patients.

CONCLUSIONThe Sandwich Procedure is a safe operation and provides symptomatic relief in these difficult patients, permitting further treatment with chemotherapy or radiotherapy.

Aged ; Bone Cements ; Bone Screws ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Spinal Neoplasms ; surgery ; Thoracic Vertebrae ; surgery ; Vertebroplasty ; adverse effects ; methods

OBJECTIVETo observe the clinical effects and complications in treating osteoporotic vertebral fractures with percutaneous kyphoplasty (PKP) and in order to found the cause and countermeasures of the complications.

METHODSFrom March 2006 to March 2007, 31 patients with osteoporotic vertebral fractures were treated with unilateral percutaneous kyphoplasty. There were 11 males and 20 females, ranging in age from 54 to 91 years with the mean of 81 years. All patients were followed up for more than three years. At pre-treatment and postoperatively immediately, 1, 2, 3 years after PKP, the height of anterior vertebral body and thoracic-lumbar and back pain were respectively analyzed by imaging data and VAS scoring.

RESULTSAt pre-treatment and postoperatively immediately, 1, 2, 3 years after PKP, the height of anterior vertebral body were (0.9 +/- 0.2), (2.6 +/- 0.3), (2.6 +/- 0.2), (2.5 +/- 0.7), (2.5 +/- 0.4) cm, respectively; the VAS soring were (7.6 +/- 1.4), (2.3 +/- 0.7), (2.4 +/- 0.5), (2.8 +/- 0.3), (3.1 +/- 0.2) scores, respectively. The height of anterior vertebral body recoveried obviously after PKP (P < 0.05); following prolongation of time, the height of anterior vertebral body gradually reduced (P > 0.05). The thoracic-lumbar and back pain relieved obviously after PKP (P < 0.05); following prolongation of time, the pain gradually aggratated, but there was no significant difference (P > 0.05). At final follow up, reinforced vertebral re-fractures was found in 2 cases, adjacent vertebral fractures in 6 cases, distal vertebral fractures in 2 cases, asymptomatic degeneration of adjacent intervertebral in 5 cases.

CONCLUSIONPKP have definite and early effects in treating osteoporotic vertebral fractures. But in mid-stage after PKP, the height of anterior vertebral body reduce and the pain aggravate gradually, especially degenerative adjacent vertebral fracture advent. Strict choosing the candidate of the precedure, improvement of materials of perfusion and reducing of volume of bone cement maybe can decrease incidence rate of complications.

Aged ; Aged, 80 and over ; Bone Cements ; adverse effects ; Contraindications ; Female ; Fractures, Compression ; surgery ; Fractures, Spontaneous ; Humans ; Kyphoplasty ; adverse effects ; methods ; Male ; Middle Aged ; Osteoporosis ; surgery ; Pain ; etiology ; Postoperative Complications ; etiology ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; drug effects ; Treatment Outcome ; Vertebroplasty ; methods

OBJECTIVETo investigate the clinical effects and safety of vertebroplasty and kyphoplasty for the senile osteoporotic vertebral compression fractures.

METHODSFrom December 2004 to June 2008, 28 patients (40 vertebrae) with osteoporotic vertebral compression fractures were treated with percutaneous vertebroplasty (PVP group), there were 11 males (14 vertebrae) and 17 females (26 vertebrae), with an average age of 72 years (ranged, 70 to 91 years). The fracture site of vertebral body was from T5 to L5. Other 31 patients (43 vertebrae) were treated with percutaneous kyphoplasty (PKP group), there were 13 males (18 vertebrae) and 18 females (25 vertebrae), with an average age of 74 years (ranged, 70 to 92 years). The fracture site of vertebral body was from T4 to L5. Theapeutic effects of all the patients were observed after operation, the item included visual analog scale (VAS), Oswestry score, Cobb angle, the height of anterior and middle column vertebra, and the incidence of cement leakage.

RESULTSThere was significant decrease in VAS score and Oswestry score after operation in both groups, there was significant difference between preoperative and postoperative (P < 0.01). There was no significant difference in VAS score and Oswestry score between two groups (P > 0.05). There was no significant difference in Cobb angles and the height of anterior and middle column vertebra between two groups before and after operation (P > 0.05). Among them, there were 3 vertebrae cement leakage in PVP group (7.5%) and 2 in PKP group (4.7%), but no clinical sympton occurred. There was no significant difference in the incidence of cement leakage between two groups (P > 0.05).

CONCLUSIONVertebroplasty and kyphoplasty are safe and effective methods in treating senile osteoporotic vertebral compression fractures, which can restore the height of fractured vertebra, relieve pain and improve function as well as minimize the incidence of cement leakage.

Aged ; Aged, 80 and over ; Bone Cements ; adverse effects ; Female ; Fractures, Compression ; surgery ; Fractures, Spontaneous ; surgery ; Humans ; Kyphoplasty ; adverse effects ; methods ; Male ; Osteoporosis ; surgery ; Postoperative Complications ; Spinal Fractures ; surgery ; Spine ; Technology Assessment, Biomedical ; Vertebroplasty ; adverse effects ; methods

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

Contraindications ; Humans ; Vertebroplasty ; adverse effects ; methods