OBJECTIVE: To compare the effectiveness of different puncture methods of the flexible bone cement delivery device in unilateral percutaneous curved vertebroplasty for osteoporotic vertebral upper 1/3 compression fractures. METHODS: A retrospective analysis was conducted on the clinical data of 67 patients with osteoporotic vertebral upper 1/3 compression fractures who were admitted and met the selection criteria between January 2023 and April 2024. The patients were divided into two groups based on the puncture method of the flexible bone cement delivery device: the oblique puncture group ( n=37) and the parallel puncture group ( n=30). There was no significant difference ( P>0.05) between the two groups in terms of gender, age, bone mineral density (T value), distribution of fractured vertebrae, time from injury to operation, and preoperative visual analogue scale (VAS) score for pain, Oswestry disability index (ODI), anterior vertebral height of the fractured vertebra, and Cobb angle of the fractured vertebra. The following parameters were compared between the two groups: operation time, incidence of secondary puncture, incidence of bone cement leakage, volume of injected bone cement, bone cement distribution score, as well as VAS score, ODI, anterior vertebral height of the fractured vertebra, and Cobb angle of the fractured vertebra at 1 day after operation and at last follow-up. RESULTS: Two cases in the oblique puncture group and 7 cases in the parallel puncture group underwent secondary puncture during operation, and the difference in the incidence of secondary puncture was significant ( P<0.05). No complications such as bone cement hypersensitivity, bone cement embolism, nerve injury, or epidural hematoma occurred in both groups. There was no significant difference in operation time, volume of injected bone cement, incidence of bone cement leakage, distribution score and rating of bone cement between the two groups ( P>0.05). All patients were followed up 6-18 months (mean, 12.0 months), and there was no significant difference in the follow-up time between the two groups ( P>0.05). No further fracture collapse or compression occurred in the fractured vertebra during follow-up. Both groups exhibited significant improvements in VAS score, ODI, anterior vertebral height, and Cobb angle of the fractured vertebra after operation compared to baseline ( P<0.05). There were also significant differences between the two time points after operation ( P<0.05). However, there was no significant difference in the above indicators between the two groups ( P>0.05). CONCLUSION For osteoporotic vertebral upper 1/3 compression fractures treated with unilateral percutaneous curved vertebroplasty, both oblique and parallel puncture methods of the flexible bone cement delivery device can effectively relieve pain, but the former is more conducive to reducing the incidence of secondary puncture.
Humans ; Bone Cements/therapeutic use* ; Fractures, Compression/surgery* ; Retrospective Studies ; Vertebroplasty/instrumentation* ; Osteoporotic Fractures/surgery* ; Spinal Fractures/surgery* ; Female ; Male ; Aged ; Middle Aged ; Treatment Outcome ; Punctures/methods* ; Aged, 80 and over

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

OBJECTIVETo investigate the feasibility and safety of the treatment for thoracolumbar fractures with pedicle screw at the fracture level and vertebroplasty via paraspinal approach.

METHODSFrom August 2007 to August 2010, 22 old patients with thoracolumbar fractures were treated with pedicle screw at the fracture level and vertebroplasty via paraspinal approach. There were 14 males and 8 females, ranging in age from 60 to 71 years (mean, 64.6 years). The time from injury to surgery varied from 1 to 4 d (mean,2.7 d). All the patients suffered from single thoracolumbar fractures and located at T11 in 2 cases, at T12 in 5 cases, at L1 in 11 cases and at L2 in 4 cases. According to the Denis fracture classification, there were 6 compression fractures and 16 burst fractures. The mean preoperative load-sharing classification of spine fractures was 5.4 score. The mean preoperative thoracolumbar injury classification and scoring was 5.2. Based on the ASIA neurologic grading system, preoperative neurological function was grade B in 2 cases,grade C in 3 cases, grade D in 7 cases and grade E in 10 cases. The neurological function, vertebral central and anterior height, kyphotic angle of the vertebral fractures by radiographs and visual analog scale were calculated pre-operatively, post-operatively and at the last follow-up.

RESULTSMedian operating time was 60.8 min (ranged from 50 to 95 min) and median blood loss was 84 ml (ranged from 50 to 130 ml). The operative incisions were healed well. The duration of follow-up averaged 21.6 months (ranged from 12 to 48 months). The anterior vertebral body height was corrected from preoperative (52.3 +/- 10.3) % to postoperative (6.1 +/- 4.2) % and (6.8 +/- 5.4) % at the last follow-up. The central vertebral body height was corrected from preoperative (38.9 +/- 11.2) % to postoperative (8.3 +/- 4.7) % and (9.4 +/- 4.5)% at the last follow-up. The Cobbs angle of the injured vertebral segment was corrected from preoperative (19.5 +/- 9.5) degrees to postoperative (4.3 +/- 4.1) degrees and (6.2 +/- 4.7) degrees at the last follow-up. The VAS scores reduced from preoperative 8.56 +/- 0.88 to post-operative 3.48 +/- 0.91 and 3.20 +/- 0.92 at the last follow-up. The postoperative neurologic function of all 22 patients improved 1 to 2 degrees except 10 patients of grade E. There were no instances of instrumentation failure and no patient had persistent postoperative back pain.

CONCLUSIONThe pedicle screw at the fracture level and vertebroplasty via paraspinal approach has the advantages of less invasive and blood loss, and could prevent the development of kyphosis and offers improvement of the spinal cord function. Furthermore, it could decrease the risks of postoperative back pain and the failure of instrumentation.

Aged ; Bone Screws ; Female ; Humans ; Lumbar Vertebrae ; diagnostic imaging ; injuries ; surgery ; Male ; Middle Aged ; Recovery of Function ; Retrospective Studies ; Spinal Cord ; physiopathology ; Spinal Fractures ; diagnostic imaging ; physiopathology ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; injuries ; surgery ; Tomography, X-Ray Computed ; Vertebroplasty ; instrumentation

OBJECTIVETo explore the therapeutic effects of percutaneous vertebroplasty with Genex combined with pedical screw fixation in the treatment of thoracolumbar burst fractures.

METHODSFrom February 2007 to October 2009, 38 patients with thoracolumbar burst fractures were treated with percutaneous vertebroplasty with Genex and pedical screw fixation. There were 25 males and 13 females, with a mean age of 42 years old (ranged, 30 to 68 years). The cause of injuries included road accident of 9 cases,crush injury of 7 cases,crash of 21 cases and others of 1 case. The fractures were classified according to Denis classification: 6 cases of type A, 22 cases of type B, 7 cases of type C and 3 cases of type D. Functional assessment of nerves was assessed according to ASIA criteria: 4 cases of type A,7 cases of type B, 10 cases of type C, 6 cases of type D and 11 cases of type E. Therapeutic effects were assessed by imaging and ASIA standard.

RESULTSAll the patients were followed up, and the duration ranged from 6 months to 34 months,with a mean period of 16.5 months. The results were observed after 1 week by X-ray inspection that vertebrate column array of all patients were restored to normal, anterior height of centrum restored to (98.50 +/- 2.17)%, posterior height of centrum for (98.87 +/- 1.82)%; and Cobb angle of injured vertebra decreased to average of (1.63 +/- 2.15) degree; the stenosis rate restored to (1.45 +/- 3.47)%. By X-ray inspection, it was observed that the vertebral height kept good at 6 months after operation, and the bone density almostly normal. By CT scanning, it was observed that bone defects of vertebrae disappeared, and restored to normal bony tissue. The nerve function restored 1 to 2 grades 6 months after operation.

CONCLUSIONArtificial bone of Genex applied in vertebral body-plasty has good biocompatibility, strong bone inducibility, no complications, little loss of vertebrae height and Cobb angle, and satisfactory results in the near future.

Adult ; Aged ; Female ; Follow-Up Studies ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Lumbosacral Region ; diagnostic imaging ; injuries ; physiopathology ; surgery ; Male ; Middle Aged ; Skin ; Thoracic Injuries ; diagnostic imaging ; physiopathology ; surgery ; Tomography, X-Ray Computed ; Vertebroplasty ; instrumentation

OBJECTIVEThe histological changes of rhBMP-2/calcium phosphate cement (CPC) were evaluated in vertebroplasty on nonhuman primate models in order to determine the feasibility of this carrier formulation instead of PMMA.

METHODSPercutaneous vertebroplasty (PVP) was performed in 4 adult rhesus monkeys which were evenly distributed in two groups. Ten vertebral bodies(VBs) from T10 to L7, of each rhesus were selected, and the 20 VBs in each group were randomly divided into 3 sub-groups. Group A:8 VBs, filled with rhBMP-2/CPC; Group B:6 VBs, filled with injectable PMMA; Group C:6 VBs, as control, filled with normal saline. The 2 rhesus monkeys in each group were killed at 2 and 6 months after operation, respectively, and the specimens of all the 40 VBs were collected for histological examination.

RESULTSIn group A,radiographic and histologic studies confirmed that part of the rhBMP-2/CPC cement degraded with new bone and new vessels ingrowth into the material after 2 months. No gap, fibrous hyperplasia or sclerotic callus was found in the interface. After six months, the cement was almost completely replaced by mature bone tissue. In group B, no new bone formation and material degradation but inflammatory cell infiltration and fibrous membrane gap were found 2 months after operation. After 6 months, the inflammatory cell infiltration subsided, the fibrous membrane gap became narrower, but there were still no new bone formation and material degradation. In group C, the tunnels were filled with irregular new trabeculae after 2 months and unrecognizable from the surrounding mature bone after 6 months, indicating the completion of bone healing.

CONCLUSIONSWith the characteristic of osteo-induction, the rhBMP-2/CPC can accelerate the healing of vertebral bone in nonhuman primates. Bone substitution is synchronous with material degradation, and the complete degradation of this material in late stage can avoid the potential adverse effects of PMMA on contiguous vertebral fracture and annulus degeneration. It might be a perfect bone substitute material for vertebroplasty instead of PMMA in the future.

Animals ; Bone Cements ; Bone Morphogenetic Proteins ; Bone Substitutes ; Calcium Phosphates ; Macaca mulatta ; Male ; Random Allocation ; Spine ; pathology ; Vertebroplasty ; instrumentation

OBJECTIVETo study a new implant material (carbonated hydroxyapatite, CHA) united pedicle screw to cure spine fracture.

METHODSThirty-two cases of spine compressed fracture were used with pedicle screw fixator and vertebroplasty. Before operation, patients' vertebral body were compressed (46 + 21)% (20% approximately 70%) on average. In operation, broken vertebral body was reposition through pedicle screw technique, then used self-made syringe to inject CHA into anterior and central column of broken vertebral body through pedicle. And all of patients were not given any bone-graft.

RESULTSIn 6 - 26 months followed-up, no immunologic rejection was found about hydroxyapatite, and no any broken of the screws and shafts was found, no loosing and other complications either. All the patients could move in 3 - 5 days after operation. The height of the broken vertebral body were reduced 97% compared with pre-operation. And CHA in vertebral body was degraded gradually, and at the same time it was replace by new bone in vertebral body. After operation, VAS score was 61 +/- 32, and there was significant difference compared with pre-operation.

CONCLUSIONSThe pedicle screw fixation united vertebroplasty is an efficient way to prevent the failure of the treatment of spine fracture.

Adult ; Bone Screws ; Bone Substitutes ; therapeutic use ; Durapatite ; therapeutic use ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; methods ; Fractures, Compression ; surgery ; Humans ; Male ; Middle Aged ; Spinal Fractures ; surgery ; Vertebroplasty ; methods

OBJECTIVETo test the efficacy of kyphoplasty using an enhanced balloon expander in restoring the height of vertebral compression fractures (OVCF).

METHODSFifteen lumbar vertebral bodies (L1-L5) were harvested from 3 young male fresh cadavers and separated into individual vertebral bodies with the bilateral pedicles of the vertebral arch removed. Before operation, plain X-ray films of all the vertebral bodies were obtained. All the vertebral bodies were compressed lengthwise to approximately 80% of their original heights using a universal material-testing machine to result in compression fractures. Post-compression vertebral bodies were then repaired using an enhanced balloon expander, and the delivery of the bone cement into the vertebral bodies was observed. The heights of the anterior and posterior borders of the vertebral bodied were measured before and after compression as well as after kyphoplasty.

RESULTSThe inflation of the balloon expander averaged 2.95-/+0.18 ml and the pressure was 122.67-/+27.89 psi (1 psi=6895 Pa). Kyphoplasty resulted in significant restoration of the vertebral body height lost due to the compression (P<0.01).

CONCLUSIONKyphoplasty using an enhanced balloon expander may restore vertebral body height damaged by compression and correct the kyphotic deformity. The balloon expander can be a effective and economic choice for kyphoplasty for its relatively low cost.

Adult ; Bone Cements ; Cadaver ; Catheterization ; Fractures, Compression ; etiology ; surgery ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Spinal Fractures ; complications ; surgery ; Tissue Expansion Devices ; Vertebroplasty ; instrumentation ; methods

OBJECTIVETo compare the clinical results of balloon percutaneous kyphoplasty (PKP) and "Sky-bone expander" PKP.

METHODSFrom October 2004 to February 2006, 25 cases (57 vertebrae) balloon PKP and 24 cases (29 vertebrae) "Sky-bone expander" PKP procedures were performed. The operation time, bleeding volume, cement injected volume were recorded during operation. The patients' pain relief and functional activities recovery were evaluated after operation. The distribution of the cement and the restoration of vertebral height were also observed post-operation. All these patients were followed-up by telephone or clinic consults after discharged.

RESULTSAll cases were successfully experienced procedures. There are no significant differences in operative time, bleeding volume and cost of every vertebrae in these two group (P > 0.05). The balloon group had larger cement injected volume per pedicle than Sky group (4.27 +/- 1.08) ml vs. (3.15 +/- 0.78) ml (P < 0.05). The VAS and ODI scoring of these two groups were both decreased significantly after operation. The vertebral height were restored in both two groups with anterior height and midline height restored significantly in balloon group and midline height restored significantly in Sky group. The cement distribution of "Sky-bone expander" PKP with unipediclar injection mostly limited in the injective side of the vertebral body, but most of the balloon PKP vertebrae with unipediclar injection can be seen a cross-midline cement distribution in the anterior-posterior position X ray film.

CONCLUSIONSBoth balloon PKP and "Sky-bone expander" PKP are efficacious and safety in the treatment of vertebral compression fractures. "Sky-bone expander" PKP is more suitable for single level compressive fracture while balloon PKP is especially suitable for multiple level compressive fractures.

Aged ; Aged, 80 and over ; Catheterization ; instrumentation ; Female ; Follow-Up Studies ; Fractures, Compression ; etiology ; surgery ; Humans ; Male ; Middle Aged ; Osteoporosis ; complications ; Spinal Fractures ; etiology ; surgery ; Tissue Expansion Devices ; Vertebroplasty ; instrumentation ; methods