OBJECTIVE: To analyze the correlation between bone cement cortical leakage and injury degree of osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP), and to provide guidance for reducing clinical complications. METHODS: A clinical data of 125 patients with OVCF who received PKP between November 2019 and December 2021 and met the selection criteria was selected and analyzed. There were 20 males and 105 females. The median age was 72 years (range, 55-96 years). There were 108 single-segment fractures, 16 two-segment fractures, and 1 three-segment fracture. The disease duration ranged from 1 to 20 days (mean, 7.2 days). The amount of bone cement injected during operation was 2.5-8.0 mL, with an average of 6.04 mL. Based on the preoperative CT images, the standard S/H ratio of the injured vertebra was measured (S: the standard maximum rectangular area of the cross-section of the injured vertebral body, H: the standard minimum height of the sagittal position of the injured vertebral body). Based on postoperative X-ray films and CT images, the occurrence of bone cement leakage after operation and the cortical rupture at the cortical leakage site before operation were recorded. The correlation between the standard S/H ratio of the injured vertebra and the number of cortical leakage was analyzed. RESULTS: Vascular leakage occurred in 67 patients at 123 sites of injured vertebrae, and cortical leakage in 97 patients at 299 sites. Preoperative CT image analysis showed that there were 287 sites (95.99%, 287/299) of cortical leakage had cortical rupture before operation. Thirteen patients were excluded because of vertebral compression of adjacent vertebrae. The standard S/H ratio of 112 injured vertebrae was 1.12-3.17 (mean, 1.67), of which 87 cases (268 sites) had cortical leakage. The Spearman correlation analysis showed a positive correlation between the number of cortical leakage of injured vertebra and the standard S/H ratio of injured vertebra ( r=0.493, P<0.001). CONCLUSION The incidence of cortical leakage of bone cement after PKP in OVCF patients is high, and cortical rupture is the basis of cortical leakage. The more severe the vertebral injury, the greater the probability of cortical leakage.
Male ; Female ; Humans ; Aged ; Kyphoplasty/methods* ; Bone Cements ; Fractures, Compression/surgery* ; Spinal Fractures/surgery* ; Retrospective Studies ; Osteoporotic Fractures/etiology* ; Treatment Outcome ; Vertebroplasty/methods*

OBJECTIVE: To study the application of different puncture techniques to inject bone cement in osteoporotic vertebral compression fractures (OVCFs). METHODS: The clinical data of 282 patients with OVCFs treated from January 2017 to December 2019 were collected for a retrospective study. According to the surgical plan the patients were divided into group A and B, with 141 cases in each group. In group A, extreme lateral puncture was used to inject bone cement through unilateral puncture and bilateral puncture. In group B, bone cement was injected through unilateral pedicle puncture through pedicle approach. The operation status(operation time, radiation exposure time, bone cement injection volume, hospital stay) and complications were observed between two groups. Before operation and 6, 12 months after operation, the pain mediators such as serotonin 5-hydroxytryptamine (5-HT), prostaglandin E2(PGE2), substance P(SP) were compared, bone mineral density, anatomical parameters of the injured vertebrae (height of the anterior edge of the vertebral body, height of the posterior edge of the vertebral body, Cobb angle), visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated between two groups. RESULTS: There were no significant difference in operation time, radiation exposure time, hospital stay between two groups (P>0.05). The amount of bone cement injected in group A was greater than that in group B (P<0.05). The serum 5-HT, SP and PGE2 levels of group A were lower than those of group B at 12 months after operation (P<0.05). The height of anterior edge and height of the posterior edge of vertebral body in group A were greater than those of group B at 12 months after operation, Cobb angle of group A was smaller than that of group B, VAS and ODI were lower than those of group B(P<0.05). There was no significant difference in bone mineral density between two groups at 6 and 12 months postoperatively(P<0.05). There was no significant difference between two groups in postoperative complications (P>0.05). CONCLUSION Compared with unilateral puncture of the pedicle approach, unilateral puncture and bilateral cement injection technique is more conducive to the recovery of the injured vertebral anatomy and function, and do not prolong operation time, radiation exposure time, hospital stay, nor do increase the risk of nerve damage and bone cement leakage, and postoperative bone metabolism and bone mineral density are improved well, which is a safe and reliable surgical method for the treatment of OVCFs.
Humans ; Spinal Fractures/surgery* ; Fractures, Compression/surgery* ; Bone Cements ; Vertebroplasty/methods* ; Retrospective Studies ; Dinoprostone ; Serotonin ; Treatment Outcome ; Osteoporotic Fractures/surgery* ; Kyphoplasty ; Punctures

OBJECTIVE: To verify the safety of three dimensional printing percutaneous guide plate assisted percutaneous kyphoplasty(PKP) in the treatment of osteoporotic vertebral compression fractures(OVCFs). METHODS: The clinical data of 60 patients with OVCFs treated by PKP from November 2020 to August 2021 were retrospectively analyzed. There were 24 males and 36 females, aged from 72 to 86 years old with an average of (76.5±7.9) years. Routine percutaneous kyphoplasty was performed in 30 cases (conventional group) and three dimensional printing percutaneous guide plate assisted PKP was performed in 30 cases (guide plate group). Intraoperative pedicle puncture time (puncture needle to posterior vertebral body edge) and number of fluoroscopy, total operation time, total number of fluoroscopy, amount of bone cement injection, and complication (spinal canal leakage of bone cement) were observed. The visual analogue scale (VAS) and the anterior edge compression rate of the injured vertebra were compared before operation and 3 days after operation between two groups. RESULTS: All 60 patients were successfully operated without complication of spinal canal leakage of bone cement. In the guide plate group, the pedicle puncture time was(10.23±3.15) min and the number of fluoroscopy was(4.77±1.07) times, the total operation time was (33.83±4.21) min, the total number of fluoroscopy was(12.27±2.61) times;and in the conventional group, the pedicle puncture time was (22.83±3.09) min and the number of fluoroscopy was (10.93±1.62) times, the total operation time was(44.33±3.57) min, the total number of fluoroscopy was(19.20±2.67) times. There were statistically significant differences in the pedicle puncture time, intraoperative number of fluoroscopy, the total operation time, and the total number of fluoroscopy between the two groups(P<0.05). There was no significant difference in amount of bone cement injection between the two groups(P>0.05). There were no significant differences in VAS and the anterior edge compression rate of the injured vertebra at 3 days after operation between two groups(P>0.05). CONCLUSION Three dimensional printing percutaneous guide plate assisted percutaneous kyphoplasty is safe and reliable, which can reduce the number of fluoroscopy, shorten the operation time, and decrease the radiation exposure of patients and medical staff, and conforms to the concept of precise orthopaedic management.
Male ; Female ; Humans ; Aged ; Aged, 80 and over ; Kyphoplasty/methods* ; Fractures, Compression/surgery* ; Spinal Fractures/surgery* ; Bone Cements ; Retrospective Studies ; Treatment Outcome ; Osteoporotic Fractures/surgery*

OBJECTIVE: To compare the efficacy between vesselplasty and percutanous kyphoplasty (PKP) in the treatment of Kümmell disease. METHODS: The clinical data of patients with Kümmell disease from July 2018 to December 2019 were retrospectively analyzed. According to the different therapeutic methods, the patients were divided into vesselplasty group and PKP group. There were 20 patients in vesselplasty group, including 2 males and 18 females, aged from 54 to 83 years with an average of (67.40±7.44)years, 1 case of T₁₀ fracture, 3 cases of T₁₂ fracture, 9 cases of L₁ fractures, 5 cases of L₂ fractures and 2 cases of L₃ fractures. There were 20 patients in PKP group, including 3 males and 17 females, aged from 56 to 81 with an average of(67.20±7.01) years, 2 cases of T₁₀ fracture, 1 case of T₁₁ fracture, 6 cases of T₁₂ fracture, 10 cases of L₁ fracture and 1 case of L₃ fracture. Visual analogue scale(VAS), Cobb angle, anterior vertebral height were recorded before operation, 1 day after operation and 1 year after operation. Oswestry Disability Index(ODI) was recorded before operation, 1 month after operation and 1 year after operation. And bone cement leakage rate was compared between two groups after operation. RESULTS: All the patient were followed up for more than 1 year. In vesselplasty group, VAS score was 1.20±0.41, ODI was(13.50±3.10)%, Cobb angle was(17.20±3.12)° and anterior vertebral height was(20.20±1.35) mm at 1 year after operation. In PKP group, VAS score was 1.15±0.40, ODI was (13.20±3.00)%, Cobb angle was (17.10±3.19)° and anterior vertebral height was (20.10±1.37) mm at 1 year after operation. These index was significantly better than pre-operation through intra-group comparison(P<0.05), and there was no statistically difference between the two groups(P>0.05). There were 20 cases (20 vertebrae) in vesselplasty group, of which 1 case had bone cement leakage at the upper endplate, with a leakage rate of 5%(1/20). In PKP group, there were 20 cases (20 vertebrae), 3 cases of upward endplate leakage(3/7), 1 case of downward endplate leakage(1/7), 1 case of leakage to the front of the vertebral body(1/7), 2 cases of leakage to the side of the vertebral body(2/7), with a leakage rate of 35% (7/20). The difference between two groups was statistically significant(P<0.05). CONCLUSION Vesselplasty in the treatment of Kümmell disease can better reduce leakage rate of bone cement and reduce complications.
Bone Cements ; Female ; Fractures, Compression/surgery* ; Humans ; Kyphoplasty/methods* ; Male ; Osteoporotic Fractures/surgery* ; Retrospective Studies ; Spinal Fractures/surgery* ; Spondylosis ; Treatment Outcome ; Vertebroplasty

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*

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

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the factors affecting the incidence of new vertebral fractures and the survival rate associated with the occurrence of a new fracture in an adjacent vertebra after vertebroplasty or kyphoplasty for single-vertebral body fracture due to osteoporosis. SUMMARY OF LITERATURE REVIEW: It is controversial whether adjacent-vertebra fractures after vertebroplasty or kyphoplasty are due to the natural course of osteoporosis or are a complication of vertebroplasty. MATERIALS AND METHODS: From May 2002 to January 2010, among 490 cases of vertebroplasty and kyphoplasty for the fracture of a single vertebral body due to osteoporosis, 250 cases were analyzed retrospectively, and a survival rate analysis was performed based on the incidence of a new fracture in an adjacent vertebral body. The survival rate analysis was conducted based on age at the time of surgery, gender, surgical method, leakage of cement into the vertebral disc, compression rate before surgery, recovery of vertebral height after surgery, bone density before surgery, surgeon, the presence of diabetes, and smoking. The average follow-up period was 13.8 months (range, 1 month to 7 years and 11 months) and the mean age at the time of surgery was 72.1 years (range, 47-92 years). RESULTS: Among the 250 cases, a new fracture in an adjacent vertebral body occurred in 30 cases (12%). The 1-year survival rate of patients undergoing vertebroplastry or kyphoplasty for a vertebral fracture was 88.4%, the 5-year rate was 66.8%, and the 7-year rate was 53.5%. When the cases were analyzed according to whether the patient's age at the time of surgery was under or over 70 years, the survival rate was significantly higher in the under-70 group (p=0.026). Moreover, when analyzing the survival rate using a 3% vertebral height recovery rate after surgery as baseline, the group that showed 3% or less had a significantly higher survival rate (p=0.04); moreover, the survival rate was significantly higher in patients with a bone density higher than −3.6 (p=0.046). In multiple factor analysis, age at the time of surgery (p=0.022) and the vertebral height recovery rate after surgery (p=0.046) were found to be statistically significant factors. CONCLUSIONS: The survival rate associated with a new fracture in an adjacent vertebra after vertebroplasty or kyphoplasty for osteoporotic compression fractures was significantly decreased at 1, 5, and 7 years. Based on the survival rate analysis, the most crucial factors were age and the vertebral height recovery rate after surgery.
Bone Density ; Follow-Up Studies ; Fractures, Compression ; Humans ; Incidence* ; Kyphoplasty* ; Methods ; Osteoporosis ; Retrospective Studies ; Smoke ; Smoking ; Spine* ; Survival Analysis* ; Survival Rate ; Vertebroplasty*

Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures (OVCFs) after kyphoplasty. This finite element study was to examine whether short segment pedicle screw fixation (PSF) with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae after kyphoplasty for OVCFs. By simulating cement augmentation with or without short segment pedicle screw fixation (PSF), two tridimensional, anatomically detailed finite element models of the T10-L2 functional spinal junction were developed. The insertion of pedicle screws into the intact vertebra apparently decreased the stress distribution of the treated vertebra in vertical compression and other load situations. The stress distribution in the bone structures of the intact vertebra adjacent to the intact-screwed vertebra was much less than that in the one adjacent to the treated vertebra. The insertion of pedicle screws into the intact vertebra greatly decreased the maximum displacement of the cortical bones and cancellous bones of the vertebrae. Our results indicated that short segment PSF with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae in the management of OVCFs.
Computer Simulation ; Finite Element Analysis ; Fracture Fixation, Internal ; adverse effects ; instrumentation ; methods ; Humans ; Kyphoplasty ; adverse effects ; instrumentation ; methods ; Osteoporotic Fractures ; etiology ; prevention & control ; Pedicle Screws ; adverse effects ; Postoperative Complications ; prevention & control ; Spinal Fractures ; etiology ; prevention & control ; Spine ; diagnostic imaging ; surgery

OBJECTIVETo evaluate the therapeutic effects of percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fracture (OVCF) with degenerative scoliosis.

METHODSFrom March 2009 to March 2014,121 patients undergoing PKP for the treatment of osteoporotic vertebral compression fracture (OVCF) with degenerative scoliosis were retrospective analyzed. There were 41 males and 80 females,ranging in age from 56 to 92 years with an average of 73.2 years. Preoperative and postoperative 3 d respectively pain visual analogue scale (visual analogue score, VAS) and Oswestry Disability Index assessed pain and functional recovery of patients and preoperative and postoperative 3 d lumbar lordosis, scoliosis Cobb angle were analyzed.

RESULTSAll the patients were followed up, and the duration ranged from 6 to 24 months, with a mean time of 11 months. All the patients achieved success in operation without serious complications. The operation time ranged from 30 to 65 min with an average of 42.2 min. Local leakage of bone cement was not found in canal. The VAS and Oswestry Disability Index at the 3rd day after operation decreased significantly compared with those of the preoperative (P < 0.05), and the lumbar lordosis and scoliosis Cobb angle also improved significantly compared with those of the preoperative (P < 0.05).

CONCLUSIONPercutaneous kyphoplasty (PKP) for the treatment of thoracolumbar scoliosis osteoporotic fracture can significantly improve patients spinal deformity, pain relief, which is worth of recommending.

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