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Objective:To evaluate the risk factors for adjacent vertebral compression fracture (AVCF) after fusion surgery of lumbar canal stenosis in the elderly.Methods:A retrospective cohort study was designed for 297 patients with lumbar canal stenosis who underwent fusion surgery in Hubei Provincial Hospital of Integrated Chinese and Western Medicine from January 2017 to December 2020. There were 42 males and 255 females, aged 68-85 years [(76.3±7.2)years]. The patients were divided into AVCF group ( n=67) and non-AVCF group ( n=230) according to with or without the occurrence of AVCF. The indicators recorded were the gender, age, body mass index, education level, number of combined basic diseases, course of the disease, preoperative bone mineral density, intraoperative bleeding volume, number of level fused during operation, postoperative blood transfusion volume, postoperative observation in the ICU, types of postoperative external fixation and time of external fixation. Univariate analysis was conducted to analyze the correlation between above risk factors and AVCF after fusion surgery of lumbar canal stenosis in the elderly. Multivariate Logistic regression analysis was used to determine the independent risk factors for the occurrence of AVCF in these patients. Results:In the univariate analysis, age, education level, preoperative bone mineral density, intraoperative bleeding volume, postoperative blood transfusion volume and postoperative observation in the ICU were correlated with AVCF after fusion surgery of lumbar canal stenosis in the elderly ( P<0.05 or 0.01), while there was no correlation of AVCF with gender, body mass index, number of combined basic diseases, course of the disease, number of level fused during operation, types of postoperative external fixation and time of external fixation (all P>0.05). Multivariate Logistic regression analysis showed that gender ( OR=4.02, 95% CI 1.35, 12.00, P<0.05), preoperative bone mineral density≤-2.5 SD ( OR=2.01, 95% CI 1.47, 2.75, P<0.01), intraoperative bleeding volume≥475 ml ( OR=1.01, 95% CI 1.00, 1.01, P<0.01) and postoperative blood transfusion volume≥434 ml ( OR=0.99, 95% CI 0.98, 1.00, P<0.01) were significantly associated with AVCF after fusion surgery of lumbar canal stenosis in the elderly. Conclusion:The female, bone mineral density≤-2.5 SD, intraoperative bleeding volume≥476 ml and postoperative blood transfusion volume≥434 ml are independent risk factors for AVCF after fusion surgery of lumbar canal stenosis in the elderly.
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BACKGROUND: Simple bone cement is easy to cause refracture of adjacent vertebra due to its high hardness. Currently, a material that can reduce the incidence of adjacent vertebra fracture is urgently needed. OBJECTIVE: To observe the clinical efficacy of percutaneous vertebroplasty using mineralized collagen modified bone cement. METHODS: Totally 60 patients with fresh single osteoporotic vertebral compression fractures who underwent percutaneous vertebroplasty were randomly divided into two groups, with 30 cases in each group. Patients in the simple bone cement group were given polymethyl methacrylate bone cement. Patients in the modified bone cement group were given mineralized collagen modified bone cement mixed with artificial bone repair material and simple polymethyl methacrylate bone cement. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The follow-up time was 6-12 months. The clinical effect was assessed by the visual analogue scale, Oswestry Disability Index, Cobb angle and percentage of vertebral anterior edge height before surgery, at 2 days after surgery and during the last follow-up. Postoperative complications were recorded. RESULTS AND CONCLUSION: (1) All patients underwent successful operation. A total of four patients were found to have different degrees of bone cement leakage, and none of the patients presented obvious clinical discomfort symptoms. (2) Compared with pre-operation, visual analogue scale and Oswestry Disability Index were significantly improved (P 0.05) at 2 days after operation and during the last follow-up in the two groups. There were no significant differences in above indexes between the two groups at the same time point (P > 0.05). (3) The number of adjacent fractures in the simple bone cement group was more than that in the modified bone cement group, but there was no statistically significant difference in the incidence of adjacent vertebral fractures between the two groups (P > 0.05). (4) It is confirmed that compared with simple bone cement, mineralized collagen modified bone cement has no obvious disadvantages. In addition, mineralized collagen modified bone cement can give better biological properties while ensuring the strength of bone cement support and reducing pain. Further studies are needed to reduce the incidence of adjacent vertebral fractures.
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STUDY DESIGN: Retrospective cohort study. PURPOSE: To evaluate the incidence and risk factors for early adjacent vertebral fractures following balloon kyphoplasty (KP). OVERVIEW OF LITERATURE: KP is a safe and effective treatment for pain alleviation in patients with osteoporotic vertebral compression fractures (OVCF). However, some studies have reported that the risk of newly developed fractures increases at the adjacent vertebra after KP. METHODS: Total 123 consecutive patients with painful OVCF who underwent KP were enrolled from January 2009 to June 2016. Early adjacent vertebral fractures were defined as new fractures that had developed within 3 months after surgery. Sex, age, body mass index (BMI), bone mineral density (BMD), vertebral height, kyphotic angle, Visual Analog Scale score, cement amount, and leakage were evaluated as risk factors for adjacent vertebral fractures. Only cement leakage into the disc space was included in this study. RESULTS: Early adjacent vertebral fractures were identified in 20 (16.2%) of the 123 patients. The mean time to diagnosis of fractures was 1.7±0.7 months after KP. The average patient age was 78.0±0.7 years, average BMI was 23.06±3.83 kg/m², and mean BMD was −3.61±1.22 g/m². Cement leakage was present in 16 patients, and fractures developed in 11 (68.7%). In contrast, fractures developed in nine patients (8.2%) without cement leakage. There were no significant differences in terms of age, BMI, BMD, kyphotic angle, or vertebral body height ratio between the fracture and control groups. CONCLUSIONS: Cement leakage into the disc increased the risk of early adjacent vertebral fractures after balloon KP.
Subject(s)
Humans , Body Height , Body Mass Index , Bone Density , Cohort Studies , Diagnosis , Fractures, Compression , Incidence , Kyphoplasty , Retrospective Studies , Risk Factors , Spine , Visual Analog ScaleABSTRACT
10.3969/j.issn.2095-4344.2013.26.006
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STUDY DESIGN: A retrospective study. OBJECTIVES: To find out the characteristics and the risk factors of adjacent vertebral compression fracture after percutaneous vertebroplasty. SUMMARY OF LITERATURE REVIEW: Percutaneous vertebroplasty is regarded as more effective treatment than conservative care, but additional fracture could cause complications during follow up. MATERIALS AND METHODS: We analyzed 43 patients who had only one vertebral compression fracture after one vertebroplasty. The number of patients who had additional compression fracture within one level from the operated vertebra were 23 cases (Group I); beyond two levels from the operated vertebra were 20 cases (Group II). We compared the onset period of additional compression fracture, the degree of osteoporosis, age, level, restoration of vertebral body height and kyphosis between the two groups. RESULTS: The onset period of additional compression fracture was 18.7+/-28.1 months in Group I and 42.7+/-39.4 months in Group II, showing significant difference between the two groups. Group I had more cases of previous vertebroplasty on thoraco-lumbar vertebra than Group II. The restoration rate of vertebral body height of Group I was 42.3+/-40.9% and that of Group II was 22.8+/-21.6%, which shows significant difference between the two. CONCLUSION: Adjacent vertebral compression fracture after vertebroplasty can occur earlier than non adjacent one. We need to pay attention to the patients who had higher restoration rate of vertebral body height after vertebroplsty as they are more prone to having additional adjacent compression fracture.