Risk factors of adjacent vertebral collapse after kyphoplasty with cement injection in older adult women / 中国组织工程研究

BACKGROUND: Up to now, there are no reports on the risk factors of adjacent vertebral fractures after kyphoplasty with bone cement injection in older adult women in Haikou city or Hainan province of China. OBJECTIVE: To investigate the risk factors of adjacent vertebral collapse (fracture) in older adult women with osteoporotic vertebral compression fractures after kyphoplasty with cement injection. METHODS: 192 older adult women with osteoporotic vertebral compression fractures, aged 61 -84 years, who underwent kyphoplasty with bone cement injection during January 2015-October 2018 in Hainan General Hospital, were included in this study. General indexes, orthopedic indexes, and the incidence of adjacent vertebral fractures within 3 months after surgery were recorded. The correlation between patient's medical records and adjacent vertebral fractures after surgery was analyzed. This study was approved by the Medical Ethics Committee of Hainan General Hospital of China (approval No. 20180917). RESULTS AND CONCLUSION: (1) Adjacent vertebral fractures occurred in 53 patients (68 vertebrae) within 3 months after surgery. The incidence of adjacent vertebral fractures was 27. 60%. (2) Univariate analysis showed that age, body mass index, menopausal age, diabetes mellitus, bone mineral density T value, the number of augmented vertebral bodies, bone cement extravasation, amount of bone cement and use of zoledronic acid after surgery could affect the occurrence of adjacent vertebral fractures after kyphoplasty (P 0. 05). (3) Multivariate logistic analysis showed that age (s 75 years old), bone mineral density T value (< -4. 5), bone cement extravasation, and the number of augmented vertebral bodies were risk factors for adjacent vertebral fractures (P < 0. 05). Menopausal age (£ 47 years old) and use of zoledronic acid after surgery were protective factors for adjacent vertebral fractures (P < 0. 05). (4) The results showed that in older adult women with osteoporotic vertebral compression fractures treated by kyphoplasty, in addition to age, bone mineral density T value, bone cement extravasation, the number of augmented vertebral bodies, and anti-osteoporosis treatment, premature menopause should also be paid attention to.

Combined Treatment of Degenerative Spinal Stenosis and Osteoporotic Compression Fracture / 대한골다공증학회지

OBJECTIVES: To analyze the treatment results of combined treatment with percutaneous vertebroplasty and adhesiolysis in the patients who happened the osteoporotic compression fractures during the conservative treatment of pre-existing degenerative spinal stenosis. MATERIALS AND METHODS: A retrospective review was carried out on 38 patients who happened the osteoporotic compression fractures during the conservative treatment of pre-existing degenerative spinal stenosis. We performed percutaneous vertebroplasty for osteoporotic compression fractures and adhesiolysis for degenerative spinal stenosis after 4 weeks after vertebroplasty. Radiologic results were evaluated by progression of compression rate, fractures in adjacent segment and change of the BMD. Clinical results were evaluated with Denis pain scale for osteoporotic compression fractures and Katz satisfaction scale for degenerative spinal stenosis. RESULTS: The compression rate was 30.2% preoperatively, 21.4% postoperatively, and 24.6% at 12 months postoperatively. There was no fracture in adjacent segment. Clinically, the Denis score were P3 in 13 and P4 in 25, preoperatively, P1 in 11 and P2 in 26, P3 in 1, postoperatively (P=0.03). In regard to degenerative diseases, the Kats scale were 38 to 5, 86.8% in low back pain (P=0.017) and 38 to 4, 89.4% in claudication (P=0.006). The overall Katz satisfaction scale was 81.5% at 12 months postoperatively. The BMD changes in patients who treated neuroplasty was not significant (P=0.175). CONCLUSIONS: The combined treatment with percutaneous vertebroplasty and adhesiolysis may be an effective treatment strategy for the osteoporotic compression fracture and spinal stenosis without surgical intervention in old age patients.

Treatment of Combined Degenerative Lumbar Disease and Adjacent Vertebral Fracture / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVE: To analyze the treatment results of vertebroplasty in patients who suffered osteoporotic compression fractures during conservative treatments for pre-existing degenerative lumbar disease. SUMMARY AND LITERATURE REVIEW: Whilst spinal fusion has shown satisfactory clinical results, solid fusion has been reported to accelerate the degenerative changes at the unfused adjacent levels. Therefore, the level of spinal fusion in patients with compression fractures and pre-existing degenerative lumbar disease is controversial. Few studies have evaluated the outcomes of spinal fusion and adjacent segment vertebroplasty. MATERIALS AND METHODS: A retrospective review was carried out on 28 patients who suffered the osteoporotic compression fractures during conservative treatment for pre-existing degenerative lumbar disease. Posterolateral fusion and vertebroplasty were performed for degenerative disease and compression fractures. The average fusion level was 1.82. The mean compressed vertebral bodies were 1.68. The radiology results were evaluated to determine the progression of the compression rate and fractures in the adjacent segment. The clinical results were evaluated using the Denis pain scale for compression fractures and Katz satisfaction scale for degenerative lumbar disease. RESULTS: The average compression rate was 30.2% preoperatively, 21.4% postoperatively, and 24.6% at the final follow-up. There was no fracture in the adjacent segment. Clinically, the preoperative Denis score was P3 and P4 in 8 and 20 patients, respectively. On the other hand, the postoperative Denis score was P1, P2 and P3 in 8, 19 and 1 patients, respectively. In regard to degenerative diseases, the overall satisfaction was 82.1%. CONCLUSION: The stability of fracture sites in vertebroplasty of patients with pre-existing lumbar disease was confirmed. However, further compression of the fractured vertebral body was observed after vertebroplasty in long fusion. Therefore, a followup study of more cases will be necessary to confirm the changes in the vertebroplasty site.

Percutaneous vertebroplasty: technical considerations / 中国介入影像与治疗学

Percutaneous vertebroplasty (PVP) is a relative new interventional technique, which is widely used in treatment of vertebral collapse caused by vertebral neoplasms and osteoporotic compression fractures. The general technical considerations of PVP techniques are discussed based on authors' experience obtained over 400 patients in the past years in this article, including preparation of PMMA, instrument of PVP, guidance and puncture approaches, and technique of the procedure, etc. The conclusion is that PVP is a safe procedure if the physicians handle it properly.

Outcome of Percutaneous Vertebroplasty Assessed by Ambulatory Scale in Patients with Osteoporotic Vertebral Compression Fractures

OBJECTIVE: The purpose of this study is to evaluate the outcome of percutaneous vertebroplasty based on the ambulatory scale, classified at our institution, and to determine the factors influencing on prognosis of vertebroplasty. METHODS: We retrospectively reviewed a consecutive patients undergoing percutaneous vertebroplasty between June 1999 and December 2001. A total of 151 patients underwent percutaneous vertebroplasty. We investigated the effects of clinical and radiological variables on ambulatory outcome of percutaneous vertebroplasty. RESULTS: Ambulatory status was improved in 94.7% and 88.7% of the patients at postoperative 1 day and last follow-up, respectively. Symptom duration, the remain of vertebral body height, the level and numbers of procedure, the amount of PMMA and presence of PMMA leakage did not influence on the ambulatory outcome of vertebroplasty(p>0.05). A stepwise logistic regression analysis demonstrated that preoperative ambulatory score and the severity of osteoporosis were important prognostic factors at postoperative 1 day, while only the patients' age was a significant prognostic factor at last follow-up, in patients with osteoporotic compression fractures. CONCLUSION: Percutaneous vertebroplasty can be an effective treatment modality for improvement in ambulatory status in patients with osteoporotic vertebral compression fractures, especially when the osteoporosis is severe and preoperative ambulatory score is low. At long term follow-up, only patients' age has an important prognostic value.

Measurement of Bone Mineral Density of Lumbar Spine in Osteoporotic Patients Treated with Percutaneous Vertebroplasty / 대한마취과학회지

BACKGROUND: Osteoporosis and associated fractures have become increasingly common in Korea. We studied the bone mineral density (BMD) of the vertebral body using dual energy X-ray absorptiometry in a percutaneous vertebroplasty group and compared it with that in an osteoporotic group to investigate the correlations between BMD, age distribution and fracture site and to estimate the fracture threshold in the percutaneous vertebroplasty group. METHODS: We analyzed 32 patients who were older than 50 years and performed percutaneous vertebraoplasty due to osteoporotic compression fractures. Thoraco-lumbar and lumbo-sacral films were taken of all patients. Measurement of vertical height of the anterior, middle and posterior regions of the vertebrae was made on standard lateral radiographs of the spine. BMD of the lumbar spine was determined by dual energy x-ray absorptiometry (DEXA Lunar PRODIGY, GE system, Madison, Wis, USA). RESULTS: Age related BMD changes decreased markedly between the sixth and seventh decades. BMD in the percutaneous vertebroplasty group was significantly lower than in the osteoporotic group. The osteoporotic compression fracture rate increased with age. A lower BMD showed a higher incidence of osteoporotic compression fracture. In the percutaneous vertebroplasty group, the 90th percentile of BMD was defined as the fracture threshold at 0.81 g/cm2. The 12th thoracic vertebrae and the 1st lumbar vertebrae were the most frequent fracture sites. CONCLUSIONS: We conclude that when the BMD decreases to less than 0.81 g/cm2, the risk of osteoporotic compression fractures escalates rapidly. Postmenopausal women with BMDs lower than this fracture threshold should receive prophylaxes for osteoporotic fracture.