Application value of bone cement containing rhbFGF and RHBMP-2 in PKP treatment of osteoporotic lumbar compression fracture / 中国骨伤

OBJECTIVE@#To investigate the effect of bone cement containing recombinant human basic fibroblast growth factor (rhbFGF) and recombinant human bone morphogenetic protein-2 (rhBMP-2) in percutaneous kyphoplasty(PKP)treatment of osteoporotic vertebral compression fracture(OVCF).@*METHODS@#A total of 103 OVCF patients who underwent PKP from January 2018 to January 2021 were retrospectively analyzed, including 40 males and 63 females, aged from 61 to 78 years old with an average of (65.72±3.29) years old. The injury mechanism included slipping 33 patients, falling 42 patients, and lifting injury 28 patients. The patients were divided into three groups according to the filling of bone cement. Calcium phosphate consisted of 34 patients, aged(65.1±3.3) years old, 14 males and 20 females, who were filled with calcium phosphate bone cement. rhBMP-2 consisted of 34 patients, aged (64.8±3.2) years old, 12 males and 22 females, who were filled with bone cement containing rhBMP-2. And rhbFGF+rhBMP-2 consisted of 35 patients, aged (65.1±3.6) years old, 14 males and 21 females, who were filled with bone cement containing rhbFGF and rhBMP-2. Oswestry disability index (ODI), bone mineral density, anterior edge loss height, anterior edge compression rate of injured vertebra, visual analog scale (VAS) of pain, and the incidence of refracture were compared between groups.@*RESULTS@#All patients were followed for 12 months. Postoperative ODI and VAS score of the three groups decreased (P<0.001), while bone mineral density increased (P<0.001), anterior edge loss height, anterior edge compression rate of injured vertebra decreased first and then slowly increased (P<0.001). ODI and VAS of group calcium phosphate after 1 months, 6 months, 12 months were lower than that of rhBMP-2 and group rhbFGF+rhBMP-2(P<0.05), bone mineral density after 6 months, 12 months was higher than that of rhBMP-2 and group calcium phosphate(P<0.05), and anterior edge loss height, anterior edge compression rate of injured vertebra of group rhbFGF+rhBMP-2 after 6 months and 12 months were lower than that of group rhBMP-2 and group calcium phosphate(P<0.05). There was no statistical difference in the incidence of re-fracture among the three groups (P>0.05).@*CONCLUSION@#Bone cement containing rhbFGF and rhBMP-2 could more effectively increase bone mineral density in patients with OVCF, obtain satisfactory clinical and radiological effects after operation, and significantly improve clinical symptoms.

Clinical observation of gelfoam in preventing cement leakage via the anterior vertebral wall in Kümmell's patients treated with percutaneous kyphoplasty / 中国骨伤

OBJECTIVE@#To evaluate the efficacy of gelfoam granules application in prevention of cement leakage via anterior vertebral wall in Kümmell's patients treated with percutaneous kyphoplasty (PKP).@*METHODS@#From June 2017 to December 2019, 13 patients with Kümmell disease were treated with PKP, and gelatin sponge was inserted into the anterior wall of vertebral body to prevent bone cement leakage. There were 3 males and 10 females, with an average age of (73.84±8.44) years. The visual analogue scale (VAS) was used to record the degree of pain before treatment and 1 day and 3 months after treatment; Oswestry Disability Index (ODI) was used to evaluate the thoracolumbar function before treatment and 3 monthsafter treatment;X-ray was used to observe the bone cement leakage after operation.@*RESULTS@#The VAS scores were 7.31±0.83, 2.92±1.13 and 1.69±1.11 before treatment and 1 day and 3 months after treatment, respectively. The VAS scores on the 1st day and 3 months after treatment were lower than those before treatment (@*CONCLUSION@#The application of gelfoam granules in PKP can effectively prevent the leakage of bone cement via the anterior vertebral wall of Kümmell patients, and reduce the risk of thermal and mechanical injury of soft tissues such as the aorta in front of the vertebral body, and does not affect the postoperative pain relief and the recovery of thoracolumbar function.

Analysis of related risk factors for the refracture of adjacent vertebral body after percutaneous kyphoplasty / 中国骨伤

OBJECTIVE@#To investigate the risk factors of vertebral refracture after percutaneous kyphoplasty (PKP) for osteoprotic vertebral compression fractures (OVCFs), and to provide reference for clinical prevention.@*METHODS@#A retrospective analysis of 228 OVCFs patients who met the inclusion criteria admitted from November 6, 2013 to December 14, 2018. There were 35 males and 193 females, with a male-to-female ratio of 3∶20, and aged 58 to 91 years with an average of (69.70±7.03) years. All patients were treated with PKP and had complete clinical data. According to whether refracture occurred after operation, they were divided into refracture group (24 cases) and non refracture group (204 cases). Factors that may be related to refracture (including gender, age, surgical segment, number of vertebral bodies in the surgical segment, whether combined with degenerative scoliosis, whether anti-osteoporosis treatment) were included in the univariate analyses, and the single factor analysis of statistically significant risk factors was carried out with multiple Logistic regression analysis to further clarify the independent risk factors for vertebral body refracture after PKP. Survival analysis was performed using the time of vertebral refracture after PKP as the end time of follow up, the occurrence of refracture after PKP as the endpoint event, and the presence or absence of degenerative lateral curvature as a variable factor.@*RESULTS@#All 228 patients were followed up for 1.8 to 63.6 months with an average of (28.8±15.6) months, and the refracture rate was 10.5%(24/228). There were statistically significant differences between two groups in age, number of operative vertebral bodies, whether combinedwith degenerative scoliosis and whether anti osteoporosis treatment (@*CONCLUSION@#Combined scoliosis is an independent risk factor for refracture after OVCFs vertebroplasty, and it is also a possible high-risk factor for refracture after surgery.

Effect of Kyphoplasty in the Treatment of Osteoporotic Vertebral Fractures Compared to Vertebroplasty ­ Overview of Systematic Reviews

Introduction Vertebroplasty and kyphoplasty are possible options for vertebral augmentation after osteoporotic fractures. Both are percutaneous techniques with specific advantages and disadvantages. Our aim is to compare the clinical and radiological results of these two procedures. Methods An overview of published systematic reviews in the literature on the effects of kyphoplasty compared with vertebroplasty was performed. Results After short and long follow-up, the kyphoplasty group had lower pain scores on the visual analogue scale (VAS), lower scores in the Oswestry Disability index (ODI), greater restoration of the vertebral body height and lower kyphosis angle in the immediate postoperative period. There was less leakage of cement to the vertebral canal and extraspinal spaces. Conclusions Compared with vertebroplasty, kyphoplasty achieved better results in pain relief, quality of life, correction of spinal deformity and lower risk of cement leakage.

Introdução Vertebroplastia e cifoplastia são opções possíveis de tratamento para fraturas vertebrais osteoporóticas. Ambas são técnicas percutâneas com vantagens e desvantagens específicas. Nosso objetivo é comparar os resultados clínicos e radiológicos dos dois procedimentos. Métodos Foi realizada uma revisão sistemática da literatura publicada sobre os efeitos da cifoplastia em comparação com a vertebroplastia. Resultados No acompanhamento a curto e longo prazo, o grupo de cifoplastia teve valores mais baixos na escala visual analógica (EVA) de dor, valores mais baixos no índice de incapacidade de Oswestry (IIO), maior restauração da altura do corpo vertebral e menor ângulo de cifose no pós-operatório imediato. Houve menor incidência de extravasamento de cimento no canal vertebral e nos espaços extraespinhais. Conclusões Em comparação com a vertebroplastia, a cifoplastia obteve melhores resultados no alívio da dor, na qualidade de vida, na correção de deformidade espinhal e menor risco de extravasamento de cimento.

Revision Surgery after Vertebroplasty or Kyphoplasty

BACKGROUND: We wanted to investigate the leading cause of failed vertebroplasty or kyphoplasty. METHODS: Twelve patients (10 females and 2 males) who underwent revision surgery after vertebroplasty or kyphoplasty were included. In 4 cases, vertebroplasty was done for two or more levels. Six cases with kyphoplasty were included. Through the retrospective review of the radiographic studies and medical record, we analyzed the etiology of the revision surgery. RESULTS: Uncontrolled back pain was the main clinical presentation. In 4 cases, neurological symptoms were noted, including one case with conus medullaris syndrome. The average time to the revision surgery after vertebroplasty or kyphoplasty was 15 months. Infection (4 cases) and progressive kyphosis with collapse (8 cases) were the causes for the revision. A solid pattern of inserted bone cement and bone resorption around the cement were noted in the all cases with progressive collapse and kyphosis. CONCLUSIONS: Infection, misdiagnosis and progressive kyphosis were causes of the revision surgery after vertebroplasty and kyphoplasty. A solid pattern of accumulation of bone cement and peri-cement bone resorption might be related with the progressive collapse.