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.

Poor outcomes of bone filling mesh container vertebroplasty for the treatment of osteoporotic vertebral compression fractures with vertebral body wall incompetence / 中国组织工程研究

BACKGROUND: Bone filling mesh container vertebroplasty can effectively correct the kyphotic deformity of the vertebral body, restore the height of the vertebral body, and effectively reduce the rate of bone cement leakage. However, there are few reports on the poor prognosis of bone filling mesh container vertebroplasty in thoracolumbar compression fractures with vertebral body wall incompetence. OBJECTIVE: To discuss adverse outcomes of bone filling mesh container vertebroplasty for the treatment of osteoporotic vertebral compression fractures with vertebral body wall incompetence. METHODS: Totally 19 cases with osteoporotic vertebral compression fracture with vertebral body wall incompetence, who were treated in the Tianjin First Central Hospital from April 2017 to October 2018, were enrolled in this study, including 3 males and 16 females, at the age of 60-86 years. The patients underwent bone filling mesh container vertebroplasty. Postoperative complications were recorded during follow up. Visual analogue scale score and Oswestry disability index were assessed. X-ray films were taken to measure the height of injured vertebral body and Cobb’s angle. This study was approved by the Ethics Committee of Clinical Research Project of Tianjin First Central Hospital (approval No. 2018N150KY). RESULTS And CONCLUSION: (1) All 19 patients were follow-up for 9-20 months. No death occurred during and after operation, and no severe complications such as pulmonary embolism, bone cement allergy or infection occurred. Among them, seven cases had poor prognosis, including five cases of bone cement leakage, four cases of above moderate pain and two cases of adjacent vertebral fractures. (2) Visual analogue scale score, Oswestry disability index, height of injured vertebral body and Cobb’s angle were significantly improved during the final follow-up in 19 patients (P < 0.05). (3) Results showed that poor outcomes of bone filling mesh container vertebroplasty for the treatment of osteoporotic vertebral compression fractures with vertebral body wall incompetence included bone cement leakage, adjacent vertebral body fracture, and postoperative pain. The operation should be carried out in strict accordance with the relevant operation specifications, and the relevant treatment and preventive measures should be made to minimize the occurrence of adverse reactions.

Risk Factors of New Adjacent Compression Fracture after Percutaneous Vertebroplasty: Effectiveness of Bisphosphonate in Osteoporotic or Osteopenic Elderly Patients / 대한신경손상학회지

OBJECTIVE: The purpose of this study is to investigate the incidence of new compression and to analyze factors that influence the fractures in adjacent levels after percutaneous vertebroplasty (PVP). METHODS: This retrospective study examined 206 patients who had undergone PVP for single level osteoporotic or osteopenic compression fractures during the last seven years in our department. After PVP, the patients were observed for at least over one year, and 29 patients showed new additional compression fractures in adjacent levels. One hundred seventy seven patients who did not show additional compression fractures were analyzed as the control group. Statistical comparisons were performed between the groups, in terms of age, gender, bone mineral density, whether bisphosphonate (BPP) was treated, preoperative kyphosis, preoperative wedge angle, change in wedge angle, amount of bone cement, existence of intradiscal bone cement leakage, and initial fracture levels. RESULTS: The statistically significant factors that influence new compression fractures in adjacent levels after PVP were as follows: being female, initial thoracolumbar junction fracture, preoperative large kyphotic, preoperative large wedge angle, change in wedge angle, administration of BPP in osteopenia group, and intradiscal cement leakage. CONCLUSION: This study identified many factors that influence newly developed compression fractures in adjacent levels after PVP. Interestingly, the administration of BPP in osteopenia group had positive influence on new fractures in this study. Therefore, we recommend early administration of BPP to patients with osteopenia.

Fraturas vertebrais adjacentes: cifoplastia versus vertebroplastia / Adjacent vertebral fractures: kyphoplasty versus vertebroplasty / Fracturas vertebrales adyacentes: cifoplastía vs vertebroplastía

OBJETIVO: Comparar a incidência de fraturas de vértebras adjacentes nos pacientes submetidos à vertebroplastia e cifoplastia. MÉTODOS: Estudo retrospectivo baseado na análise de prontuários e exames radiográficos pré e pós-operatórios de janeiro de 2002 a janeiro de 2009. O seguimento mínimo foi de três meses. Os pacientes foram divididos em dois grupos distintos: Vertebroplastia (V) e Cifoplastia (C), de acordo com o procedimento realizado. Foram comparadas entre os dois grupos, a altura dos corpos vertebrais e a cifose angular antes e depois de cada procedimento e correlacionadas com a incidência de fraturas vertebrais adjacentes. A análise estatística foi feita pelos testes qui-quadrado, t de Student e ANOVA de dois fatores seguida por teste post-hoc de Bonferroni. RESULTADOS: Foram analisados os prontuários de 55 pacientes. Dez pacientes foram excluídos do estudo. Vinte e seis pacientes realizaram vertebroplastia e dezenove pacientes realizaram cifoplastia. Foi observada redução da cifose angular média nos pacientes do grupo C de 1,81 graus quando comparados aos pacientes do grupo V. Não houve diferença estatística entre os dois grupos quanto à altura média do corpo vertebral pré- e pós-operatória. Três pacientes do grupo V e dois pacientes do grupo C apresentaram fratura vertebral adjacente. Os dois pacientes com fraturas adjacentes do grupo C estavam em uso de corticosteroides. Os três pacientes do grupo V com fraturas adjacentes apresentaram extravasamento de cimento. CONCLUSÃO: Não houve diferença na incidência de fraturas vertebrais adjacentes entre os dois grupos.

OBJECTIVE: To compare the incidence of adjacent vertebral fractures between vertebroplasty and kyphoplasty. METHODS: We reviewed medical records and radiographs pre and postoperatively from January 2002 to January 2009. The minimal follow-up time was three months. The patients were divided in two distinct groups: vertebroplasty (V) and kyphoplasty (K) group, according to the procedure performed. The vertebral body height and the angular kyphosis before and after each procedure were compared between these two groups and correlated to the incidence of adjacent vertebral fractures. RESULTS: We analyzed 55 medical records. Ten patients were excluded from the study. Twenty-six patients underwent vertebroplasty and nineteen patients underwent kyphoplasty. We found a reduction in the mean angular kyphosis of the kyphoplasty group of 1.81 degrees when compared to the vertebroplasty group. There was no statistical difference related to the mean vertebral body height pre- and postoperatively between the two groups. Three patients of the vertebroplasty group and two patients of the kyphoplasty group presented adjacent vertebral fracture. The two patients of the kyphoplasty group were corticoid-dependent. The three patients of the vertebroplasty group presented cement leakage. CONCLUSION: There was no difference in the adjacent vertebral fracture incidence between the two groups.

OBJETIVO: Comparar la incidencia de fracturas de vértebras adyacentes en los pacientes sometidos a vertebroplastía y cifoplastía. MÉTODOS: Estudio retrospectivo basado en el análisis de historias médicas y exámenes radiográficos pre y posoperatorios, de enero de 2002 a enero de 2009. El seguimiento mínimo fue de tres meses. Los pacientes fueron divididos en dos grupos diferentes: Vertebroplastía (V) y Cifoplastía (C), de acuerdo con el procedimiento realizado. Se comparó, entre los dos grupos, la altura de los cuerpos vertebrales y la cifosis angular, antes y después de cada procedimiento, y fueron correlacionadas con la incidencia de fracturas vertebrales adyacentes. El análisis estadístico fue hecho por las pruebas chi-cuadrado, t de Student y ANOVA de 2 factores seguida por prueba post-hoc de Bonferroni. RESULTADOS: Fueron analizadas las historias médicas de 55 pacientes. Diez pacientes fueron excluidos del estudio. Veintiséis pacientes realizaron vertebroplastía y diecinueve pacientes hicieron cifoplastía. Fue observada reducción de la cifosis angular promedio, en los pacientes del grupo C, de 1,81 grados cuando se compararon con los pacientes del grupo V. No hubo diferencia estadística entre los dos grupos cuanto a la altura promedio del cuerpo vertebral pre y posoperatoria. Tres pacientes del grupo V y dos pacientes del grupo C presentaron fractura vertebral adyacente. Los dos pacientes, con fracturas adyacentes del grupo C, estaban en uso de corticosteroides. Los tres pacientes del grupo V, con fracturas adyacentes, presentaron extravación de cemento. CONCLUSIÓN: No hubo diferencia en la incidencia de fracturas vertebrales adyacentes entre los dos grupos.

Risk Factors of New Compression Fractures in Adjacent Vertebrae after Percutaneous Vertebroplasty

STUDY DESIGN: Retrospective study. PURPOSE: To evaluate risk factors related to the development of new fractures in adjacent vertebrae after percutaneous vertebroplasty. OVERVIEW OF LITERATURE: Recent reports indicate that undue numbers of new fractures in adjacent vertebral bodies occur after percutaneous vertebroplasty. METHODS: One hundred four of 369 patients who underwent percutaneous vertebroplasty were followed for over 1 year. Fifty-four patients (51.9%) subsequently suffered from adjacent vertebral fractures. Age, lumbar lordotic angle, sacral slope, pelvic tilt, pelvic incidence, bone mineral density, amounts of cement injected, the restoration of vertebral height, kyphotic angle differences preexisting fracture, and intradiscal cement leakage were noted. RESULTS: Average bone mineral density was -3.52 in the fracture group and -2.91 in the fracture-free group; the risk of adjacent vertebral fracture increased as bone mineral density decreased (p < 0.05). Intradiscal cement leakage occurred in 18 patients (33.3%) in the fracture group, indicating that the risk of adjacent vertebral fracture increased with intradiscal cement leakage. In addition, 36 patients (66.7%) in the fracture group had a pre-existing fracture; thus, the presence of a preexisting fracture was found to be significantly associated with an increased risk of an adjacent vertebral fracture (p < 0.05). Higher restoration rates are associated with a greater likelihood of developing adjacent vertebral fractures (p < 0.05). CONCLUSIONS: The factors found to contribute significantly to new fractures in adjacent vertebral bodies after percutaneous vertebroplasty were a lower bone mineral density, a greater restoration rate of vertebral height, a pre-existing fracture, and intradiscal cement leakage.

Successful Bone Union Following Calcium Phosphate Cement-Assisted Percutaneous Transpedicular Balloon Kyphoplasty of a Large Interbody Cleft on Long-term Hemodialysis Patient

A 68-year-old diabetic man, who had been on dialysis for 3 years, suffered a five week history of severe back pain that was unresponsive to bed rest, analgesics, and bracing. The vertebral cleft formed by an injury gradually increased in size on sequential plain films. Hence, he underwent calcium phosphate cement-assisted percutaneous transpedicular balloon kyphoplasty to treat a painful interbody vacuum cleft. Immediate pain relief and firm bone union were obtained.

Risk Factors of New Compression Fractures in Adjacent Vertebrae after Percutaneous Vertebroplasty

PURPOSE: To evaluate the risk factors related to the development of new fractures in adjacent vertebrae after vertebroplasty. MATERIALS AND METHODS: The study was conducted on 46 patients in whom 296 patients were performed during last 9 years. We were especially concerned with the restoration rate of vertebral height and kyphotic angle and estimated them on simple X-ray films. RESULTS: In patients experienced subsequent vertebral fractures and no subsequent vertebral fractures after vertebroplasty, the mean height restoration rate of treated vertebra were 16.7% and 7.07%, and the kyphotic angle difference were 2.53 degree and 4.2 degree. The greater degree of height restoration of the vertebral body, especially in middle vertebral height and the lesser degree of kyphotic angle difference increased the risk of adjacent vertebral fracture risk. This results were available statistically (all p<0.05, Logistic regression test, SPSS 13.0). CONCLUSION: It may be thought that the vertebral body height restoration rate will become risk factor of adjacent vertebral fractures.