Truths and myths about augmentation techniques in the treatment of fragility fractures. / Verdades y mentiras de las técnicas de cementación en el tratamiento de las fracturas por fragilidad.

The main event of osteoporosis is fragility fractures. Vertebral compression fractures are the most commonly fragility fracture related to osteoporosis. Our goal is to review the available literature to confirm or deny concepts learned about spinal cementation and adapt our clinical practice according to scientific evidence. In the complex world of spine surgery, constant innovations seek to improve the quality of life of patients. Among these, vertebral augmentation has emerged as an increasingly popular technique, but often shrouded in myths and misunderstandings. In this systematic review, we will thoroughly explore the truths behind vertebral augmentation, unraveling common myths and providing a clear insight into this technique. As specialists in the field, it is crucial to understand the reality surrounding these interventions to offer our patients the best possible information and make informed decisions.

Correction to: Long-term safety and clinical performance of kyphoplasty and SpineJack® procedures in the treatment of osteoporotic vertebral compression fractures: a pilot, monocentric, investigator-initiated study.

The author list was incomplete. The complete list of authors is the following: D. Noriega, F. Rodrίguez-Monsalve, R. Ramajo, I.Sánchez-Lite, B. Toribio, F. Ardura. The corresponding author regrets sincerely this error. The original article got update.

Long-term safety and clinical performance of kyphoplasty and SpineJack® procedures in the treatment of osteoporotic vertebral compression fractures: a pilot, monocentric, investigator-initiated study.

This pilot monocenter study in 30 patients with painful osteoporotic vertebral compression fractures compared two vertebral augmentation procedures. Over a 3-year post-surgery follow-up, pain/disability/quality of life remained significantly improved with both balloon kyphoplasty and SpineJack® techniques, but the latter allowed better vertebral body height restoration/kyphosis correction. INTRODUCTION: Patient follow-up rarely exceed 2 years in trials comparing vertebral augmentation procedures for the treatment of painful osteoporotic vertebral compression fractures (VCFs). This pilot, investigator-initiated, prospective study aimed to compare long-term results of SpineJack® (SJ) and balloon kyphoplasty (BKP). Preliminary results showed that SJ resulted in a better restoration of vertebral heights and angles, maintained over 12 months. METHODS: Thirty patients were randomized to SJ (n = 15) or BKP (n = 15). Clinical endpoints were analgesic consumption, back pain intensity (visual analog scale (VAS)), the Oswestry Disability Index (ODI), and quality of life (EQ-VAS score). They were recorded preoperatively, at 5 days (except EQ-VAS), 1, 3, 6, 12, and 36 months post-surgery. Spine X-rays were taken 48 h prior to the procedure and 5 days, 6, 12, and 36 months after. RESULTS: Clinical improvements were observed with both procedures over the 3-year period without significant inter-group differences, but the final mean EQ-5Dindex score was significantly in favor of the SJ group (0.93 ± 0.11 vs 0.81 ± 0.09; p = 0.007). Vertebral height restoration/kyphotic correction was still evident at 36 months with a greater mean correction of anterior (10 ± 13% vs 2 ± 8% for BKP, p = 0.007) and central height (10 ± 11% vs 3 ± 7% for BKP, p = 0.034) and a larger correction of the vertebral body angle (- 5.0° ± 5.1° vs 0.4° ± 3.4°; p = 0.003) for SJ group. CONCLUSIONS: In this study, both techniques displayed very good long-term clinical efficiency and safety in patients with osteoporotic VCFs. Over the 3-year follow-up, vertebral body height restoration/kyphosis correction was better with the SpineJack® procedure.

Safety and clinical performance of kyphoplasty and SpineJack(®) procedures in the treatment of osteoporotic vertebral compression fractures: a pilot, monocentric, investigator-initiated study.

UNLABELLED: Clinical performance and safety of two percutaneous vertebral cement augmentation (VA) procedures (SpineJack® and Kyphx Xpander® balloon) were compared in patients with osteoporotic compression fractures. Both techniques were safe, efficient, and led to a rapid and marked improvement in clinical signs; nevertheless, SpineJack showed better restoration of vertebral heights and angles, maintained over time. INTRODUCTION: In patients with osteoporotic vertebral compression fractures (VCFs), both SpineJack® (SJ) and balloon kyphoplasty (BKP) led to a rapid and marked improvement in clinical signs. This pilot, monocentric, investigator-initiated, prospective study aimed to compare two percutaneous vertebral augmentation procedures in the painful osteoporotic VCF treatment. METHODS: Thirty patients were randomized to receive SJ (n = 15) or BKP (n = 15). Analgesic consumption, back pain intensity (visual analog scale (VAS)), and Oswestry Disability Index (ODI) scores were recorded preoperatively, at 5 days and 1, 3, 6, and 12 months post-surgery. Quality of life (EQ-VAS score) was evaluated at 1, 3, 6, and 12 months. Spine X-rays were taken 48 h prior to procedure and 5 days and 6 and 12 months after. RESULTS: SpineJack® led to a significantly shorter intervention period (23 vs 32 min; p < 0.001), a strong, rapid, and long-lasting decline in pain (94 vs 82 % at 12 months) and in functional disability (94 vs 90 % at 12 months), a greater and sustainable mean correction of anterior (12 ± 13 vs 0 ± 7 % for BKP, p = 0.003) and central height (12 ± 10 vs 2 ± 6 % for BKP, p = 0.001) at 12 months, and a larger restoration of the vertebral body angle still evident 12 months after implantation (-4.4° ± 5.8° vs 0.2° ± 3.0° for BKP; p = 0.012). CONCLUSIONS: This pilot study showed that both techniques were safe and efficient for the osteoporotic VCF treatment. Radiological results indicate that the SpineJack® procedure has a higher potential for vertebral body height restoration and maintenance over time.

Resultados del tratamiento quirúrgico de la seudoartrosis de escafoides carpiano con la técnica de Fisk-Fernández / Results of surgical treatment of carpal scaphoid pseudarthrosis using the Fisk-Fernández technique

Objetivo. Valorar los resultados clínicos y radiológicos obtenidos en el tratamiento de la seudoartrosis de escafoides del carpo inestable en los pacientes tratados en el Hospital Clínico Universitario de Valladolid con la técnica de Fisk Fernández. Material y método. Revisión de 43 casos de seudoartrosis intervenidos quirúrgicamente mediante técnica de Fisk Fernández, con un seguimiento mínimo de 6 meses, en la que se han valorado el tiempo hasta la intervención quirúrgica, el tratamiento previo, el mecanismo de lesión, tipo de seudoartrosis y la existencia de artrosis radio-carpiana. Hemos realizado una evaluación subjetiva utilizando el cuestionario Scaphoid Score y el DASH y una valoración objetiva mediante la escala modificada de Green & O'Brien, junto con la medida de los ángulos intraescafoideos, radiolunar, escafolunar y la altura del carpo. Resultados. En nuestra serie el tiempo medio hasta consolidación fue entre 16-24 semanas, excepto en 3 pacientes que no consolidaron y precisaron cirugías de rescate. La variación entre los ángulos y la altura pre y postoperatorios del carpo medidos en las radiografías muestra que esta diferencia ha sido estadísticamente significativa. Discusión. Existen diferentes técnicas y materiales de osteosíntesis para el tratamiento de la seudoartrosis. La evaluación de resultados se realiza con escalas objetivas y subjetivas mostrando resultados variables entre estudios. Las diferentes técnicas van encaminadas a evitar la progresión de la enfermedad. Conclusión. La técnica de Fisk Fernández permite la corrección de la deformidad del escafoides, mediante injerto en cuña y la osteosíntesis con agujas de Kirschner o tornillos (AU)

Aim. The aim of the study was to evaluate the clinical and radiological results obtained in the treatment of carpal scaphoid non-union treated at the University Hospital of Valladolid using the Fisk Fernandez technique. Material and methods. A review was performed on 43 cases of surgically treated non-union using Fisk Fernandez technique with a minimum of 6 months follow-up. The time until surgery, previous treatment, the mechanism of injury, type of non-union, and the existence of radio-carpal arthrosis were evaluated. A subjective evaluation was performed using the "Scaphoid Score" and the DASH, plus an objective assessment with the modified Green & O’Brien, together with the measurement of the intra-scaphoid, radioulnar, scapholunate angles, and carpal height. Results. The median time to healing in the series was between 16 to 24 weeks, except in 3 patients who failed to heal and required salvage surgery. There was a statistically significant variation between the preoperative and postoperative angles and carpal height measured in the X-rays. Discussion. There are different osteosynthesis techniques and materials for the treatment of non-union. The evaluation of results performed using objective and subjective scales showed variable results between studies. Different techniques are aimed at preventing the progression of the disease. Conclusion. The Fisk Fernandez technique enables the deformity of the scaphoid to be corrected by wedge grafting and internal fixation with Kirschner wires or screws (AU)

[Results of surgical treatment of carpal scaphoid pseudarthrosis using the Fisk-Fernández technique]. / Resultados del tratamiento quirúrgico de la seudoartrosis de escafoides carpiano con la técnica de Fisk-Fernández.

AIM: The aim of the study was to evaluate the clinical and radiological results obtained in the treatment of carpal scaphoid non-union treated at the University Hospital of Valladolid using the Fisk Fernandez technique. MATERIAL AND METHODS: A review was performed on 43 cases of surgically treated non-union using Fisk Fernandez technique with a minimum of 6 months follow-up. The time until surgery, previous treatment, the mechanism of injury, type of non-union, and the existence of radio-carpal arthrosis were evaluated. A subjective evaluation was performed using the "Scaphoid Score" and the DASH, plus an objective assessment with the modified Green & O'Brien, together with the measurement of the intra-scaphoid, radioulnar, scapholunate angles, and carpal height. RESULTS: The median time to healing in the series was between 16 to 24 weeks, except in 3 patients who failed to heal and required salvage surgery. There was a statistically significant variation between the preoperative and postoperative angles and carpal height measured in the X-rays. DISCUSSION: There are different osteosynthesis techniques and materials for the treatment of non-union. The evaluation of results performed using objective and subjective scales showed variable results between studies. Different techniques are aimed at preventing the progression of the disease. CONCLUSION: The Fisk Fernandez technique enables the deformity of the scaphoid to be corrected by wedge grafting and internal fixation with Kirschner wires or screws.

Tratamiento de la enfermedad de Dupuytren mediante la colagenasa del Clostridium histolyticum / Treatment of Dupuytren's disease using collagenase from Clostridium histolyticum

Objetivo. La colagenasa del Clostridium histolyticum es una nueva opción terapéutica y el primer tratamiento farmacológico en el tratamiento de la enfermedad de Dupuytren. Material y métodos. Estudio prospectivo de 35 pacientes afectos de la enfermedad de Dupuytren. Se evaluó los resultados clínicos, funcionales, la satisfacción del paciente y la seguridad del fármaco. Resultados. Los resultados funcionales y clínicos tras su administración son buenos sobre todo en la articulación metacarpofalángica, con una recuperación rápida. El índice de contractura del dedo MCF previo a la punción fue de 64° y tras la punción de 4°; en las IFP previo a la punción fue de 83,3 grados y tras la punción de 15°; en MCF/IFP previo a la punción fue de 140° y tras la punción de 25°. Conclusiones. Es una alternativa de tratamiento de la enfermedad de Dupuytren, fundamentalmente en los ancianos. La investigación es necesaria para clarificar el índice de recurrencia de la enfermedad, las posibles reacciones adversas y comparar la eficacia y durabilidad con otras alternativas de tratamiento (AU)

Objective: The collagenase from Clostridium histolyticum is a new therapeutic option, and the first pharmacological one, in the treatment of Dupuytren’s disease. Material and methods: A prospective study was conducted on 35 patients with Dupuytren’s disease. The clinical and functional variables, as well as patient satisfaction and drug safety were evaluated. Results: The functional and clinical results after its administration were good, with a rapid recovery, especially at the metacarpophalangeal (MCP) joint. The index finger contracture prior to MCP puncture was 64 degrees and after puncture it was 4 degrees. In the proximal interphalangeal (PIP) prior to puncture it was 83.3 degrees and after puncture it was 15 degrees; In the MCP/PIP prior to puncture it was 140 degrees, and after puncture it 25 degrees. Conclusions: Collagenase from Clostridium histolyticum an alternative of treatment of Dupuytren’s disease, mainly in the elderly. More research is required in order to clarify the rate of recurrence of the disease, the possible adverse reactions, and to compare the efficiency and permanence with other treatment options (AU)

[Treatment of Dupuytren's disease using collagenase from Clostridium histolyticum]. / Tratamiento de la enfermedad de Dupuytren mediante la colagenasa del Clostridium histolyticum.

OBJECTIVE: The collagenase from Clostridium histolyticum is a new therapeutic option, and the first pharmacological one, in the treatment of Dupuytren's disease. MATERIAL AND METHODS: A prospective study was conducted on 35 patients with Dupuytren's disease. The clinical and functional variables, as well as patient satisfaction and drug safety were evaluated. RESULTS: The functional and clinical results after its administration were good, with a rapid recovery, especially at the metacarpophalangeal (MCP) joint. The index finger contracture prior to MCP puncture was 64 degrees and after puncture it was 4 degrees. In the proximal interphalangeal (PIP) prior to puncture it was 83.3 degrees and after puncture it was 15 degrees; In the MCP/PIP prior to puncture it was 140 degrees, and after puncture it 25 degrees. CONCLUSIONS: Collagenase from Clostridium histolyticum an alternative of treatment of Dupuytren's disease, mainly in the elderly. More research is required in order to clarify the rate of recurrence of the disease, the possible adverse reactions, and to compare the efficiency and permanence with other treatment options.

Valor diagnóstico de hallazgos citomorfológicos de Clamydia tracomatis en extendidos cervicales

Cuatro mil seiscientos ochenta extendidos cervicales de rutina fueron estudiados prospectivamente durante un año y medio. Ciento veinte (2,6%) tuvieron cambios citológicos compatibles con infección por Clamydia tracomatis. Estos cambios fueron correlacionados con la edad, síntomas génito-urinarios, métodos anticonceptivos y enfermedades venéreas. Los extendidos fueron teñidos con el método de Papanicolau y luego teñidos con PAS. Todas las fases del ciclo de Clamydia tracomatis fueron teñidas. Del total de casos estudiados, 115 (95,8%) tenían células de metaplasia, 10 (8,3%) estaban asociadas con CIN y 10 (8,3%) con atipia coilocitótica. De estos últimos, 2 estaban asociados con CIN I, 2 con CIN II y 6 tenían atipia coilocitótica solamente

Valor diagnóstico de hallazgos citomorfológicos de Clamydia tracomatis en extendidos cervicales

Cuatro mil seiscientos ochenta extendidos cervicales de rutina fueron estudiados prospectivamente durante un año y medio. Ciento veinte (2,6%) tuvieron cambios citológicos compatibles con infección por Clamydia tracomatis. Estos cambios fueron correlacionados con la edad, síntomas génito-urinarios, métodos anticonceptivos y enfermedades venéreas. Los extendidos fueron teñidos con el método de Papanicolau y luego teñidos con PAS. Todas las fases del ciclo de Clamydia tracomatis fueron teñidas. Del total de casos estudiados, 115 (95,8%) tenían células de metaplasia, 10 (8,3%) estaban asociadas con CIN y 10 (8,3%) con atipia coilocitótica. De estos últimos, 2 estaban asociados con CIN I, 2 con CIN II y 6 tenían atipia coilocitótica solamente (AU)