Preliminary study on a single balloon cross-midline expansion via unipedicular approach in kyphoplasty.

BACKGROUND: Recently, bilateral transpedicular kyphoplasty with a single balloon was performed for osteoporotic vertebral body compression fractures (OVCFs) to reduce the fees of the operation, but the time of operation and radiation exposure are longer. The aim of this study was to determine the safety and effectiveness of a single balloon cross-midline expansion via unipedicular approach in kyphoplasty for OVCFs. METHODS: Thirty-six patients with painful OVCFs (61 vertebrae) were enrolled in this research. Unilateral transpedicular puncture was performed under the fluoroscopy monitoring of an oblique angle down the pedicle. A single balloon was introduced through unipedicular approach. The final balloon position was in the midline of the vertebral body with the balloon cross-midline expansion and bone cement filled. Clinical outcomes were determined by comparison of the preoperative and postoperative visual analogue scale (VAS) and Oswestry disability index (ODI). Radiographic assessment included restoration of vertebral height and correction of kyphosis. Follow-up was conducted for 6 - 12 months (mean 9.2 months). RESULTS: Thirty-six consecutive patients with 61 vertebrae were successfully operated on with a mean operation time of 37.4 minutes per vertebra. All patients had dramatic pain relief and functional recovery within 96 hours after the procedure with no surgery or device-related complications. VAS score improved from 7.27 +/- 1.02 preoperatively to 2.71 +/- 0.75 postoperatively (P < 0.01). ODI score was decreased from (71.14 +/- 10.94)% preoperatively to (26.56 +/- 6.35)% postoperatively. The average loss of anterior body height was (14.33 +/- 2.76) mm before procedure and (10.03 +/- 1.83) mm after procedure (P < 0.01), while the average loss of middle body height was (10.15 +/- 2.70) mm before procedure and (5.89 +/- 1.83) mm after procedure (P < 0.01). The kyphotic deformity was corrected from (23.43 +/- 5.00) degree to (16.16 +/- 2.77) degree (P < 0.01). The pain relief and functional recovery were substantial and maintained to the last follow-up without any re-collapse or adjacent level fracture. CONCLUSIONS: A single-balloon cross-midline expansion via unipedicular approach in kyphoplasty for OVCFs is an effective and safe procedure with less cost, less operation time and less radiation exposure when compared with the conventional kyphoplasty technique.

[Percutaneous kyphoplasty with double or single balloon in treatment of osteoporotic vertebral body compressive fracture: a clinical controlled study].

OBJECTIVE: To evaluate the clinical efficacy of percutaneous bipediculary kyphoplasty with double or single balloon I treatment of osteoporosis vertebral compressive fractures. METHODS: Fifty-one patients with painful osteoporotic vertebral compressive fracture involving 69 vertebrae. 19 males and 32 females, aged 72.5 (63 - 85), underwent percutaneous kyphoplasty with double inflatable balloon (29 cases, 38 vertebrae) or single inflatable balloon (22 cases, 31 vertebrae) under X-ray fluoroscopy monitoring. The fractured vertebral bodies were punctuated, balloon was put into the subsided areas and then distended, and bone cement was injected into the cavity. The vertebral height and Cobb angle, preoperative and postoperative, were measured by radiography. Follow-up was conducted for 6 - 12 months. RESULTS: All patients tolerated the procedure well with dramatic pain relief within 96 hours after the procedure. No clinical complication was found. Visual analog scale score was improved from 7.8 preoperatively to 2.6 postoperatively (P < 0.01). Oswestry disability index was decreased from 73% preoperatively to 26% postoperatively. In the double balloon group, the heights loss of the anterior and middle portions of the vertebral body reduced from 14.7 mm and 10.5 mm to 10.1 mm and 5.5 mm respectively (both P < 0.01), and the Cobb angle was corrected from 22.4 degrees to 12.3 degrees (P < 0.01). In the single balloon group, the heights loss of the anterior and middle portions of the vertebral body reduced from 14.7 mm and 10.6 mm to 10.4 mm and 6.5 mm respectively (both P < 0.01), and the. Cobb angle was corrected averagely from 21.2 degrees to 11.6 degrees (P < 0.01). The mean vertebral height restoration rates were 72.8% and 70.1% in the double and single balloon groups respectively. The mean Cobb angle correct degrees were 10.1 degrees and 9.5 degrees in double and single balloon groups respectively. There were no significant differences in the average height restoration rate and Cobb angle correction between the double and single balloon groups (72.8% vs 70.1%, and 10.0 degrees vs 9.5 degrees both P > 0.05). The pain relief and functional recovery were substantial and maintained to the last follow up. CONCLUSION: Percutaneous bipediculary kyphoplasty with double or single balloon for painful osteoporotic vertebral body compressive fractures is effective and safe.

Percutaneous vertebroplasty using instruments and drugs made in China for vertebral metastases.

OBJECTIVES: To evaluate the effect of percutaneous vertebroplasty on vertebral tumor metastasis using instruments and drugs made in China and to explore the technique of percutaneous vertebroplasty. METHODS: Thirty-two patients with vertebral metastasis were treated with percutaneous vertebroplasty with instruments and drugs made in China. Anterolateral approach for cervical vertebrae and transpedicular approach for thoracic and lumbar vertebrae were used. The volume of disease focus and the amount of polymethy methacrylate (PMMA) injected were calculated with formula V = 4/3pi (D/2)(3) preoperatively. PMMA with contrast was mixed according to the ratio of powder/liquid/contrast of 3:2:1. The procedures were monitored under fluoroscopy. PMMA was injected in the polymerization time. CT scanning was performed before and after the operation. RESULTS: The percentage of lesion PMMA fill was more than 50% as demonstrated by CT. Clinical data were obtained from the cases followed up for 7 - 12 months, and the rate of pain relief was 90.6% (29/32) at one week, 71.8% (23/32) at six months, and 58.6% (17/29) at 12 months after operation. There were no cases of PMMA leakage that affected clinical performance. CONCLUSIONS: Percutaneous vertebroplasty for vertebral tumor metastasis using instruments and drugs made in China was effective. It is important to prevent paravertebral leaks of PMMA and to ensure that PMMA is injected within the polymerization time.