CT features and risk factors of pulmonary cement embolism after vertebroplasty or kyphoplasty in patients with vertebral compression fracture: a retrospective cohort study.

Background: Pulmonary cement embolism (PCE) caused by cement leakage is one of the complications of percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). The aim of our study was to explore the imaging features on computed tomography (CT) and analyze the risk factors of PCE in patients with a vertebral compression fracture to compare the incidences of PCE caused by PVP and PKP. Methods: In this single-center, retrospective study, 373 patients (96 males and 277 females; mean age 76.2±9.4 years) from January 2017 to December 2020 who underwent PVP or PKP for treatment of vertebral compression fracture in the China-Japan Friendship Hospital were retrospectively included. Their clinical data were recorded, and their postprocedural chest CT scans were reviewed and evaluated for PCE. Results: Of the 373 patients, 258 patients underwent PVP while the other 115 underwent PKP. PCE was found on the postprocedural chest CT scans in 64 patients (17.2%), including 47 patients with PVP and 17 patients with PKP. The incidence of PCE of PVP and PKP was similar (χ2=0.660; P=0.460). The typical CT findings of PCE were multiple linear or branching radiopaque densities in pulmonary arteries. The upper lobes of bilateral lungs were the most frequently involved. In addition, postprocedural chest CT demonstrated that 103 cases had cement emboli in the azygos vein, and 8 cases had cement emboli in the inferior vena cava. Binary logistic regression analysis demonstrated that PVP or PKP in the T9 vertebra [odds ratio (OR) =4.222; 95% CI: 1.490-11.966] and cement emboli in the azygos vein (OR =7.647; 95% CI: 3.937-14.856) or the inferior vena cava (OR =42.701; 95% CI: 7.525-242.302) were the risk factors of PCE. Conclusions: The incidence of PCE during PVP or PKP was 17.2%. Postprocedural chest CT clearly showed PCE as branching hyperdense or radiopaque lesions confined within the pulmonary artery courses. PVP or PKP in the T9 vertebra and cement emboli in the azygos vein or the inferior vena cava were risk factors for PCE.

Balloon kyphoplasty combined with percutaneous pedicle screw (PPS) for the treatment of osteoporotic thoracolumbar fractures has minimum correction loss 2 years after surgery: compared to vertebroplasty using hydroxyapatite block combined with PPS.

BACKGROUND: Balloon kyphoplasty (BKP) is a useful treatment performed in patients with painful osteoporotic vertebral body fracture (OVF). However, in cases with large intra-vertebral clefts and cases with posterior spinal tissue damage, adjacent vertebral body fractures (AVFs), and cement migration may occur early after BKP, which may be a factor for poor results. In such cases, percutaneous vertebroplasty (PVP) combined with percutaneous pedicle screw (PPS) is useful treatment. This study compared BKP combined with PPS (BKP + PPS) compared to PVP using hydroxyapatite (HA) block combined with PPS (HAVP + PPS) for thoracolumbar OVF (TLOVF). METHODS: Twenty-eight patients who sustained painful TLOVFs without neurologic deficits underwent HAVP + PPS (group H, n=14) or BKP + PPS (group B, n=14). We evaluated time from injury to surgery, pre- and post-operative visual analogue scale (VAS) of low back pain, wedging angle of fractured vertebra, duration of operation, intraoperative blood loss, number of instrumented vertebra, and length of stay at hospital. RESULTS: Group B had significantly less surgery time and less blood loss during surgery. VAS of low back pain improved equally in both groups, but at 1 year and 2 years postoperatively, wedging angle of fractured vertebra progressed significantly in group H compared with group B. CONCLUSIONS: PPS fixation combined with percutaneous vertebral cement augmentation with BKP for OVF was suggested to be minimally invasive in the elderly patients. In addition, there is no correction loss of the fractured vertebral body after BKP + PPS, which is considered to be a useful surgical procedure.

Robot-assisted percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a retrospective matched-cohort study.

PURPOSE: This study aims to introduce the principle, clinical efficacy, and learning curve of robot-assisted percutaneous vertebroplasty (PVP). METHODS: Forty-two patients who underwent robot-assisted single-level PVP were analyzed retrospectively and 42 age-matched patients using freehand technique were selected as the control group. The visual analog scale, operation time, radiation exposure, accuracy, and learning curve were analyzed. RESULTS: The puncture time and total operation time were significantly shorter, and the puncture and total fluoroscopy number were fewer in the robot group. The deviation between pre-operative planned and actual puncture trajectory well met clinical requirement. The puncture time, total operation time, and puncture fluoroscopy number were significantly more in early cases than in later cases in the robot group. CONCLUSION: The robot-assisted pedicle puncture technique shortens the operation time and reduces radiation exposure, and the accuracy meets the clinical requirement in PVP. The learning curve is short and not steep.

Lumbar posterior group muscle degeneration: Influencing factors of adjacent vertebral body re-fracture after percutaneous vertebroplasty.

Objective: The purpose of the study was to explore the influencing factors of adjacent vertebral re-fracture after percutaneous vertebroplasty (PVP) for osteoporosis vertebral compression fractures (OVCFs). Methods: We retrospectively analyzed the clinical data of 55 patients with adjacent vertebral re-fracture after PVP operation for OVCFs in our hospital from January 2016 to June 2019, they were followed up for 1 year and included in the fracture group. According to the same inclusion and exclusion criteria, we collected the clinical data of 55 patients with OVCFs without adjacent vertebral re-fracture after PVP in the same period and included them in the non-fracture group. We performed univariate and multivariate logistic regression analysis on the influencing factors of adjacent vertebral re-fracture in patients with OVCFs after PVP. Results: There were significant differences in body mass index (BMI), bone mineral density (BMD) T-value, amount of bone cement injected, bone cement leakage, history of glucocorticoid use, cross-sectional area (CSA), cross-sectional area asymmetry (CSAA), fat infiltration rate (FIR), and fat infiltration rate asymmetry (FIRA) of lumbar posterior group muscles [multifidus (MF) and erector spinae (ES)] between the two groups (p < 0.05). There was no significant difference in sex, age, or time from the first fracture to operation, the CAS, CSAA, FIR, and FIRA of psoas major (PS) between the two groups (p > 0.05). Multivariate logistic regression showed that a higher dose of bone cement, greater CSAA and FIR of multifidus, and higher CSAA of erector spinae were independent risk factors for recurrent fractures of adjacent vertebrae after PVP. Conclusion: There are many risk factors for recurrent vertebral fracture after PVP in patients with OVCFs, and degeneration of paraspinal muscles (especially posterior lumbar muscles) may be one of the risks.

Efficacy of vertebral augmentation in the treatment of osteoporotic vertebral compression fractures: a systematic review and meta-analysis.

BACKGROUND: Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are common vertebral augmentation (VA) procedures for the treatment of osteoporotic vertebral compression fractures (OVCF), each with their own advantages and disadvantages. In recent years, the development of new implant-assisted technologies has provided a breakthrough in VA. This study systematically evaluated and meta-analyzed the reports on new implant-assisted VA techniques in recent years, so as to provide evidence for clinical diagnosis and treatment. METHODS: The PubMed, Embase, Ovid, and SpringerLink databases were searched for randomized controlled studies on VA in the treatment of OVCF. In this study, patients in the experimental group were treated with PVP using the new implant-assisted VA technique, while patients in the control group were treated with PKP. Bias assessment was conducted using the tool integrated with the Revman 5.4 software, and meta-analysis was carried out to compare the mid-term postoperative pain relief, functional status, quality of life, and cement extravasation between the two groups (each presented with a forest plot). RESULTS: Eight articles were finally included in the selection, involving a total of 1,027 patients. PVP surgery using the new implant-assisted VA technique was superior to PKP surgery in relieving postoperative pain [mean difference (MD) =-3.77, 95% CI: -5.63, -1.92, P<0.0001] and improving the postoperative Oswestry Disability Index (ODI) score (MD =-1.59, 95% CI: -3.01, -0.16, P=0.03). However, it was not significantly different from PKP surgery in improving postoperative quality of life (MD =-0.27, 95% CI: -3.55, 3.01, P=0.87), and the cement extravasation rate was significantly lower than that of PKP surgery [odd ratio (OR) =0.38, 95% CI: 0.19, 0.74, P=0.004]. DISCUSSION: The new implant-assisted VA technique can significantly relieve pain, reduce clinical symptoms, improve postoperative quality of life, and significantly reduce the problem of cement extravasation. However, this new technology is still evolving, and more high-quality randomized controlled studies on this topic are needed to provide stronger evidence.

Video-Assisted Thoracoscopic Surgery for Re-Collapse of Vertebrae after Percutaneous Vertebral Augmentation (PVA).

INTRODUCTION: Due to the increase in osteoporosis accompanying the aging society in Japan, osteoporotic vertebral fractures (OVFs) are increasing. Percutaneous vertebral augmentation (PVA) has been widely used for OVFs because it reduces pain immediately with less invasiveness. Re-collapse of vertebral body after PVA is a rare, but important, complication. Once the re-collapse has occurred, patients should undergo an additional invasive salvage surgery. METHODS: We treated 5 patients with re-collapse after PVA in our hospital. For re-collapse after PVA, we performed anterior column reconstruction with video-assisted thoracoscopic surgery (VATS), posterior fixation with percutaneous pedicle screws (PPSs) and minimally invasive spine stabilization (MISt). RESULTS: The mean postoperative follow-up was at 62.8 months. At the final follow-up, the patients were free of low back pain, and bony union was achieved in all cases. The postoperative correction loss was 6 degrees. Perioperative complications included aspiration pneumonia in one patient and bone fracture of an adjacent vertebral body in two patients. There were no reoperation cases. CONCLUSIONS: We perform minimally invasive combined anterior and posterior surgery with VATS for re-collapse after PVA. This procedure is useful in elderly patients with less reserve capacity.

Percutaneous vertebroplasty (PVP) to treat specialized type of endplate fractures around the Schmorl's node: a prospective study of 65 patients.

BACKGROUND: The Schmorl's nodes (SNs) are defined as the herniation of the intervertebral disc into the vertebral body. Endplate fractures around the Schmorl's node could result in severe back pain that is similar to vertebral compression fractures. The objective of this study was to prospectively analyze the surgical effectiveness and safety of percutaneous vertebroplasty (PVP) for endplate fractures around the SNs. METHODS: Seventy-one consecutive patients with the fresh endplate fracture around SNs from October 2017 to February 2018 were enrolled in this study. The visual analog scale (VAS) and Oswestry disability index (ODI) scores of low back pain were evaluated in all patients preoperatively, postoperatively, and at 1 month, 6 months, and 1 year after primary single level PVP. Surgery-related data including duration of the operation, injected cement volumes, and surgical complications were recorded. RESULTS: Sixty-five patients with fresh endplate fractures around the SNs were treated successfully via percutaneous vertebroplasty. Our study showed that the VAS scores and ODI scores of patients were obviously improved after operation. Cement leakage into the disc space occurred in 5 patients (7.7%), and adjacent segment refractures occurred in 2 patients (3.1%). No other surgical complications, including infections or nerve root injuries were encountered. CONCLUSIONS: Based on the results of this prospective study, PVP was an effective and safe procedure for endplate fractures around the SNs. TRIAL REGISTRATION: ChiCTR, ChiCTR1800016453 . Registered 2 June 2018-retrospectively registered, http://www.chictr.org.cn/com/25/historyversionpuben.aspx?regno=ChiCTR1800017602.

Clinical characteristics and management of cardiac and/or pulmonary cement embolus after percutaneous vertebroplasty: a single center experience.

BACKGROUND: Cardiac and/or pulmonary cement embolus (CPCE) caused by the leakage of bone cement after percutaneous vertebroplasty (PVP) are rare but are lethal complications in patients with vertebral compression fracture (VCF). Literature in this field is limited, and guidelines for the management of such complications are unclear. This study aimed to review our center's experience. METHODS: Medical records (clinical characteristics and management) and imaging data (X-ray findings, CT findings, and fluoroscopic findings) of 12 patients with CPCE after PVP between October 2015 and July 2018 at our hospital were collected and examined retrospectively. Their health conditions were also evaluated through a telephone follow-up survey. RESULTS: Twelve patients with an average age of 76.8±8.5 years were included in our study. One patient who had a cardiac cement embolus and one patient who suffered from an inferior vena cava (IVC) cement embolus were successfully treated via percutaneous retrieval. Ten asymptomatic patients with pulmonary cement embolus (PCE) were managed with conservative observation. All of the patients were alive and remained asymptomatic during the follow-up period (median time, 6.5 months; range, 1-50 months). CONCLUSIONS: More attention should be paid to the possibility of development of CPCE. For patients with cardiac cement embolus, open heart surgery should be considered as a preferred treatment, and percutaneous procedure could be used as an alternative treatment for patients with surgical contraindication or other surgical high-risk factors. For patients with an IVC cement spike, percutaneous retrieval could be recommended. Careful observation and clinical follow-up could be recommended for patients with asymptomatic peripheral or central PCEs.

Percutaneous Vertebral Augmentation for Osteoporotic Vertebral Compression Fracture in the Midthoracic Vertebrae (T5-8): A Retrospective Study of 101 Patients with 111 Fractured Segments.

OBJECTIVE: Data reporting percutaneous vertebroplasty (PVP) or percutaneous balloon kyphoplasty (PKP) application to the midthoracic vertebrae remain limited. This study aimed to summarize our experiences and explore the efficacy and safety of PVP or PKP in dealing with osteoporotic vertebral compression fracture (OVCF) in the midthoracic vertebrae. METHODS: Patients receiving PVP or PKP for midthoracic OVCF in our institution from January 2015 to January 2018 were retrospectively enrolled. All patients were grouped according to cement augmentation procedure types, surgical approaches, and puncture routes. All patients underwent a postoperative follow-up of 2-36 months. Visual analog scale (VAS) and ECOG Scale of Performance Status scores were evaluated pre- and postoperatively. Cement distribution and rate of cement leakage were assessed by radiographs. Associations of these variables and clinical scores and radiographic indices were analyzed. RESULTS: A total of 101 consecutive patients with 111 fractured centrums were enrolled. Both VAS and ECOG Scale of Performance Status scores of all patients decreased significantly after the operation, and progressively decreased at the final follow-up. The cement distribution of the bipedicular group was significantly better than the unipedicular group, but the total leakage rate of the former (71.7%) was significantly higher than the latter (43.1%). The rate of epidural cement leakage in the PKP group (5.4%) was significantly lower than that of the PVP group (20.3%), whereas the left puncture group (28.6%) was significantly higher than that of the right puncture group (2.7%). CONCLUSIONS: PKP and a bipedicular approach can help improve cement distribution and reduce the epidural cement leakage rate and therefore should be preferred over PVP or a unipedicular approach in OVCF of the midthoracic vertebrae.

[Acupuncture combined with local anesthesia for percutaneous vertebroplasty].

OBJECTIVE: To observe the analgesic and sedative effects of acupuncture combined with local anesthesia for percutaneous vertebroplasty (PVP). METHODS: Sixty patients of single segmental osteoporotic vertebral compression fractures who were prepared to receive PVP were randomly divided into an observation group, a control 1 group, a control 2 group, 20 cases in each group. The patients in the observation group were treated with electroacupuncture (EA) at Hegu (LI 4), Neiguan (PC 6) and Zusanli (ST 36) 20 min before operation; during operation, EA was given combined with regular anesthesia. The patients in the control 1 group were treated with intramuscular injection of parecoxib sodium (40 mg), combined with regular anesthesia. The patients in the control 2 group were treated with intravenous injection of dezocine (5 mg), combined with regular anesthesia. Visual analogue scale (VAS) and Ramesy sedation score were compared among the three groups. RESULTS: In the observation group and control 2 group, the VAS during puncture and bone cement placement was higher than that before acupuncture (all P<0.01); the VAS during bone cement placement was higher than that before puncture (P<0.05, P<0.01); the VAS after operation was lower than that during puncture and bone cement placement (P<0.05, P<0.01). In the control 1 group, the VAS during puncture and bone cement placement and after operation was higher than that before acupuncture (P<0.01, P<0.05), the VAS after operation was lower than that during puncture and bone cement placement (P<0.05, P<0.01). There was no significant difference in VAS and Ramesy score among three groups at all time points (all P>0.05). CONCLUSION: Compared with local anesthesia and analgesics, acupuncture combined with local anesthesia has similar analgesic and sedative effect for PVP, which could be considered a better method for PVP anesthesia.

3-Dimensional printing guide template assisted percutaneous vertebroplasty: Technical note.

Percutaneous vertebroplasty (PVP) is currently considered as an effective treatment for pain caused by acute osteoporotic vertebral compression fracture. Recently, puncture-related complications are increasingly reported. It's important to find a precise technique to reduce the puncture-related complications. We report a case and discussed the novel surgical technique with step-by-step operating procedures, to introduce the precise PVP assisted by a 3-dimensional printing guide template. Based on the preoperative CT scan and infrared scan data, a well-designed individual guide template could be established in a 3-dimensional reconstruction software and printed out by a 3-dimensional printer. In real operation, by matching the guide template to patient's back skin, cement needles' insertion orientation and depth were easily established. Only 14 times C-arm fluoroscopy with HDF mode (total exposure dose was 4.5 mSv) were required during the procedure. The operation took only 17 min. Cement distribution in the vertebral body was very good without any puncture-related complications. Pain was significantly relieved after surgery. In conclusion, the novel precise 3-dimensional printing guide template system may allow (1) comprehensive visualization of the fractured vertebral body and the individual surgical planning, (2) the perfect fitting between skin and guide template to ensure the puncture stability and accuracy, and (3) increased puncture precision and decreased puncture-related complications, surgical time and radiation exposure.

Is percutaneous kyphoplasty the better choice for minimally invasive treatment of neurologically intact osteoporotic Kümmell's disease? A comparison of two minimally invasive procedures.

PURPOSE: The purpose of this study was to compare and evaluate the safety and efficacy of percutaneous vertebroplasty at a hyperextension position (PVPHP) and percutaneous kyphoplasty at a hyperextension position (PKPHP) for the treatment of osteoporotic Kümmell's disease. METHODS: This study was a retrospective, single-centre study. There were 35 patients with osteoporotic Kümmell's disease who were analyzed. Twenty-two of them underwent PVPHP and the other 13 patients underwent PKPHP from January 2013 to January 2015. The volume of bone cement injection and operation costs were compared. We compared the visual analogue score (VAS) and vertebral Cobb's angle at pre-operation, the second day after operation, and the final follow-up. We compared the Oswestry disability index (ODI) score at the pre-operation and the final follow-up. RESULTS: There were no significant differences in gender, age, course of disease, bone mineral density (BMD), and mean follow-up time between the two groups (P > 0.05). Regarding the costs of the operation, the PKPHP group was significantly higher than the PVPHP group (P < 0.05). Compared with the pre-operation (P < 0.05), the post-operative ODI score, VAS, and Cobb's angle of the two groups were improved significantly. Even though the correction of Cobb's angle in the PKPHP group was slightly better than the PVPHP position group, there were no significant differences between two groups (P > 0.05). At the final follow-up, the Cobb's angle was increased in both groups, but there was no significant difference (P > 0.05). There was no significant difference in the bone cement leakage rate between the two groups (P > 0.05). CONCLUSION: For the treatment of Kümmell's disease, PVPHP and PKPHP are both safe and effective, but PVPHP is more economical and can be considered a preferred method of treatment.

Finite Element Analysis and Clinical Application of Unilateral/Bilateral Percutaneous Vertebroplasty for Treating Osteoporotic Vertebral Compression Fractures in Elderly Patients / 医用生物力学

Objective To investigate the biomechanical properties and clinical effects of the unilateral/bilateral percutaneous vertebroplasty (PVP) on the treatment of osteoporotic vertebral compression fractures in elderly patients. Methods The finite element models of the unilateral/bilateral percutaneous vertebroplasty (PVP) in osteoporotic vertebral compression fractures were established to evaluate changes in strain and stress of the fractured vertebra after surgery. Eighty patients with osteoporotic vertebral compression fractures underwent unilateral or bilateral PVP were collected for retrospective analysis. The operation time,intraoperative fluoroscopy times,injected bone cement volume, bone cement leakage rate and visual analogue scales (VAS) score between the two groups were analyzed. Results The maximum strain and stress in unilateral PVP group were 1.18 times and 1.15 times of those in bilateral PVP group,respectively.The operation time and intraoperative fluoroscopy times in unilateral PVP group were obviously smaller than those in bilateral PVP group (P0.05).Conclusions The biomechanical effect of unilateral PVP was similar to that of bilateral PVP. The puncture needle localization of unilateral PVP for treating elderly patients with osteoporotic vertebral compression fractures had the advantage of less operation time and limited X-ray exposure.

Acupuncture combined with local anesthesia for percutaneous vertebroplasty / 中国针灸

<p><b>OBJECTIVE</b>To observe the analgesic and sedative effects of acupuncture combined with local anesthesia for percutaneous vertebroplasty (PVP).</p><p><b>METHODS</b>Sixty patients of single segmental osteoporotic vertebral compression fractures who were prepared to receive PVP were randomly divided into an observation group, a control 1 group, a control 2 group, 20 cases in each group. The patients in the observation group were treated with electroacupuncture (EA) at Hegu (LI 4), Neiguan (PC 6) and Zusanli (ST 36) 20 min before operation; during operation, EA was given combined with regular anesthesia. The patients in the control 1 group were treated with intramuscular injection of parecoxib sodium (40 mg), combined with regular anesthesia. The patients in the control 2 group were treated with intravenous injection of dezocine (5 mg), combined with regular anesthesia. Visual analogue scale (VAS) and Ramesy sedation score were compared among the three groups.</p><p><b>RESULTS</b>In the observation group and control 2 group, the VAS during puncture and bone cement placement was higher than that before acupuncture (all <0.01); the VAS during bone cement placement was higher than that before puncture (<0.05, <0.01); the VAS after operation was lower than that during puncture and bone cement placement (<0.05, <0.01). In the control 1 group, the VAS during puncture and bone cement placement and after operation was higher than that before acupuncture (<0.01, <0.05), the VAS after operation was lower than that during puncture and bone cement placement (<0.05, <0.01). There was no significant difference in VAS and Ramesy score among three groups at all time points (all >0.05).</p><p><b>CONCLUSION</b>Compared with local anesthesia and analgesics, acupuncture combined with local anesthesia has similar analgesic and sedative effect for PVP, which could be considered a better method for PVP anesthesia.</p>

Percutaneous vertebroplasty versus conservative treatment for osteoporotic vertebral compression fractures: An updated meta-analysis of prospective randomized controlled trials.

BACKGROUND: This meta-analysis of Randomized Controlled Trials (RCTs) aims to evaluate the efficacy and safety in percutaneous vertebroplasty (PVP) and conservative treatment (CT) for osteoporotic vertebral compression fractures (OVCFs). METHODS: The authors searched RCTs in electronic databases (Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Medline, Embase, Springer Link, Web of Knowledge, OVID and Google Scholar) in a timeframe from their establishment to Feb 2017. We also manually searched the reference lists of reports and reviews for possible relevant studies. Researches on PVP versus CT in OVCFs were selected in this meta-analysis. The quality of all studies was assessed and effective data were pooled for this meta-analysis. The outcomes were measured by pain relief (one week, one month, three months and six months), quality of life (RDQ, ED-5Q and QUALEFFO) and the rate of adjacent vertebral fracture. Publication bias assessment was also performed, respectively. The meta-analysis was performed using RevMan 5.1. RESULTS: 13 reports (12 RCTs) with a total 1231 patients (623 in the PVP and 608 in the CT) met inclusion criteria. Patients were followed up for at least 2 weeks in all the studies. Statistical differences were found between pain relief (one week (MD 1.36, 95% CI (0.55, 2.17)), one month (MD 1.56, 95% CI (0.43, 2.70)) and six months (MD -1.59, 95% CI (-2.9, -0.27))) and QUALEFFO (MD -5.03 95%CI (-7.94, -2.12)). No statistical differences were found between pain relief (three months (MD -0.28, 95% CI (-1.46, 0.90))), RDQ (MD -0.59, 95% CI (-1.31, 0.13)), ED-5Q (MD 0.10, 95% CI (-0.01, 0.22)) and the rate of adjacent vertebral fracture (RR 1.21, 95% CI (0.89, 1.62)). CONCLUSIONS: PVP is associated with higher pain relief than CT in the early period. Furthermore, PVP did not increase the rate of adjacent vertebral fracture. The results indicate that it is a safe and effective treatment for OVCFs. Because of some limitations, these findings should be interpreted with caution. Additional studies are needed. Large, definitive RCTs are needed.

Comparison of external radiotherapy and percutaneous vertebroplasty for spinal metastasis.

AIM: To compare the efficacy of external radiotherapy (ERT) and percutaneous vertebroplasty (PVP) for spinal metastasis. METHODS: A total of 137 patients with 174 spinal metastases between June 2006 and April 2009 in our hospital were reviewed. For their spinal metastasis, 52 patients received ERT; 46 patients received PVP; and 39 patients received both ERT and PVP. Pain and neurological deficit response, overall survival, and side effects were evaluated. RESULTS: ERT combined with PVP achieved pain remission in 84.8% of the patients, which was higher than ERT (72.5%) or PVP (76.3%) alone. It also showed a higher remission rate of neurological deficits (50%) than ERT (18.2%) or PVP (11.1%) alone. Toxicities from the employed treatments were mild. The Karnofsky Performance Score and visceral or brain metastases were the significant influencing factors for overall survival. Patients with spinal metastases derived from breast cancer had a significantly better overall survival than those whose spinal metastases were derived from lung cancer. CONCLUSION: ERT combined with PVP can be a more effective treatment for spinal metastases; however, prospective randomized trials are needed to draw any definitive conclusion.

Percutaneous vertebroplasty for treatment of osteoporotic thoracolumbar vertebral compression fracture by filling auto-solidification calcium phosphate cement / 中华创伤骨科杂志

Objective To explore the clinical effect of the percutaneous vertebroplasty(PVP) and filling auto-solidification calcium phosphate cement(CPC) in treatment of osteoporotic thoracolumbar vertebral fractures. Methods From January, 2004, 26 patients with osteoporotic thoracolumbar vertebral compression fracture (29 vertebral bodies) were treated with intraoperative manipulative reduction, PVP and filling auto-solidification CPC. Results PVP were successfully performed with unilateral or bilateral vertebral pedicles for the 29 vertebrae. The average injection dose of CPC was 4.6 mL. CPC leakage occurred during the procedure in 5 vertebrae of 5 cases. All the patients were followed up for 3 to 8 months (averaging 4.6 months) and experienced complete pain relief. There was no severe complication related to the treatment. Except in 3 patients who lost 15%of the vertebral body height, the anterior height of the injured vertebral body in the other 23 patients recovered averagely to 80%of the normal one. Conclusion PVP with filling auto-solidification CPC is safe and effective in the treatment of osteoporotic thoracolumbar vertebral compression fractures.