Objective To explore the feasibil ity and efficacy of percutaneous kyphoplasty (PKP) for the treatment of severe osteoporotic vertebral compression fracture (OVCF), and to assess the cl inical result of the PKP technique. Methods From May 2006 to October 2007, 12 patients with severe OVCF affecting more than 2/3 of the original vertebral body height were treated by using domestic PKP and percutaneous vertebroplasty (PVP) tool systems. There were 3 malesand 9 females, with the age of 56-82 years and a mean disease course of 4.2 months (1-49 months). Eleven thoracic vertebra and 4 lumbar vertebra suffered from severe vertebral compression fractures, which included 3 extremely severe thoracic OVCF. Four thoracic vertebra and 3 lumbar vertebra had not severe OVCF. There were 4 cases of single vertebral compression fracture, 6 cases of double fractures, and 2 cases of triple fractures. Only single side PKP and PVP were performed via extrapedicular approach in thoracic vertebra, and via transpedicular approach in lumbar spine under fluoroscopic control. Eight patients with severe thoracic compression fractures and 4 with severe lumbar fractures were treated by PKP. Four patients with relatively mild thoracic compression fractures and 3 with lumbar fractures were treated by PVP. Results The operation was successfully, 3 patients with extremely severe thoracic compression fractures received no intervention. The maximum expansion pressure of balloon was (1 068 ± 298) kPa, and the volume was (3.1 ± 1.2) mL during operation. The average operative time of PKP was (44.9 ± 10.6) minutes per vertebra, while the average operative time of PVP was (36.5 ± 6.8) minutes per vertebra. The average volume of injected bone cement was (2.5 ± 0.6) mL per thoracic vertebra, and (3.6 ± 1.2) mL per lumbar vertebra. The mean hospitalization time were (3.7 ± 1.6) days. Twelve cases were followed up 5-18 months (mean 8.6 months). The visual analogue scale scoreswere (2.35 ± 0.61) points 2 days after operation and (2.89 ± 1.07) points at last follow-up, there were statistically significant differences when compared with before operation (8.27 ± 1.36) points (P lt; 0.01). Extravertebral leakage of the bone cement into the paravertebral tissue and/or disc occurred in 6 patients (9 vertebra) without significant symptom. Conclusion One side approach PKP is a safe and effective technique for treatment of severe OVCF with markedly rel ief of pain.
ObjectiveEvaluating the clinical efficacy of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) for osteoporotic vertebral compressive fracture (OVCF). MethodsPatients with OVCF were retrospectively analyzed from Feb. 2008 to Feb. 2013 in Department of Orthopaedics, Tianjin Medical University General Hospital. Patients were divided into the PVP group and the PKP group. The VAS, vertebral kyphosis angle, vertebral height and bone cement leakage of both groups were compared, and the SPSS13.0 software was used for data analysis. ResultsA total of 55 patients were included. Of which, 25 patients were in the PVP group and 30 patients were in the PKP group. All patients were followed up from 5 to 20 months, with an average time of 15.5 months. The VAS scores in both groups were all improved after the operation (P<0.05), but no significant difference was found between both groups. The vertebral kyphosis angle in both groups were improved after the operation (P<0.05), and the PKP group was better than the PVP group. Six patients in the PVP group occurred the leakage of bone cement, and 4 patients in the PKP group. Five patients in the PVP groups occurred vertebral fracture again, while 7 patients in the PKP group. ConclusionUsing PVP and PKP for the treatment of OVCF can quickly relieve pain and increase the stability of the vertebral body. PKP can restore vertebral body height better and reduce the incidence of cement leakage.
ObjectiveTo compare the clinical efficacy and safety between percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fracture (OVCF) with intravertebral vacuum cleft (IVC). MethodsBetween January 2010 and December 2013, 68 patients with single OVCF and IVC were treated, and the clinical data were retrospectively analyzed. Of 68 patients, 48 underwent PVP (PVP group) and 20 underwent PKP (PKP group). There was no significant difference in age, gender, disease duration, fracture level, bone mineral density (BMD), visual analogue scale (VAS), Oswestry disability index (ODI), and preoperative radiological parameters between 2 groups (P > 0.05). The intraoperative incidence of cement leakage, cement volume, and operative time were compared between 2 groups; VAS score was used for evaluation of back pain and ODI for evaluation of dysfunction; the incidence of adjacent vertebral fracture was observed within 2 years. The vertebral height and kyphotic angle were measured on X-ray films; the rate of vertebral compression (CR), reduction rate (RR), progressive height loss (PHL), reduction angle (RA), and progressive angle (PA) were calculated. ResultsThere was no significant difference in cement volume and the incidence of cement leakage between 2 groups (P > 0.05). The operative time in PVP group was shorter than that in PKP group, showing significant difference (t=-8.821, P=0.000). The mean follow-up time was 2.4 years (range, 2.0-3.1 years). The VAS scores and ODI were significantly reduced at 1 day, 1 year, and 2 years after operation when compared with preoperative scores (P < 0.05), but there was no significant difference between different time points after operation in 2 groups (P > 0.05). Adjacent vertebral fracture occurred in 5 cases (10.4%) of PVP group and in 2 cases (10.0%) of PKP group, showing no significant difference (χ2=0.003, P=0.963). BMD was significantly increased at 1 year and 2 years after operation when compared with preoperative BMD (P < 0.05), but no significant difference was found between 2 groups (t=0.463, P=0.642; t=0.465, P=0.646). The X-ray films showed that CR and kyphotic angle were significantly restored at immediate after operation in 2 groups (P < 0.05); but vertebral height and kyphotic angle gradually aggravated with time, showing significant difference between at immediate and at 1 and 2 years after operation (P < 0.05); there was no significant difference in CR and kyphotic angle between 2 groups at each time point (P > 0.05). RR, RA, PHL, and PA showed no significant difference between 2 groups (P > 0.05). ConclusionThere is similar clinical and radiological efficacy between PVP and PKP for treatment of OVCF with IVC. Re-collapse could happen after operation, so strict observation and follow-up are needed.
Objective To investigate the efficiency of manual reduction combined with uni-lateral percutaneous kyphoplasty (PKP) in treating osteoporotic vertebral compression fracture (OVCF). Methods Between May 2005 and May 2009, the manual reduction combined with uni-lateral PKP was appl ied to treat 42 patients with OVCF (group A), and the simple uni-lateral PKP was appl ied to treat 43 patients with OVCF (group B) at the same period. The visual analogue scale (VAS), the vertebral height, and the Cobb angle were determined before operation, and at 3 days and 6 months after operation. Ingroup A, there were 6 males and 36 females aged 59-93 years (76.5 years on average) with an average disease duration of 7 days (range, 3 hours to 21 days); 27 segments of thoracic vertebrae and 31 segments of lumbar vertebrae were involved, including 15 segments at mild degree, 38 segments at moderate degree, and 5 segments at severe degree according to degree classification system of compression fractures of Zoarski and Peh. In group B, there were 9 males and 34 females aged 54-82 years (75.3 years on average) with an average disease duration of 7 days (range, 1 hour to 20 days); 26 segments of thoracic vertebrae and 35 segments of lumbar vertebrae were involved, including 21 segments at mild degree, 36 segments at moderate degree, and 4 segments at severe degree according to degree classification system of compression fractures of Zoarski and Peh. There were no significant difference (P gt; 0.05) in sex, age, affected site, degree, and disease duration between 2 groups. Results There was no significant difference (P gt; 0.05) in operative time, blood loss, or injected cement volume between 2 groups. No serious compl ication or death occurred in 2 groups. Cement leakage was observed in 4 cases (9.5%) of group A and in 5 cases (11.6%) of group B. The VAS scores after operation significantly decreased in 2 groups (P lt; 0.01). At 3 days and 6 months after operation, the VAS scores in group A were significantly lower than those in group B (P lt; 0.05). The postoperative compression rates of affected vertebral body in 2 groups significantly decreased (P lt; 0.01). The compression rates of affected vertebral body at 3 days and 6 months after operation, and the height recovery rate at 3 days after operation in group A were superior to those in groupB (P lt; 0.05). The postoperative Cobb angles in 2 groups were significantly diminished (P lt; 0.01). The Cobb angles at 3 days and 6 months after operation, and the recovery rate at 3 days after operation in group A were superior to those in group B (P lt; 0.05). Conclusion The cl inical efficiency of the manual reduction combined with uni-lateral PKP is superior to that of simple uni-lateral PKP in treatment of severe OVCF.
Objective To evaluate the efficacy of percutaneous kyphoplasty (PKP) in hyperextension position for the treatment of osteoporotic vertebral compression fracture (OVCF) with vacuum phenomenon. Methods Between April 2004and August 2009, 35 patients who suffered from OVCF with vacuum phenomenon were treated with PKP in hyperextension position, 8 patients were excluded because of lost follow-up. In 27 follow-up cases, there were 9 males and 18 females with an average age of 75 years (range, 58-90 years) and with an average disease duration of 9.8 months (range, 2-17 months). One vertebral body was involved in 26 cases and 2 vertebral bodies were involved in 1 case. According to the imaging examination and Krauss et al. criterion, all patients were diagnosed as having vertebral vacuum phenomenon. Refer to the lateral X-ray views, the height and the kyphotic angle of the involved vertebral body were measured pre- and postoperatively. The surgical outcomes were evaluated by using visual analogue scale (VAS) and Oswestry disabil ity index (ODI) system. Results All operations were performed successfully with no severe compl ication. The mean follow-up of 27 patients was 32 months (range, 24-58 months). The mean cl inical heal ing time of OVCF was 4 months (range, 3-6 months). The VAS score, ODI system, anterior and medial height of involved vertebral body, kyphotic angle of involved vertebral body were improved significantly at 1 week after operation and at last follow-up (P lt; 0.05); there was no significant difference between at 1 week after operation and at last follow-up (P gt; 0.05). There was no significant difference in the posterior height of involved vertebral body among different postoperative time-points (P gt; 0.05). Asymptomatic cement leakage occurred in 3 patients. Adjacent vertebral fracture occurred in 1 patient at 7 months. Intravertebral vacuums showed a compact and sol id cement fill ing pattern. Conclusion PKP in hyperextension position can significantly rel ieve back pain, restore vertebral height, and correct local kyphosis in the treatment of OVCF with vacuum phenomenon.
ObjectiveTo systematically review the efficacy of zoledronic acid (ZOL) on postoperative osteoporosis vertebral fracture (OVFs) of patients undergoing percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP).MethodsWe searched databases including PubMed, EMbase, CBM, CNKI, VIP and WanFang Data to collect randomized controlled trials (RCTs) about ZOL on postoperative OVFs of patients undergoing PVP or PKP from inception to June 30th, 2016. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies. Then, RevMan 5.3 software was used for meta-analysis.ResultsA total of 11 RCTs involving 950 cases of OVFs were included. The results of meta-analysis showed that: the bone mineral densities of the ZOL group at 6 months (SMD=0.62, 95%CI 0.06 to 1.18, P=0.03) and 12 months (SMD=1.32, 95%CI 0.62 to 2.02, P=0.000 2) after the operation were higher than those of the control group. The re-fracture risk of the ZOL group was lower than that of the control group (RR=0.27, 95%CI 0.16 to 0.47, P<0.000 01). The visual analogue scales of the ZOL group were lower than those of the control group at 3 weeks (SMD=–1.03, 95%CI –1.42 to –0.63, P<0.000 01), 1 month (SMD=–1.57, 95%CI –2.30 to –0.83, P<0.000 01), 3 months (SMD=–1.53, 95%CI –2.20 to –0.86, P<0.000 01), 6 months (SMD=–2.59, 95%CI –3.42 to –1.76, P<0.000 01), and 12 months (SMD=–2.69, 95%CI –4.21 to –1.18, P=0.000 5) after the operation. In addition, Oswestry disability index (ODI) score of the ZOL group was better than that of the control group at 1 year after the operation (SMD=–1.61, 95% CI–2.42 to –0.81, P<0.000 1).ConclusionsThe current evidence shows that the usage of ZOL after PVP/PKP has better effects, it relieves the pain further, increases the quantity of bone significantly, ameliorates the BMD, reduces the incidence of re-fracture and improves the quality of life. Due to the limited quantity and quality of included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo compare the effect of percutaneous kyphoplasty (PKP) with different phases bone cement for treatment of osteoporotic vertebral compression fracture (OVCF).MethodsThe clinical data of 219 OVCF patients who treated with PKP and met the selection criteria between June 2016 and May 2018 were retrospectively analyzed. According to the different time of intraoperative injection of bone cement, they were divided into observation group [116 cases, intraoperative injection of polymethyl methacrylate (PMMA) bone cement in low-viscosity wet-sand phase)] and control group (103 cases, intraoperative injection of PMMA bone cement in low-viscosity wire-drawing phase). There was no significance in general date of gender, age, disease duration, body mass index, bone mineral density T value, fracture vertebral body, preoperative fracture severity of the responsible vertebral body, anterior height ratio of the responsible vertebral body, preoperative pain visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The VAS score and ODI score were used to evaluate the improvement of patients’ symptoms at immediate, 2 days, 3 months after operation and at last follow-up. At 1 day, 3 months after operation, and at last follow-up, X-ray film and CT of spine were reexamined to observe the distribution of bone cement in the vertebral body, bone cement leakage, and other complications. During the follow-up, the refracture rate of the responsible vertebral body and the fracture rate of the adjacent vertebral body were recorded.ResultsThe injection amount of bone cement in the observation group and control group were (4.53±0.45) mL and (4.49±0.57) mL, respectively, showing no significant difference between the two groups (t=1.018, P=0.310). Patients in both groups were followed up 6-18 months (mean, 13.3 months). There were 95 cases (81.9%) and 72 cases (69.9%) of the bone cement distribution range more than 49% of the cross-sectional area of the vertebral body in the observation group and the control group, respectively, showing significant difference in the incidence between the two groups (χ2=4.334, P=0.037). The VAS score and ODI score of the postoperative time points were significantly improved compared with those before operation (P<0.05), and there were significant differences among the postoperative time points (P<0.05). The VAS score and ODI score of the observation group were significantly better than those of the control group (P<0.05) at immediate, 2 days, and 3 months after operation, and there was no significant difference between the two groups at last follow-up (P>0.05). At 1 day after operation, the cement leakage occurred in 18 cases of the observation group (8 cases of venous leakage, 6 cases of paravertebral leakage, 4 cases of intradiscal leakage) and in 22 cases of the control group (9 cases of venous leakage, 8 cases of paravertebral leakage, 5 cases of intradiscal leakage). There was no significant difference between the two groups (P>0.05). During the follow-up, 5 cases (4.3%) in the observation group, 12 cases (11.7%) in the control group had responsible vertebral refracture, and 6 cases (5.2%) in the observation group and 14 cases (13.6%) in the control group had adjacent vertebral fracture, the differences were significant (χ2=4.105, P=0.043; χ2=4.661, P=0.031).ConclusionBone cement injection with wet-sand phase in PKP is beneficial for the bone cement evenly distributed, strengthening the responsible vertebral, relieving the short-term pain after operation, decreasing the rate of responsible vertebral refracture and adjacent vertebral fracture without increasing the incidence of relevant complications and can enhance the effectiveness.
Objective To manage the preoperative, intraoperative and postoperative pain of percutaneous kyphoplasty (PKP) under the concept of enhanced recovery after surgery (ERAS) and explore the role of pain management under the ERAS concept in enhancing postoperative rehabilitation of PKP. Methods From January to December 2016, 136 patients with osteoporotic compression fractures treated with PKP of local anesthesia were selected, among which 71 patients in the ERAS group were treated between July and December 2016, who were treated with celecoxib capsule for analgesia before the operation and such local anesthetics as lidocaine and ropivacaine combined with intravenous injection of dexmedetomidine hydrochloride for multi-mode analgesia during the operation; after the operation, celecoxib capsules and tizanidine hydrochloride tablets were orally administered by the routine for analgesia; if the pain was increased, 40 mg parecoxib would be added for analgesia by intramuscular injection. While 65 patients in the conventional group were treated between January and June 2016, who were given intraoperative local anesthesia with lidocaine; if the patients suffered from severe pain after the operation, they would be given 40 mg parecoxib by intramuscular injection. The Visual Analogue Scale (VAS), mean arterial pressure (MAP), the complications after surgery, postoperative infections, bed rest time, length of hospital stay and patient satisfaction were compared between the two groups. Results There was no statistical difference in age, gender or fracture vertebral number between the two groups (P>0.05). The preoperative, intraoperative and postoperative VAS scores (4.0±1.5, 4.8±1.8, 1.6±1.1), MAP change [(22.0±4.7) mm Hg (1 mm Hg=0.133 kPa)], bed rest time [(1.5±0.7) days], and length of hospital stay [(3.8±0.8) days] in the ERAS group were significantly less than those in the conventional group [4.7±1.7, 5.7±1.5, 2.4±1.1, (31.3±6.1) mm Hg, (2.1±0.8) days, and (5.0±1.6) days, respectively] (P<0.05). The incidence of intraoperative complication of bone cement leakage (4.2%, 3/71) in the ERAS group was lower than that in the conventional group (13.8%, 9/65) (P<0.05); there was no statistical difference in postoperative pulmonary infection between the two groups (P>0.05). Patients’ satisfaction was significantly improved from 86.2% (the conventional group) to 95.8% (the ERAS group) (P<0.05). There was no incision infection, urinary tract infection or venous thrombosis in the two groups. Conclusion With the concept of ERAS, taking a management of pain can effectively alleviate the dis-comfortable pain feeling, improve the patients’ satisfaction, and enhance the recovery for the patients after PKP surgery.
ObjectiveTo observe the clinical effect of unilateral puncture percutaneous kyphoplasty (PKP) through transverse process-pedicle approach (TPA) for the treatment of lumbar osteoporotic vertebral fractures (OVF).MethodsFrom January 2014 to June 2019, a total of 220 OVF patients (321 fractured vertebral bodies) were enrolled, and PKP was performed by unilateral TPA puncture. The distribution of bone cement in vertebral body exceeding the midline of vertebral body was defined as the success of puncture, and the success rates of puncture of different vertebral bodies were recorded. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), anterior and middle heights of the vertebral body, and the local Cobb angle were compared between three time points namely before operation, 1 day after operation, and 6 months after operation. Surgery-related complications were recorded.ResultsThe 220 patients included 57 males and 163 females, with a mean age of (70.3±6.5) years, a mean course of disease of (18.7±17.7) d, and a mean bone mineral density of ?3.3±0.6. The success rate of puncture from L1 to L5 was 81.7% (85/104), 95.2% (80/84), 100.0% (69/69), 97.6% (41/42), and 72.7% (16/22), respectively. The mean volume of bone cement injected into the vertebral bodies was (5.8±0.9) mL. Two patients were followed up for less than 6 months because of death or loss to follow-up, and the other 218 patients were followed up for 6-57 months, with an average of (19.6±8.7) months. Before surgery, 1 day after surgery, and 6 months after surgery, the median (lower quartile, upper quartile) of VAS scores was 6 (6, 8), 1 (1, 2), and 2 (1, 2), respectively, with statistically significant differences in all the two-two comparisons (P<0.017). At the three time points, the median (lower quartile, upper quartile) of ODI was 61% (54%, 66%), 26% (22%, 30%), and 25% (24%, 31%), respectively, the mean height of anterior vertebral body was (18.3±2.8), (22.6±3.0), and (22.6±3.1) mm, respectively, the mean height of middle vertebral body was (17.8±2.2), (22.9±2.8), and (22.9±2.7) mm, respectively, the mean local Cobb angle was (19.9±2.6), (14.4±2.8), (14.4±2.8)°, respectively, and the values at 1 day and 6 months after surgery all differed from those before surgery (P<0.017). A total of 32 cases (42 vertebrae) had bone cement leakage, of whom 4 cases had related symptoms. There were 32 re-fractures of the vertebral bodies, including 18 adjacent vertebral body fractures, with an incidence rate of 5.6%. There were 3 vertebral infections after operation, the incidence was 0.9%.ConclusionPatients with OVF of the lumbar spine undergoing unilateral TPA puncture for PKP surgery have a high success rate, definite clinical effect, and satisfactory correction of local deformities.
ObjectiveTo investigate the effectiveness of synchronous unilateral percutaneous kyphoplasty (PKP) in the treatment of double noncontiguous thoracolumbar osteoporotic vertebral compression fracture (OVCF). MethodsBetween December 2018 and September 2020, 27 patients with double noncontiguous thoracolumbar OVCF were treated by synchronous unilateral PKP. There were 11 males and 16 females, with an average age of 75.4 years (range, 66-92 years). The fractures were caused by falls in 22 cases and sprains in 5 cases. The time from injury to hospital admission was 0.5-7.0 days, with an average of 2.1 days. The fractured vertebrae located at T9 in 2 cases, T10 in 3 cases, T11 in 10 cases, T12 in 15 cases, L1 in 12 cases, L2 in 6 cases, L3 in 4 cases, and L4 in 2 cases. The volume of bone cement injected into each vertebral body, operation time, and intraoperative fluoroscopy times were recorded. Anteroposterior and lateral X-ray films of thoracolumbar spine were taken to observe the anterior height of the injured vertebra, the Cobb angle of kyphosis, and the diffusion and good distribution rate of bone cement in the thoracolumbar spine. Visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the pain and functional improvement. ResultsAll operations completed successfully. The operation time was 34-70 minutes, with an average of 45.4 minutes. The intraoperative fluoroscopy was 21- 60 times, with an average of 38.6 times. The volume of bone cement injected into each vertebral body was 2-9 mL, with an average of 4.3 mL. All patients were followed up 6-21 months, with an average of 11.3 months. X-ray film reexamination showed that the anterior height of the injured vertebra and Cobb angle at each time point after operation were significantly improved than those before operation (P<0.05), and there was no significant difference between different time points after operation (P>0.05). The distribution of bone cement was excellent in 40 vertebral bodies, good in 13 vertebral bodies, and poor in 1 vertebral body, and the excellent and good rate was 98.1% (53/54). The pain of all patients significantly relieved or disappeared, and the function improved. The VAS score and ODI at each time point after operation were significantly lower than those before operation (P<0.05), and there was no significant difference between different time points after operation (P>0.05).ConclusionFor the double noncontiguous thoracolumbar OVCF, the synchronous unilateral PKP has the advantages of simple puncture, less trauma, less intraoperative fluoroscopy, shorter operation time, satisfactory distribution of bone cement, etc. It can restore the height of the vertebral body, correct the kyphotic angle, significantly alleviate the pain, and improve the function.