Percutaneous vertebroplasty for symptomatic osteoporotic vertebral compression fracture adjacent to lumbar instrumented circumferential fusion

The purpose of this study was to evaluate the efficacy and safety of percutaneous vertebroplasty for patients with symptomatic osteoporotic vertebral compression fractures adjacent to lumbar instrumented circumferential fusion. Between January 2005 and June 2010, eighteen patients in the authors' institution with lumbar instrumented circumferential fusion had adjacent symptomatic osteoporotic vertebral compression fractures. The patients received percutaneous vertebroplasty using polymethylmethacrylate bone cement augmentation. Radiographs and magnetic resonance imaging were used. The visual analog pain scale and modified Brodsky's criteria were used to compare clinical outcomes pre- and postoperatively. Minimum follow-up was 18 months. Dual-energy x-ray absorptiometry scan confirmed osteoporosis in all patients. The average interval between fusion surgery and sustaining osteoporotic vertebral compression fractures was 24.8 months. The average interval between sustaining osteoporotic vertebral compression fractures and undergoing percutaneous vertebroplasty was 49.3 days. One-level percutaneous vertebroplasty was performed in 13 patients, and 2 levels were performed in 5 patients. The patients' visual analog pain scale scores improved by an average of 53 points postoperatively. Fifteen patients returned to preinjury activities of daily living. The average restoration of the fractured vertebral body height was 12.1%. No major surgery-related complications, occurred except asymptomatic cement leakage in 3 patients. Elderly patients undergoing lumbar instrumented fusion surgery should be aware of the possibility of adjacent vertebral compression fractures. Percutaneous vertebroplasty is a minimally invasive and effective procedure to treat such adjacent segment disease.     

Current concepts and techniques in percutaneous vertebroplasty

Percutaneous vertebroplasty is a safe and effective alternative for the treatment of many different types of painful vertebral lesions, including osteoporotic compression fractures,hemangiomas, or malignancy-induced pathologic vertebral fractures. Medical therapy often is limited to pain control and immobilization. Because surgery is contraindicated frequently in patients who have osteoporotic compression fractures, and because patients who have widespread metastatic disease often are not surgical candidates, vertebroplasty may be the only practical option. In experienced hands and with appropriately selected patients, percutaneous vertebroplasty is a safe, inexpensive, and highly efficacious procedure; however, because of the potential for devastating complications, all efforts must be made to optimize patient safety.     

经皮椎体成形术在骨质疏松椎体压缩性骨折治疗中的应用

目的 评估经皮椎体成形术在治疗骨质疏松椎体压缩性骨折中的疗效。方法 对19例22个骨质疏松椎体压缩性骨折患行经皮椎体成形术。结果 所有患经3～12个月的随访，疗效满意，其中优4例(21％)，良12例(63％)，可3例(19％)。术后5例患需阶段性口服药物缓解疼痛，2例骨水泥外溢，但未造成不良后果。结论 经皮椎体成形术是一种微创治疗方法，用于治疗骨质疏松椎体压缩性骨折有明显疗效，可在短时间内解除患痛苦，恢复正常活动。     

Percutaneous vertebroplasty for pain relief and spinal stabilization

STUDY DESIGN: This was a retrospective review of 47 consecutive patients (1995-1998) in whom percutaneous intraosseous methylmethacrylate cement injection (percutaneous vertebroplasty) was used to treat osteoporotic vertebral compression fractures and spinal column neoplasms. OBJECTIVES: To present initial results regarding pain relief, spinal stabilization, and complications after treatment with percutaneous vertebroplasty. SUMMARY OF BACKGROUND DATA: Percutaneous vertebroplasty was developed in France in the late 1980s. Several European reports have described excellent results for treatment of compression fractures and neoplasms. The procedure was not performed in the United States until 1994. Only a single series of 29 patients treated in the United States has been reported. METHODS: A retrospective review was conducted of 47 consecutive patients with 84 vertebrae treated with percutaneous vertebroplasty. Thirty-eight patients with 70 vertebrae had symptomatic, osteoporotic fractures and had failed medical therapy. Eight patients with 13 vertebrae had primary or metastatic neoplasms. One patient had a hemangioma. Immediate and long-term pain response, spinal stability, and complications were evaluated. RESULTS: Among the 38 patients treated for osteoporotic fractures, 24 (63%) had marked to complete pain relief, 12 (32%) moderate relief and 2 (5%) no significant change. Only 4 of the 8 patients with malignancies had significant pain relief. In 7 of these patients, no further vertebral compression occurred, and spinal canal compromise was prevented. The patient with the hemangioma had no significant pain reduction. Minor complications occurred in 3 (6%) patients. CONCLUSIONS: Percutaneous vertebroplasty provided significant pain relief in a high percentage of patients with osteoporotic fractures. The procedure provided spinal stabilization in patients with malignancies but did not produce consistent pain relief. Complications were minor and infrequent. Percutaneous vertebroplasty is a promising therapy for patients with osteoporotic fractures and for selected vertebral column neoplasms.     

Modified unilateral transpedicular percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures

Objective: To comparatively assess the clinical outcome of modified unilateral percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures. Methods: The clinical outcome and incidence of cement extrusion in a consecutive group of 70 patients at our institution between December 2005 and December 2008 was retrospectively reviewed. Thirty‐five patients were randomly distributed to modified percutaneous vertebroplasty (Group A) and 35 to traditional percutaneous vertebroplasty (Group B). A visual analog scale (VAS) was used on the first post‐operative day and 1 year later to assess the severity of pain before and after vertebroplasty. The incidence of cement extrusion on CT scan was also compared between the two groups. Results: The treatment was successful in all seventy patients. The incidence of cement extrusion was 14.29% (5/35 patients) in group A, and 37.12% (13/35 patients) in group B, this difference being statistically significant (P < 0.05). No patients had serious complications. Complete pain relief was achieved in 50 patients, and significant relief in the other 20 (20/70 patients). There was no statistically significant difference between Groups A and B. Conclusion: Modified percutaneous vertebroplasty enhances the accuracy of cement injection into the center of the vertebral body, increasing the safety of the procedure with no increase in cost. It is a safer and more easily performed technique for treating patients with osteoporotic vertebral compression fractures than traditional percutaneous vertebroplasty.     

椎体后凸成形术与椎体成形术治疗骨质疏松性椎体压缩骨折的Meta分析

目的:用Meta分析的方法评价椎体后凸成形术(percutaneous kyphoplasty,PKP)与椎体成形术(percu-taneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的疗效及安全性。方法:计算机检索1997年1月～2011年1月的Ovid medline数据库、Web of science数据库、EMbase数据库及Cochrane central register of controlled trial(2011年第1期),手工检索相关杂志,搜集关于PKP与PVP治疗骨质疏松性椎体压缩骨折疗效比较的对照研究。按纳入和排除标准筛选文献,评价文献质量后采用RevMan 5.0.25进行数据分析。结果:最终纳入9个非随机前瞻性对照试验,1个随机对照试验,共749例患者。两组(PKP组及PVP组)病例术后疼痛症状均得到缓解,随访1年内患者,PKP组疼痛缓解效果略高于PVP组(P<0.05);随访大于1年者,PKP组效果明显高于PVP组(P<0.05);两组病例术后疼痛功能障碍均得到缓解,但两组间效果无明显差异(P>0.05)。大多数研究表明PVP组在矫正畸形和恢复椎体高度方面更有优势(P<0.05),但亦有部分研究认为2组间无差异性(P>0.05);两组病例在生活质量改善上效果相似(P>0.05);两组病例术后并发症发生率上PKP组小于PVP组(P<0.05)。结论:PKP在缓解疼痛、增加椎体高度及纠正畸形方面较PVP更有优势,且更为安全,但不能完全否定PVP的作用。     

Vertebroplasty: benefits are more than risks in selected and evidence-based informed patients. A retrospective study of 59 cases

Vertebral compression fractures represent a frequent pathology among elderly population, with potentially devastating consequences. More than 20 years have passed since percutaneous vertebroplasty was initially used in the treatment of angiomas, representing nowadays a widely used treatment for osteoporotic vertebral fractures. The authors present a retrospective review of 59 consecutive patients (in total 94 fractured levels) that underwent polymethylmethacrylate percutaneous vertebroplasty for vertebral compression fractures due to senile or secondary osteoporosis. All fractures were free from neurologic involvement and were classified as A1 type according to Magerl classification. All of patients were initially treated conservatively, by application of orthosis that allows immediate deambulation. At control, patients who complained of pain and limitation of daily activities underwent MRI. If presence of marrow signal changes, especially hypertense signal in T2-weighted images was confirmed, percutaneous vertebroplasty procedure was performed (we could call it “sub-acute” procedure). A limited group of patients that did not tolerate brace and had an insufficient pain control underwent vertebroplasty “in acute”, few days after fracture. Immediate post-operative pain reduction and follow-up clinical outcome (estimating quality of life and residual back pain) were evaluated by means of Visual Analogue Scale, SF-36 and Oswestry Disability Index. In the immediate post-operative course a significant pain relief was found in 39 patients (66.1%), moderate pain relief in 17 (28.8%), while 3 (5.1%) did not achieve relevant pain improvement. Pain intensity and life quality was maintained within satisfactory limits after a mean follow-up of 16 months. In conclusion, percutaneous vertebroplasty is an effective and safe procedure for treating vertebral compression fractures in the elderly. It provides immediate pain relief and allows early mobilization, thus avoiding potentially severe complications related to persistent back pain and prolonged bed rest. When performed by experienced surgeon complication rate is low, representing a safe procedure, able to provide a satisfactory outcome.     

Percutaneous vertebroplasty for vertebral compression fracture

BACKGROUND: Percutaneous vertebroplasty has become an option for the treatment of painful osteoporotic compression fractures in patients in whom conservative medical management has failed. AIM: This paper assessed the effectiveness and safety of percutaneous vertebroplasty in patients with focal pain caused by compression vertebral body fractures. MATERIALS AND METHODS: Over a twenty-five-month period 63 patients underwent percutaneous vertebroplasty, and ten of these patients were subsequently retreated, for a total of 73 operations on 93 vertebrae. The patients were affected by osteoporotic compression fractures (n=57) or by benign or malignant infiltrative processes (n=6). All patients were examined at discharge and thereafter to assess the level of pain and investigate possible changes in the quality of life. The mean length of follow-up was 15.2 months. RESULTS: After treatment, almost 90% of patients reported complete disappearance or significant alleviation of the pain. In 7 of 63 of the patient (11%) there were small asymptomatic leakages of cement outside the vertebral body. A substantial number of patients with osteoporosis, 19% of the study population, experienced new fractures following treatment with vertebroplasty. DISCUSSION: Our experience confirms the effectiveness of vertebroplasty to pain caused by vertebral fractures. If the indications are strictly followed, improvement of symptoms is often immediate, allowing the return of mobility, and patient satisfaction with surgery is higher. The use of appropriate systems limits the number of complications.     

保守疗法和椎体成形术治疗骨质疏松性椎体压缩骨折的系统评价

[目的]评价保守疗法和经皮椎体成形术治疗骨质疏松性椎体压缩骨折的疗效.[方法]全面收集保守疗法和PVP治疗骨质疏松性椎体压缩骨折的随机对照研究,在严格文献质量评价的基础上,进行系统评价.[结果]共纳入4篇RCT,共计285例患者.在减轻疼痛方面,经皮椎体成形术组在术后ld、2周均优于保守组.在再骨折和邻椎骨折方面,尚不能得出确切结论.[结论]经皮椎体成形术和保守疗法均是治疗骨质疏松性椎体压缩骨折的有效治疗方法,近期疼痛缓解情况经皮椎体成形术组优于保守组,再骨折的评价缺乏足够的证据,尚需更多设计严谨的临床试验证实.     

四步法单侧入路椎体成形术在胸椎骨质疏松性骨折中的应用

目的探讨四步法单侧入路的经皮椎体成形术(PVP)在胸椎骨质疏松性骨折中的应用。方法运用四步法,对胸椎骨质疏松性骨折椎体进行单侧入路的经皮椎体成形术,计录手术时间,观察骨水泥弥散分布情况,在术前、术后3 d、术后12个月随访时进行疼痛视觉类比评分(VAS)。结果18例21个椎体操作均成功,手术时间10~25 min,平均(16±2.2)min,骨水泥在椎体内弥散分布均越过椎体中线,VAS评分由术前(8.5±1.2)分降低至(2.5±1.4)分,术后效果良好。结论四步法单侧入路椎体成形术治疗胸椎骨质疏松性骨折简单快速、安全有效。