Treatment of severe vertebral body compression fractures with percutaneous vertebroplasty

Objective  

Evaluate the efficacy of percutaneous vertebroplasty for severe vertebral body compression fractures.     

Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty

OBJECTIVE: Most fractures treated with percutaneous vertebroplasty are subacute and less than 1 year old. We report our experience treating chronic vertebral fractures with vertebroplasty. MATERIALS AND METHODS: Our database identified 41 patients with symptomatic fractures more than 1 year old. These patients were categorized into subgroups determined by fracture age: 12 months 1 day-24 months (n = 16) or more than 24 months 1 day (n = 25). Changes in pain and mobility for the study group were compared with those in 49 patients with fractures less than 1 year old. RESULTS: Thirty-three (80%) of the 41 patients in the study group had improvement in pain-seven (17%) had complete and 26 (63%) had partial relief. Forty-five (92%) of the 49 control group patients had improvement in pain-24 (49%) had complete and 21 (43%) had partial relief. The number of patients achieving partial or complete relief of pain was not statistically different between groups (p > 0.05), although complete relief was significantly more frequent in the control group (p = 0.002). Twenty patients (49%) in the study group versus 34 patients (69%) in the control group had improved mobility after vertebroplasty (p = 0.047). Patients with fractures 12 months 1 day-24 months old had improvement in mobility similar to that in patients in the control group (p = 0.962). Fractures more than 24 months 1 day old were associated with significantly less improvement in mobility (p = 0.006). CONCLUSION: Most patients with fractures more than 1 year old will experience clinical benefit from vertebroplasty. Complete relief of pain is more likely when less mature fractures are treated.     

Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures

PURPOSE: To determine the efficacy of percutaneous vertebroplasty in treating severe vertebral body compression fractures, or vertebra plana, in patients with osteoporosis. MATERIALS AND METHODS: In 155 patients, 310 percutaneous vertebroplasties were performed during 25 months and 15 days. Of these, 37 patients (27 women, 10 men; mean age, 73.6 years) underwent 48 vertebroplasties for severe osteoporotic vertebral body compression fractures. The fractures were defined as vertebrae that have collapsed to less than one-third of their original height. Imaging and clinical features were analyzed, including the extent of vertebral collapse, location of the involved vertebra, pattern of vertebral compression, volume of polymethylmethacrylate injected, vertebroplasty complications, and clinical outcome. RESULTS: Vertebral body collapse averaged 23% (range, 4.5%-33.0%) of the original height. Involved vertebrae were located from levels T5 to L5, with one-half affected at the thoracolumbar junction. Patterns of vertebral compression were divided into gibbus (31 of 48 or 65%), plana (13 of 48 or 27%), and H shape (four of 48 or 8%). The mean volume of the cement injected was 6.0 mL (range, 1.5-12.5 mL). Complications observed on radiographs included cement leakage to the adjacent disc (17 of 48 or 35%) and the paravertebral soft tissues (four of 48 or 8%). There were no major complications. At clinical follow-up (mean duration, 11 months and 3 days; range, 3-24 months), pain relief was complete in 14 (47%) of 30 patients, partial in 15 (50%), and unchanged in one (3%). No patient required surgery. CONCLUSION: Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures is safe and effective and should not be withheld in this group of patients.     

经皮椎体成形术在椎体压缩性骨折治疗中的应用

由外伤或骨质疏松导致的胸、腰椎体压缩骨折相当常见,患者的主要症状是顽固而严重的腰背疼痛。以往传统的保守与外科疗法有一定疗效,但均存在治疗周期长与疗效欠佳的缺点,我们利用由德国引进的经皮穿刺椎体成形(PVP)技术,自2002年10月至2003年10月间,为12例胸、腰椎压缩骨折的患者进行了治疗,并获得满意效果,现报道如下。资料与方法一、一般资料2002年10月至2003年10月间,我院共收治12例胸、腰椎椎体压缩骨折的患者,其中男4例,女8例;年龄38~72岁,平均60岁。病史8h至半年不等,有明显外伤史者4例,轻微外伤史者6例,自诉无明显外伤史者2例;伴…     

经皮椎体成形术治疗椎体重度压缩性骨折合并囊性改变的临床疗效

目的：探讨经皮椎体成形术（PVP）治疗骨质疏松重度压缩性骨折合并椎体囊性改变患者的临床疗效。 方法：选取2006年9月至2017年12月我院收治的25例重度压缩性骨折合并椎体囊性改变患者,均采用PVP进行治疗,分析PVP手术成功率,术后24 h、1周及1、3、6、12个月分别随访患者疼痛情况并记录有效率。采用卡方检验比较各个时期的疼痛缓解有效率。 结果：所有患者均成功接受PVP手术,手术成功率100%。手术时间25~45 min,平均32 min;出血量1~5 ml,平均2.4 ml;骨水泥填充量为4.5~20 ml,平均8.6 ml。25例中除1例患者因冠心病于术后10个月死亡外,其余24例均完成第12个月随访。术后24 h、1周及1、3、6和12个月的疼痛缓解有效率分别为72%（18/25）、64%（16/25）、68%（17/25）、76%（19/25）、76%（19/25）和70.8%（17/24）,差异无统计学意义（χ²=1.326,P>0.05）。 结论：PVP治疗严重的骨性椎体椎体压缩骨折合并椎体囊性改变是安全有效的。     

应用经皮椎体成形术及SKy椎体后凸成形术治疗胸腰椎压缩性骨折

目的探讨微创法经皮椎体成形术(PVP)及SKy骨膨胀椎体后凸成形术(SKy-PKP)治疗胸腰椎压缩性骨折的临床疗效。方法应用微创法治疗胸腰椎压缩性骨折患者38例,其中经皮椎体成形术治疗25例,SKy骨膨胀椎体后凸成形术治疗13例。术后随访3~20个月,平均14个月,记录对比疼痛视觉模拟评分(VAS)及伤椎形态变化。结果所有患者手术均获成功,无神经损伤并发症,伤椎处疼痛术后均获得快速显著缓解。VAS评分平均改变PVP组从6.6±2.9降至1.7±1.6,SKy-PKP组从6.9±2.9降至1.8±1.5;伤椎压缩恢复程度PVP组伤椎Cobb角平均改善11°,SKy-PKP组伤椎Cobb角平均改善18°。随访期间,疗效均满意,无手术后遗症及伤椎高度明显丢失情况。结论采用微创法PVP及SKy-PKP治疗胸腰椎压缩性骨折能够迅速缓解疼痛,增加椎体的稳定性。PVP主要适合于创伤或病理性新鲜压缩性骨折;SKy-PKP适应证较广,也可适用于新鲜及陈旧性压缩性骨折。     

经皮穿刺椎体成形术治疗椎体骨质疏松性压缩骨折

目的　通过X线透视下进行经皮穿刺椎体成形术治疗椎体骨质疏松性压缩骨折 ,探讨该技术的临床疗效及应用注意事项。　方法　本组 2 3例 ( 44个椎体 ) ,男 8例 ,女 15例 ;年龄 48～ 83岁 ,平均 6 9岁。脊柱骨折部位为T5～L3,其中胸椎 2 0个椎体 ,腰椎 2 4个椎体。采用C形臂X线机透视引导下于俯卧位或侧卧位进行经皮穿刺椎体成形术 ,注射聚甲基丙烯酸甲酯 (骨水泥 )。在术前、术后 2d、随访期进行疼痛视觉类比评分 (VAS)、活动能力评分和止痛药使用评分。随访时间 1～ 7个月 ,平均 3.1个月。　结果　 2 1例 40个椎体手术成功 ,2例 ( 4个椎体 )因不能耐受俯卧位而手术失败。骨水泥注射量 1.0～ 8.0ml 椎体。VAS术前 ( 7.5± 1.2 ) ,术后 2d ( 2 .8± 1.0 )较术前显著下降 (P <0 .0 0 1) ;随访时为 2 .3± 0 .9,比术后 2d又略有下降。活动能力评分 ,术后 2d ( 1.6± 0 .3)较术前 ( 2 .3± 0 .8)明显改善 (P <0 .0 5 ) ;随访时为 1.4± 0 .4,行动能力进一步改善。止痛药使用评分 ,术后 2d ( 0 .6± 0 .6 )较术前 ( 2 .2± 0 .5 )显著改善 (P <0 .0 1) ;随访时为 0 .8± 0 .6 ,与术后比较无显著变化。　结论　经皮穿刺椎体成形术是治疗椎体骨质疏松性压缩骨折的有效微创技术 ,单平面C形臂X线机透视监视即可满足     

低温骨水泥灌注技术在经皮椎体成形术中的应用

目的比较低温灌注技术与常温灌注技术,评价其在经皮椎体成形术(percutaneous vertebroplasty,PVP)中治疗骨质疏松性椎体压缩性骨折中的疗效。方法回顾性分析贵阳市第四人民医院脊柱外科2015年1月—2017年1月诊断为胸腰椎骨质疏松性压缩性骨折并行PVP治疗的66例患者,按骨水泥灌注技术不同分为常温灌注组(采用常温下调制好骨水泥分两次灌注的方法)33例、36个椎体,低温灌注组(将调好的骨水泥置于0℃冰盐水中缓慢、低压、间断灌注)33例、35个椎体。比较术前、术后3d及末次随访(术后6~15个月)时两组的视觉模拟评分(VAS),Oswestry功能指数(ODI),伤椎椎体前缘高度,椎体后凸角度,骨水泥渗漏及弥散情况。结果低温灌注组的骨水泥工作时间(10.2±1.2)min明显长于常温组(8.3±1.5)min,差异有统计学意义(P0.05),两组术后平均随访(12.7±4.5)个月和(12.4±2.9)个月,差异无统计学意义(P0.05)。两组患者VAS评分、ODI术后与术前比较差异有统计学意义(P0.05);末次随访与术后比较常温灌注组差异有统计学意义(P0.05),低温灌注组差异无统计学意义(P0.05);两组患者组间比较VAS评分、ODI末次随访时差异有统计学意义(P0.05),其余时间点差异无统计学意义(P0.05)。两组之间伤椎椎体前缘高度和椎体后凸角度比较术前、术后及末次随访时上述指标差异无统计学意义(P0.05)。低温灌注组骨水泥同时接触上下终板比例多于常温组(P0.05),低温灌注组骨水泥渗漏率显著低于常温灌注组(P0.05)。结论骨水泥低温灌注技术应用于椎体成形术时,可以显著延长骨水泥的工作时间,在获得良好骨水泥弥散效果的同时,有效降低渗漏率,可以获得满意的临床效果。     

Comparative study of percutaneous vertebral body perforation and vertebroplasty for the treatment of painful vertebral compression fractures

BACKGROUND AND PURPOSE:Percutaneous vertebral body perforation is a new technique for treating painful VCFs. Herein, we compare the therapeutic effect of vertebral perforation and conventional vertebroplasty for treating VCFs.MATERIALS AND METHODS:One hundred eight patients with single painful VCFs were assigned to undergo vertebral perforation (perforation group) or vertebroplasty (PVP group). Clinical outcomes were assessed by using the VAS. The associations of analgesic effect and clinical factors were also analyzed by multivariate regression. Plain radiographs were used to quantify the progression of vertebral body compression after surgery and to evaluate cement leakage and new vertebral fractures. The median follow-up time was 10 months.RESULTS:Baseline characteristics were similar in the 2 groups. No factors correlated with analgesic effects in the PVP group. The analgesic effect of vertebral perforation was, however, related to the preoperative severity of vertebral compression and was low in patients with severe deformity (P < .05). Among patients with preoperative vertebral percentage of compression below 30%, there were no significant differences between the 2 groups in analgesic effect at any postoperative intervals. Progression of vertebral compression after surgery occurred in 22.2% and 16.0% of treated vertebrae in the perforation and PVP groups, respectively (P = .38). Respectively, 3.7% and 20.0% of the perforation and PVP groups had new postoperative fractures during follow-up (P < .05). There were no other complications.CONCLUSIONS:Vertebral perforation was safe and effective for painful VCFs with slight compression. However, vertebroplasty should be considered for patients with marked vertebral body compression.

Vertebroplasty using bone cement has been performed worldwide to control pain due to osteoporotic VCFs resistant to conservative treatment.^1–8 While marked analgesic effect and improvement in ADL are apparent immediately after vertebroplasty, problems including postoperative fractures of adjacent vertebral bodies, pulmonary embolism due to leakage of bone cement out of the vertebral body, and symptoms of spinal cord compression have been reported.^9–11 In particular, postoperative fractures have been reported to occur in 41%–67% of patients, suggesting that the treatment itself may induce new fractures.^12–14 Because no effective method of avoiding such fractures has been established, to our knowledge, this complication is currently a major limitation of vertebroplasty. Thus, breakthroughs to overcome this problem are awaited.Fracture pain and increased intraosseous pressure have long been regarded as being closely related. In fact, there have been a number of reports evaluating increased intraosseous vertebral pressure in VCFs.^15–23 Intraosseous decompression for the treatment of fracture pain is thought to have therapeutic benefits and is covered by medical insurance in Japan. It is well-known that there is no dose-escalation effect of bone cement used for the treatment of VCFs.^24,25 Furthermore, we have actually experienced some patients who obtained a remarkable analgesic effect despite injection of a small amount of bone cement into painful fractured vertebrae. We aimed at reducing increased intraosseous vertebral pressure, which was a cause of pain in this study. We prospectively performed percutaneous vertebral body perforations without bone cement in patients with VCFs resistant to conservative treatment. We evaluated the therapeutic effects, complications, and factors affecting its analgesic effect and compared them with those of conventional vertebroplasty.     

CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures

The purpose of this study was to determine the efficacy and safety of CT-guided percutaneous vertebroplasty in the treatment of vertebral compression fractures. The primary objectives were pain reduction and bone-cement leakage during a long-term follow-up in patients with osteoporotic vertebral compression fractures. CT-guided percutaneous vertebroplasty was carried out in 61 patients (mean age 71.4 years; range 42–83; female ratio: 73.8%) with vertebral compression fractures. Treatment was carried out on an outpatient basis. Pain, bone-cement leakage and complications were monitored and recorded. The mean follow-up time was 19.8 months (range 3–52). Paired comparison procedures were used for the analysis of the results, which showed that all patients had a significant reduction of pain. The mean visual-analogue scale (VAS) before treatment was 8.8 points (range 6.5–9.8 points). The mean VAS score after treatment was significantly reduced to 2.6 points (range 1.5–4.1 points; p<0.01). No clinical or neurological complications were documented. Minor and asymptomatic bone-cement leakage was observed in 54% of the cases. Percutaneous vertebroplasty is an efficient and safe interventional procedure which rapidly improves the mobility and quality of life of patients with vertebral compression fractures. CT-guidance is a reasonable upgrade in the treatment procedure which reduces the amount of bone-cement leakage.T.J. Vogl and D. Proschek contributed equally to this work.     

Treatment of painful compression vertebral fractures with vertebroplasty: results and complications

AIM: The aim of this paper is to assess the effectiveness and safety of percutaneous vertebroplasty in patients with focal pain caused by compression vertebral body fractures. MATERIALS AND METHODS: Over an eleven-month period 49 patients underwent percutaneous vertebroplasty, of which seven were retreated, for a total of 56 operations on 108 vertebrae. The patients were affected by osteoporotic compression fractures (n=28) or by benign and malignant infiltrative processes (n=21). All of the patients were examined at discharge and later at one week, and one, three, six and nine months after surgery to ascertain the development of the pain and possible changes in the quality of life. The mean length of follow-up was 3.8 months. RESULTS: One week after treatment all patients reported complete disappearance or significant alleviation of the pain. In 8 out of 49 patients (16.3%) there was a reoccurrence of pain; 7 of these patients underwent further treatment at another level with immediate pain relief. After surgery only three patients (6.1%) continued to take non-steroidal anti-inflammatory drugs (NSAIDs), whereas prior to surgery all patients were taking pain medication. We also observed an important benefit in the quality of life, in that after treatment all patients reported an improvement in functional abilities, and only three (6.1%) still had to wear a back brace (against 15 in the preoperative period). We only had one serious complication (1.7%) which involved the formation of a subcutaneous paravertebral haematoma, which was resolved in about a week. Eight patients (16.3%) developed transient pain at the site of the puncture or radiculopathy in the days following the operation. In 63 out of 108 of the treated vertebrae (58) there were small asymptomatic leakages of cement outside the vertebral body and in two asymptomatic patients (3.5%) the chest radiograph revealed a small pulmonary embolism of cement. DISCUSSION: Our experience confirms the effectiveness of vertebroplasty in the treatment of pain caused by vertebral fractures. If the indications are respected the improvement of symptoms is often immediate, such as the return of mobility, and patient satisfaction with surgery is higher. The use of appropriate guiding systems limits the number of complications.     

经皮椎体成形术在椎体压缩骨折及椎体血管瘤治疗中的应用

目的:总结经皮椎体成形术治疗疼痛性椎体压缩性骨折和疼痛性椎体血管瘤的临床经验,评估其治疗疗效。方法:回顾性分析26例疼痛性椎体压缩性骨折和3例疼痛性椎体血管瘤的椎体成形术治疗病例。病椎39个,其中胸椎18个,腰椎21个,36个采用单侧椎弓根入路,3个采用双侧椎弓根入路。结果:29例治疗均获得成功,注射骨水泥2.5~5.0ml,平均3.2ml。术后随访6~12个月,完全缓解(CR)、部分缓解(PR)、轻微缓解(MR)和无效(NR)例数分别为24、3、2、0,疼痛缓解率93.1%。患者的视觉模拟评分(VAS)术后显著下降(P0.05)。结论:采用经皮椎体成形术治疗疼痛性椎体压缩性骨折及疼痛性椎体血管瘤是一种微创、安全、有效的治疗手段。     

椎体骨质疏松性骨折两种椎体成形术的疗效比较

 目的 比较经皮椎体成形术(percutaneous vertebroplasty,PVP)和经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗老年骨质疏松椎体压缩性骨折的疗效。方法 选取2017-01至2019-12医院收治的因骨质疏松椎体骨折行PVP或PKP治疗的老年患者共112例(132椎),根据选择术式的不同分为PVP组和PKP组,其中PVP组伤椎68个,PKP组伤椎64个。记录两种不同术式手术前后 VAS 评分、伤椎椎体增加高度、骨水泥注入量、手术时间、骨水泥渗漏情况。结果 PVP 组和PKP组术前和术后1 d的VAS评分比较,差异无统计学意义。PKP组术后修复伤椎高度为(11.5±3.2)mm,明显高于PVP组的(2.1±1.3)mm,差异有统计学意义(P<0.05)。PKP组骨水泥注入量也明显多于PVP组,两组比较差异有统计学意义(P<0.05)。PVP 组术中骨水泥渗漏 23个椎体(33.8%),PKP 组渗漏12个椎体(18.8%),PVP 组并发症高于PKP 组。结论 两种手术方式均能达到很好的止痛效果。但PKP恢复椎体高度上优于PVP,骨水泥注入量多,渗漏率低,临床治疗更有优势。     

闭合复位联合经皮椎体成形术治疗骨质疏松性椎体压缩骨折

对57例骨质疏松压缩性骨折采用术前牵引过伸复位,再行经皮椎体成形术(PVP)治疗,术后患者疼痛明显减轻,椎体高度显著恢复,无严重并发症。闭合复位联合PVP是治疗骨质疏松性椎体压缩骨折的有效方法。     

Prospective clinical follow-up after percutaneous vertebroplasty in patients with painful osteoporotic vertebral compression fractures

PURPOSE: To prospectively assess short-term, midterm, and long-term pain relief in patients with painful osteoporotic vertebral compression fractures (VCFs) treated with percutaneous vertebroplasty (PV). MATERIALS AND METHODS: Visual analog scale (VAS) scores for pain at the treated vertebral level, analgesic use, and satisfaction with outcome were assessed in 112 patients after PV of 168 VCFs. Serial follow-up was performed at 24 hours and 3, 6, and 12 months and in a small number of patients at 1-3 years. Procedure-related complications were evaluated by physical examination and computed tomography of treated levels. RESULTS: After PV, VAS scores for pain at the individual vertebral levels treated and use of analgesic agents were significantly reduced compared with before treatment at every follow-up period. Within 24 hours after the procedure, the decreases in all scores were less compared with scores at later follow-up periods, but this was not significant. The preprocedural mean VAS score was 8.8 (range, 5-10). At follow-up, mean VAS scores ranged from 2.5 to 3.3 (range, 0-10). In the short term after PV, patients used significantly less analgesic drugs and 86% of patients were satisfied with the outcome. At midterm and long-term follow-up, patients used even less analgesic drugs and 95%-100% of patients were satisfied with the outcome of PV. Procedure-related complications with clinical consequences occurred in three patients (2.7%): one patient experienced a cardiovascular reaction, one patient had a pedicle chip fracture, and one had a rib fracture. CONCLUSION: PV of painful osteoporotic VCFs provides significant pain reduction in nearly all treated patients.     

椎体内裂隙样变对椎体成形术治疗椎体压缩骨折疗效的影响

目的 研究经皮椎体成形术(PVP)治疗并存椎体内裂隙样变骨质疏松性椎体压缩骨折的疗效,并与单纯性(不合并椎体内裂隙样变)骨质疏松性椎体压缩骨折的疗效进行对比,以分析椎体内裂隙样变对疗效的影响.方法 回顾性分析PVP治疗95例患者、176节椎体骨质疏松性压缩骨折的临床及影像学资料.本组研究中除外多节段骨折、合并肿瘤病史、影像资料不全和术后随访不配合患者.入选43例分A、B两组,18例骨质疏松性椎体压缩骨折合并裂隙样变患者为A组,25例无椎体内裂隙样变患者为B组.比较两组间术前疼痛和功能障碍情况,分析两组术后1周局部疼痛缓解和功能改善情况;观察两组并发症情况.结果 A组与B组术后1周疼痛缓解及日常活动功能改善明显(P＜0.05);两组间术后1周疼痛缓解的程度和日常活动功能改善的程度差异无统计学意义(P＞0.05);两组间骨水泥外漏发生率相似(P＞0.05),但两组间骨水泥外漏类型分布有差异(P＜0.05).结论 PVP是治疗骨质疏松性椎体压缩骨折的有效方法;椎体内裂隙样变对PVP的止痛疗效、功能改善与骨水泥外漏发生率无明显影响,但对骨水泥的外漏类型有一定影响.