Percutaneous vertebroplasty for compression fracture: analysis of vertebral body volume by CT volumetry

PURPOSE: To evaluate the relationships between volume of vertebral bodies with compression fracture (measured by CT volumetry) before percutaneous vertebroplasty, the amount of bone cement injected, and the effect of treatment. MATERIAL AND METHODS: We examined 49 consecutive patients, with 104 vertebral body compression fractures, who underwent percutaneous injection of bone cement. Vertebral body volume was measured by CT volumetry. The patient's pain level was assessed using a visual analog scale (VAS) before and after the procedure. Improvement in VAS was defined as the decrease in VAS after the procedure. Relationships between vertebral body volume, the amount of bone cement, and the effect of treatment were evaluated using Pearson's correlation coefficient test. RESULTS: Average vertebral body volume was 26.3 +/- 8.1 cm3; average amount of bone cement was 3.2 +/- 1.1 ml; and average improvement in VAS was 4.9 +/- 2.7. The vertebral body volume was greater if a larger amount of bone cement was injected. There was a significant positive correlation between vertebral body volume and amount of bone cement (r = 0.44; P < 0.0001). However, there was no correlation between vertebral body volume and improvement in VAS, or between amount of bone cement and improvement in VAS. CONCLUSION: In percutaneous vertebroplasty for vertebral body compression fracture, there is a positive correlation between vertebral body volume and amount of bone cement, but improvement in VAS does not correlate with vertebral body volume or amount of bone cement.     

经皮椎体成形术在胸腰椎压缩性骨折中的应用

目的探讨经皮椎体成形术（paructaneous vertebroplasty，PVP）在治疗胸腰椎压缩性骨折中的应用。方法采用PVP治疗腰椎压缩性骨折患者44例，其中单节段28例，双节段12例，3节段以上的4例，共67个椎体，进行临床和影像学评价。结果本组患者均获得4—23个月的随访（平均15个月）。40例患者术后背部疼痛得到改善；19例患者术后当天下床活动，25例患者术后次日下床，术后X线检查椎内骨水泥分布均匀，无外漏。结论PVP具有止痛和稳定椎体，微创、并发症少等优点，是治疗胸腰椎压缩性骨折安全有效的治疗方法。     

Vertebroplasty in the treatment of back pain

PURPOSE: The aim of this study is to show the utility of vertebroplasty in the treatment of some types of back pain. Vertebroplasty is a venous embolisation of the vertebral body performed under computed tomography (CT) or fluoroscopy guidance with transpedicular, anterolateral, intercostovertebral or posterolateral approach with acrylic cement. MATERIALS AND METHODS: We report our experience in 85 patients suffering from low back and thoracic pain and treated with percutaneous vertebroplasty owing to osteoporotic vertebral compression fractures, vertebral haemangiomas or secondary lytic lesions of the spine. Patient selection was performed on the basis of physical examination, magnetic resonance or less frequently, with bone scan. CT has a minor role in selected cases to evaluate the integrity of the posterior wall. We treated 55 patients affected by acute osteoporotic vertebral compression fracture, 10 patients with vertebral haemangioma and 20 patients with metastatic lesions. The patients were placed in the prone position and the procedure was performed under fluoroscopy guidance in 80 patients and under CT guidance in 5 patients affected by metastatic lesions. In no cases was phlebography performed before the treatment. The approach adopted was bilateral in 45 patients and unilateral in the remaining 30 cases. Injection with a low viscosity cement was performed under fluoroscopy guidance with extreme precision in all cases. The amount of cement injected ranged from 4 ml (thoracic level) up to 12 ml (lumbar level). RESULTS: The results were better for osteoporotic cases (95%) and patients with vertebral haemangioma (90%) than with metastatic lesions (77%), with improvement within 24-72 hours after the treatment. We noted asymptomatic cement leakage in 39 cases but only in 2 cases was there an acute radiculopathy due to epidural cement leakage, which was treated and resolved medically in 1 month. At follow-up no cases were noted of fractures of vertebral bodies adjacent to the treated vertebrae. DISCUSSION AND CONCLUSIONS: Since the first case of vertebroplasty was used in vertebral haemangioma, the possibility of using this technique in other pathological conditions such as metastatic lesions and osteoporotic compression fractures has been clear. MR has a key role in the selection of patients while bone scan and CT can be useful in selected cases. Absolute controindication is local or systemic infection while relative controindications are epidural extension of the neoplastic lesion, vertebra plana, clinical signs of myelopathy or radiculopathy and coagulation disorders. The results of our study were better in patients treated for osteoporosis or haemangioma than in cancer patients. We consider percutaneous vertebroplasty a valid technique for the treatment of the pain due to osteoporotic compression fractures, vertebral haemangiomas or metastatic lesions.     

Pain response in the first trimester after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures with or without bone marrow edema

BACKGROUND AND PURPOSE: Presence of bone marrow edema (BME) in osteoporotic vertebral compression fractures (VCF) detected by MR imaging as selection criterion for percutaneous vertebroplasty (PV) is speculative. To clarify significance of BME in VCF, we assessed pain response after PV in patients with VCF with full BME versus patients with VCF with absent BME. METHODS: From a cohort of patients with painful VCF selected for PV, pain response in 14 patients with absent BME in VCF was prospectively compared with pain response in 31 patients with full BME in VCF. Pain was evaluated before PV and at 1 and 3 months after PV with visual analog scores and analgesics used. Back pain in general and at treated vertebral levels was assessed. RESULTS: Pain decrease after PV at treated levels was observed in 10 (71%) patients with absent BME in VCF at both follow-up periods and in 29 (94%) patients with full BME 1 month after PV and 30 (97%) at 3 months after PV. Differences between the groups were significant (P = .04 at 1 month; P = .01 at 3 months). Pain response was not affected by other patient or imaging characteristics. General back pain after PV was comparable in both groups after PV (P = .08 at 1 month; P = .4 at 3 months). CONCLUSION: Pain decrease after PV in patients with VCF is more frequently observed when full BME is present. Because 71% of patients with VCF with absent BME responded favorably on pain, PV should not be withheld based on absence of BME alone.     

Vertebral Augmentation for Neoplastic Lesions with Posterior Wall Erosion and Epidural Mass

BACKGROUND AND PURPOSE:The presence of a cortical erosion of the posterior wall or an epidural mass is commonly considered a contraindication to performing a vertebral augmentation, considering the perceived increased risk of an epidural cement leak. Our aim was to assess technical and clinical complications of vertebral augmentation procedures performed for pain palliation and/or stabilization of neoplastic lytic vertebral body lesions, with cortical erosion of the posterior wall, often associated with a soft-tissue epidural mass.MATERIALS AND METHODS:In 48 patients, we performed retrospective vertebral augmentation assessment on 70 consecutive levels with cortical erosion of the posterior wall, as demonstrated by preprocedural CT/MR imaging. An epidural mass was present in 31/70 (44.3%) levels. Cavity creation was performed with Coblation Wands before cement injection in 59/70 levels. Injection of high-viscosity polymethylmethacrylate was performed under real-time continuous fluoroscopic control. Postprocedural CT of the treated levels was performed in all cases. Clinical follow-up was performed at 1 and 4 weeks postprocedurally.RESULTS:In 65/70 (92.8%) levels, the vertebral augmentation resulted in satisfactory polymethylmethacrylate filling of the lytic cavity and adjacent trabecular spaces in the anterior half of the vertebral body. An epidural leak of polymethylmethacrylate occurred in 10/70 (14.2%) levels, causing radicular pain in 3 patients, which spontaneously resolved within 1 week in 2 patients, while 1 patient with a T1–T2 foraminal leak developed severe weakness of the intrinsic hand muscles and a permanent motor deficit.CONCLUSIONS:In our series of vertebral augmentation of neoplastic lytic vertebral lesions performed for palliation of pain and/or stabilization, we observed a polymethylmethacrylate epidural leak in only 14.2% of levels, despite the presence of cortical erosion of the posterior wall and an epidural mass, with an extremely low rate of clinical complications. Our data seem to justify use of vertebral augmentation in patients with intractable pain or those at risk for vertebral collapse.

Spinal metastases, which are present in approximately 5% of patients with systemic cancer,^1,2 are often associated with severe pain and reduced quality of life and can lead to potential catastrophic complications linked to spinal cord compression.³Vertebroplasty, first described in 1987,⁴ and, in more general terms, vertebral augmentation (VA) procedures are widely performed, especially for osteoporotic fractures⁵ but also as palliative treatment for painful or at-risk-of-collapse neoplastic lytic vertebral body lesions.⁶ The intent of the procedure is to relieve pain and/or stabilize the vertebral body to arrest a developing fracture or prevent a new one.^7–9 Multiple recent studies have shown a significant improvement in clinical outcomes (including pain) by using percutaneous vertebroplasty with or without kyphoplasty.^10–12 The presence of a cortical erosion of the posterior wall (CE-PW) or an epidural mass (EM) is commonly considered a contraindication to performing VA, considering the perceived increased risk of an epidural polymethylmethacrylate (PMMA) cement leak.¹³ A PMMA epidural leak carries the risk of compression of the spinal cord and/or the nerve roots. The cement may also displace the tumor posteriorly, through a dehiscent posterior wall into the spinal canal; this event may be an even more dangerous complication, given the lack of control and visualization under fluoroscopy.¹³The recently introduced controlled ablation (Coblation; ArthroCare, Austin, Texas) is a technique that allows the destruction of the tumor by placing a radiofrequency “wand” through the vertebroplasty needle and uses the activation of a plasma field to vaporize the neoplastic soft tissue and create a cavity¹⁴; this cavity can then be filled more precisely and with low-pressure injection with PMMA, with a reduced risk of cement leak and posterior tumor displacement.^15,16 The use of high-viscosity PMMA has a rationale in the treatment of such lesions, having been reported to help reduce the rate of extravertebral cement leak in benign and malignant fractures.¹⁷The aim of this work was to assess technical and clinical complications of VA, performed for pain palliation and/or stabilization of neoplastic lytic vertebral body lesions, in a cohort of patients with CE-PW with or without associated soft-tissue EM.     

The risk of new osteoporotic vertebral compression fractures in the year after percutaneous vertebroplasty

PURPOSE: To prospectively assess the incidence, location, and possible causative mechanisms of new vertebral compression fractures (VCFs) in 66 symptomatic patients with osteoporotic VCFs treated with percutaneous vertebroplasty (PV) and to study the relation between new VCFs and back pain symptoms. MATERIALS AND METHODS: Sixty-six patients with 102 painful symptomatic VCFs were treated with PV. All patients had baseline total spinal magnetic resonance (MR) imaging. Follow-up MR imaging was performed at 3, 6, and 12 months to locate new VCFs. Visual analog scales for pain and pain medication consumption were used to assess clinical outcomes. The following characteristics were compared in patients with new VCFs after PV versus patients without new VCFs: patient age, sex, presence of secondary osteoporosis, bone mineral density, number of preexisting VCFs, shape and grade of VCFs, type of bone cement used for PV, volume of injected cement, and cement leakage in intervertebral disc spaces. RESULTS: Sixteen of 66 patients had 26 new VCFs during 1 year of follow-up after PV. Most new VCFs occurred within 3 months of PV, half of new VCFs appeared in levels adjacent to treated levels, and half of the new VCFs were symptomatic. The presence of more than two preexisting VCFs was the only independent risk factor for the development of a new VCF. CONCLUSIONS: New VCFs occurred after PV in 24% of patients. Half of new VCFs occurred in levels adjacent to treated levels and half were symptomatic. The presence of more than two preexisting VCFs was the only independent risk factor for the development of a new VCF.     

Treatment of type-A3 amyelic thoracolumbar fractures (burst fractures) with kyphoplasty: initial experience

The authors propose a minimally invasive procedure for treating type-A3 amyelic thoracolumbar fractures according to Magerl classification (compression burst fractures). The procedure, percutaneous kyphoplasty, allows the fracture to be reduced and vertebral height to be restored by injecting bone cement into a cavity created in the vertebral body by an inflatable balloon introduced with the percutaneous approach. Four patients were successfully treated, with clinical and functional benefit in all cases. There were no complications.     

Percutaneous osteoplasty as a treatment for painful malignant bone lesions of the pelvis and femur

The purposes of this report are to describe percutaneous osteoplasty as a highly effective minimally invasive procedure to treat painful malignant bone lesions of the pelvis, ilium, and femur and to discuss the relevant literature. Five patients with histologically proven metastases to the pelvis, ilium, or femur were treated by percutaneous injection of liquid bone cement as an attempt to control severe bone pain. After percutaneous osteoplasty, all five patients experienced immediate and substantial pain relief and did not require pain medication for the duration of follow-up. No clinically significant complications occurred. Whereas percutaneous osteoplasty of the spine (vertebroplasty) is well-described and widely accepted to treat pain caused by benign or malignant vertebral body diseases, osteoplasty of bones outside the spine is less known. The immediate good clinical results observed in our small patient group should encourage more widespread application of this palliative treatment.     

Bone marrow edema in osteoporotic vertebral compression fractures after percutaneous vertebroplasty and relation with clinical outcome

BACKGROUND AND PURPOSE: Little is known about the evolution of bone marrow edema (BME) in osteoporotic vertebral compression fractures (VCF) after percutaneous vertebroplasty (PV) or about its relation with relief of pain. In this study, we prospectively assessed changes in BME with MR imaging at 3, 6, and 12 months after PV and related changes in BME with pain evolution and analgesic use over time. METHODS: BME percentage was assessed in 64 patients after PV of 89 VCF with serial MR imaging follow-up at 3, 6, and 12 months. Pain was assessed before PV and at every follow-up interval by visual analog scale for pain and type of analgesic used. Relation between changes in BME and pain evolution was assessed in a subgroup of 31 patients with a single treated VCF and neither new VCF at follow-up nor pain at another untreated level. RESULTS: BME gradually decreased over time. At 1 year after PV, 29% of treated VCF still demonstrated BME. Once BME disappeared, it did not return. Pain relief was most striking the first 3 months after PV and remained constant thereafter. There was no relation between relief of pain and extent, presence, or absence of BME after PV. CONCLUSION: A gradual decrease of BME in osteoporotic VCF treated with PV is apparent during 12 months of MR imaging follow-up. Decrease of BME is unrelated to relief of pain.     

Does vertebral height restoration achieved at vertebroplasty matter?

PURPOSE: Altered vertebral and spinal configuration after osteoporotic vertebral compression fracture (VCF) is believed to contribute to postfracture morbidity. The objective of this study was to determine whether patients in whom partial vertebral height restoration (VHR) was achieved at percutaneous vertebroplasty had greater pain relief or improved quality of life compared with patients in whom no anatomic restoration was achieved. MATERIALS AND METHODS: Consecutive subjects undergoing percutaneous vertebroplasty for painful osteoporotic VCFs completed the Osteoporosis Quality of Life Questionnaire (OQLQ) a validated, disease specific instrument that measures health related quality of life in women with osteoporosis with back pain caused by VCF. At postoperative week 2, month 2, and month 6, all subjects completed the mini-OQLQ, a validated extraction of OQLQ. Pain was rated with a standard visual analogue scale (VAS). Radiographs were manually digitized and evaluated for the presence of dynamic mobility and VHR. The relationship between VHR achieved at percutaneous vertebroplasty and postoperative pain relief and quality of life outcome was examined by multivariate analysis. RESULTS: Forty-six subjects (32 women) underwent 49 percutaneous vertebroplasty procedures to treat 66 painful VCFs. Mean patient age was 74.3 years+/-10.9. Mean fracture age was 2.5 months+/-2.1. Pain rating fell from 7.7+/-1.8 to 2.8+/-1.8 within 1 day of percutaneous vertebroplasty and remained improved through month 6 (P<.001). All OQLQ domains improved substantially at week 2 (P<.02) and remained improved through month 6 (P相似文献   

CT引导下125I粒子植入联合经皮椎体成形术治疗椎体转移性肿瘤

目的:探讨CT引导下125I粒子植入联合经皮椎体成形术(PVP)治疗椎体转移性肿瘤的临床价值.方法:15例患者共累及22节椎体,1～3节/倒,其中颈椎1节、胸椎11节,腰椎10节.所有病例均在CT 引导下采用粒子针直接穿刺或粒子针通过骨水泥针同轴技术进行125I粒子植入,并采用粒子针或联合骨水泥针完成PVP治疗.结果:...     

经皮椎体成形术在椎体肿瘤治疗中的临床应用

目的:探讨经皮椎体成形术(PVP)治疗椎体肿瘤性病变的临床效果.方法:应用PVP治疗32例44个椎体良恶性肿瘤病变.在C型臂X光机透视导向下经皮穿刺到病变椎体后注入骨水泥.记录患者术前、术后24 h、术后1周、术后1个月的疼痛视觉模拟划线得分(VAS),观察止痛效果和并发症.结果:44个椎体皆一次穿刺成功,穿刺成功率100%.一月后疼痛缓解程度为:完全缓解(CR)者8例,部分缓解(PR)者21例,轻度缓解(MR)者2例,无效(NR)者1例,总有效率(CR PR)为90.6%(29/32).患者术前与术后24 h、术后1周、术后1个月的VAS得分差异有显著性意义(P<0.05).PVP术后8个椎体发生无症状的骨水泥渗漏无1例椎体塌陷加重或发生新的骨折,无1例发生严重并发症.结论:PVP治疗椎体肿瘤性病变成功率高,效果良好.     

Pulmonary cement embolism after percutaneous vertebroplasty: a rare and nonthrombotic cause of pulmonary embolism

Percutaneous vertebroplasty consists of injection of acrylic cement - polymethylmethacrylate - into a vertebral body to obtain pain relief and increase its mechanical stability. The procedure is indicated for painful hemangiomas and for painful vertebral compression fractures due to osteoporosis or malignancy. Although vertebroplasty is an efficient treatment, it is not free of complications. We present the case of a patient with pulmonary cement embolism after percutaneous vertebroplasty. Because such patients may be completely asymptomatic, but may also present with acute and severe, cardiovascular instability, clinicians and nuclear physicians should be aware that pulmonary embolism of polymethylmethacrylate may occur after percutaneous vertebroplasty.     

CT引导下经皮穿刺椎体后凸成形治疗骨质疏松性椎体压缩性骨折

目的:探讨CT引导下经皮穿刺球囊扩张椎体后凸成形治疗骨质疏松性椎体压缩性骨折的临床价值。方法:经皮椎体后凸成形术治疗的57例患者,累及69个椎体。在CT引导下,经皮穿刺两侧椎弓根,使用球囊扩张,改善椎体高度和使椎体内造成空腔,注入骨水泥。结果:69个压缩椎体其前缘和中部的压缩程度术前为(15.36±3.27)mm和(11.24±3.16)mm,术后为(10.89±3.23)mm和(5.17±1.98)mm,手术前后差异有显著性意义(P<0.01)。Cobb角由术前的26.89°±6.41°,矫正至术后18.13°±3.45°,手术前后差异有显著性(P<0.01),表明压缩程度有明显改善。骨水泥向椎间隙少量渗漏3例,向椎体侧旁软组织少量渗漏4例,向椎体后缘、后纵韧带前面少量渗漏1例,渗漏发生率11.69%(8/57),无1例导致临床症状。结论:CT引导下球囊扩张椎体后凸成形术治疗疏松性椎体压缩性骨折具有创伤小、并发症少、恢复快、穿刺定位准确、止痛效果明显、矫正后凸畸形特点。该手术属非血管性介入,多排螺旋CT三维重建引导下对骨科临床手术有较好指导价值。     

经皮骶椎成形术

经皮骶椎成形术是经皮椎体成形术的衍生技术,在影像设备引导下经皮向骶骨的病变处注入骨水泥,可以稳定椎体,增强椎体强度,减轻甚至完全缓解患者疼痛。该方法主要用于治疗骶尾部病变致难治性疼痛,该法创伤小、安全可靠。该文就经皮骶椎成形术定义、术前影像学检查、适应证与禁忌证、技术要点、并发症等作一综述。     

CT-guided percutaneous vertebroplasty: personal experience in the treatment of osteoporotic fractures and dorsolumbar metastases

PURPOSE: This study was performed to evaluate the results and complications of percutaneous vertebroplasty (PVP) performed under CT guidance. MATERIALS AND METHODS: We treated 106 patients (182 PVP): 67 for osteoporotic vertebral compression fracture, and 39 for osteolytic metastases. The first 78 patients were treated using computed tomography (CT) combined with conventional fluoroscopy as an imaging guide (135 PVP). In 28 patients, the procedure was performed with multislice CT fluoroscopy (47 PVP). RESULTS: Partial or complete pain relief was obtained in 98% of patients within 24 h from the treatment; significant results were also obtained with regard to improvement in functional mobility and reduction of analgesic use. CT allowed the detection of cement leakage in 43.9%. Severe complications were one case of pneumothorax and two cases of symptomatic cement leakage. Mild complications included two cases of cement pulmonary embolism. During the follow-up, eight osteoporotic patients presented a new vertebral fracture, and new vertebral metastases appeared in two oncological patients. CONCLUSIONS: Our personal experience confirms the efficacy of PVP treatment for both osteoporotic and oncological patients. The use of CT guidance reduces the risk of complications in comparison with conventional fluoroscopy alone, as well as facilitates the detection of small cement leakages.     

Vertebroplastie zur Therapie des Rückenschmerzes

BACKGROUND: Percutaneous vertebroplasty (PVP) represents a minimally invasive option which is gaining in importance for the treatment of vertebral compression fractures (VCF) and osteolysis of the spine. This article describes the indications for its use, peri-interventional imaging, technique, and results of PVP. MATERIAL AND METHODS: The current guidelines for performance of PVP are explained in accordance with the "Interdisciplinary Consensus Paper on Vertebroplasty and Kyphoplasty" of the German Professional Associations and the 2005 CIRSE Guidelines. The results of our own study carried out in 2002 are compared to the complication rates and clinical outcomes reported in the literature. RESULTS: Painful osteoporotic VCF and osteolysis within the vertebral body due to metastases and multiple myeloma are indications for PVP. Absolute contraindications are, in particular, asymptomatic VCF, alleviation of pain by drug treatment, therapy-refractory coagulopathies, allergies to cement components, and active infections. MRI or CT is indicated before undertaking PVP to assess the fracture age, to exclude other causes of pain, and to evaluate the posterior edge of the vertebral body. High-quality mono- or biplanar fluoroscopy--preferably in combination with CT (fluoroscopy)--is necessary for PVP to minimize the risk of cement leakage. A clear reduction in pain [mean reduction of 6.1 points (VAS)] is achieved in 86-92% of the patients with PVP. Our own study treating 58 patients (mean follow-up 323+/-99 days) revealed a clear alleviation of pain in 77% [-5.7 points (VAS)]. CONCLUSION: PVP constitutes a safe and effective minimally invasive treatment approach to stabilize and reduce acute and chronic back pain due to osteoporotic VCF and tumor-associated osteolysis.     

国产骨水泥行经皮椎体成形术治疗椎体压缩性骨折的临床应用

目的 探讨应用国产骨水泥行经皮椎体成形术(PVP)治疗椎体压缩性骨折的临床应用价值.资料与方法 在大型C臂X线机或CT机导引下,应用国产骨水泥采用经单侧椎弓根注射法行PVP治疗骨质疏松性椎体压缩性骨折患者60例,观察其临床疗效及并发症.结果 60例骨质疏松性椎体压缩性骨折患者共106个椎体行PVP治疗,技术成功率100%,其中52例患者疼痛完全缓解(CR);8例患者疼痛部分缓解(PR);总有效率100%.2例出现骨水泥外溢至椎间盘,未出现临床症状,全部病例未出现严重并发症.结论 应用国产骨水泥行PVP术治疗外伤和骨质疏松性椎体压缩性骨折安全有效,能明显地缓解疼痛和加固椎体,是一种值得临床推广应用的治疗方法.     

A Randomized Trial Comparing Balloon Kyphoplasty and Vertebroplasty for Vertebral Compression Fractures due to Osteoporosis

BACKGROUND AND PURPOSE:Several trials have compared vertebral augmentation with nonsurgical treatment for vertebral compression fractures. This trial compares the efficacy and safety of balloon kyphoplasty and vertebroplasty.MATERIALS AND METHODS:Patients with osteoporosis with 1–3 acute fractures (T5–L5) were randomized and treated with kyphoplasty (n = 191) or vertebroplasty (n = 190) and were not blinded to the treatment assignment. Twelve- and 24-month subsequent radiographic fracture incidence was the primary end point. Due to low enrollment and early withdrawals, the study was terminated with 404/1234 (32.7%) patients enrolled.RESULTS:The average age of patients was 75.6 years (77.4% female). Mean procedure duration was longer for kyphoplasty (40.0 versus 31.8 minutes, P < .001). At 12 months, 7.8% fewer patients with kyphoplasty (50/140 versus 57/131) had subsequent radiographic fracture, and there were 8.6% fewer at 24 months (54/110 versus 64/111). The results were not statistically significant (P > .21). When we used time to event for new clinical fractures, kyphoplasty approached statistical significance in longer fracture-free survival (Wilcoxon, P = .0596). Similar pain and function improvements were observed. CT demonstrated lower cement extravasation for kyphoplasty (157/214 versus 164/201 levels treated, P = .047). For kyphoplasty versus vertebroplasty, common adverse events within 30 postoperative days were procedural pain (12/191, 9/190), back pain (14/191, 28/190), and new vertebral fractures (9/191, 17/190); similar 2-year occurrence of device-related cement embolism (1/191, 1/190), procedural pain (3/191, 3/190), back pain (2/191, 3/190), and new vertebral fracture (2/191, 2/190) was observed.CONCLUSIONS:Kyphoplasty and vertebroplasty had similar long-term improvement in pain and disability with similar safety profiles and few device-related complications. Procedure duration was shorter with vertebroplasty. Kyphoplasty had fewer cement leakages and a trend toward longer fracture-free survival.

Vertebral compression fractures (VCFs) are clinically recognized in 1.4 million individuals worldwide annually,¹ often resulting in pain, disability, vertebral deformity,² and considerable negative economic impact.³ Balloon kyphoplasty (BKP) and vertebroplasty (VP) are percutaneous procedures aimed at reducing pain and providing fracture stability. Balloon kyphoplasty uses orthopedic inflatable bone tamps before bone cement injection in an attempt to correct vertebral deformity and control cement distribution.^4–6 Vertebroplasty is similar, using needles to deliver bone cement without orthopedic balloons.⁷ When Kyphoplasty and Vertebroplasty In the Augmentation and Restoration of vertebral body compression fractures (KAVIAR) was initiated, no comparative randomized controlled trials (RCTs) existed, and evidence remains limited.⁸ Several RCTs demonstrated better clinical outcomes for kyphoplasty and vertebroplasty compared with nonsurgical management.^4,7,9–11 The KAVIAR study objectives were to document and compare BKP and VP safety and effectiveness in patients with osteoporosis with VCF. The primary end point, subsequent radiographic VCF incidence, was selected because stabilization and deformity correction may have an effect on new VCF occurrence.¹² Secondary end points included pain, disability, and quality-of-life assessments.     

经皮椎体成形术治疗脊椎恶性肿瘤

目的通过评价经皮椎体成形术治疗脊椎恶性肿瘤的临床疗效,分析与疗效的相关因素,提高治疗技术。方法173例次,239节椎体病变,经病史、影像学或病理证实椎体恶性肿瘤行PVP术,临床疼痛症状为Ⅰ级(轻度疼痛)39例,Ⅱ级(中度疼痛)84例,Ⅲ级(重度疼痛)50例。术后采用WHO标准观察1周～1个月,平均2周。结果239节椎体穿刺失败1例1节椎体,技术成功率99．6％,共197个椎体行术前造影检查：造影剂经肿瘤破坏区向椎体外渗漏57节椎体,6例6节椎体有造影剂进入相邻椎间盘;注入聚甲基丙烯酸甲酯(PMMA)剂量颈椎1．5～2．5ml,胸椎为2～4ml,腰椎为2～6ml;短期内疗效显示疼痛完全缓解54．9％,部分缓解39．9％,总有效率94．8％。术后CT证实PMMA向椎体周围组织渗漏63例,包括9例引流静脉、4例椎管内硬膜囊外和3例渗漏入相邻椎间盘,47例向椎体旁渗漏,仅1例瘫痪患者出现临床症状加重。结论PVP短期内可明显减轻脊椎恶性肿瘤所致的疼痛症状。术前对脊椎恶性肿瘤的准确评估,结合术中椎体内造影,严格掌握注射时机,可提高治疗疗效,避免严重并发症的发生。