单侧椎弓根外侧入路椎体成形术治疗骨质疏松性压缩骨折的临床研究

目的探讨单侧经椎弓根外侧入路在椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)的特点与疗效。方法回顾性分析2010年1月～2012年1月我院收治的60例OVCFs患者(共85个椎体)的临床资料,均采用单侧椎弓根外侧入路行PVP术。受伤至手术时间平均5.7(3～31)d。术中观察穿刺针针尖达到椎体中线的比率、手术时间、出血量、骨水泥灌注量、骨水泥向椎体外渗漏率以及患者的满意度,比较术前、术后1 d及术后12月随访时视觉疼痛评分(visual analogue scales,VAS)、后凸角的改善率。结果 60例(85个椎体)均经单侧椎弓根外入路完成PVP操作。手术时间31～52 min,术中出血0～5 ml,骨水泥灌注量2.0～4.5 ml。骨水泥在椎体内分布对称,无穿刺并发症。5个椎体发生骨水泥渗漏,渗漏率5.9%。术后均获得随访,随访时间12个月。VAS评分术前平均为8.17±0.52,术后1 d平均为3.72±0.35,术后12月平均为2.21±0.25,三者比较,术前与术后1 d、术后12月时VAS评分差异均有统计学意义(P﹤0.05),疼痛均得到了明显改善;术前、术后1 d及术后12月时Cobb角分别为9.50°±3.19°、9.41°±3.08°、9.45°±2.83°,差异均无统计学意义(P﹥0.05),椎体高度无明显塌陷。患者满意率达100%。结论单侧椎弓根外穿刺入路行PVP术治疗胸腰椎OVCFs是一种安全、可行和有效的治疗方法。     

数字减影血管造影引导下单侧穿刺椎体成形治疗骨质疏松性椎体压缩骨折

目的:探讨数字减影血管造影(digital subtraction angiography,DSA)引导下单侧椎弓根外途径精准穿刺经皮椎体成形术(percataneous vertebroplasty,PVP)或经皮椎体后凸成形术(percataneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)的实施方法与疗效。方法:回顾性分析2015年8月至2018年12月收治的骨质疏松性压缩骨折68例,男20例,女48例,年龄为56～90(73.5±8.0)岁,双节段40例,3节段28例,共168个椎体,均采用DSA引导下经单侧椎弓根外途径精准穿刺行PVP或PKP。椎体分布:T_1-T_629椎,T_6-T_(12)89椎,L_1-L_550椎。术中观察穿刺针针尖达到椎体中线的比率,术后记录骨水泥向椎体外渗漏率,测量骨折椎体前缘和椎体中间高度,术前、术后3 d及末次随访时采用视觉模拟评分(visual analogue scale,VAS)和Oswestry指数(Oswestry Disability Index,ODI)分别对疼痛和腰椎功能进行评定。结果:68例椎体骨折均穿刺成功,术中透视穿刺针尖均达到椎体中线,骨水泥在椎体内弥散良好,左右对称分布。手术时间为35～60(41.6±3.2) min,无穿刺并发症。骨水泥每椎注射量3～5(3.6±0.5) ml。骨水泥渗漏8例,渗漏率11.76%。68例患者随访时间12～27(14.3±3.5)个月。术后3 d及末次随访时的VAS评分、ODI指数明显改善(P0.05)。术后3 d及末次随访时的椎体前缘高度和椎体中间高度明显恢复(P0.05)。结论:DSA引导下经单侧椎弓根外途径精准穿刺行PVP或PKP治疗骨质疏松性椎体压缩骨折,能够有效缓解疼痛,恢复椎体高度和脊柱功能,是一种安全、快速、有效的手术方法。     

单侧椎弓根外入路经皮椎体成形和后凸成形术治疗高位胸椎转移性肿瘤

[目的]探讨单侧椎弓根外入路经皮椎体成形(percutaneous vertebroplasty,PVP)和后凸成形术(percuta-neous kyphoplasty,PKP)治疗高位胸椎转移性肿瘤椎体破坏的可行性和安全性,评价临床疗效。[方法]2008年3月,1例T1~3肺癌转移,男性,59岁,诊断肺癌8个月,上胸椎及左侧肩部剧烈疼痛6个月,药物镇痛效果不佳,无手术可能。使用国产PVP和PKP工具包,采用局部麻醉,在透视引导下单侧椎弓根外入路完成T2和T3椎体强化。随访观察治疗效果。[结果]手术过程顺利,T3和T2椎体分别进行PKP和PVP治疗,T1椎体因患者不能继续耐受而放弃。T3椎体PKP时间57 min,骨水泥填充量1.9 ml,T2椎体PVP时间49 min,骨水泥填充量1.5 ml。T2椎体左侧椎弓根破坏骨水泥外漏但无临床症状,无其它并发症发生。患者术后5 d出院。术前、术后2 d和3个月随访时VAS评分分别为10分、3分和6分,使用镇痛药物可控制疼痛。[结论]单侧椎弓根外入路PVP和PKP是治疗高位胸椎转移性肿瘤的安全有效方法,能够有效缓解疼痛。     

双侧穿刺PKP治疗骨质疏松性椎体压缩骨折的疗效

目的探讨经皮穿刺双侧椎弓根注入小剂量骨水泥椎体后凸成形术（percutaneous kyphoplasty,PKP）治疗骨质疏松性椎体压缩骨折的临床疗效及安全性。方法回顾性分析2010年4月至2012年8月我院收治的132例骨质疏松性椎体压缩骨折患者,均新鲜单椎体压缩骨折,采用经皮穿刺椎体后凸成形术（PKP）双侧注入小剂量骨水泥,其中男46例,女86例;平均年龄（65.1±6.9）岁。骨折时间平均（6.2±4.6）d,骨折椎体分布：T92个、T1010个、T1120个、T1237个,L135个,L213个,L311个、L44个。术中透视下两侧分别注入1.5～3.0mL聚甲基丙烯酸甲酯骨水泥,每个椎体平均（3.2±1.1）mL,术后72h及3个月随访时测量骨折椎体高度及Cobb角的恢复值、视觉疼痛评分（visual analogue scale,VAS）的改善率、骨水泥向椎体外渗漏率、患者日常活动功能障碍的变化以及患者的满意度。结果 132个椎体均经双侧椎弓根穿刺椎体后凸成形术治疗成功,骨水泥在椎体内左右对称分布,所有患者均无临床并发症。VAS评分、日常活动功能BI评分、伤椎高度、Cobb角均较术前有明显改善,疼痛明显缓解或消失,功能改善,椎体高度恢复。随访3个月,无邻椎骨折。结论经双侧椎弓根穿刺PKP改善了急性和亚急性骨质疏松性椎体压缩骨折患者的生活质量,减轻了腰背痛和残障程度,且骨水泥渗漏、肺栓塞、相邻节段骨折等不良事件发生率低。总之,经双侧椎弓根穿刺PKP治疗骨质疏松性椎体压缩骨折是一种安全、有效、微创的治疗方法。     

单侧椎弓根穿刺PVP或PKP治疗老年骨质疏松性胸腰椎骨折

目的探讨经单侧椎弓根穿刺椎体成形(PVP)或后凸成形术(PKP)治疗骨质疏松性胸腰椎骨折的疗效。方法对168例骨质疏松性胸腰椎压缩骨折均予行单侧椎弓根穿刺,组合使用PVP和PKP技术灌注骨水泥治疗。结果随访6~36个月,其中5例高龄患者6个月后因死亡失访。椎体高度由术前平均(56.2±9.6)%增加到术后(87.3±10.2)%,56个椎体发生骨水泥外渗,其中15例渗入邻近椎间隙,3例少量渗入椎管内,患者无明显神经症状,38例渗入椎旁软组织内。术前VAS评分(8.6±1.5)分,术后3 d评分(3.4±1.2)分,末次随访时为(3.8±1.3)分,末次随访时与术前比较差异显著,与术后3 d时比较无明显差异。结论单侧椎弓根穿刺PVP或PKP治疗骨质疏松性胸腰椎骨折是一种简单、安全、有效的方法。     

提高骨水泥注入安全性的改良椎体成形术

[目的]介绍一项可以提高骨水泥注入安全性的改良椎体成形术（percutaneous vertebroplasty, PVP）或后突成形术（percutaneous kyphoplasty, PKP）的手术技术和初步临床效果。[方法] 2015年1月—2020年1月作者采用改良PVP/PKP治疗骨质疏松性椎体压缩性骨折199例。创新点在于骨折区域靶点穿刺置管、侧口推杆辅助骨水泥靶点注入、椎弓根拖尾锚定3项技术整合应用。通过术中透视及术后X线片、CT观察骨水泥弥散填充及泄露情况。[结果]所有患者均顺利完成手术，手术时间单节段平均（1.0±0.3） h，无骨水泥过敏、肺栓塞并发症、手术部位感染等重大并发症发生。单侧穿刺78例，双侧穿刺121例；骨水泥渗漏5例，其中椎间隙渗漏3例，椎旁血管渗漏2例，均未出现明显临床症状，不需特殊处理。随访12～30个月，VAS评分术前（7.9±1.4）分、术后1 d (2.6±0.7)分、末次随访时（2.4±0.6）分，疼痛均明显减轻。影像显示病椎前缘高度明显恢复；骨水泥在骨折区域充分弥散填充，椎弓根处锚定稳定。[结论]改良椎体成形术可有效降低骨水泥渗漏、移位...     

应用弯角装置单侧穿刺行PVP治疗骨质疏松性胸腰椎压缩骨折的疗效分析

目的:探讨应用弯角装置单侧穿刺行经皮椎体后凸成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性胸腰椎压缩骨折(osteoporotic vertebral compression fractures,OVCFs)的临床效果。方法:回顾性分析我院2015年1月~2016年1月应用弯角装置行单侧穿刺PVP治疗的47例OVCFs患者的临床资料,男14例,女33例;年龄53~89岁(66.4±6.5岁)。36例为单节段椎体骨折,11例为双节段椎体骨折;骨折椎体:T9 7节,T10 7节,T11 9节,T12 13节,L1 12节,L2 9节,L3 1节。记录术中透视时间、骨水泥用量,采用VAS评分、ODI评估手术前后疼痛程度及腰椎功能情况;测量计算手术前后伤椎相对高度,观察局部后凸Cobb角恢复情况;观察术中骨水泥渗漏(静脉渗漏及椎体周围渗漏)及其他并发症的发生情况。结果:术中透视时间1.6±0.3min;骨水泥用量6.7±1.2ml,骨水泥分布均匀;11例患者术中出现骨水泥渗漏,骨水泥渗漏率为23.4%。术后随访3~12个月(6.5±1.3个月),术前、术后2d和末次随访时的VAS评分、ODI、伤椎相对高度及局部后凸Cobb角分别为:7.6±1.3分、(71.4±3.2)%、0.48±0.21、15.5°±4.2°;2.2±1.0分、(27.2±2.6)%、0.82±0.17、7.2°±2.8°;1.7±0.7分、(26.5±2.7)%、0.80±0.15、7.5°±3.7°;术后2d和末次随访时的VAS评分、ODI和局部后凸Cobb角均较术前明显改善,伤椎相对高度较术前均明显恢复,差异均有统计学意义(P0.05);术后2d与末次随访时比较差异均无统计学意义(P0.05)。结论:应用弯角装置行单侧穿刺PVP治疗OVCFs可使骨水泥分布均匀,安全有效,临床效果满意。     

椎体后凸成形术治疗骨质疏松性椎体压缩骨折的并发症及预防

目的:总结经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteo-porotic vertebral compression fractures,OVCFs)的并发症,探讨其发生原因及预防措施。方法:2003年6月～2009年12月,采用PKP治疗OVCFs患者187例共233个椎体。所有病例术前均无神经根及脊髓受压症状,年龄52~93岁,男31例,女156例。椎体周壁破坏34例47个椎体,椎体周壁无破坏153例186个椎体;手术部位:T5~L5,T10及以下椎体经椎弓根入路,T9及以上椎体经椎弓根旁入路。术后随访2~78个月,平均20.8个月。结果:患者手术均顺利完成。共出现并发症23例,发生率为12.3%。骨水泥渗漏7例共7个椎体,6例未产生临床症状,1例术后疼痛症状加重,口服消炎镇痛药3d后症状缓解;椎体周壁有破坏者和无破坏者骨水泥渗漏的发生率分别为8.5%(4/47)和1.6%(3/186),差异有显著性(P0.05);有骨水泥渗漏患者骨水泥注入量胸椎为4.53±0.31ml,腰椎为6.75±0.42ml,无渗漏者胸椎为3.50±0.40ml,腰椎为5.60±0.60ml,有骨水泥渗漏与无骨水泥渗漏患者骨水泥注入量有显著性差异(P0.05);不同手术入路和手术部位的骨水泥渗漏率无统计学差异(P0.05)。3例术中出现一过性血压降低,紧急处理后30min内恢复正常。2例术后疼痛加重,分别服用消炎镇痛药2d、7d后症状缓解。术后发生低热5例,给予对症处理后体温均恢复正常。随访过程中非手术椎体新发压缩骨折6例,4例经保守治疗,2例行PKP手术后,均恢复日常活动。结论:PKP治疗OVCFs有一定的并发症,骨水泥渗漏仍是主要并发症,严格掌握手术适应证,提高手术技术水平可减少并发症的发生。     

两种术式治疗老年骨质疏松性椎体压缩性骨折的疗效比较

目的探讨椎体成形术(PVP)和椎体后凸成形术(PKP)治疗老年骨质疏松性椎体压缩性骨折(OVCF)的临床疗效。方法将112例OVCF患者根据入院先后顺序分成PVP单侧穿刺组(32例)、PVP双侧穿刺组(28例)、PKP单侧穿刺组(27例)、PKP双侧穿刺组(25例)。比较4组间手术时间、骨水泥渗漏率、椎体前缘高度比、住院天数、手术前后疼痛VAS评分。结果 112例患者均获得随访,时间6～13个月。手术时间:PVP单侧穿刺组与双侧穿刺组比较差异无统计学意义(P 0. 05),PKP单侧穿刺组与双侧穿刺组比较差异有统计学意义(P 0. 01),且PVP两组与PKP两组间比较差异均有统计学意义(P 0. 01)。骨水泥渗漏率、椎体前缘高度比:PVP两组间比较差异无统计学意义(P 0. 05),PKP两组间比较差异无统计学意义(P0. 05),但PVP两组与PKP两组间比较差异有统计学意义(P 0. 01)。住院天数、手术前后VAS评分4组间比较差异均无统计学意义(P 0. 05)。结论 OVCF采用PVP与PKP治疗疗效均满意。PVP手术时间短、费用低,但骨水泥渗漏率偏高,不能恢复压缩椎体高度; PKP骨水泥渗漏率低,利于恢复压缩椎体高度,但手术时间长、费用高。     

单侧椎弓根外入路与椎弓根入路PVP治疗胸腰段骨质疏松性椎体压缩骨折

目的比较单侧椎弓根外入路与椎弓根入路经皮椎体成形术(PVP)治疗胸腰段骨质疏松性椎体压缩骨折的临床疗效。方法回顾性分析自2018-10—2019-02诊治的60例胸腰段骨质疏松性椎体压缩骨折,30例采用椎弓根外入路PVP手术治疗(观察组),30例采用经椎弓根入路PVP手术治疗(对照组),比较2组手术时间、术中透视次数、正位穿刺到达中线情况以及术后2d疼痛VAS评分。结果60例均顺利完成手术并获得完整随访,随访时间平均6.5(3~12)个月。观察组手术时间较对照组短,术中透视次数较对照组少,差异有统计学意义(P<0.05)。2组正位穿刺到达中线情况比较差异无统计学意义(P>0.05)。观察组出现2例骨水泥分布不均,1例上位椎间盘骨水泥少量渗漏;对照组出现1例椎体后缘骨水泥少量渗漏,均无特殊不适。2组术后2d疼痛VAS评分比较差异无统计学意义(P>0.05)。结论胸腰段PVP单侧经椎弓根外入路是安全的、有效的,与经椎弓根入路相比,可减少手术时间与透视次数,并且术中穿刺较易到达中线,是值得推广的一种穿刺途径。     

中上胸椎骨质疏松性椎体压缩骨折的椎体成形术治疗

目的探讨单侧穿刺经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）治疗中上胸椎骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fractures,OVCF）的疗效。方法 2005年12月～2010年5月,对22例（28椎）中上胸椎（T4～T8）OVCE,在C形臂X线机监视引导下,进行单侧穿刺PKP。术前和术后3 d、6个月采用疼痛视觉模拟评分（VAS）和骨折椎体压缩率对疼痛缓解程度和骨折椎体复位程度进行评价。结果椎体内骨水泥注射剂量1.2～5 ml,平均2.6 ml。术中未发生并发症。术后疼痛均明显缓解或消失。术前、术后3 d、术后6个月VAS评分分别为（8.6±1.2）、（2.2±1.6）、（1.3±0.8）分,术前与术后3 d、6个月比较有显著性差异（q=24.138,P〈0.05;q=27.532,P〈0.05）,术后3 d与6个月比较有统计学差异（q=3.394,P〈0.05）。椎体压缩率术前与术后3 d、6个月分别为（28.1±16.5）%、（19.2±12.6）%、（20.1±8.1）%,术前与术后3 d、6个月比较有明显恢复（P=0.048）。结论单侧穿刺PKP治疗中上胸椎OVCF安全、有效。     

Percutaneous vertebral augmentation: an elevation in adjacent-level fracture risk in kyphoplasty as compared with vertebroplasty.

BACKGROUND CONTEXT: Osteoporotic vertebral compression fractures (VCFs) are being increasingly treated with minimally invasive bone augmentation techniques such as kyphoplasty and vertebroplasty. Both are reported to be an effective means of pain relief; however, there may be an increased risk of developing subsequent VCFs after such procedures. PURPOSE: The purpose of this study was to compare the effectiveness and complication profile of kyphoplasty and vertebroplasty in a single patient series. STUDY DESIGN/SETTING: A clinical series of 36 patients with VCFs treated by vertebral augmentation procedures was retrospectively analyzed for surgical approach, volume of cement injected, cement extravasation (symptomatic and asymptomatic), the occurrence of subsequent adjacent level fracture, and pain relief. PATIENT SAMPLE: Thirty-six patients with 46 VCFs underwent either kyphoplasty or vertebroplasty after failing conservative therapy. The mean patient age was not significantly different between the kyphoplasty group (70; range, 46-83) and vertebroplasty group (72; range, 38-90) (p=.438). OUTCOME MEASURES: Outcomes were assessed by using self-report measures (a comparative pain rating scale) and physiologic measures (pre- and postoperative radiographs). METHODS: Thirty-six patients with VCFs underwent 46 augmentation procedures (17 patients had 20 fractures treated via kyphoplasty, and 19 patients had 26 fractures treated via vertebroplasty). Seventeen patients in this series underwent kyphoplasty using standard techniques involving bone void creation with balloon tamps, followed by cement injection. Nineteen patients underwent a percutaneous vertebroplasty procedure using a novel cannulated, fenestrated bone tap developed to direct cement anteriorly into the vertebral body to avoid backflow of cement onto neural elements. RESULTS: Pain improvement was seen in >90% of patients in both groups. Mean cement injection per vertebral body was 4.65 mL and 3.78 mL for the kyphoplasty and vertebroplasty groups, respectively (p=.014). Ninety-five percent of the kyphoplasty procedures were performed bilaterally, whereas only 19% of the vertebroplasty procedures required bilateral augmentation (p<.001). There was no cement extravasation resulting in radiculopathy, or myelopathy in either group. Asymptomatic cement extravasation was seen in 5 of 46 (11%) of the total series (3/20 [15%] and 2/26 [7.7%] of kyphoplasty and vertebroplasty, respectively) (p=.696). Within a 3-month period, there were 5 new adjacent level fractures seen in 3 patients who underwent a kyphoplasty procedure (5/20 [25%]) and none in the vertebroplasty group (p<.05). CONCLUSIONS: Vertebroplasty appears to offer a comparable rate of postoperative pain relief as kyphoplasty while using less bone cement more often via a unilateral approach and without the attendant risk of adjacent level fracture.     

Spinal loads after osteoporotic vertebral fractures treated by vertebroplasty or kyphoplasty

Vertebroplasty and kyphoplasty are routine treatments for compression fractures of vertebral bodies. A wedge-shaped compression fracture shifts the centre of gravity of the upper body anteriorly and generally, this shift can be compensated in the spine and in the hips. However, it is still unclear how a wedge-shaped compression fracture of a vertebra increases forces in the trunk muscle and the intradiscal pressure in the adjacent discs. A nonlinear finite element model of the lumbar spine was used to estimate the force in the trunk muscle, the intradiscal pressure and the stresses in the endplates in the intact spine, and after vertebroplasty and kyphoplasty treatment. In this study, kyphoplasty represents a treatment with nearly full fracture reduction and vertebroplasty one without restoration of kyphotic angle although in reality kyphoplasty does not guarantee fracture reduction. If no compensation of upper body shift is assumed, the force in the erector spine increases by about 200% for the vertebroplasty but by only 55% for the kyphoplasty compared to the intact spine. Intradiscal pressure increases by about 60 and 20% for the vertebroplasty and kyphoplasty, respectively. In contrast, with shift compensation of the upper body, the increase in muscle force is much lower and increase in intradiscal pressure is only about 20 and 7.5% for the vertebroplasty and kyphoplasty, respectively. Augmentation of the vertebral body with bone cement has a much smaller effect on intradiscal pressure. The increase in that case is only about 2.4% for the intact as well as for the fractured vertebra. Moreover, the effect of upper body shift after a wedge-shaped vertebral body fracture on intradiscal pressure and thus on spinal load is much more pronounced than that of stiffness increase due to cement infiltration. Maximum von Mises stress in the endplates of all lumbar vertebrae is also higher after kyphoplasty and vertebroplasty. Cement augmentation has only a minor effect on endplate stresses in the unfractured vertebrae. The advantages of kyphoplasty found in this study will be apparent only if nearly full fracture reduction is achieved. Otherwise, differences between kyphoplasty and vertebroplasty become small or vanish. Our results suggest that vertebral body fractures in the adjacent vertebrae after vertebroplasty or kyphoplasty are not induced by the elevated stiffness of the treated vertebra, but instead the anterior shift of the upper body is the dominating factor.     

Biomechanical evaluation of kyphoplasty and vertebroplasty with calcium phosphate cement in a simulated osteoporotic compression fracture

 Kyphoplasty and vertebroplasty with polymethylmethacrylate (PMMA) have been used for the treatment of osteoporotic vertebral compression fractures. We performed kyphoplasty and vertebroplasty with α-tricalcium phosphate cement (CPC) and PMMA to compare the biomechanical properties. Thirty osteoporotic vertebrae were harvested from nine embalmed cadavers. We randomized the vertebrae into four treatment groups: (1) kyphoplasty with CPC; (2) kyphoplasty with PMMA; (3) vertebroplasty with CPC; and (4) vertebroplasty with PMMA. Prior to injecting the cement, all vertebrae were compressed to determine their initial strength and stiffness. They were then recompressed to determine their augmented strength and stiffness. Although the augmented strength was greater than the initial strength in all groups, there was no significant difference between the two bone cements for either kyphoplasty or vertebroplasty. The augmented stiffness was significantly less than the initial stiffness in the kyphoplasty groups, but the difference between the two cements did not reach significance. In the vertebroplasty groups, the augmented stiffness was not significantly different from the initial stiffness. There was no significant difference between the two bone cements for either procedure when cement volume and restoration of anterior height were assessed. We concluded that kyphoplasty and vertebroplasty with CPC were viable treatment alternatives to PMMA for osteoporotic vertebral compression fractures. Received: July 18, 2002 / Accepted: November 6, 2002 Offprint requests to: S. Tomita     

Minimal invasive stabilization of osteoporotic vertebral fractures: a prospective nonrandomized comparison of vertebroplasty and balloon kyphoplasty

OBJECTIVE: During recent years, the benefits of balloon kyphoplasty and vertebroplasty have been frequently discussed for the treatment of osteoporotic vertebral compression fractures. Because of the lack of comparative studies, we performed an investigation to describe the mechanical effects and the impact on life quality during a follow-up period of 2 years. METHODS: Patients with nonrecent fractures of vertebral bodies, ongoing bone remodeling, and major kyphotic deformity were treated with minimal invasive stabilization. The median duration of pain was 8 weeks before surgery. Because of the availability of the equipment, 28 patients were nonrandomly assigned to balloon kyphoplasty and 23 patients to vertebroplasty. The follow-up was performed 2 years after surgery. RESULTS: The kyphotic wedge of the vertebral bodies was decreased 6 degrees by balloon kyphoplasty but not by vertebroplasty. With both methods, we found a rapid decrease of pain down to one-half of the preoperative value. A long-lasting effect on pain was found only after balloon kyphoplasty. In the kyphoplasty group, a decrease of the Oswestry Disability Index (ODI) score was found during the first postoperative year. After 2 years, the ODI was not different from preoperative values in both groups. CONCLUSIONS: In nonrecent fractures, the reduction of the kyphotic wedge by balloon kyphoplasty was superior in decreasing pain persisting over a period of 2 years. The ability to improve disability after kyphoplasty was limited to 1 year. In nonrecent fractures, the consequences of age and osteoporosis seem to equalize the effects of the restored sagittal profile on disability but not on pain.     

Non-traumatic compression fractures of the thoracic spine following a seizure -- treatment by percutaneous kyphoplasty.

A 26-year-old male presented with acute mid-thoracic back pain following a witnessed grand mal seizure. There was no trauma and the patient was on steroids for systemic lupus erythematosus. X-rays and CT scans of the thoracic spine revealed compression fractures at T5 and T6, with 50 % loss of vertebral height and kyphosis. He underwent percutaneous kyphoplasty of both vertebrae, with symptomatic improvement. Non-traumatic compression fractures of the thoracic spine following seizures are a rare injury. This may be related to the compressive forces exerted on the vertebral column by the contractions of the truncal muscles, during a seizure. These compression fractures are suitable for treatment by minimally invasive techniques, such as kyphoplasty.     

Percutaneous vertebral body cement augmentation for back pain related to occult osteomyelitis/diskitis

Although complications related to vertebroplasty or kyphoplasty are few, we treated 2 patients with vertebroplasty or kyphoplasty for pain, presumed to be due to vertebral compression fractures, which were subsequently found to be due to occult osteomyelitis/diskitis. The onset of their infections appeared to have preceded their vertebral body augmentation procedures and was possibly due to prior interventional procedures for histories of back pain.An 86-year-old woman had had 3 prior kyphoplasty procedures for fractures at T10, T11, and L1. She reported continued severe pain, and subsequent magnetic resonance imaging was misinterpreted for another fracture at T12, resulting in her fourth kyphoplasty. She became septic and had some improvement with antibiotics, but she declined specialty care and died. A 74-year-old man with chronic back pain had recently undergone lumbar facet joint injections. Computed tomography and subsequent bone scan found uptake at both L2 and L3. Despite abnormal erythrocyte sedimentation rate and C-reactive protein level and normal radiographic vertebral height, he underwent a vertebroplasty. His pain increased, and subsequent workup found L2-3 diskitis. He recovered with antibiotics and specialty care. Similar to prior reports of spondylodiskitis, both patients had multiple medical comorbidities.This article emphasizes the need for clinical reevaluation and scrutiny in the interpretation of imaging studies, including for infection in patients with continued pain after spinal procedures. The differential diagnosis of infectious etiology is an important consideration prior to vertebral cement augmentation for presumed fragility fracture.     

Vertebroplasty and Kyphoplasty in Spinal Trauma

Abstract Kyphoplasty and vertebroplasty have become recognized procedures for the treatment of vertebral fractures, especially in patients with osteoporosis. In most cases of osteoporotic spinal vertebral fracture in elderly patients, polymethylmethacrylate (PMMA) cement is used to fill the defect and stabilize the vertebral body. The techniques of vertebroplasty and kyphoplasty differ in the possibility of realignment and reconstruction of the vertebral body and spinal column. Long-term results in terms of integration of the cement and bioreactivity of the vertebral body are still lacking; so, these procedures are still no options in the treatment of younger patients. Vertebroplasty and kyphoplasty show different success in the management of fresh traumatic spine fractures. The acute traumatic vertebral fracture has to be classified sensitively, to find the right indication for cement augmentation. Mild acute compression fractures can be treated by vertebroplasty or kyphoplasty, severe compression and burst fractures by combination of internal fixation and kyphoplasty. The indications for use of biological or osteoinductive cement in spinal fracture management must still be regarded as restricted owing to the lack of basic biomechanical research data. Such cement should not be used except in clinical studies.     

Transcostovertebral kyphoplasty of the mid and high thoracic spine

While Kyphoplasty is increasingly becoming a recognised minimally invasive treatment option for osteoporotic vertebral fractures and neoplastic vertebral collapse, the experience in the treatment of vertebrae of the mid (T5-8)- and high (T1-4) thoracic levels is limited. The slender pedicle morphology restricts the transpedicular approach at these levels, necessitating extrapedicular placement techniques. Fifty five vertebrae of 32 consecutive patients were treated with kyphoplasty at levels ranging from T2-T8 for vertebral fractures (27 patients) or osteolytic collapse (5 patients). All procedures were performed through the transcostovertebral approach under fluoroscopic guidance. The radioanatomical landmarks of this minimally invasive approach were consistently identified and strictly adhered to. One fracture required open instrumentation due to posterior column injury in addition to kyphoplasty. Identification of specific radioanatomical landmarks allowed precise tool introduction in all cases without intraspinal or paravertebral malplacement. Average operating time for patients with osteoporotic fractures was 30 min per level (range 13–60 min) and 52 min per level (range 35–95 min) in neoplastic cases. Biopsy yield in patients with known or suspected malignancies was 100%. Epidural cement leakage was detected in one patient with pedicular osteolysis. Perforation of the lateral vertebral cortex during balloon inflation occurred in another patient. Both intraoperative complications were without clinical significance. Kyphoplasty in mid- to -high thoracic levels is possible via the transcostovertebral route under fluoroscopic guidance. Strict adherence to a stepwise protocol of tool introduction following defined radioanatomical landmarks is mandatory for the safe completion of this minimally invasive technique.