Analysis of adjacent vertebral fracture after percutaneous vertebroplasty: do radiological or surgical features matter?

PURPOSE: To report the incidence and risk factors of adjacent vertebral fracture (AVF) after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fractures (OVCFs). We focused to investigate effect of radiological or surgical features on AVF. METHODS: All patients with OVCFs who were treated with PVP between January 2016 and December 2019 were retrospectively reviewed. Patients were followed up at least 12 months after procedure according to treatment protocol. AVF was defined as postoperatively recurrent intractable back pain and subsequently presence of fracture on magnetic resonance imaging (MRI) in adjacent levels. Clinical, radiological, and surgical factors potentially affecting occurrence of AVF were recorded and analyzed using univariate and multivariate analysis. RESULTS: Totally, 1077 patients with 1077 fractured vertebrae who underwent PVP were enrolled in the study, after inclusion and exclusion criteria were met. Mean follow-up time was 24.3 ± 11.9 months (range, 12-59 months). AVF was identified in 98 (9.1%) patients. Univariate analysis showed that seven significant factors related to AVF were older age, non-traumatic fracture, cortical disruption on anterior wall, cortical disruption on lateral wall, basivertebral foramen, type-B leakage and type-C leakage. In multivariate analysis, two clinical factors, older age (P = 0.031) and non-traumatic fracture (P = 0.002), were significantly associated with AVF. However, any radiological or surgical factor did not reach significance in final model analysis. CONCLUSIONS: Incidence of AVF after PVP in patients with OVCFs was 9.1% (98/1077). Older age and non-traumatic fracture were two clinical risk factors for AVF. Neither radiological nor surgical feature was significantly correlated with AVF.

The impact of intravertebral cleft on cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a case-control study.

BACKGROUND: The impact of intravertebral cleft (IVC) on cement leakage in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs) has been discussed. However, the results were conflicting, as the study population and cement leakage classification were heterogeneous. The aim of the study was to evaluate the impact of IVC on the incidence of leakage through vein, leakage through cortex as well as general leakage in PVP for OVCFs. METHODS: All patients with OVCFs who underwent PVP between January 2016 and June 2019 at our institution were retrospectively reviewed. Patients were eligible for this case-control study if they were diagnosed as single level fracture in spine. After inclusive and exclusive criteria were met, a total of 139 patients with IVC were enrolled as the study group. Non-IVC controls were matched in a 1:1 ratio in age (within 3 years), sex and fracture severity with patients in study group. Cement leakage were classified into four types [type B (through basivertebral vein), type S (through segmental vein), type-C (through a cortical defect), and type D (intradiscal leakage)], furtherly into two types [venous type (type-B or/and type S) and cortical type (type-C or/and type-D)]. A general leakage rate and a specific leakage rate per each type were compared between both groups. RESULTS: Each group included 139 patients. Groups were homogenous for age, sex, fracture severity, fracture location, fracture type, cement volume, puncture approach and property of cement. Compared with control group, IVC group had a significantly lower rate of type-B (20.9% vs. 31.7%, P = 0.041), type-S (24.5% vs. 52.5%, P = 0.000), and venous type leakage (37.4% vs. 67.6%, P = 0.000), a significantly higher rate of type-C (25.9% vs. 12.2%, P = 0.004), type-D (16.5% vs. 6.5%, P = 0.009), and cortical type leakage (40.3% vs. 16.5%, P = 0.000), no significant difference on the rate of general leakage (67.6% vs. 76.3%, P = 0.109). CONCLUSION: IVC decreased the risk of cement leakage through vein and increased the risk of cement leakage through cortex. However, it had no significant effect on the occurrence of general leakage.

Risk Factors for Cement Leakage in Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: An Analysis of 1456 Vertebrae Augmented by Low-Viscosity Bone Cement.

STUDY DESIGN: Retrospective study. OBJECTIVE: To identify risk factors for cement leakage in percutaneous vertebroplasty (PVP) using low-viscosity bone cement for osteoporotic vertebral compression fractures (OVCFs). SUMMARY OF BACKGROUND DATA: Cement leakage is the most common complication for PVP and its risk factors have been discussed. However, data in previous series were heterogeneous. Additionally, relative smaller patient sample or more types of cement leakage classified in those studies made the results conflicting. METHODS: A total of 1090 patients who underwent PVP with low-viscosity bone cement for OVCFs in 1456 levels between January 2016 and June 2019 were retrospectively reviewed. Parameters potentially affecting the occurrence of cement leakage were assessed using univariate and multivariate analyses. Cement leakage was assessed using postoperative computed tomography scanning, and classified into two types (cortical leakage and venous leakage) considering the mechanism. RESULTS: The incidence of cortical and venous leakage were 20.3% (295/1456) and 56.2% (819/1456), respectively. Cortical disruption, basivertebral foramen were the strongest risk factors for cortical leakage (P = 0.000), venous leakage (P = 0.000), respectively. Greater cement volume is one risk factor for both cortical leakage and venous leakage. The intravertebral cleft, solid type of cement distribution were significant risk factors for cortical leakage, and they both were protective factors for venous leakage. For cortical leakage, older age and trauma were another two risk factors. For venous leakage, female was another one risk factor, and higher grade of fracture severity is the strongest protective factor. CONCLUSION: Both cortical leakage and venous leakage are prevalent. Adequate known of risk factors could help balance the incidence of two type leakage in unique vertebra and reduce the incidence of leakage in general in PVP for OVCFs.Level of Evidence: 3.

Which is the better timing between embolization and surgery for hypervascular spinal tumors, the same day or the next day?: A retrospective comparative study.

Previous series presented the timing between embolization and surgery in a wide range on the basis of their experience rather than supportive data. And comparative studies were limited to small samples. In addition, there is no study publishing the timing by considering both safety and efficacy of embolization. The aim of this study was to determine the better timing (the same day or the next day) between embolization and surgery for hypervascular spinal tumors by assessing the safety and efficacy of embolization.One hundred twenty-five embolizations with subsequent 120 operations for hypervascular spinal tumors between January 2010 and April 2013 were retrospectively reviewed. The time between embolization and surgery was mainly determined by interventional radiologist schedules and operating room available. Major complications of embolization were documented. The efficacy of embolization was compared between the same day and the next day group.Of the 125 embolizations, there were 4 major complications, all of which occurred on the same day of procedure. Of the 120 operations, 36 cases were operated on the same day of embolization, 74 on the next day, and 10 on the second day. When comparing the efficacy of embolization between the same day and the next day group, intraoperative blood loss (1483 ±â€Š1475 vs 1548 ±â€Š1099 mL, P = .80), intraoperative transfusion requirement (1011 ±â€Š1200 vs 1112 ±â€Š890 mL, P = .62), and postoperative blood loss (1146 ±â€Š933 vs 1031 ±â€Š777 mL, P = .50) were not significantly different.Embolization carries certain risks (4/125, 3.2%) for major complications, which may occur within the time window of 1 day. Two patient groups showed no difference on the efficacy of embolization. Operation should be scheduled on the next day of embolization if possible.

Risk factors for major complications in surgery for hypervascular spinal tumors: an analysis of 120 cases with adjuvant preoperative embolization.

PURPOSE: To determine the frequency of major complications and identify related risk factors in surgery for hypervascular spinal tumors after preoperative selective arterial embolization. METHODS: Patients with spinal tumors who underwent preoperative embolizations between January 2010 and March 2013 were retrospectively reviewed. Perioperative complications were classified as either major or minor. Preoperative and intraoperative factors were analyzed for any association with major complications using univariate and multivariate regression analysis. RESULTS: There were 120 embolizations with subsequent 120 spine operations that met the inclusion and exclusion criteria. Overall, 27.5% (33/120) experienced major complications and 11.7% (14/120) had at least two major complications. Respiratory complications were the most commonly seen with a rate of 10.8% (13/120). Multivariate regression analysis identified two risk factors for major complications: reoperation and higher score of surgical invasiveness index. Two risk factors were identified for two or more major complications: age≥65 years and higher score of surgical invasiveness index. Two risk factors were identified for major respiratory complications: thoracic surgery and higher score of surgical invasiveness index. However, embolization-related factors did not reach significance in the multiple regression model. CONCLUSION: Major complications in surgery for hypervascular spinal tumors after embolization are prevalent. Risk factors identified in this study are useful prognostic indicators when considering surgical treatment combined with embolization.

[Evaluation of efficacy and safety of rivaroxaban in the prevention of postoperative venous thromboembolism in adult patients with primary bone tumor undergoing knee operation].

OBJECTIVE: To explore the incidence of postoperative venous thromboembolism (VTE) in adult patients with primary bone tumor undergoing knee operation and evaluate its efficacy and safety in the prevention of VTE. METHODS: For this prospective, randomized and negative-control single-center trial, a total of 100 eligible patients were selected and randomly divided into observation and control groups. Observation group (rivaroxaban): the first rivaroxaban tablet was taken in the first 24 hours after operation. Rivaroxaban was administered daily every 24 hours up to Day 14. CONTROL GROUP: no anticoagulant was taken postoperatively. RESULTS: Efficacy indictors: 6 cases of DVT (an incidence of 12%) occurred in the observation group versus 15 (30%) in the control group. Significant statistical difference existed between two groups (P < 0.05). Furthermore, neither pulmonary embolism nor death was found in either group. Safety indicators:a total of 3 bleeding (1 major and 2 non-major) cases occurred in observation group versus a total of 2 bleeding (no major and 2 non-major) cases in control group. No significant statistical difference existed in bleeding events (P > 0.05). The total incidence of adverse effect was 6% (3/50) in the observation group. The drainage volume of the observation group was a little more than that of the control group. But no significant statistical difference existed in drainage duration (P > 0.05). And there was almost no change in the coagulation system by laboratory examination after oral administration. CONCLUSION: With an excellent safety profile and a low incidence of adverse effects, Rivaroxaban is effective and safe in the prevention of VTE in adult patients with primary bone tumor undergoing knee operation.