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1.
Eur Rev Med Pharmacol Sci ; 26(10): 3642-3647, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35647845

RESUMO

OBJECTIVE: The study was undertaken to determine the clinical effectiveness of percutaneous kyphoplasty (PKP) with unilateral balloon infusion of low dose of bone cement for treatment of osteoporotic vertebral compression fractures (OVCFs) in the elderly. PATIENTS AND METHODS: A retrospective study was carried out. A total of 36 patients with OVCFs treated by PKP from August 2019 and August 2020 were included. Patients were divided into two groups according to the amount of bone cement infused into the vertebral body. The amount of cement in conventional-dose group was 3.5-6.0 mL and the amount of cement in small-dose group was 1.8-3.0 mL. Pain relief before and after the operation were evaluated, and the leakage of bone cement in the two groups was also observed. RESULTS: Two groups of patients have obtained a good clinical efficacy. Pain has significant differences before and after the operation (p < 0.05). More importantly, compared with conventional-dose group, small-dose group has lower bone cement leakage rate (p < 0.05). CONCLUSIONS: PKP with small-dose bone cement infusion can obtain the same clinical effects of conventional-dose, but the incidence of bone cement leakage is lower and safe.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Idoso , Cimentos Ósseos/uso terapêutico , Fraturas por Compressão/cirurgia , Humanos , Fraturas por Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/cirurgia , Dor/tratamento farmacológico , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia
2.
BMC Musculoskelet Disord ; 23(1): 529, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35655255

RESUMO

BACKGROUND: Vertebral compression fractures caused by osteoporosis are common in elderly patients and are often encountered by clinical physicians. Percutaneous balloon kyphoplasty (PKP) is widely accepted as a minimally invasive procedure for effectively relieving pain and correcting deformities, but complications may occur. Radiculopathy with a delayed onset caused by a retropulsed bone fragment has not been adequately described in the literature. Thus, this article presents a case report of four cases of retropulsed bone fragment-related radiculopathy after PKP. CASE PRESENTATION: In this article, we reported that four out of 251 patients developed radiculopathy after PKP between January 2012 and January 2019 despite experiencing substantial improvements in back pain. All patients with radiculopathy were female and diagnosed with osteoporosis, and their ages ranged from 68 to 89 years. Radiculopathy occurred from 2 to 16 weeks after PKP. All four patients underwent another operation (posterior decompression and instrumentation). Three patients recovered completely, and one died of postoperative intracranial haemorrhage. A detailed imaging study with pre- and postoperative magnetic resonance imaging (MRI) revealed that retropulsed bone fragments that impinged on the corresponding root after PKP were responsible for this complication, and all four patients developed a disrupted posterior vertebral rim preoperatively. No leakage of cement or pedicle track violations were observed. CONCLUSION: Although PKP is a safe and effective treatment for painful osteoporotic vertebral compression fractures, a risk of catastrophic neurological injury remains. Radiculopathy with delayed onset caused by a retropulsed bone fragment after kyphoplasty is rare and challenging to treat, and the integrity of the posterior vertebral cortex should be carefully evaluated preoperatively to prevent this complication.


Assuntos
Fraturas por Compressão , Cifoplastia , Osteoporose , Fraturas por Osteoporose , Radiculopatia , Fraturas da Coluna Vertebral , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/etiologia , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/efeitos adversos , Cifoplastia/métodos , Masculino , Osteoporose/complicações , Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/cirurgia , Radiculopatia/diagnóstico por imagem , Radiculopatia/etiologia , Radiculopatia/cirurgia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/lesões
3.
Int J Clin Pract ; 2022: 7770214, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35685568

RESUMO

Background: Percutaneous kyphoplasty (PKP) is an effective minimally invasive technique for the treatment of osteoporotic vertebral fracture (OVF) in recent years. This study focuses on the analysis of PKP surgery and anesthesia in osteoporotic vertebral facture patients over 90 years old with the concept of "enhanced recovery after surgery." Methods: This study reviewed 239 patients who were diagnosed with OVF retrospectively between October 2015 and June 2019. According to the method of anesthesia, these patients were divided into Group A (n = 125) and Group B (n = 114). According to the pedicle puncture approach, these patients were divided into Group C (n = 102) and Group D (n = 137). The anterior vertebral height (AVH) and local kyphosis angle (LKA) were used to evaluate the degree of vertebral damage and restoration. The visual analogue scale (VAS) and the Oswestry Disability Index (ODI) scores were used for assessing functional outcomes. Some parameters were used to assess the perioperative conditions such as operation time, amount of bone cement perfusion, intraoperative fluoroscopy times, anesthesia recovery time, time out of the bed, hospital stay, hospitalization cost, and complications. Results: The visual analogue scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), and local kyphosis angle (LKA) 1 day, 1 year after surgery, and at the last follow-up all showed significant improvement (P < 0.05) in comparison with those before surgery both in Groups A and B and Groups C and D. The ODI 1 day after surgery was significantly better in Group B than Group A (P < 0.05). Compared with Group B, Group A required longer time of anesthesia, operation time, anesthesia recovery time, time to get out of bed, and length of hospital stay and more hospitalization costs (P < 0.05). Group D required longer operation time, longer time to get out of bed, more bone cement volume, fluoroscopy time, and more operation hospitalization costs compared with Group C (P < 0.05). Conclusion: We recommend unilateral puncture under local anesthesia for OVF in the patients aged over 90 from the perspective of rapid recovery.


Assuntos
Anestesia , Fraturas por Compressão , Cifoplastia , Cifose , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Idoso , Idoso de 80 Anos ou mais , Cimentos Ósseos/uso terapêutico , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/métodos , Cifose/cirurgia , Fraturas por Osteoporose/cirurgia , Punções , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia
4.
BMC Musculoskelet Disord ; 23(1): 621, 2022 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-35764978

RESUMO

BACKGROUND: To investigate the stress changes between different bone cement forms and injection volumes in adjacent vertebrae after percutaneous kyphoplasty (PKP) by establishing a three-dimensional finite element model of osteoporosis. METHODS: A male healthy volunteer was selected. CT of scans L1 to L3 vertebrae were imported into Mimics 21.0 software.The vertebral model of osteoporosiswas established based on previous literature reference. The models were divided into three groups: unilateral, bilateral integration and bilateral separation groups, with each group injecting 2 ml, 4,ml and 6 ml of bone cement, respectively. In all models, a vertical compressive load of 500 N, anterior flexion/posterior extension, left/right bending, and left/right rotation were applied with a moment of 7.5 N/m, of which 85% was applied to the anterior mid-column and 15% to the posterior column. The stress changes between adjacent vertebrae under different conditions were calculated. RESULTS: After percutaneous kyphoplasty was applied to the L2 vertebral body, some differences can be found between the effects of different cement injection volumes and cement morphology on adjacent structures. There was no major difference between the groups when the bone cement injection volume was 2 ml. When the amount of bone cement injected was 4 ml, the bone cement morphology of the bilateral integration group (BIG) produced less stress between adjacent vertebral bodies. The minimum stress was 14.95 MPa in the L3 vertebral body in posterior extension. Whereas the stress levels on adjacent intervertebral structures, BIG shaped bone cement shows some superiority. In addition, the adjacent vertebrae and intervertebral structures are subjected to less stress during left and right rotation. CONCLUSIONS: The present finite element study suggested that bilateral integration bone cement is a suitable form of cement injection, and when the injection volume is 4 ml, reduces stress on adjacent segments by approximately 15% while maintaining the stability of the injected vertebral body.


Assuntos
Cifoplastia , Cimentos Ósseos , Análise de Elementos Finitos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Corpo Vertebral
5.
Zhongguo Gu Shang ; 35(5): 429-34, 2022 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-35535530

RESUMO

OBJECTIVE: To compare the efficacy between vesselplasty and percutanous kyphoplasty (PKP) in the treatment of Kümmell disease. METHODS: The clinical data of patients with Kümmell disease from July 2018 to December 2019 were retrospectively analyzed. According to the different therapeutic methods, the patients were divided into vesselplasty group and PKP group. There were 20 patients in vesselplasty group, including 2 males and 18 females, aged from 54 to 83 years with an average of (67.40±7.44)years, 1 case of T10 fracture, 3 cases of T12 fracture, 9 cases of L1 fractures, 5 cases of L2 fractures and 2 cases of L3 fractures. There were 20 patients in PKP group, including 3 males and 17 females, aged from 56 to 81 with an average of(67.20±7.01) years, 2 cases of T10 fracture, 1 case of T11 fracture, 6 cases of T12 fracture, 10 cases of L1 fracture and 1 case of L3 fracture. Visual analogue scale(VAS), Cobb angle, anterior vertebral height were recorded before operation, 1 day after operation and 1 year after operation. Oswestry Disability Index(ODI) was recorded before operation, 1 month after operation and 1 year after operation. And bone cement leakage rate was compared between two groups after operation. RESULTS: All the patient were followed up for more than 1 year. In vesselplasty group, VAS score was 1.20±0.41, ODI was(13.50±3.10)%, Cobb angle was(17.20±3.12)° and anterior vertebral height was(20.20±1.35) mm at 1 year after operation. In PKP group, VAS score was 1.15±0.40, ODI was (13.20±3.00)%, Cobb angle was (17.10±3.19)° and anterior vertebral height was (20.10±1.37) mm at 1 year after operation. These index was significantly better than pre-operation through intra-group comparison(P<0.05), and there was no statistically difference between the two groups(P>0.05). There were 20 cases (20 vertebrae) in vesselplasty group, of which 1 case had bone cement leakage at the upper endplate, with a leakage rate of 5%(1/20). In PKP group, there were 20 cases (20 vertebrae), 3 cases of upward endplate leakage(3/7), 1 case of downward endplate leakage(1/7), 1 case of leakage to the front of the vertebral body(1/7), 2 cases of leakage to the side of the vertebral body(2/7), with a leakage rate of 35% (7/20). The difference between two groups was statistically significant(P<0.05). CONCLUSION: Vesselplasty in the treatment of Kümmell disease can better reduce leakage rate of bone cement and reduce complications.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Espondilose , Vertebroplastia , Cimentos Ósseos , Feminino , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/métodos , Masculino , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
6.
Comput Math Methods Med ; 2022: 2330472, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35602341

RESUMO

Objective: Proposing parameters to quantify cement distribution and increasing accuracy for decision prediction of vertebroplasty postoperative complication. Methods: Finite element analysis was used to biomechanically assess vertebral mechanics (n = 51) after percutaneous vertebroplasty (PVP) or kyphoplasty (PKP). The vertebral space was divided into 27 portions. The numbers of cement occupied portions and numbers of cement-endplate contact portions were defined as overall distribution number (oDN) and overall endplate contact number (oEP), respectively. And cement distribution was parametrized by oDN and oEP. The determination coefficients of vertebral mechanics and parameters (R 2) can validate the correlation of proposed parameters with vertebral mechanics. Results: oDN and oEP were mainly correlated with failure load (R 2 = 0.729) and stiffness (R 2 = 0.684), respectively. oDN, oEP, failure load, and stiffness had obvious difference between the PVP group and the PKP group (P < 0.05). The regional endplate contact number in the front column is most correlated with vertebral stiffness (R 2 = 0.59) among all regional parameters. Cement volume and volume fraction are not dominant factors of vertebral augmentation, and they are not suitable for postoperative fracture risk prediction. Conclusions: Proposed parameters with high correlation on vertebral mechanics are promising for clinical utility. The oDN and oEP can strongly affect augmented vertebral mechanics thus is suitable for postoperative fracture risk prediction. The parameters are beneficial for decision-making process of revision surgery necessity. Parametrized methods are also favorable for surgeon's preoperative planning. The methods can be inspirational for clinical image recognition development and auxiliary diagnosis.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Cimentos Ósseos , Humanos , Cifoplastia/efeitos adversos , Cifoplastia/métodos , Fraturas por Osteoporose/complicações , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento , Vertebroplastia/efeitos adversos , Vertebroplastia/métodos
7.
BMC Musculoskelet Disord ; 23(1): 458, 2022 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-35568857

RESUMO

BACKGROUND: The main objective of this study was to investigate the risk factors for recollapse of new vertebral compression fractures (NVCFs) after percutaneous kyphoplasty (PKP) treatment for osteoporotic vertebral compression fracture (OVCF) and to construct a new nomogram model. METHODS: We retrospectively analysed single-level OVCFs from January 2017 to June 2020, randomizing patients to a training set and a testing set. In the training set, independent risk factors for NVCFs in OVCF patients treated with PKP were obtained by univariate and multivariate regression analyses. These risk factors were then used as the basis for constructing a nomogram model. Finally, internal validation of the built model was performed in the testing set using the consistency index (C-index), receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA). RESULTS: In total, 371 patients were included in this study. NVCFs occurred in 21.7% of the training set patients, and multivariate regression analysis showed that a low Hounsfield unit (HU) value, cement leakage, and thoracolumbar (TL) junction fracture were independent risk factors for NVCF after PKP. The C-index was 0.81 (95% CI: 0.74-0.81), and the validation showed that the predicted values of the established model were in good agreement with the actual values. CONCLUSIONS: In this study, three independent risk factors were obtained by regression analysis. A nomogram model was constructed to guide clinical work and to make clinical decisions relatively accurately to prevent the occurrence of vertebral recollapse fractures.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Idoso , Cimentos Ósseos/efeitos adversos , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/etiologia , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/efeitos adversos , Nomogramas , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
8.
Phys Med Rehabil Clin N Am ; 33(2): 425-453, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35526978

RESUMO

Vertebral fractures are a common problem in the United States, which is why copious research has been performed to determine the best approaches to repair such fractures-including determining the least invasive procedures with the greatest benefits and fewest complications. In the past 3 decades, vertebral augmentation procedures (VAPs) have been very effective, with new techniques appearing in the field that has very reasonable outcomes and marked improvement in patients' quality of life. This article highlights the different VAPs approaches-comparing the advantages, disadvantages, and potential side effects of each approach.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas da Coluna Vertebral , Vertebroplastia , Fraturas por Compressão/complicações , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/efeitos adversos , Cifoplastia/métodos , Qualidade de Vida , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento , Estados Unidos , Vertebroplastia/efeitos adversos , Vertebroplastia/métodos
9.
Front Public Health ; 10: 874672, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35586015

RESUMO

Background: The published literatures indicate that patients with osteoporotic vertebral compression fractures (OVCFs) benefit significantly from percutaneous kyphoplasty (PKP), but this surgical technique is associated with frequent postoperative recollapse, a complication that severely limits long-term postoperative functional recovery. Methods: This study retrospectively analyzed single-segment OVCF patients who underwent bilateral PKP at our academic center from January 1, 2017 to September 30, 2019. Comparing the plain films of patients within 3 days after surgery and at the final follow-up, we classified patients with more than 10% loss of sagittal anterior height as the recollapse group. Univariate and multivariate logistic regression analyses were performed to determine the risk factors affecting recollapse after PKP. Based on the logistic regression results, we constructed one support vector machine (SVM) classifier to predict recollapse using machine learning (ML) algorithm. The predictive performance of this prediction model was validated by the receiver operating characteristic (ROC) curve, 10-fold cross validation, and confusion matrix. Results: Among the 346 consecutive patients (346 vertebral bodies in total), postoperative recollapse was observed in 40 patients (11.56%). The results of the multivariate logistical regression analysis showed that high body mass index (BMI) (Odds ratio [OR]: 2.08, 95% confidence interval [CI]: 1.58-2.72, p < 0.001), low bone mineral density (BMD) T-scores (OR: 4.27, 95% CI: 1.55-11.75, p = 0.005), presence of intravertebral vacuum cleft (IVC) (OR: 3.10, 95% CI: 1.21-7.99, p = 0.019), separated cement masses (OR: 3.10, 95% CI: 1.21-7.99, p = 0.019), cranial endplate or anterior cortical wall violation (OR: 0.17, 95% CI: 0.04-0.79, p = 0.024), cement-contacted upper endplate alone (OR: 4.39, 95% CI: 1.20-16.08, p = 0.025), and thoracolumbar fracture (OR: 6.17, 95% CI: 1.04-36.71, p = 0.045) were identified as independent risk factors for recollapse after a kyphoplasty surgery. Furthermore, the evaluation indices demonstrated a superior predictive performance of the constructed SVM model, including mean area under receiver operating characteristic curve (AUC) of 0.81, maximum AUC of 0.85, accuracy of 0.81, precision of 0.89, and sensitivity of 0.98. Conclusions: For patients with OVCFs, the risk factors leading to postoperative recollapse were multidimensional. The predictive model we constructed provided insights into treatment strategies targeting secondary recollapse prevention.


Assuntos
Doenças Ósseas Metabólicas , Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Algoritmos , Doenças Ósseas Metabólicas/complicações , Fraturas por Compressão/complicações , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/efeitos adversos , Cifoplastia/métodos , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Aprendizado de Máquina Supervisionado
10.
Biomed Res Int ; 2022: 9637831, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35578725

RESUMO

Purpose: This study aimed to assess whether the third-generation PVAS was superior to percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) in treating patients with OVCFs. Methods: Databases, including Pubmed, Embase, and Cochrane library, were searched to identify relevant interventional and observational articles in vivo or in vitro comparing the third-generation PVAS to PVP/PKP in OVCFs patients. A meta-analysis was performed under the guidelines of the Cochrane Reviewer's Handbook. Results: 11 in vivo articles involving 1035 patients with 1320 segments of diseased vertebral bodies and 8 in vitro studies enrolling 40 specimens with 202 vertebral bodies were identified. The vivo studies indicated no significant differences were found in visual analog scale (VAS), Oswestry Disability Index (ODI), operation time, or injected cement volume (P > 0.05). The third-generation PVAS was associated with significant improvement in vertebral height and Cobb angle (P < 0.05) and also with a significantly lower risk of cement leakages and new fractures (P < 0.05). The vitro studies suggest that the third-generation PVAS was associated with better anterior vertebral height (AVH) and kyphotic angle (KA) after deflation and cement. No significant differences were found in stiffness or failure load after cement between the two groups (P > 0.05). Conclusion: Based on current evidence, although providing similar improvement in VAS and ODI, the third-generation PVAS may be superior to PVP/PKP in local kyphosis correction, vertebral height maintenance, and adverse events reduction. Further high-quality randomized studies are required to confirm these results.


Assuntos
Fraturas por Compressão , Cifoplastia , Cifose , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Resinas Acrílicas , Cimentos Ósseos/uso terapêutico , Fraturas por Compressão/tratamento farmacológico , Humanos , Cifoplastia/métodos , Cifose/tratamento farmacológico , Fraturas por Osteoporose/tratamento farmacológico , Estudos Retrospectivos , Fraturas da Coluna Vertebral/etiologia , Resultado do Tratamento , Vertebroplastia/métodos
11.
J Int Med Res ; 50(5): 3000605221102088, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35638519

RESUMO

BACKGROUND: Percutaneous kyphoplasty is a popular technique in the treatment of osteoporotic vertebral fractures, but intracardiac cement embolism can be a life-threatening complication.Case presentation: The authors present a case involving a patient who developed dyspnea and chest tightness after percutaneous kyphoplasty. Echocardiography and chest computed tomography confirmed several foreign bodies in the right atrium and pulmonary arteries causing cardiac perforation and pericardial tamponade. Conservative treatment was administered, and the patient died of respiratory and heart failure. CONCLUSIONS: The present case highlights that surgical removal may be the first-choice treatment for symptomatic intracardiac cement embolism.


Assuntos
Embolia , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Cimentos Ósseos/efeitos adversos , Embolia/diagnóstico por imagem , Embolia/etiologia , Humanos , Cifoplastia/efeitos adversos , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/efeitos adversos
12.
Int J Surg ; 101: 106632, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35452848

RESUMO

BACKGROUND: Pulmonary cement embolism (PCE) was a rare but fatal complication for percutaneous vertebral augmentation (PVA). Thus we did a systematic review and meta-analysis of cohort studies to investigate the risk factors for PCE after PVA. METHODS: We systematically searched PubMed, EMBASE, Cochrane library, Google Scholar, web of science, and ClinicalTrial.gov from the establishment of the database to September 2021. All eligible studies assessing the risk factors for PCE after PVA were incorporated. Dichotomous data was calculated by risk difference (RD) from Mantel-Haenszel method (M - H method); continuous data was analyzed by mean difference (MD) from Inverse-Variance method (I-V method). All variables were taken as measure of effect by fixed effect model. Heterogeneity, sensitivity, and publication bias analyses were also performed. RESULTS: This study totally included 13 studies. According to the Newcastle-Ottawa Scale (NOS), 7 studies were considered as low quality, with NOS< 6. The others were of relatively high quality, with NOS≥6. 144/6251 patients (2.3%) had PCE after PVA. percutaneous vertebroplasty (PVP) (RD = 0.02, 95%CI: [0.01, 0.04], Z = 3.70, P < 0.01), thoracic vertebra (RD = 0.03, 95%CI: [0.01, 0.05], Z = 3.53, P < 0.01), higher cement volume injected per level (MD = 0.23, 95%CI: [0.05, 0.42], Z = 2.44, P = 0.01), more than three vertebrae treated per session (MD = -0.05, 95%CI: [-0.08, -0.02], Z = 3.65, P < 0.01), venous cement leakage (RD = 0.07, 95%CI: [0.03, 0.11], Z = 3.79, P < 0.01) were more likely to cause PCE. CONCLUSION: This study showed that risk factors for PCE included PVP, thoracic vertebra, higher cement volume injected per level, more than three vertebrae treated per session, venous cement leakage. As a serious complication, PCE should be paid attention and avoided.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Embolia Pulmonar , Fraturas da Coluna Vertebral , Vertebroplastia , Cimentos Ósseos/efeitos adversos , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/métodos , Fraturas por Osteoporose/cirurgia , Embolia Pulmonar/induzido quimicamente , Fatores de Risco , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento , Vertebroplastia/efeitos adversos , Vertebroplastia/métodos
13.
BMC Musculoskelet Disord ; 23(1): 356, 2022 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-35418060

RESUMO

BACKGROUND: The restauration of the local kyphosis is crucial to thoracolumbar fractures outcomes. Recently, the Tektona™ (Spine Art) system, constituted by a flexible lamella for corporeal reduction has emerged as a promising solution for osteoporotic fractures. However, no study has yet focused on its results on traumatic fractures. METHODS: A retrospective longitudinal study on prospectively collected data was conducted on 53 patients that had a kyphoplasty by Tektona™, associated or not to percutaneous fixation. The data collected were clinical, surgical and scannographic (measurement of AVH, MVH and PVH (anterior/medium/posterior vertebral height), and RTA (regional traumatic angle) in°), preoperatively, post-operatively and at last follow-up. RESULTS: Fractures were mainly located at the upper lumbar spine and were AOSpine A3 type for 74%. The mean RTA was 12° in pre-operative, 4° in post-operative (p = 2e- 9), and 8° at the last follow-up (p = 0,01). The mean correction of RTA for the fixation group was - 10 ± 6° versus - 7 ± 4° for the kyphobroplasty alone group (p = 0,006). The mean correction for fractures located at T10-T12 was - 9 ± 3°, - 9 ± 5° for L1, - 8 ± 3° for L2 and - 5 ± 3° for L3-L5 (p = 0,045). CONCLUSIONS: The Tektona® system appears to be efficient for acute thoraco-lumbar fractures, comparable to other available systems, allowing a real intracorporeal reduction work. Its relevance, especially in the long term needs further investigation. The association of a percutaneous fixation allow to obtain a better correction of the RTA but did not seem to prevent the loss of correction at follow-up.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/métodos , Estudos Longitudinais , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Fraturas por Osteoporose/complicações , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Corpo Vertebral
14.
Medicine (Baltimore) ; 101(10): e29034, 2022 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-35451411

RESUMO

BACKGROUND: There is currently no pooled data in the literature to support whether additional facet joint block results in better clinical analgesia after percutaneous kyphoplasty. We assessed the existing evidence on the safety and efficacy of facet joint block in the treatment of patients with thoracolumbar compression fractures undergoing percutaneous kyphoplasty based on qualified trials. METHODS: We will search PubMed, Springer, ScienceDirect, Wanfang, and Cochrane Library databases through April, 2022. Cohort studies focusing on assessing and comparing the effect of facet joint block and control group will be included. The studies are screened and evaluated by 2 reviewers independently for eligibility. The following outcome measures must be showed: pain scores, Oswestry Disability Index, satisfaction, and complications observed within both groups from baseline to the end of follow-up period. Review Manager software (v 5.3; Cochrane Collaboration) is used for the meta-analysis. A P value of <.05 is considered to be statistically significant. Two independent reviewers will assess the risk of bias of the included studies at study level. RESULTS: It is hypothesized that additional facet joint block is associated with better pain control. CONCLUSIONS: This study expects to provide credible and scientific evidence for the efficacy and safety of facet joint block in the treatment of patients with thoracolumbar compression fractures undergoing percutaneous kyphoplasty. REGISTRATION NUMBER: 10.17605/OSF.IO/ARY3C.


Assuntos
Analgesia , Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Articulação Zigapofisária , Fraturas por Compressão/etiologia , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/métodos , Metanálise como Assunto , Fraturas por Osteoporose/cirurgia , Dor/etiologia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Revisões Sistemáticas como Assunto , Resultado do Tratamento
15.
Clin Med Res ; 20(2): 95-106, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35478096

RESUMO

Physicians involved in treating spine fractures secondary to osteopenia and osteoporosis should know the pathogenesis and current guidelines on managing the underlying diminished bone mineral density, as worldwide fracture prevention campaigns are trailing behind in meeting their goals. This is a narrative review exploring the various imaging and laboratory tests used to diagnose osteoporotic fractures and a comprehensive compilation of contemporary medical and surgical management. We have incorporated salient recommendations from the Endocrine Society, the American Association of Clinical Endocrinology (AACE), and the American Society for Bone and Mineral Research (ASBMR). The use of modern scoring systems such as Fracture Risk Assessment Tool (FRAX®) for evaluating fracture risk in osteoporosis with a 10-year probability of hip fracture and major fractures in the spine, forearm, hip, or shoulder is highlighted. This osteoporosis risk assessment tool can be easily incorporated into the preoperative bone health optimization strategies, especially before elective spine surgery in osteoporotic patients. The role of primary surgical intervention for vertebral compression fracture and secondary fracture prevention with pharmacological therapy is described, with randomized clinical trial-based wisdom on its timing and dosage, drug holiday, adverse effects, and relevant evidence-based literature. We also aim to present an evidence-based clinical management algorithm for treating osteoporotic vertebral body compression fractures, tumor-induced osteoporosis, or hardware stabilization in elderly trauma patients in the setting of their impaired bone health. The recent guidelines and recommendations on surgical intervention by various medical societies are covered, along with outcome studies that reveal the efficacy of cement augmentation of vertebral compression fractures via vertebroplasty and balloon kyphoplasty versus conservative medical management in the elderly population.


Assuntos
Fraturas por Compressão , Cifoplastia , Osteoporose , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Idoso , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/etiologia , Fraturas por Compressão/terapia , Humanos , Cifoplastia/efeitos adversos , Cifoplastia/métodos , Osteoporose/complicações , Osteoporose/diagnóstico , Osteoporose/terapia , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/terapia , Resultado do Tratamento , Vertebroplastia/efeitos adversos , Vertebroplastia/métodos
16.
World Neurosurg ; 163: e420-e425, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35395426

RESUMO

OBJECTIVE: To evaluate functional outcome after combined radiofrequency ablation and vertebral augmentation in patients with metastatic spinal tumors using visual analog scale and Oswestry Disability Index scores. METHODS: This retrospective study included 41 patients with metastatic spinal tumors. There were 19 women and 22 men with a mean age of 67 years (range, 45-87 years). Visual analog scale and Oswestry Disability Index were used to assess the intensity of pain and quality of life. The assessments were performed before the procedure and at 1 week and 1, 2, 3, and 6 months after the procedure. RESULTS: No serious complications were seen in the periprocedural period. Two patients (4.8%) had transient neurological motor deficits without cement leakage, and 1 patient had a pulmonary embolism with transient mild symptoms. The comparison of preprocedural visual analog scale and Oswestry Disability Index scores with postprocedural scores up to 6 months after treatment revealed significant pain control and good functional state. CONCLUSIONS: Spinal metastasis is a frequent entity in the growing population of patients with cancer. A multidisciplinary approach using several nonsurgical and minimally invasive methods (e.g., radiofrequency ablation, vertebroplasty, balloon kyphoplasty) is key to successful management, and combining these procedures is effective against spinal metastatic pain.


Assuntos
Ablação por Cateter , Fraturas por Compressão , Cifoplastia , Fraturas da Coluna Vertebral , Neoplasias da Coluna Vertebral , Vertebroplastia , Idoso , Ablação por Cateter/métodos , Feminino , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/métodos , Masculino , Dor/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/secundário , Resultado do Tratamento , Vertebroplastia/métodos
17.
World Neurosurg ; 163: e522-e531, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35427793

RESUMO

OBJECTIVE: This study aims to evaluate the therapeutic reliability of posterior percutaneous cement-augmented screws short fixation (PASF) in patients with severe osteoporotic vertebral burst fractures (OVBFs). METHODS: Single-level OVBFs with an anterior vertebral body height reduction ≥60% were included. A Frailty Index was used for preoperative frailty assessment. Back pain and related disability were assessed through the visual analog scale (VAS) and Oswestry Low Back Pain Disability Index (ODI), administered at injury time, preoperatively, postoperatively, at 12 months and at last patient follow-up evaluation. The main radiologic outcomes were represented by Cobb angle (CA) and anterior vertebral body compression percentage, measured at injury time, preoperative, postoperatively and at 12-month examination. In addition, the incidence of cement leakages and hardware failures was assessed. RESULTS: Thirty-three patients met the inclusion criteria. All patients were frail (76%) or semi-frail (24%). Significant vertebral body height restoration and segmental kyphosis improvement after PASF were documented (anterior vertebral body compression percentage, -40 [-43 to -37] vs. -67 [-70 to -65], P = 0.0001; CA, 10 [8-12] vs. 24 [23-26], P = 0.0001). The mean VAS and ODI scores documented optimal and long-enduring pain relief and related disability reduction after PASF (VAS score, 2 [2-3] vs. 8 [7-8], P = 0.0001; ODI, 22 [17-26] vs. 64 [60-69], P = 0.0001). Only 1 cement leakage (3%), asymptomatic, occurred. After a mean follow-up of 33 months, no early/late hardware failures were reported. CONCLUSIONS: The clinical and radiologic results of this study suggest that PASF could be a safe and effective treatment option for severe OVBFs when conservative treatments have failed.


Assuntos
Fraturas por Compressão , Fragilidade , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Cimentos Ósseos/uso terapêutico , Parafusos Ósseos/efeitos adversos , Fraturas por Compressão/complicações , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Fragilidade/complicações , Humanos , Cifoplastia/métodos , Fraturas por Osteoporose/complicações , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
18.
Eur Spine J ; 31(5): 1122-1130, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35249143

RESUMO

BACKGROUND: To compare high- versus low-viscosity bone cement on the clinical outcomes and complications in patients with Osteoporotic vertebral compression fractures (OVCFs) who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). METHODS: PubMed, Embase, and the Cochrane Library were searched for papers published from inception up to February 2021 for potentially eligible studies comparing high- versus low-viscosity cement for PVP/PKP. The outcomes were the leakage rate, visual analog scale (VAS), and Oswestry Disability Index (ODI). RESULTS: Eight studies (558 patients; 279 in each group) were included. The meta-analysis showed that the leakage rate was lower with high-viscosity cement than with low-viscosity cement (OR = 0.23, 95%CI 0.14-0.39, P < 0.001; I2 = 43.5%, Pheterogeneity = 0.088); similar results were observed specifically for the disk space, paravertebral space, and peripheral vein, but there were no differences regarding the epidural space and intraspinal space. The VAS was decreased more significantly with high-viscosity cement than with low-viscosity cement (WMD = - 0.21, 95%CI - 0.38, - 0.04, P = 0.015; I2 = 0.0%, Pheterogeneity = 0.565). Regarding the ODI, there was no difference between high- and low-viscosity cement (WMD = - 0.88, 95%CI - 3.06, 1.29, P = 0.426; I2 = 78.3%, Pheterogeneity < 0.001). CONCLUSIONS: There were lower cement leakage rates in PVP/PKP with high-viscosity bone cement than low-viscosity bone cement. The two groups have similar results in ODI, but the VAS scores favor high-viscosity bone cement. Therefore, the administration of high-viscosity bone cement in PVP/ PKP could be a potential option for improving the complications of leakage in OVCFs, while the clinical efficacy of relieving pain is not certain.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Cimentos Ósseos/uso terapêutico , Fraturas por Compressão/complicações , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/métodos , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento , Vertebroplastia/métodos , Viscosidade
19.
Eur Spine J ; 31(5): 1131-1137, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35316408

RESUMO

OBJECTIVE: The present study is aimed to validate the ability of the vertebral bone quality (VBQ) score to evaluate bone quality in patients with osteoporotic vertebral compression fractures (OVCF) and to compare it with the ability of T-score by DXA. In addition, the sensitivity of VBQ score with cerebrospinal fluid (CSF) of L2 and L3 segments as baseline is evaluated. METHODS: 196 inpatients were collected and assigned into OVCF and Non-OVCF groups, respectively. For each patient, the VBQ score was calculated by the signal intensity of the L1-L4 vertebral bodies and CSF at L3 or L2 level from T1-weighted MRIs, while T-score from DXA was also obtained. The VBQ and T-score was compared between OVCF and non-OVCF groups, and among age groups. The OVCF ORs by VBQ score and T-score were calculated using logistic regression. RESULTS: OVCF group was significantly different to the non-OVCF group in the T-score (- 2.9 vs. - 0.7) and VBQ score (4.0 vs. 3.5). VBQ score and T-score in patient aged 60-79 years old could indicate the bone quality, but only T-score in patients aged 50-59 years old. OVCF are associated with both higher VBQ score and lower T-score. The VBQ scores calculated by L2 CSF and L3 CSF were similar. CONCLUSIONS: The VBQ score is an effective indicator of bone quality in OVCF patients and comparable to T-score, particularly in people over 60 years old. The VBQ score is not sensitive to CSF of different segments as a baseline.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Idoso , Fraturas por Compressão/diagnóstico por imagem , Humanos , Vértebras Lombares , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
20.
Med Sci Monit ; 28: e935080, 2022 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-35342190

RESUMO

BACKGROUND Cement leakage is the most common complication following percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs). Dynamic fracture mobility was determined by comparing preoperative standing lateral radiographs with intraoperative prone lateral radiographs. This retrospective study from a single center aimed to evaluate the effect of dynamic fracture mobility on cement leakage in PVP and PKP in 286 patients with OVCFs. MATERIAL AND METHODS Records of patients who underwent PVP or PKP in our department between January 2016 and December 2019 were retrospectively analyzed, showing that 156 patients received PVP and 130 patients received PKP. Variables that were significantly related to presence of cement leakage in the univariate analysis were subsequently included in a multivariate logistic regression analysis for determining the independent risk factors for cement leakage. RESULTS The univariate analysis showed that dynamic fracture mobility (P<0.001), operative approach (P=0.026), peripheral vertebrae wall damage (P<0.001), intravertebral cleft (P<0.001), and cement volume injected (P<0.001) were correlated with cement leakage. Factors that showed differences by univariate analysis underwent multivariate logistic regression analysis, showing that peripheral vertebrae wall damage (OR=11.774,95% CI 4.384-31.619, P=0.000), dynamic fracture mobility (OR=5.884, 95% CI 2.295-15.087, P=0.000), operative approach (OR=3.143, 95% CI 1.136-8.698, P=0.027), and cement volume injected (OR=1.486, 95% CI 1.119-1.973, P=0.006) were independent risk factors for postoperative cement leakage. CONCLUSIONS This retrospective study showed that dynamic fracture mobility, peripheral vertebrae wall damage, operative approach, and cement volume injected were risk factors for cement leak following PVP and PKP.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Cimentos Ósseos/efeitos adversos , Fraturas por Compressão/etiologia , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/efeitos adversos , Cifoplastia/métodos , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento , Vertebroplastia/efeitos adversos , Vertebroplastia/métodos
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