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At least 19 recordsLinked to original sources
PubMed2005

The reduction of endplate fractures during balloon vertebroplasty: a detailed radiological analysis of the treatment of burst fractures using pedicle screws, balloon vertebroplasty, and calcium phosphate cement.

STUDY DESIGN: In a human cadaveric burst fracture model, the amount of endplate fracture reduction after posterior instrumentation and balloon vertebroplasty was investigated quantitatively. OBJECTIVES: To assess, in a burst fracture model, the vertebral body and adjacent disc heights, in parallel sagittal planes with 3-dimensional (3D) rotational x-ray imaging, at various phases during pedicle screw fixation and subsequent balloon vertebroplasty. SUMMARY OF BACKGROUND DATA: In recent human cadaveric thoracolumbar fracture studies, it was found that vertebral body height could be restored significantly with inflatable bone tamps. However, limited quantitative data exist on the amount of fracture reduction that can be achieved and how much of the reduction will be lost after deflation and removal of the bone tamps before the cement is injected. METHODS: Twenty burst fractures were created and balloon vertebroplasty with calcium phosphate cement was performed after pedicle screw instrumentation. A 3D dataset was obtained during the following phases: intact, fractured, after reduction and stabilization with pedicle screws, after inflation of the balloons, after deflation and removal of the balloons, after injection of the cement. The fractured vertebral body and adjacent disc heights were measured from five reconstructed sagittal images and compared for the six phases of the procedure. Furthermore, the difference between the vertebral body height centrally and peripherally was calculated. RESULTS: The mean vertebral body height at the thoracic level was Tintact = 19.5 +/- 2.2 mm, Tfractured = 14.6 +/- 3.8 mm, Treduction = 17.3 +/- 2.2 mm, Tinflation = 20.1 +/- 2.0 mm, Tdeflation = 18.0 +/- 2.0 mm, and Tcement = 17.8 +/- 1.8 mm. The overall change in vertebral body height between these phases was significant (P < 0.001). At the lumbar level the mean vertebral body height was Tintact = 23.2 +/- 3.8 mm, Tfractured = 14.7 +/- 3.0 mm, Treduction = 18.4 +/- 2.5 mm, Tinflation = 23.2 +/- 3.5 mm, Tdeflation = 19.3 +/- 2.3 mm, and Tcement = 20.2 +/- 2.8 mm. The overall change in MCVBH between these phases was also significant (P < 0.001). The increase in vertebral body height resulted in a decrease of the adjacent disc height. No difference was found for the amount of endplate reduction in the center or at the periphery. No leakage of cement was detected in the spinal canal. CONCLUSIONS: Reduction of endplate fractures, both in the center and at the periphery, seems feasible and safe with combined fracture reduction and balloon vertebroplasty. The endplate fracture reduction that was gained by inflation of the bone tamps could not be maintained after deflation.

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PubMed2005

Biomechanical impact of vertebroplasty. Postoperative biomechanics of vertebroplasty.

OBJECTIVES: To examine the biomechanisms underlying adjacent fractures following vertebroplasty, an emerging procedure to stabilize fractured vertebrae. In this procedure, bone cement is injected percutaneously into the vertebral cancellous bone. Once hardened, the cement offers mechanical reinforcement to the weakened vertebra. Recent clinical and biomechanical reports suggest that this procedure may cause new fractures adjacent to the one augmented. The cause and extend is unclear yet. The focus here is on the biomechanical hypothesis resulting from the rigid cement augmentation. METHODS: A combination of experimental and numerical studies, in additional to a review of recent clinical reports. RESULTS: The broader finding suggests that vertebroplasty changes the mechanical loading in adjacent vertebrae. Specifically, an increase in adjacent loading in the range of 17% has been found. The mechanism underlying this increase seemed to stem from the excessive cement rigidity that reduced the endplate bulge of the augmented vertebra, thereby reducing the local spinal joint flexibility. The reduction in joint flexibility seeks to reverse itself by creating an increase in the inter-vertebral disc pressure. The increased disc pressure seeks to relieve itself by increasing the load on the adjacent vertebra. The increased load on the adjacent vertebra relates directly to an increased risk of fracture. CONCLUSIONS: Although an increasing amount of evidence exists to support this theory of the origin of adjacent fractures, one must be cautious. Vertebroplasty is a relatively new procedure and further observations and, ultimately, prospective clinical studies are required to conclusively determine the cause and extend of adjacent fractures.

Bone Cements↗
PubMed2026

Comparative efficacy of percutaneous vertebroplasty combined with minimally invasive pedicle screw fixation versus percutaneous vertebroplasty alone in the treatment of elderly osteoporotic vertebral compression fractures.

The study aimed to assess the comparative efficacy of percutaneous vertebroplasty (PVP) combined with minimally invasive pedicle screw fixation versus PVP alone in elderly patients with osteoporotic vertebral compression fractures (OVCF). Ninety-four elderly patients with OVCF were randomly classified into the control (47 patients) and combined (47 patients) groups. The control group received PVP, while the combined group received PVP combined with minimally invasive pedicle screw fixation. Perioperative indicators such as intraoperative blood lose, operative time, and hospitalization time were recorded. Pain was assessed using the VAS before and at baseline and 1, 3, and 7 days postoperatively. At 1 and 3 days postoperatively, Serum CRP levels, WBC, and neutrophil counts were measured postoperatively. Radiographic outcomes (vertebral height ratio and Cobb angle), ADL scores, JOA scores, and ODI were evaluated preoperatively and at 3 months post-operation. Postoperative complications were documented. Baseline characteristics were comparable. The combined group showed superior pain relief, vertebral height restoration, Cobb angle correction, functional recovery, and reduced inflammatory markers (CRP, WBC, neutrophils) postoperatively (all P&#x2009;<&#x2009;0.05). Blood loss and hospital stay were shorter in the combined group, though operative time was longer (P&#x2009;<&#x2009;0.05). Complication rates did not differ significantly (P&#x2009;>&#x2009;0.05). PVP combined with minimally invasive pedicle screw fixation yields better outcomes in elderly OVCF patients by enhancing pain control, vertebral height, and functional recovery without increasing perioperative risk.

Humans↗
PubMed2003

Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases.

PURPOSE: To describe the immediate outcome of a large cohort of patients who underwent percutaneous polymethylmethacrylate (PMMA) vertebroplasty for treatment of one or more vertebral fractures. MATERIALS AND METHODS: This retrospective cohort study included seven university-based and private hospitals in the United States. Of 488 consecutive patients (mean age, 76 years) who underwent percutaneous PMMA vertebroplasty between 1996 and 1999, 245 were successfully interviewed retrospectively after vertebroplasty (median time, 7 months). Through telephone interview, patients completed our self-developed questionnaire designed to measure pain (10-point scale), ambulation (five-point scale), and ability to perform activities of daily living (ADL) (five-point scale) before and after vertebroplasty. Differences in reported pain, ambulation, and ability to perform ADL before and after vertebroplasty were evaluated with paired t tests. Differences in proportions were compared with the McNemar test. Subgroup analyses were performed to assess the consistency of differences in pre- and postprocedural pain and functional status by patient age, number of fractures, time from fracture to vertebroplasty, and time from vertebroplasty to questionnaire completion. RESULTS: On a 10-point scale, mean pain decreased from 8.9 before vertebroplasty to 3.4 afterward (P <.001). Seventy-two percent of patients had substantially impaired ambulation before vertebroplasty compared with 28% afterward (P <.001). Ability to perform ADL was also significantly improved following vertebroplasty (P <.001). Twelve patients (4.9%) experienced symptomatic complications (none major or life threatening). CONCLUSION: Treatment of vertebral fractures with percutaneous PMMA vertebroplasty appears to be safe and results in substantial immediate pain reduction and improved functional status. A randomized controlled trial appears warranted to assess the efficacy and safety of vertebroplasty.

Activities of Daily Living↗
PubMedDate not supplied

Intravertebral clefts opacified during vertebroplasty: pathogenesis, technical implications, and prognostic significance.

BACKGROUND AND PURPOSE: Intravertebral clefts have long been considered as pathognomonic for avascular necrosis and as a rare cause of compression fracture. We have observed unsuspected clefts opacifying frequently during vertebroplasty. Our purpose in this study was to determine the incidence of these clefts in symptomatic osteoporotic compression fractures, assess the sensitivity of MR imaging and conventional radiography in the detection of these clefts, and determine whether there is any prognostic significance of these clefts in patients treated with vertebroplasty. METHODS: Retrospective chart reviews were conducted of 135 vertebroplasty procedures performed during a 2-year period. MR images and conventional radiographs were reviewed for the presence of clefts defined as fluid-filled cavities on MR images or gas-filled cavities on conventional radiographs. Digital radiographs obtained at the time of the procedure were inspected for the presence of opacified clefts. Imaging findings were correlated with subjective pain scores documented before the procedure and at 1 week, 1 month, 6 months, and 12 months after vertebroplasty. RESULTS: Two hundred thirty-six osteoporotic compression fractures were treated with polymethylmethacrylate in 125 patients. Thirty-one and eight-tenths percent of the fractures were noted to contain clefts at the time of vertebroplasty. Fluid-filled clefts were detected on preoperative MR images in only 52.8% of the fractures with opacified clefts at vertebroplasty. Gas-filled clefts were evident on preoperative conventional radiographs in only 11.4% of the fractures with opacified clefts at vertebroplasty. No significant difference was noted in numerical pain scores between the two populations at baseline or 1 week or 1 month after the procedure. Pain scores at 6 and 12 months after vertebroplasty showed a trend toward greater pain relief in patients with clefts, although the difference was not statistically significant. A sustained, statistically significant decrease in pain scores after treatment (P <.01) was noted in both groups. CONCLUSION: Intravertebral clefts are much more common than previously described and probably represent fracture nonunions. Imaging is not sensitive in detecting these clefts before vertebroplasty. We advocate complete filling of the cleft with cement during vertebroplasty to maximize stabilization of the fracture fragments. There is a trend toward greater pain relief being achieved 6 and 12 months after the procedure in patients with clefts that are opacified at the time of vertebroplasty.

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PubMed2006

Symptomatic refractures after vertebroplasty in patients with steroid-induced osteoporosis.

BACKGROUND AND PURPOSE: Refracture after percutaneous vertebroplasty in patients receiving oral glucocorticoid therapy has caused some patients and referring physicians to have negative perceptions concerning the efficacy of the initial vertebroplasty treatment. The purpose of this study was to analyze symptomatic refractures after vertebroplasty in patients on oral steroid therapy. We hypothesized that the higher refracture rate of patients on oral glucocorticoid therapy after percutaneous vertebroplasty is due not to an inadequacy of the procedure but rather to a naturally higher predisposition of these patients to refracture compared with patients with primary osteoporosis. METHODS: A retrospective analysis was performed on all osteoporosis patients having initial vertebroplasty from August 1999 to August 2003. The follow-up period was limited to 1 year after initial vertebroplasty session, with the last follow-up date ending in August 2004. Data were collected on 387 osteoporosis patients. RESULTS: Of the patients with primary osteoporosis, 20.6% patients refractured whereas 37.8% of the patients with steroid-induced osteoporosis had symptomatic refractures within 1 year of initial vertebroplasty. Relative risk of refracture within 1 year for the patients with steroid-induced osteoporosis was 1.84 compared with the patients with primary osteoporosis. In addition, the patients with steroid-induced osteoporosis were more likely to refracture after their second treatment session (within 1 year of initial vertebroplasty) than those with primary osteoporosis. CONCLUSION: Patients presenting on oral steroid therapy at their initial vertebroplasty are almost twice more likely to have symptomatic refractures than primary osteoporosis patients within 1 year of initial vertebroplasty.

Administration, Oral↗
PubMed2005

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.

Arthroplasty↗
PubMed2006

Percutaneous vertebroplasty for patients with osteoporosis: a one-year follow-up.

PURPOSE: To evaluate changes in height and wedge angle of treated vertebral bodies and kyphosis angle 1 year after vertebroplasty. MATERIAL AND METHODS: We reviewed radiographs of 95 vertebral bodies treated with vertebroplasty in 60 patients with osteoporosis. Only vertebral bodies with imaging evidence of a new fracture or avascular necrosis received vertebroplasty. Images were obtained for evaluation before vertebroplasty (B), within 2 weeks after vertebroplasty (T), and after 1 year (T1). RESULTS: The mean wedge angle decreased by 5.4 degrees from B to T1. Mean of the anterior, central, and posterior heights of the fractured bodies increased by 12.6%, 9.6%, and 3.1%, respectively, from B to T1. The kyphosis angle improved by 3.2 degrees initially from B to T, but the improvement later disappeared. In 48% of these patients, a new fracture developed after vertebroplasty, and 63% of the fractures were adjacent to a vertebroplasty-treated vertebral body. CONCLUSION: The increase in height and wedge angle of the vertebral bodies generally lasted at least 1 year. Improvement in kyphosis angles was lost 1 year after vertebroplasty because new fractures occurred in 48% of these patients. Prevention of new fractures after vertebroplasty remains an important task.

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PubMed2002

Biomechanical evaluation of an injectable calcium phosphate cement for vertebroplasty.

STUDY DESIGN: Destructive biomechanical tests using fresh cadaveric thoracolumbar vertebral bodies. OBJECTIVES: To evaluate the compression strength of human vertebral bodies injected with a new calcium phosphate (CaP) cement with improved infiltration properties for augmentation of the vertebral bodies before compression fracture and also for vertebroplasty in comparison with polymethylmethacrylate (PMMA) injection. SUMMARY OF BACKGROUND DATA: Vertebroplasty is the percutaneous injection of PMMA cement into the vertebral body. While PMMA has high mechanical strength, it cures fast and thus allows only a short handling time. Other potential problems of using PMMA injection may include damage to surrounding tissues by a high polymerization temperature or by the unreacted toxic monomer, and the lack of long-term biocompatibility. Bone mineral cements, such as calcium carbonate and CaP cements, have longer working time and low thermal effect. They are also biodegradable while having a good mechanical strength. However, the viscosity of injectable mineral cements is high, and the infiltration of these cements into vertebral body has been questioned. Recently, the infiltration properties of a CaP cement have been significantly improved, which is ideal for the transpedicular injection to the vertebral bodies for vertebroplasty or augmentation of osteoporotic vertebral body strength. METHODS: The bone mineral densities of 30 vertebral bodies (T2-L1) were measured using dual-energy x-ray absorptiometry. Ten control specimens were compressed at a loading rate of 15 mm/min to 50% of their original height. The other specimens had 6 mL of PMMA (n = 10) or the new CaP (n = 10) cement injected through the bilateral pedicle approach before being loaded in compression. Additionally, after the control specimens had been compressed, they were injected with either CaP (n = 5) or PMMA (n = 5) cement using the same technique, to simulate vertebroplasty. Loading experiments were repeated with the displacement control of 50% vertebral height. Load to failure was compared among groups and analyzed using analysis of variance. RESULTS: Mean bone mineral densities of all five groups were similar and ranged from 0.56 to 0.89 g/cm2. The size of the vertebral body and the amount of cement injected were similar in all groups. Load to failure values for PMMA, the new CaP, and vertebroplasty PMMA were significantly greater than that of control. Load to failure of the vertebroplasty CaP group was higher than control but not statistically significant. The mean stiffness of the vertebroplasty CaP group was significantly smaller than control, PMMA, and the new CaP groups. The mean height gains after injection of the new CaP and PMMA cements for vertebroplasty were minimal (3.56% and 2.01%, respectively). CONCLUSION: Results of this study demonstrated that the new CaP cement can be injected and infiltrates easily into the vertebral body. It was also found that injection of the new CaP cement can improve the strength of a fractured vertebral body to at least the level of its intact strength. Thus, the new CaP cement may be a good alternative to PMMA cement for vertebroplasty, although further in vivo animal and clinical studies should be done. Furthermore, the new CaP may be more effective in augmenting the strength of osteoporotic vertebral bodies for preventing compression fractures considering our biomechanical testing data and the known potential for biodegradability of the new CaP cement.

Absorptiometry, Photon↗
PubMed2004

Quality of life following vertebroplasty.

BACKGROUND: Percutaneous vertebroplasty may be indicated when a patient with a painful osteoporotic vertebral compression fracture remains intolerably symptomatic in spite of comprehensive, nonoperative management. Relief of pain and quality of life following percutaneous vertebroplasty, however, remain incompletely defined. We investigated these outcomes with use of a visual analog scale and a validated, osteoporosis-specific health-related quality-of-life instrument. METHODS: We performed a prospective study of consecutive patients who underwent percutaneous vertebroplasty. At the time of enrollment, all patients completed the Osteoporosis Quality of Life Questionnaire, a validated thirty-item, five-domain, 7-point response-option instrument that measures health-related quality of life in osteoporotic women with back pain due to vertebral compression fracture. At two weeks, two months, and six months postoperatively, all patients completed a validated extraction of the Osteoporosis Quality of Life Questionnaire. The minimal, clinically important difference in this 7-point scale is 0.5 unit per question. To assess pain, a visual analog scale (ranging from 1 to 10) was completed preoperatively, one day postoperatively, and at each evaluation thereafter. RESULTS: Forty-six consecutive patients (thirty-two women and fourteen men) underwent forty-nine percutaneous vertebroplasty procedures for the treatment of sixty-six vertebral compression fractures. The mean age of the patients was 74.3 years. The mean fracture age was 2.5 months. The mean pain rating decreased from 7.7 preoperatively to 2.8 one day after the vertebroplasty (p < 0.001), and it remained substantially improved at two weeks, two months, and six months postoperatively (p < 0.001). All five domains of the Osteoporosis Quality of Life Questionnaire were improved at two weeks postoperatively and remained improved at each evaluation point through six months (p </= 0.007). Multivariate analysis demonstrated no consistent correlation between postoperative pain relief or any postoperative Osteoporosis Quality of Life Questionnaire domain score and gender, smoking history, previous or current steroid use, bone mineral density, dynamic mobility, or the presence of an intravertebral cleft. Immediate postoperative pain relief was weakly and positively associated with age (p < 0.03). Four incident vertebral compression fractures occurred in three (6.5%) of the forty-six patients, and five patients died within six months after the vertebroplasty. No deaths or serious adverse events appeared to be related to vertebroplasty. CONCLUSIONS: Rapid and substantial relief of pain and improvement in the quality of life are observed following percutaneous vertebroplasty, and these improvements are maintained for at least six months. Percutaneous vertebroplasty can be performed safely in frail, elderly patients, with no apparent increase in the incidence of fractures postoperatively. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Adult↗
PubMedDate not supplied

The therapeutic benefit of repeat percutaneous vertebroplasty at previously treated vertebral levels.

BACKGROUND AND PURPOSE: Recurrent pain after vertebroplasty is relatively common, usually representing a new fracture at a different vertebral level. In a small cohort described herein, clinical and imaging findings indicated that recurrent pain arose from abnormality of the previously treated level. Our purpose was to demonstrate that repeat percutaneous vertebroplasty performed within the same fractured vertebra can offer therapeutic benefit for patients with recurrent pain after initial treatment. METHODS: We conducted a retrospective review of consecutive vertebroplasty procedures performed at our institution to define a patient population that underwent repeat vertebroplasty for recurrent pain at previously treated vertebral levels. We identified six such patients over an 8-year period, and clinical outcomes were assessed through quantitative measurements of pre- and postoperative levels of pain and mobility. RESULTS: Initial vertebroplasty resulted in substantial improvement in pain in all six patients. Patients developed recurrent pain between 8 days and 167 days after initial vertebroplasty. After repeat vertebroplasty, five of the six patients reported a reduction of at least 3 points in their rating of pain, with a mean reduction of 6.5 points and a mean postoperative pain level of 3.5 points (11-point scale). Four of six patients reported impaired mobility before repeat vertebroplasty, and all four demonstrated a postoperative improvement in mobility. Mean increase in mobility was 1.50 points, and the mean postoperative mobility impairment was 0.25 points (5-point scale). CONCLUSION: The clinical outcomes of the patients within this case series suggest that repeat percutaneous vertebroplasty performed at previously treated vertebral levels for recurrent pain offer therapeutic benefit.

Aged↗
PubMed2005

Can vertebroplasty restore normal load-bearing to fractured vertebrae?

STUDY DESIGN: Cadaver motion segments were used to evaluate the effects of vertebroplasty on spinal loading following vertebral fracture. OBJECTIVES: To determine if vertebroplasty reverses fracture-induced changes in the distribution of compressive stress in cadaver motion segments. SUMMARY OF BACKGROUND DATA: Vertebroplasty involves reinforcement of vertebrae by injection of cement and is now being used increasingly to treat osteoporotic vertebral fractures. However, its effects on spinal load-bearing are largely unknown. We hypothesize that vertebroplasty, following vertebral fracture, helps to equalize stress acting on the intervertebral disc and adjacent vertebral bodies. METHODS: Nineteen cadaver thoracolumbar motion segments (age 64-90 years) were induced to fracture by compressive overload. Specimens were then subjected to vertebroplasty, and subsequently creep loaded for 1 hour at 1.5 kN. The compressive stress acting on the intervertebral disc was measured before and after fracture, after vertebroplasty, and after creep, by pulling a pressure transducer mounted in a 1.3-mm needle across the disc's midsagittal diameter. This information was then used to calculate neural arch load-bearing. At each time point, measurements were also made of compressive stiffness. RESULTS: Vertebral fracture reduced motion segment compressive stiffness, decompressed the adjacent nucleus, increased stress concentrations in the posterior anulus, and increased neural arch load-bearing, all by a significant amount. Vertebroplasty partially, but significantly, reversed all of these fracture-induced changes. CONCLUSIONS: Vertebroplasty reduces stress concentrations in the anulus and neural arch resulting in a more even distribution of compressive stress on the intervertebral disc and adjacent vertebral bodies.

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PubMed2003

Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation.

OBJECTIVES: We aimed to evaluate the efficacy of reinforcing short-segment pedicle screw fixation with polymethyl methacrylate (PMMA) vertebroplasty in patients with thoracolumbar burst fractures. METHODS: We enrolled 70 patients with thoracolumbar burst fractures for treatment with short-segment pedicle screw fixation. Fractures in Group A (n = 20) were reinforced with PMMA vertebroplasty during surgery. Group B patients (n = 50) were not treated with PMMA vertebroplasty. Kyphotic deformity, anterior vertebral height, instrument failure rates, and neurological function outcomes were compared between the two groups. RESULTS: Kyphosis correction was achieved in Group A (PMMA vertebroplasty) and Group B (Group A, 6.4 degrees; Group B, 5.4 degrees). At the end of the follow-up period, kyphosis correction was maintained in Group A but lost in Group B (Group A, 0.33-degree loss; Group B, 6.20-degree loss) (P = 0.0001). After surgery, greater anterior vertebral height was achieved in Group A than in Group B (Group A, 12.9%; Group B, 2.3%) (P < 0.001). During follow-up, anterior vertebral height was maintained only in Group A (Group A, 0.13 +/- 4.06%; Group B, -6.17 +/- 1.21%) (P < 0.001). Patients in both Groups A and B demonstrated good postoperative Denis Pain Scale grades (P1 and P2), but Group A had better results than Group B in terms of the control of severe and constant pain (P4 and P5) (P < 0.001). The Frankel Performance Scale scores increased by nearly 1 in both Groups A and B. Group B was subdivided into Group B1 and B2. Group B1 consisted of patients who experienced instrument failure, including screw pullout, breakage, disconnection, and dislodgement (n = 11). Group B2 comprised patients from Group B who did not experience instrument failure (n = 39). There were no instrument failures among patients in Group A. Preoperative kyphotic deformity was greater in Group B1 (23.5 +/- 7.9 degrees) than in Group B2 (16.8 +/- 8.40 degrees), P < 0.05. Severe and constant pain (P4 and P5) was noted in 36% of Group B1 patients (P < 0.001), and three of these patients required removal of their implants. CONCLUSION: Reinforcement of short-segment pedicle fixation with PMMA vertebroplasty for the treatment of patients with thoracolumbar burst fracture may achieve and maintain kyphosis correction, and it may also increase and maintain anterior vertebral height. Good Denis Pain Scale grades and improvement in Frankel Performance Scale scores were found in patients without instrument failure (Groups A and B2). Patients with greater preoperative kyphotic deformity had a higher risk of instrument failure if they did not undergo reinforcement with vertebroplasty. PMMA vertebroplasty offers immediate spinal stability in patients with thoracolumbar burst fractures, decreases the instrument failure rate, and provides better postoperative pain control than without vertebroplasty.

Adult↗
PubMed2006

Efficacy of postural reduction in osteoporotic vertebral compression fractures followed by percutaneous vertebroplasty.

OBJECTIVE: Vertebroplasty in the symptomatic osteoporotic vertebral fracture has become increasingly popular. However, there have been some limitations in restoring the height of the collapsed vertebrae and in preventing the leaking of cement. In the severely collapsed vertebrae of more than two thirds of their original height, vertebroplasty is regarded as a contraindication. We tried postural reduction using a soft pillow under the compressed level. This study was undertaken to investigate the effectiveness of the combination of postural reduction and vertebroplasty for re-expansion and stabilization of the osteoporotic vertebral fractures. METHODS: A total of 75 patients with single level vertebral compression fracture were treated with postural reduction followed by vertebroplasty. In 30 patients, the vertebral body was severely collapsed more than two-thirds of its original height. We calculated the compression ratio (anterior height/posterior height) and measured the Cobb angle. We analyzed the degree of re-expansion according to the onset duration. RESULTS: The mean compression ratio was 0.60 +/- 0.15 initially and increased to 0.75 +/- 0.17 after vertebroplasty. The mean Cobb angle was 16.14 +/- 11.29 degrees and corrected to 10.71 +/- 12.08 degrees. The degree of re-expansion showed significant relation with the onset duration. Twenty-eight of 30 (93%) severely collapsed vertebrae re-expanded after postural reduction, which made vertebroplasty possible. CONCLUSION: This new method of vertebroplasty leads to significant restoration of height and correction of kyphosis. The re-expansion was closely related with onset duration. In cases of severely collapsed vertebrae which is able to be re-expanded by postural reduction, vertebroplasty could be applied safely.

Aged↗
PubMed2006

Calcium phosphate cement-based vertebroplasty compared with conservative treatment for osteoporotic compression fractures: a matched case-control study.

OBJECT: Few studies have been conducted to compare vertebroplasty and conservative treatment for osteoporotic vertebral compression fractures (OVCFs). To investigate the effects of calcium phosphate cement (CPC)-based vertebroplasty on relief of pain and augmentation of the fractured vertebral body (VB), the authors compared the results of CPC-assisted vertebroplasty with those of conservative treatment alone. METHODS: Two groups of patients were examined: the vertebroplasty group (30 consecutive patients with primary OVCF) and the control group (30 patients matched for age, sex, interval from injury to treatment, and grade of the posterior wall defects of the fractured VB). Outcome measures included the visual analog scale (VAS) score of back pain and analgesic requirements, and the radiographically documented rate of the VB kyphosis. The follow-up duration was more than 12 months (mean 17 months). The mean VAS score at 12 months after injury was 0.67 cm in the vertebroplasty group and 1.97 cm in the control group, and the mean improvement rates in the VAS scores were 91.6 and 73.6%, respectively (p < 0.0001). The mean duration of analgesic requirement was 8.3 days in the vertebroplasty group and 62.2 days in the control group (p = 0.0005). The mean kyphosis rate at 12 months after injury was 72.9% in the vertebroplasty group and 58% in the control group, and the mean recovery rate of kyphosis was +8.4 and -21%, respectively (p < 0.0001). CONCLUSIONS: The authors conclude that CPC-assisted vertebroplasty provides better clinical and radiological results than conservative treatment for primary OVCF.

Aged↗
PubMed2005

Vertebroplasty in the inpatient population.

BACKGROUND AND PURPOSE: Vertebroplasty is frequently offered to patients hospitalized for refractory pain due to vertebral fractures, because it is assumed that the procedure will facilitate resolution of pain and a rapid hospital discharge. We report our experience with inpatient vertebroplasty, with attention to rapidity of discharge and relevant clinical parameters. METHODS: We retrospectively reviewed the duration of hospitalization in patients admitted with primary diagnoses of back pain or vertebral fracture who were treated with vertebroplasty. We cataloged outcomes in the form of verbal pain scales (graded 0-10), in-hospital medication use (graded 0-6), and posthospitalization medication use. Outcomes were assessed at baseline and at 1 week, 1 month, 6 months, 1 year, and 2 years postvertebroplasty. RESULTS: We identified 66 such patients who had a median total hospital stay of 6.0 days (range, 1-26 days). Median length of stay before and after vertebroplasty were 4.0 (range, 1-24 days) and 1.5 days (range, 0-7 days), respectively. Ten (15%) patients were discharged the day of vertebroplasty. By days 2 and 3, 33 (50%) and 48 (72.7%) of the 66 patients had been discharged. Patients who received vertebroplasty earlier in the course of hospitalization demonstrated greater decreases in medication strength by discharge (P = .045). There was significant improvement in all outcome measures by 1 week, with continued improvement at 1 and 6 months. CONCLUSION: This study confirms that vertebroplasty facilitates a rapid hospital discharge as well as long-term improvement in patients admitted for refractory pain. Vertebroplasty administered earlier in hospitalization also leads to greater decreases in analgesic requirements.

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