A Retrospective Study to Evaluate the Effect of Dynamic Fracture Mobility on Cement Leakage in Percutaneous Vertebroplasty and Percutaneous Kyphoplasty in 286 Patients with Osteoporotic Vertebral Compression Fractures

Ren, Huajian; Feng, Tao; Cao, Jianhui; Hu, Yaning; Yu, Dahai; Pan, Shuo; Yao, Guangqing

doi:10.12659/msm.935080

Cited by 10 publications

(4 citation statements)

References 34 publications

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“…Kyphoplasty also produces better immediate postoperative kyphosis correction and less progressive kyphotic degeneration than vertebroplasty and nonsurgical treatments [ 45 ]. The high incidence of cortical defects and instability of crushed vertebrae in TLBFs has been attributed to bone cement leakage [ 46 , 47 ]. Improvement in the components of conventional high-viscosity PMMA bone cement is necessary to prevent cement leakage [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Hybrid kyphoplasty with short-versus intermediate- and long-segment pedicle screw fixations for the management of thoracolumbar burst fractures

Chou,

Wang,

Chung

et al. 2024

BMC Musculoskelet Disord

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Background This study aimed to determine if the hybrid short-segment (HSS) technique is a good alternative to the intermediate-segment (IS) and long-segment (LS) techniques in pedicle screw fixations for acute thoracolumbar burst fractures (TLBFs). Methods In this retrospective evaluation, we examined 43 patients who underwent surgical treatments, including one- or two-level suprajacent (U) and infrajacent (L) pedicle screw fixations, for acute single-level TLBFs with neurological deficits between the T11 and L2 levels from July 2013 to December 2019. Among these patients, 15 individuals underwent HSS (U1L1), 12 received IS (U2L1), and 16 underwent LS (U2L2) fixations. Supplemental kyphoplasty of the fractured vertebral bodies was performed exclusively in the HSS group. Our analysis focused on assessing blood loss and surgical duration. Additionally, we compared postoperative thoracolumbar kyphotic degeneration using the data on Cobb angles on lateral radiographic images acquired at three time points (preoperatively, postoperative day 1, and follow-up). The end of follow-up was defined as the most recent postoperative radiographic image or implant complication occurrence. Results Blood loss and surgical duration were significantly lower in the HSS group than in the IS and LS groups. Additionally, the HSS group exhibited the lowest implant complication rate (2/15, 13.33%), followed by the LS (6/16, 37.5%) and IS (8/12, 66.7%) group. Implant complications occurred at a mean follow-up of 7.5 (range: 6–9), 9 (range: 5–23), and 7 (range: 1–21) months in the HSS, IS, and LS groups. Among these implant complications, revision surgeries were performed in two patients in the HSS group, two in the IS group, and one in the LS group. One patient treated by HSS with balloon kyphoplasty underwent reoperation because of symptomatic cement leakage. Conclusions The HSS technique reduced intraoperative blood loss, surgical duration, and postoperative implant complications, indicating it is a good alternative to the IS and LS techniques for treating acute single-level TLBFs. This technique facilitates immediate kyphosis correction and successful maintenance of the corrected alignment within 1 year. Supplemental kyphoplasty with SpineJack® devices and high-viscosity bone cements for anterior reconstruction can potentially decrease the risk of cement leakage and related issues.

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Section: Discussionmentioning

confidence: 99%

Hybrid kyphoplasty with short-versus intermediate- and long-segment pedicle screw fixations for the management of thoracolumbar burst fractures

Chou,

Wang,

Chung

et al. 2024

BMC Musculoskelet Disord

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“…While PKP was designed to reduce the incidence of cement leakage observed in PVP, [4] instances of cement leakage still occur in PKP. [28][29][30] Whether VBS could decrease the incidence of cement leakage is controversial. Werner et al [16] found no significant advantage of VBS over PKP with regard to cement leakage.…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinical and radiological outcomes of vertebral body stenting versus percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis

Zhang,

Peng,

2023

Jt Dis Relat Surg

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Objectives The study aimed to compare the efficacy and safety of percutaneous kyphoplasty (PKP) and vertebral body stenting (VBS) in the treatment of osteoporotic vertebral compression fractures (OVCFs) and evaluate the clinical efficacy, Cobb angle correction, and cement leakage associated with both methods for OVCFs. Patients and methods A systematic search was conducted in PubMed, EMBASE, Cochrane Library, Medline, China National Knowledge, and Wanfang Data for clinical studies comparing VBS with PKP for OVCF up to May 2023. The meta-analysis was performed using Review Manager 5.3, with a focus on evaluating clinical and radiologic outcomes. Results A total of eight eligible clinical studies were included in this meta-analysis. In terms of clinical outcomes, VBS was found to have a longer surgical time compared to PKP (standard mean difference [SMD]=1.06 min; 95% confidence interval [CI]: 0.20, 1.92; p=0.02). However, VBS demonstrated comparable blood loss to PKP (SMD =0.00 mL; 95% CI: –0.45, 0.45; p=0.99). Additionally, VBS showed slight superiority in alleviating back pain as measured by the Visual Analog Scale (VAS) (SMD=–0.38; 95% CI: –0.63, –0.12; p=0.004), as well as in improving functional disability based on the Oswestry Disability Index (ODI) (SMD= –0.28; 95% CI: –0.54, –0.03; p=0.03). Radiographically, VBS achieved better Cobb angle correction compared to PKP (SMD= –1.00; 95% CI: –1.48, –0.51; p<0.0001), while there was no significant difference in cement leakage between VBS and PKP (odds ratio=0.81; 95% CI: 0.21, 3.14; p=0.76). Conclusion The findings suggest that VBS has a comparable clinical outcome to PKP based on operation time, intraoperative blood loss, VAS, and ODI. Furthermore, VBS showed slightly better maintenance of Cobb angle correction, whereas VBS did not demonstrate a significant advantage over PKP in terms of cement leakage.

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“…There is some controversy regarding the amount of bone cement injected; it has been suggested that the more adequate the dispersion of the bone cement, the better the pain relief; however, a higher amount of bone cement injected is more likely to trigger the risk of adjacent vertebral fracture and the probability of bone cement leakage. [19][20][21] Furthermore, bone cement leakage is a common postoperative complication of PKP, which may lead to nerve compression, and stimuli such as bone cement toxicity or allergy can cause symptoms such as decreased blood pressure and dyspnoea. 20,22 And, without compromising clinical outcomes, unilateral puncture requires only one set of puncture equipment, which can save patients' hospitalization costs.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Unilateral and Bilateral Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures

Yu¹,

Wang²,

Liu³

et al. 2023

JPR

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Objective To investigate the clinical efficacy of percutaneous kyphoplasty (PKP) with a unilateral versus bilateral approach in the treatment of osteoporotic vertebral compression fractures (OVCFs). Methods We retrospectively analyzed a total of 147 patients (unilateral group: 79, bilateral group: 68) with OVCFs treated with PKP at the Department of Spine Surgery, Wuhan Fourth Hospital between August 2020 and January 2022. Patients’ personal information, operation time, bone cement injection volume, as well as pre- and post-operative visual analogue scale (VAS), Oswestry disability index (ODI), anterior vertebral body height and Cobb angle were recorded. Results All 147 patients were successfully treated with PKP and were followed up for at least 6 months. Our results showed that the operative time was significantly shorter in the unilateral group (41.60±5.64) minutes than in the bilateral group (66.53±9.40) minutes, and the volume of bone cement injected was also significantly less in the unilateral group (5.27±0.73) mL than in the bilateral group (6.87±0.93) mL ( P <0.01). The VAS score, ODI index, vertebral height and Cobb angle at postoperative follow-up were significantly improved in both groups compared to the preoperative period ( P <0.01); However, the difference between the two groups was not statistically significant ( P >0.05). Repeat thoracic and lumbar radiographs showed cement leakage in seven cases (8.86%) in the unilateral group and five cases (7.35%) in the bilateral group, but all were asymptomatic and required no further management. During our entire follow-up period, there were five adjacent vertebral fractures in the unilateral group (6.33%) and four in the bilateral group (5.88%). Conclusion There was no significant difference between the two groups in terms of improvement in VAS score, ODI index, restoration of vertebral body height, and posterior convexity deformity, but unilateral puncture had the advantage of shorter operative time and less cement injection.

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A Retrospective Study to Evaluate the Effect of Dynamic Fracture Mobility on Cement Leakage in Percutaneous Vertebroplasty and Percutaneous Kyphoplasty in 286 Patients with Osteoporotic Vertebral Compression Fractures

Cited by 10 publications

References 34 publications

Hybrid kyphoplasty with short-versus intermediate- and long-segment pedicle screw fixations for the management of thoracolumbar burst fractures

Hybrid kyphoplasty with short-versus intermediate- and long-segment pedicle screw fixations for the management of thoracolumbar burst fractures

Comparison of clinical and radiological outcomes of vertebral body stenting versus percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis

Comparison of Unilateral and Bilateral Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures

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