Clinical observation of two bone cement distribution modes of percutaneous vertebroplasty in the treatment of thoracolumbar Kümmell’s disease

Abstract

Background In recent years, percutaneous vertebroplasty (PVP) has provided a new option for the treatment of Kümmell’s disease (KD). The purpose of this study is to study the differences in clinical characteristics, clinical efficacy and related complications between two types of bone cement distribution patterns in the PVP treatment of KD. Methods Retrospective analysis from January 2016 to February 2018 showed that 63 patients with KD who received PVP treatment were included in the study. According to X-ray distribution modes of bone cement after treatment, all patients were divided into blocky group (30 cases ) and spongy group (33 cases). Clinical features and disease severity Preoperatively of the two groups, and clinical efficacy and related complications postoperatively were compared between the two groups. Results There was no significant difference in gender, injured segment, VAS and ODI preoperatively between the two groups (all P > 0.05). The duration of disease, age, Cobb angle and vertebral compression rate preoperatively were significantly higher in the blocky group than in the spongy group (P < 0.05, respectively). The height of vertebral anterior margin and BMD were significantly lower in the blocky group than in the spongy group (P < 0.05, respectively). The two groups were followed for at least 24 months. There were no statistically differences in the follow-up time, operation time, intraoperative blood loss, number of fluoroscopy, bone cement leakage and adjacent vertebral fracture between the two groups (all P > 0.05). The amount of bone cement injected into the blocky group was significantly higher than that of the spongy group (P = 0.000). VAS score and ODI postoperatively of the two groups were significantly reduced at 1 day, 1 year and the last follow-up (all P = 0.000), and were maintained at the last follow-up. VAS score and ODI postoperatively decreased significantly in the spongy group compared with the blocky group (P = 0.000). The correction degrees of kyphosis and vertebral compression postoperatively in the two groups were significantly corrected, but gradually decreased over time (P < 0.05), and these correction degrees of the blocky group was significantly higher than that of the spongy group and the postoperative loss was also more serious. Conclusions The treatment of KD by PVP can effectively relieve pain, improve function, restore vertebral height and correct kyphosis. The disease in the blocky group was more serious than that in the spongy group. The amount of bone cement, correction degrees of postoperative kyphosis and vertebral compression were significantly higher in the blocky group than in the spongy group, but the postoperative loss was also more serious in the blocky group. However, for pain relief and functional recovery, the spongy group was superior to the blocky group. Therefore, the spongy distribution pattern should be formed during the injection of bone cement to obtain better therapeutic effect.

Clinical Observation of Two Bone Cement Distribution Modes After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures

“…The strength and stiffness of the vertebral body after bone cement strengthening are signi cantly higher than the adjacent vertebrae, and the inhomogeneous distribution of bone cement makes the strength and stiffness of the vertebral body asymmetrical in all areas, and all of these factors tend to increase the risk of fracture of the adjacent vertebral body after PVP [24,38,39]. Therefore, numerous studies have con rmed that homogeneous distribution of bone cement within cancellous bone can reduce stress concentration and thus reduce the risk of fracture in adjacent vertebrae [29,40]. The spongy group has a spongy and homogeneous distribution of bone cement, which can ll the cancellous bone better and reduce the concentrated stress between adjacent vertebrae.…”

“…The rate of bone cement leakage was lower in the blocky group than spongy, but the difference was not statistically signi cant. This may be due to the diffuse distribution of the spongy cement, which is more widely distributed than the blocky group and more likely to leak through the broken bone cortex or endplate to the intervertebral disc or paravertebral area [40]. Therefore, the surgeon should carefully analyze the imaging data preoperatively and should suspend the procedure in case of intraoperative cement leakage.…”

A nomogram for predicting the residual back pain after percutaneous vertebroplasty for osteoporotic vertebral compression fractures

“…Although, PVP or percutaneous kyphoplasty(PKP) has been recommended to treat patients with OVCFs with IVC and achieved an ideal outcome [34]. However, some studies still report that the presence of preoperative IVC during long-term follow-up will more or less affect the clinical outcome after PVP, such as vertebral body re-collapse, severe over residual back pain, or even compression fractures of adjacent vertebrae [14,35]. The presence of IVC sign in OVCFs has been reported to be a major risk factor for postoperative re-collapse of the injured vertebra, progressive kyphosis, and chronic back pain [34,36,37].…”

Comparison of Unipedicular and Bipedicular Percutaneous Kyphoplasty for Kummell's Disease

“…For pain relief and functional recovery, the spongy group was superior to the blocky group. Therefore, the spongy distribution pattern should be formed during the injection of bone cement to obtain better therapeutic effect [21] . Yu et al concluded that due to the presence of broperichondrium on the inner wall of the cleft and sclerosis of the surrounding bone, bone cement is di cult to diffuse into the surrounding cancellous bone and form effective adhesion, only form solid lump in the cleft [22] .…”