Effect of Bone Cement Volume Fraction on Adjacent Vertebral Fractures After Unilateral Percutaneous Kyphoplasty

Lin, Dasheng; Jian-ming, Hao; Li, Lin; Wang, Lei; Zhang, Huantang; Zou, Weitao; Lian, Kejian

doi:10.1097/bsd.0000000000000204

Cited by 43 publications

(35 citation statements)

References 16 publications

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“…This void effect has been shown to lower the intergradient effect between bone and cement (32) and increases the incidence of new VCF (23). At the same time, increased cement volume fractures were also found to increase adjacent fractures (33). In acute cases, the dispersed fill pattern and load-bearing properties of the bioactive composite may also result in fewer subsequent fractures (23,34).…”

Section: Discussionmentioning

confidence: 95%

Earlier Vertebroplasty for Osteoporotic Thoracolumbar Compression Fracture May Minimize the Subsequent Development of Adjacent Fractures: A Retrospective Study

Lee

2018

Pain Phys

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Background: Percutaneous vertebroplasty (PVP) is widely used to treat osteoporotic vertebral compression fractures (OVCFs). The influence of timing (early vs. late) of PVP on the development of adjacent vertebral fractures (AVF) has rarely been discussed. Objective: This study aimed to compare the incidence of AVF among patients who received early PVP (≤ 30 days after symptom onset, EPVP) or late PVP (> 30 days after symptom onset, LPVP) in the thoracolumbar region (T10 to L2) after a 1-year follow up. Study Design: A retrospective cohort study. Setting: Department of Orthopedic, an affiliated hospital of a medical university. Methods: Patients who had single-level, T-score ≤ -2.5 of lumbar bone mineral density (BMD), primary OVCF in the thoracolumbar region (T10 to L2) and who received PVP between July 2012 and June 2014 were included in the study. They were divided into early PVP and late PVP groups according to the interval between symptom onset and treatment. The risk factors associated with subsequent AVFs were analyzed. Results: Of the 225 patients reviewed, 124 met the criteria and were followed for a minimum of 1 year. Eleven patients (14.1%) in the EPVP group (n = 78) and 18 patients (39.1%) in the LPVP group (n = 46) experienced an AVF during the first year following vertebroplasty. Outcomes were significantly better in patients with higher bone mineral density, lower cement volume, and without cement leakage (P < 0.01). Cox regression indicated an increase risk for AVF for LPVP, with an adjusted hazard ratio of 6.08 (95% confidence interval: 2.50–14.81). Limitation: The incidence of AVFs could be over estimated due to this being a retrospective study with a small case number and lack of either biomechanical study of intra-vertebral cement distribution by times to support the result. Conclusions: Compared with later interventions, PVP performed within 30 days after fracture development may be associated with a lower risk of adjacent fractures in the thoracolumbar region. Key words: Percutaneous vertebroplasty, osteoporosis, osteoporotic vertebral compression fracture, adjacent vertebral fracture

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Section: Discussionmentioning

confidence: 95%

Earlier Vertebroplasty for Osteoporotic Thoracolumbar Compression Fracture May Minimize the Subsequent Development of Adjacent Fractures: A Retrospective Study

Lee

2018

Pain Phys

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“…In our study, no signi cantly difference of bone cement volume was found between groups. Additionally, an increase in the cement volume may increase the risk of cement leakage [28,29,30]. Compared with percutaneous kyphoplasty (PKP), PVP may achieve better cement distribution.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Bone Cement Distribution on the Outcome of Percutaneous Vertebroplasty: A Case cohort study

Tan

Wen²,

Guo

et al. 2020

Preprint

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Background: To analyze the effect of different types of bone cement distribution after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fracture (OVCF). Methods: 137 patients with single level OVCF who underwent PVP were retrospectively analyzed. The patients were divided into two groups according to bone cement distribution. Group A: bone cement contacted both upper and lower endplates; Group B: bone cement missed at least one endplate. Group B was divided into 3 subgroups. Group B1: bone cement only contacted the upper endplates; Group B2: bone cement only contacted the lower endplates; Group B3: bone cement only located in the middle of vertebral body. The visual analogue scale (VAS) score at 24 hours post operation and last follow-up, anterior vertebral height restoration ratio (AVHRR), anterior vertebral height loss ratio (AVHLR), local kyphotic angle change and vertebral body recompression rate were compared. Results: 24 hours post operation, the pain of all groups were significantly improved. The average follow-up time was 15.3 ± 6.3 (6-24) months. At last follow-up, the VAS score of group A was lower than that of group B. There were 14 cases (10.2%) of adjacent vertebral fracture, 5 cases (8.6%) in group A and 9 cases (11.4%) in group B. There were 9 cases (6.6%) of cement leakage, 4 cases (6.9%) in group A and 5 cases (6.3%) in group B. At last follow-up, there were 16 cases (11.7%) of vertebral body recompression, including 3 cases (5.2%) in group A and 13 cases (16.5%) in group B. There was no significant difference in AVHRR between two groups. Local kyphotic angle change was significant larger in group B. At last follow-up, AVHLR in group B was higher than that in group A. In subgroup analysis, there was no significant difference in VAS score, local kyphotic angle change, vertebral recompression rate, AVHRR or AVHLR. Conclusions: If the bone cement fully contacted both the upper and lower endplates, it can better restore the strength of the vertebral body and maintain the height of the vertebral body, reduce the risk of the vertebral body recompression and long-term pain.

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“…Our previous study found that low E 2 concentration might be associated with vertebral refracture after kyphoplasty [ 24 ]. 4) Some surgical factors, including balloon volume, cement volume, recovery of vertebral height, and cement leakage may be correlated with the incidence of vertebral fracture after kyphoplasty [ 26 , 31 ]. 5) Lifestyle factors may also be involved.…”

Section: Introductionmentioning

confidence: 99%

The risk factors of vertebral refracture after kyphoplasty in patients with osteoporotic vertebral compression fractures: a study protocol for a prospective cohort study

Feng

Chen

et al. 2018

BMC Musculoskelet Disord

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BackgroundPercutaneous kyphoplasty (PKP) is the first-line treatment for osteoporotic vertebral compression fractures (OVCFs) that can immediately relieve pain and allow the quick recovery of lost mobility. However, some studies reported that after PKP, the incidence of vertebral refracture, particularly adjacent vertebral fracture (AVF), was high. Our previous meta-analysis suggested that the risks for vertebral refracture and AVF did not increase after percutaneous vertebral augmentation in OVCF patients. Despite the negative results of our meta-analysis, there is still significant evidence regarding the relationship between kyphoplasty and AVF, so a new prospective cohort study is warranted. In addition, in our previous retrospective study, we found that advanced age, female sex and low oestradiol (E2) concentrations might be related to the occurrence of postoperative vertebral refracture after PKP. To sufficiently evaluate the probable factors involved in the occurrence of postoperative vertebral refracture, we designed this prospective study.MethodsThis is a prospective cohort study of patients admitted for PKP to treat painful OVCFs. The baseline data, including demographic information, lifestyle, bone metabolic status, sex hormone and sex hormone-binding globulin (SHBG) levels, and clinical characteristics will be collected at the time of enrolment. Surgical features of PKP will be recorded on the operation day. Lifestyle, bone metabolic status, sex hormone levels, and SHBG levels will be assessed during the follow-up period at 1 m, 3 m, 12 m, and 24 m postoperatively. Patients suffering from acutely aggravated back pain will be referred to an orthopaedist, and refractured vertebrae will be confirmed by magnetic resonance imaging and computed tomography. The primary outcome will be the incidence of vertebral refracture. Multivariate analyses will be carried out to evaluate the variables that are independently correlated with vertebral refracture.DiscussionTo evaluate the risk of postoperative refracture preoperatively and to identify the surgical points related to postoperative refracture, this study will explore the risk factors related to vertebral refracture after PKP. The results may provide new information about defining OVCF patients suitable for PKP treatment.Trial registrationChiCTR-ROC-17011562. Registered on July 4th, 2017.

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Effect of Bone Cement Volume Fraction on Adjacent Vertebral Fractures After Unilateral Percutaneous Kyphoplasty

Cited by 43 publications

References 16 publications

Earlier Vertebroplasty for Osteoporotic Thoracolumbar Compression Fracture May Minimize the Subsequent Development of Adjacent Fractures: A Retrospective Study

Earlier Vertebroplasty for Osteoporotic Thoracolumbar Compression Fracture May Minimize the Subsequent Development of Adjacent Fractures: A Retrospective Study

The Effect of Bone Cement Distribution on the Outcome of Percutaneous Vertebroplasty: A Case cohort study

The risk factors of vertebral refracture after kyphoplasty in patients with osteoporotic vertebral compression fractures: a study protocol for a prospective cohort study

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