Role of percutaneous vertebroplasty with high-viscosity cement in the treatment of severe osteoporotic vertebral compression fractures

Abstract

Severe osteoporotic vertebral compression fractures (OVCFs) were considered as relative or even absolute contraindication for vertebroplasty and kyphoplasty and these relevant reports are very limited. This study aimed to evaluate and compare the efficacy of vertebroplasty with high-viscosity cement and conventional kyphoplasty in managing severe OVCFs. 37 patients of severe OVCFs experiencing vertebroplasty or kyphoplasty were reviewed and divided into two groups, according to the procedural technique, 18 in high-viscosity cement percutaneous vertebroplasty (hPVP) group and 19 in conventional percutaneous kyphoplasty (cPKP) group. The operative time, and injected bone cement volume were recorded. Anterior vertebral height (AVH), Cobb angle and cement leakage were also evaluated in the radiograph. The rate of cement leakage was lower in hPVP group, compared with cPKP group (16.7% vs 47.4%, P = 0.046). The patients in cPKP group achieved more improvement in AVH and Cobb angle than those in hPVP group postoperatively (37.2 ± 7.9% vs 43.0 ± 8.9% for AVH, P = 0.044; 15.5 ± 4.7 vs 12.7 ± 3.3, for Cobb angle, P = 0.042). At one year postoperatively, there was difference observed in AVH between two groups (34.1 ± 7.4 vs 40.5 ± 8.7 for hPVP and cPKP groups, P = 0.021), but no difference was found in Cobb angle (16.6 ± 5.0 vs 13.8 ± 3.8, P = 0.068). Similar cement volume was injected in two groups (2.9 ± 0.5 ml vs 2.8 ± 0.6 ml, P = 0.511). However, the operative time was 37.8 ± 6.8 min in the hPVP group, which was shorter than that in the cPKP group (43.8 ± 8.2 min, P = 0.021). In conclusion, conventional PKP achieved better in restoring anterior vertebral height and improving kyphotic angle, but PVP with high-viscosity cement had lower rate of cement leakage and shorter operative time with similar volume of injected cement.

Effect of cement distribution type on clinical outcome after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in the aging population

“…It has been widely used in treating OVCF in the thoracolumbar spine with proven efficacy, becoming the gold standard for treating OVCF patients ( 2 , 3 ). The mechanism of vertebroplasty is to fix microfractures and enhance the stability of the vertebral body by injecting bone cement into the vertebral body ( 4 ). Thus, the distribution of bone cement in the vertebral body is linked to clinical efficacy ( 5 , 6 ).…”

Vertebroplasty with high‐viscosity cement versus conventional kyphoplasty for osteoporotic vertebral compression fractures: a meta‐analysis

“…Seven studies displayed the change in Cobb's angle before and after surgery. Among them, one study (114 cases) 19 reported no significant difference for both groups, four studies (341 cases) 21,23,25,27 reported significant differences for both groups, and two studies (166 cases) 22,26 reported significant differences in favour of PKP. We extracted Cobb's angles at two time points for analysis according to data available.…”

“…TSA was performed to determine whether the present evidence was reliable and conclusive. During TSA, the study of Li et al 27 . was automatically ignored due to the very small sample size (<20 for each group).…”

“…Following the removal of replicated records and subsequent screening of results according to titles and abstracts, there were 59 candidate studies under full-text assessment for eligibility. Then 12 articles [16][17][18][19][20][21][22][23][24][25][26][27] remained eligible and were eventually included in the analysis (Fig. 1).…”

The effect of bone cement on the curative effect of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture

“…The operation was performed following the methods described by Li et al (14). Bucinnazine was routinely injected 30 minutes before surgery, and electrocardiogram monitoring was conducted throughout the operation.…”