The therapeutic effects of percutaneous kyphoplasty on osteoporotic vertebral compression fractures with or without intravertebral cleft

2020

Preprint

Background The purpose of this study is to investigate and compare the therapeutic effect and distribution characteristics of bone cement in the PVP treatment for thoracolumbar Kümmell's diseases and OVCFs. Methods A prospective analysis of 35 patients with Kümmell ’s disease (K group) and 35 patients with OVCFs (O group) who underwent PVP treatment from February 2016 to February 2018 was conducted. The vertebral compression rate and degree of osteoporosis were more serious in the K group than in the O group ( P <0.05, respectively). Distribution pattern, volume and leakage rate of bone cement, operation time, VAS score, ODI, correction rates of vertebral compression and kyphosis, re-fracture rate of adjacent vertebrae in 2 years between the two groups were compared to assess clinical effect. Results The follow-up time of the two groups was 24-48 months. The amount of intraoperative bone cement injection was significantly higher in the K group than in the O group ( P =0.025). The cement distribution pattern of local solid lump was dominant in the K group (65.71%), while intercalation with trabeculae was dominant in the O group (74.29%) ( P <0.001). VAS score and ODI were significantly lower both in the two groups at 1 day, 1 year and 2 years after surgery than before surgery (all P <0.05), but significantly lower in the K group than in the O group at each time point after surgery (all P <0.05). The correction rates of kyphosis and vertebral compression in both groups was significantly corrected ( P <0.05, respectively) and gradually lost with time ( P <0.05, respectively). The correction rates of kyphosis and vertebral compression were significantly higher in the K group than in the O group at each time point after surgery (all P <0.05). Conclusions PVP has the advantages of simple operation, short operation time, small trauma and quick recovery in treating both Kümmell's disease and OVCFs. However, PVP can better restore partial vertebral height and correct kyphosis in the treatment of Kümmell's disease, while can better alleviate pain and improve ODI in the treatment of OVCFs.

Section: Resultssupporting

confidence: 90%

Comparison of the clinical outcomes and cement distribution patterns after percutaneous vertebroplasty in the treatment of thoracolumbar Kümmell’s disease and OVCFs

Wang¹,

2020

Preprint

“…Patients often suffer intractable lumbar and back pain, and even nerve injury. Imaging examination shows IVC or localized uid lling in the vertebral body [14]. In this study, the course of Kümmell's disease was signi cantly longer than the course of OVCFs.…”

Section: Resultsmentioning

confidence: 50%

Comparison of the clinical manifestations and cement distribution after percutaneous vertebroplasty between thoracolumbar Kümmell’s disease and OVCFs

Wang¹,

2020

Preprint

Background：Kümmell's disease is a chronic, non-healing osteoporotic vertebral compression fractures (OVCFs), which is associated with ischemic necrosis and vertebral pseudarthrosis. The purpose of this study was to compare the therapeutic effect and distribution characteristics of bone cement in the percutaneous vertebroplasty (PVP) treatment between thoracolumbar Kümmell's diseases and OVCFs.Methods: A total of 70 patients with Kümmell ’s disease (K group) or OVCFs (O group) who underwent PVP surgery from February 2016 to February 2018 were included in this study. The follow-up time was 24-48 months. The course of disease was significantly longer in the K group than in the O group (P=0.000). Most cases in the K group had no history of trauma, while most cases in the O group had a history of falls (P=0.001). The vertebral compression rate and degree of osteoporosis were more serious in the K group than in the O group (P<0.05, respectively). Distribution pattern, volume and leakage rate of bone cement, operation time, VAS score, ODI, correction rates of vertebral compression and kyphosis, re-fracture rate of adjacent vertebrae between the two groups were compared to assess clinical effect.Results: The amount of bone cement injected was significantly higher in the K group than in the O group (P=0.025). The cement distribution pattern of local solid lump was dominant in the K group (65.71%), while intercalation with trabeculae was dominant in the O group (74.29%) (P<0.001). VAS and ODI were significantly lower both in the two groups at the 1st day, 1st year and 2nd years after surgery than before surgery (all P<0.05), but significantly lower in the K group than in the O group at each time point after surgery (all P<0.05). The correction rates of kyphosis and vertebral compression in both groups were significantly improved (P<0.05, respectively) and gradually lost with time (P<0.05, respectively). The correction rates of kyphosis and vertebral compression were significantly higher in the K group than in the O group at each time point after surgery (all P<0.05).Conclusion: Kümmell's disease has a higher degree of disease progression and osteoporosis than OVCFs. PVP can better restore partial vertebral height and correct kyphosis in the treatment of Kümmell's disease, while can better alleviate pain and improve ODI in the treatment of OVCFs.

“…In this study, VAS and ODI postoperatively were significantly reduced in both groups and were maintained to the last follow-up. Li et al [27] found that VAS and ODI were significantly improved at the last follow-up compared with those before treatment in patients with KD after intensive vertebral treatment. In this study, spongy group is superior to the blocky group in terms of pain relief and functional recovery.…”

Section: Resultsmentioning

confidence: 98%

“…A small dose of bone cement can restore the mechanical properties of the fractured vertebral body, and the amount of bone cement injected has no obvious correlation with the analgesic effect [26,27].…”

Section: Resultsmentioning

confidence: 99%

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

Xiao²,

et al. 2020

Preprint

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.