Transpedicle body augmenter in painful osteoporotic compression fractures

Li, Kung Chia; Li, Anna F.Y.; Hsieh, Ching Hsiang; Chen, Hsiang Ho

doi:10.1007/s00586-006-0197-6

Cited by 27 publications

(24 citation statements)

References 49 publications

(51 reference statements)

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“…We used polymethylmethacrylate (PMMA) cement with Stryker Precision Cement Delivery System and KyphX Inflatable Bone Tamps (Kyphon, Inc., Sunnyvale, CAUSA) in VP and KP patients, respectively. Other, points of surgical technique were similar to what has been mentioned previously [10, 23–25]. …”

Section: Methodssupporting

confidence: 79%

Does Percutaneous Kyphoplasty Have Better Functional Outcome Than Vertebroplasty in Single Level Osteoporotic Compression Fractures? A Comparative Prospective Study

Omidi-Kashani

Samini

Hasankhani

et al. 2013

Journal of Osteoporosis

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Purpose. To evaluate the relative differences in surgical outcome of kyphoplasty (KP) versus vertebroplasty (VP) in the patients with single level refractory osteoporotic compression fractures (OCFs). Method. From August 2008 to May 2012, we intermittently treated 57 patients with single level OCF by PV and KP (Groups A and B, resp.). We used visual analogue scale (VAS) and short form 36 (SF36) questionnaire to measure functional recovery and followed them for six months. Independent samples t- and Kendall's tau-b tests were for statistics. Results. In terms of age, number, and bone mineral density of the patients, there were no significant differences between the two groups. In both groups, VAS and SF-36 scores improved significantly and remained relatively stable throughout the follow-up period. We had 9 and 6 asymptomatic cement extravasations and 5 and 8 new vertebral fractures in Group A and B, respectively. In comparing the two groups, the results indicated that KP almost failed to show any significant higher effect relative to VP during this period. Conclusions. In considering the high cost of KP relative to VP in the developing countries like Iran, there is no logical reason to use KP in a single level refractory OCF in these regions.

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Section: Methodssupporting

confidence: 79%

Does Percutaneous Kyphoplasty Have Better Functional Outcome Than Vertebroplasty in Single Level Osteoporotic Compression Fractures? A Comparative Prospective Study

Omidi-Kashani

Samini

Hasankhani

et al. 2013

Journal of Osteoporosis

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“…Osteoporosis renders bone fragile, which can lead to treatment failure. The use of intracorporeal devices in addition to bone grafting for internal support to maintain body height and support cancellous bone regeneration has been reported and provides a new option for treating VCF [23,24]. The combination of short-segment fixation with I-VEP represents a less invasive procedure that allows for intracorporeal augmentation.…”

Section: Discussionmentioning

confidence: 99%

Reduction of the domino effect in osteoporotic vertebral compression fractures through short-segment fixation with intravertebral expandable pillars compared to percutaneous kyphoplasty: a case control study

Hsieh

Wang

et al. 2013

BMC Musculoskelet Disord

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BackgroundOsteoporotic vertebral compression fracture is the leading cause of disability and morbidity in elderly people. Treatment of this condition remains a challenge. Osteoporotic vertebral compression fractures can be managed with various approaches, but each has limitations. In this study, we compared the clinical outcomes obtained using short-segment fixation with intravertebral expandable pillars (I-VEP) to those obtained with percutaneous kyphoplasty in patients who had suffered vertebral compression fractures.MethodsThe study included 46 patients with single-level osteoporotic thoracolumbar fractures. Twenty-two patients in Group I underwent short-segment fixation with I-VEP and 24 patients in Group II underwent kyphoplasty. All patients were evaluated pre- and postoperatively using a visual analogue scale, anterior height of the fractured vertebra, and kyphotic angle of the fractured vertebra. The latter 2 radiological parameters were measured at the adjacent segments as well.ResultsThere was no significant difference between the groups in terms of gender or fracture level, but the mean age was greater in Group II patients (p = 0.008). At the 1-year follow-up, there were no significant differences in the visual analogue scale scores, anterior height of the fractured vertebra, or the value representing anterior height above the fractured vertebra and kyphotic angle below the fractured vertebra, after adjusting for the patients’ gender, fracture level, and age. When considered separately, the anterior height below the fractured vertebra was significantly higher and the kyphotic angle above the fractured vertebra was significantly smaller in Group I than in Group II (p = 0.029 and p = 0.008, respectively). The kyphotic angle of the fractured vertebra was significantly smaller in Group II than in Group I (p < 0.001).ConclusionsIn older individuals with vertebral compression fractures, kyphoplasty restored and maintained the collapsed vertebral body with less kyphotic deformity than that induced by short-segment fixation with I-VEP. Short-segment fixation with I-VEP was more effective in maintaining the integrity of adjacent segments, which prevented the domino effect often observed in patients with osteoporotic kyphotic spines.

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“…Reconstruction with structural bone graft and instrumentation may be performed in patients with concurrent spinal instability or neurological compromise from an anterior or posterior approach; however, the success of these techniques is limited by the patient's poor bone quality and general medical condition. Manual reduction and TpBA have been reported to restore and maintain the vertebra in VCFs and pathologic vertebral compression fractures successfully 3338. The concept is that a fractured body can be reduced by manual reduction and reconstructed with a transpedicle body augmenter via a posterior paramedian approach.…”

Section: Discussionmentioning

confidence: 99%

“…All patients initially underwent manual reduction 33–38. Acute and nonunion compression fractures were reduced easily by the manual procedure, leaving a substantial bony defect in the vertebral body.…”

Section: Methodsmentioning

confidence: 99%

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Transpedicle body augmenter for vertebral augmentation in symptomatic multiple osteoporotic compression fractures

Li¹,

Li²,

Hsieh

2010

IJOO

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Background:Multiple osteoporotic vertebral compression fractures (VCFs) have been treated with polymethylmethacrylate augmentation; however, there are cement complications and long-term fracture healing that are unknown. Transpedicle body augmenter (a porous titanium spacer) has been reported as an internal support to reconstruct the vertebral body combining short-segment fixation in burst fracture and Kümmell's disease with cord compression. Transpedicle body augmenter for vertebral augmentation (TpBA) also has been reported successfully in treating single painful VCF and vertebral metastasis lesions including pending fractures and pathologic compression fractures. To test the hypothesis that TpBA can effectively and safely treat the symptomatic multiple VCFs, this retrospective study was done by analyzing the radiographic and clinical results.Materials and Methods:We retrospectively reviewed clinical and radiographic results of TpBA for symptomatic multiple (more than two levels) VCFs in 62 patients with a total of 236 levels, i.e. 3.8 VCFs per patient. Manual reduction and TpBA via paramedian incisions with blunt dissection were done. One incision was made for two continuous levels and alternative side was selected for next incision. Mean age was 74.3 years (range, 62-87 years), and female-male ratio was 5.2:1. Anterior vertebral height and wedge angle by radiographic findings were measured at preoperative, initial follow-up and final follow-up. Clinical results were assessed by questionnaires and clinical observations. By July 2008, 58 patients returned to answer the questionnaire including quantification of pain on the visual analog scale, the response to operations (better, same, or worse after operation), returned to their pre-fracture function (yes/no) and satisfaction (a scale of 0 = completely dissatisfied to 10 = completely satisfied).Results:The mean symptom duration was 7 months, and follow-up, 48 months. The average operation time was 21 min per level, blood loss was 74 cc per level and hospitalization was 4.4 days. No patient had neurological deterioration. There was no dislodgement of implant in the final visit. Forty-eight patients (77.4%) could walk within 6-8 h after operation and the others, within 24 h. The anterior vertebral restoration was 7.3 mm initially and 6.2 mm at final follow-up. Wedge angle correction was 10.4° initially and was 9.3° at final follow-up. Pain, by the visual analog scale, was 8.5 preoperatively, 2.7 at day 7 follow-up and 2.9 at final follow-up. By the questionnaire, 52 of 58 respondents reported a decrease in discomfort after TpBA and 48 of 58 patients reported a return to normal activity after operation. The final satisfaction rate was 89.7%.Discussion:The symptoms of multiple osteoporotic compression fracture may be due to unstable fracture, radiculopathy, and global traumatic kyphosis with posture changes, which can be corrected by multiple TpBA. The transpedicle body augmenter was initially stabilized by the sinking and locking mechanism and finally by bone ingro...

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Transpedicle body augmenter in painful osteoporotic compression fractures

Cited by 27 publications

References 49 publications

Does Percutaneous Kyphoplasty Have Better Functional Outcome Than Vertebroplasty in Single Level Osteoporotic Compression Fractures? A Comparative Prospective Study

Does Percutaneous Kyphoplasty Have Better Functional Outcome Than Vertebroplasty in Single Level Osteoporotic Compression Fractures? A Comparative Prospective Study

Reduction of the domino effect in osteoporotic vertebral compression fractures through short-segment fixation with intravertebral expandable pillars compared to percutaneous kyphoplasty: a case control study

Transpedicle body augmenter for vertebral augmentation in symptomatic multiple osteoporotic compression fractures

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