What is the importance of “halo” phenomenon around bone cement following vertebral augmentation for osteoporotic compression fracture?

Kim, K. H.; Kuh, Sung Uk; Park, J. Y.; Chin, Dong Kyu; Cho, Y. E.

doi:10.1007/s00198-012-1896-y

Cited by 20 publications

(14 citation statements)

References 19 publications

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“…Recent literature evaluating Balloon Kyphoplasty postoperatively have indicated significant height loss and vertebral re-collapse in patients exhibiting a bone-cement halo phenomenon on radiographs [5]. The results from the current study show that height loss induced load changes initiate a shift in stress distribution to the posterior parts of the interface region.…”

Section: Discussion and Analysissupporting

confidence: 49%

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Stress Distribution at the Bone-cement Interface Changes during Kyphoplasty Rehabilitation

Purcell¹,

Tyndyk²,

McEvoy³

et al. 2013

2013 29th Southern Biomedical Engineering Conference

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Abstract-Balloon Kyphoplasty uses an inflatable bone tamp and cement augmentation to repair vertebral compression fractures. A recent clinical study observed a 78% re-collapse rate in patients showing a radiolucent phenomenon at the bonecement interface following Kyphoplasty. Two experimental studies showed significant height loss following Balloon Kyphoplasty under cyclical loads. The present study investigates the alteration in load angle corresponding to this height loss and its effect on load transfer to the bone-cement interface. A validated finite element model of a human thoracolumbar spine was segmented into a single L1 vertebral body and modified to replicate bilateral Balloon Kyphoplasty. Cement was modeled using prolate spheroids surrounded by an interface region divided into anterior, middle and posterior sections. Interface thickness was calculated using a mathematical model with a bone volume fraction of 0.3 and 50% bone compaction. An 800N load was applied at angles of 0 o and 20 o from the vertebral axis. Results indicate that a change in the applied load angle significantly alters the principal stress components and directions across the interface region. This alteration in loading must be considered in the context of the highly compliant interface region and therefore is hypothesized to be a contributory factor to vertebral recollapse.

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Section: Discussion and Analysissupporting

confidence: 49%

“…A recent clinical study [5] of 175 patients drew attention to a radiological halo phenomenon around the bone-cement interface following Kyphoplasty. The authors statistically correlated this radiological feature with a 78% re-collapse rate and attributed the phenomenon to a lack of cement interdigitation into the trabecular structure.…”

Section: Introductionmentioning

confidence: 99%

Stress Distribution at the Bone-cement Interface Changes during Kyphoplasty Rehabilitation

Purcell¹,

Tyndyk²,

McEvoy³

et al. 2013

2013 29th Southern Biomedical Engineering Conference

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“…Furthermore, there are no published data to clarify the potential long-term consequences of bone cement placed into the vertebral body, and speculation about interference with the natural vertebral body healing process might be correct. 9 A wide variation in the rate of transpedicular screw misplacement with the open technique has been reported. Gelalis et al 4 analyzed 26 prospective clinical studies including a total of 1105 patients (6617 screws inserted).…”

Section: Discussionmentioning

confidence: 99%

Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up

Vaněk

Bradáč

Konopková

et al. 2014

SPI

112

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Object The main aim of this study was to compare clinical and radiological outcomes after stabilization by a percutaneous transpedicular system and stabilization from the standard open approach for thoracolumbar spine injury. Methods Thirty-seven consecutive patients were enrolled in the study over a period of 16 months. Patients were included in the study if they experienced 1 thoracolumbar fracture (A3.1–A3.3, according to the AO/Magerl classification), had an absence of neurological deficits, had no other significant injuries, and were willing to participate. Eighteen patients were treated by short-segment, minimally invasive, percutaneous pedicle screw instrumentation. The control group was composed of 19 patients who were stabilized using a short-segment transpedicular construct, which was performed through a standard midline incision. The pain profile was assessed by a visual analog scale (VAS), and overall satisfaction by a simple 4-stage scale relating to performance of daily activities. Working ability and return to original occupation were also monitored. Radiographic follow-up was defined by the vertebral body index (VBI), vertebral body angle (VBA), and bisegmental Cobb angle. The accuracy of screw placement was examined using CT. Results The mean surgical duration in the percutaneous screw group was 53 ± 10 minutes, compared with 60 ± 9 minutes in the control group (p = 0.032). The percutaneous screw group had a significantly lower perioperative blood loss of 56 ± 17 ml, compared with 331 ± 149 ml in the control group (p < 0.001). Scores on the VAS in patients in the percutaneous screw group during the first 7 postoperative days were significantly lower than those in the control group (p < 0.001). There was no significant difference between groups in VBI, VBA, and Cobb angle values during follow-up. There was no significant difference in screw placement accuracy between the groups and no patients required surgical revision. There was no significant difference between groups in overall satisfaction at the 2-year follow-up (p = 0.402). Working ability was insignificantly better in the percutaneous screw group; previous working position was achieved in 17 patients in this group and in 12 cases in the control group (p = 0.088). Conclusions This study confirms that the percutaneous transpedicular screw technique represents a viable option in the treatment of preselected thoracolumbar fractures. A significant reduction in blood loss, postoperative pain, and surgical time were the main advantages associated with this minimally invasive technique. Clinical, functional, and radiological results were at least the same as those achieved using the open technique after a 2-year follow-up. The short-term benefits of the percutaneous transpedicular screw technique are apparent, and long-term results have to be studied in other well-designed studies evaluating the theoretical benefit of the percutaneous technique and assessing whether the results of the latter are as durable as the ones achieved by open surgery.

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“…Kim et al reported that the solid lump pattern was significantly related to recollapse of augmented vertebrae and the peri-cement halo phenomenon. The presence of the halo phenomenon further indicated a high risk of recollapse (17). Lump cement is usually associated with the presence of IVC in vertebroplasty (15,17), and the presence of IVC is reported as a risk factor for refracture of augmented vertebrae (8,9,15).…”

Section: Discussionmentioning

confidence: 99%

“…The presence of the halo phenomenon further indicated a high risk of recollapse (17). Lump cement is usually associated with the presence of IVC in vertebroplasty (15,17), and the presence of IVC is reported as a risk factor for refracture of augmented vertebrae (8,9,15). Heo et al reported that solid lump cement in vertebrae with IVC results from injecting the cement into a cystlike area under low pressure.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting recompression of augmented vertebrae after successful percutaneous balloon kyphoplasty: a retrospective analysis

et al. 2014

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What is the importance of “halo” phenomenon around bone cement following vertebral augmentation for osteoporotic compression fracture?

Abstract: The peri-cement halo was found to be associated with vertebral recollapse, this sign likely represents a poor prognostic factor after vertebral augmentation for osteoporotic compression fractures.

Cited by 20 publications

References 19 publications

Stress Distribution at the Bone-cement Interface Changes during Kyphoplasty Rehabilitation

Stress Distribution at the Bone-cement Interface Changes during Kyphoplasty Rehabilitation

Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up

Factors affecting recompression of augmented vertebrae after successful percutaneous balloon kyphoplasty: a retrospective analysis

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