Objective To evaluate the effectiveness of robot-assisted percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fracture (OVCF) in the elderly. Methods The clinical data of 90 elderly patients with OVCF treated in Sichuan Science City Hospital between June 2019 and March 2021 were retrospectively analyzed. The patients were divided into robot-assisted group (40 cases) and C-arm-assisted group (50 cases). The pre- and post-operative Visual Analogue Scale (VAS) score, pre- and post-operative Oswestry Disability Index (ODI) score, intraoperative cement leakage, intraoperative fluoroscopy frequency, operation time, and the loss of hemoglobin were recorded and compared between the two groups. Results The incidence of intraoperative cement leakage (5% vs. 20%), intraoperative fluoroscopy frequency [(18.3±3.2) vs. (41.3±7.8) times], operation time [(28.3±4.6) vs. (43.2±7.3) min] and the loss of hemoglobin [(7.2±2.0) vs. (15.2±4.4) g/L] of the robot-assisted group were less than those of the C-arm-assisted group (P<0.05). There was no statistically significant difference between the two groups in the decrease of VAS score or ODI score (3.63±1.64 vs. 3.40±1.65, P>0.05; 50.70±4.95 vs. 52.10±6.69, P>0.05). Conclusions Robot-assisted PVP for elderly patients with OVCF can significantly reduce the risk of cement leakage, shorten the operation time, reduce the intraoperative fluoroscopy frequency, and reduce the surgical hidden blood loss. It can be used for clinical promotion and application.
Objective
To evaluate the feasibility and safety of percutaneous endoscopic technique in the treatment of intraspinal cement leakage after percutaneous vertebroplasty (PVP).
Methods
Between May 2014 and March 2016, 5 patients with lower limb pain and spinal cord injury caused by intraspinal cement leakage after PVP, were treated with percutaneous endoscopic spinal decompression. Of 5 cases, 3 were male and 2 were female, aged from 65 to 83 years (mean, 74.4 years). The course of disease was 10-30 days (mean, 16.2 days). Imageological examinations confirmed the levels of cement leakage at T
12, L
1 in 3 cases, and at L
1, 2 in 2 cases; bilateral sides were involved in 1 case and unilateral side in 4 cases. Two patients had lower limb pain, whose visual analogue scale (VAS) were 8 and 7; 3 patients had lower extremities weakness, whose Japanese Orthopedic Association (JOA) 29 scores were 18, 20, and 19. According to American Spinal Injury Association (ASIA) impairment scale, neural function was rated as grade E in 2 cases and grade D in 3 cases.
Results
The operation time was 55-119 minutes (mean, 85.6 minutes), and the blood loss was 30-80 mL (mean, 48 mL). CT scan and three-dimensional (3D) reconstruction at 1 day after operation showed that cement leakage was removed in all patients. Five cases were followed up 6-21 months (mean, 12 months). In 2 patients with lower limb pain, and VAS score was significantly decreased to 2 at last follow-up. In 3 patients with lower extremities weakness, the muscle strength was improved progressively, and the JOA29 scores at last follow-up were 21, 23, and 22.
Conclusion
Percutaneous endoscopic technique for intraspinal cement leakage after PVP is safe, effective, and feasible.
Objective To investigate the epidemiological and clinical characteristics of patients with thoracolumbar osteoporotic vertebral compression fracture (OVCF) treated by percutaneous vertebroplasty (PVP). MethodsThe clinical and imaging data of 681 patients with thoracolumbar OVCF treated with PVP between January 2017 and December 2021 were collected. The epidemiological and clinical characteristics of the patients with thoracolumbar OVCF in single center were summarized from the aspects of demographic distribution (mainly including gender, age), fracture characteristic analysis [including pathological segments, bone mineral density, and body mass index (BMI)], and operation related results (including the distribution of unilateral and bilateral puncture and bone cement injection, postoperative effectiveness analysis and refracture). ResultsOf the 681 patients, 134 (19.68%) were male and 547 (80.32%) were female, with a male-to-female ratio of 1∶4.08. The age ranged from 53 to 105 years, with an average of 75.3 years. The age group of 60-90 years old had the largest number of patients (91.04%); the high incidence age group of men was 70-90 years old (13.95%), and that of women was 60-80 years old (72.98%). A total of 836 vertebrae were involved, and the morbidity of thoracolumbar vertebrae (T11-L1) was the highest (56.34%, 471/836). The main type of fracture was compression fracture (92.58%, 774/836) and Kümmell disease (7.42%, 62/836). There were 489 cases (71.81%) of osteoporosis, including 66 males and 423 females, with a male-to-female ratio of 1∶6.42. There was significant difference in distribution of bone mineral density between male and female groups (Z=–5.810, P<0.001). BMI showed 206 cases (30.25%) of underweight, 347 (50.95%) cases of normal, 58 cases (8.52%) of overweight, 42 cases (6.17%) of obese, and 28 cases (4.11%) of extremely obese. The difference in BMI distribution between male and female groups was significant (Z=–2.220, P=0.026). Of 836 vertebral bodies, 472 (56.46%) were punctured unilaterally and 364 (43.54%) bilaterally. Most of the vertebral bodies (49.88%, 417/836) were injected with 5.0-6.9 mL bone cement, and most of them were distributed in thoracolumbar and lumbar vertebral bodies (T11-L3). The visual analogue scale (VAS) score and Oswestry disability index (ODI) of patients with unilateral puncture and bilateral puncture significantly improved at 6 months after operation (P<0.001), and also the difference was significant between the two groups in the difference of pre- and post-operation (P<0.001). There were 628 cases (92.22%) with the first occurrence of OVCF, and 53 cases (7.78%) with two or more times of OVCF, all of which were female patients, and 26 cases (49.06%) occurred in the adjacent segment of the previous PVP operation. ConclusionFemale were more than male in OVCF patients. Thoracolumbar vertebral body has the highest morbidity. Patients with low BMI are more likely to have osteoporosis, and patients with high BMI have a higher risk of compression fracture. The amount of bone cement injected through bilateral puncture was greater than that through unilateral puncture.
Objective To evaluate the effectiveness of Confidence high viscosity bone cement system and postural reduction in treating acute severe osteoporotic vertebral compression fracture (OVCF). Methods Between June 2004 and June2009, 34 patients with acute severe OVCF were treated with Confidence high viscosity bone cement system and postural reduction. There were 14 males and 20 females with an average age of 72.6 years (range, 62-88 years). All patients had single thoracolumbar fracture, including 4 cases of T11, 10 of T12, 15 of L1, 4 of L2, and 1 of L3. The bone density measurement showed that T value was less than —2.5. The time from injury to admission was 2-72 hours. All cases were treated with postural reduction preoperatively. The time of reduction in over-extending position was 7-14 days. All patients were injected unilaterally. The injected volume of high viscosity bone cement was 2-6 mL (mean, 3.2 mL). Results Cement leakage was found in 3 cases (8.8%) during operation, including leakage into intervertebral space in 2 cases and into adjacent paravertebral soft tissue in 1 case. No cl inical symptom was observed and no treatment was pearformed. No pulmonary embolism, infection, nerve injury, or other complications occurred in all patients. All patients were followed up 12-38 months (mean, 18.5 months). Postoperatively, complete pain rel ief was achievedin 31 cases and partial pain refief in 3 cases; no re-fracture or loosening at the interface occurred. At 3 days after operation and last follow-up, the anterior and middle vertebral column height, Cobb angle, and visual analogue scale (VAS) score were improved significantly when compared with those before operation (P lt; 0.05)；and there was no significant difference between 3 days and last follow-up (P gt; 0.05). Conclusion Confidence high viscosity bone cement system and postural reduction can be employed safely in treating acute severe OVCF, which has many merits of high viscosity, long time for injection, and easy-to-control directionally.
Objective To investigate the treatment methods and the cl inical therapeutic effects of symptomatic cervical vertebral hemangioma associated with cervical spondylotic myelopathy. Methods A retrospective analysis was performed in 18 patients (10 males and 8 females, aged 30-62 years with an average age of 45.3 years) with cervical vertebral hemangioma associated with cervical spondylotic myelopathy between January 2006 and September 2008. The disease duration was 10-26 months (mean, 15.6 months). All patients had single vertebral hemangioma, including 2 cases at C3, 3 cases at C4, 5 cases at C5, 5 cases at C6, and 3 cases at C7. The X-ray films showed a typical “pal isade” change. According to the cl inical and imaging features, there were 13 cases of type II and 5 cases of type IV of cervical hemangioma. The standard anterior cervical decompression and fusion with internal fixation were performed and then percutaneous vertebroplasty (PVP) was used. The cervical X-ray films were taken to observe bone cement distribution and the internal fixation after operation. The recovery of neurological function and the neck pain rel ief were measured by Japanese Orthopaedic Association (JOA) score and visual analogue scale (VAS) score. Results All operations were successful with no spinal cord and nerves injury, and the incisions healed well. Anterior bone cement leakage occurred in 2 cases without any symptoms. All cases were followed up 24-28 months (mean, 26 months) and the symptoms were improved at different degrees without fracture and collapse of vertebra or recurrence of hemangioma. During the follow-up, there was no implant loosening, breakage and displacement, and the mean fusion time was 4 months (range, 3-4.5 months). The JOA score and VAS score had a significant recovery at 3 months and at last follow-up when compared with preoperative values (P lt; 0.05). Based on JOA score at last follow-up, the results were excellent in 9 cases, good in 6 cases, fair in 2 cases, and poor in 1 case. Conclusion The anterior cervical decompression and fusion with internalfixation combined with PVP treatment is one of the ideal ways to treat symptomatic cervical vertebral hemangioma associated with cervical spondylotic myelopathy, which could completely decompress the spinal cord and effectively alleviate the cl inical symptoms caused by vertebral hemangioma.
ObjectiveTo explore the safety and effectiveness of graded infusion of bone cement in the unipedicular percutaneous vertebroplasty (PVP) for Kummell's disease.
MethodsEighteen patients with Kummell's disease were treated by unipedicular PVP with graded infusion of bone cement between January 2012 and January 2014. Of 18 cases, 6 were male and 12 were female, aged from 65 to 88 years (mean, 75 years), with a disease duration from 3 to 32 months (mean, 11.6 months). The bone mineral density was measured by dual-energy X-ray absorptiometry; the T value ranged from -4.0 to -2.8 (mean, -3.4). Affected segments included T11 in 3 cases, T12 in 10 cases, L1 in 3 cases, and L2 in 2 cases. X-ray films were taken after operation to observe bone cement leakage and anterior height changes of affected vertebrae. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess pain status and functional activity.
ResultsAll cases underwent smoothly unipedicular PVP and were followed up 12-26 months (mean, 14 months). Cement leakage occurred in 4 patients, including 1 case of anterior paravertebral soft tissue leakage, 2 cases of intervertebral disc leakage, and 1 case of canal venous leakage, but there was no other complications. The anterior height of affected vertebrae were significantly improved (P<0.05) from 29.1%±6.7% at preoperation to 68.1%±7.3% at 3 days after operation and 67.8%±5.9% at last follow-up; the VAS scores were significantly decreased (P<0.05) from 8.11±1.32 at preoperation to 2.14±0.78 at 3 days and 1.97± 0.50 at last follow-up; and ODI were significantly decreased (P<0.05) from 84.6%±8.5% to 24.1%±9.7% and 23.8%±10.2%; but no significant difference was found between at 3 days and at last follow-up (P>0.05).
ConclusionGraded infusion of bone cement in unipedicular PVP is a safe and effective procedure for Kummell's disease and this technique could decrease the incidence of bone cement leakage.
Objective
To study the effectiveness of long segment fixation combined with vertebroplasty (LSF-VP) for severe osteoporotic thoracolumbar compressive fractures with kyphosis deformity.
Methods
Between March 2006 and May 2012, a retrospective analysis was made on the clinical data of 48 cases of severe osteoporotic thoracolumbar compressive fractures with more than 50% collapse of the anterior vertebral body or more than 40
°
of sagittal angulation, which were treated by LSF-VP in 27 cases (LSF-VP group) or percutaneous kyphoplasty (PKP) in 21 cases (PKP group). All patients suffered from single thoracolumbar vertebral compressive fracture at T11 to L2. There was no significant difference in gender, age, spinal segment, and T values of bone mineral density between 2 groups (P gt; 0.05). The effectiveness of the treatment was appraised by visual analogue scale (VAS), Cobb angle of thoracolumbar kyphosis, height of anterior/posterior vertebral body, and compressive ratio of vertebrae before and after operations.
Results
The LSF-VP group had longer operation time, hospitalization days, and more bone cement injection volume than the PKP group, showing significant differences (P lt; 0.05). Intraoperative blood loss in LSF-VP group ranged from 220 to 1 050 mL (mean, 517 mL). No pulmonaryor cerebral embolism or cerebrospinal fluid leakage was found in both groups. Asymptomatic bone cement leakage was found in 3 cases of LSF-VP group and 2 cases of PKP group. The patients were followed up for 16-78 months (mean, 41.1 months) in LSF-VP group, and 12-71 months (mean, 42.1 months) in PKP group. No fixation failure such as loosened or broken pedicle screw was found in LSF-VP group during the follow-up, and no re-fracture or adjacent vertebral body fracture was found. Two cases in PKP group at 39 and 56 months after operation respectively were found to have poor maintenance of vertebral height and loss of rectification (Cobb angle was more than 40o) with recurrence of pain, which were treated by second surgery of LSF-VP; another case had compressive fracture of the adjacent segment and thoracolumbar kyphosis at 16 months after operation, which was treated by second surgery of LSF-VP. There were significant differences in the other indexes between each pair of the three time points (P lt; 0.05), except the Cobb angle of thoracolumbar kyphosis, and the height of posterior vertebral body between discharge and last follow-up in LSF-VP group, and except the Cobb angle of thoracolumbar kyphosis and compressive ratio of bertebrae between discharge and last follow-up in PKP group (P gt; 0.05). After operation, the other indexes of LSF-VP group were significantly better than those of PKP group at each time point (P lt; 0.05), except the VAS score and the height of posterior vertebral body at discharge (P gt; 0.05).
Conclusion
The effectiveness of LSF-VP is satisfactory in treating severe osteoporotic thoracolumbar compressive fractures with kyphosis deformity. LSF-VP can acquire better rectification of kyphosis and recovery of vertebral body height than PKP.
Objective To compare the effectiveness of different puncture methods of the flexible bone cement delivery device in unilateral percutaneous curved vertebroplasty for osteoporotic vertebral upper 1/3 compression fractures. Methods A retrospective analysis was conducted on the clinical data of 67 patients with osteoporotic vertebral upper 1/3 compression fractures who were admitted and met the selection criteria between January 2023 and April 2024. The patients were divided into two groups based on the puncture method of the flexible bone cement delivery device: the oblique puncture group (n=37) and the parallel puncture group (n=30). There was no significant difference (P>0.05) between the two groups in terms of gender, age, bone mineral density (T value), distribution of fractured vertebrae, time from injury to operation, and preoperative visual analogue scale (VAS) score for pain, Oswestry disability index (ODI), anterior vertebral height of the fractured vertebra, and Cobb angle of the fractured vertebra. The following parameters were compared between the two groups: operation time, incidence of secondary puncture, incidence of bone cement leakage, volume of injected bone cement, bone cement distribution score, as well as VAS score, ODI, anterior vertebral height of the fractured vertebra, and Cobb angle of the fractured vertebra at 1 day after operation and at last follow-up. Results Two cases in the oblique puncture group and 7 cases in the parallel puncture group underwent secondary puncture during operation, and the difference in the incidence of secondary puncture was significant (P<0.05). No complications such as bone cement hypersensitivity, bone cement embolism, nerve injury, or epidural hematoma occurred in both groups. There was no significant difference in operation time, volume of injected bone cement, incidence of bone cement leakage, distribution score and rating of bone cement between the two groups (P>0.05). All patients were followed up 6-18 months (mean, 12.0 months), and there was no significant difference in the follow-up time between the two groups (P>0.05). No further fracture collapse or compression occurred in the fractured vertebra during follow-up. Both groups exhibited significant improvements in VAS score, ODI, anterior vertebral height, and Cobb angle of the fractured vertebra after operation compared to baseline (P<0.05). There were also significant differences between the two time points after operation (P<0.05). However, there was no significant difference in the above indicators between the two groups (P>0.05). Conclusion For osteoporotic vertebral upper 1/3 compression fractures treated with unilateral percutaneous curved vertebroplasty, both oblique and parallel puncture methods of the flexible bone cement delivery device can effectively relieve pain, but the former is more conducive to reducing the incidence of secondary puncture.
Objective To evaluate the effectiveness of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fracture (OVCF) through unilateral puncture of extreme extrapedicular approach and bilateral injection of bone cement. Methods The clinical data of 156 patients with OVCF who met the selection criteria between January 2014 and January 2016 were retrospectively analyzed. All patients were treated with PVP through unilateral puncture. According to different puncture methods, the patients were divided into two groups. In group A, 72 cases were performed PVP through the unilateral puncture of extreme extrapedicular approach and bilateral injection of bone cement, while in group B, 84 cases were performed PVP through the unilateral puncture of transpedicular approach. There was no significant difference in general data of gender, age, weight, bone mineral density, lesion segment, and disease duration between the two groups (P>0.05). The radiation exposure time, operation time, volume of bone cement injection, rate of bone cement leakage, pre- and post-operative visual analogue scale (VAS) score and local Cobb angle were recorded and compared between the two groups. Results There was no significant difference in radiation exposure time and operation time between the two groups (P>0.05), but the volume of bone cement injection in group A was significantly more than that in group B (t=20.024, P=0.000). Patients in both groups were followed up 24-32 months (mean, 26.7 months). There were 9 cases (12.5%) and 10 cases (11.9%) of cement leakage in group A and B, respectively. There was no significant difference in the incidence (χ2=0.013, P=0.910). No neurological symptoms and discomfort was found in the two groups. The VAS scores of the two groups were significantly improved after operation (P<0.05). There was no significant difference in local Cobb angle between before and after operation in group A (P>0.05); but the significant difference was found in local Cobb angle between at 2 years after operation and other time points in group B (P<0.05). The VAS score and local Cobb angle in group A were significantly better than those in group B at 2 years after operation (P<0.05). Conclusion It is simple, safe, and feasible to use the unilateral puncture of extreme extrapedicular approach and bilateral injection of bone cement to treat OVCF. Compared with the transpedicular approach, the bone cement can be distributed bilaterally in the vertebral body without prolonging the operation time and radiation exposure time, and has an advantage of decreasing long-term local Cobb angle losing of the fractured vertebrae.
Objective To investigate the feasibil ity, safety and operative techniques of percutaneous vertebroplasty (PVP) in treating osteolytic bone metastasis of cervical vertebra and reconstructing the function of cervical vertebra. Methods From March 2005 to December 2007, 10 patients with osteolytic bone metastatic carcinoma in single cervical vertebral body received PVP, including 5 males and 5 females aged 38-75 years (mean 54.5 years). Among them, 5 patients had primary lung tumor, 1 primary renal tumor, 1 primary breast tumor, 1 primary cervical tumor and 2 unknown primary lesion. The course of disease was 2-4 years. All the patients suffered from obviously cervical pain and l imitation of activity, including 4 cases of metastatic tumor of the C2 vertebral body, 2 of C3, 2 of C6 and 2 of C7. The general condition of patients was stable before operation, and no blood coagulation dysfunction, radiculalgia and spinal cord compression were detected. Lateral PVP was performed on 6 cases, approaching between the vertebral artery and the carotid sheath under CT guidance and anterolateral PVP was performed on the rest 4 cases, approaching between the trachea and the internal carotid artery under continuously X-ray fluoroscopy. The amount of bone cement injected was 3-4 mL, and the fill ing rate was 50%-100%. Results Without obvious bleeding or organ injury, the puncture was performed successfully on all the patients. Without symptom of spinal cord compression, patients suffered from pain during operation (1 case) and such compl ications noted by immediate CT or X-rays examination after operation as paravertebral epidural cement leakage (2 ases),transverse foramen cement leakage (1 case) and pinhole reflux (3 cases). The pain of patients was improved to various degree postoperatively, the visual analogue scales score was (5.9 ± 1.2) points before operation, which was changed to (2.6 ± 1.2) points at 1 hour after PVP and (1.6 ± 1.3) points at 1 week after PVP, indicating there was a significant difference between pre- and postoperation (P lt; 0.05). During the regular follow-up at 1 week, 3 and 12 months after PVP, all patients had no dislocation of cervical vertebra body, spinal cord compression and paralysis. Five patients died from multiple organ failure due to primary tumor progression, including 3 cases at 6 months after PVP and 2 at 12 months after PVP, and the rest 5 patients’ cervical pain were under control, with sound functional recovery. Conclusion PVP can rel ieve pain quickly and reinforce the stabil ity of the vertebral body, and has sl ight compl ications; the lateral approach is safe and effective.
