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Schematic diagram of refracture caused by endplate cortical disruption. Shows the presence of endplate cortical disruption (a). When the bone cement is injected, the displacement of the anterior edge of the vertebral body offsets the force of the bone cement to diffuse into the trabecular bone and causes NPEC (b). When subjected to axial pressure, part of the force will migrate to the horizontal direction, and the vertebral body is weak against the horizontal direction, resulting in refracture (c)
Source publication
Background
To determine the related imaging findings and risk factors to refracture of the cemented vertebrae after percutaneous vertebroplasty (PVP) treatment.
Methods
Patients who were treated with PVP for single vertebral compression fractures (VCFs) and met this study’s inclusion criteria were retrospectively reviewed from January 2012 to Janu...
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Purpose
To explore the risk factors of bone cement displacement after percutaneous vertebral augmentation (PVA) in patients with osteoporotic vertebral compression fracture (OVCF).
Methods
We retrospectively reviewed the records of 1,538 patients with OVCF treated with percutaneous vertebroplasty (PVP) or percutaneous vertebroplasty (PKP) from Jan...
Objective
To explore the high-risk factors of augmented vertebra recompression after percutaneous vertebral augmentation (PVA) in the treatment of osteoporotic vertebral compression fracture (OVCF) and analyze the correlation between these factors and augmented vertebra recompression after PVA.
Methods
A retrospective analysis was conducted on 353...
Purpose
To explore the optimal volume fraction percentage (VF%) and influencing factors of bone cement distribution in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF) using digital techniques.
Patients and methods
From January 2019 to February 2021, 150 patients with 0VCF who underwent PVP surgery in our h...
Background
Osteoporotic vertebral compression fractures (OVCF) appear to be more common as the population ages. Previous studies have found that percutaneous vertebroplasty (PVP) can achieve better short-term clinical outcomes than conservative treatment (CT) for OVCF. However, the long-term outcomes of PVP compared with CT for OVCF has been rare e...
Background
Osteoporotic vertebral compression fracture (OVCF) is one of the most common fragile fractures, and percutaneous vertebroplasty provides considerable long-term benefits. At the same time, there are many reports of postoperative complications, among which fracture after percutaneous vertebroplasty is one of the complications after vertebr...
Citations
... [1][2][3][4] However, complications such as refracture of previously operative vertebral body have been reported. [5][6][7][8][9][10] Refracture of augmented vertebral body may result in decreased vertebral body height, aggravation of the kyphotic deformity, and even compression of the spinal cord, which usually requires further treatment. ...
... Excessive recovery of vertebral body height is an important risk factor for cemented vertebral body refracture after 296 operation. 6,7,10 In this study, the mean vertebral height restoration and mean kyphosis angle restoration in the PCVP group was less than that in the PKP group after operation (P<0.01). And the refracture rate of cemented vertebra of PCVP group was less than that of PKP group. ...
Purpose
The purpose of this study is to compare the refracture rate of the cemented vertebral body of percutaneous curved vertebroplasty (PCVP) and bilateral percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF).
Methods
Ninety-four patients with single segment thoracolumbar OVCF were randomly divided into two groups (47 patients in each) and underwent PCVP or bilateral PKP surgery, respectively. Refracture of cemented vertebral body, bone cement injection volume and cement pattern, cement leakage rate, total surgical time, intraoperative fluoroscopy time, preoperative and postoperative Cobb angles and anterior vertebral height, Oswestry disability index questionnaire (ODI) and visual analog scales (VAS) were recorded.
Results
The PCVP group had significantly lower refracture incidence of the cemented vertebral than the bilateral PKP group (p<0.05). There was a significant postoperative improvement in the VAS score and ODI in both group (p<0.01), and no significant difference was found between two groups. The operation time and intraoperative fluoroscopy times were significantly less in the PCVP group than in the bilateral PKP group (p<0.01). The mean kyphosis angle correction and vertebral height restoration in the PCVP group was significantly less than that in the bilateral PKP group (p<0.01).
Conclusion
Both PCVP and PKP were safe and effective treatments for OVCF. The PCVP had lower refracture rate of the cemented vertebral than the bilateral PKP group, and PCVP entailed less exposure to fluoroscopy and shorter operation time than bilateral PKP.
... [8,9] Among these complications, secondary new vertebral compression fractures (SNVCFs) have become particularly concerning, as patients experience a recurrence of severe pain and may be unable to perform normal daily activities again and hence require an additional VP. Recently, several studies have analyzed the risk factors-decreased bone mineral density (BMD), cement leakage into the disc, sagittal imbalance, the presence of an intravertebral cleft, endplate cortical disruption, and the degree of restoration of the vertebral height-associated with SNVCFs after VP. [10][11][12][13][14][15] However, the results are contradictory and remain inconclusive. Furthermore, whether SNVCFs are caused by VP or by spontaneous progression of osteoporosis is yet to be confirmed. ...
... [29] Leakage of bone cement into the intervertebral space mechanically irritates the endplates of the vertebral bodies and accelerates disc degeneration, which adds to the stress on adjacent vertebral bodies, increasing the risk of fractures. [18] Cement leakage into the disc has been identified as a risk factor for SNVCF in several studies [15,18,21] ; however, this finding remains controversial. The present study also identified cement leakage into the disc as a risk factor for SNVCF through univariate and multivariate analyses. ...
Vertebroplasty (VP) effectively treats vertebral compression fractures (VCFs). However, the issue of secondary new VCFs (SNVCFs) after VP is yet to be addressed. Therefore, identification of risk factors for SNVCFs after VP may aid the development of strategies to minimize SNVCF risk. This study aimed to retrospectively evaluate risk factors for SNVCFs after VP, including those associated with the type of anti-osteoporotic treatment administered after VP. Data from 128 patients who underwent single-level VP were collected and reviewed. Patients were divided into 2 groups: those with (n = 28) and without (n = 100) SNVCF within 1 year of VP. We collected the following patient data: age, sex, site of compression fracture, medical history, bone mineral density (BMD), history of long-term steroid use, history of osteoporosis drug use, duration between fracture and VP, VP implementation method (unilateral or bilateral), cement usage in VP, cement leakage into the disc, compression ratio before VP, pre- and postoperative recovery ratio of the lowest vertebral body height, and kyphotic angle of fractured vertebrae. These data were analyzed to identify factors associated with SNVCFs after VP and to investigate the effects of the type of anti-osteoporotic treatment administered for SNVCFs. SNVCFs occurred in 28 patients (21.9%) within 1 year of VP. Logistic regression analysis identified BMD, cement leakage into the disc, and long-term steroid use to be significantly associated with the occurrence of SNVCFs. The group treated with zoledronate after VP had a significantly reduced SNVCF incidence compared with the group treated with calcium (P < .001). In addition, the zoledronate group had a lower SNVCF incidence compared with the groups treated with alendronate (P = .05), selective estrogen receptor modulators (P = .26), or risedronate (P = .22). This study showed that low BMD, presence of an intradiscal cement leak, and long-term steroid use were risk factors for developing SNVCFs following VP. Additionally, among osteoporosis treatments prescribed for VP, zoledronate may be the preferred choice to reduce the risk of SNVCFs.
... Despite these advantages, there are many complications after PKP, among which new vertebral compression fracture (NVCF) is one of the most common complications, with an incidence of up to 50% [6,7]. There are various statistical methods for estimating the probability of occurrence of binary events such as NVCF, the most commonly used being logistic regression (LR). ...
Background
The use of machine learning has the potential to estimate the probability of a second classification event more accurately than traditional statistical methods, and few previous studies on predicting new fractures after osteoporotic vertebral compression fractures (OVCFs) have focussed on this point. The aim of this study was to explore whether several different machine learning models could produce better predictions than logistic regression models and to select an optimal model.
Methods
A retrospective analysis of 529 patients who underwent percutaneous kyphoplasty (PKP) for OVCFs at our institution between June 2017 and June 2020 was performed. The patient data were used to create machine learning (including decision trees (DT), random forests (RF), support vector machines (SVM), gradient boosting machines (GBM), neural networks (NNET), and regularized discriminant analysis (RDA)) and logistic regression models (LR) to estimate the probability of new fractures occurring after surgery. The dataset was divided into a training set (75%) and a test set (25%), and machine learning models were built in the training set after ten cross-validations, after which each model was evaluated in the test set, and model performance was assessed by comparing the area under the curve (AUC) of each model.
Results
Among the six machine learning algorithms, except that the AUC of DT [0.775 (95% CI 0.728–0.822)] was lower than that of LR [0.831 (95% CI 0.783–0.878)], RA [0.953 (95% CI 0.927–0.980)], GBM [0.941 (95% CI 0.911–0.971)], SVM [0.869 (95% CI 0.827–0.910), NNET [0.869 (95% CI 0.826–0.912)], and RDA [0.890 (95% CI 0.851–0.929)] were all better than LR.
Conclusions
For prediction of the probability of new fracture after PKP, machine learning algorithms outperformed logistic regression, with random forest having the strongest predictive power.
Graphical Abstract
... However, complications such as refracture of previously ooperative vertebral body have been reported [5][6][7][8][9][10]. Refracture of augmented vertebral body may result in decreased vertebral body height, aggravation of the kyphotic deformity, and even compression of the spinal cord, which usually requires further treatment. ...
... When the loading transmitting through the augmented vertebra, the sponge pattern of cement distribution in PCVP causes less stress concentration than mass pattern in PKP, resulting in less refracture. Excessive recovery of vertebral body height is an important risk factor for cemented vertebral body refracture after operation [6,7,10]. In this study, the mean vertebral height restoration and mean kyphosis angle restoration in the PCVP group was less than that in the PKP group after operation(P < 0.01). ...
Refracture of cemented vertebral body is a complication after vertebroplasty in treatment of osteoporotic compression fractures (OVCF). The cemented vertebra refracture incidence was compared between PCVP and PKP and the results showed that PCVP had lower refracture incidence, and entailed less fluoroscopy and operation time than bilateral PKP.
Introduction The purpose of this study is to compare the refracture incidence of the cemented vertebral body of percutaneous curved vertebroplasty (PCVP) and bilateral percutaneous kyphoplasty (PKP) in the treatment of OVCF.
Methods Ninety-four patients with single segment thoracolumbar OVCF were randomly divided into two groups (47 patients in each) and underwent PCVP or bilateral PKP surgery respectively. The refracture of cemented vertebral body, bone cement injection volume and cement pattern, cement leakage rate, the total surgical time, intraoperative fluoroscopy time, preoperative and postoperative Cobb angles and anterior vertebral height, Oswestry disability index questionnaire (ODI) and visual analog scales (VAS) were recorded.
Results The PCVP group had significantly lower refracture incidence of the cemented vertebral than the bilateral PKP group (p<0.05). There was a significant postoperative improvement in the VAS score and ODI in both group (p<0.01), and no significant difference was found between two groups. The operation time and intraoperative fluoroscopy times were significantly less in the PCVP group than the bilateral PKP group (p<0.01). The mean kyphosis angle correction and vertebral height restoration in the PCVP group was significantly less than that in the bilateral PKP group (p<0.01).
Conclusion Both PCVP and PKP were safe and effective treatment for OVCF.
The PCVP had lower refracture incidence of the cemented vertebral than the bilateral PKP group, and PCVP entailed less exposure to fluoroscopy and shorter operation time than bilateral PKP.
... The results demonstrate that the EVA ® vertebral body reduction implants are able to achieve effective endplate reduction and provide similar biomechanical stability to that of the OsseoFix ® implant. Another issue of concern in vertebroplasty is the refracture of cemented vertebrae, which occurs in up to 30% of osteoporotic patients [45,46]; associated risk factors include intraosseous vacuum cleft, overcorrection of the anterior VBH, low BMD, and mostly inadequate cement filling pattern [45,46]. The advantage of the EVA ® device is not only the increased strength compared with the intact groups but also the enhanced symmetric distribution of cement into the surrounding trabeculae by the expanded blades. ...
... The results demonstrate that the EVA ® vertebral body reduction implants are able to achieve effective endplate reduction and provide similar biomechanical stability to that of the OsseoFix ® implant. Another issue of concern in vertebroplasty is the refracture of cemented vertebrae, which occurs in up to 30% of osteoporotic patients [45,46]; associated risk factors include intraosseous vacuum cleft, overcorrection of the anterior VBH, low BMD, and mostly inadequate cement filling pattern [45,46]. The advantage of the EVA ® device is not only the increased strength compared with the intact groups but also the enhanced symmetric distribution of cement into the surrounding trabeculae by the expanded blades. ...
... The advantage of the EVA ® device is not only the increased strength compared with the intact groups but also the enhanced symmetric distribution of cement into the surrounding trabeculae by the expanded blades. Thus, more interdigitated cement distribution resulting in less recollapse incidence could be expected [45,46]. ...
Unacceptable sagittal alignment and cement leakage are major concerns of percutaneous vertebroplasty when treating patients with painful vertebral osteoporotic compression fractures. To maintain the restored vertebral height and reduce the reliance on cement as the major stabilizer, an expandable vertebral augment system (EVA®) made of titanium alloy consisting of a rigid tube encased by a barrel with an anterior expansion mechanism was developed. The aim of the current study was to determine whether this novel design is as effective as existing procedures in terms of height restoration and biomechanical performance. Eight osteoporotic vertebrae (T12-L3) confirmed by dual-energy X-ray absorptiometry from two fresh-frozen human cadavers (70- and 72-year-old females) were used. Twenty-five percent reduced anterior wedge vertebral compression fractures were created using a material testing machine. Four randomized specimens were augmented with EVA® (Chang Gu Biotechnology Co. Ltd., Taipei city, Taiwan), and another four randomized specimens were augmented with OsseoFix® (AlphaTec Spine Inc., Carlsbad, CA, USA). The implant size and cement volume were controlled. The anterior vertebral body height (VBH) ratio and pre/postaugmented ultimate strength and stiffness were measured and compared. The mean anterior VBH restoration ratio was 8.54% in the EVA® group and 8.26% in the OsseoFix® groups. A significant difference from augmentation was measured in both groups (p < 0.05), but there was no significant difference between the EVA® and OsseoFix® groups in anterior VBH restoration. The ultimate strengths of the EVA® and OsseoFix® groups were 6071.4 ± 352.6 N and 6262.9 ± 529.2 N, respectively, both of which were statistically significantly higher than that of the intact group (4589.9 ± 474.6 N) (p < 0.05). The stiffnesses of the EVA®, OsseoFix®, and intact groups were 1087.2 ± 176.9, 1154.9 ± 168.9, and 1637.3 ± 340.8 N/mm, respectively, indicating that the stiffness was significantly higher in the intact group than in both the EVA® and OsseoFix® groups (p < 0.05). No significant differences were observed between the two augmentation procedures in height restoration or ultimate strength and stiffness. This novel EVA® system showed comparable height restoration and biomechanical performance to those of existing implants for human cadaveric osteoporotic compression fractures. Potential advantages of preventing cement posterior leakage and promoting cement interdigitation are expected with this ameliorated design.
... However, it is often difficult to completely correct the deformity of the endplate during surgery, which leads to increased stress in the perivertebral portion of patients with endplate fractures. In addition, the aggravation of kyphosis is related to the insertion of the intervertebral disc into the vertebral body or endplate from the fracture of the endplate, and the intervertebral disc embedded in the vertebral body or endplate is more likely to lose the height of the injured vertebral body due to necrosis after surgery (18). Therefore, the loss of postoperative vertebral height and the occurrence of kyphosis are closely related to the biomechanical changes of the vertebral body caused by changes in the stress distribution of the endplates (19). ...
Background
Endplate fractures is an important factor affecting the curative effect of percutaneous kyphoplasty for spinal fracture. The purpose of this study is to investigate the effect of sealing endplate fracture with bone cement on minimally invasive treatment of spinal fracture.
Methods
A total of 98 patients with osteoporotic vertebral fractures combined with endplate fractures treated with bone cement surgery in our hospital were retrospectively analyzed. They were grouped according to whether bone cement was involved in the endplate fractures. Group A: bone cement was not only distributed in the fractured vertebral body, but also dispersed into the endplate fractures. Group B: bone cement was confined to the fractured vertebra but did not diffuse into the cracks of the endplate. The basic information, imaging changes of the fractured vertebral body, VAS score, ODI score, bone cement distribution and postoperative complications of the two groups were analyzed and compared.
Results
The height of the injured vertebra and the kyphotic Cobb angle in the two groups were significantly improved after surgery, but the anterior height of the vertebra in group B was lower than that in group A and the kyphotic Cobb angle was higher than that in group A at the last follow-up ( P < 0.05). VAS score and ODI score in 2 groups were significantly improved after operation ( P < 0.05), but the VAS score and ODI score in group A were lower than those in group B at the last follow-up ( P < 0.05). The incidence of bone cement leakage and adjacent vertebral fracture in group A was higher than that in group B ( P < 0.05).
Conclusion
Diffusion of bone cement into the cracks of the endplate may also restore and maintain the height of the injured vertebra, relieve pain and restore lumbar function. However, diffusion of bone cement into the cracks of the endplate can increase the incidence of cement leakage and adjacent vertebral fractures.
... Intravertebral cleft (IVC) is characterized by linear or cystic light transmission area on imaging, which is common in patients with osteoporotic vertebral compression fracture and has been widely concerned by scholars [7,8]. Intravertebral cleft is generally considered to be an important factor leading to progressive vertebral collapse and kyphosis, intractable back pain and even spinal cord injury in patients with osteoporotic vertebral fracture [9]. ...
Background:
Intravertebral cleft is common in osteoporotic vertebral compression fracture, and the bone sclerosis around the fissure brings difficulties to the surgical treatment. It is not known whether the balloon dilatation mode of percutaneous kyphoplasty affects the distribution of bone cement in the fracture vertebral body and further affects the surgical effect. The purpose of this study was to discuss the effect of balloon dilatation mode on percutaneous kyphoplasty in the treatment of osteoporotic vertebral fractures with intravertebral cleft.
Methods:
According to the inclusion criteria and exclusion criteria, a retrospective analysis of patients with osteoporotic vertebral fracture combined with intravertebral cleft treated by percutaneous kyphoplasty in our hospital was conducted. All patients were divided into two groups based on way of balloon dilation. The mode of balloon dilatation, imaging changes of vertebral body, VAS score, ODI score, bone cement distribution and postoperative complications were analyzed.
Results:
A total of 96 patients with osteoporotic vertebral fracture combined with intravertebral cleft were included in the study, including 51 patients treated with single balloon bilateral alternating dilatation technique and 45 patients treated with double balloon bilateral dilatation technique. The vertebral height, Cobb's angle of kyphosis, VAS score and ODI score were significantly improved in both groups after operation (P < 0.05). The postoperative vertebral height and Cobb's angle of kyphosis in the double balloon bilateral dilatation group were better than those in single balloon bilateral alternating dilatation group (P < 0.05). The distribution of bone cement in the single balloon bilateral alternating dilatation group was more inclined to insert filling, while the double balloon bilateral dilatation group was more inclined to fissure filling. The VAS score and ODI score at the final follow-up in the single balloon bilateral alternating dilatation group were lower than those in the double balloon bilateral dilatation group (P < 0.05).
Conclusion:
Double balloon bilateral dilatation technique can better restore the injured vertebral height in patients with osteoporotic vertebral fracture combined with intravertebral cleft. However, the distribution of injured vertebral cement in patients with single balloon bilateral alternating dilatation technique is more likely to be inserted and filled, and the long-term analgesia and lumbar function of patients are better.
Polymethylmethacrylate (PMMA) bone cement extensively utilized for the treatment of osteoporotic vertebral compression fractures due to its exceptional handleability and mechanical properties. Nevertheless, the clinical application of PMMA bone cement is restricted by its poor bioactivity and excessively high modulus of elasticity. Herein, mineralized small intestinal submucosa (mSIS) was incorporated into PMMA to prepare a partially degradable bone cement (mSIS–PMMA) that provided suitable compressive strength and reduced elastic modulus compared to pure PMMA. The ability of mSIS-PMMA bone cement to promote the attachment, proliferation, and osteogenic differentiation of bone marrow mesenchymal stem cells was shown through cellular experiments carried out in vitro, and an animal osteoporosis model validated its potential to improve osseointegration. Considering these benefits, mSIS-PMMA bone cement shows promising potential as an injectable biomaterial for orthopedic procedures that require bone augmentation.
Background:
Percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP) are commonly employed for Kummell's disease in stages II-III; however, these techniques produce some complications.
Objective:
To compare the clinical efficacy and imaging results of percutaneous vertebroplasty + bone cement-augmented short-segment pedicle screw fixation (PSPVP) versus transpedicular intracorporeal bone grafting + pedicle screw fixation (PSIBG) in the treatment of stage II-III Kummell's disease.
Methods:
A total of 69 patients admitted between November 2017 and March 2021 were included in this study; 36 of these were treated with PSPVP, and 33 were treated with PSIBG. Patients in the two groups were compared in terms of perioperative, follow-up, and imaging data.
Results:
No statistically significant differences were found between the two groups in terms of operation duration (P > 0.05). However, the PSPVP group was superior to the PSIBG group in terms of incision length, intraoperative blood loss, and length of stay (P < 0.05). All patients were followed up for more than 12 months. The VAS score, height of anterior vertebral margin, kyphosis Cobb angle, wedge angle of the affected vertebra at seven days after surgery and last follow-up, and the ODI index at the last follow-up of the two groups were significantly improved compared with figures before surgery (P < 0.05). Compared with values before surgery, no statistically significant differences were found in the height of the posterior vertebral margin in the PSPVP group at seven days after surgery and at the last follow-up (P > 0.05). There were also no statistically significant differences in the VAS score, ODI index, kyphosis Cobb angle, and wedge angle of the affected vertebra between the two groups at corresponding time points (P > 0.05). The heights of the anterior and posterior vertebral margins in the PSIBG group were better than those in the PSPVP group after surgery and at the last follow-up (P < 0.05). In the PSPVP group, a pedicle screw fracture occurred in one patient two months after surgery, while an upper adjacent vertebral fracture occurred in one patient eight months after surgery.
Conclusion:
Both PSPVP and PSIBG can achieve good early clinical efficacy in the treatment of stage II-III Kummell's disease, with PSPVP being relatively less invasive while producing a poorer orthopedic effect and more complications than PSIBG.
