Figure 1 - uploaded by Daniele Vanni
Content may be subject to copyright.
Source publication
Background:
To evaluate the role of third generation percutaneous vertebral augmentation systems (Spine Jack(®)) as alternative to the corpectomies and expandable cages replacement (X-Core(®) Adjustable VBR System) in the treatment of vertebra plana (VP) as complication of the osteoporosis vertebral fracture (OVF).
Methods:
Spine Jack(®) is a ne...
Context in source publication
Context 1
... they could be very dangerous, they might represent the one and only chance to obtain the restoration of the anterior and middle column, in order to achieve the mechanical stability. The aim of this work is to evaluate the role of third generation percutaneous vertebral augmentation systems (Spine Jack ® ) (Figure 1) as alternative to the corpectomies and expandable cages replacement (X-Core ® Adjustable VBR System) ( Figure 2) in the treatment of vertebra plana (VP) as complication of the OVF. ...
Similar publications
Background context:
Balloon kyphoplasty (BKP) is a commonly performed vertebral augmentation procedure for painful osteoporotic vertebral compression fractures (OVCFs).
Objective:
This study aimed to support a non-inferiority finding for the use of a titanium implantable vertebral augmentation device (TIVAD) compared to BKP.
Study design:
Pros...
Citations
... On the other hand, the relative or absolute contraindications for interventional therapies are technical difficulties with the percutaneous approach [13,[106][107][108][109][110][111][112][113][114]. Recent studies reported that vertebroplasty could be no more a contraindication thanks to the radioguided approach and the reduced risk of medullar lesions or cement leakage into the spinal canal or into the perivertebral veins [12,115,116]. Others demonstrated the efficacy of third-generation vertebroplasty, percutaneous kyphoplasty with an expandable SpineJack implant, reporting a correct and stable reconstruction of the vertebra [115,117]. ...
... Recent studies reported that vertebroplasty could be no more a contraindication thanks to the radioguided approach and the reduced risk of medullar lesions or cement leakage into the spinal canal or into the perivertebral veins [12,115,116]. Others demonstrated the efficacy of third-generation vertebroplasty, percutaneous kyphoplasty with an expandable SpineJack implant, reporting a correct and stable reconstruction of the vertebra [115,117]. ...
Vertebra plana is a rare radiologic condition characterized by a uniform loss of height of a vertebral body that represents a diagnostic challenge for surgeons. The purpose of this study was to review all possible differential diagnoses that may present with a vertebra plana (VP) described in the current literature. For that purpose, we performed a narrative literature review in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, analyzing 602 articles. Patient demographics, clinical presentation, imaging characteristics and diagnoses were investigated. VP is not a pathognomonic feature of Langerhans cell histiocytosis, but other oncologic and non-oncologic conditions should be considered. The list of differential diagnoses, based on our literature review, can be recalled with the mnemonic HEIGHT OF HOMO: H—Histiocytosis; E—Ewing’s sarcoma; I—Infection; G—Giant cell tumor; H—Hematologic neoplasms; T—Tuberculosis; O—Osteogenesis imperfecta; F—Fracture; H—Hemangioma; O—Osteoblastoma; M—Metastasis; O—Osteomyelitis, chronic.
... Expandable cages have been used successfully to reconstruct the anterior spinal column in the treatment of traumatic cervical spine injury, neoplastic, infectious causes such as Pott's spine, degenerative spine disease and ossification of the posterior longitudinal ligament (OPLL). [5][6][7][8][9] Optimal graft placement and sizing are especially important in the reconstruction following multilevel corpectomy and fusion. Although titanium mesh cage has its own advantages but one technical problem often faced is the preparation of exact size of the implant matching into the corpectomy defect. ...
Objective After anterior cervical corpectomy expandable cage were used with or without using anterior cervical plate for structural support are being preferred over autologous bone graft and other types of cages. Nowadays, the preferable type of cages and application of anterior cervical plate remain a debatable topic with studies giving divergent results. The purpose of this study is to evaluate the outcomes of expandable cages used alone or expandable cage used with anterior cervical plate following anterior cervical corpectomy.
Materials and Methods This study was conducted on 100 patients from January 2019 to December 2021 and all patients were undergone anterior cervical corpectomy and fusion and divided in two groups with expandable cage only (Group A) and expandable cage with anterior cervical plate (Group B). Various long-term benefits and radiological outcomes were studied in both groups.
Statistical Analysis and Results In this study, 100 patients were included and all patients underwent corpectomy followed by insertion of expandable cage alone or with anterior cervical plate. There was an improvement in C2–C7 Cobb's angle in group B was significantly higher than group A (p < 0.05) and decrease in Nurick's scale score in group B was significantly higher than group A (p < 0.05). The outcomes were measured with fusion rate (94%), subsidence rate (15%) and change in C2–C7 Cobb's angle was 4 degrees in this study.
Conclusion Expandable cage with or without anterior cervical plate was used after anterior cervical corpectomy for various cervical pathological conditions. In this study, we conclude the long-term benefits and radiological outcomes of two groups as expandable cage was used alone or with additional application of anterior cervical plate. In this study, the results were more in favor of additional application of anterior cervical plate as compared with expandable cage alone and more studies were required in future for more established long-term benefits and drawbacks.
... 35 Adopting multiplanar intermittent imaging with dual CT and fluoroscopic guidance is preferable, 36 but interventional techniques can be performed with fluoroscopy or cone beam CT as a stand-alone. In the cervical, thoracic, and lumbar spine, spine augmentation can be achieved by balloon kyphoplasty, vertebroplasty, or for T5-L5 36 ; instrumented expandible devices, such as Spine Jack, 37 and other expandible titanium mesh implants, such as OsseoFix. Percutaneous image-guided sacroplasty offers an effective treatment for sacral insufficiency fracture and its pain. ...
... 36 Relative contraindications include chronic fractures with sclerosis because they are unlikely to benefit from the augmentation procedures, as well as the presence of direct posterior spinal cord compromise depicted on a preprocedural MR scan, where surgical decompression should be performed first, or fracture of the posterior column due to the increased risk of cement leakage. 36,37 Limitations to implementing image-guided interventional procedures for metabolic bone disease affecting the spine include the availability of trained radiologists, absence of institutional or national pathways to refer the patients within the first 6 weeks of fracture (optimal time interval for excellent outcomes), lack of reimbursement agreements, and paucity of double-blind randomized controlled trials with value-based analysis and long-term benefit evaluations against therapeutic options currently offered to patients. Nevertheless, image-guided procedures offer safe and effective therapeutic strategies to patients presenting with spinerelated pain and reduced mobility due to metabolic bone diseases and should be offered within multidisciplinary integrated fracture liaison services. ...
... Nevertheless, image-guided procedures offer safe and effective therapeutic strategies to patients presenting with spinerelated pain and reduced mobility due to metabolic bone diseases and should be offered within multidisciplinary integrated fracture liaison services. 35,37,38,40 Conclusion Metabolic bone diseases diffusely affect the bones and result in abnormalities of bone mass, structure mineral homeostasis, bone turnover, or growth. Some diseases have typical features of involvement of the spine. ...
Metabolic bone diseases comprise a wide spectrum. Of them, osteoporosis is the most frequent and the most commonly found in the spine, with a high impact on health care systems and on morbidity due to vertebral fractures (VFs).
This article discusses state-of-the-art techniques on the imaging of metabolic bone diseases in the spine, from the well-established methods to the latest improvements, recent developments, and future perspectives.
We review the classical features of involvement of metabolic conditions involving the spine. Then we analyze the different imaging techniques for the diagnosis, characterization, and monitoring of metabolic bone disease: dual-energy X-ray absorptiometry (DXA) and DXA-based fracture risk assessment applications or indexes, such as the geometric parameters, Bone Strain Index, and Trabecular Bone Score; quantitative computed tomography; and magnetic resonance and ultrasonography-based techniques, such as radiofrequency echographic multi spectrometry. We also describe the current possibilities of imaging to guide the treatment of VFs secondary to metabolic bone disease.
... Vertebral compression fractures with VP morphology are considered severe fractures, 24,25 and surgical stabilization is generally recommended to restore segmental stability, allow early mobilization, and avoid pseudoarthrosis. 10,[26][27][28] Kyphosis correction is important because kyphotic deformity is an independent risk factor for breathing difficulties and pulmonary complications, increasing morbidity and mortality. 29,30 Open surgical treatment is typically recommended, including anterior instrumentation to reconstruct the anterior spinal column. ...
... 38,39 The use of third-generation, rigid, intrasomatic distraction devices, such as SpineJack (Stryker) has been reported as a potential minimally invasive transpedicular replacement of expandable cages and, combined with posterior instrumentation, has been reported as a possible solution to treat VP fractures. 27 The SAIF technique applies a treatment rationale that is wellsuited to patients with severe vertebral collapse. The rigid stents obtain and maintain predictable fracture reduction, avoid deflation effect, and create room for cement, thus reducing the risk of leakage. ...
Background and purpose:
Fractures with "vertebra plana" morphology are characterized by severe vertebral body collapse and segmental kyphosis; there is no established treatment standard for these fractures. Vertebroplasty and balloon kyphoplasty might represent an undertreatment, but surgical stabilization is challenging in an often elderly osteoporotic population. This study assessed the feasibility, clinical outcome, and radiologic outcome of the stent screw-assisted internal fixation technique using a percutaneous implant of vertebral body stents and cement-augmented pedicle screws in patients with non-neoplastic vertebra plana fractures.
Materials and methods:
Thirty-seven consecutive patients with vertebra plana fractures were treated with the stent screw-assisted internal fixation technique. Vertebral body height, local and vertebral kyphotic angles, outcome scales (numeric rating scale and the Patient's Global Impression of Change), and complications were assessed. Imaging and clinical follow-up were obtained at 1 and 6 months postprocedure.
Results:
Median vertebral body height restoration was 7 mm (+74%), 9 mm (+150%), and 3 mm (+17%) at the anterior wall, middle body, and posterior wall, respectively. Median local and vertebral kyphotic angles correction was 8° and 10° and was maintained through the 6-month follow-up. The median numeric rating scale score improved from 8/10 preprocedure to 3/10 at 1 and 6 months (P < .001). No procedural complications occurred.
Conclusions:
The stent screw-assisted internal fixation technique was effective in obtaining height restoration, kyphosis correction, and pain relief in patients with severe vertebral collapse.
... Patients with continually painful osteoporotic vertebral fractures and patients with or without pain that present with progressively worsening fractures should be recommended for surgery, despite conservative treatment or bracing. Surgery can involve either open reduction, corpectomy with multilevel pedicle screw fixation, or more recently short segment fixation combined with vertebroplasty, which has been recommended to try and correct the kyphosis, or different types of percutaneous vertebral augmentation [3,4]. Open surgery can be problematic in these elderly patients since the screws will often not hold well in softer osteoporotic bone and elderly patients typically have significant medical comorbidities, increasing their risk of complications from blood loss and time under general anesthesia. ...
... These 100 patients had 110 acute and subacute high-degree osteoporotic fractures which is the subject of this report. This group of patients was then further subdivided into fractures with collapse between 50% and 70% which we designated as HDF and those over 70% defined in the literature as VP fractures [2][3][4]. These cases were selected only from a referral neurosurgical practice seeing patients after their initial evaluation by family medicine, internal medicine, orthopedics, or pain management because of persistent symptoms, degree of fracture, multiple fractures, or complicating co-morbidities. ...
... The surgical treatment of symptomatic osteoporotic fractures has evolved from open surgical correction with multi-level pedicle screw fixation, requiring general anesthesia and multiple-day hospital stay, to more minimally invasive percutaneous vertebroplasty, balloon kyphoplasty, or internal expansion devices such as the SJR, all combined with use of polymethyl methacrylate (PMMA) bone cement [4][5][6][7][8][9]. This study demonstrates that VP fractures can be safely and routinely treated percutaneously. ...
This is a retrospective study that evaluated surgical versus non-surgical treatment of 100 patients followed for up to six years diagnosed with severe osteoporotic vertebral compression fractures (VCF). Fractures were classified by percent collapse of vertebral body height as "high-degree fractures" (HDF) (>50%) or vertebra plana (VP) (>70%). A total of 310 patients with VCF were reviewed, identifying 110 severe fractures in 100 patients. The HDF group was composed of 47 patients with a total of 50 fractures. The VP group was composed of 53 patients with a total of 60 fractures. Surgical intervention was performed in 59 patients, comprised entirely of percutaneous vertebral cement augmentation procedures, including vertebroplasty, balloon kyphoplasty, or cement with expandable titanium implants. The remaining 41 patients only underwent conservative treatment that is the basis of the comparison study. All procedures were performed as an outpatient under local anesthesia with minimal sedation and there were no procedural complications. The initial or pre-procedural visual analog scale (VAS) score averaged 8.4 in all patients, with surgical patients having the most marked drop in VAS, averaging four points. This efficacy was achieved to a greater degree in surgically treated VP fractures compared to HDF. Non-surgical patients persisted with the most pain in both short- and long-term follow-up. This large series, with follow-up up to six years, demonstrated that the more severe fractures respond well to different percutaneous cement augmentation procedures with reduction of pain without increased complications in a comparison to conservatively treated patients.
... It was recommended to perform multilevel pedicle screw fixation but this was problematic in already osteoporotic elderly patients, where pedicle screws in adjacent osteoporotic vertebrae would loosen or not hold, as well as the elderly patients having significant medical co-morbidities that precluded a major spinal surgical procedure. Often fixation was done without correction of the collapsed vertebrae or correction of the kyphosis, which led to further fracture progression [2,3]. Recently, short segment pedicle fixation combined with kyphoplasty or vertebral corpectomy and vertebral replacement was suggested to improve the kyphosis [4]. ...
The surgical treatment of osteoporotic vertebral fractures with greater than 70% collapse, known as "Vertebra Plana (VP)" has been controversial. Originally VP was a considered a contraindication to vertebroplasty or kyphoplasty because of presumed difficulty of entering the collapsed vertebra as well as obtaining significant re-expansion or correct associated sagittal kyphosis. In some cases, multilevel pedicle screw fixation with or without attempts to correct the collapse is still performed to correct the kyphosis or prevent progression. With experience it was clear that the pedicle could be accessed and VP could be treated without added risk of epidural leak of cement or epidural extravasation. Now, with the introduction of newer third-generation intraspinal expansion devices that are larger and need to be placed bilaterally, their use in cases of VP was again an issue since VP cases were excluded from the original multicenter studies used for worldwide approval. This report reviews six cases of VP treated with bilateral SpineJack® implants (Stryker Corp, Kalamazoo, Michigan, USA) demonstrating it is not only feasible to place these larger size implants but achieve significant reconstitution of vertebral height as well as correction of the kyphotic deformity.
... On the other hand, these comminuted fractures are more at risk of secondary loss of reduction when compared with less comminuted fractures. Vanni et al. [30] used the SpineJack for anterior and middle column reconstruction as a valid alternative to the corpectomy in a limited number of patients with vertebra plana, especially in elderly patients and those with high operative risk. All cases were performed with posterior instrumentation and fusion. ...
This article is to review the different types of vertebral augmentation implants recently becoming available for the treatment of benign and malignant spinal compression fractures. After a detailed description of the augmentation implants, we review the available clinical data. We will conclude with a summary of the advantages and disadvantages of vertebral implants and how they can affect the future treatment options of compression fractures.
... Expandable cages (ECs) are frequently used to reconstruct the anterior spinal column after corpectomy. Indications include spinal canal stenosis with compression of the spinal cord [1], fracture [2,3], spondylodiscitis [4], and metastases [5]. Corpectomy of the cervical spine is performed through the anterior approach with the need of a graft or implant device for reconstruction [6]. ...
... Several clinical studies have shown the efficacy of the expandable cage, mostly in the cervical spine [2][3][4][5][6][7]10,[15][16][17][18][19][20][21]. Most common indications were, similar to our study, cervical spinal canal stenosis [7,12], metastases [5,10,17], fractures [2,6] and spondylodiscitis [4,19]. ...
... Several clinical studies have shown the efficacy of the expandable cage, mostly in the cervical spine [2][3][4][5][6][7]10,[15][16][17][18][19][20][21]. Most common indications were, similar to our study, cervical spinal canal stenosis [7,12], metastases [5,10,17], fractures [2,6] and spondylodiscitis [4,19]. Indications for surgery of spine metastases include intractable pain, spinal cord compression and stabilization of impending pathological fractures [5]. ...
Background and objectives: Expandable cages are frequently used to reconstruct the anterior spinal column after a corpectomy. In this retrospective study, we evaluated the perioperative advantages and disadvantages of corpectomy reconstruction with an expandable cage. Materials and Methods: Eighty-six patients (45 male and 41 female patients, medium age of 61.3 years) were treated with an expandable titanium cage for a variety of indications from January 2012 to December 2019 and analyzed retrospectively. The mean follow-up was 30.7 months. Outcome was measured by clinical examination and visual analogue scale (VAS); myelopathy was classified according to the EMS (European Myelopathy Scale) and gait disturbances with the Nurick score. Radiographic analysis comprised measurement of fusion, subsidence and the C2–C7 angle. Results: Indications included spinal canal stenosis with myelopathy (46 or 53.5%), metastasis (24 or 27.9%), spondylodiscitis (12 or 14%), and fracture (4 or 4.6%). In 39 patients (45.3%), additional dorsal stabilization (360° fusion) was performed. In 13 patients, hardware failure occurred, and in 8 patients, adjacent segment disease occurred. Improvement of pain symptoms, myelopathy, and gait following surgery were statistically significant (p < 0.05), with a medium preoperative VAS of 8, a postoperative score of 3.2, and medium EMS scores of 11.3 preoperatively vs. 14.3 postoperatively. Radiographic analysis showed successful fusion in 74 patients (86%). As shown in previous studies, correction of the C2–C7 angle did not correlate with improvement of neurological symptoms. Conclusion: Our results show that expandable titanium cages are a safe and useful tool in anterior cervical corpectomies for providing adequate anterior column support and stability.
... This may be because of the poor general condition and frequent instrumentation failure resulting from low bone quality in elderly patients. To treat these patients, a less invasive surgical approach in combination with more rigid fixation may be optimal [8], but some patients still require revision surgery because of progression of their kyphotic deformity, instrumentation failure, or both. Numerous comparative studies of surgical procedures have focused on clinical and radiographical outcomes, as well as the effect of bone fragility on the outcome of spinal surgery [9,10]. ...
Abtsract Background Numerous comparative studies of surgical procedures have focused on clinical and radiographical outcomes, as well as the effect of bone fragility on the outcome of spinal surgery; however, insights concerning a risk of mortality or morbidity have been limited. Additionally, the effect of surgical therapy on survival after vertebral compression fractures remains controversial. Our aim was to evaluate the preoperative factors that affected the long-term survival of patients who underwent spinal surgery for an insufficient union following osteoporotic vertebral fractures (OVF) and to determine postoperative mortality. Methods We retrospectively reviewed the cases of 105 consecutive patients who underwent spinal surgery for OVF. Mortality was estimated using the Kaplan-Meier method and a log-rank test. The preoperative backgrounds of patients were analyzed to determine which risk factors led to death among the OVF cases. Kaplan-Meier curves were used to estimate survival based on preoperative albumin levels of ≤3.5 g/dL (hypoalbuminemia) versus > 3.5 mg/dL. Results The mean follow-up time was 4.1 ± 0.8 years. Two years after surgery, percentage of patients who had died was 15%. The VAS scores and modified Frankel classification were significantly improved one year after surgery. The ratio of male-to-female was significantly higher for patients with OVF who died than for those who were still alive. No significant difference in mortality was observed among surgical procedures for OVF. The univariate analysis showed that male gender, serum albumin
... This may be because of the poor general condition and frequent instrumentation failure resulting from low bone quality in elderly patients. To treat these patients, a less invasive surgical approach in combination with more rigid xation may be optimal [8], but some patients still require revision surgery because of progression of their kyphotic deformity, instrumentation failure, or both. ...
Background: Numerous comparative studies of surgical procedures have focused on clinical and radiographical outcomes, as well as the effect of bone fragility on the outcome of spinal surgery; however, insights concerning a risk of mortality or morbidity have been limited. Additionally, the effect of surgical therapy on survival after vertebral compression fractures remains controversial. Our aim was to evaluate the preoperative factors that affected the long-term survival of patients who underwent spinal surgery for an insufficient union following osteoporotic vertebral fractures (OVF) and to determine postoperative mortality.
Methods: We retrospectively reviewed the cases of 105 consecutive patients who underwent spinal surgery for OVF. Mortality was estimated using the Kaplan-Meier method and a log-rank test. The preoperative backgrounds of patients were analyzed to determine which risk factors led to death among the OVF cases. Kaplan-Meier curves were used to estimate survival based on preoperative albumin levels of £ 3.5 g/dL (hypoalbuminemia) versus > 3.5 mg/dL.
Results: The mean follow-up time was 4.1 ±0.8 years. Two years after surgery, percentage of patients who had died was 15%. The VAS scores and modified Frankel classification were significantly improved one year after surgery. The ratio of male-to-female was significantly higher for patients with OVF who died than for those who were still alive. No significant difference in mortality was observed among surgical procedures for OVF. The univariate analysis showed that male gender, serum albumin <3.5g/dl, creatinine clearance<60mg/dl, and the American Society of Anesthesiologists classificat0ion ≥3 were significant risk factors for postoperative mortality. Multivariate analysis revealed that only serum albumin £3.5 g/dL was a significant risk factor for long-term postoperative mortality of patients with OVF.
Conclusions: Preoperative hypoalbuminemia was associated with postoperative mortality following surgery for OVF.
Level of Evidence: Level 3
