The present role of vertebroplasty and kyphoplasty in the treatment of fresh vertebral compression fractures.

Minerva Chir. 2010 Aug;65(4):429-37

Authors: Röllinghoff M, Zarghooni K, Dargel J, Schlegel UJ, Siewe J, Eysel P, Sobottke R

Vertebroplasty (VP) and kyphoplasty (KP) are minimally invasive vertebral augmentation procedures for the treatment of fresh vertebral compression fractures (VCFs) associated with osteoporosis, trauma, malignant conditions, hemangiomas, and osteonecrosis. During these procedures, bone cement (e.g., polymethylmethacrylate) is percutaneously injected into the vertebral body. Systematic reviews of both procedures have shown significantly improved back pain and quality of life compared to conservative therapy. Direct comparison between VP and KP is not possible because of the lack of prospective randomized data comparing the two procedures. Both appear to improve patient functional status in most studies, although it is difficult to pool the available data because of differing measurement scales. With increasing popularity of both techniques, particularly over the past ten years, a rising number of publications have detailed potential complications secondary to cement extravasation, from compression of neural elements to venous embolism. Overall complication rates for both procedures are low. Systematic reviews have found significantly higher rates of cement leakage after VP (40%) versus KP (8%), with 3% of VP leaks being symptomatic. The evidence for increased risk of adjacent level fracture after these procedures compared to conservative treatment is inconclusive. When performed by a well-trained practitioner in appropriately selected patients, vertebroplasty and kyphoplasty are both safe and effective treatments for fresh vertebral compression fractures. Results from ongoing randomized controlled trials will provide further detailed information about both procedures in the future.

PMID: 20802431 [PubMed - in process]

Silk fibroin added to calcium phosphate cement to prevent severe cardiovascular complications.

Med Sci Monit. 2010 Aug 7;16(9):HY23-26

Authors: Ding T, Yang H, Maltenfort M, Xie R

As a bone cement in vertebroplasty and kyphoplasty, calcium phosphate cement (CPC) has several advantages over polymethylmethacrylate (PMMA) including biomcompatibility, biodegradability and osteoconductivity. However, its decay properties raise the risk of pulmonary embolism and consequent cardiovascular complications. Animal experiments have demonstrated that the disintegration of CPC forming more emboli, especially microemboli, causes more severe cardiovascular deterioration than PMMA. Current efforts focus on the incorporation of organic proteins or polymers into CPC to improve its stability in fluids, by enhancing the hydroxyapatite (HA) formation and reducing the fluid penetration. Silk fibroin (SF) can regular the mineralization process and bond with HA to form fibroin-HA nanocomposites with increased gelation properties. SF also has excellent biomechanical, biocompatible and biodegradable properties, and is convenient and inexpensive to produce. We hypothesize that silk fibroin can be used as an additive to improve the cohesion of CPC and decrease its risk of cardiovascular complications in its application in veterbroplasty/kyphoplasty.

PMID: 20802422 [PubMed - in process]

A Clinical Comparative Study on Low Versus Medium Viscosity PolyMethylMetAcrylate Bone Cement in Percutaneous Vertebroplasty: Viscosity Associated With Cement Leakage.

Spine (Phila Pa 1976). 2010 Aug 26;

Authors: Nieuwenhuijse MJ, Muijs SP, van Erkel AR, Dijkstra SP

STUDY DESIGN.: Comparative, prospective follow-up study. OBJECTIVE.: Comparison of outcome between patients treated with Percutaneous VertebroPlasty (PVP) using low and medium viscosity PolyMethylMetAcrylate (PMMA) bone cement. SUMMARY OF BACKGROUND DATA.: Viscosity is the characterizing parameter of PMMA bone cement, currently the standard augmentation material in PVP, and influences interdigitation, cement distribution inside the vertebral body, injected volume and extravasation, thereby affecting the clinical outcome of PVP. Currently, low, medium, and high viscosity PMMA bone cements are used interchangeably. However, effect of viscosity on clinical outcome in patients with Osteoporotic Vertebral Compression Fractures (OVCFs) has not yet been explicit subject of investigation. METHODS.: Follow-up was conducted using a 0 to 10 Pain Intensity Numerical Rating Scale (PI-NRS) and the Short Form 36 (SF-36) Quality of Life questionnaire before PVP and at 7 days (PI-NRS only), 1, 3, and 12 months after PVP. Injected cement volume, degree of interdigitation, and cement leakage were analyzed on direct postoperative computed tomography scanning. At 6 and 52 weeks and at suspicion, patients were analyzed for new fractures. RESULTS.: A total of 30 consecutive patients received PVP using low viscosity PMMA bone cement (OsteoPal-V) for 62 OVCFs, followed by 34 patients who received PVP using medium viscosity PMMA bone cement (Disc-O-Tech) for 67 OVCFs. Results regarding PI-NRS and SF-36 were comparable between both groups. Postoperative comparison of injected cement volume, degree of interdigitation, proportion of bipedicular procedures, incidence of new vertebral fractures and complications revealed no differences between both groups. Viscosity was identified as a risk factor for the occurrence of cement leakage (yes/no, OR: 2.925, 95% confidence interval: [1.072-7.984], P = 0.036). CONCLUSION.: No major differences in clinical outcome after PVP in OVCFs using low and medium viscosity PMMA bone cement were found. Viscosity of PMMA bone cement was identified as an independent predictor of cement leakage.

PMID: 20802393 [PubMed - as supplied by publisher]

Vertebroplasty of the C2 Vertebral Body and Dens Using an Anterior Cervical Approach: Technical Case Report.

Neurosurgery. 2010 Aug 27;

Authors: Dorman JK

BACKGROUND AND IMPORTANCE:: This article is the first description of an anterior approach for a biopsy and vertebroplasty of the C2 body and dens. CLINICAL PRESENTATION:: A 52-year-old woman presented with a 9-month history of neck pain and a destructive lesion of the dens. The patient was treated with pain medication as well as steroid injections without relief of her pain. A biopsy and vertebroplasty of the C2 body and dens was performed using an anterior cervical approach. CONCLUSION:: This report describes the first vertebroplasty of C2 using an open anterior cervical approach.

PMID: 20802357 [PubMed - as supplied by publisher]

Vertebroplasty for acute osteoporotic spinal fractures-best evidence?

J Vasc Interv Radiol. 2010 Sep;21(9):1330-3

Authors: Clark W, Goh AC

PMID: 20800775 [PubMed - in process]

Related Articles

A prospective comparative study of kyphoplasty using the Jack vertebral dilator and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures.

J Bone Joint Surg Br. 2010 Sep;92(9):1282-8

Authors: Shen GW, Wu NQ, Zhang N, Jin ZS, Xu J, Yin GY

This study prospectively compared the efficacy of kyphoplasty using a Jack vertebral dilator and balloon kyphoplasty to treat osteoporotic compression fractures between T10 and L5. Between 2004 and 2009, two groups of 55 patients each underwent vertebral dilator kyphoplasty and balloon kyphoplasty, respectively. Pain, function, the Cobb angle, and the anterior and middle height of the vertebral body were assessed before and after operation. Leakage of bone cement was recorded. The post-operative change in the Cobb angle was significantly greater in the dilator kyphoplasty group than in the balloon kyphoplasty group (-9.51 degrees (sd 2.56) vs -7.78 degrees (sd 1.19), p < 0.001)). Leakage of cement was less in the dilator kyphoplasty group. No other significant differences were found in the two groups after operation, and both procedures gave equally satisfactory results in terms of all other variables assessed. No serious complications occurred in either group. These findings suggest that vertebral dilator kyphoplasty can facilitate better correction of kyphotic deformity and may ultimately be a safer procedure in reducing leakage of bone cement.

PMID: 20798449 [PubMed - in process]

Vertebral body fracture after anterolateral instrumentation and interbody fusion in two osteoporotic patients.

Spine J. 2010 Sep;10(9):e11-e15

Authors: Dua K, Kepler CK, Huang RC, Marchenko A

BACKGROUND CONTEXT: The XLP plate is an anterolateral instrumentation system developed as a part of the eXtreme Lateral Interbody Fusion (XLIF) system for lateral transpsoas interbody fusion, an alternative to anterior interbody fusion. PURPOSE: To report two cases of atraumatic coronal plane vertebral body fractures in the early postoperative period after interbody fusion using XLIF cages, lateral plating using the XLP plate, and unilateral posterior pedicle screw instrumentation. STUDY DESIGN: Case report. METHODS/SUMMARIES: Both patients were septuagenarian women with normal body mass indices and osteoporosis. The patients underwent L4-L5 XLIF with anterolateral instrumentation followed by posterior decompression and fusion using unilateral pedicle screws. In the early postoperative period (

PMID: 20797649 [PubMed - as supplied by publisher]