Thoracic spinal cord injury and paraplegia caused by intradural cement leakage after percutaneous kyphoplasty: A case report

BACKGROUND Percutaneous kyphoplasty(PKP)is a pivotal intervention for osteoporotic fractures,pathological vertebral compression fractures,and vertebral bone tumors.Despite its efficacy,the procedure presents challenges,notably complications arising from intradural cement leakage.Timely and accurate diagnosis,coupled with emergent intervention is imperative to improve patient prognosis.This case report illuminates the intricacies and potential complications associated with PKP,emphasizing the critical need for vigilant monitoring,prompt diagnosis,and immediate intervention to mitigate adverse outcomes.CASE SUMMARY A 58-year-old male patient,experiencing a T7 osteoporosis-related pathological compression fracture,underwent PKP at a local hospital.Two weeks postprocedure,the patient developed paraplegic and dysuric symptoms,necessitating emergency decompression surgery.Gradual improvement was achieved,marked by the restoration of muscle strength,sensation,and mobility.CONCLUSION PKP Intradural cement leakage following PKP is unusual and potentially fatal.Prompt imaging examinations,urgent evaluation,and the decompression surgery are essential,which help alleviate symptoms associated with spinal damage,markedly improving the overall prognosis.

Clinical efficacy and safety of kyphoplasty for the treatment of osteoporotic vertebral compression fractures at different surgical timings based on the theory of“dynamic-static integration”

Objective:To investigate the clinical efficacy and safety of percutaneous kyphoplasty at different surgical timings in the treatment of osteoporotic vertebral compression fracture(OVCF)based on the theory of“dynamic-static integration”.Methods:Patients with OVCF who underwent percutaneous kyphoplasty in our hospital were selected and divided into Groups A,B,and C for those undergoing surgery within 7,7—21,and>21 days of fracture occurrence.The variations in the amount of bone cement injected,pre-and post-operative pain levels,functional activity,deformity correction of the injured vertebrae,bone cement leakage,and vertebral body height loss were compared among the three groups.Results:Regarding pain relief and functional activity,the postoperative Visual Analog Scale and Oswestry Disability Index scores of the three groups significantly improved.Furthermore,the deformities of the injured vertebrae in the three groups were significantly corrected,with Groups A and B exhibiting superior correction compared to Group C.Moreover,the bone cement leakage rates in groups A and C were higher than that in Group B.At the 3-month follow-up,the loss of vertebral height in Group C was significantly higher than those in groups A and B.Conclusion:Kyphoplasty is effective for OVCF treatment.Early surgery can effectively restore the vertebral height of the injured vertebra,reduce kyphosis,and reduce height loss of the injured vertebra after surgery;nevertheless,treatment within 1—3 weeks of the fracture can reduce the occurrence of bone cement leakage,making the surgery safer.Therefore,surgical treatment within 1—3 weeks of fracture is safer and can achieve satisfactory therapeutic effects.From the perspective of traditional Chinese medicine,PKP surgery can transform the fracture end from a micromotion state to a fixed state,which fully embodies the theory of“dynamic-static integration”.

Percutaneous kyphoplasty in the treatment of Kümmell disease in lumbar scoliosis:A case report

BACKGROUND Due to mechanical imbalance in the spine,elderly scoliosis patients tend to develop vertebral fracture nonunion,i.e.,Kümmell disease,when osteoporotic vertebral compression fractures occur.However,accompanying vertebral rotational deformities make surgical procedures challenging risky.Such patients are usually compelled to undergo conservative treatment and there are very few reports on minimally invasive surgeries for them.We first-time report a patient with Kümmell disease and lumbar scoliosis treated with percutaneous kyphoplasty(PKP)under O-arm guidance.CASE SUMMARY An 89-year-old female was admitted to the hospital due to delayed low back pain after a fall.She was diagnosed with Kümmell disease based on physical and radiologic examinations.The patient experienced severe scoliosis and subsequently underwent O-arm-guided kyphoplasty,resulting in a significant alleviation of low back pain.CONCLUSION PKP has good efficacy in treating Kümmell disease.However,surgical risks are elevated in scoliosis patients with Kümmell disease due to the abnormal anatomical structure of the spine.O-arm assisted operations play a crucial role in decreasing surgical risks.

Vertebroplasty and Kyphoplasty: Indications and Results, a Preliminary Senegalese Experience from the Neurosurgery Department of the CHNU of Fann

Introduction: Vertebroplasty and kyphoplasty are percutaneous techniques that consist in injecting an acrylic cement into the body of a pathological vertebra. This work aims to report the experience the of Fann’s neurosurgery department in treating certain spinal pathologies by vertebroplasty and kyphoplasty. Methods: During a 3-year period from July 1, 2019 to July 31, 2022, we conducted a retrospective, descriptive and analytical study, including patients who underwent vertebroplasty or kyphoplasty for dorsolumbar spinal pathology. Results: The mean age of the 13 patients in our study was 51.61 years. Female gender was predominant in 62% (n = 8). The context of spontaneous onset was found in six patients. Nine patients had a VAS (visual analogue scale) ≥ 8 (69.23%). On clinical examination, all patients had a syndrome without neurological deficits. 84.61% of patients had a CT scan (n = 11). The dorsolumbar hinge was most affected with 53.85% of cases. Seven patients had a vertebral compression of between 25% and. The average degree of kyphosis was 8˚ and seven patients had a degree of kyphosis ≥ 10˚. Tumour aetiology accounted for 46.15% of cases. Kyphoplasty was performed in 61.53% (n = 9) of the cases and vertebroplasty was performed in 38.47% (n = 4) of the patients. Kyphoplasty was associated with biopsy in two cases and with osteosynthesis in one patient. Vertebroplasty was always associated with a biopsy. The evolution was favourable with a significant reduction in pain and vertebral kyphosis. The mean VAS decreased from 8.15 to 0.69 three months after treatment and the mean kyphosis decreased from 8˚ to 2˚. Conclusion: Kyphoplasty and vertebroplasty as percutaneous techniques allow consolidation of the vertebral body and pain relief. Kyphoplasty alone not only reduces pain but also restores the height of the compacted vertebral body.

Comparative review of vertebroplasty and kyphoplasty

The aim of this review is to compare the effectiveness of percutaneous vertebroplasty and kyphoplasty to treat pain and improve functional outcome from ver-tebral fractures secondary to osteoporosis and tumor conditions. In 2009, two open randomized controlled trials published in the New England Journal of Medicine questioned the value of vertebroplasty in treating ver-tebral compression fractures. Nevertheless, the prac-tice of physicians treating these conditions has barely changed. The objective of this review is to try to clarify the most important issues, based on our own experi-ence and the reported evidence about both techniques, and to guide towards the most appropriate choice of treatment of vertebral fractures, although many ques-tions still remain unanswered.

The impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity during treatment of osteoporotic vertebral compression fractures with balloon kyphoplasty

This retrospective study investigated the impact of endplate fracture on postoperative vertebral height loss and kyphotic deformity in 144 patients with osteoporotic vertebral compression fracture （OVCF）, who received balloon kyphoplasty. Patients were divided into four groups： Group 1 had no superior endplate fracture, Group 2 had fractures on the anterior portion of the superior endplate, Group 3 had fractures on the posterior portion of the superior endplate, and Group 4 had complete superior endplate fractures. Anterior and middle vertebral body height, vertebral compression ratio, vertebral height loss rate, and kyphosis Cobb angle of each patient were measured and visual analogue scale （VAS） and Oswestry disability index （ODI） scores were recorded. The anterior vertebral height and kyphosis deformity of all groups significantly improved after the surgery, whereas substantial anterior vertebral height loss and increased Cobb angle were observed in all patients at the last follow-up. Although the vertebral height loss rate and the Cobb angle in Group 2, 3 and 4 were larger compared with Group 1 at the last follow-up, only the vertebral height loss rate in Group 4 and the increase in the Cobb angle in Group 2 and 4 were statistically different from those in Group 1. The VAS and ODI scores in all groups measured after the surgery and at the last follow-up were significantly lower compared with preoperative scores, but there was no significant difference among these groups. Balloon kyphoplasty significantly improved vertebral fracture height and kyphosis. Vertebral height loss and increased kyphotic deformity were observed in OVCF patients with endplate fractures after the surgery. Postoperative aggravation of kyphosis was observed in Group 2. Furthermore, severe vertebral height loss and increased kyphotic deformity were confirmed in Group 4 after the surgery. Our results suggested that postoperative vertebral height loss and aggravation of kyphosis may be associated with biomechanical changes in the vertebral body caused by endplate fracture. Therefore, surgery should not only restore compressed vertebral body height and correct kyphosis, but also correct the deformity of endplate to achieve an effective treatment of OVCF patients with endplate fracture.

Pedicle Screw Fixation with Kyphoplasty Decreases the Fracture Risk of the Treated and Adjacent Non-treated Vertebral Bodies:a Finite Element Analysis

Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures（OVCFs） after kyphoplasty.This finite element study was to examine whether short segment pedicle screw fixation（PSF） with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae after kyphoplasty for OVCFs.By simulating cement augmentation with or without short segment pedicle screw fixation（PSF）,two tridimensional,anatomically detailed finite element models of the T10–L2 functional spinal junction were developed.The insertion of pedicle screws into the intact vertebra apparently decreased the stress distribution of the treated vertebra in vertical compression and other load situations.The stress distribution in the bone structures of the intact vertebra adjacent to the intact-screwed vertebra was much less than that in the one adjacent to the treated vertebra.The insertion of pedicle screws into the intact vertebra greatly decreased the maximum displacement of the cortical bones and cancellous bones of the vertebrae.Our results indicated that short segment PSF with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae in the management of OVCFs.

Vertebral fracture assessment:Current research status and application in patients with kyphoplasty

Imaging of the spine is of paramount importance for the recognition of osteoporotic vertebral fractures(VFs), and standard radiography(SR) of the spine is the suggested diagnostic method but is not routinely used because of the cost and radiation exposure considerations. VF assessment(VFA) is an efficient, low radiation method for identifying VFs at the time of bone mineral density(BMD) measurement. Prediction models used to indicate the need for VFA may have little predictive power in subspecialty referral populations such as rheumatologic patients or patients who underwent kyphoplasty. Rheumatologic patients are frequently at increased risk for VFs, and VFA should be performed on an individual basis, also taking in account the guidelines for the general population. Kyphoplasty is a new minimal invasive procedure for the treatment of VFs and is being performed with increasing frequency. Following kyphoplasty, there may be a risk of new VFs in adjacent vertebrae. The assessment and follow-up of patients who underwent kyphoplasty requires repetitive X-ray imaging with the known limitations of SR. Thus, VFA may facilitate the evaluation of VFs in these patients because most of the kyphoplasty patients would fulfill the criteria. In a pilot study, we measured the BMD and performed VFA in 28 patients treated with kyphoplasty. Ratios of anterior to posterior(A/P) and middle to posterior(M/P) height were measured, and Genant's method was used to classify vertebrae accordingly. Intraobserver and interobserver reliability for A/P, M/P and the Genant's method were determined. Only 1 patient did not meet the criteria for VFA. Of the 364 available vertebrae, 295 could be analyzed. Most missing data(concerning 69 vertebrae) occurred in the upper thoracic region. Three of the 69 non-eligible vertebrae were lumbar vertebrae with cement leakage from the kyphoplasty procedure. In our hands, VFA was highly reproducible, demonstrating very good agreement in terms of intraobserver and interobserver reliability. Agreement was very good onthe vertebral level, "vertebrae with kyphoplasty" level and "2 above and 1 below the kyphoplasty vertebrae"level. The application of Genant's method to these patients also resulted in perfect agreement. We believe that the potential value of VFA in patients treated with kyphoplasty requires further evaluation, particularly comparing VFA with SR and performing a longitudinal follow-up. More research will help to adopt care processes that determine which patients require VFA and how often VFA should be performed, while also considering the impact of this technique on the cost of healthcare organizations.

A comparison of robot-assisted and fluoroscopy-assisted kyphoplasty in the treatment of multi-segmental osteoporotic vertebral compression fractures

Osteoporotic vertebral compression fracture(OVCF)has become a major public health issue that becomes more pressing with increasing global aging.Percutaneous kyphoplasty(PKP)is an effective treatment for OVCF.Robot-assisted PKP has been utilized in recent years to improve accuracy and reduce complications.However,the effectiveness of robot-assisted PKP in the treatment of multi-segmental OVCF has yet to be proved.This study was designed to compare the efficacy of robot-assisted and conventional fluoroscopy-assisted multi-segmental PKP.A total of 30 cases with multi-segmental OVCF between April 2019 and April 2021 were included in this study.Fifteen cases were assigned to the robot-assisted PKP group(robot group)and 15 cases to the conventional fluoroscopy-assisted PKP group(conventional fluoroscopy group).The number of fluoroscopic exposures,fluoroscopic dose,operation time,cement leakage rate,visual analog scale(VAS)score,vertebral kyphosis angle(VKA),and height of fractured vertebral body(HFV)were compared between the 2 groups.The number of fluoroscopic exposures,fluoroscopic doses,and cement leakage rates in the robot group were lower than in the conventional fluoroscopy group(P<0.05)while the operative time in the robot group was longer than in the conventional fluoroscopy group(P<0.05).VAS score and VKA were decreased and HFV was increased after surgery in both groups(P<0.05).Therefore,robot-assisted PKP for the treatment of multi-segmental OVCF can reduce the number of fluoroscopic exposures,fluoroscopic doses,and cement leakage compared to conventional treatment.As such,robot-assisted PKP has good application prospects and is potentially more effective in the treatment of multi-segmental OVCF.

A Comparative Study of High-viscosity Cement Percutaneous Vertebroplasty vs. Low-viscosity Cement Percutaneous Kyphoplasty for Treatment of Osteoporotic Vertebral Compression Fractures

The clinical effects of two different methods–high-viscosity cement percutaneous vertebroplasty（PVP） and low-viscosity cement percutaneous kyphoplasty（PKP） in the treatment of osteoporotic vertebral compression fractures（OVCFs） were investigated. From June 2010 to August 2013, 98 cases of OVCFs were included in our study. Forty-six patients underwent high-viscosity PVP and 52 patients underwent low-viscosity PKP. The occurrence of cement leakage was observed. Pain relief and functional activity were evaluated using the Visual Analog Scale（VAS） and Oswestry Disability Index（ODI）, respectively. Restoration of the vertebral body height and angle of kyphosis were assessed by comparing preoperative and postoperative measurements of the anterior heights, middle heights and the kyphotic angle of the fractured vertebra. Nine out of the 54 vertebra bodies and 11 out of the 60 vertebra bodies were observed to have cement leakage in the high-viscosity PVP and low-viscosity PKP groups, respectively. The rate of cement leakage, correction of anterior vertebral height and kyphotic angles showed no significant differences between the two groups（P〉0.05）. Low-viscosity PKP had significant advantage in terms of the restoration of middle vertebral height as compared with the high-viscosity PVP（P〈0.05）. Both groups showed significant improvements in pain relief and functional capacity status after surgery（P〈0.05）. It was concluded that high-viscosity PVP and low-viscosity PKP have similar clinical effects in terms of the rate of cement leakage, restoration of the anterior vertebral body height, changes of kyphotic angles, functional activity, and pain relief. Low-viscosity PKP is better than high-viscosity PVP in restoring the height of the middle vertebra.

A combination of digital design and three-dimensional printing to assist treatment of thoracolumbar compression fractures using percutaneous kyphoplasty

Objective:To evaluate the clinical efficacy of the preoperative digita1 design combined with three dimensional(3D)printing models to assist percutaneous kyphoplasty(PKP)treatment for thoracolumbar compression frac tures.Methods:From January 2018 to August 2020,we obtained data of 99 patients diagnosed thoracolumbar compression fractures.These patients were divided into control group(n=50)underwent traditional PKP surgery,and observation group(n=49)underwent preoperative digital design combined with 3D printing model assisted PKP treatment.The clinical efficacy was evaluated with five parameters,including operation time,number of intraoperative radiographs,visual analogue scale(VAS)score,Cobb Angle change,and high compression rate of injured vertebrae.Results:There were statistically significant differences of operation time and number of intraoperative radio graphs between the two groups(P<0.05).For VAS score,Cobb Angle change and vertebral height compression rate,all of these three parameters were significantly improved when the patients accepted surgery teatment in two groups(P<0.05).However,there were no significant differences between control group and observation group for these three parameters either before or after surgery(P>0.05).Conclusions:Through the design of preoperative surgical guide plate and the application of 3D printing model to guide the operation,the precise design of preoperative surgical puncture site and puncture Angle of the injured vertebra was realized,the number of intraoperative radiographs was reduced,the operation time was shortened and the operation efficiency was improved.

Percutaneous vertebroplasty versus percutaneous kyphoplasty for the treatment of delayed post-traumatic vertebral body collapse(Kümmell’s disease) in Chinese patients: a systematic review and meta-analysis

Objective: To compare the clinical efficacy between percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP) in the treatment of Kümmell's disease in Chinese patients.Methods: The studies using randomized controlled trials to compare clinical efficacy between PVP and PKP in the treatment of Kümmell's disease in Chinese patients were retrieved from Embase, Pubmed, Central, Cinahl, PQDT, CNKI, CQVIP, Wanfang Data, and CBM(from September 2008 to September 2018). Keywords for both Chinese and English search were: percutaneous vertebroplasty, PVP, percutaneous kyphoplasty, PKP, and Kümmell's disease. A total of 132 articles were retrieved based on the search strategy through online database searching and manual searching. Finally, one foreign report and seven Chinese reports were included. After extracting the data, statistical software Review Manager 5.3 was used for data analysis.Results: Through comparison, Cobb angle(95% CI [0.54, 4.42), P = 0.01] and Oswestry Dysfunction Index(ODI)(95% CI [0.21, 2.15], P= 0.02) of PKP group was smaller than that of PVP group. Postoperative anterior vertebral body height of the PKP group was better than PVP group(95% CI [-1.27,-0.66], P < 0.001]. However, the PVP group had shorter operation time than PKP group(95% CI [-13.48,-7.43), P = 0.001]. In the other outcome measures, including Visual Analogue Scale(VAS) score(95% CI [-0.04, 0.27), P = 0.15), cement volume(95% CI [-0.82, 0.32], P = 0.39) and cement leakage(95% CI [0.90, 2.76], P = 0.11), there was no significant differences between the two procedures.Conclusions: At this stage, there is sufficient evidence to support that PKP is better than PVP in the treatment of Kümmell's disease in Chinese patients. Although PVP surgery requires much less operation time, PKP has better postoperative radiological results and lower ODI. Moreover, both of them had similar clinical results(e.g., analgesic effects, cement dosage, and leakage rate). Further evidence is dependent on the emergence of randomized controlled trials with higher quality and larger sample sizes in the future.

Diagnosis and Treatment and Infection Protection Strategy of Osteoporotic Vertebral Compression Fractures Minimally Invasive Percutaneous Kyphoplasty Surgery during the Prevention and Control of COVID-19

Background: As the global novel coronavirus pneumonia (NCP) remains severe, elderly people are at high risk for NCP and osteoporotic vertebral compression fractures, with high complications and mortality. How to treat patients and protect medical staff from infection, and at the same time strictly prevent the occurrence of clustered transmission events in the hospital, the establishment of perfect pre-hospital emergency measures and infection prevention and control strategy is the first element to ensure success. Objective: To establish the diagnosis and treatment and infection protection strategy for Osteoporotic vertebral compression fractures (OVCF) patients undergoing minimally invasive percutaneous kyphoplasty (PKP) surgery during the prevention and control of COVID-19, so as to ensure the stable, orderly and safe medical treatment. Methods: A total of 583 OVCF patients were admitted to the First Affiliated Hospital of Hebei North University during the epidemic prevention and control period from January 2020 to July 2022. After urgent and outpatient strict standardized screening, 382 patients met the inclusion criteria, including 112 males and 270 females, aged (70.50 ± 5.49) years. The preoperative visual analogue scale (VAS) score was 6.92 ± 1.86. Preoperative Oswestry disability index (ODI) was 74.67 ± 4.84. The satisfaction rate was (45.89 ± 3.67) %. According to the clinical diagnostic criteria and classification, 367 patients were diagnosed as ordinary OVCF, including 156 cases of mild compression and 226 cases of moderate compression. The clinical classification of 15 patients with OVCF diagnosed as COVID-19 was type I, including 10 cases of mild COVID-19 and 5 cases of common COVID-19. All patients were treated with PKP. Results: All patients were followed up at 1 day, 1 month and 3 months after operation, VAS (2.01 ± 0.56, 0.45 ± 0.11, 0 ± 0), ODI (45.41 ± 4.15, 10.22 ± 2.73, 4.03 ± 1.57) and satisfaction (90.12%, 95.57%, 99.23%) were significantly improved compared with those before operation (p < 0.05), and the original medical diseases were not aggravated. In this group, 15 cases of OVCF diagnosed with COVID-19 were given priority to treat COVID-19 under strict three-level protection in the designated isolation ward. PKP was carried out after the condition was stable, and the areas, items and personnel in contact with patients during the perioperative period must be strictly and thoroughly disinfected. The patient had a good prognosis, no complications, no cross-infection in the hospital, and no infection rate among medical staff. Conclusions: The implementation of the diagnosis and treatment and infection protection strategy for OVCF patients undergoing minimally invasive PKP surgery during the prevention and control of COVID-19 has a guiding role in preventing the spread of infection, improving the cure rate, promoting rapid recovery, reducing complications and reducing mortality.

Biomechanical Study of the Effects of Balloon Kyphoplasty on the Adjacent Vertebrae

We used the finite element method (FEM) to investigate the stress profiles of vertebrae in patients who underwent balloon kyphoplasty (BKP) for vertebral fracture. BKP is often performed for persistent pain after vertebral fractures. However, fractures are frequently reported in the adjacent vertebrae after BKP. The purpose was to clarify the mechanism of fractures that occur in the adjacent vertebrae after BKP. The subjects were two patients (first case: 74-year-old woman;second case: 88-year-old woman) who had BKP for osteoporotic vertebral fractures (L1). A bone analysis software program, Mechanical Finder, was used to construct three-dimensional finite element models (T11-L3) from computed tomographic (CT) digital imaging and communications in medicine (DICOM) data. Moment loadings were examined to evaluate stress concentrations on the vertebrae. Young’s moduli were lower in the second case than in the first case at all vertebral levels. Maximum Drucker-Prager stresses after BKP were larger in the second case than in the first case for compression, flexion, extension, and axial rotation. Strain energy density decreased in L1 and increased in the adjacent ver-tebrae. Our results suggest that post-BKP fractures of the adjacent vertebrae not only are due to bone fragility, but also can be caused by increased rigidity in the vertebrae filled with bone cement, which increases stress concentration on the adjacent verte-brae and raises the likelihood of fracture.

The Clinical Effect of Zoledronic Acid Combined with Teriparatide in Perverting Recurrent Fracture of Osteoporotic Vertebral Compressive Fractures in the Elderly after Percutaneous Kyphoplasty

Background: Zoledronic acid and teriparatide have been proved to be effective in improving bone metabolism and preventing fractures, but there is no clear clinical report on the efficacy of their combined application. Purpose: To discuss the clinical effect of zoledronic acid combined with teriparatide in perverting recurrent fracture of osteoporotic vertebral compressive fractures (OVCF) in the elderly after percutaneous kyphoplasty (PKP). Method: A randomized clinical trial was conducted at the First Affiliated Hospital of Hebei North University in China from September 2018 and September 2019. A total of 60 patients with OVCF were enrolled in the study (zoledronic acid: 20 cases;teriparatide: 20 cases;zoledronic acid + teriparatide: 20 cases). Observe and compare the changes of bone mineral density (BMD), pro-collagen type I N-terminal propeptide (PINP) and cross-linked C-terminal telopeptide of type I collagen (β-CTX) before surgery, 6 months and 1 year after surgery. At the same time, secondary fracture events and adverse reaction events were recorded during the follow-up period. Results: After normalized treatment, the bone metabolism indexes of PINP and β-CTX were improved and BMD was increased in three groups. Adverse Reactions: There was no statistical significance in the incidence of fever, gastrointestinal reactions and myalgia among the three groups (P > 0.05). The incidence of recurrent fractures in group A was higher than that in group C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). Conclusion: Zoledronic acid combined with teriparatide is superior to Zoledronic acid in preventing the risk of recurrent fracture after PKP for old patients with OVCF, but it has no significant advantage over teriparatide.

Balloon Kyphoplasty to Thoracic Vertebral Fracture with Postoperative Treatment Difficulty: A Case Report

<span style="font-family:Verdana;line-height:1.5;">In this communication, we report our experience with a case of thoracic vertebral fracture which was treated by balloon kyphoplasty and which later developed an infection at the fracture site, causing treatment difficulty. The patient was a 74-year old female with a history of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome as well as diabetes mellitus. She had been diagnosed with mycoplasma pneumonia as well as a fracture of the T12 vertebral and was admitted to the Department of Internal Medicine to receive medical/non-surgical treatment. Medical treatment was carried out and the pneumonia symptoms improved but getting out of bed was impossible due to the continuing of back pain. Therefore, T12 balloon kyphoplasty was performed in order to allow for early ambulation. Back pain started to improve immediately after surgery, but at 2 months after surgery, the back pain relapsed, and fever developed. Imaging tests revealed a vertebral osteolysis of T11-T12 and, as a measure against vertebral collapse due to postoperative infection or osteomyelitis of the thoracic spine, the feasibility of balloon kyphoplasty was considered. Antibiotic treatment was carried out, and when findings showed that the infection had resolved, posterior fusion (T9-L2) was performed using percutaneous pedicle screws. When balloon kyphoplasty for the treatment of a vertebral fracture is performed in an immunocompromised patient early after injury, the treatment needs to be chosen carefully, and the possibility of a latent vertebral osteomyelitis should be kept in mind.

Meta-analysis of percutaneous kyphoplasty for elderly osteoporotic vertebral compression fractures

Objective:To evaluate the clinical efficacy of percutaneous kyphoplasty(PKP)in the treatment of osteoporotic vertebral compression fractures(OVCF)in the elderly by meta-analysis,and to provide a basis for clinical application.Methods:CNKI,Wanfang,Weipu,CBM,PubMed,the Cochrane Library and EMbase were retrieved by computer from the date of establishment to January 2019.The literature on randomized controlled trials of PKP and conservative treatment of OVCF was collected and diagnosed as thoracolumbar vertebral compression fracture by X-ray,CT,and MRI.Osteoporosis of thoracolumbar vertebrae(T<2.5)was determined by bone mineral density measurements.Age(>50 years old)and course of the disease(<3 months).Postoperative outcome indicators included at least one of the following indicators:visual analogue scale.VAS and Oswestry Dysfunction Index(ODI),changes of Cobb angle of diseased vertebrae and height of the anterior edge of diseased vertebrae.The quality of the included literature was evaluated by referring to the evaluation criteria for randomized controlled trials provided in the Cochrane Systematic Evaluation Manual.Results:Six randomized controlled trials studies were included,all of which were Chinese literature.Five of them had 4 or more points in methodological quality evaluation and one had 3 points in methodology quality evaluation.There were 525 patients in the two groups,267 in the PKP group and 258 in the conservative treatment group.Meta-analysis showed that the pain visual analogue score in the PKP group was significantly higher than that in the conservative treatment group[MD=2.10,95%CI(-2.25,-1.95),P<0.00001].There were significant differences between the PKP group and the conservative treatment(CT)group[MD=8.90,95%CI(-9.86,-7.94),P<0.00001]in the changes of the Cobb angle of the diseased vertebrae after treatment.There were significant differences in the ODI and the height of the anterior edge of the diseased vertebrae(P<0.05).Conclusion:PKP treatment of OVCF can effectively reduce pain visual analogue score,improve dysfunction index(ODI)and improve the quality of life of patients.It can also effectively restore the height of vertebral loss,correct the Cobb angle of the diseased vertebrae,and reduce the risk of recurrent fracture of the adjacent vertebral body and serious complications.

Research of the Clinical Effect of Kyphoplasty in the Treatment of Multiple Senile Osteoporotic Spinal Fractures

Objective:To evaluate the clinical effect of kyphoplasty in the treatment of multiple osteoporotic vertebral fractures in the elderly.Methods:The duration of the study was selected from January 2018 to December 2020,and 38 patients with multiple osteoporotic spinal fractures were selected for study evaluation.All patients were treated with kyphoplasty.The clinical indicators of the two groups were compared and analyzed.Results:The total effective rate was 94.7%and the complication rate was 5.3%.The height of midline,anterior and posterior vertebral body,Cobb angle,VAS score,ODI score and ADL score of 38 patients before and after treatment were compared,which were significantly better than those before treatment(P<0.05).Conclusion:The clinical effect of kyphoplasty in the treatment of elderly patients with multiple osteoporosis is significant,which can be promoted in all levels of medical institutions.

Surgical Management of Lumbar and Thoracolumbar Spinal Fractures: Indications, Surgical Technique and Evaluation on a Series of 64 Patients Treated with Percutaneous Posterior Osteosynthesis Combined with Kyphoplasty or Anterior Arthrodesis

Introduction: Fractures of the lumbar spine and thoracolumbar junction are common in spinal trauma. The aim of this work is to analyze the nature of the indications, the morbidity as well as the results of these treatment regimens. Patients and Methods: A retrospective, single-center study, based on a review of 64 patients with lumbar spine and thoracolumbar junction fractures (T10-L2) without neurological disorders, was collected in the neurosurgery department of the North Hospital and University Hospital (CHU), Marseille over a period of 2 years from January 2015 to December 2016. Posterior percutaneous osteosynthesis were more or less associated with kyphoplasty preceded anterior arthrodesis. Clinical and radiological endpoints were collected at least 6 months later. Results: The mean follow-up was 9.5 months (6 - 24). The clinical evaluation found a mean VAS at last follow-up at 14/100 (0 - 30) and an average Oswestry score at the last follow-up at 88%. The initial average vertebral kyphosis went from 13° to 4° at the last follow-up with a correction loss of 1°, an absolute gain of 8°. No postoperative neurological complications were noted in our series. Conclusion: The implementation of a two-step therapeutic strategy with anterior reconstruction in Magerl’s lumbar spine or A3.3 thoracolumbar junction fractures allows effective and long-lasting correction of lumbar lordosis and thoracic kyphosis, and obtaining a balanced spine in the sagittal plane. Our functional results are close to normal, with low morbidity and a low complication rate.

Biomechanical assessment of new surgical method instead of kyphoplasty to improve the mechanical behavior of the vertebra:Micro finite element study

AIM To reduce post treatments of kyphoplasty, as a common treatment for osteoporotic vertebrae.METHODS This study suggests a new method for treating vertebrae by setting the hexagonal porous structure instead of the rigid bone cement mass in the kyphoplasty(KP). The KP procedure was performed on the fresh ovine vertebra of the level L1. Micro finite element modeling was performed based on micro computed tomography of ovine trabecular cube. The hexagonal porous structure was set on one cube instead of the bone cement mass. For the implant designing, two geometrical parameters were considered: Spacing diameter and thickness.RESULTS The results of micro finite element analyses indicated the improvement in the mechanical behavior of the vertebra treated by the hexagonal porous structures, as compared to those treated by vertebroplasty(VP) and KP under static loading. The improvement in the mechanical behavior of the vertebra, was observed as 54% decrease in the amount of maximum Von Misses stress(improvement of stress distribution), in trabecular cube with embedded hexagonal structure, as compared to VP and KP. This is comparable to the results of the experimental study already performed; it was shown that the improvement of mechanical behavior of the vertebra was observed as: 83% increase in the range of displacements before getting to the ultimate strength(increasing the toughness) after setting hexagonal pearls inside vertebrae. Both the material and geometry of implant influenced the amount of Von Mises stress in the structure.CONCLUSION The new proposed method can be offered as a substitute for the KP. The implant geometry had a more obvious effect on the amount of Von Mises stress, as compared to the implant material.