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.

Anterior vertebral body tethering for idiopathic scoliosis in growing children:A systematic review

BACKGROUND The management of idiopathic scoliosis(IS)in skeletally immature patients should aim at three-dimensional deformity correction,without compromising spinal and chest growth.In 2019,the US Food and Drug Administration approved the first instrumentation system for anterior vertebral body tethering(AVBT),under a Humanitarian Device Exception,for skeletally immature patients with curves having a Cobb angle between 35°and 65°.AIM To summarize current evidence about the efficacy and safety of AVBT in the management of IS in skeletally immature patients.METHODS From January 2014 to January 2021,Ovid Medline,Embase,Cochrane Library,Scopus,Web of Science,Google Scholar and PubMed were searched to identify relevant studies.The methodological quality of the studies was evaluated and relevant data were extracted.RESULTS Seven clinical trials recruiting 163 patients were included in the present review.Five studies out of seven were classified as high quality,whereas the remaining two studies were classified as moderate quality.A total of 151 of 163 AVBT procedures were performed in the thoracic spine,and the remaining 12 tethering in the lumbar spine.Only 117 of 163(71.8%)patients had a nonprogressive curve at skeletal maturity.Twenty-three of 163(14.11%)patients required unplanned revision surgery within the follow-up period.Conversion to posterior spinal fusion(PSF)was performed in 18 of 163(11%)patients.CONCLUSION AVBT is a promising growth-friendly technique for treatment of IS in growing patients.However,it has moderate success and perioperative complications,revision and conversion to PSF.

Quantitative Evaluation of Fat Composition in Lumbar Vertebral Body and Paraspinal Muscle by Proton Density Fat Fraction with MRI

Purpose: Bone marrow and muscle adiposity have been considered to correlate with osteoporosis and Sarcopenia. Proton Density Fat Fraction (PDFF) can be measured by Magnetic Resonance Imaging (MRI). The purpose of the present study was to measure PDFF in the lumbar spine, paraspinal muscle and subcutaneous fat tissue. Methods: Participants were comprised of 30 patients (18 males, 12 females;age range, 14 - 87 years) who underwent MRI due to low back symptoms. PDFFs for the body of the fourth lumbar vertebra (L4), paraspinal muscle, and subcutaneous fat were measured. Results: PDFFs of the vertebral body and subcutaneous fat were significantly higher than that of paraspinal muscle (p < 0.001). PDFF was significantly higher for subcutaneous fat than for the vertebral body (p < 0.001). Although no significant differences in PDFF of the vertebral body, paraspinal muscle, and subcutaneous fat between females and males, PDFFs of the vertebral body and paraspinal muscle were significantly higher in older subjects (>63 years) than in younger subjects (Conclusions: PDFF of the vertebral body was significantly higher than that of paraspinal muscle. PDFFs of the vertebral body and paraspinal muscle were significantly lower in younger subjects than in older subjects.

Submandibular retropharyngeal cervical vertebra hook-plate for the treatment of C2 vertebral body tumors

Objective To evaluate the clinical results of sub-mandibular retropharyngeal cervical vertebrahook-plate (RCHP)reconsruction for the treatment of of C2 vertebral body tumors.Methods Nine patents with C2 vertebral body tumors

Three-dimensional analysis of pedicle screw channel,screw entry point and lateral surface of cervical vertebral body

Objective To explore three-dimensional relations of pedicle screw channel (PSC) ,screw entry point and lateral surface of cervical vertebral body by digital techniques. Methods CT scan images of cervical

Aspergillus Infection of the Thoracolumbar Vertebral Body in a Chronic Hepatitis B-Related Hepatocellular Carcinoma Patient:A Case Report

This study reports a rare case of an Aspergillus infection of the thoracolumbar vertebral body in a chronic hepatitis B-related hepatocellular carcinoma patient.We report a hepatocellular carcinoma patient who presented with a 3-month history of lumbago after liver transcatheter arterial chemoembolization,and was finally diagnosed with a pulmonary and thoracolumbar vertebral body Aspergillus infection after diagnostic antifungal treatment for 1year.This case suggests that diagnostic antifungal therapy is of great significance for patients with clinically suspected Aspergillus infections when it is difficult to obtain tissue specimens for determined diagnosis.

Managements of osteoporotic vertebral compression fractures:A narrative review

Osteoporotic vertebral compression fractures(OVCFs)are the most common fragility fracture and significantly influence the quality of life in the elderly.Currently,the literature lacks a comprehensive narrative review of the management of OVCFs.The purpose of this study is to review background information,diagnosis,and surgical and non-surgical management of the OVCFs.A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed.Combinations of the following terms were used:compression fractures,vertebral compression fractures,osteoporosis,osteoporotic compression fractures,vertebroplasty,kyphoplasty,bisphosphonates,calcitonin,and osteoporosis treatments.Additional articles were also included by examining the reference list of articles found in the search.OVCFs,especially those that occur over long periods,can be asymptomatic.Symptoms of acute OVCFs include pain localized to the mid-line spine,a loss in height,and decreased mobility.The primary treatment regimens are pain control,medication management,vertebral augmentation,and anterior or posterior decompression and reconstructions.Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain.Bisphosphonates and denosumab are the first-line treatments for osteoporosis.Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief.Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications.Calcium and vitamin D supplementation can have a protective and therapeutic effect.Management of OVCFs must be combined with multiple approaches.Appropriate exercises and activity modification are important in fracture prevention.Medication with different mechanisms of action is a critical long-term causal treatment strategy.The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods.Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present.The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.

Age- and direction-related adaptations of lumbar vertebral trabecular bone with respect to apparent stiffness and tissue level stress distribution

The objective of this study was to study the age-related adaptation of lumbar vertebral trabecular bone at the apparent level, as well as the tissue level in three orthogonal directions. Ninety trabecular specimens were obtained from six normal L4 vertebral bodies of six male cadavers in two age groups, three aged 62 years and three aged 69 years, and were scanned using a high-resolution micro-computed tomography （micro-CT） system, then converted to micro- finite element models to do micro-finite element analyses. The relationship between apparent stiffness and bone volume fraction, and the tissue level yon Mises stress distribution for each trabecular specimen when compressed separately in the longitudinal direction, medial-lateral and anterior-posterior directions （transverse directions） were derived and compared between two age groups. The results showed that at the apparent level, trabecular bones from 69-year group had stiffer bone structure relative to their volume fractions in all three directions, and in both age groups, changes in bone volume fraction could explain more variations in apparent stiffness in the longitudinal direction than the transverse directions; at the tissue level, aging had little effect on the tissue von Mises stress distributions for the compressions in all the three directions. The novelty of the present study was that it provided quantitative assessments on the age and direction- related adaptation of Chinese male lumbar vertebral trabecular bone from two different levels： stiffness at the apparent level and stress distribution at the tissue level. It may help to understand the failure mechanisms and fracture risks of vertebral body associated with aging and direction for the prevention of fracture risks in elder individuals.

Adult Congenital Lumbar Kyphosis Requiring Anteroposterior Correction and Fusion: A Case Report with 32-Year Follow-Up

Congenital pure kyphosis due to failure of vertebral body segmentation is a relatively rare entity, and surgical intervention is infrequent compared to that for failure of vertebral body formation [1] [2]. There are very few reports of long-term follow-up of surgical treatment in patients with congenital pure kyphosis, and all the reported cases were diagnosed as failure of formation and had an age at the time of surgery of less than 18 years. It is important for orthopedic surgeons to follow the postoperative course of rare cases over 30 years. Here, we present a surgically treated case with ultra-long term follow-up of a 50-year-old patient with congenital pure kyphosis of the lumbar spine. Imaging of the lumbar spine showed six vertebrae and an unsegmented bar at L3-4 causing a pure kyphosis of 54°. The wedge-shaped block vertebra had 4 pedicles with the neural foramen between the pedicles without concomitant disc space, with compensatory thoracic hypokyphosis and lower lumbar hyperlordosis. One-stage correction and fusion surgery using anterior opening and posterior closing osteotomy was successfully performed. Both clinical and radiographic results were excellent and have been maintained for over 30 years postoperatively. The basic principle in the surgical treatment of adult spinal deformity is to achieve and maintain a good global sagittal balance over time. This case reaffirms the importance of spinopelvic harmony.

Spinal cord biological safety of image-guided radiation therapy versus conventional radiation therapy

Tumor models were simulated in purebred Beagles at the T9-10 levels of the spinal cord and treated with spinal image-guided radiation therapy or conventional radiation therapy with 50 or 70 Gy total radiation. Three months after radiation, neuronal injury at the T9-10 levels was observed, including reversible injury induced by spinal image-guided radiation therapy and apoptosis induced by conventional radiation therapy. The number of apoptotic cells and expression of the proapoptotic protein Fas were significantly reduced, but expression of the anti-apoptotic protein heat shock protein 70 was significantly increased after image-guided radiation therapy compared with the conventional method of the same radiation dose. Moreover, the spinal cord cell apoptotic index positively correlated with the ratio of Fas/heat shock protein 70. These findings indicate that 3 months of radiation therapy can induce a late response in the spinal cord to radiation therapy; image-guided radiation therapy is safer and results in less neuronal injury compared with conventional radiation therapy.

Osteoporosis affects both post-yield microdamage accumulation and plasticity degradation in vertebra of ovariectomized rats

Estrogen withdrawal in postmenopausal women increases bone loss and bone fragility in the vertebra. Bone loss with osteoporosis not only reduces bone mineral density (BMD), but actually alters bone quality, which can be comprehensively represented by bone post-yield behaviors. This study aimed to provide some information as to how osteoporosis induced by estrogen depletion could influence the evolution of post-yield microdamage accumulation and plastic deformation in vertebral bodies. This study also tried to reveal the part of the mechanisms of how estrogen deficiency-induced osteoporosis would increase the bone fracture risk. A rat bilateral ovariectomy (OVX) model was used to induce osteoporosis. Progressive cyclic compression loading was developed for vertebra testing to elucidate the post-yield behaviors. BMD, bone volume fraction, stiffness degradation, and plastic deformation evolution were compared among rats raised for 5 weeks (ovx5w and sham5w groups) and 35 weeks (ovx35w and sham35w groups) after sham surgery and OVX. The results showed that a higher bone loss in vertebral bodies corresponded to lower stiffness and higher plastic deformation. Thus, osteoporosis could increase the vertebral fracture risk probably through microdamage accumulation and plastic deforming degradation.

Assessment of Spinal Tumor Treatment Using Implanted 3D-Printed Vertebral Bodies with Robotic Stereotactic Radiotherapy

To investigate the feasibility and early efficacy of 3D-printed vertebral body implantation combined with robotic radiosurgery in the treatment of spinal tumors.This study included 14 patients with spinal tumors from December 2017 to June 2018.Before surgery,all patients were subjected to CT scan and 3D data of the corresponding vertebral segments were collected.Titanium alloy formed 3D-printed vertebral body implantation and robotic stereotactic radiotherapy were performed because of the risk of postoperative residual,high risk of recovery,or recurrence after surgery.The main outcomes included the remission of symptoms,vertebral body stability,robotic stereotactic surgical precision,and local tumor control.All patients received complete and successful combination therapy,and all healed primarily without complications.The error of the coverage accuracy for robotic radiosurgery was less than 0.5 mm,and the error of the rotation angle was less than 0.5
.The therapeutic toxicity was limited(mainly in grades 1–2),and adverse events were uncommon.The evaluation of vertebral body stability and histocompatibility for all patients met the postoperative clinical requirements.For patients with post spinal injury,the pain symptoms were reduced or disappeared(93%),and nerve function was improved or even recovered after treatment(100%).During our follow-up period,most tumors were locally well controlled(93%).3D-printed vertebral body implantation combined with robotic radiosurgery may offer a new treatment of spinal tumors.Chinese clinical trial registry:ChiCTR-ONN-17013946.