Injectable bioactive polymethyl methacrylate-hydrogel hybrid bone cement loaded with BMP-2 to improve osteogenesis for percutaneous vertebroplasty and kyphoplasty

Poly methyl methacrylate(PMMA)bone cement is used in augmenting and stabilizing fractured vertebral bodies through percutaneous vertebroplasty(PVP)and percutaneous kyphoplasty(PKP).However,applications of PMMA bone cement are limited by the high elasticity modulus of PMMA,its low biodegradability,and its limited ability to regenerate bone.To improve PMMA bio activity and biodegradability and to modify its elasticity modulus,we mixed PMMA bone cement with oxidized hyaluronic acid and carboxymethyl chitosan in situ cross-linking hydrogel loaded with bone morphogenetic protein-2(BMP-2)to achieve novel hybrid cement.These fabric ated PMMA-hydrogel hybrid cements exhibited lower setting temperatures,a lower elasticity modulus,and better biodegradability and biocompatibility than that of pure PMMA cement,while retaining acceptable setting times,mechanical strength,and inj ectability.In addition,we detected release of BMP-2 from the PMMA-hydrogel hybrid cements,significantly enhancing in vitro osteogenesis of bone marrow mesenchymal stem cells by up-regulating the gene expression of Runx2,Coll,and OPN.Use of PMMA-hydrogel hybrid cements loaded with BMP-2 on rabbit femoral condyle bone-defect models revealed their biodegradability and enhanced bone formation.Our study demonstrated the favorable mechanical properties,biocompatibility,and biodegradability of fabricated PMMA-hydrogel hybrid cements loaded with BMP-2,as well as their ability to improve osteogenesis,making them a promising material for use in PKP and PVP.

Total spinal anesthesia caused by lidocaine during unilateral percutaneous vertebroplasty performed under local anesthesia:A case report

BACKGROUND Intradural anesthesia caused by anesthetic drug leakage during percutaneous vertebroplasty(PVP)has rarely been reported.We here report a 71-year-old woman who suffered this rare and life-threatening complication during PVP.CASE SUMMARY A 71-year-old woman,who suffered from 2 wk of severe back pain with a visual analog score of 8,came to our outpatient clinic.She was later diagnosed with a newly compressed L1 fracture and was then admitted in our department.PVP was initially attempted again under local anesthesia.However,serendipitous intradural anesthesia leading to total spinal anesthesia happened.Fortunately,after successful resuscitation of the patient,PVP was safely and smoothly performed.Great pain relief was achieved postoperatively,and she was safely discharged on postoperative day 4.The patient recovered normally at 3-mo follow-up.CONCLUSION Total spinal anesthesia secondary to PVP by anesthetic drug leakage rarely occurs.In cases of inadvertent wrong puncture leading to drug leakage when performing it under local anesthesia,surgeons should be highly vigilant during the whole procedure.Electrocardiogram monitoring,oxygen inhalation,intravenous cannula set prior to surgery,regular checking of motor activity and a meticulous imaging monitoring with slower pushing of anesthetic drugs,etc.should be highly recommended.

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.

Traditional Chinese medicine manipulative reduction combined with percutaneous vertebroplasty for treating type Ⅲ Kummell's disease: A case report

BACKGROUND A patient with type Ⅲ Kummell’s disease had a ruptured posterior cortex of the fractured vertebral body, which caused spinal cord compression. An open surgery was considered the best choice of operation. However, the patient and her family refused open surgery and instead demanded a minimally invasive surgical treatment such as percutaneous vertebroplasty(PVP). After preoperative discussion, we finally adopted the novel therapy of traditional Chinese medicine manipulative reduction(TCMMR) combined with PVP.CASE SUMMARY A patient with type Ⅲ Kummell’s disease exhibiting bone block-induced spinal cord compression was admitted to our hospital. She suffered from a variety of medical disorders but refused open surgery, and instead asked for PVP surgery. TCMMR, in parallel with PVP, was used to restore the height of the compressed vertebral body and reduce the symptoms of spinal cord compression by the bone block in order to strengthen the vertebral body and prevent further collapse. The surgery was very successful. The height of the compressed vertebra was restored, and the symptom of spinal cord compression by bone block was reduced successfully via TCMMR. The fractured vertebra was solidified by the PVP. The pain visual analog score declined from preoperative 7 scores to postoperative 2 scores, and the Frankel spinal cord scale increased from preoperative D degree to postoperative E degree.CONCLUSION The new method has advantages in treating patients with type Ⅲ Kummell’s disease who cannot be treated with open surgery.

Treatment of Kümmell’s disease with sequential infusion of bone cement:A retrospective study

BACKGROUND Percutaneous vertebroplasty(PVP)is an effective method for the treatment of neurologically intact Kümmell’s disease,but bone cement leakage during surgery is a problem that deserves attention.AIM To reduce bone cement leakage and evaluate the effect of the sequential infusion of bone cement during PVP for the treatment of stage I or II Kümmell’s disease.METHODS Patients with Kümmell’s disease treated in our hospital from September 2015 to September 2018 were retrospectively analyzed.Patients meeting the inclusion and exclusion criteria were divided into two groups:Traditional single infusion and sequential infusion(SI).The visual analog scale(VAS)and Oswestry disability index(ODI)were evaluated and compared,and duration of operation,bone cement content and complications were recorded.RESULTS Forty-five patients were included in this study;there were 24 in the traditional single infusion group and 21 in the SI group.The VAS and ODI were significantly different for both groups when compared pre-and postoperatively,whereas the differences between 1 wk postoperatively and at the final follow-up were not statistically.When the VAS and ODI of the two groups were compared,there were no significant differences at any time point.The leakage rate of bone cement was significantly lower in the SI group(14.3%,3 of 21)than that in the traditional single infusion group(41.7%,10 of 24).CONCLUSION SI in unipedicular PVP is a safe and effective procedure for neurologically intact Kümmell’s disease,and this technique could decrease the incidence of bone cement leakage.

Full-endoscopic spine surgery treatment of lumbar foraminal stenosis after osteoporotic vertebral compression fractures:A case report

BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral compression fractures.We herein report such a case,including the patient’s treatment process and doctor’s surgical experience.CASE SUMMARY A 79-year-old man presented with symptoms of radiculopathy after sustaining L4 vertebral compression fractures.Imaging and physical examination revealed L4 vertebral compression fractures combined with L3/4 Lumbar foraminal stenosis(LFS).The patient’s symptoms were low back pain with pain in the lateral left leg.Although many reports have described radiculopathy induced by osteoporotic vertebral compression fractures,the use of FESS combined with PVP has rarely been reported.This case report indicates that the combination of FESS and PVP is a safe and effective approach for the treatment of LFS-induced radiculopathy after vertebral compression fractures.This minimally invasive technique has great potential to replace traditional lumbar fixation and decompression surgery.Thus,we suggest the continued accumulation of similar cases to discuss the wider application of FESS.CONCLUSION For patients with osteoporotic vertebral compression fracture(OVCF)and LFS,PVP and FESS can be used to restore the vertebral height and reduce the pressure around the intervertebral foramen.Additionally,the combination of FESS and PVP can treat the pain or numbness of the low back and lower limbs and allow for recovery in a short time with excellent postoperative effects.In general,FESS is a good treatment for radiculopathy caused by foraminal stenosis after OVCF.

Poly(methyl methacrylate) bone cement composited with mineralized collagen for osteoporotic vertebral compression fractures in extremely old patients

To examine the clinical effects of a new bone cement composed of poly(methyl methacrylate)(PMMA)and mineralized collagen(MC)compared with pure PMMA bone cement in treating osteoporotic vertebral compression fractures(OVCFs)in patients aged over 80.In all,32 cases using pure PMMA bone cement and 31 cases using MC-modified PMMA(MC-PMMA)bone cement for OVCFs between June 2014 and March 2016 were screened as PMMA group and MC-PMMA group,respectively,with an average age of over 80.The operation duration,intraoperative blood loss,hospital stay,oswestry disability index(ODI),visual analogue scale(VAS),anterior vertebral height(AVH),intermediate vertebral height(IVH)and posterior vertebral height(PVH)of injured vertebrae,vertebral computed tomography value,re-fracture rate of adjacent vertebrae,correction rate of spinal kyphotic angle and wedge-shaped vertebra angle and surgical complications were compared between the two groups.In the early post-operative period,the VAS,ODI,AVH and IVH in MC-PMMA group were comparable to those in the traditional PMMA group.Moreover,the MC-PMMA group showed better effects compared with the PMMA group 12months after surgery.Thus,this new bone cement has superior clinic effects in the long term.