Objective To investigate the diagnosis and effectiveness of improved percutaneous kyphoplasty (PKP) for patients with thoracolumbar metastatic tumors, who could not tolerate anesthesia and open operation. Methods Between September 2009 and September 2010, 16 patients with thoracolumbar metastatic tumors underwent improved PKP. Of 16 patients, 7 were male and 9 were female with an average age of 64.5 years (range, 60-73 years). All patients had vertebralmetastasis tumor. The disease duration was 3-6 months with an average of 4 months. The visual analogue scale (VAS) score was 8.9 ± 0.8. No spinal cord compression and nerve root compression was observed. The involved vertebrae included T7 in 1 case, T8 in 1, T12 in 1, L2 in 2, L3 in 2, L4 in 3, T1, 2 in 1, T3, 4 in 1, T7, 8 in 1, T11, 12 in 1, T7-L1 in 1, and T12-L4 in 1. Nine patients had vertebral compression fracture with a vertebral compression rate below 75%. Results All patients were successfully performed PKP. There was no serious adverse reactions in cardiopulmonary and brain vascular systems and no perioperative death. The biopsy results showed that all were metastatic adenocarcinoma. All patients were followed up 9-18 months mean, 14 months). Complete pain rel ief was achieved in 14 cases and partial rel ief in 2 cases 6 months after operation according to World Health Organization criterion, with a pain-rel ief rate of 87.5%. The VAS score was 1.8 ± 0.6 at 6 months postoperatively, showing significant difference when compared with the preoperative score (P lt; 0.05). Two patients had cement leakages in 3 vertebrae with no symptoms at 6 months postoperatively. During follow-up, 12 patients died and the others survived with tumor. Conclusion For patients with thoracolumbar metastatic tumors who can not tolerate anesthesia and open operation, improved PKP has the advantages such as minimal invasion, high diagnostic rate, and early improvement of pain in the biopsy and treatment. It can improve patient’s qual ity of l ife in the combination of radiotherapy or chemotherapy.
Objective To research the feasibility and effectiveness of percutaneous kyphoplasty (PKP) by improved injecting tube through unipedicular puncturing. Methods Between January 2012 and Junuary 2016, 60 cases (68 vertebrae) of osteoporotic vertebral compression fractures (OVCF) were treated. PKP was performed through unipedicular puncturing with routine injecting tube in 30 cases (34 vertebrae, routine group), and with improved injecting tube in 30 cases (34 vertebrae, improved group). There was no significant difference in age, gender, disease duration, fracture level, preoperative visual analogue scale (VAS), or vertebral height between 2 groups (P>0.05). The operation time, the volume of bone cement injected, preoperative and postoperative VAS, and preoperative and postoperative vertebral height, and postoperative distribution coefficient of bone cement were recorded and compared between 2 groups. Results Good healing of puncture points was achieved in 2 groups after PKP, and no serious complication occurred. There was no significant difference in operation time and the volum of bone cement injected between 2 groups (t=0.851,P=0.399;t=1.672,P=0.101). Bone cement leakage was observed in 2 cases of 2 groups respectively. The distribution coefficient of bone cement in routine group was significantly less than that in improved group (t=13.049,P=0.000). All patients were followed up 12-36 months (mean, 19 months). The postoperative VAS and vertebral height were significantly improved when compared with preoperative ones in 2 groups (P<0.05), but there was no significant difference in VAS between at 2 days after operation and at last follow-up, in vertebral height between at 2 days after operation and at 1 year after operation, and between 2 groups after operation (P>0.05). X-ray films showed vertebral compression fractures in 6 cases of routine group and in 1 case of improved group during follow-up. Conclusion PKP by improved injecting tube through unipedicular puncturing can improve the distribution of bone cement, restore the height and strength of vertebral body, and reduce the incidence of re-fracture.
Objective To evaluate the effect of remote controlled injection manipulator system (RCIM) assisted percutaneous kyphoplasty (PKP) for the treatment of rupture of posterior vertebral osteoporotic vertebral fracture by comparing with intermittent hand bolus injection of bone cement during operation. Methods Between September 2010 and January 2016, a retrospective analysis was made on the clinical data of 48 senile patients with single segment rupture of the posterior vertebral osteoporotic thoracolumbar fracture undergoing PKP who accorded with the inclusion criteria. Of 48 patients, 22 received intermittent hand bolus injection of bone cement in the control group, and 26 received RCIM assisted bone cement perfusion in the trial group. There was no significant difference in age, gender, duration of disease, causes of injury, implicated vertebral bodies, bone mineral density T value, pain duration, preoperative visual analogue scale (VAS), relative vertebral body height in the anterior part, and posterior convex Cobb angle between groups (P>0.05). The bone cement perfusion time, the radiation dose of both doctors and patients, and the amount of bone cement injection were recorded; treatment effects were evaluated based on VAS score, posterior convex Cobb angle, relative ver-tebral body height in the anterior part, ratios of bone cement diffusion area and bone cement leakage rate. Results The patients were followed up for 6 months; no complications of toxic effect of bone cement, spinal cord or nerve root injuries, infection and vascular embolization occurred during follow-up period. There was no significant difference in bone cement injection amount and radiation dose of doctors between groups (P>0.05), but bone cement perfusion time, ratios of bone cement diffusion area, and radiation dose of patients were significantly lower in the trial group than the control group (P<0.05). Bone cement leakage was observed in 6 cases of the control group (27.27%) and 2 cases of the trial group (7.69%), showing significant difference between groups (χ2=4.850,P=0.029); no cement leakage into the spinal canal was found in both groups. VAS score, relative vertebral body height in the anterior part, and posterior convex Cobb angle were significantly improved at 3 days and 6 months after operation when compared with preoperative ones (P<0.05), but no significant difference was observed in the above indexes between groups at 3 days and 6 months after operation (P>0.05). Conclusion Satisfactory effectiveness can be achieved by applying RCIM assisted PKP for the treatment of rupture of posterior vertebral osteoporotic vertebral fracture. RCIM can shorten perfusion time, reduce radiation dose, and decrease incidence of bone cement leakage.
ObjectiveTo explore the effect of percutaneous kyphoplasty (PKP) on lumbar-pelvic correlation in osteoporotic vertebral compressive fracture (OVCF).MethodsAccording to the inclusion criteria, 63 patients with primary osteoporosis between January 2012 and June 2017 were selected as the control group and 67 patients with single-segment lumbar OVCF receiving PKP and complete clinical data were included as the observation group. There was no significant difference in gender, age, and lumbar spine bone density between the two groups (P>0.05). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) score were used to assess lumbar pain and function before operation and at 3 days after operation in the observation group; lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured in lumbar lateral X-ray films which were taken before PKP and at 1 month after PKP. The same parameters were measured in the lumbar lateral X-ray films which were taken at the time of initial diagnosis in the control group.ResultsAll patients were followed up 3-24 months with an average of 5.8 months in the observation group. The VAS score decreased from 5.6±1.8 before PKP to 2.8±1.3 at 3 days after PKP (t=14.082, P=0.000); ODI decreased from 50.1%±5.0% before PKP to 18.2%±1.8% (t=47.011, P=0.000). Compared with the control group, the LL, PI, and SS decreased and the PT increased in the observation group, and only the difference in LL between the two groups was significant (P<0.05). In the observation group, the LL and SS significantly increased (P<0.05) and PT significantly decreased (P<0.05) at 1 month after operation when compared with preoperative ones, and PI decreased, but the difference was not significant (P>0.05). In the control group, LL was positively correlated with PI and SS (P<0.05); PI was positively correlated with PT and SS (P<0.05). In the observation group, PI was positively correlated with SS (P<0.05) before and after PKP.ConclusionOVCF patients lost the specific lumbar-pelvic correlation. PKP can restore lumbar lordosis, but it still can not restore the normal physiological fitting.
ObjectiveTo compare the short-term effectiveness and safety of unipedicular versus bipedicular percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) with posterior wall broken.MethodsThe clinical data of 68 patients with OVCF with posterior wall broken and without posterior ligament complex injury and spinal cord nerve injury between June 2013 and December 2018 were retrospectively analyzed. According to the different operative approaches, the patients were divided into two groups: group A (36 cases received PKP via bilateral pedicle puncture) and group B (32 cases received PKP via unilateral pedicle paracentesis). There was no significant difference between the two groups in gender, age, fracture vertebra distribution, time from injury to operation, preoperative pain visual analogue scale (VAS) score, Oswestry disability index (ODI), and height of injured vertebra (P>0.05). The operation time, intraoperative fluoroscopy times, and bone cement volume were recorded and compared between the two groups. The VAS score and ODI score were used to evaluate the effectiveness before operation, at 1 day and 6 months after operation; the height of injured vertebra was measured on the lateral X-ray film, and the recovery height of injured vertebra at 1 day after operation and the loss height of injured vertebra at 6 months after operation were calculated; the intraoperative and postoperative complications of the two groups were recorded.ResultsThe operation time, intraoperative fluoroscopy times, and bone cement volume of group B were significantly less than those of group A (P<0.05). All patients were followed up 10-35 months, with an average of 18 months. During the operation, there were 2 cases (5.56%) of cement leakage in group A and 9 cases (28.13%) in group B, showing significant difference (χ2=4.808, P=0.028). There was no adverse reactions of bone cement, iatrogenic spinal cord injury, infection of puncture port, or other complications in the two groups. During the follow-up period, there were 3 cases (8.3%) of adjacent vertebral fractures in group A and 2 cases (6.3%) in group B, showing no significant difference between the two groups (χ2=0.027, P=0.869). The height of injured vertebra of the two groups at 1 day and 6 months after operation were significantly improved when compared with preoperative ones (P<0.05). There was no significant difference in the height of injured vertebrae and the recovery height of injured vertebra at 1 day after operation between the two groups (P>0.05). However, at 6 months after operation, the height of injured vertebra in group B was significantly lower than that in group A (P<0.05), and the loss height of injured vertebra in group B was significantly higher than that in group A (P<0.05). The VAS score and ODI score at 1 day and 6 months after operation were significantly improved when compared with preoperative ones in both groups (P<0.05), but there was no significant difference between the two groups (P>0.05).ConclusionBoth bipedicular and unipedicular PKP can obtain satisfactory effectiveness for the treatment of OVCF with posterior wall broken, but the former may have advantages of lower cement leakage rate and less height loss.
ObjectiveTo evaluate the safety and effectiveness of robot-guided percutaneous kyphoplasty (PKP) in treatment of multi-segmental thoracolumbar osteoporotic vertebral compression fracture (OVCF).MethodsA clinical data of 63 cases with multi-segmental thoracolumbar OVCF without neurologic deficit treated with PKP between October 2017 and February 2019 were analyzed retrospectively. The patients were divided into robot-guided group (33 cases) and traditional fluoroscopy group (30 cases). There was no significant difference in gender, age, fracture segment, bone mineral density, and preoperative visual analogue scale (VAS) score, midline vertebral height, and Cobb angle between the two groups (P>0.05). The time to establish the tunnel, the times of fluoroscopy, the dose of fluoroscopy, the deviation of puncture, the distribution of bone cement, the leakage of bone cement, the puncture angle, and the postoperative VAS score, midline vertebral height, and Cobb angle were recorded and compared.ResultsThe patients in two groups were followed up 11-13 months (mean, 12 months). Compared with traditional fluoroscopy group, the time to establish the tunnel, the times and dose of fluoroscopy in robot-guided group were significantly lower, the deviation of puncture was slighter, the distribution of bone cement was better, and the puncture angle was larger, the differences between the two groups were significant (P<0.05). There were 8 segments (9.3%, 8/86) of bone leakage in robot-guided group and 17 segments (22.6%, 17/75) in traditional fluoroscopy group, the difference between the two groups was significant (χ2=5.455, P=0.020). There was no significant difference in VAS score, the midline vertebral height, and Cobb angle between the two groups at 2 days after operation and last follow-up (P>0.05).ConclusionRobot-guided PKP in treatment of multi-segmental thoracolumbar OVCF can shorten the operation time, improve the accuracy of puncture, reduce the times and dose of fluoroscopy, reduce the leakage of bone cement, and achieve better cement distribution.
ObjectiveTo investigate the effectiveness of Vesselplasty and percutaneous kyphoplasty (PKP) in treatment of Kümmell disease.MethodsBetween January 2015 and December 2018, 63 patients with Kümmell disease were treated. Among them, 28 cases were treated with Vesselplasty (Vesselplasty group) and 35 cases were treated with PKP (PKP group). There was no significant difference in gender, age, disease duration, bone mineral density (T value), fracture distribution, and preoperative pain visual analogue scale (VAS) score, Oswestry Disability Index (ODI), anterior height of injured vertebrae, and kyphosis Cobb angle between the two groups (P>0.05). The operation time, intraoperative fluoroscopy time, bone cement injection volume, the leakage rate of bone cement, the diffusion area ratio of bone cement, and the complications of the two groups were recorded. VAS score, ODI, anterior height of injured vertebrae, and kyphosis Cobb angle were compared between the two groups before operation and at 1 day after operation and last follow-up.ResultsAll patients of the two groups were followed up 12-36 months, with an average of 24.2 months. The operation time, intraoperative fluoroscopy time, bone cement injection volume, and diffusion area ratio of bone cement were significantly lower in the Vesselplasty group than in the PKP group (P<0.05). The leakage rate of bone cement was significantly lower in the Vesselplasty group (7.14%) than in the PKP group (34.29%) (χ2=5.153, P=0.023). At 1 day after operation and last follow-up, the VAS score, ODI, anterior height of injured vertebrae, and kyphosis Cobb angle of the two groups were superior to those before operation (P<0.05), and no significant difference between the two groups (P>0.05). During the follow-up, there was no re-collapse of vertebrae, and the adjacent vertebrae fracture occurred in 2 cases of the Vesselplasty group and 5 cases of PKP group. There was no significant difference in the incidence of adjacent vertebrae fracture between the Vesselplasty group (7.14%) and the PKP group (14.29%) (χ2=0.243, P=0.622).ConclusionVesselplasty and PKP have similar effectiveness in the treatment of Kümmell disease. They can effectively relieve the pain symptoms, improve the quality of life, partially restore the height of injured vertebrae, and correct kyphosis. But the Vesselplasty has the advantages of shorter operation time, less intraoperative fluoroscopy time, and less bone cement leakage.
ObjectiveTo evaluate the feasibility and short-term effectiveness of bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture (OVCF) of lumbar.MethodsA retrospective analysis was made on the clinical data of 93 patients with OVCF of lumbar who met the selection criteria between January 2018 and June 2019. According to the different surgical methods, they were divided into group A (44 cases, treated with bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach) and group B [49 cases, treated with percutaneous kyphoplasty (PKP) via bilateral transpedicle approach]. There was no significant difference in gender, age, body mass index, T value of bone mineral density, injury cause, fractured level, time from injury to operation, comorbidities, and preoperative Cobb angle of injured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The operation time, intraoperative fluoroscopy times, bone cement injection amount, and incidence of bone cement leakage were recorded and compared between the two groups; Cobb angle of the injured vertebrae, VAS score, and ODI were measured before operation, at 2 days and 1 year after operation. The contralateral distribution ratio of bone cement was calculated according to the anteroposterior X-ray film at 2 days after operation.ResultsThe operation time and the intraoperative fluoroscopy times in group A were significantly less than those in group B (P<0.05). There was no bone cement adverse reactions, cardiac and cerebrovascular adverse events, and no complications such as puncture needles erroneously inserted into the spinal canal and nerve injuries occurred in the two groups. Bone cement leakage occurred in 6 cases and 8 cases in groups A and B, respectively, all of which were asymptomatic paravertebral or intervertebral leakage, and no intraspinal leakage occurred; the bone cement injection amount and incidence of bone cement leakage between the two groups showed no significant differences (P>0.05). The contralateral distribution ratio of bone cement in group A was significantly lower than that in group B (t=2.685, P=0.009). Patients in both groups were followed up 12-20 months, with an average of 15.3 months. The Cobb angle of the injured vertebrae, VAS score, and ODI in the two groups were significantly improved at 2 days after operation, however, the Cobb angle of the injured vertebra at 1 year after operation was significantly lost when compared with the 2 days after operation, the VAS score and ODI at 1 year after operation were significantly further improved when compared with the 2 days after operation, the differences were all significant (P<0.05). There was no significant difference in the Cobb angle of the injured vertebrae, VAS score, and ODI between the two groups at each time point after operation (P>0.05).ConclusionBilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach is comparable to bilateral PKP in short-term effectiveness with regard to fracture reduction, reduction maintenance, pain relief, and functional improvement. It has great advantages in reducing operation time and radiation exposure, although it is inferior in bone cement distribution.
ObjectiveTo evaluate the effectiveness of orthopedic robot with modified tracer fixation (short for modified orthopedic robot) assisted percutaneous kyphoplasty (PKP) in treatment of single-segment osteoporotic vertebral compression fracture (OVCF). Methods The clinical data of 155 patients with single-segment OVCF who were admitted between December 2017 and January 2021 and met the selection criteria was retrospectively analyzed. According to the operation methods, the patients were divided into robot group (87 cases, PKP assisted by modified orthopedic robot) and C-arm group (68 cases, PKP assisted by C-arm X-ray fluoroscopy). There was no significant difference in gender, age, body mass index, T value of bone mineral density, therapeutic segment, grade of vertebral compression fracture, and preoperative visual analogue scale (VAS) score, midline vertebral height, and Cobb angle between the two groups (P>0.05). The effectiveness evaluation indexes of the two groups were collected and compared. The clinical evaluation indexes included the establishment time of working channel, dose of intraoperative fluoroscopy, the amount of injected cement, VAS score before and after operation, and the occurrence of complications. The imaging evaluation indexes included the degree of puncture deviation, the degree of bone cement diffusion, the leakage of bone cement, the midline vertebral height and the Cobb angle before and after operation. Results The establishment time of working channel in robot group was significantly shorter than that in C-arm group, and the dose of intraoperative fluoroscopy was significantly larger than that in C-arm group (P<0.001). There was no significant difference in the amount of injected cement between the two groups (t=1.149, P=0.252). The patients in two groups were followed up 10-14 months (mean, 12 months). Except that the intraoperative VAS score of the robot group was significantly better than that of the C-arm group (P<0.05), there was no significant difference between the two groups at other time points (P>0.05). No severe complication such as infection, spinal cord or nerve injury, and pulmonary embolism occurred in the two groups. Five cases (5.7%) in robot group and 7 cases (10.2%) in C-arm group had adjacent segment fracture, and the difference in incidence of adjacent segment fracture between the two groups was not significant (χ2=1.105, P=0.293). Compared with C-arm group, the deviation of puncture and the diffusion of bone cement at 1 day after operation, the midline vertebral height and Cobb angle at 1 month after operation and last follow-up were significantly better in robot group (P<0.05). Eight cases (9.1%) in the robot group and 16 cases (23.5%) in the C-arm group had cement leakage, and the incidence of cement leakage in the robot group was significantly lower than that in the C-arm group (χ2=5.993, P=0.014). There was no intraspinal leakage in the two groups. ConclusionCompared with traditional PKP assisted by C-arm X-ray fluoroscopy, modified orthopedic robot-assisted PKP in the treatment of single-segment OVCF can significantly reduce intraoperative pain, shorten the establishment time of working channel, and improve the satisfaction of patients with operation. It has great advantages in reducing the deviation of puncture and improving the diffusion of bone cement.
ObjectiveTo analyze the correlation between bone cement cortical leakage and injury degree of osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP), and to provide guidance for reducing clinical complications. Methods A clinical data of 125 patients with OVCF who received PKP between November 2019 and December 2021 and met the selection criteria was selected and analyzed. There were 20 males and 105 females. The median age was 72 years (range, 55-96 years). There were 108 single-segment fractures, 16 two-segment fractures, and 1 three-segment fracture. The disease duration ranged from 1 to 20 days (mean, 7.2 days). The amount of bone cement injected during operation was 2.5-8.0 mL, with an average of 6.04 mL. Based on the preoperative CT images, the standard S/H ratio of the injured vertebra was measured (S: the standard maximum rectangular area of the cross-section of the injured vertebral body, H: the standard minimum height of the sagittal position of the injured vertebral body). Based on postoperative X-ray films and CT images, the occurrence of bone cement leakage after operation and the cortical rupture at the cortical leakage site before operation were recorded. The correlation between the standard S/H ratio of the injured vertebra and the number of cortical leakage was analyzed. Results Vascular leakage occurred in 67 patients at 123 sites of injured vertebrae, and cortical leakage in 97 patients at 299 sites. Preoperative CT image analysis showed that there were 287 sites (95.99%, 287/299) of cortical leakage had cortical rupture before operation. Thirteen patients were excluded because of vertebral compression of adjacent vertebrae. The standard S/H ratio of 112 injured vertebrae was 1.12-3.17 (mean, 1.67), of which 87 cases (268 sites) had cortical leakage. The Spearman correlation analysis showed a positive correlation between the number of cortical leakage of injured vertebra and the standard S/H ratio of injured vertebra (r=0.493, P<0.001). ConclusionThe incidence of cortical leakage of bone cement after PKP in OVCF patients is high, and cortical rupture is the basis of cortical leakage. The more severe the vertebral injury, the greater the probability of cortical leakage.