Objective To investigate the clinical therapeutic effects on malignant spinal tumors treated by percutaneous vertebroplasty(PVP) under the guidance of the digital subtraction angiography(DSA). Methods A retrospective analysis was performed in 196 patients (99 males and 97 females, aged 23-85 years, averaged 60.4 years) with malignant spinal tumors, who underwent the PVP treatment combined with standard chemotherapy and other comprehensive treatment from January 2002 to January 2005. The malignant spinal tumors had their origins as follows: lung cancer (66 cases), breast cancer (55 cases), liver cancer (19 cases), colon cancer (15 cases), stomach cancer (9 cases), prostate cancer (12 cases), multiple myeloma (16 cases), and malignant lymphoma of the spine (4 cases).The metastatic tumors involved the cervical vertebra (32 cases), thoracic vertebra (93 cases), lumbar vertebra (71 cases), and spinal column, including 1 vertebral segment (135 cases), 2 segments (50 cases), and more than 3 segments (11 cases). During the follow-up survey, changes in the visual analogue pain scale(VAS) and changes in the X-ray measurements of the average anterior height, midline height, and posterior height of the diseased vertebra were observed. Results The follow-up for 6 months to 3 years revealed that the percutaneous vertebroplasty on279 vertebral segments had a success with an operational success rate of 100%. Bone cement was injected into the lesions 1-9 ml per segment of the spine. The postoperative X-ray and CT evaluations revealed that spinal stabilization was obtained in all the patients. After operation, 193（98.5%）patients had an obvious decrease or disappearance of the pain in the lower back, and only 3 (1.5%) patients had no obvious improvement in the pain. There was a significant statist-ical difference in the VAS scores between before operation and after operation (Plt;0.05). There were also significant statistical differences in the average anterior height of the diseased vertebra between before operation and after operation（15.71±2.80 mm vs 16.61±3.01 mm）, in the midline height（13.65±2.93 mm vs 14.52±2.72 mm）, and in the posterior height（23.67±2.81 mm vs 23.70±3.13 mm,Plt;0.05). The patients with lung or liver cancer had a mean survival time of 9 monthsafter PVP; the patients with breast cancer, stomach cancer, prostate cancer, lymphoma, or other metastatic tumors had a mean survival time of 18 months. The patients with multiple myeloma had a mean survival time of 27 months. The differences were statistically different (Plt;0.01). Conclusion PVP under the guidance of the DSA is an easier operation witha small wound and few complications. It can effectively alleviate the patient’s pain due to metastatic spinal tumor, stabilize the spine, improve the patient’s quality of life, and reduce the incidence of paraplegia.
Objective To investigate the feasibil ity, safety and operative techniques of percutaneous vertebroplasty (PVP) in treating osteolytic bone metastasis of cervical vertebra and reconstructing the function of cervical vertebra. Methods From March 2005 to December 2007, 10 patients with osteolytic bone metastatic carcinoma in single cervical vertebral body received PVP, including 5 males and 5 females aged 38-75 years (mean 54.5 years). Among them, 5 patients had primary lung tumor, 1 primary renal tumor, 1 primary breast tumor, 1 primary cervical tumor and 2 unknown primary lesion. The course of disease was 2-4 years. All the patients suffered from obviously cervical pain and l imitation of activity, including 4 cases of metastatic tumor of the C2 vertebral body, 2 of C3, 2 of C6 and 2 of C7. The general condition of patients was stable before operation, and no blood coagulation dysfunction, radiculalgia and spinal cord compression were detected. Lateral PVP was performed on 6 cases, approaching between the vertebral artery and the carotid sheath under CT guidance and anterolateral PVP was performed on the rest 4 cases, approaching between the trachea and the internal carotid artery under continuously X-ray fluoroscopy. The amount of bone cement injected was 3-4 mL, and the fill ing rate was 50%-100%. Results Without obvious bleeding or organ injury, the puncture was performed successfully on all the patients. Without symptom of spinal cord compression, patients suffered from pain during operation (1 case) and such compl ications noted by immediate CT or X-rays examination after operation as paravertebral epidural cement leakage (2 ases),transverse foramen cement leakage (1 case) and pinhole reflux (3 cases). The pain of patients was improved to various degree postoperatively, the visual analogue scales score was (5.9 ± 1.2) points before operation, which was changed to (2.6 ± 1.2) points at 1 hour after PVP and (1.6 ± 1.3) points at 1 week after PVP, indicating there was a significant difference between pre- and postoperation (P lt; 0.05). During the regular follow-up at 1 week, 3 and 12 months after PVP, all patients had no dislocation of cervical vertebra body, spinal cord compression and paralysis. Five patients died from multiple organ failure due to primary tumor progression, including 3 cases at 6 months after PVP and 2 at 12 months after PVP, and the rest 5 patients’ cervical pain were under control, with sound functional recovery. Conclusion PVP can rel ieve pain quickly and reinforce the stabil ity of the vertebral body, and has sl ight compl ications; the lateral approach is safe and effective.
Objective To explore the effectiveness of unilateral percutaneous vertebroplasty (PVP) through mild side and severe side approaches in the treatment of elderly osteoporotic vertebral compression fracture (OVCF). Methods The clinical data of 100 patients with OVCF with symptoms on one side who were admitted between June 2020 and June 2021 and met the selection criteria were retrospectively analyzed. The patients were divided into the severe side approach group (group A) and the mild side approach group (group B) according to the cement puncture access during PVP, with 50 cases in each group. There was no significant difference between the two groups in terms of general information such as gender composition, age, body mass index, bone density, damaged segments, disease duration, and chronic comorbidities (P>0.05). The lateral margin height of the vertebral body on the operated side in group B was significantly higher than that of group A (P<0.001). The pain level and spinal motor function were evaluated using the pain visual analogue scale (VAS) score and Oswestry disability index (ODI) before operation, at 1 day, 1 month, 3 months, and 12 months after operation in both groups, respectively. Results No intraoperative or postoperative complications such as bone cement allergy, fever, incision infection, and transient hypotension occurred in both groups. Four cases of bone cement leakage occurred in group A (3 cases of intervertebral leakage and 1 case of paravertebral leakage), and 6 cases of bone cement leakage occurred in group B (4 cases of intervertebral leakage, 1 case of paravertebral leakage, and 1 case of spinal canal leakage), and none of them had neurological symptoms. Patients in both groups were followed up 12-16 months, with a mean of 13.3 months. All fractures healed and the healing time ranged from 2 to 4 months, with a mean of 2.9 months. The patients had no complication related to infection, adjacent vertebral fracture, or vascular embolism during follow-up. At 3 months postoperatively, the lateral margin height of the vertebral body on the operated side in groups A and B were improved when compared with preoperative ones, and the difference between pre- and post-operative lateral margin height of the vertebral body in group A was higher than that in group B, all showing significant differences (P<0.001). The VAS scores and ODI in both groups improved significantly at all postoperative time points when compared with those before operation, and further improved with time after operation (P<0.05). The differences in VAS scores and ODI between the two groups before operation were not significant (P>0.05); VAS scores and ODI in group A were significantly better than those in group B at 1 day, 1 month, and 3 months after operation (P<0.05), but no significant difference was found between the two groups at 12 months after operation (P>0.05). Conclusion Patients with OVCF have more severe compression on the more symptomatic side of the vertebral body, and patients with PVP have better pain relief and better functional recovery when cement is injected through the severe symptomatic side.
Objective To investigate the treatment methods and the cl inical therapeutic effects of symptomatic cervical vertebral hemangioma associated with cervical spondylotic myelopathy. Methods A retrospective analysis was performed in 18 patients (10 males and 8 females, aged 30-62 years with an average age of 45.3 years) with cervical vertebral hemangioma associated with cervical spondylotic myelopathy between January 2006 and September 2008. The disease duration was 10-26 months (mean, 15.6 months). All patients had single vertebral hemangioma, including 2 cases at C3, 3 cases at C4, 5 cases at C5, 5 cases at C6, and 3 cases at C7. The X-ray films showed a typical “pal isade” change. According to the cl inical and imaging features, there were 13 cases of type II and 5 cases of type IV of cervical hemangioma. The standard anterior cervical decompression and fusion with internal fixation were performed and then percutaneous vertebroplasty (PVP) was used. The cervical X-ray films were taken to observe bone cement distribution and the internal fixation after operation. The recovery of neurological function and the neck pain rel ief were measured by Japanese Orthopaedic Association (JOA) score and visual analogue scale (VAS) score. Results All operations were successful with no spinal cord and nerves injury, and the incisions healed well. Anterior bone cement leakage occurred in 2 cases without any symptoms. All cases were followed up 24-28 months (mean, 26 months) and the symptoms were improved at different degrees without fracture and collapse of vertebra or recurrence of hemangioma. During the follow-up, there was no implant loosening, breakage and displacement, and the mean fusion time was 4 months (range, 3-4.5 months). The JOA score and VAS score had a significant recovery at 3 months and at last follow-up when compared with preoperative values (P lt; 0.05). Based on JOA score at last follow-up, the results were excellent in 9 cases, good in 6 cases, fair in 2 cases, and poor in 1 case. Conclusion The anterior cervical decompression and fusion with internalfixation combined with PVP treatment is one of the ideal ways to treat symptomatic cervical vertebral hemangioma associated with cervical spondylotic myelopathy, which could completely decompress the spinal cord and effectively alleviate the cl inical symptoms caused by vertebral hemangioma.
ObjectiveTo investigate the risk factors of cement leakage in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). MethodsBetween March 2011 and March 2012, 98 patients with single level OVCF were treated by PVP, and the cl inical data were analyzed retrospectively. There were 13 males and 85 females, with a mean age of 77.2 years (range, 54-95 years). The mean disease duration was 43 days (range, 15-120 days), and the mean T score of bone mineral density (BMD) was-3.8 (range, -6.7--2.5). Bilateral transpedicular approach was used in all the patients. The patients were divided into cement leakage group and no cement leakage group by occurrence of cement leakage based on postoperative CT. Single factor analysis was used to analyze the difference between 2 groups in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, preoperative vertebral body wall incompetence, cement volume, and volume ratio of intravertebral bone cement to vertebral body. All relevant factors were introduced to logistic regression analysis to analyze the risk factors of cement leakage. ResultsAll procedures were performed successfully. The mean operation time was 40 minutes (range, 30-50 minutes), and the mean volume ratio of intravertebral bone cement to vertebral body was 24.88% (range, 7.84%-38.99%). Back pain was alleviated significantly in all the patients postoperatively. All patients were followed up with a mean time of 8 months (range, 6-12 months). Cement leakage occurred in 49 patients. Single factor analysis showed that there were significant differences in the volume ratio of intravertebral bone cement to vertebral body and preoperative vertebral body wall incompetence between 2 groups (P < 0.05), while no significant difference in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, and cement volume (P > 0.05). The logistic regression analysis showed that the volume ratio of intravertebral bone cement to vertebral body (P < 0.05) and vertebral body wall incompetence (P < 0.05) were the risk factors for occurrence of cement leakage. ConclusionThe volume ratio of intravertebral bone cement to vertebral body and vertebral body wall incompetence are risk factors of cement leakage in PVP for OVCF. Cement leakage is easy to occur in operative level with vertebral body wall incompetence and high volume ratio of intravertebral bone cement to vertebral body.
ObjectiveEvaluating the clinical efficacy of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) for osteoporotic vertebral compressive fracture (OVCF). MethodsPatients with OVCF were retrospectively analyzed from Feb. 2008 to Feb. 2013 in Department of Orthopaedics, Tianjin Medical University General Hospital. Patients were divided into the PVP group and the PKP group. The VAS, vertebral kyphosis angle, vertebral height and bone cement leakage of both groups were compared, and the SPSS13.0 software was used for data analysis. ResultsA total of 55 patients were included. Of which, 25 patients were in the PVP group and 30 patients were in the PKP group. All patients were followed up from 5 to 20 months, with an average time of 15.5 months. The VAS scores in both groups were all improved after the operation (P<0.05), but no significant difference was found between both groups. The vertebral kyphosis angle in both groups were improved after the operation (P<0.05), and the PKP group was better than the PVP group. Six patients in the PVP group occurred the leakage of bone cement, and 4 patients in the PKP group. Five patients in the PVP groups occurred vertebral fracture again, while 7 patients in the PKP group. ConclusionUsing PVP and PKP for the treatment of OVCF can quickly relieve pain and increase the stability of the vertebral body. PKP can restore vertebral body height better and reduce the incidence of cement leakage.
Objective To summarize the research progress of secondary fracture of adjacent vertebral body after percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). Methods Recent literature concerning PVP and PKP was extensively reviewed and summarized. Results The main reasons of secondary fracture of adjacent vertebral body after PVP and PKP are the natural process of osteoporosis, the initial fracture type, the bone cement, the surgical approach, the bone mineral density, and other factors. Conclusion Secondary fracture of adjacent vertebral body after PVP and PKP is a challenge for the clinician, a variety of factors need to be suficiently considered and be confirmed by a lot of basic and clinical epidemiological studies.
Objective To observe the influence on adjacent lumbar bone density after strengthening of T12, L1 segment vertebral osteoporotic compression fracture by percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in postmenopausal female. Methods Between January 2008 and June 2011, 59 patients with T12, L1 segment thoracolumbar osteoporotic compression fracture were treated with PVP in 29 cases (PVP group) and PKP in 30 cases (PKP group), who were in accordance with the inclusion and exclusion criteria. No significant difference was found in gender, duration of menopause, disease druation, causes of injury, fractured vertebral body, and vertebral fracture classification between 2 groups (P gt; 0.05). The kyphosis Cobb angle of surgical area was measured at preoperation, 1 week after operation, and last follow-up; the lower three lumbar spine bone mineral density (BMD) of the surgical area, the femoral neck BMD, and body mass index (BMI) of patients were measured at perioperative period and last follow-up to find out the statement of anti-osteoporosis; FRAX online tools were used to evaluate the probability of major osteoporotic fracture and hip fracture of the next 10 years. Results The average follow-up was 25.5 months (range, 12-48 months) in 2 groups. There was significant difference in kyphosis Cobb angle of T12, L1 between preoperation and last follow-up in 2 groups (P lt; 0.05); the Cobb angle of PKP group was significantly less than that of PVP group at 1 week after operation and last follow-up (P lt; 0.05). No significant difference was found in BMI between 2 groups, and between perioperative period and last follow-up in the same group (P gt; 0.05). The lower three lumbar spine BMD of the surgical area and its T value at last follow-up was improved significantly when compared with BMD at perioperative period (P lt; 0.05); there was no significant difference in the lower three lumbar spine BMD and its T value between 2 groups at perioperative period (P gt; 0.05), but significant difference was found between two groups at last follow-up (P lt; 0.05). Difference was not significant in the femoral neck BMD and its T value between 2 groups, and between perioperative period and last follow-up in the same group (P gt; 0.05). The probability of major osteoporotic fracture and hip fracture of the next 10 years was not significantly different between 2 groups and between perioperative period and last follow-up in the same group (P gt; 0.05). Conclusion The increased BMD of adjacent lumbar spine can improve the strength of the vertebral body and reduce the incidence of adjacent vertebral fracture in patients with T12, L1 segment vertebral osteoporotic compression fracture after PVP/PKP, and PKP is superior to PVP increasing BMD of adjacent lumbar spine.
Objective To evaluate the effectiveness of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fracture (OVCF) through unilateral puncture of extreme extrapedicular approach and bilateral injection of bone cement. Methods The clinical data of 156 patients with OVCF who met the selection criteria between January 2014 and January 2016 were retrospectively analyzed. All patients were treated with PVP through unilateral puncture. According to different puncture methods, the patients were divided into two groups. In group A, 72 cases were performed PVP through the unilateral puncture of extreme extrapedicular approach and bilateral injection of bone cement, while in group B, 84 cases were performed PVP through the unilateral puncture of transpedicular approach. There was no significant difference in general data of gender, age, weight, bone mineral density, lesion segment, and disease duration between the two groups (P>0.05). The radiation exposure time, operation time, volume of bone cement injection, rate of bone cement leakage, pre- and post-operative visual analogue scale (VAS) score and local Cobb angle were recorded and compared between the two groups. Results There was no significant difference in radiation exposure time and operation time between the two groups (P>0.05), but the volume of bone cement injection in group A was significantly more than that in group B (t=20.024, P=0.000). Patients in both groups were followed up 24-32 months (mean, 26.7 months). There were 9 cases (12.5%) and 10 cases (11.9%) of cement leakage in group A and B, respectively. There was no significant difference in the incidence (χ2=0.013, P=0.910). No neurological symptoms and discomfort was found in the two groups. The VAS scores of the two groups were significantly improved after operation (P<0.05). There was no significant difference in local Cobb angle between before and after operation in group A (P>0.05); but the significant difference was found in local Cobb angle between at 2 years after operation and other time points in group B (P<0.05). The VAS score and local Cobb angle in group A were significantly better than those in group B at 2 years after operation (P<0.05). Conclusion It is simple, safe, and feasible to use the unilateral puncture of extreme extrapedicular approach and bilateral injection of bone cement to treat OVCF. Compared with the transpedicular approach, the bone cement can be distributed bilaterally in the vertebral body without prolonging the operation time and radiation exposure time, and has an advantage of decreasing long-term local Cobb angle losing of the fractured vertebrae.
ObjectiveTo discuss the safety and effectiveness of the improved technique by comparing the effects of low temperature bone cement infusion before and after the improvement in the percutaneous vertebroplasty (PVP).MethodsThe clinical data of 170 patients (184 vertebrae) with osteoporotic vertebral compression fracture who met the selection criteria between January 2016 and January 2018 were retrospectively analyzed. All patients were treated with PVP by low-temperature bone cement perfusion technology. According to the technical improvement or not, the patients were divided into two groups: the group before the technical improvement (group A, 95 cases) and the group after the technical improvement (group B, 75 cases). In group A, the patients were treated by keeping the temperature of bone cement at 0℃ and parallel puncture; in group B, the patients were treated by increasing the temperature of bone cement or reducing the time of bone cement in ice salt water and cross puncture. There was no significant difference in gender, age, disease duration, T value of bone mineral density, operative segment, and preoperative vertebral compression rate, visual analogue scale (VAS) score between the two groups (P>0.05). CT examination was performed immediately after operation, and the leakage rate of bone cement was calculated. The amount of bone cement perfusion and the proportion of bone cement in contact with the upper and lower endplates at the same time were compared between the two groups. The vertebral compression rate was calculated and the VAS score was used to evaluate the pain before operation, at immediate after operation, and last follow-up.ResultsThere was no complication such as incision infection, spinal nerve injury, or pulmonary embolism in both groups. There was no significant difference in the amount of bone cement perfusion between groups A and B (t=0.175, P=0.861). There were 38 vertebral bodies (36.89%) in group A and 49 vertebral bodies (60.49%) in group B exposed to bone cement contacting with the upper and lower endplates at the same time, showing significant difference (χ2=10.132, P=0.001). Bone cement leakage occurred in 19 vertebral bodies (18.45%) in group A and 6 vertebral bodies (7.41%) in group B, also showing significant difference (χ2=4.706, P=0.030). The patients in group A and group B were followed up (13.3±1.2) months and (11.5±1.1) months, respectively. The vertebral compression rates of the two groups at immediate after operation were significantly lower than those before operation (P<0.05), but the vertebral compression rate of group A at last follow-up was significantly higher than that at immediate after operation (P<0.05), and there was no significant difference in group B between at immediate after operation and at last follow-up (P>0.05). The VAS scores of the two groups at immediate after operation were significantly lower than those before operation (P<0.05); but the VAS scores of group A at last follow-up were significantly higher than those at immediate after operation (P<0.05) and there was no siginificant difference in group B (P>0.05). There was no significant difference in VAS scores between the two groups at immediate after operation (t=0.380, P=0.705); but at last follow-up, VAS score in group B was significantly lower than that in group A (t=3.627, P=0.000).ConclusionThe improved advanced low-temperature bone cement perfusion technology during PVP by increasing the viscosity of bone cement combined with cross-puncture technology, can reduce bone cement leakage, improve the distribution of bone cement in the vertebral body, and reduce the risk of vertebral collapse, and achieve better effectiveness.