Objective To investigate the effects of different puncture levels on bone cement distribution and effectiveness in bilateral percutaneous vertebroplasty for osteoporotic thoracolumbar compression fractures. Methods A clinical data of 274 patients with osteoporotic thoracolumbar compression fractures who met the selection criteria between December 2017 and December 2020 was retrospectively analyzed. All patients underwent bilateral percutaneous vertebroplasty. During operation, the final position of the puncture needle tip reached was observed by C-arm X-ray machine. And 118 cases of bilateral puncture needle tips were at the same level (group A); 156 cases of bilateral puncture needle tips were at different levels (group B), of which 87 cases were at the upper 1/3 layer and the lower 1/3 layer respectively (group B1), and 69 cases were at the adjacent levels (group B2). There was no significant difference in gender, age, fracture segment, degree of osteoporosis, disease duration, and preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between groups A and B and among groups A, B1, and B2 (P>0.05). The operation time, bone cement injection volume, postoperative VAS score, ODI, and bone cement distribution were compared among the groups. Results All operations were successfully completed without pulmonary embolism, needle tract infection, or nerve compression caused by bone cement leakage. There was no significant difference in operation time and bone cement injection volume between groups A and B or among groups A, B1, and B2 (P>0.05). All patients were followed up 3-32 months, with an average of 7.8 months. There was no significant difference in follow-up time between groups A and B and among groups A, B1, and B2 (P>0.05). At 3 days after operation and last follow-up, VAS score and ODI were significantly lower in group B than in group A (P<0.05), in groups B1 and B2 than in group A (P<0.05), and in group B1 than in group B2 (P<0.05). Imaging review showed that the distribution of bone cement in the coronal midline of injured vertebrae was significantly better in group B than in group A (P<0.05), in groups B1 and B2 than in group A (P<0.05), and in group B1 than in group B2 (P<0.05). In group A, 7 cases had postoperative vertebral collapse and 8 cases had other vertebral fractures. In group B, only 1 case had postoperative vertebral collapse during follow-up. ConclusionBilateral percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures can obtain good bone cement distribution and effectiveness when the puncture needle tips locate at different levels during operation. When the puncture needle tips locate at the upper 1/3 layer and the lower 1/3 layer of the vertebral body, respectively, the puncture sites are closer to the upper and lower endplates, and the injected bone cement is easier to connect with the upper and lower endplates.
ObjectiveTo evaluate the effectiveness of pedicle subtraction osteotomy (PSO) assisted with anterior column reconstruction in the treatment of chronic osteoporotic vertebral compression fracture (OVCF). MethodsBetween January 2008 and October 2014, 11 cases of chronic OVCF were treated. There were 2 males and 9 females, aged 65-76 years (mean, 72.3 years). The vertebral compression fracture segment involved T11 in 2 cases, T12 in 2 cases, L1 in 4 cases, L2 in 2 cases, and L3 in 1 case. At preoperation, the Oswestry disability index (ODI) score was 31.1±10.2; kyphosis Cobb angle of fractured vertebrae was (36.5±10.2)° on the lateral X-ray films of the spine; and distance between C7 plumb vertical line (C7 PL) and sagittal vertical axis (SVA) of the S1 superior border was (5.2±2.5) cm. Six cases had spinal cord injury (SCI), including 4 cases of Frankel grade C and 2 cases of grade D. At last follow-up, ODI score, kyphosis Cobb angle of fractured vertebrae, and distance between C7 PL and SVA were recorded and compared with preoperative values. Postoperative Frankle scores were recorded in SCI cases. X-ray film and CT scan were taken to evaluate bone fusion at 12 months after operation. ResultsThe operation was completed successfully without serious complications. Nerve root radiation symptoms occurred in 2 cases undergoing lumbar PSO, which was relieved after conservative treatment. Cerebrospinal fluid leakage occurred in 1 case and was cured after 2 weeks. All cases were followed up 12-24 months (mean, 15.6 months). No internal fixation failure or pseudarthrosis was found postoperatively.Screw loosening was found in 1 case (2 screws of the upper level) and titanium Cage cutting vertebral body was found in 1 case. Bone fusion was obtained in all cases at 12 months after operation. At last follow-up, ODI score was significantly improved to 13.7±5.7(t=4.417, P=0.018), kyphosis Cobb angle of fractured vertebrae to (7.0±15.2)° (t=5.113, P=0.009), and the distance between C7 PL and SVA to (2.8±2.2) cm (t=3.285, P=0.032). In 6 SCI cases, Frankle grade was recovered to E (1 case), to D (1 case), and no improvement (2 cases) from C, and to E from D (2 cases). ConclusionPSO assisted anterior column reconstruction was an effective method in treatment of chronic OVCF.
ObjectiveTo evaluate the safety of photoelectric guided navigation unilateral puncture of the percutaneous kyphoplasty (PKP) in the treatment of thoracolumbar osteoporotic vertebral compression fracture (OVCF).MethodsA randomized controlled clinical research was performed between June 2015 and January 2017. Eighty-five cases of OVCF were treated with photoelectric guided navigation unilateral puncture of the PKP (trial group, 43 cases) or C arm fluoroscopy unilateral puncture of the PKP (control group, 42 cases) respectively. There was no significant difference in gender, age, disease duration, segmental fracture, AO classification, bone mineral density, and preoperative visual analogue scale (VAS) score between 2 groups (P>0.05). The concordance rate of puncture path and design path, the incidence of pedicle wall breaking, the incidence of bone cement leakage, and the rate of bone cement distribution center were observed and calculated on postoperative CT images; the intraoperative X-ray exposure frequency, frequency of puncture, operation time, VAS scores before operation and at 2 days after operation, and postoperative blood vessel or nerve injury were recorded and compared.ResultsThe intraoperative X-ray exposure frequency and puncture frequency in trial group were significantly less than those in control group (P<0.05), but there was no significant difference in operation time between 2 groups (t=0.440, P=0.661). The VAS scores of 2 groups at 2 days after operation were significantly improved when compared with preoperative ones (P<0.05), but there was no significant difference in VAS score at 2 days after operation between 2 groups (t=0.406, P=0.685). All the patients were followed up 6-18 months (mean, 10 months). No blood vessel or nerve injury occurred in 2 groups. The incidence of pedicle wall breaking, the incidence of bone cement leakage, the concordance rate of puncture path and design path, and the rate of bone cement distribution center in trial group were 2.33% (1/43), 2.33% (1/43), 86.05% (37/43), and 88.37% (38/43) respectively, all showing significant differences when compared with those of control group [19.05% (8/42), 21.43% (9/42), 45.24% (19/42), and 50.00% (21/42) respectively] (P<0.05).ConclusionIntraoperative photoelectric guided navigation unilateral puncture of the PKP can improve the success rate of target puncture and reduce the incidence of pedicle wall breaking effectively, and achieve better bone cement distribution and better security.
ObjectiveTo compare the clinical efficacy and safety between percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fracture (OVCF) with intravertebral vacuum cleft (IVC). MethodsBetween January 2010 and December 2013, 68 patients with single OVCF and IVC were treated, and the clinical data were retrospectively analyzed. Of 68 patients, 48 underwent PVP (PVP group) and 20 underwent PKP (PKP group). There was no significant difference in age, gender, disease duration, fracture level, bone mineral density (BMD), visual analogue scale (VAS), Oswestry disability index (ODI), and preoperative radiological parameters between 2 groups (P > 0.05). The intraoperative incidence of cement leakage, cement volume, and operative time were compared between 2 groups; VAS score was used for evaluation of back pain and ODI for evaluation of dysfunction; the incidence of adjacent vertebral fracture was observed within 2 years. The vertebral height and kyphotic angle were measured on X-ray films; the rate of vertebral compression (CR), reduction rate (RR), progressive height loss (PHL), reduction angle (RA), and progressive angle (PA) were calculated. ResultsThere was no significant difference in cement volume and the incidence of cement leakage between 2 groups (P > 0.05). The operative time in PVP group was shorter than that in PKP group, showing significant difference (t=-8.821, P=0.000). The mean follow-up time was 2.4 years (range, 2.0-3.1 years). The VAS scores and ODI were significantly reduced at 1 day, 1 year, and 2 years after operation when compared with preoperative scores (P < 0.05), but there was no significant difference between different time points after operation in 2 groups (P > 0.05). Adjacent vertebral fracture occurred in 5 cases (10.4%) of PVP group and in 2 cases (10.0%) of PKP group, showing no significant difference (χ2=0.003, P=0.963). BMD was significantly increased at 1 year and 2 years after operation when compared with preoperative BMD (P < 0.05), but no significant difference was found between 2 groups (t=0.463, P=0.642; t=0.465, P=0.646). The X-ray films showed that CR and kyphotic angle were significantly restored at immediate after operation in 2 groups (P < 0.05); but vertebral height and kyphotic angle gradually aggravated with time, showing significant difference between at immediate and at 1 and 2 years after operation (P < 0.05); there was no significant difference in CR and kyphotic angle between 2 groups at each time point (P > 0.05). RR, RA, PHL, and PA showed no significant difference between 2 groups (P > 0.05). ConclusionThere is similar clinical and radiological efficacy between PVP and PKP for treatment of OVCF with IVC. Re-collapse could happen after operation, so strict observation and follow-up are needed.
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 effectiveness of robot assisted and C-arm assisted percutaneous kyphoplasty (PKP) in the treatment of single/double-segment osteoporotic vertebral compression fracture (OVCF).MethodsThe clinical data of 108 cases of single/double-segment OVCF who met the selection criteria between May 2018 and October 2019 were retrospectively analyzed. There were 65 cases of single-segment fractures, of which 38 cases underwent “TiRobot” orthopedic robot-assisted PKP (robot group), 27 cases underwent C-arm X-ray machine fluoroscopy-assisted PKP (C-arm group). There were 43 cases of double-segment fractures, including 21 cases in robot group and 22 cases in C-arm group. There was no significant difference in gender, age, T value of bone mineral density, fracture segment distribution, time from injury to operation, and preoperative visual analogue scale (VAS) score, vertebral kyphosis angle (VKA), and height of fractured vertebra (HFV) in the patients with single/double-segments fractures between robot group and C-arm group (P>0.05). The operation time, the fluoroscopy frequency of the surgeons and the patient, the fluoroscopy exposure time of the surgeons and the patient, the radiation dose of the C-arm; the VAS scores, VKA, HFV before operation, at 1 day and 6 months after operation; and the complications in the two groups were recorded and compared.ResultsAll patients underwent surgery successfully. The operation time of the single-segment robot group was significantly longer than that of the C-arm group (t=5.514, P=0.000), while the operation time of the double-segment robot group was not significantly different from that of the C-arm group (t=1.892, P=0.205). The single/double-segment robot group required three-dimensional scanning, so the fluoroscopy frequency, fluoroscopy exposure time, and radiation dose of C-arm received by the patient were significantly higher than those of the C-arm group (P<0.05); the fluoroscopy frequency and the fluoroscopy exposure time received by the surgeons were significantly less than those of the C-arm group (P<0.05). There was no infection, embolism, neurological injury, and adjacent segmental fractures. The single/double-segment robot group showed lower rate of cement leakage when compared with the C-arm group (P<0.05), all the cases of cement leakage happened outside the spinal canal. The VAS score, VKA, and HFV of the single/double-segment robot group and the C-arm group were significantly improved at 1 day and 6 months after operation (P<0.05), and the VAS score at 6 months after operation was further improved compared with that at 1 day after operation (P<0.05). At 1 day and 6 months after operation, there was no significant difference in VAS score between the single/double-segment robot group and the C-arm group (P>0.05). The VKA and HFV of robot group were significantly better than those of the C-arm group (P<0.05).ConclusionFor single/double-segment OVCF, robot assisted PKP has more advantages in correcting VKA and HFV, reducing fluoroscopy exposure of surgeons and bone cement leakage rate; C-arm assisted PKP has more advantages in reducing the operation time of single-segment OVCF and fluoroscopy exposure of patients during operation.
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.
Objective To compare the effectiveness of TiRobot-assisted and C-arm X-ray fluoroscopy assisted percutaneous kyphoplasty (PKP) via pedicle of vertebra in the treatment of osteoporotic vertebral compression fracture (OVCF) of thoracic vertebrae. Methods The clinical data of 85 patients with OVCF of thoracic vertebrae who were admitted between January 2020 and March 2023 and met the selection criteria was retrospectively analyzed including 40 patients (50 vertebrae) undergoing PKP assisted by TiRobot (group A) and 45 patients (50 vertebrae) undergoing PKP assisted by C-arm X-ray fluoroscopy (group B). There was no significant difference in the comparison of baseline data such as gender, age, body mass index, bone mineral density T-value, fracture segment, trauma history, and preoperative numerical rating scale (NRS) score, Oswestry disability index (ODI), and Cobb angle of injured vertebra between the two groups (P>0.05). The effectiveness evaluation indexes of the two groups, including the operation time, the volume of injected cement, the times of fluoroscopies, the length of hospital stay, and the occurrence of postoperative complications were collected and compared. Anteroposterior and lateral X-ray films and CT of the injured vertebra were reviewed at 1 day after operation to observe whether there was cement leakage and to evaluate the distribution of cement in the injured vertebra. Before and after operation, pain was assessed using the NRS score, dysfunction was assessed using the ODI, and vertebral height recovery was assessed by measuring the Cobb angle of the injured vertebrae by X-ray films. Results Both groups of patients successfully completed the operation, the operation time, the volume of injected cement, the times of fluoroscopies, and the length of hospital stay in group A were significantly less than those in group B (P<0.05). The patients in two groups were followed up 4-12 months (mean, 9.6 months). Bone cement leakage occurred in 5 vertebrae in group A and 15 vertebrae in group B after operation, all of which leaked to the intervertebral space and around the vertebral body, and the patients had no obvious clinical symptoms. The difference of bone cement leakage between the two groups was significant (P<0.05). No severe complication such as intraspinal leakage, infection, or vascular embolism was found in the two groups. At 1 day after operation, the distribution index of bone cement in group A was mostly grade Ⅴ, which was well dispersed; while in group B, it was mostly grade Ⅱ and grade Ⅴ; the difference of bone cement distribution index between the two groups was significant (P<0.05). The NRS score, ODI, and Cobb angle of injured vertebra in both groups were significantly improved at 1 day after operation when compared with preoperative ones (P<0.05). There was no significant difference in the difference of the above indexes between the two groups before and after operation (P>0.05). Conclusion TiRobot-assisted unilateral PKP in the treatment of OVCF of thoracic vertebrae is safe and effective, which can reduce the X-ray transmission times during operation, shorten the operation time, reduce the volume of bone cement injection, and thus decrease incidence of bone cement leakage.