Bone cement distribution patterns of osteoporotic vertebral fractures with intravertebral clefts after vertebroplasty

doi:10.3969/j.issn.2095-4344.2013.26.006

Abstract

Abstract:

BACKGROUND: There is no domestic research on the effectiveness of bone cement distribution patterns of osteoporotic vertebral fractures with intravertebral clefts after treated by using percutaneous kyphoplasty.
OBJECTIVE: To evaluate the clinical effectiveness of bone cement distribution patterns of osteoporotic vertebral fractures with intravertebral clefts after treated by using percutaneous kyphoplasty.
METHODS: Between February 2008 and November 2011, the clinical data of 61 patients of osteoporotic vertebral fractures with intravertebral clefts undergoing percutaneous kyphoplasty were retrospectively reviewed. The vertebral height restoration and kyphosis correction were measured, and the injection volume of bone cement, bone cement leakage distribution and adjacent vertebral fractures were recorded. The Visual Analogue Scale score was used to evaluate the degree of low back pain, and the Oswestry disability index was used to evaluate the limitation degree of activity function.
RESULTS AND CONCLUSION: According to the vertebral bone cement distribution in the X-ray film or CT image, the study was divided into bulky group (n=29) and sponge-like group (n=32). The bone cement injection volume was (5.20±0.62) mL in the bulky group and (4.80±0.66) mL in the sponge-like group, and there was significant difference between groups (P < 0.05). All patients were followed-up for 16 months. The Visual Analogue Scale score and Oswestry disability index were decreased significantly at 3 days after operation and final follow-up when compared with those before treatment (P < 0.05), and the pain relief in the sponge-like group was better than that in the bulky group (P < 0.05). The frontal vertebral height, midline vertebral height and kyphosis correction in two groups were significantly recoved (P < 0.05), and the restoration rate of imaging index in the bulky group was better that that in the sponge-like group (P < 0.05). The incidence of secondary adjacent vertebral fracture in bulky group was 14%, and 6% in the sponge-like group, and there was significant difference between two groups (P < 0.05). The incidence of bone cement leakage was 17% in bulky group and 25% in the sponge-like group, and there was significant difference between groups (P < 0.05). The results indicate that the sponge-like bone cement distribution pattern can relieve the pain effectively and stably than bulky distribution pattern, and it can improve the life quality of the patients, but with a high incidence of bone cement leakage. The bulky distribution pattern can recover the vertebral height better than sponge-like distribution pattern with a high incidence of secondary adjacent vertebral fracture.

Key words: bone and joint implants, spinal implants, osteoporotic vertebral compressive fracture, percutaneous kyphoplasty, bone cement distribution, bulky distribution, sponge-like distribution, vertebral height, kyphotic angle, adjacent vertebral fracture

CLC Number:

R318

Li Liang, Yu Xue-zhong, Sui Hai-tao, Ren Yue-bing, Liu Guang-quan. Bone cement distribution patterns of osteoporotic vertebral fractures with intravertebral clefts after vertebroplasty[J]. Chinese Journal of Tissue Engineering Research, doi: 10.3969/j.issn.2095-4344.2013.26.006.

Figures/Tables 5

References

[1] Kim YJ, Lee JW, Kim KJ, et al. Percutaneous vertebroplasty for intravertebral cleft: analysis of therapeutic effects and outcome predictors.Skeletal Radiol. 2010;39(8):757-766.

[2] Maldague BE, Noel HM, Malghem JJ.The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology. 1978;129(1):23-29.

[3] Zhang ZD,Zhao HQ,Hao HT. Zhongguo Yixue Yingxiangxue Zazhi. 2009;17 (3):230-232.张子东,赵洪全,郝洪涛.推体缺血性压缩骨折的X线、CT及MRI表现[J].中国医学影像学杂志,2009,17(3):230-232.

[4] Wu QX,Ni WF,Chi YL. Jizhu Waike Zazhi. 2012;10(1):56-59.吴爱悯,倪文飞,池永龙. 椎体内裂隙征的形成机理、影像学特征及手术治疗[J].脊柱外科杂志,2012,10(1):56-59.

[5] Libicher M, Appelt A, Berger I,et al.The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures: results from a radiological and histological study.Eur Radiol. 2007;17(9):2248-2252.

[6] Maldague BE, Noel HM, Malghem JJ.The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology. 1978;129(1):23-29.

[7] Freedman BA, Heller JG. Kummel disease: a not-so-rare complication of osteoporotic vertebral compression fractures. J Am Board Fam Med. 2009;22(1):75-78.

[8] Kaneda K, Asano S, Hashimoto T,et al. The treatment of osteoporotic-posttraumatic vertebral collapse using the Kaneda device and a bioactive ceramic vertebral prosthesis.Spine (Phila Pa 1976). 1992;17(8 Suppl): S295-303.

[9] Galibert P, Deramond H, Rosat P, et al. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty.Neurochirurgie. 1987;33(2):166-168.

[10] Jang JS, Kim DY, Lee SH. Efficacy of percutaneous vertebroplasty in the treatment of intravertebral pseudarthrosis associated with noninfected avascular necrosis of the vertebral body. Spine (Phila Pa 1976). 2003; 28(14):1588-1592.

[11] Grohs JG, Matzner M, Trieb K,et al.Treatment of intravertebral pseudarthroses by balloon kyphoplasty. J Spinal Disord Tech. 2006;19(8):560-565.

[12] Mathis JM. Percutaneous vertebroplasty: complication avoidance and technique optimization. AJNR Am J Neuroradiol. 2003;24(8):1697-1706.

[13] Kaneda K, Asano S, Hashimoto T,et al. The treatment of osteoporotic-posttraumatic vertebral collapse using the Kaneda device and a bioactive ceramic vertebral prosthesis.Spine (Phila Pa 1976). 1992 ;17(8 Suppl):S295-303.

[14] Krauss M, Hirschfelder H, Tomandl B,et al. Kyphosis reduction and the rate of cement leaks after vertebroplasty of intravertebral clefts. Eur Radiol. 2006;16(5):1015-1021.

[15] Baroud G, Vant C, Giannitsios D, et al. Effect of vertebral shell on injection pressure and intravertebral pressure in vertebroplasty.Spine (Phila Pa 1976). 2005;30(1):68-74.

[16] Chen LH, Lai PL, Chen WJ.Unipedicle percutaneous vertebroplasty for spinal intraosseous vacuum cleft. Clin Orthop Relat Res. 2005;(435):148-153.

[17] Lane JI, Maus TP, Wald JT,et al. Intravertebral clefts opacified during vertebroplasty: pathogenesis, technical implications, and prognostic significance. AJNR Am J Neuroradiol. 2002; 23(10):1642-1646.

[18] Jang JS, Kim DY, Lee SH. Efficacy of percutaneous vertebroplasty in the treatment of intravertebral pseudarthrosis associated with noninfected avascular necrosis of the vertebral body.Spine (Phila Pa 1976). 2003;28(14):1588-1592.

[19] Trout AT, Kallmes DF, Lane JI,et al. Subsequent vertebral fractures after vertebroplasty: association with intraosseous clefts. AJNR Am J Neuroradiol. 2006;27(7):1586-1591.

[20] Wiggins MC, Sehizadeh M, Pilgram TK,et al. Importance of intravertebral fracture clefts in vertebroplasty outcome. AJR Am J Roentgenol. 2007;188(3):634-640.

[21] Mousavi P, Roth S, Finkelstein J,et al. Volumetric quantification of cement leakage following percutaneous vertebroplasty in metastatic and osteoporotic vertebrae. J Neurosurg. 2003;99(1 Suppl):56-59.

[22] Meng ZB,Li J,Fu K,et al. Shengwu Guke Cailiao yu Linchuang Yanjiu. 2012;9(2):1-4.孟志斌,李俊,付昆,等. PKP 技术治疗骨质疏松性椎体骨折不愈合的临床观察[J].生物骨科材料与临床研究,2012,9(2):1-4.

[23] Grohs JG, Matzner M, Trieb K,et al.Treatment of intravertebral pseudarthroses by balloon kyphoplasty. J Spinal Disord Tech. 2006;19(8):560-565.

[24] Wiggins MC, Sehizadeh M, Pilgram TK,et al. Importance of intravertebral fracture clefts in vertebroplasty outcome. AJR Am J Roentgenol. 2007;188(3):634-640.

[25] Kaufmann TJ, Trout AT, Kallmes DF.The effects of cement volume on clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol. 2006;27(9):1933-1937.

[26] Liang D,Jiang XB,Yao ZS,et al. Zhongguo Jizhu Jisui Zazhi. 2010;20(3):260-261.粱德,江晓兵,姚珍松,等. 过伸体位下椎体成形术治疗Kümmell病的近期疗效[J].中国脊柱脊髓杂志,2010,20(3): 260-261.

[27] Libicher M, Appelt A, Berger I,et al.The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures: results from a radiological and histological study. Eur Radiol. 2007;17(9):2248-2252.

[28] Huang WG,Yi JF,Bai RF,et al. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2011;15(30):5669-5674.黄卫国,易军飞,白瑞飞,等.椎体成形穿刺注射骨水泥防止灾难性并发症:87例137个椎体资料分析[J].中国组织工程研究与临床康复,2011,15(30):5669-5674.

[29] Li DG,Su PJ,Chen GF,et al. Zhongguo Zuzhi Gongcheng Yanjiu. 2012;16(4):713-716.李大刚,苏培基,陈敢峰,等. 椎体成形和椎体后凸成形治疗骨质疏松性椎体压缩骨折的Meta分析[J].中国组织工程研究,2012, 16(4):713-716.

[30] Trout AT, Kallmes DF, Lane JI,et al. Subsequent vertebral fractures after vertebroplasty: association with intraosseous clefts. AJNR Am J Neuroradiol. 2006;27(7):1586-1591.

[31] Pflugmacher R, Schroeder RJ, Klostermann CK. Incidence of adjacent vertebral fractures in patients treated with balloon kyphoplasty: two years' prospective follow-up. Acta Radiol. 2006;47(8):830-840.

[32] Tohmeh AG, Mathis JM, Fenton DC,et al. Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic compression fractures.Spine (Phila Pa 1976). 1999;24(17):1772-1776.

[33] Wang LS,Lv SQ,Tan JW,et al. Zhongguo Weichuang Waike Zazhi. 2011;11(4):338-341.王磊升,吕世桥,谭江威,等. 单侧经皮椎体后凸成形术治疗有“真空裂隙征”的骨质疏松椎体骨折[J].中国微创外科杂志,2011, 11(4):338-341.

[34] Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine (Phila Pa 1976). 2001;26(14):1547- 1554.