Comparison of percutaneous vertebroplasty and percutaneous
curved vertebroplasty for osteoporotic vertebral compression fractures: distribution
and leakage rate of injected bone cement

doi:10.3969/j.issn.2095-4344.2248

Abstract

Abstract:

BACKGROUND: Percutaneous curved vertebroplasty is a modified surgical method of percutaneous vertebroplasty; the most prominent feature of which is that it can make the bone cement distributed symmetrically and balance the strength on both sides of the vertebral body. In theory, it can ensure the distribution of bone cement in the vertebral body, and solve the problem that the uneven distribution of bone cement in the traditional percutaneous vertebroplasty and single injection leads to poor pain relief effect in the fracture area.

OBJECTIVE: To compare the clinical efficacy of percutaneous curved vertebroplasty and percutaneous vertebroplasty bone cement injection in the treatment of osteoporotic vertebral compression fractures, and to discuss the value of percutaneous curved vertebroplasty in clinical application.

METHODS: Seventy patients with single vertebral osteoporotic vertebral compression fractures from the Third Affiliated Hospital of AnHui Medical University between 2017 and 2018 were selected. The patients were randomly divided into two groups. Percutaneous curved vertebroplasty group (n=35) received treatment with percutaneous curved vertebroplasty. Percutaneous vertebroplasty group (n=35) received treatment with percutaneous vertebroplasty. Distribution and leakage of bone cement were observed in the two groups. Visual analogue scale score and Oswestry disability index were assessed preoperatively and 1 day postoperatively. Postoperative follow-up was conducted for 1 year to observe the recovery of the height of the anterior edge of the injured vertebra and the occurrence of adjacent vertebral fractures. The trial was approved by the Ethics Committee of the Third Affiliated Hospital of Anhui Medical University.

RESULTS AND CONCLUSION: (1) Compared with the percutaneous vertebroplasty group, the distribution of bone cement was more uniform and satisfactory (P < 0.05), and the leakage rate of bone cement was lower in the percutaneous curved vertebroplasty group (P < 0.05). (2) Both the visual analogue scale score and Oswestry disability index of the two groups at 1 day after surgery were significantly improved compared with those before surgery (P < 0.05). The improvement of Oswestry disability index of the percutaneous curved vertebroplasty group was better than that of the percutaneous vertebroplasty group (P < 0.05). (3) The height of the anterior edge of the injured vertebral body of the two groups improved significantly one year after surgery compared with that before surgery (P < 0.05), and there was no significant difference between the two groups (P > 0.05). (4) There was no significant difference in the incidence of adjacent vertebral fractures between the two groups (P > 0.05). (5) The results showed that compared with the treatment of percutaneous vertebroplasty, the treatment of osteoporotic vertebral body compression fractures by percutaneous curved vertebroplasty can reduce the rate of bone cement leakage and improve the quality of life of patients.

Key words: bone cement, osteoporotic fracture, spinal fracture, vertebroplasty, percutaneous curved vertebroplasty, vertebral height, visual analogue scale score, Oswestry disability index

CLC Number:

Li Fanjie, Du Yibin, Liu Yiming, Zhang Zhidong, Li Jian, Ma Li, Li Chun, Cheng Yonghong. Comparison of percutaneous vertebroplasty and percutaneous curved vertebroplasty for osteoporotic vertebral compression fractures: distribution and leakage rate of injected bone cement [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(10): 1484-1490.

Figures/Tables 8

References

[1] YE LQ, LIAN G, JIANG XB, et al.Risk Factors for the Occurrence of Insufficient Cement Distribution in the Fractured Area after Percutaneous Vertebroplasty in Osteoporotic Vertebral Compression Fractures.Pain Physician.2018;21(1):E33-E42.
[2] MCCARTHY J, DAVIS A.Diagnosis and Management of Vertebral Compression Fractures. Am Fam Physician. 2016;94(1):44-50.
[3] KAN SL, YUAN ZF, CHEN LX, et al.Which is best for osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty or non-surgical treatment? A study protocol for a Bayesian network meta-analysis.BMJ Open.2017; 7(1):e012937.
[4] FENG L, FENG C, CHEN J, et al.The risk factors of vertebral refracture after kyphoplasty in patients with osteoporotic vertebral compression fractures: a study protocol for a prospective cohort study. BMC Musculoskelet Disord. 2018;19(1):195.
[5] SHI C, ZHANG M, CHENG AY, et al.Percutaneous kyphoplasty combined with zoledronic acid infusion in the treatment of osteoporotic thoracolumbar fractures in the elderly. Clin Interv Aging.2018;13:853-861.
[6] ZHAO WT, QIN DP, ZHANG XG, et al.Biomechanical effects of different vertebral heights after augmentation of osteoporotic vertebral compression fracture: a three-dimensional finite element analysis.J Orthop Surg Res.2018;13(1):32.
[7] ZHOU T, LIN H, WANG H, et al.Comparative study on the biomechanics between improved PVP and traditional PKP in the treatment of vertebral peripheral wall damage-type OVCF. Exp Ther Med. 2017;14(1):575-580.
[8] YU WB, JIANG XB, LIANG D, et al.Risk factors and score for recollapse of the augmented vertebrae after percutaneous vertebroplasty in osteoporotic vertebral compression fractures. Osteoporos Int.2019;30(2):423-430.
[9] MANSOUR A, ABDEL-RAZEQ N, ABUALI H, et al.Cement pulmonary embolism as a complication of percutaneous vertebroplasty in cancer patients. Cancer Imaging.2018;18(1): 5.
[10] 蒋国强,蒋国强,蔡凯文,等.椎间隙骨水泥渗漏的不同分型对邻椎相邻终板应力分布的影响：三维有限元研究[J].中华骨科杂志, 2019, 39(6):364.
[11] YI HJ, JEONG JH, IM SB, et al.Percutaneous Vertebroplasty versus Conservative Treatment for One Level Thoracolumbar Osteoporotic Compression Fracture: Results of an Over 2-Year Follow-up. Pain Physician.2016;19(5):E743-750.
[12] SARACEN A, KOTWICA Z.Complications of percutaneous vertebroplasty: An analysis of 1100 procedures performed in 616 patients. Medicine (Baltimore).2016;95(24):e3850.
[13] GRASSO G.Does Optimal Volume Fraction in Percutaneous Vertebroplasty Prevent Cement Leakage? World Neurosurg. 2018; 116:489-490.
[14] TAKURA T, YOSHIMATSU M, SUGIMORI H, et al. Cost-Effectiveness Analysis of Percutaneous Vertebroplasty for Osteoporotic Compression Fractures.Clin Spine Surg. 2017;30(3): E205-E210.
[15] SUN H, LU PP, LIU YJ, et al.Can Unilateral Kyphoplasty Replace Bilateral Kyphoplasty in Treatment of Osteoporotic Vertebral Compression Fractures? A Systematic Review and Meta-analysis. Pain Physician.2016;19(8):551-563.
[16] FIRANESCU CE, De VRIES J, LODDER P, et al. Percutaneous Vertebroplasty is no Risk Factor for New Vertebral Fractures and Protects Against Further Height Loss (VERTOS IV). Cardiovasc Intervent Radiol.2019;42(7): 991-1000.
[17] 熊森,毛克亚,韩振川,等.弯角输送装置在体外椎体成形实验中的效果观察[J].军医进修学院学报,2016,37(7):769-772.
[18] SOON WC, MATHEW RK, TIMOTHY J.Comparison of vertebroplasty using directional versus straight needle. Acta Radiol Open.2015;4(3):2047981615569268.
[19] SI L, WINZENBERG TM, JIANG Q, et al.Projection of osteoporosis-related fractures and costs in China: 2010-2050. Osteoporos Int.2015;26(7):1929-1937.
[20] ZHOU X, MENG X, ZHU H, et al.Early versus late percutaneous kyphoplasty for treating osteoporotic vertebral compression fracture: A retrospective study.Clin Neurol Neurosurg.2019; 180:101-105.
[21] ZUO XH, ZHU XP, AO HG, et al.Network meta-analysis of percutaneous vertebroplasty, percutaneous kyphoplasty, nerve block, and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures (OVCFs) in short-term and long-term effects. Medicine (Baltimore). 2018;97(29):e11544.
[22] ZAPALOWICZ K, RADEK M. Percutaneous balloon kyphoplasty in the treatment of painful vertebral compression fractures: effect on local kyphosis and one-year outcomes in pain and disability. Neurol Neurochir Pol.2015;9(1):11-15.
[23] LIU J, LI CS, CHANG CS, et al.Long-term follow-up study of osteoporotic vertebral compression fracture treated using balloon kyphoplasty and vertebroplasty. J Neurosurg Spine. 2015;23(1):94-98.
[24] BAZ AB, AKALIN S, KILICASLAN OF, et al.Efficiency of Balloon Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures. Kobe J Med Sci. 2016;62(3):E49-54.
[25] KANAYAMA M, OHA F, IWATA A, et al.Does balloon kyphoplasty improve the global spinal alignment in osteoporotic vertebral fracture? Int Orthop. 2015;39(6):1137-1143.
[26] WANG CH, MA JZ, ZHANG CC, et al.Comparison of high-viscosity cement vertebroplasty and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Pain Physician.2015;18(2):E187-194.
[27] GAO C, ZONG M, WANG WT, et al.Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures.Acta Radiol. 2018;59(5):577-585.
[28] ZHANG H, XUAN J, CHEN TH, et al.Projection of the Most Anterior Line of the Spinal Canal on Lateral Radiograph: An Anatomic Study for Percutaneous Kyphoplasty and Percutaneous Vertebroplasty.J Invest Surg.2018:1-7.
[29] LI YX, GUO DQ, ZHANG SC, et al.Risk factor analysis for re-collapse of cemented vertebrae after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP).Int Orthop.2018;42(9):2131-2139.
[30] 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.
[31] BELKOFF SM, MATHIS JM, JASPER LE, et al.The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior. Spine (Phila Pa 1976). 2001;26(14):1537-1541.