Corpectomy and expandable cage replacement versus third generation percutaneous augmentation system in case of vertebra plana: rationale and recommendations (original) (raw)
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Saudi Medical Journal, 2015
Objectives: To evaluate the feasibility of a minimally invasive technique using a titanium expandable device to achieve anatomical restoration of vertebral compression fractures (VCF) of the thoracolumbar spine. Methods: This prospective study included 27 patients diagnosed with VCF (Magerl classification A.1.2, A.1.3, and A.3.1) of the thoracolumbar spine treated with percutaneous cement augmentation using the SpineJack® device. The study was conducted in Valladolid University Hospital, Valladolid, Spain from January to December 2012, with a minimum one-year follow up. Preoperative evaluation included visual analogue scale (VAS) for pain, and radiological assessment of the VCF using 3-dimensional computed tomography (3D-CT) scans for measurements of vertebral heights and angles. The patients were followed at 3, 6, and 12 months with clinical VAS and radiological assessments. Results: The procedure was performed in 27 patients with a mean age of 55.9 ± 17.3 years, 55.6% females. All patients underwent surgery within 6 weeks from time of injury. No procedure related complications occurred. Pain measured by VAS score decreased from 7.0 preoperatively to 3.2 within 24 hours, and remained 2.2 at 3 months, 2.1 at 6 months, and 1.5 at 12-months follow-up (p<0.05). Mean height restorations for the anterior was 3.56 mm, central was 2.49, and posterior vertebral was 1.28 mm, and maintained at 12-months follow-up (p=0.001). Conclusion: This new percutaneous technique for VCF has shown good clinical results in pain control and the possibility to reduce both vertebral kyphosis angles and fractured endplates seen in 3D-CT scans assessment method. Further studies are needed to confirm those results on larger cohorts with long-term follow up.
Journal of Craniovertebral Junction and Spine, 2012
Introduction: The prevalence of osteoporotic vertebral fractures (OVF) increased in the last years. Compression fractures promote a progressive spine kyphosis increase, resulting in a weight shift and anterior column overload, with OVF additional risk (domino effect). The aim of this study is to evaluate the OVF treatment outcome using Spine Jack ® , a titanium device for third generation percutaneous vertebral augmentation procedures (PVAPs). Materials and Methods: From February 2010, a prospective randomized study was performed examining 300 patients who underwent PVAP due to OVF type A1 according to Magerl/AO spine classifi cation. Patients enrolled in the study were divided in two homogenous groups with regards to age (65-85 years), sex, and general clinical fi ndings. Group A included 150 patients who underwent PVAP using Spine Jack ® system; the second, group B (control group), included 150 patients treated by conventional balloon kyphoplasty. Patients underwent a clinical (visual analogue scale and Oswestry disability index) and radiographic follow-up, with post-operative standing plain radiogram of the spine at 1, 6, and 12 months. The radiographic parameters that were taken into account were: Post-operative anterior vertebral body height, pre-operative anterior vertebral body height, cephalic anterior vertebral body height, and caudal anterior vertebral body height. Results: Compared to the Spine Jack ® group, the kyphoplasty group required a little longer operation time (an average of 40 min-group A vs. 45 min-group B, P < 0.05) and a greater amount of polymethylmethacrylate (4.0 mL-group A vs. 5.0 mL-group B, P < 0.05;). The post-operative increase in vertebral body height was greater in the Spine Jack ® group than in the kyphoplasty group (P < 0.05). Discussion: PVAP are based on the cement injection into the vertebral body. Vertebroplasty does not allow the vertebral body height recovery. Balloon kyphoplasty allows a temporary height restoration. Spine Jack ® has some new features compared to other systems: It is equipped with a mechanical and not a hydraulic opening control; this ensures a gradual and controlled vertebral fracture reduction. Conclusions: In our study, we demonstrated that the third generation PVAP with Spine Jack ® is able to determine a safe vertebral body height restoration compared to the conventional balloon kyphoplasty.
Trends in Vertebral Augmentation Practice for Osteoporotic Vertebral Fracture
Sabuncuoglu Serefeddin Health Sciences, 2023
Osteoporosis is characterized by low bone mass, primarily affecting older individuals and a common complication is vertebral fractures. The collapse-induced height loss in vertebrae can result in spinal instability and progressive kyphotic deformity. Surgical intervention for osteoporotic vertebrae poses challenges due to poor bone quality and frequent medical comorbidities. In recent years, it has become the predominant method for vertebral augmentation in acute fractures, aiming to relieve pain, strengthen the vertebral structure, and prevent deformities by restoring height. These procedures involve percutaneous placement of cannulas into each collapsed vertebral body through a unipedicular or bipedicular approach. Novel products are emerging to strengthen vertebrae in treating osteoporotic compression fractures. Balloon kyphoplasty and vertebroplasty are widely accepted and recognized as effective vertebral augmentation methods. Treatment guidelines are evolving with the introduction of innovative systems like Vertebral Body Stenting, Titanium Mesh, and Sky Bone Expander, claiming to achieve exceptional vertebral height restoration. Controversies persist regarding the optimal timing for vertebral augmentation post-fracture. Polymethylmethacrylate cement is extensively used to stabilize fractured vertebral bodies. Additionally, new calcium phosphate-based nanocomposite cements are gaining prominence. These advancements underscore the ongoing development in the treatment of osteoporotic vertebral compression fractures. Each innovative implant introduces unique features and indications. Precise
Research Square (Research Square), 2021
Background: The restauration of the local kyphosis is crucial to thoracolumbar fractures outcomes. Recently, the Tektona ™ (Spine Art) system, constituted by a flexible lamella for corporeal reduction has emerged as a promising solution for osteoporotic fractures. However, no study has yet focused on its results on traumatic fractures. Methods: A retrospective longitudinal study on prospectively collected data was conducted on 53 patients that had a kyphoplasty by Tektona ™ , associated or not to percutaneous fixation. The data collected were clinical, surgical and scannographic (measurement of AVH, MVH and PVH (anterior/medium/posterior vertebral height), and RTA (regional traumatic angle) in°), preoperatively, post-operatively and at last follow-up. Results: Fractures were mainly located at the upper lumbar spine and were AOSpine A3 type for 74%. The mean RTA was 12° in pre-operative, 4° in post-operative (p = 2e − 9), and 8° at the last follow-up (p = 0,01). The mean correction of RTA for the fixation group was − 10 ± 6° versus − 7 ± 4° for the kyphobroplasty alone group (p = 0,006). The mean correction for fractures located at T10-T12 was − 9 ± 3°, − 9 ± 5° for L1, − 8 ± 3° for L2 and − 5 ± 3° for L3-L5 (p = 0,045). Conclusions: The Tektona ® system appears to be efficient for acute thoraco-lumbar fractures, comparable to other available systems, allowing a real intracorporeal reduction work. Its relevance, especially in the long term needs further investigation. The association of a percutaneous fixation allow to obtain a better correction of the RTA but did not seem to prevent the loss of correction at follow-up.
European review for medical and pharmacological sciences, 2011
Minimally invasive spine surgery has gained a great consent in the treatment of vertebral osteoporotic fractures. We perform a retrospective clinical and radiographic review on 32 consecutive patients (22 female and 10 male) surgically treated for a thoracolumbar osteoporotic fracture (type A) by a minimally invasive system. By this study, we propose to determine the safety and efficacy of an expandable, percutaneous, minimally invasive technique to reduce the disability caused by vertebral osteoporotic fractures. We retrospectively reviewed 32 patients who were operated on between 2003 and 2004 by means of an innovative technique which employs an expandable system inserted by a minimally invasive approach into the vertebral body. Average age at surgery was 64.8 years (range, 27-82). All patients were mobilized in first post-operative day with no external immobilization and discharged from the Hospital in the second post-operative day. This innovative technique which employs an expa...
Objective: Minimally invasive percutaneous vertebral augmentation techniques such as vertebroplasty and kypho-plasty are the preferred treatment option for vertebral compression fractures. The objectives of this study were to evaluate the results of 124 patients treated by kyphoplasty and vertebroplasty. Methods: We retrospectively reviewed the hospital records of 124 consecutive patients treated with kyphoplasty or vertebroplasty in our department. Patients with osteoporotic compression fractures, traumatic compressions and osteolytic vertebral tumors, including various metastases, hemangiomas and multiple myeloma, were included in the study. Preoperative and postoperative visual analog scale pain scores, percentages of vertebral compression and kyphotic angles were measured and compared as well as demographic characteristics and postoperative complications. Results: One hundred fifty-three levels were treated in 113 patients with kyphoplasty and 15 levels were treated with vertebroplasty in 11 patients. The mean visual analog scale was 90.5 ± 11.7 preoperatively and 9.7 ± 12.9 postoperatively. The mean follow-up was six months. The mean preoperative kyphotic angle of the compressed vertebral segment was 11.46° ± 7.3°, whereas the mean postoperative kyphotic angle was 6.65° ± 6.1°. We achieved an average of 5° of improvement in the kyphotic angle of the VB after the procedure. The percentage of the compression of the vertebral segment improved from 28.98% ± 16.84% to 15.6% ± 11.9% after the procedure. Both the improvements of the kyphotic angle and percentage of the vertebral compression , were statistically significant (P = 0.01, wilcoxon signed rank test). Asymptomatic cement extravasa-tion occurred in four patients and four additional fractures occurred in previously untreated levels during the follow up period. Conclusion: Percutaneous vertebroplasty and balloon kyphoplasty are both effective and safe minimally invasive procedures for the stabilization of vertebral compression fractures. These procedures are very effective in relieving pain. Balloon kyphoplasty also restores vertebral height and helps normalizing the overall sagittal alignment as much as possible.
Spinal loads after osteoporotic vertebral fractures treated by vertebroplasty or kyphoplasty
European Spine Journal, 2006
Vertebroplasty and kyphoplasty are routine treatments for compression fractures of vertebral bodies. A wedge-shaped compression fracture shifts the centre of gravity of the upper body anteriorly and generally, this shift can be compensated in the spine and in the hips. However, it is still unclear how a wedge-shaped compression fracture of a vertebra increases forces in the trunk muscle and the intradiscal pressure in the adjacent discs. A nonlinear finite element model of the lumbar spine was used to estimate the force in the trunk muscle, the intradiscal pressure and the stresses in the endplates in the intact spine, and after vertebroplasty and kyphoplasty treatment. In this study, kyphoplasty represents a treatment with nearly full fracture reduction and vertebroplasty one without restoration of kyphotic angle although in reality kyphoplasty does not guarantee fracture reduction. If no compensation of upper body shift is assumed, the force in the erector spine increases by about 200% for the vertebroplasty but by only 55% for the kyphoplasty compared to the intact spine. Intradiscal pressure increases by about 60 and 20% for the vertebroplasty and kyphoplasty, respectively. In contrast, with shift compensation of the upper body, the increase in muscle force is much lower and increase in intradiscal pressure is only about 20 and 7.5% for the vertebroplasty and kyphoplasty, respectively. Augmentation of the vertebral body with bone cement has a much smaller effect on intradiscal pressure. The increase in that case is only about 2.4% for the intact as well as for the fractured vertebra. Moreover, the effect of upper body shift after a wedge-shaped vertebral body fracture on intradiscal pressure and thus on spinal load is much more pronounced than that of stiffness increase due to cement infiltration. Maximum von Mises stress in the endplates of all lumbar vertebrae is also higher after kyphoplasty and vertebroplasty. Cement augmentation has only a minor effect on endplate stresses in the unfractured vertebrae. The advantages of kyphoplasty found in this study will be apparent only if nearly full fracture reduction is achieved. Otherwise, differences between kyphoplasty and vertebroplasty become small or vanish. Our results suggest that vertebral body fractures in the adjacent vertebrae after vertebroplasty or kyphoplasty are not induced by the elevated stiffness of the treated vertebra, but instead the anterior shift of the upper body is the dominating factor.
2021
Many studies analyze the increase in vertebral body height after percutaneous vertebroplasty (PVP) in the sagittal plane. However, the vertebral body is a three-dimensional structure. The aim of this study is to determine if there is a volume change in the vertebral body after PVP, and to determine possible differences according to the spine segment treated. This prospective study included 25 patients (51 vertebrae, BMI 26.4kg/m2, T-score − 2.6) treated with PVP. The volumetric study was performed with MRI pre and post-surgery. We studied the amount of injected cement, the volume of cement inside the vertebral body, the fractured vertebra volume, percentage of volume loss, percentage of volume restoration and percentage of bone filling. Thoracolumbar fractures predominated. The average volume of injected cement was 3.6ml (range, 0.9–6.5). The volume loss was 4.1±3.3ml (16.2%). In the vertebral body, there was an increase in volume after PVP (difference + 1.6±1.6ml, 95% CI 1.1–2.03)....