Modified Percutaneous Kyphoplasty Technique in the Treatment of Osteoporotic Thoracolumbar Burst Fractures: Could It Reduce the Odds of Cement Leakage?

Overview

Journal BMC Surg

Publisher Biomed Central

Specialty General Surgery

Date 2020 May 9

PMID 32381083

Citations 6

Authors

Xuan-Geng Deng

Xiao-Ming Xiong

Dun Wan

Hua-Gang Shi

Guo-Long Mei

Wei Cui

Affiliations

Soon will be listed here.

Abstract

Background: Osteoporotic thoracolumbar burst fracture (OTLBF) is common in seniors. Due to the fracture of the posterior vertebra and spinal canal occupancy, the risk of cement leakage and spine injury is high in OTLBF patients, thus the application of vertebroplasty and kyphoplasty is limited in these patients. This study aims to investigate the efficacy and safety of the modified percutaneous kyphoplasty (MPKP) in the treatment of OTLBF.

Methods: Clinical data of the OTLBF patients treated with MPKP and the osteoporotic thoracolumbar compression fracture (OTLCF) patients undergone PKP from January 2014 to June 2016 were collected. The key procedure of the MPKP was to fill the bone cavity with gel-foam by the first balloon inflation and to press the gel-foam by a second balloon inflation. Pain intensity, Oswestry disability index (ODI), and bone cement leakage of the patients in the two groups were analyzed.

Results: In the burst fracture group, the overall spinal canal occupancy was relatively low, and the maximum occupancy was 1/3 of the sagittal diameter of the spinal canal. The surgical duration was longer in the burst fracture group (39.0 ± 5.0 min with 95% CI: 37.7, 40.3) than in the compression fracture group (31.7 ± 4.3 min with 95% CI: 31.1, 32.3), and the difference between the two groups was statistically significant (Z = -8.668 and P = 0.000). Both the Oswestry disability index (ODI) and the visual analog scales (VAS) were apparently improved, but there was no significant difference between the two groups. Cement leakage occurred in 13 out of the 53 cases (24.5%) in the burst fracture group and 35 out of the 193 cases (18.1%) in the compression fracture group, and there was no significant difference between the two groups (Z = - 1.038 and P = 0.299). Neither group had consequential symptoms, such as spinal cord lesion, pain, and numbness of the peripheral nerve.

Conclusion: Similar to the efficacy of PKP in the treatment of OTLCF, MPKP efficiently reduced the cement leakage rate and improved the safety of the surgery, although it prolonged the surgical duration and introduced more surgical steps.

Citing Articles

How I do it: spine jack expansion kyphoplasty for AO spine A4 complete burst fracture with neurological deficit.

Beucler N Acta Neurochir (Wien). 2024; 166(1):457.

PMID: 39546008 DOI: 10.1007/s00701-024-06362-x.

Percutaneous kyphoplasty combined with pediculoplasty (PKCPP) augments and internally fixates the severe osteoporotic vertebral fractures: a retrospective comparative study.

Xiao C, Wang H, Lei Y, Dai H, Zhang K, Xie M Arch Osteoporos. 2024; 19(1):95.

PMID: 39377968 DOI: 10.1007/s11657-024-01456-6.

Single-staged three columns reconstruction of thoracolumbar AO Spine A4 burst fracture with traumatic canal stenosis causing neurological deficit using posterior open monoaxial pedicle screw distraction fixation, laminectomy, and titanium jack....

Beucler N Neurosurg Rev. 2024; 47(1):267.

PMID: 38862732 DOI: 10.1007/s10143-024-02476-z.

Percutaneous kyphoplasty combined with pediculoplasty for the surgical treatment of osteoporotic thoracolumbar burst fractures.

Xiao C, Wang H, Lei Y, Xie M, Li S J Orthop Surg Res. 2024; 19(1):87.

PMID: 38254114 PMC: 10804617. DOI: 10.1186/s13018-024-04562-w.

Finite element analysis of dynamic changes in spinal mechanics of osteoporotic lumbar fracture.

Yan J, Liao Z, Yu Y Eur J Med Res. 2022; 27(1):142.

PMID: 35933368 PMC: 9356497. DOI: 10.1186/s40001-022-00769-x.

References

Landham P, Gilbert S, Baker-Rand H, Pollintine P, Robson Brown K, Adams M . Pathogenesis of Vertebral Anterior Wedge Deformity: A 2-Stage Process?. Spine (Phila Pa 1976). 2015; 40(12):902-8. DOI: 10.1097/BRS.0000000000000905. View

Reinhold M, Knop C, Beisse R, Audige L, Kandziora F, Pizanis A . [Operative treatment of traumatic fractures of the thoracic and lumbar spinal column: Part III: Follow up data]. Unfallchirurg. 2009; 112(3):294-316. DOI: 10.1007/s00113-008-1539-0. View

Gonschorek O, Hauck S, Weiss T, Buhren V . Percutaneous vertebral augmentation in fragility fractures-indications and limitations. Eur J Trauma Emerg Surg. 2017; 43(1):9-17. DOI: 10.1007/s00068-016-0753-7. View

Borges C, de Almeida J, Lima D, Cabral M, Bandeira F . Prevalence of morphometric vertebral fractures in old men and the agreement between different methods in the city of Recife, Brazil. Rheumatol Int. 2014; 34(10):1387-94. DOI: 10.1007/s00296-014-3035-x. View

Papanastassiou I, Eleraky M, Murtagh R, Kokkalis Z, Gerochristou M, Vrionis F . Comparison of Unilateral versus Bilateral Kyphoplasty in Multiple Myeloma Patients and the Importance of Preoperative Planning. Asian Spine J. 2014; 8(3):244-52. PMC: 4068843. DOI: 10.4184/asj.2014.8.3.244. View

Xu Z, Hao D, He L, Guo H, He B, Liu T . An assessment system for evaluating the severity of thoracolumbar osteoporotic fracture and its clinical application: A retrospective study of 381 cases. Clin Neurol Neurosurg. 2015; 139:70-5. DOI: 10.1016/j.clineuro.2015.09.006. View

Diamond T, Clark W, Kumar S . Histomorphometric analysis of fracture healing cascade in acute osteoporotic vertebral body fractures. Bone. 2006; 40(3):775-80. DOI: 10.1016/j.bone.2006.10.009. View

Wang H, Sribastav S, Ye F, Yang C, Wang J, Liu H . Comparison of Percutaneous Vertebroplasty and Balloon Kyphoplasty for the Treatment of Single Level Vertebral Compression Fractures: A Meta-analysis of the Literature. Pain Physician. 2015; 18(3):209-22. View

Reinhold M, Audige L, Schnake K, Bellabarba C, Dai L, Oner F . AO spine injury classification system: a revision proposal for the thoracic and lumbar spine. Eur Spine J. 2013; 22(10):2184-201. PMC: 3804719. DOI: 10.1007/s00586-013-2738-0. View

10.

Ringer A, Bhamidipaty S . Percutaneous access to the vertebral bodies: a video and fluoroscopic overview of access techniques for trans-, extra-, and infrapedicular approaches. World Neurosurg. 2012; 80(3-4):428-35. DOI: 10.1016/j.wneu.2012.09.005. View

11.

Vaccaro A, Lehman Jr R, Hurlbert R, Anderson P, Harris M, Hedlund R . A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine (Phila Pa 1976). 2005; 30(20):2325-33. DOI: 10.1097/01.brs.0000182986.43345.cb. View

12.

Gan M, Yang H, Zhou F, Zou J, Wang G, Mei X . Kyphoplasty for the treatment of painful osteoporotic thoracolumbar burst fractures. Orthopedics. 2010; 33(2):88-92. DOI: 10.3928/01477447-20100104-17. View

13.

Bozkurt M, Kahilogullari G, Ozdemir M, Ozgural O, Attar A, Caglar S . Comparative analysis of vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures. Asian Spine J. 2014; 8(1):27-34. PMC: 3939366. DOI: 10.4184/asj.2014.8.1.27. View

14.

Chen A, Cohen D, Skolasky R . Impact of nonoperative treatment, vertebroplasty, and kyphoplasty on survival and morbidity after vertebral compression fracture in the medicare population. J Bone Joint Surg Am. 2013; 95(19):1729-36. DOI: 10.2106/JBJS.K.01649. View

15.

Koh I, Marini G, Widmer R, Brandolini N, Helgason B, Ferguson S . In silico investigation of vertebroplasty as a stand-alone treatment for vertebral burst fractures. Clin Biomech (Bristol). 2016; 34:53-61. DOI: 10.1016/j.clinbiomech.2016.03.008. View

16.

Baerlocher M, Saad W, Dariushnia S, Barr J, McGraw J, Nikolic B . Quality improvement guidelines for percutaneous vertebroplasty. J Vasc Interv Radiol. 2013; 25(2):165-70. DOI: 10.1016/j.jvir.2013.09.004. View

17.

Sun H, Lu P, Liu Y, Yang X, Zhou P, Shen X . 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. View

18.

Ender S, Eschler A, Ender M, Merk H, Kayser R . Fracture care using percutaneously applied titanium mesh cages (OsseoFix®) for unstable osteoporotic thoracolumbar burst fractures is able to reduce cement-associated complications--results after 12 months. J Orthop Surg Res. 2015; 10:175. PMC: 4644291. DOI: 10.1186/s13018-015-0322-5. View

19.

Wong E, Whyne C, Singh D, Ford M . A Biomechanical Assessment of Kyphoplasty as a Stand-Alone Treatment in a Human Cadaveric Burst Fracture Model. Spine (Phila Pa 1976). 2015; 40(14):E808-13. DOI: 10.1097/BRS.0000000000000967. View

20.

Chang X, Lv Y, Chen B, Li H, Han X, Yang K . Vertebroplasty versus kyphoplasty in osteoporotic vertebral compression fracture: a meta-analysis of prospective comparative studies. Int Orthop. 2014; 39(3):491-500. DOI: 10.1007/s00264-014-2525-5. View