Complications and safety aspects of kyphoplasty for osteoporotic vertebral fractures: a prospective follow-up study in 102 consecutive patients

Robinson, Yohan; Tschöke, Stefan; Stahel, Philip F.; Kayser, R.; Heyde, Christoph E.

doi:10.1186/1754-9493-2-2

Cited by 60 publications

(50 citation statements)

References 57 publications

(57 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[1][2][3][4]8,11,18,19 Studies showed that it provides nearly immediate pain relief in over 80% of cases, thus allowing patients to mobilize postoperatively. 2,3,20 From 2009 to 2010, 3 randomized controlled trials concluded that there was no superiority of vertebroplasty over nonsurgical management, or over a sham procedure. 9,18,21,22 This led to restrictions of its use in North America.…”

Section: Discussionmentioning

confidence: 98%

Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine

Hey

Tan

et al. 2015

SPINE

View full text Add to dashboard Cite

Study Design. A case-control study.Objective. In this study, we investigated the correlation between level-specific preoperative bone mineral density and subsequent vertebral fractures. We also identified factors associated with subsequent vertebral fractures. Summary of Background Data. Complications of cement augmentation of the spine include subsequent vertebral fractures, leading to unnecessary morbidity and more treatment. Ability to predict at-risk vertebra will help guide management. Methods. We studied all patients with osteoporotic compression fractures who underwent cement augmentation in a single institution from November 2001 to December 2010 by a single surgeon. Association between level-specific bone mineral density T-scores and subsequent fractures was assessed. Multivariable analysis was performed to identify significant factors associated with subsequent vertebral fractures. Results. 93 patients followed up for a mean duration of 25.1 months (12 -96) had a mean age of 76.8 years (47 -99). Vertebroplasty was performed in 58 patients (62.4%) on 68 levels and kyphoplasty in 35 patients (37.6%) on 44 levels. Refracture was seen in 16 patients (17.2%). The time to subsequent fracture post cement augmentation was 20.5 months (2-90). For refracture cases, 43.8% (7/16) fractured in the adjacent vertebrae. Subsequently fractured vertebra had a mean T-score of À2.860 (95% confidence interval À3.268 to À2.452) and nonfractured vertebra had a mean T-score of À2.180 (95% confidence interval À2.373 to À1.986). A T-score of À2.2 or lower is predictive of refracture at that vertebra (P ¼ 0.047). Odds ratio increases with decreasing T-scores from À2.2 or lower to À2.6 or lower. A T-score of À2.6 or lower gives no additional predictive advantage. After multivariable analysis, age (P ¼ 0.049) and loss of preoperative anterior vertebral height (P ¼ 0.017) are associated with refracture. Conclusion. Level-specific T-scores are predictive of subsequent fractures and the odds ratio increases with lower Tscores from À2.2 or less to À2.6 or less. They have a low positive predictive value, but a high negative predictive value for subsequent fractures. Other significant associations with subsequent refractures include age and anterior vertebral height.

show abstract

Section: Discussionmentioning

confidence: 98%

Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine

Hey

Tan

et al. 2015

SPINE

View full text Add to dashboard Cite

show abstract

“…The most common complications associated with vertebroplasty and kyphoplasty are uncontrolled bone cement leakage over the venous plexus, which can even result in a pulmonary embolism. Leakage of the cement into the epidural space might cause neurological damage and even paraplegia [10] [13] [35]. Due to the elevated risk of cement leakage into the epidural space, in fractures that involve the posterior vertebral wall, these two procedures should only be used with great caution [22].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Stabilization System Osseofix® for Treatment of Osteoporotic Vertebral Compression Fractures - Clinical and Radiological Results after 12 Months

et al. 2013

Self Cite

View full text Add to dashboard Cite

Study DesignA prospective consecutive cohort study (follow-up study).ObjectiveOur study investigated whether implantation of an expandable titanium mesh cage (Osseofix®) is a successful and safe minimally invasive therapy for osteoporotic vertebral compression fractures (VCF). Our experiences, clinical and radiological findings after 12 months follow-up are presented. Kypho- and vertebroplasty are well-established minimally invasive procedures for the treatment of osteoporotic VCF. The main complications associated with both procedures are uncontrolled bone cement leakage. Therefore a suitable alternative has been investigated.MethodsDuring June 2010 to May 2011 24 patients were included with 32 osteoporotic VCF (T6 to L4). All of them were stabilized with the Osseofix® system. Preinterventionally we performed X-ray, MRI, and bone density measurements (DXA). Clinical and radiological results were evaluated preop., postop. and after 12 months postop. based on the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS), X-ray (Beck Index, Cobb-angle) and CT.ResultsThere was a significant improvement in the mean ODI (70,6% to 30,1%) as well as a significant reduction in pain intensity (VAS) (7,7 to 1,4) after 12 month. The mean kyphotic angle according to Cobb showed significant improvements (11,7° to 10,4°) after 12 months. Postinterventional imaging showed only one case of loss of height in a stabilized vertebral body (3.1%). We saw no changes in posterior vertebral wall or adjacent fractures. Except for one pronounced postoperative hematoma we saw no surgical complications including no cement leakage.ConclusionsStabilization of symptomatic osteoporotic VCF with Osseofix® system is a safe and effective procedure, even in fractures with posterior wall involvement. The clinical mid-term results are good at a very low complication rate. The Osseofix® system is an interesting alternative to the established procedures of cement augmentation.

show abstract

“…The use of fast-setting calcium phosphate appears to represent a safe and efficient technique for filling the metaphyseal void and providing adequate support for the articular surface to prevent secondary subsidence [14,16]. However, as with any appealing new surgical technique, the early enthusiasm regarding potential benefits must be critically weighed against potential complications and the risk of inducing patient harm on the surgical “learning curve” until a new technique is well established and validated [21]. To date, the available evidence supporting the concept of balloon-guided reduction of tibial plateau fracture is restricted to cadaveric studies, anecdotal case reports, and “expert opinion” technical notes [14-18].…”

Section: Introductionmentioning

confidence: 99%

Incidence and pattern of technical complications in balloon-guided osteoplasty for depressed tibial plateau fractures: a pilot study in 20 consecutive patients

et al. 2013

Self Cite

View full text Add to dashboard Cite

BackgroundInflation bone tamps are becoming increasingly popular as a reduction tool for depressed tibial plateau fractures. A number of recent publications have addressed the technical aspects of balloon inflation osteoplasty. However, no study has yet been published to describe the technical limitations, intraoperative complications, and surgical bailout strategies for this new technology.MethodsObservational retrospective study of all patients managed with inflatable bone tamps for depressed tibial plateau fractures between October 1, 2010 and December 1, 2012. The primary outcome parameter was the rate of complications, which were stratified into “minor” and “major” depending on the necessity for altering the surgical plan intraoperatively, and based on the risk for patient harm. This study was approved by the Institutional Review Board of the State of Colorado.ResultsA consecutive series of 20 patients were managed by balloon inflation osteoplasty for depressed tibial plateau fractures during the 15 months study period. The mean age was 42.8 years (range 20–79), with 9 females and 11 males. A total of 13 patients sustained an adverse intraoperative event (65%), with three patients sustaining multiple technical complications. Minor events (n = 8) included the burst of a balloon with extrusion of contrast dye, and the unintentional posterior wall displacement during balloon inflation. Major events (n = 5) included the intra-articular injection of calcium phosphate in the knee joint, and the inability to elevate the depressed articular fragment with the inflatable bone tamp.ConclusionThe observed intraoperative complication rate of 65% reflects a steep learning curve for the use of inflation bone tamps to reduce depressed tibial plateau fractures. Specific surgical bailout options are provided in this article, based on our early anecdotal experience in a pilot series of 20 consecutive cases. Patients should be advised on the benefits and risks of this new technology as part of the shared decision-making process during the informed consent.

show abstract

Complications and safety aspects of kyphoplasty for osteoporotic vertebral fractures: a prospective follow-up study in 102 consecutive patients

Cited by 60 publications

References 57 publications

Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine

Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine

Percutaneous Stabilization System Osseofix® for Treatment of Osteoporotic Vertebral Compression Fractures - Clinical and Radiological Results after 12 Months

Incidence and pattern of technical complications in balloon-guided osteoplasty for depressed tibial plateau fractures: a pilot study in 20 consecutive patients

Contact Info

Product

Resources

About