Percutaneous Treatment of Vertebral Compression Fractures

Lee, Michael J.; Dumonski, Mark; Cahill, Patrick J.; Stanley, T. D.; Park, Daniel; Singh, Kern

doi:10.1097/brs.0b013e3181a3c742

Cited by 182 publications

(122 citation statements)

References 6 publications

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“…In contrast, the BKP arm yielded more consistent results. The lower rate of cement extravasation after BKP is consistent with previous studies [15,18,[49][50][51][52]. A number of factors may have contributed to the heterogeneity in the VP group: procedural technique, variation in considering extravasation as a complication [51], different postoperative radiological follow-up (plain films vs. computed tomography [51,53]), cement viscosity (inverse relationship [52]), cement pressure [49], fracture level (higher extravasation rates above T7), and cement volume (dose dependent [54]).…”

Section: Cement Extravasationsupporting

confidence: 86%

Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies

et al. 2012

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Purpose To determine if differences in safety or efficacy exist between balloon kyphoplasty (BKP), vertebroplasty (VP) and non-surgical management (NSM) for the treatment of osteoporotic vertebral compression fractures (VCFs). Methods As of February 1, 2011, a PubMed search (key words: kyphoplasty, vertebroplasty) resulted in 1,587 articles out of which 27 met basic selection criteria (prospective multiple-arm studies with cohorts of C20 patients).This systematic review adheres to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.Results Pain reduction in both BKP (-5.07/10 points, P \ 0.01) and VP (-4.55/10, P \ 0.01) was superior to that for NSM (-2.17/10), while no difference was found between BKP/VP (P = 0.35). Subsequent fractures occurred more frequently in the NSM group (22 %) compared with VP (11 %, P = 0.04) and BKP (11 %, P = 0.01). BKP resulted in greater kyphosis reduction than VP (4.88 vs. 1.7°, P \ 0.01). Quality of life (QOL) improvement showed superiority of BKP over VP (P = 0.04), along with a trend for disability improvement (P = 0.08). Cement extravasation was less frequent in the BKP (P = 0.01). Surgical intervention within the first 7 weeks yielded greater pain reduction than VCFs treated later. Conclusions BKP/VP provided greater pain relief and fewer subsequent fractures than NSM in osteoporotic VCFs. BKP is marginally favored over VP in disability improvement, and significantly favored in QOL improvement. BKP had a lower risk of cement extravasation and resulted in greater kyphosis correction. Despite this analysis being restricted to Level I and II studies, significant heterogeneity suggests that the current literature is delivering inconsistent messages and further trials are needed to delineate confounding variables.

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Section: Cement Extravasationsupporting

confidence: 86%

Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies

et al. 2012

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“…In prospective studies, the medical complications, symptomatic cement leakage, and mortality all occurred in less that 1% of patients each. (25) Asymptomatic cement leakage in osteoporotic fractures was seen as high as 21% and 7% for vertebroplasty and kyphoplasty, respectively. New fracture risk was similar to that observed in this meta-analysis, ranging 16% to 18%.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures

Anderson

Froyshteter

Tontz

2012

Journal of Bone and Mineral Research

175

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Cement augmentation is a controversial treatment for painful vertebral compression fractures (VCF). Our research questions for the meta-analysis were: Is there a clinical and statistical difference in pain relief, functional improvement, and quality of life between conservative care and cement augmentation for VCF and, if so, are they maintained at longer time points? We conducted a search of MEDLINE from January 1980 to July 2011 using PubMed, Cochrane Database of Systematic Reviews and Controlled Trials, CINAHL, and EMBASE. Searches were performed from Medical Subject Headings. Terms ''vertebroplasty'' and ''compression fracture'' were used. The outcome variables of pain, functional measures, health-related quality of life (HRQOL), and new fracture risk were analyzed. A random effects model was chosen. Continuous variables were calculated using the standardized mean difference comparing improvement from baseline of the experimental group with the control group. New vertebral fracture risk was calculated using log odds ratio. Six studies met the criteria. The pain visual analog scale (VAS) mean difference was 0.73 (confidence interval [CI] 0.35, 1.10) for early (<12 weeks) and 0.58 (CI 0.19, 0.97) for late time points (6 to 12 months), favoring vertebroplasty (p < 0.001). The functional outcomes at early and late time points were statistically significant with 1.08 (CI 0.33, 1.82) and 1.16 (CI 0.14, 2.18), respectively. The HRQOL showed superior results of vertebroplasty compared with conservative care at early and late time points of 0.39 (CI 0.16, 0.62) and 0.33 (CI 0.16, 0.51), respectively. Secondary fractures were not statistically different between the groups, 0.065 (CI À0.57, 0.70). This meta-analysis showed greater pain relief, functional recovery, and health-related quality of life with cement augmentation compared with controls. Cement augmentation results were significant in the early (<12 weeks) and the late time points (6 to 12 months). This meta-analysis provides strong evidence in favor of cement augmentation in the treatment of symptomatic

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“…3 A meta-analysis of complications from BKP in cancer patients showed that the 2 main complications were cement extravasation (rarely symptomatic) and adjacent-level VCF, which occurred in 6.1% and 16% of patients, respectively. 14 The purpose of our investigation was to describe a new complication secondary to BKP that we characterize as "tumor extravasation." This phenomenon has been largely discussed as a theoretical complication, but no reports have been published until now.…”

Section: Discussionmentioning

confidence: 99%

Tumor extravasation following a cement augmentation procedure for vertebral compression fracture in metastatic spinal disease

Cruz

Sahgal

Whyne

et al. 2014

SPI

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Balloon kyphoplasty (BKP) has been proven to be safe and effective in the management of pathological vertebral compression fracture (VCF) due to metastatic spinal disease. The most common serious complications related to BKP include cement extravasation and new fractures at adjacent levels. Although the potential for “tumor extravasation” has been discussed as a potential iatrogenic complication, it has yet to be confirmed. The authors report on 2 cases of tumor extravasation following BKP, which they base on an observed unusual rapid tumor spread pattern into the adjacent tissues. They postulate that by increasing the vertebral body internal pressure and disrupting the tissues during balloon inflation and cement application, a soft-tissue tumor can be forced beyond the vertebral bony boundaries through pathological cortical defects. This phenomenon can manifest radiologically as subligamentous spread and/or extension into venous sinusoids, resulting in epidural venous plexus involvement, with subsequent tumor migration into the adjacent vertebral segments. Accordingly, the authors advise caution in using BKP when significant epidural tumor is present. The complication they encountered has caused them to modify their preference such that they now first use radiosurgery and subsequently BKP to ensure the target is appropriately treated, and they are currently developing possible modifications of procedural technique to reduce the risk.

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Percutaneous Treatment of Vertebral Compression Fractures

Cited by 182 publications

References 6 publications

Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies

Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies

Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures

Tumor extravasation following a cement augmentation procedure for vertebral compression fracture in metastatic spinal disease

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