Percutaneous Vertebroplasty in the Treatment of Osteoporotic Vertebral Body Compression Fractures

Jensen, Mary E.

doi:10.1016/s1051-0443(99)71060-2

Cited by 364 publications

(589 citation statements)

References 5 publications

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“…During the last 30 years, two FDA-approved techniques for minimally invasive cement augmentation used for treatment of refractory osteoporotic vertebral compression fractures have been developed: vertebroplasty and kyphoplasty. These procedures gained widespread popularity after multiple studies provided evidence that they reduced pain, limited analgesic medication requirements, and were associated with a low incidence of complications [11,16,22,32,33]. However, two prospective randomized clinical trials published in 2009 indicated that vertebroplasty was not associated with improvements in clinical outcome (pain, quality of life, disability) relative to a sham surgical procedure at 1-month and 6-month followups [6,18].…”

Section: Introductionmentioning

confidence: 99%

Can Internet Information on Vertebroplasty be a Reliable Means of Patient Self-education?

Sullivan

Ahn

2014

Clinical Orthopaedics &Amp; Related Research

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Background Studies of the quality and accuracy of health and medical information available on the Internet have shown that many sources provide inadequate information. However, to our knowledge, there are no published studies analyzing the quality of information available online regarding vertebroplasty. Because this has been a highvolume procedure with highly debated efficacy, it is critical that patients receive complete, accurate, and well-balanced information before deciding a treatment course. Additionally, few studies have evaluated the merit of academic site authorship or site certification on information quality, but some studies have used measurements of quality that are based primarily on subjective criteria or information accuracy rather than information completeness. Questions/purposes The purposes of our study were (1) to evaluate and analyze the information on vertebroplasty available to the general public through the Internet; (2) to see if sites sponsored by academic institutions offered a higher quality of information; and (3) to determine whether quality of information varied according to site approval by a certification body. Methods Three search engines were used to identify 105 web sites (35 per engine) offering information regarding vertebroplasty. Sites were evaluated for authorship/sponsorship, content, and references cited. Information quality was rated as ''excellent,'' ''high,'' ''moderate,'' ''low,'' or ''unacceptable.'' Sites also were evaluated for contact information to set up an appointment. Data were analyzed as a complete set, then compared between authorship types, and finally evaluated by certification status. Academic sites were compared with other authorship groups and certified sites were compared with noncertified sites using Student's t-test. Results Appropriate indications were referenced in 74% of sites, whereas only 45% discussed a contraindication to the procedure. Benefits were expressed by 100% of sites, but risks were outlined in only 53% (p \ 0.001). Ninety-nine percent of sites provided step-by-step descriptions of the procedure, and 44% of sites also included images. Alternative treatments were mentioned by 51% of sites. Twenty-seven percent of sites referenced peer-reviewed literature, 41% offered experiential or noncited data based on American populations, and 7% offered analogous data from international populations. Thirty percent of sites provided contact information for patient appointment scheduling. Seven percent of sites were classified as excellent quality, 6% as high quality, 11% as moderate quality, 19% as poor quality, and 57% as unacceptable. Sixteen percent of sites were sponsored by academic institutions, 62% by private groups, 8% by biomedical device companies, and 14% were sponsored otherwise. Academic sites reported fewer risks of the procedure than private sites or other sites (p = 0.05 and p = 0.04), but reported more risks Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial a...

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Section: Introductionmentioning

confidence: 99%

Can Internet Information on Vertebroplasty be a Reliable Means of Patient Self-education?

Sullivan

Ahn

2014

Clinical Orthopaedics &Amp; Related Research

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“…The procedure is not without risk, however. Cement extrusion from the vertebra reported in up to 30% of vertebroplasty [31] has been improved to 0-8.6% by using the bone tamp in kyphoplasty [40,56,58]. Additionally, the initial cost of kyphoplasty may be higher than nonoperative care (including implanted PMMA and disposable instrumentation), but may be offset by reduced use of medical resources after hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty

Zampini

White

McGuire

2010

Clinical Orthopaedics &Amp; Related Research

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Background The majority of the 700,000 osteoporotic vertebral compression fractures (VCFs) that occur annually in the United States affect women. The total treatment costs exceed $17 billion and approximate the total costs of breast cancer ($13 billion) and heart disease ($19 billion). Balloon-assisted percutaneous vertebral augmentation with bone cement (kyphoplasty) reportedly reduces VCF-related pain and accelerates return of independent functional mobility. Kyphoplasty may decrease overall cost of VCF treatment costs by reducing use of posttreatment medical resources. Questions/purposes We evaluated complications, mortality, posthospital disposition, and treatment costs of kyphoplasty compared with nonoperative treatment using the Nationwide Inpatient Sample database.Methods We identified 5766 VCFs (71% female) in patients 65 years of age or older with nonneoplastic VCF as the primary diagnosis in nonroutine hospital admissions; 15.3% underwent kyphoplasty. Demographic data, medical comorbidities, and fracture treatment type were recorded. Outcomes, including complications, mortality, posthospital disposition, and treatment costs, were compared for each treatment type. Results Women were more likely to be treated with kyphoplasty than were men. Patients undergoing kyphoplasty had comorbidity indices equivalent to those treated nonoperatively. Kyphoplasty was associated with a greater likelihood of routine discharge to home (38.4% versus 21.0% for nonoperative treatment), a lower rate of discharge to skilled nursing (26.1% versus 34.8%) or other facilities (35.7% versus 47.1%), a complication rate equivalent to nonoperative treatment (1.7% versus 1.0%), and a lower rate of in-hospital mortality (0.3% versus 1.6%). Kyphoplasty was associated with higher cost of hospitalization (mean $37,231 versus $20,112).

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“…The new fractures often seen in these patients could be due to the natural history of the osteoporosis [20][21][22], due to the increased load caused by a wedge-shaped fracture [13], or due to the increased stiffness of the augmented vertebral body [11,12,23].…”

Section: Introductionmentioning

confidence: 99%

A probabilistic finite element analysis of the stresses in the augmented vertebral body after vertebroplasty

et al. 2010

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Fractured vertebral bodies are often stabilized by vertebroplasty. Several parameters, including fracture type, cement filling shape, cement volume, elastic moduli of cement, cancellous bone and fractured region, may all affect the stresses in the augmented vertebral body and in bone cement. The aim of this study was to determine numerically the effects of these input parameters on the stresses caused. In a probabilistic finite element study, an osteoligamentous model of the lumbar spine was employed. Seven input parameters were simultaneously and randomly varied within appropriate limits for [110 combinations thereof. The maximum von Mises stresses in cancellous and cortical bone of the treated vertebral body L3 and in bone cement were calculated. The loading cases standing, flexion, extension, lateral bending, axial rotation and walking were simulated. In a subsequent sensitivity analysis, the coefficients of correlation and determination of the input parameters on the von Mises stresses were calculated. The loading case has a strong influence on the maximum von Mises stress. In cancellous bone, the median value of the maximum von Mises stresses for the different input parameter combinations varied between 1.5 (standing) and 4.5 MPa (flexion). The ranges of the stresses are large for all loading cases studied. Depending on the loading case, up to 69% of the maximum stress variation could be explained by the seven input parameters. The fracture shape and the elastic modulus of the fractured region have the highest influence. In cortical bone, the median values of the maximum von Mises stresses varied between 31.1 (standing) and 61.8 MPa (flexion). The seven input parameters could explain up to 80% of the stress variation here. It is the fracture shape, which has always the highest influence on the stress variation. In bone cement, the median value of the maximum von Mises stresses varied between 3.8 (standing) and 12.7 MPa (flexion). Up to 75% of the maximum stress variation in cement could be explained by the seven input parameters. Fracture shape, and the elastic moduli of bone cement and of the fracture region are those input parameters with the highest influence on the stress variation. In the model with no fracture, the maximum von Mises stresses are generally low. The present probabilistic and sensitivity study clearly showed that in vertebroplasty the maximum stresses in the augmented vertebral body and in bone cement depend mainly on the loading case and fracture shape. Elastic moduli of cement, fracture region and cancellous bone as well as cement volume have sometimes a moderate effect while number and symmetry of cement plugs have virtually no effect on the maximum stresses.

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Percutaneous Vertebroplasty in the Treatment of Osteoporotic Vertebral Body Compression Fractures

Cited by 364 publications

References 5 publications

Can Internet Information on Vertebroplasty be a Reliable Means of Patient Self-education?

Can Internet Information on Vertebroplasty be a Reliable Means of Patient Self-education?

Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty

A probabilistic finite element analysis of the stresses in the augmented vertebral body after vertebroplasty

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