Results of percutaneous cervical vertebroplasty using an anterolateral approach for cervical spine tumors

Ramazanoğlu, Ali Fatih; Sarıkaya, Caner; Etli, Mustafa Umut; Yaltırık, Cumhur Kaan; Onen, Mehmed Resid; Naderi, Sait

doi:10.5152/j.aott.2022.22035

Cited by 2 publications

(1 citation statement)

References 28 publications

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“…Second, that a large proportion of our cohort’s fractures were comminuted body fractures with concomitant pars fractures raises the question of whether a simple odontoid screw would be efficacious in preventing these complicated fracture patterns. Another potential preventative measure could be cement augmentation of C2, which has been demonstrated safe and effective for treatment of cancerous lesions of the dens through minimally invasive anterior approaches (transoral and anterolateral) [ 36 – 43 ]. This theoretically could be performed pre-operatively, intra-operatively, or post-operatively in a staged fashion.…”

Section: Discussionmentioning

confidence: 99%

Odontoid fractures above C2 to pelvis posterior instrumented fusions: a single center’s 11-year experience

Lim,

Clark,

Deviren

et al. 2023

Spine Deform

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Purpose To define the prevalence, characteristics, and treatment approach for proximal junction failure secondary to odontoid fractures in patients with prior C2-pelvis posterior instrumented fusions (PSF). Methods A single institution’s database was queried for multi-level fusions (6+ levels), including a cervical component. Posterior instrumentation from C2-pelvis and minimum 6-month follow-up was inclusion criteria. Patients who sustained dens fractures were identified; each fracture was subdivided based on Anderson & D’Alonzo and Grauer’s classifications. Comparisons between the groups were performed using Chi-square and T tests. Results 80 patients (71.3% female; average age 68.1 ± 8.1 years; 45.0% osteoporosis) were included. Average follow-up was 59.8 ± 42.7 months. Six patients (7.5%) suffered an odontoid fracture post-operatively. Cause of fracture in all patients was a mechanical fall. Average time to fracture was 23 ± 23.1 months. Average follow-up after initiation of fracture management was 5.84 ± 4 years (minimum 1 year). Three patients sustained type IIA fractures one of which had a concomitant unilateral C2 pars fracture. Three patients sustained comminuted type III fractures with concomitant unilateral C2 pars fractures. Initial treatment included operative care in 2 patients, and an attempt at non-operative care in 4. Non-operative care failed in 75% of patients who ultimately required revision with proximal extension. All patients with a concomitant pars fracture had failure of non-operative care. Patients with an intact pars were more stable, but 50% required revision for pain. Conclusions In this 11-year experience at a single institution, the prevalence of odontoid fractures above a C2-pelvis PSF was 7.5%. Fracture morphology varied, but 50% were complex, comminuted C2 body fractures with concomitant pars fractures. While nonoperative management may be suitable for type II fractures with simple patterns, more complex and unstable fractures likely benefit from upfront surgical intervention to prevent fracture displacement and neural compression. As all fractures occurred secondary to a mechanical fall, inpatient and community measures aimed to minimize risk and prevent mechanical falls would be beneficial in this high-risk group.

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Section: Discussionmentioning

confidence: 99%

Odontoid fractures above C2 to pelvis posterior instrumented fusions: a single center’s 11-year experience

Lim,

Clark,

Deviren

et al. 2023

Spine Deform

View full text Add to dashboard Cite

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Study on the causes of infection after percutaneous vertebroplasty and the treatment of posterior surgery

xie,

li,

guo

et al. 2024

Preprint

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Background To conduct a retrospective study on patients who developed infections after vertebral augmentation procedures, analyzing the causes of post-procedural infections, evaluating the efficacy of posterior fixation surgeries, and determining whether complete removal of bone cement is necessary. This study aims to provide valuable insights for the clinical prevention of infections following vertebral augmentation procedures. PURPOSE A retrospective study was conducted on 30 patients with post-vertebral body reconstruction infections following vertebral augmentation procedures from January 2016 to April 2023 among 3817 PVP patient. . The aim was to analyze the preoperative clinical characteristics of post-vertebral body reconstruction infections, assess the effectiveness of posterior approach surgeries, and determine the necessity of complete removal of bone cement. The findings aim to provide insights for the clinical prevention and treatment of post-vertebral body reconstruction infections. STUDY DESIGN Retrospective clinical study PATIENT SAMPLE Consecutive series of 30 patients at a single hospital Outcome measures The study aims to investigate the variance in clinical efficacy between conservative and surgical treatments, the necessity of bone cement removal during surgical intervention, the potential of achieving clinical cure without bone cement removal in cases of non-specific spondylitis and spinal tuberculosis, and to evaluate postoperative living ability using the ODI score. METHODS We included 30 cases of post-vertebral augmentation procedure infections (PvP) rom January 2016 to April 2023 among 3817 PVP patient. . The study aimed to investigate whether there was a difference in clinical efficacy between patients who had bone cement removed during surgical treatment and those who did not. We specifically examined whether non-specific spinal infections and spinal tuberculosis could both achieve clinical cure without removing bone cement, using the Oswestry Disability Index (ODI) to assess postoperative functional abilities. Data analysis was performed using SPSS version 25.0 software. Normally distributed continuous variables were presented as mean ± standard deviation (x± s) and compared using independent sample t-tests. Categorical data were presented as frequencies and percentages, and intergroup comparisons were conducted using the chi-square test. Statistical significance was set at P < 0.05. RESULTS In this study, we collected data from 30 cases of post-vertebroplasty (PVP) infection. There were 22 cases in the surgical group, including one patient who underwent surgery after strict conservative treatment failure. Among the surgical group, 21 cases underwent posterior approach surgeries for lesion debridement and vertebral augmentation, with 8 cases retaining bone cement (3 cases of tuberculosis, 5 cases of non-specific infection) and 11 cases completely removing bone cement. Two cases died within 6 months after surgery, and one case underwent posterior approach fixation alone. The conservative treatment group comprised 8 cases, with one death occurring 6 months after treatment. Except for the deceased patients, all others achieved clinical cure. The mortality rates were not statistically different between the surgical group (91%) and the conservative treatment group (75%). The ODI scores for post-operative infection were significantly lower in the posterior approach surgery group (mean: 17.55) compared to the conservative treatment group (mean: 45), with a statistically significant difference (P<0.05). However, there was no statistically significant difference in ODI scores between the subgroup that removed bone cement (mean: 18.0) and the conservative group that retained bone cement (mean: 17.1). For patients with post-PVP infections (whether tuberculosis or non-specific inflammation), infection resolution was achievable with vertebral augmentation and fixation procedures, regardless of complete bone cement removal. Moreover, there was no statistically significant difference in postoperative ODI scores between the groups. CONCLUSION Before undergoing PVP surgery, it is crucial to actively treat infections in other parts of the body. Following a PVP infection, performing posterior approach surgeries for lesion debridement and vertebral augmentation leads to clinical cure, whether the infection is non-specific spinal infection or spinal tuberculosis. Even when complete removal of bone cement is challenging, clinical cure can still be achieved.

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Results of percutaneous cervical vertebroplasty using an anterolateral approach for cervical spine tumors

Cited by 2 publications

References 28 publications

Odontoid fractures above C2 to pelvis posterior instrumented fusions: a single center’s 11-year experience

Odontoid fractures above C2 to pelvis posterior instrumented fusions: a single center’s 11-year experience

Study on the causes of infection after percutaneous vertebroplasty and the treatment of posterior surgery

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