Surgical procedure and initial radiographic results of a new augmentation technique for vertebral compression fractures

Abstract

Purpose Recently, a new minimally invasive technique called 'vertebral body stenting' (VBS) was introduced for the treatment of osteoporotic vertebral fractures. The technique was developed to prevent the loss of reduction after deflation of the balloon and to reduce the complication rate associated with cement leakage. Methods The amount of kyphosis correction, improvement of vertebral body height and quantitative cement leakage rate by applying CT-based quantitative volumetry after VBS were measured in 27 patients (55 vertebra) and compared with a control group (29 patients, 61 vertebrae), which was treated with conventional vertebroplasty. Results After VBS, a significant improvement was seen in vertebral height, compared to conventional vertebroplasty. The mean improvement in segmental kyphosis and vertebral kyphosis were 5.8°(p \ 0.05) and 3.5°( p \ 0.05), respectively. In the VBS group, the mean injected volume of cement per vertebral body was 7.33 cm 3 (3.34-10.19 cm 3 ). The average amount of cement outside the vertebrae was 0.28 cm 3 (0.01-1.64 cm 3 ), which was 1.36 % of the applied total cement volume. In the vertebroplasty group, the applied mean volume of the cement per level was 2.7 cm 3 (1-5.8 cm 3) and the average amount of cement outside the vertebrae was 0.15 cm 3 (0.01-1.8 cm 3 ), which was 11.5 % (0.2-60 %) of the applied total volume of cement. Conclusion The frequency of cement leakage after VBS was 25.5 % compared to 42.1 % in the vertebroplasty group. VBS led to a significant decrease in the leakage rate compared with conventional vertebroplasty.

Radiographic and safety details of vertebral body stenting: results from a multicenter chart review

“…Thaler et al reported a 25.5% extrusion rate in their VBS series and Werner et al had a 20% minor and 10% major leakage rate. In both studies, a viscometer was used [12,13]. The final rate of symptomatic extrusions in our series was 1% which is lower than the 2.6% in VP and comparable with the 1.3% in BKP reported by Hulme [2].…”

“…Moreover, stratified results by fracture type were not reported, which may have revealed differences between the two therapies. Thaler et al could only achieve an average 3.5° reduction of vertebral kyphosis in 27 patients, but the mean preoperative Beck Index of 0.87 implies a smaller reduction potential than that of our group (preop 0.73), which may explain the better reduction of 4.2° in the current study [12]. …”

Subsequent Vertebral Fractures Post Cement Augmentation of the Thoracolumbar Spine

“…[15][16][17] It is widely used in osteoporotic vertebral compression fractures, with numerous studies showing its effectiveness as a form of pain control and preventing further vertebral collapse. [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.…”

Neurologic Disorders Associated with Bone and Joint Disease

“…40 Narcotics are occasionally required for pain, and calcitonin may provide relief in the acute phase. 42 Preventive treatments for osteoporosis play an increasing role in reducing the number of vertebral fractures in postmenopausal women and the elderly. 38 Vertebroplasty is a technique involving injecting polymethylmethacrylate into a fractured vertebral body; compared to conservative treatment, it shows greater pain relief, functional recovery, and health-related quality of life.…”