Vertebral Body Stenting System for the Treatment of Osteoporotic Vertebral Compression Fracture: Follow-up at 12 Months in 20 Cases

Abstract

We describe our preliminary experience with the vertebral body stenting system (VBS) for the treatment of osteoporotic vertebral fracture or traumatic vertebral fracture showing our clinical results at 12 months follow-up. Twenty patients (16 women, four men, mean age 71 years): four with traumatic vertebral fracture (Magerl A1 fractures) and 16 with osteoporotic vertebral compression fracture (VCFs) resistant to conservative therapy, were treated by vertebral body stenting system (VBS) as follows: two at level T11, four at T12, one at L1, two at L2, five at L3 and six at L4. All patients were studied by MR (protocol: sagittal T1W, T2W and T2 STIR) and MDCT with MPR reconstructions. All procedures were performed under local anesthesia with fluoroscopy guidance and a bipeduncular approach. VBS, a new system of implantation of endovertebral stent used as an alternative to conventional vertebroplasty (VP), was implanted in all patients to restore the loss of height in the fractured vertebral body. A clinical and x-ray follow-up was performed at six and 12 months evaluating the result by VAS and ODS scale. New vertebral fractures at a distant level were observed in two cases and treated by VP. VBS was successful and led to an excellent outcome in all patients with clinical improvement stable at six months and one year follow-up. The height in the fractured vertebral body was increased in 12 of the 20 VCFs by an average of 1.5 mm. No vascular, extraforaminal or epidural leakage or other adverse events were observed. In the clinical 12 months follow-up we recorded a reduction of four scores in the VAS evaluation and a 40% reduction in the ODS score compared with the pre-treatment values. Endovertebral stents were stable at 12 months at x-ray control in 19/20 patients. No new vertebral fracture located in adjacent vertebrae were observed at 12 month follow-up. By using a stent, the VBS system reduces the collapsed vertebral body and offers good height restoration. The mechanical scaffold of the stent restores the height and at the same time offers a cavity for injection of highly viscous PMMA bone cement without increasing the rate of new vertebral fracture post-VP. A long-term follow-up is recommended.

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

“…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]. Klezl had 2 asymptomatic leakages in 20 treated vertebral bodies and Muto had none [10,11]. Klezl pointed out the more difficult situation in osteoporotic bone where a slight and careful overfilling of cement should be aimed at for achieving a good interdigitation of cement with bone [10].…”

“…The procedural details of the intervention have been well described by Klezl and Muto [10,11]. In the current series, a transpedicular approach was chosen in 94 (OP 97) %, a lateral extrapedicular one in 6 (OP 3) % of the cases.…”

Percutaneous Treatment of Vertebral Fractures

“…Pain relief is obtained in 90% of patients with a reduction of four points in the VAS evaluation and a reduction of 40% in the ODS score. 26 The mean vertebral kyphosis correction is $ 3.2 degrees with a segmental kyphosis of 5 degrees. Compared with BKP, there is a minor height reduction observed at follow-up, losing 0.8 degrees of vertebral kyphosis and 2.1 degrees of segmental kyphosis correction.…”

Stentoplasty effectiveness and safety for the treatment of osteoporotic vertebral fractures: A systematic review

“…After removing duplicates and applying the exclusion criteria, five studies were finally included [16][17][18][19][20] (Fig. 1): two clinical trials [16,20] (one non-randomized [16]) and three observational prospective [18,19] and retrospective studies [17].…”

“…Three case series studies [17][18][19] were identified about effectiveness and safety of stentoplasty, two of them [18,19] retrospectively and one [17], prospectively. No data from these studies could be pooled because of missing data and no coincidence of follow-up time intervals.…”