Search

Background: Intradiscal cement leakage (ICL) is a common complication following percutaneous vertebroplasty (PVP). However, the risk factors for such a complication are under debate and there is no accurate predictive nomogram to predict ICL., Objectives: To establish an effective and novel nomogram for ICL following PVP in patients with osteoporotic-related vertebral compression fractures (OVCFs)., Study Design: This was a retrospective study approved by the Institutional Review Board of our institution., Setting: This study consists of patients from a large academic center., Methods: Patients with OVCFs who underwent their first PVP in our department between January 2007 and December 2013 were included in this study. All the potential risk factors of ICL after PVP were recorded. Univariate and multivariate analyses were used to identify the independent risk factors. The nomogram was then created based on the identified independent risk factors., Results: A total of 241 patients and 330 vertebrae were included. The mean age of the patients was 73.5 (SD 7.9) years old, and the mean number of treated vertebrae was 1.4 per person. ICL was observed in 93 (28.2%) of the treated vertebrae. Greater fracture severity (P = 0.016), cortical disruption of the endplate (P < 0.0001), absence of Kummell's disease (P = 0.010), and higher computed tomography (CT) values (P = 0.050) were the independent risk factors for ICL., Limitations: The main limitation of this study is that it is a retrospective study., Conclusion: Greater fracture severity, cortical disruption of the endplate, absence of Kummell's disease, and higher CT values are the independent risk factors for ICL. The novel nomogram gives an accurate prediction of ICL.

Purpose: We aim to determine the predictors of new adjacent vertebral fractures (AVCFs) after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fractures (OVCFs) and to construct a risk prediction score to estimate a 2-year new AVCF risk-by-risk factor condition., Materials and Methods: Patients with OVCFs who underwent their first PVP between December 2006 and December 2013 at Hospital A (training cohort) and Hospital B (validation cohort) were included in this study. In training cohort, we assessed the independent risk predictors and developed the probability of new adjacent OVCFs (PNAV) score system using the Cox proportional hazard regression analysis. The accuracy of this system was then validated in both training and validation cohorts by concordance (c) statistic., Results: 421 patients (training cohort: n = 256; validation cohort: n = 165) were included in this study. In training cohort, new AVCFs after the first PVP treatment occurred in 33 (12.9%) patients. The independent risk factors were intradiscal cement leakage and preexisting old vertebral compression fracture(s). The estimated 2-year absolute risk of new AVCFs ranged from less than 4% in patients with neither independent risk factors to more than 45% in individuals with both factors., Conclusions: The PNAV score is an objective and easy approach to predict the risk of new AVCFs.

Background: Percutaneous vertebroplasty (PVP) is widely used for the treatment of painful vertebral compression fractures (VCFs). However, new VCFs occur frequently after PVP., Objectives: We aim to establish an objective risk score system to assess the possibility of new vertebral fractures in patients with VCFs undergoing PVP., Study Design: This study was a retrospective study, and it was approved by the Institutional Review Board of our 2 institutions., Setting: This study consists of patients from 2 large academic centers., Methods: Patients with VCFs who underwent their first PVP and met the inclusion criteria between January 2007 and December 2013 at Hospital A (training cohort) and Hospital B (validation cohort) were included. In the training cohort, the independent risk factors for new VCFs after PVP were identified by multivariate stepwise backward Cox regression analysis from the risk factors selected by univariate analysis and Harrell's C-statistics and used to develop the score system (assessment for new VCFs after PVP [ANVCFV]) to predict the probability of new VCFs., Results: In total, 397 patients (training cohort: n = 241; validation cohort: n = 156) were included in this study. In the training cohort, the ANVCFV score was developed based on 5 independent risk factors for the new VCFs after PVP, including lower computed tomography (CT) values, pre-existing old VCFs, intradiscal cement leakage, more than one vertebra treated, and superior or inferior marginal cement distribution in the vertebra. The patients were divided into 2 groups by the ANVCFV score of -1.5 to 8.5 vs. > 8.5 points in the probability of new VCFs (median fracture-free time: 1846 vs. 732 days; P < 0.001) in the training cohort. The accuracy of this score system was 77.4% for the training cohort and 85.3% for the validation cohort., Limitations: The main limitations of this study are that it is a retrospective study and that there is a significant difference of the treated vertebrae of PVP per session between the 2 cohorts., Conclusion: Patients who underwent their first PVP with an ANVCFV score > 8.5 points may exhibit an increased chance of suffering from new VCFs.

Purpose: To determine the risk factors for new vertebral compression fractures (VCFs) following percutaneous vertebroplasty (PV) in patients with osteoporosis., Materials and Methods: This prospective study included 132 consecutive patients with osteoporosis treated with PV in a single institution over 46 months from March 2005 to December 2008. Multivariable logistic regression and univariate analysis were employed to identify risk factors for new VCFs after PV, including patient demographic data, parameters of the initial and new fractured vertebrae, procedure-related information, and follow-up data., Results: During the follow-up period (22.4 months ± 12.1), 80 new vertebral fractures occurred in 36 (27.3%) patients. Multivariate analysis showed that number of VCFs per time frame, computed tomography (CT) value of nonfractured vertebrae (T11-L2), activity level after discharge, duration of follow-up, and cement distribution in the inferior part of the vertebral body or close to the endplate were statistically correlated with new fractures (odds ratios, 2.63, 0.96, 3.59, 1.00, 0.30, and 0.05; P = .006, P = .001, P = .007, P = .004, P = .021 and P = .029). Univariate analysis showed preexisting old VCFs were correlated with new VCFs (P = .045). Subsequent compression fractures in adjacent vertebrae (45 of 80) occurred more frequently and sooner than nonadjacent vertebral fractures (both P < .05)., Conclusions: The incidence of new VCFs after PV is relatively high and affected by several risk factors that are related to both the PV procedure and the natural course of osteoporosis., (Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the influencing factors of cement leakage in vertebroplasty for the treatment of osteoporosis vertebral compression fracture (OVCF) and vertebral metastases (VM)., Methods: Retrospective analysis was conducted for 653 vertebrae in 356 patients undergoing vertebroplasty at our hospital from May 2007 to January 2011. 251 cases had 438 vertebrae with painful OVCF while 105 cases had 215 vertebrae with VM. Pre-operative computed tomography (CT) was performed to determine the presence of cortical defects or osteolysis and within 3 days after PVP to observe the distribution of polymethylmethacrylate (PMMA) in vertebrae and whether leakage occurred. Volume of PMMA injected into each vertebral body and types of cement leakage were compared between the OVCF and VM groups by Z test or χ². The correlation between cortical defects and cement leakages around vertebrae was assessed with Pearson correlation coefficient., Results: The successful rate of PVP was 100%. The mean volume of PMMA injected into each vertebra was (5.0 ± 2.0) ml and (4.0 ± 1.7) ml in the OVCF and VM groups respectively (P < 0.05). Asymptomatic PMMA leakage was demonstrated by CT in 93 vertebrae (21.2%) in the OVCF group and in 53 vertebrae (28.8%) in the VM group respectively (P < 0.05). Cement leakages into disk were found in 58 vertebrae in the OVCF group and 16 vertebrae in the VM group respectively (P = 0.025). Cement leakages into paravertebral vein were found in 12 vertebrae in the OVCF group and 26 vertebrae in the VM group respectively (P < 0.0001). Correlation was found between cortical defects and cement leakage into paravertebral soft tissues in the OVCF group (r = 0.14) or in the VM group (r = 0.27), between end-plate defects and cement leakage into disk in the OVCF group (r = 0.29) or in the VM group (r = 0.31)., Conclusion: As a common occurrence in vertebroplasty, cement extravasation is well-tolerated in most patients. It occurs more frequently in the patients with VM than those with OVCF, especially in cases of leakage into paravertebral vein. Cement leakage into disc or paravertebral soft tissue is predisposed in vertebrae with end plate, cortical defects or osteolysis.

Objective: To determine the therapeutic efficacy and the influencing factors for the long/middle-term outcomes of percutaneous vertebroplasty (PVP) in the treatment of painful osteoporotic vertebral compression fractures (OVCFs)., Methods: This prospective study recruited a total of 131 consecutive OVCF patients treated with PVP at a single institution from March 2005 to December 2009. There were 106 females and 25 males. Pre- and postoperative evaluations included a visual analog scale (VAS) for pain, the Roland-Morris disability questionnaire (RDQ) scores and patient activity levels. Various factors probably correlated with long-mid term efficacy were also analyzed., Results: Both VAS and RDQ scores decreased significantly (P < 0.05). And the activity levels showed significant post-therapeutic improvement (P < 0.01); Univariate and multivariate analysis showed that the influencing factors for the long/middle-term efficacy were age, number of OVCF(s) per time, activity level after discharge and newly occurring OVCF (Z = -2.03, -2.68, 5.38 and -1.73; P = 0.043, 0.007, 0.001 and 0.034 respectively)., Conclusion: PVP is an efficient pain-relieving procedure. The long/middle-term efficacy after PVP is mostly correlated with both the patient age and the natural course of underlying conditions.

Objective: To evaluate the efficacy and safety of combining transarterial chemoembolization and percutaneous vertebroplasty (PVP) in the treatment of vertebral and paravertebral metastatic tumors., Methods: A retrospective review was conducted in 49 patients with severer painful tumor metastasis in 72 vertebrae and paravertebral tissue who had failed noninvasive treatment at our institution from March 2003 to December 2009. Among them, there were intractable radicular pain (n = 17) and slight or no motor and sensory function (n = 6). All patients under transarterial chemoembolization were followed within 6 days by PVP. Computed tomography (CT) was performed within 3 days after PVP to observe the distribution of PMMA (para-methoxymethamphetamine)in vertebrae and whether or not there was any leakage. The efficacy was assessed by the change of pain level after combined treatment., Results: Bilateral vertebral arteries were selected in 44 cases with 65 vertebrae. And only unilateral vertebral artery was selected in 5 cases with 7 vertebrae. Except for 2 vertebrae with simple artery infusion, 29 vertebrae were embolized by 1 - 2 ml of lipiodolization and gelfoam particles and 41 vertebrae by gelatine particles. And an average volume of 4.23 ml and 5.39 ml was injected in each thoracic and lumbar vertebra respectively. The rate of efficacy was at 87.8% within 3 months after combined therapy. There were CR (complete response) 21 cases (42.9%), PR (partial response) 22 cases (44.9%) and MR/NR (minimal/no response) 6 cases (12.2%). No serious complication related to the technique occurred. Only 12 cases with asymptomatic PMMA leakage around 16 vertebrae were demonstrated on post-operative CT., Conclusion: Transarterial chemoembolization plus PVP is an effective and safe procedure in the treatment of severe painful vertebral and paravertebral metastatic tumors.

Objective: To evaluate the clinical efficacy of percutaneous vertebroplasty (PVP) in patients with symptomatic vertebral hemangiomas and determine whether prior intraosseous venography decreases extravertebral leakage of PMMA and improves clinical outcomes in these procedures., Methods: Retrospective review was conducted on 45 consecutive patients with 53 symptomatic vertebral hemangiomas associated with chronic pain (all cases) or paralysis caused by spinal cord compression (1 case) or vertebral compression fractures (3 cases) treated with PVP at our institution to define two populations. Group A consisted of 27 vertebral hemangiomas in 23 patients who underwent intraosseous venography before injection polymethylmethacrylate (PMMA). Group B consisted of 26 vertebrae in 22 patients who underwent injection PMMA without prior venography. CT was done 1 to 3 days after PVP to observe PMMA distribution in vertebrae and whether leakage. Clinical outcomes, included pain relief, leakage of PMMA, volume of PMMA injected, expense and X-ray exposure times in each vertebral body, were compared in the two groups by using χ(2) or t test., Results: No significant difference was seen between the groups with respect to age, sex, the number of treated vertebrae, or preprocedural degrees of pain. The successful rate of technique of PVP was 100%. The mean volume of PMMA injected in each vertebra was 3.96 ml. CR, PR and NR was obtained respectively 84.5%, 13.3% and 2.2% during 6 months to 5 years of follow-up expect one case had unrelieved pain in group A. At 6 months after PVP, 22 cases (95.7%) in group A and 22 cases (100%) in group B achieved adequate pain relief (P = 0.323). 6 vertebrae (6/27) in group A and 2 vertebrae (2/26) in group B with asymptomatic leakage of PMMA were demonstrated by CT (P = 0.140). The mean volume of PMMA injected in each vertebra was 3.70 ml in group A and 4.23 ml in group B (P = 0.157). The mean expense of each vertebra was ¥7.24 × 10(3) in group A and ¥5.84 × 10(3) in group B (P = 0.000), the mean decreases were ¥1.4 × 10(3) in group B than group A. The mean X-ray exposure times on each vertebral body was 13.28 minutes in group A and 8.78 minutes in group B (P = 0.000), the mean decreases were 4.5 minutes in group B than group A., Conclusions: PVP is an effective and safe procedure for treating symptomatic vertebral hemangiomas. Prior intraosseous venography does not significantly improve the effectiveness or safety of PVP for vertebral hemangiomas performed by qualified, experienced operators, on the other hand, it increases the expense and X-ray exposure times of PVP.

Study Design: A retrospective study was performed in patients with a repeat percutaneous vertebroplasty (PV) at the vertebral levels previously undergoing vertebroplasty., Objective: Our purpose of this study is to examine if a repeat PV is effective on pain-relief at the vertebral levels previously undergoing vertebroplasty., Summary of Background Data: Although pain-relief is usually high with the treatment of PV in the painful osteoporotic vertebral compression fractures, there are still about 5% to 22% of such patients experiencing no improvement on pain after PV. A repeat PV at the same vertebrae previously treated with PV may be an option for these patients without a pain-relief., Methods: Out of 334 procedures of PV in 242 patients with osteoporotic vertebral compression fractures from October 2000 to June 2006 in our institute, 15 vertebrae in 15 patients with unrelieved pain in 4 to 32 days after an initial PV were treated with a repeat vertebroplasty. The clinical outcomes were assessed by measurements of visual analog scale, and the imaging features were analyzed pre- and postprocedure., Results: The mean volume of Polymethylmethacrylate injected in each vertebra was 4.0 mL (range, 1.5-9 mL) in the repeat PV. During the first month of follow-up after repeat PV in this series, a mean visual analog scale scores of the pain level was reduced from 8.6 (range, 7-10) preprocedure to 1.67 points (range, 0-4) postprocedure, with a mean reduction of 6.93 points (range, 4-8). Complete and partial pain relief were reached in 11 (73%) and 4 patients (27%), respectively in a mean follow-up of 15 months. No serious complications related to the procedures occurred, but asymptomatic Polymethylmethacrylate leakage around vertebrae was demonstrated on radiograph or computed tomography in 2 patients., Conclusion: The outcomes of this series suggest that repeat PV is effective at the same vertebral levels in patients without pain-relief who underwent previous PV. Absent or inadequate filling of cement in the unstable fractured areas of the vertebral body may be responsible for the unrelieved pain after the initial PV.