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      Percutaneous kyphoplasty assisted with/without mixed reality technology in treatment of OVCF with IVC: a prospective study

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          Abstract

          Background

          The purpose of this study was to assess the clinical outcome of percutaneous kyphoplasty (PKP) assisted with mixed reality (MR) technology in treatment of osteoporotic vertebral compression fracture (OVCF) with intravertebral vacuum cleft (IVC).

          Method

          Forty cases of OVCF with IVC undergoing PKP were randomized into a MR technology-assisted group (group A) and a traditional C-arm fluoroscopy group (group B). Both groups were performed PKP and evaluated by VAS scores, ODI scores, radiological evidence of vertebral body height, and kyphotic angle (KA) at pre-operation and post-operation. The volume of injected cement, fluoroscopy times, and operation time were recorded. And cases of non-PMMA-endplates-contact(NPEC) in radiological evidence was also recorded postoperatively. The clinical outcomes and complications were evaluated afterwards. All patients received 10 to 14 months follow-up, with an average of 12 months.

          Result

          This MR-assisted group (group A) acquired more about the amount of the polymethyl methacrylate (PMMA) injection and postoperative vertebral height and less about postoperative KA, fluoroscopy times, and operation time compared with the control group (group B) ( P < 0.05). The VAS scores and ODI scores in both groups have improved, but more significantly in group A ( P < 0.05). Also, more cases achieve both-endplates-touching of cement in group A ( P < 0.05). And there are less of the loss of vertebral height, KA, and occurrence of re-collapse of the vertebra in group A during the follow-up ( P < 0.05).

          Conclusion

          PKP assisted with MR technology can accurately orientate the position of IVC area, which can be augmented by the balloon leading to more satisfied vertebral height improvement, cement diffusion, and pain relief.

          Trial registration

          ClinicalTrials.gov Identifier: NCT03959059. Registered 25 September 2016.

          Related collections

          Most cited references 46

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          Recollapse of previous vertebral compression fracture after percutaneous vertebroplasty.

          This study was undertaken to investigate the incidence rate, characteristics, and predisposing factors associated with recollapse of the same vertebrae after percutaneous vertebroplasty (PVP). Recollapse of the same vertebra after PVP is the one of the complications of the procedure, and the incidence rate in our study was 3.21%. The most important predisposing factor was pre-operative osteonecrosis. Recollapse was not related to trauma. PVP using polymethylmethacrylate has become a popular treatment for osteoporotic vertebral compression fracture. Recollapse of the same vertebrae after PVP has rarely been reported. This study was undertaken to investigate the incidence, characteristics, and predisposing factors associated with recollapse of the same vertebrae after PVP. Eleven patients (seven females and four males; mean age, 69.91 +/- 5.49 years), out of a total of 343 patients, developed recollapse of the same vertebra after PVP. The 11 patients who developed recollapse comprised the "recollapse group", while the remaining 332 patients comprised the "well-maintained group". Pre-operative magnetic resonance imaging revealed that the incidence of osteonecrosis was significantly higher in the recollapse group than the well-maintained group (p < 0.05). The degree of re-expansion of the compressed vertebral body after PVP was significantly higher in the recollapse group than in the well-maintained group (p < 0.05). The most important predisposing factor for recollapse was pre-operative osteonecrosis. Recollapse was not related to trauma. Osteoporotic vertebral compression fracture with osteonecrosis or pseudoarthrosis has been regarded as a relative indication for PVP; however, the findings of this study suggest that this disease category may be a relative contraindication for PVP.
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            Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy.

            We sought to determine whether percutaneous vertebroplasty--which involves the injection of cement to stabilize a fractured vertebral body--may be an effective treatment for vertebral fracture. We enrolled 79 consecutive osteoporotic patients (24 men and 55 women; ages 51 to 93 years) presenting with acute vertebral fractures. Clinical characteristics and bone densitometry were measured at baseline. Pain scores (on a 0 to 25 scale) and levels of function (on a 0 to 20 scale) were recorded on presentation, at 24 hours, at 6 weeks, and 6 to 12 months after therapy. Fifty-five patients (70%) were treated by percutaneous vertebroplasty and 24 (30%) were treated by conservative therapy alone. They were followed for a mean of 215 days (range, 57 to 399 days). The baseline clinical characteristics, bone densitometry, and fracture data were similar in the two groups. Twenty-four hours after vertebroplasty, there was a 53% reduction in pain scores (from 19 to 9; P = 0.0001) and a 29% improvement in physical functioning (from 14 to 18; P = 0.0001), whereas pain scores and physical functioning remained unchanged at 24 hours in the patients treated conservatively (both P = 0.0001 compared with the changes after percutaneous vertebroplasty). Thirteen patients (24%) treated by percutaneous vertebroplasty were able to cease all analgesia after 24 hours (P = 0.0001 compared with none of the 24 patients treated conservatively). Clinical outcomes at 6 weeks and 6 to 12 months were similar in both groups. When compared with conservative therapy, percutaneous vertebroplasty results in prompt pain relief and rapid rehabilitation. In experienced hands, it is a safe and effective procedure for treating acute osteoporotic vertebral compression fractures.
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              Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures.

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                Author and article information

                Contributors
                +86-25-85221050 , wlmnjyy@126.com
                Journal
                J Orthop Surg Res
                J Orthop Surg Res
                Journal of Orthopaedic Surgery and Research
                BioMed Central (London )
                1749-799X
                8 August 2019
                8 August 2019
                2019
                : 14
                Affiliations
                Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, No. 68 of ChangLe Road, Nanjing, 210029 Jiangsu Province China
                Article
                1303
                10.1186/s13018-019-1303-x
                6686364
                31395071
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Surgery

                mixed reality, pkp, ivc, ovcf

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