Percutaneous cement augmentation for osteoporotic vertebral fractures

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Abstract

Thoracolumbar vertebral fracture incidents usually occur secondary to a high velocity trauma in young patients and to minor trauma or spontaneously in older people.
Osteoporotic vertebral fractures are the most common osteoporotic fractures and affect one-fifth of the osteoporotic population.
Percutaneous fixation by ‘vertebroplasty’ is a tempting alternative for open surgical management of these fractures.
Despite discouraging initial results of early trials for vertebroplasty, cement augmentation proved its superiority for the treatment of symptomatic osteoporotic vertebral fracture when compared with optimal medical treatment.
Early intervention is also gaining ground recently.
Kyphoplasty has the advantage over vertebroplasty of reducing kyphosis and cement leak.
Stentoplasty, a new variant of cement augmentation, is also showing promising outcomes.
In this review, we describe the additional techniques of cement augmentation, stressing the important aspects for success, and recommend a thorough evaluation of thoracolumbar fractures in osteoporotic patients to select eligible patients that will benefit the most from percutaneous augmentation. A detailed treatment algorithm is then proposed.

Cite this article: EFORT Open Rev 2017;2:293–299. DOI: 10.1302/2058-5241.2.160057

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Most cited references 40

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A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures.

Rachelle Buchbinder, Richard Osborne, Peter R Ebeling … (2009)

Vertebroplasty has become a common treatment for painful osteoporotic vertebral fractures, but there is limited evidence to support its use. We performed a multicenter, randomized, double-blind, placebo-controlled trial in which participants with one or two painful osteoporotic vertebral fractures that were of less than 12 months' duration and unhealed, as confirmed by magnetic resonance imaging, were randomly assigned to undergo vertebroplasty or a sham procedure. Participants were stratified according to treatment center, sex, and duration of symptoms ( or = 6 weeks). Outcomes were assessed at 1 week and at 1, 3, and 6 months. The primary outcome was overall pain (on a scale of 0 to 10, with 10 being the maximum imaginable pain) at 3 months. A total of 78 participants were enrolled, and 71 (35 of 38 in the vertebroplasty group and 36 of 40 in the placebo group) completed the 6-month follow-up (91%). Vertebroplasty did not result in a significant advantage in any measured outcome at any time point. There were significant reductions in overall pain in both study groups at each follow-up assessment. At 3 months, the mean (+/-SD) reductions in the score for pain in the vertebroplasty and control groups were 2.6+/-2.9 and 1.9+/-3.3, respectively (adjusted between-group difference, 0.6; 95% confidence interval, -0.7 to 1.8). Similar improvements were seen in both groups with respect to pain at night and at rest, physical functioning, quality of life, and perceived improvement. Seven incident vertebral fractures (three in the vertebroplasty group and four in the placebo group) occurred during the 6-month follow-up period. We found no beneficial effect of vertebroplasty as compared with a sham procedure in patients with painful osteoporotic vertebral fractures, at 1 week or at 1, 3, or 6 months after treatment. (Australian New Zealand Clinical Trials Registry number, ACTRN012605000079640.) 2009 Massachusetts Medical Society

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A randomized trial of vertebroplasty for osteoporotic spinal fractures.

David F Kallmes, Bryan Comstock, Patrick Heagerty … (2009)

Vertebroplasty is commonly used to treat painful, osteoporotic vertebral compression fractures. In this multicenter trial, we randomly assigned 131 patients who had one to three painful osteoporotic vertebral compression fractures to undergo either vertebroplasty or a simulated procedure without cement (control group). The primary outcomes were scores on the modified Roland-Morris Disability Questionnaire (RDQ) (on a scale of 0 to 23, with higher scores indicating greater disability) and patients' ratings of average pain intensity during the preceding 24 hours at 1 month (on a scale of 0 to 10, with higher scores indicating more severe pain). Patients were allowed to cross over to the other study group after 1 month. All patients underwent the assigned intervention (68 vertebroplasties and 63 simulated procedures). The baseline characteristics were similar in the two groups. At 1 month, there was no significant difference between the vertebroplasty group and the control group in either the RDQ score (difference, 0.7; 95% confidence interval [CI], -1.3 to 2.8; P=0.49) or the pain rating (difference, 0.7; 95% CI, -0.3 to 1.7; P=0.19). Both groups had immediate improvement in disability and pain scores after the intervention. Although the two groups did not differ significantly on any secondary outcome measure at 1 month, there was a trend toward a higher rate of clinically meaningful improvement in pain (a 30% decrease from baseline) in the vertebroplasty group (64% vs. 48%, P=0.06). At 3 months, there was a higher crossover rate in the control group than in the vertebroplasty group (51% vs. 13%, P<0.001) [corrected]. There was one serious adverse event in each group. Improvements in pain and pain-related disability associated with osteoporotic compression fractures in patients treated with vertebroplasty were similar to the improvements in a control group. (ClinicalTrials.gov number, NCT00068822.) 2009 Massachusetts Medical Society

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[Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty].

P Galibert, H Deramond, P Rosat … (1987)

Findings in several cases are used to demonstrate that certain vertebral angiomas may not be congenital and can ultimately provoke medullary or radicular neurologic complications. Radiotherapy is the usual treatment but is not always accepted unconditionally close to spinal cord. Destruction of angioma and consolidation of vertebral column can be obtained by percutaneous intrasomatic injection of acrylic cement. The preoperative radiologic examination includes direct phlebography with insertion of trocar, the vertebroplasty being performed under television screen surveillance. Results in seven patients treated are very encouraging but the current 2-year follow up requires extension. However, the method appears to be able to be included amongst treatment for an affection of sometimes seriously questioned benign nature.

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Author and article information

Journal

Journal ID (nlm-ta): EFORT Open Rev

Journal ID (iso-abbrev): EFORT Open Rev

Title: EFORT Open Reviews

Publisher: British Editorial Society of Bone and Joint Surgery

ISSN (Electronic): 2058-5241

Publication date Collection: June 2017

Publication date (Electronic): 22 June 2017

Volume: 2

Issue: 6

Pages: 293-299

Affiliations

[1 ]Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

[2 ]Department of Orthopedic Surgery, Centre Hospitalier Paris Saint Joseph, Paris, France

Author notes

[*]Ghassan Maalouf, Department of Orthopedic Surgery, Bellevue Medical Center University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon. Email: gmaalouf@ 123456bmc.com.lb

Article

Publisher ID: 10.1302_2058-5241.2.160057

DOI: 10.1302/2058-5241.2.160057

PMC ID: 5508856

PubMed ID: 28736621

SO-VID: a5830cd2-d48d-481b-9b05-03cd6e807566

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This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.

Percutaneous cement augmentation for osteoporotic vertebral fractures

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Most cited references 40

A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures.

A randomized trial of vertebroplasty for osteoporotic spinal fractures.

[Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty].

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