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  • Radiologic Outcomes of Single Level Extrapedicular Vertebroplasty by Injection Pattern of Bone Cement

    Final Number:

    Yong-Jun Cho MD PhD; Suk-Hyung Kang MD; Hyuk Jae Choi MD; Jin-Seo Yang MD; Mi-Sook Yong RN

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Vertebroplasty involves distribution of bone cements on fractured vertebral body via a bilateral transpedicular or single extrapedicular approach. There are several studies comparing the clinical results using conventional and extrapedicular approach or only one itself. However, studies of radiologic outcomes depending on the distribution pattern of bone cements were rarely reported. To comparatively assess the radiological outcomes of percutaneous extrapedicular vertebroplasty by injection pattern of bone cement for the treatment of single level osteoporotic vertebral compression fracture.

    Methods: Fourty osteoporotic vertebral compression fractures treated with extrapedicular vertebroplasty were allocated four groups according to distribution types of bone cement; Central (Group A ,n=15), Central to paracentral (Group B, n=8), Paracentral (Group C, n=7), Diffuse (Group D, n=10). All groups had done only single level procedure and no extravasation. Vertebral body height and segmental kyphotic angle were analyzed before procedure, after procedure, and at final follow-up. The radiologic results were analyzed using general linear model and p-value of less than 0.05 was considered statically significant.

    Results: In all four groups, postoperative vertebral body height (p=0.001) was improved compared with preoperative radiologic findings and there were no statistically significant differences in postoperative segmental kyphotic angle (p=0.060) and each groups (p=0.228, p=0.179). At 6 months follow-up, vertebral body height was worsen compared with preoperative and postoperative radiologic results and in segmental kyphotic angle and each groups were not statistically significant differences.

    Conclusions: According to our radiologic results, in the process of vertebroplasty using extrapedicular approach as the treatment for osteoporotic vertebral compression fracture, the injection pattern of bone cement for augmentation of collapse vertebral body do not affect final the compression ratio and segmental kyphotic angle change of vertebral body.

    Patient Care: It will provide informations related to the bone cement injection.

    Learning Objectives: Participants should be able to describe the importance of distribution of bone cement.

    References: Nieuwenhuijse MJ, van Erkel AR, Dijkstra PD. Percutaneous vertebroplasty for subacute and chronic painful osteoporotic vertebral compression fractures can safely be undertaken in the first year after the onset of symptoms. J Bone Joint Surg Br 2012;94:815-20. 2. Edidin AA, Ong KL, Lau E, et al. Cost-effectiveness analysis of treatments for vertebral compression fractures. Appl Health Econ Health Policy 2012;10:273-84. 3. Farrokhi MR, Alibai E, Maghami Z. Randomized controlled trial of percutaneous vertebroplasty versus optimal medical management for the relief of pain and disability in acute osteoporotic vertebral compression fractures. J Neurosurg Spine 2011;14:561-9. 4. Boonen S, Wahl DA, Nauroy L, et al. Balloon kyphoplasty and vertebroplasty in the management of vertebral compression fractures. Osteoporos Int 2011;22:2915-34. 5. McKiernan F, Faciszewski T, Jensen R. Quality of life following vertebroplasty. J Bone Joint Surg Am 2004;86-A:2600-6. 6. Yoo CM, Park KB, Hwang SH, et al. The analysis of patterns and risk factors of newly developed vertebral compression fractures after percutaneous vertebroplasty. J Korean Neurosurg Soc 2012;52:339-45. 7. Svedbom A, Alvares L, Cooper C, et al. Balloon kyphoplasty compared to vertebroplasty and nonsurgical management in patients hospitalised with acute osteoporotic vertebral compression fracture: a UK cost-effectiveness analysis. Osteoporos Int 2012. 8. Dong R, Chen L, Tang T, et al. Pain reduction following vertebroplasty and kyphoplasty. Int Orthop 2012. 9. Belkoff SM, Mathis JM, Jasper LE, et al. The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior. Spine 2001;26:1537-41. 10. Dean JR, Ison KT, Gishen P. The strengthening effect of percutaneous vertebroplasty. Clin Radiol 2000;55:471-6. 11. Komemushi A, Kariya TS, Kojima KH, et al. Percutaneous vertebroplasty for compression fracture: analysis of vertebral body volume by CT volumetry. Acta Radiologica 2005;46:276-9.

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