Skip to main content

Advertisement

SpringerLink
Log in

Surgical procedure and initial radiographic results of a new augmentation technique for vertebral compression fractures

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Recently, a new minimally invasive technique called ‘vertebral body stenting’ (VBS) was introduced for the treatment of osteoporotic vertebral fractures. The technique was developed to prevent the loss of reduction after deflation of the balloon and to reduce the complication rate associated with cement leakage.

Methods

The amount of kyphosis correction, improvement of vertebral body height and quantitative cement leakage rate by applying CT-based quantitative volumetry after VBS were measured in 27 patients (55 vertebra) and compared with a control group (29 patients, 61 vertebrae), which was treated with conventional vertebroplasty.

Results

After VBS, a significant improvement was seen in vertebral height, compared to conventional vertebroplasty. The mean improvement in segmental kyphosis and vertebral kyphosis were 5.8° (p < 0.05) and 3.5° (p < 0.05), respectively. In the VBS group, the mean injected volume of cement per vertebral body was 7.33 cm3 (3.34–10.19 cm3). The average amount of cement outside the vertebrae was 0.28 cm3 (0.01–1.64 cm3), which was 1.36 % of the applied total cement volume. In the vertebroplasty group, the applied mean volume of the cement per level was 2.7 cm3 (1–5.8 cm3) and the average amount of cement outside the vertebrae was 0.15 cm3 (0.01–1.8 cm3), which was 11.5 % (0.2–60 %) of the applied total volume of cement.

Conclusion

The frequency of cement leakage after VBS was 25.5 % compared to 42.1 % in the vertebroplasty group. VBS led to a significant decrease in the leakage rate compared with conventional vertebroplasty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ 3rd (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 7(2):221–227. doi:10.1002/jbmr.5650070214

    Article  PubMed  CAS  Google Scholar 

  2. Shen GW, Wu NQ, Zhang N, Jin ZS, Xu J, Yin GY (2010) A prospective comparative study of kyphoplasty using the Jack vertebral dilator and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. J Bone Joint Surg Br 92(9):1282–1288. doi:10.1302/0301-620X.92B9.23739

    PubMed  CAS  Google Scholar 

  3. Hollingworth W, Jarvik JG (2006) Evidence on the effectiveness and cost-effectiveness of vertebroplasty: a review of policy makers’ responses. Acad Radiol 13(5):550–555. doi:10.1016/j.acra.2006.01.003

    Article  PubMed  Google Scholar 

  4. Rhyne A 3rd, Banit D, Laxer E, Odum S, Nussman D (2004) Kyphoplasty: report of eighty-two thoracolumbar osteoporotic vertebral fractures. J Orthop Trauma 18(5):294–299 (pii: 00005131-200405000-00005)

    Article  PubMed  Google Scholar 

  5. Muijs SP, Nieuwenhuijse MJ, Van Erkel AR, Dijkstra PD (2009) Percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures: evaluation after 36 months. J Bone Joint Surg Br 91(3):379–384. doi:10.1302/0301-620X.91B3.20970

    PubMed  CAS  Google Scholar 

  6. Barr JD, Barr MS, Lemley TJ, McCann RM (2000) Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 25(8):923–928

    Article  PubMed  CAS  Google Scholar 

  7. Heini PF, Walchli B, Berlemann U (2000) Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J 9(5):445–450

    Article  PubMed  CAS  Google Scholar 

  8. Garfin SR, Buckley RA, Ledlie J (2006) Balloon kyphoplasty for symptomatic vertebral body compression fractures results in rapid, significant, and sustained improvements in back pain, function, and quality of life for elderly patients. Spine 31(19):2213–2220. doi:10.1097/01.brs.0000232803.71640.ba

    Article  PubMed  Google Scholar 

  9. Taylor RS, Taylor RJ, Fritzell P (2006) Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine 31(23):2747–2755. doi:10.1097/01.brs.0000244639.71656.7d

    Article  PubMed  Google Scholar 

  10. Voggenreiter G (2005) Balloon kyphoplasty is effective in deformity correction of osteoporotic vertebral compression fractures. Spine 30(24):2806–2812 pii: 00007632-200512150-00019

    Article  PubMed  Google Scholar 

  11. Rotter R, Martin H, Fuerderer S, Gabl M, Roeder C, Heini P, Mittlmeier T (2010) Vertebral body stenting: a new method for vertebral augmentation versus kyphoplasty. Eur Spine J 19(6):916–923. doi:10.1007/s00586-010-1341-x

    Article  PubMed  Google Scholar 

  12. Huang MH, Barrett-Connor E, Greendale GA, Kado DM (2006) Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo study. J Bone Miner Res 21(3):419–423. doi:10.1359/JBMR.051201

    Article  PubMed  Google Scholar 

  13. Klezl Z, Majeed H, Bommireddy R, John J (2011) Early results after vertebral body stenting for fractures of the anterior column of the thoracolumbar spine. Injury 42(10):1038–1042. doi:10.1016/j.injury.2011.04.006

    Article  PubMed  Google Scholar 

  14. Ulmar B, Brunner A, Guhring M, Schmalzle T, Weise K, Badke A (2010) Inter- and intraobserver reliability of the vertebral, local and segmental kyphosis in 120 traumatic lumbar and thoracic burst fractures: evaluation in lateral X-rays and sagittal computed tomographies. Eur Spine J 19(4):558–566. doi:10.1007/s00586-009-1231-2

    Article  PubMed  Google Scholar 

  15. Yeom JS, Kim WJ, Choy WS, Lee CK, Chang BS, Kang JW (2003) Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg Br 85(1):83–89

    Article  PubMed  CAS  Google Scholar 

  16. Tohmeh AG, Mathis JM, Fenton DC, Levine AM, Belkoff SM (1999) Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic compression fractures. Spine 24(17):1772–1776

    Article  PubMed  CAS  Google Scholar 

  17. Feltes C, Fountas KN, Machinis T, Nikolakakos LG, Dimopoulos V, Davydov R, Kassam M, Johnston KW, Robinson JS (2005) Immediate and early postoperative pain relief after kyphoplasty without significant restoration of vertebral body height in acute osteoporotic vertebral fractures. Neurosurg Focus 18(3):e5 pii: 180305

    Article  PubMed  Google Scholar 

  18. Fribourg D, Tang C, Sra P, Delamarter R, Bae H (2004) Incidence of subsequent vertebral fracture after kyphoplasty. Spine 29(20):2270–2276 (pii: 00007632-200410150-00013, discussion 2277)

    Article  PubMed  Google Scholar 

  19. Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P (2000) Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 39(12):1410–1414

    Article  CAS  Google Scholar 

  20. Lin EP, Ekholm S, Hiwatashi A, Westesson PL (2004) Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol 25(2):175–180

    PubMed  Google Scholar 

  21. Lieberman IH, Dudeney S, Reinhardt MK, Bell G (2001) Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine 26(14):1631–1638

    Article  PubMed  CAS  Google Scholar 

  22. Heini PF, Orler R (2004) Kyphoplasty for treatment of osteoporotic vertebral fractures. Eur Spine J 13(3):184–192. doi:10.1007/s00586-003-0654-4

    Article  PubMed  Google Scholar 

  23. Schmidt R, Cakir B, Mattes T, Wegener M, Puhl W, Richter M (2005) Cement leakage during vertebroplasty: an underestimated problem? Eur Spine J 14(5):466–473. doi:10.1007/s00586-004-0839-5

    Article  PubMed  CAS  Google Scholar 

  24. Ryu KS, Park CK, Kim MC, Kang JK (2002) Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. J Neurosurg 96(1 Suppl):56–61

    PubMed  Google Scholar 

  25. Eck JC, Nachtigall D, Humphreys SC, Hodges SD (2008) Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature. Spine J 8(3):488–497. doi:10.1016/j.spinee.2007.04.004

    Article  PubMed  Google Scholar 

  26. Komemushi A, Tanigawa N, Kariya S, Kojima H, Shomura Y, Komemushi S, Sawada S (2006) Percutaneous vertebroplasty for osteoporotic compression fracture: multivariate study of predictors of new vertebral body fracture. Cardiovasc Intervent Radiol 29(4):580–585. doi:10.1007/s00270-005-0138-5

    Article  PubMed  Google Scholar 

  27. Liebschner MA, Rosenberg WS, Keaveny TM (2001) Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine 26(14):1547–1554

    Article  PubMed  CAS  Google Scholar 

  28. Luo J, Daines L, Charalambous A, Adams MA, Annesley-Williams DJ, Dolan P (2009) Vertebroplasty: only small cement volumes are required to normalize stress distributions on the vertebral bodies. Spine 34(26):2865–2873. doi:10.1097/BRS.0b013e3181b4ea1e

    Article  PubMed  Google Scholar 

  29. Li YA, Lin CL, Chang MC, Liu CL, Chen TH, Lai SC (2012) Subsequent vertebral fracture after vertebroplasty: incidence and analysis of risk factors. Spine 37(3):179–183. doi:10.1097/BRS.0b013e3181f72b05

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria

    Martin Thaler, Ricarda Lechner & Michaela Gstöttner

  2. Institute of Experimental Orthopaedics, Medical University Innsbruck, Salurnerstr. 15, 6020, Innsbruck, Austria

    Michael Nogler

  3. St. Remigius Krankenhaus Opladen, An St. Remigius 26, 51379, Leverkusen, Germany

    Christian Bach

Authors
  1. Martin Thaler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ricarda Lechner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Nogler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michaela Gstöttner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christian Bach
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Thaler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thaler, M., Lechner, R., Nogler, M. et al. Surgical procedure and initial radiographic results of a new augmentation technique for vertebral compression fractures. Eur Spine J 22, 1608–1616 (2013). https://doi.org/10.1007/s00586-012-2603-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-012-2603-6

Keywords

Search

Navigation