scholarly journals Can Additional Facet Joint Block Improve the Clinical Outcome of Kyphoplasty for Acute Osteoporotic Vertebral Compression Fractures?

2021 ◽  
pp. 283-291
Author(s):  
Ding-Jun Hao
Keyword(s):  
Clinical Outcome ◽  
Facet Joint ◽  
Satisfaction Score ◽  
Vertebral Compression Fractures ◽  
Medial Branch ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Mineral Density ◽  
Compression Fractures ◽  
Percutaneous Kyphoplasty

Background: Percutaneous kyphoplasty (PKP) has been reported to provide a favorable analgesic effect for pain caused by osteoporotic vertebral compression fractures (OVCFs). However, a systematic review demonstrated that pain relief was only reported for approximately 86% of kyphoplasty treatments. Objectives: To explore whether an additional facet joint block (FJB) can minimize pain and improve the clinical outcome of PKP in patients with acute OVCFs. Study Design: Prospective study. Setting: All data were from Honghui Hospital in Xi’an. Methods: According to the inclusion and exclusion criteria, 194 patients were eventually included in our study; they were randomly divided into 2 groups of 97 patients each and treated with either PKP + FJB or PKP alone. Follow-up consultations were scheduled 1 day, 3 days, 1 week, 1 month, 3 months, and 1 year postoperatively; the demographic characteristics, related surgical information, and complications observed within both groups were recorded. The clinical evaluation parameters included the intraoperative satisfaction score, the Visual Analog Scale (VAS) score, and the Oswestry Disability Index (ODI). Results: A total of 171 patients (61 men and 110 women; age range: 62–85 years) completed the full postoperative follow-up schedule, with 83 patients in the PKP + FJB group and 88 in the PKP group. No significant differences were observed in the genders, ages, preoperative bone mineral density, surgical levels, or volume of cement injected between the 2 groups (P > 0.05, respectively). The average duration of the surgeries in the PKP + FJB group was slightly longer than that in the PKP group (35.5 ± 4.8 min vs. 31.8 ± 4.3 min; P = 0.038), and in terms of the clinical outcomes, the average intraoperative satisfaction score was significantly higher in the PKP + FJB group (8.6 ± 1.1 vs. 6.3 ± 1.3; P < 0.001). Compared with the preoperative data, significant improvements in the VAS scores of back pain and ODI were observed at each follow-up interval (P < 0.05, respectively). These scores were significantly higher in the PKP + FJB group than in the PKP group; however, this was only observed within the first month after the procedure. Limitations: A single-center noncontrol study. Conclusions: The addition of an FJB (which in our study involved a unique combination of ropivacaine, prednisolone, and vitamin B12) improved the short-term clinical outcome of PKP for acute OVCFs. The local anti-inflammatory and analgesic effects on the facet joints resulted in higher intraoperative satisfaction and lower VAS and ODI scores for the first postoperative month when compared with the PKP group. Key words: Osteoporotic vertebral compression fracture, pain, posterior elements, percutaneous kyphoplasty, facet joint block, medial branch

Incidence and risk factors of facet joint violation following percutaneous kyphoplasty for osteoporotic vertebral compression fractures

2018 ◽  
Vol 60 (6) ◽  
pp. 755-761 ◽  
Author(s):  
Yao Li ◽  
Xiangyang Wang ◽  
Kaixia Jiang ◽  
Jiaoxiang Chen ◽  
Yan Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Facet Joint ◽  
Multiple Logistic Regression Analysis ◽  
Vertebral Compression Fractures ◽  
Facet Joints ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Percutaneous Kyphoplasty ◽  
Facet Joint Violation

Background Percutaneous kyphoplasty (PKP) has been widely used to osteoporotic vertebral compression fractures (OVCFs). No previous investigations have reported the incidence and risk factors of facet joint violation (FJV) caused by PKP. Purpose To determine the incidence and risk factors of FJV following PKP in patients with OVCFs. Material and Methods We reviewed a total of 153 patients who underwent bilateral PKP. Postoperative computed tomography (CT) scans were assessed to determine the degree of FJV owing to invasion by a puncture trocar. Clinical outcomes, including visual analogue scale (VAS) scores and Oswestry Disability Index (ODI) scores, were collected from all patients. Clinical and radiological data were analyzed to identify the risk factors for FJV. Results FJV caused by PKP affected 18.9% of patients and 9.6% of facet joints; approximately 3.9% and 5.7% of facet joints were considered to have grade 1 and grade 2 violations, respectively. There were significant differences between the FJV and non-FJV groups in VAS and ODI scores after surgery. Significant differences were found with respect to the facet joint angle (FJA), the pedicle diameter (PD), and the distance from the entry point to the facet joint space (DEF). Multiple logistic regression analysis indicated that an FJA > 55°, a PD < 5 mm, and a DEF < 5 mm were independent risk factors for FJV. Conclusion The placement of a puncture trocar can cause FJV in patients with OVCFs and impact clinical outcomes after PKP. Special attention should be given to patients with an FJA > 55°, a PD < 5 mm, and a DEF < 5 mm.

scholarly journals Effectiveness Analysis of Percutaneous Kyphoplasty Combined with Zoledronic Acid in Treatment of Primary Osteoporotic Vertebral Compression Fractures

2019 ◽  
Vol 1 (22;1) ◽  
pp. 63-68
Author(s):  
Shao-Xiong Xiao
Keyword(s):  
Bone Mineral Density ◽  
Zoledronic Acid ◽  
Treatment Group ◽  
Vertebral Compression Fractures ◽  
Control Group ◽  
P Value ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Mineral Density ◽  
Compression Fractures

Objective: To investigate the therapeutic effectiveness of percutaneous kyphoplasty (PKP) combined with zoledronic acid in treatment of primary osteoporotic vertebral compression fractures. Study Design: A perspective cohort study was conducted at a single institution for patients, who received PKP operation due to primary osteoporotic vertebral compression fracture between January 2014 and January 2015. Setting: According to whether they received postoperative zoledronic acid or not, patients were divided into treatment or control groups, with 30 randomly-selected cases per group. Methods: The visual analogue scale (VAS), which was used to assess the degree of pain, and the bone mineral density, was analyzed at 1-, 6-, and 12-month follow-ups. Results: In general, patients experienced marked pain relief after surgery. No significant difference in pain relief was observed in the control group between the 6 and 12-month followup. In contrast, the VAS score of the treatment group at 12-month follow-up was significantly lower than that at 6-month (P value = 0.03). Moreover, it was also significantly lower than the VAS score in the control group at the 12-month follow-up (P value = 0.0018). The bone mineral density of patients from the treatment group increased significantly and progressively after the surgery (pre-operation versus 6-month follow-up: P value = 0.01; 6-month versus 12-month follow-up: P value < 0.001), and it was also remarkably higher than that of the control group at the 12-month follow-up (P value < 0.0001). Limitations: Patients were collected from a single hospital. The maximum postoperative followup time was 12 months. The sample size was relatively small. Thus, bias could occur in the selection of cases if they are not representative of the population. Conclusion: The combined treatment of zoledronic acid with PKP for primary osteoporotic vertebral compression fractures safely and effectively relieved low back pain, significantly increased bone density, and improved the quality of life. The clinical effectiveness is promising and worthy of further study. Key words: Kyphoplasty, zoledronic acid, primary osteoporotic vertebral compression fractures

scholarly journals Correlation Analysis Between Basic Diseases and Subsequent Vertebral Fractures After Percutaneous Kyphoplasty (PKP) for Osteoporotic Vertebral Compression Fractures

2021 ◽  
Vol 24 (6) ◽  
pp. E803-E810
Keyword(s):  
Risk Factors ◽  
Gallstone Disease ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Single Center ◽  
Mineral Density ◽  
Fracture Group ◽  
Compression Fractures ◽  
Percutaneous Kyphoplasty ◽  
History Of

BACKGROUND: Percutaneous kyphoplasty (PKP) is a widely accepted surgical treatment modality for painful osteoporotic vertebral compression fractures. The risk factors cause of subsequent vertebral fractures after PKP are debated. OBJECTIVES: To evaluate risk factors for the occurrence of new vertebral compression fractures after PKP. STUDY DESIGN: A retrospective study. SETTING: A single-center inpatient population. METHODS: A total of 921 patients (1,152 vertebrae) with PKP were investigated. Among those patients, 111 patients (155 levels) incurred refractures after PKP. RESULTS: The average bone mineral density was -3.27 in the “refracture”group and -3.00 in the “no fracture” group (P = 0.031). Morbidities of women were significantly higher in the “refracture” group (90.99%) compared with the “no fracture” group (81.73%) (P = 0.015). Among the basic diseases, several diseases (history of previously fracture, previously osteoporosis, gallstone disease, stomach disease, and ovariectomy) are associated with refractures after PKP (P < 0.05). And antiosteoporotic treatment (calcium + vitamin D or zoledronate) after PKP can also significantly reduce the occurrence of refracture (P < 0.000). In addition, logistic regression analysis also showed that most of the above contents had significant correlation with the refracture after PKP (P < 0.05), except for gallstone disease (P = 0.362). LIMITATIONS: Retrospective study, single center. CONCLUSION: Osteoporosis is the main cause of refracture after PKP. Elderly women were found to be more susceptible than elderly men to refracture. Patients with a history of previously fracture, previously osteoporosis, stomach ulcer, and ovariectomy are more likely to be refracture. Antiosteoporosis treatment (calcium + vitamin D or zoledronate) after PKP can reduce the risk of refracture. KEY WORDS: Osteoporosis, percutaneous kyphoplasty, vertebral compression fractures, bone mineral density

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