Osteoporosis surgery: Difference between revisions

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* It is commonly done following [[kyphoplasty]], when the balloon is deflated and the [[vertebrae]] is ready to be injected with [[cement]].  It is often used as an alternative to [[vertebroplasty]] as  it is more cost effective. This procedure may correct the [[Kyphosis|kyphotic]] angle of the [[spinal column]] by 11 to 13 degrees, leading to significant [[pain]] relief in 90% of patients.<ref name="pmid26895528">{{cite journal |vauthors=Hoppe S, Budmiger M, Bissig P, Aghayev E, Benneker LM |title=Lordoplasty: midterm outcome of an alternative augmentation technique for vertebral fractures |journal=J Neurosurg Spine |volume=24 |issue=6 |pages=922–7 |year=2016 |pmid=26895528 |doi=10.3171/2015.10.SPINE151016 |url=}}</ref> Lordoplasty has a much better 3 months outcome than [[kyphoplasty]], especially in postural and anatomical deviations.<ref name="pmid21165313">{{cite journal |vauthors=Kim SB, Jeon TS, Lee WS, Roh JY, Kim JY, Park WK |title=Comparison of kyphoplasty and lordoplasty in the treatment of osteoporotic vertebral compression fracture |journal=Asian Spine J |volume=4 |issue=2 |pages=102–8 |year=2010 |pmid=21165313 |pmc=2996621 |doi=10.4184/asj.2010.4.2.102 |url=}}</ref>
* It is commonly done following [[kyphoplasty]], when the balloon is deflated and the [[vertebrae]] is ready to be injected with [[cement]].  It is often used as an alternative to [[vertebroplasty]] as  it is more cost effective. This procedure may correct the [[Kyphosis|kyphotic]] angle of the [[spinal column]] by 11 to 13 degrees, leading to significant [[pain]] relief in 90% of patients.<ref name="pmid26895528">{{cite journal |vauthors=Hoppe S, Budmiger M, Bissig P, Aghayev E, Benneker LM |title=Lordoplasty: midterm outcome of an alternative augmentation technique for vertebral fractures |journal=J Neurosurg Spine |volume=24 |issue=6 |pages=922–7 |year=2016 |pmid=26895528 |doi=10.3171/2015.10.SPINE151016 |url=}}</ref> Lordoplasty has a much better 3 months outcome than [[kyphoplasty]], especially in postural and anatomical deviations.<ref name="pmid21165313">{{cite journal |vauthors=Kim SB, Jeon TS, Lee WS, Roh JY, Kim JY, Park WK |title=Comparison of kyphoplasty and lordoplasty in the treatment of osteoporotic vertebral compression fracture |journal=Asian Spine J |volume=4 |issue=2 |pages=102–8 |year=2010 |pmid=21165313 |pmc=2996621 |doi=10.4184/asj.2010.4.2.102 |url=}}</ref>


* The procedure consists of applying 6 [[Cannula|cannulas]], each of them has 2 [[pedicles]], for any single [[fracture]] site in [[vertebrae]]. On the other hand, the intact [[cranial]] and [[caudal]] [[vertebrae]] are injected with dense [[cement]] and strengthened with [[Cannula|cannulas]] that have 4 [[pedicles]]. Then, with the support of [[cranial]] and [[caudal]] [[vertebrae]], the [[Kyphosis|kyphotic]] [[Osteoporosis|osteoporotic]] [[vertebra]] could be pushed toward the [[lordosis]] and rearranged in a normal position. All [[vertebral]] positions are allied by use of a cross bolt, while 2 [[Cannula|cannulas]] in fracture site deliver the [[PMMA]] cement to the collapsed [[vertebra]]; been left to [[cement]] become hard. Finally, [[Cannula|cannulas]] are replaced from the site.<ref name="pmid21629479">{{cite journal| author=Jeon TS, Kim SB, Park WK| title=Lordoplasty: an alternative technique for the treatment of osteoporotic compression fracture. | journal=Clin Orthop Surg | year= 2011 | volume= 3 | issue= 2 | pages= 161-6 | pmid=21629479 | doi=10.4055/cios.2011.3.2.161 | pmc=3095789 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21629479  }}</ref>
* The procedure consists of applying 6 [[Cannula|cannulas]], each of them has 2 [[pedicles]], for any single [[fracture]] site in [[vertebrae]]. On the other hand, the intact [[cranial]] and [[caudal]] [[vertebrae]] are injected with dense [[cement]] and strengthened with [[Cannula|cannulas]] that have 4 [[pedicles]]. Then, with the support of [[cranial]] and [[caudal]] [[vertebrae]], the [[Kyphosis|kyphotic]] [[Osteoporosis|osteoporotic]] [[vertebra]] could be pushed toward the [[lordosis]] and rearranged in a normal position. All [[vertebral]] positions are allied by use of a cross bolt, while 2 [[Cannula|cannulas]] in fracture site deliver the [[Polymethylmethacrylate|polymethylmethacrylate (PMMA)]]) ([[PMMA]]) cement to the collapsed [[vertebra]]; been left to [[cement]] become hard. Finally, [[Cannula|cannulas]] are replaced from the site.<ref name="pmid21629479">{{cite journal| author=Jeon TS, Kim SB, Park WK| title=Lordoplasty: an alternative technique for the treatment of osteoporotic compression fracture. | journal=Clin Orthop Surg | year= 2011 | volume= 3 | issue= 2 | pages= 161-6 | pmid=21629479 | doi=10.4055/cios.2011.3.2.161 | pmc=3095789 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21629479  }}</ref>


==== Indications ====
==== Indications ====

Revision as of 15:48, 19 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Surgery is not the first-line treatment option for patients with osteoporosis. Vertebroplasty, kyphoplasty, lordoplasty, and vesselplasty are the procedures that are usually reserved for patients with either pathological or osteoporotic vertebral fractures and also in patients refractory to medical therapy. Surgery options for osteoporosis are very limited. In case of hip fracture, open reduction internal fixation or total hip replacement surgery, in rare cases, are the options.

Surgery

Surgery is not the first-line treatment option for patients with osteoporosis. Vertebroplasty, kyphoplasty, lordoplasty, and vesselplasty are the procedures that are usually reserved for patients with either pathological or osteoporotic vertebral fractures and also in patients refractory to medical therapy. Surgery options for osteoporosis are very limited. In case of hip fracture, open reduction internal fixation or total hip replacement surgery, in rare cases, are the options.

Fracture site Surgery method Brief description Indications Contraindications Complications
Vertebrae Vertebroplasty
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Kyphoplasty
Lordoplasty
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Hip Open reduction internal fixation (ORIF)
Total hip replacement

Vertebroplasty

Indications

Contraindications

Complications

Kyphoplasty

  • Kyphoplasty procedure last about 1.5 hours. The patient usually needs to be observed for only a few hours, but in some cases, it may be necessary to hospitalize the patient for a day.[10]

Indications

Contraindications

Contraindications for kyphoplasty for osteoporosis include:

Complications

The main complication is cement leakage following the procedure. Other possible complications include pulmonary embolism and rarely balloon rupture.[11]

Lordoplasty

  • The most cost effective procedure to alleviate the vertebral compression fracture is lordoplasty.
  • It is commonly done following kyphoplasty, when the balloon is deflated and the vertebrae is ready to be injected with cement. It is often used as an alternative to vertebroplasty as it is more cost effective. This procedure may correct the kyphotic angle of the spinal column by 11 to 13 degrees, leading to significant pain relief in 90% of patients.[12] Lordoplasty has a much better 3 months outcome than kyphoplasty, especially in postural and anatomical deviations.[13]

Indications

Indications for lordoplasty for osteoporosis include

Contraindications

Contraindications for surgery for osteoporosis include:

Complications

Regarding that 6 cannulas are introduced in vertebrae, the most important complication of lordoplasty may be cement leakage. The cement high viscosity and wide cannulas used to inject the cement are the solutions for the problems.

Vesselplasty

The instrument used in vesselplasty - By Aspine, Via: Wikimedia.org[15]

This procedure is based on pre-injection of a "porous" material, polyethylene terephthalate, in the site of osteoporotic vertebral fracture. The main purpose is to prepare a hollow container in a place where the cement is about to injected; therefore, the cement goes through the vertebral bodies much deeper and leak back from there so much lesser than kyphoplasty or lordoplasty. The concluded vertebrae will be more stable and have less height loss during the time.[16]

Mainly, kyphoplasty procedure is to inject the cement materials in fractured vertebrae in place of the removed deflated balloon, that is the main fact of correction in vertebral osteoporotic fractures. Whereas, in some cases, the main tissue in place is not as hard as main vertebral bone tissue and may collapse after removing or deflating the balloon, such as soft tumor tissue that has led to pathological fracture, indeed. The best way to solve this problem is a modified kyphoplasty, also named vesselplasty, used to treat osteoporotic fractures. The non-stretchable balloon that is used in vesselplasty to inject the cement through, prevent the re-collapse of soft tissue around the fracture.[17]

Vesselplasty, like kyphoplasty, has safer cement delivery to the fractured bone and also less cement leakage, postoperatively.[18]

Indications

Indications for vesselplasty for osteoporosis include patients with osteoporotic vertebral fracture and also pathological vertebral fracture due to soft tumor tissues.

Contraindications

Contraindications for surgery for osteoporosis include infection, coagulation disorders, allergy to bone cement or any other material that may be used during the operation, and also any anatomical variations that would disturb the normal route of surgery, such as posterior vertebral cortical bone fusion and retroverted fragments.[3]

Complications

The complications of vesselplasty procedure include any allergic reaction to bone cement or other material that used during the operation, pneumothorax, pulmonary embolism, epidural hematoma, arterial injury, anterior spinal artery syndrome, and death.[17]

Hip fracture surgery

Hip fractures are treated by open reduction internal fixation (ORIF).

Some patients with a hip fracture who are at high risk for another fracture may benefit from a total hip replacement surgery.

References

  1. Lapras C, Mottolese C, Deruty R, Lapras C, Remond J, Duquesnel J (1989). "[Percutaneous injection of methyl-metacrylate in osteoporosis and severe vertebral osteolysis (Galibert's technic)]". Ann Chir (in French). 43 (5): 371–6. PMID 2757346.
  2. Hemama M, El Fatemi N, Gana R (2017). "Percutaneous vertebroplasty in Moroccan patients with vertebral compression fractures". Pan Afr Med J. 26: 225. doi:10.11604/pamj.2017.26.225.9872. PMC 5491720. PMID 28690739.
  3. 3.0 3.1 3.2 3.3 3.4 El-Fiki M (2016). "Vertebroplasty, Kyphoplasty, Lordoplasty, Expandable Devices, and Current Treatment of Painful Osteoporotic Vertebral Fractures". World Neurosurg. 91: 628–32. doi:10.1016/j.wneu.2016.04.016. PMID 27072339.
  4. Cotten A, Boutry N, Cortet B, Assaker R, Demondion X, Leblond D, Chastanet P, Duquesnoy B, Deramond H (1998). "Percutaneous vertebroplasty: state of the art". Radiographics. 18 (2): 311–20, discussion 320–3. doi:10.1148/radiographics.18.2.9536480. PMID 9536480.
  5. Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG (2009). "A randomized trial of vertebroplasty for osteoporotic spinal fractures". N. Engl. J. Med. 361 (6): 569–79. doi:10.1056/NEJMoa0900563. PMC 2930487. PMID 19657122.
  6. 6.0 6.1 Hargunani R, Le Corroller T, Khashoggi K, Murphy KJ, Munk PL (2011). "Percutaneous vertebral augmentation: the status of vertebroplasty and current controversies". Semin Musculoskelet Radiol. 15 (2): 117–24. doi:10.1055/s-0031-1275594. PMID 21500131.
  7. Al-Nakshabandi NA (2011). "Percutaneous vertebroplasty complications". Ann Saudi Med. 31 (3): 294–7. doi:10.4103/0256-4947.81542. PMC 3119972. PMID 21623061.
  8. Lee JH, Lee DO, Lee JH, Lee HS (2014). "Comparison of radiological and clinical results of balloon kyphoplasty according to anterior height loss in the osteoporotic vertebral fracture". Spine J. 14 (10): 2281–9. doi:10.1016/j.spinee.2014.01.028. PMID 24462536.
  9. Kim KH, Kuh SU, Chin DK, Jin BH, Kim KS, Yoon YS, Cho YE (2012). "Kyphoplasty versus vertebroplasty: restoration of vertebral body height and correction of kyphotic deformity with special attention to the shape of the fractured vertebrae". J Spinal Disord Tech. 25 (6): 338–44. doi:10.1097/BSD.0b013e318224a6e6. PMID 21705918.
  10. "Balloon kyphoplasty: an evidence-based analysis". Ont Health Technol Assess Ser. 4 (12): 1–45. 2004. PMC 3387743. PMID 23074451.
  11. Ledlie JT, Renfro M (2003). "Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels". J. Neurosurg. 98 (1 Suppl): 36–42. PMID 12546386.
  12. Hoppe S, Budmiger M, Bissig P, Aghayev E, Benneker LM (2016). "Lordoplasty: midterm outcome of an alternative augmentation technique for vertebral fractures". J Neurosurg Spine. 24 (6): 922–7. doi:10.3171/2015.10.SPINE151016. PMID 26895528.
  13. Kim SB, Jeon TS, Lee WS, Roh JY, Kim JY, Park WK (2010). "Comparison of kyphoplasty and lordoplasty in the treatment of osteoporotic vertebral compression fracture". Asian Spine J. 4 (2): 102–8. doi:10.4184/asj.2010.4.2.102. PMC 2996621. PMID 21165313.
  14. Jeon TS, Kim SB, Park WK (2011). "Lordoplasty: an alternative technique for the treatment of osteoporotic compression fracture". Clin Orthop Surg. 3 (2): 161–6. doi:10.4055/cios.2011.3.2.161. PMC 3095789. PMID 21629479.
  15. Own work, CC BY-SA 3.0, <https://commons.wikimedia.org/w/index.php?curid=7614604>
  16. Flors L, Lonjedo E, Leiva-Salinas C, Martí-Bonmatí L, Martínez-Rodrigo JJ, López-Pérez E; et al. (2009). "Vesselplasty: a new technical approach to treat symptomatic vertebral compression fractures". AJR Am J Roentgenol. 193 (1): 218–26. doi:10.2214/AJR.08.1503. PMID 19542417.
  17. 17.0 17.1 Klingler JH, Sircar R, Deininger MH, Scheiwe C, Kogias E, Hubbe U (2013). "Vesselplasty: a new minimally invasive approach to treat pathological vertebral fractures in selected tumor patients - preliminary results". Rofo. 185 (4): 340–50. doi:10.1055/s-0032-1330443. PMID 23471680.
  18. Bouza C, López-Cuadrado T, Cediel P, Saz-Parkinson Z, Amate JM (2009). "Balloon kyphoplasty in malignant spinal fractures: a systematic review and meta-analysis". BMC Palliat Care. 8: 12. doi:10.1186/1472-684X-8-12. PMC 2746801. PMID 19740423.

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