Cement Directed Kyphoplasty Reduces Cement Leakage as Compared With Vertebroplasty: Results of A Controlled, Randomized Trial
STUDY DESIGN.A novel randomized, controlled, unblinded clinical trial comparing 2 procedural interventions for painful osteoporotic vertebral compression fractures. OBJECTIVE.The primary study objective was to evaluate cement leakage for a cement directed kyphoplasty system (CDKS) with anteriorly bi...
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| Veröffentlicht in: | Spine (Philadelphia, Pa. 1976) Pa. 1976), 2013-09, Vol.38 (20), p.1730-1736 |
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| container_title | Spine (Philadelphia, Pa. 1976) |
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| creator | Vogl, Thomas J. Pflugmacher, Robert Hierholzer, Johannes Stender, Gerd Gounis, Matthew Wakhloo, Ajay Fiebig, Christian Hammerstingl, Renate |
| description | STUDY DESIGN.A novel randomized, controlled, unblinded clinical trial comparing 2 procedural interventions for painful osteoporotic vertebral compression fractures.
OBJECTIVE.The primary study objective was to evaluate cement leakage for a cement directed kyphoplasty system (CDKS) with anteriorly biased cement flow and vertebroplasty. The secondary study objective was to compare adjacent level fracture rates and vertebral body height for these 2 intervention methods.
SUMMARY OF BACKGROUND DATA.Cement leakage remains a significant clinical problem associated with vertebroplasty and kyphoplasty procedures. Uncontrolled cement flow in the posterior direction can result in leakage into the vertebral veins or spinal canal, leading to potentially serious clinical complications.
METHODS.Seventy-seven patients with painful osteoporotic vertebral compression fractures were enrolled. Patients were randomized 2:1 for treatment with CDKS (49 patients, 65 levels) or vertebroplasty (28 patients, 39 levels). Cement leakage was evaluated from radiographs and computed tomographic scans. Three- and 12-month follow-ups included additional radiographs and computed tomographic scans to assess changes in vertebral body height and the incidence of new fractures.
RESULTS.Treatment with CDKS significantly reduced the number of levels with leaks and the total number of leaks per level, as compared with vertebroplasty (P = 0.0132 and P = 0.0012, respectively). Significantly, fewer lateral cortical and spinal canal leaks (posterior leaks) occurred in the CDKS group (P = 0.0050, P = 0.02260, respectively). Three adjacent level fractures occurred in the vertebroplasty group, as compared with 2 in the CDKS group. Vertebral body height maintenance was equivalent.
CONCLUSION.Cement directed kyphoplasty effectively reduces posterior cement leakage, reducing the risk of leakage related complications.Level of Evidence2 |
| doi_str_mv | 10.1097/BRS.0b013e3182a14d15 |
| format | Article |
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OBJECTIVE.The primary study objective was to evaluate cement leakage for a cement directed kyphoplasty system (CDKS) with anteriorly biased cement flow and vertebroplasty. The secondary study objective was to compare adjacent level fracture rates and vertebral body height for these 2 intervention methods.
SUMMARY OF BACKGROUND DATA.Cement leakage remains a significant clinical problem associated with vertebroplasty and kyphoplasty procedures. Uncontrolled cement flow in the posterior direction can result in leakage into the vertebral veins or spinal canal, leading to potentially serious clinical complications.
METHODS.Seventy-seven patients with painful osteoporotic vertebral compression fractures were enrolled. Patients were randomized 2:1 for treatment with CDKS (49 patients, 65 levels) or vertebroplasty (28 patients, 39 levels). Cement leakage was evaluated from radiographs and computed tomographic scans. Three- and 12-month follow-ups included additional radiographs and computed tomographic scans to assess changes in vertebral body height and the incidence of new fractures.
RESULTS.Treatment with CDKS significantly reduced the number of levels with leaks and the total number of leaks per level, as compared with vertebroplasty (P = 0.0132 and P = 0.0012, respectively). Significantly, fewer lateral cortical and spinal canal leaks (posterior leaks) occurred in the CDKS group (P = 0.0050, P = 0.02260, respectively). Three adjacent level fractures occurred in the vertebroplasty group, as compared with 2 in the CDKS group. Vertebral body height maintenance was equivalent.
CONCLUSION.Cement directed kyphoplasty effectively reduces posterior cement leakage, reducing the risk of leakage related complications.Level of Evidence2</description><identifier>ISSN: 0362-2436</identifier><identifier>EISSN: 1528-1159</identifier><identifier>DOI: 10.1097/BRS.0b013e3182a14d15</identifier><identifier>PMID: 23804157</identifier><language>eng</language><publisher>United States: by Lippincott Williams & Wilkins</publisher><subject>Aged ; Aged, 80 and over ; Bone Cements - adverse effects ; Bone Cements - therapeutic use ; Extravasation of Diagnostic and Therapeutic Materials - diagnostic imaging ; Extravasation of Diagnostic and Therapeutic Materials - etiology ; Female ; Follow-Up Studies ; Fractures, Compression - surgery ; Humans ; Kyphoplasty - adverse effects ; Kyphoplasty - methods ; Male ; Middle Aged ; Osteoporotic Fractures - surgery ; Postoperative Complications - diagnostic imaging ; Postoperative Complications - etiology ; Prospective Studies ; Spinal Fractures - surgery ; Spine - diagnostic imaging ; Spine - surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Vertebroplasty - adverse effects ; Vertebroplasty - methods</subject><ispartof>Spine (Philadelphia, Pa. 1976), 2013-09, Vol.38 (20), p.1730-1736</ispartof><rights>2013 by Lippincott Williams & Wilkins</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3055-324b741d51d845a04a7061fdb6640a98988bd7e36ce913f1ed301382356774823</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23804157$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vogl, Thomas J.</creatorcontrib><creatorcontrib>Pflugmacher, Robert</creatorcontrib><creatorcontrib>Hierholzer, Johannes</creatorcontrib><creatorcontrib>Stender, Gerd</creatorcontrib><creatorcontrib>Gounis, Matthew</creatorcontrib><creatorcontrib>Wakhloo, Ajay</creatorcontrib><creatorcontrib>Fiebig, Christian</creatorcontrib><creatorcontrib>Hammerstingl, Renate</creatorcontrib><title>Cement Directed Kyphoplasty Reduces Cement Leakage as Compared With Vertebroplasty: Results of A Controlled, Randomized Trial</title><title>Spine (Philadelphia, Pa. 1976)</title><addtitle>Spine (Phila Pa 1976)</addtitle><description>STUDY DESIGN.A novel randomized, controlled, unblinded clinical trial comparing 2 procedural interventions for painful osteoporotic vertebral compression fractures.
OBJECTIVE.The primary study objective was to evaluate cement leakage for a cement directed kyphoplasty system (CDKS) with anteriorly biased cement flow and vertebroplasty. The secondary study objective was to compare adjacent level fracture rates and vertebral body height for these 2 intervention methods.
SUMMARY OF BACKGROUND DATA.Cement leakage remains a significant clinical problem associated with vertebroplasty and kyphoplasty procedures. Uncontrolled cement flow in the posterior direction can result in leakage into the vertebral veins or spinal canal, leading to potentially serious clinical complications.
METHODS.Seventy-seven patients with painful osteoporotic vertebral compression fractures were enrolled. Patients were randomized 2:1 for treatment with CDKS (49 patients, 65 levels) or vertebroplasty (28 patients, 39 levels). Cement leakage was evaluated from radiographs and computed tomographic scans. Three- and 12-month follow-ups included additional radiographs and computed tomographic scans to assess changes in vertebral body height and the incidence of new fractures.
RESULTS.Treatment with CDKS significantly reduced the number of levels with leaks and the total number of leaks per level, as compared with vertebroplasty (P = 0.0132 and P = 0.0012, respectively). Significantly, fewer lateral cortical and spinal canal leaks (posterior leaks) occurred in the CDKS group (P = 0.0050, P = 0.02260, respectively). Three adjacent level fractures occurred in the vertebroplasty group, as compared with 2 in the CDKS group. Vertebral body height maintenance was equivalent.
CONCLUSION.Cement directed kyphoplasty effectively reduces posterior cement leakage, reducing the risk of leakage related complications.Level of Evidence2</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bone Cements - adverse effects</subject><subject>Bone Cements - therapeutic use</subject><subject>Extravasation of Diagnostic and Therapeutic Materials - diagnostic imaging</subject><subject>Extravasation of Diagnostic and Therapeutic Materials - etiology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fractures, Compression - surgery</subject><subject>Humans</subject><subject>Kyphoplasty - adverse effects</subject><subject>Kyphoplasty - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Osteoporotic Fractures - surgery</subject><subject>Postoperative Complications - diagnostic imaging</subject><subject>Postoperative Complications - etiology</subject><subject>Prospective Studies</subject><subject>Spinal Fractures - surgery</subject><subject>Spine - diagnostic imaging</subject><subject>Spine - surgery</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><subject>Vertebroplasty - adverse effects</subject><subject>Vertebroplasty - methods</subject><issn>0362-2436</issn><issn>1528-1159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE2LFDEQQIMo7rj6D0Ry9GCvqc5ne9sdP3FAGFc9NulOtdNuetImaZYR_O9GZvTgwVNB8V4VPEIeA7sA1ujnV9uPF6xjwJGDqS0IB_IOWYGsTQUgm7tkxbiqq1pwdUYepPSNMaY4NPfJWc0NEyD1ivxc44T7TF-OEfuMjr4_zLswe5vygW7RLT0memI2aG_sV6S2bMI021jwL2Pe0c8YM3bxpL0oXlp8TjQM9LKg-xyD9-ie0a3duzCNP4p4HUfrH5J7g_UJH53mOfn0-tX1-m21-fDm3fpyU_WcSVnxWnRagJPgjJCWCauZgsF1SglmG9MY0zmNXPXYAB8AHS9dTM2l0lqUeU6eHu_OMXxfMOV2GlOP3ts9hiW1IHitwGhtCiqOaB9DShGHdo7jZOOhBdb-Dt-W8O2_4Yv25PRh6SZ0f6U_pQtgjsBt8BljuvHLLcZ2h9bn3f9v_wJXIZFF</recordid><startdate>20130915</startdate><enddate>20130915</enddate><creator>Vogl, Thomas J.</creator><creator>Pflugmacher, Robert</creator><creator>Hierholzer, Johannes</creator><creator>Stender, Gerd</creator><creator>Gounis, Matthew</creator><creator>Wakhloo, Ajay</creator><creator>Fiebig, Christian</creator><creator>Hammerstingl, Renate</creator><general>by Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130915</creationdate><title>Cement Directed Kyphoplasty Reduces Cement Leakage as Compared With Vertebroplasty: Results of A Controlled, Randomized Trial</title><author>Vogl, Thomas J. ; Pflugmacher, Robert ; Hierholzer, Johannes ; Stender, Gerd ; Gounis, Matthew ; Wakhloo, Ajay ; Fiebig, Christian ; Hammerstingl, Renate</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3055-324b741d51d845a04a7061fdb6640a98988bd7e36ce913f1ed301382356774823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bone Cements - adverse effects</topic><topic>Bone Cements - therapeutic use</topic><topic>Extravasation of Diagnostic and Therapeutic Materials - diagnostic imaging</topic><topic>Extravasation of Diagnostic and Therapeutic Materials - etiology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fractures, Compression - surgery</topic><topic>Humans</topic><topic>Kyphoplasty - adverse effects</topic><topic>Kyphoplasty - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Osteoporotic Fractures - surgery</topic><topic>Postoperative Complications - diagnostic imaging</topic><topic>Postoperative Complications - etiology</topic><topic>Prospective Studies</topic><topic>Spinal Fractures - surgery</topic><topic>Spine - diagnostic imaging</topic><topic>Spine - surgery</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><topic>Vertebroplasty - adverse effects</topic><topic>Vertebroplasty - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vogl, Thomas J.</creatorcontrib><creatorcontrib>Pflugmacher, Robert</creatorcontrib><creatorcontrib>Hierholzer, Johannes</creatorcontrib><creatorcontrib>Stender, Gerd</creatorcontrib><creatorcontrib>Gounis, Matthew</creatorcontrib><creatorcontrib>Wakhloo, Ajay</creatorcontrib><creatorcontrib>Fiebig, Christian</creatorcontrib><creatorcontrib>Hammerstingl, Renate</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vogl, Thomas J.</au><au>Pflugmacher, Robert</au><au>Hierholzer, Johannes</au><au>Stender, Gerd</au><au>Gounis, Matthew</au><au>Wakhloo, Ajay</au><au>Fiebig, Christian</au><au>Hammerstingl, Renate</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cement Directed Kyphoplasty Reduces Cement Leakage as Compared With Vertebroplasty: Results of A Controlled, Randomized Trial</atitle><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle><addtitle>Spine (Phila Pa 1976)</addtitle><date>2013-09-15</date><risdate>2013</risdate><volume>38</volume><issue>20</issue><spage>1730</spage><epage>1736</epage><pages>1730-1736</pages><issn>0362-2436</issn><eissn>1528-1159</eissn><abstract>STUDY DESIGN.A novel randomized, controlled, unblinded clinical trial comparing 2 procedural interventions for painful osteoporotic vertebral compression fractures.
OBJECTIVE.The primary study objective was to evaluate cement leakage for a cement directed kyphoplasty system (CDKS) with anteriorly biased cement flow and vertebroplasty. The secondary study objective was to compare adjacent level fracture rates and vertebral body height for these 2 intervention methods.
SUMMARY OF BACKGROUND DATA.Cement leakage remains a significant clinical problem associated with vertebroplasty and kyphoplasty procedures. Uncontrolled cement flow in the posterior direction can result in leakage into the vertebral veins or spinal canal, leading to potentially serious clinical complications.
METHODS.Seventy-seven patients with painful osteoporotic vertebral compression fractures were enrolled. Patients were randomized 2:1 for treatment with CDKS (49 patients, 65 levels) or vertebroplasty (28 patients, 39 levels). Cement leakage was evaluated from radiographs and computed tomographic scans. Three- and 12-month follow-ups included additional radiographs and computed tomographic scans to assess changes in vertebral body height and the incidence of new fractures.
RESULTS.Treatment with CDKS significantly reduced the number of levels with leaks and the total number of leaks per level, as compared with vertebroplasty (P = 0.0132 and P = 0.0012, respectively). Significantly, fewer lateral cortical and spinal canal leaks (posterior leaks) occurred in the CDKS group (P = 0.0050, P = 0.02260, respectively). Three adjacent level fractures occurred in the vertebroplasty group, as compared with 2 in the CDKS group. Vertebral body height maintenance was equivalent.
CONCLUSION.Cement directed kyphoplasty effectively reduces posterior cement leakage, reducing the risk of leakage related complications.Level of Evidence2</abstract><cop>United States</cop><pub>by Lippincott Williams & Wilkins</pub><pmid>23804157</pmid><doi>10.1097/BRS.0b013e3182a14d15</doi><tpages>7</tpages></addata></record> |
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| ispartof | Spine (Philadelphia, Pa. 1976), 2013-09, Vol.38 (20), p.1730-1736 |
| issn | 0362-2436 1528-1159 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Aged Aged, 80 and over Bone Cements - adverse effects Bone Cements - therapeutic use Extravasation of Diagnostic and Therapeutic Materials - diagnostic imaging Extravasation of Diagnostic and Therapeutic Materials - etiology Female Follow-Up Studies Fractures, Compression - surgery Humans Kyphoplasty - adverse effects Kyphoplasty - methods Male Middle Aged Osteoporotic Fractures - surgery Postoperative Complications - diagnostic imaging Postoperative Complications - etiology Prospective Studies Spinal Fractures - surgery Spine - diagnostic imaging Spine - surgery Tomography, X-Ray Computed Treatment Outcome Vertebroplasty - adverse effects Vertebroplasty - methods |
| title | Cement Directed Kyphoplasty Reduces Cement Leakage as Compared With Vertebroplasty: Results of A Controlled, Randomized Trial |
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