Navigation techniques assisted kyphoplasty for the treatment of osteoporotic spinal compression fracture

Department of Orthopeadics, Beijing Hospital, Beijing 100730, China.
Chinese medical journal (Impact Factor: 1.05). 05/2009; 122(8):987-9. DOI: 10.3760/cma.j.issn.0366-6999.2009.08.020
Source: PubMed
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    ABSTRACT: Reports of applying cervical pedicle screw (CPS) system in the posterior cervical spine surgeries are limited because of its inherent risk of neurovascular injury. The clinical results of cervical spine instability treated with CPS system were retrospectively analyzed, and the clinical efficacy and safety of this management were evaluated. Twenty-five patients with cervical spine instability undergoing posterior C3 - C7 single/double door laminoplasty and free-hand CPS fixation as well as graft fusion were investigated; of whom, 3 were due to trauma, and 22 degenerative cervical pathogenesis. One hundred and fifty in total, CPSs were implanted in 5 cervical segments for 1 patient, 4 for 2, 3 for 18, and 2 for 4. Japanese Orthopaedic Association (JOA) score and its improvement rate, neck disability index (NDI), segmental stability, pedicle cortex perforation rate and other complication-associated parameters were assessed. The average follow-up was 16.6 (6 - 30) months. Compared with pre-operative values, JOA score improved by 4.10 +/- 0.84 points on average (P < 0.05) at 6 months post operation, with a mean improvement rate of 61%. While the pre-operative and 6-month post-operative NDI were 32.96 +/- 6.13 and 16.84 +/- 4.40 (P < 0.05), respectively. At 6-month post-operation and the final follow-up, fused segments were stable. Pedicle cortex perforation rate was 8.0%, with no neurovascular complications observed. Anatomizing the pre-operative radiographic data facilitates the precise operative design prior to surgery; and CPS system is capable of offering safe and satisfying outcomes in the management of cervical spine instability.
    Chinese medical journal 09/2009; 122(17):1985-9. DOI:10.3760/cma.j.issn.0366-6999.2009.17.005 · 1.05 Impact Factor
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    ABSTRACT: Increasing the successful puncture rate of the percutaneous vertebroplasty (PVP) in thoracic vertebral compression fracture by unilateral puncture is a problem that spinal surgeons are trying to solve. The aim of this study was to assess the value of preoperative MRI imaging measurements for PVP using a unilateral puncture. We performed a retrospective, comparative study of two groups of osteoporotic thoracic vertebral compression fracture patients who had received a PVP using a unilateral puncture. Group A (22 patients with 27 valid vertebrae) received PVP with a unilateral puncture between October 2005 and February 2007. Group B (18 patients with 24 valid vertebrae) received a routine MRI imaging measurements before a PVP between March 2007 and June 2008. We determined the target area to puncture based on the preoperative MRI cross-sectional images of vertebra. The PVP used a simultaneous puncture through a unilateral posterolateral approach, so the vertical distance from the point of skin puncture to the posterior median line, as well as the puncture angle, were measured using the MRI. The results were used to guide the PVP operation. We compared these two groups based on the average time for a single vertebra operation, the achievement ratio of puncture, and the incidence of bone cement leakage during surgery. The mean follow-up period was 14.2 months (range 12 - 23 months). The pre- and post-operative visual analogue score (VAS) (3 and 12 months post-surgery), the variation of Oswestry disability index (ODI) and the incidence of long-term complications were also compared. The average time of a single vertebra operation in groups A and B were (34.7 ± 5.4) and (23.3 ± 4.2) minutes, respectively. In groups A and B, the success rates of puncture were 74.1% and 91.7%, respectively. Postoperative reduction of the average VAS scores in groups A and B at 3 and 12 months post-surgery were 5.8 ± 2.1, 6.1 ± 1.8, 6.1 ± 2.0, 6.2 ± 1.6, respectively. However, the ODI increase was 41.6% ± 5.7%, 40.6% ± 6.0%, 46.3% ± 5.2%, 46.1% ± 6.7%. Paired t test evaluation of the values above showed a significant difference in the time of single-vertebra operation and the success rates between groups A and B (P < 0.05), but no significant difference was seen in the reduction of VAS scores and ODI (P > 0.05). There was no statistically significant difference in the complication rate between the two groups. A preoperative MRI measurement effectively reduced the time of PVP with a unilateral puncture, which improved the success rate of the puncture without an additional risk of operation related complication.
    Chinese medical journal 11/2010; 123(21):2983-8. DOI:10.3760/cma.j.issn.0366-6999.2010.21.006 · 1.05 Impact Factor
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    ABSTRACT: Balloon kyphoplasty is a common treatment for osteoporotic and pathologic compression fractures. Advantages include minimal tissue disruption, quick recovery, pain relief, and in some cases prevention of progressive sagittal deformity. The benefit of image-based navigation in kyphoplasty has not been established. The goal of this study was to determine whether there is a difference between fluoroscopy-guided balloon kyphoplasty and 3-dimensional image-based navigation in terms of needle malposition rate, cement leakage rate, and radiation exposure time. The authors compared navigated and nonnavigated needle placement in 30 balloon kyphoplasty procedures (47 levels). Intraoperative 3-dimensional image-based navigation was used for needle placement in 21 cases (36 levels); conventional 2-dimensional fluoroscopy was used in the other 9 cases (11 levels). The 2 groups were compared for rates of needle malposition and cement leakage as well as radiation exposure time. Three of 11 (27%) nonnavigated cases were complicated by a malpositioned needle, and 2 of these had to be repositioned. The navigated group had a significantly lower malposition rate (1 of 36; 3%; P=.04). The overall rate of cement leakage was also similar in both groups (P=.29). Radiation exposure time was similar in both groups (navigated, 98 s/level; nonnavigated, 125 s/level; P=.10). Navigated kyphoplasty procedures did not differ significantly from nonnavigated procedures except in terms of needle malposition rate, where navigation may have decreased the need for needle repositioning. [Orthopedics. 2015; 38(1):17-23.]. Copyright 2015, SLACK Incorporated.
    Orthopedics 01/2015; 38(1):17-23. DOI:10.3928/01477447-20150105-51 · 0.96 Impact Factor