Comparison of percutaneous balloon dilation kyphoplasty and percutaneous vertebroplasty in treatment for thoracolumbar vertebral compression fractures

By London Spine

OBJECTIVE: Osteoporotic vertebral compression fractures (OVCFs) are common diseases in elderly patients and can cause serious thoracolumbar compression fractures. For patients with such fractures, conservative treatment, nail-stick fixation, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) can be selected as treatment methods. In this study, we aimed to compare the clinical efficacy of PKP and PVP in the treatment of osteoporotic thoracolumbar vertebral compression fractures. PATIENTS AND METHODS: One hundred and sixty-one patients with single-stage osteoporotic vertebral compression fracture in thoracolumbar were enrolled and divided into two groups, percutaneous balloon kyphoplasty (PKP group) and percutaneous vertebroplasty (PVP group). The subjects were selected from patients who were once treated in our hospital from January 2012 to December 2015. There were 91 cases in PKP group and 70 cases in PVP group. The hospitalization time, operation-related index (including blood loss, bone cement injection, surgical time and number of intraoperative fluoroscopy), bedrest time, visual analog pain score (VAS), Cobb’s angle, vertebral anterior height, Oswestry Disability Index (ODI) dysfunction index and quality of life score were compared to evaluate the clinical effects of the two treatment methods. RESULTS: There were significant differences in hospitalization time, operation-related index (including blood loss, bone cement injection, operation time, number of intraoperative fluoroscopies) and bed rest time between the two groups. Compared with the patients in PVP group, patients of PKP group had less hospital stay (p<0.001), less time in bed (p<0.05) and less intraoperative blood loss (p<0.05). In addition, the number of times we used intraoperative fluoroscopy was significantly different between the two groups (p<0.001). However, the operation time of PKP group was longer than that of PVP group, and the amount of intraoperative cement injection was more than that of PVP group (p<0.05). After treatment, VAS scores in both groups were dramatically decreased, of which the scores in PKP group were markedly lower than that in PVP group and the difference was statistically significant (p<0.05). The changes of Cobb's angle, the height of anterior vertebral body and ODI scores in PKP group were noticeably better than PVP group (p<0.05). There were 5 cases occurring intraoperative cement leakage in PKP group and 12 cases in PVP group, indicating that the former is relatively better (p<0.001). However, no significant difference was found between the two groups in the occurrence of secondary vertebral fractures at 1 month, 3 months, 6 months and 12 months after treatment (p>0.05). CONCLUSIONS: The clinical effects of both PKP and PVP in the treatment of osteoporotic vertebral compression fractures are good, of which the reductive and analgesic effect of PKP is superior to that of PVP and the former has less leakage of cement, higher safety and fewer complications

Expressions of IL-1? and MMP-9 in degenerated lumbar disc tissues and their clinical significance.

By London Spine
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Expressions of IL-1α and MMP-9 in degenerated lumbar disc tissues and their clinical significance.

Eur Rev Med Pharmacol Sci. 2017 Sep;21(18):4007-4013

Authors: Li PB, Tang WJ, Wang K, Zou K, Che B

Abstract
OBJECTIVE: To observe the expression levels of interleukin-1α (IL-1α) and matrix metalloproteinase-9 (MMP-9) in degenerated lumbar disc tissues and to investigate their clinical significance.
PATIENTS AND METHODS: Fifty patients with lumbar disc degeneration received the operative treatment were divided into three groups according to the magnetic resonance imaging (MRI) results: protrusion group, extrusion group, and free group. The degenerated intervertebral disc tissues were taken, and the normal intervertebral disc tissues of 20 patients received the operative treatment due to lumbar bursting fracture, and were selected as the control group. The bone mineral densities of all patients were measured. The mRNA and protein expression levels of MMP-9 and IL-1α were detected via Real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA), respectively.
RESULTS: The bone mass of patients with lumbar disc degeneration was significantly decreased compared with that of the control group, and the bone mass was decreased more significantly in a free group than that in protrusion group. The mRNA and protein levels in IL-1α and MMP-9 of patients with lumbar disc degeneration were significantly increased compared with those in control group; the mRNA and protein levels in IL-1α and MMP-9 of extrusion group and free group were significantly higher than those in protrusion group, and the mRNA and protein levels in IL-1α and MMP-9 of free group were significantly higher than those in extrusion group.
CONCLUSIONS: The levels of IL-1α and MMP-9 in degenerated lumbar disc tissues are higher than normal levels, and the increasing levels are positively correlated with the disease condition.

PMID: 29028103 [PubMed – in process]

The use of targeted percutaneous laser disc decompression under the guidance of puncture-radiating pain leads to better short-term responses in lumbar disc herniation

By London Spine

OBJECTIVE: Traditional percutaneous laser disc decompression (PLDD) eliminates nucleus pulposus in the center of lumbar discs. Targeted PLDD is an alternative technique that involves elimination and decompression of the target area located 5-8 mm in the front of the herniated disc. We aimed to compare the efficacy of targeted PLDD with traditional PLDD in the treatment of lumbar disc herniation and evaluate the usefulness of guidance by puncture-radiating pain on clinical outcomes of PLDD. PATIENTS AND METHODS: We treated 61 patients with lumbar disc herniation. Patients were stratified into control group, which included patients who underwent traditional PLDD, and study group in patients underwent targeted PLDD. Clinical outcomes and efficacies were evaluated at different time points using the visual analog scale (VAS) and modified MacNab criteria. RESULTS: Patients in the study group demonstrated significantly greater decreases in the VAS scores compared with those in control group. These differences were observed on Day 3, and 1 and 3 months after the treatment. Further, VAS scores were markedly lower in the patients whose treatment was guided by the puncture-radiating pain. Thus, at 1 month after the operation, 64.1% of those patients showed excellent or good outcomes based on MacNab criteria, which was almost twice the percentage seen in patients who did not experience the puncture-radiating pain (36.4%). CONCLUSIONS: Targeted PLDD is an effective, minimally invasive, and safe technique for lumbar disc herniation, and this technique achieves better short-term postsurgical outcomes than traditional PLDD. Puncture-radiating pain is an important prognostic indicator for better short-term responses to the treatment