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Preliminary results for the treatment of a pain-causing osteoporotic vertebral compression fracture with a Sky Bone Expander.

Liu JB, Tang XM, Xu NW, Bao HT - Korean J Radiol (2008 Sep-Oct)

Bottom Line: Following the expansion, the Sky Bone Expander was contracted and removed, resulting in a cavity to be filled with bone cement.The Cobb angle improved from 18.5 +/- 8.2 degrees preoperatively to 9.2 +/- 4.0 degrees postoperatively (p < 0.01).The Visual Anabog Scale scores decreased from 7.7 +/- 1.8 points preoperatively to 3.1 +/- 2.0, 2.9 +/- 1.7, 2.6 +/- 1.5 and 2.9 +/- 11.3 after 1 day, 1 week, 1 month and 3 months after the operation, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Central Laboratory, Changzhou No 2 Hospital, Changzhou, China. jsczljb@yahoo.com.cn

ABSTRACT

Objective: Vertebral compression fractures (VCFs) are common complications of osteoporosis. The expansion of VCFs with a Sky Bone Expander is a new procedure which improves kyphotic deformities and decreases pain associated with VCFs. The purpose of this study was to investigate the preliminary results for the treatment of painful osteoporotic VCFs with a Sky Bone Expander.

Materials and methods: Twenty-six patients with pain-causing VCFs were treated with a Sky Bone Expander. This operation involved the percutaneous insertion of the Sky Bone Expander into a fractured vertebral body transpedicularly. Following the expansion, the Sky Bone Expander was contracted and removed, resulting in a cavity to be filled with bone cement. All fractures were analyzed for improvement in sagittal alignment. Clinical complications, pain relief and ambulation status were evaluated 1 day, 1 week, 1 month, and 3 months after the operation.

Results: Twenty-four hours after the operation, all the patients treated experienced some degree of pain relief. In addition, no postoperative neurologic complications were noted. The average operative time was 42.4 +/- 15.5 min per vertebra. Moreover, an average cement volume of 3.5 mL (range, 2.5 +/- 5.0 mL) was injected per vertebra. The average anterior height was 18.4 +/- 5.1 mm preoperatively and 20.5 +/- 5.3 mm postoperatively (p < 0.01). Furthermore, the average midline height was 15.5 +/- 5.2 mm preoperatively and 18.9 +/- 4.0 mm postoperatively (p < 0.01). The Cobb angle improved from 18.5 +/- 8.2 degrees preoperatively to 9.2 +/- 4.0 degrees postoperatively (p < 0.01). The Visual Anabog Scale scores decreased from 7.7 +/- 1.8 points preoperatively to 3.1 +/- 2.0, 2.9 +/- 1.7, 2.6 +/- 1.5 and 2.9 +/- 11.3 after 1 day, 1 week, 1 month and 3 months after the operation, respectively. Cement extrusion was observed in four patients without any neurologic symptoms.

Conclusion: As a result of this study, we can postulate that the expansion of compressed vetrebra with a Sky Bone Expander is a safe and minimally invasive procedure resulting in the restoration of vertebral body height and the relief of pain associated with VCFs.

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Configurations of a Sky-bone expander.A. Before expansionB. After full expansion
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Figure 1: Configurations of a Sky-bone expander.A. Before expansionB. After full expansion

Mentions: The Sky Bone Expander is a device made of a highly rigid polymeric material. In the contracted configuration, it is 4 or 5 mm in diameter and can be inserted via a pedicle cannula into the vertebral body. In turn, its fully expanded shape is a trapezoid or cubic configuration with a maximal diameter of 14 or 16 mm. This shape elevates the endplates restoring the vertebral body height (Fig. 1). The procedures were carried out as described previously (2-4). In brief, all procedures were performed in the operation room with the patient positioned in the prone position with the spine extended. The skin and subcutaneous tissues were locally anesthetized with 1% lidocaine. The proper placement of the Sky Bone Expander involved identifying the transpedicular entry point into the vertebral body using a guide pin and with the aid of fluoroscopy. A hand-mounted drill bit was then used to ream a corridor for insertion of the device. With the guide of a lateral radiograph, the radiopaque polymer tube was ideally situated under the collapsed endplate (Fig. 2A). The creation of the cavity for injection of bone cement was achieved by radial expansion (Fig. 2B), followed by the contraction and removal of the SKY Bone Expander. Furthermore, with the aid of continuous fluoroscopic guidance, bone cement was injected into the created cavity through the implant core (Figs. 2C, D). Cement filling was stopped when the cement mantle reached two thirds of the way back to the posterior vertebral body cortex or when cement extrusion was observed on the lateral fluoroscopic images. The same procedure was repeated on the opposite side of the vertebra if necessary. A single procedure can treat 1-4 vertebral levels, with an average bone cement injection volume of 3.5 mL (range, 2.5-5.0 mL) per vertebrate level.


Preliminary results for the treatment of a pain-causing osteoporotic vertebral compression fracture with a Sky Bone Expander.

Liu JB, Tang XM, Xu NW, Bao HT - Korean J Radiol (2008 Sep-Oct)

Configurations of a Sky-bone expander.A. Before expansionB. After full expansion
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627204&req=5

Figure 1: Configurations of a Sky-bone expander.A. Before expansionB. After full expansion
Mentions: The Sky Bone Expander is a device made of a highly rigid polymeric material. In the contracted configuration, it is 4 or 5 mm in diameter and can be inserted via a pedicle cannula into the vertebral body. In turn, its fully expanded shape is a trapezoid or cubic configuration with a maximal diameter of 14 or 16 mm. This shape elevates the endplates restoring the vertebral body height (Fig. 1). The procedures were carried out as described previously (2-4). In brief, all procedures were performed in the operation room with the patient positioned in the prone position with the spine extended. The skin and subcutaneous tissues were locally anesthetized with 1% lidocaine. The proper placement of the Sky Bone Expander involved identifying the transpedicular entry point into the vertebral body using a guide pin and with the aid of fluoroscopy. A hand-mounted drill bit was then used to ream a corridor for insertion of the device. With the guide of a lateral radiograph, the radiopaque polymer tube was ideally situated under the collapsed endplate (Fig. 2A). The creation of the cavity for injection of bone cement was achieved by radial expansion (Fig. 2B), followed by the contraction and removal of the SKY Bone Expander. Furthermore, with the aid of continuous fluoroscopic guidance, bone cement was injected into the created cavity through the implant core (Figs. 2C, D). Cement filling was stopped when the cement mantle reached two thirds of the way back to the posterior vertebral body cortex or when cement extrusion was observed on the lateral fluoroscopic images. The same procedure was repeated on the opposite side of the vertebra if necessary. A single procedure can treat 1-4 vertebral levels, with an average bone cement injection volume of 3.5 mL (range, 2.5-5.0 mL) per vertebrate level.

Bottom Line: Following the expansion, the Sky Bone Expander was contracted and removed, resulting in a cavity to be filled with bone cement.The Cobb angle improved from 18.5 +/- 8.2 degrees preoperatively to 9.2 +/- 4.0 degrees postoperatively (p < 0.01).The Visual Anabog Scale scores decreased from 7.7 +/- 1.8 points preoperatively to 3.1 +/- 2.0, 2.9 +/- 1.7, 2.6 +/- 1.5 and 2.9 +/- 11.3 after 1 day, 1 week, 1 month and 3 months after the operation, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Central Laboratory, Changzhou No 2 Hospital, Changzhou, China. jsczljb@yahoo.com.cn

ABSTRACT

Objective: Vertebral compression fractures (VCFs) are common complications of osteoporosis. The expansion of VCFs with a Sky Bone Expander is a new procedure which improves kyphotic deformities and decreases pain associated with VCFs. The purpose of this study was to investigate the preliminary results for the treatment of painful osteoporotic VCFs with a Sky Bone Expander.

Materials and methods: Twenty-six patients with pain-causing VCFs were treated with a Sky Bone Expander. This operation involved the percutaneous insertion of the Sky Bone Expander into a fractured vertebral body transpedicularly. Following the expansion, the Sky Bone Expander was contracted and removed, resulting in a cavity to be filled with bone cement. All fractures were analyzed for improvement in sagittal alignment. Clinical complications, pain relief and ambulation status were evaluated 1 day, 1 week, 1 month, and 3 months after the operation.

Results: Twenty-four hours after the operation, all the patients treated experienced some degree of pain relief. In addition, no postoperative neurologic complications were noted. The average operative time was 42.4 +/- 15.5 min per vertebra. Moreover, an average cement volume of 3.5 mL (range, 2.5 +/- 5.0 mL) was injected per vertebra. The average anterior height was 18.4 +/- 5.1 mm preoperatively and 20.5 +/- 5.3 mm postoperatively (p < 0.01). Furthermore, the average midline height was 15.5 +/- 5.2 mm preoperatively and 18.9 +/- 4.0 mm postoperatively (p < 0.01). The Cobb angle improved from 18.5 +/- 8.2 degrees preoperatively to 9.2 +/- 4.0 degrees postoperatively (p < 0.01). The Visual Anabog Scale scores decreased from 7.7 +/- 1.8 points preoperatively to 3.1 +/- 2.0, 2.9 +/- 1.7, 2.6 +/- 1.5 and 2.9 +/- 11.3 after 1 day, 1 week, 1 month and 3 months after the operation, respectively. Cement extrusion was observed in four patients without any neurologic symptoms.

Conclusion: As a result of this study, we can postulate that the expansion of compressed vetrebra with a Sky Bone Expander is a safe and minimally invasive procedure resulting in the restoration of vertebral body height and the relief of pain associated with VCFs.

Show MeSH
Related in: MedlinePlus