Safety and Efficacy Studies of Vertebroplasty, Kyphoplasty, and Mesh-Container-Plasty for the Treatment of Vertebral Compression Fractures: Preliminary Report

Abstract

To evaluate the clinical safety and efficacies of percutaneous vertebroplasty (PVP), percutaneous kyphoplasty (PKP), and percutaneous mesh-container-plasty (PMCP) for the treatment of vertebral compression fractures (VCFs), a retrospective study of 90 patients with VCFs who had been treated by PVP (n = 30), PKP (n = 30), and PMCP (n = 30) was conducted. The clinical efficacies of these three treatments were evaluated by comparing their PMMA cement leakages, cement patterns, height restoration percentages, wedge angles, visual analogue scales (VAS), and oswestry disability index (ODI) at the pre- and post-operative time points. 6.67%, 3.33%, and 0% of patients had PMMA leakage in PVP, PKP, and PMCP groups, respectively. Three (solid, trabecular, and mixed patterns), two (solid and mixed patterns), and one (mixed patterns) types of cement patterns were observed in PVP, PKP, and PMCP groups, respectively. PKP and PMCP treatments had better height restoration ability than PVP treatment. PVP, PKP, and PMCP treatments had significant and similar ability in pain relief and functional recovery ability for the treatment of VCFs. These results indicate minimally invasive techniques were effective methods for the treatment of VCFs. Moreover, these initial outcomes suggest PMCP treatment may be better than both PVP treatment and PKP treatment.

Fig 1. PVP surgical procedure for the treatment of a 61-year-old male patient with single VCF in L1 vertebra.

(A): A puncture needle entered into the anterior column of the wedge L1 vertebra via the left pedicle. (B): PMMA bone cement was injected into the fractured vertebral body via the puncture needle. PMMA cement dispersed into the fractured vertebral body and the vertebral height was uplifted. (C): After the PMMA injection, the puncture needle was withdrawn.

Fig 2. PKP surgical procedure for the treatment of a 73-year-old female patient with single VCF in T11 vertebra.

(A): A puncture needle entered into the anterior column of the wedge T11 vertebra via the left pedicle and a bone drill was placed in to drill a circular hole in the fractured vertebral body as a working channel. (B): After withdrawing the bone drill, an inflatable bone tamp was placed into the working channel and was slowly inflated, which induced the uplift of the vertebra height. (C): After PMMA cement injection, the puncture needle was withdrawn.

Fig 3. PMCP instruments.

(A): puncture needle, push rod for mesh container, mesh container and its delivery instrument, bone drill, expansion brace, cement pump, and connection tube (from left to right). (B) the enlarged mesh container.

Fig 4. PMCP surgical procedure for the treatment of a 68-year-old female patient with single VCF in T12 vertebra.

(A): A puncture needle entered into the anterior column of the wedge T12 vertebra via the left pedicle and a bone drill was placed in to drill a circular hole in the fractured vertebral body as a working channel. (B): An expansion brace was placed into the working channel. The surrounding bone tissues were cut by expanding the spring leaves and rotating the bone expansion brace. (C): After withdrawing the expansion brace, a mesh container was placed into the cavity (indicated by the black arrow). (D): PMMA cement was injected into the mesh container and the mesh container was slowly inflated. (E): The mesh container was continued to be inflated by continuous PMMA injection. (F) PMMA cement leaked outside of the mesh container from the meshes. After PMMA cement injection, the puncture needle was withdrawn.

Fig 5. Radiographs of PMMA cement leakage.

(A) In a case of PVP treatment, PMMA leaked into vein in a linear way. (B) In a case of PVP treatment, PMMA leaked outside of the treated vertebra. (C) In a case of PKP treatment, PMMA leaked from the broken endplate to the intervertebral disc.

Fig 6. Long-term observation of PVP surgery for the treatment of a 74-year-old female patient with single VCF in L1 vertebra.

(A): 1 month; (B): 3 months; (C): 6 months.

Fig 7. Long-term observation of PVP surgery for the treatment of a 70-year-old female patient with single VCF in L2 vertebra.

(A): 1 month; (B): 3 months; (C): 6 months.

Fig 8. Long-term observation of PVP surgery for the treatment of a 67-year-old male patient with single VCF in L2 vertebra.

(A): 1 month; (B): 3 months; (C): 6 months.