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David F Kallmes - One of the best experts on this subject based on the ideXlab platform.
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comparison of costs and postoperative outcomes between vertebroplasty and Kyphoplasty for osteoporotic vertebral compression fractures analysis from a state level outpatient database
World Neurosurgery, 2020Co-Authors: Mohammed Ali Alvi, David F Kallmes, Jad Zreik, Yagiz U Yolcu, Anshit Goyal, Brett A Freedman, Mohamad BydonAbstract:Background Vertebral cement augmentation techniques are routinely used to treat osteoporotic vertebral compression fractures (VCFs). In the current study, we used a state-level outpatient database to compare costs and postoperative outcomes between vertebroplasty and Kyphoplasty. Methods We queried the 2016 Florida State-Ambulatory Surgery Database of the Healthcare Cost and Utilization Project for patients undergoing thoracolumbar vertebroplasty or Kyphoplasty for osteoporotic VCFs. Demographic and clinical characteristics, as well as postoperative outcomes were compared between the 2 groups. Results A total of 105 patients (11.6%) who underwent vertebroplasty and 801 patients (88.4%) who underwent Kyphoplasty were identified. Patients undergoing Kyphoplasty were more likely to stay overnight or longer, with the P value trending toward significance (Kyphoplasty with >1 day stay: 7.4% vs. vertebroplasty with >1 day stay: 1.9%; P = 0.086). Patients undergoing vertebroplasty had a significantly higher rate of discharge to home routine compared with patients undergoing Kyphoplasty (97.1% [n = 102] vs. 94.1% [n = 754]; P 0.05). The rates of 30-day, 90-day, and overall readmission because of a new-onset fracture were also similar (all P > 0.05). However, vertebroplasty had a higher rate of readmissions associated with a procedure within a year (21.9% [n = 23] vs. 14.5% [n = 116]; P = 0.047). Conclusions Our analyses from a state-level database of patients undergoing vertebroplasty and Kyphoplasty for osteoporotic VCFs show similar postoperative outcomes for the 2 procedures but a higher cost for Kyphoplasty.
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randomized controlled trial of vertebroplasty versus Kyphoplasty in the treatment of vertebral compression fractures
Journal of NeuroInterventional Surgery, 2016Co-Authors: Avery J Evans, Waleed Brinjikji, Kennith F Layton, M Jensen, John R Gaughen, David F KallmesAbstract:Background We present the results of a randomized controlled trial evaluating the efficacy of vertebroplasty versus Kyphoplasty in treating vertebral body compression fractures. Methods Patients with vertebral body compression fractures were randomly assigned to treatment with Kyphoplasty or vertebroplasty. Primary endpoints were pain (0–10 scale) and disability assessed using the Roland–Morris Disability Questionnaire (RMDQ). Outcomes were assessed at 3 days, 1 month, 6 months, and 1 year following the procedure. Results 115 subjects were enrolled in the trial with 59 (51.3%) randomly assigned to Kyphoplasty and 56 (48.7%) assigned to vertebroplasty. Mean (SD) pain scores at baseline, 3 days, 30 days, and 1 year for Kyphoplasty versus vertebroplasty were 7.4 (1.9) vs 7.9 (2.0), 4.1 (2.8) vs 3.7 (3.0), 3.4 (2.5) vs 3.6 (2.9), and 3.0 (2.8) vs 2.3 (2.6), respectively (p>0.05 at all time points). Mean (SD) RMDQ scores at baseline, 3 days, 30 days, 180 days, and 1 year were 17.3 (6.6) vs 16.3 (7.4), 11.8 (7.9) vs 10.9 (8.2), 8.6 (7.2) vs 8.8 (8.5), 7.9 (7.4) vs 7.3 (7.7), 7.5 (7.2) vs 6.7 (8.0), respectively (p>0.05 at all time points). For baseline to 12-month assessment in average pain and RMDQ scores, the standardized effect size between Kyphoplasty and vertebroplasty was small at −0.36 (95% CI −1.02 to 0.31) and −0.04 (95% CI −1.68 to 1.60), respectively. Conclusions Our study indicates that vertebroplasty and Kyphoplasty appear to be equally effective in substantially reducing pain and disability in patients with vertebral body compression fractures. Trial registration number NCT00279877.
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outcomes of vertebroplasty compared with Kyphoplasty a systematic review and meta analysis
Journal of NeuroInterventional Surgery, 2016Co-Authors: Chris N Gu, Waleed Brinjikji, Avery J Evans, Mohammad Hassan Murad, David F KallmesAbstract:Background and purpose Many studies demonstrate that both Kyphoplasty and vertebroplasty are superior to conservative therapy in the treatment of osteoporotic vertebral body compression fractures. We performed a systematic review and meta-analysis of studies comparing the outcomes of vertebroplasty and Kyphoplasty, which included prospective non-randomized, retrospective comparative, and randomized studies. Materials and methods We searched MEDLINE, EMBASE, and the Web of Science databases for studies of Kyphoplasty versus vertebroplasty from 1 January 1990 to 30 November 2014 and compared the following outcomes: procedure characteristics, pain and disability improvement, complications and anatomic outcomes. A subgroup analysis was performed comparing pain outcomes based on the risk of bias. Results 29 studies enrolling 2838 patients (1384 Kyphoplasty and 1454 vertebroplasty) were included. 16 prospective non-randomized studies, 10 retrospective comparative studies, and 3 randomized controlled studies were included. No significant differences were found in mean pain scores between the two groups postoperatively (2.9±1.5 Kyphoplasty vs 2.9±1.7 vertebroplasty, p=0.39) and at 12 months (2.7±1.8 Kyphoplasty vs 3.2±1.8 vertebroplasty, p=0.64). No significant differences were found in disability postoperatively (34.7±7.1 Kyphoplasty group vs 36.3±7.8 vertebroplasty group, p=0.74) or at 12 months (28.3±16 Kyphoplasty group vs 29.6±13.9 vertebroplasty group, p=0.70). Kyphoplasty was associated with lower odds of new fractures (p=0.06), less extraosseous cement leakage (p Conclusions No significant difference was found between vertebroplasty and Kyphoplasty in short- and long-term pain and disability outcomes. Further studies are needed to better determine if any particular subgroups of patients would benefit more from vertebroplasty or Kyphoplasty in the treatment of vertebral body compression fractures.
William J Vogel - One of the best experts on this subject based on the ideXlab platform.
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combination Kyphoplasty and spinal radiosurgery a new treatment paradigm for pathological fractures
Journal of Neurosurgery, 2005Co-Authors: Peter C Gerszten, Anand V Germanwala, Steven A Burton, William C Welch, Cihat Ozhasoglu, William J VogelAbstract:OBJECT: Patients with symptomatic pathological compression fractures require spinal stabilization surgery for mechanical back pain control and irradiation for the underlying malignant process. The authors evaluated a treatment paradigm of closed fracture reduction and fixation involving Kyphoplasty and subsequent spinal radiosurgery. METHODS: Twenty-six patients (six men and 20 women, mean age 72 years) with pathological compression fractures (16 thoracic and 10 lumbar) were prospectively evaluated. Histological diagnoses included 11 lung, nine breast, four renal, one cholangiocarcioma, and one ocular melanoma. Seven lesions had received prior external-beam radiation therapy. All patients underwent Kyphoplasty that involved the percutaneous transpedicular technique. Fiducial markers allowing for image guidance during CyberKnife treatment were placed, at time of the Kyphoplasty, in the pedicles at adjacent levels. Patients underwent single-fraction radiosurgery (mean time after Kyphoplasty 12 days) in an outpatient setting. The tumor dose was maintained at 16 to 20 Gy (mean 18 Gy) to the 80% isodose line. The treated tumor volume ranged from 12.7 to 37.1 cm3. No acute radiation-induced toxicity or new neurological deficit occurred during the follow-up period (range 11-24 months, median 16 months). Axial pain improved in 24 (92%) of 26 patients. CONCLUSIONS: The combined Kyphoplasty and spinal radiosurgery treatment paradigm was found to be clinically effective in patients with pathological fractures; there was no significant spinal canal compromise. In this technique two minimally invasive surgical procedures are combined to avoid the morbidity associated with open surgery while providing both immediate fracture fixation and administering a single-fraction tumoricidal radiation dose.
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combination Kyphoplasty and spinal radiosurgery a new treatment paradigm for pathological fractures
Neurosurgical Focus, 2005Co-Authors: Peter C Gerszten, Anand V Germanwala, Steven A Burton, William C Welch, Cihat Ozhasoglu, William J VogelAbstract:Object. Patients with symptomatic pathological compression fractures require spinal stabilization surgery for mechanical back pain control and irradiation for the underlying malignant process. The authors evaluated a treatment paradigm of closed fracture reduction and fixation involving Kyphoplasty and subsequent spinal radiosurgery. Methods. Twenty-six patients (six men and 20 women, mean age 72 years) with pathological compression fractures (16 thoracic and 10 lumbar) were prospectively evaluated. Histological diagnoses included 11 lung, nine breast, four renal, one cholangiocarcioma, and one ocular melanoma. Seven lesions had received prior external-beam radiation therapy. All patients underwent Kyphoplasty that involved the percutaneous transpedicular technique. Fiducial markers allowing for image guidance during CyberKnife treatment were placed, at time of the Kyphoplasty, in the pedicles at adjacent levels. Patients underwent single-fraction radiosurgery (mean time after Kyphoplasty 12 days) in an o...
J. M. Lane - One of the best experts on this subject based on the ideXlab platform.
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Vertebral height restoration in osteoporotic compression fractures: Kyphoplasty balloon tamp is superior to postural correction alone
Osteoporosis International, 2006Co-Authors: M. K. Shindle, M. J. Gardner, J. Koob, S. Bukata, J. A. Cabin, J. M. LaneAbstract:Introduction Kyphoplasty has been shown to restore vertebral height and sagittal alignment. Proponents of vertebroplasty have recently demonstrated that many vertebral compression fractures (VCFs) are mobile and positional correction can lead to clinically significant height restoration. The current investigation tested the hypothesis that positional maneuvers do not achieve the same degree of vertebral height correction as Kyphoplasty balloon tamps for the reduction of low-energy VCFs. Methods Twenty-five consecutive patients with a total of 43 osteoporotic VCFs were entered into a prospective analysis. Each patient was sequentially evaluated for postural and balloon vertebral fracture reduction. Preoperative standing and lateral radiographs of the fractured vertebrae were compared with prone cross-table lateral radiographs with the patient in a hyper-extension position and on pelvic and sternal rolls. Following positional manipulation, patients underwent a unilateral balloon Kyphoplasty. Postoperative standing radiographs were evaluated for the percentage of height restoration related to positioning and balloon Kyphoplasty. Results In the middle portion of the vertebrae, the percentage available for restoration restored with extension positioning was 10.4% (median 11.1%) and after balloon Kyphoplasty was 57.0% (median 62.2%). This difference was statistically significant ( p 10% restoration of the central portion of the vertebral body, whereas 90.7% of fractures improved at least 10% following balloon Kyphoplasty ( p 4.5-fold over the positioning maneuver alone and accounted for over 80% of the ultimate reduction. If height restoration is the goal, Kyphoplasty is clearly superior in most cases to the positioning maneuver alone.
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vertebral height restoration in osteoporotic compression fractures Kyphoplasty balloon tamp is superior to postural correction alone
Osteoporosis International, 2006Co-Authors: M. K. Shindle, M. J. Gardner, J. Koob, S. Bukata, J. A. Cabin, J. M. LaneAbstract:Introduction Kyphoplasty has been shown to restore vertebral height and sagittal alignment. Proponents of vertebroplasty have recently demonstrated that many vertebral compression fractures (VCFs) are mobile and positional correction can lead to clinically significant height restoration. The current investigation tested the hypothesis that positional maneuvers do not achieve the same degree of vertebral height correction as Kyphoplasty balloon tamps for the reduction of low-energy VCFs.
Gregg H Zoarski - One of the best experts on this subject based on the ideXlab platform.
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Kyphoplasty.
Techniques in vascular and interventional radiology, 2020Co-Authors: A Orlando Ortiz, Gregg H Zoarski, Michael BeckermanAbstract:Kyphoplasty is a relatively new procedure that is indicated for the treatment of osteoporotic or pathologic compression fractures of the thoracic and/or lumbar spine. This minimally invasive procedure requires imaging guidance. Kyphoplasty entails the inflation of a balloon tamp, prior to the injection of opacified acrylic bone cement, within the compressed vertebral body in an attempt to restore vertebral body height and reduce the associated kyphotic deformity. Preliminary studies show that Kyphoplasty, like vertebroplasty, provides significant pain relief in properly selected patients. Definitive demonstration of height restoration and kyphosis correction are still under investigation.
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vertebroplasty versus Kyphoplasty a comparison and contrast
American Journal of Neuroradiology, 2004Co-Authors: John M. Mathis, Orlando A Ortiz, Gregg H ZoarskiAbstract:The phrase “vertebroplasty versus Kyphoplasty” evokes images of competitive procedures and groups of entrenched physicians locked in battle. Our involvement in the development and introduction of percutaneous vertebroplasty (PV) and Kyphoplasty (KP) in the United States has given us a unique
Peter C Gerszten - One of the best experts on this subject based on the ideXlab platform.
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combination Kyphoplasty and spinal radiosurgery a new treatment paradigm for pathological fractures
Journal of Neurosurgery, 2005Co-Authors: Peter C Gerszten, Anand V Germanwala, Steven A Burton, William C Welch, Cihat Ozhasoglu, William J VogelAbstract:OBJECT: Patients with symptomatic pathological compression fractures require spinal stabilization surgery for mechanical back pain control and irradiation for the underlying malignant process. The authors evaluated a treatment paradigm of closed fracture reduction and fixation involving Kyphoplasty and subsequent spinal radiosurgery. METHODS: Twenty-six patients (six men and 20 women, mean age 72 years) with pathological compression fractures (16 thoracic and 10 lumbar) were prospectively evaluated. Histological diagnoses included 11 lung, nine breast, four renal, one cholangiocarcioma, and one ocular melanoma. Seven lesions had received prior external-beam radiation therapy. All patients underwent Kyphoplasty that involved the percutaneous transpedicular technique. Fiducial markers allowing for image guidance during CyberKnife treatment were placed, at time of the Kyphoplasty, in the pedicles at adjacent levels. Patients underwent single-fraction radiosurgery (mean time after Kyphoplasty 12 days) in an outpatient setting. The tumor dose was maintained at 16 to 20 Gy (mean 18 Gy) to the 80% isodose line. The treated tumor volume ranged from 12.7 to 37.1 cm3. No acute radiation-induced toxicity or new neurological deficit occurred during the follow-up period (range 11-24 months, median 16 months). Axial pain improved in 24 (92%) of 26 patients. CONCLUSIONS: The combined Kyphoplasty and spinal radiosurgery treatment paradigm was found to be clinically effective in patients with pathological fractures; there was no significant spinal canal compromise. In this technique two minimally invasive surgical procedures are combined to avoid the morbidity associated with open surgery while providing both immediate fracture fixation and administering a single-fraction tumoricidal radiation dose.
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combination Kyphoplasty and spinal radiosurgery a new treatment paradigm for pathological fractures
Neurosurgical Focus, 2005Co-Authors: Peter C Gerszten, Anand V Germanwala, Steven A Burton, William C Welch, Cihat Ozhasoglu, William J VogelAbstract:Object. Patients with symptomatic pathological compression fractures require spinal stabilization surgery for mechanical back pain control and irradiation for the underlying malignant process. The authors evaluated a treatment paradigm of closed fracture reduction and fixation involving Kyphoplasty and subsequent spinal radiosurgery. Methods. Twenty-six patients (six men and 20 women, mean age 72 years) with pathological compression fractures (16 thoracic and 10 lumbar) were prospectively evaluated. Histological diagnoses included 11 lung, nine breast, four renal, one cholangiocarcioma, and one ocular melanoma. Seven lesions had received prior external-beam radiation therapy. All patients underwent Kyphoplasty that involved the percutaneous transpedicular technique. Fiducial markers allowing for image guidance during CyberKnife treatment were placed, at time of the Kyphoplasty, in the pedicles at adjacent levels. Patients underwent single-fraction radiosurgery (mean time after Kyphoplasty 12 days) in an o...
