At present, strong requirements in orthopaedics are still to be met, both in bone and joint substitution and in the repair and regeneration of bone defects. In this framework, tremendous advances in the biomaterials field have been made in the last 50 years where materials intended for biomedical purposes have evolved through three different generations, namely first generation (bioinert materials), second generation (bioactive and biodegradable materials) and third generation (materials designed to stimulate specific responses at the molecular level). In this review, the evolution of different metals, ceramics and polymers most commonly used in orthopaedic applications is discussed, as well as the different approaches used to fulfil the challenges faced by this medical field.

https://royalsocietypublishing.org/doi/pdf/10.1098/rsif.2008.0151

Biomaterials in orthopaedics.

Transpedicular vertebroplasty for the treatment of compression fractures of the thoracic and lumbar spine has been well described, and the reported complication rates are low. In this paper we present two cases of patients treated with vertebroplasty despite a history of prior infection. Osteomyelitis and abscess developed in these patients and they underwent corpectomy with anterior reconstruction and posterior stabilization. Great care should be taken when using vertebroplasty to treat patients who have a history of infection, because they may suffer osteomyelitis.

Report of two cases and review of the literature

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(09)60010-6.pdf

Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial.

STUDY DESIGN: Systematic literature review. OBJECTIVE: To evaluate the safety and efficacy of vertebroplasty and kyphoplasty using the data presented in published clinical studies, with respect to patient pain relief, restoration of mobility and vertebral body height, complication rate, and incidence of new adjacent vertebral fractures. SUMMARY OF BACKGROUND DATA: Vertebroplasty and kyphoplasty have been gaining popularity for treating vertebral fractures. Current reviews provide an overview of the procedures but are not comprehensive and tend to rely heavily on personal experience. This article aimed to compile all available data and evaluate the clinical outcome of the 2 procedures. METHODS: This is a systematic review of all the available data presented in peer-reviewed published clinical trials. The methodological quality of included studies was evaluated, and data were collected targeting specific standard measurements. Where possible, a quantitative aggregation of the data was performed. RESULTS: A large proportion of subjects had some pain relief, including 87% with vertebroplasty and 92% with kyphoplasty. Vertebral height restoration was possible using kyphoplasty (average 6.6 degrees ) and for a subset of patients using vertebroplasty (average 6.6 degrees ). Cement leaks occurred for 41% and 9% of treated vertebrae for vertebroplasty and kyphoplasty, respectively. New fractures of adjacent vertebrae occurred for both procedures at rates that are higher than the general osteoporotic population but approximately equivalent to the general osteoporotic population that had a previous vertebral fracture. CONCLUSIONS: The problem with stating definitely that vertebroplasty and kyphoplasty are safe and effective procedures is the lack of comparative, blinded, randomized clinical trials. Standardized evaluative methods should be adopted.

/pdf/vertebroplasty-and-kyphoplasty-a-systematic-review-of-69-27mm39raap.pdf

Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies.

Introduction Vertebroplasty and kyphoplasty have been gaining popularity for treating vertebral fractures Current reviews provide an overview of the procedures but are not comprehensive and tend to rely heavily on personal experience This paper aimed to compile all available data and evaluate the clinical outcome of the two procedures The objective was to evaluate the safety and efficacy of vertebroplasty and kyphoplasty using the data presented in published clinical studies, with respect to patient pain relief, restoration of mobility and vertebral body height, complication rate, and incidence of new adjacent vertebral fractures Methods This is a systematic review of all the available data presented in peer reviewed published clinical trials (69 papers) Where possible a quantitative aggregation of the data was performed Data was collected for each study under the headings: general information, participants, intervention, outcomes, complications, and follow-up Outcome data was collected detailing: pain relief, general health, functional improvements, satisfaction with treatment, and reduction in kyphosis Complications included: cement leakage (asymptomatic and symptomatic), neurological deficits, cardiovascular, pulmonary and any other clinically relevant complication Long term follow-up information included all the items recorded under the heading “outcome” with the addition of new fracture details Results A large proportion of subjects experienced some pain relief (87% vertebroplasty, 92% kyphoplasty) Vertebral height restoration was possible using kyphoplasty (average 66°) and for a subset of patients using vertebroplasty Cement leaks occurred for 41% and 9% of treated vertebrae for vertebroplasty and kyphoplasty respectively New fractures of adjacent vertebrae occurred for both procedures at rates that are greater than the general osteoporotic population but approximately equivalent to the general osteoporotic population that had a previous vertebral fracture Discussion The pain relief experienced by patients is promising for both kyphoplasty and vertebroplasty in the short term (

Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies

Study design Literature review Objectives To describe new treatments for painful osteoporotic compression fractures in light of available scientific literature and clinical experience Summary of background data Painful vertebral osteoporotic compression fractures lead to significant morbidity and mortality This relates to pulmonary dysfunction, eating disorders (nutritional deficits), pain, loss of independence, and mental status change (related to pain and medications) Medications to treat osteoporosis (primarily antiresorptive) do not effectively treat the pain or the fracture, and require over 1 year to reduce the degree of osteoporosis Kyphoplasty and vertebroplasty are new techniques that help decrease the pain and improve function in fractured vertebrae Methods This is a descriptive review of the background leading to vertebroplasty and kyphoplasty, a description of the techniques, a review of the literature, as well as current ongoing studies evaluating kyphoplasty Results Both techniques have had a very high acceptance and use rate There is 95% improvement in pain and significant improvement in function following treatment by either of these percutaneous techniques Kyphoplasty improves height of the fractured vertebra, and improves kyphosis by over 50%, if performed within 3 months from the onset of the fracture (onset of pain) There is some height improvement, though not as marked, along with 95% clinical improvement, if the procedure is performed after 3 months Complications occur with both and relate to cement leakage in both, and cement emboli with vertebroplasty Conclusion Kyphoplasty and vertebroplasty are safe and effective, and have a useful role in the treatment of painful osteoporotic vertebral compression fractures that do not respond to conventional treatments Kyphoplasty offers the additional advantage of realigning the spinal column and regaining height of the fractured vertebra, which may help decrease the pulmonary, GI, and early morbidity consequences related to these fractures Both procedures are technically demanding

New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures.

Study Design: Literature review Objectives: To describe new treatments for painful osteoporotic compression fractures in light of available scientific literature and clinical experience. Summary of Background Data. Painful vertebral osteoporotic compression fractures lead to significant morbidity and mortality. This relates to pulmonary dysfunction, eating disorders (nutritional deficits), pain, loss of independence, and mental status change (related to pain and medications). Medications to treat osteoporosis (primarily antiresorptive) do not effectively treat the pain or the fracture, and require over 1 year to reduce the degree of osteoporosis. Kyphoplasty and vertebroplasty are new techniques that help decrease the pain and improve function in fractured vertebrae. Methods. This is a descriptive review of the background leading to vertebroplasty and kyphoplasty, a description of the techniques, a review of the literature, as well as current ongoing studies evaluating kyphoplasty. Results: Both techniques have had a very high acceptance and use rate. There is 95% improvement in pain and significant improvement in function following treatment by either of these percutaneous techniques. Kyphoplasty improves height of the fractured vertebra, and improves kyphosis by over 50%, if performed within 3 months from the onset of the fracture (onset of pain). There is some height improvement, though not as marked, along with 95% clinical improvement, if the procedure is performed after 3 months. Complications occur with both and relate to cement leakage in both, and cement emboli with vertebroplasty. Conclusion: Kyphoplasty and vertebroplasty are safe and effective, and have a useful role in the treatment of painful osteoporotic vertebral compression fractures that do not respond to conventional treatments. Kyphoplasty offers the additional advantage of realigning the spinal column and regaining height of the fractured vertebra, which may help decrease the pulmonary, GI, and early morbidity consequences related to these fractures. Both procedures are technically demanding. [

http://ossano.com/Bibliotek/VerteKyphoPlastik/L03%20%20Garfin.pdf

Kyphoplasty and Vertebroplasty for the Treatment of Painful Osteoporotic Compression Fractures

Low back pain is the most common type of adult pain and is a leading cause of disability. While this complaint may be ubiquitous, there are many possible causes. Studies have shown that the sacroiliac joint is the cause in approximately 15% of patients with low back pain. The exact pattern is complex. Provocative physical examination maneuvers may help provide a presumptive sacroiliac joint pain diagnosis. Confirmatory diagnosis is achieved with diagnostic injection. For disabling pain that fails to respond to nonoperative treatment, surgical fusion may be necessary; different fusion approaches have been described and are presented.

Mark A. Reiley

Papers

New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures.

Kyphoplasty and Vertebroplasty for the Treatment of Painful Osteoporotic Compression Fractures

Diagnosis and treatment of sacroiliac joint pain