What is the efficacy of the Stryker SpineJack system in the treatment of osteoporotic vertebral fractures?

Answer

Even after balloon kyphoplasty, osteoporotic compression fractures have a high rate of continued collapse with subsequent loss of height and the development of angulation and deformity. This appears to increase the risk for adjacent level fractures. The SpineJack system (Stryker Corp, Kalamazoo, MI) consists of bilateral expandable titanium implants supplemented with bone cement. This system provides more symmetric and balanced lateral and anterior support, and requires lower volumes of bone cement compared to balloon kyphoplasty. Using this system, clinicians can now achieve better pain control, restore vertebral body height, restore spinal alignment, and reduce the risk of adjacent level fractures.

One important advantage of SpineJack kyphoplasty over standard balloon kyphoplasty or vertebroplasty is the ability to perform kyphoplasty safely in patients with mild–moderate retropulsion of the posterior endplate without neurological compromise. In certain situations, the SpineJack device has been used to elevate the fractured endplates serving to reduce the retropulsed bone fragment. In circumstances where patients have a retropulsed bone fragment, SpineJack is superior for the aforementioned reason. Retropulsed bone fragments are a relative contraindication to balloon kyphoplasty.

This finding was noted in the SAKOS study, which directly compared SpineJack kyphoplasty versus balloon kyphoplasty and showed that SpineJack patients had better pain reduction at 1 month and 6 months post treatment. The SAKOS study also showed that SpineJack is associated with a reduced incidence of adjacent level fractures.^[13]

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Media Gallery

Materials and devices for percutaneous vertebroplasty - Needle (11G, 6" [DBMNJ1106]); polymethylmethacrylate (PMMA) cement (Howmedica Simplex Codman Cranioplastic Kit); barium (opacifying agent, sterile barium sulfate, 6-g packets); syringes (1-cc Luer-Lok syringes).
Percutaneous vertebroplasty, transpedicular approach.
Percutaneous vertebroplasty, transpedicular approach under fluoroscopic guidance, lateral view.
Percutaneous vertebroplasty, transpedicular approach under fluoroscopic guidance, anteroposterior view.
Illustration of thoracic vertebrae showing vertebral body, pedicles, facets, transverse process, rib joints, spinous process, and lamina.
Lumbar vertebrae are characterized by massive bodies and robust spinous and transverse processes. Their articular facets are oriented somewhat parasagittally, which is thought to contribute the large range of anteroposterior bending possible between lumbar vertebrae. Lumbar vertebrae also contain small mammillary and accessory processes on their bodies. These bony protuberances are sites of attachment of deep lumbosacral muscles.

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Author

Gaurav Gupta, MD Assistant Professor, Section Head, Endovascular and Cerebrovascular Neurosurgery, Fellowship Director, Endovascular Neurosurgery Fellowship (Site), Department of Surgery, Division of Neurosurgery, Rutgers Robert Wood Johnson Medical School

Gaurav Gupta, MD is a member of the following medical societies: American Academy of Neurology, American Association for the Advancement of Science, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, Congress of Neurological Surgeons, Facial Pain Association, Society for Neuroscience, Society of NeuroInterventional Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Sudipta Roychowdhury, MD Clinical Associate Professor of Radiology, Department of Radiology, Rutgers Robert Wood Johnson Medical School; Attending Radiologist/Neuroradiologist, University Radiology Group, PC

Sudipta Roychowdhury, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Society of Neuroradiology, Medical Society of New Jersey, Radiological Society of New Jersey, Radiological Society of North America, Society of NeuroInterventional Surgery

Disclosure: Nothing to disclose.

Raja Jani, DO, MHA Resident Physician, Department of Neurosurgery, Rutgers New Jersey Medical School

Raja Jani, DO, MHA is a member of the following medical societies: American College of Healthcare Executives, American Medical Association, Gold Humanism Honor Society

Disclosure: Nothing to disclose.

Asif Shafiq, DO Resident Physician, Division of Neurosurgery, Saint Barnabas Medical Center

Asif Shafiq, DO is a member of the following medical societies: American Association of Neurological Surgeons, American College of Osteopathic Surgeons, American Osteopathic Association, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Justin A Siegal, MD Radiologist, Department of Radiology, Virginia Mason Medical Center

Disclosure: Nothing to disclose.

Additional Contributors

Jorge E Mendizabal, MD Consulting Staff, Corpus Christi Neurology

Jorge E Mendizabal, MD is a member of the following medical societies: American Academy of Neurology, National Stroke Association, American Headache Society, Stroke Council of the American Heart Association

Disclosure: Nothing to disclose.

Manish K Singh, MD Assistant Professor, Department of Neurology, Teaching Faculty for Pain Management and Neurology Residency Program, Hahnemann University Hospital, Drexel College of Medicine; Medical Director, Neurology and Pain Management, Jersey Institute of Neuroscience

Manish K Singh, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American Headache Society, American Association of Physicians of Indian Origin, American Medical Association, American Society of Regional Anesthesia and Pain Medicine

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Jashvant Patel, MD, to the development and writing of this article.

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