ABSTRACT
Objective: To treat vertebral fractures with posterior wall injury in the elderly, vertebral bone grafting is generally performed through a posterior transpedicular approach, combined with pedicle screw fixation. An autologous bone is ideal to treat this disorder. However, harvesting autologous bones from the elderly with osteoporosis is limited by the amount and quality of available autologous bone. Thus, we developed a bone-grafting substitute. The newly developed unidirectional porous β-tricalcium phosphate, with a porosity of 57% (UDPTCP; Affinos®, Kuraray Co., Ltd., Tokyo, Japan), is used in the bone-grafting procedure. This is the first report of UDPTCP used as an artificial bone graft in patients with an acute vertebral burst fracture.Materials and Methods: UDPTCP (mean: 4.2 g) was implanted through the pedicle, and posterior instrumentation was achieved with pedicle screws in five elderly patients. Resorption of UDPTCP and substitution with the autologous bone were evaluated on computed tomography (CT) and plain X-ray performed immediately and at 3, 6, and 12 months after the operation.Results: In case 1, the pedicle screws did not loosen, and UDPTCP was completely resorbed and replaced with the autologous bone at 3 postoperative months. In the other four cases, although the pedicle screws or the caudal part loosened because of osteoporosis, resorption of UDPTCP was observed at 3 postoperative months. At 6 postoperative months, progressive substitution with the autologous bone was confirmed, and at 12 postoperative months, formation of the good autologous bone was confirmed.Conclusion: This preliminary case series demonstrated that the newly developed UDPTCP shows good clinical potential as a bone-graft substitute for acute vertebral burst fractures in the elderly, including patients with osteoporosis.
ABSTRACT
In a study involving 43 patients with osteoporotic vertebral fracture aged ≥ 65 years, three different therapeutic methods were designed based on a quantitative evaluation of vertebralbody instability that used dynamic radiographs taken at the initial visit. Vertebral body instability was defined as the difference between the percentage ratio of vertebral collapse (%) in the standing position and that in the supine position. When the difference was ≤ 5%, no bed rest was prescribed and ambulation was permitted as soon as a Jewett-type hard corset was ready (approximately 1 week). When the difference was between ＞5% and ＜20%, 2 weeks of bed rest was prescribed, after which ambulation while wearing the corset was permitted. When the difference was ≥ 20%, 2 weeks of bed rest was prescribed followed by ambulation, but when pain persisted or rehabilitation showed no progress, treatment was changed to surgery. At 3 months after starting treatment, bone union, degree of improvement of pain, activities of daily living, and quality of life were evaluated. Findings showed that almost satisfactory treatment outcomes were achieved with all three treatment approaches. These findings suggest that while priority should be given to conservative treatment based on a quantitative evaluation of vertebral body instability, the possibility of surgery should also be considered. Particularly in cases with ≥ 20% difference in the percentage ratio of vertebral collapse, surgical interventionat a relatively early stage may help reduce to zero the potential for delayed union, pseudarthrosis, and delayed paralysis.
ABSTRACT
A 43-year-old male patient with C5 giant cell tumor (GCT) underwent tumor resection and anterior bone fusion of C4-C6. The tumor recurred locally 9 months after surgery with the patient complaining of neck and shoulder pain similar to his preoperative symptoms. Denosumab was administered and his pain disappeared after a two-month administration, with a sclerotic rim formation seen at the tumor site on computed tomography. He has been followed for 18 months with no evidence of tumor recurrence. Complete resection is generally recommended, but is not easy for many patients with cervical GCT because of the existence of neurovascular structures. Some patients suffer from recurrence and treatment becomes more difficult. As such, denosumab may be an efficacious option for treatment of recurrent GCT of the cervical spine, although long-term follow-up is required to monitor for presence or absence of recurrence.