Zolidronic acid combined with percutaneous kyphoplasty in the treatment of osteoporotic compression fractures: A meta-analysis of bone density improvement, recurrent vertebral fractures prevention, and long-term efficacy evaluation / 中国组织工程研究

BACKGROUND: The clinical application of zoledronic acid in the treatment of osteoporosis lacks systematic scientific evaluation and evidence-based basis. Therefore, the clinical efficacy of zoledronic acid combined with percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture is still uncertain. OBJECTIVE: To systematically evaluate the efficacy of zoledronic acid combined with percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture. METHODS: A computer search of all randomized controlled studies and clinical trials of zolidronic acid combined with percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fracture published in CNKI, Wanfang, VIP, CBM, PubMed and Cochrane prior to September 2019 was performed. The experimental group was treated with zoledronic acid and percutaneous kyphoplasty, while the control group was treated with percutaneous kyphoplasty. Literature screening and data extraction were conducted by the two researchers independently. The quality of the included randomized controlled trials was evaluated one by one according to the Cochrane collaboration standards. Meta-analysis was performed on RevMan 5.3 for those that met the inclusion criteria. RESULTS AND CONCLUSION: (1) Five randomized controlled trials were included, including 175 in the experimental group and 184 in the control group. (2) Meta-analysis results showed that the bone mineral density was higher in the experimental group than in the control group [MD=0.12, 95%CI(0.08, 0.17), P < 0.000 01]. The visual analogue scale score was lower in the experimental group than that of the control group 6 and 12 months after treatment [MD=0.46, 95%CI(0.18, 0.75), P=0.002; MD=0.85, 95%CI(0.20, 1.50), P=0.01]. At 1 year after treatment, Oswestry disability index was lower in the experimental group than in the control group [MD=6.59, 95%CI(4.77，8.41), P < 0.000 01]. Bone cement leakage rate and recurrence rate of vertebral fractures were lower in the experimental group than in the control group [OR=0.22, 95%CI(0.08, 0.59), P=0.003; OR=0.18, 95%CI(0.07, 0.50), P=0.000 8]. Vertebral height recovery and kyphotic Cobb angle were not significantly different between the two groups [MD=0.65, 95%CI(-0.27, 1.56), P=0.16; MD=-0.60, 95%CI(-2.45, 1.25), P=0.53]. (3) Results showed that compared with percutaneous kyphoplasty alone, zoledronic acid combined with percutaneous kyphoplasty has significant advantages in improving bone mineral density, reducing the recurrence rate of vertebral fracture, improving the long-term clinical symptoms of patients, preventing the bone cement leakage, but a large number of high-quality multi-center randomized controlled studies are still needed to provide more sufficient evidence in the later stage.

The Efficacy of Fentanyl Transdermal Patch as the First-Line Medicine for the Conservative Treatment of Osteoporotic Compression Fracture / 대한신경손상학회지

OBJECTIVE: There are no strong guidelines on how long or how we should undertake conservative treatment during the acute period of an osteoporotic vertebral compression fracture (VCF). METHODS: We treated 202 patients with conservative treatment on VCF from March 2012 to August 2015. On inclusion criteria, 75 patients (22 males and 53 females) were included in the final analysis. After admission, a transdermal fentanyl patch with low dose (12.5 µg) application was attempted in all patients. In an unresponsive patient, the fentanyl patch was increased by 25 µg. After identifying the tolerable toilet ambulation of the patient without any assistance, hospital discharge was recommended. We classified two patient groups into one favorable group and one unfavorable group and compared several clinical and radiological factors. RESULTS: Among 75 patients, the clinical outcome of 57 patients (76%) was favorable, but that of 18 patients (24%) was unfavorable. In clinical outcomes, the numeric rating scale at 6 and 12 months and Odom's criteria at 12 months was significantly different between the favorable and the unfavorable groups. The dose of the patches used showed statistically significant differences between the two groups (p=0.001). CONCLUSION: The only statistically significant affecting factor for an unfavorable outcome was the use of a higher dose fentanyl patch. Our data inferred that the unresponsiveness to a low-dose fentanyl patch could be helpful to select patients necessary for percutaneous vertebroplasty or kyphoplasty.

Role of vertebroplasty in osteoporotic compression fracture

xMajority of osteoporotic vertebral compression fracture present with back pain and some of them with spinal deformity. Percutaneous vertebroplasty not only addresses pain relief but also the correction of spinal deformity with least post-operative morbidity. 72 patients with osteoporotic compression fracture and spinal deformity with chronic invalidating pain treated with percutaneous vertebroplasty were followed for 2.8 years with an average of 1.3 years.47% showed excellent,13% showed good and 40% showed fair result on vas score. There was good improvement in stature in 43%, fair in 40% and 17% showed no improvement.

The Fate of Injected Cement on Percutaneous Vertebroplasty / 대한골다공증학회지

INTRODUCTION: Percutaneous vertebroplasty(PVP) is effective surgical method for treating osteoporotic compression fracture. But there is a few data for long term follow-up radiologic result, especially injected bone cement features. We assessed the radiographic features of patients who underwent percutaneous vertebroplasty in osteoporotic compression fractures with a minimum of 7 years follow-up retrospectively. MATERIALS AND METHODS: Between January 2000 and August 2007, 253 patients were treated with PVP for osteoporotic compression fracture at our department; 81 patients died during follow-up and 101 patients (177 vertebrae) were available for follow-up for over 7 years. We analyzed the radiologic outcome focused on injected bone cement feature. RESULTS: The mean follow-up period was 7.9 years. A new adjacent vertebral fracture was documented by 55 vertebral bodies in 35 patients. Anterior body height in the last follow-up was improved about 0.3 mm compared with the preprocedural value, but was not statistically significant. Also, the focal kyphotic angle was reduced from 12.3° at the preprocedural state to 11.7° at the postprocedural state but was not statistically significant (P>0.05). Out of the 101 cases, the 89 cases for whom the cement was injected into the vertebral body were kept in a stable condition. Seven cases of radiolucent line with decreased bone density in the adjacent area of cement and 5 cases of cement cracks accompanied with vertebral collapse were observed. CONCLUSIONS: The bone cement injected vertebrae showed stable radiologic progression without significant changes in vertebral height or kyphotic angle.

Prevention and Treatment of Multiple Osteoporotic Compression Fracture

Korea's demographic profile is undergoing tremendous change as the country rapidly ages at one of the fastest rates in the world. Indeed, the country is expected to become an "aged society" in 2018 when the proportion of elderly is estimated to reach 14.3% of the total population. With the notable increase in the number of elderly individuals, the incidence of osteoporotic fractures will also likely increase. Osteoporosis is a systemic musculoskeletal disease that is characterized by the decreased bone quantity and the abnormalities of the microstructures. There are both conservative and surgical treatment modalities for the fracture: conservative treatments include pharmacological treatments and orthosis; surgical treatments include vertebroplasty, kyphoplasty, and reconstructive surgery. Clinicians should consider the severity of osteoporosis, the concurrent osteoporotic fracture, the age and sex of the patient, and the underlying diseases in making a patient-tailored prescription.

Influence of Compression Ratio Differences between Magnetic Resonance Images and Simple Radiographs on Osteoporotic Vertebral Compression Fracture Prognosis after Vertebroplasty

OBJECTIVE: The extent of collapse progression after vertebroplasty in osteoporotic vertebral compression fractures (OVCF) has known to be various. In this study, we investigated that how much difference of compression ratio between standing simple radiograph and supine magnetic resonance imaging (MRI) affects the collapse progression after vertebroplasty. METHODS: This retrospective cohort study was carried out based on 27 patients with 31 OVCFs undergone vertebrplastyin the thoracolumbar junction (T12-L2), from January to December 2009. The OVCFs were divided to two groups, the smaller group A and larger group B, by mean compression ratio difference (8.1%) between standing simple radiograph and supine MRI. RESULTS: There were no significant differences in the baseline characteristics of the two groups except age. There were also no significant differences between the periodic compression ratio, back pain, Cobb's angle during follow-up period. However, Group B seemed to show improvements from the initial state to the point just after the operation, but eventually took a much worse course than group A. In the end, judging from the compression ratios of the two groups at the last follow up, group A showed less progression. CONCLUSION: Although the clinical outcome was not different significantly, a greater compression ratio difference in the initial study resulted in a greater collapse progression at last follow-up. Therefore, we suggest that it is important to check the initial standing simple radiograph, as well as supine MRI, for predicting collapse progression after vertebroplasty.

Risk Factors for Subsequent Fracture after Osteoporotic Vertebral Compression Fracture / 대한신경손상학회지

OBJECTIVE: Percutaneous vertebroplasty is an effective treatment that relieves pain caused by vertebral compression fracture. However, vertebroplasty may increase the risk for subsequent vertebral compression fracture. The purpose of this study is to evaluate the incidence of and risk factors for subsequent fracture after vertebroplasty. METHODS: A retrospective analysis was performed for 112 patients who were diagnosed with a first osteoporotic compression fracture at a single level and underwent vertebroplasty at that level. Possible risk factors for subsequent fracture, such as age, sex, bone mineral density (BMD), location of treated vertebrae, pattern of cement distribution, cement volume, presence of intradiscal cement leakage, and direction of cement leakage, were analyzed. RESULTS: During the follow-up period, 18 new subsequent vertebral fractures developed (16.1%). Subsequent fractures were more common in osteoporotic patients (T-score or =3.5 cc were also associated with a significantly higher risk of fracture (p=0.012, r=0.238). CONCLUSION: Low BMD and volume of intravertebral cement were the factors most strongly associated with subsequent fracture after percutaneous vertebroplasty.

Risk Factors for Subsequent Fracture after Osteoporotic Vertebral Compression Fracture / 대한신경손상학회지

OBJECTIVE: Percutaneous vertebroplasty is an effective treatment that relieves pain caused by vertebral compression fracture. However, vertebroplasty may increase the risk for subsequent vertebral compression fracture. The purpose of this study is to evaluate the incidence of and risk factors for subsequent fracture after vertebroplasty. METHODS: A retrospective analysis was performed for 112 patients who were diagnosed with a first osteoporotic compression fracture at a single level and underwent vertebroplasty at that level. Possible risk factors for subsequent fracture, such as age, sex, bone mineral density (BMD), location of treated vertebrae, pattern of cement distribution, cement volume, presence of intradiscal cement leakage, and direction of cement leakage, were analyzed. RESULTS: During the follow-up period, 18 new subsequent vertebral fractures developed (16.1%). Subsequent fractures were more common in osteoporotic patients (T-score or =3.5 cc were also associated with a significantly higher risk of fracture (p=0.012, r=0.238). CONCLUSION: Low BMD and volume of intravertebral cement were the factors most strongly associated with subsequent fracture after percutaneous vertebroplasty.

Asymptomatic Pulmonary Embolus Following Percutaneous Kyphoplasty: A Case Report / 대한골다공증학회지

Percutaneous vertebroplasty is a relatively recent procedure in the treatment of osteoporotic vertebral compression fractures. Bone cement embolism is a severe and potentially life-threatening complication of percutaneous vertebroplasty with cement. The risk for cement pulmonary embolism ranges between 3.5 and 23% for osteoporotic fractures. Bone cement leakage may be usually more frequent with vertebroplasty than with kyphoplasty. We experienced a 69-year-old female patient of an asymptomatic pulmonary embolus (length 8 cm) after kyphoplasty for an osteoporotic vertebral compression fracture

Clinical Results of Unilateral Partial Vertebroplasty(UPVP) in Osteoporotic Vertebral Fracture

STUDY DESIGN: This is a prospective clinical study. OBJECTIVES: We wanted to compare the clinical results of conventional vertebroplasty(VP) and the newly devised unilateral partial vertebroplasty(UPVP). SUMMARY OF LITERATURE REVIEW: There has not been any study on how to reduce the amount of cement used while maintaining the height of the vertebral body and minimizing the adjacent compression fractures. MATERIALS AND METHODS: From 2004 to 2008, Group 1 underwent VP and group 2 underwent UPVP. We compared the difference of the VAS score, the period of hospitalization, the infused amount of cement, the progression of the vertebral body collapse and fresh fracture of the adjacent vertebral body on the follow-up simple radiographs. RESULTS: In group 1, the mean VAS score changed from 6.69 to 2.80, the mean period of hospitalization was 2.30 days and the mean amount of cement infused was 6.50cc. The degree of vertebral body collapse was 0.83, 0.76, 0.69 and 0.63 on follow-up, and 3 cases had fresh fracture. In group 2, the mean VAS score changed from 6.41 to 2.61, the mean period of hospitalization was 2.23 days and the mean amount of cement infused was 3.74cc. The degree of collapse was 0.71, 0.69, 0.68 and 0.63 on follow up and 1 case had fresh fracture. The two groups showed no statistical significance for the change of the VAS score and the period of hospitalization, and the amount of cement was significantly less in group 2. The degree of collapse was not significantly different on the 4 times of follow-up. The frequency of fresh fracture was significantly less in group 2. CONCLUSIONS: UPVP could achieve similar results for pain relief, the period of hospitalization and vertebral body collapse as compared to that of VP, but fresh fracture of the adjacent vertebral body was less. So, UPVP could be a better method than VP.

The Usefulness and Technique of Unilateral Extrapedicular Approach in Vertebroplasty

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the effectiveness of unilateral extrapedicular approach in the treatment of osteoporotic compression fracture, as compared to transbipedicular approach. SUMMARY OF LITERATURE REVIEW: There has been no comparative study assessing this topic. MATERIALS AND METHODS: 115 patients presenting with percutaneous vertebroplasty between Mar. 2002 and Feb. 2009, were divided into three groups: Group A (43 vertebrae; 29 patients) who were treated with bipedicular approach, Group B (66 vertebrae; 47 patients) treated with early cases of unilateral extrapedicular approach, and Group C (43 vertebrae; 39 patients) treated with late cases of unilateral extrapedicular approach. We analyzed radiological test results including the volume of injected cement and the distribution of intravertebral body, cement leakage, height restoration and kyphosis correction. Statistical analysis was done using SPSS. Clinical results were analyzed using VAS scores. RESULTS: The mean follow-up period varied from one year at minimum to seven years and six months at maximum. The mean volume of injected cement was 3.39cc/5.39cc/3.79cc for groups A, B and C respectively. Cement leakage was at 13.4/34.8/12.8% in each group. Cement leakage was higher in group B, but most leakage took place in early cases that we tried to inject more and more cement in early inexperienced period. Bilaterally well distributed cement in the vertebral body was at 85.7/76.9% in groups B and C respectively. VAS scores improved from 8.4/8.3/8.5 preoperatively to 2.0/2.0/1.6 postoperatively. CONCLUSIONS: Percutaneous vertebroplasty treated with unilateral extrapedicular approach can lessen perioperative operating time. This treatment led to clinical and radiologic results that were comparable to those with a bilateral transpedicular approach.

Deep Vein Thrombosis after Fusion Operation of Osteoporotic Spinal Compression Fracture / 대한골다공증학회지

The risk of deep vein thrombosis (DVT) is well studied for some orthopedic surgery. However, the incidence of postoperative DVT is less well-defined in patients who have spinal surgery. In addition, there is insufficient evidence to suggest that screening patients before spinal surgery and to use of prophylactic method such as anticoagulants, compression stockings, and pneumatic compression device. We experienced a 78-year-old female patient of DVT after fusion operation with pedicular screws in T12 osteoporotic compression fracture. As risk of DVT after major spinal surgery is fairly low, it seems reasonable to consider prophylactic management after spinal surgery in old aged patients with difficult ambulation.

Effectiveness of Facet Joint Injection for Treatment of Acute Osteoporotic Vertebral Compression Fracture / 대한골다공증학회지

OBJECTIVES: To evaluate the effectiveness of facet joint injection for acute phase of osteoporotic vertebral compression fracture as alternative method for vertebrolplasty. MATERIALS AND METHODS: From January 2001 to May 2007, a total 275 patient of osteoporotic vertebral compression fracture treated with conservative treatment or facet joint injection were selected. We divided all patients into two groups as treated only conservative treatment or facet joint injection. RESULTS: In comparison, group of patient who took facet joint injection showed significantly increased effects than the other group in pain, using pain controller and activity (P<0.05). Group of patient who took conservative treatment, are treated with vertebroplasty in 52 patients, are showed the loss of height in vertevral body in 4 patients. Group of patient who took facet joint injection, are treated with vertebroplasty in 43 patients, are showed the loss of height in vertevral body in 29 patients. There was no complication with facet joint injection or vertebroplasty. CONCLUSIONS: Facet joint injection is the effective and stable technique for acute pain on acute osteoporotic vertebral compression fracture. The loss of height in vertevral body is more frequent at group of patient who took facet joint injection.

The Effect of Early Percutaneous Vertebroplasty in Occult Osteoporotic Vertebral Fracture

OBJECTIVE: Recently, the definition of occult osteoporotic vertebral fracture has been established, and its clinical significance has come to our interest. We report the effect of early percutaneous vertebroplasty in occult osteoporotic vertebral fracture. METHODS: From January 2006 to January 2008, we performed percutaneous vertebroplasty for 50 levels in 47 patients. 21 levels (21 patients) of them were classified into occult osteoporotic vertebral fracture group, 29 levels (26 patients) were categorized into control group (not occult osteoporotic vertebral fracture) by the Pham T..s criteria. We obtained VAS score and measured the compression ratio at first hospital day and 1 day, 1 month, 3 months after procedure. RESULTS: There are noticeable improvements in VAS score. The mean VAS score at admission was 6.44 in occult group and 6.15 in control group, which changed 2.23 in occult group and 2.68 in control group after procedure. The compression rate was 1.008, 1.018, 1.016 in occult group and 0.862, 0.891, 0.881 in control group at admission and 1 month, 3 months after procedure. The conservative effect for vertebral height was higher than control group (p=0.011). CONCLUSION: Percutaneous vertebroplasty in occult osteoporotic compression fracture provided significant pain relief and conservative effect for vertebral height. It is probable that it can lower the rate of secondary adjacent vertebral compression fracture.

Balloon Kyphoplasty through Extrapedicular Approach in the Treatment of Middle Thoracic Osteoporotic Compression Fracture : T5-T8 Level

OBJECTIVE: Kyphoplasty performed in the middle thoracic spine presents technical challenges that differ from those in the lower thoracic or lumbar region due to small pedicle size and angular severity for thoracic kyphosis. The purpose of this study was to evaluate the efficacy of balloon kyphoplasty through extrapedicular approach for the treatment of intractable osteoporotic compression fractures in the middle thoracic spine. METHODS: The patients who were performed with one level balloon kyphoplasty through extrapedicular approach due to painful osteoporotic compression fractures at T5-T8 from June 2003 to July 2005 were retrospectively analyzed. Imaging and clinical features were analyzed including involved vertebrae level, vertebral height, injected cement volume, clinical outcome and complications. RESULTS: Eighteen female patients (age ranged from 60 to 77 years old) were included in this study. The average amount of the implanted cement was 4.2+/-1.5 cc. The mean cobb angle and compression rate were improved from 12.1+/-6.5 degrees to 8.5+/-7.2 degrees and from 30% to 15%, respectively. The mean pain score (visual analogue scale) prior to kyphoplasty was 7.9 and it decreased to 3.0 after the procedure. Cement leakage to the adjacent disc (2 cases) and paravertebral soft tissues (1 case) were seen but there were no major complications such as pneumothorax, segmental artery injury, pulmonary embolism, or epidural leakage. CONCLUSION: Balloon kyphoplasty through extrapedicular approach is considered as a safe and effective in treating the middle thoracic regions with low complication rate.

Comparison between Vertebroplasty and Kyphoplasty in Osteoporotic Vertebral Compression Fractures / 대한정형외과학회잡지

PURPOSE: To compare the outcome of vertebroplasty with kyphoplasty in the treatment of painful osteoporotic vertebral compression fractures. MATERIALS AND METHODS: From May 2002 through April 2004, 55 patients were analyzed. Vertebroplasties were performed on 29 patients under local anesthesia. The patients were divided into two groups: group I consisted of 15 patients who underwent vertebroplasties within two weeks from the onset of the fractures; group II consisted of 14 patients who underwent kyphoplasties after two weeks from the onset of the fractures. Kyphoplasties were performed on 26 patients under general anesthesia. These patients were also divided into two groups, based on the same criteria as those patients who underwent vertebroplasties. For the radiological assessment, we measured the kyphotic angle with Cobb's method and the reduction rate in the anterior, middle, and posterior portions of the vertebral bodies. The clinical results were assessed with the Oswestry Disability Index and Visual Analogue Scale. RESULTS: The reduction rates of the anterior and middle portions of the vertebral bodies were greater than 50 % in patients who underwent vertebroplasties within two weeks from the onset of the fractures and the patients who received kyphoplasty. The reduction rates of the anterior and middle parts of the vertebral bodies in patients who underwent vertebroplasties after two weeks from the onset of the fractures, was much less than in other three groups. There were no significant differences in clinical comparison among the 4 groups: i.e., all the patient had satisfactory results in terms of pain relief and pre-fracture activity levels. CONCLUSION: We obtained better results from kyphoplasties when we compared vertebroplasties with kyphoplasties, regardless of the operation dates. However, when we performed vertebroplasties within two weeks from the onset of the fractures, we obtained radiological results that were similar to those with kyphoplasties. In clinical comparison, there were no statistically significant differences among the 4 groups. The pain scores improved dramatically after the operations and pre-fracture activity levels resumed.

Vertebroplasty for the Treatment of Compression Fractures in the Upper and Middle Thoracic Spine / 대한통증학회지

BACKGROUND: Vertebroplasty that is performed in the upper and middle thoracic spine presents technical challenges that are different from those in the lower thoracic or lumbar region due to the small pedicle size and angular severity for thoracic kyphosis. We report the results of percutaneous vertebroplasty and review its effectiveness in treating intractable osteoporotic compression fractures in the upper and middle thoracic spine. METHODS: Patients who underwent vertebroplasty due to painful osteoporotic compression fractures at T3-T8 were retrospectively analyzed. The compression rate, volume of injected cement, clinical outcome (VAS score) and complications were analyzed. RESULTS: Forty-three vertebral bodies from 41 patients (32 females and 9 males, age from 64 to 78 years old) underwent vertebroplasty. The mean compression rate improved from 35% to 17%. Bipedicular injections of bone cement were performed at 3 levels of 2 patients, and unipedicular injections were performed in 40 levels of 39 patients. The mean VAS score prior to surgery was 7.7, which improved to 2.4 within 48 hours after surgery, and the mean VAS score after 6 months was 1.5, which was significantly lower. All patients recovered uneventfully, and the neurological examination revealed no deficits. Cement leakage to the adjacent disc (9 levels) and paravertebral soft tissues (10 levels) developed. However, there were no significant complications related to the procedure such as a pneumothorax or pulmonary embolism. CONCLUSIONS: Transpedicular vertebroplasty is a safe and effective treatment for the upper and middle thoracic regions, and has a low complication rate.

Vertebroplasty in the Treatment of Osteoporotic Compression Fracture: More Than 1 Year Follow Up

PURPOSE: To assess the clinical and functional outcome of the patients who underwent percutaneous vertebroplasty with bone cement for the osteoporotic compression fracture and who had been followed up for minimum 1 year. MATERIALS AND METHODS: Among 110 patients who had been undergone percutaneous vertebroplasty with bone cement for osteoporotic compression fracture in Gangneung Asan Hospital from January 2001 to August 2002, 75 patients who had been followed up for more than 1 year were selected. And retrospectively, we analyzed the clinical and radiographic finding of 1 year, 2 year and 3 year follow-up. The patients were divided into 3 groups, the first group who have follow-up period of the from 1 to 2 years had 75 patients, the second group who the from 2 to 3 years, 49 patients, and the third group who the more than 3 years, 20 patients. We graded the clinical results to excellent, good, normal, fair and poor. Also, we assessed the height of vertebral body, the adjacent vertebral body fracture and the leakage of bone cement. RESULTS: 74 patients (98.6%) had the excellent or good results postoperatively. 69 patients (92%) of the first group, 46 patients (93.8%) of the second group and 16 patients (80%) of the third group had excellent or good results at last follow-up. There was no statistical correlation of each groups (p>0.05). In first group, the average height of body was 71.1% preoperatively, 73.5% postoperatively and 73.5% at follow-up. In second group, 71.5%, 75.5%, and 73.1%. In third group, 71.2%, 78.0% and 77.8%. There was no significant statistical correlation of each groups (p>0.05). 47cases (38.8%) had some leakage of cement immediate postoperatively. In 4 cases (7 vertebra), there were adjacent vertebral body fractures. CONCLUSION: Based on the results of our study, percutaneous vertebroplasty is a useful method in the treatment for the osteoporotic compression fracture of vertebra body.

Complication of the Augmented Vertebral Body after Percutaneous Vertebroplasty in Patients with Osteoporotic Compression Fracture: Hammer Effect: Preliminary Report

OBJECTIVE: Percutaneous vertebroplasty has been known to be one of the most effective procedure for the treatment of osteoporotic vertebral compression fractures, providing immediate relief of the pain and early mobilization. The goal of this study is to find out the influence of the augmented vertebral body on the adjacent bodies after percutaneous vertebroplasty. METHODS: One hundred and thirty-two patients with osteoporotic vertebral compression fractures were treated with percutaneous vertebroplasty from 1998 to 2000. 10 patients were suffered from severe back pain without any obvious traumatic event during the follow-up period and underwent magnetic resonance(MR) images. RESULTS: Despite of absence of the traumatic events, MR imagies showed compression fracture of the adjacent vertebral body with low signal on T1WI. Among 10 patients, percutaneous vertebroplasty was repeated in 8 patients, One case was treated with conservative treatment and 1 case with refusal of vertbroplasty. All patients result in good relief of the pain except refusal case. CONCLUSION: Our preliminary results suggest that the spontaneous vertebral compression fracture might be developed due to'Hammer effect'without any obvious traumatic event after percutaneous vertebroplasty in osteoporosis.

Frequency of Vertebral Compression Fractures in Spinal Osteoarthritis Patients in Relation to Bone Mineral Density / 대한류마티스학회지

OBJECTIVE: To investigate the association between bone mineral density (BMD) and osteoporotic compression fractures in radiographic spinal osteoarthritis (OA) patients. METHODS: Subjects were 382 female patients (ages 45 to 85) from outpatient clinic for osteoporosis and rheumatic diseases. BMD was measured at lumbar spine and hip by dual X-ray absorptiometry (Hologic QDR 2000). The standard anteroposterior and lateral plain radiographs of thoracic and lumbar spine were taken to define spinal OA and vertebral compression fractures. Radiographic spinal OA was defined by grade of disc degeneration and facet joint degeneration. Frequency of vertebral fractures was compared between spinal OA and control patients in relation to their BMD, age, weight, body mass index (BMI) and years post menopause. RESULTS: Higher proportion of fracture cases were observed in spinal OA patients than non-spinal OA patients (34.1%, 44/129 vs. 18.2%, 46/253, p<0.001) despite comparable mean BMD (0.836+/-0.152 vs. 0.834+/-0.185, p=0.89) and older mean age (65.8+/-8.5 vs. 57.8+/-10.3, p<0.001). In subjects of ages from 65 to 74, spinal OA patients showed significantly higher BMD than non-spinal OA patients (0.784+/-0.125 vs. 0.719+/-0.119, p=0.007), but the frequency of fractures seems to be higher than that of non-spinal OA patients (44.9%, 22/50 patients vs. 34%,19/55 patients, p=0.58). When all study subjects were stratified according to their spine BMD (normal, osteopenia, and osteoporosis), significantly higher proportion of vertebral compression fractures was noted in spinal OA than non-spinal OA patients in osteopenia group (38.5% vs. 13.5%, p<0.001). CONCLUSION: Higher BMD does not seem to be translated directly into decreased risk of osteoporotic compression fractures in spinal OA patients. Careful assessment of risk factors for osteoporotic fractures and newer methods for assessing bone strength in this group of patients are needed.