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.

Measurement of Vertebral Compression and Kyphosis in the Thoracolumbar and Lumbar Fractures

STUDY DESIGN: A retrospective radiologic study. OBJECTIVES: We wanted to compare the compression ratio and kyphosis of thoracolumbar and lumbar fractures according to the radiologic measuring methods and we wanted to analyze their relationship with the stability of fracture. SUMMARY OF THE LITERATURE REVIEW: There are several methods for measuring the compression ratio and kyphotic angle in thoracolumbar fractures, but no definitive measurements and no different values according to the stability have been established. MATERIALS AND METHODS: From July 2002 to August 2008, the plain films, CT, MRI and medical records of thoracolumbar and lumbar fracture were reviewed. The compression ratio and kyphotic angle were calculated by several different formulas with using the lateral view of the plain X-ray film, the sagittal reconstruction image of CT and the sagittal image of MRI and the results were compared. Each subject was classified according to both McAfee's classification and the TLISS classification. RESULTS: Two hundred forty eight vertebral bodies of 205 thoracolumbar fracture patients were analyzed. The compression ratio according to formula 1, which was calculated as 1-anterior vertebral height/posterior vertebral height, was significantly correlated with Cobb's angle and the local kyphotic angle. There was no significant difference between the Cobb's angle calculated using the lateral X-ray and that using the sagittal view of CT; however, it was significantly less using the sagittal MRI view. The unstable fractures according to McAfee's classification showed a significantly higher compression ratio and kyphotic angle compared to those of the stable fractures. CONCLUSIONS: The compression ratio formula 1 was most significantly correlated with the kyphotic deformity. The unstable fractures showed a mean compression ratio higher than 30%, a mean Cobb's angle of 15degrees and local kyphotic angle of 18degrees. The sagittally reconstructed CT was a useful measuring method for the evaluation of kyphotic deformity, and it was more accurate than that of the plain film.

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.

Effect of Percutaneous Vertebroplasty in Chronic Osteoporotic Compression Fracture of Thoracic and Lumbar Vertebra

OBJECTIVE: This study was conducted to assess the effect of percutaneous vertebroplasty in the patients with chronic osteoporotic compression fracture at the thoracic and the lumbar vertebra. METHOD: Twelve patients with chronic osteoporotic compression fracture of thoracic and lumbar vertebra were engaged in this study. Treated levels were from the ninth thoracic vertebra to the fifth lumbar vertebra. Effects were assessed on the first day, 1 month after treatment and the last follow up (average 164 days after vertebroplasty; range 60 days to 302 days) by visual analogue scale (VAS), McGill pain questionnaire (MPQ), and compression ratio of vertebral body. Complication rate was assessed. RESULTS: Significant improvement by VAS and MPQ was noticed on the first day, 1 month after treatment and the last follow up. Further vertebral height loss was not noticed on follow-up. CONCLUSION: Percutaneous vertebroplasty can be an effective treatment method in patients with chronic back pain due to osteoporotic compression fracture at the thoracic and the lumbar vertebra.

Ultrasonographic Study of Median Nerve after Carpal Tunnel Release

OBJECTIVE: To assess the median nerve compression with ultrasonography before and after the carpal tunnel release and to assess the correlation between electrophysiologic findings and ultrasonographic findings of the median nerve. METHOD: We studied 50 hands of 29 patients diagnosed as carpal tunnel syndrome electrophysiologically and 20 hands of 19 asymptomatic controls. We evaluated the flattening ratio and compression ratio through the short axis and long axis of the median nerve by ultrasonography before carpal tunnel release, 2 weeks and 3 months after release. The correlation of the improvement between the eletrophysiologic findings and compression ratio was analyzed. RESULTS: The compression ratio of the median nerve was decreased significantly after carpal tunnel release, compared with that before release. The decrease of the compression ratio correlated with the improvement of the electrophysiologic findings significantly. CONCLUSION: The ultrasonography is useful to follow up the median nerve after carpal tunnel release