Impact of intravertebral cleft on adjacent vertebral fractures after percutaneous vertebral augmentation / 中国医学影像技术

Objective: To investigate the impact of intravertebral cleft on adjacent vertebral fracture (AVF) after percutaneous vertebral augmentation. Methods: Data of 172 patients with osteoporotic vertebral compression fracture (OVCF) who underwent percutaneous vertebral augmentation were retrospectively analyzed. The patients were divided into intravertebral cleft group (n=37) and control group (n=135) according to the presence or absence of intravertebral cleft before operation. The operative information and postoperative imaging characteristics were compared between 2 groups, and the impact of intravertebral cleft on AVF was analyzed. Results: The incidence of AVF after vertebral augmentation in intravertebral cleft group (54.55%, 24/44) was significantly higher than that in control group (23.21%, 39/168, χ2=16.39,P50% (75.00%) was significantly higher than in those ≤50% (42.86%, χ2=4.24, P=0.04), but there was no statistical difference of the incidence of AVF among different fracture locations nor components (χ2=2.13, 0.27, both P>0.05). Conclusion: OVCF patients with intravertebral cleft are at increased risk of recurrence AVF after percutaneous vertebral augmentation, especially those with higher anterior wall height decreased ratio, postoperative bone cement mass distribution and bone cement-bone surface fluid signs and being required close follow-up observation.

Posttraumatic Delayed Vertebral Collapse : Kummell's Disease

Posttraumatic delayed vertebral collapse, known as Kummell’s disease, is increasing in number of patients. This disease is already progressive kyphosis due to vertebral collapse at the time of diagnosis and it causes intractable pain or neurologic deficit due to intravertebral instability. Treatment is very difficult after progression of the disease, and the range of treatment, in hospital day, and cost of treatment are both increased. Clinical features, pathogenesis and radiologic findings of these disease groups were reviewed to determine risk factors for delayed vertebral collapse. The purpose of this article is to suggest appropriate treatment before vertebral collapse for patients with osteoporotic vertebral compression fracture who have risk factors for posttraumatic delayed vertebral collapse.

Posttraumatic Delayed Vertebral Collapse : Kummell's Disease

Posttraumatic delayed vertebral collapse, known as Kummell’s disease, is increasing in number of patients. This disease is already progressive kyphosis due to vertebral collapse at the time of diagnosis and it causes intractable pain or neurologic deficit due to intravertebral instability. Treatment is very difficult after progression of the disease, and the range of treatment, in hospital day, and cost of treatment are both increased. Clinical features, pathogenesis and radiologic findings of these disease groups were reviewed to determine risk factors for delayed vertebral collapse. The purpose of this article is to suggest appropriate treatment before vertebral collapse for patients with osteoporotic vertebral compression fracture who have risk factors for posttraumatic delayed vertebral collapse.

Observation of clinical effects of percutaneous vertebroplasty in the treatment of vertebral compression fractures complicated with intravertebral clefts / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of percutaneous vertebroplasty(PVP)in the treatment of osteoporotic vertebral compression fractures complicated with intravertebral clefts.</p><p><b>METHODS</b>The clinical data of 176 patients with osteoporotic vertebral compression fractures underwent treatment from January 2013 to May 2016 were retrospectively analyzed. All the patients were treated by unilateral PVP procedure, 37 patients with intravertebral clefts. Seven cases were excluded according to the standard and 30 patients were internalized in the study. There were 14 males and 16 females, aged from 60 to 93 years old with an average of (77.73±9.33) years. The mean bone mineral density was (-3.16±0.48) SD (ranged from -2.3 to -4.1 SD). The Oswestry Disability Index(ODI), visual analogue scale (VAS) were analyzed before operation and 1 day, 3 months, 1 year after operation. The compression ratio of injured vertebrae was measured by X-ray before operation and 3 days, 3 months after operation.</p><p><b>RESULTS</b>All the operations were successful and all the patients were followed up more than 1 year. Postoperative at 1 d, 3 months, 1 year, VAS scores were obviously released (2.93±0.83, 2.07±0.58, 1.57±0.68, respectively) than preoperative 7.00±1.41(<0.01);and ODI scores were obviously improved (36.2±4.1, 22.9±6.7, 18.8±5.9, respectively) than preoperative 40.5±3.9(<0.01). Postoperative at 3 days, 3 months, vertebral height percent of injured vertebrae were (79.26±8.57)% , (77.68±8.96)% , respectively, which had obviously improvement compared to preoperative (72.00±12.14)% (<0.05).</p><p><b>CONCLUSIONS</b>PVP is an effective and reliable method in the treatment of osteoporotic vertebral compression fractures complicated with intravertebral clefts. It can effectively restore the height of the vertebral body, obviously improve the patient's pain and functional status.</p>

Risk Factors for Cement Loosening after Vertebroplasty for Osteoporotic Vertebral Fracture with Intravertebral Cleft: A Retrospective Analysis

STUDY DESIGN: Retrospective case-control study. PURPOSE: To evaluate the primary outcomes and radiographic results of percutaneous vertebroplasty (PVP) in patients with singlelevel osteoporotic vertebral fracture (OVF) with intravertebral cleft (IVC) to identify the risk factors for cement loosening after PVP. OVERVIEW OF LITERATURE: PVP is a widely accepted method for managing painful OVF; however, cement loosening occasionally occurs with poor outcomes. METHODS: This retrospective study involved 195 patients treated with PVP for single-level OVF with IVC. Six months thereafter, the primary outcomes were evaluated using the Visual Analog Scale (VAS) for back pain and the modified Oswestry Disability Index. Computed tomography was conducted to detect cement loosening. Possible risk factors, such as age, sex, wedging angle, intravertebral instability, Parkinson’s disease, spinous process fracture, ankylosing spinal hyperostosis, split vertebrae, and adjacent intervertebral vacuum, were assessed. RESULTS: Forty-nine patients (25%) experienced cement loosening 6 months after PVP. The mean VAS scores were significantly higher in patients with cement loosening than in those without (50 vs. 26 mm, respectively; p < 0.01). Cement loosening was closely associated with intravertebral instability (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.04–1.40; p =0.015), Parkinson’s disease (OR, 54.31; 95% CI, 4.47–659.53; p =0.002), spinous process fracture (OR, 7.11; 95% CI, 1.65–30.60; p =0.009), and split vertebrae (OR, 11.59; 95% CI, 1.64–82.02; p =0.014). CONCLUSIONS: Patients with cement loosening experienced worse back pain than those without cement loosening. The important risk factors that influenced cement loosening after PVP were high intravertebral instability, Parkinson’s disease, spinous process fracture, and split vertebrae.

Infectious Spondylitis Mimicking Osteoporotic Vertebral Compression Fractures: Report of Two Cases

STUDY DESIGN: Case study of two cases. OBJECTIVES: The aim of our study is to describe the rare MR imaging patterns of infectious spondylitis. SUMMARY OF LITERATURE REVIEW: It is generally accepted that the intravertebral cleft sign is not shown in cases of infection or malignancy, and thus, its recognition can obviate unnecessary imaging or biopsy because of its benign significance. MATERIALS AND METHODS: Two patients are presented who developed worsening back pain after a minor trauma. Preoperative MR images of these patients showed intravertebral fluid and benign vertebral compression fractures. Anterior decompression and fusion were done and the bacteria isolated from the intraoperative cultures were Listeria monocytogenes and Mycobacterium tuberculosis, respectively. RESULTS: After 2 years of follow-up, the patients were free of pain, without signs of infection, and showed correct fusion. CONCLUSIONS: MR findings in infectious spondylitis may simulate the patterns of osteoporotic VCFs.

Usefulness of Prone Cross-Table Lateral Radiographs in Vertebral Compression Fractures

BACKGROUND: Dynamic radiographs are recommended to investigate non-healing evidence such as the dynamic mobility or intravertebral clefts in osteoporotic vertebral compression fractures (VCFs). However, it is difficult to examine standing flexion and extension lateral radiographs due to severe pain. The use of prone cross-table lateral radiographs (PrLRs) as a diagnostic tool has never been proposed to our knowledge. The purpose of this study is to clarify the usefulness of PrLRs in diagnosis and treatment of VCFs. METHODS: We reviewed 62 VCF patients examined with PrLRs between January 1, 2008 and June 30, 2011. To compare the degree of pain provoked between standing extension lateral radiographs (StLRs) and PrLRs, numeric rating scale (NRS) scores were assessed and compared by a paired t-test. Vertebroplasty was done for 40 patients and kyphoplasty was done for 9 patients with routine manners. To assess the degree of postural reduction, vertebral wedge angles (VWA) and vertebral height ratios (VHR) were calculated by using preoperative StLRs, PrLRs, and postoperative lateral radiographs. Two variables derived from changes in VWA and VHR between preoperative and postoperative radiographs were compared by a paired t-test. RESULTS: The average NRS scores were 6.23 +/- 1.67 in StLRs and 5.18 +/- 1.47 in PrLRs. The degree of pain provocation was lower in using PrLRs than StLRs (p < 0.001). The average changes of VWA between preoperative and postoperative status were 5.24degrees +/- 6.16degrees with PrLRs and 3.46degrees +/- 3.47degrees with StLRs. The average changes of VHR were 0.248 +/- 0.178 with PrLRs and 0.148 +/- 0.161 with StLRs. The comparisons by two variables showed significant differences for both parameters (p = 0.021 and p < 0.001, respectively). The postoperative radiological status was reflected more precisely when using PrLRs than StLRs. CONCLUSIONS: In comparison with StLR, the PrLR was more accurate in predicting the degree of restoration of postoperative vertebral heights and wedge angles, and provoked less pain during examination. The PrLR could be a useful diagnostic tool to detect intravertebral cleft or intravertebral dynamic instability.

Definition, Diagnosis, Pathophysiology and Treatment of Kummell's Disease / 대한골다공증학회지

Over 100 years ago, Hermann Kummell described a clinical condition in which patients sustained a trivial trauma, had essentially asymptomatic period lasting weeks to months, then developed a painful, progressive angular kyphosis. Since then, many post-traumatic delayed kyphosis have been reported as a Kummell's disease. As a radiologic finding of intravertebral cleft sign was related to this delayed collapse, this abnormal gas or fluid signal in the involved vertebral body was considered as a pathognomic sign. However, recent evidences indicate this delayed progressive collapse and kyphosis of the spine is related to osteoporotic spine fracture in many reports. At this point, by defining and reviewing the definition and etiology of Kummell's disease, we have to look into whether Kummell's disease is a distinct or rare pathophysiologic entity or a complicated clinical result of osteoporotic spine fracture. In this review, author tried to clearly define the definition and diagnosis criteria to diagnose Kummell's disease as a complicated osteoporotic spine fracture and review treatment modalities for this complicated clinical condition.

The Surgical Treatment of Osteoporotic Vertebral Collapse Caused by Minor Trauma / 대한정형외과학회잡지

With an aging population, osteoporotic vertebral collapse is an increasingly common condition. This compression fractures has been considered a benign entity, quite responsive to conservative treatment. In a rare patients, however, a major neurologic complication and painful kyphosis despite conservative treatment can develop. Therefore, the purpose of this present study is to analyze the surgical results of 14 patients with severe back pain, an increasing kyphosis and neurologic deficits caused hy osteoporotic vertebral collapse following minor trauma, who were treated surgically. Presenting signs and symptoms included severe back pain with progression of kyphosis in 6 patients and increasing neural deficit in 8 patients. Of 14 patients, eight patients had an intravertebral cleft sign (vacuum sign). Indications for surgery included increasing kyphotic deformity, intractable pain, or increasing neurologic deficit. There was no correlation between intravertebral cleft sign and neurologic deficit. However, patients who had intravertebral cleft sign had not well respond to conservative treatment. As treatments, combined anterior and posterior fusion in 8, anterior fusion in 4, posterior instrumentation, and wide decompressive laminectomry in one patient, respectively, were carried out. The final correction of the deformity averaged 0.3 degrees. Therefore. correction of kyphosis was not favorably maintained because of variable surgical methods, and sinking of graft bone or instrumentation into the osteoporotic vertebral bodies. However, pain was reduced significantly in all patients. In addition neurological symptoms improved in 7 patients. One patient underwent reoperation with nnterior inierbody tusion together with anterior instrument because of an increasing kyphosis, neurologic. iymptoms and scvcre hack pain following wide decompressive laminectomy. There was no complication relatecl to instruments. The authors strongly helieved that surgical intervention has highly satisfactory results in patients who have intravertehral cleft sign with persistent back pain despite conservative treatment, and proressive or persistent neurologic deficits following osteoporotic vertebral collapse.