Surgical options for delayed osteoporotic vertebral collapse / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the surgical options and clinical effects of delayed osteoporotic vertebral collapse.</p><p><b>METHODS</b>From May 2010 to October 2014, 19 patients (20 vertebrae) with delayed osteoporotic vertebral collapse(Kümmell's disease) were enrolled in this study. There were 7 males and 12 females, aged from 65 to 87 years old with a mean of (73.5±5.62) years. According to Li staging system of Kümmell's disease, 3 cases were stage II, 13 cases (14 vertebrae) were stage III without spinal cord injury, 3 cases were stage III with spinal cord injury. Patients were respectively treated with percutaneous vertebroplasty(PVP) or percutaneous kyphoplasty(PKP) on the basis of the degree of postural reduction during operation. Injected cement volume, cement leakage, vertebral height restoration and local kyphotic reduction were observed. Visual analogue scale (VAS) and Oswestry Disability Index(ODI) were respectively used to assess the pain and function before and after operation. Frankel grade were used to evaluate neurological status.</p><p><b>RESULTS</b>Seven vertebrae with satisfactory postural reduction were treated with PVP, 13 vertebrae with unsatisfactory postural reduction were treated with PKP, 3 patients with spinal cord injury were treated with decompression and posterior short segment fixation at the same time. All patients were followed up from 10 to 48 months with an average of 21.2 months. Cement leakage occurred in 4 cases with no symptom, 1 cases in PVP group and 3 cases in PKP group, there was no significant difference between two groups(=0.561). The priming volume of cement was (6.40±0.94) ml in PVP group and (5.46±1.09) ml in PKP group (>0.05). Three days after operation vs preoperation, the vertebral height restoration and kyphotic improvement was(31.71±11.35)%, (9.79±4.64)° in PVP group and (24.77±8.51)%, (8.15±2.97)° in PKP. There was no significant difference between two groups(>0.05). Three days after operation, VAS of low back pain and ODI in all patients were improved than preoperative data(<0.05), but there was no significant difference between two groups or between postoperative at 3 d and final follow up(>0.05). Nerve function of 3 patients underwent decompression and fixation from Frankel D to E.</p><p><b>CONCLUSIONS</b>According to Li staging system and the degree of introperative postural reduction, individualized surgical treatment for Kümmell's disease can obtain good clinical results. Bad postural reduction during operation maybe a risk factor of cement leakage.</p>

Nonoperative Treatment of Thoracolumbar Fractures without Neurological Deficit / 中国康复理论与实践

@#Objective To evaluate the clinical effect of postural reduction and bracing on thoracolumbar fractures without neurological deficit.Methods21 patients with thoracolumbar fractures(T11～L2

Percutaneous Vertebroplasty Following Postural Reduction in Unstable Vertebra Plana; Is it a Contraindication?

OBJECTIVE: Severe vertebral body collapse (vertebra plana) is considered a contraindication to vertebroplasty by most authors. The purpose of this study is to determine the efficacy of vertebroplasty in treating severe compression fracture patients with osteoporosis. METHODS: 16 patients underwent 18 vertebroplasties following postural reduction for vertebra plana. The fractures were defined vertebrae that have collapsed to more than 75% of their original height. Imaging and clinical features were analyzed, including involved vertebrae level, vertebral height after postural reduction for 2 days, injected cement volume, clinical outcome and complications. RESULTS: Involved veretebra were located from level T7 to L4. Vertebral body collapse averaged 79% (range 12~25%) of the original height. After pillow reduction for 2 days, vertebral body height increased 35% of the original height (range 15~45%). The kyphotic wedge was 12 degrees before procedure and was decreased 7.0 degree after vertebroplasty. The mean injected cement volume was 3.8 ml (range 2.0~4.9 ml). After the procedure, surgical outcome was excellent in 8 (50%) of 16 patients, good in 7 (42%) and unchanged in one (8%). The mean pain score (VAS score) prior to vertebroplasty was 8.3 and it changed 3.2 after the procedure. Cement leakage to the adjacent disc (5 cases) and paravertebral soft tissues (4 cases) developed but there were no major complications. CONCLUSION: We propose that vertebra plana due to osteoporosis is not a contraindication to vertebroplasty. Vertebroplasty following postural reduction for severe compression fracture is safe and effective treatment.

The Significance of Postural Reduction for Kyphotic Deformity in the Posterior Instrumentation of Unstable Burst Fracture / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the significance of the intraoperative postural reduction for kyphotic deformity in unstable burst fracture and confirm the relations of postural reduction and the final correction after loss of correction by posterior instrumentation. SUMMARY OF LITERATURE REVIEW: The loss of kyphotic correction after instrumentation in unstable burst fracture is found. Some methods have been developed to reduce the loss of correction. MATERIALS AND METHODS: 24 short-segment pedicle screw instrumentations in the patients with a unstable burst fracture were performed. We measured sagittal index, wedge angle of vertebral body and anterior vertebral height preoperatively, intraoperatively, postoperatively and at final follow-up. RESULTS: Sagittal index was 20.2 degrees preoperatively, 7.5 degrees intraoperatively, 0.9 degrees postoperatively and 7.2 degrees at final follow-up, so the loss of correction was 32.6%. Wedge angle of vertebral body was 20.3 degrees preoperatively, 10.1 degrees intraoperatively, 6.8 degrees postopera-tively and 9.4 degrees at final follow-up, so the loss of correction was 19.3%. Anterior vertebral height was 57.0%, 79.3%, 85.0%, and 78.8% respectively, so the loss of correction was 22.1%. The loss of correction occurred more in the disc space and less in the vertebral body itself. Postural reduction corrected 63% of sagittal index, 50% of wedge angle of vertebral body and 52% of anterior vertebral height. CONCLUSIONS: Postural reduction corrected kyphotic deformity appropriately. The correction by posterior instrumentation in unstable burst fracture was lost in some amount. The final correction was similar to the one by postural reduction. It is important to obtain the maximum postural reduction intraoperatively to prevent kyphotic deformity caused by loss of correction after surgery.

Postural Reduction in Compression Fracture of Spines

121 patients with cervical(45 patients), thoracolumbar(76 patients) compression or mild burst fractures from January 1984 to December 1994 were studied:98 patients were treated postural reduction with hyperextension posture and 23 patients were with postural reduction and surgical methods. We compared the initial and post-reduction compression height ratio, wedge angle and kyphosis angle of compression fractures. The results were not only expansion of a compressed vertebral body but also successful fusion. The neurological recovery status according to Frankel classification was also improved after postural reduction. Most of the compression fractures or stable burst fractures of the cervical, thoracolumbar spines can be restored by the postural reduction.

Postural Reduction for the Compression Fracture of the Thoracolumbar Spines

Postural reduction was performed in 20 cases of the closed thoracolumbar compression fracture using a soft pillow from January 1982 to June 1985. The results were summarized as following: 1) The compression fracture or mild burst fracture of the thoracolumbar spines can be restored by the postural reduction in hyperextension position using a soft pillow under the back of thoracolumbar junction. 2) The postural reduction resulted in not only expansion of a compressed vertebral body but also successful fusion. 3) It was most satisfactory when the postural reduction was performed as early as possible, at least within 1 week after injury. 4) The postural reduction is considered a simple and convenient treatment of the thoracolumbar compression fracture.