Percutaneous Vertebroplasty of the Entire Thoracic and Lumbar Vertebrae for Vertebral Compression Fractures Related to Chronic Glucocorticosteriod Use: Case Report and Review of Literature

Glucocorticosteroid-induced osteoporosis is the most frequent of all secondary types of osteoporosis, and can increase the risk of vertebral compression fractures (VCFs). There are promising additions to current medical treatment for appropriately selected osteoporotic patients. Few studies have reported on the efficiency of percutaneous vertebroplasty (PVP) or kyphoplasty for whole thoracic and lumbar glucocorticosteroid-induced osteoporotic vertebral compression fractures. We report a case of a 67-year-old man with intractable pain caused by successional VCFs treated by PVP.

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.

Lordoplasty: An Alternative Technique for the Treatment of Osteoporotic Compression Fracture

We report here on a new technique using polymethylmethacrylate to manage vertebral osteoporotic compression fractures in three patients. These patients presented with acute back pain that manifested itself after minor trauma. Osteoporotic compression fractures were diagnosed via plain X-ray and magnetic resonance imaging studies. The patients were treated with absolute bed rest and non-steroidal anti-inflammatory drugs. Despite of the conservative treatment, the patients experienced severe, recalcitrant and progressive pain. The vertebrae were collapsed over 50% or kyphotic deformity was seen on the radiologic materials. We performed a new technique called lordoplasty, which is derived from percutaneous vertebroplasty. The patients experienced a reduction in pain after the procedure. The wedge and kyphotic angles of the fractured vertebrae were significantly restored.

CT-Guided Percutaneous Vertebroplasty in the Treatment of an Upper Thoracic Compression Fracture

Percutaneous vertebroplasty (PVP) has been used to relieve pain and to prevent further collapse of the vertebral body in patients with an osteoporotic compression fracture. The most commonly affected site for the use of PVP is the thoracolumbar junction. There are few reports that have described on the usefulness of PVP in the treatment of a high thoracic compression fracture. We report a case of an upper thoracic compression fracture that was treated with computed tomography (CT)-guided PVP. It was possible to obtain easy access to the narrow thoracic pedicle and it was also possible to monitor continuously the proper volume of polymethylmethacrylate employed, under CT guidance.