Effects of conservative treatment of 2-week rigorous bed rest on muscle disuse atrophy in osteoporotic vertebral fracture patients / Journal of Rural Medicine

Objective: Osteoporotic vertebral fracture (OVF) is conventionally treated with conservative management such as bed rest, but a relatively prolonged bed rest has the potential risk of muscle disuse atrophy. This study aimed to examine whether the 2-week of rigorous bed rest affects muscle disuse atrophy in OVF patients.Patients and Methods: A total of 54 OVF patients (16 males; 38 females; mean age, 80.2 ± 9.2 years) were treated with an initial 2-week rigorous bed rest by hospitalization with persistent rehabilitation. Cognitive function, swallowing function, grip strength, and lower extremity circumference were evaluated at three-time points (admission, end of bed rest, and discharge).Results: Of the 51 patients who were able to walk independently before the injury, one patient (2.0%) had to use a wheelchair after the injury. During hospitalization, cognitive function decline was observed in 33.3% of patients, but not in patients with Revised Hasegawa’s Dementia Scale score ≥25 at admission. Swallowing function decline was observed in one patient, and none of the patients developed aspiration pneumonia during hospitalization. The grip strength significantly improved both at the end of bed rest (P=0.04) and discharge (P=0.02). Although the lower extremity circumference significantly decreased at the end of bed rest (P<0.01), it was recovered afterward. The lower extremity circumference did not significantly differ between the admission and discharge (P=0.17).Conclusion: Our results suggested that conservative treatment of OVF through an initial 2-week rigorous bed rest with persistent hospital rehabilitation poses a low risk of muscle disuse atrophy. If cognitive dysfunction is observed on admission, close monitoring for exacerbation should be performed during the hospital stay.

Relationship between vertebral instability caused by intravertebral clefts and neurologic injury / 中国组织工程研究

BACKGROUND: The details of clinical symptoms of osteoporotic vertebral fracture with intravertebral clefts are poorly understood at present. OBJECTIVE: To investigate the relationship between clinical symptoms and imaging features of osteoporotic vertebral fracture with intravertebral clefts. METHODS: Clinical data of 168 patients with single-level osteoporotic vertebral fracture with intravertebral clefts were retrospectively analyzed. The clinical symptoms were evaluated by Visual Analogue Scale score and Oswestry Disability Index. The incidence of delayed neurologic deficit was recorded. X-ray was used to measure the local kyphosis angle and vertebral instability, and CT was used to diagnose the posterior wall fracture of the vertebral body. The relationship between clinical symptoms and imaging features of osteoporotic vertebral fracture with intravertebral clefts was analyzed. RESULTS AND CONCLUSION: (1) The Visual Analogue Scale score and Oswestry Disability Index were 7.7±1.6 and (62.9±19.2)%, respectively. Delayed neurologic deficit occurred in 37 patients (22.0%). Local kyphosis angle and vertebral instability was (16.8±7.7)° and (7.9±4.4)°, respectively. The incidence of posterior wall fracture was 89.8%. (2) The Visual Analogue Scale and Oswestry Disability Index were significantly correlated with vertebral instability (r=0.33, P < 0.001; r=0.53, P < 0.001), but had weak correlation with local kyphosis angle (r=-0.16, P=0.03; r=-0.16, P=0.03). (3) The incidence of vertebral instability in patients with delayed neurologic deficit was significantly higher than that in patients without delayed neurologic deficit (P < 0.001), but there was no difference in local kyphosis angle between two groups (P=0.18). All patients with delayed neurologic deficit had posterior wall fracture, but only 2/3 patients with posterior wall fracture had delayed neurologic deficit. (4) In summary, vertebral instability is one of the factors leading to clinical symptoms of osteoporotic vertebral fracture patients with intravertebral clefts. The vertebral instability may be the main cause of delayed neurologic deficit. In order to treat back pain and delayed neurologic deficit effectively, it is important to control vertebral instability of osteoporotic vertebral fracture patients with intravertebral clefts.

Percutaneous Cement Vertebroplasty & Kyphoplasty: A Minimally Invasive Solution for Osteoporotic Vertebral Fracture

Introduction: Osteoporotic fracture is common among theelderly people. It occurs following minor trauma like slipping onthe floor or due to jolt while travelling in a vehicle on an unevenroad. It is usually associated with severe crippling local painwhich aggravates on movement, sitting or standing.Objective: Our goal in this study is to find out the outcome ofpercutaneous cement vertebroplasty & kyphoplasty forosteoporotic vertebral fracture.Methodology: This cross sectional study was carried out atDepartment of Neurosurgery, BMSSU, Dhaka from January2017 to June 2018 where 28 patients data were evaluated onthe basis of their history, clinical examination. Among thecases Per. Vertebroplasty was 23 and Balloon kyphoplastywas 5. 60% patients were female and 40% patients were male.The entered data were cross-checked and confirmed.Results: Percutaneous vertebroplasty is a minimally invasiveprocedure with very good results for the treatment of severepain due to vertebral compression fracture. It providessignificant pain relief with the potential for improving functionaloutcome.Conclusion: Percutaneous vertebroplasty and balloonkyphoplasty not only relives pain instantly but can also restorevertebral height.

Unilateral Biportal Endoscopy as a Treatment for Acute Radiculopathy after Osteoporotic Lumbar Compression Fracture: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To document unilateral biportal endoscopy (UBE) as a treatment for acute radiculopathy after osteoporotic vertebral fracture. SUMMARY OF LITERATURE REVIEW: Acute radiculopathy after osteoporotic vertebral fracture leads to claudication. Treatment of osteoporotic vertebral fractures with accompanying radiating pain is challenging. MATERIALS AND METHODS: A 74-year-old woman was diagnosed with an osteoporotic vertebral fracture at L3 after slipping and falling. Vertebroplasty was performed for the osteoporotic vertebral fracture at L3. She still complained of right lower extremity radiating pain. UBE was performed to treat acute radiculopathy. RESULTS: Foraminal decompression using UBE was performed at the L3–4 right foraminal area. Her symptoms resolved after surgery. CONCLUSIONS: UBE is a useful treatment method for acute radiculopathy after osteoporotic vertebral fracture.

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.

What Effects Does Necrotic Area of Contrast-Enhanced MRI in Osteoporotic Vertebral Fracture Have on Further Compression and Clinical Outcome?

OBJECTIVE: The objective of this study was to analyze the correlation between further compression and necrotic area in osteoporotic vertebral fracture (OVF) patients with contrast-enhanced magnetic resonance imaging (CEMRI). In addition, we investigated the radiological and clinical outcome according to the range of the necrotic area. METHODS: Between 2012 and 2014, the study subjects were 82 OVF patients who did not undergo vertebroplasty or surgical treatment. The fracture areas examined on CEMRI at admission were defined as edematous if enhancement was seen and as necrotic if no enhancement was seen. The correlation between further compression and the necrotic and edematous areas of CEMRI, age, and bone mineral density was examined. Also, necrotic areas were classified into those with less than 25% (non-necrosis group) and those with more than 25% (necrosis group) according to the percentages of the entire vertebral body. For both groups, further compression and the changes in wedge and kyphotic angles were examined at admission and at 1 week, 3 months, and 6 months after admission, while the clinical outcomes were compared using the visual analog scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status grade. RESULTS: Further compression was 14.78±11.11% at 1 month and 21.75±14.43% at 6 months. There was a very strong correlation between the necrotic lesion of CEMRI and further compression (r=0.690, p<0.001). The compression of the necrosis group was 33.52±12.96%, which was higher than that of the non-necrosis group, 14.96±10.34% (p<0.005). Also, there was a statistically significantly higher number of intervertebral cleft development and surgical treatments being performed in the necrosis group than in the non-necrosis group (p<0.005). Moreover, there was a statistical difference in the decrease in the height of the vertebral body, and an increase was observed in the kyphotic change of wedge angle progression. There was also a difference in the VAS and ECOG performance scales. CONCLUSION: The necrotic area of CEMRI in OVF had a strong correlation with further compression over time. In addition, with increasing necrosis, intervertebral clefts occurred more frequently, which induced kyphotic changes and resulted in poor clinical outcomes. Therefore, identifying necrotic areas by performing CEMRI on OVF patients would be helpful in determining their prognosis and treatment course.

Surgical techniques and clinical evidence of vertebroplasty and kyphoplasty for osteoporotic vertebral fractures

Osteoporotic vertebral fracture is a disease condition with high morbidity and mortality, whose prevalence rises with mean increase in the life span. Conventional treatments for an osteoporotic vertebral fracture include bed rest, pain medication and brace implementation, but if the patient's pain is severe, cement augmentation procedures, including vertebroplasty and kyphoplasty, are performed. Vertebroplasty and kyphoplasty are relatively easy procedures that have been reported to be effective in controlling acute pain. But, the risk of complication and additional adjacent segment fracture and their superiority over conventional treatment remain debatable. Therefore, the authors have summarized the procedures, complications, and clinical evidence of vertebroplasty and kyphoplasty in this review.

Effect of Smoking on Osteoporotic Vertebral Fracture in Postmenopausal Women

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the association between smoking and osteoporotic vertebral fractures (OVFs) in postmenopausal women. SUMMARY OF LITERATURE REVIEW: Several studies have examined the relationship of smoking with hip fractures, but few studies have analyzed the relationship of smoking with spine fractures in women thus far. MATERIALS AND METHODS: This study considered 1255 postmenopausal women aged 50 years and older (enrollment from April 2008 to January 2009) from 62 study sites in a nationwide hospital. The amount of smoking was calculated in pack-years. Further, OVFs were diagnosed using a semi-quantitative method. To analyze the relationship between smoking and OVFs, we used a paired t-test, a χ2-test, and a binary logistic regression analysis. RESULTS: The past history of smoking was 7.2% in the patient group and 4.3% in the control group (p=0.025). The mean pack-years of smoking was 0.34 in the control group and 0.62 in the patient group (p=130). The mean T-score in the lumbar bone mass density (BMD) was –1.64 in the control group and –2.19 in the patient group (p=0.409). Smoking was a risk factor of vertebral fractures in postmenopausal women (odd's ratio=1.68, 95% confidence interval=1.020–2.759, p=0.042) irrespective of the lumbar BMD and the medical treatment for osteoporosis and obesity. CONCLUSIONS: Smoking is a risk factor for osteoporotic vertebral fractures in postmenopausal women independently without regard to lumbar BMD. Therefore, cessation of smoking is important for the prevention of OVFs in postmenopausal women.

Percutaneous Vertebroplasty: A First Line Treatment in Traumatic Non-Osteoporotic Vertebral Compression Fractures

STUDY DESIGN: This was a prospective cohort study. PURPOSE: The purpose of this study was to document and evaluate the clinical and radiological results of percutaneous vertebroplasty (PV) as a first line treatment in traumatic non-osteoporotic vertebral compression fractures (TNVCFs). OVERVIEW OF LITERATURE: PV is commonly used for osteoporotic and neoplastic compression fractures, however its use in traumatic non-osteoporotic compression fractures is uncertain. METHODS: We included 23 patients with traumatic non-osteoporotic TNVCFs and normal bone mineral densitometry scores who were treated with PV. Pain was evaluated at 2 hours, 1 week, 1 month, 6 months, 1 year, and 2 years post procedure using the 10-point visual analogue scale (VAS). Ronald-Morris disability Questionnaire (RDQ) scores were also collected. Statistical analysis included a 2-tailed t test comparing postoperative data with preoperative values. Range of mobility was also evaluated. RESULTS: The 23 patients had an average age of 36 years, and 69.5% were female. There was a significant improvement in VAS scores of pain at rest and in motionand in RDQ scores (p<0.05). CONCLUSIONS: The results of this study proved that PV can be used successfully as a first line treatment in patients with non-osteoporotic compression fractures. It is also, an effective method to decrease pain, increase mobility, and decrease narcotic administration.

Minimum 7 Years Follow-up of Percutaneous Vertebroplasty in Osteoporotic Compression Fracture / 대한골다공증학회지

INTRODUCTION: Percutaneous vertebroplasty is effective surgical method for treating osteoporotic compression fracture. But there is a few data for long term follow-up clinical and radiologic result, especially injected cement features. We assessed the radiographic features of patients who underwent percutaneous vertebroplasty (PVP) in osteoporotic compression fractures with a minimum of 7 years follow-up retrospectively. 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 vertebras) were available for follow-up for over 7 years. We analyzed the radiologic outcome focused on injected 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. During the follow-up period, 81 patients (44.5%) in 182 patients died. 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 12.3degrees at the preprocedural state to 11.7degrees 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. CONCLUSION: PVP for osteoporotic compression fracture is an efficient procedure for pain relief by long term follow-up. The cement injected vertebrae showed stable radiologic progression without significant changes in vertebral height or kyphotic angle.

Quality of Life in Patients with Osteoporotic Vertebral Fractures

STUDY DESIGN: A case-control study. PURPOSE: To examine several dimensions of health-related quality of life (HRQL) in postmenopausal women with osteoporotic vertebral fractures, compared with a control group. OVERVIEW OF LITERATURE: Osteoporotic vertebral fractures are a major cause of morbidity among postmenopausal women. There have been many reports of a decrease in the quality of life in patients with osteoporotic vertebral fractures. However,few reports have analyzed which dimensions contribute to the decline in quality of life. METHODS: One thousand five hundred forty-five postmenopausal women aged 50 years and older from 17 study sites in nationwide hospitals were in enrolled in the study (between April 2008 and January 2009). HRQL was measured using the European Quality of Life 5 Domains (EQ-5D), and visual analogue scale (VAS). RESULTS: The average VAS of the case group was 57.80, and that of the control group was 64.10 (p=0.001). All domains of the EQ-5D score were significantly worse in the case group (p=0.001). Among the case group, the average VAS of the 559 patients (45%) who were operated on was 56.8, and that of the remaining 680 patients (55%) who were treated conservatively was 58.6 (p=0.135). Among the case group, the averages of each EQ-5D domain of the 559 patients (45%) who were operated on were: 1.87 in mobility, 1.81 in self-care, 1.99 in usual activities, 2.11 in pain, and 1.62 in anxiety or depression. Those of the 680 patients (55%) who were treated conservatively were: 1.72 in mobility, 1.60 in self-care, 1.76 in usual activities, 1.98 in pain, and 1.57 in anxiety or depression. Except for the domain of anxiety or depression, scores for the other domains were all significantly worse in the patients who were operated on (p=0.001). CONCLUSIONS: Health related quality of life in the patients with osteoporotic vertebral fractures was significantly worse in both the EQ-5D domains and VAS. Among the osteoporotic vertebral fracture patients, the patients who were operated on had a worse quality of life in EQ-5D.

Is Kyphoplasty Necessary?

We describe four cases of delayed union in female patients with severe osteoporotic vertebral fractures, which were treated in a similar but less costly method to kyphoplasty. Due to domestic regulations, inflatable tamps for kyphoplasty are not available to every clinical orthopedists in Japan. In our clinical experience of four cases of delayed lumbar spine union between 2009 and 2010, we performed vertebroplasty using a reduction and spreading prod (Oyamada prod) for fracture reduction and a pediatric uromatic balloon (Medicon Co. Ltd.) to enlarge the pre-existing cavity. Our clinical results were comparable to those of kyphoplasty procedures performed in the USA. Our procedure could be used to overcome the shortage of medical supplies in developing countries or in countries such as Japan, which often prioritize financial concerns over providing optimal health care. Our method could serve as a useful compromise for moribund patients considering its cost efficiency.

The Influence of Fat Infiltration of Back Extensor Muscles on Osteoporotic Vertebral Fractures

STUDY DESIGN: Retrospective study. PURPOSE: To investigate the influence of fat infiltration at low back extensor muscles on osteoporotic vertebral fracture. OVERVIEW OF LITERATURE: In persons with stronger back muscles, the risk of osteoporotic vertebral fractures will likely be lower than in those persons with weaker back muscles. However, the degree of influence of fat infiltration of the back extensor muscle on osteoporotic vertebral fracture remains controversial. METHODS: Two hundred and thirty-seven patients who had undergone lumbar spine magnetic resonance imaging and bone mineral density (BMD) were enrolled in this study. The amount of low back extensor muscle was determined using the pseudocoloring technique on an axial view of the L3 level. The patients were divided into two groups: osteoporotic vertebral fracture group (group A) and non-fracture group (group B). The amount of low back extensor muscle is compared with BMD, degenerative change of disc, osteophyte grade of facet joint and promontory angle to reveal the association between these factors. RESULTS: A negative correlation is found between age and the amount of low back extensor muscle (p=0.001). The amount of low back extensor muscle in group A and group B was 60.3%+/-14.5% and 64.2%+/-9.3% respectively, thus showing a significantly smaller amount of low back extensor muscle in the osteoporotic vertebral fracture group (p=0.015). CONCLUSIONS: Fat infiltration of low back extensor muscle was increased in osteoporotic vertebral fracture patients. Therefore, fat infiltration of low back extensor muscle in an elderly person may be a risk factor of osteoporotic vertebral fracture.

Long-term Follow-up of Percutaneous Vertebroplasty in Osteoporotic Compression Fracture: Minimum of 5 Years Follow-up

STUDY DESIGN: This was designed as a retrospective study. PURPOSE: We assessed the radiographic and clinical outcome of patients who underwent percutaneous vertebroplasty (PVP) in osteoporotic compression fractures with a minimum of 5 years follow-up. OVERVIEW OF LITERATURE: Percutaneous vertebroplasty is effective surgical method for treating osteoporotic compression fracture. METHODS: Between January 2000 and August 2005, 159 patients were treated with PVP for osteoporotic compression fracture at our department; 43 patients died during follow-up, and 69 patients (121 vertebras) were available for follow-up for over 5 years. We analyzed the clinical and radiologic outcome including cement feature. RESULTS: The mean follow-up period was 5.7 years. Clinical outcome by mean visual analogue scale (VAS) score revealed a decreased 4.9 points perioperatively. A decreased score was maintained over 5 years in 46% of patients. A new adjacent vertebral fracture was documented by 33 vertebral bodies in 22 patients. During the follow-up period, 43 patients (38%) in 112 patients died. Anterior body heig ht 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 12.3degrees at the preprocedural state to 11.7degrees at the postprocedural state, but was not statistically significant (p > 0.05). CONCLUSIONS: PVP for osteoporotic compression fracture is an efficient procedure for pain relief by long term follow-up. The cement injected vertebrae showed stable radiologic progression without significant changes in vertebral height or kyphotic angle.

Survival Analysis of Conservative Treatement in Osteoporotic Vertebral Fracture

STUDY DESIGN: Prospective study. OBJECTIVES: To define the prognostic factors by analyzing the survival rates of osteoporotic vertebral fracture treated by conservative management. SUMMARY OF THE LITERATURE REVIEW: Due to an increasing elder population, many recent studies of osteoporosis have been done; pointing out that osteoporotic vertebral fracture may produce serious complications. However, there is nothing obviously demonstrated in both the management and prognosis of the osteoporotic vertebral fracture. MATERIALS AND METHODS: Survival analysis was done for 130 patients who had undergone conservative management for a single level vertebral fracture. Univariant and multivariant survival analysis was done for age at trauma, sex, body mass index (BMI), bone mineral density (BMD), smoking, diabetic history, fracture level, fracture type, vertebral compression ratio and regional Cobb's angle. RESULTS: Survival rate for conservative management was 70.7%. Univariant analysis for survival rate revealed significantly inferior results for age over 78 (p=0.008), T score< -3.5 (p=0.047), and crush or biconcave type than wedge type (p=0.021). Only the age factor showed significance in multivariant analysis (p=0.025, Hazard ratio=2.08). CONCLUSION: Conservative management in a single level osteoporotic vertebral fracture, showed a survival rate of 70.7% and age was the most important factor in conservative management. We should notice that age of more than 78 years is at high risk for failure in conservative management of vertebral fracture.

Minimally Invasive Treatment of Painful Osteoporotic Vertebral Fractures

The consequences of osteoporotic vertebral compression fractures are pain, progressive vertebral collapse with resultant kyphosis, and systemic manifestations. Minimally invasive stabilization procedures such as vertebroplasty and balloon kyphoplasty have been introduced to treat for refractory pain due to these fractures. Vertebroplasty and kyphoplasty are new alternatives for the treatment of osteoporotic vertebral compression fractures. Both methods stabilize the fractured vertebra with polymethylmethacrylate cement to relieve pain and allow immediate mobilization. Kyphoplasty is an extension of vertebroplasty that uses an inflatable bone tamp to restore the vertebral body height while creating a cavity to be filled with bone cement. A large proportion of subjects had some pain relief both in vertebroplasty and kyphoplasty. Vertebral height restoration was possible using kyphoplasty and for a subset of patients using vertebroplasty. Cement leaks occurred in both groups but, the incidence of cement leakage in kyphoplasty is lower than that of the vertebroplasty. Vertebroplasty and kyphoplasty are safe and effective procedures. Good short-term results have been reported following both vertebroplasty and kyphoplasty for the painful osteoporotic vertebral fractures. Severe complications result from bone cement leakage into the spinal canal or the vascular system have been reported but the incidence was very rare. Both vertebroplasty and kyphoplasty offer therapeutic benefit significantly reducing pain and improving mobility in patients with vertebral fracture without significant differences between groups in term of quality. While early results are promising, more research is needed to better understand the log-term effects of both procedures on the human spine.

Long Term Use of Glucocorticoid Induced Osteoporotic Multiple Compression Fractures in Autoimmune Diseases / 대한류마티스학회지

Reduced bone mineral density precedes the development of vertebral fractures in patients under long term glucocorticoid therapy. Osteoporosis is a frequent complication in steroid-dependent patients, and the risk of developing vertebral fractures in these patients is much higher than involutional osteoporosis. We described a 54-year-old patient who presented with autoimmune hepatitis and had a 6-year history of steroid medication. The patient had multiple compression fractures (T10~L5) without trauma, and was treated successfully with multi-level vertebroplasty and an intravenous injection of bisphosphonate without complications.

Kyphoplasty with Calcium Phosphate Cement (Calcibon(R)) in Osteoporotic Vertebral Fracture / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: We analyzed clinical and radiological results to verify the efficacy of calcium phosphate cement in kyphoplasty for treatment of osteoporotic vertebral fracture. SUMMARY AND LITERATURE REVIEW: Calcium phosphate is a biocompatible alternative to PMMA for vertebral augmentation in painful osteoporotic vertebral fracture as it is osteoconductive, non-exothermic, and injectable. MATERIALS AND METHODS: We analyzed 45 cases treated from April 2005 to August 2006 with a minimum of 1 year follow-up. Preoperative and post operative pain scores (visual analogue scale), ambulatory status, and patient satisfaction were measured. Anterior vertebral height, as well as the status and size of cement were assessed radiologically preoperatively, postoperatively, and at 3 months and 1 year. RESULTS: Pain scores (visual analogue scale) and ambulatory status improved significantly after kyphoplasty and remained unchanged during follow-up. Overall patient satisfaction was 93%. Radiological findings showed that mean vertebral height was significantly higher than preoperative (p<0.05). According to follow-up radiological finding, we divided cases into 4 groups: Group 1, 2; maintained vertebral height with minimal or some cement resorption; Group 3, 4; cement crack resorption and vertebral collapse. Group 1, 2 and Group 3, 4 had 38 patients (84%) and 7 patients(16%) respectively. Revision surgery was needed in 3 cases (antero-posterior surgery in 2 cases of group 4, and decompression in 1 case of extravasation into the neural canal). CONCLUSIONS: Kyphoplasty with calcium phosphate may be a good alternative for treatment of osteoporotic vertebral fracture, but non-union of the vertebral body with a large cleft showed a high risk of premature resorption and collapse of the vertebral body. The presumed advantage over PMMA needs longer follow-up.

Operative Treatment of Delayed Collapse of Osteoporotic Vertebral Fracture with Claudication: Transpedicular Bone Graft and Pedicle Screw Fixation / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the efficacy of transpedicular bone graft and pedicle screw fixation in delayed collapse of osteoporotic vertebral fracture with claudication. SUMMARY OF LITERTURE REVIEW: Delayed collapse of osteoporotic vertebral fracture may result in seemingly unrelenting back pain and neurologic deficits. Though there are many surgical options for such cases, comprehensive improvement of symptoms is uncertain. MATERIALS AND METHODS: Nineteen patients who underwent operation and were followed-up for more than 2 years were studied. The regional sagittal angle, restoration ratio of the vertebral body, standing sagittal balance, and additional fracture were assessed. Improvement of back and leg pain was assessed using 10 point Visual Analog Scales (VAS). The causes of sustained clinical symptoms were analyzed. RESULTS: The regional sagittal angle was corrected from 25.2+/-13.9degrees to 12.4+/-10.4degrees (p=0.000). The vertebral body ratio was restored from 36+/-14.1% to 72+/-16.7% (p=0.000). Six cases were found to be neutral and 13 cases showed a positive sagittal balance. Additional fractures were found in 11 cases. The VAS value for leg pain was improved from 6.6+/-1.0 to 1.0+/-1.1 (p=0.000), while that for back pain was not improved (6.4+/-1.7 to 7.1+/-2.3, p=0.474). Positive sagittal balance was a significant risk factor (p=0.037, odds ratio=58.084) for sustained back pain. CONCLUSION: For the treatment of delayed collapse of osteoporotic vertebral fracture with claudication, transpedicular bone graft and pedicle screw fixation was effective in improving claudication and restoring the vertebral body and regional sagittal angle. However, it was not capable of alleviating back pain. Positive sagittal balance was considered to be a cause of sustained back pain.

Differential diagnosis of acute from chronic osteoporotic vertebral fractures / 中国矫形外科杂志

[Objective]To investigate the differentiation of acute from chronic osteoporotic vertebral fractures.[Method]The clinical presentation,X-ray,CT and MRI of patients with osteoporotic vertebral fractures were evaluated in the study.[Result]In 36 cases,64% were identified as acute and 36% with chronic osteoporotic vertebral fractures.The decreased anterior vertebral height was a most important criterium for the diagnosis of osteoporotic vertebral fractures.Degenerative changes on the X-ray film were usually found in chronic fractures.A high intense signal in a specific T2 under eliminating fat tissue was always observed in acute fracture.[Conclusion]The local back pain located at the level of the fractured vertebral body suggests an acute vertebral fracture.Degenerative changes occurred in the edged vertebra is indicative of a chronic fracture.The finding of a specific T2 high intense signal under eliminating fat tissue on MRI is a gold standard for the diagnosis of an acute vertebral fracture.