Analysis of Osteoporotic Spinal Compression Fractures in Whole Spine Sagittal MR Images

OBJECTIVES: To analyze the fracture type and adjacency of accompanied fractures in acute osteoporotic spinal compression fracture using whole spine sagittal MRI (WS-MRI), and to know the relation of sagittal vertical axis (SVA), body mass index (BMI), and lumbar bone mineral density (BMD). METHODS: From June 2007 to December 2010, 167 patients who had acute spinal compression fractures confirmed by WS-MRI divide in three groups. 82 patients (M/F : 25/57) who had acute fractures only were in group 1, 79 patients who had acute and old fractures were in group 2, and 20 patients who had acute fractures after vertebroplasy were in group 3. To analyze the fracture type and adjacency of accompanied fractures in acute osteoporotic spinal compression fractures which combined chronic fracture or vertebroplasty using the WS-MRI and compared with the control group who had no spinal fractures measured the SVA. In all groups, we measured BMI, and BMD. RESULTS: In WS-MRI, 31 patients in group 1 had L1 which was the most common fracture site. Twenty two patients had chronic fractures and more than 3 remote levels at the acute fracture site in group 2 and especially among there 14 patients have each level in cervicothoracic and lumbar vertebrae. In group 3 had old fracture and adjacent fracture was 14 and 11 patients. Compared with the control group, all groups had increased SVA, especially in group 2 which has acute and chronic compression fractures. They have no significantly difference of BMI in each group, but group 2 and 3 had a significant lower BMD than group 1. CONCLUSION: Fourteen patients of coexisting fractures in acute osteoporotic spinal compression fractures with WS-MRI which could be missed in the conventional MRI. Additionally this study suggests that longer SVA causes sagittal imbalance, and BMD is more relative than BMI in refractures of chronic compression fracture patients.

Efficacy and Safety of Balloon Kyphoplasty in the Treatment of Osteoporotic Vertebral Body Compression Fractures: Compared with Vertebroplasty

OBJECTIVE: Kyphoplasty and vertebroplasty are two minimally invasive procedures for osteoporotic vertebral compression fractures. The purpose of this retrospective study was to compare the radiological findings and clinical outcomes between two procedures. METHODS: Osteoporotic vertebral fractures were treated in 76 vertebrae, using kyphoplasty (n=35 vertebrae) and using vertebroplasty (n=41 vertebrae). Fractured vertebral bodies were diagnosed by correlating the clinical symptoms with radiologic study. The responses of pain symptoms were measured by a self-reported Visual Analog Scale (VAS) score. Plain X-rays were checked preoperatively and postoperatively at admission and 6 months. The vertebral body height and kyphotic angle were measured to assess the reduction of the sagittal alignment. RESULTS: The mean pain scores were decreased significantly for both procedures postoperatively, but there were no significant differences between two groups. Kyphoplasty led to a significant reduction of the vertebral body height and improvement of kyphotic angle. There were no neurological deficits after kyphoplasty, but one patient experienced paraparesis after vertebroplasty. During the 6 months follow-up both procedures provided stabilization of the sagittal alignment. CONCLUSION: Kyphoplasty and vertebroplasty are considered effective minimally invasive techniques for the stabilization of osteoporotic vertebral body fractures, leading to a statistically significant reduction in pain. Kyphoplasty significantly restore sagittal alignment. Also, complications and the incidence of bone cement leakage are significantly lesser than vertebroplasty. Therefore, kyphoplasty seems to be reasonable procedure for osteoporotic vertebral body compression fractures when medical treatment fail.

The Effects of Facet Joint Injection in Osteoporotic Spinal Compression Fractures

OBJECTIVE: To evaluate the effects of facet joint injection in the conservative management of osteoporotic spinal compression fractures METHOD: Among 27 patients with osteoporotic spinal compression fractures which were confirmed by plain radiography and bone densitometry (dual energy x-ray absorptiometry), 9 patients were control group and 18 patients received facet joint injection treatment. Facet joint injection of thoracolumbar spine was done under fluoroscopic guide with 1% lidocaine 1 ml and triamcinolone 10 mg at each joint above and below the level of compression fracture at both side. Main outcome measures were visual analog scale (VAS), spinal movement (modified Schober's and lateral bending test), and physical activity from bed-ridden state (grade I) to outdoor activity without pain (grade V). The treatment outcomes were assessed before injection, 2 weeks and 4 weeks after injection. RESULTS: There were significant decrease in VAS at 2 weeks and 4 weeks after injection in the study group (p<0.05). Physical activity was significantly improved at post injection 2 weeks and 4 weeks (p<0.05). There were no significant differences between the two groups in spinal movement. CONCLUSION: These results suggest that facet joint injection of thoracolumbar spine is useful method in the conservative management of painful osteoporotic compression fractures.