Pressure ulcers and acute risk factors in individuals with traumatic spinal fractures with or without spinal cord injuries: A prospective analysis of the National Spinal Column/Cord Injury Registry of Iran (NSCIR-IR) data / 中华创伤杂志(英文版)

PURPOSE@#To identify risk factors for developing pressure ulcers (PUs) in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries (SCIs).@*METHODS@#Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran (NSCIR-IR) from individuals with traumatic spinal fractures with or without SCIs, inclusive of the hospital stay from admission to discharge. Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay. The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification. In addition to PU, following data were also extracted from the NSCIR-IR datasets during the period of 2015 - 2021: age, sex, Glasgow coma scale score at admission, having SCIs, marital status, surgery for a spinal fracture, American Spinal Injury Association impairment scale (AIS), urinary incontinence, level of education, admitted center, length of stay in the intensive care unit (ICU), hypertension, respiratory diseases, consumption of cigarettes, diabetes mellitus and length of stay in the hospital. Logistic regression models were used to estimate the unadjusted and adjusted odds ratio (OR) with 95% confidence intervals (CI).@*RESULTS@#Altogether 2785 participants with traumatic spinal fractures were included. Among them, 87 (3.1%) developed PU during their hospital stay and 392 (14.1%) had SCIs. In the SCI population, 63 (16.1%) developed PU during hospital stay. Univariate logistic regression for the whole sample showed that marital status, having SCIs, urinary incontinence, level of education, treating center, number of days in the ICU, age, and Glasgow coma scale score were significant predictors for PUs. However, further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center, marital status, having SCIs, and the number of days in the ICU. For the subgroup of individuals with SCIs, marital status, AIS, urinary incontinence, level of education, the treating center, the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis. After adjustment in the multivariate model, the treating center, marital status (singles vs. marrieds, OR = 3.06, 95% CI: 1.55 - 6.03, p = 0.001), and number of days in the ICU (OR = 1.06, 95% CI: 1.04 - 1.09, p < 0.001) maintained significance.@*CONCLUSIONS@#These data confirm that individuals with traumatic spinal fractures and SCIs, especially single young patients who suffer from urinary incontinence, grades A-D by AIS, prolonged ICU stay, and more extended hospitalization are at increased risk for PUs; as a result strategies to minimize PU development need further refinement.

Mechanisms of mid-thoracic spine fracture/dislocation due to falls during horse racing: A report of two cases / 中华创伤杂志(英文版)

We reported two cases of jockeys who sustained fracture/dislocation of the mid-thoracic spine due to traumatic falls during horse racing. We examined the injury mechanism based upon the patients' diagnostic images and video footage of races, in which the accidents occurred. Admission imaging of patient 1 (a 42 years old male) revealed T5 burst fracture with bony retropulsion of 7 mm causing complete paralysis below T5/6. There existed 22° focal kyphosis at T5/6, anterolisthesis of T5 relative to T6, T5/6 disc herniation, cord edema and epidural hemorrhage from T4 through T6, and cord injury from C3 through C6. Admission imaging of patient 2 (a 23 years old male) revealed T4/5 fracture/dislocation causing incomplete paralysis below spinal level. There existed compression fractures at T5, T6, and T7; 4 mm anterior subluxation of T4 on T5; diffuse cord swelling from T3 through T5; comminuted fracture of the C1 right lateral mass; right frontal traumatic subarachnoid hemorrhage; and extensive diffuse axonal injury. The injuries were caused by high energy flexion-compression of the mid-thoracic spine with a flexed posture upon impact. Our results suggest that substantially greater cord compression occurred transiently during trauma as compared to that documented from admission imaging. Video footage of the accidents indicated that the spine buckled and failed due to abrupt pocketing and deceleration of the head, neck and shoulders upon impact with the ground combined with continued forward and downward momentum of the torso and lower extremities. While a similar mechanism is well known to cause fracture/dislocation of the cervical spine, it is less common and less understood for mid-thoracic spine injuries. Our study provides insight into the etiology of fracture/dislocation patterns of the mid-thoracic spine due to falls during horse racing.

Baseline characteristics of postmenopausal women with osteoporosis treated with teriparatide in a real-world setting in Latin America: a subregional analysis from the Asia and Latin America Fracture Observational Study (ALAFOS)

Abstract Background: Osteoporosis is a major healthcare concern in Latin America. Factors such as changing demographics, fragmented healthcare systems, and financial considerations may result in a huge increase in the burden of osteoporosis in this region. The aim of this article is to describe the baseline clinical characteristics and fracture history of patients who are prescribed teriparatide in normal clinical practice in Latin America. Methods: We conducted a prospective, multinational, observational study (the Asia and Latin America Fracture Observational Study [ALAFOS]) in 20 countries worldwide to assess the incidence of fractures in postmenopausal women with osteoporosis receiving teriparatide as a part of routine clinical practice in a real-world setting. In this subregional analysis of the ALAFOS study, we report the clinical characteristics, fracture history, risk factors for osteoporosis, comorbidities, previous osteoporosis therapies and health-related quality of life measures at baseline for patients from the four participant Latin American countries: Argentina, Brazil, Colombia, and Mexico. Results: The Latin America subregional cohort included 546 postmenopausal women (mean [SD] age: 71.0 [10.1] years; range: 40-94 years), constituting 18% of the ALAFOS total population. The baseline mean (SD) bone mineral density T-scores were - 3.02 (1.23) at the lumbar spine and - 2.31 (0.96) at the femoral neck; 62.8% of patients had a history of low trauma fracture after the age of 40 years and 39.7% of patients had experienced ≥1 fall in the past year. Osteoporosis medications were used by 70.9% of patients before initiating teriparatide. The median (Q1, Q3) EQ-5D-5 L Visual Analog Scale (VAS) scores for perceived health status at baseline was 70 (50, 80). The mean (SD) worst back pain numeric rating scale score for the overall Latin American cohort was 4.3 (3.4) at baseline. Conclusions: This baseline analysis of the Latin America subregion of the ALAFOS study indicates that patients who are prescribed teriparatide in the four participant countries had severe osteoporosis and high prevalence of fractures. They also had back pain and poor health-related quality of life. The proportions of patients with severe or extreme problems on the EQ-5D-5 L individual domains were lower than those in the overall ALAFOS study population.

Instrumentación anterior y posterior para tratamiento de fractura por Metástasis Vertebral / Anterior and posterior instrumentation for fracture treatment due to Vertebral Metastasis

Las fracturas tumorales en columna vertebral son parte de la etiología de las fracturas patológicas a este nivel, que por edad de presentación, así como la clínica observada puede otorgar directrices del tipo de tumor que afecta al esqueleto axial. Por tanto, resulta importante su identificación, clasificación y terapéutica a seguir, en especial en aquellos casos donde se encuentra afectada la parte neurológica distal. Teniendo en consideración estos aspectos planteamos este caso clínico.

Tumoral fractures in spine are part of the etiology of pathologic fractures in this level, age of presentation and the observed clinical can give guidance on the type of tumor that affects the axial skeleton, it is important to identify, classification and therapeutic to follow, especially those who are affected neurological distal part. Considering this aspect propose clinical case below.

Fracturas vertebrales en niños con osteogénesis imperfecta tipo I / Vertebral fractures in children with Type I Osteogenesis imperfecta

La Osteogénesis imperfecta (OI) es una enfermedad hereditaria del tejido conectivo, que se caracteriza principalmente por fragilidad ósea, deformidad y alteración del crecimiento. La OI tipo I (OI tipo I) es la más frecuente, leve y clínicamente homogénea. Su mayor complicación es la presencia de fracturas vertebrales, asociadas a morbilidad esquelética y cardiopulmonar. Objetivo: Caracterizar clinicamente una cohorte de niños con OI tipo I. Pacientes y Método: Se examinó una cohorte histórica de pacientes menores de 20 años mediante la revisión de fichas clínicas, rescatando las características demográficas, clínicas, bioquímicas y radiológicas. Resultados: Se incluyeron 67 pacientes, 55% varones, 69% de la Región Metropolitana. La edad media de diagnóstico fue de 2,9 años, el 70% de los pacientes presentó fracturas vertebrales de predominio torácico, y el 50% lo hizo antes de los 5 años. Un 15% presentó fracturas al momento del diagnóstico, siendo en ellos el diagnóstico de OI tipo I cerca de los 5 años. Los parámetros metabólicos óseos estuvieron en rangos adecuados durante el seguimiento, sin cambios significativos al diagnóstico de las fracturas vertebrales, excepto una disminución de la ingesta recomendada de calcio. Conclusiones: En este estudio, la OI tipo I presenta un diagnóstico precoz, principalmente en preescolares, y se asocia a alta frecuencia de fracturas vertebrales. La disminución en la ingesta de calcio demostrada al momento de la primera fractura requiere especial atención en estos pacientes.

Osteogenesis imperfecta (OI) is an hereditary disease affecting conective tissue, mainly associated to growth retardation and pathological fractures. OI type I (OI type I), is the mildest, most often, and homogeneous in its fenotype. Vertebral fractures are the most significant complications, associated to skeletical and cardiopulmonary morbidity. Objectives: To characterize clinically a cohort of children with OI type I. Patients and Methods: A cohort of OI type I children younger than 20 year old was evaluated. Demographic, clinical, biochemical and radiological data were registered. Results: Sixty seven patients were included, 55% male, 69% resident in the Metropolitan Region. The mean age of diagnose was 2.9 years, 70% presented vertebral fractures on follow-up, mostly thoracic, and 50% before the age of 5 years. Fifty percentage presented vertebral fractures at diagnose, which was about the age of 5 years. Bone metabolic parameters were in the normal range, without significant change at the moment of vertebral fractures. Calcium intake was found to be below American Academy of Pediatrics recommendations at the time of the first fracture. Conclusions: In this study OI type I has an early diagnose, and vertebral fractures show a high incidence, mostly in toddlers. Calcium intake was found to be below reccomended values, and should be closely supervised in these patients.

Risk of Vertebral Fracture in Patients Diagnosed with a Depressive Disorder: A Nationwide Population-Based Cohort Study

OBJECTIVE: Previous studies have reported that depression may play a crucial role in the occurrence of vertebral fractures. However, a clear correlation between depressive disorders and osteoporotic fractures has not been established. We explored the association between depressive disorders and subsequent new-onset vertebral fractures. Additionally, we aimed to identify the potential risk factors for vertebral fracture in patients with a depressive disorder. METHODS: We studied patients listed in the Taiwan National Health Insurance Research Database who were diagnosed with a depressive disorder by a psychiatrist. The comparison cohort consisted of age- and sex-matched patients without a depressive disorder. The incidence rate and hazard ratios of subsequent vertebral fracture were evaluated. We used Cox regression analysis to evaluate the risk of vertebral fracture among patients with a depressive disorder. RESULTS: The total number of patients with and without a depressive disorder was 44,812. The incidence risk ratio (IRR) between these 2 cohorts indicated that depressive disorder patients had a higher risk of developing a subsequent vertebral fracture (IRR=1.41, 95% confidence interval [CI]=1.26-1.57, p<0.001). In the multivariate analysis, the depressive disorder cohort showed a higher risk of vertebral fracture than the comparison cohort (adjusted hazard ratio=1.24, 95% CI=1.11-1.38, p<0.001). Being older than 50 years, having a lower monthly income, and having hypertension, diabetes mellitus, cerebrovascular disease, chronic obstructive pulmonary disease, autoimmune disease, or osteoporosis were considered predictive factors for vertebral fracture in patients with depressive disorders. CONCLUSIONS: Depressive disorders may increase the risk of a subsequent new-onset vertebral fracture.

Manejo con instrumentación 360 o de enfermedad ósea metastásica que condiciona inestabilidad en columna cervical. Reporte de un caso clínico / 360 degrees instrumentation for cervical instability due to metastatic bone disease. Case report

Resumen: Introducción: La columna vertebral es el sitio más frecuente de localización para las metástasis óseas; siendo los tumores de mama, próstata y pulmón los que mayor afectación presentan. La columna torácica es afectada en un 70% de los casos, seguida de la región lumbar y cervical. Material y métodos: se presenta el caso de un paciente con diagnóstico de adenocarcinoma mamario derecho, con enfermedad ósea metastásica en región cervical a nivel de C2, C3, inestabilidad del segmento cervical por fractura por compresión del cuerpo C3 de mayor al 80%, sin invasión a canal medular, inicia con parestesias de extremidades torácicas. Se realiza instrumentación 360º en dos tiempos. Posterior al procedimiento la paciente evolucionó sin dolor cervical y tolerando la vía oral. Discusión: la enfermedad ósea metastásica genera lesiones importantes en la columna vertebral condicionando inestabilidad; la instrumentación mejora el estado funcional y el pronóstico.

Abstract: Introduction: The spine is the most common site for bone metastases; being the breast, prostate and lung cancer which have most affected. The thoracic spine is involved in 70% of cases, followed by the lumbar and cervical region. Material and methods: This is a 59 years old female diagnosed with breast adenocarcinoma and metastatic bone disease in cervical spine C2, C3 level and instability of that segment because of a compression fracture of C3 greater than 80% without invasion of the spinal canal, she begins with paresthesias of upper limbs. A 360º instrumentation was performed in two stages. After the surgical procedure the patient were without neck pain and a good neurological status. Discussion: Metastatic bone disease causes significant damage to the spine sometimes create instability proper instrumentation is needed to improve the functional status and prognosis of these lesions.

Asymptomatic vertebral fractures in patients with low bone mineral density / Fraturas vertebrais assintomáticas em indivíduos com baixa massa óssea

Summary Objective: Vertebral fracture assessment (VFA) is a test technique that can be used to detect asymptomatic vertebral fractures (AVF). It uses dual energy X-ray bsorptiometry (DXA) and can be performed concurrently with bone densitometry. This study aims to assess the prevalence of AVF in patients with low bone mass. Methods: Cross-sectional study including 135 individuals with low bone mineral density (BMD) with a T-score < -2.0 standard deviation (SD) in a densitometry clinic located in the city of Blumenau (state of Santa Catarina). Anthropometric, clinical and lifestyle variables were obtained from history-taking and physical examination. Densitometric variables were obtained by bone mineral densitometry and VFA (Explorer, Hollogic®). Vertebral fractures were classified according to the Genant criteria. Student's t, chi-square and logistic regression were performed for statistical analysis. Results: AVFs occurred in 24.4% of the subjects. They were older compared to those without AVF (65±9.25 versus 60.1±8.66; p=0.005), and had a history of lowimpact fractures (38.24% versus 19.8%; OR 2.5; p=0.03). Half of the patients that reported steroid therapy had AVFs, compared to one fifth of those who did not use steroids (50% versus 21.49%; OR 3.6; p=0.01). Conclusion: Asymptomatic vertebral fractures were present in approximately one fourth of patients. The risk factors associated were history of low-impact fracture, use of steroids and age > 61 years.

Resumo Objetivos: vertebral fracture assessment (VFA) é uma técnica de exame que pode ser aplicada na detecção de fraturas vertebrais assintomáticas (FVA). Utiliza absorciometria de raios-X de dupla energia (DXA) e pode ser realizada concomitantemente ao exame de densitometria óssea. Este estudo visa a avaliar a prevalência de FVA em indivíduos com baixa massa óssea. Métodos: estudo transversal realizado em 135 indivíduos, com baixa densidade mineral óssea (DMO), com T-score < -2,0 desvio padrão (DP), em uma clínica de densitometria de Blumenau (SC). As variáveis antropométricas, clínicas e referentes ao estilo de vida foram obtidas por anamnese e exame clínico; as variáveis densitométricas foram obtidas por DMO e VFA (aparelho modelo Explorer, marca Hollogic®). As fraturas vertebrais foram classificadas de acordo com os critérios de Genant. Os testes estatísticos foram t de student, qui-quadrado e regressão logística. Resultados: FVA ocorreram em 24,4% dos indivíduos. A idade desses indivíduos foi superior à dos indivíduos sem FVA (65±9,25 vs. 60,1±8,66; p=0,005), assim como o antecedente de fratura por baixo impacto (38,24% vs.19,8%; OR 2,5; p=0,03). A metade dos indivíduos que relataram corticoterapia possuíam FVA, contrastando com um quinto dos indivíduos sem corticoterapia (50% vs. 21,49%; OR 3,6; p=0,01). Conclusão: fraturas vertebrais assintomáticas estiveram presentes em aproximadamente um quarto dos pacientes. Os fatores de risco associados foram história de fratura por baixo impacto, corticoterapia e idade > 61 anos.

Patterns of Treatment for Metastatic Pathological Fractures of the Spine: The Efficacy of Each Treatment Modality

BACKGROUND: Metastatic pathological fractures of the spine are a major problem for cancer patients; however, there is no consensus on treatment strategy. The purpose of this study was to evaluate various treatment options by analyzing their patterns for metastatic pathological fractures of the spine. METHODS: In this study, 54 patients (male:female = 36:18) who were diagnosed with metastatic pathological fractures of spine were recruited. Demographic data, origin of cancer, type of treatment, and results were obtained from electronic medical records. Treatment options were divided into radiotherapy (RT), vertebroplasty (VP) or kyphoplasty (KP), operation (OP), and other treatments. Treatment results were defined as aggravation, no response, fair response, good response, and unknown. The survival time after detection of pathologic fractures was analyzed with the Kaplan-Meier method. RESULTS: The mean age of the patients was 62.3 years. Hepatocellular carcinoma was the most common cancer of primary origin (n = 9), followed by multiple myeloma (n = 8). RT was the most common primary choice of treatment (n = 29, 53.7%), followed by OP (n = 13, 24.1%), and VP or KP (n = 10, 18.5%). Only 13 of 29 RT cases and 7 of 13 OP cases demonstrated a fair or good response. The mean survival time following detection of pathological spinal fractures was 11.1 months for 29 patients, who died during the study period. CONCLUSIONS: RT was the most common primary choice of treatment for metastatic pathological fractures of the spine. However, the response rate was suboptimal. Although OP should be considered for the relief of mechanical back pain or neurologic symptoms, care should be taken in determining the surgical indication. VP or KP could be considered for short-term control of localized pain, although the number of cases was too small to confirm the conclusion. It is difficult to determine the superiority of the treatment modalities, hence, a common guideline for the diagnosis and treatment of metastatic pathological fractures of the spine is required.

Evaluation of vertebral hidden fractures in patients with proximal femoral fractures / Avaliação de fraturas vertebrais ocultas em pacientes com fraturas do femur proximal / Evaluación de fracturas vertebrales ocultas en pacientes con fracturas del fémur proximal

Objective: To evaluate the Spine Deformity Index (SDI) and serum levels of vitamin D in patients surgically treated for proximal femur fracture and its relationship with osteoporosis. Methods: Between August and November 2013, patients older than 50 years-old with surgical fracture of the proximal femur by low-energy trauma underwent radiographic evaluation of the spine and the vitamin D levels, and enquired about diagnoses and previous treatment of osteoporosis. Results: Sixty-six patients met the inclusion criteria. The mean age was 78 years; the average level of vitamin D was 19 ng/mL. The SDI ranged between zero and 25, with a mean of 8.2. Eighty percent of these patients had never been treated for osteoporosis. Of the patients analyzed, 89.3% had insufficient levels of vitamin D. Of these, 68.1% had also SDI above 5, and only one fifth of them had any treatment for osteoporosis. Statistical significance was found between age and levels of vitamin D as well as age and SDI. Gender was not predictive of the vitamin D levels or the amount of hidden spine fractures. The season of the year had no direct influence on vitamin D levels. Conclusions: Hospitalized patients with surgical fractures of the proximal femur had a higher SDI associated with vitamin D insufficiency, with osteoporosis most often untreated, which results in delayed spinal fractures diagnosis of spinal fractures and increased risk of new fractures. .

Objetivo: Avaliar o índice de deformidade espinhal (SDI) e níveis séricos de vitamina D em pacientes tratados cirurgicamente por fratura do fêmur proximal e a relação desses dados com osteoporose. Método: Entre agosto e novembro de 2013, pacientes com mais de 50 anos e fratura cirúrgica do fêmur proximal por trauma de baixa energia foram submetidos à avaliação radiográfica da coluna vertebral e do nível sérico de vitamina D e questionados sobre diagnóstico e tratamentos prévios para osteoporose. Resultados: Sessenta e seis pacientes satisfizeram os critérios de inclusão. A média de idade foi 78 anos e o nível sérico médio de vitamina D foi 19 ng/mL. O SDI variou entre zero e 25, com média de 8,2. Oitenta por cento desses pacientes nunca receberam tratamento para osteoporose. Dos pacientes analisados, 89,3% tinham níveis insuficientes de vitamina D. Destes, 68,1% também tinham índice de deformidade espinhal acima de 5, e somente um quinto deles realizou algum tipo de tratamento para osteoporose. Houve significância estatística entre a idade e a concentração de vitamina D e entre a idade e o SDI. O sexo não foi preditivo dos níveis de vitamina D ou da quantidade de fraturas ocultas de coluna. A época do ano não teve influência sobre o nível de vitamina D dos pacientes. Conclusão: Pacientes internados com fratura de fêmur proximal apresentam índice de deformidade espinhal elevado associado ...

Objetivo: Evaluar el índice de deformidad de la columna vertebral (SDI) y los niveles séricos de vitamina D en los pacientes tratados quirúrgicamente por fractura del fémur proximal. Evaluar la relación de estos datos con la osteoporosis. Métodos: Entre agosto y noviembre de 2013, los pacientes con más de 50 años y con fractura quirúrgica del fémur proximal por un traumatismo de baja energía fueron sometidos a la evaluación radiográfica de la columna vertebral y a la determinación del nivel sérico de vitamina D y se les pregunto sobre el diagnóstico y los tratamientos previos para la osteoporosis. Resultados: Sesenta y seis pacientes cumplieron los criterios de inclusión. La edad promedio fue de 78 años la media del nivel sérico de vitamina D fue de 19 ng/mL. El SDI osciló entre zero y 25, con una media de 8,2. El ochenta por ciento de estos pacientes nunca fueron tratados para la osteoporosis. De los pacientes analizados, el 89,3% tenían niveles insuficientes de vitamina D. De ellos, el 68,1% tenían índice de deformidad de la columna superior a 5 y solamente una quinta parte recibió algún tratamiento para la osteoporosis. Se ha verificado significación estadística entre la edad y el nivel de vitamina D y entre la edad y el SDI. El sexo no fue predictivo de los niveles de vitamina D o la cantidad de fracturas de columna ocultas. La época del año no tuvo influencia en la concentración de vitamina D. Conclusión: Los pacientes hospitalizados ...

Apophyseal ring fracture associated with two levels extruded disc herniation: case report and review of the literature / Fratura do anel apofisário associada à hérnia discal extrusa de dois níveis: relato de caso e revisão da literatura

Apophyseal ring fractures are rare injuries that may be associated with lumbar disc herniation in young patients. We report a unique case in the literature of a 15-year-old male patient who played football and was admitted at our service complaining of sciatica radiating into the left leg. An apophysial ring injury of L5 vertebral body was observed. This injury caused two extruded disc herniation in adjacent levels. Surgical procedure was indicated after failure of conservative treatment.

As fraturas do anel apofisário são lesões raras, que podem estar associadas à hérnia de disco lombar nos pacientes jovens. Apresentamos aqui um caso único na literatura de paciente de 15 anos, gênero masculino, praticante de futebol, com queixa de ciatalgia para o membro inferior esquerdo. Houve lesão do anel apofisário, nos planaltos superior e inferior do corpo vertebral de L5, ocasionando hérnias discais extrusas nos níveis adjacentes. O procedimento cirúrgico foi indicado após a falha do tratamento conservador.

Cifoplastia guiada por TC: una opción técnica en el tratamiento de fracturas vertebrales patológicas / CT-guided kyphoplasty: a technical option in the treatment of pathological vertebral fractures

Pathological vertebral fractures are caused by various entities. They cause significant pain and impaired quality of life of patients. The CT-guided kyphoplasty relieves or eliminates pain and stabilizes the fractured vertebral bodies. 49 patients were treated. The procedure is performed percutaneously by inserting a needle that is subsequently removed, leaving a cannula. Through this a balloon-like device is introduced and subsequently inflated to create a cavity, which is then filled with polymethylmethacrylate (PMMA). The technique was performed successfully in all cases without serious complications, with good results. Its advantages are that the needle placement as well as the injection of PMMA can be correctly visualized using real-time CT fluoroscopy. In addition a single needle is used throughout the entire procedure, which minimizes the risk of complications as it is less traumatic.

Las fracturas vertebrales patológicas se originan por diversas entidades. Producen dolor importante y deterioro de la calidad de vida de los pacientes. La cifoplastia guiada por tomografía computarizada (TC) alivia o elimina el dolor y estabiliza los cuerpos vertebrales fracturados. Se han tratado 49 pacientes. El procedimiento se realiza por vía percutánea, mediante la inserción de una aguja que posteriormente se retira dejando una cánula. A través de la misma se introduce un dispositivo que lleva incorporado un balón que se infla creando una cavidad, que se rellena con polimetilmetacrilato (PMMA). La técnica se practicó con éxito en todos los casos sin complicaciones graves, con buenos resultados. Sus ventajas son visualizar correctamente la posición de la aguja y la inyección del PMMA mediante la escopia del TC en tiempo real. Además se utiliza una sola aguja para todo el procedimiento, lo cual minimiza el riesgo de complicaciones siendo menos traumático.

Mastocitosis sistémica: repercusión ósea / Systemic mastocytosis: bone impact

La mastocitosis sistémica es una enfermedad caracterizada por acumulación de mastocitos en varios órganos, de los cuales el más afectado es la piel. La repercusión ósea de esta enfermedad es poco frecuente y en general se la asocia al desarrollo de osteoporosis secundaria con o sin fracturas óseas. Se presentan tres pacientes con lesiones características en piel de mastocitosis y diferentes manifestaciones óseas; el primer caso es una mujer de 51 años en la que se observó una variante esclerosante muy poco frecuente, con densitometría ósea en valores normales-altos y aumento de la densidad ósea observada en varias vértebras por radiografías. Una punción-biopsia de cresta ilíaca confirmó el compromiso óseo de su enfermedad de base. El segundo caso fue una mujer de 57 años que mostró signos característicos de mastocitosis sistémica con diarreas, gastritis, flushes y reacciones cutáneas particulares ante exposición a alérgenos. Se observó además grave disminución de la densidad mineral ósea tanto en columna lumbar como en cuello de fémur con parámetros bioquímicos de aumento de la resorción ósea, por lo que fue necesario tratarla con bisfosfonatos. La tercera paciente, de 67 años de edad, presentó varias fracturas vertebrales, con densitometría ósea levemente disminuida. En esta última paciente se constató una hiperplaquetosis con diagnóstico histológico de trombocitemia esencial, cuadro que suele asociarse a la mastocitosis sistémica. En definitiva, se presentan y discuten tres variantes óseas diferentes de mastocitosis sistémica.

Systemic mastocytosis is a disease characterized by accumulation of mast cells in various organs of which the most affected is the skin. The bone impact of this disease is very rare and generally associated with the development of secondary osteoporosis with or without fractures. We present three cases of patients with skin mastocytosis lesions and different bone manifestations; the first case was a 51 year old woman in whom we observed a rare sclerosing variant with a normal-high bone density and increased density presented in several vertebrae x-rays. An iliac crest biopsy confirmed bone involvement of the underlying disease. The second case was a 57 year old woman who had characteristic signs of systemic mastocytosis with diarrhea, gastritis, flushes and specific cutaneous reactions to exposure to allergens. She also presented severe decrease in bone mineral density in both lumbar spine and femoral neck, with biochemical parameters of increased bone resorption, so had to be treated with bisphosphonates. The third patient, a 67-year-old woman, had several vertebral fractures, with slightly decreased bone densitometry. This last patient showed a hiperplaquetosis with histological diagnosis of essential thrombocythemia, a picture usually associated with systemic mastocytosis. In conclution, we present and discuss three different bone variants of systemic mastocytosis.

Identification of fresh and old vertebral compression fractures by MRI / 法医学杂志

OBJECTIVE@#To analyze and explore the value of MRI in distinguishing fresh from old vertebral compression fractures.@*METHODS@#The features of MRI in 43 cases with compression fractures of thoracic or lumbar vertebral bodies were analyzed. MRI sequences included T1WI, T2WI and STIR.@*RESULTS@#Fifty-five vertebral bodies in total were found compression fractures in 43 cases. Forty-six vertebral bodies, which showed low signals or low signals mixing a few high signals on T1WI, high signals on T2WI and significantly high signals on STIR, were identified as fresh compression fractures. Nine vertebral bodies were identified as old compression fractures, because they showed the same signals as normal vertebral bodies on T1WI, T2WI and STIR.@*CONCLUSION@#MRI could accurately distinguish fresh and old vertebral compression fractures, so it is valuable for the distinguishment in forensic identification.

Revision Surgery after Vertebroplasty or Kyphoplasty

BACKGROUND: We wanted to investigate the leading cause of failed vertebroplasty or kyphoplasty. METHODS: Twelve patients (10 females and 2 males) who underwent revision surgery after vertebroplasty or kyphoplasty were included. In 4 cases, vertebroplasty was done for two or more levels. Six cases with kyphoplasty were included. Through the retrospective review of the radiographic studies and medical record, we analyzed the etiology of the revision surgery. RESULTS: Uncontrolled back pain was the main clinical presentation. In 4 cases, neurological symptoms were noted, including one case with conus medullaris syndrome. The average time to the revision surgery after vertebroplasty or kyphoplasty was 15 months. Infection (4 cases) and progressive kyphosis with collapse (8 cases) were the causes for the revision. A solid pattern of inserted bone cement and bone resorption around the cement were noted in the all cases with progressive collapse and kyphosis. CONCLUSIONS: Infection, misdiagnosis and progressive kyphosis were causes of the revision surgery after vertebroplasty and kyphoplasty. A solid pattern of accumulation of bone cement and peri-cement bone resorption might be related with the progressive collapse.

Percutaneous vertebroplasty: a comparison between the procedure using the traditional and the new side-opening cannula for osteoporotic vertebral fracture / Vertebroplastia percutânea: uma comparação entre o procedimento usando a cânula tradicional e a nova cânula de orifício lateral para fratura vertebral osteoporótica

A total of 47 percutaneous vertebroplasties (PVs) were performed for osteoporotic vertebral fractures in 31 patients, 25 PVs were performed using the frontal-opening cannula (FOC) and 22 using the new side-opening cannula (SOC), randomly distributed. The incidence of cement extrusion was 27 percent with the SOC, and 68 percent with the FOC, all asymptomatic (p<0.01). The pain control was similar for both groups, with good improvement of pain in most of the patients, and there were no clinical relevant complications. The cement leakage can be significantly reduced with this new SOC, which allows for a better cement injection toward the center of the vertebral body, increasing the safety of the procedure, with no increase in cost.

Um total de 47 vertebroplastias percutâneas (VP) foram realizadas para fraturas vertebrais osteoporóticas em 31 pacientes, 25 VP foram realizadas usando-se a cânula de orifício frontal (COF) e 22 com a nova cânula de orifício lateral (COL), distribuídos randomicamente. A incidência de extrusão de cimento ortopédico ocorreu em 27 por cento com a COL, e 68 por cento com a COF, todas assintomáticas (p<0,01). O controle da dor foi similar em ambos os grupos, com boa melhora da dor na maioria dos pacientes, sem complicações clínicas relevantes. A extrusão do cimento pode ser significativamente reduzida com esta nova COL, que permite uma melhor injeção do cimento para o centro do corpo vertebral, aumentando a segurança do procedimento, sem aumento no seu custo.

Cifoplastia percutanea con balón en fracturas por compresión de etiología no traumática en columna torácica y lumbar / Percutaneous balloon kyphoplasty in non-traumatic lumbar and thoracic spinal compression fractures

Purpose: To describe our experience with percutaneous balloon kyphoplasty for the treatment of non-traumatic vertebral compression fractures. Material and Methods: Between march 2007 and June 2008, 25 vertebrae interventions were performed in 10 patients. Ten cases corresponded to osteoporotic fractures, while fifteen of them revealed a tumoral etiology. Vertebral compromise was evaluated via CT scan or MRI, as appropriate. We applied a percutaneous technique. Balloons were inserted into the vertebral body, and then inflated to create a cavity to be filled with polymethylmethacrylate (PMMA), which reduces and stabilizes the fracture, thus reducing pain. Results: The technique was performed successfully in al I cases. Pain intensity assessed by Visual Analogue Scale (VAS) before and after the procedure showed a variation ranging from 4 to 7 levels per patient. The mean inicial VAS score was 7, whereas average final VAS was 1.2. The decrease in pain levels averaged 5.8 per intervention. Complications occurred in 7 levels: 3 cases of thoracic extravasations and 4 cases in lumbar spine. All of them were asymptomatic. No severe complications were reposed. Conclusions: Percutaneous balloon kyphoplasty offers a good alternative treatment to conservative pain management in vertebral compression fractures.

Propósito: Describir nuestra experiencia en cifoplastía percutanea con balón en fracturas vertebrales debidas a compresión no traumática. Material y Métodos: Se intervinieron 25 vértebras en 10 pacientes, 15 lumbares y 10 torácicas, entre marzo 2007 y junio 2008. La etiología de las fracturas fue osteoporótica en 10 casos y tumoral en 15. Se evaluó el compromiso vertebral mediante tomografía computada o resonancia magnética, según el caso. La técnica fue percutanea; se insertaron balones en el cuerpo vertebral, que se inflaron, creando así una cavidad que se relleno inyectando polimetilme-tacrilato (PMMA), que redujo y estabilizó la fractura, disminuyendo así el dolor. Resultados: La técnica fue realizada satisfactoriamente en todos los casos. La intensidad del dolor medida según la Escala Visual Análoga (EVA), antes y después del procedimiento, varió entre 4 y 7 niveles por paciente. El EVA de ingreso promedio fue de 7, y el de egreso de 1.2. La disminución del dolor fue en promedio 5.8 niveles por intervención. Hubo complicaciones en 7 niveles: 3 casos de extravasación torácica y 4 en columna lumbar, todas asintomáticas. No hubo complicaciones severas. Conclusiones: La cifoplastía con balón es una buena alternativa analgésica al manejo conservador en fracturas vertebrales por compresión.

Fracturas vertebrales osteoporóticas: manejo conservador / Osteoporotic vertebral fractures: conservative management

Osteoporotic vertebral fractures are a consequence of a systemic skeletall disease (osteoporosis) that results in an increase of bone fragility and fracture risk. The Orthopedic Surgeon may be the only doctor who evaluate a patient with a fracture and should be able to show whether this is due to osteoporotic process, to give an integral treatment and prevent future fractures. Vertebral osteoporotic fracture, are associated with pain, disability, increased morbidity and mortality and a major economic impact on society. Conservative treatment of these fractures is composed of non-pharmacological and pharmacological treatment. The nonpharmacological treatment serves as a complement to pharmacological treatment and optimizes the reduction in risk of fractures. The main objective of treatment is to prevent future fractures. The secondary objectives are to reduce pain and disability associated. In this review of the literature, we summarize the drugs and techniques currently used to treat osteoporosis and to prevent future fractures.

Las fracturas vertebrales osteoporóticas son parte de una enfermedad esquelética sistémica (osteoporosis) que resulta en un aumento de la fragilidad ósea y del riesgo a fracturarse. El traumatólogo puede ser el único médico que evalúe a un paciente con una fractura y debe ser capaz de demostrar si esta es de causa osteoporótica, para así dar un tratamiento integral y prevenir fracturas futuras. Las fracturas vertebrales osteoporóticas (FVO) se asocian a dolor, discapacidad, aumento de morbi-mortalidad y un gran impacto económico para la sociedad. El tratamiento de estas fracturas tiene un manejo farmacológico y no farmacológico. El tratamiento no farmacológico complementa el tratamiento farmacológico y optimiza la reducción del riesgo de fracturas. El principal objetivo del tratamiento es el de prevenir nuevas fracturas. Los objetivos secundarios son disminuir el dolor y la discapacidad asociada. En esta revisión de la literatura se señalaran los fármacos y técnicas utilizadas en la actualidad para el tratamiento de la osteoporosis y prevención de nuevas fracturas.

Osteoporosis-related vertebral fractures in postmenopausal women: prevalence in a Saudi Arabian sample

The study aimed to determine hospital-based prevalence of vertebral fractures in postmenopausal Saudi Arabian women. Chest radiographs from consecutive Saudi women over the age of 50 years visiting the emergency room at King Fahd Hospital of the University were evaluated. Of 785 radiographs analysed 159 [20.3%] patients had 198 vertebral fractures. The mean age of the women was 65.7 [SD 8.5] years. In only 37.8% of the radiographs with fractures was a vertebral fracture highlighted in the radiologist's report, and only 13.2% of the women with vertebral fractures were on antiresorptive therapy for osteoporosis