Determinations of symptomatical fractured vertebrae in treating osteoporotic vertebral compression fractures with vertebroplasty and pitfalls as well as preventive strategy / 中国矫形外科杂志

ABSTRACT

[Objective]Osteoporotic vertebral compression fractures(OVCFs)are commonly multiple fractures and this study is aimed to explore how to determine the symptomatical fractured vertebrae as well as the pitfalls in treating OVCFs using percutaneous vertebroplasty(PVP).[Method]Forty-eight OVCFs patients(78 vertebrae)undergoing PVP were retrospectively analyzed.All the patients had anteroposterior and lateral plain X-rays as well as T1W1,T2W1 and fat-compressing(STIR)MR images preoperatively.The symptomatical fractured vertebrae were determined with combination of regional pain、X-rays and MR images.Of all the patients,36 were injected unilaterally while 12 were injected bilaterally.The mean injected volume of PMMA were 3-7 ml.[Result]The back pain of all the patients were relieved to different degrees postoperatively.The back pain completely disappeared in 30 patients while the left back pain was not improved though the right back pain disappeared in 2 patients who were injected via right approach.The back pain almost disappeared but the bilateral rib pain was not improved in 1 patient with T8 vertebral fracture.No severe complications including pulmonary emboli occurred.[Conclusion]The symptomatical fractured vertebrae should be determined comprehensively not only based on preoperative X-rays but also on the MR images,especially fat-compressing MR images.Only when the fractured vertebrae demonstrate low intensity on T1W1 MR image and high-intensity on T2W1 or fat-compressing MR image can we consider them new fractures.Otherwhise,the fractured vertebrae are considered old fractures and they see no necessity to be injected.The injection should reach the most severely fractured part and if necessary the bilateral approaches are considered.PMMA should be injected after the bone cements are solid enough so as not to develop complications such as pulmonary emboli.