Magnetic resonance imaging of lumbar intervertebral discs in elderly patients with minor trauma.

PURPOSE: Vertebral body fractures due to minor trauma, which commonly occur in the elderly, are a frequently encountered clinical problem. We utilized MRI in patients with acute back pain following minor injury to ensure the earliest possible diagnosis. Lumbar discs adjacent to fractured vertebral bodies were evaluated, using magnetic resonance imaging (MRI), to elucidate how often these discs were injured and how the injured discs were depicted by MRI. MATERIALS AND METHODS: We retrospectively reviewed MR images of 74 discs from 37 elderly patients (>65-year-old) with a single level vertebral fracture (fracture group). Patients with multiple-level fractures, burst fractures and/or major trauma, such as that resulting from a traffic accident, were excluded from this study. We also reviewed MR images of 190 discs from 27 elderly patients diagnosed with lumbar stenosis, who had no previous history of vertebral body fractures (stenosis group). RESULTS: In the fracture group, 23% (17/74) of T1-weighted images exhibited a high-intensity area in the disc, whereas only 3% (5/190) exhibited a high-intensity area in the stenosis group. In some cases, in the T2-weighted images we also found a high-intensity zone in discs that showed low- or iso-intensity. This phenomenon was more frequently observed in the fracture group (47%: 35/74) than in the stenosis group. CONCLUSION: The present study indicates that, in elderly patients, intervertebral discs adjacent to vertebral fractures resulting from minor trauma are often injured. Because hemorrhage is the most likely cause of a high-intensity T1-weighted image, the results indicate that hemorrhage can be induced in a disc adjacent to a vertebral body fractured by even minor trauma.

Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience.

To assess the efficacy and feasibility of vertebroplasty and posterior short-segment pedicle screw fixation for the treatment of traumatic lumbar burst fractures. Short-segment pedicle screw instrumentation is a well described technique to reduce and stabilize thoracic and lumbar spine fractures. It is relatively a easy procedure but can only indirectly reduce a fractured vertebral body, and the means of augmenting the anterior column are limited. Hardware failure and a loss of reduction are recognized complications caused by insufficient anterior column support. Patients with traumatic lumbar burst fractures without neurologic deficits were included. After a short segment posterior reduction and fixation, bilateral transpedicular reduction of the endplate was performed using a balloon, and polymethyl methacrylate cement was injected. Pre-operative and post-operative central and anterior heights were assessed with radiographs and MRI. Sixteen patients underwent this procedure, and a substantial reduction of the endplates could be achieved with the technique. All patients recovered uneventfully, and the neurologic examination revealed no deficits. The post-operative radiographs and magnetic resonance images demonstrated a good fracture reduction and filling of the bone defect without unwarranted bone displacement. The central and anterior height of the vertebral body could be restored to 72 and 82% of the estimated intact height, respectively. Complications were cement leakage in three cases without clinical implications and one superficial wound infection. Posterior short-segment pedicle fixation in conjunction with balloon vertebroplasty seems to be a feasible option in the management of lumbar burst fractures, thereby addressing all the three columns through a single approach. Although cement leakage occurred but had no clinical consequences or neurological deficit.

Pattern of orthopaedic injuries in bear attacks: report from a tertiary care centre in Kashmir.

Interaction between humans and wild animals has increased in recent times, because of overlap of habitats. A proportion of this interaction is violent. Most of the literature describing the injuries sustained by humans in such contact pertains to the involvement of soft tissues. Trauma to bones and joints is only witnessed when larger animals attack humans. We studied the pattern of orthopaedic injuries over a period of 2 years in a series of 32 cases presenting to our hospital with a history of being attacked by the Asian black bear (Ursus thibetanus). This paper also documents the complications and challenges involved in managing these injuries. We suggest that orthopaedic traumatologists need to be prepared to deal with such cases in areas where interaction between humans and large wild animals is manifest.

Acute peg in hole docking in the management of infected non-union of long bones.

The Ilizarov method has been studied extensively in the management of non-union of long bones. In most cases this involves filling of defects present primarily or after débridement by bone transport. Acute docking over gaps longer than 2 cm has not been adequately studied, however. The purpose of this paper is to report the efficacy of acute peg in hole docking as a bone graft-sparing modality in the management of infected non-union of long bones.

Percutaneous vertebroplasty for osteoporotic fractures.

BACKGROUND: Vertebral augmentation has been widely used to treat vertebral body compression fractures caused by varied pathologies. The lifetime risk of a vertebral body compression fracture is 16% for women and 5% for men, and exponential increase of osteoporotic fractures worldwide. PURPOSE: To determine the efficacy and durability of percutaneous vertebroplasty for the treatment of back pain associated with osteoporotic vertebral fractures. DESIGN: A prospective study. MATERIALS AND METHODS: A prospective evaluation of pain relief in 30 patients, with mean age of 73.7 years, who underwent percutaneous injection of polymethyl methacrylate into 54 vertebrae under fluoroscopic guidance over a period of 35 months was done. Before the procedure and at follow up, patients were asked to quantify their pain on a visual analogue scale. RESULTS: The procedure was technically successful in all the patients. Mean duration of follow up was 21.5 months (6-44 months). Ninety-seven percent of the patients reported a significant relief 24 hours after the procedure. Ninety-two percent reported significant improvement in back pain, previously associated with a compression fracture, as well as improved ambulatory ability. Before vertebroplasty, the VAS score was 8.91+/- 1.82 compared to a score of 2.02+/- 1.95 at follow up. The mean difference in VAS score was significant (p<.0001). One patient had an asymptomatic epidural leak of PMMA, however did not require any further intervention. CONCLUSION: Percutaneous vertebroplasty of symptomatic osteoporotic vertebral compression fractures is a minimally invasive procedure that provides immediate and sustained pain relief in patients with refractory pain.