Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome with Destructive Spondylitis: A Case Report.

INTRODUCTION: Spinal lesions in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome generally have a good prognosis and rarely cause structural destruction or neurological deterioration. We described a surgical case of posterior instrumented surgery without anterior reconstruction and bone graft in a patient with SAPHO syndrome with destructive spondylitis and reviewed the literature on surgical treatment for this entity. CASE REPORT: We describe the case of a 73-year-old male who presented with palmoplantar pustulosis. He experienced progressive low back and leg pain for the past 3 months. Destructive spondylitis and lumbar canal stenosis were detected with magnetic resonance imaging (MRI), and aspiration biopsy was used to exclude pyogenic spondylitis and spinal tumors. He underwent posterior decompression and fixation surgery without anterior reconstruction and bone grafting. Low back and leg pain improved after surgery. Postoperative radiography and computed tomography showed boney bridge between vertebral bodies, and MRI showed the decrease of bone marrow edema. CONCLUSIONS: Posterior fusion without anterior reconstruction produced a bony bridge between the vertebral bodies. Taking the pathophysiology of SAPHO syndrome into consideration, anterior reconstructed fusion for patients with SAPHO syndrome might not be needed.

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.

Percutaneous vertebroplasty for osteoporotic vertebral compression fracture with intravertebral cleft associated with delayed neurologic deficit.

INTRODUCTION: The number of cases of osteoporotic vertebral compression fracture (OVCF) with intravertebral cleft (IVC) with delayed neurologic deficit (DND) is increasing as the population ages. However, the cause of DND is poorly understood, and no definitive treatment of the disease has been established. The purpose of this study was to clarify the radiographic parameters contributing to the occurrence of DND, and to evaluate the efficacy and safety of percutaneous vertebroplasty for this pathology. METHODS: Percutaneous vertebroplasty was prospectively performed for 244 patients with OVCF with IVC; 30 had DND and 214 did not. Radiographic parameters of local kyphotic angle, percent spinal canal compromise and intravertebral instability were investigated for correlations to DND. Procedural outcomes were evaluated using visual analog scale (VAS), Oswestry Disability Index (ODI), and modified Frankel grades. RESULTS: Before vertebroplasty, no substantial difference in local kyphotic angle was seen between OVCF with IVC with and without DND, but percent spinal canal compromise and intravertebral instability were greater in OVCF with IVC with DND (P < 0.001). After vertebroplasty, 25 of 30 cases (84%) of OVCF with IVC with DND achieved clinically meaningful improvement (CMI), but 5 (17%) did not. Patients with CMI showed substantial improvements in intravertebral instability (P < 0.001), and no change in local kyphotic angle or percent spinal canal compromise. In five patients without CMI, four showed an initial improvement, but subsequent vertebral fracture adjacent to the treated vertebra caused neurologic re-deterioration. One patient with percent spinal canal compromise 54.9% and intravertebral instability 4° achieved no neurologic improvement following vertebroplasty. No serious complications or adverse events related to the procedure were encountered. CONCLUSIONS: Intravertebral instability is the dominant cause of DND. Percutaneous vertebroplasty appears effective and safe in the treatment of OVCF with IVC with DND. Patients with less intravertebral instability and severe spinal canal compromise could be candidates for conventional surgical treatment.