The correlation between self-Hounsfield units and adjacent vertebral fracture after percutaneous vertebral augmentation: a retrospective cohort study.

Background: Adjacent vertebral fracture (AVF) represents a prevalent and challenging complication after percutaneous vertebral augmentation (PVA) treatment for osteoporosis vertebral compressive fracture (OVCF). Lower bone mineral density (BMD) and intervertebral leakage are reportedly independent risk factors for AVF. Vertebral Hounsfield units (HU) measured from computed tomography (CT) scans can evaluate bone quality. This study sought to explore the risk factors associated with AVF and analyze the relationship between AVF and the Hounsfield units of adjacent vertebrae (self-HU) following PVA. Methods: In this retrospective cohort study, we included consecutive OVCF patients who presented to Xuzhou Central Hospital in Jiangsu Province, China from 1 January 2016, to 31 December 2019 for PVA treatment. Clinical and imaging data were collected, and baseline data were recorded. Patients were divided into the AVF group and the no-AVF group based on the presence of AVF during follow-up. Patients in the AVF group were further subdivided into the leakage group and the no-leakage group according to the presence of intervertebral leakage. Age, body mass index (BMI), fracture location, prior fracture, self-HU, and intervertebral leakage were included in univariate logistic regression analysis. Variables with a P value of less than 0.1 were then included in multivariate logistic regression analysis to determine the risk factors for AVF. Kaplan-Meier curves were plotted to assess the effect of intervertebral leakage on AVF using a log-rank test. Results: A total of 460 patients were included in this study and followed up for an average of 50.9 months (range, 37-83 months). Among them, 82 cases (17.83%) developed AVF and were included in the AVF group. Multivariate logistic regression analysis showed that lower self-HU [odds ratio (OR) =0.972, 95% confidence interval (CI): 0.959-0.985, P<0.001] and intervertebral leakage (OR =2.618, 95% CI: 1.415-4.844, P=0.002) were risk factors for AVF following PVA. In the AVF group, 29 patients (35.37%) with intervertebral leakage were included in the leakage group. Patients in the leakage group had a shorter time to AVF (22.07±13.83 vs. 31.42±18.73, P=0.021) and higher self-HU (78.05±16.41 vs. 64.23±20.49, P=0.002) than those in the no-leakage group. Kaplan-Meier curves showed that the fracture-free time was shorter in the leakage group compared to the no-leakage group (log-rank test, P=0.014). Conclusions: Lower self-HU and intervertebral leakage are risk factors for AVF, and higher self-HU may lead to AVF when intervertebral leakage is present.

The cranial vertebral body suffers a higher risk of adjacent vertebral fracture due to the poor biomechanical environment in patients with percutaneous vertebralplasty.

BACKGROUND CONTEXT: Adjacent vertebral fracture (AVF), a frequent complication of PVP, is influenced by factors such as osteoporosis progression, increased intervertebral cement leakage (ICL), and biomechanical deterioration. Notably, the risk of AVF is notably elevated in the cranial vertebral body compared with the caudal counterpart. Despite this knowledge, the underlying pathological mechanism remains elusive. PURPOSE: This study delves into the role of biomechanical deterioration as a pivotal factor in the heightened risk of AVF in the cranial vertebral body following PVP. By isolating this variable, we aim to unravel its prominence relative to other potential risk factors. STUDY DESIGN: A retrospective study and corresponding numerical mechanical simulations. PATIENT SAMPLE: Clinical data from 101 patients treated by PVP were reviewed in this study. OUTCOME MEASURES: Clinical assessments involved measuring Hounsfield unit (HU) values of adjacent vertebral bodies as a representation of patients' bone mineral density (BMD). Additionally, the rates of ICL were compared among these patients. Numerical simulations were conducted to compute stress values in the cranial and caudal vertebral bodies under various body positions. METHODS: In a retrospective analysis of PVP patients spanning July 2016 to August 2019, we scrutinized the HU values of adjacent vertebral bodies to discern disparities in BMD between cranial and caudal regions. Additionally, we compared ICL rates on both cranial and caudal sides. To augment our investigation, well-validated numerical models simulated the PVP procedure, enabling the computation of maximum stress values in cranial and caudal vertebral bodies across varying body positions. RESULTS: The incidence rate of cranial AVF was significantly higher than the caudal side. No notable distinctions in HU values or ICL rates were observed between the cranial and caudal sides. The incidence of AVF showed no significant elevation in patients with ICL in either region. However, numerical simulations unveiled heightened stress values in the cranial vertebral body. CONCLUSIONS: In patients postPVP, the cranial vertebral body faces a heightened risk of AVF, primarily attributed to biomechanical deterioration rather than lower BMD or an elevated ICL rate.

A Case Report of Rare Presentation and Delay in the Diagnosis of Neuropathic Abdominal Pain Secondary to Asymptomatic Pott's Spine in Elderly Patients.

The presence of vertebral tuberculosis (TB) in developing countries and Southeast Asia is well known, but developed nations such as the USA and UK also claim a good share because of immigrants and the HIV population. We present a unique case series of two patients with chronic abdominal pain where various differentials and arduous investigation were employed. Finally, after a few months, we could locate the lower thoracic Pott's spine and commenced the treatment with successful resolution of symptoms. Surgeons and gastroenterologists should rule out the spinal cause of abdominal pain and also be aware of other atypical presentations before labeling it functional or irritable bowel syndrome (IBS) or somatoform disorders. Extensive investigation, cost, delay in diagnosis, and emotional disturbances could be the end product commonly encountered in a neuropathic abdominal pain patient if a high level of suspicion is not kept at the initial presentation. Above all, potential bony deformity, neurological deficits, and their irreversible sequelae such as paraparesis can also be thwarted.

[Effect of percutaneous kyphoplasty on lumbar-pelvic correlation in osteoporotic vertebral compressive fractures].

OBJECTIVE: To explore the effect of percutaneous kyphoplasty (PKP) on lumbar-pelvic correlation in osteoporotic vertebral compressive fracture (OVCF). METHODS: According to the inclusion criteria, 63 patients with primary osteoporosis between January 2012 and June 2017 were selected as the control group and 67 patients with single-segment lumbar OVCF receiving PKP and complete clinical data were included as the observation group. There was no significant difference in gender, age, and lumbar spine bone density between the two groups ( P>0.05). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) score were used to assess lumbar pain and function before operation and at 3 days after operation in the observation group; lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured in lumbar lateral X-ray films which were taken before PKP and at 1 month after PKP. The same parameters were measured in the lumbar lateral X-ray films which were taken at the time of initial diagnosis in the control group. RESULTS: All patients were followed up 3-24 months with an average of 5.8 months in the observation group. The VAS score decreased from 5.6±1.8 before PKP to 2.8±1.3 at 3 days after PKP ( t=14.082, P=0.000); ODI decreased from 50.1%±5.0% before PKP to 18.2%±1.8% ( t=47.011, P=0.000). Compared with the control group, the LL, PI, and SS decreased and the PT increased in the observation group, and only the difference in LL between the two groups was significant ( P<0.05). In the observation group, the LL and SS significantly increased ( P<0.05) and PT significantly decreased ( P<0.05) at 1 month after operation when compared with preoperative ones, and PI decreased, but the difference was not significant ( P>0.05). In the control group, LL was positively correlated with PI and SS ( P<0.05); PI was positively correlated with PT and SS ( P<0.05). In the observation group, PI was positively correlated with SS ( P<0.05) before and after PKP. CONCLUSION: OVCF patients lost the specific lumbar-pelvic correlation. PKP can restore lumbar lordosis, but it still can not restore the normal physiological fitting.

Effect of percutaneous kyphoplasty on lumbar-pelvic correlation in osteoporotic vertebral compressive fractures / 中国修复重建外科杂志

Objective: To explore the effect of percutaneous kyphoplasty (PKP) on lumbar-pelvic correlation in osteoporotic vertebral compressive fracture (OVCF). Methods: According to the inclusion criteria, 63 patients with primary osteoporosis between January 2012 and June 2017 were selected as the control group and 67 patients with single-segment lumbar OVCF receiving PKP and complete clinical data were included as the observation group. There was no significant difference in gender, age, and lumbar spine bone density between the two groups ( P>0.05). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) score were used to assess lumbar pain and function before operation and at 3 days after operation in the observation group; lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured in lumbar lateral X-ray films which were taken before PKP and at 1 month after PKP. The same parameters were measured in the lumbar lateral X-ray films which were taken at the time of initial diagnosis in the control group. Results: All patients were followed up 3-24 months with an average of 5.8 months in the observation group. The VAS score decreased from 5.6±1.8 before PKP to 2.8±1.3 at 3 days after PKP ( t=14.082, P=0.000); ODI decreased from 50.1%±5.0% before PKP to 18.2%±1.8% ( t=47.011, P=0.000). Compared with the control group, the LL, PI, and SS decreased and the PT increased in the observation group, and only the difference in LL between the two groups was significant ( P0.05). In the control group, LL was positively correlated with PI and SS ( P<0.05); PI was positively correlated with PT and SS ( P<0.05). In the observation group, PI was positively correlated with SS ( P<0.05) before and after PKP. Conclusion: OVCF patients lost the specific lumbar-pelvic correlation. PKP can restore lumbar lordosis, but it still can not restore the normal physiological fitting.

Correlation between spinal sagittal balance and quality of life after treatment of percutaneous kyphoplasty in osteoporotic vertebral compressive fracture / 实用医学杂志

Objective To explore the correlation between spinal sagittal balance and quality of life after the treatment of percutaneous kyphoplasty in osteoporotic vertebral compressive fractures. Methods We retrospec-tively enrolled and screened 85 patients with osteoporotic vertebral compression fractures(OVCF),treated by per-cutaneous kyphoplasty(PKP)in spinal surgery department of Shanghai East Hospital from January 2012 to Decem-ber 2016. The full length of the spine X-ray examinations had been taken preoperatively,pre-discharge and during the follow-up and spine-pelvis sagittal parameters included C7 sagittal vertical axis(C7SVA),thoracic kyphosis (TK),lumber lordosis(LL),pelvic incidence(PT)and sacral slope(SS). Shot Form 36 Health Survey Question-naire(SF-36)was used for the scoring. Results In the last follow-up,C7SVA decreased from(35.9 ± 17.1)mm to(30.8 ± 12.8)mm(P=0.002)and SF-36 scores varied significantly(P<0.01). Before the surgery,follow-up 3 days,6 months and 12 months after the surgery,C7SVA was negatively correlated with the general health status in each period of SF-36(r=-0.343,-0.264,-0.272,-0.258;P=0.001,0.015,0.012,0.017). Conclusions PKP has a significant effect on OVCFs and changes the spine-pelvic sagittal balance in patients with OVCF. Spinal-pel-vic sagittal balance is closely related to the quality of life of these patients.

Biomechanical research progress of osteoporotic vertebra compressive fracture / 医用生物力学

Osteoporosis (OP)-related vertebral fractures often occur in the transitional thoracolumbar region,which are the earliest signs of OP deterioration in elderly patients.Such fractures can be regarded as a physical incident that occurs when the vertebral stress load exceeds the mechanical structural strength.To OP patients,preventing the occurrence of OP fracture is the primary goal for preventative measures,treatment and research of OP.This paper reviews the biomechanical research progress of osteoporotic vertebra compressive fracture (OVCF),and advocates early prevention of OVCF in OP patients,who should avoid activities that might exceed the security scope of the vertebral body load in daily life,so as to prevent subsequent fractures of the vertebral fracture cascade.

Biomechanical research progress of osteoporotic vertebra compressive fracture / 医用生物力学

Osteoporosis (OP)-related vertebral fractures often occur in the transitional thoracolumbar region,which are the earliest signs of OP deterioration in elderly patients.Such fractures can be regarded as a physical incident that occurs when the vertebral stress load exceeds the mechanical structural strength.To OP patients,preventing the occurrence of OP fracture is the primary goal for preventative measures,treatment and research of OP.This paper reviews the biomechanical research progress of osteoporotic vertebra compressive fracture (OVCF),and advocates early prevention of OVCF in OP patients,who should avoid activities that might exceed the security scope of the vertebral body load in daily life,so as to prevent subsequent fractures of the vertebral fracture cascade.

Biomechanical research progress of osteoporotic vertebra compressive fracture / 医用生物力学

Osteoporosis (OP)-related vertebral fractures often occur in the transitional thoracolumbar region, which are the earliest signs of OP deterioration in elderly patients. Such fractures can be regarded as a physical incident that occurs when the vertebral stress load exceeds the mechanical structural strength. To OP patients, preventing the occurrence of OP fracture is the primary goal for preventative measures, treatment and research of OP. This paper reviews the biomechanical research progress of osteoporotic vertebra compressive fracture (OVCF), and advocates early prevention of OVCF in OP patients, who should avoid activities that might exceed the security scope of the vertebral body load in daily life, so as to prevent subsequent fractures of the vertebral fracture cascade.

Biomechanical research progress of osteoporotic vertebra compressive fracture / 医用生物力学

Osteoporosis (OP)-related vertebral fractures often occur in the transitional thoracolumbar region,which are the earliest signs of OP deterioration in elderly patients.Such fractures can be regarded as a physical incident that occurs when the vertebral stress load exceeds the mechanical structural strength.To OP patients,preventing the occurrence of OP fracture is the primary goal for preventative measures,treatment and research of OP.This paper reviews the biomechanical research progress of osteoporotic vertebra compressive fracture (OVCF),and advocates early prevention of OVCF in OP patients,who should avoid activities that might exceed the security scope of the vertebral body load in daily life,so as to prevent subsequent fractures of the vertebral fracture cascade.

Percutaneous extrapedicular vertebroplasty with expandable intravertebral implant in compression vertebral body fracture in pediatric patient-technical note.

PURPOSE: The aim of the article is to present the new extrapedicular percutaneous technique for posttraumatic vertebral column fracture. METHODS: A 15-year-old boy needed a surgical Th8 posttraumatic vertebral body (VB) compressive fracture reduction due to insufficient conservative treatment and consistent severe clinical symptoms. After 6 months of external Jevett long-roll brace stabilization, progressive sagittal balance disturbance of thoracic kyphosis was measured and persistent clinical symptoms were observed. It was decided to present a surgical technique method allowing to attempt to reduce VB fracture, rebalance the vertebral column (VC) without any motion limitation, and decrease clinical symptoms. The procedure was performed percutaneously from extrapedicular approach with intravertebral implant (Spine Jack®-Vexim™) and cement (Interface®-Vexim™) under fluoroscopic imaging (Ziehm™ 8000®). RESULTS: The whole procedure was uneventful. Now, the child is free from clinical symptoms and the partial reduction of VB fracture was achieved. The patient has been followed for 3 months. In the control CT scans, the VB fracture reduction is stable and no progression of thoracic kyphosis angle is observed. Furthermore since the surgical procedure, the patient is clinical symptom free. CONCLUSION: The extrapedicular percutaneus technique of VB fracture reduction with intravertebral fixation allowed to partially reduce the VB compressive fracture, rebalance the VC without any motion limitation, avoid external long-roll brace, and eliminate clinical symptoms. The procedure is minimally invasive, fast, and clinically effective. However, the technique should be restricted only to carefully selected clinical cases.

Risk factors and prognosis of vertebral compressive fracture in pyogenic vertebral osteomyelitis.

OBJECTIVES: To analyse the clinical, microbiological and radiological characteristics, and to identify risk factors of vertebral compressive fracture (VF) in spontaneous pyogenic vertebral osteomyelitis (VO). METHODS: A retrospective clinical study and blinded radiological review of adult patients with VO. RESULTS: Eighty-eight patients were included: 57 (65%) had a definitive diagnosis of VO (positive microbiology), and 31 (35%) had a probable diagnosis of VO. Of these, 27 (30.7%) presented with VF at diagnosis of VO, and 4 afterwards (total 31, 35.2%). Patients with VF were considered to be at higher risk of osteopenia--they were older (74 vs 66 years, p = 0.013), and included high percentage of women (33 vs 41%, NS)--; and presented more dorsal involvement (56 vs 21%; p < 0.007). Causal microorganisms were similar between groups (VF, no VF). The time to diagnosis of VO was longer in the presence of VF (65 vs 23 days, p = 0.001), and also in cases with no isolated organisms. All patients received antibiotics, and just one patient required spinal stabilisation (VF). After 357 median days of follow-up, all patients were cured. Clinical improvement (residual pain, functional recovery) tended to be slower in patients with VF (log-rank 0.19 and 0.15, respectively), but clinical symptoms were similar in most patients at the last follow-up (VF, no VF). CONCLUSIONS: VF is a common complication in pyogenic VO that causes slower clinical recovery. Risk factors of VF are: osteopenia, a delayed diagnosis and dorsal involvement. Conservative management is probably appropriate for most cases, but spinal stabilisation should be considered in some specific cases.

Spinal intraosseous epidural arteriovenous fistula with perimedullary drainage obliterated with Onyx embolization: case report.

The authors report an extremely rare case of spinal intraosseous epidural arteriovenous fistula (AVF) with perimedullary vein reflux causing symptoms of myelopathy. The intraosseous fistula tracts were completely obliterated with Onyx embolic agent, resulting in a total resolution of symptoms. The unique features of this case include the rare location of the fistula in the vertebral body and the association of the fistula with a compressive fracture. Imaging studies confirmed these hemodynamic findings and provided clarity and direct evidence regarding the association of epidural AVF formation with the vertebral compressive fracture. The authors also propose a possible disease evolution based on the previously adduced reflux-impending mechanism.

A discriminatory mechanical testing performance indicator protocol for hand-mixed glass-ionomer restoratives.

OBJECTIVES: To identify a reproducible and discriminatory mechanical testing methodology to act as a performance indicator for hand-mixed glass-ionomer (GI) restoratives. METHODS: Groups of 20 (five batches of four) cylinders (6.0±0.1 mm height, 4.0±0.1 mm diameter) for compressive fracture strength (CFS) and compressive modulus (CM) testing, bars (25.0±0.1 mm length, 2.0±0.1 mm width, 2.0±0.1 mm thickness) for three-point flexure strength (TFS) and tensile flexural modulus (TFM) testing, discs (13.0±0.1 mm diameter, 1.0±0.1 mm thickness and 10.0±0.1 mm diameter, 3.10±0.03 mm thickness) for biaxial flexure strength (BFS) and Hertzian indentation (HI) testing, respectively, were prepared using a hand-mixed GI restorative manipulated with 100-20% (in 10% increments) of the manufacturers recommended powder content for a constant weight of liquid. Data were statistically analyzed at p<0.05, the coefficient of variation (CoV) was assessed for the four tests at each powder:liquid mixing ratio investigated (n=9) and a Weibull analysis performed on the CFS, TFS and BFS data to assess the reliability of the data sets. The failure mode and fracture origin of the HI specimens was assessed by fractography. RESULTS: For the hand-mixed GI restorative, a progressive reduction in the powder content (by 10% for a constant weight of liquid) resulted in a progressive linear deterioration (p<0.001) in the CFS (R2=0.957), CM (R2=0.961) and TFM (R2=0.982) data. However, no linear deterioration (p>0.05) was identified for the TFS (R2=0.572), BFS (R2=0.81) and HI (R2=0.234). The CoV and Weibull data identified distinct regions--three for the CFS and TFS data and two for the BFS data sets, within the range of powder:liquid mixing ratios investigated. Fractographic analysis of HI specimens revealed a transition in failure mode from bottom-initiated radial cracking to top-initiated cone cracking on reducing the powder content for a constant weight of liquid. SIGNIFICANCE: The CFS test is the only discriminatory performance indicator for hand-mixed GIs from amongst the four mechanical testing approaches (CFS, TFS, BFS and HI) investigated. The CM and TFM represent an intrinsic material property independent of specimen dimensions and may be used as an adjunct to a mechanical testing approach when investigating hand-mixed GIs.

Basivertebral foramen could be connected with intravertebral cleft: a potential risk factor of cement leakage in percutaneous kyphoplasty.

BACKGROUND CONTEXT: Among different types of cement leakage in percutaneous kyphoplasty (PKP) for osteoporotic vertebral body compression fractures, leaks into the spinal canal are considered to be the most common complication. One potential structure causing this type of cement leakage is the potential connection between the basivertebral foramen and the intravertebral cleft, which is revealed clearly on magnetic resonance (MR) images, but is often ignored in the literature. PURPOSE: The purpose of this study is to assess the incidence rate of different types of cement leakage in PKP with or without intravertebral clefts and to determine whether the basivertebral foramen could be connected to the intravertebral cleft. STUDY DESIGN: This study is a retrospective assessment of the presence of an intravertebral cleft in osteoporotic vertebral bodies and the different types of cement leakage after PKP on radiographs, computed tomographic (CT) scans, and MR images. PATIENT SAMPLE: A total of 164 consecutive patients underwent PKP to treat 204 osteoporotic vertebral compression fractures. OUTCOME MEASURES: Outcome measures include the occurrence of different types of cement leakage in the groups with an intravertebral cleft and without intravertebral clefts. METHODS: A total of 204 vertebrae in 164 consecutive patients who underwent PKP to treat osteoporotic vertebral compression fractures were classified into two patterns based on preoperative radiographs, CT scans, and/or MR images of the treated levels: cleft pattern (with an intravertebral cleft in the vertebral body) and trabecular pattern (without intravertebral clefts). When an intravertebral cleft was identified, the investigators examined the basivertebral foramen and looked for a communication between the two structures on three-dimensional CT scans and MR images. On direct postoperative images, the patterns of cement leakage were classified as five types: type A, through a cortical defect into the paraspinal soft tissues; type B, through the basivertebral foramen; type C, via the needle channel; type D, through a cortical defect into the disc space; and type E, via the paravertebral vein. The association of the distribution of the cement leakage and the presence of an intravertebral cleft was analyzed retrospectively. Moreover, the association of type B leakage with the communication between the basivertebral foramen and the intravertebral cleft was also assessed. RESULTS: The average interobserver kappa values for determining the type of cement leakage and the presence of intravertebral cleft were 0.916 (range, 0.792-1) and 0.935, respectively. In 41 of 204 vertebrae (19.9%), an intravertebral cleft was confirmed on preoperative images. A communication between the intravertebral cleft and the basivertebral foramen was seen in 10 vertebrae (24.4%). Cement leakage was 36.2% in the group with a trabecular pattern and 41.5% in the group with a cleft pattern (p>.05). Leaks through the basivertebral foramen (type B; N=30, 14.7%) and through cortical defects into the disc space (type D; N=14, 6.9%) were more common than other types. Twenty of 163 vertebrae with the trabecular pattern (12.3%) and 10 of 41 vertebrae with the cleft pattern (24.4%) were identified as type B leaks, which reached statistical significance (p<.05). There was no statistical difference between the trabecular pattern and the cleft pattern on other types of leaks. CONCLUSIONS: Type B leaks are more common in vertebrae with an intravertebral cleft, which supports the presence of a connection between an intravertebral cleft and the basivertebral foramen. Thus, care must be taken when PKP is performed in these patients to avoid direct cement leakage into the spinal canal through the basivertebral foramen.

Bone cement distribution patterns of osteoporotic vertebral fractures with intravertebral clefts after vertebroplasty / 中国组织工程研究

10.3969/j.issn.2095-4344.2013.26.006

MR Predictors of Bone Cement Leakage in Percutaneous Vertebroplasty and Kyphoplasty for Painful Osteoporotic Vertebral Compression Fracture / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVES: To determine MR findings that affect the bone cement leakage in patients with osteoporotic compressive fractures who are receiving percutaneous vertebroplasties and kyphoplasties. MATERIALS AND METHODS: A retrospective review was conducted on 105 patients with 131 vertebrae treated by percutaneous vertebroplasties (group 1: 66 patients and 78 cases) and kyphoplasties (group 2: 39 patients and 53 cases) from October 2001 to October 2005. The study was performed to determine whether cement leakage was related to any of the following MR findings: level of injured vertebra, severity of anterior height loss, posterior cortical disruption, endplate disruption, presence of either vacuum or cystic portions, linear sclerosis that was low in signal intensity in T1 and T2-weighted images. RESULTS: Bone cement leakage was detected in 51 (65.3%) of 78 treated vertebrae in group 1 and 18 (33.9%) of 53 treated vertebrae in group 2. There was a statistically significant difference between the incidences (p<0.05). Vertebral endplate disruption had a positive correlation in both groups (p<0.05). There was more cement leakage in group 1 (48.5%) than in group 2 (18.1%) in cases of endplate disruption (p<0.05). Vacuum or cystic change had negative correlations to bone cement leakage in group 1 (p<0.05). No other MR findings demonstrated a statistically significant correlation with bone cement leakage. CONCLUSION: On the MR findings, vertebral endplate disruption and vacuum or cystic change in fractured vertebrae demonstrated a significant correlation with bone cement leakage in group 1. There was relatively less cement leakage into the intervertebral spaces with kyphoplasties than with vertebroplasties in the cases of vertebral endplate disruption.

Ex vivo comparative study between single and double balloon bilateral dilatation of kyphoplasty / 中国矫形外科杂志

[Objective]To compare the difference between single and double balloon kyphoplasty to treat osteoporotic vertebral body.[Method]Twenty osteoporotic vertebral bodies were harvested from 10 embalmed cadavers,alternatingly assigned to either the single and double group.All vertebraes were compressed by 25% of their initial height using materials testing machine to create vertebral compression fractures and determine their augmented strength and stiffness before and after injecting the cement.Precompression,postcompression and posttreatment height of vertebrae were measured.[Result]Both treatments resulted in significantly stronger vertebral bodies relative to their initial state(P

Effect of percutaneous kyphoplasty in treatment of acute and chronic osteoporotic vertebral compression fractures / 中国矫形外科杂志

[Objective]To analyze the therapeutic effects of percutaneous kyphoplasty for acute versus chronic osteoporotic vertebral compressive fracture.[Method]Percutaneous kyphoplasty was performed in 56 patients(137 vertebraes) with osteoporotic vertebral compression fracture (VCF).Based on the changes on MRI,all compression fractures were divided into 3 types:acute VCF,repairing VCF and chronic VCF.Types were examined for differences in treatment efficacy,according to the anterior/middle vertebral body height,Cobb's angle and visual analogue scale(VAS) at pre-and post-operation.[Result]All patients with the VCFs had rapid and significant improvement in back pain following percutaneous kyphoplasty.VAS was from 8.09?1.12 preoperatively to 2.31?0.91 postoperatively,and 2.26?0.88 at final follow-up.The results showed that 41 cases were Type Ⅰ on MRI,69 were Type Ⅱ and 27 were Type Ⅲ.Significant improvement was observed at the post-operative versus pre-operative assessments in Type Ⅰ and Type Ⅱ.No significant differences were observed between post-and pre-operative assessments in Type Ⅲ.[Conclusion]The curative effect of percutaneous kyphoplasty for the treatment of acute VCFs appears superior to that of chronic VCFs.After a definite diagnosis of VCFs,percutaneous kyphoplasty should be performed as early as possible in order to obtain a better therapeutic effect.