Adjacent Fractures Research Articles

New Rate-Transient Analysis for Fractured Shale Gas Wells Using a Tri-linear Flow Model

Fractured shale gas wells often exhibit long-term linear flow. Previous studies have developed some linear flow models to analyse this behaviour. In this study, we developed a tri-linear flow model for simulating shale gas production. Our model does not assume that the length of secondary fractures is equal to the half-distance between adjacent hydraulic fractures, which is an improvement over previous tri-linear flow models. Based on the tri-linear flow model, we developed simplified equations for characterizing bilinear and linear flow regimes. Combining the tri-linear flow model and simplified equations, we developed a new rate-transient analysis (RTA) workflow to analyse shale gas production data. The new RTA workflow not only includes the identification of flow regimes and their analysis using a log-log plot of the reciprocal of production rate versus time, i.e., straight line analysis, but also history-matching. The results obtained from straight line analysis serve as additional constraints in history-matching. This helps to reduce the non-uniqueness issue of history-matching. The new RTA workflow was validated using two synthetic and five field examples.

Safety of vertebral augmentation with cranio-caudal expansion implants in vertebral compression fractures with posterior wall protrusion.

Vertebral augmentation (VA) has become routinely used in vertebral compression fractures (VCFs). VCFs are often associated with posterior wall protrusions (PWPs), which theoretically contraindicates vertebroplasty due to a higher risk of neurological complications. Thelatest generation of VA devices uses intravertebral cranio-caudal expandable implants to improve the correction of structural deformities but could also be used to prevent further PWP during cement injection. The aim of this study was to evaluate the safety of VA with expandable implant for VCFs with PWP. All consecutive patients treated with expandable implants were considered eligible for inclusion if they met the following criteria: (1) non-neurological VCF, (2) considered unstable (A3-A4 in AOSpine classification), (3) significant PWP (> 2mm), (4) back pain with a visual analogue scale (VAS) ≥ 4. PWPs were independently measured by two investigators; Pearson's statistics were used for interobserver reproducibility. Fifty-one consecutive patients, with a mean age of 75 ± 8.3years (range, 50-92), were included. There was a slight decrease between mean preoperative (6.7mm ± 2.2mm) and postoperative (6.5mm ± 2.2mm) PWP (p= 0.02), with an excellent interobserver reproducibility (Pearson correlation coefficient = 0.92). A mean kyphosis reduction of 34.9% (± 28.4) was observed (p< 0.001). Forty-two patients (82.4%) had significant pain improvements (mean preoperative VAS = 6.9 [± 1.7] versus 3.1 [± 2.0] postoperatively [p< 0.001]). Secondary adjacent level fractures were noted in 16 patients (31.4%), with a reduction of that risk down to 18.8% if a preventive adjacent vertebroplasty was performed, without reaching the significance threshold (p= 0.14). VA with expandable implants appeared safe for non-neurological VCFs with PWP, while allowing satisfactory pain relief. • Vertebral augmentation with cranio-caudal expandable implants is safe for non-neurological vertebral compression fractures with posterior wall protrusions. • Vertebral augmentation with cranio-caudal expandable implants might increase the occurrence of secondary adjacent level fractures. • Adjacent level vertebroplasty might be helpful to prevent secondary adjacent level fractures.

Percutaneous vertebroplasty and balloon kyphoplasty in the treatment of osteoporotic vertebral fractures: a prospective randomized comparison.

The purpose of this study is to compare the efficacy and safety of percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP) in the treatment of osteoporotic vertebral compression fractures. Patients with osteoporotic vertebral body fractures (T4-L5) were randomized and not blinded to kyphoplasty (n = 69) or vertebroplasty (n = 70). The postoperative pain score (VAS) at 12months was the primary end point. The radiographic results were evaluated in relation to the resolution of the fracture and the possible onset of further osteoporotic fractures during follow-up. A total of one hundred and thirty-nine patients were eligible for randomization (n = 70 for PVP group and n = 69 for BKP), and twenty-six patients (twenty in the BKP group and six in the PVP group) were excluded. The mean average age of patients was 73years, and 82% of the patients were females. VAS pain score was significantly reduced after surgery in both groups, and there were no significant differences between the two groups in postoperative VAS score. There was a significant reduction in kyphotic wedge angle and improvement of the sagittal index in both groups, but there was no significant difference between the two groups. There was a significant higher risk incidence of adjacent level fractures in the vertebroplasty group. In terms of clinical outcomes, there were no differences between the two groups. Both showed a significant clinical improvement, vertebral body height restoration and reduction in the kyphotic angle. There was a significant higher risk of adjacent level fractures in the vertebroplasty group.

Percutaneous kyphoplasty using expandable SpineJack® implant for the treatment of osteoporotic vertebral fractures

IntroductionL'objectif était d’évaluer le résultat de notre prise en charge chirurgicale des fractures ostéoporotiques vertébrales avec un extenseur vertébral percutané de type SpineJack®.MéthodesIl s'agit d'une étude rétrospective analytique et mono centrique de 33 mois (avril 2015 - décembre 2017). Elle avait porté sur les patients ayant été traités par kyphoplastie avec le pour une fracture vertébrale ostéoporotique. Le kit comprenant un extenseur vertébral en titane à type de SpineJack® de Vexim et le ciment acrylique avait été utilisé. Les patients présentant une rachialgie d'intensité croissante malgré le traitement lié à une fracture vertébrale ostéoporotique ont été inclus dans l'étude ainsi que ceux ayant acceptés le principe de la chirurgie et donner leur consentement éclairé. La fracture vertébrale était diagnostiquée à la tomodensitométrie (TDM) et son caractère récent confirmé par l'imagerie par résonnance magnétique (IRM).RésultatsEntre avril 2015 et décembre 2017, trente-sept patients porteurs de fractures ostéoporotiques vertébrales ont été traités par kyphoplastie avec un extenseur vertébral en titane. L'âge moyen était de 73,4 ans avec un sexe ratio à 0,6. L'échelle visuelle analogique moyenne était de 7,3. Le score d'Osvestry était en moyenne de 81,6. Les fractures étaient prédominantes au niveau de la charnière thoraco-lombaire. L'angle de cyphose vertébrale mesurait en moyenne 18,45°. La kyphoplastie avait concerné 44 vertèbres. Quatre cas de complications opératoires avaient été enregistrés. La durée moyenne d'hospitalisation était de 5,4 jours. A 6 mois de suivi, 9 patients étaient encore sous traitement antalgique. A un an, aucun cas de fracture de vertèbre adjacente n'avait été trouvé.ConclusionLa kyphoplastie percutanée avec un extenseur en titane est un moyen thérapeutique sûr et efficace des fractures vertébrales ostéoporotiques. Avec son effet quasi immédiat, il permet au patient, un retour rapide à la vie active.

Trauma-Associated Pulmonary Laceration in Dogs-A Cross Sectional Study of 364 Dogs.

In this study, we describe the computed tomography (CT) features of pulmonary laceration in a study population, which included 364 client-owned dogs that underwent CT examination for thoracic trauma, and compared the characteristics and outcomes of dogs with and without CT evidence of pulmonary laceration. Lung laceration occurred in 46/364 dogs with thoracic trauma (prevalence 12.6%). Dogs with lung laceration were significantly younger than dogs in the control group (median 42 months (interquartile range (IQR) 52.3) and 62 months (IQR 86.1), respectively; p = 0.02). Dogs with lung laceration were significantly heavier than dogs without laceration (median 20.8 kg (IQR 23.3) and median 8.7 kg (IQR 12.4 kg), respectively p < 0.0001). When comparing groups of dogs with thoracic trauma with and without lung laceration, the frequency of high-energy motor vehicle accident trauma was more elevated in dogs with lung laceration than in the control group. No significant differences were observed between groups regarding tge frequency and length of hospitalization and 30-day mortality. Similar to the human classification scheme, four CT patterns are described in dogs in this study: Type 1, large pulmonary laceration located deeply in the pulmonary parenchyma or around an interlobar fissure; Type 2, laceration occurring in the paraspinal lung parenchyma, not associated with vertebral fracture; Type 3, subpleural lung laceration intimately associated with an adjacent rib or vertebral fracture; Type 4, subpleural lesions not associated with rib fractures. Complications were seen in 2/46 dogs and included lung abscess and collapse.

Prevention of Proximal Junctional Kyphosis or Failure: Cement Augmentation

Vertebral cement augmentation (vertebroplasty) has recently garnered increasing attention as a possible prophylactic treatment for the prevention of proximal junctional kyphosis and proximal junctional failure in osteoporotic patients undergoing long spinal fusions. The supporting data mostly comes from small retrospective case series, but indicates a modest benefit, particularly in the prevention of proximal junctional failure. Common risks include possible cement extravasation leading to embolization events, and a theoretical increased risk of adjacent segment fracture. Deformity surgeons should familiarize themselves with the pros and cons of this technique and may wish to utilize it in appropriately selected cases.

INTRA-VERTEBRAL INSTABILITY WITH PARAPARESIS AFTER KYPHOPLASTY FOR A STABLE OSTEOPOROTIC FRACTURE WITH ADJACENT HEALED FRACTURES

Introduction: Kyphoplasty, an established low-risk procedure for the management of symptomatic osteoporotic fractures, has been a topic of debate due to doubts regarding its efficacy and its associated complications like adjacent segment fractures and cement leakage. We present a unique case of failure of kyphoplasty due to dynamic instability through the vertebral body in a patient with a recent onset osteoporotic fracture treated by double-balloon kyphoplasty. To the best of our knowledge, there are no reported cases of dynamic instability with paraparesis after kyphoplasty for a fresh stable osteoporotic fracture associated with adjacent multiple healed osteoporotic fractures. Case Presentation: A 78-year-old female with complaints of back pain and imaging suggestive of old osteoporotic fractures of T12 and L1 vertebra with a fresh stable osteoporotic fracture L2 vertebra was treated with kyphoplasty after the failure of conservative treatment. After an initial good response, the patient started complaining of back pain and anterior thigh pain with weakness in both lower limbs. Dynamic X-rays and MRI of the patient revealed intra-vertebral instability at the L2 level. The patient was operated with interbody fusion L1–L2 and posterior stabilization L1–L3, and co-existing L5–S1 spondylolisthesis was dealt with by postero-lateral fusion L5–S1. Discussion: Recurrence of back pain after kyphoplasty can be caused by re-fracture at the same level or adjacent vertebral fracture. Neurological complications are rarely reported after balloon kyphoplasty and are mostly related to cement leakage into the spinal canal. The old adjacent segment fractures altering the biomechanics with resulting undue stress on the augmented stiff vertebra may have resulted in intra-vertebral instability and paraparesis. In balloon kyphoplasty, cement is put in the anterior part of the vertebral body and the posterior body lacks support. This may also have contributed to instability. Conclusion: Dynamic instability at the intra-vertebral level can be a cause of failure of kyphoplasty especially when adjacent osteoporotic fractures are altering the biomechanics of the spine. The treatment of osteoporotic fractures should be individualized and in the presence of such factors, they may be better managed by alternative methods.

Fracture path interaction of two adjacent perforations subjected to different injection rate increments

During the fracturing of shale gas reservoirs, the injection rate and its variation affect the fracture propagation path and fracture connectivity between two adjacent perforations. To reveal the interaction mechanism of injection rate change on hydraulic fracture propagation of adjacent perforations, an extended finite element method (XFEM) was employed for simulating the fracture propagation and interactions between adjacent hydraulic fractures under different injection rate increments. Considering the heterogeneity of rock minerals and based on the results of shale mineral composition analysis via X-ray diffraction (XRD), a code segment was written in Python to establish a computational network model with a random distribution of different material properties. Acoustic emission (AE) data extraction and fracture location during the process of fracture propagation were realised using MATLAB programming. Simulation results revealed that the closer the injection rate increments in adjacent perforations, the greater the compressive stress between the perforations. Variations in the pressure difference and fracture width difference between the two perforations dynamically reflect their interactions; both anisotropy and stress shadow determine the fracture propagation path. This study provides a good technical basis for fracture design optimisation.

Risk Factors for Cement Leakage and Adjacent Vertebral Fractures in Kyphoplasty for Osteoporotic Vertebral Fractures.

Cement leakage and adjacent vertebral fractures are not uncommon after percutaneous augmentation. However, conclusive identification of risk factors for postprocedural complications remains elusive. The anticipation of leakage and successive fractures through the identification of risk factors will help physicians better inform patients of potential complications and establish procedural refinements key to risk reduction. The aim of this retrospective study was to summarize available reports of the risk factors for cement leak and adjacent vertebral fracture in or after kyphoplasty for osteoporotic vertebral compression fractures. A total of 102 cases of bilateral percutaneous kyphoplasty (PKP), performed between January 2014 and December 2016, were retrospectively reviewed. Each case surveyed in this review included a minimum 1-year follow-up and data on age, sex, bone mineral density, Visual Analog Scale score, preoperative compression rate, kyphotic angle, treatment time, the volume of cement, and the intactness of the vertebral posterior wall (computed tomography scan) were collected. Pearson χ test and independent samples test were used to determine the relative risk factors of cement leak and adjacent vertebral fracture in patient subsets. Diabetic status and alteration in the Cobb angle after PKP exhibited a statistically significant correlation with the incidence of new adjacent vertebral fracture (group B) (P<0.05). In addition, the integrity of vertebral walls (P=0.001) and the volume of injected cement (P=0.026) significantly boosted the potential risk of cement leakage (P<0.05), although these variables did not associate with the adjacent fracture. Additional examined variables, including age, sex, Visual Analog Scale scores, number of fractures were not significantly associated with leakage or adjacent vertebral fracture risk. Diabetes and the alteration of the Cobb angle following PKP are factors positively related to the occurrence of postoperative adjacent vertebral fractures. It is also demonstrated that the integrity of vertebral walls and average volumes of injected cement are the possible risk factors of cement leakage while performing the PKP.

Comparison of the diagnostic accuracy of X-ray and computed tomography in patients with wrist injury

BackgroundThis study aimed to compare CT and XR images of patients admitted to the emergency department due to wrist injuries and to evaluate the accuracy of XR in the diagnosis of fractures. MethodsPatients; who admitted to ED with injuries due to wrist trauma and who underwent XR imaging and CT scans in the period from 1 January 2017 to 1 January 2018, were included in the study. CT scan image interpretation reports recorded in the hospital automation system were considered eligible to be included in the study. XR images were interpreted by an orthopedics and traumatology specialist. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and Kappa (κ) coefficient of XR were calculated according to CT. Inter-rater agreement was graded according to κ values. ResultsA total of 274 patients were included in the study. Fractures were identified in the XR images in 180 (66%) patients and in the CT images in 196 (72%) patients. Compared to CT, the Sn, Sp, PPV, NPV and κ coefficient of XR were 89%, 92%, 97%, 77% and 0.764 respectively. Compared to CT, the highest sensitivity of XR was measured to detecting radius (Sn: 95%, κ: 0.896) and 5th metacarpal fractures (Sn: 77%, κ: 0.859), the lowest sensitivity of XR was calculated in detecting scaphoid, capitate, pisiform, trapezium hamate, and triquetrum fractures (Sn: 59–14%, κ: 0.619–0.240). The sensitivity and κ coefficient of XR were calculated 54% and 0.530 in the adjacent bone fracture, 83% and 0.830 in joint dislocation, 75% and 0.661 in the fractures extending to the joint space. ConclusionsXR is the first-choice imaging modality in the evaluation of wrist injuries, but CT imaging should be preferred when fractures extending to the joint space, adjacent bone fracture and carpal bone fracture are being considered.

The treatment of osteoporotic thoraco-lumbar burst fractures by unilateral percutaneous kyphoplasty: A prospective observation study.

Osteoporotic thoraco-lumbar burst fractures with serious pain are very common, and the optimal treatment of burst fractures without any neurological deficits has not yet been properly codified. The objective of this study was to evaluate prospectively the clinical effects and pain relief of unilateral percutaneous kyphoplasty (PKP) on osteoporotic thoraco-lumbar burst fractures. Forty-six patients with osteoporotic thoraco-lumbar burst fractures were treated by PKP in our hospital from January 2016 to January 2017. The height of posterior wall (HPW), the height of anterior wall (HAW) and kyphotic angle (KA) were measured via x-ray radiographs before surgery, one day after surgery and at final follow-up. Visual analogue scale (VAS) score and the oswestry disability index (ODI) score were evaluated preoperatively, postoperatively and at final follow-up. All the patients with osteoporotic thoraco-lumbar burst fractures were treated by unilateral PKP. Radiological evaluation (anteroposterior and lateral x-ray radiographs and CT) was performed. All patients were followed-up, and the mean follow-up was 28.8±7.0months. The preoperative HAW was 20.1±2.3mm, and the HAW was significantly improved to 22.9±2.4mm after operation (p<.05), and at the final follow-up, the HAW was 19.9±2.1mm, which was lower than the postoperative HAW. The HPW was also significantly corrected after surgery (p<.05). There were no significant differences between postoperative HPW and HPW at the final follow-up (p>.05). The KA was significantly corrected after operation (p<.05), but relapse occurred at the final follow-up, and at the final follow-up, the average of KA was 19.4±1.6 degree. The VAS and ODI were significantly improved at the final follow-up compared to the preoperative period (p<.05). Cement leakage was found in eight patients, and adjacent vertebral fracture (VF) was found in two patients. Our results showed that unilateral PKP acquired satisfactory treatment effect and pain relief in the management of osteoporotic thoraco-lumbar burst fractures. Meticulous evaluation of preoperative images and careful repetitious injection of cement are important to prevent cement leakage. Our present results showed that unilateral PKP was an effective method to obtain satisfactory pain relief in the management of osteoporotic thoraco-lumbar burst fractures. It may a good indication for the patients with osteoporotic thoraco-lumbar burst fractures, and the patients could not tolerate the serious acute pain by conservative treatment.

Risk factors of adjacent segmental fractures when percutaneous vertebroplasty is performed for the treatment of osteoporotic thoracolumbar fractures

The study aimed to analyze the radiographic and magnetic resonance imaging (MRI) findings that might predict the risk for adjacent segmental fractures (ASFs) when percutaneous vertebroplasty (PV) is used for the treatment of osteoporotic thoracolumbar fractures (OTFs). A total of 92 OTFs patients who underwent PV between January 2013 and January 2015 were retrospectively reviewed. The visual analog scale (VAS), Oswestry-Disability Index (ODI) and radiolographic measurements were assessed. The VAS and ODI scores improved significantly at the final follow-up (FU) compared with the preoperation scores. Compared with the preoperative values, the fractured body alignment (FBA) significantly improved at the 3-month FU and the final FU, but the adjacent segment alignment (ASA) and thoracolumbar alignment (TLA) did not improve. According to the correlation analysis, the final FU TLA and the final FU ASA were correlated with the preoperative FBA, ASA, and TLA on plain radiography and were highly correlated on MRI. However, the final FU FBA was not correlated with the preoperative FBA, ASA, or TLA on plain radiography or MRI (P > 0.05). The ASFs were correlated with the 3-month FU TLA (r = 0.6044, P = 0.0037) and the final FU TLA (r = 0.5699, P = 0.007) on plain radiography, and the final TLA was more correlated with the preoperative FBA, ASA, and TLA on MRI than on plain radiography. In conclusion, the preoperative ASA and TLA on MRI were risk factors associated with ASFs in OTFs treated with PV.

Low volumetric bone density is a risk factor for early complications after spine fusion surgery

Lumbar spine (LS) fusion surgery is increasingly performed worldwide. Complications after fusion result in significant morbidity and healthcare costs. Multiple factors, including osteoporosis, have been suggested to contribute to risk of complications and re-operation. However, most studies have used DXA, which is subject to artifact in patients with spine pathology, and none have investigated the relationship between BMD and timing of post-operative complications. This study aims to investigate LS volumetric bone density (vBMD) as a risk factor for complications (pseudoarthrosis, instrumentation failure, adjacent fractures), re-operation, and time to complication after fusion. We evaluated a cohort of 359 patients who had initial LS fusion surgery at our institution, had pre-operative LS CTs and post-operative imaging available for review. Demographic factors, smoking status, vBMD, and details of surgical procedure were related to likelihood and timing of post-operative complications. Mean age was 60 ± 14years, vBMD 122 ± 37g/cm3. Median follow-up was 11months. Skeletal complications occurred in 47 patients (13%); 34 patients (10%) required re-operation. Low vBMD (directly measured and estimated using HU) and smoking were associated with increased risk of skeletal complications. Each increase in baseline vBMD of 10g/cm3 decreased the complication hazard and increased the complication-free duration in time-to-event analysis (hazard ratio 0.91, 95% CI 0.83-0.98, p < 0.02). Low vBMD was a significant risk factor for early post-operative complications in patients undergoing LS fusion. Prospective studies are needed to confirm these findings and to elucidate the optimal timing for follow-up and strategies for prevention of post-operative complications in this population.

Presence or absence of adjacent vertebral fractures has no effect on long-term global alignment and quality of life in patients with osteoporotic vertebral fractures treated with balloon kyphoplasty

BackgroundGlobal sagittal malalignment after osteoporotic vertebral fracture is correlated with decreased quality of life. Balloon kyphoplasty promotes short-term global alignment, but long-term correction is difficult in patients with such fractures. Adjacent vertebral fracture is one of the major complications of balloon kyphoplasty. We investigated the correlation of the incidence of adjacent vertebral fracture with the loss of global alignment correction after balloon kyphoplasty. MethodsForty patients were enrolled in this retrospective study. Adjacent vertebral fracture occurred in 17 patients. Sagittal vertical axis, the angle between the two vertebrae above and below the balloon kyphoplasty site (local alignment angle), and the vertebral kyphotic angle at the kyphoplasty site were measured pre- and post-operatively. Clinical results were assessed. ResultsThere were no significant differences between the sagittal vertical axis before and after balloon kyphoplasty in groups with (+) or without (−) adjacent vertebral fracture. Local alignment angles decreased soon after balloon kyphoplasty, but increased during follow-up in both groups. Vertebral kyphotic angles decreased significantly soon after balloon kyphoplasty in both groups; although this increased significantly in the adjacent vertebral fracture (−) group, but not in the adjacent vertebral fracture (+) group, during follow-up. Correction loss of alignment was found in both adjacent vertebral fracture (+) and (−) groups, attributed to adjacent vertebral fracture in the former and re-collapse of the balloon kyphoplasty site in the latter. No significant differences in clinical results were observed between the groups, although these were strongly correlated with sagittal vertical axis before balloon kyphoplasty. ConclusionsThe adjacent vertebral fracture (+) and (−) groups exhibited similar correction loss of alignment and improved quality of life. The presence or absence of adjacent vertebral fractures had no effect on long-term global alignment and patient quality of life.

Outcomes of vertebroplasty in osteoporotic vertebral fractures with limited indication

IntroductionVertebroplasty has been shown to be effective for improving quality of life and pain of osteoporotic vertebral fractures (OVF) without neurological deficit and not susceptible to conservative treatment. It is advisable to perform them on recent fractures with 50% crush and without the involvement of the canal, although there are no standard recommendations. In some cases these limits are exceeded. We analyse the outcomes of percutaneous vertebroplasty (PVP) in OVF with relative/limit indication. Materials and methodsRetrospective analysis of 88 patients (126 fractures) who underwent surgery by PVP; 95/126 were osteoporotic fractures. Thirty-four cases (35%) were included in the relative indication group, with at least one of the following: canal involvement, >50% collapse, and >12 months of evolution of the fracture. The rest of the cases were included in the standard indication group. We performed clinical-radiological follow-up, collected intraoperative data on techniques and complications, occurrence of leaks, postoperative clinical improvement (according to VAS), new adjacent fractures, and satisfaction. ResultsMost fractures were between D11-L2 (66%) with 6–8 months follow-up. No significant differences were observed regarding clinical improvement in either group. A higher percentage of leaks were detected in the relative indication group, 44% in comparison to 29.5% in the standard indication group, without statistical significance. All leakages were asymptomatic. There were 3 new OVF after PVP in the relative indication group and 4 in the standard group, without statistically significant differences. Discussion and ConclusionsThe use of cement in OVF with relative indication led to the same clinical benefit in our sample as those with standard indication. A higher number of leakages occurred in the relative indication group with no clinical consequences or adjacent fractures.

Impact of Adjacent Vertebral Fractures on Clinical Outcomes Following Balloon Kyphoplasty and Development of a Scoring System for their Prediction

Impact of Adjacent Vertebral Fractures on Clinical Outcomes Following Balloon Kyphoplasty and Development of a Scoring System for their Prediction

Analysis of adjacent vertebral fracture after Balloon Kyphoplasty for non-union of osteoporotic vertebral fracture

Analysis of adjacent vertebral fracture after Balloon Kyphoplasty for non-union of osteoporotic vertebral fracture

Cement Augmented Anterior Reconstruction and Decompression without Posterior Instrumentation: A Less Invasive Surgical Option for Osteoporotic Thoracolumbar Fracture with Cord Compression.

ObjectiveWe investigated the clinical and radiological outcomes of a cement augmented anterior reconstruction and decompression without pedicle screw fixation in patients with osteoporotic thoracolumbar vertebral fracture with myelopathy.MethodsThere were 2 male and 6 female patients with thoracolumbar fracture and myelopathy included in the study. The mean follow-up period was more than 1 years. The anterolateral decompression and cement augmented anterior reconstruction with poly(methyl methacrylate) (PMMA) was performed. Demographic data, clinical outcomes, perioperative parameters and radiologic parameter were retrospectively evaluated.ResultsThe symptoms due to myelopathy were improved in all patients. The preoperative median visual analog scale score for lower back and leg were 8.5 that improved 4.25 and 3 at last follow up. The preoperative function state showed a median Oswestry Disability Index score 61.5 that improved 33. After surgery, preoperative encroachment of the spinal canal (5.12 mm, 37%) was disappeared. The median height of fractured vertebral body significantly increased from 7.83 to 12.63 mm. At the last follow-up point, the median height was 9.91 mm. The median kyphotic deformity was improved from 22.12° to 14.31°. At the final follow-up, the improvement was preserved (median value: 15.03). The acute complication according to PMMA such as leakage and embolization was none, but adjacent compression fracture as late complication according to cement augmentation was. One patient developed surgical site infection.ConclusionOn the basis of the preliminary results, we considered that anterolateral decompression and PMMA augmentation might be an optimal method for treating osteoporotic fracture with myelopathy in elderly patients or those with multiple medical comorbidities.

Kyphoplasty for occult and non-occult osteoporotic vertebral fractures: a retrospective study.

ObjectiveTo compare the safety and efficacy of kyphoplasty in the treatment of occult and non-occult osteoporotic vertebral compression fractures (OOVF).Material and MethodsFrom 2015 to 2017, 82 OOVF and 105 non-occult osteoporotic vertebral compression fractures (N-OOVF) were evaluated with the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and vertebral height preoperatively, immediately postoperatively, and one year postoperatively. Operative time, fluoroscopy time, and cement injection volume were recorded.ResultsCompared with the preoperative VAS and ODI scores, the scores of both groups were significantly improved after surgery. Preoperative ODI and VAS scores of the OOVF were lower than those of the N-OOVF. The operative time, fluoroscopy time, and bone cement injection volume of the OOVF were significantly lower than those of the N-OOVF. Vertebral height of the N-OOVF improved significantly after surgery. There were differences in cement leakage and adjacent vertebral fractures between the two groups.ConclusionCompared with N-OOVF, OOVF are safer with kyphoplasty, and it is necessary to diagnose OOVF in a timely manner.

Minimally invasive reduction of thoracolumbar burst fracture using monoaxial percutaneous pedicle screws: Surgical technique and report of radiological outcome.

To describe the reduction technique of thoracolumbar burst fracture using percutaneous monoaxial screws and its radiological outcomes compared to polyaxial screws. All surgeries were performed by minimally invasive technique with either percutaneous monoaxial or percutaneous polyaxial screws inserted at adjacent fracture levels perpendicular to both superior end plates. Fracture reduction is achieved with adequate rod contouring and distraction maneuver. Radiological parameters were measured during preoperation, postoperation, and follow-up. A total of 21 patients were included. Eleven patients were performed with monoaxial pedicle screws and 10 patients performed with polyaxial pedicle screws. Based on AO thoracolumbar classification system, 10 patients in the monoaxial group had A3 fracture type and 1 had A4. In the polyaxial group, six patients had A3 and four patients had A4. Total correction of anterior vertebral height (AVH) ratio was 0.30 ± 0.10 and 0.08 ± 0.07 in monoaxial and polyaxial groups, respectively (p < 0.001). Total correction of posterior vertebral height (PVH) ratio was 0.11 ± 0.05 and 0.02 ± 0.02 in monoaxial and polyaxial groups, respectively (p < 0.001). Monoaxial group achieved more correction of 13° (62.6%) in local kyphotic angle compared to 8.2° (48.0%) in polyaxial group. Similarly, in regional kyphotic angle, 16.5° (103.1%) in the monoaxial group and 8.1° (76.4%) in the polyaxial group were achieved. Monoaxial percutaneous pedicle screws inserted at adjacent fracture levels provided significantly better fracture reduction compared to polyaxial screws in thoracolumbar fractures.