Single-level Osteoporotic Vertebral Compression Fractures Research Articles

Risk factors for predicting cement leakage following percutaneous vertebroplasty for osteoporotic vertebral compression fractures.

The purpose of the present study is to identify independent risk factors for the occurrence of cement leakage (CL) during percutaneous vertebroplasty (PVP) for four different leakage types in treating osteoporotic vertebral compression fractures (OVCFs). We retrospectively reviewed 292 patients who underwent PVP for single-level OVCF from January 2009 to March 2011. The influences of several potential risk factors that might affect the occurrence of CL were assessed using univariate and multivariate analyses. Cement leakage was evaluated by computed tomography and classified into four different types: through the basivertebral vein (B-type), the segmental vein (S-type), a cortical defect (C-type), and intradiscal leakage (D-type). Cement leakage was found in 227 of the 292 treated vertebrae. None of the parameters showed a statistically significant effect by univariate analysis. However, multivariate analysis showed that cement viscosity was an independent risk factor in B-type CL, fracture severity and fracture type were in S-type CL, fracture severity and presence of cleft on MRI were in C-type CL, and fracture severity, cortical disruption on MRI, presence of cleft on MRI and cement viscosity were in D-type CL. Each different vertebral fracture pattern has its own risk factors for CL. Identification of the above predicting factors for CL preoperatively might be helpful for more rigorous and strict patient selection criteria for the appropriate candidates for PVP.

Reducing radiation exposure during kyphoplasty with the use of a remote control injection system: a prospective study.

A prospective study. To compare surgeons' radiation exposure during kyphoplasty with and without the use of a remote control injection system. Distance from radiation sources is a critical factor for reducing radiation exposure during spine surgery. A newly designed device was used to minimize operators' radiation exposure during kyphoplasty. Forty-four patients admitted for single-level osteoporotic vertebral compression fracture were randomly divided into 2 groups (groups A and B) and treated with kyphoplasty. The remote control injection system was used only in group B. The radiation doses to the surgeon's eyes, thyroid, chest, and right wrist were recorded with 4 unprotected radiometers simultaneously. Operation time, fluoroscopic time, cement amount, patient-reported pre- and postoperative visual analogue scale scores for pain, and complications were recorded. For group A, the radiation doses at the eyes, thyroid, and right wrist were 1.132 ± 0.104 mSv, 0.647 ± 0.049 mSv, 0.578 ± 0.056 mSv, and 1.877 ± 0.214 mSv, respectively; for Group B, these doses were 0.257 ± 0.067 mSv, 0.201 ± 0.049 mSv, 0.145 ± 0.033 mSv, and 0.353 ± 0.046 mSv, respectively (P < 0.05). Comparisons of the radiation doses the chief surgeon and the resident surgeon received showed that the resident surgeon received more radiation during group A procedures; during group B procedures, the surgeons received similar doses. The proportion of average fluoroscopic time devoted to the bone cement injection step for groups A and B was 64% and 63%, respectively, and the average proportion of the radiation doses that were received during the bone cement injection step was 66% for group A and 36% for group B. Compared with the preoperative visual analogue scale score, the postoperative visual analogue scale score was significantly reduced in both groups. During kyphoplasty, the use of the remote control injection system can significantly reduce surgeons' radiation exposure without affecting the efficiency of procedures.

Preventive effects of conservative treatment with short-term teriparatide on the progression of vertebral body collapse after osteoporotic vertebral compression fracture

The progression of fractured vertebral collapse is not rare after a conservative treatment of vertebral compression fracture (VCF). Teriparatide has been shown to directly stimulate bone formation and improve bone density, but there is a lack of evidence regarding its use in fracture management. Conservative treatment with short-term teriparatide is effective for decreasing the progression of fractured vertebral body collapse. Few studies have reported on the prevention of collapsed vertebral body progression after osteoporotic VCF. Teriparatide rapidly enhances bone formation and increases bone strength. This study evaluated preventive effects of short-term teriparatide on the progression of vertebral body collapse after osteoporotic VCF. Radiographs of 68 women with single-level osteoporotic VCF at thoracolumbar junction (T11-L2) were reviewed. Among them, 32 patients were treated conservatively with teriparatide (minimum 3 months) (group I), and 36 were treated with antiresorptive (group II). We measured kyphosis and wedge angle of the fractured vertebral body, and ratios of anterior, middle, and posterior heights of the collapsed body to posterior height of a normal upper vertebra were determined. The degree of collapse progression was compared between two groups. The progression of fractured vertebral body collapse was shown in both groups, but the degree of progression was significantly lower in group I than in group II. At the last follow-up, mean increments of kyphosis and wedge angle were significantly lower in group I (4.0° ± 4.2° and 3.6° ± 3.6°) than in group II (6.8° ± 4.1° and 5.8° ± 3.5°) (p = 0.032 and p = 0.037). Decrement percentages of anterior and middle border height were significantly lower in group I (9.6 ± 10.3 and 7.4 ± 7.5 %) than in group II (18.1 ± 9.7 and 13.8 ± 12.2 %) (p = 0.001 and p = 0.025), but not in posterior height (p = 0.086). In female patients with single-level osteoporotic VCF at the thoracolumbar junction, short-term teriparatide treatment did not prevent but did decrease the progression of fractured vertebral body collapse.

Percutaneous Vertebroplasty for Vertebral Compression Fractures with Intravertebral Cleft: Cement Injection under Vacuum Aspiration

Purpose To evaluate the efficacy of cement injection under vacuum aspiration (CIVAS) of cleft contents in percutaneous vertebroplasty for osteoporotic vertebral compression fractures with an intravertebral cleft. Materials and Methods From April 2008 to October 2010, vertebroplasty for single-level osteoporotic vertebral compression fractures with clefts was performed in 34 patients (seven women, 27 men; mean age, 77 y) with CIVAS and in 41 patients (three women, 38 men; mean age, 77 y) by conventional injection (control group). In this retrospective study, the cement volume, cement ratio, visual analog scale (VAS) pain score, and incidences of leakage, new vertebral compression fracture, and nonhealing were compared between groups. Vertebral height changes in the CIVAS group were also evaluated. Results There were significant decreases in VAS scores in both groups ( P < .001). There were no significant differences in complications between groups (cement leakage, P = .70; new vertebral compression fracture, P = .17; nonhealing, P = .086). Vertebral height was significantly decreased by vacuum aspiration and increased by cement injection ( P < .001). The mean cement volume was significantly higher ( P = .0057) in the CIVAS group (4.87 mL) than in the control group (3.58 mL). Cement filling was achieved more sufficiently in the CIVAS group ( P = .014). Conclusions The CIVAS method is feasible and appears to improve cleft filling in the treatment of single-level vertebral compression fractures with a cleft, compared with conventional cement injection.