Osteoporotic Thoracolumbar Vertebral Fractures Research Articles

Characteristics of Osteoporotic Low Lumbar Vertebral Fracture and Related Lumbosacral Sagittal Imbalance.

Osteoporotic vertebral fracture (OVF) usually occurs in the thoracolumbar region and rarely affects the low lumbar region. The characteristics of osteoporotic low lumbar fracture (OLLF) have not been reported. Lumbosacral sagittal balance plays an important role in preserving the normal physiologic function of the spine. However, it is unknown how lumbosacral parameters vary in patients with OLLF. The authors retrospectively analyzed the clinical and radiologic characteristics of patients with OLLF and osteoporotic thoracolumbar vertebral fracture (OTVF) who were treated at their institution. Vertebral height, local deformity angle, and visual analog scale and Oswestry Disability Index scores were assessed preoperatively and postoperatively for both groups. The changes in lumbosacral parameters were measured for patients with OLLF. The results showed that OLLF was more likely to occur at L3 (53.66%) and that the prevalence of severe trauma (29.27%) was higher among patients with OLLF (P<.05). The most common morphologic type of the vertebrae affected by OLLF was biconcave (58.54%, P<.05). Patients who had OLLF showed an apparent increase in pelvic tilt and a decrease in local lordosis and sacral slope. Postoperatively, vertebral height, local deformity angle, and visual analog scale and Oswestry Disability Index scores were significantly improved compared with preoperative values (P<.05). Among patients with OLLF, local lordosis and sacral slope increased significantly, whereas pelvic tilt decreased significantly after percutaneous kyphoplasty. Restoration of local lordosis had a mean value of 6.29°±4.80°. These results indicate that OLLF has unique characteristics compared with OTVF and that it results in lumbosacral sagittal imbalance. Percutaneous kyphoplasty is effective and safe for the treatment of OLLF and plays an important role in postoperative improvement of sagittal imbalance. [Orthopedics. 2021;44(1):e7-e12.].

The role of vertebroplasty in steroid-induced vertebral osteoporotic fractures

Abstract Background Data: Glucocorticoid-induced osteoporosis is a well-known significant health problem worldwide that causes morbidity and mortality. Glucocorticoid-induced vertebral compression fracture is one of the most common types of osteoporotic fractures associated with significant morbidities such as severe agonizing pain, limited mobility, and spinal deformity. Percutaneous vertebroplasty (PV) can be performed in the treatment of refractory back pain in these cases of osteoporotic vertebral fractures (OVFs) without significant complication when conservative treatment fails. Purpose: To evaluate the clinical and radiographic outcomes of thoracolumbar OVFs treated with PV in adult osteoporotic patients with long-term corticosteroid therapy. Study Design: Retrospective clinical case series. Patients and Methods: Twenty-eight patients with painful steroid-induced OVFs underwent vertebroplasty in 61 vertebral levels. Inclusion and exclusion criteria were applied. Preoperatively, all patients were subjected to intensive diagnostic workups, including history taking and clinical and radiological examinations, such as CT scan and MRI. The procedure was guided by C-arm and considered complete when the unfilled area was less than 25% of the vertebral body height in the lateral radiograph. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess pre- and postoperative back pain and functional status of our patients. Results: Seventeen patients (60.71%) were males and eleven patients (39.28%) were females. The mean age was 57 ± 5.04 (range, 49–68) years. The mean follow-up of the patients was 38.4 2± 11.16 (range, 24–60) months. Overall, 61 levels were reported including 10 patients (39%) with a single level and 18 patients (61%) with two levels or more as follows: two levels in eight patients, three levels in six patients, four levels in three patients, and one patient with five levels. The most common affected region was the thoracolumbar junction (T11, T12, and L1) in 38.69%. Back pain VAS decreased from 7.29 ± 1.04 before vertebroplasty to 3.25 ± 0.75 one week after vertebroplasty, 1.68 + −0.66 at 12 months postoperatively, and 3.11 ± 1.13 at final follow-up 24 months postoperatively (p < 0.00) Conclusion: This study suggests that fast and substantial pain relief and quality of life improvement could be achieved after percutaneous vertebroplasty in most patients of glucocorticoid induced osteoporotic vertebral fractures. These improvements could be maintained up to one year, however this effect decline with time due to the progressive nature of the underlying disease. (2020ESJ209) Abstract: Background Data: Glucocorticoids induced osteoporosis (G-OP) is a well-known significant health problem worldwide that causes morbidity and mortality. Glucocorticoids induced vertebral compression fracture (G-VCF) is one of the most common types of osteoporotic fractures that associated with significant morbidities as severe agonizing pain, limited mobility and spinal deformity. Percutaneous vertebroplasty (PV) can be performed in treatment of refractory back pain in cases of G-VFs without significant complication when the conservative treatment failed. Purpose: Clinical and radiographical evaluation of thoracolumbar osteoporotic vertebral fractures treated by percutaneous vertebroplasty in adult osteoporotic patients with long time of corticosteroid therapy. Study design: Retrospective clinical case series. Patients and methods: Twenty-eight patients with painful steroid induced VCFs underwent vertebroplasty in sixty-one vertebral levels. Inclusion and exclusion criteria were applied. Preoperatively, intensive diagnostic workups were performed in all patients including history, clinical, radiological examination, and CT scanning. Sometimes, MRI thoracolumbar spine had been done. The procedure was guided by the C-arm and considered complete when the unfilled area was less than 25% of the vertebral body height in the lateral radiograph. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess pre and postoperative back pain and functional status of our patients. Results: Seventeen patients (60.71%) were males and eleven patients (39.28%) were female. The Mean age was 57±5.04 (range: 49-68) years. Over-all 61 levels reported including 10 patients (39%) with single level and 18 patients (61%) with two levels or more as follows (two levels in eight patients, three levels in six patients, four levels in three patients and only one patient with five levels). Most common region affected was thoracolumbar junction (T11, T12, L1) in (38.69%). Back pain VAS decreased from 7.29 ± 1.04 before vertebroplasty to VAS 3.25±0.75 one week after vertebroplasty, 1.68 ± 0.66 at 12 months postoperative, and 3.11±1.13 at final follow up 24 months postoperative (P<0.001). ODI improved from 40.82±12.32 (14-66) preoperative to 16.68±3.19 (10-24) at 12 months postoperatively and to 20.92±4.66(10-30) at final follow 24 months postoperatively (P<0.000). Conclusion: This study suggest that fast and substantial pain relief and quality of life improvement could be achieved after percutaneous vertebroplasty (PV) and these improvements could be maintained up to one year in most patients. PV can be performed efficiently and effectively in patients of glucocorticoids OVFs for treatment of refractory back pain without significant complication. (2020ESJ209) Key words: Osteoporotic Vertebral Fractures (OVFs), Glucocorticoids, Vertebroplasty. Thoracolumbar spine.

Prospective Comparison of Osteoporotic Vertebral Fracture Treatment

Thoracolumbar osteoporotic vertebral fractures often occur in elderly patients. Possible treatment options include conservative therapy with orthoses and minimally invasive therapies like balloon kyphoplasty. Studies show advantages in pain reduction post-kyphoplasty. In contrast, activating orthoses seem to have a longer-term positive effect on muscles and thus the sagittal plane of the spine.

Short-term Study of Bushen Jiangu Decoction Combined with PVP in the Treatment of Elderly Patients with Osteoporotic Thoracolumbar Vertebral Compression Fracture

To investigate the clinical effects of Bushen Jiangu Decoction combined with percutaneous vertebroplasty (PVP) in the treatment of elderly patients with osteoporotic thoracolumbar vertebral compression fracture (OVCF). Seventy-four elderly patients with OVCF were enrolled in our hospital and randomized by digital table method, 37 cases each. The control group received PVP treatment, and the observation group was treated with Bushen Jiangu Decoction on the basis of PVP treatment. Cobb angle, bone mineral density, Oswestry dysfunction index questionnaire (ODI) score, and visual analogue scale (VAS) were compared before and after treatment. After treatment, the Cobb angle of the observation group was smaller than that of the control group, and the bone density was higher than that of the control group (P&lt;0.05). The ODI score of the observation group was lower than that of the control group after treatment (P&lt;0.05); 1 month and 3 months after treatment, the VAS score of the 6-month observation group was lower than that of the control group (P&lt;0.05). Bushen Jiangu Decoction combined with Western medicine in the treatment of elderly patients with OVCF can restore Cobb angle, increase bone density, reduce postoperative pain and improve thoracic and lumbar spine function.

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.

Efficacy comparison of pedicle screw with vertebroplasty or intermediate screw for osteoporotic thoracolumbar compression fractures

Objective To compare the efficacy of pedicle screw with vertebroplasty (PSV) or intermediate screw (PSIS) for osteoporotic thoracolumbar compression fractures. Methods A retrospective case control study was conducted to analyze the clinical data of 141 patients with osteoporotic thoracolumbar vertebral compression fractures admitted to Honghui Hospital, College of Medicine, Xi'an Jiaotong University from January 1, 2012 to December 31, 2015. There were 59 males and 82 females, aged 60-75 years, with an average age of 65.4 years. All the fractures had bone mineral density (BMD) T value 15 degrees or anterior column compression > 40%. There were 65 patients with thoracic vertebral fractures (T10-T12) and 76 with lumbar vertebral fractures (L1-L4). Among all patients, 68 received PSV treatment (PSV group) and 73 received fixed PSIS treatment (PSIS group). The operation time, intraoperative blood loss, visual analogue scale (VAS), anterior height ratio, central height ratio, and segmental kyphosis angle at 3 days, 3 months, 6 months, 1 year and 2 years after operation were compared between the two groups. The complications were recorded. Results All patients were followed up for 25-31 months, with an average of 27.9 months. There were no significant differences in operation time and intraoperative blood loss between the two groups (P>0.05). VAS at each time point of postoperative follow-up was significantly lower than those before operation in both groups (P 0.05). Anterior height ratios of PSV group were higher than those of PSIP group at postoperative 3 months, 6 months, 1 year and 2 years (P<0.05) [(95.2±5.2) vs. (92.6±7.1), (93.8±5.2) vs. (91.4±3.2), (93.3±4.9) vs. (91.2±5.1), (92.6±5.5) vs. (90.1±4.7)]. The central height ratios of PSV group were higher than those of PSIP group at postoperative 6 months, 1 year and 2 years [(91.4 ±6.9) vs. (88.9±7.2), (90.8±7.4) vs. (88.4±5.9), (90.1±7.6) vs. (87.1±7.2)](P<0.05). Segmental kyphosis angle of PSV group was lower than that of PSIP group at postoperative 3 months, 6 months, 1 year and 2 years [(2.9±0.4)° vs. (3.2±0.9)°, (3.0±0.5)° vs. (3.2±0.3)°, (3.1±0.7)° vs. (3.4±0.4)°, (3.1±0.4)° vs. (3.4±0.7)°](P<0.05 or 0.01). Bone cement leakage from screws occurred in two patients in PSV group and three patients in PSIS group. Cement leakage occurred in the injured vertebra in four patients of PSV group, with no any symptom. In PSIS group, two patients suffered from one side rod breakage at 9 months and 1 year after surgery, respectively. CT showed sound bone healing, without any further management. Conclusion For osteoporotic thoracolumbar compression fractures, PSV can attain similar pain relief compared with PSIS, but the former is more conducive to reducing the loss of anterior and middle column height and correcting kyphosis deformity. Key words: Osteoporotic fractures; Spinal fractures; Bone cement

Application of operation bed and C-arm digital metrology adjustment in the percutaneous vertebroplasty for osteoporotic thoracolumbar vertebral fractures

To explore the application effect of operation bed and C-arm digital metrology adjustment in percutaneous vertebroplasty for osteoporotic thoracolumbar vertebral fractures. Ninty-four patients with osteoporotic thoracolumbar vertebral fractures admitted to our hospital from February 2015 to February 2017 were divided into control group and observation group according to random number table method, with 47 cases in each group. Control group adjusted C-arm and operating bed based on experience. For observation group surgical bed and C arm were measured and adjusted digitally and metrologically during percutaneous vertebroplasty. The operation time, times of fluoroscopy, hidden blood loss and bone cement volume were recorded in two groups. The clinical efficacy of two groups was observed by visual analogue score (VAS) and Oswestry Disability Index(ODI). Cobb angle and height of injured vertebrae before and after surgery were analyzed by imaging data. The operation time, times of fluoroscopy, and hidden blood loss were significantly lower in observation group than in control group (P<0.05), but there was no significant difference in bone cement volume between two groups (P>0.05); VAS and ODI of observation group were significantly lower than that of the control group(P<0.05); there was no significant difference in Cobb angle and height of injured vertebrae before and after operation between two groups. There were 3 cases of cement leakage, 1 case of urinary tract infection, 1 case of pulmonary infection, 2 cases of bedsore in observation group with complication rate was 14.89%(7/47); there were 8 cases of cement leakage, 2 cases of spinal nerve injury, 1 case of urinary tract infection, 3 cases of pulmonary infection, 2 cases of bedsore in control group with complication rate was 34.04% (16/47). The incidence of complications in observation group was significantly lower than that of control group (P<0.05). Operation bed and C-arm digital metrology adjustment can improve the surgical effect in percutaneous vertebroplasty for osteoporotic thoracolumbar vertebral fractures and promote rapid recovery.

Importance of polymethylmethacrylate augmentation in the treatment of thoracolumbar osteoporotic vertebral fractures

Importance of polymethylmethacrylate augmentation in the treatment of thoracolumbar osteoporotic vertebral fractures

Hybrid stabilization of unstable osteoporotic thoracolumbar vertebral body fractures: clinical and radiological outcome after a mean of 4years.

The aim of this study was to evaluate midterm results after hybrid stabilization of unstable osteoporotic fractures of the thoracolumbar junction. This retrospective study was performed at a level I trauma center. A total of 113 patients aged 61 and older were stabilized using hybrid stabilization consisting of short-segmental posterior instrumentation and augmentation of the fractured vertebral body after suffering an unstable osteoporotic vertebral body fracture at the thoracolumbar spine. All patients were treated by hybrid stabilization. The primary outcome parameters were the ODI score and loss of reduction. Secondary radiological outcome parameters were the sagittal alignment parameters. Seventy-two women and 41 men (74.6 ± 6.8years) were included. Sixty-nine patients (61%) were re-evaluated after a mean of 48months. Seventeen patients have died during the follow-up period (15%). A total of five in-patient complications were documented (4.4%). Additionally, 12 patients (17.4%) suffered from further osteoporotic vertebral body fractures affecting vertebral bodies of different levels. The average ODI score at the final follow-up was 29.9 (± 22.0). Thereby, 66.6% of all patients had low to moderate limitations. The average regional sagittal loss of reduction was 7.4% (± 5.6%). Loss of reduction was below 10° in 78% of the patients. There were statistically significant correlations between the loss of reduction and the ODI score, pelvic incidence and latest Cobb angle, and between the ODI scores and the lumbar lordosis. The majority of patients had low or moderate limitations and low to moderate reduction loss. Thereby, high loss of reduction correlated directly with inferior outcomes. These slides can be retrieved under Electronic Supplementary Material.

Surgical outcomes of spinal fusion for osteoporotic thoracolumbar vertebral fractures in patients with Parkinson\u2019s disease: what is the impact of Parkinson\u2019s disease on surgical outcome?

BackgroundTo date, there have been little published data on surgical outcomes for patients with PD with thoracolumbar OVF. We conducted a retrospective multicenter study of registry data to investigate the outcomes of fusion surgery for patients with Parkinson’s disease (PD) with osteoporotic vertebral fracture (OVF) in the thoracolumbar junction.MethodsRetrospectively registered data were collected from 27 universities and their affiliated hospitals in Japan. In total, 26 patients with PD (mean age, 76 years; 3 men and 23 women) with thoracolumbar OVF who underwent spinal fusion with a minimum of 2 years of follow-up were included (PD group). Surgical invasion, perioperative complications, radiographic sagittal alignment, mechanical failure (MF) related to instrumentation, and clinical outcomes were evaluated. A control group of 296 non-PD patients (non-PD group) matched for age, sex, distribution of surgical procedures, number of fused segments, and follow-up period were used for comparison.ResultsThe PD group showed higher rates of perioperative complications (p < 0.01) and frequency of delirium than the non-PD group (p < 0.01). There were no significant differences in the degree of kyphosis correction, frequency of MF, visual analog scale of the symptoms, and improvement according to the Japanese Orthopaedic Association scoring system between the two groups. However, the PD group showed a higher proportion of non-ambulators and dependent ambulators with walkers at the final follow-up (p < 0.01).ConclusionsA similar surgical strategy can be applicable to patients with PD with OVF in the thoracolumbar junction. However, physicians should pay extra attention to intensive perioperative care to prevent various adverse events and implement a rehabilitation regimen to regain walking ability.

BKP shorten the hospital stays compared to the conservative therapy in the thoracolumbar osteoporotic vertebral fracture cohort

BKP shorten the hospital stays compared to the conservative therapy in the thoracolumbar osteoporotic vertebral fracture cohort

The impact of magnetic resonance imaging in the diagnostic and classification process of osteoporotic vertebral fractures

IntroductionStandard radiographs are still considered as the gold standard for the early assessment of thoraco-lumbar osteoporotic vertebral fractures (OVFs), although several studies demonstrated superior accuracy of magnetic resonance imaging (MRI) in the diagnostic process of OVFs. The aim of this study was to quantify the misdiagnosis rate of OVFs and analyse the impact of MRI on early diagnosis and classification, compared to standard radiographs alone. Materials and methodsA total of 173 patients were enrolled in this study. All participants were 55 years of age or older (60 years for men) and complained acute back pain with suspected thoracolumbar OVFs without history of high-energy trauma. Diagnosis of OVF was initially performed on standard radiographs obtained in the emergency room. Then, all the patients underwent MRI scan with short-tau inversion recovery (STIR) sequencing within 7 days. We compared the level and number of fractures identified on standard radiographs with the MRI scan results. The discordance between radiographic and MRI diagnosis was quantified. Fractures were classified according to AO Spine Classification. ResultsMean age of the study participant was 74.2 years (range 55–92). They were 100 males and 73 females. MRI modified initial diagnosis in 52% (90/173) of our patients: in 43.9% of patients MRI identified one or more new thoracolumbar fracture. In 14 cases (8.1%) MRI disproved the evidence of any thoracolumbar fracture, even those recognized at plain X-rays. Bone bruise was detected by MRI in 19 vertebral bodies in 8 patients (4.6%) at levels that were classified as unremarkable on X-ray alone. In addition, 63 patients (36.4%) presented a total of 93 old fractures. The classification of fracture pattern after MRI changed in 28.90% of the patients (changes mostly involved AO type A1 patterns). ConclusionsUnderdiagnosis of osteoporotic vertebral fractures is a common problem due to a lack of radiographic detection. Our results showed that the extensive use of MRI imaging allows better accuracy in the diagnostic process and in the classification assessment, compared to conventional radiographs. Further investigation should provide additional information about the impact of early MRI on treatment and management of elderly patients with suspected OVFs, including the decision to hospitalize or not, and how it could affect clinical outcome and social costs.

Do the dynamic stress mobility radiographs predict the postoperative vertebral height restoration, kyphosis correction, and cement volume injected after vertebroplasty for osteoporotic thoracolumbar vertebral fractures with intravertebral cleft?

This prospective clinical-radiological study was conducted to determine whether the dynamic mobility stress radiographs can predict the postoperative vertebral height restoration, kyphosis correction, and cement volume injected after vertebroplasty. Patients included had the diagnosis of significant back pain caused by osteoporotic vertebral compression fracture secondary to trivial injury. All the patients underwent routine preoperative sitting lateral spine radiograph, supine stress lateral spine radiograph, and supine anteroposterior spine radiograph. The radiological parameters recorded were anterior vertebral height (AVH), middle vertebral height (MVH), posterior vertebral height (PVH), MVH level below, wedge endplate angle (WEPA), and regional kyphotic angle (RKA). The supine stress versus sitting difference (SSD) for all the above parameters were calculated. A total of 28 patients (4 males; 24 females) with the mean age of 75.6 ± 7.7 years were recruited into this study. The mean cement volume injected was 5.5 ± 1.8 ml. There was no difference between supine stress and postoperative radiographs for AVH ( p = 0.507), PVH ( p = 0.913) and WEPA ( p = 0.379). The MVH ( p = 0.026) and RKA ( p = 0.005) were significantly less in the supine stress radiographs compared to postoperative radiographs. There was significant correlation ( p < 0.05) between supine stress and postoperative AVH, MVH, PVH, WEPA, and RKA. The SSD for AVH, PVH, WEPA, and RKA did not have significant correlation with the cement volume ( p > 0.05). Only the SSD-MVH had significant correlation with cement volume, but the correlation was weak ( r = 0.39, p = 0.04). Dynamic mobility stress radiographs can predict the postoperative vertebral height restoration and kyphosis correction after vertebroplasty for thoracolumbar osteoporotic fracture with intravertebral clefts. However, it did not reliably predict the amount of cement volume injected as it was affected by other factors.

Early versus delayed kyphoplasty for thoracolumbar osteoporotic vertebral fractures: The effect of timing on clinical and radiographic outcomes and subsequent compression fractures

ObjectiveOsteoporotic vertebral body fractures (OVFs) represent a significant medical and socioeconomic burden. There is ongoing debate concerning the role of cement augmentation versus conservative management, but we are increasingly recognizing the longer-term effects of kyphotic vertebral alignment on functional outcomes, pain, and subsequent fracture rates. The purpose of this study was to determine the effect of timing of intervention with percutaneous balloon kyphoplasty (BKP) for OVF on clinical and radiographic outcomes. Patients and Methods51 patients (mean age, 75.5 years) who underwent BKP for OVF were analyzed. Patients were divided into two groups based on timing of BKP: early (<4 weeks) or late (>4 weeks). Multiple factors were assessed preoperatively and throughout follow up and compared between groups using bivariate testing, including: focal kyphosis, subsequent vertebral fracture, and low back pain. ResultsThis was a retrospective sub-group analysis. There were 32 patients in the early group and 19 patients in the late group. There was no significant difference in preoperative bone density between groups. Mean follow-up was 1.2 years. Local kyphosis at final follow-up was significantly greater in the late group (−28.4°) than in the early group (−9.5°; p < 0.001). There was no significant difference in local kyphosis between preoperative measurement and final follow-up in the early (p = 0.741) or late cohort (p = 0.794). Patients treated with early BKP demonstrated significantly better LBP scores (p < 0.05) and a lower rate of subsequent vertebral fracture (p < 0.05). ConclusionBKP is able to prevent progressive collapse and kyphosis after OVF, but not effectively restore alignment, and as a result, patients who undergo early BKP (<4 weeks) demonstrate better alignment, better LBP scores, and reduced rates of subsequent fracture at an average of 1.2 years following treatment.

Three-material decomposition with dual-layer spectral CT compared to MRI for the detection of bone marrow edema in patients with acute vertebral fractures

ObjectivesTo assess whether bone marrow edema in patients with acute vertebral fractures can be accurately diagnosed based on three-material decomposition with dual-layer spectral CT (DLCT).Materials and methodsAcute (n = 41) and chronic (n = 18) osteoporotic thoracolumbar vertebral fractures as diagnosed by MRI (hyperintense signal in STIR sequences) in 27 subjects (72 ± 11 years; 17 women) were assessed with DLCT. Spectral data were decomposed into hydroxyapatite, edema-equivalent, and fat-equivalent density maps using an in-house-developed algorithm. Two radiologists, blinded to clinical and MR findings, assessed DLCT and conventional CT independently, using a Likert scale (1 = no edema; 2 = likely no edema; 3 = likely edema; 4 = edema). For DLCT and conventional CT, accuracy, sensitivity, and specificity for identifying acute fractures (Likert scale, 3 and 4) were analyzed separately using MRI as standard of reference.ResultsFor the identification of acute fractures, conventional CT showed a sensitivity of 0.73–0.76 and specificity of 0.78–0.83, whereas the sensitivity (0.93–0.95) and specificity (0.89) of decomposed DLCT images were substantially higher. Accuracy increased from 0.76 for conventional CT to 0.92–0.93 using DLCT. Interreader agreement for fracture assessment was high in conventional CT (weighted κ [95% confidence interval]; 0.81 [0.70; 0.92]) and DLCT (0.96 [0.92; 1.00]).ConclusionsMaterial decomposition of DLCT data substantially improved accuracy for the diagnosis of acute vertebral fractures, with a high interreader agreement. This may spare patients additional examinations and facilitate the diagnosis of vertebral fractures.

Percutaneous kyphoplasty for the treatment of distal lumbosacral pain caused by osteoporotic thoracolumbar vertebral fracture.

Background Kyphoplasty has been demonstrated to be minimally invasive and effective in treating osteoporotic vertebral fracture patients with back pain over the level of the fractured vertebrae. Rare studies have reported on thoracolumbar vertebral fracture patients presenting with distal lumbosacral pain (DLP). Whether kyphoplasty had a favorable therapeutic benefit for these patients remains unclear. Purpose To evaluate the therapeutic efficacy of kyphoplasty in treating osteoporotic thoracolumbar vertebral fracture (OTVF) patients with DLP and assess the clinical significance of focal tenderness to palpation in these patients. Material and Methods Thirty-two OTVF patients who only complained of DLP were treated by kyphoplasty. The vertebral heights, local kyphotic angle, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI) scores were assessed preoperatively, one day after surgery, and at last follow-up. All patients were evaluated regarding their degree of satisfaction with kyphoplasty. In addition, we compared the therapeutic efficacy of kyphoplasty in patients with and without focal tenderness to palpation. Results All patients successfully underwent kyphoplasty without complications. The vertebral heights, local kyphotic angles, VAS, and ODI scores were all significantly improved after kyphoplasty and maintained at last follow-up in our patients ( P < 0.001). At last follow-up, all patients expressed satisfaction with kyphoplasty. No significant differences in these parameters were detected between patients with and without focal tenderness. Conclusion The possibility of thoracolumbar vertebral fractures in elderly patients complaining of DLP should not be neglected. Kyphoplasty presents a superior benefit in treating OTVF patients with DLP. The absence of focal tenderness does not influence the clinical efficacy in these patients.

Impact of spino-pelvic and global spinal alignment on the risk of osteoporotic vertebral collapse.

Introduction Numerous studies have reported the risk factors of osteoporotic vertebral collapse. However, whether spino-pelvic and global spinal alignments are associated with the occurrence of osteoporotic vertebral collapse remains unclear. This study aimed to investigate the association between spino-pelvic and global spinal alignments and the occurrence of osteoporotic vertebral collapse. Methods A total of 46 consecutive patients who underwent a nonoperative treatment for a single-level fresh osteoporotic thoracolumbar vertebral compression fracture (T10 to L3) were retrospectively reviewed. The parameters evaluated were the pelvic incidence, anterior deviation of the C7 plumb line, distance between the C7 plumb line and the center of the fractured vertebra, and kyphotic wedge angle of the fractured vertebra in a standing whole-spine radiograph at the beginning of the nonoperative treatment. As an outcome measure, the presence or absence of osteoporotic vertebral collapse was radiographically evaluated at the final follow-up. Multiple logistic regression analysis was used to determine significant risk factors of osteoporotic vertebral collapse. Results The mean values for each parameter were as follows: pelvic incidence, 58.0 degrees; anterior deviation of the C7 plumb line, 3.0 cm; distance between the C7 plumb line and the center of the fractured vertebra, 5.7 cm; and kyphotic wedge angle of the fractured vertebra, 14.6 degrees. Multiple logistic regression analysis revealed that the distance between the C7 plumb line and center of the fractured vertebra was a significant risk factor of osteoporotic vertebral collapse (p = 0.012; odds ratio, 1.025). The anterior deviation of the C7 plumb line (p = 0.214), pelvic incidence (p = 0.728), and kyphotic wedge angle of the fractured vertebra (p = 0.07) did not affect the occurrence of osteoporotic vertebral collapse. Conclusions A large distance between the C7 plumb line and center of the fractured vertebra was a significant risk factor of osteoporotic vertebral collapse. The distance approximately represents that of between gravity center of trunk cranial to the fractured vertebra and the fractured vertebra. Accordingly, the large distance may cause larger flexion moment to the fractured site, leading to stress concentration that results in insufficient bone healing.

Study on the effect of the distribution of bone cement on the efficacy of vertebroplasty

Objective To investigate the effect of bone cement distribution on efficacy of vertebroplasty. Methods From January 2013 to June 2016, a total of 132 cases (132 vertebrae) with single segment osteoporotic thoracolumbar vertebral fractures underwent parallel vertebroplasty surgery, and there were 57 male, 75 female, with an average age of (71.6±2.2) years old (ranged from 65 to 86 years old). On the basis of the postoperative X-ray films of bone cement distribution were divided into 3 groups. The bone cement was biased to the lateral side of the vertebral body (partial group, 35 cases), the bone cement was over the vertebral midline, but not completely filled with contralateral vertebral body (near midline group, 46 cases), and the bone cement was filled with bilateral vertebral body (bilateral group, 51 cases). There were 15 males and 20 females in the partial group, aged (70.3±5.3) years old; 20 males and 26 females in the proximal midline group, aged (72.1±3.2) years old; 22 males and 29 females in the bilateral group, aged (71.2±4.6) years old. Local anesthesia was used to make the patient prone to operate on the operating bed.The head and tail of the bed were increased at the same time slightly and vertebral compression fractures reduction was performed. Bone cement was injected into the vertebral body through partial or bilateral transpedicular approach. The visual analogue scores (VAS) were measured of preoperation, postoperation and 3, 6, 12 months after surgery. Analysis of variance for each group and VAS before and after operation, and postoperative complications were observed too. Results All the 132 cases were followed up for 1-12 months, with an average of (11±0.3) months. There were statistically significant differences in the immediate effect of postoperation among partial group, near middle group and the bilateral group (F=90.472, P=0.000) , VAS score in partial group was lower than that in bilateral group (t=11.433, P=0.000), but higher than that in near midline group (t=11.106, P=0.000), and the differences were statistically significant, but there was no significant difference between near midline group and bilateral group (t=0.581, P=0.563). VAS score showed no statistically difference among the three groups 3 months, 6 months and 1 year follow-up after operation (F=0.892, P=0.413; F=0.342, P=0.713; F=0.834, P=0.441). In 3 cases of partial group, the pain was not relieved due to unfilled cement until the contralateral bone was injected into the bone cement. However, there were 11 cases of cement leakage in partial group, 13 cases in near midline group, and 3 cases in bilateral group. Conclusion The distribution of bone cement is one of the main factors affecting the clinical efficacy after vertebroplasty, and the clinical effect of distributing the midline of vertebral body is better than the one side. Key words: Spine; Vertebroplasty; Osteoporosis

Diagnosis and Treatment of Osteoporotic Thoracolumbar Vertebral Fracture

Diagnosis and Treatment of Osteoporotic Thoracolumbar Vertebral Fracture

Indication for Partial Vertebral Osteotomy and Realignment in Posterior Spinal Fixation for Osteoporotic Thoracolumbar Vertebral Collapse with Neurological Deficits.

Instrumented spinal fixation is ordinarily required in patients who present with myelopathy or cauda equina syndrome secondary to vertebral collapse following osteoporotic thoracolumbar fracture. Posterior spinal fixation is a major surgical option, and partial vertebral osteotomy (PVO) through a posterior approach is occasionally reasonable for achievement of complete neural decompression and improvement of excessive local kyphosis. However, the indications and need for PVO remain unclear. The objectives of this retrospective study were to determine the efficacy and safety of posterior spinal fixation with or without PVO for osteoporotic thoracolumbar vertebral collapse and identify patients who require neural decompression and alignment correction by PVO. We retrospectively reviewed the clinical records of 20 patients (13 females, 7 males; mean age, 67.1 years) who underwent instrumented posterior fixation for osteoporotic thoracolumbar vertebral fracture. Clinical outcomes were assessed by the Japanese Orthopedic Association score and visual analog scale scores in the lumbar and leg areas. PVO was added with posterior spinal fixation in eight patients because neural decompression was incomplete after laminectomy as indicated by intraoperative echo imaging. Neurological and functional recovery significantly improved during follow-up. Clinical outcomes in patients who underwent PVO were similar to those in patients who did not undergo PVO. However, correction of the local kyphotic angle and improvement of spinal canal compromise after surgery was significant in patients who underwent PVO. The patients who required PVO had a less local kyphotic angle in the supine position and higher occupation rate of the fractured fragment in the spinal canal in the preoperative examination.