Thoracolumbar Vertebral Compression Fractures Research Articles

Comparative analysis on curative effects of percutaneous vertebroplesty and kyphoplasty in the treat-ment for thoracolumbar vertebral compression fracture

[Objective]To explore and compare the clinical efficacy of treatment of thoracolumbar vertebral compression fracture by percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP).[Methods]46 cases of thoracolumbar vertebral compression fractures in patients with surgical Methods were divided into vertebral angioplasty group and kyphoplasty group,intraoperative blood loss of two groups,operative time,the bone cement injected volume,bone cement leakagerate and clinical efficacy before and after surgery were compared in two groups.Resrlts Patients were successfully completed with surgery,infection,complications of hematoma,nerve root injury,and vertebral body fractures.There was no statistical significant difference in operative time and blood loss in two groups(P＞ 0.05).But there was significant differences in the injection volume of hone cement,bone cement leakage rate between the two groups (P＜0.05).Two groups' restoring vertebral height extent had significant improvement in VAS score than the preoperative group,difference was statistically significant (P＜ 0.05) but no significant difference found between two groups (P＞ 0.05).Mter 2weeks in PVP group,and the PKP group,1 year after the efficiency difference was not significant (P＞ 0.05).[Conclusion]s PVP and PKP treatment of thoracic and lumbar vertebral compression fracture may derive significant clinical efficacy,with less trauma,shorter operative time,less bleeding,fewer complications,minimally invasive characteristics.PKP can effectively correct the kyphosis,greatly reduce the occurrence of bone cement leakage than PVP increased security,hut the cost is higher; PVP operation is relatively simple,inexpensive,hut the bone cement leakage rate is relatively high.It should be combined with a vasiety of factors to select the appropriate surgical clinical. Key words: Percutaneous vertebroplasty(PVP); Percutaneous kyphoplasty(PKP); Compression fracture; Osteoporosis; Bone cement; Curative effect

Vertebroplasty versus conservative treatment for severe thoracolumbar wedge-shaped osteoporotic vertebral compression fractures

Objective To compare the clinical outcomes of percutaneous vertebroplasty (PVP) and conservative treatment for patients with severe thoracolumbar wedge-shaped osteoporotic vertebral compression fracture (OVCF).Methods From January 2007 to January 2010,a total of 43 patients with severe thoracolumbar wedge-shaped OVCF were nonrandomly assigned to undergo PVP (19 cases) or conservative treatment (24 cases) according to their own will.The baseline clinical and radiological characteristics in both groups were comparable.Clinical outcomes were determined by pain visual analogue scale(VAS) and short form 36 health survey(SF-36).Vertebral height,kyphotic angle and cement leakage were assessed by radiography while new OVCFs by MRI.Results All the 43 patients obtained a follow-up of at least one year.The PVP group vas significantly superior to the conservative group regarding VAS score,physical component summary (PCS) score,anterior and central vertebral heights and kyphotic angle at all postoperative intervals( P ＜ 0.05),while no significant differences were found between the 2 groups regarding posterior vertebral height,new OVCF incidence or mental component summary (MCS) score at all postoperative intervals( P ＞ 0.05) except for the first month after treatment.New OVCFs were found 53 days earlier in the PVP group than in the conservative group,with a significant difference( P ＜ 0.05).Asymptomatic cement leakage occurred in 52.6％ (10/19) of the treated vertebrae in PVP group and 70.0％ of them (7/10) occurred in the intervertebral disc.Conclusions PVP is technically feasible for treatment of severe thoracolumbar wedge-shaped OVCF in spite of a high rate of asymptomatic leakage.PVP may lead to immediate and sustained pain relief and physical functional improvement,without increasing the risk of new OVCFs,which are significantly greater than what can be achieved by the conservative treatment. Key words: Spinal fractures; Osteoporosis; Vertebroplasty

Finite element analysis of cement volume affecting adjacent vertebral endplate in percutaneous kyphoplasty

Objective To analyze the stress contribution of different cement volume to the adjacent vertebral endplates in percutaneous kyphoplasty (PKP) so as to explore the possible mechanism of adjacent vertebral fractures after PKP. Methods The three-dimensional finite element model of osteoporotic thoracolumbar vertebral compression fractures was established to simulate vertebral body partial restoration (80％) with PKP.During the process,two doses of bone cement ( polymethylmethacrylate,PMMA) were filled in the vertebral body (4.0 ml bone cement filling 15％ of the vertebral body volume and 8.0 ml bone cement filling 30％ of the vertebral body volume).Endplate stress under conditions of axial compression,flexion and extension was analyzed. Results Regarding the two filling doses in PKP,the adjacent vertebral endplate stress under the above-mentioned conditions was all increased at T11 and L1 vertebral body compared with that before operation.Meanwhile,endplate stress had positive correlation with the cement volume and the stress concentrated largely in the anterior and middle parts of endplate. Conclusions The stress of adjacent vertebral endplate is positively correlated with cement volume,with anterior and middle parts of endplate as the stress concentration.The probability of adjacent vertebral fractures shows a rising trend with the increase of cement volume in PKP. Key words: Kyphosis; Arthroplasty; Finite element analysis

Comparison of Kyphoplasty and Lordoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture

Study DesignA retrospective study.PurposeTo compare the level of restoration of the vertebral height, improvement in the wedge and kyphotic angles, and the incidence of complications in osteoporotic compression fracture in patients treated with either kyphoplasty or lordoplasty.Overview of LiteratureKyphoplasty involves recompression of the vertebral bodies. Recently, a more effective method known as lordoplasty was introduced.MethodsBetween 2004 and 2009, patients with osteoporotic thoracolumbar vertebral compression fractures were treated by either kyphoplasty (n = 24) or lordoplasty (n = 12) using polymethylmethacrylate (PMMA) cement, and the results of the two interventions were compared. A visual analogue scale was used to measure the pain status. Preoperative and postoperative radiographs were analyzed to quantify the anterior vertebral height restoration and the wedge and kyphotic alignment correction.ResultsAll patients in both groups reported a significant decrease in pain. The anterior heights increased 24.2% and 17.5% after the lordoplasty and kyphoplasty procedures, respectively (p < 0.05). Three months after the procedures, there was a larger decrease in the loss of anterior vertebral height in the kyphoplasty group (12.8%) than in the lordoplasty group (6.3%, p < 0.05). The wedge angles decreased after both procedures. The wedge angle in the lordoplasty group maintained its value after 3 months (p < 0.05). The kyphotic angular correction was 11.4 and 7.0° in the lordoplasty and kyphoplasty groups, respectively (p < 0.05). Both kyphotic deformities worsened to a similar degree of 5° after 3 months.ConclusionsLordoplasty is more useful than kyphoplasty in terms of the improved anatomic restoration and postoperative maintenance.

Delayed Subsequent Refracture of a Thoracolumbar Vertebral Compression Fracture

Delayed Subsequent Refracture of a Thoracolumbar Vertebral Compression Fracture

C2/C3 pathologic fractures from polyostotic fibrous dysplasia of the cervical spine treated with percutaneous vertebroplasty

We will discuss a potential role of percutaneous vertebroplasty (PVP) in the management of patients with severe fibrous dysplasia of the spine with multiple cervical lesions and C2-C3 pathologic fractures that may not be a good surgical candidate. Polyostotic fibrous dysplasia involvement of the cervical spine is rare. Review of literature indicates only few reported cases of surgical management with one case of mortality indicating increased risks associated with surgical intervention. While PVP is commonly used for the treatment of osteoporotic thoracolumbar vertebral compression fractures, its role in vertebral stabilization for fibrous dysplasia has not been reported. A 35-year-old man with McCune-Albright syndrome and severe polyostotic fibrous dysplasia of C2 and C3 vertebrae presented with severe neck pain, radiculopathy, quadriparesis and myelopathy. The lesion had pathologic fractures, and there was an os odontoideum with cervical cord atrophy at the C1 level. After discussing need for aggressive surgical management and potential complications, we offered PVP due to surgical risks involved. PVP was performed with a posterolateral transpedicular approach without complication. The patient had remarkable improvement in clinical relief of neck pain and improvement of myelopathic symptoms at 1-year follow-up. We present a case that illustrates a potential use of PVP in the management of a patient with symptomatic spinal fibrous dysplasia with associated pathologic fractures who was poor surgical candidate.

Pathological Fractures from Craniocervical Polyostotic Fibrous Dysplasia Treated with Percutaneous Vertebroplasty: Case Report

We will discuss a potential role of percutaneous vertebroplasty (PVP) in the management of patients with severe fibrous dysplasia of the spine with multiple cervical lesions and C2-C3 pathologic fractures who may not be good surgical candidates. Polyostotic fibrous dysplasia involvement of the cervical spine is rare. Review of the literature indicates only few reported cases of surgical management with one case of mortality indicating increased risks associated with surgical intervention. While PVP is commonly used for the treatment of osteoporotic thoracolumbar vertebral compression fractures, its role in vertebral stabilization for fibrous dysplasia has not been reported. A 35-year-old man with McCune-Albright syndrome and severe polyostotic fibrous dysplasia of C2 and C3 vertebrae presented with severe neck pain, radiculopathy, quadriparesis, and myelopathy. The lesion had pathologic fractures, and there was an osodontoideum with cervical cord atrophy at the C1 level. After discussing need for aggressive surgical management and potential complications, we offered PVP because of the surgical risks involved. PVP was performed with a posterolateral transpedicular approach without complication. The patient had remarkable improvement in clinical relief of neck pain and improvement of myelopathic symptoms at the 1-year follow-up. We present a case that illustrates a potential use of PVP in the management of a patient with symptomatic spinal fibrous dysplasia with associated pathologic fractures who was a poor surgical candidate.

Changes in Vertebral Wedging Rate Between Supine and Standing Position and its Association With Back Pain: A Prospective Study in Patients With Osteoporotic Vertebral Compression Fractures

Prospective consecutive series. To analyze supine and standing radiographs and the association of back pain using subjective pain criteria. It has been considered that there is little correlation between the degree of collapse of the vertebral body and the level of pain. In previous studies, however, measurements have only been based on supine radiographs. Although there were 2 authors who reported the results of supine lateral and standing lateral radiographs in patients with thoracolumbar vertebral fractures, as far as we know, there has not been any detailed report concerning the correlation between radiologic findings using supine and standing lateral radiographs and back pain. We examined 100 consecutively treated patients, prospectively. Back pain and the supine and standing radiographs were assessed 1 month after injury. Changes in vertebral wedging rate (WR) from supine to standing position (Delta WR) was reported by the following equation: Delta WR = WR(standing)-WR(supine). The median age of the cohort was 75 years (range, 60-89 years). The median VAS of back pain at supine position, at standing position, and when standing erect was 13, 33, and 41, respectively. The median wedging rate on the supine and standing radiographs were 28% and 37%, respectively (P < 0.001). There was a significant correlation between Delta WR and back pain when standing erect (r = 0.79, P < 0.001). Changes in vertebral wedging rate between supine and standing position and its association with back pain may give a clue to the pathogenesis of pain from osteoporotic thoracolumbar vertebral compression fractures.

Percutaneous vertebroplasty for treatment of osteoporotic thoracolumbar vertebral compression fracture by filling auto-solidification calcium phosphate cement

目的 探讨应用经皮椎体成形术(PVP)自固化磷酸钙人工骨(CPC)充填治疗骨质疏松性胸腰椎压缩性骨折的临床疗效.方法自2004年1月起,对26例29个椎体骨质疏松性胸腰椎压缩骨折患者,采用术中手法复位、PVP 自固化CPC充填治疗.结果 26例患者经单侧或双侧椎弓根穿刺椎体成形术成功治愈.胸腰椎自固化CPC平均充填量为4.6 mL.术中CPC渗漏者5例5个椎体.无一例出现严重并发症.经3～8个月(平均4.6个月)随访,术后所有患者疼痛消失.除3例椎体高度丢失15%外,其余椎体高度平均恢复达正常的80%.结论 PVP自固化CPC充填治疗骨质疏松性胸腰椎压缩性骨折是一种安全、简单、有效的方法。