Treatment Of Osteoporotic Vertebral Fractures Research Articles

A review of osteoporotic vertebral fracture nonunion management.

Osteoporotic vertebral fractures are a frequently encountered clinical problem, and like other fractures, they may develop nonunion that can often go unrecognized. The aim of this study is to review the related articles reporting the osteoporotic vertebral fracture nonunion and discuss the radiological characteristics, diagnosis, and treatment of osteoporotic vertebral fractures.

Discriminating imaging findings of acute osteoporotic vertebral fracture: a prospective multicenter cohort study.

BackgroundAppropriate treatment of osteoporotic vertebral fractures (OVF) requires knowledge of the age of the fracture. Although diagnostic imaging has made remarkable progress in recent years, it remains difficult to differentiate acute fractures from old. Our purpose was to investigate chronological changes in radiological findings after OVF and to identify discriminators of acute versus older injuries.MethodsWe evaluated 139 vertebrae in 136 patients. All patients underwent X-ray and magnetic resonance imaging (MRI) examination within 2 weeks of injury and again after 6 months. The anterior vertebral height ratio (AVHR) was calculated on lateral X-ray, and the intensity change of the posterior wall of the fractured vertebra was evaluated on T1-weighted MRI. The cutoff AVHR value to diagnose acute fracture was determined by receiver operating characteristic (ROC) curve analysis.ResultsAverage AVHR fell from 84.6% at initial visit to 63.7% at 6 months. When acute fracture was defined as AVHR >75%, sensitivity was 85.6%, specificity was 67.6%, and positive predictive value was 72.6%. On MRI, 83.5% of fractured vertebrae showed intensity change in the posterior wall in the acute stage, which fell to 41.7% of vertebrae after 6 months. When intensity change in the posterior wall and AVHR >75% were both present, the specificity and positive predictive value for diagnosing acute fracture improved to 87.1% and 84.7%, respectively.ConclusionsThis study suggests that vertebral fracture rarely shows significant collapse on X-ray in the first 2 weeks after injury. The combination of intensity change in the posterior wall on MRI and AVHR >75% on X-ray indicates a high probability of acute fracture.

Temperature Control of Bone Cement for Enhancing Applicability and Safety in Vertebroplasty

Vertebroplasty has been widely accepted in treatment of osteoporotic vertebral fractures. Polymerization of bone cement stabilizes the fractured vertebra by increasing its mechanical strength, thereby providing symptomatic pain relief. Many factors affect the reaction of polymerization of polymethylmethacrylate and, therefore, the reaction rate and injection permeability of bone cement. This may increase the probability of a surgeon missing the crucial period, leading to the increase of the risks of uneven cement distribution, cement leakage and premature hardening of cement. Hypothermic manipulation of bone cement is expected to reduce reaction rate and hence, extending the handling time. However, in a manner of reducing the environmental temperature of bone cement, there are still uncertainties on handling time, cement distribution pattern and injection permeability of cement. This study is thus designed to investigate the efficacy of temperature control for enhancing applicability and safety of bone cement.

Comparison of unipedicular versus bipedicular percutaneous vertebroplasty for osteoporotic vertebral compression fractures

Objective To compare the clinical efficacy and safety of unipedicular versus bipedicular percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures.Methods Enrolled for this study were 101 patients with osteoporotic vertebral compression fracture who had been treated by PVP in our department from January 2009 to January 2012 and followed up for at least one year.They were divided into 2 groups according to the approaches they used.In the unilateral group,there were 45 patients,11 males and 34 women,with a mean age of 69.4 ± 10.4 years; in the bilateral group,there were 56 patients,6 males and 50 women,with a mean age of 69.7 ± 9.7 years.The 2 groups were compared in terms of operation time,bone cement volume injected,cement leakage,vertebral height restoration,kyphosis correction and visual analogue scale (VAS) score.Results The unipedicular group incurred significantly shorter operation time (36.4±6.0 min) and significantly less bone cement volume injected (3.72 ± 1.09 mL) than the bipedicular group (52.9 ± 6.8 min and 4.29 ± 1.12 mL respectively) (P ＜ 0.05).There were no significant differences between the 2 groups in anterior vertebral height restoration,middle vertebral height restoration or kyphosis correction (P ＞ 0.05).The VAS scores at 24 hours,3 and 12 months postoperation were significantly lower than preoperation in both groups (P ＜ 0.05),but there were no such significant differences between the 2 groups (P ＞ 0.05).The cement leakage rate for the unipedicular group [28.9％ (13/45)]was insignificantly lower than that for the bipedicular group [46.4％ (26/56)] (P ＞ 0.05).Conclusions Both unipedicular and bipedicular PVP can obtain satisfactory analgesia for the treatment of osteoporotic vertebral compression fractures but the former may have advantages of less invasion and shorter operation time. Key words: Spinal fractures; Osteoporosis; Fractures, compression; Vertebroplasty

Percutaneous vertebroplasty for the treatment of osteoporotic vertebral fracture in the elderly

Objective To investigate the effects of percutaneous vertebroplasty in the treatment of old symp -tomatic osteoporotic vertebral fractures in elderly .Methods 56 patients with osteoporotic vertebral fractures in elder-ly were selected and treated with percutaneous vertebroplasty .The age of the patients were from 67 to 83 years old, average of 72.5 years old.Among them,there were 15 male cases and 41 female cases.The Cobb angles,Visual Ana-logue Scale score ,and postoperative complications were measured .Results All the operations were successfully com-pleted which took the time from 30 min to 55min.2-5ml bone cement was used in the operation .Pains of 56 patients were significantly reduced or disappeared .VAS：（7.9 ±1.5） of pre-operation,VAS：（2.3 ±1.2） of post operation, Cobb angles：（25.8 ±4.9） of pre-operation,Cobb angles：（12.6 ±3.6） of post operation.The patients could move after operation with the protection of waist in 3 to 9 days.After the follow-up visit of 2 to 14 months,the pains of patients were disappear , no complications of nerves injury , pulmonary embolism and bone cement leakage of spinal canal.Conclusion It suggests that percutaneous vertebroplasty can relieve the pain and improve the life quality of the patients with old symptomatic osteoporotic vertebral fractures .It is worthy of clinical promotion . Key words: Osteoporosis; Fractures; Vertebroplasty; Aged

Percutaneous vertebroplasty with bone cement in cases of thoracolumbar vertebral fractures

Occurrence of vertebral fractures in cases of osteoporosis in Uzbekistan is of 15 % in average. Percutaneous vertebroplasty (PV) is a minimally invasive procedure , which is currently used for the treatment of osteoporotic vertebral fractures (OVF).Purpose: to evaluate results of vertebroplasty with bone cement in the cases of compression OVF.Methods: 42 patients (9 male and 33 female, mean age 65 years) with thoracolumbar spine OVF whom PV was performed in 2010-2012. Period of existence of fractures was not less than 3 months. During this period of time conservative treatment was performed. There were none neurological signs in these patients. 30 patients were able to move independently, 10 – with assistance, and 2 were not able to move because of dorsal pain. Localization of lesion was at ThX/LV level. Multiple OVF were in 30 patients. Plan of examination included radiological absorptiometry, X-ray filming, CT and MRI scanning. Pain was assessed by means of visual analogue scale (VAS), and limitations of movement was assessed by means of Roland-Maurice questionnaire. Vertebroplasty was done by only one surgeon under local anesthesia with 1% of lidocaine under X-ray control. We used polymethylmetakrylat with Karl Storz equipment. PV at one level was in 40 patients (10 dorsal and 30 lumbar vertebrae), at two levels was in 2 ones. After PV we prescribed bed rest allowed to walk on the second day after surgery. Patients were prescribed such osteotropic drugs as alendronate sodium (70 mg 1 time per week), Ca (1000 mg daily) and vitamin D3 (400 MYE per day).Results: good results of treatment obtained in 30 patients, satisfactory - in 10, and poor – in 2 ones. After 1 year T-score values increased to 2.7 SD (from -2.3 to 3.5) in average. Before surgery T-score values were -2.9 SD (from -2.9 to -4.0) in average. Average VAS score was 7 (from 6 to 8) before surgery and 3 (from 2 to 4) after surgery. RDQ before surgery was 17.5 (26 to 23) in average, and after one year improved to 12 (from 8 to19) due to pain reduced. In 3 patients penetration of cement into the intervertebral disc, in 1 - into paravertebral tissues, and in 1 – into the spinal canal without any clinical symptoms were revealed.Conclusion: PV is an effective and safe procedure in cases of OVF but selection of patients is crucial to successful outcome.

Treatment of Osteoporotic Vertebral Fractures

Treatment of Osteoporotic Vertebral Fractures

Treatment of Osteoporotic Vertebral Fractures

Treatment of Osteoporotic Vertebral Fractures

Treatment of Osteoporotic Vertebral Fractures—Reply

Treatment of Osteoporotic Vertebral Fractures—Reply

Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for the treatment of osteoporotic vertebral fractures: a systematic review and cost-effectiveness analysis

Percutaneous vertebroplasty (PVP) is a minimally invasive surgical procedure in which bone cement is injected into a fractured vertebra. Percutaneous balloon kyphoplasty (BKP) is a variation of this approach, in which an inflatable balloon tamp is placed in the collapsed vertebra prior to cement injection. To systematically evaluate and appraise the clinical effectiveness and cost-effectiveness of PVP and percutaneous BKP in reducing pain and disability in people with osteoporotic vertebral compression fractures (VCFs) in England and Wales. A systematic review was carried out. Ten databases including MEDLINE and CINAHL were searched from inception to November 2011, and supplemented by hand-searching relevant articles and contact with an expert. Studies met the inclusion criteria if they were randomised controlled trials (RCTs) including people with painful osteoporotic VCFs with a group receiving PVP or BKP. In addition, lead authors of identified RCTs were contacted for unpublished data. Primary outcomes were health-related quality of life; back-specific functional status/mobility; pain/analgesic use; vertebral body height and angular deformity; incidence of new vertebral fractures and progression of treated fracture. A manufacturer provided academic-in-confidence observational data indicating that vertebral augmentation may be associated with a beneficial mortality effect, and that, potentially, BKP was more efficacious than PVP. These data were formally critiqued. A mathematical model was constructed to explore the cost-effectiveness of BKP, PVP and operative placebo with local anaesthesia (OPLA) compared with optimal pain management (OPM). Six scenario analyses were conducted that assessed combinations of assumptions on mortality (differential beneficial effects for BKP and PVP; equal beneficial effects for BKP and PVP; and no effect assumed) and derivation of utility data (either mapped from visual analogue scale pain score data produced by a network meta-analysis or using direct European Quality of Life-5 Dimensions data from the trials). Extensive sensitivity analyses were conducted on each of the six scenarios. This report contains reference to confidential information provided as part of the National Institute for Health and Care Excellence appraisal process. This information has been removed from the report and the results, discussions and conclusions of the report do not include the confidential information. These sections are clearly marked in the report. A total of nine RCTs were identified and included in the review of clinical effectiveness. This body of literature was of variable quality, with the two double-blind, OPLA-controlled trials being at the least risk of bias. The most significant methodological issue among the remaining trials was lack of blinding for both study participants and outcome assessors. Broadly speaking, the literature suggests that both PVP and BKP provide substantially greater benefits than OPM in open-label trials. However, in double-blinded trials PVP was shown to have no more benefit than local anaesthetic; no trials of BKP compared with local anaesthesia have been conducted. A formal analysis of observational mortality data undertaken within this report concluded that it was not possible to say with certainty if there is a difference in mortality between patients undergoing BKP and PVP compared with OPM. Results from the cost-effectiveness analyses were varied, with all of BKP, PVP and OPLA appearing the most cost-effective treatment dependent on the assumptions made regarding mortality effects, utility, hospitalisation costs and OPLA costs. Data on key parameters were uncertain and/or potentially confounded, making definitive conclusions difficult to make. For people with painful osteoporotic VCFs refractory to analgesic treatment, PVP and BKP perform significantly better in unblinded trials than OPM in terms of improving quality of life and reducing pain and disability. However, there is as yet no convincing evidence that either procedure performs better than OPLA. The uncertainty in the evidence base means that no definitive conclusion on the cost-effectiveness of PVP or BKP can be provided. Further research should focus on establishing whether or not BKP and PVP have a mortality advantage compared with OPLA and on whether or not these provide any utility gain compared with OPLA. This study was registered as PROSPERO number CRD42011001822. The National Institute for Health Research Health Technology Assessment programme.

Comparison of the effect and safety of percutaneous vertebroplasty and conservative therapy in the treatment of osteoporotic vertebral compressive fractures

目的 探讨经皮椎体成形术与保守治疗骨质疏松性椎体压缩性骨折(OVCF)的临床疗效及安全性.方法 选取OVCF患者101例,按随机数字表法分为两组,手术治疗组42例,行经皮椎体成形术治疗;保守治疗组59例,采用卧休、药物等保守治疗;观察比较两组临床疗效以及安全性.结果 手术治疗组术后椎体前缘高度恢复至(37.6±6.7)mm,后凸Cobb角矫正至(5.6±3.9)°,与保守治疗组的(23.6±5.6)mm及(6.3±4.1)差异均有统计学意义(t=4.09、3.87,均P＜0.05).治疗3个月后,手术治疗组视觉模拟评分(VAS)(0.42±0.12)分,显著低于保守治疗组的(1.23±0.23)分(t=3.65、P＜0.05);手术治疗组术后3个月,Oswestry功能障碍指数问卷表(ODI)为(4.42±1.12)分,低于保守治疗组的(11.23±2.23)分(t=8.96、P＜0.05).保守治疗组出现压疮、肺部感染及泌尿系统感染共5例(5/59,8.47%),而手术治疗组则无(0/42,0.00%)(χ2=5.09、P＜0.05).结论 与保守治疗OVCF相比,经皮椎体成形术是一种简单、微创、安全有效的治疗方法。

Pulmonary Cement Embolism following Percutaneous Vertebroplasty.

Percutaneous vertebroplasty is a minimal invasive procedure that is applied for the treatment of osteoporotic vertebral fractures. During vertebroplasty, the leakage of bone cement outside the vertebral body leads to pulmonary cement embolism, which is a serious complication of this procedure. Here we report a 48-year-old man who was admitted to our hospital with dyspnea after percutaneous vertebroplasty and diagnosed as pulmonary cement embolism.

Controversial issues in kyphoplasty and vertebroplasty in osteoporotic vertebral fractures.

Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed for many years for the treatment of osteoporotic vertebral fractures. The purpose of this review is to resolve the controversial issues raised by the two randomized trials that claimed no difference between VP and SHAM procedure. In particular we compare nonsurgical management (NSM) and KP and VP, in terms of clinical parameters (pain, disability, quality of life, and new fractures), cost-effectiveness, radiological variables (kyphosis correction and vertebral height restoration), and VP versus KP for cement extravasation and complications profile. Cement types and optimal filling are analyzed and technological innovations are presented. Finally unipedicular/bipedicular techniques are compared. Conclusion. VP and KP are superior to NSM in clinical and radiological parameters and probably more cost-effective. KP is superior to VP in sagittal balance improvement and cement leaking. Complications are rare but serious adverse events have been described, so caution should be exerted. Unilateral procedures should be pursued whenever feasible. Upcoming randomized trials (CEEP, OSTEO-6, STIC-2, and VERTOS IV) will provide the missing link.

Nonlinear mechanical analysis of posterior spinal instrumentation for osteoporotic vertebra: Effects of mechanical properties of the rod on the failure risks around the screw

In spinal fusion with instrumentation for the treatment of osteoporotic vertebral fracture, it is common for pedicle screws, which are inserted into vertebrae and strongly immobilized by a rigid rod, to loosen and dissociate. One of their expected causes is failure and reduction of fixity around a screw. An improved rod with a damper structure has thus been proposed to increase the freedom of movement of the rod and allow more flexible fixation of the spine. To evaluate the availability of the proposed structure and establish appropriate improved design of screws and rods with fewer occurrences of loosening and dissociation, effects of the structural change to the improved rod on the distribution of failure risks around the screw need to be investigated. In the present study, we performed nonlinear fracture analysis for spinal instrumentation surgery using an osteoporosis model and evaluated the failure distribution in the vertebrae while changing the apparent stiffness of the damper joint. Our finite element analysis showed that there were few expected failures in the flexible fixation model, indicating the effectiveness of the improved structure of the rod in reducing the loosening and dissociation of screws. It also suggested that the reduction was derived from the allowance of horizontal deformation in the damper joint in the improved rod. The potential of the structural improvement and the mechanism responsible for reducing the risks of loosening and dissociation are discussed.

Percutaneous Vertebroplasty Using Fresh Frozen Allogeneic Bone Chips as Filler

BackgroundVertebroplasty is not free from cement related complications. If an allograft is used as a filler, most of them can be averted.MethodsForty consecutive cases of osteoporotic vertebral fracture were divided into two groups by self-selection. The study and the control groups underwent vertebroplasty with fresh frozen allogeneic bone chips and bone cement, respectively. Clinical results were assessed at preoperation, postoperative day 1 and months 3, 6, and 12 by 10-grade visual analog scale (VAS), and radiological results were assessed at the same time by vertebral kyphotic angle (VKA) and local kyphotic angle (LKA). The results were compared within and between the groups. Survival function was analyzed. The criteria of an event were clinical or radiological deterioration versus pre-index surgery state.ResultsVAS was improved in the study group from 8.4 ± 0.8 to 5.2 ± 1.4, 6.4 ± 1.2, 5.5 ± 2.7, and 3.7 ± 1.4 at postoperative day 1 and months 3, 6, and 12, respectively, and in the control group from 8.4 ± 1.2 to 3.2 ± 1.1, 3.2 ± 1.7, 3.2 ± 2.7, and 2.5 ± 1.7, respectively (within group, p < 0.001; between groups, p < 0.001). VKA was improved in the study group from 18.9° ± 8.0° to 15.2° ± 6.1° (p = 0.046) and in the control group from 14.7° ± 5.2° to 10.3° ± 4.7° (p < 0.001) at postoperative day 1. LKA was not improved in the study group but was improved in the control group from 16.8° ± 11.7° to 14.3° ± 9.6° (p = 0.015). Correction angle was 2.7° ± 4.6°, -7.9° ± 5.3°, -7.2° ± 5.2°, and -7.4° ± 6.3° at postoperative day 1 and months 3, 6, and 12, respectively, in the study group and 4.3° ± 3.7°, 0.7° ± 3.6°, 0.7° ± 4.2°, and 0.1° ± 4.4°, respectively, in the control group. Correction loss was significant in both groups (p < 0.001) and more serious in the study group (p < 0.001). The 6-month survival rate was 16.7% in the study group and 64.3% in the control group (p = 0.003; odds ratio, 5.250).ConclusionsIn treatment of osteoporotic vertebral fracture, fresh frozen allogeneic bone chips are not recommendable as a filler for its worse results than bone cement.

Major surgical treatment of osteoporotic vertebral fractures in the elderly: a comparison of anterior spinal fusion, anterior-posterior combined surgery and posterior closing wedge osteotomy.

Study DesignA retrospective study.PurposeTo clarify the differences among the three major surgeries for osteoporotic vertebral fractures based on the clinical and radiological results.Overview of LiteratureMinimally invasive surgery like balloon kyphoplasty has been used to treat osteoporotic vertebral fractures, but major surgery is necessary for severely impaired patients. However, there are controversies on the surgical procedures.MethodsThe clinical and radiographic results of patients who underwent major surgery for osteoporotic vertebral fracture were retrospectively compared, among anterior spinal fusion (group A, 9 patients), single-stage combined anterior-posterior procedure (group AP, 8 patients) and posterior closing wedge osteotomy (group P, 9 patients). Patients who underwent revision surgery were evaluated just before the revision surgery, and the other patients were evaluated at the final follow-up examination, which was defined as the end point of the evaluations for the comparison.ResultsThe operation time was significantly longer in group AP than in the other two groups. The postoperative correction of kyphosis was significantly greater in group P than in group A. Although the differences were not significant, better outcomes were obtained in group P in: back pain relief at the end point; ambulatory ability at the end point; and average loss of correction.ConclusionsThe posterior closing wedge osteotomy demonstrated better surgical results than the anterior spinal fusion procedure and the single-stage combined anterior-posterior procedure.

Major Medical Outcomes With Spinal Augmentation vs Conservative Therapy

The symptomatic benefits of spinal augmentation (vertebroplasty or kyphoplasty) for the treatment of osteoporotic vertebral compression fractures are controversial. Recent population-based studies using medical billing claims have reported significant reductions in mortality with spinal augmentation compared with conservative therapy, but in nonrandomized settings such as these, there is the potential for selection bias to influence results. To compare major medical outcomes following treatment of osteoporotic vertebral fractures with spinal augmentation or conservative therapy. Additionally, we evaluate the role of selection bias using preprocedure outcomes and propensity score analysis. Retrospective cohort analysis of Medicare claims for the 2002-2006 period. We compared 30-day and 1-year outcomes in patients with newly diagnosed vertebral fractures treated with spinal augmentation (n = 10,541) or conservative therapy (control group, n = 115,851). Outcomes were compared using traditional multivariate analyses adjusted for patient demographics and comorbid conditions. We also used propensity score matching to select 9017 pairs from the initial groups to compare the same outcomes. Spinal augmentation (vertebroplasty or kyphoplasty) or conservative therapy. Mortality, major complications, and health care utilization. Using traditional covariate adjustments, mortality was significantly lower in the augmented group than among controls (5.2% vs 6.7% at 1 year; hazard ratio, 0.83; 95% CI, 0.75-0.92). However, patients in the augmented group who had not yet undergone augmentation (preprocedure subgroup) had lower rates of medical complications 30 days post fracture than did controls (6.5% vs 9.5%; odds ratio, 0.66; 95% CI, 0.57-0.78), suggesting that the augmented group was less medically ill. After propensity score matching to better account for selection bias, 1-year mortality was not significantly different between the groups. Furthermore, 1-year major medical complications were also similar between the groups, and the augmented group had higher rates of health care utilization, including hospital and intensive care unit admissions and discharges to skilled nursing facilities. After accounting for selection bias, spinal augmentation did not improve mortality or major medical outcomes and was associated with greater health care utilization than conservative therapy. Our results also highlight how analyses of claims-based data that do not adequately account for unrecognized confounding can arrive at misleading conclusions.

Intraoperative PEEP-ventilation during PMMA-injection for augmented pedicle screws: improvement of leakage rate in spinal surgery.

Within the last two decades the use of polymethylmethacrylate (PMMA) in the treatment of osteoporotic vertebral fractures has been established widely. Several techniques of cement application in spinal surgery have been described. Besides classical vertebroplasty, kyphoplasty and related techniques that reinforce stability of the fractured vertebral body itself, augmentation of pedicle screws became an issue in the past 10years. Aim of this technique is strengthening of the implant-bone-interface and the prevention of loosening and failure of posterior instrumentation in limited bone quality due to osteoporosis. PMMAuse in spinal surgery always bears the risk of cement leakage and cement embolism. There are only few publications dealing with cement leakage in pedicle screw augmentation. We examined our cohort concerning incidence and type of leakage in comparison to the literature. In particular, we evaluated a possible role of intrathoracic pressure during cementation procedure. In this retrospective study 42 patients were included. Mean age was 74 (57-89) years. 311 fenestrated, augmented screws were analyzed postoperatively concerning leakage and subsequent pulmonary embolism of cement particles. Overall, there was a leakage rate of 38.3%, and 28.6% of patients showed pulmonary embolism of PMMA. During surgery, patients were in part ventilated with a positive end-expiratory pressure (PEEP) of 15cmH2O during cement injection. These individuals showed significantly less leakage locally as well as less PMMA-emboli in the pulmonary circulation in contrast to patients ventilated without increased PEEP. PEEP elevation during administration of PMMA via fenestrated pedicle screws is reducing the leakage rate in spinal surgery. These beneficial effects warrant further evaluation in prospective studies.

Reduced loosening rate and loss of correction following posterior stabilization with or without PMMA augmentation of pedicle screws in vertebral fractures in the elderly.

Therapy of vertebral fractures in the elderly is a growing challenge for surgeons. Within the last two decades, the use of polymethylmethacrylate (PMMA) in the treatment of osteoporotic vertebral fractures has been widely established. Besides vertebroplasty and kyphoplasty, the augmentation of pedicle screws with PMMA found widespread use to strengthen the implant-bone interface. Several studies showed an enhanced pullout strength of augmented screws compared to standard pedicle screws in osteoporotic bone models. To validate the clinical relevance, we analyzed postoperative radiologic follow-up data in regard to secondary loss of correction and loosening of pedicle screws in elderly patients. In this retrospective comparative study, 24 patients admitted to our level I trauma center were analyzed concerning screw loosening and secondary loss of correction following vertebral fracture and posterior instrumentation. Loss of correction was determined by the bisegmental Cobb angle and kyphosis angle of the fractured vertebra. Follow-up computed tomography (CT) scans were used to analyze the prevalence of clear zones around the pedicle screws as a sign of loosening. In 15 patients (mean age 76±9.3years) with 117 PMMA-augmented pedicle screws, 4.3% of screws showed signs of loosening, whereas in nine patients (mean age 75±8.2years) with 86 uncemented screws, the loosening rate was 62.8%. Thus, PMMA-augmented pedicle screws showed a significantly lower loosening rate compared to regular pedicle screws. Loss of correction was minimal, despite poor bone quality. There was significantly less loss of correction in patients with augmented pedicle screws (1.1°±0.8°) as compared to patients without augmentation (5°±3.8°). The reinforcement of pedicle screws using PMMA augmentation may be a viable option in the surgical treatment of spinal fractures in the elderly.

Kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fractures

Background The incidence of osteoporotic vertebral compression fractures increases with advancing age and is associated with significant healthcare expenditure. Patients who have sustained fractures from osteoporosis are at increased risk of additional fractures because of loss of bone strength caused by osteoporosis. Vertebroplasty is a minimally invasive vertebral augmentation procedure to relieve pain; it stabilizes the vertebral body. Kyphoplasty is a minimally invasive method for correction and augmentation of osteoporotic vertebral fractures. Materials and methods This study included two groups of patients suffering from painful osteoporotic vertebral compression fractures: the first group comprised 26 patients with 33 vertebral compression fractures treated by percutaneous vertebroplasty between April 2007 and October 2008. The results of this group were compared with those of another group of 18 patients (24 vertebrae) who were treated by kyphoplasty between November 2008 and July 2011. The visual analog scale (VAS) and the Oswestry Disability Index (ODI) were applied for the assessment of patients preoperatively and postoperatively. Results In the vertebroplasty group, the mean VAS score improved from 7.8 to 2.4 according to VAS and from 69 to 15 according to ODI. Cement leakage was noted in four patients (15.4%), without clinical consequence. Ten vertebrae (30.3%) revealed a mean improvement in vertebral height of 11% (8–14%). No patient showed progression of vertebral angles of the augmented vertebrae during the follow-up period. In the kyphoplasty group, the mean pain score improved from 8 to 2.1 according to VAS and from 71 to 17 according to ODI. Cement leakage was noted in two patients (11.11%), without clinical consequence. No thoracolumbar back pain was reported after kyphoplasty. Nineteen vertebrae (79.16%) revealed a mean improvement in vertebral height of 22% (range, 18–38%). No patient showed progression of vertebral angles of the augmented vertebrae during the follow-up period. Conclusion Both vertebroplasty and kyphoplasty resulted in significant improvement in VAS pain scores. Vertebroplasty, although less expensive than kyphoplasty, had a statistically greater risk for cement leakage and adjacent vertebral fracture.