Vertebral Kyphosis Research Articles

Posterior reduction and short pedicle screw fixation at fracture level for treatment of single level compress thoracolumbar fractures

Objective To assess the efficacy and safety of posterior reduction and short pedicle screw fixation at fracture level(method A)for treatment of single level compress thoracolumbar fractures.Methods The clinical data of 87patients with single level compress thoracolumbar fractures,who were surgically treated between January 2010and January 2012in our hospital,were retrospectively analyzed.treated by posterior.The patients were divided into two groups according to surgical methods.Group A:Patients were treated with method A;Group B:Patients were treated by conventional posterior decompression,redultion of fracture and short segment fusion and internal fixation.The operation time and intraoperative blood loss were recorded and the postoperative pain was evaluated.The adjacent vertebral Cobb angle and the anterior height of the injured vertebra on the lateral radiographs were measured before surgery,immediately after surgery,and 1year after surgery,and the vertebral compression ratio was calculated.Results Among the 73patients who were finally included in the study,38were in group A and 35in group B.There were no significant differences in patient age,compression ratio,Cobb angle before or after surgery between the two groups.The operation time in group A was signficantly longer than that in group B(121min vs 92min,P0.05);the compression ratios immediately and 1year after surgery in group A were significantly higher than those in group B([immediately after surgery:91.3%(82%-93%)vs 77.2%(73%-86%),P0.05;1year after sugtery:87.2%(79%-93%)vs 73.1%(68%-80%),P0.05]).The Cobb angle at 1year after operation in group A was significantly smaller than that in group B(7.8°[0°-15°]vs 11°[2°-17°],P0.05).There was no significant differences in blood loss or scores of low back painbetween the two groups.Conclusion Posterior reduction and short pedicle screw fixation can safely and effectively reconstruct the vertebral body height and correct kyphosis in patients with single level compress thoracolumbar fractures.

Percutaneous Cement-Augmented Screws Fixation in the Fractures of the Aging Spine: Is It the Solution?

Introduction. Management of elderly patients with thoracolumbar fractures is still challenging due to frequent osteoporosis and risk of screws pull-out. The aim of this study was to evaluate results of a percutaneous-only procedure to treat these fragile patients using cement-augmented screws. Methods. 12 patients diagnosed with a thoracolumbar fracture associated with an important loss of bone stock were included in this prospective study. Surgical procedure included systematically a percutaneous osteosynthesis using cemented fenestrated screws. When necessary, additional anterior support was performed using a kyphoplasty procedure. Clinical and radiographic evaluations were performed using CT scan. Results. On the whole series, 15 fractures were diagnosed and 96 cemented screws were inserted. The difference between the pre- and postoperative vertebral kyphosis was statistically significant (12.9° versus 4.4°, P = 0.0006). No extrapedicular screw was reported and one patient was diagnosed with a cement-related pulmonary embolism. During follow-up period, no infectious complications, implant failures, or pull-out screws were noticed. Discussion. Aging spine is becoming an increasing public health issue. Management of these patients requires specific attention due to the augmented risk of complications. Using percutaneous-only screws fixation with cemented screw provides satisfactory results. A rigorous technique is mandatory in order to achieve best outcomes.

Application of nanometer calcium phosphate ceramic artificial bone in percutaneous kyphoplasty: a short-term clinical observation

Objective To observe the clinical effects of nanometer calcium phosphate ceramic artificial bone(NCPCAB) in percutaneous kyphoplasty for treatment of osteoporotic vertebral compression fractures. Methods Totally 33 cases of osteoporotic vertebral compression fractures were selected in the present study.All cases were injected with NCPCAB for percutaneous kyphoplasty via bilateral transpedicular balloon approach.Anterior vertebral reset rate and kyphosis correction rate were calculated after treatment.The visual analogue scales(VAS) were observed preoperatively and postoperatively.The changes of blood pressure and SPO2 were observed preoperatively,at injection of the artificial bone,5 min after injection and at the end of surgery. Results The postoperative vertebra reduction rate and kyphosis correction rate were(24.90±3.02)% and(45.80±7.13)%,respectively.The pain was greatly reduced after operation.The blood pressure was stable after injection of the artificial bone,and SPO2 was not markedly different at each time point. Conclusion Application of NCPCAB in percutaneous kyphoplasty is safe and effective for treatment of osteoporotic vertebral compression fractures,with little influence on the vital signs of patients.

Prospective Analysis of Magnetic Resonance Imaging Accuracy in Diagnosing Traumatic Injuries of the Posterior Ligamentous Complex of the Thoracolumbar Spine

Prospective cohort study. To study magnetic resonance imaging (MRI) accuracy in diagnosing posterior ligamentous complex (PLC) damage, when applying the new dichotomic instability criteria in a prospective cohort of patients with vertebral fracture. Recent studies dispute MRI accuracy to diagnose PLC injuries. They analyze the complex based on 3 categories (intact/indeterminate/rupture), including the indeterminate in the ruptured group (measurement bias) in the accuracy analysis. Moreover, fractures with conservative treatment (selection bias) are not included. Both facts reduce the specificity. A recent study has proposed new criteria where posterior instability is determined with supraspinous ligament (SSL) rupture. Prospective study of patients with acute thoracolumbar fracture, using radiography and MRI (FS-T2-w/short-tau inversion-recovery sequences). 1. The integrity (ruptured/unruptured) of each isolated component of the PLC (facet capsules, interspinous ligament, SSL, and ligamentum flavum) was assessed via MRI and surgical findings. 2. PLC integrity as a whole was assessed, adopting the new dichotomic stability criteria from previous studies. In the MR images, PLC is considered ruptured when the SSL is found discontinued, and intact when not (this excludes the "indeterminate" category). In surgically treated fractures, PLC stability as a whole was assessed dynamically (ruptured/unruptured). In conservative fractures, PLC stability was assessed according to change in vertebral kyphosis measured with the local kyphotic angle at 2-year follow-up (ruptured if difference is > 5°/unruptured if difference is < 5°).3. Comparative analysis among findings provided MRI accuracy in diagnosing PLC damage. Fifty-eight vertebral fractures were studied (38 surgical, 20 conservative), of which 50% were in males; average age, 40.4 years. MRI sensitivity for injury diagnosis of each isolated PLC component varied between 92.3% (interspinous ligament) and 100% (ligamentum flavum). Specificity varied between 52% (facet capsules) and 100% (SSL). PLC integrity sensitivity and specificity as a whole were 91% and 100%, respectively. Adopting the new stability criteria, MRI accuracy in PLC injury diagnosis increases. Specificity is increased (true positives) both in isolated component analysis and PLC as a whole.

Comparison between percutaneous and traditional fixation of lumbar spine fracture: Intraoperative radiation exposure levels and outcomes

To compare radiation exposure doses and clinical and radiological outcomes between percutaneous pedicular screwing (closed reduction internal fixation [CRIF]) and classical open reduction internal fixation (ORIF) in lumbar spine fracture without neurologic deficit. Sixty patients (mean age, 42.5 years) were divided into two treatment groups: (Percutaneous) CRIF versus (traditional) ORIF. Screw position and anatomic vertebral reconstruction were checked on routine control X-ray and postoperative CT scan. Study parameters comprised: surgery time, radiation exposure time, radiation dose level for X-ray (DAP) and for CT (DLP),blood loss, length of hospital stay and postoperative pain (VAS). At a mean 25.5 months' follow-up,there were no significant inter-group differences on the epidemiological parameters: age, gender, fracture level, fracture type on the Magerl classification, preoperative local vertebral kyphosis angle, or fracture-to-surgery interval. Effective radiation dose was 3-fold higher in CRIF than in ORIF, but 6-fold lower than for the postoperative CT scan. Postoperative pain on VAS was significantly lower after CRIF, allowing earlier gait resumption and return to work and daily activity. There were no significant differences in length of hospital stay, patient satisfaction, screw malpositioning or postoperative or end-of-follow-up kyphosis angle. Percutaneous surgery provided clinical and radiological outcomes strictly comparable to those of open surgery, but with a higher effective radiation exposure dose, including for the medical team and especially for the surgeon. This higher exposure dose, however, is to be relativized by comparison to that of the postoperative CT scan, which involved a much higher exposure dose for the patient. Level IV. Retrospective study.

Surgical procedure and initial radiographic results of a new augmentation technique for vertebral compression fractures

Recently, a new minimally invasive technique called 'vertebral body stenting' (VBS) was introduced for the treatment of osteoporotic vertebral fractures. The technique was developed to prevent the loss of reduction after deflation of the balloon and to reduce the complication rate associated with cement leakage. The amount of kyphosis correction, improvement of vertebral body height and quantitative cement leakage rate by applying CT-based quantitative volumetry after VBS were measured in 27 patients (55 vertebra) and compared with a control group (29 patients, 61 vertebrae), which was treated with conventional vertebroplasty. After VBS, a significant improvement was seen in vertebral height, compared to conventional vertebroplasty. The mean improvement in segmental kyphosis and vertebral kyphosis were 5.8° (p < 0.05) and 3.5° (p < 0.05), respectively. In the VBS group, the mean injected volume of cement per vertebral body was 7.33 cm(3) (3.34-10.19 cm(3)). The average amount of cement outside the vertebrae was 0.28 cm(3) (0.01-1.64 cm(3)), which was 1.36% of the applied total cement volume. In the vertebroplasty group, the applied mean volume of the cement per level was 2.7 cm(3) (1-5.8 cm(3)) and the average amount of cement outside the vertebrae was 0.15 cm(3) (0.01-1.8 cm(3)), which was 11.5% (0.2-60%) of the applied total volume of cement. The frequency of cement leakage after VBS was 25.5% compared to 42.1% in the vertebroplasty group. VBS led to a significant decrease in the leakage rate compared with conventional vertebroplasty.

A Randomized Trial of Balloon Kyphoplasty and Nonsurgical Management for Treating Acute Vertebral Compression Fractures: Outcomes and Vertebral Body Kyphosis Correction and Surgical Parameters

A Randomized Trial of Balloon Kyphoplasty and Nonsurgical Management for Treating Acute Vertebral Compression Fractures: Outcomes and Vertebral Body Kyphosis Correction and Surgical Parameters

Minimally invasive management of thoraco-lumbar fractures: Combined percutaneous fixation and balloon kyphoplasty

Retrospective review of prospectively collected data. There is no consensus regarding the ideal treatment of thoraco-lumbar spine fractures without neurological compromise. Many surgical techniques have been described but none has proved its definite superiority. The main drawback of these procedures is directly related to the morbidity of the approach. As minimally invasive fixation combined with balloon kyphoplasty for treatment of thoraco-lumbar fractures is gaining popularity, its efficacy has yet to be established. The purpose of this study is to report operative data, clinical and radiological outcomes of patients undergoing minimally invasive management of thoraco-lumbar fracture at our institutions. Forty-one patients underwent percutaneous kyphoplasty and stabilization for treatment of single-level fracture of the thoracic or lumbar spine. All patients were neurologically intact. There were 20 males and 21 females with an average age of 50 years. The mean follow-up was 15 months (3-90 months). The mean operative time was 102 minutes (range 35-240 minutes) and the mean blood loss was <100mL. VAS was significantly improved from 6.7 to 0.7 at last follow-up. Vertebral kyphosis decreased by 16° to 7.8° postoperatively (P<0.001). Local kyphosis and percentage of collapse were also significantly improved from 8° to 5.6° and from 35% to 16% at last follow-up. Fifteen leaks have been identified, three of which were posterior; all remained asymptomatic. No patient worsened his or her neurological condition postoperatively. Percutaneous stabilization plus balloon kyphoplasty seems to be a safe and effective technique to manage thoraco-lumbar fractures without neurological impairment.

Improved percutaneous vertebroplasty for osteoporotic vertebral compression fractures

Objective To evaluate the curative efficacy of improved percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures (OVCF) in comparison with conventional PVP and percutaneous kyphoplasty (PKP). Methods Between June 2007 and July 2010,97 senior OVCF patients were surgically treated and followed up in our department.They were 36 men and 61 women,with an average age of 68.3 years (ranging from 56 to 89 years).Altogether 124 vertebral bodies were treated,including 73 thoracic vertebrae and 51 lumbar vertebrae.Seventy-four patients had a single vertebra fractured,19 had 2 vertebrae fractured and 4 had 3 vertebrae fractured.The patients received improved PVP,conventional PVP and PKP respectively.The visual analogue scale (VAS) scores and the cobb angles of the injured vertebra before operation,one week and 6 months after operation and the postoperative cement leakage as well were compared between the 3 groups of patients. Results The patients obtained an average follow-up of 13 months (from 7 to 20 months).Mild radicular symptoms were observed in 3 patients.No spinal injury,infection or vascular embolism occurred.There was a significant difference between the preoperative and postoperative VAS scores in all the 3 groups( P ＜ 0.05) but there was no significant difference among the 3 groups regarding the VAS score at the same time point ( P ＞ 0.05). PKP and improved PVP were significantly better than conventional PVP in correction of the cobb angle ( P ＜ 0.05).Moreover,PKP and improved PVP resulted in significantly fewer events of cement leakage than conventional PVP ( P ＜ 0.05). Conclusions Compared with conventional PVP,improved PVP makes a significant improvement in correction of vertebral kyphosis and reduction of cement leakage while it can also rapidly relieve pain in patients with OVCF.Improved PVP is as therapeutically effective as PKP,but much less expensive than PKP. Key words: Spinal fractures; Osteoporosis; Vertebroplasty

Evaluation of percutaneous surgery in the treatment of thoracolumbar fractures. Preliminary results of a prospective study on 65 patients

We conducted a prospective, single-center, continuous study of patients operated for fractures urelated to osteoporosis at the thoracolumbar junction level using percutaneous techniques. The aim of this study was to investigate the clinical and radiological outcomes of percutaneous techniques for these indications. This study included patients who underwent standalone balloon kyphoplasty surgery or combined with percutaneous posterior osteosynthesis in cases of associated distraction. The fractures were classified according to the Magerl classification. The patients were evaluated clinically (visual analog scale [VAS], the Oswestry Disability Index, and autonomy) and radiologically (vertebral kyphosis and height variations of the vertebral body) for 12 months. Sixty-five patients were included. The mean age at the time of the surgery was 45.4 years (range, 19-72 years). The main indications were A.1 fractures of L1. We noted 22% cement leakages, none having a clinical impact. In the overall series, the VAS at the lesional level improved from 5.5 (range, 3-8) preoperatively to 0.6 (range, 1-3) at 12 months. In all, 95% of the workers resumed their occupation. Traumatic kyphosis improved from 13.3° (range, 5-23°) before the surgery to 8.3° (range, 1-20°). The complication rate was low. The radiological results are comparable to those reported in the literature for other series with percutaneous surgery. Only the loss of the correction observed in the group undergoing standalone kyphoplasty with calcium phosphate cement led us to propose another type of treatment for these indications. This study must be continued over the long term to detect the appearance of discopathy related to cement leakage and to answer questions as to how cement evolves. III, prospective study with low statistical power.

Percutaneous pedicle screw fixation combined with transpedicular interbody bone grafting for the treatment of thoracolumbar fractures

Objective To investigate the efficacy of percutaneous pedicle screw fixation combined with transpedicular interbody bone grafting for the treatment of thoracolumbar fractures.Methods A total of 20 patients with thoracolumbar fractures (type A,load sharing ≥7,without neurological deficit) underwent percutaneous pedicle screw fixation of Sextant systems combined with transpedicular interbody bone grafting were retrospectively studied.The perioperative parameters,radiographic and clinical outcomes were compared with another 20 patients underwent traditional short-segment pedicle screw fixation combined with transpedicular interbody bone grafting.All patients were followed up for at least 2 years after surgery.Results There were no significant differences between the two groups in sex,age,injury to operation interval,and load sharing scores.However,there were significant differences between the two groups in operating time and blood loss (P＜0.05).The vertebral body height and kyphosis angle were corrected significantly after surgery (P＜O.05),however,the recovery of the vertebral body height and kypbosis angle were reduced significantly one year after surgery in both groups (P＜0.05).At the final follow-up,there were no significant progressive losses of the recovery of the vertebral body height and kyphosis angle,as compared with that of one year after surgery in two groups.There were no significant differences in radiographic parameters and the clinical outcomes between the two groups,even though less radiographic correction and better clinical outcomes were found in percutaneous techniques.Conclusion Short-segment pedicle screw fixation with transpedicular grafting remains a reliable surgical method for the treatment of severe thoracolumbar fractures without neurological deficit.Percutaneous pedicle screw fixation proved to be an effective method with the advantages of minimal invasiveness and less blood loss. Key words: Spinal fractures; Fracture fixation, internal; Surgical procedures, minimally invasive; Bone screws

A case of posterior element fracture in Kummell's disease

Kummell's disease is a rare, delayed posttraumatic collapse of a vertebral body that can occur several months or even years after an osteoporotic compression fracture. However, there are few reports of posterior element fractures associated with Kummell's disease. A 72-year-old man who had sustained an L1 osteoporotic compression fracture 14 months prior was admitted to our institution with incapacitating back pain. Plain radiographs showed progressive collapse of the L1 vertebral body and severe kyphosis at the thoracolumbar junction. Magnetic resonance imaging revealed a posterior element fracture as well as osteonecrosis of the L1 vertebral body. An L1 percutaneous vertebroplasty was performed, followed by bone cement-augmented screw fixation to maintain stability and correct the kyphotic deformity. After surgery, pain relief was immediate, and the patient was able to walk unassisted. This case illustrates that continuous axial distraction stress caused by aggravated kyphosis secondary to Kummell's disease may result in posterior element fractures. Our discussion concludes with a literature review.

Restoration of Spinal Alignment and Disk Mechanics following Polyetheretherketone Wafer Kyphoplasty with StaXx FX

EPFs sustained during VCFs degrade the disk's ability to develop IDP under load. This inability to develop pressure in combination with residual kyphotic deformity increases the risk for adjacent vertebral fractures. We tested the hypothesis that StaXx FX reduces kyphosis and endplate deformity following vertebral compression fracture, restoring disk mechanics. Eight thoracolumbar, 5-vertebrae segments were tested. A void was selectively created in the middle vertebra. The specimens were compressed until EPF and to a grade I-II VCF. PEEK wafer kyphoplasty was then performed. The specimens were then tested in flexion-extension (±6 Nm) under 400-N preload intact, after EPF, VCF, and kyphoplasty. Endplate deformity, kyphosis, and IDP adjacent to the fractured body were measured. Vertebral body height at the point of maximal endplate deformity decreased after EPF and VCF and was partially corrected after StaXx FX, remaining less than intact (P = .047). Anterior vertebral height decreased after VCF (P = .002) and was partially restored with StaXx FX, remaining less than intact (P = .015). Vertebral kyphosis increased after VCF (P < .001) and reduced after StaXx FX, remaining greater than intact (P = .03). EPF reduced IDP in the affected disk in compression-flexion loading (P < .001), which was restored after StaXx FX (P = 1.0). IDP in the unaffected disk did not change during testing (P > .3). StaXx FX reduced endplate deformity and kyphosis, and significantly increased anterior height following VCF. Although height and kyphosis were not fully corrected, the disk's ability to pressurize under load was restored.

Percutaneous internal fixation combined with kyphoplasty for neurologically intact thoracolumbar fractures: A prospective cohort study of 24 patients with one year of follow-up

Neurologically intact lumbar and thoracolumbar fractures are frequent but their treatment is not codified. The purpose of this study was to evaluate the effectiveness of minimally invasive treatment of such fractures by percutaneous fixation associated with balloon kyphoplasty. Between November 2008 and July 2010, 24 patients were treated. There were 12 men and 12 women, with a mean age of 53 years (range 20-88 years). Fractures were classified as one Magerl lesion type A1, one type A2, 19 A3 (five A31, 10 A32, four A33), and three type B2. The treatment was kyphoplasty of the fractured vertebra followed by percutaneous fixation of the vertebra above and below the fracture. Patient follow-up included an analysis of pain using the visual analogic score, the Oswestry score, and functional X-ray and CT analysis. Surgery lasted a mean 99 minutes. At the last follow-up, the mean pain was scored at 0.9 and the Oswestry score was 13.2. Reduction of vertebral kyphosis was 8.6° and reduction of the corrected regional angle was 7.1°. The gain in vertebral height was 17%. All pedicle screws were positioned correctly and no neurological, septic, or thromboembolic complications were observed. Percutaneous osteosynthesis combined with balloon kyphoplasty is a valuable surgical technique in the treatment of thoracolumbar and lumbar fractures with no neurologic deficit. The clinical results are good and the technique allows the patient to return home earlier without having to wear a corset. The X-ray result scores are very encouraging, with corrections similar to conventional surgery in terms of vertebral height and kyphosis. This technique can be an alternative to conventional open surgery. IV: Prospective observational study.

Spinal shortening and monosegmental posterior spondylodesis in the management of dorsal and lumbar unstable injuries

Introduction:Patients with spinal injuries have been treated in the past by laminectomy in an attempt to decompress the spinal cord. The results have shown insignificant improvement or even a worsening of neurologic function and decreased stability without effectively removing the anterior bone and disc fragments compressing the spinal cord. The primary indication for anterior decompression and grafting is narrowing of the spinal canal with neurologic deficits that cannot be resolved by any other approach. One must think of subsequent surgical intervention for increased stability and compressive posterior fusion with short-armed internal fixators.Aim:To analyze the results and efficacy of spinal shortening combined with interbody fusion technique for the management of dorsal and lumbar unstable injuries.Materials and Methods:Twenty-three patients with traumatic fractures and or fracture-dislocation of dorsolumbar spine with neurologic deficit are presented. All had radiologic evidence of spinal cord or cauda equina compression, with either paraplegia or paraparesis. Patients underwent recapping laminoplasty in the thoracic or lumbar spine for decompression of spinal cord. The T-saw was used for division of the posterior elements. After decompression of the cord and removal of the extruded bone fragments and disc material, the excised laminae were replaced exactly in situ to their original anatomic position. Then application of a compression force via monosegmental transpedicular fixation was done, allowing vertebral end-plate compression and interbody fusion.Results:Lateral Cobb angle (T10–L2) was reduced from 26 to 4 degrees after surgery. The shortened vertebral body united and no or minimal loss of correction was seen. The preoperative vertebral kyphosis averaged +17 degrees and was corrected to +7 degrees at follow-up with the sagittal index improving from 0.59 to 0.86. The segmental local kyphosis was reduced from +15 degrees to −3 degrees. Radiography demonstrated anatomically correct reconstruction in all patients, as well as solid fusion.Conclusion:This technique permits circumferential decompression of the spinal cord through a posterior approach and posterior interbody fusion.

Short-term therapeutic effect of vertebral pillar block insertion through vertebral pedicle in treatment of thoracolumbar vertebral fractures

Objective To study the therapeutic effect of vertebral pillar block insertion through vertebral pedicle in treatment of thoracolumbar vertebral fractures. Methods The study involved 23patients (25 vertebrae and 47 vertebral pillar blocks) with thoracolumbar vertebral fractures treated with vertebral pillar block insertion through vertebral pedicle in our hospital from March 2008 to July 2009.There were two patients with T11 fractures, nine with T12 fractures, seven with L1 fractures and five with L2 fractures (four patients were treated with decompression by fenestration between vertebral plates and vertebral pedicle fixation with vertebral pillar block). Surgical operation, operation duration, blood loss during operation, postoperative and follow-up X-ray films were observed, and the ratio of anterior vertebral height and normal height, degree of Cobb angle correction and early postoperative recovery were determined. Results Twenty-three patients were followed up for 7-16 months (mean 12.5 months),which showed little postoperative vertebral height loss and significantly improved postoperative anterior vertebral compression rate and the Cobb angle (P ＜ 0. 05). Conclusions Vertebral pillar block can effectively restore the mechanical properties of vertebral bodies, reduce further loss of vertebral height,kyphosis reproduction and other complications and take advantages of shorter operative time, less bleeding, faster recovery and better adaptation to the biological fixation in treatment of thoracolumbar vertebral fractures. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Vertebral pillar

Inter- and intraobserver reliability of the vertebral, local and segmental kyphosis in 120 traumatic lumbar and thoracic burst fractures: evaluation in lateral X-rays and sagittal computed tomographies.

Evaluation of the kyphosis angle in thoracic and lumbar burst fractures is often used to indicate surgical procedures. The kyphosis angle could be measured as vertebral, segmental and local kyphosis according to the method of Cobb. The vertebral, segmental and local kyphosis according to the method of Cobb were measured at 120 lateral X-rays and sagittal computed tomographies of 60 thoracic and 60 lumbar burst fractures by 3 independent observers on 2 separate occasions. Osteoporotic fractures were excluded. The intra- and interobserver reliability of these angles in X-ray and computed tomogram, using the intra class correlation coefficient (ICC) were evaluated. Highest reproducibility showed the segmental kyphosis followed by the vertebral kyphosis. For thoracic fractures segmental kyphosis shows in X-ray "excellent" inter- and intraobserver reliabilities (ICC 0.826, 0.802) and for lumbar fractures "good" to "excellent" inter- and intraobserver reliabilities (ICC = 0.790, 0.803). In computed tomography, the segmental kyphosis showed "excellent" inter- and intraobserver reliabilities (ICC = 0.824, 0.801) for thoracic and "excellent" inter- and intraobserver reliabilities (ICC = 0.874, 0.835) for the lumbar fractures. Regarding both diagnostic work ups (X-ray and computed tomography), significant differences were evaluated in interobserver reliabilities for vertebral kyphosis measured in lumbar fracture X-rays (p = 0.035) and interobserver reliabilities for local kyphosis, measured in thoracic fracture X-rays (p = 0.010). Regarding both fracture localizations (thoracic and lumbar fractures), significant differences could only be evaluated in interobserver reliabilities for the local kyphosis measured in computed tomographies (p = 0.045) and in intraobserver reliabilities for the vertebral kyphosis measured in X-rays (p = 0.024). "Good" to "excellent" inter- and intraobserver reliabilities for vertebral, segmental and local kyphosis in X-ray make these angles to a helpful tool, indicating surgical procedures. For the practical use in lateral X-ray, we emphasize the determination of the segmental kyphosis, because of the highest reproducibility of this angle. "Good" to "excellent" inter- and intraobserver reliabilities for these three angles could also be evaluated in computed tomographies. Therefore, also in computed tomography, the use of these three angles seems to be generally possible. For a direct correlation of the results in lateral X-ray and in computed tomography, further studies should be needed.

Studying the influence of age and short or long segments of pedicle screw instrumentation to the clinical efficacy of early single thoracolumbar fracture

To study the influence of different age and short or long segments of pedicle screw fixation to the clinical efficacy of early single thoracolumbar fracture. From June 2005 to June 2008, 27 patients of early single thoracolumbar fracture were treated using short or long segments pedicle screw instrumentation, fracture vertebral (AO classification: type A1 or A2) was between T11 or L2. All patients were divided into A or B group according to age. A group: 12 cases mean age (32.6+/-10.7) years old (range, 16-55 years old). B group: 15 cases mean age (66.8+/-9.2) years old (range, 56-78 years old). All patients were treated with bony autograft by transpedicular of fracture vertebral and internal fixation by pedicle instrumentation. Pedicle screws were inserted in the pedicles of above and lower adjacent vertebral body of fracture vertebral, and others were inserted in the pedicles of above and lower two vertebral bodies of injured vertebral. Recorded operation time, blood loss and occurrence of complications. All patients took X radiograph plane examination (anterior-posterior position and lateral position) before operation and during 1 week of post operation and more than 1 year of follow up. Measured percentage of anterior compression vertebral high and kyphosis angle of the fracture vertebral by the same one group doctors. Mean follow up time was (29.6+/-9.1) months (range, 10 - 34 months). The patients using short segments pedicle screw fixation in A and B group, mean operation time were (102+/-16) min and (118+/-24) min (P=0.072), mean volume of loss blood were (315+/-87) ml and (331+/-87) ml (P=0.064) respectively. The patients using long segments pedicle screw fixation in A and B group, Mean operation time were (138+/-22) min and (159+/-31) min (P=0.052), Mean volume of loss blood were (446+/-102) ml and (482+/-148) ml (P=0.055) respectively. There was no statistic different significantly between A and B group. The patients using short segments fixation, preoperative, during one week of post operation, one year of follow up, in A group the percentage of anterior compression vertebral high were 41.3+/-14.0, 5.4+/-1.0, 13.6+/-1.1, and 38.5+/-11.2, 8.3+/-2.1, 21.4+/-5.2 in B group. The patients using long segments fixation, at some time of preoperative, during one week of post operation and one year of follow up the percentage of anterior compression vertebral high were 40.8+/-11.5, 4.6+/-1.2, 8.3+/-1.0 in group A, and 44.3+/-10.2, 9.7+/-2.1, 11.2+/-3.0 in group B. In group A and B the kyphosis angle of fracture segment was 17.5 degrees+/-1.0 degrees and 16.3 degrees+/-3.1 degrees before operation, 4.2 degrees+/-1.0 degrees and 6.0 degrees+/-1.1 degrees in one week of postoperation and 11.5 degrees+/-1.0 degrees, 13.4 degrees+/-3.0 degrees in one year later postoperation. All the compression vertebral high was recovered and kyphosis was corrected significantly during one week and one year after operation (P<0.05), but there was some loss of kyphosis correction rate in follow up. There is better clinical efficacy of short segments pedicle instrumentation for treating early thoracolumbar fracture in the young group, but long segments fixation of pedicle instrumentation is more suitable for the older group.

Closed reduction and levering manipulation in vertebroplasty

Objective To discuss the effects of closed reduction and levering manipulation on ver-tebral height restoration and kyphosis correction in vertebroplasty for osteoporotic compression fractures. Methods From January 2005 to June 2007, a total of 38 patients with osteoporotic vertebral compression fractures were treated with vertebroplasty. In closed reduction, a transfixion pin was used to lever the collapsed vertebral endplate through the pedicle. Before and after surgery, pain relief and functional improvement were evaluated using a visual analogue scale (VAS) and the Oswestry' s disability index (ODI). Changes in ver-tebral height and kyphotic angle and distribution of bone cement in the vertebral body were observed by Lee's method. Results All patients were followed up for 6 to 24 (average, 13.4) months. The average VSA scores were reduced from preoperative 8.6±2.3 to postoperative 3.8±2.6. The average ODI scores reduced from preoperative 64.8% to postoperative 48.7%. The differences were of statistical significance. The average increase in vertebral body height was 5.8 mm anteriorly, 6.6 mm centrally, and 1.0 mm posteriorly. The mean reduction in the kyphosis angle was 9.7 degrees. The percentages of restoration of vertebral height were 54.6% at the anterior border, 58.1% at the center, and 46.5% at the posterior border. The differences were of sta-tistical significance between preoperation and postoperation. Conclusion Closed reduction and levering manipulation is effective in vertebroplasty for osteoporotie vertebral compression fractures. Key words: Osteoporosis; Spinal fractures; Vertebroplasty; Closed reduction

OPEN KYPHOPLASTY FOR MANAGEMENT OF SEVERE OSTEOPOROTIC SPINAL FRACTURES

Osteoporotic compression fractures, which can lead to neurological complications in some cases, are an increasingly frequent occurrence. These lesions require decompression surgery with or without spinal stabilization procedures. In this article, we present the preliminary results obtained using open kyphoplasty, a new method of treating vertebral compression disorders. Sixteen patients were included in this prospective study, and a total of 17 vertebrae were treated. All of the patients had vertebral compression fractures associated with neurological disorders. The surgical treatment consisted of open kyphoplasty after laminectomy and decompression. Short-segment vertebral osteosynthesis was also performed in patients with pronounced local kyphosis. Pain was rated at clinical assessments, and radiological assessments were performed to determine the restored vertebral height and the correction of any local vertebral kyphosis. Analysis of the results obtained using this method showed that vertebral height was significantly improved (P < 0.001) and local kyphosis was significantly reduced (P < 0.001). The mean operating time was 90 minutes. The neurological status of all patients improved; 14 patients recovered completely from their neurological symptoms. The last 2 patients had associated neurological disease but were able to walk. There were 2 superficial postoperative infections. This method for treating severe osteoporotic compression fractures associated with neurological disorders gives successful results and can be used to treat neurological compression fractures while consolidating the vertebral body. Therefore, this less invasive approach seems to be particularly useful for treating compression fractures in the thoracolumbar spine junction in elderly patients who often have comorbidities.