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PubMed2002

[Differentiation of benign osteoporotic and neoplastic vertebral compression fractures with a diffusion-weighted, steady-state free precession sequence].

PURPOSE: To evaluate the diagnostic accuracy of a diffusion-weighted, steady-state free precession (SSFP) sequence for the differentiation of acute benign osteoporotic and neoplastic vertebral compression fractures. METHODS: 85 patients with 102 vertebral compression fractures were examined with MR imaging using a spine array surface coil (Siemens, Vision, 1.5 Tesla). The following sequences were performed in sagittal orientation: T1-weighted spin echo (SE), short-tau inversion recovery (STIR) and a diffusion-weighted SSFP sequence (TR = 25 msec, diffusion pulse length delta = 3 msec). The SSFP images were evaluated qualitatively on a 5-grade scale from strongly hypointense to strongly hyperintense. Quantitative analysis was performed with region of interest measurements (ROI) and calculation of a bone marrow ratio. RESULTS: 60 fractures were due to osteoporosis and 42 fractures were caused by malignancy. "Hyperintensity" in a vertebral fracture on a SSFP sequence provided a sensitivity of 100 % and a specificity of 93 %. The positive predictive value was 91 %, the negative predictive value was 100 %. Quantitative analysis of the bone marrow ratio showed a statistically significant difference between the osteoporosis and the tumor group (p < 0.001). The mean value for the osteoporotic fractures was - 0.32 (SD 0.33) and + 2.07 (SD 1.37) for the tumor group. CONCLUSION: The SSFP sequence provides a high accuracy in the differentiation of benign osteoporotic and neoplastic vertebral compression fractures.

Adult↗
PubMed2006

Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts.

We present the clinical and radiological results of percutaneous vertebroplasty in the treatment of 58 vertebral compression fractures in 51 patients at a minimum follow-up of two years. Group 1 consisted of 39 patients, in whom there was no associated intravertebral cleft, whilst group 2 comprised 12 patients with an intravertebral cleft. The Oswestry disability index (ODI) and visual analogue scale (VAS) scores were recorded prospectively. The radiological evidence of kyphotic deformity, vertebral height, leakage of cement and bone resorption around the cement were studied retrospectively, both before and after operation and at the final follow-up. The ODI and VAS scores in both groups decreased after treatment, but the mean score in group 2 was higher than that in group 1 (p = 0.02 (ODI), p = 0.02 (VAS)). There was a greater initial correction of the kyphosis in group 2 than in group 1, although the difference was not statistically significant. However, loss of correction was greater in group 2. Leakage of cement was seen in 24 (41.4%) of 58 vertebrae (group 1, 32.6% (15 of 46); group 2, 75% (9 of 12)), mainly of type B through the basal vertebral vein in group 1 and of type C through the cortical defect in group 2. Resorption of bone around the cement was seen in three vertebrae in group 2 and in one in group 1. There were seven adjacent vertebral fractures in group 1 and one in group 2. Percutaneous vertebroplasty is an effective treatment for osteoporotic compression fractures with or without an intravertebral cleft. Nonetheless, higher rates of complications related to the cement must be recognised in patients in the presence of an intravertebral cleft.

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PubMed2006

Void filling of tibia compression fracture zones using a novel resorbable nanocrystalline hydroxyapatite paste in combination with a hydroxyapatite ceramic core: first clinical results.

INTRODUCTION: It is a generally accepted standard surgical practice to fill-in the metaphyseal defect zones resulting from the reduction of tibia compression fractures. The development of various innovative bone substitutes is also currently on the increase. MATERIALS AND METHODS: In our prospective study, we used Ostim, a novel resorbable nanocrystalline hydroxyapatite paste, together with Cerabone, a solid hydroxyapatite ceramic, in combination with angularly stable osteosynthesis to treat 24 tibia compression fractures. Types B2 and B3, as well as types C2 and C3 fractures, according to the AO classification, were included in the study. RESULTS: The mean total range of joint motion in terms of flexion and extension was improved from the immediate postoperative value of 79 +/- 14 degrees to 97 +/- 13 degrees at 6 weeks after surgery, to 109 +/- 16 degrees at 3 months, and finally to 118 +/- 17 degrees at 1 year. In three patients, a delayed wound healing was observed as a local complication. CONCLUSION: The use of the Ostim and Cerabone combination is an effective method in treating tibia compression fractures with large defect zones left after reduction.

Absorbable Implants↗
PubMed2006

[Percutaneous vertebroplasty for vertebral compression fracture].

BACKGROUND: Percutaneous vertebroplasty has become an option for the treatment of painful osteoporotic compression fractures in patients in whom conservative medical management has failed. AIM: This paper assessed the effectiveness and safety of percutaneous vertebroplasty in patients with focal pain caused by compression vertebral body fractures. MATERIALS AND METHODS: Over a twenty-five-month period 63 patients underwent percutaneous vertebroplasty, and ten of these patients were subsequently retreated, for a total of 73 operations on 93 vertebrae. The patients were affected by osteoporotic compression fractures (n=57) or by benign or malignant infiltrative processes (n=6). All patients were examined at discharge and thereafter to assess the level of pain and investigate possible changes in the quality of life. The mean length of follow-up was 15.2 months. RESULTS: After treatment, almost 90% of patients reported complete disappearance or significant alleviation of the pain. In 7 of 63 of the patient (11%) there were small asymptomatic leakages of cement outside the vertebral body. A substantial number of patients with osteoporosis, 19% of the study population, experienced new fractures following treatment with vertebroplasty. DISCUSSION: Our experience confirms the effectiveness of vertebroplasty to pain caused by vertebral fractures. If the indications are strictly followed, improvement of symptoms is often immediate, allowing the return of mobility, and patient satisfaction with surgery is higher. The use of appropriate systems limits the number of complications.

Activities of Daily Living↗
PubMed2004

Minimally invasive treatment of osteoporotic vertebral compression fracture.

BACKGROUND: The use of percutaneous vertebroplasty (PV) to treat osteoporotic vertebral fractures is increasing. This investigation assesses the efficacy and safety of PV for refractory pain owing to osteoporotic vertebral compression fractures. METHODS: A retrospective investigation of PV was conducted with a minimal of 1 year follow up. PV with polymethylmethacrylate (PMMA) was performed on 75 patients with osteoporotic vertebral compression fractures that responded poorly to the conservative therapy. Patients were asked to quantify their degree of pain using Huskisson's visual analogue scale to assess the clinical results. RESULTS: Eighty-seven vertebrae treated using PV in 70 patients were evaluated with a minimal of 1 year follow up. Pain, as assessed on the VAS, decreased from 80+/-16 mm before PV to 36+/-28 mm at 1 month after PV and 30+/-19 mm at the most recent follow up. The reduction in pain from the baseline to 1 month (p=0.031) and to final follow up (p=0.023) were both statistically significant. Sixty-two patients (85.5%) quickly returned to their pre-injury activity level and achieved better quality of life. CONCLUSIONS: PV is effective in pain reduction for painful vertebral compression fractures. It provided significant pain relief. Skillful techniques and careful safeguards can minimize the risks of PMMA migration.

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PubMed2001

Percutaneous transpedicular polymethylmethacrylate vertebroplasty for the treatment of spinal compression fractures.

OBJECTIVE: To assess the safety, feasibility, and clinical outcome of percutaneous transpedicular polymethylmethacrylate vertebroplasty (PTPV) for the treatment of spinal compression fractures causing refractory pain. METHODS: We retrospectively reviewed a consecutive group of patients undergoing PTPV at our institution between April 1998 and January 2001. Outcome measures included analgesic requirements, ambulatory status, sleep comfort, and overall quality of life 2 weeks after the procedure. RESULTS: A total of 97 patients (73 women and 24 men) underwent 258 PTPV procedures during 133 treatment sessions. The mean age was 76 years (range, 42-99 yr). The mean duration of follow-up was 14.7 months (range, 2-35 mo). Most of the patients had osteoporotic compression fractures, although some had osteolytic malignancies. Complete follow-up was obtained in 81 patients (84%). Narcotic and analgesic usage decreased in 63% of patients, increased in 7%, and remained the same in 30%. Ambulation and mobility were improved in 51%, worse in 1% and the same in 48%. One-half of the patients were able to sleep more comfortably after the procedure, whereas the other half remained the same. Most patients who reported no change in sleep or ambulation had experienced no impairment of these activities before PTPV. Overall, 74% of patients believed that PTPV significantly enhanced their quality of life and 26% reported no change. No patient was worse after PTPV. One patient with preexisting pneumonia died of respiratory failure after the procedure; another died of an acute stroke weeks later. One patient developed symptomatic pulmonary embolism of cement, and another developed transient quadriceps weakness from radiculopathy. Other complications were minor and infrequent. There were no infections. CONCLUSION: PTPV provided significant relief in a high percentage of patients with refractory pain. PTPV is a safe and feasible treatment for patients with spinal compression fractures.

Adult↗
PubMed2007

Case report: vertebral compression fracture in a fused and instrumented lumbar segment.

Although vertebral fractures in fused spinal segments have been reported, we are not aware of any descriptions of vertebral body compression fractures in solidly fused and instrumented segments. We report a patient who sustained a vertebral-body compression fracture of the L1 vertebra in an instrumented and fused spinal segment from T10 to L5. The fracture occurred during self-insertion of a rectal suppository. No intervention was required to treat the fracture, and there was no long-term clinical effect.

Aged↗
PubMed2003

[Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: first short term results].

OBJECTIVE: To describe the technique of percutaneous vertebroplasty and the short-term results in patients with symptomatic, osteoporotic vertebral compression fractures. DESIGN: Prospective follow-up study. METHOD: In a pilot-study to evaluate the short-term safety and effectiveness of percutaneous vertebroplasty, 18 consecutive patients with a total of 33 osteoporotic thoracic or lumbar vertebral compression fractures were treated from October 2001 to June 2002 with a follow-up of 3-6 months. The indication for treatment was a symptomatic, therapy-resistant osteoporotic vertebral compression fracture. Percutaneous vertebroplasty was performed under radiographic control, after previous intraossal venography, using bone cement mixed with barium sulphate. Post-procedural follow-up consisted of radiological evaluation with conventional thoracolumbar X-rays and MRI scans, and interviews of the patients. RESULTS: Percutaneous vertebroplasty was technically successful in 31 of 33 vertebral fractures (94%), and in 16 of 18 patients (89%). One patient with extreme venous contrast leakage could not be treated. Sixteen patients had less or no pain after treatment. One patient retained thoracolumbar back pain after inadequate cementations and refused further treatment. None of the patients reported aggravation of symptoms following the procedure. Contrast leakage was absent in 18 vertebrae. In 8 vertebrae there was contrast leakage to paravertebral veins. In three of these cases the leakage was so severe that embolisation was performed, with success in one case. In 13 vertebrae, cement leakage to intervertebral and paravertebral spaces and pedicular cement spurs were seen, without clinical consequences. Immediately after the procedure and during follow-up there were no clinically relevant complications. CONCLUSION: Percutaneous vertebroplasty was a technically feasible treatment in these patients with symptomatic, therapy-resistant, osteoporotic vertebral fractures. The first short-term results were comparable with results in the literature. A prospective randomised intervention study will be needed to compare percutaneous vertebroplasty with optimal conservative treatment.

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PubMed2002

Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma.

PURPOSE: We prospectively evaluated the safety and efficacy of kyphoplasty in the treatment of osteolytic vertebral compression fractures resulting from multiple myeloma. The principle symptoms in multiple myeloma result from bone destruction, especially the spine. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps (IBT) into the vertebral body. The purpose of the IBT is to restore the vertebral body back toward its original height, while creating a cavity that can be filled with highly viscous bone cement. PATIENTS AND METHODS: Fifty-five consecutive kyphoplasty procedures were performed in 18 patients with osteolytic vertebral compression fractures resulting from multiple myeloma. Cement leakage and any complications were recorded. Early objective analysis was made by comparing preoperative and latest Short Form 36 Health Survey scores. Height restoration was estimated by measuring vertebral height on lateral radiographs. RESULTS: The mean age of patients was 63.5 years, mean duration of symptoms was 11 months, and mean follow-up was 7.4 months. There were no major complications related directly to use of this technique. On average, 34% of height lost at the time of fracture was restored. Asymptomatic cement leakage occurred at two (4%) of 55 levels. Significant improvement in SF36 scores occurred for Bodily Pain (23.2 to 55.4, P =.0008), Physical Function (21.3 to 50.6, P =.0010), Vitality (31.3 to 47.5, P =.010), and Social Functioning (40.6 to 64.8, P =.014). CONCLUSION: Kyphoplasty was efficacious in the treatment of osteolytic vertebral compression fractures resulting from multiple myeloma. Kyphoplasty is associated with early clinical improvement of pain and function as well as some restoration of vertebral body height.

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PubMed1998

Percutaneous vertebroplasty treatment of steroid-induced osteoporotic compression fractures.

This report describes the case of a woman in whom multiple compression fractures of the lower thoracic and lumbar spine occurred in association with long-term corticosteroid therapy for systemic lupus erythematosus. Pain markedly limited the patient's mobility and daily activities, and conservative therapy with bracing and narcotic analgesics gave little improvement. Affected vertebrae were treated with polymethylmethacrylate, introduced percutaneously under fluoroscopic guidance. The resulting reinforcement of the fractured vertebral bodies eliminated the pain and the need for narcotic analgesics. The utilization of percutaneous verterbroplasty as a therapeutic alternative for the treatment of pain resulting from osteoporotic compression fractures is described.

Adult↗
PubMed2005

Successful treatment of a chronic post-traumatic 5-year-old osteoporotic vertebral compression fracture by percutaneous vertebroplasty.

Osteoporotic vertebral compression fracture (VCF) is a frequently encountered clinical problem associated with chronic pain and disability. Conservative treatment in the form of bed rest, pain control and bracing may create a vicious circle, in which reduced activity leads to further reduction in bone density and fracture risk. Percutaneous vertebroplasty (PVP) is an accepted treatment modality for osteoporotic vertebral body collapse present for less than 1 year, vertebral myeloma, haemangioma, metastasis and recent traumatic fractures (between 3 and 12 months). We describe an osteoporotic patient in whom successful PVP was performed, under general anaesthesia using CT and fluoroscopic guidance, in a post-traumatic 5-year-old VCF with complete alleviation of debilitating pain. In the light of our experience, we suggest that PVP should be carried out in a series of similar patients to asses its value as a treatment option in patients with chronic osteoporotic vertebral fractures for pain relief and improvement in mobility, independent of fracture age.

Back Pain↗