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PubMed2004

Evaluation of a synthetic bone defect test model to aid in the selection of materials for use in vertebral body compression fracture repair.

A synthetic test model was developed to assist in screening injectable cements with a focus on mechanical strength for vertebral body compression fracture repair. The two-part defect model consisted of a polyurethane foam cube to simulate trabecular bone and a defect to which various injectable cements could be introduced. In addition, a finite element analysis model was developed and the results were compared to laboratory testing. Agreement was found between the finite element analysis and test results. Once the finite element analysis model was validated with experimental data, an additional finite element analysis was conducted to study various parameters affecting mechanical performance such as simulated bone and cement stiffness. Finite element analysis models were also created using orthotropic bone properties typical of healthy trabecular bone and were compared to various foam stiffnesses. The foam model was a good in vitro representation of actual trabecular bone found in vertebral bodies and is a valid model to evaluate the mechanical strength of injectable cements for percutaneous vertebral body fracture repair.

Bone Cements↗

PubMed2005

Balloon kyphoplasty is effective in deformity correction of osteoporotic vertebral compression fractures.

STUDY DESIGN: A prospective radiographic analysis of deformity correction during the balloon kyphoplasty procedure. OBJECTIVE: To determine the spontaneous reduction of the deformity in prone position, the subsequent deformity correction by the inflatable bone tamp, and the overall deformity correction after deposition of the cement. SUMMARY OF BACKGROUND DATA: Fracture mobility has been shown to contribute to fracture reduction in vertebroplasty. Spontaneous reduction has not been taken into account in recently published series of balloon kyphoplasty, but it must be considered when performing vertebral augmentation and when reporting and interpreting the significance of vertebral height restoration. METHODS: A consecutive series of 39 osteoporotic vertebral compression fractures were treated in 30 patients. Lateral radiographs were taken and analyzed at six different time points: 1) Preoperative standing. During the kyphoplasty procedure, four consecutive radiographs were obtained: 2) after placing the patient in prone position on the operation table, 3) after inflation of the bone tamp (IBT), 4) after deflation and removal of the IBT, and 5) after deposition of the cement. 6) Standing lateral radiographs were taken after the procedure. All fractures were analyzed for improvement in sagittal alignment (Cobb angle, kyphotic angle, sagittal index, vertebral height), complications, and reduction of pain (VAS). RESULTS: Placement of the patient in prone position displayed a significant spontaneous reduction in deformity of 6.5 degrees +/- 4.1 degrees Cobb angle. Inflation of the IBT demonstrated a further reduction of the fracture and a significant improvement of the Cobb angle of 3.4 degrees compared with baseline prone. After deflation and removal of the IBT and placement of the cement, no significant loss of fracture reduction was seen. Postoperative measurement of the Cobb angle by means of standing radiographs demonstrated a 3.1 degrees significant loss of reduction compared with the intraoperative measurement in prone position after cement application. Cement leaks occurred in 9 of 39 vertebral fractures. All patients subjectively reported immediate relief of their typical fracture pain. The VAS score significantly improved from 8.7 +/- 1.4 before surgery to 2.3 +/- 0.9. CONCLUSION: The restoration of height in kyphoplasty is attributed to dynamic fracture mobility as well as to the expansion of the inserted balloon tamp.

Aged↗

PubMed2005

Vertebroplasty and kyphoplasty for treatment of painful osteoporotic compression fractures.

PURPOSE: To review the pathophysiology of osteoporosis and describe vertebroplasty and kyphoplasty, which are minimally invasive procedures to treat the pain associated with vertebral compression fractures (VCFs). DATA SOURCES: Extensive literature review of osteoporosis, vertebroplasty, and kyphoplasty supplemented by case study and clinical experience in the minimally invasive interventional neuroradiology interventions. CONCLUSIONS: Osteoporosis is a progressive debilitating process that destroys the cancellous bone, weakening the overall integrity and stability of the bone. The loss of bone mass places the individual at increased risk for vertebral body, hip, and wrist fractures. In the past, there was no treatment option to repair vertebral body deformity or instability after osteoporotic VCFs. Management solely relied on the use of nonsteroidal anti-inflammatory drugs, narcotics, muscle relaxants, and/or orthotic bracing to provide pain relief. VCFs alter the stability of the vertebral body and column, and the lack of stabilization can lead to chronic pain syndrome, immobility, pulmonary compromise, progression of spinal deformity, increase in the risk for additional VCFs, and increase in the risk for comorbidities and mortality related to immobility. IMPLICATIONS FOR PRACTICE: Vertebroplasty and kyphoplasty are minimally invasive procedures aimed at pain control, stabilization of the vertebral body, and with kyphoplasty, the ability to provide some correction of deformity with partial restoration of vertebral body height. Providing pain control and stabilization of the vertebral column improves mobility, thus decreasing the potential risks associated with immobility.

Aged↗

PubMed2002

Prevalence of vertebral compression fracture deformity by X-ray absorptiometry of lateral thoracic and lumbar spines in a population referred for bone densitometry.

The presence of a vertebral compression fracture has been demonstrated to be a predictor of future fracture independent of bone mineral density in prospective cohort studies. Fan-beam densitometers are now available that can image the thoracic and lumbar spines and detect deformities consistent with fracture. We report a pilot study of 342 patients referred for bone densitometry who had lateral vertebral imaging performed. Fifty patients (14.6%) of the entire cohort had one or more vertebral deformities identified on lateral vertebral imaging. Seventy-three patients (21.3%) of the entire cohort were 60 or more years of age and had osteopenia by World Health Organization (WHO) criteria (T-score: -1.0 to -2.4 at the spine, total hip, or femoral neck). Twenty of these patients (27.4%) had one or more vertebral deformities. Without identifying prevalent vertebral deformities, these individuals at high risk for fracture may not be offered pharmacologic therapy to reduce fracture risk. Therefore, it may be reasonable to obtain lateral vertebral imaging at least for individuals age > or =60 yr who have mild to moderate bone loss at the spine or hip.

Absorptiometry, Photon↗

PubMed2003

Vertebral compression fractures: manage aggressively to prevent sequelae.

New drugs to treat osteoporosis, along with two new minimally invasive surgical procedures, are important options for preventing vertebral compression fractures and treating severe back pain and disability. However, the mainstay treatments remain cautious use of analgesics, limited bed rest, and physical rehabilitation.

Bone Cements↗

PubMedDate not supplied

Medial oblique compression fracture of the coronoid process of the ulna.

The most widely recognized coronoid fractures have been described as occurring in the coronal plane according to the amount of process detached from the ulna. Over the last few years, we have recognized that the coronoid fracture is a much more complex injury than originally thought. This report calls attention to an oblique, medial compression fracture of the coronoid, a fracture so subtle as to be missed by routine assessment but sometimes associated with joint subluxation or dislocation. The currently accepted classification system based on a simple fracture pattern in the coronal plane may be too simplistic to characterize fractures of the coronoid fully.

Accidental Falls↗

PubMed2004

Multiple thoracic vertebral compression fractures caused by non-accidental injury: case report with radiological-pathological correlation.

We report a 21-month-old boy with multiple contiguous thoracic vertebral compression fractures involving eight vertebral bodies, attributable to non-accidental injury. No subluxation was associated, however, there was extensive injury to the upper cervical and lower lumbar regions of the spinal cord. Anterosuperior beaking, thought to represent a previous injury, was evident in a mid-lumbar vertebra. Clinical examination revealed bilateral retinal hemorrhages and retinoschisis. Death occurred as a result of severe brain edema with bilateral subdural and subarachnoid hemorrhages. Radiological-pathological correlation is presented.

Fatal Outcome↗

PubMed2004

Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients.

To assess the immediate efficacy of percutaneous vertebroplasty (PVP) in relief of pain and improving mobility of patients with vertebral compression fractures (VCF) secondary to osteoporosis, 205 cases (175 patients) underwent 250 percutaneous injections of polymethylmethacrylate (PMMA; unilateral, 247 levels; bilateral, 3 levels) into vertebrae under CT and fluoroscopic guidance for 34 months. Patients were prospectively asked to quantify their pain on a visual analog scale (VAS) before and a day after PVP. The interval to mobilization was recorded in those who were immobilized because of pain and/or bed-rest therapy (115 cases). PVP was technically successful in all patients, with three cases of minimal complications. The mean VAS score available for 196 cases was improved from 7.22+/-1.89 (range, 3-10) to 2.07+/-1.19 (range, 0-10) by PVP. Ninety-four of 115 immobilized cases (81.7%) were mobile by 24 h after PVP, and the mean value was 1.9+/-2.8 days. The incidence of recurrent and new fractures was 15.6% in 4-25 months (mean, 15.3 months). PVP is a safe and effective treatment for relieving the pain associated with osteoporotic VCF and strengthening the vertebrae, avoiding refractures. This therapy leads to early mobilization and avoidance of the dangers of conservative therapy of bed-rest.

Aged↗

PubMed2003

[Preliminary experience with balloon kyphoplasty for the treatment of painful osteoporotic compression fractures].

PURPOSE: To describe the technique and to evaluate the safety and efficacy of percutaneous kyphoplasty as a new treatment in patients with painful osteoporotic vertebral body compression fractures of the lumbar and thoracic spine. MATERIALS AND METHODS: In this prospective study balloon kyphoplasty was performed in 34 consecutive patients (25 females, 9 males; mean age 75 years) with 56 painful osteoporotic vertebral fractures (from T6-L5), of which 22 showed a posterior wall involvement and retropulsion on preoperative CT. The median duration of symptoms was 9.7 weeks. Symptomatic levels were identified by correlating the clinical presentation with MRI, conventional radiographs and CT including bone-densitometry. Pre- and postoperative examinations (radiographs, CT) as well as Karnofsky and visual analogy pain scores (Visual Analog Scale = VAS) were documented and compared to evaluate the success of the procedure. RESULTS: The median Karnofsky score improved from 40 % (pre-) to 70 % (post-treatment). Simultaneously, median pain scores (VAS) decreased from 64 (pre-) to 21 (post-treatment) (p < 0.001). Perioperative morbidity included one transient L2 nerve root bruise. The procedure led to a partial restoration of the height of the vertebral body by reducing the median sagittal index from 11.5(3) to 5(3). In none of our patients, the procedure led to worsening of the fracture-induced narrowing of the spinal canal. Clinically asymptomatic cement leakage occurred in 10 cases, with leakage 4 times into the paraspinal space, 3 times into the spinal canal and 3 times into the disc space. CONCLUSION: Balloon kyphoplasty is a safe and effective procedure. It is applicable even in fractures with posterior wall involvement since it is a low-pressure technique in contrast to vertebroplasty and restores vertebral body height partially. It results in immediate clinical improvement of mobility and pain relief. While short-term results are excellent, follow-up data have to be awaited for the final judgment of this method.

Aged↗

PubMedDate not supplied

Acute versus chronic vertebral compression fractures treated with kyphoplasty: early results.

BACKGROUND CONTEXT: Kyphoplasty, a minimally invasive technique for fracture reduction and stabilization, has been shown to reduce pain and restore vertebral body height in patients with vertebral compression fractures (VCFs). Analyses comparing treatment outcomes of acute versus chronic VCFs have not yet been reported. PURPOSE: To assess whether kyphoplasty results in better clinical outcome and fracture reduction in patients with either acute or chronic VCFs. STUDY DESIGN: A prospective, consecutive cohort study of patients who underwent kyphoplasty between March 2000 and December 2001 to treat osteoporotic VCFs that were either less than 10 weeks old (acute) or more than 4 months old (chronic). Fifteen subacute fractures (treated 10 to 16 weeks after fracture) were excluded from analyses. PATIENT SAMPLE: Eighty-six VCFs in 47 patients (35 female and 12 male) were treated during 55 kyphoplasty procedures. Mean patient age was 74 years (range, 47 to 91). METHODS: Clinical outcomes were determined by comparison of preoperative and postoperative data from patient-reported indexes (pain assessment, pain medication usage and Oswestry Disability Index for Back Pain). Radiographs were assessed as to percent vertebral collapse, vertebral height restoration and local kyphosis correction. RESULTS: By 2 weeks after surgery, 90% of acute and 87% of chronic fractures were associated with pain relief. Narcotic usage decreased and Oswestry scores improved in almost all patients. Mean vertebral body height significantly improved after kyphoplasty (acute: 58% to 86% of estimated normal vertebral height, p< .001; chronic: 56% to 79% of estimated normal vertebral height, p< .001). Restoration to 89% or greater estimated normal vertebral height was achieved in 60% of acute fractures and 26% of chronic fractures. In addition, more acute fractures were reducible (greater than 80% restoration of height lost) compared with chronic fractures (p= .01). After kyphoplasty, less than 10% correction of height lost occurred in 8% of acute fractures and 20% of chronic fractures. Local kyphosis significantly improved after kyphoplasty (mean local Cobb angle: acute, 15 to 8 degrees, p< .001; chronic, 15 to 10 degrees, p< .001). CONCLUSION: Fracture reduction was best achieved in acute fractures. Symptomatic chronic fractures may also remain candidates for kyphoplasty because pain relief and improvement in patient function are reliable and some kyphosis correction can still be achieved in many of these patients.

Acute Disease↗

PubMed1976

Osteoporosis of the slender smoker. Vertebral compression fractures and loss of metacarpal cortex in relation to postmenopausal cigarette smoking and lack of obesity.

A group of thirty-eight women under age 70 who sustained vertebral compression fractures during minor trauma included more postmenopausal smokers than a group of 34 similar women with fractures resulting from major trauma and more than a group of 572 other women. Advanced idiopathic osteoporosis occurring before age 65 was found rarely among nonsmokers. The percent cortical area at the second metacarpal midpoint was measured in 103 white women aged 40 to 49 years, and 208 white women aged 60 to 69 years. In the younger group, no quantitative differences were demonstrated between bones of the obese and the nonobese or between smokers and nonsmokers. In contrast, among the older group, postmenopausal smokers exhibited much more bone loss than did nonsmokers (P less than .001), and nonobese women demonstrated much more bone loss than did obese women, this difference being most striking among smokers.

Adult↗

PubMed2002

Percutaneous vertebroplasty: an emerging therapy for vertebral compression fractures.

Osteoporosis is a debilitating disease that occurs in epidemic proportions in Western societies and has a large economic impact. Percutaneous vertebroplasty is successful in alleviating subacute and chronic pain caused by osteoporotic compression fractures and pathological vertebral fractures from tumor infiltration. The technique is safe and can be performed on an outpatient basis utilizing high-resolution fluoroscopy.

Bone Cements↗

PubMed2003

Cement augmentation of osteoporotic compression fractures and intraoperative navigation: summary statement.

Emerging techniques and technologies in treating spinal disorders appear to be very promising. Vertebroplasty and kyphoplasty are new techniques that have been developed for treating osteoporotic vertebral compression fractures with early promising clinical results. More sophisticated and technically advanced methods of surgical navigation are also being developed as spinal surgery moves toward less invasive or minimally invasive procedures. Cost effectiveness, complication rates, and clinical efficacy need to be better defined to determine the exact role of these emerging techniques and technologies.

Bone Cements↗

PubMed1976

[Remote results of treatment of compression fractures of the calcaneus].

Late results of treatment in fractures of the calcanean bone were studied in 72 patients within the terms from 2 to 11 years. In 41 of these cases a grave compression fracture of the calcanean bone was observed, in 9--there was a damage of both calcanean bones. 37 patients were treated clinically and 4--under outpatient conditions. Skeletal extension was used in 12 patients during 10--25 days, in 3--it was complicated with suppuration. Manual reposition was employed in 19 cases, and it was not used in 6. It is the author's opinion that permanent and one-moment skeletal extension by multiple pins inserted under general aneshesia and roentgeno-telecontrol should be preferred.

Adult↗

PubMed2006

Osteoporotic compression fractures: outcomes after single- versus multiple-level percutaneous vertebroplasty.

PURPOSE: To compare single- and multiple-level percutaneous vertebroplasty (PV) in terms of pain relief, activity level, and analgesic use in patients with osteoporotic vertebral compression fractures (VCFs). MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained, and the study was HIPAA compliant. One hundred seventy-three patients (mean age at treatment, 73.8 years +/- 11.9 [standard deviation]) with 422 symptomatic osteoporotic VCFs underwent 204 treatment sessions for over 4 years. Pain immediately before and after PV was measured by using a visual analogue scale (VAS). Pain degree, activity level, and analgesic use were assessed at 2 weeks and 1, 3, 6, 12, and 24 months after PV by using telephone interview questionnaires. Data were analyzed by using a combination of paired t tests, analysis of variance, contingency tables, and chi2 tests. RESULTS: Findings of 172 PV treatment sessions for 149 patients (mean age at treatment, 73.4 years +/- 12), 110 (74%) of whom were women, were assessed; 32 treatment cases were lost to follow-up or lost owing to death. A single fracture level was treated at 65 sessions; two fracture levels, at 52 sessions; and three or more fracture levels, at 55 sessions. The mean VAS pain score decreased significantly (P < .001), from 76 +/- 21 before to 19 +/- 27 immediately after PV. Of the outcomes reported at 24 months, 82% (64 of 78 treatment sessions) were marked to complete resolution of the initial pain, 51% were complete cessation of analgesic use, and 51% were increased activity levels. These results did not differ greatly over time or when stratified into groups according to the number of fracture levels treated. CONCLUSION: PV performed at a single fracture level and that performed at multiple fracture levels were equally effective in facilitating long-term pain relief, increased activity level, and decreased analgesic use in patients with osteoporotic VCFs.

Aged↗

PubMed2002

Vertebral body compression fracture after removal of pedicle screws: a report of two cases.

While the risks of pedicle screw insertion are well established, there is a paucity of reports on complications associated with implant removal. We report two cases of acute osteoporotic vertebral compression fractures of the instrumented vertebral body adjacent to the fractured vertebra due to removal of pedicle screws in two female patients previously treated for vertebral lumbar burst fractures. Both patients had experienced only mild occasional pain at the thoracolumbar junction prior to the removal of the implants. In the formerly almost asymptomatic individuals, the acute osteoporotic fractures led to persistent severe back pain despite prolonged intensive treatment. Patients must be thoroughly informed of the rare but potential risks of spinal implant removal, particularly in cases of osteoporosis. We therefore do not recommend removal of spinal implants unless there are clear clinical indications for implant removal.

Back Pain↗

PubMed2002

Acute vertebral body compression fractures: discrimination between benign and malignant causes using apparent diffusion coefficients.

Diffusion weighted MRI was performed on patients with acute vertebral body compression. The usefulness of the apparent diffusion coefficient (ADC) in differentiating between benign and malignant fractures was evaluated. A total of 49 acute vertebral body compression fractures were found in 32 patients. 25 fractures in 18 patients were due to osteoporosis, 18 fractures in 12 patients were histologically proven to be due to malignancy, and 6 fractures in 2 patients were due to tuberculosis. Signal intensities on T(1) weighted, short tau inversion recovery (STIR) and diffusion weighted images were compared. ADC values of normal and abnormal vertebral bodies were calculated. Except for two patients with sclerotic metastases, benign acute vertebral fractures were hypointense and malignant acute vertebral fractures were hyperintense with respect to normal bone marrow on diffusion weighted images. Mean combined ADCs (ADC(cmb); average of the combined ADCs in the x, y and z diffusion directions) were 0.23 x 10(-3) mm(2) s(-1) in normal vertebrae, 0.82 x 10(-3) mm(2) s(-1) in malignant acute vertebral fractures and 1.94 x 10(-3) mm(2) s(-1) in benign acute vertebral fractures. The differences between ADC(cmb) values were statistically significant (p<0.001). The ADC is useful in differentiating benign from malignant acute vertebral body compression fractures, but there may be overlapping ADC values between malignant fractures and tuberculous spondylitis.

Acute Disease↗

PubMed1989

[The effect of the group and individual characteristics of the vertebrae on their strength in experimental compression fractures].

The authors give an account of their investigation into the strength characteristics of the vertebrae preparations depending on a number of geometric characteristics of the vertebral bodies, the biological state of the bone tissue (osteoporosis, degenerative and dystrophic changes) and their group belonging. A number of factors has been revealed in some parameters of which it is possible to determine the dynamics of the state of the support function of the injured segment in the modelling of compressive fractures of the vertebral bodies. The results obtained by the authors allow to specify the literature data concerning the strength properties of the compressed vertebral body.

Biomechanical Phenomena↗