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PubMed2004

Vertebral compression fractures in the elderly.

Compression fracture of the vertebral body is common, especially in older adults. Vertebral compression fractures usually are caused by osteoporosis, and range from mild to severe. More severe fractures can cause significant pain, leading to inability to perform activities of daily living, and life-threatening decline in the elderly patient who already has decreased reserves. While the diagnosis can be suspected from history and physical examination, plain roentgenography, as well as occasional computed tomography or magnetic resonance imaging, are often helpful in accurate diagnosis and prognosis. Traditional conservative treatment includes bed rest, pain control, and physical therapy. Interventional procedures such as vertebroplasty can be considered in those patients who do not respond to initial treatment. Family physicians can help patients prevent compression fractures by diagnosing and treating predisposing factors, identifying high-risk patients, and educating patients and the public about measures to prevent falls.

Activities of Daily Living↗

PubMed2006

Percutaneous vertebroplasty in the therapy of osteoporotic vertebral compression fractures: a critical review.

Percutaneous vertebroplasty has become an efficient technique for the treatment of painful vertebral fractures. Osteoporotic vertebral compression fractures are characterized by severe back pain and immobilization causing other complications like thrombosis or pneumonia. Vertebral cement augmentation provides increased strength of the vertebral body and an obvious pain relief. Between 1989 and 2004, 30 studies and a total of 2,086 treated patients have been published in literature. A review of these studies has been performed. The number and age of the patients, number of treated vertebrae, pre- and postoperative outcome of pain and complications of the different studies were assessed and analyzed. Percutaneous vertebroplasty is an efficient technique with low complication rates and a significant reduction in pain. It rapidly improves the mobility and quality of life of patients with vertebral compression fractures. With an increasing number of treated patients, experience with this interventional technique has become excellent. But still there are no randomized controlled trials available, showing that percutaneous vertebroplasty has a significantly better outcome than other treatment options, especially after a long-term follow-up.

Adult↗

PubMed2005

Treating osteoporotic and neoplastic vertebral compression fractures with vertebroplasty and kyphoplasty.

BACKGROUND: Compression fractures are common in patients with osteoporosis and cancer. In particular, vertebral compression fractures are crippling, and pose an additional risk of cord compression. Although a number of nonmedical options such as bracing and exercise programs may help these patients, the combination of constant, severe pain and spinal instability was until recently almost invariably synonymous with painful gradual deterioration and a poor quality of life. Vertebroplasty, and more recently kyphoplasty, are minimally invasive procedures that aim at limiting or reversing painful collapse of the vertebrae, while providing stability to the treated segment of the spine. As these new options are highly effective and involve minimal risk, it is important that physicians be familiar with them. OBJECTIVE: This paper reviews the demographics of vertebral compression fractures, both osteoporotic and neoplastic, the technical aspects of vertebroplasty and kyphoplasty, and current results and outcomes. RESULTS: Pain relief rates in excess of 90% have been reported with both vertebroplasty and kyphoplasty in patients with vertebral compression fractures. Procedural complication rates should be very low, in the 1%-2% range at most with proper technique. CONCLUSIONS: Until the advent of vertebroplasty, almost no effective therapeutic option could be offered to patients suffering from neoplastic or osteoporotic vertebral compression fractures, which are relatively common and often crippling. The technical feasibility of these procedures is high, the risk low, and the effectiveness high. Therefore, it is important that physicians consider vertebroplasty and kyphoplasty as viable and strong options.

Fractures, Compression↗

PubMed2006

Acute vertebral compression fractures in patients with multiple myeloma: evaluation of vertebral body edema patterns on MR imaging and the implications for vertebroplasty.

The presence of edema on MR imaging is a common finding in acute or subacute vertebral body compression fractures. Compression fractures can present in patients with benign osteoporosis, metastases, multiple myeloma, or hemangiomas. We present 2 patients with multiple myeloma who had symptomatic acute and subacute compression fractures documented on imaging studies without associated edema on MR imaging evaluation.

Bone Cements↗

PubMed1994

[Pathomorphology, stability and classification of wedge compression fractures of the thoracolumbar spine].

Compression fractures with anterior wedging of the vertebral body are the most frequent fractures of the thoraco-lumbal spine. As yet, there is no fracture classification that has achieved general clinical acceptance. A classification is presented that defines fractures as A, B, and C types, according to their pathomorphology and mechanical stability. The main types are subdivided into A1-A2, B1-B2 and C1-C2. The A fractures incorporated a compression lesion of the anterior column with minimal or moderate loss of anterior height of the vertebral body. An intact intervertebral disc defines the A1 lesion. With loss of disc function through disc rupture into the fractured body, the vertebral segment is biomechanically destabilized and the lesion is classified as A2. The B-type wedge compression fracture defines a disc and bone lesion of the anterior column with severe wedging combined with a distraction lesion of the posterior column involving mostly ligaments. Not infrequently, the middle column presents with a dorso-cranial wall fragment, which may be dislocated into the spinal but without endangering the cord. Isolated lesions of the anterior and posterior columns are considered B1 lesions. B2 lesions incorporate an additional stable osseous lesion of the middle column. Wedge compression fractures of the C type are mechanically and neurologically unstable three-column lesions producing cord compression by way of dislocated fragments of the dorso-cranial vertebral body, which compromises the spinal canal. C1 fractures are like B fractures in the degree of severity of the anterior and posterior column lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗

PubMed2003

Interdisciplinary approach to balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures.

Osteoporotic vertebral compression fractures (VCFs) are associated with a series of clinical consequences leading to increased morbidity and even mortality. Early diagnosis and therapeutic intervention is desirable in order to remobilise patients and prevent further bone loss. Not all fractures are, however, sufficiently treatable by conservative measures. Here, vertebroplasty and kyphoplasty may provide immediate pain relief by minimally invasive fracture stabilisation. In cases of acute fractures, kyphoplasty has the potential to reduce kyphosis and restore the normal sagittal alignment of the spine. The complex nature of systemic osteoporosis, coupled with the intricate biomechanics of vertebral fractures, leads to a clinical setting which is ideally treated interdisciplinarily by the rheumatologist and spine surgeon.

Aged↗

PubMed2003

Percutaneous treatment of osteoporotic spinal compression fractures.

Osteoporotic spinal compression fractures are a significant health risk for elderly females, as well as other patient groups. These fractures are associated with an increased risk of mortality in comparison with age-matched controls. Recent techniques of minimally invasive surgical treatment show promising early results with respect to pain reduction and restoration of function, with low procedural complication rates.

Aged↗

PubMed1993

[Effect of soft tissue injuries on the biomechanics of sagittally symmetric thoracolumbar vertebral compression fractures].

Thoracolumbar compression-fractures were performed in an in-vitro model with a deformity of 9.7 degrees and 12.3 degrees. After stabilisation of the fracture additional soft tissue injuries were carried out by dissection of the posterior ligaments and ruptures of the nucleus and annulus of the intervertebral disc. The disc injuries led to a significant instability. The degree of kyphotic deformation showed the most distinct influence on torsion with an increase in range of motion of 64% (9.7 degrees) versus 181% (12.3 degrees).

Biomechanical Phenomena↗

PubMedDate not supplied

Percutaneous vertebroplasty--initial clinical experience in osteoporotic and myelomatous compression fractures.

BACKGROUND: To review the clinical impact of vertebroplasty in osteoporotic and myelomatous compression fractures METHODS: Eleven compression fractures in eight patients were treated by percutaneous cement vertebroplasty over a three-year period, May 2000 to May 2003. RESULTS: Successful percutaneous stabilisation and cement injection was performed in all compression fractures. In five of eight patients (eight of eleven compression fractures) injection of cement yielded dramatic reduction in pain within 24 hours of the procedure. CONCLUSION: Preliminary experience suggests that percutaneous cement vertebroplasty is an effective well tolerated method of stabilisation of spinal wedge compression fractures resulting in dramatic reduction in associated pain in most cases.

Administration, Cutaneous↗

PubMed2002

Percutaneous vertebroplasty in the management of osteoporotic vertebral compression fractures: initial experience.

INTRODUCTION: Vertebral compression fractures related to osteoporosis may cause persistent pain which impairs mobility and reduces the quality of life. Percutaneous vertebroplasty is a therapeutic interventional radiology procedure which is used in the management of pain relief in such fractures. It involves the injection of bone cement [polymethylmethacrylate (PMMA)] into the collapsed vertebrae under radiological guidance. This provides pain relief as well as increases the strength and stability of the vertebra. MATERIALS AND METHODS: A total of 16 patients with 17 osteoporotic compression fractures which were treated with percutaneous vertebroplasty over an 18-month period were studied. There were all women with the exception of 1 male patient. Their ages ranged from 61 to 87 years. The fracture sites were at the thoracolumbar junction from T12 to L3 levels. The majority of cases only required a unipedicular injection, with bipedicular injections in 3 cases. All cases were performed in the angiographic suite in the radiology departments, with biplanar fluoroscopy in one hospital. PMMA was injected in a semi-solid state under radiological guidance and screening into the collapsed vertebrae. RESULTS: All cases showed good technical success with no mortality or major complications. Only 2 cases had minor complications of cement leakage into the soft tissues of the back and adjacent disc space, respectively. There was sufficient pain relief in all patients and they were well enough to be discharged within 1 to 5 days after the procedure. Patients were followed up to evaluate the degree of long-term pain relief as well as analgesic usage. CONCLUSION: Percutaneous vertebroplasty is a new and minimally-invasive modality of treating pain in patients with osteoporotic compression fractures who are refractory to medical therapy. Under adequate imaging guidance, the risks of complications are minimal while the potential benefit to patients and their care-givers are significant.

Aged↗

PubMedDate not supplied

Percutaneous vertebroplasty improves pain and physical functioning in elderly osteoporotic vertebral compression fracture patients.

BACKGROUND: Osteoporotic vertebral compression fractures are being recognized increasingly often in the elderly. They frequently cause severe and prolonged back pain and physical decline. Bed rest, narcotic analgesia, and external bracing were the only therapeutic modalities available in the past and had limited success. OBJECTIVE: The purpose of our study was to determine the efficacy of percutaneous vertebroplasty in treating osteoporotic vertebral compression fractures in the elderly. METHODS: Twenty-two vertebroplasties were performed in 16 elderly patients. Pain relief, medication requirements, and physical functioning were evaluated before and 24 h and 6 months after vertebroplasty. RESULTS: There was 81% improvement in pain intensity 24 h after operation, and 94% improvement was noted at the 6-month follow-up checkup. Physical functioning improved 69% 24 h after vertebroplasty and 63% 6 months later. Medication requirements also decreased in 75% of the patients. CONCLUSION: Percutaneous vertebroplasty for osteoporotic vertebral compression fractures is safe and effective and should not be withheld from the elderly.

Administration, Cutaneous↗

PubMed2002

Blood perfusion of vertebral lesions evaluated with gadolinium-enhanced dynamic MRI: in comparison with compression fracture and metastasis.

PURPOSE: To investigate blood perfusion of vertebral lesions using dynamic Gd-DTPA-enhanced MRI. MATERIALS AND METHODS: Dynamic MR studies were performed for cases of acute compression fracture, chronic compression fracture, metastatic vertebral lesions with or without compression fracture. A total of 42 patients (71 vertebral segments) were included. Five types of time-intensity curves (TICs) were defined as: nearly no enhancement (type A), slow enhancement (type B), a rapid contrast wash-in followed by an equilibrium phase (type C), a rapid contrast wash-in followed by early wash-out (type D), and a rapid contrast wash-in with a second slower-rising slope (type E). RESULTS: Metastatic vertebral lesions with or without fracture had a higher peak enhancement percentage and steeper enhancement slope than those of chronic compression fracture, but had no difference as compared to those of acute compression fracture. The type D curve had high positive predictive value for metastatic group (100%), and the type E curve had high positive predictive value for benign compression fracture (85.7%). CONCLUSION: Type D and E curves are valuable in the differentiation of benign and malignant vertebral lesions.

Adult↗

PubMed1992

[Indications, technique and results of monosegmental dorsal spondylodesis in wedge compression fractures (grade II) of the thoracolumbar spine].

The management of wedge compression fractures of the thoracolumbar spine remains a controversial subject. Although there is an increasing tendency for operative intervention of spinal injuries, non-operative treatment of compression fracture has been the method of choice. The compression fracture is a fracture occurring during compressive forces of the anterior column due to flexion mechanisms. The more severe the compressive fracture, the more likely it will be to present, in an addition to anterior wedging, a failure of the posterior column indicating tension forces at that level. These fractures, defined as mechanically unstable and classified as compression fractures Grade II, are concentrated in the thoracolumbar region. Between June 1987 and July 1990 14 patients with compression fractures Grade II were treated posteriorly with one level internal fixation. Of the 14 patients, 9 had stabilization with plates and cerclage wire, 5 with an internal fixator. All patients received a localized fusion. In order to permit a more reliable analysis of the results of our stabilizing procedures, a comparison was made with a series of 11 cases with equivalent fractures treated non-operatively between 1986 and 1989. At clinical and radiographic follow-up evaluation, the results in the operative group were much more favourable, both subjective and objective, than in the non-operative group. We derive from these results that in thoracolumbar compression fractures Grade II, posterior one level stabilization and fusion is a recommendable surgical procedure.

Adult↗

PubMed2006

Vertebroplasty - a new treatment for vertebral compression fractures.

BACKGROUND: The lifetime risk of a vertebral body compression fracture is 16% for women and 5% for men. Vertebroplastyn involves the injection of artificial bone cement and an opacifier into the inter-trabecular marrow space of the fractured vertebra. OBJECTIVE: This article describes vertebroplasty as a treatment of vertebral compression fractures. DISCUSSION: Treatment for vertebral compression fractures regardless of aetiology has been largely conservative and directed toward pain control. Vertebroplasty has gained popularity since 1987 for treatment of vertebral compression fractures. Vertebroplasty is a safe, effective, and cost effective procedure when performed in an appropriate technical environment by adequately trained interventional radiologists.

Bone Cements↗

PubMed2006

Classification of symptomatic osteoporotic compression fractures of the thoracic and lumbar spine.

The pathophysiology of osteoporotic compression fractures is different from those occurring secondary to traumatic spinal injury, and currently, there is no classification suitable for symptomatic osteoporotic compression fractures treated by percutaneous vertebroplasty. We propose a new classification based on the radiological appearance in the subacute or chronic stage of the clinical presentation of these fractures. They are classified by the authors based on observations and measurements from preoperative and postoperative dynamic lateral radiographs. Compression fractures are divided into two types. Type I is a compression fracture involving the anterior column only. Type II is a fracture involving both the anterior and middle column. Each type is divided into two groups: fractures with union and those with non-union. Type II compression fractures have a higher incidence of non-union than type I (p<0.05). In both type I and II non-union groups, fractures achieve greater increase in vertebral body height after vertebroplasty than both type I and type II union group fractures (p<0.05). In both non-union groups, fractures achieved a greater reduction of kyphotic angle post-vertebroplasty than type I and II union group fractures (p<0.05). Further clinical follow-up of these patients will confirm and extend this classification.

Body Weight↗

PubMed1990

Prevalence of vertebral compression fractures due to osteoporosis in ankylosing spondylitis.

OBJECTIVE: To determine the prevalence of vertebral compression fractures due to osteoporosis in patients with ankylosing spondylitis. DESIGN: Prospective study of 111 consecutive patients; patients with vertebral compression fractures were entered into a case-control study. SETTING: Outpatient clinic at the centre for rheumatic diseases, Glasgow. PATIENTS: 111 Consecutive patients with ankylosing spondylitis. Patients with compression fractures were matched for age and sex with two controls selected from the rest of the group. Patients with biconcave vertebral fractures were also studied. MAIN OUTCOME MEASURES: Assessments of spinal deformity and mobility and analysis of lateral radiographs of spines for presence of syndesmophytes. RESULTS: Fifteen patients with compression fractures and five with biconcave fractures were studied. Compared with the controls the patients with compression fractures had increased formation of syndesmophytes in the lumbar spine, whereas those with biconcave fractures had increased formation throughout the spine. Patients with compression fractures also had a greater degree of spinal deformity (distance from wall to tragus 24.5 cm v 12.7 cm in controls), less spinal mobility (20 v 45.6 degrees of flexion), and reduced chest expansion (2 cm v 3cm). CONCLUSION: Vertebral compression fractures due to osteoporosis are a common but frequently unrecognised complication of ankylosing spondylitis and may contribute to the pathogenesis of spinal deformity and back pain.

Adolescent↗

PubMed1998

Diffusion-weighted MR imaging of bone marrow: differentiation of benign versus pathologic compression fractures.

PURPOSE: To evaluate the usefulness of diffusion-weighted magnetic resonance (MR) imaging of bone marrow for differentiating between benign and pathologic vertebral compression fractures. MATERIALS AND METHODS: Thirty patients with 39 vertebral compression fractures were examined with MR imaging. Diffusion-weighted MR imaging was performed with a steady-state free precession sequence in 22 acute benign osteoporotic and/or traumatic fractures and 17 pathologic compression fractures. Biplanar radiographs, T1-weighted spin-echo (SE) MR images, and short inversion time inversion-recovery (STIR) MR images were available for all patients. The signal intensity characteristics were analyzed qualitatively and quantitatively (bone marrow contrast ratios and signal-to-noise ratios) for all sequences. RESULTS: At diffusion-weighted MR imaging, all benign vertebral compression fractures were hypo- to isointense to adjacent normal vertebral bodies. Pathologic compression fractures were hyperintense to normal vertebral bodies. Benign vertebral fractures had negative bone marrow contrast ratios at diffusion-weighted imaging, whereas pathologic vertebral fractures had positive values (P < .001). The difference in bone marrow contrast ratios for benign and pathologic compression fractures at T1-weighted SE and STIR imaging was not significant (P > .01). CONCLUSION: Diffusion-weighted MR imaging provided excellent distinction between pathologic and benign vertebral compression fractures.

Adult↗

PubMed2003

Kyphoplasty--minimally invasive vertebral compression fracture repair.

OSTEOPOROSIS is a skeletal disorder that compromises bone strength, predisposing a person to an increased risk of fracture. An estimated 700,000 spinal fragility fractures, such as vertebral compression fractures, directly related to osteoporosis occur annually. KYPHOPLASTY, a minimally invasive fracture reduction procedure, has become a treatment option for osteoporotic fractures. A balloon is used in place of the conventional bone tamp to reduce the fracture and create a void in cancellous spinal bone. Polymethylmethacrylate, a cement-like material, is injected into the void to stabilize the fracture. EARLY DIAGNOSIS AND TREATMENT of vertebral compression fractures with kyphoplasty allows normal anatomy to be restored, ultimately decreasing the risk of patient morbidity.

Bone Cements↗