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PubMedDate not supplied

Radiological follow-up of new compression fractures following percutaneous vertebroplasty.

The purpose of the present study was to ascertain chronological changes in the analgesic effects of percutaneous vertebroplasty (PVP) on osteoporotic vertebral compression fractures and to radiologically follow new compression fractures after PVP. Seventy-six patients (206 vertebral bodies) were followed radiologically for a mean of 11.5 months. A visual analog scale (VAS; 0-10) was used to assess pain severity, and frontal and lateral plain radiographs of the thoracic and lumbar vertebrae were taken 1-3 days and 1, 4, 10, and 22 months after PVP. The average VAS score was 7.2 +/- 2.0 (mean pain score +/- standard deviation) before PVP, 2.5 +/- 2.3 at 1-3 days after PVP, 2.2 +/- 2.3 at 1 month, 1.9 +/- 2.2 at 4 months, 1.8 +/- 2.4 at 10 months, and 1.0 +/- 0.2 at 22 months. A new compression fracture was confirmed in 56 vertebral bodies in 28 patients (36.8%), affecting 38 adjacent vertebral bodies (67.8%), 17 nonadjacent vertebral bodies (30.4%), and 1 treated vertebral body (1.8%). A new compression fracture occurred within 1 week of PVP in 2 vertebral bodies (3.6%), between 1 week and 1 month after PVP in 22 (39.3%), between 1 and 3 months in 12 (21.4%), between 3 and 6 months in 12 (21.4%), and after more than 6 months in 8 (14.3%). PVP was highly effective in relieving the pain associated with osteoporosis-induced vertebral compression fractures, and this analgesia was long lasting. Radiological follow-up observation revealed new compression fractures in about one-third of patients. More than half of these new compression fractures occurred in adjacent vertebral bodies within 3 months of PVP.

Contrast Media↗
PubMedDate not supplied

Minimally invasive treatment of osteoporotic vertebral body compression fractures.

BACKGROUND CONTEXT: Seven hundred thousand osteoporotic compression fractures occur yearly. Approximately 260,000 lead to severe pain, and 150,000 require hospital admissions. Associated with the fractures are increased loss of pulmonary function (90% decreased forced vital capacity per fracture level) and an increase in gastrointestinal complications (early satiety, and therefore malnutrition) and increased mortality (greater than that associated with osteoporotic hip fractures). New treatments available for these painful disorders include kyphoplasty and vertebroplasty. The injections of polymethylmethacrylate into the vertebrae (vertebroplasty technique) decrease pain and improve function. Kyphoplasty (percutaneous placement of a balloon tamp to improve height and create a void, and then the filling of this void with cement) improves function, decreases pain and helps realign the spine. PURPOSE: To compare kyphoplasty and vertebroplasty, and assess their various merits, treatment indications, and outcomes. STUDY DESIGN/SETTING: Literature review with presentation of early results of a national, clinical study. METHODS: Literature review for overview. Retrospective chart/patient review for clinical data presented on kyphoplasty. RESULTS: Ninety-five percent of individuals treated for painful osteoporotic compression fractures have significant improvement in symptoms and function after kyphoplasty or vertebroplasty. Kyphoplasty improves vertebral body height and kyphotic alignment by 50%, if performed within 3 months of the onset of the fracture collapse. CONCLUSIONS: Vertebroplasty and kyphoplasty both have roles in the treatment of painful osteoporotic compression fractures. Only kyphoplasty helps improve height and kyphosis, which should help prevent pulmonary and gastrointestinal complications.

Humans↗
PubMed1988

Osteoporosis and fracture patterns. A study of split-compression fractures of the lateral tibial condyle.

The initial radiographs of 42 split-compression fractures of the lateral tibial condyle were studied. The breadth of the wedge-shaped fragments, measured at the level of the articular surface, was found to decrease with increasing severity of osteoporosis. Ranks were assigned to the breadths and average ranks to the grades (low ranks for normals). Spearman's rank correlation co-efficient was -0.507, which is significant at the 1% level. The length of the fragments showed a similar decrease with advancing bone loss. Rank correlation with the degree of osteoporosis was -0.393, which is significant at the 5% level. These results support the hypothesis that the fracture pattern depends on the changes in bony architecture which results from osteoporosis.

Adult↗
PubMed1997

Vertebral compression fractures in multiple myeloma. Part I. Distribution and appearance at MR imaging.

PURPOSE: To study the appearance and distribution of vertebral compression fractures on magnetic resonance (MR) images in patients with multiple myeloma. MATERIALS AND METHODS: Two hundred twenty-four vertebral compression fractures were studied on 216 sagittal T1-weighted spin-echo and T2*-weighted gradient-echo MR images of the thoracolumbar spine obtained before and during treatment in 37 patients with multiple myeloma. Vertebral compression fractures observed at diagnosis and during follow-up were determined as being benign- or malignant-appearing at MR imaging according to literature criteria, and their distribution along the spine was recorded. RESULTS: One hundred forty-nine (67%) of the 224 vertebral compression fractures appeared benign; 75 (33%) appeared malignant. Of the 37 patients, 14 (38%) had only benign-appearing vertebral compression fractures at diagnosis. One hundred five fractures (87%) were observed between T-6 and L-4, and 112 (50%) occurred between T-11 and L-3. Eight (4%) vertebral compression fractures involved the upper three thoracic vertebrae. CONCLUSION: Most vertebral compression fractures in patients with multiple myeloma appear benign at MR imaging, and their distribution is similar to that observed in osteoporotic fractures. The possibility of multiple myeloma should not be excluded in patients with benign-appearing vertebral compression fractures at MR imaging.

Adult↗
PubMedDate not supplied

Biomechanical changes after the augmentation of experimental osteoporotic vertebral compression fractures in the cadaveric thoracic spine.

BACKGROUND CONTEXT: Osteoporotic compression fractures are an important public health concern, leading to significant morbidity, mortality and economic burden. Cement augmentation procedures used to treat these fractures alter the biomechanics of the fractured segment, which could promote adjacent failure. However, if alignment is improved or restored, there will be less risk of adjacent failure. PURPOSE: To determine the effects of load (compression/flexion), adjacent vertebral location (superior/inferior) and augmentation on vertebral segment stiffness and adjacent vertebral strain in the upper and lower thoracic spine. STUDY DESIGN: Human cadaveric thoracic spine segments were tested under load control before and after the creation of experimentally augmented vertebral compression fractures. METHODS: Six T1-T5 and six T8-T12 segments were obtained from eight thoracic spines with known bone mineral density (BMD). Rosette strain gauges were applied to T2, T4, T9 and T11 to measure strain adjacent to the experimental fracture sites T3 and T10. Two compression fractures were created in succession, the first in flexion preceded by a weakening defect in T3 and T10 and the second created in an adjacent vertebra in compression without prior weakening. The first fracture was reduced with the inflatable bone tamp (IBT) and augmented with cement. Compression and flexion tests were performed before and after the first fracture while measuring vertebral cortical shear strain on T2, T4, T9 and T11 and stiffness of the entire segment. Strain and stiffness were compared by using a repeated measures analysis using adjacent vertebral location (superior/inferior), augmentation and load (compression/flexion) as factors. RESULTS: The mean BMD was 0.61+/-0.11 g/cm(2) (T1-T5) and 0.78+/-0.07 g/cm(2) (T8-T12). Stiffness in compression and flexion increased with load (p<.05, and p>.27, respectively). Augmentation reduced compressive and bending stiffness (p=.23, and p=.19, respectively), whereas the adjacent vertebral strain increased (p>.11). The adjacent strain in flexion was much greater than in compression (p<.03). Cement augmentation caused greater amounts of inferior than superior adjacent strain (p>.19). The applied moment at first fracture was 2.98+/-1.28 Nm (T1-T5) and 8.44+/-1.02 Nm (T8-T12). The compressive load at second fracture was 1122+/-993 N (T1-T5) and 2906+/-1008 N (T8-T12). Adjacent vertebral strain during the second compression and flexion tests exceeded that during the first compression and flexion tests (p=.11). Adjacent vertebral strain at second fracture exceeded that at first fracture (p=.007) and was greater on the superior adjacent vertebra than the inferior (p=.47). CONCLUSION: With axial compressive loads, the addition of flexion increases fracture risk. Cement augmentation of a fractured vertebral segment reduces stiffness while increasing both the superior and inferior adjacent cortical strain. This increment in strain that is greatest on the inferior adjacent vertebra effectively redistributes loads from the superior adjacent vertebra to the inferior adjacent vertebra, sparing the superior adjacent vertebra from failure.

Adult↗
PubMed1993

Association of osteoporotic vertebral compression fractures with impaired functional status.

PURPOSE: To determine if vertebral compression fractures in elderly women were associated with impairments in physical, functional, and psychosocial performance. SUBJECTS AND METHODS: Ten white women with confirmed vertebral compression fractures were age- and race-matched with 10 control subjects without fractures in a case-control design. All subjects invited to participate in this study were patients of the Geriatrics Division of the Department of Medicine at Duke University Medical Center. All study participants lived either in the community or in the independent-living sections of local retirement communities in and around Durham, NC. Subjects with fractures (mean age = 81.9 years, SD = 5.9 years) had two or more vertebral compression fractures in their medical records, whereas control subjects (mean age = 79.6 years, SD = 6.5 years) had no history of vertebral fractures. Spinal radiographs of all women confirmed group assignment. Physical, functional, and psychosocial performances were evaluated. Physical performance was assessed by measurements of maximal trunk extension torque and thoracic and lumbar spinal motion in the sagittal plane, functional reach, mobility skills, 10-ft timed walk, and 6-minute walk test. Thoracic and lumbar spinal configurations were also determined. Functional performance was assessed using the Functional Status Index. Psychosocial performance was assessed with the following scales: Hopkins Symptom Checklist 90 Revised, Rosenberg Self-Esteem Scale, West Haven-Yale Pain Inventory, Beck Depression Inventory, and single-item health-belief questions. RESULTS: Control subjects were not significantly different from patients with fractures in age, weight, number of current illnesses, number of prescribed medications, number of pain medications, ratings of lumbar spine degenerative disc disease, or lumbar spine facet joint arthritis. Activity levels and exercise participation were similar in both groups. Control subjects had no vertebral fractures, whereas fracture subjects had 4.2 +/- 2.6 fractures (range: 2 to 10). Thoracic kyphosis was increased and lumbar lordosis was reduced in fracture subjects. Fracture subjects had reduced maximal trunk extension torque, thoracic and lumbar spine sagittal plane motion, functional reach, mobility skills, and 6-minute walk test. The Functional Status Index showed reduced levels of functional performance in fracture subjects compared with controls with increased levels of assistance, pain with activity, and difficulty in activities. Psychosocial performance was limited in fracture subjects with increased psychiatric symptoms, increased pain, and greater perception of problems caused by health. CONCLUSION: Vertebral compression fractures are associated with significant performance impairments in physical, functional, and psychosocial domains in older women.

Activities of Daily Living↗
PubMedDate not supplied

Osteoporotic compression fractures of the spine; current options and considerations for treatment.

BACKGROUND CONTEXT: Vertebral compression fractures affect at least one-fourth of all postmenopausal women. The most significant risk factor is osteoporosis, most commonly seen among Caucasian women a decade or so after menopause. Osteoporosis typically results from inadequate accumulation of bone mass during childhood and early adulthood followed by rapid resorption after menopause. Primary treatment of osteoporosis includes consideration of underlying metabolic abnormalities and provision of supplemental calcium/vitamin D in conjunction with bisphosphonates or calcitonin, or both. Routine hormone replacement therapy has fallen out of favor because of concerns regarding adverse effects identified in long-term follow-up studies. Acute osteoporotic vertebral compression fracture management includes bracing, analgesics, and functional restoration. Patients with chronic pain beyond 2 months may be appropriate candidates for vertebral body augmentation, ie, vertebroplasty or balloon tamp reduction. Open surgical management with decompression and stabilization should be reserved for the rare patient with neural compression and progressive deformity with neurologic deficits. PURPOSE: To review current principles in the evaluation and treatment of osteoporotic compression fractures of the spine. STUDY DESIGN/SETTING: A literature review on management of the osteoporotic spine. METHODS: MEDLINE search of all English-language literature published between 1981 and 2005 on surgical and nonsurgical treatment of the osteoporotic spine. The references selected for listing at the conclusion of this review are those containing specific information cited within the text. RESULTS: Over 200 separate scientific and clinical studies addressing the epidemiology, pathophysiology, diagnosis, and treatment of osteoporotic vertebral compression fractures were reviewed. CONCLUSIONS: Osteoporotic vertebral compression fractures are a common presenting complaint to spinal care specialists. Thorough differential diagnosis should be considered before attributing fractures to osteoporosis. Appropriate evaluation and medical treatment of underlying osteoporosis should be recommended or instituted. Nonsurgical management of the spinal fracture should focus on pain control and maximizing functional outcome. The role of surgical treatment remains controversial and should be reserved for patients who fail initial nonsurgical management options.

Bone Density Conservation Agents↗
PubMed2006

Gadolinium-enhanced magnetic resonance imaging after percutaneous vertebroplasty does not improve the short-term prediction of new compression fractures.

PURPOSE: To investigate the relationships between contrast-enhanced magnetic resonance imaging (MRI) findings and new compression fractures occurring after percutaneous vertebroplasty (PVP) in order to determine the necessity of contrast-enhanced MRI. MATERIAL AND METHODS: The material comprised 13 consecutive patients (27 vertebrae) with compression fractures who underwent vertebroplasty. Twenty-nine adjacent vertebrae were monitored for new compression fractures. We performed contrast-enhanced MRI within the 5 days following PVP. RESULTS: The 29 adjacent vertebrae displayed 10 enhanced lesions and 19 vertebral bodies without enhancement-unenhanced lesions on MRI within the 5 days after PVP. In 4 out of 10 vertebrae, enhanced lesions were seen within the 5 days after PVP, but no abnormalities were seen on preoperative MRI. In these 4 vertebrae, new compression fractures were seen within the 1 month following PVP. In the other 6 vertebrae, enhanced lesions were seen within the 5 days after PVP, and these signal changes were detected by preoperative MRI in the same area. In 3 of these 6 vertebrae, new compression fractures occurred at 4, 8, and 9 months after PVP, respectively. However, all of the enhanced lesions were detectable on unenhanced MRI, which was conducted at the same time as enhanced MRI. CONCLUSION: New compression fractures after PVP may be predicted with early postoperative MRI. Contrast-enhanced MRI does not improve detection of the new lesions.

Aged↗
PubMedDate not supplied

Distribution of anterior cortical shear strain after a thoracic wedge compression fracture.

BACKGROUND CONTEXT: Vertebral compression fractures (VCFs) are a common clinical problem and may follow trauma or be pathological. Osteoporosis increases susceptibility to fracture by reducing bone mass and weakening bone architecture. Approximately 2.5 million osteoporotic fractures occur worldwide annually, usually involving the vertebrae, wrist and hip. In the United States 700,000 VCFs occur annually, causing significant morbidity, mortality and economic burden. An initial VCF often leads to subsequent VCFs. The strain distribution along the anterior cortex, the major load-bearing pathway in flexion, may be predictive of impending VCF. Regions of high strain distribution are likely to experience secondary fracture. PURPOSE: To investigate the distribution of anterior cortical strain at, above and below an experimentally created index VCF to determine the vertebral body at risk of secondary fracture. STUDY DESIGN: In vitro experimental study using cadaveric thoracic spinal segments. METHODS: Seventeen thoracic spines underwent dual-energy X-ray absorptiometry (DEXA) to assess bone mineral density and were divided into T1-T3 (Subsegment 1), T4-T6 (Subsegment 2), T7-T9 (Subsegment 3) and T10-T12 (Subsegment 4). Rectangular rosette strain gauges were applied to the anterior cortices of the vertebrae of each subsegment (vertebrae in each specimen were denoted V1-superior, V2-intermediate and V3-inferior). V1 and V3 were partially embedded into polyester resin blocks, which were used to mount the specimens in a materials testing machine. Nondestructive predefect testing was performed in compression at 125 N and 250 N, followed by flexion at 1.25 Nm and 2.5 Nm. To ensure fracture reproducibility, V2 of each specimen had a trabecular defect created to a volume of 21.3+/-4.4% of the V2 centrum. Postdefect nondestructive compression and flexion were then performed in a manner similar to the predefect tests, followed by destructive testing in flexion. Anterior cortical shear strain on V1, V2 and V3, applied moments and applied flexion angle were all measured and analyzed. RESULTS: A VCF occurred in 55 of the 59 subsegments. Fifty-one VCF (93%) were seen in V2 and 4 VCF (7%) were seen in V1. After the creation of the trabecular defect, the shear strain on V2 increased, but a comparison of the postdefect with the predefect nondestructive tests showed no significant differences. The pre- and postdefect shear strain distribution in compression and flexion was V1strain>V3strain>V2strain. Shear strain at failure was highest on V2, and in all subsegments there were significant differences between V2 and V3 (p<.05). In all subsegments there were no significant differences between V2 and V1 (p>.05) at failure with the exception of Subsegment 1 where V2 and V1 were significantly different (p<.05). The predominant strain pattern at failure was (V2strain>V1strain>V3strain V2strain>>V3strain). Using shear strain as the codeterminant of peak moment with bending stiffness and applied angle at failure, the strain on V1 was the greatest predictor (p=.0084; R2=0.78). These findings suggest that the events leading to a secondary fracture probably start before the index VCF occurs and continue with loading beyond the index VCF. CONCLUSION: Anterior cortical strain is concentrated at the apex of a thoracic kyphotic curve. The vertebral body immediately above the index VCF has the next highest amount of strain and therefore the highest risk of secondary fracture.

Absorptiometry, Photon↗
PubMed2001

Initial outcome and efficacy of "kyphoplasty" in the treatment of painful osteoporotic vertebral compression fractures.

STUDY DESIGN: An Institutional Review Board-approved Phase I efficacy study of inflatable bone tamp usage in the treatment of symptomatic osteoporotic compression fractures. OBJECTIVES: To evaluate the safety and efficacy of inflatable bone tamp reduction and cement augmentation, "kyphoplasty," in the treatment of painful osteoporotic vertebral compression fractures. SUMMARY OF BACKGROUND DATA: Osteoporotic compression fractures can result in progressive kyphosis and chronic pain. Traditional treatment for these patients includes bed rest, analgesics, and bracing. Augmentation of vertebral compression fractures with polymethylmethacrylate, "vertebroplasty," has been used to treat pain. This technique, however, makes no attempt to restore the height of the collapsed vertebral body. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps into the vertebral body. Once inflated, the bone tamps restore the vertebral body back toward its original height while creating a cavity that can be filled with bone cement. PATIENTS AND METHODS: Seventy consecutive kyphoplasty procedures were performed in 30 patients. The indications included painful primary or secondary osteoporotic vertebral compression fractures. Mean duration of symptoms was 5.9 months. Symptomatic levels were identified by correlating the clinical data with MRI findings. Perioperative variables and bone tamp complications or issues were recorded and analyzed. Preoperative and postoperative radiographs were compared to calculate the percentage height restored. Outcome data were obtained by comparing preoperative and latest postoperative SF-36 data. RESULTS: At the completion of the Phase I study there were no major complications related directly to use of this technique or use of the inflatable bone tamp. In 70% of the vertebral bodies kyphoplasty restored 47% of the lost height. Cement leakage occurred at six levels (8.6%).SF-36 scores for Bodily Pain 11.6-58.7, (P = 0.0001) and Physical Function 11.7-47.4, (P = 0.002) were among those that showed significant improvement. CONCLUSIONS: The inflatable bone tamp was efficacious in the treatment of osteoporotic vertebral compression fractures. Kyphoplasty is associated with early clinical improvement of pain and function as well as restoration of vertebral body height in the treatment of painful osteoporotic compression fractures.

Aged↗
PubMed2002

Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes.

PURPOSE: Osteoporotic vertebral compression fractures may cause debilitating pain that lasts for weeks or months, and which is often neither quickly nor completely relieved by conventional conservative therapy. Previous retrospective studies have suggested significant and nearly immediate pain relief, as well as rapid and sustained functional recovery, after percutaneous polymethylmethacrylate vertebroplasty (PPV). This prospective, quantitative study with long-term follow-up was designed to evaluate the safety and efficacy of PPV as a new treatment for patients with osteoporotic vertebral body compression fractures of the lumbar and thoracic spine. MATERIALS AND METHODS: PPV was performed in 30 patients with 54 symptomatic osteoporotic vertebral compression fractures who had a less-than-satisfactory response to conventional therapy. All procedures were performed by a single operator with significant experience in performing PPV. The Musculoskeletal Outcomes Data Evaluation and Management Scale (MODEMS) spinal intervention questionnaire, which includes the SF-36, was administered to all patients before intervention and exactly 2 weeks after the final PPV procedure. Pain and disability, treatment expectations and satisfaction, mental function, and quality of life were evaluated by four specialized modules, and responses to questionnaires preceding treatment were compared to those obtained at follow-up. Results of a long-term follow-up questionnaire were collected 15-18 months after the final vertebroplasty treatment. RESULTS: Our population consisted of three men and 27 women, with a mean age of 79 years. Fifty-four PPV procedures were performed for compression fractures in these 30 patients. Significant postprocedural improvement in all four MODEMS modules was demonstrated at 2 weeks (treatment score, P <.0001; pain and disability, P <.0001; physical function, P =.0004; and mental function, P =.0009). A small epidural leak of polymethylmethacrylate in one patient was asymptomatic and did not require intervention. At long-term follow-up (15-18 mo), 22 of 23 patients responding remained satisfied with the outcome of therapy and believed that the procedure had provided durable pain relief. Verbal pain scores documented significantly diminished back pain at 2 weeks (P <.0001) and again at long-term follow-up when compared to baseline (P <.0001). CONCLUSIONS: PPV is a safe and efficacious procedure for the relief of pain and disability after osteoporotic vertebral compression fractures. Patient satisfaction is high and persists when compared to preprocedural expectations; durable pain relief is provided.

Aged↗
PubMed2004

Closed reduction vertebroplasty for the treatment of osteoporotic vertebral compression fractures. Technical note.

The purpose of this study was to determine the efficacy and feasibility of closed reduction vertebroplasty for the treatment of osteoporotic vertebral compression fractures. Two hundred consecutive patients (183 women and 17 men) with single-level osteoporotic vertebral compression fracture were included in this study. After induction of general anesthesia, the patient was placed prone on an operating table. Closed reduction of the fractured and kyphotic spine was achieved by extending the table to restore the kyphotic angle and vertebral body (VB) height. Percutaneous vertebroplasty was then performed to treat the fractured vertebra. The results were quantitatively evaluated, according to the concept of estimated VB height. The anterior, middle, and posterior VB heights of the fractured vertebra were measured preoperatively and immediately after surgery by studying plain standing lateral radiographs. In 162 (81%) of the compression fractures the anterior VB height was restored (57.1 +/- 24.8% of lost anterior VB height); in 152 (76%) of the compression fractures the middle VB height was restored (61.4 +/- 20.6% of lost middle VB height); and in 52 (26%) of the compression fractures the posterior VB height was restored (51.3 +/- 23.1% of lost posterior VB height). In 141 (71.5%) of the compression fractures kyphosis was corrected by 12.5 +/- 3.8 degrees [mean 61.6 +/- 23.7%]). Closed reduction vertebroplasty is an efficacious and simple method in the treatment of osteoporotic vertebral compression fracture and was able to restore the VB height and kyphotic angle in postions of fractured vertebrae. Its associated, long-term effects on treated vertebrae, however, need further evaluation.

Aged↗
PubMed2003

Quantitative assessment of diffusion abnormalities in benign and malignant vertebral compression fractures by line scan diffusion-weighted imaging.

OBJECTIVE: Acute vertebral collapse is common, and it is sometimes difficult to determine whether the cause is benign or malignant. Recently, diffusion-weighted imaging has been reported to be useful for differentiating the two types. The purpose of this study was to evaluate diffusion abnormalities quantitatively in benign and malignant compression fractures using line scan diffusion-weighted imaging. SUBJECTS AND METHODS. Line scan diffusion-weighted imaging was prospectively performed in 17 patients with 20 acute vertebral compression fractures caused by osteoporosis or trauma, in 12 patients with 16 vertebral compression fractures caused by malignant tumors, and in 35 patients with 47 metastatic vertebrae without collapse. Images were obtained at b values of 5 and 1,000 sec/mm(2). The apparent diffusion coefficient (ADC) was measured in vertebral compression fractures and metastatic vertebrae without collapse. RESULTS: The ADC (mean +/- SD) was 1.21 +/- 0.17 x 10(-3) mm(2)/sec in benign compression fractures, 0.92 +/- 0.20 x 10(-3) mm(2)/sec in malignant compression fractures, and 0.83 +/- 0.17 x 10(-3) mm(2)/sec in metastatic vertebral lesions without collapse. The ADC was significantly higher in benign compression fractures than in malignant compression fractures (p < 0.01), although the two types showed considerable overlap. CONCLUSION: Although the quantitative assessment of vertebral diffusion provides additional information concerning compressed vertebrae, the benign and malignant compression fracture ADC values overlap considerably. Therefore, even a quantitative vertebral diffusion assessment may not always permit a clear distinction between benign and malignant compression fractures.

Aged↗
PubMed2001

Gray ramus communicans nerve block: novel treatment approach for painful osteoporotic vertebral compression fracture.

BACKGROUND: Osteoporotic vertebral compression fracture (OVCF) is a common complication of osteoporosis in the aging population. Refractory chronic pain may develop, and few effective treatment options exist. METHODS: We retrospectively analyzed 52 cases in which gray ramus communicans nerve block was used for painful OVCF after failure of conservative analgesic therapy. All were office-based, fluoroscopically guided procedures; a combination of 2% lidocaine and 2% sterile triamcinolone diacetate (Aristocort) was injected on the gray ramus tract of the somatic nerve root corresponding with radiographically documented OVCF. Patient-reported and physician-reported pain scores, analgesic medication use, and overall patient satisfaction were measured. The average follow-up period was 9 months. RESULTS: A 1-point improvement in pain scores was reported by 92% of patients and 88% of physicians; a 4-point improvement was reported by 63% and 58%, respectively. No patients reported increased pain scores; physicians reported increases in two cases. Decreased analgesic requirement was documented in 42%. Patient satisfaction was "high" in 50% and "medium" in 25%. No procedural complications occurred. CONCLUSION: Prompt and sustained improvements in all parameters, especially pain scores, support widespread clinical application of this safe effective and cost-effective therapy.

Aged↗
PubMedDate not supplied

Biomechanical evaluation of kyphoplasty with calcium sulfate cement in a cadaveric osteoporotic vertebral compression fracture model.

BACKGROUND CONTEXT: Vertebral compression fractures can cause deformity, pain, and disability. Kyphoplasty involves percutaneous insertion of an inflatable balloon tamp into a fractured vertebra followed by injection of polymethylmethacrylate (PMMA) bone cement. PMMA has several disadvantages such as potential thermal necrosis and monomer toxicity. Calcium sulfate cement (CSC) is nontoxic, osteoconductive, and bioabsorbable. PURPOSE: To evaluate the biomechanical performance of CSC for kyphoplasty in cadaveric osteoporotic vertebral bodies. STUDY DESIGN: Destructive biomechanical tests using fresh cadaveric thoracolumbar vertebral bodies. METHODS: Thirty-three vertebral bodies (T9 to L4) from osteoporotic cadaveric spines were disarticulated, stripped of soft tissue, and measured for height and volume. Each vertebral body was compressed at 0.5 mm/s using a hinged plating system on a materials testing machine to create an anterior wedge fracture and reduce the anterior height by 25%. Pretreatment strength and stiffness were measured. Two KyphX inflatable balloon tamps were used to reexpand each vertebral body. After randomization, three groups were created: Group A-no cement; Group B-PMMA; Group C-calcium sulfate cement. Groups B and C were filled with the corresponding cement to 25% of the vertebral body volume. All vertebral bodies were then recompressed by 25% of the post-kyphoplasty anterior height to obtain posttreatment strength and stiffness. RESULTS: Treatment with PMMA restored vertebral strength to 127% of the intact level (4168.2 N+/-2288.7) and stiffness to 70% of the intact level (810.0 N/mm+/-380.6). Treatment with CSC restored strength to 108% of the intact level (3429.6 N+/-2440.7) and stiffness to 46% of the intact level (597.7 N/mm+/-317.5). CSC and PMMA were not significantly different for strength restoration (p=.4). Significantly greater strength restoration was obtained with either PMMA or CSC, compared with the control group (p=.003 and .03, respectively). Stiffness restoration tended to be greater with PMMA than for CSC, but this difference was not statistically significant (p=.1). Both cements had significantly greater stiffness when compared with the control group (p=.001 and p=.04, respectively). CONCLUSIONS: Use of CSC for kyphoplasty yields similar vertebral body strength and stiffness as compared with PMMA. It may be a useful alternative bone cement for kyphoplasty. Further studies are required to assess the bioabsorption of CSCs after kyphoplasty in vivo.

Aged↗