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PubMed1981

Prevertebral hematoma in cervical spine injury: incidence and etiologic significance.

In a consecutive series of 30 hospitalized cervical injury patients, 18 proved to have widening of the prevertebral soft tissue space due to hematoma. The upper limit of normal width in 50 noninjury patients was used as a reference. Hematoma almost exclusively manifested at C1-C4 and proved to be closely related to fractures of anterior elements of the spine. Relatively small hematomas were encountered in odontoid fractures and compression fractures of vertebral bodies; relatively large hematoma in disruptive hyperextension injury. Large hematomas are explained by extensive anterior ligamentous damage with rupture of larger blood vessels. As a rule, most hematomas disappeared within 2 weeks after the injury.

Adolescent↗

PubMed2000

[Thoracolumbar injuries: pathomorphology of and a new classification].

OBJECTIVE: To introduce a new classification of thoracolumbar injuries. METHODS: Three modes were used to classify the injuries according to the mechanisms of injuries: Type A, flexion-compression fractures; Type B, vertical compression fractures; Type C, distraction injuries. Two groups were used to distinguish the fractures in one type according to the pathomorphological differences and the clinical incidence: Group A, with a more clinical incidence, and Group B, with a less clinical incidence. Three subgroups were used to divide the injuries in one group in consideration of the severity of the fracture instability and the fracture displacement: fracture, subluxation, and dislocation. RESULTS: A new classification of thoracolumbar fractures was established. CONCLUSION: The new classification is more systemic and more convenient.

Humans↗

PubMed1992

[The role of CT in diagnosis and therapy of fractures of the pelvic girdle].

The conventional pelvic overview and special projections of the pelvic ring are often not conclusive for the diagnosis of pelvic ring fractures. The superimposition of multiple bony and soft tissue structures interfere with correct three-dimensional orientation of the bony lesions in spite of special projections. CT offers the possibility of identifying pelvic fractures that are not visible in conventional radiographs. Dislocated fractures can especially be appreciated. With CT, it was possible for the first time to classify lesions of the sacroiliac joint: (I) distortion (vacuum phenomena), (II) rupture of the ventral sacroiliac ligaments (open book), (III) lesions of the ventral and dorsal sacroiliac ligaments, and (IV) luxation of the os sacrum. Lesions of the sacrum can also be classified into four groups: (I) diastasis of the sacroiliac joint, (II) sacral lip fractures, (III) vertical fractures and compression fractures, (IV) comminuted fractures. Above all, the CT scan facilitates an accurate examination of the dorsal pelvic ring. Furthermore, better appreciation of intrapelvic soft tissue lesions is possible. In a retrospective study on 53 patients, in 88.7% we had quite helpful and extremely helpful CT examinations, and 90% higher precision in comparison to conventional radiographs.

Female↗

PubMed2006

Vertebral augmentation complicated by perioperative addisonian crisis.

BACKGROUND: We describe a case of perioperative Addisonian crisis induced by vertebral augmentation. While several complications of vertebral augmentation have been reported previously, related to the technical procedure, to our knowledge, perioperative Addisonian crisis from vertebral augmentation has not been reported in the literature. OBJECTIVE: To report an Addisonian crisis perioperative to vertebral augmentation. DESIGN: Case report. METHOD: Retrospective case review. RESULTS: The patient had a history of adrenal insufficiency treated previously with steroids. He developed an L3 vertebral compression fracture, failed conservative therapy and was eventually referred for vertebral augmentation. Immediately after starting the procedure, the patient developed profound hypotension unresponsive to intravenous fluids and vasopressors, consistent with Addisonian crisis. After intravenous steroids had resolved the Addisonian crisis, he underwent vertebral augmentation without further complication. CONCLUSION: Addisonian crisis may be triggered by vertebral augmentation. Practitioners need to recognize immediately this potentially lethal disorder in patients with known or suspected adrenal insufficiency and treat with intravenous hydrocortisone.

Addison Disease↗

PubMed1991

The causes of subsequent arthrodesis of the ankle joint.

Between 1917 and 1984, we performed 217 arthrodesis of the ankle joint. Posttraumatic states were the cause of the osteoarthritis in 153 cases, whereas 118 of these cases were malleolar fractures. The accident X-rays were analyzed, and the fractures were classified in accordance with the classification of Weber (11). Our own system was used for the radiological classification of the degree of arthritis. The extent of malunion after the initial care was assessed. We found type-C malleolar fractures most frequently, the most striking malunion being the shortening of the fibula. In all fractures requiring subsequent arthrodesis, osteoarthritis of degree III-IV was present. In most cases the malleolar fractures treated surgically showed a shortening of the fibula and must be considered failures of initial care. The classification into types according to Weber also seems to provide prognostic information about the subsequent need for arthrodesis. Here it can be observed that C-fractures and compression fractures more often require arthrodeses.

Ankle Injuries↗

PubMed1990

[Intragenicular subchondral fracture. Report of 10 cases].

10 cases of subchondral fracture of femoral condyle or tibial plateau with or without rupture of lateral meniscus were reported. All these fractures were compressive type and were treated by open poking reduction and filling of the remaining defect with cancellous bone. Follow-up for 5 to 9 years of the 10 patients showed that they regained painless stable knee and resumed their previous works. We purposely reviewed genicular radiograms of 100 cases who had knee joint injuries, and found that certain number of them showed depression on articular surfaces of femoral condyles, possibly compressive fractures, which should have been considered more seriously. The essential points of diagnosis and the operative keys of surgery for this kind of injury have been mentioned in the paper.

Adolescent↗

PubMed1990

[Functional treatment of calcaneal fractures].

The authors discuss functional treatment of fractures of the calcaneus. They compare the therapeutic results of the most serious type of these fractures--intraarticular compressive fractures with depression of Böhler's angle, treated in the classical manner by long-term plaster and by the modern method--functional treatment which involves a minimal period of immobilization--general and local--and makes early and intensive rehabilitation possible very soon after the injury. The functional method gives very good results and reduces the period of treatment. By reducing the period of work incapacity it is an asset for the national economy.

Adult↗

PubMed1989

Ventral spondylodesis: basic method in the treatment of cervical spine injuries.

Ventral spondylodesis or ventrofixation is the most important surgical method for the treatment of severe cervical spine injuries accompanied by instability. Its wide indications include fracture-dislocations, compression fractures of the vertebral body, injuries to the disc, luxations, 'tear drop fractures' as well as "hangman's fractures". The essential parts of its technique: previous reduction by traction, anterior cervical approach, removal of the injured parts of vertebral body and disc(s), replacement by corticocancellous bone graft with subsequent plate-screw fixation. The authors performed in their Institute nearly 100 operations of this type, in a 10-year period of which; detailed account is given. Good results of surgery can be expected only by ensuring adequate technical conditions and professional knowledge, performing the operations in centres having sufficient experience.

Bone Plates↗

PubMed1993

[Stabilization of 150 unstable spinal injuries with the Cotrel-Dubousset instrument--analysis of results].

The present study is a retrospective analysis of spinal fracture treatment with the Cotrel-Dubousset instrumentation technique. 150 unstable injuries of the spine were treated with the CD implant at the University of Louisville--Level I Trauma Center--between February 1985 and March 1989. There were 67 burst fractures, 48 compression fractures and 21 fracture dislocations, 8 flexion distraction fractures and 6 flexion rotation injuries. Ninety-three patients underwent anterior cord decompression and strut grafting followed by posterior CD instrumentation and posterolateral fusion. Fifty-seven patients had posterior CD instrumentation and fusion alone. No neurological deterioration after the procedure was observed, 33 patients improved neurologically. Hospital stay ranged between 7 and 60 days (mean 20 days). 114 patients had a minimum follow up of 6 months (range 6-52 months). The mean follow up was 17.7 months. At final follow up 77.8% of the patients had returned to work and 84.2% of the patients were almost painfree. The mean loss of correction in the sagittal plane was 6.2 degrees (range: 0 and 42 degrees) at final follow up. As technical complications there were four hook cut outs (2.6%) of which two underwent reosteosynthesis and two did not effect the clinical or radiographic result. The high stability of the device provides a decreased risk of neurological deterioration, a decreased risk of posttraumatic kyphosis and early rehabilitation.

Adolescent↗

PubMed2003

Pseudo-Kümmel's disease: a unique application for vertebroplasty.

Compression fractures of the vertebrae are a major public health concern. There are approximately 700,000 compression fractures of the vertebrae diagnosed on an annual basis in the thoracolumbar spine. The etiology of senile osteoporosis is multifactorial with the most significant reason being age-related bone loss. Multiple effects of compression fractures include acute and chronic pain syndromes, inability to perform activities of daily living, insomnia and depression. Conventional treatment concepts relate to immobilization of the spine, medical pain control, bracing of the back and physical therapy. Vertebroplasty was developed in the 1980s as a treatment for painful cervical hemangiomas in France. Vertebroplasty has been utilized since 1993 to treat painful, osteoporotic compression fractures. In 1891, Kümmell described the disease with a posttraumatic osteitis in which patients developed a painful kyphosis after a period of being symptom free. Inferential evidence includes that vertebrae in this disease are being subjected to a form of avascular necrosis with intraosseous vacuum phenomenon. Patients with Kümmell's disease, treated with vertebroplasty, have been reported to do very well. In a patient with an advanced case of vertebrae plana, without so intending, authors placed air into the vertebral body and created so-called pseudo-Kümmell's disease. This case report describes with high risk or extreme vertebroplasty to alleviate symptomatology. It is concluded that as the clinical experience with percutaneous vertebroplasty continues to expand, the approaches to treatment can become more focused on the specific disease state and specific treatment paradigms.

Journal Article↗

PubMed2003

[Vertebroplasty in osteoporotic vertebral compression].

BACKGROUND AND PURPOSE: Osteoporotic vertebral compression fractures are a frequently encountered clinical problem. We aimed to perform a critical, structured review of the current literature and to compare the results with our own experiences. MATERIAL AND METHODS: A structured review of 7 studies about vertebroplasty in osteoporotic compression fractures was performed; each study assessed at least 16 patients and was published in English since 1997. The results were compared to our own experience in 22 patients treated in 2002. RESULTS: Over the past decade, vertebroplasty has increasingly been performed for the treatment of painful osteoporotic vertebral body compression fractures. In good correlation with our own results, all authors reported a significant improvement of pain immediately after treatment and a reduction of pain of up to 90% within 24 h after vertebroplasty. Furthermore, a significant reduction in the use of analgetics and a substantial improvement of functional status has been described in recent studies. In our own evaluation, we were also able to demonstrate a significant improvement of pain after vertebroplasty in 17 of 22 (77%) of our patients. 18 of 22 (82%) patients were able to diminish or even discontinue their analgesic medication. DISCUSSION: Reported results for vertebroplasty have demonstrated a rapid improvement in pain and physical functioning in patients with osteoporotic vertebral compression fractures. Percutaneous vertebroplasty has proven to provide a valuable treatment option for osteoporotic vertebral compression fractures.

Bone Cements↗

PubMed2005

Combination kyphoplasty and spinal radiosurgery: a new treatment paradigm for pathological fractures.

OBJECT: Patients with symptomatic pathological compression fractures require spinal stabilization surgery for mechanical back pain control and irradiation for the underlying malignant process. The authors evaluated a treatment paradigm of closed fracture reduction and fixation involving kyphoplasty and subsequent spinal radiosurgery. METHODS: Twenty-six patients (six men and 20 women, mean age 72 years) with pathological compression fractures (16 thoracic and 10 lumbar) were prospectively evaluated. Histological diagnoses included 11 lung, nine breast, four renal, one cholangiocarcioma, and one ocular melanoma. Seven lesions had received prior external-beam radiation therapy. All patients underwent kyphoplasty that involved the percutaneous transpedicular technique. Fiducial markers allowing for image guidance during CyberKnife treatment were placed, at time of the kyphoplasty, in the pedicles at adjacent levels. Patients underwent single-fraction radiosurgery (mean time after kyphoplasty 12 days) in an outpatient setting. The tumor dose was maintained at 16 to 20 Gy (mean 18 Gy) to the 80% isodose line. The treated tumor volume ranged from 12.7 to 37.1 cm3. No acute radiation-induced toxicity or new neurological deficit occurred during the follow-up period (range 11-24 months, median 16 months). Axial pain improved in 24 (92%) of 26 patients. CONCLUSIONS: The combined kyphoplasty and spinal radiosurgery treatment paradigm was found to be clinically effective in patients with pathological fractures; there was no significant spinal canal compromise. In this technique two minimally invasive surgical procedures are combined to avoid the morbidity associated with open surgery while providing both immediate fracture fixation and administering a single-fraction tumoricidal radiation dose.

Aged↗

PubMed2005

Combination kyphoplasty and spinal radiosurgery: a new treatment paradigm for pathological fractures.

OBJECT: Patients with symptomatic pathological compression fractures require a stabilization procedure for mechanical control of back pain as well as radiation therapy for the underlying malignant process. In this study the authors evaluated a treatment paradigm of closed fracture reduction and fixation in which kyphoplasty was used, followed by single-fraction spinal radiosurgery performed with the CyberKnife. METHODS: Twenty-six patients (six men and 20 women, mean age 72 years) with histologically confirmed pathological compression fractures (16 thoracic, 10 lumbar) were prospectively evaluated. For inclusion in the study, the patients' presenting symptoms were limited to pain without neurological deficits. Histological findings included 11 lung, nine breast, and four renal carcinomas, one cholangiocarcinoma, and one ocular melanoma. All patients underwent kyphoplasty of the affected vertebral body, for which a percutaneous transpedicular procedure was used. Fiducial markers that allow image guidance for CyberKnife radiosurgery were placed into the pedicles at the adjacent levels at the time of the kyphoplasty procedure. Patients then underwent single-fraction radiosurgery (at a mean of 12 days after kyphoplasty) in an outpatient setting. The tumor dose was maintained at 16 to 20 Gy to the 80% isodose line (mean 18 Gy). Treated tumor volume ranged from 12.7 to 37.1 cm3. Axial pain improved in 24 (92%) of 26 patients during the follow-up period of 7 to 20 months. CONCLUSIONS: A combined kyphoplasty and spinal radiosurgery treatment paradigm was found to be safe and clinically effective for patients with pathological fractures without significant spinal canal compromise. This technique combines two minimally invasive surgical procedures, thereby avoiding the morbidity associated with open surgery while providing immediate fracture fixation as well as a single-fraction tumoricidal radiation dose.

Aged↗

PubMed1995

Compression plating of acute femoral shaft fractures.

Although intramedullary fixation has standardized the management of femoral shaft fractures, compression plating may offer a viable alternative. A retrospective review of acute femoral shaft fractures managed by open reduction and compression plating between 1980 and 1987 revealed 71 fractures in 69 patients. There were 58 closed fractures, and six grade I and seven grade II open fractures. All patients received prophylactic antibiotics. Sixty-nine percent of patients were bone grafted. Sixty-six of 71 fractures (93%) healed uneventfully. The average time until union was 16 weeks (range: 23 to 72). Complications included two nonunions, two refractures, and one broken implant (7%). Careful adherence to the principles of prophylactic antibiotics, medial cancellous bone grafting, and meticulous soft tissue technique can significantly reduce the complication rate of compression plating.

Adolescent↗

PubMed2006

Unsuspected lymphoma diagnosed with use of biopsy during kyphoplasty.

BACKGROUND: Vertebral augmentation procedures are currently widely performed to treat vertebral compression fractures. In selecting appropriate patients for these procedures, it is important to distinguish the pain caused by a fracture from other causes of back pain. The purpose of this study was to determine the frequency of underlying, previously unrecognized malignant tumors in a consecutive series of patients undergoing kyphoplasty to treat vertebral compression fractures. Our hypothesis was that an unsuspected malignant tumor will exist and that a bone-marrow aspiration from the iliac crest would enhance our ability to detect a malignant tumor. METHODS: A prospective histological evaluation of vertebral body biopsy specimens from presumed osteoporotic vertebral compression fractures and a concurrent bone-marrow aspiration from the iliac crest were performed in order to identify latent hematopoietic dyscrasias. Over a four-year period, vertebral body biopsies from 523 vertebral levels as well as iliac crest bone-marrow aspirations were performed in 238 patients. Both specimens were evaluated histologically, and the prevalence of an underlying occult malignant neoplasm was determined. RESULTS: All specimens from the vertebral bodies showed signs of bone-remodeling and/or fracture-healing. However, in three patients, both the bone biopsy specimen and the bone-marrow aspirate showed evidence of B-cell lymphoma. The bone-marrow aspirate did not provide any additional information compared with the vertebral body biopsy specimen, and multiple myeloma was not identified in any patient. CONCLUSIONS: Lymphoma is an uncommon cause of a vertebral compression fracture, but on the basis of our experience in this series, we recommend that vertebral body biopsy specimens be obtained in all patients managed with kyphoplasty and vertebroplasty to rule out an unsuspected malignant tumor. However, we do not recommend the routine use of an additional bone-marrow aspiration from the iliac crest during vertebral augmentation procedures because doing so did not appear to enhance our ability to detect a malignant tumor.

Adult↗

PubMed1990

Non-contiguous spinal fractures.

A retrospective review of 817 spinal fracture patients revealed a 6.4% (52/817) incidence of non-contiguous spine fractures. Seventy-three per cent of the non-contiguous injuries were comprised of combinations of injuries in the cervical and thoracic regions or in the thoracic and lumbar regions. Forty-five per cent of fractures were a combination of compression fractures, 40% a combination of a compression fracture and a major spine fracture (i.e., one more likely to cause a neurologic deficit), and 15% a combination of major fractures.

Fractures, Bone↗

PubMed1991

[MRI in osteoporotic and metastatic vertebral compressions: apropos of 60 cases].

Magnetic resonance imaging (MRI) was performed in 60 patients with vertebral compression fractures caused by either bone metastasis (BM) or osteoporosis (OP). In the BM group (20 patients, 62 BM with 22 compression fractures), the signal was decreased on T1-weighted images in all cases and was usually increased on T2 sequences, in the whole vertebral body or in patchy areas. The vertebral body showed a diffuse posterior bulging in 85% of patients; malignant infiltration often involved pedicles, posterior arch or soft tissues. In the OP group (40 patients, 160 vertebral fractures): a significant recession of one of the corners of the vertebral body, different from metastatic bulging, was observed in 37% of patients; the spinal cord signal depended on the stage: during the first 4 months, the signal was low on T1 and high on T2 sequences, with a characteristic band disposition, which may involve most of the vertebral body even in mild fractures; the modifications extended to the pedicles in 5 cases; after 6 months, the signal was normal. MRI specificity was 92% between malignant versus benign compression fractures. MRI had a better sensitivity than bone scan for depicting vertebral BM. In OP, MRI signal modifications disappeared several months before increased uptake of technetium. This study emphasizes the value of MRI for the diagnosis of osteoporotic versus metastatic vertebral compression fractures when morphological and chronological parameters are added to the signal intensity analysis.

Adult↗

PubMed1995

Comparison of residual stability in thoracolumbar spine fractures using neutral zone measurements.

Because treatment algorithms for spinal injuries depend largely on the clinical assessment of stability after injury, this study both quantified and compared the mechanical stability after three different patterns of injury in the thoracolumbar spine. We created compression fractures, burst fractures, and flexion-distraction injuries in 26 thoracolumbar specimens from human cadavers in order to compare residual stability as a function of type of injury. Spinal stability was evaluated using measurements of the boundaries of the neutral zone, which provide a measure of spinal laxity in various directions of motion. An increase after injury was indicative of greater spinal laxity and hence reduced residual stability. Geometric characteristics (or parameters) of the neutral zone boundaries were used for statistical comparison between the types of injury. Of the three groups, burst fractures retained the least residual stability and compression fractures, the greatest. The angular ranges of motion in the neutral zone for burst fractures demonstrated increases (compared with average values for intact specimens) of 154% in flexion-extension, 134% in lateral bending, and 108% in torsion after injury. The results for flexion-distraction injuries were similar to those for burst fractures in flexion-extension (126%) and torsion (62%); however, more residual stability was retained in lateral bending than was seen for burst fractures (48%). Compression fractures retained the most residual stability, with increases in motion of 40% in flexion-extension, 56% in lateral bending, and 3% in torsion. These findings may be useful in determining the necessity for surgical stabilization of the spine and selection of the appropriate system of fixation.

Biomechanical Phenomena↗