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PubMed1986

Effect of compression on fracture healing. Plate fixation studied in rabbits.

Bilateral osteotomies in rabbit tibiae were secured with six-hole rigid plates, using axial compression on the right and no compression on the left side. Histological, histomorphometric and torsiometric analysis was performed up to 24 weeks postoperatively. Histological analysis showed end-to-end primary bone healing regardless of treatment. The fracture gaps tended to be smaller in the compression osteotomies, but union was achieved within the same time on both sides, and at 6 weeks torsiometric analysis of the paired specimens revealed similar mechanical properties. By the time the fracture had united both groups of bones showed similar degrees of subendosteal resorption. As a result of this porotic transformation the strength of the cortical bone was slightly impaired from 6 weeks onward, whether or not compression had been applied. The results suggest that axial compression does not augment fracture healing of plated cortical bone.

Animals↗
PubMed2002

Low lumbar spinal fractures: management options.

Fifty-four patients with low lumbar spinal fractures were retrospectively reviewed. Of these, there were 25 compression fractures, 21 burst fractures, three flexion-distraction fractures and five fracture-dislocations. Three patients had a complete neurological lesion, 17 sustained an incomplete neurological injury, and 34 were neurologically intact. Twenty-six patients were treated non-operatively and 28 underwent surgery. All patients were followed up for l-12 years. Forty-three patients (79.6%) have returned to their former employment or activity level. Four patients had experienced significant improvement but suffered from some limitation of activity. Five patients were unable to stand up and walk without support although they had some degree of improvement. Two remained completely paralyzed. There were no differences in neurologic function between patients treated non-operatively or operatively (P>0.05). The patients treated operatively had significantly less pain compared to the patients treated non-operatively (P<0.01). Because of the unique anatomy and biomechanics, fractures of the low lumbar spine are different from those in the remaining regions of spine. Most compression fractures are stable, and therefore conservative management is indicated. Surgery should be performed in those with burst fractures or flexion-distraction fractures, with severe spinal stenosis or kyphotic deformity, and fracture-dislocation.

Adult↗
PubMed2000

An evidence-based evaluation of percutaneous vertebroplasty.

BACKGROUND INFORMATION: Percutaneous vertebroplasty is a therapeutic, interventional radiologic procedure that involves injection of bone cement into a cervical, thoracic, or lumbar vertebral body lesion for the relief of pain and the strengthening of bone. This procedure only recently has been introduced, and is being used for patients with lytic lesions due to bone metastases, aggressive hemangiomas, or multiple myeloma, and for patients who have medically intractable debilitating pain resulting from osteoporotic vertebral collapse. FINDINGS: Results from two uncontrolled prospective studies and several case series reports, including one with 187 patients, indicate that percutaneous vertebroplasty can produce significant pain relief and increase mobility in 70 percent to 80 percent of patients with osteolytic lesions in the vertebrae from hemangiomas, metastases, or myeloma, or with osteoporotic compression fractures. In these reports, pain relief was apparent within one to two days after injection, and persisted for at least several months up to several years. While experimental studies and preliminary clinical results suggest that percutaneous vertebroplasty can also strengthen the vertebral bodies and increase mobility, it remains to be proven whether this procedure can prevent additional fractures in the injected vertebrae. In addition, the duration of effect is not known; there were no long-term follow-up data on most of these patients, and these data may be difficult to obtain and interpret in patients with an underlying malignant process, because disease progression may confound evaluation of the treatment effect. Complications were relatively rare, although some studies reported a high incidence of clinically insignificant leakage of bone cement into the paravertebral tissues. In a few cases, the leakage of polymer caused compression of spinal nerve roots or neuralgia. Several instances of pulmonary embolism were also reported. Although patient selection criteria have not been definitely established, percutaneous vertebroplasty is considered appropriate treatment for patients with vertebral lesions resulting from osteolytic metastasis and myeloma, hemangioma, and painful osteoporotic compression fractures if the following criteria have been met: o Severe debilitating pain or loss of mobility that cannot be relieved by correct medical therapy. o Other causes of pain, such as herniated intervertebral disk have been ruled out by computed tomography or magnetic resonance imaging. o The affected vertebra has not been extensively destroyed and is at least one third of its original height. o Radiation therapy or concurrent surgical interventions, such as laminectomy, may also be required in patients with compression of the spinal cord due to ingrowth of a tumor. CONCLUSIONS: Percutaneous vertebroplasty has only recently been introduced as a treatment for osteolytic lesions and osteoporotic compression fractures of the vertebrae, but early results are promising. Up to 80 percent of patients with pain unresponsive to correct medical treatment experience a significant degree of pain relief, and few serious complications have been reported. However, relatively few patients have undergone this procedure, and there are no data from controlled clinical trials or from studies with long-term follow-up. At the present time this procedure is still in the investigational stages, but may be appropriate for patients with no other reasonable options for medical treatment.

Bone Cements↗
PubMed1989

[Vertebral body lesions as an interference factor in quantitative computed tomography of the lumbar spine. An analysis of 1116 standardized performed measurements].

The type, frequency and location of lumbar vertebral lesions that may interfere with quantitative computed tomographic (QCT) estimation of bone mineral content were analysed in 1166 cases. All examinations were carried out with a standard protocol on the second, third and fourth vertebral body. A total of 130 lesions were identified, the majority of which included degenerative sclerosis of L4 and compression fractures of L2. Evaluation of 28 QCTs with compression fracture in one vertebral body showed that an accurate BMC value was obtained with an interendplate distance of 13 mm or more.

Bone Density↗
PubMed2004

Kyphoplasty enhances function and structural alignment in multiple myeloma.

We prospectively evaluated 19 patients with multiple myeloma who had kyphoplasty for vertebral compression fractures. Functional status was assessed preoperatively and 3 months postoperatively using the Oswestry Disability Index. Restoration of anterior and midvertebral height was assessed using lateral radiographs. Meaningful improvement occurred in 16 of 19 patients, with a reduction of the average Oswestry Disability Index from 49 +/- 16.6 to 32.6 +/- 13.6. Partial restoration of anterior vertebral body height was achieved in 76% of levels with an average of 37.8% restoration of the defect. Partial restoration of midvertebral body height was achieved in 91% of levels with an average restoration of 53.4% of the defect. There were no significant complications. These results were compared with results of a cohort of 26 patients with osteoporotic compression fractures treated with kyphoplasty at 37 levels. There was no difference between the groups in terms of Oswestry Disability Index improvement and midvertebral height restoration after 3 months. Greater anterior vertebral height restoration was achieved in the osteoporotic group (51.2% versus 37.8%). Kyphoplasty is a safe treatment modality for myeloma-related vertebral compression fractures. Efficacy in terms of pain relief and functional outcome is comparable with the results in patients with osteoporosis.

Aged↗
PubMed2002

Advances in surgical treatment of osteoporotic fractures of the spine.

INTRODUCTION: To highlight recent advances in the management of osteoporotic compression fractures of the spine. METHODS: A MEDLINE search was conducted from January 1975 to October 2001. Keywords included osteoporotic compression fractures, osteoporosis and spine fractures. RESULTS: Osteoporotic fractures of the spine often cause significant morbidity to the elderly individual. Diagnosis requires a detailed history and physical examination and investigations are usually required to exclude other causes of back pain. Magnetic resonance imaging (MRI) is often helpful in excluding other causes of pathologic fracture but may not be confirmatory. Conservative treatment was the traditional approach, but newer percutaneous treatments, such as vertebroplasty and kyphoplasty, are safe and simple day surgery procedures which allow for rapid recovery of symptoms and prevention of increasing spinal deformity. Neurological deficit as a result of spinal canal compromise from retropulsed fragments, though relatively uncommon, is well recognised as a cause of significant morbidity and is a major indication for open spinal surgery. Various spinal approaches including anterior or posterior decompression combined with a variety of stabilisation techniques have been reported in the literature. Rehabilitation is often required to improve physical function. CONCLUSIONS: Osteoporotic fractures of the spine are a common cause of morbidity in the elderly. Patients who have persistent pain despite conservative treatment require investigation to exclude other pathological causes of fracture. Percutaneous vertebroplasty and kyphoplasty are new techniques that offer much promise in the treatment of these elderly patients. Open surgery may still be required where there is significant neurologic compromise.

Aged↗
PubMed2003

Increase in vertebral body height after vertebroplasty.

BACKGROUND AND PURPOSE: During clinical work, we have seen increases in vertebral body height associated with vertebroplasty, but our literature search revealed no reports as to how often and to what degree those increases occur. The purpose of this study was to document the frequency and degree of changes in vertebral body height after vertebroplasty. METHODS: The heights of 85 vertebral bodies in 37 patients were measured before and after vertebroplasty. In addition, one adjacent vertebral body was measured in each patient as a control. Twenty-six patients had compression fractures in the thoracic spine, and 24 patients had compression fractures in the lumbar spine. Vertebroplasty was performed with a bilateral transpedicular approach by injecting polymethylmethacrylate, under biplane fluoroscopic control. Measurements were performed on preoperative MR images and on postoperative CT sagittal reformations. Anterior, central, and posterior vertebral body height measurements were obtained in the midsagittal plane. RESULTS: The average increase in vertebral body height was 2.5 mm anteriorly, 2.7 mm centrally, and 1.4 mm posteriorly. Thirteen of 85 treated vertebrae remained unchanged. All control vertebral bodies also remained unchanged. CONCLUSION: Vertebral body height often increases during vertebroplasty. The clinical significance of increasing vertebral body height is unknown.

Aged↗
PubMed2006

Prospective study of standalone balloon kyphoplasty with calcium phosphate cement augmentation in traumatic fractures.

Prospective consecutive series cases study to investigate the clinical and radiological results of standalone balloon kyphoplasty and cement augmentation with calcium phosphate in traumatic fractures. Independent observer evaluation of radiological and computer tomography results, visual analogue scale (VAS), Roland-Morris score and complications with acute traumatic compression fractures type A, treated with a standalone balloon kyphoplasty and cement augmentation with calcium phosphate (Calcibon); follow-up time at a mean of 30 months (24-37 months). From August 2002 to August 2003, consecutive patients with traumatic compression fractures (Magerl type A) without neurological deficit underwent standalone kyphoplasty with Calcibon. We report here the pre-, post-operative and the follow-up results, applying the VAS (0-10) for pain rating, the Roland-Morris (0-24) disability score, CT-scan examination, detailed radiographic evaluation of vertebral body (VB) deformity and segmental kyphosis measurement. The pre-operative X-ray measurements, VAS and the 7 days Roland-Morris scores are compared with the post-operative and the 30 months follow-up findings. Twenty-eight patients with 33 treated fracture levels were included in this study. The mean initial vertebral deformity (VB kyphosis) was 17 degrees, corrected to a post-operative of 6 degrees. We noted a loss of correction at the follow-up in comparison to the post-operative standing X-ray at 24 h of 3 degrees vertebral deformity and 3 degrees segmental kyphosis. The VAS score demonstrates a decrease over time from a mean of 8.7-3.1 at 7 days and to 0.8 at the last follow-up. The Roland-Morris disability score demonstrates a similar improvement. We noticed no major complications related to the procedure. The mean cement resorption after 1 year was 20.3% (0.3-35.3%) and is related to the individual biological resorption process and is not predictable. All patients with vertebral fractures as sole medical problem were discharged within 48 h. All active patients returned to the same work within 3 months with the same working ability as before the accident. Standalone balloon kyphoplasty is a potential alternative mini-invasive technique to reduce the fractures. However, due to the intrinsic characteristic of calcium phosphate cement (Calcibon) we recommend the application of this biological cement for standalone reduction and stabilisation only in fractures type A1 and A3.1 in young patient. In case of higher destruction levels of the VB, we propose the utilisation of Calcibon associated with posterior instrumentation. Having regard to the pointed out indications, our preliminary results demonstrate a new possibility to treat this kind of fractures, allowing a rapid handling of pain, early discharge and return to normal activities.

Adolescent↗
PubMed2005

Immediate and early postoperative pain relief after kyphoplasty without significant restoration of vertebral body height in acute osteoporotic vertebral fractures.

OBJECT: Painful osteoporotic vertebral compression fractures (VCFs) are a significant cause of disability in the elderly population. Kyphoplasty, a recently developed minimally invasive procedure, has been advocated for the successful management of these fractures in terms of immediate pain relief, and also for restoration of the premorbid level of daily activities. In this retrospective study the authors report on their experience with the early management of VCFs with kyphoplasty. METHODS: A retrospective analysis was conducted in 13 patients (seven women and six men) whose ages ranged from 48 to 87 years (mean age 71.5 +/- 11 years [mean +/- standard deviation]). The interval between onset of symptoms and surgical intervention ranged from 4 to 9 weeks. Twenty levels (12 thoracic, eight lumbar) were treated in this cohort. Immediate and early postoperative (1-month follow-up visit) visual analog scale (VAS) pain scores, activity levels, and restoration of vertebral body (VB) height were assessed. The mean preoperative VAS score was 8 +/- 1, whereas the immediate and early postoperative scores were 1 +/- 1. These findings reflected a resolution of 90 to 100% of preoperative pain. All patients resumed routine activities within hours of the procedure, although improvement in VB height was not accomplished in this cohort. No major complications were encountered in this clinical series. CONCLUSIONS: Kyphoplasty is a safe and effective method for the treatment of osteoporotic VCFs. Failure to restore VB height does not seem to interfere with the excellent pain management and good functional outcome provided by this procedure.

Aged↗
PubMed1996

Delayed post-traumatic syringohydromyelia after an uncomplicated fracture of the spine: case report and literature review.

A patient who had had a traffic accident resulting with a compression fracture of the L1 vertebra but with no neurological deficits, developed urinary incontinence and weakness in his lower extremities 25 years after the spinal injury. An MRI scan of the spine revealed gliosis of the conus medullaris at the level of the compression fracture, with syringohydromyelia extending from T6 to conus medullaris. The patient underwent a rehabilitation program at the end of which he was able to ambulate independently.

Accidents, Traffic↗
PubMed2002

[Decompression and internal fixation in the treatment of thoracolumbar spine and spinal cord injury: report of 166 cases].

OBJECTIVE: To evaluate the therapeutic effect of several internal fixation methods in the surgical treatment of thoracolumbar spine and spinal cord injury (SSI-TL). METHODS: In the 166 SSI-TL cases included in this retrospective analysis, 37 had vertebral body burst fracture, 109 had vertebral body compression fracture (with compression to a degree over 50%),14 had vertebral body fracture and dislocation and 6 had multilevel vertebral fractures or jumping fracture. In view of the spinal cord injury 59 belonged to Frankel grade A, 46 grade B, 42 grade C and 19 grade D. Posterior decompression, reduction and internal fixation were performed in 122 patients and the other 44 underwent anterior decompression, reduction and ilium bone grafting. RESULTS: Follow-up study for 3 to 18 month was conducted in 123 cases, in which RF screws cracking occurred in 4 cases, Harrington upper hook dislocation in 5 cases and Harrington rod cracking in 6, while the rest cases were free of theses incidents. In terms of the function recovery of the spinal cord, 88 cases showed improvement of the spinal cord and cauda equina of 1 to 3 Frankel grades, leaving only 35 lingering in grade A. CONCLUSION: Decompression should be performed at early stages of SSI-TL, and employment of various internal fixation instrument helps maintain and enhance spinal stability, preventing secondary lesion of the spinal cord and promoting the function recovery of the injured spinal cord.

Adolescent↗
PubMed1979

Fractures of the distal tibial metaphysis with intra-articular extension--the distal tibial explosion fracture.

In a study of 26 distal tibial explosion fractures in 24 patients two fracture patterns were identified: Type A, a rotational pattern; and Type B, a compressive fracture pattern. The rotational pattern was found to be less common than the compressive fracture and to have a substantially better prognosis. Operative treatment of the Type A pattern led to an overall acceptable result of 84%, while the Type B patients had 53% acceptable results. The results of operative treatment were however, superior to the results of nonoperative treatment in both fracture groups. Adequate treatment consists of anatomic reconstruction of the distal tibia, rigid internal fixation, early active motion, and nonweight bearing in 3 to 5 months.

Ankle↗
PubMed1981

Stabilization of flail chest by compression osteosynthesis--experimental and clinical results.

It has been demonstrated that the impaired ventilatory parameters can be normalized after early stabilization of flail chest. Most methods for operative fixation, however, have given disappointing results and only plate fixation procedures have been effective. The experimental results of osteosynthesis with dynamic compression plates are presented and demonstrate the superiority of compression osteosynthesis in rib fractures. Compression osteosynthesis resulted in a primary fracture healing with stable fragments after 14 days, whereas conventional plate fixation techniques required a much longer time and showed secondary fracture healing. The benefits of compression osteosynthesis could also be demonstrated in 10 patients with traumatic flail chest. Osteosynthesis resulted in marked pain relief, immediate stabilization of the chest wall, and a shorter time of intubation. Not all fractured ribs need stabilization, dorsal fractures are well fixed by the strong erector muscles, and in the lateral position only ribs III to VII need to be considered. Reasonable stabilization may be achieved with fixation of every second rib. In patients with bilateral rib serial fractures subcutaneous implantation of one or 2 rib struts is recommended--good results were obtained in 12 patients. The indication for operative stabilization of flail chest should be restricted to: 1. Patients with severe ventilatory restriction due to chest wall paradox alone. 2. Flail chest combined with intra-thoracic lesions which require thoracotomy. 3. Flail chest combined with lesions which require a prone position for surgical exploration. 4. Respiratory distress patients when the unstable chest wall interferes with mechanical ventilation or with underlying organs.

Adolescent↗