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PubMed2002

[Percutaneous transpedicular vertebroplasty for treatment of osteoporosis-induced vertebral fractures].

Osteoporosis plays an increasing medical, social, and economic role in our society. Vertebral body fractures are the most common fractures, along with fractures around the hip joint, and fractures of the distal radius due to osteoporosis. An osteoporotic vertebral compression fracture can lead to incapacitating back pain and immobility and often requires in-hospital treatment. Vertebroplasty is an effective procedure consisting of the percutaneous injection of polymethylmethacrylate (PMMA) cement into vertebral bodies. Preliminary studies showed promising clinical results with this new technique. As there is a high incidence of cement leakage during the injection of the cement, we prefer to perform the procedure under computed tomography control with a fluoro-CT-option. Furthermore, we recommend that the procedure is only done in collaboration with a spine surgeon. In case of a neurological complication, immediate decompression of the spinal canal is mandatory. Vertebroplasty is a very promising, effective and safe method for the treatment for osteoporotic vertebral compression fractures. Based on our preliminary results, this method can be recommended for a more widespread clinical use.

Administration, Cutaneous↗
PubMed2004

A review of complications associated with vertebroplasty and kyphoplasty as reported to the Food and Drug Administration medical device related web site.

In 2002, approximately 38,000 vertebroplasties and 16,000 kyphoplasties were performed in the United States. As the use of both modalities for the treatment of vertebral compression fractures has increased, so have questions regarding safety and efficacy. The authors addressed this by reviewing both the current literature and complications data reported to the Food and Drug Administration (FDA) Center for Devices and Radiological Health through the on-line database (http://www.fda.gov/cdrh/maude.html) and through the Office of the Freedom of Information Act at the FDA. Although both procedures are largely safe, the FDA data highlight two main concerns: reactions to the use of acrylic (polymethylmethacrylate) bone cement, including hypotension and, in some cases, death, especially when multiple vertebral levels are treated in one setting; and a possible increased risk with kyphoplasty of pedicle fracture and cord compression.

Access to Information↗
PubMed2006

The biomechanical evaluation of calcium phosphate cements for use in vertebroplasty.

OBJECT: The authors evaluate the biomechanical properties of vertebral bodies (VBs) stabilized with calcium phosphate (CaP) cements for use in vertebroplasty in comparison with polymethylmethacrylate (PMMA). METHODS: In the first phase of the study, 73 VBs (T3-L2; thoracic region [T3-8] and thoracolumbar region [T9-L2]) were collected from seven fresh human cadavers. Compression tests were performed before and after vertebroplasty using PMMA (compression strength 80 MPa) and three kinds of CaP cements-CaP1 (5 MPa), CaP2 (20 MPa), and CaP3 (50 MPa). The authors compared the maximal compression loads (MCLs) and stiffness before and after vertebroplasty in each of the four cement groups. In the second phase of the study, 18 paired spinal units (PSUs) were collected from three fresh human cadavers, and the authors injected two types of cement selected from the first phase of the study into the lower level of six PSUs. They compared the MCLs of the untreated and two treated groups (there were six PSUs in each type of group) to analyze the tendency of inducing compression fractures in the upper level of the PSUs. The MCLs of the PMMA-injected vertebrae were significantly increased after vertebroplasty. The MCL levels of the CaP3-injected vertebrae and the CaP2-injected thoracolumbar vertebrae were decreased from those of untreated vertebrae without being significant. The MCLs of CaP1-injected vertebrae and CaP2-injected thoracic vertebrae were significantly decreased after vertebroplasty. The stiffness of all cement groups was decreased after vertebroplasty compared with initial stiffness, significantly so in all three thoracic CaP groups. In the second compression test with PSUs, the MCLs of the CaP2- and CaP3-injected PSUs were not significantly different from those of the untreated control PSUs. CONCLUSIONS: The CaP3-injected vertebrae restored the MCLs of human vertebrae closer to their initial levels than the PMMA-injected vertebrae did. The CaP2- and CaP3-injected PSUs showed no tendency to induce compression fractures in adjacent VBs.

Aged↗
PubMed2002

[Neurologic sequelae of bone changes in multiple myeloma and its therapy].

Multiple myeloma (MM) is a plasma cell malignancy characterized by infiltration of bone marrow, bone destruction, infiltration of soft tissues with plasma cells, and suppression of normal hematopoiesis. The production of monoclonal immunoglobulins with or without light chains is a major feature of the disease. Full spectrum of plasma cell dyscrasias include monoclonal gammapathy of undetermined significance, smouldering myeloma, indolent multiple myeloma, and fully developed, symptomatic multiple myeloma. The usual presenting features of MM include bone pain, weakness, fatigue, fever and infection. Neurologic symptoms are less common but one must not forget that MM may present with a neurologic disease. Careful neurologic history and examination are mandatory in patients with MM. Neurologic symptoms may be a direct manifestation of MM or may be due to the immune effect of monoclonal proteins directed against different neural structures. Finally, metabolic consequences (uremia, hypercalcemia, hyperviscosity) of MM may produce a broad spectrum of different neurologic symptoms including headache, blurring of vision, drowsiness, precoma, coma, vertigo, ataxia, hemiparesis and epileptiform seizures. The most common location of bone changes in MM is the thoracic spine, where it causes osteolytic changes with consequent compressive fractures. The most disastrous sequel is paraplegia. Multiple vertebral involvement with the evidence of osteolytic changes in other bones is usual, but solitary vertebral myeloma may occur. Myeloma usually involves the bone of the vertebral body and then spreads into the extradural space. However, patients with solitary extradural myeloma have been reported. Skull myeloma is frequently asymptomatic. It may grow externally or, rarely, there is intracranial expansion. Involvement of the cranial nerves is not rare, with II, V, VI, VII and VIII cranial nerves being most often affected. Isolated intracerebral plasmacytomas are extremely rare. Diagnostic approach includes plain X-rays of the skeleton, which was found to be the method of choice for demonstration of osteolytic changes, whereas magnetic resonance with gadolinium enhancement most reliably displays the degree of vertebral involvement and demonstrates any associated soft tissue mass. Current treatment of osteolytic changes in multiple myeloma include chemotherapy, radiotherapy in combination with dexamethasone, monthly infusions of bisphosphonates, surgical decompression, and kyphoplasty. Therapeutic approach is dictated by the presenting symptoms. In case of pain as the predominant symptom, treatment with chemotherapy and radiotherapy may be appropriate. Compressive symptoms are relieved with dexamethasone followed by radiotherapy and chemotherapy. Surgical decompression is used in patients with vertebral collapse and vertebral instability. Kyphoplasty is a new method used in the treatment of osteolytic changes of vertebral bodies. A viscous cement is injected into the cavity by a balloon-like inflatable bone tampon. It has been successfully employed to improve the quality of life, to reduce pain, and to increase overall functioning in patients with vertebral compression fractures by restoring most of the original height of the vertebral body. Bisphosphonates reduce pain associated with osteolytic changes in multiple myeloma, but also significantly reduce skeletal events (pathologic fracture, spinal cord compression, surgery or irradiation of bone) via unknown mechanism. It seems that bisphosphonates, by inhibiting bone resorption, alter the microenvironment in which the MM cells grow.

Central Nervous System Diseases↗
PubMed2005

Kyphoplasty: 2 years of experience in a neurosurgery department.

BACKGROUND: Kyphoplasty is a new technique to treat collapsed vertebral body (VB) fractures. The technique is very effective for achieving rapid pain relief, restoring bone height,and consequent vertebral realignment,and thus stabilization of the vertebra. METHODS: We reviewed 57 patients with vertebral compression fractures. All patients were neurologically intact and presented with severe low back pain or localized pain over the thoracolumbar region. Indications for kyphoplasty were osteoporotic and traumatic compression fractures, osteolytic tumor metastases, and aggressive hemangiomas without spinal canal compression. RESULTS: In 57 patients, 77 levels were treated. Follow-up was 6.5 months. Patients were evaluated with a visual analog scale (VAS) preoperatively and postoperatively. The mean preoperative VAS score was 91.08 for pain, whereas the mean postoperative VAS score was 11.22. Percentage of mean pain relief was 87.9% during the first 6 months of follow-up. We achieved a 43.6% improvement in the height of the compressed VB and 6.3 degrees of improvement in the kyphotic angle. No serious complications occurred. Mean hospital stay was 24 hours. CONCLUSIONS: Kyphoplasty carries significantly less morbidity than vertebroplasty or open surgery. Risk for embolization is low. Normal kyphotic angle can be restored or improved by this technique. In the hands of experienced surgeons, kyphoplasty is a safe and a minimally invasive technique for patients with neoplastic, traumatic, or osteoporotic lesions of the vertebra or sacrum.

Aged↗
PubMed2003

A modeling capacity of vertebral fractures exists during growth: an up-to-47-year follow-up.

STUDY DESIGN: The study is an observational cohort study. OBJECTIVES: To determine the incidence and the long-term outcome of thoracic or lumbar vertebral fractures in children. SUMMARY OF BACKGROUND DATA: The incidence of vertebral fractures in children is described as rare and the outcome as favorable. However, no studies evaluate the clinical and radiographic long-term outcome and if a fractured vertebra could be rebuilt during growth. METHOD: The incidence of vertebral fractures in children was evaluated through the radiographic archives. Twelve boys and 12 girls, aged 7-16 when sustaining the fracture, 21 one-column compression fractures and 3 burst fractures Denis type B, all without neurologic deficits, attended the follow-up. Primary treatment consisted of immediate mobilization without brace. Clinical and radiographic examinations were performed 27-47 years after the injury. RESULTS: The annual incidence of thoracic and lumbar vertebral body fractures in individuals below age 16 was 0.07%. Twenty-one individuals had, at follow-up, no subjective complaints, 3 had occasional back pain (Oswestry Scores 8, 22, and 26), 23 were classified as Frankel E, and 1 as Frankel D. The radiographic ratio anterior height/posterior height of the fractured vertebral body increased from 0.75 after injury to 0.87 at follow-up (P < 0.001). The posttraumatic kyphosis in the fractured region decreased in 8 individuals (33%), all aged 13 or less at fracture. No increased disc degeneration was observed. CONCLUSION: Thoracolumbar vertebral fractures without neurologic deficits, sustained during growth, have a favorable long-term outcome. A modeling capacity, reducing the fracture deformity, exists at least in the youngest patients.

Adolescent↗
PubMed2003

[Relevance and advantages of new angular stable screw-plate systems for diaphyseal fractures (locking compression plate versus intramedullary nail].

Intramedullary nailing still remains the golden standard for the treatment of diaphyseal fractures of the long bones in adults. The operative technique is standardised and usually minimal invasive, the primary healing rate is high, and complications arise rarely. However, for problem zones (meta-diaphyseal region), in poor bone quality and in other relative contraindications for nailing (narrow medullary canal, fractures in adolescents and polytrauma) the new angular stable screw-plate-systems (LISS, LCP) offer an excellent alternative for the operative stabilisation. The high primary stability in combination with newly developed minimal-invasive techniques (MIPO = minimal invasive plate osteosynthesis) are the bases for a functional after treatment and a rapid bony consolidation with a low complication rate.

Adolescent↗
PubMed2003

Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis.

PURPOSE: To investigate the prevalence and findings of vertebral body compression fractures adjacent to those previously treated with percutaneous vertebroplasty. MATERIALS AND METHODS: The findings in 177 patients treated with percutaneous vertebroplasty for more than 2 years were reviewed retrospectively. The following parameters were reviewed: primary diagnosis, patient age and sex, date of treatment with vertebroplasty, vertebral level(s) treated, pedicular approach, and amount of polymethylmethacrylate injected per vertebral body. Patients with acute compression fractures secondary to osteoporosis were selected. RESULTS: Of 177 patients treated with percutaneous vertebroplasty, 22 (12.4%) developed a total of 36 new vertebral body fractures following treatment. Of the 36 newly documented fractures, 24 (67%) involved vertebrae adjacent to the previously treated vertebral level(s), whereas 12 (33%) involved the collapse of nonadjacent vertebrae. In addition, 24 (67%) of the 36 new vertebral fractures occurred within 30 days after treatment of the initial fracture(s). CONCLUSION: A substantial number of patients with osteoporosis develop new fractures after undergoing percutaneous vertebroplasty; two-thirds of these new fractures occur in vertebrae adjacent to those previously treated.

Aged↗
PubMed1998

Osteogenesis imperfecta with joint contractures: bruck syndrome.

We describe an Egyptian boy with osteogenesis imperfecta who was born with thumb contractures and bilateral antecubital pterygia. He was seen at 16 months of age with femur and tibial fractures, thoracic vertebral compression fractures, scoliosis and Wormian bones. The findings are consistent with a diagnosis of Bruck syndrome.

Abnormalities, Multiple↗
PubMed1999

Spinal cord injury and snowboarding--the British Columbia experience.

Snowboarding is an alpine sport growing in popularity, particularly among male youth. This study of 10 consecutive cases admitted to the Vancouver Hospital and Health Sciences Centre Acute Spinal Cord Injury Unit, over the 1997 to 1998 winter season, analyzes the epidemiology of snowboarding spinal injury. Information was collected retrospectively on the mechanism, location, and pattern of injury, and personal details of the individuals who suffered the injuries. The average age at time of injury was 22.4 years, with a range of 16 to 29. All but 1 of the cases were self-acknowledged expert-level snowboarders, with an average of 6.25 years experience. Nine of the injured were male. There was only 1 cervical injury, with the majority being low thoracolumbar, and 4 incidences of L-1 fracture. Compression and burst fracture were the predominant vertebral fracture patterns and there was a 50% incidence of significant neurologic injury and deficit. The most common mechanism of injury was axial loading following a failed jump or fall from a height, varying from 2 to 25 feet. The lack of associated injuries in 9 of the cases suggests a limited ability of the extremities to offset such falls. Contributing factors included the inherent riskiness of the sport, participant characteristics, lack of formal instruction, and self-constructed jumps. Poor weather conditions, unfamiliarity with a run, collisions, and consumption of alcohol also played lesser roles. The frequent association between spinal fracture and significant neurologic deficit in this group has not previously been reported in other studies.

Adolescent↗
PubMedDate not supplied

Posterior shoulder (glenohumeral) dislocation.

While shoulder dislocations are a common injury, dislocation in the posterior direction is unusual and often missed clinically. A traumatic posterior shoulder dislocation can be caused by a direct blow to the anterior shoulder or if a posteriorly directed force is axially applied through the forward flexed arm. A posterior shoulder dislocation can occur after a violent muscle contraction induced by an electrical shock or grand mal seizure. Posterior shoulder dislocations are commonly associated with posterior glenoid rim fractures and anterior compression fractures of the humeral head. This diagnosis should not be missed if a complete physical and radiographic exam are properly performed.

Adult↗
PubMed1981

The use of cast-bracing as treatment for fractures of the tibial plateau.

A series of 29 patients with fractures of the tibial plateau were treated by means of a cast-brace. There were seven wedge fractures of the lateral tibial condyle, two dicondylar fractures and 20 compression fractures involving the lateral tibial plateau. The seven patients with wedge fractures were treated by skin or skeletal traction, followed as soon as possible by flexion exercises for the knee. Cast-braces were applied to all fractures as soon as possible after injury, and the patients allowed to bear weight freely. Early restoration of function of the injured limb was thereby achieved. The results of our study over a period of two and a half years indicate that cast-bracing is a very satisfactory method of treating fractures of the tibial plateau. All the fractures united, the movements and control of the knee were excellent, and valgus or varus deformity was unchanged before application and after removal of the brace.

Adolescent↗
PubMed2005

Evaluating bone mass and bone quality in patients with breast cancer.

Bone remodeling is a process by which bone renews itself focally in distinct areas on cancellous (ie, trabecular) bone and/or in the Haversian systems of cortical (or compact) bone. Normal bone turnover involves the ordered metabolism of bone-resorbing cells (osteoclasts) and bone-forming cells (osteoblasts). Estrogen exerts a multitude of actions on bone tissues and is integral to bone health, and estrogen deprivation leads to accelerated bone loss. Bone strength reflects the integration of bone density and bone quality. Methods to assess bone strength fall into 3 categories: radiologic (ie, bone mineral density [BMD]), biochemical (ie, markers of bone turnover), and histologic (ie, bone biopsies for histomorphometry). The beneficial effect of aromatase inhibitors (AIs) and inactivators on breast cancer depends on reducing levels of circulating estrogens in the peripheral blood. There appears to be variability in the effects of AIs on bone in experimental animals, and this variability may not be the same in humans. In general, bone loss is an expected side effect of the AIs. For postmenopausal women receiving adjuvant anastrozole or other AIs, a BMD measurement using dual-energy x-ray absorptiometry is recommended, to be repeated every 1-2 years. Regular physical exercise is advised together with added calcium 1500 mg and vitamin D 800 U daily. If the T-score reaches a level of >2.5, or if it is between -1.5 and -2.5 in the presence of a fragility fracture or vertebral compression fracture, or if height loss > 2 cm occurs or BMD decreases > 3% in 1 year at the lumbar spine or > 5% at the femoral neck, bisphosphonate therapy should be considered.

Absorptiometry, Photon↗
PubMed2002

[Physical rehabilitation for osteoporotic fractures].

Osteoporotic fractures usually occur in elderly patients. If the patients are kept in bed due to pain or therapeutic purposes, they are likely to suffer from various complications such as suppressed physical function, pneumonia, pressure sore, dementia, and deep vein thrombosis. Such disuse syndrome is commonly observed after femoral neck fracture and spinal compression fracture in the osteoporotic patients. In order to prevent the patients from the bed ridden condition, early ambulation is mandatory in consideration of the general condition. After ambulation, the maintenance of daily physical activity and the prevention of additional fractures are essential points in the management of osteoporotic patients.

English Abstract↗
PubMed1993

[Fractures of a single bone of the forearm in children].

A series of 69 one bone forearm fractures in children is reported. Thirty six ulna and 33 radius were involved. Average age was 7.6 years. The fracture type varied: compression fracture in 2 cases, greenstick fracture in 45 cases and impacted fracture in 22 cases. For 25 cases, a plastic bowing of the other forearm bone was associated. Treatment was immobilization without reduction (53), or reduction with anesthesia (16). One proximal radial fracture was treated with medullary nailing the 15th day, after 2 secondary displacements. Early radiological results were very good in 40 per cent, good in 32 per cent, fair in 19 per cent, and poor in 7 per cent. Eleven children with a poor or fair initial result had clinical and radiological evaluation with long term follow-up; functional and radiological results were always good or very good. The reduction of the plastic deformity as reported by Sanders allowed to achieve better early results.

Age Factors↗