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PubMed2006

Development and psychometric properties of the Vertebral Compression Fracture Pain and Functional Disability Questionnaire.

OBJECT: Vertebral compression fractures (VCFs) result in severe and disabling pain, diminished quality of life, and substantial medical costs. There exists no standard instrument with which to measure pain and functional status before and after treatment of VCFs. METHODS: A questionnaire was specifically developed to assess pain and disability in patients with VCFs before and after undergoing percutaneous polymethylmethacrylate-augmented vertebroplasty. The first section of the baseline questionnaire (before treatment) contains 11 items that address the patient's previous and current levels of back pain and distress. The second section of the baseline questionnaire lists 24 activities of daily living (ADLs), each measured on a four-point scale ranging from "able to do without pain" to "cannot do because of pain." The follow-up questionnaire (after treatment) is similar in format. Among 72 vertebroplasty-treated patients, the internal consistency reliability of the 24 ADLs ranged from 0.87 to 0.98, with similar results observed before and after treatment. Correlations of 0.29 to 0.72 were observed among the 24 ADLs and the internal measures of pain and distress measured on both visual analog and adjectival scales. Similar correlations (range 0.35-0.63) were observed between the questionnaire and 10 dimensions of the Oswestry Disability Index's low-back pain questionnaire, an external instrument used to assess criterion-referenced validity. Evidence in support of the validity of the questionnaire was present before and after treatment. CONCLUSIONS: The Vertebral Compression Fracture Pain and Functional Disability Questionnaire appears to be a reliable and valid instrument for assessing back pain and functional ability in patients before and after treatment for VCFs.

Activities of Daily Living↗
PubMedDate not supplied

Percutaneous vertebroplasty for osteoporotic compression fracture: multivariate study of predictors of new vertebral body fracture.

PURPOSE: To investigate the risk factors and relative risk of new compression fractures following vertebroplasty. METHODS: Initially, we enrolled 104 consecutive patients with vertebral compression fractures caused by osteoporosis. A total of 83 of the 104 patients visited our hospital for follow-up examinations for more than 4 weeks after vertebroplasty. Logistic regression analysis of the data obtained from these 83 patients was used to determine relative risks of recurrent compression fractures, using 13 different factors. RESULTS: We identified 59 new fractures in 30 of the 83 patients: 41 new fractures in vertebrae adjacent to treated vertebrae; and 18 new fractures in vertebrae not adjacent to treated vertebrae. New fractures occurred in vertebrae adjacent to treated vertebrae significantly more frequently than in vertebrae not adjacent to treated vertebrae. Only cement leakage into the disk was a significant predictor of new vertebral body fracture after vertebroplasty (odds ratio = 4.633). None of the following covariates were associated with increased risk of new fracture: age, gender, bone mineral density, the number of vertebroplasty procedures, the number of vertebrae treated per procedure, the cumulative number of vertebrae treated, the presence of a single untreated vertebra between treated vertebrae, the presence of multiple untreated vertebrae between treated vertebrae, the amount of bone cement injected per procedure, the cumulative amount of bone cement injected, cement leakage into the soft tissue around the vertebra, and cement leakage into the vein.

Aged, 80 and over↗
PubMed2006

Biomechanical performance of the new BeadEx implant in the treatment of osteoporotic vertebral body compression fractures: restoration and maintenance of height and stability.

BACKGROUND: Vertebral compression fractures are counted among the most common complications of osteoporosis. For treatment, a new, alternative implant has been developed (BeadEx, Expandis, Hof HaCarmel, Israel). The aim of the present in vitro study was to evaluate whether this implant is able to restore the initial height and three-dimensional stability after fracture and whether it is able to maintain this height and stability during complex cyclic loading. METHODS: The BeadEx implant consists of small titanium rolls, which are pressed into the vertebral body through specially designed, hollow pedicle screws. The height and the three-dimensional flexibility of 18 bisegmental spine specimens (nine T12-L2, nine L3-L5) was measured, first, before and after creating a wedge compression fracture at the middle vertebral body (L1 resp. L4), second, after treatment of the fracture, and, third, during and after complex cyclic loading. The fractures were treated either with BeadEx plus internal fixator, BeadEx plus bone cement or vertebroplasty for comparison. FINDINGS: The height before fracture could almost be restored by BeadEx plus bone cement but not by BeadEx plus fixator and vertebroplasty. The total height loss after cyclic loading was smallest with BeadEx plus bone cement (in median -4.7mm with respect to the intact specimens) but -6.2mm with BeadEx plus fixator and -7.8mm with vertebroplasty. The three-dimensional stability of the specimens was clearly higher if treated with BeadEx plus fixator than with BeadEx plus bone cement or vertebroplasty. INTERPRETATION: From a biomechanical point of view, BeadEx plus bone cement can be recommended as an alternative to vertebroplasty in the treatment of osteoporotic vertebral body fractures. BeadEx plus fixator can be recommended if additional stability is needed.

Biomechanical Phenomena↗
PubMed1995

Can we distinguish between benign versus malignant compression fractures of the spine by magnetic resonance imaging?

STUDY DESIGN: The authors investigate the usefulness of magnetic resonance imaging in differentiating benign versus malignant compression fractures by reviewing patients and a fracture model in a canine model. OBJECTIVES: To determine the sensitivity and specificity of magnetic resonance imaging in differentiating benign versus malignant compression fractures of the spine and to obtain distinguishing features in magnetic resonance imaging. SUMMARY OF BACKGROUND DATA: The differentiation between benign and abnormal compression fractures of the thoracolumbar spine has important implications regarding patient treatment and prognosis. Plain radiographs, bone scans, and computed tomography are not accurate imaging modalities for this purpose. METHODS: Magnetic resonance imaging scans of 22 patients with confirmed lesions of the thoracolumbar spine were studied. There were 11 malignant and 11 benign lesions. Two experienced neuroradiologists blindly reviewed the magnetic resonance imaging scans and determined benign or malignant lesions. A canine study was performed to simulate a compression fracture model with a vertebral osteotomy in two dogs, and serial contrast-enhanced magnetic resonance imaging scans were performed 15, 30, 60 and 90 days after surgery. RESULTS: The correct interpretation between two neuroradiologists was 77% and 95%. The combined sensitivity rate was 88.5%, and the specificity rate was 89.5%. Magnetic resonance imaging reliably distinguished benign versus malignant lesions based on the anatomic distribution and intensity of signal changes of bone and adjacent tissues, contrast enhancement characteristics, and changes over time. Only one malignant lesion was misinterpreted by both neuroradiologists as benign, whereas there was one additional missed malignant lesion and three misinterpreted benign lesions by one radiologist. In the canine study, signal changes and enhancement were found 60 days after surgery, but no signal changes or enhancement were noted on the scan 90 days after surgery. CONCLUSIONS: Magnetic resonance imaging scans can detect malignant vertebral lesions early, but acute healing compression fractures may mimic the findings of metastatic lesions. The use of contrast-enhanced magnetic resonance imaging scans and serial magnetic resonance imagings are helpful for additional differentiation between benign and malignant compression fractures. In addition to magnetic resonance imaging scans, other diagnostic tests and clinical findings should be correlated before biopsy or surgery of the suspected lesion.

Adult↗
PubMed2003

Minimally invasive treatments of osteoporotic vertebral compression fractures: vertebroplasty and kyphoplasty.

Although nonsurgical treatment of osteoporotic vertebral compression fractures, including medication, exercise, bracing, and bed rest, have been reasonably effective, vertebroplasty and kyphoplasty have evolved as valuable adjunctive treatment options. Over the past decade, vertebroplasty, which involves the percutaneous injection of bone cement directly into the fractured vertebral body, has been used as a treatment for painful osteoporotic vertebral body compression fractures, a leading cause of morbidity in the elderly. Kyphoplasty, another minimally invasive procedure that allows for correction of spinal deformity and for controlled cement filling of the fractured vertebral body, involves the percutaneous cannulation of the vertebral body followed by the placement of an inflatable bone tamp. Reported results for both vertebroplasty and kyphoplasty suggest rapid improvement in pain and physical functioning in patients with osteoporotic vertebral compression fractures. Kyphoplasty allows for low-pressure cement injection and affords the opportunity to correct spinal deformity. Further study is required to define the precise indications, timing, and relative merits of these techniques.

Contraindications↗
PubMed2004

Vertebral neoplastic compression fractures: assessment by dual-phase chemical shift imaging.

PURPOSE: To compare normal vertebrae with vertebrae with neoplastic compression fractures by means of opposed-phase (OP) and in-phase (IP) gradient-echo (GRE) imaging. MATERIALS AND METHODS: On OP and IP T1-W GRE images (obtained at 1.5 T with the fast low-angle shot (FLASH) technique) of dual-phase chemical shift sequences, we compared the signal intensity ratios (SIRs) of normal and compression-fractured vertebrae in 108 patients. Dual-phase chemical shift sequences were measured in three groups of vertebral bone marrow in terms of the relative SIR in OP and IP images: group 1: normal vertebrae (N = 30 with 90 vertebrae); group 2: non-neoplastic compression-fractured vertebrae (N = 58 with 73 vertebrae); and group 3: neoplastic compression-fractured vertebrae (N = 20 with 27 vertebrae). The presence of compressed vertebrae was ascertained based on the consensus of two experienced radiologists. The mean SIRs among the three groups were compared by means of the Tukey-Kramer test. RESULTS: The mean SIRs of the three groups (group 1: 0.46 +/- 0.14; group 2: 0.63 +/- 0.21; and group 3: 1.02 +/- 0.11) were significantly different according to the Tukey-Kramer test (P < 0.01). CONCLUSION: OP and IP T1-W GRE MRI of vertebral SI abnormalities can help predict the nature of compression fractures.

Aged↗
PubMed2004

Primary and secondary osteoporosis' incidence of subsequent vertebral compression fractures after kyphoplasty.

STUDY DESIGN: Retrospective review of prospective database. OBJECTIVES: Define the incidence of adjacent and remote fractures after kyphoplasty vertebral augmentation, and identify vulnerable subpopulations at increased risks. SUMMARY OF BACKGROUND DATA: Painful osteoporotic compression fractures can be effectively treated with methyl methacrylate vertebral augmentation, but the effect of intervention on the generation of future remote and adjacent fractures has not been identified. No paper has analyzed the association of long-term steroid use to subsequent compression fractures. METHODS: A total of 175 patients were treated for compression fractures, from October 1999 to November 2001, 60 patients were excluded due to insufficient follow-up (less than 3 months) or malignancy related fracture. The remaining 115 patients' charts and radiographs were then individually analyzed. New fractures were identified based on changes from baseline imaging studies (). Demographic information, vertebral levels treated, adjacent fractures, and remote fractures underwent statistical analyzed (P < 0.05). RESULTS: A total of 225 vertebral bodies were treated in 115 patients using the kyphoplasty technique; of those, 26 patients developed 34 subsequent compression fractures. The mean follow-up was 11 months (range, 3-33 months). The incidence of subsequent fracture per procedure per kyphoplasty was 15.1% (34 of 225), overall incidence per patient was 22.6% (26 of 115). There were 80 patients with primary osteoporosis and 35 patients with secondary steroid-induced osteoporosis. These populations were similar in terms of demographics, single or multiple sites, along with two or three adjacent levels treated. Seventeen of the 26 (65%) patients with subsequent fracture had secondary steroid-induced osteoporosis, while only 9 of the 26 (35%) patients had primary osteoporosis. Therefore, the incidence of post-kyphoplasty VCF in the primary osteoporotic patient was 11.25% (9 of 80) and the incidence in the steroid-induced osteoporotic patient was 48.6% (17 of 35). This increased fracture rate in the steroid-dependent patients was significant (P < 0.0001), along with adjacent fractures (12 of 19 on steroids, P = 0.0009), and remote fractures (7 of 9 on steroids, P = 0.027). CONCLUSIONS: Steroid-induced compression fractures appear to have an increased incidence of subsequent fractures after the kyphoplasty procedure. The kyphoplasty protocol with concurrent medical osteoporotic regimen does not appear to increase, and may serve to reduce, the incidence of remote and adjacent fractures for primary osteoporotic fractures.

Aged↗
PubMed2003

Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures.

STUDY DESIGN: A prospective consecutive cohort study of clinical and radiographic outcomes after kyphoplasty for treatment of osteoporotic vertebral compression fractures. OBJECTIVES: To measure changes in spinal deformity, activity level, and pain after kyphoplasty treatment. SUMMARY OF BACKGROUND DATA: Pain and kyphosis caused by osteoporotic vertebral compression fractures adversely affect quality of life and survival. Kyphoplasty involves the inflation of a balloon bone tamp, percutaneously placed in a fractured vertebral body, followed by deposition of bone cement into the resulting cavity. Previous reports indicate that kyphoplasty improves patient function and restores height of collapsed vertebral bodies, but limited data about the effects of kyphoplasty on spinal sagittal alignment are available. METHODS: Twenty-nine patients with osteoporotic vertebral compression fractures who did not respond to medical therapy were treated by kyphoplasty. These patients underwent 37 operations to treat 61 vertebral compression fractures between T6 and L5. Sagittal alignment was analyzed from standing radiographs (pre- and postkyphoplasty). Patient surveys were used to assess pain relief, improvement in activity, and satisfaction with the surgical procedure. RESULTS: In this cohort, a mean of 8.8 degrees (range 0-29 degrees ) of correction of local spinal kyphosis was achieved with kyphoplasty. Thirty of 52 fractures (17 patients) were considered reducible and had >5 degrees of correction, with a mean improvement in sagittal alignment of this population of 14.2 degrees. Patient surveys revealed significant pain reduction within the first week after surgery and improved activity levels for a majority of patients. CONCLUSIONS: Kyphoplasty improves physical function, reduces pain, and may correct kyphotic deformity associated with vertebral compression fractures.

Aged↗
PubMed1986

Thoracic spine compression fractures in Finland.

The incidence and prevalence of thoracic spine compression fractures were studied in an extensive population sample of Finnish men and women. A segment of the population (57,440 persons) aged 15 years or older participated in the baseline health examinations; 17,557 of the 57,440 were reexamined approximately five years later. Compression fractures were identified from 100 X 100 mm thorax photofluorograms. In the whole Finnish population aged 15 years or older, the incidence rate of compression fractures per 100,000 person-years was estimated to be 31.6 in men and 36.8 in women, with a prevalence rate of 0.75% in men and 0.44% in women. In men, the prevalence and incidence increased gradually with age, whereas in women an abrupt rise was found after the age of 65; this reflects differences in patterns of age-related osteoporosis between the sexes.

Adolescent↗
PubMedDate not supplied

Leakage of polymethylmethacrylate in percutaneous vertebroplasty: comparison of osteoporotic vertebral compression fractures with and without an intravertebral vacuum cleft.

OBJECTIVE: We compared polymethylmethacrylate (PMMA) leakage from vertebral bodies in osteoporotic compression fractures with and without intravertebral vacuum clefts (IVCs) on computed tomography (CT) after vertebroplasty. METHODS: Percutaneous vertebroplasty was performed in 59 patients, comprising 36 compression fractures with IVCs in 33 patients and 49 fractures without IVCs in 26 patients. All patients underwent postprocedural CT of treated and adjacent vertebral bodies. CT findings and clinical complications were assessed retrospectively with regard to the presence of PMMA leakage. When present, leakage types were classified as intradiscal, epidural, foraminal, and perivertebral venous. The frequencies and types of leakages were compared in both groups using chi and Fisher exact tests, respectively. RESULTS: The PMMA leakage occurred in 20 (55.5%) of 36 fractures with IVCs and in 25 (51.0%) of 49 fractures without IVCs, without significant difference (P=0.679). No patients experienced clinical complications. The leakage types that frequently occurred were intradiscal (13/20, 65.0%), perivertebral venous (5/20, 25%), epidural (1/20, 5%), and foraminal (1/20, 5%) in compression fractures with IVCs; and epidural (11/25, 44.0%), intradiscal (6/25, 24%), and perivertebral venous (8/25, 32%) in those without. A significant difference was found between the most frequent types in both groups (P=0.006, P=0.003, respectively). CONCLUSIONS: On CT after vertebroplasty, the incidences of PMMA leakage in osteoporotic compression fractures with and without IVCs were similar; however, leakage type frequencies differed.

Adult↗
PubMed1996

Magnetic resonance imaging of vertebral compression fractures.

In this study, magnetic resonance imaging (MRI) was used to analyze the signal intensity and vascularity of compression fractures of vertebrae in 74 patients. The possibility of nonunion was assessed according to the specific image findings and clinical presentation. All patients had chronic back pain for more than 3 months and compression fractures of the vertebrae initially demonstrated by plain radiography. Pre-enhanced T1 and T2*-weighted images (*multiplaner gradient recall sequence) and postenhanced MRI were obtained. Images were divided into three categories according to the signal intensity of the fractured vertebrae such as hyperintensity (n = 35), hypointensity (n = 24) on T1-weighted image and necrotic type compression fractures of the vertebrae (n = 15). Of the 15 necrotic-type cases, 13 disclosed "fluid"-containing space at the collapsed vertebrae and two showed "air"-containing space at the vertebral body. We believe that these findings are pathognomonic signs of nonunion of the collapsed vertebrae. Surgical specimens were obtained from the four patients whose vertebrae showed necrosis and granulation tissue. After posterior spinal instrumentation, the collapsed vertebral body regained the height and presence of the open end-plate of the vertebra on postoperative lateral radiography. The superior capabilities of MRI offers useful criteria that make the diagnosis of nonunion in compression fractures of the spine possible. Thus, a space with "fluid" or "air" collection at the anterior aspect of a collapsed vertebra as well as strong enhancement with Gd-DTPA at the posterior aspect of the collapsed vertebra may be considered to be pathognomonic signs of nonunion of the fractured vertebra.

Aged↗
PubMed2002

Treatment of lower lumbar radiculopathy caused by osteoporotic compression fracture: the role of vertebroplasty.

The authors used vertebroplasty for the treatment of severe lower lumbar radicular pain caused by osteoporotic compression fracture. Patients presented with severe radiating leg pain rather than lower back pain from recent osteoporotic compression fracture of lower lumbar vertebra. Radiologic findings showed osteoporotic compression fracture combined with preexisting stenosis of the intervertebral foramen resulting in root compression. After injection of polymethylmethacrylate into the compressed vertebral body through the pedicle of the symptomatic side, all seven patients experienced dramatic pain relief that lasted throughout the mean follow-up duration of 9.1 months. They conclude that vertebroplasty may be an effective way of relieving radicular pain caused by osteoporotic compression fracture combined with foraminal stenosis.

Aged↗
PubMedDate not supplied

High-resolution imaging of the spine using multidetector-row computed tomography: differentiation between benign and malignant vertebral compression fractures.

OBJECTIVE: The purpose of this study was to investigate the ability of high-resolution computed tomography (CT) images to distinguish between benign and malignant vertebral compression fractures. METHODS: Computed tomography images of 45 benign compression fractures in 40 patients and 33 malignant compression fractures in 33 patients were evaluated. A 16-slice multidetector-row CT scanner was used for data acquisition, and axial images with a slice thickness of 1 mm and sagittal and coronal multiplanar reconstruction images with a slice thickness of 0.7 to 1 mm were used for interpretation. RESULTS: The following findings were significantly more frequent in malignant fractures: destruction of the anterolateral and/or posterior cortex of the vertebral body, destruction of the cancellous bone of the vertebral body, destruction of the end plate, destruction of the pedicle, a paraspinal soft tissue mass, and an epidural mass. The extremely reliable signs of malignancy were destruction of the anterolateral and/or posterior cortex of vertebral body (100% accuracy) and destruction of the cancellous bone of the vertebral body (97.4% accuracy). CONCLUSION: High-resolution CT can provide many useful signs for differentiating between benign and malignant vertebral compression fractures, and its diagnostic ability is sufficient for clinical use.

Aged↗
PubMed2001

Injuries to the posterolateral aspect of the knee accompanied by compression fracture of the anterior part of the medial tibial plateau.

We present 12 cases of patients with injury to the posterolateral aspect of the knee accompanied by a compression fracture of the anterior part of the medial tibial plateau. There were 11 male patients and 1 female patient with an average age of 26 years (range, 17 to 44 years). There were 4 cases of posterolateral rotatory instability and 8 cases of straight lateral instability of the knee. The size of the compression fracture was classified into 2 types, small (8 cases) and large (4 cases). Although the mechanism of injury was considered to be hyperextension and varus force, the pattern of cruciate ligament injuries varied from case to case. The following 3 questions should be considered to determine which cruciate ligament is damaged: (1) Was the ipsilateral foot fixed to the ground? (2) Was forward inertia involved? (3) Was there a direct blow to the anteromedial aspect of the tibia or to the femur? Accompanied fractures of the medial tibial plateau were considered to have been compressed by the medial femoral condyle. The size of the accompanying compression fracture varied; 7 of 8 cases with a small-type fracture had posterior cruciate ligament injuries and 3 of 4 cases with a large-type fracture had anterior cruciate ligament injuries. The size of the fracture is determined by which point of the medial tibial plateau touched the medial femoral condyle. We propose that a compression fracture of the anterior part of the medial tibial plateau indicates a coexistent posterolateral aspect injury, and that especially a small compression fracture strongly suggests an accompanying posterior cruciate ligament injury, as well.

Adolescent↗
PubMed2004

Malignant and benign compression fractures: differentiation and diagnostic pitfalls on MRI.

The distinction between malignant and benign compression fractures is a common problem in clinical practice. Various imaging techniques (plain radiography, computed tomography, bone scintigraphy) have been used to differentiate these conditions but they are often inadequate in distinguishing the nature of compression fracture. This review illustrates the magnetic resonance imaging (MRI) features of malignant and benign compression fractures with emphasis on the usefulness, limitations and pitfalls of MRI.

Back Pain↗
PubMedDate not supplied

New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women.

BACKGROUND AND PURPOSE: Percutaneous vertebroplasty has been performed in the United States in an increasing volume since the mid-1990s. The purpose of this study is to analyze the risk of a new symptomatic vertebral compression fractures within 1 year of having an acute/subacute fracture treated with vertebroplasty. METHODS: A retrospective analysis was performed in which 253 female patients were found to have acute/subacute vertebral compression fractures secondary to osteoporosis treated with percutaneous vertebroplasty. Occurrences of new symptomatic vertebral compression fractures were recorded for a year following initial vertebroplasty. RESULTS: Fifty-five patients (21.7%) of the 253 osteoporotic women with one or more initial fractures experienced a new symptomatic vertebral compression fracture within 1 year. CONCLUSION: Roughly one-fifth of osteoporotic women with acute/subacute fracture treated with vertebroplasty will have a subsequent fracture within 1 year.

Aged↗
PubMed2005

CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures.

The purpose of this study was to determine the efficacy and safety of CT-guided percutaneous vertebroplasty in the treatment of vertebral compression fractures. The primary objectives were pain reduction and bone-cement leakage during a long-term follow-up in patients with osteoporotic vertebral compression fractures. CT-guided percutaneous vertebroplasty was carried out in 61 patients (mean age 71.4 years; range 42-83; female ratio: 73.8%) with vertebral compression fractures. Treatment was carried out on an outpatient basis. Pain, bone-cement leakage and complications were monitored and recorded. The mean follow-up time was 19.8 months (range 3-52). Paired comparison procedures were used for the analysis of the results, which showed that all patients had a significant reduction of pain. The mean visual-analogue scale (VAS) before treatment was 8.8 points (range 6.5-9.8 points). The mean VAS score after treatment was significantly reduced to 2.6 points (range 1.5-4.1 points; p<0.01). No clinical or neurological complications were documented. Minor and asymptomatic bone-cement leakage was observed in 54% of the cases. Percutaneous vertebroplasty is an efficient and safe interventional procedure which rapidly improves the mobility and quality of life of patients with vertebral compression fractures. CT-guidance is a reasonable upgrade in the treatment procedure which reduces the amount of bone-cement leakage.

Adult↗