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PubMed1986

[Peculiarities of juvenile vertebral fractures and dislocations of the cervical vertebrae].

In addition to diagnostic and therapeutic problems of the bony spine injuries in childhood, questions of the participation of the growth plate arise and indicate the following treatment. In the last decade we treated 23 spine injuries, resulting after fall from height. Most of the cases showed single to multiple compression fractures of the anterior spine followed in a descending frequence by the lateral compression fractures, the disconnection ot the epiphyseal plate of the axis and the actual luxation fractures with injury of the stratum germinativum. In contrast to the prognostic favourable impression fractures with a spontaneous correction, luxation fractures with or without paraplegia must be repositionned and stabilized.

Cervical Vertebrae↗
PubMed2005

Speed bump-induced spinal column injury.

INTRODUCTION: Compression fracture of the vertebral body is common, especially in older adults. Injuries to the spinal column are one of the most frequent injuries by accidents and falls from heights. Vertebral fracture associated with minor trauma, however, is a rare occasion. CASE REPORT: Five cases were injured in the inner city buses after passing onto speed bumps are presented. On presentation, four patients complained of severe pain in the thoracolumbar region, while in the other patient, physical examination revealed pain and tenderness on the neck. No neurologic deficit was noted except for one patient with tenderness on thoracic spines. Examination of the thoracolumbar X-ray and computed tomography displayed compression fractures in four patients. Other laboratory data obtained on admission were within normal limits. Posterior instrumentation was applied to three patients. All patients recovered well except for the one with cervical fracture. CONCLUSION: Drivers should be strongly warned and educated on the potential hazards of traversing past such bumps in roads too fast and such barriers should be built regarding tested standards.

Accidents, Traffic↗
PubMed1993

Spine fracture with neurological deficit in osteoporosis.

The literature suggests that spinal fractures acquired after minimal trauma in osteoporotic patients cause neurological problems only extremely rarely. This report describes 9 patients with severe osteoporosis in whom minimal trauma led to a fracture of the thoracic or lumbar spine causing significant neurological deficit. All patients presented originally with isolated back pain after minimal trauma. Initial radiographs documented what appeared to be 'benign' compression fractures with minimal loss of vertebral height. Over the following 1-12 weeks all patients described a gradual onset of severe radicular pain which was subsequently associated with profound lower extremity weakness in 7 cases. Repeat radiographs revealed advanced collapse of the fractured level. CT and MRI images revealed violation of the posterior cortex of the vertebrae with retropulsion of bone into the spinal canal. In 2 cases, two simultaneous fractures of this kind were noted; in both of these cases the fractures occurred at adjacent levels. The upper lumbar spine was most frequently involved. This relatively small series suggests that caution should be used in the assessment of benign-appearing compression fractures in osteoporotic patients. The delayed appearance of neurological signs and symptoms may lead to a late or missed diagnosis. The onset of back pain in an elderly patient quite frequently represents the acquisition of a fracture; subsequent complaints of leg pain or lower extremity dysfunction may indicate progression of such a fracture, with compromise of the neutral elements.

Aged↗
PubMed2005

The behavior of thoracic trabecular bone during flexion.

Thoracic compression fractures are often described as anterior wedge fractures. Although the radiographic signs of these fractures are easily identified, the mechanism of the trabecular failure is not well understood. The current study addressed this mechanism in the lower thoracic spine by measuring the trabecular strain. Trabecular strain was measured in six human thoracic cadaver spines during 1) compressive and 2) flexural loading. The strains were measured at incremental loads using a texture correlation. They were analyzed by global contour plots and regional analysis of the T11 vertebrae. Specimens loaded under only compression exhibited uniform strains in the vertebral body. During flexion, however, the strains were concentrated in the anterosuperior margin of the vertebral body and the compressive and shear strain magnitudes in this region were significantly increased. These results demonstrate that the flexural position places the lower thoracic spine at greater risk of anterior compression fracture as seen clinically.

Aged↗
PubMed1988

Vertebral fractures without neurological deficit. A long-term follow-up study.

Twenty-five patients, who did not have osteoporosis and who were between the ages of seventeen and sixty years, were treated for one or more stable compression fractures of a vertebra with compaction of less than 50 per cent and without an associated neurological deficit. The patients were followed for a minimum of nine years. Associated vertebral fractures (12 per cent) were identified during the first three months after the injury, but no deformity progressed after three months. Radiographic changes of degenerative disc disease were evident in eight patients, but the changes did not correlate with symptoms or with level of activity. With one exception, all patients functioned as well as uninjured subjects of comparable age. Patients who have a compression fracture of a vertebra should have serial radiographs made for at least three months to ensure that all fractured vertebrae are identified and to document any progression of deformity.

Adolescent↗
PubMed2005

Prospective analysis of clinical outcomes after percutaneous vertebroplasty for painful osteoporotic vertebral body fractures.

BACKGROUND AND PURPOSE: Previous studies have retrospectively reported the positive effects of percutaneous vertebroplasty. The purpose of our study was to evaluate prospectively the effects of vertebroplasty on mobility, analgesic use, pain, and SF-36 (short-form 36-item) scales for patients with painful vertebral compression fractures that are refractory to medical therapy. METHODS: We prospectively followed 167 patients who received 207 vertebroplasty treatment sessions for stabilization of 264 symptomatic vertebral compression fractures between August 1999 and January 2003. The average age of patients was 74.6 years (SD = 12.2 years), and 76% were women. Pre- and postprocedural measurements of pain, mobility, analgesic use, and SF-36 scales were compared at 1 month after the procedure and between 6 months and 3 years after the procedure with the SF-36 scales. RESULTS: Respective pre- and post-treatment pain scores were 8.71 (SE = 0.1) and 2.77 (SE = 0.18; P < .00001). Respective pre- and post-treatment analgesic use scores were 2.93 (SE = 0.9) and 1.64 (SE = 0.09; P < .00001). Respective pre- and post-treatment activity levels were 2.66 (SE = 0.1) and 1.64 (SE = 0.11; P < .00001). There was a statistically significant improvement on nine of 10 SF-36 scales (P < .001) after 1 month and on eight of 10 SF-36 scales (P < .02) at long-term follow-up. CONCLUSION: Percutaneous vertebroplasty offers statistically significant benefits in decreasing pain, decreasing use of analgesics, and increasing mobility in appropriately selected patients. Percutaneous vertebroplasty also offers a statistically significant benefit in most SF-36 scales at both short- and long-term follow-up.

Activities of Daily Living↗
PubMed2005

Percutaneous vertebroplasty: indications, contraindications, technique, and complications.

Percutaneous vertebroplasty is emerging as one of the most promising new interventional procedures for relieving (or reducing) painful vertebra, with the injection of surgical polymethylmethacrylate or cement into vertebral bodies. This imaged-guided technique, originally used to treat vertebral hemangioma, has recently been extended to the treatment of metastases, osteoporotic compression fractures, and vertebral myeloma. It is increasingly being accepted as a main treatment of choice in the management of resistant back pain due to vertebral compression fractures, especially in the elderly individual who is not a candidate for surgery. In this article, we review indications, contraindications, technique, and complications of percutaneous vertebroplasty.

Bone Cements↗
PubMed1989

[Effect of filler system on the mechanical properties of light-cured composite resins. II. Mechanical properties of visible light-cured composite resins with binary filler system].

To improve the fracture resistance of the composite resin system under highly stressed conditions, a variable amount of microfiller was incorporated into the light-cured composite resins containing splinter-shaped silica filler. With the increasing the microfiller content (10-30 wt%) in the resin matrix, the elastic modulus, compressive proportional limit and compressive fracture strength of the composite resin were increased. The plastic deformation of the composite resins under compressive stress were decreased with increasing microfiller content. These findings suggested that the combination of a larger silica filler and microfiller would increase the compressive fracture resistance of the composite resin systems.

Composite Resins↗
PubMed2004

Biomechanical comparison of kyphoplasty with different bone cements.

STUDY DESIGN: Ex vivo biomechanical study. OBJECTIVES: To compare the biomechanical properties of isolated, fractured, osteoporotic vertebral bodies after treatment by kyphoplasty with one of two cements: alpha-tri-calcium phosphate cement (Biopex-R; Mitsubishi Materials Corp., Tokyo, Japan) or polymethylmethacrylate (Simplex P; Stryker-Howmedica-Osteonics, Mahwah, NJ). SUMMARY OF BACKGROUND DATA: Kyphoplasty and vertebroplasty typically use polymethylmethacrylate cements for the treatment of osteoporotic compression fractures. Scant information exists regarding the use of alternative cements in kyphoplasty. METHODS: Simulated compression fractures were created in 24 vertebral bodies (T6-T9, L2-L5) harvested from three female cadavers. Vertebral bodies were assigned to one of two groups: kyphoplasty with Biopex-R or kyphoplasty with Simplex P. The kyphoplasty treatment consisted of inserting bone tamps bipedicularly into each vertebral body, inflating the tamp, and filling the created void with Biopex-R or Simplex P. Pretreatment and post-treatment heights were measured, and the repaired vertebral bodies were recompressed to determine posttreatment strength and stiffness values. Differences were checked for significance (P < 0.05) using a repeated-measures analysis of variance followed by Tukey's test. RESULTS: Kyphoplasty with Biopex-R restored strength in the lumbar and thoracic vertebral bodies. Kyphoplasty with Simplex P displayed significantly greater posttreatment strength than initial strength in the thoracic region. Vertebral bodies augmented with either cement were significantly less stiff than their initial conditions, except for the thoracic vertebrae treated with Simplex P, in which stiffness was restored. There was no significant difference in percentage of height restored between the cement treatments. CONCLUSIONS: Kyphoplasty with either cement restored initial strength. In general, stiffness was not restored.

Aged↗
PubMed2000

Biomechanical evaluation of a new bone cement for use in vertebroplasty.

STUDY DESIGN: Comparative ex vivobiomechanical study. OBJECTIVES: To determine the strength and stiffness of osteoporotic vertebral bodies subjected to compression fractures and subsequently stabilized via bipedicular injection of one of two bone cements: one is a commercially available polymethylmethacrylate (Simplex P) and one is a proprietary glass-ceramic-reinforced BisGMA/BisEMA/TEGDMA matrix composite that is being developed for use in vertebroplasty (Orthocomp). SUMMARY OF BACKGROUND DATA: Osteoporotic compression fractures present diagnostic and therapeutic challenges for the clinician. Vertebroplasty, a new technique for treating such fractures, stabilizes vertebral bodies by injection of cement. Little is known, however, about the biomechanics of this treatment. METHODS: Five vertebral bodies (L1-L5) from each of four fresh spines were harvested from female cadavers (age, 80 +/- 5 years), screened for bone density using DEXA (t = -3.4 to -6.4), disarticulated, and compressed in a materials testing machine to determine initial strength and stiffness. The fractures then were repaired using a transpedicular injection of either Orthocomp or Simplex P and recrushed. RESULTS: For both cement treatments, vertebral body strength after injection of cement was significantly greater than initial strength values. Vertebral bodies augmented with Orthocomp recovered their initial stiffness; however, vertebral bodies augmented with Simplex P were significantly less stiff than they were in their initial condition. CONCLUSIONS: Augmentation with Orthocomp results in similar or greater mechanical properties compared with Simplex P, but these biomechanical results have yet to be substantiated in clinical studies.

Aged↗
PubMedDate not supplied

An ex vivo biomechanical evaluation of a hydroxyapatite cement for use with kyphoplasty.

BACKGROUND AND PURPOSE: Previous ex vivo biomechanical studies have shown that kyphoplasty with polymethylmethacrylate cement increases vertebral body (VB) strength and restores VB stiffness and height after compression fracture. The purpose of the current study was to determine if a hydroxyapatite cement used as a void filler during kyphoplasty provides mechanical stabilization similar to that of a polymethylmethacrylate cement. METHODS: Simulated compression fractures were experimentally created in 33 osteoporotic VBs harvested from female cadaver spines. VBs were assigned to one of three groups: 1) kyphoplasty with a custom mixture of Simplex P; 2) kyphoplasty with BoneSource; and 3) no treatment. The kyphoplasty treatment consisted of inserting a balloon-like device into the VB via both pedicles, inflating the tamp, and filling the created void with Simplex P bone cement or BoneSource. VBs in the no-treatment group received no interventions. Pre- and posttreatment heights were measured, and the repaired VBs were recompressed to determine posttreatment strength and stiffness values. RESULTS: Kyphoplasty with altered Simplex P restored strength, whereas kyphoplasty with BoneSource and the no-treatment protocol both resulted in significantly weaker VBs relative to initial strength. All treatments resulted in significantly less stiff VBs relative to their initial condition. All VBs lost significant height after initial compression, but a significant amount of lost height was restored by kyphoplasty with either cement. CONCLUSION: Kyphoplasty with either cement significantly restored VB height. Kyphoplasty with altered Simplex P resulted in stronger repairs than did no treatment or kyphoplasty with BoneSource.

Aged↗
PubMed2004

Effectiveness of high trough levels of cyclosporine for 5 months in a case of steroid-dependent nephrotic syndrome with severe steroid toxicity.

Glucocorticoid treatment for steroid-dependent nephrotic syndrome (NS) is associated with severe adverse effects, such as bone fractures and epidural lipomatosis. Furthermore, a high trough level of cyclosporine (CsA) over an extended period of time is known to induce CsA nephropathy. We present a girl with steroid-dependent NS and steroid-induced vertebral compression fractures and epidural lipomatosis who was treated with a high-dose of prednisolone after experiencing several relapses. A high CsA trough level (between 147 and 225 ng/mL) over a period of only 5 months was effective in improving the vertebral compression fractures, alleviating the epidural lipomatosis by enabling the discontinuation of prednisolone treatment. Thus, high trough levels of CsA over a short period of time may enable prednisolone to be discontinued in cases of steroid-dependent NS without causing any clinical, histological, serum and/or urinary CsA-related adverse effects.

Child, Preschool↗
PubMed1990

Relationship of lung function to severity of osteoporosis in women.

To determine if the severity of osteoporosis and its resultant hyperkyphosis cause measurable impairment of lung function, 74 women referred for osteoporosis evaluation underwent pulmonary function testing. Women with thoracic wedge compression fractures secondary to osteoporosis had significantly lower percent predicted FVC than did those without fractures. In hierarchical regression analysis, after controlling for age and arm span, there was a significant effect on FVC of the degree of hyperkyphosis as measured by Cobb's angle (increment in R2 = 0.14, p less than 0.001). The addition of the number of vertebral fractures to the model was also significant (increment in R2 = 0.06, p less than 0.002), but cortical bone volume, bone mineral density, and smoking status did not significantly improve the model. From one half of subjects tested, a regression equation was generated relating %FVC and the number of thoracic fractures: %FVC = 103.4 - 9.4 x number of fractures. When used to predict lung function impairment in the second half of study subjects, the correlation between measured and %FVC was r = 0.59 (p less than 0.002). Kyphosis and thoracic compression fractures caused by osteoporosis produce modest but predictable declines in vital capacity in women.

Adult↗
PubMed2000

Evaluation of metastatic bone disease with pentavalent 99Tc(m)-dimercaptosuccinic acid: a comparison with whole-body scanning and 4/24 hour quantitation of vertebral lesions.

The aim of this study was to establish the value of 99Tcm(V)-DMSA scintigraphy in the detection of metastatic bone lesions and compare the results to 99Tcm-MDP bone scintigraphy. Thirty-four patients presenting with metastatic bone disease (Group 1) and 12 controls with degenerative skeletal lesions (Group 2) were studied. Conventional bone scanning and 99Tcm(V)-DMSA whole-body scanning were performed on all patients. All scans were interpreted visually. Furthermore, lesion-to-normal bone ratios (L/N) in vertebral metastases on the 4 and 24 h bone scans were obtained in 58 lesions of cancer patients and in 23 benign (degenerative) vertebral lesions of the control group. 99Tcm-MDP L/N ratios at 24 h (3.08 +/- 0.32) were significantly higher than those at 4 h (2.48 +/- 0.24) in the malignant foci (P < 0.001). No significant difference was observed in benign lesions (P > 0.05). In 167 (164 metastatic, 3 traumatic) of 186 99Tcm-MDP positive lesions (90%) of Group 1, 99Tcm(V)-DMSA uptake was observed. The remaining 19 lesions (10%) were 99Tcm(V)-DMSA negative. Fourteen of these 19 sites were diagnosed as benign. The remaining five foci were malignant. In four lung cancer metastases showing no 99Tcm-MDP uptake, 99Tcm(V)-DMSA uptake was observed. There was no 99Tcm(V)-DMSA accumulation in any of the 99Tcm-MDP positive degenerative lesions of Group 2. All quantitatively evaluated (n = 42) vertebral metastatic foci and two compression fractures in Group 1 showed 99Tcm(V)-DMSA accumulation and an increased 99Tcm-MDP L/N ratio at 24 h. A total of 36 degenerative lesions (Groups 1 and 2) and one compression fracture (Group 1) showed neither 99Tcm(V)-DMSA uptake nor an increased 99Tcm-MDP L/N ratio at 24 h. Our results indicate that quantitative 4/24 h analysis of vertebral lesions on 99Tcm-MDP scans has a similar diagnostic value to 99Tcm(V)-DMSA imaging in the detection of bone metastases. However, the accumulation of 99Tcm(V)-DMSA in four lung cancer metastases showing no 99Tcm-MDP uptake is encouraging and justifies further research in patients with proven bone metastases and negative bone scans.

Bone Neoplasms↗
PubMed2000

Percutaneous vertebroplasty for pain relief and spinal stabilization.

STUDY DESIGN: This was a retrospective review of 47 consecutive patients (1995-1998) in whom percutaneous intraosseous methylmethacrylate cement injection (percutaneous vertebroplasty) was used to treat osteoporotic vertebral compression fractures and spinal column neoplasms. OBJECTIVES: To present initial results regarding pain relief, spinal stabilization, and complications after treatment with percutaneous vertebroplasty. SUMMARY OF BACKGROUND DATA: Percutaneous vertebroplasty was developed in France in the late 1980s. Several European reports have described excellent results for treatment of compression fractures and neoplasms. The procedure was not performed in the United States until 1994. Only a single series of 29 patients treated in the United States has been reported. METHODS: A retrospective review was conducted of 47 consecutive patients with 84 vertebrae treated with percutaneous vertebroplasty. Thirty-eight patients with 70 vertebrae had symptomatic, osteoporotic fractures and had failed medical therapy. Eight patients with 13 vertebrae had primary or metastatic neoplasms. One patient had a hemangioma. Immediate and long-term pain response, spinal stability, and complications were evaluated. RESULTS: Among the 38 patients treated for osteoporotic fractures, 24 (63%) had marked to complete pain relief, 12 (32%) moderate relief and 2 (5%) no significant change. Only 4 of the 8 patients with malignancies had significant pain relief. In 7 of these patients, no further vertebral compression occurred, and spinal canal compromise was prevented. The patient with the hemangioma had no significant pain reduction. Minor complications occurred in 3 (6%) patients. CONCLUSIONS: Percutaneous vertebroplasty provided significant pain relief in a high percentage of patients with osteoporotic fractures. The procedure provided spinal stabilization in patients with malignancies but did not produce consistent pain relief. Complications were minor and infrequent. Percutaneous vertebroplasty is a promising therapy for patients with osteoporotic fractures and for selected vertebral column neoplasms.

Adult↗
PubMed1990

Trabecular mineral contents of lumbar vertebra in patients with osteoporosis.

The trabecular mineral contents (TMCs) of the third lumbar vertebra in normal subjects and patients with spinal osteoporosis and with femoral neck fracture were measured by quantitative computed tomography (QCT) using a reference phantom. The present paper describes these results. The TMCs in patients with spinal osteoporosis and with femoral neck fracture were significantly lower than those in normal subjects. When evaluated in terms of the ratio to the mean trabecular mineral content (mTMC) in normal subjects of the same decade groups, it was assumed that there should be a threshold value of vertebral compression fracture, and that value was approximately 50% of the mTMC in normal subjects. A correlation was noted between the data of the QCT method and those of the microdensitometric method in the groups with vertebral compression fracture and with femoral neck fracture, but not in the group without vertebral fracture.

Adult↗
PubMed1996

Intertrabecular pattern of tumors metastatic to bone.

BACKGROUND: The prevalence of radiologically invisible metastatic tumors to bone is not known. To clarify this, the authors examined histologic sections, radiographs, bone scans, and magnetic resonance (MR) images of autopsied patients with bone metastases. METHODS: Complete slices of the vertebral column, including C3-S1, were obtained from 52 cadavers with metastatic tumors to the spine. Macroscopic and histologic features were compared with postmortem roentgenographs (52 patients), bone scans with 99mTc-labelled methylene diphosphonate (17 patients), and MR images (4 patients). Morphologic patterns were classified into intertrabecular, osteoblastic, osteolytic, mixed, small lesion, and compression fracture. RESULTS: Metastatic lesions were found in 734 of the 1194 vertebral bodies. The lesions were intertrabecular in 255 vertebrae, osteoblastic in 185, osteolytic in 114, mixed in 70, small lesion in 83, and compression fracture in 27. Postmortem radiographs demonstrated lesions in 367 (50%) of the 734 vertebrae, bone scans in 103 (34.7%) of the 297 vertebrae examined, and MR images in all 42 (100%) vertebral bodies imaged. Lesions showing an intertrabecular pattern were detected in only 7.1% of the radiographs and 4.5% of the bone scans. CONCLUSIONS: Radiographs and bone scans often fail to show metastatic lesions, especially those with an intertrabecular pattern. The intertrabecular pattern is a unique histologic form that is difficult to detect on radiographs and bone scans.

Adult↗