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PubMed2002

Delayed post-traumatic osteonecrosis of a vertebral body (Kummell's disease).

Kummell's disease is a rare spinal disorder characterized as avascular necrosis of a vertebral body occurring in a delayed fashion after minor trauma. The disease derives its name from the German surgeon Hermann Kummell, who described a series of patients with the disorder in 1895. Kummell's disease is distinguished from typical osteoporotic compression fractures, by virtue of the fact that patients with Kummell's disease develop symptoms in delayed fashion. In addition, Kummell's disease exhibits different signal characteristics on magnetic resonance imaging when compared to osteoporotic compression fractures. In this review we discuss the pathophysiology, histopathology and treatment of this interesting disorder.

Aged↗
PubMed1989

[The value of pinhole collimator imaging in the scintigraphic analysis of vertebral diseases].

Recent findings suggested a possible role for pinhole collimator scintigraphy to differentiate between metastases, infection and fractures of the vertebrae. The aim of this study was to verify these findings and to ascertain whether we could identify any other specific scintigraphic patterns. The study group consisted of 58 patients. A metastatic pattern was obtained in 18 patients, while 16 showed the compression fracture pattern, 3 the tuberculosis pattern and 1 the pyogenic infection pattern. The study was considered normal in 4 patients and showed a nonspecific pattern in 4. Sensitivity was 85% for the metastatic pattern and 83% for the compression fracture pattern. Specificity was 94% for both patterns. Unique new patterns were identified in Paget's disease and in degenerative disease of the vertebrae (12 patients). Pinhole scintigraphy of the vertebrae is a valuable aid for detecting specific diseases of the vertebrae. Our findings suggest a valuable new role for skeletal scintigraphy, improving the specificity and obviating, in most cases of vertebral disease, the need for additional investigations.

Evaluation Studies as Topic↗
PubMed1995

[Correlation of bone mineral density with lumbago and vertebral fracture in climacteric women].

Lumbago is considered to be an important clinical symptom of involutional osteoporosis, and is designated by the Ministry of Health and Welfare of Japan as one of the principal symptoms included in the criteria for the diagnosis of that condition. A study was designed to investigate the relationship between bone mineral density (BMD) and lumbago, as well as between BMD and vertebral compressive fractures in climacteric women. The study included a total of 400 outpatients (aged 49.2 +/- 0.4 years) visiting our department. The degree of lumbago was evaluated on the basis of an oral questionnaire. BMD was measured simultaneously by X-ray of the thoracic and lumbar vertebrae, the MD/MS and DXA. The presence or absence of vertebral fracture was judged on the X-ray image. As a result, there was seen to be no relation between lumbago and BMD. BMD was found to be significantly (p < 0.01) lower in 15 subjects with compressive fracture at thoracic and/or lumbar levels as judged on X-ray image than in subjects without fractures (n = 328). The above results suggested that, rather than considering lumbago as an important clinical symptom, the exact measurement of BMD and assessment of fracture in accordance with the definition of osteoporosis is the first step in diagnosing this disease. The upper limit of the fracture threshold determined from L2-4 BMD in these 15 subjects was 0.982 g/cm2. Of the subjects without fractures, 48.3% were found to have L2-4 BMD values at this level or lower, suggesting that they are at high risk of future fracture.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1992

Calcitonin in the treatment of osteoporotic bone pain.

Calcitonin has been observed to have an analgesic effect on painful bone conditions. A case illustrating the antinociceptive effect of calcitonin on bone pain caused by osteoporotic vertebral compression fracture is presented. There is increasing clinical evidence supporting this phenomenon, though few rigorously controlled studies exist. Calcitonin may have an advantage over other analgesics in the treatment of bone pain resulting from an osteoporotic compression fracture, because, in addition to the observed analgesic effect, it is useful in treating the underlying disorder.

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PubMed2000

Magnetic resonance imaging in the evaluation of patients for percutaneous vertebroplasty.

Osteoporosis and osteoporotic compression fractures of the vertebral bodies are major health problems facing women and older people of both sexes. In the last several years, percutaneous vertebroplasty has been developed as a treatment for pain caused by vertebral body compression fractures and primary or metastatic neoplasms. A large part of the success of this procedure depends on correct patient selection. As such, magnetic resonance imaging (MRI) plays a vital role in this process. In this review, the clinical evaluation of patients considered for vertebroplasty, the role of MRI in the pretreatment process, the postvertebroplasty appearance of the spine on MRI, and the future applications, such as real-time guidance with MR imaging, will be discussed.

Aged↗
PubMed1979

The healing of experimental fractures by compression osteosynthesis. I. Torsional strength.

Biomechanical properties of osteotomized rabbit tibio-fibular bones fixed with 6-hole stainless steel AO/DCP plates were investigated with torsional loading 3 to 24 weeks postoperatively. During the first 9 weeks maximum torque capacity, energy absorption and torsional rigidity increased, reflecting progressive bony union between the fractured bone ends. From 9 to 24 weeks the values of torque capacity and energy absorption decreased, whereas torsional rigidity seemed to reach a steady state without further significant changes. For the three parameters considered, the mean percentage differences between the osteotomized plated bones and their paired-sham-operated controls were 69, 64 and 80 per cent, respectively. The results suggest that internal fixation of fractured bones provides conditions for undisturbed fracture healing, but that subsequently the rigid nature of the implant has an adverse effect on the cortical bone, which slowly loses strength. Thus the optimal time for removal of the plate seems to be shortly after the fracture has healed and before the bony tissue had been weakened by secondary changes, such as cancellous transformation and spatial rearrangement of the tubular bone.

Animals↗
PubMed2003

[Percutaneous vertebroplasty (pv): indications, contraindications, and technique].

PURPOSE: Percutaneous vertebroplasty (pv) is a worldwide increasingly performed interventional therapeutic procedure. This article addresses indications, patient preparation, technical requirements and approach as well as possible complications of percutaneous vertebroplasty. TECHNIQUE: Percutaneous vertebroplasty is a technique consisting in an injection of bone cement into a vertebral body under imaging guidance. This procedure is performed to relief pain and support the mechanical stability in partially collapsed vertebral bodies. RESULTS: In the management of spinal compression fractures secondary to osteoporosis, myeloma, osteolytic metastases and aggressive hemangiomas, percutaneous vertebroplasty yields analgesic effect, and provides additional fortification in weakened segments of the vertebral column. Contraindications include major bleeding disorders, radicular pain and pain caused by compression of the myelon. DISCUSSION: Percutaneous vertebroplasty results in prompt pain relief and rapid rehabilitation. In experienced hands, using correct technique, pv is a safe and effective procedure for treating pain, caused either by osteoporotic or malignant vertebral compression fractures.

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PubMed1986

Incidental vertebral lesions identified during technetium-99m sulfur colloid liver-spleen imaging.

Three vertebral lesions, two compression fractures, and one metastasis in two patients, were incidentally demonstrated during Tc-99m sulfur colloid liver-spleen studies. Although the scintigraphic photon-deficient area could not be differentiated due to the metastasis and the compression fracture, the abnormal radiocolloid findings of vertebrae may lead to further studies using Tc-99m diphosphonate, Ga-67, radiographic studies, and/or biopsy.

Aged↗
PubMed2002

An in vivo comparison of the potential for extravertebral cement leak after vertebroplasty and kyphoplasty.

STUDY DESIGN: A prospective in vivo study was conducted during the performance of kyphoplasty for the treatment of osteoporotic vertebral compression fractures, comparing extravertebral contrast extravasation with kyphoplasty and vertebroplasty. OBJECTIVE: To determine the frequency and pattern of extravertebral contrast extravasation after intravertebral injection during kyphoplasty and vertebroplasty, which have implications for cement leakage during these procedures. SUMMARY OF BACKGROUND DATA: Vertebroplasty involves the injection of cement directly into the cancellous bone of a fractured vertebral body in an attempt to stabilize the fracture. High rates of extravertebral cement leakage have been noted. Injection of contrast into the vertebral body under fluoroscopy has been recommended in an attempt to predict and minimize cement leakage. An alternative procedure, balloon kyphoplasty, involves the percutaneous placement of an inflatable bone tamp into the fractured vertebral body. As the tamp is inflated, vertebral body height is restored and a cavity is created within the vertebral body, allowing for low-pressure cement filling of the cavity. METHODS: During 20 kyphoplasty surgeries for vertebral compression fractures, contrast studies were performed. Immediately after positioning of an 11-gauge biopsy needle within the midvertebral body, 5 mL of Omnipaque was injected, mimicking vertebroplasty injection. Cinefluoroscopic images were obtained during injection. After bilateral fracture reduction and intravertebral cavity creation using inflatable bone tamps (kyphoplasty), contrast was injected again, mimicking cement injection during kyphoplasty. Scoring of the extravertebral contrast leakage was based on filling of the inferior vena cava and epidural vessels, as well as direct contrast extension through the vertebral cortex. RESULTS: The mean contrast leak scores for vertebroplasty- and kyphoplasty-stage injections were, respectively, 4.3 and 0.8 of 6 (P = 0.0001). The scores for epidural vessel and inferior vena cava filling and transcortical contrast leak each was significantly lower for kyphoplasty- than for vertebroplasty-stage injections (P = 0.0001 each). CONCLUSIONS: The findings showed less vascular and transcortical extravasation of injected contrast with kyphoplasty than with vertebroplasty. Although leakage of contrast may not correlate precisely with polymethylmethacrylate leakage, the authors believe this study highlights the relative safety of these procedures.

Aged↗
PubMed2002

Spinal injuries caused by the acceleration of ejection.

The speed and altitude at which modern military aircraft operate are such that escape can only be achieved by some means of forcibly propelling the aircrew clear of the aircraft. The most common method of doing this is by use of an ejection seat. The use of such seats, whilst generally life saving, exposes aircrew to forces that may be at the limits of human tolerance. Each phase of the ejection sequence is associated with characteristic injury patterns and of particular concern is the occurrence of spinal compression fractures, which are caused by the upward acceleration of the ejection seat. Thorough investigation of aircrew who eject is necessary and magnetic resonance imaging of the spines of these aircrew is now becoming mandatory. Aircrew who sustain stable anterior wedge compression fractures usually require no invasive treatment, but are prevented from flying aircraft fitted with ejection seats for 3-4 months.

Acceleration↗
PubMed2002

An ex vivo evaluation of an inflatable bone tamp used to reduce fractures within vertebral bodies under load.

STUDY DESIGN: Ex vivo biomechanical study using osteoporotic cadaveric vertebral bodies. OBJECTIVE: To determine if fracture reduction could be achieved by the inflatable bone tamp (tamp) in vertebral bodies under simulated physiologic loads. SUMMARY OF BACKGROUND DATA: Previous ex vivo biomechanical studies showed that kyphoplasty restored vertebral body height with vertebral body endplates under stress-free conditions. METHODS: Simulated compression fractures were experimentally created in 18 osteoporotic vertebral bodies alternatingly assigned to one of two treatment (tamp inflation) groups: low axial load (111 N) or high axial load (222 N). Each vertebral body was then placed between two platens in a special radiolucent loading fixture and subjected to the preassigned load to simulate in vivo physiologic loading. The tamps were inflated and postreduction heights were measured fluoroscopically. The effect of applied load and condition on vertebral body height was checked for significance (P < 0.05). RESULTS: Comparing the experimental conditions (initial, postcompression, postinflation), there were no significant vertebral body height differences between the load groups (low load vs. high load). However, vertebral body height differences between conditions within each load group were all significant. For the low-load and high-load groups, mean postinflation heights (24.4 and 24.4 mm) were significantly greater than mean postcompression heights (21.6 and 22.5 mm) but significantly less than initial vertebral body heights (26.6 and 26.3 mm), respectively. Initial heights were fully restored in 22% (two of nine) of vertebral bodies in both groups. CONCLUSION: The inflatable bone tamp restored some of the height lost to compression fractures in vertebral bodies under simulated physiologic loads.

Absorptiometry, Photon↗
PubMed1999

Severe complications of ulcerative colitis after high-dose prednisolone and azathioprine treatment.

We report a rare case of ulcerative colitis (UC) associated with methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa infections in multiple organs, and with compressive fracture from osteoporosis after the administration of high-dose prednisolone and azathioprine. A 25-year-old man had been treated with high-dose prednisolone for UC. He suddenly experienced severe lumbago, which prevented him from walking. Plain X-ray demonstrated compressive fractures of the thoracic and the lumbar vertebrae, which were thought to be due to osteoporosis as a side effect of the high-dose prednisolone. At this admission, in another hospital, he also had a bloody discharge from the rectum, and azathioprine was started; however, the patient's condition still did not show any improvement. The total doses of azathioprine and prednisolone he had received were 3150 mg and more than 15,000 mg, respectively. Considering the presence of the serious complications, surgical intervention was the treatment selected. Culture study revealed MRSA in the feces and nasal cavity, and P. aeruginosa in the feces and urine. Vancomycin hydrochloride and gentamicin were administered, and were effective, with a subsequent negative culture study. Subtotal colectomy with mucus fistula was performed. After the operation, culture studies remained negative. Major steroid side effects such as bone fracture and osteoporosis should be considered as an indication for surgery in UC patients. MRSA and P. aeruginosa are a menace, especially for UC immunosuppressed patients on steroid or immunosuppressive therapy. When these bacteria are detected, there should be prompt and adequate antimicrobial therapy against the organisms and the immunosuppressive therapy should be immediately discontinued. We conclude that surgical therapy should be considered in the earlier stage for patients with intractable UC, rather than continuing long-term administration of steroid or azathioprine, which may lead to serious complications.

Adult↗
PubMed2000

Can insertional torque predict screw loosening and related failures? An in vivo study of pedicle screw fixation augmenting posterior lumbar interbody fusion.

STUDY DESIGN: An investigation of the relation between intraoperative insertional torque of pedicle screws, bone mineral density of the vertebra, and development of screw loosening in vivo. OBJECTIVES: To determine the usefulness of intraoperative measurement of the insertional torque of pedicle screws. SUMMARY OF BACKGROUND DATA: Some biomechanical studies have demonstrated that the insertional torque is highly correlated with bone mineral density and the stability of pedicle screws in vitro. METHODS: Pedicle screw fixation was performed with posterior lumbar interbody fusion in 62 consecutive patients. The mean age of the patients at the time of surgery was 58 years. The insertional torque of pedicle screws was measured intraoperatively in all patients. The mean follow-up period was 2.7 years. RESULTS: The mean insertional torque was 1.28 +/- 0.37 Nm in patients with screw loosening and 1.50 +/- 0. 40 Nm in patients without the problem. The mean insertional torque in patients with compression fractures in the upper vertebra adjacent to the fixed segment was 0.83 +/- 0.23 Nm. There was no significant difference between the mean insertional torque in patients with screw loosening and those without the condition. The mean insertional torque in patients without screw loosening was significantly greater than in patients with compression fractures (P < 0.01). A high correlation was found between insertional torque and bone mineral density (P < 0.01). CONCLUSIONS: Although a high correlation was found between the insertional torque of pedicle screws and bone mineral density in vivo, the insertional torque could not objectively predict screw loosening.

Bone Density↗
PubMed1980

[Investigations of stability with the fixateur externe during strain of bending. Vertical and eccentric strain during compression of the fracture line and while the distance of support is changed (author's transl)].

The Fixateur externe was investigated under vertical and eccentric load when the fracture line was compressed and the distance of support was changed. Three kinds of mounting were used: R (Fixateur externe as frame), Z (three dimensional Fixateur externe) and Z2S (three dimensional Fixateur externe with two screws according to Schanz). If the distance of outer support was increased, the stability became greatly reduced. A compression increased the stability around the fracture line and on the free end of the system. A compression force of 10 kp at the fracture line yielded the greatest increase in stability. If in case of the methods R and Z, the compression was increased beyond 70 kp, there resulted even an instability, which depended on the distance of support. The most stable method of mounting was the three-dimensional Fixateur externe with two screws according to Schanz. The stability was compared if there was either a defect or a compression at the line of the fracture: there resulted a strikingly increased instability, if the distance of support was increased. The compression made it possible to compensate partly for the loss of stability.

Biomechanical Phenomena↗
PubMed2002

Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10 year follow-up of postmenopausal women.

The long-term protective effect of stronger back muscles on the spine was determined in 50 healthy white postmenopausal women, aged 58-75 years, 8 years after they had completed a 2 year randomized, controlled trial. Twenty-seven subjects had performed progressive, resistive back-strengthening exercises for 2 years and 23 had served as controls. Bone mineral density, spine radiographs, back extensor strength, biochemical marker values, and level of physical activity were obtained for all subjects at baseline, 2 years, and 10 years. Mean back extensor strength (BES) in the back-exercise (BE) group was 39.4 kg at baseline, 66.8 kg at 2 years (after 2 years of prescribed exercises), and 32.9 kg at 10 years (8 years after cessation of the prescribed exercises). Mean BES in the control (C) group was 36.9 kg at baseline, 49.0 kg at 2 years, and 26.9 kg at 10 years. The difference between the two groups was still statistically significant at 10 year follow-up (p = 0.001). The difference in bone mineral density, which was not significant between the two groups at baseline and 2 year follow-up, was significant at 10 year follow-up (p = 0.0004). The incidence of vertebral compression fracture was 14 fractures in 322 vertebral bodies examined (4.3%) in the C group and 6 fractures in 378 vertebral bodies examined (1.6%) in the BE group (chi-square test, p = 0.0290). The relative risk for compression fracture was 2.7 times greater in the C group than in the BE group. To our knowledge, this is the first study reported in the literature demonstrating the long-term effect of strong back muscles on the reduction of vertebral fractures in estrogen-deficient women.

Aged↗
PubMed2003

Pulmonary function tests, respiratory muscle strength, and endurance of patients with osteoporosis.

BACKGROUND: It has been shown that patients with thoracic kyphosis due to osteoporosis have diminished pulmonary function. The aim of this study was to determine the pulmonary function, respiratory muscle strength, and endurance of patients with osteoporosis who did not have compression fractures. METHODS: The patient group consisted of 88 recently diagnosed postmenopausal osteoporotic women without spinal fractures. They were matched for age and body mass index with 54 healthy women, who formed the control group. Bone mineral density, pulmonary function test (PFT), maximum voluntary ventilation (MVV), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) measurements of both groups were performed. RESULTS: There were no significant differences between the two groups regarding PFT parameters and MIP and MEP. However, osteoporotic patients had significantly lower MW values. CONCLUSION: Women with postmenopausal osteoporosis without spinal compression fractures have normal PFT, MIP, and MEP values, but they have reduced respiratory muscle endurance.

Aged↗
PubMed1984

Spinal instability as defined by the three-column spine concept in acute spinal trauma.

This article is a presentation of the concept of the three-column spine. The concept evolved from a retrospective review of 412 thoracolumbar spine injuries and observations on spinal instability. The posterior column consists of what Holdsworth described as the posterior ligamentous complex. The middle column includes the posterior longitudinal ligament, posterior annulus fibrosus, and posterior wall of the vertebral body. The anterior column consists of the anterior vertebral body, anterior annulus fibrosus, and anterior longitudinal ligament. Major spinal injuries are classified into four different categories, all definable in terms of the degree of involvement of each of the three columns. Each type is defined also in terms of its pathomechanics, roentgenograms, and computerized axial tomograms, as well as in terms of its particular stability. The compression fracture is basically stress failure of the anterior column with an intact middle column. The burst fracture indicates failure under compression of both the anterior and middle columns. The seat-belt-type spinal fracture is the result of failure of the posterior and middle columns under tension with an intact anterior hinge. In fracture-dislocations, the structure of all three columns fails from forces acting to various degrees from one or another direction.

Biomechanical Phenomena↗