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Results for “Fractures, Compression”

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PubMed1993

The cluster phenomenon in patients who have multiple vertebral compression fractures.

Little is known about the natural history of patients who have multiple compression fractures. During an eight-year period, eight patients who suffered relentless nonmechanical back pain after an initial compression fracture were evaluated. Radiographs and radionuclide bone scans were obtained in all eight patients and showed the temporal clustering of at least five spontaneous thoracic or lumbar vertebral compression fractures within a period of eight months. The patient database during this eight-year period included 21 patients with a similar number of fractures but without the phenomenon of temporal clustering. Age and gender distribution, premorbid activity levels, presence of secondary causes of osteopenia, dietary history, and vertebral bone density measurements were similar in both groups. Five of the eight patients with cluster fractures were on chronic glucocorticoid therapy for treatment of an underlying illness. All five patients experienced an exacerbation of their chronic illness that required an increase in the dose of their steroid medication within three months preceding the onset of the cluster fractures. No patient in the noncluster fracture control group experienced a similar exacerbation of an underlying illness or required a similar boost in their steroid medication. The temporal clustering of numerous fractures (cluster phenomenon) is a cause of transient severe disability in patients who have profound osteopenia, and may be precipitated by exacerbation of an intercurrent illness or by an associated obligate increase in glucocorticoid medication in a patient with preexisting severe osteopenia.

Aged↗

PubMed1990

Benign versus pathologic compression fractures of vertebral bodies: assessment with conventional spin-echo, chemical-shift, and STIR MR imaging.

Differentiation of benign from pathologic compression fractures of vertebral bodies was evaluated with magnetic resonance imaging in a prospective study of 53 patients. Twenty-six patients had 34 benign posttraumatic compression fractures. Twenty-seven patients had metastatic disease to the vertebral column and seven pathologic fractures. T1- and T2-weighted spin-echo (SE) sequences (1.5 T) were performed in all patients. A presaturation technique was used to obtain "fat" and "water" images to better assess the degree of normal fatty marrow replacement in fractured vertebrae. Short inversion-time inversion-recovery (STIR) images were also obtained. Discrimination between benign and pathologic compression fractures was generally possible with the SE sequences. Chronic benign fractures demonstrated isointense marrow signal intensity (SI), compared with that of normal vertebrae with all sequences. Pathologic fractures showed low SI on T1-weighted images and high SI on T2-weighted images. Fat images revealed complete replacement of normal fatty marrow, shown as absent SI in the involved vertebral body. Water and STIR images showed diffuse high SI in pathologic fractures, with STIR images having the highest contrast between abnormal and normal marrow. Acute benign compression fractures also demonstrated high SI on T2-weighted, water, and STIR images, but the SI was less pronounced and the pattern was generally more inhomogeneous than that of pathologic compressions. In general, fat images showed only partial replacement of normal fatty marrow by low SI, in contrast to the complete absence of marrow SI typical of pathologic fractures.

Adolescent↗

PubMed1979

Unilateral lateral mass compression fractures of the axis.

Lateral mass compression fractures of the axis involve compression of the pedicle and displacement of the overlying facet, with or without an accompanying fracture of the odontoid. These unilateral fractures are not rare. Correlation is made between clinical cases and cadaver material with analysis of microradiographs. Criteria for recognition of the resultant healed fracture deformity include: (1) Tilting of the odontoid; (2) Loss of the odontoid shoulder on the affected side; (3) Increased downward slope of the affected facet; (4) Lateral compression, possibly with buckling; (5) Asymmetrical apophyseal joints between axis and atlas; and (6) Tilting downward of occiput on affected side, often with evidence of rotation between the occiput and the axis. Not all criteria need be present. Clinical sequelae often include persistent neck pain, limited rotation of the head, and occipital headaches radiating anteriorly.

Adult↗

PubMed2001

New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures.

STUDY DESIGN: Literature review. OBJECTIVES: To describe new treatments for painful osteoporotic compression fractures in light of available scientific literature and clinical experience. SUMMARY OF BACKGROUND DATA: Painful vertebral osteoporotic compression fractures lead to significant morbidity and mortality. This relates to pulmonary dysfunction, eating disorders (nutritional deficits), pain, loss of independence, and mental status change (related to pain and medications). Medications to treat osteoporosis (primarily antiresorptive) do not effectively treat the pain or the fracture, and require over 1 year to reduce the degree of osteoporosis. Kyphoplasty and vertebroplasty are new techniques that help decrease the pain and improve function in fractured vertebrae. METHODS: This is a descriptive review of the background leading to vertebroplasty and kyphoplasty, a description of the techniques, a review of the literature, as well as current ongoing studies evaluating kyphoplasty. RESULTS: Both techniques have had a very high acceptance and use rate. There is 95% improvement in pain and significant improvement in function following treatment by either of these percutaneous techniques. Kyphoplasty improves height of the fractured vertebra, and improves kyphosis by over 50%, if performed within 3 months from the onset of the fracture (onset of pain). There is some height improvement, though not as marked, along with 95% clinical improvement, if the procedure is performed after 3 months. Complications occur with both and relate to cement leakage in both, and cement emboli with vertebroplasty. CONCLUSION: Kyphoplasty and vertebroplasty are safe and effective, and have a useful role in the treatment of painful osteoporotic vertebral compression fractures that do not respond to conventional treatments. Kyphoplasty offers the additional advantage of realigning the spinal column and regaining height of the fractured vertebra, which may help decrease the pulmonary, GI, and early morbidity consequences related to these fractures. Both procedures are technically demanding.

Aged↗

PubMed2003

Diagnosis and treatment of osteoporosis in patients with vertebral compression fractures.

OBJECTIVES: To determine whether patients with vertebral compression fractures are diagnosed with or treated for osteoporosis. DESIGN: Retrospective cohort study. SETTING: Two primary care practices in Massachusetts. PARTICIPANTS: Two hundred six patients with vertebral compression fractures noted on routine radiographs in 1997-1998. MEASUREMENTS: Percentage of patients diagnosed with osteoporosis and treated with prescription medications (estrogen, bisphosphonates, raloxifene, or calcitonin). Factors associated with missed osteoporosis diagnosis and treatment, including risk factors for osteoporosis, comorbidities, vertebral fracture severity, and processes of care communication were also examined. RESULTS: The median patient age was 76, 71% of the cohort was female, and 13% of patients had a history of corticosteroid use. Thirty-eight percent of subjects (46% of women and 19% of men) were diagnosed with osteoporosis and 32% (39% of women and 14% of men) received prescription medications for osteoporosis. Of women who were diagnosed with osteoporosis, 69% received prescription medications. In adjusted analyses women younger than 50 (adjusted odds ratio (AOR) = 0.09; 95% confidence interval (CI) = 0.01-0.71) and 90 and older (AOR = 0.27; 95% CI = 0.08-0.98) were less likely to be diagnosed with osteoporosis, whereas women with a prior hip or radial fracture (AOR = 3.65; 95% CI = 1.28-10.38) or back pain (AOR = 2.84; 95% CI = 1.38-5.85) were more likely to be diagnosed with osteoporosis. CONCLUSIONS: Physicians frequently did not diagnose osteoporosis in primary care patients with vertebral fractures, missing an important preventive opportunity for patients at high risk for future fractures. Efforts targeted to improving diagnosis of osteoporosis could improve patient care.

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PubMed2004

Osteoporotic spinal deformity: a biomechanical rationale for the clinical consequences and treatment of vertebral body compression fractures.

This review article develops a biomechanical rationale for the clinical consequences and treatment of osteoporotic vertebral body compression fracture. In patients with osteoporotic vertebral fractures and spinal deformity, altered spinal biomechanics and global spinal imbalance are important factors in the increased morbidity and mortality reported in this population. Severe spinal deformity impairs physical functioning, health, and quality of life. The spinal deformity itself, independent of pain, is a significant cause of disability. Spinal deformity is also an independent risk factor for hip fracture. Treatments directed at osteoporotic vertebral compression fractures should ideally address spinal deformity as well as pain. Balloon kyphoplasty, the minimally invasive technique of reduction and internal fixation of osteopenic vertebral body compression fractures that addresses pain and spinal deformity, is discussed.

Biomechanical Phenomena↗

PubMedDate not supplied

Nonprogression of vertebral area or bone mineral content on DXA does not predict compression fractures.

The 2003 International Society for Clinical Densitometry consensus guidelines recommend exclusion of vertebral bodies for lack of increase in bone area (BA) or bone mineral content (BMC), or an unusual T-score discrepancy (>1 standard deviation [SD]) between adjacent vertebrae. It is unclear how often nonprogression in BA, BMC, and T-score discrepancies predicts abnormal vertebral morphology, such as compression fractures. We prospectively studied 101 individuals sent for clinical dual-energy X-ray absorptiometry (DXA) scanning, including 20.8% males and 79.2% females. The population was 85% Caucasian, 13% African-American, and 3% Hispanic. The mean age was 65.6 yr; 20.2% were currently on steroids and 22.7% were taking drugs for osteoporosis. All subjects underwent the usual posteroanterior (PA) spine DXA scan PA and lateral vertebral fracture analysis (VFA). The presence of vertebral compression fractures and/or scoliosis of the lumbar spine by VFA were correlated with nonprogression of area or BMC, and/or a difference of >1 SD in T-scores using Fisher's exact test. By VFA, we detected 22 lumbar compression fractures among 101 subjects, which was 16% of the population. Nonprogression of BA, BMC, and T-score discrepancy were not statistically associated with the presence of vertebral compression fracture as assessed by VFA. Thirty percent of subjects had lumbar spine scoliosis. The presence of scoliosis was significantly related to a T-score discrepancy at L1-L4.

Absorptiometry, Photon↗

PubMed2002

Acute osteoporotic and neoplastic vertebral compression fractures: fluid sign at MR imaging.

PURPOSE: To evaluate the occurrence, location, and shape of the fluid sign in acute osteoporotic and neoplastic vertebral compression fractures at magnetic resonance (MR) imaging. MATERIALS AND METHODS: The study group comprised 87 consecutive patients with acute vertebral compression fractures due to osteoporotic (n = 52) or neoplastic (n = 35) infiltration. The MR imaging protocol included nonenhanced T1-weighted spin-echo and short inversion time inversion-recovery sequences and a 1.5-T system. Readers blinded to the outcome documented the occurrence, shape, and location of the fluid sign with consensus. The fluid sign was correlated with the cause, age, and severity of the fracture. The diagnosis was confirmed with surgery, follow-up MR imaging, clinical follow-up, or unequivocal imaging findings. Wilcoxon and chi(2) tests were used to assess significance. RESULTS: In fractured vertebral bodies, the fluid sign was adjacent to the fractured end plates and exhibited signal intensity isointense to that of cerebrospinal fluid. The fluid sign was linear (n = 16), triangular (n = 5), or focal (n = 2) and was significantly associated with osteoporotic fractures (21 [40%] of 52; P <.001). The fluid sign occurred in two (6%) of 35 neoplastic compression fractures. Histologic examination demonstrated osteonecrosis, edema, and fibrosis at the site of the fluid sign. There was a tendency toward older fractures exhibiting the fluid sign, but this relationship was not significant (P >.05). In osteoporotic fractures, the fluid sign was significantly associated with fracture severity (P <.05). CONCLUSION: The fluid sign is featured in acute vertebral compression fractures that show bone marrow edema. It can be an additional sign of osteoporosis and rarely occurs in metastatic fractures.

Aged↗

PubMed2003

[Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: review of the literature].

OBJECTIVE: To determine the effectiveness and safety of percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures as published in the scientific literature. DESIGN: Literature review. METHOD: Medline and the Cochrane library were searched with the terms 'percutaneous vertebroplasty', 'vertebral compression fractures', 'osteoporotic' and 'osteoporosis'. Criteria for inclusion were: (a) the studies had to have been published in the period January 1985-August 2002, (b) the study population had to include at least 10 patients, (c) the patients had to have been treated with percutaneous vertebroplasty, and (d) the diagnosis had to have been 'osteoporotic vertebral compression fracture'. RESULTS: Twelve studies met the inclusion criteria. Pain relief was seen in 60%-100% of the patients within the first 24 hours and this result improved to 78-100% in the long term (maximum 4 years). The complications immediately after the procedure were related to cement leakages and were mostly of no clinical consequence. Serious complications such as pulmonary embolism were rare. In the long term, percutaneous vertebroplasty was associated with an increased risk of fractures in the adjacent vertebrae. CONCLUSION: Percutaneous vertebroplasty seems to be effective and safe in the treatment of osteoporotic vertebral compression fractures. A prospective randomised intervention study has, however, not yet been performed. For the time being, percutaneous vertebroplasty should be reserved for carefully selected patients in whom conservative therapy has not produced results.

Adult↗

PubMed2003

Pain and debility associated with spinal compression fractures.

Approximately twenty percent of women will suffer a compression fracture sometime in their later years. Almost always the result of postmenopausal osteoporosis, they create dramatic and lasting consequences that lead to pain, reduced physiologic function and increased frailty. Recognition and treatment of compression fractures is an important step in maintaining an acceptable level of comfort and an optimal functional ability.

Aged↗

PubMed1959