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PubMed2001

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

STUDY DESIGN: Comparative ex vivo biomechanical study. OBJECTIVE: To determine the strength and stiffness of osteoporotic vertebral bodies subjected to compression fractures and stabilized via bipedicular injections of the following: 1) Simplex P (Stryker-Howmedica-Osteonics, Rutherford, NJ), 2) Simplex P formulated consistent with the practice of vertebroplasty (F2), or 3) BoneSource (Stryker-Howmedica-Osteonics). SUMMARY OF BACKGROUND DATA: Little is known about the mechanical stabilization afforded by new materials proposed for use with vertebroplasty. METHODS: Vertebral bodies (T8-T10 and L2-L4) from each of 10 fresh spines were harvested from female cadavers (81 +/- 12 years), screened for bone density (t score, -3.8 +/- 1.1; bone mineral density, 0.75 +/- 15 g/cm2), disarticulated, and compressed to determine initial strength and stiffness. The fractured vertebral bodies were stabilized via bipedicular injections of 4 mL (thoracic) or 6 mL (lumbar) and then recrushed. RESULTS: Vertebral bodies repaired with Simplex P resulted in significantly greater strength (P < 0.05) relative to their prefracture states, those repaired with BoneSource resulted in the restoration of initial strength for both the thoracic and lumbar level, and those repaired with F2 resulted in significantly greater strength (P < 0.05) in the thoracic region and restoration of strength in the lumbar region. All cement treatments resulted in significantly less stiffness compared with initial values. CONCLUSIONS: All three materials tested restored or increased vertebral body strength, but none restored stiffness. Both new materials show promise for use in percutaneous vertebroplasty, but they need clinical evaluation.

Aged↗

PubMed1989

Surgical management of cervical spine injuries.

On the basis of increasing experience, only by keeping strictly to the basic rules, especially through the advantages of a stable internal fixation, better results can be obtained with surgical treatment of cervical spine injuries. For surgical treatment related to the given anatomical situation, the injuries must be subdivided into those above C 3 and the injuries at or below C 3. In injuries above C 3, we would regard the axis body fracture with or without a hangman's fracture and a fresh fracture-dislocation or pseudoarthrosis of the odontoid process as requiring an operation. In injuries above C 3, a posterior modified stabilization without cranial fixation is recommended. The injuries at and below C 3 generally require an anterior approach. With axial deviation, dislocation and fracture-dislocation a stable internal fixation is performed in addition to the fusion of the intervertebral space. With compression and severe compression fractures, the vertebral body is pulled back and firmly fixed by two wires drawn through epidurally behind the vertebral body. The indications for and the late results of early surgical treatment are presented in 125 cases who have undergone such treatment.

Fracture Fixation, Internal↗

PubMed2003

Spine fractures in falling accidents: analysis of multidetector CT findings.

The purpose of the present study was to assess incidence, fracture type, and location of spine fractures due to falls. All emergency room CT requests during a time period of 26 months were reviewed retrospectively. Patients who had fallen or jumped and were initially examined with multidetector CT (MDCT) were included. The MDCT studies were evaluated by two radiologists for trauma location, fracture type, and multiple level involvement. A total of 237 patients (184 males, 53 female, age range 16-86 years, mean age 42 years) met the inclusion criteria. A total of 203 vertebral fractures were seen in 127 patients. Burst fracture (n=78) was the most frequent type of trauma, usually located in the thoracolumbar junction (50%). Also, compression fracture (n=52) was most common in the thoracolumbar junction (39%). Posterior column fracture (n=52) was most frequently detected in the cervical spine (40%). Multiple-level spine fractures were seen in 41 (32%) of the injured patients, of which 12 (29%) had fractures at noncontinuous levels. With increasing height the overall incidence of fractures increased, and burst fractures and multiple level spine fractures became more frequent. Age had no effect on fracture type or location. Spine fractures due to falls are common. Burst fracture is the most common fracture type and most frequently seen in the thoracolumbar junction. Multiple-level fractures were seen in 32% of the cases, of which 29% were seen at noncontinuous levels. Serious spine fractures are seen in all falling height and age groups.

Accidental Falls↗

PubMedDate not supplied

Health status and risk for hip fracture: a case control study of 70-75-year-olds.

A study concerning health status and social factors was performed of all hip fracture patients (n = 868) admitted to the orthopaedic clinics in Gothenburg, Sweden, during the course of 1 year. All non-institutionalized patients aged 70-75 years were invited 6 months after the fracture to a case-control survey with age-matched controls from the gerontological studies in Gothenburg. The hip-fracture patients had lower body mass index (BMI), lower bone mineral content (BMC) and higher prevalence of vertebral compression fractures. The serum concentrations of osteocalcin, aminoterminal peptide from procollagen-III and alkaline phosphatase activity were higher in the fracture group while serum creatinine concentrations and muscle strength were significantly lower. The prevalences of previous stroke and of Parkinsonism were greater in the hip fracture group. No differences in medication were observed. Thirty-nine percent of the hip fracture patients were suffering from pain and 88% had some form of walking disability at the follow-up study.

Journal Article↗

PubMed1990

Low back syndromes. The challenge of accurate diagnosis and management.

The causes of low back pain range from ruptured lumbar disks and spinal stenosis to compression fractures and osteoarthritis. Although surgery may be indicated in some cases, conservative measures are often effective, and preventive regimens may be successful in patients who are obese or otherwise physically unfit. In patients who have been injured on the job or in an automobile accident, the question of compensation may hinder treatment. Hysterical patients may need psychiatric referral.

Back Pain↗

PubMed2004

The radiographic failure of single segment anterior cervical plate fixation in traumatic cervical flexion distraction injuries.

STUDY DESIGN: A radiographic review of 87 patients with either unilateral or bilateral facet dislocations or fracture/dislocations treated with anterior cervical discectomy, fusion, and plating. OBJECTIVE: The primary objective of this study was to report the incidence of radiographic failure and factors that would predispose to this loss of alignment. The secondary objective was to report the rate of pseudarthrosis. SUMMARY OF BACKGROUND DATA: Biomechanical and clinical data conflict regarding the appropriate approach and method of fixation of distractive flexion cervical injuries. Unilateral and bilateral facet fracture subluxations may be surgically stabilized by anterior cervical discectomy, fusion, and plating, posterior instrumentation, or both. There are no documented reports of the rate of radiographic failure of this procedure when limited to a single level injury from a distractive flexion mechanism. METHODS: Inclusion criteria were all single-level unilateral and bilateral facet fracture dislocations or subluxations treated with a single-level anterior cervical discectomy, fusion, and plating. Retrospectively, 107 cases were identified (87 with complete radiographs) from January 1994 to December 2001. Radiographic failure was defined as a change in translation of greater than 4 mm and/or change in angulation of greater than 11 degrees between the immediate postoperative films and the most recent follow-up. Fusion was assessed radiographically. RESULTS: A 13% incidence of radiographic loss of alignment is reported in 87 unilateral and bilateral facet fracture subluxations stabilized with anterior cervical discectomy, fusion, and plating. Radiographic failure correlated with the presence of endplate compression fracture and facet fractures on injury radiographs. There was no correlation between radiographic failure and age, gender, surgeon, unilateral or bilateral injury, plate type, level of injury, degree of translation, or sagittal alignment at the time of injury. CONCLUSION: Loss of postoperative alignment occurred in 13% of facet fracture subluxations treated with anterior cervical discectomy, fusion, and plating. Concern regarding mechanical failure of flexion/distraction injuries should be high when they are associated with fractures of either the facets or of the endplate. Endplate fracture was associated with both mechanical failure and pseudarthrosis.

Adolescent↗

PubMed1982

Intra-articular fractures of the distal tibia.

In a study of 23 intra-articular fractures of the distal tibia of which 18 were re-examined after an average follow-up period of 5.4 years, two major fracture patterns were identified: type A, a rotational pattern, caused by low energy trauma and type B, a compressive fracture pattern caused by high energy trauma. Type B fractures could be divided into three subgroups: 1) An isolated fracture of the anterior or posterior margin of the distal tibia, 2) an extra-articular comminuted fracture with extension into the ankle joint and 3) a comminuted intra-articular fracture. When the initial displacement and comminution were severe or the reduction was not complete, the final results of the comminuted intra-articular fractures were not acceptable. The incidence of osteoarthritis was highest in the group of comminuted intra-articular fractures. The extra-articular comminuted fractures seemed to have a better prognosis as indicated by the final clinical results, including the occurrence of osteoarthritis. It is clear from this study that comminuted intra-articular fractures should not be treated by primary operation. All fractures treated non-operatively had acceptable final clinical results.

Adult↗

PubMed1995

[The characteristics of the spinal trauma in catapulted pilots].

The article discusses the peculiarities of spinal fractures in catapulted pilots: mechanism of fracture--indirect axial load in combination with front or front-lateral bending; morphological picture--wedge-shaped compression fracture of vertebral body; type of fracture--stable; clinic peculiarities--scanty clinic picture as a rule; localization--mid-thorax section and thoracolumbar zone; number of vertebrae affected--1 as a rule. Diagnostic and treatment recommendations are enclosed. The author also deals with a phenomenon which accompanies the emergency abandon of an aircraft--microlesion of spongy osseous tissue of vertebrae without fracture signs under the influence of shock overload, which later can be the reason of degenerative and dystrophic diseases of spine. Preventive and medical measures are described which assure an adequate rehabilitation of functional state of spine.

Accidents, Aviation↗

PubMed1976

Late instability in cervical spine fractures secondary to laminectomy.

Of 256 patients with a major spinal cord injury as a result of fracture of the cervical spine, 38 per cent had a laminectomy. Three months after injury, 33 per cent of the patients with laminectomy required fusion for instability compared to 22 per cent of the nonlaminectomy group. There were no cases of late instability in pure flexion or extension fracture groups. Ninety per cent of the late instability cases were in the groups with hyperflexion and flexion compression fractures. Laminectomy should be avoided for these fractures, but early fusion may be necessary to prevent progressive deformity.

Adolescent↗

PubMedDate not supplied

Fracture of the cuboid in children: case report and review of the literature.

Although fractures of the cuboid are rare, they can be very disabling. The diagnosis is often missed, and overlooked cuboid fractures can lead to severe alterations in foot mechanics and function. We report the case of a displaced compression fracture of the cuboid in an 8-year-old girl after a fall from a height, which we treated by open reduction, bone grafting, and internal fixation. Follow-up examination 2 years after the injury revealed a very good result. Cuboid fractures should be considered in the differential diagnosis of limping toddlers. Children seen with pain, swelling, and inability to bear weight on the lateral aspect of the foot require proper evaluation and treatment.

Accidental Falls↗

PubMed2000

Tibial plateau fracture as a measure of early estrogen-dependent bone fragility in rats.

The goals of this study were to develop a protocol to induce a compressive fracture at the tibial plateau of the rat knee in vitro and to determine if the biomechanical parameters provided a sensitive assessment of the early skeletal changes induced by estrogen deficiency. Sixty-one rats underwent an ovariectomy (n = 36) or sham operation (n = 25) and were maintained for 50 days after the procedure. Just before death, the proximal tibia of each animal was scanned with high-resolution x-ray tomography. From the three-dimensional images, the mean trabecular bone volume, thickness, and separation and the number of trabeculae were calculated. The knees were then harvested and mounted into a servohydraulic materials testing system so that the distal femoral condyle could be forced into the proximal tibial plateau until fracture. The fracture load of the ovariectomized rats was 24% less than that of the rats that had the sham operation. Similarly, the structural stiffness of the ovariectomized knees was decreased by 22%. Both of these differences were statistically significant (p < 0.01) and were explained by differences in trabecular bone volume (r = 0.56, p < 0.0001 and r = 0.42, p < 0.005, respectively). The other measures of trabecular bone structure were correlated with the volume and did not improve the prediction by the biomechanical parameters. These data demonstrate that biomechanical testing of the tibial plateau in rats can quantify the structural consequences of estrogen deficiency at an early time point before they become apparent at other bone sites, such as the lumbar spine.

Animals↗

PubMed1989

Rationale for the management of flexion-distraction injuries of the thoracolumbar spine based on a new classification.

A new classification of flexion-distraction injuries of the spine is described based on the bony and soft tissue injuries to the posterior complex and the anterior column. In addition, the classification includes the status of the vertebral body, that is, the association of a wedge-compression fracture or a burst injury. The soft tissue component provides a rationale for surgical intervention. Most injuries were treated by compression instrumentation, but it is recommended that those injuries associated with a burst component require distraction instrumentation.

Adolescent↗

PubMed1987

Ability of four different techniques of measuring bone mass to diagnose vertebral fractures in postmenopausal women.

Since bone mass has been shown to be an important determining factor of fractures in vitro, we undertook a study to evaluate whether bone mass measurements could separate postmenopausal women with vertebral compression fractures from women of a similar age without fractures. We also wanted to see if methods of measuring bone mass at the spine would be more sensitive or specific than methods that measured bone at the wrist or the entire skeleton. The techniques used were: total body calcium by neutron activation analysis (TBC), single photon absorptiometry (SPA), dual photon absorptiometry (DPA), and quantitative computed tomography (QCT). Normal women aged 20-85 were measured, but only those greater than 50 yr were used in the analysis. Mean values for women with fractures were significantly lower than normals (p less than .001): TBC 642 +/- 103 g vs. 764 +/- 114; SPA .658 +/- .134 g/cm vs. .779 +/- .142; DPA 3.75 +/- .82 g/cm vs. 4.37 +/- .86; QCT 59.0 +/- 25.7 mg/cc vs. 92.6 +/- 36.0. However, each of the methods showed considerable overlap between women with and without fractures. At 90% specificity the sensitivities of the tests were: TBC 34%; SPA 29%; DPA 33%; QCT 36%. When values were expressed as the % expected (based on age and height) then the sensitivities were: TBC 52%; SPA 36%; DPA 35%; QCT 44%. Using Bayes' theorem, we constructed curves showing the posttest probability of these tests at a prevalence of 20%. None of these bone mass measuring techniques showed complete separation between normal and osteoporotic women with fractures; about one-half of the women with fractures were below the normal range. The risk of having a fracture increases as bone mass declines, but our data suggest that bone mass is not the only factor leading to vertebral fractures in postmenopausal women.

Adult↗

PubMed1990

Lumbosacral lesions associated with pelvic ring injuries.

In pelvic ring injuries, an anterior lesion is usually combined with a lesion of the posterior ring segment. A fracture of the sacrum is the most common type of posterior lesion. Its severity ranges from a stable minimal compression fracture of the ala of the sacrum to a displaced fracture with complete loss of stability. The fracture line commonly involves the first and second sacral foramina, exiting the bone distally through its free border and proximally just lateral to the articular process of S1. This study shows that in a number of cases the proximal fracture line passes through or medial to the articular process of S1. Consequently, displacement of the involved hemipelvis causes no damage to the lumbosacral junction if the fracture line passes lateral to the articular process of S1. However, any displacement of the mobile hemipelvis must injure the lumbosacral junction with the latter fracture pattern if the fracture line passes through or medial to the articular process of S1. We found an injury of the lumbosacral junction in 6% of all of our pelvic ring injuries and in 38% of those with an unstable vertical sacral fracture. One kind of these lesions, the locked dislocation of the L5/S1 joint, was shown to inhibit reduction of a displaced sacral fracture. Furthermore, these lesions may be responsible for some of the lumbosacral pain frequently persisting after pelvic ring injuries.

Fractures, Bone↗

PubMedDate not supplied

The three column spine and its significance in the classification of acute thoracolumbar spinal injuries.

From a retrospective study of 412 thoracolumbar injuries, the author introduces the concept of middle column or middle osteoligamentous complex between the traditionally recognized posterior ligamentous complex and the anterior longitudinal ligament. This middle column is formed by the posterior wall of the vertebral body, the posterior longitudinal ligament and posterior annulus fibrosus. The third column appears crucial, as the mode of its failure correlates both with the type of spinal fracture and with its neurological injury. Spinal injuries were subdivided into minor and major. Minor injuries are represented by fractures of transverse processes, facets, pars interarticularis, and spinous process. Major spinal injuries are classified into four different categories: compression fractures, burst fractures, seat-belt-type injuries, and fracture dislocations. These four well-recognized injuries have been studied carefully in clinical terms as well as on roentgenograms and computerized axial tomograms. They were then subdivided into subtypes demonstrating the very wide spectrums of these four entities. The correlation between the three-column system, the classification, the stability, and the therapeutic indications are presented.

Adolescent↗

PubMed1997

Osteoporosis. Definition and clinical presentation.

Osteoporosis is a skeletal condition characterized by decreased density (mass/volume) of normally mineralized bone. The reduced bone density leads to decreased mechanical strength, thus making the skeleton more likely to fracture. Postmenopausal osteoporosis (Type I) and age-related osteoporosis (Type II) are the most common primary forms of bone loss seen in clinical practice. Secondary causes of osteoporosis include hypercortisolism, hyperthyroidism, hyperparathyroidism, alcohol abuse, and immobilization. In the development of osteoporosis, there is often a long latent period before the appearance of the main clinical manifestation, pathologic fractures. The earliest symptom of osteoporosis is often an episode of acute back pain caused by a pathologic vertebral compression fracture, or an episode of groin or thigh pain caused by a pathologic hip fracture. In the diagnostic process, the extent and severity of bone loss are evaluated and secondary forms of bone loss are excluded. A careful diagnostic work-up that includes clinical history, physical examination, laboratory evaluation, bone densitometry, and radiographic imaging will allow the clinician to determine the cause of osteoporosis and to institute medical interventions that will stabilize and even reverse this frequently preventable condition.

Back Pain↗

PubMed2005

Quantitative morphometric analysis of vertebral fracture severity in healthy Thai (women and men).

The vertebral morphometry and severity of fracture were studied in normal healthy Thais (602 women and 74 men) Their mean (+/-SD) age was 41.4 (+/- 8.7) years, ranging from 20-81 years. A standard lateral thoraco-lumbar (T-L) spine radiograph was done by centering the X-ray at L1. Vertebral heights (anterior: Ha, middle: Hm and posterior: Hp), disc height (Hd) and 4 vertebral ratios (anterior wedging: Ha/Hp, central wedging: Hm/Hp, vertebral body index: Hm/Hd and spine score: Hm/Ha) of T10-L3 were assessed. Degree of severity of anterior and central wedging fracture was derived to mild, moderate and severe fracture ratios (0.80-0.89, 0.70-0.79 and < 0.70, respectively). In Thai females, anterior and central wedging significantly changed at T11 after the 40-49 age group, while spine score markedly declined at L2-L3 after the 30-39 age group. The change of vertebral body index was not seen. The overall (T10-L3) mean of all ratios of women aged <50 years were more than that of those aged > or = 50 years (p < 0.05). No statistical change of the above ratios was seen at any levels of the spine in males (p > 0.05). The prevalence of mild and moderate degree of anterior vertebral fracture was 22.76% and 0.50% in females and 25.68 and 0% in males. Percentage of mild and moderate degree of central vertebral fracture was 66.61 and 1.00 in females and 68.92 and 1.35 in males. The prevalence of anterior and central compression fracture in females and males who were aged > or = 50 years were higher than those aged <50 years. No severe degree of anterior and central vertebral fracture was detected in both sexes. 407 young adults mean (20-40 years) of the 4 ratios at T10-L3 were also surveyed and calculated for Thai reference databases. The prevalence of the 4 ratios below young adult mean 1, 1.5, 2, 2.5 and 3 SDs in males were greater than in females. In the older age groups, the percentage of females and males who had a mean ratio below young adult mean was much more than that in the younger age groups. In screening of spinal osteoporosis, the authors suggested that the age after 40 years of populations should be x-rayed and spinal radiograph should have an observed focus at T11, L2 and L3.

Absorptiometry, Photon↗

PubMed2004

Vertebroplasty and kyphoplasty in the treatment of malignant vertebral fractures.

The purpose of this retrospective study was to assess the effectiveness and safety of Percutaneous Vertebroplasty and Kyphoplasty, in the treatment of pain deriving from neoplastic vertebral compression fractures (VCF). We treated 33 oncologic patients with these new techniques (2 pts with aggressive haemangiomas, 8 pts with myelomas and 23 pts with metastases) suffering from severe motion pain in the back, notwithstanding conservative treatment with medication and corset therapy, in the absence of neurological signs. In 3 selected patients we associated radiofrequency heat ablation with vertebroplasty in the treatment of metastases. The aim is to destroy tumor tissue and to thrombose the paravertebral and intravertebral venous plexus before stabilizing the vertebra.

Aged↗