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PubMed1991

Marginal ridge strength in Class II tunnel restorations.

This in vitro study evaluated the compressive fracture resistance of marginal ridges of teeth with Class II tunnel preparations. Tunnel preparations were completed in extracted human bicuspid and molar teeth (bicuspids, bur size: #2, #4, #6; molars, bur size: #4, #6, #8). Control teeth in both the molar and bicuspid groups remained unprepared. Half the preparations in each group were restored with a glass ionomer cermet. After thermocycling, each marginal ridge was loaded in compression in an Instron Universal testing machine. Fracture values were compared with a two-factor ANOVA. A Dunnet post hoc test was used to compare the strength of each group to its control. Results indicated that up to a certain size, tunnel preparations could be completed without diminishing the strength of the undermined marginal ridges. Placement of a glass-ionomer cermet in the tunnel preparations restored the strength of all but the largest preparations (#6 bur in the bicuspid group) to a level which was not statistically significantly different from the controls.

Bicuspid↗

PubMed2005

Biomechanical in vitro comparison of different mono- and bisegmental anterior procedures with regard to the strategy for fracture stabilisation using minimally invasive techniques.

Endoscopic minimally invasive techniques have become an established method of fracture stabilisation in the spine. In view of this fact, anterior stabilisation strategies must be reconsidered, as monosegmental A 3.1 compression fractures are increasingly being stabilised endoscopically from the anterior aspect using minimally invasive techniques. This study investigated the biomechanical necessity of anterior two-point or four-point stabilisation in the instrumentation of mono- and bisegmental fractures. In three biomechanical in vitro studies, burst fracture stabilisation was simulated, and anterior short fixation devices were tested under load with pure moments up to 3.75 Nm to evaluate the biomechanical stabilising characteristics of different kinds of instrumentations in flexion/extension, lateral bending, and axial rotation. Only anterior four-point stabilisation resulted in sufficient primary stability both in mono- and bisegmental instrumentation and therefore represents the standard procedure in open as well as in minimally invasive spinal surgery.

Biomechanical Phenomena↗

PubMed2004

The surgical management of thoracolumbar injuries.

This review addresses the epidemiology, clinical examination, and radiographic evaluation and fracture classification of thoracolumbar injuries. The factors that indicate surgical intervention and the surgical management of specific injuries such as compression fractures, burst fractures, flexion-distraction, and fracture-dislocation injuries are described, as well as their potential complications. In addition, postoperative management is covered, including deep venous thrombosis prophylaxis.

Clinical Laboratory Techniques↗

PubMed1982

Osteoporosis--a review and update.

Osteoporosis is a common disorder in women. Fifty percent of women more than 65 years of age have bone mineral density below the fracture threshold. Factors which accelerate bone loss include deficiency of gonadal hormones, nutritional effects, lack of exercise, smoking, alcoholism and endocrinopathies. Fractures of the hip, vertebra and radius occur much more frequently in patients with osteoporosis. Chronic pain is caused by compression fractures of vertebrae resulting in mechanical changes in the spine. The most desirable treatment is prevention. Adequate dietary intake of calcium, exercise and avoidance of excess intake of protein and phosphorus should be advised. Treatment with fluoride is promising but requires further study.

Aged↗

PubMed1994

[Value and results of radioguided deep spinal biopsy].

MATERIAL AND METHODS. 76 percutaneous vertebral biopsies were performed with fluoroscopic guidance at the Radiology B Service, Hôpital Cochin in Paris, from November 1991 to March 1994. There were 12 cervical, 23 thoracic, 45 lumbar and sacral biopsies. There were 71 patients (28 women and 43 men), aged 22 to 88 years old (mean age 55.9). The needle used was either a trophine needle (Mazabraud) or a cutting needle (Surcut) or both. We have been doing vertebral percutaneous biopsies for 20 years in our radiology Service, and we published a review of 100 cases in 1983. The aim of this second review is to actualize the technique and the results. RESULTS. An accurate diagnosis was made in 80% of all cases. Diagnosis were: malignancy (34 cases), infection (21 cases), benign compression fracture (10 cases), miscellaneous (11 cases). There were two complications, one at the cervical spine (aggravation of a cervical cord compression) and one at the thoracic spine (pneumothorax). CONCLUSION. Percutaneous vertebral biopsy under fluoroscopic guidance is a safe and reliable method of obtaining a diagnosis in different spine lesions, avoiding thus, in most cases, a surgical procedure.

Adult↗

PubMed1995

[Renal acidification mechanism disorders in patients with osteoporosis].

Eight patients (6 women and 2 men) with osteoporosis caused or aggravated by renal acidification defects are presented. Three of the female patients were premenopausal; the others were 9, 20 and 22 years postmenopausal, and two of them were on hormonal replacement therapy. Two patients had nephrolithiasis: one male with recurrent calcium phosphate stones and a left sided staghorn calculus, and one female with nephrocalcinosis due to medullary sponge kidney and hypercalciuria (patients No. 1 and 2, respectively, Table 1). In the remaining subjects, clinical suspicion was based on: a) Hip fracture in a 44-yr-old premenopausal female without any risk factor (No. 3, Table 2). b) Several vertebral compression fractures in a 45-yr-old male without hypogonadism or other predisposing factors (No. 7, Table 2). c) Lack of response to antiosteoporotic therapy in 3 women (patients No. 4, 6 and 8, Table 2). Serum bicarbonate levels and urine acidification capacity were studied in all patients. Three had low serum bicarbonate (two of whom showed high fractional excretion of bicarbonate), four had a distal defect, and one had a mixed form. Serum creatinine and potassium, and venous blood pH were normal in all cases, suggesting incomplete renal tubular acidosis. Bone mineral density in Z-score (means +/- s.e.m.) was - 1.75 +/- 0.08 in the lumbar spine (n = 8), and - 1.57 +/- 0.09 in the femoral neck (n = 4) [Tables 1 and 2; Figs 1 and 2]. Following one year treatment with oral sodium bicarbonate and potassium citrate, total skeletal calcium increased by 3-10% in five of the patients. Whereas the high prevalence of renal acidification defects among renal stone formers with or without hypercalciuria is well acknowledged, renal tubular acidosis is not included in the list of entities causing secondary osteoporosis. As shown in 6 patients of this series, incomplete RTA should be considered as another disease capable of causing osteoporosis or worsening involutional bone loss.

Acidosis, Renal Tubular↗

PubMed2006

Vertebroplasty versus kyphoplasty: biomechanical behavior under repetitive loading conditions.

STUDY DESIGN: Ex vivo biomechanical study using osteoporotic cadaveric fractured vertebral bodies. OBJECTIVE: To investigate the behavior of fractured osteoporotic vertebral bodies treated with either vertebroplasty or kyphoplasty under repetitive loading conditions. SUMMARY OF BACKGROUND DATA: Vertebroplasty and kyphoplasty are newer alternatives for the treatment of osteoporotic vertebral fractures. Loading conditions that can lead to fractures treated with these methods will likely be encountered subsequently; as such, it is important to understand differences in the biomechanical behavior of the resultant constructs. METHODS: There were 7 pairs of osteoporotic T8 and T10 vertebral bodies cyclically loaded to produce a vertebral compression fracture. Of each pair, one was assigned to the kyphoplasty group and the other to the vertebroplasty group. After treatment, specimens were cyclically loaded to 100,000 cycles, between 20% and 70% of the predicted failure load. RESULTS: Height was restored with kyphoplasty, but the vertebral bodies showed significant height loss during cyclic loading. Vertebroplasty specimens had higher compression stiffness and smaller height reduction. CONCLUSIONS: Under repetitive loading conditions, fractured vertebral bodies treated with kyphoplasty were initially taller, but because of a progressive loss of height during loading, the resulting constructs were shorter after 100,000 cycles than those treated with vertebroplasty.

Aged↗

PubMed1997

Fracture studies of selected dental restorative composites.

OBJECTIVES: The purpose of this study was to evaluate the flexure strength, elastic modulus, and fracture toughness (mode I, mode II, and mixed mode) of resin and four specially made dental restorative composite materials. METHODS: Testing was done on prismatic bars in flexure and disk specimens in diametral compression. Fracture strengths were analyzed using Weibull statistics. Statistical analysis consisted of a one-way analysis of variance followed by a Tukey multiple means analysis for each of the materials. In addition, the fracture strengths were analyzed using Weibull statistics due to the brittle behavior exhibited by these materials. RESULTS: The experimental results showed that the addition of fillers resulted in a significant three-fold increase in flexure modulus and a significant 30-50% increase in fracture toughness from the resin. As was indicated by the different Weibull modulus values, strength data obtained from four-point bending were not related with strength data from three-point bending. A straight notch vs. a relatively sharp V-notch gave higher fracture toughness values. Fracture toughness was dependent on the depth of a straight notch and was practically independent of the V-notch depth. Mode I and II fracture toughness in two composites (75Sr and 75Sr10) were carried out on precracked disk specimens in diametral compression. The results of mode I toughness were close to those obtained from the flexure testing. The mode II toughness values were greater than the mode I values by more than 30%. The data fit an equation of the form KI/KIC + (KII/KIIC)2 = 1(where KI, KII are the mode I and II stress intensity factors and KIC, KIIC are the respective critical values). SIGNIFICANCE: Notching technique, testing configuration (three-point vs. four-point loading), and method of testing (bar vs. disk) have significant effect on the fracture properties.

Analysis of Variance↗

PubMed1994

An unusual type of Hangman's fracture with cord compression: a case report.

An unusual case of hangman's fracture with neurologic sequelae is described in a 43-year-old woman. The fracture involved the body of C-2 with gross dislocation of the anterior part of C-2 and C-1 forward on C-3, associated with severe cord compression. The patient was successfully treated with a decompression of the foramen magnum and C-1 laminectomy, accompanying in situ fusion. The images obtained by computed tomography and magnetic resonance imaging were useful in understanding the true nature of the injury and planning the appropriate surgical treatment.

Adult↗

PubMed1995

Early surgery for thoracolumbar spinal cord injury: initial experience from a developing spinal cord injury centre in India.

The spinal cord injury centre of Nizam's Institute of Medical Sciences, Andhra Pradesh, India has been functioning now for 8 months and offers its services to the population of 80 million in the state. To date, 92 patients with a spinal cord injury have been treated; 51 had a thoracolumbar spinal injury. This report presents the results of the management of these 51 patients. Preoperatively both CT and MRI were performed and the radiological findings were correlated with outcome. Twenty five had a thoracic and 26 a lumber location. Twenty nine patients underwent surgical treatment (15 thoracic and 14 lumbar) and the others were treated conservatively (10 thoracic and 12 lumbar). All these operations were carried out within 2 weeks following trauma, and methylprednisolone therapy was instituted in those who reached the hospital early. Contraindications for surgery included a delay in admission of more than 3 weeks following trauma, a focus of sepsis, bedsores, a generalised bone disorder such as osteopenia, and medical illnesses. Transpedicular screw-plate fixation was performed in 27 patients, and two patients underwent decompressive laminectomy and interlaminar bone and wire fixation. Delayed spinal decompression was offered to one patient to relieve radiculopathy. Fracture-dislocation spinal injury and those with transection of the spinal cord had the worst outcome, whilst patients with a wedge compression fracture and cord oedema fared better. Operated cases had a shorter hospital stay, and complications of immobilisation were limited. Positive psychological influence of mobilisation and early acclimatisation to the altered style of living with their disability were the most significant outcomes following surgery.

Female↗

PubMedDate not supplied

Percutaneous kyphoplasty: new treatment for painful vertebral body fractures.

AIMS AND BACKGROUND: The purpose of this study was to assess the effectiveness and safety of Percutaneous Kyphoplasty as a new method of treatment for pain deriving from vertebral compression fractures (VCF). PATIENTS AND METHODS: We treated sixteen patients with unremitting pain over spine, which increased particularly when pressure was applied over the spinous process, in absence of neurological signs and refractory to conventional medical therapy. RESULTS: The method demonstrated swift pain relief associated with an evident augmentation in the resistance and restoration of the vertebral body's physiological shape. Polymethylmethacrylate (PMMA) leakages were not observed in the epidural space or foraminal area. The presence of complications such as pulmonary embolism involving the venous plexus, toxicity due to PMMA and infection due the procedure did not occur. CONCLUSION: Kyphoplasty is an effective, alternative, simple and safe treatment of vertebral collapse consequent to osteoporosis. aggressive haemangiomas, myelomas and metastases.

Aged↗

PubMedDate not supplied

Ex vivo biomechanical comparison of hydroxyapatite and polymethylmethacrylate cements for use with vertebroplasty.

BACKGROUND AND PURPOSE: Little is known about the mechanical stabilization afforded by new materials proposed for use with vertebroplasty. This comparative ex vivo biomechanical study was designed to determine the strength and stiffness of osteoporotic vertebral bodies (VBs) subjected to compression fractures and stabilized with bipedicular injections of Cranioplastic altered in a manner consistent with the practice of vertebroplasty or BoneSource cement. METHODS: VBs T8-T10 and L2-L4 from 10 fresh spines were harvested from female cadavers (aged 91.5 years +/- 3.9 at death). These were screened for bone density (t score, -4.9 +/- 1.4; bone mineral density, 0.61 g/cm(2) +/- 0.19), disarticulated, and compressed to determine initial strength and stiffness. The fractured VBs were stabilized with bipedicular injections of a predetermined quantity and type of cement and then re-crushed. RESULTS: At both the thoracic and lumbar levels, VBs repaired with altered Cranioplastic resulted in significantly greater strength (P <.05) than that in their prefracture states, whereas those repaired with BoneSource were restored to their initial strength. Cranioplastic resulted in significantly stronger repairs than BoneSource in the thoracic region; however, repair strengths in the lumbar region were not significantly different. The repaired stiffness was significantly lower than the initial stiffness in all treatments and in both regions. Differences in the repaired stiffness between the treatment groups in either region and differences in the mechanical parameters obtained by adding an additional 2 mL of BoneSource were not significant. CONCLUSION: Both materials in the volumes used either restored or increased VB strength, but none restored stiffness.

Aged↗

PubMed2000

Posterior locked lateral compression injury of the pelvis: report of three cases.

Lateral compression injuries to the pelvis typically result in a rotationally unstable and vertically stable condition including an impaction and compression fracture of the posterior pelvic ring. The operative and postoperative management, as well as the morbidity and mortality, of these fractures differs significantly from vertical shear injuries to the pelvis, which are characterized by vertical and rotational instability. We report on three unusual lateral compression injuries to the pelvis, resulting in a complete disruption of the pelvic ring with vertical and rotational instability, by definition. Nevertheless, in these patients, locking of the posterior pelvic ring with medial translation of the iliac wing anterior to the sacrum resulted in a pseudostable condition. Their high rate of fracture-related associated injuries and possible complications, as well as the malalignment of the pelvis, required surgical restoration of the pelvic ring. Fracture reduction was successfully performed through an anterior approach in one patient and a posterior approach in two patients; the posterior approach was preferred. Open reduction and internal fixation of these pelvic ring fractures can result in a satisfactory outcome if the associated injuries are successfully dealt with.

Adolescent↗

PubMed2006

Mechanical characterisation of three percutaneous vertebroplasty biomaterials.

Percutanous vertebroplasty (PVP) is gaining popularity for the treatment of vertebral compression fractures. The need of obtaining low viscosity materials for injection through small bore needles and the necessity of visualising the fluid flow during injection have led users to the formulation of a number of ad-hoc recipes aimed at adapting PMMA cements for this use. Industry, on its part, has addressed these requirements by developing specific products for this application. This study aimed at providing a direct comparison of a wide range of mechanical properties between three commercially available biomaterials developed for PVP: two PMMA based materials, Osteopal V (Merck Biomaterial GMBH, Dermstedt, D) and Verterbroplastic (DePuy Acromed, Inc, MA, USA), and a Bis-GMA composite, Cortoss (Orthovita, PA, USA). Cortoss consistently exhibited higher values for compressive strength, bending modulus and shear strength to both Osteopal V and Vertebroplastic. The creep behaviour of Cortoss was also different from that of the two PMMA cements.PVP can take advantage from the development of new injectable biomaterials in response to the problems associated with the use of PMMA in a highly vascularised area such as the vertebral body. In addition careful modulation of the mechanical properties of the material has the potential to further improve the outcome of PVP, possibly reducing the risk of adjacent level fractures associated with the procedure.

Biocompatible Materials↗

PubMed1991

The limitations of magnetic resonance imaging in the diagnosis of pathologic vertebral fractures.

Magnetic resonance imaging has been increasingly used in recent years to screen patients with suspected spinal metastases. The authors present four cases, all of whom were elderly patients with vertebral compression fractures, who were diagnosed with magnetic resonance imaging to have probable neoplastic involvement. In each case, vertebral body biopsies indicated a benign pathology. The authors discuss the diagnostic criteria of magnetic resonance imaging of spinal metastases and the limitations of magnetic resonance imaging in the diagnosis of pathologic vertebral fractures.

Aged↗

PubMed1986

Spinal injury and computerized tomography: a review of fracture pathology and a new approach to canal decompression.

The plain X-rays and CT scans of 23 cases of thoracolumbar and 18 cases of lower cervical (below C2) spinal compression fractures were compared. A new picture of the fracture pathology has emerged as several features consistently appeared and are described: a midline or slightly oblique split of the vertebral body; posterolateral fractures of the body in the region of the developmental neurocentral joint; fragments of the body displaced backwards into the canal at the level of the pedicles; oblique laminal fractures; and separation of the zygapophyseal rim in thoracolumbar fractures. With this more complete picture of the bony injury, in particular canal encroachment, a new method of anterolateral canal decompression has been tried and is described.

Adolescent↗

PubMedDate not supplied

Percutaneous kyphoplasty: indications and technique in the treatment of vertebral fractures from myeloma.

AIMS AND BACKGROUND: The purpose of our research was to assess the effectiveness and safety of percutaneous kyphoplasty, the new method of treatment for pain deriving from vertebral compression fractures due to myeloma. METHODS: We treated 3 patients with pain refractory to conventional medical therapy (analgesics, bed-rest, bracing with orthopedic devices for more than 4 weeks), localized in the lumbar area, painful to the touch and in the absence of neurological signs. RESULTS: The method demonstrated a swift pain relief associated with an evident augmentation in the resistance and restoration of the vertebral body's physiological shape. Polymethylmethacrylate leaks were not observed in the epidural or foraminal area, nor were complications such as pulmonary embolism for involvement of the venous plexus or related to phenomenon of infections due to the procedure, or toxicity due to the polymethylmethacrylate. CONCLUSIONS: Kyphoplasty was found to be an effective alternative, simple and safe in the treatment of vertebral collapse consequent to multiple myeloma. The same injection of polymethylmethacrylate can be done before the radiotherapy treatment, thereby synergizing its delayed analgesic action to pain, or after the failure or in the case of local recurrence.

Fractures, Spontaneous↗

PubMed2005

Minimal invasive stabilization of osteoporotic vertebral fractures: a prospective nonrandomized comparison of vertebroplasty and balloon kyphoplasty.

OBJECTIVE: During recent years, the benefits of balloon kyphoplasty and vertebroplasty have been frequently discussed for the treatment of osteoporotic vertebral compression fractures. Because of the lack of comparative studies, we performed an investigation to describe the mechanical effects and the impact on life quality during a follow-up period of 2 years. METHODS: Patients with nonrecent fractures of vertebral bodies, ongoing bone remodeling, and major kyphotic deformity were treated with minimal invasive stabilization. The median duration of pain was 8 weeks before surgery. Because of the availability of the equipment, 28 patients were nonrandomly assigned to balloon kyphoplasty and 23 patients to vertebroplasty. The follow-up was performed 2 years after surgery. RESULTS: The kyphotic wedge of the vertebral bodies was decreased 6 degrees by balloon kyphoplasty but not by vertebroplasty. With both methods, we found a rapid decrease of pain down to one-half of the preoperative value. A long-lasting effect on pain was found only after balloon kyphoplasty. In the kyphoplasty group, a decrease of the Oswestry Disability Index (ODI) score was found during the first postoperative year. After 2 years, the ODI was not different from preoperative values in both groups. CONCLUSIONS: In nonrecent fractures, the reduction of the kyphotic wedge by balloon kyphoplasty was superior in decreasing pain persisting over a period of 2 years. The ability to improve disability after kyphoplasty was limited to 1 year. In nonrecent fractures, the consequences of age and osteoporosis seem to equalize the effects of the restored sagittal profile on disability but not on pain.

Aged↗