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PubMed1989

Mild versus definite osteoporosis: comparison of bone densitometry techniques using different statistical models.

The purpose of this investigation was to determine the ability of three bone densitometry techniques to discriminate subjects with mild vertebral deformities from those with definite compression fractures. We determined bone mineral density (BMD) in 68 postmenopausal women by quantitative computed tomography (QCT) and dual-photon absorptiometry (DPA) of the spine, as well as single-photon absorptiometry (SPA) of the radius. Forty four individuals were classified as having mild deformities of the spine and 24 were considered to have definite vertebral compressions. Several statistical approaches were used to compare these subgroups and to estimate the relative risk of vertebral fracture. Included among these were percent decrements and zeta-scores, ROC curves, odds ratio estimations, and logistic regression analysis. Individuals with definite vertebral fractures had lower bone mineral density at all sites, but measurement of radial compact bone by SPA failed to reach significance. Using ROC analysis to distinguish mild deformities from true compressions, we found that measurement of spinal trabecular bone by QCT to be the most sensitive discriminator; although measurement of spinal integral bone by DPA also gave satisfactory discrimination, whereas assessment of radial compact bone did not adequately differentiate patients with mild deformities from those with definite compressions. Likewise, we found determination of spinal trabecular bone to be the most robust predictor of relative risk of definite fracture using either odds ratios or logistic regression analysis. Measurement of BMD in the peripheral cortical skeleton offered no predictive power for true vertebral fracture. We concluded that direct assessment of the spine, particularly of the trabecular portion, offered the strongest discrimination and relative risk prediction for definite osteoporotic fractures compared with milder forms of this condition.

Aged↗

PubMed1998

High turnover bone disease following lung transplantation.

Recipients of lung transplants are at very high risk for significant bone loss. Nevertheless, data on bone disease after lung transplantation are still limited. We, therefore, retrospectively evaluated the data of 33 patients surviving at least 1 year after lung transplantation (LTx) who were seen in our outpatient clinic for osteologic evaluation. Results of clinical evaluations, radiographs, and dual-energy X-ray absorptiometry (DXA) were related to each other, to clinical variables, and to serum levels of osteocalcin, parathyroid hormone (PTH), and 25-hydroxyvitamin D: 14 of 33 patients (42%) had vertebral fractures, 9 of whom were diagnosed within 2 years after transplantation. Bone mineral density values (DXA) were markedly decreased and predictive of compression fractures. 25-Hydroxyvitamin D levels were low in 13 patients (39%) and PTH was elevated in 7 (21%). Despite corticosteroids and low 25-hydroxyvitamin D, serum osteocalcin was elevated in 12 patients (36%). This was only partially explained by hyperparathyroidism, low sex hormones, and impaired renal function, and may partly be caused by cyclosporin A. We thus conclude that severe symptomatic bone disease is common in lung transplant recipients and due to a complex situation including high turnover bone loss and hypovitaminosis D. DXA can be used to estimate fracture risk for individual patients.

Absorptiometry, Photon↗

PubMedDate not supplied

Osteoporosis at presentation of childhood ALL: management with pamidronate.

Vertebral fractures at diagnosis of childhood acute lymphoblastic leukemia (ALL) are an uncommon but recognized problem. Clinical issues associated with pathological fractures in these children include pain control and the potential for further treatment-associated fractures and long-term bony morbidity. The authors report the successful use of pamidronate in two children who presented with vertebral compression fractures at diagnosis of ALL. Both patients had pain and low bone mineral density at baseline. In addition to standard chemotherapy, pamidronate (1 mg/kg, IV) was given bimonthly. Initial rapid symptom relief and gradual improvement of bone mineral density was demonstrated in both patients.

Bone Density↗

PubMedDate not supplied

Fracture sacrum.

An extremely rare case of combined transverse and vertical fracture of sacrum with neurological deficit is reported here with a six month follow-up. The patient also had an L1 compression fracture. The patient has recovered significantly with conservative management.

Accidental Falls↗

PubMed1989

Non-ejection cervical spine injuries due to +Gz in high performance aircraft.

The potential for significant neck injuries exists in today's high performance fighter aircraft. The G-loads required to produce injury need not be excessive, nor is experience level necessarily protective. Eight cervical spine injury cases, due to or aggravated by +Gz in F-15 and F-16 aircrew members are reviewed. These include two compression fractures (C5/C7), three left HNP's (C5-6/C6-7), one fracture of the spinous process (C7), one interspinous ligament tear (C6-7), and one myofascial syndrome (C6). Mechanisms of injury and evaluation are discussed. Exercise conditioning may play an important role in prevention and protection. The role of screening X-rays and improving equipment remain as areas where further work needs to be done.

Adult↗

PubMed1995

Severe symptomatic osteopenia in a man with pigmented micronodular adrenal hyperplasia.

The authors describe the unusual case of a 52-year-old man with Cushing's syndrome caused by bilateral pigmented micronodular adrenal hyperplasia. The only features of hypercortisolism were hypertension and severe symptomatic osteopenia with vertebral, rib, and scapular fractures. Four years after bilateral adrenalectomy, the bone density had increased slightly, but the patient remained osteopenic and continued to have vertebral compression fractures. This case report emphasizes the importance of an indepth search for secondary causes of osteoporosis, including evaluation of adrenal function in patients who have unexplained osteoporosis. Early diagnosis and treatment is imperative to prevent severe bone loss and associated skeletal morbidity.

Adrenal Glands↗

PubMed1993

Effect of luting media on the compressive strengths of two types of all-ceramic crown.

This study evaluated the effect of selected luting media on the compressive strength of two types of all-ceramic crown. Tooth preparation was standardized; each preparation had a shoulder width of approximately 1.2 mm, and all internal preparation angles were rounded. Hi-Ceram and Dicor all-ceramic crowns were fabricated and cemented into the preparations with zinc phosphate, glass-ionomer, or composite resin cement. Coronal compressive fracture strengths were determined, using a set of unrestored teeth as a control. There were no statistically significant differences among the mean compressive strengths of the three luting media, and there was no statistically significant difference between the mean compressive strength of Dicor and that of the natural tooth control.

Aluminum Oxide↗

PubMed2002

Delayed posttraumatic vertebral collapse with intravertebral vacuum cleft.

OBJECTIVE: To discuss the case of a 79-year-old man who had a delayed posttraumatic vertebral collapse and an intravertebral vacuum cleft. The patient had been on long-term corticosteroid therapy. A discussion of Kummell's disease and the controversy surrounding the etiology of the condition is also presented. CLINICAL FEATURES: Six weeks before coming to the clinic, the patient remembered twisting, hearing a pop, and having severe low back pain. Two weeks after the incident, while hospitalized for bacterial cellulitis, he underwent lumbar spine radiography. The radiographs showed degenerative changes and remote (healed) compression fractures but did not demonstrate any deformity of L2. Four weeks later, he sought care for persistent low back pain. Radiographs revealed marked compression of the L2 vertebral body with an intravertebral vacuum phenomenon. INTERVENTION AND OUTCOME: The patient was referred to his geriatrician for evaluation as a candidate for vertebroplasty or other stabilization procedures. He required a moderately high dose (60 mg) of prednisone daily to combat the symptoms of myasthenia gravis; therefore, the prognosis appears unfavorable for this patient. CONCLUSION: Clinical research is needed to determine the definitive etiology and pathophysiology of Kummell's disease. This case demonstrates that the intravertebral vacuum is a dynamic entity, subject to changes in size and shape. Previous case reports have suggested that Kummell's disease only presents as a linear, horizontal cleft. This disease needs further investigation to determine the true correlation between radiographic signs and the underlying pathophysiology.

Aged↗

PubMed1982

Mechanism of vertebral fracture in the F/FB-111 ejection experience.

A review of the accident investigation reports of all non-fatal F/FB-111 ejections which occurred from 19 October 1967 to 26 March 1980 was conducted. The available spinal radiographs of the ejectees were also reviewed. The overall rate of vertebral compression fractures among the survived ejectees in a properly functioning module is 29.5% (23 of 78). The general mechanism of vertebral injury is a combined mechanism involving both axial compression and flexion. There is no evidence to indicate a hyperextension injury mechanism during retraction, nor is there evidence to support the presumed efficacy of the crossed-arms bracing procedure recommended for landing impact in modifying the vertebral injury rate. It appears that a significant reduction in the rate of vertebral fractures among F/FB-111 ejectees will require decreasing the acceleration stresses imposed on the crewmembers during landing impact.

Acceleration↗

PubMed2005

Esophageal perforation complicating with spinal epidural abscess, iatrogenic or secondary to first thoracic spine fracture?

A 49-year-old drunken man was involved in a motorbike crash. He presented with cervical spine injury and multiple limbs fracture. Neuro-imaging demonstrated disruption of the C5-6 anterior longitudinal ligament, herniation of C3-4 and C5-6 discs, and Th1 compression fracture. The neurological deficits improved after anterior cervical decompression, fusion and fixation. One week later, he suffered from fever and severe upper back pain, and he developed paraplegia subsequently. The following image study disclosed esophageal perforation at the level of Th1 and epidural abscess spreading from levels Th1 to Th5. After proper management and rehabilitation, he achieved good recovery one year later at follow-up. We report the unique case of Th1 fracture with esophageal perforation complicated with spinal epidural abscess. The possible mechanism and the controversy concerning therapy for esophageal perforation are discussed.

Cervical Vertebrae↗

PubMed1989

Identification of women at risk for developing postmenopausal osteoporosis with vertebral fractures: role of history and single photon absorptiometry.

Putative risk factors for the development of postmenopausal osteoporosis (PMO) with vertebral fractures were examined in a retrospective study of 663 postmenopausal white females aged 45-75 years (266 women with non-traumatic vertebral compression fractures (VF+), 134 non-fractured women from a general medicine clinic (controls) and 263 non-fractured women who were evaluated when they presented specifically for osteoporosis screening (VF-]. The VF+ women differed from control women in several respects. The VF+ group reported a higher prevalence of a positive family history of osteoporosis, and a higher prevalence of a history of medical or surgical conditions known to be independently associated with metabolic bone disease, had fewer children, were smaller (weight, height) and were slightly older. The two groups, VF+ and controls, did not differ with respect to cigarette smoking, alcohol consumption, exercise habits, menstrual or menopausal history, dietary intake of milk and cheese or in amount taking calcium supplements during pregnancy. The VF+ group also differed in certain respects from the VF- group. The VF+ group were smaller (weight, height) and were older. The VF+ group had lower cortical bone mass (measured by single photon absorptiometry of the non-dominant forearm) than either the control or VF- groups. The latter two groups did not differ from each other with respect to this measurement. These markers demonstrated limited sensitivity and specificity as estimated from a confirmatory data set, particularly for the historical and anthropometric variables. We conclude that an assessment of the risk of developing PMO with vertebral fractures cannot be based on the putative risk factors as measured in our study, but must be based on measurement of bone mass.

Absorptiometry, Photon↗

PubMed1988

Quantification of osteopenia in hip fracture patients.

Osteopenia was assessed in 56 consecutive hip fracture patients by using dual photon absorptiometry of the lumbar spine and uninjured, contralateral femoral neck and by performing iliac crest biopsy. Of the 56 patients, 47 were female and 9 were male. The mean age was 78 years. There were 31 femoral neck and 25 intertrochanteric fractures. Two comparison populations were also studied. Population 1 consisted of 269 postmenopausal females older than 60 years of age with no history of fracture who were referred for dual photon absorptiometry of the lumbar spine as screening for osteoporosis. Population 2 included 94 patients with vertebral compression fractures who underwent transilial biopsy to evaluate osteoporosis. All transilial biopsies were assessed with the use of quantitative histomorphometry. Dual photon absorptiometry of the lumbar spine indicated that 76.9% of the hip fracture patients had severe bone loss (less than 1 gm/cm2). Nevertheless, no difference in spinal bone density was found when the hip fracture patients were compared to population 1. No difference in density of the lumbar spine or femoral neck was found in patients in the hip fracture group when intertrochanteric and femoral neck fractures were compared. No difference in histomorphometric measurements of total bone, cortical bone, and cancellous bone volume was noted between the hip fracture patients and population 2. There was no difference noted when the intertrochanteric and femoral neck fracture patients were compared. No evidence of osteomalacia was noted in any group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2002

Osteogenesis imperfecta type VI: a form of brittle bone disease with a mineralization defect.

Osteogenesis imperfecta (OI) is a heritable disease of bone in which the hallmark is bone fragility. Usually, the disorder is divided into four groups on clinical grounds. We previously described a group of patients initially classified with OI type IV who had a discrete phenotype including hyperplastic callus formation without evidence of mutations in type I collagen. We called that disease entity OI type V. In this study, we describe another group of 8 patients initially diagnosed with OI type IV who share unique, common characteristics. We propose to name this disorder "OI type VI." Fractures were first documented between 4 and 18 months of age. Patients with OI type VI sustained more frequent fractures than patients with OI type IV. Sclerae were white or faintly blue and dentinogenesis imperfecta was uniformly absent. All patients had vertebral compression fractures. No patients showed radiological signs of rickets. Lumbar spine areal bone mineral density (aBMD) was low and similar to age-matched patients with OI type IV. Serum alkaline phosphatase levels were elevated compared with age-matched patients with type IV OI (409 +/- 145 U/liter vs. 295 +/- 95 U/liter; p < 0.03 by t-test). Other biochemical parameters of bone and mineral metabolism were within the reference range. Mutation screening of the coding regions and exon/intron boundaries of both collagen type I genes did not reveal any mutations, and type I collagen protein analyses were normal. Qualitative histology of iliac crest bone biopsy specimens showed an absence of the birefringent pattern of normal lamellar bone under polarized light, often with a "fish-scale" pattern. Quantitative histomorphometry revealed thin cortices, hyperosteoidosis, and a prolonged mineralization lag time in the presence of a decreased mineral apposition rate. We conclude that type VI OI is a moderate to severe form of brittle bone disease with accumulation of osteoid due to a mineralization defect, in the absence of a disturbance of mineral metabolism. The underlying genetic defect remains to be elucidated.

Adolescent↗

PubMed1975

[Circular fractures of the skull base during traffic accidents].

With reference to 5 cases of circular fracture of the base of the skull occurring in relation to road accidents, the literature is reviewed. Two different types may be distinguished: --"compression" fractures, --"hyperextension' fractures, the latter being special on the basis of the site of the fracture line and the application of forces via the face or chin. Reconstruction of trajectories during accidents, on the basis of the anatomical lesions and the damage caused to vehicles, as well as the study of films made during the experimental reproduction of similar lesions, make it possible to explain the mode of production of these hyperextension fractures. Such understanding is essential to the study of safety precautions for vehicle occupants.

Acceleration↗

PubMed2004

Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body.

BACKGROUND AND PURPOSE: Patients successfully treated with vertebroplasty often return with new pain caused by a new vertebral body fracture. The new fractures often are adjacent to the vertebral bodies that were initially treated. In our clinical work, we have observed that cement leakage into the disk increases the risk of new fracture of the adjacent vertebral body. This study analyzed the risk of new fractures of adjacent vertebral bodies in relationship to cement leakage into the disk. METHODS: This study was based on 38 patients with painful compression fractures treated with vertebroplasty. Patients who returned with new pain after initial successful vertebroplasty were evaluated by repeat MR imaging. We analyzed the incidence of new fractures of adjacent vertebral bodies in relationship to cement leakage into the disk that had occurred during the initial vertebroplasty. RESULTS: Fourteen patients developed new fractures during the follow-up period. In 10 patients, the new fractures were associated with cement leakage into the disk, whereas four patients had new fractures that were not associated with cement leakage into the disk. This difference was statistically significant (P =.018). A detailed analysis showed that 58% of vertebral bodies adjacent to a disk with cement leakage fractured during the follow-up period compared with 12% of vertebral bodies adjacent to a disk without cement leakage (P <.0005). CONCLUSION: Leakage of cement into the disk during vertebroplasty increases the risk of a new fracture of adjacent vertebral bodies.

Aged↗

PubMed1990

[Performance of X-ray absorptiometry in post-menopausal vertebral osteoporosis. Discriminant value of vertebral and femoral measurements, fracture threshold, reproducibility].

The aim of this study was to assess the performance of a new bone densitometry technique, X-ray absorptiometry, in vertebral osteoporosis with fracture(s). Vertebral and femoral (neck, Ward's triangle and trochanter) bone density was measured in 60 women with at least one vertebral compression fracture of osteoporotic origin (mean age: 61), 100 controls of the same age and in 40 young adults (mean age: 30). Osteoporosis patients had significantly (p less than 0.0005) low bone density values in comparison with the young adults: -40 to -50% (T-score -1.9 to -2.3) for the femur and with control subjects of the same age: -20 to -30% (Z-score -2.2 to -2.6) for the spine; -10 to -20 (Z-score -1.1 to -1.3) for the femur. Measurements using the spine and Ward's triangle had the best discriminant values assessed by the ROC (Receiver Operating Characteristics) technique (areas under the curve: 95% and 84% respectively). The fracture threshold was fixed at a vertebral bone density of 0.78 g/cm2, this value giving the best compromise between sensitivity (83%) and specificity (95%) with 91% of subjects appropriately classified. Reproducibility was assessed in the short term in 9 osteoporosis patients. The mean standard deviation of measurements was 0.017 g/cm2 (coefficient of variation: 2.6%) as compared with 0.010 g/cm2 (coefficient of variation: 0.8%) in the young adult. These results emphasise the true advance represented by X-ray absorptiometry in the area of bone densitometry, notably in the assessment and monitoring of demineralisation disorders.

Absorptiometry, Photon↗

PubMed1993

Architecture and vertebral fracture.

Bone strength is determined by mass density, structural arrangement, and the presence of microdamage. This presentation focuses on trabecular microstructure as an element of bone strength, particularly in the syndrome of vertebral compression fracture. The base material comes from transilial biopsies from 90 patients with the crush fracture syndrome and from 34 normal volunteers who underwent transilial biopsy. Trabecular connectivity was compared in these two groups. Patients and normals were then matched for trabecular bone volume (BV/TV). To highlight measures of trabecular connectivity, three general methods for examining trabecular connectivity were applied to the 23 patient-control pairs matched for BV/TV. The conventional method of Parfitt showed that trabecular number was decreased by 11%, trabecular separation was increased by 9%, and trabecular thickness was increased by 9% in patients compared with controls. The method of counting trabecular nodes and trabecular free ends showed that in the patients, free ends were decreased by 37% and nodes were decreased by 37%. The marrow space star volume (the average volume of marrow measured from radii placed at random points within the marrow and extending to trabecular surface) was 36% greater in the patients. All three methods are measures of trabecular connectivity (the density of connections between trabeculae). All three demonstrated less trabecular connectivity in the patients versus controls for identical BV/TV. Patients with vertebral fractures had fewer trabecular elements rather than global thinning of trabeculae. Differences in measures or connectivity were not accompanied by significant differences in any of the measures of bone remodeling dynamics, as examined by tetracycline labels.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1999

Complications in thoracoscopic spinal surgery: a study of 90 consecutive patients.

BACKGROUND: The literature contains few reports on negative outcomes after thoracoscopic spinal surgery. METHODS: From November 1995 to February 1998, 90 patients underwent minimally invasive spinal surgery by thoracoscopic assistance as treatment for their anterior spinal lesions. The diagnoses included 41 spinal metastases, 13 cases of scoliosis, 12 burst fractures, 10 cases of tuberculous spondylitis, 8 cases of pyogenic spondylitis, 2 thoracic disc herniations, 2 cases of ankylosing spondylitis with discitis, 1 osteoporotic compression fracture, and 1 case of thoracolumbar kyphosis. The procedures included biopsy only (3 patients); thoracic discectomy (3 patients); multilevel anterior releases, discectomy, and fusion (14 patients); corpectomy for decompression (6 patients); corpectomy and interbody fusion (32) patients; and internal instrumentation (28 patients). RESULTS: A total of 30 complications were noted in 22 patients (24.4%). Two fatal complications occurred, resulting from massive blood transfusion in one case and postoperative pneumonia in another. Other nonfatal complications included four cases of transient intercostal neuralgia, three superficial wound infections, three cases of pharyngeal pain, two cases of lung atelectasis, two cases of residual pneumothorax, two cases of subcutaneous emphysema, one inadvertent pericardial penetration due to adhesion, one chylothorax that resolved after conservative management, one vertebral screw malposition, and one graft dislodgement that needed late revision surgery. Three patients required ventilatory support for longer than 72 hours. Five patients with spinal metastases had an estimated intraoperative blood loss of more than 2,000 ml. No injury to the internal organs or spinal cord was observed. There were four conversions to open procedures due to two cases of severe pleural adhesions and two poorly tolerated one-lung ventilation. At the latest follow-up, nine patients had died as a result of cancer dissemination. CONCLUSIONS: (a) Well-selected patients and attention to details are essential to optimizing surgical results. (b) A refined technique for less invasive tumor surgery has been developed. (c) Surgeons had better experience with the standard anterior spinal approach and showed no hesitation in converting to an open procedure when necessary. A procedure failure does not mean a treatment failure.

Adolescent↗