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PubMed2004

Undertreatment of osteoporosis in women, based on detection of vertebral compression fractures on chest radiography.

BACKGROUND: Fractures attributable to ostcoporosis are responsible for preventable suffering and health care costs. Until they experience a fracture, many older adults, particularly women, are unaware that they have osteoporosis. Although radiographs taken for reasons other than evaluating the possibility of osteoporosis may suggest the presence of fracture, such fractures often go undetected and effective treatments are not implemented. OBJECTIVE: The goal of this study was to determine the adequacy of treatment of osteoporotic vertebral compression fractures in middle-aged and older women in an internal medicine clinic, as ascertained by reports of chest radiography. The hypothesis was that patients having chest radiographs with observable vertebral compression fractures often did not receive adequate treatment. METHODS: This was a retrospective, cross-sectional study conducted at a general internal medicine clinic at a university-affiliated county hospital. The records of an academic internal medicine practice were searched to identify women aged >or=40 years with radiologic evidence of vertebral compression fractures during the period from June 1, 1992, through May 31, 2002. Electronic prescription records were then searched to determine whether patients had received a prescription for a medication for the treatment of osteoporosis. An analysis also was conducted to describe the frequency distribution of various medications for the treatment of osteoporosis. RESULTS: One hundred thirteen women were identified who met the study criteria. Their mean (SD) age was 68.1 (21.9) years. Fifty-six (50%) of these women received pharmacologic treatment for osteoporosis. The most commonly prescribed medications were estrogens (35%), calcitonin (16%), and bisphosphonates (12%). CONCLUSIONS: No more than half of patients identified as having a vertebral compression fracture on chest radiography received even 1 prescription for the treatment of osteoporosis. Because this study did not examine adherence or long-term medication use, the proportion of women who received adequate osteoporosis therapy was probably much less than half. Physicians should be alert to the possible presence of vertebral compression fractures and take a more aggressive approach to treatment when a fracture is present.

Adult↗
PubMed2002

New advances in treating osteoporotic compression fractures.

Osteoporosis is a chronic and potentially debilitating disease. A painful consequence of osteoporosis is a compression fracture of a vertebral body of the spine. These fractures can lead to physical deformities and emotional trauma. Treatment options for these fractures are limited and occasionally ineffective. New surgical advances in treating vertebro-compression fractures are evolving. Kyphoplasty is a new surgical procedure now being used to treat the painful compression fracture.

Humans↗
PubMed2003

[Vertebroplasty for osteoporotic vertebral compression fractures].

Vertebroplasty for osteoporotic vertebral compression fractures is a minimally invasive procedure which could provide immediate pain relief by injecting PMMA into the vertebral body percutaneously. Kyphoplasty, which is designed to restore the vertebral height by inflating balloon, has recently been developed and the excellent early clinical results were reported. Calcium phosphate cement may have potential advantages over the PMMA for the use in vertebroplasty or kyphoplasty.

English Abstract↗
PubMed2002

Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures.

PURPOSE: To determine the efficacy of percutaneous vertebroplasty in treating severe vertebral body compression fractures, or vertebra plana, in patients with osteoporosis. MATERIALS AND METHODS: In 155 patients, 310 percutaneous vertebroplasties were performed during 25 months and 15 days. Of these, 37 patients (27 women, 10 men; mean age, 73.6 years) underwent 48 vertebroplasties for severe osteoporotic vertebral body compression fractures. The fractures were defined as vertebrae that have collapsed to less than one-third of their original height. Imaging and clinical features were analyzed, including the extent of vertebral collapse, location of the involved vertebra, pattern of vertebral compression, volume of polymethylmethacrylate injected, vertebroplasty complications, and clinical outcome. RESULTS: Vertebral body collapse averaged 23% (range, 4.5%-33.0%) of the original height. Involved vertebrae were located from levels T5 to L5, with one-half affected at the thoracolumbar junction. Patterns of vertebral compression were divided into gibbus (31 of 48 or 65%), plana (13 of 48 or 27%), and H shape (four of 48 or 8%). The mean volume of the cement injected was 6.0 mL (range, 1.5-12.5 mL). Complications observed on radiographs included cement leakage to the adjacent disc (17 of 48 or 35%) and the paravertebral soft tissues (four of 48 or 8%). There were no major complications. At clinical follow-up (mean duration, 11 months and 3 days; range, 3-24 months), pain relief was complete in 14 (47%) of 30 patients, partial in 15 (50%), and unchanged in one (3%). No patient required surgery. CONCLUSION: Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures is safe and effective and should not be withheld in this group of patients.

Adult↗
PubMed2006

[Different approaches of vertebroplasty for management of severe osteoporotic vertebral compression fractures].

OBJECTIVE: To compare the clinical efficacy of 3 approaches of vertebroplasty in the treatment of severe osteoporotic vertebral compression fractures. METHODS: Twenty-five patients with severe osteoporotic vertebral compression fractures were observed, whose average age was 72 years with average disease history of 12 days and average compression of the affected vertebral bodies of 73%. The patients were divided into 3 groups for 3 different fracture types according to Rao's classification of osteoporotic vertebral structure and deformity, namely wedge type (group A, n= 12), biconcave type (group B, n= 7) and crush type (group C, n=6). Unipedicular approach was adopted in group A, far lateral bipedicular approach in group B, and posterior wall vertebroplasty and pedicle screw fixation in group C. The average follow-up time was 1 year. Visual analog scale (VAS), analgesic use and the mobility were measured in the patients preoperatively and 3 days (7 days in group C) and 6 months after the operation, respectively, and the success rates and complications were observed. RESULTS: All the surgical procedures were successful. The average operation time was 35 min in group A, 50 min in group B, and 2 h in group C. The average volume of cement injected into each vertebral body was 2.0 ml. The average blood loss was 30 ml in groups A and B, and 600 ml in group C. The procedure increased mobility and decreased analgesic use. VAS was decreased by a mean of 4.8 in Group A, 6.2 in group B 3 days after the operation and 5.4 in group C 7 days postoperatively, and remained stable till 6 months after the operation (P<0.01). Cement extravasation occurred in 9 cases, cement in the vertebral canal in 2 cases with transient neurological symptoms, and cement extravasation in the intervertebral space and the anterior space of the vertebral bodies took place in 5 and 2 cases, respectively. No neurological complications were observed. CONCLUSION: Different types of severe osteoporotic vertebral compression fractures require management with different approaches of vertebroplasty for adequate filling of the remaining vertebral body, which provides significant pain relief with wider indications.

Aged↗
PubMed2006

Percutaneous vertebroplasty as a treatment for osteoporotic vertebral compression fractures: a systematic review.

Percutaneous vertebroplasty has been performed for more than ten years to treat painful osteoporotic vertebral compression fractures. Clinical results have been encouraging, but little is known about the efficacy and safety of this minimally invasive procedure. We therefore performed a systematic review to assess the efficacy and safety of percutaneous vertebroplasty in osteoporotic vertebral compression fractures. A search was conducted using Medline, Embase and The Cochrane Controlled Trials Register. The search yielded fifteen studies, eleven prospective, three retrospective and one controlled trial. Totally 1,136 interventions were performed on 793 patients. Mean pain scores, measured using a 0 to 10 VAS score, improved significantly from 7.8 to 3.1 (-60.3%) immediately after percutaneous vertebroplasty. The short-term complication rate varied between 0.4 and 75.6%. Leakage of cement outside the vertebral body was markedly common, ranging from 3.3 to 75.6%. Although the majority was asymptomatic, a few devastating clinical adverse effects were reported (mean 2.4%). Although percutaneous vertebroplasty is a widely accepted treatment for osteoporotic vertebral fractures, we revealed only a single controlled trial. We conclude that there are insufficient data available to reliably assess efficacy of percutaneous vertebroplasty. The procedure has a low rate of clinical complications, but potential complications can be devastating. In the future, assessing the efficacy of percutaneous vertebroplasty requires controlled trials with long-term follow-up.

Fractures, Compression↗
PubMedDate not supplied

MR appearance at different ages of osteoporotic compression fractures of the vertebrae.

PURPOSE: To elucidate the MR appearance at different ages of osteoporotic vertebral compression fractures. METHODS: We retrospectively analyzed sequential MR studies of 107 vertebrae in 75 patients with osteoporotic compression fractures. RESULTS: Vertebral deformities comprised 35 anteriorly wedged vertebrae, 65 fish vertebrae, four flat vertebrae, and others. Signal alterations were depicted as geographic areas of low intensity on T1-weighted images (T1-WI) and high intensity on T2*-WI, or linear areas of low intensity on T1-WI and high or low intensity on T2*-WI. In the acute stage, geographic alteration predominated. During a three-month period following the injuries, the extent of the geographic areas increased in 40% of cases on T1-WI. Geographic alteration declined in the chronic stage, whereas the prevalence of linear signals increased. Restoration of fatty marrow was preceded by linear signals without geographic signals on T1-WI (36%). The anteriorly wedged vertebrae collapsed faster than the fish vertebrae. CONCLUSIONS: The acute or subacute stage of compression fractures is characterized by a larger alteration of the geographic signal, whereas the chronic stage was evidenced by a smaller area of alteration of the geographic and linear signals or by restoration of fatty marrow.

Acute Disease↗
PubMed2001

Intradural arachnoid cyst associated with thoracic spinal compression fracture: 7-year follow up after surgery.

STUDY DESIGN: A case report with long-term follow after a surgical procedure. OBJECTIVES: To describe a case of intradural arachnoid cyst secondary to a compression fracture in the thoracic spine and to report long-term results after surgical treatment with hemilaminectomy. SETTING: Osaka, Japan. METHODS: A 68-year-old man who had a traumatic intradural arachnoid cyst following an adjacent compression fracture of T5 underwent surgery. Intraoperatively, after recognition of intradural arachnoid cyst with an echogram following hemilaminectomy, the dural sac was incised and the arachnoid cyst was resected under microscopic observation. RESULTS: At 7 years after the operation, the low intensity within the vertebral body of the compression fracture had resolved and the spinal cord remained in its normal shape and position. No progression of kyphotic deformity was detected. CONCLUSION: A compression fracture of the thoracic spine can be associated with an intradural arachnoid cyst. Microscopic resection via hemilaminectomy for the cyst showed a good result in a 7-year follow up.

Arachnoid Cysts↗