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PubMed2003

Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy.

PURPOSE: We sought to determine whether percutaneous vertebroplasty--which involves the injection of cement to stabilize a fractured vertebral body--may be an effective treatment for vertebral fracture. METHODS: We enrolled 79 consecutive osteoporotic patients (24 men and 55 women; ages 51 to 93 years) presenting with acute vertebral fractures. Clinical characteristics and bone densitometry were measured at baseline. Pain scores (on a 0 to 25 scale) and levels of function (on a 0 to 20 scale) were recorded on presentation, at 24 hours, at 6 weeks, and 6 to 12 months after therapy. RESULTS: Fifty-five patients (70%) were treated by percutaneous vertebroplasty and 24 (30%) were treated by conservative therapy alone. They were followed for a mean of 215 days (range, 57 to 399 days). The baseline clinical characteristics, bone densitometry, and fracture data were similar in the two groups. Twenty-four hours after vertebroplasty, there was a 53% reduction in pain scores (from 19 to 9; P = 0.0001) and a 29% improvement in physical functioning (from 14 to 18; P = 0.0001), whereas pain scores and physical functioning remained unchanged at 24 hours in the patients treated conservatively (both P = 0.0001 compared with the changes after percutaneous vertebroplasty). Thirteen patients (24%) treated by percutaneous vertebroplasty were able to cease all analgesia after 24 hours (P = 0.0001 compared with none of the 24 patients treated conservatively). Clinical outcomes at 6 weeks and 6 to 12 months were similar in both groups. CONCLUSION: When compared with conservative therapy, percutaneous vertebroplasty results in prompt pain relief and rapid rehabilitation. In experienced hands, it is a safe and effective procedure for treating acute osteoporotic vertebral compression fractures.

Aged↗

PubMed1996

Bone densitometry: patients receiving prolonged steroid therapy.

Bone mass loss and osteoporosis are associated with various conditions, such as asymptomatic primary hyperparathyroidism, and treatments, such as prolonged steroid therapy. Bone densitometry is used to measure bone mass density to determine the degree of osteoporosis and to estimate fracture risk. Bone densitometers measure the radiation absorption by the skeleton to determine bone mass of the peripheral, axial, and total skeleton. Common techniques include single-photon absorptiometry (SPA) of the forearm and heel, dual-photon (DPA) and dual-energy x-ray absorptiometry (DXA) of the spine and hip, quantitative computed tomography (QCT) of the spine or forearm, and radiographic absorptiometry (RA) of the hand. Part I of this report addresses important technical considerations of bone densitometers, including radiation dose, site selection, and accuracy and precision, as well as cost and charges. Part II evaluates the clinical utility of bone densitometry in the management of patients receiving prolonged steroid therapy. Steroids have broad effects on both immune and inflammatory processes and have been used to treat a wide variety of immunologically mediated diseases. Osteoporosis and vertebral compression fractures have been considered major complications of prolonged steroid therapy. Bone loss is also a direct result of many of the diseases treated with steroids. Issues addressed are the type and extent of bone loss associated with steroid therapy, risk for fracture, whether steroid dose reduction or alternative therapy is an option, and whether osteoporosis associated with prolonged steroid use can be prevented or treated. The other assessments in this series address the clinical utility of bone densitometry for patients with: asymptomatic primary hyperparathyroidism, end-stage renal disease, vertebral abnormalities, and estrogen-deficient women.

Absorptiometry, Photon↗

PubMed1996

Correlations of dual-energy X-ray absorptiometry, quantitative computed tomography, and single photon absorptiometry with spinal and non-spinal fractures.

Controversy continues as to which method of measuring bone mineral density (BMD) best detects osteoporosis and best correlates with fractures of the spine, hip and elsewhere. To answer these questions the prevalence of fractures was carefully determined among 90 subjects (70 with osteoporosis, 6 with mild primary hyperparathyroidism, 1 with osteomalacia and 13 normals) and simultaneous measurements were made using spinal computed tomography (QCT), spinal anteroposterior (AP) and supine lateral dual X-ray absorptiometry (DXA), femoral neck and total hip DXA, and distal third radial DXA and single photon absorptiometry (SPA). The DXA measurements which had the greatest sensitivity in detecting osteoporosis (defined as a BMD lower than -2.5 SD of peak bone mass at age 30 years) were the supine lateral spine DXA (84%) and femoral neck DXA (75%); less sensitive were the DXA measurements of the distal third of the radius (61%) and AP spine (51%). DXA measurements of the femoral neck and distal third of the radius were more useful than spinal measurements in detecting the osteopenia of mild primary hyperparathyroidism. Vertebral compression fractures (VCF) correlated well with spinal QCT (r = 0.38) and lateral spine DXA (r = -0.41), but poorly with AP spine DXA (r = -0.17) and distal third radial DXA (r = -0.02). Non-spinal fractures correlated best with the distal third radial DXA (r = -0.42). In conclusion, spinal QCT, supine lateral spine DXA and femoral neck DXA are the best BMD methods to screen for osteoporosis, whereas AP spine DXA is a poor screening method in women over 60 years of age. Spinal QCT and lateral spine DXA correlate well with VCFs, whereas correlations of VCFs with AP spine DXA, femoral neck DXA and distal third radial DXA are poor.

Absorptiometry, Photon↗

PubMed2003

Reduced iliac cancellous osteocyte density in patients with osteoporotic vertebral fracture.

UNLABELLED: Iliac cancellous osteocyte density declines with age, but its relationship to vertebral fracture pathogenesis is unknown. We performed iliac bone biopsy in 44 women with clinical vertebral fracture and 56 healthy women. The fracture patients had 34% fewer osteocytes but no reduction in percent occupied lacunae. Some patients destined to sustain vertebral fracture make cancellous bone with fewer osteocytes. INTRODUCTION: Patient's with vertebral fracture have less bone than appropriate healthy controls, but other factors may contribute to bone fragility. Iliac cancellous osteocyte density declines with age in healthy women; we asked whether this variable differed between fracture patients and healthy controls. METHODS: Two groups of women were assembled. Forty-four (mean age, 66.2 years) had unequivocal evidence of bone fragility manifested as painful nontraumatic vertebral fracture, and 56 (mean age, 62.2 years) were skeletally healthy. All subjects underwent iliac bone biopsy. From archival embedded biopsy cores, new sections were stained with Goldner's trichrome, in which we enumerated osteocyte-occupied lacunae (stained), empty lacunae (unstained), and total lacunae per bone area. RESULTS: Cancellous osteocyte density was 34% lower in the fracture group than in the controls (p < 0.001); this difference was not a consequence of higher turnover, having less bone, or the small difference in age. The area under the receiver operating characteristic (ROC) curve for discrimination between the groups was >90% for osteocyte density and <75% for bone volume/tissue volume (BV/TV). The disease-related osteocyte deficit was accompanied by a proportionate reduction in empty lacunae and no change in percent occupied lacunae; therefore, it was not the result of premature death. Both superficial bone (<25 microm from the surface) and deep bone (>45 microm from the surface) were affected. In contrast, the age-related deficit is accompanied by an increase in empty lacunae and fall in percent osteocyte-occupied lacunae and occurs only in deep bone, but not in superficial bone. CONCLUSIONS: In some patients destined to sustain spontaneous vertebral compression fracture, iliac cancellous bone is made with fewer osteocytes than normal; the mechanism of osteocyte incorporation into bone needs more detailed study. Osteocyte deficiency could contribute to bone fragility, either by impairing the detection of fatigue microdamage or by reducing canalicular fluid flow. Current practices of defining vertebral fracture based on morphometry alone regardless of symptoms, and diagnosing osteoporosis based on bone densitometry alone regardless of fracture history, should be reexamined.

Aged↗

PubMedDate not supplied

Osteoporosis with lymphoid nodules and hematopoietic marrow hyperplasia.

OBJECTIVE: In 1983 Vigorita reported 3 cases of osteoporosis associated with intramedullary lymphoid nodules. We present 8 patients with osteoporosis and lymphoid nodules (LN) in whom we studied the clinical, biological and histological features and the course of the disease. METHODS: Three men (mean age 52 yrs., range 43-68 yrs.) and 5 women (mean age 60 yrs., 49-66 yrs.), 6 of them with osteoporosis with fracture and 2 with osteoporosis on bone densitometry (T score < -2.5 SD) were enrolled in this study. The following parameters were studied: immunobinding with IG determination, phosphorus and calcium levels, PTH, 25 and 1-25 OH D3, osteocalcin, urinary deoxypyridinoline, histomorphometry, tests for autoanti-bodies, HIV, HTLV, EBV and CMV serology. The results were compared with those of 20 patients with osteoporosis but without LN. Five patients underwent a second BMB a mean of 2 years after the first. RESULTS: Five patients had asthenia, 4 had joint pain and 3 had hyperlymphocytosis. Immunologic and virologic investigations were negative in all cases. Bone marrow was hypercellular (59.9 +/- 5.3 vs 40.1 +/- 13%, p: 0.001). At the second BMB, LN were absent but bone marrow was still hypercellular. In all cases, no cause of demineralization was found and osteoporosis progressed rapidly (an average of 3 vertebral compression fractures in three months, with increased resorption (ES 6.5 +/- 1.6 vs 3 +/- 1.2, p: 0.05) with decreased calcification rate (CR 0.62 +/- 0.07 vs 0.79 +/- 0.1, p: 0.04). CONCLUSION: Some interesting questions are raised by this study. Did an undiscovered viral infection cause the asthenia and joint pain via cytokines or PTHrp in our patients, and can activated lymphocytes perhaps modify bone remodeling?

Adult↗

PubMed2006

Pseudoarthrosis of vertebral fracture: radiographic and characteristic clinical features and natural history.

BACKGROUND: We examined mobility based on radiographic appearance, clinical appearance, and the natural course of osteoporotic vertebral pseudoarthrosis (VPA) in a prospective study in 34 consecutive cases of VPA in 27 patients with osteoporosis. METHODS: Conventional lateral, lateral flexion, and extension stress radiography (XP) and supine cross-table lateral XP were performed. Anterior vertebral body height and vertebral kyphotic angle were measured to assess vertebral mobility. If vertebral cleft or vertebral instability, which means a difference in vertebral body height between conventional and supine cross-table lateral XP, was present, VPA was diagnosed. Back pain was classified into five grades. RESULTS: The average anterior vertebral height was 9.9 +/- 5.6 mm on conventional lateral XP; it increased to 11.4 +/- 6.5 mm on extension stress XP (not significant) and 18.3 +/- 5.7 mm on cross-table lateral XP (significant). The vertebral kyphotic angle was 24.1 degrees +/- 9.7 degrees on conventional lateral XP; it decreased to 21.6 degrees +/- 9.8 degrees on extension stress XP (not significant) and 11.8 degrees +/- 8.5 degrees on cross-table lateral XP (significant). Intravertebral clefts were detected by conventional lateral XP, extension stress XP, and supine cross-table XP in 3 of 34 (8.8%), 7 of 21 (33.3%), and 28 of 34 (82.4%) vertebral compression fractures (VCFs), respectively. Surgical treatment was performed in seven patients (two because of severe pain and five because of neurological deficits) and in one patient who died. Except in these eight patients, back pain decreased by at least one grade with time in 18 of 19 patients (95%) in whom the clinical course was analyzed. Radiographic follow-up using supine cross-table XP was performed in 15 of 19 patients. Although 11 of these 15 patients (73%) showed vertebral instability on supine cross-table lateral XP, 10 of 11 patients (91%) did not complain of intolerable back pain during daily activity at the final follow-up. CONCLUSIONS: VPA is often detected on supine cross-table lateral XP but not usually on extension stress XP. Despite the presence of vertebral instability, many patients did not complain of intolerable back pain during their daily activity. Surgical treatment to alleviate back pain should be performed for painful VPA after conservative treatment for about 4 months.

Aged↗

PubMed1994

Osteoporosis and bone morbidity in cardiac transplant recipients.

PURPOSE: To evaluate the incidence and etiology of osteopenia and pathologic fractures in cardiac transplant recipients. PATIENTS: Thirty-one adult male cardiac transplant recipients and 14 adult men with congestive heart failure (CHF) awaiting cardiac transplantation. METHODS: Assessment of indices of bone and mineral metabolism and of bone mineral density (BMD) by dual-energy x-ray absorptiometry. RESULTS: BMD in the proximal femur was below normal in both groups compared to that in age-matched control subjects, whereas BMD in the lumbar spine was normal. There was no significant difference in BMD at any site between the two groups. No clinical parameter predicted BMD. In all patients, laboratory indices of bone mineral metabolism, except parathyroid hormone (PTH) levels, were normal and not statistically different between the two groups. CHF patients had a trend toward elevations of PTH, 1,25-dihydroxyvitamin D, and urinary calcium excretion compared to transplant patients. Eight of 31 transplant patients and 2 of 14 CHF patients had vertebral compression fractures (c2 = 11.8, p < 0.0006). Transplant recipients with fractures had twice as many rejection episodes as did transplant patients without fractures, but did not differ in cumulative dose of steroids. Two patients developed avascular necrosis of the femoral head following transplantation. CONCLUSIONS: Cardiac transplant recipients and patients with CHF awaiting transplantation had decreased hip BMD, but normal spine BMD. Although immunosuppressive therapy did not appear to influence bone mass, loop diuretics prior to transplantation may have stimulated a mild secondary increase in PTH that could have differentially caused loss of bone density at the hip in both groups. Pulse corticosteroids used in treating rejection may have contributed to the increased incidence of vertebral fractures in transplant patients. These data suggest that severe CHF with its associated diuretic use and decreased activity are primary contributors to osteopenia in these patients.

Absorptiometry, Photon↗

PubMed2004

[Clinical study on treatment of postmenopausal osteoporosis by Yigu capsule].

OBJECTIVE: To observe the efficacy and safety of Yigu capsule (YGC, a Chinese herbal compound preparation) in treating postmenopausal osteoporosis (PMO) and to explore its possible mechanism. METHODS: The clinical study was conducted adopting prospective, randomized, double blinded method for 6 months with placebo and positive controls. Two hundred and ten PMO patients with confirmed diagnosis were divided into the YGC group, the osteocalcin group and the placebo group, they were treated with YGC, osteocalcin capsule and placebo capsule, respectively. The symptoms, as new fracture and ostealgia, bone mineral density (BMD) of the 2nd to the 4th lumbar vertebrae (L24) and upper segment of femur, blood and urinary indexes for bone metabolism, sex hormone level and adverse reaction were observed. RESULTS: In the YGC group, the total effective rate was 95.50%, no new fracture occurred, which was significantly better than that in the other two groups (P < 0.05). The increase of BMD was 9.83% in L2-4, 4.09% in femoral neck, 4.60% in Wards triangle, 3.00% in greater trochanter, which were better than those in the placebo group (P < 0.05, P < 0.01). As compared with the placebo group, in the YGC group, levels of urinary oxyproline hydroxyproline/creatinine, urinary calcium/creatinine were lower, serum and bone alkaline phosphatase, osteocalcin, estradiol, and estradiol/testosterone were higher, but with no difference in level of testosterone. In the observation period, no abnormal findings in blood and urine routine examination as well as in liver and renal function were found. Mild, transient gastro-intestinal response occurred in individual patients but it didn't affect the treatment. CONCLUSION: YGC could treat PMO effectively, it could obviously increase the BMD of lumbar vertebrae and hip, elevate the alleviating rate of ostealgia and incessant motion time, without new compressive fracture of vertebrae, and without any related adverse reaction. YGC could not only promote the formation, but also inhibit the absorption of bone, and increase the sex hormone level, therefore, it is a pure Chinese herbal compound preparation that worths further deep research and development.

Absorptiometry, Photon↗

PubMed2000

Relationship of Schmorl's nodes to vertebral body endplate fractures and acute endplate disk extrusions.

BACKGROUND AND PURPOSE: Literature regarding clinical pain syndromes associated with acute, traumatic Schmorl's nodes (SNs) is limited. Our purpose was to determine whether an SN could be related to a previous traumatic event producing either acute SN or a vertebral endplate fracture. METHODS: Two neuroradiologists independently reviewed initial and follow-up MR examinations of 14 patients with a clinical diagnosis of acute, symptomatic thoracolumbar SNs or vertebral body endplate fractures that evolved into SNs to evaluate marrow edema, signal intensity, margin definition, presence of intravertebral extruded disk material, and pattern of contrast enhancement. RESULTS: Edema of the affected vertebral body, adjacent to an endplate without wedging or collapse, was observed on the initial MR images in all cases. The initial MR images of six (43%) of 14 patients exhibited only edema of the marrow immediately adjacent to the endplate without wedging or collapse. The MR images obtained at the time of follow-up showed subsequent formation of a chronic and eventually asymptomatic SN for all six patients. The initial MR images of eight (57%) of the 14 patients showed the typical appearance of acute SNs with marrow edema of the affected vertebra. The contrast-enhanced images of three patients manifested enhancement of the invaginated disk material in three (100%) of three cases and enhancement of the surrounding vertebral body in one case (33%). Six (43%) of 14 patients had acute typical compression fracture of a vertebral body of at least one additional level. CONCLUSION: Most (57%) of the SNs in this series could be traced to episodes of significant, sudden-onset, localized, nonradiating back pain and tenderness for which the MR images showed SNs surrounded by vertebral body marrow edema. The remaining SNs (43%) were not immediately apparent as SNs and manifested only as vertebral body edema representing endplate fracture but did evolve into classical chronic SNs that follow-up imaging revealed.

Acute Disease↗

PubMed2005

A clinical study of Yigu capsule in treating postmenopausal osteoporosis.

OBJECTIVE: To observe the efficacy and safety of Yigu capsule (YGC), a Chinese herbal compound preparation, in treating postmenopausal osteoporosis (PMO) and to explore its possible mechanism. METHODS: The clinical study was conducted in a prospective, randomized, double blinded method lasting for 6 months with placebo and positive control. Two hundred and ten PMO patients with confirmed diagnosis were assigned into the YGC group, the calciferol group and the placebo group. Besides being administered element calcium, they were treated with YGC, calciferol capsule and placebo capsule respectively. And such symptoms as newly found fracture and ostealgia, bone mineral density (BMD) of the 2nd-4th lumbar vertebrae (L(2-4)) and upper femur, blood and urinary indexes for bone metabolism, sex hormone level and adverse reaction that occurred in patients were observed. RESULTS: In the YGC group, the total effective rate was 95.50%, with no new occurrence of fractures, which was significantly better than that in the other two groups (P < 0.05). Moreover, in the YGC group, the increase rate of BMD was 9.83% in L(2-4), 4.09% in femoral neck, 4.60% in Wards triangle, 3.00% in greater trochanter, which was also better than that in the placebo group (P < 0.05, P < 0.01). As compared with the placebo group, levels in the YGC group of urinary oxyproline hydroxyproline/creatinine, urinary calcium/creatinine were significantly lower, serum and bone alkaline phosphatase, osteocalcin, estradiol and estradiol/testosterone were significantly higher, but no difference was shown in the comparison of testosterone level. In the observation period, no abnormality in blood or urine routine, liver or renal function was found. Only mild, transient gastro-intestinal response occurred in individual patients, but it did not affect the treatment. CONCLUSION: YGC could treat PMO effectively, as it could obviously increase the BMD of lumbar vertebrae and coxafemoral bone, elevate the alleviating rate of ostealgia and incessant motion time, yet causing no newly found compressive fracture of vertebrae, or and any related adverse reaction. YGC could not only promote the formation, but also inhibit the absorption of bone as well as increase the sex hormone level. Therefore, it is a pure Chinese herbal compound preparation worthy of further research and development.

Administration, Oral↗

PubMed2003

Glenoid rim morphology in recurrent anterior glenohumeral instability.

BACKGROUND: Knowledge regarding the morphology of the glenoid rim is important when patients with recurrent anterior glenohumeral instability are assessed. Ordinary imaging techniques are not always sensitive enough to demonstrate the morphology of the glenoid rim accurately. We developed a method of three-dimensionally reconstructed computed tomography with elimination of the humeral head to evaluate glenoid morphology. The purpose of the present study was to quantify glenoid osseous defects and to define their characteristics in patients with recurrent anterior instability. METHODS: The morphology of the glenoid rim in 100 consecutive shoulders with recurrent unilateral anterior glenohumeral instability was evaluated on three-dimensionally reconstructed computed tomography images with the humeral head eliminated. The configuration of the glenoid rim was evaluated on both en face and oblique views. Concurrently, we also investigated seventy-five normal glenoids, including both glenoids in ten normal volunteers. Shoulders without an osseous fragment at the anteroinferior portion of the glenoid were compared with the contralateral shoulder in the same patient to determine if the glenoid morphology was normal. In shoulders with an osseous fragment, the fragment was evaluated quantitatively and its size was classified as large (>20% of the glenoid fossa), medium (5% to 20%), or small (<5%). Finally, all 100 shoulders were evaluated arthroscopically to confirm the presence of the lesion at the glenoid rim that had been identified with three-dimensionally reconstructed computed tomography. RESULTS: Investigation of the normal glenoids revealed no side-to-side differences. Investigation of the affected glenoids revealed an abnormal configuration in ninety shoulders. Fifty glenoids had an osseous fragment. One fragment was large (26.9% of the glenoid fossa), twenty-seven fragments were medium (10.6% of the glenoid fossa, on the average), and twenty-two were small (2.9% of the glenoid fossa, on the average). In the forty shoulders without an osseous fragment, the anteroinferior portion of the glenoid appeared straight on the en face view and it appeared obtuse or slightly rounded, compared with the normally sharp contour of the normal glenoid rim, on the oblique view, suggesting erosion or a mild compression fracture at this site. Arthroscopic investigation revealed a Bankart lesion in ninety-seven of the 100 shoulders and an osseous fragment in forty-five of the fifty shoulders in which an osseous Bankart lesion had been identified with the three-dimensionally reconstructed computed tomography. In the shoulders with distinctly abnormal morphology on three-dimensionally reconstructed computed tomography, the arthroscopic appearance of the anteroinferior portion of the glenoid rim was compatible with the appearance demonstrated by the three-dimensionally reconstructed computed tomography. CONCLUSIONS: We introduced a method to evaluate the morphology of the glenoid rim and to quantify the osseous defect in a simple and practical manner with three-dimensionally reconstructed computed tomography with elimination of the humeral head. Fifty percent of the shoulders with recurrent anterior glenohumeral instability had an osseous Bankart lesion; 40% did not have an osseous fragment but demonstrated loss of the normal circular configuration on the en face view and an obtuse contour on the oblique view, suggesting erosion or compression of the glenoid rim.

Adolescent↗

PubMed2005

Long-term results of occipitothoracic fusion surgery in RA patients with destruction of the cervical spine.

OBJECTIVE: This is a retrospective study of the outcome of occipitothoracic fusion surgery in rheumatoid arthritis (RA) patients with destruction of the cervical spine, designed to assess the efficacy of halo vest before surgery, the postoperative outcome, and the activities-of-daily living (ADL) problems associated with surgical management. There have been no reports regarding these issues, including surgical effect on subjacent vertebrae. METHODS: This study included 20 RA patients with destruction of the cervical spine. All patients underwent preoperative halo vest followed by occipitothoracic fusion with an average follow-up of 5 years. The long-term clinical outcomes were analyzed using a modified Ranawat classification. RESULTS: Before halo application, the neurologic status was assessed as IIIC in 15 patients and IIIB in 5 patients. After halo application, the neurologic status improved in all patients: IIIA in 12 patients and IIIB in 8 patients. After surgery, the neurologic status did not improve in six of the eight IIIB patients but improved to IIIA in two patients. Of the 12 IIIA patients, the neurologic status improved to II in 6 patients but did not improve in the other 6 patients. Patient satisfaction was excellent for 14 patients, good for 3 patients, and fair for only 3 patients (1 had difficulty drinking, another had back pain, and the last had low back pain associated with a compression fracture of the lumbar spine). CONCLUSIONS: We have performed occipitothoracic fusion surgery in RA patients with destruction of the cervical spine. Preoperative halo vest was very effective for improving the neurologic status, for the general condition, and for an optimal sagittal alignment. Occipitothoracic fusion using unit rods gave satisfactory long-term clinical results compared with the prognosis of patients in whom the disease follows its natural course.

Activities of Daily Living↗

PubMed2005

Honda sign and variants in patients suspected of having a sacral insufficiency fracture.

PURPOSE: The purpose of this study was to reassess whether the Honda sign (HS) and its variants on bone scans can be used to differentiate an insufficiency fracture (IF) of the sacrum from a metastasis and to evaluate extrapelvic tracer accumulation in patients suspected of having a sacral IF. METHODS AND MATERIALS: We retrospectively reviewed 34 bone scans of 26 patients suspected of having a sacral IF between January 1998 and June 2003. RESULTS: Twenty-four of the patients had a sacral IF and 1 had a sacral metastasis from prostate cancer and another from lung cancer. The bone scans of only 15 (63%) of the 24 patients with a sacral IF exhibited the HS, 8 (33%) scans exhibited variants, and 4 (4%) scans showed whole-sacrum uptake. One of the 2 patients with metastasis exhibited the HS and the other exhibited a variant. The sensitivity and positive predictive value of HS plus its variants as diagnostic criteria for sacral IF were 96% and 92%, respectively. Seventeen patients (71%) had extrasacral accumulation. The most common site was the pubic bone (50%, 12 of 24), and the second most common site was the spine (46%, 11 of 24), where the accumulation was the result of a compression fracture or degenerative joint disease of the spine. CONCLUSIONS: A "Honda sign or variation" with evidence of fractures elsewhere or no evidence of other metastatic disease should be strong evidence for a sacral insufficiency fracture. The likelihood of having a solitary metastasis to the sacrum is small.

Aged↗

PubMed1996

Can strong back extensors prevent vertebral fractures in women with osteoporosis?

OBJECTIVE: To determine the influence of back extensor strength on vertebral fractures in 36 women with osteoporosis. DESIGN: We conducted a cross-sectional study of female patients with osteoporosis by assessing anthropometric variables, bone mineral density, muscle strength, level of physical activity, and radiographic findings in the spine. MATERIAL AND METHODS: The 36 study subjects with osteoporosis, who ranged from 47 to 84 years of age, satisfied specific inclusion and exclusion criteria that minimized confounding factors related to pathophysiologic features, diet, and medications. A physical activity score was determined for each subject on the basis of daily physical activities relating to homemaking, occupation, and sports. RESULTS: The range of the physical activity scores-from 2 to 13-indicated that no subject was involved in unusually demanding physical activities. Bone mineral density values ranged from 0.49 to 0.92 g/cm2. Thoracic kyphosis ranged from 31.0 to 84.0 degrees. Isometric strength of the back extensor muscles ranged from 7.3 to 34.0 kg. Statistical analysis demonstrated a significant negative correlation between the strength of the back extensor muscles and thoracic kyphosis. Significant negative correlations were also found between back extensor strength and the number of vertebral compression fractures and between bone mineral density and the number of vertebral fractures. CONCLUSION: The negative association between back extensor strength and both kyphosis and number of vertebral fractures suggests that increasing back strength may prove to be an effective therapeutic intervention for the osteoporotic spine. In persons with stronger back muscles, the risk of vertebral fractures will likely decrease.

Aged↗

PubMed1998

Suspected spinal cord compression in breast cancer patients: a multidisciplinary risk assessment.

Breast cancer is the most common cause of metastatic epidural spinal cord compression (SCC) in women, and this condition results in significant neurologic dysfunction and morbidity. Prior studies of patients with suspected SCC did not employ multivariate analysis techniques, often included persons with a wide variety of malignancies, and generally focused on identifying associated neurologic and radiologic features. We therefore conducted a study examining a more comprehensive set of potential clinical risk factors in breast cancer patients with suspected SCC. We retrospectively analysed 123 episodes of suspected SCC among 93 breast cancer patients evaluated by spine computed tomography (CT) scanning. Multiple logistic regression analysis was employed to identify independent predictors of SCC. Clinically significant metastatic epidural cancer was defined as thecal sac compression (TSC), which occurred in 33 episodes (27%). Four independent predictors of TSC were identified and included oncologic features (known bone metastases > or = 2 years, metastatic disease at initial diagnosis) in addition to neurologic and radiologic features (objective weakness, vertebral compression fracture on spine radiograph). These four predictors stratified episodes into subgroups with widely varying risks of TSC, ranging from 12% (0 risk factors) to 85% (> or = 3 risk factors). These results suggest that the evaluation of breast cancer patients with suspected SCC should include clinical information about their disease course in addition to neurologic examination and prior imaging studies. If confirmed, these predictors may help clinicians assess risk in this patient population.

Adult↗

PubMed1992

Spinal epidural tumor in patients with prostate cancer. Clinical and radiographic predictors of response to radiation therapy.

The authors retrospectively reviewed 50 episodes of spinal epidural tumor that occurred in 42 patients with metastatic prostate cancer and were treated with external-beam radiation. Treatment response was evaluated in terms of symptoms, neurologic status, and, in most cases, reduction of tumor on repeat myelography. At the completion of therapy, 92% of treated patients experienced pain relief and 67% had significant to complete improvement on neurologic examination. Thirty days after treatment, repeat myelography was performed in 40 of the 50 cases; compared with the initial findings immediately preceding radiation therapy (RT), the results of 58% of these studies had normalized completely, results were improved in 25%, and the results had not changed in 18%. The presence of a high-grade compression fracture of the vertebral body was an indicator of poor prognosis for tumor response on repeat myelography. The ability of a patient to walk before treatment and tumor response on repeat myelography were associated significantly with improved outcome of RT and with survival. The authors conclude that RT can effectively palliate epidural lesions from metastatic prostate cancer. The prognosis for the long-term response to therapy may be indicated by pretreatment ambulatory status and posttreatment imaging of the epidural space.

Adenocarcinoma↗

PubMed2003

The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty.

STUDY DESIGN: An ex vivo biomechanical study was conducted using osteoporotic cadaveric vertebral bodies. OBJECTIVE: To determine the relationship between the percentage of osteoporotic vertebral body volume filled with polymethylmethacrylate cement during percutaneous vertebroplasty and the percentage restoration of strength and stiffness. SUMMARY OF BACKGROUND DATA: A previous biomechanical study reported a weak relationship between the volume of cement injected and restoration of vertebral body strength and stiffness. Vertebral bodies vary considerably in size among regions and among spines, and the weak correlation may be attributed to the fact that the volume of vertebral bodies was not explicitly considered. METHODS: The volume of 120 vertebral bodies (T6-L5) harvested from 10 osteoporotic female cadaver spines was determined by Archimedean displacement. Compression fractures were experimentally created, and initial strength and stiffness were determined. The vertebral bodies were stabilized using bipedicular injections of 2-8 mL of cement and then recompressed, after which posttreatment strength and stiffness were measured. Linear regression was used to analyze the relationship between percentage of volume fill and percentage of restored stiffness and strength. RESULTS: The correlations between percentage of fill and restored strength and stiffness were weak: r2 = 0.21 and r2 = 0.27, respectively. On average, restoration of strength and stiffness required vertebral body cement fills of 16.2% and 29.8%, respectively. CONCLUSION: Strength and stiffness are weakly correlated with the percentage fill volume of cement injected during vertebroplasty.

Absorptiometry, Photon↗

PubMed2006

[Vertebroplasty in the treatment of back pain].

BACKGROUND: Percutaneous vertebroplasty (PVP) represents a minimally invasive option which is gaining in importance for the treatment of vertebral compression fractures (VCF) and osteolysis of the spine. This article describes the indications for its use, peri-interventional imaging, technique, and results of PVP. MATERIAL AND METHODS: The current guidelines for performance of PVP are explained in accordance with the "Interdisciplinary Consensus Paper on Vertebroplasty and Kyphoplasty" of the German Professional Associations and the 2005 CIRSE Guidelines. The results of our own study carried out in 2002 are compared to the complication rates and clinical outcomes reported in the literature. RESULTS: Painful osteoporotic VCF and osteolysis within the vertebral body due to metastases and multiple myeloma are indications for PVP. Absolute contraindications are, in particular, asymptomatic VCF, alleviation of pain by drug treatment, therapy-refractory coagulopathies, allergies to cement components, and active infections. MRI or CT is indicated before undertaking PVP to assess the fracture age, to exclude other causes of pain, and to evaluate the posterior edge of the vertebral body. High-quality mono- or biplanar fluoroscopy--preferably in combination with CT (fluoroscopy)--is necessary for PVP to minimize the risk of cement leakage. A clear reduction in pain [mean reduction of 6.1 points (VAS)] is achieved in 86-92% of the patients with PVP. Our own study treating 58 patients (mean follow-up 323+/-99 days) revealed a clear alleviation of pain in 77% [-5.7 points (VAS)]. CONCLUSION: PVP constitutes a safe and effective minimally invasive treatment approach to stabilize and reduce acute and chronic back pain due to osteoporotic VCF and tumor-associated osteolysis.

Back Pain↗