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At least 127 records · Page 7Linked to original sources
PubMed2004

Vertebroplasty for the treatment of osteoporotic compression spinal fracture: comparison of remedial action at different stages of injury.

BACKGROUND: Outstanding results have been achieved using vertebroplasty for the treatment of osteoporotic compression spinal fractures, and a number of studies have reported the results from the application of this procedure. This study compared the results of vertebroplasty used at the different stages of injury. METHODS: A retrospective study reviewing the period between January 2001 and July 2001 investigated 68 patients who underwent single-level vertebroplasty: 22 patients within 2 weeks of the injury, 22 patients 2 weeks to 2 months after the injury, and 24 patients more than 2 months after the injury. Clinical evaluations compared the results of treatment at different injury stages during a mean follow-up period of 13 months. RESULTS: Although all the patients undergoing vertebroplasty in the acute and subacute stages reported satisfaction within 1 week of the operation, only 72.7% of the acute-stage group reported satisfaction with 24 hours of surgery. Moreover, evidence of cement leakage after vertebroplasty was detected for 27.3% of the acute-stage patients. This percentage significantly higher than for the patients in the subacute and chronic stages. Radiographic examination showed that new, adjacent compression fracture had occurred for 10.3% of the patients, with anterior interbody restabilization occurring for 11.8%. CONCLUSIONS: The results for vertebroplasty treatment of osteoporotic compression fractures appear to be injury stage dependent, with patients in the acute-injury stage needing longer recovery times, and with cement leakage quite common. These findings lead to the conclusion that the subacute stage is optimal for vertebroplasty. Furthermore, it is suggested that the use of spinal orthoses and postsurgical supplementation for the bone matrix reduces the risk of new, adjacent compression fractures and increases anterior interbody restabilization. Importantly, the findings suggest that a presurgical magnetic resonance imaging evaluation is an absolute necessity.

Acute Disease↗
PubMedDate not supplied

A biomechanical study of thoracolumbar spinal fractures with bone in the canal. Part I. The effect of laminectomy.

A simulation of thoracolumbar spinal fractures with bone in the canal was performed using fresh cadaver spines. In the study, a hole was drilled anterior to posterior in vertebral body T12 to accommodate a microload cell and displacement transducer that was then manually pushed into the canal to simulate the compressive effect of retropulsed bone on the spinal cord. In this part of the study, measurements were made pre- and postlaminectomy. The results indicated that laminectomy had no decompressive effect with up to 35% occlusion of the canal. Measurements of dural wall deflection during penetration of the load cell indicated that the anterior wall deformed locally due to penetration of the load cell with minimal displacement of the posterior wall occurring.

Adult↗
PubMed1992

Posterior reduction of a pathologic spinal fracture. A case of indirect anterior dural decompression.

In a patient with paraparesis resulting from a pathologic fracture of Th9, which was due to a breast cancer metastasis, indirect anterior decompression via posterior reduction was performed. The rationale for the operation technique was the similarity between a pathologic fracture of the thoracolumbar spine and a traumatic burst fracture. The method, which uses a transpedicular reduction and fixation device, is substantially less invasive than a formal anterior decompression.

Adult↗
PubMed1989

Internal fixation of unstable spinal fractures: the Hartshill system.

The first 69 cases with a minimum of 1 year follow-up using the Hartshill system for the internal fixation of unstable spinal fractures (cervical 11, thoracic 8, thoracolumbar 42 and lumbar 8 are reported. The instrumentation is uncomplicated but attention to detail in technique is important. The system allows secure stabilization of the spine and early mobilization, irrespective of any neurological damage incurred in the primary injury.

Fracture Fixation, Internal↗
PubMed1989

Spinal fractures complicating ankylosing spondylitis.

Individuals with ankylosing spondylitis (AS) are at increased risk for developing fractures of the spine, especially in the cervical region. This tendency is related to the ossification of spinal ligaments and osteopenic changes in the spinal vertebrae. We reviewed our clinical experience of SCI occurring due to AS, and the literature regarding the natural history of these fractures. A significant number of individuals are not aware of their increased risk for spinal fracture and sustain spinal fractures without realizing it. Difficulties in diagnosis and inappropriate management of spinal fractures in these individuals have often resulted in severe neurologic sequelae and a mortality rate approximately twice that observed with similar fractures in a normal spine. The need for better patient education emphasizing the significance of even minor trauma, and a thorough evaluation of AS patients with a history of trauma is stressed.

Cervical Vertebrae↗
PubMed2004

Is a single anterolateral screw-plate fixation sufficient for the treatment of spinal fractures in the thoracolumbar junction? A biomechanical in vitro investigation.

Controversy exists about the indications, advantages and disadvantages of various surgical techniques used for anterior interbody fusion of spinal fractures in the thoracolumbar junction. The purpose of this study was to evaluate the stabilizing effect of an anterolateral and thoracoscopically implantable screw-plate system. Six human bisegmental spinal units (T12-L2) were used for the biomechanical in vitro testing procedure. Each specimen was tested in three different scenarios: (1) intact spinal segments vs (2) monosegmental (T12/L1) anterolateral fixation (macsTL, Aesculap, Germany) with an interbody bone strut graft from the iliac crest after both partial corpectomy (L1) and discectomy (T12/L1) vs (3) bisegmental anterolateral instrumentation after extended partial corpectomy (L1), and bisegmental discectomy (T12/L1 and L1/L2). Specimens were loaded with an alternating, nondestructive maximum bending moment of +/-7.5 Nm in six directions: flexion/extension, right and left lateral bending, and right and left axial rotation. Motion analysis was performed by a contact-less three-dimensional optical measuring system. Segmental stiffness of the three different scenarios was evaluated by the relative alteration of the intervertebral angles in the three main anatomical planes. With each stabilization technique, the specimens were more rigid, compared with the intact spine, for flexion/extension (sagittal plane) as well as in left and right lateral bending (frontal plane). In these planes the bisegmental instrumentation compared to the monosegmental case had an even larger stiffening effect on the specimens. In contrast to these findings, axial rotation showed a modest increase of motion after bisegmental instrumentation. To conclude, the immobilization of monosegmental fractures in the thoracolumbar junction can be secured by means of bone grafting and the implant used in this study for all three anatomical planes. After bisegmental anterolateral stabilization a sufficient reduction of the movements was registered for flexion/extension and lateral bending. However, the observed slight increase of the range of motion in the transversal plane may lead to loosening of the implant before union. Therefore, the use of an additional dorsal fixation device should be considered.

Adult↗
PubMed1994

Vertebral body index and bone mineral density in women with spinal fractures. 66 probands compared with controls.

The bone mineral density (BMD) was measured in 61 women with compression fractures of the spine and 66 normal pre-menopausal women. Radiographs of the lateral spine were also obtained and the vertebral body index (VBI) was measured in the region L2-L4. Women with spinal fractures had lower BMD and VBI values. Using both BMD and VBI, 3 regions of fracture risk were defined. All but 2 of the fracture patients were in the moderate- or high-risk region for fracture.

Adult↗
PubMedDate not supplied

A biomechanical study of thoracolumbar spinal fractures with bone in the canal. Part II. The effect of flexion angulation, distraction, and shortening of the motion segment.

In the second part of this biomechanical study of thoracolumbar spinal fractures with bone in the neural canal contract force on the spinal cord--meningeal complex was measured with relation to varying fracture wedge depth, flexion angulations, and distraction and shortening of the fracture model motion segment. The removal of progressively deeper vertebral body wedges did not change the measured contact force/depth of penetration characteristics, however, the resistance to flexion angulation was decreased. Distraction of the motion segment an average of 5.2 mm increased significantly the contact force at the same depth of penetration compared with the case of normal vertebral body height. Shortening an average of 3.2 mm did not have a significant effect. Flexion angulation to 20 degrees did not change the depth/force characteristic in either the shortened or distracted case.

Adult↗
PubMedDate not supplied

Pathogenesis and diagnosis of delayed vertebral collapse resulting from osteoporotic spinal fracture.

BACKGROUND CONTEXT: In recent years there have been an increasing number of reports on surgical cases involving delayed neurological deficits caused by vertebral collapse after osteoporotic vertebral fracture. PURPOSE: We do not yet know which patients are most susceptible to delayed vertebral collapse and subsequent neurological deficits, or whether this pathological condition can be prevented or predicted. In this study, we investigated the mechanism of progression and radiographic features characteristic of this disease, and we report here the predictive or risk factors for delayed osteoporotic vertebral collapse. STUDY DESIGN: Retrospectively, we investigated the pathogenesis and diagnosis of delayed vertebral collapse with neurological deficit resulting from osteoporosis. PATIENT SAMPLE: A total of 28 patients (7 men and 21 women) with neurological deficits resulting from vertebral collapse caused by osteoporotic vertebral fractures were the subjects for this study. OUTCOME MEASURES: Comparisons and investigations about clinical features and radiographic findings between the patient group of delayed vertebral collapse with neurological deficits and the group of osteoporotic spinal fracture with no neurological deficits. METHODS: The following factors were examined: the cause of injury; the length of time from injury, or the onset of pain, to the onset of neurological symptoms; radiographic findings obtained during the above period; the clinical course of vertebral fracture on plain X-ray films; time of appearance of the intravertebral cleft, and its localization and changes. RESULTS: Six patients were hospitalized and prescribed a period of 2 weeks of bed rest followed by the fitting of a corset; seven outpatients were corseted but not prescribed bed rest; 15 patients were given medication only at an outpatient clinic. At radiography, intravertebral clefts were detected in 22 patients (79%) during the period from the appearance of pain to the onset of neurological deficit. In 14 patients (50%) who were radiographed every 1 to 2 weeks from the injury to the onset of neurological symptoms, the course of progression to collapse of the vertebral body could be observed. CONCLUSION: Initial correct diagnosis and immobilization are important in preventing the delayed collapse with neurological deficit. The presence of an intravertebral cleft and instability of the affected vertebra represent risk factors for vertebral collapse with neurological deficit, requiring careful observation.

Aged↗
PubMed1983

Endogenous cortisol and sex steroids in patients with osteoporotic spinal fractures.

Vertebral fractures due to osteoporosis commonly occur in postmenopausal women. Levels of cortisol and sex steroids in the circulation vary among older women. It has been suggested that this variation may contribute to the occurrence of osteoporotic fractures in some subjects but not others. To examine this, 30 patients with osteoporotic spinal fractures were compared to an equal number of controls matched to the patients for age and years since menopause. All subjects had intact ovaries and had not taken estrogen replacement therapy for more than 3 months during their entire lifetime. Spinal bone mineral density determined by dual photon absorptiometry was significantly lower (P less than .01) in the fraction group (0.75 +/- 0.03 g/cm2) than in the controls (1.0 +/- 0.03 g/cm2). No significant differences in body habitus or cortisol and sex steroid levels (both total and free) were found, with the exception of total estradiol levels, which were 16% higher in the fracture patients. This difference was presumably coincidental as there was no difference of free estradiol levels between groups. It is concluded that factors other than the differences of endogenous cortisol and sex steroid levels present in these postmenopausal women were responsible for the reduced bone mineral density of the spine observed in the fracture patients.

Androgens↗
PubMed2002

[Treatment of spinal fracture in ankylosing spondylitis].

Clinical guidelines for the treatment of vertebral fractures associated with ankylosing spondylitis are derived from case reports and a review of literature. The coincidence of paravertebral calcifications and fracture formations leads to problems in the establishment of a proper initial diagnosis. Therefore computed tomography and magnetic resonance imaging have to be employed to define the extent of fracture and the presence of spinal lesions. As a rule vertebral fractures based upon spondylitic alterations are extremely unstable and tend to secondary dislocation with a high risk of spinal cord injuries. Operative osteosynthesis is the method of choice in the fracture treatment. A successful stabilization requires an extended spondylodesis comprising at least five vertebral segments by a dorsal or a combined ventral instrumentation.

Adult↗
PubMed1984

A stretcher that facilitates the radiographic evaluation and closed reduction of spinal fractures.

A rigid and exceptionally radiolucent stretcher with an attachment for cervical traction has been constructed. A patient is able to remain on this stretcher in the same position during the entire radiographic examination of a spinal fracture, including plain x-ray and computed tomographic and myelographic studies. Two advantages are obtained if this stretcher is used: 1) A patient's spine is well supported and does not need to be moved at any time during these radiographic studies, and 2) the application of traction during the myelography or closed reduction of a cervical fracture is facilitated.

Equipment and Supplies↗