What is your diagnosis? Lysis of the vertebral body of C7, with a pathologic compression fracture and compression of the spinal cord at the level of C7.
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Animals↗
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Results for “Fractures, Compression”
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[Compressive strength, fracture compression and modulus of elasticity of filling plastics depending on masticatory force-related threshold pressure loadings].
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Chemical Phenomena↗
[Burst fracture: osteoporotic vertebral compression fracture associated with paraplegia].
It is rare that vertebral compression fracture of senile osteoporosis causes paraplegia. This article reviews 164 cases reported in Japan since 1974. These fractures were characterized as follows: 1) paraplegia occurred in elderly females (average 69.3 years old) with severe osteoporosis, 2) traumatic histories were revealed in 52%, 3) 91% of the fractures were classified into burst type, 4) location was in the thoracolumber region (80.5%), 5) average onset of paraplegia was 5.7 months after fracture. One hundred and twenty nine cases were surgically treated either by anterior vertebral fusion or by posterior instrumentation and 35 cases were conservatively treated. Surgical cases showed better recovery of walking ability than conservative cases.
Aged↗
The clinical consequences of vertebral compression fracture.
Vertebral compression fractures (VCFs) may be defined radiographically or as a clinical event. The prevalence of these fractures in women aged 50 and over has been estimated at 26% when defined as a reduction in vertebral height greater than 15%. Retrospective reviews of case records have shown a clinical detection rate of VCF in white women of 153/100,000 person years. Of these clinically detected VCFs, 84% were associated with pain. VCF may be defined as a clinical event characterised by loss of height and acute pain. The pain of acute fracture usually lasts 4 to 6 weeks with intense pain at the site of fracture. Chronic pain may also occur in patients with multiple compression fractures, height loss and low bone density but is probably due to structural changes or osteoarthritis. Radiographic VCF may not be symptomatic. The greater the deformity, the greater the likelihood of pain and disability. As height is lost, patients experience discomfort from the rib cage pressing downward on the pelvis. Patients develop a thoracic kyphosis, a lumbar lordosis, and a protuberant abdomen with prominent horizontal skinfold creases. The reduced thoracic space may result in decreased exercise tolerance and reduced abdominal space may give rise to early satiety and weight loss. Sleep disorders may also occur. Patients lose self esteem. Self care may become difficult. They are often depressed. They become fearful of further fracture. They have distorted body image and poor health perception. Patients with one vertebral fracture are at increased risk of peripheral fracture and further vertebral fracture. The aims of acute management are to reduce symptoms and mobilise the patient as quickly as possible.(ABSTRACT TRUNCATED AT 250 WORDS)
Body Height↗
Current status of percutaneous vertebral augmentation techniques for vertebral compression fractures.
Vertebral compression fracture (VCF) is a common and debilitating problem that occurs in patients with osteoporosis and osteolytic tumors. Standard conservative management with narcotic analgesics, bracing, and immobilization is often ineffective, and major reconstructive surgery is poorly tolerated by this frail patient population. The limitations of conventional treatments stimulated the development of minimally invasive, percutaneous vertebral augmentation techniques, including vertebroplasty and kyphoplasty, which have become established as safe and effective treatments for VCF. This report reviews the current status of vertebroplasty and kyphoplasty in the management of acute VCF.
Fracture Fixation, Internal↗
Transpedicle body augmenter in painful osteoporotic compression fractures.
Osteoporotic compression fractures (VCFs) can result in progressive kyphosis and chronic pain. Polymethylmethacrylate has been used for augmentation of VCFs; however, there are cement complications, and long-term fracture healing is unknown. The transpedicle body augmenter (TpBA), a porous titanium spacer, has been reported as an internal support to reconstruct the vertebral body combining short segment fixation in burst fracture. We retrospectively reviewed radiographic and clinical results of TpBA vertebroplasty for single symptomatic VCF in 80 patients. Manual reduction and TpBA vertebroplasty via a paramedian incision with blunt dissection was done. Mean age was 72.3 years (range 51-87 years), and female-male ratio was 66:14. The mean symptom duration was 5 months, and follow-up 44 months. Peri-operative variables and radiographic and clinical results were evaluated. The average operation time was 26.1 min, blood loss 92 cc, and hospitalization 2.3 days. No patient had neurological deterioration. TpBA was found sinking into vertebral body initially, then locked by residual cortex, and finally stabilized within the vertebra. There was no dislodgement of TpBA in the final visit. Sixty-two patients (77.5%) could walk within 3-6 h after operation and the others within 24 h. The anterior vertebral restoration was 8.0 mm initially and 6.1 mm at final follow-up. Wedge angle correction was 11.5 degrees initially and 9.4 degrees at final follow-up. Pain, by the visual analog scale, was 8.6 pre-operatively, 2.5 at day 7 follow-up, and 2.9 at final follow-up. By the questionnaire, 72 of 76 respondents reported a decrease in discomfort after TpBA vertebroplasty, and 63 of 76 patients reported a return to normal activity after operation. The final satisfaction rate was 93.4%. TpBA vertebroplasty led to early and medium-term clinical improvement and anatomic restoration of painful VCFs.
Aged↗
Diagnostic value of increased diffusion weighting of a steady-state free precession sequence for differentiating acute benign osteoporotic fractures from pathologic vertebral compression fractures.
BACKGROUND AND PURPOSE: Differentiating acute benign from neoplastic vertebral compression fractures can pose a problem in differential diagnosis on routine MR sequences, as signal changes can be quite similar. Our purpose was to assess the value of increasing the diffusion weighting of a diffusion-weighted steady-state free precession (SSFP) sequence for differentiating these two types of vertebral compression fractures. METHODS: Twenty-nine patients with 32 acute vertebral compression fractures caused by osteoporosis (n = 15) or malignancy (n = 17) were examined with a diffusion-weighted SSFP sequence, a T1-weighted spin-echo sequence, and a short-inversion-time inversion recovery sequence. The SSFP sequence was performed with increased diffusion weighting (delta = 0.6, 3.0, 6.0, and 9.0 ms). The signal intensities of the fractured vertebral bodies were rated on a five-point scale from markedly hypointense to markedly hyperintense relative to normal adjacent vertebral bodies. Quantitative analysis was performed by region-of-interest measurements and by calculating the bone marrow contrast ratio. Statistical analysis was performed with the Mann Whitney U test and Student's t test. RESULTS: At delta = 3 ms, the osteoporotic fractures yielded hypointense signal in seven cases, isointense signal in six, and hyperintense signal in two. The fractures showed a progressive signal loss with increased diffusion weighting, so that hypointensity was reached in all but one case. All metastatic fractures had hyperintense signal with delta = 3 and 6.0 ms. With delta = 9.0 ms, four fractures became isointense. CONCLUSION: Increasing diffusion weighting can reduce false-positive hyperintense osteoporotic fractures or make hypointensity more obvious in cases of osteoporotic fractures.
Acute Disease↗
Early progressive kyphosis following compression fractures. Two case reports from a series of "stable" thoracolumbar compression fractures.
In an 18-year-old man and an 18-year-old woman, significant kyphotic deformity progressively developed in the course of the healing of apparently stable thoracic compression fractures. The common features were: (1) multiple adjacent fractures; (2) location in the thoracic spine; (3) associated thoracic injury; and (4) youth. The possibility of early progressive kyphotic deformity should be carefully monitored so that appropriate treatment can be instituted before the deformity becomes significant. Although both isolated fractures and multiple-level fractures of the thoracolumbar spine occur predominantly between T12 and L2, there is a secondary area that is predisposed to compression fractures in sequence from T5 to T7.
Accidents↗
Balloon kyphoplasty for vertebral compression fractures in solid organ transplant recipients: results of treatment and comparison with primary osteoporotic vertebral compression fractures.
BACKGROUND CONTEXT: Balloon kyphoplasty has become established as a useful treatment for vertebral compression fractures (VCF) associated with primary osteoporosis and osteolytic tumors. Organ transplant recipients are also at risk for VCF because of their underlying disease process and because they require long-term treatment with steroids and other immunosuppressive drugs. PURPOSE: To explore whether balloon kyphoplasty is an effective treatment for VCF that develop in solid organ transplant recipients. A secondary goal was to determine whether there are any differences between VCF in transplant patients and VCF in patients with primary osteoporosis, with respect to disease severity and new fracture development. STUDY DESIGN: Prospective, longitudinal clinical series. PATIENT SAMPLE: The transplant group included 10 consecutive transplant patients (9 liver and 1 kidney), with a total of 29 symptomatic VCFs. The comparison group included 10 consecutive patients with primary osteoporosis and no history of organ transplantation, with a total of 15 VCFs. OUTCOME MEASURES: The primary clinical end point was back pain, measured using the Visual Analog Scale (VAS), which was recorded at baseline, and 1 and 12 months postprocedure. Radiographic evaluation included measurement of Cobb angles for each treated vertebral segment on preprocedure and 1-month postprocedure lateral radiographs. An improvement of >5 degrees was considered significant. The number of fractures seen at the time of diagnosis and the number of new fractures occurring during the follow-up period were recorded. METHODS: Balloon kyphoplasty was performed at all symptomatic levels. All fractures were treated within 3 months of onset. Patient follow-up was 12 months. RESULTS: The transplant group had significantly higher levels of pain at baseline, (mean VAS 9.3 and 7.7 for the transplant group and primary osteoporosis group, respectively: p=.013). After treatment, the VAS decreased to 3.2 in the transplant group and 1.5 in the comparison group. Improvement was highly significant in both groups (p<.001), and was maintained at 12-month follow-up. Sagittal alignment was improved by >5 degrees in three patients in each group (30%). There were no procedural complications in either group. Compared with the primary osteoporosis group, the transplant group was more likely to have multiple fractures at the time of diagnosis (2.9 vs. 1.5, p=.03), had a twofold greater incidence of new fractures during the follow-up period (40% vs. 20%), was more than a decade younger (64 vs. 75 years, p<.01), was much more likely to have received chronic immunosuppressive therapy with glucocorticoids and calcineurin phosphate inhibitors (100% vs. 0%, p<.001), and had a higher percentage of males (70% vs. 10%, p=.02), CONCLUSIONS: These data suggest that balloon kyphoplasty can be performed safely in organ transplant recipients with VCFs. The degree of pain relief is equivalent to that seen in patients with primary osteoporosis. Results are durable at 12-month follow-up. Transplant patients developed earlier and more severe bony disease, with more severe baseline pain, a higher incidence of multiple fractures at the time of diagnosis, and a greater risk of new fracture development posttreatment, as compared with the primary osteoporosis group.
Aged↗
Osteoporotic vertebral compression fractures.
Osteoporotic vertebral compression fractures are a commonly encountered clinical problem. Although the majority of patients with this injury experience a benign and self-limited course of gradually resolving pain, a significant number continue to experience chronic pain and disability. In evaluating a patient with a vertebral compression fracture, the differential diagnosis must consider not only osteoporosis, but also various causes of osteomalacia, endocrinopathy, and malignancy. Accumulation of multiple compression fractures and increased thoracolumbar kyphosis are associated with a poor prognosis. Multiple medical treatments--including hormone replacement therapy, calcitonin, and bisphosphonates--are effective in maintaining or increasing bone mass and reducing the risk of compression fracture. Conventional treatment in the form of pain medication, activity limitation, and occasionally bracing is effective in returning most patients to their previous level of functioning. When therapies fail, patients may be considered for minimally invasive treatments such as vertebroplasty or kyphoplasty. Surgery, although enormously challenging because of poor underlying health status and structurally weak bone, may be the last resort for a small percentage of patients experiencing progressive deformity or neurologic deficit.
Aged↗
Three-level bilateral pediculolysis following osteoporotic lumbar compression fracture.
BACKGROUND CONTEXT: Osteoporotic compression fractures frequently occur at the thoracolumbar junction as a result of anterior column failure. Fractures of the pedicles are much less common and are not known to be associated with a prior compression fracture. Bilateral pedicle fractures over several consecutive lumbar levels in an osteoporotic elderly patient have not been previously reported. PURPOSE: To draw attention to this unusual case and to review the relevant literature. STUDY DESIGN: A clinical case report of bilateral fractures of the pedicles from L3 through L5 in an 83-year-old male 2 years after an osteoporotic L3 compression fracture presenting with low back pain. METHODS: An 83-year-old male presented with low back pain two years after sustaining osteoporotic compression fracture at L3 due to a fall. He had another minor fall and his radiographic workup revealed bilateral fractures of the pedicles of the L3, L4, and L5 vertebrae. The patient was treated nonoperatively. RESULTS: The patient's symptoms improved without surgical intervention. Subsequent radiographic evaluation with plain films, computed tomography, and bone scan demonstrated union of the fractured pedicles. CONCLUSIONS: In this uncommon case of bilateral lumbar pedicle fractures over three consecutive levels, isolated failure of the posterior rather than the anterior column occurred. This unusual fracture pattern may have been precipitated by the previous vertebral compression fracture. Nonsurgical management may result in acceptable clinical outcome.
Aged, 80 and over↗
In vitro study of fracture incidence and compressive fracture load of all-ceramic crowns cemented with resin-modified glass ionomer and other luting agents.
STATEMENT OF PROBLEM: Anecdotal reports based on clinical observation have recently linked resin-modified glass ionomer luting agents with postcementation fracture of all-ceramic crowns. PURPOSE: This study evaluated the fracture incidence of In-Ceram and VitaDur Alpha porcelain jacket all-ceramic crowns cemented with 5 luting agents (Fuji I, Fuji Plus, Vitremer, Advance, and Panavia 21) during 2 months storage in 0.8% NaCl solution. MATERIAL AND METHODS: Fifty human maxillary premolar teeth were prepared for each ceramic system and divided into 5 subgroups of 10 teeth to be cemented with 5 luting cements. Specimens were observed for fracture lines and crack initiation at storage times up to 2 months. Incidence of fracture was analyzed with Fisher's Exact test. Specimens that did not fracture during storage were loaded in compression to failure. Failure loads were analyzed by analysis of variance and multiple pairwise comparisons. RESULTS: Only all-ceramic crowns cemented with Advance cement fractured during the 2-month observation period, and porcelain jacket crowns were found to fracture earlier and more frequently than In-Ceram crowns. Cracks initiated at the crown margin, and multiple crack lines were found as the time of storage increased. In-Ceram crowns were significantly stronger (140 +/- 21.5 kg) than porcelain jacket crowns (98.6 +/- 17.8 kg) at P <.05. For In-Ceram crowns, cement type did not influence failure load while for porcelain jacket crowns, Fuji I (110.5 kg) was significantly higher than Vitremer (86.6 kg) at P <.05. CONCLUSIONS: For the cements studied, only crowns cemented with Advance cement demonstrated fracture during 2-month storage. Results for the true resin-modified glass ionomer cements do not support anecdotal reports of fracture of all-ceramic crowns cemented with these materials.
Cementation↗
Vertebral compression fractures: treatment and evaluation.
Vertebral compression fractures can occur secondary trauma, malignancies, or most commonly osteoporosis. Osteoporosis causes almost 1.5 million fractures throughout the United States every year and nearly 700,000 of these fractures are vertebral compression fractures. These fractures are frequently seen in elderly women; 40 percent of women older than 80 years old are affected by vertebral compression fractures. These injuries can be treated both conservatively and surgically. The conservative route includes bed rest, pain control, bracing, and strength training. The surgical method includes percutaneous vertebroplasty and kyphoplasty, both minimally invasive procedures. This article provides a general introduction to vertebral compression fractures and osteoporosis, the diagnostic methods used to identify vertebral compression fractures, and the known treatments.
Aged, 80 and over↗
Functional outcomes of kyphoplasty for the treatment of osteoporotic and osteolytic vertebral compression fractures.
INTRODUCTION: Vertebral body compression fractures secondary to osteoporosis or malignant osteolysis are an increasingly common problem. The primary purpose of our study was to assess functional outcomes of kyphoplasty for the treatment of osteoporotic and osteolytic vertebral compression fractures. Our secondary purpose was to compare such functional outcomes in patients with osteoporosis versus multiple myeloma. METHODS: The 314 consecutive patients prospectively included in our study had progressive and painful compression fractures as a result of osteoporosis or multiple myeloma that were refractory to nonoperative modalities. Of those 314 patients, the 211 (67.2%) patients (155 with osteoporosis and 56 with multiple myeloma) who had complete preoperative and postoperative data formed our final study group. All patients tolerated the kyphoplasty procedure well (that is, there were no adverse events in terms of perioperative patient condition). Follow-up ranged from 1 to 235 weeks (mean 55.0 weeks). Functional outcomes were assessed by the SF-36 and Oswestry Disability Index at baseline and at follow-up examinations. Data were analyzed by Student's t-test and the level of significance was set at P<or=0.05. RESULTS: The average Owestry Disability Index score decreased by 12.6 points (P<0.001) in the overall group, by 11.8 points (P<0.001) at short-term follow-up, and by 8.6 points (P<0.001) at long-term follow-up. All SF-36 sub-scores except for general health and role-emotional showed statistically significant improvement from baseline values at the same time points. There was no statistically significant difference with regard to functional outcome in the osteoporosis and multiple myeloma sub-groups. CONCLUSIONS: Kyphoplasty provided a safe and effective treatment for pain and disability in patients with verterbral compression fractures secondary to osteoporosis and multiple myeloma. In addition, we found no statistically significant difference with regard to functional outcome between patients with osteoporosis and multiple myeloma.
Adult↗
Percutaneous balloon kyphoplasty for the correction of spinal deformity in painful vertebral body compression fractures.
Vertebral body compression fractures can cause chronic pain and may result in progressive kyphosis. Although vertebroplasty has been used to treat pain, it does not attempt to restore vertebral body height and eliminate spinal deformity. Percutaneous balloon kyphoplasty is a novel technique, which involves the introduction of inflatable bone tamps into the fractured vertebral body for elevation of the endplates, prior to fixation of the fracture with bone cement. Our initial experience with this minimally invasive procedure indicates that percutaneous balloon kyphoplasty can be efficacious in the treatment of painful, osteoporotic vertebral compression fractures.
Adult↗
Medical consequences of osteoporotic vertebral compression fractures.
Osteoporotic vertebral compression fractures are an increasingly common source of morbidity and mortality in the aging population. Previously, these fractures were assumed to be benign, self-limited entities with few, if any, significant sequelae. More recently, however, individual cohorts and population-wide analyses demonstrate high rates of chronic pain, functional decline, physiologic disorder, psychosocial dysfunction, and early mortality among patients with osteoporotic vertebral body compression fractures.
Aged↗
[Occurrence of diabetes mellitus in 201 patients with femoral neck fractures and spinal compression fractures].
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Diabetes Complications↗
Nocturnal vertebral compression fracture. A presenting feature of unrecognized epileptic seizures.
Bone fractures, especially vertebral compression fractures, are well-known complications of convulsive seizures. Acute vertebral fractures of unclear cause, often labeled idiopathic, may be due to unwitnessed epileptic seizures. We reviewed the records of 2 patients with new onset of seizures seen at the Adult Epilepsy Clinic at the Henry Ford Hospital, Detroit, Mich, who had a history of vertebral compression fractures preceding the diagnosis of epilepsy. The patients, who had no risk factors for pathologic fractures, awoke with severe midback pain. X-ray films revealed thoracic vertebral fractures in both patients. The first recognized seizure occurred 1 week later in 1 patient and 6 months later in the other. Nocturnal vertebral compression fractures may be the presenting feature of unwitnessed convulsive seizures, and evaluation for epilepsy should be considered in cases of idiopathic vertebral compression fractures.
Adult↗