Osteoporotic thoracolumbar junctional fracture accompanied by spinous process fracture without posterior ligament injury: its clinical and radiologic significances

Intraoperative analgesic effect of intravertebral lidocaine injection during percutaneous kyphoplasty in the treatment of thoracolumbar compression fractures in elderly patients

BACKGROUND

In recent years, percutaneous kyphoplasty (PKP) has been increasingly used in clinical settings.

OBJECTIVE

In this study, we aimed to determine the analgesic effect of intravertebral lidocaine injections in PKP.

METHODS

A total of 60 patients who were treated with PKP were enrolled in this study. Lidocaine hydrochloride was chosen as the medication for the experimental group. Patients were randomly assigned into three groups using a double-blind study design: In group A (20 cases), no drugs were injected into the vertebral body during surgery; group B (20 cases) received intravertebral injection of normal saline; and in group C (20 cases), lidocaine hydrochloride was administered into the vertebral body during surgery. The age of patients, operation time, balloon dilatation pressure, balloon dilatation volume, and amount of bone cement injected were compared across the three groups. A pain visual analog scale (VAS) was used to assess pain suffered by the patients before, during, and 24 hours after the surgery.

RESULTS

Age, operation time, balloon dilatation pressure, balloon dilatation volume, and amount of bone cement injected did not differ significantly among the three groups (P> 0.05). The differences in VAS scores 24 hours before and after surgery were not statistically significant (P> 0.05). Group C had lower intraoperative VAS scores than groups A and B, and the difference was statistically significant (P< 0.01). There was no statistically significant difference between group A and group B (P> 0.05).

CONCLUSION

Intravertebral injections of lidocaine during PKP can successfully reduce intraoperative pain.

Spinous Process Fractures in Osteoporotic Vertebral Fractures: A Cross-Sectional Study

Introduction

The purpose of this study was to assess radiological features and clinical scores of osteoporotic vertebral fracture (OVF) accompanied by spinous process fracture (SPF).

Methods

We included painful patients with single-level OVF with intravertebral cleft. SPF was detected using magnetic resonance imaging (MRI) and/or computed tomography (CT). The plain radiographs of the vertebral fractures were evaluated based on the wedging angle of the fractured vertebrae and vertebral instability. We investigated the clinical parameters of age, gender, visual analog scale (VAS) score for low back pain (LBP), Oswestry Disability Index (ODI), and the period from the onset of acute fracture.

Results

MRI and/or CT indicated among 195 patients of OVF with LBP, 41 patients (20.5%) had SPFs. SPFs were observed one level above the fractured vertebral body in 35 patients (85.4%) and at the same level as the fractured vertebral body in 6 patients (14.6%). The prevalence of vertebral fracture of thoracic spine in the SPF-positive group was significantly greater than that in the SPF-negative group. There were no significant differences in age, gender, VAS, ODI, the time period from the onset of acute LBP, wedging angle, and vertebral instability between the presence or absence of SPFs.

Conclusions

SPFs occurred in 20.5% of patients with OVF and LBP. In addition, SPFs often occurred one level above the fractured vertebra, and SPFs with OVF tended to be located in the thoracic spine.

Fracture of the Ankylosed Spine Following a Direct Anterior Approach for Total Hip Arthroplasty on a Fracture Table: A Case Report

CASE

An 85-year-old man with diffuse idiopathic skeletal hyperostosis underwent total hip arthroplasty (THA) through a direct anterior approach. Postoperatively, persistent blood loss and worsening abdominal and back pain prompted computed tomography, which identified an L1 hyperextension fracture-dislocation. The patient underwent staged posterior and anterior instrumented fusion. At the 5-year follow-up, he had persistent dorsal column dysfunction.

CONCLUSION

Fracture-dislocation of the ankylosed spine is a rare complication following THA. We recommend lateral decubitus positioning, pelvic and back support, careful limb manipulation, and an in situ femoral neck osteotomy to avoid excessive loads on the stiff spine during THA.