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Wang W, Liu H, Wu Z, Teng Y, Huang Y, Liu T, Yang H. A Comparison of Percutaneous Kyphoplasty with High-Viscosity and Low-Viscosity Bone Cement for Treatment of Osteoporotic Vertebral Compression Fractures: A Retrospective Study. Geriatr Orthop Surg Rehabil 2022; 13:21514593221119625. [PMID: 36090795 PMCID: PMC9459459 DOI: 10.1177/21514593221119625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/13/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background Osteoporotic vertebral compression fracture (OVCF) has become a health issue
of worldwide concern. Percutaneous kyphoplasty (PKP) is one of the main
surgical methods for OVCFs. This study aimed to evaluate and compare the
clinical efficacy and safety of PKP with high- and low-viscosity bone cement
for OVCFs. Methods Totally 62 patients with single-level OVCF were enrolled in this study from
December 2018 to April 2021. Among them, 32 cases underwent PKP with
high-viscosity bone cement, while 30 cases underwent PKP with low-viscosity
bone cement. Visual analog scale (VAS) scores and Oswestry disability index
(ODI) scores were used in the pre- and post-operative period to assess
patients’ rehabilitation. Compression rates of anterior vertebra height
(AVH) and posterior vertebra height (PVH) were analyzed to evaluate the
restoration of vertebra height. Leakage rates and locations were recorded to
show clinical safety. Results VAS and ODI scores both significantly improved in 2 groups at 1 day, 1 month,
and 3 months after surgery. Compression rates of AVH and PVH at 1 day and
3 months after PKP were lower than those before surgery. However, there was
no significant difference in VAS scores, ODI scores, and compression rates
between both groups. However, PKP with high-viscosity bone cement achieved a
lower bone cement leakage rate significantly, which showed the safety of
high-viscosity bone cement in PKP. Conclusions PKP with high- and low-viscosity bone cement both improved the recovery of
patients and restored vertebra heights. Notably, PKP with high-viscosity
bone cement can achieve favorable clinical outcomes as well as lower bone
cement leakage rate.
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Affiliation(s)
- Wenhao Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhikai Wu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun Teng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yixue Huang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
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Moura DFL, Gabriel JP. Evolution of vertebral posttraumatic necrosis to bone healing after self-stabilizing osteophytosis development-case report. JOURNAL OF SPINE SURGERY (HONG KONG) 2021; 7:524-531. [PMID: 35128127 PMCID: PMC8743292 DOI: 10.21037/jss-21-58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/03/2021] [Indexed: 05/28/2023]
Abstract
Post-traumatic vertebral necrosis and pseudarthrosis at the thoracolumbar transition level usually progresses to bone resorption, leading to vertebral collapse, sometimes with retropulsion of the posterior wall and neurological deficit. As such, the therapeutic goal is the interruption of this evolution, seeking to stabilize the vertebral body, preventing collapse progression and the risk of neurological deficits. We present a clinical case regarding the evolution of a vertebral pseudarthrosis that self-stabilized with the development of an exuberant anterior osteophyte mass, joining the anterolateral surfaces of the adjacent vertebrae bodies. Vertebrae stabilization would have made it possible to minimize the pathological hypermobility that perpetuated pseudarthrosis and would have ensured sufficient stabilization to obtain clinically and imagiologically proven vertebrae bone healing. However, despite the unusually favorable evolution of this clinical case, in order to avoid highly disabling symptoms for several months, as occurred with the patient for 4 to 6 months, we consider that early percutaneous surgical stabilization of symptomatic vertebral pseudarthrosis is indicated, allowing for almost immediate pain relief and functional improvement, which is beneficial in terms of health and quality of life. This is a clinical case of unusual evolution of vertebral pseudarthrosis, which, however, is useful to confirm the prolonged duration and intensity of symptoms in the face of a conservative treatment for this disease.
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Affiliation(s)
- Diogo Filipe Lino Moura
- Orthopedics Department, Spine Unit, Coimbra University Hospital, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Spine Institute of Ohio, Grant Medical Center, Columbus, OH, USA
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Ruiz Santiago F, Láinez Ramos-Bossini AJ, Wáng YXJ, López Zúñiga D. The role of radiography in the study of spinal disorders. Quant Imaging Med Surg 2020; 10:2322-2355. [PMID: 33269230 DOI: 10.21037/qims-20-1014] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite the growing use of computed tomography (CT) and magnetic resonance imaging (MRI) in the study of spinal disorders, radiography still plays an important role in many conditions affecting the spine. However, the study and interpretation of spine radiograph is receiving less attention and radiologists are increasingly unfamiliar with the typical findings in normal and pathologic conditions of the spine. The aim of this article is to review the radiologic indications of radiograph in different pathologic conditions that affect the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumour disorders, as well as their main radiographic manifestations.
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Affiliation(s)
- Fernando Ruiz Santiago
- Department of Radiology, Neuro-traumatology Hospital, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
| | | | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Daniel López Zúñiga
- Department of Radiology, Neuro-traumatology Hospital, Hospital Virgen de las Nieves, University of Granada, Granada, Spain
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Wu XF, Ping Y, Zeng XQ, Feng Y, Wang Z, Li T, Wu DJ. Percutaneous Vertebroplasty with Side-Opening Cannula or Front-Opening Cannula in the Treatment of Kummell Disease? Orthop Surg 2020; 12:1190-1198. [PMID: 32638545 PMCID: PMC7454207 DOI: 10.1111/os.12730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/22/2020] [Accepted: 05/17/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To explore the effect of bone cement distribution, cement leakage, and clinical outcomes with side‐opening cannula for bone cement injection in percutaneous vertebroplasty (PVP) in treatment of Kummell disease. Methods A prospective study of patients with Kummell disease undergoing PVP was conducted from April 2012 to September 2017. In total, 43 patients (11 males, 32 females) with Kummell disease who received bilateral PVP were included in the study. The patients were divided into front‐opening cannulas (FOC) group with front‐opening cannulas and side‐opening cannulas (SOC) group with side‐opening cannulas. All patients were followed up for 6 months. The patient general information such as gender, age, bone density, compression ratio, operative time, and location of fracture vertebrae were recorded. Visual analogue scale (VAS), Oswestry Disability Index (ODI), bone cement distribution, radiation exposure time, bone cement leakage rate and vertebral height, and kyphosis angle were measured and compared for two groups before surgery, 1 day and 6 months after surgery. Results A total of 43 patients were enrolled, including 11 males and 32 females, aged 61–84 years. The bone density (T value) was 2.5 ± 0.6 in FOC group and 2.4 ± 0.6 in SOC group (P > 0.05). The compression ratio and operative time were 36.1% ± 13.0%, 39.3 ± 7.9 min in FOC group and 35.2% ± 13.7%, 40.0 ± 10.7 min in SOC group (P > 0.05). There was no significance between FOC and SOC groups in the location of fracture vertebrae. All patients underwent at least 6 months of follow‐up. At 6 months postoperatively, the VAS and ODI were significantly higher in the FOC group (3.0 ± 0.8, 35.7% ± 2.1%) than in the SOC group (1.3 ± 0.4, 18.6% ± 2.4%) (P < 0.05). The cement leakage rate of the SOC group was 4.8%, which was lower than that of the FOC group (31.8%, P < 0.05), and the bone cement distribution ratio was higher than that of the FOC group (63.1% ± 7.9% vs 40.5% ± 8.6%, P < 0.05). At 6 months after operation, the height of the anterior and posterior vertebral bodies of the patients in the SOC group restored better than the FOC group (anterior SOC: FOC 5.1 ± 0.5 mm vs 4.5 ± 0.5 mm; posterior SOC: FOC 0.6 ± 0.1 mm vs 0.3 ± 0.1 mm, P < 0.05), and the kyphosis correction was more obvious than patients in FOC group (SOC: FOC 8.5° ± 1.4° vs 4.6° ± 0.8°, P < 0.05). Conclusion Percutaneous vertebroplasty with side‐opening cannula is safe and effective in avoiding bone cement leakage, improving bone cement distribution, and restoring vertebral height.
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Affiliation(s)
- Xi-Fa Wu
- Department of Spinal Surgery, Zibo Central Hospital, ZiBo, China
| | - Yong Ping
- Department of Orthopaedics, Rizhao Central Hospital, Rizhao, China
| | - Xiang-Qin Zeng
- Department of Radiology, Zibo Central Hospital, ZiBo, China
| | - Yong Feng
- Department of Orthopaedics, Chongqing University Central Hospital, Chongqing, China
| | - Zhen Wang
- Department of Spinal Surgery, Zibo Central Hospital, ZiBo, China
| | - Tao Li
- Department of Spinal Surgery, Zibo Central Hospital, ZiBo, China
| | - Dong-Jin Wu
- Department of Spinal Surgery, The Second Hospital of Shandong University, Jinan, China
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Efficacy and Safety of High-Viscosity Bone Cement Vertebroplasty in Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft. World Neurosurg 2019; 132:e739-e745. [PMID: 31415893 DOI: 10.1016/j.wneu.2019.08.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/03/2019] [Accepted: 08/05/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate and compare clinical outcomes and cement leakage of high-viscosity bone cement versus low-viscosity bone cement vertebroplasty in treating osteoporotic vertebral compression fractures with intravertebral cleft. METHODS The study included 72 patients with osteoporotic vertebral compression fractures with intravertebral cleft, who were divided into high-viscosity cement (HVC) (38 cases) and low-viscosity cement (LVC) (34 cases) groups according to the viscosity of bone cement used. Cement leakage, visual analog scale score, Oswestry Disability Index, and kyphotic angle (KA) were evaluated. RESULTS All patients were followed for at least 12 months. Overall cement leakage rate was 18.4% in the HVC group, lower than the rate of 61.8% obtained in the LVC group. A statistically significant difference was found in the overall cement leakage rate between the groups (P < 0.05). Visual analog scale and Oswestry Disability Index scores were significantly improved after percutaneous vertebroplasty without significant differences between the HVC and LVC groups (P > 0.05). The KA of patients from both groups was also significantly corrected immediately after surgery. Although the KA gradually increased in both groups during the follow-up period, there was no statistically significant difference between the HVC and LVC groups in KA during follow-up (P > 0.05). CONCLUSIONS Percutaneous vertebroplasty using HVC to treat osteoporotic vertebral compression fractures with intravertebral cleft significantly reduces cement leakage and improves the safety of the operation. In terms of clinical efficacy and prevention of augmented vertebral recollapse, HVC may not have obvious advantages.
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Barreau X, Palussiere J, Fauche C. La radiologie interventionnelle en pathologie rachidienne. Presse Med 2019; 48:696-705. [DOI: 10.1016/j.lpm.2019.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/02/2019] [Indexed: 10/26/2022] Open
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Liu J, Liu Z, Luo J, Gong L, Cui Y, Song Q, Xiao PF, Zhou Y. Influence of vertebral bone mineral density on total dispersion volume of bone cement in vertebroplasty. Medicine (Baltimore) 2019; 98:e14941. [PMID: 30896660 PMCID: PMC6709149 DOI: 10.1097/md.0000000000014941] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to investigate the influence of vertebral bone mineral density (BMD) on total diffusion volume of bone cement in percutaneous vertebroplasty (PVP). This study was a retrospective review of prospectively collected data of consecutive patients with A1.2 thoracolumbar compression fractures treated by PVP. Vertebral BMD was measured before surgery and participants were divided into 3 groups according to World Health Organization diagnostic criteria for osteoporosis: Group A (normal BMD), Group B (reduced BMD), and Group C (osteoporosis). All vertebrae were injected with 3 mL of bone cement via the unilateral pedicle and scanned by computed tomography after surgery. Actual injection volume (bone cement only) and total diffusion volume (bone cement plus trabeculae and space) were calculated. Pain severity was determined by the visual analog scale before surgery and at both 1 day and 1 month after surgery. There were no significant differences in injection volume among the groups (P > .05), but the total dispersion volume was greater than injection volume in all groups (P < .05). Pairwise comparison showed a significant difference in total diffusion volume of bone cement between groups, with Group A having the largest volume and Group C the smallest volume. Pain was significantly reduced 1 day after surgery in each group compared with before surgery, but there were no significant between-group differences at 1 day or 1 month. Increasing vertebral BMD was positively correlated with increasing total diffusion volume. BMD does not significantly affect pain relief, despite producing a significantly lower distribution volume in osteoporotic patients.
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Affiliation(s)
- Jun Liu
- Department of Orthopedic, Shaanxi Provincial People's Hospital
| | | | - Jing Luo
- Departments of Nursing Administration, Honghui Hospital, Xi’an Jiaotong University College of Medicine
| | - Liqun Gong
- Department of Orthopedic, Shaanxi Provincial People's Hospital
| | - Yaqing Cui
- Department of Surgery Center, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi, People's Republic of China
| | - Qichun Song
- Department of Orthopedic, Shaanxi Provincial People's Hospital
| | - Pei Fen Xiao
- Department of Orthopedic, Shaanxi Provincial People's Hospital
| | - Yongchun Zhou
- Department of Orthopedic, Shaanxi Provincial People's Hospital
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Nakamae T, Yamada K, Tsuchida Y, Osti OL, Adachi N, Fujimoto Y. Risk Factors for Cement Loosening after Vertebroplasty for Osteoporotic Vertebral Fracture with Intravertebral Cleft: A Retrospective Analysis. Asian Spine J 2018; 12:935-942. [PMID: 30213178 PMCID: PMC6147866 DOI: 10.31616/asj.2018.12.5.935] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/04/2018] [Indexed: 12/19/2022] Open
Abstract
STUDY DESIGN Retrospective case-control study. PURPOSE To evaluate the primary outcomes and radiographic results of percutaneous vertebroplasty (PVP) in patients with singlelevel osteoporotic vertebral fracture (OVF) with intravertebral cleft (IVC) to identify the risk factors for cement loosening after PVP. OVERVIEW OF LITERATURE PVP is a widely accepted method for managing painful OVF; however, cement loosening occasionally occurs with poor outcomes. METHODS This retrospective study involved 195 patients treated with PVP for single-level OVF with IVC. Six months thereafter, the primary outcomes were evaluated using the Visual Analog Scale (VAS) for back pain and the modified Oswestry Disability Index. Computed tomography was conducted to detect cement loosening. Possible risk factors, such as age, sex, wedging angle, intravertebral instability, Parkinson's disease, spinous process fracture, ankylosing spinal hyperostosis, split vertebrae, and adjacent intervertebral vacuum, were assessed. RESULTS Forty-nine patients (25%) experienced cement loosening 6 months after PVP. The mean VAS scores were significantly higher in patients with cement loosening than in those without (50 vs. 26 mm, respectively; p <0.01). Cement loosening was closely associated with intravertebral instability (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.04-1.40; p =0.015), Parkinson's disease (OR, 54.31; 95% CI, 4.47-659.53; p =0.002), spinous process fracture (OR, 7.11; 95% CI, 1.65-30.60; p =0.009), and split vertebrae (OR, 11.59; 95% CI, 1.64-82.02; p =0.014). CONCLUSIONS Patients with cement loosening experienced worse back pain than those without cement loosening. The important risk factors that influenced cement loosening after PVP were high intravertebral instability, Parkinson's disease, spinous process fracture, and split vertebrae.
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Affiliation(s)
- Toshio Nakamae
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Kiyotaka Yamada
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Yasuyuki Tsuchida
- Department of Radiology, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Orso Lorenzo Osti
- Spinal Service, Calvary Health Care, North Adelaide Campus, North Adelaide, SA, Australia
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshinori Fujimoto
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
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Cho Y. Corpectomy and circumferential fusion for advanced thoracolumbar Kümmell's disease. Musculoskelet Surg 2017; 101:269-274. [PMID: 28664486 DOI: 10.1007/s12306-017-0480-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/31/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The aim of this study was to investigate the surgical treatment of neurologically compromised advanced Kümmell's disease. The surgical treatment of Kümmell's disease has various options according to clinical and radiologic status. Far collapsed Kümmell's disease patients with neurological deficit need to be treated surgically. MATERIALS AND METHODS We retrospectively analyzed 22 patients operated to our hospital with neurologically compromised Kümmell's disease between January 2011 and January 2014. Surgical approach was vertebrectomy, mesh cage insertion and segmental cement-augmented pedicle screw fixation. Corpectomy tissue was examined histopathologically. Anterior vertebral heights, kyphotic angle, the visual analog scale (VAS) and the Frankel classification were used to evaluate the effects of the surgery. RESULTS The mean time of follow-up was 26 months (range, 13-40 months). The VAS, anterior vertebral heights, kyphotic angle and neurological state were improved significantly immediate postoperatively and at the last follow-up compared with the preoperative examinations (P < 0.05). Most of the patients in this study exhibited intravertebral clefts, and postoperative pathology revealed bone necrosis. CONCLUSION Posterior vertebrectomy with mesh cage insertion and segmental cement-augmented pedicle screw fixation is an effective option for advanced Kümmell's disease with neurological deficits.
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Affiliation(s)
- Y Cho
- Department of Neurosurgery, Mok-Dong Hospital, Ewha Womans University College of Medicine, Mok-Dong, YangChun-Gu, Seoul, 158-710, Korea.
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Posterior Vertebrectomy and Circumferential Fusion for the Treatment of Advanced Thoracolumbar Kümmell Disease with Neurologic Deficit. Asian Spine J 2017; 11:634-640. [PMID: 28874983 PMCID: PMC5573859 DOI: 10.4184/asj.2017.11.4.634] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 12/19/2022] Open
Abstract
Study Design Single-center, retrospective case series. Purpose To investigate the effectiveness of posterior vertebrectomy and circumferential fusion in patients with advanced Kümmell disease with neurologic deficit. Overview of Literature Various surgical options exist for the treatment of Kümmell disease, and determination of the appropriate treatment is based on the clinical and radiologic status of the patient. However, surgical intervention is required for patients with advanced Kümmell disease accompanied by neurologic deficit. Methods We retrospectively analyzed 22 neurologically compromised patients with advanced Kümmell disease who were treated surgically at Ewha Womans Hospital between January 2011 and January 2014. The surgical approach used by us was a posterior vertebrectomy with mesh cage insertion and segmental cement-augmented pedicle screw fixation. The tissue from the corpectomy was histopathologically examined. Anterior vertebral height, kyphotic angle, visual analog scale (VAS) score, and the Frankel classification were used to evaluate the efficacy of the procedure. Results The mean follow-up period was 26 months (range, 13–40 months). VAS score, anterior vertebral height, kyphotic angle, and neurologic state were significantly improved immediately postoperatively and at the last follow-up compared with preoperatively (p<0.05). Most patients exhibited intravertebral clefts on imaging, and postoperative pathology revealed bone necrosis. Conclusions Posterior vertebrectomy with mesh cage insertion and segmental cement-augmented pedicle screw fixation is an effective approach for treating patients with advanced Kümmell disease with neurologic deficit.
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Sun ZY, Li XF, Zhao H, Lin J, Qian ZL, Zhang ZM, Yang HL. Percutaneous Balloon Kyphoplasty in Treatment of Painful Osteoporotic Occult Vertebral Fracture: A Retrospective Study of 89 Cases. Med Sci Monit 2017; 23:1682-1690. [PMID: 28386056 PMCID: PMC5391800 DOI: 10.12659/msm.903997] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The definition of a vertebral fracture is usually based on the presence of a deformation of the vertebral body and this can be misleading in the presence of a fracture without radiologic collapse with the definition of occult osteoporotic vertebral fractures (OOVFs). STIR sequence of MRI images showing hyperintensity signal was the most confirmative screening examination used to determine the presence of painful OOVFs. To date, clinical management of OOVFs has been rarely discussed. MATERIAL AND METHODS Between 2011 and 2013, 89 patients suffering from painful OOVFs underwent 142 percutaneous balloon kyphoplasty (PKP) procedures. Outcome data (mean variation of anterior and middle vertebral body height, visual analog scale [VAS] scores, Oswestry Disability Index [ODI] scores, and SF-36 scores) were recorded preoperatively, postoperatively, and at 1 month, 6 months, and 2 year after treatment, to evaluate the results. RESULTS We successfully treated 89 patients (142 vertebral bodies) with PKP. Cement leakages were observed in 12 (8.45%) treated vertebral bodies and there were 5 new adjacent vertebral fractures during the follow-up period. The mean variation of anterior and middle vertebral body height changed from 96.5±3.4% preoperatively to 97.2±2.5% postoperatively (p>0.05) and from 96.3±2.8% preoperatively to 97.9±3.1% postoperatively (p>0.05), respectively. The mean VAS scores were reduced significantly from pre-surgery to post-surgery (8.3±1.2 to 2.9±0.7; p<0.05), as was the ODI score (76.4±12.5 to 26.7±5.6; p<0.05). The SF-36 scores, including Bodily Pain (BF), Vitality (VT), Physical Function (PF), and Social Functioning (SF), all showed notable improvement (P<0.05). These variations were maintained during the 2-year follow-up period. CONCLUSIONS PKP is a safe and effective method in the treatment of painful OOVFs.
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Affiliation(s)
- Zhi-Yong Sun
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Xue-Feng Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Huan Zhao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jun Lin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Zhong-Lai Qian
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Zhi-Ming Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Hui-Lin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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Nakamae T, Fujimoto Y, Yamada K, Hiramatsu T, Hashimoto T, Olmarker K, Adachi N. Relationship between clinical symptoms of osteoporotic vertebral fracture with intravertebral cleft and radiographic findings. J Orthop Sci 2017; 22:201-206. [PMID: 28081928 DOI: 10.1016/j.jos.2016.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 11/19/2016] [Accepted: 12/01/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND With aging of the population, the numbers of osteoporotic vertebral fractures with intravertebral cleft have been increasing. However, the details of clinical symptoms of osteoporotic vertebral fractures with intravertebral cleft are poorly understood. The purpose of this study was to evaluate the relationship between clinical symptoms of osteoporotic vertebral fractures with intravertebral cleft and radiographic findings. METHODS Two hundred seventeen patients with single-level osteoporotic vertebral fractures with intravertebral cleft were examined. Clinical symptoms were evaluated using Numerical Rating Scale for back pain and the Oswestry Disability Index for physical disability. The presence of delayed neurologic deficit was also detected. Radiography and computed tomography were used to measure local kyphotic angle and vertebral instability and to detect the presence of posterior wall fracture of the vertebral body. Correlations between clinical symptoms of osteoporotic vertebral fractures with intravertebral cleft and radiographic findings were investigated. RESULTS Mean Numerical Rating Scale and Oswestry Disability Index were 7.4 and 58.0%, respectively. Delayed neurologic deficit occurred in 41 patients (19%). The mean local kyphotic angle, vertebral instability, and rate of posterior wall fracture of the vertebral body were 19.4°, 7.3°, and 91%, respectively. Numerical Rating Scale and Oswestry Disability Index were statistically correlated with vertebral instability but not with local kyphotic angle and presence of posterior wall fracture. In the patients with delayed neurologic deficit, vertebral instability was significantly higher and posterior wall fractures were significantly more frequent than in the patients without delayed neurologic deficit. Local kyphotic angle was not correlated with delayed neurologic deficit. CONCLUSIONS Vertebral instability is a factor causing symptoms of osteoporotic vertebral fractures with intravertebral cleft. In addition, vertebral instability may be the predominant cause of delayed neurologic deficit. To manage osteoporotic vertebral fractures with intravertebral cleft and delayed neurologic deficit efficiently, it may be important to control vertebral instability of osteoporotic vertebral fractures.
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Affiliation(s)
- Toshio Nakamae
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan.
| | - Yoshinori Fujimoto
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Kiyotaka Yamada
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Takeshi Hiramatsu
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Takashi Hashimoto
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Kjell Olmarker
- Muskuloskeletal Research, Department of Medical Chemistry and Cellbiology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Ruiz Santiago F, Tomás Muñoz P, Moya Sánchez E, Revelles Paniza M, Martínez Martínez A, Pérez Abela AL. Classifying thoracolumbar fractures: role of quantitative imaging. Quant Imaging Med Surg 2016; 6:772-784. [PMID: 28090452 DOI: 10.21037/qims.2016.12.04] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This article describes different types of vertebral fractures that affect the thoracolumbar spine and the most relevant contributions of the different classification systems to vertebral fracture management. The vertebral fractures types are based on the three columns model of Denis that includes compression, burst, flexion-distraction and fracture-dislocation types. The most recent classifications systems of these types of fractures are reviewed, including the Thoracolumbar Injury Classification and Severity score (TLICS) and the Arbeitsgemeinschaft für Osteosynthesefragen Spine Thoracolumbar Injury Classification and Severity score (AOSpine-TLICS). Correct classification requires a quantitative imaging approach in which several measurements determine TLICS or AOSpine-TLICS grade. If the TLICS score is greater than 4, or the AOSpine-TLICS is greater than 5, surgical management is indicated. In this review, the most important imaging findings and measurements on radiography, multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are described. These include degree of vertebral wedging and percentage of vertebral height loss in compression fractures, degree of interpedicular distance widening and spinal canal stenosis in burst fractures, and the degree of vertebral translation or interspinous widening in more severe fractures types, such as flexion-distraction and fracture-dislocation. These findings and measurements are illustrated with schemes and cases of our archives in a didactic way.
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Affiliation(s)
- Fernando Ruiz Santiago
- Radiology Department, Hospital of Traumatology, Carretera de Jaen SN, Granada 18014, Spain
| | - Pablo Tomás Muñoz
- Radiology Department, Ciudad Sanitaria Virgen de las Nieves (Hospital Complex University of Granada), Avenida de las Fuerzas Armadas 2, Granada 18014, Spain
| | - Elena Moya Sánchez
- Radiology Department, Ciudad Sanitaria Virgen de las Nieves (Hospital Complex University of Granada), Avenida de las Fuerzas Armadas 2, Granada 18014, Spain
| | - Marta Revelles Paniza
- Radiology Department, Ciudad Sanitaria Virgen de las Nieves (Hospital Complex University of Granada), Avenida de las Fuerzas Armadas 2, Granada 18014, Spain
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Ge CY, He LM, Zheng YH, Liu TJ, Guo H, He BR, Qian LX, Zhao YT, Yang JS, Hao DJ. Tuberculous Spondylitis Following Kyphoplasty: A Case Report and Review of the Literature. Medicine (Baltimore) 2016; 95:e2940. [PMID: 26986102 PMCID: PMC4839883 DOI: 10.1097/md.0000000000002940] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Tuberculous spondylitis of the augmented vertebral column following percutaneous vertebroplasty or kyphoplasty has rarely been described. We report an unusual case of tuberculous spondylitis diagnosed after percutaneous kyphoplasty (PKP). A 61-year-old woman presented to our institution complaining of back pain following a fall 7 days before. Radiologic studies revealed an acute osteoporotic compression L1 fracture. The patient denied history of pulmonary tuberculosis (TB) and there were no signs of infection. The patient was discharged from hospital 4 days after undergoing L1 PKP with a dramatic improvement in her back pain. Two years later, the patient was readmitted with a 1 year history of recurrent back pain. Imaging examinations demonstrated long segmental bony destruction involving L1 vertebra with massive paravertebral abscess formation. The tentative diagnosis of tuberculous spondylitis was made, after a serum T-SPOT. The TB test was found to be positive. Anterior debridement, L1 corpectomy, decompression, and autologous rib graft interposition, and posterior T8-L4 instrumentation were performed. The histologic examination of the resected tissue results confirmed the diagnosis of spinal TB. Anti-TB medications were administered for 12 months and the patient recovered without sequelae. Spinal TB and osteoporotic vertebral compression fractures are similar clinically and radiologically. Spinal surgeons should consider this disease entity to avoid misdiagnosis or complications. Early surgical intervention and anti-TB treatment should be instituted as soon as the diagnosis of spinal TB after vertebral augmentation is made.
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Affiliation(s)
- Chao-Yuan Ge
- From the Department of Spine Surgery, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Beilin District, Xi'an, Shaanxi Province, China
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