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Ruiz Santiago F, Láinez Ramos-Bossini AJ, Moraleda-Cabrera B. Factors influencing vertebral collapse in osteoporotic vertebral fractures: a case-control study of symptomatic patients attended in the emergency department. Arch Osteoporos 2023; 19:6. [PMID: 38146037 DOI: 10.1007/s11657-023-01365-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/11/2023] [Indexed: 12/27/2023]
Abstract
This study aimed to identify risk factors for the collapse of osteoporotic vertebral fractures (OVFs). We analyzed data from conventional radiography and computed tomography in patients with OVFs and found that older age and two radiological measurements were predictive for vertebral collapse. These factors can be useful for clinical practice. PURPOSE To identify risk factors for collapse of osteoporotic vertebral fractures (OVF) on computed tomography (CT) and conventional radiography (CR). METHODS This is a retrospective case-control study including a series of patients with OVF diagnosed at the emergency department of our institution from January to September 2019. Inclusion criteria were to have standing CR and supine CT within 2 weeks after the diagnosis of OVF and a follow-up CR at 6 months or later. We evaluated different imaging measurements at the initial diagnostic examinations, including vertebral height loss, local kyphosis, vertebral density, and fracture type according to the grading systems of Genant, Sugita, Association of Osteosynthesis (AO) Spine, and the German Society for Orthopaedics and Trauma. Vertebral collapse was defined as loss of ≥ 50% of vertebral area or height. Cases and controls were defined as OVFs which collapse and do not collapse, respectively, on follow-up. RESULTS Fifty-six patients were included in the study, with a mean age of 72.6 ± 1.2 years, including 48 women. Twenty-five (44.6%) OVFs developed collapse on follow-up. None of the fracture classification systems were found to be predictive of collapse. Multivariate analysis showed that older age, increased density ratio (≥ 2) between the fractured and non-fractured vertebral bodies, and a ≥ 6% difference in posterior vertebral height (PVH) loss between standing CR and supine CT exhibited 88% discriminative power in predicting vertebral collapse. CONCLUSIONS Age over 72.5 years, a density ratio ≥ 2 between the fractured and non-fractured vertebral bodies, and a difference equal to or higher than 6% in PVH loss between standing CR and supine CT, are risk factors for developing vertebral collapse after OVF.
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Affiliation(s)
- Fernando Ruiz Santiago
- Section of Musculoskeletal Radiology, Department of Radiology, Hospital Universitario Virgen de Las Nieves, Avda Fuerzas Armadas, 2, 18014, Granada, Spain
- Advanced Medical Imaging Group. Biosanitary Institute of Granada (Ibs.GRANADA), 18016, Granada, Spain
- Department of Radiology and Physical Medicine, Faculty of Medicine, University of Granada, 18016, Granada, Spain
| | - Antonio Jesús Láinez Ramos-Bossini
- Section of Musculoskeletal Radiology, Department of Radiology, Hospital Universitario Virgen de Las Nieves, Avda Fuerzas Armadas, 2, 18014, Granada, Spain.
- Advanced Medical Imaging Group. Biosanitary Institute of Granada (Ibs.GRANADA), 18016, Granada, Spain.
- University of Granada, 18014, Granada, Spain.
| | - Beatriz Moraleda-Cabrera
- Section of Musculoskeletal Radiology, Department of Radiology, Hospital Universitario Virgen de Las Nieves, Avda Fuerzas Armadas, 2, 18014, Granada, Spain
- Advanced Medical Imaging Group. Biosanitary Institute of Granada (Ibs.GRANADA), 18016, Granada, Spain
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Láinez Ramos-Bossini AJ, Ruiz Santiago F, Moraleda Cabrera B, López Zúñiga D, Ariza Sánchez A. Imaging of low-energy vertebral fractures. RADIOLOGIA 2023; 65:239-250. [PMID: 37268366 DOI: 10.1016/j.rxeng.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/01/2023] [Indexed: 06/04/2023]
Abstract
Low-energy vertebral fractures pose a diagnostic challenge for the radiologist due to their often-inadvertent nature and often subtle imaging semiology. However, the diagnosis of this type of fractures can be decisive, not only because it allows targeted treatment to prevent complications, but also because of the possibility of diagnosing systemic pathologies such as osteoporosis or metastatic disease. Pharmacological treatment in the first case has been shown to prevent the development of other fractures and complications, while percutaneous treatments and various oncological therapies can be an alternative in the second case. Therefore, it is necessary to know the epidemiology and typical imaging findings of this type of fractures. The objective of this work is to review the imaging diagnosis of low-energy fractures, with special emphasis on the characteristics that should be outlined in the radiological report to guide a specific diagnosis that favours and optimizes the treatment of patients suffering of low energy fractures.
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Affiliation(s)
- A J Láinez Ramos-Bossini
- Sección de Radiología Musculoesquelética, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto Biosanitario de Granada (ibs.GRANADA), Granada, Spain; Programa de doctorado en Medicina Clínica y Salud Pública, Universidad de Granada, Granada, Spain; Departamento de Psiquiatría, Facultad de Medicina, Universidad de Granada, Granada, Spain
| | - F Ruiz Santiago
- Sección de Radiología Musculoesquelética, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto Biosanitario de Granada (ibs.GRANADA), Granada, Spain; Departamento de Medicina Física y Rehabilitación, Facultad de Medicina, Universidad de Granada, Granada, Spain.
| | - B Moraleda Cabrera
- Sección de Radiología Musculoesquelética, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto Biosanitario de Granada (ibs.GRANADA), Granada, Spain
| | - D López Zúñiga
- Sección de Radiología Musculoesquelética, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto Biosanitario de Granada (ibs.GRANADA), Granada, Spain
| | - A Ariza Sánchez
- Sección de Radiología Musculoesquelética, Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto Biosanitario de Granada (ibs.GRANADA), Granada, Spain
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Ko MJ, Lee BJ. Kummell's Disease is Becoming Increasingly Important in an Aging Society: A Review. Korean J Neurotrauma 2023; 19:32-41. [PMID: 37051029 PMCID: PMC10083447 DOI: 10.13004/kjnt.2023.19.e13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/28/2023] Open
Abstract
Kummell's disease (KD) is referred to as delayed posttraumatic vertebral collapse, avascular necrosis of vertebrae, or ischemic vertebral collapse. KD is no longer rare in an aging society. It is mainly caused by minor trauma, and nonunion occurs secondary to avascular necrosis at the vertebral body fracture site, which can lead to vertebral kyphosis or intravertebral instability. Clinical symptoms of KD range from no symptoms to severe paralysis due to nerve injury. KD is considered a complication of osteoporotic vertebral compression fractures, and conservative treatment, including osteoporosis treatment, is important. Timely interventions such as vertebral augmentation or surgery, with active regular follow-up are necessary before the onset of neurological deficits due to osteonecrotic collapse in patients with suspected KD. In this study, we summarize the pathogenesis, diagnosis, and treatment of KD, which is showing increasing prevalence in an aging society. We have presented a literature review and discussed clinical guidelines and therapeutic strategies to reduce the morbidity and mortality associated with KD.
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Affiliation(s)
- Myeong Jin Ko
- Department of Neurosurgery, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Byung-Jou Lee
- Department of Neurosurgery and Neuroscience & Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Láinez Ramos-Bossini A, Ruiz Santiago F, Moraleda Cabrera B, López Zúñiga D, Ariza Sánchez A. Diagnóstico por imagen de las fracturas vertebrales de baja energía. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Ren H, Feng T, Hu Y, Yao G, Yu D, Cao J. The Value of Dynamic Fracture Mobility in Determining the Optimum Operation Choice for Acute Osteoporotic Vertebral Compression Fracture. J Pain Res 2022; 15:2327-2336. [PMID: 35992249 PMCID: PMC9386056 DOI: 10.2147/jpr.s368493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This retrospective study aimed to verify whether the use of a balloon in balloon kyphoplasty (BKP) could offer a higher degree of vertebral height restoration and deformity correction than percutaneous vertebroplasty (PVP) after adjustment for preoperative dynamic fracture mobility. We expect that this research will help surgeons to determine the optimum operation choice (PVP or BKP) for treating osteoporotic vertebral compression fractures (OVCFs). Patients and Methods We evaluated retrospectively 262 patients who were treated by PVP or BKP for acute, single-level OVCF at our institution from July 2015 to July 2019. According to the presence or absence of dynamic fracture mobility, the patients were divided into two groups: mobile group and fixed group. We compared the changes in the vertebral height and kyphotic angle for PVP and BKP, respectively, within each group. Results In the mobile group, the anterior vertebral height restoration (BKP group, 8.73±5.27%; PVP group, 2.96±1.59%), middle vertebral height restoration (BKP group, 7.58±5.18%; PVP group, 2.74±1.24%) and kyphotic angle correction (BKP group, 4.41±4.46°; PVP group, 1.38±1.60°) due to percutaneous vertebral augmentation technique itself were more obvious in BKP group compared with PVP group (P < 0.05). The BKP group has lower incidence of bone cement leakage (BKP group, 10.17%; PVP group, 25.53%, P < 0.05). In the fixed group, differences from comparison of changes were not statistically significant between PVP and BKP (P > 0.05). Conclusion The use of a balloon in BKP could offer greater kyphosis correction, higher vertebral body height restoration, and lower cement leakage rate than PVP if a fractured vertebral body existed dynamic mobility. However, all these advantages of BKP over PVP are not obvious and could be overrated for a fixed fracture exhibited no mobility. BKP is recommended for a fractured vertebral body with dynamic mobility. PVP is suggested for a fixed fractured vertebral body with no mobility as it produces similar capability of vertebral height restoration, kyphosis correction, and cement leakage as BKP.
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Affiliation(s)
- Hu Ren
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, People's Republic of China
| | - Tao Feng
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, People's Republic of China
| | - Yaning Hu
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, People's Republic of China
| | - Guangqing Yao
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, People's Republic of China
| | - Dahai Yu
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, People's Republic of China
| | - Jianhui Cao
- Department of Orthopedic Surgery, Shijiazhuang People's Hospital, Shijiazhuang, People's Republic of China
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Scheyerer MJ, Spiegl UJA, Grueninger S, Hartmann F, Katscher S, Osterhoff G, Perl M, Pumberger M, Schmeiser G, Ullrich BW, Schnake KJ. Risk Factors for Failure in Conservatively Treated Osteoporotic Vertebral Fractures: A Systematic Review. Global Spine J 2022; 12:289-297. [PMID: 33541142 PMCID: PMC8907647 DOI: 10.1177/2192568220982279] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Osteoporosis is one of the most common diseases of the elderly, whereby vertebral body fractures are in many cases the first manifestation. Even today, the consequences for patients are underestimated. Therefore, early identification of therapy failures is essential. In this context, the aim of the present systematic review was to evaluate the current literature with respect to clinical and radiographic findings that might predict treatment failure. METHODS We conducted a comprehensive, systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist and algorithm. RESULTS After the literature search, 724 potentially eligible investigations were identified. In total, 24 studies with 3044 participants and a mean follow-up of 11 months (range 6-27.5 months) were included. Patient-specific risk factors were age >73 years, bone mineral density with a t-score <-2.95, BMI >23 and a modified frailty index >2.5. The following radiological and fracture-specific risk factors could be identified: involvement of the posterior wall, initial height loss, midportion type fracture, development of an intravertebral cleft, fracture at the thoracolumbar junction, fracture involvement of both endplates, different morphological types of fractures, and specific MRI findings. Further, a correlation between sagittal spinal imbalance and treatment failure could be demonstrated. CONCLUSION In conclusion, this systematic review identified various factors that predict treatment failure in conservatively treated osteoporotic fractures. In these cases, additional treatment options and surgical treatment strategies should be considered in addition to follow-up examinations.
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Affiliation(s)
- Max J. Scheyerer
- Department of Orthopedic and Trauma
Surgery, Medical Faculty, University of Cologne, Cologne, Germany,Max J. Scheyerer, PD Dr., Department of
Orthopedic and Trauma Surgery, Medical Faculty, University of Cologne, Kerpener
Straße 62, 50937 Cologne, Germany.
| | - Ulrich J. A. Spiegl
- Department of Orthopaedics, Trauma
Surgery and Plastic Surgery, University Hospital Leipzig, Sachsen Germany
| | - Sebastian Grueninger
- Department of Orthopaedics and
Trauma Surgery, University Hospital, Paracelsus University, Hospital Nürnberg,
Nuernberg, Germany
| | - Frank Hartmann
- Department of Orthopaedics and
Trauma Surgery, Ev.Stift St. Martin, Hospital Mittelrhein, Koblenz,
Germany
| | | | - Georg Osterhoff
- Department of Orthopaedics, Trauma
Surgery and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Mario Perl
- Department of Trauma Surgery,
University Hospital Erlangen, Erlangen, Germany
| | - Matthias Pumberger
- Spine Department, Center for
Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin,
Germany
| | - Gregor Schmeiser
- Center for Spine Therapy, Schön
Klinik Hamburg Eilbeck, Hamburg, Germany
| | - Bernhard W. Ullrich
- Department of Trauma and Plastic
Surgery, University Hospital Jena, Jena, Germany
| | - Klaus J. Schnake
- Center for Spine and Scoliosis
Therapy, Malteser Waldkrankenhaus St. Marien, Erlangen, Bayern, Germany,Department of Orthopedics and
Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg,
Germany
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Park SJ. Treatment of Kümmell’s disease following the occurrence of osteoporotic vertebral compression fracture. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.11.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: The incidence of osteoporotic vertebral compression fracture (OVCF) is increasing with the increase in the elderly population. Kümmell’s disease following OVCF occurrence is not a rare complication and is frequently associated with severe pain or neurologic deficit with progressive kyphotic deformity. Kümmell’s disease initially meant post-traumatic delayed vertebral collapse, but now it is also termed nonunion, osteonecrosis, or intravertebral vacuum cleft, all of which suggest the disruption of the healing process.Current Concepts: The major pathogenesis of Kümmell’s disease is a vascular compromise caused by mechanical stress or intravascular pathology. The key radiologic sign to diagnose Kümmell’s disease is the presence of intravertebral vacuum cleft, observed using simple X-ray, computed tomography, or magnetic resonance imaging. Magnetic resonance imaging is the most useful diagnostic tool showing gas or fluid signals. The risk factors for the progression of Kümmell’s disease after OVCF include middle-column injury, confined low signal intensity on T2-weighted image, posterior wall combined fracture, kyphotic angle >10°, and a height loss >15%. Its treatment can be broadly classified as conservative treatment, bone cement injection, and surgical treatment. The appropriate treatment method is selected based on the pain intensity, neurological symptoms, and the severity of the kyphotic deformity.Discussion and Conclusion: Kümmell’s disease usually develops along with osteoporosis. Therefore, the treatment should be focused on relief from symptoms associated with Kümmell’s disease and osteoporosis. It is recommended that an anabolic agent should be administered after the diagnosis of Kümmell’s disease, regardless of the treatment modality.
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López Zúñiga D, Láinez-Ramos-Bossini AJ, Ruiz Santiago F. Radiographic diagnosis of osteoporotic vertebral fractures. An updated review. Med Clin (Barc) 2021; 158:125-132. [PMID: 34392986 DOI: 10.1016/j.medcli.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022]
Abstract
The radiological diagnosis of osteoporotic vertebral fractures (OVFs) is of major importance considering its therapeutic and prognostic implications. Both radiologists and clinicians have the opportunity to diagnose OVFs in daily clinical practice due to the widespread use of spine and chest radiography. However, several studies have reported an under-diagnosis of OVFs, particularly by a lack of consensus on the diagnostic criteria. Therefore, up-to-date knowledge of the most relevant approaches for the diagnosis of OVFs is necessary for many physicians. This article aims to review the most commonly used classification systems in the diagnosis of OVFs based on conventional radiography. We discuss their rationale, advantages and limitations, as well as their utility according to the context. This review will provide a concise yet useful understanding of the typology of OVFs, their clinical significance and prognosis. Finally, we include anatomical variations that can be confused with OVFs by non-experts.
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Affiliation(s)
- Daniel López Zúñiga
- Department of Radiology, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Antonio Jesús Láinez-Ramos-Bossini
- Department of Radiology, "Virgen de las Nieves" University Hospital, Granada, Spain; Department of Radiology and Physical Medicine, University of Granada, Granada, Spain
| | - Fernando Ruiz Santiago
- Department of Radiology, "Virgen de las Nieves" University Hospital, Granada, Spain; Department of Radiology and Physical Medicine, University of Granada, Granada, Spain.
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Ma YH, Tian ZS, Liu HC, Zhang BY, Zhu YH, Meng CY, Liu XJ, Zhu QS. Predictive risk factors for recollapse of cemented vertebrae after percutaneous vertebroplasty: A meta-analysis. World J Clin Cases 2021; 9:2778-2790. [PMID: 33969060 PMCID: PMC8058688 DOI: 10.12998/wjcc.v9.i12.2778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/18/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND As one of the most common complications of osteoporosis, osteoporotic vertebral compression fracture (OVCF) increases the risk of disability and mortality in elderly patients. Percutaneous vertebroplasty (PVP) is considered to be an effective, safe, and minimally invasive treatment for OVCFs. The recollapse of cemented vertebrae is one of the serious complications of PVP. However, the risk factors associated with recollapse after PVP remain controversial.
AIM To identify risk factors for the recollapse of cemented vertebrae after PVP in patients with OVCFs.
METHODS A systematic search in EMBASE, MEDLINE, the Cochrane Library, and PubMed was conducted for relevant studies from inception until March 2020. Studies investigating risk factors for the recollapse of cemented vertebrae after PVP without additional trauma were selected for analysis. Odds ratios (ORs) or standardized mean differences with 95% confidence interval (CI) were calculated and heterogeneity was assessed by both the chi-squared test and the I-squared test. The methodological quality of the included studies was assessed according to the Newcastle-Ottawa Scale.
RESULTS A total of nine case-control studies were included in our meta-analysis comprising 300 cases and 2674 controls. The significant risk factors for the recollapse of cemented vertebrae after PVP in OVCF patients were fractures located at the thoracolumbar junction (OR = 2.09; 95%CI: 1.30 to 3.38; P = 0.002), preoperative intravertebral cleft (OR = 2.97; 95%CI: 1.93 to 4.57; P < 0.00001), and solid lump distribution pattern of the cement (OR = 3.11; 95%CI: 1.91 to 5.07; P < 0.00001). The analysis did not support that age, gender, lumbar bone mineral density, preoperative visual analogue scale score, injected cement volume, intradiscal cement leakage, or vertebral height restoration could increase the risk for cemented vertebra recollapse after PVP in OVCFs.
CONCLUSION This meta-analysis suggests that thoracolumbar junction fractures, preoperative intravertebral cleft, and solid lump cement distribution pattern are associated with the recollapse of cemented vertebrae after PVP in OVCF patients.
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Affiliation(s)
- Yi-Hang Ma
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Zhi-Sen Tian
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Hao-Chuan Liu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Bo-Yin Zhang
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Yu-Hang Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Chun-Yang Meng
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Xiang-Ji Liu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
| | - Qing-San Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
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Govindasamy R, Gopal S, Rudrappa S. The effectiveness of cement augmentation in kyphosis correction of dynamically loaded osteoporotic vertebral fractures: A retrospective case series. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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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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Efficacy of Postural Reduction of Vertebral Compression Fracture with Extension Lateral Radiograph Before Vertebroplasty. World Neurosurg 2020; 143:e430-e441. [PMID: 32750516 DOI: 10.1016/j.wneu.2020.07.188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This retrospective comparative study aimed to evaluate the efficacy of postural reduction of vertebral compression fracture (VCF) using the hyperextension posture before vertebroplasty (VP). METHODS Sixty-five consecutive patients who underwent VP were retrospectively reviewed. Thirty patients who underwent passive expansion of compression fracture before VP (postural reduction vertebroplasty [PRV] group) were compared with 35 patients who underwent in situ vertebroplasty (ISV group). Patient characteristics, complications, local kyphosis angle (LKA), Cobb angle, sagittal index (SI), anterior body height (ABH), and posterior body height were assessed. RESULTS LKA and SI significantly improved from preoperative measurements at the final follow-up in the ISV and PRV groups. ABH significantly improved only in the PRV group and ABH improvement at the final follow-up was significantly greater in the PRV group. However, there were no significant differences in LKA, Cobb angle, SI, ABH, and posterior body height at the final follow-up. Within the subgroup analysis of patients with preoperative ABH ≤15 mm, ABH and amount of ABH improvement at final follow-up were significantly greater in the PRV group. CONCLUSIONS Hyperextension postural reduction showed superior ABH improvement. It also showed higher ABH at the final follow-up when performed on patients with preoperative ABH ≤15 mm. Although routine hyperextension postural reduction should be carefully approached, postural reduction using supine extension lateral radiography would provide more effective vertebral body height restoration in patients with moderate collapse of vertebral compression fracture with ABH ≤15 mm.
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Is Redo Vertebroplasty an Effective Treatment on the Same Vertebra? Cardiovasc Intervent Radiol 2018; 41:1058-1066. [PMID: 29511869 DOI: 10.1007/s00270-018-1920-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/21/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Redo vertebroplasty is rarely reported. Previous studies on redo vertebroplasty included a small number of patients and lacked radiographic analysis. The purpose of this study was to assess the radiographic outcomes (restoration of vertebral body) and clinical outcomes (pain relief) in patients with recurrent or unrelieved pain after vertebroplasty with a minimum follow-up duration of 12 months. MATERIALS AND METHODS The records of 22 patients (23 cases), who underwent redo vertebroplasty between March 2001 and February 2014, were analyzed. Vertebral height loss (VHL) and wedge angle (WA) were measured before and after redo vertebroplasty. Subjective back pain was assessed via the numeric rating scale (NRS) score. RESULTS VHL after the initial vertebroplasty was 18.7%. Preoperative and final VHL of redo vertebroplasty were 32.3 and 18.3%, respectively. WA after initial vertebroplasty was 9.5°. Preoperative and final WA of redo vertebroplasty was 13.9° and 9°, respectively. Changes of VHL and WA values at each time point were significant (p < 0.01). The change of NRS pain score at each time point, including the period between post-initial vertebroplasty and final follow-up, was statistically significant (p < 0.01); 18 patients (82%) showed marked pain relief and 4 patients (18%) showed partial pain relief. CONCLUSIONS Redo vertebroplasty seems to be an effective way to achieve pain relief and vertebral body height restorations without major complications in patients with unrelieved or recurrent back pain after vertebroplasty. LEVEL OF EVIDENCE Level 4, case series.
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Morphological changes of vertebral compression fracture with intra-vertebral cleft treated with percutaneous vertebroplasty. J Orthop Sci 2018; 23:237-247. [PMID: 29174421 DOI: 10.1016/j.jos.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 09/08/2017] [Accepted: 11/08/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vertebroplasty represents an established treatment option for osteoporotic vertebral compression fracture (OVCF), but its radiographic and clinical outcomes have not been clearly described in patients with intra-vertebral cleft (IVC). The aim of this study was to assess vertebral height restoration, recollapse and change of back pain in OVCF patients with or without IVC. METHODS The records of 108 patients with IVC (group I) and 233 patients without IVC (group II) were included in our analysis between March 2001 and February 2014. The heights of the anterior, middle, and posterior columns, as well as the wedge angle (WA) of the fractured vertebral body were measured. For each vertebral column, the mean height of the superior and inferior vertebral body served as reference. Pre-operative, postoperative, and final compression rates (CR), as well as restoration and recollapse rates were calculated for each column. Subjective back pain was assessed as the numeric rating scale (NRS) score. RESULTS The overall incidence of IVC in OVCF patients who underwent vertebroplasty was 20.8% (127/611 patients). Group I showed significantly higher CR over the entire follow-up period, with the exception of CR for the anterior column at final follow-up, and CR for the posterior column throughout the follow-up. The mean restoration rates at the anterior and middle column immediately after vertebroplasty were also significantly larger in group I. Recollapse rate in all columns was similar for groups I and II. The mean wedge angle was significantly larger in group I over the entire follow-up period. The groups did not differ in terms of NRS score at final follow-up. CONCLUSIONS Vertebroplasty restores vertebral body heights and WA more effectively in OVCF patients with IVC, and provides satisfactory radiographic and clinical outcomes regardless of the presence of IVC.
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Lim J, Choi SW, Youm JY, Kwon HJ, Kim SH, Koh HS. Posttraumatic Delayed Vertebral Collapse : Kummell's Disease. J Korean Neurosurg Soc 2017; 61:1-9. [PMID: 29354230 PMCID: PMC5769843 DOI: 10.3340/jkns.2017.0505.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/17/2017] [Accepted: 10/19/2017] [Indexed: 12/11/2022] Open
Abstract
Posttraumatic delayed vertebral collapse, known as Kummell’s disease, is increasing in number of patients. This disease is already progressive kyphosis due to vertebral collapse at the time of diagnosis and it causes intractable pain or neurologic deficit due to intravertebral instability. Treatment is very difficult after progression of the disease, and the range of treatment, in hospital day, and cost of treatment are both increased. Clinical features, pathogenesis and radiologic findings of these disease groups were reviewed to determine risk factors for delayed vertebral collapse. The purpose of this article is to suggest appropriate treatment before vertebral collapse for patients with osteoporotic vertebral compression fracture who have risk factors for posttraumatic delayed vertebral collapse.
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Affiliation(s)
- Jeongwook Lim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seung-Won Choi
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin-Young Youm
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyon-Jo Kwon
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seon-Hwan Kim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyeon-Song Koh
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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Zou D, Zhang K, Ren Y. Therapeutic effects of PKP on chronic painful osteoporotic vertebral compression fractures with or without intravertebral cleft. Int J Clin Exp Med 2015; 8:15780-15786. [PMID: 26629076 PMCID: PMC4658965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/06/2015] [Indexed: 06/05/2023]
Abstract
This study aims to investigate clinical effects of protruding after percutaneous vertebral plasty (PKP holds) for treatment of chronic painful osteoporotic vertebral compression fractures (CPOVCFs), and assess its safety and effectiveness. One hundred and eighteen CPOVCFs patients were included, and analyzed and followed up therapeutic effects of PKP holds. All of these patients were divided into NIVC (73 cases) and IVC (45 cases) group. Comparing operation time, bone cement perfusion, pain intensity modulus visual grading scoring, Oswestry disability index, fracture fanterior relative height, local convex Angle, and surgical complications between the two groups. There were no significant differences between two groups for operation time of PKP holds (P>0.05). Amount of bone cement injection in IVC groups was significantly higher compared to NIVC group (P<0.05). Pain intensity visual modulus ratings and Oswestry disability index were significantly improved in both groups after surgery and postoperative follow-up period compared to pre-operation (P<0.05). Fracture fanterior margin relative height and local convex angle were also significantly improved (P<0.05). Fracture fanterior margin relative height was also significantly improved for IVC compared to NIVC group (P<0.05). There were no differences for bone cement leakage rate and adjacent segment fracture between two groups (P>0.05). But there was a case of bone cement loose, which needs to be treated for further step. In conclusion, PKP holds is a kind of effective and safe method for the IVC and NIVC patients. Especially for the IVC patients, PKP holds can significantly improve the fracture fanterior margin relative height.
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Affiliation(s)
- Debo Zou
- Department of Spine Surgery, Shandong Provincial Qianfoshan Hospital Jinan 250014, Shandong, P. R. China
| | - Kaining Zhang
- Department of Spine Surgery, Shandong Provincial Qianfoshan Hospital Jinan 250014, Shandong, P. R. China
| | - Yanjun Ren
- Department of Spine Surgery, Shandong Provincial Qianfoshan Hospital Jinan 250014, Shandong, P. R. China
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