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Zhang S, Chen H, Bao L, Jia P, Sun H, Wang K, Chen M, Tang H. Association Between Spinopelvic Parameters and Intravertebral Cleft in Osteoporosis Vertebral Compression Fractures. World Neurosurg 2024; 183:e813-e817. [PMID: 38218435 DOI: 10.1016/j.wneu.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND The high incidence of nonunion in osteoporosis vertebral compression fractures (OVCFs) among the elderly population is a significant concern. But the hypothesis about etiopathogenesis of the intravertebral cleft (IVC) is not convincing. This study aims to investigate the association between spinopelvic parameters and IVC. METHODS Patients with single segment IVC or healed vertebral compression fracture (HVCF) were retrospectively recruited for the study. Patients with IVC were assigned to the IVC group, the others were assigned to the HVCF group. We estimated whether IVC or HVCF locates the vertebra inflection point on lumbar lateral radiography. Distance between the sagittal line passing through the anterosuperior corner of S1and the center of the vertebra of healed fracture or with IVC (DSVA) and sacral slope (SS) were measured on lumbar lateral plain films. Intergroup spinopelvic parameters were analyzed. analysis to identify independent variables associated with IVC incidence. The receiver operating characteristics (ROC) curve was generated to identify the optimal cut-off point for statistically significant variables. RESULTS Sixty-five patients were included in the study. Thirty patients (mean age: 74 ± 7.16 years) had single-level IVC, and 35 patients (mean age: 67.71 ± 7.30 years) had single-level HVCF. Age, body mass index (BMI), and DSVA were statistically different between the groups (all P < 0.05). The occurrence of IVC was related to the DSVA in the multivariate logistic regression analysis (OR = 0.73, P < 0.05). CONCLUSIONS According to the results of this study, large DSVA was a risk factor for IVC formation in patients with OVCFs. Patients with global spinal malalignment should be actively observed during conservative treatment.
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Affiliation(s)
- Shuangjiang Zhang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hao Chen
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Li Bao
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Pu Jia
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Haibo Sun
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Kaiyu Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Mengmeng Chen
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hai Tang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
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Zhang T, Kang Y, Wang Y, Zhang P, Zhang D, Xue F. Does segmental artery occlusion cause intravertebral cleft following osteoporotic vertebral fracture: a prospective magnetic resonance angiography study. BMC Musculoskelet Disord 2022; 23:103. [PMID: 35101014 PMCID: PMC8802505 DOI: 10.1186/s12891-022-05064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background The avascular necrosis (AVN) hypothesis of intravertebral cleft (IVC) formation in osteoporotic vertebral fracture (OVCF) has received increasing attention. The aim of this article is to detect whether the segmental artery occlusion causes the IVC following OVCF. Methods Between December 2019 and April 2020, 44 OVCF patients with 46 fracture levels were prospectively enrolled and the vertebral segmental arteries were evaluated by magnetic resonance angiography (MRA). The artery conditions were divided into patent, narrow and occluded. The lesion segmental occlusion rate (LSOR) and the total occlusion rate (TOR) were calculated. The association of segmental artery occlusion and IVC formation was assessed. Results LOSR was 15.34% and TOR was 15.12%. The segmental arteries of the unfractured vertebrae had a higher occlusion rate at thoracolumbar levels than at non-thoracolumbar levels. There was no significant difference between the IVC group and the non-IVC group in the fractured levels artery occlusion rate (20.24 ± 28.08 vs 9.78 ± 19.56, P = 0.156) or the total segmental arteries occlusion rate (13.83 ± 12.04 vs 11.57 ± 9.25, P = 0.476). Conclusions In patients with vertebral osteoporotic fracture, segmental artery occlusion is not associated with the development of intravertebral cleft.
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Affiliation(s)
- Tianyu Zhang
- Department of Urology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yu Kang
- Department of Radiology, Peking University People's Hospital, Beijing, 100044, China
| | - Yanhua Wang
- Department of Traumatic Orthopaedics, Peking University People's Hospital, Beijing, 100044, China
| | - Peixun Zhang
- Department of Traumatic Orthopaedics, Peking University People's Hospital, Beijing, 100044, China.,Institute of Trauma and Nerve Regeneration, Peking University People's Hospital, Beijing, 100044, China
| | - Dianying Zhang
- Department of Traumatic Orthopaedics, Peking University People's Hospital, Beijing, 100044, China.,Institute of Trauma and Nerve Regeneration, Peking University People's Hospital, Beijing, 100044, China
| | - Feng Xue
- Department of Traumatic Orthopaedics, Peking University People's Hospital, Beijing, 100044, China. .,Institute of Trauma and Nerve Regeneration, Peking University People's Hospital, Beijing, 100044, China.
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Tang B, Xu S, Chen X, Cui L, Wang Y, Yan X, Liu Y. The impact of intravertebral cleft on cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a case-control study. BMC Musculoskelet Disord 2021; 22:805. [PMID: 34537042 PMCID: PMC8449924 DOI: 10.1186/s12891-021-04685-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/31/2021] [Indexed: 12/25/2022] Open
Abstract
Background The impact of intravertebral cleft (IVC) on cement leakage in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs) has been discussed. However, the results were conflicting, as the study population and cement leakage classification were heterogeneous. The aim of the study was to evaluate the impact of IVC on the incidence of leakage through vein, leakage through cortex as well as general leakage in PVP for OVCFs. Methods All patients with OVCFs who underwent PVP between January 2016 and June 2019 at our institution were retrospectively reviewed. Patients were eligible for this case-control study if they were diagnosed as single level fracture in spine. After inclusive and exclusive criteria were met, a total of 139 patients with IVC were enrolled as the study group. Non-IVC controls were matched in a 1:1 ratio in age (within 3 years), sex and fracture severity with patients in study group. Cement leakage were classified into four types [type B (through basivertebral vein), type S (through segmental vein), type-C (through a cortical defect), and type D (intradiscal leakage)], furtherly into two types [venous type (type-B or/and type S) and cortical type (type-C or/and type-D)]. A general leakage rate and a specific leakage rate per each type were compared between both groups. Results Each group included 139 patients. Groups were homogenous for age, sex, fracture severity, fracture location, fracture type, cement volume, puncture approach and property of cement. Compared with control group, IVC group had a significantly lower rate of type-B (20.9% vs. 31.7%, P = 0.041), type-S (24.5% vs. 52.5%, P = 0.000), and venous type leakage (37.4% vs. 67.6%, P = 0.000), a significantly higher rate of type-C (25.9% vs. 12.2%, P = 0.004), type-D (16.5% vs. 6.5%, P = 0.009), and cortical type leakage (40.3% vs. 16.5%, P = 0.000), no significant difference on the rate of general leakage (67.6% vs. 76.3%, P = 0.109). Conclusion IVC decreased the risk of cement leakage through vein and increased the risk of cement leakage through cortex. However, it had no significant effect on the occurrence of general leakage.
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Affiliation(s)
- Benqiang Tang
- Department of Spinal Surgery, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, 101149, China
| | - Songjie Xu
- Department of Spinal Surgery, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, 101149, China
| | - Xueming Chen
- Department of Spinal Surgery, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, 101149, China.
| | - Libin Cui
- Department of Spinal Surgery, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, 101149, China
| | - Yanhui Wang
- Department of Spinal Surgery, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, 101149, China
| | - Xin Yan
- Department of Spinal Surgery, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, 101149, China
| | - Yadong Liu
- Department of Spinal Surgery, Beijing Luhe Hospital, Capital Medical University, No.82, Xinhua South Road, Touzhou District, Beijing, 101149, China
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Chen Z, Lou C, Yu W, He D. Comparison of Intravertebral Clefts between Kümmell Disease and Acute Osteoporotic Vertebral Compression Fracture: A Radiological Study. Orthop Surg 2021; 13:1979-1986. [PMID: 34523812 PMCID: PMC8528973 DOI: 10.1111/os.13025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 12/28/2022] Open
Abstract
Objective The aim of this study was to compare the radiological features of intravertebral clefts (IVC) between Kümmell disease (KD) and acute osteoporotic vertebral compression fracture (OVCF). Materials and Methods This is a retrospective study. A total of 79 patients with IVC from January 2014 to December 2018 were included in this study. There were 22 men and 57 women, with an average of 73.5 years. Based on the exact time interval from injury to treatment and the pathological examination results, the patients were divided into KD group (44 patients) and acute OVCF group (35 patients). The two groups were compared by the margin sclerosis of IVC, vertebra and pedicle ossification, stress fracture of the spinous process, paravertebral callus, the shape of IVC, cleft in the adjacent disc, and flatness of IVC's margin from plain radiographs and computed tomography (CT). The two groups were compared by the IVC content, double‐line sign, and signal of fracture vertebral from their magnetic resonance imaging (MRI). Results There were no significant differences in sex, age, and fracture distribution between the KD group and the acute OVCF group. IVC was present in both the KD group and the acute OVCF group. Six radiological features were only present in the KD group, including sclerosis of the cleft margin (95.5%, 42/44), ossification of the fractured vertebrae (100%, 44/44), ossification of the pedicle (31.8%, 14/44), double‐line sign (27.3%, 12/44), stress fracture of the spinous process (13.6%, 6/44), and even formation of paravertebral callus (18.2%, 8/44). Although there were statistical differences in the other four radiological features of content of IVC (P = 0.02), cleft sign in adjacent intervertebral disc (P < 0.01), margin of IVC (P = 0.02), and the shape of IVC (P = 0.01) between the KD group and acute OVCF group, these characteristics could be found in both groups. Conclusion IVC could present in patients with both KD and acute OVCF; however, we found that marginal cleft sclerosis, vertebral and pedicle ossification, double‐line sign, spinous process fracture, and formation of paravertebral callus are unique radiological features of KD and could be used for differentiation of KD from acute OVCF with IVC.
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Affiliation(s)
- Zhenzhong Chen
- Department of Orthopedics, 5th Affiliated Hospital, Lishui Municipal Central Hospital, Wenzhou Medical College, Lishui, China
| | - Chao Lou
- Department of Orthopedics, 5th Affiliated Hospital, Lishui Municipal Central Hospital, Wenzhou Medical College, Lishui, China
| | - Weiyang Yu
- Department of Orthopedics, 5th Affiliated Hospital, Lishui Municipal Central Hospital, Wenzhou Medical College, Lishui, China
| | - Dengwei He
- Department of Orthopedics, 5th Affiliated Hospital, Lishui Municipal Central Hospital, Wenzhou Medical College, Lishui, China
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Dong L, Dong C, Zhu Y, Wei H. Intravertebral cleft in pathological vertebral fracture resulting from spinal tuberculosis: a case report and literature review. BMC Musculoskelet Disord 2020; 21:619. [PMID: 32948151 PMCID: PMC7501658 DOI: 10.1186/s12891-020-03642-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 09/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background Among common findings in osteoporotic vertebral compression fractures (OVCFs), the intravertebral cleft (IVC) is usually considered a benign lesion. The current study was aimed to present a rare case of vertebral fracture caused by IVC-related spinal tuberculosis. Case presentation A 73-year-old female complained of back pain and weakness in lower limbs for 2 weeks. 3 months ago, after a minor trauma, she got back pain without weakness in lower limbs. Initially, she was diagnosed with a L1 compression fracture and accepted conservative treatment. After an asymptomatic period, she complained progressive pain at the fracture position with weakness of both lower limbs and was referred to our hospital with suspicion of Kümmell’s disease. The patient underwent posterior debridement and internal fixation for decompression and stabilization of the spine. Pathological examinations revealed the patient with spinal tuberculosis. Conclusions Although IVC is common in patients with OCVFs, there are some cases believed to be found in patients with spinal tuberculosis or infection. Further test, like CT-guided puncture biopsy, may be required before decisive treatment when an IVC is observed.
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Affiliation(s)
- Liang Dong
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No 555, YouYi East road, Xi'an, 710054, China.
| | - Chunke Dong
- Beijing University of Chinese Medicine, 11 North Third Ring Road East, Chaoyang District, Beijing, 100029, China
| | - Yuting Zhu
- Beijing Tongzhou Integrative Medicine Hospital, 89 Chezhan Road, Tongzhou District, Beijing, 101100, China
| | - Hongyu Wei
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
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Wei H, Dong C, Zhu Y, Ma H. Analysis of two minimally invasive procedures for osteoporotic vertebral compression fractures with intravertebral cleft: a systematic review and meta-analysis. J Orthop Surg Res 2020; 15:401. [PMID: 32912267 PMCID: PMC7488103 DOI: 10.1186/s13018-020-01938-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/01/2020] [Indexed: 12/16/2022] Open
Abstract
Background A systematic review and meta-analysis to assess the pros and cons of percutaneous vertebroplasty (PVP) versus kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral cleft (IVC) including all available evidence from controlled trials. Methods Databases including Pubmed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched to identify relevant studies comparing PVP and PKP for OVCFs with IVC. The outcomes mainly included visual analog scale (VAS), Oswestry Disability Index (ODI), local kyphotic angle (LKA), rate of vertebral height (VH%), and adverse events. Results Nine studies enrolling 688 patients were eligible for meta-analysis. The results indicated no significant differences between the two groups in the short-and long-term VAS, ODI, LKA, or VH% (P > 0.05). Compared with PVP, PKP was associated with significantly longer operation time (P < 0.05), higher cost (P > 0.05), and more injected cement volume (P < 0.05). In terms of adverse events, PKP has a lower risk of cement leakage (P < 0.05), while with no significant difference in adjacent-level fracture rates (P > 0.05). Conclusion The two procedures have similar short- and long-term pain relief, functional recovery, local kyphosis correction, and vertebral height maintenance in OVCFs with IVC. PKP is superior to PVP for the injected cement volume, and lower cement leakage rate, however, with longer operation time, more fluoroscopy times, and higher cost. Further randomized controlled trials (RCTs) should be conducted to confirm these results.
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Affiliation(s)
- Hongyu Wei
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Chunke Dong
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.,Beijing University of Chinese Medicine, 11 North Third Ring Road East, Chaoyang District, Beijing, 100029, China
| | - Yuting Zhu
- Beijing Tongzhou Integrative Medicine Hospital, 89 Chezhan Road, Tongzhou District, Beijing, 101100, China
| | - Haoning Ma
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
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Tang S, Fu W, Zhang H, Zhang H, Liang B. Efficacy and Safety of High-Viscosity Bone Cement Vertebroplasty in Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft. World Neurosurg 2019; 132:e739-45. [PMID: 31415893 DOI: 10.1016/j.wneu.2019.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Chongyan W, Zhang X, Li S, Liu J, Shan Z, Wang J, Chen J, Fan S, Zhao F. Mechanism of formation of intravertebral clefts in osteoporotic vertebral compression fractures: An in vitro biomechanical study. Spine J 2018; 18:2297-2301. [PMID: 30075299 DOI: 10.1016/j.spinee.2018.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intravertebral clefts (IVCs) are vacuum-like cavities commonly associated with osteoporotic vertebral compression fractures (OVCFs). IVCs promote cement leakage during kyphoplasty, suggesting a physical link with the basivertebral foramen, although this is uncertain. PURPOSE The present study aims to create IVCs in mechanical experiments on cadaveric spines in order to clarify their pathogenesis, structure, and links with the basivertebral foramen. STUDY DESIGN AND METHODS In total, 15 three-vertebra lumbar specimens from five cadavers aged 68 to 71 years were subjected to axial compressive overload followed by cyclic loading in flexion and extension to create an OVCF together with an IVC. Computed tomography scans and radiographs were used to confirm structural changes and micro-CT was used to measure trabecular bone properties in five specimens. Unipedicular vertebroplasty was then performed on 10 damaged specimens until fluoroscopy revealed extravasation of cement. RESULTS In every specimen, loading created an OVCF with an IVC. Dissection and imaging showed that the IVC was always connected with the basivertebral foramen. The central vertebral region, including the IVC, had the lowest connectivity density, trabecular number, and bone volume fraction, and the highest trabecular separation. Vertebroplasty caused cement leakage through the basivertebral foramen in nine specimens and into an adjacent disc in one specimen. CONCLUSION Cyclic loading in flexion and extension applied to a fractured osteoporotic vertebra can create an IVC, which then allows cement leakage via the basivertebral foramen.
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Affiliation(s)
- Wang Chongyan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Xuyang Zhang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Shengyun Li
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Junhui Liu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Zhi Shan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Jiasheng Wang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Jian Chen
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Shunwu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Fengdong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Yu W, Xu W, Jiang X, Liang D, Jian W. Risk Factors for Recollapse of the Augmented Vertebrae After Percutaneous Vertebral Augmentation: A Systematic Review and Meta-Analysis. World Neurosurg 2017; 111:119-129. [PMID: 29253703 DOI: 10.1016/j.wneu.2017.12.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/01/2017] [Accepted: 12/04/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Recollapse of the augmented vertebrae after percutaneous vertebral augmentation treatment for osteoporotic vertebral compression fractures has obtained much attention. Although many potential risk factors have been proposed, they are still disputed. The aim of our study was to identify the characteristics of the augmented vertebrae that had undergone a recollapse according to a systematic review from the earliest available records up to August 2017 and then conduct a meta-analysis based on eligible studies to assess significant potential risk factors for recollapse of the augmented vertebrae. METHODS Fourteen studies were identified for investigating recollapse of the augmented vertebrae. Of those studies, 9 studies were eligible for meta-analysis. RESULTS Pooled results showed that 5 primary factors were associated with recollapse of the augmented vertebrae, including preoperative intravertebral cleft, the affected vertebrae in the thoracolumbar region, preoperative severe kyphotic deformity, solid lump cement distribution pattern, and higher vertebral height restoration. It was possibly another risk factor that the distance between PMMA and superior end plate was relatively large. CONCLUSIONS Careful observation of patients with these risk factors and reasonable intervention could be useful to prevent deterioration of their clinical course.
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Affiliation(s)
- Weibo Yu
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Weixing Xu
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China
| | - Xiaobing Jiang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - De Liang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Wang Jian
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China.
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12
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Hatano H, Oike N, Ariizumi T, Sasaki T, Kawashima H. Intravertebral cleft in pathological vertebral collapse resulting from cancer metastasis: report of three cases. Skeletal Radiol 2016; 45:1747-50. [PMID: 27714415 DOI: 10.1007/s00256-016-2505-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/28/2016] [Accepted: 09/28/2016] [Indexed: 02/02/2023]
Abstract
Intravertebral cleft (IVC) is a common finding in osteoporotic compression fracture. However, since the vertebral collapse attributable to cancer metastasis is rarely associated with IVC, the phenomenon is generally considered as a sign of a benign lesion. In this study, we retrospectively reviewed the radiographs, computed tomography scans, and magnetic resonance images of 111 patients with spinal metastasis. Three cases (2.7 %) had IVC in the collapsed thoracic vertebral bodies (T7, T8, and T11) attributable to cancer metastasis. IVC alone is not necessarily an indicator of a benign vertebral collapse.
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Nakamae T, Fujimoto Y, Yamada K, Hashimoto T, Olmarker K. Efficacy of Percutaneous Vertebroplasty in the Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft. Open Orthop J 2015; 9:107-13. [PMID: 26157525 PMCID: PMC4484235 DOI: 10.2174/1874325001509010107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/18/2015] [Accepted: 03/20/2015] [Indexed: 11/30/2022] Open
Abstract
Intravertebral cleft (IVC) is frequently observed in patients with painful osteoporotic vertebral compression fracture (OVCF). Some studies reported the usefulness of percutaneous vertebroplasty (PVP) for treating OVCF with IVC. However, systematic studies are scarce, and their results are conflicting. The purpose of this study was to evaluate the clinical and radiographic results of PVP in the treatment of painful OVCF with IVC. Two hundred ninety-one patients with OVCF with IVC underwent PVP. Back pain was measured using a visual analog scale (VAS), and physical disability was assessed using the Oswestry Disability Index (ODI). Three radiological parameters were assessed: the local kyphotic angle, percentage spinal canal cross-sectional area of compromise, and intravertebral instability of the affected vertebra. The mean follow-up period was 28 months. The mean values for the VAS and ODI were 8.4 and 60.0%, respectively, before PVP, versus 3.9 and 35.4%, respectively, at the final follow-up. The average local kyphotic angle, percentage spinal canal cross-sectional area of compromise, and intravertebral instability were 10.5°, 17.9% and 6.1°, respectively, before PVP and 8.1°, 15.2%, and 0.8°, respectively, at the final follow-up. There were no neurological or systemic complications due to cement leakage. PVP is an effective and safe intervention for treating OVCF with IVC.
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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
| | - 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
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Zhang GQ, Gao YZ, Chen SL, Ding S, Gao K, Wang HQ. Comparison of percutaneous vertebroplasty and percutaneous kyphoplasty for the management of Kümmell's disease: A retrospective study. Indian J Orthop 2015; 49:577-82. [PMID: 26806962 PMCID: PMC4705721 DOI: 10.4103/0019-5413.168752] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Post traumatic osteonecrosis of a vertebral body occurring in a delayed fashion was first described by the German doctor Kümmell in 1895. Several studies have reported percutaneous vertebroplasty (PVP), or percutaneous kyphoplasty (PKP) for Kümmell's disease achieves good outcomes. However, it is unknown whether a technique is superior for the treatment of this disease. The objective of the study is to compare the efficacy of PVP and PKP for the treatment of Kümmell's disease. MATERIALS AND METHODS A retrospective review was conducted for 73 patients with Kümmell's disease. PVP was performed in 38 patients and PKP in 35 patients. Visual analogue score (VAS) was used to evaluate pain. The anterior vertebral height was measured. The operative time, the incidence of cement leakage and the costs were recorded. RESULTS In both PVP group and PKP group, the VAS and anterior vertebral height significantly improved at 1-day postoperatively (P < 0.05), and the improvement sustained at the final followup (P > 0.05). Between the PVP and PKP groups, there were no significant differences in VAS and the anterior vertebral height at 1-day postoperatively and at the final followup (P > 0.05). The operating time and expense in the PKP group were higher than the PVP group (P < 0.001). Cement leakages in the PKP group were fewer than PVP group (P < 0.05). CONCLUSIONS PVP is a faster, less expensive option that still provides a comparable pain relief and restoration of vertebral height to PKP for the treatment of Kümmell's disease. PKP has a significant advantage over PVP in term of the fewer cement leakages.
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Affiliation(s)
- Guang-Quan Zhang
- Department of Orthopedic, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Yan-Zheng Gao
- Department of Orthopedic, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China,Address for correspondence: Prof. Yan-Zheng Gao, Department of Orthopedic, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Zhengzhou 450003, China. E-mail:
| | - Shu-Lian Chen
- Department of Orthopedic, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Shuai Ding
- Department of Orthopedic, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Kun Gao
- Department of Orthopedic, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Hong-Qiang Wang
- Department of Orthopedic, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
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Wang C, Fan S, Liu J, Suyou L, Shan Z, Zhao F. Basivertebral foramen could be connected with intravertebral cleft: a potential risk factor of cement leakage in percutaneous kyphoplasty. Spine J 2014; 14:1551-8. [PMID: 24314766 DOI: 10.1016/j.spinee.2013.09.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 07/24/2013] [Accepted: 09/19/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT Among different types of cement leakage in percutaneous kyphoplasty (PKP) for osteoporotic vertebral body compression fractures, leaks into the spinal canal are considered to be the most common complication. One potential structure causing this type of cement leakage is the potential connection between the basivertebral foramen and the intravertebral cleft, which is revealed clearly on magnetic resonance (MR) images, but is often ignored in the literature. PURPOSE The purpose of this study is to assess the incidence rate of different types of cement leakage in PKP with or without intravertebral clefts and to determine whether the basivertebral foramen could be connected to the intravertebral cleft. STUDY DESIGN This study is a retrospective assessment of the presence of an intravertebral cleft in osteoporotic vertebral bodies and the different types of cement leakage after PKP on radiographs, computed tomographic (CT) scans, and MR images. PATIENT SAMPLE A total of 164 consecutive patients underwent PKP to treat 204 osteoporotic vertebral compression fractures. OUTCOME MEASURES Outcome measures include the occurrence of different types of cement leakage in the groups with an intravertebral cleft and without intravertebral clefts. METHODS A total of 204 vertebrae in 164 consecutive patients who underwent PKP to treat osteoporotic vertebral compression fractures were classified into two patterns based on preoperative radiographs, CT scans, and/or MR images of the treated levels: cleft pattern (with an intravertebral cleft in the vertebral body) and trabecular pattern (without intravertebral clefts). When an intravertebral cleft was identified, the investigators examined the basivertebral foramen and looked for a communication between the two structures on three-dimensional CT scans and MR images. On direct postoperative images, the patterns of cement leakage were classified as five types: type A, through a cortical defect into the paraspinal soft tissues; type B, through the basivertebral foramen; type C, via the needle channel; type D, through a cortical defect into the disc space; and type E, via the paravertebral vein. The association of the distribution of the cement leakage and the presence of an intravertebral cleft was analyzed retrospectively. Moreover, the association of type B leakage with the communication between the basivertebral foramen and the intravertebral cleft was also assessed. RESULTS The average interobserver kappa values for determining the type of cement leakage and the presence of intravertebral cleft were 0.916 (range, 0.792-1) and 0.935, respectively. In 41 of 204 vertebrae (19.9%), an intravertebral cleft was confirmed on preoperative images. A communication between the intravertebral cleft and the basivertebral foramen was seen in 10 vertebrae (24.4%). Cement leakage was 36.2% in the group with a trabecular pattern and 41.5% in the group with a cleft pattern (p>.05). Leaks through the basivertebral foramen (type B; N=30, 14.7%) and through cortical defects into the disc space (type D; N=14, 6.9%) were more common than other types. Twenty of 163 vertebrae with the trabecular pattern (12.3%) and 10 of 41 vertebrae with the cleft pattern (24.4%) were identified as type B leaks, which reached statistical significance (p<.05). There was no statistical difference between the trabecular pattern and the cleft pattern on other types of leaks. CONCLUSIONS Type B leaks are more common in vertebrae with an intravertebral cleft, which supports the presence of a connection between an intravertebral cleft and the basivertebral foramen. Thus, care must be taken when PKP is performed in these patients to avoid direct cement leakage into the spinal canal through the basivertebral foramen.
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16
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Kim YC, Kim YH, Ha KY. Pathomechanism of intravertebral clefts in osteoporotic compression fractures of the spine. Spine J 2014; 14:659-66. [PMID: 24055039 DOI: 10.1016/j.spinee.2013.06.106] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/20/2013] [Accepted: 06/29/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intravertebral cleft (IVC) associated with vertebral collapse is not uncommon in osteoporotic compression fracture. However, the pathomechanism of IVC is poorly understood. Bone ischemia is indicated in the current hypothesis. PURPOSE To clarify the pathomechanism of IVC in delayed posttraumatic vertebral collapse, referred to as Kummell's disease. STUDY DESIGN Magnetic resonance (MR) angiography and histology of segmental arteries and vertebral bodies in delayed posttraumatic vertebral collapse were investigated. PATIENT SAMPLE All elderly patients admitted to the authors' spine clinic of tertiary referral center for a 105-month period. OUTCOME MEASURES All imaging tests including plain radiographs, computed tomography, and MR angiography were reviewed by authors using a double-blind method. All operations were performed by one experienced surgeon. The statistical data were analyzed using SPSS program. METHODS Evaluations using MR angiography and computed tomography were performed in 22 patients. Twelve of the 22 patients underwent corpectomy and anterior interbody fusion. At operation, segmental artery and bone surrounding IVC were harvested and microscopically evaluated. RESULTS Magnetic resonance angiography showed occlusions of bilateral segmental arteries in nine of 22 patients. Seven patients had unilateral occlusion. In six patients, no occlusion was seen. Microscopically, the left segmental arteries of three patients were completely obstructed by thrombosis. Histologic examination of necrotic bone showed fragile trabecular bone and sparse osteocytes. CONCLUSIONS The findings of thrombosis of the segmental arteries of the vertebral body with IVC could suggest a mechanism by which IVC is formed, and the progressive collapse may develop following osteoporotic spinal fracture.
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Affiliation(s)
- Yoon-Chung Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Ban Po-Dong, Seo Cho-Gu, Seoul 137-701, Korea
| | - Young-Hoon Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Ban Po-Dong, Seo Cho-Gu, Seoul 137-701, Korea
| | - Kee-Yong Ha
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Ban Po-Dong, Seo Cho-Gu, Seoul 137-701, Korea.
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Abstract
BACKGROUND Intravertebral cleft is a structural change in osteoporotic vertebral compression fractures (OVCF), which is the manifestation of ischemic vertebral osteonecrosis complicated with fracture nonunion and pseudoarthrosis and appears in the late stage of OVCF. Despite numerous studies on OVCF, few aim to evaluate the clinicoradiological characteristics and clinical significance of intravertebral cleft in OVCF. This study investigates clinicoradiological characteristics of intravertebral cleft in OVCF and the effect on the efficacy of percutaneous balloon kyphoplasty (PKP). MATERIALS AND METHODS PKP was performed on 139 OVCF patients without intravertebral cleft (group A) and 44 OVCF patients with intravertebral cleft (group B). The frequency distribution of the affected vertebral body, bone cement infusion volume, imaging manifestation, leakage rate and type, preoperative and postoperative height of the affected vertebral body, visual analog scale (VAS) and Oswestry disability index (ODI) score were evaluated. RESULTS Significant differences were found in the frequency distribution of the affected vertebral body and bone cement leakage type between the two groups (P < 0.05). However, differences in bone cement infusion volume and leakage rate (P > 0.05) were not detected. In both groups, the postoperative height of the affected vertebral body was significantly improved (P < 0.05). The restoration of vertebral body height in group B was more evident than that in group A (P < 0.05). The preoperative VAS and ODI scores in group B were significantly higher than those in group A (P < 0.05). After surgical treatment, pain relief and daily activity function in both groups were significantly improved (P < 0.05), and no significant difference in postoperative scores was detected between the two groups (P > 0.05). CONCLUSION Intravertebral cleft exhibits specific clinical and imaging as well as bone cement formation characteristics. PKP can effectively restore the affected vertebral body height, alleviate pain, and improve daily activity function of patients.
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Affiliation(s)
- Bao Chen
- Department of Orthopedics, Jiaxing Second Hospital, Jiaxing 314000, China
| | - Shunwu Fan
- Department of Orthopedics, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China,Address for correspondence: Dr. Shunwu Fan, Department of Orthopedics, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, No. 3 Qingchun East Road, Hangzhou 310016, China. E-mail:
| | - Fengdong Zhao
- Department of Orthopedics, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China
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Pedicelli A, Lozupone E, Gatto A, Gulino P, D'Argento F, Capozzi A, Colosimo C. Vertebra plana: reappraisal of a contraindication to percutaneous vertebroplasty. Eur J Radiol 2013; 82:2303-8. [PMID: 24050881 DOI: 10.1016/j.ejrad.2013.08.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 08/10/2013] [Accepted: 08/17/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE We evaluated the efficacy of percutaneous vertebroplasty (PVP) in treating symptomatic vertebra plana, which is considered a relative contraindication to the procedure. METHODS Out of 540 levels treated in 260 patients, we treated 40 patients (mean age: 74 years) with vertebra plana between T6 and L3 (37 osteoporotic and 3 metastatic levels). In most cases, the vertebra was accessed with fluoroscopic guidance from a single, transpedicular approach. All patients underwent a preliminary MRI examination, an immediate, post-procedure radiological examination, and a follow-up examination (mean duration, 6 months). RESULTS Both immediate and follow-up examinations showed that the mean pain and physical disability scores were significantly reduced compared to the scores before treatment (p ≤ 0.001). No complications occurred during the procedures. In 23/40 cases, asymptomatic intradiscal cement leakage occurred. Posterior or perivertebral leakage never occurred. In most cases, an intravertebral cleft was present, and we filled it with polymethylmethacrylate, which healed the pseudarthrosis. Partial vertebral height was restored in 7 cases. In 6 cases, a new fracture occurred between 1 and 3 months at a different level from the treated level. CONCLUSION Our preliminary results showed that PVP was a safe, effective treatment for symptomatic vertebra plana; thus, it should not be discounted for this group of patients. In most cases, the procedure was favored by the presence of an intravertebral cleft that appeared to contribute to minimizing the risk of posterior cement leakage. Filling the cleft with polymethylmethacrylate allowed intravertebral stabilization.
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Affiliation(s)
- Alessandro Pedicelli
- Department of Radiological Sciences, Catholic University School of Medicine (A. Gemelli Hospital), Italy.
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Hirata H, Hiwatashi A, Yoshiura T, Togao O, Yamashita K, Kamano H, Kikuchi K, Honda H. Resolution of epidural hematoma related to osteoporotic fracture after percutaneous vertebroplasty. World J Radiol 2013; 5:325-327. [PMID: 24003359 PMCID: PMC3758501 DOI: 10.4329/wjr.v5.i8.325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/09/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
We are the first to report a case that showed spontaneous resolution of epidural hematoma which was related to a steroid-induced osteoporotic compression fracture. The patient had a painful fracture with an intravertebral cleft at L1 accompanying an epidural hematoma posteriorly. Immediate pain relief was achieved after percutaneous vertebroplasty. Complete resolution of hematoma was noted three months after procedure. We theorized that intravertebral stability after treatment might have played a role in this patient.
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Cho JH, Shin SI, Lee JH, Yeom JS, Chang BS, Lee CK. Usefulness of prone cross-table lateral radiographs in vertebral compression fractures. Clin Orthop Surg 2013; 5:195-201. [PMID: 24009905 PMCID: PMC3758989 DOI: 10.4055/cios.2013.5.3.195] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 03/18/2013] [Indexed: 01/08/2023] Open
Abstract
Background Dynamic radiographs are recommended to investigate non-healing evidence such as the dynamic mobility or intravertebral clefts in osteoporotic vertebral compression fractures (VCFs). However, it is difficult to examine standing flexion and extension lateral radiographs due to severe pain. The use of prone cross-table lateral radiographs (PrLRs) as a diagnostic tool has never been proposed to our knowledge. The purpose of this study is to clarify the usefulness of PrLRs in diagnosis and treatment of VCFs. Methods We reviewed 62 VCF patients examined with PrLRs between January 1, 2008 and June 30, 2011. To compare the degree of pain provoked between standing extension lateral radiographs (StLRs) and PrLRs, numeric rating scale (NRS) scores were assessed and compared by a paired t-test. Vertebroplasty was done for 40 patients and kyphoplasty was done for 9 patients with routine manners. To assess the degree of postural reduction, vertebral wedge angles (VWA) and vertebral height ratios (VHR) were calculated by using preoperative StLRs, PrLRs, and postoperative lateral radiographs. Two variables derived from changes in VWA and VHR between preoperative and postoperative radiographs were compared by a paired t-test. Results The average NRS scores were 6.23 ± 1.67 in StLRs and 5.18 ± 1.47 in PrLRs. The degree of pain provocation was lower in using PrLRs than StLRs (p < 0.001). The average changes of VWA between preoperative and postoperative status were 5.24° ± 6.16° with PrLRs and 3.46° ± 3.47° with StLRs. The average changes of VHR were 0.248 ± 0.178 with PrLRs and 0.148 ± 0.161 with StLRs. The comparisons by two variables showed significant differences for both parameters (p = 0.021 and p < 0.001, respectively). The postoperative radiological status was reflected more precisely when using PrLRs than StLRs. Conclusions In comparison with StLR, the PrLR was more accurate in predicting the degree of restoration of postoperative vertebral heights and wedge angles, and provoked less pain during examination. The PrLR could be a useful diagnostic tool to detect intravertebral cleft or intravertebral dynamic instability.
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Affiliation(s)
- Jae Hwan Cho
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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