Usefulness of dynamic stabilisation with mobile percutaneous pedicle screw for thoracic vertebral fractures in diffuse idiopathic skeletal hyperostosis

2021 ◽  
Vol 14 (4) ◽  
pp. e242042
Author(s):  
Yawara Eguchi ◽  
Munetaka Suzuki ◽  
Sumihisa Orita ◽  
Seiji Ohtori
Keyword(s):  
Vertebral Fracture ◽  
Vertebral Fractures ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Body Height ◽  
Pedicle Screws ◽  
Low Back ◽  
Vertebral Body Height ◽  
Bone Fusion ◽  
Dynamic Stabilisation ◽  
Percutaneous Pedicle Screw

We report a case of vertebral fracture with diffuse idiopathic skeletal hyperostosis (DISH) who underwent posterior dynamic stabilisation using mobile percutaneous pedicle screws (PPS) with 1 above-1 below and obtained good bone fusion. A 76-year-old man experienced severe low back pain after he fell backward 1 m off a stepladder during work. A 12th thoracic vertebral fracture with DISH was observed. As the fractured part was unstable due to a three-column injury, and the conservative treatment of resting was not successful, posterior dynamic stabilisation with a mobile PPS between T11–L1 was performed the 38th day after injury. Immediately after surgery, a fracture gap was observed, but 5 months later, vertebral body height was shortened by about 4 mm, and good bone fusion was observed without loosening of the screw. The mobile PPS flexibly adapts to spinal plasticity and may be useful for bone union in vertebral fractures associated with DISH.

Relationship Between the OF Classification and Radiological Outcome of Osteoporotic Vertebral Fractures After Kyphoplasty

2020 ◽  
pp. 219256822096405
Author(s):  
Yannick Palmowski ◽  
Sophie Balmer ◽  
Zhouyang Hu ◽  
Tobias Winkler ◽  
Klaus John Schnake ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Vertebral Fractures ◽  
Body Height ◽  
Postoperative Outcome ◽  
Osteoporotic Fractures ◽  
Preoperative Assessment ◽  
Visual Analogue Scale Pain ◽  
Vertebral Body Height ◽  
Osteoporotic Vertebral Fractures ◽  
Clinical And Radiological Results

Study Design: Retrospective cohort study. Objectives: The OF classification is a new classification for osteoporotic vertebral fractures. The aim of this study was to clarify the relationship between preoperative OF subgroups and the postoperative outcome after kyphoplasty in patients with such fractures. Methods: Patients who underwent kyphoplasty of a single osteoporotic vertebral fracture were included and divided into groups according to the OF subgroups. Pre- and postoperative plain radiographs were analyzed in regard to the restoration of vertebral body height and local kyphotic angle (LKA). Additionally, clinical data including pre- and postoperative Visual Analogue Scale pain scores was documented. The clinical and radiological results were compared pre- and postoperatively within groups and between groups. Results: A total of 156 patients from OF subgroups 2 to 4 were included (OF 2: n = 58; OF 3: n = 36; OF 4: n = 62). Patients from all groups experienced significant pain relief postoperatively ( P < .001). Patients with OF 2 fractures showed a repositioning of the vertebral body height in the anterior and middle portions (both P < .001), but no significant improvement in LKA. For OF 3 and 4 fractures, there was a significant restoration of vertebral body height ( P < .001 for both) and a significant improvement of LKA ( P < .001 for both). The highest average restoration was noted in the OF 4 group. Conclusions: A higher OF subgroup is related to a higher radiological benefit from kyphoplasty. This confirms that the OF classification is an appropriate tool for the preoperative assessment of osteoporotic fractures.

scholarly journals Time Course of Acute Vertebral Fractures: A Prospective Multicenter Cohort Study

2021 ◽  
Vol 10 (24) ◽  
pp. 5961
Author(s):  
Hiroyuki Inose ◽  
Tsuyoshi Kato ◽  
Shinichi Shirasawa ◽  
Shinji Takahashi ◽  
Masatoshi Hoshino ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Low Back Pain ◽  
Back Pain ◽  
Vertebral Fracture ◽  
Vertebral Fractures ◽  
Low Back ◽  
Osteoporotic Vertebral Fractures ◽  
Significant Difference

To date, it is still unclear how fresh osteoporotic vertebral fractures (OVFs) affect the patient’s quality of life and low back pain during a follow-up period of more than 1 year. In the previous trial, women with fresh OVF were randomized to rigid or soft brace for 12 weeks, then both groups were followed for the subsequent 48 weeks. In women completing this trial at our affiliated hospitals, we conducted a follow-up study to investigate the long-term course of an acute vertebral fracture in terms of pain and quality of life. When comparing visual analog scale scores for low back pain and European Quality of Life-5 Dimensions Questionnaire scores between consecutive time points, a significant difference was found between 0 and 12 weeks, but not between 12 and 48 weeks or between 48 weeks and final follow-up. A total 25% had residual low back pain at the final follow-up. A stepwise logistic regression analysis identified age and previous vertebral fracture as predictors of residual low back pain at the final follow-up. Therefore, the degree of low back pain and impairment of the quality of life improved by 12 weeks after injury and did not change thereafter until a mean follow-up of 5.3 years.

A study on the relationship between the rate of vertebral body height loss before balloon kyphoplasty and early adjacent vertebral fracture

2021 ◽  
pp. 1-8
Author(s):  
Hun Kyu Shin ◽  
Jai Hyung Park ◽  
In Gyu Lee ◽  
Jin Hun Park ◽  
Jun Hyoung Park ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Vertebral Fractures ◽  
Body Height ◽  
Balloon Kyphoplasty ◽  
Height Loss ◽  
Vertebral Body Height ◽  
Fracture Group ◽  
Significant Difference ◽  
Adjacent Vertebral Fracture ◽  
The Relationship

BACKGROUND: The number of patients with an osteoporotic vertebral compression fracture, which is often accompanied by lower back pain and restrained activities, is growing. Balloon kyphoplasty involves the inflation of a balloon to restore height and reduce kyphotic deformity before stabilization with polymethylmethacrylate. However, there is a great deal of debate about whether balloon kyphoplasty also increases fracture morbidity by either inducing or facilitating subsequent adjacent vertebral fractures. OBJECTIVE: To evaluate the relationship between the rate of vertebral body height loss before balloon kyphoplasty and the etiology of early adjacent vertebral fracture after augmentation. METHODS: A total of 59 patients with osteoporotic vertebral compression fractures who underwent kyphoplasty were enrolled. This study defined early adjacent segmental fractures as new fractures occurring within three months after surgery. This study included the rate of vertebral body height loss. RESULTS: Early adjacent vertebral fractures were diagnosed in nine (15%) of the 59 patients. The patients were divided into two groups, with and without adjacent vertebral fractures. There was no significant difference in terms of age, body mass index, bone mineral density, local kyphotic angle, Cobb’s angle, cement volume, cement leakage, and percent height restored between the groups with fractures and without fractures. There was a statistically significant difference between the two groups in the rate of vertebral body height loss. The rate of vertebral body height loss was significantly higher in the fracture group than in the without fracture group. CONCLUSIONS: A high rate of vertebral body height loss increased the risk of early adjacent vertebral fractures after balloon kyphoplasty.

scholarly journals Thoracic spondylotic myelopathy presumably caused by diffuse idiopathic skeletal hyperostosis in a patient who underwent decompression and percutaneous pedicle screw fixation

2021 ◽  
Vol 9 ◽  
pp. 2050313X2098779
Author(s):  
Shota Miyoshi ◽  
Tadao Morino ◽  
Haruhiko Takeda ◽  
Hiroshi Nakata ◽  
Masayuki Hino ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Pedicle Screw Fixation ◽  
Vertebral Bone ◽  
Bone Bridge ◽  
Percutaneous Pedicle Screw ◽  
Bilateral Lower Limb ◽  
Upper Thoracic ◽  
Percutaneous Pedicle Screw Fixation

A 74-year-old man developed bilateral lower limb spastic paresis. He was diagnosed with thoracic spondylotic myelopathy presumably caused by mechanical stress that was generated in the intervertebral space (T1-T2) between a vertebral bone bridge (C5-T1) due to diffuse idiopathic skeletal hyperostosis after anterior fixation of the lower cervical spine and a vertebral bone bridge (T2-T7) due to diffuse idiopathic skeletal hyperostosis in the upper thoracic spine. Treatment included posterior decompression (T1-T2 laminectomy) and percutaneous pedicle screw fixation at the C7-T4 level. Six months after surgery, the patient could walk with a cane, and the vertebral bodies T1-T2 were bridged without bone grafting. For thoracic spondylotic myelopathy associated with diffuse idiopathic skeletal hyperostosis, decompression and percutaneous pedicle screw fixation are effective therapies.

scholarly journals Type 2 Diabetes Mellitus and Vertebral Fracture Risk

2021 ◽  
Author(s):  
Fjorda Koromani ◽  
Samuel Ghatan ◽  
Mandy van Hoek ◽  
M. Carola Zillikens ◽  
Edwin H. G. Oei ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Vertebral Fracture ◽  
Fracture Risk ◽  
Vertebral Fractures ◽  
Bone Fragility ◽  
Marrow Fat ◽  
Systematic Screening ◽  
Published Evidence ◽  
Vertebral Fracture Risk

Abstract Purpose of Review The purpose of this review is to summarize the recently published evidence concerning vertebral fracture risk in individuals with diabetes mellitus. Recent Findings Vertebral fracture risk is increased in individuals with T2DM. The presence of vertebral fractures in T2DM is associated with increased non-vertebral fracture risk and mortality. TBS could be helpful to estimate vertebral fracture risk in individuals with T2DM. An increased amount of bone marrow fat has been implicated in bone fragility in T2DM. Results from two recent studies show that both teriparatide and denosumab are effective in reducing vertebral fracture risk also in individuals with T2DM. Summary Individuals with T2DM could benefit from systematic screening in the clinic for presence of vertebral fractures.

scholarly journals Posterior and Anterior Spinal Fusion for the Management of Deformities in Patients with Parkinson's Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Masashi Sato ◽  
Takeshi Sainoh ◽  
Sumihisa Orita ◽  
Kazuyo Yamauchi ◽  
Yasuchika Aoki ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Low Back Pain ◽  
Back Pain ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Anterior Fusion ◽  
Low Back ◽  
Surgical Methods ◽  
Correction Surgery

Introduction. Spinal scoliosis and kyphosis in elderly people sometimes cause severe low back pain. Surgical methods such as osteotomy are useful for correcting the deformity. However, complications during and after surgery are associated with the osteotomy procedure. In particular, it is difficult to manage deformity correction surgery for patients with Parkinson's disease. Here, we present two cases of combined anterior and posterior surgery for deformity in patients with adult scoliosis and kyphosis due to Parkinson's disease.Case Presentation. Two 70-year-old women had spinal scoliosis and kyphosis due to Parkinson's disease. They had severe low back pain, and conservative treatment was not effective for the pain. Surgery was planned to correct the deformity in both patients. We performed combined posterior and anterior correction surgery. At first, posterior fusions were performed from T4 to the ilium using pedicle screws. Next, cages and autograft from the iliac crest were used in anterior lumbar surgery. The patients became symptom free after surgery. Bony fusion was observed 12 months after surgery.Conclusions. Combined posterior and anterior fusion surgery is effective for patients who show scoliosis and kyphosis deformity, and symptomatic low back pain due to Parkinson's disease.

scholarly journals Hemoptysis as the Presenting Clinical Sign of a T8-T9 Spine Fracture with Diffuse Idiopathic Skeletal Hyperostosis Changes

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Ioannis Siasios ◽  
John Pollina ◽  
Vassilios G. Dimopoulos
Keyword(s):  
Clinical Sign ◽  
Screw Fixation ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Pedicle Screw Fixation ◽  
Percutaneous Pedicle Screw ◽  
Lung Hemorrhage ◽  
The Right ◽  
Percutaneous Pedicle Screw Fixation ◽  
Neurologically Intact ◽  
Lung Base

Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory degenerative disease that affects multiple spine levels and, in combination with osteoporosis, makes vertebrae more prone to fractures, especially in elderly people. We describe a rare case of thoracic fracture in an ankylosed spine in which hemoptysis was the only clinical sign. The patient (age in the early 80s) presented with chest pain and a cough associated with hemoptysis. The patient had no complaints of back pain and no neurological symptoms. Computed tomography (CT) angiography of the chest revealed changes consistent with DISH, with fractures at the T8 and T9 vertebra as well as lung hemorrhage or contusion in the right lung base. CT and magnetic resonance imaging of the thoracic spine showed similar findings, with a recent T8-T9 fracture and DISH changes. The patient underwent percutaneous pedicle screw fixation from T7 to T11 and remained neurologically intact with an uneventful postoperative course.

scholarly journals Relationship between diffuse idiopathic skeletal hyperostosis and fragility vertebral fracture: a prospective study in older men

Rheumatology ◽  
2020 ◽  
Author(s):  
Anaïs Guiot ◽  
Charline Estublier ◽  
Marine Gaude ◽  
Pawel Szulc ◽  
Roland Chapurlat
Keyword(s):  
Vertebral Fracture ◽  
Fracture Risk ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Older Men ◽  
Fracture Prediction ◽  
Intervertebral Space ◽  
Disc Space Narrowing ◽  
Disc Space ◽  
Vertebral Fracture Risk ◽  
A Prospective Study

Abstract Objective To analyse the risk of incident vertebral and non-vertebral fracture in men with DISH. Methods In 782 men ages 50–85 years, DISH was diagnosed using Resnick’s criteria. In men followed prospectively for 7.5 years, a radiographic incident vertebral fracture was defined by a decrease of ≥20% or ≥4mm in any vertebral height vs baseline. Self-reported incident non-vertebral fractures were confirmed by medical records. Results Men with DISH had higher BMD at the lumbar spine (P &lt; 0.05), but not at other skeletal sites. After adjustment for confounders including disc space narrowing (DSN) and endplate irregularity, the risk of vertebral fracture was higher in men with DISH vs men without DISH [10/164 (6.1%) vs 16/597 (2.7%), P &lt; 0.05; odds ratio (OR) 2.89 (95% CI 1.15, 7.28), P &lt; 0.05]. DISH and low spine BMD were each associated with a higher vertebral fracture risk. The vertebral fracture risk was higher in men who had both DISH and severe DSN. DISH and endplate irregularities (EIs) were each associated with higher vertebral fracture risk. DISH, DSN and EIs define the intervertebral space dysfunction, which was associated with higher vertebral fracture risk [OR 3.99 (95% CI 1.45, 10.98), P &lt; 0.01]. Intervertebral space dysfunction improved the vertebral fracture prediction (ΔAUC = +0.111, P &lt; 0.05), mainly in men with higher spine BMD (&gt;0.9 g/cm2; ΔAUC = +0.189, P &lt; 0.001). DISH was not associated with the risk of non-vertebral fracture. Conclusion DISH is associated with higher vertebral fracture risk, independently of other risk factors. Assessment of the intervertebral space dysfunction components may improve the vertebral fracture prediction in older men.

scholarly journals Is It Necessary to Reduce Thoracolumbar Compression Fractures  with Intermediate Screws in the Fractured Vertebra?

2021 ◽  
Author(s):  
ZeJun Xing ◽  
Shuai Hao ◽  
XiaoFei Wu
Keyword(s):  
Blood Loss ◽  
Body Height ◽  
Pedicle Screws ◽  
Operation Time ◽  
Short Segment ◽  
Compression Fractures ◽  
Significant Difference ◽  
Before And After ◽  
Screw Group

Abstract PurposeTo compare the efficacy and safety of percutaneous short-segment pedicle screws fixation (PPSF) with or without intermediate screws (IS) for the treatment of thoracolumbar compression fractures.MethodsFrom January 2016 to March 2019, a retrospective study of 38 patients with thoracolumbar compression fractures conducted. The patients were divided into a 4-screw group (without IS) and a 6-screw group (with IS) according to whether pedicle screws were placed in the fractured vertebrae. Combined positional reduction effects with the technique of pre-contoured lordotic rods were used to reduce the fracture by lengthening the anterior column of the fractured vertebrae. The posterior structure of the fractured vertebrae was undertaken as the fulcrum point for both groups. The operation time, intra-operative blood loss, visual analogue scale (VAS), anterior vertebral body height (AVBH), segment kyphosis（SK）before and after operation and complications were recorded.ResultsAlthough the operation time and blood loss in the 6-screw group were higher than in the 4-screw group, difference was not significant (P＞0.05). There was no significant difference in VAS, AVBH and SK between the two groups (P＞0.05). Nevertheless, these results were significant differences between the preoperative and the immediate postoperative, between preoperative and follow-up groups (P < 0.001). No neurologic injury was observed in either groups. ConclusionsIn the treatment of thoracolumbar compression fractures, percutaneous short-segment pedicle screws fixation without intermediate screws in the 4-screw construct may obtain the same clinical effect as that in the 6-screw construct.

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