Vertebral Compression Fractures and Options for Treatment

Compression Fracture ◽

Initial Step ◽

The United States ◽

Invasive Procedures ◽

First Line ◽

Compression Fractures ◽

Prompt Diagnosis

Vertebral compression fracture, a condition that affects almost one quarter of women in the United States, often presents as unrelenting pain with even minor movement. The condition has a significant effect on the decrease in quality of life of patients affected. Prompt diagnosis and treatment are key in the management of this condition. Although a conservative regimen with back braces and analgesics is the first initial step, invasive procedures, such as kyphoplasty and vertebroplasty, may be employed earlier in cases with severe debilitating pain, which is often not improved by first-line treatment.

EVALUATION OF SHORT AND LONG TERM BENEFITS/SIDE EFFECTS OF CEMENT AUGMENTATION IN PATIENTS WITH NON INFECTIVE PATHOLOGICAL OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES

10.36106/ijsr/4301540 ◽

2020 ◽

pp. 44-48

Author(s):

Abhay Singh ◽

Rahul Gupta ◽

Shachi Shachi

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Pain Relief ◽

Compression Fracture ◽

Cement Augmentation ◽

Hybrid Technique

BACKGROUND: Vertebral compression fracture usually occurs in old age population with osteoporosis. Due to severity of pain, quality of life becomes very poor. During the study period 67 patients fullling the eligibility cri METHODS: teria underwent vertebroplasty/ kyphoplasty/ cement augmented screw xation/ hybrid procedures were included. Short term and long term benets /side effects were evaluated in all patients. Patients were evaluated on visual analogue score and modied ranking scale. RESULTS: Vertebroplasty was performed in 26(38.8%) whereas kyphoplasty, cement augmented screw xation and hybrid procedure were performed in 18(26.8%), 17(25.4%) and 6(9.0%) respectively. Signicant pain relief occurred in all patients which were evaluated by Visual Analogue Scale. Quality of life also improved which was evaluated with Modied Rankin Scale. In our study, complications which occurred were local cement leak, hematoma formation, infection in 8 (11.9%), 3(4.5%) and 2(3.0%) patients respectively. Use of biological cement has revolutionized CONCLUSION: the management of vertebral compression fracture. Both vertebroplasty and kyphoplasty procedures which are minimal invasive, almost cure the non infective pathological fractures with instant pain relief and very low procedure related morbidity. In cases requiring xation, cement augmentation signicantly improves the purchase of the screw and makes the construct more reliable. Hybrid technique helps to prevent extensive long level xation.

Innovative Spine Implants for Improved Augmentation and Stability in Neoplastic Vertebral Compression Fracture

Medicina ◽

10.3390/medicina55080426 ◽

2019 ◽

Vol 55 (8) ◽

pp. 426 ◽

Cited By ~ 1

Author(s):

Cornelis ◽

Joly ◽

Nouri-Neuville ◽

Ben-Ammar ◽

Kastler ◽

...

Keyword(s):

Clinical Performance ◽

Compression Fracture ◽

Treatment Decision ◽

Definitive Treatment ◽

Compression Fractures ◽

Good Pain Relief ◽

Severe Back Pain ◽

And Function

Background and objectives: Tumor-related vertebral compression fractures often result in severe back pain as well as progressive neurologic impairment and additional morbidities. The fixation of these fractures is essential to obtain good pain relief and to improve the patients’ quality of life. Thus far, several spine implants have been developed and studied. The aims of this review were to describe the implants and the techniques proposed to treat cancer-related vertebral compression fractures and to compile their safety and efficacy results. Materials and Methods: A systematic MEDLINE/PubMed literature search was performed, time period included articles published between January 2000 and March 2019. Original articles were selected based on their clinical relevance. Results: Four studies of interest and other cited references were analyzed. These studies reported significant pain and function improvement as well as kyphotic angle and vertebral height restoration and maintain for every implant and technique investigated. Conclusions: Although good clinical performance is reported on these devices, the small numbers of studies and patients investigated draw the need for further larger evaluation before drawing a definitive treatment decision tree to guide physicians managing patients presenting with neoplastic vertebral compression fracture.

Risk Factors for Refracture following Primary Osteoporotic Vertebral Compression Fractures

January 2018 - Pain Physician ◽

10.36076/ppj.2021/24/e335 ◽

2021 ◽

pp. E335-E340

Author(s):

Weihua Cai

Keyword(s):

Risk Factors ◽

Compression Fracture ◽

Osteoporotic Vertebral Compression Fractures ◽

Hounsfield Units ◽

Secondary Fracture ◽

Compression Fractures ◽

Fracture History ◽

Primary Fracture

Background: In the aging population, osteoporosis and related complications have become a global public health problem. Osteoporotic vertebral compression fractures are among the most common type of osteoporotic fractures and patients are at risk of secondary vertebral compression fracture. Objectives: To identify risk factors for secondary vertebral compression fracture following primary osteoporotic vertebral compression fractures. Study Design: Retrospective study. Setting: Department of Orthopedic, an affiliated hospital of a medical university. Methods: This retrospective cohort study evaluated the risk factors for secondary vertebral compression fracture in 317 consecutive patients with systematic osteoporotic vertebral compression fractures who received percutaneous vertebroplasty and kyphoplasty or conservative treatment. Patients were divided into secondary vertebral compression fracture (n = 43) and non- secondary vertebral compression fracture (n = 274) groups. We retrospectively analyzed clinical characteristics and radiographic parameters, including gender, age, body mass index, number of primary fractures, primary treatment (percutaneous vertebroplasty and kyphoplasty or conservative treatment), nonspinal fracture history before primary fracture, primary fracture at the thoracolumbar junction, steroid use, bisphosphonate therapy, and Hounsfield units value of L1. Results: Comparison between the groups showed significant differences in age (P = 0.001), nonspinal fracture history (P < 0.001), and Hounsfield units value of L1 (P < 0.001). The receiver operating characteristic curves demonstrated that the optimal thresholds for age and Hounsfield units value of L1 were 75 (sensitivity: 55.8%; specificity: 67.5%) and 50 (sensitivity: 88.3%; specificity: 67.4%), respectively. In multivariate logistic regression analysis, nonspinal fracture history (OR = 6.639, 95% CI = 1.809 – 24.371, P = 0.004) and Hounsfield units value of L1 < 50 (OR = 15.260, 95% CI = 6.957 – 33.473, P < 0.001) were independent risk factors for secondary vertebral compression fracture. Limitations: The main limitation is the retrospective nature of this study. Conclusion: Patients with low Hounsfield units value of L1 or non-spinal fracture history are an important population to target for secondary fracture prevention. Key words: Risk factor, vertebral, secondary fracture, osteoporosis

Previous vertebral compression fractures add to the deterioration of the disability and quality of life after an acute compression fracture

European Spine Journal ◽

10.1007/s00586-009-1162-y ◽

2009 ◽

Vol 19 (4) ◽

pp. 567-574 ◽

Cited By ~ 19

Author(s):

Nobuyuki Suzuki ◽

Osamu Ogikubo ◽

Tommy Hansson

Keyword(s):

Quality Of Life ◽

Compression Fracture ◽

Compression Fractures

Extrapedicular approach of percutaneous vertebroplasty in the treatment of upper and mid‐thoracic vertebral compression fracture

Acta Radiologica ◽

10.1080/02841850510021058 ◽

2005 ◽

Vol 46 (3) ◽

pp. 280-287 ◽

Cited By ~ 17

Author(s):

K.‐R. Han ◽

C. Kim ◽

J.‐S. Eun ◽

Y.‐S. Chung

Keyword(s):

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

Safe Procedure ◽

Compression Fractures ◽

Clinical Complications ◽

Technical Procedure ◽

One Year ◽

Changes Over Time

Purpose: To evaluate the clinical outcome of the extrapedicular approach of percutaneous vertebroplasty (PVP) for upper and mid‐thoracic vertebral compression fractures in patients. Material and Methods: Extrapedicular vertebroplasty was performed in painful compression fractures at T4–T8 levels. The assessment criteria were changes over time in visual analog scale (VAS) and mobility score. We evaluated the volume of cement injected, the size of needle required, and complications. Results: Procedures were performed in 27 patients with a total of 34 affected vertebral bodies. Early (within a week) and one year later, clinical follow‐ups showed that pain intensity had decreased by 50% one day after operation and later by 70–80%. Mobility scores of all patients were improved immediately after the procedure. Average volume of polymethylmethacrylate (PMMA) per vertebral body was 3.8±1.2 ml. Leakage of PMMA occurred in one vertebral level (intradiskal space), but did not cause clinical complications. Conclusion: PVP of upper and mid‐thoracic spine with an extrapedicular approach is an efficient and safe procedure for treating painful thoracic vertebral compression fracture under a cautious patient selection and meticulous technical procedure.

Interventional Treatments for Acute and Chronic Pain: Systematic Review

10.23970/ahrqepccer247 ◽

2021 ◽

Author(s):

Roger Chou ◽

Rongwei Fu ◽

Tracy Dana ◽

Miranda Pappas ◽

Erica Hart ◽

...

Keyword(s):

Usual Care ◽

Older Patients ◽

Interventional Procedures ◽

Compression Fracture ◽

Controlled Trials ◽

Compression Fractures ◽

Radiofrequency Denervation ◽

And Function

Objective. To evaluate the benefits and harms of selected interventional procedures for acute and chronic pain that are not currently covered by the Centers for Medicare & Medicaid Services (CMS) but are relevant for and have potential utility for use in the Medicare population, or that are covered by CMS but for which there is important uncertainty or controversy regarding use. Data sources. Electronic databases (Ovid® MEDLINE®, PsycINFO®, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews) to April 12, 2021, reference lists, and submissions in response to a Federal Register notice. Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) for 10 interventional procedures and conditions that evaluated pain, function, health status, quality of life, medication use, and harms. Random effects meta-analysis was conducted for vertebral compression fracture; otherwise, outcomes were synthesized qualitatively. Effects were classified as small, moderate, or large using previously defined criteria. Results. Thirty-seven randomized trials (in 48 publications) were included. Vertebroplasty (13 trials) is probably more effective at reducing pain and improving function in older (>65 years of age) patients, but benefits are small (less than 1 point on a 10-point pain scale). Benefits appear smaller (but still present) in sham-controlled (5 trials) compared with usual care controlled trials (8 trials) and larger in trials of patients with more acute symptoms; however, testing for subgroup effects was limited by imprecision. Vertebroplasty is probably not associated with increased risk of incident vertebral fracture (10 trials). Kyphoplasty (2 trials) is probably more effective than usual care for pain and function in older patients with vertebral compression fracture at up to 1 month (moderate to large benefits) and may be more effective at >1 month to ≥1 year (small to moderate benefits) but has not been compared against sham therapy. Evidence on kyphoplasty and risk of incident fracture was conflicting. In younger (below age for Medicare eligibility) populations, cooled radiofrequency denervation for sacroiliac pain (2 trials) is probably more effective for pain and function versus sham at 1 and 3 months (moderate to large benefits). Cooled radiofrequency for presumed facet joint pain may be similarly effective versus conventional radiofrequency, and piriformis injection with corticosteroid for piriformis syndrome may be more effective than sham injection for pain. For the other interventional procedures and conditions addressed, evidence was too limited to determine benefits and harms. Conclusions. Vertebroplasty is probably effective at reducing pain and improving function in older patients with vertebral compression fractures; benefits are small but similar to other therapies recommended for pain. Evidence was too limited to separate effects of control type and symptom acuity on effectiveness of vertebroplasty. Kyphoplasty has not been compared against sham but is probably more effective than usual care for vertebral compression fractures in older patients. In younger populations, cooled radiofrequency denervation is probably more effective than sham for sacroiliac pain. Research is needed to determine the benefits and harms of the other interventional procedures and conditions addressed in this review.

Kyphoplasty for the treatment of an atypical osteoporotic vertebral compression fracture of the lumbar spine: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x17744985 ◽

2017 ◽

Vol 5 ◽

pp. 2050313X1774498

Author(s):

Sanjeev Kumar ◽

Leon Anijar ◽

Rishi Agarwal

Keyword(s):

Older Patients ◽

Compression Fracture ◽

Osteoporotic Vertebral Compression Fracture ◽

Clinical Scenario ◽

Vertebral Augmentation ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Lumbar Vertebral Body

Vertebral augmentation is a minimally invasive but sometimes technically challenging intervention typically reserved for the treatment of older patients with painful vertebral compression fractures due to osteoporosis or neoplasms. We report the successful treatment of osteoporotic vertebral compression fractures of the first lumbar vertebral body (L1) using kyphoplasty in a paraplegic young patient with multiple comorbidities. Despite the unusual and complicated clinical scenario, kyphoplasty was nonetheless performed with immediate and lasting pain relief.

Comparison of Rigid and Soft-Brace Treatments for Acute Osteoporotic Vertebral Compression Fracture: A Prospective, Randomized, Multicenter Study

Journal of Clinical Medicine ◽

10.3390/jcm8020198 ◽

2019 ◽

Vol 8 (2) ◽

pp. 198 ◽

Cited By ~ 8

Author(s):

Tsuyoshi Kato ◽

Hiroyuki Inose ◽

Shoichi Ichimura ◽

Yasuaki Tokuhashi ◽

Hiroaki Nakamura ◽

...

Keyword(s):

Quality Of Life ◽

Back Pain ◽

Outcome Measures ◽

Vertebral Body ◽

Compression Fracture ◽

Secondary Outcome ◽

Brace Treatment ◽

Compression Fractures

While bracing is the standard conservative treatment for acute osteoporotic compression fracture, the efficacy of different brace treatments has not been extensively studied. We aimed to clarify and compare the preventive effect of the different brace treatments on the deformity of the vertebral body and other clinical results in this patient cohort. This multicenter nationwide prospective randomized study included female patients aged 65–85 years with acute one-level osteoporotic compression fractures. We assigned patients within four weeks of injury to either a rigid-brace treatment or a soft-brace treatment. The main outcome measure was the anterior vertebral body compression percentage at 48 weeks. Secondary outcome measures included scores on the European Quality of Life-5 Dimensions (EQ-5D), visual analog scale (VAS) for lower back pain, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). A total of 141 patients were assigned to the rigid-brace group, whereas 143 patients were assigned to the soft-brace group. There were no statistically significant differences in the primary outcome and secondary outcome measures between groups. In conclusion, among patients with fresh vertebral compression fractures, the 12-week rigid-brace treatment did not result in a statistically greater prevention of spinal deformity, better quality of life, or lesser back pain than soft-brace.

Treatment of Osteoporotic Vertebral Compression Fracture with Target-Anchored Vertebral Body Plasty

Journal of Biomaterials and Tissue Engineering ◽

10.1166/jbt.2019.2073 ◽

2019 ◽

Vol 9 (8) ◽

pp. 1081-1085

Author(s):

Liu Yang ◽

Xiangbei Qi ◽

Tao Lei ◽

Jingtao Zhang ◽

Junming Cao

Keyword(s):

Bone Cement ◽

Vertebral Body ◽

Compression Fracture ◽

Target Group ◽

Osteoporotic Vertebral Compression Fractures ◽

Traditional Group ◽

Compression Fractures ◽

Fracture Area

Objective: To analyze the clinical effect of target-anchored vertebroplasty and traditional percutaneous vertebroplasty on the treatment of osteoporotic vertebral compression fractures. Methods: 50 female New Zealand rabbits were selected for establishing the osteoporotic vertebral compression fracture model and divided into two groups, traditional group and target group followed by analysis of the anterior, posterior, and posterior vertebral body anterior height of the fracture and the injection volume of the bone cement at full filling, and to compare the ultimate compressive strength and stiffness differences between the two groups of specimens by biomechanical testing. Results: In traditional group, the operative time was significantly shorter than that of target group, and the intraoperative bleeding was significantly lower than that of target group (P < 0.05). The fracture area of target group was filled with sufficient bone cement, in the traditional group, 3 cases (12%) showed that bone cement was not filled in the fracture area (P < 0.05), but the total bone cement filling volume was not significantly different between the two groups, but the traditional group had more complete bone cement filling than the bone cement filling, the difference was statistically significant (P < 0.05). In addition, the anterior vertebral body height of each group was significantly higher than other observation points in the group (P < 0.05). However, the distribution of permeability and osmotic type of bone cement between the two groups was not significantly different (P > 0.05). Conclusion: Target-anchored vertebroplasty can improve the quality of clinical treatment of osteoporotic vertebral compression fractures, indicating that it might be a new surgical method.

Orthopedic treatment of vertebral compression fractures in osteoporosis

Orvosi Hetilap ◽

10.1556/oh.2011.29178 ◽

2011 ◽

Vol 152 (33) ◽

pp. 1328-1336

Author(s):

Péter Pál Varga ◽

István Béla Bors ◽

Áron Lazáry

Keyword(s):

Systemic Disease ◽

Treatment Options ◽

Compression Fracture ◽

Orthopedic Treatment ◽

Adequate Treatment ◽

Mortality And Morbidity ◽

Compression Fractures ◽

Spine Care

Vertebral compression fracture is the most common type of fractures in osteoporosis increasing the mortality and morbidity of the systemic disease. Adequate treatment of the vertebral compression fractures is always in the focus of the national and international spine meetings and one of the most innovative fields in the spine care is the surgical therapy of the osteoporotic spine. Here, the authors summarize the orthopedic treatment options for vertebral compression fractures based on a literature review