scholarly journals Posterior Fixation of Osteoporotic Thoracolumbar Vertebral Fracture and Indication for Partial Vertebral Body Resection

2015 ◽  
Vol 29 (2) ◽  
pp. 208-210
Author(s):  
Toshiyuki Takahashi ◽  
Junya Hanakita ◽  
Mizuki Watanabe ◽  
Taigo Kawaoka ◽  
Yasufumi Ohtake ◽  
...  
Keyword(s):  
Vertebral Fracture ◽  
Vertebral Body ◽  
Posterior Fixation ◽  
Thoracolumbar Vertebral Fracture

Altered disc pressure profile after an osteoporotic vertebral fracture is a risk factor for adjacent vertebral body fracture

2017 ◽  
Author(s):  
Μιχαήλ Τζερμιαδιανός
Keyword(s):  
Risk Factor ◽  
Vertebral Fracture ◽  
Vertebral Body ◽  
Pressure Profile ◽  
Osteoporotic Vertebral Fracture ◽  
Adjacent Vertebral Body ◽  
Vertebral Body Fracture ◽  
Body Fracture

Η κύφωση από ένα οστεοπορωτικό σπονδυλικό κάταγμα θεωρείται παράγοντας κίνδυνου για νέα κατάγματα, ιδιαίτερα στους παρακείμενους σπονδύλους. Όμως, ο ρόλος της παραμόρφωσης της τελικής πλάκας δεν έχει εκτιμηθεί. Η παρούσα μελέτη ελέγχει την υπόθεση ότι η αλλαγή στις μηχανικές ιδιότητες του μεσοσπονδύλιου δίσκου μετά από κάταγμα της τελικής του πλάκας, ακόμη και επί απουσίας κύφωσης, αλλάζει την μεταφορά φορτίων και προδιαθέτει σε παρακείμενα σπονδυλικά κάταγμα. Χρησιμοποιήθηκαν οκτώ ανθρώπινα θωρακοσφυϊκά παρασκευάσματα, αποτελούμενα από πέντε σπονδύλους. Για την επιλεκτική θραύση της μίας τελικής πλάκας του μεσαίου σπονδύλου δημιουργήθηκε κενό στο σπογγώδες οστό κάτω από την τυχαία επιλεγμένη πλάκα και το παρασκεύασμα συμπιέστηκε σε θέση κάμψης. Στη συνέχεια εφαρμόστηκε ροπή έκτασης υπό συμπιεστικό φορτίο 150 Ν, η οποία αποκατέστησε το ύψους του πρόσθιου τοιχώματος και την κυφωτική παραμόρφωση του σπονδυλικού σώματος, ενώ η τελική πλάκα παρέμεινε σημαντικά παραμορφωμένη. Το σπονδυλικό σώμα πληρώθηκε στην αναταγμένη θέση με πολυμεθακρυλικό τσιμέντο μετά τον προσεκτικό καθαρισμό του από τις οστικές δοκίδες ώστε να διασφαλιστεί η ομοιόμορφη κατανομή του τσιμέντου κάτω από τις τελικές πλάκες. Κάθε παρασκεύασμα ελέγχθηκε σε κάμψη και έκταση (ροπή ±6 Nm) υπό φορτίο 400 Ν, ενώ γινόταν καταγραφή της πίεση στους δίσκους άνω και κάτω του μεσαίου σπονδύλου και της τάσης (strain) στο πρόσθιο τοίχωμα των παρακείμενων σπονδύλων. Η πίεση των δίσκων στα άθικτα παρασκευάσματα αυξήθηκε κατά την κάμψη κατά 26 ± 14%. Μετά την ενίσχυση με τσιμέντο η πίεση των δίσκων κατά την κάμψη αυξήθηκε κατά 15 ± 11% στους δίσκους με άθικτη τελική πλάκα, ενώ μειώθηκε κατά 19,0 ± 26,8% στους δίσκους με παραμορφωμένη τελική πλάκα. Κατά την κάμψη, η συμπιεστική φόρτιση στο πρόσθιο τοίχωμα του σπονδύλου που βρισκόταν δίπλα από την παραμορφωμένη πλάκα αυξήθηκε κατά 94,2 ± 22,8% σε σχέση με τα άθικτα παρασκευάσματα (p<0,05), ενώ δεν άλλαξε σημαντικά στο σπόνδυλο δίπλα στην μη παραμορφωμένη πλάκα (18,2 ± 7,1%, p>0,05). Επακόλουθη κάμψη με συμπίεση προκάλεσε παρακείμενα κατάγματα δίπλα από την παραμορφωμένη πλάκα σε έξι παρασκευάσματα και μη παρακείμενο κάταγμα σε ένα, ενώ σε άλλο ένα παρασκεύασμα δεν παρατηρήθηκε νέο κάταγμα.Στους δίσκους με ακέραιες τελικές πλάκες η πίεση του πυρήνα αυξάνεται κατά την κάμψη αποτρέποντας την υπερβολική συγκέντρωση φορτίου στο πρόσθιο τοίχωμα. Ο αυξημένος χώρος που διατίθεται στον πυρήνα μετά από ένα οστεοπορωτικό κάταγμα επηρεάζει την ικανότητά του να κατανέμει το φορτίο και αναγκάζει τον ινώδη δακτύλιο να μεταφέρει περισσότερο φορτίο κατά την κάμψη, με αποτέλεσμα την υπέρμετρη καταπόνηση του πρόσθιου τμήματος του παρακείμενου σπονδύλου που προδιαθέτει σε κάταγμα ακόμη και μετά από διόρθωση της κύφωσης. Η παρούσα μελέτη υποδεικνύει ότι η διόρθωση της παραμόρφωσης της τελικής πλάκας μπορεί να έχει ρόλο στη μείωση του κινδύνου παρακείμενων καταγμάτων.

scholarly journals Nonsurgical Corrective Union of Osteoporotic Vertebral Fracture with Once-Weekly Teriparatide

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Naohisa Miyakoshi ◽  
Akira Horikawa ◽  
Yoichi Shimada
Keyword(s):  
Vertebral Fracture ◽  
Fracture Healing ◽  
Clinical Experience ◽  
Vertebral Body ◽  
Vertebral Fractures ◽  
Surgical Intervention ◽  
Osteoporotic Vertebral Fracture ◽  
Kyphosis Angle ◽  
Osteoporotic Vertebral Fractures

Osteoporotic vertebral fractures usually heal with kyphotic deformities with subsidence of the vertebral body when treated conservatively. Corrective vertebral union using only antiosteoporotic pharmacotherapy without surgical intervention has not been reported previously. An 81-year-old female with osteoporosis presented with symptomatic fresh L1 vertebral fracture with intravertebral cleft. Segmental vertebral kyphosis angle (VKA) at L1 was 20° at diagnosis. Once-weekly teriparatide administration, hospitalized rest, and application of a thoracolumbosacral orthosis alleviated symptoms within 2 months. Corrective union of the affected vertebra was obtained with these treatments. VKA at 2 months after injury was 8° (correction, 12°) and was maintained as of the latest follow-up at 7 months. Teriparatide has potent bone-forming effects and has thus been expected to enhance fracture healing. Based on the clinical experience of this case, teriparatide may have the potential to allow correction of unstable vertebral fractures without surgical intervention.

scholarly journals Risk of Fracture After Single Fraction Image-Guided Intensity-Modulated Radiation Therapy to Spinal Metastases

2009 ◽  
Vol 27 (30) ◽  
pp. 5075-5079 ◽  
Author(s):  
Peter S. Rose ◽  
Ilya Laufer ◽  
Patrick J. Boland ◽  
Andrew Hanover ◽  
Mark H. Bilsky ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Vertebral Fracture ◽  
High Risk ◽  
Vertebral Body ◽  
Spinal Metastases ◽  
Intensity Modulated Radiation Therapy ◽  
Risk Of Fracture ◽  
Single Fraction ◽  
Image Guided ◽  
Intensity Modulated

Purpose Single-fraction image-guided intensity-modulated radiation therapy (IG-IMRT) allows for tumoricidal treatment of traditionally radioresistant cancers while sparing critical adjacent structures. Risk of vertebral fracture after IG-IMRT for spinal metastases has not been defined. Patients and Methods We evaluated 62 consecutive patients undergoing single fraction IG-IMRT at 71 sites for solid organ metastases. A neuroradiologist and three spine surgeons evaluated prospectively obtained magnetic resonance/computed tomography (CT) imaging studies for post-treatment fracture development and tumor recurrence. Results Fracture progression was noted in 27 vertebrae (39%). Multivariate logistic regression analysis showed that CT appearance, lesion location, and percent vertebral body involvement independently predicted fracture progression. Lesions located between T10 and the sacrum were 4.6 times more likely to fracture than were lesions above T10 (95% CI, 1.1 to 19.7). Lytic lesions were 6.8 times more likely to fracture than were sclerotic and mixed lesions (95% CI, 1.4 to 33.3). As percent vertebral body involvement increased, odds of fracture also increased. Patients with fracture progression had significantly higher narcotic use, change in Karnofsky performance score, and a strong trend toward higher pain scores. Local tumor progression occurred in seven patients and contributed to one fracture. Obesity, posterior element involvement, bisphosphonate use, and local kyphosis did not confer increased risk. Conclusion Vertebral fracture is common after single fraction IG-IMRT for metastatic spine lesions. Lytic disease involving more than 40% of the vertebral body and location at or below T10 confer a high risk of fracture, the presence of which yields significantly poorer clinical outcomes. These results may help clinicians identify high-risk patients who would benefit from prophylactic vertebro- or kyphoplasty.

Epidemiological and Clinical Studies in Cats with Thoracolumbar Vertebral Fracture and Luxation and Its Management

2020 ◽  
Author(s):  
I. Nath ◽  
S. Dhanalakshmi ◽  
M. R. Das ◽  
S. K. Panda ◽  
A. K. Kundu ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Vertebral Fracture ◽  
Conservative Treatment ◽  
Clinical Outcome ◽  
Epidemiological Data ◽  
Neurological Dysfunction ◽  
Grade 3 ◽  
Time Of Presentation ◽  
Thoracolumbar Vertebral Fracture

Background: Thoraco-lumbar spinal trauma frequently results in neurological dysfunction of varying degrees in domestic cats. The consequences may be permanent disability or death depending on severity and segment of spinal cord affected. Assessment of primary damage to spinal cord is important to prevent secondary damage and complications arising from neurological deficit. Since assessment of neurological dysfunction and its treatment in spinal trauma in cats is an evolving field, the present study was undertaken with an objective to record and associate epidemiological data and clinical examination findings at the time of presentation with clinical outcome on 60th post-treatment day in cats with thoracolumbar vertebral fracture and luxation, for a better clinical approach in this condition. Methods: 24 affected cats were assessed epidemiologically and clinically at the time of presentation. All the cats were treated either conservatively or surgically based on extent of neurological dysfunction and severity of injury on radiographic evaluation. Post-treatment observations was then correlated with epidemiological data and clinical findings to assess the clinical outcome. Result: In the present study, sub-adult semi-domicile cats were most affected and major cause was automobile accident. Presence of concomitant injuries (30%) affected recovery. Thoracolumbar spinal cord segment (T3-L3) was most affected (71%). Among 16 cats with unstable vertebral fractures, 5/6 cats recovered after surgical treatment and 2/10 cats recovered after conservative treatment. Survival and recovery was poor when degree vertebral canal displacement was more than 70% (10 cats). All 7 cats with grade 1 or grade 2 and one cat with grade 3 neurological dysfunction recovered after conservative treatment. 5 cats with grade 3 and 2 cats with grade 4 neurological dysfunction recovered after surgical treatment. Selection of surgical treatment provided better recovery in cats with unstable vertebral fractures and greater degree of neurological dysfunction.

Anterior construct location following vertebral body metastasis reconstruction through a posterolateral transpedicular approach: does it matter?

2011 ◽  
Vol 14 (6) ◽  
pp. 734-741 ◽  
Author(s):  
Ahmed Shawky Eid ◽  
Ung-Kyu Chang
Keyword(s):  
Vertebral Body ◽  
Spinal Injury ◽  
Visual Analog Scale Score ◽  
Posterior Fixation ◽  
Kyphotic Angle ◽  
Transpedicular Approach ◽  
Angle Change ◽  
Significant Difference ◽  
Pain Visual Analog Scale ◽  
Screw Density

Object The posterolateral transpedicular approach (PTA) is a widely used method for the surgical treatment of vertebral body metastases. It is crucial to understand the optimal location of the anterior graft in terms of sound and durable reconstruction following PTA. The purpose of this study was to investigate whether postoperative construct stability is related to the location of anterior grafts. Methods The authors conducted a retrospective review of 45 cases of metastatic spine disease with epidural tumor extension in which patients underwent circumferential decompression and fusion by means of PTA. Mechanical (anterior construct stability), pain (visual analog scale score), and neurological (American Spinal Injury Association scale) outcomes were evaluated and correlated with the anterior graft location (lateral or central) and surgical approach (unilateral or bilateral), number of decompressed levels, types of anterior graft, screw density of posterior fixation (number of screws used divided by the number of pedicles spanned), and kyphotic angle change from the immediate postoperative period to the most recent follow-up. Results Seven of 45 constructs were judged unstable—5 with a lateral location of the anterior graft and 2 with a central location. The anterior graft was located laterally in 31 cases (69%), centrally in 11 (24%), and bilaterally in 3 (7%). A unilateral approach was used in 33 cases and a bilateral approach in 12. Neither the location of the anterior graft nor the approach had a significant effect on the stability of the reconstructed spine (p > 0.05). There was a significant difference in construct stability between the single-level decompression group (33 patients) and the multiple-level decompression group (12 patients) (p = 0.0001). The types of anterior graft, screw density, and kyphotic angle change were not correlated to the mechanical outcome. Conclusions The anterior graft location showed no significant relationship to the final mechanical, pain, and neurological outcomes.

scholarly journals Percutaneous vertebroplasty: a comparison between the procedure using the traditional and the new side-opening cannula for osteoporotic vertebral fracture

2009 ◽  
Vol 67 (2b) ◽  
pp. 377-381 ◽  
Author(s):  
Nicandro Figueiredo ◽  
Filipe Barra ◽  
Laryssa Moraes ◽  
Roger Rotta ◽  
Luiz Augusto Casulari
Keyword(s):  
Vertebral Fracture ◽  
Vertebral Body ◽  
Vertebral Fractures ◽  
Pain Control ◽  
Percutaneous Vertebroplasty ◽  
Cement Leakage ◽  
Osteoporotic Vertebral Fracture ◽  
Cement Injection ◽  
Osteoporotic Vertebral Fractures ◽  
Good Improvement

A total of 47 percutaneous vertebroplasties (PVs) were performed for osteoporotic vertebral fractures in 31 patients, 25 PVs were performed using the frontal-opening cannula (FOC) and 22 using the new side-opening cannula (SOC), randomly distributed. The incidence of cement extrusion was 27% with the SOC, and 68% with the FOC, all asymptomatic (p<0.01). The pain control was similar for both groups, with good improvement of pain in most of the patients, and there were no clinical relevant complications. The cement leakage can be significantly reduced with this new SOC, which allows for a better cement injection toward the center of the vertebral body, increasing the safety of the procedure, with no increase in cost.

scholarly journals Treatment of C2 Vertebral Body and Dens Tumors with Intraoperative Transoral or Transpedicular Vertebroplasty and Occipitocervical Posterior Fixation

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554587-s-0035-1554587
Author(s):  
Zoltan Papp ◽  
Miklos Marosfoi ◽  
Istvan Szikora ◽  
Peter Banczerowski
Keyword(s):  
Vertebral Body ◽  
Posterior Fixation

scholarly journals Response to: Long versus Short Segment Instrumentation in Osteoporotic Thoracolumbar Vertebral Fracture

2021 ◽  
Vol 15 (6) ◽  
pp. 882-883
Author(s):  
Massimo Girardo ◽  
Alessandro Massè ◽  
Salvatore Risitano ◽  
Federico Fusini
Keyword(s):  
Vertebral Fracture ◽  
Short Segment ◽  
Thoracolumbar Vertebral Fracture

scholarly journals Image Classification of Osteoporotic Vertebral Fracture with Endplate-disc Complex Injury

2021 ◽  
Author(s):  
Shuai Zhang ◽  
Song Wang ◽  
Qing Wang ◽  
Jin Yang ◽  
Shuang Xu
Keyword(s):  
Vertebral Fracture ◽  
Vertebral Body ◽  
Vertebral Fractures ◽  
Mineral Density ◽  
Severe Osteoporosis ◽  
Complex Injury ◽  
Lumbar Vertebral Body ◽  
Signal Changes ◽  
Grade 3

Abstract Background The purpose of this study was to observe the condition of osteoporosis vertebral fracture(OVF) combined with endplate-disc complex (EDC) injury through MRI and CT, and to classify the degree of EDC injury according to the changes in the signal and morphology of the EDC on the image.Methods A total of 479 cases of OVF were included in this study. Baseline data were recorded. We investigate the incidence of EDC injury, observed the morphology and signal changes of EDC injury through MRI and CT, and divided it into grades 0-4 according to the severity of injury.We compared whether there were differences in the degree of EDC injury among different vertebral fractures, bone mineral density(BMD), and severity of vertebral fractures. Results Among 479 patients, 321 cases had EDC injury adjacent to fractured vertebral body. Among them, 158 cases were grade 0, 66 cases were grade 1, 72 cases were grade 2, 78 cases were grade 3, and 92 cases were grade 4. The degree of EDC injury combined with thoracolumbar vertebral fractures was more serious than that of thoracic and lumbar vertebral body fractures.Vertebral fractures with severe osteoporosis were combined with more severe EDC injury. The more severe the vertebral fracture, the more severe the combined EDC injury.Conclusion This study found that the incidence rate of EDC injury reached 67.0%. To patients with OVF, severe osteoporosis, and severe fractures in the thoracolumbar segments often have more severe EDC injury.

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