scholarly journals Differentiation of Traumatic Osteoporotic and Non-Osteoporotic Vertebral AO A3 Fractures by Analyzing the Posterior Edge Morphology—A Retrospective Feasibility Study

2020 ◽  
Vol 9 (12) ◽  
pp. 3910
Author(s):  
Thomas Vordemvenne ◽  
Dirk Wähnert ◽  
Sebastian Klingebiel ◽  
Jens Lohmaier ◽  
René Hartensuer ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Vertebral Fractures ◽  
Osteoporotic Fractures ◽  
Hounsfield Units ◽  
Posterior Edge ◽  
Simple Method ◽  
Dorsal Edge ◽  
Osteoporotic Vertebral Fractures ◽  
Edge Fragment ◽  
Edge Morphology

Background: Differentiation between traumatic osteoporotic and non-osteoporotic vertebral fractures is crucial for optimal therapy planning. We postulated that the morphology of the posterior edge of the cranial fragment of A3 vertebral fractures is different in these entities. Therefore, the purpose of this study is to develop and validate a simple method to differentiate between osteoporotic and non-osteoporotic A3 vertebral fractures by morphological analysis. Methods: A total of 86 computer tomography scans of AO Type A3 (cranial burst) vertebral body fractures (52 non-osteoporotic, 34 osteoporotic) were included in this retrospective study. Posterior edge morphology was analyzed using the sagittal paramedian slice with the most prominent shaped bulging. Later, the degree of bulging of the posterior edge fragment was quantified using a geometric approach. Additionally, the Hounsfield units of the broken vertebral body, the vertebra above, and the vertebra below the fracture were measured. Results: We found significant differences in the extent of bulging comparing osteoporotic and non-osteoporotic fractures in our cohort. Using the presented method, sensitivity was 100%, specificity was 96%. The positive predictive value (PPV) was 94%. In contrast, by evaluating the Hounsfield units, sensitivity was 94%, specificity 94% and the PPV was 91%. Conclusions: Our method of analysis of the bulging of the dorsal edge fragment in traumatic cranial burst fractures cases allows, in our cases, a simple and valid differentiation between osteoporotic and non-osteoporotic fractures. Further validation in a larger sample, including dual-energy X-ray absorptiometry (DXA) measurements, is necessary.

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 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 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.

MRI PATTERN OF VERTEBRAL FRACTURES DUE TO OSTEOPOROSIS, INFECTION, AND MALIGNANT TUMORS

2010 ◽  
Vol 13 (02) ◽  
pp. 57-63
Author(s):  
Mohamed El-Sayed Abdel-Wanis ◽  
Mohamed Tharwat Mahmoud Solyman ◽  
Nahla Mohamed Ali Hasan
Keyword(s):  
Vertebral Body ◽  
Vertebral Fractures ◽  
Malignant Tumors ◽  
Compression Fracture ◽  
Osteoporotic Fractures ◽  
Spinal Infection ◽  
Vertebral Compression Fractures ◽  
Vertebral Collapse ◽  
Compression Fractures ◽  
Vertebral Wedging

No previous studies discussed the significance of the MRI pattern of vertebral collapse in differentiation between vertebral compression fractures due to malignancy, osteoporosis, and infections. MRI was used in the evaluation of 152 atraumatic vertebral compression fractures in 80 patients: 85 malignant, 34 osteoporotic, and 33 infective. Central collapse of the fractured vertebral body was the commonest pattern in malignant fractures (57 vertebrae, 67%), followed by uniform collapse (21 vertebrae, 24.7%), then anterior wedging (5 vertebrae, 5.9%), and finally posterior wedging (2 vertebrae, 2.4%). In osteoporotic fractures, anterior wedging was the commonest pattern (18 vertebrae, 53%), followed by central collapse (11 vertebrae, 32.3%), then uniform collapse (4 vertebrae, 11.8%), and finally posterior wedging (1 vertebra, 2.9%). In vertebral compression fractures due to spinal infection, anterior wedging was the commonest pattern (20 vertebrae, 60.6%), followed by uniform collapse (12 vertebrae, 36.4%), while only one vertebra (3%) was centrally collapsed. Central collapse of the vertebral body is highly suggestive of malignant compression fracture while anterior vertebral wedging is highly suggestive of a benign compression fracture.

Percutaneous Transpedicular Vertebroplasty versus Conservative Management in Osteoporotic Vertebral Fractures

2016 ◽  
Vol 695 ◽  
pp. 205-211
Author(s):  
Iulian Popa ◽  
Petre Matusz ◽  
Diana Andrei ◽  
Mihai Mardare ◽  
Dan V. Poenaru
Keyword(s):  
Conservative Management ◽  
Vertebral Fractures ◽  
Percutaneous Vertebroplasty ◽  
Osteoporotic Fractures ◽  
Control Group ◽  
First Year ◽  
Lung Capacity ◽  
Osteoporotic Vertebral Fractures ◽  
Group 2 ◽  
Group 1

Osteoporotic vertebral fractures can lead to late collapse which often cause kyphotic spinal deformity, persistent back pain, decreased lung capacity, increased fracture risk and increased mortality. The purpose of our study is to compare the efficacy and safety of vertebroplasty against conservative management of osteoporotic vertebral fractures without neurologic symptoms. A total of 66 patients with recent OVF on MRI examination were included in the study. All patients were admitted from September 2009 to September 2012. The cohort was divided in two groups: first study group consisted of 33 prospectively followed consecutive patients who suffered 40 vertebral osteoporotic fractures treated by percutaneous vertebroplasty (Group 1), and the control group consisted of 33 patients who suffered 41 vertebral osteoporotic fractures treated conservatory because they reffused vertebroplasty (Group 2). Vertebroplasty with PMMA was performed in 30 patients on 39 VBs, including four thoracic vertebras, 27 vertebras of the thoracolumbar jonction and 8 lumbar vertebras. In the Group 2 were included 30 patients with 39 OVFs (four thoracic vertebras, 23 vertebras of the thoracolumbar junction and 11 lumbar vertebras). In our study on OVF, vertebroplasty delivered superior clinical and radiological outcomes over the first year from intervention when compared to consevative treatment of patients with osteoporotic compression fractures without neurological deficit.

scholarly journals Opportunistic diagnosis of osteoporotic vertebral fractures on standard imaging performed for alternative indications

BJR|Open ◽  
2021 ◽  
Author(s):  
Shane W. Davy ◽  
Diane Bergin
Keyword(s):  
Vertebral Fractures ◽  
Imaging Modality ◽  
Osteoporotic Fractures ◽  
Clinical Suspicion ◽  
Clinical Indication ◽  
X Rays ◽  
X Ray ◽  
Osteoporotic Vertebral Fractures ◽  
Increased Risk ◽  
Bone Scans

Osteoporotic vertebral fractures (VF) are the most common type of osteoporotic fracture. Patients with VF are at increased risk of hip fractures or additional VFs, both of which contribute to patient morbidity and mortality. Early diagnosis of VFs is essential so patients can be prescribed appropriate medical therapy. Most patients with clinical suspicion for VF have an X-ray of the spine. Many VFs are invisible on X-ray and require further imaging. CT can provide excellent bony detail but uses high doses of ionising radiation. MRI provides excellent soft tissue detail and can distinguish old from new fractures in addition to differentiating osteoporotic VFs from other causes of back pain. Bone scans have a limited role due to poor specificity. The literature suggests that radiologists frequently miss or do not report VFs when imaging is requested for an alternative clinical indication and when there is no clinical suspicion of VF. Common examples include failure to identify VFs on lateral chest x-rays, sagittal reformats of CT thorax and abdomen, lateral localizers on MRI and scout views on CT. Failure to diagnose a VF is a missed opportunity to improve management of osteoporosis and reduce risk of further fractures. This article discusses the role of radiographs, CT, MRI and Bone Scintigraphy in the assessment and recognition of osteoporotic fractures. This article focuses on opportunistic diagnosis of vertebral fractures on imaging studies that are performed for other clinical indications. It does not discuss use of DXA which is a specific imaging modality for osteoporosis.

scholarly journals OUTCOMES OF VERTEBROPLASTY FOR TREATMENT OF PATHOLOGIC VERTEBRAL FRACTURES AND HAEMANGIOMAS

2006 ◽  
pp. 038-042
Author(s):  
Igors Aksiks ◽  
Viktors Vestermanis ◽  
Edmunds Karklinsh ◽  
Karlis Kupchs
Keyword(s):  
Bone Morphogenetic Proteins ◽  
Vertebral Fractures ◽  
Percutaneous Vertebroplasty ◽  
Osteoporotic Fractures ◽  
Pain Syndrome ◽  
Cement Leakage ◽  
Osteoporotic Vertebral Fractures ◽  
Before And After ◽  
Satisfaction With Treatment

Objective. To compare the intensity of pain-relieving effect of percutaneous vertebroplasty (PV) in patients with gemangiomas, osteoporotic vertebral fractures, and malignant metastases. Matherial and Methods. 210 percutaneous vertebroplasties (VP) were performed in 121 patients at the age of 18 to 87 years. Out of them 22 patients had metastases into vertebral body/bodies, 72 patients – osteoporotic fractures, and 27 patients – vertebral haemangiomas with high-grade pain syndrome. The levels of vertebroplasty were between T3 and S1, predominantly (178 cases) from T9 to L4 levels. Significant anatomic abnormalities in seven cases required CT-guidance of the percutaneous vertebroplasty. Pain syndrome intensity before and after PV was assessed by visualanalogue scale. Results. Percutaneous vertebroplasty resulted in significant pain relief in all patients. One hundred-and-one patients reported full satisfaction with treatment, 17 patients – partial satisfaction, and 3 patients were not satisfied. Vertebroplasty complicated by cement leakage into the spinal canal in two patients with multiple myeloma. One patient with osteoporotic fractures has developed L5 radiculopathy after four-level PV, which was eliminated in 5 days. Three patients had transient complications. Conclusion. The achieved results confirm a high painrelieving efficacy of percutaneous vertebroplasty. A choice of vertebroplasy technique depends on a nature of pathology and peculiarities of vertebral anatomy. Application of cement based on calcium phosphate, bioceramic and bone morphogenetic proteins improves the long-term outcomes of percutaneous vertebroplasty.

scholarly journals UNILATERAL PERCUTANEOUS VERTEBROPLASTY FOR SYMPTOMATIC OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES -EVALUATION OF RADIOLOGICAL AND CLINICAL OUTCOMES

2021 ◽  
pp. 1-2
Author(s):  
Sandeep Kumar ◽  
Kumari Rashmi ◽  
Kumar Anshuman ◽  
Debarshi Jana
Keyword(s):  
Vertebral Fractures ◽  
Local Anaesthesia ◽  
Percutaneous Vertebroplasty ◽  
Compression Fracture ◽  
Osteoporotic Fractures ◽  
Early Mobilization ◽  
Vertebral Compression Fractures ◽  
Vas Score ◽  
Osteoporotic Vertebral Fractures

Background: Vertebral fractures are the most common type of osteoporotic fractures. These are developing into a significant health problem worldwide as about 30% of the patients above 50 years suffer from a fracture secondary to osteoporosis. Osteoporotic vertebral fractures may be treated with rest and analgesics. Some fractures may also require surgery. Percutaneous procedure like vertebroplasty and kyphoplasty done under local anaesthesia can reduce the pain and restore height of vertebral body without need for an open surgery. The aim of the study was to assess the clinical and radiological outcomes following unilateral percutaneous vertebroplasty under local anaesthesia. Methods: 21 patients who underwent unilateral vertebroplasty for symptomatic osteoporotic compression fracture between August 2019 and July 2020 were included in the study. Unilateral vertebroplasty using an 11-gauge trocar through transpedicular technique was performed under c-arm guidance. Patient was mobilized as soon as tolerated. Oswestry disability index and visual analogue scale were assessed pre-operatively, in the immediate post-op and at 1-year follow up. Results: There were 15 females and 6 males. The mean age was 70.04±6.07 years. The pre-op ODI score was 76.8±7.6. The pre-op VAS score was 7.66±0.71. The average time period from fracture to vertebroplasty is 4.19±3.19 days. The immediate post-operative VAS score was 5.76±0.8 and the ODI score was 62.85±7.17. The VAS at final follow up was 1.23±1.19. ODI at final follow up was 9.04±3.19. There was a showed a significant improvement when preoperative, immediate post-operative ODI and VAS scores and final follow up (p<0.001). Conclusions: In our study unilateral percutaneous vertebroplasty has provided pain relief, early mobilization of the patient with less complication without the requirement of general anaesthesia.

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