scholarly journals Percutaneous Vertebroplasty for Osteoporotic Fractures

2007 ◽  
Vol 4;10 (7;4) ◽  
pp. 559-663
Author(s):  
Suhail Afzal
Keyword(s):  
Back Pain ◽  
Pain Relief ◽  
Vertebral Body ◽  
Percutaneous Vertebroplasty ◽  
Compression Fracture ◽  
Osteoporotic Fractures ◽  
Percutaneous Injection ◽  
Compression Fractures ◽  
Vas Score

Background: Vertebral augmentation has been widely used to treat vertebral body compression fractures caused by varied pathologies. The lifetime risk of a vertebral body compression fracture is 16% for women and 5% for men, and exponential increase of osteoporotic fractures worldwide. Purpose: To determine the efficacy and durability of percutaneous vertebroplasty for the treatment of back pain associated with osteoporotic vertebral fractures. Design: A prospective study. Materials and Methods: A prospective evaluation of pain relief in 30 patients, with mean age of 73.7 years, who underwent percutaneous injection of polymethyl methacrylate into 54 vertebrae under fluoroscopic guidance over a period of 35 months was done. Before the procedure and at follow up, patients were asked to quantify their pain on a visual analogue scale. Results: The procedure was technically successful in all the patients. Mean duration of follow up was 21.5 months (6-44months). Ninety-seven percent of the patients reported a significant relief 24 hours after the procedure. Ninety-two percent reported significant improvement in back pain, previously associated with a compression fracture, as well as improved ambulatory ability. Before vertebroplasty, the VAS score was 8.91+/- 1.82 compared to a score of 2.02+/- 1.95 at follow up. The mean difference in VAS score was significant (p<.0001). One patient had an asymptomatic epidural leak of PMMA, however did not require any further intervention. Conclusion: Percutaneous vertebroplasty of symptomatic osteoporotic vertebral compression fractures is a minimally invasive procedure that provides immediate and sustained pain relief in patients with refractory pain. Key words: Compression fracture, osteoporosis; pain, vertebroplasty, polymethylmethacrylate

scholarly journals Percutaneous vertebroplasty in vertebral osteonecrosis (Kümmell's spondylitis)

1999 ◽  
Vol 7 (1) ◽  
pp. E4 ◽  
Author(s):  
Huy M. Do ◽  
Mary E. Jensen ◽  
William F. Marx ◽  
David F. Kallmes
Keyword(s):  
Back Pain ◽  
Mr Imaging ◽  
Vertebral Body ◽  
Chronic Back Pain ◽  
Percutaneous Vertebroplasty ◽  
Fluid Collection ◽  
Compression Fracture ◽  
Response To Therapy ◽  
Vertebral Osteonecrosis

The authors report the clinical symptoms and response to therapy of a series of patients who presented with subacute or chronic back pain due to vertebral osteonecrosis (Kümmell's spondylitis) and who underwent percutaneous vertebroplasty. The authors performed a retrospective chart review of a series of 95 patients in whom 149 painful, nonneoplastic compression fractures were demonstrated and who were treated with percutaneous transpediculate polymethylmethacrylate (PMMA) vertebroplasty. In six of these patients there was evidence of vertebral osteonecrosis, as evidenced by the presence of an intravertebral vacuum cleft on radiography or by intravertebral fluid on magnetic resonance (MR) imaging. Clinical and radiological findings on presentation were noted. Technical aspects of the vertebroplasty technique were compiled. Response to therapy, defined as qualitative change in pain severity and change in level of activity, was noted immediately following the procedure and at various periods on follow-up reviews. One man and five women, who ranged in age from 72 to 90 years (mean 81 years), were treated. Each patient had one compression fracture. The fractures were at T-11 (one patient), L-1 (two patients), L-3 (two patients), and L-4 (one patient). The pain pattern was described as severe and localized to the affected vertebra, and sometimes radiated along either flank. Pain duration ranged from 2 to 12 weeks, and the pain was refractory to conservative therapy that consisted of bedrest, analgesics, and external bracing. At the time of treatment, all patients were bedridden because of severe back pain. In all patients either plain radiographic or computerized tomography evidence of intravertebral vacuum cleft or MR imaging evidence of vertebral fluid collection consistent with avascular necrosis of the vertebral body was demonstrated. Four patients underwent bilateral transpediculate vertebroplasty, and two patients underwent unilateral transpediculate vertebroplasty. The fracture cavities were specifically targeted for PMMA injection. Additional fortification of the osteoporotic vertebral body trabeculae was also performed when feasible. "Cavitygrams" or intraosseous venograms with gentle contrast injection were obtained prior to application of cement mixture. In all patients subjective improvement in pain and increased mobility were demonstrated posttreatment. The follow-up period ranged from 4 to 24 hours after treatment. Two patients made additional office visits at 1 and 3 months, respectively. Patients presenting with vertebral osteonecrosis (Kümmell's spondylitis) often suffer from local paraspinous or referred pain. When performing vertebroplasty on these patients, confirmation of entry into the fracture cavities with contrast-enhanced "cavitygrams" should be performed prior to injection of PMMA cement. The response to vertebroplasty with regard to amelioration of pain and improved mobility is encouraging.

scholarly journals Percutaneous Vertebroplasty versus Conservative Treatment for One Level Thoracolumbar Osteoporotic Compression Fracture: Results of an Over 2-Year Follow-up

2016 ◽  
Vol 5;19 (5;19) ◽  
pp. E743-E750
Author(s):  
Je Hoon Jeong
Keyword(s):  
Lumbar Spine ◽  
Conservative Treatment ◽  
Percutaneous Vertebroplasty ◽  
Compression Fracture ◽  
Compression Fractures ◽  
Vas Score ◽  
Group 2 ◽  
Osteoporotic Compression Fractures ◽  
Group 1

We retrospectively compared the clinical and radiological results of percutaneous vertebroplasty with those of conservative treatment in the management of thoracolumbar osteoporotic compression fractures. Sixty-five patients who could be followed up for more than 2 years with thoracic and lumbar spine osteoporotic compression fractures, between January 2005 and October 2010, were reviewed. The patients were divided into 2 groups according to the type of management: group 1, non-operated group treated conservatively; group 2, operated group that underwent percutaneous vertebroplasty. We assessed the clinical and radiological changes at postoperative and follow-up periods in both groups. The male-to-female ratio and mean age of the patients were 11:54 and 73.04 years (range, 50 – 90 years), respectively. The location and number of treated vertebrae were as follows: T4 = 1, T6 = 1, T7 = 3, T8 = 1, T9 = 2, T10 = 1, T11 = 8, T12 = 11, L1 = 17, L2 = 10, L3 = 6, L4 = 3, and L5 = 1. The mean T-score was -3.37. The overall VAS score and the VAS score until 6 months post-injury were statistically more improved in group 2 than in group 1 (P < 0.05 and P < 0.005, respectively). Overall, the compression ratio was statistically more improved in group 2 than in group 1 (P < 0.05). Early pain control and restoration of the compressed vertebral body are the beneficial and real effects of percutaneous vertebroplasty in patients with thoracolumbar osteoporotic compression fractures. Key words: Osteoporosis, compression fracture, vertebroplasty, osteoplasty, comparative study, thoracic spine, lumbar spine, polymethylmethacrylate (PMMA)

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.

scholarly journals Unilateral percutaneous vertebroplasty for symptomatic osteoporotic vertebral compression fractures -evaluation of radiological and clinical outcomes

2018 ◽  
Vol 5 (1) ◽  
pp. 19
Author(s):  
Shanmuga Sundaram Pooswamy ◽  
Niranjanan Raghavn Muralidharagopalan
Keyword(s):  
Vertebral Fractures ◽  
Local Anaesthesia ◽  
Percutaneous Vertebroplasty ◽  
Compression Fracture ◽  
Osteoporotic Fractures ◽  
Early Mobilization ◽  
Vertebral Compression Fractures ◽  
Vas Score ◽  
Osteoporotic Vertebral Fractures

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 21 patients who underwent unilateral vertebroplasty for symptomatic osteoporotic compression fracture between 2012 and 2015 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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&lt;0.001).</p><p class="abstract"><strong>Conclusions:</strong> In our study unilateral percutaneous vertebroplasty has provided pain relief, early mobilization of the patient with less complication without the requirement of general anaesthesia.</p>

Efficacy of percutaneous vertebroplasty combined with radiotherapy in osteolytic metastatic spinal tumors

2005 ◽  
Vol 2 (3) ◽  
pp. 243-248 ◽  
Author(s):  
Jee-Soo Jang ◽  
Sang-Ho Lee
Keyword(s):  
Pain Relief ◽  
Percutaneous Vertebroplasty ◽  
Invasive Procedure ◽  
Spinal Tumors ◽  
Percutaneous Injection ◽  
Content Type ◽  
Spinal Stabilization ◽  
Before And After ◽  
Fine Print

Object. Vertebroplasty involves the percutaneous injection of polymethylmethacrylate into collapsed vertebral bodies due to hemangioma, osteoporosis, or malignant tumor. The purpose of this study was to evaluate the merits and efficacy of percutaneous vertebroplasty (PVP) combined with radiotherapy in treating patients with osteolytic metastatic spinal tumors (OMSTs). Methods. Twenty-eight patients with OMSTs underwent PVP for the treatment of 72 vertebrae after administration of a local anesthetic or induction of general anesthesia for pain relief and spinal stabilization. Radiotherapy for suppressing tumor or inducing pain relief was performed immediately after PVP in 22 patients. Pain levels were assessed before and after the procedure by using a visual analog scale (VAS), and follow-up assessment was conducted at 1, 3, 6, and 9 months. On postoperative Day 3, marked-to-complete VAS score—based pain relief was achieved in 13 patients (48%) and moderate relief was demonstrated in 11 (41%). The mean VAS pain score was reduced from 8.2 to 3, and major complications were absent in all cases. Follow-up plain radiography was performed to assess vertebral column stability. Neither additional vertebral collapse in the treated vertebrae nor neurological deterioration was observed. Conclusions. Percutaneous vertebroplasty is a minimally invasive procedure and, when combined with radiotherapy, seems to be effective in providing pain relief and stabilization in patients with OMSTs.

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.

Diastematomyelia in Adults

2009 ◽  
Vol 22 (4) ◽  
pp. 448-451 ◽  
Author(s):  
G. Callari ◽  
A. Arrigo
Keyword(s):  
Pain Relief ◽  
Medical Treatment ◽  
Vertebral Body ◽  
Pain Control ◽  
Percutaneous Vertebroplasty ◽  
Compression Fracture ◽  
Control Case ◽  
Vertebral Body Compression Fracture

We describe two cases of incidentally discovered split cord malformations in adults undergoing MR for symptoms unrelated to that malformation. Case 1 is an 80-year-old woman with pain due to a D7 and D8 vertebral body compression fracture resistant to medical treatment where we performed D7 and D8 percutaneous vertebroplasty with no complications and satisfactory pain control. Case 2 is a 59-year-old woman with L5 radiculopathy due to L5-S1 spondilolysthesis who had a satisfactory pain relief under medical treatment. The implementation and worldwide diffusion of MR revealed that diastematomyelia, split cord malformations traditionally seen in children, may be less rare than we thought in adults and can remain asymptomatic.

scholarly journals Risk Factors for the Occurrence of Insufficient Cement Distribution in the Fractured Area after Percutaneous Vertebroplasty in Osteoporotic Vertebral Compression Fractures

2018 ◽  
Vol 1 (21;1) ◽  
pp. E33-E42
Author(s):  
Xiaobing Jiang
Keyword(s):  
Risk Factors ◽  
Pain Relief ◽  
Percutaneous Vertebroplasty ◽  
Compression Fracture ◽  
Bone Mass Density ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Compression Fractures ◽  
Cement Distribution ◽  
Superior Portion

Background: Insufficient cement distribution (ICD) in the fractured area has been advocated to be responsible for unsatisfied pain relief after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs). However, little is known about risk factors for the occurrence of ICD. Objective: The present study aimed to identify independent risk factors of the emergence of ICD. Study Design: A retrospective cohort study. Setting: Department of spinal surgery, an affiliated hospital of a medical university. Methods: Patients who underwent PVP for single-level OVCF from January 2012 to September 2014 and met this study’s inclusion criteria were retrospectively reviewed. Associations of ICD with co-variates (age, gender, bone mass density with a T-score, amount of injected cement, cement leakage, fracture level, fracture age, fracture severity grade, and location of the fractured area) and the influence of ICD on pain relief were analyzed. Results: A total of 225 patients were included. ICD was found in 26 (11.6%) patients. Fractured area located in the superior portion of the index vertebra was significantly associated with occurrence of ICD. No further significant associations between the studied co-variates and emergence of ICD were seen in the adjusted analysis. In addition, patients with ICD had significantly higher immediate postoperative visual analog scale scores of back pain compared with those with sufficient cement distribution in the fractured area. Limitation: Location of the fractured area and cement distribution in the fractured area could not be evaluated quantitatively. Conclusions: The incidence of ICD is higher in patients with the fractured area located in the superior portion of the index vertebra and ICD might be responsible for unsatisfied pain relief after PVP for OVCFs. Key words: Percutaneous vertebroplasty, insufficient cement distribution, fractured area, risk factor, osteoporosis, vertebral compression fracture, spine, unsatisfied pain relief, cement augmentation

scholarly journals Percutaneous vertebroplasty

2003 ◽  
Vol 7 (3) ◽  
pp. 5-8
Author(s):  
Ivann F. Van der Merwe
Keyword(s):  
Polymethyl Methacrylate ◽  
Vertebral Body ◽  
Selection Criteria ◽  
Multidisciplinary Approach ◽  
Percutaneous Vertebroplasty ◽  
Osteoporotic Fractures ◽  
Percutaneous Injection ◽  
Strict Adherence ◽  
Successful Method ◽  
Metastatic Lesions

Percutaneous vertebroplasty is a safe and successful method for the treatment of vertebral lesions due to osteoporotic fractures, metastatic lesions or haemangiomas. The procedure involves the percutaneous injection of polymethyl methacrylate (PMMA) into a pathological vertebral body. The technique is described in detail together with potential complications. Strict adherence to selection criteria, a multidisciplinary approach and the need for excellent imaging equipment are stressed.

Percutaneous vertebroplasty for compression fracture: analysis of vertebral body volume by CT volumetry

2005 ◽  
Vol 46 (3) ◽  
pp. 276-279 ◽  
Author(s):  
A. Komemushi ◽  
N. Tanigawa ◽  
S. Kariya ◽  
H. Kojima ◽  
Y. Shomura ◽  
...  
Keyword(s):  
Bone Cement ◽  
Vertebral Body ◽  
Percutaneous Vertebroplasty ◽  
Compression Fracture ◽  
Body Volume ◽  
Ct Volumetry ◽  
Percutaneous Injection ◽  
Positive Correlation ◽  
Before And After ◽  
Effect Of Treatment

Purpose: To evaluate the relationships between volume of vertebral bodies with compression fracture (measured by CT volumetry) before percutaneous vertebroplasty, the amount of bone cement injected, and the effect of treatment. Material and Methods: We examined 49 consecutive patients, with 104 vertebral body compression fractures, who underwent percutaneous injection of bone cement. Vertebral body volume was measured by CT volumetry. The patient's pain level was assessed using a visual analog scale (VAS) before and after the procedure. Improvement in VAS was defined as the decrease in VAS after the procedure. Relationships between vertebral body volume, the amount of bone cement, and the effect of treatment were evaluated using Pearson's correlation coefficient test. Results: Average vertebral body volume was 26.3±8.1 cm3; average amount of bone cement was 3.2±1.1 ml; and average improvement in VAS was 4.9±2.7. The vertebral body volume was greater if a larger amount of bone cement was injected. There was a significant positive correlation between vertebral body volume and amount of bone cement ( r = 0.44; P<0.0001). However, there was no correlation between vertebral body volume and improvement in VAS, or between amount of bone cement and improvement in VAS. Conclusion: In percutaneous vertebroplasty for vertebral body compression fracture, there is a positive correlation between vertebral body volume and amount of bone cement, but improvement in VAS does not correlate with vertebral body volume or amount of bone cement.

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