Percutaneous Vertebroplasty: Efficacy of Unipedicular Vertebroplasty as Compared to Bipedicular Vertebroplasty

Introduction Percutaneous vertebroplasty has been used for treatment of intractable painful fractures of vertebral bodies. With the help of refined procedures and standard techniques, the interventional radiologist can now offer help to orthopedics and neurosurgeons in these cases, which include treatment of vertebral compression fracture. Vertebroplasty is aimed at reducing the pain induced by collapse. Vertebroplasty is the standard mode of treatment for vertebral collapse, and in our study, bipedicular vertebroplasty was compared with unipedicular approach as bipedicular vertebroplasty is the routinely used approach. Aim To compare efficacy of unipedicular percutaneous vertebroplasty with that of bipedicular percutaneous vertebroplasty. Material and Methods A total of 52 vertebroplasties were done over a period of 2 years. Out of 52 patients, 28 patients underwent unipedicular vertebroplasty and 24 patients underwent bipedicular vertebroplasty. Visual analogue scale (VAS) scores were used to assess the pain prior to vertebroplasty and after vertebroplasty. Efficacy of the two procedures were assessed by comparing VAS scores. Results There was no statistically significant difference observed in the preprocedure and postprocedure VAS scores (p-value < 0.0001, < 0.0001, respectively). The mean procedure time was lesser in unipedicular vertebroplasty (41.9 ± 3.90) than bipedicular vertebroplasty (54.5 ± 3.4). Conclusion Unipedicular vertebroplasty is as effective as bipedicular vertebroplasty, as there is insignificant difference in postprocedure VAS scores between the unipedicular and bipedicular vertebroplasty.

Monostotic Fibrous Dysplasia in the Femur Strongly Expressing RANKL With Concomitant Osteoporotic Vertebral Compression Fracture: A Case Report

Background/Aim: This study aimed to present a rare case of fibrous dysplasia (FD) in a healthy young adult man with a concomitant osteoporotic vertebral compression fracture. FD is a benign lesion of the bone characterized by replacement of the medullary component with fibro-osseous tissue that contains abnormally arranged trabeculae of immature woven bone. Recently it has been reported that several bone tumors including FD express the receptor activator of nuclear factor-kappa B (RANK) and its ligand (RANKL). Therefore, we hypothesized that FD contributed to osteoporosis, linked by the RANK-RANKL pathway of osteoclastogenesis. Case Report: We report the case of a healthy man with monostotic femoral fibrous dysplasia (FD) with concomitant 7th thoracic vertebra compression fracture due to osteoporosis [young adult mean (YAM) was 79% in bone mineral density (BMD)]. After curettage of the FD, artificial bone grafting in the cavity, and administration of alendronate sodium, BMD improved considerably within 9 months. FD is a benign bone condition in which abnormal fibrous tissue replaces normal bone. The axis of the receptor activator of nuclear factor-kappa B (RANK) and its ligand (RANKL) has been implicated in osteoporosis pathogenesis. RANKL immunohistochemical staining was performed, and strong staining of stromal cells was observed compared to other FD cases that showed weak to moderate staining. Conclusion: The presence of FD might have contributed to the low BMD due to the RANK-RANKL axis acting as osteoclastogenesis stimulator.

Pigmented epithelioid melanocytoma (PEM) of the spine with compression fracture: case report

Background Pigmented epithelioid melanocytoma (PEM) is a sporadic type of pigmented melanocytic tumor with uncertain malignant potential. PEM arises as a solitary neoplasm that predominantly occurs spontaneously in otherwise healthy patients. Due to its rarity, a gold standard treatment regimen does not exist; however, symptomatic cases should be managed with radiotherapy and surgery. Case presentation A 28-year-old Thai female presented with a sudden onset of back pain and weakness of the lower extremities during the postpartum period. Magnetic resonance imaging demonstrated abnormal soft tissue formation from T4 to T7; it extended to the vertebral bodies, left neural foramina, and posterior columns of T6 and T7. The patient underwent complete tumor debulking, decompressive laminectomy from T4 to T8, and posterior instrumentation from T3 to T10. The histopathology and immunohistochemistry suggested PEM. The patient fully resolved back pain after surgery. Nevertheless, as the patient re-presented with a neurological deficit a few months after the operative intervention, it was decided to perform a surgical resection via an en bloc vertebrectomy. At the one-year follow-up, although the patient reported continued improvement of her back pain, there was no motor power improvement. Conclusions Spinal cord compression due to PEM is uncommon, especially in adults. Early diagnosis and treatment provide a good prognosis and help to regain lost neurological functions. Complete tumor removal and decompression of the spinal cord must be considered as a treatment strategy. Perioperative radiotherapy and chemotherapy have also been highlighted as treatment modalities for spinal tumors. With our reported case, early operative intervention coupled with radiotherapy produced satisfying outcomes.

Polymethylmethacrylate-augmented Cannulated Pedicle Screw Fixation for High-energy Vertebral Compression Fracture with Osteoporosis

Background: High-energy vertebral compression fractures (HVCFs) with osteoporosis puts forward higher requirement for the stability of pedicle screw internal fixation system. However, few studies have concentrated on the clinical outcomes of cannulated pedicle screw to augment fixation with polymethylmethacrylate (PMMA) under this condition. This study aims to investigate the mid-term efficacy of bone cement-injectable cannulated pedicle screw (CICPS) in HVCFs with osteoporosis.Methods: Eighteen patients with HVCFs (T < -2.5) were underwent spinal fixation by CICPS from 2012 to 2017. The operation time, blood loss, and hospitalization time were recorded. Pain and functional recovery were evaluated by Visual Analog Scale VAS) and Oswestry Disability Index (ODI), respectively. X-ray films were taken to evaluate the loss of vertebral height, kyphosis angle, pedicle screw loosening, and bony fusion. Surgical related complications were also recorded.Results: The average follow-up time was 18.5 ± 8.7 months (range, 6-54 months). VAS and ODI scores indicated significant improvements in postoperative pain and activity function (P < 0.05). Comparing the last follow-up with the postoperative imaging findings, the loss of vertebral height and kyphosis angle was 3.4 ± 1.2 mm and 7.8 ± 3.8°, respectively. The rate of bone graft fusion was 100% while no case was involved in screw loosening or extraction. 1 case of superficial infection, 2 cases of PMMA leakage, and 1 case of cerebrospinal fluid leakage were found.Conclusions: CICPS fixation using PMMA augmentation may be suggested as a feasible surgical technique in osteoporotic patients with HVCFs.

Rehabilitation Strategies in Management of Complex Case of Cervical Burst Fracture- A Case Report

A burst fracture is a descriptive term for an injury to the spine in which the vertebral body is severely compressed. They typically occur from severe trauma, such as a motor vehicle accident or a fall from a height. With a great deal of force vertically onto the spine, a vertebra may be crushed .If it is only crushed in the front part of the spine, it becomes wedge shaped and is called a compression fracture. However, if the vertebral body is crushed in all directions it is called a burst fracture. Burst fractures cause severe pain. The diagnosis of a burst fracture is usually made by x-rays and a CT scan. Occasionally, an MRI scan may be ordered as well, in order to assess the amount of soft tissue trauma, bleeding or ligament disruption. The review of the CT scan and x-rays allows the treating physician to make a determination as to the level of the fracture, whether it is a compression fracture, burst fracture or fracture dislocation. A spinal compression fracture also may be caused by trauma to the spine. Events that may cause trauma to the spine can include: A car accident, a hard fall or a fall from a height of more than 15 feet, landing on the feet, and a blow to the head. Any fall from a standing height that results in a spinal compression fracture or any other fracture most likely indicates weak bones due to osteoporosis. The physical exam should be performed to document both spinal deformity, that is, angulation of the spine or tenderness of the spine at the level of fracture, as well as, a neurologic exam. Neurologic exam should include testing of the muscle strength, sensation, and reflexes of the lower extremities, as well as, testing of bowel and bladder sphincter control. A 36 year old man was brought to the hospital as he had a fall from electric pole approximately 20 feet height. He had sustaining injury to the neck. Surgery was done as patient was diagnosed with C6 burst fracture with fracture dislocation of C5-C7. Therapeutic Interventions includes exercises, strengthening exercises, cervical fracture fixation, and traction.

Thoracolumbar flexion dysfunction and thoracolumbar compression fracture in postmenopausal women: a single-center retrospective study

Objective To investigate whether thoracolumbar flexion dysfunctions increase the risk of thoracolumbar compression fractures in postmenopausal women. Methods The records of postmenopausal women with thoracolumbar vertebral compression fractures and without vertebral compression fractures were surveyed. Demographic data, clinical data, and quantitative computed tomography (QCT) findings were compared between the groups. Chi-squared tests, unpaired t-tests, Spearman, and Mann–Whitney U were used to assess the group characteristics and proportions. The relationship between the risk of fracture and the difference of Cobb’s angle of thoracolumbar segment (DCTL) was evaluated by logistic regression. DCTL was calculated by subtracting thoracolumbar Cobb’s angles (TLCobb’s) from thoracolumbar hyperflexion Cobb’s angles (TLHCobb’s). Quantitative computed tomography (QCT) values and spinal osteoarthritis (OA) of postmenopausal women in the two groups were compared. Results 102 of 312 were enrolled to the study group of postmenopausal women with the fracture, and 210 of 312 were enrolled to the control group of postmenopausal women without the fracture. There were significant differences in QCT values and spinal OA including disc narrowing (DSN) and osteophytes (OPH) between the two groups (p < 0.001 for all four). The risk of thoracolumbar compression fractures in the postmenopausal women with DCTL ≤ 8.7° was 9.95 times higher (95% CI 5.31–18.64) than that with > 8.7° after adjusting for age, BMI, and QCT values. Conclusion Low DCTL may be a risk factor of thoracolumbar compression fractures in postmenopausal women, and a DCTL ≤ 8.7° can be a threshold value of thoracolumbar compression fractures.

Microstructure and Phase Formation of Novel Al80Mg5Sn5Zn5X5 Light-Weight Complex Concentrated Aluminum Alloys

In this work, three novel complex concentrated aluminum alloys were developed. To investigate the unexplored region of the multicomponent phase diagrams, thermo-physical parameters and the CALPHAD method were used to understand the phase formation of the Al80Mg5Sn5Zn5Ni5, Al80Mg5Sn5Zn5Mn5, and Al80Mg5Sn5Zn5Ti5 alloys. The ingots of the alloys were manufactured by a gravity permanent mold casting process, avoiding the use of expensive, dangerous, or scarce alloying elements. The microstructural evolution as a function of the variable element (Ni, Mn, or Ti) was studied by means of different microstructural characterization techniques. The hardness and compressive strength of the as-cast alloys at room temperature were studied and correlated with the previously characterized microstructures. All the alloys showed multiphase microstructures with major α-Al dendritic matrix reinforced with secondary phases. In terms of mechanical properties, the developed alloys exhibited a high compression yield strength up to 420 MPa, high compression fracture strength up to 563 MPa, and elongation greater than 12%.