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Tang X, Zhou C, Li H, Qiao L, Liao Y, Zhang J, Wang Y, Xie L. Impact of Intravertebral Clefts Sclerosis on Percutaneous Vertebroplasty Efficacy in Osteoporotic Vertebral Compression Fractures. World Neurosurg 2025; 194:123504. [PMID: 39586463 DOI: 10.1016/j.wneu.2024.11.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 11/17/2024] [Accepted: 11/18/2024] [Indexed: 11/27/2024]
Abstract
OBJECTIVE To investigate the effect of intravertebral cleft sclerosis on the efficacy of percutaneous vertebroplasty (PVP) in osteoporotic vertebral compression fractures (OVCFs). METHODS We analyzed 68 OVCF patients with intravertebral clefts treated with PVP from January 2020 to June 2022. Patients were divided into 2 groups based on computed tomography findings: intravertebral clefts sclerosis (IVCs, 36 cases) and intravertebral clefts nonsclerosis (IVCns, 32 cases). Preoperative data included gender, age, bone mineral density, fractured vertebrae distribution, and disease duration. Excluding those with contraindications, all underwent PVP. Operation time, cement injection volume, leakage rate, and distribution patterns were recorded. Outcomes were evaluated using visual analog scale scores, oswestry disability index, anterior vertebral height, and Cobb angle preoperatively, and at 2 days and 1 year postoperatively. RESULTS The IVCs group had a longer disease duration (P < 0.05). No significant differences in operation time, cement volume, or leakage rate were observed between groups (P > 0.05). Cement distribution was mass-like in IVCs and sponge-like in IVCns (P < 0.05). Both groups showed significant improvements postoperatively (P < 0.05), but IVCns had better recovery in anterior vertebral height, Cobb angle, and oswestry disability index (P < 0.05). CONCLUSIONS IVCs affect cement distribution and recovery outcomes, with IVCns achieving better results. Early treatment is advised for OVCF with intravertebral clefts.
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Affiliation(s)
- Xuebin Tang
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China; Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chengqiang Zhou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hua Li
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Liang Qiao
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China; Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yifeng Liao
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Junwei Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yunqing Wang
- Department of Orthopedics, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Lin Xie
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.
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Yang XG, Dong YQ, Liu X, Liu XL, Luo HT, Bao Y, Peng Z, Zhao Y, Yang Q, Lu S. Incidence and prognostic factors of residual back pain in patients treated for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:4521-4537. [PMID: 39103616 DOI: 10.1007/s00586-024-08426-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 07/07/2024] [Accepted: 07/21/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Osteoporotic vertebral compression fracture (OVCF) is a common consequence of osteoporosis and can significantly impact the quality of life for affected individuals. Despite treatment options such as vertebroplasty and kyphoplasty, many patients continue to experience residual back pain (RBP) even after the fracture has healed. The incidence of RBP after OVCF treatment varies among studies, and there is a need for further research to understand the risk factors associated with RBP. METHODS A systematic review and meta-analysis were conducted following the PRISMA guidelines. Electronic databases were searched, and relevant studies were selected based on inclusion and exclusion criteria. Data extraction and quality assessment were performed independently by two authors. Statistical analysis included single-proportion meta-analyses and pooling of odds ratios (OR) using the inverse-variance method, to calculate the overall incidences of RBP and cement leakage and identify risk factors associated with RBP. RESULTS A total of 19 studies were included in the analysis. The overall incidences of RBP and cement leakage were found to be 16% and 18%, respectively. Several risk factors were identified, including gender, bone mineral density, depression, baseline visual analog scale (VAS) score, intravertebral vacuum cleft, number of fractured segments, cement distribution, history of vertebral fracture, thoracolumbar fascial injury, and fracture non-union. CONCLUSIONS This study provides potential value within the scope of the incidence and risk factors of RBP following treatment of OVCFs. The identified risk factors can help clinicians identify high-risk patients and tailor appropriate interventions. Future research should focus on standardizing the definition of RBP and patient selection criteria to improve the accuracy of estimates and facilitate better management strategies for OVCF patients.
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Affiliation(s)
- Xiong-Gang Yang
- Department of Orthopedic Surgery, the Key Laboratory of Digital Orthopaedics of Yunnan Province, the First People's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Xishan District, Kunming City, 650034, Yunnan Province, China
- The Key Laboratory of Digital Orthopedics of Yunnan Province, No. 157 Jinbi Road, Xishan District, Kunming City, 650034, Yunnan Province, China
| | - Yue-Qiu Dong
- Department of Rehabilitation, Affiliated Hospital of Hebei University of Technology, Handan City, 056000, Hebei Province, China
| | - Xiang Liu
- Department of Orthopedic Surgery, the Key Laboratory of Digital Orthopaedics of Yunnan Province, the First People's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Xishan District, Kunming City, 650034, Yunnan Province, China
- The Key Laboratory of Digital Orthopedics of Yunnan Province, No. 157 Jinbi Road, Xishan District, Kunming City, 650034, Yunnan Province, China
| | - Xiao-Liang Liu
- Department of Orthopedic Surgery, the Key Laboratory of Digital Orthopaedics of Yunnan Province, the First People's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Xishan District, Kunming City, 650034, Yunnan Province, China
- The Key Laboratory of Digital Orthopedics of Yunnan Province, No. 157 Jinbi Road, Xishan District, Kunming City, 650034, Yunnan Province, China
| | - Hao-Tian Luo
- Department of Orthopedic Surgery, the Key Laboratory of Digital Orthopaedics of Yunnan Province, the First People's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Xishan District, Kunming City, 650034, Yunnan Province, China
- The Key Laboratory of Digital Orthopedics of Yunnan Province, No. 157 Jinbi Road, Xishan District, Kunming City, 650034, Yunnan Province, China
| | - Yi Bao
- Department of Orthopedic Surgery, the Key Laboratory of Digital Orthopaedics of Yunnan Province, the First People's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Xishan District, Kunming City, 650034, Yunnan Province, China
- The Key Laboratory of Digital Orthopedics of Yunnan Province, No. 157 Jinbi Road, Xishan District, Kunming City, 650034, Yunnan Province, China
| | - Zhi Peng
- Department of Orthopedic Surgery, the Key Laboratory of Digital Orthopaedics of Yunnan Province, the First People's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Xishan District, Kunming City, 650034, Yunnan Province, China
- The Key Laboratory of Digital Orthopedics of Yunnan Province, No. 157 Jinbi Road, Xishan District, Kunming City, 650034, Yunnan Province, China
| | - Yu Zhao
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, 30021, China
| | - Sheng Lu
- Department of Orthopedic Surgery, the Key Laboratory of Digital Orthopaedics of Yunnan Province, the First People's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, No. 157 Jinbi Road, Xishan District, Kunming City, 650034, Yunnan Province, China.
- The Key Laboratory of Digital Orthopedics of Yunnan Province, No. 157 Jinbi Road, Xishan District, Kunming City, 650034, Yunnan Province, China.
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Wang J, Zhang J, Huang J, Chen J, Dong Q, Zhu H, Huang X, Luo J. Clinical effect analysis of vertebroplasty with high viscosity and standard bone cement for Kummell disease. Medicine (Baltimore) 2024; 103:e39960. [PMID: 39465754 PMCID: PMC11460861 DOI: 10.1097/md.0000000000039960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Indexed: 10/29/2024] Open
Abstract
This study aims to observe and compare the effects of high-viscosity bone cement versus standard bone cement on the postoperative outcomes of percutaneous vertebroplasty (PVP) in patients with Kummell disease. A retrospective analysis was conducted on 135 patients with Kummell disease who underwent PVP between January 2019 and May 2023. Patients were divided into 2 groups: the high-viscosity group (group H, 63 cases) received high-viscosity bone cement during surgery, while the standard group (group S, 72 cases) received standard bone cement. Surgery duration, bone cement volume, bone cement leakage rate, as well as preoperative and postoperative evaluations using the Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), anterior vertebral height, and kyphotic Cobb angle were recorded and compared between the 2 groups. In the group H, significant improvements were observed in VAS scores, ODI, anterior vertebral height, and Cobb angle at 24 hours, 3 months, and 1 year postoperatively compared to preoperative values (P < .01). In the group S, VAS scores and ODI showed significant improvement at 24 hours, 3 months, and 1 year postoperatively (P < .01), but there were no significant differences in anterior vertebral height or Cobb angle compared to preoperative values (P > .05). Comparatively, the group H demonstrated superior outcomes in terms of bone cement volume, leakage rate, recovery of anterior vertebral height, and Cobb angle correction at 24 hours, 3 months, and 1 year postoperatively (P < .05). However, there were no significant differences between the 2 groups in terms of surgery duration, VAS scores, and ODI at the same time points (P > .05). PVP is an effective treatment for Kummell disease, providing significant pain relief and improved spinal function. The use of high-viscosity bone cement allows for greater volume infusion, better restoration of vertebral height, and correction of deformities, while also reducing the risk of cement leakage.
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Affiliation(s)
- Jian Wang
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Jianxin Zhang
- Department of Orthopedics, The Hospital of Zhangping City, Zhangping, China
| | - Jianbiao Huang
- Department of Orthopedics, The Hospital of Zhangping City, Zhangping, China
| | - Jie Chen
- Department of Orthopedics, The Hospital of Zhangping City, Zhangping, China
| | - Qunwei Dong
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Hui Zhu
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Xusheng Huang
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Jianxian Luo
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
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Du W, Wu Z, Wu H, Li Y, Jin Y. Global trends and frontiers of research on Kümmell's disease: A bibliometric analysis. Medicine (Baltimore) 2024; 103:e38833. [PMID: 38968467 PMCID: PMC11224852 DOI: 10.1097/md.0000000000038833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/17/2024] [Indexed: 07/07/2024] Open
Abstract
The prevalence of Kümmell's disease (KD) has been increasing due to the aging population and the rise of osteoporotic vertebral compressibility fractures. As a result, there has been a growing concern about this condition. Despite the rapid advancements in its related research fields, the current research status and hotspot analysis of KD remain unclear. Therefore, our goal was to identify and analyze the global research trends on KD using bibliometric tools. All KD data were obtained from the Web of Science Core Collection. The information of research field was collected, including title, author, institutions, journals, countries, references, total citations, and years of publication for further analysis. From 1900 to 2022, a total of 195 articles and 1973 references have been published in this field, originating from 27 countries/regions and 90 journals, with China leading the contributions. The most significant institutional and author contributions come from Soochow University and Kim, HS, respectively. The journal with the highest number of published research and total citation frequency is Spine. The latest research focuses in this field include "risk factor," "osteoporotic vertebral compression fracture," "pedicle screw fixation," "percutaneous vertebroplasty," and "bone cement," and should be closely monitored. Additionally, we have conducted a comprehensive analysis of the 50 most-cited articles in KD, providing a valuable list of articles to guide clinical decision-making and future research for clinicians and researchers. In recent years, there has been a significant increase in scientific research on KD. Future research in KD is likely to focus on surgical treatment, risk factors, and complications.
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Affiliation(s)
- Weifeng Du
- Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Zhoutong Wu
- Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Huaiju Wu
- Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Yanlei Li
- Bengbu Medical College, Bengbu, Anhui, China
| | - Yebin Jin
- Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
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Wang R, Hao Y, Chen M, Jia P, Zhou F. Comparison of the Clinical Outcomes of Vesselplasty vs. Percutaneous Vertebroplasty for the Treatment of Neurologically Intact Osteoporotic Kümmell's Disease: A Retrospective Study. Calcif Tissue Int 2024; 114:360-367. [PMID: 38308720 DOI: 10.1007/s00223-024-01186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
Kummell's disease (KD) is a rare clinical complication of osteoporotic vertebral compression fractures (OVCFs). Minimally invasive surgery is an important way to treat KD. In this paper, we used Percutaneous Vertebroplasty (PVP) and Vesselplasty (VP) to treat KD. 125 patients with KD were admitted to our hospital. Among them, 89 patients received PVP and 36 received VP. All patients underwent operations successfully. VAS scores and ODI of both groups at each postoperative time point were lower than preoperatively. Postoperative Cobb angle of both groups postoperatively was lower than preoperatively (p < 0.05). The anterior height and ratio of vertebra compression of both groups postoperatively was lower than preoperatively (p < 0.05). Cement leakage occurred in 16 vertebrae (16/89) in PVP group and one (1/36) in VP group. Two patients suffered from transient paraplegia in PVP group immediately after operation. Adjacent vertebral fractures occurred in one patient in PVP group and one in VP group. Re-fracture of affected vertebra occurred in one patient in PVP group. Besides, four patients suffered from bone cement loosening in PVP group while one in VP group. Both PVP and VP play an important effect in pain relief and functional recovery for the treatment of KD. And VP is more effective than PVP in preventing cement leakage.
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Affiliation(s)
- Ruideng Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Youliang Hao
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People's Republic of China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Mengmeng Chen
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pu Jia
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People's Republic of China.
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Shen H, Tang W, Yin X, Shao T, Liu X, Gu J, Hu Y, Yu L, Yu Z, Zhang Z. Comparison between percutaneous short-segment fixation and percutaneous vertebroplasty in treating Kummell's disease: A minimum 2-year follow-up retrospective study. J Back Musculoskelet Rehabil 2024; 37:195-203. [PMID: 37694352 PMCID: PMC10789354 DOI: 10.3233/bmr-230083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Percutaneous kyphoplasty (PKP) or percutaneous short-segment fixation (PSSF) is often used to treat Kummell's disease. However, it is not clear which treatment is better for patients. OBJECTIVE To retrospectively compare the clinical efficacy of PVP and PSSF for the treatment of Kummell's disease. METHOD 60 patients were involved in this research and the period of follow-up was at least 2 years. 27 of them were treated with PVP (Group I) and the rest who received PSSF (Group II). The visual analog scale (VAS) and radiographic indexes of each participant had been measured preoperatively as well as 1 week, 3 months, and 2 years postoperatively. Additionally, the Oswestry Disability Index (ODI) scores were assessed at the last time point. RESULTS Comparing the two groups, no statistical significance was found among all parameters preoperatively. The time of operations and blood loss is less in Group I. At each time point after operation, the imaging indices in Group II are lower (P< 0.05). One week after treatments, the VAS scores are lower in Group I, and similarly, 3 months are the same (P< 0.05), while VAS are similar at the last time point. In the aspect of ODI scores, they are lower in Group II during long-term follow-up. CONCLUSION For the treatment of Kummell's disease, both PVP and PSSF have been found to be effective. PVP can provide rapid pain relief with a shorter operation time. However, in cases with severe kyphosis deformity, PSSF should be given priority.
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Affiliation(s)
| | | | - Xiaoyu Yin
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tuo Shao
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xing Liu
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jiaao Gu
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yuhang Hu
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Lei Yu
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhange Yu
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhenyu Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Ko YI, Ko MS, Bang C, Park HY, Kim SI, Kim YH. Understanding Kummell's Disease: Definition, Diagnosis, Pathophysiology, and Treatment. JOURNAL OF KOREAN SOCIETY OF SPINE SURGERY 2024; 31:23. [DOI: 10.4184/jkss.2024.31.1.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/04/2024] [Accepted: 03/04/2024] [Indexed: 10/17/2024]
Affiliation(s)
- Young-Il Ko
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung-Sup Ko
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chungwon Bang
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung-Youl Park
- Department of Orthopaedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Il Kim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Hoon Kim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Moura DL, Gabriel JP. EXPANDABLE INTRAVERTEBRAL IMPLANTS IN POST-TRAUMATIC VERTEBRAL NECROSIS - NEW CLASSIFICATION SUGGESTION. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e262943. [PMID: 37547239 PMCID: PMC10400001 DOI: 10.1590/1413-785220233104e262943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 11/22/2022] [Indexed: 08/08/2023]
Abstract
The progressive evolution of post-traumatic vertebral necrosis and consequent loss of structural integrity of the vertebral body along with neurological risk, makes it one of the most feared and unpredictable pathologies in spine traumatology. Several studies have addressed the role of vertebroplasty, kyphoplasty, and corpectomy in its treatment; however, it remains a controversial concept without a defined therapeutic algorithm. The recent emergence of expandable intravertebral implants, which allow, by a percutaneous transpedicular application, the capacity for intrasomatic filling and maintenance of the height of the vertebral body, makes them a viable option, not only in the treatment of acute vertebral fractures, but also in non-union cases. In this study, we present a review of the current evidence on the application of expandable intravertebral implants in cases of post-traumatic vertebral necrosis. Based on the available scientific literature, including previous classifications of post-traumatic necrosis, and on the mechanical characteristics of the main expandable intravertebral implants currently available, we propose a simplified classification of this pathology, considering parameters that influence surgical therapeutic guidance, the morphology and the dynamics of the necrotic vertebra's mobility. According to its stages and based on authors' experience and on the scarce literature, we propose an initial therapeutic algorithm and suggest preventive strategies for this disease, considering its main risk factors, that is, fracture comminution and impairment of vertebral vascularity. Therefore, expandable intravertebral implants have a promising role in this condition; however, large prospective studies are needed to confirm their efficacy, to clarify the indications of each of these devices, and to validate the algorithm suggestion regarding treatment and prevention of post-traumatic vertebral necrosis. Level of Evidence III, Systematic Review/Actualization.
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Affiliation(s)
- Diogo Lino Moura
- Centro Hospitalar e Universitario de Coimbra, Serviço de Ortopedia, Setor de Coluna Vertebral, Coimbra, Portugal
- Universidade de Coimbra, Faculdade de Medicina, Instituto de Anatomia e Clinica Universitaria de Ortopedia, Coimbra, Portugal
- Grant Medical Center, Spine Institute of Ohio, Columbus, OH, United States
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Qin GB, Wu YH, Chen HS, Huang YT, Yi JF, Xiao Y. Correlation analysis between morphologic characteristics of the thoracolumbar basivertebral foramen and Kummell's disease in patients with osteoporosis using imaging techniques. BMC Musculoskelet Disord 2023; 24:513. [PMID: 37353769 DOI: 10.1186/s12891-023-06609-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 06/06/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND The aging of the population is a social problem faced by many countries in the world. With the increase in the elderly population, the number of patients with Kummell's disease is also gradually increasing. No study has demonstrated that Kummell's disease has a clear correlation with the foramen of a vertebrobasilar vein. OBJECTIVES The research was conducted to describe and evaluate the morphological characteristics of a basivertebral foramen in patients with osteoporosis and Kummell's disease by CT; to infer whether the specific morphological characteristics of basivertebral foramen may be one of the risk factors of Kummell's disease; to provide clinical suggestions for the treatment of Kummell's disease. DESIGN Retrospective analysis from January 2020 to December 2021 on 83 patients with 83 vertebral bodies (T8-L5) diagnosed with senile osteoporosis and Kummell's disease hospitalized in our hospital due to chronic low back pain, including 57 women and 23 men. Group A was assigned for the following patients: the age ranged from 59 to 86 years old, with the average age of 67.30 ± 7.32 years old; the body mass index ranged from 20.01 to 29.46 kg/m2, with the average body mass index of 23.51 ± 3.03 kg/m2.Group B was assigned for the following patients: 83 patients diagnosed with senile osteoporosis in our outpatient department from January 2020 to December 2021, including 41 males and 42 females; the age ranged from 60 to 85 years, with an average age of 68.52 ± 4.68 years old; the height to weight ratio met the normal reference standard (except 20% above or 10% below the standard weight). Through the lanwon PACS imaging system, the related parameters of the vertebrobasilar foramen in patients with osteoporosis and Kummell's disease were measured to evaluate and analyze the correlation between the morphological characteristics of the vertebrobasilar foramen in patients with osteoporosis and Kummell's disease. RESULTS In patients with osteoporosis, the distribution of incidence rate of Kummell's disease in the spine was consistent with that of osteoporotic compression fractures. Sagittal view of the vertebral body on CT scan and the triangular-shaped, trapezoidal-shaped, and irregular-shaped basivertebral foramen in group A accounted for 18%,57%,and 36%,respectively. In group B, triangular-shaped, trapezoidal-shaped, and irregular-shaped foramen accounted for 51%,17%,and 26%,respectively.The distribution of triangular-shaped, trapezoidal-shaped, and irregular-shaped foramen was compared between groups A and B, and the difference was recorded as statistically significant (P < 0.05). Additionally, the difference in the distribution of triangular-shaped, trapezoidal-shaped, and irregular-shaped foramen in group A was found statistically significant (P < 0.05),while that of Group B was found statistically insignificant (P > 0.05).On a horizontal CT scan of the vertebra of group A, triangles, trapezoids, and irregularities accounted for 28%, 26%, and 47%, respectively. In group B, triangles,trapezoids,and irregularities accounted for 31%, 37%, and 30%, respectively. The difference in the distribution of the triangular-shaped and trapezoidal-shaped foramen in groups A and B was statistically insignificant (P > 0.05), while that of irregular-shaped was statistically significant (P < 0.05). Additionally, there was no statistical significance (P > 0.05) in the difference in the morphological distribution of triangular-shaped and trapezoidal-shaped foramen in group A, while that of irregular-shaped was found to be statistically significant (P < 0.05). Further, the difference in the morphological distribution of triangular-shaped, trapezoidal-shaped, and irregular-shaped foramen in group B was not statistically significant (P > 0.05).In general, about 8% of the vertebral body of BF has an osseous septum. In group A, 97% are single-holed while the remaining 3% are porous; in group B, those with single holes accounted for 76%, while the remaining 24% are porous. In groups A and B, the difference in the morphological distribution of single-holed and multi-holed T8, T11, T12, L1, L2, L4, and L5 vertebral bodies was statistically significant (P < 0.05). In group A, the difference in the distribution of single-holed and multi-holed L1 and L5 vertebral bodies was statistically significant (P < 0.05). Similarly, the difference in the distribution of single-holed and multi-holed T8, T11, T12, L1, L2, and L4 basivertebral foramen was statistically significant (P < 0.05). CONCLUSIONS In patients with osteoporosis, the incidence of vertebral Kummell's disease can be associated with the morphological characteristics of the basivertebral foramen, as observed in the CT scan. Furthermore, the vertebral body with trapezoidal-shaped and irregular-shaped basivertebral foramen and boneless septum in the foramen is highly susceptible to Kummell's disease.
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Affiliation(s)
- Guang Bing Qin
- Department of Orthopaedic Surgery, Affiliated Liutie Centarl Hospital of GuangXi Medical University, Guangxi Province, Liuzhou, China
| | - Yi Hua Wu
- Department of Orthopaedic Surgery, Hechi People's Hospital, Guangxi Province, Hechi, China
| | - Huan Shi Chen
- Department of Orthopaedic Surgery, Affiliated Liutie Centarl Hospital of GuangXi Medical University, Guangxi Province, Liuzhou, China
| | - Yu Ting Huang
- Department of Radiological Diagnosis, Affiliated Liutie Centarl Hospital of GuangXi Medical University, Guangxi Province, Liuzhou, China
| | - Jun Fei Yi
- Department of Orthopaedic Surgery, Affiliated Liutie Centarl Hospital of GuangXi Medical University, Guangxi Province, Liuzhou, China
| | - Ying Xiao
- Department of Orthopaedic Surgery, Affiliated Hospital of Guilin Medical University, Guangxi Province, GuiLin, China.
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Li Y, Qian Y, Shen G, Tang C, Zhong X, He S. Percutaneous mesh-container-plasty versus percutaneous kyphoplasty for the treatment of Kümmell's disease: a retrospective cohort study. J Orthop Surg Res 2023; 18:260. [PMID: 36998039 PMCID: PMC10061694 DOI: 10.1186/s13018-023-03753-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Both percutaneous kyphoplasty (PKP) and percutaneous mesh-container-plasty (PMCP) were important procedures for the treatment of Kümmell's disease. This study aimed to compare the clinical and radiological results of PKP and PMCP for the treatment of Kümmell's disease. METHODS This study included patients with Kümmell's disease treated at our center between January 2016 and December 2019. A total of 256 patients were divided into two groups according to the surgical treatment they received. Clinical, radiological, epidemiological, and surgical data were compared between the two groups. Cement leakage, height restoration, deformity correction, and distribution were evaluated. The visual analog scale (VAS), Oswestry Disability Index (ODI), and short-form 36 health survey domains "role-physical" (SF-36 rp) and "bodily pain" (SF-36 bp) were calculated preoperatively, immediately after surgery, and 1-year postoperatively. RESULTS The VAS and ODI scores improved in the PKP [preoperative: 6 (6-7), 68.75 ± 6.64; postoperative: 2 (2-3), 23.25 ± 3.50, respectively] (p < 0.05) and the PMCP [preoperative: 6 (5-7), 67.70 ± 6.50; postoperative: 2 (2-2), 22.24 ± 3.55, respectively] groups (p < 0.05). There were significant differences between the two groups. The mean cost in the PKP group was lower than that in the PMCP group (3697 ± 461 vs. 5255 ± 262 USD, p < 0.05). The cement distribution in the PMCP group was significantly higher than that in the PKP group (41.81 ± 8.82% vs. 33.65 ± 9.24%, p < 0.001). Cement leakage was lower in the PMCP group (23/134) than in the PKP group (35/122) (p < 0.05). The anterior vertebral body height ratio (AVBHr) and Cobb's angle improved in the PKP (preoperative: 70.85 ± 16.62% and 17.29 ± 9.78°; postoperative: 80.28 ± 13.02% and 13.05 ± 8.40°, respectively) and PMCP (preoperative: 70.96 ± 18.01% and 17.01 ± 10.53°; postoperative: 84.81 ± 12.96% and 10.76 ± 9.23°, respectively) groups (p < 0.05). There were significant differences in vertebral body height recovery and segmental kyphosis improvement between the two groups. CONCLUSIONS PMCP had advantages over PKP in terms of pain relief and functional recovery for the treatment of Kümmell's disease. Moreover, PMCP is more effective than PKP in preventing cement leakage, increasing cement distribution, and improving vertebral height and segmental kyphosis, despite its higher cost.
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Affiliation(s)
- Yimin Li
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Yunfan Qian
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Guangjie Shen
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Chengxuan Tang
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Xiqiang Zhong
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China
| | - Shaoqi He
- Department of Orthopaedic Surgery, Third Affiliated Hospital of Wenzhou Medical University, 108 WanSong Road, Ruian, Wenzhou, Zhejiang, China.
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Ko MJ, Lee BJ. Kummell's Disease is Becoming Increasingly Important in an Aging Society: A Review. Korean J Neurotrauma 2023; 19:32-41. [PMID: 37051029 PMCID: PMC10083447 DOI: 10.13004/kjnt.2023.19.e13] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/28/2023] Open
Abstract
Kummell's disease (KD) is referred to as delayed posttraumatic vertebral collapse, avascular necrosis of vertebrae, or ischemic vertebral collapse. KD is no longer rare in an aging society. It is mainly caused by minor trauma, and nonunion occurs secondary to avascular necrosis at the vertebral body fracture site, which can lead to vertebral kyphosis or intravertebral instability. Clinical symptoms of KD range from no symptoms to severe paralysis due to nerve injury. KD is considered a complication of osteoporotic vertebral compression fractures, and conservative treatment, including osteoporosis treatment, is important. Timely interventions such as vertebral augmentation or surgery, with active regular follow-up are necessary before the onset of neurological deficits due to osteonecrotic collapse in patients with suspected KD. In this study, we summarize the pathogenesis, diagnosis, and treatment of KD, which is showing increasing prevalence in an aging society. We have presented a literature review and discussed clinical guidelines and therapeutic strategies to reduce the morbidity and mortality associated with KD.
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Affiliation(s)
- Myeong Jin Ko
- Department of Neurosurgery, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Byung-Jou Lee
- Department of Neurosurgery and Neuroscience & Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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12
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Mourad C, Omoumi P, Vande Berg B. The Many Faces of Marrow Necrosis. Semin Musculoskelet Radiol 2023; 27:103-113. [PMID: 36868248 DOI: 10.1055/s-0043-1761497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Depending on the age and location within the skeleton, bone marrow can be mostly fatty or hematopoietic, and both types can be affected by marrow necrosis. This review article highlights the magnetic resonance imaging findings of disorders in which marrow necrosis is the dominant feature.Fatty marrow necrosis is detected on T1-weighted images that show an early and specific finding: the reactive interface. Collapse is a frequent complication of epiphyseal necrosis and detected on fat-suppressed fluid-sensitive sequences or using conventional radiographs. Nonfatty marrow necrosis is less frequently diagnosed. It is poorly visible on T1-weighted images, and it is detected on fat-suppressed fluid-sensitive images or by the lack of enhancement after contrast injection.Pathologies historically "misnamed" as osteonecrosis but do not share the same histologic or imaging features of marrow necrosis are also highlighted.
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Affiliation(s)
- Charbel Mourad
- Department of Diagnostic and Interventional Radiology, Hôpital Libanais Geitaoui - CHU, Beyrouth, Lebanon.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bruno Vande Berg
- Department of Radiology, Musculoskeletal Section, Centre Hospitalier Chretien, CHC, Clinique Mont Legia, Liege, Belgium
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Moura DL, Cavaca AR. Internal replacement of a vertebral body in pseudarthrosis-Armed kyphoplasty with bone graft-filled stents: Case report. Front Surg 2023; 10:1142679. [PMID: 37181593 PMCID: PMC10172676 DOI: 10.3389/fsurg.2023.1142679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/20/2023] [Indexed: 05/16/2023] Open
Abstract
Background Post-traumatic vertebral necrosis and pseudarthrosis represents one of the most concerning and unpredictable challenges in spinal traumatology. The evolution of this disease at the thoracolumbar transition usually courses with progressive bone resorption and necrosis, leading to vertebral collapse, retropulsion of the posterior wall and neurological injury. As such, the therapeutic goal is the interruption of this cascade, seeking to stabilize the vertebral body and avoid the negative consequences of its collapse. Case description We present a clinical case of a pseudarthrosis of T12 vertebral body with severe posterior wall collapse, treated with removal of intravertebral pseudarthrosis focus by transpedicular access, T12 armed kyphoplasty with VBS® stents filled with cancellous bone autograft, laminectomy and stabilization with T10-T11-L1-L2 pedicle screws. We present clinical and imaging detailed results at 2-year follow-up and discuss our option for this biological minimally invasive treatment for vertebral pseudarthrosis that mimics the general principles of atrophic pseudarthrosis therapeutic and allows to perform an internal replacement of the necrotic vertebral body, avoiding the aggression of a total corpectomy. Conclusions This clinical case demonstrates a successful outcome of the surgical treatment of pseudarthrosis of vertebral body (mobile nonunion vertebral body) in which expandable intravertebral stents allow to perform an internal replacement of the necrotic vertebral body by creating intrasomatic cavities and filling them with bone graft, obtaining a totally bony vertebra with a metallic endoskeleton, which is biomechanically and physiologically more similar to the original one. This biological internal replacement of the necrotic vertebral body technique can be a safe and effective alternative over cementoplasty procedures or total vertebral body corpectomy and replacement for vertebral pseudarthrosis and may have several advantages over them, however long-term prospective studies are needed in order to prove the effectiveness and advantages of this surgical option in this rare and difficult pathological entity.
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Affiliation(s)
- Diogo Lino Moura
- Spine Unit, Orthopedics Department, Coimbra University Hospital, Coimbra, Portugal, Coimbra, Portugal
- Anatomy Institute and Orthopedics Department, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Correspondence: Diogo Lino Moura
| | - Ana Rita Cavaca
- Orthopedics Department, Coimbra University Hospital, Coimbra, Portugal
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14
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Gou P, Jing W, Zhou J, Wang R, Wang Z, Chang F, Xue Y. Magnetic Resonance Imaging Negative Spine Trauma Followed by a Delayed Intravertebral Vacuum Cleft-Kümmell's Disease: A Case Report and Literature Review. Orthop Surg 2023; 15:366-370. [PMID: 36245398 PMCID: PMC9837236 DOI: 10.1111/os.13559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/06/2022] [Accepted: 09/16/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Kümmell's disease (KD) is a rare clinical entity characterized by delayed post-traumatic vertebral body collapse, in which an intravertebral vacuum cleft (IVC) is formed. The patient sustained a minor spinal trauma, and their spine X-ray examinations were negative. However, after an asymptomatic period of months, they developed recurrent back pain because of the progressive vertebral collapse of the affected spine. However, no imaging examination could confirm the magnetic resonance imaging (MRI)-negative initial spinal trauma followed by delayed vertebral collapse with IVC. CASE PRESENTATION We report a case of KD occurring in a 66-year-old postmenopausal patient whose lumbar MRI on sagittal planes were immediately performed following the initial trauma (a ground-level fall) and revealed that the vertebral integrity or connectivity was not interrupted and the marrow signal was even. After an asymptomatic period of 8 months, the back pain reappeared and progressively exacerbated. The wedge-shaped change in the T11 vertebra with an IVC was confirmed by lumbar computed tomography and MRI. Finally, KD was diagnosed following extensive routine hematological and biochemical workups. Percutaneous kyphoplasty was performed to relieve her back pain by restoring her vertebral stability. CONCLUSIONS We confirmed that the OVF was not the first step in the KD sequence, and the IVC - KD - could from an initial MRI-negative spine trauma.
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Affiliation(s)
- Pengguo Gou
- Department of Orthopaedic SurgeryTianjin Medical University General HospitalTianjinChina
- Department of Orthopaedic SurgeryThe Fifth Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Wanli Jing
- Department of Orthopaedic SurgeryTianjin Medical University General HospitalTianjinChina
- Department of Orthopaedic SurgeryTianjin First Center HospitalTianjinChina
| | - Jiaming Zhou
- Department of Orthopaedic SurgeryTianjin Medical University General HospitalTianjinChina
| | - Rui Wang
- Department of Orthopaedic SurgeryTianjin Medical University General HospitalTianjinChina
| | - Zun Wang
- Department of Orthopaedic SurgeryTianjin Medical University General HospitalTianjinChina
| | - Feng Chang
- Department of Orthopaedic SurgeryThe Fifth Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Yuan Xue
- Department of Orthopaedic SurgeryTianjin Medical University General HospitalTianjinChina
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15
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Si F, Yuan S, Zang L, Fan N, Wu Q, Wang T, Wang A. Paraspinal Muscle Degeneration: A Potential Risk Factor for New Vertebral Compression Fractures After Percutaneous Kyphoplasty. Clin Interv Aging 2022; 17:1237-1248. [PMID: 35990803 PMCID: PMC9385132 DOI: 10.2147/cia.s374857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background The paraspinal muscle is essential for maintaining normal spine function and structure, which degeneration is closely related to various spinal diseases. The main objective of this study was to identify the potential role of paraspinal muscle degeneration in the occurrence of new vertebral compression fractures (NVCF) and develop a clinically applicable nomogram for prospective NVCF risk prediction. Methods A total of 202 patients with single-level osteoporotic vertebral compression fractures (OVCF) who underwent percutaneous kyphoplasty treatment between January 2016 and March 2019 were included in this study. Demographic, clinical, radiological, and treatment data were collected and analyzed. The paraspinal muscle cross-sectional area (CSA) and fat signal fraction (FSF) were measured to quantify the extent of muscle degeneration. Multivariate binary logistic regression analysis was performed to select risk factors to build a nomogram that predicted the occurrence of NVCF. The concordance index (C-index) and calibration curve were used to evaluate the discriminative capacity and predictive accuracy of the nomogram. Results NVCF occurred in 54 of 202 patients (26.7%). The erector spinae FSF (OR = 1.064; P = 0.001), psoas major FSF (OR = 1.326; P < 0.001), and the difference index of the muscle CSA between multifidus and psoas major (OR = 1.048; P < 0.001) were independent risk factors for the occurrence of NVCF. The nomogram performance was good after evaluation using the calibration curves and C-index (95% confidence interval, 0.854–0.943). Conclusion Paraspinal muscle degeneration is a potential risk factor for NVCF occurrence. A nomogram was designed to precisely predict the risk of NVCF. This predictive nomogram may help clinicians to make better clinical decisions and provide more accurate functional exercise protocol for OVCF patients.
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Affiliation(s)
- Fangda Si
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
| | - Qichao Wu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
| | - Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
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16
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Zhang X, Li ZX, Yin LJ, Chen H. Selective nerve block for the treatment of neuralgia in Kummell’s disease: A case report. World J Clin Cases 2022; 10:7523-7530. [PMID: 36158019 PMCID: PMC9353927 DOI: 10.12998/wjcc.v10.i21.7523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/01/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neuralgia is frequently noted in patients with Kummell’s disease, and its mechanism is complex, rendering it challenging to treat. Percutaneous kyphoplasty (PKP) has been widely used to treat osteoporotic vertebral compression fractures with satisfactory outcomes. However, it is not optimal for managing severely collapsed vertebrae, as cement injection may not be feasible. This report describes the use of a selective nerve block for the treatment of neuralgia caused by severely collapsed vertebrae in a patient with Kummell’s disease.
CASE SUMMARY In our patient, three vertebrae were involved. The collapse of T11 was particularly severe. After managing T8 and T9 using PKP, these two segments were effectively strengthened; consequently, back pain was significantly relieved. However, the structure and strength of T11 could not be effectively restored using a minimally invasive surgical method because there was little room for cement injection. This caused obvious neuralgia according to the postoperative status of the PKP. Thus, we performed selective nerve blocks for the treatment of neuralgia, which resulted in satisfactory outcomes.
CONCLUSION Selective nerve block may be a possible therapeutic strategy for neuralgia due to severely collapsed vertebrae in Kummell’s disease.
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Affiliation(s)
- Xin Zhang
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Zong-Xi Li
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Li-Jun Yin
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
- Department of Anesthesiology, Ningbo Women and Children’s Hospital, Ningbo 315012, China
| | - Hui Chen
- Department of Anesthesiology and Perioperative Medicine, Shanghai The Fourth People’s Hospital Affiliated to Tongji University School of Medicine, shanghai 200434, China
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17
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Bone microarchitecture and metabolism in elderly male patients with signs of intravertebral cleft on MRI. Eur Radiol 2022; 32:3931-3943. [PMID: 34989849 DOI: 10.1007/s00330-021-08458-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/17/2021] [Accepted: 11/04/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Intravertebral cleft (IVC) is a common but not unique imaging manifestation in Kümmell's disease. To date, great controversy exists regarding the specific mechanisms of IVC. In this study, we aimed to investigate the characteristics of microarchitecture and metabolism in patients with IVC and to analyse the correlations between degree of vertebral collapse and risk factors. METHODS A total of 79 elderly men were included in this study. We divided all patients into two groups: the IVC group (30 patients) and the non-IVC group (49 patients). We compared the differences in microarchitecture and bone turnover marker (BTM) serum concentrations between the groups and analysed risk factors affecting vertebral collapse by using the Mann-Whitney U test and Spearman's correlation test. RESULTS Quantitative analysis of the microarchitecture showed higher content of necrotic bone (p < 0.001) and lower content of lamellar bone (p < 0.001) in the IVC group. Analysis of BTMs identified lower concentration of N-terminal propeptide of type I collagen (PINP, p = 0.002) and higher concentration of β-isomerized C-terminal telopeptide (β-CTX, p < 0.001) in the IVC group. The correlation analysis showed that lamellar bone content (p < 0.001) and spine T-score (p = 0.011) were significantly correlated with the degree of vertebral collapse. CONCLUSIONS IVC is a radiological feature of excessive bone resorption by higher activities of osteoclasts and decreased bone remodelling ability by lower activities of osteoblasts. Histomorphological feature in patients with IVC is delayed callus mineralisation, which may increase the risk of vertebral collapse. KEY POINTS • A key histomorphological feature in patients with IVC is delayed callus mineralisation, which may aggravate the degree of vertebral collapse. • We investigated bone metabolism in patients with IVC to evaluate the activities of osteoclasts and osteoblasts directly. • We propose a novel hypothesis for the pathogenesis of IVC: bone resorption by higher activity of osteoclasts and decreased callus mineralisation ability by lower activity of osteoblasts are the main mechanisms leading to IVC.
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18
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Yu SH, Jeong YM, Lee SW. Revisiting Kümmell's disease: MRI findings beyond the intraosseous cavity for improved diagnosis. Neuroradiology 2022; 64:1681-1688. [PMID: 35577995 DOI: 10.1007/s00234-022-02976-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/05/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The diagnostic tool for Kümmell's disease (KD), including the intravertebral vacuum cavity on imaging, is still limited. The purpose of this study was to find other magnetic resonance imaging (MRI) findings that could help the diagnosis of KD. METHODS A total of 289 patients (103 males and 186 females with a mean age of 69 ± 15 years) with thoracolumbar compression fracture were included. Medical records were reviewed to note symptom duration. MRIs were analyzed for intraosseous cavities (IOC), prevertebral soft-tissue changes (PreSC), posterior wall fracture (PoF), and posterior ligamentous complex tear (PLCT). KD was diagnosed based on surgical findings or clinical report. MRI findings and symptom duration in the presence or absence of KD were compared with chi-squared test, logistic regression, and Student's t-test and area under the curve (AUC) analyses. RESULTS KD was diagnosed in 55 cases. IOC was noted in 33 (60%) cases in the KD group and 82 (35%) cases in non-KD group. Definite PreSC was noted in 44 (80%) cases in the KD group and 94 (40%) cases in the non-KD group. PoF was seen in 36 (65%) and 140 (60%) cases, and PLCT was seen in 7 (13%) and 26 (11%) cases in KD and non-KD groups, respectively. The IOC and PreSC MRI findings were significantly correlated with KD (p < 0.001), but not with PoF (p = 0.539) or PLCT (p = 0.814). AUC of combined IOC and PreSC was 0.72, higher than that of IOC alone (0.63) or PreSC alone (0.69) (both p < 0.001). The average duration of symptom was 64 days in the KD group and 14 days in the non-KD group (p < 0.001). Positive IOC and PreSC findings were associated with longer symptom duration (p < 0.001). CONCLUSIONS Prevertebral soft-tissue changes and intraosseous cavity are associated with KD. Combined findings of prevertebral soft-tissue changes and intraosseous cavity can help the diagnosis of KD.
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Affiliation(s)
- Sung Hyun Yu
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Yu Mi Jeong
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Sheen-Woo Lee
- Department of Radiology, College of Medicine, The Catholic University of Korea Eunpyeong St. Mary's Hospital, Tongil-ro, Eunpyeong-gu, Seoul, 1021, Korea.
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Seo EH, Yoon YS, Cha JG, Kim HK. Intraosseous ganglion cyst mimicking chondrosarcoma on MRI: a case report. Eur J Med Res 2022; 27:8. [PMID: 35027087 PMCID: PMC8756681 DOI: 10.1186/s40001-022-00631-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/30/2021] [Indexed: 11/15/2022] Open
Abstract
Background The intraosseous ganglia is a benign cyst, rarely locate in the olecranon process. As intraosseous ganglia can mimic malignant bone tumor, computed tomography (CT) is important for diagnosis even when magnetic resonance imaging (MRI) suggests malignant bone tumor, such as chondrosarcoma. Case presentation In this paper, we report a 42-year-old woman with intraosseous ganglia in the olecranon process of the ulna. She complained pain in right elbow for 3 weeks. MRI revealed an intraosseous mass which initially diagnosed as chondrosarcoma. However, followed computed tomography (CT) demonstrated scattered intralesional gas and no underlying mineralization, and we can exclude chondrosarcoma from diagnosis. Conclusions The intraosseous ganglia can mimic bone tumor in MRI; therefore, CT is essential for accurate characterization of bone tumor. Even if MR imaging strongly suggests chondrosarcoma of the bone, CT should be performed as additional study.
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Affiliation(s)
- Eun Hye Seo
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea
| | - Yu Sung Yoon
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea.
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea
| | - Hee Kyung Kim
- Department of Pathology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea
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20
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Moura DFL, Gabriel JP. Evolution of vertebral posttraumatic necrosis to bone healing after self-stabilizing osteophytosis development-case report. JOURNAL OF SPINE SURGERY (HONG KONG) 2021; 7:524-531. [PMID: 35128127 PMCID: PMC8743292 DOI: 10.21037/jss-21-58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/03/2021] [Indexed: 05/28/2023]
Abstract
Post-traumatic vertebral necrosis and pseudarthrosis at the thoracolumbar transition level usually progresses to bone resorption, leading to vertebral collapse, sometimes with retropulsion of the posterior wall and neurological deficit. As such, the therapeutic goal is the interruption of this evolution, seeking to stabilize the vertebral body, preventing collapse progression and the risk of neurological deficits. We present a clinical case regarding the evolution of a vertebral pseudarthrosis that self-stabilized with the development of an exuberant anterior osteophyte mass, joining the anterolateral surfaces of the adjacent vertebrae bodies. Vertebrae stabilization would have made it possible to minimize the pathological hypermobility that perpetuated pseudarthrosis and would have ensured sufficient stabilization to obtain clinically and imagiologically proven vertebrae bone healing. However, despite the unusually favorable evolution of this clinical case, in order to avoid highly disabling symptoms for several months, as occurred with the patient for 4 to 6 months, we consider that early percutaneous surgical stabilization of symptomatic vertebral pseudarthrosis is indicated, allowing for almost immediate pain relief and functional improvement, which is beneficial in terms of health and quality of life. This is a clinical case of unusual evolution of vertebral pseudarthrosis, which, however, is useful to confirm the prolonged duration and intensity of symptoms in the face of a conservative treatment for this disease.
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Affiliation(s)
- Diogo Filipe Lino Moura
- Orthopedics Department, Spine Unit, Coimbra University Hospital, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Spine Institute of Ohio, Grant Medical Center, Columbus, OH, USA
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Nozawa S, Kato H, Kawaguchi M, Nozawa A, Yamada K, Iwai C, Fushimi K, Miyamoto K, Hosoe H, Shimizu K, Matsuo M, Akiyama H. Ectopic gas in the fibular graft after anterior cervical corpectomy and fusion. BMC Musculoskelet Disord 2021; 22:995. [PMID: 34844589 PMCID: PMC8630856 DOI: 10.1186/s12891-021-04874-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background Ectopic gas in the graft is occasionally encountered upon follow-up computed tomography (CT) after anterior cervical corpectomy and fusion (ACCF). However, most cases lack inflammatory responses and manifestations of infection. Although the clinical significance of ectopic gas in the graft has not yet been established, to the best of our knowledge, no previous studies have described ectopic gas in the graft after ACCF. This study evaluated ectopic gas in the fibular graft upon follow-up CT after ACCF. Methods We reviewed 112 patients who underwent ACCF and follow-up CT, with a minimum follow-up period of 3 years. CT images were retrospectively reviewed to confirm the presence of ectopic gas in the graft and bone fusion. Bone fusion was defined as follows: mobility less than 2 mm between spinous processes on the flection-extension radiograph or a bone bridge on CT images. Results Of the 112 patients, 30 (27%) patients had ectopic gas in the fibular grafts. Among them, ectopic gas was initially observed 3 months after surgery (early onset) in 23 (77%) patients and 6 months after surgery (late-onset) in the remaining seven (23%) patients. Upon the latest follow-up CT, ectopic gas more frequently remained in late-onset (4/7, 57%) rather than in early-onset (3/23, 13%) cases (p = 0.033). Bone fusion was not observed when CT images exhibited ectopic gas in the graft, whereas ectopic gas was not observed when CT images exhibited bone fusion. Conclusion Ectopic gas in the fibular graft was observed at both early and late-onset after ACCF; late-onset gas remained significantly. The remaining gas was strongly associated with pseudoarthrosis; therefore, pseudoarthrosis should be considered when ectopic gas in the graft is observed on CT images.
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Affiliation(s)
- Satoshi Nozawa
- Department of Orthopaedic Surgery, School of Medicine, Gifu University, 1-1 Yanagido, Gifu city, Gifu, 501-1194, Japan.
| | - Hiroki Kato
- Department of Radiology, School of Medicine, Gifu University, Gifu, Japan
| | - Masaya Kawaguchi
- Department of Radiology, School of Medicine, Gifu University, Gifu, Japan
| | - Asae Nozawa
- Department of Radiology, School of Medicine, Gifu University, Gifu, Japan
| | - Kazunari Yamada
- Department of Orthopaedic Surgery, School of Medicine, Gifu University, 1-1 Yanagido, Gifu city, Gifu, 501-1194, Japan
| | - Chizuo Iwai
- Department of Orthopaedic Surgery, School of Medicine, Gifu University, 1-1 Yanagido, Gifu city, Gifu, 501-1194, Japan
| | - Kazunari Fushimi
- Department of Orthopaedic Surgery, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Kei Miyamoto
- Department of Orthopaedic Surgery, Gifu Municipal Hospital, Gifu, Japan
| | - Hideo Hosoe
- Department of Orthopaedic Surgery, Hirano General Hospital, Gifu, Japan
| | - Katsuji Shimizu
- Department of Orthopaedic Surgery, Gifu Municipal Hospital, Gifu, Japan
| | - Masayuki Matsuo
- Department of Radiology, School of Medicine, Gifu University, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, School of Medicine, Gifu University, 1-1 Yanagido, Gifu city, Gifu, 501-1194, Japan
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Park SJ. Treatment of Kümmell’s disease following the occurrence of osteoporotic vertebral compression fracture. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.11.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: The incidence of osteoporotic vertebral compression fracture (OVCF) is increasing with the increase in the elderly population. Kümmell’s disease following OVCF occurrence is not a rare complication and is frequently associated with severe pain or neurologic deficit with progressive kyphotic deformity. Kümmell’s disease initially meant post-traumatic delayed vertebral collapse, but now it is also termed nonunion, osteonecrosis, or intravertebral vacuum cleft, all of which suggest the disruption of the healing process.Current Concepts: The major pathogenesis of Kümmell’s disease is a vascular compromise caused by mechanical stress or intravascular pathology. The key radiologic sign to diagnose Kümmell’s disease is the presence of intravertebral vacuum cleft, observed using simple X-ray, computed tomography, or magnetic resonance imaging. Magnetic resonance imaging is the most useful diagnostic tool showing gas or fluid signals. The risk factors for the progression of Kümmell’s disease after OVCF include middle-column injury, confined low signal intensity on T2-weighted image, posterior wall combined fracture, kyphotic angle >10°, and a height loss >15%. Its treatment can be broadly classified as conservative treatment, bone cement injection, and surgical treatment. The appropriate treatment method is selected based on the pain intensity, neurological symptoms, and the severity of the kyphotic deformity.Discussion and Conclusion: Kümmell’s disease usually develops along with osteoporosis. Therefore, the treatment should be focused on relief from symptoms associated with Kümmell’s disease and osteoporosis. It is recommended that an anabolic agent should be administered after the diagnosis of Kümmell’s disease, regardless of the treatment modality.
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Chen Z, Lou C, Yu W, He D. Comparison of Intravertebral Clefts between Kümmell Disease and Acute Osteoporotic Vertebral Compression Fracture: A Radiological Study. Orthop Surg 2021; 13:1979-1986. [PMID: 34523812 PMCID: PMC8528973 DOI: 10.1111/os.13025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 12/28/2022] Open
Abstract
Objective The aim of this study was to compare the radiological features of intravertebral clefts (IVC) between Kümmell disease (KD) and acute osteoporotic vertebral compression fracture (OVCF). Materials and Methods This is a retrospective study. A total of 79 patients with IVC from January 2014 to December 2018 were included in this study. There were 22 men and 57 women, with an average of 73.5 years. Based on the exact time interval from injury to treatment and the pathological examination results, the patients were divided into KD group (44 patients) and acute OVCF group (35 patients). The two groups were compared by the margin sclerosis of IVC, vertebra and pedicle ossification, stress fracture of the spinous process, paravertebral callus, the shape of IVC, cleft in the adjacent disc, and flatness of IVC's margin from plain radiographs and computed tomography (CT). The two groups were compared by the IVC content, double‐line sign, and signal of fracture vertebral from their magnetic resonance imaging (MRI). Results There were no significant differences in sex, age, and fracture distribution between the KD group and the acute OVCF group. IVC was present in both the KD group and the acute OVCF group. Six radiological features were only present in the KD group, including sclerosis of the cleft margin (95.5%, 42/44), ossification of the fractured vertebrae (100%, 44/44), ossification of the pedicle (31.8%, 14/44), double‐line sign (27.3%, 12/44), stress fracture of the spinous process (13.6%, 6/44), and even formation of paravertebral callus (18.2%, 8/44). Although there were statistical differences in the other four radiological features of content of IVC (P = 0.02), cleft sign in adjacent intervertebral disc (P < 0.01), margin of IVC (P = 0.02), and the shape of IVC (P = 0.01) between the KD group and acute OVCF group, these characteristics could be found in both groups. Conclusion IVC could present in patients with both KD and acute OVCF; however, we found that marginal cleft sclerosis, vertebral and pedicle ossification, double‐line sign, spinous process fracture, and formation of paravertebral callus are unique radiological features of KD and could be used for differentiation of KD from acute OVCF with IVC.
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Affiliation(s)
- Zhenzhong Chen
- Department of Orthopedics, 5th Affiliated Hospital, Lishui Municipal Central Hospital, Wenzhou Medical College, Lishui, China
| | - Chao Lou
- Department of Orthopedics, 5th Affiliated Hospital, Lishui Municipal Central Hospital, Wenzhou Medical College, Lishui, China
| | - Weiyang Yu
- Department of Orthopedics, 5th Affiliated Hospital, Lishui Municipal Central Hospital, Wenzhou Medical College, Lishui, China
| | - Dengwei He
- Department of Orthopedics, 5th Affiliated Hospital, Lishui Municipal Central Hospital, Wenzhou Medical College, Lishui, China
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24
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Osawa H, Komagamine J, Sato Y. Gas in Vertebrae. Am J Med 2021; 134:e420-e421. [PMID: 33621534 DOI: 10.1016/j.amjmed.2020.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Haruka Osawa
- Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan.
| | - Junpei Komagamine
- Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
| | - Yukako Sato
- Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
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Gou P, Wang Z, Zhao Z, Wang Y, Jiang Y, Xue Y. Restoration of the intravertebral stability in Kümmell's disease following the treatment of severe postmenopausal osteoporosis by 1-34PTH-a retrospective study. Osteoporos Int 2021; 32:1451-1459. [PMID: 33471147 DOI: 10.1007/s00198-020-05761-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022]
Abstract
UNLABELLED Following the 1-34PTH application for conservative treatment of Kümmell's disease, the intravertebral cleft was filled or bridged by the osseous tissue; the radiological evidence of further collapsing was absent. Pain and the neurological disorder were relieved; bone turnover markers, BMD as well as the health-related quality of life were improved. INTRODUCTION Kümmell's disease (KD) patients with severe osteoporosis were applied by the 1-34PTH; the fracture union and the increased bone mineral density (BMD) following this treatment were retrospectively reviewed. METHODS Twenty-one postmenopausal osteoporosis (PMOP) patients with KD received at least 6 months of 1-34PTH treatment. The medical records, including clinical evaluation symptoms, radiological evaluation for bone union and the stability of intravertebral vacuum cleft (IVC), BMD, and laboratory examination for osteoporosis recovery and health-related quality of life (HRQOL), were reviewed. RESULTS From baseline to month 12, visual analog scale decreased from 8.24 ± 0.54 to 1.71 ± 0.56 (P < 0.001) and the modified Japanese Orthopedic Association scores increased from 6.86 ± 1.77 to 10.43 ± 1.29 (P < 0.001). Sagittal CT demonstrated that the IVC was filled or bridged by the osseous tissue in all patients. Within the vertebra, the IVC area (IVCA) decreased from 4.50 ± 2.50 to 0 mm2 (P = 0.001) and the mineralized bone area (MBA) increased from 170.91 ± 102.23 to 259.56 ± 98.60 mm2 (P < 0.001). The area ratio of IVC to vertebra decreased from 0.97 ± 0.46 to 0% (P < 0.001), and the area ratio of mineral bone to vertebra was increased from 32.85 ± 14.51 to 54.97 ± 14.01% (P < 0.001). The kyphosis angle increment was 3.43 ± 1.80°, and the loss rate of anterior border height was 11.14 ± 4.82%. No differences were found in posterior border height and spinal canal diameter. The PINP, β-CTx, BMD, and Short Form-36 Health Survey scores markedly increased. CONCLUSIONS In KD patients with severe PMOP, 1-34PTH treatment could alleviate the clinical evaluation symptoms, facilitate the recovery of the intravertebral stability, ameliorate the BMD, and improve the HRQoL.
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Affiliation(s)
- P Gou
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Department of Orthopedics Surgery, The Fifth People's Hospital of Datong, Ping Cheng District, Datong, 037006, Shanxi, China
| | - Z Wang
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Z Zhao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Department of Orthopedics Surgery, Tianjin Fourth Centre Hospital, Tianjin, 300140, China
| | - Y Wang
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Department of Orthopedics Surgery, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Y Jiang
- Department of Medical Image Center, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Y Xue
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China.
- Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, 300052, China.
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Tang J, Liu J, Gu Z, Song B. Outcomes of Augmentation in Osteoporotic Vertebral Compression Fractures Showing a Cleft Sign on MRI. Cardiovasc Intervent Radiol 2021; 44:428-435. [PMID: 33388869 DOI: 10.1007/s00270-020-02753-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/18/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Intravertebral clefts (IVCs) typically occur in association with osteoporotic vertebral compression fractures (OVCFs) and can be characterized based on magnetic resonance imaging (MRI). This study aimed to identify the clinical characteristics of IVCs with different MRI signals and assess their influence on outcomes of vertebral augmentation. MATERIALS AND METHODS We retrospectively recruited patients with OVCFs and associated IVCs who underwent vertebral augmentation. Patients were stratified into two groups based on whether the IVCs were full of liquid or gas, as determined by MRI signals. Patients were also stratified based on whether vertebral augmentation involved percutaneous kyphoplasty (PKP) or vertebroplasty (PVP). Pre- and postprocedural parameters were compared between groups. RESULTS A total of 194 fractured vertebrae (86 liquid-filled, 108 gas-filled) were examined. Scores for bone cement distribution were significantly higher in the gas group than in the liquid group, indicating broader cement distribution in the gas group. In both groups, intervention significantly improved pain and mobility scores. Among patients with gas-filled IVCs, the incidence of bone cement leakage and recollapse of treated vertebrae were significantly higher after PKP than after PVP. In the liquid group, incidence of bone cement leakage and recollapse of treated vertebrae did not differ significantly between patients who received PKP or PVP. CONCLUSION Vertebral augmentation is effective for treating OVCFs with gas- or liquid-filled IVCs. However, in patients with gas-filled IVCs, PKP may be associated with higher incidence of cement leakage and recollapse of treated vertebrae than PVP. Liquid-filled IVCs may not promote bone cement distribution.
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Affiliation(s)
- Jing Tang
- Department of Radiology, Sichuan University West China Hospital, Guoxue Xiang, No. 37, Chengdu, 610041, China
| | - Jin Liu
- Department of Orthopedics, Chengdu First People's Hospital, Wanxiang North Road, No.18, Chengdu, 610000, China.
| | - Zuchao Gu
- Department of Orthopedics, Chengdu First People's Hospital, Wanxiang North Road, No.18, Chengdu, 610000, China
| | - Bin Song
- Department of Radiology, Sichuan University West China Hospital, Guoxue Xiang, No. 37, Chengdu, 610041, China.
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Zhang X, Li YC, Liu HP, Zhou B, Yang HL. Treatment of Kümmell’s disease with sequential infusion of bone cement: A retrospective study. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.5884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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28
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Zhang X, Li YC, Liu HP, Zhou B, Yang HL. Treatment of Kümmell's disease with sequential infusion of bone cement: A retrospective study. World J Clin Cases 2020; 8:5887-5893. [PMID: 33344587 PMCID: PMC7723727 DOI: 10.12998/wjcc.v8.i23.5887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/06/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Percutaneous vertebroplasty (PVP) is an effective method for the treatment of neurologically intact Kümmell's disease, but bone cement leakage during surgery is a problem that deserves attention. AIM To reduce bone cement leakage and evaluate the effect of the sequential infusion of bone cement during PVP for the treatment of stage I or II Kümmell's disease. METHODS Patients with Kümmell's disease treated in our hospital from September 2015 to September 2018 were retrospectively analyzed. Patients meeting the inclusion and exclusion criteria were divided into two groups: Traditional single infusion and sequential infusion (SI). The visual analog scale (VAS) and Oswestry disability index (ODI) were evaluated and compared, and duration of operation, bone cement content and complications were recorded. RESULTS Forty-five patients were included in this study; there were 24 in the traditional single infusion group and 21 in the SI group. The VAS and ODI were significantly different for both groups when compared pre- and postoperatively, whereas the differences between 1 wk postoperatively and at the final follow-up were not statistically. When the VAS and ODI of the two groups were compared, there were no significant differences at any time point. The leakage rate of bone cement was significantly lower in the SI group (14.3%, 3 of 21) than that in the traditional single infusion group (41.7%, 10 of 24). CONCLUSION SI in unipedicular PVP is a safe and effective procedure for neurologically intact Kümmell's disease, and this technique could decrease the incidence of bone cement leakage.
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Affiliation(s)
- Xing Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
- Department of Orthopaedics, Gaoyou People’s Hospital Affiliated to Soochow University, Yangzhou 225600, Jiangsu Province, China
| | - Yong-Chao Li
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Hong-Peng Liu
- Department of Orthopaedics, Gaoyou People’s Hospital Affiliated to Soochow University, Yangzhou 225600, Jiangsu Province, China
| | - Bing Zhou
- Department of Orthopaedics, Gaoyou People’s Hospital Affiliated to Soochow University, Yangzhou 225600, Jiangsu Province, China
| | - Hui-Lin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
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Dong C, Wei H, Zhu Y, Zhou J, Ma H. Application of Titanium Alloy 3D-Printed Artificial Vertebral Body for Stage III Kümmell's Disease Complicated by Neurological Deficits. Clin Interv Aging 2020; 15:2265-2276. [PMID: 33293803 PMCID: PMC7719306 DOI: 10.2147/cia.s283809] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The current study aimed to compare the clinical and radiographic results of the 3D-printed artificial vertebral body (3DP-AVB) and titanium mesh cage (TMC) for the treatment of Kümmell’s disease (KD) complicated by neurological deficits. Patients and Methods From January 2014 to July 2018, 28 consecutive patients diagnosed with KD and nerve injuries in our department were treated by posterior vertebral column resection and internal fixation. The patients were divided into two groups (3DP-AVB group and TMC group) based on the different anterior column reconstruction implants. Clinical and radiographic parameters were used to evaluate the outcomes. Results The two groups achieved excellent clinical and radiographic results 1 month after surgery with no significant difference (P>0.05), while 3DP-AVB group showed better outcomes compared with TMC group during the follow-up after 6 months (P<0.05). The risk of subsidence in 3DP-AVB group was lower than that in TMC group (41.6% vs 87.5%, P<0.05), and severe subsidence (≥5 mm) was correlated with the recurrence of back pain and bad daily life function. No significant difference was found in the improvement of neurological function between the two groups (P>0.05). The blood loss and operation time in 3DP-AVB group were significantly less than both in TMC group (P<0.05). Conclusion The lower incidence of cage subsidence, with a better long-term efficacy in maintaining the height of the fused segment, relieving back pain, and improving daily life function indicates that the 3DP-AVB may be a superior alternative for KD with neurological deficits.
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Affiliation(s)
- Chunke Dong
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, People's Republic of China
| | - Hongyu Wei
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Yuting Zhu
- Beijing Tongzhou Integrative Medicine Hospital, Beijing 101100, People's Republic of China
| | - Jun Zhou
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Haoning Ma
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
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30
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Kim YW, Taihi L, Viry F, Bossard P, Polivka M, Bousson V. Aggressive vertebral hemangioma: a post-bioptic finding, the gas web sign-report of two cases. BJR Case Rep 2020; 6:20190091. [PMID: 33029370 PMCID: PMC7527010 DOI: 10.1259/bjrcr.20190091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 01/18/2020] [Accepted: 01/27/2020] [Indexed: 12/02/2022] Open
Abstract
Vertebral hemangiomas are relatively frequent among tumors of the spine. Most of them are asymptomatic and the diagnosis is usually made based solely on imaging. However, although rare, some hemangiomas with atypical imaging features (aggressive hemangiomas) can pose a diagnostic challenge. Clinically, these patients present with neurological symptoms. In imaging, aggressive hemangiomas appear as lesions with significant osseous expansion or extraosseous extension, mimicking the appearance of other tumors, such as metastasis or plasmacytoma. In such cases, a biopsy is often required to obtain a histopathological diagnosis in order to rule out the differential diagnoses mentioned above. We report on two cases of aggressive hemangiomas whose diagnosis remained uncertain until the pathology analysis. On CT-scan control immediately after biopsy, we have been surprised to observe the formation of gas bubbles inside the biopsied lesion, spreading over almost the whole vertebra. This gas web sign may support its liquid-filled spaces composition and its benign nature. Our goal was to highlight this finding and its usefulness.
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Affiliation(s)
- Young-Wouk Kim
- Service d'Imagerie Ostéo-Articulaire, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
| | | | - Flore Viry
- Service d'Imagerie Ostéo-Articulaire, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
| | - Philippe Bossard
- Service d'Imagerie Ostéo-Articulaire, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
| | - Marc Polivka
- Service d'Anatomopathologie, Hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
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Wei H, Dong C, Zhu Y, Ma H. Analysis of two minimally invasive procedures for osteoporotic vertebral compression fractures with intravertebral cleft: a systematic review and meta-analysis. J Orthop Surg Res 2020; 15:401. [PMID: 32912267 PMCID: PMC7488103 DOI: 10.1186/s13018-020-01938-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/01/2020] [Indexed: 12/16/2022] Open
Abstract
Background A systematic review and meta-analysis to assess the pros and cons of percutaneous vertebroplasty (PVP) versus kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral cleft (IVC) including all available evidence from controlled trials. Methods Databases including Pubmed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched to identify relevant studies comparing PVP and PKP for OVCFs with IVC. The outcomes mainly included visual analog scale (VAS), Oswestry Disability Index (ODI), local kyphotic angle (LKA), rate of vertebral height (VH%), and adverse events. Results Nine studies enrolling 688 patients were eligible for meta-analysis. The results indicated no significant differences between the two groups in the short-and long-term VAS, ODI, LKA, or VH% (P > 0.05). Compared with PVP, PKP was associated with significantly longer operation time (P < 0.05), higher cost (P > 0.05), and more injected cement volume (P < 0.05). In terms of adverse events, PKP has a lower risk of cement leakage (P < 0.05), while with no significant difference in adjacent-level fracture rates (P > 0.05). Conclusion The two procedures have similar short- and long-term pain relief, functional recovery, local kyphosis correction, and vertebral height maintenance in OVCFs with IVC. PKP is superior to PVP for the injected cement volume, and lower cement leakage rate, however, with longer operation time, more fluoroscopy times, and higher cost. Further randomized controlled trials (RCTs) should be conducted to confirm these results.
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Affiliation(s)
- Hongyu Wei
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
| | - Chunke Dong
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.,Beijing University of Chinese Medicine, 11 North Third Ring Road East, Chaoyang District, Beijing, 100029, China
| | - Yuting Zhu
- Beijing Tongzhou Integrative Medicine Hospital, 89 Chezhan Road, Tongzhou District, Beijing, 101100, China
| | - Haoning Ma
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
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Hao DJ, Yang JS, Tuo Y, Ge CY, He BR, Liu TJ, Huang DG, Jia SJ, Liu P, Zhang JN, Du JP. Reliability and application of the new morphological classification system for chronic symptomatic osteoporotic thoracolumbar fracture. J Orthop Surg Res 2020; 15:348. [PMID: 32831125 PMCID: PMC7444256 DOI: 10.1186/s13018-020-01882-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/11/2020] [Indexed: 12/18/2022] Open
Abstract
Background We propose a new classification system for chronic symptomatic osteoporotic thoracolumbar fracture (CSOTF) based on fracture morphology. Research on CSOTF has increased in recent years; however, the lack of a standard classification system has resulted in inconvenient communication, research, and treatment. Previous CSOTF classification studies exhibit different symptoms, with none being widely accepted. Methods Imaging data of 368 patients with CSOTF treated at our hospital from January 2010 to June 2017 were systematically analyzed to develop a classification system. Imaging examinations included dynamic radiography, computed tomography scans, and magnetic resonance imaging. Ten investigators methodically studied the classification system grading in 40 cases on two occasions, examined 1 month apart. Kappa coefficients (κ) were calculated to determine intraobserver and interobserver reliability. Based on the radiographic characteristics, the patients were divided into 5 types, and different treatments were suggested for each type. Clinical outcome evaluation included using the visual analog score (VAS), the Oswestry disability index (ODI), and the American Spinal Injury Association (ASIA) impairment scale. Results The new classification system for CSOTF was divided into types I–V according to whether the CSOTF exhibited dynamic instability, spinal stenosis or kyphosis deformity. Intra- and interobserver reliability were excellent for all types (κ = 0.83 and 0.85, respectively). The VAS score and ODI of each type were significantly improved at the final follow-up compared with those before surgery. In all patients with neurological impairment, the ASIA grading after surgery was significantly improved compared with that before surgery (P < 0.001). Conclusions The new classification system for CSOTF demonstrated excellent reliability in this initial assessment. The treatment algorithm based on the classification can result in satisfactory improvement of clinical efficacy for the patients of CSOFT.
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Affiliation(s)
- Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No 555, Friendship Rd, District Beilin, Xi'an, 710054, China.
| | - Jun-Song Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No 555, Friendship Rd, District Beilin, Xi'an, 710054, China
| | - Yuan Tuo
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No 555, Friendship Rd, District Beilin, Xi'an, 710054, China
| | - Chao-Yuan Ge
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No 555, Friendship Rd, District Beilin, Xi'an, 710054, China
| | - Bao-Rong He
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No 555, Friendship Rd, District Beilin, Xi'an, 710054, China
| | - Tuan-Jiang Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No 555, Friendship Rd, District Beilin, Xi'an, 710054, China
| | - Da-Geng Huang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No 555, Friendship Rd, District Beilin, Xi'an, 710054, China
| | - Shuai-Jun Jia
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No 555, Friendship Rd, District Beilin, Xi'an, 710054, China
| | - Peng Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No 555, Friendship Rd, District Beilin, Xi'an, 710054, China
| | - Jia-Nan Zhang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No 555, Friendship Rd, District Beilin, Xi'an, 710054, China
| | - Jin-Peng Du
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No 555, Friendship Rd, District Beilin, Xi'an, 710054, China
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Muratore M, Ferrera A, Masse A, Bistolfi A. Can We Predict the Progression of Vertebral Collapse in Conservative Treatment of Osteoporotic Vertebral Fractures? A 3-Year Retrospective Study of 180 Patients From the Emergency Department. Int J Spine Surg 2020; 14:641-648. [PMID: 32986588 DOI: 10.14444/7084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Osteoporotic vertebral fractures (OVFs) have a high incidence in the elderly population and are usually treated conservatively with good outcomes. Nevertheless, failure of the conservative treatment may lead to serious complications. The aim of the study is to identify clinical, radiographic, and magnetic resonance imaging findings potentially related to the failure of the conservative treatment of OVFs. METHODS Data from 620 patients treated in the emergency department for vertebral fracture from 2014 to 2016 were analyzed; after patient identification and inclusion criteria, only fresh OVFs of patients older than 65 years have been included. Main outcome measurements were vertebral collapse, fracture shape types, and progression of vertebral collapse. A progression of vertebral collapse >100% was taken as an independent variable to underline the statistically significant difference among the risk factors. RESULTS A total of 180 patients (138 women; 42 men) and 200 OVFs were analyzed (mean age = 77 years, range = 65-94 years). Potential risks factors for the progression of vertebral collapse >100% were found when fractures occurred in the thoraco-lumbar junction. The swelling type and the bow-shaped type showed higher risk of vertebral collapse, while the concave was the most stable type of fracture with good prognosis. Traumatic fractures had lower risks of fracture progression compared to nontraumatic fractures (eg, fractures after an effort). A linear black signal pattern on short inversion time inversion recovery findings of magnetic resonance imaging corresponded to a risk of progression of the vertebral collapse. CONCLUSIONS Thoraco-lumbar fractures, swelling and bow-shaped fractures, and a linear black area at MR are negative prognostic factors for the failure of conservative treatment. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE The identification of negative prognostic factors may lead to different strategies of treatment to prevent vertebral collapse or failure of conservative treatment.
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Affiliation(s)
- Marco Muratore
- Hospital Città della Salute e della Scienza, Department of Orthopaedics, Traumatology, and Rehabilitation, Orthopaedic and Trauma Centre, CTO, Turin, Italy
| | - Andrea Ferrera
- University of the Studies of Turin, School of Orthopaedics and Traumatology, Turin, Italy
| | - Alessandro Masse
- Hospital Città della Salute e della Scienza, Department of Orthopaedics, Traumatology, and Rehabilitation, Orthopaedic and Trauma Centre, CTO, Turin, Italy.,University of the Studies of Turin, School of Orthopaedics and Traumatology, Turin, Italy
| | - Alessandro Bistolfi
- Hospital Città della Salute e della Scienza, Department of Orthopaedics, Traumatology, and Rehabilitation, Orthopaedic and Trauma Centre, CTO, Turin, Italy
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Cianci F, Ferraccioli G, Ferraccioli ES, Gremese E. Comprehensive review on intravertebral intraspinal, intrajoint, and intradiscal vacuum phenomenon: From anatomy and physiology to pathology. Mod Rheumatol 2020; 31:303-311. [PMID: 32374204 DOI: 10.1080/14397595.2020.1764744] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The term 'vacuum phenomenon' (VP), is characterized by gas-like density areas due to a rapid increase in the joint space volume ('acute VP') or represent a chronic gas collection. It can occur within a collapsed vertebral body, the spinal canal, joints but mainly the intervertebral disc. Studies support that VP is originated by a dynamic process involving the balance between tissues' liquid and gaseous components, influenced by the duration and the depth of mechanical and metabolic alterations, by the nature of neighboring tissues and the variability in both pressure and permeability of disc or vertebral or joint structures. Prevalence of VP in the general population is about 2%, reaching 20% in the elderly with disc degeneration. Although it's often a random finding in asymptomatic patients, VP is an eventually painful expression of disc degeneration, or disc or vertebral fracture, or bone lesions. In sporadic cases, intradiscal gas can be expelled (all-in-one or gradually), resulting in a gaseous cyst, causing pain and neurological symptoms. Considering that spontaneous resolution and recurrence after surgery are both possible, most of the authors recommend conservative treatment in patients with intradiscal and intravertebral VP; occasionally percutaneous CT(computed tomography) -guided aspiration or vertebral stabilization.
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Affiliation(s)
- Francesco Cianci
- Istitute of Rheumatology, Università Cattolica del Sacro Cuore, Roma, Italy
| | | | | | - Elisa Gremese
- Istitute of Rheumatology, Università Cattolica del Sacro Cuore, Roma, Italy
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Evirgen Ş, Yüksel HT, Yüksel G, Kaki B, Kamburoğlu K. Assessment of intravertebral pneumatocysts, degenerative joint disease, and ponticulus posticus in the cervical spine through cone beam computed tomography examination. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:531-538. [PMID: 32033933 DOI: 10.1016/j.oooo.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/28/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To identify the prevalence rates and radiologic characteristics of intravertebral pneumatocysts (IVP), degenerative joint disease (DJD), and ponticulus posticus (PP) in the cervical spine by using cone beam computed tomography (CBCT) images. The correlations of the lesions with patient age and sex, as well as the correlations among the lesions, were also evaluated. STUDY DESIGN CBCT images obtained from 440 patients were assessed retrospectively. Correlations between patient demographic characteristics and IVP, DJD, and PP in the cervical vertebrae were analyzed by using χ2 tests and logistic regression analysis. A difference of P < .05 was considered statistically significant. RESULTS IVP occurred in 22 of 1792 vertebrae (1.2%) and in 17 of 440 patients (3.9%). DJD findings were observed in the cervical vertebrae of 260 patients (59.1%). PPs were found in 245 patients (55.7%). The prevalence rate of DJD varied significantly by age group (P = .002), whereas the prevalence rates of IVP and PP did not. There was a significant correlation between both DJD and PP with demographic characteristics (P < .001) and between DJD and PP in patients without IVPs (P = .038). CONCLUSIONS Although DJD is common, radiologists should carefully examine CBCT scans of vertebrae for IVP and PP. Patients with DJD should be evaluated for the presence of PP.
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Affiliation(s)
- Şehrazat Evirgen
- Associate Professor, Dentomaxillofacial Radiology, Faculty of Dentistry, Usak University, Uşak, Turkey
| | - Halil Tolga Yüksel
- Assistant Professor, Dentomaxillofacial Radiology, Faculty of Dentistry, Usak University, Uşak, Turkey
| | - Gökçe Yüksel
- Specialist, Department of Radiology, Training and Education Hospital, Usak University, Uşak, Turkey
| | - Barış Kaki
- Assistant Professor, Uşak University, Faculty of Economics and Administrative Sciences, Department of Econometrics, Uşak, Turkey
| | - Kıvanç Kamburoğlu
- Professor, Head, Ankara Univesity, Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara, Turkey.
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Yu H, Li Y, Yao X, Lin J, Pan Y, Zhuang H, Wang P. Application of percutaneous vertebroplasty and percutaneous kyphoplasty in treating Kümmell’s patients with different stages and postural correction status. Expert Rev Med Devices 2020; 17:357-364. [PMID: 32125194 DOI: 10.1080/17434440.2020.1736039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Haiming Yu
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Yizhong Li
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Xuedong Yao
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Jinkuang Lin
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Yuancheng Pan
- Department of Orthopedics, The Second Hospital of Fuzhou, Fuzhou, Fujian, China
| | - Huafeng Zhuang
- Department of Orthopedics, The Second Hospital of Fuzhou, Fuzhou, Fujian, China
| | - Peiwen Wang
- Department of Orthopedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
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Posterior Fixation Combined with Vertebroplasty or Vertebral Column Resection for the Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft Complicated by Neurological Deficits. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4126818. [PMID: 31915692 PMCID: PMC6931022 DOI: 10.1155/2019/4126818] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 12/28/2022]
Abstract
Purpose The aim of the current study was to evaluate the relative benefits of posterior fixation combined with vertebroplasty (PFVP) or vertebral column resection (PVCR) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral cleft (IVC) complicated by neurological deficits. Methods From June 2010 to January 2015, 45 consecutive patients suffering OVCFs with IVC and spinal cord injuries were treated with PFVP or PVCR in our department. The visual analogue scale (VAS) score, anterior vertebral height (AVH), posterior vertebral height (PVH), local kyphotic angle (LKA), and neurologic function were evaluated and compared, and the operative duration, blood loss, and complications were also recorded. Results They all achieved excellent pain relief, vertebral height recovery, and kyphosis correction one month after surgery, and no significant differences existed between the two groups. No significant differences were observed between the 1-month postoperative and final follow-up VAS, AVH, and LKA values in the PVCR group (P > 0.05), while AVH and LKA worsened in the PFVP group at the final follow-up (P < 0.05). Similarly, the initial improvements in VAS scores decreased over time (P < 0.05). Neurologic function improved in both groups, and no significant differences were observed between the 2 groups either preoperatively or postoperatively (P > 0.05). The blood loss and operative duration were significantly lower in the PFVP group than those in the PVCR group (P < 0.05). Conclusion Compared with PVCR, PFVP had equivalent short-term clinical outcomes with less blood loss and operative duration which can be very beneficial for treating elderly patients with extreme comorbidities in this condition. However, based on the long-term efficacy of pain relief, vertebral height maintenance, and deformity correction, PVCR is a more reasonable choice.
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Chiu CK, Lisitha KA, Elias DM, Yong VW, Chan CYW, Kwan MK. Do the dynamic stress mobility radiographs predict the postoperative vertebral height restoration, kyphosis correction, and cement volume injected after vertebroplasty for osteoporotic thoracolumbar vertebral fractures with intravertebral cleft? J Orthop Surg (Hong Kong) 2019; 26:2309499018806700. [PMID: 30352524 DOI: 10.1177/2309499018806700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This prospective clinical-radiological study was conducted to determine whether the dynamic mobility stress radiographs can predict the postoperative vertebral height restoration, kyphosis correction, and cement volume injected after vertebroplasty. METHODS Patients included had the diagnosis of significant back pain caused by osteoporotic vertebral compression fracture secondary to trivial injury. All the patients underwent routine preoperative sitting lateral spine radiograph, supine stress lateral spine radiograph, and supine anteroposterior spine radiograph. The radiological parameters recorded were anterior vertebral height (AVH), middle vertebral height (MVH), posterior vertebral height (PVH), MVH level below, wedge endplate angle (WEPA), and regional kyphotic angle (RKA). The supine stress versus sitting difference (SSD) for all the above parameters were calculated. RESULTS A total of 28 patients (4 males; 24 females) with the mean age of 75.6 ± 7.7 years were recruited into this study. The mean cement volume injected was 5.5 ± 1.8 ml. There was no difference between supine stress and postoperative radiographs for AVH ( p = 0.507), PVH ( p = 0.913) and WEPA ( p = 0.379). The MVH ( p = 0.026) and RKA ( p = 0.005) were significantly less in the supine stress radiographs compared to postoperative radiographs. There was significant correlation ( p < 0.05) between supine stress and postoperative AVH, MVH, PVH, WEPA, and RKA. The SSD for AVH, PVH, WEPA, and RKA did not have significant correlation with the cement volume ( p > 0.05). Only the SSD-MVH had significant correlation with cement volume, but the correlation was weak ( r = 0.39, p = 0.04). CONCLUSIONS Dynamic mobility stress radiographs can predict the postoperative vertebral height restoration and kyphosis correction after vertebroplasty for thoracolumbar osteoporotic fracture with intravertebral clefts. However, it did not reliably predict the amount of cement volume injected as it was affected by other factors.
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Affiliation(s)
- Chee Kidd Chiu
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Dahlia Munchar Elias
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Voon Wei Yong
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- 1 Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Efficacy and Safety of High-Viscosity Bone Cement Vertebroplasty in Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft. World Neurosurg 2019; 132:e739-e745. [PMID: 31415893 DOI: 10.1016/j.wneu.2019.08.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/03/2019] [Accepted: 08/05/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate and compare clinical outcomes and cement leakage of high-viscosity bone cement versus low-viscosity bone cement vertebroplasty in treating osteoporotic vertebral compression fractures with intravertebral cleft. METHODS The study included 72 patients with osteoporotic vertebral compression fractures with intravertebral cleft, who were divided into high-viscosity cement (HVC) (38 cases) and low-viscosity cement (LVC) (34 cases) groups according to the viscosity of bone cement used. Cement leakage, visual analog scale score, Oswestry Disability Index, and kyphotic angle (KA) were evaluated. RESULTS All patients were followed for at least 12 months. Overall cement leakage rate was 18.4% in the HVC group, lower than the rate of 61.8% obtained in the LVC group. A statistically significant difference was found in the overall cement leakage rate between the groups (P < 0.05). Visual analog scale and Oswestry Disability Index scores were significantly improved after percutaneous vertebroplasty without significant differences between the HVC and LVC groups (P > 0.05). The KA of patients from both groups was also significantly corrected immediately after surgery. Although the KA gradually increased in both groups during the follow-up period, there was no statistically significant difference between the HVC and LVC groups in KA during follow-up (P > 0.05). CONCLUSIONS Percutaneous vertebroplasty using HVC to treat osteoporotic vertebral compression fractures with intravertebral cleft significantly reduces cement leakage and improves the safety of the operation. In terms of clinical efficacy and prevention of augmented vertebral recollapse, HVC may not have obvious advantages.
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Chongyan W, Zhang X, Li S, Liu J, Shan Z, Wang J, Chen J, Fan S, Zhao F. Mechanism of formation of intravertebral clefts in osteoporotic vertebral compression fractures: An in vitro biomechanical study. Spine J 2018; 18:2297-2301. [PMID: 30075299 DOI: 10.1016/j.spinee.2018.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intravertebral clefts (IVCs) are vacuum-like cavities commonly associated with osteoporotic vertebral compression fractures (OVCFs). IVCs promote cement leakage during kyphoplasty, suggesting a physical link with the basivertebral foramen, although this is uncertain. PURPOSE The present study aims to create IVCs in mechanical experiments on cadaveric spines in order to clarify their pathogenesis, structure, and links with the basivertebral foramen. STUDY DESIGN AND METHODS In total, 15 three-vertebra lumbar specimens from five cadavers aged 68 to 71 years were subjected to axial compressive overload followed by cyclic loading in flexion and extension to create an OVCF together with an IVC. Computed tomography scans and radiographs were used to confirm structural changes and micro-CT was used to measure trabecular bone properties in five specimens. Unipedicular vertebroplasty was then performed on 10 damaged specimens until fluoroscopy revealed extravasation of cement. RESULTS In every specimen, loading created an OVCF with an IVC. Dissection and imaging showed that the IVC was always connected with the basivertebral foramen. The central vertebral region, including the IVC, had the lowest connectivity density, trabecular number, and bone volume fraction, and the highest trabecular separation. Vertebroplasty caused cement leakage through the basivertebral foramen in nine specimens and into an adjacent disc in one specimen. CONCLUSION Cyclic loading in flexion and extension applied to a fractured osteoporotic vertebra can create an IVC, which then allows cement leakage via the basivertebral foramen.
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Affiliation(s)
- Wang Chongyan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Xuyang Zhang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Shengyun Li
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Junhui Liu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Zhi Shan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Jiasheng Wang
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Jian Chen
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Shunwu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China
| | - Fengdong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Rd, Hangzhou 30016, PR China.
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Cement Distribution Patterns in Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft: Effect on Therapeutic Efficacy. World Neurosurg 2018; 123:e408-e415. [PMID: 30503288 DOI: 10.1016/j.wneu.2018.11.181] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine cement distribution patterns on therapeutic efficacy after percutaneous vertebroplasty treatment of osteoporotic vertebral compression fractures (OVCFs) with intravertebral cleft (IVC). METHODS Patients who were treated with percutaneous vertebroplasty for single OVCFs with IVC and met this study's inclusion criteria were retrospectively reviewed. The follow-up period was at least 2 years. Distribution patterns of cement in the IVC area were respectively specified into 2 groups: group 1: solid lump distribution pattern (n = 22); group 2: the comparatively diffused pattern (n = 90). Radiologic and clinical parameters were analyzed and compared. Then, associations of recollapse with covariates and a risk score were further analyzed and developed to predict recollapse of the augmented vertebrae. RESULTS At the immediate postoperative period, all patients benefited from significant improvement in vertebrae height and kyphotic angle correction. However, significant recollapse was observed at the 2 years postoperative follow-up for the patients in group 1. Furthermore, we found that preoperative severe kyphotic deformity (a cutoff value of 12.5°), solid lump cement distribution pattern, and larger reduction angle (a cutoff value of 8.3°) was significantly associated with increased risk for recollapse. A risk score was developed based on the number of risk factors present in each patient and the receiver operating characteristic curve of the risk score generated an area under the curve of 0.788 (95% confidence interval 0.702-0.873, P = 0.000). CONCLUSIONS The comparatively diffused pattern shows better long-term radiologic and clinical outcomes for the treatment for OVCFs with IVC. A risk score can be used to predict the incidence of recollapse.
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Kim HS, Adsul N, Bang JS, Singh R, Park CH, Jang IT. Refracture of Kummell Disease Combined with Huge Epidural Hematoma After Minor Trauma. World Neurosurg 2018; 120:500-505. [PMID: 30266694 DOI: 10.1016/j.wneu.2018.09.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Kummell disease is defined as avascular necrosis of vertebra, occurs after the delayed posttraumatic osteoporotic vertebral collapse, and mainly occurs in adults older than 50 years of age. We report the first case of refracture of Kummell disease and epidural hematoma followed by paraparesis. CASE DESCRIPTION A 67-year-old woman with a known case of osteoporotic T12 fracture (3 months back) visited our outpatient clinic complaining of persistent back pain and paraparesis after jerking while getting up from the bed. Her neurology worsened suddenly in the next 2 days. A physical examination revealed grade 3 power in lower extremities with a lower extremity paresthesia and diminished bilateral knee and ankle reflexes. Urinary retention was also present. A plain radiographic examination of her thoracolumbar spine revealed osteoporotic compression fractures with almost 50% reduction in height of the 12th thoracic vertebra. Magnetic resonance imaging showed dorsal epidural soft tissue mass that caused posterior compression of the spinal cord at the T12-L3 levels. We performed thoracic lateral retropleural corpectomy and cage insertion at T12. Bone cement-augmented pedicle screw fixation was performed at the T10, T11, and L1 levels with laminectomy and decompression of hematoma at the T12, L1, L2, and L3 levels as a stage 1 procedure. CONCLUSIONS Although rare, the possibility of refracture of Kummell disease and spinal epidural hematoma should be kept in mind in patients with osteoporotic fractures. Periodic follow-up and treatment are essential for preventing tragic neurologic impairment.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea.
| | - Nitin Adsul
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | - Jung Soo Bang
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | - Ravindra Singh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
| | - Chang Hwan Park
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea; Medical School, University of Debrecen, Debrecen, Hungary
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
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What is the Current Evidence on Vertebral Body Osteonecrosis?: A Systematic Review of the Literature. Asian Spine J 2018; 12:586-599. [PMID: 29879789 PMCID: PMC6002160 DOI: 10.4184/asj.2018.12.3.586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 01/19/2023] Open
Abstract
Osteonecrosis (ON) is a clinical entity characterized by a pattern of cell death and complex process of bone resorption and formation. Studies related to ON have largely focused on certain anatomical sites; however, the evidence on vertebral body ON (VBON) is largely inconsistent and fragmented. The aim of this study was to clarify the pathophysiology, risk factors, imaging findings, and available treatment modalities for VBON. A systematic review of the relevant articles published in English was performed using PubMed, Embase, Medline, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases. A total of 81 articles were included in this study. Three main topics about VBON were identified: (1) pathophysiology and risk factors, (2) diagnosis, and (3) treatment. Forty-five studies were based on the pathophysiology, 52 on diagnosis, and 38 on the treatment options for VBON. The literature on VBON was limited and mainly focused on post-traumatic cases with a considerable overlap with nonunion and pseudoarthrosis.
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Tai R, Bolinske T, Ghazikhanian V, Mandell JC. The association of the medial joint vacuum phenomenon with ulnar collateral ligament injury in symptomatic elbows of younger athletes. Skeletal Radiol 2018; 47:795-803. [PMID: 29322208 DOI: 10.1007/s00256-017-2864-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/18/2017] [Accepted: 12/27/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the prevalence of intra-articular gas (IAG) on elbow radiography and evaluate variables, including IAG, as predictors of UCL injury. MATERIALS AND METHODS This IRB-approved retrospective study consisted of 241 consecutive elbow radiographic studies containing AP radiographs with valgus stress of both symptomatic and asymptomatic sides in 234 patients. The IAG, medial joint space (MJS), and MJS difference between the symptomatic and asymptomatic elbow (MJSD) were evaluated by two readers, as well as patient age, gender, sport played, and handedness. Primary outcomes included IAG on valgus stress radiographs and UCL injury, which was determined by intraoperative findings as the reference standard or MRI if surgery was not performed. Univariate analysis with Student's t, Fisher's exact, and chi-square tests were performed. RESULTS IAG only manifested with valgus stress and was demonstrated in 30/482 (6.2%) valgus stress radiographs in 27/234 (11.5%) patients. Overall, 21/241 (8.7%) valgus stress radiographs of the symptomatic elbow demonstrated IAG in 21 patients. A total of 128/241 (53.1%) elbow studies had evidence of UCL injury. MJS IAG (p = 0.0147) and increased MJSD (p = 0.0088) were significantly associated with UCL injury. Patient gender, age, handedness, laterality, sport played, and absolute MJS were not associated with UCL injury. MJS IAG with valgus stress demonstrates a sensitivity of 11.7% and specificity of 98.3% in detecting UCL injury for the symptomatic elbow. CONCLUSIONS MJS IAG infrequently manifests on valgus stress radiographs, but is specific for UCL injury in the symptomatic elbow of overhead throwing athletes. MJS IAG and increased MJSD are significantly associated with UCL injury.
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Affiliation(s)
- Ryan Tai
- Department of Radiology, UMass Memorial Medical Center, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Tyson Bolinske
- Department of Radiology, Radiology Associates of Durango, 1010 Three Springs Avenue, Durango, CO, 81301, USA
| | - Varand Ghazikhanian
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jacob C Mandell
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Morphological changes of vertebral compression fracture with intra-vertebral cleft treated with percutaneous vertebroplasty. J Orthop Sci 2018; 23:237-247. [PMID: 29174421 DOI: 10.1016/j.jos.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 09/08/2017] [Accepted: 11/08/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vertebroplasty represents an established treatment option for osteoporotic vertebral compression fracture (OVCF), but its radiographic and clinical outcomes have not been clearly described in patients with intra-vertebral cleft (IVC). The aim of this study was to assess vertebral height restoration, recollapse and change of back pain in OVCF patients with or without IVC. METHODS The records of 108 patients with IVC (group I) and 233 patients without IVC (group II) were included in our analysis between March 2001 and February 2014. The heights of the anterior, middle, and posterior columns, as well as the wedge angle (WA) of the fractured vertebral body were measured. For each vertebral column, the mean height of the superior and inferior vertebral body served as reference. Pre-operative, postoperative, and final compression rates (CR), as well as restoration and recollapse rates were calculated for each column. Subjective back pain was assessed as the numeric rating scale (NRS) score. RESULTS The overall incidence of IVC in OVCF patients who underwent vertebroplasty was 20.8% (127/611 patients). Group I showed significantly higher CR over the entire follow-up period, with the exception of CR for the anterior column at final follow-up, and CR for the posterior column throughout the follow-up. The mean restoration rates at the anterior and middle column immediately after vertebroplasty were also significantly larger in group I. Recollapse rate in all columns was similar for groups I and II. The mean wedge angle was significantly larger in group I over the entire follow-up period. The groups did not differ in terms of NRS score at final follow-up. CONCLUSIONS Vertebroplasty restores vertebral body heights and WA more effectively in OVCF patients with IVC, and provides satisfactory radiographic and clinical outcomes regardless of the presence of IVC.
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Huang YS, Ge CY, Feng H, Zhang HP, Niu XB, Shi SY, Zhu ZQ, Hao DJ. Bone Cement-Augmented Short-Segment Pedicle Screw Fixation for Kümmell Disease with Spinal Canal Stenosis. Med Sci Monit 2018; 24:928-935. [PMID: 29443957 PMCID: PMC5820999 DOI: 10.12659/msm.905804] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background This study aimed to explore the feasibility and efficacy of bone cement-augmented short-segmental pedicle screw fixation in treating Kümmell disease. Material/Methods From June 2012 to June 2015, 18 patients with Kümmell disease with spinal canal stenosis were enrolled in this study. Each patient was treated with bone cement-augmented short-segment fixation and posterolateral bone grafting, and posterior decompression was performed when needed. All patients were followed up for 12–36 months. We retrospectively reviewed outcomes, including the Oswestry disability index (ODI), visual analog scale (VAS) score, anterior and posterior heights of fractured vertebrae, kyphotic Cobb angle, and neurological function by Frankel classification. Results The VAS grades, ODI scores, anterior heights of affected vertebrae, and kyphotic Cobb angles showed statistically significant differences between pre- and postoperative and between preoperative and final follow-up values (P<0.05), whereas the differences between postoperative and final follow-up values were not statistically significant (P>0.05). The differences between posterior vertebral heights at each time point were not statistically significant (P>0.05). Improved neurological function was observed in 12 cases at final follow-up. Three cases had complications, including asymptomatic cement leakage in 2 patients and delayed wound infection in 1 patient. Conclusions Bone cement-augmented short-segment pedicle screw fixation is safe and effective for treating Kümmell disease, and can achieve satisfactory correction of kyphosis and vertebral height, with pain relief and improvement in neurological function, with few complications.
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Affiliation(s)
| | - Chao-Yuan Ge
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Hang Feng
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Hai-Ping Zhang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Xing-Bang Niu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Shao-Yan Shi
- Xi'an Medical Uniyersity, Xi'an, Shaanxi, China (mainland)
| | - Zi-Qi Zhu
- Xi'an Medical Uniyersity, Xi'an, Shaanxi, China (mainland)
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
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Lim J, Choi SW, Youm JY, Kwon HJ, Kim SH, Koh HS. Posttraumatic Delayed Vertebral Collapse : Kummell's Disease. J Korean Neurosurg Soc 2017; 61:1-9. [PMID: 29354230 PMCID: PMC5769843 DOI: 10.3340/jkns.2017.0505.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/17/2017] [Accepted: 10/19/2017] [Indexed: 12/11/2022] Open
Abstract
Posttraumatic delayed vertebral collapse, known as Kummell’s disease, is increasing in number of patients. This disease is already progressive kyphosis due to vertebral collapse at the time of diagnosis and it causes intractable pain or neurologic deficit due to intravertebral instability. Treatment is very difficult after progression of the disease, and the range of treatment, in hospital day, and cost of treatment are both increased. Clinical features, pathogenesis and radiologic findings of these disease groups were reviewed to determine risk factors for delayed vertebral collapse. The purpose of this article is to suggest appropriate treatment before vertebral collapse for patients with osteoporotic vertebral compression fracture who have risk factors for posttraumatic delayed vertebral collapse.
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Affiliation(s)
- Jeongwook Lim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seung-Won Choi
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin-Young Youm
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyon-Jo Kwon
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seon-Hwan Kim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hyeon-Song Koh
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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Yasuda H, Hoshino M, Tsujio T, Terai H, Namikawa T, Kato M, Matsumura A, Suzuki A, Takayama K, Takahashi S, Nakamura H. Difference of clinical course between cases with bone union and those with delayed union following osteoporotic vertebral fractures. Arch Osteoporos 2017; 13:3. [PMID: 29285640 DOI: 10.1007/s11657-017-0411-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/02/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED In this prospective multicenter study of osteoporotic vertebral fractures (OVFs), delayed union of OVF at 6-month follow-up caused prolonged pain, QOL impairment, ADL impairment, cognitive status deterioration, and vertebral collapse progression. PURPOSE Delayed union following osteoporotic vertebral fracture displayed as an intravertebral cleft on plain X-rays was reported to be a factor for prolonged severe pain. However, the difference of clinical course between bone union and delayed union cases still remains unclear. The purpose of this study was to identify how OVF delayed union following conventional conservative treatment influences the clinical course with a prospective multicenter study. METHODS A total of 324 OVF patients from 25 institutes in Osaka, Japan, were included in the study. At the 6-month follow-up after initial visit to each institute, the patients were classified into bone union and delayed union groups based on plain X-ray findings. The outcome assessments included a VAS for back pain, SF-36 for quality of life (QOL), severity of bed-ridden state for activities of daily living (ADL), MMSE for cognitive functions, and degree of vertebral collapse on plain X-rays. RESULTS Overall, 280 patients were included into the union group and 44 into the delayed union group. The VAS score at 6 months was significantly worse in the delayed union group (p = 0.01). The scores for the SF-36 scales of physical functioning and bodily pain at 6 months were significantly lower in the delayed union group (p = 0.019, p = 0.01, respectively). The percentage of nearly or completely bed-ridden patients was significantly higher in the delayed union group. The percentage of newly developed cognitive impairment was significantly higher in the delayed union group (p = 0.02). Progression of vertebral collapse during the 6-month follow-up was more pronounced in the delayed union group (p < 0.01). CONCLUSION The present results revealed that delayed union following OVF causes prolonged pain, QOL impairment, ADL impairment, cognitive status deterioration, and vertebral collapse progression.
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Affiliation(s)
- Hiroyuki Yasuda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan. .,Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, 1-2-22 Matsuzaki-cho, Osaka, Japan.
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Tadao Tsujio
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Nara, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Takashi Namikawa
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Minori Kato
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Akira Matsumura
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kazushi Takayama
- Department of Orthopaedic Surgery, Seikeikai Hospital, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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Li HK, Hao DJ, Yang JS, Huang DG, Yu CC, Zhang JN, Gao L, Li H, Qian B. Percutaneous kyphoplasty versus posterior spinal fixation with vertebroplasty for treatment of Kümmell disease: A case-control study with minimal 2-year follow-up. Medicine (Baltimore) 2017; 96:e9287. [PMID: 29390489 PMCID: PMC5758191 DOI: 10.1097/md.0000000000009287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
This is a retrospective case-control study.The aim of this study was to compare the surgical results of percutaneous kyphoplasty (KP) and posterior spinal fixation with vertebroplasty (PSF+VP) for treatment of Kümmell disease (KD).KD is rare form of post-traumatic delayed avascular necrosis of the vertebral body. It is reported that KP is an effect measure for treatment of KD. Some studies have recommended posterior spinal fixation with vertebroplasty for KD.A total of 100 patients with KD who underwent spinal surgery at our hospital were enrolled from January 2008 to December 2013. The inclusion criteria were monosegment lesion without neurological deficit; the segments are restricted to T11-L2; conservative treatment is invalid. The exclusion criteria were metastatic spinal tumors, infection, primary bone tumor, and multiple myeloma; bisegments and multi-segments; patients with neurological symptoms; the defect of posterior wall of vertebral body; the occupying of vertebral canal. The symptomatic vertebrae were restricted to T11-L2. Patients who were followed-up for less than 2 years after surgery were excluded. Finally, there are 25 patients in the KP group and 21 in the PSF+VP group. There were no significant differences in patient age, disease duration, or the length of follow-up between the 2 groups.Operative time (43.2 ± 21.8 vs 230.6 ± 87.1 minutes) was significantly longer and bleeding volume (5.3 ± 3.1 vs 215.0 ± 170.2 mL) significantly greater in the PSF+VP group. No significant difference between the 2 groups was observed in Visual analog scale score (VAS) (1.3 ± 0.9 vs 1.2 ± 0.9), Oswestry disability index score (ODI) (27.2 ± 9.0 vs 26.0 ± 6.3), and Cobb angle (17.0 ± 7.2 vs 16.5 ± 2.8). KP resulted in a shorter operation time, less bleeding volume, and fewer postoperative complications than PSF+VP.This study shows that both treatments KP and PSF+VP for KD can be safe and effective for the patients with monosegment lesion and without neurological deficit. However, KP show the advantages in a shorter surgical duration, less blood loss, and fewer postoperative complications.
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Cho Y. Corpectomy and circumferential fusion for advanced thoracolumbar Kümmell's disease. Musculoskelet Surg 2017; 101:269-274. [PMID: 28664486 DOI: 10.1007/s12306-017-0480-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/31/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The aim of this study was to investigate the surgical treatment of neurologically compromised advanced Kümmell's disease. The surgical treatment of Kümmell's disease has various options according to clinical and radiologic status. Far collapsed Kümmell's disease patients with neurological deficit need to be treated surgically. MATERIALS AND METHODS We retrospectively analyzed 22 patients operated to our hospital with neurologically compromised Kümmell's disease between January 2011 and January 2014. Surgical approach was vertebrectomy, mesh cage insertion and segmental cement-augmented pedicle screw fixation. Corpectomy tissue was examined histopathologically. Anterior vertebral heights, kyphotic angle, the visual analog scale (VAS) and the Frankel classification were used to evaluate the effects of the surgery. RESULTS The mean time of follow-up was 26 months (range, 13-40 months). The VAS, anterior vertebral heights, kyphotic angle and neurological state were improved significantly immediate postoperatively and at the last follow-up compared with the preoperative examinations (P < 0.05). Most of the patients in this study exhibited intravertebral clefts, and postoperative pathology revealed bone necrosis. CONCLUSION Posterior vertebrectomy with mesh cage insertion and segmental cement-augmented pedicle screw fixation is an effective option for advanced Kümmell's disease with neurological deficits.
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Affiliation(s)
- Y Cho
- Department of Neurosurgery, Mok-Dong Hospital, Ewha Womans University College of Medicine, Mok-Dong, YangChun-Gu, Seoul, 158-710, Korea.
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