Minimally invasive techniques for the treatment of osteoporotic vertebral fractures

Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.
Instructional course lectures 02/2007; 56(8):273-85.
Source: PubMed

ABSTRACT Osteoporotic vertebral compression fractures are a leading cause of disability and morbidity in the elderly. The consequences of these fractures include pain, progressive vertebral collapse with resultant spinal kyphosis, and systemic manifestations. Nonsurgical measures have proved unsuccessful in a portion of this population and for this group, minimally invasive vertebral augmentation can be beneficial. Vertebroplasty is designed to address vertebral fracture pain. It involves percutaneous injection of polymethylmethacrylate (PMMA) directly into a fractured vertebral body with the goals of pain relief and prevention of further collapse of the fractured vertebra. Kyphoplasty is designed to address the kyphotic deformity as well as the fracture pain. It involves the percutaneous insertion of an inflatable bone tamp into a fractured vertebral body. Bone tamp inflation works to elevate the end plates and create a cavity to be filled with PMMA with the goals of pain relief, restoration of vertebral body height, and reduced kyphotic deformity. Optimizing surgical technique can improve outcomes and decrease complication rates, and decrease radiation exposure to the patient and surgical team. Obtaining a biopsy prior to cement injection has proved efficacious and may result in the diagnosis of occult pathology underlying a seemingly routine vertebral fracture. As competence and surgical success are acquired, the indications will continue to expand to encompass more challenging pathologies. Recently, vertebral augmentation during spinal decompression and instrumented fusion for burst fracture with neurologic insult has been reported to be successful.

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    ABSTRACT: To determine the efficacy of percutaneous vertebroplasty in treating severe vertebral body compression fractures, or vertebra plana, in patients with osteoporosis. In 155 patients, 310 percutaneous vertebroplasties were performed during 25 months and 15 days. Of these, 37 patients (27 women, 10 men; mean age, 73.6 years) underwent 48 vertebroplasties for severe osteoporotic vertebral body compression fractures. The fractures were defined as vertebrae that have collapsed to less than one-third of their original height. Imaging and clinical features were analyzed, including the extent of vertebral collapse, location of the involved vertebra, pattern of vertebral compression, volume of polymethylmethacrylate injected, vertebroplasty complications, and clinical outcome. Vertebral body collapse averaged 23% (range, 4.5%-33.0%) of the original height. Involved vertebrae were located from levels T5 to L5, with one-half affected at the thoracolumbar junction. Patterns of vertebral compression were divided into gibbus (31 of 48 or 65%), plana (13 of 48 or 27%), and H shape (four of 48 or 8%). The mean volume of the cement injected was 6.0 mL (range, 1.5-12.5 mL). Complications observed on radiographs included cement leakage to the adjacent disc (17 of 48 or 35%) and the paravertebral soft tissues (four of 48 or 8%). There were no major complications. At clinical follow-up (mean duration, 11 months and 3 days; range, 3-24 months), pain relief was complete in 14 (47%) of 30 patients, partial in 15 (50%), and unchanged in one (3%). No patient required surgery. Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures is safe and effective and should not be withheld in this group of patients.
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    ABSTRACT: Patients experience more than 700,000 osteoporotic vertebral compression fractures each year in the United States, primarily because of bone brittleness and the inability of the vertebrae to resist increased forces applied to them. Patients diagnosed with this type of fracture are given the option of conservative or operative treatment approaches. Although a typical compression fracture generally heals in 6 to 12 weeks, patients may be offered the kyphoplasty procedure, which reduces the fracture and stabilizes it with cement. Although this procedure is not without risk, it is deemed a safe and effective treatment option. This article reviews the indications, implications, and care provided to patients pursuing kyphoplasty after osteoporotic vertebral compression fracture.
    Orthopaedic Nursing 11/2007; 26(6):342-6; quiz 347-8. DOI:10.1097/01.NOR.0000300942.56214.2e · 0.60 Impact Factor
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    ABSTRACT: Vertebral compression fractures are the most common skeletal injuries due to osteoporosis. Osteoporotic vertebral compression fractures stand for the leading cause of disability and morbidity in the elderly.The aim of the paper was to present the modern management of osteoporotic vertebral fractures.The paper presents the results of the treatment of 44 patients with osteoporotic vertebral fractures in the period from January 1, 2002 to December 31, 2005 at the Clinic of Orthopaedic Surgery and Traumatology, Clinical Center Nis. In the analyzed group there were 31 (70.45%) females and 13 (29.55%) males. The subjects in the sixth decade -16 (36.36%), the fifth decade – 13 (29.55) and the seventh decade of life – 6 (13.66) prevailed. The most frequent cause of osteoporotic vertebral fractures in the elderly was minor trauma. Most of the patients – 34 (77.27%) with osteoporotic vertebral fractures were treated with bed rest and analgesic medications, 7 (15.91%) patients were treated with bed rest, analgesic medications and bracing, while three patients were treated by vertebroplasty. Anti-osteoporotic drugs (calcium, vitamin D, bisphosphonates) were administered to all patients. Among the complications associated with osteoporotic vertebral fractures, the collapse of vertebral body followed by chronic pain was reported in 15 (34.09%) cases and development of kyphotic deformity in 12 (27.27%) cases. In the patients treated by vertebroplasty, no complications were registered. Good results have been reported following vertebroplasty in the treatment of osteoporotic vertebral fractures.

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