ABSTRACT: The role of whole-body Tc-MDP bone scanning in the management of vertebral compression fractures with kyphoplasty has not been clearly established.
To determine the accuracy of bone scanning in patient selection, planning treatment and predicting response to kyphoplasty.
Retrospective chart reviews were undertaken of all kyphoplasties performed by the same orthopaedic surgeon between June 2000 and June 2004. All patients who underwent plain radiographs (X-ray) of the spine and bone scanning within 4 weeks of treatment were included. Response to treatment was assessed via a questionnaire administered to the patient 3 weeks after intervention and concomitant objective assessment. Response was graded as excellent, intermediate or poor. Each bone scan was reviewed by two nuclear physicians blinded to the initial scan results, level of treatment and therapeutic response. The readers were asked to indicate the level(s) to be treated according to the bone scan findings. Sites of chronic fractures were also recorded.
Sixty-six procedures on 60 patients fulfilled the selection criteria. Fifty-three patients were managed by X-ray and bone scanning (A) and seven were managed by X-ray only (B). There was a significant difference in the rates of sub-optimal results between (A) and (B) (11/53 vs. 7/7, P=0.0001). There was also a significant difference in chronic fracture rates between patients with excellent outcome and those with sub-optimal results (3/42 vs. 7/11, P=0.0002). A high rate of incorrect level selection (3/7) was found in (B). In 12 patients (20%) X-ray showed multiple fractures but the bone scanning demonstrated only one level of acute disease.
Bone scanning is an excellent predictor of response to kyphoplasty and decreases the number of vertebrae to be treated as suggested by X-ray. Preoperative bone scanning is recommended to avoid incorrect selection of treatment level. Even when the appropriate level has been selected an incomplete response can be expected if additional chronic fracture is seen on bone scanning. In the event of unexpected incomplete response, re-evaluation with bone scanning may demonstrate new disease amenable to therapy.
Nuclear Medicine Communications 04/2008; 29(3):247-53. · 1.40 Impact Factor
ABSTRACT: A growing population of patients with osteoporosis and fragility fractures has developed. Fragility fractures, including vertebral compression fractures, have been associated with increased mortality. Early operative interventions for patients sustaining hip fractures have been found to reduce mortality.
To determine if kyphoplasty improves survival after vertebral compression fractures.
A retrospective chart review of all kyphoplasty procedures performed by the same orthopedic surgeon between June 2000 and June 2004 and a review of patients receiving nonoperative care consisting of oral analgesia and an orthosis during the same time period were conducted.
Patients seen by a single surgeon for an osteoporotic vertebral body fracture.
The primary outcome measured was patient death within the study time period.
Data from both groups were tabulated and analyzed for statistical differences by Student t test and chi-squared analysis. Kaplan-Meier curves comparing age, medical comorbidity, and surgical intervention were constructed. Log-rank test was used to analyze the survival curves.
Of the 94 patients who elected for kyphoplasty, 38 patients were deceased at the close of the current study which ended in September 2006, whereas 26 of the 90 patients who elected for conservative therapy had died. Student t test revealed a significant age difference between patients treated with kyphoplasty and those who were treated nonoperatively (p=.0002). Chi-squared analysis revealed a significant difference between the two populations with respect to Charlson score (p=.050) but no statistical difference between the two populations with respect to ASA (p=.81) or gender (p=.1207). Kaplan-Meier curves were constructed to independently assess the influence of age, medical comorbidity, and kyphoplasty on survival. A significant relationship was detected by log-rank test for age (p=.0172), ASA (p=.0497), and Charlson score (p=.0015) but not treatment with kyphoplasty (p=.1037). An age-adjusted mortality rate was calculated and was found to be 35.3 per 1,000 patient-years for the conservative treatment population and 40.1 for the surgical population. A multivariate analysis comparing age, comorbidity, and surgical treatment with survival did not detect a statistical relationship.
Kyphoplasty did not seem to effect the survival of patients with a vertebral compression fracture.
The Spine Journal 08/2007; 8(5):763-9. · 3.29 Impact Factor
ABSTRACT: Osteoporotic compression fractures cause great morbidity to the aging population. Various percutaneous methods have been developed to aid in treatment, including vertebral kyphoplasty. Biomechanical studies and recent published data relate concerns about adjacent fracture.
This study investigated the incidence of recurrent fracture after the kyphoplasty procedure.
Retrospective review of kyphoplasty procedures preformed by a single surgeon.
A total of 109 procedures in 94 patients were reviewed.
Patient medical records were reviewed as well as the radiology database at two major regional hospitals.
Patient records were reviewed for fracture recurrence.
Confounding factors of age at procedure, sex, and chronic steroid use were also considered and found to have no statistically significant difference between those with fracture recurrence and those without fracture recurrence (p=.1979, p=.2058, p=.4684, respectively). Eleven kyphoplasty procedures resulted in a recurrent fracture after kyphoplasty within the first 90 days (34+/-19). After the first 90 days, five recurrent fractures occurred (459+/-101). The number of vertebral levels treated was found to be related to incidence of recurrent fracture with a p value of .0005 via chi-square testing. Patients who sustained a recurrent fracture tended to have a higher number of vertebral levels treated. There was no statistically significant difference between the survival time of kyphoplasty procedures that resulted in recurrent adjacent versus distant vertebral body fracture (survival time 112+/-145 vs. 237+/-268, p value .2362).
The incidence of recurrent fracture after kyphoplasty is substantial at 10% within the first 90 days. It is difficult to determine if this fracture rate is the result of surgical intervention or the natural history of the patient's osteoporosis.
The Spine Journal 6(5):488-93. · 3.29 Impact Factor