VP and KP are 2 minimally invasive procedures that have been shown to be effective in the treatment of symptomatic vertebral compression fractures. Although the incidence of adverse events for both VP and KP are low, it appears that VP is associated with a statistically significant increased rate of procedure-related complications and cement extravasation (symptomatic and asymptomatic). Future prospective studies with large patient enrollment will be needed to further validate the finding of this meta-analysis.

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Osteoporotic burst fractures with neurologic symptoms are typically treated with neural decompression and multilevel instrumented fusion. These large surgical interventions are challenging because of patients' advanced ages, medical co-morbidities, and poor fixation secondary to osteoporosis. The purpose of this retrospective clinical study was to describe a novel technique for the treatment of osteoporotic burst fractures and symptomatic spinal stenosis via a limited thoracolumbar decompression with open cement augmentation [vertebroplasty (VP) or kyphoplasty (KP)]. Indications for decompression and cement augmentation were intractable pain at the level of a known osteoporotic burst fracture with symptoms of spinal stenosis. As such, 25 patients (mean age, 76.1 years) with low-energy, osteoporotic, thoracolumbar burst fractures (7 males, 18 females; 39 fractures) were included. In all cases, laminectomy of the stenotic level(s) was followed by vertebral cement augmentation (9 VP; 16 KP). When a spondylolisthesis at the decompressed level was present, instrumentation was applied across the listhetic level (n = 9). Clinical outcome (1 = poor to 4 = excellent) was assessed on last clinical follow-up (mean, 44.8 wks). In addition, a modified MacNab's grading criteria was used to objectively assess patient outcomes postoperatively. Radiographic analysis of sagittal contour was assessed preoperatively, immediately postoperatively, and at final follow-up. The average time from onset of symptoms to intervention was 19 weeks (range, 0.3-94 wks). A mean of 1.6 fractures/patient was augmented (range, 1-3 fractures) and 2.8 levels were decompressed (range, 1-6 levels). No statistical difference in anatomic distribution or number of fractures between the VP and KP groups or in the instrumented versus noninstrumented patients was noted (P > 0.05). An overall subjective outcome score of 3.4 was noted. Twenty of 25 patients were graded as excellent/good according to the modified MacNab's criteria. The choice of augmentation procedure or use of instrumentation did not predict outcome (P = 0.08). Overall, 1.7 degrees of sagittal correction was obtained at final follow-up. One patient was noted to have progressive kyphosis after KP. The use of a limited-posterior decompression and open cement augmentation via VP or KP is a safe treatment option for patients who have osteoporotic burst fractures and who are incapacitated from fracture pain and concomitant stenosis. After thoracolumbar decompression, open VP/KP provides direct visualization of the posterior vertebral body wall, allowing for safe cement augmentation of burst fractures, stabilizing the spine, and obviating the need for extensive spinal reconstruction. Although clinically successful, this technique warrants careful patient selection.

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HistoryA 10-year-old 9.1-kg (20-lb) neutered male domestic shorthair cat was evaluated because of an acute onset of lethargy, vomiting, anorexia, and paradoxical breathing a few hours prior to hospital admission. Physical examination revealed mild tachypnea (40 breaths/min), paradoxical breathing, and absence of lung sounds ventrally on the right side of the thorax. Anemia (Hct, 17%; reference range, 30% to 45%), thrombocytopenia (140,000 platelets/µL; reference range, 300,000 to 700,000 platelets/µL), and a stress leukogram (neutrophil count, 19,500 neutrophils/ µL; reference range, 2,500 to 12,500 neutrophils/µL; lymphocyte count, 1,100 lymphocytes/µL; reference range, 1,700 to 7,000 lymphocytes/µL) were detected on CBC. Mild hypoproteinemia (4.2 g/dL; reference range, 5.8 to 8.0 g/dL) was detected on serum biochemical analysis. Prothrombin time and partial thromboplastin time were within the reference ranges. Radiographs of the thorax were obtained (Figure 1).Determine whether additional imaging studies are required, or make your diagnosis from Figure 1-then turn the page → Figure 1-Left lateral (A) and ventrodorsal (B) radiographic views of the thorax of a 10-year-old 9.1-kg (20-lb) neutered male domestic shorthair cat evaluated because of an acute onset of lethargy, vomiting, anorexia, and paradoxical breathing a few hours prior to hospital admission.