<b>Percutaneous Vertebroplasty:</b>Treatment of Painful Vertebral Compression Fractures with Intraosseous Vacuum Phenomena

Peh, Wilfred C.G.; Gelbart, Michael S; Gilula, Louis A.; Peck, Dallas

doi:10.2214/ajr.180.5.1801411

Cited by 112 publications

(95 citation statements)

References 31 publications

(76 reference statements)

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“…Despite the presence of intravertebral micromotion, mechanical failures such as the dislodgement of PMMA cement have not been reported in the literature [11][12][13] or in the present study. This may be attributed to relatively short follow-up periods in these studies.…”

Section: Discussioncontrasting

confidence: 59%

“…PVP has been performed in patients with vertebral pseudarthrosis [11][12][13]19] and much more widely in patients with vertebral compression fractures [19][20][21]. The suitability of PVP for incident vertebral fractures remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…One reason for such controversy is the lack of studies evaluating bone union status following PVP for incident fracture, as bone union is a standard endpoint of A small number of patients, short follow-up periods, and the absence of a control group represent limitations of this study. Because of the rarity of vertebral pseudarthrosis, other studies of PVP for vertebral pseudarthrosis comprised of 20 or fewer patients [11][12][13]19]. Unless we conduct a comparative analysis with a control group, we are not able to answer the question whether or not PVP can change the A preoperative reconstruction CT scan image (a) showed accumulation of air in the intravertebral cleft, which was communicated with the intradiscal air in the L2/L3 intervertebral disc.…”

Section: Discussionmentioning

confidence: 99%

“…To date, controversies still prevail regarding terminology, pathogenesis, and treatment of this condition. Accordingly, a variety of surgical procedures have been reported, including osteosynthesis [5], decompression and fusion surgeries by anterior [6,7], posterior [7][8][9], and anteroposterior [10] approaches, percutaneous vertebroplasty (PVP) [11][12][13], and percutaneous kyphoplasty [14]. Whereas osteosynthesis and fusion surgeries aim at solid bone union for stabilization of the affected vertebra, union status following PVP or percutaneous kyphoplasty has not yet been addressed.…”

Section: Introductionmentioning

confidence: 99%

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Conversion to hypertrophic vertebral pseudarthrosis following percutaneous vertebroplasty

et al. 2010

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To determine the role of percutaneous vertebroplasty (PVP) in bone formation and the union of vertebral pseudarthrosis, we analyzed 14 patients with an average follow-up duration of 21 months. Evaluation methods included back pain (visual analog scale: VAS), wedge angle, dynamic mobility, radiographic remodeling including callus and spur formation, and union status. The Student's t test was used for statistical analysis and a probability of less than 0.05 was determined as a significant difference. Back pain improved in all 14 patients with a VAS score of 57.8 ± 23.5 mm (average ± standard deviation) preoperatively and 14.7 ± 16.4 mm at the final follow-up (P \ 0.001). The wedge angle decreased from 21.6°± 8.3°(average ± standard deviation) preoperatively to 13.2°± 6.9°at the final follow-up (P \ 0.001). Callus formation was seen in four patients. Bony spurs were seen in the affected vertebra in preoperative radiographs in all patients, and were further developed to a solidified form during follow up after PVP. Dynamic mobility of the affected vertebrae was 6.9 ± 2.9 mm preoperatively, which decreased to 1.1°± 0.7°at the final follow-up (P \ 0.001). Notably, all patients showed the dynamic vertebral mobility of 2 mm or less. Nevertheless, only two patients exhibited the dynamic vertebral mobility of 0 mm at the final follow-up, which is referred to as bone union. These findings indicate that PVP serves as a mechanical stabilizer for vertebral pseudarthrosis, which leads to immediate pain relief and segmental bony responses.

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Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Conversion to hypertrophic vertebral pseudarthrosis following percutaneous vertebroplasty

et al. 2010

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“…Some patients present with intractable back pain for prolonged periods of time, while others suffer from neurological deficits within a few months' time after fracture. In such cases, insufficient union is often noted on plain radiography and/or MRI [18,22]. Recently, reports of insufficient union have been increasing [13,15,19,26,29].…”

Section: Introductionmentioning

confidence: 99%

Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture

et al. 2009

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The purpose of this study was to examine factors affecting the severity of neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture (OVF). Reports of insufficient union following OVF have recently increased. Patients with this lesion have various degrees of neurological deficits and back pain. However, the factors contributing to the severity of these are still unknown. A total of 45 patients with insufficient union following OVF were included in this study. Insufficient union was diagnosed based on the findings of vertebral cleft on plain radiography or CT, as well as fluid collection indicating high-intensity change on T2-weighted MRI. Multivariate logistic regression analysis was performed to determine the factors contributing to the severity of neurological deficits and back pain in the patients. Age, sex, level of fracture, duration after onset of symptoms, degree of local kyphosis, degree of angular instability, ratio of occupation by bony fragments, presence or absence of protrusion of flavum, and presence or absence of ossification of the anterior longitudinal ligament (OALL) in the adjacent level were used as explanatory variables, while severity of neurological deficits and back pain were response variables. On multivariate analysis, factors significantly affecting the severity of neurological deficits were angular instability of more than 15°[adjusted odds ratio (OR), 9.24 (95% confidence interval, CI 1.49-57.2); P \ 0.05] and ratio of occupation by bony fragments in the spinal canal of more than 42% [adjusted OR 9.23 (95%CI 1.15-74.1); P \ 0.05]. The factor significantly affecting the severity of back pain was angular instability of more than 15°[ adjusted OR 14.9 (95%CI 2.11-105); P \ 0.01]. On the other hand, presence of OALL in the adjacent level reduced degree of back pain [adjusted OR 0.14 (95%CI 0.03-0.76); P \ 0.05]. In this study, pronounced angular instability and marked posterior protrusion of bony fragments in the canal were factors affecting neurological deficits. In addition, marked angular instability was a factor affecting back pain. These findings are useful in determining treatment options for patients with insufficient union following OVF.

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Biomechanical Considerations

Belkoff

Percutaneous Vertebroplasty and Kyphoplasty

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Percutaneous Vertebroplasty:Treatment of Painful Vertebral Compression Fractures with Intraosseous Vacuum Phenomena

Abstract: Percutaneous vertebroplasty is effective in the treatment of patients with painful vertebral compression fractures with intraosseous vacuum phenomena.

Cited by 112 publications

References 31 publications

Conversion to hypertrophic vertebral pseudarthrosis following percutaneous vertebroplasty

Conversion to hypertrophic vertebral pseudarthrosis following percutaneous vertebroplasty

Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture

Biomechanical Considerations

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