Clinical Analysis of Acute Radiculopathy after Osteoporotic Lumbar Compression Fracture

Kim, Do Eon; Kim, Hyeun Sung; Kim, Seok Won; Kim, Hyun Sook

doi:10.3340/jkns.2015.57.1.32

Cited by 22 publications

(19 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[ 52 ] Although the exact mechanism of pain remission remains unclear, there were several categories of axis and nonmidline pain from OVCFs patients. [ 53 ] Pain is likely to be attributable to vertebral body and other factors such as paravertebral muscles, tendon, [ 5 ] facet joint, [ 6 ] sympathy nerve, and radiculopathy due to foraminal height or space decreases with vertebral body collapse, facet hypertrophy, decreased disc height, foraminal, or extraforaminal disc herniations [ 7 ] (Fig. 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…[ 3 , 4 ] Although the exact mechanism of pain remission remains unclear, pain is likely to be attributable to vertebral body and other factors such as paravertebral muscles, tendon, [ 5 ] facet joint, [ 6 ] sympathy nerve, and radiculopathy due to foraminal height or space decreases with vertebral body collapse, facet hypertrophy, decreased disc height, and foraminal or extraforaminal disc herniations. [ 7 ] Various nonsurgery treatments including conservative treatment (CT), percutaneous vertebral augmentation (PVA, both PVP and PKP) and nerve block (NB), are performed with the goal of reducing pain, stabilizing the vertebrate, and restoring mobility. CT was considered the gold standard for treating OVCFs in the past, which includes treatments with a combination of antiosteoporotic drugs, short periods of bed rest or bedridden, postural reduction, various pharmacological agents, recreational therapy, bracing, and physical therapy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Network meta-analysis of percutaneous vertebroplasty, percutaneous kyphoplasty, nerve block, and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures (OVCFs) in short-term and long-term effects

et al. 2018

View full text Add to dashboard Cite

Background:Osteoporotic vertebral compression fractures (OVCFs) commonly afflicts most aged people resulting back pain, substantial vertebral deformity, functional disability, decreased quality of life, and increased adjacent spinal fractures and mortality. Percutaneous vertebral augmentation (PVA) included percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP), nerve block (NB), and conservative treatment (CT) are used for the nonsurgery treatment strategy of OVCFs, however, current evaluation of their efficacy remains controversial.Methods and analysis:A systematic literature search was carried out in PubMed, EMBASE, Web of Knowledge, and the Cochrane Central Register of Controlled Trials up to October 31, 2017. Randomized controlled trials (RCTs) were compared PVP, PKP, NB, or CT for treating OVCFs. The risk of bias for each trial was rated according to the Cochrane Handbook. Mean differences (MDs) with 95% confidence intervals (CIs) were utilized to express VAS (visual analog scale) outcomes. The network meta-analysis (NMA) of the comparative efficacy measured by change of VAS on acute/subacute and chronic OVCFs was conducted for a short-term (<4 weeks) and long-term (≥6–12months) follow-up with the ADDIS software.Results:A total of 18 trials among 1994 patients were included in the NMA. The PVA (PVP and PKP) had better efficacy than CT. PKP was first option in alleviating pain in the case of the acute/subacute OVCFs for long term, and chronic OVCFs for short term and long term, while PVP had the most superiority in the case of the acute/subacute OVCFs for short term. NB ranks higher probability than PKP and PVP on acute/subacute OVCFs in short and long-term, respectively.Conclusions:The present results suggest that PVA (PVP/PKP) had better performance than CT in alleviating acute/subacute and chronic OVCFs pain for short and long-term. NB may be used as an alternative or before PVA, as far as pain relief is concerned. Various nonsurgery treatments including CT, PVA (PVP/PKP), NB, or a combination of these treatments are performed with the goal of reducing pain, stabilizing the vertebrae, and restoring mobility.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Network meta-analysis of percutaneous vertebroplasty, percutaneous kyphoplasty, nerve block, and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures (OVCFs) in short-term and long-term effects

et al. 2018

View full text Add to dashboard Cite

show abstract

“…With spinal tumors, there is often a significant time delay between the onset of symptoms and diagnosis because of the insidiousness of the symptoms that can mimic the back pain and leg complaints seen with general degenerative back complaints, with the average time to diagnosis just for lumbar tumors averaging eight months [5]. Patients with osteoporotic spinal fractures, which are found in the elderly population, have a significant incidence of lumbar stenosis with possible symptoms of neurogenic claudication, which can be confused with CES, although neurogenic claudication symptoms are more intermittent and positional and rarely associated with urinary incontinence [6]. Low force osteoporotic traumatic fractures rarely present initially with either radicular symptoms or CES but can develop these symptoms as a result of progressive kyphotic deformity and gradual stenosis of the canal in the fractured area [7].…”

Section: Introductionmentioning

confidence: 99%

Cauda Equina Syndrome in a Patient with Intradural Schwannoma at the Same Level as an Acute L2 Compression Fracture

Mallol¹,

Taveras²,

Hartman

et al. 2019

Cureus

View full text Add to dashboard Cite

Intradural tumors are found often as either incidental findings or during evaluation during magnetic resonance imaging (MRI) for lumbar and/or radicular pain. This patient presented with an acute L2 compression fracture, however, the initial MRI identified a large spinal mass separate from the fracture but at the same level. The patient had acute upper lumbar pain after a fall but the neurologic examination also revealed findings of early cauda equina syndrome with muscle weakness, asymmetric leg numbness, and urinary incontinence. Further history revealed the patient had been using a cane for several months and having difficulty walking with some upper lumbar pain but had not seen a physician. The differential was an extruded disc associated with the fractured endplate versus a tumor. Because of the neurologic symptoms, emergency open decompression combined with multilevel screw fixation was performed. At the time of the laminectomy, the dura bulged posteriorly, no ventral disc was found, and a 3-cm intradural schwannoma was successfully excised with rapid neurologic recovery. The article will review the relationship of cauda equina syndrome with osteoporotic fractures and the rarity of actual true disc extrusion with compression fractures, as well as the more common relationship of finding cauda equina syndrome with intradural tumors when there is severe canal stenosis as seen in this unusual case.

show abstract

“…Lower lumbar vertebral compression fractures are less common. Lower lumbar fractures from L3 to L5 compose only 8% to 12% of a large series of VCF and sacral fractures less than 4% of large study groups [ 5 - 6 ]. Generally, VCFs are more commonly associated with localized spinal pain than with neurologic complaints; however, lower lumbar fractures, especially at L5, have a significant incidence of presenting with radiculopathy.…”

Section: Introductionmentioning

confidence: 99%

“…Generally, VCFs are more commonly associated with localized spinal pain than with neurologic complaints; however, lower lumbar fractures, especially at L5, have a significant incidence of presenting with radiculopathy. Leg pain is seen in 15% to 25% of lumbar fractures and is definitely more frequent with fractures at L4 and L5 compared to L2 and L3 [ 5 - 6 ]. Since these elderly patients frequently have lumbar stenosis (LS), often with degenerative spondylolisthesis (DS) or lumbar degenerative scoliosis (LDS), determining the cause of radiculopathy or directly relating it to the fracture can be difficult [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Multilevel Contiguous Osteoporotic Lumbar Compression Fractures: The Relationship of Scoliosis to the Development of Cascading Fractures

Sabo¹,

Hatgis²,

Granville

et al. 2017

Cureus

View full text Add to dashboard Cite

Osteoporotic patients can present with either single or multiple fractures secondary to repeated falls and progressive osteoporosis. Multiple fractures often lead to additional spinal deformity and are a sign of more severe osteoporosis. In the thoracic spine, multiple fractures are associated with the development of gradual thoracic kyphosis but neurologic deficits are uncommon. In the lumbar spine, patients with multiple lumbar fractures have more constant lumbar pain, may have symptoms related to concurrent lumbar stenosis or degenerative scoliosis, and may present with radiculopathy, especially with fractures at L4 and L5. In a review of a series of patients with recurrent multiple lumbar fractures or 'cascading' fractures, it was found that all the patients were female, had severe osteoporosis, often untreated, had a previous history of multiple previous thoracic and lumbar fractures, and all had associated scoliotic spinal deformities ranging from 6 o to 50 o . It was found that if the curve progressed and the greater the degree of curvature, the more frequently subsequent multiple fractures developed, leading to recurrent acute episodes of pain. Forty percent also had additional sacral insufficiency fractures, an unusually high percentage. Biomechanically, the lumbar spine is both more mobile and supports a larger portion of the spinal load compared to the thoracic spine. The existence or worsening of a lumbar spinal deformity from degenerative lumbar scoliosis shifts the mechanical forces more to one side on already weakened osteoporotic lumbar vertebrae and sacrum, leading to an increased incidence of these fractures. Because of the chronic and uneven lower lumbar spinal load with severe vertebral osteoporosis in certain patients with repeat lumbar fractures and worsening degenerative lumbar scoliosis, there may be a rationale to add preventive vertebroplasty at adjacent vertebral endplates when treating acute recurrent lumbar fractures to decrease the incidence of recurrence in other vertebrae.

show abstract

Clinical Analysis of Acute Radiculopathy after Osteoporotic Lumbar Compression Fracture

Cited by 22 publications

References 9 publications

Network meta-analysis of percutaneous vertebroplasty, percutaneous kyphoplasty, nerve block, and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures (OVCFs) in short-term and long-term effects

Network meta-analysis of percutaneous vertebroplasty, percutaneous kyphoplasty, nerve block, and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures (OVCFs) in short-term and long-term effects

Cauda Equina Syndrome in a Patient with Intradural Schwannoma at the Same Level as an Acute L2 Compression Fracture

Multilevel Contiguous Osteoporotic Lumbar Compression Fractures: The Relationship of Scoliosis to the Development of Cascading Fractures

Contact Info

Product

Resources

About