Kyphosis reduction and the rate of cement leaks after vertebroplasty of intravertebral clefts

Abstract

To assess the results of vertebroplasty in patients with intravertebral clefts compared to patients with normal osteoporotic fractures, we evaluated the pre- and postoperative images and pain scores (VAS) of 114 patients with 192 vertebroplasty procedures treated between March 2002 and February 2005. Intravertebral clefts were identified on conventional radiographs, MR or CT images as gas- or fluid-filled spaces adjacent to an endplate of a fractured vertebra. Forty-four vertebrae showed intravertebral clefts. All clefts were filled with PMMA showing a typical filling pattern. Due to the prone positioning of the patient during vertebroplasty, a significant reduction of the kyphosis angle was achieved in the cleft group. Cement leakage occurred in 18.2% of clefts and 46% of regular osteoporotic fractures. In all patients, good filling of the cleft was achieved no matter where the needle tip was placed in the vertebra. The VAS score was 9.1 preoperatively, 3.6 before discharge and 3.9 6 months postoperatively, showing no significant difference between both groups. Patients with intravertebral clefts show a significant reduction of the kyphosis angle compared to non-cleft patients and have a significantly lower risk of experiencing cement leakage during vertebroplasty. Pain reduction is the same in both groups.

Nonunion of Osteoporotic Vertebral Fractures: Clinical Characteristics and Surgical Treatment

“…Ha et al 45 found the difference between patients with and without a cleft in the Oswertry Disability Index (ODI) and visual analog scale (VAS) scores at the final follow-up was not statistically significant. This agrees with the results of McKiernan et al 29 Krauss et al 46 also found pain reduction to be the same in both groups, but patients with intravertebral clefts showed a significant reduction of the kyphosis angle compared to noncleft patients during vertebroplasty.…”

“…This higher rate, compared to that of compression fractures without intravertebral vacuum clefts, may be attributed to the presence of a cleft. However, Krauss et al 46 Cement leakage types differed in osteoporotic compression fractures with and without intravertebral vacuum clefts. Jung et al 13 reported that the leakage types were intradiscal (65.0%), perivertebral venous (25%), epidural (5%), and foraminal (5%) in compression fractures with clefts; and epidural (44.0%), perivertebral venous (32%), and intradiscal (24%) in those without clefts.…”

“…Some scholars 15,45,46 have that believed percutaneous vertebroplasty is effective for treating the fracture nonunion. Ha et al 45 found the difference between patients with and without a cleft in the Oswertry Disability Index (ODI) and visual analog scale (VAS) scores at the final follow-up was not statistically significant.…”

“…Enlargement of the cleft by postural reduction can restore the vertebral body height in mobile fractured vertebrae with nonunion. Thus, Krauss et al 46 believed that kyphoplasty is not necessary for the nonunion. However, Garfin et al 9 and Yoon et al 17 thought kyphoplasty offers the additional advantages of restoring vertebral body height and correcting kyphosis with the use of sufficient cement volume.…”

Kummell’s disease: delayed post-traumatic osteonecrosis of the vertebral body

“…Vertebroplasty for vertebral fracture with or without intravertebral clefts have yielded similar results in terms of pain relief [12,13]. The results with regard to kyphosis reduction, maintenance of disc height and risk of complications, such as cement extrusion after vertebroplasty, for fractures with or without clefts, however, have been heterogeneous [12,13].…”