Percutaneous vertebroplasty for osteoporotic vertebral compression fracture with intravertebral cleft associated with delayed neurologic deficit

Abstract

Introduction The number of cases of osteoporotic vertebral compression fracture (OVCF) with intravertebral cleft (IVC) with delayed neurologic deficit (DND) is increasing as the population ages. However, the cause of DND is poorly understood, and no definitive treatment of the disease has been established. The purpose of this study was to clarify the radiographic parameters contributing to the occurrence of DND, and to evaluate the efficacy and safety of percutaneous vertebroplasty for this pathology. Methods Percutaneous vertebroplasty was prospectively performed for 244 patients with OVCF with IVC; 30 had DND and 214 did not. Radiographic parameters of local kyphotic angle, percent spinal canal compromise and intravertebral instability were investigated for correlations to DND. Procedural outcomes were evaluated using visual analog scale (VAS), Oswestry Disability Index (ODI), and modified Frankel grades. Results Before vertebroplasty, no substantial difference in local kyphotic angle was seen between OVCF with IVC with and without DND, but percent spinal canal compromise and intravertebral instability were greater in OVCF with IVC with DND (P \ 0.001). After vertebroplasty, 25 of 30 cases (84 %) of OVCF with IVC with DND achieved clinically meaningful improvement (CMI), but 5 (17 %) did not. Patients with CMI showed substantial improvements in intravertebral instability (P \ 0.001), and no change in local kyphotic angle or percent spinal canal compromise. In five patients without CMI, four showed an initial improvement, but subsequent vertebral fracture adjacent to the treated vertebra caused neurologic re-deterioration. One patient with percent spinal canal compromise 54.9 % and intravertebral instability 4°achieved no neurologic improvement following vertebroplasty. No serious complications or adverse events related to the procedure were encountered. ConclusionsIntravertebral instability is the dominant cause of DND. Percutaneous vertebroplasty appears effective and safe in the treatment of OVCF with IVC with DND. Patients with less intravertebral instability and severe spinal canal compromise could be candidates for conventional surgical treatment.

Posterior Fixation Combined with Vertebroplasty or Vertebral Column Resection for the Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft Complicated by Neurological Deficits

“…Owing to the progression of kyphosis with vertebral collapse and intravertebral instability at the cleft site, patients with advanced-stage Kummell's disease are more susceptible to neurological deficits [19]. Minimally invasive procedures, such as percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP), have been widely applied once conservative treatment fails for OVCFs with IVC [10,[20][21][22][23].…”

“…Minimally invasive procedures, such as percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP), have been widely applied once conservative treatment fails for OVCFs with IVC [10,[20][21][22][23]. Although a few studies have confirmed that vertebroplasty could be an alternative intervention for the effective and safe treatment of OVCFs with IVC complicated by neurological deficits, patients with low intravertebral stability and severe spinal cord injuries should be considered candidates for reconstructive surgery [19]. Currently, several open surgery options, mainly consisting of posterior fixation combined with vertebroplasty (PFVP) or vertebral column resection (PVCR) for IVC complicated by neurological deficits, have been reported in the literature [20,[24][25][26].…”

Modified Pedicle Subtraction Osteotomy for Osteoporotic Vertebral Compression Fractures

“…However, vertebroplasty or kyphoplasty is less effective for spinal stability or neurological recovery, and Nakamae et al . also reported that it is ineffective in cases of high‐grade spinal canal compromise and an absence of remarkable dynamic instability. Furthermore, increasing attention on health and developments in medicine have created rapid growth of the aging population.…”

The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the “medical” articles in the European Spine Journal, 2013

“…The paper by Nakamae et al [22], which also appears in the July issue deals with osteoporotic vertebral compression fractures (OVCF) with an intervertebral cleft (IVC) and delayed neurologic deficit (DND). The aim of this study was to clarify the mechanisms of delayed neurologic deficit and evaluate the efficacy of percutaneous vertebroplasty in OVCF with IVC associated with DND.…”