Vertebral Pseudarthrosis in the Osteoporotic Spine

Hara, Kazuhiro; Homma, Takao; Uchiyama, Seiji; Takahashi, Hideaki

doi:10.1097/00007632-199810150-00011

Cited by 124 publications

(94 citation statements)

References 15 publications

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“…In the present study, we found that IVC (10 recompressions out of 24 IVCs) was one of the factors most strongly related to recompression. IVC provides radiological evidence of osteonecrosis [5,19,22,24,27], or nonunion and pseudoarthrosis after vertebral fracture [1,2,11,13,23]. Whatever the reasons, IVC might be made in chronic period of fracture healing process after initial trauma.…”

Section: Discussionmentioning

confidence: 99%

Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture

2010

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The purpose of this retrospective clinical study was to evaluate the factors that affect recompression of operated vertebrae after percutaneous balloon kyphoplasty (PKP) for osteoporotic vertebral compression fractures (VCFs) and assess their clinical importance. PKP has been used for VCFs with satisfactory results. Several studies about subsequent VCFs adjacent to cemented vertebrae have been reported after PKP. However, the presence and significance of recompression of operated vertebrae have not been adequately described. In total, 80 patients treated with PKP for single thoracolumbar VCFs were reviewed. The follow-up period was at least 1 year. Patients were divided into those without recompression (maintained group, n = 70) and those with recompression (recompressed group, n = 10). Plain roentgenography (preoperative, operative, and last), preoperative BMD, and preoperative MRI were checked. Age, gender, T-score in BMD, duration of symptom, compression rate (CR) of VCF, reduction rate, kyphotic angle (KA), reduction angle, intervertebral cleft (IVC), and non-PMMA-endplate-contact (NPEC) were evaluated. To evaluate the clinical results, we checked the VAS score at each follow-up period. All data were analyzed statistically. The CR for the recompressed group increased significantly after surgery and decreased at the last follow-up (p \ 0.05). The last CR was not significantly different from the preoperative CR. The KA showed the same pattern. The preoperative, postoperative, and last VAS scores were significantly different from one another in both groups (p \ 0.05). Between the groups, preoperative KA, postoperative KA, last KA, IVC, and NPEC were significantly different (p \ 0.05). In particular, last KA, IVC, and NPEC showed highly significant differences (p \ 0.001). In a correlation test for the evaluated factors, IVC (r = 0.557) and NPEC (r = 0.496) were the most significant. The presence of IVC and NPEC may play an important role in inducing recompression of treated vertebrae after PKP. Careful observation of patients with these conditions is necessary to prevent deterioration of their clinical course.

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Section: Discussionmentioning

confidence: 99%

Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture

2010

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“…Ettinger et al reported that vertebral deformities cause marked back pain if vertebral height ratios fall four standard deviations below the normal mean [6]. However, pseudoarthrosis following OVF has recently come to be considered a poor prognostic factor for prolonged and intractable pain [10,14,16]. On the other hand, Hashidate et al reported that in 66.7% of patients back pain decreased naturally despite the presence of vertebral instability in cases of vertebral pseudoarthrosis [11].…”

Section: Discussionmentioning

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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“…Vertebral pseudarthrosis is a relatively rare, painful condition associated with osteoporotic vertebral fractures [1][2][3][4]. To date, controversies still prevail regarding terminology, pathogenesis, and treatment of this condition.…”

Section: Introductionmentioning

confidence: 99%

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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Vertebral Pseudarthrosis in the Osteoporotic Spine

Cited by 124 publications

References 15 publications

Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture

Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture

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

Conversion to hypertrophic vertebral pseudarthrosis following percutaneous vertebroplasty

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