Percutaneous transpedicular vertebroplasty with calcium phosphate cement in the treatment of osteoporotic vertebral compression and burst fractures.
OBJECTIVE
Osteoporotic vertebral fractures occasionally lead to late-onset collapse, kyphosis, persistent back pain, and disability. The authors describe a series of patients in whom they performed percutaneous vertebroplasty by using calcium phosphate cement (CPC) to obtain early pain relief and improve the integrity of the osteoporotic vertebral body (VB).


METHODS
Between August 2000 and February 2001, they performed 17 percutaneous transpedicular CPC-assisted vertebroplasty procedures in 16 patients who harbored thoracic or lumbar osteoporotic vertebral fractures. Following repositioning and curettage of the pathological soft tissues, CPC-assisted vertebroplasty was percutaneously performed in four patients with osteoporotic burst fracture and pseudarthrosis (Procedure A). In situ CPC-assisted vertebroplasty was performed in 12 patients with fresh vertebral compression fractures due to osteoporosis (Procedure B). Back pain and low-back pain were evaluated using a visual analog scale (VAS). The deformity index of the VB was measured on a lateral radiograph as the ratio of the VB's height (sum of measurements at anterior, middle, and posterior regions) to its longitudinal diameter. Based on VAS scores, pain was decreased in all patients immediately after surgery, and pain relief was maintained at the last follow up. The mean preoperative deformity index score of the VB was 1.43 in Procedure A and 1.67 in Procedure B; postoperatively scores improved to 1.59 and 1.93, respectively. At the 6-month follow-up examination, the mean deformity index score rebounded to 1.52 in Procedure A and 1.79 in Procedure B. Bone union was documented in all patients. Complications, such as a temporary respiratory insufficiency and a small amount of CPC leakage into the spinal canal, were observed in patients who underwent Procedure B.


CONCLUSIONS
Percutaneous transpedicular CPC-assisted vertebroplasty is a minimally invasive procedure that provides early relief of pain and prevents vertebral collapse and pseudarthrosis in patients with osteoporotic vertebral fracture.
Nakano
Masato
M
Department of Orthopaedic Surgery, Toyama Rosai Hospital, Japan. mnakano-tym@umin.ac.jp
Hirano
Norikazu
N
Matsuura
Kousou
K
Watanabe
Hiroki
H
Kitagawa
Hideki
H
Ishihara
Hirokazu
H
Kawaguchi
Yoshiharu
Y
D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000601:surgery; D001843:Bone Cements / Q000627:therapeutic use*; D002130:Calcium Phosphates / Q000627:therapeutic use*; D004867:Equipment Design; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000601:surgery; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation; D010024:Osteoporosis / Q000150:complications*; D010166:Palliative Care; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed
D001843:Bone Cements; D002130:Calcium Phosphates; C485828:alpha-tricalcium phosphate; C485830:tetracalcium phosphate; C485838:calcium phosphate, monobasic, anhydrous; C020243:calcium phosphate; C485829:calcium phosphate, dibasic, anhydrous