title: Intravertebral vacuum phenomenon in osteoporotic compression fracture: report of 67 cases with quantitative evaluation of intravertebral instability.
abstract: OBJECTIVE
  The objectives of this study were to: 1) describe the incidence and clinical features of intravertebral vacuum phenomenon (IVVP) in a relatively large number of cases; 2) quantitatively evaluate intravertebral instability and determine the factors affecting instability; and 3) evaluate the efficacy of percutaneous vertebroplasty in the treatment of this phenomenon.
  
  
  METHODS
  A retrospective review was conducted of the records of 67 patients with IVVP among 652 consecutive cases of osteoporotic compression fracture. Comparisons between the IVVP group and a control group, a stable group, and an unstable group were conducted. Percutaneous vertebroplasty was performed in all patients. There were 67 patients (10.3%) in whom there were 70 vacuum phenomena of the intravertebral space. Intravertebral vacuum phenomena occurred predominantly in the thoracolumbar junction (81%) and in patients with a longer duration of symptoms (10.6 +/- 9.8 months) compared with the control group. Of 59 vertebrae for which flexion-extension radiographs were available, 26 vertebrae were categorized as stable and 33 as unstable. Twenty-one vertebrae (64%) had undergone compression fracture in the unstable group compared with nine (35%) compression fractures in the stable group. There were 28 (85%) fractures of the wedged vertebrae in the unstable group compared with 16 (61%) fractures in wedged vertebrae in the stable group. Percutaneous vertebroplasty was performed with successful clinical outcome.
  
  
  CONCLUSIONS
  Intravertebral vacuum phenomenon is more common than has been previously appreciated. The results of this study indicate that biomechanics, not ischemic or avascular theory, may play an important role in pathogenesis of this phenomenon. Percutaneous vertebroplasty was found to be a minimally invasive and effective procedure for the treatment of IVVP.
authors.affiliation: Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea. nstopaz@yahoo.co.kr
authors.forename: Dong-Yun
authors.initials: DY
authors.lastname: Kim
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: Jee Soo
authors.initials: JS
authors.lastname: Jang
authors.forename: Sang Ki
authors.initials: SK
authors.lastname: Chung
authors.forename: Ho-Yeon
authors.initials: HY
authors.lastname: Lee
mesh_terms: D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007278:Injections, Spinal; D007593:Joint Instability / Q000000981:diagnostic imaging* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010020:Osteonecrosis / Q000000981:diagnostic imaging* / Q000601:surgery; D010024:Osteoporosis / Q000175:diagnosis* / Q000601:surgery; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011542:Pseudarthrosis / Q000175:diagnosis* / Q000601:surgery; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014618:Vacuum
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate