Percutaneous vertebroplasty for the treatment of osteoporotic burst fractures.
BACKGROUND
Vertebroplasty is a minimally invasive surgical procedure which involves injecting polymethylmethacrylate into the compressed vertebral body. At present the indications include the treatment of osteoporotic compression fractures, vertebral myeloma, and metastases. The value of vertebroplasty in osteoporotic compression fracture has been discussed comprehensively. The surgical operation for burst fractures without neurological deficit remains controversial. Some authors have asserted that vertebroplasty is contraindicated in patients with burst fracture. However, we performed the procedure, after considering the patents general condition, to reduce surgical risks and the duration of immobilisation. The purpose of this study is to investigate clinical outcomes, kyphosis correction, wedge angle, and height restoration of thoraco-lumbar osteoporotic burst fractures treated by percutaneous vertebroplasty.


METHODS
Twenty-five patients with osteoporotic burst fracture were treated with postural reduction followed by vertebroplasty. We measured the kyphosis, wedge angle, spinal canal compromise and the height of the fractured vertebral body initially, after postural reduction, and after vertebroplasty.


RESULTS
The average height of the collapsed vertebral bodies was 24.8% of the original height. Average kyphosis angle was 19.4 degrees and average wedge angle was 19.8 degrees at first. Mean canal encroachment was initially 25.1%. Kyphosis angle, wedge angle, and anterior, middle, and posterior height improved significantly after the procedure. The mean amelioration of the spinal canal encroachment after vertebroplasty was 23.3%. The average increase in anterior vertebral body height was 7.5 mm, central was 5.8 mm, and posterior was 0.9 mm. The mean reduction in kyphosis angle was 6.8 degrees and the mean reduction in wedge angle was 9.7 degrees .


CONCLUSIONS
Although vertebroplasty has been considered as contraindicated in thoraco-lumbar burst fractures, we successfully used the procedure as a safe treatment in patients with osteoporotic burst fracture without neurologic deficit. This method could eliminate the need for and risks of major spinal surgery. We would like to offer it as a relatively safe and effective methods of management in thoraco-lumbar burst fractures.
Shin
Jun Jae
JJ
Department of Neurosurgery, Sanggye Paik Hospital, Inje University, Nowon-gu, Seoul, South Korea. zunzae@hanmail.net
Chin
Dong Kyu
DK
Yoon
Young Sul
YS
D000367:Age Factors; D000368:Aged; D001416:Back Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D010024:Osteoporosis / Q000150:complications*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013130:Spinal Stenosis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods* / Q000706:statistics & numerical data