title: The existence of intravertebral cleft impact on outcomes of nonacute osteoporotic vertebral compression fractures patients treated by percutaneous kyphoplasty: a comparative study.
abstract: METHODS
  A retrospective comparative study.
  
  
  OBJECTIVE
  The purpose of this study is to assess radiologic features of intravertebral cleft (IVC) in nonacute osteoporotic vertebral compression fractures (OVCFs) patients, and analyze the existence of IVC impact on outcomes of percutaneous kyphoplasty (PKP).
  
  
  BACKGROUND
  The IVC sign is regarded as vertebral instability and the cause of persisting pain. It is more likely to happen at nonacute OVCFs patients. Patients with IVC sign have different outcomes from these without IVC treated by percutaneous vertebroplasty. There were rare reports about the outcomes of patients with IVC sign treated by PKP.
  
  
  METHODS
  We divided 92 nonacute OVCFs patients (total of 113 vertebrae) into 2 groups according to the existence of IVC. Preoperative and postoperative Visual Analogue Scales, Oswestry Disability Index, kyphotic angulation (KA), and anterior vertebral height were recorded; the incidence and radiologic features of IVC were analyzed.
  
  
  RESULTS
  The diagnostic sensitivity of IVC on plain radiograph, computed tomography, and magnetic resonance imaging were 35.4%, 89.3%, and 83.3%, respectively. The IVC group had an average correction KA of 9.14 degrees and reduction of ratio of compression of 20.09%, and the non-IVC group was 8.76 degrees and 20.23%, respectively. Cleft pattern of cement accounted for 64.6% in IVC group and 27.7% in non-IVC group. Five/7 of cement leakage in IVC group was intradiscal leakage, whereas 7/9 of cement leakage in non-IVC group was perivertebral leakage.
  
  
  CONCLUSIONS
  Computed tomography and magnetic resonance imaging were more sensitivity to diagnose IVC sign than X-ray. PKP could improve pain, functional activity, KA, and anterior height of both IVC and non-IVC groups, however, there was more cleft pattern of cement and higher intradiscal cement leakage in the IVC group.
authors.affiliation: Department of Spinal Surgery, Second Affiliated Hospital of Wenzhou Medical College, Zhejiang Spine Research Center, Wenzhou, Zhejiang, People's Republic of China.
authors.forename: Ai Min
authors.initials: AM
authors.lastname: Wu
authors.forename: Zhong Ke
authors.initials: ZK
authors.lastname: Lin
authors.forename: Wen Fei
authors.initials: WF
authors.lastname: Ni
authors.forename: Yong Long
authors.initials: YL
authors.lastname: Chi
authors.forename: Hua Zi
authors.initials: HZ
authors.lastname: Xu
authors.forename: Xiang Yang
authors.initials: XY
authors.lastname: Wang
authors.forename: Qi Shan
authors.initials: QS
authors.lastname: Huang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000009:adverse effects; D019245:Compressive Strength; D004185:Disability Evaluation; D005260:Female; D050815:Fractures, Compression / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D058498:Kyphoplasty / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013131:Spine / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements