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Bian C, Gu H, Chen G, Cheng X, Huang Z, Xu J, Yin X. A Retrospective Study of 91 Patients Treated with Percutaneous Kyphoplasty for Mild Osteoporotic Vertebral Compression Fractures and a New Evaluation Scale of Shape and Filling Effect of Cement. World Neurosurg 2024; 186:e134-e141. [PMID: 38522788 DOI: 10.1016/j.wneu.2024.03.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Percutaneous kyphoplasty (PKP) is commonly used to treat severe osteoporotic vertebral compression fractures (OVCFs) by restoring vertebral height. However, its application in mild cases is not frequently discussed. METHODS The study retrospectively included 100 treated vertebral bodies of the 91 patients mentioned before, and efficacy was evaluated using visual analog scale (VAS) and Oswestry Disability Index (ODI) scores preoperatively, 2 days postoperatively, and at 1 and 6 months after treatment, as well as mean variation in vertebral body height. The study also examined complications such as pain recurrence, delayed vertebral fracture, and loss of vertebral height, and developed a scale to assess the shape and filling effect of cement (SFEC) and its impact on complications. RESULTS The results showed significant reductions in mean VAS and ODI scores from pre-to post-surgery and an increase in vertebral body height. However, complications occurred in 10 patients who received treatment for 11 vertebral bodies, including pain recurrence, fractures, and loss of vertebral height. Among the 10 patients with complications, 7 (63.6%) vertebral bodies had dissatisfied SFEC scores, compared with 22 (24.7%) vertebral bodies with dissatisfied SFEC scores in 81 patients without complications (89 vertebral bodies). CONCLUSIONS PKP is a safe and effective method for treating mild OVCFs, but attention should be paid to the shape and filling effects of cement during surgery to prevent later complications. The developed SFEC scale provides a specific and quantitative standards for evaluating the recovery status after PKP, which need further validations.
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Affiliation(s)
- Chong Bian
- Department of Orthopedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Huijie Gu
- Department of Orthopedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Guangnan Chen
- Department of Orthopedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Xiangyang Cheng
- Department of Orthopedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Zhongyue Huang
- Department of Orthopedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Jun Xu
- Department of Orthopedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Xiaofan Yin
- Department of Orthopedics, Minhang Hospital, Fudan University, Shanghai, China.
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Radiographic assessment of acute vs chronic vertebral compression fractures. Emerg Radiol 2023; 30:11-18. [PMID: 36271261 DOI: 10.1007/s10140-022-02092-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/07/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE Distinguishing between acute and chronic vertebral compression fractures typically requires advanced imaging techniques such as magnetic resonance imaging (MRI). Recognizing specific radiographic findings associated with fracture acuity may improve the accuracy of radiographic assessment. METHODS Patients with compression fractures that had both radiographic and MRI studies of the lumbar spine within a 30-day time frame were retrospectively reviewed. MRI studies were used to determine compression fracture acuity. Radiographs were interpreted by a separate group of radiologists blinded to the MRI results. Radiographic findings of endplate osteophyte, subendplate density, subendplate cleft, and subendplate cyst were recorded as was the overall impression of fracture acuity. RESULTS Sensitivity and specificity for radiographic reporting of acute fracture were 0.52 (95% CI: 0.42, 0.61) and 0.95 (95% CI: 0.93, 0.97) respectively. For chronic fractures, the sensitivity and specificity were 0.52 (95% CI: 0.41, 0.63) and 0.94 (95% CI: 0.92, 0.96). The radiographic presence of a subendplate cleft increased the odds of a fracture being acute by a factor of 1.75 (95% CI: 1.09, 2.81; P = 0.0202). The radiographic presence of subendplate density increased the odds of a fracture being acute by a factor of 1.78 (95% CI: 1.21, 2.63; P = 0.0037). The presence of an endplate osteophyte or subendplate cyst was not significantly associated with fracture acuity. CONCLUSION Radiographs are relatively insensitive in distinguishing between acute and chronic lumbar compression fractures but the presence of a subendplate cleft or subendplate density increases the likelihood that a given fracture is acute.
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Zhou Z, Sun Z, Wang Y, Zhu X, Qian Z. Kyphoplasty for occult and non-occult osteoporotic vertebral fractures: a retrospective study. J Int Med Res 2019; 48:300060519894764. [PMID: 31885305 PMCID: PMC7783268 DOI: 10.1177/0300060519894764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To compare the safety and efficacy of kyphoplasty in the treatment of occult
and non-occult osteoporotic vertebral compression fractures (OOVF). Material and Methods From 2015 to 2017, 82 OOVF and 105 non-occult osteoporotic vertebral
compression fractures (N-OOVF) were evaluated with the Visual Analog Scale
(VAS), Oswestry Disability Index (ODI), and vertebral height preoperatively,
immediately postoperatively, and one year postoperatively. Operative time,
fluoroscopy time, and cement injection volume were recorded. Results Compared with the preoperative VAS and ODI scores, the scores of both groups
were significantly improved after surgery. Preoperative ODI and VAS scores
of the OOVF were lower than those of the N-OOVF. The operative time,
fluoroscopy time, and bone cement injection volume of the OOVF were
significantly lower than those of the N-OOVF. Vertebral height of the N-OOVF
improved significantly after surgery. There were differences in cement
leakage and adjacent vertebral fractures between the two groups. Conclusion Compared with N-OOVF, OOVF are safer with kyphoplasty, and it is necessary to
diagnose OOVF in a timely manner.
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Affiliation(s)
- Zhangzhe Zhou
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhiyong Sun
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yimeng Wang
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiaoyu Zhu
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhonglai Qian
- The Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Pan M, Ge J, Li Q, Li S, Mao H, Meng B, Yang H. Percutaneous vertebral augmentation in special Genant IV osteoporotic vertebral compression fractures. J Orthop Translat 2019; 20:94-99. [PMID: 31908939 PMCID: PMC6938938 DOI: 10.1016/j.jot.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/29/2019] [Accepted: 07/04/2019] [Indexed: 11/30/2022] Open
Abstract
Background Percutaneous vertebral augmentation is widely used for treating osteoporotic vertebral compression fractures (OVCFs). Bony encroachment in the spinal canal can be detected in some severe cases, increasing the difficulty of operation and risks of perioperative complications. Purpose A special type of OVCF has been introduced, and the clinical efficacy of vertebral augmentation has been evaluated in treating this special OVCF. Materials and methods The medical history of patients with OVCF treated with vertebral augmentation was reviewed. The vertebral body height and local kyphotic angle were measured and calculated on the lateral plain radiographs. The visual analogue scale and Oswestry Disability Index were assessed preoperatively, two days after operation, and at final follow-up periods. Complications such as cement leakage and recurrent vertebral fractures were also recorded and followed up. Results Twenty-nine patients with special Genant IV OVCF accepted vertebral augmentation, and 28 of them were followed up. The mean follow-up duration was 21.9 months, ranging from 17 to 34 months. The lateral plain radiographs revealed significant restoration of vertebral body height and local kyphotic angle. Both visual analogue scale and Oswestry Disability Index scores showed improvement 2 days after surgery and at final follow-up. Four patients experienced asymptomatic cement leakage, and 6 patients suffered OVCF recurrence in other segments. Conclusion Despite a great challenge, vertebral augmentation can be considered as a safe and effective option for treating special the Genant IV OVCF, showing significant restoration of vertebral body height, local kyphotic angle, and daily life function. The translational potential of this article Vertebral augmentation has been proven a safe and effect surgery method for special Genant IV OVCF. While surgery complications related to the commercially available filling material – polymethyl methacrylate (PMMA) is common and inevitable. Hence, this article is aimed to provide practical surgical techniques and suggestions to the modification of PMMA and fabrication of newly developed bone cements.
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Affiliation(s)
- Mingming Pan
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, PR China
| | - Jun Ge
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, PR China
| | - Qifan Li
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, PR China
| | - Sucheng Li
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, PR China
| | - Haiqing Mao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, PR China
| | - Bin Meng
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, PR China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, PR China
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Liu H, Zhang J, Liang X, Qian Z, Zhou Z, Lu H, Bou EH, Meng B, Mao H, Yang H, Liu T. Distribution Pattern Making Sense: Patients Achieve Rapider Pain Relief with Confluent Rather Than Separated Bilateral Cement in Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures. World Neurosurg 2019; 126:e1190-e1196. [PMID: 30880212 DOI: 10.1016/j.wneu.2019.03.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND It has been reported the distribution of bone cement in percutaneous kyphoplasty (PKP) has an impact on the curative effect. No studies have compared between confluent and separated cement pattern of bilateral bone cement in PKP for patients with osteoporotic vertebral compression fractures. METHODS Between 2010 and 2016, 1341 patients were enrolled and divided into 2 groups. Group A (n = 723), bilateral cement was confluent; Group B (n = 618), bilateral cement was separated. The visual analogue scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), and local kyphotic angle (LKA) were obtained preoperatively, 2 days after surgery, and at the final follow-up to assess the functional and radiographic efficacy of the surgery. RESULTS The VAS, ODI, AVH, and LKA 2 days after operation and at the final follow-up were significantly improved compared with the preoperative for both groups (P < 0.05). There existed no significant difference between groups at various time point in ODI, AVH, and LKA (P > 0.05). Group A showed better VAS than group B 2 days after surgery (1.91 ± 0.98 vs. 2.35 ± 0.78, P < 0.001), also with better pre-postoperative VAS change (6.23 ± 0.76 vs. 5.75 ± 1.02, P < 0.001). Multiple linear regression for pain relief degree revealed group A (P < 0.001), older age (P < 0.001), and more cement volume (P < 0.001) contribute to rapid improvement of back pain. The cement leakage rate was 3.7% in group A and 2.9% in group B, with no significant difference (P = 0.405). CONCLUSIONS Patients achieved rapider pain relief with confluent rather than separated bilateral bone cement pattern in PKP for osteoporotic vertebral compression fracture.
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Affiliation(s)
- Hao Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Junxin Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiao Liang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhonglai Qian
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhangzhe Zhou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hui Lu
- Department of Orthopaedic Surgery, Integrated Traditional Chinese and Western Medicine Hospital, Suzhou, Jiangsu, China
| | - Emily Hong Bou
- Biochemistry Department, University of Waterloo, Waterloo, Canada
| | - Bin Meng
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Haiqing Mao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Tao Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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Sun ZY, Li XF, Zhao H, Lin J, Qian ZL, Zhang ZM, Yang HL. Percutaneous Balloon Kyphoplasty in Treatment of Painful Osteoporotic Occult Vertebral Fracture: A Retrospective Study of 89 Cases. Med Sci Monit 2017; 23:1682-1690. [PMID: 28386056 PMCID: PMC5391800 DOI: 10.12659/msm.903997] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The definition of a vertebral fracture is usually based on the presence of a deformation of the vertebral body and this can be misleading in the presence of a fracture without radiologic collapse with the definition of occult osteoporotic vertebral fractures (OOVFs). STIR sequence of MRI images showing hyperintensity signal was the most confirmative screening examination used to determine the presence of painful OOVFs. To date, clinical management of OOVFs has been rarely discussed. MATERIAL AND METHODS Between 2011 and 2013, 89 patients suffering from painful OOVFs underwent 142 percutaneous balloon kyphoplasty (PKP) procedures. Outcome data (mean variation of anterior and middle vertebral body height, visual analog scale [VAS] scores, Oswestry Disability Index [ODI] scores, and SF-36 scores) were recorded preoperatively, postoperatively, and at 1 month, 6 months, and 2 year after treatment, to evaluate the results. RESULTS We successfully treated 89 patients (142 vertebral bodies) with PKP. Cement leakages were observed in 12 (8.45%) treated vertebral bodies and there were 5 new adjacent vertebral fractures during the follow-up period. The mean variation of anterior and middle vertebral body height changed from 96.5±3.4% preoperatively to 97.2±2.5% postoperatively (p>0.05) and from 96.3±2.8% preoperatively to 97.9±3.1% postoperatively (p>0.05), respectively. The mean VAS scores were reduced significantly from pre-surgery to post-surgery (8.3±1.2 to 2.9±0.7; p<0.05), as was the ODI score (76.4±12.5 to 26.7±5.6; p<0.05). The SF-36 scores, including Bodily Pain (BF), Vitality (VT), Physical Function (PF), and Social Functioning (SF), all showed notable improvement (P<0.05). These variations were maintained during the 2-year follow-up period. CONCLUSIONS PKP is a safe and effective method in the treatment of painful OOVFs.
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Affiliation(s)
- Zhi-Yong Sun
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Xue-Feng Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Huan Zhao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jun Lin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Zhong-Lai Qian
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Zhi-Ming Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Hui-Lin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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Abstract
STUDY DESIGN Review article. OBJECTIVE The article mainly reviewed the development and current situation of percutaneous kyphoplasty (PKP) in China, aiming to introduce native efforts and progress for PKP procedure on the exploring road. SUMMARY OF BACKGROUND DATA Since PKP was first reported in China in 2002, Chinese orthopedic researchers have performed lots of clinical applications and studies on the treatment of osteoporotic vertebral compression fracture, spinal metastatic tumor, hemangioma, myeloma, vertebral nonunion, and so on. METHODS We reviewed the papers on PKP published by native researchers in English and Chinese via Pubmed, EMBASE, the Scopus database, and a series of Chinese databases including Wanfang Data, China National Knowledge Infrastructure (CNKI), and the China Science and Technology Journal Database. The large sample capacity researches, convictive systematic analysis, and overviews were mainly elected as convictive evidence to describe the overall situation of clinical outcomes, complications, and the various technical aspects used to improve conventional surgical management and clinical applications of PKP in China. RESULTS Until October 2015, 211 articles in English and 2352 studies in Chinese about PKP were reported by 1443 Chinese institutions from 22 provinces around China. More than 50976 patients reported through published articles have received the treatment of PKP. With the technique gradually improved, including puncture, bone cement infusion, vertebral expander instruments, diagnosis, and treatment of special type of vertebral fractures, PKP is performed with the better efficacy and less complication. CONCLUSION With the progression of minimally invasive spinal surgery around the world, PKP in China has been performed with a trend towards a rapid, safe, and effective treatment. Digital, real-time and artificial intelligence are the directions of future development of PKP. LEVEL OF EVIDENCE 4.
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Papanastassiou ID, Filis AK, Gerochristou MA, Vrionis FD. Controversial issues in kyphoplasty and vertebroplasty in malignant vertebral fractures. Cancer Control 2015; 21:151-7. [PMID: 24667402 DOI: 10.1177/107327481402100208] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed in the treatment of pathological vertebral fractures. METHODS A critical review of the medical literature was performed and controversial issues were analyzed. RESULTS Evidence supports KP as the treatment of choice to control fracture pain and the possible restoration of sagittal balance, provided that no overt instability or myelopathy is present, the fracture is painful and other pain generators have been excluded, and positive radiological findings are present. Unilateral procedures yield similar results to bilateral ones and should be pursued whenever feasible. Biopsy should be routinely performed and 3 to 4 levels may be augmented in a single operation. Higher cement filling appears to yield better results. Radiotherapy is complementary with KP and VP but must be individualized. CONCLUSIONS In cases of painful cancer fractures, if overt instability or myelopathy is not present, unilateral KP should be pursued, whenever feasible, followed by radiotherapy. The technological advances in hardware and biomaterials, as well as combining KP with other modalities, will help ensure a safe and more effective procedure. Address.
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Abstract
Osteoporotic vertebral fractures are a frequently encountered clinical problem, and like other fractures, they may develop nonunion that can often go unrecognized. The aim of this study is to review the related articles reporting the osteoporotic vertebral fracture nonunion and discuss the radiological characteristics, diagnosis, and treatment of osteoporotic vertebral fractures.
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Controversial issues in kyphoplasty and vertebroplasty in osteoporotic vertebral fractures. BIOMED RESEARCH INTERNATIONAL 2014; 2014:934206. [PMID: 24724106 PMCID: PMC3960523 DOI: 10.1155/2014/934206] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/17/2014] [Indexed: 12/29/2022]
Abstract
Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed for many years for the treatment of osteoporotic vertebral fractures. The purpose of this review is to resolve the controversial issues raised by the two randomized trials that claimed no difference between VP and SHAM procedure. In particular we compare nonsurgical management (NSM) and KP and VP, in terms of clinical parameters (pain, disability, quality of life, and new fractures), cost-effectiveness, radiological variables (kyphosis correction and vertebral height restoration), and VP versus KP for cement extravasation and complications profile. Cement types and optimal filling are analyzed and technological innovations are presented. Finally unipedicular/bipedicular techniques are compared. Conclusion. VP and KP are superior to NSM in clinical and radiological parameters and probably more cost-effective. KP is superior to VP in sagittal balance improvement and cement leaking. Complications are rare but serious adverse events have been described, so caution should be exerted. Unilateral procedures should be pursued whenever feasible. Upcoming randomized trials (CEEP, OSTEO-6, STIC-2, and VERTOS IV) will provide the missing link.
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Kim YJ, Chae SU, Kim GD, Park KH, Lee YS, Lee HY. Radiographic Detection of Osteoporotic Vertebral Fracture without Collapse. J Bone Metab 2013; 20:89-94. [PMID: 24524063 PMCID: PMC3910315 DOI: 10.11005/jbm.2013.20.2.89] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/07/2013] [Accepted: 10/08/2013] [Indexed: 01/10/2023] Open
Abstract
Background On retrospective basis, we investigated the detection of osteoporotic vertebral fractures (OVFs) without radiologic collapse using a modified Yoshida's classification, which was designed by the authors. Methods We observed 82 cases in 76 patients with confirmed OVFs without collapse at the thoracolumbar junction. The following factors were measured: age, gender, body mass index (BMI, kg/m2), bone mineral density (BMD, mg/cm3), type of a modified Yoshida's classification. The correct diagnosis rate for the presence and location of OVFs and the correct diagnosis rate according to the morphological type by a modified Yoshida's classification of the OVFs were analyzed. Results The mean BMI was 21.2; mean BMD, 44.1; and T-score, -4.4. As for the four subtypes of anterior cortical morphological change, there were 14 cases of the protruding type, 12 cases of the indented type, 5 cases of the disrupted type and 8 cases of the prow type. As for the three subtypes of endplate depression, there were 20 cases of upper endplate depression, 12 cases of lower endplate depression and 11 cases of endplate slippage type. According to the examiners, there was a significant difference between being informed before and after the modified Yoshida's classification. For the relationship of examiners and the type of fracture, there was a significant difference between being informed before and after the modified Yoshida's classification, particularly in the protruding type and the upper plate type. Conclusions A modified Yoshida's classification can be helpful for the diagnosis of OVFs without radiologic collapse in a simple radiograph.
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Affiliation(s)
- Yeung Jin Kim
- Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Soo Uk Chae
- Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Gang Deuk Kim
- Department of Radiology, School of Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Kyung Hee Park
- Department of Radiology, School of Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Yeum Sik Lee
- Department of Radiology, School of Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Hwang Yong Lee
- Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, Iksan, Korea
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Henes FO, Groth M, Kramer H, Schaefer C, Regier M, Derlin T, Adam G, Bannas P. Detection of occult vertebral fractures by quantitative assessment of bone marrow attenuation values at MDCT. Eur J Radiol 2013; 83:167-72. [PMID: 24144447 DOI: 10.1016/j.ejrad.2013.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/10/2013] [Accepted: 09/17/2013] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To determine a cut-off value of Hounsfield attenuation units (HU) at multidetector computed tomography (MDCT) for valid and reliable detection of bone marrow oedema (BME) related to occult vertebral fractures. METHODS 36 patients underwent both MDCT and Magnetic Resonance Imaging (MRI) for evaluation of vertebral fractures of the thoracolumbar spine and were included in this retrospective study. Two readers independently assessed HU values at MDCT in a total of 196 vertebrae. Reliability was assessed by intraclass correlation coefficient and Bland-Altman analysis. For each patient we determined the vertebra with the lowest HU value and calculated the HU-difference to each other vertebral body. HU-differences were subjected to receiver operating characteristic (ROC) curve analysis to determine the diagnostic accuracy for detection of BME as determined by MRI, which served as the reference standard. Results of HU-measurements were compared with standard visual evaluation of MDCT. RESULTS HU measurements demonstrated a high interrater reliability (ICC=0.984). ROC curve analysis (AUC=0.978) exhibited an ideal cut-off value of 29.6 HU for detection of BME associated with vertebral fractures with an accuracy of 97.4% as compared to 93.4% accuracy of visual evaluation. Particularly, HU-measurements increased the sensitivity for detection of vertebral fractures from 78.0% to 92.7% due to the detection of 7 of 9 occult fractures that were missed by visual evaluation alone. CONCLUSIONS Assessing bone marrow density by HU measurements using the cut-off of 29.6 HU is a valid and reliable tool for detection of BME related to occult vertebral fractures in MDCT. The introduced technique may allow more accurate treatment decisions and may make further diagnostic work-up with MRI unnecessary.
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Affiliation(s)
- Frank Oliver Henes
- Department of Diagnostic and Interventional Radiology, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - Michael Groth
- Department of Diagnostic and Interventional Neuroradiology, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Harald Kramer
- Department of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr. 15, 81377 Munich, Germany; Department of Radiology, University of Wisconsin - Madison, Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
| | - Christian Schaefer
- Department of Trauma-, Hand- and Reconstructive Surgery, Spine Center, Center for Surgical Sciences, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Marc Regier
- Department of Diagnostic and Interventional Radiology, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Thorsten Derlin
- Department of Diagnostic and Interventional Radiology, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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