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Miyamoto A, Parihar U, Kumawat C, El Kader Al Askar A, Tanaka M, Gunjotikar S, Taoka T, Komatsubara T, Fujiwara Y, Uotani K, Arataki S. Retrospective Cohort Study of Early versus Delayed Ballon Kyphoplasty Intervention for Osteoporotic Vertebral Fracture Treatment. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:519. [PMID: 38674165 PMCID: PMC11052441 DOI: 10.3390/medicina60040519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
Objectives: To investigate the outcomes of early balloon kyphoplasty (BKP) intervention compared with late intervention for osteoporotic vertebral fracture (OVF). Background: Osteoporotic vertebral fracture can lead to kyphotic deformity, severe back pain, depression, and disturbances in activities of daily living (ADL). Balloon kyphoplasty has been widely utilized to treat symptomatic OVFs and has proven to be a very effective surgical option for this condition. Furthermore, BKP is relatively a safe and effective method due to its reduced acrylic cement leakage and greater kyphosis correction. Materials and Methods: A retrospective cohort study was conducted at our hospital for patients who underwent BKP for osteoporotic vertebral fractures in the time frame between January 2020 and December 2022. Ninety-nine patients were included in this study, and they were classified into two groups: in total, 36 patients underwent early BKP intervention (EI) at <4 weeks, and 63 patients underwent late BKP intervention (LI) at ≥4 weeks. We performed a clinical, radiological and statistical comparative evaluation for the both groups with a mean follow-up of one year. Results: Adjacent segmental fractures were more frequently observed in the LI group compared to the EI group (33.3% vs. 13.9%, p = 0.034). There was a significant improvement in postoperative vertebral angles in both groups (p = 0.036). The cement volume injected was 7.42 mL in the EI, compared with 6.3 mL in the LI (p = 0.007). The mean surgery time was shorter in the EI, at 30.2 min, compared with 37.1 min for the LI, presenting a significant difference (p = 0.0004). There was no statistical difference in the pain visual analog scale (VAS) between the two groups (p = 0.711), and there was no statistical difference in cement leakage (p = 0.192). Conclusions/Level of Evidence: Early BKP for OVF treatment may achieve better outcomes and fewer adjacent segmental fractures than delayed intervention.
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Affiliation(s)
- Akiyoshi Miyamoto
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan; (A.M.); (U.P.); (C.K.); (A.E.K.A.A.); (S.G.); (T.T.); (T.K.); (Y.F.); (S.A.)
| | - Umesh Parihar
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan; (A.M.); (U.P.); (C.K.); (A.E.K.A.A.); (S.G.); (T.T.); (T.K.); (Y.F.); (S.A.)
| | - Chetan Kumawat
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan; (A.M.); (U.P.); (C.K.); (A.E.K.A.A.); (S.G.); (T.T.); (T.K.); (Y.F.); (S.A.)
| | - Abd El Kader Al Askar
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan; (A.M.); (U.P.); (C.K.); (A.E.K.A.A.); (S.G.); (T.T.); (T.K.); (Y.F.); (S.A.)
| | - Masato Tanaka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan; (A.M.); (U.P.); (C.K.); (A.E.K.A.A.); (S.G.); (T.T.); (T.K.); (Y.F.); (S.A.)
| | - Sharvari Gunjotikar
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan; (A.M.); (U.P.); (C.K.); (A.E.K.A.A.); (S.G.); (T.T.); (T.K.); (Y.F.); (S.A.)
| | - Takuya Taoka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan; (A.M.); (U.P.); (C.K.); (A.E.K.A.A.); (S.G.); (T.T.); (T.K.); (Y.F.); (S.A.)
| | - Tadashi Komatsubara
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan; (A.M.); (U.P.); (C.K.); (A.E.K.A.A.); (S.G.); (T.T.); (T.K.); (Y.F.); (S.A.)
| | - Yoshihiro Fujiwara
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan; (A.M.); (U.P.); (C.K.); (A.E.K.A.A.); (S.G.); (T.T.); (T.K.); (Y.F.); (S.A.)
| | - Koji Uotani
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 7000-8558, Japan;
| | - Shinya Arataki
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan; (A.M.); (U.P.); (C.K.); (A.E.K.A.A.); (S.G.); (T.T.); (T.K.); (Y.F.); (S.A.)
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Sato K, Kogawa M, Yamada Y, Yamashiro M, Kasama F, Matsuda M. Equivalent values between anterior vertebral height, wedge ratio, and wedge angle for evaluating vertebral mobility and deformity in osteoporotic vertebral fractures: a conventional observational study. J Orthop Surg Res 2023; 18:284. [PMID: 37031169 PMCID: PMC10082485 DOI: 10.1186/s13018-023-03758-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/26/2023] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND Vertebral mobility (V-mobility) has been used to diagnose fresh osteoporotic vertebral fractures (OVFs) and determine bone union by setting cutoff values for these purposes. V-mobility is the difference in vertebral height on dynamic radiographs taken in the sitting and lateral decubitus or supine positions. The dimensions for V-mobility were presented as anterior vertebral height (Ha; mm), wedge ratio (WR; %), and wedge angle (WA; °) in previous reports. This study was performed to obtain WR and WA values equivalent to V-mobility of 1.0 mm in Ha. METHODS Lateral radiographs of 284 OVFs (grade 1-3 deformed vertebrae) from T11 to L2 were obtained from 77 patients with OVF. V-mobility presented as Ha, posterior vertebral height, and WA was obtained by the difference in these dimensions on dynamic radiographs. The WR and WA values equivalent to 1.0 mm in Ha were obtained by dividing the V-mobility values for WR and WA by that for Ha. RESULTS The mean WR values corresponding to 1.0 mm in Ha for grade 1, 2, and 3 vertebrae were 3.2% ± 1.4%, 3.2% ± 0.9%, and 3.4% ± 1.0%, respectively, and the corresponding value for grade 1-3 vertebrae was 3.3% ± 1.0%. The mean WA values corresponding to 1.0 mm in Ha for grade 1, 2, and 3 vertebrae were 1.5° ± 0.8°, 1.5° ± 0.6°, and 1.5° ± 0.8°, respectively, and the corresponding value for grade 1-3 vertebrae was 1.5° ± 0.7°. CONCLUSIONS The WR and WA values equivalent to V-mobility of 1.0 mm in Ha were 3.3% and 1.5°, respectively, in grade 1-3 vertebrae. These findings may be useful to secure a reliable value of V-mobility of OVFs using simultaneous measurements in three dimensions (Ha, WR, and WA) in clinical practice and to establish cutoff values for V-mobility to determine bone union.
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Affiliation(s)
- Kozo Sato
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa Aza Tatsutayashiki, Izumi-Ku, Sendai, Miyagi, 981-3217, Japan
| | - Masakazu Kogawa
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa Aza Tatsutayashiki, Izumi-Ku, Sendai, Miyagi, 981-3217, Japan.
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, The University of Adelaide, North Terrace and George St., Adelaide, SA, 5005, Australia.
| | - Yuichiro Yamada
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa Aza Tatsutayashiki, Izumi-Ku, Sendai, Miyagi, 981-3217, Japan
| | - Masahiro Yamashiro
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa Aza Tatsutayashiki, Izumi-Ku, Sendai, Miyagi, 981-3217, Japan
| | - Fumio Kasama
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa Aza Tatsutayashiki, Izumi-Ku, Sendai, Miyagi, 981-3217, Japan
| | - Michimasa Matsuda
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa Aza Tatsutayashiki, Izumi-Ku, Sendai, Miyagi, 981-3217, Japan
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Pieroh P, Spiegl UJA, Völker A, Märdian S, von der Höh NH, Osterhoff G, Heyde CE. Spinal Orthoses in the Treatment of Osteoporotic Thoracolumbar Vertebral Fractures in the Elderly: A Systematic Review With Quantitative Quality Assessment. Global Spine J 2023; 13:59S-72S. [PMID: 37084346 PMCID: PMC10177312 DOI: 10.1177/21925682221130048] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Spinal orthoses are frequently used to non-operatively treat osteoporotic vertebral fractures (OVF), despite the available evidence is rare. Previously systematic reviews were carried out, presenting controversial recommendations. The present study aimed to systematic review the recent and current literature on available evidence for the use of orthoses in OVF. METHODS A systematic review was conducted using PubMed, Medline, EMBASE and CENTRAL databases. Identified articles including previous systematic reviews were screened and selected by three authors. The results of retrieved articles were presented in a narrative form, quality assessment was performed by two authors using scores according to the study type. RESULTS Thirteen studies (n = 5 randomized controlled trials, n = 3 non- randomized controlled trials and n = 5 prospective studies without control group) and eight systematic reviews were analyzed. Studies without comparison group reported improvements in pain, function and quality of life during the follow-up. Studies comparing different types of orthoses favor non-rigid orthoses. In comparison to patients not wearing an orthosis three studies were unable to detect beneficial effects and two studies reported about a significant improvement using an orthosis. In the obtained quality assessment, three studies yielded good to excellent results. Previous reviews detected the low evidence for spinal orthoses but recommended them. CONCLUSION Based on the study quality and the affection of included studies in previous systematic reviews a general recommendation for the use of a spinal orthosis when treating OVF is not possible. Currently, no superiority for spinal orthoses in OVF treatment was found.
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Affiliation(s)
- Philipp Pieroh
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Ulrich J A Spiegl
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Anna Völker
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Sven Märdian
- Centre for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Nicolas H von der Höh
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Christoph-E Heyde
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
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Funayama T, Tatsumura M, Fujii K, Ikumi A, Okuwaki S, Shibao Y, Koda M, Yamazaki M. Therapeutic Effects of Conservative Treatment with 2-Week Bed Rest for Osteoporotic Vertebral Fractures: A Prospective Cohort Study. J Bone Joint Surg Am 2022; 104:1785-1795. [PMID: 36005391 DOI: 10.2106/jbjs.22.00116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UPDATE This article was updated on October 19, 2022, because of previous errors, which were discovered after the preliminary version of the article was posted online. On page 1787, in the legend for Figure 2, the sentence that had read "The vertebral collapse rate (in %) was defined as 1 - (A/P) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images." now reads "The vertebral collapse rate (in %) was defined as (1 - [A/P]) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images." On page 1788, in the section entitled "Data Collection," the sentence that had read "The vertebral collapse rate (in %) was defined as 1 - (anterior vertebral wall height/posterior vertebral wall height) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images 9 ." now reads "The vertebral collapse rate (in %) was defined as (1 - [anterior vertebral wall height/posterior vertebral wall height]) × 100, and vertebral instability (in %) was defined as the difference in vertebral collapse rate between the loaded and non-loaded images 9 ." Finally, on page 1791, in Table IV, the footnote for the "Primary outcome" row that had read "N = 113 in the rest group and 99 in the no-rest group." now reads "N = 116 in the rest group and 108 in the no-rest group."
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Affiliation(s)
- Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masaki Tatsumura
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Ibaraki, Japan
| | - Kengo Fujii
- Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Takahagi, Ibaraki, Japan.,Department of Orthopaedic Surgery, Showa General Hospital, Kodaira, Tokyo, Japan
| | - Akira Ikumi
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Ibaraki, Japan.,Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Takahagi, Ibaraki, Japan
| | - Shun Okuwaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Takahagi, Ibaraki, Japan
| | - Yosuke Shibao
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Characteristic imaging findings predicting the risk of conservative treatment resistance in fresh osteoporotic vertebral fractures with poor prognostic features on magnetic resonance imaging. J Orthop Sci 2022; 27:330-334. [PMID: 33642206 DOI: 10.1016/j.jos.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/27/2020] [Accepted: 01/06/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recent studies have reported that confined high-intensity and diffuse low-intensity on sagittal T2-weighted magnetic resonance imaging (MRI) are distinctive features that are highly predictive of delayed union or nonunion on osteoporotic vertebral fracture (OVF). The objective of this study was to identify the characteristics of imaging findings predicting the risk for requiring surgical treatment in fresh OVF with poor prognostic features on MRI. METHODS We conducted a retrospective study of 74 patients (17 men and 57 women with a mean age of 81.1 years) of OVF with the poor prognostic MRI findings. We compared the imaging findings between the surgery group (16 patients) and the conservative group (58 patients): vertebral instability defined as the difference between the vertebral collapse ratio in dynamic X-rays, and the grade of posterior wall injury (Grade I, no spinal canal encroachment; Grade II, <2 mm; Grade III, ≥2 mm) as well as the presence or absence of pedicle fracture (Grade I, none; Grade II, unilateral; Grade III, bilateral) on computed tomography. RESULTS The mean vertebral instability was 24.0% ± 10.1% in the surgery group and 13.0% ± 7.8% in the conservative group, which was significantly different. Posterior wall injury in the surgery and conservative groups was Grade I in 0 and 29 cases, Grade II in 5 and 21 cases, and Grade III in 11 and 8 cases, respectively, constituting a significant difference. Pedicle fracture in the surgery and conservative groups was Grade I in 5 and 55 cases, Grade II in 6 and 2 cases, and Grade III in 5 and 1 case, respectively, also constituting a significant difference. CONCLUSIONS The most high-risk OVF patients with poor prognostic MRI findings who required surgical treatment were those who exhibited greater vertebral instability as well as either more severe posterior wall injury or pedicle fracture. STUDY DESIGN Retrospective clinical study.
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Sato K, Kogawa M, Yamada Y, Yamashiro M, Kasama F, Matsuda M. Equivalent values between anterior vertebral height, wedge ratio, and wedge angle in osteoporotic vertebral fractures. J Bone Miner Metab 2022; 40:132-140. [PMID: 34420088 DOI: 10.1007/s00774-021-01264-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Vertebral mobility (V-mobility) has been used to diagnose fresh osteoporotic vertebral fractures (OVFs), and determine or predict bone union by setting cutoff values for these purposes. V-mobility is defined as the difference in shape of vertebral bodies between lateral radiographs taken in weight-bearing and non-weight-bearing positions. The parameters for V-mobility have varied in previous reports among anterior vertebral height (Ha, mm), wedge ratio (WR, %), and wedge angle (WA, degrees). The present study aimed to clarify WR and WA equivalent to Ha of 1.0 mm, and to compare the reported cutoff values for V-mobility presented as Ha, WR, or WA. MATERIALS AND METHODS Lateral radiographs of 446 normal vertebrae (grade 0) and 146 deformed vertebrae (grade 1-3) from T11 to L2 were obtained from 183 female patients aged > 60 years. WR (%) values equivalent to Ha of 1.0 mm were calculated by Ha (1.0 mm)/Hp × 100 (Hp: posterior vertebral height). Corresponding WA values were calculated by trigonometric function using vertebral dimensions. RESULTS The mean WR values equivalent to Ha of 1.0 mm in the vertebrae from T11 to L2 were 3.2%, 3.2%, 3.5%, and 3.7% for grades 0, 1, 2, and 3, respectively, and the corresponding WA values were 1.6°, 1.6°, 1.5°, and 1.4°. CONCLUSION The equivalent values for V-mobility presented as Ha, WR, and WA were obtained. The mean WR and WA values equivalent to Ha of 1.0 mm in grade 1-3 vertebrae were 3.5% and 1.5°, respectively.
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Affiliation(s)
- Kozo Sato
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa aza Tatsutayashiki, Izumi-ku, Sendai, Miyagi, 981-3217, Japan
| | - Masakazu Kogawa
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa aza Tatsutayashiki, Izumi-ku, Sendai, Miyagi, 981-3217, Japan.
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, The University of Adelaide, North Terrace and George St., Adelaide, SA, 5005, Australia.
| | - Yuichiro Yamada
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa aza Tatsutayashiki, Izumi-ku, Sendai, Miyagi, 981-3217, Japan
| | - Masahiro Yamashiro
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa aza Tatsutayashiki, Izumi-ku, Sendai, Miyagi, 981-3217, Japan
| | - Fumio Kasama
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa aza Tatsutayashiki, Izumi-ku, Sendai, Miyagi, 981-3217, Japan
| | - Michimasa Matsuda
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa aza Tatsutayashiki, Izumi-ku, Sendai, Miyagi, 981-3217, Japan
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Ikumi A, Funayama T, Terajima S, Matsuura S, Yamaji A, Nogami Y, Okuwaki S, Kawamura H, Yamazaki M. Effects of conservative treatment of 2-week rigorous bed rest on muscle disuse atrophy in osteoporotic vertebral fracture patients. J Rural Med 2021; 16:8-13. [PMID: 33442429 PMCID: PMC7788296 DOI: 10.2185/jrm.2020-036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/29/2020] [Indexed: 12/30/2022] Open
Abstract
Objective: Osteoporotic vertebral fracture (OVF) is conventionally treated
with conservative management such as bed rest, but a relatively prolonged bed rest has the
potential risk of muscle disuse atrophy. This study aimed to examine whether the 2-week of
rigorous bed rest affects muscle disuse atrophy in OVF patients. Patients and Methods: A total of 54 OVF patients (16 males; 38 females; mean
age, 80.2 ± 9.2 years) were treated with an initial 2-week rigorous bed rest by
hospitalization with persistent rehabilitation. Cognitive function, swallowing function,
grip strength, and lower extremity circumference were evaluated at three-time points
(admission, end of bed rest, and discharge). Results: Of the 51 patients who were able to walk independently before the
injury, one patient (2.0%) had to use a wheelchair after the injury. During
hospitalization, cognitive function decline was observed in 33.3% of patients, but not in
patients with Revised Hasegawa’s Dementia Scale score ≥25 at admission. Swallowing
function decline was observed in one patient, and none of the patients developed
aspiration pneumonia during hospitalization. The grip strength significantly improved both
at the end of bed rest (P=0.04) and discharge (P=0.02).
Although the lower extremity circumference significantly decreased at the end of bed rest
(P<0.01), it was recovered afterward. The lower extremity
circumference did not significantly differ between the admission and discharge
(P=0.17). Conclusion: Our results suggested that conservative treatment of OVF through
an initial 2-week rigorous bed rest with persistent hospital rehabilitation poses a low
risk of muscle disuse atrophy. If cognitive dysfunction is observed on admission, close
monitoring for exacerbation should be performed during the hospital stay.
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Affiliation(s)
- Akira Ikumi
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Japan
| | - Toru Funayama
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Sho Terajima
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Japan
| | - Satoshi Matsuura
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Japan
| | - Akihiro Yamaji
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Japan
| | - Yuko Nogami
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Japan
| | - Shun Okuwaki
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Japan
| | - Haruo Kawamura
- Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
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Hofler RC, Jones GA. Bracing for Acute and Subacute Osteoporotic Compression Fractures: A Systematic Review of the Literature. World Neurosurg 2020; 141:e453-e460. [PMID: 32474094 DOI: 10.1016/j.wneu.2020.05.199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many treatment options for osteoporotic vertebral fractures are available. However, limited and variable findings have been reported on the efficacy of the individual therapies. The objective of the present study was to systematically review the reported data for evidence of efficacy of spinal orthoses for osteoporotic vertebral fractures. METHODS A systematic review of the PubMed database was performed. Two reviewers evaluated the studies found for eligibility. Randomized controlled trails (RCTs) and prospective nonrandomized, prospective single-arm, and retrospective comparative studies of the treatment of acute osteoporotic vertebral fractures with spinal orthoses were included. RESULTS A total of 16 studies were included: 5 RCTs, 6 nonrandomized prospective comparative studies, 1 retrospective case-control study, and 4 prospective single-arm studies. Of the 16 studies, 4 (3 single-arm studies and 1 nonrandomized study) provided low-quality evidence that bracing, with or without bedrest, was safe. Also, 1 nonrandomized and 1 single-arm study provided low-quality evidence that bracing improved pain and disability. In addition, 4 studies demonstrated that the use of a rigid brace was equivalent to the use of a soft brace or no brace (2 high-quality RCTs, 2 nonrandomized studies, 1 low-quality RCT). Two nonrandomized and one case-control study demonstrated a benefit of kyphoplasty compared with bracing alone (all low quality). Two RCTs had provided low-quality evidence that bracing was superior to no brace and one nonrandomized study provided low-quality evidence that a dynamic brace was superior to rigid orthosis. CONCLUSIONS Limited evidence has suggested the safety of spinal orthoses for the treatment of osteoporotic compression fractures. At present, compelling evidence is not available to suggest that a rigid brace is superior to a soft brace or no brace. Kyphoplasty might be of benefit for select patients.
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Affiliation(s)
- Ryan C Hofler
- Department of Neurosurgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - G Alexander Jones
- Department of Neurosurgery, Loyola University Medical Center, Maywood, Illinois, USA.
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Sato K, Yamada Y, Kogawa M, Sekiguchi T. Vertebral mobility is a valuable indicator for predicting and determining bone union in osteoporotic vertebral fractures: a conventional observation study. J Orthop Surg Res 2020; 15:166. [PMID: 32370793 PMCID: PMC7201770 DOI: 10.1186/s13018-020-01649-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/27/2020] [Indexed: 12/30/2022] Open
Abstract
Background Conservative treatments for osteoporotic vertebral fractures (OVFs) have not been standardized, and criteria for determining bone union have not been established. To determine bone union, we have adopted a cutoff value of 1.0 mm for vertebral mobility (V-mobility), defined as the difference in anterior vertebral height (Ha) between lateral radiographs taken in weight-bearing and non-weight-bearing positions. The present study aimed to investigate the usefulness of V-mobility for determining bone union and predicting bone union at 6 months after OVF onset. Methods The study included 54 acute OVFs from T11 to L3 in 53 patients (12 males, 41 females; mean age 82 years; age range 55–97 years) who were hospitalized at ≤ 3 weeks after OVF onset. Vertebral deformity (V-deformity) and V-mobility were evaluated in accordance with Ha on lateral radiographs taken in the sitting position (SIT), lateral decubitus position (DEC), and supine position (SUP). OVFs showing V-mobility of ≤ 1.0 mm between SIT and DEC radiographs and no intravertebral cleft on DEC radiograph were defined as semi-union, while those showing V-mobility of ≤ 1.0 mm between SIT and SUP radiographs and no intravertebral cleft on SUP radiograph were defined as bone union. We calculated the bone union rates including semi-unions associated with V-mobility cutoff values of 1.0 mm, 1.5 mm, and 2.0 mm and estimated cutoff values for V-mobility at 5 weeks after OVF onset to predict bone union at 6 months after OVF onset. Results The cumulative number of bone unions including semi-unions was more influenced by the different V-mobility cutoff values in Ha for determining bone union in the earlier period compared with the later period in the time course of OVF. Receiver-operating characteristic curve analyses revealed that V-mobility cutoff value of 2.1 mm in Ha between SIT and DEC radiographs at 5 weeks after OVF had moderate accuracy for predicting bone union including semi-union at 6 months after OVF. The mean V-deformity value on SIT radiographs did not progress significantly. Conclusion V-mobility in the early stage after OVF can predict bone union at 6 months after OVF and is a useful quantitative indicator for determining bone union.
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Affiliation(s)
- Kozo Sato
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa aza Tatsutayashiki, Izumi ku, Sendai, Miyagi, 981-3217, Japan
| | - Yuichiro Yamada
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa aza Tatsutayashiki, Izumi ku, Sendai, Miyagi, 981-3217, Japan
| | - Masakazu Kogawa
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa aza Tatsutayashiki, Izumi ku, Sendai, Miyagi, 981-3217, Japan. .,Centre for Orthopaedics and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Takuya Sekiguchi
- Department of Orthopaedic Science, Iwate Prefectural Central Hospital, 1-4-1, Ueda, Morioka, Iwate, 020-0066, Japan
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Zhou X, Meng X, Zhu H, Zhu Y, Yuan W. Early versus late percutaneous kyphoplasty for treating osteoporotic vertebral compression fracture: A retrospective study. Clin Neurol Neurosurg 2019; 180:101-105. [PMID: 30953973 DOI: 10.1016/j.clineuro.2019.03.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/19/2019] [Accepted: 03/30/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Osteoporotic vertebral compression fracture (OVCF) is a common disease in the aged population that can greatly affect the quality of life. Percutaneous kyphoplasty (PKP) has become a mainstream approach for treating OVCF, but the optimal surgical timing for treating OVCF with PKP remains controversial. In the current study, we retrospectively studied patients with OVCF that underwent PKP, and aimed to find out whether surgical timing could affect the clinical and radiological outcomes. PATIENTS AND METHODS We retrospectively studied 62 patients who underwent PKP for OVCF. Patients were divided into 2 groups based on the timing of PKP: operation within 4 weeks (group A) and operation later than 4 weeks (group B). VAS, ODI, height of fracture vertebra, restored height rate, local kyphosis angle and complications were assessed preoperatively and throughout the follow-up. RESULTS There were 36 cases (58 fracture vertebra) in the group A and 26 cases (40 fracture vertebra) in the group B. There was no significant difference between the two groups regarding to the demographic data before surgery. In terms of the VAS and ODI, no statistical difference was observed before operation, after operation and at the 6th month follow-up between the two groups. The HRR after operation and at the 6th month follow-up in the group A was 17.5 ± 5.3% and 10.5 ± 3.7%, and that in the group B was 7.2 ± 3.2% and 3.6 ± 1.1%, and there is significant difference between the two groups (p < 0.05). The LKA (preoperatively / post-operatively / 6th month follow-up) was -12.7°, -7.3°, -11.4° in the group A and -17.6°, -14.4°, -16.1° in the group B. There was significant difference between the two groups at all the time points for local kyphosis angle (p < 0.01), with a lower rate of subsequent vertebral fracture in the group A (p < 0.05). CONCLUSION Both surgical timings of PKP showed similar outcomes in terms of the VAS and ODI. Early PKP could result in better restoration of vertebral body height and reduced rate of subsequent fracture compared to late PKP.
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Affiliation(s)
- Xiaoshu Zhou
- Department of Orthopedics, First Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang, China
| | - Xiaotong Meng
- Department of Orthopedics, First Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang, China
| | - Haitao Zhu
- Department of Orthopedics, First Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang, China
| | - Yue Zhu
- Department of Orthopedics, First Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang, China.
| | - Wei Yuan
- Department of Orthopedics, First Hospital of China Medical University, No. 155 Nanjing North Street, Shenyang, China.
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Initial hospitalization with rigorous bed rest followed by bracing and rehabilitation as an option of conservative treatment for osteoporotic vertebral fractures in elderly patients: a pilot one arm safety and feasibility study. Arch Osteoporos 2018; 13:134. [PMID: 30470939 PMCID: PMC6267386 DOI: 10.1007/s11657-018-0547-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 11/12/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED We assessed the safety and feasibility of a unified conservative treatment protocol for osteoporotic vertebral fractures in the elderly patients with a 24-week follow-up. Our results showed that initial hospitalization with rigorous bed rest followed by a rehabilitation program using a Jewett brace was safe and feasible in managing patients. PURPOSE The purpose of this study was to prove the safety and feasibility of a unified conservative treatment protocol, which included initial hospitalization with rigorous bed rest followed by a rehabilitation program with Jewett brace for osteoporotic vertebral fractures (OVFs) in the elderly patients with a 24-week follow-up. METHODS Between April 2012 and Mach 2015, one hundred fifty-four patients met the eligibility for this study. Radiological findings at the 3-week, 6~8-week, 24-week assessment were evaluated. Among these, 11 patients underwent early surgery within the first 2 weeks after admission and 19 patients lost follow-up. Therefore, 124 patients were assessed at the final follow-up visit. RESULTS The average vertebral instability in all the present series was 4.9 ± 4.8° at 3-week, 2.9 ± 3.5° at 6~8-week, and 1.8 ± 3.0° at 24-week follow-up visit. Delayed union was observed in 16 patients on the 24-week follow-up visit. Therefore, the present conservative treatment protocol resulted in bony union in 98 out of 124 patients (79.0%, per protocol set analysis) and 98 out of 154 patients including drop-out (63.6%, intention-to-treat analysis). There was no severe adverse event related to initial bed rest. The vertebral instability at 3-week assessment was significantly higher in the delayed union group when compared with that in the union group. Univariate analyses followed by multivariate logistic regression analysis revealed that T2-weighted image of confined high intensity on MRI and having more than 5° of vertebral instability on dynamic X-ray at 3-week assessment are the independent risk factors for delayed union of conservative treatment in the present series. CONCLUSIONS Our results showed that initial hospitalization with rigorous bed rest followed by a rehabilitation program using a Jewett brace was safe and feasible. Therefore, the present conservative treatment protocol can be one of the acceptable treatment options in managing OVF patients.
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Gondim Teixeira PA, Savi de Tové KM, Abou Arab W, Raymond A, Louis M, Polet Lefebvre K, Blum A. Subchondral linear hyperintensity of the femoral head: MR imaging findings and associations with femoro-acetabular joint pathology. Diagn Interv Imaging 2016; 98:245-252. [PMID: 27401501 DOI: 10.1016/j.diii.2016.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/09/2016] [Accepted: 06/14/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE The goal of this study was to evaluate the associations between linear hyperintensity in the subchondral bone of the femoral head on T2-weighted MR imaging and structural bone lesions. MATERIAL AND METHODS The MR imaging examinations of 63 patients (66 hips) that showed a bone marrow edema pattern (BMEP) of the hip were retrospectively evaluated (study group). The study group comprised 43 men and 20 women, with a mean age of 55.3 years±16.9 (SD) (range: 19-84 years). A control group of 61 patients (77 hips) without BMEP of the hip on MR imaging was created. The control group comprised 30 men and 31 women, with a mean age of 53.1 years±15.6 (SD) (range: 25-83 years). The presence of linear abnormalities of the subchondral bone on T2-weighted fat-saturated sequences (TR/TE=4220-4340/42-45ms) was evaluated and MR imaging findings were correlated with structural femoro-acetabular pathology (advanced chondropathy, osteonecrosis, subchondral insufficiency fractures and macroscopic fractures) and with pain duration. RESULTS A linear hyperintensity in the subchondral bone on T2-weighted MR imaging was found in 43/66 hips with areas of BMEP (65.1%) and in 3/77 hips without BMEP (3.8%). Subchondral linear hyperintensity was seen in 15/16 (93.7%) hips with a subchondral insufficiency fracture. Among the 16 hips with an ARCO stage III osteonecrosis, 13 (76.9%) presented BMEP associated with a subchondral linear hyperintensity. BMEP was present in 6/8 hips with ARCO stage IV osteonecrosis; however, only two hips (25%) exhibited subchondral linear hyperintensities. Finally, 77.7% of patients with subchondral linear hyperintensities presented with acute or subacute hip pain (P<0.0001). CONCLUSION Femoral head subchondral linear hyperintensity on T2-weighted MR imaging is common and is associated with acute subchondral bone damage.
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Affiliation(s)
- P A Gondim Teixeira
- Guilloz Department of Imaging, Hôpital Central, CHU de Nancy, 29, avenue Maréchal-Lattre-de-Tassigny, 54035 Nancy, France.
| | - K-M Savi de Tové
- University of Medicine, Université de Parakou, P.O. Box 02, Parakou, Benin
| | - W Abou Arab
- Guilloz Department of Imaging, Hôpital Central, CHU de Nancy, 29, avenue Maréchal-Lattre-de-Tassigny, 54035 Nancy, France
| | - A Raymond
- Guilloz Department of Imaging, Hôpital Central, CHU de Nancy, 29, avenue Maréchal-Lattre-de-Tassigny, 54035 Nancy, France
| | - M Louis
- Guilloz Department of Imaging, Hôpital Central, CHU de Nancy, 29, avenue Maréchal-Lattre-de-Tassigny, 54035 Nancy, France
| | - K Polet Lefebvre
- Service d'imagerie médicale de femme et périnatale, Maternité Universitaire Régionale, 54035 Nancy, France
| | - A Blum
- Guilloz Department of Imaging, Hôpital Central, CHU de Nancy, 29, avenue Maréchal-Lattre-de-Tassigny, 54035 Nancy, France
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Newman M, Minns Lowe C, Barker K. Spinal Orthoses for Vertebral Osteoporosis and Osteoporotic Vertebral Fracture: A Systematic Review. Arch Phys Med Rehabil 2015; 97:1013-25. [PMID: 26615791 DOI: 10.1016/j.apmr.2015.10.108] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/27/2015] [Accepted: 10/31/2015] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To systematically review the evidence of effectiveness of spinal orthoses for adults with vertebral osteoporosis. DATA SOURCES We conducted a systematic literature search using the databases of PubMed, MEDLINE, EMBASE, AMED, CINAHL, PEDro, and the Cochrane Library from January 1995 to October 2014. STUDY SELECTION Two reviewers evaluated eligibility. Randomized controlled trials (RCTs), pilot RCTs, and prospective nonrandomized controlled studies of spinal orthoses for people with vertebral osteoporosis or osteopenia with and without osteoporotic vertebral fracture (OVF) that examined outcomes related to fracture consolidation, pain, strength, posture, balance, physical function, quality of life, and complications were eligible. DATA EXTRACTION Two reviewers independently extracted data and evaluated methodological quality using a domain-based risk-of-bias approach. DATA SYNTHESIS Twelve studies were included: 8 RCTs or pilot RCTs and 4 nonrandomized studies involving 626 participants. Three studies (n=153) evaluated orthoses after acute OVF; none were of high quality. Complications were highest with rigid orthoses. Evidence that orthoses could affect vertebral deformity was lacking. Nine studies (n=473) of varying quality considered orthoses in subacute and longer rehabilitation. Three suggested a semirigid backpack thoracolumbar orthosis (TLO) could benefit strength, pain, posture, and quality of life. One found a weighted kypho-orthosis (WKO) improved balance. CONCLUSIONS The limited evidence about orthoses after acute OVF is inconclusive; better evidence of efficacy is needed, particularly when considering complications. The promising evidence regarding the backpack TLO and WKO needs to be explored further in studies of sufficient size and quality that include men.
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Affiliation(s)
- Meredith Newman
- Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, England; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England.
| | - Catherine Minns Lowe
- Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, England
| | - Karen Barker
- Physiotherapy Research Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, England; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England
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Discriminating imaging findings of acute osteoporotic vertebral fracture: a prospective multicenter cohort study. J Orthop Surg Res 2014; 9:96. [PMID: 25300643 PMCID: PMC4195983 DOI: 10.1186/s13018-014-0096-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 09/30/2014] [Indexed: 11/21/2022] Open
Abstract
Background Appropriate treatment of osteoporotic vertebral fractures (OVF) requires knowledge of the age of the fracture. Although diagnostic imaging has made remarkable progress in recent years, it remains difficult to differentiate acute fractures from old. Our purpose was to investigate chronological changes in radiological findings after OVF and to identify discriminators of acute versus older injuries. Methods We evaluated 139 vertebrae in 136 patients. All patients underwent X-ray and magnetic resonance imaging (MRI) examination within 2 weeks of injury and again after 6 months. The anterior vertebral height ratio (AVHR) was calculated on lateral X-ray, and the intensity change of the posterior wall of the fractured vertebra was evaluated on T1-weighted MRI. The cutoff AVHR value to diagnose acute fracture was determined by receiver operating characteristic (ROC) curve analysis. Results Average AVHR fell from 84.6% at initial visit to 63.7% at 6 months. When acute fracture was defined as AVHR >75%, sensitivity was 85.6%, specificity was 67.6%, and positive predictive value was 72.6%. On MRI, 83.5% of fractured vertebrae showed intensity change in the posterior wall in the acute stage, which fell to 41.7% of vertebrae after 6 months. When intensity change in the posterior wall and AVHR >75% were both present, the specificity and positive predictive value for diagnosing acute fracture improved to 87.1% and 84.7%, respectively. Conclusions This study suggests that vertebral fracture rarely shows significant collapse on X-ray in the first 2 weeks after injury. The combination of intensity change in the posterior wall on MRI and AVHR >75% on X-ray indicates a high probability of acute fracture.
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Park JH, Kang KC, Shin DE, Koh YG, Son JS, Kim BH. Preventive effects of conservative treatment with short-term teriparatide on the progression of vertebral body collapse after osteoporotic vertebral compression fracture. Osteoporos Int 2014; 25:613-8. [PMID: 23943161 DOI: 10.1007/s00198-013-2458-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/02/2013] [Indexed: 12/26/2022]
Abstract
UNLABELLED The progression of fractured vertebral collapse is not rare after a conservative treatment of vertebral compression fracture (VCF). Teriparatide has been shown to directly stimulate bone formation and improve bone density, but there is a lack of evidence regarding its use in fracture management. Conservative treatment with short-term teriparatide is effective for decreasing the progression of fractured vertebral body collapse. INTRODUCTION Few studies have reported on the prevention of collapsed vertebral body progression after osteoporotic VCF. Teriparatide rapidly enhances bone formation and increases bone strength. This study evaluated preventive effects of short-term teriparatide on the progression of vertebral body collapse after osteoporotic VCF. METHODS Radiographs of 68 women with single-level osteoporotic VCF at thoracolumbar junction (T11-L2) were reviewed. Among them, 32 patients were treated conservatively with teriparatide (minimum 3 months) (group I), and 36 were treated with antiresorptive (group II). We measured kyphosis and wedge angle of the fractured vertebral body, and ratios of anterior, middle, and posterior heights of the collapsed body to posterior height of a normal upper vertebra were determined. The degree of collapse progression was compared between two groups. RESULTS The progression of fractured vertebral body collapse was shown in both groups, but the degree of progression was significantly lower in group I than in group II. At the last follow-up, mean increments of kyphosis and wedge angle were significantly lower in group I (4.0° ± 4.2° and 3.6° ± 3.6°) than in group II (6.8° ± 4.1° and 5.8° ± 3.5°) (p = 0.032 and p = 0.037). Decrement percentages of anterior and middle border height were significantly lower in group I (9.6 ± 10.3 and 7.4 ± 7.5 %) than in group II (18.1 ± 9.7 and 13.8 ± 12.2 %) (p = 0.001 and p = 0.025), but not in posterior height (p = 0.086). CONCLUSIONS In female patients with single-level osteoporotic VCF at the thoracolumbar junction, short-term teriparatide treatment did not prevent but did decrease the progression of fractured vertebral body collapse.
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Affiliation(s)
- J-H Park
- Department of Neurological Surgery, Yonsei Sarang Hospital, 478-3, Bangbae-dong, Seocho-gu, Seoul, Republic of Korea
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