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Vertebroplasty Using Calcium Phosphate Cement for Osteoporotic Vertebral Fractures: Study of Outcomes at a Minimum Follow-up of Two Years.

Nakano M, Hirano N, Zukawa M, Suzuki K, Hirose J, Kimura T, Kawaguchi Y - Asian Spine J (2012)

Bottom Line: The mean duration of follow-up was forty-four months.Complete bone union was observed in all cases by six months after surgery.The mean recovery rate of deformity index was 5.9% in procedure A and 0.02% in procedure B at the final follow-up visit.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan.

ABSTRACT

Study design: A case-series study.

Purpose: To assess the long-term clinical and radiographic outcomes after vertebroplasty using calcium phosphate cement (CPC) for treatment of osteoporotic vertebral fractures (OVF).

Overview of literature: Vertebroplasty has become common for the treatment of OVF. However, few studies have reported the clinical application of CPC to vertebroplasty.

Methods: We reviewed 86 consecutive patients undergoing 99 vertebroplasties using CPC. Following repositioning and curettage of the pathological soft tissue of the vertebral body (VB), vertebroplasty using CPC was performed in patients with osteoporotic burst fracture and pseudoarthrosis (procedure A). Vertebroplasty was also performed in patients with osteoporotic compression fractures (procedure B). Back pain and lower back pain were evaluated using the visual analogue scale (VAS). The VB deformity index was measured in a lateral radiograph as the ratio of the VB's height to its longitudinal diameter.

Results: The mean age at time of surgery was 77 years old. The mean duration of follow-up was forty-four months. All patients reported decreased pain according to the VAS immediately after vertebroplasty, and pain relief was maintained at the last follow-up in all patients without new OVFs. Complete bone union was observed in all cases by six months after surgery. The mean recovery rate of deformity index was 5.9% in procedure A and 0.02% in procedure B at the final follow-up visit.

Conclusions: Vertebroplasty using CPC gave a satisfactory outcome and no delayed complications in elderly patients with osteoporotic vertebral fractures at follow-up times of at least two years.

No MeSH data available.


Related in: MedlinePlus

Representative radiographs and computed tomography (CT) findings demonstrating a typical example of pseudoarthrosis following osteoporotic compression fracture. (A, B) Preoperative flexion-extension lateral radiographs demonstrating significant instability and kyphotic deformity of the vertebral body at T12 and L1. (C) A postoperative radiograph obtained immediately after procedure A revealing excellent augmentation of the vertebral body and significant correction of the kyphotic deformity of 30° in the Cobb measurement. (D) At 3 months after surgery, the correction is relatively decreased because the CPC mass was partially broken and displaced anteriorly. (E, F) A postoperative CT finding obtained one week after surgery demonstrating the preoperative defect filled with calcium phosphate cement at T12 (E) and L1 (F).
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Figure 2: Representative radiographs and computed tomography (CT) findings demonstrating a typical example of pseudoarthrosis following osteoporotic compression fracture. (A, B) Preoperative flexion-extension lateral radiographs demonstrating significant instability and kyphotic deformity of the vertebral body at T12 and L1. (C) A postoperative radiograph obtained immediately after procedure A revealing excellent augmentation of the vertebral body and significant correction of the kyphotic deformity of 30° in the Cobb measurement. (D) At 3 months after surgery, the correction is relatively decreased because the CPC mass was partially broken and displaced anteriorly. (E, F) A postoperative CT finding obtained one week after surgery demonstrating the preoperative defect filled with calcium phosphate cement at T12 (E) and L1 (F).

Mentions: We selected two procedures [9]: 1) Following repositioning and curettage of the pathological soft tissues of the VB, vertebroplasty using CPC (Biopex, Pentax, Tokyo, Japan) was performed in patients with osteoporotic burst fracture and pseudoarthrosis (procedure A) (Figs. 1 and 2). 2) Vertebroplasty was also performed in patients with osteoporotic compression fractures (procedure B). The selection criteria for procedure A included computed tomography (CT) scanning evidence of a posterior wall fracture of the VB with displacement and bulging of more than 2 mm and/or presentation more than eight weeks after the time of the injury. Those for procedure B included both CT scanning evidence of posterior wall fracture of VB with displacement and bulging of less than 2 mm, and presentation fewer than eight weeks after the time of the injury.


Vertebroplasty Using Calcium Phosphate Cement for Osteoporotic Vertebral Fractures: Study of Outcomes at a Minimum Follow-up of Two Years.

Nakano M, Hirano N, Zukawa M, Suzuki K, Hirose J, Kimura T, Kawaguchi Y - Asian Spine J (2012)

Representative radiographs and computed tomography (CT) findings demonstrating a typical example of pseudoarthrosis following osteoporotic compression fracture. (A, B) Preoperative flexion-extension lateral radiographs demonstrating significant instability and kyphotic deformity of the vertebral body at T12 and L1. (C) A postoperative radiograph obtained immediately after procedure A revealing excellent augmentation of the vertebral body and significant correction of the kyphotic deformity of 30° in the Cobb measurement. (D) At 3 months after surgery, the correction is relatively decreased because the CPC mass was partially broken and displaced anteriorly. (E, F) A postoperative CT finding obtained one week after surgery demonstrating the preoperative defect filled with calcium phosphate cement at T12 (E) and L1 (F).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3302913&req=5

Figure 2: Representative radiographs and computed tomography (CT) findings demonstrating a typical example of pseudoarthrosis following osteoporotic compression fracture. (A, B) Preoperative flexion-extension lateral radiographs demonstrating significant instability and kyphotic deformity of the vertebral body at T12 and L1. (C) A postoperative radiograph obtained immediately after procedure A revealing excellent augmentation of the vertebral body and significant correction of the kyphotic deformity of 30° in the Cobb measurement. (D) At 3 months after surgery, the correction is relatively decreased because the CPC mass was partially broken and displaced anteriorly. (E, F) A postoperative CT finding obtained one week after surgery demonstrating the preoperative defect filled with calcium phosphate cement at T12 (E) and L1 (F).
Mentions: We selected two procedures [9]: 1) Following repositioning and curettage of the pathological soft tissues of the VB, vertebroplasty using CPC (Biopex, Pentax, Tokyo, Japan) was performed in patients with osteoporotic burst fracture and pseudoarthrosis (procedure A) (Figs. 1 and 2). 2) Vertebroplasty was also performed in patients with osteoporotic compression fractures (procedure B). The selection criteria for procedure A included computed tomography (CT) scanning evidence of a posterior wall fracture of the VB with displacement and bulging of more than 2 mm and/or presentation more than eight weeks after the time of the injury. Those for procedure B included both CT scanning evidence of posterior wall fracture of VB with displacement and bulging of less than 2 mm, and presentation fewer than eight weeks after the time of the injury.

Bottom Line: The mean duration of follow-up was forty-four months.Complete bone union was observed in all cases by six months after surgery.The mean recovery rate of deformity index was 5.9% in procedure A and 0.02% in procedure B at the final follow-up visit.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan.

ABSTRACT

Study design: A case-series study.

Purpose: To assess the long-term clinical and radiographic outcomes after vertebroplasty using calcium phosphate cement (CPC) for treatment of osteoporotic vertebral fractures (OVF).

Overview of literature: Vertebroplasty has become common for the treatment of OVF. However, few studies have reported the clinical application of CPC to vertebroplasty.

Methods: We reviewed 86 consecutive patients undergoing 99 vertebroplasties using CPC. Following repositioning and curettage of the pathological soft tissue of the vertebral body (VB), vertebroplasty using CPC was performed in patients with osteoporotic burst fracture and pseudoarthrosis (procedure A). Vertebroplasty was also performed in patients with osteoporotic compression fractures (procedure B). Back pain and lower back pain were evaluated using the visual analogue scale (VAS). The VB deformity index was measured in a lateral radiograph as the ratio of the VB's height to its longitudinal diameter.

Results: The mean age at time of surgery was 77 years old. The mean duration of follow-up was forty-four months. All patients reported decreased pain according to the VAS immediately after vertebroplasty, and pain relief was maintained at the last follow-up in all patients without new OVFs. Complete bone union was observed in all cases by six months after surgery. The mean recovery rate of deformity index was 5.9% in procedure A and 0.02% in procedure B at the final follow-up visit.

Conclusions: Vertebroplasty using CPC gave a satisfactory outcome and no delayed complications in elderly patients with osteoporotic vertebral fractures at follow-up times of at least two years.

No MeSH data available.


Related in: MedlinePlus