We report here on a new technique using polymethylmethacrylate to manage vertebral osteoporotic compression fractures in three patients. These patients presented with acute back pain that manifested itself after minor trauma. Osteoporotic compression fractures were diagnosed via plain X-ray and magnetic resonance imaging studies. The patients were treated with absolute bed rest and non-steroidal anti-inflammatory drugs. Despite of the conservative treatment, the patients experienced severe, recalcitrant and progressive pain. The vertebrae were collapsed over 50% or kyphotic deformity was seen on the radiologic materials. We performed a new technique called lordoplasty, which is derived from percutaneous vertebroplasty. The patients experienced a reduction in pain after the procedure. The wedge and kyphotic angles of the fractured vertebrae were significantly restored.
Aged ; Female ; Fractures, Compression/radiography/*surgery ; Humans ; Magnetic Resonance Imaging ; Orthopedic Procedures/*methods ; Osteoporotic Fractures/radiography/*surgery ; Spinal Fractures/radiography/*surgery ; Thoracic Vertebrae/*injuries/radiography/surgery

The accurate diagnosis of spine trauma is essential to its proper management, since therapeutic decisionsdepend on radiography and clinical data. Failure to recognize significant injury to the spine can lead to severeneurological deficit in the previously neulogically intact patient. The developmemt of CT has open a new demensionin evaluation of spinal column. In our experience CT not only offer the accurate and thorough evaluation of spinalinjury, but does so in a rapid and more efficient manner when compared with conventional radiolgraphy. CT hasbecome the diagnostic procedure of choice when screening plain film and clinical examination indecate that acomprehensive radiographic evaluation is necessary. Eighteen patients with thoracic and lumber spinal fracturewere studied with CT. Four had multiple level injuries. The resuls are summerized as follow; 1. Among the 18patients, 4 had multiple level injuries and other 14 patients had single spinal injury. 2. 8 patients (11 spines)had simple compression fracture and 12 patients (13 spines) had burst fracture of vertebral body. 3. 15 spinesamong the 24 involved spines are located at T12 and L1 level. 4. Spineal canal narrowing and bony fragment in thecanal are defiend only 7 of 13 spines (53.8%) of burst fracture in conventional radiography. However CT showed inall spines of burst fracture. 5. Spinal posterior element involvement is suggested only one of 12 spines of burstfracture, but correctly interpretated by CT in 7 spines(11 anatomical position).
Diagnosis ; Fractures, Compression ; Humans ; Mass Screening ; Radiography ; Spinal Fractures ; Spinal Injuries ; Spine

OBJECTIVES: Since vertebroplasty has been introduced, we performed short segment pedicle screw fixation with augmented intra-operative vertebroplasty in patients with unstable thoraco-lumbar fracture. Our intentions are to demonstrate the efficacy and indication of this new technique compare to conventional methods. MATERIAL AND METHODS: The surgery comprised of pedicle screw fixations on one level above and below the fracture site, and the fractured level itself, if pedicle is intact, and intra-operative vertebroplasty under the fluoroscopic guide with in-situ postero-lateral bone graft. Also, in cases of bone apposition, we removed those with small impactor through a transfascetal route. During the last 2 years, we performed in seven(7) unstable thoraco-lumbar fracture patients who consisted of two different characteristics, those four(4) with primary or secondary osteoporosis and three(3) of young and very healthy. All patients were followed clinically by A.S.I.A. score and radiography. RESULTS: Mean follow up period was 14 months. We observed well decompressed state via transfascetal route in cases of bone fragments apposition and no hardware pullout in osteoporotic cases, no poly-methyl-methacrylate (PMMA) leakage through the fracture sites into the spinal canal, and no kyphotic deformities in both cases during follow-up periods. All patients demonstrated solid bony fusion except one following osteoporotic compression fracture on other sites. CONCLUSIONS: In the management of unstable thoraco-lumbar fracture, we believe that this short segment pedicle screw fixation with augmented intra-operative vertebroplasty reduce the total length or levels of pedicle screw fixation without post-operative kyphotic deformity.
Congenital Abnormalities ; Follow-Up Studies ; Fractures, Compression ; Humans ; Intention ; Osteoporosis ; Radiography ; Spinal Canal ; Transplants ; Vertebroplasty*

A twenty-one year old man, who had been treated for medulloblastoma 6 years ago, complained progressive right knee joints pain and back pain. Multiple thoracic vertebral compression fracture was detected in radiography. The bone mineral density(BMD) was in osteoporotic range in duel energy X-ray absorpometry. Growth hormone deficiency and primary hypothyroidism were detected after endocrine function test. We treated him by cyclic intravenous pamidronate because he had complained severe back pain and difficulty to walk. After pamidronate therapy, the pain was decreased and the BMD was increased. No severe adverse effect was noted. This is the first case report of pamidronate therapy in patient who had osteoporotic vertebral compression fracture due to a sequela of childhood medulloblastoma.
Back Pain ; Bone Density ; Fractures, Compression ; Growth Hormone ; Humans ; Hypothyroidism ; Knee Joint ; Medulloblastoma* ; Radiography

Compression fractures are the most common vertebral fractures. They involve the anterior column of the spine, and are considered stable fractures due to the presence of intact posterior ligaments that aid in resisting further collapse and deformity. They are thus often managed conservatively. We describe a series of 3 cases that were initially diagnosed as compression fractures and managed conservatively. With the abundance of compression fractures and increase in preference for conservative management of compression fractures, it is of utmost importance to recognize the possibility of other spinal co-pathologies, especially that of hyperostosis of the spine, both by clinical judgment as well as radiological analysis before embarking on conservative management, should there be under-treatment and development of complications that could have otherwise been avoided, as in the cases presented in this series.
Congenital Abnormalities ; Fractures, Compression* ; Hyperostosis ; Hyperostosis, Diffuse Idiopathic Skeletal* ; Judgment ; Ligaments ; Radiography ; Spine

Percutaneous vertebroplasty is an effective, minimally invasive procedure for the treatment of vertebral compression fractures, and is a technique for treating lower back pain that appears to be increasingly popular throughout the world. We experienced two cases involving a rare complication of percutaneous vertebroplasty, namely pulmonary embolism caused by acrylic cement. One patient showed no subjective symptoms after vertebroplasty, while the other experienced chest pain. In the former, fluoroscopy demonstrated perivertebral venous leakage during vertebroplasty, and at chest radiography, tubular or branching high-density linear structures were observed. In addition, intravascular emboli were identified at CT. In the second patient, symptomatic therapy led to reduced chest pain.
Chest Pain ; Fluoroscopy ; Fractures, Compression ; Humans ; Low Back Pain ; Pulmonary Embolism* ; Radiography ; Thorax ; Vertebroplasty*

The thoracolumbar spine is relatively easily traumatized and result in serious complications such as neurologic impairment and instability, so its proper management is very important. Formerly the thoracolumbar spine injury was evaluated mainly by plain radiographs, and tomograms if indicated,but because computed tomography visualizes bone and soft tissues three-dimensionally, we tried to compare its value with that of plain radiographs in potentially unstable thoracolumbar injuries. From January 1984, we determined the stability of the potentially unstable thoracolumbar spine injury according to computed tomography finding and compared with plain radiography finding, and the following results were obtained. 1. By Holdsworth classification, it was difficult to determine the stability of the thoracolumbar spine injury. 2. In cases of compression fracture and burst fracture by Denis classification, it was necessary to determine the stability by computed tomography. 3. In cases of unstable burst fracture by McAfee classification, there was no direct relationship between the degree of canal occlusion and neurological deficit, but above 25% in conus medullaris lesion and above 50% in cauda equina lesion usually manifested neurological deficit. 4. In our cases, the neurological status of initial injury was important factor to determine the improvement rate.
Cauda Equina ; Classification ; Clinical Study ; Fractures, Compression ; Radiography ; Spinal Cord ; Spine

Accidents, Traffic ; Adult ; Fractures, Compression ; diagnostic imaging ; etiology ; pathology ; surgery ; Humans ; Male ; Radiography ; Spinal Fractures ; diagnostic imaging ; etiology ; pathology ; surgery

Although little attention has been paid to the less common rheumatoid involvement of the thoracic and lumbar regions, some studies have shown that rheumatoid synovitis with erosive changes can develop in these diarthrodial joints. We report a patient with seropositive rheumatoid arthritis (RA) involving the thoracic and lumbar vertebra with a collapse of the T12 vertebra, who was treated with percutaneous vertebroplasty. In this case of a painful pathological fracture due to RA, percutaneous vertebroplasty was found to be helpful in eliminating the pain. The paper presents the histological evidence, the pathogenesis and treatment of the thoracolumbar lesions affected by RA with a review of the relevant literature.
Arthritis, Rheumatoid/blood/complications/*pathology/radiography ; Female ; Fractures, Compression/etiology/radiography/surgery ; Humans ; Lumbar Vertebrae/*pathology/radiography ; Middle Aged ; Thoracic Vertebrae/*pathology/radiography ; Vertebroplasty

PURPOSE: The diagnosis of acute thoracic spinal fractures is often missed by plain radiography, alone. The purpose of this study was to compare the accuracy of radionuclide imaging with radiography, thoracic for detection of acute thoracic spinal fractures and to propose radionuclide imaging as screening tests for the diagnosis of acute thoracic spinal fractures before thoracic spine CT or MRI. METHODS: Out of the patients who were admitted to our medical center, Emergency Medicine Department for trauma from June 1, 2001, to February 28, 2003. We are retrospectively studied 67 patients who had undergone radionuclide imaging and thoracic MRI to detect acute thoracic spinal fractures. Because of their symptoms those 67 patients were suspected of having thoracic compression fractures, but those fractures had not been detected on plain thoracic spine radiographics. RESULTS: In 19 patients, 43 acute thoracic spinal fractures were detected by thoracic MRI, in 17 patients, 29 acute thoracic spinal fractures were detected by radionuclide imaging (67.4%) and in 11 patients, 14 acute thoracic spinal fractures were detected by radiography, thoracic (32.6%). The diagnostic agreement of radionuclide imaging with thoracic MRI (Kappa=0.771) was higher than that of plain radiography, thoracic with thoracic MRI (Kappa=0.439). The sensitivity, specificity, and accuracy of radionuclide imaging were 67.4%, 100%, and 93.9%, respectively, and those of plain radiography, thoracic were 32.6%, 100%, and 87.3%. The sensitivity and accuracy of radionuclide imaging for the diagnosis of acute thoracic spinal fractures were significantly higher than those of plain radiography, thoracic (p<0.05). CONCLUSION: Radionuclide imaging is more sensitive and accurate in detecting acute thoracic spinal fractures than plain thoracic spine radiography. Further study is required to prove whether radionuclide imaging is a useful screening test for acute thoracic spinal fractures instead of performing expensive thoracic spine CT or MRI.
Diagnosis* ; Emergency Medicine ; Fractures, Compression ; Humans ; Magnetic Resonance Imaging ; Mass Screening* ; Radiography ; Radiography, Thoracic ; Radionuclide Imaging* ; Retrospective Studies ; Sensitivity and Specificity ; Spinal Fractures* ; Spine