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

OBJECTIVE: Vertebral compression fractures (VCFs) are common complications of osteoporosis. The expansion of VCFs with a Sky Bone Expander is a new procedure which improves kyphotic deformities and decreases pain associated with VCFs. The purpose of this study was to investigate the preliminary results for the treatment of painful osteoporotic VCFs with a Sky Bone Expander. MATERIALS AND METHODS: Twenty-six patients with pain-causing VCFs were treated with a Sky Bone Expander. This operation involved the percutaneous insertion of the Sky Bone Expander into a fractured vertebral body transpedicularly. Following the expansion, the Sky Bone Expander was contracted and removed, resulting in a cavity to be filled with bone cement. All fractures were analyzed for improvement in sagittal alignment. Clinical complications, pain relief and ambulation status were evaluated 1 day, 1 week, 1 month, and 3 months after the operation. RESULTS: Twenty-four hours after the operation, all the patients treated experienced some degree of pain relief. In addition, no postoperative neurologic complications were noted. The average operative time was 42.4 +/- 15.5 min per vertebra. Moreover, an average cement volume of 3.5 mL (range, 2.5 +/- 5.0 mL) was injected per vertebra. The average anterior height was 18.4 +/- 5.1 mm preoperatively and 20.5 +/- 5.3 mm postoperatively (p < 0.01). Furthermore, the average midline height was 15.5 +/- 5.2 mm preoperatively and 18.9 +/- 4.0 mm postoperatively (p < 0.01). The Cobb angle improved from 18.5 +/- 8.2 degrees preoperatively to 9.2 +/- 4.0 degrees postoperatively (p < 0.01). The Visual Anabog Scale scores decreased from 7.7 +/- 1.8 points preoperatively to 3.1 +/- 2.0, 2.9 +/- 1.7, 2.6 +/- 1.5 and 2.9 +/- 11.3 after 1 day, 1 week, 1 month and 3 months after the operation, respectively. Cement extrusion was observed in four patients without any neurologic symptoms. CONCLUSION: As a result of this study, we can postulate that the expansion of compressed vetrebra with a Sky Bone Expander is a safe and minimally invasive procedure resulting in the restoration of vertebral body height and the relief of pain associated with VCFs.
Aged ; Aged, 80 and over ; Bone Cements ; Female ; Fractures, Compression/etiology/radiography/*surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Osteoporosis/*complications ; Pain/etiology/*surgery ; Postoperative Complications ; Prospective Studies ; Radiography, Thoracic ; Spinal Fractures/etiology/radiography/*surgery ; *Tissue Expansion Devices ; Treatment Outcome

Few studies have been conducted to explain the pain patterns resulting from osteoporotic vertebral compression fractures (OVCF). We analyzed pain patterns to elucidate the pain mechanism and to provide initial guide for the management of OVCFs. Sixty-four patients underwent percutaneous vertebroplasty (N=55) or kyphoplasty (N=9). Three pain patterns were formulized to classify pains due to OVCFs: midline paravertebral (Type A), diffuse paravertebral (Type B), and remote lumbosacral pains (Type C). The degree of compression was measured using scale of deformity index, kyphosis rate, and kyphosis angle. Numerical rating scores were serially measured to determine the postoperative outcomes. As vertebral body height (VBH) decreased, paravertebral pain became more enlarged and extended anteriorly (p<0.05). Type A and B patterns significantly showed the reverse relationship with deformity index (p<0.05), yet Type C pattern was not affected by deformity index. Postoperative pain severity was significantly improved (p<0.05), and patients with a limited pain distribution showed a more favorable outcome (p<0.05). The improvement was closely related with the restoration of VBH, but not with kyphosis rate or angle. Thus, pain pattern study is useful not only as a guide in decision making for the management of patients with OVCF, but also in predicting the treatment outcome.
Aged ; Aged, 80 and over ; Female ; Fracture Fixation, Internal/methods ; Fractures, Compression/etiology/radiography/*surgery ; Humans ; Kyphosis/therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Osteoporosis/*complications/diagnosis ; Pain/etiology/*surgery ; Pain Measurement ; Pain, Postoperative/etiology ; Polymethyl Methacrylate/administration & dosage/therapeutic use ; Questionnaires ; Sickness Impact Profile ; Spinal Fractures/radiography/*surgery ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo evaluate the efficacy and safety of percutaneous balloon kyphoplasty as a new therapy for patients with painful osteoporotic vertebral compressive fractures of the lumbar and thoracic spine.

METHODSA retrospective analysis was conducted in 38 consecutive patients (28 females, 10 males), whose ages ranged from 56 to 82 years (mean age 72 years). The symptom- and sign-positive spinal segment was identified by MRI. The time between onset of symptoms and surgical intervention ranged from 2 days to 1 year. 62 segments (36 thoracic, 26 lumbar) were treated in this cohort. The pain score estimated by Visual Analog Scale and activity degree were assessed immediately after operation and at 1-, 6-, and 12-month postoperative follow-up. Preoperative and postoperative anterior, midline vertebral heights in fractured vertebrae were measured on lateral radiographs to evaluate the effect of the procedure.

RESULTSThe method achieved a swift pain relief associated with an evidently increased weight-bearing ability. The pain score was reduced from 8.2 to 2.4 points. The anterior and midline vertebral heights in 62 fractured vertebral bodies increased up to 82.76%+/-26.84%, 88.82%+/-21.75% and the wedge decreased from 15 to 8 degrees. This effect persisted at least over a period of two years. The procedure did not induce narrowing of the spinal canal and no severe complications occurred.

CONCLUSIONSBalloon kyphoplasty can result in immediate clinical improvement of mobility and pain relief, increase vertebral body height, and quickly return patient's activity. The short-term results are approved excellent, and the long-term results need further judgment.

Aged ; Aged, 80 and over ; Female ; Humans ; Lumbar Vertebrae ; diagnostic imaging ; injuries ; surgery ; Male ; Middle Aged ; Osteoporosis ; complications ; diagnostic imaging ; Pain Measurement ; Radiography ; Spinal Fractures ; diagnostic imaging ; etiology ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; injuries ; surgery ; Treatment Outcome

OBJECTIVETo evaluate the therapeutic effects of fixation and fusion with lateral mass screws of the atlas and vertebra dentata pedicle screws for the treatment of upper vertebral instability.

METHODSTen patients with atlantoaxial instability, including 3 with old odontoid fracture and 7 with fresh odontoid fracture (Aderson II) received surgeries for fixation and fusion with lateral mass screws of the atlas and vertebra dentata pedicle screws.

RESULTSNo spinal cord or vertebral artery injuries occurred in these patients after the surgery. The follow-up duration ranged from 3 to 15 months with an average of 8 months. The postoperative JOA scores were from l3.2 to l6.8, with an average of l4.8. Clinical improvement was achieved in 87.5% of the patients, and the implanted bones all fused successfully without internal fixation rupture or mobilization.

CONCLUSIONLateral mass screws of the atlas combined with vertebra dentata pedicle screws allows three-dimensional fixation for treatment of atlantoaxial instability.

Adult ; Atlanto-Axial Joint ; diagnostic imaging ; surgery ; Axis, Cervical Vertebra ; injuries ; surgery ; Bone Screws ; Cervical Atlas ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Joint Instability ; etiology ; surgery ; Male ; Middle Aged ; Radiography ; Spinal Fractures ; complications ; diagnostic imaging ; surgery ; Spinal Fusion ; methods

According to the literature, thoracic outlet syndrome (TOS) secondary to the malunion of displaced fractures of the clavicle is rare. Various surgical methods, including simple neurolysis, resection of the first rib or clavicle and corrective osteotomy, have been reported. We report a case of TOS secondary to malunion of the clavicle that was treated by an anterior and middle scalenectomy without a rib resection.
Adult ; Humans ; Low Back Pain/etiology ; Lumbar Vertebrae/surgery ; Male ; Postoperative Complications/*microbiology ; Spondylitis/etiology/*microbiology ; Thoracic Vertebrae/*microbiology/pathology ; Tuberculosis/drug therapy/*microbiology ; Tuberculosis, Spinal/complications/drug therapy/*microbiology ; Adult ; Clavicle/*injuries ; Fractures, Malunited/*complications ; Humans ; Male ; Thoracic Outlet Syndrome/etiology/radiography/*surgery

OBJECTIVETo study the treatment of spinal fractures in ankylosing spondylitis.

METHODSNineteen cases of spinal fractures complicating ankylosing spondylitis admitted in our hospital were studied retrospectively.

RESULTSAll of 19 cases were up to the diagnosis standards of ankylosing spondylitis. Eleven patients had cervical fracture and 8 had thoracolumbar fracture. Of the patients with cervical fracture, fractures occurred at C(5 - 7) in 9 patients. Of the patients with thoracolumbar injury, stress fractures were seen in 7 patients and all of seven fractures occurred at T(10)-L(2). Sixteen of the 19 patients sustained fractures through three columns of the spine. Nine patients had spinal cord injures; eight of the 9 cases had cervical fracture. All of the 19 patients were treated operatively. Four different surgical procedures were used in patients with cervical fracture; decompression, fusion and stabilization with instrumentation by anterior approach were performed in 9 patients. Of the patients with thoracolumbar fractures, four different operations were performed; fusion by both anterior and posterior approach plus a long posterior instrument were used in 5 cases. Eighteen patients had an average follow-up period of 46.6 months. Nine patients with preoperative neurological deficits improved in 8 and was stabilized in 1. Radiographic evidence of fusion was observed in all of the 18 patients. Two patients suffered neurological deterioration during surgery. One patient died from cerebrovascular infarction. Two patients had pneumonia after the operative procedure.

CONCLUSIONSSpinal fractures in ankylosing spondylitis are associated with a high rate of neurological injury. Shearing fracture usually occurs at the lower cervical spine (C(5 - 7)) and stress fracture at thoracolumbar spine. Most of the fractures involve three columns of spine. Surgical intervention may be indicated in this injury. Fracture union and neurological improvement can be achieved in most patients treated by operation. We suggest that, fusion and stabilization with instrumentation by anterior approach is indicated in most cervical shearing fracture, and a combined fusion by both sides plus a long posterior instrument is probably beneficial in patients with thoracolumbar stress fracture. Complications is not rare after surgery and appropriate preventive measures are necessary for these patients.

Adult ; Aged ; Cervical Vertebrae ; diagnostic imaging ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Hyperostosis, Diffuse Idiopathic Skeletal ; complications ; surgery ; Lumbar Vertebrae ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Osteoporosis ; complications ; Postoperative Care ; Postoperative Complications ; prevention & control ; Radiography ; Retrospective Studies ; Spinal Fractures ; etiology ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; pathology ; surgery ; Treatment Outcome