Cauda Equina ; injuries ; Decompression, Surgical ; Electric Stimulation Therapy ; Emergency Medical Services ; methods ; Fracture Fixation, Internal ; Humans ; Prognosis ; Spinal Cord Injuries ; prevention & control ; therapy ; Spinal Fractures ; surgery ; Spinal Fusion

Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures (OVCFs) after kyphoplasty. This finite element study was to examine whether short segment pedicle screw fixation (PSF) with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae after kyphoplasty for OVCFs. By simulating cement augmentation with or without short segment pedicle screw fixation (PSF), two tridimensional, anatomically detailed finite element models of the T10-L2 functional spinal junction were developed. The insertion of pedicle screws into the intact vertebra apparently decreased the stress distribution of the treated vertebra in vertical compression and other load situations. The stress distribution in the bone structures of the intact vertebra adjacent to the intact-screwed vertebra was much less than that in the one adjacent to the treated vertebra. The insertion of pedicle screws into the intact vertebra greatly decreased the maximum displacement of the cortical bones and cancellous bones of the vertebrae. Our results indicated that short segment PSF with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae in the management of OVCFs.
Computer Simulation ; Finite Element Analysis ; Fracture Fixation, Internal ; adverse effects ; instrumentation ; methods ; Humans ; Kyphoplasty ; adverse effects ; instrumentation ; methods ; Osteoporotic Fractures ; etiology ; prevention & control ; Pedicle Screws ; adverse effects ; Postoperative Complications ; prevention & control ; Spinal Fractures ; etiology ; prevention & control ; Spine ; diagnostic imaging ; surgery

OBJECTIVETo evaluate the therapeutic effect of percutaneous vertebroplasty (PVP) guided by X-ray fluoroscopy in treating osteoporotic spinal compression fractures, hemangioma of vertebra and metastatic carcinoma of vertebra.

METHODSOne hundred and ninety patients with 275 diseased vertebra underwent PVP under the guidance of C-arm fluoroscopy (male 80, female 110, ranging in age from 53 to 91 years, with an average of 66 years). Bone marrow biopsy needle was inserted percutaneously via transpedicular way into the diseased vertebra. Polymethylmethacrylate (PMMA) was then injected into the diseased vertebra. Visual analogue scale (VAS), mobility and analgesic usage were evaluated pre-operation and 3 months after PVP.

RESULTSPVP was successful in 190 cases (275 vertebrae). VAS was tested by t test at 3 months after PVP (P < 0.05). Simultaneously, scale of patient's mobility and scale of analgesic usage was tested by rank sum test at 3 months after PVP (P < 0.05).

CONCLUSIONAs the mimimally invasive operation, PVP can alleviate pain in early time, avoid kinds of complications by shortening the patient's time in bed and have the characteristic of simply operative procedure and low expenses. It is an effective mini-invasive technique for osteoporotic spinal compression fractures, hemangioma of vertebra and metastatic carcinoma of vertebra.

Aged ; Aged, 80 and over ; Female ; Fluoroscopy ; Fractures, Compression ; surgery ; Humans ; Male ; Middle Aged ; Osteoporosis ; complications ; Polymethyl Methacrylate ; Postoperative Complications ; prevention & control ; Spinal Fractures ; surgery ; Spinal Neoplasms ; surgery ; Vertebroplasty ; adverse effects ; methods

Percutaneous vertebroplasty (PVP) is widely used as an effective treatment for compression fracture, additional adjacent vertebral body fractures are frequently reported after operation, but the relationship between the vertebroplasty and adjacent vertebral body fracture remains unknown. The possible causes of refracture after operation include mechanical force factor, bone cement and clinical factors. Except for the changes of stress and stiffness of the adjacent vertebral bodies, the extravasation of cement and osteoporosis itself of the vertebral bodies should be concerned about. To aim at above-mentioned reasons, simultaneously, preventive strategies, such as prophylactic cement injection into adjacent non-fractured vertebrae, additional PVP and injectable copolymer hydrogel are approached in this review.
Biomechanical Phenomena ; Bone Cements ; therapeutic use ; Fractures, Bone ; prevention & control ; surgery ; Fractures, Compression ; prevention & control ; surgery ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; injuries ; Osteoporosis ; prevention & control ; surgery ; Spinal Fractures ; etiology ; prevention & control ; surgery ; Thoracic Vertebrae ; injuries ; Treatment Outcome ; Vertebroplasty ; adverse effects

OBJECTIVETo explore the treatment of anterior decompression and reconstruction for burst thoracolumbar fractures with anterior and median column injury and to evaluate the therapeutic effect.

METHODSThirty-four patients suffering from burst thoracolumbar fractures with anterior and median column injury (male 22 and female 12, aged from 20 to 63,with an average of 40.5 years) were treated by anterior decompression and reconstruction from May 2001 to October 2006. Operative duration, bleeding and the neurological function of patients were recorded.

RESULTSAll the patients were followed up from 3 to 60 months and the average time was 24.5 months. Operative duration was (178 +/- 65) min. The volume of bleeding was (1 750 +/- 950) ml and the volume of autotransfusion was (950 +/- 750) ml. Cobb angle were corrected from 27.0 degrees +/- 6.5 degrees to 3.0 degrees +/- 1.5 degrees. All fractures obtained fusion. No failure of internal fixation and formation of false joint happened.

CONCLUSIONThe technique of anterior decompression and reconstruction for burst thoracolumbar fractures with anterior and median column injury is effective, with which the decompression and reconstruction of the spinal stability can be performed under direct vision at one stage, and the sagittal alignment can be corrected at the same time. The procedure will be more smoothly by the application of the intraoperative autotransfusion.

Adult ; Decompression, Surgical ; methods ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; surgery

OBJECTIVETo study the clinical effects of percutaneous vertebroplasty and kyphoplasty in the treatment of fresh thoracolumbar fractures in the elderly.

METHODSFrom May 2004 to March 2009, among 29 patients (32 vertebras) with thoracolumbar fractures, 18 patients (21 vertebras) were treated with percutaneous vertebroplasty (PVP) and 11 patients (11 vertebras) were treated with percutaneous kyphoplasty (PKP). The visual analogue scale (VAS) and mobility were evaluated 3 days before and after operation. During follow-up period, patients were observed and evaluated in terms of relief of back pain and regaining of living ability. Complications such as bone cement leakage were analyzed.

RESULTSAll the patients got successful operation. The average operation time was 38.6 minutes for the 18 patients (21 vertebras) with PVP performed, and 3.2 ml (2-5 ml) bone cement was injected. For the 11 patients (11 vertebras) with PKP performed, the average operation time was 43 minutes, and an average of 3.8 ml (2-6 ml) bone cement was injected. The VAS decreased from preoperative (7.5 +/- 0.7) to (2.2 +/- 0.5) at the 3rd day after operation; the mobility scores of the patients decreased from preoperative (2.4 +/- 0.6) to (1.2 +/- 0.3) at the 3rd day after operation; the vertebral height increased from an average of (52.4 +/- 9.7)% pre-operation to (85.2 +/- 10.6)% after operation; and the average kyphosis correction of Cobb angle was 11.2 degrees. During an average of 12.6 months follow-up, no patients reported vertebral pain. Review of X-ray films showed no significant loss of vertebral height. One patient died from complications of heart disease 5 months being discharged from hospital. Another patient died from the same cause at 6 months after opertaion. Paravertebral leakage of bone cement was also found in 2 patients. No serious complications occurred and patients were satisfied with the treatment.

CONCLUSIONPVP, PKP can be used to instantly reinforce vertebral injury, relieve pain, and improve the patient's mobility. For elder people with fresh thoracolumbar fractures, when health conditions are allowed, PVP or PKP surgery is the right treatment.

Aged ; Aged, 80 and over ; Bone Cements ; Female ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Vertebroplasty ; methods

OBJECTIVETo analyze the reasons of the complications,and the measures taken for the prevention and treatment by percutaneous vertebroplasty (PVP) for osteoporotic thoracolumbars vertebral compressive fractures.

METHODSFrom May 2004 to June 2008, 204 patients with 286 diseased vertebrae underwent PVP under the guidance of C-arm fluoroscopy, and 56 patients with complications included 18 males, 38 females, ranging in age from 58 to 93 years, with an average of 72 years. The condition of leakage of bone cement and complications was observed.

RESULTSThe complications related to the leakage of PMMA found in 60 vertebrae in 49 cases: vertebral canal in 5 cases, intervertebral foramina in 3 cases, soft tissue besides vertebrae in 20 cases,intervertebral discs in 15 cases, venous plexus besides vertebrae in 6 cases. The complications no related to the leakage of PMMA found in 7 cases: the nerve roots injuried in 3 cases; the pain of the patient worsened temporarily in 2 cases; the blood pressure of the patient descent temporarily in 2 cases.

CONCLUSIONThe main reasons of complications are no-integrated of the compressived vertebrae,unstandard skills of injecting,unsuitable opportunity and quantity of injecting PMMA, unsufficient monitoring of C-arm fluoroscopy, the toxicity of PMMA. The measures of prevention and treatment is strict indication, standard skills of injecting, sufficient monitoring of C-arm fluoroscopy, suitable opportunity and quantity of injecting PMMA, electrocardio-monitoring in operation.

Aged ; Aged, 80 and over ; Bone Cements ; adverse effects ; Female ; Fractures, Compression ; complications ; surgery ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Polymethyl Methacrylate ; adverse effects ; Postoperative Complications ; prevention & control ; Spinal Fractures ; complications ; surgery ; Vertebroplasty

Since the late 20th century owing to the improvement of spinal surgery techniques, the diagnosis and treatment of thoracolumbar fracture have been perfected more and more. Although the advent of modern spinal surgery in China was late, we have gained some advanced achievements owing to various international communications benefited from the open policy. Therefore, it is essential to evaluate the current status and perspective of diagnosis and treatment of thoracolumbar fracture. There are several issues we would like to discuss here.
China ; Female ; Follow-Up Studies ; Fracture Fixation ; standards ; trends ; Fracture Healing ; physiology ; Humans ; Injury Severity Score ; Lumbar Vertebrae ; injuries ; Male ; Quality of Health Care ; Spinal Cord Injuries ; prevention & control ; Spinal Fractures ; diagnosis ; surgery ; Thoracic Vertebrae ; injuries

BACKGROUND/AIMS: We investigated differences in identifying candidates for antiosteoporotic treatment in rheumatoid arthritis (RA) patients according to two available clinical guidelines. METHODS: We prospectively enrolled 100 female patients aged 50 years or older with RA who visited Hanyang University Hospital for periodic examinations between April 2011 and August 2011. We applied the glucocorticoid-induced osteoporosis (GIOP) recommendations and the National Osteoporosis Foundation (NOF) guidelines to RA patients and examined agreement between the guidelines for identifying candidates for antiosteoporotic treatment. We also analyzed the impact of screening vertebral fractures (VFs) in determining the treatment of osteoporosis in RA patients. RESULTS: The 57 patients taking glucocorticoids were classified into high-risk (n = 23), medium-risk (n = 16), and low-risk (n = 18) groups according to the GIOP recommendations. Based on the NOF guidelines, 36 of 57 patients were candidates for antiosteoporotic treatment and the agreement between two guidelines was high (kappa = 0.76). Two of the 18 patients in the low-risk group and 19 of 43 patients not eligible per the GIOP recommendations were classified as candidates for antiosteoporotic treatment by the NOF guidelines. CONCLUSIONS: In determining antiosteoporotic treatment for RA patients, using only the GIOP recommendations is insufficient. Application of the NOF guidelines in patients not eligible for or classified into the low-risk group per the GIOP recommendations and screening for VFs may be helpful in deciding on antiosteoporotic treatment in RA patients.
Aged ; Arthritis, Rheumatoid/diagnosis/*drug therapy ; Bone Density Conservation Agents/*therapeutic use ; *Decision Support Techniques ; Female ; Glucocorticoids/*adverse effects ; Hospitals, University ; Humans ; Middle Aged ; Osteoporosis/*chemically induced/diagnosis/*prevention & control ; Osteoporotic Fractures/chemically induced/prevention & control ; Patient Selection ; Practice Guidelines as Topic ; Predictive Value of Tests ; Prospective Studies ; Republic of Korea ; Risk Assessment ; Risk Factors ; Spinal Fractures/chemically induced/prevention & control

Radiology is an important adjunct to clinical practice, but for many clinicians, requesting X-rays was something that was learnt on the job. This article provides guidelines on when and how to request X-rays for acute conditions such as head and cervical spine trauma, suspected rib and extremity fractures, low back pain and acute abdominal pain. We also highlight what to write in the request form, in order to obtain maximum value from the examination and allow the radiologist to generate a useful, accurate report.
Ankle Injuries ; diagnostic imaging ; Cervical Vertebrae ; diagnostic imaging ; Emergency Service, Hospital ; standards ; Fractures, Bone ; diagnostic imaging ; Health Care Costs ; Hospitals ; Humans ; Medical Errors ; prevention & control ; Neck Pain ; diagnostic imaging ; Radiology ; methods ; organization & administration ; standards ; Spinal Injuries ; diagnostic imaging ; Tomography, X-Ray Computed ; X-Rays