Nonoperative Management of Minimally Displaced Lateral Compression Type 1 Pelvic Ring Injuries With and Without Occult Instability.

OBJECTIVES: To determine the association of pelvic fracture displacement on lateral stress radiographs (LSRs) with the hospital course of patients with minimally displaced lateral compression type 1 (LC1) pelvic injuries. DESIGN: Retrospective review. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: Twenty-eight adult patients with minimally displaced (<1 cm) LC1 injuries. INTERVENTION: Nonoperative management. MAIN OUTCOME MEASUREMENTS: Delayed operative fixation, days to clear physical therapy, mobilization, hospital length of stay, and total hospital opioid morphine equivalent dose. RESULTS: LSR displacement was correlated with delayed operative fixation [r = 0.23, 95% confidence interval (CI) 0.05-1.11; P = 0.01], days to clear PT (r = 0.13, CI 0.01-0.28; P = 0.02), length of stay (r = 0.13, CI 0.006-0.26; P = 0.02), and opioid morphine equivalent dose (r = 19.4, CI 1.5-38.1; P = 0.03). A receiver operating characteristic curve for delayed operative fixation over LSR displacement had an area under the curve of 0.87. The LSR displacement threshold that maximized sensitivity and specificity for detecting patients who required delayed fixation was 10 mm (100% sensitivity and 78% specificity). Ten of the 15 patients with ≥10 mm of displacement on LSRs underwent delayed operative fixation for pain with mobilization at a median of 6 days (interquartile range 3.7-7.5). Patients with ≥10 mm of displacement on LSRs took longer to clear PT, took longer to walk 15 feet, had longer hospital stays, and used more opioids. CONCLUSIONS: LC1 fracture displacement on LSRs is associated with delayed operative fixation, difficulty mobilizing secondary to pain, longer hospital stays, and opioid use. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Vertebral augmentation plus short-segment fixation versus vertebral augmentation alone in Kümmell's disease: a systematic review and meta-analysis.

Osteoporotic vertebral compression fractures of the thoracolumbar spine can progress to Kümmell's disease, an avascular vertebral osteonecrosis. Vertebral augmentation (VA)-vertebroplasty and/or kyphoplasty-is the main treatment modality, but additional short-segment fixation (SSF) has been recommended concomitant to VA. The aim is to compare clinical and radiological outcomes of VA + SSF versus VA alone. Systematic review, including comparative articles in Kümmell's disease, was performed. This study assessed the following outcome measurements: visual analog scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), local kyphotic angle (LKA), operative time, blood loss, length of stay, and cement leakage. Six retrospective studies were included, with 126 patients in the VA + SSF group and 152 in VA alone. Pooled analysis showed the following: VAS, non-significant difference favoring VA + SSF: MD -0.61, 95% CI (-1.44, 0.23), I2 91%, p = 0.15; ODI, non-significant difference favoring VA + SSF: MD -9.85, 95% CI (-19.63, -0.07), I2 96%, p = 0.05; AVH, VA + SSF had a non-significant difference over VA alone: MD -3.21 mm, 95% CI (-7.55, 1.14), I2 92%, p = 0.15; LKA, non-significant difference favoring VA + SSF: MD -0.85°, 95% CI (-5.10, 3.40), I2 95%, p = 0.70. There were higher operative time, blood loss, and hospital length of stay for VA + SSF (p < 0.05), but with lower cement leakage (p < 0.05). VA + SFF and VA alone are effective treatment modalities in Kümmell's disease. VA + SSF may provide superior long-term results in clinical and radiological outcomes but required a longer length of stay.

Minding the Gap in Vertebroplasty: Vertebral Body Fracture Clefts and Cement Nonunion.

BACKGROUND: Vertebroplasty and kyphoplasty are leading treatments for patients with vertebral body compression fractures. Although cement augmentation has been shown to help relieve pain and instability from fractures containing a cleft, there is some controversy in the literature regarding the procedure's efficacy in these cases. Additionally, some of the literature blurs the distinction between clefts and cement patterns (including cement nonunion and cement fill pattern). Both clefts and cement patterns have been mentioned in the literature as risks for poorer outcomes following cement augmentation, which can result in complications such as cement migration. OBJECTIVES: This study aims to identify the prevalence of fracture clefts and cement nonunion, the relationship between them as well as to cement fill pattern, and their association with demographics and other variables related to technique and outcomes. STUDY DESIGN: Retrospective cohort study. SETTING: Interventional radiology department at a single site university hospital. METHODS: This retrospective cohort study assessed 295 vertebroplasties/kyphoplasties performed at the University of Colorado Hospital from 2008 to 2018. Vertebral fracture cleft and cement nonunion were the main variables of interest. Presence and characterization of a fracture cleft was determined on pre-procedural imaging, defined as an air or fluid filled cavity within the fractured vertebral body on magnetic resonance or computed tomography. Cement nonunion was evaluated on post-procedural imaging, defined as air or fluid surrounding the cement bolus on magnetic resonance or computed tomography or imaging evidence of cement migration. Cement fill pattern was assessed on procedural and/or post-procedural imaging. Pain improvement scores were based on a visual analog score immediately prior to the procedure and during clinical visits in the short-term follow-up period. Additional patient demographics, medical history, and procedure details were obtained from electronic medical chart review. RESULTS: Pre-procedural vertebral fracture clefts were demonstrated in 29.8% of our cases. Increasing age, secondary osteoporosis, and thoracolumbar junction location were associated with increased odds of clefts. There was no significant difference in pain improvement outcomes in patients following cement augmentation between clefted and non-clefted compression fractures. Clefts, especially large clefts, and cleft-only fill pattern were associated with increased odds of cement nonunion. Procedure techniques (vertebroplasty, curette, and balloon kyphoplasty) demonstrated similar proportion of cement nonunion and distribution of cement fill pattern. LIMITATIONS: Cement nonunion was observed in only 6.8% of cases. Due to this low proportion, statistical inference tends to have low power. Multiple levels were treated in nearly half of the study's patients undergoing a single vertebroplasty/kyphoplasty session; in these cases, each level was treated as independent rather than spatially correlated within the same study patient. CONCLUSIONS: Vertebral body fracture clefts are not uncommon and are related to (but distinct from) cement nonunion and cement fill patterns. Our study shows that, although patients with clefts will benefit from cement augmentation just as much as patients without a cleft, the performing provider should take note of cement fill and take extra steps to ensure optimal cement fill. These providers should also identify cement nonunion and associated complications (such as cement migration) on follow-up imaging.

Thoracolumbar Burst Fracture: McCormack Load-sharing Classification: Systematic Review and Single-arm Meta-analysis.

STUDY DESIGN: A systematic review and single-arm meta-analysis of randomized clinical trials. OBJECTIVE: The aim of this study was to evaluate whether the load-sharing classification (LSC) is reliable to predict the best surgical approach for thoracolumbar burst fracture (TBF). SUMMARY OF BACKGROUND DATA: There is no previous review evaluating the efficacy of the use of LSC as a guide in the surgical treatment of burst fractures. METHODS: On April 19th, 2019, a broad search was performed in the following databases: EMBASE, PubMed, Cochrane, SCOPUS, Web of Science, LILACS, and gray literature. This study was registered on the International Prospective Register of Systematic Reviews. We included clinical trials involving patients with TBF undergoing posterior surgical treatment, classified by load-sharing score, and that enabled the analysis of the outcomes loss of segmental kyphosis and implant failure (IF). We performed random- or fixed-effects models meta-analyses depending on the data homogeneity. Heterogeneity between studies was estimated by I2 and τ2 statistics. RESULTS: The search identified 189 references, out of which nine studies were eligible for this review. All articles presenting LSC up to 6 proved to be reliable in indicating that only posterior instrumentation is necessary, without screw failures or loss of kyphosis correction. For cases where the LSC was >6, only 2.5% of the individuals presented IF upon posterior approach alone. For loss of kyphosis correction, only 5% of patients had this outcome where LSC >6. For both outcomes together, we had 6% of postoperative problems (I2 = 77%, τ2 < 0.0015, P < 0.01). CONCLUSION: Load-sharing scores up to 6 are 100% reliable, only requiring posterior instrumentation for stabilization. For scores >6, the risk of implant breakage and loss of kyphosis correction in posterior fixation alone is low. Thus, other factors should be considered to define the best surgical approach to be adopted.Level of Evidence: 1.

Radiculopathy Following Vertebral Body Compression Fracture: The Role of Percutaneous Cement Augmentation.

BACKGROUND: Vertebral cement augmentation is a commonly used procedure in patients with vertebral body compression fractures from primary or secondary osteoporosis, metastatic disease, or trauma. Many of these patients present with radiculopathy as a presenting symptom, and can experience symptomatic relief following the procedure. OBJECTIVES: To determine the incidence of preprocedural radiculopathy in patients with vertebral body compression fractures presenting for cement augmentation, and present their postoperative outcomes. STUDY DESIGN: Retrospective cohort study. SETTING: Interventional pain practice in a tertiary care university hospital. METHODS: In this cohort study, all patients who underwent kyphoplasty (KP) or vertebroplasty (VP) procedures in a 7-year period within our practice were evaluated through a search of the electronic medical records. The primary endpoint was to evaluate the prevalence of noncompressive preprocedural radiculopathy in our patients. Evaluation of each patient's relative improvement following the procedure, respective to the initial presence or absence of radicular symptoms (including and above T10, above and below T10, and below T10) was included as a secondary endpoint. Additional subanalysis was performed with respect to patients demographics, fracture location, and primary indication for the procedure (osteoporosis, trauma, etc.). RESULTS: A total of 302 procedures were performed during this time period, encompassing 544 total vertebral body levels. After exclusion criteria were applied to this cohort, 31.6% of patients demonstrated radiculopathy prior to the procedure that could not be explained by nerve impingement. Nearly half of patients demonstrated an optimal clinical outcome (48.5% nearly complete/complete resolution of symptoms, 40.1% partial resolution of symptoms, 11.4% little to no resolution of symptoms). Patients with fractures above T10 were more likely to see complete resolution, whereas patients with fractures above and below T10 were likely to not see any resolution. Men and women without initial radiculopathy symptoms were more likely to see little to no resolution, regardless of fracture location. LIMITATIONS: This retrospective study used an electronic chart review of clinicians' notes to determine the presence of radiculopathy and their relative improvement following the procedure. CONCLUSIONS: Preprocedural radiculopathy is a common symptom of patients presenting for the evaluation of VP or KP. The presence of radiculopathy in the absence of nerve impingement may be an important marker for those patients who may experience greater benefit from the procedure. KEY WORDS: Radiculopathy, kyphoplasty, vertebroplasty, osteoporosis, compression fracture, spine, cement augmentation.

Clinical comparison between a percutaneous hydraulic pressure delivery system and balloon tamp system using high-viscosity cement for the treatment of osteoporotic vertebral compression fractures.

OBJECTIVES: Osteoporotic vertebral compression fractures (OVCFs) affect the elderly population, especially postmenopausal women. Percutaneous kyphoplasty is designed to treat painful vertebral compression fractures for which conservative therapy has been unsuccessful. High-viscosity cement can be injected by either a hydraulic pressure delivery system (HPDS) or a balloon tamp system (BTS). Therefore, the purpose of this study was to compare the safety and clinical outcomes of these two systems. METHODS: A random, multicenter, prospective study was performed. Clinical and radiological assessments were carried out, including assessments of general surgery information, visual analog scale, quality of life, cement leakage, and height and angle restoration. RESULTS: Using either the HPDS or BTS to inject high-viscosity cement effectively relieved pain and improved the patients' quality of life immediately, and these effects lasted at least two years. The HPDS using high-viscosity cement reduced cost, surgery time, and radiation exposure and showed similar clinical results to those of the BTS. In addition, the leakage rate and the incidence of adjacent vertebral fractures after the HPDS treatment were reduced compared with those after treatment using the classic vertebroplasty devices. However, the BTS had better height and angle restoration abilities. CONCLUSIONS: The percutaneous HPDS with high-viscosity cement has similar clinical outcomes to those of traditional procedures in the treatment of vertebral fractures in the elderly. The HPDS with high-viscosity cement is better than the BTS in the treatment of mild and moderate OVCFs and could be an alternative method for the treatment of severe OVCFs.

Clinical comparison between a percutaneous hydraulic pressure delivery system and balloon tamp system using high-viscosity cement for the treatment of osteoporotic vertebral compression fractures

OBJECTIVES: Osteoporotic vertebral compression fractures (OVCFs) affect the elderly population, especially postmenopausal women. Percutaneous kyphoplasty is designed to treat painful vertebral compression fractures for which conservative therapy has been unsuccessful. High-viscosity cement can be injected by either a hydraulic pressure delivery system (HPDS) or a balloon tamp system (BTS). Therefore, the purpose of this study was to compare the safety and clinical outcomes of these two systems. METHODS: A random, multicenter, prospective study was performed. Clinical and radiological assessments were carried out, including assessments of general surgery information, visual analog scale, quality of life, cement leakage, and height and angle restoration. RESULTS: Using either the HPDS or BTS to inject high-viscosity cement effectively relieved pain and improved the patients' quality of life immediately, and these effects lasted at least two years. The HPDS using high-viscosity cement reduced cost, surgery time, and radiation exposure and showed similar clinical results to those of the BTS. In addition, the leakage rate and the incidence of adjacent vertebral fractures after the HPDS treatment were reduced compared with those after treatment using the classic vertebroplasty devices. However, the BTS had better height and angle restoration abilities. CONCLUSIONS: The percutaneous HPDS with high-viscosity cement has similar clinical outcomes to those of traditional procedures in the treatment of vertebral fractures in the elderly. The HPDS with high-viscosity cement is better than the BTS in the treatment of mild and moderate OVCFs and could be an alternative method for the treatment of severe OVCFs.

Anesthesia in a patient with Stiff Person Syndrome / Anestesia em paciente com síndrome da pessoa rígida

Abstract Stiff Person Syndrome (SPS), typified by rigidity in muscles of the torso and extremities and painful episodic spasms, is a rare autoimmune-based neurological disease. Here we present the successful endotracheal intubation and application of TIVA without muscle relaxants on an SPS patient. A 46 years old male patient was operated with ASA-II physical status because of lumber vertebral compression fracture. After induction of anesthesia using lidocaine, propofol and remifentanil tracheal intubation was completed easily without neuromuscular blockage. Anesthesia was maintained with propofol, remifentanil and O2/air mixture. After a problem-free intraoperative period the patient was extubated and seven days later was discharged walking with aid. Though the mechanism is not clear neuromuscular blockers and volatile anesthetics may cause prolonged hypotonia in patients with SPS. We think the TIVA technique, a general anesthetic practice which does not require neuromuscular blockage, is suitable for these patients.

Resumo A síndrome da pessoa rígida (SPR), caracterizada pela rigidez dos músculos do tronco e das extremidades e por episódios de espasmos dolorosos, é uma doença neurológica autoimune rara. Apresentamos o ocaso de intubação endotraqueal bem-sucedida e aplicação de AVT sem relaxantes musculares em um paciente com SPR. Paciente do sexo masculino, 46 anos, estado físico ASA-II, submetido à cirurgia devido à fratura por compressão da coluna lombar. Após a indução da anestesia com lidocaína, propofol e remifentanil, a intubação traqueal foi concluída com facilidade, sem bloqueio neuromuscular. A anestesia foi mantida com propofol, remifentanil e mistura de ar/O2. Após o período intraoperatório, que transcorreu sem intercorrências, o paciente foi extubado e, sete dias depois, recebeu alta, deambulando com ajuda. Embora o mecanismo não esteja claro, bloqueadores neuromusculares e anestésicos voláteis podem causar hipotonia prolongada em pacientes com SPR. Acreditamos que a técnica de AVT, uma prática de anestesia geral que não requer bloqueio neuromuscular, é adequada para esses pacientes.

Anesthesia in a patient with Stiff Person Syndrome.

Stiff Person Syndrome (SPS), typified by rigidity in muscles of the torso and extremities and painful episodic spasms, is a rare autoimmune-based neurological disease. Here we present the successful endotracheal intubation and application of TIVA without muscle relaxants on an SPS patient. A 46 years old male patient was operated with ASA-II physical status because of lumber vertebral compression fracture. After induction of anesthesia using lidocaine, propofol and remifentanil tracheal intubation was completed easily without neuromuscular blockage. Anesthesia was maintained with propofol, remifentanil and O2/air mixture. After a problem-free intraoperative period the patient was extubated and seven days later was discharged walking with aid. Though the mechanism is not clear neuromuscular blockers and volatile anesthetics may cause prolonged hypotonia in patients with SPS. We think the TIVA technique, a general anesthetic practice which does not require neuromuscular blockage, is suitable for these patients.

Controversies on vertebroplasty and kyphoplasty for vertebral compression fractures / Controvérsias em vertebroplastia e cifoplastia para fraturas vertebrais em compressão / Controversias en vertebroplastia y cifoplastia para fracturas de compresión vertebral

Vertebroplasty and kyphoplasty are widely used for osteoporotic and cancer-related vertebral compression fractures refractory to medical treatment. Many aspects of these procedures have been extensively discussed in the literature during the last few years. In this article, we perform a critical appraisal of current evidence on effectiveness and ongoing controversies regarding surgical technique, indications and contraindications, clinical outcomes and potential complications of these procedures.

A vertebroplastia e a cifoplastia têm sido amplamente utilizadas para fraturas por compressão osteoporóticas e relacionadas a tumor refratárias ao tratamento clinico. Nos últimos anos, vários aspectos relacionados a esses procedimentos têm sido amplamente discutidos na literatura. Neste artigo, realizamos uma análise crítica da evidência atual sobre a efetividade desses procedimentos e sobre as controvérsias referentes a técnica cirúrgica, indicações e contraindicações, resultados clínicos e possíveis complicações.

La vertebroplastia y la cifoplastia han sido ampliamente utilizadas en fracturas por compresión osteoporóticas y relacionadas con tumor refractarias al tratamiento clínico. En los últimos años, diversos aspectos relacionados con estos procedimientos han sido ampliamente discutidos en la literatura. En este artículo, presentamos un análisis crítico de la evidencia actual sobre la eficacia y las controversias relativas a la técnica quirúrgica, indicaciones y contraindicaciones, resultados clínicos y posibles complicaciones.

Percutaneous Vertebroplasty Versus Conservative Treatment and Rehabilitation in Women with Vertebral Fractures due to Osteoporosis: A Prospective Comparative Study.

BACKGROUND: Percutaneous vertebroplasty is commonly used in the management of osteoporosis-related vertebral fractures, although there is controversy on its superiority over conservative treatment. Here we compare pain and function in women with vertebral osteoporotic fractures who underwent percutaneous vertebroplasty versus conservative treatment with a protocolized rehabilitation program. METHODS: A longitudinal and comparative prospective study was conducted. Women ≥ 60 years of age with a diagnosis of osteoporosis who had at least one vertebral thoracic or lumbar compression fracture were included and divided into two groups, conservative treatment or vertebroplasty. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess pain and function, respectively, as the outcome measures. RESULTS: We included 31 patients, 13 (42%) treated with percutaneous vertebroplasty and 18 (58%) with conservative treatment. Baseline clinical characteristics, bone densitometry and fracture data were similar in both groups. At baseline, VAS was 73.1 ± 28.36 in the vertebroplasty group and 68.6 ± 36.1 mm in the conservative treatment group (p = 0.632); at three months it was 33.11 ± 10.1 vs. 42 ± 22.21 mm (p = 0.111); and at 12 months, 32.3 ± 11.21 vs. 36.1 ± 12.36 mm (p = 0.821). The ODI at baseline was 83% in the vertebroplasty group vs. 85% for conservative management (p = 0.34); at three months, 36 vs. 39% (p = 0.36); and at 12 months, 29.38 vs. 28.33% (p = 0.66). CONCLUSIONS: Treatment with percutaneous vertebroplasty had no advantages over conservative treatment for pain and function in this group of women ≥ 60 years of age with osteoporosis.

Treatment of vertebral body compression fractures using percutaneous kyphoplasty guided by a combination of computed tomography and C-arm fluoroscopy with finger-touch guidance to determine the needle entry point.

This study aimed to evaluate the results and complications of image-guided percutaneous kyphoplasty (PKP) using computed tomography (CT) and C-arm fluoroscopy, with finger-touch guidance to determine the needle entry point. Of the 86 patients (106 PKP) examined, 56 were treated for osteoporotic vertebral compression fractures and 30 for vertebral tumors. All patients underwent image-guided treatment using CT and conventional fluoroscopy, with finger-touch identification of a puncture point within a small incision (1.5 to 2 cm). Partial or complete pain relief was achieved in 98% of patients within 24 h of treatment. Moreover, a significant improvement in functional mobility and reduction in analgesic use was observed. CT allowed the detection of cement leakage in 20.7% of the interventions. No bone cement leakages with neurologic symptoms were noted. All work channels were made only once, and bone cement was distributed near the center of the vertebral body. Our study confirms the efficacy of PKP treatment in osteoporotic and oncological patients. The combination of CT and C-arm fluoroscopy with finger-touch guidance reduces the risk of complications compared with conventional fluoroscopy alone, facilitates the detection of minor cement leakage, improves the operative procedure, and results in a favorable bone cement distribution.

Fracture of the talar neck associated with a compression fracture of the calcaneocuboid joint in a 5-year-old child: a case report.

OBJECTIVE: The objectives of this present case study are to report a rare combination of a displaced talar neck fracture with a compression fracture of the calcaneocuboid joint in a 5-year-old child and to describe its radiological features, surgical treatment and clinical outcome. A 5-year-old male boy was injured in a car accident in which his left foot underwent one of the tires. On arrival at the hospital, a displaced talar neck fracture associated both with a cuboid fracture and compression of the articular surface of the cuboid at the calcaneocuboid join was identified. Fractures were fixed surgically. Leg was protected with a below-knee plaster split immobilization and non-weight-bearing for 5 weeks. After that period, the patient initiated a rehabilitation protocol with active and passive motion exercises. DISCUSSION: Fractures and fracture dislocations at the mid-tarsal joint have an important impact on the global foot function because malunion can result in post-traumatic arthritis and three-dimensional deformities of the foot. If a cuboid compression fracture is not reduced properly, it can result in the shortening of the lateral column with the development of an abduction, pronation and flat foot deformity. A talar neck fracture, if unreduced, can result in medial column displacement and rotational dislocation of the talar head, leading to a subluxation in the talonavicular joint with severe restriction of foot function. With early surgical treatment and open reduction and internal fixation, our patient recovered from the accident without having symptoms of pain, avascular necrosis, postoperative foot deformities or neurovascular deficits. CONCLUSIONS: The combination of a displaced talar neck fracture with a compression fracture of the calcaneocuboid joint in children usually requires correct diagnoses and early treatment with anatomic reduction and internal fixation to prevent severe post-traumatic deformities. LEVEL OF EVIDENCE: V.

Kyphoplasty in the treatment of osteoporotic Vertebral Compression Fractures (VCF) : procedure description and analysis of the outcomes in 128 patients.

In recent years, the advent of percutaneous techniques in the management of osteoporotic vertebral compression fractures has proven to be a great step forward in the evolution of patients suffering from this pathology.Vertebroplasty, which was developed in 1984 by Galibert and Deramond, presents the disadvantage of leakage of the cementation material and the impossibility to restore spinal deformity. Kyphoplasty has shown to be almost a definite solution to these problems. The description of the technique, its indications, and the outcomes resulting from our series of 200 vertebral fractures in 128 patients are presented in this paper.

Cifoplastia percutanea con balón en fracturas por compresión de etiología no traumática en columna torácica y lumbar / Percutaneous balloon kyphoplasty in non-traumatic lumbar and thoracic spinal compression fractures

Purpose: To describe our experience with percutaneous balloon kyphoplasty for the treatment of non-traumatic vertebral compression fractures. Material and Methods: Between march 2007 and June 2008, 25 vertebrae interventions were performed in 10 patients. Ten cases corresponded to osteoporotic fractures, while fifteen of them revealed a tumoral etiology. Vertebral compromise was evaluated via CT scan or MRI, as appropriate. We applied a percutaneous technique. Balloons were inserted into the vertebral body, and then inflated to create a cavity to be filled with polymethylmethacrylate (PMMA), which reduces and stabilizes the fracture, thus reducing pain. Results: The technique was performed successfully in al I cases. Pain intensity assessed by Visual Analogue Scale (VAS) before and after the procedure showed a variation ranging from 4 to 7 levels per patient. The mean inicial VAS score was 7, whereas average final VAS was 1.2. The decrease in pain levels averaged 5.8 per intervention. Complications occurred in 7 levels: 3 cases of thoracic extravasations and 4 cases in lumbar spine. All of them were asymptomatic. No severe complications were reposed. Conclusions: Percutaneous balloon kyphoplasty offers a good alternative treatment to conservative pain management in vertebral compression fractures.

Propósito: Describir nuestra experiencia en cifoplastía percutanea con balón en fracturas vertebrales debidas a compresión no traumática. Material y Métodos: Se intervinieron 25 vértebras en 10 pacientes, 15 lumbares y 10 torácicas, entre marzo 2007 y junio 2008. La etiología de las fracturas fue osteoporótica en 10 casos y tumoral en 15. Se evaluó el compromiso vertebral mediante tomografía computada o resonancia magnética, según el caso. La técnica fue percutanea; se insertaron balones en el cuerpo vertebral, que se inflaron, creando así una cavidad que se relleno inyectando polimetilme-tacrilato (PMMA), que redujo y estabilizó la fractura, disminuyendo así el dolor. Resultados: La técnica fue realizada satisfactoriamente en todos los casos. La intensidad del dolor medida según la Escala Visual Análoga (EVA), antes y después del procedimiento, varió entre 4 y 7 niveles por paciente. El EVA de ingreso promedio fue de 7, y el de egreso de 1.2. La disminución del dolor fue en promedio 5.8 niveles por intervención. Hubo complicaciones en 7 niveles: 3 casos de extravasación torácica y 4 en columna lumbar, todas asintomáticas. No hubo complicaciones severas. Conclusiones: La cifoplastía con balón es una buena alternativa analgésica al manejo conservador en fracturas vertebrales por compresión.

[Anterior approach in patients with traumatic compression fracture type of thoracolumbar spine (T11-L2)]. / Acesso anterior para pacientes com fraturas traumáticas do tipo compressão do segmento toracolombar (T11 a L2) da coluna vertebral.

OBJECTIVE: To describe experience with anterior access in compression fractures of thoracolumbar segment (T11 to L2) traumatic fractures that undergone anterior access surgery. METHOD: A prospective study was conducted between January 1994 and January 2004 with 32 patients. The bone fusion and thoracolumbar alignment were analyzed 6 months and 12 months after the surgery. RESULTS: The average age was 36.53 years old with 23 male patients. The most compromised vertebrae was L1 (n=12). The 23 patients that was ASIA/IMSOP C and ASIA/IMSOP D turned to ASIA/IMSOP E after 1 month (n=12) and 12 months (n=5) of surgery. The preoperative angular deformity average was 14.9 degrees +/-7.5 degrees. Statistical significance was found (p<0.0001) when compared to the 30 days postoperative value. CONCLUSION: The anterior access permits a better spinal canal decompression and angular deformity correction when compared with the posterior access alone.

Acesso anterior para pacientes com fraturas traumáticas do tipo compressão do segmento toracolombar (T11 a L2) da coluna vertebral / Anterior approach in patients with traumatic compression fracture type of thoracolumbar spine (T11-L2)

OBJETIVO: Relatar a experiência com o acesso anterior em fraturas traumáticas do tipo compressão no segmento toracolombar (T11 a L2) que foram submetidos à cirurgia pelo acesso anterior. MÉTODO: Estudo prospectivo de janeiro de 1994 a janeiro de 2004 envolvendo 32 pacientes. A presença da fusão óssea e do alinhamento foram analisadas 6 e 12 meses após a cirurgia. RESULTADOS: A idade média foi 36,53 anos, sendo 23 do sexo masculino. A vértebra mais atingida foi L1 (n=12). A maioria dos casos que internaram em ASIA/IMSOP C (n=10) e D (n=13) evoluiram para ASIA/IMSOP E. A média da deformidade angular pré-operatória foi 14,9°±7,5°, com diferença estatística (p<0,0001) na comparação com o valor encontrado no pós-operatório de 30 dias. CONCLUSÃO: A via anterior permite melhor descompressão do canal e uma correção da deformidade angular superior à observada pela via posterior isolada.

OBJECTIVE: To describe experience with anterior access in compression fractures of thoracolumbar segment (T11 to L2) traumatic fractures that undergone anterior access surgery. METHOD: A prospective study was conducted between January 1994 and January 2004 with 32 patients. The bone fusion and thoracolumbar alignment were analyzed 6 months and 12 months after the surgery. RESULTS:The average age was 36.53 years old with 23 male patients. The most compromised vertebrae was L1 (n=12). The 23 patients that was ASIA/IMSOP C and ASIA/IMSOP D turned to ASIA/IMSOP E after 1 month (n=12) and 12 months (n=5) of surgery. The preoperative angular deformity average was 14.9°±7.5°. Statistical significance was found (p<0.0001) when compared to the 30 days postoperative value. CONCLUSION: The anterior access permits a better spinal canal decompression and angular deformity correction when compared with the posterior access alone.