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1.
Gene ; 741: 144543, 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32165300

RESUMO

INTRODUCTION: Collagen cross-linking, which is regulated by lysyl oxidase (LOX), plays critical roles in bone mechanical strength. LOX can influence bone remodeling by modulating osteoblast and osteoclast activity. This study aimed to explore the effect of LOX gene polymorphisms on osteoporotic fractures susceptibility in postmenopausal Chinese women. METHODS: This was a prospective study of postmenopausal women who visited the outpatient and community clinics of the local Hospital. Five tagging single nucleotide polymorphisms (SNPs) in the LOX gene were determined. Bone mineral density (BMD) was measured at the lumbar spine, femoral neck, and hip using dual-energy X-ray absorptiometry. Fractures were confirmed by X-ray and divided into: vertebral compression fracture (OVCF) and non-OVCF (all other fractures). RESULTS: This study included 602 patients with non-traumatic fractures and 1343 healthy volunteers. The rs1800449 was significantly associated with vertebral compression fracture (OVCF) after adjusting for age and BMI (P = 0.012). Compared with subjects with the GG genotype, the risk of having OVCF was 1.28 and 1.74, respectively for subjects with the GA and AA genotypes (P = 0.043 and P = 0.018). A recessive genetic model showed that carriers of the AA genotype had higher fracture risk compared to G carriers (GA and GG genotypes) (P = 0.015). The rs2288393 SNP exhibited marginally significant association with OVCF (P = 0.051). Haplotype analyses corroborated our single SNP results: both haplotype CGA and CCG contained rs10519694, rs2288393, and rs1800449, and were significant associated with OVCF (P = 0.048 and P = 0.032, respectively). On the other hand, we found no evidence of an association of LOX gene allelic variants with either BMD or non-OVCF (all P > 0.05). CONCLUSION: The results suggest that genetic polymorphisms in LOX may contribute to susceptibility to OVCF in Chinese postmenopausal women.


Assuntos
Fraturas por Compressão/genética , Osteoporose Pós-Menopausa/genética , Fraturas por Osteoporose/genética , Proteína-Lisina 6-Oxidase/genética , Absorciometria de Fóton , Idoso , Densidade Óssea/genética , Feminino , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/fisiopatologia , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/fisiopatologia , Genótipo , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/diagnóstico por imagem , Osteoporose Pós-Menopausa/fisiopatologia , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/fisiopatologia , Pós-Menopausa/genética , Pós-Menopausa/fisiologia , Fatores de Risco
2.
Medicine (Baltimore) ; 99(7): e19037, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049800

RESUMO

RATIONALE: We present a rare case of a traumatic intradural ruptured disc associated with a mild vertebral body compression fracture along with a review of the relevant medical literature. An intradural ruptured disc often occurs due to chronic degenerative diseases and is rarely due to trauma. It can cause irreversible neurological complications if the appropriate treatment is not planned. PATIENT CONCERNS: A 32-year-old male presented with motor paraparesis (grade 3/5), right ankle dorsiflexion, and great toe dorsiflexion (grade 1/5), along with radiating pain at his right L4 and L5 sensory dermatome following a fall. DIAGNOSES: Computed tomography revealed a compression fracture of the L2 body. Lumbar magnetic resonance imaging showed an intradural mass-like lesion on the ventral side of his spinal cord and an epidural mass-like lesion on the dorsal side of his spinal cord, indicating a hematoma. INTERVENTIONS: An emergency L2 laminectomy was performed to remove the space-occupying lesions and to decompress the cauda equina and nerve root. The mass-like lesion was removed. No other lesions were found in the spinal canal. OUTCOMES: Pathologic examination of the intradural mass lesion revealed fibrocartilage similar to that found in disc material. The patient still continued to experience motor weakness at the 1-year follow-up examination. LESSONS: We report a rare case of a traumatic lumbar disc rupture into the dural sac associated with a mild vertebral body compression fracture. Early diagnosis and prompt surgical intervention are essential, as is performing a magnetic resonance imaging or computed tomography myelogram promptly to evaluate the spinal canal when there are unexplained neurologic symptoms. An intraspinal canal evaluation should be completed before the postural reduction of the vertebral body fracture to prevent any neurological complications.


Assuntos
Fraturas por Compressão/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Acidentes por Quedas , Adulto , Descompressão Cirúrgica , Fraturas por Compressão/diagnóstico por imagem , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Laminectomia , Imagem por Ressonância Magnética , Masculino , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(6): e19053, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028424

RESUMO

RATIONALE: Traditionally, transpedicular approach was used in the treatment of osteoporotic lumbar compression fracture. In order to avoid the risks of pedicle disruption and spinal canal intrusion, extrapedicular approache has been attempted. The aim of the article is to present the modified extrapedicular kyphoplasty technique for the treatment of osteoporotic lumbar compression fracture. PATIENT CONCERNS: A 62-year-old woman suffered from severe low back pain after an accidental fall 10 days ago. Low back pain was obvious when turning over and getting out of bed. It was not relieved after bed rest and conservative treatment. Visual analog scale (VAS) of low back pain was 8 points and Oswestry disability index score was 80%. DIAGNOSIS: Magnetic resonance imaging showed osteoporotic vertebral compression fracture of L2 and L3. INTERVENTIONS: We performed modified extrapedicular kyphoplasty for the patient. The technique has a standardized operating procedure. The puncture point of skin is determined according to preoperative computer tomography and X-ray. The puncture point of vertebral body is located at the outer upper edge of the pedicle. The puncture direction is from the upper edge of the pedicle to the lower edge of the contralateral pedicle. OUTCOMES: The operation time was 20 minutes. The intraoperative blood loss was 5 mL. The amount of bone cement was 4 mL in L2 and 5 mL in L3. VAS of low back pain was 2 points in 1 day after surgery. Preoperative symptoms were significantly improved. LESSONS: Modified extrapedicular kyphoplasty is a safe and effective technique for the treatment of osteoporotic lumbar compression fracture, which should be promoted and applied.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/cirurgia , Perda Sanguínea Cirúrgica , Feminino , Fraturas por Compressão/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Duração da Cirurgia , Radiografia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
4.
Nat Med ; 26(1): 77-82, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31932801

RESUMO

Methods for identifying patients at high risk for osteoporotic fractures, including dual-energy X-ray absorptiometry (DXA)1,2 and risk predictors like the Fracture Risk Assessment Tool (FRAX)3-6, are underutilized. We assessed the feasibility of automatic, opportunistic fracture risk evaluation based on routine abdomen or chest computed tomography (CT) scans. A CT-based predictor was created using three automatically generated bone imaging biomarkers (vertebral compression fractures (VCFs), simulated DXA T-scores and lumbar trabecular density) and CT metadata of age and sex. A cohort of 48,227 individuals (51.8% women) aged 50-90 with available CTs before 2012 (index date) were assessed for 5-year fracture risk using FRAX with no bone mineral density (BMD) input (FRAXnb) and the CT-based predictor. Predictions were compared to outcomes of major osteoporotic fractures and hip fractures during 2012-2017 (follow-up period). Compared with FRAXnb, the major osteoporotic fracture CT-based predictor presented better receiver operating characteristic area under curve (AUC), sensitivity and positive predictive value (PPV) (+1.9%, +2.4% and +0.7%, respectively). The AUC, sensitivity and PPV measures of the hip fracture CT-based predictor were noninferior to FRAXnb at a noninferiority margin of 1%. When FRAXnb inputs are not available, the initial evaluation of fracture risk can be done completely automatically based on a single abdomen or chest CT, which is often available for screening candidates7,8.


Assuntos
Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/diagnóstico , Medição de Risco , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Automação , Biomarcadores/metabolismo , Calibragem , Feminino , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/diagnóstico por imagem , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/diagnóstico por imagem
5.
PLoS One ; 15(1): e0228341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31999783

RESUMO

BACKGROUND: Osteoporotic vertebral compression fractures (OVCFs) often cause local kyphosis. Percutaneous kyphoplasty (PKP) is a common method for the treatment of local kyphosis. However, the influence of kyphoplasty on spino-pelvic alignment and global sagittal balance when performed at specific treatment sites in the spine remains unclear. The purpose of the study is to investigate the influence of different fracture sites and PKP treatment on the spino-pelvic alignment and global sagittal balance in patients with OVCFs. METHODS: 90 patients with OVCF who underwent PKP were included in the retrospective study. According to the site of the fractured vertebrae, all the cases were divided into 3 groups: Main thoracic (MT) group (T1 to T9), Thoracolumbar (TL) group (T10 to L2) and Lumbar (LU) group (L3 to L5). 26 healthy elderly volunteers (aged over 59) were enrolled as the control group. Sagittal spino-pelvic parameters were measured on the full-spine radiographs preoperatively and postoperatively. Information of sagittal spino-pelvic parameters and global sagittal balance was gathered. RESULTS: Compared with the Control group, TL group showed significant differences in almost all parameters, except pelvic incidence (PI) and lumbar lordosis (LL). While only local sagittal parameters (Thoracic kyphosis (TK), Thoracolumbar kyphosis (TLK), LL) were significantly different in MT group. There was no significant difference in almost all of the parameters except for PT and TPA in LU group. Correspondingly, the sagittal parameters of TL group improved best after PKP, except for thoracic kyphosis (TK) and sagittal vertical axis (SVA). In MT group, only TLK was significantly decreased, while in LU group, only local kyphosis Cobb angle and SSA were improved. CONCLUSIONS: OVCF mainly occurs in the thoracolumbar region. Compared with MT group and LU group, OVCF occurred in the thoracolumbar region had greater influence on the spino-pelvic alignment and global sagittal balance. When PKP was performed, the improvement of sagittal balance parameters of TL group was the best in the three groups.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Cifose/cirurgia , Osteoporose/complicações , Fraturas da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Fraturas por Compressão/complicações , Fraturas por Compressão/diagnóstico por imagem , Humanos , Cifose/diagnóstico por imagem , Cifose/etiologia , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Equilíbrio Postural , Radiografia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Resultado do Tratamento
6.
Biomed Res Int ; 2019: 1386510, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886170

RESUMO

The treatment of traumatic low-degree vertebral compression fracture remains in a wide range between functional treatment, bracing, vertebroplasty, kyphoplasty, and even surgical fixation. The objective was to assess the innovation of instrumented kyphoplasty and to report the early and mid-term functional and radiological results. This study is a retrospective review of patients enrolled from 2012 to 2017. 104 consecutive endovertebral implantations of instrumented kyphoplasty were reviewed for the study. There were 56 women and 48 men. 93 of 104 patients were evaluated, of whom 27 were evaluated only by retrospective medical record review and 66 with follow-up visit. Clinical parameters were the pain rating scale (VAS) and the Oswestry score questionnaire. The radiological parameters were the vertebral kyphosis, vertebral height, lumbar lordosis, and adjacent disc degeneration (UCLA scale). Statistical correlations between before/after surgery/last follow-up were performed. The average follow-up was 26.7 months (3 to 55). The average VAS decreased from 8.2 to 3.2 the day after surgery, allowing immediate standup. The average Oswestry score was 14.6 at follow-up. The average vertebral kyphosis decreased from 12.9° to 6.5° post-op and stabilized at 8.0° at the last follow-up, corresponding to 28% gain on vertebral height. The lumbar lordosis was restored (+6.6°). Adjacent disc degeneration increased by 1 UCLA grade in 17 patients (16.3%) at follow-up. The instrumented kyphoplasty in acute led to immediate and lasting pain relief, with no bracing or bed rest, short stay in hospital, and quick return to daily life including professional activities. The good clinical results were associated to a stable radiological restoration of the vertebral anatomy.


Assuntos
Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Dor/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Idoso , Cimentos para Ossos/uso terapêutico , Doenças Ósseas Metabólicas/tratamento farmacológico , Doenças Ósseas Metabólicas/fisiopatologia , Doenças Ósseas Metabólicas/terapia , Feminino , Fixação Interna de Fraturas/métodos , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/fisiopatologia , Humanos , Cifoplastia/efeitos adversos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Dor/fisiopatologia , Medição da Dor/métodos , Radiologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/fisiopatologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/fisiopatologia , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Vertebroplastia/métodos
7.
BMC Musculoskelet Disord ; 20(1): 423, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31510985

RESUMO

BACKGROUND: Percutaneous kyphoplasty (PKP) can effectively treat osteoporotic vertebral compression fractures (OVCFs). Although satisfactory clinical outcomes can be achieved, bone cement leakage remains a primary complication of PKP. Previous studies have found many high risk factors for bone cement leakage into the spinal canal; however, less attention to the posterior wall morphologies of different vertebral bodies may be one reason for the leakage. Here, we investigated the effect of posterior vertebral wall morphology in OVCF patients on bone cement leakage into the spinal canal during PKP. METHODS: Ninety-eight OVCF patients with plain computed tomography (CT) scans and three-dimensional (3D) reconstruction images from T6 to L5 were enrolled. 3D-CT and multiplanar reconstructions (MPR) were used to measure the concave posterior vertebral wall depth (PVWCD) and the corresponding midsagittal diameter of the nonfractured vertebral body (VBSD), and the PVWCD/VBSD ratio was calculated. All subjects were divided into the thoracic or lumbar groups based on the location of the measured vertebrae to observe the value and differences in the PVWCD between both groups. The differences in PVWCD and PVWCD/VBSD between the thoracic and lumbar groups were compared. Three hundred fifty-seven patients (548 vertebrae) who underwent PKP within the same period were also divided into the thoracic and lumbar groups. The maximal sagittal diameter (BCSD), the area of the bone cement intrusion into the spinal canal (BCA), and the spinal canal encroachment rate (BCA/SCA × 100%) were measured to investigate the effect of the thoracic and lumbar posterior vertebral wall morphologies on bone cement leakage into the spinal canal through the Batson vein during PKP. RESULTS: The PVWCDs gradually deepened from T6 to T12 (mean, 4.6 mm); however, the values gradually became shallower from L1 to L5 (mean, 0.6 mm). The PVWCD/VBSD ratio was approximately 16% from T6 to T12 and significantly less at 3% from L1 to L5 (P < 0.05). The rate of bone cement leakage into the spinal canal through the Batson vein was 10.1% in the thoracic group and 3.7% in the lumbar group during PKP. In the thoracic group, the BCSD was 3.1 ± 0.5 mm, the BCA was 30.2 ± 3.8 mm2, and the BCA/SCA ratio was 17.2 ± 2.0%. In the lumbar group, the BCSD was 1.4 ± 0.3 mm, the BCA was 14.8 ± 2.2 mm2, and the BCA/SCA ratio was 7.4 ± 1.0%. The BCSD, BCA and BCA/SCA ratio were significantly higher in the thoracic group than in the lumbar group (P < 0.05). CONCLUSIONS: The PVWCD in the middle and lower thoracic vertebrae can help reduce bone cement leakage into the spinal canal by enabling avoiding bone cement distribution over the posterior 1/6 of the vertebral body during PKP. The effect of the difference between the thoracic and lumbar posterior vertebral wall morphology on bone cement leakage into the spinal canal through the Batson vein in OVCF patients during PKP is one reason that the rate of bone cement leakage into the thoracic spinal canal is significantly higher than that into the lumbar spinal canal.


Assuntos
Cimentos para Ossos/efeitos adversos , Corpos Estranhos/epidemiologia , Cifoplastia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Canal Vertebral/lesões , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/etiologia , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Imageamento Tridimensional , Cifoplastia/métodos , Vértebras Lombares/anatomia & histologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Canal Vertebral/irrigação sanguínea , Canal Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/anatomia & histologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Veias
8.
J Orthop Surg Res ; 14(1): 299, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488174

RESUMO

PURPOSE: Our purpose was to combine intravoxel incoherent motion diffusion-weighted MR imaging (IVIM-DWI) and magnetic resonance spectroscopy (MRS) to differentiate osteoporotic fractures from osteolytic metastatic vertebral compression fractures (VCFs). METHODS: A total of 70 patients with VCFs were included and divided into two groups, according to their causes of fractures based on pathological findings or clinical follow-up. All patients underwent conventional sagittal T1WI, T2WI, STIR, IVIM-DWI, and single-voxel MRS. The diffusion coefficient (D), pseudo diffusion (D*), and perfusion fraction (f) parameters from IVIM-DWI and the lipid water ratio (LWR) and fat fraction (FF) parameters from MRS were obtained and compared among groups. Furthermore, the diagnostic performance of MRS, IVIM-DWI, and IVIM-DWI combined with MRS for differentiation between osteoporotic and osteolytic metastatic VCFs was assessed by using receiver operating characteristic (ROC) curve analysis. RESULTS: Compared with the osteoporotic group, the metastatic group had significantly lower values for f, D, and FF, but higher D* (all P < 0.05). The area under the receiver operating characteristic (ROC) curve of MRS, IVIM-DWI, and IVIM-DWI combined with MRS were 0.73, 0.88, and 0.94, respectively. Among these, the IVIM-DWI combined with MRS showed the highest sensitivity, specificity, and accuracy, which are 90.63% (29/32), 97.37 % (37/38), and 94.29% (66/70), respectively. CONCLUSIONS: IVIM-DWI combined with MRS can be more accurate and efficient for differentiation between osteoporotic and osteolytic metastatic VCFs than single MRS or IVIM-DWI.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Fraturas por Compressão/diagnóstico por imagem , Espectroscopia de Ressonância Magnética/métodos , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética/normas , Feminino , Fraturas por Compressão/metabolismo , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/metabolismo , Espectroscopia de Ressonância Magnética/normas , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/metabolismo , Fraturas da Coluna Vertebral/metabolismo , Neoplasias da Coluna Vertebral/metabolismo , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/metabolismo
9.
J Orthop Surg Res ; 14(1): 255, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395071

RESUMO

BACKGROUND: The purpose of this study was to assess the clinical outcome of percutaneous kyphoplasty (PKP) assisted with mixed reality (MR) technology in treatment of osteoporotic vertebral compression fracture (OVCF) with intravertebral vacuum cleft (IVC). METHOD: Forty cases of OVCF with IVC undergoing PKP were randomized into a MR technology-assisted group (group A) and a traditional C-arm fluoroscopy group (group B). Both groups were performed PKP and evaluated by VAS scores, ODI scores, radiological evidence of vertebral body height, and kyphotic angle (KA) at pre-operation and post-operation. The volume of injected cement, fluoroscopy times, and operation time were recorded. And cases of non-PMMA-endplates-contact(NPEC) in radiological evidence was also recorded postoperatively. The clinical outcomes and complications were evaluated afterwards. All patients received 10 to 14 months follow-up, with an average of 12 months. RESULT: This MR-assisted group (group A) acquired more about the amount of the polymethyl methacrylate (PMMA) injection and postoperative vertebral height and less about postoperative KA, fluoroscopy times, and operation time compared with the control group (group B) (P < 0.05). The VAS scores and ODI scores in both groups have improved, but more significantly in group A (P < 0.05). Also, more cases achieve both-endplates-touching of cement in group A (P < 0.05). And there are less of the loss of vertebral height, KA, and occurrence of re-collapse of the vertebra in group A during the follow-up (P < 0.05). CONCLUSION: PKP assisted with MR technology can accurately orientate the position of IVC area, which can be augmented by the balloon leading to more satisfied vertebral height improvement, cement diffusion, and pain relief. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03959059 . Registered 25 September 2016.


Assuntos
57943 , Fraturas por Compressão/cirurgia , Cifoplastia/métodos , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas por Compressão/diagnóstico por imagem , Humanos , Masculino , Fraturas por Osteoporose/diagnóstico por imagem , Estudos Prospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vácuo
10.
World Neurosurg ; 132: e739-e745, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31415893

RESUMO

OBJECTIVE: To evaluate and compare clinical outcomes and cement leakage of high-viscosity bone cement versus low-viscosity bone cement vertebroplasty in treating osteoporotic vertebral compression fractures with intravertebral cleft. METHODS: The study included 72 patients with osteoporotic vertebral compression fractures with intravertebral cleft, who were divided into high-viscosity cement (HVC) (38 cases) and low-viscosity cement (LVC) (34 cases) groups according to the viscosity of bone cement used. Cement leakage, visual analog scale score, Oswestry Disability Index, and kyphotic angle (KA) were evaluated. RESULTS: All patients were followed for at least 12 months. Overall cement leakage rate was 18.4% in the HVC group, lower than the rate of 61.8% obtained in the LVC group. A statistically significant difference was found in the overall cement leakage rate between the groups (P < 0.05). Visual analog scale and Oswestry Disability Index scores were significantly improved after percutaneous vertebroplasty without significant differences between the HVC and LVC groups (P > 0.05). The KA of patients from both groups was also significantly corrected immediately after surgery. Although the KA gradually increased in both groups during the follow-up period, there was no statistically significant difference between the HVC and LVC groups in KA during follow-up (P > 0.05). CONCLUSIONS: Percutaneous vertebroplasty using HVC to treat osteoporotic vertebral compression fractures with intravertebral cleft significantly reduces cement leakage and improves the safety of the operation. In terms of clinical efficacy and prevention of augmented vertebral recollapse, HVC may not have obvious advantages.


Assuntos
Cimentos para Ossos/uso terapêutico , Fraturas por Compressão/cirurgia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos/efeitos adversos , Avaliação da Deficiência , Feminino , Fraturas por Compressão/diagnóstico por imagem , Humanos , Masculino , Fraturas por Osteoporose/diagnóstico por imagem , Medição da Dor , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento , Vertebroplastia/efeitos adversos , Viscosidade
11.
J Orthop Surg Res ; 14(1): 228, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324196

RESUMO

OBJECTIVE: Vertebroplasty is the most widely used method for treating osteoporotic vertebral compression fractures (OVCF). During this procedure, bone cement is injected into the vertebral body. Fracture and additional fractures can occur adjacent to the treatment site. Thus, we studied factors causing such vertebral fractures after vertebroplasty and calculated the appropriate amount of bone cement to inject. METHODS: From September 2012 to March 2016, 187 patients with OVCF undergoing vertebroplasty were selected, and 112 patients with complete follow-up information were selected. Of these, 28 had adjacent vertebral fractures (refracture group) during the follow-up period, and 84 patients had no adjacent vertebral fractures (control group). Then, sex, age, body weight, bone mineral density (BMD), and bone cement injection (bone cement injection volume and bone fracture vertebral volume percent) were compared. RESULTS: All patients had significant pain relief within 24 h (preoperative and postoperative [24 h later] VAS scores were 7.4 ± 0.8 and 2.3 ± 0.5, respectively). The age and weight were not statistically significantly different (P > 0.05). BMD values were statistically significantly different between groups as was sex (P < 0.05). CONCLUSIONS: Bone cement injection volume, BMD values, and sex were statistically significantly related to adjacent vertebral fractures after vertebroplasty, and cement injection volumes exceeding 40.5% caused adjacent vertebral fractures.


Assuntos
Cimentos para Ossos/efeitos adversos , Fraturas por Osteoporose/cirurgia , Complicações Pós-Operatórias/etiologia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Fraturas por Osteoporose/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Fatores de Risco , Fatores Sexuais , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Vertebroplastia/tendências
12.
World Neurosurg ; 130: e933-e940, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31302276

RESUMO

OBJECTIVE: To assess outcomes in obese patients with chronic obstructive pulmonary disease (COPD) who sustained an osteoporotic vertebral compression fracture (OVCF) treated by percutaneous vertebroplasty (PVP) in the improved prone position and right lateral position. METHODS: Between January 2015 and May 2016, a total of 60 patients were enrolled in this randomized controlled study. Patients in group A were placed in the improved prone position for a bilateral transpedicular technique, and those in group B were placed in the right lateral position for a left transverse process-pedicle approach. Clinical and radiologic outcomes were assessed and compared between the 2 groups during the 12-month follow-up period. RESULTS: All operations were successfully completed without any serious sequelae. The operation time, fluoroscopic time, scores for respiratory condition during the operation, intravertebral cement volume, and incidence of cement leakage were significantly greater in group A compared with group B (P < 0.01). During the follow-up period, all patients in both groups experienced significant improvement in pain relief. Satisfactory functional improvement was obtained at 3 months postoperatively. CONCLUSIONS: Treatment of obese patients with COPD suffering from painful OVCF by PVP in both the improved prone position with a bilateral technique and the right lateral position with a unilateral technique was relatively safe and effective. However, unilateral PVP in the right lateral position was associated with a shorter operation time, limited fluoroscopic time, and minimal cement leakage.


Assuntos
Fraturas por Compressão/cirurgia , Obesidade/cirurgia , Fraturas por Osteoporose/cirurgia , Posicionamento do Paciente/métodos , Doença Pulmonar Obstrutiva Crônica/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Feminino , Seguimentos , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/epidemiologia , Humanos , Masculino , Obesidade/diagnóstico por imagem , Obesidade/epidemiologia , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Dor/diagnóstico por imagem , Dor/epidemiologia , Dor/cirurgia , Manejo da Dor/métodos , Decúbito Ventral , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Resultado do Tratamento
13.
Comput Math Methods Med ; 2019: 8348631, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31191711

RESUMO

Spinal compression fractures commonly occur at the thoracolumbar junction. We have previously constructed a 3-dimensional whole-spine model from medical images by using the finite element method (FEM) and then used this model to develop a compression fracture model. However, these models lacked the rib cage. No previous study has used whole-spine models including the rib cage constructed from medical images to analyze compression fractures. Therefore, in this study, we added the rib cage to whole-spine models. We constructed the models, including a normal spine model without the rib cage, a whole-spine model with the rib cage, and whole-spine models with compression fractures, using FEM analysis. Then, we simulated a person falling on the buttocks to perform stress analysis on the models and to examine to what extent the rib cage affects the analysis of compression fractures. The results showed that the intensity of strain and the vertebral body with minimum principle strain differed between the spine model including the rib cage and that excluding the rib cage. The strain on the spine model excluding the rib cage had approximately twice the intensity of the strain on the spine model including the rib cage. Therefore, the rib cage contributed to the stability of the thoracic spine, thus preventing deformation of the upper thoracic spine. However, the presence of the rib cage increased the strain around the site of compression fracture, thus increasing the possibilities of a refracture and fractures of adjacent vertebral bodies. Our study suggests that the analysis using spine models including the rib cage should be considered in future investigations of disorders of the spine and internal fracture fixation. The development of improved models may contribute to the improvement of prognosis and treatment of individual patients with disorders of the spine.


Assuntos
Simulação por Computador , Análise de Elementos Finitos , Fixação Interna de Fraturas , Fraturas por Compressão/fisiopatologia , Fraturas da Coluna Vertebral/fisiopatologia , Adulto , Fenômenos Biomecânicos , Diagnóstico por Imagem , Fraturas por Compressão/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Prognóstico , Caixa Torácica/diagnóstico por imagem , Software , Fraturas da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Estresse Mecânico , Tomografia Computadorizada por Raios X
14.
Cardiovasc Intervent Radiol ; 42(11): 1579-1587, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31201507

RESUMO

INTRODUCTION: To evaluate the effectiveness of percutaneous image-guided vertebral body stenting (VBS) at restoring vertebral height in acute, stable, traumatic thoracolumbar fractures in a young, non-osteoporotic population. MATERIALS AND METHODS: A single-centre retrospective review of all traumatic non-osteoporotic fractures treated with VBS between 2010 and 2017 was performed. Inclusion criteria included patients with recent (< 10 days), symptomatic and stable thoracolumbar compression fractures. Patients with low-energy fractures, osteoporosis and age > 60/50 years (male/female) were excluded. Primary outcomes included: correction of vertebral height, correction of kyphosis angle and Beck Index on reconstructed pre- and post-procedural CBCT images. Secondary outcomes included intra-procedural stent recoil, complications, cement leakage and factors predicting height restoration. RESULTS: Thirty-nine patients (26 men, 13 women; mean age 33.6 years, range 15-57 years) underwent VBS 5 days post-trauma on average (range 1-10), for stable compression fractures located between T5 and L5. Mean vertebral height gain, vertebral kyphosis angle correction and Beck index improvement were 3.8 mm (95% CI 3.36-4.50; P(> 3 mm) = 99.9%), 4.3° (95% CI 3.50-5.20; P(> 3°) = 99.9%) and 0.07 [95% CI 0.053-0.11], respectively (all statistically significant). Technical success was 92%, with 3 "major" stent recoils resulting in loss of vertebral height correction. No symptomatic complications were observed. No predictive factors for procedural success were identified. CONCLUSION: VBS can significantly restore vertebral height in young patients with traumatic vertebral compression fractures.


Assuntos
Fraturas por Compressão/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Stents , Adolescente , Adulto , Tomografia Computadorizada de Feixe Cônico/métodos , Feminino , Fraturas por Compressão/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista/métodos , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Resultado do Tratamento , Adulto Jovem
15.
Surg Innov ; 26(5): 551-559, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31167616

RESUMO

Objective. In this randomized, nonblinded, controlled study, the feasibility and precision of "targeted percutaneous vertebroplasty" ("targeted PVP") for osteoporotic vertebral compression fracture (OVCF) was evaluated. Methods. A total of 42 patients, aged 50 to 87 years, with OVCF were randomly divided into 2 groups: A and B. Group A underwent "targeted PVP," and group B underwent traditional PVP with the guidance of C-arm fluoroscopy. Fluoroscopy times for skin puncture points (FTSPP), total radiation doses (TRD), total fluoroscopy times (TFT), and operation time were set as the main evaluation indicators. Results. FTSPP (1.52 ± 0.51 in group A vs 6.62 ± 2.58 in group B, U < .001), TRD (6.26 ± 1.51 in group A vs 11.32 ± 4.21 in group B, P < .001), TFT (16.57 ± 2.79 in group A vs 26.05 ± 6.18 in group B, P < .001), and operation time (20.05 ± 3.38 in group A vs 25.43 ±5.11 in group B, U < .001) were statistically different in the 2 groups. The incidence of cement leakage that occurred in group A (1/21, 4.76%) was significantly less than that in group B (9/21, 42.9%, P < 0.05). Conclusions. "Targeted PVP" may achieve (1) less skin positioning fluoroscopy times, less total fluoroscopy times and dose, shorter operation time, which is more precise than traditional PVP; (2) less incidence of cement leakage; and (3) visualization of the fractured vertebra, which is probably more valuable for the treatment of complicated OVCF patients.


Assuntos
Fraturas por Compressão/cirurgia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Fluoroscopia , Fraturas por Compressão/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Fraturas por Osteoporose/diagnóstico por imagem , Doses de Radiação , Fraturas da Coluna Vertebral/diagnóstico por imagem
16.
BMC Surg ; 19(1): 49, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088435

RESUMO

BACKGROUND: Kummell's Disease has insidious progression. Neurological deficit is usually slow in onset and progression and only few cases of acute neurological deficit have been reported. We came across a case of Kummell's disease which progressed to burst fracture, developed neurological deficit within two weeks. We managed patient with "pivot ligamentotaxis" and Polymethylmethacrylate augmented, posterior compressed, short segment percutaneous pedicle screw fixation. CASE PRESENTATION: Eighty-three years old woman following fall was on conservative management at another hospital. She had no neurological deficit. A week later her back pain aggravated and two weeks later developed bilateral buttock pain, bilateral lower limb weakness and diminished sensation in the sacral area. Radiological investigations (X-rays, Magnetic resonance imaging and Computed tomography) showed L1 vertebral body fracture with vacuum cleft and fracture fragment retropulsed into the spinal canal. A diagnosis of Kummell's disease with burst fracture of L1 vertebra & neurological deficit was made. Patient was managed with Polymethylmethacrylate augmented, posterior compressed, short segment percutaneous pedicle screw fixation. The reduction of the retropulsed fragment was achieved by virtue of "Pivot ligamentotaxis". The patient got relieved of the symptoms (Preoperative VAS 8 and postoperative VAS 3) and was allowed brace assisted ambulation on first postoperative day. CONCLUSION: This study reports acute occurrence of the burst fracture in unstable vertebra inflicted by Kummell's disease and role of spinal stability in recovery. We achieved closed reduction of the fracture fragments and relief of the cord compression by posterior compression with "pivot ligamentotaxis".


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Cominutivas/cirurgia , Fraturas por Compressão/cirurgia , Hipestesia/etiologia , Debilidade Muscular/etiologia , Osteonecrose/complicações , Fraturas da Coluna Vertebral/cirurgia , Idoso de 80 Anos ou mais , Cimentos para Ossos , Parafusos Ósseos , Feminino , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/etiologia , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/etiologia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Polimetil Metacrilato , Radiografia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Tomografia Computadorizada por Raios X
17.
J Orthop Surg Res ; 14(1): 98, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971275

RESUMO

INTRODUCTION: Compressive-flexion type cervical spine fracture is typically accompanied by apparent dislocation of the facet joints, undesirable cervical alignment, and devastating neurological dysfunction, which provides strong rationale for rendering prompt operative treatment. However, the validity of conservative treatment for compressive-flexion cervical spine injury in cases with preserved congruity of the facet joints has yet to be elucidated. The purpose of this study is to evaluate the long-term outcome of cervical alignment following conservative treatment for compressive-flexion cervical spine injury with preserved congruity of the facet joints. METHODS: A total of 662 patients who experienced spinal cord injury from 2007 to 2017 were included and underwent retrospective review in a single institute. Thirteen patients were identified as receiving conservative therapy following compressive-flexion cervical spine fractures with spinal cord injury. Clinical and radiological results were collected, including vertical fractures of the vertebral column, laminar fractures, progression of local kyphosis, and neurological status. The degree of the local cervical kyphosis was evaluated with two methods: the posterior tangent method and the endplate method. RESULTS: All 13 patients were male, and the mean age at the time of injury was 28.4 years. The mean follow-up period was 3 years. Although none of the patients presented neurological deterioration after the injury, the degree of local kyphosis was increased at the time of final follow-up compared to what was observed at the time of injury. Patient age at the time of injury and concurrent vertical fracture of vertebral body could have been influencing factors for the progression of the kyphosis. While laminar fracture affected the kyphosis at the time of injury, it was not a strong influencing factor of the overall progression of local kyphosis. CONCLUSIONS: The conservative option for the compressive-flexion cervical injury allowed us to treat without exacerbating neurological symptoms as long as the facet joints are preserved. However, in terms of cervical alignment, surgical stabilization may have been desirable for these patients. Notably, the younger patients and the patients with vertical fracture of the cervical vertebral column in this type of injury required closer observation to help prevent the progression of local kyphosis.


Assuntos
Vértebras Cervicais/lesões , Tratamento Conservador/efeitos adversos , Fraturas por Compressão/terapia , Cifose/etiologia , Traumatismos da Medula Espinal/terapia , Fraturas da Coluna Vertebral/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Vértebras Cervicais/diagnóstico por imagem , Tratamento Conservador/métodos , Progressão da Doença , Fraturas por Compressão/diagnóstico por imagem , Humanos , Cifose/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Radiografia , Estudos Retrospectivos , Traumatismos da Medula Espinal/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
18.
Rev Med Suisse ; 15(647): 815-820, 2019 Apr 17.
Artigo em Francês | MEDLINE | ID: mdl-30994983

RESUMO

Osteoporotic vertebral fractures (VF) are common and can induce acute and chronic pain, having a negative impact on quality of life and lifespan. One man and one women over five will have one or more osteoporotic VF after the age of 50. The screening of these fractures is important because they are predictive of subsequent fractures. Most of the vertebral fractures are asymptomatic and therefore under-diagnosed. Clinics is the first screening tool and radiologic imaging will confirm any suspicion. The initiation of anti-fracture treatment is crucial to avoid future fractures. Physiotherapy and analgesics are part of the management of pain as well as vertebroplasty or kyphoplasty.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia , Masculino , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Qualidade de Vida , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento , Vertebroplastia
19.
Osteoporos Int ; 30(7): 1533-1536, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31016352

RESUMO

This case report describes a case of an elderly woman diagnosed with acute osteoporotic vertebral compression fracture (OVCF) at thoracic spine after using an electrical automated massage chair (EAMC). Care should be taken when using an EAMC, especially by those with or at risk of developing osteoporosis. Osteoporotic vertebral compression fracture (OVCF) is a common problem among elderly population and presents a high burden to society. Osteoporotic fractures may occur after a minimal trauma of the vertebrae. Electrical automated massage chair (EAMC) is a device that uses a programmed algorithm to perform automated massage. The massage chair, a popular device among elderly with back pain, relies on friction and rhythmic tapping created by a motorized roller. However, research regarding the safety of this device is lacking, especially in the perspective of OVCF. We present a case of an elderly woman diagnosed with acute OVCF of the thoracic spine after using an EAMC. The patient had no risk factor for fragility fracture and experienced an abrupt onset of severe upper back pain while using EAMC. Imaging studies revealed an isolated acute compression fracture at T8 vertebra (AO classification type A1) while dual-energy X-Ray absorptiometry scan confirmed osteoporosis. The patient was treated with a plastic orthosis and oral medications for osteoporosis. After 6-months follow-up, the patient showed union of the fractured T8 vertebra and no remaining symptoms. This case highlights that OVCF can be induced by EAMC. Therefore, patients with or at risk for osteoporosis should be cautious while opting for deep tissue massage using EAMC.


Assuntos
Fraturas por Compressão/etiologia , Massagem/efeitos adversos , Fraturas por Osteoporose/etiologia , Fraturas da Coluna Vertebral/etiologia , Idoso , Feminino , Fraturas por Compressão/diagnóstico por imagem , Humanos , Massagem/instrumentação , Fraturas por Osteoporose/diagnóstico por imagem , Radiografia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões
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