Percutaneous vertebroplasty for the treatment of osteoporotic burst fractures |
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Authors: | Jun Jae Shin Dong Kyu Chin Young Sul Yoon |
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Institution: | (1) Department of Neurosurgery, Sanggye Paik Hospital, College of Medicine, Inje University, Sanggye-7 dong, 761-1, Nowon-gu, Seoul, 139-707, South Korea;(2) Department of Neurosurgery, The Spine and Spinal Cord Institute, Yongdong Severance Spine Hospital, College of Medicine, Yonsei University, 146-92, Dogok-Dong, Kangnam-gu, Kangnam, P.O. Box 1217, Seoul, 135-720, South Korea |
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Abstract: | Background Vertebroplasty is a minimally invasive surgical procedure which involves injecting polymethylmethacrylate into the compressed
vertebral body. At present the indications include the treatment of osteoporotic compression fractures, vertebral myeloma,
and metastases. The value of vertebroplasty in osteoporotic compression fracture has been discussed comprehensively. The surgical
operation for burst fractures without neurological deficit remains controversial. Some authors have asserted that vertebroplasty
is contraindicated in patients with burst fracture. However, we performed the procedure, after considering the patents general
condition, to reduce surgical risks and the duration of immobilisation. The purpose of this study is to investigate clinical
outcomes, kyphosis correction, wedge angle, and height restoration of thoraco-lumbar osteoporotic burst fractures treated
by percutaneous vertebroplasty.
Materials and methods Twenty-five patients with osteoporotic burst fracture were treated with postural reduction followed by vertebroplasty. We
measured the kyphosis, wedge angle, spinal canal compromise and the height of the fractured vertebral body initially, after
postural reduction, and after vertebroplasty.
Findings The average height of the collapsed vertebral bodies was 24.8% of the original height. Average kyphosis angle was 19.4° and
average wedge angle was 19.8° at first. Mean canal encroachment was initially 25.1%. Kyphosis angle, wedge angle, and anterior,
middle, and posterior height improved significantly after the procedure. The mean amelioration of the spinal canal encroachment
after vertebroplasty was 23.3%. The average increase in anterior vertebral body height was 7.5 mm, central was 5.8 mm, and
posterior was 0.9 mm. The mean reduction in kyphosis angle was 6.8° and the mean reduction in wedge angle was 9.7°.
Conclusion Although vertebroplasty has been considered as contraindicated in thoraco-lumbar burst fractures, we successfully used the
procedure as a safe treatment in patients with osteoporotic burst fracture without neurologic deficit. This method could eliminate
the need for and risks of major spinal surgery. We would like to offer it as a relatively safe and effective methods of management
in thoraco-lumbar burst fractures. |
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Keywords: | Percutaneous vertebroplasty Postural reduction Burst fracture Thoraco-lumbar spine |
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