OJRad  Vol.3 No.3 , September 2013
Image Findings Following Vertebroplasty in Osteoporotic Vertebral Compression Fractures: Bone Healing and Sagittal Alignment
ABSTRACT

Purpose: To clarify the effect of percutaneous vertebroplasty for vertebral compression fracture by assessing the changes of radiographic and CT image findings. Materials and Methods: A retrospective radiological analysis comprising 101 vertebrae of 48 patients who underwent percutaneous vertebroplasty for painful osteoporotic vertebral compression fracture was conducted. Whole spine radiographs and CT images were compared in patients preoperatively and 6 months postoperativey. Sagittal Cobb angles in three regions, sagittal vertical axis, and pelvic tilt were measured using whole spine lateral radiographs. CT findings due to the vertebral compression fracture, its healing process, and complications were evaluated. Results: On radiographs, sagittal alignment had an average gain of no more than 2.5° in each region. Sagittal vertical axis and pelvic tilt did not show significant change. Out of 68 vertebrae that demonstrated cortical disruption on preoperative CT, 37 (54%) demonstrated fusion of disrupted cortex on postoperative CT. Conclusion: No significant difference was observed between preoperative and postoperative spinal sagittal alignment on radiographs. However, CT did reveal healing process through fusion of disrupted cortex, intervertebral bridging, and increased density of cancellous bone. It is suggested that cement in the space of fracture may play a role in both mechanical stability and bone union.


Cite this paper
H. Ikeda, M. Nishio, S. Matsuoka, B. Lohman, S. Matsushita, Y. Ogawa, S. Hamaguchi, Y. Nakajima, A. Kojima, Y. Torii and Y. Sasao, "Image Findings Following Vertebroplasty in Osteoporotic Vertebral Compression Fractures: Bone Healing and Sagittal Alignment," Open Journal of Radiology, Vol. 3 No. 3, 2013, pp. 152-158. doi: 10.4236/ojrad.2013.33025.
References
[1]   J. J. Verlaan, F. C. Oner and W. J. Dhert, “Anterior Spinal Column Augmentation with Injectable Bone Cements,” Biomaterials, Vol. 27, No. 3, 2006, pp. 290-301. doi:10.1016/j.biomaterials.2005.07.028

[2]   S. R. Garfin, H. A. Yuan and M. A. Reiley, “New Technologies in Spine: Kyphoplasty and Vertebroplasty for the Treatment of Painful Osteoporotic Compression Fractures,” Spine (Phila Pa 1976), Vol. 26, No. 14, 2001, pp. 1511-1515.

[3]   M. O. Baerlocher, P. L. Munk, D. M. Liu, G. Tomlinson, M. Badii, et al. “Clinical Utility of Vertebroplasty: Need for Better Evidence,” Radiology, Vol. 255, No. 3, 2010, pp. 669-674.
doi:10.1148/radiol.10092107

[4]   W. T. Ploeg, A. G. Veldhuizen, B. The and M. S. Sietsma “Percutaneous Vertebroplasty as a Treatment for Osteoporotic Vertebral Compression Fractures: A Systematic Review,” European Spine Journal, Vol. 15, No. 12, 2006, pp. 1749-1758. doi:10.1007/s00586-006-0159-z

[5]   M. Krauss, H. Hirschfelder, B. Tomandl, G. Lichti and I. Bar, “Kyphosis Reduction and the Rate of Cement Leaks after Vertebroplasty of Intravertebral Clefts,” European Radiology, Vol. 16, No. 5, 2006, pp. 1015-1021. doi:10.1007/s00330-005-0056-6

[6]   M. B. Pitton, U. Koch, P. Dreesand and C. Duber, “Midterm Follow-Up of Vertebral Geometry and Remodeling of the Vertebral Bidisk Unit (VDU) after Percutaneous Vertebroplasty of Osteoporotic Vertebral Fractures,” CardioVascular and Interventional Radiology, Vol. 32, No. 5, 2009, pp. 1004-1010. doi:10.1007/s00270-009-9521-y

[7]   C. R. Krestan, H. Noske, V. Vasilevska, M. Weber, G. Schueller, et al., “MDCT versus Digital Radiography in the Evaluation of Bone Healing in Orthopedic Patients,” American Journal of Roentgenology, Vol. 186, No. 6, 2006, pp. 1754-1760. doi:10.2214/AJR.05.0478

[8]   J. E. Kuhlman, E. K. Fishman, D. Magid, W. W. Scott Jr., A. F. Brooker and S. S. Siegelman, “Fracture Nonunion: CT Assessment with Multiplanar Reconstruction,” Radiology, Vol. 167, No. 2, 1988, pp. 483-488.

[9]   S. Sakaino, K. Takizawa, M. Yoshimatsu, Y. Ogawa, K. Yagihashi and Y. Nakajima, “Percutaneous Vertebroplasty Performed by the Isocenter Puncture Method,” Radiation Medicine, Vol. 26, No. 2, 2008, pp. 70-75. doi:10.1007/s11604-007-0197-4

[10]   M. F. O’Brien, T. R. Kuklo, K. M. Blanke, et al., “Radiographic Measurement Manual,” Spinal Deformity Study Group (SDSG), Medtronic SofamorDanek, 2004.

[11]   P. Roussouly and C. Nnadi, “Sagittal Plane Deformity: An Overview of Interpretation and Management,” European Spine Journal, Vol. 19, No. 11, 2010, pp. 18241836. doi:10.1007/s00586-010-1476-9

[12]   H. K. Genant, C. Y. Wu, C. van Kuijk and M. C. Nevitt, “Vertebral Fracture Assessment Using a Semiquantitative Technique,” Journal of Bone and Mineral Research, Vol. 8, No. 9, 1993, pp. 1137-1148. doi:10.1002/jbmr.5650080915

[13]   D. Muller, J. S. Bauer, M. Zeile, E. J. Rummeny and T. M. Link, “Significance of Sagittal Reformations in Routine Thoracic and Abdominal Multislice CT Studies for Detecting Osteoporotic Fractures and Other Spine Abnormalities,” European Radiology, Vol. 18, No. 8, 2008, pp. 1696-1702. doi:10.1007/s00330-008-0920-2

[14]   J. S. Bauer, D. Muller, A. Ambekar, M. Dobritz, M. Matsuura, et al., “Detection of Osteoporotic Vertebral Fractures Using Multidetector CT,” Osteoporosis International, Vol. 17, No. 4, 2006, pp. 608-615. doi:10.1007/s00198-005-0023-8

[15]   V. Braunstein, C. M. Sprecher, A. Gisep, L. Benneker, K. Yen, et al., “Long-Term Reaction to Bone Cement in Osteoporotic Bone: New Bone Formation in Vertebral Bodies after Vertebroplasty,” Journal of Anatomy, Vol. 212, No. 5, 2008, pp. 697-701. doi:10.1111/j.1469-7580.2008.00883.x

[16]   M. Libicher, J. Hillmeier, U. Liegibel, U. Sommer, W. Pyerin, et al., “Osseous Integration of Calcium Phosphate in Osteoporotic Vertebral Fractures after Kyphoplasty: Initial Results from a Clinical and Experimental Pilot Study,” Osteoporosis International, Vol. 17, No. 8, 2006, pp. 1208-1215. doi:10.1007/s00198-006-0128-8

[17]   I. A. Grafe, M. Baier, G. Noldge, C. Weiss, K. Da Fonseca, et al., “Calcium-Phosphate and Polymethylmethacrylate Cement in Long-Term Outcome after Kyphoplasty of Painful Osteoporotic Vertebral Fractures,” Spine (Phila Pa 1976) , Vol. 33, No. 11, 2008, pp. 1284-1290.

[18]   E. M. Ooms, J. G. Wolke, M. T. van de Heuvel, B. Jeschke and J. A. Jansen, “Histological Evaluation of the Bone Response to Calcium Phosphate Cement Implanted in Cortical Bone,” Biomaterials, Vol. 24, No. 6, 2003, pp. 989-1000. doi:10.1016/S0142-9612(02)00438-6

[19]   M. Hoshino, H. Nakamura, H. Terai, T. Tsujio, M. Nabeta, et al., “Factors Affecting Neurological Deficits and Intractable Back Pain in Patients with Insufficient Bone Union Following Osteoporotic Vertebral Fracture,” European Spine Journal, Vol. 18, No. 9, 2009, pp. 1279-1286. doi:10.1007/s00586-009-1041-6

[20]   T. Hashimoto, K. Kaneda and K. Abumi, “Relationship between Traumatic Spinal Canal Stenosis and Neurologic Deficits in Thoracolumbar Burst Fractures,” Spine (Phila Pa 1976), Vol. 13, No. 11, 1988, pp. 1268-1272.

[21]   M. J. Nieuwenhuijse, H. Putter, A. R. van Erkel and P. D. Dijkstra, “New Vertebral Fractures after Percutaneous Vertebroplasty for Painful Osteoporotic Vertebral Compression Fractures: A Clustered Analysis and the Relevance of Intradiskal Cement Leakage,” Radiology, Vol. 266, No. 3, 2013, pp. 862-870.

[22]   N. Tanigawa, S. Kariya, A. Komemushi, M. Nakatani, R. Yagi, et al., “Percutaneous Vertebroplasty for Osteoporotic Compression Fractures: Long-Term Evaluation of the Technical and Clinical Outcomes,” American Journal of Roentgenology, Vol. 196, No. 6, 2011, pp. 1415-1418. doi:10.2214/AJR.10.5586

[23]   V. Lafage, F. Schwab, A. Patel, N. Hawkinson and J. P. Farcy, “Pelvic Tilt and Truncal Inclination: Two Key Radiographic Parameters in the Setting of Adults with Spinal Deformity,” Spine (Phila Pa 1976), Vol. 34, No. 17, 2009, pp. E599-606.

[24]   Y. Sasao, A. Kojima, M. Kaneko, A. Fujii, Y. Torii, et al., “Short-Term Outcome of Percutaneous Vertebroplasty (PVP),” Journal of St. Marianna University, Vol. 1, 2010, pp. 83-91.

[25]   D. H. Heo, J. H. Choi, M. K. Kim, H. C. Choi, J. H. Jeong, et al., “Therapeutic Efficacy of Vertebroplasty in Osteoporotic Vertebral Compression Fractures with Avascular Osteonecrosis: A Minimum 2-Year Follow-Up Study,” Spine (Phila Pa 1976) , Vol. 37, No. 7, 2012, pp. E423-429.

 
 
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