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Turkish Journal of Medical Sciences Apr 2021Vertebral compression fracture is a hallmark of osteoporosis (OP) and by far the most prevalent fragility fracture. It is well proven that patients who develop a... (Review)
Review
Vertebral compression fracture is a hallmark of osteoporosis (OP) and by far the most prevalent fragility fracture. It is well proven that patients who develop a vertebral compression fracture are at substantial risk for additional fractures. Diagnosis is based on adequate clinical evaluation, imaging, and laboratory tests. The imaging of OP and fragility fractures includes conventional radiology to evaluate spinal fractures, bone mineral density (BMD) testing by dual energy x-ray densitometry, quantitative computerized tomography, magnetic resonance imaging, bone scintigraphy (if necessary), and ultrasound. Screening and treatment of individuals with high risk of osteoporotic fracture are cost-effective, but approximately two-thirds of the vertebral compression fractures (VCF) that occur each year are not accurately diagnosed and, therefore, not treated. Evaluation of VCFs, even though they may be asymptomatic, seems essential to health-related and/or clinical research on OP.
Topics: Bone Density; Female; Fractures, Compression; Humans; Lumbar Vertebrae; Male; Mass Screening; Osteoporosis; Osteoporotic Fractures; Spinal Fractures; Spine; Thoracic Vertebrae
PubMed: 32967415
DOI: 10.3906/sag-2005-315 -
Clinical Medicine & Research Jun 2022Physicians involved in treating spine fractures secondary to osteopenia and osteoporosis should know the pathogenesis and current guidelines on managing the underlying... (Review)
Review
Physicians involved in treating spine fractures secondary to osteopenia and osteoporosis should know the pathogenesis and current guidelines on managing the underlying diminished bone mineral density, as worldwide fracture prevention campaigns are trailing behind in meeting their goals. This is a narrative review exploring the various imaging and laboratory tests used to diagnose osteoporotic fractures and a comprehensive compilation of contemporary medical and surgical management. We have incorporated salient recommendations from the Endocrine Society, the American Association of Clinical Endocrinology (AACE), and the American Society for Bone and Mineral Research (ASBMR). The use of modern scoring systems such as Fracture Risk Assessment Tool (FRAX®) for evaluating fracture risk in osteoporosis with a 10-year probability of hip fracture and major fractures in the spine, forearm, hip, or shoulder is highlighted. This osteoporosis risk assessment tool can be easily incorporated into the preoperative bone health optimization strategies, especially before elective spine surgery in osteoporotic patients. The role of primary surgical intervention for vertebral compression fracture and secondary fracture prevention with pharmacological therapy is described, with randomized clinical trial-based wisdom on its timing and dosage, drug holiday, adverse effects, and relevant evidence-based literature. We also aim to present an evidence-based clinical management algorithm for treating osteoporotic vertebral body compression fractures, tumor-induced osteoporosis, or hardware stabilization in elderly trauma patients in the setting of their impaired bone health. The recent guidelines and recommendations on surgical intervention by various medical societies are covered, along with outcome studies that reveal the efficacy of cement augmentation of vertebral compression fractures via vertebroplasty and balloon kyphoplasty versus conservative medical management in the elderly population.
Topics: Aged; Fractures, Compression; Humans; Kyphoplasty; Osteoporosis; Osteoporotic Fractures; Randomized Controlled Trials as Topic; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 35478096
DOI: 10.3121/cmr.2021.1612 -
American Family Physician Jul 2016Vertebral compression fractures (VCFs) are the most common complication of osteoporosis, affecting more than 700,000 Americans annually. Fracture risk increases with... (Review)
Review
Vertebral compression fractures (VCFs) are the most common complication of osteoporosis, affecting more than 700,000 Americans annually. Fracture risk increases with age, with four in 10 white women older than 50 years experiencing a hip, spine, or vertebral fracture in their lifetime. VCFs can lead to chronic pain, disfigurement, height loss, impaired activities of daily living, increased risk of pressure sores, pneumonia, and psychological distress. Patients with an acute VCF may report abrupt onset of back pain with position changes, coughing, sneezing, or lifting. Physical examination findings are often normal, but can demonstrate kyphosis and midline spine tenderness. More than two-thirds of patients are asymptomatic and diagnosed incidentally on plain radiography. Acute VCFs may be treated with analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs, narcotics, and calcitonin. Physicians must be mindful of medication adverse effects in older patients. Other conservative therapeutic options include limited bed rest, bracing, physical therapy, nerve root blocks, and epidural injections. Percutaneous vertebral augmentation, including vertebroplasty and kyphoplasty, is controversial, but can be considered in patients with inadequate pain relief with nonsurgical care or when persistent pain substantially affects quality of life. Family physicians can help prevent vertebral fractures through management of risk factors and the treatment of osteoporosis.
Topics: Analgesics; Bone Density Conservation Agents; Calcitonin; Conservative Treatment; Fractures, Compression; Humans; Kyphoplasty; Nerve Block; Osteoporosis; Osteoporotic Fractures; Pain Management; Physical Therapy Modalities; Radiography; Spinal Fractures; Vertebroplasty
PubMed: 27386723
DOI: No ID Found -
Journal of Orthopaedic Surgery and... Mar 2022Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat osteoporotic vertebral compression fractures (OVCF), but the risk of vertebral... (Meta-Analysis)
Meta-Analysis Review
Risk factors of vertebral re-fracture after PVP or PKP for osteoporotic vertebral compression fractures, especially in Eastern Asia: a systematic review and meta-analysis.
OBJECTIVE
Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat osteoporotic vertebral compression fractures (OVCF), but the risk of vertebral re-fracture after PVP/PKP remains controversial. This study aims to investigate the incidence and risk factors of vertebral re-fracture after PVP/PKP.
METHODS
Relevant literatures published up to November 2021 were collected from PubMed, Embase and Web of Science. A meta-analysis was performed to extract data associated with risk factors of SVCF following the PRISMA guidelines. Also, pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence interval (CI) was calculated.
RESULTS
A total of 23 studies, encompassing 9372 patients with OVCF, met the inclusion criteria. 1255 patients (13.39%) suffered re-fracture after PVP/PKP surgery. A total of 22 studies were from Eastern Asia and only 1 study was from Europe. Female sex (OR = 1.34, 95%CI 1.09-1.64, P = 0.006), older age (WMD = 2.04, 95%CI 0.84-3.24, P = 0.001), lower bone mineral density (BMD, WMD = - 0.38, 95%CI - 0.49-0.26, P < 0.001) and bone cement leakages (OR = 2.05, 95% CI 1.40-3.00, P < 0.001) increased the risk of SVCF. The results of subgroup analysis showed the occurrence of re-fracture was significantly associated with gender (P = 0.002), age (P = 0.001) and BMD (P < 0.001) in Eastern Asia. Compared with the unfractured group, anterior-to-posterior vertebral body height ratio (AP ratio, WMD = 0.06, 95%CI 0.00-0.12, P = 0.037) and visual analog scale score (VAS, WMD = 0.62, 95%CI 0.09-1.15, P = 0.022) were higher in the refracture group, and kyphotic angle correction ratio (Cobb ratio, WMD = - 0.72, 95%CI - 1.26-0.18, P = 0.008) was smaller in Eastern Asia. In addition, anti-osteoporosis treatment (OR = 0.40, 95% CI 0.27-0.60, P < 0.001) could be a protective factor.
CONCLUSION
The main factors associated with re-fracture after PVP/PKP are sex, age, bone mineral density, AP ratio, Cobb ratio, VAS score, bone cement leakage and anti-osteoporosis treatment, especially in Eastern Asia.
Topics: Bone Cements; Female; Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Reoperation; Risk Factors; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 35279177
DOI: 10.1186/s13018-022-03038-z -
Orthopaedics & Traumatology, Surgery &... Feb 2014Vertebroplasty and balloon kyphoplasty are percutaneous techniques performed under radioscopic control. They were initially developed for tumoral and osteoporotic... (Review)
Review
Vertebroplasty and balloon kyphoplasty are percutaneous techniques performed under radioscopic control. They were initially developed for tumoral and osteoporotic lesions; indications were later extended to traumatology for the treatment of pure compression fracture. They are an interesting alternative to conventional procedures, which are often very demanding. The benefit of these minimally invasive techniques has been demonstrated in terms of alleviation of pain, functional improvement and reduction in both morbidity and costs for society. The principle of kyphoplasty is to restore vertebral body anatomy gently and progressively by inflating balloons and then reinforcing the anterior column of the vertebra with cement. In vertebroplasty, cement is introduced directly under pressure, without prior balloon inflation. Both techniques can be associated to minimally invasive osteosynthesis in certain indications. In our own practice, we preferably use acrylic cement, for its biomechanical properties and resistance to compression stress. We use calcium phosphate cement in young patients, but only associated to percutaneous osteosynthesis due to the risk of secondary correction loss. The evolution of these techniques depends on improving personnel radioprotection and developing new systems of vertebral expansion.
Topics: Biomechanical Phenomena; Cost Savings; Fracture Fixation, Internal; Fracture Healing; Fractures, Compression; Humans; Kyphoplasty; Minimally Invasive Surgical Procedures; Patient Positioning; Polymethyl Methacrylate; Spinal Fractures; Surgery, Computer-Assisted; Surgical Equipment; Surgical Instruments; Tomography, X-Ray Computed
PubMed: 24406028
DOI: 10.1016/j.otsr.2013.11.005 -
Rhode Island Medical Journal (2013) Oct 2022Fragility fractures, particularly in the hip and spine, are the most common complication of osteoporosis. In the US, approximately 1-1.5 million vertebral compression...
Fragility fractures, particularly in the hip and spine, are the most common complication of osteoporosis. In the US, approximately 1-1.5 million vertebral compression fractures (VCFs) occur annually. While patients may present with sudden onset of low back pain and limited mobility, more than two-thirds of VCFs are asymptomatic and are detected incidentally. X-rays are the standard imaging modality for diagnosis, with CT and MRI indicated if neurological deficits are present or a malignant cause is considered. Initial management is often non-surgical, with medications, physical therapy, and bracing. Surgical management in the form of cement augmentation (kyphoplasty or vertebroplasty) or instrumented fusion can be considered after failure of non-operative treatment, cases of deformity, or neurologic deficits. Subsequent VCFs occur frequently, and risk factors for refracture include advanced age, low bone mineral density, and low BMI. Treatment of primary VCFs with anti-resorptive medication is essential to reduce the risk of subsequent fractures.
Topics: Bone Diseases, Metabolic; Fractures, Compression; Humans; Medicine; Spinal Fractures
PubMed: 36173908
DOI: No ID Found -
Biomedical Journal 2013
Topics: Discitis; Fractures, Compression; Humans; Minimally Invasive Surgical Procedures; Spinal Fractures
PubMed: 23989308
DOI: 10.4103/2319-4170.116283 -
Journal of Orthopaedic Surgery and... Dec 2021To investigate whether thoracolumbar flexion dysfunctions increase the risk of thoracolumbar compression fractures in postmenopausal women.
OBJECTIVE
To investigate whether thoracolumbar flexion dysfunctions increase the risk of thoracolumbar compression fractures in postmenopausal women.
METHODS
The records of postmenopausal women with thoracolumbar vertebral compression fractures and without vertebral compression fractures were surveyed. Demographic data, clinical data, and quantitative computed tomography (QCT) findings were compared between the groups. Chi-squared tests, unpaired t-tests, Spearman, and Mann-Whitney U were used to assess the group characteristics and proportions. The relationship between the risk of fracture and the difference of Cobb's angle of thoracolumbar segment (DCTL) was evaluated by logistic regression. DCTL was calculated by subtracting thoracolumbar Cobb's angles (TLCobb's) from thoracolumbar hyperflexion Cobb's angles (TLHCobb's). Quantitative computed tomography (QCT) values and spinal osteoarthritis (OA) of postmenopausal women in the two groups were compared.
RESULTS
102 of 312 were enrolled to the study group of postmenopausal women with the fracture, and 210 of 312 were enrolled to the control group of postmenopausal women without the fracture. There were significant differences in QCT values and spinal OA including disc narrowing (DSN) and osteophytes (OPH) between the two groups (p < 0.001 for all four). The risk of thoracolumbar compression fractures in the postmenopausal women with DCTL ≤ 8.7° was 9.95 times higher (95% CI 5.31-18.64) than that with > 8.7° after adjusting for age, BMI, and QCT values.
CONCLUSION
Low DCTL may be a risk factor of thoracolumbar compression fractures in postmenopausal women, and a DCTL ≤ 8.7° can be a threshold value of thoracolumbar compression fractures.
Topics: Female; Fractures, Compression; Humans; Lumbar Vertebrae; Postmenopause; Retrospective Studies; Spinal Fractures
PubMed: 34876177
DOI: 10.1186/s13018-021-02857-w -
Medicina (Kaunas, Lithuania) Jul 2019Tumor-related vertebral compression fractures often result in severe back pain as well as progressive neurologic impairment and additional morbidities. The fixation of... (Review)
Review
Tumor-related vertebral compression fractures often result in severe back pain as well as progressive neurologic impairment and additional morbidities. The fixation of these fractures is essential to obtain good pain relief and to improve the patients' quality of life. Thus far, several spine implants have been developed and studied. The aims of this review were to describe the implants and the techniques proposed to treat cancer-related vertebral compression fractures and to compile their safety and efficacy results. A systematic MEDLINE/PubMed literature search was performed, time period included articles published between January 2000 and March 2019. Original articles were selected based on their clinical relevance. Four studies of interest and other cited references were analyzed. These studies reported significant pain and function improvement as well as kyphotic angle and vertebral height restoration and maintain for every implant and technique investigated. Although good clinical performance is reported on these devices, the small numbers of studies and patients investigated draw the need for further larger evaluation before drawing a definitive treatment decision tree to guide physicians managing patients presenting with neoplastic vertebral compression fracture.
Topics: Fractures, Compression; Humans; Neoplasms; Prostheses and Implants; Quality of Life; Spinal Fractures; Spine; Treatment Outcome
PubMed: 31370309
DOI: 10.3390/medicina55080426 -
Interventional Neuroradiology : Journal... Jun 2015Vertebroplasty (VP) is a percutaneous mini-invasive technique developed in the late 1980s as antalgic and stabilizing treatment in patients affected by symptomatic... (Review)
Review
Vertebroplasty (VP) is a percutaneous mini-invasive technique developed in the late 1980s as antalgic and stabilizing treatment in patients affected by symptomatic vertebral fracture due to porotic disease, traumatic injury and primary or secondary vertebral spine tumors. The technique consists of a simple metameric injection of an inert cement (poly-methyl-methacrylate, PMMA), through a needle by trans-peduncular, parapeduncular or trans-somatic approach obtaining a vertebral augmentation and stabilization effect associated with pain relief. The technique is simple and fast, and should be performed under fluoroscopy or CT guidance in order to obtain a good result with low complication rate. The aim of this paper is to illustrate the utility of VP, the indications-contraindications criteria, how to technically perform the technique using imaging guidance, and the results and complications of this treatment in patients affected by symptomatic vertebral compression fracture.
Topics: Cementoplasty; Fluoroscopy; Fractures, Compression; Humans; Magnetic Resonance Imaging; Osteoporotic Fractures; Pain Measurement; Polymethyl Methacrylate; Radiography, Interventional; Spinal Fractures; Tomography, X-Ray Computed
PubMed: 26015527
DOI: 10.1177/1591019915582364