30. What is the Rate of Occurence of New Fractures at Levels Adjacent to Index Fractures in Osteoporotic Nonagenarians after Percutaneous Vertebroplasty

DePalma, Michael J.; Ketchum, Jessica M.; Queler, Evan D.; Frankel, Bruce; Frey, Michael E.

doi:10.1016/j.spinee.2009.08.039

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“…A growing contention has surfaced calling attention to an escalation in new VCFs occurring at a level adjacent to the index, augmented level [28‐30], perhaps because of a “stress riser” of the bone cement [29,30]. However, a large prospective case series of osteoporotic patients with VCFs treated with verebroplasty demonstrated adjacent level fractures with a prevalence similar to that encountered in osteoporotic VCF patients not treated with vertebroplasty [31]. The rate at which these adjacent VCFs occurred was faster after vertebroplasty but not more common.…”

Section: Case Scenario: Partmentioning

confidence: 99%

Vertebroplasty

DePalma

Beall

Frey

et al. 2010

PM&R

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An 85-year-old man with a history of osteoporosis, osteoarthritis, pulmonary embolus, and central lumbar spinal stenosis at L3-L4 and L4-L5 presented with a 1-day history of acute onset of thoracolumbar back pain described as severe, sharp, nonradiating, and limiting his ability to stand erect or lie in bed comfortably. He reported no trauma with this event. He required the use of a walker to get to the office. Before this event, the patient worked 2 to 4 hours a day in an administrative capacity at his own business, played golf, and was the primary driver for his wife. The osteoporosis was managed by his primary care physician with annual bone density testing (T score in the femoral neck and lumbar spine of Ϫ3.2) and alendronate sodium. He had successfully been treated for the spinal stenosis (manifesting with clinical symptoms of low back pain and lower extremity pain with ambulation) during a period of 3 years with conservative efforts, including physical therapy, occasional medications, fluoroscopically guided contrast-enhanced transforaminal epidural steroid injections on 3 different occasions, and regular attendance at an arthritis pool-exercise classes.Physical examination revealed a patient in moderate distress. He was unable to stand erect because of pain at the thoracolumbar junction. The pain worsened with thoracic and lumbar flexion. The neurological examination for the lower extremities was normal, including muscle strength, reflex, and sensory testing. Provocative maneuvers for the hip (including flexion, abduction, external rotation [ie, FABER] and log roll) were negative, and straight leg raise was negative. He was able to ambulate in a forward flexed position with the use of a rolling walker. Radiographs in the office revealed a T12 vertebral body with 60% compression that was not present on magnetic resonance imaging (MRI) performed 1 year previously. The radiologist's report included the following: "There is diffuse osteopenia seen. Compression fracture of 60% height loss anteriorly is seen at the T12 vertebral body. Severe degenerative disk disease is noted at L2-L3 with disk space narrowing and diskogenic sclerosis with disk space narrowing at L5-S1."The patient was prescribed pain medications, a thoracolumbar soft binder because he was unable to tolerate a hardshell thoracolumbosacral orthosis, and aquatic-based therapy. He was instructed to avoid repetitive activities that required flexion or lift anything weighing more than 10 lbs. An MRI was ordered (Figures 1-3), which confirmed the T12 compression fracture without any evidence of other pathology. The patient progressed slowly in therapy but continued to have pain. At 3-and 7-week follow-up visits, his pain remained localized to the thoracolumbar region and increased with thoracolumbar flexion. His neurological status remained normal.The patient was offered an evaluation for vertebral augmentation, but he declined and wanted to proceed with noninvasive treatment. Because his neurological status remained normal and the patient was improvi...

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Section: Case Scenario: Partmentioning

confidence: 99%