Pathophysiology and natural history of avascular necrosis of bone

Lafforgue, P.

doi:10.1016/j.jbspin.2006.01.025

Cited by 204 publications

(168 citation statements)

References 52 publications

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“…The possible pathogenesis is disruption of the blood supply related to fracture and inadequate revascularization of bone marrow [4,28]. Besides, increased marrow pressure caused by intramedullary hemorrhage leads to increased adipocyte size with a proportionate decrease in intraosseous blood flow, also predisposing patients to ischemic necrosis of the vertebral body [29].…”

Section: Discussionmentioning

confidence: 99%

MRI fluid sign is reliable in correlation with osteonecrosis after vertebral fractures: a histopathologic study

Lin

Huang

et al. 2012

Eur Spine J

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Introduction Magnetic resonance images (MRI) fluid sign and intravertebral vacuum phenomenon of the plain radiograph are considered as the characteristic radiological findings for vertebral osteonecrosis after spinal fractures. We aim to study the association between the radiological and histopathologic findings of vertebral osteonecrosis through the use of an open retrieval of specimens. Materials and methods Twenty consecutive patients (54-84 years, mean 73 years) of unstable vertebral compression fractures treated with anterior corpectomy and fusion were included. All the images and pathologies were correlated, especially the histopathologic changes to the fluid sign and vacuum phenomenon.Results MRI fluid signs and the histopathologic findings of vertebral osteonecrosis were significantly correlated and both were noted in the first 5 months after injury. The power of the fluid sign in diagnosing vertebral osteonecrosis was better than that of the intravertebral vacuum phenomenon (diagnostic odds ratio 65 vs. 2, sensitivity 86 vs. 50 %, specificity 100 vs. 67 %). Conclusion MRI fluid sign is more predictable to diagnose vertebral osteonecrosis in operative case, especially within the initial 5 months after injury.

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Section: Discussionmentioning

confidence: 99%

MRI fluid sign is reliable in correlation with osteonecrosis after vertebral fractures: a histopathologic study

Lin

Huang

et al. 2012

Eur Spine J

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“…Several reports have noted that the presence of Kümmell disease is associated with deteriorated prognosis for OVCF with intravertebral cleft (IVC). This disease could prolong back pain and predispose to vertebral collapse, which may result in delayed neurologic deficit (DND) [12,14,16,17,20,21,30]. The following factors have been suspected as causes of DND: (1) progression of kyphosis with vertebral collapse; (2) neural compression secondary to retropulsed bone fragments; and (3) intravertebral instability at the fracture site [1-3, 12, 13, 27, 32, 34].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous vertebroplasty for osteoporotic vertebral compression fracture with intravertebral cleft associated with delayed neurologic deficit

et al. 2013

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Introduction The number of cases of osteoporotic vertebral compression fracture (OVCF) with intravertebral cleft (IVC) with delayed neurologic deficit (DND) is increasing as the population ages. However, the cause of DND is poorly understood, and no definitive treatment of the disease has been established. The purpose of this study was to clarify the radiographic parameters contributing to the occurrence of DND, and to evaluate the efficacy and safety of percutaneous vertebroplasty for this pathology. Methods Percutaneous vertebroplasty was prospectively performed for 244 patients with OVCF with IVC; 30 had DND and 214 did not. Radiographic parameters of local kyphotic angle, percent spinal canal compromise and intravertebral instability were investigated for correlations to DND. Procedural outcomes were evaluated using visual analog scale (VAS), Oswestry Disability Index (ODI), and modified Frankel grades. Results Before vertebroplasty, no substantial difference in local kyphotic angle was seen between OVCF with IVC with and without DND, but percent spinal canal compromise and intravertebral instability were greater in OVCF with IVC with DND (P \ 0.001). After vertebroplasty, 25 of 30 cases (84 %) of OVCF with IVC with DND achieved clinically meaningful improvement (CMI), but 5 (17 %) did not. Patients with CMI showed substantial improvements in intravertebral instability (P \ 0.001), and no change in local kyphotic angle or percent spinal canal compromise. In five patients without CMI, four showed an initial improvement, but subsequent vertebral fracture adjacent to the treated vertebra caused neurologic re-deterioration. One patient with percent spinal canal compromise 54.9 % and intravertebral instability 4°achieved no neurologic improvement following vertebroplasty. No serious complications or adverse events related to the procedure were encountered. ConclusionsIntravertebral instability is the dominant cause of DND. Percutaneous vertebroplasty appears effective and safe in the treatment of OVCF with IVC with DND. Patients with less intravertebral instability and severe spinal canal compromise could be candidates for conventional surgical treatment.

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“…In spite of the impressive improvements in the survival of patients with SCD, scientific advances in chronic bone diseases are still lagging [12,13]. AVN, which refers to bone destruction due to subchondral oxygen deficiency, remains Journal of Hematology and Blood Disorders Volume 2 | Issue 1 the leading cause of crippling disability and the most common manifestation in patients with SCD [14,15]. Approximately 50% of the individuals with SCD are likely to develop some form of bone fragility syndrome by the age of 35 years [3].…”

Section: Resultsmentioning

confidence: 99%