The Value of Dynamic Radiographs in Diagnosing Painful Vertebrae in Osteoporotic Compression Fractures

Chen, Y.-J.; Lo, D.-F.; Chang, Cheng-Yen; Chen, H.-T.; Hsu, Horng‐Chaung

doi:10.3174/ajnr.a2233

Cited by 22 publications

(30 citation statements)

References 7 publications

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“…They concluded that in any article in which vertebral height restoration is claimed, there must be control for the occurrence of dynamic mobility of the fractured vertebrae. In a study by Chen et al, 7 87.5% of 144 MR imagingϪproved edematous VCFs were demonstrated to be mobile. The average vertebral body height increase from sitting to supine with bolster lateral radiographs was 8.48 Ϯ 5.36 mm (range, Ϫ1.17-24.04 mm), which was statistically significant (P Ͻ .001).…”

Section: Discussionmentioning

confidence: 99%

“…A recent study, which used sitting and supine cross-table (with a bolster beneath) lateral radiographs, demonstrated that dynamic mobility occurred in 87.5% of the treated vertebrae. 7 The authors found that 87.5% of 144 MR imagingϪproved edematous VCFs were demonstrated to be mobile. The average vertebral body height increase from sitting position to supine with bolster was 8.48 Ϯ 5.36 mm.…”

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confidence: 99%

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Significance of Dynamic Mobility in Restoring Vertebral Body Height in Vertebroplasty

Chen¹,

Chen²,

Tsai³

et al. 2011

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Many authors have reported the increase in vertebral body height after vertebroplasty. However, McKiernan et al demonstrated dynamic mobility in patients who underwent vertebroplasty and concluded that any article that claims vertebral height restoration must control for the dynamic mobility of fractured vertebrae. The purpose of this study was to compare prevertebroplasty (supine cross-table with a bolster beneath) with postvertebroplasty vertebral body height to find out whether vertebroplasty itself really increases the vertebral height.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Significance of Dynamic Mobility in Restoring Vertebral Body Height in Vertebroplasty

Chen¹,

Chen²,

Tsai³

et al. 2011

AJNR Am J Neuroradiol

Self Cite

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“…Dynamic fracture mobility raises concern in OVCFs as it implies complete corticocancellous disruption and permits the vertebral height restoration after postural reduction3,17). As the injury of OVCFs produced is an anterior wedge fracture, postural reduction in prone hyperextended position can re-expand the compressed anterior column11).…”

Section: Discussionmentioning

confidence: 99%

“…There is a reduction of post-fracture kyphosis in up to 47% to 92% cases after kyphoplasty4,7,15,18). However, it has been demonstrated that many OVCFs are mobile and postural reduction can lead to clinically significant height restoration3,17). Therefore, the real efficacy of the kyphoplasty procedure can only be evaluated after the postural reduction in prone hyperextended position3,11,23).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Postural Correction and Subsequent Balloon Inflation in Deformity Correction of Acute Osteoporotic Vertebral Fractures

Liu

Shang

et al. 2014

J Korean Neurosurg Soc

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ObjectiveTo determine deformity correction by postural correction and subsequent balloon inflation in acute vertebral compression fractures (OVCFs) and to examine the effect of bone mineral density on deformity correction.MethodsA totol of 50 acute OVCFs received balloon kyphoplasty. Lateral radiographs were taken and analyzed at five different time points : 1) preoperative, 2) after placing the patient in prone hyperextended position, 3) after balloon inflation, 4) after deposition of the cement, and 5) postoperative. All fractures were analyzed for height restoration of anterior (Ha), middle (Hm) and posterior (Hp) vertebra as well as Cobb angle and Kyphotic angle. The bone mineral density (BMD) of lumbar spine was measured by dual-energy X-ray absorptiometry. According to the T-score, the patients were divided into two groups which were osteoporosis group and osteopenia group.ResultsPostoperative measurements of Ha, Hm and the Cobb angle demonstrated significant reduction of 4.62 mm, 3.66 mm and 5.34° compared with the preoperative measurements, respectively (each p<0.05). Postural correction significantly increased Ha by 5.51 mm, Hm by 4.35 mm and improved the Cobb angle by 8.32° (each p<0.05). Balloon inflation did not demonstrate a significant improvement of Ha, Hm or the Cobb angle compared with baseline prone hyperextended. Postural correction led to greater improvements of Ha, Hm and Cobb angle in osteoporosis group than osteopenia group (each p<0.05).ConclusionIn acute OVCFs, the height restoration was mainly attributed to postural correction rather than deformity correction by balloon inflation. BMD affected deformity correction in the process of postural correction.

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“…In this regard, McKiernan et al4) suggested the usefulness of supine cross-table lateral radiographs (SuLRs) and recommended examination for evaluating dynamic mobility. Several authors followed these methods and confirmed its usefulness 5,6). However, there are several problems in the methods including possible pain stimulations and different positions with real operative settings.…”

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confidence: 96%

Usefulness of Prone Cross-Table Lateral Radiographs in Vertebral Compression Fractures

et al. 2013

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BackgroundDynamic radiographs are recommended to investigate non-healing evidence such as the dynamic mobility or intravertebral clefts in osteoporotic vertebral compression fractures (VCFs). However, it is difficult to examine standing flexion and extension lateral radiographs due to severe pain. The use of prone cross-table lateral radiographs (PrLRs) as a diagnostic tool has never been proposed to our knowledge. The purpose of this study is to clarify the usefulness of PrLRs in diagnosis and treatment of VCFs.MethodsWe reviewed 62 VCF patients examined with PrLRs between January 1, 2008 and June 30, 2011. To compare the degree of pain provoked between standing extension lateral radiographs (StLRs) and PrLRs, numeric rating scale (NRS) scores were assessed and compared by a paired t-test. Vertebroplasty was done for 40 patients and kyphoplasty was done for 9 patients with routine manners. To assess the degree of postural reduction, vertebral wedge angles (VWA) and vertebral height ratios (VHR) were calculated by using preoperative StLRs, PrLRs, and postoperative lateral radiographs. Two variables derived from changes in VWA and VHR between preoperative and postoperative radiographs were compared by a paired t-test.ResultsThe average NRS scores were 6.23 ± 1.67 in StLRs and 5.18 ± 1.47 in PrLRs. The degree of pain provocation was lower in using PrLRs than StLRs (p < 0.001). The average changes of VWA between preoperative and postoperative status were 5.24° ± 6.16° with PrLRs and 3.46° ± 3.47° with StLRs. The average changes of VHR were 0.248 ± 0.178 with PrLRs and 0.148 ± 0.161 with StLRs. The comparisons by two variables showed significant differences for both parameters (p = 0.021 and p < 0.001, respectively). The postoperative radiological status was reflected more precisely when using PrLRs than StLRs.ConclusionsIn comparison with StLR, the PrLR was more accurate in predicting the degree of restoration of postoperative vertebral heights and wedge angles, and provoked less pain during examination. The PrLR could be a useful diagnostic tool to detect intravertebral cleft or intravertebral dynamic instability.

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The Value of Dynamic Radiographs in Diagnosing Painful Vertebrae in Osteoporotic Compression Fractures

Cited by 22 publications

References 7 publications

Significance of Dynamic Mobility in Restoring Vertebral Body Height in Vertebroplasty

Significance of Dynamic Mobility in Restoring Vertebral Body Height in Vertebroplasty

The Effect of Postural Correction and Subsequent Balloon Inflation in Deformity Correction of Acute Osteoporotic Vertebral Fractures

Usefulness of Prone Cross-Table Lateral Radiographs in Vertebral Compression Fractures

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