Vertebral compression fractures: Still an unpredictable aspect of osteoporosis

Kutsal, Fatma Yeşim; Ergani, Gizem Olgu Ergin

doi:10.3906/sag-2005-315

Cited by 47 publications

(36 citation statements)

References 29 publications

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“…However, long-term bed rest can cause dysfunction of the body, which is not only conducive to the recovery of bone volume but also easily accelerates the loss of bone mass, aggravates the pain, and causes muscle atrophy ( 17 ). Besides, for elderly OVCF patients, long-term bed rest treatment can also induce other diseases such as pneumonia and deep vein thrombosis, accelerate the deterioration of the disease, and even lead to death ( 18 ). Importantly, conservative treatment fails to quickly relieve pain symptoms in OVCF patients, which also aggravates the limitation of conservative treatment.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Elderly Patients with Acute Symptomatic OVCF: A Study of Comparison of Conservative Treatment and Percutaneous Kyphoplasty

et al. 2022

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ObjectiveThe present study was designed for the contrastive analysis of conservative and percutaneous kyphoplasty (PKP) on pain severity and recovery of injured vertebrae in elderly patients with acute symptomatic osteoporotic vertebral compression fracture (OVCF).MethodsA total of 60 elderly patients with acute symptomatic OVCF were divided into two groups according to different treatment protocols, with 30 patients in each group. Patients in the Con group received conservative treatment, while patients in the PKP group received percutaneous kyphoplasty treatment. Clinical evaluation included the visual analogue scale (VAS), the Dallas pain questionnaire, the vertebral body leading edge height, the Cobb angle of injured vertebrae, the MOS item short-form health survey (SF-36), the Barthel index, and the mini-mental state examination (MMSE).ResultsAt 3 days, 3 months, and 6 months post-treatment, the score of VAS and the Cobb angle of injured vertebrae in patients of the PKP group were all significantly lower than those in the Con group (P < 0.05), while the height of vertebral body leading edge in patients of the PKP group was significantly longer than that in the Con group (P < 0.05). At 6 months post-treatment, the scores of the four dimensions of the Dallas pain questionnaire scale in the PKP group were all significantly lower than those in the Con group (P < 0.05), while the score of SF-36 (PCS), SF-36 (MCS), and Barthel index in patients of the PKP group were all significantly lower than those in the Con group (P < 0.05), and there was no significant difference in the scores of MMSE between these two groups (P > 0.05).ConclusionCompared with conservative treatment, PKP treatment of elderly patients with acute symptomatic OVCF provides rapid pain relief, restoration of damaged vertebral body height, correction of Cobb's angle, and improved quality of life.

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Section: Discussionmentioning

confidence: 99%

Treatment of Elderly Patients with Acute Symptomatic OVCF: A Study of Comparison of Conservative Treatment and Percutaneous Kyphoplasty

et al. 2022

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“…Even though OVCFs are very common, they are often undiagnosed because patients can be asymptomatic, especially those that occur slowly over time[ 1 ]. Further contributing to the lack of diagnosis is the fact that neurological complications are rare and acute symptoms can be overlooked[ 8 , 9 ].…”

Section: Diagnosis and Manifestationmentioning

confidence: 99%

“…Further contributing to the lack of diagnosis is the fact that neurological complications are rare and acute symptoms can be overlooked[ 8 , 9 ]. Some signs that can be indicative of OVCFs are a decrease in height, change in kyphosis (when adjusted for age, Figure 1 ), acute-onset back pain that increases when changing posture and decreases when lying supine, and limited mobility[ 1 , 9 ]. These acute fractures typically occur in the lower thoracic vertebra and can be due to a fall in people with moderate osteoporosis or minor activities such as coughing in people with severe osteoporosis[ 1 ].…”

Section: Diagnosis and Manifestationmentioning

confidence: 99%

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Managements of osteoporotic vertebral compression fractures: A narrative review

Patel¹,

Liu²,

Ebraheim³

2022

WJO

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Osteoporotic vertebral compression fractures (OVCFs) are the most common fragility fracture and significantly influence the quality of life in the elderly. Currently, the literature lacks a comprehensive narrative review of the management of OVCFs. The purpose of this study is to review background information, diagnosis, and surgical and non-surgical management of the OVCFs. A comprehensive search of PubMed and Google Scholar for articles in the English language between 1980 and 2021 was performed. Combinations of the following terms were used: compression fractures, vertebral compression fractures, osteoporosis, osteoporotic compression fractures, vertebroplasty, kyphoplasty, bisphosphonates, calcitonin, and osteoporosis treatments. Additional articles were also included by examining the reference list of articles found in the search. OVCFs, especially those that occur over long periods, can be asymptomatic. Symptoms of acute OVCFs include pain localized to the mid-line spine, a loss in height, and decreased mobility. The primary treatment regimens are pain control, medication management, vertebral augmentation, and anterior or posterior decompression and reconstructions. Pain control can be achieved with acetaminophen or nonsteroidal anti-inflammatory drugs for mild pain or opioids and/or calcitonin for moderate to severe pain. Bisphosphonates and denosumab are the first-line treatments for osteoporosis. Vertebroplasty and kyphoplasty are reserved for patients who have not found symptomatic relief through conservative methods and are effective in achieving pain relief. Vertebroplasty is less technical and cheaper than kyphoplasty but could have more complications. Calcium and vitamin D supplementation can have a protective and therapeutic effect. Management of OVCFs must be combined with multiple approaches. Appropriate exercises and activity modification are important in fracture prevention. Medication with different mechanisms of action is a critical long-term causal treatment strategy. The minimally invasive surgical interventions such as vertebroplasty and kyphoplasty are reserved for patients not responsive to conservative therapy and are recognized as efficient stopgap treatment methods. Posterior decompression and fixation or Anterior decompression and reconstruction may be required if neurological deficits are present. The detailed pathogenesis and related targeted treatment options still need to be developed for better clinical outcomes.

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“…Vertebral osteoporotic compression fracture could lead to severe pain, dysfunction, and even disability. Besides, vertebral osteoporotic compression fracture was unpredictable and a substantial risk for additional fractures [ 11 ]. Osteoporosis and the subsequent fragility vertebral fractures had a significant impact on individual mortality, quality of life, morbidity, and social healthcare systems [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

A novel bone cement injector augments Chinese osteoporotic lumbar pedicle screw channel: a biomechanical investigation

Wang

et al. 2022

BMC Musculoskelet Disord

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Background The study aimed to (1) create a series of pedicle injectors with different number of holes on the sheath especially for the Chinese elderly patients and (2) further investigate the effects of the injectors on the augmentation of pedicle screw among osteoporotic lumbar pedicle channel. Methods This study used the biomechanical test module of polyurethane (Pacific Research Laboratory Corp, USA) to simulate the mechanical properties of human osteoporotic cancellous bone. The bone cement injectors were invented based on anatomical parameters of lumbar pedicle in Chinese elderly patients. Mechanical test experiments were performed on the bone cement injectors according to the three groups, namely, a local augmentation group, a full-length augmentation group, and a control group. The local augmentation group included three subgroups including 4-hole group, 6-hole group, and 8-hole group. All holes were laterally placed. The full-length augmentation group was a straight-hole injector. The control group was defined that pedicle screws were inserted without any cement augmentation. Six screws were inserted in each group and the maximum insertion torque was recorded. After 24 h of injecting acrylic bone cement, routine X-ray and CT examinations were performed to evaluate the distribution of bone cement. The axial pull-out force of screws was tested with the help of the material testing system 858 (MTS-858) mechanical tester. Results The bone cement injectors were consisted of the sheaths and the steel rods and the sheaths had different number of lateral holes. The control group had the lowest maximum insertion torque as compared with the 4-hole, 6-hole, 8-hole, and straight pore groups (P < 0.01), but the differences between the 4-hole, 6-hole, 8-hole, and straight pore groups were no statistical significance. The control group had the lowest maximum axial pull-out force as compared with the other four groups (P < 0.01). Subgroup analysis showed the 8-hole group (161.35 ± 27.17 N) had the lower maximum axial pull-out force as compared with the 4-hole group (217.29 ± 49.68 N), 6-hole group (228.39 ± 57.83 N), and straight pore group (237.55 ± 35.96 N) (P < 0.01). Bone cement was mainly distributed in 1/3 of the distal end of the screw among the 4-hole group, in the middle 1/3 and distal end of the screw among the 6-hole group, in the proximal 1/3 of the screw among the 8-hole group, and along the long axis of the whole screw body in the straight pore group. It might indicate that the 8-hole and straight-hole groups were more vulnerable to spinal canal cement leakage. After pullout, bone cement was also closely connected with the screw without any looseness or fragmentation. Conclusions The bone cement injectors with different number of holes can be used to augment the pedicle screw channel. The pedicle screw augmented by the 4-hole or 6-hole sheath may have similar effects to the straight pore injector. However, the 8-hole injector may result in relatively lower pull-out strength and the straight pore injector has the risks of cement leakage as well as cement solidarization near the screw head.

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Vertebral compression fractures: Still an unpredictable aspect of osteoporosis

Abstract: Vertebral compression fractures: Still an unpredictable aspect of osteoporosis "The good physician treats the disease; the great physician treats the patient who has the disease".

Cited by 47 publications

References 29 publications

Treatment of Elderly Patients with Acute Symptomatic OVCF: A Study of Comparison of Conservative Treatment and Percutaneous Kyphoplasty

Treatment of Elderly Patients with Acute Symptomatic OVCF: A Study of Comparison of Conservative Treatment and Percutaneous Kyphoplasty

Managements of osteoporotic vertebral compression fractures: A narrative review

A novel bone cement injector augments Chinese osteoporotic lumbar pedicle screw channel: a biomechanical investigation

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