Current Treatment Options of Osteoporotic Thoracolumbal Spinal Fractures
Authors:
I. Černohousová; J. Kočiš; P. Wendsche; V. Mužík; A. Bilik
Authors‘ workplace:
Klinika traumatologie LF MU v Úrazové nemocnici v Brně, přednosta: prof. MUDr. Peter Wendsche, CSc.
; Úrazová nemocnice v Brně, ředitel: doc. MUDr. Petr Svoboda, CSc., FRCS(T)
Published in:
Rozhl. Chir., 2007, roč. 86, č. 12, s. 671-677.
Category:
Monothematic special - Original
Overview
Aim of the study:
Retrospective assessment of a patient group, including patients with osteoporotic thoracolumbal fractures. Only patients over 65 years of age were included in the study.
Methods:
During IX/2005–VII/2006, 45 patients with osteoporotic fractures were managed: 28 females, 17 males aged 65–85 y.o.a, their mean age was 72.6 y.o.a. The mechanisms of the injury included falls in 39 subjects, car- motocycle accidents in 5 subjects, a submerge accident in a single subject. Three patients sufferred from neurological symptoms. T1-T10 injury was diagnosed in 8 subjects, T11-L2 in 43 subjects, L3-L5 in 5 subjects. Type A injuries prevailed – in 47 subjects, type B injury were diagnosed in 4 subjects, type C in 2 subjects. Conservative therapy was indicated in 25 subjects; transpedicular stabilization in 15 subjects, stabilization using isolated anterior approach in one patient, vertebroplasty in 5 patients. The majority of the injuries were monotraumas – 31 subjects, associated traumas in 12 subjects, polytraumas in 2 subjects.
Results:
The authors assessed data collected from 25 patients. 6 patients exited, 14 failed to turn up for their follow up examination at 12 months. GDW (Grunddeckplattenwinkel), VAS (Visual Analog Scale) and Oswestry score and complication rates were assessed. Prior to the therapy, the mean VAS score in the conservative group, surgical management and vertebroplasty groups was 7.0; 8.2 and 7.9, respectively; at 12 months the score was reduced to 3.8; 3.4 and 3.7, respectively. The Oswestry score figures in the respective treatment groups were 25.3 %, 27.1 % and 23.5 %. There were no statistically significant differencies between the results. At the time of the injury, the mean GDW in the conservative group was -2°, at 12 months -6°. Prior to vertebroplasty it was +4°, following the procedure +6°, and at 12 months +2°. Prior to surgical stabilization it was -10°, postoperatively +3° and at 12 months 0°. An early infectious complication , a wound absces, was recorded in one patient. A late complication, implant failure, was recorded in the same patient at 6 months postoperatively.
Conclusion:
Treatment of osteoporotic thoracolumbal spinal fractures requires individual thorough assessment of therapeutical options.
Key words:
osteoporosis – vertebral body fracture – vertebroplasty – kyphoplasty – posterior instrumentation
Sources
1. Blattert, T. R., Glasmacher, S., Josten, C. Ballonkyphoplastie: Indikation, Diagnostik, operative Technik, Ergebnisse. Teil 2: Ergebnisse. Aktuelle Traumatologie, 2006, roč. 36, s. 14–17.
2. Cook, S. D., Salkeld, S. L., Stanley, T., Faciane, A., Miller, S. D. Biomechanical study of pedicle screw fixation in severely osteoporotic bone. The Spine Journal, 2004, roč. 4, č. 4, s. 402–408.
3. Deramond, H., Depriester, C., Toussaint, P., Galibert, P. Percutaneous vertebroplasty. Semin Musculoskelet Radiol., 1997, roč. 1, č. 2, s. 285–296.
4. Epstein, S. Update of current therapeutic options for the treatment of postmenopausal osteoporosis. Clinical therapeutics, 2006, roč. 28, č. 2, s. 151–173.
5. Fairbank, J. C. T., Pynsent, P. B. The Oswestry Disability Index. Spine, 2000, roč. 25(22), s. 2940–2953.
6. Galibert, P., Deramond, H. Preliminary Note on the Treatment of Vertebral Angioma by Percutaneous Acrylic Vertebroplasty. Neurochirurgie, 1987, roč. 33, s. 166–168.
7. Garfin, S. R., Yuan, H. A., Reiley, M. A. New Technologies in Spine. Kyphoplasty and Vertebroplasty for the Treatment of Painful Osteoporotic Compression Fractures. Spine, 2001, roč. 26, č. 14, s. 1511–1515.
8. Heini, P. F. The current treatment – a survey of osteoporotic fracture treatment. Osteoporotic spine fractures: the spine surgeon‘s perspective. Osteoporosis International, 2005, roč. 16, s. S85–S92.
9. Chaloupka, R., Roubalová, J., Krbec, M., et al. Vybrané kapitoly z LTV ve spondylochirurgii. 1. vyd. Brno: IDVPZ, 2003. 186 s. ISBN 80-7013-375-9
10. Johannson, C., Black, D., Johnell, O., Oden, A., Melstrom, D. Bone mineral density is a predictor of survival. Calcif Tissue Int, 1998, č. 63, s. 190–196.
11. Johnell, O., Kanis, J. Epidemiology of Osteoporotic Fractures. Osteoporosis International, 2005, č. 16, s. S3–S7.
12. Magerl, F., Aebi, M., Gertzbein, S. D., Harms, J., Nazarian, S. A. Comprehensive classification of thoracic and lumbar injuries. Eur Spine, 1994, č. 3, s. 184–201.
13. Morris, S., Dar, W., Kelly, I. Natural history of osteoporotic vertebral fractures: conservative treatment or vertebroplasty? Journal of Bone and Joint Surgery – British Volume, roč. 87-B, č. suppl. III, s. 242.
14. Perren, S. M., Linke, K., Schwieger, K., Wahl, D., Schneider, E. Aspects of Internal Fixation of Fractures in Porotic Bone. Principles, Technologies and Procedures Using Locked Plate Screws. Acta Chir. orthop. Traum. čech., 2005, roč. 72, č. 2, s. 89–97.
15. Pippan, M. C., Richter, M. Spinal Body Reconstruction in Osteoporosis. European Journal of Trauma, 2006, roč. 32, č. 3, s. 238–243.
16. Ryška, P., Málek, V., Kaltofen, K. et al. Postavení perkutánní kyfoplastiky při léčbě osteoporotických zlomenin páteře. Česká radiologie, 2007, roč. 61, č. 2, s. 184–188.
17. Ryška, P., Málek, V., Klzo, L., et al. Perkutánní vertebroplastika v léčbě akutních fraktur hrudní a bederní páteře. Česká radiologie, 2007, roč. 61, č. 2, s. 180–183.
18. Syed, M. I., Shaikh, A. Vertebroplasty: A Systematic Approach. Pain Physician, 2007, roč. 10, č. 2, s. 367–380.
19. Štěpán, J. Osteoporóza v praxi. 1. vyd. Praha: Triton, 1997. 156 s.ISBN 80-85875-50-0
20. Štěpán, J., Havelka, S., Kamberská, Z. Epidemiologie der Osteoporose in der Tschechischen Republik. J. Mineralstoffwechsel, 2002, roč. 9, č. 3, s. 7–13.
21. Voggenreiter, G., Lenz, E., Obertacke, U., Ascherl, R. Effektivität von Vertebroplastie und Kyphoplastie in der Aufrichtung osteoporotischer Wirbelkörperfrakturen. Aktuelle Traumatologie, 2006, roč. 36, s. 1–5.
22. Wendsche, P., Haupt, R., Višňa, P., Kočiš, J. Úskalí a komplikace při stabilizaci torakolumbální páteře. Úrazová chirurgie, 1995, roč. 3, č. 4, s. 17–31.
23. Wendsche, P., Kočiš, J., Višňa, P. Diferencovaný postup při stabilizaci zlomenin hrudní a bederní páteře. Acta spondylologica, 2002, roč. 1, č. 1, s. 54–68.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2007 Issue 12
Most read in this issue
- Stapled Hemorrhoidopexy (Long method) – Procedure for Prolapsing Hemorrhoids (PPH) – Eight-Year Experience with the Method
- The Commonest Neuroendocrine GIT Tumors – Carcinoids
- Malignant Somatostatinoma (Brief Overview and a Case Review)
- Current Treatment Options of Osteoporotic Thoracolumbal Spinal Fractures