PERCUTANEOUS VERTEBROPLASTY TO TREAT OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES COMBINED WITH INTRAVERTEBRAL CLEFTS BY UNILATERAL APPROACH_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GAO Wanxu , MI Shijun , GAO Jingchun.

Department of Orthopedics, Fengrun County People’s Hospital, Tangshan Hebei, 064000, P.R.China. Corresponding author: GAO Wanxu, E-mail: gaowanxu@sina.com;

Corresponding author：

Keywords：

Percutaneous vertebroplasty; Osteoporotic vertebral compression fracture; Intravertebral cleft; Unilateral approach

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ObjectiveTo evaluate the effectiveness of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures with or without intravertebral clefts by unilateral approach and the impact of intravertebral clefts on the effectiveness. MethodsThe clinical data of 65 patients who met the inclusion criteria of osteoporotic vertebral compression fracture were retrospectively analyzed. According to having intravertebral clefts or not, the patients were divided into 2 groups: cleft group (group A, n=25) and non-cleft group (group B, n=40). There was no significant difference in gender, age, cause of injury, the level of fracture vertebrae, degree of damage, and interval of injury and operation between 2 groups (P gt; 0.05). All patients were given PVP procedure by unilateral approach. The operation time, the injected volume of bone cement, time to ambulate, complications, and adjacent vertebral re-fracture were recorded. The height of anterior and middle column and the posterior convex Cobb angle of injured spine were measured on the lateral X-ray film in standing position at preoperation and 1, 48 weeks after operation. The visual analogue scale (VAS) score and Oswestry disability index (ODI) system were used to evaluate the pain relief and improvement of daily activity function respectively at preoperation and 1, 4, and 48 weeks after operation. ResultsThere was no significant difference in the operation time and time to ambulate between 2 groups (P gt; 0.05). The injected volume of bone cement in group B was significantly less than that in group A (t=1.833, P=0.034). Asymptomatic cement leakage occurred in 6 patients (4 in group A and 2 in group B), in group A including 1 case of venous leakage, 2 cases of paravertebral leakage, and 1 case of intradiscal leakage; in group B including 2 cases of venous leakage. No symptomatic pulmonary embolism was observed. The vital sign was stable during operation and postoperatively. All patients were followed up 12-30 months (mean, 18.5 months). No re-fracture of the vertebrae occurred during the follow-up. The postoperative VAS score, ODI, the height of anterior and middle column, and the posterior convex Cobb angle of injured spine were improved significantly when compared with the preoperative ones in 2 groups (P lt; 0.05), but no significant difference was found between 2 groups at pre- and post-operation (P gt; 0.05). ConclusionPVP by unilateral approach is safty and efficacy in the treatment of osteoporosis vertebral compression fracture combined with intravertebral clefts. Intravertebral clefts have no significant impact on the effectiveness in the pain relief and function improvement.

Citation： GAO Wanxu,MI Shijun,GAO Jingchun.. PERCUTANEOUS VERTEBROPLASTY TO TREAT OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES COMBINED WITH INTRAVERTEBRAL CLEFTS BY UNILATERAL APPROACH. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(11): 1330-1335. doi: Copy

1.	Genant HK, Jergas M. Assessment of prevalent and incident vertebral fractures in osteoporosis research. Osteoporos Int, 2003, 14(3 Suppl): 43-45.
2.	Maldague BE, Noel HM, Malghem JJ. The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology, 1978, 129(1): 23-29.
3.	Mirovsky Y, Anekstein Y, Shalmon E, et al. Vacuum clefts of the vertebral bodies. AJNR Am J Neuroradiol, 2005, 26(7): 1634-1640.
4.	Kumpan W, Salomonowitz E, Seidl G, et al. The intravertebral vacuum phenomenon. Skeletal Radiol, 1986, 15(6): 444-447.
5.	Yang H, Gan M, Zou J, et al. Kyphoplasty for the treatment of Kümmell’s disease. Orthopedics, 2010, 33(7): 479.
6.	Koike Y, Takizawa K, Ogawa Y, et al. Percutaneous vertebroplasty for vertebral compression fractures with intravertebral cleft: cement injection under vacuum aspiration. J Vasc Interv Radiol, 2011, 22(12): 1721-1726.
7.	张云庆, 杨惠光, 刘勇, 等. 球囊扩张椎体后凸成形术结合过伸体位复位治疗中晚期 Kümmell 病的疗效分析. 中国修复重建外科杂志, 2012, 26(4): 411-415.
8.	Lane JI, Maus TP, Wald JT, et al. Intravertebral clefts opacified during vertebroplasty: pathogenesis, technical implications, and prognostic significance. AJNR Am J Neuroradiol, 2002, 23(10): 1642-1246.
9.	McKiernan F, Faciszewski T. Intravertebral clefts in osteoporotic vertebral compression fractures. Arthritis Rheum, 2003, 48(5): 1414-1419.
10.	Theodorou DJ. The intravertebral cleft sign. Radiology, 2001, 221(3): 787-788.
11.	Oka M, Masaki M, Nobuo K, et al. Intravertebral cleft sign on fat-suppressed contrast enhanced MR: correlation with cement distribution pattern on percutaneous vertebroplasty. Acad Radiol, 2005, 12(8): 992-999.
12.	Gagnerie F, Taillan B, Euller-Ziegler L, et al. Intravertebral vacuum phenomenon in multiple myeloma. Clin Rheumatol, 1987, 6(4): 597-599.
13.	Heini PF, Wälchli B, Berlemann U. Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J, 2000, 9(5): 445-450.
14.	Mathis JM, Barr JD, Belkoff SM, et al. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. AJNR Am J Neuroradiol, 2001, 22(2): 373-381.
15.	Li KC, LI AF, Hsieh CH, et al. Another option to treat kummell’s disease with cord compression. Eur-Spin J, 2007, 16(19): 1479-1487.
16.	Mochida J, Toh E, Chiba M, et al. Treatment of osteoporotic late collapse of a vertebral body of thoracic and lumbar spine. J Spinal Disord, 14(5): 393-398.
17.	Kaneda K, Asano S, Hashimoto T, et al. The treatment of osteoporotic post-traumatic vertebral collapse using the Kaneda device and abioactive ceramic vertebral prosthesis. Spine (Phila Pa 1976), 17(8 Suppl): S295-303.
18.	Krauss M, Hirschfelder H, Tomandl B, et al. Kyphosis reduction and the rate of cement leaks after vertebroplasty of intravertebral clefts. Eur Radiol, 2006, 16(5): 1015-1021.
19.	Hadjipavlou AG, Tzermiadianos MN, Katonis PG, et al. Percutaneous vertebroplasty and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures and osteolytic tumours. J Bone Joint Surg (Br), 2005, 87(12): 1595-1604.
20.	Mathis JM. Percutaneous vertebroplasty: complication avoidance and techque optimization. AJNR Am J Neuroadiol, 2003, 24(8): 1697-1706.
21.	Chen LH, Lai PL, Chen WJ. Unipedicle percutaneous vertebroplasty for spinal intraosseous vacuum cleft. Clin Orthop Relat Res, 2005, (435): 148-153.
22.	Hasegawa K, Homma T, Uchiyama S, et al. Vertbral pseudorthrosis in the osteoporotic spine. Spine (Phila Pa 1976), 1998, 23(20): 2201-2206.
23.	Peh WCG , Gelbart MS, Gilula LA, et al. Percutaneous vertebroplasty: treatment of painful vertebral compression fractures with intraosseous vacuum phenomena. AJR Am J Roentgenol, 2003, 180(5): 1411-1417.
24.	Ha KY, Lee JS, Kim KW, et al. Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts. J Bone Joint Surg (Br), 2006, 88(5): 629-633.
25.	Wiggins MC, Sehizadeh M, Pilgram TK, et al. Importance of intravertebral fracture clefts in vertebroplasty outcome. AJR Am J Roentgenol, 2007, 188(3): 634-640.
26.	Kim YJ, Lee JW, Kim KJ, et al. Percutaneous vertebroplasty for intravertebral cleft: analysis of therapeutic effects and outcome predictors. Skeletal Radiol, 2010, 39(8): 757-766.

1. Genant HK, Jergas M. Assessment of prevalent and incident vertebral fractures in osteoporosis research. Osteoporos Int, 2003, 14(3 Suppl): 43-45.
2. Maldague BE, Noel HM, Malghem JJ. The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology, 1978, 129(1): 23-29.
3. Mirovsky Y, Anekstein Y, Shalmon E, et al. Vacuum clefts of the vertebral bodies. AJNR Am J Neuroradiol, 2005, 26(7): 1634-1640.
4. Kumpan W, Salomonowitz E, Seidl G, et al. The intravertebral vacuum phenomenon. Skeletal Radiol, 1986, 15(6): 444-447.
5. Yang H, Gan M, Zou J, et al. Kyphoplasty for the treatment of Kümmell’s disease. Orthopedics, 2010, 33(7): 479.
6. Koike Y, Takizawa K, Ogawa Y, et al. Percutaneous vertebroplasty for vertebral compression fractures with intravertebral cleft: cement injection under vacuum aspiration. J Vasc Interv Radiol, 2011, 22(12): 1721-1726.
7. 张云庆, 杨惠光, 刘勇, 等. 球囊扩张椎体后凸成形术结合过伸体位复位治疗中晚期 Kümmell 病的疗效分析. 中国修复重建外科杂志, 2012, 26(4): 411-415.
8. Lane JI, Maus TP, Wald JT, et al. Intravertebral clefts opacified during vertebroplasty: pathogenesis, technical implications, and prognostic significance. AJNR Am J Neuroradiol, 2002, 23(10): 1642-1246.
9. McKiernan F, Faciszewski T. Intravertebral clefts in osteoporotic vertebral compression fractures. Arthritis Rheum, 2003, 48(5): 1414-1419.
10. Theodorou DJ. The intravertebral cleft sign. Radiology, 2001, 221(3): 787-788.
11. Oka M, Masaki M, Nobuo K, et al. Intravertebral cleft sign on fat-suppressed contrast enhanced MR: correlation with cement distribution pattern on percutaneous vertebroplasty. Acad Radiol, 2005, 12(8): 992-999.
12. Gagnerie F, Taillan B, Euller-Ziegler L, et al. Intravertebral vacuum phenomenon in multiple myeloma. Clin Rheumatol, 1987, 6(4): 597-599.
13. Heini PF, Wälchli B, Berlemann U. Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J, 2000, 9(5): 445-450.
14. Mathis JM, Barr JD, Belkoff SM, et al. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. AJNR Am J Neuroradiol, 2001, 22(2): 373-381.
15. Li KC, LI AF, Hsieh CH, et al. Another option to treat kummell’s disease with cord compression. Eur-Spin J, 2007, 16(19): 1479-1487.
16. Mochida J, Toh E, Chiba M, et al. Treatment of osteoporotic late collapse of a vertebral body of thoracic and lumbar spine. J Spinal Disord, 14(5): 393-398.
17. Kaneda K, Asano S, Hashimoto T, et al. The treatment of osteoporotic post-traumatic vertebral collapse using the Kaneda device and abioactive ceramic vertebral prosthesis. Spine (Phila Pa 1976), 17(8 Suppl): S295-303.
18. Krauss M, Hirschfelder H, Tomandl B, et al. Kyphosis reduction and the rate of cement leaks after vertebroplasty of intravertebral clefts. Eur Radiol, 2006, 16(5): 1015-1021.
19. Hadjipavlou AG, Tzermiadianos MN, Katonis PG, et al. Percutaneous vertebroplasty and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures and osteolytic tumours. J Bone Joint Surg (Br), 2005, 87(12): 1595-1604.
20. Mathis JM. Percutaneous vertebroplasty: complication avoidance and techque optimization. AJNR Am J Neuroadiol, 2003, 24(8): 1697-1706.
21. Chen LH, Lai PL, Chen WJ. Unipedicle percutaneous vertebroplasty for spinal intraosseous vacuum cleft. Clin Orthop Relat Res, 2005, (435): 148-153.
22. Hasegawa K, Homma T, Uchiyama S, et al. Vertbral pseudorthrosis in the osteoporotic spine. Spine (Phila Pa 1976), 1998, 23(20): 2201-2206.
23. Peh WCG , Gelbart MS, Gilula LA, et al. Percutaneous vertebroplasty: treatment of painful vertebral compression fractures with intraosseous vacuum phenomena. AJR Am J Roentgenol, 2003, 180(5): 1411-1417.
24. Ha KY, Lee JS, Kim KW, et al. Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts. J Bone Joint Surg (Br), 2006, 88(5): 629-633.
25. Wiggins MC, Sehizadeh M, Pilgram TK, et al. Importance of intravertebral fracture clefts in vertebroplasty outcome. AJR Am J Roentgenol, 2007, 188(3): 634-640.
26. Kim YJ, Lee JW, Kim KJ, et al. Percutaneous vertebroplasty for intravertebral cleft: analysis of therapeutic effects and outcome predictors. Skeletal Radiol, 2010, 39(8): 757-766.

Chinese Journal of Reparative and Reconstructive Surgery

PERCUTANEOUS VERTEBROPLASTY TO TREAT OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES COMBINED WITH INTRAVERTEBRAL CLEFTS BY UNILATERAL APPROACH

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