Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Aug 6:20:94-99.
doi: 10.1016/j.jot.2019.07.002. eCollection 2020 Jan.

Percutaneous vertebral augmentation in special Genant IV osteoporotic vertebral compression fractures

Mingming Pan  1 , Jun Ge  1 , Qifan Li  1 , Sucheng Li  1 , Haiqing Mao  1 , Bin Meng  1 , Huilin Yang  1
Affiliations

Percutaneous vertebral augmentation in special Genant IV osteoporotic vertebral compression fractures

Mingming Pan et al. J Orthop Translat. .

Abstract

Background: Percutaneous vertebral augmentation is widely used for treating osteoporotic vertebral compression fractures (OVCFs). Bony encroachment in the spinal canal can be detected in some severe cases, increasing the difficulty of operation and risks of perioperative complications.

Purpose: A special type of OVCF has been introduced, and the clinical efficacy of vertebral augmentation has been evaluated in treating this special OVCF.

Materials and methods: The medical history of patients with OVCF treated with vertebral augmentation was reviewed. The vertebral body height and local kyphotic angle were measured and calculated on the lateral plain radiographs. The visual analogue scale and Oswestry Disability Index were assessed preoperatively, two days after operation, and at final follow-up periods. Complications such as cement leakage and recurrent vertebral fractures were also recorded and followed up.

Results: Twenty-nine patients with special Genant IV OVCF accepted vertebral augmentation, and 28 of them were followed up. The mean follow-up duration was 21.9 months, ranging from 17 to 34 months. The lateral plain radiographs revealed significant restoration of vertebral body height and local kyphotic angle. Both visual analogue scale and Oswestry Disability Index scores showed improvement 2 days after surgery and at final follow-up. Four patients experienced asymptomatic cement leakage, and 6 patients suffered OVCF recurrence in other segments.

Conclusion: Despite a great challenge, vertebral augmentation can be considered as a safe and effective option for treating special the Genant IV OVCF, showing significant restoration of vertebral body height, local kyphotic angle, and daily life function.

The translational potential of this article: Vertebral augmentation has been proven a safe and effect surgery method for special Genant IV OVCF. While surgery complications related to the commercially available filling material - polymethyl methacrylate (PMMA) is common and inevitable. Hence, this article is aimed to provide practical surgical techniques and suggestions to the modification of PMMA and fabrication of newly developed bone cements.

Keywords: Clinical efficacy; Complications; OVCF; Vertebral augmentation.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The measurement of body height. H = vertebral body height; M = the fracture vertebra; U = upper segment; L = lower segment; a = anterior part of the vertebra; m = middle part of the vertebra.
Figure 2
Figure 2
Measurement of the local kyphotic angle (LKA).
Figure 3
Figure 3
An 88-year-old woman with the special Genant IV OVCF was treated with kyphoplasty. (A) Preoperative sagittal CT reconstruction showed V-shaped OVCF at L2. (B–D) The preoperative MR revealed bone marrow oedema and spinal canal encroachment. (E–F) The postoperative radiograph displayed great recovery of the vertebral body height and LKA without cement leakage. CT = computed tomography; LKA = local kyphotic angle; OVCF = osteoporotic vertebral compression fracture.
Figure 4
Figure 4
(A) CT scanning showed a special Genant IV OVCF in L2. (B) MR imaging showed bone marrow oedema in L2 and compression of dura. (C) Postoperative X-rays indicated intervertebral leakage. (D) Eight months later, MR imaging showed bone marrow oedema in L1 and L3 (blue arrows), suggesting OVCF recurrence. CT = computed tomography; MR = magnetic resonance; OVCF = osteoporotic vertebral compression fracture.
Figure 5
Figure 5
(A–C) Preoperative MR imaging showed low signal intensity in the T1-weighted image and high signal intensity in the T2-weighted image in T10, which is a classical sign of intravertebral fluid. (D) Postoperative X-ray showed a solid fixation of the fracture. (E) Five months later, MR imaging showed bone marrow oedema in T9, and the patient underwent another vertebral augmentation. (F) Postoperative X-ray image of the second surgery. MR = magnetic resonance.
See this image and copyright information in PMC

References

    1. Luthman S., Widén J., Borgström F. Appropriateness criteria for treatment of osteoporotic vertebral compression fractures. Osteoporos Int. 2018;29:793–804. - PubMed
    1. Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8:1137–1148. - PubMed
    1. Nieuwenhuijse M.J., van Erkel A.R., Dijkstra P.D. Percutaneous vertebroplasty in very severe osteoporotic vertebral compression fractures: feasible and beneficial. J Vasc Interv Radiol. 2011;22:1017–1023. - PubMed
    1. Rabei R, Patel K, Ginsburg M, Patel MV, Turba UC, Arslan B. Percutaneous vertebral augmentation for vertebral compression fractures: national trends in the medicare population (2005-2015) Spine (Phila Pa 1976) 2019;44:123–133. - PubMed
    1. Röllinghoff M, Zarghooni K, Schlüter-Brust K, Sobottke R, Schlegel U, Eysel P. Indications and contraindications for vertebroplasty and kyphoplasty. Arch Orthop Trauma Surg. 2010;130:765–774. - PubMed