Nonunion Of Osteoporotic Vertebral Compression Fractures: Diagnosis And Treatment

Objective::To discuss the mechanism, clinical manifestation,imaging characteristics, diagnosis and treatment opinions for nonunion of osteoporotic vertebral compression fractures. Methods:Retrospective analysis of 20 cases with 28 painful vertebral fractures from September 2008 to September 2009, which have complete informations and all diagnose as nonunion of osteoporotic vertebral compression fractures. Average age of 75 years old(from 59 to 95). All the patients have a severe back pain for mean 7.9 months(from 20 days to 5 years ). 7 of which have explicit traumas(35%). Summarize their clinical and imaging characteristics. Contrast the preoperative and postoperative scores of VAS and make statistical analysis of the results. Results: Nonunion of OVCFs mainly occurred in thoracolumbar(23 vertebrae, 82.1%). Intravertebral vacuum clefts was found in 26 vertebrae (92.8). Vertebrae without IVC shows sclerosis in imaging characteristics. Clefts associated with the upper endplate observed in 21 vertebrae(80.8%), 2 associated with the lower endplate(7.7%), 3 were found to pass from the upper to the lower endplate(11.5%). 88.5% clefts were detected by MRI, 34.6% by X-RAY, 65.4% by CT. VAS Scores of preoperative is 8.370±0.926, reduced to 1.000±0.738. Cobb angle of preoperative is 13.07±8.028°,reduced to 10.85±6.106°. Compression ratio of preoperative is 47.51±18.530%, reduced to 35.786±9.3578%. No obvious change showed during the follow-up visit. Conclusion:1,Nonunion of osteoporotic vertebral compression fractures was induced by series of factors. 2,Patients with these fllowing clinical characteristics can be diagnosis as nonunion of OVCFs :①Long period of severe back pain(more than 3 months), conservative treatment did not work out well.②Back pain can be relieved by clinostatism or some specific position, aggravated when the patient take any movement.③Progressive kyphosis, or delayed spinal cord injury.④Appearance of Intravertebral Vacuum Clefts in radiograph. 3,Vertebroplasty can be effective for the treatment of Nonunion of OVCFs.