The Classification And Significance Of The Fracture Lines In Fresh Osteoporotic Vertebral Compression Fractures

Part1The analysis of the fracture lines in fresh osteoporotic vertebral compression fractures base on multiplanar reconstruction CT and MRIAbstractObjectiveTo investigate the usefulness of multiplanar reconstruction CT and magnetic resonance imaging (MRI) in the analysis of the fracture line in fresh vertebral fractures in patients with osteoporosis. We also devised a new classification of fracture line in osteoporotic vertebral compression fracture(OVCF) and determined its implication.Methods85consecutive patients with OVCFs were reviewed retrospectively, who were performed with multiplanar reconstruction CT and MRI in our spine surgery department from Sep,2011to Jan,2013. The subjects consisted of17men and68women with average age73.1years, and average duration of16.3ds(2h～3Od).120fresh fractured vertebrae were diagnosed base on MRI, and the features of fracture line were classified into two type according to multiplanar reconstruction CT and MRI.Results:Fracture lines in103vertebrae can be shown on multiplanar reconstruction CT can clearly, but17vertebrae can not be shown clearly, while109vertebrae can be shown on MRI and11vertebrae can not be shown clearly. There exists high level of consistency in the observation of fracture lines in vertebral osteoporotic compression fractures based on two methods(Kappa=0.598, P<0.05). In sagittal imaging of CT and MRI, the types of fracture lines can be divided into impacted fracture line82(68.4%) and cleft fracture line34(28.3%), but4vertebrae (3.3%) could not accurately describe the morphology of fracture line. According to the site in vertebrae the fracture lines can be divided into5types:superior (51), inferior (26), anterior (10), central(21) and mixed (7).ConclusionThe classification and types of fracture lines in fresh OVCFs can be effectively observed by multiplanar reconstruction CT and MRI, which may be significant for analysis of the mechanism of injury. Part2The effect of i nsuff i c i ent d i str i but ion of bone cement in the fracture lines on the outcome of percutaneous vertebroplasty AbstractObjectiveTo evaluate the effect of insufficient distribution of bone cement in the fracture lines on the outcome of percutaneous vertebroplasty. Methods:45patients were analyzed retrospectively in this study, who were diagnosed with thoracolumbar osteoporosis vertebral compression fracture and treated by percutaneous vertebroplasty (each patient just suffered from individual fracture vertebrae from T10～L2) in our spine surgery department from Jan2012to Jan,2013. There are14men and31women, with mean age of72.18years(53-88ys), and average duration of17.36ds(2h-4m). The distritution of vertebral fracture lines was determined based on preoperative CT or MRI. According to the relationship between bone cement and fracture lines in postoperative X-ray or CT, patients were allocated to group A(n=30):bone cement diffusing in fracture line sufficiently, and group B(n=15):bone cement diffusing in fracture line insufficiently or absently. VAS, ODI and local kyphotic Cobb angle of pre-operation,3days after the operation and the last follow-up timepoint and complication were compared between these two groups.ResultsPVP procedures were successfully completed in the all patients without severe complication. There wasn’t significant difference between the baseline characters between two groups except the BMD. VAS and ODI of post-operation improved significantly comparing with pre-operation in the both groups (P<0.05), Comparing with preoperative VAS and ODI, the improved value3days after surgery in group A was better than the corresponding value in group B,(VAS:5.03±1.33vs3.53±1.13, ODI:26.17±2. lOvs24±2.03, P<0.05), but there was no significant difference between them at the last follow-up timepoint (P>0.05). The local kyphotic Cobb angle at3days of post-operation in two groups decreased significantly comparing with preoperative status (P<0.05), There wasn’t significant difference between3days after operation and the last follow-up timepoint in group A(P>0.05). However, in group B, the local kyphotic cobb angle at the end of the follow-up was significantly larger than3days after surgery (P<0.05). Lost degree of kyphosis correction in group A was significantly lower than group B (1.08°±0.38°vs3.58°±0.37°,P <0.05).8cases and6cases underwent asymptomatic bone cement leakage in the group A and group B respectively, with the total leakage rate of31.1%.ConclusionPercutaneous vertebroplasty is an effective therapy for thoracolumbar osteoporosis vertebral compression fracture to relieve pain and improve disability. Insufficient bone cement distribution in the fracture lines may affect the short-term clinical outcome of PVP, furthermore, it may be a risky factor giving rise to progressive kyphotic deformity after PVP.