Role of the supine lateral radiograph of the spine in vertebroplasty for osteoporotic vertebral compression fracture: a prospective study

BMC Musculoskeletal Disorders

Research Article

Meng-Huang Wu¹  Chin-Chang Cheng²  Yen-Yao Li²  Robert Wen-Wei Hsu²  Tsung-Jen Huang³ 

[1] Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan;Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan;College of Medicine, Chang Gung University, Taoyuan, Taiwan;Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan;College of Medicine, Chang Gung University, Taoyuan, Taiwan;Department of Orthopedic Surgery, Xiamen Chang Gung Hospital, Xiamen, Fujian, China;

关键词: Visual Analogue Scale Score;    Vertebral Compression Fracture;    Vertebral Height;    Cement Leakage;    Percutaneous Vertebroplasty;   

DOI  :  10.1186/1471-2474-11-164

 received in 2010-05-18, accepted in 2010-07-19,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundSeverely collapsed vertebral compression fracture (VCF) is usually considered as a contraindication for vertebroplasty because of critically decreased vertebral height (less than one-third the original height). However, osteoporotic VCF can possess dynamic mobility with intravertebral cleft (IVC), which can be demonstrated on supine lateral radiographs (SuLR) and standing lateral radiographs (StLR). The purposes of this study were to: (1) evaluate the efficacy of SuLR to detect IVCs and assess the intravertebral mobility in VCFs, and (2) evaluate the short-term results of vertebroplasty in severely collapsed VCFs with IVCs.MethodsWe enrolled 37 patients with 40 symptomatic osteoporotic VCFs for vertebroplasty; 11 had severely collapsed VCFs with concurrent IVCs detected on the SuLR, the others had not-severely collapsed VCFs. A preoperative StLR, SuLR, magnetic resonance imaging (MRI), and postoperative StLR were taken from all patients. Radiographs were digitized to calculate vertebral body morphometrics including vertebral height ratio and Cobb's kyphotic angle. The intensity of the patient's pain was assessed by the visual analogue scale (VAS) on the day before operation and 1 day, 1 month, and 4 months after operation. The patient's VAS scores and image measurement results were assessed with the paired t-test and Pearson correlation tests; Mann-Whitney U test was used for VAS subgroup comparison. Significance was defined as p < 0.05.ResultsIVCs in patients with not-severely collapsed VCFs were detected in 21 vertebrae (72.4%) by MRI, in 15 vertebrae (51.7%) by preoperative SuLR, and in 7 vertebrae (24.1%) by preoperative StLR. Using the MRI as a gold standard to detect IVCs, SuLR exhibit a sensitivity of 0.71 as compared to StLR that yield a sensitivity of 0.33. In patients with VCFs with IVCs detected on SuLR, the average of the postoperative restoration in vertebral height ratio was significantly higher than that in those without IVCs (17.1% vs. 6.4%). There was no statistical difference in the VAS score between severely collapsed VCFs with IVCs detected on SuLR and not-severely collapsed VCFs at any follow-up time point.ConclusionsThe SuLR efficiently detects an IVC in VCF, which indicates a better vertebral height correction after vertebroplasty compared to VCF without IVC. Before performing a costly MRI, SuLR can identify more IVCs than StLR in patients with severely collapsed VCFs, whom may become the candidates for vertebroplasty.

【 授权许可】

Unknown   
© Wu et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.