| Comparison of the Outcomes of Osteoporotic Vertebral Compression Fractures with an Intravertebral Cleft Treated Using Different Modalities in Elderly Patients |
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James Ki Shinn1 , Ji Yong Kim1 , Yeo Ju Kim2 , Seung Hwan Yoon1* |
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Departments of 1Neurosurgery, of 2Radiology, Inha University School of Medicine, Incheon, Korea |
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| Abstract |
Objective
Vertebral osteonecrosis (VON) is defined as avascular vertebral necrosis, and exhibits intravertebral vacuum cleft (IVV) or intravertebral fluid (IVF) signs on magnetic resonance images. The aim of this study was to analyze the clinical and radiological outcomes of VON with different radiologic findings, such as, IVF or IVV, for different treatments.
Methods
Visual analog scale (VAS) scores and Oswestry disability indices (ODIs) were used to assess clinical outcomes with preoperative, immediately postoperative, and at last follow-up visits. Cobb’s angles and kyphotic angles were used to evaluate radiologic outcomes on initial and last follow‐up lateral plain radiographs. Osteonecrosis was treated conservatively, by cement augmentation including vertebroplasty or kyphoplasty, or surgically using instrumentation.
Results
One hundred and twenty‐eight patients (36 men, 92 women; 141 vertebral bodies) were enrolled in the study. Initial Cobb’s angles of affected vertebral bodies were no different between treatment modalities (p=0.32). At final followup (12.6±13.3 months), changes in VAS, ODI, and Cobb’s angle were significantly different for the three treatment modalities in cases with IVF or IVV (p<0.01). Plain radiographs taken at last follow‐up showed Cobb’s angle changed less in the surgical group than in the cement augmentation and conservative management groups regardless of the presence of IVF or IVV (p<0.01).
Conclusion
The authors suggest surgeons should consider surgery for the management of vertebral osteonecrosis because it may prevent kyphosis progression in patients exhibiting IVF and correct kyphosis in patients exhibiting IVV more so than conservative treatment or cement augmentation. |
| Key Words:
Vertebral osteonecrosis, Osteoporosis, Vertebroplasty, Surgery, Conservative, Compression fracture |
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