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A study was conducted to evaluate the efficacy and safety of vertebroplasty as a method of treatment for painful osteoporotic vertebral fractures. Results indicated that there were no beneficial effects of this form of treatment.

Background: A loss of reduction due to inadequate support of the anterior column when using short-segment instrumentation to treat burst fracture and novel methods for support of the anterior column through a posterior approach to augment posterior instrumentation have been reported in the literature. We hypothesized that if anterior column support is an important adjunct to posterior short-segment instrumentation, then avoidance of axial load until sufficient anterior column healing occurs, allowing load-sharing with the implant, would improve spinal alignment at follow-up. Methods: We conducted a retrospective cohort study in which consecutive patients who had instrumentation and fusion with the AO spinal fixator were immediately ambulated after surgery or had 4 weeks of bedrest. We measured kyphosis and wedge angles preoperatively, immediately postoperatively and at the time of final follow-up. We used radiologic measures to assess instrumentation and bone failure. Results: We found significant differences in the mean loss of wedge and kyphosis angle correction between patients immediately ambulated and those who had 4 weeks of bedrest (0.71[degrees] v. -4.73[degrees] for wedge and 1.81[degrees] v. -6.55[degrees] for kyphosis, respectively). There was significant correlation between instrumentation and bone failure in both the immediate ambulation and bedrest groups. Conclusion: Bedrest improves the maintenance of intraoperative sagittal alignment correction, which is in agreement with the theory that inadequate support of the anterior spinal column is the mechanism for loss of reduction when using short-segment instrumentation to treat burst fractures. Therefore, addressing the anterior column directly through anterior surgery or by employing novel techniques in posterior surgery is recommended if one of the goals of treatment is to maintain the sagittal correction achieved at the time of surgery. Trying to achieve this goal by addressing posterior implant design or bone quality alone will not be successful because instrumentation and bone failure occur together. Contexte : La litterature fait etat de reductions incompletes attribuables au soutien insuffisant de la colonne anterieure lors de la pose de segments de plaques courts dans le traitement de la fracture-eclatement, et signale de nouvelles methodes de soutien de la colonne anterieure par un abord posterieur afin d'augmenter l'osteosynthese par plaques par la voie posterieure. Nous avons emis l'hypothese selon laquelle si le soutien de la colonne anterieure contribue substantiellement a l'osteosynthese obtenue au moyen de plaques posterieures courtes, l'evitement de toute mise en charge axiale jusqu'a l'atteinte d'un degre suffisant de consolidation de la colonne anterieure pour permettre la repartition de la charge sur l'implant ameliorerait l'alignement spinal au moment du suivi. Methodes : Nous avons realise une etude de cohorte retrospective au cours de laquelle des patients consecutifs ayant subi un montage par plaques et osteosynthese au moyen d'un fixateur spinal AO ont ete mobilises immediatement apres la chirurgie ou ont plutot ete confines au lit pendant 4 semaines. Nous avons mesure la cyphose et les angles de cuneiformisation en preoperatoire, en post-operatoire immediat et au moment du suivi final. Nous avons utilise des mesures radiologiques pour evaluer l'echec au niveau du montage et de l'os. Resultats : Nous avons decouvert des differences significatives quant a la perte moyenne de cuneiformisation et la correction de l'angle de la cyphose selon que les patients avaient ete immediatement mobilises ou etaient restes alites pendant 4 semaines (0,71 [degrees] c. -4,73 [degrees] pour la cuneiformisation et 1,81 [degrees] c. -6,55 [degrees] pour la cyphose, respectivement). On a note une correlation significative entre l'echec au niveau du montage et au niveau osseux selon que les patients appartenaient au groupe immediatement mobilise et maintenu alite. Conclusion : Le repos au lit ameliore le maintien de la correction de l'alignement sagittal peroperatoire, ce qui concorde avec la theorie selon laquelle un soutien inadequat de la colonne spinale anterieure serait le mecanisme par lequel se produirait la reduction incomplete lors de l'utilisation de montages par fragments courts pour traiter les fractures-eclatements. Par consequent, on recommande de traiter la colonne anterieure directement par l'abord chirurgical anterieur ou au moyen de nouvelles techniques utilisant l'abord posterieur si l'un des objectifs du traitement est de maintenir la correction sagittale obtenue au moment de la chirurgie. Tenter d'atteindre cet objectif en misant sur un implant concu pour un abord posterieur ou sur la qualite osseuse seulement ne produira pas les resultats escomptes, parce que l'echec survient simultanement au niveau du montage et de l'os., Burst fractures comprise about 15% of all thoracolumbar spinal injuries. (1-4) Treatment options include nonoperative management, posterior surgery, anterior surgery and combined anterior and posterior surgery, and there is much [...]

OBJECTIVE: To determine whether patients with osteoporotic compression fractures would have decreased fracture recurrence or a longer time before refracture after percutaneous vertebroplasty (PVP) if they also participated in the [...]

Byline: D. M. Kado (1), T. Duong (2), K. L. Stone (2), K. E. Ensrud (3,4), M. C. Nevitt (2), G. A. Greendale (1), S. R. Cummings (2) Keywords: Incident vertebral fractures; Mortality; Older women Abstract: Older persons who have prevalent vertebral fractures have an increased risk of mortality. It is not known whether incident vertebral fractures are also associated with an increased risk of mortality. To determine whether older women with incident vertebral fractures have an increased risk of mortality, we conducted a prospective cohort study of 7233 community-dwelling older women aged 65 years or older who were enrolled in the Study of Osteoporotic Fractures. We measured incident vertebral fractures by radiographic morphometry of paired lateral spine X-rays taken an average of 3.7 years apart. We also collected information on baseline prevalent vertebral fractures calcaneal bone density anthropometric measures and demographic, medical history, and lifestyle variables. Overall mortality was assessed and confirmed by receipt of death certificates. Over an average of 3.7 years, 389 (5.4%) women developed at least one incident vertebral fracture. During an additional 8 years of follow-up, 1617 (22%) women died. Women with at least one new fracture had an age-adjusted 32% increased risk of mortality (RH=1.32 95% CI=1.10--1.58, P=0.003) compared to those without incident vertebral fractures. After adjustment for weight loss, physical frailty markers, and nine other predictors of mortality, there was no longer an independent association between incident vertebral fractures and mortality (RH=1.06 95% CI=0.88 1.28). Older women with incident vertebral fractures have an increased risk of mortality that may be explained by weight loss and physical frailty. Author Affiliation: (1) Division of Geriatrics, Department of Medicine, The David Geffen School of Medicine at University of California, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA, 90095, USA (2) Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, 94105, USA (3) Section of General Internal Medicine, Minneapolis VA Medical Center, Minneapolis, MN, 55417, USA (4) Division of Epidemiology. School of Public Health, University of Minnesota, Minneapolis, MN, 55454, USA Article History: Received Date: 25/11/2002 Accepted Date: 19/02/2003 Online Date: 24/06/2003 Article note: The abstract was presented at the annual meeting of the American Society of Bone and Mineral Research, in Phoenix, Arizona on 12 October 2001.

Pulmonary tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis and characterized by the presence of granuloma. (1) Features of spinal tuberculosis (Pott disease), an extrapulmonary form, include destruction [...]

Hyperkyphosis, or "dowager's hump"--the exaggerated forward curvature of the upper spine--is a condition that affects older adults and can be caused by multiple factors including osteoporosis, chronic poor posture, and [...]

Patients who underwent surgery for spinal stenosis--a narrowing of the spinal canal that can squeeze the nerves and spinal cord--showed significantly better improvement in all major outcomes, such as physical [...]