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Percutaneous vertebroplasty for osteoporotic vertebral compression fracture with intravertebral cleft associated with delayed neurologic deficit

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Abstract

Introduction

The number of cases of osteoporotic vertebral compression fracture (OVCF) with intravertebral cleft (IVC) with delayed neurologic deficit (DND) is increasing as the population ages. However, the cause of DND is poorly understood, and no definitive treatment of the disease has been established. The purpose of this study was to clarify the radiographic parameters contributing to the occurrence of DND, and to evaluate the efficacy and safety of percutaneous vertebroplasty for this pathology.

Methods

Percutaneous vertebroplasty was prospectively performed for 244 patients with OVCF with IVC; 30 had DND and 214 did not. Radiographic parameters of local kyphotic angle, percent spinal canal compromise and intravertebral instability were investigated for correlations to DND. Procedural outcomes were evaluated using visual analog scale (VAS), Oswestry Disability Index (ODI), and modified Frankel grades.

Results

Before vertebroplasty, no substantial difference in local kyphotic angle was seen between OVCF with IVC with and without DND, but percent spinal canal compromise and intravertebral instability were greater in OVCF with IVC with DND (P < 0.001). After vertebroplasty, 25 of 30 cases (84 %) of OVCF with IVC with DND achieved clinically meaningful improvement (CMI), but 5 (17 %) did not. Patients with CMI showed substantial improvements in intravertebral instability (P < 0.001), and no change in local kyphotic angle or percent spinal canal compromise. In five patients without CMI, four showed an initial improvement, but subsequent vertebral fracture adjacent to the treated vertebra caused neurologic re-deterioration. One patient with percent spinal canal compromise 54.9 % and intravertebral instability 4° achieved no neurologic improvement following vertebroplasty. No serious complications or adverse events related to the procedure were encountered.

Conclusions

Intravertebral instability is the dominant cause of DND. Percutaneous vertebroplasty appears effective and safe in the treatment of OVCF with IVC with DND. Patients with less intravertebral instability and severe spinal canal compromise could be candidates for conventional surgical treatment.

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Acknowledgments

We thank Prof. John G. Heller (Department of Orthopaedic Surgery, Emory University Medical Center and the Spine Surgery Service, Emory Orthopaedic and Spine Center, Decatur, Georgia) for helpful comments. We are also indebted to Dr. Hiroto Kuwabara (Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University, Baltimore, MD) for his helpful suggestions and excellent assistance in creating this article.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan

    Toshio Nakamae, Yoshinori Fujimoto, Kiyotaka Yamada & Haruhiko Takata

  2. Department of Clinical Research and Informatics, National Center for Global Health and Medicine, Tokyo, Japan

    Takuro Shimbo

  3. Department of Radiology, JA Hiroshima General Hospital, Hiroshima, Japan

    Yasuyuki Tsuchida

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  1. Toshio Nakamae
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  2. Yoshinori Fujimoto
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  3. Kiyotaka Yamada
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Correspondence to Toshio Nakamae.

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Nakamae, T., Fujimoto, Y., Yamada, K. et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture with intravertebral cleft associated with delayed neurologic deficit. Eur Spine J 22, 1624–1632 (2013). https://doi.org/10.1007/s00586-013-2686-8

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  • DOI: https://doi.org/10.1007/s00586-013-2686-8

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