Increase in Vertebral Body Height after Vertebroplasty
Akio Hiwatashia, Toshio Moritania, Yuji Numaguchia and Per-Lennart Westessona+Author Affiliations
- aFrom the Department of Diagnostic Radiology, University of Rochester Medical Center, Rochester, NY
- Address reprint requests to Akio Hiwatashi, M.D., Department of Diagnostic Radiology, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642-8648
Abstract
During clinical work, we have seen increases in vertebral body height associated with vertebroplasty, but our literature search revealed no reports as to how often and to what degree those increases occur. The purpose of this study was to document the frequency and degree of changes in vertebral body height after vertebroplasty.
METHODS:
The heights of 85 vertebral bodies in 37 patients were measured before and after vertebroplasty. In addition, one adjacent vertebral body was measured in each patient as a control. Twenty-six patients had compression fractures in the thoracic spine, and 24 patients had compression fractures in the lumbar spine. Vertebroplasty was performed with a bilateral transpedicular approach by injecting polymethylmethacrylate, under biplane fluoroscopic control. Measurements were performed on preoperative MR images and on postoperative CT sagittal reformations. Anterior, central, and posterior vertebral body height measurements were obtained in the midsagittal plane.
RESULTS:
The average increase in vertebral body height was 2.5 mm anteriorly, 2.7 mm centrally, and 1.4 mm posteriorly. Thirteen of 85 treated vertebrae remained unchanged. All control vertebral bodies also remained unchanged.
CONCLUSION:
Vertebral body height often increases during vertebroplasty. The clinical significance of increasing vertebral body height is unknown.
Copyright © American Society of Neuroradiology
- Y.-J. Chena,c, H.-Y. Chenb, P.-P. Tsaib, D.-F. Loa, H.-T. Chena and H.-C. Hsua,c – Author Affiliations
- aDepartments of Orthopedic Surgery (Y.-J.C., D.-F.L., H.-T.C., H.-C.H.)
- bRadiology (H.-Y.C., P.-P.T.), China Medical University Hospital, Taichung, Taiwan
- cDepartment of Orthopedic Surgery, School of Medicine (Y.-J.C., H.-C.H.), China Medical University, Taichung, Taiwan.
- Please address correspondence to Yen-Jen Chen, MD, Department of Orthopedic Surgery, China Medical University Hospital, No 2, Yuh-Der Rd, Taichung 404, Taiwan; e-mail: yenjenc.tw@yahoo.com.tw
Abstract
BACKGROUND AND PURPOSE:
Many authors have reported the increase in vertebral body height after vertebroplasty. However, McKiernan et al demonstrated dynamic mobility in patients who underwent vertebroplasty and concluded that any article that claims vertebral height restoration must control for the dynamic mobility of fractured vertebrae. The purpose of this study was to compare prevertebroplasty (supine cross-table with a bolster beneath) with postvertebroplasty vertebral body height to find out whether vertebroplasty itself really increases the vertebral height.
MATERIALS AND METHODS:
From July 2005 to July 2010, 102 consecutive patients with 132 VCFs underwent vertebroplasty at our institution. The indications for vertebroplasty were severe pain that was not responsive to medical treatment, and MR imaging−confirmed edematous lesions. Prevertebroplasty (supine cross-table with bolster beneath) lateral radiographs were compared with postvertebroplasty radiographs to evaluate the height change in vertebroplasty. Kyphotic angle and anterior vertebral body height were measured.
RESULTS:
The patients ranged in age from 62 to 90 years. There were 16 men and 86 women. The difference in the kyphotic angle between supine cross-table with bolster and postvertebroplasty was −0.49 ± 3.59° (range, −9°–16°), which was not statistically significant (P = 0.124). The difference in the anterior vertebral body height between supine cross-table with bolster and postvertebroplasty was 0.84 ± 3.01 mm (range, −7.91–8.81 mm), which was statistically significant (P = .002).
CONCLUSIONS:
The restoration of vertebral body height in vertebroplasty seems to be mostly due to the dynamic mobility of fractured vertebrae; vertebroplasty itself does not contribute much to the restoration of vertebral height.
SPINE
Kyphoplasty and Vertebroplasty Produce the Same Degree of Height Restoration
- A. Hiwatashia,b, P.-L.A. Westessona, T. Yoshiurab, T. Noguchib, O. Togaob, K. Yamashitab, H. Kamanob and H. Hondab – Author Affiliations
- aDivision of Diagnostic and Interventional Neuroradiology, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY
- bDepartment of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Please address correspondence to Akio Hiwatashi, MD, Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; e-mail: hiwatasi@radiol.med.kyushu-u.ac.jp
Abstract
BACKGROUND AND PURPOSE:
There are few comparative studies regarding morphologic changes after kyphoplasty and vertebroplasty. The purpose of this study was to compare restoration of vertebral body height and wedge angle and cement leakage with kyphoplasty and vertebroplasty in osteoporotic compression fractures.
MATERIALS AND METHODS:
Forty patients (57 vertebrae) were treated with kyphoplasty, and 66 patients (124 vertebrae) were treated with vertebroplasty. Cement leakage into the disk space and paravertebral soft tissues or veins was analyzed on immediate postoperative CT scans. The height and wedge angle were measured before and after treatment and analyzed with the Mann-Whitney U test and χ2 test.
RESULTS:
Kyphoplasty and vertebroplasty both improved vertebral body height and the wedge angles (P < .05). However, these differences were not statistically significant when the 2 techniques were compared (P > .05). There were 18% of the kyphoplasty group and 49% of the vertebroplasty group that showed cement leakage into the paravertebral soft tissues or veins (P < .01). Cement leakage into the disk space occurred in 12% of the kyphoplasty group and in 25% of the vertebroplasty group (P < .01). However, no complications related to cement leakage were noted.
CONCLUSIONS:
Both kyphoplasty and vertebroplasty achieved the same degree of height restoration and improvement of the wedge angle. Kyphoplasty resulted in less cement leakage into the disk space and paravertebral soft tissues or veins than vertebroplasty.
Copyright © American Society of Neuroradiology
Kyphoplasty versus Vertebroplasty to Increase Vertebral Body Height: A Cadaveric Study
- Akio Hiwatashi, MD, Ravinder Sidhu, MD, Ryan K. Lee, MD, Ramon R. deGuzman, MD, Diane T. Piekut, PhD and Per-Lennart A. Westesson, MD, PhD, DDS
- 1From the Departments of Radiology (A.H., R.S., R.K.L., R.R.d., P.L.A.W.) and Neurobiology and Anatomy (D.T.P.), University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642-8648. Received September 26, 2004; revision requested December 2; revision received December 21; accepted January 21, 2005.
- Address correspondence to A.H. (e-mail: Akio_Hiwatashi@urmc.rochester.edu).
Abstract
PURPOSE:
To prospectively compare the vertebral height restoration achieved with kyphoplasty and vertebroplasty in fresh cadavers by using multi–detector row computed tomography (CT).
MATERIALS AND METHODS:
Institutional review board approval was not required because the donors had registered in and consented to an anatomic gift program prior to their death. Thirty-seven vertebrae were harvested from four donated cadavers of elderly female individuals (mean age, 82 years; age range at death, 73–87 years). The vertebrae were dissected free of the surrounding muscles and imaged with multi–detector row CT. Compression fractures were induced, and the vertebrae were again imaged. The vertebrae were randomized to be treated with kyphoplasty (n = 19) or vertebroplasty (n = 18) and were then imaged at multi–detector row CT. The anterior, central, and posterior vertebral body heights and wedge angles were measured in the midsagittal plane of the reformatted images. The amount of cement injected was determined by weighing the vertebrae before and after treatment. The statistical significance of changes in vertebral body height, wedge angle, and weight with the two treatment techniques was evaluated with the independent t test or Mann-Whitney U test.
RESULTS:
The increase in vertebral height was greater with kyphoplasty than with vertebroplasty (5.1 mm vs 2.3 mm, respectively; P < .05). The original vertebral height was restored in 93% of vertebrae with kyphoplasty and in 82% with vertebroplasty (P < .05). There was a greater decrease in wedge angle with kyphoplasty than with vertebroplasty (3.1° vs 1.6°, respectively); however, this difference was not significant (P > .05). There was no significant difference in the amount of cement injected with kyphoplasty and vertebroplasty (P > .05).
CONCLUSION:
Kyphoplasty increased vertebral body height more than vertebroplasty in this model of acutely created fractures in fresh cadaver specimens.
© RSNA, 2005
SPINE
Kyphosis Correction and Height Restoration Effects of Percutaneous Vertebroplasty
- Michael Mu Huo Tenga, Chao-Jung Weia, Liang-Chen Weia, Chao-Bao Luoa, Jiing-Feng Lirnga, Feng-Chi Changa, Chien-Lin Liub and Cheng-Yen Changa – Author Affiliations
- aDepartment of Radiology, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan
- bDepartment of Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan
- Address reprint requests to Dr Michael Mu Huo Teng, Department of Radiology, Taipei Veterans General Hospital, 201, Sec 2, Shih-Pai Road, Peitou District, Taipei 11217, Taiwan
Abstract
BACKGROUND AND PURPOSE:
Percutaneous vertebroplasty is known for its pain-relieving effect. Our purpose was to evaluate its effect on the kyphosis angle, wedge angle, and height of the fractured vertebral body.
METHODS:
We reviewed digital radiographs of 73 vertebral bodies in 53 patients before and after vertebroplasty. We measured the spinal kyphosis angle and the wedge angle of the fractured vertebral body. Ratios of the height of the anterior border, center, and posterior borders of the collapsed vertebra to the height at the posterior border of an adjacent normal vertebral body were measured. Gain from vertebroplasty and the restoration percentage (gain divided by loss) were calculated for each parameter.
RESULTS:
The kyphosis angle, wedge angle, anterior height, center height, and posterior height significantly improved after vertebroplasty. The mean reduction in the kyphosis angle was 4.3°, and the wedge-angle reduction was 7.4°. The mean wedge-angle reduction in fractured vertebral bodies containing gas was 10.2°. Restoration percentages for the kyphosis angle and wedge angle were 19% and 44%, respectively. Gain in the height of the fractured vertebral bodies was 16.7% for the anterior border, 14% for the center, and 7% for the posterior border. Restoration percentages for the height of the vertebral body were 29% for the anterior border and 27% for the center.
CONCLUSION:
Vertebroplasty increases the height of the fractured vertebra and reduces the wedge and kyphosis angles. These effects are most remarkable in fractured vertebra containing gas.
Copyright © American Society of Neuroradiology
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