Hirotaka Ikeda MD, Presenter: Nothing to Disclose

Misako Yoshimatsu, Abstract Co-Author: Nothing to Disclose

Kenji Takizawa MD, PhD, Abstract Co-Author: Nothing to Disclose

Shin Matsuoka MD, Abstract Co-Author: Nothing to Disclose

Shingo Hamaguchi MD, Abstract Co-Author: Nothing to Disclose

Shoichiro Matsushita, Abstract Co-Author: Nothing to Disclose

Yasuo Nakajima MD, Abstract Co-Author: Nothing to Disclose

Percutaneous vertebroplasty(PVP) is a minimally invasive procedure performed for the treatment of severe back pain associated with vertebral compression fracture(VCF) in which conservative therapy is failed. In the literatures analyzing the image findings after PVP, a lot of attention have been paid to intravertebral cleft and local kyphosis improvement , however, little information is available concerning the overall kyphosis change and CT findings after PVP. The purpose of this study is to assess the overall spinal alignment change using whole spine radiograph, and to observe the local healing process of VCF using MDCT before and after PVP procedure.

We performed a retrospective analysis of 48 patients with 101 vertebrae who underwent PVP for painful osteoporotic VCF after the failure of conservative therapy and had preinterventional and 6 months postinterventional evaluation of whole spine lateral radiograph and spine CT. Sagittal tilt angle, sagittal balance, and pelvic incidence were measured using whole spine lateral radiographs on standing position. We evaluated 7 CT findings regarding VCF, its healing process, and complication of PVP - cortical disruption, minimal spinal diameter, hyperdense cancellous bone, fusion of disrupted cortex, intervertebral bridging, cement leakage, and additional VCF.

On whole spine radiograph, the average of the gain of sagittal tilt angle was no more than 2.3°in each section, the gain of sagittal balance was 3.3mm, and the gain of pelvic incidence was 1.3°. Out of 68 vertebrae that cortical disruption was seen on preinterventional CT, fusion of disrupted cortex was seen in 37 vertebrae on postinterventional CT. On posinterventional CT, increased density of cancellous bone was seen in 26 vertebrae, intervertebral bridging at 11 intervertebral levels.

PVP for VCF does not cause significant change on overall spinal sagittal alignment on radiograph, however, fusion of disrupted cortex, intervertebral bridging, and hyperdence cancellous bone were seen as the CT findings of fixation of fractured vertebrae. That is to say, PVP freezes VCF.

The CT findings help judging whether the fixation of VCF are successful when the information of the effect of PVP is expected by patients and physicians to determine the next treatment strategy.

Ikeda, H, Yoshimatsu, M, Takizawa, K, Matsuoka, S, Hamaguchi, S, Matsushita, S, Nakajima, Y, The Change of CT and Radiographic Findings Following Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fracture.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12023744.html