Underestimation of bone loss of the spine with posterior-anterior dual-energy X-ray absorptiometry in patients with spinal cord injury.

J Spinal Cord Med. 2010;33(3):214-20

Authors: Bauman WA, Kirshblum S, Cirnigliaro C, Forrest GF, Spungen AM

BACKGROUND: Bone mineral density (BMD) of the lumbar spine (L-spine) has been reported to be normal by routine posterior-anterior (PA) bone density imaging in patients with chronic spinal cord injury (SCI). OBJECTIVE: To determine BMD of the L-spine by PA and lateral (LAT) dual-energy radiographic absorptiometry (DXA) in patients with chronic SCI. DESIGN: Prospective study. SETTING: Veterans Affairs Medical Center and a private rehabilitation facility. METHODS: Measurements of the PA and LAT L-spine and hip were performed in 15 patients with SCI: 9 with tetraplegia and 6 with paraplegia. The DXA (GE Lunar Advance DXA) images were obtained using standard software. Results are reported as mean +/- SD. RESULTS: The mean age was 35 +/- 15 years (range = 20-62 years), and the duration of injury was 57 +/- 74 months (range = 3-240 months). T- and Z-scores were lower for the LAT L-spine than those for PA L-spine (T-scores L2: -0.7 +/- 1.2 vs. 0.0 +/- 1.4, P < 0.01; L3: -0.9 +/- 1.6 vs. 0.3 +/- 1.3, P < 0.002; L2-L3: -0.8 +/- 1.3 vs. 0.2 1.3 vs. 0.2 +/- P < 0.001; Z-scores Z-0.3 +/- 1.1 vs. 0.2 +/- 1.2, P < 0.05; L3: -0.6 +/- 1.3 vs. 0.5 +/- 1.3, P < 0.01; L2-L3: -0.4 +/- 1.1 vs. 0.4 +/- 1.2, P < 0.005). The T- and Z-scores for the total hip (-1.1 +/- 1.0 and -1.0 +/- 1.0, respectively) and L2-L3 LAT L-spine demonstrated remarkable similarity, whereas the L2-L3 PA L-spine scores were not reduced. Bone mineral density of the LAT L-spine, but not the PA L-spine, was significantly reduced with increasing duration of injury. CONCLUSIONS: Individuals with SCI may have bone loss of the L-spine that is evident on LAT DXA that may be misdiagnosed by PA DXA, underestimating the potential risk of fracture.

PMID: 20737794 [PubMed - in process]

[Non-surgical treatment of thoracolumbar fractures]

Zhongguo Gu Shang. 2010 Jun;23(6):475-7

Authors: Liu DG, Zhou H, Sun HH, Wu FF

PMID: 20669593 [PubMed - indexed for MEDLINE]

[Application of pedicle screw in the thoracolumbar fixation]

Zhongguo Gu Shang. 2010 Jun;23(6):473

Authors: Tao J, Zhang ZQ, Liu RB

PMID: 20669591 [PubMed - indexed for MEDLINE]

[Percutaneous vertebroplasty and kyphoplasty for the treatment of thoracolumbar fractures in the elderly]

Zhongguo Gu Shang. 2010 Jun;23(6):448-50

Authors: Liu LC, Ding WJ, Li SJ, Li FJ

OBJECTIVE: To study the clinical effects of percutaneous vertebroplasty and kyphoplasty in the treatment of fresh thoracolumbar fractures in the elderly. METHODS: From May 2004 to March 2009, among 29 patients (32 vertebras) with thoracolumbar fractures, 18 patients (21 vertebras) were treated with percutaneous vertebroplasty (PVP) and 11 patients (11 vertebras) were treated with percutaneous kyphoplasty (PKP). The visual analogue scale (VAS) and mobility were evaluated 3 days before and after operation. During follow-up period, patients were observed and evaluated in terms of relief of back pain and regaining of living ability. Complications such as bone cement leakage were analyzed. RESULTS: All the patients got successful operation. The average operation time was 38.6 minutes for the 18 patients (21 vertebras) with PVP performed, and 3.2 ml (2-5 ml) bone cement was injected. For the 11 patients (11 vertebras) with PKP performed, the average operation time was 43 minutes, and an average of 3.8 ml (2-6 ml) bone cement was injected. The VAS decreased from preoperative (7.5 +/- 0.7) to (2.2 +/- 0.5) at the 3rd day after operation; the mobility scores of the patients decreased from preoperative (2.4 +/- 0.6) to (1.2 +/- 0.3) at the 3rd day after operation; the vertebral height increased from an average of (52.4 +/- 9.7)% pre-operation to (85.2 +/- 10.6)% after operation; and the average kyphosis correction of Cobb angle was 11.2 degrees. During an average of 12.6 months follow-up, no patients reported vertebral pain. Review of X-ray films showed no significant loss of vertebral height. One patient died from complications of heart disease 5 months being discharged from hospital. Another patient died from the same cause at 6 months after opertaion. Paravertebral leakage of bone cement was also found in 2 patients. No serious complications occurred and patients were satisfied with the treatment. CONCLUSION: PVP, PKP can be used to instantly reinforce vertebral injury, relieve pain, and improve the patient's mobility. For elder people with fresh thoracolumbar fractures, when health conditions are allowed, PVP or PKP surgery is the right treatment.

PMID: 20669580 [PubMed - indexed for MEDLINE]

[Surgical treatment of severe lumbar vertebral fracture by partial resection of vertebral body through posterolateral approach]

Zhongguo Gu Shang. 2010 Jun;23(6):425-6

Authors: Wang J, Zhu BH, Liu MB

PMID: 20669572 [PubMed - indexed for MEDLINE]

Related Articles

Lumbar spinous process avulsion fracture in an adolescent dancer.

Clin J Sport Med. 2010 May;20(3):213-4

Authors: Koehler SM, Lin JD, Stets KC, Qureshi SA, Martins DA, Hecht AC

PMID: 20445364 [PubMed - indexed for MEDLINE]