RESUMO

BACKGROUND: Patients with epilepsy have a higher risk of skeletal injuries, and some of these fractures occur in the spine during a seizure. Seizure-induced spinal fractures (SISF) are unusual injuries that typically occur in the thoracolumbar spine. Because these skeletal injuries are not well described in the literature, this article aims to analyze the characteristics of this uncommon clinical entity. METHODS: A PubMed and Scopus search adhering to preferred reporting items for systematic reviews and meta-analyses guidelines was performed to include studies reporting patients with SISF. The data gathered from this review were analyzed to characterize this condition. RESULTS: The search yielded 34 articles with a total of 38 patients with SISF. All studies were case reports (level 5 evidence). Most fractures occurred in the thoracic and lumbar spine, and the most common injuries were type A1 and A4 fractures according to the AO spine classification system. Different characteristics of SISF are described including demographics, clinical findings, imaging, and treatment. CONCLUSIONS: SISF should be ruled out in patients who have a recent history of seizures and who report persistent dorsolumbar pain or neurological deficit. SISF usually occurs in the thoracolumbar spine and less frequently in the cervical spine. This review shows that different patterns of neurological deficits, some of them severe, may occur in approximately a quarter of patients with SISF. CLINICAL RELEVANCE: This study provides awareness of an uncommon spine condition. Physicians should suspect SISF in patients with persistent dorsolumbar pain after a seizure.

RESUMO

INTRODUCTION: Vertebral compression fractures (VCF) are frequently asymptomatic; incidental diagnosis is a valuable opportunity to identify low bone mass and to start treatment. We aimed to determine the proportion of patients over 60 years old evaluated with chest plus abdominal and pelvic computed tomography (CT) scans, allowing visualization of the entire thoraco-lumbar spine, who incidentally present VCF. MATERIALS AND METHODS: We evaluated 300 patients over 60 years old who under went chest plus abdominal and pelvic CT scans. Using sagittal reformats we looked for VCF using the method described by Genant. Accordingly, VCF were classified into mild, moderate or severe. We also determined the percentage of VCF described in the radiological reports. RESULTS: In our cohort [median age 72.5 years (61-94)], 45.67% were males and 54.33% were females. In total, 43 patients (14.33%) had at least one VCF; 32 (10.67%) had one VCF, whereas 11 (3.67%) exhibited multiple VCF, with a total of 84 fractures. 42 were mild fractures, 29 moderate and 13 severe. The proportion of males (13.87%) and females (14.72%) with VCF was not different (p = 0.83). Patients with VCF were older than those without VCF (p < 0.01). Only age but not sex was independently associated with the presence of VCF. Only 32.56% of patients we identified as having a VCF had a description in their report (14 patients). CONCLUSION: An important proportion of patients over 60 years old evaluated with chest plus abdominal and pelvic CT scans present VCF. The reporting of these VCF is insufficient; radiologists and clinicians should include their detection in their search pattern.

Assuntos

RESUMO

OBJECTIVES: Osteoporotic vertebral compression fractures (OVCFs) affect the elderly population, especially postmenopausal women. Percutaneous kyphoplasty is designed to treat painful vertebral compression fractures for which conservative therapy has been unsuccessful. High-viscosity cement can be injected by either a hydraulic pressure delivery system (HPDS) or a balloon tamp system (BTS). Therefore, the purpose of this study was to compare the safety and clinical outcomes of these two systems. METHODS: A random, multicenter, prospective study was performed. Clinical and radiological assessments were carried out, including assessments of general surgery information, visual analog scale, quality of life, cement leakage, and height and angle restoration. RESULTS: Using either the HPDS or BTS to inject high-viscosity cement effectively relieved pain and improved the patients' quality of life immediately, and these effects lasted at least two years. The HPDS using high-viscosity cement reduced cost, surgery time, and radiation exposure and showed similar clinical results to those of the BTS. In addition, the leakage rate and the incidence of adjacent vertebral fractures after the HPDS treatment were reduced compared with those after treatment using the classic vertebroplasty devices. However, the BTS had better height and angle restoration abilities. CONCLUSIONS: The percutaneous HPDS with high-viscosity cement has similar clinical outcomes to those of traditional procedures in the treatment of vertebral fractures in the elderly. The HPDS with high-viscosity cement is better than the BTS in the treatment of mild and moderate OVCFs and could be an alternative method for the treatment of severe OVCFs.

Assuntos

RESUMO

Las fracturas vertebrales por compresión son de alta prevalencia y se relacionan principalmente a osteoporosis y cáncer. Frecuentemente tienen consecuencias devastadoras en la calidad de vida de los pacientes. Aquellos pacientes que no responden al tratamiento conservador se pueden beneficiar de una técnica mínimamente invasiva, la vertebroplastía, para reforzar la vértebra fracturada con cemento y así controlar el dolor. La vertebroplastía es un procedimiento ambulatorio con baja tasa de efectos colaterales cuando la realiza un médico con experiencia y el entrenamiento adecuado. Su tasa de éxito va del 65 al 95 por ciento, dependiendo de la indicación. Sólida evidencia científica se requiere aún para apoyar su amplio uso clínico.

Vertebral compression fractures are highly prevalent. Osteoporosis and cancer are the main causes. As a consequence patients endure excruciating breakthrough pain and debilitating experience that affect their quality of life. Those individuals that do not respond to classic treatment might benefit of vertebral cement augmentation. This is a totally ambulatory procedure aimed to control pain and stabilize the bone. Percutaneous approach is usually undertaken. Long lasting pain relief results in 65 to 95 percent of patients with a very low profile of complications when the procedure is done by experienced practitioners. Randomized, blinded and prospective studies are still required.

Assuntos