Clin Orthop Surg.  2011 Jun;3(2):161-166. 10.4055/cios.2011.3.2.161.

Lordoplasty: An Alternative Technique for the Treatment of Osteoporotic Compression Fracture

• Jeon TS
• Kim SB
• Park WK

• KMID: 1719315
• DOI: http://doi.org/10.4055/cios.2011.3.2.161

Abstract

We report here on a new technique using polymethylmethacrylate to manage vertebral osteoporotic compression fractures in three patients. These patients presented with acute back pain that manifested itself after minor trauma. Osteoporotic compression fractures were diagnosed via plain X-ray and magnetic resonance imaging studies. The patients were treated with absolute bed rest and non-steroidal anti-inflammatory drugs. Despite of the conservative treatment, the patients experienced severe, recalcitrant and progressive pain. The vertebrae were collapsed over 50% or kyphotic deformity was seen on the radiologic materials. We performed a new technique called lordoplasty, which is derived from percutaneous vertebroplasty. The patients experienced a reduction in pain after the procedure. The wedge and kyphotic angles of the fractured vertebrae were significantly restored.

Keyword

Compression fracture; Osteoporosis; Vertebroplasty; Lordoplasty

MeSH Terms

Aged
Female
Fractures, Compression/radiography/*surgery
Humans
Magnetic Resonance Imaging
Orthopedic Procedures/*methods
Osteoporotic Fractures/radiography/*surgery
Spinal Fractures/radiography/*surgery
Thoracic Vertebrae/*injuries/radiography/surgery

Figure

• 

  Fig. 1 The cement was injected under control using an image intensifier. The condition of the cement at the tip of the cannula must be observed.

• 

  Fig. 2 The cement spreads like a growing cloud and it should be gradually injected.

• 

  Fig. 3 Relevant reduction of the vertebral body was achieved with using lordotic force.

• 

  Fig. 4 The cannulas were maintained after a lordotic movement.

• 

  Fig. 5 The procedure was completed.

• 

  Fig. 6 A 78-year-old female patient: lordoplasty was performed on a vertebral compression fracture of T11.

• 

  Fig. 7 A 65-year-old female patient: closed reduction was carried out.

• 

  Fig. 8 A 74-year-old female patient: The kyphotic and wedge angles were recovered.

Reference

1. Schlaich C, Minne HW, Bruckner T, et al. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int. 1998. 8(3):261–267.

2. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000. 15(4):721–739.

3. Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976). 2001. 26(14):1511–1515.

4. Heini PF, Orler R. Kyphoplasty for treatment of osteoporotic vertebral fractures. Eur Spine J. 2004. 13(3):184–192.

5. Taylor RS, Fritzell P, Taylor RJ. Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis. Eur Spine J. 2007. 16(8):1085–1100.

6. Orler R, Frauchiger LH, Lange U, Heini PF. Lordoplasty: report on early results with a new technique for the treatment of vertebral compression fractures to restore the lordosis. Eur Spine J. 2006. 15(12):1769–1775.

7. Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology. 2003. 226(1):119–124.

8. Furtado N, Oakland RJ, Wilcox RK, Hall RM. A biomechanical investigation of vertebroplasty in osteoporotic compression fractures and in prophylactic vertebral reinforcement. Spine (Phila Pa 1976). 2007. 32(17):E480–E487.

9. Kobayashi N, Numaguchi Y, Fuwa S, et al. Prophylactic vertebroplasty: cement injection into non-fractured vertebral bodies during percutaneous vertebroplasty. Acad Radiol. 2009. 16(2):136–143.

10. Bohner M, Gasser B, Baroud G, Heini P. Theoretical and experimental model to describe the injection of a polymethylmethacrylate cement into a porous structure. Biomaterials. 2003. 24(16):2721–2730.