Prospective Cohort Study

Study design Literature review Objectives To describe new treatments for painful osteoporotic compression fractures in light of available scientific literature and clinical experience Summary of background data Painful vertebral osteoporotic compression fractures lead to significant morbidity and mortality This relates to pulmonary dysfunction, eating disorders (nutritional deficits), pain, loss of independence, and mental status change (related to pain and medications) Medications to treat osteoporosis (primarily antiresorptive) do not effectively treat the pain or the fracture, and require over 1 year to reduce the degree of osteoporosis Kyphoplasty and vertebroplasty are new techniques that help decrease the pain and improve function in fractured vertebrae Methods This is a descriptive review of the background leading to vertebroplasty and kyphoplasty, a description of the techniques, a review of the literature, as well as current ongoing studies evaluating kyphoplasty Results Both techniques have had a very high acceptance and use rate There is 95% improvement in pain and significant improvement in function following treatment by either of these percutaneous techniques Kyphoplasty improves height of the fractured vertebra, and improves kyphosis by over 50%, if performed within 3 months from the onset of the fracture (onset of pain) There is some height improvement, though not as marked, along with 95% clinical improvement, if the procedure is performed after 3 months Complications occur with both and relate to cement leakage in both, and cement emboli with vertebroplasty Conclusion Kyphoplasty and vertebroplasty are safe and effective, and have a useful role in the treatment of painful osteoporotic vertebral compression fractures that do not respond to conventional treatments Kyphoplasty offers the additional advantage of realigning the spinal column and regaining height of the fractured vertebra, which may help decrease the pulmonary, GI, and early morbidity consequences related to these fractures Both procedures are technically demanding

New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures.

Bone metabolism and disease in chronic kidney disease

Study Design. An Institutional Review Board-approved Phase I efficacy study of inflatable bone tamp usage in the treatment of symptomatic osteoporotic compression fractures. Objectives. To evaluate the safety and efficacy of inflatable bone tamp reduction and cement augmentation, kyphoplasty, in the treatment of painful osteoporotic vertebral compression fractures. Summary of Background Data. Osteoporotic compression fractures can result in progressive kyphosis and chronic pain. Traditional treatment for these patients includes bed rest, analgesics, and bracing. Augmentation of vertebral compression fractures with polymethylmethacryiate, vertebroplasty, has been used to treat pain. This technique, however, makes no attempt to restore the height of the collapsed vertebral body. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps into the vertebral body. Once inflated, the bone tamps restore the vertebral body back toward its original height while creating a cavity that can be filled with bone cement. Patients and Methods. Seventy consecutive kyphoplasty procedures were performed in 30 patients. The indications included painful primary or secondary osteoporotic vertebral compression fractures. Mean duration of symptoms was 5.9 months. Symptomatic levels were identified by correlating the clinical data with MRI findings. Perioperative variables and bone tamp complications or issues were recorded and analyzed. Preoperative and postoperative radiographs were compared to calculate the percentage height restored. Outcome data were obtained by comparing preoperative and latest postoperative SF-36 data. Results. At the completion of the Phase I study there were no major complications related directly to use of this technique or use of the inflatable bone tamp. In 70% of the vertebral bodies kyphoplasty restored 47% of the lost height. Cement leakage occurred at six levels (8.6%). SF-36 scores for Bodily Pain 11.6-58.7, (P = 0.0001) and Physical Function 11.7-47.4, (P = 0.002) were among those that showed significant improvement. Conclusions. The inflatable bone tamp was efficacious in the treatment of osteoporotic vertebral compression fractures. Kyphoplasty is associated with early clinical improvement of pain and function as well as restoration of vertebral body height in the treatment of painful ostecporotic compression fractures.

Initial outcome and efficacy of kyphoplasty in the treatment of painful osteoporotic vertebral compression fractures

Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results.

Caractérisation des perturbations du flux de LCS dans l'aqueduc du mésencéphale par IRM-CP à la phase aiguë de l'hémorragie méningée

Although traumatic vertebral artery dissections are commonly observed, the association with an upper cervical spine is very rare judging from the scarcity of cases reported in the literature. This report describes the case of a patient with a Jefferson fracture causing a delayed vertebral artery dissection. CT brain scan and magnetic resonance angiography showed an infarction of the cerebellum and brainstem. The patient required a shunt, was treated by a halo orthosis and was anti-coagulated with heparin. The evolution was unfavourable. This case draws attention to the fact that a displacement of the lateral masses of the atlas can cause a vertebral artery dissection. This occlusion and ischemic symptoms can be delayed. Resonance angiogram or selective angiography should be used to demonstrate vessel dissections, especially for polytraumatised patients.

Dissection of the vertebral artery complicating Jefferson fracture

[Clinico-radiological data of 48 cases of immunocompetent primary cerebral lymphoma].

ObjectiveTo evaluate the impact of dwell time on the efficacy of the direct aspiration thrombectomy in ischemic stroke.MethodsThe study is a review of our prospective cerebral thrombectomy database...

Direct aspiration for thrombectomy in ischemic stroke: Impact of dwell time:

Since percutaneous vertebroplasty (PV) was introduced in Europe in 1984, it has become an increasingly popular technique. It was introduced in the United States in the early 1990s, and since 1998 it has been the standard of care for painful compression fractures (1). Although less commonly used than PV, kyphoplasty (KP), or “balloon-assisted vertebroplasty,” introduced in the late 1990s, has also become popular for treating the pain associated with vertebral compression fractures (VCFs). Both procedures are structurally similar and use percutaneously introduced bone cement to augment a fractured or destroyed vertebral body. This chapter evaluates the types of complications that have occurred with both procedures and indicates ways to avoid these complications. Initially, training for both procedures was achieved through short (usually 1-day) cadaver courses given by experienced physicians worldwide. This ideally was followed by several proctored cases to get the “physician in training” off to a safe start. No formal training was offered in universities for residents until more recently. The first physicians doing the procedures progressed through their learning curves carefully as the procedure was cautiously applied. Few complications were initially experienced and reported. Severe or permanent complications were rare. However, since the procedures were first devised, complication reports have been collected and have identified definite risks of the procedures. Although complications cannot be eliminated completely, they can be minimized through good image guidance (high-quality fluoroscopic equipment or computed tomography), a thorough knowledge of the spinal anatomy involved in both PV and KP, and a complete understanding of the criteria for performing these procedures safely. This means appropriate patient selection, adherence to safe procedure technique, proper material selection, and good judgement that minimizes the patient risk while affording a high probability of successful outcome. It should be remembered that preventing complications is the key to a safe procedure.

Hervé Deramond

Papers

Caractérisation des perturbations du flux de LCS dans l'aqueduc du mésencéphale par IRM-CP à la phase aiguë de l'hémorragie méningée

Dissection of the vertebral artery complicating Jefferson fracture

[Clinico-radiological data of 48 cases of immunocompetent primary cerebral lymphoma].

Direct aspiration for thrombectomy in ischemic stroke: Impact of dwell time:

Complications Associated with Vertebroplasty and Kyphoplasty