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.

Percutaneous vertebroplasty (PV) is a safe and effective treatment for relieving pain in patients complaining of severe back pain induced by osteoporotic compression fractures. The success rate exceeds 90% and the complication rate is lower than 1%. Most of the complications are transient and should be avoided using good technique. The classic indication for PV is severe, persistent, and incapacitating focal back pain not responding to standard medical therapy and related to one or more collapsed vertebral bodies of 4 to 12 weeks duration. PV should be used earlier in patients at risk of immobilization complications and requiring narcotics. PV should be always considered as a good alternative treatment compared with medical therapy in patients with pain and osteoporotic compression fractures.

Vertebroplasty in osteoporosis.

Basic Science and Techniques. - History and Early Development of Percutaneous Vertebroplasty. -Spine Anatomy. -The Medical Management of Bone Health and Osteoporosis. -Surgical Options for Vertical Compression Fractures. -Patient Evaluation and Selection. -Biomechanical Considerations. -Percutaneous Vertebroplasty: Procedure Technique. -Balloon Kyphoplasty and Lordoplasty. -Vertebroplasty versus Kyphoplasty: A Comparison and Contrast. -Tumors. -Extreme Vertebroplasty: Techniques for Treating Difficult Lesions. -Sacroplasty. -Complications Associated with Vertebroplasty and Kyphoplasty. -Standards for the Performance of Percutaneous Vertebroplasty: American College of Radiology and Society of Interventional Radiology Guidelines.- Case Studies.- Single Level Vertebroplasty and Biopsy. -Multilevel Vertebroplasty. -Vertebra with Cleft or Cavity. -The Mobile Vertebra (Height Restoration). -Extreme Vertebral Collapse. -Anterior Cervical Approach. -Vertebral Refracture after Percutanous Vertebroplasty. -Percutaneous Sacroplasty. -Percutaneous Pelvic Augmentation: Supra-Acetabular Region. -Kyphoplasty in Osteoporotic Compression Fractures. -Femoral Neck.

Percutaneous vertebroplasty and kyphoplasty

Dynamic measurements of total hepatic blood flow with Phase Contrast MRI

The aim of this study was to determine the neuropsychological consequences of a middle interhemispheric approach for the removal of tumors of the third or lateral ventricles. A retrospective analysis of eight callosotomized patients for ventricular tumors (three males/five females; mean age: 48.7 ± 11.2 years; education level: 11.9 ± 2.9 years) and eight healthy subjects was performed. An extensive neuropsychological test battery was used to evaluate global intellectual efficiency, memory capacities, executive functions, and interhemispheric transfer of a procedural learning task (serial reaction time task/SRTT). Neuropsychological results showed that: (1) five of eight patients operated through a middle transcallosal approach had disturbances of verbal or visual memory; (2) three of eight patients displayed a dysexecutive cognitive syndrome(two of eight of whom presenting with a deficit of verbal fluency); (3) two of eight patients presented a dysexecutive behavior syndrome; and (4) with regard to the SRTT, although all participants learned the task, in contrast to controls, the callosotomized patients showed an increase in reaction times and an absence of interhemispheric transfer of learning from one hand to the other. The transcallosal approach transects a large number of callosal fibers. This damage accounts for the deficits of memory, the dysexecutive cognitive and behavioral syndrome, and disturbances in interhemispheric transfer of learning.

/pdf/functional-consequences-of-a-section-of-the-anterior-part-of-1dntj4dqid.pdf

Functional consequences of a section of the anterior part of the body of the corpus callosum: evidence from an interhemispheric transcallosal approach

The authors emphasize an unusual complication of venous angiomas in the brain: venous infarction. The patient in this case is a 32-year-old man who presented with a clinical history of headache followed by a worsening of his neurological status. Neuroimaging studies demonstrated a brain infarct in the posterior fossa, which was related to thrombosis of the draining vein of a cerebral venous angioma. A conservative treatment approach without anticoagulation therapy was followed and the patient completely recovered. Nonhemorragic venous infarction caused by thrombosis of a venous angioma is exceptional and only nine previous cases have been reported in the literature.

Hervé Deramond

Papers

Vertebroplasty in osteoporosis.

Percutaneous vertebroplasty and kyphoplasty

Dynamic measurements of total hepatic blood flow with Phase Contrast MRI

Functional consequences of a section of the anterior part of the body of the corpus callosum: evidence from an interhemispheric transcallosal approach

Cerebral venous angioma of the pons complicated by nonhemorrhagic infarction. Case report.