Vertebroplasty and kyphoplasty: new evidence adds heat to the debate
ABSTRACT Cement bone augmentation has become very popular worldwide in treating painful noncomplicated spine fractures. Controversy about the effectiveness was raised by two randomized trials in 2009. Recent new evidence contradicts those findings giving credit to vertebroplasty/kyphoplasty.
Well designed prospective clinical trials in cancer and noncancer vertebral fractures as well as an excellent meta-analysis showed that painful vertebral compression fractures have better and faster pain relief, better functional outcomes, and with low complication rate when treated with percutaneous cement than conservatively.
The saga is unfinished. The treatment of vertebral compression fractures with cement augmentation is still in its infancy. The potential for development with new materials and the injection of biologic and active bone cements or anticancer products, in metastatic disease, will revolutionize the treatment of this condition.
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ABSTRACT: Vertebral compression fractures are a prevalent disease affecting osteoporotic patients. When symptomatic, they cause significant pain and loss of function and have a high public health impact. In this paper we outline the diagnosis and management of these patients, with evidence-based review of treatment outcomes for the various therapeutic options. Diagnosis involves a clinical history focusing on the nature of the patient's pain as well as various imaging studies. Management is multimodal in nature and starts with conservative therapy consisting of analgesic medication, medication for osteoporosis, physical therapy, and bracing. Patients who are refractory to conservative management may be candidates for vertebral augmentation through either vertebroplasty or kyphoplasty.Journal of Multidisciplinary Healthcare 06/2013; 6:205-14. DOI:10.2147/JMDH.S31659
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ABSTRACT: Background: The transpedicular route in percutaneous vertebroplasty (PVP) is a well-established approach for the treatment of vertebral compression fractures (VCFs). However, the value of simple transpedicular biopsy in VCFs is less addressed. The purpose of this study is to evaluate the value of transpedicular biopsy during PVP for uncovering the malignancy in VCFs in a 10-year retrospective study. Materials and Methods: During the study period of the 1019 patients who underwent PVP for VCFs, 450 patients comprising of 127 male and 323 female underwent transpedicular biopsy during PVP for 705 fractured vertebras. The medical records were analyzed for age, gender, imaging studies, operation notes, pre-operative and post-operative diagnoses, date of vertebroplasty and biopsy, vertebral level and pathological reports. Results: Pathology of the specimens of the 450 patients confirmed non-malignant VCFs in 389 (86.44%) and malignancy in 61 (13.56%). The malignant pathology included: 52 (11.56%) distant metastases to vertebra, in 3 (0.67%) of the spinal metastases was unsuspected and in 49 (10.89%) of them the malignancy was suspected pre-operatively. There were 9 (2%) primary spinal malignancies, 2 (0.44%) unsuspected multiple myeloma and 7 (1.56%) pre-operatively suspected primary malignancies. The frequency of unsuspected malignancy was 1.11% (5/450) in this study. There was no complication associated with transpedicular biopsy during PVP. Conclusions: VCFs harbored 1.11% of unexpected malignancy. During the vertebroplasty, concomitant transpedicular vertebral biopsy is a safe and useful procedure for distinguishing non-malignant from malignant compression fractures, especially in diagnosing unsuspected malignancy.Neurology India 11/2013; 61(6):587-592. DOI:10.4103/0028-3886.125249 · 1.08 Impact Factor
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ABSTRACT: Percutaneous vertebroplasty is a minimally invasive radiological procedure intended for relieving painful vertebral fractures. Suitability depends largely on fracture age, with acute osteoporotic fractures being most appropriate. Selection and planning usually involves either Tc MDP scintigraphy or MRI. There is evidence indicating that either modality is predictive of response to vertebroplasty, but there is limited evidence promoting their combined use. The aim of the study was to establish the degree of concordance between MRI and Tc MDP scintigraphy in vertebral fracture assessment. Our institution routinely uses both MRI and Tc MDP scintigraphy in vertebroplasty planning. This retrospective analysis included 39 patients, with a total of 73 vertebral fractures, all treated with vertebroplasty. The fractures were classified according to fracture age, aetiology and intermodality concordance. The overall concordance between MRI and Tc MDP scintigraphy was 63%. Almost twice as many fractures classified as 'acute/ subacute' on MRI were so classified on Tc MDP scintigraphy. Using MRI without Tc MDP scintigraphy, 48.2% of the potentially suitable vertebroplasty targets (37% of the total vertebral lesions) would likely have been overlooked. Clearly, Tc MDP scintigraphy and MRI provide different but complementary information on vertebral fractures, and these results support the use of dual-modality assessment in vertebroplasty selection and planning (See video abstract, Supplemental digital content 1, http://links.lww.com/NMC/A23).Nuclear Medicine Communications 04/2014; 35(7). DOI:10.1097/MNM.0000000000000110 · 1.37 Impact Factor