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Current trend in kyphoplasty for osteoporotic vertebral fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Kalliopi Alpantaki, Georgios Vastardis, Alexander G. Hadjipavlou
The contraindications for these procedures include complete loss of vertebral height (vertebra plana), high-velocity burst fractures (although this was challenged by some [51]), infections, uncorrected coagulopathy or therapeutic anticoagulation, fractured pedicles, and contrast allergy (in kyphoplasty, balloons are filled with contrast that can extravasate if ruptured). Although a severely collapsed vertebra is considered as a contraindication, it has been shown that a significant percentage of these vertebrae can reexpand when placing the patient in hyperextension (52,53). For patients under the age of 40 years, cement vertebral augmentation should be exercised with caution.
New Technologies in Spine: Kyphoplasty and Vertebroplasty for the Treatment of Painful Osteoporotic Compression Fractures *
Published in Alexander R. Vaccaro, Charles G. Fisher, Jefferson R. Wilson, 50 Landmark Papers, 2018
Osteoporotic vertebral compression fractures have a significant negative impact on quality of life, physical function, mental health, and mortality.† This study reviewed the literature surrounding the vertebral augmentation procedures vertebroplasty and kyphoplasty as treatments for vertebral compression fractures. It found generally favorable results with a reported success rate in pain relief of 70%–90%. Most patients also had decreased narcotic requirements following these procedures. Additionally, patients who underwent kyphoplasty had some reduction in their deformity. The average anterior height was 83% ± 14% pretreatment and 99% ± 13% posttreatment (p <0.01). In cases where vertebral height loss was greater than 15 degrees, the average anterior height was 68% ± 12% pretreatment and 84% ± 14% following treatment (p <0.01).
Osteoporosis and Exercise in the Older Adult
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Roger P. Rossi, Talya K. Fleming, Krishna J. Urs, Sara J. Cuccurullo
There are times when noninterventional approaches to management of vertebral compression fractures are not sufficient to achieve adequate pain relief and mobility. Vertebral augmentation procedures are increasingly common as more individuals are diagnosed with vertebral compression fracture and efficacy and safety of the techniques improves. Surgery for treating osteoporotic vertebral fractures usually consists of a percutaneous minimally invasive procedure known as vertebroplasty or kyphoplasty. The purposes of surgical treatment are the rapid relief of pain, the restoration of the vertebral body height and the prevention of the kyphosis deformity (83). To guide placement, both procedures utilize fluoroscopy, which provides real-time radiograph images of the procedure.
Percutaneous minimally invasive thermal ablation for management of osseous metastases: recent advances
Published in International Journal of Hyperthermia, 2019
Anderanik Tomasian, Jack W. Jennings
Patient performance status is typically assessed by widely used and validated Karnofsky performance status [3]. Spinal instability is a relative contraindication for percutaneous thermal ablation depending upon severity. Spinal instability is determined using the spinal instability neoplastic score (SINS) [45]. Scores range from 0 to 18, and higher scores indicate greater instability. Although there is no score cutoff to prompt surgery, surgical evaluation for potential tumor resection and/or stabilization is recommended for scores of 7 or higher [46]. At our institutions, we treat patients with spinal instability who are not surgical candidates with vertebral augmentation, which does not entirely restore stability but relieves pain related to motion at fracture site. Surgery is the treatment of choice for spinal metastases complicated by central canal stenosis [47]; however, in the absence of spinal cord compression, thermal ablation may be considered as an alternative for patients who are not surgical candidates. CT and MR imaging are used to determine if central canal stenosis is due to tumor alone or in combination with retropulsion of fracture fragments as ablation may arrest or cause retraction of epidural tumor but will not alleviate symptoms related to osseous central canal stenosis. Such patients are alternatively managed by epidural corticosteroid and long-acting anesthetic injections [48].
Percutaneous radiofrequency ablation of painful spinal metastasis: a systematic literature assessment of analgesia and safety
Published in International Journal of Hyperthermia, 2018
Roberto Luigi Cazzato, Julien Garnon, Jean Caudrelier, Pramod Prabhakar Rao, Guillaume Koch, Afshin Gangi
All studies applied cement augmentation following RFA in some (40–60%) or all (100%) patients, or in the vast majority of the treated vertebrae (94–95.8%). In 6 out of 8 studies and in the majority of patients (95.8%) treated by Anchala et al. [10], cement augmentation followed RFA during the same interventional session. Interestingly, two of the 4 patients not receiving vertebral augmentation in Anchala et al. [10] went on to bone insufficiency fractures and subsequently needed cement augmentation at 3 and 12 months, respectively. In the end, 4 patients in Grönemeyer et al. [19] underwent cement augmentation 3 to 7 days after RFA.
Low-power bipolar radiofrequency ablation and vertebral augmentation for the palliative treatment of spinal malignancies
Published in International Journal of Hyperthermia, 2018
Roberto Luigi Cazzato, Julien Garnon, Jean Caudrelier, Pramod Prabhakar Rao, Guillaume Koch, Afshin Gangi
Following RFA, all the treated levels received vertebral augmentation: simple PMMA augmentation was applied in 10/11 (90.9%) cases; one patient presenting with a pathologic vertical fracture of S1 underwent percutaneous osteosynthesis coupled to PMMA injection to fill the lytic cavity and to fix the tip of the screws in healthy distal bone (Figure 5). Technical success was reached in all cases.