Vertebroplasty and kyphoplasty are minimally invasive procedures used to treat painful vertebral compression fractures. Vertebroplasty involves injecting bone cement into the fractured vertebra to stabilize it, while kyphoplasty first uses an inflatable balloon to restore vertebral height before cement injection. Both procedures provide effective pain relief, though kyphoplasty may reduce risks of new fractures and cement leakage compared to vertebroplasty. Candidate selection, technical execution, and post-procedure management are important to achieve optimal outcomes and minimize complications.
Pain from acute vertebral fracture appears to be due in part to instability (non-union or slow union at the fracture site), while more than 1/3 of patients become chronically painful.
Traditional treatment for patients with painful VCFs includes bed rest, narcotic analgesics and bracing, resulting in increased pain because of acceleration bone loss and muscle weakness.
Vertebroplasty is an effective, minimally invasive spine procedure where acrylic bone cement is injected into a painful pathologically compressed vertebral body.
Pain from acute vertebral fracture appears to be due in part to instability (non-union or slow union at the fracture site), while more than 1/3 of patients become chronically painful.
Traditional treatment for patients with painful VCFs includes bed rest, narcotic analgesics and bracing, resulting in increased pain because of acceleration bone loss and muscle weakness.
Vertebroplasty is an effective, minimally invasive spine procedure where acrylic bone cement is injected into a painful pathologically compressed vertebral body.
Operative treatment of osteoporotic spinal fracturesAlexander Bardis
Osteoporosis is a systemic disease, which results in :
progressive bone mineral loss
concurrent changes in bony architecture
leaving the spinal column vulnerable to compression fractures, usually after minimal or no trauma.
Hip dysplasia in adults, types, radiographs and management!
Useful for Orthopaedic residents and Surgeons.
Include most of the basics from reliable sources, pardon for any mistakes. Contact at singh_prabhjeet@yahoo.com for any corrections.
Distal femur fractures what makes it complex ,dr mohamed ashraf,hod orthopae...drashraf369
distal femur fractures are notorious for post operative complications due to malreduction and improper fixation.unless plan and execute a sound and stable fixation,this injury will lead to undesirable results.dr mohamed ashraf HOD orthopaedics govt TD medical college is presenting how to avoid complications in surgical management of these fractures..
Tensor fascia lata[tfl] muscle pedicle grafting for avn hip dr mohamed ashraf...drashraf369
slide presentation of a very promising surgical technic for a very elusive condition called avascular necrosis of femoral head.good clinical and surgical demo by dr mohamed ashraf,HOD, govt TD medical college ,alleppey,kerala, india
Operative treatment of osteoporotic spinal fracturesAlexander Bardis
Osteoporosis is a systemic disease, which results in :
progressive bone mineral loss
concurrent changes in bony architecture
leaving the spinal column vulnerable to compression fractures, usually after minimal or no trauma.
Hip dysplasia in adults, types, radiographs and management!
Useful for Orthopaedic residents and Surgeons.
Include most of the basics from reliable sources, pardon for any mistakes. Contact at singh_prabhjeet@yahoo.com for any corrections.
Distal femur fractures what makes it complex ,dr mohamed ashraf,hod orthopae...drashraf369
distal femur fractures are notorious for post operative complications due to malreduction and improper fixation.unless plan and execute a sound and stable fixation,this injury will lead to undesirable results.dr mohamed ashraf HOD orthopaedics govt TD medical college is presenting how to avoid complications in surgical management of these fractures..
Tensor fascia lata[tfl] muscle pedicle grafting for avn hip dr mohamed ashraf...drashraf369
slide presentation of a very promising surgical technic for a very elusive condition called avascular necrosis of femoral head.good clinical and surgical demo by dr mohamed ashraf,HOD, govt TD medical college ,alleppey,kerala, india
An Introduction, History, Diagnosis, Current Guidelines on Treatment of trochanteric fractures of femur. Presentation also contain an introduction of Dynamic Hip Screw and Surgical Techniques.
Evaluation of Lumbar Spine Disease starts with understanding the clinical back grounds. It starts with good history and physical examination. This is a teaching lecture given twice by Prof. Dr. Mohamed Mohi Eldin, professor of neurosurgery, in the Basic Spine Course, Egyptian Medical Syndicate, Cairo, March 2009 and in 2010.
Basic spine anatomy is the first step in understanding the spine profession. Being familiar with spine anatomy makes you spine-minded, understand pathological spine diseases, correlate symptoms and signs, and facilitate your surgical skills.
This is a teaching lecture given twice by Prof. Dr. Mohamed Mohi Eldin, professor of neurosurgery, in the Basic Spine Course, Egyptian Medical Syndicate, Cairo, March 2009 and in 2010.
Schmorl’s nodes (SN) or Intervertebral Disc Herniations are Commonly observed on routine radiographs at autopsy.
This is a teaching lecture given by Prof. Dr. Mohamed Mohi Eldin, professor of neurosurgery, in the weekly conference of kasr El Aini Neurosurgery Department, Cairo University, November 2010.
Degenerative Marrow Changes (Signal intensity changes) adjacent to the endplates of degenerated discs are a common observation on MR images.
This is a teaching lecture given twice by Prof. Dr. Mohamed Mohi Eldin, professor of neurosurgery, in the weekly conference of kasr El Aini Neurosurgery Department, Cairo University, November 2010 and January 2013.
This is a teaching lecture given twice by Prof. Dr. Mohamed Mohi Eldin, professor of neurosurgery, in the weekly conference of kasr El Aini Neurosurgery Department, Cairo University, October 2010 and January 2013.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Vertebral Augmentation by Vertebroplasty and Kyphoplasty: Introductory concerns
1. Vertebroplasty and Kyphoplasty
Introductory Concerns
Mohamed Mohi Eldin,
Professor of Neurosurgery,
Faculty of Medicine,
Cairo University
One-Day Spine Clinic 4th workshop & hands-on,
27-28 December 2017
2. History
Acrylic cements have been used for bone
augmentation for over 5 decades
Stabilization of large tumor defects after (Vidal, 1969)
Hip replacement (Chamley, 1970)
First reported case of percutaneous
vertebroplasty in Amiens, France
Galibert and Deramond, 1984
50 year-old female with neck pain due to a cervical (C2)
hemangioma
3. Vertebral Augmentation
Cementoplasty
(X-ray guided spine augmentation)
• Vertebroplasty (1984): Injection of material (usually PMMA
cement) into vertebral body
• Kyphoplasty (1998): Injection after manipulation involving
cavity creation
• Spinoplasty
• Pediculoplasty
• Sacroplasty
• Cannulated, Fenestrated, Augmented Screws
Indicated for painful compression fractures
osteoporosis
cancer
4. PRACTICE GUIDELINE FOR THE PERFORMANCE OF VERTEBROPLASTY. American College of
Radiology. 2009.
Who are Qualified Personnel ?
1. Experience
1. 6 months of training involving cross-sectional imaging
2. 4 months of training involving interventional procedures
3. or equivalent experience
2. Performance of successful vertebroplasties in at least 5
patients as the primary operator, under the supervision of a
qualified consultant, and without complications
3. Relevant knowledge and skill of spine, radiation, etc.
6. Vertebroplasty
(V-plasty)
• A minimally invasive procedure done primarily
to relieve pain caused by fracture of the spinal
vertebrae (vertebral body).
• Injected bone cement (PMMA) into the
affected vertebra stabilizes the bone and
relieve pain.
• Most effective for fractures that are less than
six month old.
9. Vertebroplasty
Indications
Even without obvious loss of
vertebral body height
• Symptomatic vertebral body
microfracture as documented by
– magnetic resonance imaging [MRI]
– nuclear imaging, and/or
• Lytic lesion (seen on CT)
PRACTICE GUIDELINE FOR THE PERFORMANCE OF VERTEBROPLASTY. American College of
Radiology. 2009.
14. Osteoporotic Compression Fractures
Conservative Therapy
• NSAIDS
• Opioids
• Muscle relaxants
• Bed rest
• Orthotic bracing
VCF healing should occur in 6-12 weeks
Refractory in 15-20% of patients
15. Osteoporotic Compression Fractures
Traditional Management
Side effects can be significant
• Analgesics
– Temporary
– Side effects
• Bed rest
– Deep venous thrombosis
– Pneumonia
• Immobilization
– Variable success
– further demineralization
• Surgery
– Challenging
– For neuro compromise
19. Relative Contraindications
• Radiculopathy (unrelated)
• Retropulsion of a fragment
(severe canal compromise)
• Tumor extension into canal
• Systemic infection
• Improvement on medical
therapy.
• NO Prophylaxis in
osteoporosis
• Myelopathy at fracture level
20. Vertebroplasty
Objectives
• To provide relief from a
painful vertebra
• To provide stability
• To prevent further
vertebral collapse that
would
– Lead to further loss of
height
– Result in kyphosis
– Be associated with
fractures at adjacent levels
21. What about
Early Intervention ??
May Reduce
• Duration of
– acute pain
– Medication use
– immobilization
• Occurrence of chronic back pain
• Further collapse of the treated vertebra
– Height loss
– Kyphosis
– Incidence of pulmonary embolism and pneumonia
22. Vertebroplasty
Patient Selection Criteria
– Painful fracture (Increased on loading)
– Not responding after 4 weeks of treatment
– Acute or subacute compression fracture(s) on
plain radiographs or MRI (altered signal in body)
– Pain corresponding to level of the fracture (Local
tenderness over spinous process)
23. Vertebroplasty
Patient Good Selection
• Patients who tend to respond the best
– 1 to 3 levels of fractures.
– Focal pain and tenderness corresponding to the
level of edema by MRI
– Fracture present < 2 months
– Recent worsening of fracture
– No sclerosis of fractured vertebra
24. Vertebroplasty
Patient Bad Selection
• Patients who are less likely to respond
– Fracture present for >1 year
– Other causes for back pain
• Disc herniation,
• spinal stenosis,
• facet or sacroiliac joint disease
– Radicular pain related to disc herniation
25. Benefits of Vertebroplasty
• Pain relief
– Quick
– Complete: osteoporosis > neoplasia
• Improved mobility
– Patient able to stand and walk within first 24
hours
Success Rates Threshold for Review
Neoplastic 70% to 92% <60%
Osteoporosis 80% to 95% <70%
PRACTICE GUIDELINE FOR THE PERFORMANCE OF VERTEBROPLASTY. American College of Radiology. 2009.
26. Efficacy of Vertebroplasty
• Osteoporotic compression fracture
– 75-90% dramatic or complete relief of pain
within several to 72 hours
• Neoplastic compression fracture
– 59-86% marked reduction in narcotic
requirements or complete pain relief
Low complication rate
Very high success rate
27. Why Vertebroplasty Alleviate Pain?
• Stabilizes fracture
– microfractures
– macrofractures
• Allows healing to occur
• Destruction of sensitive nerve
endings (mechanical, chemical
and thermal forces)
• Prevents further collapse
• Tumors??
– Thermal effect
– Toxic effect
– Mass effect
28. Vertebroplasty
is a palliative procedure
does not correct the underlying cause
of vertebral fracture
So,
Medical management of osteoporosis or
malignancy must be initiated and continued
31. Pre-Procedure Imaging
Magnetic resonance imaging
T1, T2, STIR sequences.. Why ?!
– Assess for vertebral body marrow edema
– Exclude stenosis due to disc and/or facet disease
Computed tomography
– If MRI contraindicated
– Assesses cortical integrity of posterior vertebral
body and pedicles
32. Think twice!
• Fractures above T6
• Less than 55 yrs
without history of
trauma
• Patients with known
malignancy
33. Age of fracture
• Best indicator of age is
the history
• Plain films
• MRI
– Low signal T1
– High signal T2
– High signal STIR
34. Bone Scan
• Not as commonly used
as MRI
• Been show to have a
93% predictive value in
vertebroplasty!
• May be abnormal when
MRI is normal
• Maynard et al. Value of bone scan imaging
in predicting pain relief in vertebroplasty.
AJNR 2000;21:1807-12.
35. Pre-Procedure Consultation
• Examination under fluoroscopy
– Concordance between painful sites and levels of
vertebral body compression
– Occasionally needed
• Informed consent
36. Pre-Procedure Care
• NPO after midnight
• Antibiotics
– Optional.
– Recommended for immune compromised patients.
– Systemic.
– Local: Added to cement.
• Patient Positioning and Draping
– Patient prone.
– Strict sterile technique.
44. Spinoplasty
APPLYING VERTEBROPLASTY TO POSTERIOR ARCH
(posterior arch & spinous processes/laminae complex)
Needle placement in the spinous processes. Fluoroscopic ventral
limit to avoid central canal violation is the posterior margin of the
inferior articular process
49. Pediculoplasty
Similar to vertebroplasty but with increased procedural risks because of the
immediate vicinity of neural structures,
performed under high-quality biplane fluoroscopic guidance
51. Sacroplasty Indications
• Sacral fracture
– Insufficiency
fracture
– Pathologic fracture
– Post-traumatic
fracture
• Painful sacral
neoplasm/mass
severe osteoporosis and bilateral comminuted
fractures of the sacral alae
52. Sacral insufficiency fractures
Occur when the quality of the sacral bone has become
insufficient to handle the stress of weight bearing (weak
bone) usually because of osteoporosis
Occur most often in older women.
characteristic H-shaped sacral
insufficiency fracture
bilateral ill-defined sacral lucencies
(sacral ala fractures)
57. Kyphoplasty
• Minimally-invasive
• Percutaneous
• Can restore lost vertebral
height
• Immediate pain reduction
• Fewer complications
compared to vertebroplasty
• By 2005, performed on
170,000 patients
58. How does it work?
• Structural support – but no good correlation
with amount of cement injected
• Thermal properties
• Decompression
• Placebo effect
59. How is it done?
Preoperative on-table reduction
61. How is it done?
• Usually under general anaesthetic
• in prone position
• 3-4 cm bilateral incision
• via the pedicles using
– trocar,
– guidewire,
– cannula,
– bone tamp,
– cement
• Maximum of 3 vertebral bodies
64. Indications for
vertebroplasty/kyphoplasty
• Only needed in a small
subset of patients
• High signal on STIR.
• Pain on percussion
• Increased activity on
bone scan
• T5 and below-
kyphoplasty
• Timing?
66. Timing
• The best evidence is that the best results are
achieved within 6 weeks of onset!
• 50% + get better within 6 weeks
conservatively treated.
• Philosophical when to treat.
• Most fractures treated > 3 months old.
67. Timing
Older fractures
• No randomised control trials for efficacy of
treatment of old fractures.
• There are trials suggesting similar success
rates to acute fractures of 80% success in
fractures a year or older.
• Brown et al. Treatment of Chronic symptomatic vertebral compression
fractures with percutaneous vertebroplasty . AJN 2004;182:319-312.
70. Balloon Kyphoplasty Case Study
Patient: 76 YO Female
Diagnosis: Metastatic Lung Cancer
Fracture Reduced: T8, 8 weeks old
Courtesy of Henry Small, M.D., Houston, TX
71. Conclusions
• Kyphoplasty is a safe and effective treatment
for back pain due to osteoporotic VCFs.
• Providers should include kyphoplasty in the
discussion of options for the VCF patient
• Reimbursement available by Medicare and
private insurance companies
72. Vertebroplasty v Kyphoplasty
My best protocol
• Fractures less than 6
weeks old who need to be
hospitilised.
• Failure of conservative
treatment after 3 months
• Vertebroplasty for all
except where middle
column is involved –
Kyphoplasty,
• Bone scan +ve
74. Vertebroplasty v Kyphoplasty
Vertebroplasty
• Cheaper
• Quicker
Kyphoplasty
• Expensive
• Takes longer
• Restoration of vertebral
height?
• Less adjacent fractures
• Less cement leakage
• Quality of life
75. Vertebroplasty v Kyphoplasty
A review of 168 studies
Vertebroplasty
• Mean change in VAS 5.68
• New fracture 17.9%
• Cement leak 19.7%
Kyphoplasty
• Mean change in VAS 4.60
p<0.001
• New fracture 14.1%
p<0.01
• Cement leak 7.0%
p<0.001
• Comparison of vertebroplasty and
kyphoplasty in vertebral compression
fractures: a meta-analysis of the
literature. Spine J 2008;8:488-97.
76. Meta-Analysis of Complications
Total Procedure-
Related
Complications
Cement-Related
Complications
Access-Related
Complications
Non-Device-
Related
Complications
Balloon Kyphoplasty
N = 1947 patients
14
(0.7%)
3
(0.2%)
4
(0.2%)
7
(0.4%)
Vertebroplasty
N = 6808 patients
199
(2.9%)
132
(1.9%)
28
(0.4%)
39
(0.6%)
p-value 0.0002* <0.0001* 0.3791 0.8781
*Balloon kyphoplasty has statistically significant lower complication
rates compared to vertebroplasty
Data on file, Medtronic Spine LLC.
77. Taylor Study*
Cement Leakage Results
p < 0.0001
BK: 90/1111 = 8%
VP: 614/1551 = 40%
(p-value not reported)
BK: 0/1094 = 0%
VP: 8/275 = 3%
Taylor, Taylor, Fritzell. Spine. 2006;31:2747–2755 – See Table 6.
*Includes fracture of all etiologies. BK = balloon kyphoplasty. VP = vertebroplasty.
79. Problems
Fracture acuity
Bone marrow oedema indicates
an acute fracture
but a detectable fracture line sufficed for
inclusion.
Sometimes in MRI or Bone scan
fracture age was uncertain.
80. Developments
• Calcium phosphate in young patients with traumatic
fractures
• Prophylaxis
• Adding chemotherapy agents or radioactive isotopes
to the cement in tumour