Kyphoplastie

[Spinal fractures]

Osteoporotic spinal fractures are typical age-related fragility fractures. Their impact on the quality of life is often underestimated; therefore, anti-osteoporotic drug treatment according to the current guidelines is essential. Occult vertebral fractures may be difficult to detect and a differentiation between fresh and old fractures is often only possible with magnetic resonance imaging (MRI) to reveal cancellous bone edema. Treatment recommendations are predominantly based on traumatic fractures in younger adults and are thus not applicable in orthogeriatrics. A new classification currently under validation and presented in this article was developed in order to aid decision-making for operative interventions. Minimally invasive treatment options include vertebroplasty, kyphopasty and internal fixation. The application of cement provides additional stability but can be accompanied by cement-specific complications, such as extravasation and embolism.

[Operative therapy of spinal metastases from urological tumors]

The treatment of bone metastases from urological tumors represents a palliative form of therapy, apart from the resection of solitary metastases from renal cell carcinomas. Due to the high incidence of spinal metastases this can result in clinically significant symptoms and possible complications for patients, such as pain, spinal instability and compression of the spinal canal with corresponding neurological deficits. By the use of targeted diagnostics and induction of radiotherapeutic and/or surgical treatment, for the majority of patients an immediate reduction in pain as well as early mobilization and sometimes even regression of existing neurological deficits and therefore an improved quality of life can be achieved.

Polyostotic fibrous dysplasia of the thoracic spine: case report and review of the literature

STUDY DESIGN

A case report of polyostotic fibrous dysplasia including thoracic spine, sacral vertebrae, and temporal bone, with the symptom of back pain.

OBJECTIVE

To treat the lesions with percutaneous kyphoplasty.

SUMMARY OF BACKGROUND DATA

Polyostotic fibrous dysplasia involving either spine or temporal bone is rarely seen. Few reports of this disorder appear in the literature. This is the first case including thoracic spine, sacrum, and temporal bone together presented to date.

METHODS

The patient was a 56-year-old woman with polyostotic fibrous dysplasia involving the thoracic spine of the eighth, ninth, and 10th vertebral body; adjacent rib; the right temporal bone and the sacrum. Percutaneous kyphoplasty in ninth and 10th vertebral body was carried out to achieve substantial pain relief and rapid stabilization of the spine with minimal invasion.

RESULTS

The patient experienced complete pain relief and had no clinical complications associated with the cement leakage. The patient tolerated the procedure well. There were no clinical complications and substantial pain relief was noted within hours of the procedure. She has no pain or disability at 1-year follow-up.

CONCLUSION

Percutaneous kyphoplasty was a good therapeutic option for the reported patient.

[Degeneration and osteoporosis of the spine. Is there a modified procedure?]

Reduced bone quality due to osteoporosis poses a fundamental problem in spine surgery instrumentation. The consequences observed most often are insufficient implant anchoring and adjacent fractures. In cases of manifest osteoporosis, several modern anchoring possibilities are at our disposal that, to differing degrees, increase the stability of the instrumentation. Cement augmentation of a fractured vertebra by means of kyphoplasty or vertebroplasty verifiably leads to significantly better pain reduction than conservative treatment does, at least in the short-term postoperative course. A difference between these two techniques has not yet been substantiated. The rate of adjacent fractures occurring after cement augmentation is not higher than in conservatively treated patients.

[Kyphoplasty in osteoporotic spinal fractures]

Kyphoplasty has been the standard procedure for osteoporotic fractures for more than 5 years but the material costs are still very high. The aim of this study was to clarify whether pain reduction could be achieved without increasing the rate of new fractures and also in what areas costs could possibly be reduced. From 15.01.2007 until 15.01.2008, a total of 100 patients with 126 recent osteoporotic spinal fractures were treated by kyphoplasty with an average operation time of 38 min and follow-up times up to 12 months. During this follow-up period 15 lateral and 2 dorsal cement leakages remained asymptomatic and 1 dorsal leakage caused an incomplete paraparesis, which was finally cured completely. All patients were very content and pain measured on the visual analogous scale could be lowered from 8.0 before the operation to 2.7 points after the operation. With material costs of 3,056 Euro, there were additional operation costs of 247 Euro per case. The average effective weight was 2.84. On average 7,810 Euro returns could be achieved, deducting material and operation costs left 4,507 Euro per case. More than 40% of gains were reinvested in operation and material costs. Within 12 months 6 new fractures occurred despite medicinal prophylactic treatment which could also be successfully treated by kyphoplasty. The average visual analogous scale after 12 months was 2.1 points.Kyphoplasty still causes financial deficits due to high material costs, however, patients benefit from a reduction of pain.