Vertebroplasty for vertebral compression fractures secondary to Cushing's syndrome induced by an ACTH-producing bronchial carcinoid tumour.
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Adrenocorticotropic hormone (ACTH)-producing bronchial carcinoid tumours are a rare cause of Cushing's syndrome. Cushing's syndrome is frequently complicated by osteoporosis, which results in an increased tendency for the development of vertebral compression fractures. Percutaneous vertebroplasty has been shown to be an effective treatment option in the setting of painful osteoporotic compression fractures refractory to conservative therapies. We report a case where vertebroplasty was performed on a 36-year-old woman with osteoporosis and compression fractures secondary to hypercorticolism. A bronchial carcinoid tumour was found to be the source of excess ACTH production. Three-level percutaneous vertebroplasty resulted in a marked improvement in pain. (+info)
Redo kyphoplasty with vertebroplasty technique: a case report and review of the literature.
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Osteoporosis is a metabolic disorder which may result in devastating medical problems if not treated appropriately. However, even in the best treated patients fractures may occur. The most devastating fractures are spine and hip. Traditionally, treating fractures of the spine consisted of bed rest, opioid analgesic medications, and bracing. This resulted in increased risk of side-effects from medication, myocardial infarction, pulmonary embolism, pneumonia, admissions to nursing homes, and death. Vertebroplasty and kyphoplasty techniques were developed to decrease the detrimental effects of "conservative care" by decreasing or eliminating the pain and stabilizing the fracture. The safety and efficacy of vertebroplasty and kyphoplasty are similar with several biased opinions in the literature which denotes conflict. Choosing one technique over the other is a physician and/or facility performed preference. There are a small percentage of patients that either vertebroplasty or kyphoplasty does not help. Possibilities could be that not enough cement was used, an adjacent level fracture has occurred, or worsening fracture around the previously treated fracture is causing the pain. For the latter, a repeat vertebral augmentation could be medically necessary. Due to technical constraints, placing an additional kyphoplasty after one has already been accomplished may be technically dangerous and a simpler less costly vertebroplasty technique may be beneficial. This is a case report and review of the literature on the treatment of repeat vertebral augmentation after a previously treated vertebral fracture with kyphoplasty technique. To this date, this is the first article published regarding the use of vertebroplasty technique over a kyphoplasty treated patient. In this case report, a redo vertebroplasty was performed over a previously treated kyphoplasty or vertebroplasty. This procedure can give a patient significant pain relief when they are suffering with pain after a previously treated fracture. (+info)
Postoperative bedrest improves the alignment of thoracolumbar burst fractures treated with the AO spinal fixator.
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BACKGROUND: A loss of reduction due to inadequate support of the anterior column when using short-segment instrumentation to treat burst fracture and novel methods for support of the anterior column through a posterior approach to augment posterior instrumentation have been reported in the literature. We hypothesized that if anterior column support is an important adjunct to posterior short-segment instrumentation, then avoidance of axial load until sufficient anterior column healing occurs, allowing load-sharing with the implant, would improve spinal alignment at follow-up. METHODS: We conducted a retrospective cohort study in which consecutive patients who had instrumentation and fusion with the AO spinal fixator were immediately ambulated after surgery or had 4 weeks of bedrest. We measured kyphosis and wedge angles preoperatively, immediately postoperatively and at the time of final follow-up. We used radiologic measures to assess instrumentation and bone failure. RESULTS: We found significant differences in the mean loss of wedge and kyphosis angle correction between patients immediately ambulated and those who had 4 weeks of bedrest (0.71 masculine v. - 4.73 masculine for wedge and 1.81 masculine v. - 6.55 masculine for kyphosis, respectively). There was significant correlation between instrumentation and bone failure in both the immediate ambulation and bedrest groups. CONCLUSION: Bedrest improves the maintenance of intraoperative sagittal alignment correction, which is in agreement with the theory that inadequate support of the anterior spinal column is the mechanism for loss of reduction when using short-segment instrumentation to treat burst fractures. Therefore, addressing the anterior column directly through anterior surgery or by employing novel techniques in posterior surgery is recommended if one of the goals of treatment is to maintain the sagittal correction achieved at the time of surgery. Trying to achieve this goal by addressing posterior implant design or bone quality alone will not be successful because instrumentation and bone failure occur together. (+info)
Phase I/II clinical study of percutaneous vertebroplasty (PVP) as palliation for painful malignant vertebral compression fractures (PMVCF): JIVROSG-0202.
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The intravertebral cleft in benign vertebral compression fracture: the diagnostic performance of non-enhanced MRI and fat-suppressed contrast-enhanced MRI.
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