Efficacy of percutaneous vertebroplasty combined with radiotherapy in osteolytic metastatic spinal tumors

2005 ◽  
Vol 2 (3) ◽  
pp. 243-248 ◽  
Author(s):  
Jee-Soo Jang ◽  
Sang-Ho Lee
Keyword(s):  
Pain Relief ◽  
Percutaneous Vertebroplasty ◽  
Invasive Procedure ◽  
Spinal Tumors ◽  
Percutaneous Injection ◽  
Content Type ◽  
Spinal Stabilization ◽  
Before And After ◽  
Fine Print

Object. Vertebroplasty involves the percutaneous injection of polymethylmethacrylate into collapsed vertebral bodies due to hemangioma, osteoporosis, or malignant tumor. The purpose of this study was to evaluate the merits and efficacy of percutaneous vertebroplasty (PVP) combined with radiotherapy in treating patients with osteolytic metastatic spinal tumors (OMSTs). Methods. Twenty-eight patients with OMSTs underwent PVP for the treatment of 72 vertebrae after administration of a local anesthetic or induction of general anesthesia for pain relief and spinal stabilization. Radiotherapy for suppressing tumor or inducing pain relief was performed immediately after PVP in 22 patients. Pain levels were assessed before and after the procedure by using a visual analog scale (VAS), and follow-up assessment was conducted at 1, 3, 6, and 9 months. On postoperative Day 3, marked-to-complete VAS score—based pain relief was achieved in 13 patients (48%) and moderate relief was demonstrated in 11 (41%). The mean VAS pain score was reduced from 8.2 to 3, and major complications were absent in all cases. Follow-up plain radiography was performed to assess vertebral column stability. Neither additional vertebral collapse in the treated vertebrae nor neurological deterioration was observed. Conclusions. Percutaneous vertebroplasty is a minimally invasive procedure and, when combined with radiotherapy, seems to be effective in providing pain relief and stabilization in patients with OMSTs.

Monostotic fibrous dysplasia of the thoracic spine: clinopathological description and follow up

2004 ◽  
Vol 100 (4) ◽  
pp. 378-381 ◽  
Author(s):  
Mehmet Arazi ◽  
Onder Guney ◽  
Mustafa Ozdemir ◽  
Omer Uluoglu ◽  
Nuket Uzum
Keyword(s):  
Fibrous Dysplasia ◽  
Thoracic Spine ◽  
Histopathological Examination ◽  
En Bloc Resection ◽  
Spinal Tumors ◽  
En Bloc ◽  
Content Type ◽  
Thoracic Spinal ◽  
Fine Print

✓ The authors report the case of a 53-year-old woman with monostotic fibrous dysplasia of the thoracic spine. The patient presented with a 1-month history of pain in the thoracic spinal region. En bloc resection of the lesion was successfully performed via a transthoracic approach, and a histopathological examination confirmed the diagnosis of fibrous dysplasia. At 24-month follow-up examination, pain and vertebral instability were absent. The findings in this case illustrate that, although very rare, monostotic fibrous dysplasia of the thoracic spine should be considered in the differential diagnosis of spinal tumors. Although a consensus for management of this disease has not been achieved, the authors recommend radical removal of all involved bone as well as internal fixation or bone graft—assisted fusion to achieve long-term stabilization.

Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures

2002 ◽  
Vol 96 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Kyung Sik Ryu ◽  
Chun Kun Park ◽  
Moon Chan Kim ◽  
Joon Ki Kang
Keyword(s):  
Pain Relief ◽  
Epidural Space ◽  
Percutaneous Vertebroplasty ◽  
Vertebral Compression Fractures ◽  
Osteoporotic Vertebral Compression Fractures ◽  
Content Type ◽  
Compression Fractures ◽  
Dose Dependent ◽  
Pmma Cement ◽  
Fine Print

Object. The use of polymethylmethacrylate (PMMA) cement by percutaneous injection in cases requiring vertebroplasty provides pain relief in the treatment of osteoporotic vertebral compression fractures. A retrospective study was performed to assess what caused PMMA cement to leak into the epidural space and to determine if this leakage caused any changes in its therapeutic benefits. Methods. Polymethylmethacrylate was injected into 347 vertebral compression fractures in 159 patients. The cement leaked into the epidural space in 92 (26.5%) of 347 treated vertebrae in 64 (40.3%) of the 159 patients, as demonstrated on postoperative computerized tomography scanning. Epidural leakage of PMMA cement occurred more often when injected above the level of T-7 (p = 0.001) than below. The larger the volume of PMMA injected the higher the incidence of epidural leakage (p = 0.03). Using an injector also increased epidural leakage (p = 0.045). The position of the needle tip within the vertebral body and the pattern of venous drainage did not affect epidural leakage of the cement. Leakage of PMMA into the epidural space reduced the pain relief expected after vertebroplasty. The immediate postoperative visual analog scale scores were higher (and therefore reflective of less pain relief) in patients in whom epidural PMMA leakage occurred (p = 0.009). Three months postoperatively, the authors found the highest number of patients presenting with pain relief, including those in the group with epidural leakage, and at this follow-up stage there were no significant differences between the two groups. Conclusions. The authors found that epidural leakage of PMMA after percutaneous vertebroplasty was dose dependent. The larger amount of injected PMMA, the higher the incidence of leakage. Injecting vertebral levels above T-7 also increased the incidence of epidural leakage. Epidural leakage of PMMA may attenuate only the immediate therapeutic effects of vertebroplasty.

CyberKnife stereotactic radiosurgical treatment of spinal tumors for pain control and quality of life

2005 ◽  
Vol 2 (5) ◽  
pp. 540-549 ◽  
Author(s):  
Jeffrey W. Degen ◽  
Gregory J. Gagnon ◽  
Jean-Marc Voyadzis ◽  
Donald A. McRae ◽  
Michael Lunsden ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Well Being ◽  
Spinal Tumors ◽  
Content Type ◽  
Cyberknife Radiosurgery ◽  
The Mean ◽  
Initial Score ◽  
Fine Print

Object. The authors conducted a study to assess safety, pain, and quality of life (QOL) outcomes following CyberKnife radiosurgical treatment of spinal tumors. Methods. Data obtained in all patients with spinal tumors who underwent CyberKnife radiosurgery at Georgetown University Hospital between March 2002 and March 2003 were analyzed. Patients underwent examination, visual analog scale (VAS) pain assessment, and completed the 12-item Short Form Health Survey (SF-12) before treatment and at 1, 3, 6, 8, 12, 18, and 24 months following treatment. Fifty-one patients with 72 lesions (58 metastatic and 14 primary) were treated. The mean follow-up period was 1 year. Pain was improved, with the mean VAS score decreasing significantly from 51.5 to 21.3 at 4 weeks (p < 0.001). This effect on pain was durable, with a mean score of 17.5 at 1 year, which was still significantly decreased (p = 0.002). Quality of life was maintained throughout the study period. After 18 months, physical well-being was 33 (initial score 32; p = 0.96) and mental well-being was 43.8 (initial score 44.2; p = 0.97). (The mean SF-12 score is 50 ± 10 [standard deviation].) Adverse effects included self-limited dysphagia (three cases), diarrhea (two cases), lethargy (three cases), paresthesias (one case), and wound dehiscence (one case). Conclusions. CyberKnife radiosurgery improves pain control and maintains QOL in patients treated for spinal tumors. Early adverse events are infrequent and minor. The authors await long-term follow-up data to determine late complications and tumor control rates.

Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression

2002 ◽  
Vol 96 (3) ◽  
pp. 527-531 ◽  
Author(s):  
Elizabeth C. Tyler-Kabara ◽  
Amin B. Kassam ◽  
Michael H. Horowitz ◽  
Louise Urgo ◽  
Constantinos Hadjipanayis ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Long Term Results ◽  
Content Type ◽  
Significant Pain ◽  
Fine Print

Object. Microvascular decompression (MVD) has become one of the primary treatments for typical trigeminal neuralgia (TN). Not all patients with facial pain, however, suffer from the typical form of this disease; many patients who present for surgical intervention actually have atypical TN. The authors compare the results of MVD performed for typical and atypical TN at their institution. Methods. The results of 2675 MVDs in 2264 patients were reviewed using information obtained from the department database. The authors examined immediate postoperative relief in 2003 patients with typical and 672 with atypical TN, and long-term follow-up results in patients for whom more than 5 years of follow-up data were available (969 with typical and 219 with atypical TN). Outcomes were divided into three categories: excellent, pain relief without medication; good, mild or intermittent pain controlled with low-dose medication; and poor, no or poor pain relief with large amounts of medication. The results for typical and atypical TN were compared and patient history and pain characteristics were evaluated for possible predictive factors. Conclusions. In this study, MVD for typical TN resulted in complete postoperative pain relief in 80% of patients, compared with 47% with complete relief in those with atypical TN. Significant pain relief was achieved after 97% of MVDs in patients with typical TN and after 87% of these procedures for atypical TN. When patients were followed for more than 5 years, the long-term pain relief after MVD for those with typical TN was excellent in 73% and good in an additional 7%, for an overall significant pain relief in 80% of patients. In contrast, following MVD for atypical TN, the long-term results were excellent in only 35% of cases and good in an additional 16%, for overall significant pain relief in only 51%. Memorable onset and trigger points were predictive of better postoperative pain relief in both atypical and typical TN. Preoperative sensory loss was a negative predictor for good long-term results following MVD for atypical TN.

Gamma knife surgery for refractory postherpetic trigeminal neuralgia: targeting in one session both the retrogasserian trigeminal nerve and the centromedian nucleus of the thalamus

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 276-282 ◽  
Author(s):  
Marcus F. Keep ◽  
Paul A. DeMare ◽  
Lynn S. Ashby
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Treatment Session ◽  
Single Treatment ◽  
Content Type ◽  
Centromedian Nucleus ◽  
Single Treatment Session ◽  
Fine Print

Object. The authors tested the hypothesis that two targets are needed to treat postherpetic trigeminal neuralgia (TN): one in the trigeminal nerve for the direct sharp pain and one in the thalamus for the diffuse burning pain. Methods. Three patients with refractory postherpetic TN were treated with gamma knife surgery (GKS) through a novel two-target approach. In a single treatment session, both the trigeminal nerve and centromedian nucleus were targeted. First, the trigeminal nerve, ipsilateral to the facial pain, was treated with 60 to 80 Gy. Second, the centromedian nucleus was localized using standard coordinates and by comparing magnetic resonance images with a stereotactic atlas. A single dose of 120 to 140 Gy was delivered to the target point with a single 4-mm isocenter. Patients were followed clinically and with neuroimaging studies. Pain relief was scored as excellent (75–100%), good (50–75%), poor (25–50%), or none (0–25%). Follow up ranged from 6 to 53 months. There were no GKS-related complications. Two patients died of unrelated medical illnesses but had good or excellent pain relief until death. One patient continues to survive with 44 months follow up and no decrease in pain intensity, but with a decreased area of pain. Conclusions. Combined GKS of the centromedian nucleus and trigeminal nerve in a single treatment session is feasible and safe, and the effect was promising. A larger study is required to confirm and expand these results.

Risk of persistent cranial nerve injury after carotid endarterectomy

2004 ◽  
Vol 101 (3) ◽  
pp. 445-448 ◽  
Author(s):  
Edwin J. Cunningham ◽  
Rick Bond ◽  
Marc R. Mayberg ◽  
Charles P. Warlow ◽  
Peter M. Rothwell
Keyword(s):  
Carotid Endarterectomy ◽  
Nerve Injury ◽  
Cranial Nerve ◽  
Nerve Injuries ◽  
Content Type ◽  
Before And After ◽  
Cranial Nerve Injury ◽  
Cranial Nerve Injuries ◽  
Fine Print

Object. Cranial nerve injuries, particularly motor nerve injuries, following carotid endarterectomy (CEA) can be disabling and therefore patients should be given reliable information about the risks of sustaining such injuries. The reported frequency of cranial nerve injury in the published literature ranges from 3 to 23%, and there have been few series in which patients were routinely examined before and after surgery by a neurologist. Methods. The authors investigated the risk of cranial nerve injuries in patients who underwent CEA in the European Carotid Surgery Trial (ECST), the largest series of patients undergoing CEA in which neurological assessment was performed before and after surgery. Cranial nerve injury was assessed and recorded in every patient and persisting deficits were identified on follow-up examination at 4 months and 1 year after randomization. Risk factors for cranial nerve injury were examined by performing univariate and multivariate analyses. There were 88 motor cranial nerve injuries among the 1739 patients undergoing CEA (5.1% of patients; 95% confidence interval [CI] 4.1–6.2). In 23 patients, the deficit had resolved by hospital discharge, leaving 3.7% of patients (95% CI 2.9–4.7) with a residual cranial nerve injury: 27 hypoglossal, 17 marginal mandibular, 17 recurrent laryngeal, one accessory nerve, and three Horner syndrome. In only nine patients (0.5%; 95% CI 0.24–0.98) the deficit was still present at the 4-month follow-up examination; however, none of the persisting deficits resolved during the subsequent follow up. Only duration of operation longer than 2 hours was independently associated with an increased risk of cranial nerve injury (hazard ratio 1.56, p < 0.0001). Conclusions. The risk of motor cranial nerve injury persisting beyond hospital discharge after CEA is approximately 4%. The vast majority of neurological deficits resolve over the next few months, however, and permanent deficits are rare. Nevertheless, the risk of cranial nerve injury should be communicated to patients before they undergo surgery.

Percutaneous transpedicular vertebroplasty with calcium phosphate cement in the treatment of osteoporotic vertebral compression and burst fractures

2002 ◽  
Vol 97 (3) ◽  
pp. 287-293 ◽  
Author(s):  
Masato Nakano ◽  
Norikazu Hirano ◽  
Kousou Matsuura ◽  
Hiroki Watanabe ◽  
Hideki Kitagawa ◽  
...  
Keyword(s):  
Back Pain ◽  
Calcium Phosphate ◽  
Pain Relief ◽  
Vertebral Fractures ◽  
Calcium Phosphate Cement ◽  
Content Type ◽  
Osteoporotic Vertebral Fractures ◽  
The Mean ◽  
Fine Print

Object. Osteoporotic vertebral fractures occasionally lead to late-onset collapse, kyphosis, persistent back pain, and disability. The authors describe a series of patients in whom they performed percutaneous vertebroplasty by using calcium phosphate cement (CPC) to obtain early pain relief and improve the integrity of the osteoporotic vertebral body (VB). Methods. Between August 2000 and February 2001, they performed 17 percutaneous transpedicular CPC-assisted vertebroplasty procedures in 16 patients who harbored thoracic or lumbar osteoporotic vertebral fractures. Following repositioning and curettage of the pathological soft tissues, CPC-assisted vertebroplasty was percutaneously performed in four patients with osteoporotic burst fracture and pseudarthrosis (Procedure A). In situ CPC-assisted vertebroplasty was performed in 12 patients with fresh vertebral compression fractures due to osteoporosis (Procedure B). Back pain and low-back pain were evaluated using a visual analog scale (VAS). The deformity index of the VB was measured on a lateral radiograph as the ratio of the VB's height (sum of measurements at anterior, middle, and posterior regions) to its longitudinal diameter. Based on VAS scores, pain was decreased in all patients immediately after surgery, and pain relief was maintained at the last follow up. The mean preoperative deformity index score of the VB was 1.43 in Procedure A and 1.67 in Procedure B; postoperatively scores improved to 1.59 and 1.93, respectively. At the 6-month follow-up examination, the mean deformity index score rebounded to 1.52 in Procedure A and 1.79 in Procedure B. Bone union was documented in all patients. Complications, such as a temporary respiratory insufficiency and a small amount of CPC leakage into the spinal canal, were observed in patients who underwent Procedure B. Conclusions. Percutaneous transpedicular CPC-assisted vertebroplasty is a minimally invasive procedure that provides early relief of pain and prevents vertebral collapse and pseudarthrosis in patients with osteoporotic vertebral fracture.

Polymethylmethacrylate-augmented screw fixation for stabilization in metastatic spinal tumors

2002 ◽  
Vol 96 (1) ◽  
pp. 131-134 ◽  
Author(s):  
Jee Soo Jang ◽  
Sang Ho Lee ◽  
Chang Hun Rhee ◽  
Seung Hoon Lee
Keyword(s):  
Vertebral Column ◽  
Screw Fixation ◽  
Neurological Deficits ◽  
Spinal Tumors ◽  
Complete Relief ◽  
Content Type ◽  
Vertebral Bodies ◽  
The Mean ◽  
Fine Print

✓ Screw fixation augmented with polymethylmethacrylate (PMMA) or some other biocompatible bone cement has been used in patients with osteoporosis requiring spinal fusion. No clinical studies have been conducted on PMMA-augmented screw fixation for stabilization of the vertebral column in patients with metastatic spinal tumors. The purpose of this study was to determine whether screw fixation augmented with PMMA might be suitable in patients treated for multilevel metastatic spinal tumors. Ten patients with metastatic spinal tumors involving multiple vertebral levels underwent stabilization procedures in which PMMA was used to augment screw fixation after decompression of the spinal cord. Within 15 days, partial or complete relief from pain was obtained in all patients postoperatively. Two of four patients in whom neurological deficits caused them to be nonambulatory before surgery were able to ambulate postoperatively. Neither collapse of the injected vertebral bodies nor failure of the screw fixation was observed during the mean follow-up period of 6.7 months. Screw fixation augmented with PMMA may offer stronger stabilization and facilitate the instrumentation across short segments in the treatment of multilevel metastatic spinal tumors.

Treatment of essential trigeminal neuralgia with gamma knife surgery

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 29-33 ◽  
Author(s):  
Dusan Urgosik ◽  
Roman Liscak ◽  
Josef Novotny ◽  
Josef Vymazal ◽  
Vilibald Vladyka
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Success Rate ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Recurrent Pain ◽  
Content Type ◽  
Fine Print ◽  
Initial Success Rate

Object. The authors present the long-term follow-up results (minimum 5 years) of patients with essential trigeminal neuralgia (TN) who were treated with gamma knife surgery (GKS). Methods. One hundred seven patients (61 females and 46 males) underwent GKS. The median follow up was time was 60 months (range 12–96 months). The target was the trigeminal root, and the maximum dose was 70 to 80 Gy. Repeated GKS was performed in 19 patients for recurrent pain, and the same dose was used. Initial successful results were achieved in 96% of patients, with complete pain relief in 80.4%. Relief was achieved after a median latency of 3 months (range 1 day–13 months). Gamma knife surgery failed in 4% of patients. Pain recurred in 25% of patients after a median latent interval of 36 months (6–94 months). The initial success rate after a second GKS was 89% and 58% of patients were pain free. Pain relapse occurred in only one patient in this group. Hypesthesia was observed in 20% of patients after the first GKS and in 32% after the second GKS. The median interval to hypaesthesia was 35 months (range 3–94 months) after one treatment and 21 months (range 1–72 months) after a second treatment. Conclusions. The initial success rate of pain relief was high and comparable to that reported in other studies. A higher than usual incidence of sensory impairment after GKS could be the long duration of follow-up study and due to the detailed neurological examination.

Dedicated linear accelerator radiosurgery for the treatment of trigeminal neuralgia

2003 ◽  
Vol 99 (3) ◽  
pp. 511-516 ◽  
Author(s):  
Zachary A. Smith ◽  
Antonio A. F. De Salles ◽  
Leonardo Frighetto ◽  
Bryan Goss ◽  
Steve P. Lee ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Linear Accelerator ◽  
Facial Pain ◽  
Content Type ◽  
Excellent Outcome ◽  
Linac Radiosurgery ◽  
Root Entry Zone ◽  
Fine Print

Object. In this study the authors evaluate the efficacy of and complications associated with dedicated linear accelerator (LINAC) radiosurgery for trigeminal neuralgia (TN). Methods. Between August 1995 and February 2001, 60 patients whose median age was 66.1 years (range 45–88 years) were treated with dedicated LINAC radiosurgery for TN. Forty-one patients (68.3%) had essential TN, 12 (20%) had secondary facial pain, and seven (11.7%) had atypical features. Twenty-nine patients (48.3%) had undergone previous surgical procedures. Radiation doses varied between 70 and 90 Gy (mean 83.3 Gy) at the isocenter, with the last 35 patients (58.3%) treated with a 90-Gy dose. A 5-mm collimator was used in 45 patients (75%) and a 7.5-mm collimator in 15 patients (25%). Treatment was focused at the nerve root entry zone. At last follow up (mean follow-up period 23 months, range 2–70 months), 36 (87.8%) of the 41 patients with essential TN had sustained significant pain relief (good plus excellent results). Twenty-three patients (56.1%) were pain free without medication (excellent outcome), 13 (31.7%) had a 50 to 90% reduction in pain with or without medication (good outcome), and five (12.2%) had minor improvement or no relief. Of 12 patients with secondary facial pain, significant relief was sustained in seven patients (58.3%); worse results were found with atypical pain. Fifteen (25%) of the 60 patients experienced new numbness postprocedure; no other significant complications were found. Pain relief was experienced at a mean of 2.7 months (range 0–12 months). Conclusions. Dedicated LINAC radiosurgery is a precise and effective treatment for TN.

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