Percutaneous vertebroplasty of a myelomatous compression fracture in the presence of previous posterior instrumentation

2006 ◽  
Vol 5 (2) ◽  
pp. 168-171 ◽  
Author(s):  
Indro Chakrabarti ◽  
Allen W. Burton ◽  
Ganesh Rao ◽  
Iman Feiz-Erfan ◽  
Roman Hlatky ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Back Pain ◽  
Percutaneous Vertebroplasty ◽  
Posterior Instrumentation ◽  
Compression Fracture ◽  
The Other ◽  
Posterior Stabilization ◽  
Patient Reported ◽  
Acute Back Pain ◽  
Effective Analgesia

✓ The authors report the use of percutaneous transpedicular vertebroplasty performed using polymethylmethacrylate (PMMA) in two patients. These men (53 and 57 years old) had previously undergone open surgery and posterior instrumentation to treat myelomatous compression fractures. Both patients presented with acute back pain that manifested after minor activities. Kyphotic wedge fractures were diagnosed at T-11 in one case and at L-1 in the other. Both patients were treated at other hospitals with laminectomy and instrumented fusion; multiple myeloma was diagnosed after surgery. The patients experienced severe, recalcitrant, and progressive pain; on referral, they were found to have persistent kyphosis. Multiple myelomatous lesions of the spine were seen in one case and in the other the L-1 fracture represented the only site of disease. Percutaneous vertebroplasty was performed by injecting PMMA into the anterior third of the compressed vertebral body. Both patients experienced a 50% reduction in pain immediately after treatment; 3 months later both were walking and reported minimal back pain while undergoing treatment for multiple myeloma. Three years after surgery one patient reported no back pain and no progressive instability of the spine. Four years after surgery the other patient remains pain free, ambulatory, and with overall disease remission. Percutaneous vertebroplasty provided effective analgesia in these two patients with progressive back pain despite posterior stabilization. In both cases, the anterior column was effectively stabilized. A much larger operative intervention with its attendant risks of morbidity was avoided. In addition, subsequent aggressive medical treatment was well tolerated.

scholarly journals Pigmented epithelioid melanocytoma (PEM) of the spine with compression fracture: case report

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Sarthak Nepal ◽  
Borriwat Santipas ◽  
Wasan Yotchai ◽  
Manasmon Chairatchaneeboon ◽  
Sirichai Wilartratsami ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Back Pain ◽  
Posterior Instrumentation ◽  
Compression Fracture ◽  
Operative Intervention ◽  
Treatment Modalities ◽  
Spinal Tumors ◽  
En Bloc ◽  
Patient Reported ◽  
Complete Tumor

Abstract Background Pigmented epithelioid melanocytoma (PEM) is a sporadic type of pigmented melanocytic tumor with uncertain malignant potential. PEM arises as a solitary neoplasm that predominantly occurs spontaneously in otherwise healthy patients. Due to its rarity, a gold standard treatment regimen does not exist; however, symptomatic cases should be managed with radiotherapy and surgery. Case presentation A 28-year-old Thai female presented with a sudden onset of back pain and weakness of the lower extremities during the postpartum period. Magnetic resonance imaging demonstrated abnormal soft tissue formation from T4 to T7; it extended to the vertebral bodies, left neural foramina, and posterior columns of T6 and T7. The patient underwent complete tumor debulking, decompressive laminectomy from T4 to T8, and posterior instrumentation from T3 to T10. The histopathology and immunohistochemistry suggested PEM. The patient fully resolved back pain after surgery. Nevertheless, as the patient re-presented with a neurological deficit a few months after the operative intervention, it was decided to perform a surgical resection via an en bloc vertebrectomy. At the one-year follow-up, although the patient reported continued improvement of her back pain, there was no motor power improvement. Conclusions Spinal cord compression due to PEM is uncommon, especially in adults. Early diagnosis and treatment provide a good prognosis and help to regain lost neurological functions. Complete tumor removal and decompression of the spinal cord must be considered as a treatment strategy. Perioperative radiotherapy and chemotherapy have also been highlighted as treatment modalities for spinal tumors. With our reported case, early operative intervention coupled with radiotherapy produced satisfying outcomes.

scholarly journals Percutaneous vertebroplasty in vertebral osteonecrosis (Kümmell's spondylitis)

1999 ◽  
Vol 7 (1) ◽  
pp. E4 ◽  
Author(s):  
Huy M. Do ◽  
Mary E. Jensen ◽  
William F. Marx ◽  
David F. Kallmes
Keyword(s):  
Back Pain ◽  
Mr Imaging ◽  
Vertebral Body ◽  
Chronic Back Pain ◽  
Percutaneous Vertebroplasty ◽  
Fluid Collection ◽  
Compression Fracture ◽  
Response To Therapy ◽  
Vertebral Osteonecrosis

The authors report the clinical symptoms and response to therapy of a series of patients who presented with subacute or chronic back pain due to vertebral osteonecrosis (Kümmell's spondylitis) and who underwent percutaneous vertebroplasty. The authors performed a retrospective chart review of a series of 95 patients in whom 149 painful, nonneoplastic compression fractures were demonstrated and who were treated with percutaneous transpediculate polymethylmethacrylate (PMMA) vertebroplasty. In six of these patients there was evidence of vertebral osteonecrosis, as evidenced by the presence of an intravertebral vacuum cleft on radiography or by intravertebral fluid on magnetic resonance (MR) imaging. Clinical and radiological findings on presentation were noted. Technical aspects of the vertebroplasty technique were compiled. Response to therapy, defined as qualitative change in pain severity and change in level of activity, was noted immediately following the procedure and at various periods on follow-up reviews. One man and five women, who ranged in age from 72 to 90 years (mean 81 years), were treated. Each patient had one compression fracture. The fractures were at T-11 (one patient), L-1 (two patients), L-3 (two patients), and L-4 (one patient). The pain pattern was described as severe and localized to the affected vertebra, and sometimes radiated along either flank. Pain duration ranged from 2 to 12 weeks, and the pain was refractory to conservative therapy that consisted of bedrest, analgesics, and external bracing. At the time of treatment, all patients were bedridden because of severe back pain. In all patients either plain radiographic or computerized tomography evidence of intravertebral vacuum cleft or MR imaging evidence of vertebral fluid collection consistent with avascular necrosis of the vertebral body was demonstrated. Four patients underwent bilateral transpediculate vertebroplasty, and two patients underwent unilateral transpediculate vertebroplasty. The fracture cavities were specifically targeted for PMMA injection. Additional fortification of the osteoporotic vertebral body trabeculae was also performed when feasible. "Cavitygrams" or intraosseous venograms with gentle contrast injection were obtained prior to application of cement mixture. In all patients subjective improvement in pain and increased mobility were demonstrated posttreatment. The follow-up period ranged from 4 to 24 hours after treatment. Two patients made additional office visits at 1 and 3 months, respectively. Patients presenting with vertebral osteonecrosis (Kümmell's spondylitis) often suffer from local paraspinous or referred pain. When performing vertebroplasty on these patients, confirmation of entry into the fracture cavities with contrast-enhanced "cavitygrams" should be performed prior to injection of PMMA cement. The response to vertebroplasty with regard to amelioration of pain and improved mobility is encouraging.

scholarly journals Analysis of Influencing Factors of Residual Low Back Pain After PVP

2021 ◽  
Author(s):  
Fengwei Qin ◽  
Wencai Zhang ◽  
Shuai Wang ◽  
feng Jiao ◽  
yonghui Feng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Back Pain ◽  
Back Pain ◽  
Bone Cement ◽  
Vertebral Compression Fracture ◽  
Percutaneous Vertebroplasty ◽  
Compression Fracture ◽  
Low Back ◽  
Surgical Data ◽  
Magnetic Resonance Imaging Mri

Abstract Background: PVP (Percutaneous vertebroplasty) has been used to treat patients with OVCFs, however, we found that some patients did not significantly relieve back pain after surgery. The purpose of this paper is to explore the possible risk factors for residual low back pain after PVP and to Method: A retrospective study was conducted on 1120 patients hospitalized for osteoporotic vertebral compression fracture (OVCF) and treated with PVP between from July 2014 to June 2020 at our hospital. Baseline, clinical and surgical data were collected to analyze the factors associated with residual low back pain after PVP.Results: A total of 61 patients complained of residual low back pain, and the prevalence was 5.4%. Among the observed indices included, there were significant differences in preoperative thoracolumbar fascia injury (TFI) and a liquefaction signal on magnetic resonance imaging (MRI) of the affected vertebrae; the number of responsible vertebrae and the distribution of bone cement were different between the two groups (P<0.05). Multivariate analysis revealed that preoperative TFI (OR=5.378, 95% CI: 1.713-16.888, P=0.004), a liquefaction signal on MRI of the affected vertebrae (OR=6.111, 95% CI：1.898-19.673, P=0.002), the number of responsible vertebrae (OR=0.098, 95% CI: 0.039-0.249, P=0.004), and the distribution of bone cement (OR=0.253, 95% CI: 0.079-0.810, P=0.021) were risk factors for residual low back pain after PVP.Conclusion: TFI, a liquefaction signal on MRI of the affected vertebrae, the number of responsible vertebrae and the distribution pattern of bone cement could be risk factors for residual low back pain after PVP.

scholarly journals Percutaneous Vertebroplasty for Osteoporotic Fractures

2007 ◽  
Vol 4;10 (7;4) ◽  
pp. 559-663
Author(s):  
Suhail Afzal
Keyword(s):  
Back Pain ◽  
Pain Relief ◽  
Vertebral Body ◽  
Percutaneous Vertebroplasty ◽  
Compression Fracture ◽  
Osteoporotic Fractures ◽  
Percutaneous Injection ◽  
Compression Fractures ◽  
Vas Score

Background: Vertebral augmentation has been widely used to treat vertebral body compression fractures caused by varied pathologies. The lifetime risk of a vertebral body compression fracture is 16% for women and 5% for men, and exponential increase of osteoporotic fractures worldwide. Purpose: To determine the efficacy and durability of percutaneous vertebroplasty for the treatment of back pain associated with osteoporotic vertebral fractures. Design: A prospective study. Materials and Methods: A prospective evaluation of pain relief in 30 patients, with mean age of 73.7 years, who underwent percutaneous injection of polymethyl methacrylate into 54 vertebrae under fluoroscopic guidance over a period of 35 months was done. Before the procedure and at follow up, patients were asked to quantify their pain on a visual analogue scale. Results: The procedure was technically successful in all the patients. Mean duration of follow up was 21.5 months (6-44months). Ninety-seven percent of the patients reported a significant relief 24 hours after the procedure. Ninety-two percent reported significant improvement in back pain, previously associated with a compression fracture, as well as improved ambulatory ability. Before vertebroplasty, the VAS score was 8.91+/- 1.82 compared to a score of 2.02+/- 1.95 at follow up. The mean difference in VAS score was significant (p<.0001). One patient had an asymptomatic epidural leak of PMMA, however did not require any further intervention. Conclusion: Percutaneous vertebroplasty of symptomatic osteoporotic vertebral compression fractures is a minimally invasive procedure that provides immediate and sustained pain relief in patients with refractory pain. Key words: Compression fracture, osteoporosis; pain, vertebroplasty, polymethylmethacrylate

Percutaneous Vertebroplasty in Osteoporotic Vertebral Body Compression Fracture

2001 ◽  
Vol 44 (2) ◽  
pp. 145 ◽  
Author(s):  
Hyuk Jung Kim ◽  
Seon Kyu Lee ◽  
Hee Young Hwang ◽  
Hyung Sik Kim ◽  
Joon Seok Ko ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Percutaneous Vertebroplasty ◽  
Compression Fracture ◽  
Vertebral Body Compression Fracture

Risk factors for the development of chronic back pain after percutaneous vertebroplasty vs conventional treatment

2014 ◽  
Author(s):  
Pilar Peris ◽  
Jordi Blasco ◽  
Josep L Carrasco ◽  
Angels Martinez-Ferrer ◽  
Juan Macho ◽  
...  
Keyword(s):  
Risk Factors ◽  
Back Pain ◽  
Conventional Treatment ◽  
Chronic Back Pain ◽  
Percutaneous Vertebroplasty

A Rare Case of Spinal Leprosy Mimicking Spinal Tuberculosis

2019 ◽  
pp. 33
Author(s):  
K Thuraikumar ◽  
V Naveen ◽  
Mustaqim A ◽  
Arieff AA ◽  
K Shri ◽  
...  
Keyword(s):  
Back Pain ◽  
Soft Tissue ◽  
Histopathological Examination ◽  
Posterior Instrumentation ◽  
Spinal Tuberculosis ◽  
Previous History ◽  
Skin Lesions ◽  
Titanium Implants ◽  
Paravertebral Abscess ◽  
History Of

Introduction: Spinal tuberculosis is the most common manifestation of extrapulmonar y tuberculosis. A combination of leprosy and tuberculosis is a rare entity.Case report: A 44-year-old male patient working as a laborer presented to our hospital with complaints of severe back pain and swelling over the back, difficulty in walking, associated with constitutional symptoms. On admission, he was febrile and had leukocytosis. Initial spine X-ray showed end plate destruction and increase in soft tissue shadow at the level of T8-T9. CT spine revealed thoracic paravertebral collection extending from T7 to T9 levels, suggest ive of tuberculous spondylitis with cold abscess. Patient refused a transpedicular biopsy and was started on anti-tubercular therapy. Two weeks after commencement of treatment, he developed worsening back pain and weakness of the lower extremities. MRI spine showed a paravertebral abscess and posterior soft tissue edema involving level of T7 to T11. Patient underwent a posterior decompression, debridement and posterior instrumentation. He was discharged well, there was improvement of his lower limb power. Upon clinic review, he complained of multiple hyperpigmented, painless, nonpruritic skin lesions over the trunk and back. No previous history of eczema, psoriasis and Tinea corporis. Given the history of allergy, initial impression was hypersensitivity reaction towards the titanium implants, and he was started on anti-histamines. However, there was no improvements seen. Histopathological examination of skin lesions revealed presence of granuloma within the dermis layer, composed of epitheloid, histiocytes, lymphocytes and plasma cells. Wade-Fite stain for Mycobacterium leprae is positive. Slit skin smear shows multibacillary leprosy. Patient was started on multidrug therapy (rifampicin, clofazimine and dapsone) for 1 year. He has recovered well.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 33

scholarly journals The analgesic efficacy of extracorporeal shock wave combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures in postmenopausal women

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Xiaowei Liu ◽  
Hui Wang ◽  
Yang Zhang ◽  
Mingling Wang ◽  
Yujin Qiu ◽  
...  
Keyword(s):  
Shock Wave ◽  
Postmenopausal Women ◽  
Percutaneous Vertebroplasty ◽  
Reduction Rate ◽  
Compression Fracture ◽  
Analgesic Efficacy ◽  
Small Sample ◽  
Compression Fractures ◽  
Extracorporeal Shock Wave ◽  
Post Operation

Abstract Background To explore the analgesic efficacy of extracorporeal shock wave (ESW) combined with percutaneous vertebroplasty (PVP) after reduction in overextension position in the treatment of osteoporotic thoracolumbar compression fractures in postmenopausal women. Methods The data of postmenopausal women with osteoporotic thoracolumbar compression fracture admitted in our department from January 2017 to October 2019 were analyzed retrospectively. They were divided into groups of unipedicular percutaneous kyphoplasty (U-PKP n = 21), bipedicular PKP (B-PKP n = 20), and ESW combined with PVP after reduction in overextension position (EP-PVP n = 18). The improvement of pain and vertebral height in three groups was compared. Results Postoperative compression rate and Cobb angle of vertebral fractures in the three groups were all lower than those before surgery, and the differences between pre-operation and post-operation were statistically significant (P < 0.05). The visual analog scale (VAS) and Oswestry dysfunction index (ODI) scores of the three groups decreased significantly after the operation (P < 0.05). The ODI scores of the EP-PVP group in the third months after the operation were significantly improved compared with the other two groups, and the difference was statistically significant (P < 0.05). Conclusions In our small-sample study, all three treatment schemes can treat osteoporotic compression fracture of thoracolumbar vertebrae in postmenopausal women, relieve pain, and improve quality of life. ESW combined with PVP after reduction in overextension position could achieve a good vertebral reduction rate and improve kyphosis, and may reduce the application of analgesic drugs.

scholarly journals Vertebral sarcoidosis with associated Darier-Roussy disease manifesting as acute back pain

2021 ◽  
pp. 101330
Author(s):  
Mohamad Syafeeq Faeez ◽  
Naveen Rajadurai ◽  
Thajunnisa Hassan ◽  
Alias Mardziah ◽  
Robert Penafort ◽  
...  
Keyword(s):  
Back Pain ◽  
Acute Back Pain
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