The Outcome of Radiofrequency Kyphoplasty in the Treatment of Vertebral Compression Fractures in Osteoporotic Patients

STUDY DESIGN: Retrospective study. PURPOSE: The study aims to assess the effectiveness and safety of radiofrequency (RF) kyphoplasty in the treatment of vertebral compression fractures (VCFs) in osteoporotic patients. OVERVIEW OF LITERATURE: Vertebroplasty and balloon kyphoplasty are established procedures for the treatment of osteoporotic VCFs. However, RF kyphoplasty is a new method which controls cement viscosity. METHODS: We reviewed the results of 41 consecutive patients with 23 thoracic and 38 lumbar VCFs who underwent RF kyphoplasty. The study population included 14 males (34%) and 27 females (66%). The mean patients age was 78 years (range, 51–89 years), and the follow-up period was 1 year. Clinical and radiographic analyses were performed during follow-up at 6 weeks, 6 months, and 1 year. All patients were assessed clinically pre- and postoperative using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Radiological assessment with X-ray in two views preoperatively, postoperatively, and during follow-up visits. RESULTS: The mean preoperative VAS was 8.7 (range, 5–10; standard deviation [SD], 1.2). Postoperatively, VAS decreased by 3.3 (range, 2–5; SD, 0.9). At the end of the follow-up, VAS decreased by 1.22 (range, 0–7; SD, 1.6). The mean preoperative ODI score was 85.9, decreasing to 9.6 postoperatively and improving to 18.4 during the 1-year follow-up. The mean local kyphotic angle was 9.04° before the procedure and decreased by a mean of 6.16° after the operation and at the end of the follow-up. The mean increase in vertebral body height was 3.3 mm postoperatively and after 1-year follow-up. The rate of cement leakage was 8% (five out of 61 levels of fracture). CONCLUSIONS: RF kyphoplasty is a safe and effective augmentation technique with an advantage of controlling the cement viscosity to minimize the risk of cement leakage. It also shortens operation time.

Two-body wear behavior of human enamel versus monolithic zirconia, lithium disilicate, ceramometal and composite resin

PURPOSE: To investigate and compare the surface roughness (SR), weight and height of monolithic zirconia (MZ), ceramometal (CM), lithium disilicate glass ceramic (LD), composite resin (CR), and their antagonistic human teeth enamel. MATERIALS AND METHODS: 32 disc shaped specimens for the four test materials (n=8) and 32 premolars were prepared and randomly divided. SR, weight and height of the materials and the antagonist enamel were recorded before and after subjecting the specimens to 240,000 wear-cycles (49 N/0.8 Hz/5℃/50℃). SR, height, weight, and digital microscopic qualitative evaluation were measured. RESULTS: CM (0.23 + 0.08 µm) and LD (0.68 + 0.16 µm) exhibited the least and highest mean difference in the SR, respectively. ANOVA revealed significance (P=.001) between the materials for the SR. Paired T-Test showed significance (P < .05) for the pre- and post-SR for all the materials. For the antagonistic enamel, no significance (P=.987) was found between the groups. However, the pre- and post-SR values of all the enamel groups were significant (P < .05). Wear cycles had significant effect on enamel weight loss against all the materials (P < .05). CR and MZ showed the lowest and highest height loss of 0.14 mm and 0.46 mm, respectively. CONCLUSION: MZ and CM are more resistant to SR against the enamel than LD and CR. Enamel worn against test materials showed similar SR. Significant variations in SR values for the tested materials (MZ, LD, CM, and CR) against the enamel were found. Wear simulation significantly affected the enamel weight loss against all the materials, and enamel antagonist against MZ and CM showed more height loss.

Treatment of lumbar canal stenosis by a microscopic assisted percutaneous approach

Prospective study on the efficacy of a microscopically assisted less invasive approach for the operative treatment of lumbar canal stenosis. Less invasive techniques e.g. percutaneous endoscopic and microscopic assisted procedures play now an important role in spine surgery. The advantage of these techniques is to minimize the surgical trauma and accordingly the surgical stress to which the patient is subjected. This is valuable in elderly patients, as lumbar canal stenosis is usually associated with other systemic diseases that add risk to the operative intervention. The aim of this study is to evaluate the efficacy of this minimal invasive approach as an alternative for the operative treatment of lumbar canal stenosis. 50 consecutive patients with a mean age of 72.26 years were operated upon using this technique. The study included 70 lumbar segments. The mean follow up period was 21.58 months. The Visual Analogue Scale [VAS] for back and leg pain together with Oxford Claudication Score [OCS] were used to assess the patients pre-operatively as well as post-operatively. The average operative time for one level decompression was 81 minutes and the average blood loss was 50 ml/patient. Three patients [6%] were revised by open surgery. The OCS showed statistically significant improvement from 28.84 pre-operatively to 14.8 post-operatively [p<0.0001]. VAS for back pain and leg pain showed also statistically significant improvement [p < 0.0001]. This percutaneous technique is effective in decompressing lumbar canal stenosis. It carries the advantage of early mobilization and rehabilitation especially in elderly patients