Management of painful vertebral hemangiomas with kyphoplasty: a report of two cases and a literature review.

BACKGROUND AND OBJECTIVES: Although uncommon, symptomatic vertebral hemangiomas can be a painful condition limiting daily activities. Balloon kyphoplasty is a developing technique that has successfully been used in the treatment of vertebral hemangiomas as reported in a few publications. The aim of this paper is to describe 2 cases of painful vertebral hemangiomas effectively treated with percutaneous balloon kyphoplasty and review the current literature. DESIGN AND METHODS: A 38-year-old male with a painful L5 biopsy-proven hemangioma and a 75-year-old female with a painful T12, hemangioma MRI-proven both presented with thoraco-lumbar pain. Physical exams correlated with imaging findings and no neurological symptoms were present. Both patients received conservative management including physical therapy and a variety of spinal injections without benefit. Percutaneous balloon kyphoplasty was subsequently performed on each patient to relieve pain. RESULTS: After kyphoplasty, both patients' pain resolved immediately and they were able to resume previous levels of activity. CONCLUSIONS: This case series demonstrates a successful response to vertebral augmentation using balloon kyphoplasty when other treatment modalities failed. When compared to traditional first line treatments such as vertebroplasty or lytic therapies, kyphoplasty may offer fewer procedural risks such as a decreased exposure to radiation, a decreased risk of excessive hemorrhage, and a decreased risk of cement leakage which may make it the preferred treatment of painful vertebral hemangiomas in the future.

The prevention of discitis during discography.

BACKGROUND CONTEXT: Because of the severe complications, discitis represents the most feared complication stemming from discography. Varying needle techniques have been used to prevent discitis, and evidence for the use of intravenous (IV) and/or intradiscal antibiotics is conflicting and often lacking. Consequently, no consensus has been formed for disc infection prevention during discography. PURPOSE: The objectives of this review are to summarize and integrate all the available basic science, animal, and clinical evidence regarding prevention of infection from discography and to develop areas of future research. STUDY DESIGN: A comprehensive review of the literature dealing with discitis stemming from discography was conducted. METHODS: The MEDLINE and SCOPUS databases were searched focusing on prospective and retrospective studies and published case reports on the prevention of discitis. A meta-analysis could not be completed because of the scarcity of data and published randomized controlled trials. RESULTS: Of the seven articles that specifically focused on the prevention of discitis, no randomized or controlled trials were located. Two prospective, nonrandomized trials, three retrospective case series, and two literature reviews have been published, but no consensus has been formed for the prevention of discitis during discography. Fifteen articles focused on penetration, efficacy, and dosage of antibiotics into intervertebral discs for the prevention of discitis. There are 14 additional articles that report incidences of discitis. CONCLUSIONS: Based on the available clinical evidence, IV or intradiscal antibiotics during discography have not been conclusively shown to decrease the rate of discitis over sterile technique alone. Animal model research supports prophylactic antibiotic use when used before iatrogenic inoculation of intervertebral discs. Both single- and double-needle techniques when used with stylettes are superior to nonstyletted techniques.