New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures.

STUDY DESIGN: Literature review. OBJECTIVES: To describe new treatments for painful osteoporotic compression fractures in light of available scientific literature and clinical experience. SUMMARY OF BACKGROUND DATA: Painful vertebral osteoporotic compression fractures lead to significant morbidity and mortality. This relates to pulmonary dysfunction, eating disorders (nutritional deficits), pain, loss of independence, and mental status change (related to pain and medications). Medications to treat osteoporosis (primarily antiresorptive) do not effectively treat the pain or the fracture, and require over 1 year to reduce the degree of osteoporosis. Kyphoplasty and vertebroplasty are new techniques that help decrease the pain and improve function in fractured vertebrae. METHODS: This is a descriptive review of the background leading to vertebroplasty and kyphoplasty, a description of the techniques, a review of the literature, as well as current ongoing studies evaluating kyphoplasty. RESULTS: Both techniques have had a very high acceptance and use rate. There is 95% improvement in pain and significant improvement in function following treatment by either of these percutaneous techniques. Kyphoplasty improves height of the fractured vertebra, and improves kyphosis by over 50%, if performed within 3 months from the onset of the fracture (onset of pain). There is some height improvement, though not as marked, along with 95% clinical improvement, if the procedure is performed after 3 months. Complications occur with both and relate to cement leakage in both, and cement emboli with vertebroplasty. CONCLUSION: Kyphoplasty and vertebroplasty are safe and effective, and have a useful role in the treatment of painful osteoporotic vertebral compression fractures that do not respond to conventional treatments. Kyphoplasty offers the additional advantage of realigning the spinal column and regaining height of the fractured vertebra, which may help decrease the pulmonary, GI, and early morbidity consequences related to these fractures. Both procedures are technically demanding.

Effect of augmentation on the mechanics of vertebral wedge fractures.

STUDY DESIGN: The effect of cement augmentation of wedge-fractured vertebral bodies on spine segment compliance was studied in 16 cadaver specimens. OBJECTIVES: 1) To assess the mechanical effects of cement augmentation of vertebral wedge fractures. 2) To determine whether a new reduction/injection procedure has the same mechanical effects as the established direct injection procedure. SUMMARY OF BACKGROUND DATA: Although wedge fractures cause pain and disability in hundreds of thousands of people, few effective treatments are available. Clinical studies have shown that cement augmentation, a new procedure, effectively relieves pain and restores mobility in patients suffering from weak or fractured vertebrae. However, only a few studies have examined the mechanics of vertebral augmentation. METHODS: A wedge fracture was created in the middle vertebra of 16 three-vertebra cadaver spine segments. Neutral and full-load compliance of each fractured spine segment in flexion/extension and lateral bending were assessed by measuring the relative rotation of the vertebral bodies in response to applied moments. Eight of the fractured vertebral bodies were then augmented using direct injection, while the remaining eight fractured vertebral bodies were augmented using a combined reduction/injection procedure. Compliance of the augmented segments was then assessed. RESULTS: Augmentation significantly reduced the neutral compliance (reduction of 25% +/- 23%) (mean +/- standard deviation) and the full-load compliance (reduction of 23% +/- 20%) in flexion/extension (P < 0.005). Augmentation also significantly reduced the neutral compliance (reduction of 34% +/- 20%) and the full-load compliance (reduction of 26% +/- 17%) in lateral bending (P < 0.0001). No significant difference was found between the two procedures for compliance reduction. CONCLUSIONS: Augmentation of wedge fractures using both direct injection and reduction/injection reduces spine segment compliance significantly.

Metastasis to skeletal muscle from colorectal carcinoma. A case report.

In a 75-year-old woman, adenocarcinoma of the rectum recurred in the skeletal muscle after a two-year disease-free interval. Spread of colorectal carcinoma to skeletal muscle is infrequent. Only three cases seem to have been previously reported in the literature.

Spondylo-megaepiphyseal-metaphyseal dysplasia: a new bone dysplasia resembling cleidocranial dysplasia.

Eight patients are presented who have a generalized bone dysplasia that resembles severe cleidocranial dysplasia but lacks the cranial and clavicular features of that well-defined condition. Vertebral-body ossification is markedly defective, and ossification centers of the tubular bones are grossly enlarged. These patients also differ from those with variant forms of cleidocranial dysplasia described in the literature. It is suggested that they constitute a separate entity sharing some features of cleidocranial dysplasia, and the descriptive term spondylo-megaepiphyseal-metaphyseal dysplasia is offered as a provisional term until it can be more specifically categorized. The condition appears to be transmitted as an autosomal recessive trait.

Vascular complications following total hip arthroplasty. A review of the literature and a report of two cases.

Major vascular, nonthromboembolic complications of total hip arthroplasty are rare: only 23 have been reported over the last 20 years. This is a report of two additional cases. In an 84-year-old woman, the external iliac artery was lacerated following removal of the acetabular component. Two such injuries have been reported previously, but this is the first case that resulted from a posterolateral approach to the hip. In a 69-year-old woman, a heretofore unrecorded complication consisted of external iliac vein compression occurring 20 months after total hip arthroplasty and culminating in iliac artery thrombosis and an ischemic foot. A below-knee amputation was performed after removal of the total hip components.

Racial and sexual differences in the standard electrocardiogram of black vs white adolescents.

Standard 12-lead electrocardiograms were recorded in 114 healthy adolescents to substantiate possible influences of race and sex on the "juvenile pattern" (increased precordial voltages of QRS complex, precordial T wave inversions, and ST-segment elevations considered pathologic in adults) in this age group. Black male subjects had the highest precordial QRS amplitudes and the highest incidence of biphasic or negative precordial T waves and ST-segment deviations. In white male subjects, these findings were less pronounced but were more evident than in black or white female subjects. Results indicate the following: (1) race-specific and sex-specific normal electrocardiographic standards should be developed in adolescents; (2) criteria for left ventricular hypertrophy are race-specific and sex-specific and should be tested against independent anatomic or physiologic information in adolescents with left ventricular overload; and (3) the "juvenile pattern" may be viewed as a predictable continuum of age-related changes starting in childhood and progressing through adolescence on to later life.