Dirk Proschek

Percutaneous vertebroplasty in the therapy of osteoporotic vertebral compression fractures: a critical review

Percutaneous vertebroplasty has become an efficient technique for the treatment of painful vertebral fractures. Osteoporotic vertebral compression fractures are characterized by severe back pain and immobilization causing other complications like thrombosis or pneumonia. Vertebral cement augmentation provides increased strength of the vertebral body and an obvious pain relief. Between 1989 and 2004, 30 studies and a total of 2,086 treated patients have been published in literature. A review of these studies has been performed. The number and age of the patients, number of treated vertebrae, pre- and postoperative outcome of pain and complications of the different studies were assessed and analyzed. Percutaneous vertebroplasty is an efficient technique with low complication rates and a significant reduction in pain. It rapidly improves the mobility and quality of life of patients with vertebral compression fractures. With an increasing number of treated patients, experience with this interventional technique has become excellent. But still there are no randomized controlled trials available, showing that percutaneous vertebroplasty has a significantly better outcome than other treatment options, especially after a long-term follow-up.

MR-compatible Assistance System for Biopsy in a High-Field-Strength System: Initial Results in Patients with Suspicious Prostate Lesions

PURPOSE To examine the feasibility and safety of magnetic resonance (MR)-guided biopsy by using a transgluteal approach in patients with suspicious prostate lesions by using an MR-compatible robotic system and a 1.5-T MR system. MATERIALS AND METHODS The study was approved by the institutional review board of University Frankfurt, and informed consent was obtained from each patient. A total of 20 patients (age range, 57.8-71.9 years; mean age, 65.1 years) underwent biopsy in a closed-bore high-field-strength MR system. Biopsy was performed with an MR-compatible pneumatically driven robotic system. T1-weighted gradient-echo fast low-angle shot and T2-weighted true fast imaging with steady-state precession sequences were used to plan and guide the intervention with a transgluteal access on the external planning computer of the assistance system. The system calculated the trajectory and then moved the guiding arm to the insertion point. The cannula was advanced manually, and biopsies were performed with the coaxial technique by using a 15-gauge pencil tip needle. Intervention time, complications, and biopsy findings were documented. RESULTS The MR-compatible robotic system did not interfere with image quality, nor did MR imaging cause dysfunction of the robot. In one patient, the interventionist caused a fail-safe system shutdown. This was due to inadvertent displacement of the guiding arm during cannula insertion. This problem was solved by increasing the displacement threshold. Accurate coaxial cannula biopsy could be performed in all subsequent patients. Sufficient histopathologic assessment was performed in 19 patients. Insufficient material was retrieved in the patient who experienced fail-safe system shutdown. The median intervention time was 39 minutes (23-65 minutes). No procedure-related complications were observed. CONCLUSION Preliminary results indicate that MR-guided robot-assisted biopsy is feasible and can be performed safely with highly accurate cannula placement.

CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures.

The purpose of this study was to determine the efficacy and safety of CT-guided percutaneous vertebroplasty in the treatment of vertebral compression fractures. The primary objectives were pain reduction and bone-cement leakage during a long-term follow-up in patients with osteoporotic vertebral compression fractures. CT-guided percutaneous vertebroplasty was carried out in 61 patients (mean age 71.4 years; range 42–83; female ratio: 73.8%) with vertebral compression fractures. Treatment was carried out on an outpatient basis. Pain, bone-cement leakage and complications were monitored and recorded. The mean follow-up time was 19.8 months (range 3–52). Paired comparison procedures were used for the analysis of the results, which showed that all patients had a significant reduction of pain. The mean visual-analogue scale (VAS) before treatment was 8.8 points (range 6.5–9.8 points). The mean VAS score after treatment was significantly reduced to 2.6 points (range 1.5–4.1 points; p<0.01). No clinical or neurological complications were documented. Minor and asymptomatic bone-cement leakage was observed in 54% of the cases. Percutaneous vertebroplasty is an efficient and safe interventional procedure which rapidly improves the mobility and quality of life of patients with vertebral compression fractures. CT-guidance is a reasonable upgrade in the treatment procedure which reduces the amount of bone-cement leakage.

Die Magnetresonanztomografie in der Orthopädie

ZusammenfassungDie Magnetresonanztomografie (MRT) hat sich in der Orthopädie als wichtiges bildgebendes Verfahren etabliert, da wichtige Gelenkstrukturen wie Knorpel, Sehnen, Bänder und Muskulatur kontrastreich und überlagerungsfrei dargestellt werden können. Weitere entscheidende Vorteile sind die fehlende Strahlenbelastung und die Beurteilung von entzündlichen oder tumorösen Prozessen nach Kontrastmittelgabe. Auf der anderen Seite stellt das Verfahren hohe Ansprüche an die Ausführung der Untersuchung und an die Befundung der MRT-Bilder. Unverzichtbar sind klinische Angaben, ein Röntgenbild und eine präzise Fragestellung, um das enorme diagnostische Potential dieser Methode optimal zu nutzen.Dieser Artikel soll dazu dienen, den klinisch und praktisch tätigen Orthopäden allgemein mit dem MRT-Verfahren und seinen diagnostischen Möglichkeiten vertraut zu machen. Dabei werden auch Kontraindikationen, verfahrenstechnische Fehlerquellen und Grenzbereiche aufgezeigt, die den Einsatz alternativer Verfahren erfordern.AbstractMagnetic resonance imaging (MRI) is an established diagnostic tool in orthopaedics. Superior soft tissue contrast, lack of ionised radiation and free slice orientation are the key points for optimal evaluation of joint structures, muscles and ligaments. Application of contrast agents improves the detection of inflammation and tumour tissue. However, measuring and interpretation of magnetic resonance imaging is a challenge both for orthopaedists and radiologists. Basic requirements for good diagnosis are clinical findings, plain radiographs and a clear indication.This report provides information about the method of magnetic resonance imaging, artefacts, indications, risks and drawbacks as well as limitations of this method that necessitate alternative imaging modalities.

Magnetic resonance imaging in orthopaedic medicine

ZusammenfassungDie Magnetresonanztomografie (MRT) hat sich in der Orthopädie als wichtiges bildgebendes Verfahren etabliert, da wichtige Gelenkstrukturen wie Knorpel, Sehnen, Bänder und Muskulatur kontrastreich und überlagerungsfrei dargestellt werden können. Weitere entscheidende Vorteile sind die fehlende Strahlenbelastung und die Beurteilung von entzündlichen oder tumorösen Prozessen nach Kontrastmittelgabe. Auf der anderen Seite stellt das Verfahren hohe Ansprüche an die Ausführung der Untersuchung und an die Befundung der MRT-Bilder. Unverzichtbar sind klinische Angaben, ein Röntgenbild und eine präzise Fragestellung, um das enorme diagnostische Potential dieser Methode optimal zu nutzen.Dieser Artikel soll dazu dienen, den klinisch und praktisch tätigen Orthopäden allgemein mit dem MRT-Verfahren und seinen diagnostischen Möglichkeiten vertraut zu machen. Dabei werden auch Kontraindikationen, verfahrenstechnische Fehlerquellen und Grenzbereiche aufgezeigt, die den Einsatz alternativer Verfahren erfordern.AbstractMagnetic resonance imaging (MRI) is an established diagnostic tool in orthopaedics. Superior soft tissue contrast, lack of ionised radiation and free slice orientation are the key points for optimal evaluation of joint structures, muscles and ligaments. Application of contrast agents improves the detection of inflammation and tumour tissue. However, measuring and interpretation of magnetic resonance imaging is a challenge both for orthopaedists and radiologists. Basic requirements for good diagnosis are clinical findings, plain radiographs and a clear indication.This report provides information about the method of magnetic resonance imaging, artefacts, indications, risks and drawbacks as well as limitations of this method that necessitate alternative imaging modalities.

Radiofrequency Ablation in Bone Metastases

The radiologist has emerged as a consultant with increased interaction with patients. In fact, the interventional radiologist has assumed the role of the surgeon for many conditions; for example, minimally invasive therapy of bone metastases using radiofrequency techniques. Recent advances in imaging and interventional techniques have had an impact on medical diagnosis. Interventional imaging-based procedures include percutaneous biopsy, which has decreased the need for open surgical procedures. Due to the advent of system hardware and improvements in different technical systems and instruments, interventional radiology is now an upcoming special field in radiology.

[Contrast-enhanced diagnostics in orthopaedics].

ZusammenfassungDie konventionelle Funktionsdiagnostik stellt einen entscheidenden Zugang zu orthopädischen Problemen dar. Die diagnostische Kompetenz des Orthopäden ermöglicht es nicht nur, sinnvolle Therapiekonzepte durchzuführen, sondern sich auch den aktuellen sozialen und gesundheitsstrukturellen Herausforderungen zu stellen.Neben der klinischen Diagnostik gewinnt die apparative Diagnostik durch voranschreitende technische Entwicklungen zunehmend an Bedeutung. Eine Sonderrolle nimmt hierbei die kontrastmittelgestützte Untersuchung ein. Diese ermöglicht insbesondere in schwierigen oder unklaren Fällen einen entscheidenden Informationsgewinn.Die aktuellen Neuerungen auf den Gebieten der Phlebografie, Angiografie, Myelografie und Arthrografie werden vorgestellt. Indikationsstellungen, Risiken und Komplikationen sowie das technische Procedere werden kritisch diskutiert.AbstractThe diagnostic competence of the orthopaedist not only allows him to perform adequate therapy concepts, but also to meet the current structural challenges, both social and health related.In addition to clinical diagnosis, machine-aided diagnosis is becoming more important due to technical advances. In this context, contrast-enhanced examination has a special place, as it has an important diagnostic advantage in difficult or unclear cases.Current improvements in the areas of phlebography, myelography, arthrography and angiography are reviewed. Indications, risks and complications as well as the technical procedure are critically discussed.