Michael E. Frey

Efficacy and safety of percutaneous sacroplasty for painful osteoporotic sacral insufficiency fractures: a prospective, multicenter trial.

Study Design. A prospective observational cohort study of consecutive osteoporotic patients with sacral insufficiency fractures (SIFs). Objective. Assess the safety and efficacy of sacroplasty in treating osteoporotic SIFs. Summary of Background Data. SIFs can cause low back pain in osteoporotic patients. Symptomatic improvement may require up to 12 months. Treatment includes limited weight-bearing and bed rest, oral analgesics, and sacral corsets. Significant mortality and morbidity are associated with pelvic insufficiency fractures. Percutaneous sacroplasty is an alternative treatment for SIF patients, and initial reports have documented its safe and effective performance. Yet, follow-up intervals have been short, and study cohorts small precluding definitive assessment of sacroplasty’s safety and efficacy. Methods. Baseline Visual Analogue Scale (VAS), analgesic usage, and duration of symptoms were recorded. Subsequent VAS ratings were assessed at 30 minutes and at 2, 4, 12, 24, and 52 weeks postprocedure. Analgesic usage and patient satisfaction were assessed at final follow-up. Each procedure was performed under intravenous conscious sedation using fluoroscopy. Two bone trochars were inserted between the sacral foramen and sacroiliac joint through which 2 to 3 mL of polymethylmethacrylate was injected. Results. Thirty-seven patients, 27 females, were treated. Mean age was 76.6 years, and mean symptom duration was 34.4 days. All patients were available at each follow-up interval except 1 patient who died due to unrelated pulmonary disease before the 4-week follow-up. The mean VAS score at baseline was 7.7 and 3.2 within 30 minutes, and 2.1 at 2, 1.7 at 4, 1.3 at 12, 1.0 at 24, and 0.7 at 52 weeks postprocedure. Improvement at each interval and overall was statistically significant using the Wilcoxon Rank Sum Test. One case of transient S1 radiculitis was encountered. Conclusions. Sacroplasty appears to be a safe and effective treatment for painful SIF. The rate of improvement is rapid and sustained through 1 year.

Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures in the Nonagenarians : A Prospective Study Evaluating Pain Reduction and New Symptomatic Fracture Rate

Study Design. A prospective observational cohort study of consecutive osteoporotic vertebral compression fractures (VCFs) in ≥90-year-old patients evaluated at a multidisciplinary, university spine center. Objective. Assess efficacy, safety, and new fracture occurrence after percutaneous vertebroplasty (PV) in a large uncontrolled cohort of ultra elderly VCF patients. Summary of Background Data. VCFs are associated with increased morbidity and mortality. Percutaneous injection of polymethylmethacrylate into the fractured vertebral body, vertebroplasty, has been extensively performed as an effective minimally-invasive treatment option for VCF patients. The patient sample included consecutive, osteoporotic patients with symptomatic VCFs electing to enter the study. Methods. Baseline visual analogue scale rating, analgesic usage, duration of symptoms. Subsequent VAS ratings, analgesic utilization, and new fractures were assessed within 30 minutes after the procedure, at 2 weeks, 1 month, 3 months, 6 months, 1 year, and 2 years postprocedure. Outcome measures: Visual Analogue Scale score, analgesic utilization, patient satisfaction, cement extravasation, and new fractures. Results. A total of 123 (74% female) underwent PV for 163 VCFs. Eleven patients did not complete final follow-up at 2 years due to death unrelated to the PV procedure. The mean VAS score was 7.6 at baseline and 3.1 at 30 minutes after the procedure, and 2.3, 1.2, 1.1, 0.9, 0.8, and 0.5 at 2 weeks, 1 month, 3 months, 6 months, 1 year, and 2 years, respectively. Improvement over time was statistically significant using repeated measures analysis of variance (P < 0.05). No complications were encountered during the follow-up intervals. Thirteen new fractures were observed (10.6%) at a mean 20.8 weeks (1–52 weeks) after PV with 6 new fractures (4.9%) involving an adjacent level in 5 patients (4.1%). Conclusion. Vertebroplasty for VCFs in the very elderly appears effective and safe without increased risk of adjacent level fracture.

C1-2 Steroid Injection for Crowned Dens Syndrome

rowned dens syndrome (CDS) is a rare disorder characterized by neck pain and an imaging tudy demonstrating a calcified mass in the peri-odontoid space [1]. Typically, women etween ages 25 and 75 years are afflicted. They may describe acute neck pain, but insidious rogression is more common. Inflammatory signs with fever and erythrocyte sedimentation ate elevation are present in one-third of cases [2]. These symptoms are frequently mistaken or spondylodiskitis, tumor, or meningitis. A medical history of other symptomatic articular roblems (eg, pain at the hip or shoulder with evidence of chondrocalcinosis) is not ncommon [2]. Neurologic involvement is rare—there has been only a single report of ompressive myelopathy from calcium pyrophosphate deposition, leading to a subsequent iagnosis of CDS [3]. Individuals who have excessive levels of hydroxyapatite or, rarely, calcium pyrophoshate dihydrate (CPPD) crystal deposition, can develop CDS [4]. CDS can occur indepenently or in association with inflammatory, noninflammatory, or endocrine disorders [1]. ost patients are diagnosed with computed tomography (CT) scan [2]. A majority of atients have complete symptom reduction with conservative measures, such as nonsteroial anti-inflammatory drugs (NSAIDs) [1].