The spine journal : official journal of the North American Spine Society
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Vertebroplasty is commonly performed for the management of pain associated with benign compression fractures, multiple myelomas, lymphomas, vertebral metastatic lesions, and hemangiomas. We describe a severe complication associated with this procedure; only one previous case has been reported in the literature. ⋯ Although percutaneous vertebroplasty has many benefits, including its simplicity and relative safety, it could lead to serious complications. The current case demonstrates the direct leakage of cement within the anterior spinal artery leading to an irreversible paralysis. The clinicians should be aware of such complications to happen and explain it to their patients.
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Vertebral compression fractures (VCFs) are a substantial health concern. Kyphoplasty (KP) and vertebroplasty (VP) are vertebral augmentation procedures (VAPs) used to treat VCFs. ⋯ Vertebral augmentation procedures have seen a continued increase in use from 2004 to 2008. Use of KP significantly outpaces the use of VP. Reasons for the increasing utilization of KP likely include financial incentives, the specialty performing KP, perceived safety, and effectiveness of vertebral height restoration. Conflicting evidence regarding which procedure is safer warrants further evaluation.
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Laminectomy for lumbar stenosis-associated radiculopathy is associated with improvement in pain, disability, and quality of life. However, given rising health-care costs, attention has been turned to question the cost-effectiveness of lumbar decompressive procedures. The cost-effectiveness of multilevel hemilaminectomy for radiculopathy remains unclear. ⋯ Multilevel hemilaminectomy improved pain, disability, and quality of life in patients with lumbar stenosis-associated radiculopathy. Total cost per QALY gained for multilevel hemilaminectomy was $33,700 when evaluated 2 years after surgery with Medicare fees, suggesting that multilevel hemilaminectomy is a cost-effective treatment of lumbar radiculopathy.
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The integrity of the posterior ligamentous complex (PLC) has been proposed to be an integral aspect in the treatment algorithm for spinal trauma. Magnetic resonance imaging (MRI) has been reported as the ideal tool to determine the integrity of the PLC. The ability to assess disruption of the PLC by reviewers of differing levels of training has not been described. In addition, the MRI sequence most suggestive of injury for each component of the PLC has not been clearly determined. ⋯ The interpretation of traumatic MRI is very sensitive and accurate regardless of years of training of the observer. The attending-level spine surgeon was statistically more specific in the evaluation of injury MRIs. The fluid-weighted STIR sagittal sequences are most useful in determining injury to the SSL, ISL, LF, and cervical facets capsules. Lumbar facet capsules are best evaluated with axial T2 MRI. The evaluation of the PLC on MRI can be accurately and efficiently interpreted by physicians at multiple levels of training, thus providing a key imaging modality in determining stability and need for stabilization.