Balloon kyphoplasty or percutaneous vertebroplasty for osteoporotic vertebral compression fracture? An updated systematic review and meta-analysis

By London Spine

BACKGROUND: Both kyphoplasty (KP) and vertebroplasty (VP) are effective for patients with osteoporotic vertebral compression fracture (OVCF), but which approach might be more effective remains unclear, so we decided to update earlier systematic reviews. OBJECTIVE: Review and analyze studies published as of August 2015 that compared clinical outcomes and complications of KP versus VP. DESIGN: Systematic review and meta-analysis. SEARCH METHOD: Published reports up to August 2015 were found in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). SELECTION CRITERIA: Randomized controlled trials (RCTs) and prospective and retrospective cohort stud.ies comparing KP and VP in patients with OVCF. DATA COLLECTION AND ANALYSIS: Two authors independently assessed the studies and extracted data. RESULTS: Thirty-two studies involving 3274 patients fulfilled the inclusion criteria. There were significant differences between the two groups in short- and long-term postoperative changes in measures of pain intensity and dysfunction (P < .01), in anterior and middle height (P < .01), kyphotic angle (P < .01), and time to injury, but not in posterior height (P=.178). There were no significant differences in the rate of postoperative fractures including adjacent and total fractures, but cement leakage to the intraspinal space was greater in the VP group (P=.035). KP surgery took longer and required a greater volume of injected cement. CONCLUSIONS: KR resulted in better pain relief, improvements in Oswestry dysfunction and radiographic outcomes with less cement leakage, but further RCTs are needed to verify this conclusion. LIMITATIONS: Only four RCTs with a certain of risk of bias. Most studies were observational

Caudal epidural block in children and infants: retrospective analysis of 2088 cases.

By London Spine
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Caudal epidural block in children and infants: retrospective analysis of 2088 cases.

Ann Saudi Med. 2011 Sep-Oct;31(5):494-7

Authors: Beyaz SG, Tokgöz O, Tüfek A

BACKGROUND AND OBJECTIVES: Regional anesthesia is usually preferred as caudal block via the epidural space. However, the number of large-scale studies including pediatric caudal blocks is small. The objective of this study was to evaluate complications and side effects of local anesthetics and adjuvant drugs.
DESIGN AND SETTING: Retrospective, descriptive study of cases occurring during the period December 2007 to October 2009.
METHODS: Of 4815 medical records were screened, 2088 pediatric cases were identified and included in this study.
RESULTS: As a local anesthetic, we preferred mostly levobupivacaine in 1669 (79.9%) patients and bupivacaine in 419 (20.1%) patients. As adjuvant drug, we preferred mostly morphine (41 patients), fentanyl (7 patients) and adrenaline (6 patients) in 54 (2.5%) patients. For general anesthesia induction, we preferred mostly propofol (1996 patients, 94.2%); for maintenance, sevoflurane (1773 patients, 84.9%). For airway control, we preferred mostly the ProSeal laryngeal mask (PLMA), in 1008 (48.2%) patients. One thousand six hundred five (76.9%) patients were from outpatient clinics and 483 (23.1%) patients were from inpatient clinics. No permanent complication was encountered after caudal blocks.
CONCLUSION: We conclude that caudal epidural blocks are a safe and effective method for subumbilical day-case pediatric surgeries when performed by anesthetists.

PMID: 21911987 [PubMed – indexed for MEDLINE]