Sciatica Specialist Harley Street

By Jaimig Aljorna

Sciatica consists of pain, weakness, numbness or tingling in the leg. Injury or pressure on the sciatic nerve can cause it. Sciatica is a symptom; it is not a disease on its own. Where is the pain located? The pain can adopt different locations. For instance, it can either extend from the lower back to…

Consultants – London Spine Specialists

By Jaimig Aljorna

Our specialists at the London Spine Unit, Harley Street Hospital are leading teaching hospital consultants. They are highly trained in the management of all spine disorders. In fact, our doctors discuss the most complex cases at regular multidisciplinary meetings. These meetings involve spine surgeons, radiologists, neurologists, rheumatologists, pain specialists, physiotherapists, and others. The goal is…

Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial.

By London Spine
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Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial.

Lancet Oncol. 2011 Mar;12(3):225-35

Authors: Berenson J, Pflugmacher R, Jarzem P, Zonder J, Schechtman K, Tillman JB, Bastian L, Ashraf T, Vrionis F, Cancer Patient Fracture Evaluation (CAFE) Investigators

Abstract
BACKGROUND: Non-randomised trials have reported benefits of kyphoplasty in patients with cancer and vertebral compression fractures (VCFs). We aimed to assess the efficacy and safety of balloon kyphoplasty compared with non-surgical management for patients with cancer who have painful VCFs.
METHODS: The Cancer Patient Fracture Evaluation (CAFE) study was a randomised controlled trial at 22 sites in Europe, the USA, Canada, and Australia. We enrolled patients aged at least 21 years who had cancer and one to three painful VCFs. Patients were randomly assigned by a computer-generated minimisation randomisation algorithm to kyphoplasty or non-surgical management (control group). Investigators and patients were not masked to treatment allocation. The primary endpoint was back-specific functional status measured by the Roland-Morris disability questionnaire (RDQ) score at 1 month. Outcomes at 1 month were analysed by modified intention to treat, including all patients with data available at baseline and at 1 month follow-up. Patients in the control group were allowed to crossover to receive kyphoplasty after 1 month. This study is registered with ClinicalTrials.gov, NCT00211237.
FINDINGS: Between May 16, 2005, and March 11, 2008, 134 patients were enrolled and randomly assigned to kyphoplasty (n=70) or non-surgical management (n=64). 65 patients in the kyphoplasty group and 52 in the control group had data available at 1 month. The mean RDQ score in the kyphoplasty group changed from 17·6 at baseline to 9·1 at 1 month (mean change -8·3 points, 95% CI -6·4 to -10·2; p<0·0001). The mean score in the control group changed from 18·2 to 18·0 (mean change 0·1 points; 95% CI -0·8 to 1·0; p=0·83). At 1 month, the kyphoplasty treatment effect for RDQ was -8·4 points (95% CI -7·6 to -9·2; p<0·0001). The most common adverse events within the first month were back pain (four of 70 in the kyphoplasty group and five of 64 in the control group) and symptomatic vertebral fracture (two and three, respectively). One patient in the kyphoplasty group had an intraoperative non-Q-wave myocardial infarction, which resolved and was attributed to anaesthesia. Another patient in this group had a new VCF, which was thought to be device related.
INTERPRETATION: For painful VCFs in patients with cancer, kyphoplasty is an effective and safe treatment that rapidly reduces pain and improves function.
FUNDING: Medtronic Spine LLC.

PMID: 21333599 [PubMed – indexed for MEDLINE]

[Role of interventional radiology in diagnosis and management of the painful spine.]

By London Spine
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[Role of interventional radiology in diagnosis and management of the painful spine.]

Med Clin (Barc). 2012 Nov 20;

Authors: Ruiz Santiago F, Castellano García MD, Aparisi Rodríguez F

Abstract
The aim of this article is to perform a general review of the different radiological percutaneous procedures used to diagnose and treat the many causes of back pain. These procedures can be merely diagnostic, such as discography and biopsy, diagnostic and therapeutic, such as epidural and facets injections, or only therapeutic, such as vertebroplasty, decompressive techniques of the intervertebral disk and tumour ablation. We review the indications, advantages and complications of these techniques.

PMID: 23177315 [PubMed – as supplied by publisher]

[Vertebral stability in management of spinal metastases. Criteria and strategies for operative interventions].

By London Spine
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[Vertebral stability in management of spinal metastases. Criteria and strategies for operative interventions].

Orthopade. 2012 Aug;41(8):623-31

Authors: Wiedenhöfer B, Möhlenbruch M, Hemmer S, Lehner B, Klöckner K, Akbar M

Abstract
BACKGROUND: Metastases are responsible for most tumor manifestations of the spine. About 25% are symptomatic; however, due to interdisciplinary management the tumor-associated mortality is regressing. Associated acute spinal cord injury (SCI) syndromes raise patient morbidity with a loss of independence and quality of life associated with a fair potential for recovery. Therefore, the management is focused on the avoidance of SCI. The assessment of mechanical stability of vertebral bodies is a central part of decision-making when considering operative therapy. This review gives an update on the current evidence-based data for metastasis management. DECISION MAKING: The NOMS concept is well established. Especially the parameters origin, neurologic symptoms, stability and vascularization are described and illustrated by clinical cases. OPERATIVE THERAPY CONCEPTS: Evidence-based operative therapy concepts are shown reflecting palliative and curative approaches. ASSESSMENT OF PARAMETERS FOR THERAPY ALGORITHM: Clinical and radiological parameters help to find the individual therapy. Generally a number of scores with significant time expenditure are needed. The spine instability neoplastic score (SINS) simplifies the management. Operative therapy shows the best results for the parameters pain and quality of life. However, potential perioperative and postoperative complications have to be estimated and should be avoided. Using these facts our therapy algorithm is helpful for therapy management. CONCLUSIONS: With rising life expectancy operative therapy is of increasing relevance. Decision-making uses information about tumor origin, neurologic symptoms, stability, prognostic factors and vascularisation to determine the individual therapy.

PMID: 22864656 [PubMed – indexed for MEDLINE]