Osteoporotic vertebral compression fractures: surgery versus non-operative management.

Osteoporotic vertebral compression fractures: surgery versus non-operative management.

J Int Med Res. 2011;39(4):1438-47

Authors: Tang H, Zhao J, Hao C

Abstract
This 12-month retrospective study compared pain relief, quality of life (QoL), treatment cost-effectiveness and complication rates in patients with acute osteoporotic vertebral compression fracture (OVCF) undergoing percutaneous vertebroplasty (PVP; n = 58), percutaneous kyphoplasty (PKP; n = 55), or conservative medical therapy (CMT; n = 55). After surgery, Cobb angle and vertebral height were significantly improved in the PKP group. PVP and PKP patients had significantly less pain immediately after surgery than CMT patients, but this difference disappeared between weeks 2-8, only to return from months 6-12. QoL was significantly better among the surgical groups after surgery and was lower in the CMT group than in the surgical groups. Treatment times were shorter with PVP and PKP, but costs were lower with CMT. The rate of secondary fractures during follow-up was greater with CMT. Overall, PVP was considered the first choice treatment for OVCF with refractory pain.

PMID: 21986146 [PubMed – in process]

Surgical technique of temporary arterial occlusion in the operative management of spinal hemangioblastomas.

Surgical technique of temporary arterial occlusion in the operative management of spinal hemangioblastomas.

World Neurosurg. 2010 Jul;74(1):200-5

Authors: Clark AJ, Lu DC, Richardson RM, Tihan T, Parsa AT, Chou D, Barbaro NM, Kunwar S, Weinstein PR, Lawton MT, Berger MS, McDermott MW

Spinal hemangioblastomas (SH) are definitively treated by en bloc microsurgical resection. Although benign, their highly vascular nature makes resection challenging. A major difficulty involves intraoperative differentiation of vessels supplying the tumor from those supplying the spinal cord.

PMID: 21300014 [PubMed – indexed for MEDLINE]

Predictive factors influencing clinical outcome with operative management of lumbar spinal stenosis.

Predictive factors influencing clinical outcome with operative management of lumbar spinal stenosis.

Spine J. 2011 Apr 8;

Authors: Athiviraham A, Wali ZA, Yen D

BACKGROUND CONTEXT: Lumbar spinal stenosis is now the most common and fastest growing reason for spinal surgery in adults older than 65 years. There are not yet clearly identified preoperative predictive factors for postoperative clinical outcome. We have previously reported on the clinical outcome of patients treated operatively and nonoperatively. PURPOSE: The purpose of this study was to identify independent predictors of clinical outcome in our operative group to guide management in future patients. STUDY DESIGN/SETTING: This is a prospective nonrandomized cohort study done in a university center providing secondary and tertiary care. PATIENT SAMPLE: Ninety-four consecutive patients were evaluated. OUTCOME MEASURES: We used a validated patient-oriented disability questionnaire. METHODS: We evaluated patients treated operatively for lumbar spinal stenosis. Ninety-four patients were treated surgically. Clinical outcomes were measured using the modified Roland-Morris questionnaire with 2-year follow-up. RESULTS: Patients treated surgically had significant improvement at 2-year follow-up. Higher values of body mass index and a history of psychiatric disease were factors associated with a worse outcome, whereas those with more preoperative disability had a better outcome. Age, gender, cardiovascular or musculoskeletal comorbidities, duration of symptoms for more than 1 year, multiple-level decompression, spinal fusion, history of neurogenic claudication, symptomatic lumbosacral extension, subjective numbness or weakness, and objective decrease in sensation or reflex abnormalities were not predictive of outcome. CONCLUSIONS: On average, patients who choose to have surgery will have improvement. However, not all patients having surgery will note improvement, and there are factors predictive for outcome.

PMID: 21482198 [PubMed – as supplied by publisher]