AIM: The modern spinal surgery accepts the percutaneous vertebroplasty (PV) with polymethylmethacrylate (PMMA) as a routine procedure for treatment of painful osteoporotic, neoplastic and traumatic compression fractures in the thoracic and lumbar region of the spinal column. Although considered to be a minimally invasive and safe procedure, it could be affected by severe disabling and even life-threatening complications. The aim of the present study is to evaluate the different potential complications with their clinical presentation, diagnostics and different treatment options. MATERIALS AND METHODS: The study analyzed a cohort of 56 consecutive patients (66 levels) treated with PV in our clinic for the period January, 2008-July, 2012. Of them, 31 (55.4%) were women and 25 (44.6%)-men at a mean age of 61.7 (23-80) years. The osteoporotic and traumatic compression fractures subgroup was comprised of 44 (78.6%) patients, while the patients with neoplastic fractures were 12 (21.4%). All the fractures were classified as A1 Magerl's fractures with no neurologic deficit. RESULTS: Complications and unwanted events were registered in 9 (16.1%) patients. Of them, 2 experienced transient increased pain syndrome intensity, one of the patients presented with index level radiculopathy, 2 patients were diagnosed with extravertebral leakage of the cement in the spinal canal with compression of the neural structures and subsequently operated, 1 patient had a cement leak in the adjacent disk, 2 patients-a cement leak in the paravertebral soft tissues and the paravertebral venous system, and one had cement pulmonary embolism. CONCLUSION: PV is a minimally invasive and effective procedure that is used in the treatment of painful osteoporotic, traumatic and neoplastic compression fractures on neurologically intact patients. The clinically significant complications and unwanted events are a relatively rare encounter and in the majority of the cases are treatable with conservative measures. The epidural cement migration with neural elements compression is the only indication for surgical decompression and removal of the compressing cement.

AIM: The vertebral compression fractures (VCF) are among the most common complications of osteoporosis that could be a cause for permanent and debilitating pain, restricted mobility and hence-significant worsening of the quality of the life. The surgical treatment of VCF is indicated after a failure of the conservative treatment or after established spinal instability or neurological deficit. The most commonly used surgical procedures are the percutaneous vertebroplasty with polymethyl methacrylate (PMMA) and the transpedicular screw fixationreconstruction. The aim of the present investigation is to summarize and elucidate the indications for the different types of spinal techniques, the potential complications and their treatment. MATERIALS AND METHODS: 72 consecutive patients with compression spinal osteoporotic fractures treated in our clinic from January, 2009 to July, 2012 were analyzed. Of these, 38 patients (M14 / F24) at an average age of 66.8 years (54-80) underwent PV on 46 levels. All the fractures were without neurological deficit and classified as A1 type in Magerl. The remaining 34 patients (M5 / F29) at an average age of 67.3 years (56-85) underwent transpedicular screw spinal reconstruction addressing incomplete burst compression fractures in which the anterior two columns were damaged. A total of 40 levels were addressed. The indications for surgery were severe pain syndrome, neurological deficit, presence of bone fragments in the spinal canal or spinal instability. RESULTS: In our series the VCF are most commonly located in the thoracolumbar (Th11-L2) segment of the spine-75.6%, (65/86) levels. In 7 patients 2 levels were treated in one settings, 2 patients had 3 levels treated and one patient 4 levels. Our PV subgroup showed very good outcome in 84.2% (32/38) of the patients. Due to migration of the cement in the spinal canal, two patients underwent surgical decompression. The results in the spinal instrumentation subgroup are good in 82.4% (28/34) of the cases. In 6 of the instrumented cases a revision surgery was performed, due to progressing neurological deficit and persistent pain. The surgery addressed screw pull-outs and implant malposition/displacement. CONCLUSION: Our results indicate that modern surgical treatment of osteoporotic patients with symptomatic VCF presents low incidence of complications and allows for a significant reduction of pain, spinal stability, improved quality of life and prolonged active life. PV is a minimally invasive procedure with a good effectiveness and uncommon complications that are clinically significant. The spinal instrumented reconstruction is indicated in cases of severe multilevel VCF, spinal instability, and compression of the neural structures.

Cerebrovascular diseases are a global medical and social issue because of the high morbidity, mortality and disability they cause. WHO announces 15 Mio ischemic stroke occurrences per year globally, with 5 Mio associated deaths and 5 Mio left permanently disabled. Thrombolysis (TL) with tissue plasminogen activator (rt-PA) is currently an approved differentiated pharmaco-therapeutic treatment of ischemic stroke (IS) in its acute phase. There is irrefutable evidence of better health results and efficient clinical management of ischemic strokes within an integrated therapeutic approach as a key factor for improving the functional outcome in stroke patients. Quality is one of the most widely discussed issues in the theory and practice of disease management. The rigid compliance with the standards for treatment of ischemic strokes is an indicator of high quality patient management.

Stroke remains a major health care challenge worldwide and is the third leading cause of death and the leading cause of disability in developed countries. The management of acute ischemic stroke has advanced greatly over the past 20 years. Now the treatment of stroke can be described with one word-variety.The current review is dedicated to the problems of endovascular treatment in acute ischemic stroke. The different methods of treatment, pros and cons of each of them, discussing the different options for the patients are presented.

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