No abstract

The phrase "vertebroplasty versus kyphoplasty" evokes images of competitive procedures and groups of entrenched physicians locked in battle. Our involvement in the development and introduction of percutaneous vertebroplasty (PV) and kyphoplasty (KP) in the United States has given us a unique perspective on the safety and efficacy of both procedures. We feel that PV and KP both offer potential benefit with acceptable safety when used by skilled physicians. The real hurdles now are to further assess and develop the appropriate indications, advantages, and shortcomings of each procedure. We must then select the appropriate method of therapy to maximally benefit our patients. Finally, all practitioners must venture beyond the dogma of their respective subspecialties and understand the full spectrum of tools and techniques that are available to treat vertebral compression fractures.

The aim of this study was to assess the feasibility of and venous leakage reduction in percutaneous vertebroplasty (PV) using a new high-viscosity bone cement (PMMA). PV has been used effectively for pain relief in osteoporotic and malignant vertebral fractures. Cement extrusion is a common problem and can lead to complications. Sixty patients (52 female; mean age, 72.2 +/- 7.2) suffering from osteoporosis (46), malignancy (12), and angiomas (2), divided into two groups (A and B), underwent PV on 190 vertebrae (86 dorsal, 104 lumbar). In Group A, PV with high-viscosity PMMA (Confidence, Disc-O-Tech, Israel) was used. This PMMA was injected by a proprietary delivery system, a hydraulic saline-filled screw injector. In Group B, a standard low-viscosity PMMA was used. Postprocedural CT was carried out to detect PMMA leakages and complications. Fisher's exact test and Wilcoxon rank test were used to assess significant differences (p < 0.05) in leakages and to evaluate the clinical outcome. PV was feasible, achieving good clinical outcome (p < 0.0001) without major complications. In Group A, postprocedural CT showed an asymptomatic leak in the venous structures of 8 of 98 (8.2%) treated vertebrae; a discoidal leak occurred in 6 of 98 (6.1%). In Group B, a venous leak was seen in 38 of 92 (41.3%) and a discoidal leak in 12 of 92 (13.0%). Reduction of venous leak obtained by high-viscosity PMMA was highly significant (p < 0.0001), whereas this result was not significant (p = 0.14) related to the disc. The high-viscosity PMMA system is safe and effective for clinical use, allowing a significant reduction of extravasation rate and, thus, leakage-related complications.

No abstract

BACKGROUND AND PURPOSE:The appropriate choice of treatment for traumatic extracranial carotid artery injury is still debated. The purpose of this study was to evaluate outcomes of endovascular carotid repair with regard to vessel patency and retreatment rates.