Comparative Analysis of Vertebroplasty and Kyphoplasty for Osteoporotic Vertebral Compression Fractures

Study DesignA retrospective study.PurposeThe aim of this study is to compare the efficacy and outcome of vertebroplasty compared with unipedicular and bipedicular kyphoplasty for the treatment of osteoporotic vertebral compression fractures in terms of pain, functional capacity and height restoration rates.Overview of LiteratureThe vertebroplasty procedure was first performed in 1984 for the treatment of a hemangioma at the C2 vertebra. Kyphoplasty was first performed in 1998 and includes vertebral height restoration in addition to using inflation balloons and high-viscosity cement. Both are efficacious, safe and long-lasting procedures. However, controversy still exists about pain relief, improvement in functional capacity, quality of life and height restoration the superiority of these procedures and assessment of appropriate and specific indications of one over the other remains undefined.MethodsBetween 2004 and 2011, 296 patients suffering from osteoporotic vertebral compression fracture underwent 433 vertebroplasty and kyphoplasty procedures. Visual analogue scale (VAS), the Oswestry Disability Index (ODI) and height restoration rates were used to evaluate the results.ResultsMean height restoration rate was 24.16%±1.27% in the vertebroplasty group, 24.25%±1.28% in the unipedicular kyphoplasty group and 37.05%±1.21% in the bipedicular kyphoplasty group. VAS and ODI scores improved all of the groups.ConclusionsVertebroplasty and kyphoplasty are both effective in providing pain relief and improvement in functional capacity and quality of life after the procedure, but the bipedicular kyphoplasty procedure has a further advantage in terms of height restoration when compared to unipedicular kyphoplasty and vertebroplasty procedures

Is Placing Prophylactic Dural Tenting Sutures a Dogma?

Objective In this study, we investigated if and when dural tenting sutures are necessary during craniotomy. Methods Results from 437 patients aged 18 to 91 years (average, 43.5 years) who underwent supratentorial craniotomy between 2014 and 2019 were evaluated. The patients were categorized into 1 of 3 groups, patients who had at least 3 prophylactic dural tenting sutures placed before opening of the dura (group 1), at least 3 dural tenting sutures placed after surgery was completed, during closure (group 2), or no dural tenting sutures (group 3 [control]). All such sutures in groups 1 and 2 were placed in the circumference of the craniotomy and dural junction. No central dural tenting sutures were placed in any of the patients. Results Among the 437 patients, 344 underwent surgery for the first time and 93 were undergoing a second surgery. Cranial computed tomography imaging was performed for each patient 1 hour, 3 days, and 1 month after surgery. In group 1, 3 patients had a cerebral cortex contusion and 2 patients had acute subdural hematoma after the sutures were placed. In groups 2 and 3, none of the patients had a cerebral cortex contusion or acute subdural hematoma. Fewer complications were observed when dural tenting sutures were placed during postsurgical closure. Conclusion Placing dural tenting sutures is an important technique for ensuring hemostasis. However, when not needed, they seem to cause inadvertent complications. As our results suggest, knowing when and where to use them is equally important

Assessment for efficacy of vertebroplasty and kyphoplasty in the treatment of painful osteoporotic vertebral compression fractures in elderly patients

Amaç: Konservatif tedaviden fayda görmeyen ağrılı osteoporotik vertebra çökme kırıklı yaşlı hastaların vertebroplasti ve kifoplasti ile tedavi edilerek, beklenen morbidite ve mortaliteden korunmaları ve yaşam kalitelerinin arttırılması amaçlanmıştır. Gereç ve Yöntem: Ankara Üniversitesi Tıp Fakültesi Nöroşirürji Anabilim Dalında 2003-2004 yılları arasında, ağrılı osteoporotik vertebra çökme kırığı olan dokuz yaşlı hastaya (iki erkek, yedi kadın, 60 yaş üzeri) kifoplasti ve vertebroplasti uygulanmıştır. Yöntemlerin etkinliği, klinik ve radyografik olarak değerlendirilmiştir. Sonuçlar: Osteoporotik vertebra kırıkları, serimizde kadınlarda daha yüksek oranda bulunmuştur. Tüm hastalar osteopenik veya osteoporotiktir ve dirençli ağrı en belirgin semptomdur. İlaç tedavisine ve fizik tedaviye yanıt vermemişlerdir. Torakolomber vertebroplasti ve kifoplasti uygulanan dokuz hastadan sadece birinde klinik olarak önemsiz epidural kaçak gelişmiştir. Tüm hastaların şikayetlerinde akut düzelme izlenmiş, radyografik olarak da %88.8’inde postoperatif vertebra elevasyonu sağlanmıştır. Seride mortalite ve morbidite yoktur. Tüm hastalar aynı gün mobilize edilmiş ve ilk üç gün içinde taburcu edilmişlerdir. Tartışma: Osteoporotik vertebra kompresyon kırıkları, yaşlılarda önemli bozukluklara ve mortaliteye yol açar. Bu kırıkların cerrahi tedavisinde, hastanın ağrısını en aza indirmek, kifozu önlemek ve daha iyi yaşam koşullarını minimal invaziv bir yolla gerçekleştirmek hedeflenmelidir.Purpose: It is aimed to increase health-related quality of life and to avoid the clinical consequences of osteoporotic vertebral compression fractures in elderly patients by performing vertebroplasty and kyphoplasty. Material-Methods: Nine elderly patients (two men, seven women, aged over 60) with painful osteoporotic vertebral compression fractures were treated with vertebroplasty and kyphoplasty in University of Ankara Faculty of Medicine, Department of Neurosurgery between 2003-2004. The efficacy of the procedures was assessed clinically and radiographically. Results: Osteoporotic vertebrae fractures were slightly more common in females in our series. All the patients had low bone mineral density and intractable pain. Clinical outcomes were unchanged following medical and physical therapy. In one of the nine patients undergone thoracolomber vertebroplasty and kyphoplasty, the cement leaked into the epidural space after kyphoplasty causing no change in its therapeutic benefits. All the patients had good pain relief, improved function and vertebral body elevation at a rate of 88.8%. There was no mortality and morbidity. All the patients were mobilized the day after the procedures were performed and discharged within three days postoperatively. Conclusion: Osteoporotic vertebral compression fractures represent a significant cause of disability and mortality in the elderly. The surgical treatment of these fractures should address the need to reduce the fracture related pain and the kyphotic deformity and to provide better quality of life to the elderly patients in a minimally invasive fashion

Convexity dural chondroma: a case report and review of the literature.

The majority of intracranial chondromas arise from cartilage rests in the synchondrosis at the base of the skull. Chondromas are most commonly found in the sellar and parasellar regions, usually located extradurally. In rare instances, these tumours originate from the dura mater of the convexity. We report a rare case of a chondroma arising from the convexity dura mater. The origin of this tumour is analysed and the literature reviewed

Acetaminophen modulations of chemotherapy efficacy in MDAH 2774 human endometrioid ovarian cancer cells in vitro

Epidemiological data have correlated consumption of nonsteroidal antinflammatory drugs with lowered risk for many types of cancer, and some recent studies indicate a reverse correlation with acetaminophen consumption and ovarian malignancy. In this study we examined effects of acetaminophen on plating, S-phase and colony growth of MDAH 2774 human endometrioid ovarian carcinoma, as well as sensitivity of this cell line to carboplatin in all three tests, and paclitaxel to clonogenic assay. Acetaminophen significantly enhanced S-phase in first 72 hours and enhanced cell population in 96 hours of plating monitorization, but decreased one week colony growth by approximately 80%, which was in the range of cytotoxic drugs. Interestingly with low dose carboplatin in first 72 hours acetaminophen enhanced cell proliferation more profoundly, but only thereafter decreased cell growth synergistically with carboplatin. It did not effect paclitaxel colony growth inhibiting acitivity

The effect of COX-2 inhibitor, nimesulide, on angiogenetic factors in primary endometrial carcinoma cell culture

Angiogenesis, the development of new blood vessels from preexisting capillaries, is essential for the development, growth and advancement of solid tumours. Angiogenesis is enhanced by prostaglandins (PGs) that are synthesised by the catalysis of cyclooxygenases (COX-1 and COX-2) from arachidonic acid. COX-2 is upregulated in a variety of malignancies and favours the growth of malignant cells by stimulating proliferation and angiogenesis. The aim of this study is to investigate the angiogenetic process by determining the levels of vascular endothelial growth factor (VEGF), monocyte chemoattractant protein (MCP)-1 and interleukin (IL)-8 in endometrial cancer cells and to study the effect of nimesulide, a selective COX-2 inhibitor, on these mediators using cell culture. Endometrial tissue specimens were obtained from subjects with endometrial cancer and intramural leiomyoma. Cells were incubated with either 10 or 50 mu M nimesulide for 24 h. VEGF, MCP-1 and IL-8 concentrations were determined by sandwich quantitative enzyme immunoassay (ELISA). VEGF concentration was significantly higher in cancer cells than normal endometrial cells. VEGF was decreased with 10 mu M nimesulide in cancer cells whereas it remained unaltered in normal cells. Both MCP-1 and IL-8 concentrations were lower in cancer cells than normal cells. MCP-1 levels were decreased with both doses of nimesulide in normal cells, whereas IL-8 levels were significantly affected only by 50 mu M of nimesulide. These results suggest that COX-2 inhibitors may be effective in the treatment of endometrial cancer via suppression of angiogenesis

Stem cell therapy in spinal cord injury in vivo and postmortem tracking of bone marrow Mononuclear or mesenchymal stem cells

The aim of this study was to address the question of whether bone marrow-originated mononuclear cells (MNC) or mesenchymal stem cells (MSC) induce neural regeneration when implanted intraspinally. The study design included 4 groups of mice: Group 1, non-traumatized control group; Groups 2, 3 and 4 spinal cord traumatized mice with 1 g force Tator clips, which received intralesionally either no cellular implants (Group 2), luciferase (Luc) (+) MNC (Group 3) or MSC (Group 4) obtained from CMV-Luc or beta-actin Luc donor transgenic mice. Following the surgery until decapitation, periodical radioluminescence imaging (RLI) and Basso Mouse Scale (BMS) evaluations was performed to monitor neural activity. Postmortem immunohistochemical techniques were used to analyze the fate of donor type implanted cells. All mice of Groups 3 and 4 showed various degrees of improvement in the BMS scores, whereas there was no change in Groups 1 and 2. The functional improvement was significantly better in Group 4 compared to Group 3 (18 vs 8, p = 0.002). The immunohistochemical staining demonstrated GFP(+)Luc(+) neuronal/glial cells that were also positive with one or more of these markers: nestin, myelin associated glycoprotein, microtubule associated protein or myelin oligodendrocyte specific protein, which is considered as indicator of donor type neuronal regeneration. Frequency of donor type neuronal cells; Luc + signals and median BMS scores were observed 48-64 % and 68-72 %; 44-80 %; 8 and 18 within Groups III and IV respectively. MSCs were more effective than MNC in obtaining neuronal recovery. Substantial but incomplete functional improvement was associated with donor type in vivo imaging signals more frequently than the number of neuronal cells expressing donor markers in spinal cord sections in vitro. Our results are in favor of functional recovery arising from both donor MSC and MNCs, contributing to direct neuronal regeneration and additional indirect mechanisms.This study was supported by grants from the Turkish Scientific Research Council TUBITAK, Ankara University Research Resources (SBAG) and the Turkish Academy of Sciences