Vertebral Body Compression Fractures Research Articles

Facet Joint Signal Change on MRI at Levels of Acute/Subacute Lumbar Compression Fractures

The prevalence of facet joint signal change in acute/subacute lumbar vertebral body compression fractures is unknown. We hypothesized that facet joint signal change on MR imaging is more common in facet joints associated with an acute/subacute lumbar compression fracture than those associated with normal vertebral bodies or ones that have a chronic compression fracture. Three neuroradiologists and a neuroradiology fellow retrospectively graded facet joint inflammatory change on MR imaging in 900 facet joints in 75 patients with at least 1 painful osteoporotic lumbar compression fracture. Facet joint signal change was assessed on T2-weighted images with chemical fat-saturation, STIR images, and/or gadolinium-enhanced T1-weighted images with chemical fat-saturation. Each facet joint from the T12/L1 to L5/S1 level was assessed individually. An overall facet joint signal-change score, which is a composite measure of the grade of signal change for all 4 facet joints associated with a given lumbar vertebral level, was devised, and statistical significance was assessed via Wilcoxon rank sum tests. The overall facet joint signal-change scores were significantly higher at vertebral body levels affected by an acute/subacute compression fracture compared with control levels, which were associated with either normal bodies or chronic compression fractures. Our findings suggest an association between facet joint signal change on MR imaging and acute/subacute lumbar vertebral body compression fractures.

Solitary Bone Plasmacytoma

Can Respir J Vol 20 No 1 January/February 2013 Plasma cell dyscrasias are a group of entities characterized by the neoplastic proliferation of a single clone of plasma cells, typically producing a monoclonal immunoglobulin. Fewer than 5% of patients with a plasma cell dyscrasia present with a single bone (solitary bone plasmacytoma [SBP]) or extramedullary lesion due to malignant plasma cell infiltrate without apparent evidence of systemic myeloma. Most often presenting as a painful lesion (but also asymptomatically), as in the present case of a 64-year-old woman with an enlarging anterior chest wall mass over a six-month period, SBP may be diagnosed during routine clinical or radiological examination for other conditions (Figure 1). A soft tissue extension of the tumour may result in a palpable mass, particularly if a rib is involved. Pathological fracture of ribs and compression fractures of vertebral bodies, as well as cord compression, may be the other presenting features of SBP. For extramedullary plasmacytomas, the lesions may grow in the aerodigestive tracts and cause hoarseness, dyspnea and hemoptysis. Extramedullary

Acute Spinal Cord Infarction: Diffusion-Weighted MR Imaging - Case Report -

Study Design: A case report. Objective: We present a rare case of acute spinal cord infarction and usefulness of diffusion weighted MR imaging. Summary of Literature Review: T1-weighted and T2-weighted images are often normal in a patient with acute spinal cord infarction. Material and Methods: An 82-year-old presented with acute onset of paraplegia and urinary retention. His symptoms developed 6 days ago without any trauma. He had a history of vertebroplasty due to compression fracture of 12th thoracic vertebral body 6 years ago. There was no evidence of spinal cord compression on routine T1-and T2-weighted MRI. Results: In diffusion-weighted MRI, a high intensity signal intensity lesion in the spinal cord and conus medullaris was observed. Conclusion: We report an example for the usefulness of diffusion-weighted image for early and accurate diagnosis of acute spinal cord infarction.

FRACTURES OF VERTEBRAL BODIES IN THE STRUCTURE OF CHILDREN’S TRAUMATISM

The aim of the study was to establish the frequency and features of uncomplicated compression fractures of vertebral bodies in children and to determine its place in the rank structure of children’s injuries. In order to achieve this goal in 2011 the medical records were studied studied: case register of emergency trauma care, hospital records, medical records, X-ray archive. The authors have found that fractures of vertebral bodies took place XVIII ranking in the structure of child’s injury, which accounted for 0.55% of traumatic injuries. Frequently the fractures of vertebral bodies occur in children aged 8-12 years. Mainly the vertebra ThVIII was injured - 11.44% of cases. Children with fractures of vertebral bodies constitute 15.66% of inpatient emergency trauma patients in a specialized children’s orthopedic trauma department

EXPERIENCE OF SURGICAL TREATMENT OF INJURIES OF MIDDLE AND LOWER CERVICAL SPINE WHILE DIVING

Objective - to analyze the long-term results of surgical treatment of patients with injuries of middle- and lower cervical spine in diving. Materials and methods. An analysis of surgical treatment of 27 patients and assessment of the long-term results of 20 patients in a period of 6 months to 6 years were performed with analysis of clinical, neurological, radiographic data and mortality. Results. Mostly the C5 vertebra was damaged - in 17 patients (63%). Compression fractures of vertebral bodies met in 6 (22%), compression-comminuted fractures - in 16 (59%) patients, dislocations - in 5 (19%). All patients had neurological disorders. All observations noted rigid stabilization of the spine with an implant made of porous nickel-titanium, the presence of bone-metal block at the level of the damaged vertebral body Mortality in the postoperative period was 26%. In the long-term period the initial neurological symptoms were observed in 7 (30%) patients, 13 (48%) patients had marked regression of neurological symptoms. Full functional maladjustment was observed in 6 patients with no motor function below the damaged segment, originally belonging to groups A and B on the classification of H.L. Frankel. Moderate and mild degree of functional adaptation disorders were present in 5 and 4 patients respectively. In the remaining patients we did not reveal a functional maladjustment. Range of motion in the cervical spine in all patients was considered as good. Conclusions. Anterior decompressive-stabilizing surgeries on the spine with an implant made of porous nickel-titanium and metal plate CSLP allows reliably stabilization of the injured spine and the rehabilitation of this severe category of patients.

Treatment of thoracolumbar fracture with pedicle screws at injury level: a biomechanical study based on three-dimensional finite element analysis

The aim of this study was to investigate the biomechanical mechanisms of treatment of thoracolumbar compression fracture with pedicle screws at injury level based on a three-dimensional finite element method. We constructed one three-dimensional finite element model of T11-L1 in a patient with a compression fracture of the T12 vertebral body(anterior edges of vertebral body were compressed to 1/2, and kyphosis Cobb angle was 18.6°) fixed by four pedicle screws and another model fixed by six pedicle screws at the injured vertebrae, and then assigned different forces to the two models to account for axial compression, flexion, extension, left lateral bending, and rightward axial rotation by Ansys software. After different loading forces were applied to the models, we recorded stress measurements on the vertebral pedicle screws, as well as the maximum displacement of T11. The stress distribution suggested that stress concentration was appreciable at the root of the pedicle screws under different loading modalities. Under axial compression, flexion, extension, left lateral bending, and rightward axial rotation load, the stress for the superior screw was significantly greater than the stress for the inferior screw (P < 0.05). The stress in the six pedicle screw fixation model was significantly decreased compared to the four screw interbody fusion model (P < 0.05), but the maximum displacement of T11 between two models under different loadings was not statistically different. The use of pedicle screws at injured vertebral bodies may optimize internal fixation load and reduce the incidence of broken screws.

Surgical placement of biologic mesh spacers prior to external beam radiation for retroperitoneal and pelvic tumors

PurposeTo determine the feasibility of surgical placement of biologic mesh spacers to displace bowel and other radiation-sensitive organs prior to external beam radiation for difficult retroperitoneal and pelvic tumors. Methods and MaterialsTumors were resected if possible, and intraoperative electron radiation therapy (IOERT) was directed to the tumor or tumor bed in selected patients. Biologic mesh spacers comprised of cadaveric human skin treated to remove cells and preserve extracellular matrix (Alloderm; Lifecell, Branchburg, NJ) were then placed around the tumor or tumor bed. External radiation techniques included proton beam radiation therapy (PBRT) and intensity modulated radiation therapy (IMRT). ResultsPatients had primary sarcomas (n = 2), radiation-associated sarcomas (n = 1), or isolated metastases (n = 2) in the retroperitoneum or pelvis. One patient received preoperative radiation. Three tumors were marginally resected (R1 resection) while 2 tumors were left in situ, and 3 patients received IOERT (10-17 Gy) to the tumor or tumor bed. Up to 4 sheets of biologic mesh were used as spacers around the tumor or tumor bed to displace small bowel, colon, ureter, bladder, or pancreas. The average distance of the 4 closest organs prior to mesh placement was 1.3-9 mm and after mesh placement was 8.0-23.5 mm. Preoperative or postoperative radiation 36-76 Gy was delivered by IMRT or PBRT. There were no early complications from mesh placement and late complications possibly related to radiation included 1 vertebral body compression fracture and 1 deep vein thrombosis. There were no mesh-related infections and none of the meshes required removal. All 5 patients currently remain free of disease progression after 3-38 months. ConclusionsBiologic mesh spacers can be placed around tumors or tumor beds to displace radiation-sensitive organs and may allow for safer delivery of external beam radiation.

Spinal loads during position changes

BackgroundRecommendations exist how patients should change from one body position to another in order to keep the spinal loads low. However, until now it is not clear whether the loads are in fact lower if the patients follow these recommendations. The aim was to measure the loads while changing the body position. MethodsTelemeterized vertebral body replacements have been inserted into 5 patients who had a severe compression fracture of a lumbar vertebral body. The acting loads were measured during a changing of the body position while lying and when moving from lying to sitting, from sitting to standing and vice versa. FindingsWhen the lying patients changed their position according to the physiotherapist's recommendations, the resultant force was nearly as high as it was during relaxed standing. Otherwise, the force was nearly twice as high. Changing from a lateral lying position to sitting and vice versa caused forces of about 180% of those seen for standing when the recommendations were heeded. Without instructions, the loads were about 70% higher. Use of a trapeze bar mounted to the bed did not increase the loads. Rising from a chair with the arms hanging down laterally led to average resultant forces of 380% related to standing. Placing the hands on armrests reduced this value to 180%. InterpretationHigh forces may act on the spine when changing from one body position to another. These loads can be minimized when following the physiotherapist's instructions and when supporting the upper body by the arms.

SURGICAL TREATMENT OF C7 VERTEBRAL BODY FRACTURE WITH BIOSCORP IMPLANT

The paper presents the first experience with using of BioScorp implant in the treatment of a patient with unstable compression fracture of the C7 vertebral body. Results demonstrated that BIOSCORP provided reliable stabilization in the motion segment and allowed for early patient mobilization. In the long-term postoperative follow-up the implant lysis and formation of a solid bone block were observed. Hir. Pozvonoc. 2012;(1):26-30.

Varón de 45 años con tumoración lumbar

A 45 year old Filipino male, with history of Hepatitis B virus infection, was seen in his primary care clinic with a lumbar mass for the past three months. On physical examination the lower limbs showed decrease strength, chest X-rays showed bilateral thickening of the apical pleura, the Mantoux skin test was positive and a lumbar magnetic resonance imaging study showed a compression fracture of D4 vertebral body and soft-tissue abscess in L1. Microbiological examination was positive for M. tuberculosis complex, and with the diagnosis of Pott́s disease, he began treatment. With the advent of anti-tuberculosis drugs, spinal involvement of tuberculosis is rare, but it continues to have a high impact on morbidity. Treatment of vertebral involvement is based on anti-tuberculosis drugs and surgery.

Abstract No. 386: Percutaneous vertebroplasty performed with an 18 G needle for the treatment of severe compression fracture of cervical vertebral body due to malignancy

No. 386 Percutaneous vertebroplasty performed with an 18 G needle for the treatment of severe compression fracture of cervical vertebral body due to malignancy L. Chen, R. Ni; Interventional Radiology, The First Affiliated Hospital of Suzhou University, SuZhou, China Purpose: Percutaneous vertebroplasty (PVP) provides pain relief and strengthening of the bone of vertebrae weakened by disease. It is increasingly accepted as one of the treatment options in the management of intractable pain due to vertebral compression. Severe vertebral compression, refers to vertebral body collapse to less than one-third of its original height and is considered to be a situation in which PVP is technically difficult to perform, especially for the treatment of cervical vertebral body. The purpose of this study was to investigate the clinical feasibility and efficacy of PVP performed with an 18G needle for the treatment of severe compression fractures of cervical vertebral body due to malignancy. Materials and Methods: PVP was performed in 4 patients with severe compression fractures of cervical vertebral body due to malignanc. A total of 5 diseased vertebral bodies were detected, which distributed in the C5 (n 1), C6 (n 3), C7 (n 1) vertebral bodies. Under fluoroscopic guidance an 18G needle was punctured into the target vertebral body and then polymethylmethacrylate bone cement was in. A follow-up lasting for one month was conducted. Results: The technical success of both needle puncturing and bone cement injection was achieved in all patients. The mean amount of bone cement injected in each diseased vertebra was 2.2 ml (1.5 3.2)m1. Marked pain relief was quickly obtained in all 4 patients. No major complications occurred in this series, except for asymptomatic bone cement leaking around vertebra which appeared in one vertebral bodies. Conclusion: PVP with 18G needle is a safe, effective technique in treating the malignant severe cervical vertebral body compression fractures. Educational Exhibit Abstract No. 387 Simulation training in percutaneous image-guided interventions J. Ghassemi, B. Jeun, B.B. Pua; Radiology, Weill Cornell Medical Center, New York, NY Learning Objectives: Users will gain familiarity with key technical aspects and necessary steps required for percutaneous imageguided interventions, namely the placement of an abscess drainage catheter. Background: Current limitations in resident work hours, though essential for physician health and decision-making, has unfortunately resulted in decreased hands on procedural and operative experience. This paradigm shift has resulted in the need for accurate simulation modules to allow the training physician to both learn the steps of procedures as well as develop comfort in its technical aspects. We have developed a software application that simulates the sequential steps required for percutaneous image-guided interventions. The program was written in the Adobe Flash environment to construct an interactive graphical display interface (GUI) to enhance the user experience. Clinical Findings/Procedure Details: Our training module simulates the deployment of a CT-guided drainage catheter. Briefly, a video of an actual abscess drainage case was recorded after obtaining patient consent. The video was subsequently edited and imported into our software program, which also utilizes a list of images that a user can select from the computer screen. Each image, which represents a key step in the procedure, is temporally synchronized to its appropriate position in the video. For instance, an image of a biopsy grid may be associated with video playback demonstrating the technique of localizing proper site of percutaneous access. The list of images is randomized, and the simulation will only proceed forward if the end user selects the correct chronologic sequence of steps. Lastly, a narrative is provided throughout the video to provide more details on each step. Conclusion and/or Teaching Points: Simulation technologies play an integral role in medical training and practice. We have developed a training module that simulates the sequential steps required in the placement of a CT-guided percutaneous drainage catheter. Educational Exhibit Abstract No. 388 Complications of percutaneous radiological gastrostomy/gastrojejunostomy tube insertions: S154 Poster Sessions JVIR Po st er Se ss io ns

Management of Painful Vertebral Compression Fracture With Kyphoplasty in a Sever Cardio-Respiratory Compromised Patient

IntroductionVertebral body compression fractures due to osteoporosis, often lead to pain and disability which can be successfully treated by injecting cement into the vertebral body, a procedure known as Balloon Kyphoplasty. In this procedure, an inflatable balloon is used to restore vertebral body height before injection of the cement. Vertebral compression fractures have been treated conservatively with the bed rest, pain medications, and back bracing to decrease the patient’s pain, but the spine was left in its deformed state. Open surgical treatment can address the deformity, but it is usually reserved for patients with a neurological deficit. Kyphoplasty have been developed as an alternative to surgery for the treatment of painful vertebral compression fractures.Case PresentationA 65 year-old female had a compression fracture and decrease height of L1 due to falling down. She had a local severe pain (VAS 8) and tenderness over L1 to L4 vertebra and in her physical examination, there were not any neurologic deficits or bowel and bladder dysfunction. She had a severe cardiovascular disease with low ejection fraction (30%) and had a pace maker, hypertension, diabetes, Chronic obstructive pulmonary disease (COPD), and used about 15 drugs daily. The risk of anesthesia and open surgery was high, therefore she was nominated for the Balloon Kyphoplasty as an interventional procedure.ConclusionsAfter Kyphoplasty, her pain was immediately resolved, vertebral body height was restored to normal, and pain score was reduced from 8 to 1. She was discharged with a normal neurological examination and good general condition, and returned to her normal life. In this case, Balloon Kyphoplasty resulted in the restoration of the vertebral body height, decrease in pain, and returning to daily activity. Therefore, this technique can be an appropriate alternative for surgery in cardio-pulmonary compromised patients.

Open vertebroplasty in the treatment of spinal metastatic disease

BackgroundMetastatic spine tumors can cause vertebral body (VB) osteolysis, microfractures, and/or compression fractures, and requires restabilization of the VB. Curative or curettage surgery, such as vertebrectomy and reconstruction, is currently the main method of treatment. In certain situations however, such as a patient's poor condition, multi-level involvement, or a limited life expiration, major surgery is not recommended. ObjectiveTo evaluate a new method of open vertebroplasty (OVP) in the treatment of VB metastasis and to investigate the indications for, limitations of, and the result of this new procedure. MethodsBetween May 2007 and May 2010, the authors treated 18 patients with VB metastasis disease by OVP. Patients consisted of 12 men and 6 women with a mean age of 53 years. All patients suffered severe back pain preoperatively (mean VAS score of 6.82). Spinal cord compression resulted in eight and isolated radicular compression occurred in three of the 18 patients. In these 18 patients, 28 vertebral levels were treated: three levels in 3 patients; two levels in 4 patients; and one level in the remaining 11 patients. OVP was used accompanied by vertebral fixation or medullary compression. ResultsThe mean duration of the OVP procedure was 37min. Blood loss ranged from 50 to 150ml. In all patients, pain improved within seven days after the intervention, and the mean VAS score decreased to 2.31. Patients who suffered from neurological dysfunction preoperatively improved in Frankel degree (the result of spinal cord decompression). Most patients reached an excellent score, according to the Modified MacNab Criteria. Postoperative radiography revealed cement leaks into pulmonary veins in one case. After OVP or PVP, all patients underwent radiotherapy or chemotherapy. ConclusionsOVP has a comprehensive application in metastasis spinal column disease, being easily performed and accompanied by few complications. Importantly, this procedure allows decompression of the spinal cord and consolidation of the VB, thus stabilizing the vertebral column. Results from the clinic demonstrate that patients experience pain relief and neural function recovery following the OVP procedure.

Investigation of polymethylmethacrylate pulmonary embolus in a patient ten years following vertebroplasty

Percutaneous vertebroplasty (PV) is a procedure commonly used for the treatment of vertebral compression fractures, and the number of procedures has been steadily increasing over the past decade. We report a case of an 81 year old female with a history of breast cancer that developed two vertebral body compression fractures and was subsequently treated with PV. The patient developed a subsegmental pulmonary polymethylmethacrylate (PMMA) embolus as a complication of the procedure. Ten years following the procedure, she remained asymptomatic with the PMMA embolus being discovered incidentally during workup for a suspected chronic obstructive pulmonary disease (COPD) exacerbation. In reviewing the case, we describe the typical presentation of a pulmonary PMMA embolus and consider methods to decrease the incidence of this complication.

In silico evaluation of stress distribution after vertebral body augmentation with conventional acrylics, composites and glass polyalkenoate cements

There exists clinical evidence of fractures in adjacent vertebrae subsequent to vertebral augmentation procedures, such as vertebroplasty (VP) and kyphoplasty (KP). A potential contributory factor to such fractures may be the excessive mismatch of mechanical properties between contemporary bone cements ( i.e. polymethyl methacrylate (PMMA) and bisphenol-a-glycidyl dimethacrylate (BIS-GMA)) and bone. Aluminum-free glass polyalkenoate cements (GPCs) present an interesting alternative to conventional bone cements. GPCs adhere to the philosophy that implant materials should have mechanical characteristics similar to those of the bone, and also offer chemical adhesion and intrinsic bioactivity. However, their influence on the loading patterns of augmented vertebrae (as compared with conventional bone cements) is not available in the literature. The present work investigates how the moduli of PMMA, BIS-GMA and GPC implants affect the stress distribution within a single, augmented vertebra, in both healthy and osteoporotic states. Using a finite element model of the L4 vertebra derived from computed tomography data, with simulated augmentation, it was found that, as cement stiffness increased, stress was redistributed from the cortical and trabecular bone to the cement implant. The GPC implant exhibited the least effect on stress redistribution in both the healthy and osteoporotic models compared to its acrylic counterparts. The significance of this work is that, under simulated physiological loading conditions, aluminum-free GPCs exhibit stress distribution throughout the vertebral body similar to that of the healthy bone. In comparison to conventional augmentation materials, the use of aluminum-free GPCs in VP and KP may help to ameliorate the clinical complication of adjacent vertebral body compression fractures.

Measured loads on a vertebral body replacement during sitting

Sitting is frequently assumed to cause high spinal loads because people with sedentary work often suffer from low back pain. It is assumed that the posture while sitting, as well as several seat parameters, also affects the spinal loads. To measure the loads on a spinal implant for different upper body inclinations, backrest declinations, seat heights, types of seat, and arm positions. Loads on a vertebral body replacement during sitting were measured in five patients with telemeterized implants. The telemeterized vertebral body replacement measures all six load components. Itwas implanted into five patients suffering from compression fractures of a lumbar vertebral body. Loads were measured when the patients were sitting on a stool and inclining their upper body between 15° flexion and 10° extension in steps of 5°; on a chair with an adjustable backrest that allowed declination angles between 108° and 180°; on an office chair while the seat height was varied between 40 and 60 cm in steps of 5 cm; and successively on seven different types of seats. The effect of the arm position was also studied. The resultant implant force was increased on the average by 48% for 15° flexion and decreased by 19% for 10° extension of the trunk. When sitting on a chair with an adjustable backrest, the loads decreased with an increasing backrest declination angle. The seat height had in most cases only a minor effect on implant loads. In comparison to sitting on a stool, the loads were reduced when sitting on a bench (7%) or a stool with a padded wedge (9%), a knee stool (19%), a chair (35%), and an office chair (41%). Sitting on a physiotherapy ball increased the loads by 7%. Placing the hands on the thighs reduced the implant loads on the average by 19% in comparison to arms hanging on the sides. Spinal loads can be reduced by leaning against the backrest, placing the arms on the armrest or the thighs, and by decreasing the flexion angle of the upper body.

Erratum to: Treatment of severe vertebral body compression fractures with percutaneous vertebroplasty

Erratum to: Treatment of severe vertebral body compression fractures with percutaneous vertebroplasty

Treatment of severe vertebral body compression fractures with percutaneous vertebroplasty

Evaluate the efficacy of percutaneous vertebroplasty for severe vertebral body compression fractures. Over a period of 6years and 8months, 661 vertebroplasties were performed in 292 patients at our institution. Of these, 69 patients met our criteria for a severe vertebral body compression fracture defined as vertebral body collapse to less than one-third of the original height. Of the 69, 25 underwent single level vertebroplasty. Imaging features were then analyzed including location, extent of collapse, pattern of compression, pre- and post-kyphotic angle and adjacent disc height. Complications and clinical outcomes were then evaluated. Involved vertebra ranged from T6 to L5 with 60% at the thoracolumbar junction. Vertebral body collapse ranged from 30 to 14% (mean 22%) of original height. Pattern of collapse included 11/ 25 (44%) plana, 8/25 (32%) gibbus, and 6/25 (24%) H-shaped. Kyphotic angle before vertebroplasty ranged from 33-0° (mean 16°) with an average correction of 1.2° after vertebroplasty. Mean disc height before vertebroplasty was 7.3mm above and 7.7mm below. Complications included cement leak to the adjacent disc in 16 (64%) and the paravertebral soft tissues in 3 (12%). Cement leak into the proximal azygous vein was documented in one case. International Quality of Life Questionnaire VAS was completed before and after (6weeks) the procedure by all but six patients. Mean pre-intervention VAS was reported as 7.00 (range 5-10, SD 1.73) and mean post-intervention VAS was reported as 5.11 (range 0-9, SD 2.56), demonstrating a statistically significant improvement in pain (P < 0.015, 95% CI = 0.83-2.96) with 84% or 16/19 patients reporting some degree of improvement. Percutaneous vertebroplasty is safe and effective in the treatment of single level severe vertebral body compression fractures.

Extramedullary Ependymoma Near the Conus Medullaris With Lumbar Nerve Root Attachment: Case Report

Ependymomas are the most common primary spinal cord tumor, most frequently located near the cauda equina and conus medullaris. We believe that this is the first reported case of a low-grade, nonmyxopapillary (World Health Organization grade 2), intradural, extramedullary ependymoma involving a spinal nerve root. An 87-year-old woman presented with a chief complaint of acute onset of severe right hip and lateral thigh pain without midline back pain. She had baseline chronic bladder dysfunction, which remained unchanged. Her physical examination was significant for 4/5 strength in her right hip flexion (possibly related to pain), and 5 beats of clonus bilaterally. She had no point tenderness at the level of her compression fracture. Computed tomography of the patient's lumbar spine revealed a well-corticated, chronic compression fracture of the L3 vertebral body. Magnetic resonance images demonstrated an ovoid-shaped, 1.5×1-cm, well-circumscribed, intradural, extramedullary lesion at the conus medullaris. The patient underwent an L1-3 laminectomy with intradural resection of the mass, which was found to be intricately involved with a single nerve root. The nerve root was coagulated and sectioned, and a gross total resection of the tumor was achieved. The patient tolerated the procedure well, with no complications or any postoperative neurological deficit. Her right-sided pain immediately resolved after surgery. Her strength and ambulation were normal after surgery. No adjuvant radiotherapy was offered to the patient. This case illustrates a unique tumor presentation and the successful surgical treatment of the condition.

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

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. 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. 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. For painful VCFs in patients with cancer, kyphoplasty is an effective and safe treatment that rapidly reduces pain and improves function. Medtronic Spine LLC.