Injection Of Polymethylmethacrylate Research Articles

Advantages of unilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures-a systematic review and meta-analysis.

To investigate the advantages of unilateral percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures(OVCFs). The systematic evaluation program met all program requirements (CRD 42023422383) by successfully passing the PROSPERO International Prospective Systematic Evaluation Registry. Researchers searched the references of English-language randomized controlled trials comparing unilateral and bilateral PKP for the treatment of osteoporotic vertebral compression fractures published between 2010 and 2023 and manually searched for known primary and review articles. The study statistically analyzed data from all the included literature, which primarily included time to surgery, visual pain score(VAS) and Oswestry disability index(ODI) at postoperative follow-up time points, polymethylmethacrylate (PMMA, bone cement) injection dose, cement leakage, radiation dose, and improvement in kyphotic angle. This meta-analysis searched 416 articles published from 2010 to 2023 based on keywords, and 18 articles were finally included in this study. The results of the forest plot showed that unilateral PKP operative time, amount of bone cement used, and radiation dose to the patient were significantly reduced (p < 0.01, p < 0.01, and p < 0.01, respectively), and unilateral and bilateral PKP had comparable cement leakage (p = 0.49, 95% CI = 0.58-1.30), and there was no significant difference in the kyphotic angle between unilateral and bilateral PKP (p = 0.42, 95% CI = - 2.29-0.96). During follow-up, there was no significant difference in pain relief between unilateral and bilateral PKP (p = 0.70, 95% CI = - 0.09-0.06), nor was there a significant difference in ODI (p = 0.27, 95% CI = - 0.35-1.24). There is no difference in clinical efficacy between unilateral PKP and bilateral PKP, but unilateral PKP has a shorter operative time, a lower incidence of cement leakage, a lower amount of cement, and a lower radiation dose to the patient and operator. Unilateral PKP is a better option for patients with OVCFs.

The Pursuit of the Perfect Body: Need for Myocardial Revascularization and Dialysis After Polymethylmethacrylate Injection

The Pursuit of the Perfect Body: Need for Myocardial Revascularization and Dialysis After Polymethylmethacrylate Injection

Cement pulmonary embolism as a complication of percutaneous vertebroplasty

Percutaneous Vertebroplasty (PV) involves the injection of Poly Methylmeth Acrylate (PMA) Bone Cement (BC) into the vertebral body

Second-generation bone cement-injectable cannulated pedicle screws for osteoporosis: biomechanical and finite element analyses

BackgroundBiomechanical and finite element analyses were performed to investigate the efficacy of second-generation bone cement-injectable cannulated pedicle screws (CICPS) in osteoporosis.MethodsThis study used the biomechanical test module of polyurethane to simulate osteoporotic cancellous bone. Polymethylmethacrylate (PMMA) bone cement was used to anchor the pedicle screws in the module. The specimens were divided into two groups for the mechanical tests: the experimental group (second-generation CICPS) and control group (first-generation CICPS). Safety was evaluated using maximum shear force, static bending, and dynamic bending tests. Biomechanical stability evaluations included the maximum axial pullout force and rotary torque tests. X-ray imaging and computed tomography were used to evaluate the distribution of bone cement 24 h after PMMA injection, and stress distribution at the screw fracture and screw–cement–bone interface was assessed using finite element analysis.ResultsMechanical testing revealed that the experimental group (349.8 ± 28.6 N) had a higher maximum axial pullout force than the control group (277.3 ± 8.6 N; P < 0.05). The bending moments of the experimental group (128.5 ± 9.08 N) were comparable to those of the control group (113.4 ± 20.9 N; P > 0.05). The screw-in and spin-out torques of the experimental group were higher than those of the control group (spin-in, 0.793 ± 0.015 vs. 0.577 ± 0.062 N, P < 0.01; spin-out, 0.764 ± 0.027 vs. 0.612 ± 0.049 N, P < 0.01). Bone cement was mainly distributed at the front three-fifths of the screw in both groups, but the distribution was more uniform in the experimental group than in the control group. After pullout, the bone cement was closely connected to the screw, without loosening or fragmentation. In the finite element analysis, stress on the second-generation CICPS was concentrated at the proximal screw outlet, whereas stress on the first-generation CICPS was concentrated at the screw neck, and the screw–bone cement–bone interface stress of the experimental group was smaller than that of the control group.ConclusionThese findings suggest that second-generation CICPS have higher safety and stability than first-generation CICPS and may be a superior choice for the treatment of osteoporosis.

Polymethylmethacrylate injections for augmentation and strengthening of abdominal muscles: an experimental model

Introduction: Polymethylmethacrylate (PMMA) is a synthetic, inert, biocompatible and nontoxic polymer, the applications in the medical field are numerous, and indications are increasingly broad. Objectives: To evaluate whether the fibrous response to injection of PMMA microspheres into striated muscles confers increased volume and resistance to muscle stretch. Methods: A total of 20 Wistar rats were injected with, 30% PMMA gel into the right rectus abdominis muscle, while the left rectus muscle received SHAM injections. After 4 weeks, all abdominal rectus muscles were measured and stretched on a bench dynamometer until rupture. The samples were analyzed histologically to verify the tissue response to PMMA. Results: The right rectus abdominis muscles of rats that received PMMA gel injection had increased volume and the breaking strength was greater than 100% compared to the left rectus muscles that received SHAM injections. There was a significant deposition of type I and III collagen fibers around the PMMA injection sites. Conclusion: PMMA microspheres implanted into the rectus abdominis muscle of Wistar rats promote neocollagenesis and significantly increase the breaking strength when subjected to stretch test. The mild and desired foreign body type tissue reaction around the PMMA is not objection to the augmentation of the rectus abdominis muscle.

A NOVEL TYPE THERMOPLASTIC INJECTABLE BONE SUBSTITUTE

A spine compression fracture is a very common form of fracture in elderly with osteoporosis. Injection of polymethyl methacrylate (PMMA) to fracture sites is a minimally invasive surgical treatment, but PMMA has considerable clinical risks. We develop a novel type thermoplastic injectable bone substitute contains the proprietary composites of synthetic ceramic bone substitute and absorbable thermoplastic polymer.We used thermoplastic biocompatible polymers Polycaproactone (PCL) to encapsulate calcium-based bone substitutes hydroxyapatite (Ca10(PO4)6(OH)2, HA) and tricalcium phosphate (TCP) to form a biodegradable injectable bone composite material. The space occupation ration PCL:HA/TCP is 1:9. After heating process, it can be injected to fracture site by specific instrument and then self-setting to immediate reinforce the vertebral body.The thermoplastic injection bone substitute can obtain good injection properties after being heated by a heater at 90˚C for three minutes, and has good anti-washout property when injected into normal saline at 37˚C. After three minutes, solidification is achieved. Mechanical properties were assessed using the material compression test system and the mechanical support close to the vertebral spongy bone.In vitro cytotoxicity MTT assay (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) was performed and no cell cytotoxicity was observed.In vivo study with three New Zealand rabbits was performed, well bone growth into bone substitute was observed and can maintain good mechanical support after three months implantation.The novel type thermoplastic injection bone substitute can achieve (a) adequate injectability and viscosity without the risk of cement leakage; (b) adequate mechanical strength for immediate reinforcement and prevent adjacent fracture; (c) adequate porosity for new bone ingrowth; (e) biodegradability. It could be developed as a new option for treating vertebral compression fractures.

Early warm compress treatment can promote recanalization of vascular embolisms and reduce tissue necrosis after polymethyl methacrylate injection

Injection of fillers for soft tissue augmentation can lead to a variety of complications, among which vascular occlusion caused by intravascular injection of filler will induce severe or permanent damage. The treatment strategies for intravascular embolization caused by injection include warm compress application, but the exact beneficial effects of this therapy have not been confirmed. The purpose of this study is to construct an intravascular injection embolism model and observe the effectiveness of warm and cold compress through a randomized, controlled trial. Thirty rabbit’s sixty ears were randomly divided into warm compress group, cold compress group, and control group. Polymethyl methacrylate (PMMA) was slowly injected into the central ear artery (CEA) to cause vascular embolism. Warm compress and cold compress treatment were performed respectively. The vascular recanalization and other related indexes were observed at 30 min, 1 day, and 7 days after injection, and the tissue necrosis was analyzed at 7 days. In the early stage of vascular embolization, warm compress can immediately promote vascular dilatation, blood circulation and partial blood flow recovery. One day after intravascular injection, warm compress can reduce intravascular embolization and reduce the incidence of tissue necrosis. At 7 days after intravascular injection, the vessels in the cold compress and control groups were still embolized while the percentage of recanalization in the warm compress group was 47.4% (P < 0.000). Early-stage warm compress after intravascular PMMA injection is conducive to recanalization of vascular embolization and reducing tissue necrosis.

Ultrasonography-Guided Cannula Method for PMMA Injection in Aesthetic Gluteal Augmentation: A Technical Note

Purpose: Revolumization with deep injections has become increasingly common, even in high-risk areas for intravascular infusion or nerve injury. This study aimed to assess the usefulness of the ultrasonography-guided cannula method for preventing side effects during the injection of polymethylmethacrylate (PMMA) fillers. Real-time ultrasonography was used to monitor the injection of PMMA as a filler in the gluteus for aesthetic purposes. This way, adjacent anatomical structures such as arteries, veins, and nerves could be seen during the whole procedure. Materials and Methods: This study describes the technique used for ultrasound-guided injections of PMMA in the gluteal region of two patients. Patients 1 and 2 were injected with 300 mL and 220 mL of the filler, respectively. Injections were administered intramuscularly and subcutaneously into sites that had been marked before the procedure. While one professional performed the injections, another guided them with real-time ultrasound imaging, using the same equipment for both patients. The location and depth of blood vessels and nerves were determined before the procedure, and the insertion of the cannula was accompanied by ultrasound imaging. Results: The PMMA filler, as well as the cannula, blood vessels, and nerves, was visualized using ultrasound. Some differences were observed between the cases. In the first patient, a small amount of PMMA from a previous procedure could be found (hyperechoic images), while the second one had had no filler injection before. Conclusion: Based on these cases, ultrasonography can be seen as a complementary tool to monitor tissue filler injections, especially in the gluteal region, thus, avoiding possible vascular and nervous injuries. Real-time ultrasound makes the procedure safer, protecting regional structures from lesions. The ultrasonography-guided method succeeded in localizing the cannula, blood vessels, and the sciatic nerve, allowing for safe injection of PPMA filler into a deep gluteal region.

CEMENTING THE SIDE EFFECTS OF KYPHOPLASTY: CEMENT EMBOLI IN THE CARDIOPULMONARY SYSTEM

CEMENTING THE SIDE EFFECTS OF KYPHOPLASTY: CEMENT EMBOLI IN THE CARDIOPULMONARY SYSTEM

Venous injection of a triphasic calcium-based implant in a sheep model of pulmonary embolism demonstrates minimal acute systemic effects

PurposeImplant leakage is the most common complication of vertebral augmentation. Alternative injectable materials must demonstrate intravascular safety comparable to or better than polymethyl methacrylate (PMMA). This study assessed the systemic effects of a triphasic calcium-based implant or PMMA injected directly into the femoral vein in a large animal model designed to mimic severe intravascular implant leakage.MethodsSix skeletally mature female sheep were randomly assigned (n = 3) to either the PMMA or the triphasic implant (AGN1, composition: calcium sulfate, β-tricalcium phosphate, brushite) treatment group. Femoral veins of each sheep were directly injected with 0.5 mL of implant material to mimic leakage volumes reported during PMMA vertebroplasty. To compare acute systemic effects of the materials, cardiovascular parameters, laboratory coagulation markers, and calcium and sulfate serum levels were monitored for 60 min after implant injection. Thrombotic and embolic events were evaluated by radiologic imaging, necropsy, and histopathology.ResultsHeart rate, systemic arterial blood pressure, arterial oxygenation, arterial carbon dioxide content, and coagulation markers remained within physiological range after either AGN1 or PMMA injection. No blood flow interruption in the larger pulmonary vessels was observed in either group. Lung histopathology revealed that the severity of thrombotic changes after AGN1 injection was minimal to slight, while changes after PMMA injection were minimal to massive.ConclusionAcute systemic effects of intravascular AGN1 appeared to be comparable to or less than that of intravascular PMMA. Furthermore, in this preliminary study, the severity and incidence of pulmonary histological changes were lower for AGN1 compared to PMMA.

FOREIGN BODY GRANULOMAS CAUSED BY POLYMETHYLMETHACRYLATE (PMMA) LONG-TERM/PERMANENT FACIAL FILLERS: A LITERATURE REVIEW

<h3>Objectives</h3> To conduct a literature review regarding the characteristics of foreign body granuloma (FBG) caused by permanent facial fillers consisting of polymethylmethacrylate (PMMA). <h3>Study Design</h3> We searched articles in the following databases: PubMed, Scopus, Web of Science, Science Direct, and Scielo. The search included all articles published up to 2021, with no time restrictions. <h3>Results</h3> Permanent injectable facial fillers are used to treat wrinkles, loss of volume, and facial structures caused by aging. Fillers containing PMMA are associated with many adverse events. The formation of FBG is considered one of these events, with a frequency of 0.01%. FBG usually appear 6 to 24 months after PMMA injection; however, there are reports of lesions appearing up to 10 years after injection. FBG presents as hardening, swelling, color change, and sensitivity in the affected area. Its etiology is related to the host's response, infection, and/or flaws in filling techniques. Treatment requires corticosteroids or antibiotics and oral nonsteroidal anti-inflammatory drugs. Surgical removal can be performed if the lesion is well demarcated. All treatment modalities result in complete resolution. <h3>Conclusions</h3> Patients must be informed about the injection technique and the adverse effects related to permanent injectable fillers composed of PMMA.

Percutaneous Intervertebral-Vacuum Polymethylmethacrylate Injection for Foraminal Stenosis with Degenerative Lumbar Scoliosis

Percutaneous intervertebral-vacuum polymethylmethacrylate injection (PIPI) is a minimally invasive procedure for low back pain in elderly patients with degenerative lumbar scoliosis (DLS). Patients with DLS often have radiculopathy as a result of foraminal stenosis in addition to low back pain. The purpose of this study was to evaluate the clinical and radiologic results of PIPI for foraminal stenosis with radiculopathy in elderly patients with DLS. We included patients with de novo DLS aged 65 years or older who underwent PIPI. The presence of an intervertebral vacuum on computed tomography and bone marrow edema on magnetic resonance imaging was required for inclusion. The intersegmental radiologic parameters on plain radiographs and computed tomography and the extent of bone marrow edema on magnetic resonance imaging were measured. The clinical outcomes were evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI). We enrolled 40 patients with DLS who underwent PIPI. There were 16 men and 24 women, and the mean age was 79.0 ± 6.3 years. The mean foraminal height and extent of bone marrow edema showed a significant increase and reduction, respectively, after PIPI (P < 0.05). VAS score for radiculopathy and ODI significantly improved after PIPI (P < 0.01). The minimum clinically important differences in VAS score for radiculopathy and ODI at the final follow-up were 73.9% and 63.6%, respectively. PIPI is a minimally invasive procedure not only for low back pain but also for radiculopathy in elderly patients with DLS. It leads to intervertebral stabilization and indirect decompression of the foramen.

Molecular Dynamics Analysis of Silica/PMMA Interface Shear Behavior.

The mechanical properties of cementitious materials injected by epoxy have seldom been modeled quantitatively, and the atomic origin of the shear strength of polymer/concrete interfaces is still unknown. To understand the main parameters that affect crack filling and interface strength in mode II, we simulated polymethylmethacrylate (PMMA) injection and PMMA/silica interface shear deformation with Molecular Dynamics (MD). Injection simulation results indicate that the notch filling ratio increases with injection pressure (100 MPa–500 MPa) and temperature (200 K–400 K) and decreases with the chain length (4–16). Interface shear strength increases with the strain rate ( s– s). Smooth interfaces have lower shear strengths than polymer alone, and under similar injection conditions, rough interfaces tend to be stronger than smooth ones. The shear strength of rough interfaces increases with the filling ratio and the length of the polymer chains; it is not significantly affected by temperatures under 400 K, but it drops dramatically when the temperature reaches 400 K, which corresponds to the PMMA melting temperature for the range of pressures tested. For the same injection work input, a higher interface shear strength can be achieved with the entanglement of long molecule chains rather than with asperity filling by short molecule chains. Overall, the mechanical work needed to break silica/PMMA interfaces in mode II is mainly contributed by van der Waals forces, but it is noted that interlocking forces play a critical role in interfaces created with long polymer chains, in which less non-bond energy is required to reach failure in comparison to an interface with the same shear strength created with shorter polymer chains. In general, rough interfaces with low filling ratios and long polymer chains perform better than rough interfaces with high filling ratios and short polymer chains, indicating that for the same injection work input, it is more efficient to use polymers with high polymerization.

Effect of local massage on prevention and treatment of intra-arterial polymethyl methacrylate embolism complications: An experimental animal study

BackgroundMassage is generally believed to be a simple and effective method for preventing necrosis when intravascular injection emboli are suspected. Due to its good dispersive properties, polymethyl methacrylate (PMMA) was used as the test filler. The main purpose of this study was to observe whether local massage as a simple remedial measure can promote the diffusion of filler and reduce the necrosis rate for intra-arterial embolism. MethodsRabbit ears with the central ear artery (CEA) main trunk totally or segmentally obstructed 5 ​min after PMMA injection were studied. In order to simulate the massage effect of the fingers, the massage group was treated with a small beauty massage bar with a fixed vibration frequency along the direction of the blood flow. CEA blood flow and skin lesions were also analyzed. ResultsThe baseline data were similar between the control and massage groups. Compared to the control group, the recanalization rate of the CEA trunk in the treatment group increased significantly after massage. However, there was no significant difference in the visible rate of transparent embolus on the 1st day after treatment, nor in the necrosis degree or area of soft tissue damage on the 7th day after treatment. Further analysis showed that massage tended to have a positive effect on segmentally obstructed cases at 5 ​min after injection but a negative effect on totally obstructed ears at 5 ​min. ConclusionLocal massage cannot reduce the complications of tissue necrosis after intra-arterial PMMA injection. Prevention is key to reducing complications.

Management of Spinal Bone Metastases With Radiofrequency Ablation, Vertebral Reinforcement and Transpedicular Fixation: A Retrospective Single-Center Case Series.

Spine is a frequent site of bone metastases, with a 8.5 months median survival time after diagnosis. In most cases treatment is only palliative. Several advanced techniques can ensure a better Quality of Life (QoL) and increase life expectancy. Radiofrequency ablation (RFA) uses alternating current to produce local heating and necrosis of the spinal lesion, preserving the healthy bone. RFA is supported by vertebral reinforcement through kyphoplasty and vertebroplasty in order to stabilize the fracture with polymethylmethacrylate (PMMA) injection, restoring vertebral body height and reducing the weakness of healthy bone. The aim of this study is to demonstrate the efficacy and advantages of RFA plus vertebral reinforcement through PMMA vertebroplasty and fixation in patients affected by bone spinal metastases. We retrospectively analyzed 54 patients with thoraco-lumbar metastatic vertebral fractures admitted to our Unit between January 2014 and June 2020. Each patient underwent RFA followed by PMMA vertebroplasty and transpedicle fixation. We evaluated pain relief through the Visual Analogue Scale (VAS) Score and PMMA vertebral filling based on the mean Saliou filling score. Analysis of variance (ANOVA) was used to test pain relief with statistical significance for p<0.05. A total of 54 patients (median age 63,44 years; range 34-86 years), with a total of 63 infiltrated vertebrae, were treated with RFA, PMMA vertebroplasty and transpedicular screw fixation; average operative time was 60.4 min (range 51–72). The preoperative average VAS score decreased significantly from 7.81 to 2.50 (p < 0.05) after 12 months. Based on Saliou filling score, filling was satisfactory (12–18) in 20 vertebrae (31,7%), mediocre (6–11) in 33 vertebrae (52,4%), inadequate (0–5) in 10 vertebrae (15,9%). A consistent PMMA filling of vertebral bodies was successfully achieved with significant pain relief. Concomitant RFA, PMMA vertebroplasty and pedicle screw fixation represent a safe and effective technique for the management of spinal metastases, improving clinical outcome and pain control.

Percutaneous Vertebroplasty with the Polymethyl Methacrylate - Gelatin Sponge Complex in the Treatment of Patients with Osteoporotic Vertebral Compression Fractures Accompanied by Superior Endplate Injurie.

To explore the clinical efficacy of percutaneous vertebroplasty (PVP) combined with the polymethyl methacrylate-gelatin sponge (PMMA-GS) complex in the treatment of patients with osteoporotic vertebral compression fractures (OVCFs) accompanied by superior endplate injuries MATERIAL and METHODS: A total of 77 OVCF patients with superior endplate injuries who were treated with PVP from January 2017 to December 2020 were retrospectively analyzed. The visual analogue scale (VAS) score, Oswestry disability index (ODI), and injured vertebral height ratio at one day (1d) before surgery, three days (3d) after surgery, and one year (1y) after surgery were compared between both groups. Besides, the surgical duration, PMMA (polymethyl methacrylate) injection volume, PMMA leakage rate, and adjacent vertebral fracture rate were compared between these two groups. Among these patients, there were 39 individuals treated with PVP combined with the PMMA-GS complex (the observation group) and 38 individuals treated with PVP (the control group). These patients in both groups completed the surgery successfully. There were no such complications as pulmonary embolism, hemopneumothorax, rib fracture, spinal cord nerve injuries, and vital organ injuries. In these two groups, the VAS score, ODI, and injured vertebral height ratio 1d before surgery were significantly different from those 3d and 1y after surgery (p < 0.05). However, there was no significant difference in these indexes between both groups (p > 0.05). There was no significant difference in the surgical duration and PMMA injection volume between both groups (p > 0.05). However, the PMMA leakage rate and adjacent vertebral fracture rate in the observation group were significantly lower than those in the control group (p < 0.05). Compared with traditional PVP, this therapy PVP combined with PMMA-GS complex in the treatment of OVCF patients with superior endplate injuries can effectively reduce the incidence of PMMA leakage and the incidence of adjacent vertebral fracture rate.

Changes in bone density, intraosseous pressure of distal femoral articular cartilage and subchondral bone after proximal femoral medullary cavity cement filling in rabbits.

Bone cement is widely used, particularly in hip replacements, but the potential clinical complications of its use have been largely unrecognized. The purpose of the present study was to investigate the effects of bone cement in the proximal femoral medullary cavity (PFMC) on bone mineral density (BMD), intraosseous pressure (IOP), articular cartilage and subchondral bone in the distal femurs of rabbits. A total of 32 New Zealand white rabbits were randomly numbered and the left hind limb of the odd-numbered rabbits and the right hind limb of the even numbered rabbits were selected as the experimental side. For each rabbit, the non-experimental hind limb was labeled as the control side by the principal investigator. An intramedullary injection of polymethyl methacrylate was made into the experimental hindlimb of each rabbit and the PFMC filled with bone cement. BMD and IOP of the distal femur of the bilateral hindlimb were measured at 4 and 16 weeks after surgery, and histological and ultra-fine structural features were examined by light and transmission electron microscopy, respectively. At week 4 after the operation, IOP in the experimental limb was significantly higher and BMD lower compared with the control limb. At the 16th week after operation, the IOP in the experimental limb was lower than at the 4th week after operation, but still higher compared with controls, and the BMD was significantly higher than the controls. In the controls, IOP and BMD was not significantly different between the 4th and 16th week after operation. Compared with controls, the cartilage in the experimental group was thinner, the chondrocytes partially necrotic and the trabecular structure of the subchondral bone broken. Analysis of ultra-fine structural features in the experimental group showed chondrocytes with necrotic cytoplasm and pyknotic nuclei relative to controls. The results indicated that blockage of the PFMC with bone cement resulted in an increase in the IOP in the distal femur, a change in BMD and damage to the subchondral bone and articular cartilage.

Medical Image of the Month: Severe Acute Respiratory Distress Syndrome and Embolic Strokes from Polymethylmethacrylate (PMMA) Embolization

No abstract available. Article truncated after 150 words. A 35-year-old lady with a history of depression and anxiety presented to the emergency room with worsening shortness of breath after receiving polymethylmethacrylate (PMMA) injections in her buttock for cosmetic purposes in Mexico. Immediately after the injection in the outpatient office, she became acutely short of breath, tachypneic, and tachycardic. She was brought to the emergency room where she was hypoxic with oxygen saturations in the low 80s on a non-rebreather, tachypneic with a respiratory rate in the 40s, and tachycardic with heart rates in 140s. She was emergently intubated. A CTA of the chest demonstrated bilateral ground glass opacities throughout, most pronounced in the upper lobes which progressed to significant bilateral airspace disease consistent with acute respiratory distress syndrome (Figure 1). Her neurological examination declined over the course of her hospitalization. An MRI of the brain with contrast demonstrated bilateral foci of susceptibility artifact throughout the entirety of the …

Long-term outcome of targeted therapy for low back pain in elderly degenerative lumbar scoliosis.

Treatment of low back pain (LBP) associated with elderly degenerative lumbar scoliosis (DLS) remains controversial. We have developed percutaneous intervertebral-vacuum polymethylmethacrylate injection (PIPI) targeting to the intervertebral vacuum as a minimally invasive surgery. The present study compared the long-term clinical outcomes of PIPI to that of nonoperative treatment. Patients with de novo DLS, aged ≥ 65years, who had LBP with visual analog scale (VAS) of ≥ 50 for ≥ 6months with intervertebral vacuum on computed tomography and bone marrow edema (BME) on magnetic resonance imaging were included. The clinical outcomes were evaluated using VAS and the Oswestry Disability Index (ODI) at baseline, 1, 6, 12, 24months, and at the final follow-up. The course of BME was also evaluated. One hundred and one patients underwent PIPI and 61 received nonoperative treatment. The mean follow-up duration after PIPI and nonoperative treatment was 63.7 ± 32.4 and 43.9 ± 20.9months, respectively. VAS and ODI after PIPI were significantly improved compared to post-nonoperative treatment. BME decreased substantially in the PIPI group and it was significantly correlated with VAS and ODI improvement. Following PIPI, LBP recurred in 28 patients (35%). LBP recurrence was identified at the same level of PIPI in 10 patients, at the adjacent level of PIPI in 11 patients, and at the non-adjacent level of PIPI in seven patients. Eighteen patients underwent additional PIPIs, and both VAS and ODI were significantly improved after additional PIPIs. Bone marrow lesions of the endplate are strongly associated with the presence of LBP. PIPI can be considered as an effective, safe and repeatable treatment for LBP in elderly DLS patients.

Radiologic features of pulmonary cement embolism after percutaneous vertebroplasty in a case and review of literature

Percutaneous vertebroplasty is a well-known treatment modality for vertebral compression fractures caused by osteoporosis and malignant metastases. The procedure involves the injection of polymethyl methacrylate (PMMA, bone cement), into the desired vertebral body. Pulmonary cement embolism (PCE) refers to the embolization of PMMA into the pulmonary arteries. Patients are often asymptomatic and it may be detected incidentally for imaging done for another reason. The most common symptoms of pulmonary cement embolization are chest pain and breathlessness, and rarely it can present as acute respiratory distress syndrome. In this case, we aimed to present a 73-year-old male patient of PCE with computed tomography (CT) images. We want to raise the awareness that all patients undergoing vertebroplasty procedure should have routine chest X-ray after the procedure. However, CT is the best modality to determine PCE.