VERTEBROPLASTY IN THE TREATMENT OF VERTEBRAL FRACTURES CAUSED BY PLASMACYTOMA.

The aim of this study was to compare and evaluate clinical results before and after vertebroplasty in the treatment of myeloma-induced vertebral fractures. Success of the surgery was defined by increased or reduced pain intensity before and after the treatment, as assessed using the visual analog scale (VAS). The study was designed as a retrospective-prospective study. The study included 26 patients, 14 women and 12 men. Data on patients treated for myeloma-induced vertebral fractures were collected at the Department of Orthopedics, Osijek University Hospital Centre. The following data were analyzed: gender, duration of illness, intensity of pain before and after treatment (using VAS), radiological changes before and after treatment, grade of vertebral fracture, and extracorporeal cement leakage from the vertebral body to the surrounding tissue during the procedure. Difference in pain intensity before and after the surgery was statistically significant. All patients complained of pain before the surgery (pain intensity median 8), whereas after the surgery, pain intensity decreased in all patients (pain intensity median 2). In conclusion, improvement in clinical results of the treatment of myeloma-induced vertebral fractures with vertebroplasty proved to be significant.

Quality of Life in Patients Following Vertebroplasty.

AIM: To examine the quality of life in patients who underwent vertebroplasty treatment and compare it to the preoperative quality of life. STUDY DESIGN: The Cross-sectional study conducted at the Department of Orthopaedics, Clinical Hospital Centre Osijek. PATIENTS AND METHODS: The research included 50 patients under stationary treatment in hospital at the Department of Orthopaedics. The research instruments include a questionnaire containing demographic data and the standardised EuroQuol Research Foundation Questionnaire (EQ-5D-5L) consisting of five dimensions which include mobility, self-care, usual activities, pain level and anxiety. RESULTS: The average score of the current health status before surgery was 67.5 whereas post-operative health was rated 80 (p < 0.001). After the procedure, a significantly higher number of respondents reported greater mobility levels, and lower pain intensity; fewer respondents reported feeling anxious or depressed (p < 0.001), more respondents rated their self-care abilities higher (p = 0.003), and felt improvements when performing usual activities (p = 0.031). CONCLUSION: After the vertebroplasty, a significantly higher number of respondents reported higher levels of mobility, lower pain or discomfort levels, and a smaller number of respondents felt anxious or depressed, more respondents felt they can take better care of themselves, and are better at performing usual activities when compared to the preoperative status.

Application of high viscosity bone cement in vertebroplasty for treatment of painful vertebral body fracture.

Aim To evaluate the effectiveness and complication of vertebroplasty with high viscosity cement (HVC). Methods The patients with intensive pain caused by a fractured vertebrae were treated by application of HVC into the vertebral body, through unilateral transpedicular approach. The application was performed in 422 patients (221 were treated for osteoporosis and 201 for malignancy) on 846 vertebrae. Results Preoperative Visual Analogue Scale (VAS) score was 8.35 and 2.21 (p<0.00001) 24 hours after surgery and 3 months later, respectively. There was no serious intra- and post-surgery complication. By diascopy during the surgery in 121 (14.3%) vertebrae cement leakage from the fractured vertebral body was evidenced, which did not cause any aggravation of patients' clinical status. Conclusion Vertebroplasty with HVC is a method that successfully combines all advantages of this method but it also minimizes the risk of extra-ossal cement leakage which makes it significantly safer for the surgeon and for the patient as well.

Cystic fibrosis: model of pathogenesis based on the apical membrane potential.

A simple model of cystic fibrosis (CF) is proposed, based on the apical membrane (ApM) potential. The ApM of epithelial cells is highly permeable to sodium and activation of CFTRs makes it permeable to chloride. Calculated ApM potentials of cells with activated cystic fibrosis transmembrane conductance regulators (CFTRs) are between the sodium and chloride Nernst values and thus allow rapid absorption of both ions in exocrine glands. In CF patients the potential is near the sodium Nernst value and thus more salt is left in the ducts. Simulation predicts that the sodium driving force increases more than 3.5 times if the ApM permeability for Cl- increases from 5-94% of the sodium permeability. In pancreatic ductal cells basolateral sodium bicarbonate cotransporters (pNBC1) allows influx of bicarbonates with sodium. Bicarbonates are exchanged for intraductal chloride by anion exchanger 1 (AE1) in the ApM. Activated CFTRs let some chloride to leak back to ducts, followed by water that dilutes ductal proteins. Replenished intraductal chloride allows more bicarbonate secretion. In CF patients, pancreatic water and bicarbonate secretion is limited by the intraductal chloride pool.

Transforaminal lumbar interbody fusion (TLIF) and unilateral transpedicular fixation.

TLIF (transforaminal lumbar interbody fusion) is a method of interbody fusion, which is alternative to other vertebral fusion wherein, with an approach through intervertebral foramen, through lateral segment of intervertebral space, complications occurring with other methods are reduced. Today, there are numerous versions of this method in terms of implants and transplants. At our Department patients with axial pain resistant to conservative treatment of minimum six months underwent TLIF method with unilateral transpendicular fixation with polyaxial screws, CAGE filled with autologous transplant obtained by lamina resection, and posteromedial contralateral fusion. 22 procedures were performed at 22 levels, 10 for relapsing hernia, and 12 for disc herniation combined with degenerative changes on the same level. Pain reduction was significant; according to VAS score, lumbar pain was reduced from preoperative 8.5 +/- 0.8 to 2.4 +/- 0.85 (-72.63%) a year after, and leg pain was reduced significantly from preoperative 8.45 +/- 0.91 to 2.072 +/- 0.81 (71%) 12 months after surgery. The Wilcoxon paired test demonstrated a significant difference between preoperative VAS score and the value measured 12 months after surgery (n = 22, Z = 4.1, p < 0.001) leg and back, respectively. In 15 (68.2%) patients fusion was evidenced on standard X-ray of lumbar spine, and in 4 patients, with aggravated clinical presentation, fusion in 2 patients and pseudoarthrosis in 2 patients were evidenced by CT. Total 17 patients (77.3%) showed signs of fusion. In our study we demonstrated that unilateral ipsilateral transpedicular fixation, with positioning of one CAGE filled with local autologous transplant represents a reliable and successful method of treatment of axial lumbar pain.

Arthroscopic removal of metal foreign bodies from the knee joint after explosive war injuries.

The results of arthroscopic removal of metallic fragments from knee joint due to explosive war injuries are presented. In period from 1991-1995 during war in Croatia we have operated 25 knee joints. Indications for arthroscopy were based on radiographic and clinical findings. The foreign bodies in the joint were found in 19 patients while additional 6 had foreign bodies in the periarticular soft tissues. Arthroscopies were performed on average one month after wounding. The foreign bodies were placed in different parts of the joint with no prediction sites. In 8 knees foreign bodies were freely mobile, and in 11 were anchored to different intraarticular structures. There were no complications during early postoperative period as well as in follow up period.

Vertebroplasty for vertebral compression fracture.

The patients with intensive pain caused by the vertebra body fracture were treated by application of bone cement under local or general anesthesia, by means of diascopy through unilateral transpedicular approach. The intensity of pain was followed-up on the VAS scale before surgery, 24 hours after surgery and three months after surgery. The cement was applied in 55 patients (43 women, 12 men). The average age of the tests was 68.43 years (38 to 82 years). Fifty five procedures were implemented on 85 vertebrae, i.e. 32 metastatic fractures and 23 osteoporotic fractures. The procedures were applied on 28 thoracal and 57 lumbar vertebrae. The average VAS before surgery was 8.36 and 2.23 (p < 0.005) 24 hours after surgery, and it remained almost unchanged three months later. There were 1 serious complication, a paraparesis caused by the leakage of cement into the spinal canal, which was partially recovered after decompression and rehabilitation treatment, and 2 superficial infections with S. epidermidis which were cured by means of antibiotics. By means of Wilcoxon paired test a significant difference was found between the preoperative VAS and the value 24 hours after surgery (n = 55, Z = 6.451, p < 0.00001) and 3 months after surgery (Z = 6.45, p < = 0.00001), while there was a compliance between two VAS measurements after surgery (Z = 1.308, p = 0.191) which indicates that the fast pain reduction remained stable during the 3 month follow-up. The vertebroplasty is a safe and efficient surgical method in treatment of compressive vertebrae fractures which do not react to the conventional method of treatment. The achieved analgesic effect 24 hours after surgery is a good predictor of pain intensity 3 months after surgery.