RESUMEN
Percutaneous vertebroplasty with acrylic cement (usually polymethylmethacrylate) consists of injecting cement into vertebral bodies weakened by osseous lesions. The objective of this procedure is to obtain an analgesic effect by mechanical stabilization in destructive lesions of the spine. The three major indications are aggressive vertebral hemangiomas, severe or refractory pain related to osteoporotic vertebral fractures, and malignant vertebral tumors. Complications are infrequent, but occur essentially in patients with vertebral malignant tumors. We present our experience with 148 patients that underwent 192 percutaneous PMMA vertebroplasties for the treatment of painful osteoporotic compression fractures (76 patients, 105 vertebral levels), hemangiomas (31 patients, 43 vertebral levels) and neoplasms (31 patients, 43 vertebral levels). In a vast majority of appropriately selected cases and especially in osteoporotic cases, vertebroplasty constitutes a relatively simple procedure with a very high rate of success.
Asunto(s)
Dolor de Espalda/cirugía , Polimetil Metacrilato/uso terapéutico , Prótesis e Implantes/tendencias , Enfermedades de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/cirugía , Columna Vertebral/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Dolor de Espalda/diagnóstico por imagen , Dolor de Espalda/patología , Femenino , Hemangioma/diagnóstico por imagen , Hemangioma/patología , Hemangioma/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Selección de Paciente , Cuidados Posoperatorios/normas , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios/normas , Prótesis e Implantes/normas , Prótesis e Implantes/estadística & datos numéricos , Estudios Retrospectivos , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Enfermedades de la Columna Vertebral/patología , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/patología , Fracturas de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/secundario , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/patología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Carotid endarterectomy has been validated with results of several randomized controlled trials in which its effectiveness has been demonstrated over that of the best nonsurgical therapy. However, in the past several years, carotid angioplasty with stent placement has emerged as a potential safe and effective alternative to carotid endarterectomy. In this article we examine the current status of carotid angioplasty with the recent introduction of innovative cerebral protection devices and improved endovascular devices. We present a brief description of the current randomized trials evaluating carotid endarterectomy compared to carotid angioplasty as well as our combined experience in 262 patients.