Clinical features and inpatient rehabilitation outcomes of infection-related myelopathy.

STUDY DESIGN: This was a retrospective cohort study. OBJECTIVES: The objectives of this study were to determine clinical features of infection-related myelopathy (IRM) and functional outcomes compared with other nontraumatic and traumatic myelopathies. SETTING: US academic inpatient rehabilitation unit. METHODS: This was a 16-year retrospective review of patients with myelopathy discharged from inpatient rehabilitation between 1 January 1995 and 31 December 2010. Patients comprised three injury groups: IRM, nontraumatic myelopathy (NTM) and traumatic spinal cord injury (TSCI). Information collected includes demographic characteristics, functional data, length of stay, injury completeness and discharge destination. Primary outcome measures were change in Functional Independence Measure (FIM) and daily FIM change. For IRM, data were collected regarding injury characteristics, risk factors, presenting symptoms, neurologic impairment level and treatment. RESULTS: Of the 1601 patients, 40 (2.5%) had IRM, 1105 (69.0%) had NTM and 456 (28.5%) had TSCI. IRM mean (s.d.) age was 58.6 (15.7) years (male gender, 72.5%). The majority in each group had incomplete injuries. IRM had longer lengths of stay (P<0.001), lower admission (P=0.001) and discharge (P=0.005) FIM scores and lower FIM daily change (P=0.002) than NTM. Degree of functional improvement was similar in all groups, and most patients in each group were discharged home. Infectious pathogens were bacterial (80.0%, n=32), viral (7.5%, n=3), tuberculous (7.5%, n=3), parasitic (2.5%, n=1) and multiple types (2.5%, n=1). The most common bacterial cause (65.6%) was Staphylococcus aureus. CONCLUSIONS: Infectious etiologies comprise a small proportion of NTM but represent a unique entity with distinct recovery patterns and outcomes. These patients can achieve similar functional improvements as other NTM patients during inpatient rehabilitation, although over a longer period of time.

The association between the duration of preoperative pain and pain improvement in vertebral augmentation: a meta-analysis.

BACKGROUND AND PURPOSE: Most physicians consider length of preoperative pain as an important factor to include patients for SA. Our aim was to synthesize the available evidence regarding the influence of preprocedural pain duration on the outcome of vertebral augmentation procedures. MATERIALS AND METHODS: The MEDLINE data base was reviewed up to March 2010. Meta-regression and mixed-effect subgroup analyses were performed to evaluate the association between the outcome of interest, which was pain improvement assessed by a VAS (0-10) and the duration of preoperative pain (independent variable). RESULTS: We included 17 articles. The mean VAS improvements for subgroups of ≤6 weeks (n = 12), 6-24 weeks (n = 5), and >24 weeks (n = 3) were 5.18, 4.90, and 5.04, respectively (P = .86). The regression coefficient was -0.024, suggesting trivial association of the duration of preoperative pain and pain improvement. CONCLUSIONS: Pain relief following spine augmentation was similar among groups of patients with varying lengths of preoperative pain duration.

Asymptomatic and unrecognized cement pulmonary embolism commonly occurs with vertebroplasty.

BACKGROUND AND PURPOSE: Cement PE represents a potentially serious complication following vertebroplasty. To determine the frequency and extent of cement PE during percutaneous vertebroplasty, we performed a retrospective review of chest CT scans obtained in patients who had previously undergone ≥1 vertebroplasty procedure. MATERIALS AND METHODS: After approval by our local institutional review board, we retrospectively evaluated 244 patients who had undergone vertebroplasty at 465 levels and subsequently underwent chest CT. A thoracic radiologist evaluated the presence, number, size, and location of discrete cement PEs. We catalogued the following data: age, sex, number of treated vertebrae, cement volume per vertebra, operator, presence of cement leakage noted by the operator during the procedure, and clinical presentation at postvertebroplasty CT. RESULTS: At least 1 cement PE was detected in 23 (9.4%; 95% CI, 6%-13%) of 244 patients; 1 patient was symptomatic from a cement PE. The mean number of discrete cement PEs was 3.2 ± 3.4 (median, 2; range, 1-12). There was no correlation among the total number of treatment sessions, number of levels treated per session, cement volume per level, operator, or time between vertebroplasty and chest CT in the detection of cement PE. Those with PE were significantly younger (P=.0229) and had significantly more total levels treated (P=.0260). Cement PE was recognized by the operator during the vertebroplasty in 2 (8.7%) of 23 patients found to have it on CT. CONCLUSIONS: Small asymptomatic cement PEs are common during vertebroplasty and usually are not recognized by the operator during the procedure.

Have referral patterns for vertebroplasty changed since publication of the placebo-controlled trials?

BACKGROUND AND PURPOSE: Our aim was to determine whether referral patterns and rates of vertebroplasties at the Mayo Clinic have changed after the publication of the INVEST and the Australian Trial. In August of 2009, we performed a retrospective review of patients undergoing vertebroplasties and those patients who were referred for but did not receive vertebroplasties before and after the recently published placebo-controlled vertebroplasty trials. MATERIALS AND METHODS: After approval by our local institutional review board, we retrospectively evaluated all patients referred for vertebroplasty between January 5, 2004, and June 2, 2010. We catalogued age, sex, number of treated vertebrae, physician referring the patient for vertebroplasty, and the referring department. We calculated the mean number of referrals per month before and after August 2009, which was the month of publication for both trials. We also calculated rates for specific referring physician types. RESULTS: During the full study, 1188 patients were referred, of whom 807 underwent treatment at 1378 levels for a total of 943 separate vertebroplasty procedures. The mean number of vertebroplasty referrals per month has dropped significantly from 18.9 ± 5.3 (95% CI, 17.7-20.2) before publication to 11.3 ± 3.1 (95% CI, 9.1-13.5) referrals per month after publication (P=.0001). Before publication, 67.3 ± 14.0% (95% CI, 64.0%-70.7%) of patients referred for vertebroplasty underwent vertebroplasty, compared with 76.0 ± 14.9% (95% CI, 65.4%-86.6%) after publication (P=.11). CONCLUSIONS: The number of vertebroplasty referrals at our center has decreased significantly since the publication of INVEST and the Australian Trial, yet we continue to offer the procedure to a high proportion of referred patients.