Clinical Neuroscience

[Percutaneous-transpedicular acrylat vertebroplasty for treatment of lumbar vertebral hemangioma - case report]

KASÓ Gábor, STEFANITS János, KÖVÉR Ferenc, DÓCZI Tamás, HORVÁTH Gábor

FEBRUARY 20, 2003

Clinical Neuroscience - 2003;56(01-02)

[The authors present the management of a patient suffering from lumbar vertebral hemangioma. Percutaneous transpedicular acrylate vertebroplasty was performed. This method has widely been used for the treatment of pathological vertebral bodies of different aetiology. A brief rewiev of the literature of previous and current methods is presented. A detailed discussion is given why vertebroplasty was used in contrast to the radiological investigation where the patient's hemangioma proved to be a non-agressive type. According to the authors' knowledge this is the first Hungarian publication of acrylate vertebroplasty for the treatment of vertebral hemangioma.]

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ZSOLCZAI Sándor, PENTELÉNYI Tamás

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[The value of motor evoked potentials in the diagnosis of spondylotic myelopathy]

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[Introduction - Motor evoked potential (MEP) is the only method that is able to assess the function of the corticospinal tract in various neurological conditions, such as myelopathies. Myelopathy associated with cervical spondylosis, especially at an early stage, has often slight and non-specific clinical signs, pointing to the importance of the electrophysiological assessment of the spinal cord. The authors' aim was to investigate the sensitivity of MEP examination in the detection of myelopathy secondary to cervical spondylosis. Patients and methods - Patients were classified into three groups according to clinical signs and symptoms: Group I includes patients who have cervical spondylosis as demonstrated by MRI (narrowing of the spinal canal, discal herniation, spinal cord compression) but no complaints or signs suggestive of myelopathy. Results - In Group II patients had minor, non-specific complaints, such as paraesthesia of the legs and gait disturbance raising the possibility of myelopathy, but neurological examination revealed no pyramidal signs. In Group III patients had pyramidal signs as well. In Group I corticospinal function was normal in all patients, as assessed by MEP examination. In Group II all patients had prolonged central motor conduction time or absent responses to cortical stimulation. Likewise, in Group III MEP revealed abnormal corticospinal function in all patients but one. Conclusions - In summary, MEP proved sensitive in the detection of corticospinal dysfunction in myelopathy associated with cervical spondylosis at a stage when clinical signs of pyramidal lesion are not yet present and patients have only minor complaints. On the other hand, if patients are completely symptom free with regard to myelopathy, MEP is also unlikely to disclose corticospinal dysfunction. If pyramidal lesion is evident already by clinical examination, MEP provides no further help. ’Falsenegative’ results are also possible.]

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[Rare angioproliferative tumors mimicking aggressive spinal hemangioma with epidural expansion]

KULCSÁR Zsolt, VERES Róbert, HANZÉLY Zoltán, BERENTEI Zsolt, MAROSFŐI Miklós, NYÁRY István, SZIKORA István

[Background and purpose - We present two cases of angio-proliferative tumors that were misdiagnosed and treated as typical hemangiomas with epidural expansion. Materials and methods - Two middle-aged women presented with symptoms and radiological signs characteristic for aggressive hemangioma with epidural expansion. In the first case preoperative embolization and decompressive surgery with open transpedicular vertebroplasty was performed. Within less than a year, epidural recurrence of the tumor prompted for radical excision and corpectomy. The diagnosis after the histological studies and the further clinical evolution was metastasizing leiomyomatosis. No further recurrence occured during the next 6 years. In the second case percutaneous vertebroplasty was performed and complicated by epidural polymethyl-methacrylcate (PMMA) leakage, requiring urgent decompressive surgery. Histological study of the lesion raised the possibility of myopericytoma. This was confirmed 16 months later when complete vertebrectomy was performed due to severe epidural propagation of the recurring tumor. No further recurrence occurred in next the two years. Conclusions - Rare angio-proliferative tumors, like benign metastasizing leiomyoma and myopericytoma radiologically may resemble aggressive vertebral hemangiomas of the spine. Unlike hemangiomas, such tumors require radical removal due to their likely recurrence. As imaging studies may not be able to completely exclude such pathologies, bone biopsy and thorough histopathological studies are warranted prior to the therapeutic decision.]

Clinical Neuroscience

[APPLICATION OF VERTEBROPLASTY, NEURONAVIGATION AND KYPHOPLASTY IN THE TREATMENT OF MULTIPLEX OSTEOPOROTIC VERTEBRAL FRACTURES - CASE REPORT]

KASÓ Gábor, HORVÁTH Zsolt, KÖVÉR Ferenc, EZER Erzsébet, DÓCZI Tamás

[Vertebroplasty is a therapeutic image-guided procedure, consisting of an injection of acrylic cement through a bone biopsy needle into a vertebral body. Main indication for vertebroplasty is painful vertebral body compression fracture due to osteoporosis. The procedure is an efficient mean with high succes in pain release and prevention of further collapse of the treated vertebrae; however, the technique does not allow to realign the spine. Kyphoplasty was designed to adress the kyphotic deformitiy. It involves the percutaneous placement of an inflatable bone tamp into a vertebral body (VB). Restoration of VB height and kyphosis correction is achieved by inflation of the tamp with contrast material liquid. After deflation a cavitiy is created that eases the cement application. The most modern way of guidance in spinal surgery is neuronavigation - the use of frameless stereotaxy. The system reformats patient-specific CT images acquired prior surgery, performs image fusion with intraoperative plain X-ray. Before the operation, the surgeon may create surgical plan and simulate advancement of a virtual instrument along one or more surgical trajectories. During surgery, the system tracks the position of specialized surgical instruments. All three modalities mentioned above have been applied in the treatment of our patient suffered from multiple osteoporotic vertebral body compression fractures. Using kyphoplasty an almost total VB height restoration could be achieved. The pain relief was more than 50% after both operation.]

LAM KID

[Vertebroplasty and kyphoplasty in the clinical practice]

SZÖLLŐSI Balázs, JAKAB Gábor

[Osteoporosis affects about 600 thousand women and 300 thousand men in Hungary. The fractures give the illness its significance, among them 30-40 thousand vertebral fractures occur annually. One fifth of the patients suffering from vertebral compression fracture (VCF) sustaines an other VCF within a year. The intense pain can not always be controlled under conservative care and an efficient and fast intervention is needed to restore the quality of life of the patients. The cement augmentation (vertebroplasty or kyphoplasty) may help in days. The authors wish to present for the colleagues the details of indication, technical questions of the procedures and their complications based upon the data of numerous operated cases. They emphasize that osteoporotic patients sustained a VCF need complex care and nurture. They also mention that the danger of fracture of a neighbouring vertebra is increased due to the rigidity of the cemented one.]

Clinical Neuroscience

[Initial clinical experience with radio-frequency assisted percutaneous vertebral augmentation in the treatment of vertebral compression fractures]

MAROSFŐI Miklós, KULCSÁR Zsolt, BERENTEI Zsolt, GUBUCZ István, SZIKORA István

[Purpose - Percutaenous Vertebroplasty (PVP) is effective in alleviating pain and facilitating early mobilization following vertebral compression fractures. The relatively high risk of extravertebral leakage due to uncontrolled delivery of low viscosity bone cement is an inherent limitation of the technique. The aim of this research is to investigate the ability of controlled cement delivery in decreasing the rate of such complications by applying radiofrequency heating to regulate cement viscosity. Method and material - Thirty two vetebrae were treated in 28 patients as part of an Ethics Committee approved multicenter clinical trial using RadioFreqency assisted Percutaenous Vertebral Augmentation (RF-PVA) technique. This technique is injecting low viscosity polymethylmethacrylate (PMMA) bone cement using a pressure controlled hydraulic pump and applying radiofrequency heating to increase cement viscosity prior to entering the vertebral body. All patients were screened for any cement leakage by X-ray and CT scan. The intensity of pain was recorded on a Visual Analog Scale (VAS) and the level of physical activiy on the Oswestry Disability Index (ODI) prior to, one day, one month and three months following procedure. Results - All procedures were technically successful. There were no clinical complication, intraspinal or intraforaminal cement leakage. In nine cases (29%) a small amount of PMMA entered the intervertebral space through the broken end plate. Intensity of pain by VAS was reduced from a mean of 7.0 to 2.5 and physical inactivity dropped on the ODI from 52% to 23% three months following treatment. Conclusion - In this small series controlled cement injection using RF-PVA was capable of preventing clinically hazardous extravertebral cement leakage while achieving outcomes similar to that of conventional vertebroplasty.]