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Index
Cover
Title Page
Copyright
Contents
Videos
Preface
Contributors
1 History and Introduction to Vertebral Augmentation
1.1 Introduction
1.2 Mechanisms of Pain Relief
1.3 Procedures
1.3.1 Vertebroplasty
1.3.2 Kyphoplasty
1.3.3 Radiofrequency Kyphoplasty
1.3.4 Percutaneous Radiofrequency Ablation
1.3.5 Vertebral Augmentation with Implants
1.4 Indications and Contraindications
1.5 Risks and Complications
1.6 Clinical Applications and Evidence
1.6.1 Osteoporosis
1.6.2 Trauma
1.6.3 Bone Disease, Cancer, Metastases, and Multiple Myeloma
1.6.4 Langerhans Cell Vertebral Histiocytosis
1.6.5 Osteogenesis Imperfecta
1.7 Conclusion
2 Vertebral Compression Fractures
2.1 Introduction
2.2 Presentation and Diagnosis
2.3 Epidemiology
2.3.1 Osteoporosis
2.3.2 Cancer
2.3.3 Trauma
2.4 Vertebral Fracture Classification Systems
2.5 Treatment
2.5.1 Osteoporotic Vertebral Compression Fractures
2.5.2 Pathologic Vertebral Fractures due to Neoplasia
2.5.3 Traumatic Vertebral Fractures
2.6 Public Health and Economic Impact
2.6.1 Osteoporosis
2.6.2 Cancer
2.6.3 Trauma
2.6.4 Cost-Effectiveness
2.7 Conclusion
3 Preprocedure Assessment Prior to Vertebral Augmentation
3.1 Introduction
3.2 Anatomy, Radiologic Imaging, Identification, and Interpretation of Vertebral Compression Fractures
3.3 Preprocedure Assessment
3.4 General Indications, Contraindications, and Procedure Complications
3.5 Equipment and Room Setup
3.6 Procedure
3.7 Postprocedure Management
4 Physical Examination Findings in Patients with Vertebral Compression Fractures
4.1 Introduction
4.2 Presentation of Vertebral Compression Fractures
4.3 Risk Factors
4.4 Red Flags
4.5 Observational Findings Suggesting Compression Fracture
5 Medical Pain Management in Patients with Vertebral Compression Fractures
5.1 Introduction
5.2 Nonsteroidal Anti-Inflammatory Drugs
5.3 Acetaminophen
5.4 Opioid Analgesics
5.5 Muscle Relaxants
5.6 Calcitonin
5.7 Transdermal Lidocaine
5.8 Bisphosphonate
5.9 Anticonvulsants
5.10 Conclusion
6 Approaches to the Vertebral Body
6.1 Introduction
6.2 Indications
6.3 Anatomy
6.3.1 Planning the Trajectory
6.4 Bilateral versus Unilateral Approach
6.5 Imaging and Equipment
6.6 Procedure
6.6.1 Potential Risks and Management of Complications
6.6.2 Transpedicular Approach
6.6.3 Extrapedicular and Parapedicular Approaches
6.6.4 Extrapedicular Modified Inferior End Plate Access
6.6.5 Parapedicular Approach
6.6.6 Parapedicular Approach to the Vertebral Body
6.6.7 Approaches to the Cervical Spine
6.7 Vertebral Body Biopsy
6.8 Conclusion
7 Properties of Bone Cements and Vertebral Fill Materials: Implications for Clinical Use in Image-Guided Therapy and Vertebral Augmentation
7.1 Introduction
7.2 Bone Cement Types
7.2.1 Polymer Chemistry
7.2.2 PMMA-Based Bone Cements
7.3 Cement Properties
7.3.1 Liquid-to-Powder Ratio
7.3.2 Initiator-to-Activator Ratio
7.3.3 Radiopacifiers
7.3.4 Polymethyl Methacrylate Bead Size
7.4 Mixing Method
7.5 Antibiotics
7.6 Pain Relief
7.7 Bone Adherence
7.8 Bone Formation and Other New Developments
7.9 The Future
7.10 Conclusion
7.11 Pearls
8 Vertebroplasty
8.1 Introduction
8.2 Anatomic Features
8.3 The Procedure
8.3.1 Procedure Materials
8.3.2 Sedation and Anesthetic Preparation
8.3.3 Positioning
8.3.4 Antibiotic Prophylaxis and Skin Preparation
8.3.5 Needle Placement
8.3.6 Image Guidance
8.3.7 Needle Insertion
8.3.8 Fill Materials
8.3.9 Cement Injection
8.3.10 Volume of Cement Injected
8.4 Considerations in Cervical Vertebroplasty
8.5 Postprocedure Care
8.5.1 Initial Postprocedure Care
8.5.2 Discharge and Follow-Up
8.6 Conclusion
8.7 Key Points
9 Sacroplasty: Management of Sacral Insufficiency Fractures
9.1 Introduction
9.2 Fractures of the Sacrum: Anatomy
9.3 Sacral Insufficiency Fractures: Causes and Natural History
9.4 History and Examination
9.5 Imaging
9.6 Treatment
9.6.1 Conservative Treatment
9.6.2 Osseous Augmentation
9.7 Techniques
9.7.1 Short-Axis Technique
9.7.2 Long-Axis Technique
9.7.3 Lateral Approach Technique
9.8 Outcomes
10 Cervical and Posterior Arch Augmentation
10.1 Cervical Augmentation
10.1.1 Introduction
10.1.2 Historical Perspective
10.1.3 Image Guidance
10.1.4 Procedural Approaches
10.1.5 Prevention of Infection
10.1.6 Complications
10.1.7 Conclusion
10.2 Posterior Arch Augmentation
10.2.1 Introduction
10.2.2 Pediculoplasty
10.2.3 Laminoplasty and Spinoplasty
10.2.4 Key Points
11 Balloon Kyphoplasty
11.1 Introduction
11.2 Materials
11.2.1 Bone Access Tools
11.2.2 Balloons Tamps and Inflation Devices
11.2.3 Bone Cement
11.3 Diagnosis and Preoperative Preparation
11.4 Indications and Contraindications
11.5 Procedure
11.5.1 Bilateral versus Unilateral Approach
11.6 Risks and Benefits
11.7 Importance of Sagittal Balance Restoration and Kyphosis Correction
11.8 Adjacent Fractures
11.9 Postoperative Care
11.10 Conclusion
12 Vertebral Augmentation with Implants
12.1 Introduction
12.2 The Implants
12.3 The Procedures
12.4 Bilateral versus Unilateral Approach
12.5 Advantages and Disadvantages of Vertebral Implants
12.6 Postprocedure Care
13 Radiation Exposure and Protection: A Conversation Beyond the Inverse Square Law, Thermoluminescent Dosimeters, and Lead Aprons
13.1 Introduction
13.2 Gene Mutation and Radiation Effects on DNA Leading to the Developmentof Cancer
13.3 Radiation Dose to the Operator and Patient During Vertebroplasty/Kyphoplasty
14 Appropriateness Criteria for Vertebral Augmentation
14.1 Introduction
14.2 Indications, Guidelines, and Recommendations
14.3 Appropriateness Criteria
15 Literature Analysis of Vertebral Augmentation
15.1 Introduction
15.2 Early Data
15.3 Evidence for Efficacy
15.3.1 Vertebroplasty
15.3.2 Kyphoplasty
15.3.3 Vertebroplasty Compared with Kyphoplasty
15.3.4 The Kiva System
15.4 Evidence for Safety
15.4.1 Overall Complications
15.4.2 Cement Leakage
15.4.3 Subsequent Fractures
15.5 Mortality Benefit
15.6 Conclusion
15.7 Key Points
16 Cost-Effectiveness of Vertebral Augmentation
16.1 Introduction
16.2 Cost-Effectiveness
17 Additional and Adjacent Level Fractures after Vertebral Augmentation
17.1 Introduction
17.2 Risk Factors for Additional or Adjacent-Level Fractures
17.3 Possible Influences of Vertebral Augmentation Technique
18 Predisposing Factors to Vertebral Fractures
18.1 Introduction
18.2 Current Information Based on Recent Literature and State-of-the-Art Practice
18.2.1 Osteoporosis
18.2.2 Pathologic Fractures
18.2.3 Fractures Secondary to Infection
18.2.4 Traumatic Fractures
18.3 Key Points
19 Bracing for Spinal Fractures
19.1 Introduction
19.2 Cervical Fracture Bracing
19.3 Lumbar and Thoracic Compression Fracture Bracing
19.3.1 Introduction
19.3.2 Types of Thoracolumbar Braces
19.3.3 Concepts on the Use of the TLSO Braces
19.3.4 Bracing for Traumatic Burst Fractures of the Lumbar and Thoracic Spine
19.4 Osteoporotic Lumbar and Thoracic Fractures
20 Amount of Cement or Vertebral Fill Material for Optimal Treatment and Pain Relief
20.1 Introduction
20.2 What are the Mechanisms of Pain Relief in Vertebral Augmentation?you
20.2.1 Mechanical Stability
20.2.2 Denervation of the Vertebra and the Role of C Fibers and the Basivertebral Nerve
20.3 Treatment of Degenerative End Plate Changes with Osseous Augmentation
20.4 Conclusion
20.5 Pearls
21 Clinical Presentation and the Response to Vertebral Augmentation
21.1 Clinical Presentation
21.2 Response to Vertebral Augmentation
22 Effect of Vertebral Augmentation on Morbidity and Mortality
22.1 Introduction
22.2 Nonsurgical Management vs. Vertebral Augmentation
22.3 Outcome of Patients with Vertebral Fractures Not Treated with Vertebral Augmentation
23 Number of Levels Appropriately Treated with Vertebral Augmentation
23.1 Introduction
23.2 Neoplastic Vertebral Fractures
23.3 Risk Factors for Vertebral Compression Fractures
23.4 Number of Levels to Treat with Vertebral Augmentation
23.5 Diagnosis of Painful Vertebral Compression Fractures
23.6 Safety of Treating Multiple Vertebral Compression Fractures
23.7 Conclusion
24 Pain after Vertebral Augmentation
24.1 Introduction
24.2 Complications from Procedure
24.3 Recurrent Fracture
24.4 Facet-Mediated Pain
24.5 Sagittal Imbalance
25 Postural Fatigue Syndrome
25.1 Introduction
25.2 Clinical Presentation
25.3 Pathophysiology
25.4 Treatment
25.5 Key Points
26 Physical Therapy after Vertebral Augmentation
26.1 Introduction
26.2 Rehabilitation as Part of Routine Anti-Osteoporosis Care
26.3 Rehabilitation after Osteoporotic Vertebral Compression Fractures
26.4 Rehabilitation as Part of Postinterventional Care
26.5 Conclusion
27 Sham vs. Vertebral Augmentation
27.1 Introduction
27.2 Current Concepts of Controls in Trials
27.3 Sham vs. Vertebroplasty
27.3.1 Similarities and Differences of Controls
27.3.2 Sham vs. Vertebral Augmentation
27.4 Evidence Based on the Control and the Conduct of the Study
27.5 Conflicting Opinions
27.6 Discussion
27.7 Conclusion
28 Treatment of Chronic Vertebral Compression Fractures
28.1 Introduction
28.2 Preoperative Evaluation
28.3 Vertebral Osteonecrosis
28.4 Sequela of Chronic Fractures
28.5 The Treatment of Chronic VCFs
28.6 Conclusion
29 Treatment of Neoplastic Vertebral Compression Fractures
29.1 Introduction
29.2 Diagnosis
29.2.1 History
29.2.2 Physical Examination
29.2.3 Imaging Diagnosis
29.2.4 Valuable Scoring Systems for Evaluation of the Patients with Metastatic Bone Lesions
29.3 Treatment
29.3.1 Thoracic and Lumbar Vertebrae
29.3.2 Sacrum
29.3.3 Cervical vertebrae
29.4 Controversies
29.4.1 Vertebroplasty versus Kyphoplasty
29.4.2 Increased Risk of VCFs after Radiotherapy
29.5 Conclusion
30 Vertebral Augmentation in Instrumented Spinal Fusions
30.1 Introduction
30.2 Instrumentation in Spinal Fusion
30.3 Vertebral Augmentation in Spinal Fusion
30.4 Indications
30.5 Outcomes and Variables
30.5.1 Osteoporosis
30.5.2 Revision Surgery
30.5.3 Select High-Risk Patients
30.5.4 Adult Spinal Deformity
30.5.5 Method of Delivery
30.5.6 Thoracolumbar Burst Fractures
30.5.7 Cement
30.6 Conclusion
31 Biomechanical Changes after Vertebral Compression Fractures
31.1 Introduction
31.2 Current Information based on Recent Literature and State-of-the-Art Practice
31.2.1 Physiologic Loads on the Vertebral Body
31.2.2 Impact of Disk Degeneration on the FSU
31.2.3 Biomechanical Changes after Vertebral Compression Fractures
31.2.4 Technical Considerations during Vertebral Augmentation: Correcting Fracture and FSU-Related Instability
31.2.5 Technical Considerations during Vertebral Augmentation: Quantity of Cement to Inject
31.2.6 Biomechanics after Vertebral Augmentation: Adjacent-Level Fracture Risk
31.3 Key Points
32 Advanced Principles of Minimally Invasive Vertebral Body Stabilization in Severe Benign and Malignant Fractures: Stent-Screw Assisted Internal Fixation
32.1 Introduction
32.2 Osteoporotic Fractures
32.3 Neoplastic Osteolysis
32.4 SAIF Technique
32.4.1 Osteoporotic Fractures
32.4.2 Neoplastic Osteolysis
32.5 Conclusion
33 Cementoplasty Outside the Spine
33.1 Introduction
33.2 Anatomic Sites
33.2.1 Pelvic Cementoplasty
33.2.2 Technique of Cementoplasty
33.2.3 Assessment of Outcome
33.2.4 Acetabulum/Pelvis
33.3 Other Sites
33.4 Complications
33.5 Concomitant Use of Ablative Techniques
33.6 Conclusion
33.7 Key Points
34 Treatment of Osteoporosis after Vertebral Augmentation
34.1 Introduction
34.2 Etiology and Epidemiology
34.3 Economic Burden
34.4 Presentation and Diagnosis
34.5 Dual-Energy X-ray Absorptiometry
34.6 Vertebral Fracture Assessment
34.7 Radiographs
34.8 Trabecular Bone Score
34.9 Fracture Risk Assessment Algorithm (FRAX)
34.10 Treatment
34.10.1 Referral
34.10.2 Fracture Liaison Service
34.10.3 Nonpharmacological Treatment
34.10.4 Pharmacological Treatment
34.11 Treatment of the Osteoporosis by the Physician Treating the Fracture
34.12 Conclusion
34.13 Useful Websites
35 Miscellaneous Tips by the Masters of Vertebral Augmentation
35.1 If You Aim at Height Restoration, Mind the Access!
35.2 Pearls of Vertebroplasty and Kyphoplasty
35.3 Excellence is a Habit
35.4 Osteonecrosis of the Spine (Kümmel–Verneuil Disease)
35.5 Cement Augmentation
35.5.1 Pearls
35.6 Tips and Techniques of Vertebral Augmentation
35.6.1 Cementing Tips after Prior Vertebral Augmentation
35.6.2 Kyphoplasty and Revision of L3 Pedicle Screw after Posttraumatic Screw Displacement
35.6.3 Treating Recurring Fractures after Vertebroplasty
35.6.4 Allowing for Access to Pedicle Screw Placement after Vertebral Augmentation
35.6.5 Tips and Techniques of Vertebral Augmentation
35.7 Radiofrequency Ablation and Vertebral Implant Augmentation in a Patient with Lytic Metastatic Disease
35.8 Vertebral Hemangioma Causing Congestive Myelopathy Despite Absence of Angiographically Evident Arteriovenous Shunting
35.9 Vertebral Augmentation Devices in the Treatment of Traumatic Vertebral Fractures
35.10 Vertebral Augmentation: Tips and Tricks
35.11 Dorsal Root Ganglion Stimulation to Treat Persistent Radicular Pain after Compression Fracture
35.12 Vertebral Augmentation Tips and Tricks of the Trade
35.12.1 Thermally Accelerated Cement
35.12.2 Unipedicular Approach for Bilateral Cementation
35.12.3 Avoiding Wrong Level Surgery
35.13 Treatment of a Thoracic Vertebral Compression Fracture with Vertebra Plana
35.14 Vertebroplasty of a Myelomatous C3 Vertebral Body through an Anterolateral Route
35.14.1 Case Report
35.15 Refracture after Kyphoplasty
35.16 The Tripod Approach for Treating Vertebral Compression Fractures
Index
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