Vertebral Augmentation The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation

Vertebral Augmentation The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation

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The definitive guide to performing vertebroplastykyphoplasty, and implant augmentation from national and international experts.

Vertebral compression fractures (VCFs) result from trauma or pathologic weakening of the bone and are associated with conditions such as osteoporosis or malignancy. Worldwide, VCFs impact one in three women and one in eight men aged 50 and older, with more than 8.9 million fractures incurred annually. Copublished by Thieme and the Society of Interventional Radiology, Vertebral Augmentation: The Comprehensive Guide to Vertebroplasty, Kyphoplasty, and Implant Augmentation provides a practical, clinical discussion of these minimally invasive spine interventions.

Written and edited by Douglas Beall along with associate editors Allan Brook, M. R. Chambers, Joshua Hirsch, Alexios Kelekis, Yong-Chul Kim, Scott Kreiner, and Kieran Murphy, this richly illustrated book presents a multidisciplinary and international perspective. It features contributions from renowned experts in interventional radiology, neurosurgery, pain medicine, and physiatry. This resource fills a gap in the literature, with extensive updates on a vast amount of new information and techniques that have been introduced during the past decade. Thirty-five chapters address treatment of spine fractures, starting with a history and introduction to vertebral augmentation, discussion of VCFs, patient assessments, physical exam findings, pain management, and much more.

Key Features

Procedural chapters cover vertebroplasty, sacroplasty, cervical and posterior arch augmentation, balloon kyphoplasty, and vertebral augmentation with implants and for challenging pathologies Special topics include radiation exposure and protection, post-procedure physical therapy, osteoporosis treatment, postural fatigue syndrome, the effect on morbidity and mortality, and cementoplasty outside the spine Treatment of complex cases are also discussed extensively, including chronic vertebral compression fractures, neoplastic vertebral compression fractures, instrumented spinal fusions, and severe benign and malignant fractures The final chapter features 16 subchapters from global masters of vertebral augmentation, with personal tips, tricks, and pearls they use in their own practices This is a must-have resource for interventional radiology, neurosurgery, interventional pain management, and orthopaedic surgery residents and fellows, as well as seasoned clinicians who wish to incorporate these procedures into practice.

This book includes complimentary access to a digital copy on https://medone.thieme.com.

Microvascular decompression for trigeminal neuralgia

Microvascular decompression for trigeminal neuralgia

see Microvascular decompression for trigeminal neuralgia and multiple sclerosis

see Awake Microvascular Decompression for Trigeminal Neuralgia

see also Endoscope assisted microvascular decompression for trigeminal neuralgia.

Microvascular decompression is a first-line neurosurgical approach for classical trigeminal neuralgia with neurovascular conflict, but can show clinical relapse despite proper decompression. Second-line destructive techniques like radiofrequency thermocoagulation have become reluctantly used due to their potential for irreversible side effects. Subcutaneous peripheral nerve field stimulation (sPNFS) is a minimally invasive neuromodulatory technique which has been shown to be effective for chronic localised pain conditions.

The most frequently used surgical management of trigeminal neuralgia is Microvascular decompression (MVD), followed closely by stereotactic radiosurgery (SRS). Percutaneous stereotactic rhizotomy (PSR) , despite being the most cost-effective, is by far the least utilized treatment modality 1).

Microvascular decompression (MVD) via lateral suboccipital approach is the standard surgical intervention for trigeminal neuralgia treatment.

Teflon™ and Ivalon® are two materials used in MVD for TN. It is an effective treatment with long-term symptom relief and recurrence rates of 1-5% each year. Ivalon® has been used less than Teflon™ though is associated with similar success rates and similar complication rates 2)

Although microvascular decompression (MVD) is the most effective long-term operative treatment for TN, its use in older patient populations has been debated due to its invasive nature.


Compared with the standard microscope-assisted techniques, the 3D exoscopic endoscope-assisted MVD offers an improved visualisation without compromising the field of view within and outside the surgical field 3).

Systematic Review and Meta-Analysis

Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, PubMedCochrane Library, and Scopus were queried for primary studies examining pain outcomes after MVD for TN published between 1988 and March 2018. Potential biases were assessed for included studies. Pain freedom (ie, Barrow Neurological Institute score of 1) at last follow-up was the primary outcome measure. Variables associated with pain freedom on preliminary analysis underwent formal meta-analysis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for possible predictors.

Outcome data were analyzed for 3897 patients from 46 studies (7 prospective, 39 retrospective). Overall, 76.0% of patients achieved pain freedom after MVD with a mean follow-up of 1.7 ± 1.3 (standard deviation) yr. Predictors of pain freedom on meta-analysis using random effects models included (1) disease duration ≤5 yr (OR = 2.06, 95% CI = 1.08-3.95); (2) arterial compression over venous or other (OR = 3.35, 95% CI = 1.91-5.88); (3) superior cerebellar artery involvement (OR = 2.02, 95% CI = 1.02-4.03), and (4) type 1 Burchiel classification (OR = 2.49, 95% CI = 1.32-4.67).

Approximately three-quarters of patients with drug-resistant TN achieve pain freedom after MVD. Shorter disease duration, arterial compression, and type 1 Burchiel classification may predict a more favorable outcome. These results may improve patient selection and provider expectations 4).

Technique

Outcome

Complications

Case series

References

1)

Sivakanthan S, Van Gompel JJ, Alikhani P, van Loveren H, Chen R, Agazzi S. Surgical management of trigeminal neuralgia: use and cost-effectiveness from an analysis of the medicare claims database. Neurosurgery. 2014 Sep;75(3):220-6. doi: 10.1227/NEU.0000000000000430. PubMed PMID: 24871139.
2)

Pressman E, Jha RT, Zavadskiy G, Kumar JI, van Loveren H, van Gompel JJ, Agazzi S. Teflon™ or Ivalon®: a scoping review of implants used in microvascular decompression for trigeminal neuralgia. Neurosurg Rev. 2019 Nov 30. doi: 10.1007/s10143-019-01187-0. [Epub ahead of print] Review. PubMed PMID: 31786660.
3)

Li Ching Ng A, Di Ieva A. How I do it: 3D exoscopic endoscope-assisted microvascular decompression. Acta Neurochir (Wien). 2019 May 29. doi: 10.1007/s00701-019-03954-w. [Epub ahead of print] PubMed PMID: 31144166.
4)

Holste K, Chan AY, Rolston JD, Englot DJ. Pain Outcomes Following Microvascular Decompression for Drug-Resistant Trigeminal Neuralgia: A Systematic Review and Meta-Analysis. Neurosurgery. 2020 Feb 1;86(2):182-190. doi: 10.1093/neuros/nyz075. PubMed PMID: 30892607.
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