Use of sugammadex in a patient with limb girdle muscular dystrophy

Limb girdle muscular dystrophy, a chronic progressive muscular atrophic disease, leads to high sensitivity to depolarizing and non-depolarizing neuromuscular blocking agents. We report the successful use of the sugammadex in a patient with limb girdle muscular dystrophy (dysferlinopathy, Miyoshi distal myopathy) to reverse rocuronium-induced neuromuscular block. After neuromuscular recovery to a train-of-four ratio = 43%, we administered 3.2 mg x kg(-1) of sugammadex (200 mg) intravenously, reversing neuromuscular blockade to a train-of-four ratio = 95% within 3 min. Sugammadex can be used to reverse rocuronium-induced neuromuscular blockade in patients with limb girdle muscular dystrophy.     

Lung and respiratory muscle function in limb girdle muscular dystrophy.

BACKGROUND--Pulmonary involvement is frequently observed in patients with limb girdle muscular dystrophy and occurs early in the disease. The aim of this study was to establish the prevalence of pulmonary dysfunction; the type of dysfunction; and any correlation between patient age, disease duration, or limb weakness and lung or respiratory muscle dysfunction. METHODS--Twenty patients with strictly delineated limb girdle muscular dystrophy and 20 healthy controls were evaluated. Full inspiration chest radiographs were obtained. Standard lung and respiratory muscle function tests were performed and the data were statistically analysed. RESULTS--The mean age of the patients was 40.6 years, the mean disease duration was 18.9 years, and the mean average muscle score (a numerical expression of limb weakness) was 5.73 out of 10. Chest radiography showed unilateral paresis of the diaphragm in three patients. Increased residual volumes, with either increased or decreased total lung capacity, correlated inversely with disease duration. Respiratory muscle weakness was common but mild. Expiratory muscle function was more impaired than inspiratory muscle function and correlated positively with expiratory reserve volume. CONCLUSIONS--Respiratory muscle strength is commonly impaired in limb girdle muscle dystrophy. A dissociation of the limb and mild respiratory muscle involvement is observed; wheelchair restriction does not predict worsening of pulmonary function, and patient age, disease duration, or degree of limb weakness do not predict pulmonary morbidity. The diaphragm is not disproportionately affected by the dystrophic process compared with limb muscles.     

Methacholine bronchial challenge using a dosimeter with controlled tidal breathing.

A new inhalation synchronised dosimeter triggered by low inspiratory flow rates has been assessed. The methacholine challenge test using dosimeter nebulisation with controlled tidal breathing was compared with continuous nebulisation using De Vilbiss No 40 nebulisers with deep inhalations in 11 asthmatic subjects. Within subject PD20 FEV1 values were lower with the dosimeter method than with the continuous nebulisation method (geometric means 158 and 588 micrograms). The repeatability of the dosimeter method with controlled tidal breathing was studied in 11 asthmatic subjects, and the 95% range for a single measurement was +/- 0.72 doubling doses of methacholine. The dosimeter method has greater efficacy because aerosol is delivered during the first part of an inhalation, minimising loss of aerosol outside the respiratory tract. The dosimeter technique combined with controlled tidal breathing appears to be a useful method for carrying out standardised non-specific bronchoprovocation tests.     

保留上肢的肩胛带切除术治疗肩胛带恶性肿瘤

目的 探讨累及肩关节的肩部恶性肿瘤保肢术式的临床疗效.方法 2001年7月至2008年7月采用保留上肢的肩胛带切除术治疗肩胛带恶性肿瘤16例,男11例,女5例;年龄17～67岁,平均38.4岁.8例起源于肩胛骨,软骨肉瘤4例、Ewing肉瘤1例、转移癌3例;5例起源于肩部软组织,滑膜肉瘤2例、纤维肉瘤1例、血管外皮瘤1例、高分化脂肪肉瘤1例;3例起源于肱骨近端,骨肉瘤1例、转移癌2例.经典Tikhoff-Linberg手术12例,改良Tikhoff-Linberg手术4例.结果 手术时间2.5～4.0 h,平均3 h.术中出血1000～3000 ml,平均1600 ml.全部病例随访6～74个月,中位随访时间40个月.2例术前放疗者伤口延迟愈合,1例尺神经损伤.1例肱骨近端骨肉瘤患者出现局部复发及肺转移,行肩胛带离断术后18个月死亡.1例纤维肉瘤患者出现肺转移,23个月后死亡.1例滑膜肉瘤患者术后3个月出现肺转移,随访9个月带瘤生存.5例转移癌患者中4例于术后11～23个月死亡.至随访期末死亡6例,带瘤生存1例,无瘤生存9例.五年总体生存率34.6%.术后3个月接受经典术式者1993年美国骨肿瘤学会功能评分平均14.7分,接受改良术式者为19.5分.结论 对累及肩关节的肩部恶性肿瘤采用Tikhoff-Linberg手术可达到肿瘤广泛切除,保留上肢肢体及部分功能.经典术式术后肩部功能较差.

Abstract：

Objective To evaluate the functional outcomes of different limb salvage procedures in patients with bone and soft tissue sarcomas of the shoulder girdle.Methods From July 2001 to July 2008,16 patients with limb salvage for sarcomas of shoulder girdle were respectively analyzed,including 11 males and 5 females with an average age of 38.4 years (range,17-67).Localizations of the tumors were 8 in the scapula(including 4 chondrosarcomas,1 Ewing sarcoma,and 3 metastases),5 soft tissues of the shoulder girdie(including 2 synoviosarcomas,1 fibrosarcoma,1 hemangioperieytoma,and 1 well-differentiated liposarcoma),and 3 proximal humerus (including 1 osteosarcoma and 2 metastases).Twelve patients were treated with classical Tikhoff-Linberg procedures,and 4 with improved procedures.Results The mean surgical time duration was 3 hours.The mean blood loss was 1600 ml.The mean follow-up time was 40 months.Major complications included 2 cases of delayed wound healing,and 1 ulnar nerve injury.One patient had local recurrence and died of pulmonary metastases 18 months after second operation of interscapulothoracal amputation.The patient with fibrosarcoma also died of pulmonary metastases 23 months later.One patient with synoviosarcoma was alive with pulmonary metastases in 9 months.Four of 5 patients with carcinoma metastases died during 11 to 23 months later.The 5-year cumulative survival rate was 34.6%.Functions were preserved in the whole hand and elbow.The MSTS functional score of the patients receiving classical Tikhoff-Linberg procedures was 14.7,while improved Tikhoff-Linberg procedures was 19.5.Conclusion The Tikhoff-Linberg procedure not only provides a wide resection of tumors in the shoulder girdle but also preserve the whole hand and elbow functions.The shoulder function was poor in patients receiving classical Tikhoff-Linberg procedures.     

Improving limb salvage in critical ischemia with intermittent pneumatic compression: a controlled study with 18-month follow-up

BACKGROUND: Intermittent pneumatic compression (IPC) is an effective method of leg inflow enhancement and amelioration of claudication in patients with peripheral arterial disease. This study evaluated the clinical efficacy of IPC in patients with chronic critical limb ischemia, tissue loss, and nonhealing wounds of the foot after limited foot surgery (toe or transmetatarsal amputation) on whom additional arterial revascularization had been exhausted. METHODS: Performed in a community and multidisciplinary health care clinic (1998 through 2004), this retrospective study comprises 2 groups. Group 1 (IPC group) consisted of 24 consecutive patients, median age 70 years (interquartile range [IQR], 68.7-71.3) years, who received IPC for tissue loss and nonhealing amputation wounds of the foot attributable to critical limb ischemia in addition to wound care. Group 2 (control group) consisted of 24 consecutive patients, median age 69 years (IQR, 65.7-70.3 years), who received wound care for tissue loss and nonhealing amputation wounds of the foot due to critical limb ischemia, without use of IPC. Stringent exclusion criteria applied. Group allocation of patients depended solely on their willingness to undergo IPC therapy. Vascular assessment included determination of the resting ankle-brachial pressure index, transcutaneous oximetry (TcPO(2)), duplex graft surveillance, and foot radiography. Outcome was considered favorable if complete healing and limb salvage occurred, and adverse if the patient had to undergo a below knee amputation subsequent to failure of wound healing. Follow-up was 18 months. Wound care consisted of weekly débridement and biologic dressings. IPC was delivered at an inflation pressure of 85 to 95 mm Hg, applied for 2 seconds with rapid rise (0.2 seconds), 3 cycles per minute; three 2-hourly sessions per day were requested. Compliance was closely monitored. RESULTS: Baseline differences in demography, cardiovascular risk factors (diabetes mellitus, smoking, hypertension, dyslipidemia, renal impairment), and severity of peripheral arterial disease (ankle-brachial indices, TcPO(2), prior arterial reconstruction) were not significant. The types of local foot amputation that occurred in the two groups were not significantly different. In the control group, foot wounds failed to heal in 20 patients (83%) and they underwent a below knee amputation; the remaining four (17%, 95% confidence interval [CI], 0.59%-32.7%) had complete healing and limb salvage. In the IPC group, 14 patients (58%, 95% CI, 37.1%-79.6%) had complete foot wound healing and limb salvage, and 10 (42%) underwent below knee amputation for nonhealing foot wounds. Wound healing and limb salvage were significantly better in the IPC group (P < .01, chi(2)). Compared with the IPC group, the odds ratio of limb loss in the control group was 7.0. On study completion, TcPO(2) on sitting was higher in the IPC group than in the control group (P = .0038). CONCLUSION: IPC used as an adjunct to wound care in patients with chronic critical limb ischemia and nonhealing amputation wounds/tissue loss improves the likelihood of wound healing and limb salvage when established treatment alternatives in current practice are lacking. This controlled study adds to the momentum of IPC clinical efficacy in critical limb ischemia set by previously published case series, compelling the pursuit of large scale multicentric level 1 studies to substantiate its actual clinical role, relative indications, and to enhance our insight into the pertinent physiologic mechanisms.     

Dexmedetomidine attenuates tourniquet-induced hyperdynamic response in patients undergoing lower limb surgeries: A randomized controlled study

BackgroundActivation of sympathetic nervous system has a crucial role in mediating the pneumatic tourniquet inflation induced hyperdynamic response. Dexmedetomidine, a selective α₂-adrenergic receptor agonist, has potent sympatholytic effects. We conducted this prospective, randomized, placebo-controlled, double-blinded study to elucidate the effects of dexmedetomidine on attenuating the tourniquet-induced hyperdynamic response during general anesthesia.Materials and methodsWe included a total of 72 healthy adult patients undergoing elective lower limb surgery. Under general anesthesia, patients were randomized to the dexmedetomidine or the control group (n = 36 in each group). The dexmedetomidine group received a loading dose of dexmedetomidine (0.8 μg·kg^?1 over 10 min) followed by continuous infusion of dexmedetomidine (0.4 μg·kg^?1.h^?1) until tourniquet deflation. The control group received normal saline instead. We compared tourniquet-induced changes in hemodynamic parameters between groups to elucidate the effects of dexmedetomidine.ResultsTourniquet inflation induced significant increases in hemodynamic parameters, including heart rate, systolic arterial pressure, mean arterial pressure, diastolic arterial pressure, rate pressure product, cardiac output, and stroke volume in the control group. The effects of tourniquet inflation on increasing hemodynamic parameters were significantly attenuated by dexmedetomidine: heart rate (P < 0.001), systolic arterial pressure (P = 0.002), mean arterial pressure (P = 0.042), diastolic arterial pressure (P = 0.012), rate pressure product (P < 0.001), and cardiac output (P = 0.001) of the dexmedetomidine group were significantly lower than those of the control group. However, the stroke volume of these groups was comparable.ConclusionsDexmedetomidine attenuates tourniquet-induced hyperdynamic response in general anesthesia patients undergoing lower limb surgeries.     

Critical limb ischaemia as a main cause of death in patients with end-stage renal disease: a single-centre study.

BACKGROUND: Patients with end-stage renal disease (ESRD) have a high overall mortality rate, particularly due to cardiovascular morbidity. In an era of decline in cardiovascular diseases and early cardiovascular intervention, non-cardiac diseases seem to have a larger impact on overall mortality. METHODS: From 1997 to 2003, all incident haemodialysis patients in a single centre were enrolled in this prospective study. Those with clinical signs of vascular disease were examined by coronary or peripheral angiographies. Physicians took the patients' medical histories, examined them and followed them up until the end of the study or death. Causes of death were defined by the physicians. RESULTS: In all, 322 patients were enrolled in the study, 38% of whom were diabetic. At the start of dialysis treatment, 38% had coronary artery disease (CAD), defined as >50% stenosis of at least one coronary artery or as definite myocardial infarction, and 14% had critical ischaemia of at least one limb (CLI). In all patients with foot lesions, CLI was defined angiographically, as evidenced by stenosis or rarefication of distal vessels in the legs. Patients who died (n = 121) [due to cardiac causes (n = 25), complications of CLI (n = 22), stroke (n = 10), cachexia following a long-standing, non-malignant disease (n = 6), malignancy (n = 24), infection not related to CLI (n = 18) and other causes (n = 16)] were older (71+/-10 vs 65+/-13 years), more often male [74/121 (61%)] and often diabetic [56/121 (46%)]. CAD was documented in 82/121 (68%). Five-year survivals in patients with no risk and diabetes without CAD or CLI, CAD and CLI were 74%, 73%, 50% and 10%, respectively. Age, CLI and smoking habits independently increased the risk of death (hazard ratios: 1.052, 4.921 and 2.292, respectively). CONCLUSIONS: These results indicate that CLI with associated complications is not only an indicator of high mortality in patients with ESRD, but is also one of the main causes of death.     

Maximum flow rate-guided dilatation in patients of stricture urethra: a controlled study.

Maximum flow rate (MFR) is an objective uroflowmetric parameter for assessment of urethral stricture. Its use as a guide to assess the frequency of dilatation of the urethra on an outdoor basis could make the approach very scientific and objective. 70 cases were evaluated in two groups, study and control, each of 35 patients. Dilatation in the study group was guided by serial measurement of MFR, while in the control group, stricture was dilated on a traditional scale. A comparison between the two groups showed a statistically significant decline in the frequency of dilatation in the study group. A routine practice of MFR-guided dilatation in stricture clinics is recommended by us.     

Postoperative complications in patients with oculopharyngeal muscular dystrophy: A retrospective study

PURPOSE: Oculopharyngeal muscular dystrophy (OPMD) is a genetic disease with autosomal dominant transmission particularly common in Quebec where its prevalence is about 1:1000. The main features are bilateral ptosis of the eyelids and dysphagia. These symptoms are frequently treated surgically by levator palpebrae resection (LPR) and cricopharyngeal myotomy (CPM). The objectives of this retrospective chart review were to describe the postoperative complications in OPMD patients undergoing LPR or CPM and to determine their incidence. METHODS: Medical records of all OPMD patients who had either LPR or CPM between 1997 and 2002 were reviewed. The following complications were collected: death, pneumonia, aspiration pneumonitis, airway obstruction, reintubation, and severe coughing and choking caused by profuse secretions. RESULTS: One hundred and fourteen surgeries on 92 OPMD patients were studied. Fifty-nine were LPR under general anesthesia (LPR-GA) and 22 were LPR under local anesthesia (LPR-LA). Thirty-three surgeries were CPM, all under general anesthesia. There was no death or reintubation. Patients who had LPR-LA had shorter postanesthesia care unit (P<0.001) and ambulatory surgery unit (P<0.001) stays than those who had LPR-GA. Complications were more frequent after CPM than LPR-GA (P<0.001). CONCLUSION: The complication rate after LPR was low. Both local and general anesthesia are safe alternatives in OPMD patients operated for LPR. Patients having CPM presented more respiratory complications than those having LPR.     

Comparison between upper and lower limb lengthening in patients with achondroplasia: a retrospective study

Lengthening of the humerus is now an established technique. We compared the complications of humeral lengthening with those of femoral lengthening and investigated whether or not the callus formation in the humerus proceeds at a higher rate than that in the femur. A total of 24 humeral and 24 femoral lengthenings were performed on 12 patients with achondroplasia. We measured the pixel value ratio (PVR) of the lengthened area on radiographs and each radiograph was analysed for the shape, type and density of the callus. The quality of life (QOL) of the patients after humeral lengthening was compared with that prior to surgery. The complication rate per segment of humerus and femur was 0.87% and 1.37%, respectively. In the humerus the PVR was significantly higher than that of the femur. Lower limbs were associated with an increased incidence of concave, lateral and central callus shapes. Humeral lengthening had a lower complication rate than lower-limb lengthening, and QOL increased significantly after humeral lengthening. Callus formation in the humerus during the distraction period proceeded at a significantly higher rate than that in the femur. These findings indicate that humeral lengthening has an important role in the management of patients with achondroplasia.     

Remifentanil combined with low-dose ketamine for post-operative analgesia of lower limb fracture: a double-blind, controlled study

Objective: To investigate the adjuvant effect of intra-operative and postoperative low-dose ketamine administra-tion to remifentanil consumption in patient-controlled anal-gesia (PCA) for lower limb fracture.Methods: A total of 200 patients with lower limb frac-ture receiving the surgery were randomly divided into 4 groups. In Groups A, B and C, patients received 0.5 mg/kgketamine infusion under general anesthesia, and ketamine in a dose of 0.1 mg/kg, 0.05 mg/kg, 0.01 mg/kg per hour continuously for 24 hours after surgery, respectively. The control group (Group D) received an equivalent volume of normal saline only. With 20 μg/ml remifentanil in normal saline, postoperative PCA was administered with a back-ground infusion at 2 ml/h following 2 ml as a loading dose and 1 ml demand dose with a 3-minute lockout period. Remifentanil consumption, 11-point visual analog scale (VAS) scores, global satisfaction score (GSS), and side ef-fects were also recorded by the acute pain service. Results: Cumulative PCA remifentanil consumption in Groups A and B were (1378±377) μg and (1531±402) μg,significantly lower than (1807±510) μg and (1838±523) μg in Groups C and D (P<0.01). VAS scores in Groups A and B were significantly lower than those in Groups C and D (P<0.01). In the first 12 hours after operation, GSS was improved (P<0.01). No respiratory depression was observed. No significant dif-ference in side effects was observed among groups. Conclusion: Low-dose ketamine can relieve postop-erative pain and moderately decrease remifentanil consump-tion for PCA, with no obvious side effects of ketamine.     

Antioxidant status in patients with osteoporosis: A controlled study

ObjectiveWe aimed to investigate serum antioxidant enzymes and nitric oxide (NO) levels in postmenopausal women with osteoporosis (OP) and in healthy controls; and to determine the relationship between these enzymes, NO and clinical parameters in this present study.MethodsForty-five postmenopausal women fulfilling OP diagnostic criteria of World Health Organization (WHO) and 42 postmenopausal healthy women without OP were enrolled. Patients in the study population were selected among individuals that were not pre-diagnosed or pre-treated for OP. Patients with metabolic bone diseases, fracture history, which were smokers, alcohol users and taking antioxidant drug treatment, were excluded from the study. Dual Energy X-ray Absorptiometry (DXA) results, body mass indices and demographic data were recorded. Erythrocyte catalases (CAT), glutathione reductase (GR) enzyme activities and erythrocyte glutathione (GSH) levels, plasma malondialdehyde (MDA) levels were measured by spectrophotometer whereas plasma nitrite+nitrate (NOx) levels were measured by ELISA microplate-reader.ResultsPatients had significantly lower GR (P < 0.01) enzyme activity and higher levels of MDA (P < 0.01) and NO (P < 0.01) than non osteoporotic healthy controls. There was no significant difference between both groups in erythrocyte GSH levels and CAT activities. Total femoral BMD measurements significantly correlated with MDA levels (P = 0.001). There was no significant relationship between other antioxidants and lumbar or femoral BMD.ConclusionOxidative stress may play an important role in postmenopausal bone loss and therefore it might be considered when pathogenesis of postmenopausal OP has been investigated.     

Pelvic joint fusions in patients with chronic pelvic girdle pain: a 23-year follow-up

Purpose

Fusion of the sacroiliac joints (SIJ) has been a treatment option for patients with severe pelvic girdle pain (PGP). The primary aims were to evaluate the long-term outcomes in patients who underwent SIJ fusion and to compare 1-year outcomes with long-term outcomes. The secondary aim was to compare patients who underwent SIJ fusion with a comparable group who did not.

Methods

This study includes fifty patients that underwent SIJ fusion between 1977 and 1998. Function (the Oswestry disability index; ODI), pain intensity (visual analogue scale; VAS) and health-related quality of life (SF-36) were determined according to a patient-reported questionnaire. The questionnaire scores were compared with previously recorded 1-year outcomes and with questionnaire scores from a group of 28 patients who did not undergo SIJ fusion.

Results

The patients who underwent SIJ fusion reported a mean ODI of 33 (95 % CI 24–42) and a mean VAS score of 54 (95 % CI 46–63) 23 years (range 19–34) after surgery. Regarding quality of life, the patients reported reduced physical function, but mental health was not affected in the same manner. The patients with successful 1-year outcomes (48 %) retained significantly improved function and reduced pain levels compared with the subgroup of patients with unsuccessful 1-year outcomes (28 %). The patients who underwent surgery did not differ from the non-surgery group in any outcome at the long-term follow-up.

Conclusions

Patients treated with SIJ fusion had moderate disability and pain 23 years after surgery, and the 1-year outcomes were sustained 23 years after surgery. Although many fused patients reported good outcome, this group did not differ from the comparable non-surgical group.     

Breathing retraining for dysfunctional breathing in asthma: a randomised controlled trial

BACKGROUND: Functional breathing disorders may complicate asthma and impair quality of life. This study aimed to determine the effectiveness of physiotherapy based breathing retraining for patients treated for asthma in the community who have symptoms suggestive of dysfunctional breathing. METHODS: 33 adult patients aged 17-65 with diagnosed and currently treated asthma and Nijmegen questionnaire scores > or =23 were recruited to a randomised controlled trial comparing short physiotherapy breathing retraining and an asthma nurse education control. The main outcome measures were asthma specific health status (Asthma Quality of Life questionnaire) and Nijmegen questionnaire scores RESULTS: Of the 33 who entered the study, data were available on 31 after 1 month and 28 at 6 months. The median (interquartile range) changes in overall asthma quality of life score at 1 month were 0.6 (0.05-1.12) and 0.09 (-0.25-0.26) for the breathing retraining and education groups, respectively (p=0.018), 0.42 (0.11-1.17) and 0.09 (-0.58-0.5) for the symptoms domain (p=0.042), 0.52 (0.09-1.25) and 0 (-0.45-0.45) for the activities domain (p=0.007), and 0.50 (0-1.50) and -0.25 (-0.75-0.75) for the environment domain (p=0.018). Only the change in the activities domain remained significant at 6 months (0.83 (-0.10-1.71) and -0.05 (-0.74-0.34), p=0.018), although trends to improvement were seen in the overall score (p=0.065), the symptoms domain (p=0.059), and the environment domain (p=0.065). There was a correlation between changes in quality of life scores and Nijmegen questionnaire scores at 1 month and at 6 months. The number needed to treat to produce a clinically important improvement in health status was 1.96 and 3.57 at 1 and 6 months. CONCLUSION: Over half the patients treated for asthma in the community who have symptoms suggestive of dysfunctional breathing show a clinically relevant improvement in quality of life following a brief physiotherapy intervention. This improvement is maintained in over 25% 6 months after the intervention.     

Rebreathing during spontaneous and controlled ventilation with T-piece breathing systems: a general solution

A general solution is presented to the problem of finding the degree of rebreathing generated by T-piece breathing systems. The solution is applicable to any ventilatory waveform, dead space volume and tidal volume and is identical for spontaneous and controlled ventilation for any given ventilatory waveform. The method is graphical and its use and understanding require no mathematical skills. However, if an analytical form of the ventilatory waveform is known, the method is easily extended by use of calculus to obtain a precise analytical solution.     

Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study.

This study investigates the effects of kyphoplasty on pain and mobility in patients with osteoporosis and painful vertebral fractures compared with conventional medical management. INTRODUCTION: Pharmacological treatment of patients with primary osteoporosis does not prevent pain and impaired activity of patients with painful vertebral fractures. Therefore, we evaluated the clinical outcome after kyphoplasty in patients with vertebral fractures and associated chronic pain for >12 months. MATERIALS AND METHODS: Sixty patients with primary osteoporosis and painful vertebral fractures presenting for >12 months were included in this prospective, nonrandomized controlled study. Twenty-four hours before performing kyphoplasty, the patients self-determined their inclusion into the kyphoplasty or control group so that 40 patients were treated with kyphoplasty, whereas 20 served as controls. This study assessed changes in radiomorphology, pain visual analog scale (VAS) score, daily activities (European Vertebral Osteoporosis Study [EVOS] score), number of new vertebral fractures, and health care use. Outcomes were assessed before treatment and at 3 and 6 months of follow-up. All patients received standard medical treatment (1g calcium, 1000 IE vitamin D(3), standard dose of oral aminobisphosphonate, pain medication, physical therapy). RESULTS: Kyphoplasty increased midline vertebral height of the treated vertebral bodies by 12.1%, whereas in the control group, vertebral height decreased by 8.2% (p = 0.001). Augmentation and internal stabilization by kyphoplasty resulted in a reduction of back pain. VAS pain scores improved in the kyphoplasty group from 26.2 +/- 2 to 44.2 +/- 3.3 (SD; p = 0.007) and in the control group from 33.6 +/- 4.1 to 35.6 +/- 4.1 (not significant), whereas the EVOS score increased in the kyphoplasty group from 43.8 +/- 2.4 to 54.5 +/- 2.7 (p = 0.031) and in the control group from 39.8 +/- 4.5 to 43.8 +/- 4.6 (not significant). The number of back pain-related doctor visits within the 6-month follow-up period decreased significantly after kyphoplasty compared with controls: mean of 3.3 visits/patient in the kyphoplasty group and a mean of 8.6 visits/patient in the control group (p = 0.0147). CONCLUSIONS: The results of this study show significantly increased vertebral height, reduced pain, and improved mobility in patients after kyphoplasty. Kyphoplasty performed in appropriately selected osteoporotic patients with painful vertebral fractures is a promising addition to current medical treatment.