Vertebroplasty for acute painful osteoporotic vertebral compression fractures: An update

Vertebral compression fractures (VCFs) are a common cause of back pain and disability and are usually osteoporotic in nature. Therapy aims to adequately control pain and allow early mobilisation and return of function while preventing additional fractures. A proportion of patients do not achieve adequate pain relief using conservative measures alone. Unwanted adverse effects from medications may also ensue. Vertebroplasty represents an alternative treatment option for VCFs. Patients with acute VCFs (≤6 weeks old) may gain the most benefit from vertebroplasty as healed fractures are not as amenable to cement injection. High‐quality studies have reported conflicting results regarding the use of vertebroplasty in the treatment of acute VCFs. Despite high‐quality evidence, varying study designs and heterogenous patient cohorts make interpretation of this data difficult. Only one sham‐controlled randomised controlled trial (RCT) has evaluated vertebroplasty exclusively in patients with acute VCFs, reporting favourable results. Pooled data from RCTs also suggest vertebroplasty to be safe. This article provides a concise and critical review of the current literature regarding vertebroplasty for the treatment of acute VCFs.     

ORIGINAL ARTICLE: Long-term outcomes of vertebroplasty for osteoporotic compression fractures

Introduction: This study aimed to determine outcomes of percutaneous vertebroplasty for osteoporotic vertebral compression fractures (VCFs). Methods: Prospective assessment of short-term (≤6 weeks), medium-term (6 months) and long-term (29 months) outcomes of vertebroplasty, followed by a retrospective long-term follow-up of patients treated with vertebroplasty compared with conservative therapy. Outcomes measured were visual analogue scale pain scores, analgesic use, disability scores using the Roland Morris Disability questionnaire and a number of new VCFs. Results: In 27 patients with acute VCFs followed prospectively, vertebroplasty resulted in significant reductions in pain levels (56-mm reduction on a 100-mm scale) and disability scores (11.8-point reduction on a 24-point scale) at all follow-up points up to a mean of 29 months compared with pre-vertebroplasty levels (P < 0.001). Analgesic use was significantly less intense in the short and medium term after vertebroplasty (P < 0.005). In 25 patients who had vertebroplasty for VCF, a sustained reduction in all outcomes was demonstrated at a mean follow-up of 30 months, with less pain, significantly lower disability scores (P < 0.05) and less analgesic use (P < 0.05) compared with nine conservatively treated subjects. During the follow-up period, six new VCFs occurred in 4/25 vertebroplasty patients compared with four new VCFs in 2/9 control subjects. Conclusions: Vertebroplasty provides significant and clinically meaningful reductions in pain, analgesic use, and disability in the short, medium and long term. Compared with conservative therapy, vertebroplasty provides significantly greater functional improvement and reduction in analgesic use. The procedure is relatively safe with no clearly increased risk of new vertebral fractures.     

椎体成形术治疗乳腺癌椎体转移33例疗效分析

目的: 对乳腺癌椎体转移放化疗及药物治疗无明显疗效患者行经皮穿刺椎体成形术(Percutaneous Vert-erbreplasty,PVP)治疗并进行疗效分析。 方法: 以PVP治疗乳腺癌合并脊柱骨转移接受放疗、化疗及药物治疗无明显疗效患者33例,术后进行随访,采用数字分级法(NRS)对治疗前后疼痛评价;应用EORTCQLQ—C30行问卷调查并分析治疗前后生活质量变化;观察治疗并发症。 结果: PVP技术成功率100%,CT示所有椎体转移灶均填充良好;术前NRS评分为6.69±1.67分,术后6小时为3.09±1.84分,疼痛明显缓解(t=10.886,P=0.000);术前EORTCQLQ—C30评分为60.60±3.57分,术后6小时为34.61±4.31分,生活质量明显提高(t=43.924,P=0.000);无引起临床症状的并发症发生。 结论: PVP方法治疗乳腺癌椎体转移安全有效,生活质量提高显著。     

经皮穿刺椎体成形术治疗症状性椎体血管瘤

[目的]探讨经皮穿刺椎体成形术(percutaneousvertebroplasty,PVP)治疗症状性椎体血管瘤的临床效果。[方法]采用经皮穿刺椎体成形术(PVP)治疗椎体症状性血管瘤12例,共17个椎体。[结果]12例17个病变椎体PVP均获成功,无严重并发症发生。疼痛完全缓解10例,部分缓解2例,术后随访12～24个月。未出现新的椎体压缩性骨折,血管瘤无复发。[结论]PVP可以缓解症状性椎体血管瘤引起的疼痛,增加椎体的稳定性,是治疗椎体症状性血管瘤的理想方法。     

Primary non-Hodgkin lymphoma of the humerus following traumatic injury: case report

A case of primary non-Hodgkin lymphoma of the right humerus which occurred in a 21-year-old male patient after an impact to the right shoulder in a car accident in July 1983 is described. Seventeen years after the injury, due to a civil lawsuit, the biopsy material was revised. Immunohistochemical analysis showed CD20 and CD79a positivity on large pleomorphic cells, while small reactive lymphocytes were CD3, Bcl-2 and CD20 positive. Molecular analysis carried out with PCR revealed a monoclonal B-lymphocyte population. The diagnosis of diffuse large peripheral B cell lymphoma of the bone was confirmed. The present case concurs with the literature on primary bone lymphoma, in which the diagnostic problem, trauma-related presentation and an excellent prognosis of malignant tumour are emphasized.     

小剂量骨水泥PVP治疗多节段椎体压缩性骨折

目的 探讨采用小剂量骨水泥椎体成形术治疗多节段骨质疏松伴椎体压缩性骨折的临床效果。方法 回顾性研究自2006年９月至2011年８月我院采用小剂量骨水泥椎体成形术治疗46例多节段骨质疏松伴椎体压缩性骨折的病例。其中,男11例,女35例,年龄56～83岁,平均67.3岁。所有患者术前均行骨密度测定Ｔ值≤-2.5,提示骨质疏松,并行Ｘ线片、CT及MRI检查明确责任椎体及后壁完整情况。本组治疗的病例均为多节段椎体压缩性骨折,责任椎体分别分布在：胸６椎（１个）、胸７椎（１个）、胸８椎（２个）、 胸９椎（２个）、胸10椎（５个）、胸11椎（11个）、胸12椎（31个）、腰１椎（36个）、腰２椎（８个）,腰３椎（９个）、腰４椎（13个）、腰５椎（14个）等,本组治疗的病变椎体最少２个,最多４个,平均2.32个。所有患者均经单侧椎弓根穿刺椎体,１次对２个或２个以上责任椎体行小剂量骨水泥椎体成形术。术前、术后３天、１周、术后６个月随访时进行疼痛视觉类比评分（VAS）,评价临床治疗效果。结果 46例患者共行108个椎体成形术,平均１次2.32个椎体,单个椎体内骨水泥注射剂量约1.2～2.1 ml,平均（1.8±0.38）ml。所有患者定期随访,随访时间6～18个月（平均12.6个月）,术前患者VAS评分为7.95±0.82,术后３天VAS评分为4.48±0.80,随访时VAS评分为2.38±0.55,采用配对 t 检验对术前、术后随访时VAS评分进行统计学分析,差异有统计学意义（P＜0.001,α＝0.05）。结论 小剂量骨水泥椎体成形术作为一种微创手术,可有效地缓解多节段骨质疏松伴椎体压缩性骨折引起的疼痛症状,是一种有效的治疗方法。     

Imaging of orbital floor fractures

The aim of this study was to compare the efficacy of plain films and computed tomography (CT) in defining inferior orbital fractures and any muscle involvement. Forty-four patients with final diagnosis of orbital floor fractures in the period 1990–94 were retrospectively studied. Computed tomography was performed in 28 patients, 20 being direct coronal acquisitions and eight being fine axial acquisitions with coronal reconstructions. Water's view radiographs were performed in 34 patients. Fourteen fractures on plain films were associated with soft tissue opacities to suggest inferior rectus (IR) muscle involvement, but only two required surgical elevation of the orbital floor. The remaining patients were successfully treated conservatively. Three patients had IR entrapment on direct coronal CT, all requiring surgical elevation of the orbital floor. Seven patients had IR muscle displacement on direct coronal CT and all had conservative management. In four patients with axial acquisition and coronal reconstructions, the CT images were of inadequate quality to determine the presence or absence of a fracture. One patient who had no IR muscle involvement identified on reconstructed coronal CT required surgical elevation of the orbital floor on clinical grounds. We conclude that: (i) soft tissue opacities on plain films are not an accurate indicator of clinically significant IR involvement; (ii) axial CT is not efficacious in detection of fractures or IR involvement; and (iii) direct coronal CT is the most efficacious imaging modality.     

椎弓根间距测量在评价胸腰椎爆裂骨折严重程度中的应用价值

目的探讨胸腰椎爆裂骨折椎弓根间距与椎管狭窄、神经损伤及椎板骨折严重程度的关系。方法纳入标准：患者有完整的正侧位x线片及cT扫描、矢状面二维重建。排除标准：受伤超过10d,多椎体骨折,病理性骨折,火器伤,无法耐受影像检查,以及未行CT矢状面二维重建者。2005年9月至2012年9月收治外伤所致急性胸腰椎爆裂骨折患者160例,其中男102例,女58例,年龄17-55岁,平均38．9岁。致伤原因：高处坠落伤115例（71．9％）,平地摔伤28例（17．5％）,交通伤15例（9．4％）,其他2例（1_3％）。骨折部位：胸段（T。～T。。）17例（10．6％）,胸腰段（T11～L1）129例（80．6％）,腰段（L2～L5）14例（8．8％）。通过测量伤椎上下邻椎椎弓根间距来计算伤椎椎弓根间距（IPD）增大的比例,分析其与椎管狭窄、神经损伤及椎板骨折严重程度的关系。按照美国脊髓损伤学会的ASIA分级标准进行神经功能评价。结果除1例外,其他所有病例均有IPD：~大（99．4％）,增大比例为4．7％～115．1％,平均（17．4±12．9）％,女性（18．5±14．4）％较男性（14．7±7．8）％更加明显（P〈0．01）。椎管狭窄比例5．2％-97．3％,平均（37．9±19．4）％,IPD增大比例与椎管狭窄程度有显著相关（P=0．38;t=6．65;P〈0．01）。在伴有神经损伤和椎板骨折的病例中,IPD明显增加,分别为（24．8±12．5）％和（25．3±15．9）％。结论胸腰椎爆裂骨折病例中,通过x线片测量椎弓根间距,是评价椎管狭窄、神经损伤及椎板骨折严重程度的理想方法。     

Short term correlates of the Neuro Emotional Technique for cancer-related traumatic stress symptoms: A pilot case series

Introduction As many as one quarter of all cancer survivors report traumatic stress symptoms from cancer-related experiences. While the majority of these patients do not meet the criteria for posttraumatic stress disorder (PTSD), there is growing evidence that subsyndromal symptoms can significantly contribute to functional impairment and negative health outcomes. Treatment options for the hallmark symptoms of traumatic stress—unpleasant, intrusive thoughts and avoidant behaviors—have not been well investigated for the cancer survivorship population. Materials and methods Seven female cancer survivors with traumatic stress symptoms from cancer-related experiences and no other major psychopathology, were enrolled to receive three sessions of Neuro-Emotional Technique (NET), a brief, targeted treatment that combines traditional desensitization principles with complementary modalities. Results Psychological outcome measures (Impact of Event Scale (IES) and Subjective Units of Distress (SUD) and physiological measures (Heart Rate (HR) and Skin Conductance Level (SCL) demonstrated the following changes: 71% on IES, 88% SUD, 74% on HR, and 65% on SCL following the intervention. Statistically significant changes were observed for all four parameters, and effect size g for proportion improved were 0.50 each for IES, SUD, and HR, and 0.20 for SCL. Conclusions These cases suggest feasibility of the NET intervention for cancer-related traumatic stress and the potential for change in symptoms and physiological reactivity. Further investigation is needed to determine the specific and long-term effects of such an approach. Implications for cancer survivors Traumatic stress from cancer-related experiences might represent a constellation of symptoms that are amenable to brief, targeted interventions. This study was supported by the O.N.E. Research Foundation     

PKP联合PVP治疗多节段骨质疏松性椎体压缩性骨折的疗效评价

目的老年性骨质疏松导致的椎体压缩性骨折常导致脊柱畸形及顽固性腰背痛,传统方法因患者身体情况等原因以保守治疗为主,长期卧床常导致骨质疏松加剧而形成恶性循环,本文采用经皮椎体后凸成形术（PKP）联合椎体成形术（PVP）治疗多节段老年骨质疏松性椎体压缩性骨折（OVCF）,观察临床疗效并分析相关并发症。方法2008年8月至2011年2月共收治30例OVCF患者,其中男1In,女19例,年龄54～85岁,平均71．5岁,共计108个椎体骨折,其中R1个,T7 2个,T84个,T9 6个,T10 9个,T11 3个,T12 18个,L,23个,L219个,L3 6个,L4 5个,L5 2个,全部采用PKP联合PVP手术进行治疗,术前及术后采用疼痛视觉模拟量表（visualanaloguescale,VAS）评分及Oswestry功能障碍指数（oswestrydisabilityindex,ODI）对患者进行评分。结果所有患者随访1—2年,平均1．4年,所有患者症状均得到显著改善。术前VAS评分为7．97±0．76,术后0、24、48周VAS评分分别为2．70±0．79、2．40±0．72、2．13±0．57;术前ODI评分为79．7±4．16,术后0、24、48周ODI评分分别为20．1±3．79、22．3±4．12、24．5±6．51。对术前及术后的VAS评分及ODI评分进行配对t检验,P值均〈0．01,表明术前与术后的VAS及ODI评分差异有统计学意义,术后VAS及ODI评分显著优于术前。其中4例患者发生骨水泥渗出、拖尾,无神经症状,1例发生邻椎骨折,给予2次手术后症状改善。结论府用PKP联合PVP治疗多节段OVCF能有效缓解疼痛．节约手术时间．是一种简单、安全有效的方法。     

Denosumab: Prevention and management of hypocalcemia,osteonecrosis of the jaw and atypical fractures

Denosumab, a bone‐modifying agent, reduces the risk of skeletal‐related events in patients with bone metastases from solid tumors and is generally well tolerated. However, hypocalcemia, osteonecrosis of the jaw (ONJ) and atypical fracture are potential and important toxicities of denosumab therapy that require attention. In pivotal phase III trials in patients with bone metastases from solid tumors, the incidence of hypocalcemia was 9.6% in denosumab‐treated patients, with most events being asymptomatic, grade 2 and resolving by week 4. Established hypocalcaemia requires additional short‐term calcium and vitamin D supplementation and, if severe, administration of intravenous calcium. ONJ was reported in 1.8% of patients receiving denosumab over 3 years in these trials. Involvement of an experienced oro‐maxillary surgeon is important if ONJ is suspected. Atypical fractures were rare in a large study of denosumab using the dose and scheduling approved for the treatment of osteoporosis. To prevent toxicities, patients should maintain calcium and vitamin D supplementation, good oral hygiene and regular dental reviews throughout treatment. This article presents case studies from our clinical practice and discusses the pathophysiology of these toxicities along with guidance on prevention, diagnosis and management.     

Nasopharyngeal angiofibroma: staging and management - a review of the case series report

Juvenile angiofibroma is a rare, highly vascular, histologically benign but locally invasive tumor, affecting predominantly male adolescents. Here we present a case series of 45 patients of nasopharyngeal angiofibroma, their clinical presentation, staging and the various surgical approaches for their excision.     

Therapy-related acute myeloid leukemia: A case series

Patients with primary cancer receiving chemotherapy and/or radiotherapy may develop therapy-related acute leukemia (t-AL). Therapy-related acute myeloid leukemia (t-AML) accounts for the majority of these cases and is frequently associated with a variety of cytogenetic and molecular abnormalities. The aim of the present study was to explore the clinical characteristics, treatments and prognosis of patients with t-AML. A total of 272 cases of AML treated at our institution between 2016 and 2020 were reviewed, among which nine cases of t-AML were identified for analysis. All patients had received alkylating or topoisomerase II inhibitor chemotherapy drugs for primary cancer treatment and three patients had received radiotherapy. A total of nine patients had been administered recombinant human granulocyte colony-stimulating factor (G-CSF). The median latency period for the nine patients with t-AML was 25 months (range, 10–240 months). The molecular cytogenetic abnormalities included t(15:17)(q22:q21), inv(16)(p13q22), del(5)(q22), CBFB/MYH11(+), FLT3(+), NARS(+), IDH(+), TET2(+), and TP53(+). Out of nine patients with t-AML, eight received chemotherapy, two of whom underwent HSCT. The median survival time of the nine patients with t-AML was 10 months and the 2-year-survival rate was 44.4%. Greater clarity around the diagnosis and treatment is required to improve the outcomes of patients with t-AML.     

胸腰椎爆裂骨折手术治疗的研究进展

脊柱骨折年发病率约64／100000。随着交通、工业建筑事故的不断增加,胸腰椎骨折的发病率呈逐年上升趋势。脊柱胸腰段（T11--L2）处于相对固定的后凸脊柱与活动的前凸脊柱的转换区域,应力相对集中而容易受到传导暴力的直接损伤,该部位骨折约占脊柱创伤75％～95％,椎体发生爆裂骨折后,后缘骨折块往往突入椎管导致脊髓或马尾损伤。近年来,随着影像学、生物力学对胸腰椎骨折研究的不断深入,在治疗方面也出现了许多新理论、新技术,但手术与否、手术时机、手术人路、术式的选择方面,仍有争议;现将研究状况综述如下。     

Imatinib in advanced chordoma: A retrospective case series analysis

IntroductionImatinib showed activity in 50 chordoma patients treated within a Phase II study. In that study, 70% of patients remained with stable disease (SD), median progression free survival (PFS) was 9 months and median overall survival (OS) was 34 months. We now report on a retrospective series of PDGFB/PDGFRB positive advanced chordoma patients treated with imatinib as a single agent within a compassionate-use programme at Istituto Nazionale Tumori, Milan, Italy (INT) between August 2002 and November 2010, when the programme was closed.Methods48 patients were consecutively treated with imatinib 800 mg/d. All patients had inoperable and progressive disease before starting imatinib. Demographics, treatment duration, toxicity and response rate by Response Evaluation Criteria in Solid Tumors (RECIST) were retrospectively recorded.ResultsThe median duration of therapy was 7 months (1–46.5). No patient is on therapy at present. 46 patients were evaluable for response. No partial responses were detected. Best response was: stable disease 34 (74%), progressive disease 12 (26%). At a median follow-up of 24.5 months (0.5–117), median PFS was 9.9 months (95% confidence interval (CI) 6.7–13). Eight patients (16.5%) remained on therapy >18 months and 10 patients (21%) remained progression-free >18 months. Median OS was 30 months (95% CI 20–40), with 24 (50%) patients dead at the time of the present analysis.ConclusionsWe confirm the activity of imatinib in locally advanced and metastatic chordoma, in terms of >70% tumour growth arrest in previously progressive patients. Median duration of response lasted almost 10 months, with >20% of patients progression-free at 18+ months.     

Magnetic resonance imaging of traumatic transection of the optic chiasm

A case of traumatic transection of the optic chiasm diagnosed by magnetic resonance imaging is reported.     

Aggressive angiomyxoma: A case series and literature review

Background

Aggressive angiomyxoma was identified as a distinct clinicopathologic entity in 1983 and since then fewer than 250 cases of these rare tumors have been reported in world literature. These tumors usually arise in the pelvis and perineal regions, most often in women of the reproductive age group; however a few cases of its occurrence outside the pelvis have also been reported.

Patients and methods

We report a series of 7 women treated in our institute in the last 8 years. Relevant literature on aggressive angiomyxoma was looked at and various management options reviewed.

Conclusion

Aggressive angiomyxomas are locally aggressive, notorious for local recurrence and extremely rare to metastasize. While surgery remains the mainstay of treatment, there has been a definite shift towards less radical forms of excision, over the years. Various adjuvant treatment modalities have also been tried to reduce tumor recurrence.