80% of myeloma patients have lytic bone lesions and osteoporosis secondary to corticosteroid therapy with high rate of vertebral compression fractures (VCFs). The consequences include pain and spinal deformity. The treatment ideally should address both the fracture-related pain and associated spinal deformity. Kyphoplasty provides a new tool that may impact bone care entailing the insertion and expansion of an inflatable bone tamps (IBT) in a fractured vertebral body. Bone cement is then deposited into the cavity to correct the deformity and improvement in structural integrity of collapsed vertebra.

Eighteen VCFs were treated during 11 balloon kyphoplasty procedures in 7 multiple myeloma patients. The clinical outcomes were assessed according to visual analogue scale with 0 representing no pain and 10 severe pain. Patients rated their pain before surgery, 1 week after surgery and at 1 year-postoperative period.

Mean improvement in local sagittal alignment was 12.3°. All of the patients who had reached the 1-year postoperative period had reported a high reduction in pain.

Treatment with chemotherapy and/or radiation therapy is very important in the control of bone disease. Patients treated with kyphoplasty in combination with pharmacologic therapy return to higher activity levels, leading to increased independence and quality of life.

Purpose: To compare the clinical and radiographic outcomes of a unilateral transpedicular approach with those of standard bilateral transpedicular vertebroplasty.

Materials and methods: Retrospective review of vertebroplasty yielded 19 vertebrae in 16 patients that were treated with a standard bilateral approach and 24 vertebrae in 21 patients who were treated with unilateral transpedicular approach. Clinical outcomes, including pain relief and change in pain medication requirements, were compared in the two groups by using chi-square test and Fisher’s exact test.

Results: All patients had reported a high reduction in pain in both groups with similar clinical outcomes.

Conclusions: Use of a unilateral approach in percutaneus vertebroplasty allows filling of both vertebral halves from a single puncture site with no statistically significant difference in clinical outcome from that of a bilateral transpeduncolar vertebroplasty; this technique permits a shorter operating time with lower rate of complications.

Corticosteroid-induced osteoporosis is the most common cause of drug-related osteoporosis and appears frequently in the patients affected from rheumatoid arthritis with high rate of pathological vertebral compression fractures (VCFs). The consequences of VCFs include pain related to the fracture and spinal kyphosis. The aim of treatment of osteoporosis is to halt bone loss, to reduce pain and to prevent the occurrence of future fractures through osteoinduction. The treatment of osteoporotic VCFs ideally should address both the fracture-related pain and associated spinal deformity. Balloon kyphoplasty entails the insertion and expansion of an inflatable bone tamps (IBT) in a fractured vertebral body. Bone cement is then deposited into the cavity created by the IBT to reduce the kyphosis and repair the fracture. Twenty-nine corticosteroid-induced osteoporotic VCFs were treated during 21 balloon kyphoplasty procedures in 17 patients. Standing radiographs centered on the treated level/s obtained prekyphoplasty and postkyphoplasty were analysed for improvement in sagittal alignment using the Cobb technique. The clinical outcomes were assessed according to visual analogue scale with 0 representing no pain and 10 severe pain. Patients rated their pain before surgery, 1 week after surgery and at 1 year-postoperative period. Mean improvement in local sagittal alignment was 11.3° (range 0°–32°). All of the patients who had reached the 1-year postoperative period had reported a high reduction in pain, with 11 patients reporting no pain whatsoever. Corticosteroid-induced osteoporotic VCFs present a significant economic burden to society and result in severe clinical consequences leading to impaired function, reduced pulmonary function and overall increase in mortality. Traditional medical option including bed rest, bracing and analgesics have proven to be insufficient. Patients with rheumatoid arthritis treated with kyphoplasty in combination with pharmacologic therapy return to higher activity levels, leading to increased independence and quality of life.

Purpose: Lumbar interbody fusion cages is a valid technique in the treatment of disc diseases. The aim of this study is to evaluate its validity through the analysis of clinical outcomes and radiological findings.

Materials and methods: The paper reports a serie of 52 posterior lumbar interbody fusion cages operations. Clinical outcomes and radiological results were evaluated at a mean of 5 years post-surgery.

Results: Outcome analysis showed a gradual improvement in symptoms. After surgery, the majority of patients returned to their normal activities. Follow-up plain roentgenograms showed no loss of disc height and no signs of implant’s looseness. Computed Tomography (CT) scans showed the presence of mineralized autologous bone grafts inside the interbody cages.

Conclusions: Expandable interbody cages allow the restoration of the disc space height, giving support to the anterior column, opening the neuroforaminal area and providing increased stability. The interpretation of fusion on the basis of roentgenograms is subjected to arguement. Thin CT scan offers more information than X-rays about the fusion process.

With the plasma–spray technique of applying a hydrox-ylapatite (HA) coating bone ingrowth can be enhanced and early migration of hip prostheses reduced. The significance of coating resorption is controversial. In this study the bone growth and the degradation of the HA coatings were evaluated and compared by SEM.

Premature loosening was identified in four cups with an Ha coating over a porous-coated surface 3 years post-operatively.The Ha coating has a thickness of up to 50 μm. The cup specimens were soaked in 6% sodium hypochlorite to render them anorganic, dehydrated, and sputter-coated with gold-palladium. Secondary electron images of all specimens were obtained by field emission SEM (Zeiss:DSM.962).

Ultrastructural analysis showed that all porous-coated Ha-coated cups had bridges of lamellar bone in direct contact with the implant surface (30% bone in-on growth). Different types of coating degradation were observed. Delamination between the coating and implant surface releases numerous particles or fragments; the resorption by osteoclasts of the amorphous phase was shown to expose the crystalline phase of the coating grains.

This study suggests that resorption disintegrates the Ha coating and reduces the bonding strength between implant and bone and the strength of the coating-implant interface, which might lead to implant loosening,coating delamination and acceleration of third-body wear processes.